1 - Zill - Neck Flashcards by John Castillo

Compartments of the Neck

Posterior Compartment - Vertebrae and Muscles
1. Support and move head/neck
Anterior Compartment - Viscera
1. Rostral continuiation of GI and Respiratory Systems (trachea/esophogus)
2. Pharynx/ Larynx
Lateral Compartment
1. Blood vessels and nerve (+ carotid pulse)
2. Carotid Sheath

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Posterior Compartment - Muscles that Move Head and Neck

Posterior Side?

Lateral Side?

Anterior Side?

Posterior Side:
- Deep Muscles: EXTEND
  - Suboccipital Mucles
Lateral Side:
- Scalene Muscles - flex laterally
Anterior Side:
- Prevertebral Muscles - Direct ant. to vert, FLEX head and neck

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Anterior Compartment - Viscera

Main Contents?

Larynx and Esophagus open into Pharynx

Pharynx opens to oral and nasal cavities

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Sensation ant/pos to Paloglossal Arch?

Posterior - Vague

Anterior - Precise

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***Contents of Carotid Sheath***

Common and Internal Carotid Arteries
Internal Jugular Vein
Vagus Nerve
- - -

NOT IN CAROTID SHEATH: Sympathetic Chain (posterior to sheath)

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Muscles of Neck (Action/Innervation):

Sternocleidomastoid

Attached to Hyoid? (Y/N)

Action:

Nerve:

Muscles of Neck (Action/Innervation):

Sternocleidomastoid

Attached to Hyoid?: No

Action: Flex Neck (bilateral), Rotate head so face is directed opposite to (unilateral)

Nerve: Accessory Nerve (CN XI)

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Muscles of Neck (Action/Innervation):

Scalenus Anterior and Scalenus Medius

Attached to Hyoid? (Y/N)

Action:

Nerve:

Muscles of Neck (Action/Innervation):

Scalenus Anterior and Scalenus Medius

Attached to Hyoid: No

Action: Flex neck and elevate rib 1

Nerve: Branches of ventral rami of cervical spinal nerves

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Muscles of Neck (Action/Innervation):

Omohyoid (two bellies)

Attached to Hyoid? (Y/N)

Action:

Nerve:

Muscles of Neck (Action/Innervation):

Omohyoid (two bellies)

Attached to Hyoid? Yes

Action: Depresses Hyoid Bone

Nerve: Ansa Cervicalis

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Muscles of Neck (Action/Innervation):

Sternohyoid

Attached to Hyoid? (Y/N)

Action:

Nerve:

Muscles of Neck (Action/Innervation):

Sternohyoid

Attached to Hyoid? Yes

Action: Depresses Hyoid Bone

Nerve: Ansa Cervicalis

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Muscles of Neck (Action/Innervation):

Sternothyroid

Attached to Hyoid? (Y/N)

Action:

Nerve:

Muscles of Neck (Action/Innervation):

Sternothyroid

Attached to Hyoid? Yes

Action: Depresses Thyroid Cartilage, Indirectly depresses hyoid bone and larynx

Nerve: Ansa Cervicalis

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Muscles of Neck (Action/Innervation):

Thryohyoid

Attached to Hyoid? (Y/N)

Action:

Nerve:

Muscles of Neck (Action/Innervation):

Thryohyoid

Attached to Hyoid? Yes

Action: Depresses hyoid bone, elevate larynx

Nerve: C1 via branch hitch-hiking with Hypoglossal Nerve (CN XII)

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Sternocleidomastoid

Head Attachment(s)?

Clinical Dysfunction?

Action?

Procedure Landmark?

Two Heads: Clavicle, Sternum

Clinical: Torticollis - Contracture of Sternocleidomastoid (congenital or acquired); face “locked” in opposite direction

Action: Pulls mastoid toward sternum

Procedure Landmark: Central Line - Internal Jugular V. accessed and catherterized between Sternal and Clavicular heads

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Palpation of Thyroid Gland

Palpated in Anterior Triangle below Cricoid Cartilated, medial to Sternocleidomastoid

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Masses in Neck Diagnosis

Branchial Cyst or Fistula (Channel)

Thyroglossal Duct Cyst

Use Sternocleidomastoid as Landmark

Branchial Cyst or Fistula = Anterior to Sterno. M.

Throglossal Duct Cyst = Midline mass

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Muscles of Neck Not Attached to Hyoid as Landmark:

Scalenus Anterior and Scalenus Medius

Clinical?

Landmark for

Branchial Plexus - Between Heads

PHRENIC NERVE - Top of Scalenus Anterior; goes to Diaphragm

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Phrenic Nerve Clinical Issues

Nerve courses on top of Scalenus Anterior

“(C345), Keep Alive!”

Have to worry about respiratory issues with neck injuries that could affect Phrenic Nerve

Hyoid Bone

Parts?

Major two functions?

Free floating bone, held by muscles and ligaments

Parts: Body, Greater and Lesser Horns

Functions: Speech, Swallowling (life on land!)

Gills and Embryology

Gills became unnecessary as we developed lungs

Structures used to eventually form middle ear structures for detecting sounds

What forms an attachment for the mobile nature of the tongue?

