Anatomy II test 3 Flashcards
What are the boundaries of the neck?
Sup.-cranium
Inf.- clavicles
What does the skeleton of the neck include?
Cervical vertebrae
hyoid bone
manubrium of the sternum
clavicles
What are the functions of cervical vert.?
- framework
- supporter
- container
What articulation provides flexabiltiy?
intervertebral
c3-6 typical characteristics
body=small, oval sup. surface of body=concave, inf.=convex vertebral foramen=large triangle transverse foramina for vert. artery spinous=short, bifid sup. facets=superoposterior inf. facets=inferoposterior
C1
ring-like no spinous no body two lateral masses two arches=ant. post. articulates with occipital condyles
C2
dens=superior projection, articulates with atlas
C7
spinous=long, not bifid
large transverse
small foramen
hyoid bone
“U shaped”, body, 2 great horns, 2 lesser horns
no joint
anterior in neck at C3 vert.
btw. mandible and thyroid cartilage
suspended by muscles and ligaments
What encircles the superficial structures of the neck?
skin and superficial cervical fascia
What seperates the deep structures?
deep cervical fascia
Where does infection spread in fascia?
deep cervcal fascia compartment
What muscle is contained within the superficial cervical fascia?
platysma
What is contained in the Superficial Cervical Fascia?
cutaneous nerves blood vss. lymph vss. superficial lymph nodes fat
What nerve supplies Platysma?
CN VII
sensory nn. from cervical plexus
Where does platysma m. originate?
deep fascia of
- deltoid
- pectoralis major
Where does platysma attach?
skin of inf. border of mandible bone
stess and grimace
face shaving
platysma
What parts are in deep cervical fascia? (4)
investing
pretrachial
prevertebral
carotid sheath
Why dowe need so much fascia?
- protect viscera, blood vss., nerves
- to seperate organs
- free organ movement—swallowing
- limit pus migration
What is the most superficial deep fascia?
Investing layer
What muscles does the investing layer wrap?
trapezius
SCM
What innervates the trapezius and SCM?
CN XI
Sup. attachment of investing layer
sup. nuchal line mastoid zygomatic arch inf. border of mandible hyoid
Inf. attachment of investing layer
manubrium
clavicles
acromions
spines of scapulae
post. attachment of investing layer
C7 spinous
nuchal ligament
What chape is the nuchal ligament?
triangular
What parts make up the Pretracheal layer?
muscular part
visceral part
muscular part of pretracheal covers
infrahyoid muscles
visceral part of pretracheal covers
thyroid gland
trachea
esophagus
What are the attachments of the visceral part of the deep cervical fascia?
sup.=hyoid
inf.=heart
lateral=carotid sheaths
What does the Prevertebral layer of deep cervical fascia form?
A tubular sheath for vertebral muscles around:
- vertebral colomn
- sympathetic trunk
What are the attachments of Prevertebral layer of deep cervical fascia?
Sup.=cranial base
Inf.=endothoracic fascia and ALL at T3
Lateral=axillary sheath
The carotid sheath
is like a tube
The cortid sheath communicates with (2)
Sup.=cranial cavity via blood vss. and nerves
Inf.= mediastinum of the thorax
(potential way of infection)
The carotid sheath contains (6)
- common and internal carotid aa.
- IJV
- Vagus N.
- Deep Lymph nodes
- carotid sinus n.
- sympathetic nerve fibers
The carotid sheath attachments (2)
Ant.= investing layer of deep cervical fascia
Post.=prevertebral layer of deep cervical fascia
What is the most important interfascial space in the neck?
Retropharyngeal space
What is the buccopharyngeal fascia?
the anterior superior wall of the retropharyngeal space
The anterior inferior wall of the retropharyngeal space connects with what?
prevertebral layer of deep cervical fascia
What is the retropharyngeal space’s posterior wall?
prevertebral layer of deep cervical fascia
What is closed by the cranial base?
the superior wall
The inferior of the retropharyngeal space goes through to where?
superior mediastinum
What is the small fascia insert this space?
alar fascia
Where does alar fascia begin and end?
Begin: cranium base
End: C7
What does the alar fascia stick with?
prevertebral layer of deep cervical fascia in midline
What does the alar ligament attach to laterally?
carotid sheath
What are the 5 regions of the neck?
- SCM region
- Posterior Cervical Region
- Lateral Cervical Region (Posterior Triangle)
- Anterior Cervical Region (Anterior Triangle)
- Suboccipital Region
A Region
Between the anterior border and posterior border of SCM
B Region
After the anterior border of trapeezius
C Region
Btw. post. border of SCM,
Ant. border of trapezius
and Sup. border of clavicle
D Region
BTW. Ant. border of SCM
median neck of midline
and marginal border of mandible
What can be found in the SCM Region?
- Sup. part of EJV
- SCM
- greater auricular nerve (C2,3)
- transverse cervical n.
What are the Superior attachments of the SCM?
Mastoid-temporal
superior nuchal line-occipital
Does the SCM have two heads?
YES (name and attachment)
Sternal Head-manubrium
Clavicular head-superior surface of the medial third of the clavicle
What is the lesser supraclavicular fossa?
a fossa between the heads of SCM
What encloses the SCM?
investing layer of deep cervical fascia
What joints of the SCM can move the heads?
- craniovertebral joint
2. intervertebral joint
What is the AO joint considered?
a Craniovertebral joint!
The AO joint is between the cranium and
atlas
When can the SCM perform bilateral flexion?
- If the cervical vert. is already flexed
2. if the head is extended
When can the SCM perform biltateral extension?
when the muscles fix the vertebral column well
What is the other bilateral movement of the SCM?
elevate the clavicles, manubrium and rib
helps resperation
What is the unilateral movemant of the SCM?
laterally flex and rotate to opposite side
What does the Posterior cervical region contain?
trapezius muscles
cutanious branches
What covers the posterolateral aspet of the neck and thorax?
trapezius
What does trapezius m. attach?
the pectoral girdle to the cranium and vertebral column
Trapezius innervation
CN XI spinal accessory n.
C2 and C3 nn.
Where is the cutaneous n. in the posterior cervical region from?
Post. rami of cervical spinal nn.
