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Head And Neck > Session 1 - General Organisation of the Head and Neck > Flashcards

Session 1 - General Organisation of the Head and Neck Flashcards

0
Q

What are the borders of the posterior triangle?

A

Posterior border of sternocleidomastoid Anterior border of trapezius Lateral border of clavicle

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1
Q

What are the borders of the anterior triangle of the neck?

A

Inferior border of the mandible Anterior border of sternocleidomastoid Imaginary line in midline of neck

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2
Q

Name some of the contents of the posterior triangle:

A
  • Lymph nodes - Fat - Suprascapular nerve - Accessory nerve - External Jugular Vein - Trunks of brachial plexus
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4
Q

What are the four areas the anterior triangle can be further divided into?

A

Submental area Submandibular area Carotid area Muscular area

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5
Q

What are the borders of the submental triangle?

A

Anterior belly of digastric, hyoid bone and imaginary line in midline of neck.

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6
Q

What are the borders of the submandibular triangle?

A

Anterior and posterior bellies of the digastric muscle and the inferior border of the mandible.

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7
Q

What are the borders of the carotid triangle?

A

Posterior belly of digastric, superior belly of omohyoid muscle and the anterior border of stylocleidomastoid.

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8
Q

What are the borders of the muscular triangle?

A

The superior belly of omohyoid muscle, inferior portion of sternocleidomastoid and the imaginary line in the midline of the neck.

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9
Q

Name the prominent features of the hyoid bone:

A
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10
Q

At what level is the hyoid bone found?

A

C3

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11
Q

What is the function of the suprahyoid muscles?

A

Elevate the hyoid and larynx during swallowing.

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12
Q

What is the function of the infrahyoid muscles?

A

Depress the hyoid.

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13
Q

Name the suprahyoid muscles and give their origins and insertions.

A

Digastric - two bellies originates from the mandible and inserts (after meeting the hyoid bone) on the temporal bone.

Mylohyoid - from mandible to hyoid.

Stylohyoid - from styloid process of temporal bone to hyoid.

Geniohyoid - from mandible to hyoid

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14
Q

Name the infrahyoid bones and give their origin and insertions.

A

Thyrohyoid - From the thyroid cartilage to the hyoid bone.

Sternohyoid - From the posterior manubrium to the hyoid bone (border of the body and greater cornu)

Sternothyroid - From the posterior surface of the manubrium to the thyroid cartilage.

Omohyoid - has two bellies which is created by a fasical sling enabling the bellies to be at 90 degrees angles to each other. The omohyoid runs from the hyoid to the scapular

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15
Q

Give the origin, insertion, innervation and action of the trapezius muscle:

A

Origin: occipitaal protuberance, nuchal ligament, spinous porcesses of vertebrae C7 to T12

Insertion - Acromion, lateral clavicle and spine of scapula

Action: elevates, rotates and retracts scapula allows abduction of arm >90 degress.

Innervation: Accessory nerve (CNXI)

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16
Q

Give the origin, insertion, innervation and action of the sternocleidomastoid musce:

A

Origin: Mastoid process of temporal bone.

Insertion: Clavicular head - medial clavicle, Sternal head - manubrium of sternum

Action - rotation of the neck to the ipsilateral side and will raise head so it faces superiorly. If bilateral contraction flexion and extension of the neck.

Innervation: Accessory nerve (CNXI)

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17
Q

Give the origin, insertion, innervation and action of the platysmus muscles.

A

Origin - Inferior border of the mandible and the skin and subcutaneous fascia of the lower face. It is however deficient in the midline.

Insertion - fascia of pec major and deltoid muscles

Action - Draws corners of mouth inferiorlu and widens it (as in expression of sadness or fright)

Innervation - cervical branch of facial nerve - CNVII

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18
Q

What is the purpose of fascial planes?

A

They compartmentalise the neck allowing ease of movement by decreasing friction between the layers. They also determine the spread of infection.

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19
Q

List the layers of the neck:

A

Skin

Subcutaneous fat

Platysma muscles (anteriorly)

Deep investing layer

Pre-tracheal layer

Carotid sheath

Pre-vertebral layer

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20
Q

Name the different layers of the neck (according to colour) and what each layer contains:

A

White - skin

Yellow - subcutaneous fat - contains the platsyma muscle

Green - investing layer - contains the SCM and trapezius muscles and the submandibular and parotid salivary glands.

Purple - Pre-tracheal fascia - contains the trachea, oesophagus and thyroid

Orange (next to purple) - carotid sheaths - made from the fascia of both the pre-tracheal and pre-vertebral layers - contains common carotid artery, Internal Jugular vein, vagus nerve, deep cervical lymph nodes. CArotid sheaths are joined together by the alar fascia.

