Session 1 Flashcards
Structures in the neck are compartmentalised by layers of cervical fascia. Starting most superficially, what are the 5 layers?
1) superficial cervical fascia
2) investing layer
3) pretracheal layer
4) prevertebral layer
5) carotid sheath
(Note 2-5 are considered deep cervical fascia)
Name two contents within the superficial cervical fascial layer
Superficial blood vessels such as anterior and external jugular veins/platysma muscle/cutaneous nerves/superficial lymph nodes
Name two contents within the investing layer
Sternocleidomastoid/trapezius/submandibular glands/parotid glands
Name some contents within the pretracheal layer
Infrahyoids/thyroid gland/trachea/oesophagus
Be able to draw and label a cross section of the neck and layers etc
T
The pretracheal layer lies anterior on the neck in a cross sectional view. Posteriorly it runs to invest the muscles of the pharynx (throat) and oesophagus, here the layer is known as what?
Buccopharyngeal fascia
What are the main components within the carotid sheath?
Common carotid artery/internal jugular vein/vagus nerve (X)
Name some contents of the prevertebral layer
Axillary blood vessels/brachial plexus/prevertebral muscles
The are some neck spaces between fascial planes called deep neck spaces, abscesses/infections here can be deadly. These spaces allow for movement normally. The retropharyngeal space in particular allows the oesophagus to distend during swallowing. What complication can retropharnygeal infections cause though?
Mediastinitis (spread to the thorax and mediastinum)
Retropharyngeal infections are most common in children under 5. Give some symptoms of a retropharyngeal abscess
Young age Bulge in throat Sore throat Difficulty swallowing Stridor (High pitched breath sound) Stiff neck Fever
When looking at neck lumps we can ask a patient to swallow, if the lump moves we know that pathology is linked to the thyroid and this is in turn linked to the hyoid bone. Severe thyroid goitre can lead to tracheal compression causing stridor and facial oedema because of compression of the venous drainage of the neck
T
What muscle is used to raise the eyebrows?
Occipitofrontalis
What muscle is used to smile?
Risorius
What muscle is used to puff out the cheeks?
Buccinator
Branches of which nerve inner age all the muscles of facial expression including the platysma?
Facial (CN VII)
Which gland does the facial nerve penetrate upon exit of the skull?
Parotid, this surgery on this gland can cause facial muscle weakness
Patient presents with weakness of facial muscles on one side in association with an ipailateral enlarged parotid gland
Parotid cancer
Note - it is rare for mumps and benign conditions to damage the facial nerve
All muscles of mastication act on which joint?
Temporomandibular joint (TMJ)
Which nerve supplies the muscles of mastication?
Mandibular branch of the trigeminal nerve (CN Viii)
What are the muscles of mastication?
Masseter/temporal is/lateral and medial pterygoids
Which muscles depress the mandible (open the jaw)
Suprahyoids/lateral pterygoid (think laaaaaa)
What are the actions of the muscles of mastication except the lateral pterygoid?
Elevate the mandible (close the jaw)
What are the functions of the scalene muscles?
Accessory muscles to respiration
What important structures pass between the anterior and middle scalene muscles?
Brachial plexus and subclavian artery
The deep cervical nodes are closely related to the carotid sheath and in particular the internal jugular vein. The jugulo-digastric lymph node drains the palatine tonsil, mouth and Young’s. what common condition is it swollen in?
Tonsillitis
The branches of the facial nerve can be remembered by the mnemonic ‘5 zebras bought my car’ and placing a hand on the face to see the terminal branches. What are these branches?
Temporal Zygomatic Buccal Marginal mandibular Cervical
What are the three branches of the trigeminal nerve?
Opthalmic/maxillary/mandibular
Note the dermatomal regions of these
Is the trigeminal nerve sensory, motor or mixed?
Mixed - sensory dermatomes. Motor branch for muscles of mastication
The common carotid artery is the main blood supply to the neck. At what level does it branch?
C4
Which artery is the facial artery a branch of?
The external carotid artery
Which runs more superficially the external or internal jugular vein?
External
Which vein is the main vein draining the head and neck?
Internal jugular vein
Which nerve supplies the following muscles?
A) platysma
B) sternocleidomastoid
C) trapezius
A) facial nerve (platysma is a muscle of facial expression)
B) Accessory nerve
C) accessory nerve
What are the borders of the anterior triangles?
Base of mandible/mid-Sagittal line/Anterior border of SCM
What are the borders of the posterior triangle of the neck?
Anterior border - posterior border of SCM
Posterior border - anterior border of trapezius
Base - middle third of clavicle
Floor - scalene muscles
Generally structures in the anterior triangle are associate with head and thorax. Whereas structures in posterior triangle are associated with?
Upper limb and neck
What are the actions on the suprahyoids?
Elevate the hyoid and depress the mandible
What are the actions of the infrahyoids?
Depress and stabilise the mandible
Give an example of a suprahyoids and an infrahyoids
Suprahyoid - digastric
Infrahyoid - omohyoid
What are the borders of the carotid triangle?
Laterally - SCM
Medially - superior belly of omohyoid
Superiorly - posterior belly of digastric
Give three roles of the lymphatic system
1) remove excess fluid from interstitial space
2) return proteins and pathogens to the venous system
3) role in immune defence and surveillance
Lymphadenopathy (swollen lymph nodes) are a common cause for a neck lump. If it is caused by an infection is the lump more likely tender and mobile or hard and non-tender?
Tender and mobile
Hard and non mobile would suggest a malignancy
Exception is a lymphoma - hallmark signs of this are that it’s extremely fast growing and ‘rubbery’
Give three things to do in a case of a lymphadenopathy
1) comprehensive history
2) examine the area of tissue the node drains
3) if malignancy suspected examine other lymph nodes and body systems
Superficial nodes are within the investing layer. deep nodes are mainly associated with what?
The internal jugular vein in the carotid sheath to which they often drain
Name the 8 superficial cervical lymph nodes - be able to show the territories that they drain on an image
1) submental
2) submandibular
3) preauricular
4) postauricular
5) occipital
6) superficial cervical
7) posterior cervical
8) anterior cervical
Name the three deep cervical lymph nodes. Suggest a cause of each swelling
Jugulo-digastric - commonly tonsillitis
Jugulo-omohyoid - oesophageal cancer
Supraclavicular lymph nodes - stomach/GI cancers
Swellings on the lip and tip of tongue are likely to drain to which node?
Submental
What are the functions of the:
a) suprahyoids
b) infrahyoids
a) elevate the hyoid and depress the mandible
b) depress the hyoid and stabilise it
What levels are the following at?
thyroid cartilage - C4
Cricoid cartilage - C6
Thyroid gland - C5-T1 (isthmus is at C7)
at what cervical level do the trachea and oesophagus start at?
C6
State the contents of the carotid sheath
common carotid and internal carotid/IJV/vagus nerve/Deep cervical lymph nodes
name a structure which might drain directly to a deep cervical lymph node
posterior tongue/thyroid/larynx (anything deep to investing layer - and posterior tongue)
The orbital part of ot he orbicularis oculi forces the eye shit tightly whereas the palpebral part does it gently like when sleeping T/F?
T
List some contents of the pretracheal fascia
pharynx/oesophagus/thyroid/infrahyoids
