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BRAIN AND BEHAVIOUR > Anatomy of the Neck > Flashcards

Anatomy of the Neck Flashcards

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1
Q

What are the boundaries of the posterior triangle in the neck?

A

Medial oblique border = SCM
Lateral border = trapezius
Inferior border = middle third of clavicle

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2
Q

Why may the external jugular vein be more prominent than usual?

A

EJV functions as an internal barometer (pressure monitor), so raised venous pressure causes increased EJV prominence but heart failure, SVC obstruction, enlarged supraclavicular lymph nodes, raised intra-thoracic pressure are all causes

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3
Q

Describe the contents of the posterior triangle in the neck

A

Internal jugular vein, external jugular vein, spinal accessory nerve

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4
Q

How may the spinal accessory nerve be damaged?

A

It has a subcutaneous course and therefore it may be injured in lymph node surgery

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5
Q

What does the spinal accessory nerve innervate in the neck?

A

SCM and trapezius

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6
Q

Describe the path of the spinal accessory nerve

A

Arises as rootless from sides of the spinal cord and ascends into the cranial cavity via foramen magnum and exits through the jugular foramen

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7
Q

Which nerve roots contribute to the cervical plexus?

A

C1-4

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8
Q

Where do the cutaneous branches of the cervical plexus emerge?

A

Around the middle of the posterior border of the sternocleidomastoid muscles

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9
Q

What nerve roots supply the ansa cervicalis?

A

C1-C3

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10
Q

Describe the passage of the phrenic nerve

A

C3 and C4 pick up additional C5 roots and then descend down obliquely with the internal jugular vein, across the anterior scalene muscle and into the thorax

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11
Q

Which plexus provides the motor supply to the infrahyoid muscles?

A

Cervical plexus

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12
Q

What are the borders of the anterior triangle in the neck?

A

Lateral border = SCM muscle
Medial oblique border = midline of neck from chin to jugular notch
Superior border = Lower border of mandible to mastoid process

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13
Q

Name the four further subdivisions of the anterior triangle in the neck

A

Submandibular, sub-mental, carotid and muscular

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14
Q

Describe the submandibular subdivision of the anterior triangle in the neck

A

Submandibular gland fills most of this triangle as well as the hypoglossal nerve and parts of facial artery and vein

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15
Q

Describe the carotid subdivision of the anterior triangle in the neck

A

Highly vascular (common carotid and IJV), contains CN IX, X, XI, XII cervical sympathetic trunk and ansa cervicalis

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16
Q

Describe the muscular subdivision of the anterior triangle in the neck

A

Sternohyoid, sternothyroid, thyrohyoid and omohyoid muscles (infrahyoid muscles). This also contains the thyroid and parathyroid glands.

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17
Q

Describe the sub-mental subdivision of the anterior triangle in the neck

A

Contains the floor of the mouth (mylohyoid)

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18
Q

What is the difference between the internal and external carotid arteries?

A

Internal carotid has no branches until it enters the skull whereas the external carotid has many branches

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19
Q

Describe the borders of the carotid subdivision of the anterior triangle in the neck

A

Posterior belly of the digastric muscle, superior belly of the omohyoid muscle and by the anterior border of the SCM

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20
Q

Where is the common carotid artery palpated?

A

Anterior border of the SCM at the level of the thyroid cartilage; if palpable, this suggests a systolic pressure of at least 40mmHg

21
Q

What are the contents of the carotid sheath?

A

Contains the common carotid artery, internal carotid, IJV, CN X (vagus) ansa cervicalis and lymph nodes

22
Q

Which nerves supply presynaptic fibres to the cervical parts of the sympathetic trunk?

A

Superior thoracic nerves

23
Q

What do the sympathetic cervical ganglia send fibres to?

A

Cervical spinal nerves, thoracic viscera, head and neck viscera

24
Q

How do sympathetic nerve fibres travel back up into the brain?

A

Hitch a lift on the internal jugular vein

25
Q

What are the symptoms of Horners syndrome?

A

Pupil constriction, drooping of eyelid (due to paralysis of smooth muscle in lavatory palpebrae superioris, sinking of the eye, vasodilation and absence of sweating

26
Q

What is the cause of Horners syndrome?

