6. Root of neck

Question 1

Root of neck, boundaries?

Answer 1

Anterior: Top of manubrium & superior border of clavicle

Posterior: T1 & superior margin of scapula to coracoid process

Lateral: First pair of ribs

Inferior: Superior thoracic aperture (thoracic inlet) & axillary inlets

Question 2

Which vessels change name at lateral border of 1st rib?

Answer 2

Right subclavian artery
–>
Right axillary atery

Question 3

Root of the neck leads inferiorly into…

Answer 3

into the superior thoracic aperture (thoracic inlet)

Question 4

What is pleural cupola?

Answer 4

Apex of the lung in the cervical pleura (part of the root of the neck)

Question 5

The cervical pleura in children & infants is more susceptible to injury, why?

Answer 5

The cervical pleura in children & infants is more susceptible to injury since it extends
higher due to the relatively short length of the neck

Question 6

Injuries at root/base of neck can compromise the lungs & pleural sacs. leading to>

Answer 6

pneumothorax, haemothorax, chylothorax

Question 7

What is the suprapleural membrane?

Attachments?

Answer 7

The cervical pleura is reinforced with the suprapleural membrane (Sibson’s fascia), a strong fibrous connective tissue that is an extension of the endothoracic fascia. Provides anchorage for lunch apex

It attaches to the internal surface of rib 1 & the transverse processes of C7

Question 8

3 branches off from the aortic arch?

Answer 8

1: Brachiocephalic trunk (branching to right CCA & right subclavian)
2: Left common carotid artery
3: Left subclavian artery

Question 9

3 parts of the subclavian artery (relative to the anterior scalene muscle)?

Answer 9

• 1st part: Medial to anterior scalene muscle (from origin to muscle)
• 2nd part: Posterior to anterior scalene muscle
• 3rd part: Lateral to anterior scalene muscle (from muscle until lateral border of 1st
rib)

Question 10

Relation of brachial plexus and subclavian artery?

Answer 10

3rd part lies anterior to trunks of brachial plexus;

Question 11

Branches of 1st part?

Answer 11

Vertebral artery
Tyrocervical trunk
Internal thoracic artery

Question 12

Course of vertebral artery?

Answer 12

Branch of 1st part of subclavian
Ascends in neck as cervical part to enter foramen transversarium of C6 & ascends through C1 to C6 as vertebral part
Exits foramen transversarium crossing over posterior tubercle of C1 & travels medially to foramen magnum to eventually become basilar artery (joins vertebral artery from the opposite side)
Vertebral artery

Question 13

Course and branches of the thyrocervical trunk?

Terminal branches?

Answer 13

Branch of 1st part of subclavian
Thyrocervical trunk ascends to give off:
• Inferior thyroid artery (largest, to thyroid & gives off ascending cervical artery to prevertebral muscles & spinal cord)
• Transverse cervical artery (anterior to anterior scalene & gives superficial branch to trapezius & deep branch to rhomboids & scapula)
• Suprascapular artery (anterior to anterior scalene, supplies supraspinatus fossa)

Terminal branches:
• Inferior thyroid artery
• Ascending cervical artery

Course: Thyrocervical trunk ascends to give off inferior thyroid artery (‘primary visceral artery of the neck’ supplying larynx, trachea, oesophagus, thyroid & parathyroid glands & adjacent muscles

Question 14

Course of the internal thoracic artery>

Answer 14

Branch of 1st part of subclavian
Internal thoracic artery
DESCEND inferomedially posterior to the clavicle into the thoracic cavity to the 6th intercostal space & gives rise to anterior intercostal arteries that supply the intercostal spaces

Question 15

Branches of thyrocervical

Answer 15

• Inferior thyroid artery
• Transverse cervical artery
• Suprascapular artery

Question 16

Branches of the 2nd part of the subclavian?

Answer 16

2nd part of Subclavian gives costocervical trunk

Costocervical trunk ascends posteromedially & divides into:
• SUPREME INTERCOSTAL ARERY (to rib 1 as posterior intercostal arteries to 1st & 2nd intercostal spaces)
• DEEP CERVICAL ARTERY (ascends superiorly to back of neck to supply deep cervical muscles & to anastomose with occipital artery from ECA)

Question 17

What is the branch from the 3rd part of the subclavian artery?

