Session 1.1a - Pre-Reading

Question 1

What does the head consist of?

Answer 1

The scalp, skull, brain and its coverings (the meninges).

Question 2

What covers the brain?

Answer 2

The meninges

Question 3

Name 5 sense organs that our head houses senses for.

Answer 3

The head houses our special sense organs for taste, vision, olfaction (“smell”), hearing and balance.

Question 4

What does “olfaction” mean?

Answer 4

Smell

Question 5

Where do cranial nerves arise from?

Answer 5

The central nervous system (mainly the brainstem).

Question 6

What do cranial nerves innervate?

Answer 6

Structures of the head and neck.

Question 7

What is the route of cranial nerves?

Answer 7

They course through the skull to reach their target tissues.

For some nerves, this includes whole or part of the length of the neck.

Question 8

Where do blood vessels that supply the head and neck structures arise from or drain into?

Answer 8

Branches of large arteries (common carotids) and veins (subclavian veins).

Question 9

Which arteries and veins do the vessels supplying the structures of the head and neck arise/drain into?

Answer 9

Arteries - common carotids

Veins - subclavian veins

Question 10

Where do the common carotids and subclavian veins travel?

Answer 10

These ascend and descend up and down through the neck from and to the thorax, in close proximity to the thyroid gland, aerodigestive tracts, muscles and cervical vertebrae.

Question 11

Where do the common carotids and subclavian veins travel in close proximity to?

Answer 11

The thyroid gland, aerodigestive tracts, muscles and cervical vertebrae.

Question 12

How much area does the head and neck anatomy (blood vessels) take up?

Answer 12

In essence, there is a lot of anatomy packed into a space similar in circumference to your leg!

Question 13

Where does the neck extend from?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 13

The LOWER MARGIN OF THE MANDIBLE (jaw) to the SUPRASTERNAL NOTCH OF THE MANUBRIUM and the UPPER BORDER OF THE CLAVICLE below, connecting the head to the rest of the body.

(Self-Note: the top of the neck is the mandible, the bottom is the suprasternal notch (visible dip between neck and two collarbones) and the sides connect from the mandible to the upper border of the clavicle)

Question 14

How are structures in the neck compartmentalised?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 14

By layers of CERVICAL FASCIA

Question 15

What are the cervical fascia layers?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 15

Broadly speaking:

• a SUPERFICIAL CERVICAL FASCIA layer (just below the skin)
• three DEEP CERVICAL FASCIAL layers.

Question 16

What type of tissue is the superficial cervical fascial layer?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 16

Loose connective tissue

Question 17

What does the superficial cervical fascial layer mainly contain?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 17

Adipose

Question 18

What are some of the superficial blood vessels of the neck (found in the superficial cervical fascial layer?)

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 18

ANTERIOR and EXTERNAL JUGULAR VEINS

Question 19

What else, other than blood vessels, lie within the superficial cervical fascial layer?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 19

• Cutaneous nerves
• Superficial lymph nodes
• PLATYSMA muscle

Question 20

What are the three layers of deep cervical fascia?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 20

From most superficial to deep, you have the:

• INVESTING LAYER
• PRETRACHEAL LAYER (middle)
• PREVERTEBRAL LAYER (deep).

Question 21

Cervical Fascial Layers: Variation in Terminology Used

What is the first layer of the deep cervical layers and its compartments often described as?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 21

Most anatomy texts will refer to this as the INVESTING LAYER.

The carotid sheath is normally known as the carotid sheath.

Question 22

Cervical Fascial Layers: Variation in Terminology Used

What is the pretracheal fascia sometimes known as (and what does it include)?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 22

The pretracheal fascia (including that which encloses the infrahyoid muscles and its buccopharyngeal fascia component) is sometimes described collectively as the ‘MIDDLE LAYER’ OF DEEP CERVICAL FASCIA (relating to its position if you were approaching from the front of the neck, from superficial to deep).

Question 23

Cervical Fascial Layers: Variation in Terminology Used

What is the prevertebral fascia sometimes described as?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 23

The ‘DEEP LAYER’ of deep cervical fascia (relating to its position if you were approaching from the front of the neck, from superficial to deep).

Question 24

How is the investing layer of the deep cervical fascia organised?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 24

The INVESTING LAYER of the DEEP CERVICAL FASCIA is the MOST SUPERFICIAL of the DEEP cervical fasciae and surrounds the entire neck like a collar.

Question 25

What is the first thing you should encounter when you dissect the neck?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 25

The investing layer should be the immediately visible fascial layer.

Question 26

Where does the superior margin of the investing layer attach?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 26

Its superior margin is attached on each side to the entire lower border of the mandible (midline to angle), the mastoid process, the superior nuchal line and the external occipital protuberance in the posterior midline.

Question 27

Where does the investing layer attach to posteriorly?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 27

The spinous processes of the vertebrae and ligamentum nuchae.

Question 28

Where does the investing layer attach to inferiorly?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 28

The upper border of the manubrium, the upper surface of the clavicle, acromion and spine of the scapula.

Question 29

Why does the investing layer split?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 29

To enclose the STERNOCLEIDOMASTOID and TRAPEZIUS MUSCLES, and the SUBMANDIBULAR and PAROTID SALIVARY GLANDS.

Question 30

Describe the middle layer of the deep cervical fascia in size and location.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 30

The PRETRACHEAL LAYER is thin and limited to the anterior and lateral part of the neck.

Question 31

What is the pretracheal layer attached to superiorly and anteriorly?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 31

The hyoid bone

Question 32

What is the pretracheal layer attached to inferiorly?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 32

It EXTENDS INTO THE THORAX where it BLENDS WITH THE FIBROUS PERICARDIUM.

Question 33

What does the pretracheal layer enclose?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 33

It consists of a muscular layer enclosing THE INFRAHYOID MUSCLES and a visceral layer, which encloses the THYROID GLAND (splitting around this to form a FALSE capsule), TRACHEA and OESOPHAGUS.

Question 34

What two layers does the pretracheal layer consist of?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 34

A muscular layer and a visceral layer

Question 35

What does the muscular layer of the pretracheal layer enclose?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 35

THE INFRAHYOID MUSCLES

self-note: also known as strap muscles

Question 36

What does the visceral layer of the pretracheal layer enclose?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 36

The THYROID GLAND, TRACHEA and OESOPHAGUS

Question 37

How does the pretracheal layer enclose the thyroid gland?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 37

Its [the pretracheal layer] visceral layer splits around the thyroid gland to form a FALSE capsule.

Question 38

Part of the pretracheal fascial layer continues posteriorly to invest the muscles of which two organs?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 38

(The muscles of) the pharynx and oesophagus

Question 39

The part of the pretracheal fascial layer (which continues posteriorly to invest the muscles of the pharynx and oesophagus) blends with what?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 39

The BUCCOPHARYNGEAL FASCIA

Question 40

What is the buccopharyngeal fascia?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 40

FASCIA ASSOCIATED WITH THE PHARYNX AND OESOPHAGUS

Question 41

Where does the buccopharyngeal layer run to and from (i.e. where does it begin and end superiorly and inferiorly)?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 41

From the BASE OF THE SKULL superiorly, and to the DIAPHRAGM inferiorly

Question 42

Where does the buccopharyngeal layer begin superiorly?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 42

The BASE OF THE SKULL

Question 43

Where does the buccopharyngeal layer end inferiorly?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 43

The DIAPHRAGM

Question 44

What is the carotid sheath?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 44

The CAROTID SHEATH is a tubular, fibrous structure that extends from the base of the skull through the root of the neck to the arch of aorta.

Question 45

Where does the carotid sheath extend to and from?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 45

The base of the skull, through the root of the neck, to the arch of aorta

Question 46

Where does the carotid sheath begin superiorly?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 46

The base of the skull.

Question 47

Where does the carotid sheath run through?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 47

The root of the neck (between the base of the skull and arch of aorta)

Question 48

Where does the carotid sheath end inferiorly?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 48

The arch of aorta

Question 49

What is inside the carotid sheath?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 49

It contains a number of structures, including but not limited to:

• the COMMON CAROTID ARTERY
• INTERNAL JUGULAR VEIN
• VAGUS NERVE [CN X] which is a cranial nerve [CN]

(Self-Note: CN X = 10th cranial nerve)

Question 50

What is the major artery found inside the carotid sheath?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 50

The COMMON CAROTID ARTERY

Question 51

What is the major vein found inside the carotid sheath?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 51

The INTERNAL JUGULAR VEIN

Question 52

What is the major nerve found inside the carotid sheath?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 52

The VAGUS NERVE [CN X] (which is a cranial nerve [CN])

Question 53

How are the structures of the neck compartmentalised?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 53

By a series of fascial layers

Question 54

What is the deepest (or innermost) layer of the deep cervical fascia called?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 54

The PREVERTEBRAL layer

Question 55

What does the prevertebral layer do?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 55

Forms a sheath for the vertebral column and muscles associated with it

Question 56

Where does the prevertebral layer extend from?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 56

The base of the cranium to the 3rd thoracic vertebra

Question 57

Where does the prevertebral layer extend from superiorly?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 57

The base of the cranium

Question 58

Where does the prevertebral layer extend from inferiorly?

Answer 58

The 3rd thoracic vertebra

Question 59

The prevertebral layer extends laterally to form what?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 59

The AXILLARY SHEATH

Question 60

The axillary sheath surrounds which structures?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 60

The AXILLARY VESSELS and the BRACHIAL PLEXUS OF NERVES running into the upper limb.

Question 61

(Clinical Correlate: Deep Cervical Fasciae and Infection)

Why might having layers of deep cervical fascia be important functionally?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 61

The layers of DEEP CERVICAL FASCIA form NATURAL CLEAVAGE PLANES that allow structures to move and pass over one another with easy

Question 62

Cervical Fasciae and Infection)

Why might knowing the layers of deep cervical fascia be important in surgery?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 62

The layers of DEEP CERVICAL FASCIA form NATURAL CLEAVAGE PLANES that allow easy separation of tissues during surgery.

Question 63

Cervical Fasciae and Infection)

Why might having a knowledge of the layers of deep cervical fascia be important in disease?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 63

The fascial layers determine the DIRECTION AND EXTENT to which any INFECTION occurring within the neck may spread.

Question 64

Cervical Fasciae and Infection)

Give 3 points as to why the layers of deep cervical fascia are important to know physiologically or clinically.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 64

The layers of DEEP CERVICAL FASCIA form NATURAL CLEAVAGE PLANES that

1) allow structures to move and pass over one another with ease
2) allow easy separation of tissues during surgery.

They also
3) determine the DIRECTION AND EXTENT to which any INFECTION occurring within the neck may spread.

Question 65

The fascial compartmentalisation of structures in the neck is important for what?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 65

This means they can give rise to potential SPACES BETWEEN FASCIAL PLANES.

Question 66

What do the deep neck spaces (between the fascial planes) contain?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 66

Loose connective tissue, so they are not technically “empty” spaces.

Question 67

What might cause a fascial “space” (between fascial planes) to distend?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 67

Infection or an abscess can arise between the fascial planes causing these “spaces” to distend (DEEP NECK SPACE INFECTIONS).

