Session 1 Head & Neck Flashcards
What are the muscles of mastication and there cranial nerve ?
Masseter
Medial and Lateral Pteygoid
Temporalis
Nerve : Trigeminal Nerve
Branches of the mandibular
What are the boundaries of the anterior triangle of the neck ?
Anterior - midline of neck
Posterior - anterior border of SCM
Superior - inferior margin of the mandible
What are the Branches of the facial nerve?
Temporal Zygomatic Buccal Mandibular Cervical
What are the muscles of facial expression and nervous innervation ?
Occipitofrontalis- raises eyebrows and wrinkles the forehead
Orbicualris oris - closes the mouth , purses the lips
Orbicualris occuli - closes the eyes
Buccinator - pushes the cheek against the mouth and retracts the angle of the mouth
Zygomaticus - smiling, laughing and pushing out cheeks
Nasalis - opening and closing nostrils
Risorius - grinning
Platysma- depresses mandible and the angle of the neck
Nerve : facial nerve branches
What is the action of levator palpebrae superior ?
Keeps eyes open
Innervation by the occipital nerve.
Problems result in ptosis (unapposed closing of the eye)
What is the significance of the palperbral part of orbicualris occuli?
This is not under voluntary control and keeps eyes closed when you are sleeping or normal blinking.
Orbital part of muscle is under voluntary control
What are the borders of the posterior triangle of the neck?
Anterior border- posterior border of SCM
Posterior border - anterior border of trapezius
Inferior - clavicle
Describe fucntion and location of the SCM ?
From: the mastoid process
To : clavicle and sternum
Unilateral action : turns the head to one side and chin superiorly when you contract left hand side the head moves to the right
Bilateral action :flexion at the neck and extension of the atlantooccipital joint
Nerve : Accessory nerve
Describe function of trapezius and innervation ?
From : base of skull, nucchal ligament, and spinous processes
To : Lateral 1/3 of clavicle, spine of scapula and the acromion
Function : (movements of scapula) extending the cervical spin.
Extension, Lateral flexion and rotation of atlantoocciptial and atlantoaxial neck
Nerve : accessory nerve
How would a patient with dystonic SCM Present?
Dystonia- state of abnormal muscle tone resulting in musclular spasm and abnormal posture
Dystonia would cause tilt/ rotation to one direction .
The tilt would be ipsilateral to the SCM effected causing rotation of the chin to the contralateral side.
This is called torticollis
Newborns : congential muscular torticollis
What is the major sensory nerve of the face and scalp ?
Trigeminal
Three branches :
Opthalmic
Maxillary
Mandibular
What is the nerve responsible for being able to taste?
Facial nerve
What are the layers of fascia in the neck?
Superficial layer - loose connective tissue ( platysma and EJV are here)
Deeper layers :
1) Investing layer: Trapezius, SCM, Parotid and Submandibular gland.
2) Pre tracheal layer : Trachea, pharynx, the infrahyoid muscles, oesophagus, larynx
3) carotid sheath : common carotid artery, IJV, Vagus nerve , deep cervical lymph nodes
4) pervertebral layer : vertebral column and muscles
What is the retropharyngeal space?
Bordered anteriorly by the pretracheal (buccopharyngeal) fascia and posteriorly by the pre vertebral fascia.
Split in the middle by ala fascia which splits the area into anterior (true space) : this ends at T1- T6 and the posterior (danger) space.
Danger space infections can lead to mediastinitis.
What is the trajectory of the facial nerve ?
Nerve will travel through the parotid gland.
Parotitis can effect the nerve.
How do you detect a lump in the thyroid gland?
When the patient swallows the lump will also move, as the pretracheal fascia is attached to the hyoid bone.
What are retropharyngeal infections?
The danger space will extend to the diaphragm.
Classically more common in children : lymph nodes are present here.
Any upper respiratory infection can ultimately cause it.
Complications :abscess , sepsis , asphyxiation penumoniae, erosion of b/v, bone and organs.
What are the layers of the scalp?
Skin & subcutaneous fascia Dense connective tissue Epicranial aponeurosis Loose connective tissue - danger zone Periosteum
Why does the scalp bleed profusely ?
Bleeds as :
Many anastomoses of b/v
Connective tissue maintains the patency of the lacerated b/v
If laceration penetrates the aponeurosis this is even worse
But middle meningeal artery prevents avascular necrosis
What are the main blood vessels of the scalp?
Superficial temporal (From ECC)
Posterior auricular
Occipital
Supratrochlear (from ICC)
Supraorbital
What are the key features of the cervical spine (typical) vertebrae?
Bifid spinous process
Body shaped concave superiorly and inferiorly
Transverse foramina (conduct the vertebral arteries, veins & nerves)
Large vertebral foramen
Horizontally aligned articular processes
What are the features of C1?
Lateral masses articulate with the occipital condyles
Posterior and anterior arch
No vertebral body
No spinous processes
Odd shaped foramen (narrower anteriorly and wider posteriorly)
Posterior arch has a groove for the vertebral artery.
What are the key features of C2?
Dens (remnant of the body of the C1)
Large spinous process
This is the strongest of the cervical vertebrae.
What are the key features of C7?
Vertebrae prominens
No bifid spinous process
Transverse foramina only has the accessory vertebral veins
What is cervical spondylosis?
Cervical spondylosis
• Degenerative osteoarthritis of intervertebral joints in cervical spine
• Pressure on nerve roots leads to radiculopathy:
Dermatomal sensory symptoms: paraesthesia, pain
Myotomal motor weakness
• Pressure on the cord leads to myelopathy (less common):
(Global weakness,Gait dysfunction, Loss of balance & Loss of bladder and bowel control)
What injuries does hyperextension of the neck cause?
Hyperextension causes :
Hangmans fracture : fracture of the C2 within the pars interarticularis area, the pedicles; C2& C1 will move anteriorly on C3.
Peg fracture (dens)
Rupture of the transverse ligament
Tearing of the anterior longitudinal ligament (prevents hyperextension)
What injuries does hyperflexion cause?
Tearing of the supraspinous ligament
Effects the lower cervical vertebrae
Vertebral body fracture
What is a Jeffersons fracture?
This is a fracture of the C1, a burst fracture, where regions of the posterior and anterior arch are broken.
What movements occur at the atlantooccipital and the atlantoaxial joint?
Atlantooccipital - nodding of the head
Atlantoaxial - rotation of the head
