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Head & neck > Session 1 > Flashcards

Session 1 Flashcards

1
Q

Describe the major muscle groups of the head and neck, their nerve innervation, and broad action LO
1. Cranial nerve ->

  1. What are the major muscle groups of the neck?
A
  1. Cranial nerve -> (1) accessory, facial & Trigeminal
  2. Neck: platysma, sternocleidomastoid (SCM), trapezius, supra hyoid, infra hyoid
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2
Q

Q. What is this image showing?

A

A. Platysma

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3
Q

Q. Platysma

  1. Origin:
  2. Insertion:
  3. Innervation:
  4. Action:
    (5. Arterial supply)
  5. Test:
A

A. 1. Origin: Pectoral fascia overlying the pectoralis major and deltoid muscles
2. Insertion: Inferior border of the mandible and the parotid fascia
3. Action: Depression of the angles of the mouth and mandible
4. Nerve supply: Cervical branch of the facial nerve (VII) (Cranial Nerves)
5. Arterial supply: Facial artery
6. Demonstrate the face to the patient
Depresses mandible & angles of mouth; also used when tensing skin during shaving; arises from skin/fascia of lower face and mandible, inserts into fascia covering anterior chest wall; runs superficial to SCM and over clavicles

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4
Q

Q. Sternocleidomastoid (SCM)

  1. Origin:
  2. Insertion:
  3. Innervation:
  4. Action:
    (5. Arterial supply)
  5. Test:​
A

A. ORIGIN: Sternal head: the anterior surface of the manubrium; Clavicular head: the medial third of the clavicle.
INSERTION: Mastoid process and the lateral part of the superior nuchal line.
Action: Involved in flexing the head when both muscles contract (atlanto occipital joint) and lateral flexion of the neck tilting chin to the contralateral side
Nerve supply: Accessory nerve (CN XI). (Cranial nerve)
Arterial supply: Superior thyroid artery; occipital artery.
Test: tell patient to look over their shoulder against resistance

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5
Q

Q. What is this image showing?

A

A. Torticollis a dystonic condition defined by an abnormal, asymmetrical head, Right side is abnormal chin is tilted on the contralateral side
A. Runs over the clavicles and other neck muscles

​

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6
Q

Q. Trapezius

  1. Origin:
  2. Insertion:
  3. Innervation:
  4. Action:
    (5. Arterial supply)
  5. Test:​
A

A. ORIGIN: Descending: the external occipital protuberance, ligamentum nuchae and spinous process of the C1-C7 vertebrae; Transverse: the aponeurosis of the spinous processes at the T1-T4 vertebrae; Ascending: the spinous processes of the T5-T12 vertebrae.
INSERTION: Descending: the lateral one-third of the clavicle; Transverse: the medial side of the acromion; Ascending: the upper crest and tubercle of the scapular spine.
ACTION: Retraction, superior rotation, elevation and depression of the scapula.
NERVE SUPPLY: Accessory nerve (CN XI), C3-C4. (Cranial nerve)
ARTERIAL SUPPLY: Transverse cervical artery.
6. Elevate the shoulders against resistance

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7
Q

Q. What is this Image showing

A

A. Muscles not holding scapula muscles shrink wasting of the muscles and outlining of the scapula, Damage to nerve that supplies the trapezius accessory nerve (sternocleidomastoid is also innervated)

​

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8
Q

Q. Omohyoid

  1. Origin:
  2. Insertion:
  3. Innervation:
  4. Action:
    (5. Arterial supply)
  5. Test:
A

A. ORIGIN: Intermediate tendon.
INSERTION: Lower border of the hyoid bone lateral to the sternohyoid.
ACTION: Depression and stabilization of the hyoid and larynx for phonation and swallowing.
NERVE SUPPLY: Superior root of ansa cervicalis.
ARTERIAL SU

​

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9
Q

Q. Digastric

  1. Origin:
  2. Insertion:
  3. Innervation:
  4. Action:
    (5. Arterial supply)
  5. Test:
A

A. ORIGIN: Digastric fossa of the mandible.
INSERTION: Intermediate tendon on the minor cornu of the hyoid bone.
ACTION: Elevates the hyoid bone and depresses the mandible.
NERVE SUPPLY: Mylohyoid nerve.
VARTERIAL SUPPLY: Submental artery

