Anatomy/Physiology of Neck Flashcards
Anatomical contents of the neck?
Arteries Veins Nerves Lymph Nodes Lymphatic channels Thyroid gland Parathyroid gland Muscles Trachea
Main artery in neck? What level does it bifurcate?
Common carotid artery
Bifurcates at C4 in ECA & ICA
Branches of the External Carotid Artery in the neck?
Superior thyroid Ascending pharyngeal Lingual Occipital Facial Posterior auricular Maxillary Superficial temporal
About how many lymph nodes are in the head and neck? How are they classified?
600
Described in groups and levels
Describe the structure of the thyroid gland? What hormones does in produce?
2 lobes and an isthmus - just inferior to the larynx
Produces thyroid hormone and calcitonin
What is a thyroglossal cyst?
Easy way to diagnose?
A dilatation of the remnant of the thyroglossal duct
The cyst moves with protrusion of tongue - get patient to stick tongue out
Possible causes of a solitary thyroid nodule?
Cyst - localized haemorrhage Adenoma Carcinoma Lymphoma Prominent nodule in multi-nodular goitre
How should thyroid nodules be investigated?
Fine needle aspiration cytology
USS
What is a cyst?
A sac-like pocket of membranous tissue containing fluid. May become infected
Types of thyroid cancer?
- Papillary
- Follicular
- Medullary
- Anaplastic
Types of cells in the thyroid gland and their functions?
Follicular cells - produces thyroid hormone
Parafollicular C cells - produce calcitonin
Where do papillary tumours arise? How do they spread?
Arise in the follicular cells of the thyroid
Commonly spread via lymphatics
Where do follicular tumours arise? How do they spread?
Arise in the follicular cells of the thyroid
Commonly spread hematogenously
Where do Medullary tumours arise?
Develop in the C cells - 10% familial association (MEN2)
What is anaplastic thyroid cancer? What’s the prognosis like?
Poorly differentiated cancer - may arise from other more differentiated cancers
Very aggressive, poor prognosis
Causes of diffuse thyroid enlargement?
Colloid Goitre Grave’s disease
Thyroiditis
What is a colloid goitre?
Causes?
Non-malignant enlargement of the thyroid gland
Gland hyperplasia
Iodine deficiency
Puberty, pregnancy, lactation
What is Grave’s disease?
Treatment?
Autoimmune disease against thyroid stimulating hormone, causes hyperthyroidism
Treatment:
Anti-thyroids, beta-blockade, radio-iodine
Surgery
What are the indications for a thyroidectomy?
Airway obstruction Malignancy Thyrotoxicosis Cosmesis Retrosternal extension
Causes of multi-nodular goitre?
Grave’s disease
Toxic Goitre (multiple autonomously functioning nodules)
What is Grave’s disease?
Autoimmune disorder which results in hyperthyroidism
How many parathyroid glands are there? What is their function?
4 (usually - located on posterior thyroid)
Regulate calcium and phosphate levels
Signs of parathyroid disease?
Painful stones
Aching bones
Psychic moans
Abdominal groans
Renal failure, osteoporosis, peptic ulceration, renal calculi, polyuria
Investigations for suspected parathyroid disease?
Urea & electrolytes Bloods (creatinine, calcium, phosphate, parathyroid hormone) Vitamin D levels USS CT/MRI (identify ectopic gland)
What can parathyroid disease progress on to?
Adenoma (80%)
Hyperplasia (12%)
Malignancy
Management of parathyroid disease?
Surgical removal of adenomas/hyperplastic glands
If malignancy remove the carcinoma, thyroid gland and associated lymph nodes
4 Fascial layers of the neck?
Pre-tracheal
Pre-vertebral
Deep cervical
Carotid sheath
What is a tracheostomy?
Surgical incision in someones neck to allow passage of a tube into their windpipe
WHERE IS THE INCISION MADE??
Indications for tracheostomy?
Airway obstruction
Airway protection
Poor ventilation in dead space
What is a branchial cyst? How does it present?
Remnant of embryological structure
Presents as enlarged lump anterior to the SCM (usually only presents when infected)
What is a pharyngeal pouch (Zenker’s diverticulum)?
Herniation of the pharyngeal mucosa
- causes dysphagia, voice hoarseness
