ARS MRCS Head & Neck Recording



This is an on-demand teaching session specifically relevant to medical professionals that will cover anatomy topics from head and neck. There will be a focus on topics that are tested in MRCS and learners will be able to use Slider and Zoom to answer questions and learn about the anatomy of this region. Participants will also discuss embryology, the musculature of vocal cords, the external carotid artery, and the linguine nerve.
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Learning objectives

1. Explain the anatomy of the head and neck region in detail. 2. Identify the muscles, arteries and nerves involved in the anatomy of the head and neck. 3. Differentiate between the arches and pouches of the head and neck. 4. Define the role of the posterior cricothyroid muscle in vocal cord abduction. 5. Describe the components and functions of the external carotid artery and lingual nerve.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

I'm seeing a very excited to be starting this revision series. Um, so it's going to be, I think, successions also going through different aspects of anatomy, Um, starting with the head and neck. So I just, um, bring on to the next slide. So the main thing I need to do from these sections is get an unsettling of Deanna anatomy topics that I tested because does these are quite broad region. So the head and neck I can't cover the entirety of it in one hour. So that's why I want to try and incorporate loads of little things that Duke commonly come up in their Marcy s. Um, And see if he can see if you can understand what you need to go through for father Lining. We're going to be using the slider website Teo to send the empty cues. And I'm going to try and make it interactive that way. Eso if you can all get slider on D, uh, there'll be a link coming up just one minute. All right. So Okay, so you conjoined iron this link. Um, and then I've got the first question up on there, so we'll get started straight away. Yeah, right. Because it's the first one everyone's joining. We'll give it a couple of minutes. All right, 30 more seconds, and then I'll stop that. All right, Any last minute answers. 10 more seconds. Okay. All right. So the correct answer is the temporal bone. So let's go through an explanation. Good to see the majority of you. Got that. Okay, so and when we're looking at, the cranial faucet is easy to split up into the anterior middle and posterior cranial foster. So I think you should be able to see my see my I run. So this part here sort of forms anterior cranial foster, and then the rest of this. But here is a middle cranial fossa. It's and then you've got the posterior cranial foster. Um, and then the internal acoustic meters, which is showing in this diagram here is part of the posterior cranium Foster on this red burn. Here is a petrus part of the temporal bone. So a lot of the temporal bone, it could be split into the squamous and the Petrous parts. So a lot of the middle area is formed from the Petrous parts. Um, and the other things that the entire meat made a qc matus transmit to the facial nerve. The similar copy enough on the lab print on artery. Um, And then in this posterior, you've also got the jugular foreman, which translates, Ah, classifying Jonah Vegas. Now, on also the sigmoid Sinus, which forms the internal jugular vein. Yeah, I forgot to add, um, you can have a question answers on this on cider itself or on Zoom? I think so. Go through those at the end if you have any questions. Okay, let's move on to question too. All right, 30 seconds more. Okay, so the majority of you have got it right, But there is a bit of a mix in this. They stopped that. Okay, so this question was asking which causes vocal cord abduction. So which causes opening of the vocal cord or the remodel oxidase, which is a space here. So it's important that there's quite a few different muscles and it can seem a bit complex at first. Um, so if you're looking at this, this is a superior view. You can see the tree vocal cord and the thyroid arrest annoyed muscle posterior, cracker, wrist night and the lateral cracker retinoid on. Then, if you're looking at posterity of you, you can see the obliques oblique, a retinoid and then the posterior cracker. It annoyed, Um, so the the main thing I want you to take away. And it's this quite a common question that's asked, is the posterior cracker. It tonight is the only muscle that up dot so vocal folds, so it causes opening. So if there is any damage to this specific muscle, then it's an emergency because the vocal cords would be closed. Um, and then the other thing that will need to take away from this is that the cricothyroid is the only muscle in the intrinsic little air into your muscles that supplied by different love. So all of the others are supplied by the recurrent laryngeal nerve, part of the vagus nerve. But the crackers EIroy is the only one that's supplied by the external branch of the super superior laryngeal nerve on, and then I've put what each one does, but the main one is that the posterior abduct the rest add up, and then the crocus I rode and vocalists changed the picture of the voice. Eso again that's quite commonly asked your You'll get a pet patient who's undergone some kind of thyroid surgery and then after the surgery, they can't seem to change the pitch of their voice for us. Which muscle is affected and that would most commonly be crooked thyroid. Okay, that's what I wanted to cover. Now here. Yeah, and nose one. Another thing that they commonly ask is what happens when you get unilateral versus bilateral recurrent parent your nerve injury. So if you get you know