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10
Q

Label the diagram and state which are muscles of mastication or facial expression

A
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11
Q

Q. What two important facial muscles are missing from the diagram and how are these muscles grouped

Q. Name the major muscles of the head and group them in terms of muscles of mastication and muscles of facial expression

A

A. Medial and lateral pterygoids which are muscles of MASTICATION

A. Muscles of mastication: - medial and lateral pterygoids, temporalis and masseter
Muscles of facial expression: - epicranius, epicranial aponeurosis, obicularis oculi, zygomaticus, buccinator, orbicularis oris, platysma

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12
Q
A
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13
Q

Q. Which muscles of mastication elevate or depress the mandible

A

A. Elevate: temporalis, masseter

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14
Q

Q. Function of the cranial nerve VII (3)

A

A. 1. Motor innervation to muscles of facial expression

  1. Special sensory to tongue-taste
  2. Parasympathetic innervation to salivary and lacrimal glands ( + relationship with the parotid gland)

​

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15
Q
  1. Name the three key trigeminal branches
  2. Function of trigeminal nerve
A
  1. • Va ophthalmic division • Vb maxillary division • Vc mandibular division
    1. Main sensory nerve of face and scalp
  3. Motor innervation to muscles of mastication
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16
Q

Q. Complete the dermatome map labelling which trigeminal branches supply sensory information

A
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17
Q

Q. On the image below label and name the branches (1-3: Va, Vb, Vc) of the trigeminal nerve (cranial nerve V).

A
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18
Q
  1. Facial nerve testing:
    Trigeminal nerve testing:
  2. Where do the cranial nerves arise from?
A

A. Brain stem

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19
Q

Q. Occipitofrontalis (frontalis & occipitalis)/ Epicranius: this muscle, namely its aponeurosis, forms one of the layers of the scalp
Occipitalis n: posterior auriculur nerve action: wrinkles the forhead and elevates the eyebrows
Frontalis ORIGIN: Epicranial aponeurosis. INSERTION: Skin of the eyebrow and the forehead. ACTION: Elevates the eyebrow, wrinkles the skin of the forehead and moves the scalp. NERVE SUPPLY: Temporal branches of facial nerve.
Test: elevate eyebrows against resistance
obicularis oculi n: temporal and zygomatic action: shuts the eye test: patient tries to keep their eyes closed while you try to open them
Levator pulpae superioris: Action: elevates upper eyelid Innervation: ocular motor nerve Examination: ptosis
Zygomaticus n: zygomatic and buccal branch of the facial nerve action:dilates the mouth? elevation of the mouth action: dilator muscles of lips/ Raises corners of the mouth
Buccinator n: buccal branches of the facial nerve Action: flattens cheek, whilst chewing prevent spooling Examination: blow air in check and try to push it out
orbicularis oris Action: closes mouth opens lips CLOSES mouth. Innervation: buccal branch of facial nerve. Examination: dropping mouth and drooling.

A
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20
Q

Describe the general anatomical layout of the neck structures including their arrangement with regards to the fascial planes and anatomical triangles of the neck LO
Q. Label the diagram

A
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21
Q

Q. The anterior triangle is situated at the front of the neck.
It is bounded:
Superiorly – ?
Laterally – ?
Medially – ?
Draw an image showing the anterior triangle

A

A. Superiorly – Inferior border of the mandible (jawbone)
Laterally – Medial border of the sternocleidomastoid
Medially – Imaginary sagittal line down midline of body

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22
Q

Q. What does the anterior triangle contain?

A

A. Muscles -> infrahyoid (4 e.g. omohyoid), suprahyoid (4 e.g. digastric)
Arteries-> common carotid artery & bifurcates = external & internal
Nerves -> Facial (VII), glossopharyngeal [IX], vagus [X],accessory [XI], and hypoglossal [XII] nerves.

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23
Q

Q. Draw the carotid triangle drawing in and stating the boundries

A

A. Superior: Posterior belly of the digastric muscle.
Lateral: Medial border of the sternocleidomastoid muscle.
Inferior: Superior belly of the omohyoid muscle.

