Anatomy-Superficial and Deep Neck Flashcards
All the muscles of the neck are encircled by cervical investing fascia except for the (blank)
platsyma
How many compartments are there in the cervical cross section?
four
What is the most superficial muscle relative to the cervical compartments? Describe its position more thoroughly
the platysma
on top of the investing fascia and deep to and within the superficial fascia
What is the origin and insertion of the investing fascia of the cervical area?
Starts at clavical and inserts at zygomatic arch and attaches to superior temporal line above the attachment of the temporalis muscle.
What are the 2 ridges on the temporal bone for?
One for attachment of the temporalis (lower one) and one for the cervical investing fascia (higher one)
What is inside of the carotid sheath?
common carotid, internal carotid, internal jugular vein, vagus, branches of CN 9, deep nodes
What is right outside of the carotid sheath in the retropharyneal space (danger space)?
the sympathic trunk
What is the SCM surrounded by on both sides?
superifical cervical investing fascia
What does the prevertebral fascia surround?
all the muscles associated with vertebral muscles (intrinisic back muscles)
When the prevertebral fascia reaches anterior border of veterbral body it splits off and forms 2 layers. What are these 2 layers? What do these make?
alar layer and vertebral layer
the retropharyngeal space
What fascia is in between the esophagus and the alar layer of the prevertebral fascia?
the buccopharyngeal fascia
What fascia surrounds the larynx, esophagus, trachea, thyroid gland and STRAP muscles?
the pretracheal fascia
What are the 2 layers of the deep cervical fascia?
the superficial investing layer and the prevertebral layer
What is the visceral compartment?
the compartment covered by pretracheal fascia
Why is the retropharyngeal space dangerous?
Can conduct infection from base of skul to the thorax (superior mediastinum)
What does the retropharyngeal space allow you to do?
move your esophagus and larynx during swallowing
What are the four superficial veins of the neck?
Facial External Jugular Anterior Jugular Internal Jugular F A E I There are Four..... then start naming vowels. A E I.
Where does the facial vein drain into?
the internal jugular
What is super scary about superficial veins?
they can be easily cut which will result in air getting into them and causing an air embolis which will cause immediate block to blood flow in the heart!!
If someone has an air embolism due to a cut of a superficial vein what should you do?
choke em out and pin em on the floor (cuts off air flow and reduces neg pressure)
anterior jugular and external jugular drain into the (blank)
subclavian
What is the main drainage of the superficial veins?
the internal jugular
What are the boundaries of the posterior triangle of the neck?
SCM (medially)
trapezius (laterally)
and the clavicle (inferiorly)
What structures are found in the posterior triangle of the neck?
11 CB (play with) Scales and Sets Nerves: Cn 11 cervical plexus, roots of brachial plexus
Arteries and Veins: suprascapular artery external jugular vein transverse cervical artery subclavian artery
Muscles:
scalene muscles
myohyoid
The roots of the brachial plexus are between what two muscles?
the medial and anterior scalene muscles
What are the boundaries of the anterior triangle?
mandible
anterior midline
SCM
What are the important structures within the anterior triangle of the neck?
carotid sheath and contents
ansa cervicalis
thyroid gland
many muscles and viscera
What is the most important anterior triangle?
carotid triangle
Where will you find the cervical plexus nerves, behind or in front of the sternoclidomastoid?
behind
What are the four triangles of the anterior triangles of the neck?
carotid
submandibular
submental
muscular
What makes up the muscular floor of the the posterior triangle?
- brachial plexus b/w anterior and middle scalenes
- levator scapulae
- scalene muscles (3)
- inferior belly of omohyoid
BLIS :)
What’s the difference between thoracic outlet syndrome and scalenus anticus syndrome?
thoracic outlet syndrome is a problem bone to bone or tendon to bone (i.e you get squished because your clavicle squeezes against your first rib)
Scalenus anticus syndrome is when you anterior and middle scalene squeezes your brachial plexus or subclavian artery
What does scalenus anticus syndrome cause?
causes numbness and ischemia due to compression of subclavian artery and the brachial plexus nerves
What are the cutaneous branches of the cervical plexus?
lesser occipital
great auricular
transverse cervical
supraclavicular
The cutaneous branches of the cervical plexus are embedded where?
in the investing fascia
Where does the lesser occipital nerve run? Is this a ventral or a dorsal ramus?
runs up to the posteriorlateral side of head
ventral ramus
**remember the greater occipital is a dorsal ramus*
Where does the great auricular nerve run?
comes up behind SCM and up towards the ear (supplies similiar to lesser occipital but does more of the ear)
Where does the transverse cervical nerve run?
goes straight across the neck and innervates the anterior lateral surface of the neck
What does the supraclavicular nerve branch into? What does it do?
it goes down and branches into intermediate, medial and lateral.
