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35 Cards in this Set
- Front
- Back
Superior oblique
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a
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Inferior oblique
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a
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Lateral rectus
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a
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Medial rectus
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a
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Superior rectus
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a
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Inferior rectus
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a
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Levator palpabrae
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a
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Osteomeatal unit
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a
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Pterygopalatine fossa
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a
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MAxillary sinus
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a
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Ethmoid air cells
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a
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Frontal sinus
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a
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Sphenoid sinus
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a
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Parapharyngeal space
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a
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Masticator space
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a
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Infratemporal fossa
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a
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Base of the skull openings
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a
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Orbit walls
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Superior - frontal bone
Lateral - zygomatic bone Inferior - Maxillary bone Medial - ethmoid and lacrimal Posterior - sphenoid bone |
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Orbit contents cross section
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Central - opic nerve containing the central retinal artery and vein
surrounded by fat Inferior is inferior rectus and inferior opthalmic vein lateral to this Medial is medial rectus, and superior oblique above this Superior is the superior opthalmic vein, then the superior rectus, then levator palpebrae superioris, finally the supraorbital nerve (trigeminal 1st div) Lateral is lateral rectus The inferior oblique arises at the globe, so does not appear in the plane of the optic sheath. |
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Sinus drainage pathways
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Sphenoid - via sphenoid ostia and sphenoethmoid recess into superior meatus
Ethmoid - posterior cells via sphenoethmoid recess to superior meatus anterior cells via ethmoid bulla and hiatus semilunaris to middle meatus Maxillary - via maxillary ostium to infundibulum to hiatus semilunaris to middle meatus Frontal sinus - via frontal recess to hiatus semilunaris to middle meatus Lacrimal gland - not a sinus, but drains via lacrimal duct to inferior meatus |
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Spaces of the suprahyoid neck
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Spaces are seperated by 3 layers of fascia (deep, middle and superficial layers of the 'deep cervical fascia')
The deep layer is just anterior to the vertebrae/BoS and forms the base of the retropharyngeal space and the carotid space laterally. The middle layer is anterior and midline, and encloses the pharyngeal mucosal space. It contributes to the carotid sheath laterally. The superficial fascia encloses the superficial spaces - the masticator space, the parotid space, the submandibular space and follows the muscles down the neck SPACES: Pharyngeal mucosal space - Contains the mucosal surfaces, lymphatics and constrictor muscles. The mucosal structures and muscles (tonsils, torus tubarius, palate, levator palatini etc) are within this space. Parapharyngeal space: Lateral to the mucosal space, more in the posterior region is the parapharyngeal. Contains mainly fat (some veins). Seperates mucosal space from carotid and masticator spaces. It is a potential space that can be filled by pathology. Retropharyngeal space - Posterior to mucosal space, anterior to foramen magnum at level of pharynx, runs posterolaterally to the carotid space. Contains fat and some lymph nodes. Continuous with danger space/perivertebral space and thus communicates with mediastinum. Posterior to pharynx/oesophagus/trachea Masticator space - Anterolateral to mucosal and parapharyngeal spaces, from pterygoids to zygomatic arch. Posterior extent to around styloid process. Contains the ramus and condyle of mandible, pterygoid and temporalis muscles, masseter muscles and third division of trigeminal nerve, along with maxillary artery. Superior extent is under sygomatic arch to temple (around temporalis muscle). Parotid space - Around the parotid. From SM foramen around gland. Contains parotid, facial nerve and ECA. Carotid space - Between parotid and parapharyngeal spaces, contains the internal carotid arteries, IJVs and CN9-12. Continues down the neck as carotid sheath. |
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Spaces of the infrahyoid neck
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3 main spaces -
Anteriorly the visceral space Middle (slightly lateral) is the carotid space Posteriorly is the perivertebral space, made up of prevertebral and paraspinal components, as well as the danger space. The visceral space - contains the Oesophagus, trachea, recurrent laryngeal nerve, thyroid and parathyroids. Continues with mediastinum. The carotid space - Carotid, IJVs and CN 9-12 Prevertebral space - from base of skull to clavicles. Contains vertebral bodies, veins and arteries, scalene muscles, brachial plexus and the phrenic nerve Paraspinal - posterior spinal elements, levator scapulae and paraspinal muscles Posterior cervical space - between the perivertebral space and the superficial muscles circumferentially. Contains fat and nodes. |
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Lymphatic ring of mucosal pharyngeal space
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Waldeyer's ring
Adenoids in nasopharynx Palatine tonsils in lateral oropharynx Lingual tonsils in lower oropharynx (base of tongue) |
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Masticator space
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Contains muscles of mastication, mandibular division of trigeminal, and the branches of the 2nd portion of the maxillary artery.
The path of CNV3 is from the foramen ovale after Meckel's cave, and between the two pterygoid muscles down and lateral to the mandibular ramus. It supplies all the muscles of the masticator space, the ant digastric and mylohyoid, and senation to oral structures, including sensation to tongue via lingual nerve (which is joined in the region by chorda tympani) MUSCLES: medial and lateral pterygoids masseter temporalis |
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Parotid space
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Contains superficial lobe of parotid (deep is in parapharyngeal space)
Facial nerve (extracranial portion) External carotid artery medial to retromandibular vein behind ramus of jaw Retromandibular vein lateral to ECA. Medial to facial nerve in parotid. Joins external jugular Lymph nodes in parotid Parotid duct which passes anterior from gland and along masseter muscle. Arches through buccal space to enter mouth at 2nd upper molar |
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Carotid space
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runs from base of skull to aortic arch
Upper - Sheath contains ICA anteromedially. In this sheath, relative to the ICA is medial: CN12 posterior: CN10 medial, CN11 lateral lateral: CN9 deep posterolateral: IJV below oropharynx medial: ICA lateral: IJV posterior: CN10 |
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Retropharyngeal space
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Only fat and nodes.