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24
Q
  1. The main contents of the carotid triangle are? (3)
  2. What is the medical relevance of the carotid triangle?
A
  1. A. common carotid artery ( bifurcates (external and internal)), IVJ, hypoglossal and vagus nerves
    1. Vessels and nerves are superficial so can be targeted during surgical procedures
  3. Corotid sinus (dilated portion of the common and internal carotid arteries) contains baroreceptors which detects bp by the stretching of mechanical receptors. (Resets every 15min) fed bak by the glossopharyngeal nerve (baroreceptors can be hypersensitive in some patients so external pressure can lead to syncope)
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25
Q

Q. The neck extends above from the ? to the ?, connecting the head to the rest of the body. Structures in the neck are compartmentalised by layers of ?

A

A. lower margin of the mandible, suprasternal notch of the manubrium and the upper border of the clavicle below, cervical fascia

​

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26
Q
A
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27
Q

Q. The investing layer’s superior margin is attached to? It also attaches to the ? posteriorly. Inferiorly the investing layer attaches to the ?

A

A. Inferior border of the mandible (midline to angle), the mastoid process, the superior nuchal line and the external occipital protuberance in the posterior midline, spinous processes of the vertebrae and ligamentum nuchae, upper border of the manubrium, the upper surface of the clavicle, acromion and spine of the scapula.

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28
Q
A
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29
Q

Q. What layer splits? And what does this layer invest?

A

A. The investing layer splits to enclose the sternocleidomastoid and trapezius muscles, and the submandibular and parotid salivary glands.

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30
Q

Q. The pretracheal layer is thin and limited to the anterior and lateral part of the neck. Superiorly it is attached to the ? Inferiorly it extends into the ?

A

A. hyoid bone, thorax where it blends with the fibrous pericardium,

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31
Q

Q. What two layers does the pretracheal fascia consist of? And what does each layer enclose?

A

A. A muscular layer -> infrahyoid muscles
visceral layer -> thyroid gland (splitting around this to form a false capsule), trachea and oesophagus

​

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32
Q

Q. The part of the pretracheal fascial layer, which continues posteriorly to invest the muscles of the pharynx and ? is known as the?

A

A. oesophagus, buccopharyngeal fascia This facial layer runs from the base of the skull superiorly, to the diaphragm inferiorly.

​

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33
Q

Q. The prevertebral layer forms a sheath for the ? associated with it. This layer extends from the base of the cranium to the 3rd thoracic vertebra and extends laterally as the axillary sheath that surrounds the axillary vessels and the brachial plexus of nerves running into the upper limb.

A

A. vertebral column and muscles

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34
Q

Q. Spaces between fascial planes are actually filled with ? However can become distended, because of ?

A

A. loose connective tissue, infection or an abscess

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35
Q

Q. Name one neck space, what it lies between, what is used to contain and the pro and con of this space is t

A

A. retropharyngeal space, prevertebral layer of fascia and the fascia surrounding the pharynx (buccopharyngeal fascia); up until the age of 3- 4 years this space contains lymph nodes. Pro: Pharynx to move freely on the vertebral column and expand during swallowing
Con: Space for infection to collect, neck -> thorax as far down as the posterior mediastinum, risking the development of the rare, but life threatening condition mediastinitis

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36
Q

Q. • Superficial cervical fascia (1) : made up of?
• Deep cervical fascia (4): made up of?

A

A. • Superficial cervical fascia (1) : loose connective tissue
(subcutaneous tissue)
– Includes fat, platysma, cutaneous nerves, lymph
nodes and superficial blood vessels
• Deep cervical fascia (4): dense connective tissue
– Investing layer
– Carotid sheath
– Pre tracheal fascia
– Pre visceral fascia

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37
Q

Q. The retropharyngeal space & pre-tracheal spaces extend inferiorly into the ? Infections within these spaces can potentially spread inferiorly to involve mediastinal structures causing mediastinitus • Inserting surgical airways e.g. ?