Hyoid Bone

Infrahyoid Mucles

All depress hyoid

Omohyoid (long, from shoulder area to hyoid)

Sternohyoid (sternum to hyoid)

Sternothyroid (sternum to thyroid)

Thyrohyoid (thyroid to hyoid)

Muscles of Neck (Action/Innervation):

Digastric

Action:

Nerve:

Muscles of Neck (Action/Innervation):

Digastric

Action: Elevate hyoid bone, depress mandible

Nerve:

Posterior Belly: Facial Nerve (CN 7)

Anterior Belly: Trigeminal Nerve (V3)

Muscles of Neck (Action/Innervation):

Stylohyoid

Action:

Nerve:

Muscles of Neck (Action/Innervation):

Stylohyoid

Action: Elevate Hyoid

Nerve: Facial Nerve (CN VII)

Muscles of Neck (Action/Innervation):

Mylohyoid

Action:

Nerve:

Muscles of Neck (Action/Innervation):

Mylohyoid

Action: Elevate hyoid, raise floor of mouth during swallowing

Nerve: Trigeminal Nerve (V3)

Muscles of Neck (Action/Innervation):

Geniohyoid

Action:

Nerve:

Muscles of Neck (Action/Innervation):

Geniohyoid

Action: Elevate hyoid, draws hyoid forward

Nerve: C1 branch hitch-hiking with Hypoglossal Nerve (CN XII)

Swallowing!

\*\*Digastric\*\* (practical) Two Heads - Innervation? Embryology Origin? Major Action?

Two bellies and two cranial nerves insert to hyoid via **intermediate tendon** **Posterior Belly: Cranial Nerve VII** **Anterior Belly: Cranial Nerve V3** - - - From **First and Second Branchial Arch** Major Act: Open Mouth

Cervical Plexus Branching? Cutaneous Nerves? Where do these emerge from, and what is clinical relevance?

From C2-C4 Branching not that important, it's **deep and protected** **- - -** **Cutaneous:** 1. Lesser Occipital - Behind Ear 2. Great Auricular - Beneath Ear 3. Transverse Cervical - Anterior Neck 4. Supraclavicular - Lower Neck / Shoulder - - - Emerge from **post. border of sternocleidomastoid,** important for **anesthesia for suturing neck**

Ansa Cervicalis

Fibers from C1 join Hypoglossal Nerve (XII); some leave and join C2 / C3 to form **Ansa (Loop) Cervicalis** ## Footnote **C1 - C3 Innervated Neck Muscles, some just travel with XII** **\*\*\*Just remember this name for the practical, and write it down if you see any loop like nerves in neck!!!\*\*\***

Arteries of Head and Neck: Subclavian and its Parts \*\*\* Develop Mnemonic \*\*\*

Subclavian - At root of neck, goes to arm becomes Axillary A.; divided into three parts at _Scalenus Anterior_ * Part 1: Medial to Scalenus Anterior * **Vertebral A.** * **Internal Thoracic A.** * **Thyrocervical Trunk**: Branches: * **Inferior Thyroid** * **Transverse Cervical** * **Suprascapular** * Part 2: Posterior to Scalenus Anterior * **Costocervical Trunk**: Branches: * **Superior Intercostal A.** * **Deep Cervical A.** (deep neck) * Part 3: Lateral to Scalenus Anterior * No Branches

External Carotid Artery Anterior Branches Posterior Branches

Anterior Branches: * Superior Thyroid A. * Descends to Thyroid * Ascending Pharyngeal A. * Ascends to Pharynx * Lingual A. * Tongue * **Facial A. \*\*\*** * **Below then on surface of mandible (heavy bleeding to cuts to lips)** Posterior Branches: * Occipital A. * Post. Scalp * Post. Auricular A. * Post. to Ear

Carotid Bifurication

Location of pulse taken in neck, and level of C4

Ischemic vs Hemorrhagic Stroke

Ischemic - Occlusion (blockage); insufficient blood supply to brain Hemorrhagic - Rupture of weakened/diseased blood vessel

Venous Sinuses of Brain

Superior Sagittal - Top Middle of Falx Cerebri Straight Sinus - Top of Tentorium Cerebelli, connects to-- Inferior Sagittal Sinus - Bottom Middle of Falx Cerebri Transverse Sinus - Beneath Tentorium Cerebelli, connects to-- Sigmoid Sinus - Connects transverse sinus to internal Jugular Vein Cavernous Sinus - Clinically important ear by Turrica Sellica; location of **Carotid Siphon**

Platysma

Connective, Superficial fascia of neck

Deep Fascia of Neck Compartments?

Investing Layer of Deep Cervical Fascia - Neck, splits around muscles of neck Prevertebral Layer - Surronds vert. column, muscles of neck Pretracheal Layer - Surround respiratory/GI structures **Carotid Sheath - Surrouns Common/Int. Carotid, Int. Jugular, and Vagus (CN X) NOT Symp Chain**

Retropharyngeal Space Clinical Significance (2x)? (\*\*\*probably on practical/exam\*\*\*)

Space between **Pretracheal Layer and Prevertebral Layers** - - - Infection from head (tonsillitis) can **spread to mediastinum (Thorax)** **- - -** **\*\*\*Retropharyngeal Abscess - Can be difficult to diagnose, no external swelling, LIFE-THREATENING, can block airway\*\*\***

Lymphatics of Neck Three Groups Main Drainage Port

Groups: 1. Superficial Ring 2. Deep Ring - Pretracheal, Retropharyngeal nodes 3. Deep Cervical Chain - Along Int. Jugular Vein, receive from above nodes Main Drainage Port: Jugular Lymph Trunk - To right lymphatic duct or Thoracic Duct - - - **Drains to venous system**