Ant. border of Lateral Cervical Region (Post. Triangle)
Posterior border of SCM
Post. border of Lateral Cervical Region(Post. Triangle)
Ant. border of trapezius
Inf. border of Lateral Cervical Region
Post. Triangle
middle third of clavicle
Apex of Lateral Cervical Region
Post. Triangle
SCM and Trapezius meet at the superior nuchal line
Roof of Lateral Cervical Region
Post. Triangle
investing layer of deep cervical fascia
Floor of Lateral Cervical Region
Post. Triangle
muscles covered by prevertebral layer of Deep Cervical Fascia
What divides the Lateral Cervical Region
(Post. Triangle)?
inferior belly of omohyoid
What are the contents of the Lateral Cervical Region
(Post. Triangle)?
vessels, nerves, lymph nodes
What are the two subtriangles of the Lateral Cervical Region
(Post. Triangle)?
occipital triangle
omoclvicular triangle
What appears at the apex of the occipital triangle?
occipital artery
What makes up the border of the omoclavicular triangle?
omohyoid muscle
clavicle
What are the contents of omoclavicular triangle?
inferior EJV
Subclavian artery deep
What is the floor of the Lateral Cervical Region
(Post. Triangle)?
4 muscles:
- splenius capitus
- levator scapulae
- scalenus posterior
- scalenus medius
What appears in the Lateral Cervical Region
(Post. Triangle)?sometimes?
scalenus anterior
What are the arteries of the Lateral Cervical Region
(Post. Triangle)?
Transverse cervical artery
Suprascapular a.
Occipital a.
Third part of Subclavian a.
What is the origin of the transverse cervical artery?
thyrocervical trunk (branch of subclavian)
What is the path of the Transverse Cervical A.?
lateral—2cm sup.to clavicle—-
across phrenic and ant. scalene—
across brachial plexus—
then deep to trapezius
What are the branches of the Transverse Cervical A.?
(branch, path)
superficial-spinal accesorry nerve
deep-becomes dorsal scapular artery
Where does the dorsal scapular a. go?
deep of rhomboid muscles
30% of people
dorsal scapular n. arises from transverse cervical a.
70% of people
dorsal scapular a. arises from subclavian
Where does the Suprascapular a. arise from?
thyrocervical trunk
suprascapular a.
course
inferolateral----cross brachial plexus--- cross third part of subclavian--- cord of brachial plexus--- posterior to clavicle---- supplies posterior aspect of scapula
Occipital a.
origin
External Carotid
occipital a.
course
enters apex of triangle—
goes to posterior half of scalp
third part of subclavbian
origin
2nd part of subclavian
third part of subclavian
course
lateral border of anterior scalene, one finger’s width superior to clavicle—–
posterosuperior to subclavian vein
What is inferior to the third part of subclavian a.?
first rib
Where is omoclavicular triangle?
The area we pin the subclavian a. to first rib to stop bleeding of upper limb
veins of Lateral Cervical region?
EJV
Subclavian v.
EJV
origin
angle of mandible
subclavian v.
origin
axillary vein
subclavian v
course
passes over anterior scalene m and phrenic n.—
meets IJV at medial border of anterior scalene—
forms brachiocephalic vein
What are the nerves of the Lateral Cervical Region? (7)
1.Spinal Accessory n.
2.Roots of Brachial Plexus
3.roots of cervical plexus
4. suprascapular n.
5. Phrenic n.
6.Cutaneous nn.
7.Ansa cervical n
SPARCSR
Spinal accessory nerve CN XI
course
under SCM (and supplies it)—
enters triangle at middle third of posterior border of SCM—-
over levator scapulae—
deep at anterior border of trapezius at middle inferior third of anterior border of trapezius
roots of brachial plexus
ant. rami of C5-C8 and T1 spinal n.
roots of brachial plexus
course
BTW. anterior scalene and middle scalene—
5 rami unite to form three trunks (upper, middle, lower)—
descend inferolaterally—
pass btw first rib, clavicle, and sup. border of scapula into axilla
suprascapular n.
origin
sup. turnk of brachial plexus
suprascapular n.
course
lateral across lateral cervical region to supply supra and infra spinatus
roots of cervical plexus
origin
anterior rami of C1-C4
irregular series of loops
roots of cervical plexus
course
cross over levator scapulae and middle scalene m. deep to SCM
What branches come from the roots of the cervical plexus? (3)
cutaneous branches to skin
phrenic n. to muscles
ansa cervicalis to muscles
Where do the cutaneous branches appear after branching from cervical plexus?
middle point of posterior SCM
NERVE POINT OF THE NECK
What do the cutaneous branches of the cervical plexus supply?
skin of neck
supralateral thoracic wall
scalp btw. ear and EOP
What are the four branches of cutaneous nerves?
- lesser occipital n. (C2)
- Great Auricular n. (C2,C3)
- Transverse Cervical n.(C2,C3)
- suprascapular nn. (C3,C4)
Phrenic N.
origin
C3-C5
Phrenic N.
fibers
sensory
motor
(sympathetic)
Phrenic n.
begins
thyroid level of lateral border of anterior scalene
What and where does the Phrenic n. accept fibers from?
from cervical sympathetic ganglion atthyroid level of lateral border of anterior scalene
phrenic n.
course
thyroid level of lateral border of anterior scalene—
travels with IJV—
behind transverse a. and suprascapular a.—
bhind subclavian v.—
enters thorax to supply diaphragm, mediastinal pleura and pericardium
Ansa cervical n.
supply
muscles of hyoid (inferior part)
Anterior Cervical Region (Anterior Triangle)
Anterior Boundary
median line of neck
Anterior Cervical Region (Anterior Triangle)
Posterior Boundary
Anterior Border of SCM
Anterior Cervical Region (Anterior Triangle)
Superior Boundary
inferior border of mandible
Anterior Cervical Region (Anterior Triangle)
Apex Boundary
jugular notch
Anterior Cervical Region (Anterior Triangle)
Roof Boundary
subcutaneous tissue containing platysma
Anterior Cervical Region (Anterior Triangle)
Floor Boundary
pharynx, larynx, and thyroid
Anterior Cervical Region (Anterior Triangle)
Four Divisions
Submental triangle (unpaired)
submandibular triangle (paired)
carotid (paired)
muscular (paired)
Submental Triangle
Inferior Boundary
body of hyoid
Submental Triangle
2 lateral Boundary
Left Ant. Belly of Digastric
Right Ant. Belly of Digastric
Submental Triangle
Floor Boundary
two mylohyoid muscles
two mylohyoid muscles
meeting point
median fibrous raphe
Submental Triangle
contents
several small submental lymph nodes
small veins
Submandibular triangle
anterior boundary
anterior belly of digastric
Submandibular triangle
posterior boundary
posterior belly of digastric
Submandibular triangle
lateral boundary
inferior boundry of mandible
Submandibular triangle
floor boundary
mylohyoid m.
hyoglossusm
middle constrictor muscle of pharynx
Submandibular triangle
contents
submandibular gland hypoglossal n (CNXII) submandibular lymph nodes hyoglossus m. submental a. (branch of facial)
Carotid Triangle—vascular area
anterior Boundry
superior belly of the omohyoid m
Carotid Triangle—vascular area
posterior Boundry
anterior border of SCM
Carotid Triangle—vascular area
superior Boundry
posterior belly of digastric
Muscular Triangle
anterior boundry
median line of neck
Muscular Triangle
posterior boundry
anterior border of SCM
Muscular Triangle
Superior boundry
superior belly of the omohyoid m.