A

A. mediastinum, tracheostomy could risk transfer of bacteria into the pre tracheal space

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38
Q
A
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39
Q

Describe the implications for the spread of infection within the neck as a result of the compartmentalisation by cervical fascial planes LO
Q. Retropharyngeal Space Infections
1. Rare or common?
2. Common cause?
3. Commonly seen in?
4. Infection in this space may develop into a?
5. Signs & symptoms:

A

A.1. Rare

  1. Secondary to an upper respiratory tract infection (e.g nasal cavity, nasopharynx, oropharynx
  2. Children < 5 yrs
  3. Retropharyngeal abscess
  4. visible bulge on inspection of the oropharynx, sore throat, difficulty swallowing, stridor, reluctance to move their neck and a high temperature (morbidity & mortality)
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40
Q

Q. Lumps in the Thyroid Gland and Retrosternal Goitres

  1. Diseases affecting the thyroid gland can cause?
  2. You should ask the patient to?
  3. The ? move up with swallowing, as such so too will the thyroid gland, and any swelling or lump involving this gland
  4. An enlarged thyroid gland (goitre) can sometimes extend retrosternally (behind the sternum), through the root of the neck because the lower limit of the pre- tracheal fascia extends into the thorax. Retrosternal extension of a goitre can lead to compression of other structures running through the root of the neck (thoracic inlet) such as the ? This can lead to symptoms such as breathlessness and stridor due to tracheal compression, and facial oedema because of ?
A

A. 1. enlargement of the gland or discrete lumps

  1. swallow (moves?) can help localise pathology to the thyroid gland. This is because the thyroid gland is enclosed by pre-tracheal fascia, which is attached to the hyoid bone .
  2. hyoid bone and larynx
  3. trachea and venous blood vessels, compression impeding venous drainage from the head & neck
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41
Q

Outline the major arteries and veins of the head and neck and relate this understanding to their surface anatomy LO/ Outline the blood supply and nerve innervation of the scalp, particularly in relation to the contribution of: o Branches from the external and internal carotid arteries o Cervical and trigeminal nerves and their related dermatomal distribution.
Q. Label the diagram

A
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42
Q

Q. 1. The right common carotid artery arises from a ? This bifurcation occurs roughly at the level of the ?
2. The left common carotid artery branches directly from the arch of aorta. The left and right common carotid arteries ascend up the neck, lateral to the trachea and the oesophagus. They do not give off any branches in the neck.
At the level of the?, the carotid arteries split into the external and internal carotid arteries. This bifurcation occurs in an anatomical area known as the ?

A
  1. The common carotid and internal carotid are slightly dilated here, this area is known as the ?, and is important in detecting and regulating blood pressure.
    A. 1. bifurcation of the brachiocephalic trunk (the right subclavian artery is the other branch), right sternoclavicular joint
  2. superior margin of the thyroid cartilage (C4), carotid triangle
  3. carotid sinus
43
Q
A
44
Q

Q. What is external to the carotid sinus​

A

A. Carotid body (nervous cells) act as peripheral chemoreceptors determines O2 dat and thus breathing rate

45
Q

Q. The external carotid artery supplies the areas of the head and neck external to the cranium. After arising from the common carotid artery, it travels up the neck, posterior to the mandibular neck and anterior to the lobule of the ear. The artery ends within the parotid gland, by dividing into the superficial temporal artery and the maxillary artery. Before terminating, the external carotid artery gives off six branches:
Superior thyroid artery
Lingual artery
Facial artery
Ascending pharyngeal artery
Occipital artery
Posterior auricular artery
The facial, maxillary and superficial temporal arteries are the major branches of note. The maxillary artery supplies the deep structures of the face, while the facial and superficial temporal arteries generally supply superficial areas of the face

A
46
Q

Q. What arteries provide a dense blood supply to the scalp?

A

A. Posterior auricular, occipital and superficial temporal arteries (external) & supraorbital & supratrochlea (internal)

47
Q

Q Injuries to the scalp can cause excessive bleeding because?