Orange layer (posteriorly) - pre-vertebral layer - surrounds of the muscles that surround the vertebra.

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21
Q

What is the retropharyngeal space and why is it important clinically?

A

This is the space between the alar fascia of the pre-vertebral fascia and the buccopharyngeal fascia (a superiro extension of the pre-tracheal fascia).

It is important clinically as infection can spread from this space into the anterior mediastinum.

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22
Q

Label the following diagram:

A

Yellow - hyoid bone

White bellow yellow - Thyrohyoid membrane

Blue - thyroid catilage

White below blue - cricothyroid ligament

Green - cricoid cartilage

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23
Q

Where does the right common carotid artery arise from?

A

Right brachiocephalic artery.

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24
Q

Where does the left common carotid artery arise from?

A

Direct from the aorta.

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25
Q

At what level does the common carotid bifurcate and what is this area known as?

A

At C4 - the superior margin of the thyroid cartilage. This area is known as the carotid triangle.

Note - the common carotids do not give off any branches in the neck.

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26
Q

Where is the carotid sinus found, what is it, and what is found there?

A

The carotid sinus is a dilation of the common carotid and internal carotid artery. They contain baroreceptors which are important for control of arterial blood pressure.

27
Q

Which nerve is the afferent for the baroreceptors?

A

Glossopharyngeal nerve (CN IX)

28
Q

What general areas does the external carotid artery supply?

A

Areas of the head and neck external to the cranium.

29
Q

Name the branches (including terminal branches) of the external carotid artery:

A

Superior thyroid

Lingual artery

**Facial artery **(supplies superfial structures)

Ascending pharyngeal artery

Occipital artery

Posterior auricular

**Superficial temporal **- Terminal branch (supplies superficial structures)

**Maxillary - **Terminal branch (supplies deep structures)

30
Q

Name the five arteries (and their origins) that provide a blood supply to the scalp:

A

Posterior auricular (external carotid)

Occipital (external carotid)

Superficial temporal (external carotid)

Supra-orbital (internal carotid)

Supratrochlear (internal carotid)

31
Q

Give the three reasons why bleeding from the scalp can be excessive:

A

Laceration of the scalp at the level of the aponurosis of the occipito-frontalis muscle will cause excessive bleeding as the two bellies of the muscle pull against each other - effecitively making the laceration larger.

The walls of the arteries are in closly bound to the connective tissue of the scalp and so are unable to vasoconstrict to prevent haemorrhage.

There are numerous anastomoses of the blood vessels so it is diffuclt to limit flow.

32
Q

Why is blood supply to the bony skull spared even if there is a laceration?

A

As the skull is supplied by the middle meningeal artery which is a branch of the maxillary artery - a deep structure

33
Q

What is the weakest point of the skull?

A

The pterion - the meeting point of four bones - temporal, frontal, parietal and sphenoid. Forming an H shaped suture.

34
Q

What is at risk of being damaged if there is a fracture in the region of the pterion and what is this likely to cause?

A

Damage to the middle meningeal artery - (usually supplies the skull and dura mater) and so an extradural haematoma will form - blood collects between the dura mater and the skull.

35
Q

What in general does the internal carotid supply?

A

Forehead

The brain

Eyes

36
Q

Describe the origin, course and destination of the vertebral arteries.

A

The vertebral arteries arise from the left and right subclavian arteries. They travel through the transverse processes of the vertebrae (foramen transversarium) and enter the cranial cavity via the foramen magnum.

They give rise to basilar arteries which supply the brain. There are no branches in the neck, or to extra-cranial structures.

37
Q

What arteries supply the neck?

A

Carotids do not supply the neck.

Right and left subclavian give rise to the thyrocervical trunk.

From this there are several vessels given off:

Inferior thyroid artery - supplies thyroid gland

Ascending cervical artery (from inferior thyroid) - supplies posterior prevertebrla muscles

Transverses cervical artery - supplies trapezius and rhomboid muscles

Suprascapular artery - posterior shoulder area

38
Q

Name the typical features of cervical vertebrae:

A

Bifid spinous processes

Foramen transversium

Triangular vertebral foramen

Small vertebral bodies

39
Q

Name the atypical cervical vertebrae and give the reasons why they are atypical.

A

C1 - atlas - no body or spinous processes. Have latera masses instead.

C2 -axis - has a dens - allows movement of neck from side to side (rotation on an axis)

C7 - no bifid process, large transverse process and small foramina transversium.

40
Q

What are the common causes of cervical pain?

A

Inflammed lymph nodes

Muscle strain

Displacement/protrusion of inter-vertebral discs

Chronic pain is caused often by bony abnormalities e,g, cervical osteoathritis

Local trauma

41
Q

Which vein is responsible for the majority of venous drainage of the face?

