ANATOMY - Neck p1 Flashcards
anterior triangle of neck - superior border
inferior border mandible
anterior triangle of neck - lateral border
anterior border SCM
anterior triangle of neck - medial border
sagittal line midline neck
anterior triangle of neck - roof
investing fascia
anterior triangle of neck - floor
visceral fascia
contents of anterior triangle neck
CCA (ICA + ECA)
IJV
CN VII, IX, X, XI, XII
Suprahyoid mm
infrahyoid mm
what are the subdivisions of the anterior triangle
Carotid triangle
submental triangle
submandibular triangle
muscular triangle
contents carotid triangle (5)
CCA
IJV
CN X
CN XII
Carotid sinus
superior border carotid triangle
posterior belly digastric
lateral border carotid triangle
medial border SCM
inferior border carotid triangle
superior belly omohyoid
contents submental triangle
submental LN
inferior border submental triangle
hyoid bone
medial border submental triangle
midline neck
lateral border submental triangle
anterior belly digastric
floor submental triangle
mylohyoid
submandibular triangle contents (4)
SM gland
SM LN
facial aa
Facial vv
superior border submandibular triangle
body of mandible
anterior border submandibular triangle
anterior belly digastric
posterior border submandibular triangle
posterior belly digastric
contents muscular triangle anterior triangle (4)
infrahyoid muscles
pharynx
thyroid
parathyroid
superior border muscular triangle
hyoid
medial border muscular triangle
midline neck
superolateral border of the muscular triangle
sup belly omohyoid
inferolateral border muscular triangle
inferior portion SCM
anterior border of posterior triangle
posterior border SCM
posterior border of posterior triangle
anterior border trapezius
inferior border posterior triangle
middle 1/3 clavicle
floor of posterior triangle
pre-vertebral fascia
roof of posterior triangle
investing fascia
contents posterior triangle (12)
inf belly omohyoid
splenius capitis
levator scapulae
scalenes
EJV (+ retromandibular + post auricular draining into)
SCV
SCA
Tranverse cervical + subscapular vv
CN XI
Cervical plexus
Trunks brachial plexus
What are the 2 subdivisions of the posterior triangle of the neck
omohyoid triangle = sup to omohyoid
subclavian triangle = cont SCA
how many cervical vertebrae
7
Name for C1
ATLAS
Name for C2
Axis
what travels through the transverse foramina of the C spines
vertebral aa
vertebral vv
sympathetic nn
what 2 things does the atlas not have in comparison to the rest of the C spine vertebra
no vertebral body
no spinous processes (has lateral masses instead)
function of medial atlanto-axial joint?
rotation of head independent from torso
what are the 2 joints present throughout the whole of the vertebral column in the C spine?
betw vertebral bodies - IVD
betw vertebral arches - sup + inf processes
what type of joint is the IVD joint between vertebral bodies?
symphysis joint
what type of joint is the sup + inf processes joints between vertebral arches?
synovial joint
What are the 3 joints unique to the C spine?
lateral A-A joints x2
medial A-A joint
Atlanto-occipital joint
what are the lateral A-A joints + what type of joint are they?
betw inf facet of lateral mass C1 and sup facets C2
plane synovial joint
what is the medial A-A joint + what type of joint is it?
dens of C2 to articular facet C1
pivot synovial joint
what is the Atlanto-occipital joint and what type of joint is it
sup facet lat mass C1 to occpital condyles
condyloid synovial joint
6 ligaments of the C spine
Ant longitudinal
Post longitudinal
longitudinal ligaments cover VB + IVD
Nuchal ligament - tips of process C1-7 for mm attachment
Interspinal ligament - connects spinous processes
Ligamentum flavum - lamina of adjacent vertebra
transverse ligament axis - - connects lat masses of atlas to anchor dens
how many C spine nerves?
