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Hannah's Endocrine > Anatomy of the Neck > Flashcards

Anatomy of the Neck Flashcards

1
Q

Define the boundaries of the anterior triangles

A

Bounded by the inferior border of the mandible, the SCMs and the midline of the neck

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2
Q

Define the boundaries of the posterior triangles

A

Behind the SCMs, in front of trapezius and above the medial 1/3 of the clavicles

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3
Q

Define the upper and lower borders of the neck anteriorly and posteriorly

A

Anterior: inferior border of mandible to manubrium
Posterior: superior nuchal line on the occipital bone to C7/T1 intervertebral disc

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4
Q

What muscle does the superior nuchal line give rise to?

A

Trapezius

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5
Q

What is the platysma? Describe its innervation

A

A thin sheet of muscle continuous with the muscles of facial expression and contained within the superficial fascia of the neck
Supplied by the cervical branch of CNVII

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6
Q

Describe the course of the EJV

A

Begins at the angle of the mandible, descends vertically on SCM

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7
Q

What structures are contained within the visceral compartment of the neck?

A

Thyroid, parathyroid and thymus (if present) glands

Also intimated related to the trachea and oesophagus

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8
Q

What structures are contained within the superficial fascia?

A

Platysma

Superficial veins of the neck

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9
Q

Where is the investing fascia located and what structures does it contain?

A

Deep to the superficial fascia

Surrounds all 3 compartments (visceral, vascular and vertebral) as well as SCM anteriorly and trapezius posteriorly

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10
Q

Where does the pretracheal fascia begin and what is the clinical significance of this?

A

Begins at the hyoid bone

Structures contained with the visceral compartment move up on swallowing (can be used to identify the thyroid)

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11
Q

What 2 fascias enclose the visceral compartment of the neck?

A

Pretracheal fascia anteriorly and buccopharyngeal fascia posteriorly

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12
Q

What is the clinical significance of the fascial spaces in terms of infection?

A

The fascial spaces communicate directly with the mediastinum; provides an avenue for spread of infection/abscess into the mediastinum (can cause mediastinitis)

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13
Q

What fascia encloses the vascular compartment of the neck?

A

Carotid sheath

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14
Q

What fascia encloses the vertebral compartment of the neck?

A

Prevertebral fascia

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15
Q

What is the role of the suprahyoid muscles?

A

Form the floor of the mouth

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16
Q

Where are the anterior vertebral (“strap”) muscles located?

A

Between the investing and pretracheal fascias

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17
Q

What is the role of anterior vertebral (“strap”) muscles? Which nerve innervates these muscles?

A

Act to steady or move the hyoid bone and larynx (suprahyoid elevate structures, infrahyoid depress)
Innervated by anterior rami of cervical nerves

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18
Q

At what vertebral level and landmark does the common carotid bifurcate?

A

C3/C4, upper border of the thyroid cartilage

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19
Q

What are the branches of the internal carotid in the neck?

A

No branches in the neck; contains carotid sinus (baroreceptors) and carotid body (chemoreceptors)

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20
Q

List the branches of the external carotid

A

Anterior: superior thyroid, lingual, facial
Deep: maxillary
Posterior: posterior auricular, occipital

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21
Q

Where does the IJV run?

A

Lateral to the arteries in the carotid sheath

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22
Q

What cranial nerves pass through the anterior triangle?

A

Anterior triangle communicates with the jugular foramen (so CNIX, X, XI) and hypoglossal canal (CNXII)

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23
Q

List 5 branches of CNIX

A 
Nerve to carotid sinus
Pharyngeal
Tonsillar
Lingual
Tympanic
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24
Q

What are the 2 types of fibres in CNX and what does each supply?

A

Somatic sensory to mucous membrane of larynx

Branchial motor to muscles of pharynx, larynx and soft palate

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25
Q

Where does CNX run?

A

Descends in the carotid sheath

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26
Q

Describe the course of CNXI through the anterior and posterior triangles

A

Travels posteriorly through or beneath SCM from the anterior triangle
Crosses obliquely on levator scapulae and drops under cover of trapezius in the posterior triangle

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27
Q

What clinical symptom is associated with CNXI damage?

A

Shrug palsy on affected side

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28
Q

Describe the course of CNIX in the head/neck

A

Gives off branch to carotid sinus and then passes forward to supply oropharynx

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29
Q

What tongue muscle is not innervated by CNXII?

