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ANA exam 4 > root of the neck > Flashcards

root of the neck Flashcards

1
Q

the root of the neck is the area immediately?

A

above` the thoracic inlet.

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2
Q

what are the three muscles in the root of the neck?

A

anterior scalene, middle scalene, and posterior scalene.

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3
Q

what are the attachments of the anterior middle and posterior scalene

A

anterior: extends from the anterior tubercles of the cervical vertebrae down on the the scalene tubercle of rib 1
middle: attaches to rib 1 behind the groove for the subclavian a
posterior: attaches inferiorly to rib 2 and is often located behind, fused with the middle scalene

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4
Q

what is the innervation of all three scalene muscles?

A

the dorsal rami of c4-6

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5
Q

what is the landmark of the root of the neck? anterior to this you can find what structure? posterior?

A

anterior scalane

anterior you can see the phrenic nerve and posteriorly you can see the brachial plexus and the subclavian a.

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6
Q

where does the subclavian a arise from on the R vs the L

A

on the left is arises from the aortic arch and on the right it arises from the brachiocephalic trunk

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7
Q

when does the subclavian a become the axiallry a?

A

after it passes the groove of rib 1

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8
Q

the subclavian a can be divided into three parts, the first part extends from where and gives rise to what?

A

the first part extends from its origin to the medial border of the anterior scalene giving rise to

  1. vertebral a
  2. thyrocervical trunk
  3. internal thoracic a
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9
Q

where can you find the vertebral a?

A

ascending to enter the transverse foramen of c6 to eventually enter the cranial cavity via the foramen magnum.

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10
Q

what are the branches of the thyrocervical trunk?

A

inferior throid a
suprascapular a
transverse cervical a

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11
Q

the second part of the subclavian a is the portion of the a that is ____ to what? what does it give rise to?

A

posterior to the anterior scalene, it gives rise to the costocervical trunk which gives rise to the superior intercostal a., and the deep cervical a

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12
Q

the superior intercostal a supplies what?

A

the 1st and 2nd intercostal spaces

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13
Q

what does the deep cervical a supply?

A

muscles of the back of the neck

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14
Q

the third part of the subclavian a extends where? branches?

A

extednds from the lateral border of the anterior scalene to the distal border of the 1st rib, it has no branches arising from it

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15
Q

the thyroid gland descends from the ___ __ of the ___)_ via what duct?

A

foramen cecum, tongue, thyroglossal duct.

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16
Q

the thyroid consists of how many lobes? connected by?

A

2 lobes connected by the isthmus

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17
Q

what could arise from the isthmus in the location of the normally obliterated thyroglossal duct?

A

pyramidal lobe ( or muscle - levator galndulae)

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18
Q

the thyroid gland is what type of gland? heavily supplied with blood vessels that are freely ____. what are the blood vessels?

A

endocrine
anastomotic

sup./inf thyroid a, thyroidea ima

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19
Q

what are the parathyroid glands? number of them? blood supply?

A

tiny 6 mm masses 4-6 in number in the posterior aspect of the thyroid that are also endocrine glands that are essential to life

blood supply inferior thyroid a

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20
Q

where does the thoracic duct drain lymph? where does it begin?

A

into the venous system at the junction of the left internal jugular v and the left subclavian v. it begins in the abdomen at a sac like cyysterna chyli.

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21
Q

lymph of what regions are drained by the thoracic duct?

A

the lower extremities and abdomen are drained. just proior to entering the junction the thoracic duct accepts other trunks from the left upper limb, left side of the head and neck and the left side of the thorax.

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22
Q

lymph from the right side of the head and neck, right upper limb, and right thorax is drained into what?

A

the right lymphatic duct.

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23
Q

what are the three trunks that dump into the right lymphatic duct and thoracic duct before their junctions called?

A

the subclavian trunk (upper limb), the jugular trunk (head and neck) and the bronchomediastinal trunk (thorax)

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24
Q

regions of the lymph drainage in the head and neck?

A
  1. occipital (back of head)
  2. mastoid (behind ear)
  3. parotid (front of ear)
  4. buccal (cheek)
  5. submandibular (right below jaw bone on either side)
  6. submental (right below chin)
  7. superficial cervical (top of neck)
  8. laryngeal (near adams apple)
  9. tracheal (low neck)`
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25
Q

all lymph of the head and neck drains to a regional group of nodes and then eventually to what? found where?

A

the terminal group. the deep cervical group found along the carotid sheath adjacent to the internal jugular v.

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26
Q

what are the two ways of localizing pathologic lesions in the root of the neck?