Answer 17

Dorsal scapular artery (maybe lol)

Question 18

Order of subclavavian artery, vein and anterior scalene muscle on first rib?

Answer 18

Medial + anterior
Vein
Muscle 
Artery
Lateral + posteiror

Question 19

One tributary into subclavian vein…

Answer 19

EJV

Question 20

What vessels join to form the brachiocephalic vein?

Note: Where do the inferior thyroid veins drain into?

Subclavian enters the subclavian vein, what branches drain into it just before joining subclavian?

Answer 20

Subclavian and internal jugular vein

Inferior thyroid vein drain directly into BRACHIOCEPHALIC (not subclavian)

Anterior jugular, suprascapular and transverse cervical drain into external jugular vein, prior to its drainage into subclavian

Question 21

Where does the thoracic duct drain into?

Answer 21

Between the left internal jugular vein and the left subclavian vein.

Note: On RHS there is a right lymphatic duct entering the same venous area

Question 22

Other name for sympathetic trunk….

Answer 22

Thoracolumbar outflow i.e. fight or flight

Question 23

LSD pheumonic for sympathetics..

Answer 23

Long ciliary nerve
Sympathetics
Dilatation

Question 24

Physiological response of sympathetic innervation?

Answer 24

Dilates pupils, increases heart & respiratory rates, increases blood pressure & blood
glucose levels, dilates lung bronchioles, induces sweating

Question 25

Pre/post ganglionic fibres of sympathetic trunk?

Answer 25

Preganglionic sympathetic neurons arise from lateral horns of T1-L2
Preganglionic fibres synapse in ganglia
Postganglinic fibres leave via gray rami towards anterior rami (no white rami in
cervical region)

Question 26

Relations to cervical part of sympathetic trunk?

Answer 26

Cervical part is anterior to longus capitus & longus colli muscles & posterior to ICA & CCA

Question 27

level of 3 cervical ganglion?

Answer 27

Superior cervical ganglion at C1/C2 Middle cervical ganglion at C6 Inferior cervical ganglion at C7

NOTE: Inferior cervical ganglion fuses with 1st thoracic ganglion to form cervicothoracic ganglion (stellate ganglion) in 80% of people

Question 28

Superior cervical ganglion supplies branches via:

Answer 28

• ICA & ECA (forming plexuses)
• Cervical spinal nerves (C1-C4, cervical plexus)
• Pharynx
• Superior cardiac nerves

Question 29

MIddle cervical ganglion supplies branches via:

Answer 29

• Cervical spinal nerves (C5, C6)

* Middle cardiac nerves

Question 30

Inferior cervical ganglion supplies branches via:

Answer 30

• Vertebral artery (forming a plexus)
• Cervical spinal nerves (C7-T1; C7 & C8 to brachial plexus)
• Inferior cardiac nerves

Question 31

Cervical ganglia regulate sympathetic innervation of?

Answer 31

Eyes (pupil dilation), eyelids, lacrimal glands, carotid body, salivary glands, sweat glands

Question 32

Presentation and justification of horner’s syndrome?

Answer 32

1. Constriction of pupil (miosis) because parasympathetically stimulated sphincter of pupil (sphincter pupillae) is unopposed
2. Drooping of superior eyelid (ptosis) resulting from paralysis of the smooth muscle component (also termed as the superior tarsal muscle) of levator palpebrae superioris
3. Vasodilation & absence of sweating on face/neck (flushed face & anhydrosis) caused by lack of sympathetic (vasoconstrictive) nerve supply to blood vessels & sweat glands

Question 33

Why does horners present with pupil constriction?

Answer 33

Sympathetic supply has been lost from the long ciliary nerve.
PS supply only so sphincter pupillae is unopposed

Question 34

Why is their ptosis in horner’s syndrome?

Answer 34

Paralysis of the smooth muscle componest (i.e. superior tarsal muscle) of levator palpebrae

Question 35

Why is there vasodilation and anhydrosis in horner’s syndrome?

Answer 35

Lack of sympathetic nerve supply (vasoconstrictive) to blood vessels and sweat glands)