Head & Neck – Session 1
1 What are the main muscle groups in the head?
Max.
Mark
4
Muscles of facial expression (x1)
Muscle of the cheek (buccinators) (x1)
Occipitofrontalis muscle (x1)
Muscles of mastication (x1)
2 Where are the muscles in the face? How do they produce their effect?
Max.
Mark
The muscles of the face are in the subcutaneous tissue and they move the skin and change facial expressions (x1)
Most muscles, attached to bone or fascia produce their effects by pulling the skin (x1)
2
3 What nerve are the muscles of mastication supplied by?
Max.
Mark
The muscles of mastication are supplied by the mandibular division of the trigeminal nerve (branch of CN V) (x1)
1
4
4 What muscles does the facial nerve supply? Where does it divide into its extra-cranial branches?
Max.
Mark
Supplies the superficial muscle of the neck and chin (platysma), muscles of facial expression, buccinators, muscles of the ear and the occipitofrontalis muscle (x1) for 3
It exits the cranium and enters the substance of the parotid gland in which it divides into its extra-cranial branches (x1)
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5 What is the most common non-traumatic cause of facial paralysis? What is this called?
Max.
Mark
Inflammation of the facial nerve (x1) near its exit from the cranium at the stylomastoid foramen (x1)
Inflammation causes o edema and compression of the nerve (Bell’s palsy) in the intracranial facial canal (x1)
3
6 How does the aforementioned facial paralysis present?
Max.
Mark
1
The affected area sags, and facial expression is distorted, making it appear passive or sad (x1)
7 Why are the branches of the facial nerve at subject to injury?
What injuries are they commonly injured in? What surgical procedure is the facial nerve and its branches commonly injured in?
Max.
Mark
As the branches of the facial nerve are superficial, (x1) they are subject to injury in wounds, cuts and in child-birth (x1)
As the nerve and its branches pass through the parotid gland, they are vulnerable to injury during surgery on the gland or in disease of the gland (x1)
3
8 What artery do the arteries that supply the face mostly branch off of? What artery is the major arterial supply to the face?
Max.
Mark
Most arteries supplying the face are branches of the external carotid artery (x1)
The facial artery is the major arterial supply to the face (x1)
2
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9 Where can the pulse of the facial artery be palpated? What do you need to do in the event of facial artery laceration and
Max.
Mark why?
Inferior border of the mandible (x1)
Because the artery has many anastomoses with other arteries of the face, (x1) in the event of laceration of the artery on one side of the face, it is necessary to compress both the arteries to stop bleeding (x1)
3
10 Describe the major venous drainage of the face and what these veins drain into
Max.
Mark
The facial vein (x1) forms the major venous drainage of the face and drains into the internal jugular vein (x1)
Both internal and external jugular veins drain into the subclavian vein (x1)
2
11 Describe how the external jugular vein is formed
Max.
Mark
Superficial temporal vein, maxillary vein and other veins form the external jugular vein (x1)
1
12 What is the superficial cervical fascia? Where does it lie?
Where is it thinnest? What does it contain?
Max.
Mark
The cervical subcutaneous tissue (Superficial Cervical Fascia) is a layer of fatty connective tissue (x1)
Lies between the dermis of the skin and the investing layer of deep cervical fascia (x1)
This tissue is usually thinner than in other regions, especially anteriorly (x1)
It contains - Cutaneous nerves, blood and lymphatic vessels, superficial lymph nodes and variable amounts of fat, anterolaterally, it contains the platysma (x1 for every 3)
5
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13 Where does the Platysma develop from? What is it innervated by?
Max.
Mark
Develops from the 2nd pharyngeal arch (x1)
Supplied by branches of the facial nerve (CN VII) (x1)
2
14 Describe the action of the platysma
Max.
Mark
2
Acting from its superior attachment, the platysma tenses the skin
(x1)
Acting from its inferior attachment, the platysma helps depress the mandible and draw the corners of the mouth inferiorly, as in a grimace. (x1)
15 What are the layers of the deep cervical fascia
Max.
Mark
Investing (x1)
Pretracheal (x1)
Prevertebral (x1)
3
16 What does the carotid sheath contain?
Max.
Mark
Common carotid arteries (x1)
Internal jugular veins (x1)
Vagus nerves (x1)
3
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17 Describe the functions of the deep cervical fascia
Max.
Mark
Support (x1)