A

the superficial triangles and the facially defined spaces.

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27
Q

enlargment of a specific lymph node can be an indication of where the ____ mass would be located.

A

tumorous

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28
Q

lymph node swelling in the submental triangle would indicate what area?

A

anterior tongue, central lower lip, anterior floor of the mouth and chin.

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29
Q

lymph node swelling in the submandibular triangle drains what areas?

A

anterior and middle tongue, lateral lower lip, upper lip, lateral nose, buccal region and submandibular gland.

30
Q

lymph node swelling in the carotid traingle could indicate disease where?

A

middle and posterior tongue, tonsil, nasopharynx, superior larynx thyroid gland.

31
Q

swelling of lymph in the occipital triangle could indicate disease where

A

ant/middle/post cervical chain, superior tongue, tonsil, nasopharynx, deep cervical chain, superior larynx, thyroid gland , parotid, and auricle region

32
Q

swelling of lymph in the subclavian triangle could indicate disease where

A

inferior larynx, thyroid gland, chain tracheo, posterior scalp

33
Q

what is the scalp? what are its boundaries

A

thick five layered structure that extends from the suboccipital margin of the forehead anteriorly to the superior nuchal line of the suboccipital region posteriorly and laterally it extends down to the temporal fossae.

34
Q

within the layers of the scalp there is a membraneous aponeurosis called what? it has relationship with what muscle?

A

galea aponeurotica that represents the intermediate tendon between the two bellied of the occipital frontalis muscle?

35
Q

the occipital portion of the occipitalfrontalis m does what? frontalis portion?

A

occipital portion: attaches to the superior nuchal line and pulls the scalp posteriorly

fontalis portion: interts into the skin above the eyebrows and will pull the scalp forward to wrinkle the forehead

36
Q

scalp wounds typically __ and ___ profusely but heal quickly. what is this due to? how are scalp incisions made?

A

gape and bleed. due to diffuse anastomotic pattern of blood supply. surgical incisions are created and reflected inferiorly bc the blood supply of the scalp begins lower and comes to the top of the head

37
Q

the scalp is supplied by branches from the __ and ___ ___ _/

A

the external and internal carotid a

38
Q

what are the branches that supply the scalp from the internal carotid a >

A

supraorbital a and supratrochlear a

39
Q

external carotid a branches that supply the scalp? face?

A

scalp: superficial temporal a, posterior auricular a, occitpital a
face: fascial a and transverse facial a

40
Q

anterior to the ear, the sensory innervation of both regions is derived from the cutaneous branches of what? and what are the branches?

A

all 3 divisions of the trigeminal verve (CN V)

V1: supratochlear n and supraorbital n
V2: infraorbital n and zygomaticotemporal n
v3: mental n and auriculotemporal n

41
Q

what is CN V

A

TRIGEMINAL N

42
Q

posterior to the ear, sensory innervation is done by what>

A

spinal cutaneous nn of the cervical plexus.

  1. lesser occipital, greater occipital n (dorsal ramus of c2), third occipital n.
43
Q

superficial muscles of the face and scalp all have what innervation?

A

facial nerve CN VII (motor innervation)

44
Q

CN VII?

A

facial nerve

45
Q

what are the muscles of the scalp

?

A

occitipitalfrontalis m and the platysma (of the neck)

46
Q

superficial fascial muscles take origin from the ___ of the fascial skeleton and interto into the ____ ___ of the overlying skin and have two general functions:

A

bones insert into superficial fascia

  1. dilators/sphincters of the eye and mouth
  2. movers of the overlying skin (muscles of fascial expression)
47
Q

the facial n exits the skull via the ___ ___ and psses into the ___ of the ___ __ where it forms a plexus breaking up into at least _ major branches that radiate out onto the face to supply motor innervation of the muscles of fascial expression.

A

stylomastoid foramen, passes through the parenchyma of the parotid gland, 5

48
Q

what are the 5 branches of the fascial nerve?

A
  1. temporal
  2. zygomatic
  3. buccal
  4. mandibular
  5. cervical

ten zebras bit my cheek

49
Q

what are the superficial muscles of the face?

A 
occipitofrontalis m
zygomaticus major/minor
orbicularis oris/occuli
depressor labii inferioris
levator labii superioris 
depressor anguli oris
levator anguli oris
buccinator 
risorius 
platysma
50
Q

list the muscles of mastification from superficial to deep

A
  1. masseter (parotid region- anterior to the mandible)
  2. temporalis (in the temporal fossa-beneath zygomatic arch)
  3. lateral ptyergoid (in the infratemporal fossa)
  4. medial ptyergoid ( in the infratemporal fossa)
51
Q

all of the muscles of mastification are innervated by?

