Session 1.1a - Pre-Reading Flashcards
Workbook
What does the head consist of?
The scalp, skull, brain and its coverings (the meninges).
What covers the brain?
The meninges
Name 5 sense organs that our head houses senses for.
The head houses our special sense organs for taste, vision, olfaction (“smell”), hearing and balance.
What does “olfaction” mean?
Smell
Where do cranial nerves arise from?
The central nervous system (mainly the brainstem).
What do cranial nerves innervate?
Structures of the head and neck.
What is the route of cranial nerves?
They course through the skull to reach their target tissues.
For some nerves, this includes whole or part of the length of the neck.
Where do blood vessels that supply the head and neck structures arise from or drain into?
Branches of large arteries (common carotids) and veins (subclavian veins).
Which arteries and veins do the vessels supplying the structures of the head and neck arise/drain into?
Arteries - common carotids
Veins - subclavian veins
Where do the common carotids and subclavian veins travel?
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.
Where do the common carotids and subclavian veins travel in close proximity to?
The thyroid gland, aerodigestive tracts, muscles and cervical vertebrae.
How much area does the head and neck anatomy (blood vessels) take up?
In essence, there is a lot of anatomy packed into a space similar in circumference to your leg!
Where does the neck extend from?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
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)
How are structures in the neck compartmentalised?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
By layers of CERVICAL FASCIA
What are the cervical fascia layers?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
Broadly speaking:
- a SUPERFICIAL CERVICAL FASCIA layer (just below the skin)
- three DEEP CERVICAL FASCIAL layers.
What type of tissue is the superficial cervical fascial layer?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Loose connective tissue
What does the superficial cervical fascial layer mainly contain?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Adipose
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)
ANTERIOR and EXTERNAL JUGULAR VEINS
What else, other than blood vessels, lie within the superficial cervical fascial layer?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
- Cutaneous nerves
- Superficial lymph nodes
- PLATYSMA muscle
What are the three layers of deep cervical fascia?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
From most superficial to deep, you have the:
- INVESTING LAYER
- PRETRACHEAL LAYER (middle)
- PREVERTEBRAL LAYER (deep).
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)
Most anatomy texts will refer to this as the INVESTING LAYER.
The carotid sheath is normally known as the carotid sheath.
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)
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).
Cervical Fascial Layers: Variation in Terminology Used
What is the prevertebral fascia sometimes described as?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
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).
How is the investing layer of the deep cervical fascia organised?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
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.
What is the first thing you should encounter when you dissect the neck?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
The investing layer should be the immediately visible fascial layer.
Where does the superior margin of the investing layer attach?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
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.
Where does the investing layer attach to posteriorly?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The spinous processes of the vertebrae and ligamentum nuchae.
Where does the investing layer attach to inferiorly?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The upper border of the manubrium, the upper surface of the clavicle, acromion and spine of the scapula.
Why does the investing layer split?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
To enclose the STERNOCLEIDOMASTOID and TRAPEZIUS MUSCLES, and the SUBMANDIBULAR and PAROTID SALIVARY GLANDS.
Describe the middle layer of the deep cervical fascia in size and location.
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
The PRETRACHEAL LAYER is thin and limited to the anterior and lateral part of the neck.
What is the pretracheal layer attached to superiorly and anteriorly?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
The hyoid bone
What is the pretracheal layer attached to inferiorly?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
It EXTENDS INTO THE THORAX where it BLENDS WITH THE FIBROUS PERICARDIUM.
What does the pretracheal layer enclose?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
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.
What two layers does the pretracheal layer consist of?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
A muscular layer and a visceral layer
What does the muscular layer of the pretracheal layer enclose?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
THE INFRAHYOID MUSCLES
self-note: also known as strap muscles
What does the visceral layer of the pretracheal layer enclose?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
The THYROID GLAND, TRACHEA and OESOPHAGUS
How does the pretracheal layer enclose the thyroid gland?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
Its [the pretracheal layer] visceral layer splits around the thyroid gland to form a FALSE capsule.
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)
(The muscles of) the pharynx and oesophagus
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)
The BUCCOPHARYNGEAL FASCIA
What is the buccopharyngeal fascia?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
FASCIA ASSOCIATED WITH THE PHARYNX AND OESOPHAGUS
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)
From the BASE OF THE SKULL superiorly, and to the DIAPHRAGM inferiorly
Where does the buccopharyngeal layer begin superiorly?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The BASE OF THE SKULL
Where does the buccopharyngeal layer end inferiorly?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The DIAPHRAGM
What is the carotid sheath?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
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.
Where does the carotid sheath extend to and from?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The base of the skull, through the root of the neck, to the arch of aorta
Where does the carotid sheath begin superiorly?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The base of the skull.
Where does the carotid sheath run through?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The root of the neck (between the base of the skull and arch of aorta)
Where does the carotid sheath end inferiorly?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The arch of aorta
What is inside the carotid sheath?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
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)
What is the major artery found inside the carotid sheath?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The COMMON CAROTID ARTERY
What is the major vein found inside the carotid sheath?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The INTERNAL JUGULAR VEIN
What is the major nerve found inside the carotid sheath?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The VAGUS NERVE [CN X] (which is a cranial nerve [CN])
How are the structures of the neck compartmentalised?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
By a series of fascial layers
What is the deepest (or innermost) layer of the deep cervical fascia called?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
The PREVERTEBRAL layer
What does the prevertebral layer do?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
Forms a sheath for the vertebral column and muscles associated with it
Where does the prevertebral layer extend from?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The base of the cranium to the 3rd thoracic vertebra
Where does the prevertebral layer extend from superiorly?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The base of the cranium
Where does the prevertebral layer extend from inferiorly?
The 3rd thoracic vertebra
The prevertebral layer extends laterally to form what?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The AXILLARY SHEATH
The axillary sheath surrounds which structures?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The AXILLARY VESSELS and the BRACHIAL PLEXUS OF NERVES running into the upper limb.
(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)
The layers of DEEP CERVICAL FASCIA form NATURAL CLEAVAGE PLANES that allow structures to move and pass over one another with easy
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)
The layers of DEEP CERVICAL FASCIA form NATURAL CLEAVAGE PLANES that allow easy separation of tissues during surgery.
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)
The fascial layers determine the DIRECTION AND EXTENT to which any INFECTION occurring within the neck may spread.
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)
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.
The fascial compartmentalisation of structures in the neck is important for what?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
This means they can give rise to potential SPACES BETWEEN FASCIAL PLANES.
What do the deep neck spaces (between the fascial planes) contain?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Loose connective tissue, so they are not technically “empty” spaces.
What might cause a fascial “space” (between fascial planes) to distend?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Infection or an abscess can arise between the fascial planes causing these “spaces” to distend (DEEP NECK SPACE INFECTIONS).
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)
It would cause them to distend
What are deep neck space infections?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
DEEP NECK SPACE INFECTIONS are an infection or an abscess arising between the fascial planes, causing the “spaces” in between them to distend.
How do deep neck space infections occur?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The infective SOURCE often originates in the teeth, tissues of the pharynx, sinuses or middle ear, and spreads.
Name 4 common locations of sources of deep neck space infections.
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
- The teeth
- Tissues of the pharynx
- Sinuses
- Middle ear
(which then spread to produce deep neck space infections)
Why is it important for doctors to be aware of deep neck space infections?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
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.
What is the retropharyngeal space?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
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).
Give an example of a deep neck space.
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The RETROPHARYNGEAL SPACE
there are others
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)
The RETROPHARYNGEAL SPACE
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)
LYMPH NODES, WHICH DRAIN AREAS OF THE NOSE, ORAL CAVITY AND UPPER PHARYNX.
