002 the superficial structures of the neck Flashcards

1
Q

what structures are in the anterior compartment of the neck?

A
  • digestive, upper respiratory tract, neurovasculature
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2
Q

what structures are in the posterior compartment of the neck?

A
  • vertebral column and associated musculature
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3
Q

what is the deep cervical fascia?

A
  • encloses all neck compartments
  • beneath superficial cervical fascia and platysma
  • runs from the clavicle up to the mandible
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4
Q

what are the 3 layers of deep cervical fascia?

A
  • superficial/investigating/anterior
  • middle/pretracheal
  • deep/prevertebral/posterior
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5
Q

what is in the superficial/anterior/investing layer of deep cervical fascia?

A
  • encloses trapezius, sternocleidomastoid and carotid sheath
  • anteriorly merges with fascia around infrahyoid muscles
  • superiorly to external occipital protuberance and superior nuchal line
  • laterally to mastoid process and zygomatic arch
  • inferiorly to spine of scapula, clavicle and sternum
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6
Q

what is in the middle/pretracheal layer?

A
  • encloses infrahyoid muscles, thyroid gland, trachea and oesophagus
  • superiorly at hyoid bone
  • inferiorly upper thoracic cavity
  • separated pharynx and pretracheal layer
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7
Q

what is in the deep/prevertebral layer of the deep cervical fascia?

A
  • encloses the erector spinae, prevertebral muscles, vertebral columnand scalene muscles
  • superiorly /posteriorly = circular line around base of skull, superior nuchal line/occipital protuberance
  • anteriorly = bottom of occipital bone and carotid canal and transverse processes of vertebrae
  • laterally = mastoid process
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8
Q

what is the clinical significance of the spaces between the deep cervical fascia layers?

A
  • fluid lies between these layers and can easily be infected/spread
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9
Q

how many cervical spines are there?

A

7

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10
Q

what are the names of c1 and c2?

A

c1 = atlas
c2 = axis

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11
Q

what features do cervical spine have?

A
  • bifurcated spinous process
  • coronal superior/inferior articular facets
  • transverse process/foramen
  • vertebral canal
  • body except for atlas
    -uncinate process to join bodies
  • anterior and posterior processes
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12
Q

what are the 3 different spaces between the deep cervical fascia?

A
  • pretracheal space = between the superficial/investing fascia layer and the pretrachial fascia layer
  • retropharyngeal space = between buccopharyngeal fascia and prevertebral fascia
  • fascial space = within prevertebral layer, this layer splits into 2 laminae to create fascial space from base of skull to diaphragm
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13
Q

what are the 3 scalene muscles and what do they do?

A
  • anterior = elevation of rib 1 and lateral bending of neck
  • middle = elevation of rib 1 and lateral bending of neck
  • posterior = elevation of rib 2 and lateral bending of neck
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14
Q

what are the origins/insertions of the 3 scalene muscles?

A
  • all deep to sternocleidomastoid and omohyoid
  • anterior = transverse processes of C3-6 to upper surface of rib 1
  • middle = transverse processes of C2-6 to upper surface of rib 1
  • posterior = transverse processes of C4-6 to upper surface of rib 2
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15
Q

what are the scalene muscles innervated by?

A
  • anterior rami of C3-7
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16
Q

what are the suprahyoid muscles and what do they do?

A
  • stylohyoid, digastric, mylohyoid, geniohyoid
  • pulls hyoid upwards and back
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17
Q

what are the attachments of the stylohyoid?

A
  • from styloid process of temporal bone to lateral area of hyoid bone
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18
Q

what is the innervation and function of the stylohyoid?

A
  • facial nerve
  • pulls hyoid bone upwards and backwards
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19
Q

what are the attachments of the digastric muscles?

A
  • anterior belly = digastric fossa lower inside of mandible to tendon between bellies
  • posterior belly = tendon to mastoid process of temporal bone
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20
Q

what is the innervation and functions of the digastric muscles?

A

anterior = mylohyoid nerve (mandibular nerve branch), opens mouth by lowering mandible
posterior = fascial nerve
- when mandible fixed = raise hyoid
- when hyoid fixed = lower mandible and open mouth

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21
Q

what are the attachments of the mylohyoid

A
  • mylohyoid line on mandible to hyoid bone
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22
Q

what is the innervation and action of mylohyoid?

A

mylohyoid nerve (mandibular nerve branch)
- supports elevation of mouth / hyoid

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23
Q

what are the attachments of geniohyoid?

