Neck and face

Question 1

What is contained within prevertbebral fascia

Answer 1

The prevertebral fascia surrounds the vertebral column and its associated muscles; scalene muscles, prevertebral muscles, and the deep muscles of the back.

STRUCTURAL STUFF that support and move head in here

Question 2

Attachment of prevertebral fascia

Answer 2

Superior attachment – base of the skull.

Anterior attachment – transverse processes and vertebral bodies of the vertebral column.

Posterior attachment – along the nuchal ligament of the vertebral column

Inferior attachment – fusion with the endothoracic fascia of the ribcage.

Question 3

What is the pretracheal fascia

Answer 3

The pretracheal layer of fascia is situated in the anterior neck. It spans between the hyoid bone superiorly and the thorax inferiorly (where it fuses with the pericardium).

Associated with VISCERAL FUNCTION

Question 4

Which structures are enclosed by the pretracheal fascia, and what are the 2 parts of this fascia

Answer 4

The trachea, oesophagus, thyroid gland and infrahyoid muscles are enclosed by the pretracheal fascia.

Anatomically, it can be divided into two parts:

Anterior- Muscular part – encloses the infrahyoid muscles (aka. along with the investing cervical fascia anteriorly)

immediately posterior- Visceral part – encloses the thyroid gland, trachea and oesophagus.

Question 5

Where are blood vessels and nerves housed within the neck

Answer 5

CAROTID SHEATH (conduit for vessels and nerves)

Question 6

What are the contents of carotid sheath

Answer 6

Vagus nerve
Internal jugular
Nodes (lymph)
Common carotid artery

The carotid artery bifurcates within the sheath into the external and internal carotid arteries.

The carotid fascia is organised into a column, which runs between the base of the skull to the thoracic mediastinum. This is of clinical importance as a pathway for the spread of infection.

Question 7

How many compartments in the neck

Answer 7

4:
1Xvisceral (in the pretracheal fascia)
1Xstructural (in prevertebral fascia)
2Xvascular (in cartodi sheath)

Question 8

Name the 4 suprahyoid muscles and their innervation

Answer 8

digastric (ant belly= trigem, post. belly=facial)
stylohyoid (facial)
geniohyoid (c1 via hypoglossal) and
mylohyoid (trigem) muscles.

They are all pharyngeal muscles, with the exception of the geniohyoid muscle.

Question 9

Name the 4 strap muscles (infrahyoid) and their innervation

Answer 9

ANSA CERVICALIS C1-C4

omohyoid c1-c3…. depress larynx and hyoid,

sternohyoid c1-c3… depress hyoid after swallowing

thyrohyoid, depress hyoid (or bring thyroid cartilage superiorly if hyoid fixed)… c1 via hypoglossa nerve

sternothyroid c2-c3… depress larynx after it has been elevated for swallowing

Question 10

State what appears at the following levels in the neck: 
C1
C2 
C3
C4
C6
C7

Answer 10

C1- open mouth
C2- superior cervical ganglion (symp. to head and neck)
C3- body of the hyoid
C4- upper border of thyroid cartilage (and BIFURCATION OF COMMON CAROTID)
C6- cricoid cartilage (middle cervical ganglion)
C7-inferior cervical ganglion

C2, 6 and 7, have the cervical ganglions! (it’s ganglia but for the rhyme)

Question 11

Function of sternocleidomastoid

Answer 11

Turn the head to contralateral side

or obliquely rotate the head

Flexes neck and extends head

Question 12

Triangles of the neck border

Answer 12

Anterior: midline of the neck, the inferior border of the mandible and the anterior border of sternocleidomastoid

Posterior: middle third of the clavicle, the posterior border of sternocleidomastoid and anterior border of trapezius

Question 13

Contents of the anterior triangle

Answer 13

Platsyma (sheet muscle)
Mylohyoid
Digastric
Infrahyoids (thyrohyoid, sternohyoid, omohyoid and sternothryoid)

Carotid arteries and internal jugular vein (only in superior part because mostly under SCM) and accessory nerve

Question 14

Contents of the posterior triangle

Answer 14

External jugular vein (drains the face, runs over SCM)
Subclavian artery
Subclavian vein 
Trunks of the brachial plexus
Phrenic nerve
Vagus nerve
Spinal accessory nerve

Question 15

Where do nerve roots emerge from

Answer 15

Between anterior and middle scalene muscle

Question 16

What is the lymphatic drainage of the neck

Answer 16

Superficial ‘ring’: occipital, mastoid, pre-auricular, parotid, submental, submandibular, facial and sperficial cervical

Deep vertical cervical nodes: receive all of the lymph from the head and neck – either directly or indirectly via the superficial lymph nodes. They are organised into a vertical chain near internal jugular (superior nodes and inferior nodes)… vessels from them form the jugular ugular lymphatic trunks. Left lymphatic trunk drains into the thoracic duct and right hand side drains into the right lymphatic duct.