A
48
Q

Q. Why won’t the skull undergo a vascular necrosis?

A

A. Alternative blood source -> Middle meningeal artery

49
Q
A
50
Q

Q. Why is the middle meningeal artery unique?

A

A. Branch of maxillary artery (external carotid artery which usually supplies extra-cranial structures) but this supplies intracranial structures)

​

51
Q

Q. What does the MMA supply?

A

A. Skull and dura mater

52
Q

Q. What is the link between the MMA and an extradural haematoma

A

A. A fracture at the pterion can injure/lacerate the MMA, inc ICP

​

53
Q

Q. Symptoms of an inc in ICP and treatment

A

A. Symptoms: Nausea, vomiting, seizures, bradycardia & limb weakness
Treatment: diuretics, burr holes in the skull

​

54
Q
A
55
Q

Q. The internal carotid arteries do not supply any structures in the neck, entering the cranial cavity via the ? in the petrous part of the ? Within the cranial cavity, the internal carotid artery supplies:

A

A. carotid canal, temporal bone, The brain&Eyes&Forehead

​

56
Q

Q. What pathological significance does birfurcation of the common carotid arteries have? Symptoms?

A

A. Turbulent flow, inc risk of atheroma (internal more susceptible than others), tunica intima thickens, dec blood flow to the brain, neurological
Symptoms: headache, dizziness, muscular weakness, completely occurred = cerebral ischaemia
(Carotid endarterectomy)

​

57
Q
A
58
Q
A
59
Q

Q. The right and left vertebral arteries arise from the?, medial to the anterior scalene muscle. What route do the vertebral arteries take after?
The vertebral arteries enter the cranial cavity via the?, and ?. They then give rise to the ? which supply the brain. The vertebral arteries supply no branches to the neck, or extra-cranial structure​

A

A. subclavian arteries, they then ascend up the posterior side of the neck, through holes in the transverse processes of the cervical vertebrae, known as foramen transversarium.
foramen magnum, converge, basilar arteries,

60
Q
A
61
Q

Q. Describe which arteries supply different structures in the neck​

A

A. R & L Subclavian arteries form the thyrocervical trunk:

  • 1st branch of the thyrocervical trunk is the inferior thyroid artery -> thyroid gland
  • The ascending cervical artery arises from the inferior thyroid artery -> posterior prevertebral muscles
  • 2nd branch of the thyrocervical trunk is the transverse cervical artery (crosses the base of the carotid triangle) -> supplies the trapezius and rhomboid muscles.
  • 3rd suprascapular artery arises -> posterior shoulder
62
Q

Q. Anatomically, the venous drainage of the head and neck can be divided into three parts:​

A

A. - Venous drainage of the brain and meninges: Supplied by the dural venous sinuses.

  • Venous drainage of the scalp and face: Drained by veins synonymous with the arteries of the face and scalp. These empty into the internal and external jugular veins.
  • Venous drainage of the neck: Carried out by the anterior jugular veins.
63
Q
A
64
Q

Q. The external jugular vein and its tributaries supply the majority of the external face. It is formed by the union of two veins:​

A 
A. Posterior auricular vein – drains the area of scalp superior and posterior to the outer ear.
Retromandibular vein (posterior branch) – itself formed by the maxillary and superficial temporal veins, which drain the face.
65
Q

Q. These two veins combine immediately posterior to the angle of mandible, and inferior to the outer ear, forming the external jugular vein.
These two veins combine immediately posterior to the angle of mandible, and inferior to the outer ear, forming the external jugular vein.

After formation, the external jugular vein descends down the neck within the superficial fascia. It runs anteriorly to the sternocleidomastoid muscle, crossing it in an oblique, posterior and inferior direction.

In the root of the neck, the vein passes underneath the clavicle, and terminates by draining into the subclavian vein. Along its route down the neck, the EJV receives tributary veins – posterior external jugular, transverse cervical and suprascapular veins.

A
66
Q

Q. The EJV is relatively superficial thus can be easily damages, what happens if it is damaged by knife slash?

A

A. Lumen is open due to thick layer of investing fascia. Air will be drawn into the vein producing cyanosis, & can stop blood flow through the right atrium. Must apply pressure to the wound stop bleeding and entry of air.

67
Q

Q. The anterior jugular veins vary from person to person. They are paired veins, which drain the anterior aspect of the neck. Often they will communicate via a jugular venous arch. The anterior jugular veins descend down the midline of the neck, emptying into the subclavian vein.

A
68
Q

Describe the layers of the scalp and the importance of these layers in relation to understanding scalp lacerations and how blood and infection can spread and track.
Q. How many layers does the scalp consist of? Name these layers

A

A. 5 layers

69
Q

Q. Why is the scalp a site for profuse bleeding?​

A

A. Blood vessels highly adherent to the dense connective tissue. Unable to constrict fully if lacerated – profuse bleeding.

