Anatomy and physiology of the neck Flashcards
Anatomical contents of the neck…
Arteries, veins, nerves, lymphs, lymphatic channels, thyroid gland, parathyroid gland, muscles, trachea
4 boundaries of the neck
superior - mandible
inferior - clavicle
posterior - trapezius
anterior - anterior midline
Anterior triangle boundaries
midline of neck to anterior border of SCM
Posterior triangle boundaries
posterior border of SCM to anterior border of trapezius
Contents of anterior triangle
common carotid artery, ECA, ICA
IJV, facial vein
hypoglossal, accessory, laryngeal, vagus, glossopharyngeal
submandibular and submental nodes
Contents of posterior triangle
occipital artery
EJV
accessory nerve, cervical nerve plexus
lymph nodes
What does the accessory nerve supply?
SCM and trapezius
What level does the common carotid artery bifurcate and which artery goes on to give off branches in the neck?
C4
external carotid artery
ECA branches
superior thyroid, maxilla, occipital, lingual, frontal, superficial temporal, facial, ascending pharyngeal, posterior pharyngeal
indications for a central line
monitor central venous pressure IV nutrition drug administration cardiac pacing blood samples haemodialysis
Complications of a central line
pneumothorax
chylothorax, haematoma, sepsis, air embolism, thrombosis, cardiac tamponade
Where do the lymph nodes from the head and neck drain?
cisterna chyli –> thoracic duct on the left
7 levels of lymph nodes
1 - submental and submandibular
2,3,4 - SCM in thirds
5 posterior triangle
6,7 - midline - important for thoracic cancer
Groups of lymph nodes and what they drain
parotid - scalp, face, parotid duct
submental - lips, floor of mouth
submandibular - tongue, nose, oral cavity, paranasal sinus, sub mandibular gland
occipital - scalp
superficial cervical - breast and solid viscera
deep cervical - final drainage pathway to thoracic duct
supraclavicular - breast, oesophagus, solid viscera
3 broad categories leading to lymphadenopathy
infective, inflammatory, malignant
What does the thyroid gland produce?
calcitonin and thyroid hormone
Calcitonin function
lower calcium, raise phosphate
Thyroglossal cyst
remnant of the thyroglossal duct dilated which moves on tongue protrusion in the midline which grows with age and may become infected
USS and removal
3 broad reasons for a thyroid mass
solitary nodule
multinodular goitre
diffuse enlargement
Reasons for a solitary nodule
cyst, adenoma, carcinoma, lymphoma, prominent nodule in multinodular goitre
Solitary thyroid nodule epidemiology
Female, 30-40, 50% malignant of young
How are solitary thyroid nodules investigated?
FNAC, USS
thyroid lobectomy
Why is a biopsy needed after FNAC?
cannot tell follicular adenoma and carcinoma apart
4 types of thyroid cancer - modes of spread, epidemiology
papillary - lymphatic metastasis
follicular - haematogenous metastasis
medullary - 10% familial, parafollicular C cells
Anaplastic - aggressive, local spread, very old, poor prognosis
3 reasons for diffuse thyroid enlargement
colloid goitre
Grave’s disease
thyroiditis
Colloid goitre - explain
due to gland hyperplasia
iodine deficiency
puberty, pregnancy, lactation
dysphagia and difficulty breathing
Graves disease - results in hyperthyroidism or hypothyroidism?
hyperthyroidism
Graves disease signs, Male or female predominant?
female
thyroid eye disease
acropachy, clubbing
pre-tibial myxoedema
Treatment for grave’s disease
anti-thyroids, beta blockade, radio iodine and surgery
Indications for thyroidectomy
airway obstruction, malignancy, thyrotoxicosis, comesis, retrosternal extension
Thyroidectomy complications
voice hoarseness, infection, scar, hypo (para) thyroidism, thyroid storm, bleeding
multinodular goitre - due to…?
graves disease or toxic goitre
How to distinguish grave’s disease and toxic goitre
Graves: female, middle aged, hyperthyroid
Toxic: old, no eye signs, atrial fibrillation
How to investigate multinodular goitre
thyroid function test, FNAC, CXR
Parathyroid glands
4 - posterior poles of thyroid
Regulate calcium and phosphate
injured in surgery - hypocalcaemia
Parathyroid disease - 4 symptoms
painful stones - renal calculi
psychic moans - anxiety, paranoia, pain
aching bones - fractures, osteoporosis
abdominal groans - pain, pancreatitis
Parathyroid disease investigations
creatine, U +E, calcium, phosphate, parathyroid hormone, bicarbonate
Vitamin D
USS, CT/MRI, isotope scanning
Surgery for hyperparathyroid or hypoparathyroid?
hyperparathyroid
3 causes of hyperparathyroid
cancer, hyperplasia, adenoma
Reasons for tracheostomy
airway obstruction, protection or poor ventilation
Tracheostomy needs
long term care, humidification, suctioning
Breath cycle stridor and location of blockage
inspiratory - laryngeal
expiratory - tracheobronchial
biphasic - glottis
Treatment for airway obstruction
nebulised adrenaline
Oxygen
IV dexamethasone
2 reasons for branchial cyst
remnant of fusion failure of branchial arteries
lymph node cystic degeneration
Branchial cyst - location, treatment
anterior to SCM and junction of upper and middle thirds
transilluminates and becomes infected - excised
Pharyngeal pouch
Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of inferior constrictor of the pharynx
Symptoms of pharyngeal pouch
regurgitation - old, undigested food
voice hoarseness, dysphagia, aspiration pneumonia, neoplasia and weight loss
Investigation and treatment - pharyngeal pouch
barium swallow
excised - endoscopic or open
dilate