A

Palatoglossus (innervated by CNX)

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30
Q

Describe the course of CNXII in the head/neck

A

Passes forward over the carotids but beneath the veins

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31
Q

Where are the 2 lobes of the thyroid located?

A

In the anterior neck between the upper border of the thyroid cartilage and the 6th tracheal ring

32
Q

Where is the isthmus of the thyroid located?

A

Between the 2nd and 3rd tracheal rings

33
Q

What is the pyramidal lobe of the thyroid and when is it present?

A

A lobe remnant of the migration of the thyroid and ascending upwards from the isthmus (classically veering to the left); present in 50% of cases

34
Q

Describe the differing courses of the L and R recurrent laryngeal nerves

A

L recurrent laryngeal nerve descends to loop around the arch of the aorta (near ligamentum arteriosum) before ascending in the L tracheoesophageal groove
R recurrent laryngeal nerve loops beneath the R subclavian before ascending in the R trachoesophageal groove
Both are intimately related with the thyroid in their ascent

35
Q

What kind of complications can be caused by a large retrosternal goitre?

A

Dysphagia (due to compression of oesophagus)
Difficulty breathing (due to compression of trachea)
Hoarseness (due to compression of recurrent laryngeal nerves)
Venous distension (due to compression of IJV, SVC)

36
Q

Describe the arterial blood supply of the thyroid, including any variations

A

Paired superior thyroid arteries (from external carotid) anastomose verstically and across the midline with paired inferior thyroid arteries (from thyrocervical trunk off subclavian)
Occasionally (10%) a single thyroid ima artery passes along the isthmus (can come off aorta, brachiocephalic trunk, etc. and ascends in front of the trachea to the thyroid)

37
Q

Describe the venous blood supply of the thyroid

A

3 pairs of veins (superior, middle, inferior thyroid)

38
Q

Describe the development of the thyroid. What is the clinical significance of this?

A

Outgrowth from the floor of the embryonic larynx, descends anterior to the larynx and divides into 2 lobes; foramen caecum marks its point of origin
Nodules of aberrant thyroid tissue may be located anywhere along the path of descent and may become secretory

39
Q

What are the 2 main branches of the subclavian in the neck?

A

Vertebral

Thyrocervical

40
Q

Describe the course of the vertebral artery in the posterior triangle of the neck

A

Passes in the posterior triangle between longus colli and scalenus anterior; travels through the transverse foraminae of C6-C1

41
Q

Where are the roots of the brachial plexus located in relation to the neck and its muscles?

A

Begins in floor of posterior triangle, between scalenus anterior and medius

42
Q

What is the key branch of the cervical plexus (C1-C4)?

A

Phrenic (C3, C4, C5)

43
Q

What parts of the body are supplied by the subclavian system?

A

Upper limb
~1/2 the brain
Most of spinal cord
Part of thoracic wall

44
Q

What superficial and deep structures are supplied by the cervical plexus?

A

Superficial cutaneous branches to skin

Deep motor branches (ansa cervicalis) to “strap” muscles of neck

45
Q

Describe the lymph drainage of the neck

A

Superficial cervical with horizontal and vertical groups

Deep cervical with upper and lower groups

46
Q

What is the clinical significance of the supraclavicular LNs in the lower group of deep cervical LNs?

A

They are the “final sentinel” LNs (enlargement may indicate lymphatic spread of malignancy)

47
Q

What is the clinical significance of the jugulo-digastric/tonsillar LN in the upper group of deep cervical LNs?

A

Drains the palatine tonsil (enlarged in tonsilitis)

48
Q

Where do the horizontal group of superficial cervical LNs run?

A

At the junction of the head and neck

49
Q

Where do the vertical group of superficial cervical LNs run?

A

Along the EJV

50
Q

Describe 5 unique anatomical characteristics of a “typical” cervical vertebra

A

Transverse processes with anterior and posterior tubercles
Transverse foraminae
Bifid spinous processes
Articular surfaces oriented at 45°
“Uncinate” (hook-like) processes on bodies of C3-C6

51
Q

What is the purpose of the transverse mass with anterior and posterior tubercles seen in cervical vertebrae?

A

To provide bony protection for the vertebral arteries

To allow more room for muscular attachments

52
Q

What is the role of postvertebral muscles?