Viscera (e.g. thyroid gland)

Muscles, Vessels and deep Lymph Nodes
Limit the spread of abscesses that result from infections (x1)
Slipperiness that allows structures in the neck to move and pass over one another without difficulty (x1)

Swallowing

Turning the head and neck
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3
18 What is the most superficial fascia of the neck? What does it enclose?
Max.
Mark
Sternocleidomastoid (x1)
Trapezius (x1)
Submandibular and Parotid Salivary Glands (x1)
3
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19 Where does the pretracheal fascia blend into and with what?
Max.
Mark
Inferiorly (x1) it extends into the thorax, where it blends with the fibrous pericardium (x1)
Laterally (x1) it blends with the carotid sheath (x1)
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20 What does the pretracheal sheath enclose?
Max.
Mark
Encloses infrahyoid muscles (x1)
Thyroid gland (x1)
Trachea (x1)
Oesophagus (x1)
4
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21 What is the innermost layer of deep fascia? What does it enclose? Where does it extend?
Max.
Mark
The innermost layer of the deep fascia (x1)
Forms a sheath for the vertebral column and the muscles associated with it (x1)
Extends from the base of the cranium of the 3rd thoracic vertebra and extends laterally as the axillary sheath that surrounds the axillary vessels and the brachial plexus (x1)
3
22 Where does the carotid sheath extend from and to? What does it contain?
Max.
Mark
A tubular, fibrous structure that extends from the base of the cranium to the root of the neck (x1)
Contains:
The common carotid artery (x1)
Internal jugular vein (x1)
The vagus nerve (CN X) (x1)
4
23 What are the cleavage planes and what do they allow?
Max.
Mark
The layers of deep cervical fascia form natural cleavage planes
(x1)
Allowing separation of tissues during surgery (x1)
2
24 Describe the spread of infection between the investing layer and the muscular part of the pretracheal surrounding the
Max.
Mark infrahyoid muscles
Will not spread beyond the manubrium (x1)
1
25 Describe the spread of infection between the Investing and visceral pretracheal layers
Max.
Mark
It can spread into the thoracic cavity anterior to the pericardium
(x1)
1
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26 Where might pus from an abscess lying behind the
Prevertebral layer of deep cervical fascia extend to? What may happen if it spreads to this location? What will be the symptoms of this?
Max.
Mark
Pus from an abscess lying behind the Prevertebral layer of deep cervical fascia may extend laterally in the neck (x1)
May perforate the fascial layer and enter the retropharyngeal space
(x1)
This will produce a bulge (retropharyngeal abscess) in the pharynx, resulting in dysphasia (difficulty swallowing) and dysphonia
(difficulty speaking) (x1) for 2
4
27 What is the retropharyngeal space? What is its clinical importance?
Max.
Mark
The retropharyngeal space is a potential space between the
Prevertebral layer of fascia and the fascia surrounding the pharynx superficially (x1)
This is the largest, most important interfascial space in the neck because it is the major route of spread of infection from the neck to the thorax (x1)
The space runs to the diaphragm (x1)
3
28 Describe the borders of the anterior triangle of the neck
Max.
Mark
Anterior
– Mid line (x1)
Posterior – The anterior border of SCM (x1)
Superior – Inferior border of the mandible (x1)
Apex – Jugular notch in the manubrium (x1)
Roof
– Superficial cervical fascia, containing the platysma (x1)
Floor – Pharynx, larynx, thyroid gland (x1)
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29 The anterior triangle can be further divided into four other triangles. What are they?
Max.
Mark
Submandibular (digastric) Triangle (x1)
Submental Triangle (x1)
Carotid Triangle (x1)
Muscular (omotracheal) triangle( x1)
4
30 Name the contents in the subdivision of the anterior triangle labelled 4
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Mark
Max.
Mark
4
Submandibular gland (x1)
Submandibular lymph nodes (x1)
Hypoglossal and Mylohoid nerves (x1)
Parts of facial artery and vein (x1)
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31 Name the contents in the subdivision of the anterior triangle labelled 5
Max.
Mark
Submental lymph nodes (x1)
Small veins which unite to form anterior jugular vein (x1)
2
32 Name the contents in the subdivision of the anterior triangle labelled 7
Max.
Mark
Sternothyroid (x1)
Sternohyoid (x1)
Thryoid (x1)
Parathyroid (x1)
4
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33 Name the contents in the subdivision of the anterior triangle labelled 6
Max.
Mark
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Carotid sheath (x1)

