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Phase 2 4. Neurology > Anatomy of the neck > Flashcards

Anatomy of the neck Flashcards

1
Q

Define the posterior triangle of the neck

A

Bounded by the posterior border of the sternocleidomastoid muscle, anterior border of the trapezius muscle and the middle third of the clavicle.

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2
Q

Define the anterior triangle of the neck

A

Bounded by the anterior border of the sternocleidomastoid muscle, the inferior border of the mandible and the midline of the neck.

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3
Q

What are the names of the triangles that the anterior triangle can be subdivided into?

A
  • submandibular
  • carotid
  • muscular
  • submental
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4
Q

What is the origin of the sternocleidomastoid muscle?

A

The sternal head originates from the manubrium

The clavicular head originates from the medial third of the clavicle

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5
Q

Where does the sternocleidomastoid muscle insert?

A

Into the mastoid process and lateral half of the superior nuchal line

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6
Q

Describe the innervation of the sternocleidomastoid muscle

A

The spinal root of cranial nerve XI and C2-3

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7
Q

Describe the main actions of the sternocleidomastoid muscle

A

Tilts head to one side i.e. laterally flexes and rotates the head so the face is turned superiorly toward the opposite side; acting together the muscles flex the neck

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8
Q

What is the origin of the posterior scalene muscle?

A

The posterior tubercles of the transverse processes of C4-C6

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9
Q

Where does the posterior scalene muscle insert?

A

2nd rib

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10
Q

What is the innervation of the posterior scalene muscle

A

C6-C8

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11
Q

What is the main action of the posterior scalene muscle

A

Flexes head laterally; elevates the second rib

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12
Q

What is the origin of the middle scalene muscle?

A

The posterior tubercles of transverse processes of C2-C7

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13
Q

Where does the middle scalene muscle insert?

A

the 1st rib

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14
Q

What is the main action of the middle scalene muscle

A

Flexes head laterally; elevates 1st rib

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15
Q

What is the origin of the anterior scalene muscle

A

Anterior tubercles of transverse processes of C3-C6

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16
Q

Where does the anterior scalene muscle insert?

A

1st rib

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17
Q

What is the innervation of the anterior scalene muscle

A

C5-C7

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18
Q

What is the innervation of the middle scalene muscle?

A

C3-C8

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19
Q

What is the main action of the anterior scalene muscle?

A

Flexes head laterally; elevates 1st rib

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20
Q

What is the origin of the digastric muscle?

A

The anterior belly originates from the digastric fossa of the mandible

The posterior belly originates from the mastoid notch

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21
Q

Where does the digastric muscle insert?

A

In the intermediate tendon to hyoid bone

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22
Q

What is the innervation of the digastric muscle?

A

The anterior belly is innervated by the mylohyoid nerve, a branch of the inferior alveolar nerve

The posterior belly is innervated by the facial nerve

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23
Q

What are the main actions of the digastric muscle

A

Depresses the mandible; raises the hyoid bone and steadies it during swallowing and speaking

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24
Q

What is the origin of the sternohyoid muscle?

A

the manubrium of the sternum and medial end of the clavicle

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25
Q

Where does the sternohyoid muscle insert?

A

In the body of the hyoid bone

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26
Q

What is the innervation of the sternohyoid muscle?

A

C1-3 from ansa cervicalis

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27
Q

What is the main action of the sternohyoid muscle?

A

Depresses the hyoid bone after swallowing

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28
Q

What is the origin of the sternothyroid muscle?

A

The posterior surface of the manubrium

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29
Q

Where does the sternothyroid muscle insert?

A

the oblique line of the thyroid lamina

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30
Q

What is the innervation of the sternothyroid muscle?

A

C2 and C3 from ansa cervicalis

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31
Q

What is the main action of the sternothyroid muscle?

A

Depresses the larynx after swallowing

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32
Q

What is the origin of the thyrohyoid muscle?

A

The oblique line of the thyroid cartilage

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33
Q

Where does the thyrohyoid muscle insert?

A

The body and greater horn of the hyoid bone

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34
Q

What is the innervation of the thyrohyoid muscle?

A

C1 via hypoglossal nerve

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35
Q

What is the main action of the thyrohyoid muscle?

A

Depresses the hyoid bone and elevates the larynx when the hyoid bone is fixed

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36
Q

What is the origin of the omohyoid muscle?

A

The superior border of the scapula near the suprascapular notch

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37
Q

Where does the omohyoid muscle insert?