The superior part of the retropharyngeal space contains lymph nodes until what age?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
3-4 years
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)
The superior part
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)
- THE NOSE
- ORAL CAVITY
- UPPER PHARYNX
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)
The pharynx
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)
- Move freely on the vertebral column
- Expand during swallowing
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)
The mediastinum
Retropharyngeal infections may spread inferiorly into the thorax. How?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
The retropharyngeal space lies between fascial layers that extend the length of the neck, into the mediastinum, so infections may travel here.
Retropharyngeal infections may spread inferiorly, where?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
Into the thorax and mediastinum
Retropharyngeal infections may lead to the development of which condition?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Mediastinitis (rare, but life-threatening condition)
https://emedicine.medscape.com/article/425308-overview
What is a complication of retropharyngeal infections?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
The development of mediastinitis (because the retropharyngeal space extends into the mediastinum)
What is mediastinitis?
Topic: Organisation of Neck Structures by Cervical Fascial Planes
A rare, but life-threatening condition.
https://emedicine.medscape.com/article/425308-overview
Self-Note: See additional notes!
(Clinical Correlates: Retropharyngeal Space Infections)
What can develop from a retropharyngeal space infection?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Retropharyngeal abscess
(Clinical Correlates: Retropharyngeal Space Infections)
What age group do retropharyngeal abscesses normally affect?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Children under 5 years
(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)
History of stiff neck, e.g. for a couple of days
Hesistant to turn their neck left or right
(Clinical Correlates: Retropharyngeal Space Infections)
Do patients with pharyngeal abscesses have fever?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
They often present with a high temperature, but can be afebrile (no fever)
(Clinical Correlates: Retropharyngeal Space Infections)
What does afebrile mean?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
No fever
(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)
It will often be decreased, such as the patient only wanting to drink liquids, because they may have difficulty swallowing
(Clinical Correlates: Retropharyngeal Space Infections)
What does PO mean?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Per os (oral)
i.e. “decreased PO intake” = decreased oral intake
(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)
The patient may have problems with keeping saliva in their mouth, which can be shown visibly by drooling
(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)
If they have been drooling
This can be visible by wet patches on their clothing, especially in young children
(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)
It might feel tender to palpate, and the tenderness may not be focal, it can be tender both anteriorly and posteriorly
(Clinical Correlates: Retropharyngeal Space Infections)
What are retropharyngeal abscesses commonly misdiagnosed as?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Meningitis
(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)
Negative
(Clinical Correlates: Retropharyngeal Space Infections)
What is the Brudzinski sign?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Where severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
(Clinical Correlates: Retropharyngeal Space Infections)
What is a differential between diagnosing meningitis and retropharyngeal abscesses?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Normally, in meningitis, the Brudzinski sign is positive, whereas in retropharyngeal abscesses the Brudzinski sign is negative
(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)
Flexing the neck will hurt
Light palpation may also hurt - the patient may nearly cry even on light palpation!
(Clinical Correlates: Retropharyngeal Space Infections)
What is a HEENT exam?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
A physical examination concerning the head, eyes, ears, nose and throat.
(Clinical Correlates: Retropharyngeal Space Infections)
What is the tympanic membrane?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
The eardrum
(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)
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.
(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)
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)
(Clinical Correlates: Retropharyngeal Space Infections)
What is uvula deviation?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
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.
(Clinical Correlates: Retropharyngeal Space Infections)
How might the uvula appear in a retropharyngeal abscess?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Deviated (potentially) and inflamed
(Clinical Correlates: Retropharyngeal Space Infections)
Which nerve innervates the uvula?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
The vagus nerve
(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)
It is the contralateral nerve, so a right uvula deviation means a LEFT motor nerve lesion.
(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)
CT scans
(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)
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)
(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)
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.
(Clinical Correlates: Retropharyngeal Space Infections)
Why is it important to be aware of retropharyngeal abscesses?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
These can commonly be misdiagnosed - patient may just think they have a sore throat even!
If it is missed, retropharyngeal abscesses are very serious.
(Clinical Correlates: Retropharyngeal Space Infections)
What are complications of retropharyngeal abscesses?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
They can dissect down in the mediastinum or rupture and cause airway compromise.
(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)
Retropharyngeal space infections
(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)
Upper respiratory tract infection
(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)
In the retropharyngeal space
(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)
Nasal cavity
Nasopharynx
Oropharynx
(Clinical Correlates: Retropharyngeal Space Infections)
What age group do retropharyngeal space infections usually affect?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
Children, usually under the age of 5 years.
(Clinical Correlates: Retropharyngeal Space Infections)
Infection in the retropharyngeal space can develop into what?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
An abscess
(Clinical Correlates: Retropharyngeal Space Infections)
A retropharyngeal abscess can develop from what?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
An infection in the retropharyngeal space
(Clinical Correlates: Retropharyngeal Space Infections)
Name 6 signs and symptoms of a retropharyngeal abscess.
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
- 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
(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)
They carry significant morbidity and mortality.
(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)
Deglutition
(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)
Define retrosternal goitre.
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
A goitre with a portion of its mass >50% located in the mediastinum.
(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)
A retrosternal goitre
(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)
A goitre will move with swallowing
(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)
Diseases affecting the thyroid gland can cause enlargement of the gland or discrete (separate) lumps to appear.
(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)
This examination is to observe whether the swelling moves (which it will with goitre).
(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)
To help localise pathology to the thyroid gland.
(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)
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.
(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)
Pre-tracheal fascia
(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)
The hyoid bone
(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)
The pre-tracheal fascia
(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)
The hyoid bone
The larynx
(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)
The thyroid gland
(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)
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.
(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)
RETROSTERNALLY (behind the sternum)
(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)
Define retrosternally.
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
RETROSTERNALLY = behind the sternum
(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)
Because the LOWER LIMIT OF THE PRE-TRACHEAL FASCIA EXTENDS INTO THE THORAX.
(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)
The LOWER LIMIT OF THE PRE-TRACHEAL FASCIA EXTENDS INTO THE THORAX.
(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)
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.
(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)
Compression of other structures running through the root of the neck (thoracic inlet) such as the trachea and venous blood vessels.
(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)
Structures running through the root of the neck
(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)
Thoracic inlet
(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)
What is the thoracic inlet?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
The opening at the top of the thoracic cavity at the root of the neck
(Clinical Correlates: Lumps in the Thyroid Gland and Retrosternal Goitres)
Where is the thoracic inlet?
(Topic: Organisation of Neck Structures by Cervical Fascial Planes)
The root of the neck
(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)
The trachea and venous blood vessels
(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)
Retrosternal extension of a goitre
(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)
Venous blood vessels
(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)
Breathlessness
Stridor
(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)
The compression of the venous blood vessels will lead to the impediment of venous drainage from the head and neck, causing facial oedema.
(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)
Breathlessness
Stridor
Facial oedema
(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)
This is due to the goitre extending retrosternally and compressing structures in the thoracic inlet - namely, the trachea, which causes breathlessness and stridor.
(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)
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.
(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)
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.
How are the muscles of the head (and face) divided?
Topic: Major Muscle Groups
Into TWO BROAD GROUPS, based on commonalities in their function and nerve supply.
What are the two broad major muscle groups?
Topic: Major Muscle Groups
The MUSCLES OF FACIAL EXPRESSION and the MUSCLES OF MASTICATION.
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)
The muscles of the scalp (occipitofrontalis) and muscle of the cheek (BUCCINATOR)
What is the muscle of the scalp which is included in muscles of facial expression?