Muscular Triangle
contents
infrahyoid m.
suprahyoid muscles
mylohyoid
geniohyoid
digastric
stylohyoid
What are the functions of the suprahyoid muscles?
becomes the floor
helps with swallowing (elevate hyoid and pharynx)
helps make sound
What is between the bellies of the digastric?
tendon (held in place by trochlea from pretracheal layer of DCF)
Infrahyoid muscles
thyrohyoid omohyoid sternohyoid sternothyroid TOSS
Infrahyoid muscles
functions
help swallow
help speaking
intermediate tendon
between two bellies of omohyoid
trochlea holds to clavicle
What covers the lateral lobe of the thyroid?
sternothyroid
Where does sternothyroid attach?
oblique line of thyroid cartilage
Anterior Triangle
Arteries
Common corotid
internal carotid
external carotid
Right common corotid
beginning
bifurication of brachiocephalic trunk
Left common Carotid
beginning
arch of aorta
Where does the carotid artery divide?
superior border of the thyroid cartilage
physics checking station
carotid sinus
carotid sinus
a slight dialation of the proximal part of the internal carotid artery
what type of receptor is located in the carotid sinus
baroreceptor (pressoreceptor)
What innervates the carotid sinus?
carotid sinus nerve from glossopharyngeal CN IX
Carotid body
small, oval, tissue, located in the bifurication of the common carotid artery (close to carotid sinuses)
What type of receptor is the carotid body?
chemoreceptor (O2)
The body needs more oxygen, what happens?
sensed by carotid body—increase in rate and depth of resperation and blood pressure
carotid body
innervation
carotid sinus nerve (from CN IX)
Vagus CNX
The carotid sheath covers what structures?
carotid artery
internal jugular
vagus nerve
What is located on top of the carotid sheath?
ansa cervicalis
The Internal carotid artery enters the cranium at what structure?
carotid canal
What is the main artery for the face?
External carotid artery
External carotid Artery
course
goes superior between neck of mandible and auricle—–
embedded in parotid gland—–
divides into two terminal branches
(maxillary and superficial temporal)
External Carotid Artery
branches within neck
Superior thyroid occipital ascending pharyngeal posterior auricular facial lingual
1 medial branch of ECA
ascending pharyngeal
2 posterior branches of ECA
occipital and posterior auricular
3 anterior branches of ECA
superior thyroid
lingual
facial
Ascending pharyngeal a
path
into the deep of pharynx
ascending phayngeal a
supplies
pharynx
prevertebral muscles
middle ear
cranial meninges
occipital a
path
under the posterior belly of digastric
occipital a
supplies
occipital scalp
posterior auricular a.
path
superior between the external acoustic meatus and mastoid process
posterior auricular a
supply
adjacent muscles parotid gland facial nerves auricle scalp
superior thyroid a
path
most inferior
superior thyroid a
supplies
thyroid
infrahyoid muscles
SCM
branches to send superior laryngeal to larynx
lingual a
path
goes deep to hypoglossal nerve CN XII
posterior belly of digastric
then deep to hypoglossus mm
lingual a
supplies
posterior part of tongue
facial a
path
immediate superior to lingual a—
under the posterior belly of digastric and stylohyoid m—-
under angle of mandible—-
forward to submandibular gland—-
branches submental a to floor of mouth—
turns around to face at the middle point of the inferior of the mandible
What are the veins of the anterior triangle?
tributaries of the IJV
Where does the IJV drain blood from?
brain
face
cervical viscera
deep muscles of neck
IJV
begins
jugular foramen
IJV
continued part of
sigamoid sinus
IJV
beginning part
superior bulb
IJV
accompanies
Internal Carotid Artery
Vagus N
(within carotid sheath)
Where does the IJV merge with the subclavian v.?
sternal end of the clavicle to form brachiocephalic v.
What is the end portion of the IJV known as?
inferior bulb
IJV
tributaries (7)
Inferior petrosal sinus facial v lingual v pharyngeal v superior thyroid v middle thyroid v occipital v
Facial v.
may recieve from (4)
superior thyroid v
lingual v
retromandibular v
anterior jugular
pharyngeal v.
begins
pharyngeal plexus of pharyngeal muscles
Anterior triangle
nerves (4)
Transverse cervical n (C2,3)
Hypoglossal n (CN XII)
Branches of glossopharyngeal n (CN XI)
Branches of Vagus n (CN X)
Transverse cervical nerve
supplies
skin of anterior cervical region
Hypoglossal n
type
motor
Hypoglossal n
path
between external carotid a. and IJV—-
sends out a nerve called superior root of ansa cervicalis (this nerve is truely a branch from cervical plexus)
Hypoglossal n.
supplies
all intrinsic muscles and most extrinsic muscles except one (palatoglossus)
muscles of the tongue
general
intrinsic
extrinsic
extrinsic muscles of tongue
genioglossus
hyoglossus
styloglossus
palatoglossus
intrinsic muscles of the tongue
sup. longitudinal muscle
inf. longitudinal muscle
transverse m
verticle m
What muscle does the hypoglossal nerve not innervate?
palatoglossus
Branches of glossopharyngeal
location
submandibular triangle
carotid triangle
Branches of glossopharyngeal
supplies
tongue
pharynx
branches of vagus n.
location
submandibular triangle
carotid triangle
branches of vagus n.