8
Jefferson fracture
C1
fall on extended neck
ant or post arch fracture
Hangmans fracture
C2
fracture pars interarticularis
high velocity hyperextension
Dens fracture
40%
C2 fracture
high risk AVN
Hyoid bone level
C3
3 ligaments which attach to hyoid bone
stylohyoid
thyrohyoid
hyoepiglottic
stylohyoid ligament
styloid process temporal bone –> lesser horn hyoid
thyrohyoid ligament
sup thyroid cartilage to posterior hyoid and greater horns
hyoepiglottic
hyoid to anterior epiglottis
where does the pharynx run between?
base of skull –> inf border cricoid cartilage C6
what are the 3 parts of the pharynx
nasopharynx
oropharynx
laryngopharynx
where does nasopharynx run between?
base of skull to soft palate
cell lining nasopharynx
ciliated pseudostratified columnar ep + goblet cells
contents nasopharynx
adenoid tonsils
where does the oropharynx run between?
soft palate to sup border epiglottis
contents oropharynx (4)
posterior 1/3 tongue
superior constructor muscles
lingual tonsils
palatine tonsils
what is Waldeyers ring
ring of lymphoid tissue formed by the palatine, adenoid and lingual tonsils
where does the laryngopharynx run between?
sup border of epiglottis to inf border cricoid cartilage C6
contents laryngopharynx (2)
inf + middle constrictors
what are the 2 muscles groups of the pharynx?
3 circulator muscles
3 longitudinal muscles
which CN are the muscles of the pharynx innervated by except stylopharyngeus?
CN X
Stylopharyngeus = CN IX
superior pharyngeal constrictor origin/insertion
pterygomandibular ligament, alveolar process mandible, medial pterygoid plate –> pharyngeal tubercle occiput + pharyngeal raphe
middle pharyngeal constrictor origin/insertion
stylohyoid ligament + horns hyoid
inferior pharyngeal constrictor origin/insertion
thyropharyngeal fibres from thyroid cartilage + cricopharyngeal fibres from cricoid cartilage –> pharygneal raphe
role of longitudinal muscles in pharynx
shorten + widen pharynx
elevate larynx during swallowing
palatopharyngeus origin/insertion
hard palate –> pharyngeal wall
stylopharyngeus origin/insertion
styloid process temporal bone –> pharyngeal wall
salpingopharyngeus origin/insertion
eustachian tube –> pharyngeal wall
what does the majority of motor and sensory inn to the pharynx come from?
pharyngeal plexus
(also CN IX)
where is the pharyngeael plexus
middle constrictor
which nerves make up the pharyngeal plexus (4)
pharyngeal branch CN IX
pharyngeal branch CN X
branches ext laryngeal branch
sympathetic fibres sup cervical ganglion
aa supply pharynx
3 branches ECA - ascending pharyngeal aa, branches facial aa, branches maxillary/lingual aa
vv supply pharynx
pharyngeal vv plexus
where does the pharyngeal vv plexus drain into
IJV
larynx spans over
C3-6
what muscles are anterior to the larynx?
infrahyoid muscles
what structure is lateral to the larynx?
thyroid gland
what structure is posterior to the larynx?
oesophagus
what are the 3 sections of the larynx?
supraglottis
glottis
infraglottis
supraglottis
inferior surface of the epiglottis to the false VC
glottis
VC to 1cm below
infraglottis
inferior border of the glottis –> inferior border of the cricoid cartilage
cell lining of the larynx
pseudostratified ciliated columnar epithelium
cell lining of the VC
stratified squamous ep
aa supply to the larynx
superior and inferior laryngeal aa
superior laryngeal aa is a branch of
superior thyroid aa (^ECA)
inferior laryngeal aa is a branch of
inferior thyroid aa (^thyrocervical trunk)
what nn does the superior laryngeal aa follow
internal branch of the superior laryngeal nn
what nn does the inferior laryngeal aa follow
recurrent laryngeal nn
recurrent laryngeal nn - sensory inn
infraglottis
recurrent laryngeal nn - motor inn
all internal mm of the larynx EXCEPT CRICOTHYROID
inn - internal branch of the superior laryngeal nn
sensory info to the surpaglottis
inn - external branch of the superior laryngeal nn
motor inn to the cricothyroid
unilateral VC paralysis PS:
hoarseness of voice
bilateral VC paralysis PS
impaired breathing -stridor
cannot phonate
what are the 3 unpaired cartilages of the larynx?
