MRCS Head and neck Flashcards
The anterior triangle is further sub divided into 4 triangles, name these
- Carotid
- Submental
- Submandibular
Muscular
which lymph nodes drain from the floor of the mouth and parts of the tongue.
Submental lymph nodes.
oesopgoeal adenocarcinomas only occur in what part of the oeseophagus ?
Inferior third
when examining the nasal cavity, what is the first structure to be seen ?
inferior conchae
This is the most inferior and anterior
what structures pass through the superior orbital fissure ?
Recurrent meningeal artery*
Lacrimal nerve
Trochlear nerve
Abducens nerve
Superior ophthalmic vein
Superior division of the oculomotor nerve
at what level does the oesophagus start and terminate ?
Starts at C6
Terminates at T11
which layer of fascia forms the roof of the posterior triangle of the neck ?
Investing layer of fascia
what muscles form the floor of the posterior triangle of the neck ?
Splenius capitis
Levator scapulae
Anterior, middle and posterior scalenes
the superior thyroid artery is a branch of what artery ?
External carotid
What is the superior border of the muscular triangle?
Hyoid bone
The muscles of the pharynx are mostly innervated by the vagus nerve. Except which muscle and what nerve innervates it ?
stylopharyngeus - Innervated by the glossopharyngeal nerve.
what are the anterior and posterior attachments of the investing layer of fascia in the neck
Anterior - Hyoid bone
Posterior - Nuchal ligament
what is the semilunar hiatus ?
a crescent-shaped groove on the lateral walls of the nasal cavity. **The frontal, maxillary and anterior ethmoidal sinuses open into this space **
when do you test for calcitonin levels ?
Usually found in patients with medullary carcinoma of the thyroid
what lymph nodes drain the anterior 2/3 of the tongue
Submandibular
*remember the tip of the tongue is submittal but the bulk of the anterior tongue is submandibular
The prevertebral fascia forms the floor of which anatomical space?
Posterior triangle
what is ludwigs angina ?
life-threatening diffuse cellulitis of the soft tissue of the floor of the mouth and neck
Ludwig angina involves 3 compartments of the floor of the mouth: **sublingual, submental, and submandibular. **
what is the lymphatic drainage of the lingual tonsils ?
jugulodigastric and deep cervical lymph nodes.
special sensory innervation to the nasal canal is via the opthalmic nerve. what nerve provides general sensation ?
nasopalatine nerve (branch of maxillary nerve) and the nasociliary nerve (branch of the ophthalmic nerve)
All the intrinsic muscles of the larynx (except the cricothyroid) are innervated by what nerve ?
inferior laryngeal nerve – the terminal branch of the recurrent laryngeal nerve,
what nerve innervates the pharyngeal constrictors ?
Vagus
What is the most common bilateral benign neoplasm of the parotid
Warthins tumour
what are the two important soft tissue folds you get in the larynx ?
- Vestibular folds
- Vocal folds
which lymph nodes do vocal cord tumours metastasise to ?
The vocal cords have no lymphatic drainage and therefore this region serves as a lymphatic watershed
The larynx receives both motor and sensory innveration via what nerve ?
Vagus
The Posterior auricular and superficial temporal artery supply the parotid. Where do these arteries originate ?
Within the parotid gland. From the external carotid
List the layer that make up the deep cervical fascia
- Investing layer
- pre tracheal layer
- Pre vertebral layer
- carotid sheath
These layers go from superficial to deep
Which type of epithelium lines the luminal surface of the oesophagus?
The oesophagus is lined by stratified squamous non-keratinised epithelium.
The thyroid gland has three sources of arterial supply, what are these ?
superior and inferior thyroid artery
Thyroid aim
All the intrinsic laryngeal muscles are innervated by the recurrent laryngeal nerve except which muscle ? and what nerve innervates it ?
- Cricothyroid
- external laryngeal nerve
Hashimotos thyroiditis is a risk factor for what head and neck malignancy ?
non–Hodgkin’s B-cell lymphomas
True or false
A benign parotid gland tumor will usually invade nearby structures like the facial nerve ?
False
Which triangle does the facial artery and vein pass through?
submandibular triangle
What structure is highlighted in red ?
Pre tracheal fascia
Pus in the retropharyngeal space can track into what other space ?
Posterior mediastinum
The posterior ethmoid sinus drains into what sphenoethmoidal recess ?
Superior meatus
what is the typical source of Ludwigs angina ?
Infections of the lower second and third molars
which nerve sends signals from the carotid sinus to the brain ?
Glossopharyngeal (CN IX)
The inferior pharyngeal constrictor is split into two parts; what are those ?
the thyropharyngeus and the cricopharyngeus.
The mandibular nerve has both sensory and motor terminal branches - what are these branches ?
what is the arterial supply to the tonsils ?
tonsillar artery, a branch of the facial artery.
