ANATOMY - Neck p2 Flashcards
which nn innervates the suboccipital muscles?
suboccipital nn (posterior ramus C1)
which compartment of the neck of the are the suboccipital muscles in?
suboccipital compartment
action of the suboccipital muscles
extend + rotate neck
what are the name of the 4 suboccpital muscles?
rectus capitis post major
rectus capitis post minor
obliquus capitis superior
obliquus capitis inferior
rectus capitis post major origin/insertion
spinous process C2 –> lateral part of inferior nuchal line occipital bone
action rectus capitis post major
extend + rotate head
origin/insertion rectus capitis post minor
posterior tubercle C1 –> medial part inferior nuchal line occipital bone
action rectus capitis post minor
extends head
origin/insertion obliquus capitis superior
transverse process C1 –> occipital bone
action obliquus capitis superior
extends head
origin/insertion obliquus capitis inferior
does not attach to cranium
spinous process C2 –> transverse process C1
action obliquus capitis inferior
extends + rotates head
contents suboccipital triangle (3)
vertebral aa
suboccipital vv plexus
suboccipital nn
borders suboccipital triangle
superomed: rectus capitis post major
superolat: oblique capitis superior
inf: oblique capitis inf
floor: post atlanto-occipital membrane + posterior arch C1
roof: semispinalis capitus
what is the role of the scalene muscles?
accessory muscles of respiration
flex neck
origin/insertion anterior scalene
anterior tubercles of T processes C3-6 –> scalene tubercle 1st rib
action anterior scalene
elevates 1st rib
ipsilat: lat flexion neck
bilat: ant flexion neck
innervation anterior scalene
ant rami C5/6
origin/insertion middle scalene
post tubercle T processes C2-7 –> scalene tubercle 1st rib
action middle scalene
elevates 1st rib
ipsilat: ipsilat lat flexion neck
innervation middle scalene
ant rami C3-8
origin/insertion post scalene
post tubercles TP C5-7 –> 2nd rib
action post scalene
elevates 2nd rib
ipsilat - lat flexion neck
innervation post scalene
ant rami C6-8
relation of brachial plexus and SCA to scalene muscles
pass between anterior + middle scalene
relation of SCV and phrenic nn to scalene mm
anterior to ant scalene
interscalene nn block
block of brachial plexus at the level of the cricoid cartilage
action of suprahyoid muscles
elevate hyoid bone
what are the 5 suprahyoid muscles
geniohyoid
mylohyoid
stylohyoid
ant belly digastric
post belly digastric
aa supply suprahyoid mm
facial aa
occipital aa
lingual aa branches
which suprahyoid muscle forms the floor of the oral cavity?
mylohyoid
origin/insertion mylohyoid
mylohyoid line mandible –> hyoid bone
action mylohyoid
elevates hyoid + floor mouth
innervation mylohyoid
inf alveolar nn (V3)
where is the geniohyoid in relation to the mylohyoid
deep
origin/insertion geniohyoid
inferior mental spine of the mandible –> hyoid
action geniohyoid
depresses mandible
elevates hyoid
innervation geniohyoid
C1 nn root
relation of stylohyoid in relation to digastric mm
superior to the post belly of digastric
origin/insertion stylohyoid
styloid process temporal bone –> lat hyoid
action stylohyoid
initiates swallowing
pulls hyoid posterosuperiorly
innervation stylohyoid
stylohyoid branch CN VII
origin/insertion anterior belly digastric
digastric fossa mandible –> intermediate tendon attaching to hyoid
origin/insertion posterior belly digastric
mastoid process temporal bone –> intermediate tendon attaching to hyoid
action digastric
depress + elevate hyoid bone
innervation anterior belly digastric vs posterior belly
anterior - inf alveolar branch V3
post - digastric branch VII
how are the infrahyoid muscles split into 2 groups?
superficial plane - omohyoid + sternohyoid
deep plane (related to thyroid) - sternothyroid + thyrohyoid
aa supply infrahyoid muscles
inf + sup thyroid aa
origin/insertion omohyoid
sup belly - hyoid bone
inf belly - scapula
–> intermediate tendon clavicle
action omohyoid
depress hyoid
innervation omohyoid
anterior rami C1-3 via ansa cervicalis
origin/insertion sternohyoid
sternum + SCJ –> hyoid
action sternohyoid
depress hyoid
inn sternohyoid
anterior rami C1-3 via ansa cervicalis
origin/insertion sternothyroid
manubrium sternum –> thyroid cartilage
action sternothyroid
depress hyoid (as continues as thyrohyoid)
inn sternothyroid
ant rami C1-3 via ansa cervicalis
origin/insertion thyrohyoid
continuation of sternothyroid
thyroid cartilage –> hyoid
action thyrohyoid
depress hyoid
innervation thyrohyoid
ant ramus C1
via CN XII
nn roots phrenic nerve
C3-5
motor action phrenic nerve
diaphragm - ipsilateral side
sensory action phrenic nn
central part diaphragm, pericardium, mediastinal part parietal pleura
which cervical nerve is the main contributor to the phrenic nn
C4
anatomical course phrenic nn
1)arise at lateral border ant scalene mm
2) progresses inferior, deep to prevertebral layer fascia
3) splits into R + L, posterior to the SCV
right phrenic nn course after SCV
anterior over lateral part of R SCA
enters thorax via sup thoracic aperture
ant along R Lung root
along pericardium RA
pierces diaphragm at IVC opening opening to innervate inferior surface of diaphragm (ipsilat)
left phrenic nn course after SCV
passes anterior over medial part L SCA
enters thoracic via sup thoracic aperture
descends to L lung root
along pericardium LV
pierces and inn infer surface diaphragm
causes of phrenic nerve palsy
mechanical trauma
compression e.g. tumour
neuropathy (diabetic neuropathy)
paralysis
where is the cervical plexus?