Question 68

What would an infection or an abscess arising between the fascial planes do to the “spaces” in between?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 68

It would cause them to distend

Question 69

What are deep neck space infections?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 69

DEEP NECK SPACE INFECTIONS are an infection or an abscess arising between the fascial planes, causing the “spaces” in between them to distend.

Question 70

How do deep neck space infections occur?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 70

The infective SOURCE often originates in the teeth, tissues of the pharynx, sinuses or middle ear, and spreads.

Question 71

Name 4 common locations of sources of deep neck space infections.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 71

• The teeth
• Tissues of the pharynx
• Sinuses
• Middle ear

(which then spread to produce deep neck space infections)

Question 72

Why is it important for doctors to be aware of deep neck space infections?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 72

Although RARE, they pose significant risk to life, which means it is important for doctors to be aware of how they presents and the risks they pose.

Question 73

What is the retropharyngeal space?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 73

The RETROPHARYNGEAL SPACE is a DEEP NECK SPACE which lies between the PREVERTEBRAL LAYER OF FASCIA and the FASCIA SURROUNDING THE PHARYNX AND OESOPHAGUS (BUCCOPHARYNGEAL FASCIA).

Question 74

Give an example of a deep neck space.

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 74

The RETROPHARYNGEAL SPACE

there are others

Question 75

What is the space between the prevertebral layer of fascia and the fascia surrounding the pharynx and oesophagus (buccopharyngeal fascia) called?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 75

The RETROPHARYNGEAL SPACE

Question 76

Up until the age of 3-4 years, the superior part of the retropharyngeal space contains what?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 76

LYMPH NODES, WHICH DRAIN AREAS OF THE NOSE, ORAL CAVITY AND UPPER PHARYNX.

Question 77

The superior part of the retropharyngeal space contains lymph nodes until what age?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 77

3-4 years

Question 78

Which part of the retropharyngeal space contains lymph nodes (up until the age of 3-4 years)?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 78

The superior part

Question 79

The superior part of the retropharyngeal space contains lymph nodes (up until the age of 3-4 years), which drains which 3 areas?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 79

• THE NOSE
• ORAL CAVITY
• UPPER PHARYNX

Question 80

The retropharyngeal space allows which organ to move freely on the vertebral column and expand during swallowing?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 80

The pharynx

Question 81

Give two functions that the ‘space’ [retropharyngeal space] between fascial planes allows the pharynx to do.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 81

• Move freely on the vertebral column

- Expand during swallowing

Question 82

The retropharyngeal space lies between fascial layers that extend the length of the neck, into where?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 82

The mediastinum

Question 83

Retropharyngeal infections may spread inferiorly into the thorax. How?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 83

The retropharyngeal space lies between fascial layers that extend the length of the neck, into the mediastinum, so infections may travel here.

Question 84

Retropharyngeal infections may spread inferiorly, where?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 84

Into the thorax and mediastinum

Question 85

Retropharyngeal infections may lead to the development of which condition?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 85

Mediastinitis (rare, but life-threatening condition)

https://emedicine.medscape.com/article/425308-overview

Question 86

What is a complication of retropharyngeal infections?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 86

The development of mediastinitis (because the retropharyngeal space extends into the mediastinum)

Question 87

What is mediastinitis?

Topic: Organisation of Neck Structures by Cervical Fascial Planes

Answer 87

A rare, but life-threatening condition.

https://emedicine.medscape.com/article/425308-overview
Self-Note: See additional notes!

Question 88

(Clinical Correlates: Retropharyngeal Space Infections)

What can develop from a retropharyngeal space infection?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 88

Retropharyngeal abscess

Question 89

(Clinical Correlates: Retropharyngeal Space Infections)

What age group do retropharyngeal abscesses normally affect?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 89

Children under 5 years

Question 90

(Clinical Correlates: Retropharyngeal Space Infections)

Name two factors of common neck presentations in patients with retropharyngeal abscesses

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 90

History of stiff neck, e.g. for a couple of days

Hesistant to turn their neck left or right

Question 91

(Clinical Correlates: Retropharyngeal Space Infections)

Do patients with pharyngeal abscesses have fever?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 91

They often present with a high temperature, but can be afebrile (no fever)

Question 92

(Clinical Correlates: Retropharyngeal Space Infections)

What does afebrile mean?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 92

No fever

Question 93

(Clinical Correlates: Retropharyngeal Space Infections)

In patients with retropharyngeal abscesses, will their oral intake be affected?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 93

It will often be decreased, such as the patient only wanting to drink liquids, because they may have difficulty swallowing

Question 94

(Clinical Correlates: Retropharyngeal Space Infections)

What does PO mean?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 94

Per os (oral)

i.e. “decreased PO intake” = decreased oral intake

Question 95

(Clinical Correlates: Retropharyngeal Space Infections)

Will retropharyngeal abscesses cause any symptoms in relation to the patients’ mouth?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 95

The patient may have problems with keeping saliva in their mouth, which can be shown visibly by drooling

Question 96

(Clinical Correlates: Retropharyngeal Space Infections)

How can you tell if a patient has problems with keeping saliva in their mouth?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 96

If they have been drooling

This can be visible by wet patches on their clothing, especially in young children

Question 97

(Clinical Correlates: Retropharyngeal Space Infections)

How might the neck feel upon palpation in a patient with a retropharyngeal abscess?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 97

It might feel tender to palpate, and the tenderness may not be focal, it can be tender both anteriorly and posteriorly

Question 98

(Clinical Correlates: Retropharyngeal Space Infections)

What are retropharyngeal abscesses commonly misdiagnosed as?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 98

Meningitis

Question 99

(Clinical Correlates: Retropharyngeal Space Infections)

Is the Brudzinski sign normally negative or positive in patients’ with retropharyngeal abscesses?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 99

Negative

Question 100

(Clinical Correlates: Retropharyngeal Space Infections)

What is the Brudzinski sign?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 100

Where severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed

Question 101

(Clinical Correlates: Retropharyngeal Space Infections)

What is a differential between diagnosing meningitis and retropharyngeal abscesses?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 101

Normally, in meningitis, the Brudzinski sign is positive, whereas in retropharyngeal abscesses the Brudzinski sign is negative

Question 102

(Clinical Correlates: Retropharyngeal Space Infections)

What are 2 signs and symptoms of a patient’s neck on examination in patients with retropharyngeal abscesses?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 102

Flexing the neck will hurt

Light palpation may also hurt - the patient may nearly cry even on light palpation!

Question 103

(Clinical Correlates: Retropharyngeal Space Infections)

What is a HEENT exam?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 103

A physical examination concerning the head, eyes, ears, nose and throat.

Question 104

(Clinical Correlates: Retropharyngeal Space Infections)

What is the tympanic membrane?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 104

The eardrum

Question 105

(Clinical Correlates: Retropharyngeal Space Infections)

Are there any problems with the tympanic membrane (TM) in patients with retropharyngeal abscesses?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 105

It is normally clear, but as retropharyngeal abscesses are often secondary to other infections, it is not uncommon for the TM to be inflamed and immobile.

Question 106

(Clinical Correlates: Retropharyngeal Space Infections)

When visualising the pharynx in a physical examination of a patient with retropharyngeal abscesses, how does it appear?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 106

It is likely to be erythematous and swollen, although can be to varying degree. There may also be uvula deviation and inflammation - but not necessarily (e.g. uvula may not have deviation)

Question 107

(Clinical Correlates: Retropharyngeal Space Infections)

What is uvula deviation?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 107

When the uvula is deviated to one side - because it is innervated by the vagus nerve, uvula deviation is caused by a motor nerve lesion on the OPPOSITE side of the uvula deviation.

Question 108

(Clinical Correlates: Retropharyngeal Space Infections)

How might the uvula appear in a retropharyngeal abscess?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 108

Deviated (potentially) and inflamed

Question 109

(Clinical Correlates: Retropharyngeal Space Infections)

Which nerve innervates the uvula?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 109

The vagus nerve

Question 110

(Clinical Correlates: Retropharyngeal Space Infections)

If the uvula is deviated to the right, is it a left or right motor nerve lesion?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 110

It is the contralateral nerve, so a right uvula deviation means a LEFT motor nerve lesion.

Question 111

(Clinical Correlates: Retropharyngeal Space Infections)

What scan(s) might you do to differentiate a retropharyngeal abscess?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 111

CT scans

Question 112

(Clinical Correlates: Retropharyngeal Space Infections)

How might a patient with retropharyngeal abscesses present when asked to turn their head?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 112

They cannot turn their head (without pain) to the side, and if they try they are likely to move their whole body too (i.e. to keep their neck straight but to look that direction)

Question 113

(Clinical Correlates: Retropharyngeal Space Infections)

What happens to a patients’ speech if they have a retropharyngeal abscess?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 113

They commonly present with what’s known as a “hot-potato” voice , where their voice sounds muffled.

The patient may actually also be speaking less as a result of the abscess anyway.

Question 114

(Clinical Correlates: Retropharyngeal Space Infections)

Why is it important to be aware of retropharyngeal abscesses?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 114

These can commonly be misdiagnosed - patient may just think they have a sore throat even!

If it is missed, retropharyngeal abscesses are very serious.

Question 115

(Clinical Correlates: Retropharyngeal Space Infections)

What are complications of retropharyngeal abscesses?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 115

They can dissect down in the mediastinum or rupture and cause airway compromise.

Question 116

(Clinical Correlates: Retropharyngeal Space Infections)

Mediastinitis or airway compromises due to rupture are complications of what disease?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 116

Retropharyngeal space infections

Question 117

(Clinical Correlates: Retropharyngeal Space Infections)

Infection in the retropharyngeal space is usually secondary to which infection?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 117

Upper respiratory tract infection

Question 118

(Clinical Correlates: Retropharyngeal Space Infections)

Upper respiratory tract infections can usually cause infections where as a secondary infection?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 118

In the retropharyngeal space

Question 119

(Clinical Correlates: Retropharyngeal Space Infections)

Give 3 example locations of where an upper respiratory tract infection can arise

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 119

Nasal cavity
Nasopharynx
Oropharynx

Question 120

(Clinical Correlates: Retropharyngeal Space Infections)

What age group do retropharyngeal space infections usually affect?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 120

Children, usually under the age of 5 years.

Question 121

(Clinical Correlates: Retropharyngeal Space Infections)

Infection in the retropharyngeal space can develop into what?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 121

An abscess

Question 122

(Clinical Correlates: Retropharyngeal Space Infections)

A retropharyngeal abscess can develop from what?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 122

An infection in the retropharyngeal space

Question 123

(Clinical Correlates: Retropharyngeal Space Infections)

Name 6 signs and symptoms of a retropharyngeal abscess.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 123

• A visible bulge on inspection of the oropharynx (self-note: middle part of the throat including the base of the tongue, the tonsils, the soft palate, and the walls of the pharynx)
• Sore throat
• Difficulty swallowing
• Stridor (self-note: high-pitched, wheezing sound caused by disrupted airflow)
• Reluctance to move their neck
• High temperature

Question 124

(Clinical Correlates: Retropharyngeal Space Infections)

Why is it important to recognise and treat retropharyngeal abscesses early?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 124

They carry significant morbidity and mortality.

Question 125

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

What is another word for the action or process of swallowing?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 125

Deglutition

Question 126

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Define retrosternal goitre.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 126

A goitre with a portion of its mass >50% located in the mediastinum.

