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Year 2 Semester 3 Head and Neck > Session 2 > Flashcards

Session 2 Flashcards

1
Q

Main arteries of neck

A

• On right, subclavian and common carotid arteries arise from brachiocephalic trunk
• The vertebral, internal thoracic and thyrocervical arteries all arise from subclavian a in the base of the neck
• The common carotid artery does not give off any branches in the neck • Bifurcates to give external and internal carotid arteries
Insert slide 4

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2
Q

Thyrocervical trunk

A

slide 5

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3
Q

Vertebral and internal carotid arteries

A
  • Vertebral arteries arise from the subclavian arteries on left & right
  • Ascend in the neck through transverse foramina in cervical vertebrae 6-1 and pass through the foramen magnum
  • The vertebral arteries supply the brain along with the internal carotid arteries (see Nervous System)
  • The internal carotid artery gives no branches off in neck – Enters the skull through carotid canal
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4
Q

Location of bifurcation of common carotid artery

A

The internal jugular lies lateral to the common carotid mostly under sternocleidomastoid (scm)
The common carotid bifurcates at about the level of the superior border of the thyroid cartilage

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5
Q

Main contents of carotid triangle and what are its borders?

A

Anterior border of the sternocleidomastoid muscle, superior belly of omohyoid and posterior belly of digastric.
the main contents of the carotid triangle are the common carotid artery (which bifurcates within the carotid triangle into the external and internal carotid arteries), the internal jugular vein, and the hypoglossal and vagus nerves.
• Important for surgical approach to the carotid arteries or internal jugular vein • Can also access vagus and hypoglossal nerves via carotid triangle • Carotid pulse can be felt in carotid triangle just below bifurcation – may also be palpated more inferiorly • Carotid sinus massage

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6
Q

Carotid artery atheroma

A

• Bifurcation of the carotid artery is a common site for atheroma formation • Causes narrowing (stenosis) of the artery • Rupture of the clot can cause an embolus to travel to brain – TIA or stroke

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7
Q

Carotid sinus and carotid body

A

• Carotid sinus – swelling at region of bifurcation – Location of baroreceptors for detecting changes in arterial BP • Carotid body – Peripheral chemoreceptors which detect arterial O2

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8
Q

Internal carotid artery

A
  • Enters skull through carotid canal in petrous part of temporal bone • Turns medially and horizontally
  • Enters skull through carotid canal in petrous part of temporal bone
  • Turns medially and horizontally
  • Enters the cranial cavity then makes S – shaped bend
  • Courses through the cavernous sinus
  • Radio opaque dye in carotid system
  • Tortuous course of internal carotid artery
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9
Q

Cavernous sinus

A

• Plexus of extremely thin-walled veins on upper surface of sphenoid • Also in cavernous sinus – Internal carotid a – CNIII oculomotor – CNIV trochlear – CNVI abducent – 2 branches of trigeminal • CNV1 ophthalmic and CNV2 maxillary

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10
Q

Ophthalmic artery and its branches

A

slide 16

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11
Q

Distribution of external carotid artery

A

Six Branches: • Superior thyroid • Lingual • Facial • Ascending pharyngeal • Occipital • Posterior auricular
Plus 2 Terminal Branches: • Superficial temporal • Maxillary

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12
Q

Blood supply to the scalp

A

slide 18 and 19
• Rich blood supply with many anastomoses • Largely branches of external carotid artery • Except supratrochlear and supraorbital arteries (branches of the opthalmic artery) which arises from the internal carotid artery

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13
Q

The scalp

A

Skin Connective tissue (dense) Aponeurosis Loose connective tissue Periosteum
• Vessels of the scalp lie in the subcutaneous connective tissue layer

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14
Q

Clinical relevance of blood supply to the scalp

A

• Walls of arteries closely attached to connective tissue, limits constriction – can get profuse bleeding • Numerous anastomoses – profuse bleeding • Deep lacerations involving epicranial aponeurosiscause profuse bleeding because of opposing pull of occiptofrontalis • Note: blood supply to skull mostly middle meningeal artery – loss of scalp does not lead to bone necrosis

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15
Q

Superficial arteries of the face

A

All arise from the external carotid except supra-orbital and supratrochlear which are from internal carotid artery (via ophthalmic) Facial artery pulse can be felt at inferior border of mandible, anterior to the masseter muscle