post triangle neck, 1/2 way up SCM
within prevertebral layer cervical fascia
greater auricular nn roots
C2-3
action greater auricular nn
external ear + parotid gland sensation
lesser occipital nn roots
C2, sometimes C3
route lesser occipital nn
curves around CN XI, close to border SCM
lesser occipital nn action
cutaneous sensation to the scalp
transverse cervical nn roots
C2-3
route transverse cervical nn
curves around post SCM
then pierces deep cervical fascia and gives off branches
action transverse cervical nn
anterolat skin of the neck and upper sternum
supraclavicular nn roots
C3-4
route supraclavicular nn
arises behind post border SCM
action supraclavicular nn
skin around supraclavicular fossa, upper thoracic region + SCJ
nn to geniohyoid + thyrohyoid roots
C1
route nn to geniohyoid + thyrohyoid roots
travels with CN XII to respective mm
rectus capitis ant + lat - cervical plexus nn roots
C1-2
longus capitis - cervical plexus nn roots
C1-3
prevertebral mm + SCM contribution - cervical plexus nn roots
C2-3
levator scapulae, trapezius + scalene mm - cervical plexus nn roots
C3-4
phrenic nn contributing nn roots cervical plexus
ant rami C3-5
ansa cervicalis nn roots
C1-3
what are the 4 mm branches of the ansa cervicalis
sup belly omohyoid
inf belly omohyoid
sternohyoid
sternothyroid
how to do a cervical plexus block
midway up post border SCM
injust 3 times in fan like fashion cranially, caudally, anteriorly
RCCA origin
from bifurcation brachiocephalic trunk
LCCA origin
arch aorta
how many branches do the common carotid aa give off in the neck?
none
level of CCA bifurcation
C4 (sup margin thyroid cartilage) in carotid triangle
where does the right ECA end + terminating branches
within the parotid gland to form superficial temporal + macillary
6 other branches ECA
sup thyroid
lingual
facial
ascending pharyngeal
occipital
post auricular
what is carotid sinus hypersensitivity
decr HR + BP secondary to hypersensitive baroceptors
–> underperfused brain –> syncope
where do the vertebral aa arise from
from SCA, just medial to the anterior scalene
what are the 3 branches of the SCA
1st - inf thyroid aa (post prevertebral vv )
2nd - transverse cervical aa (trapezius + rhomboid)
3rd - suprascapular aa (post shoulder)
which 2 veins form the EJV
post auricular and retromandibular vv
where does the EJV form
posterior to the angle of mandible
route of EJV to the SCV
originates post to the angle of the mandible
descends down neck in superficial fascia, anterior to the SCM in a posteromedial direction
reaches root of neck
goes under clavicle –> SCV
what are the 3 tributaries it picks up in the neck
post ext jugular
transverse cervical
suprascapular
what does the Ant jugular vv drain
anterior aspect neck
where does the anterior jugular vein drain into
SCV
what does the IJV begin as a continuation of?
sigmoid sinus
through which opening does the IJV exit the skull>
jugular foramen
relation of IJV within the carotid sheath
deep to SCM
lateral to CCA
which vein joins the IJV to form the BCV?
SCV
which vv drain into the IJV in the neck? (4)
facial vv
lingual vv
occipital vv
sup/mid thyroid vv
what do the post auricular LN drain
area post to ear
what do the occpital LN drain
occipital areas scalp
what do the pre-auricular LN drain
superficial face + temporal regions
what do the supramandibular LN drain
cheeks, lateral nose, upper lips, lat lower lip, gums, ant tongue
what do the submandibular LN drain
mucous membranes nose, cheek, eyelids, conjuctiva
what do submental LN drain
central lower lip, floor mouth, apex + tongue
what do the parotid LN
nose, nasal cavity, EAM, tympanic cavity, lateral orbit, nasal cavities + nasopharynx
superficial cervical LN drain
superficial surafces ant neck, sup surface neck
ultimately where do the LN of the neck drain into
deep cervical LN
where is the vertical chain of the deep cervical LN
closeto the IJV within the carotid sheath
deep cervical LN –>
jugular lymphatic trunks
L trunk –> thoracic duct -> vv system via L SCV
R trunk –> R lymphatic duct –> SVV system via R SCV
Trosiers sign
raised Virchow’s node 2’ to gastric malignancy