actual, then you're still able to open part. Partially open the vocal cords so you can still breathe, but you get some hoarseness of the voice. But if there's bilateral injury that that's a medical emergency because it's completely closed, you need to do a track us to me or reintubation of the patient. Oh, okay. Next question. There's always a bit of embryology in the process, so this is a common one. I I stayed more seconds. Okay, that's the majority. You did very well on this. It's quite it can be quite confusing to know the difference between the pouches and the archers. So I've made a few tables that helpless go through that the first one is to look at this kind of diagram. Um, you can see you can see the arches here, See? But this kind of it's got associate it non artery, muscle and cartilaginous component. And then on the inside, in between, you can see the pouches. So if these are the arches and you've got the patches here in between, um and then the main main thing I don't need to remember is that the arches all have another muscle artery and like bony component to them. Um, so on d other thing is that there's no Fifth Arch because that degenerates quite quite early on in the process of embryology. And so the first arches supplied by the trigeminal nerve and then an easy way to remember remember which muscles you get from the fast arches, its all the on trigeminal nerve muscle. So it's like the muscles investigation and things like that. And then the artery for that is the maxillary artery. And then the second arch is from the facial nerve. And then again, you get all the facial nerve muscle muscles to such a Z muscles of facial expression. And here is where what the question was asking, which Where's the stapes form from again? This is quite common question. The MRCS. I think I got this question in my exam. Um, and that's from this second arch. Um, so yeah, that And then you've got the side, which is former, that cross the fire and your nerve. And then the only muscle that that enough supplies, which is the style of firing juice and then that the artery associate it is common carotid, um, Forth. You've got superior branch of the very superficial area lounge your branch of the vagus know, and then six, you've got recurrent laryngeal pharyngeal branch. So again, it's whatever these to supply. So, as I was saying before, you've got Super Reliant learned your branch surprise of crackers, thyroid and then the recurrent branch supplies or the intrinsic muscles of the larynx. Apart from that And then the other thing that's quite tricky to remember is for the fourth in six archers, the right and left archers form different things. So for the Fort Arch, the right side from subclavian artery or the left side from the aortic arch. So just remember that aortic arch is on the left side of the body and then for the six. The right form, the poor MRI arteries and the left is a doctor's arteriosus. So again, that's just to make you have to memorize so that they're the arches. And then let's come on to the pouches. I think from this part is stable. The main thing that you want to try and remember is that the 3rd and 4th form the parathyroid gland. But they saw it do it in the opposite kind of way because the thyroid power for forms, the inferior glands or the fort pouch forms the superior parathyroid guns. So again, that's a very common question to touch people out. So they try and catch me to put up before the arch. Is it between the arches and the pouches on Also, this is quite common in theory. In superior parathyroid funds, See a. Even though it's like just one topic, you they do generate a lot of different questions from this one topic. Let's me for between one. Oh, you are 30 more seconds. I mean, this is a tricky question. All right. Any last fine lunches, okay? They're the They're the mix but yes, the lingual nerve is the correct answer. Let me explain why. Okay, So if we look at this fast diagram, you can see the mandible enough, which is V three. Um And then from that you get the linguine of coming down here. And then if you look at it, if you saw a look at this diagram we can see in a clothes dissection on the lingual nerve is actually on the border of where their body meets the angle of the mandible. Um, so it's actually the nerve that's closest related to the mandible. So I guess this is quite a tricky question. Um, but I also wanted to go through what the linguine of does, because again, it's quite commonly tested enough in the MRCS. Um, so it does a few in terms of the general sensory component, it provides sensation to the anterior two thirds of the tongue, and they also it doesn't provide the special sensory taste because that's from the quarter temple. But what happened is that the quarter didn't need nerves sort of hitchhike on the lingual nerve. Eso the linguine of actually carries the fibers from the quarter tympani. Um another thing it does. It also carries fibers, the autonomic fibers that go towards the submandibular ganglion and then go on to innovate the submandibular and sublingual guns. So it's quite a complex nerve. Um, and it has a very close relation to the mandible. There's even saw a group a groove on the mandible for the linguine Earth. Yeah, question. Next question. All right, 30 more seconds. Okay, there's there's quite interesting how you guys answer this, which I'll come on two. So the two most popular were acceptable artery, which is right and inferior thyroid. Okay, so the external courted artery can quite complex. I don't know if a lot of you've heard of this pneumonic some anatomy. It's like freaking out. Poor medical student. So soft goes from here. So