A

Damage to the sympathetic trunk in the neck

27
Q

When may surgical dissection of the carotid triangle be required?

A

To reach the carotid system of arteries, IJV, vagus, hypoglossal nerves or the cervical sympathetic trunk

28
Q

What is IJV puncture?

A

The right IJV is a straight course and can be used with the brachiocephalic vein to enter the superior vena cava

29
Q

What causes the JVP?

A

Pulsations of internal jugular vein; provide information about the heart, specifically right atrial pressure as there are no valves in the brachiocephalic vein or SVC, the blood can travel up the vein when at 45 degrees

30
Q

What may cause a rise in JVP?

A

Mitral valve disease, increased pressure in pulmonary circulation or conditions of the right side of the heart

31
Q

What muscles are in the anterior cervical region?

A

Suprahyoid and infrahyoid

32
Q

What is the suprahyoid muscle?

A

Constitutes the floor of the mouth to form a base for the tongue and elevates the hyoid and larynx –> swallowing and tone production

33
Q

What is the infrahyoid muscle?

A

Depress the hyoid and larynx during swallowing and speaking

34
Q

What is the difference in action of the suprahyoid and the infrahyoid muscles?

A

Suprahyoid elevates hyoid and larynx whereas infrahyoid depresses hyoid and larynx

35
Q

What are the three constrictor muscles of the pharynx?

A

Superior, middle and inferior pharyngeal constrictors

36
Q

What are the longitudinal muscles of the pharynx?

A

Palatopharyngeus, salpingopharyngeus, stylopharyngeus - these are involved with elevating the pharynx during swallowing

37
Q

What is the main innervation to the pharynx?

A

Vagus (CN X)

38
Q

What are the extrinsic muscles of the larynx?

A

Supra and infrahyoid muscles

39
Q

What is the function of the intrinsic muscles of the larynx?

A

These move the laryngeal components and alter the length and tension of the vocal folds and size and shape of the rima glottidis changes

40
Q

What is the rima glottidis?

A

Aperture between the vocal folds

41
Q

How is the rima glottidis affected by normal respiration?

A

Laryngeal muscles relax (ligaments are relaxed) so rima glottidis becomes a narrow slit

42
Q

How is the rima glottidis affected by deep respiration

A

Vocal ligaments are abducted by the contraction of the posterior cricoarytenoid muscle –> rima glottidis opens widely

43
Q

How is sound produced in phonation?

A

Air is forced through the vocal ligaments to make sound

44
Q

What is the function of the posterior cricoarytenoid muscle?

A

The only muscles to open the vocal cords. By rotating the arytenoid cartilages laterally, these muscles abduct the vocal cords and thereby open the rima glottidis

45
Q

What is the function of the lateral cricoarytenoid muscle?

A

Adduct and medially rotate the cartilage, pulling the vocal ligaments towards the midline and backwards and so closing off the rima glottidis

46
Q

What is the innervation to the intrinsic (arytenoid) laryngeal muscles?

A

All the cricothyroid) are innervated by the inferior laryngeal nerve – the terminal branch of the recurrent laryngeal nerve, itself a branch of the vagus nerve. The cricothyroid is innervated by the external branch of the superior laryngeal nerve – again derived from the vagus nerve.

47
Q

How is the rima glottidis affected in phonation?

A

Arytenoid muscles adduct the arytenoid cartilages and simultaneously the lateral cricoarytenoids moderately adduct the vocal ligaments –> air is forced between the vocal ligaments in order to produce sound

48
Q

How is the rima glottidis affected in whispering?

A

Vocal ligaments are strongly adducted (by lateral cricoarytenoids) but the arytenoids are relaxed so air is forced through a larger gap in order to produce a softer sound

49
Q

Outline the three phases of deglutition (swallowing)

A

1) Voluntary phase - movement of food from mouth –> oropharynx, bolus pressed against palate and pushed towards oropharynx by tongue muscles
2) Involuntary and rapid phase - swallowing initiated by food touching oropharynx –> pharynx widens and shortens to receive bolus –> suprahyoid muscles contract –> nasopharynx closes and epiglottis closes off larynx
3) Involuntary phase - sequential contraction of three pharyngeal constrictor muscles

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