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anatomy of neck Flashcards

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1
Q

how can the neck be divided?

A

anterior and posterior triangles

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2
Q

what muscle separates the anterior and posterior triangles?

A

sternocleidomastoid

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3
Q

what is the posterior triangle of the neck bound by?

A
  • Posterior border of the sternocleidomastoid (SCM)
  • Anterior border of trapezius
  • Middle 1/3 of the clavicle.
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4
Q

what are the important structures in the posterior triangle of the neck?

A 
spinal accessory nerve
external jugular nerve
lymph nodes
part of the subclavian artery
Brachial plexus, cervical plexus, phrenic nerve
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5
Q

what does the spinal accessory nerve innervate?

A

SCM and trapezius

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6
Q

how can the prominence of the external jugular vein be used?

A

as an internal barometer

helps assess mean right atrial pressure - nearly identical to central venous pressure

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7
Q

where can EJV be seen?

A

above the clavicle for a short distance

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8
Q

what happens to the EJV when venous pressure is raised?

A

becomes more prominent

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9
Q

what causes the EJV to become more prominent?

A

increased intra-thoracic pressure, SVC obstruction, enlarged supraclavicular lymph nodes, heart failure, gym

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10
Q

what is mean right atrial pressure identical to?

A

central venous pressure

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11
Q

what fibres innervate SCM and trapezius?

A

somatic motor fibres

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12
Q

what spinal cord rootlets does the spinal accessory nerve form from?

A

C1-C5

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13
Q

describe the passage of the spinal accessory nerve?

A

ascends into the cranial cavity through the foramen magnum with the spinal cord
exits through the jugular foramen and becomes spinal accessory

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14
Q

what type of course does the spinal accessory nerve have?

A

subcutaneous

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15
Q

how can you injure the spinal accessory nerve?

A

lymph node surgery to the neck near SCM

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16
Q

what does spinal accessory nerve injury lead to?

A

atrophy of trapezius, drooping of shoulder, weakened shrugging shoulder

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17
Q

what spinal nerves does the cervical plexus arise from?

A

C1-C4

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18
Q

where do the cutaneous branches of the cervical plexus arise?

A

around the middle of the posterior border of the SCM

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19
Q

what are the 2 main branches of the cervical plexus?

A

phrenic nerve

ansa cervicalis

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20
Q

what are the roots of the phrenic nerve?

A

C3 and C4 and they pick up additional C5 roots

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21
Q

where does the phrenic nerve descend?

A

obliquely with IJV across anterior scalene.

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22
Q

where does the ansa cervicalis run?

A

motor loop to infrahyoid muscles

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23
Q

what are the borders of the anterior triangle of the neck?

A
  • Midline of neck from chin to jugular notch.
  • Anterior border of SCM
  • Lower border of mandible and beyond to mastoid process.
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24
Q

name the subdivisions of the anterior triangle

A
  • submandibular (digastric)
  • carotid
  • muscular
  • submental
25
Q

what is in the submandibular triangle?

A

submandibular glands fill most of the triangle, hypoglossal nerve, parts of the facial artery and vein

26
Q

what is found in the muscular triangle?

A

Sternohyoid, thyrohyoid and sternothyroid (infrahyoid muscles). Thyroid and parathyroid glands.

27
Q

what is found in the submental triangle?

A

floor of the mouth –> mylohyoid

28
Q

what is the carotid triangle bound by?

A
  • Posterior belly of digastric
  • Superior belly of Omohyoid (one of the infrahyoid muscles)
  • Anterior border of SCM
29
Q

why is the carotid highly vascular?

A

common carotid artery

internal jugular vein

30
Q

what are the contents of the carotid triangle

A 
common carotid
carotid bifurcation --> external and internal carotid arteries
carotid sinus
carotid body
internal carotid
Glossopharyngeal, vagus, Spinal accessory, Hypoglossal
Cervical sympathetic trunk
Ansa cervicalis
31
Q

what does the carotid sinus detect? what type of receptor is it?

A

blood pressure (baroreceptor)

32
Q

what does the carotid body detect? what type of receptor is it?

A

measure O2 and CO2 content of the blood

chemoreceptor

33
Q

what are the branches of the external carotid?

