Anatomy-Neck Flashcards
1
Q
Platysma
A
Broad muscle extending from the chest and shoulder muscle to the side of the chin
Most superficial
In subcutaneous tissue
Cannot be seen unless it is being tensed
2
Q
What is the action of the platysma?
A
Tenses the skin of neck and lower face
3
Q
Innervation for the platysma
A
Cranial nerve 7 (facial nerve)
4
Q
Sternocleidomastoid (SCM)
A
Divides anterior and posterior triangles
EJV descends superficial to SCM
IJV descends deep to SCM
Landmark for IJV central line placement
5
Q
Action of SCM
A
Contralateral rotation
Ipsilateral flexion
6
Q
Innervation of SCM
A
Cranial nerve 11 (accessory nerve)
7
Q
SCM attachments
A
Sternal/clavicular attachments up to mastoid process
8
Q
Upper trapezius (UT)
A
Superficial muscle that creates contour of neck/shoulder
SCM and UT originate in same embryo structure and then split, thus they have same innervation
9
Q
Innervation of UT
A
Cranial nerve 11 (accessory nerve)
10
Q
4 infrahyoid muscles
A
Sternohyoid
Sternothyroid
Thyrohyoid
Omohyoid
11
Q
Actions of the infrahyoid muscles
A
Depress hyoid bone and assist in swallowing
12
Q
Innervation of infrahyoid muscles
A
Ansa cervicalis
13
Q
Sternohyoid attachments
A
Manubrium (sternum) and hyoid
14
Q
Sternothyroid attachments
A
Manubrium and thyroid cartilage
15
Q
Thyrohyoid attachments
A
Thyroid cartilage and hyoid bone
16
Q
Omohyoid attachments
A
Scapula (inferior head) and hyoid (superior head)
17
Q
Fascial sling
A
Anchors omohyoid to clavicle
18
Q
What does the superior head of the omohyoid separate in the anterior triangle?
A
Muscular triangle and carotid triangle
19
Q
4 suprahyoid muscles
A
Digastric
Mylohyoid
Geniohyoid
Stylohyoid
20
Q
Action of the suprahyoid muscles
A
Assist with swallowing
21
Q
Mylohyoid attachments
A
Mandible and hyoid
22
Q
Mylohyoid Innervation
A
Cranial nerve 5 (trigeminal nerve)
23
Q
Geniohyoid attachments
A
Mandible (superior to mylohyoid) and hyoid
24
Q
Geniohyoid Innervation
A
Cranial nerve 12 (hypoglossal)
25
Stylohyoid attachments
Styloid process (pointy- temporal bone) and hyoid
26
Stylohyoid Innervation
Cranial nerve 7 (facial nerve)
27
Digastric posterior belly attachments
Mastoid process to hyoid
28
Digastric anterior belly attachments
Hyoid bone and mandible
29
Digastric posterior belly Innervation
Cranial nerve 7 (facial nerve)
30
Digastric anterior belly Innervation
Cranial nerve 5 (trigeminal)
31
Digastric
Anterior belly is inferior to Mylohyoid
32
Floor of mouth
Mylohyoid and Geniohyoid
33
Stylohyoid
Forms a “tunnel“ for Digastric muscle to pass through (superficial to Digastric)
34
Prevertebral muscles and their location
Longus Colli
Longus Capitis
Rectus Capitis Anterior
Rectus Capitis Lateralis
Located within preverteberal space and posterior to danger space
35
Prevertebral muscle actions
Neck flexion
36
Longus Capitis
Cervical vertebrae and occipital bone
37
Longus Colli
cervical vertebrae
38
Three scalene muscles
Anterior, middle, posterior
39
Scalene muscle actions
Elevate rib cage
Ipsilateral lateral flexion
Accessory respiratory muscles
40
Anterior and middle scalene attachment
Cervical spine and 1st rib
41
Posterior scalene attachment
Cervical spine and 2nd rib
42
Clinical application of scalenes
COPD: increase work of breathing causes overuse of scalenes (elevated shoulders)
TOS (thoracic outlet syndrome): scalenes compress brachial plexus and other thoracic vessels
43
Cervical viscera
3 layers
Endocrine- thyroid and parathyroid
Respiratory- larynx and trachea
Alimentary- pharynx and esophagus
44
Upper esophageal sphincter (UES)
Circular muscle at the back of the throat that opens to allow a mass of food to enter the esophagus
45
Lower esophageal sphincter (LES)
Prevents reflux from the stomach
“not true sphincter”
46
Pharyngeal constrictor muscles and their location
Superior, middle, inferior
Location: Anterior to retropharyngeal space
47
Superior constrictor
Attaches in the cheek
48
Middle constrictor
Attaches to hyoid bone
49
Inferior constrictor
Attaches to thyroid and cricoid cartilage
50
Brachial Plexus
Emerges between Anterior and middle scalenes
51
Cricothyroid muscles is innervated by
External branch of superior laryngeal nerve
52
Larynx
The hollow muscular organ forming an air passage to the lungs and holding the vocal cords
53
Larynx is innervated by
Cranial nerve 10 (Vagus nerve)
54
Right recurrent laryngeal nerve
Loops around right subclavian artery
55
Left recurrent laryngeal
Loops under aortic arch
56
Deep cervical fascia layers
