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Neuroendocrine Exam 1 > 1. Triangles of the Neck and The Larynx (KEIM) > Flashcards

1. Triangles of the Neck and The Larynx (KEIM) Flashcards

1
Q

Landmarks of vertebral level C3-4

A

Body of Hyoid bone

Upper margin of thyroid cartilage

Bifurcation of common carotid A.

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2
Q

Landmarks of vertebral level C5-6

A

Arch of cricoid cartilage

superior end of esophagus

superior end of trachea

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3
Q

What are the borders of the posterior triangle of the neck?

A

SCM (anterior border)

Trapezius (posterior border)

Clavicle (Base)

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4
Q

What are the borders of the anterior triangle of the neck?

A

Midline of the neck (anterior border)

SCM (posterior border)

Lower border of mandible (base)

it’s an upside-down triangle

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5
Q

What are the borders of the submandibular subdivision/triangle of the anterior triangle?

A

anterior belly of digastric M. (anterior border)

posterior belly of digastric M. (posterior border)

inferior mandible (base)

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6
Q

What are the borders of the submental subdivision/triangle of the anterior triangle?

A

Midline of neck (anterior border)

anterior belly of digastric (posterior border, kind of)

Body of hyoid bone (base)

Floor: Mylohyoid M.

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7
Q

What are the borders of the carotid subdivision/triangle of the anterior triangle?

A

Posterior belly of digastric M. (post. border)

Superior belly of omohyoid M. (ant. border)

SCM (base)

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8
Q

What are the borders of the Muscular subdivision/triangle of the anterior triangle?

A

Body of hyoid (anterior border)

superior belly of omohyoid (posterior border)

SCM (base)

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9
Q

What muscles make up the floor of the posterior triangle?

A

semispinalis capitis M.

Splenius capitis M.

Levator Scapulae M.

Posterior, middle and anterior scalene M.

All covered by prevertebral layer of deep fascia

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10
Q

The triangles are superficially covered by what structures? (superficial to deep)

A

skin

superficial facia

Platysma M.

investing deep fascia

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11
Q

What are the major arteries running through the neck within the posterior triangle? (overview)

A

subclavian a.

thyrocervical trunk

transverse cervical a.

dorsal scapular a.

suprascapular a.

part of occipital a.

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12
Q

Where is the transverse cervical artery specifically going? (thru posterior triangle)

A

it runs superficially and laterally across the phrenic nerve and anterior scalene muscle

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13
Q

Where is the suprascapular artery going, specifcially? (thru posterior triangle)

A

passes inferolaterally across the anterior scalene muscle and phrenic nerve, traveling with the suprascapular N.

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14
Q

Veins within the posterior triangle

A

external jugular vein starts below the angle of the mandible, after it joins with the posterior retromandibular vein and posterior auricular vein anterior to SCM.

Drains into subclavian

Subclavian V. is anterior to anterior scalene M. and joins with internal jugular vein to form the brachiocephalic vein.

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15
Q

Cutaneous branches of the cervical plexus within the posterior triangle include:

A

Lesser occipital, C2: neck and scalp behind ear

Great Auricular, C2-3: skin over parotid gland, mastoid process, auricle and angle of mandible

Transverse Cervical, C2-3: skin of anterior neck

Supraclavicular, C3-4: skin over clavicle and shoulder

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16
Q

Other nerves in the posterior triangle of the neck include:

A

Spinal Accessory Nerve: deep to SCM, lies in deep fascia, enters trapezius

Phrenic N. diaphragm (C3, 4, 5)

Roots of brachial plexus (C5, 6, 7, 8, T1); located between anterior and mid scalene

Ansa Cervicalis: found in fascia of carotid sheath (superior and inferior roots)

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17
Q

Clinical Note on Spinal Accessory Nerve

Torticollis

A

contraction or shortening of the SCM that causes the head to tilt forward and the face to turn away from the affected side. Can be nerve related (lesion), or muscle related.

Also most commonly cut nerve, easy to damage during procedures.

