Anatomy - Neck Flashcards by Linglee Downey

What are characteristics of typical cervical vertebrae?

transverse mass: anterior and posterior tubercles
transverse foraminae transmits vertebral a.
bifid spinous process increase surface area for muscle attachments
uncinate process
I-V foramen

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What are the 4 layers of deep cervical fascia?

investing layer
pretracheal layer
prevertebral area
carotid sheath

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What are the 3 lateral vertebral muscles?

scalenus anterior
scalenus medius
scalenus posterior

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Which neurovascular structures run between scalenus anterior and scalenus medius?

phrenic nerve
brachial plexus
subclavian artery

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Where do the lateral vertebral muscles attach?

Attach to transverse mass of cervical vertebrae (tubercles)

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Where are the lateral vertebral muscles located?

Deep to prevertebral fascia

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What are characteristics of the C1 vertebra?

Atlas:

no body
anterior and posterior arches
facet for dens
upper surfaces articulate with occipital condyles
long transverse process

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What are characteristics of the C2 vertebra?

Axis:

dens (odontoid process)
surfaces on dens articulate with anterior arch of C1
strong spinous process gives attachment to strong stabiliser muscles

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What is the passage of cervical nerve roots?

C1 and C2 pass behind facet joints

The rest pass between body and facet

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At what spinal segment does the common carotid artery bifurcate?

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Through which foraminae is vertebral a. transmited?

Transverse foraminae C6-C1

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Where may compression of common carotid artery occur?

At anterior tubercle of C6 (carotid tubercle)

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What are the superior joints (suboccipital) of the cervical spine?

Atlanto-occipital (0-C1)

Atlanto-axial (C1-C2)

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What are characteristics of intervertebral discs of the cervical spine?

thick disc with central nucleus
form cervical lordosis
relative to size of body, cervical I-V discs are largest
prevent forward slip and rotation

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What is an uncovertebral joint?

Uncinate process articulates with superior margins of body

Non-synovial joint

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What sort of injury occurs in hyperextension of facet joints?

compression injury

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What sort of movement does the atlanto-occipital joint permit?

Loose fibrous capsule permits nodding movement (flexion/extension)

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Where are the atlanto-occipital joints?

2 lateral synovial joints

- between occipital condyles and upper surfaces of atlas

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T/F

Superior cervical joints contain an intervertebral disc?

False

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What sort of movement do the atlanto-axial joints permit?

Rotation

Transverse ligament allows minimal flexion/extension

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What is the ligament between atlas and occiput?

Posterior atlanto-occipital membrane

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What ligaments are between axis and occiput?

Membrane tectoria/posterior longitudinal ligament (PLL)

Anterior atlanto-occipital membrane

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What movements do the ligaments of the cervical spine limit?

Resist movements in sagittal plane - flexion/extension

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What is the function of the transverse ligament?

Stabilises dens - prevents posterior translation of dens into the vertebral canal

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What is the function of alar ligaments?

Restricts range of rotation of atlas around dens

What are the effects of aging on the cervical spine?

- Lordosis flattens when water content of I-V disc nucleus reduces - Osteophytes may develop from uncinate processes and facet surfaces which may irritate nerve roots and occlude vertebral artery

What are the margins of the posterior neck?

Extends from superior nuchal line of the skull to C7/T1 disc

What are the compartments of the neck?

- Visceral compartment - 2 vascular compartments (carotid sheath) - Vertebral compartment

What structures are contained within the vertebral compartment?

- Cervical vertebrae | - Postural muscles

What structures are contained within the visceral compartment?

- Thyroid and parathyroid glands - Thymus gland if present - Trachea and oesophagus

What structures are contained within the vascular compartments?

- Carotid sheath - Common carotid artery or ICA and ECA (if post-bifurcation) - Internal jugular vein - Vagus

What structures are contained within the superficial fascia?

- Platysma muscle (innervated by cervical branch of facial nerve) - External jugular vein - Anterior jugular vein

What are the fascial layers of the neck?

- Superficial fascia - Investing fascia - Prevertebral fascia - Pretrachial and buccopharyngeal fascias - Carotid sheath

Where does EJV begin in the neck?

Angle of the mandible

What is the descent of EJV?

Vertical descent on SCM

What structures does the investing fascia surround?

- All compartments of the neck | - Splits to surround SCM and trapezius

What structures does the prevertebral fascia surround?

Surround the vertebral compartment which consists of cervical spine and postural muscles

Which layers of fascia surround the visceral compartment?

- Pretracheal fascia | - Buccopharyngeal fascia

What structure does the pretracheal fascia extend up to?

