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ACEM Primary Written > Anaesthetics: Anatomy - Neck > Flashcards

Anaesthetics: Anatomy - Neck Flashcards

1
Q

What is unique about the hyoid bone?

A

Does not articulate with any other bone

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2
Q

What is the usual mechanism of hyoid fracture?

A

Strangulation

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3
Q

What is the function of the hyoid?

A

Provides attachment for anterior neck muscles
Holds airway open

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4
Q

What is a possible complication of hyoid fracture?

A

Difficulty maintaining separation of respiratory and alimentary tracts when swallowing, leading to increased risk of aspiration pneumonia

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5
Q

What is the vertebral level of the hard palate?

A

C1

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6
Q

What is the vertebral level of the lower border of the mandible?

A

C2-3

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7
Q

What is the vertebral level of the hyoid?

A

C3

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8
Q

What is the vertebral level of the cricoid?

A

C6

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9
Q

Six contents of the superficial cervical fascia

A
  1. Cutaneous nerves
  2. Bloods vessels
  3. Lymphatic vessels
  4. Superficial lymph nodes
  5. Fat
  6. Platysma
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10
Q

What are the three layers of the deep cervical fascia, from superficial to deep?

A
  1. Investing layer
  2. Pretracheal fascia
  3. Prevertebral fascia
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11
Q

What is the embryological origin of the platysma?

A

Arises from mesenchyme in the 2nd pharyngeal arch

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12
Q

Where does the platysma arise and insert?

A

Fibres arise from deep fascia of upper parts of pectoralis major and deltoid, and run to inferior border of mandible
Diverge inferior to chin, leaving gap anterior to larynx and trachea

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13
Q

Which neurovascular structures are deep to the platysma in the superficial cervical fascia?

A

Main cutaneous nerves
External and anterior jugular

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14
Q

Describe the course of anterior jugular vein

A

Commences beneath the chin, continues down to suprasternal region then pierces deep fascia and lies in suprasternal space (often connected by short anastomotic vein)

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15
Q

Describe the motor and sensory nerve supply of the platysma

A

Motor supply from cervical branch of facial nerve
Sensory (proprioceptive) fibres run with transverse cervical nerve

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16
Q

What are the actions of the platysma?

A

Muscle of facial expression (tension, stress)
May help open mouth

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17
Q

What is the clinical presentation of platysma muscle paralysis?

A

Due to palsy of cervical branch of facial nerve
Skin falls away from neck in slack folds

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18
Q

Where does the investing layer of the deep cervical fascia split and why?

A

Splits at all four corners into superficial and deep layers to enclose sternocleidomastoid (anterolaterally) and trapezius (posterolaterally)

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19
Q

Six superior attachments of the investing layer of the deep cervical fascia

A
  1. Superior nuchal line of occipital bone
  2. Mastoid processes
  3. Zygomatic arches
  4. Inferior border of mandible
  5. Hyoid bone
  6. Spinous processes of cervical vertebrae
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20
Q

Three inferior attachments of the investing layer of the deep cervical fascia

A
  1. Manubrium
  2. Clavicles
  3. Acromions and spines of scapulae
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21
Q

Where does the investing layer of the deep cervical fascia split? What extensions does it have?

A

Inferior to mandible to enclose submandibular gland
Posterior to mandible to enclose parotid gland
Superior to manubrium to enclose sternocleidomastoid (forms suprasternal space)

Extends as stylomandibular ligament

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22
Q

How is the suprasternal space formed and what does it contain?

A

Between layers of the investing layer of deep cervical fascia as it splits to enclose sternocleidomastoid: superficial layer attaches to anterior manubrium, deep layer to posterior manubrium, forming suprasternal space

Contains anterior jugular veins, jugular venous arch, fat, and few deep lymph nodes

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23
Q

What are the two parts of the pretracheal fascia and what does each enclose?

A

Muscular part: encloses infrahyoid muscles (sternothyroid, sternohyoid, omohyoid)
Visceral part: encloses thyroid gland, trachea, oesophagus

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24
Q

What is the visceral part of the pretracheal fascia continuous with?

A

Superiorly and posteriorly with buccopharyngeal fascia

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25
Q

How does the omohyoid suspend the hyoid?