If severed, only Trap is affected, SCM is okay

Travels through anterior and posterior triangle

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18
Q

Posterior Triangle subdivisions include:

A

Occipital triangle-contains External Jugular V., branches of cervical plexus, spinal accessory N., cervicodorsal trunk, cervical lymph nodes

Omoclavicular Triangle: Subclavian A, part of subclavian V, Suprascapular A, Supraclavicular Lymph nodes

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19
Q

Muscle groups of the anterior triangle-one set elevates hyoid and larynx, one set depresses

A

Suprahyoid muscles-elevate hyoid and larynx during speech and swallowing

Infrahyoid muscles-depress hyoid and larynx during speech and swallowing

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20
Q

What are the suprahyoid muscles?

A

Mylohyoid

Stylohyoid

Digastric (anterior and posterior bellies)

Geniohyoid

My Stylish, Dynamic Girlfriend “Raises” her voice. (larynx)

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21
Q

What are the infrahyoid muscles?

A

Sternohyoid

Omohyoid

Sternothyroid

Thyrohyoid

Remeber that the sternum and thyroid are lower on the body and that these muscles are also low, so they will pull down on the hyoid/layrnx

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22
Q

What are the arteries of the anterior triangle?

A
  • Common carotid A. which splits at C3-4 and becomes Internal Carotid (ICA) and External Carotid Arteries (ECA)
  • Carotid sinus in proximal part of ICA
  • Carotid body in between ICA and ECA
  • External Carotid and all it’s branches
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23
Q

The External Carotid A. branches into what arteries?

A

Superior thyroid A

Ascending pharyngeal A.

Lingual A.

Fascial A.

Occipital A.

Posterior auricular A.

Maxillary A.

Superficial temporal a.

Some Anatomists Like Freaking Out Poor Med Students

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24
Q

What makes up the floor of the submandibular triangle

A

mylohyoid

hyoglossus

middle pharyngeal constrictor

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25
Q

What are the contents of the submandibular triangle?

A

submandibular gland

submandibular lymph nodes

hypoglossal N.

nerve to mylohyoid

parts of fascial a. and v.

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26
Q

What are the contents of the submental triangle?

A

Submental lymph nodes

small veins that come together to form the anterior jugular vein

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27
Q

What are the muscles/floor of Muscular triangle?

A

sternohyoid

sternothyroid

thyrohyoid

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28
Q

What are the contents of the muscular triangle?

A

Viscera: thyroid, parathyroid, larynx, trachea, esophagus

Arteries: common carotid, superior thyroid, inferior thyroid

Veins: anterior jugular v, thyroid veins (superior, middle, inferior)

Nerves: ansa cervicalis, external laryngeal, recurrent laryngeal

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29
Q

What makes up the floor of the carotid triangle?

A

thyroidhyoid, hyoglossus, middle and inferior constrictor muscles of the pharynx

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30
Q

What are the contents of the carotid triangle

A

Carotid Sheath: common and internal carotid arteries, internal jugular v, vagus n, deep cervical lymph nodes, carotid sinus n, sympathetic nerve fibers

Arteries: branches of external carotid a.

Nerves: internal and external laryngeal N, hypoglossal N, spinal accesory N. and Ansa Cervicalis

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31
Q

What does the Superior Thyroid Artery give rise to?

A

Superior Laryngeal A. to the thyroid

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32
Q

The Ascending Pharyngeal A. is the only _____ branch and is found where?

A

Medial; medial to ICA

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33
Q

Where does the Lingual A. go?

A

anterior to middle pharyngeal constrictor, deep to hypoglossal nerve, stylohyoid M and posterior belly of digastric.

Disappears deep to hyoglossus M.

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34
Q

The facial A. gives rise to what and is found where?

A

gives rise to the ascending palatine artery and tonsillar a.

is found deep to submandibular gland, angle of mandible (pulse point)

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35
Q

Where does the occipital A. go?

A

passes superficial to ICA and hypoglossal N.

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36
Q

Where does the posterior auricular A. go?

