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Dr

Paul Tierney: 13/10/05

General Anatomy of the Head and Neck (incl the Cervical Spine)
The head contains some of the most important systems that we rely on, including the brain andspecial senses General sense is touch, proprioception, pain and temperature Special senses include vision, hearing, smell and taste Some knowledge of head and neck anatomy is essential for most disciplines, but especially so for dentistry and clinical speech and language studies The Head The nomenclature of the bones can be confusing The skull is the skeleton of the head and consists of cranium and mandible (lower jaw) The cranium is made up of the calvaria and facial skeleton, with many bones whose names you need to know The calvaria encloses the cranial cavity that houses the brain The facial skeleton is complex because the soft tissues of the special senses of sight, hearing, and smell, the cranial ends of the gut tube and respiratory airway, and the many muscles that control and protect them are attached to it There is a limited number of these that you need to know The facial skeleton is also important because the muscles of facial expression are attached to it and these allow us to communicate with each other The mandible is the lower jaw bone to

Dr

Paul Tierney: 13/10/05

which are attached teeth, and muscles of jaw, tongue and neck Calvaria Composed of frontal, parietal, temporal, occipital and sphenoid bones, attached to each other along suture lines -- The upper part is named the vault, the lower part the cranial base and they enclose the cranial cavity -- The cranial cavity is divided into anterior, middle and posterior cranial fossae -- These contain different lobes of the brain, which you will need to know -- Leaving the cranial cavity are several important holes (foramina), through which cranial nerves exit the cavity to supply the head and neck, and blood vessels pass in and out of the cavity, supplying or draining the brain Facial skeleton Formed by the maxilla, frontal bone, nasal bones, zygomatic bones, palatine bones, pterygoid plates, temporal, mastoid and orbital bones (which you do not need to know individually) It contains cavities for the eyes, ears, nose and when the mandible is attached, encloses the oral cavity posterior to it The maxilla has the upper teeth embedded in it Another part, the palate separates the nasal and oral cavities The bones contain the paranasal sinuses that you need to know about, as they affect the teeth and voice The pharynx lies between the facial skeleton and the cervical spine posteriorly

Dr

Paul Tierney: 13/10/05

There are many important blood vessels and nerves passing through the facial skeleton and supplying it It has the muscles of mastication attaching it to the mandible and these move the lower jaw via the TMJ (temporomandibular joint), in eating and speech It gives attachment to muscles, which protect the eye and the mouth, the latter being used for speech and eating also The Neck This contains the cervical spine and the muscles that support the head -- It is a conduit for passage of blood vessels, nerves, gut and airway tubes to the head -- It contains essential endocrine organs; the thyroid and parathyroid glands -- Because it has the 7 pound head wobbling on top of it, it is very prone to damage from many causes Blood vessels in the head and Neck Most arteries in the head and neck are branches of the common carotids, which on the left side branch off the arch of the aorta and on the right side, the brachiocephalic trunk Common carotid arteries end by dividing into an internal carotid, which supplies the brain only, and an external carotid that supplies the neck, facial skeleton and scalp The branches of the external carotid artery you need to know are the superior thyroid, the facial, the lingual, the maxillary and the superior temporal arteries The veins drain the head and neck by similarly named tributaries as the arteries, into the internal jugular vein on either side The cervical spine

Dr

Paul Tierney: 13/10/05

The vertebral column is the flexible central bony axis of the skeleton -- It is composed of 33 vertebrae arranged in 5 distinct groups; 7 cervical, 12 thoracic, 5 lumbar, 5 sacral & 4 coccygeal -- Sacral and coccygeal vertebrae are fused -- The cervical section shows anterior curvature (lordosis) that is a 2 curvature due to strong extension of the head and wedge-shaped discs Features of a typical cervical vertebra Small oval fairly delicate body (centrum); neural arch usually bigger than body Pedicles Laminae Neural Arch Bifid or clubbed spinous process Transverse processes with foramina transversaria, with prominent anterior and posterior tubercles for muscle attachment Superior articular facets which face posterosuperiorly Upper lateral margins of the body project upwards (uncus) Lower anterior margins project downwards Atypical cervical vertebrae [C1 C2 C7] C1: The atlas -- There is no body (its space is filled by the odontoid process of the axis) -- Short anterior arch with a small anterior tubercle -- Posterior arch is longer and the posterior tubercle is more prominent -- Two lateral masses that have prominent transverse processes

Dr

Paul Tierney: 13/10/05

with foramina transversaria -- The lateral masses have large concave superior facets for the occipital condyles C2: The axis Odontoid process (dens) is the most obvious feature with facets for articulation with the atlas and transverse ligament Superior aspect has lateral masses with oval facets for articulation with the atlas lateral masses Inferior aspect has a body for articulation with C3 The axis has thick laminae and a bifid spinous process C7 -- The spinous process is horizontal and not bifid -- Foramina transversaria are narrow and sometimes absent, as the vertebral artery does not pass through them Joints of the spine Between adjacent vertebral bodies are secondary cartilaginous joints Joints between facets on superior and inferior articulating processes are plane synovial Neurocentral joints between lipped margins of cervical vertebral bodies may not be true joints at all Atlanto-occipital joints are synovial condylar type between the occipital condyles and superior facets on the lateral masses of atlas Atlantoaxial joints are plane synovial between adjacent lateral masses, and pivot synovial between odontoid process of axis and anterior arch and transverse ligament of atlas

Dr

Paul Tierney: 13/10/05

Fibrous joints exist between laminae via ligamenta flava Ligaments -- Anterior atlanto-occipital membrane between anterior arch of C1 and occiput -- Tectorial membrane between body of C2 and occiput -- Posterior atlanto-occipital membrane between posterior arch of C1 and occiput -- Anterior atlanto-occipital membrane is continuous inferiorly with the anterior longitudinal ligament -- Posterior atlanto-occipital membrane is continuous inferiorly with ligamentum flavum -- Tectorial membrane is continuous inferiorly with posterior longitudinal ligament -- Cruciform ligament lies between C1, C2 and occiput, & has transverse and longitudinal components; between the lateral masses of C1, and between the body of C2 and the occiput, respectively (Fig.above) -- Alar ligaments pass from sloping upper margin of odontoid process to the occiput -- Apical ligament, from tip of odontoid process to the occiput Movements Head nodding occurs at the atlanto-occipital joint Rotation occurs at the atlantoaxial joint Flexion and extension are occur in the remainder of the cervical vertebrae No direct rotation occurs, lateral flexion involves 2 rotation Clinical Whiplash; hyperextension, with a tear in anterior longitudinal ligament, possibly fracture of odontoid process Hyperflexion is prevented by the chin hitting the chest

Dr

Paul Tierney: 13/10/05

Disc prolapse, usually at level of C5 C6, weakened by repeated microtrauma Spondylolysis; fracture of interarticular process, due to trauma Odontoid process; vulnerable in rheumatoid arthritis & Downs Syndrome Vertebral artery impingement (due to osteophytes) may cause drop attacks Compression fracture due to falls, e.g. horseriding