Surface Anatomy - Head and Neck Flashcards
Where is the ethmoid bone located? What does it contribute to?
Singular
In midline of anterior cranium
Contributes to:
- Anterior cranial fossa/Roof of nasal cavity (cribiform plate)
- Medial wall of orbit (orbital plate of ethmoid)
- Lateral walls of nasal cavity (superior and middle conchae)
- Superior nasal septum (perpendicular plate)
Where is the sphenoid bone located? What does it contribute to?
Singular In midline of middle cranial fossa Contributes to: - Lateral wall of skull (greater wing) - Lateral wall of orbit (greater wing) - Roof of orbit (lesser wing) - Medial wall of orbit (body)
Where are the lacrimal bones found?
Medial wall of orbits
Where are the palatine bones found?
Posterior oral cavity
Hard palate
Where are the inferior conchae found?
Within nasal cavities
Where is the vomer bone found?
Posterior nasal septum
Which bones do not protect any of the special sense organs of the head?
Occipital
Parietal
What anterior major bony features of the skull can be palpated?
Maxilla
Zygoma
Orbital margin
Mental process of the mandible
What lateral major bony features of the skull can be palpated?
Angle of mandible
Zygomatic arch
Mastoid process
What bony feature can be palpated on the posterior surface of the skull?
External occipital protuberance
What structure overlaps the anterior aspect of the external auditory meatus?
Tragus
What can be palpated just anterior to the tragus?
Condyle of the mandible
If the head of the mandible is palpated and the mouth is opened, what can be felt?
The condyle rotating and moving forwards and downwards over the articular eminence of the temporal bone
How can temporalis be palpated?
Place fingers onto side of your head just above zygomatic arch; clench and relax jaw
How can the masseter be palpated?
Place fingers on mandible slightly above and anterior to angle of mandible; clench and relax jaw
How can the pterygoid muscles be palpated?
They can’t
What other muscles are involved in masticatory movements?
Suprahyoid muscles
How can frontalis be palpated?
Place finger over eyebrow and raise the same eyebrow
How can orbicularis oculi be palpated?
Close your eyes and place your finger gently on the eyelid then close eyes tightly
How can zygomaticus major be palpated?
Place fingers at edge of the zygomatic arch and smile
How can orbicularis oris be palpated?
Close lips and place finger just above your top lip and purse your lips
What changes might be seen in a cerebrovascular accident affecting CN VII?
Drooped eyelids (ptosis) Lowered corner of mouth Unable to raise: - Eyebrow - Corner of mouth
What happens if pressure is placed over the parotid and submandibular glands?
Forces saliva into mouth
What neurovascular structure lies within the parotid gland?
Parotid plexus of CN VII
How can the small vessels on the face be palpated?
Not easily - They are small
Where can the superficial temporal artery be palpated?
Between tragus of ear and neck of mandible
From what artery is the superficial temporal artery a terminal branch of? What is its other terminal branch?
External carotid artery
Maxillary artery
Where can the facial artery be palpated?
As it crosses the lower border of the body of the mandible:
- Halfway between angle and mental tubercle
From what vessel is the facial artery and anterior branch of? What other anterior branch of this artery supplies blood to deeper structures of the face?
External carotid artery
Lingual artery
Where can the supraorbital artery be palpated?
Superior medial margin of the orbit
From what artery is the supraorbital artery a branch of?
Ophthalmic artery
Why can the veins accompanying the palpable arteries of the face not be palpated?
Thin walled structures
Not pulsatile
What nerves of the trigeminal nerve can be palpated with difficulty? Where?
Supraorbital
Infraorbital
Mental branches
All can be palpated as they leave their respective foramina of the skull
When are the lymph nodes of the head and neck more easily palpable?
When enlarged due to inflammation
Where does lymph from all the nodes of the head drain to?
Cervical lymph chain
Which nodes would you expect to enlarge if the tongue was infected?
Superior deep cervical nodes
Inferior deep cervical nodes
Submandibular nodes
Submental nodes
What forms the laryngeal prominence (Adam’s apple)?