A
  • inferior mental spine on inner surface of mandible to anterior surface of hyoid
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24
Q

what is the innervation and action of geniohyoid?

A
  • hypoglossal nerve (C1)
  • fixed mandible = hyoid up and forward
  • fixed hyoid = mandible down and inwards
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25
Q

what are the infrahyoid muscles?

A
  • aka strap muscles
  • sternohyoid, omohyoid, thyrohyoid, sternohyoid
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26
Q

what are the attachments of the sternohyoid?

A
  • sternoclavicular joint to the hyoid bone
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27
Q

what is the innervation and action of the sternohyoid?

A
  • ansa cervicalis (C1-3)
  • depresses hyoid after swallowing
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28
Q

what are the attachments of the omohyoid?

A
  • superior border of scapula to the lower border of hyoid
29
Q

what is the innervation and action of the omohyoid?

A
  • ansa cervicalis (C1-3)
  • depresses and fixes hyoid bone
30
Q

what are the attachments for the thyrohyoid?

A
  • deep to sternohyoid
  • oblique line on thyroid cartilage to greater horn of hyoid
31
Q

what is the innervation and action of the thyrohyoid?

A
  • hypoglossal nerve (C1)
  • depresses hyoid bone, when hyoid bone fixed, raises larynx
32
Q

what are the attachments of the sternothyroid?

A
  • deep to sternohyoid
  • posterior surface of manubrium, sternum to the oblique line on thyroid cartilage
33
Q

what is the innervation and action of the sternohyoid?

A
  • ansa cervicalis (C1-3)
  • draws larynx down
34
Q

what are the attachments of the trapezius?

A
  • superior nuchal line, external occipital protuberance, spinous processes of C7-T12
    to lateral 1/3 of clavicle, acromion and spine of scapula
35
Q

what is the innervation of the trapezius and what does it do?

A
  • accessory nerve (C3,4)
  • rotates scapula during abduction of arm
36
Q

what are the origins of the sternocleidomastoid heads?

A
  • sternal head = upper part of anterior surface of manubrium, sternum
  • clavicular head = superior surface of medial 1/3 of clavicle
37
Q

what are the insertions of the sternocleidomastoid heads?

A
  • sternal head = lateral 1/2 of superior nuchal line
  • clavicular head = lateral surface of mastoid process
38
Q

what is the innervation and action of the sternocleidomastoid?

A

-accessory nerve (C2-4)
- lateral bending of neck, rotate head, neck flexion, head extension

39
Q

what is the main artery supplying the head and neck?

A
  • carotid arteries from aorta
40
Q

what is the main vein draining the head and neck?

A
  • jugular veins, into the superior vena cava
41
Q

what are the 2 branches of the common carotid

A
  • divides into the internal and external carotids near the superior border of the thyroid cartilage
42
Q

describe the internal carotid artery

A
  • internal = continues upwards an enters skull through carotid canal without releasing any branches, supplies cerebrum and meninges
43
Q

describe the external carotid artery

A
  • supplies the larynx, pharynx, mouth, nose, scalp, skill , meninges and some of thyroid gland via many branches
44
Q

what is the carotid sinus?

A
  • dilation of the start of the internal carotid artery, behind the bifurcation of the common carotid artery
  • sensitive to arterial blood pressure changes as it contains baro receptors
  • can also feel pulse here
45
Q

what is the carotid body?

A
  • very close to carotid sinus (not visible to naked eye)
  • containers chemoreceptors that monitor O2, CO2, pH and temperature of arterial blood
46
Q

what nerves supply the carotid sinus and body?

A
  • glossopharyngeal nerve, cervical sympathetic trunk and vagus nerve
47
Q

describe the arterial branching from the aorta on the right side of the body to the head and neck

A
  • aorta –> right brachiocephalic artery splits into the right subclavian artery and right common carotid
  • right common carotid splits into internal and external branches
  • right subclavian has a right thyrocervical trunk and right vertebral artery branching off it
48
Q

describe the arterial branching from the aorta on the left side of the body to the head and neck

A
  • aorta –> left subclavian artery and left common carotid
  • left common carotid splits into internal and external branches
  • left subclavian has left thyrocervical trunk and left vertebral arteries
49
Q

what are the 2 main lymphatic ducts in the body?

