General Organisation of Head and Neck Flashcards Preview

ESA 4 - Head and Neck > General Organisation of Head and Neck > Flashcards

Flashcards in General Organisation of Head and Neck Deck (172):
1

What does the head consist of? 

  • Scalp
  • Skull
  • Brain and its coverings (meninges)
  • Special sense organs
  • Muscles
  • Cranial nerves and their branches
  • Glands
  • Blood vessels
  • Lymphatics

 

2

What is true of many of the structures of the head? 

They also run through the neck

3

What are the structure of the head that run through the neck in close relationship with? 

  • Thyroid gland
  • Pharynx
  • Larynx
  • Trachea
  • Oesophagus
  • Cervical vertebrae

 

4

Where does the neck extend? 

  • Between the lower margin of the mandible superiorly
  • To suprasternal notch of manubrium and upper border of clavicle inferiorly

5

What is the necks overall function? 

Connects head to rest of body 

6

What happens to structures in the neck? 

They are compartmentalised by concentric fascial layers creating compartments running through the neck

7

What are the functions of the fascial planes of the neck? 

  • Form natural planes
  • Ease of movements between structures
  • Contains spread of infection 

 

8

When is ease of movement between structures in the neck important? 

During swallowing

9

Give an example of where fascial planes of the neck contain the spread of infection

Superficial skin infection in skin of neck cannot track deeper 

10

What are the layers of fascial planes of neck? 

  • Superficial fascial layer 
  • Three deep cervical fascial layers 

 

11

Where is the superficial fascial layer found? 

Just below the skin 

12

What is the superficial fascial layer made up of? 

Largely fatty tissue, with; 

  • External jugular vein
  • Cutaneous nerves
  • Superficial lymph nodes
  • Platysma muscle

 

13

What are the deep cervical fascial layers named according to? 

What they do, or the structures they're surrounding

14

What are the names of the three deep cervical fascial layers? 

  • Investing layer
  • Pretracheal layer
  • Pre-vertebral layer

 

15

What does the investing cervical fascial layer do? 

Surrounds the entire neck, like a collar

16

What is the superior margin of the investing cervical fascial layer attached to? 

  • Entire lower border of mandible (midline to angle)
  • Mastoid process
  • Superior nuchal line
  • External occipital protuberance in the posteiror midline 

 

17

What does the investing cervical fascial layer attach to posteriorly? 

  • Spinous process of vertebrae
  • Ligamentum nuchae 

 

18

What does the investing layer of cervical fascia attach to inferiorly? 

  • Upper border of manubrium
  • Upper surface of clavicle 
  • Acromion
  • Spine of scapula 

 

19

What does the investing layer of cervical fascia split to enclose? 

  • Sternocleidomastoid
  • Trapezius
  • Submandibular salivary gland
  • Parotid salivary glands

 

20

Is the pre-tracheal layer of cervical fascia thick or thin? 

Thin 

21

What is the pre-tracheal layer of cervical fascia limited to? 

Anterior part of neck 

22

What is the pretracheal layer of cervical fascia attached to in superiorly? 

Hyoid bone

23

What happens to the pre-tracheal layer of fascia inferiorly? 

It extends into the thorax, where it binds with the fibrous pericardium 

24

What does the pre-tracheal layer of cervical fascia consist of? 

  • Muscular layer
  • Visceral layer 

 

25

What does the muscular layer of the pretracheal cervical fascia do? 

Encloses the infrahyoid muscles

26

What does the visceral layer of the pre-tracheal cervical fascia do? 

Encloses; 

  • Oesophagus
  • Thyroid gland
  • Trachea

 

27

What does the visceral layer of pre-tracheal fascia do around the thyroid gland? 

Splits around it to form a 'false capsule' 

28

What does the pre-vertebral layer of cervical fascia do? 

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

29

Where does the prevertebral layer of cervical fascia extend? 

Base of cranium to 3rd thoracic vertebrae

30

How does the prevertebral layer of cervical fascia extend laterally? 