branches
pharyngeal
laryngeal
cardiac
deep structures of neck
2
prevertebral muscles
root of the neck
prevertebral muscles
location
posterior to the cervical viscera
anterolateral to the cervical vertebra column
root of the neck
location
cervical side of the superior thoracic aperture
What fascia covers prevertebral muscles?
prevertebral layer of DCF
prevertebral muscles
groups
anterior vertebral muscles
lateral vertebral muscles
anterior vertebral muscles
4
longus colli
longus capitus
rectus capitus anterior
anterior scalene
Where are the anterior vertebral muscles located in reference to the retropharyngeal space?
directly posterior
What structures make up the neurovascular plane?
cervical plaexus
brachial plexus
subclavian artery
Lateral Vertebral Muscles
5
rectus capitus lateralis splenius capitus levator scapulae middle scalene posterior scalene
Where are the lateral vertebral muscles located in reference to the neurovascular plane?
posterior
Superior Thoracic Aperture
formation
1st pair of ribs and their costal carilages
manubrium
body of T1
Arteries of the root of the neck
7
Brachiocephalic trunk Subclavian aa Vertebral a internal thoracic artery thyrocervical trunk costocervical a dorsal scapular a
Brachiocephalic Trunk
largest branch of aorta
located behind manubrium
Brachiocephalic Trunk
path
manubrium—-sternoclavicular joint—divides into right subclavian and right common carotid
left subclavian
origin
aorta
Both subclavian arteries begin at what structure?
Sternoclavicular joint
subclavian a.
path after SC joint
arch superior and lateral—-
pass behind anterior scalene mm—
disappear posterior to the middle of the clavicles
Where does subclavian a. become the axillary a?
at the outer edge of the first rib
3 parts of subclavian a.
1st- middle to ant. scalene
2nd-posterior to ant. scalene
3rd-lateral to ant. scalene
subclavian a.
supplies
upper limbs
some branches to neck and brain
subclavian a.
branches
(5)
vertebral a thyrocervical a internal thoracic a costocervical trunk dorsal scapular a. (70%)
Vertebral a.
origin
1st part of subclavian a
5% of people vertebral artery origin
aorta
vertebral a.
4 parts
cervical part
vertebral part
suboccipital part
cranial part
Cervical part of vertebral a.
path
superior between scalene and longus muscles—
vertebra part of vertebral a.
path
through transverse foramina of C6-C1
suboccipital part of vertebral a.
path
over the groove on posterior arch of C1—-
enters the cranial cavity through foramen magnum
Cranial part of vertebral a.
supplies
branches to spinal cord
medulla oblongata
part of cerebellum
dura of posterior cranial fossa
Joining of two vertebral arteries
name and location
basilar a.
inferior border of the pons
internal thoracic artery
origin
1st part of subclavian
Thyrocervical trunk
origin
1st part of subclavian
near anterior border of the anterior scalene muscle
Thyrocervical trunk
branches
suprascapular a
inferior thyroid a
transverse cervical a. (cervicodorsal trunk)
SIT
Inferior thyroid a.
branch
ascending cervical a. to upper neck
Suprascapular a.
path
posterior of scapula
supplies muscles
Transverse a.
supplies
lateral region of the neck
trapezius
Costocervical a.
origin
posterior of 2nd part of subclavian a
Costocervical a
divides into
superior intercostal a. (two first intercostal spaces)
deep cervical a. (deep cervical muscles)
Dorsal Scapular artery
origin
70% 3rd part of subclavian
30% transverse cervical a.
Dorsal Scapular artery
path
through the trunks of brachial plexus—
deep to levator scapulae m and rhomboid
Dorsal Scapular artery
extra activities
participation in arterial anastomses around scapula
Veins of root of neck
EJV
Subclavian v
EJV collects blood from
scalp and face
Subclavian v
origin
from axillary vein at outer border of first rib
subclavian v
ending
unites with IJV to form brachiocephalic v
What seperates the Subclavian v and artery?
anterior scalene muscle
venous angle
the corner made where IJV and Subclavian v meet
Where does the thoracic duct and right lymphatic trunk drain lymph into venous circulation?
venous angle
Major nerves of the root of the neck
3
vagus n
phrenis n
sympathertic trunk
vagus n
exit cranium
jugular foramen—into carotid sheath
Right vagus
path
inferiorward between 1st part of subclavian and brachiocephalic v at the right SC joint—enters thorax
Left vagus n
path
inferiorward between left common carotid and subclavian—behind the left brachiocephalic vein at posterior of left SC joint
Important branches of vagus n
2
recurrent laryngeal
cardiac branches of vagus
Right Recurrent laryngeal nn
path
loops inferior to the right subclavian a.
AT T1-T2
Left recurrent laryngeal n
path
Loops inferior to the arch of the aorta
AT T4-T5
Where do both recurrent laryngeal nn loop back to?
tracheoesophogeal groove
recurrent laryngeal nn
supplies
trachea
esophagus
all muscles of larynx except
CRICOTHYROID m.
Cardiac branches of vagus
branches
superior cervical cardiac n
inferior cervical cardiac n
Phrenic n.
formed
at lateral borders of anterior scalene
C3-C5
Phrenic n
path
inferiorward, anterior to anterior scalene muscle—
between subclavian artery and v—-
enters thoracic cavity and goes to diaphragm
Anterolateral to the vertebral column
Trunk
cervical portion of sympathetic trunk
What does the cervical portion of the sympathertic trunk not accept?
white communicating branches in the neck
Cervical sympathetic trunk
ganglions
Inferior cervical ganglion
middle cervicle ganglion
superior cevical ganglion
Inferior cervical ganglion
location
at C7 TP
80% of people ganglion
Inferior cervical ganglion fuses with 1st thoracic ganglion to form cervicothoracic ganglion (stellate ganglion)
stellate ganglion AKA
cervicothoracic ganglion
inferior cervical ganglion
branch to heart
inferior cervical cardiac n
cardiaopulmonary splanchnic n
middle cervical ganglion
location
TP of C6
middle cervical ganglion
branch to heart
middle cervical cardiac n
cardiaopulmonary splanchnic n
Superior cervical ganglion
location
TP of C1 C2
Superior cervical ganglion
size
largest
Superior cervical ganglion
branch to heart
superior cervical cardiac n.
cardiaopulmonary splanchnic n
Viscera of the Neck
layers (3)
- endocrine layer: includes thyroid glands and parathyroid glands
- respitory layer: includes larynxs and trachea
- alimentary layer: includes pharynx and esophagus
Endocrine layer of the Cervical Viscera
hormones produced
- thyroid hormone
- calcitonin
- parathomone
Thyroid Hormone
controls speed of metabolism
overproduction during puberty, the body will mature too quickly
Calcitonin
controls calcium metabolism
Parathomone
Parathyroid produced
controls phosphorus and calcium metabolism
Thyroid gland
location
before the larynx and trachea
deep to sternothyroid and sternohyoid mm
Thyroid gland
level vertebrae
C5-T1
Thyroid Gland
features
2 lobes
1 isthmus
Thyroid Gland
height of isthmus
opposite the second and third tracheal rings
Thyroid Gland
surronded by
fibrous capsule
Thyroid Gland
Fibrous Capsule
gives rise to
visceral portion of the pretracheal layer of deep cervical fascia
Thyroid Gland
Arteries
superior thyroid a
inferior thyroid a.
