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Head And Neck
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Head And Neck

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  • Transcript

    • 1. Head and Neck
    • 2. Topographical view
    • 3. Surface anatomy - neck
      • Hyoid
      • Thyroid cartilage
      • Cricoid cartilage
      • SCM muscle
      • Sternum
      • Chassaignac’s tubercles
      • Sternal notch
    • 4. Surface anatomy - neck
      • Inion
      • Trapezius
      • Trasversocostal muscle group
      • C7 spinous process
      • T1 spinous process
      • Nuchal ligament
      • Post. facet joint
      • Suboccipital muscle
      • Greator occipital nerve
    • 5. Bony Landmark Trails
    • 6. Bony Landmark Trails
    • 7. Bony Landmark Trails
    • 8. Muscles of the Head, Neck and Face
    • 9. Sternocleidomastoid
      • Action
        • Bilateral: Extends the head, assists in respiratio when the head is fixed
        • Unilateral: Tilts the head to the same side, rotates the head to the opposite side
      • Origin
        • Sternal head: Manubrium
        • Clavicular head: Medial third of the clavicle
      • Insertion
        • Mastoid process and superior nuchal line
      • Innervation
        • Acessory nerve and direct branches from the cervical plexus (C1-2)
    • 10. Sternocleidomastoid
        • Supine
        • Locate the matoid process, medial clavicle and the top of the sternum
        • Ask pt. to raise his head very slightly off the table as you palpate SCM
    • 11. Sternocleidomastoid
        • Palpate along the borders of the SCM
        • Follow it behind the earlobe and then down to the clavicle and sternum
    • 12. Test for SCM
    • 13. Test for SCM
      • Patient: Supine with elbows bent and hands beside the head, resting on table
      • Fixation: If the anterior abdominal muscles are weak, the examiner can provide fixation by exerting firm, downward pressure on the thorax
      • Test: Anterolateral neck flexion
      • Pressure: Against the temporal region of the head in an obliquely posterior direction
    • 14. Scalene muscles
      • Anterior scalene
      • Middle scalene
      • Posterior scalene
      • Actions of scalenes muscles
        • Unilaterally: Laterally flex the head and neck to the same side, rotate head and enck to the opposite side
        • Bilaterally: Elevate the ribs during inhalation, flex the head and neck
    • 15. Anterior scalene
      • Origin
        • TP of 3 rd through 6 th cervical vertebrae (ant. tubercle)
      • Insertion
        • 1 st rib
      • Innervation
        • Cervical and brachial plexus (C3-6)
    • 16. Middle scalene
      • Origin
        • TP of 3 rd through 7 th cervical vertebrae (post. tubercle)
      • Insertion
        • 1 st rib
      • Innervation
        • Cervical and brachial plexus (C3-6)
    • 17. Posterior scalene
      • Origin
        • TP of 5 th through 7 th cervical vertebrae (post. tubercle)
      • Insertion
        • 2 nd rib
      • Innervation
        • Cervical and brachial plexus (C3-6)
    • 18. Scalenes as a group
        • Supine
        • Cradle the head to allow for easier palpation
        • Place your finger pad along the ant. and lat. sides of the neck b/w SCM and trapezius
    • 19. Masseter
        • Supine
        • Locate zygomatic arch and angle of the mandible
        • Place your fingers b/w these bony landmarks and palpate the surface of the masseter
        • Ask pt. to alternately clench and relax her jaw
    • 20. Temporalis
        • Supine and locate the zygomatic arch
        • Place your finger pads 1 inch superior to the arch
        • Ask pt. to alternately clench and relax her jaw
    • 21. Temporalis
        • To locate the insertion site of the temporalis tendon, ask pt. to open her mouth wide
        • Locate and explore the coronoid process
    • 22. Occipitofrontralis
      • Frontalis fibers
        • supine
        • place fingers on the forehead
        • ask pt. to raise his eyebrows
      • Occipitalis fibers
        • supine or prone
        • locate sup. nuchal line
        • slide fingers 1 inch superiorly
    • 23. Splenius muscles
    • 24. Splenius muslces
      • 7. Splenius cervicis
      • 8. Splenius capitis
    • 25. Splenius muscles
      • Action
        • Entire muscle; bilateral contraction extends the cervical spine and head, unilateral contraction flexes and rotates the head to the same side
      • Origin
        • Splenius cervicis: Spinous process of T3-T6 vertebrae
        • Splenius capitis: Spinous process of C3-T3 vertebrae
      • Insertion
        • Splenius cervicis: Transverse process of C1-2
        • Splenius capitis: Lateral superior nuchal line, mastoid process
      • Innervation
        • Lateral branches of dorsal rami of spinal nerves C1-6
    • 26. Splenius capitis
        • Prone, locate the upper fibers of the trapezius
        • Isolate the lat. edge of the trapezius by extending pt’s head slightly
        • Palpate just lateral to the trapezius and follow the oblique fiber up to the mastoid process
    • 27. Both splenii muscles
        • Supine with head rotated 45° away from the side palpating
        • Cradle the head with one hand while the other hand locates the lamina groove of the upper cervical vertebrae
    • 28. Suboccipitalis Rectus capitis posterior major Rectus capitis post. minor Oblique capitis superior Oblique capitis inferior
    • 29. Suboccipitalis
      • Rectus capitis posterior major
      • Rectus capitis posterior minor
      • Rectus capitis superior
      • Rectus capitis inferior
    • 30. Rectus capitis posterior major
      • A: Bilateral contraction extends the head. Unilateral contraction rotates the head to the same side
      • O : SP of the axis
      • I : Inferior nuchal line of the occiput
      • N : Suboccipital
    • 31. Rectus capitis posterior minor
      • A: Bilateral contraction extends the head. Unilateral contraction rotates the head to the same side
      • O : Tubercle of the posterior arch of the atlas
      • I : Inferior nuchal line of the occiput
      • N : Suboccipital
    • 32. Oblique capitis superior
      • A: Bilateral contraction extends the head. Unilateral contraction tilts the head to the same side and rotates it to the opposite side
      • O : TP of Atlas
      • I : Above the insertion of the rectus capitis posterior major
      • N : Suboccipital
    • 33. Oblique capitis inferior
      • A: Bilateral contraction extends the head. Unilateral contraction rotates the head to the same side
      • O : Sp of the axis
      • I : TP of the atlas
      • N : Suboccipital
    • 34. Suboccipitalis
        • Supine position
        • Cradle the head in both hands
        • Passively extending the neck a bit
        • Locate sup. nuchal line and spinous process of C2
        •  Suboccipital span the area between these two landmarks
    • 35. Suboccipitals
        • Prone position
        • Locate lat. edge of the trapezius’ upper fiber
        • Palpating beside the level of C1 , place one finger at the lateral edge of the trapezius
        • Slowly sink medially into the suboccipitalis
    • 36. Test for posterolateral neck extensor
    • 37. Test for posterolateral neck extensor
      • Splenius capitis/cervicis, semispinalis capitis/cervicis, and cervical erector muscles
      • Patient: Prone with elbows bent and hands overhead, resting on the table
      • Fixation: None necessary
      • Test: Posterolateral neck extension, with the face turned toward the side being tested
      • Pressure: Against the posterolateral aspect of the head in an anterolateral direction