Head and Neck Exam Review

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Head and Neck Exam Review
2013-10-10 14:24:27

Head and Neck
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  1. Branches of Facial Artery
    • 1. Ascending Palantine Artery
    • 2. Tonsillar Artery
    • 3. Glandular Branch
    • 4. Submental Branch
    • 5. Inferior Labial Branch
    • 6. Superior Labial Branch
    • 7. Labial Nasal Artery
    • 8. Angular Artery
  2. Branches of Maxillary Artery
    • Deep Auricular Artery
    • Anterior Tympanic Artery
    • Middle Meningeal Artery
    • Accessory Meningeal Artery
    • Deep Temporal Arteries
    • Inferior Alveolar Artery
    • Mylohyoid Branch of inf. Alveolar
    • Mental artery Branch of inf. Alveolar
    • Masseteric Artery
    • Pterygoid Branch
    • Buccal Artery
  3. Pterion
    • Junction of parietal, frontal, sphenoid, and temporal bones
    • Skull fractures are serious in this area
    • Middle meningeal artery passes underneath the pterion
    • Can cause extradural hematoma
  4. Arterial Supply to Meninges
    • Anterior Meningeal Artery - crosses pterion
    • Middle Meningeal Artery - Branch of maxillary artery, has 2 branches: one enters cranium through foramen spinosum, the other is the accessory meningeal and enters through foramen ovale
    • Posterior Meningeal Artery - terminal branch of ascending pharyngeal artery, enters through jugular foramen
  5. Innervation of Dura Mater
    Trigeminal nerve, all branches, also cervical nerves
  6. Superior Sagittal Sinus
    Receives superior cerebral, diploic, and emissary veins, and CSF
  7. Inferior Sagittal Sinus
    A few cerebral veins and falx cerebri
  8. Straight Dural Sinus
    Receives inferior sagittal sinus, great cerebral vein, posterior cerebral veins, superior cerebellar veins, and veins from the falx cerebri
  9. Confluence of Sinuses
    Receives superior sagittal, straight, and occipital sinuses
  10. Transverse Sinus (Right)
    Drainage from confluence of sinuses: transverse and usually superior sagittal sinuses
  11. Transverse Sinus (Left)
    Transverse and usually straight sinuses
  12. Cavernous Sinus Drainage
    Cerebral and Ophthalmic veins, sphenoparietal sinus, emissary veins from pterygoid plexus of veins
  13. Cavernous Sinus (Things Passing Through)
    Most Important: Internal Carotid and Adbucent nerve - aneurism in the carotid here can compress abducent nerve (if patient comes in cross-eyed)

    Other things that pass through laterally: Oculomotor nerve [III], trochlear nerve [IV], Ophthalmic nerve [V1], and maxillary nerve [V2]
  14. Extradural Hemorrhage
    • Tearing of branches of meningeal artery (could be near pterion)
    • Blood collects between dura and calvaria
  15. Subdural hematoma
    • Tearing of cerebral veins where they enter superior sagittal sinus
    • Blood collects between arachnoid and dura matter
  16. Subarachnoid Hemorrhage
    • Caused by significant cerebral trauma - can lead to rupture of aneurism
    • Collects within subarachnoid space
  17. What goes through the parotid gland?
    • Facial nerve [VII]
    • External carotid
    • Retromandibular vein
  18. Branches of Facial Nerve
    • Temporal
    • Zygomatic
    • Buccal
    • Mandibular
    • Cervical
  19. Danger Area
    • Medial corner of orbit
    • Area of cheek
    • Deeper face

    Infections here can travel to the brain
  20. Central Lesion in Bell's Palsy
    • Motor nucleus lesion - ipsilateral weakness of whole face
    • Lesion in tract above nucleus - contralateral weakness of lower 1/2 of face
  21. Lesion around geniculate nucleus (Bell's Palsy)
    -ipsilateral weakness of whole face, loss of taste on ant. 2/3rds of tongue, loss of lacrimation, some salivation

    Occurs because lesion is proximal to greater petrosal nerve and chorda tympani
  22. Lesion around stylomastoid foramen
    Ipsilateral weakness of whoel face
  23. Layers of SCALP
    • Skin
    • Connective Tissue
    • Aponeurotic Layer
    • Loose Connective Tissue
    • Pericranium
  24. Trigeminal Neuralgia (tic douloureux)
    Sensory disorder of sensory root of trigeminal nerve.  Typically the pain is in the region of mandibular [V3] and maxillary [V2]
  25. Two muscles that cause drooping of eye (Ptosis)
    • Levator palpebrae superior muscle (cranial nerve III) - complete ptosis
    • Superior toursal muscle (sympathetics) - partial ptosis (horner's syndrome)
  26. Intrinsic Muscles of Eye
    • Ciliary: constricts ciliary band, relaxes tension
    • Sphincter pupillae: constricts pupil
    • Dilator pupillae: dilates pupil, only sympathetic innervation
  27. Muscles of middle ear
    • 1. Tensor Tympani: Branch of mandibular nerve [V3], contracts pulls handle of malleus medially
    • 2. Stapedius: Branch of facial nerve [VII] - contraction of stapes
  28. Fascia of the Neck
    • Superficial Fascia
    • Investing Fascia
    • Prevertebral Layer
    • Pretracheal Layer
    • Carotid Sheath
  29. Fascial Spaces (conduits for spread of infections from neck to mediastinum)
    • 1. Pretracheal Space: between investing layer and pretracheal fascia (infection would spread to superior mediastinum)
    • 2. Retropharyngeal Space: between the buccopharyngeal fascia and preverebral fascia
    • 3. Third Space: with the preverebral layer covering anterior surface of transverse processes and bodies of cervical vertebrae.