Blue Boxes

Question 1

investing layer of deep cervical fascia

Answer 1

• most superficial layer
• covers entire neck
• splits to encase trapezius and SCM
• will contain infections between it and muscular part of pretracheal fascia (muscular part surrounds infrahyoid muscles)

Question 2

if infection is between investing layer and visceral part of pretracheal fascia, then infection can spread to ___________________

Answer 2

if infection is between investing layer and visceral part of pretracheal fascia, then infection can spread to THORACIC CAVITY anterior to pericardium

Question 3

pretracheal fascia

Answer 3

Pretracheal fascia forms sling/trochlea to hold intermediate tendon of digastric muscle
-wraps around intermediate tendon of omohyoid muscle

Question 4

abscess posterior to prevertebral layer of deep cervical fascia can extend ____________

Answer 4

abscess posterior to prevertebral layer of deep cervical fascia can extend laterally (posterior to SCM) and enter RETROPHARYNGEAL SPACE (retropharyngeal abscess), bulging into the PHARYNX (dysphagia, dysarthria)

Question 5

congenital torticollis

Answer 5

• unilateral contraction/shortening of cervical muscles causing head twisting/slanting
• due to contractues from fibrous tissue tumors in SCM

-can be iatrogenic: caused by hematoma formation in SCM due to forceps-assisted delivery entrapping CN XI to SCM, causing denervation and fibrosis

Question 6

subclavian venapuncture

Answer 6

• used to place central line or Swan-Ganz catheter
• thumb on midclavicular line, index finger on jugular notch
• needle enters just inferior to thumb/clavicle
• needle angled to advance toward index finger to end at the right venous angle

Question 7

lesions of spinal accessory n (CN XI): how can it happen?

Answer 7

-can be damaged during surgery in lateral cervical region, penetrating trauma, cancerous cervical lymph nodes, or fractures of jugular foramen (exits cranium)

Question 8

lesions of spinal accessory n (CN XI): effects?

Answer 8

• weakness in turning head to side contralateral to lesion
• weakness/atrophy of trapexius
• unilateral trapezius paralysis

Question 9

endarterectomy

Answer 9

Atherosclerotic intimal thickening of internal carotid, causing TIA or stroke –> resolved by endarterectomy

• resolves stenosis by removal of plaque with the intima
• surgery poses risk to damaging CNs XI, XII, X (recurrent laryngeal), IX

Question 10

carotid sinus hypersensitivity

Answer 10

• carotid sinus acts as a baroreceptor, modulates BP (CN IX)
• hypersensitivity: external pressure on carotid sinus will simulate elevated BP –> vagus nerve provides parasympathetic innervation to lower HR/BP
• results in syncope (from decreased cerebral perfusion) and cardiac ischemia

Question 11

thyroid ima artery

Answer 11

• present in ~10% of patients

- may branch off any artery at root of neck

Question 12

thyroglossal duct cysts

Answer 12

• thyroid initially develops in embryologic pharyngeal floor at the foramen cecum (becomes dorsum of postnatal tongue)
• moves to neck, anterior to hyoid bone, but remains attached to foramen cecum by thryroglossal duct
• thyroglossal duct usually degenerates, but can leave residual epithelium, forming thyroglossal duct cysts in neck

Question 13

Le Fort I fracture

Answer 13

• horizontal fracture of maxilla
• superior to alveolar processes
• crosses nasal septum
• extends as far as pterygoid plates of sphenoid bone

Question 14

Le Fort II fracture

Answer 14

• from posterolateral region of maxillary sinuses up thru infraorbital foramina
• from ethmoids to nasal bridge
• separates hard palate/central face from cranium

Question 15

Le Fort III fracture

Answer 15

• horizontal fracture through the superior orbital fissures, ethmoid bone, nasal bones
• passes laterally across greater alae of sphenoid bone and frontozygomatic sutures
• includes fracture to zygomatic arches separating maxillary and zygomatic bones from the cranium

Question 16

coronoid process fracture of mandible

Answer 16

• rare

- singular (most others are associated with a secondary fracture)

Question 17

mandibular neck fracture

Answer 17

• transverse

- associated with ipsilateral dislocation of temporomandibular joint

Question 18

mandibular angle fracture

Answer 18

• oblique

- involves alveolus of 3rd molar tooth or it’s bony socket

Question 19

mandibular body fracture

Answer 19

-usually passes through socket of a canine tooth

Question 20

convexity of calvaria

Answer 20

distributes force to minimize impact damage (prevent fractures)

Question 21

depressed fractures of calvaria

Answer 21

• occur with blows to thin regions of the calvaria

- may compress or damage brain underneath

Question 22

linear calvarial fractures

Answer 22

• most frequent type

- occur at point of impact with radiating fracture lines

Question 23

comminuted fractures

Answer 23

-fracture of bone into several pieces

Question 24

contercoup fracture

Answer 24

no fracture at point of impact, but on opposite side of cranium