Anatomy Neck Flashcards by Elissa Mahfouz

anterior triangle borders

inferior border of mandible
anterior border of SCM
line down the midline of the neck
investing fascia covers the roof

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anterior triangle contents

suprahyoid muscles, infrahyoid muscles, common carotid artery, external and internal carotid arteries, internal jugular vein
cranial nerves 7 (facial), 9 (glossopharyngeal), 10 (vagus), 11 (accessory), 12 (hypoglossal)

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what structure bifurcates in anterior triangle

common carotid artery (bifurcates at superior border of thyroid cartilage)

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what are the suprahyoid muscles

stylohyoid, mylohyoid, geniohyoid, digastric

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what are the infrahyoid muscles

omohyoid, sternohyoid, thyrohyoid, sternothyroid

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anterior triangle subdivisions

carotid, submental, submandibular, muscular triangles

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carotid triangle contents

common carotid artery with branches, internal jugular vein, hypoglossal nerve, vagus nerve
also has carotid sinus (dilated portion of common carotid and internal carotid that has baroreceptors), glossopharyngeal nerve transmits signal to brain when stretch detected

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submental triangle contents

submental lymph nodes (filter lymph from floor of mouth and parts of tongue)

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submandibular triangle contents

submandibular (salivary) gland, lymph nodes, facial artery and vein

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muscular triangle contents

infrahyoid muscles, pharynx, thyroid, parathyroids

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posterior triangle borders

posterior border of SCM
anterior border of trapezius
middle 1/3 of clavicle

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posterior triangle major contents

omohyoid (crosses it to reach anterior triangle), external jugular vein empties into subclavian vein within triangle, transverse cervical artery and vein, suprascapular artery and vein, subclavian artery, accessory nerve, cervical plexus with phrenic nerve as branch, brachial plexus

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cervical plexus nerve block

“nerve point” of neck
used for local anesthesia of neck
injected along posterior border of SCM at the junction of its superior and middle thirds, this is where the cutaneous branches of the cervical plexus emerge

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number of cervical vertebrae

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C1 name

atlas

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C2 name

axis

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what joint allows head flexion (nodding)

atlanto-occipital joint

between the superior facets of the atlas and the occipital condyles of the cranium base

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jefferson fracture of atlas

vertical fall on neck (diving in shallow water)
transverse ligament of atlas may be ruptured
Since the vertebral foramen is large, it is unlikely that there will be damage to the spinal cord at the C1 level. However, there may be damage further down the vertebral column

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hyperextension (whiplash) injury

anterior longitudinal ligament of the spine is damaged
vertebral foramen is large so there is less chance of spinal cord involvement
dislocation or subluxation of cervical vertebrae may occur with spinal cord involvement

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Hangman’s Fracture

fracture of the pars interarticularis (bony column between the superior and inferior articular facets of the axis)
spinal cord rupture (deep unconsciousness, respiratory and cardiac failure)

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hyoid bone fracture is a characteristic finding in what

strangulation

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waldeyer’s ring

ring of lymphoid tissue in nasopharynx and oropharynx formed by the pair of palatine tonsils, lingual tonsils and adenoid tonsils

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pharyngeal pouch (diverticulum)
pathophysiology
presentation

when swallowing thyropharyngeus muscle should contract while cricopharyngeus should relax
if this coordinated relaxation did not occur, intrapharyngeal pressure rises and pharyngeal mucosa forms a midline diverticulum between the 2 muscles
dysphagia and bad oral smell due to accumulation of food
NB: these muscles are inferior pharyngeal constrictors