A
  • Superior thyroid artery
  • Ascending pharyngeal
  • Lingual
  • Facial
  • Occipital
  • Posterior auricular
  • Maxillary – middle meningeal branch supplies the dura and the periosteum in the skull
  • Superficial Temporal
34
Q

what structures does the external carotid supply?

A

face, tongue, mouth, upper jaw, eye, scalp and the inside of the skull and the dura

35
Q

what does the carotid sheath contain?

A

• Common carotid artery, Internal carotid artery, Internal jugular vein
• Vagus nerve
• Ansa cervicalis over IJV
• Ascending sympathetic fibres use internal carotid artery for support
• Lymph nodes
- cervical parts of the sympathetic trunk

36
Q

what are the 3 cervical ganglia?

A

superior
middle
inferior

37
Q

how do the cervical ganglia get their presynaptic fibres?

A

via superior thoracic nerves

38
Q

where do the cervical ganglia send post ganglionic fibres?

A

cervical spinal nerves
thoracic viscera
head and neck viscera

39
Q

what causes horner’s syndrome?

A

lesions to the sympathetic trunk in the neck or descending fibres in the brainstem

40
Q

what are the symptoms of horner’s syndrome?

A

o Contraction of pupil (miosis)
o Drooping of superior eyelid (paralysis of smooth muscle in levator palpebrae superioris)
o Sinking of eye (enophtalmos)
o Vasodilation, absence of sweating

41
Q

what can damage/compression of the vagus during surgery cause and why?

A

alteration in voice bc these nerves supply laryngeal muscles

42
Q

which IJV is used in IJV puncture and why?

A

right IJV used: straighter course with brachiocephalic vein into SVC. Thoracic duct (main lymph trunk) drains at venous angle on the left

43
Q

when does IJV pulse rise?

A

conditions such as mitral valve disease, increased pressure in pulmonary circulation

44
Q

what does the suprahyoid muscles do?

A

make up the floor of the mouth
provide base for tongue and elevate hyoid and larynx to allow for swallowing and the production of tone (include mylohyoid, digastric, stylohyoid

45
Q

what do the infrahyoid muscles do?

A

depress hyoid and larynx during swallowing and speaking (Sternohyoid, thyroid hyoid, sternothyroid, Omohyoid).

46
Q

what do the extrinsic larynx muscles do?

A

move larynx as a whole - supra and infrahyoid muscles

47
Q

what do the intrinsic muscles of the larynx do?

A

move components of the larynx: alter length and tension of vocal folds and size and shape of rima glottides and therefore the size and volume of speech

48
Q

what nerves innervate the different parts of the larynx?

A

o Cricothyroid - superior laryngeal N (CN X)

o All others - recurrent laryngeal N (CN X)

49
Q

what is the rima glottidis?

A

the gap between vocal folds

50
Q

what happens to the throat muscles during normal respiration?

A

laryngeal muscles relaxed: the rima glottides is a narrow slit

51
Q

what happens to the throat muscles during deep respiration?

A

Vocal ligaments abducted by contraction of posterior cricoarytenoid muscles (rima glottides opens widely)

52
Q

what happens to the throat muscles during phonation?

A

arytenoid muscles adduct arytenoid cartilages, cricoarytenoid adduct vocal ligaments. Air forced between vocal ligaments: sound.

53
Q

what happens to the throat muscles during whispering?

A

vocal ligaments strongly adduct, relaxed arytenoids

54
Q

what does the vagus branch into?

A

superior laryngeal nerve and recurrent laryngeal nerve

55
Q

what are the branches of the superior laryngeal nerve and what do they innervate?

A
  • Internal – sensory and autonomic to larynx above vocal cords
  • External – motor to criciothyroid
56
Q

what does the recurrent laryngeal nerve innervate?

A

o Motor to all other intrinsic muscles of the larynx

o Sensory to area below vocal folds

57
Q

how can a superior laryngeal nerve lesion occur?

A

during thyroidectomy or through compression

o Goitre

58
Q

what does paralysis of superior laryngeal nerve lead to?

A

• Anaesthesia of superior laryngeal mucosa
o Cough reflex (an important protective mechanism)
• A monotonous voice - Paralysed cricothyroid (unable to vary length and tension – but may go unnoticed)

59
Q

what does paralysis of the recurrent laryngeal lead to?

A

 Recurrent laryngeal
• Paralysed vocal folds
• Hoarseness/dysphonia

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