70
Q

Q. Give a simple description for each layer

A

A. Skin – contains numerous hair follicles and sebaceous glands (thus a common site for sebaceous cysts).
Dense Connective tissue – connects the skin to the epicranial aponeurosis. It is richly vascularised and innervated.
Epicranial Aponeurosis – a thin, tendon-like structure that connects the occipitalis and frontalis muscles.
Loose Areolar Connective Tissue – a thin connective tissue layer that separates the periosteum of the skull from the epicranial aponeurosis.
It contains numerous blood vessels, including emissary veins which connect the veins of the scalp to the diploic veins and intracranial venous sinuses.
Periosteum – the outer layer of the skull bones. It becomes continuous with the endosteum at the suture lines.

71
Q

Name the layers of the skin and its function

A
72
Q

Q. What layer in the scalp increases the risk of scalp infections

A

A. Loose connective tissue because blood and pus easily spread and can pass easily into the cranial cavity along the emissary veins. Therefore infection can spread from the scalp to the meninges -> meningitis

​

73
Q
  1. What arteries supply the scalp?
  2. More specifically what branches of the external carotid artery are supply the scalp:
A
  1. External carotid artery and the ophthalmic artery (a branch of the internal carotid)
  2. Superficial temporal – supplies the frontal and temporal regions
    Posterior auricular – supplies the area superiorly and posteriorly to the auricle.
    Occipital – supplies the back of the scalp
74
Q

Q. Mores specifically what branch of the opthalmic artery (which is a branch of the internal carotid artery) supplies the scalp? Name the areas of the scalp it supplies.

A

A. supraorbital and supratrochlear (accompany the nerves) and supply the anterior and superior aspects of the scalp.

75
Q
A
76
Q
A
77
Q

Q. The venous drainage of the scalp can be divided into?

A

A. superficial and deep components.

78
Q

Q. The veins of the scalp connect to the diploic veins of the skull via valveless emissary veins. This establishes a connection between the scalp and the dural venous sinuses.
Q. Label the diagram

A
79
Q

Q. The occipitofrontalis muscle consists of 2 occipital bellies and 2 frontal bellies. The occipital bellies arise from the ? on the occipital bone. The frontal bellies originate from the ? The occipital and frontal bellies insert into the ?
Each occipital belly is innervated by the ?, and each frontal belly is innervated by the ? The frontal bellies can raise the eyebrows.

A

A. superior nuchal lines, skin and superficial fascia of the upper eyelids, Epicranial Aponeurosis, posterior auricular branch of the facial nerve, frontal branch of the facial nerve

80
Q

Q. The scalp receives cutaneous innervation from six main nerves, which arise from the ?

A

A. Trigeminal nerve or the cervical nerves

81
Q

Q. Which branches of the trigeminal nerve supply cutaneous innervation to the scalp?

A

A. Supratrochlear nerve: Branch of the opthalmic nerve which supplies the anteromedial forehead.
Supraorbital nerve: Branch of the opthalmic nerve which supplies a large portion of the scalp between the anterolateral forehead and the vertex.
Zygomaticotemporal nerve: Branch of the maxillary nerve, this supplies the temple.
Auriculotemporal nerve: Branch of the mandibular nerve which supplies skin anterosuperior to the auricle.

​

82
Q

Q. Which branches of the cervical nerves provide cutaneous innervation to the scalp?

A

A. Lesser occipital nerve: Branch of the anterior rami of C2 and 3 supplies behind the ear.
Greater occipital nerve: Branch of the anterior rami of C2 and 3 supplies the posterior scalp up to the vertex.