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16
Q

Branches of maxillary artery

A

The maxillary artery has many branches supplying muscles and deeper structures in face
Middle meningeal Sphenopalatine

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17
Q

Blood supply to nasal septum

A
  • Anastomosis of arteries in Kiesselbach area • Most important branches – Septal branch of sphenopalatine artery (from maxillary artery) – Anterior ethmoidal arteries (from ophthalmic artery)
  • Kiesselbacharea common site for nose bleed (epistaxis)
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18
Q

Blood supply to dura and skull

A

slide 25,26,27

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19
Q

Rupture of middle meningeal artery

A

• Middle meningeal a supplies skull and dura • Fracture of skull at pterion can rupture the middle meningeal artery – Extradural haemorrhage

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20
Q

Craniotomy

A
  • Craniotomy to gain access to cranial cavity

* Bone and scalp flap reflected inferiorly to preserve blood supply

21
Q

Venous drainage of the scalp

A

• Superficial veins generally accompany arteries – Superficial temporal veins – Occipital veins – Posterior auricular veins
• Supraorbital and supratrochlear veins unite at medial angle of eye to form angular vein which drains into the facial vein • Some deep parts of scalp in temporal region have veins which drain into the pterygoid venous plexus
slide 31

22
Q

Connection between venous drainage of scalp and dural venous sinuses

A

• Veins of scalp connect to diploic veins of skull through several emissary veins and thus to dural venous sinuses • Emissary veins are valveless • Infection from scalp can spread to the cranial cavity and affect meninges

23
Q

Venous drainage of the face

A

slide 33

24
Q

Connection of facial veins with cavernous sinus and pterygoid venous plexus

A

• Veins of the face are valveless • At medial angle of eye, facial vein communicates with superior ophthalmic – Drains into cavernous sinus • Deep facial veins drain into pterygoid venous plexus – Infection from facial vein can spread to duralvenous sinuses – Thrombophlebitis of facial vein – infected clot can travel to intracranial venous system

25
Q

Danger triangle of the face

A

• Infections in this region of the face can spread through the venous system to the dural venous sinuses

26
Q

Dural venous sinuses

A

The sigmoid sinuses continue as the internal jugular veins, leaving the skull through the jugular foramina

27
Q

External & internal jugular veins and JVP

A

• EJV vein much easier to see • IJV under sternocleidomastoid • IJV better indication of pressure in right atrium

28
Q

Measuring JVP

A

• Use Right Internal Jugular Vein • Effectively like a direct connection to right atrium • Patient at 45o angle – head slightly to left • IJV largely hidden by sternocleidomastoid • Pulsations observed through muscle • Measured in cmH2O • Height from sternal angle + 5cm

29
Q

Terms to describe bone features in skull

A
  • Many bones have important osteological features
  • These include • Shallow depressions or hollows (fossae) • Bony tunnels (canal) • Holes • Round-ish = foramina • Narrow slits = fissures
30
Q

How can bones of skull be divided

A

Neurocranium (8 bones): encases/protects brain – Calvaria (“skull cap” or “vault”), cranial floor (base) and cranial cavity – ‘Vault’ bones begin as membranes (intramembranous ossification): floor/base begin as cartilage (endochondrial ossification)
Viscerocranium (14 bones): facial skeleton and jaw – Bones begin as membranes or cartilage and ossify – Structures (most) develop from the pharyngeal arches (1&2)

31
Q

Neurocranium

A 
Calvaria (vault), cranial floor and cranial cavity
‘Holes’ in cranial floor permit cranial nerves and blood vessels to enter into and out of neurocranium
Foramina, fissures and canals
Bones and Joints of Calvaria
Frontal bone
Parietal bones
Greater wing of sphenoid bone
Occipital bones
Temporal bone
Coronal suture
Bregma
Sagittal suture
Lambda
Lambdoid suture
32
Q

Infant skull: fontanelles

A

Large areas of unossified membranous gaps between flat bones of calvaria
• Fontanelles are areas of membrane between bones, that are particularly large
• Allow for alteration of the skull size and shape during childbirth
• Permit growth of infant brain
• Fontanelles fuse in early infancy • Anterior ~18 months- 2 years • Posterior ~1-3 months
• Early fusion of fontanelles and sutures = craniosynostosis (rare condition)