As the axillary sheath

31

What does the axillary sheath surround?

  • The brachial plexus of nerves
  • Axillary vessels

 

32

What is the carotid sheath? 

A tubular, fibrous structure

33

What is the carotid sheath formed from? 

All three layers of deep cervical fascia

34

Where does the carotid sheath extend? 

From base of cranium, through root of neck, to arch of aorta 

35

What does the carotid sheath create? 

A compartment for a number of neurovascular structures running between head and thorax

36

What structures run through the carotid sheath? 

  • Common carotid artery
  • Internal jugular vein 
  • Vagus nerve (CN X) 

 

37

What does the fascial compartmentilisation of structures in the neck give rise to? 

Potential spaces between fascial planes 

38

Where does the retropharyngeal space lie? 

Between the prevertebral layer of fascia and the fascia surrounding the fascia (more specificially, the buccopharyngeal fascia) 

39

What does the retropharyngeal space initially contain? 

Lymph nodes 

40

Up until when does the retropharyngeal space contain lymph nodes? 

Up until age 3-4 

41

What is the retropharyngeal space helpful in? 

  • Allow pharynx to move freely on vertebral column
  • Expanding during swallowing

 

42

What is the problem with the retropharyngeal space?

Infection can collect

43

What areas in the neck are readily palpable (sometimes visible)

  • Thyroid cartilage (Adam's Apple) 
  • Cricoid cartilage 

 

44

What is the function of cartilage in the neck? 

Supports underlying larynx

45

Where is the thyroid gland found? 

At the base of the neck

46

Is the thyroid gland palpable? 

Not unless enlarged

47

What is the purpose of the hyoid bone in the neck? 

Attachment of lots of muscles, including strap like infrahyoid muscles

 

48

What course do the infrahyoid muscles take? 

They descend from the hyoid bone 

49

What is the neck divided into by anatomical borders? 

Two triangles

50

What are the borders of the anterior triangle? 

  • Superior - Inferior margin of mandible 
  • Medial - Midline of neck
  • Lateral - Anterior margin of sternocleidomastoid

 

51

What structures are associated with the anterior triangle? 

Structures coursing between the head and thorax 

52

What are the border of the posterior triangle? 

  • Inferior - Clavicle 
  • Medial - Posterior margin of sternocleidomastoid 
  • Lateral - Anterior margin of trapezius 

 

53

What structures are associated with the posterior triangle? 

Those coursing between thorax/neck and upper limb 

54

Give an example of a structure associated with the posterior triangle? 

Trunks of brachial plexus 

55

Why are the anatomical triangles of the neck helpful? 

Because different structures are found in them 

56

What can diseases affecting the thyroid gland cause? 

  • Enlargement of the gland
  • Discrete lumps

 

57

What can help localise a pathology to the thyroid gland? 

Asking a patient with a swelling/lump in their neck to swallow, and observing wether it moves 

58

Why will swelling/lumps associated with the thyroid gland move when swallowing? 

The thyroid gland is enclosed by pre-tracheal fascia, which is attached to hyoid bone. The hyoid bone and larynx move up when swallowing, so hyoid bone will too, and any swelling or lump will involving this gland

59

What is an enlarged thyroid gland termed? 

A goite 

 

60

Where can a goite sometimes extend? 

Retrosternally, through the root of the neck

61

Why can a goite sometimes extend through the root of the neck? 

Because the lower limit of pre-tracheal fascia extends into the thorax

62

What can retrosternal extension of a goite lead to? 

Compression of other structures running through the root of the neck

63

What structures can be compressed in a retrosternal extension of goite? 

  • Trachea
  • Venous blood vessels 

 

64

What symptoms can compression of the tracheal by a retrosternally extending goite lead to? 

  • Breathlessness
  • Stridor 

 

65

What symptoms can compression of venous blood vessels due to a retrosternally extending goite lead to? 