Common carotid artery

Internal jugular vein

Vagus nerve

Deep Cervical Lymph Nodes
7
Thyroid gland (x1)
Larynx (x1)
Pharynx (x1)
External carotid artery and some of its branches (x1)
Hypoglossal and Spinal accessory nerves (x1)
Branches of cervical plexus (x1)
34 Describe the borders of the posterior triangle of the neck
Max.
Mark
Anterior
– Posterior border of SCM (x1)
Posterior – Anterior border of Trapezius (x1)
Inferiorly – Middle third of the clavicle, between Trapezius and
SCM (x1)
Apex
– Where SCM and Trapezius meet on the superior nuchal line of the occipital bone (x1)
Roof – Investing layer of deep cervical fascia (x1)
Floor
– Muscles covered by the Prevertebral layer of deep cervical fascia (x1)
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35 Name the subdivisions of the posterior triangle of the neck
Max.
Mark
Occipital Triangle (x1)
Omoclavicular (subclavian) triangle (x1)
6
2
36 Name the contents in the subdivision of the posterior triangle labelled 2
Max.
Mark
Spinal Accessory Nerve (CN XI) (x1)
Trunks of Brachial Plexus (x1)
Part of external jugular vein (x1)
Posterior branches of cervical plexus (x1)
Cervicodorsal trunk (x1)
Cervical lymph node (x1)
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37 Name the contents in the subdivision of the posterior triangle labelled 3
Max.
Mark
3rd part Subclavian Artery (x1)
Part of Subclavian Vein (x1)
Suprascapular artery (x1)
Supraclavicular lymph nodes (x1)
4
38 Where are the hyoid muscles? What do they provide attachments for? What are their function?
Max.
Mark
In the anterolateral part of the neck (x1)
The hyoid bone provides attachments for the Suprahyoid Muscles superiorly, and the Infrahyoid Muscles inferiorly (x1)
These hyoid muscles steady or move the hyoid and larynx (x1)
3
39 Name the suprahyoid muscles
Max.
Mark
Mylohyoid (x1)
Geniohyoid (x1)
Stylohyoid (x1)
Digastric Muscles (x1)
4
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40 Describe how the digastric muscle is formed and how this helps it perform its function
Max.
Mark
Two bellies (Anterior and Posterior) (x1)
Joined by an intermediate tendon (x1)
Fibrous sling, from Pretracheal layer of Deep Cervical Fascia allows the tendon to slide anteriorly and posteriorly (x1)
3
41 Describe the function of the suprahyoid muscles
Max.
Mark
2
Suprahyoid muscles constitute the substance of the floor of the mouth, supporting the hyoid in providing a base from which the tongue functions (x1)
They also elevate the hyoid and larynx in relation to swallowing and tone production (x1)
42 What are the two groups of infrahyoid muscles? Name what infrahyoid muscles are in both groups
Max.
Mark
Superficial Plane (x1)

Sternohyoid (x1)

Omohyoid (x1) - Has two bellies (Superior and Inferior), joined by an intermediate tendon. Fascial sling for the tendon connects to the clavicle
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Deep Plane (x1)

Sternothyroid (x1)

Thyrohyoid (x1)
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43 Describe the function of the infrahyoid muscles
Max.
Mark
Anchor the hyoid, sternum, clavicle and scapula (x1)
Depress the hyoid and larynx during swallowing and speaking (x1)
Work with the Suprahyoid muscles to steady the hyoid, providing a firm base for the tongue (x1)
2
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