thyroid cartilage
cricoid cartilage
epiglottis
what joins the 2 sheets of the thyroid cartilage at the front
laryngeal prominence
aka Adams apple
what is attached to the superior horns of the thyroid cartilage
lateral thyroihyoid ligaments (to hyoid)
what is attached to the inferior horns of the thyroid cartilage
cricothyroid ligaments (to cricoid)
what type of cartilage is the cricoid
complete ring of hyaline cartilage
shape of cricoid cartilage
signet ring shape
what spinal level is the cricoid cartilage
C6
shape of epiglottis
leaf shape
what type of cartilage is the epiglottis
elastic cartilage
what happens to the epiglottis during swallowing
flattens and moves posteriorly to close off the larynx
what are the 3 paired cartilages of the larynx?
arytenoid
corniculate
cuneiform
shape of arytenoid cartilage
pyramidal
what cartilage do the arytenoids sit on
cricoid
what does the apex of the arytenoid cartilages articulate with?
corniculate cartilages
what does the base of the arytenoid cartilages articulate with
superior facet of the cricoid cartilages
what attaches to the vocal process of the arytenoid
vocal ligament
what attaches to the muscle process of the arytenoid
posterior and lateral cricoarytenoid muscles
what do the corniculates articulate with
apices of the arytenoid
where are the cuneiform cartilages
within the aryepiglottic folds
how many extrinsic ligaments of the larynx are there?
5
what are the names of the extrinsic ligaments of the larynx
thyrohyoid membrane aka medial and lateral thryohyoid ligaments
hyoepiglottic ligament
cricotracheal ligament
medial criciothyroid ligament
how many intrinsic ligaments of the larynx are there
2
what are the intrinsic ligaments of the larynx
cricothyroid ligament
quadrangular membrane
which intrinsic ligament of the larynx forms the vocal ligament?
cricothyroid ligament
where does the cricothyroid ligament extend between?
cricoid cartilage to upper margin of thyroid + arytenoid
what does the lower margin of the quandrangular membrane of the larynx thicken to become?
vestibular ligament
where does the quadrangular membrane of the larynx extend between?
anterolateral arytenoid + lateral epiglottis
what are the 2 laryngeal folds
vocal folds aka true vocal folds
vestibular folds aka false VC
what are the 4 movements of the vocal folds
abduction
adduction
relaxed
tensed
what are the 4 layers of the vocal folds from superficial to deep
Non-keratinised stratified squamous ep
Reinke’s space
vocal ligament
vocalis mm
what is the space between the true and false VC called?
Rima glottidis (white)
are the false vocal cords superior or inferior to the true vocal cords?
superior
colour of false vocal cords
pink
function of false vocal cords
provide protection to larynx
which 2 extrinsic laryngeal muscle groups elevate the larynx
suprahyoid mm
stylopharyngeus
role of intrinsic muscles of the larynx
control shape of rima glottidis
innervation of intrinsic mm of the larynx (except cricothyroid)
inferior laryngeal branch of rec laryngeal nn (CNX)
innervation of cricothyroid muscle
external branch of sup laryngeal nn
what are the 5 intrinsic mm of the larynx
transverse arytenoid
post cricoarytenoid
lat cricoarytenoid
thyroarytenoid
cricothyroid
transverse arytenoid origin/insertion
arytenoid to the other arytenoid
action transverse arytenoid
adduction arytenoid
origin/insertion post cricoarytenoid
post cricoid to mm process arytenoid
action post cricoarytenoid
abductors of VC (widen rima glottidis)
origin/insertion thyroartenoid
inferopost thyroid to anterolat arytenoid
action thyroarytenoid
relaxes vocal ligament
origin/insertion lat cricoarytenoid
arch cricoid cartilage to mm process arytenoid
action lat cricoarytenoid
main adductors vocal cord
origin/insertion cricothyroid
ant cricoid cartilage –> inf horns thyroid
action cricothyroid
stretches + tenses vocal ligament
length of oesophagus
25cm
where does the oesophagus extend between?
inferior border cricoid cartilage C6 –> cardia orifice stomach T11
where is the oesophagus in the superior mediastinum?
between the trachea + VB T1-4
structure oesophagus from external to inner layer
adventitia (outer layer connective tissue)
mm layer
submucosa
mucosa
instead of adventitia in the distal portion of the oesophagus, what layer is there instead?
serosa
mm layer sup 1/3 oesophagus
voluntary striated mm
mm layer middle 1/3 oesophagus
voluntary striated + smooth mm
mm layer distal 1/3 oesophagus
smooth m
what cell type make up the mucosa of the oesophagus
non-keratinised stratified squamous ep
which muscle forms the upper oesophageal sphincter?
cricopharyngeus
what level is the lower oesophageal sphincter at?