Facial oedema, due to decreased venous drainage from head and neck

66

What do the layers of deep cervical fascia form? 

Natural cleavage plates 

67

What is the function of the natural cleavage plates formed by deep cervical fascia? 

  • Allows structure to move and pass over one another with ease
  • Allows easy seperation of tissues during surgery
  • These layers determine the direction and extent to which any infection occuring within the neck may spread 

68

Where can infection develop, regarding the fascial planes of the neck? 

  • Retropharyngeal space
  • Pre-tracheal space

 

69

What is infection in the retropharyngeal and pre-tracheal space usually secondary to? 

Throat infection

70

What can potentially result from an infection in the retropharyngeal space and pre-tracheal space? 

Can spread from neck into thorax, down as far as posterior mediastinum, which risks the development of mediastinitis

71

What is the problem with mediastinitis? 

Life threatening 

72

Is mediastinitis common? 

No, it is rare

73

What may infection in the retropharyngeal or pre-tracheal space develop into? 

Abscess 

74

What is important when someone has an abscess caused by infection in retropharyngeal or pre-tracheal space? 

Recognise and treat early 

75

Why must an abscess in the retropharyngeal or pre-tracheal space be recongised and treated early? 

Carries significant morbiditity and mortality

76

How may an abscess caused by infection in the retropharyngeal or pre-tracheal space present? 

  • Visible bulge on inspection of oropharynx
  • Sore throat
  • Difficulty swallowing
  • Stridor
  • Neck stiffness
  • High temperature

 

77

What risks the insertion of bacteria into the pre-tracheal space? 

Inserting surgical airways

78

What are most of the arteries supplying the face branches of? 

The external carotid arteries

79

How does the external carotid artery terminate? 

As superficial temporal artery and maxillary artery 

80

What happens to the external carotid artery after termination? 

It gives rise to a number of branches 

81

What important branche does the external carotid artery give rise to before termination? 

Facial artery 

82

Why is the facial artery important? 

It is the major arterial supply of the face 

83

Where can the pulse of the facial artery be palpated? 

As the artery winds around the inferior border of the mandible 

84

Where does the facial artery have many anastomoses? 

With other arteries of the face 

85

What is the result of the facial artery having many anastomoses with other arteries of the face? 

In the event of laceration of artery on one side, it is necessary to compress both arteries to stop bleeding

86

What runs with the facial artery? 

The facial vein 

87

What course does the facial vein take? 

From medial angle of eye, to inferior border of mandible 

88

What does the facial vein constitute? 

The major venous drainage of the face

89

What does the facial vein drain into? 

The internal jugular vein

90

What forms the external jugular vein? 

  • Superficial temporal vein
  • Maxillary vein
  • Other veins

 

91

What do the internal and external jugular veins drain into? 

Subclavian vein 

92

What are the major muscles and groups of the head and neck? 

  • Sternocleidomastoid
  • Trapezius
  • Muscles of facial expression
  • Muscles of the cheek (buccinators) 
  • Occipitofrontalis muscle
  • Muscles of mastication
  • Superficial muscle of neck and chin (platysma)
  • Muscle of ear

 

93

What is the sternocleidomastoid innervated by? 

Accessory nerve (CN XI) 

94

What is the origin of the sternocleidomastoid? 

Mastoid process

95

What happens to the body of the sternocleidomastoid? 

It splits into two heads, sternal and clavicular 

96

Where does the sternocleidomastoid insert? 

  • Sternal head into sternum 
  • Clavicular head into clavicle

 

97

Where does the sternocleidomastoid lie relative to the platysma? 

Deep 

98

Is the sternocleidomastoid palpable and visible? 

Yes, especially when tensing the muscle 

99

What is the action of the sternocleidomastoid? 

  • When acting unilaterally, lateral flexion of neck, moving ear towards shoulder, and rotates chin superiorly 
  • When acting bilaterally, flexion at neck and extension at joint between base of skull and cervical vertebrae (atlanto-occipital joint)

100

What does the trapezius arise from? 