Hyoid bone

What neurovascular structures does the carotid sheath contain?

- CCA/ICA and ECA - IJV - Vagus

What are the boundaries of the anterior triangle?

- In front of SCM - Beneath inferior border of the mandible - On either side of the midline of the neck

What are the boundaries of the posterior triangle?

- Behind SCM - In front of trapezius - Above middle 1/3 of clavicle

What groups of muscles are contained in the anterior triangle and where they located?

Supra and infrahyoid muscles | Between investing fascia and pretracheal fascia

What are the attachments of the suprahyoid muscles and what is their function?

Muscles of the floor of the mouth connect the hyoid bone to the skull Contraction of these muscles elevates the hyoid bone and larynx

What are the attachments of the infrahyoid muscles and what is their action?

Anchor hyoid bone to the clavicle, sternum and scapula (omohyoid) Contraction of these muscles depresses the hyoid bone and larynx

What is the innervation of anterior strap muscles?

Ventral rami of cervical nerves

What are the important structures found in the anterior compartment of the neck?

- Anterior strap muscles (supra and infrahyoid muscles) - Carotid system - IJV - CN IX, X, XI, X

At what level does the CCA bifurcate into ECA and ICA?

Level of C3/4 which also corresponds to superior border of the thyroid cartilage

T/F | ICA sends branches into the neck

False

What are the 6 main branches of the ECA?

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

What 3 branches come off the front of ECA?

- Superior thyroid a. - Lingual a. - Facial a.

What 2 branches come off the back of ECA?

- Posterior auricular a. | - Occipital a.

What branch of ECA is deeply placed?

Ascending pharyngeal a.

Where is the IJV located in relation to the arteries of the carotid sheath?

IVJ is lateral to the arteries

What foraminae are associated with the anterior compartment of the neck?

- Jugular foramen | - Hypoglossal foramen

Which nerves enter the anterior compartment of the neck via jugular foramen?

- Glossopharyngeal - Vagus - Spinal accessory

What is path does glossopharyngeal follow in the neck?

It passes forward into the oropharynx and sends a branch to the carotid sinus

What path does the vagus nerve follow in the neck?

Descending in the carotid sheath with the vascular structures

What path does spinal accessory nerve follow in the neck?

Passes backwards Pierces SCM Enters posterior triangle of the neck

What path does hypoglossal follow in the neck?

Passes forward, like glossopharyngeal but emerges from hypoglossal foramen Passes between the arterial and venous structures: -In front of ICA and ECA -Behind IJV

What are the boundaries of the thyroid gland?

Between upper border of thyroid cartilage and 6th tracheal ring

Which tracheal cartilages does the isthmus run in front of?

Tracheal cartilages 2,3,4

Which layer of fascia encloses the thyroid?

Pretracheal fascia

What structures does the thyroid gland relate to?

- Deep to strap muscles - Lateral to trachea and oesophagus - Adjacent to and overlaps carotid sheaths

What are the clinical consequences of an enlarged thyroid gland?

- Compression of the trachea may present as respiratory obstruction - Compression of oesophagus may present as dysphagia - Compression of IVJ may present as venous distension

What is the course of right recurrent laryngeal nerve as it ascends?

Comes off right vagus and loops beneath right subclavian

What is the course of left recurrent laryngeal nerve as it ascends?

Comes off left vagus and loops around ligamentum arteriosum beneath aortic arch

What is the blood supply of the thyroid?

- Superior thyroid arteries - Inferior thyroid arteries - Sometimes thyroid ima artery (10% of population) which ascends in front of trachea up to the isthmus - Superior, middle and inferior thyroid veins

What is the embryological origin of the thyroid gland?

Develops as an outgrowth of the floor of the pharynx and descends ventral to the larynx

Which structure marks the site of origin of the thyroid gland?

Foramen caecum

What are the important neurovascular structures in the posterior triangle of the neck?

- Subclavian system - Brachial plexus - CN XI - Cervical plexus

Which neurovascular structures emerge at the bottom of the posterior triangle?

Roots of brachial plexus between scalenus medius and scalenus anterior Subclavian system

Which muscle does spinal accessory nerve run on top of?

Levator scapuli

Which nerve pierces SCM?

Spinal accessory

What muscles does spinal accessory innervate?

SCM and trapezius

Which nerve roots from the cervical plexus?

Ventral rami of C1-4

Which nerve descends on scalenus anterior in the posterior triangle?

Phrenic

Which cervical roots make up the phrenic nerve?

C3,4,5

What plexus supplies the anterior strap muscles?

Ansa cervicalis

Which muscle maintains cervical lordosis?

Longus colli