A

The inferior border of the hyoid bone

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38
Q

What is the innervation of the omohyoid muscle?

A

C1-C3 from ansa cervicalis

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39
Q

What is the main action of the omohyoid muscle?

A

Depresses, retracts and fixes the hyoid bone

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40
Q

What is the origin of the mylohyoid muscle?

A

The mylohyoid line of the mandible

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41
Q

Where does the mylohyoid muscle insert?

A

In the raphe and body of the hyoid bone

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42
Q

What is the innervation of the mylohyoid muscle?

A

Mylohyoid nerve, a branch of the inferior alveolar nerve of V3

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43
Q

What is the main action of the mylohyoid muscle?

A

Elevates the hyoid bone, floor of mouth, and tongue during swallowing and speaking

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44
Q

What is the origin of the stylohyoid muscle?

A

The styloid process

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45
Q

Where does the stylohyoid muscle insert?

A

In the body of the hyoid bone

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46
Q

What is the innervation of the stylohyoid muscle?

A

The facial nerve

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47
Q

What is the main action of the stylohyoid muscle?

A

Elevates and retracts the hyoid bone

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48
Q

Which structures are contained in the carotid sheath?

A

The common carotid artery
The internal jugular vein
The vagus nerve

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49
Q

What are the three main fascial layers found in the neck?

A

The investing layer
The pretracheal layer
The prevertebral layer

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50
Q

What structures are surrounded by the investing fascial layer?

A

Surrounds the neck, and invests the trapezius and sternocleidomastoid muscles

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51
Q

What structures are surrounded by the pretracheal fascia layer?

A

(visceral) limited to the anterior neck

Invests the infrahyoid muscles, thyroid gland, trachea and oesophagus
Posteriorly called the buccopharyngeal fascia because it covers the buccinator and pharyngeal constrictor muscles

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52
Q

What structures are surrounded by the prevertebral layer?

A

Invests the prevertebral muscles and vertebral column

Includes the alar fascia anteriorly

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53
Q

What is the action of the suprahyoid muscles?

A

Raise the hyoid bone toward a stabilized mandible during swallowing

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54
Q

What is the action of the infrahyoid muscles?

A

Depress the hyoid bone and larynx during swallowing and vocalisation.

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55
Q

Name the suprahyoid muscles

A
  • Digastric muscle
  • Mylohyoid muscle
  • Stylohyoid muscle
  • Geniohyoid muscle (also extrinsic muscle of the tongue)
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56
Q

Name the infrahyoid muscles

A
  • Sternohyoid muscle
  • Sternothyroid muscle
  • Thyrohyoid muscle
  • Omohyoid muscle
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57
Q

What is the arterial blood supply to the neck?

A

The subclavian artery and some of the branches of the external carotid artery

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58
Q

What are the three descriptive divisions of the subclavian artery?

A

Part 1 - medial to the anterior scalene muscle
Part 2 - posterior to the anterior scalene muscle
Part 3 - lateral to the anterior scalene muscle

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59
Q

How many cervical vertebrae are there?

A

7

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60
Q

What is the normal shape of the cervical spine?

A

Lordosis

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61
Q

What structure can be found at C2-3?

A

The mandible

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62
Q

What structure can be found at level C3?

A

The hyoid bone

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63
Q

What structure can be found at level C4-5?

A

Thyroid cartilage

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64
Q

What structure can be found at level C6?

A

Cricoid cartilage

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65
Q

What structure can be found at level C7

A

Vertebra prominens

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66
Q

What is the distinguishing characteristics of C1

A

Ringlike bone
superior facet articulates with occipital bone
two lateral masses with facets
No body or spinous process
C1 rotates on articular facets of C2
Vertebral artery runs in groove on posterior arch

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67
Q

What is the distinguishing characteristics of C2

A

Dens projects superiorly

Strongest cervical vertebra

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68
Q

What is the distinguishing characteristics of C3 to C7?

A

Large triangular vertebral foramen

Transverse foramen, through which vertebral artery passes (except C7)

69
Q

What is the distinguishing characteristic of C3 to C5?

A

Short bifid spinous processes

70
Q

What the distinguishing characteristic of C6 to C7?

A

Long spinous process

71
Q

What is the distinguishing feature of C7?

A

Vertebra prominens; nonbifid

72
Q

Name the craniovertebral joints

A
  • The atlanto-occipital
  • The atlanto-axial

Both synovial

73
Q

What movement does the atlanto-occipital joint facilitate?

