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Brain and Behaviour > Anatomy of the Neck > Flashcards

Anatomy of the Neck Flashcards

1
Q

what are the two main triangles in the neck

A

posterior and anterior triangle

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2
Q

describe the borders of the posterior triangle

A
  • Posterior border of sternocleidomastoid
  • Anterior border of trapezius
  • Middle 1/3 of clavicle
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3
Q

describe the borders of the anterior triangle

A

– Midline of neck from chin to jugular notch
– Anterior border of sternocleidomastoid
– Lower border of mandible and beyond to mastoid process

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4
Q

what are the important structures inside the posterior triangle

A
  • Spinal accessory nerve (CN XI)
  • External jugular veins runs superficially over SCM
  • Lymph nodes
  • Part of subclavian artery
  • Brachial plexus, cervical plexus, phrenic nerve
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5
Q

where is the prominence of the external jugular vein

A
  • usually visible above the clavicle for short distances - less than 4cm above the sternal angle
  • it disappears as it runs over the SCM
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6
Q

when does the external jugular vein become more prominent

A

• Become more prominent when you have Heart failure, SVC obstruction, enlarged supraclavicular lymph nodes, raised intra-thoracic pressure

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7
Q

what does the external jugular vein helps assess

A

• The EJV helps assess mean right arterial pressure which is identical to central venous pressure

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8
Q

what does the spinal accessory supply

A

• Somatic motor fibres to accessory muscles of breathing (SCM and trapezius)

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9
Q

where is the spinal accessory

A
  • nerves forms from C1-5 spinal cord rootlets
    • Ascend into cranial cavity via foramen magnum
    • Exit through the jugular foramen
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10
Q

the spinal accessory nerve is a purely..

A

motor neurone

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11
Q

recent evidence regarding the spinal accessory nerve

A

Recent evidence suggests that the accessory nerves lacks a cranial root and has no connection to the vagus nerve but needs confirmation

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12
Q

what happens if there is spinal accessory nerve damage

A
  • Weakened shrugging shoulder, atrophy of trapezius, drooping of shoulder
  • Passive shoulder movements within normal range
  • Uni-lateral lesion usually does not produce an abnormal head position
  • Weakeness in turning head to opposite side against resistance
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13
Q

what can cause spinal accessory nerve damage

A
  • Subcutaneous course – injury lymph node surgery
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14
Q

where is the cervical plexus to and from

A

C1-C4

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15
Q

what is the anasa cervicalis

A
  • prat of the cervical plexus
  • C1-C3
  • it is the motto to the infra hyoid muscles
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16
Q

describe the branching of the cervical plexus

A
  • Cutaneous branches emerge around middle of the posterior border of SCM
  • Phrenic nerve C3-C4) picks up additional C5 roots
  • Descend down obliquely with IVJ cross the anterior scalene and passes into thorax
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17
Q

what are the 4 parts of the anterior triangle

A

submandibular, carotid, muscular and submental

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18
Q

describe the 4 parts of the anterior triangle

A

a. Submandibular (digastric) -submandibular gland fills most of triangle, hypoglossal nerve, parts of facial artery and vein
b. Carotid – anatomically important with a lot of structures
c. Muscular – sternohyoid, thyrohyoid and sternothyroid (infrahyoid muscles). Thyroid and parathyroid glands
d. Submental – floor of mouth – mylohyoid

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19
Q

what is the hyoid bone

A

– attachment point for infrahyloid muslces and muscles that are supporting the jaw of the mouth

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20
Q

what are the boundaries of the carotid triangle

A
  • Posterior belly of digastric
  • Superior belly of omohyoid
  • Anterior border of SCM
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21
Q

what goes through the carotid triangle

A

Blood vessels

  • Common carotid artery
  • Internal and external carotid arteries
  • Intenral jugular vein
Nerves 
•	Glossopharyngeal 
•	Vagus
•	Spinal accessory
•	Hypoglossal
•	Cervical sympathetic trunk
•	Ansa cervicalis
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22
Q

what are the carotid carotid triangle contents

A
  • Common carotid – at anterior border of SCM at level of the thyroid cartilage
  • Carotid bifurcation – superior border thyroid cartilage
  • Carotid sinus (IX) baroreceptors
  • Carotid body (IX X) chemoreceptors – carry the information via glossophargenal and vagus to measure carbon dioxide and oxygen content of the blood
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23
Q

the internal carotid has..

