Anatomy - Head - 1

Front 1

Anterior triangle boundaries

Back 1

superior = inferior, posterior mandible

posterior= anterior margin of SCM

anterior= midline of neck

Front 2

Subdivisions of anterior triangle

Back 2

1. Muscular triangle

2. Submental triangle

3. Submandibular triangle

4. Carotid triangle

Front 3

Hyoid bone

Back 3

1. Does not attach w/other bones - free floating

2. Attaches to muscle, ligaments

3. Attaches to muscles of tongue and floor of mouth above

4. Attaches to larynx below

5. Attaches to epiglottis and pharynx behind

6. Aids in tongue movement and swallowing, speech

Front 4

Describe cervical plexus/ansa cervicales

Back 4

C1 - hitchhikes w/hypoglossal, becomes superior root of ansa cervicales, supplies superior omohyoid

OR keeps going, supplies thyrohyoid, geniohyoid as separate nerves

C2 +3 -inferior root of ansa cervicales, supply inferior omohyoid, sternohyoid, sternothyroid

Front 5

Hyoglossus M*

Back 5

Attaches from hyoid bone to base of tongue. not really a suprahyoid muscle.

Pulls base of tongue down, initiates swallowing so tongue flattens and elevates to throw food over.

Front 6

Carotid triangle components to note

Back 6

1. IJV drains cranial cavity

3. Common carotid bifurcates into external, internal carotid.

4. Vagus nerve (CN10)

5. Carotid body, carotid sinus - baroreceptors control BP, chemoreceptors monitor pH.

Front 7

Carotid body*

Back 7

Just before bifurcation

Contains baro, chemoreceptors.

Putting direct pressure here for a tachy pt tricks body into thinking BP too high, so heart rate slows.

Otherwise, tachycardia leads to low BP, even faster HR.

Front 8

External carotid - trace pathway

Back 8

Front 9

Sympathetics in anterior triangle

Back 9

REVIEW 34-37.

superior, middle, inferior cervical ganglion

Front 10

Lymph nodes in neck

Back 10

Nodes of neck --- deep cervcical nodes --- jugular trunk --- thoracic duct/right lymph duct

Front 11

3 salivary glands

Back 11

Sublingual : all the time

Submandibular : all the time/ On floor of mouth, surrounds mylohyoid muscle (slide 40)

Parotid : only produces as needed

Front 12

Neck layers

Back 12

1. Endocrine: thyroid, parathyroid glands

2. Respiratory: Larynx, trachea

3. Alimentary: Pharynx, esophagus

Front 13

Superficial structures to note

Back 13

1. Platysma muscle - facial expression, lots of attachment to skin to keep tight.

2. EJV - small superficial vein, used for grafts. Drains superficial structures

3. Superficial nerves: great auricular, transverse cervical. Sensation to superficial structures.

4. Submandibular, parotid glands.

5. Investing layer of deep fascia

Front 14

Muscular triangle borders, components

Back 14

1. Borders: midline, anterior SCM, superior omohyoid.

2. Contains Infrahyoid (strap) muscles

Front 15

Sternohyoid M

Back 15

1. Origin: Thorax behind manubrium

2. Insertion: Hyoid bone

3. Action: Depress larynx as whole

4. Innervation: Ansa cervicales

Front 16

Omohyoid M

Back 16

1. Origin: Suprascapular notch

2. Insertion: Hyoid bone

3. Action: Depress larynx as whole

4. Innervation: Ansa cervicales

*Intermediate tendon splits into superior, inferior belly

Front 17

Sternothyroid M

Back 17

1. Origin: Posterior manubrium below sternohyoid origin

2. Inserion: oblique line of thyroid cartilage

3. Action: Depressor of larynx as whole

4. Innervation: Ansa cervicales

Front 18

Thyrohyoid M

Back 18

1. Origin: Oblique line of thyroid cartilage

2. Insertion: Hyoid bone

3. Innervation: C1 traveling with hypoglossal (12) part of ansa cervicales

4. Action: elevates larynx as whole

Front 19

Carotid triangle borders, components

Back 19

1. Borders: Anterior SCM, Superior omohyoid, inferior belly digastric

2. Components: Bifurcation of common carotid

Front 20

Carotid sheath, carotid artery

Back 20

1. Carotid sheath contains IJV, vagus nerve, common carotid artery

2. Carotid arery splits into internal, external carotid at upper border of thyroid cartilage

3. Internal carotid has no branches In neck

Front 21

External carotid artery branches (name inferior to superior branches)

Back 21

1. Superior thyroid + Superior laryngeal branch, which travels with internal branch of superior laryngeal nerve through thyrohyoid membrane.

2. Lingual artery - passes deep into hyoglossus muscle

3. Facial artery - glandular, submental, tonsilar/ascending palatine branches

4. Ascending pharyngeal - posterior external carotid to wall of pharynx

5. Occipital artery - posterior external carotid, hooks over hypoglossal nerve towards mastoid process. Travels with greater occipital nerve.

