Part two - head & neck Flashcards
Branches of the external carotid artery
Superior thyroid artery Ascending pharyngeal artery Lingual artery Facial artery Occipital artery Posterior auricular Superficial temporal artery Maxillary artery
Submandibular / digastric triangle
Borders
- Anterior belly digastric
- Posterior belly digastric
- Inferior mandibular border
Floor
- Hyoglossus muscle
- Mylohyoid muscle
Roof
- Skin
- Platysma
- Investing cervical fascia
Division of the mandibular branch of the facial nerve causes…?
Depression of the corner of the mouth
Flattening of the lower lip
Drooling
Level of hyoid bone
C3
Structures enclosed by investing layer of deep cervical fascia
Sternomoastoid muscle
Trapezius muscle
Parotid gland
+/- Submandibular gland
Posterior triangle of the neck
Borders - posterior SCM, anterior trapezius, clav
Floor - pre vertebral fascia
Roof - investing layer of deep fascia
Apex - superior nuchal line
Contents of the posterior triangle of the neck
Nerves
- Greater occipital nerve
- Accessory nerve
- Cutaneous branches of cervical plexus C1-4
Vessels
- Occipital artery
- Transverse cervical vessels
- Suprascapular vessels
- Third part SCA but not SCV
- EJV
Lymph nodes
- Occipital
- Supraclavicular
Muscles
- Inferior belly omohyoid
Course of the accessory nerve
Emerges halfway down SCM posterior border
Vertically downwards on levator scapulae
Disappears behind the anterior border of trapezius 5cm above clavicle
Surface marking of accessory nerve
Line from the atlas transverse process (anterior to mastoid) to 5cm above the clavicle along anterior trapezius border
Anterior triangle of the neck
Borders
- Lower mandibular border
- Anterior border SCM
- Midline
Divided into smaller triangles:
- Submandibular
- Submental
- Carotid
- Muscular
Lymph node levels in neck
I - submental (A) and submandibular (B)
II - upper jugular nodes
III - middle jugular nodes
IV - lower jugular nodes
V - posterior triangle nodes
A - spinal accessory nerve
B - transverse cervical vessels in supraclavicular fossa
VI - paratracheal nodesSteps for submandibular gland excision
Exposure - caution madibular branch facial nerve - do not raise flaps Capsular dissection superficial lobe - take FV/FA twice Blunt dissection deep lobe - retract posterior border mylohyoid anterior - caution lingual and hypoglossal nerves Dissect duct and ligate - caution lingual nerve Meticulous haemostasis Close over a drain
Methods of ways to identify facial nerve
Tragal pointer Posterior belly diagastric Tympanomastoid suture Peripheral branches Mastoid process
Distribution of sialolithiasis between glands?
85% submandibular galnd and duct
10% parotid gland and duct
5% sublingual and minor salivary glands
Risk factors for sialolithiasis
Salivary Glands Are HENT-Cunts That Make Dirty Dumps
Smoking Gout Age (30-60 years) Hypercalcaemia Trauma Male gender Drugs - anticholinergics, diuretics Dehydration
