Organziation of head and neck Flashcards
Explain the connections of the neck making its attatchment from the head to the rest of the body
Extends from the the lower margin of madible to suprasternal notch of manubrium and upper border of clavicle below
Structures of neck are compartmentalised by layer of what?
Cervical fascia
What is a fascia? Explain divisions of the cervical fascia
Fascia is a layer of fibrous tissue that surrounds muscles, vessels & nerves.
where is the retropharangeal space? what is its importance?
lies btw the prevertebral layer of fascia and fascia surrounding the pahrynx (buccopharyngeal fascia)
It allows pharynx to move freely on the vertebral column and during swallowing, infection can collect here too!
Explain what happens if an infection develops in the retropharyngeal space?
spreads from the neck into the thorax down to the posterioir mediastinum>> casuing life threatening MEDIASTINITS
explain how the retropharyngeal space is split?
by ALAR FASCIA
splits it into the true retropharyngeal space and the danger space
Infection in the retropharangeal space can develop into an ABSCESS, explaint he symptoms u get
- visible bulge on oropharynx
- sore throat
- difficulty swallowing
- stridor
- fever
- reluctance to move their neck
- An abscess is a painful collection of pus, usually caused by a bacterial infection.*
how dou drain a retropharyngeal abscess?
we ask a patient with a lump in their neck to swallow? why
the thyroid gland is enclosed with the pretracheal fascia which is attached to the hyoid bone, & hyoid bone and larynx move up when swallowing
what sign and symptoms do u get following a retrosternal goitre?
can lead to compression of the thoracic inlet!
(trahcea, venous Bv)
- breathless & stridor>> bc tracheal compression
- facial edema>> impedes venous drainage from heads & neck
Major muscle group of face (4)
- muscles of facial expression
- muscles of cheeks (buccinators)
- occiptofrontalis muscle
- muscles of mastication
Where do muscles of the face lie? How do they make their move?
In the subcutaneous tissue , by pulling the skin
function of buccinators?
keeps cheek taunt, helps in chewing, ensures that food remains w/ in the oral cavity
(buckle up tight!)
how many muscle of mastication r there?
innervation?
mandibular division of the trigemnal nerve
What. Structure Runs deep to platysma but runs superficial to SCM
Why might the pulsation of the external jugular vein be mistaken for the jugular venous pulse when measuring the JVP in a patient?
.
border of anterior portion of the neck? What structures r found here? (Muscle and vasculature)
- the suprahyoid muscles and infrahyoid muscles
- common carotid a. (Bifurcates into internal & external)
-internal jugular vein
-some cranial nerves
borders of posterior triangle
muscles forming posterior traingle
Borders of carotid traingle and structures running through it
it extends from where to where?
I see 10 CCโs in the IV
I See = IC (internal carotid)
10 = CN X (vagus nerve) in the IV = internal jugular vein
Extends from base of skull to aortic arch
Draw the fascial layers and identify the retropharyngeal space
In a patient with a retropharyngeal abscess, why is swallowing and movement of the neck typically difficult and painful?
While this ฺspaceฺ is helpful in allowing the pharynx to move freely on the vertebral column and expand during swallowing.
branches of facial nerve
trigeminal divisions
what r most of the arteries supplying the structures of the face and neck ?
branches of the external carotid arteries, which terminates as the superficial temporal & maxillary A.
what is torticollis?
Contraction of this SCM, either voluntarily, or involuntarily as a result of dystonia would cause the head to tilt and rotate.
explain venous drainage of face? what do they drain into?
the facial vein, (which runs with the facial artery) from the medial angle of the eye to the inferior border of the mandible, forms the major venous drainage of the face, draining into the internal jugular vein. >>
both internal and external vein drain into subclavian vein
if a laceration of the facial artery occurs, what approach must be taken? why?
compress both the arteries to stop bleeding.
bc the facial a. has many anastomses w/ other arteries of the face!
Major BV (common carotid a. and jugular v.) & nerves in the neck lack bony protection and can be injured in penetrating wounds !
shitttttt
which jugular vein is more easier to see?