(Topic: Major Muscle Groups)
Occipitofrontalis
What is the muscle of the cheek which is included in muscles of facial expression?
(Topic: Major Muscle Groups)
Buccinator
Where is the occipitofrontalis muscle?
Topic: Major Muscle Groups
In the scalp
Where is the buccinator muscle?
Topic: Major Muscle Groups
In the cheek
In which group is the occipitofrontalis muscle included in?
Topic: Major Muscle Groups
Muscles of facial expression
In which group is the buccinator muscle included in?
Topic: Major Muscle Groups
Muscles of facial expression
Muscles of facial expression are essentially …
Topic: Major Muscle Groups - Muscles of Facial Expression
Muscles of the face
Muscles of the face are known as …
Topic: Major Muscle Groups - Muscles of Facial Expression
MUSCLES OF FACIAL EXPRESSION
Where do muscles of facial expression lie?
Topic: Major Muscle Groups - Muscles of Facial Expression
In THE SUBCUTANEOUS TISSUE
What do muscles of facial expression attach to?
Topic: Major Muscle Groups - Muscles of Facial Expression
They ATTACH TO BONE, FASCIA AND OFTEN EACH OTHER
Where do most muscles of facial expression attach to?
Topic: Major Muscle Groups - Muscles of Facial Expression
Just beneath the skin
Why do most muscles of facial expression attach just beneath the skin?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
This allows their contraction to pull the skin in particular ways, giving rise to the breadth of facial expressions we possess
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)
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.
Broadly speaking, how are the muscles of facial expression arranged?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
Broadly speaking, the muscles will act as either SPHINCTERS or DILATORS around the orifices of the face.
What is a sphincter muscle?
Topic: Major Muscle Groups - Muscles of Facial Expression
A circular muscle
What are dilator muscles?
Topic: Major Muscle Groups - Muscles of Facial Expression
A muscle that widens a body part
What are the orifices of the face?
Topic: Major Muscle Groups - Muscles of Facial Expression
The orbits of the eye, the nose and mouth
What is the “orbit”, in anatomy?
Topic: Major Muscle Groups - Muscles of Facial Expression
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.
What is an exception to the sphincter/dilator type muscle in the face?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
The BUCCINATORS
What are the buccinators?
Topic: Major Muscle Groups - Muscles of Facial Expression
The muscles of your cheek
How do the buccinators ensure food remains within the oral cavity when chewing?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
They keep the cheek taut to ensure food is kept in the oral cavity (rather than ‘pooling’ between the cheek and teeth)
How does the face ensure food remains within the oral cavity properly when chewing?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
Via the BUCCINATOR muscles, which keep the cheek taut
What would happen to food in our oral cavity without the buccinator muscles?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
Food would ‘pool’ between the cheek and teeth.
The muscles of facial expression are innervated by which nerve?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
Branches of the facial nerve
Branches of the facial nerve innervate which muscles?
Topic: Major Muscle Groups - Muscles of Facial Expression
All the muscles of facial expression
The facial nerve branch innervates which muscle is the neck?
Topic: Major Muscle Groups - Muscles of Facial Expression
The PLATYSMA, a superficial muscle in the neck
The platysma is innervated by which nerve?
Topic: Major Muscle Groups - Muscles of Facial Expression
The PLATYSMA is innervated by a branch of the facial nerve.
In which compartment of the neck is the platysma muscle found?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
It is a superficial muscle of the neck.
The facial nerve is also known as what?
Topic: Major Muscle Groups - Muscles of Facial Expression
Cranial nerve VII
Cranial nerve VII is also known as what?
Topic: Major Muscle Groups - Muscles of Facial Expression
The facial nerve
Where does the facial nerve originate?
Topic: Major Muscle Groups - Muscles of Facial Expression
At the brainstem (inside the skull)
Does the facial nerve exit the skull?
Topic: Major Muscle Groups - Muscles of Facial Expression
Yes - it exits the base of the skull to become extracranial (i.e. outside skull)
How would you describe a structure that is outside the skull?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
Extracranial
Where does the facial nerve exit the skull?
Topic: Major Muscle Groups - Muscles of Facial Expression
At the base
What happens to the facial nerve once it exits the skull?
Topic: Major Muscle Groups - Muscles of Facial Expression
It runs through the SUBSTANCE OF THE PAROTID GLAND.
Which gland does the facial nerve run through extracranially?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
THE PAROTID GLAND
What is the parotid gland?
Topic: Major Muscle Groups - Muscles of Facial Expression
THE PAROTID GLAND is a salivary gland that sits just anterior and inferiorly to your ear.
Name the salivary gland that sits just anterior and inferiorly to your ear.
(Topic: Major Muscle Groups - Muscles of Facial Expression)
THE PAROTID GLAND
Where does the parotid gland lie?
Topic: Major Muscle Groups - Muscles of Facial Expression
Anterior and inferiorly to the ear.
What is the position of the facial nerve and its branches within the parotid gland?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
They run relatively superficial.
Which nerve is vulnerable to damage in facial injuries?
Topic: Major Muscle Groups - Muscles of Facial Expression
Facial nerve (branches)
Which nerve can be injured due to disease or surgery of the parotid gland, and why?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
(Branches) of the facial nerve, because they run relatively superficial within the gland.
How can the facial nerve be damaged?
Topic: Major Muscle Groups - Muscles of Facial Expression
- Facial injury
- Disease of the parotid gland
- Surgery of the parotid gland
How does the facial nerve divide in the parotid gland?
Topic: Major Muscle Groups - Muscles of Facial Expression
It divides into FIVE TERMINAL EXTRACRANIAL BRANCHES
How many branches of the facial nerve are located in the parotid gland?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
FIVE
The facial nerve divides into five terminal extracranial branches (amongst other branches). Where does this occur?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
In the parotid gland.
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)
These branches distribute widely over the face to innervate the various muscles of facial expression.
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)
Ipsilateral
Define ipsilateral.
(Topic: Major Muscle Groups - Muscles of Facial Expression)
Belonging to or occurring on the same side of the body.
Injury or pathology affecting the facial nerve will cause weakness of which muscles?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
Weakness of the muscles of facial expression on the ipsilateral side of damage.
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)
Injury or pathology affecting the facial nerve on the ipsilateral side.
i.e. left-sided weakness = left facial nerve injury
What is the most common non-traumatic cause of facial paralysis?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
The MOST COMMON NON-TRAUMATIC cause of FACIAL PARALYSIS is INFLAMMATION of the FACIAL NERVE (Bell’s palsy).
What is Bell’s palsy?
Topic: Major Muscle Groups - Muscles of Facial Expression
THE MOST COMMON NON-TRAUMATIC cause of FACIAL PARALYSIS, due to INFLAMMATION of the FACIAL NERVE ipsilaterally.
Inflammation of the facial nerve is also known as?
Topic: Major Muscle Groups - Muscles of Facial Expression
BELL’S PALSY
Inflammation of the facial nerve can cause?
Topic: Major Muscle Groups - Muscles of Facial Expression
(Otherwise known as BELL’S PALSY)
FACIAL PARALYSIS
What can inflammation of the facial nerve lead to?
Topic: Major Muscle Groups - Muscles of Facial Expression
The inflammation causes oedema and compression of the nerve as it runs through the base of the skull.
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)
Bell’s palsy
(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)
PAROTID CANCER
(Clinical Correlates)
Name some signs and symptoms of parotid cancer.