A

Flexion and extension

Nodding of the head, yes

74
Q

What movement does the atlanto-axial joint facillitate?

A

Rotation of the head side to side

Shaking of the head, no

75
Q

Name the ligaments of the antalnto-occipital joint

A
  • The articular capsule

- The anterior and posterior membranes

76
Q

What is the attachments and function of the articular capsule?

A

Surrounds facets and occipital condyles

Allows flexion and extension

77
Q

What is the attachments and function of the anterior and posterior membranes?

A

Anterior and posterior arches of C1 to foramen magnum

Limit of joint movement

78
Q

Name the ligaments of the atlanto-axial joint

A
  • Tectorial membrane
  • Apical
  • Alar
  • Cruciate
79
Q

What is the attachments and function of the tectorial membrane

A

Axis body to margin of foramen magnum

Is continuation of posterior longitudinal ligament (prevents hyperflexion)

80
Q

What is the attachments and function of the apical ligament

A

Dens to occipital bone
Is very small

Vestigial structure

81
Q

What is the attachments and function of the alar ligament?

A

Dens to occipital condyles

Limits rotation

82
Q

What is the attachments and function of the cruciate ligament?

A

Dens to lateral masses
Resembles a cross

Allows rotation

83
Q

Name the joints present between the vertebral arches

A
  • Zygapophysial (plane synovial) joint

- Intervertebral (secondary cartilaginous [symphyses]) joint

84
Q

What ligament is found in zygapophysial joints?

A

Articular capsule.
Surrounds facets and allows gliding motion.
C5-6 is most mobile.

85
Q

What ligaments are found in intervertebral joints?

A
  • Anterior longitudinal
  • Posterior longitudinal
  • Ligamenta flava
  • Interspinous
  • Supraspinous
  • Ligamentum nuchae
  • Intertransverse
  • Intervertebral discs
86
Q

What is the attachments and function of the anterior longitudinal ligament?

A

Anterior bodies and intervertebral discs

Is strong and prevents hyperextension

87
Q

What is the attachments and function of the posterior longitudinal ligament

A

Posterior bodies and intervertebral discs

is weaker than AL and prevents hyperextension

88
Q

What is the attachments and function of the ligamenta flava?

A

connects adjacent laminae of vertebrae

Limits flexion and are more elastic

89
Q

What is the attachments of the interspinous ligaments?

A

Connect spines

90
Q

What is the attachments and function of the supraspinous ligaments?

A

Connect spinous tips

Limits flexion

91
Q

What is the attachments and function of the ligamentum nuchae?

A

C7 to occipital bone
Is the cervical extension of the supraspinous ligament

Limits flexion

92
Q

What is the attachments of the intertransverse ligaments?

A

Connects transverse processes

93
Q

What is the attachments and function of the intervertebral discs?

A

Between adjacent bodies
Are secured by AL and PL ligaments

Provides cushioning

94
Q

Where is the thyroid gland found?

A

At the level of C5-T1, anterior to the trachea

95
Q

Describe the anatomical structure of the thyroid gland

A

Has a right and left lobe connected by a thin isthmus

50% of patients have a pyramidal lobe that extends superiorly from the isthmus

96
Q

At what level is the isthmus of the thyroid found?

A

Anterior to the second to fourth tracheal cartilage rings

97
Q

What fascial layer surrounds the thyroid?

A

The visceral layer of the pretracheal fascia

98
Q

Describe the blood supply and venous drainage of the thyroid gland

A
  • Superior and inferior thyroid arteries

- Superior, middle and inferior thyroid veins

99
Q

Define the larynx

A

A musculoligamentous and cartilaginous structure

100
Q

At what level is the larynx found?

A

C3-C6

superior to the trachea

101
Q

What is the function of the larynx

A

A sphincter to close off the airway

As a ‘reed’ instrument to produce sound

102
Q

How many cartilage rings does the larynx contain?

A

9

103
Q

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

A

Adjust the tension of the vocal folds, to open or close the rima glottidis and to open or close the rima vestibuli

104
Q

Name the laryngeal cartilages

A
  • Thyroid
  • Cricoid
  • Epiglottis
  • Arytenoid
  • Corniculate
  • Cuneiform
105
Q

Describe the thyroid cartilage

A

Two hyaline laminae and laryngeal prominence (adam’s apple)

106
Q

Describe the cricoid cartilage

A

Signet ring-shaped hyaline cartilage just inferior to thyroid

107
Q

Describe the epiglottis cartilage

A

Spoon-shaped elastic plate attached to thyroid cartilage

108
Q

Describe the arytenoid cartilage

A

Paired pyramidal cartilages that rotate on cricoid cartilage

109
Q

Describe the corniculate cartilage

A

Paired cartilage that lie on the apex of arytenoid cartilage

110
Q

Describe the cuneiform cartilage

A

Paired cartilages in ary-epiglottic folds that have no articulations

111
Q

Which nerve innervates the intrinsic laryngeal muscles?