It gives sensory innervation to clavicle and onto shoulder
What will C1-C4 gives branches to? Which are the major contributors to this?
the cervical plexus
C2,3,4
C2 and C3 will combine and go up to form what 2 nerves?
great auricular nerve
lesser occipital nerve
What nerves will come off of C2 and head and connect with C1 to make a large loop?
the anca cervicalis
What come off of C1 and travels with the hypoglossal nerve (CN 12)?
geniohyoid and thyrohyoid
Which nerves of the cervical plexus make up the phrenic?
345 keep the diaphragm alive
What does the phrenic lie on top of? What does the phrenic nerve lie behind? Why is this signif?
the anterior scalene
SCM
Because when trying to anesthatize the cervical plexus you need to watch out for that pesky phrenic :)
Is the phrenic nerve in a triangle?
nope
What all does the C1 of the cervical plexus give off?
the descending branch of the ansa cervicalis (which connects to the ascending branch from C2) and a nerve to the geniohyoid muscle and thryohyoid muscle
What does the ansa cervicalis supply?
all other infrahyoid muscles
What do you find running between the common cartoid and internal jugular vein?
the vagus
What do you find on top of the internal jugular vein?
the ansa cervicalis
What do you find lateral to the internal jugular vein?
the phrenic
Which is more lateral, the common carotid or internal jugular vein?
internal jugular vein
What does C3 and C4 combine to create that goes inferior?
supraclaviculars nerve and the phrenic nerve
What does C2 and C3 combine to create that goes horizontal?
transverse cervical
What nerve runs with C1?
hypoglossal
Inflamed gallbladder can irritate peritoneum on undersurface of the (blank)
diaphragm
(blank) provides somatosensory innervation to the diaphragm, including the periotneum
phrenic
Pain from the diaphragm enters dorsal horns of cervical nerves (blank, blank, blank)
C3,C4,C5
The (blank) nerve arises from C3 and C4 and innervates skin over the shoulder
Supraclavicular nerve
Any pain close to the diaphragm will refer to the (blank) because of the cervical plexus
shoulder
i.e diaphram, gall bladder, liver can refer to shoulder due to overlap of fibers onto the same dorsal horn area
Tell me where the hypoglossal nerve comes from, what it goes through and what it gives
from hypoglossal nucleus-> through hypoglossal canal-> gives motor to tongue muscles and all muscles with glossus in the name except for palatoglossus
If you damage your hypoglossal nerve you wont be able to (blank)
talk
What do you call a lower motor neuron issue that doesnt allow you to speak?
dysarthria
What do you call a upper motor neuron issue that doesnt allow you to speak?
aphasia
ALl the muscles that control the palate are innervated by CN (blank) except for the tensorpalantine.
10
Anything that starts with a T or sounds like it starts with a T (like pterygoid) is innerated by (Blank)
CN 5
The wide variety of muscles attaching to the hyoid bone allow it to (blank) and (blank) in vocalization and swallowing.
elevate and depress
What bone does the hyoid bone articulate with?
IT DOESNT it is just a floating bone
How can you palpate the hyoid bone?
you hole one side steady and then you can palpate the greater horn on the opposing side
If you pull down on the hyoid bone then the hyoid muscles will be accessory (blank)
jaw openers
What muscles makes up the floor of the mouth?
mylohyoid
What muscle extends from the styloid process of the mandible to the hyoid?
stylohyoid
What lays superficial to the mylohyoid and meets at the chin?
the anterior belly of the diagastric
What innervates the posterior belly of the digastric?
CN 7
What innervates the anterior belly of the digastric?
CN 5
What innervates the mylohyoid?
CN V3
What muscles is deep to the mylohyoid?
the genohyoid
What are the deep muscles that are below they hyoid bone?
The strap muscles (infrahyoid muscles)
What makes up the infrahyoid/ Strap muscles?
The four infrahyoid muscles are; the sternohyoid, sternothyroid, thyrohyoid and omohyoid muscles.