A

ascends between teh external auditory meatus and mastoid process

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37
Q

The external carotid A. terminates as what?

A

maxillary artery and superficial temporal artery in the face

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38
Q

Functions of the Carotid Body and Carotid Sinus

A

Carotid Sinus: Baroreceptor (BP)

“Pressure in my sinuses”

Carotid Body: Chemoreceptor (O2)

“You put chemo in a body”

Carotid sinus nerve comes from Glossopharyngeal and Vagus N.

39
Q

Structures within the carotid sheath (medial to lateral)

A

carotid arteries (anterior and medial)

internal jugular v. (lateral)

vagus N (posterior)

Ansa Cervicalis (embedded in sheath)

Lymph, Phrenic N. and Sympathetics also found in the sheath

40
Q

Branches of the Vagus N.

A

Pharyngeal branch

Superior Laryngeal branch: internal and external branches of superior laryneal n.

Carotid body branch

41
Q

Carotid Triangle Nerves include?

A

Carotid Sheath (neurovascular, contains vagus)

Vagus N.

Spinal accesory N.

Hypogossal N.

42
Q

Thoracic Inlet and Thoracic Outlet

(Not the syndrome)

A

Thoracic Inlet: superior thoracic aperture where food and air may enter

Thoracic Outlet: superior thoracic aperture where arteries and nerves emerge

Contents: apex of lung, subclavian artery and vein, brachial pelxus, vagus n., phrenic n., thoracic duct, right lymphatic duct, sympathetic chain, trachea, esophagus

43
Q

Clinical Note

Subclavian Steal Syndrome

Vertebrobasilar Insufficiency

(Add from Moore’s?)

A

Add from Moore’s?

44
Q

Clinical Note on the Phrenic N.

A

Only motor supply to diaphragm, C3, 4, 5

must be ID’ed and preserved during thoracic surgery

Neck injuries can compromise. Injuries of spinal cord below neck, may lead to lower limb paralysis but ability to breath is preserved.

45
Q

The cervical plexus is made up of anterior rami from

A

C1-C4

Superficial branches: sensory

Deep branches: motor

46
Q

What is significant about the Sympathetic Trunk?

A

It extends superiorly to C1 or base of skull

consists of three ganlgions

47
Q

Sympathetic Trunk: Superior Cervical Ganglion

A

located at C1-2

48
Q

Sympathetic Trunk: Middle Cervical Ganglion

A

located at C6 at the level of the circoid cartilage

smallest of the three and may be absent

49
Q

Sympathetic Cercival Ganglion: Inferior Cervical Ganglion

A

in 80% of people, the inferior cervical ganglion fuses with the 1st thoracic ganglion and is termed the stellate (cervicothoracic) ganglion

Located anterior to TP of C7

50
Q

What are the contents of the superficial layer of the neck?

A

Subcutaneous layer between dermis and investing layer of deep fascia

contents: cutaneous nerves, blood, lymph nodes and vessesls, fat, Platysma M.

Platysma does some facial expression, innervated by facial nerve.

51
Q

Deep Fascia: Investing Layer

Most Superficial Layer

A
  • Surrounds SCM and Trap.
  • Encloses Parotid and Submandibular glands
  • Attaches to occiptal and temporal bones, Zyg. arches, mandible, hyoid, and SP of Cerv. Vert.
  • Extends to manubrium, clavicles, acromions, and scapular spine
52
Q

Deep Facia: Pretracheal Layer

A
  • Located only in anterior region of neck
  • blends with pericardium
  • contains muscular layer (infrahyoid muscles), buccopharyngeal fascia, and a visceral layer
53
Q

Deep Fascia: Prevertebral Layer

A
  • Encloses vertebral column and muscles
  • extends laterally as the axillary sheath
  • extends from cranial base to mediastinum

Carotid Sheath is made of Deep cervical fascia

54
Q

What are the borders of the retropharyngeal space?