Is it the LEFT or RIGHT common carotid that arises directly from the aortic arch ?
Left
The accessory nerve is located in the posterior triangle. Which TWO nerve plexus’ are located in the posterior triangle ?
- Cervical plexus
- Trunks of the brachial plexus
the inferior thyroid artery is a branch of what artery ?
Subclavian [more specifically the thyrocervical trunk]
when is a radical parotidectomy performed rather than a superficial parotidectomy ?
when the lesion is though to be malignant
venous drainage from the thyroid is into a venous plexus. what veins form this plexus ?
superior, middle and inferior thyroid veins
The thyroid is enclosed in what fascial compartment ?
Pre tracheal fascia
what important structure passes through the submandibular triangle ?
Facial artery
what is the arterial supply for the palatine tonsils ?
tonsillar branch of the facial artery.
the external laryngeal nerve is a branch of what nerve ?
branch of superior laryngeal
which anatomical space is the ansa cervicalis located ?
Carotid triangle [anterior traingle]
Reed sternberg cells are seen in what condition ?
Hodgkins lymphoma
At what spinal level does the common carotid bifurcate ?
C4
where does the posterior scalene muscle insert ?
2nd rib
what is the venous drainge of the parotid ?
Retromandibular vein
List the 4 tonsils
Palatine
Pharyngeal
Tubular
Lingual
The pharynx receives sensory innervation from what nerve ?
Glossopharyngeal
What nerves supply GENERAL sensation and SPECIAL sensation [taste] to the tongue ?
In the anterior 2/3, general sensation is supplied by the trigeminal nerve (CNV). Specifically the lingual nerve, a branch of the mandibular nerve (CN V3).
special sensation in the anterior 2/3 is supplied from the facial nerve (CNVII). In the petrous part of the temporal bone, the facial nerve gives off three branches, one of which is chorda tympani. This travels through the middle ear, and continues on to the tongue.
The posterior 1/3 of the tongue is slightly easier. Both touch and taste are supplied by the glossopharyngeal nerve (CNIX).
what is the lymphatic drainage of the superior third of the oesophagus ?
deep cervical lymph nodes
Arterial supply to the pharynx is via ______
Branches of the external carotid
Other than the common carotid, what structures are found in the carotid triangle ?
- Internal jugular vein
- Vagus nerve
- Hypoglossal nerve
- accessory nerve
what vein is at risk during tonsillectomy ?
External palatine vein
What are the 4 physiological oesophageal constrictors ?
A - arch of aorta
B - Bronchus
C - Cricoid
D - Diaphragm
what two important structures pass between the anterior and middle scalene muscles ?
Brachial plexus
subclavian artery
which subdivision of the anterior triangle can you find CN X and XII ?
Carotid triangle
True or false
The internal jugular vein travels through the posterior triangle of neck.
False
The internal jugular vein travels through the ANTERIOR triangle of neck.
what two important structures pass anterior to the anterior scalene muscle ?
The subclavian vein and phrenic nerve
The ethmoidal arteries are a branch of what artery ?
Opthalmic artery
The trachea spans what vertebral levels ?
C6 -T4/5
what condition classically gives a hard, woody neck swelling ?
Riedel’s thyroiditis
The submental triangle lies within the anterior triangle of the neck.
Which muscle forms the floor of the submental triangle?
Mylohyoid
inferior thyroid veins drain into what structure ?
brachiocecphalic vein
Which potential space in the neck could allow for the tracking of pus into the posterior mediastinum?
Retropharyngeal space
oxyphil cells are seen in histological in what structure ?
Parathyroid
What nerves supply sensory innervation to the parotid
[remebery sensory and autonomic innervation is different]
Sensory innervation is supplied by the auriculotemporal nerve (gland) and the great auricular nerve (fascia).
what two important structures pass between the anterior and middle scalene muscles ?
The Subclavian artery and the brachial plexus
Identify the longitudinal pharyngeal muscles in the picture
The gastro-oesophageal junction occurs at which vertebral level?
T11
The retropharyngeal space extends from the base of the skull to the posterior mediastinum. Therefore infection can track from here into the mediastinum.
What structures make up the retropharyngeal space ?
buccopharyngeal fascia (posterior aspect of the visceral pretracheal fascia) and the prevertebral fascia.
where are the internal and external jugular veins located ?
IJV - Anterior triangle
EJV - Posterior triangle
what structure forms the roof of the posterior triangle of the neck ?
Investing layer of fascia
The pre tracheal fascia is seperated into a muscular layer and a visceral later - what structure are located in these two layers ?
Muscular part – encloses the infrahyoid muscles.
Visceral part – encloses the thyroid gland, trachea and oesophagus.
what anatomical spaces highlighted in yellow ?