What do the arteries to the thyroid gland go between?
2 layers of fascia:
- fibrous capsule
- visceral portion of DCF
Superior Thyroid Artery
origin
ECA
Superior Thyroid Artery
branches
anterior
posterior
Inferior Thyroid Artery
origin
Thyrocervical trunk
Inferior Thyroid Artery
supplies
posterior inferior of thyroid gland
What anastamosis inside the thyroid gland?
superior and inferior thyroid artery
What could also be said about this anastomosis?
it is an anastomosis of carotid and subclavian artery
Thyroid Gland
Veins
Superior
inferior
middle (Thyroid veins)
Superior Thyroid Vein
accompany and drains into
Superior thyroid artery
drains superior portion of gland to IJV
Middle thyroid vein
accompanies and drains
inferior thyroid artery
drains middle part of gland to IJV
inferior thyroid vein
accompany and drains
no accompany
drains inferior pole of gland to brachiocephalic vein
What forms the interlobar connective tissue of thyroid gland?
fibrous capsule
What collects all the lymph from the thyroid gland?
superior deep cervical lymph nodes
inferior deep cervical lymph nodes
Where do the nerves for the thyroid gland come from?
superior
inferior
middle (cervical sympathetic ganglion)
How do these nerves reach the thyroid gland?
through the arteries including superior and inferior thyroid arteries
What are the nerves of the thyroid gland called?
superior and inferior thyroid prearterial plexuses
What do the nerves of the thyroid gland do?
constrict the blood vessles of the thyroid
vasomotor nn
Why are the nerves of the thyroid important?
because the hormones sent by the thyroid need to be regulated
Parathyroid Gland
divisions
L/R superior
L/R inferior parathyroid glands
Parathyroid Gland
location
in the posterior of the L/R lobes
outside the fibrous capsule of thyroid gland
(inside their sheath)
Superior parathyroid glands
specfic location
1 cm higher than entry of inferior thyroid artery
Inferior Parathyroid glands
specific location
1 cm lower than entry of inferior thyroid artery
Can people have variations involving more or less parathyroid glands?
yes
Parathyroid Glands
Arterial supply
inferior thyroid artery
superior thyroid artery
arteries from trachea and esophagus
Parathyroid gland
lymph
deep cervical lymph nodes
Respitory Layer of Cervical Visera
parts
larynx
trachea
Respitory Layer of Cervical Visera
functions
taking and passing air to the lungs
producing sound for voice
Larynx
function
can produce voice (voice box)
protects the airway
Larynx
Location
anterior of the neck
at vertebral level C3-C6
connects with trachea
Larynx
Skeleton (Soft)
consists of nine cartiladges
Larynx
singular cartilages
thyroid cartilage
cricoid cartilage
epiglottis
Larynx
paired cartilages
arytenoid cartilage
corniculate cartilage
cuneiform cartilage
Larynx
very small embedded cartilage
cuneiform
Larynx
Thyroid Cartilage
vertebral level
at vertebral level C4-C5
Larynx
Thyroid Cartilage
parts
lamina laryngeal prominence (adam's apple) thyroid notch superior cornu (superior horn) inferior cornu (inferior horn) thyrohyoid membrane cricothyroid joint
Where is the thyrohyoid membrane?
between the hyoid bone and thyroid cartilage
Where is the cricothyroid joint?
at the articulation between inferior horn (cornu) and cricoid catilage
Larynx
Cricoid Cartilage
shape
ring-shaped
Larynx
Cricoid Cartilage
parts
lamina
arch
Larynx
Cricoid Cartilage
ligaments
median cricothyroid ligament
lateral cricothyroid ligament
cricotracheal ligament
What do the medial and lateral cricothyroid ligaments connect?
thyroid and cricoid cartilages
What does the cricotracheal ligament connect?
cricoid cartilage with first tracheal ring
Where id the place to puncture in the case of an emergency blockage?
cricotracheal ligament
close to skin
Larynx
Arytenoid Cartilage
shape
pyramidal
Larynx
Arytenoid Cartilage
processes
vocal process
muscular process
What is the joint between arytenoid and cricoid cartilage?
cricoarytenoid joints
Where does sliding and rotating occur in the cricoarytenoid joints?
superior border
Larynx
Arytenoid Cartilage
elastic ligament
vocal ligament
Vocal ligament
location
extending from back of thyroid cartilage to vocal process
Where is the conus elasticus?
between the vocal ligament and lateral cricothyroid ligament
Conus elasticus is a _______?
membrane
Larynx
Epiglottis
location
posterior to the root of the tongue
Larynx
Epiglottis
Stalk connects?
epiglottis to thyroid cartilage
Larynx
Epiglottis
ligament connects?
epiglottis to hyoid bone
Larynx
Epiglottis
membrane
quadrangular membrane
quadrangular membrane
location
between lateral side of arytenoid cartilage and
lateral side of epiglottic cartilage
quadrangular membrane
extension connection
extends into cavity of larynx to connect with vestibular ligament
quadrangular membrane
embedded in
mucosa
What is embedded in the quadrangular membrane mucosa?
Vocal ligament
What is the edge between the epiglottis and vestibular fold?
aryepiglottic fold
Corniculate cartilage
defining feature
it is small
Cuneform cartilage
embedded where
in the edge of aryepiglottic fold and by the side of the corniculate cartilage
Interior cavity of the larynx
location
from the inlet of the larynx to the inferior border of cricoid cartilage
What is the opening of the larynx?
Inlet
What is located behind the inlet of the larynx?
laryngopharynx
What continues with the larynx?
trachea
What is found in the cavity of the larynx?