A

Intermediate tendon passes through a thickening of the pretracheal fascia superior to the hyoid, forming a pulley and suspending the hyoid

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26
Q

What happens to the pretracheal fascia at its lateral and inferior borders?

A

Laterally blends with fibres of the carotid sheath
Inferiorly passes behind brachiocephalic veins and is continuous with fibrous pericardium

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27
Q

What is enclosed within the prevertebral fascia?

A

Vertebral column and associated muscles:
- Longus coli and longus capitis anteriorly
- Scalenes laterally
- Deep cervical muscles posteriorly

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28
Q

Describe the boundaries of the pretracheal fascia

A

Fixed to cranial base superiorly
Blends with endothoracic fascia and anteriorly longitudinal ligament (at approx T3) inferiorly
Extends laterally as axillary sheath

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29
Q

What structures are embedded in the prevertebral fascia?

A

Cervical parts of sympathetic trunks

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30
Q

What part of the subclavian artery lies deep to the prevertebral fascia?

A

Third part

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31
Q

Which nerves pierce the prevertebral fascia?

A

Cutaneous branches of cervical plexus:
- Greater auricular
- Lesser occipital
- Transverse cervical
- Supraclavicular

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32
Q

Where does the carotid sheath run?

A

Between cranial base to root of neck
Blends anteriorly with investing layer and pretracheal fascia, and posteriorly with prevertebral fascia

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33
Q

Contents of the carotid sheath

A

I C 10 CC’s in the IV:
- Internal Carotid
- CN 10 (vagus)
- Common Carotid
- Internal jugular Vein
- Some deep cervical lymph nodes
- Carotid sinus nerve
- Sympathetic nerve fibres (carotid peri-arterial plexuses)

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34
Q

What is the retropharyngeal space?

A

Potential space between superior part of the prevertebral fascia and the buccopharyngeal fascia
Further subdivided by alar fascia, which is attached along the midline of the buccopharyngeal fascia from cranium to C7, then extends laterally to terminate in the carotid sheath

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35
Q

What is the function of the retropharyngeal space?

A

Permits movement of viscera (pharynx, larynx, oesophagus, trachea) relative to vertebral column with swallowing

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36
Q

What is the retropharyngeal space continuous with and what is the clinical significance of this?

A

Continuous inferiorly with superior mediastinum
Retropharyngeal space infection can extend into superior mediastinum

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37
Q

How can infections in the head and neck extend into the mediastinum?

A

Posterior mediastinum: from head tracks down posterior to oesophagus
Anterior mediastinum: from head tracks down anterior to trachea, or if infection from neck enters space between investing layer and visceral part of the pretracheal fascia

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38
Q

Can infection between the investing layer and muscular part of the pretracheal fascia spread into the mediastinum?

A

No, cannot spread beyond superior border of manubrium (unless perforates into visceral part of pretracheal fascia)

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39
Q

Attachments, innervation and actions of platysma

A

Superior attachment: inferior mandible, skin and subcut tissue of lower face
Inferior attachment: deep fascia of upper parts of pec major and deltoids
Innervation: cervical branch of CN VII
Actions: facial expression

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40
Q

Three cutaneous/superficial muscles of the neck

A
  1. Platysma
  2. Sternocleidomastoid
  3. Trapezius
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41
Q

Four suprahyoid muscles from superficial to deep

A
  1. Digastric
  2. Stylohyoid
  3. Mylohyoid
  4. Geniohyoid
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42
Q

Four infrahyoid muscles from superficial to deep

A
  1. Sternohyoid
  2. Omohyoid
  3. Sternothyroid
  4. Thyrohyoid
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43
Q

Attachments, innervation and actions of sternocleidomastoid

A

Superior attachment: mastoid process and lateral superior nuchal line
Inferior attachment: sternal head to manubrium, clavicular head to medial 1/3 of clavicle
Innervation: CN XI (motor), C3-4 (pain, proprioception)
Actions: unilateral does lateral neck flexion with head turned to opposite side, bilateral does neck flexion at atlanto-occipital joint as well as chin-to-chest action and chin protrusion, also assists respiration