(Topic: Major Muscle Groups - Muscles of Facial Expression)
Weakness of the facial muscles on one side IN ASSOCIATION with an IPSILATERAL parotid enlargement is HIGHLY LIKELY TO BE A PAROTID CANCER.
(Clinical Correlates)
Which nerve is likely to be damaged in parotid cancer?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
The cancerous cells invade and damage the facial nerve during its course through the gland.
(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)
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).
(Clinical Correlates)
How does parotid cancer cause facial nerve damage?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
The facial nerve courses through the parotid gland, which is therefore damaged and invaded by the cancerous cells.
(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)
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.
(Clinical Correlates)
Give an example of an infective or inflammatory condition of the parotid gland.
(Topic: Major Muscle Groups - Muscles of Facial Expression)
Mumps
(Clinical Correlates)
What causes facial muscle weakness?
(Topic: Major Muscle Groups - Muscles of Facial Expression)
Damage to the facial nerve
How many muscles of mastication are there?
Topic: Major Muscle Groups - Muscles of Mastication
4
What do the muscles of mastication do?
Topic: Major Muscle Groups - Muscles of Mastication
The four muscles all act to MOVE THE MANDIBLE AT THE TEMPOROMANDIBULAR JOINT (TMJ).
What is the mandible?
Topic: Major Muscle Groups - Muscles of Mastication
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.
What is the temporomandibular joint (TMJ)?
Topic: Major Muscle Groups - Muscles of Mastication
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.
Where does the temporomandibular joint lie?
Topic: Major Muscle Groups - Muscles of Mastication
Between the temporal bone of the skull and the mandible (jaw) of the face.
What is another term for chewing (food)?
Topic: Major Muscle Groups - Muscles of Mastication
Masticating
What do the muscles of mastication do?
Topic: Major Muscle Groups - Muscles of Mastication
The four muscles all act to move the mandible at the TMJ, as is needed when chewing food (masticating).
Which nerve supplies the muscles of mastication?
Topic: Major Muscle Groups - Muscles of Mastication
They are all supplied by branches from the MANDIBULAR DIVISION OF THE TRIGEMINAL NERVE (a branch of CN V).
The branches of the mandibular division of which nerve innervates the muscles of mastication?
(Topic: Major Muscle Groups - Muscles of Mastication)
The TRIGEMINAL NERVE
Branches of which division of the trigeminal nerve innervate the muscles of mastication?
(Topic: Major Muscle Groups - Muscles of Mastication)
The MANDIBULAR DIVISION
The trigeminal nerve is a branch of what?
Topic: Major Muscle Groups - Muscles of Mastication
A branch of CN V (the fifth cranial nerve).
What are the muscles of mastication?
Topic: Major Muscle Groups - Muscles of Mastication
TEMPORALIS
MASSETER
and PTERYGOIDS (medial and lateral)
What does the temporalis muscle do?
Topic: Major Muscle Groups - Muscles of Mastication
It is a muscle of mastication
What does the masseter muscle do?
Topic: Major Muscle Groups - Muscles of Mastication
It is a muscle of mastication
What do the pterygoids muscles do?
Topic: Major Muscle Groups - Muscles of Mastication
They are muscles of mastication
Which muscle of mastication has a medial and lateral part?
Topic: Major Muscle Groups - Muscles of Mastication
Pterygoid
How can you palpate the contraction of the temporalis and masseter muscles?
(Topic: Major Muscle Groups - Muscles of Mastication)
By clenching your jaw
Which muscles of mastication can be palpated by clenching your jaw?
(Topic: Major Muscle Groups - Muscles of Mastication)
The contraction of the temporalis and masseter muscles
Where can you palpate the temporalis muscle?
Topic: Major Muscle Groups - Muscles of Mastication
Over the area of your temples
upon clenching your jaw
Where can you palpate the masster muscle?
Topic: Major Muscle Groups - Muscles of Mastication
The corner of your jaw as you clench your teeth
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)
Temporalis
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)
Masseter
Which muscles of mastication cannot be palpated?
Topic: Major Muscle Groups - Muscles of Mastication
The PTERYGOID MUSCLES, however, ARE NOT PALPABLE
Where do the pterygoid muscles lie?
Topic: Major Muscle Groups - Muscles of Mastication
Deep to the mandible
Why can the pterygoid muscles not be palpated?
Topic: Major Muscle Groups - Muscles of Mastication
They lie too deep.
Where do the pterygoid muscles originate?
Topic: Major Muscle Groups - Muscles of Mastication
From two bony plate-like projections at the base of the skull, called the pterygoid plates.
What are the two bony plate-like projections at the base of the skull?
(Topic: Major Muscle Groups - Muscles of Mastication)
The pterygoid plates
What are the pterygoid plates?
Topic: Major Muscle Groups - Muscles of Mastication
Two bony plate-like projections at the base of the skull, from which the pterygoid muscles originate.
Why are the pterygoid muscles so named?
Topic: Major Muscle Groups - Muscles of Mastication
They originate from the pterygoid plates (two bony plate-like projections at the base of the skull).
How are the pterygoid muscles angled (in relation to each other)?
(Topic: Major Muscle Groups - Muscles of Mastication)
Each pterygoid muscle is angled slightly different
Do the pterygoid muscles insert onto the same place?
Topic: Major Muscle Groups - Muscles of Mastication
Each pterygoid muscle inserts on to separate areas of the mandible
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)
Each pterygoid muscles is angled slightly different, and inserts on to separate areas of the mandible thus conferring their different actions on the jaw.
How do the pterygoid muscles work to open and close the jaw?
Topic: Major Muscle Groups - Muscles of Mastication
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).
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)
This enables them to confer their different actions on the jaw, one opening and one closing it.
(Hints and Tips: Red Box)
All the muscles of mastication, except one, act to do what?
(Topic: Major Muscle Groups - Muscles of Mastication)
ELEVATE THE MANDIBLE (close the jaw).
(Hints and Tips: Red Box)
Suggest a reason why all muscles of mastication close the jaw.
(Topic: Major Muscle Groups - Muscles of Mastication)
This action needs to be a powerful movement e.g. chewing food
(Hints and Tips: Red Box)
Which muscles depress the mandible/open the jaw?
(Topic: Major Muscle Groups - Muscles of Mastication)
DEPRESSING THE MANDIBLE involves a number of muscles, of which only one is part of the ‘muscles of mastication’ group.
(Hints and Tips: Red Box)
Which muscles are mainly involve in depressing the mandible?
(Topic: Major Muscle Groups - Muscles of Mastication)
A collective group of muscles called the ‘SUPRAHYOIDS’.
(Hints and Tips: Red Box)
What do the ‘suprahyoids’ do?
(Topic: Major Muscle Groups - Muscles of Mastication)
The main muscles involved in depressing the mandible
(Hints and Tips: Red Box)
What helps the ‘suprahyoids’ depress the mandible?
(Topic: Major Muscle Groups - Muscles of Mastication)
These are assisted by the pull of gravity and the LATERAL PTERYGOID.
(Hints and Tips: Red Box)
What is the action of the lateral pterygoid?
(Topic: Major Muscle Groups - Muscles of Mastication)
It assists in opening the mouth
- This can be remembered by how you pronounce lateral. Saying ‘Laaaaaa’teral requires you to open your mouth!
(Clinical Correlates)
Why might it be relevant to determine what ‘triangle’ a neck lump is located?
(Topic: Major Muscle Groups - Muscles of the Neck)
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.
How are the scalene muscles organised?
Topic: Major Muscle Groups - Muscles of the Neck
Into anterior, middle and posterior
What is the function of scalene muscles?
