Session 3: Neck and Face

Question 1

What are the 3 main functions of the neck?

Answer 1

Structural: support + move head
Visceral functions
Conduit for blood vessels + nerves

Question 2

How are the components of the functions of the neck divided structurally?

Answer 2

Structural: inside prevertebral fascia
Visceral: inside or associated with pretracheal fascia
Blood vessels + nerves: inside or associated with carotid sheaths

Question 3

What are the 2 large muscles that are found on the anterior and posterior sides of the neck?

Answer 3

Anterior: sternocleidomastoid
Posterior: trapezius

Question 4

What are the contents of the carotid sheath?

Answer 4

Internal jugular vein
Common carotid artery
Vagus nerve

Question 5

What are the contents of the visceral fascia?

Answer 5

Oesophagus
Trachea
Thyroid Gland

Question 6

What is the name given to the fascia between the posterior aspect of the oesophagus and the anterior part of the prevertebral fascia?

Answer 6

Buccopharyngeal fascia

Question 7

Which fascia splits in 2 around the sternocleidomastoid and trapezius?

Answer 7

Investing layer

Question 8

What important structures are at each of the vertebral levels C1-C7?

Answer 8

C1: Open mouth
C2: Superior cervical ganglion
C3: Body of hyoid
C4: Birfurcation of common carotid + Upper border of thyroid cartilage
C6: Cricoid cartilage + Middle cervical ganglion
C7: Inferior cervical ganglion

Question 9

What are the 2 triangles of the neck? State their borders.

Answer 9

Anterior triangle: mandible, anterior border of sternocleidomastoid + midline from mandible to sternum
Posterior triangle: posterior border of sternocleidomastoid, anterior border of trapezius + clavicle

Question 10

What are the main muscles in the anterior triangle?

Answer 10

Platysma
Mylohyoid
Digastric: anterior belly + posterior belly
Infrahyoid (strap muscles)

Question 11

Which blood vessels and nerves are in the posterior triangle?

Answer 11

External jugular vein  
Subclavian artery 
Subclavian vein
Trunks of brachial plexus  
Phrenic nerve  
Vagus nerve
Spinal accessory nerve

Question 12

Which smaller nerves are found in the posterior triangle of the neck?

Answer 12

Lesser occipital nerve
Greater auricular nerve
Transverse cervical nerve
Supraclavicular nerves

Question 13

Where do the trunks of the brachial plexus emerge?

Answer 13

Posterior to scalenus anterior

Question 14

Where are the subclavian artery and vein relative to the scalene muscles?

Answer 14

Subclavian artery = posterior to scalenus anterior

Subclavian vein = anterior to scalenus anterior

Question 15

Where is the phrenic nerve relative to the scalene muscles?

Answer 15

Phrenic nerve lies on the anterior surface of scalene anterior

Question 16

Which spinal nerves contribute to the superior, middle and inferior trunks of the brachial plexus?

Answer 16

Superior = C5 + C6 
Middle = C7 
Inferior = C8 + T1

Question 17

Which spinal nerves contribute to the phrenic nerve and what is its main function?

Answer 17

C3, C4 + C5
Motor supply of the diaphragm
Sensory innervation to the diaphragmatic pleura + peritoneum

Question 18

What is platysma innervated by?

Answer 18

Facial nerve (cervical branch)

Question 19

What is mylohyoid innervated by?

Answer 19

Mandibular division of trigeminal nerve

Question 20

What are the anterior and posterior bellies of the digastric muscle innervated by?

Answer 20

Anterior: mandibular division of trigeminal nerve
Posterior: facial nerve

Question 21

What are the infrahyoid muscles innervated by?

Answer 21

Ansa cervicalis = omohyoid + sternothyroid + sternohyoid

C1 fibres via hypoglossal nerve = thyrohyoid

Question 22

What are the clinical applications of a carotid pulse?

Answer 22

Measuring pulse rate

Question 23

List the main sites of access for central venous lines.

Answer 23

Internal jugular (most common)
Subclavian vein
Femoral vein

Question 24

What are the uses of central venous lines?

Answer 24

Long-term access e.g. for chemotherapy drugs
Administering drugs that can cause phlebitis
Parenteral nutrition
Monitoring blood pressure

Question 25

What are the complications of insertion of central venous lines?

Answer 25

``` Accidental arterial puncture Tracheal injury Arrhythmia Emboli Infection Pneumothorax or haemothorax ```

Question 26

Where does the accessory nerve exit the skull?

Answer 26

Begins in upper spinal cord + ascends to enter the skull through the foramen magnum Leaves via the jugular foramen

Question 27

What does the accessory nerve innervate?

Answer 27

Trapezius | Sternocleidomastoid

Question 28

How would you test the function of the accessory nerve?

Answer 28

Ask the patient to shrug their shoulders + hold it there

Question 29

What are the 4 infrahyoid muscles and where are they attached?

Answer 29

Omohyoid: superior border of scapula --> hyoid Sternohyoid: sternum --> hyoid Sternothyroid: sternum --> thyroid cartilage Thyrohyoid: thyroid cartilage --> hyoid

Question 30

Name the 5 groups of superficial lymph nodes around the head, their location + drainage, beginning posteriorly

Answer 30

Occipital (attachment of trapezius to skull) drain posterior scalp + neck Mastoid nodes (posterior to ear, near attachment of sternocleidomastoid) drain posterolateral half of scalp Pre-auricular + Parotid (anterior to the ear) drain anterior surface of auricle, anterolateral scalp, upper half of the face, eyelids + cheeks Submandibular (Inferior to body of mandible) drain structures along path of facial artery as high as forehead + gingivae, teeth + tongue Submental (inferior + posterior to chin) drain centre part of lower lip, chin, floor of mouth, tip of tongue + lower incisors

Question 31

Where do the occipital + mastoid nodes drain?

Answer 31

To superficial cervical nodes along the external jugular vein

Question 32

Where do the pre-auricular, parotid, submandibular + submental nodes drain?

Answer 32

To the deep cervical nodes

Question 33

What are the superficial cervical nodes?

Answer 33

A collection of lymph nodes along the EJV on the superficial surface of the sternocleidomastoid. Send vessels towards deep cervical nodes

Question 34

What are the deep cervical nodes?

Answer 34

a collection of lymph nodes that form a chain along the IJV Divided into upper + lower groups where the intermediate tendon of the omohyoid crosses the CCA + IJVs Form the right + left jugular trunks, which empty into the right lymphatic duct on the right or thoracic duct on the left

Question 35

What is indicated by soft, tender and inflamed lymph nodes?

Answer 35

Acute inflammatory process, most likely infective

Question 36

What is indicated by firm, multi nodular, large volume, rubbery nodes?

Answer 36

Lymphoma