Session 1 Flashcards
How many cervical fascia are there?
- Superficial cervical fascial layer
- 4 Deep cervical fascial layer
Where can the superficial cervical layer be found?
It is found just below the skin and largely contains adipose
What can be found within the superficial cervical layer?
- External jugular vein
- Cutaneous nerves
- Superficial lymph nodes
- Platysma
- Fat
- Superficial blood vessels
What are the 3 layers of the deep cervical fascia from superficial to deep?
From superficial to deep
- Investing layer
- Carotid sheath
- Pre tracheal layer
- Pre vertebral layer
Which fascial layer encloses the sternocleidomastoid, trapezius, submandibular and parotid salivary glands?
Investing layer
Where does the retropharyngeal space lie?
Pre-vertebral layer of fascia and the fascia surrounding the pharynx.
What are the complications of an infection that develops in the retropharyngeal space?
Can potentially spread from the neck into the thorax as far down as the posterior mediastinum risking development of a mediastinitis
What are the main muscle group of the face?
- Muscles of facial expression
- Muscles of mastication
Which nerves supplies all of the muscles of mastication?
-Mandibular division of the trigeminal nerve
Which nerve supplies the muscles of fascial expression and superficial muscle of neck and chin?
-Facial nerve
What is Bell’s palsy?
Inflammation of the facial nerve causing facial paralysis
What are the main muscles of the neck?
- Platysma
- Sternocleidomastoid
- Trapezius
- Suprahyoids: attach to the hyoid and above it
- Infrahyoids: attach to the hyoid bone and below it
What nerve supplies the muscles of the neck?
-Cranial nerves
What is the action of platysma muscle?
Depresses corners of the mouth
Contraction assists in depression of the mandible
What is the nerve supply of the platysma muscle?
Facial Nerve
What are the attachments of the sternocleidomastoid?
- Arises from the sternum and clavicle
- Inserts into the mastoid process
What is the action of the sternocleidomastoid?
- Contraction results in lateral flexion of the neck towards the side of the contraction
- Both muscles contracting bring the skull forward or flexion of the neck
What can be used to examine the sternocleidomastoid?
Put hand on the patients neck and ask them to look over their shoulder
What is the nerve supply of the sternocleidomastoid?
Accessory nerve
What is the action of the trapezius?
Contraction causes the shoulder to be shrugged.
What can be used to test the accessory nerve?
Shrug against resistance to test damage to nerve that supplies the trapezius
What are the borders of the anterior triangle?
Superiorly: inferior border of the mandible
Laterally: Medial border of the sternocleidomastoid
Medially: Imaginary saggital line down the midline of the body
What are the borders of the posterior triangle?
Anterior: Posterior border of the sternocleidomastoid
Posterior: Anterior border of the trapezius muscle.
Inferior: Middle 1/3 of the clavicle.
What does inserting surgical airways carry the risk of?
Infection of the pre tracheal space
What do muscles of the fascial expression do?
Act as sphincters and dilators. Attach to bone and the skin/fascia of the face
What do muscles of mastication do?
Act to open and close the jaw
What are the 3 branches of the trigeminal nerve?
- Opthalmic division
- Maxillary division
- Mandibular division
What does the trigeminal nerve do?
- Main sensory nerve of the face and scalp
- Motor innervation to the muscles of mastication
What does the facial nerve do?
- Motor innervation to muscle of facial expression
- Other functions e.g. special sensory to tongue taste, parasympathetic innervation to salivary and lacrimal glands
What are the main blood vessels of the head and neck?
- Common carotid artery which is the main arterial supply via its terminal branches
- Internal jugular vein which is the main vain drain head and neck structures. Also receives venous drain from the face via facial vein
- External jugular vein which also receives veins draining the scalp and face and runs more superficially than the IJV
What are the branches of the common carotid artery?
- Internal carotid artery
- External carotid artery (facial artery branch supplies the face)
Why is swallowing, movement of thence typically difficult and painful for a patient with a retropharyngeal abscess?
Compression of oesophagus causes pain to elicited when moving the neck or swallowing
What are the branches of the facial nerve?
Superior to inferior
- Temporal (above the eyes at side of head)
- Zygomatic (nose region)
- Buccal (mouth region above the lip)
- Mandibular (mouth region below lip)
- Cervical (neck region)
What are the branches of the trigeminal nerve?
- Opthalmic
- Maxillary
- Mandibular
How would you test for the trigeminal nerve?
-Movement of the jaw
How would you test for the facial nerve?
- Smile
- Frown
- Closing eyes
- Raising eyebrows
What is the action of orbicularis oculi?
- Closes the eyes
- Inner part closes the eyes lightly
- Outer part closes the eyes sharply
What can be used to examine the orbicularis oculi?
Close the eyes tightly and stop me trying to open them
What is the action of the levator palpebrae superioris?
Elevates the upper eyelid
What is the innervation of the levator palpebrae superioris?
Oculomotor nerve
What is the innervation of the orbicularis oculi?
Temporal and zygomatic branch of the facial nerve
What is the action of the occipitofrontalis?
Elevation of the eyebrows
What is the innervation of the occipitofrontalis?
- Frontalis belly by the temporal branch
- Posterior auricular nerve for the occipital part
What is the examination for for occipitofrontalis muscle?
Raise the eyebrow against resistance
What is the action of the orbicularis oris?
Closes the mouth
What is the innervation of the orbicularis oris?
Buccal branch of facial nerve
What is the examination for the orbicularis oris?
Purse lips and try to pull it up
What is the action of the Buccinator?
- Keeps food from spilling into the cheek.
- Flattens cheek and holds the cheek close to the teeth when chewing.
- Prevents food pooling between cheek and gums
What is the innervation of the Buccinator?
Buccal branch of the facial nerve
What is the examination for the buccinator?
Blow out cheeks and resist expulsion of air
What is the action of the medial pterygoid?
Elevates the mandible, closing the mouth.
What is the innervation of the medial and lateral pterygoids?
Mandibular nerve
What is the action of the lateral pterygoid?
- Acting bilaterally
- Protract the mandible
- Pushing the jaw forwards
- Unilateral action produces the ‘side to side’ movement of the jaw
What is the action of the masseter?
Elevates the mandible, closing the mouth.
What is the innervation of the masseter?
Mandibular branch of trigeminal nerve
What is the action of temporalis?
- Elevates the mandible, closing the mouth
- Also retracts the mandible, pulling the jaw posteriorly.
What is the innervation of temporalis?
Mandibular branch of trigeminal nerve
What is the examination for the temporalis?
Palpation during jaw clench
What is the action of the sternocleidomastoid?
- Head rotation to opposite side
- Lateral neck flexion
- Neck flexion
What is an examination for the sternocleidomastoid muscle?
Shake their head
What is the innervation of the trapezius?
Accessory nerve
What is the examination of the trapezius muscle?
Tell them to lift their shoulders and try to stop them
What layers would the scalpel penetrate before it reached the bone?
- Skin
- Dense Connective tissue
- Epicranial aponeurosis
- Loose areolar connective tissue
- Periosteum
How is spread of bleeding within the subperiosteal layer limited?
There are membranous gaps in the sutures which the blood goes into which limits the spread of bleeding within the sub-periosteal layer.