from the fast branches or the way to the top, um, and I found this like a really good way to solve. Memorized which arteries came off the external potted. And so it's actually the superior thyroid, not the inferior thyroid that's part of the external carotid artery. The inferior thyroid is actually a branch of the virus of Michael Trunk eso that arises here from the subclavian artery. Um, and it's not the vertebral arteries as a biggin. Also from the fast partners of really an artery. I got the autumn use. Clean this up. Okay, um and then the lateral more artery in is a branch of the opthalmic artery. So that's also not the right answer on died. Also thought I put in the middle men and your artery comes off the maxillary artery. So that's just another commonly US question in the MRCs know related to this question. But again, something that should bear in mind. Um so another thing that you should know is that the superficial temporal, the posterior regular and the occipital arteries or form kind of record dents and us to motions in the scalp. So that's why you see any sculpt lacerations can bleed quite heavily because they've got a really rich blood supply on Also, some of the muscles in the skull conserved make the wound scape even more. Um, so that's where you get a lot of bleeding and it's quite difficult to manage. Those weeds were the main things. I want you to try and take ways. Try and use this pneumonic to memory, memorize these branches because this is quite common question as well. Yeah. Yeah. Next question. You might have thought that triangles of the neck was just at med school, but it also comes up in the MRCS. Okay, 30 more seconds. Okay. Yeah. Majority of you got this right. It was a bit next. Okay, so the posterior triangle of the neck, Um, so that's showing in this time from here. Um, So you can see the anterior border of this triangle is actually the posterior border of the standard cleidomastoideus. On the basis for me by the middle third of the clavicle. And then here this posterior border is the Antara board of the trapezius. Um, and in this diagram, you can see the accessory nerve running through this triangle. Eso some of the other options were the answers. Okay, so the answer cervicalis is actually in the anterior triangle of the neck. So don't be confused between the answer cervicalis and the savaiko plexus on Do the survival plexus gives off the answers of cervicalis as a cycle, um, at which and then that goes on to supply the infrahyoid muscles. Um, and then what? What else was there there was common carotid on glass, phone deal and hypoglossal. Okay, so all of the rest of the answers are in the anterior triangle. The hyper possible nerve is actually really close relation to the internal carotid and external crowded, as is a glossopharyngeal nerve. Um, Onda. So some of the other some of the other things that come into the posterior triangle. So he said, the cervical plexus. There's also the less rock sip it'll and greater irregular nerves, transverse cervical nerves, super clavicular nerves and the phrenic nerve. So in terms of MRCS questions the most common things that they ask about when they're saying what's in the posterior triangle. It's normally accessory nerve or phrenic nerve so that the two leaky ones on that you should try and memorize from this. Andi don't just learn their triangles of the neck, but learn like the different fashion layers in the neck because they asked about what's in the crowded sheet. For example, what's in the prevertebral layers? What's in the pre trick? Your layers. So it'll that kind of detail. Okay, next question. Go quite mix for this, so keep those roots. Come in. Okay. Thank you. Seconds ball. Okay, Last 10 seconds. Okay. There's quite doesn't mix in this question. Between these two answers, the correct answer is actually extrinsic muscles of the left side of the tongue accepted political asses are paralyzed. So what's the question asking it Saying patients go on excision of the left submandibular gland for select Asia. So the hypoglossal nerve on that side is damage on the left side. What is most likely outcome? So the hypoglossal nerve supplies or the extrinsic and intrinsic muscle of the tongue, apart from the platter glasses. So that's why this is a right answer. Um, the tongue does not. The opportune the tongue, it would actually deviate towards the left. So when you've got hypoglossal nerve injury, you get it's electoral deviation of the tongue towards the side that's injured. Um, then what? So the bottom what? You've alerted what deviates towards the left, so in in a vagus nerve injury, you'd get contralateral deviation of the uvula. So if the vagus nerve want to be damaged in this case, then the evening would deviate to the right. Um, junior glasses is spared. That's not right, because it's supplied by the hypoglossal nerve on there's numbness of the posterior, one third of the tongue. That's not right either, because that's not supplied. Only the muscles are supplied by the hypoglossal. Enough. Go through this in a bit more detail. So this is probably like a diagram that you're familiar with from your anatomy days, but it's really useful to memorize this. So on the left side you've got the motor supply to the tongue. So all of the muscles, extrinsic and intrinsic, Um, apart from this plateau, glasses is supplied by the hypoglossal nerve on the plateau. Glasses is supplied by the vagus nerve. And then on this, on the right side, you got all these sent to innovation. So sensory innovation. You split into general sensory on dyspepsia century, which is taste, um, so the anterior two thirds the general sensory is a linguine