What muscle extends from the omohyoid tubercle on the scapula all the way to the hyoid bone with a superior and inferior belly that is held down by a fascial sling?
omohyoid
What muscle is on top of the thyrohyoid and the sternothyroid?
the sternohyoid
THe supra hyoids are for the most part innervated by (blank) except for the geniohyoid (done by C1)
CN
The infrahyoids, aka strap muscles, are innervated by the (blank)
cervical plexus
What muscle splits around the digastric muscle?
stylohyoid
Where does the stylohyoid come from and what is it innervated by?
comes from the second brachial arch and is innervated by CN 7
Where does the styloglossus muscle coem from and what innervates it?
derived from postotic somites and is innervated by CN 12
Where does the stylopharyngeus come from and what innervates it?
derived from branchial arch 3 and is innervated by CN 9
What are the muscles of the styloid process?
stylohyoid
styloglossus
stylopharyngeus
What are the four suprahyoid muscles?
mylohyoid
geniohyoid
stylohyoid
digastric (anterior and posterior bellies)
What muscles pierces right through the submanibular gland?
the mylohyoid
What nerve passes superior to the submanidular gland?
lingual nerve
What is the origina and insertion of the geniohyoid muscle?
the hyoid bone and the genial tubercle of the mandible
What is the mylohyoid muscle innervated by?
V3
What are the boundaries of the anterior triangle?
anterior border of SCM
anterior midline of neck
Mandible
What are the borders of the muscular triangle?
midline of neck
anterior margin of sternocleidomastoid
superior belly of omohyoid
What is on TOP of the carotid sheath?
ansa cerivicalis
What does the carotid sheath contain?
common carotid artery
internal jugular vein
vagus nerve
Which part of the carotid DOESNT have branches until it enters the cranial cavity?
Internal carotid artery
What does the external carotid artery have branches to?
the face and neck
Are there anastomotic connections between the external and internal carotid?
yes!
What part of the carotid goes to the cranial cavity?
internal carotid
Describe the path of the internal carotid
runs up to carotid canal makes sharp bend in cavernous sinus and ends in circle of willis.
Describe the path of the vertebral artery
Comes off of subclavian and goes up from C6 to C1 through transverse foramen and then courses over lamina of C1 and goes into foramen magnum and then goes to basilar then to circle of willis
Foramen spinosum and formane ovale are in what bone?
sphenoid
The foramen of the cartoid canal and jugular foramen come out of what bone?
temporal
Where does the carotid canal lead to?
middle cranial fossa
Where does the jugular foramen lead to?
posterior cranial fossa
The carotid and jugular are very close but (blank) very quickly
diverge
What passses over the top of the foramen lucerum?
the internal carotid artery
What is a swelling at the origin of the internal cartoid artery?
carotid sinus
What is the carotid sinus innervated by?
CN 9
What is the carotid sinus?
a baroreceptor
What is a mass of tissue at the bifurcation of the common carotid artery?
carotid body
What is the carotid body innervated by?
CN 9
The external carotid has these structure that the internal doesnt.
branches
Where does all viscerent afferent innervation go in the brainstem?
to the caudal part of the solitarious where they ascend to cranial avity
If you have carotid sinus and body to detect changes in pressure how come you don’t always have normal pressure?
because they adapt and only respond to transience.
What is right next to the nucleus solitariuos?
DMX
What CN does the baroreceptors (carotid sinus) use?
In on 9, out on 10
The carotid body and sinus utilize reflexes so what nerve and nucleus might they use?
vagus via dorsal motor nucleus and some sympathetics and parasympathetics
What foramen does the lesser petrosal go through?
the foramen ovale
The sensory fibers from carotid body and sinus are going into the general visceral efferent nuclei (solitarius) and out on either 10 or (blank)
sympathetics
What are the branches of the external carotid?
Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial Temporal
What is interesting about the lingual and facial artery?
they sometimes come off the external carotid as a combined lingual facial trunk
What is the very first branch off the vagus?
the pharyngeal branch
What is the second branch off the vagus? WHat does it do?
superior laryngeal nerve
gives a branch to the internal portion of the larynx and an external branch going to muscle
What should you be worried about during thyroid surgery?
recurrent laryngeal of the vagus
What are the 2 branches off the superior laryngeal nerve of the vagus?
internal branch and external branch
What does the internal branch of the superior laryngeal nerve (comes off vagus) do?
sensory above the vocal cords
What does the external branch of the superior laryngeal nerve (comes off vagus) do?
motor to cricothyroid (part of larynx)
What does the recurrent laryngeal do?
sensory below vocal cords
motor to all other muscles of the larynx (cricothyroid is part of larynx)
Where does the recurrent laryngeal recur?
around either the subclavian artery or the aortic arch
What is worrisome about the course of the recurrent laryngeal?