A

Anterior: buccopharyngeal fascia (alar)

Posterior: prevertebral gascia

Laterally: Carotid sheaths

space is located behind the pharynx and extends superiorly to the base of the skull and inferiorly to the mediastinum

55
Q

Clinical Note

Retropharyngeal Abscess

A

develop secondary to lymph drainage or spread of URI/oral infections

swelling can cause dysphasia and dysphagia and can be life-threatening

56
Q

Where is the thyroid located?

A
  • deep to sternothyroid and sternohyoid muscles
  • levels C5-T1
  • Isthmus anterior to 2nd-3rd tracheal rings
  • May or may not have pyramidal lobe
57
Q

What arteries supply the Thyroid?

A

Superior Thyroid: Supplies anterior-superior aspects of the gland

Inferior Thyroid: Supplies posterior-inferior aspects of the gland and parathyroid gland

Thyroid Ima artery: found in 10% of people, anterior to trachea

Veins: Superior, middle and inferior thyroid form the thyroid plexus of veins

58
Q

how does the thyroid relate to other nearby structures?

A

Recurrent laynrgeal nerves ascend in a groove between trachea and esophagus, passing deeply to posteromedial surface of lateral lobes

ligaments bind thyroid gland to trachea and cricoid cartilage of larynx

59
Q

What is the organization of the Larynx?

A

Located at vertebral levels C3-6

Connected to the pharynx and trachea

Functions: Phonation and patent airway

60
Q

Thyroid Cartilage Anatomy

A

Located at C4

Laminae

Laryngeal prominence (adam’s apple)

Superior thyroid notch

superior and inferior thyroid horn

61
Q

Cricoid Cartilage Anatomy

A

Located at C6

Signet ring shaped

Laminae

Arch

Also know where these cartilages are: epiglottic, arytenoid, corniculate, cuneiform

62
Q

What is the thyrohyoid membrane?

A

aperture for teh internal branch of the superior laryngeal n and superior laryngeal a.

63
Q

What is the cricothyroid membrane?

A

lateral and medial cricothyroid membranes

where cricothyrotomies are done

also be able to ID thyroepiglottic ligament, vocal ligament, cricothyroid joint

64
Q

Where is the Laryngeal Cavity?

A

Extends from the laryngeal inlet, through which it communicates with the laryngopharynx, to the inferior border of the cricoid cartilage. It is continuous with the trachea

65
Q

Where is the Laryngeal Vestibule?

A

between the laryngeal inlet and the vestibular folds

66
Q

Where is the laryngeal ventricle?

A

between the vestibular and vocal folds

67
Q

Where is the infraglottic cavity?

A

between vocal folds and the inferior borer of teh cricoid cartilage

68
Q

Where is the Rima Glottidis?

A

Space between the vocal folds

69
Q

Cricothyroid M. OIAN

A

O: cricocartilage

I: thyroid cartilage

A: stretches/tenses vocal L.

IN: External Laryngeal N (from CN X)

high pitch sound

70
Q

Thyro-arytenoid M. OIAN

A

O: Thyroid Lamina and cricothyroid L.

I: Arytenoid Surface

A: Relaxes vocal L.

N: Inferior Laryngeal N. (from CN X)

low pitch sound

71
Q

Posterior Crico-arytenoid M. OIAN

A

O: Lamina and cricoid cartilage

I: arytenoid cartilage

A: Abducts vocal folds

N: Inferior laryngeal N. (from CN X)

room to breath

72
Q

Lateral Crico-Arytenoid M. OIAN

A

O: cricoid cartilage

I: Arytenoid cartilage

A: Adducts vocal folds

N: Inferior laryngeal N. (From CN X)

phonation

73
Q

Transverse and oblique arytenoid M. OIAN

A

O: One arytenoid cartilage

I: arytenoid cartilage

A: adduct arytenoid cartilage

N: Inferior laryngeal N. (from CN X)

phonation

74
Q

Vocalis M. OIAN

A

O: Arytenoid cartilage

I: vocal L.

A: relaxes posterior vocal L. while keeping tension on anteiror part

N: Inferior laryngeal N. ( from CN X)

75
Q

What arteries supply the larynx?