Question 127

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

What is a goitre with a portion of its mass >50% located in the mediastinum known as?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 127

A retrosternal goitre

Question 128

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

What can you do on clinical examination to help diagnose a goitre?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 128

A goitre will move with swallowing

Question 129

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Diseases affecting the thyroid gland can cause ___________ of the gland or ________ _____ to appear.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 129

Diseases affecting the thyroid gland can cause enlargement of the gland or discrete (separate) lumps to appear.

Question 130

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

What would you be observing if you ask a patient with a swelling or lump in their neck to swallow?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 130

This examination is to observe whether the swelling moves (which it will with goitre).

Question 131

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Why might you ask a patient with a swelling or lump in their neck to swallow and observe whether it moves?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 131

To help localise pathology to the thyroid gland.

Question 132

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Describe what steps you would take if a patient presented with a swelling or lump in their neck, and you suspected thyroid gland involvement.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 132

You would ask the patient to swallow, and if the swelling/lump is due to pathology in the thyroid gland, the swelling/lump would move with swallowing.

Question 133

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

What is the thyroid gland enclosed by?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 133

Pre-tracheal fascia

Question 134

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

The pre-tracheal fascia is attached to which bone?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 134

The hyoid bone

Question 135

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

The hyoid bone is attached to which layer of fascia?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 135

The pre-tracheal fascia

Question 136

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Name 2 structures that move up with swallowing.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 136

The hyoid bone

The larynx

Question 137

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

If the hyoid bone and larynx move up with swallowing, what will that also lead to movement of?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 137

The thyroid gland

Question 138

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Why do goitres move up with swallowing?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 138

A goitre, by definition, is a swelling of the thyroid gland that causes a lump to form in the neck.

The thyroid gland is enclosed by the pre-tracheal fascia, which is attached to the hyoid bone.

The hyoid bone (and larynx) move up with swallowing, and therefore, so will the thyroid gland.

This means any swelling or lump associated with the gland will move up upon swallowing.

Question 139

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Where can enlarged thyroid glands (goitres) sometimes extend to?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 139

RETROSTERNALLY (behind the sternum)

Question 140

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Define retrosternally.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 140

RETROSTERNALLY = behind the sternum

Question 141

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Why can goitres sometimes extend retrosternally through the root of the neck?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 141

Because the LOWER LIMIT OF THE PRE-TRACHEAL FASCIA EXTENDS INTO THE THORAX.

Question 142

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Where does the lower limit of the pre-tracheal fascia extend into?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 142

The LOWER LIMIT OF THE PRE-TRACHEAL FASCIA EXTENDS INTO THE THORAX.

Question 143

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

The lower limit of the pre-tracheal fascia extends into the thorax. What significance does this have in relation to goitres?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 143

As the LOWER LIMIT OF THE PRE-TRACHEAL FASCIA EXTENDS INTO THE THORAX, an enlarged thyroid gland (goitre) can sometimes extend RETROSTERNALLY (behind the sternum), through the root of the neck.

Question 144

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

What complications can retrosternal extension of a goitre lead to?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 144

Compression of other structures running through the root of the neck (thoracic inlet) such as the trachea and venous blood vessels.

Question 145

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Retrosternal extension of a goitre can lead to compression of other structures where?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 145

Structures running through the root of the neck

Question 146

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

What is immediately inferior to the root of the neck?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 146

Thoracic inlet

Question 147

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

What is the thoracic inlet?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 147

The opening at the top of the thoracic cavity at the root of the neck

Question 148

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Where is the thoracic inlet?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 148

The root of the neck

Question 149

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Which structures can retrosternal extension of a goitre lead to compression of?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 149

The trachea and venous blood vessels

Question 150

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

The trachea and venous blood vessels can be compressed in which condition?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 150

Retrosternal extension of a goitre

Question 151

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Which blood vessels may be compressed in retrosternal extension of a goitre (broad category).

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 151

Venous blood vessels

Question 152

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Retrosternal extension of a goitre can lead to tracheal compression. What symptoms can this lead to?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 152

Breathlessness

Stridor

Question 153

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

What can happen to a patient with a retrosternal goitre which compresses their venous blood vessels (include a symptom)?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 153

The compression of the venous blood vessels will lead to the impediment of venous drainage from the head and neck, causing facial oedema.

Question 154

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Name 3 symptoms of retrosternal goitres.

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 154

Breathlessness
Stridor
Facial oedema

Question 155

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Why do patients with retrosternal goitres present with breathlessness and stridor?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 155

This is due to the goitre extending retrosternally and compressing structures in the thoracic inlet - namely, the trachea, which causes breathlessness and stridor.

Question 156

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

Why do patients with retrosternal goitres present with facial oedema?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 156

This is due to the goitre extending retrosternally and compressing structures in the thoracic inlet - namely, venous blood vessels, which impedes venous drainage from the head and neck and therefore causes facial oedema.

Question 157

(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)

What are the symptoms of retrosternal goitres and why do they occur?

(Topic: Organisation of Neck Structures by Cervical Fascial Planes)

Answer 157

Retrosternal extension of a goitre can lead to compression of structures running through the thoracic inlet, such as the trachea and venous blood vessels.

Compression of the trachea leads to symptoms of breathlessness and stridor.

Compression of the venous blood vessels impedes venous drainage from the head and neck, and causes facial oedema.

Question 158

How are the muscles of the head (and face) divided?

Topic: Major Muscle Groups

Answer 158

Into TWO BROAD GROUPS, based on commonalities in their function and nerve supply.

Question 159

What are the two broad major muscle groups?

Topic: Major Muscle Groups

Answer 159

The MUSCLES OF FACIAL EXPRESSION and the MUSCLES OF MASTICATION.

Question 160

The muscles of the head and face can be divided into the muscles of facial expression and the muscles of mastication. What do the muscles of facial expression also include?

(Topic: Major Muscle Groups)

Answer 160

The muscles of the scalp (occipitofrontalis) and muscle of the cheek (BUCCINATOR)

Question 161

What is the muscle of the scalp which is included in muscles of facial expression?

(Topic: Major Muscle Groups)

Answer 161

Occipitofrontalis

Question 162

What is the muscle of the cheek which is included in muscles of facial expression?

(Topic: Major Muscle Groups)

Answer 162

Buccinator

Question 163

Where is the occipitofrontalis muscle?

Topic: Major Muscle Groups

Answer 163

In the scalp

Question 164

Where is the buccinator muscle?

Topic: Major Muscle Groups

Answer 164

In the cheek

Question 165

In which group is the occipitofrontalis muscle included in?

Topic: Major Muscle Groups

Answer 165

Muscles of facial expression

Question 166

In which group is the buccinator muscle included in?

Topic: Major Muscle Groups

Answer 166

Muscles of facial expression

Question 167

Muscles of facial expression are essentially …

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 167

Muscles of the face

Question 168

Muscles of the face are known as …

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 168

MUSCLES OF FACIAL EXPRESSION

Question 169

Where do muscles of facial expression lie?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 169

In THE SUBCUTANEOUS TISSUE

Question 170

What do muscles of facial expression attach to?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 170

They ATTACH TO BONE, FASCIA AND OFTEN EACH OTHER

Question 171

Where do most muscles of facial expression attach to?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 171

Just beneath the skin

Question 172

Why do most muscles of facial expression attach just beneath the skin?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 172

This allows their contraction to pull the skin in particular ways, giving rise to the breadth of facial expressions we possess

Question 173

How do the location of our muscles of facial expression give rise to a variety of facial expressions?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 173

Many of these muscles attach just beneath the skin such that their contraction pulls the skin in particular ways, giving rise to the breadth of facial expressions we possess.

Question 174

Broadly speaking, how are the muscles of facial expression arranged?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 174

Broadly speaking, the muscles will act as either SPHINCTERS or DILATORS around the orifices of the face.

Question 175

What is a sphincter muscle?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 175

A circular muscle

Question 176

What are dilator muscles?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 176

A muscle that widens a body part

Question 177

What are the orifices of the face?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 177

The orbits of the eye, the nose and mouth

Question 178

What is the “orbit”, in anatomy?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 178

The orbit is the cavity or socket of the skull in which the eye and its appendages (protuberances) are situated. “Orbit” can refer to the bony socket, or it can also be used to imply the contents.

Question 179

What is an exception to the sphincter/dilator type muscle in the face?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 179

The BUCCINATORS

Question 180

What are the buccinators?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 180

The muscles of your cheek

Question 181

How do the buccinators ensure food remains within the oral cavity when chewing?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 181

They keep the cheek taut to ensure food is kept in the oral cavity (rather than ‘pooling’ between the cheek and teeth)

Question 182

How does the face ensure food remains within the oral cavity properly when chewing?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 182

Via the BUCCINATOR muscles, which keep the cheek taut

Question 183

What would happen to food in our oral cavity without the buccinator muscles?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 183

Food would ‘pool’ between the cheek and teeth.

Question 184

The muscles of facial expression are innervated by which nerve?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 184

Branches of the facial nerve

Question 185

Branches of the facial nerve innervate which muscles?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 185

All the muscles of facial expression

Question 186

The facial nerve branch innervates which muscle is the neck?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 186

The PLATYSMA, a superficial muscle in the neck

Question 187

The platysma is innervated by which nerve?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 187

The PLATYSMA is innervated by a branch of the facial nerve.

Question 188

In which compartment of the neck is the platysma muscle found?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 188

It is a superficial muscle of the neck.

Question 189

The facial nerve is also known as what?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 189

Cranial nerve VII

Question 190

Cranial nerve VII is also known as what?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 190

The facial nerve

Question 191

Where does the facial nerve originate?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 191

At the brainstem (inside the skull)

Question 192

Does the facial nerve exit the skull?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 192

Yes - it exits the base of the skull to become extracranial (i.e. outside skull)

Question 193

How would you describe a structure that is outside the skull?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 193

Extracranial

Question 194

Where does the facial nerve exit the skull?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 194

At the base

Question 195

What happens to the facial nerve once it exits the skull?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 195

It runs through the SUBSTANCE OF THE PAROTID GLAND.

Question 196

Which gland does the facial nerve run through extracranially?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 196

THE PAROTID GLAND

Question 197

What is the parotid gland?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 197

THE PAROTID GLAND is a salivary gland that sits just anterior and inferiorly to your ear.

Question 198

Name the salivary gland that sits just anterior and inferiorly to your ear.

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 198

THE PAROTID GLAND

Question 199

Where does the parotid gland lie?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 199

Anterior and inferiorly to the ear.

Question 200

What is the position of the facial nerve and its branches within the parotid gland?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 200

They run relatively superficial.

Question 201

Which nerve is vulnerable to damage in facial injuries?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 201

Facial nerve (branches)

Question 202

Which nerve can be injured due to disease or surgery of the parotid gland, and why?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 202

(Branches) of the facial nerve, because they run relatively superficial within the gland.

Question 203

How can the facial nerve be damaged?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 203

• Facial injury
• Disease of the parotid gland
• Surgery of the parotid gland

Question 204

How does the facial nerve divide in the parotid gland?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 204

It divides into FIVE TERMINAL EXTRACRANIAL BRANCHES

Question 205

How many branches of the facial nerve are located in the parotid gland?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 205

FIVE

Question 206

The facial nerve divides into five terminal extracranial branches (amongst other branches). Where does this occur?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 206

In the parotid gland.