A

Extend the head on the neck, extend cervical spine and help maintain cervical lordosis (the centre of gravity of the head lies in front of the axis of rotation and so muscles are required to maintain its position)

53
Q

List the 3 lateral vertebral muscles. Where in the layers of the neck are they located and where do they attach?

A

Scalenus anterior, scalenus medius, scalenus posterior
Located deep to prevertebral fascia
Attach to anterior and posterior tubercles of the transverse processes

54
Q

What 2 important structures are located between scalenus anterior and medius?

A

Subclavian artery

Brachial plexus

55
Q

What important structure overlies scalenus anterior?

A

Phrenic nerve

56
Q

What type of muscle is longus colli and where is it located? What is its role?

A

Prevertebral muscle
Located deep to the prevertebral fascia
Maintains curvature of cervical lordosis

57
Q

What is a cranial shift and in what % of the population is it present? What are some possible clinical consequences?

A

Elongation of the anterior tubercle to join the manubriosternal junction (may be joined by a fibrous band)
Present in 1% of the population
May cause nerve entrapment (especially of T1, causing difficulty moving hands and intrinsic muscle wasting)

58
Q

What is “vertebra prominens”?

A

C7, due to its long spinous process (longest in the vertebral column)

59
Q

What muscles attach to the spinous process of C2? What is their role?

A

Semispinalis cervicis and the suboccipital muscles

Help to keep C2 stable

60
Q

Where do the C1 and C2 nerve roots pass? What is the clinical significance of this?

A

Pass behind the facet joints
Susceptible to irritation and compression by osteophytic outgrowths (occur in ageing due to rubbing of adjacent surfaces)

61
Q

What other structure (besides the nerve roots) might be damaged by osteophytic outgrowths?

A

The vertebral artery

62
Q

What is the carotid tubercle and why is it so-named?

A

The anterior tubercle of C6
So-named because it separates the carotid artery from the vertebral artery (the carotid can be compressed against it using a finger)

63
Q

Where do osteophytes generally develop with ageing?

A

At the uncovertebral joint

64
Q

What is the typical cause of prolapse at the cervical levels?

A

Trauma (usually A-P due to pattern of F/E)

65
Q

What innervates the plane synovial facet joints of the cervical spine? How are they used in imaging to assess injury?

A

Posterior rami

Look for changes in symmetry of facet joints to identify damage

66
Q

Where is damage generally acquired in an A-P injury?

A

Facet capsule and articular surfaces, as well as supporting ligaments
Compression injury may occur, particularly in initial hyper-extension

67
Q

What types of joints are the atlanto-occipital joints and what structures do they join? Do they have a capsule?

A

2 lateral synovial joints between the occipital condyles and upper surfaces on atlas
Surrounded by a loose fibrous capsule

68
Q

What is the role of the loose fibrous capsule in the atlanto-occipital joints?

A

Permits nodding movements

69
Q

What kind of joints are the atlanto-axial joints and what structures do they join? What type of movement does this allow?

A

3 synovial joints including a median pivot joint between the dens of C2 and a facet on the anterior arch of the atlas, as well as 2 lateral facet joints
Allows ~50% of rotation of cervical spine

70
Q

What is the role of the transverse ligament of C1?

A

Holds dens in place and limits A-P movement to <4mm to prevent endangerment of the spinal cord
NB: RA confers risk of ligament stretch

71
Q

List the 4 ligaments of the cervical spine, including the structure they join

A

Ligamentum nuchae
Posterior atlanto-occipital membrane (between atlas and occiput)
Membrana tectoria (prolongation of posterior longitudinal ligament; between axis and occiput)
Anterior atlanto-occipital membrane (between axis and occiput)

72
Q

What is the role of the ligaments of the cervical spine?

A

Resist movements in the sagittal plane (F/E)

73
Q

What is the role of the alar ligaments? What is their clinical significance?

A

Provide strong “checks” of range of rotation of the atlas around the dens
Susceptible to injury when the head is flex and rotated with relaxation of the muscles

74
Q

What is a hangman’s fracture? What is a common cause?

A

Bilateral extension fracture of pedicles of the axis (spondylolisthesis or “slipping forward” of C2 on C3)
Seen in head-on vehicle collisions where the driver is not wearing a seat belt

75
Q

What is a Jefferson’s fracture? What is a common cause?

A

Bilateral fracture of the anterior arch and pedicles of C1

After a fall onto the vertex of the skull e.g. diving into shallow water

Hannah's Endocrine (8 decks)

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