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motor innervation of pharyngeal muscles

vagus nerve

EXCEPT stylopharyngeus by glossopharyngeal nerve

pharyngeal muscles 2 groups and function

circular muscles: superior, middle, inferior pharyngeal constrictors --> contract sequentially to propel food downwards longitudinal muscles: stylo- , palato- , salpingo- pharyngeus --> shorten and widen pharynx, elevate larynx when swallowing

sensory innervation of pharynx | blood supply

glossopharyngeal nerve | branches of external carotid artery (ascending pharyngeal artery)

cricoid cartilage location spinal cord

intrinsic muscles of larynx function and innervation

control vocal cords | all innervated by recurrent laryngeal nerve EXCEPT cricothyroid muscle by superior/external laryngeal nerve

recurrent laryngeal nerve palsy causes

``` thyroid cancer apical lung tumor aortic aneurysm cervical lymphadenopathy thyroid surgery ```

unilateral RLN injury

hoarseness

bilateral RLN injury

vocal cords paralysis in adduction position, breathing impaired, emergency

what is Adam's apple

laryngeal prominence on thyroid cartilage

cricoid cartilage importance

marks the inferior border of the larynx the only complete circle of cartilage in larynx or trachea during emergency intubation, pressure can be applied to cricoid cartilage to occlude esophagus and prevent regurgitation (cricoid pressure or Sellick’s maneuvre)

thyroid vertebrae span, what does it cover

C5 - T1, it wraps around cricoid cartilage and superior rings of trachea

what is the visceral compartment of the neck

compartment bound by pretracheal fascia | consists of trachea, thyroid, esophagus, pharynx

thyroglossal cyst etiology

developing thyroid descends from base of tongue (foramen cecum) to anterior neck during descent, it forms thyroglossal duct which regresses if duct persists it can cyst due to build-up of secretions

thyroglossal cyst presentation

midline lump in neck which rises on tongue protrusion

carotid sheath contents

common carotid artery, internal jugular vein, vagus nerve

what muscles cover the thyroid anteriorly

infrahyoid muscles | sternohyoid, sternothyroid, thyrohyoid and omohyoid

arterial supply of thyroid

superior thyroid: 1st branch of external carotid artery inferior thyroid: thyrocervical trunk (branch of subclavian) in 10% of people, thyroid ima artery: brachiocephalic trunk

Superior thyroid artery is close to what nerve

superior laryngeal nerve

inferior thyroid artery is close to what nerve

recurrent laryngeal nerve

venous drainage of thyroid

superior, middle veins: internal jugular vein | inferior vein: brachiocephalic vein

lymphatic drainage of thyroid

paratracheal and deep cervical nodes

pathway of right RLN

vagus nerve hooks around the right subclavian artery then into the tracheoesophageal groove and passes under the thyroid

pathway of left RLN

vagus hooks around aortic arch then into the tracheoesophageal groove and passes under the thyroid

parathyroid origin

superior from 4th pharyngeal pouch | inferior from 3rd pharyngeal pouch

parathyroid arterial supply and venous drainage

inferior thyroid artery (supplies posterior aspect of thyroid) 3 thyroid veins

phrenic nerve spinal roots

C 3-4-5 keeps diaphragm alive

cervical plexus spinal roots

C1 - C4

greater auricular nerve sensation

external ear and skin over parotid

Carotid sinus vs carotid body

Sinus: enlargement of common carotid artery and internal carotid artery at bifurcation, baroreceptors, detect stretch —> increased BP (glossopharyngeal nerve relays msg to brain) Body: external to carotid sinus, peripheral chemoreceptors, detect O2 content in blood to regulate RR

External carotid artery supplies

Head/face and neck external to cranium (extra cranial structures)

External carotid artery branches

``` Superior thyroid artery Lingual artery Facial artery Ascending pharyngeal artery Occipital artery Posterior auricular artery ```

Right common carotid artery origin

Branch of brachiocephalic trunk (subclavian second branch)

Left common carotid artery origin

Aortic arch

Internal carotid artery supplies

Brain, eyes, forehead (intra cranial structures)

Pterion fracture

Weakest point of skull Middle meningeal artery damage or complete laceration Extradutal hematoma (between dura and skull), increases ICP Mild: diuretics Severe: burr holes

Atherosclerosis of carotid arteries pathology, Location Features Imaging, treatment

Swelling at carotid sinus causes turbulent blood flow, internal carotid artery most susceptible Atherosclerotic thickening of walls reduces blood flow headache, dizziness, muscular weakness - stroke if complete occlusion Doppler, carotid endarterectomy