A

the mandibular division of the trigeminal N ( CN V3)

52
Q

what is the action of the masseter muscle? attachments?

A

contracts/elevates mandible

attaches to the lower border of the zygomatic arach and passes posteriorly and inferior to the angle of the ramus of the mandible

53
Q

the temporalis muscle is a __ __ muscle found where? what is it covered by? origin and insertion? fibers?

A

fan shaped muscle

found behind the zygomatic arch in the temporal fossa covered by a thick temporalis fascia, origin from the frontal/parietal bones and inserts on the coronoid process of the mandible.

anterior fibers are vertical and function in elevating the mandible

posterior fibers are horrizontal and retract the mandible.

54
Q

lateral ptyergoid muscle has how many heads? where does each arise from and where do they insert?

A

two heads

superior head arises from the greater wing of the sphenoid bone,

The inferior head arises from the lateral surface of the lateral pterygoid plate of the sphenoid

both heads insert on the neck of the mandicle as well as the capsule and articular disc of the temporomandibular joint.

55
Q

what is the function of the lateral pterygoid?

A

opening the mouth by pulling on the condylar head of the mandible as well as protracting the mandible.

56
Q

the medial ptyergoid musle is a mirror image of the ____ on the medial side of the mandibular ramus forming a ___ that functions how?

A

mirror image of the masseter ,m that forms a sling.

function is to elevate the mandible.

it attaches superiorly to the medial surface of the laterl ptyergoid plate (deep head) and inferiorly to the tuberosity of the maxilla (superficial head)

57
Q

protraction of the jaw is accomplished by what muscles?

A

the medial and lateral ptyergoids working together on both sides.

58
Q

side to side chewing movements are accomplished by the unilateral contraction of what

A

the medial and lateral ptyergoid muscles

59
Q

of the four muscles of mastification, only the ____ functions in opening the mouth

A

lateral ptyergoid.

60
Q

what other muscles are accessory muscles used to open the mouth

A

the suprahyoid muscles (digastrics, geniohyoid, mylohyoid, stylohyoid,

61
Q

what is the name of the synovial joint that is divided into two cavities by an intra articular disc ? what is this joint strengthened by?

A

temporomandibular joint, basically a hinge joint but allows gliding side to side movements.

numerous ligaments.

62
Q

the maxillary artery is a terminal branch of what artery? it can be found both anterior and posterior to what muscle?

A

external carotid a, the lateral ptyergoid m

63
Q

what are the important branches the maxillary a gives off to all the muscles in the infratemporal fossa>

A
  1. middle meningeal (dura of cranium)
  2. inferior alveolar (teeth of the lower jaw)
  3. posterior superior alveolar (teeth of the upper jaw)
  4. sphenopalatine (to the nasal cavity)
64
Q

nerves of the infratemporal fossa and where they are found? lateral to medial?

A

buccal n (sensory branch of the anterior division of the mandibular n) found between two heads of the lateral ptyergoid.

from the inf aspect of the inf head of the lateral ptyergoid is the lingual and inf alveoilar n

from lateral to medial inferior alveolar n, lingual n, buccal n

65
Q

the mandibular division of CN V has a large ___ and a small ___ component. it has branches arising from the stem of V3 the ___ divions of the nerve and the ____ division of the n.

A

sensory and small motor

anterior and posterior divisions.

66
Q

branches from the stem of the anterior division of V3 are predominantly the ___ branches. the posterior division gives off major ___ branches.

A

ant: sensory
post: motor

67
Q

branches of the posterior division of V3

A

auriculotemporal n: typically splits around the middle meningeal a and passed behind the capsule of the TMJ

lingual n

inferior alveolar n.

68
Q

the lingual n is the major sensory nerve of the _____. it accepts the ____ ___ from the CN VII. that carries specific fibers for ___.

A

tongue

chorda tympani from the fascial n that carries specific fibers for taste. this hitch hikes along with the lingual n to the dorsum of the tonguee

69
Q

the inferior alveolar n is the major sensory nerve to the ___ ___. terminal branches of this n exit as what? through where? to supply?

A

lower teeth

mental n that exits through the mental foramen to supply sensory innervation to the skin over the mandible.

70
Q

what is the motor branch that the inferior alveolar n gives off? what is its path? to innervate what?

A

the nerve to the mylohyoid that travels down superficial to the muscles of the floor of the mouth to innervate the mylohyoid and the anterior belly of the digastric mm.

ANA exam 4 (4 decks)

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