Question 207

The branches of the facial nerve that divide in the parotid gland distribute where and to innervate which muscles?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 207

These branches distribute widely over the face to innervate the various muscles of facial expression.

Question 208

Injury or pathology affecting the facial nerve will cause weakness of the muscles of facial expression on the ___________ side.

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 208

Ipsilateral

Question 209

Define ipsilateral.

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 209

Belonging to or occurring on the same side of the body.

Question 210

Injury or pathology affecting the facial nerve will cause weakness of which muscles?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 210

Weakness of the muscles of facial expression on the ipsilateral side of damage.

Question 211

Weakness of the muscles of facial expression on one side is likely to be caused by what and on which side?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 211

Injury or pathology affecting the facial nerve on the ipsilateral side.

i.e. left-sided weakness = left facial nerve injury

Question 212

What is the most common non-traumatic cause of facial paralysis?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 212

The MOST COMMON NON-TRAUMATIC cause of FACIAL PARALYSIS is INFLAMMATION of the FACIAL NERVE (Bell’s palsy).

Question 213

What is Bell’s palsy?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 213

THE MOST COMMON NON-TRAUMATIC cause of FACIAL PARALYSIS, due to INFLAMMATION of the FACIAL NERVE ipsilaterally.

Question 214

Inflammation of the facial nerve is also known as?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 214

BELL’S PALSY

Question 215

Inflammation of the facial nerve can cause?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 215

(Otherwise known as BELL’S PALSY)

FACIAL PARALYSIS

Question 216

What can inflammation of the facial nerve lead to?

Topic: Major Muscle Groups - Muscles of Facial Expression

Answer 216

The inflammation causes oedema and compression of the nerve as it runs through the base of the skull.

Question 217

Oedema and compression of the facial nerve as it runs through the base of the skull can occur in which condition?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 217

Bell’s palsy

Question 218

(Clinical Correlates)

Weakness of the facial muscles on one side in in association with an ipsilateral parotid enlargement is highly likely to be a ______ ?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 218

PAROTID CANCER

Question 219

(Clinical Correlates)

Name some signs and symptoms of parotid cancer.

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 219

Weakness of the facial muscles on one side IN ASSOCIATION with an IPSILATERAL parotid enlargement is HIGHLY LIKELY TO BE A PAROTID CANCER.

Question 220

(Clinical Correlates)

Which nerve is likely to be damaged in parotid cancer?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 220

The cancerous cells invade and damage the facial nerve during its course through the gland.

Question 221

(Clinical Correlates)

Why is weakness of the facial muscles (in association with ipsilateral parotid enlargement) a symptom of parotid cancer?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 221

The cancerous cells invade and damage the facial nerve during its course through the gland (ipsilateral parotid enlargement due to the division of cancerous cells).

Question 222

(Clinical Correlates)

How does parotid cancer cause facial nerve damage?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 222

The facial nerve courses through the parotid gland, which is therefore damaged and invaded by the cancerous cells.

Question 223

(Clinical Correlates)

Can benign, infective or inflammatory conditions of the parotid gland (e.g. mumps) cause facial weakness?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 223

It is RARE FOR BENIGN, infective or inflammatory conditions of the parotid gland to cause damage to the facial nerve, and thus, these conditions are not typically associated with facial muscle weakness.

Question 224

(Clinical Correlates)

Give an example of an infective or inflammatory condition of the parotid gland.

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 224

Mumps

Question 225

(Clinical Correlates)

What causes facial muscle weakness?

(Topic: Major Muscle Groups - Muscles of Facial Expression)

Answer 225

Damage to the facial nerve

Question 226

How many muscles of mastication are there?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 226

4

Question 227

What do the muscles of mastication do?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 227

The four muscles all act to MOVE THE MANDIBLE AT THE TEMPOROMANDIBULAR JOINT (TMJ).

Question 228

What is the mandible?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 228

The mandible, lower jaw, or jawbone, is the largest, strongest and lowest bone in the human face. it forms the lower jaw and holds the lower teeth in place.

Question 229

What is the temporomandibular joint (TMJ)?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 229

The temperomandibular joints are the two joints connecting the jawbone to the skull i.e. between the temporal bone of the skull and the mandible (jaw) of the face.

Question 230

Where does the temporomandibular joint lie?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 230

Between the temporal bone of the skull and the mandible (jaw) of the face.

Question 231

What is another term for chewing (food)?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 231

Masticating

Question 232

What do the muscles of mastication do?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 232

The four muscles all act to move the mandible at the TMJ, as is needed when chewing food (masticating).

Question 233

Which nerve supplies the muscles of mastication?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 233

They are all supplied by branches from the MANDIBULAR DIVISION OF THE TRIGEMINAL NERVE (a branch of CN V).

Question 234

The branches of the mandibular division of which nerve innervates the muscles of mastication?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 234

The TRIGEMINAL NERVE

Question 235

Branches of which division of the trigeminal nerve innervate the muscles of mastication?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 235

The MANDIBULAR DIVISION

Question 236

The trigeminal nerve is a branch of what?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 236

A branch of CN V (the fifth cranial nerve).

Question 237

What are the muscles of mastication?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 237

TEMPORALIS
MASSETER
and PTERYGOIDS (medial and lateral)

Question 238

What does the temporalis muscle do?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 238

It is a muscle of mastication

Question 239

What does the masseter muscle do?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 239

It is a muscle of mastication

Question 240

What do the pterygoids muscles do?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 240

They are muscles of mastication

Question 241

Which muscle of mastication has a medial and lateral part?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 241

Pterygoid

Question 242

How can you palpate the contraction of the temporalis and masseter muscles?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 242

By clenching your jaw

Question 243

Which muscles of mastication can be palpated by clenching your jaw?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 243

The contraction of the temporalis and masseter muscles

Question 244

Where can you palpate the temporalis muscle?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 244

Over the area of your temples

upon clenching your jaw

Question 245

Where can you palpate the masster muscle?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 245

The corner of your jaw as you clench your teeth

Question 246

What muscle can be palpated by feeling over the area of your temples when your teeth are clenched?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 246

Temporalis

Question 247

What muscle can be palpated by feeling over the corner of your jaw when your teeth are clenched?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 247

Masseter

Question 248

Which muscles of mastication cannot be palpated?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 248

The PTERYGOID MUSCLES, however, ARE NOT PALPABLE

Question 249

Where do the pterygoid muscles lie?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 249

Deep to the mandible

Question 250

Why can the pterygoid muscles not be palpated?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 250

They lie too deep.

Question 251

Where do the pterygoid muscles originate?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 251

From two bony plate-like projections at the base of the skull, called the pterygoid plates.

Question 252

What are the two bony plate-like projections at the base of the skull?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 252

The pterygoid plates

Question 253

What are the pterygoid plates?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 253

Two bony plate-like projections at the base of the skull, from which the pterygoid muscles originate.

Question 254

Why are the pterygoid muscles so named?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 254

They originate from the pterygoid plates (two bony plate-like projections at the base of the skull).

Question 255

How are the pterygoid muscles angled (in relation to each other)?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 255

Each pterygoid muscle is angled slightly different

Question 256

Do the pterygoid muscles insert onto the same place?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 256

Each pterygoid muscle inserts on to separate areas of the mandible

Question 257

How do the pterygoid muscles work together to confer their different actions on the jaw (opening vs closing)?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 257

Each pterygoid muscles is angled slightly different, and inserts on to separate areas of the mandible thus conferring their different actions on the jaw.

Question 258

How do the pterygoid muscles work to open and close the jaw?

Topic: Major Muscle Groups - Muscles of Mastication

Answer 258

Each pterygoid muscles is angled slightly different, and inserts on to separate areas of the mandible thus conferring their different actions on the jaw (opening vs closing).

Question 259

What is the significance of each pterygoid muscle being is angled and inserting on to different areas of the mandible?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 259

This enables them to confer their different actions on the jaw, one opening and one closing it.

Question 260

(Hints and Tips: Red Box)

All the muscles of mastication, except one, act to do what?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 260

ELEVATE THE MANDIBLE (close the jaw).

Question 261

(Hints and Tips: Red Box)

Suggest a reason why all muscles of mastication close the jaw.

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 261

This action needs to be a powerful movement e.g. chewing food

Question 262

(Hints and Tips: Red Box)

Which muscles depress the mandible/open the jaw?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 262

DEPRESSING THE MANDIBLE involves a number of muscles, of which only one is part of the ‘muscles of mastication’ group.

Question 263

(Hints and Tips: Red Box)

Which muscles are mainly involve in depressing the mandible?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 263

A collective group of muscles called the ‘SUPRAHYOIDS’.

Question 264

(Hints and Tips: Red Box)

What do the ‘suprahyoids’ do?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 264

The main muscles involved in depressing the mandible

Question 265

(Hints and Tips: Red Box)

What helps the ‘suprahyoids’ depress the mandible?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 265

These are assisted by the pull of gravity and the LATERAL PTERYGOID.

Question 266

(Hints and Tips: Red Box)

What is the action of the lateral pterygoid?

(Topic: Major Muscle Groups - Muscles of Mastication)

Answer 266

It assists in opening the mouth

• This can be remembered by how you pronounce lateral. Saying ‘Laaaaaa’teral requires you to open your mouth!

Question 267

(Clinical Correlates)

Why might it be relevant to determine what ‘triangle’ a neck lump is located?

(Topic: Major Muscle Groups - Muscles of the Neck)

Answer 267

By determining what ‘triangle’ a neck lump is located, we can infer from our understanding of the anatomy in that region a likely cause for the lump.

Question 268

How are the scalene muscles organised?

Topic: Major Muscle Groups - Muscles of the Neck

Answer 268

Into anterior, middle and posterior

Question 269

What is the function of scalene muscles?

Topic: Major Muscle Groups - Muscles of the Neck

Answer 269

They act as accessory muscles of respiration

Question 270

What forms the floor of the posterior triangle?

Topic: Major Muscle Groups - Muscles of the Neck

Answer 270

Scalene muscles

Question 271

Which critical structures pass in close proximity to the scalene muscles?

(Topic: Major Muscle Groups - Muscles of the Neck)

Answer 271

The BRACHIAL PLEXUS and SUBCLAVIAN VESSELS (e.g. the trunks of the brachial plexus and SUBCLAVIAN ARTERY pass BETWEEN the anterior and middle scalenes, as they had towards the upper limb.

The PHRENIC NERVE, which arises from within the neck (C3,4,5) descends along the surface of the anterior scalene before entering into the thorax.

Question 272

Where does the phrenic nerve arise?

Topic: Major Muscle Groups - Muscles of the Neck

Answer 272

From within the neck (C3,4,5)

Question 273

Which nerve arises from C3,4,5 in the neck?

Topic: Major Muscle Groups - Muscles of the Neck

Answer 273

The phrenic nerve

Question 274

What is the route of the phrenic nerve?

Topic: Major Muscle Groups - Muscles of the Neck

Answer 274

It arises from within the neck (C3,4,5), descends along the surface of the anterior scalene before entering into the thorax.

