pmdc step-1 day 4

Download PMDC Step-1 Day 4

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1. Prof.SaeedShafi PMDCStep-1Review Head&NeckClinicalAnatomy 2. LEARNING OUTCOMES a) Demonstrate integrity of cranial nerves. b) Interpret role of Neck tissue spaces in health & disease. c) Compare & contrast light & accomodation reflex. d) Correlate epistaxis to its anatomiocal basis. e) Illustrate cutaneous innervation of face, pinna &neck. f) Interpret role of PNS in health & disease. g) Correlate role of arterial anastomosis in Head& neck to rapid wound healing. 3. CERVICAL FASCIA Superficial Cervical FasciaDeep Cervical Fascia Investing layer Pretracheal Fascia Preverterbral Fascia Carotid Sheath 4. CERVICAL FASCIA & TRANSVERSE SECTION OF NECK Definitions: Cervical = neck region Fascia = a sheet or band of fibrous tissue that forms an investment for muscles & various organs of the body 5. SUPERFICIAL CERVICAL FASCIA Thin Covers the platysma May contain considerable amounts of adipose tissue Layer of loose connective tissue between dermis & deep fascia 6. DEEP CERVICAL FASCIA 7. DEEP CERVICAL FASCIA INVESTING LAYER Surrounds the neck like a collar Splits around trapezius & SCM Posteriorly : meets the ligamentum nuchae Attached to hyoid bone anteriorly Superiorly superior nuchal line; mastoid process, EOP, base of mandible Inferiorly spine of scapula; acromion process, clavicle & manubrium Between angle of mandible & mastoid process - splits to enclose parotid gland Between angle of mandible & styloid process becomes thickened and forms stylomandibular ligament Enclose submandibular gland 8. DEEP CERVICAL FASCIA PRETRACHEAL FASCIA Lies deep to infrahyoid strap muscles Attached to midline of hyoid bone & oblique line of thyroid cartilage laterally Splits to enclose & suspend thyroid gland Pierced by thyroid vessels Laterally fuses with carotid sheath Inferiorly passes behind brachiocephalic veins to blend with fibrous pericardium Provides a slippery surface for the up & down gliding of trachea during swallowing & neck movements 9. DEEP CERVICAL FASCIA PREVERTEBRAL FASCIA Lies in front of prevertebral muscles Extends from base of skull in front of longus capitus & rectus capitus lateralis to body of T3 veterbrae Covers muscles in the floor of the posterior triangle of neck Cervical plexus & subclavian artery lies deep to it Accessory nerve lie superficial to it Over the subclavian artery it becomes the axillary sheath Does not invest subclavian & axillary veins Provides a fixed surface on which pharynx, oesophagus & carotid sheath can glide during neck movements & swallowing 10. DEEP CERVICAL FASCIA CAROTID SHEATH Surrounds the carotid arteries; internal jugular vein & vagus nerve Thin over the IJV because the vein needs to be free to dilate during increased blood flow Ansa cervicalis is embedded in anterior wall Cervical symphatetics lie behind it Attached to base of skull at margins of carotid canal 11. DEEP CERVICAL FASCIA CAROTID SHEATH 12. CERVICAL FASCIA Superficial Cervical FasciaDeep Cervical Fascia Investing layer Pretracheal Fascia Preverterbral Fascia Carotid Sheath Common Carotid Artery Internal Jugular Vein Vagus Nerve In front of prevertebral muscles Forms floor of posterior triangle Encloses & suspends thyroid gland Encloses 2 muscles: SCM & Trapezius Encloses 2 glands: Parotid & Submandibular 13. TRANSVERSE SECTION OF NECK 14. TRANSVERSE SECTION OF NECK 15. Deep cervical fascia It is organized into several distinct layers Investing layer, which surrounds all structures in the neck; Prevertebral layer, which surrounds the vertebral column and the deep muscles associated with the back; Pretracheal layer, which encloses the viscera of the neck; Carotid sheaths, which receive a contribution from the other three fascial layers and surround the two major neurovascular bundles on either side of the neck. 16. Fascia of neck (transverse view) 17. Fascia of the neck, sagittal view 18. SUBMANDIBULAR GANGLION Parasympathetic peripheral ganglion Relay station for secretomotor fibres to submandibular and sublingual salivary glands Topographically related to lingual nerve Functionally connected to facial nerve (chorda tympani) Lies on hyoglossus muscle just above deep part of submandibular gland Suspended by lingual nerve by two roots 19. NERVE SUPPLY Secretomotor pathway Superior salivatory nucleus Preganglionic fibres Sensory root facial nerve Geniculate ganglion facial nerve Submandibular gland Chorda tympani Lingual nerve submandibular ganglion Postganglionic fibres 20. BLOOD SUPPLY Facial artery 21. Cleft Palate VOMER 22. Cleft palate Primary palate Secondary palate R L Hard Soft Uvula Incisor Foramen 23. Skull Brain + Meninges Spinal cord Sinuses Nose Mandible Teeth Tongue Cervical vertebrae Hyoid bone Thyroid gland 24. Take Home Message?