EJV
Name layers of scalp and describe each
Skin: contains many sweat and sebaceous glands and hair follicles.
Connective tissue: forms the thick, dense, richly vascularized subcutaneous layer that is well supplied with cutaneous nerves.
Aponeurosis (epicranial aponeurosis): the broad, strong, tendinous sheet that covers the calvaria and serves as the attachment for muscle bellies converging from the forehead and occiput (occipitofrontalis muscle)
Loose areolar tissue: a sponge-like layer including potential spaces that may distend with fluid as a result of injury or infection. This layer allows free movement of the scalp proper (the first three layersโskin, connective tissue, and epicranial aponeurosis) over the underlying calvaria.
Pericranium: a dense layer of connective tissue that forms the external periosteum of the neurocranium.
black eye smthn
scalp
cools
label
โSCALPโ
the first 3 of which are connected intimately and move as a unit (e.g., when wrinkling the forehead and moving the scalp)
innervation of scalp
anterior to the auricles of the ears is >> all divisions of trigeminal nerve
Posterior to the auricles, >> spinal cutaneous nerves (C2 and C3).
(C2&3>>someones behind meโฆ) turn around give a forehead and say TRY-MEโ
1) why do superficial scalp wounds not gape (open widely) and the margins of the wound are held together?
2) why do deep scalp wounds gape widely?
1) bc of the strength of the epicranial aponeurosis
2) Deep scalp wounds gape widely when the epicranial aponeurosis is lacerated in the coronal plane because of the pull of the frontal and occipital bellies of the occipitofrontalis muscle in opposite directions (anteriorly and posteriorly).
in which layer of the scalp do the arteries lie?
why do scalp wound bleed heavily?
The a. course within layer two of the scalp,
- the connective tissue layer between the skin and the epicranial aponeurosis
(arteries r CONNection to life)
bc they r supplied by branches of BOTH the i & E carotid a. and form anastomoses in the midline,
The arterial walls are firmly attached to the dense connective tissue in which the arteries are embedded, limiting their ability to constrict when cut. Consequently, bleeding from scalp wounds is profuse.
which layer of the scalp is the danger area of the scalp? why?
The loose aerolar layer (layer four) bc pus or blood spreads easily in it.
I
why does โblack eyesโ (peri-orbital ecchymosis) result from an injury to the scalp and/or the forehead?
An infection or fluid (e.g., pus or blood) can enter the eyelids bc the occipitofrontalis inserts into the skin & subcutaneous tissue & does not attach to the bone.
Ecchymosis (purple patches), develop as a result of extravasation of blood into the subcutaneous tissue and skin of the eyelids and surrounding regions.
How would a person with a dystonic sternocleidomastoid muscle present? What nerve supplies this muscle?
cool pic
super cool
what is cephalohaematoma?
This benign condition frequently results from birth trauma that ruptures multiple, minute periosteal arteries that nourish the bones of the calvaria.
How might an infection deep within the scalp, beneath the aponeurotic layer spread intracranially (i.e. to structures within the cranial cavity of the skull? )
infection in this layer can also pass into the cranial cavity through small emissary veins, which pass through parietal foramina in the calvaria, and reach intracranial structures such as the meninges.
what structure the facial nerve pierce in?
how is this clinically relevant?
if u get facial nerve pasly in the context of parotid gland enlargment, it is highly likely to be parotid cancer!
(though this is rare)
(facial nerve exits cranium and enter the partoid gland where it branches into 5)
what do we use that to measure JVP?
IJV,
cuz it goes horizontally down to the right side of heart and right atrium, whule the EJV has to drain the the subclavian vein
Outline the major differences between the fetal/infant and adult skull.
- large calvaria relative to the face in fetal skull;
- (in adult skull facial skeleton forms 1/3 of cranium whereas infant skull it forms 1/8)*
- Small, underdeveloped maxilla, mandible and paranasal sinuses (some of which are actually absent at birth) in fetal skull
- Absence of erupted teeth in fetal skull
- Small nasal cavities in fetal skull
- Absence of mastoid and styloid process in fetal skull
