Dent 545 Lecture 2

13. Where does the platysma originate from?

The fascia overlying the pectoral and deltoid muscles. Wiki: t is a broad sheet arising from the fascia covering the upper parts of the pectoralis major and deltoid

7. Lecture: which artery runs past vertebral bones C6-C1? Through which foramina does it run through?

Vertebral artery Transverse foramina

11. My notes: An organ of the digestive, respiratory, urogenital, and endocrine systems as well as the spleen, the heart, and great vessels;

Viscera

8. My note: what a name for internal organs in main cavity of body?

Viscera

11. What is deep to the muscular fascia? What does this fascial layer encompass?

Visceral fascia which surround the thyroid gland, esophagus, and trachea.

11. What does the superficial layer of deep cervical fascia encompass?

Sternocleidomastoid (SCM) muscle and trapezius muscles

15. Where would you find: -transverse cervical nerve -accessory nerve -ansa cervicalis -vagus nerve -great auricular nerve -lesser occipital nerve -hypoglossal nerve -phrenic nerve -supraclavicular nerves

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4. On slide: Study how each bone articulates with surrounding bones. You should also study various structures (nerves and blood vessels) which pass through the bones (and the named openings which transmit these various neurovascular structures)

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11. Lecture: Superficial fascia has fat and fascial muscles important for reconstructive surgery

...ask about this?

11. Lecture: lab guide talks about smas layer?

...ask about this?

2. What are the compartments of the anterior neck?

1. A central visceral compartment 2. Two lateral, large neurovascular bundles 3. A thin layer of musculature.

11. What is another name for the infrahyoid muscle groups?

Strap muscles

2. The posterior neck contains?

1. Vertebral column 2. Spinal cord 3. Deep musculature of the neck which surrounds and supports the vertebral column (trapezius, levator scapulae, deep neck musculature)

9. My notes: things neck nerves like cervical plexus do

1. cutaneous afferent nerve fibers 2. strap muscle efferent nerve fibers

7. What vertebral bones does the neck consist of? What are these bones referred to as?

7 vertebral bones: C1-C7 Referred to as "cervical vertebrae" These are the seven most superior vertebral bones in the spinal column.

15. My notes: Transverse cervical nerves (C2, C3) rests superficially to the sternocleidomastoid muscle in a web like pattern. Travels left and right of neck

Accessory nerve lies deep of the sternocleidomastoid muscle and lateral to the cervical plexus but connects to it via C2

14. What is just deep of the platysma muscle?

Afferent branches of cervical plexus nerve fibers (C1-C4) Cervical plexus mainly provides afferent signaling to infrahyoid muscles (strap muscles) via ansa cervicalis I believe ansa cervicalis lies deep of sternocleidomastoid

15. What are the most important nerves which pass through the platysma?

Afferent branches of the cervical plexus destined to innervate the overlying cutaneous tissue Don't think they innervate platysma, but instead go to strap muscles and cutaneous tissue

15. My note: don't forget that the cervical plexus goes across but doesn't innervate platysma muscle but instead is innervated by facial nerve VII to control facial expression

All cervical plexus that go to strap muscles (C1-C4) are efferent nerves where as those that go to the cutaneous C2-C4 are afferent (see slide 9)

3. His notes: What fascia does that is good?

Allow structures to move past each other freely. Between layer of fascia is nothing really, so saran wrap allows movement past each other easily. Ease of compartmentalization.

11. What are the two subdivisions of the muscular fascia?

Anterior: pretracheal fascia Posterior: buccopharyngeal fascia

7. What is another name for the C1 vertebral bone?

Atlas

7. What is another name for the C2 vertebral bone?

Axis

12. What are infection "highways"?

Between space between fascial compartments

9. Lecture: Know that the afferent/efferent nerve pipes come from spinal cord

Bottom line: afferent/efferent nerve fibers meet at the vertebral spinal cord to become one nerve

9. C5-C8, T1 nerves are collectively called?

Brachial plexus

15. Lecture: know cervical nerve functions C1-C4

C1: superior root of ansa cervicalis; nerve fibers to strap muscle group C2: inferior root of ansa cervicalis for strap muscles C3:

9. Cutaneous innervation of the neck by which nerve fibers?

C2, C3, C4

9. My notes: which of the cervical plexus nerves are cutaneous nerves?

C2-C4 (anterior rami)

11. What fascia is lateral and deep to the visceral fascia? What does this layer encompass?

Carotid sheath fascia Internal jugular vein, carotid artery, vagus nerve CN X My note: what has the ansa of cervicalis? Remember: carotid sheath has vasculature while muscular/infrahyoid fascia has muscles and nerves

14. What nerve innervates the platysma muscle?

Cervical branch of facial nerve CN VI provides efferent signaling to muscle

3. The fascia in the neck is referred to as?

Cervical fascia

9. C1-C4 are collectively called?

Cervical plexus

9. What set of nerves efferently innervates the strap muscles (infrahyoid, anterior neck muscles)? Via what nerve loop do they do it by?

