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Head and neck

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Global institute of medical sciences …

Global institute of medical sciences

1. www.gims-org.com
2. www.usmletutor.org


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  • 1. I. OVERVIEW OF NECK - neck is compartmentalized 1. Posterior Compartment - Plane of section Vertebrae and muscles ANT. which support and move head & neck LAT. 2. Anterior Compartment- Viscera and rostral continuation GI & Respiratory SystemsPOST. 3. Lateral Compartment- Blood vessels & nerve HORIZONTAL SECTION THROUGH NECK
  • 2. 1. POSTERIOR COMPARTMENT - muscles move head and neckBACK+ SUBOCCIP SCALENEMUSCLES MUSCLES PRE- VERTEBRAL MUSCLES Post side - Deep Lateral side - Anterior side - Muscles (like Scalene Prevertebral Muscles - back)- extensor muscles - flex directly anterior to & Suboccipital neck laterally vertebrae - flex head & Muscles neck
  • 3. 2. ANTERIOR COMPARTMENT - VISCERAEsophagusTrachea In thorax, trachea is anterior to esophagus
  • 4. ANTERIOR COMPARTMENT - VISCERAAnteriorCompartment - LarynxLarynx is part ofupper end ofrespiratory system- Tracheaspecialized forsound production;also acts as‘sphincter’ ofrespiratory system-Thyroid cartilage isAdams apple
  • 5. SAYAAHH! PHARYNX
  • 6. Nose ANTERIOR COMPARTMENT -Nasal VISCERACavity PharynxOral 1) Larynx &cavity Esophagus open into pharynx 2) Pharynx - a tube of Larynx muscles & fascia that opens to nasal and oral Trachea cavities Esophagus
  • 7. HYOID BONE- parts: body, greater & lesser horns – All Infrahyoid & Suprahyoid attach to Body of Hyoid (except Sternothyroid-> thyroid cartilage) GREATERPalpable HORNSin neck LESSER Hyoid means HORNS "U" shaped BODY
  • 8. ANTERIOR COMPARTMENT - moveable, changes shape in swallowing, speechHyoid Bone – Hyoid- means "U"attached to shapedlarynx, pharynx &tongue; free HYOID BONEfloating; attachedby ligaments and Pharynxmoved bymuscles esophagus trachea
  • 9. HYOID BONETONGUE - muscles that move hyoid bone move larynx & Hyoid tongue, for Bone Swallowing, Talking Larynx
  • 10. 3. LATERAL COMPARTMENT - CAROTID SHEATH Lateral Compartment- lateral and posterior to pharynx Contained in Carotid Sheath 1) Common and Internal Carotid arteries; 2) Int. jugular vein, 3) Vagus nerve
  • 11. OUTLINE II. MUSCLES III. NERVES IV. ARTERIES V. VEINS VI. FASCIA VII. LYMPHATICS
  • 12. II. MUSCLES OF NECK
  • 13. A. MUSCLES OF NECK - NOT ATTACHED TO HYOID -move head & neck1. STERNO-CLEIDOMASTOID0 - Two heads 1)manubrium of sternum2) clavicle- medial 1/3I - mastoid process oftemporal boneAct - bilateral - flex headunilateral rotate head,face to directed oppositeside TORTICOLLIS – Contracture ofInn - CN XI Accessory n. Sternocleidomastoid
  • 14. MUSCLES OF NECK - NOT ATTACHED TO HYOID2. SCALENUSANTERIOR ANDSCALENUS MEDIUSO - vertebrae-trans processesupper cervicalI - rib 1A - flex neck &elevate rib 1Inn - ventralrami of cervicalspinal nerves THESE MUSCLES ARE IMPORTANT LANDMARKS IN NECK
  • 15. B. INFRAHYOID MUSCLES - all depress hyoid 1. OMOHYOID (omo = greek for shoulder) - Two bellies - Inf. Belly- Scapula- medial to suprascapular notch
  • 16. INFRAHYOID MUSCLES - all depress hyoid NOSE deeper2. STERNOHYOID 4. THYROHYOID - O -O- Manubrium & thyroid cartilage; alsoclavicle elevates larynx1. OMOHYOID 3. STERNOTHYROID --intermediate O - manubrium I -tendon to thyroid cartilage; alsoclavicle, rib 1; depresses larynxSup. belly tohyoid
  • 17. SUPRAHYOID MUSCLES - all elevate hyoid
  • 18. SUPRAHYOID MUSCLES - all elevate hyoid 1. DIGASTRIC - two bellies / two cranial nerves - insert to hyoid via intermediate tendon NOSEPost Belly-Temp. Bone,mastoidnotch(medial to Ant. Belly-mastoid Mandibleprocess) Inn- CN VInn - CN VII Act- Depress mandible; - MAJOR EFFECT is to OPEN Mouth
  • 19. SUPRAHYOID MUSCLES - all elevate hyoid2. STYLOHYOIDO-styloidprocess of tempbonetendon splits tosurrounddigastric tendonInn - CN VII
  • 20. SUPRAHYOID MUSCLES - all elevate hyoid3. MYLOHYOID - forms muscular floor of mouth O - mylohyoid line on inner side of mandible Act - Elevates floor of mouth in swallowing Inn - CN V - from V3