Question 17

3 functions of the neck

Answer 17

Structural- prevertebral fascia
Visceral- pre-tracheal fascia
Conduit for nerves and vessels- carotid sheaths

Question 18

At what level does common carotid birfurcate

Answer 18

C4 (in carotid triangle)

Question 19

What are the 2 terminal branches of the external carotid

Answer 19

superficial temporal artery and the maxillary

Question 20

Where does the external carotid end

Answer 20

In the parotid gland

Question 21

Which 3 branches of external carotid supply the scalp

Answer 21

Superficial temporal
Occipital and
Posterior auricular

Question 22

What arteries generally supply the superficial areas of the face,

which supplies the deep structures of the face

Answer 22

he maxillary artery supplies the deep structures of the face,

while the facial and superficial temporal arteries generally supply superficial areas of the face.

Question 23

What is the course of the maxillary artery

Answer 23

ontinues as one of the terminal divisions of the external carotid artery at the level of the neck of the mandible

passes forwards between the neck of the mandible and the sphenomandibular ligament.

running deeply to the lower head and passes forward between the two heads of the lateral pterygoid muscle to break into its terminal branches at the pterygopalatine fossa.

Question 24

Branches of maxillary artery

DAM I AM Piss Drunk But Stupid Drunk I Prefer, Must Phone Alcoholics Anynoymous

Answer 24

D: deep auricular artery
A: anterior tympanic artery
M: middle meningeal artery

I: inferior alveolar artery

A: accessory meningeal artery
M: masseteric artery

P: pterygoid artery
D: deep temporal artery
B: buccinator artery
S: sphenopalatine artery
D: descending palatine artery
I: infraorbital artery
P: posterior superior alveoar artery
M: middle superior alveolar artery
P: pharyngeal artery
A: anterior superior alveolar artery
A: artery of the pterygoid canal

Question 25

Where does the meningeal artery originate and what is its course

Answer 25

From the mandibular part of the maxillary

Passes straight up through the foramen spinosum and to join the two roots of the auriculotemporal nerve. It supplies bones of the skull (calvaria) and the dura mater.

Question 26

What is the course of the accessory nerve (in the neck)

Answer 26

arises from neurones of the upper spinal cord, specifically C1-C5/C6 spinal nerve roots

Travels through foramen magnum superiorly

travels across posterior cranial fossa

exits through jug foramen with vagus and glossopharyngeal

runs along the internal carotid artery now it’s outside of the skull in the neck

reach the sternocleidomastoid muscle, which it innervates. It then moves across the posterior triangle of the neck to supply motor fibres to the trapezius.

Question 27

What is the course of the vagus nerve in the neck (do all of it)

Answer 27

In head…. from medulla. Exits skull via jugular foramen (gives off auriciular branch which supplies sensation to posterior part of auditory canal and external ear)

Neck….

right vagus passes anterior to subclavian and posterior to sternoclavicular join, entering thorax

left passes inferiorly between left common carotid and left subclavian, posterior to sternoclavicular joint to enter thorax

branches in the neck: 1. Pharyngeal branches (motor to majority of pharynx and soft palate muscels)

2. Superior laryngeal nerves–> splits into internal (sensory to laryngopharynx and superior part of larynx) and external (supplies cricothyroid muscle)
3. Recurrent laryngeal nerve… hooks underneath right subclavian artery and ascends into larynx. Innervates majority of intrinsic muscles of larynx

Left recurrent laryngeal hooks under arch of aorta and ascends to innervate majority of intrinsic muscles of larynx

Question 28

Coure of the phrenic nerve in the neck

Answer 28

The nerve arises at the lateral border of the anterior scalene muscle. It then passes inferiorly over the anterior surface of anterior scalene, deep to the prevertebral layer of cervical fascia. On both sides, the nerve runs posterior to the subclavian vein

Then

For right:
1. Passes anteriorly over lateral part of right subclavian artery. Enters thorax. Descneds anteriorly along right lung root
Courses along pericardium of right atrium
Pierces diaphragm and IVC opening

For elft: Passes anteriorly over medial part of left subclavian artery. Enters thorax. Descends anterior to left lung root
Crosses aortic arch bypassing vagus
Courses along percardum of left ventricle
Pierces diaphragm

Question 29

Which strap muscle is inervated by C1 via the hyoglossal nerve

Answer 29

The infrahyoid or “strap” muscles are all innervated by the ansa cervicalis except for the thyrohyoid which is innervated by the C1 fibres via the hypoglossal nerve.

Some also consider the stylopharyngeus to be a strap muscle too, but it is innervated by the glossopharangeal nerve (cranial nerve IX).

Question 30

T/f… massaging the carotid pulse can control bradycardia

Answer 30

F…
Massaging the carotid pulse stimulates the baroreceptors in the carotid sinus, which in turn results in vagal stimulation. This can be used to control supraventricular tachycardias.

Question 31

The pulse of which artery can be felt on the inferior artery of the mandible

Answer 31

Facial

Question 32

Key actions of the tongue

Answer 32

Styloglossus retracts and elevates

Hyoglossus depresses

Genioglossus protracts

Question 33

What are the following nerves:

Greater auricular
Posterior auricular
Auriculotemporal

Answer 33

Greater auricular nerve- sensory cutaneous nerve (C2,C3)

Posterior auricular nerve- branch of facial nerve Ascends in front of the mastoid process, and innervates the intrinsic and extrinsic muscles of the outer ear. It also supplies the occipital part of the occipitofrontalis muscle.

Auriculotemporal- branch of V3