Cervical plexus Ansa Cervicalis

9. Lecture: which set of nerves is a huge part of the anterior neck?

Cervical plexus (C1-C4)

9. What set of nerves afferently innervates the cutaneous tissues of the neck?

Cervical plexus (C1-C4)

8. My note: what is the name for the vertebra immediately below the skull?

Cervical vertebra (7 total) Thoracic vertebra for thorax area vertebra

7.What bones serve to attach the upper limbs to the thorax and are structures immediately inferior to the neck?

Clavicle and scapula

9. My note: ansa cervicalis loop is important

Combined efferent nerves of the cervical plexus that go and send signals to strap muscles

15. Where is the facial nerve VII located in the head?

Comes out the internal auditory meatus and immediately lateral to the parotid gland Runs transversely throughout the face

3. What is fascia composed of and what is its function?

Connective tissue Serves as mechanistic support for the body's organs and structures

8. Lecture: Within the larynx, where to people make airways? What makes this a good location to do this?

Cricothyrotomy (aka laryngotomy): At the cricoid cartilage immediately superior the tracheal rings and thyroid gland, and inferior to the larynx and thyroid cartilage (Adam's apple) Although you can perform this at the tracheal rings called tracheostomy Good to do this here at the cricoid cartilage because lack of important vascular structures anterior to thyroid membrane. Doesn't seem to be in way of thyroid gland (inferior to cricoid ring)

15. My notes: from wiki, what are the cutaneous and muscular branches of the cervical plexus?

Cutaneous: -Great auricular nerve (C2, C3) -Transverse cervical nerve (C2, C3) -Lesser occipital nerve (C2, C3) -Supraclavicular nerves (C3, C4) Muscular: -ansa cervicalis (C1-C3) -phrenic nerve (C3-C5); mainly C4

13. What is the primary action of the platysma?

Draw the corners of the mouth downward. It also assists in depression of the mandible. This allows men to shave Known as muscle of horror

14. What is the function/action of the platysma muscle?

Draws corners of mouth down; aids in depression of the mandible

9. How many cervical nerves are there?

Eight: C1-C8 These afferently and efferently serve neck and upper limb structures.

7. Lecture: What lies just posterior to the windpipe (trachea) and anterior to the spinal column?

Esophagus

14. Where is the origin of the platysma muscle?

FASCIA overlying pectoralis major and deltoid muscles

6. Lecture: What nerve is immediately deep of the platysma muscle in the mandible? What does this nerve do?

Facial nerve This nerve keeps the corner of the mouth shut

15. Also deep to the platysma are what efferent branches of the facial nerve? What does this efferent branch do?

Facial nerve supplies/controls muscle of facial expression of platysma muscle(horror, shaving)

14. What does platysma mean in Greek?

Flat plate

8. Which bone is the attachment point for strap and tongue muscles?

Hyoid bone

7. What is immediately anterior to the spinal column? (3 things)

Hyoid bone, larynx, and trachea

13. When dissecting the neck, the skin and subcutaneous tissue need to be removed. What is the subcutaneous tissue sometimes called? What does it consist of?

Hypodermis Superficial fascia and adiposity (fat) My notes: different from cervical fascia?

15. My notes: what cranial nerves anastomose with the cervical plexus?

Hypoglossal CN XII (w/ C1) and Accessory CN XI (w/ C2) nerves

13. Where does the platysma insert itself superiorly?

In the lower border of the mandible and skin of the lower face

13. Lecture: Where are the muscles of facial expression?

In the superficial fascia (hypodermis and platysma)

14. Where does the platysma muscle insert itself in the face?

Inferior border of mandible and skin of lower face

8. My note: What are the strap muscles?

Infrahyoid muscles which are a group of 4 pairs of muscles in anterior part of neck: the sternohyoid, sternothyroid, thyrohyoid and omohyoid muscles. These muscles insert/originate from the hyoid bone

4. What is the muscle in the neck that allows the head to turn from side to side on the spinal column?

Sternocleidomastoid

10. My notes: know where the sternocleidomastoid muscle is

Know where the trapezius is in respect to sternocleidomastoid muscle

15. Between C2,C3 nerves consist of what nerves? C3, C4?

Lesser occipital nerve Great auricular nerve Transverse cervical nerve Supraclavicular nerves (C3, C4)

15. My notes: great auricular nerve is superior to the transverse cervical nerves and superficial to the sternocleidomastoid muscle Moves towards face but up and downward

Lesser occipital nerve lies deep of the sternocleidomastoid nerve and lateral to the great auricular nerve Moves move straight up and down

4. What process is an important attachment point for the sternocleidomastoid muscle?

Mastoid process, a region of the temporal bone

11. Transverse cross section of neck with fascial (fascia) layers shown as well as major muscles

Memorize each fascia, muscle and neurovascular, and visceral (tracheal) groups

9. Lecture: Two types of afferent and efferent nerves that mix and go to different areas of body

Ramus

9. My/lecture note: What is a mixture of afferent and efferent peripheral nerves?

Ramus Rami: two nerve types afferent and efferent and mix to go different areas of body

7. Which bone of the spinal column is the inferior-most cervical vertebra? What is interesting about this bone?

Number 7 (C7) Its spinous process can be palpated (examined by touch) as the patient flexes his neck forward

9. What are nerves C3, C4, C5 collectively called? What do they do?

Phrenic nerves They innervate the diaphragm and allow for respiration.

