Surface Anatomy of the Head and Neck

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Inion

Also known as the external occipital protuberance

The protuberance in the midline at the back of the head; gives attachement to the ligamentum nuchae

Mastoid process

The rounded bony protuberance behind the external ear

When does the mastoid process develop

The mastoid processes are absent in the newborn but should develop by the baby's second birthday

Canthus (angle) of the eye

Corner of the eye (there are two for each eye; lateral and medial)

Zygomatic arch

Extends forward from the front of the middle of the ear to the zygomatic bone just behind and below the lateral canthus

Name two things of clinical significance associated with the temporal fossa

1. Middle meningeal artery: Trauma to the temporal fossa may result in hemmorhage from this artery and the development of a extradural hemotoma (which puts pressure on the brain) even if the temporal bone has not been fractured
2. Superficial temporal artery: This artery can become inflamed and painful to palpation due to a condition called temporal arteritis; It is important not to miss because it can lead to permanent blindness if left untreated

How does temporal arteritis usually present?

As a severe headache

Tragus of the ear

The small pointed piece of the ear immediately anterior to the hole in the ear

How do you located the temporomandibular (TM) joints

Palpate immediately anterior to the tragus of the ear while moving the jaw

What are the three parts of the mandible?

1. Ramus (descending part)
2. Angle
3. Body

How do you locate the hyoid bone?

Place the index finger on one side of the neck and the thumb on the other side at the base of the jaw; Gently squeeze and move back and forth

At what vertebral level is the hyoid bone?

CIII

Thyroid cartilage

The Adam's apple (laryngeal prominence)

At what vertebral level is the thyroid cartilage at?

Upper margin: CIV
Lower margin: CV-C6

Thyrohyoid membrane

The soft space between the hyoid bone and the upper margin of the thyroid cartilage

Cricoid cartilage

The first ring of cartilage below the thyroid cartilage

At what vertebral level is the cricoid cartilage at?

CVI

Cricothyroid membrane

The soft space between the thyroid cartilage and the cricoid cartilage

What is the clinical significant of the cricothyroid membrane?

This is where emergency airways are put in (cricothyroidotomy)

How do you visualize the sternocleidomastoid and trapezius muscles?

Get the subject to shrug their shoulders

What defines the margins of the posterior triangle>

1. Anterior: sternocleidomastoid
2. Posterior: trapezius
3. Inferior: clavicle

What defines the margins of the anterior triangle?

1. Median: lies along the midline from the mental symphysis to the suprascapular notch
2. Superior: runs from the mental symphysis to the angle of the jaw
3. Lateral: Follows the anterior border of the sternocleidomastoid muscle

Mental symphysis

Point of the chin

Where does the trachea begin?

The cricoid cartilage is the first tracheal cartilage; Thus the trachea begins at CVI

How do you determine if the trachea is in the midline?

Place a finger in the middle of the suprascapular notch and move your finger side to side

Name 3 salivary glands of interest in the head and neck area

1. parotid gland
2. sublingual gland
3. submandibular gland

How do you palpate the duct of the parotid gland?

Get the patient to clench their jaw; The duct is found about one finger's breadth below the zygomatic arch

Helix

The outermost portion of the external ear

Antihelix

The portion of the external ear that is just interior to the helix

How do you straighten the auditory canal in an adult? In a child?

Adult: Pull up and back
Child: Pull straight back or down and back

Describe the course of the carotid artery through the head and neck

Between a point midway between the point of the mastoid process and the angle of the mandible and the sternal angle

Approximately where does the carotid artery bifurcate into the internal and external carotid arteries?

At the level of the upper border of the thyroid cartilage (CIV)

Where can the facial artery be palpated?

1/3 of the way from the angle of the mandible to the mental symphysis

Where can the superficial temporal artery be palpated?

Just anterior to the tragus of the ear

What is the practical significance of locating the facial artery/superficial temporal artery?

You can take a pulse while holding a bag valve mask on

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