83
Q
A
84
Q

Q. Clinical Relevance – Scalp Lacerations
Deep lacerations to the scalp tend to bleed profusely for several reasons. These are:

A

A. The pull of the occipitofrontalis muscle prevents the closure of the bleeding vessel and surrounding skin.
The blood vessels to the scalp are adhered to dense connective tissue, preventing the vasoconstriction that normally occurs in response to damage.
The blood supply to the scalp is made up of many anastomoses, which contribute to profuse bleeding.
It is important to note that loss of blood supply to the scalp doesn’t lead to bone necrosis as most of the blood supply to the skull comes from the middle meningeal artery

85
Q

Q. Cervical and trigeminal nerves and their related dermatomal distribution LO
A.

A
86
Q

Q. A surgeon makes an incision through the scalp in order to access the skull to perform a craniotomy; what layers would the scalpel blade penetrate (from superficial to deep) before it reached bone?

A
87
Q

Q. Following a non-penetrating injury (no open wound) to the scalp e.g. as may happen if you hit your head hard against a door frame, why does the haematoma form a well circumscribed lump (see image)? Within which layer of the scalp has this bleeding likely occurred?

A

A. Loose connective tissue?

88
Q

Q. Following some head injuries involving the scalp blood can track forward causing bruising to appear around the eyes. Within which layer of the scalp has this bleeding likely occurred and from what sort of bloo d vessels (arterial or venous)?

A

A. Areolar loose connective tissue. The main vessels in this layer are the emissary veins if the rupture it spreads through the layer causing the area of the eyes to bleeding

89
Q

Q. Explain why bleeding can be profuse and difficult to stop from an incised scalp wound involving the dense connective tissue layer (clue: within which layer of the scalp are the main blood vessels supplying the scalp found and what are the features of this particular connective tissue layer?).

A
90
Q

Q. Following a difficult labour a newborn baby develops a traumatic subperiosteal haematoma (cephalohaematoma). He is otherwise well with no other complication. Does this swelling pose a risk to the baby’s brain (explain your answer)?

A
91
Q

Q. What limits the spread of bleeding within the subperiosteal layer (Clue: it cannot pass suture lines between skull bones…but why?)
Q. An incised scalp wound may gape open if the wound involves the aponeurosis: why do such wounds gape, while more superficial scalp wounds do not?​

A

A. The occipitalis and frontalis each have two muscle bellies which insert onto the Epicranial Aponeurosis thus pulling it apart resulting

92
Q

Q. 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?

A
93
Q
A

A. Name: Platysma
Action: Depresses lower jaw. Small function in drawing down lower lip. Tenses skin (eg shaving)
Innervation: Cervical branch of facial
Examination: Not usually examined

94
Q

Name, action, innervation & examination

A

A. Name: Orbicularis Oculi
Action: Closes the eye (see next slide for further detail)
Innervation: Temporal and zygomatic branches of facial nerve
Examination: Close eyes and resist opening

95
Q
A

A. Name: Levator Palpebrae Superioris
Action: Elevates upper eyelid
Innervation: Oculomotor nerve
Examination: Inspection of eyes for ptosis

96
Q
A

A. Name: Occipitofrontalis
Action: Elevates eyebrows
Innervation: Frontal belly – temporal branch of facial nerve
Occipital belly – posterior auricular branch of facial nerve
Examination: Elevate eyebrows against resistance

97
Q

Q. What are the 5 layers of the scalp plus how are the first three layers connected?

A
98
Q
A

A. Name: Orbicularis Oris
Action: Closes mouth
Innervation: Buccal branch of facial nerve
Examination: Face inspection – drooping angle of the mouth in CNVII palsy

99
Q
A

A. Name: Buccinator
Action: Flattens cheek – holds cheek close to teeth when chewing – prevents food pooling between cheek and gums
Innervation: Buccal brand of the facial nerve
Examination: Blow out cheeks and resist expulsion of air

100
Q
A

A. Name: Masseter
Action: Elevates mandible (closes jaw), stronger than medial pterygoid
Innervation: Mandibular branch of trigeminal nerve
Examination: Palpation during jaw clench

101
Q
A

A. Name: Temporalis
Action: Elevates mandible (also retrusion of mandible)
Innervation: Mandibular branch of trigeminal
Examination: Palpation during jaw clench

102
Q
A

A. Name: Sternocleidomastoid
Action: Head rotation to opposite side. (one side contracts) Lateral neck flexion (one side contracts) Neck flexion (both contract)
Innervation: Accessory nerve
Examination: Turn head against resistance (remember turn to right = left SCM!)

103
Q
A
104
Q
A

Head & neck (7 decks)

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