Question 275

Where does the arterial supply to the head and neck arise?

Topic: Major Arteries of the Head and Neck

Answer 275

From branches of the RIGHT AND LEFT COMMON CAROTID ARTERIES and the VERTEBRAL ARTERIES.

Question 276

What are the vertebral arteries?

Topic: Major Arteries of the Head and Neck

Answer 276

Branches of the SUBCLAVIAN ARTERIES

Question 277

What do the vertebral arteries supply?

Topic: Major Arteries of the Head and Neck

Answer 277

The POSTERIOR NECK AND POSTERIOR PARTS OF THE BRAIN (e.g. BRAINSTEM, CEREBELLUM)

Question 278

What arteries supply the posterior neck and posterior parts of the brain?

(Topic: Major Arteries of the Head and Neck)

Answer 278

The vertebral arteries, which are branches of the SUBCLAVIAN ARTERIES

Question 279

Give 2 examples of structures found in the posterior parts of the brain.

(Topic: Major Arteries of the Head and Neck)

Answer 279

BRAINSTEM

CEREBELLUM

Question 280

Where are the brainstem and cerebellum found?

Topic: Major Arteries of the Head and Neck

Answer 280

POSTERIOR PARTS OF THE BRAIN

Question 281

Which arteries supply the brainstem and cerebellum?

Topic: Major Arteries of the Head and Neck

Answer 281

The vertebral arteries, which are branches of the SUBCLAVIAN ARTERIES

Question 282

What route does the vertebral artery follow?

Topic: Major Arteries of the Head and Neck

Answer 282

From its origin, the vertebral artery ascends through the TRANSVERSE FORAMINA OF THE CERVICAL VERTEBRAE (EXCEPT C7) and enters the subarachnoid space just between the atlas (1st cervical vertebra) and occipital bone.

Question 283

The vertebral artery ascends through the transverse foramina of which vertebrae?

(Topic: Major Arteries of the Head and Neck)

Answer 283

The TRANSVERSE FORAMINA OF THE CERVICAL VERTEBRAE (EXCEPT C7)

Question 284

After passing through the transverse foramina of the cervical vertebrae (except C7), where does the vertebral artery travel?

(Topic: Major Arteries of the Head and Neck)

Answer 284

it enters the subarachnoid space just between the atlas (1st cervical vertebra) and occipital bone.

Question 285

What is the atlas?

Topic: Major Arteries of the Head and Neck

Answer 285

1st cervical vertebra

Question 286

What is the occipital bone?

Topic: Major Arteries of the Head and Neck

Answer 286

The bone which forms the back and base of the skull and encircles the spinal cord.

Question 287

What happens to the vertebral artery after it passes into the subarachnoid space between C1 and the occipital bone?

(Topic: Major Arteries of the Head and Neck)

Answer 287

It then passes up through the FORAMEN MAGNUM, curving around the medulla, to join the vertebral artery from the other side to form the BASILAR ARTERY.

Question 288

What is the foramen magnum?

Topic: Major Arteries of the Head and Neck

Answer 288

The hole in the base of the skull through which the spinal cord passes

Question 289

What is the hole in the base of the skull through which the spinal cord passes known as?

(Topic: Major Arteries of the Head and Neck)

Answer 289

The foramen magnum

Question 290

What is the medulla?

Topic: Major Arteries of the Head and Neck

Answer 290

Short for medulla oblongata

The continuation of the spinal cord within the skull, forming the lowest part of the brainstem and containing control centres for the heart and lungs.

Question 291

The continuation of the spinal cord within the skull, forming the lowest part of the brainstem, is known as what?

(Topic: Major Arteries of the Head and Neck)

Answer 291

The medulla oblongata

Question 292

The vertebral artery joins which artery to form what?

Topic: Major Arteries of the Head and Neck

Answer 292

The vertebral artery from the other side to form the BASILAR ARTERY.

Question 293

Which two arteries form to basilar artery?

Topic: Major Arteries of the Head and Neck

Answer 293

The vertebral artery of both sides

Question 294

What is the full route of the vertebral artery?

Topic: Major Arteries of the Head and Neck

Answer 294

From its origin, the vertebral artery ascends through the TRANSVERSE FORAMINA OF THE CERVICAL VERTEBRAE (EXCEPT C7) and enters the subarachnoid space just between the atlas (1st cervical vertebra) and occipital bone. It then passes up through the FORAMEN MAGNUM, curving around the medulla, to join the vertebral artery from the other side to form the BASILAR ARTERY.

Question 295

Where does the basilar artery run?

Topic: Major Arteries of the Head and Neck

Answer 295

Along the anterior (ventral) aspect of the brainstem (namely the pons)

Question 296

Which artery runs along hte anterior aspect of the brainstem, namely the pons?

(Topic: Major Arteries of the Head and Neck)

Answer 296

The basilar artery

Question 297

Where does the right common carotid artery originate?

Topic: Major Arteries of the Head and Neck

Answer 297

From the BRACHIOCEPHALIC ARTERY behind the right sternoclavicular joint

Question 298

From which artery does the right common carotid artery originate?

(Topic: Major Arteries of the Head and Neck)

Answer 298

The BRACHIOCEPHALIC ARTERY

Question 299

What artery originates from the brachiocephalic artery?

Topic: Major Arteries of the Head and Neck

Answer 299

The RIGHT COMMON CAROTID ARTERY

Question 300

Which artery originates from behind the right sternoclavicular joint?

(Topic: Major Arteries of the Head and Neck)

Answer 300

The RIGHT COMMON CAROTID ARTERY

Question 301

Where does the left common carotid artery arise?

Topic: Major Arteries of the Head and Neck

Answer 301

Directly from the ARCH OF THE AORTA

Question 302

Which artery arises directly from the arch of the aorta?

Topic: Major Arteries of the Head and Neck

Answer 302

The LEFT COMMON CAROTID

Question 303

Which is longer - the left or right common carotid artery?

Topic: Major Arteries of the Head and Neck

Answer 303

The left common carotid artery

Question 304

Why is one common carotid artery longer than the other?

Topic: Major Arteries of the Head and Neck

Answer 304

The left common carotid artery is slightly longer as it courses for about 2 cm in the superior mediastinum before entering the neck.

Question 305

Where does the common carotid artery ascend through the neck?

(Topic: Major Arteries of the Head and Neck)

Answer 305

Each common carotid artery ascends through the neck enclosed within the CAROTID SHEATH.

Question 306

Which artery is enclosed within the carotid sheath?

Topic: Major Arteries of the Head and Neck

Answer 306

The common carotid artery.

Question 307

What is the carotid sheath?

Topic: Major Arteries of the Head and Neck

Answer 307

A fascial envelope which encloses the CAROTID ARTERY, INTERNAL JUGULAR VEIN and VAGUS NERVE

Question 308

What is the contents of the carotid sheath?

Topic: Major Arteries of the Head and Neck

Answer 308

The CAROTID ARTERY, INTERNAL JUGULAR VEIN and VAGUS NERVE.

Question 309

Where does most of the carotid sheath run?

Topic: Major Arteries of the Head and Neck

Answer 309

Deep to the sternocleidomastoid muscle

Question 310

How is the carotid sheath derived?

Topic: Major Arteries of the Head and Neck

Answer 310

From FUSION of

a) the PREVERTEBRAL LAYER of cervical fascia (posteriorly),
b) the PRETRACHEAL LAYER (anteromedially) and
c) the INVESTING LAYER OF CERVICAL FASCIA (anterolaterally).

Question 311

The carotid sheath is derived from fusion of which layer posteriorly?

(Topic: Major Arteries of the Head and Neck)

Answer 311

The PREVERTEBRAL LAYER of cervical fascia

Question 312

The carotid sheath is derived from fusion of which layer anteromedially?

(Topic: Major Arteries of the Head and Neck)

Answer 312

The PRETRACHEAL LAYER

Question 313

The carotid sheath is derived from fusion of which layer anterolaterally?

(Topic: Major Arteries of the Head and Neck)

Answer 313

The INVESTING LAYER of CERVICAL FASCIA

Question 314

The prevertebral layer fuses to derive which part of the carotid sheath?

(Topic: Major Arteries of the Head and Neck)

Answer 314

Posterior

Question 315

The pretracheal layer fuses to derive which part of the carotid sheath?

(Topic: Major Arteries of the Head and Neck)

Answer 315

Anteromedial

Question 316

The investing layer fuses to derive which part of the carotid sheath?

(Topic: Major Arteries of the Head and Neck)

Answer 316

Anterolateral

Question 317

Is the carotid sheath thick or thin?

Topic: Major Arteries of the Head and Neck

Answer 317

The sheath is thin over the vein but thicker around the artery.

Question 318

What is the carotid sheath like around the vein?

Topic: Major Arteries of the Head and Neck

Answer 318

Thin

Question 319

What is the carotid sheath like over the artery?

Topic: Major Arteries of the Head and Neck

Answer 319

Thicker here compared to over the vein

Question 320

What is the position of the contents of the carotid sheath?

Topic: Major Arteries of the Head and Neck

Answer 320

The ARTERY lies MEDIALLY within the sheath whilst the VEIN is LATERAL and the NERVE BEHIND and in between the vessels.

Question 321

Which structure of the carotid sheath lies medially?

Topic: Major Arteries of the Head and Neck

Answer 321

The ARTERY

Question 322

Which structure of the carotid sheath lies laterally?

Topic: Major Arteries of the Head and Neck

Answer 322

The VEIN

Question 323

Which structure of the carotid sheath lies behind and in between the vessels?

(Topic: Major Arteries of the Head and Neck)

Answer 323

The NERVE

Question 324

Where does the artery lie in the carotid sheath?

Topic: Major Arteries of the Head and Neck

Answer 324

MEDIALLY

Question 325

Where does the vein lie in the carotid sheath?

Topic: Major Arteries of the Head and Neck

Answer 325

LATERALLY

Question 326

Where does the nerve lie in the carotid sheath?

Topic: Major Arteries of the Head and Neck

Answer 326

BEHIND and in between the vessels.

Question 327

Where does the sympathetic chain lie in relation to the carotid sheath?

(Topic: Major Arteries of the Head and Neck)

Answer 327

The SYMPATHETIC CHAIN lies outside of the sheath, medially and behind it.

Question 328

What lies outside of the carotid sheath, medially and behind it?

(Topic: Major Arteries of the Head and Neck)

Answer 328

The SYMPATHETIC CHAIN.

Question 329

Where do the common carotids most commonly terminate?

Topic: Major Arteries of the Head and Neck

Answer 329

At the level of the UPPER BORDER OF THE THYROID CARTILAGE (C4 LEVEL).

Question 330

Which artery terminates and divides at the leve lof the upper border of the thyroid cartilage (C4 level)?

(Topic: Major Arteries of the Head and Neck)

Answer 330

The common carotids MOST COMMONLY terminate here.

Question 331

What do the common carotids divide into?

Topic: Major Arteries of the Head and Neck

Answer 331

INTERNAL and EXTERNAL CAROTID ARTERIES

Question 332

What are the internal and external carotid arteries derived from?

(Topic: Major Arteries of the Head and Neck)

Answer 332

The common carotids.

Question 333

When the common carotid divdes/bifurcates, which artery is more bulbous - the internal or external carotid artery?