Topic: Major Muscle Groups - Muscles of the Neck
They act as accessory muscles of respiration
What forms the floor of the posterior triangle?
Topic: Major Muscle Groups - Muscles of the Neck
Scalene muscles
Which critical structures pass in close proximity to the scalene muscles?
(Topic: Major Muscle Groups - Muscles of the Neck)
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.
Where does the phrenic nerve arise?
Topic: Major Muscle Groups - Muscles of the Neck
From within the neck (C3,4,5)
Which nerve arises from C3,4,5 in the neck?
Topic: Major Muscle Groups - Muscles of the Neck
The phrenic nerve
What is the route of the phrenic nerve?
Topic: Major Muscle Groups - Muscles of the Neck
It arises from within the neck (C3,4,5), descends along the surface of the anterior scalene before entering into the thorax.
Where does the arterial supply to the head and neck arise?
Topic: Major Arteries of the Head and Neck
From branches of the RIGHT AND LEFT COMMON CAROTID ARTERIES and the VERTEBRAL ARTERIES.
What are the vertebral arteries?
Topic: Major Arteries of the Head and Neck
Branches of the SUBCLAVIAN ARTERIES
What do the vertebral arteries supply?
Topic: Major Arteries of the Head and Neck
The POSTERIOR NECK AND POSTERIOR PARTS OF THE BRAIN (e.g. BRAINSTEM, CEREBELLUM)
What arteries supply the posterior neck and posterior parts of the brain?
(Topic: Major Arteries of the Head and Neck)
The vertebral arteries, which are branches of the SUBCLAVIAN ARTERIES
Give 2 examples of structures found in the posterior parts of the brain.
(Topic: Major Arteries of the Head and Neck)
BRAINSTEM
CEREBELLUM
Where are the brainstem and cerebellum found?
Topic: Major Arteries of the Head and Neck
POSTERIOR PARTS OF THE BRAIN
Which arteries supply the brainstem and cerebellum?
Topic: Major Arteries of the Head and Neck
The vertebral arteries, which are branches of the SUBCLAVIAN ARTERIES
What route does the vertebral artery follow?
Topic: Major Arteries of the Head and Neck
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.
The vertebral artery ascends through the transverse foramina of which vertebrae?
(Topic: Major Arteries of the Head and Neck)
The TRANSVERSE FORAMINA OF THE CERVICAL VERTEBRAE (EXCEPT C7)
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)
it enters the subarachnoid space just between the atlas (1st cervical vertebra) and occipital bone.
What is the atlas?
Topic: Major Arteries of the Head and Neck
1st cervical vertebra
What is the occipital bone?
Topic: Major Arteries of the Head and Neck
The bone which forms the back and base of the skull and encircles the spinal cord.
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)
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.
What is the foramen magnum?
Topic: Major Arteries of the Head and Neck
The hole in the base of the skull through which the spinal cord passes
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)
The foramen magnum
What is the medulla?
Topic: Major Arteries of the Head and Neck
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.
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)
The medulla oblongata
The vertebral artery joins which artery to form what?
Topic: Major Arteries of the Head and Neck
The vertebral artery from the other side to form the BASILAR ARTERY.
Which two arteries form to basilar artery?
Topic: Major Arteries of the Head and Neck
The vertebral artery of both sides
What is the full route of the vertebral artery?
Topic: Major Arteries of the Head and Neck
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.
Where does the basilar artery run?
Topic: Major Arteries of the Head and Neck
Along the anterior (ventral) aspect of the brainstem (namely the pons)
Which artery runs along hte anterior aspect of the brainstem, namely the pons?
(Topic: Major Arteries of the Head and Neck)
The basilar artery
Where does the right common carotid artery originate?
Topic: Major Arteries of the Head and Neck
From the BRACHIOCEPHALIC ARTERY behind the right sternoclavicular joint
From which artery does the right common carotid artery originate?
(Topic: Major Arteries of the Head and Neck)
The BRACHIOCEPHALIC ARTERY
What artery originates from the brachiocephalic artery?
Topic: Major Arteries of the Head and Neck
The RIGHT COMMON CAROTID ARTERY
Which artery originates from behind the right sternoclavicular joint?
(Topic: Major Arteries of the Head and Neck)
The RIGHT COMMON CAROTID ARTERY
Where does the left common carotid artery arise?
Topic: Major Arteries of the Head and Neck
Directly from the ARCH OF THE AORTA
Which artery arises directly from the arch of the aorta?
Topic: Major Arteries of the Head and Neck
The LEFT COMMON CAROTID
Which is longer - the left or right common carotid artery?
Topic: Major Arteries of the Head and Neck
The left common carotid artery
Why is one common carotid artery longer than the other?
Topic: Major Arteries of the Head and Neck
The left common carotid artery is slightly longer as it courses for about 2 cm in the superior mediastinum before entering the neck.
Where does the common carotid artery ascend through the neck?
(Topic: Major Arteries of the Head and Neck)
Each common carotid artery ascends through the neck enclosed within the CAROTID SHEATH.
Which artery is enclosed within the carotid sheath?
Topic: Major Arteries of the Head and Neck
The common carotid artery.
What is the carotid sheath?
Topic: Major Arteries of the Head and Neck
A fascial envelope which encloses the CAROTID ARTERY, INTERNAL JUGULAR VEIN and VAGUS NERVE
What is the contents of the carotid sheath?
Topic: Major Arteries of the Head and Neck
The CAROTID ARTERY, INTERNAL JUGULAR VEIN and VAGUS NERVE.
Where does most of the carotid sheath run?
Topic: Major Arteries of the Head and Neck
Deep to the sternocleidomastoid muscle
How is the carotid sheath derived?
Topic: Major Arteries of the Head and Neck
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).
The carotid sheath is derived from fusion of which layer posteriorly?
(Topic: Major Arteries of the Head and Neck)
The PREVERTEBRAL LAYER of cervical fascia
The carotid sheath is derived from fusion of which layer anteromedially?
(Topic: Major Arteries of the Head and Neck)
The PRETRACHEAL LAYER
The carotid sheath is derived from fusion of which layer anterolaterally?
(Topic: Major Arteries of the Head and Neck)
The INVESTING LAYER of CERVICAL FASCIA
The prevertebral layer fuses to derive which part of the carotid sheath?
(Topic: Major Arteries of the Head and Neck)
Posterior
The pretracheal layer fuses to derive which part of the carotid sheath?
(Topic: Major Arteries of the Head and Neck)
Anteromedial
The investing layer fuses to derive which part of the carotid sheath?
(Topic: Major Arteries of the Head and Neck)
Anterolateral
Is the carotid sheath thick or thin?
Topic: Major Arteries of the Head and Neck
The sheath is thin over the vein but thicker around the artery.
What is the carotid sheath like around the vein?
Topic: Major Arteries of the Head and Neck
Thin
What is the carotid sheath like over the artery?
Topic: Major Arteries of the Head and Neck
Thicker here compared to over the vein
What is the position of the contents of the carotid sheath?
Topic: Major Arteries of the Head and Neck
The ARTERY lies MEDIALLY within the sheath whilst the VEIN is LATERAL and the NERVE BEHIND and in between the vessels.
Which structure of the carotid sheath lies medially?
Topic: Major Arteries of the Head and Neck
The ARTERY
Which structure of the carotid sheath lies laterally?
Topic: Major Arteries of the Head and Neck
The VEIN
Which structure of the carotid sheath lies behind and in between the vessels?
(Topic: Major Arteries of the Head and Neck)
The NERVE
Where does the artery lie in the carotid sheath?