A

Recurrent branch of cranial nerve X, except for the cricothyroid muscle, which is innervated by the external branch of the superior laryngeal nerve (CNX)

112
Q

Where is the sympathetic trunk found?

A

Lateral to the vertebral bodies, the entire length of the vertebral column.

113
Q

What is the origin of the trapezius muscle?

A

The superior nuchal line, external occipital protuberence, nuchal ligament and spinous processes of C7-T12.

114
Q

Where does the trapezius muscle insert?

A

Lateral third of the clavicle, acromion and spine of scapula

115
Q

What is the innervation of the trapezius muscle?

A

Accessory nerve (CN XI) and C3-C4

116
Q

What is the main action of the trapezius muscle?

A

Elevates, retracts and rotates the scapula

Lower fibers depress the scapula.

117
Q

Name the branches found in part 1 of the subclavian artery

A
  • Vertebral
  • Internal thoracic
  • Thyrocervical trunk
118
Q

Name the branch in part 2 of the subclavian artery

A

Costocervical trunk

119
Q

Name the branch in part 3 of the subclavian artery

A

Dorsal scapular

120
Q

Describe the course of the vertebral branch of the subclavian artery

A

Ascends through C6 to C1 transverse foramena and enters the foramen magnum

121
Q

Describe the course of the internal thoracic branch of the subclavian artery

A

Descends parasternally to anastomose with superior epigastric artery

122
Q

Describe the course of the thyrocervical trunk branch of the subclavian artery

A

Gives rise to the inferior thyroid, transverse cervical and suprascapular arteries

123
Q

Describe the course of the Costocervical trunk branch of the subclavian artery

A

Gives rise to the deep cervical and superior intercostal arteries

124
Q

Describe the course of the dorsal scapular branch of the subclavian artery

A

Is inconsisitent

125
Q

Which vessels drain into the subclavian vein?

A

Internal jugular vein, and the tributaries of the retromandibular vein and external jugular vein

126
Q

What vessel does the subclavian vein drain into?

A

The brachiocephalic vein along with the internal jugular vein

127
Q

Describe the separate areas of the brachial plexus

A
  • 5 roots
  • 3 trunks
  • 6 divisions (3 anterior divisions, 3 posterior divisions)
  • 3 cords
  • 5 terminal branches

(remember to drink cold beer)

128
Q

Where does the brachial plexus arise from?

A

The ventral rami of spinal nerves C5-T1

129
Q

Which motor nerve branch arises from the roots of the brachial plexus?

A

The dorsal scapular nerve (Innervates the levator scapulae and rhomboids)

130
Q

Which motor nerve branches arise from the superior trunk of the brachial plexus?

A
  • Long thoracic nerve (innervates the serratus anterior)

- Suprascapular nerve (innervates the supraspinatus and infraspinatus)

131
Q

Which motor nerve branches arise from the lateral cord of the brachial plexus?

A
  • subclavius (innervates the subclavius)
  • lateral pectoral (innervates the pectoralis major)
  • musculocutaneous (innervates the anterior compartment of the arm
132
Q

Which motor nerve branches arise from the medial cord of the brachial plexus?

A
  • Medial pectoral (innervated pectoralis minor and major)

- Ulnar (innervates some forearm and hand muscles)

133
Q

Which motor nerve branch arises from the medial and lateral cords of the brachial plexus?

A

the median nerve (innervates most of the forearm and some of the hand muscles)

134
Q

Which motor nerve branches arise from the posterior cord of the brachial plexus?

A
  • The upper subscapular (innervates the subscapularis)
  • The thoracodorsal (innervates the latissimus dorsi)
  • The lower subscapular (innervates the subscapularis and teres major)
  • The axillary (innervates the deltoid and teres minor)
  • The radial (innervates the posterior compartment muscles of the arm and forearm)
135
Q

Where is the root of the neck?

A

Medial to the first rib

136
Q

Where is the first rib in relation to the clavicle and manubrium?

A

Inferior moving posteriorly.

It is attached to the manubrium by the first costal cartilage

137
Q

Which organ sits in the root of the neck?