  • 21. SUPRAHYOID MUSCLES - all elevate hyoid 4. GENIOHYOID - O - inner side of mandible above mylohyoid A - Elevates hyoid and draws forward Inn - C1 branch hitch-hiking with Hypoglossal nerve (CN XII)
  • 22. III. NERVES OF NECK A. CERVICAL PLEXUS from C2-C4 ventral primary rami
  • 23. A. CERVICAL PLEXUS NOSE1) Lesser Occipital 2) Great Auricular - (C2, C3) skin overC2 behind ear parotid, inf. to ear 3) Transverse4) Supraclavicular - Cervical - C2, C3C3, C4 lower neck & ant. neckshoulder emerge from post border of sternocleidomastoid m.
  • 24. CERVICAL PLEXUS NOSE
  • 25. B. ANSA CERVICALIS- fibers from C1 joinHypoglossal Nerve(XII)- some leave & joinfibers of C2 & C3 toform ANSA (loop)Cervicalis- other fibers continuewith XII to innervateThyrohyoid &Geniohyoid(Looks like XIIinnervates neckmuscles; actually C1-C3 do)
  • 26. ANSA CERVICALISCN XIIReceiveshitchhikingfibers
  • 27. IV. ARTERIES OF HEAD AND NECK A. SUBCLAVIAN ARTERY At root of neck- passes to arm - becomes Axillary a. ( rib 1) - Scalenus Anterior muscle divides Subclavian into 3 parts SUBCLAVIAN A.
  • 28. SUBCLAVIAN ARTERY - divided into 3 parts by scalenus ant. musclePart 2- post to Part 1- medial toscal. ant. scal. ant,1) Costocervical 1) Vertebral a.trunk - branches 2) Int. thoracic a.a) Superior 3) Thyrocervicalintercostal a. first trunk: branches -two int spaces;b) Deep cervical a) Inf. thyroida. - deep neck b) Trans. cervical c) Suprascapular Part 3 - lat to scalenus ant. No Branches
  • 29. NOSESterno-cleidomastoid
  • 30. Phrenic n. Transverse cervical Scalenus Ant. artery M.Supra-scapularartery
  • 31. B. EXTERNAL CAROTID ARTERY 4. FACIAL A- BELOW THEN ON SURFACE OF MANDIBLE5. OCCIPITAL A-POST SCALP 3. LINGUAL A- TONGUE6. POST.AURICULAR A- 2. ASCENDINGPOST TO EAR PHARYNGEAL A- ASCENDS TO PHARYNX 1. SUPERIOR THYROID A- DESCENDS TO THYROID
  • 32. EXTERNAL CAROTID ARTERYSuperficial temporal- Maxillaryscalp & temporalisPost auricular- post. ear &scalp Facial Occipital- post. scalp Ascending pharyngeal- pharynx Lingual- tongue Superior thyroid- br. is Sup laryngeal
  • 33. EXTERNAL CAROTID ARTERY Reflect sterno- cleidomastoid Common carotid divides -> int & ext carotid at upper border thyroid cartilage
  • 34. Post side Ant side SUP. TEMPORALPOST.AURICULAR MAXILLARY OCCIPITAL FACIAL LINGUAL SUP. THYROID
  • 35. V. VEINS OF NECKPost. Sup.Auricular Temp. 1. Superficial Temporal & Maxillary vv. form Max Retromandibular V. (RM) PD Facial 2. Retromand. V. Divides Ant. RM (AD) and Post. (PD) divisions AD 3. Ant. Division joins Facial V. Common to form Common Facial V. -> facial Int. jugular V. 4. Post. Division joins Post. Auricular V. to form External Jugular V-> Subclavian V. Ant jug 5. Ant. Jugular from veins below mandible -> Ext. Jugular External above clavicle Jugular
  • 36. VEINS OF NECKPattern ofVenousDrainage
  • 37. VI. FASCIA OF NECKA. Superficialfascia:- connectivetissue belowdermis- completelysurrounds neck -thin and hard todemonstrate- containsPlatysma &Superficial veins
  • 38. FASCIA OF NECKB. Deep Cervicalfascia- one layersurrounds neck,other layers formtubes (names poorlychosen) 4. Carotid sheath 2. Prevertebral Layer 3. Pre-tracheal layer 1. Investing layer
  • 39. N O FASCIA OF NECK S E Pretracheal 1. Investing layer of deep cervical layer fascia- surrounds neck, splitsCarotid around sternocleid., trap, supra &Sheath infrahyoid 2. Prevertebral Layer- surrounds vert. column & muscles back of neck, prevertebral, lateral vertebral and suboccipital m. 3. Pretracheal Layer- surrounds trachea, esophag. & thyroid continues to mediastinum 4. Carotid Sheath- surrounds common & int carotid, int jugular and X (not: Symp. Chain) Retropharyngeal Space- between PreTrach & Pre Vert layers - infection from head (tonsillitis) can Prevertebral spread to mediastinum layer
  • 40. RETROPHARYNGEAL ABSCESS Infection in retropharyngeal space can spread unimpeded to mediastinum
  • 41. FASCIA OF NECK
  • 42. VII. LYMPHATICS OF HEAD AND NECK three groups (two arranged as rings; drain to chain) A. Superficial Ring; Submental, Submandibular, Buccal, Parotid, Retro- P RA auricular & Occipital nodesO B B. Deep Ring: Pretracheal, Retropharyngeal nodes C. Deep cervical chain- SMan SMen along Internal Jugular vein; receive lymph from all RP PT above nodes Deep Cerv. D. Jugular lymph trunk - to Chain Right lymphatic duct or Thoracic duct