11. My notes: Right outside of SCM, what muscle group can you find?

Platysma Not sure if this is right...

13. What is a muscle of fascial expression?

Platysma muscle

13. What is the first layer of muscle in the neck (most superficial)

Platysma muscle Lies within the subcutaneous tissue (hypodermis)

6. What muscle in the neck passes over the base of the mandible?

Platysma muscle in the anterior neck Memorize locations

11. What is thick fascial layer that supports the spinal column (vertebrae pl.) and deep musculature of the spinal column?

Prevertebral fascia

3. Clinically, why are fascial compartments important?

Regions BETWEEN these compartments permit the movement of fluids and pathogens. Infection, for example, may travel from the head to the thorax along these fascial planes. Similarly, infection may develop WITHIN a fascial compartment. Such compartmentalization isolates the pathogen and may impede proper healing. In cases such as these the clinician must surgically open the compartment and drain the infection material.

12. Of the "highways" which pathway is frequently traversed by apthogens traveling between the head and neck?

Space immediately anterior to the prevertebral fascia (posterior to alar fascia) MAJOR DANGER ZONE

7. What resides within the vertebral bones?

Spinal cord

8. What ligament connects the skull to the hyoid bone?

Stylohyoid ligament (because it is attached to the styloid process of the temporal bones)

11. What fascia layer forms a complete sheath around the entire neck?

Superficial layer of deep cervical fascia

15. My notes: Phrenic nerve is lateral but parallel to vagus nerve and deep of sternocleidomastoid muscle; deep of supraclavicular nerves that run superficial but parallel to phrenic

Supraclavicular nerve is lateral but on same level as sternocleidomastoid muscle; most inferior lateral nerve below transverse nerves Nerves seem to run inferior/superior

9. What is the first spinal nerve arising from the superior portion of the thoracic spinal cord?

T1

11. My notes: what nerves really take hold of the muscular fascia muscle groups?

The ansa cervicalis and C1 take on the infrahyoid muscle groups

8. The hyoid bone is anterior to which cervical vertebra?

Third cervical vertebra

8. The hyoid bone is also connected to the larynx via what membrane?

Thyrohyoid membrane

8.My note: What is the Adam's apple?

Thyroid cartilage

8. Lecture: no really important vascular structures anterior to thyroid membrane

Thyroid is an endocrine gland and it bleeds a lot if cut

8. What lies immediately inferior to the larynx?

Trachea

9. The face is innervated afferently by which nerve?

Trigeminal nerve CN V (V1, V2, V3)

15. My notes: seems like ansa cervicalis lies deep of sternocleidomastoid muscle Lies just around the internal jugular vein and common carotid artery Transverse nerves pass them transversely

Vagus nerve X lies deep and median to the ansa cervicalis Just median to internal jugular vein and common carotid artery as well

9. Lecture: Is the spinal cord a mixture of afferent and efferent nerve fibers?

Yes

3. His notes: What fascia does that is bad?

Zones inbetween compartments (wrap) allow a space highway from one space to the next: pathway from base of skull to heart; this highway connects base of skull to chest, not a good thing with bugs or metastatic cells Permits continuity from one area to another which means that an abcess in a tooth has access from right to left Medication in these regions, unless small, are not so effective Nothing inbetween fascia which means no blood vessels which means lack of medication accessibility Need to surgically open up and remove

11. My notes: What lies posterior to the visceral/buccopharyngeal fascia and anterior to the prevertebral fascia?

alar fascia not mentioned in scripts***

10. My notes: What is a hole or gap or opening?

aperture

13. What cranial nerve innervates the platysma muscle? Is this an afferent or efferent nerve?

cervical branch of Facial nerve CN VII Efferent since its a muscle

8. What types of cartilage is the larynx composed of?

cricoid cartilage (complete circle) thyroid cartilage (horse-shoe rings)

3. What subdivision of layers of the anterior and posterior neck surrounds various structures in the neck that serve to isolate and compartmentalize these structures?

fascia

11. What fascial layer is deep to the superficial layer of deep cervical fascia? What muscle group does this layer encompass?

muscular fascia a.k.a. infrahyoid fascia Infrahyoid muscle (strap) groups (wiki: The four infrahyoid muscles are; the sternohyoid, sternothyroid, thyrohyoid and omohyoid muscles.)

9. Lecture: where do the spinal nerves originate from?

spinal cord

7. Lecture: hyoid bone connected to which process in the skull?

styloid process