44
Q

Attachments, innervation and actions of trapezius

A

Medial attachments: medial superior nuchal line, occipital protuberance, nuchal ligament, C7-T12 and lumbosacral spinous processes
Lateral attachments: lateral 1/3 of clavicles, acromion and spine of scapulae
Innervation: CN XI (motor), C3-4 (pain, proprioception)
Actions: descending fibres elevate scapulae, transverse fibres retract scapulae, ascending fibres depress scapulae, assists movement of neck when shoulders fixed

45
Q

Attachments, innervation and actions of digastric

A

Origin: anterior belly from digastric fossa of mandible, posterior belly from mastoid notch on temporal bone
Insertion: intermediate tendon to body of hyoid
Innervation: anterior belly by nerve to mylohyoid, posterior belly by digastric branch of CN VII
Actions: elevates hyoid during swallowing and speaking

46
Q

Attachments, innervation and actions of stylohyoid

A

Origin: styloid process of temporal bone
Insertion: body of hyoid
Innervation: stylohyoid branch of CN VII
Actions: elevates hyoid

47
Q

Attachments, innervation and actions of mylohyoid

A

Origin: mylohyloid line on mandible
Insertion: mylohyoid raphe and body of hyoid
Innervation: nerve to mylohyoid (from inferior alveolar branch of CN V3)
Actions: elevates hyoid, floor of mouth and tongue whilst swallowing and speaking

48
Q

Attachments, innervation and actions of geniohyoid

A

Origin: inferior mental spine of mandible
Insertion: body of hyoid
Innervation: C1 via CN XII
Actions: widens pharynx, shortens floor of mouth

49
Q

Attachments, innervation and actions of omohyoid

A

Origin: superior scapula
Insertion: inferior hyoid
Innervation: C1-3 via ansa cervicalis
Actions: depresses hyoid

50
Q

Attachments, innervation and actions of sternohyoid

A

Origin: manubrium, medial clavicle
Insertion: body of hyoid
Innervation: C1-3 via ansa cervicalis
Actions: depresses hyoid

51
Q

Attachments, innervation and actions of sternothyroid

A

Origin: posterior manubrium
Insertion: oblique line of thyroid cartilage
Innervation: C2-3 via ansa cervicalis
Actions: depresses hyoid and larynx

52
Q

Attachments, innervation and actions of thyrohyoid

A

Origin: oblique line of thyroid cartilage
Insertion: inferior hyoid
Innervation: C1 via CN XII
Actions: depresses hyoid and elevates larynx

53
Q

What structure runs through the sternocleidomastoid?

A

CN XI runs through muscle

54
Q

The sternocleidomastoid is crossed superficially by which three structures?

A

Crossed superficially by (from superior to inferior): great auricular nerve, external jugular vein, transverse cervical nerve

55
Q

What structure lies deep to the upper half of the sternocleidomastoid?

A

Cervical plexus

56
Q

What structure lies deep to the lower part of the sternocleidomastoid, overlying the anterior scalene?

A

Carotid sheath

57
Q

What is the arterial blood supply of the sternocleidomastoid?

A

Occipital and superior thyroid arteries

58
Q

What nerve innervates the sternocleidomastoid?

A

Spinal part of CN XI (C2-3)

59
Q

What forms the borders of the lesser supraclavicular fossa?

A

Two heads of the sternocleidomastoid

60
Q

What structure separates the neck into anterior and lateral regions?

A

Sternocleidomastoid

61
Q

What are the four sub-triangles of the anterior triangle?

A
  1. Submandibular (digastric) triangle
  2. Submental triangle
  3. Carotid triangle
  4. Muscular (omotracheal) triangle
62
Q

What forms the floor of the anterior triangle?

A

Pharynx
Larynx
Thyroid gland

63
Q

What forms the roof of the anterior triangle?

A

Subcutaneous tissue including platysma

64
Q

What forms the borders of the carotid triangle?

A

Superior: posterior belly of digastric, stylohyoid
Medial: superior belly of the omohyoid
Inferolateral: anterior border of the sternocleidomastoid

65
Q

What are the seven contents of the carotid triangle?