Vestibular fold vocal fold laryngeal vestibule laryngeal ventricle infraglottic cavity
vestibular fold
function
to protect the vocal fold
What is found between the two vestibular folds?
an opening—rima vestibuli
What ligament is found in the vestibular fold?
vestibular ligament
Vocal Fold
ligament
vocal ligament
Vocal Fold
fine muscle
vocalis muscle
What is found between the two vocal folds?
aperture- rima glottidis
Vocal fold
controls
sound production
vocal fold and rima glottidis
common name
glottis
Laryngeal vestibule
locaton
above vestibular fold
Laryngeal Ventricle
location
between vestibular fold and vocal fold
Infraglottic cavity
location
under the vocal fold
Laryngeal muscle
extrinsic
suprahyoid elevate larynx
infrahyoid depress larynx
Laryngeal muscles
intrinsic muscles
function
adjusting the length and tension of the vocal ligament and changing the shape of the rima glottidis
Laryngeal muscles
intrinsic muscles
movements
abduction or adduction
tension or relaxation
Laryngeal muscles
intrinsic muscles
(9) TACT PLOT V
Thyroepiglotticus m
Aryepiglottic m
Cricothyroid m
Thyroarytenoid m
Posterior cricoarytenoid m.
Lateral cricoarytenoid m.
Oblique arytenoid m
Transverse arytenoid m.
Vocalis (aryvocalis) m
Laryngeal muscles
intrinsic muscles
Abduction and adduction
Posterior cricoarytenoid m -opening rima glottidis
Lateral cricoarytenoid m.- closes rima glottidis
Laryngeal muscles
intrinsic muscles
tension and relaxation
Cricothyroid m.-tension vocal ligament
thyroarytenoid m.- relaxing vocal ligament
Laryngeal muscles
arteries
superior thyroid artery-sup. laryngeal a
inferior thyroid artery- inf. laryngeal a
Laryngeal muscles
superior laryngeal artery
penetration and supply
thyrohyoid membrane
supplies internal surface of larynx
Laryngeal muscles
inferior laryngeal a.
supplies
internal surface and muscles of the inferior larynx
Larynx
lymph
superior and inferior deep cervical nodes
Larynx
Nerves
Vagus—–
superior laryngeal n.
recurrent laryngeal n.
Superior laryngeal n.
divides into
internal laryngeal n.
external laryngeal n.
Internal Laryngeal n.
path
pierces through thyrohyoid membrane w/
superior laryngeal a.
Internal Laryngeal n.
supplies
mucosa of vocal fold and above by sensory fiber
External laryngeal n.
path and supplies
w/ superior thyroid a.to supply cricothyroid m.
What does the recurrent laryngeal n. become?
inferior laryngeal n.
The inferior laryngeal n. branches into?
anterior branch
posterior branch
Anterior branch of inferior laryngeal
supplies
cricothyroid m. thyroarytenoid m. vocalis m. aryepiglottic m. thyroepiglottic m.
Posterior branch of inferior laryngeal
supplies
posterior cricoarytenoid m
transverse and oblique arytenoid mm
Damage to the larygeal nerves results in _____ or _____.
lower intensity or lost voice
What composes the trachea?
cartilage and fibers
consisting of incomplete trachea rings
What is the function of the tracheal rings?
to keep the trachea’s shape and prevent collapse
What closes the back of the trachea?
smooth muscles
Trachea
location
located in the neck
continues with larynx at C6
Trachea
lower structures
left and right bronchi
Trachea
continues with bronchi at
T4-T5 disc
Trachea
posterior
esopagus
Trachea
Anterior
ismus of thyroid
Trachea
two sides
lobe of thyroid and common carotid a.
Trachea
function
passing air to lungs
expelling dirty mucus out of body
Alimmentary layer of Cervical Viscera
Structures
Pharynx
Pharynx
boundaries
Sup.-cranial base
Inf.- continued with esophagus at the level of the inferior border of the cricoid cartilage
Anterior-nasal cavity, oral cavity and larynx
Posterior-prevertebral layer of DCF
Pharynx
widest place
hyoid bone
Pharynx
narrowest
inferior end
Pharynx
Interior
parts
nasopharynx
oropharynx
laryngopharynx
Nasopharynx
location
posterior to nose and superior to palate
Oropharynx
location
posterior to mouth
Laryngopharynx
location
posterior to the larynx
Nasopharynx
function
respiratory
Nasopharynx
boundaries
Roof-sphenoid bone and basilar part of occipital
Ant.- choanae
Inf.-Soft palate
Posterior-posterior wall of pharynx
Nasopharynx
abundant lymph tissue on the posterior wall=
pharyngeal tonsil
Nasopharynx
opening on posterior wall
opening of the pharyngotympanic tube
Nasopharynx
What is found around the opening on the posterior wall?
torus of the pharyngotymapanic tube (torus tubarius)
Nasopharynx
extension of torus of opening on posterior wall
salpingopharyngeal fold
Nasopharynx
What is found in the mucosa of the salpingopharyngeal fold?
salpingpharyngeal m
What is found posterior to the torus of the pharyngotympanic tube?
pharyngeal recess
Oropharynx
functions
respiratory
digestive
Oropharynx
boundaries
Sup.-soft palate
Inf.-tongue and superior edge of epiglottis
Lateral-palatoglossal arch and palatopharyngeal arch, palatine tonsils
Anterior-mouth
Posterior- posterior wall
Laryngopharynx
boundaries
Superior
superior edge of epiglottis and pharyngoepiglottic folds
Laryngopharynx
boundaries
Inferior
at the level of inferior border of cricoid cartilage
Laryngopharynx
boundaries
Anterior
the inlet of larynx
Laryngopharynx
boundaries
Posterior
posterior wall opposite to C4-C6 vertebrae
What is found on each side of the inlet of the larynx?
Piriform fossa
The internal laryngeal n. and recurrent laryngeal n. are deep to the mucosa, where?
Piriform fossa
If fish bones pierce the piriform fossa what nerves will be injured?
Internal laryngeal n.
recurrent laryngeal n.
Are muscles of the pharynx voluntary or involuntary?
voluntary
The external muscles of the pharynx are arranged _____?
circularly
The internal muscles of the pharynx are arranged ______?
longitudinally
Pharynx
external muscles
Superior pharyngeal constrictor m.
