Raftery Head, Neck and Spine Flashcards
Tutorial - Which of the following nerves is not contained within the posterior triangle of the neck?
Accessory nerve Phrenic nerve Greater auricular nerve Ansa cervicalis Lesser occipital nerve
Ansa cervicalis
Is located in the anterior triangle. Made up of loop of nerve fibres from C1-3. Function is to supply infrahyoid muscles, embedded in anterior wall of carotid sheath.
Geniohyoid Thyrohoid Sternothyroid Sternohyoid Superior and inferior omohyoid
Tutorial - Which of the following statements relating to the cavernous sinus is false?
A. Pituitary gland lies medially
B. Internal carotid artery passes through it
C. Temporal lobe of brain is a lateral relation
D. Mandibular branch of trigeminal nerve and optic nerve lie on the lateral wall
E. Ophthalmic veins drain into the anterior aspect of the sinus
D. Should be ophthalmic nerve lie on the lateral wall
Carvenous sinus is located on either side of sella turcica.
Tutorial - contents of cavernous sinus
Wall - CN III, IV, V1 (ophthalmic), V2 (mandibular)
Through middle -
Carotid artery, CN VI (abducens)
Tutorial - Which of the following statements regarding the relationships of the scalene muscles is false?
A. Brachial plexus passes anterior to middle scalene
B. Phrenic nerve lies anterior to anterior scalene
C. Subclavian artery passes posterior to middle scalene
D. Subclavian vein lies anterior to anterior scalene
C. should be subclavian artery passes between the anterior and middle scalene muscles
Tutorial - A 67M undergoes a carotid endarterectomy and when he is reviewed postop his voice sounds hoarse. What is the damage that is the most likely cause of this?
A. Accessory nerve B. Cervical plexus C. Glossopharyngeal nerve D. Superior laryngeal nerve E. Recurrent laryngeal nerve
Recurrent laryngeal nerve
Asymmetrical - right tucks under right subclavian artery, left tucks under aortic arch. Both run down side of trachea, gives off various branches as they go down.
Key Ix for anyone with hoarse voice = flexible nasoendoscopy
Tutorial - During a radical neck dissection, which of the following layers will expose the ansa cervicalis?
A. Pretracheal fascia B. Carotid sheath C. Prevertebral fascia D. Investing layer of fascia E. Sibsons fascia
Pretracheal fascia
Ansa cervicalis lies anterior to carotid artery on the carotid sheath, can be exposed by dissecting pretracheal fascia.
Only structure superficial to investing layer of fascia is platysma.
Tutorial - 64M has a lymph node biopsy from the posterolateral aspect of the right neck. Which of the nerves listed is at greatest risk?
A. Accessory
B. Greater auricular nerve
C. Cutaneous cervical nerve
Accessory
Split into spinal and cranial parts.
Spinal part originates from C1-5, travel together to foramen magnum. Cranial portion originates from medulla. All exit at jugular foramen. Accessory nerve then descends down internal carotid artery to supply trapezius.
Tutorial - 22F recently undergone submandibular gland surgical excision. She presents to the f/u clinic with tongue weakness on ipsilateral side to her surgery. Which nerve has been damaged?
A. Hypoglossal nerve B. Lingual nerve C. Inferior alveolar nerve D. Facial nerve E. Lesser petrosal nerve
Hypoglossal nerve
Boundaries of submandibular triangle - angle of mandible, anterior and posterior digastric muscles.
Submandibular gland divided into deep and superficial parts by mylohyoid muscle.
Nerve damage during submandibular gland surgery:
- Marginal mandibular branch of facial nerve
- Lingual nerve
- Hypoglossal nerve
Safe incision is 3cm below lower edge of mandible.
Tutorial - 52M develops a lesion affecting the lobule of his left ear. Into which of the following lymph nodes will the lesion drain?
A. Deep cervical B. Superficial cervical C. Retroauricular nodes D. Occipital nodes E. Internal jugular nodes
Superficial cervical nodes
Tutorial - Which of the following provides sensation to the lateral aspect of the nose
A. Infratrochlear nerve B. Zygomatic nerve C. Nasopalatine nerve D. Lateral nasal branches of ethmoidal nerve E. Frontal nerve
Lateral nasal branches of ethmoidal nerve
Ethmoidal nerve is a branch of nasociliary nerve which in turn is a branch of the trigeminal nerve.
Tutorial - 58F due to undergo parathyroidectomy for hyperPTH. At operation, the inferior parathyroid gland has been identified as being enlarged. A vessel is located lateral to the gland. Which vessel is it most likely to be?
A. External carotid artery B. Common carotid artery C. Internal carotid artery D. External jugular vein E. None of the above
Common carotid artery
Blood supply to inferior parathyroid gland is mainly the inferior thyroid artery. Nerve supply is sympathetic ganglia, which create plexus around the superior thyroid artery.
Tutorial - Which of these statements regarding the external carotid artery is false?
A. It ends by bifurcating into the superficial temporal and ascending pharyngeal artery
B. Its first branch is the superior thyroid artery
C. The superior thyroid, lingual and facial arteries all arise from its anterior surface
D. The ascending pharyngeal branch is a medial branch
E. Initially it lies anteromedial to the internal carotid
A. In fact, the external carotid artery terminates by dividing into the superficial temporal and maxillary branches
External carotid artery as 8 branches: Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial temporal
Tutorial - Which of the following is pierced by the parotid duct?
A. Medial pterygoid B. Buccinator C. Levator anguli oris D. Temporalis E. Masseter
Buccinator
Parotid duct (Stensen’s duct) traverses the masseter and pierces the buccinator. About 5-7cm long, opens into oral cavity near 2nd upper molar.
Submandibular duct (Wharton’s duct) emerges from deep portion of the gland between mylohyoid, hypoglossus and genioglossus muscles. About 3-5cm long, opens into oral cavity at base of lingual frenulum at sublingual papilla.
Tutorial - Which of the following nerves is responsible for innervation of the posterior digastric muscle?
A. Facial nerve B. Hypoglossal nerve C. Trigeminal nerve D. Ansa cervicalis E. Mylohyoid nerve
Facial nerve
Enters skull via internal jugular foramen. Gives off 3 branches: greater petrosal, nerve to stapedius, chorda tympani, before it exits through stylomastoid foramen.
Branches: Temporal Zygomatic Buccal Marginal mandibular Cervical
Tutorial - Which nerve provides sensation to the anterior 2/3 of the tongue?
A. Facial B. Trigeminal C. Hypoglossal D. Vagus E. Glossopharyngeal
Trigeminal nerve (lingual nerve)
Anterior 2/3 taste - facial nerve (chorda tympani)
Posterior 1/3 taste and sensation - glossopharyngeal nerve (lingual nerve)