Investing
Pretracheal
Prevertebral
Carotid sheath
57
Investing layer
Surrounds neck
Envelopes trapezius and SCM
58
Pretracheal layer (PTL)
Surrounds thyroid, trachea, and esophagus
Made of two layers (visceral and muscular)
-Muscular: infrahyoid and suprahyoid muscles
-Visceral: larynx,trachea,pharynx
59
Buccopharyngeal fascia
Thin external fascial lining of the pharyngeal constrictor muscles
60
Pre vertebral layer
Wraps around scalene muscles and pre vertebral muscles
61
Carotid sheath
The deep fascia that covers the
common carotid artery
Internal carotid artery
internal jugular vein
Vagus nerve
62
Alar fascia
Connects the right and left carotid sheaths
63
Potential anatomical space
Retropharyngeal
Danger space
Pre vertebral
64
Retropharyngeal space
Between buccopharyngeal fascia and alar fascia
Posterior to esophagus
URI can spread here
trauma/abscess —-> dysphagia “grinding” sensation throat when turn head R/L
65
Danger space
Between the alar fascia and the prevertebral fascia
Infection can easily spread down into thorax
66
Action of the intrinsic laryngeal muscle
Production of sound
67
Palatopharyngeal muscle
Ascends from back wall of pharynx to the uvula forming the palatopharyngeal arch located posterior to tonsils
68
Muscles of pharynx
Palatopharyngeal and Cricopharyngeal m. (UES)
69
Muscles of larynx
Cricothyroid and intrinsic laryngeal m.
70
Posterior triangle borders
SCM, upper trapezius, clavicle
71
Posterior triangle muscles
Scalenes, inferior omohyoid, levator scapula, splenius capitus
72
Posterior triangle nerves
CN 11 (accessory), brachial plexus, supraclavicular nerve
73
Posterior triangle vessels/lymph
External jugular vein, subclavian arteries + veins, smaller arteries
supraclavicular lymph nodes
74
Anterior triangle borders
SCM, midline (hallucinate), mandible
75
Anterior triangle subdivisions
Submandibular, carotid, muscular, submental
76
Submandibular borders
Anterior Digastric, Posterior Digastric, mandible
77
Submandibular content
Submandibular gland, CN 12, submandibular lymph nodes
78
Carotid triangle borders
SCM, posterior digastric, superior omohyoid
79
Carotid triangle content
Carotid sheath, (CCA,ICA,CN 10 (vagus) IJV), CN 11, CN 12
80
Muscular triangle border
SCM, Midline, Superior omohyoid
81
Muscular triangle content
Infrahyoid muscles, thyroid and parathyroid glands
82
Submental triangle borders (only one triangle)
Hyoid bone,right anterior digastric, left anterior digastric
83
Submental triangle content
Submental lymph nodes
84
Heart sends blood to the body via the
Aortic arch
85
3 large branches emerge from the aortic arch
1. Brachiocephalic trunk
1a. R common carotid artery
1b. R subclavian artery- which branches into R vertebral artery
2. L common carotid artery
3. L subclavian artery
86
Blood in head and neck is supplied from
Common carotid and common vertebral arteries
87
CCA ascends in
Carotid sheath with CN 10 (vagus nerve) ICA and IJV
***common site of artherosclerosis
88
CCA divides into 2 branches
External carotid artery
Internal carotid artery
89
ICA
Supplies brain (internal skull)
Ascends directly into the carotid canal and does not give off branches in the neck
90
ECA
Supplies neck and external skull
Eight branches emerge from the ECA as it ascends in the neck
91
Carotid body
Located at ICA/ECA bifurcation
Chemoreceptors monitors O2, CO2, and pH
92
Carotid sinus
Enlargement in proximal ICA (ICA/ECA junction)
Baroreceptor monitors BP
93
Eight branches of ECA (four we need to know)
Maxillary artery
Facial artery
Superior thyroid artery
Superficial temporal artery
94
Vertebral artery
Originates in R/L subclavian artery, ascends through neck in openings at cervical vertebrae known as transverse foramen
Vertebral artery does not give off any branches
Enters skull through the foramen magnum and supplies brain
95
Venous circulation of neck:
Major veins that drain the neck
Brachiocephallic vein
External jugular vein
Internal jugular vein
Vertebral veins
96
Major vein of heart
Superior vena cava
97
Brachiocephalic vein
Formed at junction of IJV and subclavian vein
All venous return coming from head and neck eventually drain into brachiocephalic veins
Brachiocephalic veins merge in SVC that drains into the heart
98
Internal jugular vein
Located in carotid sheath descends to the neck deep to SCM
IJV drains internal skull and some veins of face
IJV eventually drains into Brachiocephalic trunk and sends blood back to heart via SVC
99
External jugular vein