Muscular triangle
The abdominal segment of the oesophagus receives arterial supply from what TWO structures ?
- Left gastric artery
- Left inferior phrenic artery
what is the anatomical relationship between the scalene muscles and the phrenic nerve + subclavian vein ?
The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene
The superficial temporal artery is a branch of what major aftery ?
External carotid
what part of the jaw is out in TMJ dislocation ?
condyle
what antibodies are used to diagnose hashimotos thyroiditis
thyroglobulin, TPO and TSH-R.
what is the lymphatic drainage of the middle third of the oesophagus ?
superior and posterior mediastinal nodes
The red line highlights the pre tracheal fascia in the neck. Name all the labelled structures
The nose receives arterial blood supply from the internal carotid. what branches come off this artery ?
- Anterior and posterior ethmoidal arteries
What is the most common parotid gland tumour ?
Pleomorphic adenomas are the commonest tumours of the parotid gland and are often slow growing, smooth and mobile
The inferior laryngeal nerve is a terminal branch of what structure ?
Recurrent laryngeal nerve
what two muscles are enveloped by the investing fascia
Sternocleidomastoid and Trapezius
what is the arterial blood supply to the parotid ?
Posterior auricular and superficial temporal artery
where does the thyroid ima artery originate ?
Brachiocephalic artery
What structures make the borders of the carotid triangle ?
Superior – posterior belly of the digastric muscle.
Lateral – medial border of the sternocleidomastoid muscle.
Inferior – superior belly of the omohyoid muscle.
In which fascial layer is the platysma muscle found?
Superficial cervical
superior and middle thyroid veins drain into what structure ?
internal jugular vein
describe the venous drainage of the larynx
Venous drainage is by the superior and inferior laryngeal veins.
The superior laryngeal vein drains to the internal jugular vein via the superior thyroid, whereas the inferior laryngeal vein drains to the left brachiocephalic vein via the inferior thyroid vein.
List the cranial nerves located in the anterior triangle of the neck
- Facial nerve - VII
- Glossopharyngeal - IX
- Vagus - X
- Accessory - XI
- Hypoglossal - XII
what lymphatic drainage do all tonsils have in common ?
They all drain into the deep cervical lymph nodes
what is the most common benign parotid lesion ?
pleomorphic adenoma
When considering the instrinsic ligaments of the larynx, the vestibular ligament is formed by the free edge of which laryngeal structure?
Quadrangular ligament
what organs are located in the pre tracheal fascia ?
Trachea, Oesophagus, thyroid gland
what is the definitive management for benign parotid lesions ?
Superficial parotidectomy
List the paranasal sinus’
Frontal
Maxillary
anterior and posterior ethmoidal
which muscle is the major ADductor of the vocal cords ?
Lateral cricoaretynoids
what is the main arterial supply to the nasal cavity ?
Sphenopalaptine artery [branch of the maxillary artery which is a branch of the external carotid artery]
A lot of the vascular supply to the head is via the external carotid artery. what other artery supplies the scalp ?
Ophthalmic artery via the internal carotid
what is the deep venous drainage of the scalp ?
pterygoid venous plexus drains into the maxillary vein
what structures pass through the foramen spinous ?
It transmits the middle meningeal artery, middle meningeal vein and a meningeal branch of CN V3.
where is age carotid canal located ?
temporal bone
Which structure forms the anterolateral border of the middle cranial fossa ?
lesser wings of the sphenoid bone
Which structure forms the anteromedial border of the middle cranial fossa ?
limbus of the sphenoid bone
What structures form the floor of the middle cranial fossa ?
the floor is formed by the body and greater wing of the sphenoid, and the squamous and petrous parts of the temporal bone.
what structures pass through the internal acoustic meatus
CN VII and VIII
how does cranial nerve VII leave the skull ?
stylomastoid foramen.
what is the anatomical course of the chorda tympanic ?
The nerve arises in the facial canal, and travels across the bones of the middle ear, exiting via the petrotympanic fissure, and entering the infratemporal fossa.
Within the infratemporal fossa, the chorda tympani ‘hitchhikes’ upon the lingual nerve
what is the anatomical relationship between the greater petrosal nerve and the geniculate nucleus ?
The greater petrosal nerve arises immediately distal to the geniculate ganglion within the facial canal.
what muscle separates the submandibular space from the subingual space ?
mylohyoid
sublingual space is located above the mylohyoid
submandibular space is located below the mylohyoid
where would you insert a tracheostomy ?
between second and third tracheal rings
below the cricoid cartilage
what nerve innervates the plantysma muscle ?
Facial nerve
*The platysma is a muscle of facial expression.
where is the dens [C2] located ?
In the anterior half of the spinal canal and anterior to the transverse ligament.
what are the sensory branches of the mandibular nerve
- Inferior alveolar
- Auriculotemporal
- Lingual