A

The apex of the lung

138
Q

Which vein is found in the root of the neck?

A

The subclavian vein

139
Q

Which vessel is found when you follow the subclavian vein medially?

A

The internal jugular vein towards the midline of the neck

140
Q

Which vessel is found when you follow the subclavian vein laterally?

A

The axillary vein - once the subclavian vein passes the first rib iferolaterally, it becomes known as the axillary vein

141
Q

Where does the cervical sympathetic trunk originate from?

A

T1 and T2 spinal nerves

142
Q

What is the stellate ganglion?

A

A star shaped ganglion on the neck of the first rib

143
Q

Which two rami form the lower trunk of the brachial plexus?

A

Ventral ramus of C8 and ventral ramus of T1

144
Q

What is the arterial supply to the root of the neck?

A

The common carotid artery branches into the subclavian artery that runs laterally to the subclavian vein

145
Q

What is the brachiochephalic trunk?

A

Where the common carotid artery and the subclavian artery join and travel down behind the manubrium

146
Q

Where does the sympathetic trunk travel?

A

From the base of the skull to the superior aperture of the thorax where it is continuous with the thoracic part of the trunk

147
Q

What are the names of the three sympathetic ganglion found in the cervical region?

A
  • The superior cervical sympathetic ganglia
  • The middle cervical sympathetic ganglia
  • The inferior cervical sympathetic ganglia
148
Q

What is different about the inferior cervical sympathetic ganglia

A

It usually fuses with the first thoracic ganglion to form the cervicothoracic ganglion (stellate ganglion)

149
Q

Name the lymph nodes found in the head and neck

A
  • Parotid/pre-auricular nodes
  • Posterior auricular/retro-auricular nodes
  • Occipital nodes
  • Jugulodigastric node
  • Submental nodes
  • Submandibular nodes
  • Deep cervical nodes
  • Superficial cervical nodes
  • Juguloomohyoid node
  • Supraclavicular nodes
150
Q

Where are the parotid/pre-auricular nodes found?

A

In front of the ear along the surface of the parotid salivary glands (sometimes imbedded within the superficial aspect of the salivary glands)

151
Q

What areas does the parotid/pre-auricular nodes drain?

A

The areas of the face from before the ear to the imaginary line from the inner eyelid to the mandible

152
Q

Where are the posterior-auricular/retro-auricular nodes found?

A

Lie in the soft tissue in the area behind the ear towards the base of the skill

153
Q

What areas does the posterior-auricular/retro-auricular nodes drain?

A

They drain the lymph from behind the ear down to the base of the skull.

154
Q

Where are the submental lymph nodes found?

A

In the area under the chin

155
Q

What areas do the submental lymph nodes drain?

A

Drains the tip of the tongue, the area of the lower lip and the area inside the cheek (incisor teeth)

156
Q

Where are the submandibular lymph nodes?

A

Tucked under the mandible

157
Q

What areas do the submandibular nodes drain?

A

They drain most of the tissues of the mouth and much of the face in addition to the nasal cavity and maxillary sinus.

158
Q

Where are the occipital lymph nodes found?

A

Posterior skull on the occipital bone

159
Q

What areas do the occipital lymph nodes drain?

A

The lymph from the posterior part of the skull

160
Q

Where are the deep cervical nodes found?

A

Follow down the jugular vein

161
Q

What areas do the deep cervical lymph nodes drain?

A

They receive lymph from the higher nodes and from many structures in the neck, such as the thyroid and larynx and the deep structures of the head

162
Q

Where are the superficial cervical nodes found?

A

Within the posterior triangle

163
Q

What areas do the superficial cervical nodes drain?

A

Drains lymph from structures within the posterior triangle

164
Q

Where is the jugulodigastric node found?

A

At the junction between the digastric muscle and the internal jugular vein

165
Q

What areas does the jugulodigastric node drain?

A

The palatine tonsils, which is why this node is phsyiologically large

166
Q

Where is the juguloomohyoid node found?

A

At the junction of the internal jugular vein and the omohyoid muscle

167
Q

What structures does the juguloomohyoid node drain?

A

The lingual tonsil at the posterior aspect of the tongue.

This is why this tonsil is physiologically large

168
Q

Where is the supraclavicular node found?

A

Above the clavicle at the base of the posterior triangle

169
Q

What structures do the supraclavicular nodes drain?

A

Drain the lymphatics from the neck but also associated to the lymphatics of the chest.

Phase 2 4. Neurology (29 decks)

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