Topic: Major Arteries of the Head and Neck
MEDIALLY
Where does the vein lie in the carotid sheath?
Topic: Major Arteries of the Head and Neck
LATERALLY
Where does the nerve lie in the carotid sheath?
Topic: Major Arteries of the Head and Neck
BEHIND and in between the vessels.
Where does the sympathetic chain lie in relation to the carotid sheath?
(Topic: Major Arteries of the Head and Neck)
The SYMPATHETIC CHAIN lies outside of the sheath, medially and behind it.
What lies outside of the carotid sheath, medially and behind it?
(Topic: Major Arteries of the Head and Neck)
The SYMPATHETIC CHAIN.
Where do the common carotids most commonly terminate?
Topic: Major Arteries of the Head and Neck
At the level of the UPPER BORDER OF THE THYROID CARTILAGE (C4 LEVEL).
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)
The common carotids MOST COMMONLY terminate here.
What do the common carotids divide into?
Topic: Major Arteries of the Head and Neck
INTERNAL and EXTERNAL CAROTID ARTERIES
What are the internal and external carotid arteries derived from?
(Topic: Major Arteries of the Head and Neck)
The common carotids.
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)
At this division, or bifurcation, the internal carotid artery is more bulbous
Which carotid artery is more bulbous at its bifurcation, and why?
(Topic: Major Arteries of the Head and Neck)
At this division, or birfurcation, the internal carotid artery is more bulbous due to the CAROTID SINUS (AND CAROTID BODY).
What does the carotid sinus (and carotid body) do to the artery in that area?
(Topic: Major Arteries of the Head and Neck)
It makes the internal carotid artery more bulbous in comparison to the external carotid artery.
Why is the site of the carotid sinus clinically important?
Topic: Major Arteries of the Head and Neck
The SITE OF THE CAROTID SINUS is clinically important as rubbing this area firmly can ALLEVIATE SUPRA-VENTRICULAR TACHYCARDIAS (SVTs) i.e. CAROTID MASSAGE.
Rubbing what area firmly can alleviate SVTs?
Topic: Major Arteries of the Head and Neck
The SITE OF THE CAROTID SINUS
The carotid massage is used for what and how?
Topic: Major Arteries of the Head and Neck
Rubbing the SITE OF THE CAROTID SINUS firmly can ALLEVIATE SUPRA-VENTRICULAR TACHYCARDIAS.
What is SVT?
Topic: Major Arteries of the Head and Neck
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)
(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)
Carotid sinus massage
What nerve innervates trapezius after innervating sternocleidomastoid?
(Topic: Major Arteries of the Head and Neck)
The spinal part of the accessory nerve
Where does the spinal part of the accessory nerve run?
Topic: Major Arteries of the Head and Neck
Across the posterior triangle
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)
Trapezius, after innervating sternocleidmastoid
(!)
Why should you NOT attempt to perform a carotid sinus massage on yourself?
(Topic: Major Arteries of the Head and Neck)
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!
(!)
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)
It may cause severe bradycardia and a significant drop in blood pressure.
DO NOT ATTEMPT!
How is the internal carotid artery distinguished?
Topic: Major Arteries of the Head and Neck
The INTERNAL CAROTID ARTERY is distinguished by a LACK OF BRANCHES IN THE NECK.
Which artery is distinguished by a lack of branches in the neck?
(Topic: Major Arteries of the Head and Neck)
The INTERNAL CAROTID ARTERY
What is the route of the internal carotid artery?
Topic: Major Arteries of the Head and Neck
It ascends then enter the base of the skull, through a bony canal called the CAROTID CANAL.
Which artery passes through the carotid canal?
Topic: Major Arteries of the Head and Neck
The internal carotid artery.
How does the internal carotid artery travel intracranially?
Topic: Major Arteries of the Head and Neck
its course intracranially involves passage through a structure called the CAVERNOUS SINUS.
As well as some of the cranial nerves, which structures courses intracranially through the cavernous sinus?
(Topic: Major Arteries of the Head and Neck)
The internal carotid artery
Where does the internal carotid artery branch?
Topic: Major Arteries of the Head and Neck
Once it exits the cavernous sinus
What do the branches of the internal carotid artery supply?
Topic: Major Arteries of the Head and Neck
The brain and the eye
The brain and theeye is suplied by ______?
Topic: Major Arteries of the Head and Neck
Branches of the internal carotid artery
The external carotid artery supplies what?
Topic: Major Arteries of the Head and Neck
The EXTERNAL CAROTID ARTERY, is the MAJOR SOURCE OF BLOOD SUPPLY TO EXTRACRANIAL STRUCTURES of the head and neck region.
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)
The external carotid artery.
How many branches does the external carotid artery give rise to?
(Topic: Major Arteries of the Head and Neck)
EIGHT BRANCHES
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)
The FACIAL ARTERY
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)
The tissues of the face
What are the branches of the external carotid artery?
Topic: Major Arteries of the Head and Neck
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
Which two branches are considered the terminal branches of the external carotid artery?
(Topic: Major Arteries of the Head and Neck)
The MAXILLARY AND SUPERFICIAL TEMPORAL ARTERIES
Where do the maxillary and superficial temporal arteries arise?
(Topic: Major Arteries of the Head and Neck)
At a level behind the neck of the mandible
Which branches of the ECA arise at a level behind the neck of the mandible?
(Topic: Major Arteries of the Head and Neck)
The MAXILLARY AND SUPERFICIAL TEMPORAL ARTERIES (terminal branches of the ECA)
Where do the terminal branches of the ECA travel through?
Topic: Major Arteries of the Head and Neck
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.
Which is the main blood supply to the parotid gland?
Topic: Major Arteries of the Head and Neck
The MAXILLARY AND SUPERFICIAL TEMPORAL ARTERIES (branches of the ECA)
As well as providing the parotid gland its blood supply, the maxillary artery also supplies what?
(Topic: Major Arteries of the Head and Neck)
Deep tissue and bone structures of the face e.g. paranasal air sinuses and nasal cavity.
Paranasal air sinuses and the nasal cavity are supplied by which structure?
(Topic: Major Arteries of the Head and Neck)
The maxillary artery
The maxillary artery branches to form which artery, to supply the meninges and skull bones?
(Topic: Major Arteries of the Head and Neck)
The MIDDLE MENINGEAL ARTERY
Where does the middle meningeal artery run?
Topic: Major Arteries of the Head and Neck
Through the base of the skull
What does the middle meningeal artery upply?
Topic: Major Arteries of the Head and Neck
The meninges and skull bones
What supplies the tissues of the scalp?
Topic: Major Arteries of the Head and Neck
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).
As well as the parotid gland, what does the superficial temporal artery supply?
(Topic: Major Arteries of the Head and Neck)
The tissues of thew scalp
Does the internal carotid artery supply the tissues of the scalp?
(Topic: Major Arteries of the Head and Neck)
Its branches which exit the skull through the orbit do (alongside the superficial temporal and external carotid artery).
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)
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.
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)
The FACIAL VEIN
Where does the facial vein run?
Topic: Major Veins of the Head and Neck
From the MEDIAL ANGLE OF THE EYE TOWARDS THE INFERIOR BORDER OF THE MANDIBLE, with the facial artery.
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)
The FACIAL VEIN with the facial artery.
At the mandible, which vein does the facial vein join?
Topic: Major Veins of the Head and Neck
The INTERNAL JUGULAR VEIN.
The facial vein connects with which two veins that relate to the orbit?
(Topic: Major Veins of the Head and Neck)
`The SUPERIOR and INFERIOR OPHTHALMIC VEINS
The superior opthalmic vein has a direct connection to what structure?