  • Back of skull
  • Nuchal ligament
  • Spinous process of vertebrae 

 

101

Where does the trapezius insert? 

  • Lateral 1/3 of clavicle
  • Acromion
  • Spine of scapula 

 

102

Why does the trapezius have many actions? 

Due to it being a very broad muscle 

103

What actions of the trapezius are important when considering the neck? 

Elevates and rotates the shoulders, 'shrugging' them 

104

Is the trapezius muscle visible? 

Superior border is visible when shoulders shrugged against resistance 

105

What is the trapezius supplied by? 

The accessory nerve (CN XI)

106

What to the sternocleidomastoid and trapezius form? 

Important anatomical boundaries of the neck

107

What are the muscles of facial expression supplied by? 

The facial nerve (CN III)

108

How do many of the muscles of facial expression act? 

As dilators and sphincters 

109

Give 4 muscles of facial expression

  • Orbicularis oculi 
  • Levator palpebrae superioris 
  • Orbicularis oris 
  • Dilator muscles of lips 

 

110

What are the parts of the orbicularis oculi? 

  • Palpebral part
  • Orbital part 

 

111

What does the palpebral part of the orbicularis oculi do? 

Performs gentle closure of eyelid

112

What does the orbital part of the orbicularis oculi do? 

Closes more forcefully 

113

What does the levitor palpabrae superioris do? 

Elevates the upper eyelid 

114

What is the innervation of the levator palpebrae superioris? 

  • Oculomotor nerve (CN III) 
  • Superior tarsal muscle (located within the LPS) is innervated by sympathetic nervous system

 

115

What does the orbicularis oris do? 

Purses the lips

116

What do the dilator muscles of the lips do? 

Opens the mouth 

117

What do the muscles of the cheek do? 

  • Keep cheek taut 
  • Aid in chewing

 

118

What are the muscles of the cheek supplied by? 

Facial nerve (CN VII) 

119

Give a muscle of the cheek

Buccinator

120

What does the buccinator do? 

Pulls cheek inwards against teeth

121

What is the function of the buccinator pulling cheeks inwards against the teeth? 

Prevents accumulation of food in the area

122

What is the occipitofrontalis muscle supplied by? 

Facial nerve (CN VII)

123

What are the muscles of mastication supplied by? 

Mandibular division of trigeminal nerve (branch of CN IV)

124

What do the musles of mastication act to do? 

Open and close the jaw

125

Are there more or less muscles of mastication than muscles of facial expression? 

Less

126

Give 4 muscles of mastication 

  • Medial and lateral pterygoids 
  • Masseter
  • Temporalis 

127

What does the lateral pterygoid do? 

  • Acting bilaterally, protract the mandible, moving jaw forward
  • Acting unilaterally, produce side to side movement of jaw 

 

128

What does the medial pterygoid do? 

Elevates the mandible, closing the mouth 

129

What does the temporalis muscle do? 

  • Elevates the mandible, closing the mouth
  • Retracts the mandible, pulling the jaw posteriorly

 

130

What is the platysma supplied by? 

Facial nerve (CN VII) 

131

Describe the shape of platysma

Broad, sheet like 

132

Where does platysma lie? 

  • Anteriorly in the neck
  • Very superficial 

 

133

What are the actions of platysma? 

  • Draws corner of mouth inferiorly 
  • Draws skin of neck superiorly if teeth are clenched 

 

134

What are the muscles of the ear supplied by? 

Facial nerve (CN VII) 

135

Where do the muscles of the face lie? 

In subcutaneous tissue 

136

What do most muscles of the face attach to? 

Bone or fascia 

137

How do the muscles of the face produce their effects? 

By pulling the skin 

138

What orifaces to the muscles of the face surround? 

  • Mouth 
  • Eyes
  • Nose

 

139

What happens to the facial nerve once it has exited the cranium? 

It enters the substance of the parotid gland

140

What happens to the facial nerve in the parotid gland? 