Superficial to SCM
Drains into subclavian vein
EJV drains the veins of face and scalp
100
Jugular venous distension
Congestive pathologies such as R sided heart failure causes EJV to distend and can be observed/assessed during physical
101
Vertebral vein
Descends through transverse foramen of the cervical vertebrae and drains blood to brachiocephalic vein which eventually sends blood to heart via SVC
Drains veins from head/scalp and sub-occipital plexus and from the vertebral column (vertebral plexuses)
102
Lymph pathways in neck
A network of lymph nodes and lymph vessels that drain head and neck
The lymph nodes/vessels eventually drain into deep cervical lymph node chain that goes onto drain into the venous system via entry into either subclavian vein, IJV, or at the junction of the two
R side: R lymphatic duct
L side: thoracic duct
103
Physical exam skills for lymph node
Recognizing and palpating for abnormal (enlarged, tender) lymph nodes
104
Lymph nodes of neck (9 we have to know)
Occipital
Pre aurical
Post aurical
jugulodigastric
submandibular
submental
Superficial cervical-anterior
Deep Cervical
Supraclavicular/transverse cervical
105
Jugulodigastric
Sentinel node
First to drain lymph from tonsils, pharynx, mouth, and face
Typically largest node
106
Two nerve plexuses are located in the neck
Cervical plexus (C1-4): originates from spinal nerve roots
brachial plexus (C5-T1): originates from spinal nerve roots C5-T1, supplies arm
107
3 cranial nerves travel through the triangles of the neck
CN 10
CN 11
CN 12
108
Brachial plexus
Exits between anterior and middle scalene muscles
109
Cervical plexus
Sensation to neck region
Motor output to some neck muscles (infra hyoid) and diaphragm (phrenic nerve)
110
4 sensory nerves of cervical plexus + function
Lesser occipital (behind ear)
Greater auricular nerve (in front of ear)
transverse cervicalis
supraclavicular nerve
Supply sensation to the skin along the neck and in front of/behind the ear
111
Motor nerves of neck
Phrenic nerve
Ansa cervicalis
112
Cervical plexus nerve block
OR: localized anesthesia for a variety of procedures like carotid enderectomy, lymph node dissection, superficial neck structures etc
ED: may be used as localized anesthesia to insert jugular central venous catheters, massage clavicular fractures, repair lacerations, drain abscesses in the ear lobe/submandibular areas etc.
*use SCM as landmark because posterior SCM is where nerve block is
113
Phrenic nerve
Supplies diaphragm and originates from nerve roots C3-5
Lays on anterior scalene and descends to thoracic cavity
“3-5 stay alive”
114
Ansa cervicalis
Formed from nerve roots C1-C3
Subdivided into superior (C1, more anterior) and inferior loops (C2, C3)
Supplies infra hyoid muscles, loops around IJV and on top of carotid arteries
115
CN 11
Descends deep to SCM across the posterior triangle to the trapezius
116
CN 12
Emerges near IJV and heads towards the floor of the mouth
117
Structures of posterior neck
Upper trap, sub-occipital region, C7 spinous process (most prominent)
118
Structures of lateral neck
Upper trap, SCM, EJV, supraclavicular fossa, subclavian artery
119
Structures of anterior neck
SCM, hyoid bone, thyroid cartilage, cricoid cartilage, thyroid gland, jugular notch of manubrium
120
Hyoid
Keystone of neck
Only attached to muscles
Usually at C3 level
121
Function of thyroid gland
Calcium homeostasis
Affects all areas of the body except itself and spleen
122
Landmarks of AP “open mouth” view?
Dens and C2 body
123
consequences of a fractured hyoid bone
Can result in aspiration pneumonia due to difficulty swallowing
124
Paralysis of the platysma
Caused by injury to the cervical branch of the facial nerve
125
Torticollis
Contraction or shortening of the cervical muscles that causes twisting of the neck and slanting of the head
126
Endarterectomy
Opening an artery at its origin and stripping atherosclerotic plaque
127
Spread of infection in neck if between investing and visceral pre tracheal
Can spread into thoracic cavity, anterior to pericardium
128
Subclavian vein puncture
Normal point of central line placement
Wrong angle= perforated pleura, lung (pneumothorax) or perforated subclavian artery
129
Injury to laryngeal nerves
Can cause vocal cord paralysis
Unilateral: opposite side muscles work overtime to compensate
Bilateral: voice near absent, stridor, noisy respiration
130
External superior laryngeal nerve (damage)
Monotone (paralyzed cricothyroid can’t adjust cord length/tension)