(Topic: Major Veins of the Head and Neck)
The CAVERNOUS SINUS
The inferior opthalmic vein has a direct connection to what structure?
(Topic: Major Veins of the Head and Neck)
The PTERYGOID VENOUS PLEXUS
How is the facial vein connected to the cavernous sinus and the pterygoid venous plexus?
(Topic: Major Veins of the Head and Neck)
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).
Where does the cavernous sinus lie?
Topic: Major Veins of the Head and Neck
Intra-cranially, and thus forms part of the intra-cranial venous system
Blood draining the face via the facial vein can potentially drain where?
(Topic: Major Veins of the Head and Neck)
Blood draining the face via the facial vein can therefore POTENTIALLY drain intracranially.
Blood can be potentially drained intracranially how?
Topic: Major Veins of the Head and Neck
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.
Why might infections involving the face have serious implications?
(Topic: Major Veins of the Head and Neck)
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.
How may septic thrombi within the facial vein be dangerous to the patient?
(Topic: Major Veins of the Head and Neck)
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.
How can you get septic thrombi within the facial vein?
Topic: Major Veins of the Head and Neck
Secondary to infection in and around the tissue it drains
What is a cavernous sinus thrombosis?
Topic: Major Veins of the Head and Neck
Formation of a blood clot within the facial vein.
What are the implications of a cavernous sinus thrombosis?
Topic: Major Veins of the Head and Neck
They is extremely serious, though very rare.
How common are cavernous sinus thromboses?
Topic: Major Veins of the Head and Neck
Very rare
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)
The anastomosis between the VEINS OF THE SCALP and the INTRA-CRANIAL (DURAL) VENOUS SINUSES.
How are the extracranial and intracranial venous systems connected?
(Topic: Major Veins of the Head and Neck)
Via EMISSARY VEINS
Where od emissary veins run?
Topic: Major Veins of the Head and Neck
Through the skull
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)
This can provide a POTENTIAL ROUTE FOR INFECTION OF THE SCALP to SPREAD INTO THE CRANIAL CAVITY.
How may infection of the scalp spread into the cranial cavity?
(Topic: Major Veins of the Head and Neck)
Potentially via EMISSARY VEINS.
(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)
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.
(Clinical Correlates: Superficial Infections and Intra-Cranial Spread)
What is the ‘danger triangle’?
(Topic: Major Veins of the Head and Neck)
The area from the corners of the mouth to the bridge of the nose
(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)
Via the cavernous sinus
How is the facial vein connected to the cavernous sinus and pterygoid venous plexus?
(Topic: Major Veins of the Head and Neck)
Via the superior and inferior opthalmic vein (respectively)
How many internal jugular veins (IJV) do we have?
Topic: Major Veins of the Head and Neck
Two - a right and left
The IJV arises as a continuation of what structure?
Topic: Major Veins of the Head and Neck
Cotinuation of the SIGMOID SINUS, a venous (dural) structure found within the skull.
What are the dural venous sinuses?
Topic: Major Veins of the Head and Neck
Venous channels found between the endosteal and meningeal layers of dura mater in the brain.
The sigmoid sinus gives rise to which structure?
Topic: Major Veins of the Head and Neck
IJV
What is the sigmoid sinus?
Topic: Major Veins of the Head and Neck
Venous sinuses within the skull that receive blood from posterior dural venous sinuses.
Where does the IJV run?
Topic: Major Veins of the Head and Neck
The length of the neck within the carotid sheath, as a straight line running from the lobule of the ear to the sternoclavicular joint.
Throughout much of the IJV’s course, which muscle covers it anteriorly?
(Topic: Major Veins of the Head and Neck)
Sternocleidomastoid
The sternocleidomastoid muscle covers the IJV __________ throughout much of its course?
(Topic: Major Veins of the Head and Neck)
Anteriorly
The sternocleidomastoid muscle splits into two heads. What are their names?
(Topic: Major Veins of the Head and Neck)
Clavicular and sternal heads.
What is the relation of IJV in association with the SCM muscle heads?
(Topic: Major Veins of the Head and Neck)
Towards the inferior end of the vein, the SCM muscle splits into its clavicular and sternal heads forming a gap anterior to the vein.
What is the clinical signifiance of IJV in relation to SCM?
Topic: Major Veins of the Head and Neck
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).
Where can central lines be inserted in the neck?
Topic: Major Veins of the Head and Neck
In the internal jugular vein, found in the gap between the two heads of the SCM muscle.
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)
This gap is also the area where the normal JUGULAR VENOUS PULSATION (JVP) can be seen, when patients are positioned at 45 degrees.
Where can normal JVP be seen?
Topic: Major Veins of the Head and Neck
In the gap between the SCM muscle heads
What position do patients need to be in to observe JVP?
Topic: Major Veins of the Head and Neck
45 degrees.
Why are doctors interested in JVP?
Topic: Major Veins of the Head and Neck
Doctors use the JVP to give an indication of the pressures within the venous circulation and right side of the heart.
How can you measure pressures within the venous circulation and right side of the heart?
(Topic: Major Veins of the Head and Neck)
By observing normal jugular venous pulsation (JVP).
Which JVP is favoured for observation (right or left), and why?
(Topic: Major Veins of the Head and Neck)
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.
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)
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.
(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)
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)
(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)
For insertion of central venous catheters (CVCs)/central lines.
(Clinical Correlates: IJV and Central Venous Catheters)
What are central lines used for?
(Topic: Major Veins of the Head and Neck)
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.
(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)
- monitoring central venous pressure (blood pressure in the vena cava)
- administration of drugs
- ease of repeated blood sampling
- temporary haemodialysis (kidney dialysis)
What other veins does the IJV receive blood from during its descent?
(Topic: Major Veins of the Head and Neck)
A number of other veins, including the facial vein, and VEINS DRAINING THE THYROID GLAND AND TONGUE.
How does the (right and left) IJV end?
Topic: Major Veins of the Head and Neck
By joining with the SUBCLAVIAN vein (just behind the medial end of the clavicle)
Where does the IJV join with the subclavian vein and which IJV?
(Topic: Major Veins of the Head and Neck)
Just behind the medial end of the clavicle, and this occurs on both the right and left IJV.
The IJV joins with the subclavian vein to form which vein?
Topic: Major Veins of the Head and Neck
The BRACHIOCEPHALIC VEIN
How is the brachiocephalic vein formed?
Topic: Major Veins of the Head and Neck
By joining the IJV and SUBCLAVIAN vein.
What is the route of the IJV to the right atrium?
Topic: Major Veins of the Head and Neck
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.
The brachiocephalic vein drains into which vein before reaching the right atrium?
(Topic: Major Veins of the Head and Neck)
The SUPERIOR VENA CAVA
How is the external jugular vein formed?
Topic: Major Veins of the Head and Neck
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.
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)
The EXTERNAL JUGULAR VEIN (EJV).
Where does the EJV run?
Topic: Major Veins of the Head and Neck
Just beneath the skin, in the superficial cervical fascia of the neck.
Which vein is deep to the thin platysma muscle but superficial to the sternocleidomastoid muscle?
(Topic: Major Veins of the Head and Neck)
The external jugular vein
Where does the external jugular vein lie?
Topic: Major Veins of the Head and Neck
Deep to the thin platysma muscle but superficial to the SCM muscle
Which is more readily visible - EJV or IJV (and why)?
Topic: Major Veins of the Head and Neck
While deep to the thin platysma muscle, EJV is superficial to the sternocleidomastoid muscle and thus MORE READILY VISIBLE THAN THE IJV.