T11
what 4 factors maintain the physiological LOS?
oesophagus entering stomach at an acute angle
walls of oesophagus being compressed with increased IAP
prominent mucosal folds at GOJ
R crus diaphragm pinch cork effect
structures anterior to the thoracic oespohagus
trachea
L recurrent laryngeal nn
pericardium
structures posterior to the thoracic oesophagus
VB
thoracic duct
azygous vv
descending aorta
structures to the left to thoracic oesophagus
pleura
terminal part azygous vv
structures to the LEFT of the thoracic oesophagus
SCA
aortic arch
thoracic duct
pleura
structures anterior to the abdominal oesophagus
L CNX
posterior surface heart
Structures posterior to the abdominal oesophagus
R CNX
L crus diaphragm
aa supply thoracic oesophgagus
branches thoracic aorta + inf thyroid aa
vv drainage thoracic oesophagus
branch azygous vv + inf thyroid vv
aa supply abdominal oesophagus
L gastric aa + L phrenic aa
vv drainage abdominal oesophagus
gastric vv (portal circ)
azygous vv (systemic circ)
inn oespohagus
oesophageal plexus
parasympathetic aspect oesophageal plexus
vagal trunks - upper = nucleus ambigulus, lower = dorsal motor nucleus
sympathetic aspect oesophageal plexus
cervical/thoracic trunks
LN drainage superior 1/3 oepsphagus
deep cervical LN
LN drainage middle 1/3 oesophagus
sup + post mediastinal LN
LN drainage lower 1/3 oesophagus
L gastric + coeliac LN
where vertebra does the thyroid gland span between?
C5-T1
embryological origin thyroid gland
foramen cecum (near base of tongue)
reaches anterior neck by week 7
descends –> thyroglossal duct –> usually regresses by week 6
structures anterior to the thyroid
infrahyoid muscles
structures lateral to the thyroid
carotid sheath (cont common carotid artery, internal jugular vein and vagus nerve)
structures medial to the thyroid
Organs – larynx, pharynx, trachea and oesophagus
Nerves – external laryngeal and recurrent laryngeal
what are the 2 main aa supplying the thyroid gland?
sup + inf thyroid aa
origin sup thyroid aa
1st branch ECA
origin inf thyroid aa
thyrocergical trunk
which nn is the sup thyroid aa in close proximity to?
external sup laryngeal nn
which nn is the inf thyroid aa in close proximity to?
rec laryngeal nn
what % of the population also have the thyroid ima aa?
10%
origin of thyroid ima aa?
brachiocephalic trunk
what part of the thyroid does the thyroid ima supply
ant surface
isthmus
vv drainage thyroid
sup, mid and inf thyroid vv form venous plexus
sup and mid thyroid vv drain into
IJV
inferior thyroid vv drains into
brachiocephalic vv
inn thyroid gland
sympathetic trunk - SENSATION ONLY
LN drainage thyroid gland
paratracheal + deep cervical LN
where are the parathyroid glands?
posterior aspect of thyroid gland
within which fascia would you find the parathyroid glands?
pretracheal fascia
embryological origin sup parathyroid glands
4th pharyngeal pouch
embryological origin inf paraythyroid glands
3rd pharyngeal pouch
relation of sup parathyroid glands to inf thyroid aa
1cm superior to the entry of inf thyroid aa into glands
aa supply parathyroids
inf thyroid aa chiefly
collat from other 2 thyroid aa
vv drainage parathyroids
sup, mid + inf thyroid vv
LN drainage parathyroids
paratracheal + deep cervical LN
nn supply parathyroids
thyroid branches cervical ganglion (vasomotor)