(Topic: Major Arteries of the Head and Neck)

Answer 333

At this division, or bifurcation, the internal carotid artery is more bulbous

Question 334

Which carotid artery is more bulbous at its bifurcation, and why?

(Topic: Major Arteries of the Head and Neck)

Answer 334

At this division, or birfurcation, the internal carotid artery is more bulbous due to the CAROTID SINUS (AND CAROTID BODY).

Question 335

What does the carotid sinus (and carotid body) do to the artery in that area?

(Topic: Major Arteries of the Head and Neck)

Answer 335

It makes the internal carotid artery more bulbous in comparison to the external carotid artery.

Question 336

Why is the site of the carotid sinus clinically important?

Topic: Major Arteries of the Head and Neck

Answer 336

The SITE OF THE CAROTID SINUS is clinically important as rubbing this area firmly can ALLEVIATE SUPRA-VENTRICULAR TACHYCARDIAS (SVTs) i.e. CAROTID MASSAGE.

Question 337

Rubbing what area firmly can alleviate SVTs?

Topic: Major Arteries of the Head and Neck

Answer 337

The SITE OF THE CAROTID SINUS

Question 338

The carotid massage is used for what and how?

Topic: Major Arteries of the Head and Neck

Answer 338

Rubbing the SITE OF THE CAROTID SINUS firmly can ALLEVIATE SUPRA-VENTRICULAR TACHYCARDIAS.

Question 339

What is SVT?

Topic: Major Arteries of the Head and Neck

Answer 339

Supraventricular tachycardia (SVT) is a condition where improper electrical activity in the heart causes sudden tachycardia (>100 bpm) - either whilst resting or during exercise. It may then slow down abruptly.

It’s not usually serious but some people may need treatment. (NHS)

Question 340

(Clinical Correlates: Carotid Sinus Massage and SVTs)

A man presents with palpitations and is later found to be an SVT. Suggest a clinical treatment.

(Topic: Major Arteries of the Head and Neck)

Answer 340

Carotid sinus massage

Question 341

What nerve innervates trapezius after innervating sternocleidomastoid?

(Topic: Major Arteries of the Head and Neck)

Answer 341

The spinal part of the accessory nerve

Question 342

Where does the spinal part of the accessory nerve run?

Topic: Major Arteries of the Head and Neck

Answer 342

Across the posterior triangle

Question 343

The spinal part of the accessory nerve runs across the posterior triangle to innervate the _________, after innervating ___________________

(Topic: Major Arteries of the Head and Neck)

Answer 343

Trapezius, after innervating sternocleidmastoid

Question 344

(!)

Why should you NOT attempt to perform a carotid sinus massage on yourself?

(Topic: Major Arteries of the Head and Neck)

Answer 344

While you should practice palpating the carotid artery (one at a time) one yourself and each other DO NOT attempt to massage it, as it may cause severe bradycardia and a significant drop in blood pressure!

Question 345

(!)

What can happen if you attempt a carotid sinus massage on a patient who does not have tachycardia?

(Topic: Major Arteries of the Head and Neck)

Answer 345

It may cause severe bradycardia and a significant drop in blood pressure.

DO NOT ATTEMPT!

Question 346

How is the internal carotid artery distinguished?

Topic: Major Arteries of the Head and Neck

Answer 346

The INTERNAL CAROTID ARTERY is distinguished by a LACK OF BRANCHES IN THE NECK.

Question 347

Which artery is distinguished by a lack of branches in the neck?

(Topic: Major Arteries of the Head and Neck)

Answer 347

The INTERNAL CAROTID ARTERY

Question 348

What is the route of the internal carotid artery?

Topic: Major Arteries of the Head and Neck

Answer 348

It ascends then enter the base of the skull, through a bony canal called the CAROTID CANAL.

Question 349

Which artery passes through the carotid canal?

Topic: Major Arteries of the Head and Neck

Answer 349

The internal carotid artery.

Question 350

How does the internal carotid artery travel intracranially?

Topic: Major Arteries of the Head and Neck

Answer 350

its course intracranially involves passage through a structure called the CAVERNOUS SINUS.

Question 351

As well as some of the cranial nerves, which structures courses intracranially through the cavernous sinus?

(Topic: Major Arteries of the Head and Neck)

Answer 351

The internal carotid artery

Question 352

Where does the internal carotid artery branch?

Topic: Major Arteries of the Head and Neck

Answer 352

Once it exits the cavernous sinus

Question 353

What do the branches of the internal carotid artery supply?

Topic: Major Arteries of the Head and Neck

Answer 353

The brain and the eye

Question 354

The brain and theeye is suplied by ______?

Topic: Major Arteries of the Head and Neck

Answer 354

Branches of the internal carotid artery

Question 355

The external carotid artery supplies what?

Topic: Major Arteries of the Head and Neck

Answer 355

The EXTERNAL CAROTID ARTERY, is the MAJOR SOURCE OF BLOOD SUPPLY TO EXTRACRANIAL STRUCTURES of the head and neck region.

Question 356

What is the major source of blood supply to extracrnial structures of the head and neck region?

(Topic: Major Arteries of the Head and Neck)

Answer 356

The external carotid artery.

Question 357

How many branches does the external carotid artery give rise to?

(Topic: Major Arteries of the Head and Neck)

Answer 357

EIGHT BRANCHES

Question 358

What is the branch of the external carotid artery that is the main arterial supply to the tissues of the face?

(Topic: Major Arteries of the Head and Neck)

Answer 358

The FACIAL ARTERY

Question 359

The facial artery is one of eight branches of the ECA which is the main supply to what?

(Topic: Major Arteries of the Head and Neck)

Answer 359

The tissues of the face

Question 360

What are the branches of the external carotid artery?

Topic: Major Arteries of the Head and Neck

Answer 360

The eight branches/arteries are (from inferior to superior as the ECA ascends):

Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal (... artery)

Some Anatomists Like Freaking Out Poor Medical Students

Question 361

Which two branches are considered the terminal branches of the external carotid artery?

(Topic: Major Arteries of the Head and Neck)

Answer 361

The MAXILLARY AND SUPERFICIAL TEMPORAL ARTERIES

Question 362

Where do the maxillary and superficial temporal arteries arise?

(Topic: Major Arteries of the Head and Neck)

Answer 362

At a level behind the neck of the mandible

Question 363

Which branches of the ECA arise at a level behind the neck of the mandible?

(Topic: Major Arteries of the Head and Neck)

Answer 363

The MAXILLARY AND SUPERFICIAL TEMPORAL ARTERIES (terminal branches of the ECA)

Question 364

Where do the terminal branches of the ECA travel through?

Topic: Major Arteries of the Head and Neck

Answer 364

The MAXILLARY AND SUPERFICIAL TEMPORAL ARTERIES arise at a level behind the neck of the mandible, they arise within and travel through the substance of the PAROTID GLAND.

Question 365

Which is the main blood supply to the parotid gland?

Topic: Major Arteries of the Head and Neck

Answer 365

The MAXILLARY AND SUPERFICIAL TEMPORAL ARTERIES (branches of the ECA)

Question 366

As well as providing the parotid gland its blood supply, the maxillary artery also supplies what?

(Topic: Major Arteries of the Head and Neck)

Answer 366

Deep tissue and bone structures of the face e.g. paranasal air sinuses and nasal cavity.

Question 367

Paranasal air sinuses and the nasal cavity are supplied by which structure?

(Topic: Major Arteries of the Head and Neck)

Answer 367

The maxillary artery

Question 368

The maxillary artery branches to form which artery, to supply the meninges and skull bones?

(Topic: Major Arteries of the Head and Neck)

Answer 368

The MIDDLE MENINGEAL ARTERY

Question 369

Where does the middle meningeal artery run?

Topic: Major Arteries of the Head and Neck

Answer 369

Through the base of the skull

Question 370

What does the middle meningeal artery upply?

Topic: Major Arteries of the Head and Neck

Answer 370

The meninges and skull bones

Question 371

What supplies the tissues of the scalp?

Topic: Major Arteries of the Head and Neck

Answer 371

The superficial temporal artery, joining with other branches of the external carotid artery (and branches of the internal carotid artery that exit the skull through the orbit).

Question 372

As well as the parotid gland, what does the superficial temporal artery supply?

(Topic: Major Arteries of the Head and Neck)

Answer 372

The tissues of thew scalp

Question 373

Does the internal carotid artery supply the tissues of the scalp?

(Topic: Major Arteries of the Head and Neck)

Answer 373

Its branches which exit the skull through the orbit do (alongside the superficial temporal and external carotid artery).

Question 374

Many of the branches of the external carotid artery make a loop at their origin; why do you think this is?

(Topic: Major Arteries of the Head and Neck)

Answer 374

Arteries are able to stretch to make them narrower and wider, but cannot stretch longitudinally. It is proposed that the artery loops to aid them in movement.

An advantage of having a loop (note, not a ‘loopp-the-loop’) is that there is a little bit of extra length available. This allows movements of the head.

The neck is a very mobile structure, along with the structures within it (larynx, pharynx and thyroid cartilages etc. all move with swallowing and speaking). Thus, it is important that the blood vessels supplying the neck and face have a degree of ‘excess’ length to account for this movement - otherwise they’d be put under a degree of tension whenever we moved our neck or head.

Question 375

A number of veins drain the scalp, face and neck. Most of the structures of the face drain via which vein?

(Topic: Major Veins of the Head and Neck)

Answer 375

The FACIAL VEIN

Question 376

Where does the facial vein run?

Topic: Major Veins of the Head and Neck

Answer 376

From the MEDIAL ANGLE OF THE EYE TOWARDS THE INFERIOR BORDER OF THE MANDIBLE, with the facial artery.

Question 377

Which artery and vein runs from the medial angle of the eye towards the inferior border of the mandible?

(Topic: Major Veins of the Head and Neck)

Answer 377

The FACIAL VEIN with the facial artery.

Question 378

At the mandible, which vein does the facial vein join?

Topic: Major Veins of the Head and Neck

Answer 378

The INTERNAL JUGULAR VEIN.

Question 379

The facial vein connects with which two veins that relate to the orbit?

(Topic: Major Veins of the Head and Neck)

Answer 379

`The SUPERIOR and INFERIOR OPHTHALMIC VEINS

Question 380

The superior opthalmic vein has a direct connection to what structure?

(Topic: Major Veins of the Head and Neck)

Answer 380

The CAVERNOUS SINUS

Question 381

The inferior opthalmic vein has a direct connection to what structure?

(Topic: Major Veins of the Head and Neck)

Answer 381

The PTERYGOID VENOUS PLEXUS

Question 382

How is the facial vein connected to the cavernous sinus and the pterygoid venous plexus?

(Topic: Major Veins of the Head and Neck)

Answer 382

The facial vein connects with both the SUPERIOR and INFERIOR OPTHALMIC VEINS (relating to the orbit), which have a direct connection with the CAVERNOUS SINUS and the PTERYGOID VENOUS PLEXUS (respectively).

Question 383

Where does the cavernous sinus lie?

Topic: Major Veins of the Head and Neck

Answer 383

Intra-cranially, and thus forms part of the intra-cranial venous system

Question 384

Blood draining the face via the facial vein can potentially drain where?