6. A) Maxillary or B) Superficial temporal artery

*note: lingual artery may come off facial in variations

Front 22

Submental triangle borders

Back 22

1. 2 anterior digastric muscle bellies and hyoid bone

2. Only unpaired triangle. Contains median raphe of mylohyoid muscle

Front 23

Digastric/submandibular triangle borders and contents

Back 23

1. Two bellies of digastric muscle and lower border of mandible

2. Suprahyoid muscles - act on jaw, mouth, and tongue, innervated by cranial nerves

3. Submandibular gland

4. Submandibular lymph nodes

5. Vessels: Facial artery, facial vein

Front 24

Digastric muscle

Back 24

1. Origin: Arises from medial aspect of mastoid process, forming posterior belly

2. Intermediate tendon - pulley attached to hyoid bone

3. Insertion: Anterior belly ascends, inserts onto inner mandible (midline)

4. Innervation: Posterior = CN7, Anterior = CN5

5. Action: Elevator of larynx

Front 25

Stylohyoid

Back 25

1. Origin: Styloid process

2. Insertion: Hyoid bone

3. Splits and passes around tendon of digastric muscle

4. Innervation: CN7

5. Action: elevates larynx

Front 26

Mylohyoid

Back 26

1. Forms muscular floor of mouth

2. Origin: Mylohyoid line of mandible

3. Insertion: hyoid bone and connective tissue raphe that extends from hyoid to mandible in midline

4. Innervation: CN5

5. Action: Elevates larynx

Front 27

Geniohyoid

Back 27

1. Above mylohyoid, inside mouth

2. Origin: Inferior genial tubercle of mandible

3. Insertion: Body of hyoid bone

4. Innervation: C1, C2 through hypoglossal nerve

5. Action:???

Front 28

Submandibular gland

Back 28

1. Major salivary gland

2. Almost fills submandibular/digastric triangle

3. Lies below, in front of angle of mandible

4. Divided in large superficial (to mylohyoid), deep small (between mylohyoid, hyoglossus) part of gland

5. Submandibular duct opens at sublingual papilla

Front 29

Vessels in submandibular/digastric triangle

Back 29

1. Facial artery: Branch off external carotid. Torturous spiral fashion along lower border of mandible deep to gland, may travel within gland

A) Submental artery comes off facial

2. Facial vein: Passes over gland in subcutaneous tissue. Lies behind facial artery.

Front 30

Relationships in submandibular/submental triangle*

Back 30

1. Mylohyoid nerve is on mylohyoid muscle and sends branches to mylohyoid muscle, anterior belly of digastric

2. Intermediate tendon of digastric on surface of hyoglossus muscle, above hyoid bone

3. Hypoglossal nerve (CN12) runs forward on hyoglossus muscle deep to submandibular gland, passes between mylohyoid/hyoglossus muscles

4. Lingual nerve: btwn mylohyoid and hyoglossus

5. Lingual artery: deep to hyoglossus muscle

Front 31

Superficial venous drainage

Back 31

1. Posterior auricular vein

2. Retromandibular vein

3. Facial vein

4. External jugular vein = posterior auricular + posterior branch of retromandibular. Descends across SCM, empties into subclavian vein.

5. Common facial vein = anterior branch of retromandibular vein + facial vein. Empties into deep structures of neck.

Front 32

Retromandibular vein

Back 32

1. Formed in upper portion of parotid gland deep to neck of mandible by

A) Anterior branch - maxillary vein

B) Posterior branch - superficial temporal vein

2. Posterior to ramus of mandible

3. In parotid gland, lateral to external carotid artery

Front 33

Facial vein

Back 33

1. Supratrochlear + supra orbital ---angular ----facial

2. NO VALVES - easy for bacteria

3. Uses deep facial vein as bridge to pterygoid plexus

Front 34

External jugular

Back 34

1. Posterior auricular + posterior branch of retromandibular ---- external jugular

2. External jugular dumps ----subclavian vein

Front 35

Common facial vein

Back 35

1. Anterior branch of retromandibular + facial vein ---- common facial vein

2. Common facial vein dumps -----internal jugular

Front 36

Venous draining of deep structures

Back 36

Internal jugular vein

1. In carotid sheath w/ carotid artery, vagus nerve

2. From dural sinuses within cranial cavity

3. Moves posterior to lateral as it decends (in relation to internal carotid artery)

Front 37

Lymph drainage

Back 37

??? REVIEW!!!

Front 38

Cranial nerves*

Back 38

1. Trigeminal (5) - mylohyoid, anterior belly of digastric

2. Facial (7) - Stylohyoid and posterior belly of digastric. Cervical branch supplies platysma.

3. Glossopharyngeal (9) - carotid sinus

4. Vagus: * REVIEW

A Superior/inferior cervical cardiac nerves (visceral branches to cardiac plexus)

B. Superior laryngeal nerve

C. Pharyngeal branch

D. Recurrent (inferior) laryngeal nerve

5. Accessory nerve (11): SCM and trapezius

6. Hypoglossal (CN12)

Front 39

hypoglossal nerve

Back 39

1. Crosses external to both carotid arteries

2. Deep to mylohyoid muscle

3. Carries branches to ansa cervicalis, thyrohyoid and geniohyoid muscles (actually from C1/C2. just hitchhiking)

*review ansa cervicales slide*

Front 40

Cervical portion of sympathetic system - REVIEW

Back 40

1. Superior cervical ganglion - C1,2,3,4.

A. Internal carotid nerve/plexus

B. Superior cervical cardiac nerve

C. Pharyngeal branches

2. Middle cervical ganglion ---middle cervical cardiac nerve. C5,6.

3. Inferior cervical ganglion --inferior cervical cardiac nerve. C7,8.

4. Vertebral ganglion - may not be present.

Front 41

Thyroid gland

Back 41

1. Two lateral lobes

2. Median lob, isthmus connects two lateral lobes

3. Pyramidal lobe may be present, extending up from isthmus

4. Blood from superior thyroid artery - branch of external carotid AND inferior thyroid artery - branch of thyrocervical trunk, off subclavian

* Endocrine gland - Makes thyroxin, thrycalcitonin - metabolism regulation

5. Drained by Superior, middle, inferior thyroid veins

Front 42

Parathyroid glands

Back 42

1. On Posterior surface of thyroid

2. Superior parathyroid, inferior parathyroid

3. Close relation with recurrent laryngeal nerves on each as nerves travel posterior to thyroid gland (important clinically)

4. Makes parathyroid hormone, regulates calcium levels in blood