Session 1: General Organisationn

Question 1

what is fascia?

Answer 1

Connective tissue found throughout the body.
Is of mesenchymal origin
Functions: enveloping organs, separating body tissues, forming compartments between tissues and binding tissues of body together

Question 2

What are the 2 main classes of fascia in the neck?

Answer 2

Superficial (loose connective tissue) and Deep (dense irregular)

Question 3

What are the layers of the deep cervical fascia?

Answer 3

Investing layer
Pretracheal layer
carotid sheath
prevertebral layer

Question 4

What do you understand by the term “potential space” as it apples to fascial planes of the neck?

Answer 4

Adjacent fascial compartments of the neck are normally close to one another as to be adherent, Normally there are no anatomical spaces. However if there is blood or pus in the neck it can collect in between fascial planes thereby creating “potential spaces”

Question 5

What is the anatomical importance of the fascia in the neck?

Answer 5

It envelopes organs in the neck, separating them to that they can move against each other.
Structural organisation of tissues
Usually contains infections within fascial compartments

Question 6

What is the difference between the retropharyngeal space and the danger space?

Answer 6

Retropharyngeal space is posterior to the pretracheal layer. Extends from base of skull to a variable position between T1-T6. It is anterior to the danger space.
The danger space is a potential space posterior to the retropharyngeal space. It connects inferiorly to the mediastinum at the diaphragm, meaning infections can spread from pharynx to the mediastinum.

Question 7

Why is the knowledge of the fascia of the head and neck clinically important?

Answer 7

Enables us to understand how infections and metastases might spread from one site to another. There are many structures within the neck and its important to known the anatomical relations especially when considering trauma or intervention (e.g. internal jugular vein cannulation) to this region.

Question 8

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

Answer 8

Anterior border: median line of the neck
posterior border: anterior margin of the sternocleidomastoid muscle
Superior: The inferior border of the mandible

Question 9

What are the boundaries of the posterior triangle

Answer 9

Anterior Border: Posterior border of the SCM
Posterior border: Ant border of trapezius
Superior border: middle 1/3 of clavicle

Question 10

Why might it be useful to view the neck as territories of triangles?

Answer 10

Enables an organised approach to the anatomical structures in the neck
Allows structured examination and description of tissues in the neck

Question 11

What can the anterior triangle be split into?

Answer 11

Submental triangle
Submandibular triangle
Carotid triangle
muscular triangle

Question 12

What can the posterior triangle be split into?

Answer 12

Occipital triangle

Subclavian triangle

Question 13

In new born babies, how and why might the SCM muscle be damaged?

Answer 13

In forceps delivery, the SCM muscle is at risk of trauma due to compression damage or being pulled during a difficult birth.

Question 14

How would a person with a dystonic SCM muscle present?

Answer 14

With a head tilt and rotation.
The tilt is ipsilateral (same side of body) to the lesion. The rotation of the chin is to the contralateral side due to the origin and insertion of the SCM.
Such a presentation is known in neurology as torticollis

Question 15

What is the motor innervation of the stercleidomastoid?

Answer 15

Spinal accessory nerve CNXI

Question 16

What is the difference between the viscerocranium and the neurocranium?

Answer 16

The viscerocranium is the part of the skull known as the facial skeleton. It contains 14 bones
The neurocranium includes the skull base i.e. fossae and the calvaria. Consists of 8 cranial bones. The cranium is the part of the skull that houses the brain.

Question 17

Which are the most important muscles of facial expression?

Answer 17

The sphincters of the face (Orbicularis oris and orbicularis oculi)
Contribute to expression and are anchors into which the majority of the other small muscles attach.
Orbicularis oculi also aids in the protection of the cornea
Loss of Orbicularis oris may lead to drooling and is commonly seen in facial nerve palsy (Bell’s Palsy)

Question 18

Which nerves provide sensory innervation to the face and neck?

Answer 18

Branches of the 3 divisions of the trigeminal nerve. Cutaneous branches of the cervical nerves from the cervical plexus

Question 19

How could a parotid gland carcinoma cause weakness in the face?

Answer 19

The facial nerve enters the parotid gland. It then divides into its extracranial branches. This would cause weakness of the muscles innervated by the respective branches of the nerve .

Question 20

Why would someone with a carcinoma of the parotid gland may experience difficulty in playing the trumpet?

Answer 20

The innervation of the buccinators muscle is supplied by the buccal branch of the facial nerve. The tumour may damage this branch

Question 21

Why is the patient’s weakness of the face likely to be permanent?

Answer 21

Carcinoma of the parotid gland would most likely affect the facial nerve and its branches leading to permanent damage to the nerve fibres travelling through the gland.