(Topic: Major Veins of the Head and Neck)

Answer 384

Blood draining the face via the facial vein can therefore POTENTIALLY drain intracranially.

Question 385

Blood can be potentially drained intracranially how?

Topic: Major Veins of the Head and Neck

Answer 385

Via the facial vein - as it connects to the superior opthalmic vein which is directly connected to the cavernous sinus, which lies intracranially and forms part of the intracanial venous system.

Question 386

Why might infections involving the face have serious implications?

(Topic: Major Veins of the Head and Neck)

Answer 386

Blood draining the face via the facial vein can POTENTIALLY drain intracranially (via the cavernous sinus). This has IMPLICATIONS FOR INFECTIONS INVOLVING THE FACE, as they then can spread to involve intracranial structures, making the infection immediately more concerning.

Question 387

How may septic thrombi within the facial vein be dangerous to the patient?

(Topic: Major Veins of the Head and Neck)

Answer 387

Septic thrombi within the facial vein (secondary to infection in and around the tissue it drains) can travel, via the ophthalmic veins to the cavernous sinus and cause a CAVERNOUS SINUS THROMBOSIS.

Question 388

How can you get septic thrombi within the facial vein?

Topic: Major Veins of the Head and Neck

Answer 388

Secondary to infection in and around the tissue it drains

Question 389

What is a cavernous sinus thrombosis?

Topic: Major Veins of the Head and Neck

Answer 389

Formation of a blood clot within the facial vein.

Question 390

What are the implications of a cavernous sinus thrombosis?

Topic: Major Veins of the Head and Neck

Answer 390

They is extremely serious, though very rare.

Question 391

How common are cavernous sinus thromboses?

Topic: Major Veins of the Head and Neck

Answer 391

Very rare

Question 392

Apart from the facial vein with the opthalmic nerves, what is another important anastomosis between the extra-cranial veins and intracranial veins?

(Topic: Major Veins of the Head and Neck)

Answer 392

The anastomosis between the VEINS OF THE SCALP and the INTRA-CRANIAL (DURAL) VENOUS SINUSES.

Question 393

How are the extracranial and intracranial venous systems connected?

(Topic: Major Veins of the Head and Neck)

Answer 393

Via EMISSARY VEINS

Question 394

Where od emissary veins run?

Topic: Major Veins of the Head and Neck

Answer 394

Through the skull

Question 395

Emissary veins runs between the veins of the scalp and the intra-cranial venous sinuses. This can lead to what?

(Topic: Major Veins of the Head and Neck)

Answer 395

This can provide a POTENTIAL ROUTE FOR INFECTION OF THE SCALP to SPREAD INTO THE CRANIAL CAVITY.

Question 396

How may infection of the scalp spread into the cranial cavity?

(Topic: Major Veins of the Head and Neck)

Answer 396

Potentially via EMISSARY VEINS.

Question 397

(Clinical Correlates: Superficial Infections and Intra-Cranial Spread)

How might infections occurring on the face become immediately more serious?

(Topic: Major Veins of the Head and Neck)

Answer 397

There is significant communication between extra-cranial and intra-cranial veins. As a result, infections occurring on the face (particularly in a region called the ‘danger triangle’) and scalp can potentially track intra-cranially via the cavernous sinus, to involve the brain and/or its associated structures, becoming immediately more serious.

Question 398

(Clinical Correlates: Superficial Infections and Intra-Cranial Spread)

What is the ‘danger triangle’?

(Topic: Major Veins of the Head and Neck)

Answer 398

The area from the corners of the mouth to the bridge of the nose

Question 399

(Clinical Correlates: Superficial Infections and Intra-Cranial Spread)

How do infections occurring on the face and scalp potentially track intra-cranially?

(Topic: Major Veins of the Head and Neck)

Answer 399

Via the cavernous sinus

Question 400

How is the facial vein connected to the cavernous sinus and pterygoid venous plexus?

(Topic: Major Veins of the Head and Neck)

Answer 400

Via the superior and inferior opthalmic vein (respectively)

Question 401

How many internal jugular veins (IJV) do we have?

Topic: Major Veins of the Head and Neck

Answer 401

Two - a right and left

Question 402

The IJV arises as a continuation of what structure?

Topic: Major Veins of the Head and Neck

Answer 402

Cotinuation of the SIGMOID SINUS, a venous (dural) structure found within the skull.

Question 403

What are the dural venous sinuses?

Topic: Major Veins of the Head and Neck

Answer 403

Venous channels found between the endosteal and meningeal layers of dura mater in the brain.

Question 404

The sigmoid sinus gives rise to which structure?

Topic: Major Veins of the Head and Neck

Answer 404

IJV

Question 405

What is the sigmoid sinus?

Topic: Major Veins of the Head and Neck

Answer 405

Venous sinuses within the skull that receive blood from posterior dural venous sinuses.

Question 406

Where does the IJV run?

Topic: Major Veins of the Head and Neck

Answer 406

The length of the neck within the carotid sheath, as a straight line running from the lobule of the ear to the sternoclavicular joint.

Question 407

Throughout much of the IJV’s course, which muscle covers it anteriorly?

(Topic: Major Veins of the Head and Neck)

Answer 407

Sternocleidomastoid

Question 408

The sternocleidomastoid muscle covers the IJV __________ throughout much of its course?

(Topic: Major Veins of the Head and Neck)

Answer 408

Anteriorly

Question 409

The sternocleidomastoid muscle splits into two heads. What are their names?

(Topic: Major Veins of the Head and Neck)

Answer 409

Clavicular and sternal heads.

Question 410

What is the relation of IJV in association with the SCM muscle heads?

(Topic: Major Veins of the Head and Neck)

Answer 410

Towards the inferior end of the vein, the SCM muscle splits into its clavicular and sternal heads forming a gap anterior to the vein.

Question 411

What is the clinical signifiance of IJV in relation to SCM?

Topic: Major Veins of the Head and Neck

Answer 411

The SCM muscle splits into its clavicular and sternal heads, forming a gap anterior to the vien. The IJV can be readily accessed through this gap when inserting CENTRAL LINES (central venous catheters).

Question 412

Where can central lines be inserted in the neck?

Topic: Major Veins of the Head and Neck

Answer 412

In the internal jugular vein, found in the gap between the two heads of the SCM muscle.

Question 413

Apart from being the site of central line insertion, describe another clinical significance of the gap between the SCM muscle heads

(Topic: Major Veins of the Head and Neck)

Answer 413

This gap is also the area where the normal JUGULAR VENOUS PULSATION (JVP) can be seen, when patients are positioned at 45 degrees.

Question 414

Where can normal JVP be seen?

Topic: Major Veins of the Head and Neck

Answer 414

In the gap between the SCM muscle heads

Question 415

What position do patients need to be in to observe JVP?

Topic: Major Veins of the Head and Neck

Answer 415

45 degrees.

Question 416

Why are doctors interested in JVP?

Topic: Major Veins of the Head and Neck

Answer 416

Doctors use the JVP to give an indication of the pressures within the venous circulation and right side of the heart.

Question 417

How can you measure pressures within the venous circulation and right side of the heart?

(Topic: Major Veins of the Head and Neck)

Answer 417

By observing normal jugular venous pulsation (JVP).

Question 418

Which JVP is favoured for observation (right or left), and why?

(Topic: Major Veins of the Head and Neck)

Answer 418

The right JVP is favoured over the left, as the right has a straight, more vertical route into the right atrium and so better reflects pressures within the right side of the heart.

Question 419

Why is the right JVP favoured over the left for considering pressures within the right side of the heart?

(Topic: Major Veins of the Head and Neck)

Answer 419

The right JVP has a straight, more vertical route into the right atrium and so better reflects pressures within the right side of the heart.

Question 420

(Clinical Correlates: IJV and Central Venous Catheters)

What are common sites for insertion of central venous catheters?

(Topic: Major Veins of the Head and Neck)

Answer 420

Neck - internal jugular vein
Chest - subclavian or axillary vein
Groin - femoral vein
Arms - various veins (also known as a PICC line, or peripherally inserted central catheters)

Question 421

(Clinical Correlates: IJV and Central Venous Catheters)

Why is the knowledge of the course and anatomical relations of the IJV important to medical professionals?

(Topic: Major Veins of the Head and Neck)

Answer 421

For insertion of central venous catheters (CVCs)/central lines.

Question 422

(Clinical Correlates: IJV and Central Venous Catheters)

What are central lines used for?

(Topic: Major Veins of the Head and Neck)

Answer 422

Central lines are often used in patients hwo are very unwell for a variety of therapeutic and monitoring purposes, e.g. monitoring central venous pressure, administration of drugs, ease of repeated blood sampling and temporary haemodialysis.

Question 423

(Clinical Correlates: IJV and Central Venous Catheters)

Give 4 examples of applications of a central venous line.

(Topic: Major Veins of the Head and Neck)

Answer 423

• monitoring central venous pressure (blood pressure in the vena cava)
• administration of drugs
• ease of repeated blood sampling
• temporary haemodialysis (kidney dialysis)

Question 424

What other veins does the IJV receive blood from during its descent?

(Topic: Major Veins of the Head and Neck)

Answer 424

A number of other veins, including the facial vein, and VEINS DRAINING THE THYROID GLAND AND TONGUE.

Question 425

How does the (right and left) IJV end?

Topic: Major Veins of the Head and Neck

Answer 425

By joining with the SUBCLAVIAN vein (just behind the medial end of the clavicle)

Question 426

Where does the IJV join with the subclavian vein and which IJV?

(Topic: Major Veins of the Head and Neck)

Answer 426

Just behind the medial end of the clavicle, and this occurs on both the right and left IJV.

Question 427

The IJV joins with the subclavian vein to form which vein?

Topic: Major Veins of the Head and Neck

Answer 427

The BRACHIOCEPHALIC VEIN

Question 428

How is the brachiocephalic vein formed?

Topic: Major Veins of the Head and Neck

Answer 428

By joining the IJV and SUBCLAVIAN vein.

Question 429

What is the route of the IJV to the right atrium?

Topic: Major Veins of the Head and Neck

Answer 429

The IJV (right and left) ends by joining with the SUBCLAVIAN vein (just behind the medial end of the clavicle) to form the BRACHIOCEPHALIC VEIN, which then drains into the SUPERIOR VENA CAVA and thence the RIGHT ATRIUM.

Question 430

The brachiocephalic vein drains into which vein before reaching the right atrium?

(Topic: Major Veins of the Head and Neck)

Answer 430

The SUPERIOR VENA CAVA

Question 431

How is the external jugular vein formed?

Topic: Major Veins of the Head and Neck

Answer 431

The EXTERNAL JUGULAR VEIN (EJV) is formed by the joining of a number of VEINS THAT HAVE DRAINED THE SCALP AND THE DEEP STRUCTURES OF THE FACE.

Question 432

Which vein is formed by joining a number of veins that have drained the scalp and the deep structures of the face?

(Topic: Major Veins of the Head and Neck)

Answer 432

The EXTERNAL JUGULAR VEIN (EJV).

Question 433

Where does the EJV run?

Topic: Major Veins of the Head and Neck

Answer 433

Just beneath the skin, in the superficial cervical fascia of the neck.