A
  • right lymphatic duct (right arm, chest and right side of head)
  • thoracic duct ( all of legs and abdomen, left chest arm head)
50
Q

what is the overall pattern of lymph nodes and vessels in the head?

A
  • superficial lymph vessels drain to superficial cervical nodes, which then drain to deep cervical nodes which drain into either right lymphatic duct or thoracic duct
51
Q

what are the 5 groups of superficial lymph nodes in the head?

A
  • occipital nodes (near occipital artery)
  • mastoid nodes, including posterior auricular nodes (near auricular artery)
  • parotid and/or preauricular nodes (near superficial temporal artery)
  • submandibular nodes (near facial artery/ angle of jaw)
  • submental nodes (near facial artery/chin)
52
Q

what are the deep lymph nodes of the head and neck?

A
  • jugulodigastric node ( just under ear behind jaw), receives lymph from tonsils and tonsillar beds
  • jugulo-omohyoid node (just above omohyoid muscle and next to jugular vein) receives lymph from the tongue
  • all other lymph drains into chain of deep cervical nodes in the neck, associated with the internal jugular vein and carotid sheath beneath the sternocleidomastoid
53
Q

what are the deep lymph nodes of the head and neck?

A
  • jugulodigastric node ( just under ear behind jaw), receives lymph from tonsils and tonsillar beds
  • jugulo-omohyoid node (just above omohyoid muscle and next to jugular vein) receives lymph from the tongue
  • all other lymph drains into chain of deep cervical nodes in the neck, associated with the internal jugular vein and carotid sheath beneath the sternocleidomastoid
54
Q

what are the nervous structures (from superficial to deep) in the neck?

A
  • cervical plexus, vagus nerve, other cranial nerves, sympathetic trunks, spinal cord
55
Q

what is the cervical plexus?

A
  • nerve system formed by the anterior rami of cervical nerves C1-4
  • forms muscular/ deep branches and cutaneous/superficial branches
56
Q

give some examples of the muscular/deep branches of the cervical plexus

A
  • phrenic nerve, from anterior rami of C3-5
  • ansa cervicalis (C1-3)
    -C1 motor to thyrohyoid and geniohyoid muscles
57
Q

what is the ansa cervicalis?

A
  • neural loop in the neck formed from superior root from C1 and and inferior root from C2,3
  • innervates infrahyoid muscles
58
Q

what are the cutaneous/superficial branches of the cervical plexus?

A
  • lesser optical nerve (C2) = skin of neck and scalp
  • great auricular nerve (C2,3) = skin of ear and mastoid
  • transverse cervical nerve (C2,3) = skin of lateral and anterior neck
  • supraclavicular nerve (C3,4) = skin over clavicle and shoulder
59
Q

how can you locate the cervical plexus branches?

A
  • in posterior neck triangle, follow the sternocleidomastoid posterior border
60
Q

what is a?

A

lesser occipital nerve

61
Q

what is b?

A

greater auricular nerve

62
Q

what is c?

A

transverse cervical nerve

63
Q

what is d?

A

supraclavicular nerve

64
Q

what is the pathway accessory(XI) nerve?

A
  • accessory nerve has a spinal and cranial portion
  • enters skull via foramen magnum (into cranial portion)
  • travels with the vagus nerve through the jugular foramen to the pharyngeal plexus and laryngeal nerves
  • the spinal portion reaches the sternocleidomastoid and trapezius
65
Q

what is the pathway of the vagus (X) nerve?

A
  • travels from medulla and leaves skull via the jugular foramen
  • travels with accessory nerve to pharyngeal plexus and laryngeal nerves
  • then ravels in carotid sheath to he thorax
66
Q

describe the pathway of the glossopharyngeal (IX) nerve

A
  • leaves the skull via the jugular foramen, crosses over the internal carotid but below the external carotid
67
Q

describe the pathway of the hypoglossal (XII) nerve

A
  • follows the stylopharyngeal muscle, crossing underneath the accessory and over the vagus nerve in the neck to reach the back of the tongue
68
Q

what is the sympathetic trunk in the neck?

A
  • located alongside the carotid sheaths anterior to the transverse processes of the cervical vertebrae
  • then goes into sympathetic trunk of thorax
  • collection of sympathetic nerves
69
Q

where are the 3 ganglion of the sympathetic trunk in the neck?

A
  • superior/upper ganglion = C1-4
  • middle ganglion = C5-6
  • inferior/lower/thoraco-cervical/stellate ganglion = C7-T1