It divides into its five extracranial branches 

141

What will injury or pathology involving the facial nerve cause? 

Muscle weakness of muscles of facial expression on ipsilateral side 

142

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

Bell's palsy 

143

What is Bell's palsy? 

Inflammation of facial nerve near its exit from the cranium at the stylomastoid foramen 

144

What does inflammation of the facial nerve cause? 

Oedema and compression of nerve in intracranial facial canal 

145

What is the clinical relevance of the facial nerve in the parotid gland?

As the facial nerve and its branches run through the parotid gland, and lie relatively superficial, they are vulnerable to damage in injuries to face, and in disease or surgery of the parotid gland 

146

Where do cranial nerves arise from? 

Brainstem, or slightly above

147

Where to the cranial nerves leave the skull? 

  • Those supplying face leave through front of skull 
  • Those supplying neck leave through base of skull 

 

148

What cranial nerve is the trigeminal nerve a branch of? 

V

149

What are the key branches of the trigeminal nerve? 

  • Opthalmic
  • Maxillary
  • Mandibular 

 

150

What does the mandibular nerve do? 

Supplies motor innervation to the muscles of mastication

151

What is the importance of the trigeminal nerve? 

Main sensory nerve of the face and scalp 

152

Draw a diagram illustrating the cutaneous distribution of the trigeminal nerve

153

What aspects of the trigeminal nerve can be tested? 

  • Sensory supply
  • Motor supply

 

154

How is the sensory supply of the trigeminal nerve tested? 

  • Ask patient to close their eyes
  • Introduce cottom wisp into areas of face supplied by three divisions of trigeminal nerve

This detects tactile sensory competence 

 

 

155

How is the motor supply of the trigeminal nerve tested? 

  • Ask patient to clench their jaw, and palpate; 
    • Superior to zygomatic arch 
    • Inferiorly 
  • Ask patient to open mouth and deviate mandible to left and right 

 

156

What is being felt for when palpating superior to zygomatic arch in trigeminal nerve testing? 

Temporalis 

157

What is being felt for when palpating inferiorly in trigeminal nerve testing? 

Masseter 

158

What is being tested for when asking patient to open mouth and deviate mandible to left and right in trigeminal nerve testing? 

Competence of medial and lateral pterygoid muscles 

159

What cranial nerve is the facial nerve derived from? 

VII

160

What are the key branches of the facial nerve? 

  • Temporal 
  • Zygomatic
  • Buccal
  • Marginal mandibular branches
  • Cervical 

 

161

What does the temporal branch of the facial nerve innervate? 

  • Frontalis 
  • Orbicularis oculi 
  • Corrugator supercilli 

 

162

What do the zygomatic branches of the facial nerve innervate? 

Orbicularis oculi 

163

What do the buccal branches of the facial nerve innervate? 

  • Orbicularis oris 
  • Buccinator
  • Zygomaticus

 

164

What do the marginal mandibular branches of the facial nerve innervate? 

Mentalis 

165

What does the cervical branch of the facial nerve innervate? 

Platysma 

166

What are the non-motor functions of the facial nerve? 

  • Special sensory to the tongue, for taste
  • Provides parasympathetic innervation to lacrimal glands and salivary glands

 

 

167

What can pathology of the parotid gland cause, regarding the facial nerve? 

Can also affect the nerve, causing paralysis of facial expression

168

How is the facial nerve tested? 

  • Test corneal reflex
  • Ask patient to; 
    • Raise eyebrows
    • Close eyes, and keep them closed against resistance
    • Puff their cheeks
    • Reveal their cheeks

 

 

169

When is the corneal reflex absent? 

In damage to trigeminal/opthalmic nerve, or facial nerve

170

What is the corneal reflex? 

Involuntary blinking of eyelids, stimulated by tactile, thermal, or physical stimulation of cornea 

 

 

171

Why must both side of the face be tested in facial nerve testing? 

As they are paired nerves

172

ADD PICTURES