A
  1. Carotid sheath and its contents:
    - Common carotid artery (and bifurcation into internal and external carotids)
    - Internal jugular vein
    - CN X
    - Cervical lymph nodes
    - Sympathetic nerve fibres (carotid peri-arterial plexuses)
    - Carotid sinus nerve)
  2. CN XI
  3. CN XII
  4. Superior root of ansa cervicalis
  5. Thyroid gland
  6. Larynx
  7. Pharynx
66
Q

What forms the apex of the anterior triangle?

A

Jugular notch

67
Q

What forms the borders of the submental triangle?

A

Lateral: anterior belly of the digastric
Medial: midline
Inferior: hyoid bone

68
Q

What forms the borders of the submandibular (digastric) triangle?

A

Superior: inferior border of the mandible
Medial: anterior belly of the digastric
Inferolateral: stylohyoid, posterior belly of the digastric

69
Q

What forms the borders of the muscular (omotracheal) triangle?

A

Superior: hyoid, posterior belly of digastric
Medial: midline
Lateral: superior belly of omohyoid
Inferior: anterior border of sternocleidomastoid

70
Q

What are the two contents of the submental triangle?

A
  1. Submental lymph nodes
  2. Small veins (unite to form anterior jugular)
71
Q

What are the four contents of the muscular triangle?

A
  1. Sternohyoid
  2. Sternothyroid
  3. Thyroid gland
  4. Parathyroid glands
72
Q

What are the five contents of the submandibular (digastric) triangle?

A
  1. Submandibular gland (takes up most of the triangle)
  2. Submandibular lymph nodes
  3. CN XII
  4. Mylohyoid nerve (branch of CN V3)
  5. Parts of facial artery and vein
73
Q

What are the borders of the posterior triangle?

A

Anterior: posterior border of sternocleidomastoid
Posterior: anterior border of trapezius
Inferior: middle 1/3 of clavicle
Apex: superior nuchal line

74
Q

What are the two sub-triangles of the posterior triangle?

A
  1. Occipital triangle
  2. Omoclavicular (subclavian) triangle
75
Q

What forms the roof of the posterior triangle?

A

Investing layer of the cervical fascia

76
Q

What forms the floor of the posterior triangle?

A

Prevertebral muscles:
- Splenius capitis
- Levator scapulae
- Middle scalene
- Posterior scalene

77
Q

What structure separates the occipital and omoclavicular triangles?

A

Inferior belly of the omohyoid

78
Q

What are the borders of the occipital triangle?

A

Anterosuperior: posterior border of sternocleidomastoid
Anteroinferior: inferior belly of omohyoid
Inferior: middle 1/3 of clavicle
Posterior: anterior border of trapezius
Apex: superior nuchal line

79
Q

What are the seven contents of the occipital triangle?

A
  1. Part of external jugular vein
  2. Posterior branches of cervical plexus
  3. CN XI
  4. Trunks of brachial plexus
  5. Cervicodorsal trunk (transverse cervical artery)
  6. Superficial and deep cervical lymph nodes
  7. Occipital and superficial cervical arteries
80
Q

What are the borders of omoclavicular (subclavian) triangle?

A

Posterior: inferior belly of omohyoid
Anterior: posterior border of sternocleidomastoid
Inferior: middle 1/3 of clavicle

81
Q

What are the three contents of the omoclavicular (subclavian) artery?

A
  1. Third part of subclavian artery (+/- vein)
  2. Suprascapular artery and vein
  3. Supraclavicular lymph nodes
82
Q

What are the two contents of the posterior cervical region?

A
  1. Trapezius
  2. Cutaneous branches of posterior rami of cervical spine nerves
83
Q

What the five tributaries of the internal jugular vein? What vein is sometimes a sixth tributary?

A
  1. Sigmoid sinus
  2. Inferior petrosal sinus
  3. Facial and lingual veins
  4. Pharyngeal veins
  5. Superior and middle thyroid veins
    (6. Occipital vein - usually drains to suboccipital venous plexus but may drain to internal jugular vein)
84
Q

Describe the course of the external jugular vein

A

Descends in posterior triangle
Begins at angle of mandible from union of posterior division of retromandibular vein and posterior auricular vein
Crosses sternocleidomastoid obliquely
Pierces investing layer of deep cervical fascia at posterior border of sternocleidomastoid
Enters subclavian vein

85
Q

Describe the surface anatomy of the internal, external, and anterior jugular veins

A

Internal: runs from earlobe to sternoclavicular joint
External: runs from earlobe to mid-point of clavicle
Anterior: runs from below chin under platysma

86
Q

Where are the superior and inferior bulbs of the internal jugular?