On the left side it has a long course down into the thorax and onto the ligamentum arteriosum which means lung cancer can spread here :(
What cranial nerves does the cough reflex use?
in on 9, out on 10
What cranial nerves does the gag reflex use?
in on 9 out on 10
What kinds of fibers does vagus have?
general sensory, viscerosensory, visceromotor, branchiomotor
Where do you find DMX and what does it contain?
in mid medulla and contains GVE :)
Where do you find the nucleus solitarius?
in the medulla next to DMX
What does the inferior ganlion of X provide?
taste to the epiglottis and motor to the thorax and abdomen
What does the superior ganglion of X provide?
Sensory to the ear and lower pharynx
What do the pregang. parasympathetics go from CN X?
to ganglia in heart, thorax, and abdomen
What does the nucleus ambiguus do for CN X?
it provides motor innervation to the striated muscle of soft palate, pharynx, larynx and upper esophagus
Where do they superior thyroid arteries originate from?
Where do they inferior thyroid arteries originate from?
external carotid artery
subclavian arteries via the thyrocervical trunk
The brachiocephalic artery branches into what 2 things?
the right subclavian artery and the common carotid
How is the right subclavian artery connected to the carotid?
via the thryocervical trunk
Where does the vertebral and the inferior thyroid artery come off of?
the subclavian artery
There is an (blank) between thesuperior and inferior thyroid arteries.
anastomoses
the superior thyroid vein drains into the (blank)
internal juguar vein
the middle thyroid vein drains into the (blank)
internal jugular vein
The inferior thyroid vein drains into the (blank)
brachiocephalic vein
What is the pyramidal lobe?
the weird tongue like projection on the thyroid gland that strangly enough is a remnant of the descent from the tongue
A (blank) is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive facial trauma.
cricothyrotomy (coniotomy)
(blank) is an incision in the windpipe made to relieve an obstruction to breathing
tracheostomy
The thyroid gland develops at the base of the (blanK) and can leave remnants in many places.
tongue
Where are places to find aberrant thyroid tissue?
lingual intralingual thyroglossal tract sublingual thyroglossal cyst prelaryngeal intratracheal substernal
Preganglionic fibers from the sympathetic trunk ascend from the (blank)
thorax
Where do sympathetics to the head synpase?
T1, T2, T3
Where do postganglionic sympathetics go?
join cervical spinal nerves and travel on blood vessels to the head (like the internal carotid)
The preganglionic parasympathetics can synapse in the superior middle and inferior, however depending on where they synapse determines where they go… tell me where they go please
superior goes to head
middle and inferior can go to head or neck
What does disruption of the sympathetic chain cause (horners syndrome)?
ptosis
flushed face
dry face
constricted pupil
How can you get horner’s syndrome?
cutting sympathetic chain above T1
damage to T1-T3 preganglionic neurons in the lateral horn
damaging outflow to the head that is traveling on internal carotid
damage to input on sympathetic preganglioncs (inside spinal corn)
(i.e can get it in chain, spinal cord, carotid atery, brainstem)
What are the branches of the subclavian artery??
Vertebral Internal Thoracic Thyrocervical Trunk -Inferior thyroid -Transverse cervical -Suprascapular Costocervical
VIT C
T=> ITS
What is more anterior, the subclavian vein or artery?
subclavian vein (vein is ventral)
Where do you find the deepest nodes of the neck and what is especially important about them?
find them on the internal jugular and all the superficial nodes will go to the deep nodes before going to the thoracic duct or right lymphatic duct
What nodes are within the pericervical collar?
occipital, retro-auricular, parotid, buccal, submental, dubmandibular
The superifical cervical (post. and ant) nodes drain where?
to the internal jugular vein
What node is capable of going across the midline and allows for collaterals and thus lymph can travel from one side to the other?
submental node
Lymph from median part of tongue drains to (blank) and (blank) sides
right and left
Which are more medial, the submental lymph nodes or the submandibular lymph nodes?
the submental lymph nodes
WHere doe the deep cervical lymphatics lie?
along the course of the internal jugular
What are the most clinically significant lymph nodes in the neck?
Why?
the supraclavicular
because they can indicate pathology in the head, neck or thoracic cage
What are the deep cervical nodes?
jugulodigastric node
jugulo-omohyoid node
inferior deep cervical node
transver cervical nodes or supraclavicular nodes
What junction does the thoracic duct enter? How does the thoracic duct course in relation to this junction?
the junction of the subclavian and internal jugular veins
posterior to it
What does the thoracic duct drain into?
the left subclavian vein
What does the thoracic duct arch over?
the arch of the aorta (medial to the branches) around C8
