6. Root of neck Flashcards
Root of neck, boundaries?
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
Which vessels change name at lateral border of 1st rib?
Right subclavian artery
–>
Right axillary atery
Root of the neck leads inferiorly into…
into the superior thoracic aperture (thoracic inlet)
What is pleural cupola?
Apex of the lung in the cervical pleura (part of the root of the neck)
The cervical pleura in children & infants is more susceptible to injury, why?
The cervical pleura in children & infants is more susceptible to injury since it extends
higher due to the relatively short length of the neck
Injuries at root/base of neck can compromise the lungs & pleural sacs. leading to>
pneumothorax, haemothorax, chylothorax
What is the suprapleural membrane?
Attachments?
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
3 branches off from the aortic arch?
1: Brachiocephalic trunk (branching to right CCA & right subclavian)
2: Left common carotid artery
3: Left subclavian artery
3 parts of the subclavian artery (relative to the anterior scalene muscle)?
• 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)
Relation of brachial plexus and subclavian artery?
3rd part lies anterior to trunks of brachial plexus;
Branches of 1st part?
Vertebral artery
Tyrocervical trunk
Internal thoracic artery
Course of vertebral artery?
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
Course and branches of the thyrocervical trunk?
Terminal branches?
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
Course of the internal thoracic artery>
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
Branches of thyrocervical
- Inferior thyroid artery
- Transverse cervical artery
- Suprascapular artery
Branches of the 2nd part of the subclavian?
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)
What is the branch from the 3rd part of the subclavian artery?
Dorsal scapular artery (maybe lol)
Order of subclavavian artery, vein and anterior scalene muscle on first rib?
Medial + anterior Vein Muscle Artery Lateral + posteiror
One tributary into subclavian vein…
EJV
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?
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
Where does the thoracic duct drain into?
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
Other name for sympathetic trunk….
Thoracolumbar outflow i.e. fight or flight
LSD pheumonic for sympathetics..
Long ciliary nerve
Sympathetics
Dilatation
Physiological response of sympathetic innervation?
Dilates pupils, increases heart & respiratory rates, increases blood pressure & blood
glucose levels, dilates lung bronchioles, induces sweating
