Anatomy and Physiology of the neck Flashcards
What are the boundaries of the neck?
- Superior - mandible
- Anterior – anterior midline
- Inferior - Clavicle
- Posterior - Trapezius
What are the boundaries of the anterior triangle of the neck?
o Anterior: midline of the neck
o Posterior: anterior border of sternocleidomastoid
What are the boundaries of the posterior triangle of the neck?
o Anterior: posterior border of sternocleidomastoid
o Posterior: anterior border of trapezius
List the contents of the anterior triangle of the neck
- Common carotid artery
- Internal carotid artery
- External carotid artery
- Internal jugular vein
- Facial artery
- Facial vein
- Hypoglossal nerves
- Accessory nerves
- Vagus nerves
- Laryngeal nerves
- Glossopharyngeal nerves
- Submandibular nodes
- Submental nodes
List the contents of the posterior triangle of the neck
- Accessory nerve
- Cervical nerve plexus
- Occipital artery
- External jugular vein
- Lymph nodes
At what vertebral level does the common carotid artery split into the ICA and ECA?
C4
Which branch of the common carotid artery continues to branch, and what into?
External carotid artery is the only artery with branches in the neck: o Superior thyroid o Ascending pharyngeal o Lingual o Occipital o Facial o Posterior auricular o Maxillary o Superficial temporal
When are central lines indicated?
o Central venous pressure o Fluid resuscitation o Drug administration o Haemodialysis o Cardiac pacing o Intravenous nutrition o Blood sampling
What are some complications associated with central lines?
o Pneumothorax o Air embolism o Thrombosis o Haematoma o Chylothorax o Sepsis o Cardiac tamponade o False passage o Line blockage
How are central lines inserted?
Catheters can be placed in veins in the neck (internal jugular vein), chest (subclavian vein or axillary vein), groin (femoral vein), or through veins in the arms (also known as a PICC line, or peripherally inserted central catheters, in cephalic or basilic veins).
Where do the lymph nodes of the head and neck drain into?
- Drain to cisterna chyli
* Then drain to thoracic duct on left
What do each group of lymph nodes in the head and neck drain?
Parotid nodes - scalp, face & parotid gland
Occipital nodes - scalp
Superficial cervical nodes - breast & solid viscera
Deep cervical nodes - final drainage pathway to thoracic duct
Submandibular nodes - tongue, nose, paranasal sinuses, submandibular gland, oral cavity
Submental nodes - lips, floor of mouth
Supraclavicular nodes - breast, oesophagus, solid viscera
What can cause lymphadenopathy?
- Infection
- Inflammation
- Malignancy
Describe the structure and function of the thyroid gland
- Endocrine gland
- 2 lobes, “butterfly gland” joined by isthmus
- Produce thyroid hormones and calcitonin
- Calcitonin acts to lower calcium and raise phosphate. High levels of calcitonin can suggest thyroid cancers so levels are monitored during treatment
Why does the thyroid gland move when you swallow?
Moves with swallowing as its attached to the laryngeal framework – if a lump moves with swallowing it can indicate its involved with the thyroid gland
Why must an ultrasound be carried out before surgical removal of a thyroglossal cyst?
Need ultrasound scan prior to removal to ensure functioning thyroid tissue elsewhere
What are some symptoms of neck lumps?
- Pain/odynophagia (pain when swallowing)
- Stridor or SOB
- Dysphagia
- Weight loss
What can cause diffuse thyroid enlargement?
Colloid goitre: benign, noncancerous enlargement of thyroid tissue. Although they may grow large, and there may be more than one, they are not malignant and they will not spread beyond the thyroid gland.
o Due to gland hyperplasia (hyperthyroidism)
o Iodine deficiency (hypothyroidism)
o Puberty, pregnancy, lactation
Grave’s disease – AI disease that affects thyroid gland, can commonly cause hyperthyroidism
Thyroiditis
When is thyroid removal indicated?
- Suspicion of cancer
- Unsightly
- Distressing symptoms – odynophagia, dysphagia, stridor, SOB
- Causes retrosternal goiter and Pemberton’s sign
What is Pembertons sign?
Pemberton maneuver is a physical examination tool used to demonstrate the presence of latent pressure in the thoracic inlet. The maneuver is achieved by having the patient elevate both arms until they touch the sides of the face. A positive Pemberton’s sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minute
When is a thyroidectomy indicated?
o Airway obstruction o Malignancy or suspected malignancy o Thyrotoxicosis o Cosmesis o Retrosternal extension
What are some complications associated with thyroidectomies?
o Bleeding-primary or secondary o Voice hoarseness o Thyroid storm o Infection o Hypoparathyroidism o Hypothyroidism o Scar (keloid/ hypertrophic)
What can cause multi-nodular goitre?
Grave’s disease or toxic goitre (thyrotoxicosis)
What are the clinical features of graves disease?
- F>M
- Auto-antibodies against thyroid-stimulating hormone receptor stimulate receptor
- Hyperthyroidism occurs as a result, and can lead to a goitre
- Thyroid eye disease, acropachy/clubbing, pre-tibial myxoedema
- Treatment: anti-thyroids, beta-blockade, radio-iodine & surgery
What are the clinical features of toxic goitre?
o Older
o No eye signs
o Atrial fibrillation
What investigations can be used to differentiate between graves disease and toxic goitre?
Thyroid function tests
FNAC
chest x-ray
What can increased calcium levels in the blood signify?
Increased calcium levels in the blood can indicate parathyroid tumours, therefore level of calcium is closely monitored
What are some symptoms of parathyroid disease?
- Painful stones
- Aching bones
- Psychic moans
- Abdominal groans
- Renal calculi, polyuria, renal failure
- Pathological fractures, osteoporosis, bone pain
- Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss
- Anxiety & depression, confusion, paranoia
What are some signs and symptoms of hypoparathyroidism?
- Muscle aches or cramps
- Tingling, burning, or numbness in the fingertips, toes, and lips
- Muscle spasms, especially around the mouth
- Patchy hair loss
- Dry skin
- Brittle nails
- Fatigue
- Anxiety or depression
What are some signs and symptoms of hyperparathyroidism?
- Fragile bones that easily fracture (osteoporosis)
- Kidney stones
- Excessive urination
- Abdominal pain
- Tiring easily or weakness
- Depression or forgetfulness
- Bone and joint pain
- Frequent complaints of illness with no apparent cause
What are some causes of hyperparathyroidism?
- Adenoma – 80% of hyperparathyroidism, single or multiple
- Hyperplasia – 12% of hyperparathyroidism. Common in secondary hyperparathyroidism due to low calcium e.g. renal failure. Calcium levels normal but phosphate levels high
- Malignancy (rare)
What are some indications for tracheostomy?
o Airway obstruction
o Airway protection
o Poor ventilation to reduce dead space
What are the different types of stridor?
o Inspiratory – laryngeal (above vocal cords) obstruction
o Expiratory – tracheobronchial (small airways) obstruction
o Biphasic – glottic/subglottic obstruction
What is a pharyngeal pouch?
- Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx
- Food can become trapped in these pouches and be seen on endoscopy
What are some symptoms of a pharyngeal pouch?
o Voice hoarseness o Regurgitation of old undigested food o Dysphagia o Weight loss o Aspiration pneumonia o Neoplasia 1%