Middle pharyngeal constrictor muscle
Inferior pharyngeal constrictor muscle
Pharynx
internal muscles
palatopharyngeus m.
stylopharyngeus m.
salpingopharyngeus m.
What is the function of the muscles of the pharynx?
elevate and
constrict the pharynx
during swallowing and speaking
What fascia surrounds the muscles of the pharynx?
pharyngobasilar fascia-connecting from cranial base
Buccopharyngeal fascia- we know haha
How many overlappings of pharyngeal constrictor mm?
four
1st pharyngeal muscle gap
location
between cranium and superior constrictor m.
1st pharyngeal muscle gap
what passes through
levator veli palatine m.
pharyngotympanic tube
ascending palatine a
2nd pharyngeal muscle gap
location
between the superior and middle constrictor m.
2nd pharyngeal muscle gap
what passes through
stylopharyngeus m
stylohyoid ligament
glossopharyngeal n.
3rd pharyngeal muscle gap
location
between middle and inferior cnstrictor m.
3rd pharyngeal muscle gap
what passes through
internal laryngeal n.
superior laryngeal a.
4th pharyngeal muscle gap
location
under inferior constrictor
4th pharyngeal muscle gap
what passes here
recurrent laryngeal n.
inferior laryngeal a.
Pharynx
blood supply
Tonsil a.
from carotid
Pharynx
lymph
pharyngeal tonsilar ring
- palatine tonsils
- lingual tonsils
- pharynx tonsils
Pharynx
lymph drainage
mandibular lymph nodes and jugulodigastric nodes
Pharyngeal plexus
parts (3)
vagus n
glossopharyngeal n.
sympathetic n. from superior cervical ganglion
Pharyngeal plexus
location
on superior pharyngeal constrictor m.
All muscles of the pharynx recieve motor innervation from the ______?
(1 exception)
Vagus
The stylopharyngeus m. recieves motor innervation from what n.?
glossopharyngeal
Where does sensory innervation of the pharynx come from?
glossopharyngeal
some maxillary
Esophagus
voluntary striated
superior third
Esophagus
voluntary/ involuntary
middle third
Esophagus
involuntary/ smooth
inferior third
Esophagus-superior third
Boundaries
Superior vertebral level
C6
Esophagus-superior third
Boundaries
Inferior
superior border of manubrium
Esophagus-superior third
Boundaries
Anterior
trachea
Esophagus-superior third
Boundaries
Posterior
cervical vertebral column
Esophagus-superior third
Boundaries
Left and Right side
thyroid gland and carotid sheath
Esophagus-superior third
blood supply
branches of inferior thyroid a.
Esophagus-superior third
lymph drainage
deep cervical lymph nodes
Esophagus-superior third
Nerve supply
recurrent laryngeal n.
sympathetic from plexus around inferior thyroid a.
Largest cranial n.
trigeminal-CN5
Trigeminal n. CN5
origin
lateral sides of pons
Trigeminal n. CN5
mostly what kind of fibers
sensory (large root)
Trigeminal n. CN5
flattened ganglion location
trigeminal impression—-
lateral to cavernous sinus
Trigeminal n. CN5
neurons from flattened ganglion
pseudounipolar neurons—–
peripheral processes to face
Trigeminal n. CN5
branches
Opthalmic
maxillary
mandibular
Trigeminal n. CN5
zones of cutaneous innervation
dermatome
Trigeminal n. CN5
motor root
mandibular
Trigeminal n. CN5
mandibular motor supply what muscles
muscles of mastication mylohyoid anterior belly of digastric tensor veli palatine tensor tympani
Trigeminal n. CN5
has none of these fibers
presynaptic parasympathetic fibers
All parasympathetic ganglions are associated with
branches of the trigeminal n.
Opthalmic n. CN5/1
exit cranium
superior orbital fissure
Opthalmic n. CN5/1
distribution
cornea
upper conjuctiva
mucosa of anterosuperior nasal cavity
etc. page 117
Opthalmic n. CN5/1
branches
tentorial n lacrimal n. frontal n. nasociliary n. ciliary nn. (infratrochlear, anterior and posterior ethmoid nn)
Maxillary N. CN5/2
fibers
passage
sensory
foramen rotundum
Maxillary N. CN5/2
distribution
dura mater or anterior middle cranial fossa conjunctiva of inferior eyelid mucosa of poseroinferior nasal cavity maxillary sinus palate anterior of superior oral vestibule maxillary teeth skin of lateral external nose inferior eyelid anterior cheek upper lip
Maxillary N. CN5/2
branches
A LOT of them
meningeal branch zygomatic branch zygomaticofacial branch communicating branch with lacrimal ganglionic branches of pterygopalatine- ganglion posterior superior alveolar branches superior labial inferior palpebral external nasal greater palatine posterior inferior lateral nasal lesser palatine posterior superior lateral nasal pharyngeal nasopalatine
Mandibular N CN5/3
fibers
passage
sensory and motor
foramen ovale
Mandibular N CN5/3
distribution
sensory innervation:
mucosa of anterior 2/3 of tongue floor of mouth posterior and anterior oral vestibule mandibular teeth skin of lower lip buccal region temporal region external ear
Mandibular N CN5/3
branches
sensory
meningeal branch buccal n. auricotemporal n. lingual n. inferior alveolar n. inferior dental plexus mental n
Mandibular N CN5/3
branches
motor
masseter n temporal n medial pterygoid lateral pterygoid mylohyoid anterior belly of digastric n tensor tympani n tensor veli palatine n
Facial N. CN7
origin
inferior border of pons
Facial N. CN7
cranial route
internal acoustic meatus—
facial canal
Facial N. CN7
passage
stylomastoid foramen
Facial N. CN7
penetrates
parotid gland—-
to form parotid nerve plexus
Facial N. CN7
fibers (components) (4)
- Branchial (sp?) (special visceral efferent)
- Visceral motor (general visceral)
- Special sensory (special visceral)
- General sensory (general somatic)
Facial N. CN7
Branchial motor fiber
innervates
striated muscles from pharyngeal arches
Facial N. CN7
Visceral motor fiber
innervates
smooth muscles and glands
Facial N. CN7
Special sensory
innervate
taste and smell mucosa
Facial N. CN7
General sensory
innervate
skin and general mucosa
Facial N. CN7
Branchial motor fiber
origin
branchiomotor nucleus
Facial N. CN7
Visceral motor fiber
origin
superior salivary nucleus
Facial N. CN7
Special sensory
origin
solitary tract nucleus
Facial N. CN7
General sensory
origin
spinal nucleus of trigeminal
Facial N. CN7
Branchial motor fiber
branch destination
stapedius m posterior belly of digastric m sylohyoid m scalp m facial m
Facial N. CN7
Visceral motor fiber
branch destination
lacrimal glands
submandibular gland
sublingual gland
Facial N. CN7
Visceral motor fiber
branches
intermediate n greater petrosal n. lesser petrosal n. tympanic plexus chorda tympani
Facial N. CN7
Visceral motor fiber
presynaptic parasympathetic
intermediate n.
