12-A Superficial Neck

Question 1

Describe the cervical investing fascia, what does it invest?

Answer 1

the first layer beneath the superficial facia, encloses the sternocleidomastoid and the trapezius muscles and invests the entire neck

Question 2

What does the pre vertebral fascia surround?

Answer 2

the vertebral column and associated muscles (splenius, semispinalis etc.)

Question 3

What fascia invests around the carotid artery and internal jugular veins and the vagus nerve?

Answer 3

carotid sheath (along with part of the cervical plexus)

Question 4

What does the visceral fascia invest?

Answer 4

digestive and respiratory tracts in the neck and associated muscles

Question 5

What are the two subdivisions of the visceral fascia

Answer 5

pre-tracheal (anteriorly and laterally) and buccopharyngeal (posterior aspect of pharynx and esophagus)

Question 6

What borders the potential space called the retropharyngeal space?

Answer 6

buccopharyngeal fascia and the pre vertebral fascia (infectious material in this space in the neck can spread to the superior mediastinum)

Question 7

Describe the motion of the SCM and results of pathology.

Answer 7

rotates head towards the opposite side and laterally flexes the neck (pathologic shortening of the muscles results in a condition called torticollis (wryneck)

Question 8

Describe the motion of the trapezius and its pathological state.

Answer 8

trapezius moves the head and neck and is critical in movements of the shoulder girdle, paralysis produces “winging” of the scapula

Question 9

What are the borders of the posterior cervical triangle?

Answer 9

trapezius, clavicle and SCM (posterior margin)

Question 10

What are the borders of the anterior cervical triangle?

Answer 10

SCM (anterior border), anterior midline of neck and inferior margin of the mandible

Question 11

Where can the pulse be located in the neck?

Answer 11

carotid triangle, a subdivision of the anterior cervical triangle, separated from the muscular triangle by the superior belly of the omohyoid muscle

Question 12

What does the carotid triangle contain?

Answer 12

portions of the common, internal and external carotid arteries, vagus, hypoglossal nerves, superior root of the ansa cervicalis, thyroid gland, pharynx and larynx

Question 13

Describe the two sources of innervation to the trapezius and SCM muscles.

Answer 13

branchiomotor via the accessory nerve and sensory innervation via branches of the cervical nerves (accessory nerve travels upward first then out wards, where cervical spinal nerves just branch from the spinal cord outwards from roots)

Question 14

Describe the general movement of the hyoid muscles

Answer 14

contribute to movements of the mandible, tongue in speech and swallowing activities

Question 15

What tissue derives into supra hyoid muscle and what innervates theses muscles?

Answer 15

muscles positioned above the hyoid bone are mostly derived from branchial arch mesoderm and innervated by branches of cranial nerves (form the floor of the mouth: geniohyoid ad myohyoid)

Question 16

What tissues derives the infra hyoid muscles, and what innervates these muscles?

Answer 16

the “strap” muscles are derived from cervical somintes and innervated by branches of cervical spinal nerves (with one exception)

Question 17

Describe the attachments of the following muscles: sternohyoid, sternothyroid, omohyoid and thyrohyoid

Answer 17

sternohyoid: from the sternum to the hyoid bone
sternothyroid: sternum to the thyroid cartilage
omohyoid : (two bellies) from scapula, through fascial sling attached to the clavicle then hyoid bone
thyrohyoid: from the thyroid cartilage to the hyoid bone

Question 18

Describe the attachments of the following muscles: digastric, mylohyoid, stylohyoid, geniohyoid

Answer 18

a. digastric (anterior and posterior bellies): from the mastoid bone through a fibrous loop that is attached to the hyoid bone to attch to the mandible (anterior belly branchial arch 1 and posterior belly develops from branchial arch 2)
b. mylohyoid
: (floor of the mouth) BA1, inferior alveolar branch, elevates the hyoid bone, floor of the moth and tongue, attaches to the mandible
c. stylohyoid: runs from the styloid process to the hyoid bone, BA2, CNVII, elvates and retracts the hyoid bone

d. geniohyoid: from mandible to back to the hyoid bone, innervated by 1st cervical spinal nerve that run with CN XII, pulls the hyoid bone forward

Question 19

Branches of which spinal nerves form the cervical plexus? What is the purpose of the plexus?

Answer 19

C1-4 spinal nerves (includes sympathetic) form the cervical plexus and bring fibers together to sort them into separate sensory and motor branches

Question 20

What are 4 nerve branches that emerged from the posterior marching of the SCM and function as sensory to the neck?

Answer 20

b. - great auricular
: crosses the SCM and runs parallel to the external jugular vein on its way to the auricle
c. lesser occipital: follows posterior border of the SCM to the occipital region
d. transverse cervical: runs horizontally forward across the sternocleidomastoid
e. – supraclavicular: descend toward the clavicle, important in phrenic referred pain

Question 21

What is the name of the motor component of the cervical plexus?

Answer 21

ansa cervicalis

Question 22

Which spinal nerves come together to form the superior and inferior limbs of the cervical plexus

Answer 22

C1-2 superior limb C3-4 inferior limb

Question 23

What part of the cervical plexus runs with the hypoglossal nerve?

Answer 23

superior limb, which eventually branches into two nerves that

Question 24

What is the insertion/ origin of he scalene muscles and what is there motion?

Answer 24

transverse process to 1st and second ribs: laterally move the neck, rotate head to opposite side and elevate first two ribs

Question 25

What runs between the anterior and middle scalene muscles?

Answer 25

brachial plexus and middle scalene muscles

Question 26

Describe the names and locations of the cervical lymph nodes

Answer 26

occipital, retroauricular, parotid, submandibular and submandibular receive lymph from the face and scalp

More detail: i. back of head drains into the occipital nodes

ii. parietal region drains into the retroauricular and parotid nodes
iii. lateral face and eyelids drain into the parotid and superficial cervical nodes
iv. front of face, forehead, upper lip and lateral lower lip drain into submandibular nodes
v. chin and middle lower lip drain into the buccal, submandibular and submental nodes

Question 27

Where can you find the deep cervical lymph nodes?

Answer 27

jugulodigastric along the internal jugular vein (drains the tongue, palatine tonsil; also the supraclavicular nodule

Question 28

What is the purpose of a subclavian venipuncture?

Answer 28

a. Purpose: provide central line for drugs and feeding, to assess cardiac function, to assess central venous pressure and to administer contrast for certain radiological tests

Question 29

What is the technique used for a subclavian venipuncture?

Answer 29

b. Technique: easiest on the right, jugular preferred (to reduce the risk of pneumothorax)
i. Insert needle at the apex of triangle formed by the insertion SCM on clavical and sternum and push inferiorly and slightly laterally