Where does the EJV ultimately drain into?
Topic: Major Veins of the Head and Neck
The subclavian vein
How does the EJV drain into the subclavian vein?
Topic: Major Veins of the Head and Neck
After piercing the investing layer of deep cervical fascia at the lower end of the neck.
Image: Fig. 1
Label anterior and posterior on this image.
Anterior is towards the bottom, posterior is towards the back (cervical vertebra visible with spinous process extending)
Image: Fig. 1
Identify the superficial cervical fascia
Outer yellow (with adipose)
Image: Fig. 1
Identify the investing layer
Green
Image: Fig. 1
Identify the pretracheal layer
Purple
Image: Fig. 1
Identify the prevertebral layer
Blue
Image: Fig. 1
Identify the carotid sheath
Red
Image: Fig. 1
Identify the sternocleidomastoid muscles
Found in the investing layer anteriorly (bottom of picture)
Image: Fig. 1
Identify the trapezius muscles
Found in the investing layer posteriorly (top of picture)
Image: Fig. 1
Identify the platysma muscles
Found in the superficial cervical layer (yellow) anteriorly (bottom of picture)
Image: Fig. 1
Identify the spinous process
Pointy white bit in centre (line)
Image: Fig. 1
Identify the superior articular processes
Side of cervical vertebra
Image: Fig. 1
Identify the spinal cord
Central white dot
Image: Fig. 1
Identify the nervous rami
Yellow in middle
Image: Fig. 1
Identify the common carotid artery
Smaller shaded circle in carotid sheath
Image: Fig. 1
Identify the internal jugular vein
Larger shaded circle in carotid sheath
Image: Fig. 1
Identify the retropharyngeal space
Between blue and red/purple lines of cervical vertebra/oesophagus (between carotid sheaths)
Image: Fig. 1
Identify the oesophagus
Most posterior of the prevertebral layer (spongy)
Image: Fig. 1
Identify the thyroid
Both bow shaped structures in prevertebral layer
Image: Fig. 1
Identify the trachea
Rings of cartilage which extends superior and inferior to the thyroid - can see top-most rings of cartilage
Image: Fig. 2
Identify the trachea
See image
Image: Fig. 2
Identify the oesophagus
See image
Image: Fig. 2
Identify the carotid sheath
See image
Image: Fig. 2
Identify the retropharyngeal space
See image
Image: Fig. 2
Identify the prevertebral fascia
See image
Image: Fig. 2
Identify the pretracheal fascia
See image
Image: Fig. 2
Identify lose connective tissue
See image
What is the function of occipitofrontalis?
Raises eyebrows, produces horizontal wrinkles forehead (see Fig. 3)
Which muscles raises the eyebrows and wrinkles the forehead?
Occipitofrontalis (see Fig. 3)
What is the function of corrugator supercilii?
Draws the eyebrows downward and medially (frowning), producing vertical wrinkles of the forehead (see Fig. 3)
Which muscle is responsible for ‘frowning’?
Corrugator supercilii (see Fig. 3)
What is the function of procerus together with the transverse part of nasalis?
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)
Which muscles flare the nostrils whilst frowning?
Procerus + transverse part of nasalis (see Fig. 3)
What is the function of orbicularis oculi?
Closes the eyelids (see Fig. 3)
Which muscle closes the eyelids?
Orbicularis oculi (see Fig. 3)
What is the function of levator labii superioris alaeque nasi muscle with the alar part of nasalis?
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)
Which muscles dilate the nostrils?
Levator labii superioris alaeque nasi + alar part of nasalis (see Fig. 3)
What is the function of the buccinator + orbicularis oris muscles together?
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)
What is the function of zygomaticus major + minor?
Zygomaticus major draws the angle of the mouth upward and laterally i.e. smiling
Zygomaticus minor elevates the upper lip (see Fig. 3)
Which muscles are used in genuine smiling?
Zygomaticus major + minor (see Fig. 3)
What is the function of risorius?
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)
Which muscle is used to produce a smile that does not involve the eyes?
Risorius (see Fig. 3)
What is the function of risorius together with depressor labii inferioris?
Risorius - ‘fake smile’
Depressor labii inferioris - depression of the lower lip (see Fig. 3)
Which muscles produce an open-mouthed smile (albeit disingenuous)?
Risorius + depressor labii inferioris (see Fig. 3)
What is the function of levator labii superioris together with depressor labii inferioris?
levator labii superioris - elevates the upper lip
Depressor labii inferioris - depresses the lower lip (see Fig. 3)
Which two muscles open the mouth in such a way to bare one’s teeth?
Levator labii sup. + depressor labii (see Fig. 3)
Image: Fig. 4
What is this clinical presentation representative of?
Weakness of the facial muscles on one side in association with an ipsilateral parotid enlargement is highly likely to be a PAROTID CANCER.
Image: Fig. 5
Label the vertebra C5-T1
See image
Image: Fig. 5
Identify the middle scalene muscle
See image
Image: Fig. 5
Identify the anterior scalene muscle
See image
Image: Fig. 5
Identify the brachial plexus
See image
Image: Fig. 5
Identify the subclavian artery
See image
Image: Fig. 5
Identify the subclavian vein
See image
Image: Fig. 5
Identify the clavicle
See image
Image: Fig. 6
Identify the vertebral artery
Passes through transverse foramina of cervical vertebrae
Image: Fig. 6
Identify the common carotid artery
See image
Image: Fig. 6
Identify the subclavian artery
See image
Image: Fig. 6
Identify the transverse foramina of the cervical vertebrae
Vertebral artery runs through here
Image: Fig. 6
Identify the subarachnoid space between C1 and the occipital bone
Vertebral artery curbes here
Image: Fig. 6
Identify the foramen magnum
Where the vertebral artery enters the skull
Image: Fig. 7
Identify the right internal carotid artery
See image
Image: Fig. 7
Identify the right external carotid artery
See image
Image: Fig. 8
Identify the carotid sheath
See image
Image: Fig. 8
Identify sternocleidomastoid
See image
Image: Fig. 8
Identify the spinal part of the accessory nerve
See image
Image: Fig. 8
Identify the posterior triangle
See image
Image: Fig. 8
Identify trapezius
See image
Image: Fig. 9a
Identify the supra-orbital vein
See image
Image: Fig. 9a
Identify the vorticose veins
See image
Image: Fig. 9a
Identify the superior ophthalmic vein
See image
Image: Fig. 9a
Identify the approx. location of the cavernous sinus
See image
Image: Fig. 9a
Identify the inferior ophthalmic vein
See image
Image: Fig. 9a
Identify the approx. location of the pterygoid venous plexus
See image
Image: Fig. 9a
Identify the infra-orbital vein
See image
Image: Fig. 9a
Identify the angular vein
See image
Image: Fig. 9a
Identify the facial vein
See image
Image: Fig. 9b
What is the relevance of this triangle?
The ‘danger triangle’, where infections here are susceptible to spreading to the brain due to intracranial and extracranial communication.
Image: Fig. 10
What is this image showing?
A central venous catheter in a patient via the internal jugular vein.
Image: Fig. 11
Which is the left and right side of this image?
Left side is the right half of the image
Image: Fig. 11
Which muscles have been removed to visualise the veins in this image?
Sternocleidomastoid muscles
Image: Fig. 11
Identify the external jugular vein
See image
Image: Fig. 11
Identify the subclavian vein
See image
Image: Fig. 11
Identify the left brachiocephalic vein
See image
Image: Fig. 11
Identify the internal jugular vein
See image