of, um and this taste. The special century is called a tympani, which is part of the facial nerve. You've got overlapping sensation, but generally the posterior third, you've got the glass of fire. And Jonah, no supplies are mostly all of it for general and special sensory. So just general century and taste. Um, and you've got a very small part towards a buck, which is vagus nerve. Um, again, this is, like of really commonly ask question, um, And then this diagram here shows the past of the hypoglossal nerve. So it comes down, although way and as you can see, it's really closely related to where the by if occassion of the carotid artery is, um se If there's any question asking about what stroke it could be added from, I don't know if it's asking my cartia end up our track to me or something. Then the answer is most commonly hypoglossal nerve. Um, and you can see it's sort of loops down here and then enters into the junior classes and supplies over the other intrinsic muscles as well. Um, okay, next question really very know enough. And the foramen that come they go out is really common us a swell who give you 30 more seconds. This one. Okay, so I thought this would cut your few people up, but it didn't s Oh, yeah, the answer is opthalmic artery. And the thing that you've got to be wary of is that the opthalmic nerve comes out the superior orbital fisher. Um, but not no out the optic now, but the opthalmic artery does so explain it in this next slide. Um, so they threw the optic now. So here we've got in this picture the middle middle cranial fosters a show. You at the beginning, the anterior middle and posterior. Um, the middle got quite a lot of different form and foramina that it has that a lot of different nerves in arteries go through. So mainly through the optic can are you get the optic nerve on the opthalmic arteries, not the optometrist pains. And then through a super orbital, fisher, you got You have the ocular motor. You have the trochlear. You have first part of trigeminal, which is the upside nerve. Um, and then you also have the Abdus since now, or go through the superior or bit of Fisher? Yeah, your atomic veins. And also some sympathetic drivers. And see, really, this is also really, commonly us because they want to try and catch people out into opthalmic artery, going through the optimum optic an hour and not the super orbital. Fisher. So, um, I'm glad a lot of you caught that one, right. Um, and again, try and learn all these different for foramina because they come up for both party. And I think only for Part B is well, you can be asked to label them in a partner or ski station. Okay. Okay. All right. 30 more seconds. All right, Chris, in the fall. So, yeah, that was quite a big difference in the answers to this. But the right answer is plus two, five. And you know of, um So if we try and skip out some of the others, the hypoglossal nerve is largely a motor nerve. Um, and the superior lounge own of is what's supplying some of the air into your muscles again. The facial nerve is largely Moten IV also has some special sensory fibers. All right, The glossopharyngeal nerve is quite a trick enough because it does a lot of different things. I just want to spend some time going through going through this, um, so originates in the middle. Uh um And then you saw cars goes down this kind of past, um, so quite closely related to the tongue and the mile a higher Brussels on. But it's got one motor supply, which is a style of fire and, yes, muscle. So again, that's something to memorize because it's an easy answer acute for them to ask. Um, the century component is quite complex, so it's called a few different branches. It's got the tympanic nerve, which surprised middle air in a tympanic membrane on the inner surface of the eustation tube. So that's what the question was asking here so commonly, if you have, because it this is supplying the middle area and the little battery memory is, well, a Z, the thant tonsils, a politician, tonsils if you have tonsillitis or if you have a tonsillectomy, a lot of the common side effects or symptoms that you can get afterwards is having middle AARP A. Nor it just referred a pain on Do that. The nerve that's responsible for that is that lost a fire in June of so, apart from the tympanic and the tops of the branch, it also has a fine job front that surprised or if I things and also a lingual brunch. Don't be confused between the lung Lingle branch of the glass of Find You and the lingual nerve there completely to do two separate things. Um, but it's the lingual branch that gives general taste sorry, general sensation to the posterity, third of the tongue on. So that's general century. And then it's also got a special sensory component on, and that's giving taste to the posterior. Third, um, and then as well as a low, those three. It's also got a parasympathetic component, Um, which you can see in this diagram. So it originated in the medulla, and then it also passes and sign ups is in the otic ganglion. So there's quite a few different ganglion in the head and neck, which do occasionally come up with questions. S. So it's useful to know that's quite good description on Teach Me. And that's me that goes through the different ganglion in the head and neck. Um, specifically for the loss of find your nerve. It goes to the otic congregation, Um, and then the fibers actually hitchhike. So they traveled by the irregular temporal nerve, which is part of the mandibular nerve ongoing surprise, the prostate gland. So a really common question is which nerve provides the person pathetic supply to the particle and and that would be the closet. Find your