A

Facial vein - internal jugular vein

42
Q

Which veins drain into the external jugular vein?

A

Superficial temporal vein, maxillary vein and others.

43
Q

Where do the internal and external jugular veins drain into?

A

Subclavian vein.

44
Q

What is the difference between the skull and the cranium?

A

The skull includes all of the bones in the head, the crium involves all the bones that envelope the brain and includes all bones except the mandible.

45
Q

Name the bones of the skull:

A

Frontal, Temporal, Parietal, Occipital, Sphenoidal, Facial bones, mandible.

22 in total.

46
Q

Name some of the cavities of the skull:

A

Orbit

Cranial cavity

Nasal cavity

Para nasal sinuses

Oral cavity

Auditory canal

47
Q

What are the functions of the skull?

A

Enclose and protect the brain and other special sense organs.

Create a specialied environment

Site of attachement for muscles and openings.

48
Q

Name the sututres of the skull and the points where they meet.

A
49
Q

Describe the layers of the flat bone seen in the skull.

A

There are outer and inner tablet layers which are made of compact bone. The inner diploe is made of trabecular bone.

50
Q

Name the bones involved in the following parts of the cranial floor:

Anterior fossa

Middle fossa

Posterior fossa

A

Anterior fossa: Frontal bone, ethmoid bone

Middle fossa: Sphenoid bone, temporal bone

Posterior fossa: Occipital bone

51
Q

Name some of the contents entering the cranium

A

Venous blood (in some sections)

Infections

Arterial supply to brain and meninges

Sensory nerves

Sympathetic fibres

52
Q

Name some of the contents leaving the cranium.

A

Venous supply

Cranial nerves (motor)

Parasympathetic outflow

Lymphatics

Infections

53
Q

For the following bones name the structures they make up and their key features.

Frontal bone, ethmoid bone, sphenoid bone, parietal bone, occipital bone

A

Frontal bone - forms the roof of the cranium and the orbit. Also forms the upper margin of the orbit.

Ethmoid bone - found in the midline of the anterior cranial fossa. Allows passge of the olfactory nerves. Cribifrom plate with the crista gali a prominence in the centre.

Sphenoid bone - makes up the orbit and is formed of a central body with greater and lesser wings.

Pariteal bone - makes up the majority of the lateral and roof of the cranial cavity. On its inner surface has a groove for MMA.

Occipital bone - makes up the posterior aspect of the cranial cavity and surrounds the foramen magnum.

54
Q

Name the labelled parts of the temporal bone.

A
  1. Squamous part
  2. Mastoid process
  3. Tympanic membrane
  4. Styloid Process
  5. Zygomatic process
  6. Petrous part
55
Q

What are some on the differences between a newborn and adult skull?

A

In the newborn the sutures have not completely formed yet and there are gaps between the bones held together by a thick connective tissue matrix, called a fontanelle.

This allows the bone to moves. During birth the sutures lock together to protect the brain.

56
Q

Name the bones of the face:

A
57
Q

What is a countercoup fracture?

A

A fracture that occurs on the opposite side of the cranium to where the impact occured.

58
Q

Name and describe the four types of skull fracture:

A

Simple - a break in the bone without a break in the skin.

Linear - A think line that does not splinter or isnt depressed or distorted.

Depressed - the bone is pushed towards the brain

Compound - result in a break in the skin and splintering of the bone accompanied by brain injury and bleeding.

59
Q

Give some of the symptoms of a skull fracture:

A

Bleeding for the wound, ear, nose or around the eyes.

Bruising

Draining of CSF from ears or nose

Swelling, Confusion, Convulsions, diffulties balancung, drowsiness, headache, loss of consciousness, nausea, vomiting, visual disturbance, stiff neck and slurred speech,

60
Q

What is a Jefferson/Burst Fracture?

A

A fracture of the lateral masses of the C1 vertebrae and can cause damage to the transverse ligament.

Occurs due to a head first fall from a height - onto an extended neck.

There may or may not be damage to the spinal cord.

61
Q

What is a Hangman’s Fracture?

A

Damage to the interarticularis area between superior and inferior facets.

Results from rapid hyperextension of the neck

Ruptures the spinal cord

62
Q

What is a fracture of the dens?

A

Fracture of the dens process on C2.

Results from a horizantal blow to head e.g. during traffic collision.

Patient can’t rotate head.

May sheer basal artery and lead to haematoma

63
Q

Explain what whiplash injury is:

A

Severe hyperextension of the neck.

Can result in tearing of the anterior and posterior longitudinal ligaments, fracture of cervical spinous processes, disc rupture or neck muscle and blood vessel injuries.

Head And Neck (8 decks)

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