greater petrosal n
chorda tympani
Facial N. CN7
Visceral motor fiber
greater petrosal ganglion
pterygopalatine ganglion
Facial N. CN7
Visceral motor fiber
chorda tympani ganglion
submandibular ganglion
Facial N. CN7
Special sensory
destination
anterior 2/3 of tongue
soft palate
Facial N. CN7
Special sensory
first path
intermediate n.
Facial N. CN7
Special sensory
ganglion
geniculate ganglion
Facial N. CN7
Special sensory
path after ganglion
chorda tympani—
lingual n—
ant. 2/3 of tongue and soft palate
Facial N. CN7
General sensory
destination
skin of the external acoustic meatus
Facial N. CN7
segments (4)—path
labyrinthine segment-internal acoustic meatus
geneculate segment- in canal, between the 1 and 3
tympanic segment-in canal, close to tympanic cavity, passes by medial wall of this cavity
mastoid segment- in canal, passes mastoid process
Facial N. CN7
laceration or contusion results in
paralysis of facial muscles
Facial N. CN7
temporal bone fracture could result in
increased sensitivity to noise
dry mouth and cornea
loss of taste on anterior 2/3 of tongue
(in addition to paralysis of facial muscles)
Facial N. CN7
temporal bone fracture could result in
why sensitivity to noise?
damage to stepedius m. nerve
Facial N. CN7
roots
motor
intermediate
Facial N. CN7
greater petrosal n.
arises from
geniculum
Facial N. CN7
greater petrosal n.
accepts what nerve, then becomes what n.?
accepts- deep petrosal n.
becomes- n. of the pterygoid canal
Facial N. CN7
greater petrosal n.
ganglion and distribution
pterygopalatine ganglion
lacrimal gland
glands of nose an palate
Facial N. CN7
stapedius n
destination
stapedius m.
Facial N. CN7
chorda tympani
path
into tympanic cavity--- across melleus bone--- exits from petrotympanic fascia----- into infratemporal fossa--- joins lingual n--- some fibers to anterior 2/3 of tongue--- some fibers to submandibular ganglion and on to glands
Pharyngeal Apparatus
gill=
structure of fetus, brachial apparatus
Humans don’t develop gills so brachial plexus is instead known as
pharyngeal apparatus
Why is pharyngeal appartaus not a good name?
doesn’t include all organs of face and neck
Pharyngeal apparatus includes what structures?
most head and neck organs
not the brain or eye
What is a deformation?
abnormalities originating from something wrong in the embryo or fetus
Embryo stage
4 parts
pharyngeal arches
pharyngeal pouches
pharyngeal grooves
pharyngeal membranes
Pharyngeal Arches
begin
in fourth week
when neural crest cells move into head and neck area
Pharyngeal Arches
number of arches
4
Pharyngeal Arches
components
aortic arch
cartilaginous rod
muscular component
nerve
Pharyngeal Arches
components become what
aortic arch-blood vessels
cartilaginous rod-skeleton
muscular component-muscles
nerve-nerve to mucosa and muscles
Pharyngeal Pouches
first pouch develops into what
tympanic cavity
pharyngotympanic tube
Pharyngeal Pouches
second pouch develops into what
tonsilar fossa
Pharyngeal Pouches
third pouch develops into what
inferior parathyroid gland and thymus
Pharyngeal Pouches
fourth pouch develops into what
superior parathyroid gland
Pharyngeal Pouches
What continues to develop after birth?
thymus
becomes small when teenaged
Pharyngeal Grooves
first groove becomes
external acoustic meatus
after birth
Pharyngeal Pouches
other 3 grooves combined
cervical sinus and later become cervical vesicle
Pharyngeal Pouches
What happens if the sinus or vesicle does not close and disappear?
A small sinus eill be seen on neck skin
Pharyngeal membranes
location
between endoderm and extoderm (mesenchyme)
Pharyngeal membranes
limited to
first groove and pouch
Pharyngeal membranes
becomes
tympanic membrane
Development of cranium
3 stages
fetus cranium
new born cranium
postnatal growth of cranium
Fetus cranium
developed from
mesenchyme of brain
Fetus cranium
four parts
cartilaginous neurocranium
membranous neurocranium
cartilaginous vscerocranium
membarnous viscerocranium
cartilaginous neurocranium
beginning
6th week
cartilaginous neurocranium
two kinds of cartilage
parachrodial cartilages
hypophysial cartilage
When the fetus is born cartilaginous neurocranium becomes?
Part of occipital bone
petrous and mastoid part of the temporal bone
sphenoid bone
ethmoid bone
Membranous neurocranium
becomes
calveria
frontal bone
parietal bone
part of occipital
Membranous neurocranium
membranes—temporally not ossificated
frontanelles (keep until 1-2 years)
Membranous neurocranium
membranes purpose
to help head of fetus through passage during birth
Membranous neurocranium
movable change in the cranium is known as
molding
Membranous neurocranium
problems with fusing
craniosynostosis
Membranous neurocranium
problems with fusing include these conditions (4)
Scaphocephaly
Oxycephaly
Plagiocephaly
Trigonocephaly
What is the cause of all the fusing abnormalities listed?
premature closure of the cranial suture
before birth
Cartilaginous viscerocranium
develop into
malleus Incus Stapes Styloid process Lesser horn of hyoid Superior part of hyoid Greater horn of hyoid Inferior part of hyoid laryngeal cartilage except epiglottis
Membranous viscerocranium
squamous part of temporal bone
maxillary bone
zygomatic bone
mandible bone
New Born Cranium
has no
sinuses
Postnatal Growth of Cranium
permit brain development
fibrous sutures
Postnatal Growth of Cranium
fastest development
first two years
Postnatal Growth of Cranium
sinuses begin growth
after teenage years???