A

no branches until it enters the skull

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24
Q

what does the external carotid supply

A

blood supply to the face, neck and skull, inside of the skull and the dura

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25
what are the branches of the external carotid
``` – some anatomists like freaking out poor medical students – Sup. Thyroid a – Ascending pharyngeal – Lingual – Facial – Occipital – Posterior auricular – Superficial temporal – Maxillary ```
26
what is in the carotid sheath
- Common and internal carotid arereis, internal jugular vein and CNX
27
what leaves the carotid sheath
- Escaping upper sheath are CN IX, superior laryngeal N, spinal root of CN XI and CN XIII
28
what uses the internal carotid artery for support
- Ascending sympathetic firbes use internal carotid artery for support
29
where is the anasa cerviclis
- it is over the internal jugular vein
30
the internal jugular is...
usually larger on one side than the other
31
no cranial nerves have...
sympathetic innervation
32
how do you get sympathetic innervation to the head
- Therefore the sympathetic information has to come through the symaptehtic trunk, there are 3 cervical ganglia, they get presynaptic firbes via superior thoracic nerves - Synapse in ganglia to send fibres to – cervical spinal nerves, thoracic viscera, head and neck viscera - Use the internal carotid artery as a guide into the skull
33
what do you get if you damage the cervical sympathetic trunk
Horner’s syndrome or descending fibres in brainstem
34
what are the symptoms of Horner's syndrome
– Contraction of pupil (miosis) – Drooping of superior eyelid (paralysis of smooth muscle in levator palpebrae superioris – ptiosis ) – Sinking of eye (enophthalmos) – Vasodilation and absence of sweating – there is no innervation to the sweat glands so the skin is warm and dry
35
how do you differnate Horner's syndrome from cranial III damage
Differentiate it form cranial nerve III – degree of ptosis is not as great and Crnaial nerve IiI innervates extraoclular eye muscles so the eyes would look down and out
36
what happens if you damage the vagus
- can damage it in dissection of the carotid triangle - Damage or compression of the vagus or recurrent laryngeal nerves during sugery of carotid triangle and may produce an alternation in voice as these nerves supply the laryngeal muscles
37
what is an IVJ puncture used for
- used for access through the brachiocephalic vein into the svc
38
What do pulsations of the IVJ tell us
- internal jugular pulse | - tells us about rich atrial pressure
39
what shows that there is an increase in the IVJ
usually the same as 2cm of water, if it is above that then this shows that there is an increase in pressure
40
when can blood travel up the internal jugular vein
- No valves in brachiocephalic vein and superior vena cava so blood can travel up vein when at ~45o
41
what causes the Internal Jugular vein pulse to rise
- mitral valve disease, - increased pressure in pulmonary circulation - right side of heart problems
42
what are the muscles in the cervical region divided into
supra hyoid and infrahyoid
43
what do the suprhyoid do
- Suprahyoid muscles constitute floor of mouth, providing a base for tongue and elevating hyoid and larynx – swallowing and tone production
44
what muscles makes up the supra hyoid
 Mylohyoid, digastric, stylohyoid
45
what does the infrayoid do
- Infrahyoid (strap) muscles depress hyoid and larynx during swallowing and speaking
46
what muscles make up the infrhyoid
o Sternohyoid, thyrohyoid(undenegat sternothyoid), sternothyroid, omohyoid
47
what innervates the infrahyoud
by annus cerviculars of the cervical plexus
48
what do the extrinsic muscles of the larynx do and what muscles make up them
* Extrinsic muscles move the larynx as a whole | * Supra and infrahyoid muscles
49
what do the intrsic muscles of the larynx do
• Intrinsic muscles move the laryngeal components, altering the length and tension of the vocal folds and size and shape of rima glottides
50
what innervates the muscles of the larynx
* Cricothyroid - superior laryngeal N (CN X) | * All others - recurrent laryngeal N (CN X)
51
what is the rima glottis
this is the aperture between the vocal folds and how tight it is
52
what happens to the rima glottidis in normal respiration
laryngeal muscles released and rima glottides narrow slit
53
what happens to the rima glottidis in deep respiration
vocal ligaments abducted by contraction of posterior cricoarytenoid muscles – rima glottides opens widely to allow more air in
54
describe how phonation happens
o Arytenoid muscles adduct arytenoid cartilages at same time lateral cricoarytenoids moderately adduct vocal ligaments o Air forced between vocal ligaments = sound
55
describe how whispering happens
o Vocal ligaments strongly adducted but relaxed arytenoids
56
what is the two nerves that innervate the larynx
both from the vagus - superior laryngenal nerve - recurrent laryngeal nerve
57
what does the superior laryngeal split into
internal laryngeal nerve | external laryngeal nerve
58
what does the superior laryngeal nerve do
* Internal laryngeal (sensory + autonomic) to larynx above vocal folds * External laryngeal nerve (motor to cricothyroid) – loss ability of pitch
59
what does the recurrent laryngeal nerve do
* Motor to all other intrinsic muscles of the larynx and sensory to area below vocal folds * On left recurrent laryngeal loops under the arch of the aorta * On right recurrent laryngeal loops under the right subclavian artery
60
How can paralysis of the superior laryngeal nerve happen
- Any surgery to the thyroid or growth of the thyroid can compress it and damage it - Can occur during thyroidectomy or through compression - Goitre
61
what does paralysis of the superior laryngeal nerve do
Anaesthesia of superior laryngeal mucosa - Cough reflex (an important protective mechanism) A monotonous voice - Paralysed cricothyroid (unable to vary length and tension – but may go unnoticed)
62
what happens when there is injury to the recurrent laryngeal nerve
- Paralysed vocal folds | - Causes hoarseness/dysphonia

Brain and Behaviour (34 decks)

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