33
Q

Anterior Fontanelle

A

• Slightly convex shape in a healthy baby
• Inspection and gentle palpation of anterior fontanelle can be used to assess intracranial pressure and state of hydration
Assessment of the fontanelles is taken in the context of how the infant appears (unwell/well) and the presence of other clinical signs and symptoms

34
Q

Bones of the Calvaria

A 
A trilaminar arrangement in cross-section. Tri-laminar arrangement confers  protective strength without adding significant weight
Compact bone (outer table)
Diploe (spongy bone)
Compact bone (inner table)
35
Q

periosteum

A

Individual Skull Bones: ‘Shrink-Wrapped’ in Periosteum
Periosteum covers surface of outer and inner table of skull bones Strongly adhered to bone edges at suture line and continuous through suture and onto inner table of same bone

36
Q

Cranial Floor

A

Three ‘bowl-shaped’ depressions form the cranial floor
• Anterior, middle and posterior cranial fossae • Seat different parts of the brain and its associated structures • Made up of numerous bones • Numerous foramina, canals and fissures (learn and explore in Session 3 SGW)

37
Q

Frontal Bone

A

use p

38
Q

Ethmoid Bone

A

p

39
Q

Sphenoid Bone

A

wings

40
Q

Temporal Bone

A

Petrous Part of Temporal Bone Houses Middle and Inner Ear Structures

41
Q

Occipital Bone

A

panopto

42
Q

cranial fractures

A

Cranial Vault or Cranial Floor
• Significant trauma and force required to fracture skull – Thickness of cranial bones varies, resistance to fracture therefore varies
• Risk of injury to intracranial structure (i.e. brain, blood vessels, cranial nerves) – Presence of skull fracture associated with higher incidence of intracranial pathology, neurological deficits and poorer outcomes
• BUT can still have intracranial injury following head injury, even in absence of skull fracture

Cranial Vault: linear or comminuted
• Linear fairly straight, involve no bone displacement
• Comminuted (multiple fracture lines) • Fragments may or may not displace inwards towards the brain (depressed vs non-depressed)

Cranial Vault: Pterion Thinnest area of skull: relatively easy to fracture
• Important relationship between pterion and an underlying blood vessel: . . (anterior branch)
• Blows to the side of the head can fracture bone in area of pterion and injury blood vessel lying immediately below • Intracranial haemorrhage (extradural)
Skull Base (Basilar) Fractures Rarer type of skull fracture but important not to miss!

43
Q

Facial Skeleton (viscerocranium)

A

slide 26 lec 2

44
Q

Facial Injuries and Fractures

A

Supraorbital ridge (frontal bone) very tough
Fractures of the maxillae are rare
Zygoma- forms part of zygomatic arch

45
Q

Temporomandibular Joint

A

Articulation between temporal bone and mandible
• Synovial hinge-type joint divided into two synovial cavities by fibrocartilaginous disc
• Number of conditions – TMJ disorder (pain [often refers to ear, jaw, lateral side of head*], clicking, locking…) – Dislocation (e.g. secondary to trauma, yawning) – Arthritis
• Innervated by auriculotemporal nerve – Branch of mandibular division of trigeminal (Vc)

46
Q

Anatomy of TMJ

A

• Articular surfaces of bones lined with fibrocartilage and do not come into direct contact
• Separated by fibrocartilaginous disc
• Divides joint into two synovial-line cavities filled with synovial fluid
• Stabilised by a joint capsule and a series of (3) extracapsular ligaments (not shown in image)
use slide 30

47
Q

Movements of TMJ

A

Hinge and Gliding Action
Depression of the mandible (opening jaw)
1. Hinge (rotational) action • Inferior half of joint cavity
2. Gliding forward action • Condyle slides onto articular tubercle • Superior half of joint cavity
Simple retraction and protraction of mandible • Gliding action at superior joint capsuleCondyle

ue slide 31 lec 2

48
Q

Movements of mandible at TMJ and the muscles involved

A

slide 32lec 2

49
Q

Dislocation of TMJ

A
  • Facial trauma (blow to side of jaw, especially if open) and yawning can cause TMJ dislocation
  • Jaw locks as joint fixes in open position due to anterior dislocation of condyle over the articular tubercle (lies anterior to the tubercle)
  • Contraction of muscles around joint (muscles of mastication) keep joint locked in anterior displacement

Year 2 Semester 3 Head and Neck (12 decks)

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