Nodes only above the hyoid. Medial and lateral groups bilaterally |
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Temperomandibular joint
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Complex diarthrodial joint, involved in both rotatory and sliding movements.
PARTS: Articular surface - Mandibular fossa and articular eminence (anterior prominence bordering the mandibular fossa) on the zygomatic portion of the squamous temporal bone. Located anterior to IAM Mandibular condyle - Posterior protrusion/head of mandible. Articular disk - Made up of anterior and posterior bands. The posterior band sits in the mandibular fossa, above the condyle. It is fixed posteriorly to the mandibular fossa, restricting it's forward movement during jaw opening. A inferior posterior band of fibrous tissue attaches to the condyle. The smaller anterior band rests in front to the peak of the articular eminence. Here it is integrated into the superior portion of the lateral pterygoid muscle. TMJ compartments - Superior compartment above disc, below mandibular fossa Inferior compartment below disc and condyle, with an anterior and posterior recess adjacent to condyle. Capsule and ligaments - The capsule runs from the articular eminence and mandibular fossa around the condyle and to the condylar neck. ACTION: on mouth opening the joint initially rotates, but then slips forward over the articular eminence. The disc moves with it, and the forward motion is restricted by the posterior band between the mandibular fossa and condylar head. The other mandibular process - the coronoid - is a site of muscle insertion. |
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Head and neck veins
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There are 3 main drainage trunks externally
The common facial vein anteriorly from the face The retromandibular vein from the scalp The occipital vein from the occiput. Additionally, the anterior neck is drained by the anterior jugular vein. FACIAL: Courses from the angular vein along the lateral border of the nostril, down inder the zygoma, over the muscles of mastication and under the angle of the jaw to drain to the IJV. RETROMANDIBULAR: The superficial temporal vein, maxillary and posterior auricular vein join together, passing behind the mandibular ramus to drain to the IJV and EJV. These 2 veins (facial and retromandibular) both drain the pterygoid plexus veins OCCIPITAL: The occipital vein drains the scalp over the occiput, and runs into the EJV. Finally the anterior neck is drained by the anterior jugular vein. |
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Cartilages of the throat
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MAIN RINGS:
Hyoid bone - anterior wishbone only Thyroid cartilage - Anterior batwing shaped. Has a superior central notch seperating 2 laminae. These laminae have superior and inferior horns. Cricoid cartilage - Circumferential, only complete ring MNEMONIC - HTC Additional cartilages - the aretynoids run upwards from the posterior cricoid cartilage. These are topped by the small corniculate cartilages. The true vocal cords attach to the aretynoid cartilages. EPIGLOTTIS: A leaf shaped cartilage that acts as the lid to the larynx. It is attached inferiorly to the hyoid (midline hyoepiglottic ligament), the thyroid cartilage (thyroepiglottic ligament) and more superiorly the opening of the vallecula are bounded by the pharyngoepiglottic fold laterally and the glossoepiglottic fold in the midline. Anteriorly from the epiglottis is the preglottic space, and laterally is the paraglottic space. |
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Vocal cords
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True vocal cords run between vocal process of aretynoid and the thyroid cartilage.
The bulk of the cord is made up of the thyroaretynoid muscle. The medial 'cord' is called the vocal ligament. Neuro - the recurrent laryngeal nerve controls the muscles. It runs up the neck from the turning point at the great vessels. In the most superior part it sits between the inferior cornu of the thyroid cartilage posteriorly, and the cricoid ring. The mucous membranes of the paraglottic space become the false cords, seperated from the true cords by the laryngeal ventricle. |
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Hypopharynx/larynx
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Supraglottic and Glottic/subglottic divisions (develop seperately).
SUPRAGLOTTIC REGION: GLOTTIC REGION: True vocal cords, between thyroid and aretynoid cartilages. SUBGLOTTIC REGION: from true vocal cords to inferior surface of cricoid cartilage. Minimal nodes (Cancer here far less likely to metastasise to nodes). |
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Thyroid
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Lies anterior and lateral to trachea in the visceral space of the infrahyoid neck
PARTS: Lateral lobes, with upper and lower poles. Commonly asymmetric. Isthmus between lobes Parathyroids (usually 4) near the deep surface of the gland in each pole. Blood supply - Superior thyroid artery from external carotid Inferior thyroid artery from thyrocervical trunk (of subclavian) Variant: Thyroidea ima, a single vessel from the aortic arch or brachiocephalic in 3% VENOUS: Superior and middle veins to IJV Inferior vein to left brachiocephalic |
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Trachea
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10-13cm tube from larynx (C6) to carina (T5)
PARTS: Cartilage rings - enclose anterior 2/3rds of trachea, with flat fibromuscular membrane closing posterior portion Blood supply: Inferior thyroid arteries and veins |
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Oesophagus
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25cm tube from C6 behind hypopharynx to T11 at hiatus.
Cervical oesophagus is supplied blood by inferior thyroid arteries and veins |