Anatomy of the Neck Flashcards

1
Q

Describe the organisation of fascia in the neck

A

Superficial fascia (between the dermis and deep fascia):

  • neurovascular supply to the skin
  • superficial veins (EJV)
  • platysma (CNVII - originates as 2 heads from pectoralis major and deltoid muscles and inserts on the inferior border of the mandible)
  • superficial lymph nodes
  • fat
Deep Fascia:
Investing fascia (surrounds all neck structures: splits to surround SCM and trapezius

Pre-tracheal fascia (in anterior neck from hyoid bone to thorax):

  • muscular part: encloses infrahyoid muscles
  • visceral part: encloses trachea, oesophagus and thyroid gland
  • posteriorly forms the buccopharyngeal fascia (covering pharynx)

Pre-vertebral fascia (surrounds vertebral column, scalene and pre-vertebral muscles, and deep muscles of the back): surrounds brachial plexus forming the axillary sheath

Carotid sheath (encloses neurovascular bundle):

  • common carotid artery
  • vagus nerve
  • IJV
  • cervical lymph nodes
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2
Q

Describe the fascial spaces in the neck

A

Pre-tracheal: between pre-tracheal and investing fascia, between neck and superior mediastinum

‘True’ retropharyngeal fascia: between buccopharyngeal and alar fascia, between base of skull and superior mediastinum

Danger space: between alar and deep layer of pre-vertebral fascia, between the base of skull and diaphragm

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3
Q

What are the boundaries of the anterior triangle?

A
  • inferior border of mandible
  • anterior border of SCM
  • midline of neck

roof: deep investing fascia around muscles
floor: pre-tracheal fascia and carotid sheath

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4
Q

What is the contents of the anterior triangle?

A

Submandibular triangle (bound by ant. and post. bellies of digastric and body of mandible):

  • submandibular gland and lymph nodes
  • facial artery and vein
  • part of facial nerve CNVII
Submental triangle (bound by ant. belly of digastric, midline of neck and hyoid): 
* submental lymph nodes

Carotid triangle (bound by post. belly of digastric, sup. belly of omohyoid and SCM):

  • thyroid gland
  • larynx and pharynx
  • carotid sheath
  • branches of cervical plexus
  • deep cervical nodes
  • part of accessory n and hypoglossal n.

Omo-tracheal triangle (bound by sup. belly of omohyoid, sternohyoid and SCM):

  • sternohyoid muscles
  • sternothyroid muscles
  • thyroid and parathyroid glands
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5
Q

Describe the digastric muscle

A
  • anterior belly originates at digastric fossa on lower medial mandible and is innervated by the nerve to mylohyoid (V3).

It raises hyoid and opens mouth by lowering the mandible.

  • posterior belly originates at the mastoid notch of medial mastoid process and is innervated by the digastric branch of the facial nerve (CNVII)

It elevates and retracts the hyoid.

  • both insert onto the tendon of hyoid
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6
Q

Describe the connections of hyoid (muscles, role and innervation)

A

Suprahyoid muscles (My, Dad, Studies, German: mylohyoid, digastric, stylohyoid, geniohyoid

  • elevates hyoid in swallowing

Infrahyoid muscles (Save Our Souls Today): sternohyoid, omohyoid, sternothyroid, thyrohyoid

  • can depress hyoid but is mainly gravity
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7
Q

Form, position, role and blood supply of thyroid gland

A
  • 2 lateral lobes extending to 5th tracheal ring, with a middle isthmus
  • some have middle pyramidal gland (remnant of thyroglossus)
  • role is to release T3, T4, and calcitonin (regulated by hypothalamus and pituitary gland)
  • arterial: superior thyroid artery (from external carotid a.), and inferior thyroid artery (from thyrocervical trunk of subclavian a.)
  • venous: superior and middle thyroid v. to IJV, and inferior thyroid v. to brachiocephalic v.
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8
Q

Form, position and blood supply of parathyroid gland

A
  • 2 pairs of small glands on posterior side of thyroid
  • arterial: inferior thyroid artery
  • venous: same as thyroid gland
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9
Q

Nerve supply and close relations of thyroid and parathyroid glands

A

Innervated by thyroid branches of cervical ganglia.

Closely related to recurrent laryngeal nerve of vagus (CNX)

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10
Q

What are the boundaries of the posterior triangle?

A
  • posterior border of SCM
  • anterior border of trapezius
  • middle 3rd of clavicle
  • occipital bone

Roof: deep investing fascia, SCM and trapezius
Floor: pre-vertebral fascia, spleinus captitis, levator scapulae and scalene muscles

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11
Q

What is the contents of the posterior triangle?

A

Occipital triangle: contains the accessory nerve and the brachial plexus

Omoclavicular triangle

Minor supraclavicular triangle: contains the inferior bulb of IJV

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12
Q

What is the contents of the retromandibular fossa?

A
  • parotid gland
  • styloglossus, stylohyoid, stylopharyngeus (Give, Him, Pain)
  • stylohyoid and stylomandibular ligaments (Hate, Men)
  • retromandibular vein, maxillary and superficial temporal vessels
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12
Q

What is the contents of the retromandibular fossa?

A
  • parotid gland
  • styloglossus, stylohyoid, stylopharyngeus (Give, Him, Pain)
  • stylohyoid and stylomandibular ligaments (Hate, Men)
  • retromandibular vein, maxillary and superficial temporal vessels
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12
Q

What is the contents of the retromandibular fossa?

A
  • parotid gland
  • styloglossus, stylohyoid, stylopharyngeus (Give, Him, Pain)
  • stylohyoid and stylomandibular ligaments (Hate, Men)
  • retromandibular vein, maxillary and superficial temporal vessels
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13
Q

Describe the cervical plexus

A

Formed by anterior rami of C1-4, deep to SCM

Muscular branches:

  • phrenic nerve to diaphragm (C3-5)
  • ansa cervicalis to infrahyoid muscles (C1-3)

Cutaneous branches (become superficial at Erb’s point):

  • lesser occipital nerve (C2)
  • great auricular nerve (C2-3)
  • transverse cervical nerve (C2-3)
  • supraclavicular nerve (C3-4)
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14
Q

What is the carotid sinus and body, its roles and innervations?

A

Carotid body:

  • enlargement at bifurcation of common carotid arteries at C3/4
  • monitors BP with baroreceptors in homeostasis
  • innervated by glossopharyngeal nerve (IX)

Carotid sinus:

  • small organ at bifurcation of common carotid arteries
  • monitors O2, CO2 and temperature with chemoreceptors to respond in emergency situations
  • innervated by the glossopharyngeal nerve (IX)
15
Q

Describe the pathways of the superficial veins in the neck

A

IJV:

  • continuation of sigmoid sinus which exits cranium by the jugular foramen to enter the carotid sheath
  • travels lateral to common carotid artery
  • joins subclavian vein to become brachiocephalic vein

EJV:

  • originates at angle of mandible
  • joins retromandibular and posterior auricular veins to cross SCM and pierce investing fascia
  • drains to subclavian vein

AJV:

  • arises near hyoid bone and runs on each side of the midline
  • drains to EJV
16
Q

Describe the drainage of the cervical lymph nodes

A
  • submental and facial nodes go to submandibular nodes
  • all nodes drain to superior lateral deep cervical nodes

9 groups:

  • occipital
  • mastoid
  • parotid
  • buccal
  • infrahyoid
  • submandibular
  • superficial cervical
  • deep cervical (retropharyngeal, jugulodigastric, jugulo-omohyoid)