stuff. The fibers only travel with this knife. They don't actually come from this stuff. Yeah, it's quite a complex stuff. Okay, I think this is our pen ultimate question. All right, thank you. More seconds. Okay, so we got quite a mix. And I think this is one of the questions with you Haven't, actually. What the right answer, Actually, the marginal mandibular gland in the face with facial nerve. Eso this question, it's it's quite complex because it's asking few different things that you need to look out for. Um, so it's a patient that's got a superficial submandibular gland carcinoma. So you need to know that this of mandibular gland it's it's split into a superficial and a deep part on this question is specifically asking which structure cross is superficial to the submandibular of mandibular gland. So if it is a superficial part of it, then it will be what's even more superficial to that. Um, let's go through what the answers, like, why it's not these answers. Um so So, again, the different Slithery glands in the head and neck, quite commonly tested in terms of their know supply their relations. Relations in general is quite heavily tested in there must. Yes. Like what's more superficial? What's more deep? Um, so if we're looking at the submandibular gland in this picture, you can see here this dispute is a superficial part. And then here is the D part, Um, and that's actually lying so outside where the mandible is. So we said, we said before that the lingual nerve travels on the inside of the mandible, So that's not a relation to the superficial part of this of mandibular gland. Um, the mylohyoid actually lives in between the superficial part in the deep part of the gland. So again, that's not the right answer, because it's not superficial to the gland. Um, and then the hypoglossal nerve lies deep to put the dye gastric muscle on the land. Um, so again, that's not the answer. The marginal mandibular brunch lies but superior and super early on superficially. So that's why it's the right answer. Um, really common question you can also get is what nerve convene damaged during incisions for removal of the submandibular gland on bats. A marginal mandibular brunch because it's in really close relation between the skin and the gland. Eso What surgeons typically do is they try and keep one finger breaths Distance between the mandible and where their incision is between the border of the month for and the incision to try and avoid this nerve on different Look at this diagram here showing you the submandibular triangle. So again, another part where triangles come up in this on Do you've got different borders? You've got until Aleve, but the anterior belly of diagnostic. And then he gave potty. You've got posterior belly of digest trick on. Then you've got the body of the mandible forming the roof. So yeah, I Even though it's like you wouldn't think a lot of questions. Congenital A tid just from the submandibular gland. It's quite a complex gland and school of different things going on. Okay, so that's not last question. Just do this one. Okay. 30 seconds ball. Okay. We're quite a split result in this. The right answer is actually for men of Magenta and Lucia. Eso this questions asking you, um to see it's a if it's connected to the subarachnoid space from the ventricles was asking. So how does the CSF get from the ventricles to the subarachnoid space? So there is quite a complex system that this year's have. Follow this. If we have a look at this diagram, it's sort of showing you a few different components of this system. So the CSF, it's first produced in the carotid plexus and nuts line by ependyma cells. Eso it passes from this, the lateral ventricles. So you've got the left and right lateral ventricles, um, through the foreman of Munro into this blue and the thyroid ventricle on. Then, from here, it goes through this sort of small fisher here, which is called the PSA Report Aqueduct, or sometimes called the at productive Sylvia's on. Then it goes from the side ventricle into the fourth ventricle and then in the roof of the fourth ventricle you have the the foreman of Magenta, which is in the midline. And you sugar, which is actually on day, released the CSF from this fourth ventricle into the CSF space. Uh, then goes down and coats the spinal cord and everything. Um, and then the CSF is reabsorbed via subarachnoid systems or on, but that's formed by the arachnoid ville eye on that drains into the your venous Sinuses. So quite a complex system that up forms. Three. Okay, so that was a little questions. I think we're doing okay. Just okay for time. Um, if there's any questions blank, are there any questions in the chart or anything? No, no. No questions and travels. If there are any, just put them in or shot come out of mind. Do you check insider anyone's Austin questions? Almost. I think this is also a link for the feedback. So we really you helpful to know if for five sections you rather have it, um, having less questions on, But more times going through the detailed on at any topics. Or if you rather get through a lot of different topics have led to different questions. So I think this feet, but it could be really useful for future sessions. So the slides in the record is will be made available on metal. We have the slides and recording. I think prank A has a question to that, um, preschool of the feet back in the chart. Yeah, Give me one second. Yeah, Thank you. Very welcome. I mean, the next session will be on the thorax and after me in about two weeks, I on broncos also put the feedback link in the chart. Thanks for the kind messages. Yeah, thank you noted. That's that's good feedback point.