A

Superior bulb after vein emerges from jugular foramen
Inferior bulb before vein enters the right subclavian

87
Q

What landmarks correspond to the level of the carotid bifurcation?

A

Superior border of thyroid
Vertebral level C3/4

88
Q

Describe the location of the carotid sinus and carotid bodies

A

Carotid sinus (baroreceptor): proximal part of internal carotid artery
Carotid bodies (chemoreceptor): lie between internal and external carotid arteries

89
Q

What are the branches of the internal carotid in the neck?

A

No named branches in the neck

90
Q

What part of the external cranium is not suppled by branches of the external carotid?

A

Orbit and part of the forehead and scalp supplied by supraorbital artery (branch of ophthalmic artery from the internal carotid artery)

91
Q

Describe the course of the external carotid

A

Runs posteromedially between mandible and earlobe before being embedded in the parotid gland and terminating upon division into maxillary artery and superficial temporal artery

92
Q

Name the branches of the external carotid, in ascending order

A

Some Anaesthetists Like Fun, Others Prefer S&M:
1. Superior thyroid
2. Ascending pharyngeal
3. Lingual
4. Facial
5. Occipital
6. Posterior auricular
7. Superficial temporal
8. Maxillary

93
Q

What are the anterior, medial, and posterior branches of the external carotid?

A

1 medial, 2 posterior and 3 anterior
Medial: ascending pharyngeal
Posterior: occipital, posterior auricular
Anterior: superior thyroid, lingual, facial

94
Q

Describe the course of the superior thyroid artery. Which structures does it supply?

A

Runs deep to infrahyoid muscles and extends to thyroid
Supplies: superior thyroid, infrahyoid muscles, sternocleidomastoid, larynx via the superior laryngeal branch

95
Q

Describe the course of the ascending pharyngeal artery. Which structures does it supply?

A

Ascends on pharynx medial (deep) to internal carotid
Supplies: pharynx, prevertebral muscles, middle ear, cranial meninges

96
Q

Describe the course of the lingual artery. What structures does it supply?

A

Arches superoanteriorly, deep to CN XII and posterior belly of digastric
Supplies: tongue

97
Q

Describe the course of the facial artery. What branches does it give off and what structures does it supply?

A

Gives off palatine and tonsillar branches, then passes superiorly under digastric and stylohyoid, and then angle of mandible, before giving off submental artery
Supplies: submandibular gland, floor of mouth via submental artery, most facial muscles

98
Q

Describe the course of the occipital nerve. What structures does it supply?

A

Passes behind posterior belly of digastric in occipital groove of temporal bone, before terminating in many branches in the scalp
Supplies: posterior scalp

99
Q

What structures are supplied by the posterior auricular artery?

A

Supplies: parotid gland, facial nerve, auricle, nearby scalp and muscles

100
Q

How long is the thyroid?

A

5cm

101
Q

Across what vertebral levels does thyroid extend? What tracheal ring does it extend to?

A

C5-T1
To 6th tracheal ring

102
Q

Describe the arterial supply of the thyroid

A

Superior thyroid arteries supply superior poles
Inferior thyroid arteries supply inferior poles and all parathyroid glands
Many anastomoses between the arteries)

103
Q

Describe the course of the superior thyroid artery

A

Arises from external carotid artery
Pierces pretracheal fascia
Divides into anterior and posterior branches

104
Q

Describe the course of the inferior thyroid artery

A

Arises from thyrocervical trunks (off subclavian) with many branches

105
Q

Why can hoarseness be a complication of thyroidectomy?

A

Recurrent laryngeal nerve (particularly on the right) is intimately related to thyroid and therefore at risk of injury during thyroidectomy

106
Q

Describe the venous supply of the thyroid

A

Superior, middle and inferior thyroid veins from the thyroid venous plexus

107
Q

Where do the superior, middle, and inferior thyroid veins drain?

A

Superior and middle drain to internal jugular vein
Inferior drains to brachiocephalic vein

ACEM Primary Written (150 decks)

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