Thyroid cartilage
What can be palpated by passing your fingers from the thyroid cartilage downwards by 3-4cm?
Cricoid cartilage
What neck structures can be palpated with discomfort?
Hyoid bone
Trachea
How can the hyoid bone be palpated?
Locate thyroid cartilage and pass fingers superiorly to palpate hyoid bone
Where does the hyoid bone lie in relation to the mandible?
3-5cm below mandible
Where can the tracheal rings be palpated?
Area of jugular notch
What happens to the laryngeal cartilages and hyoid bone when swallowing?
Move superiorly
How can the sternocleidomastoid muscle be easily palpated?
Turn head to one side and palpate the muscle on the contralateral side
What is the proximal attachment of the SCM?
Mastoid process
What are the distal attachments of the SCM?
Clavicle
Sternum
What structures lie immediately beneath the SCM?
Carotid sheath: - IJV - Common carotid artery - CN X Ansa cervicalis Cervical plexus Phrenic nerve Deep cervical nodes
What anatomical sites does the SCM border?
Anterior and posterior triangles of the neck Anterior triangle: - Carotid triangle - Muscular (omotracheal triangle) Posterior triangle: - Occipital triangle - Omoclavicular (subclavian) triangle
Can the transverse processes of the cervical vertebrae be palpated?
Yes
How can the cervical spinous processes be more easily palpated?
Ask someone to lie prone with forehead on hands and chin tucked in slightly
Where can the spinous process of C2 be palpated?
3cm inferior to the external occipital protuberance in the midline
What spinous processes of the neck are most easy to palpate?
C6
C7
When palpating the spinous processes of C6 and C7, how can you differentiate between the two?
Place finger on C6 spinous process and ask volunteer to extend head and neck:
- C6 will move forward
- C7 will not move
What connective tissue structure attaches to the cervical spinous processes?
Nuchal ligament
What are the relations of the carotid sheaths?
Lie to either side of the laryngeal cartilages
Covered by SCM
Where can the common carotid artery be palpated?
Just lateral to thyroid cartilage
Medial to SCM
Where is the internal jugular vein typically accessed?
Superior apex of triangle formed from the two heads of the distal attachments of the SCM and the clavicle - aim towards opposite nipple (central approach)
OR
Medial edge of SCM at the level of the thyroid cartilage - aim towards ipsilateral nipple (anterior approach)
OR
Point where horizontal line from cricoid cartilage meets lateral border of SCM - aim towards sternal notch (posterior approach)
How can the pulse wave of the internal jugular vein be seen?
If head and upper body raised to a 30 degree angle and head rotated to opposite side
Can the internal jugular vein be palpated?
No
Where does the internal jugular vein lie?
Lateral to the common carotid artery
When are the surface markings of veins in the neck important?
Assessment of trauma
Venous access
What are the surface markings of the external jugular vein?
From angle of mandible to middle of clavicle
What are the surface markings of the internal jugular vein?
Line:
- From lobe of the ear
- To medial end of clavicle
What are the superficial cervical lymph nodes associated with?
External jugular veins
What are the deep cervical lymph nodes associated with?
Internal jugular veins
What other vessel can some lymph nodes be associated with in the neck?
Anterior jugular veins
What do enlarged (and thus palpable) cervical lymph nodes often indicate?
Respiratory or tonsillar infections
What metastases may cause enlargement of the cervical lymph nodes?
Thyroid gland
Lungs
Breast tissue
Why can nerves in the neck not be palpated?
Superficial nerves - Too small
Deep nerves - Covered by muscular and fascial structures
Where would anaesthetic be injected for a cervical plexus block?
Posterior border of SCM
Where would anaesthetic be injected for a supraclavicular block?
Superior to the midpoint of the clavicle
What structure must be avoided in inserting a needle at the posterior border of the SCM (cervical plexus block)? What happens if this structure is damaged?
Phrenic nerve:
- Paralysis of hemidiaphragm
What thoracic structures extend into the root of the neck and thus may be damaged in a supraclavicular block? What happens if this structure is hit?
Lungs:
- Pneumothorax