Question 434

Which vein is deep to the thin platysma muscle but superficial to the sternocleidomastoid muscle?

(Topic: Major Veins of the Head and Neck)

Answer 434

The external jugular vein

Question 435

Where does the external jugular vein lie?

Topic: Major Veins of the Head and Neck

Answer 435

Deep to the thin platysma muscle but superficial to the SCM muscle

Question 436

Which is more readily visible - EJV or IJV (and why)?

Topic: Major Veins of the Head and Neck

Answer 436

While deep to the thin platysma muscle, EJV is superficial to the sternocleidomastoid muscle and thus MORE READILY VISIBLE THAN THE IJV.

Question 437

Where does the EJV ultimately drain into?

Topic: Major Veins of the Head and Neck

Answer 437

The subclavian vein

Question 438

How does the EJV drain into the subclavian vein?

Topic: Major Veins of the Head and Neck

Answer 438

After piercing the investing layer of deep cervical fascia at the lower end of the neck.

Question 439

Image: Fig. 1

Label anterior and posterior on this image.

Answer 439

Anterior is towards the bottom, posterior is towards the back (cervical vertebra visible with spinous process extending)

Question 440

Image: Fig. 1

Identify the superficial cervical fascia

Answer 440

Outer yellow (with adipose)

Question 441

Image: Fig. 1

Identify the investing layer

Answer 441

Green

Question 442

Image: Fig. 1

Identify the pretracheal layer

Answer 442

Purple

Question 443

Image: Fig. 1

Identify the prevertebral layer

Answer 443

Blue

Question 444

Image: Fig. 1

Identify the carotid sheath

Answer 444

Red

Question 445

Image: Fig. 1

Identify the sternocleidomastoid muscles

Answer 445

Found in the investing layer anteriorly (bottom of picture)

Question 446

Image: Fig. 1

Identify the trapezius muscles

Answer 446

Found in the investing layer posteriorly (top of picture)

Question 447

Image: Fig. 1

Identify the platysma muscles

Answer 447

Found in the superficial cervical layer (yellow) anteriorly (bottom of picture)

Question 448

Image: Fig. 1

Identify the spinous process

Answer 448

Pointy white bit in centre (line)

Question 449

Image: Fig. 1

Identify the superior articular processes

Answer 449

Side of cervical vertebra

Question 450

Image: Fig. 1

Identify the spinal cord

Answer 450

Central white dot

Question 451

Image: Fig. 1

Identify the nervous rami

Answer 451

Yellow in middle

Question 452

Image: Fig. 1

Identify the common carotid artery

Answer 452

Smaller shaded circle in carotid sheath

Question 453

Image: Fig. 1

Identify the internal jugular vein

Answer 453

Larger shaded circle in carotid sheath

Question 454

Image: Fig. 1

Identify the retropharyngeal space

Answer 454

Between blue and red/purple lines of cervical vertebra/oesophagus (between carotid sheaths)

Question 455

Image: Fig. 1

Identify the oesophagus

Answer 455

Most posterior of the prevertebral layer (spongy)

Question 456

Image: Fig. 1

Identify the thyroid

Answer 456

Both bow shaped structures in prevertebral layer

Question 457

Image: Fig. 1

Identify the trachea

Answer 457

Rings of cartilage which extends superior and inferior to the thyroid - can see top-most rings of cartilage

Question 458

Image: Fig. 2

Identify the trachea

Answer 458

See image

Question 459

Image: Fig. 2

Identify the oesophagus

Answer 459

See image

Question 460

Image: Fig. 2

Identify the carotid sheath

Answer 460

See image

Question 461

Image: Fig. 2

Identify the retropharyngeal space

Answer 461

See image

Question 462

Image: Fig. 2

Identify the prevertebral fascia

Answer 462

See image

Question 463

Image: Fig. 2

Identify the pretracheal fascia

Answer 463

See image

Question 464

Image: Fig. 2

Identify lose connective tissue

Answer 464

See image

Question 465

What is the function of occipitofrontalis?

Answer 465

Raises eyebrows, produces horizontal wrinkles forehead (see Fig. 3)

Question 466

Which muscles raises the eyebrows and wrinkles the forehead?

Answer 466

Occipitofrontalis (see Fig. 3)

Question 467

What is the function of corrugator supercilii?

Answer 467

Draws the eyebrows downward and medially (frowning), producing vertical wrinkles of the forehead (see Fig. 3)

Question 468

Which muscle is responsible for ‘frowning’?

Answer 468

Corrugator supercilii (see Fig. 3)

Question 469

What is the function of procerus together with the transverse part of nasalis?

Answer 469

Procerus draws down the medial angle of the eyebrow, assisting in flaring the nostrils and frowning

The transverse part of nasalis assists in elevating the corners of the nostrils (‘flaring’) (see Fig. 3)

Question 470

Which muscles flare the nostrils whilst frowning?

Answer 470

Procerus + transverse part of nasalis (see Fig. 3)

Question 471

What is the function of orbicularis oculi?

Answer 471

Closes the eyelids (see Fig. 3)

Question 472

Which muscle closes the eyelids?

Answer 472

Orbicularis oculi (see Fig. 3)

Question 473

What is the function of levator labii superioris alaeque nasi muscle with the alar part of nasalis?

Answer 473

Levator labii superioris alaeque nasi (Lev. labii sup. alaeque nasi) - Latin for “lifter of both the upper lip and of the wing of the nose” - dilates the nostril, elevates the upper lip and wing of the nose.

The alar part of nasalis elevates corners of the nostrils (see Fig. 3)

Question 474

Which muscles dilate the nostrils?

Answer 474

Levator labii superioris alaeque nasi + alar part of nasalis (see Fig. 3)

Question 475

What is the function of the buccinator + orbicularis oris muscles together?

Answer 475

The buccinator compresses the cheeks against the teeth and is used in acts such as blowing.

Orbicularis oris is used to pucker the lips (‘kissing muscle’) (see Fig. 3)

Question 476

What is the function of zygomaticus major + minor?

Answer 476

Zygomaticus major draws the angle of the mouth upward and laterally i.e. smiling

Zygomaticus minor elevates the upper lip (see Fig. 3)

Question 477

Which muscles are used in genuine smiling?

Answer 477

Zygomaticus major + minor (see Fig. 3)

Question 478

What is the function of risorius?

Answer 478

Retracts the angle of the mouth to produce a smile - although does not involve the skin around the eye ‘fake smile’ (see Fig. 3) (as opposed to the zygomaticus muscles which cause “crow’s feet” around the eyes via orbicularis oculi” (see Fig. 3)

Question 479

Which muscle is used to produce a smile that does not involve the eyes?

Answer 479

Risorius (see Fig. 3)

Question 480

What is the function of risorius together with depressor labii inferioris?

Answer 480

Risorius - ‘fake smile’

Depressor labii inferioris - depression of the lower lip (see Fig. 3)

Question 481

Which muscles produce an open-mouthed smile (albeit disingenuous)?

Answer 481

Risorius + depressor labii inferioris (see Fig. 3)

Question 482

What is the function of levator labii superioris together with depressor labii inferioris?

Answer 482

levator labii superioris - elevates the upper lip

Depressor labii inferioris - depresses the lower lip (see Fig. 3)

Question 483

Which two muscles open the mouth in such a way to bare one’s teeth?

Answer 483

Levator labii sup. + depressor labii (see Fig. 3)

Question 484

Image: Fig. 4

What is this clinical presentation representative of?

Answer 484

Weakness of the facial muscles on one side in association with an ipsilateral parotid enlargement is highly likely to be a PAROTID CANCER.

Question 485

Image: Fig. 5

Label the vertebra C5-T1

Answer 485

See image

Question 486

Image: Fig. 5

Identify the middle scalene muscle

Answer 486

See image

Question 487

Image: Fig. 5

Identify the anterior scalene muscle

Answer 487

See image

Question 488

Image: Fig. 5

Identify the brachial plexus

Answer 488

See image

Question 489

Image: Fig. 5

Identify the subclavian artery

Answer 489

See image

Question 490

Image: Fig. 5

Identify the subclavian vein

Answer 490

See image

Question 491

Image: Fig. 5

Identify the clavicle

Answer 491

See image

Question 492

Image: Fig. 6

Identify the vertebral artery

Answer 492

Passes through transverse foramina of cervical vertebrae

Question 493

Image: Fig. 6

Identify the common carotid artery

Answer 493

See image

Question 494

Image: Fig. 6

Identify the subclavian artery

Answer 494

See image

Question 495

Image: Fig. 6

Identify the transverse foramina of the cervical vertebrae

Answer 495

Vertebral artery runs through here

Question 496

Image: Fig. 6

Identify the subarachnoid space between C1 and the occipital bone

Answer 496

Vertebral artery curbes here

Question 497

Image: Fig. 6

Identify the foramen magnum

Answer 497

Where the vertebral artery enters the skull

Question 498

Image: Fig. 7

Identify the right internal carotid artery

Answer 498

See image

Question 499

Image: Fig. 7

Identify the right external carotid artery

Answer 499

See image

Question 500

Image: Fig. 8

Identify the carotid sheath

Answer 500

See image

Question 501

Image: Fig. 8

Identify sternocleidomastoid

Answer 501

See image

Question 502

Image: Fig. 8

Identify the spinal part of the accessory nerve

Answer 502

See image

Question 503

Image: Fig. 8

Identify the posterior triangle

Answer 503

See image

Question 504

Image: Fig. 8

Identify trapezius

Answer 504

See image

Question 505

Image: Fig. 9a

Identify the supra-orbital vein

Answer 505

See image

Question 506

Image: Fig. 9a

Identify the vorticose veins

Answer 506

See image

Question 507

Image: Fig. 9a

Identify the superior ophthalmic vein

Answer 507

See image

Question 508

Image: Fig. 9a

Identify the approx. location of the cavernous sinus

Answer 508

See image

Question 509

Image: Fig. 9a

Identify the inferior ophthalmic vein

Answer 509

See image

Question 510

Image: Fig. 9a

Identify the approx. location of the pterygoid venous plexus

Answer 510

See image

Question 511

Image: Fig. 9a

Identify the infra-orbital vein

Answer 511

See image

Question 512

Image: Fig. 9a

Identify the angular vein

Answer 512

See image

Question 513

Image: Fig. 9a

Identify the facial vein

Answer 513

See image

Question 514

Image: Fig. 9b

What is the relevance of this triangle?

Answer 514

The ‘danger triangle’, where infections here are susceptible to spreading to the brain due to intracranial and extracranial communication.

Question 515

Image: Fig. 10

What is this image showing?

Answer 515

A central venous catheter in a patient via the internal jugular vein.

Question 516

Image: Fig. 11

Which is the left and right side of this image?

Answer 516

Left side is the right half of the image

Question 517

Image: Fig. 11

Which muscles have been removed to visualise the veins in this image?

Answer 517

Sternocleidomastoid muscles

Question 518

Image: Fig. 11

Identify the external jugular vein

Answer 518

See image

Question 519

Image: Fig. 11

Identify the subclavian vein

Answer 519

See image

Question 520

Image: Fig. 11

Identify the left brachiocephalic vein

Answer 520

See image

Question 521

Image: Fig. 11

Identify the internal jugular vein

Answer 521

See image