A

Superior laryngeal A: travels with internal branch of superior laryngeal n. and supplies larynx above vocal folds

inferior laryngeal A: travels with inferior laryngeaal n. and supplies inferior larynx below the vocal folds

76
Q

What innervates the larynx?

A

Superior laryngeal n. branches into internal and external

  • Internal branch:* sensory above vocal cords
  • external branch*: motor to cricothyroid muscle

Internal laryngeal N. is the terminal branch of the recurrent laryngeal nerve

Sensory below the vocal cords

77
Q

What are the functions of the superficial lymph nodes of the head?

A

five groups that form a ring around the head

drain the face and scalp

Drainage from occipital and mastoid nodes passes to superficial cervical nodes along the external jugular vein

Drainage from pre-auricular, parotid, submanibular, submental nodes passes to the deep cervical nodes

78
Q

List the superificial lymph nodes of the head:

A

Occipital: drain posterior scalp and neck

Mastoid: drain posterolateral half of scalp

Pre-auricular and parotid: drain anterior auricle, anterlateral scalp, upper half of face

Submandibular: follows facial artery, drains gums, teeth, tongue, upper lip and lateral lower lip

Submental: drains center lower lip, chin, floor, mouth, tip of tongue, and lower incisors

79
Q

Superficial cervical lymph nodes lie along

A

the external jugular vein

receive lymph from posterior and posterolateral regions of scalp

will eventually drain into deep cervical nodes

80
Q

Deep cervical lymph nodes lie along the

A

internal jugular vein

divideded into upper and lower

Jugulodigastric: Most superior node in the upper deep cervical region, located at C3-4 near posterior belly of diagastric M. (drains throat and tonsils)

Jugulo-omohyoid M: Associated with lower deep cervical nodes, located at C6, inferior to tendon of omohyoid

THESE WILL NOT MOVE WHEN YOU SWALLOW!

81
Q

What does a prominent EJV indicate?

A

increased venous pressure possibly due to heart failure or obstruction of the vena cava

82
Q

What’s relevant about subclavian vein?

A

central line/port placement

83
Q

Facial and Lingual A. may

A

come off common trunk in lab

84
Q

Hypoglossal N. wraps around which artery?

A

occipital A.

85
Q

What can happen if you get stabbed/shot/injured in the neck above the first rib or clavicle?

What are some things that can go wrong in a Subclavian Central Line placement?

A

Can injure the lung and cause a PTX

Can puncture the subclavian A. or the lung causing a PTX. Better get an Xray after each placement.

86
Q

What is posterior to the carotid sheath?

A

Phrenic N. (superficial to anterior scalene)

87
Q

KNOW

A

Draw Cervical Plexus and Know Horner’s Syndrome

88
Q

Clinical Note on Deep Cervical Fascia

Mumps

A

Swelling ins painful because the glands swell which causes the investing fascia to tighten

89
Q

When you swallow, ______ moves while ____ remain stationary

A

Thyroid; Lymph Nodes

90
Q

What structure allows phonation?

What structure provides flexibility for ranges of sound?

A

Vocal Ligament

Conus Elasticus

91
Q

Dr Keim said this 3x within 30sec so you should know that the

internal branch of the superior laryngeal N. does this:

A

SENSORY INNERVATION ABOVE THE VOCAL FOLDS

92
Q

Above the vocal folds:

A

N: Internal branch of superior laryngeal N. (sensory)

B: Superior Laryngeal A.

L: runs with superior laryngial A. and goes to deep cervical LNs

If you swallow water with your trachea, the internal branch of the superior laryngeal N. will sense it.

93
Q

Below the vocal folds:

A

N: inferior laryngeal N.

B: Inferior Laryngeal A.

L: goes to prelaryngeal Deep Cervical LNs.

94
Q

The right lymphatic duct will drain

A

right head

right UE

right chest wall

Left does everything else

Neuroendocrine Exam 1 (22 decks)

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