Head and Neck

Learning & Test Objectives

  1. Skull and cervical vertebrae- Tempromandibular joint, spaces and foramina.
  2. Fasciae and compartmentation.
  3. Arrangement of muscles within their functional groups.
  4. Origin and insertion, innervation, and function of muscles, vessels and nerves of the head and neck. 
  5. Topographical spaces of the head and neck.
  6. Identifying and drawing structures observed on cross-sections.

 

Description of the test

The test is held by the general rules of written tests (see Continuous Testing – Organisation).

The test will  be focused on the head and neck covering: the skeleton and joints, major vessels, origins, insertions, functions, innervations and groups of the muscles of the neck, as well as their basic development and developmental defects. For the skull, it is necessary to know the topographic spaces, openings and passages, including the contents and connections on the skull and spine. In the case of mimic muscles, it is necessary to know their name, function, innervation and only their orientation and attachments (for the buccinator muscle, it is necessary to know the exact beginning and attachment of the muscle). Apart from the masticatory muscles, it is not required to know the precise origins and insertions of the mimetic muscles. In the case of deep neck muscles, it is necessary to know their name, function and only their beginnings, attachments and innervation. The test includes questions on general myology, fascia, fissura scalenorum, trigonum suboccipitale and structures on images of bones and joints of the skull and corresponding parts of the axial skeleton. In mimic and masticatory muscles, it is not necessary to know the individual branches of the facial nerve and mandibular nerve (n. V3). At the end of the test, students will be required to draw and describe one of the required pictures (see list of required pictures).

 

Clinical notes

The masseter muscle may be overloaded with frequent use of chewing gum. Overload can also occur in people under stress, during which they cannot bite something. The patient does not complain of pain in the muscle, but of toothache (upper or lower stools), in the ear or above the orbit.

Trigger points in the medial and lateral pterygoid muscles  must be considered in the differential diagnosis of ear pain. The muscles are palpated in the oral cavity and the trigger points are tender upon palpation.

The danger triangle of the face (trigonum mortis) is an area richly supplied with blood, located between the angles of the mouth and root of the nose. Venous blood from this area drains into the intracranial venous sinuses, thus there is a risk of a pathological process spreading to the intracranial space from this area.

Torticollis is a shortening of the sternocleidomastoid muscle with the head tilted to the affected side and rotated to the opposite side.

Brachial plexus and subclavian artery compression may occur at the fissura scalenorum. It is one of the manifestations of thoracic outlet syndrome (TOS) or thoracic outlet syndrome (TOS)

Other interesting notes

Modiolus anguli oris is a nodal point in the corners of the mouth that serves as an attach point for mimic muscles, creating the "motor center" of the face.

The subgaleal layer consists of loose connective tissue is the site of weakest resistance and allows mobility of the scalp against the skull, including the galea aponeurotica, to be detached from the cranial vault.

The musculi scaleni function mainly as a deep stabilization system of the cervical spine. They have respiratory function and contract during significant respiratory effort.

 

Pictures to draw

  • Transverse section of the neck at the C6 level 

 

Radiographical images

Radiolographs of the bone and joints of the axial skeleton

Created: 2. 2. 2021 / Modified: / Responsible person: MUDr. Azzat Al-Redouan