Anterior Cervical Triangle, Cervical Viscera, Root of Neck Flashcards
What are the boundaries of the anterior cervical triangle??
anterior: midline of the neck
posterior: SCM
superior: inferior border of the mandible
What is at the apex of the anterior cervical triangle?
jugular notch
What makes up the roof of the anterior cervical triangle?
skin and the platysma
What makes up the floor of the anterior cervical triangle?
muscles
What are the muscular contents of the anterior cervical triangle?
suprahyoids and infrahydoids
We talk about muscles of the anterior cervical triangle relative to the _____
hyoid bone
What is unique about the hyoid bone?
doesn’t articulate with other bones of the body
moves because of muscles it’s attached to
Name the suprahyoids
Stylohyoid m
Digastric m
Mylohyoid m
Geniohyoid m
Name the infrahyoids
Omohyoids
Sternohyoid
Thyrohyoid
Sternothyroid
What is the action of stylohyoid?
stylohyoid is a suprahyoid muscle
action: pulls hyoid bone upward in postero-superior direction
What is the innervation of stylohyoid?
stylohyoid is a suprahyoid muscle
innervated by CN 7, facial nerve
Why is stylohyoid innervated by CN VII?
because stylohyoid muscle comes from pharyngeal arch 2
What is the action of digastric m.?
digastric muscle is a suprahyoid muscle
digastric muscle does actions according to what is fixed.
If mandible is fixed –> it raises the hyoid bone (important for swallowing)
if hyoid bone is fixed –> opens mouth (by lowering/depressing mandible)
Wha tis the innervation of digastric m?
digastric m is a suprahyoid muscle
digastric muscle has two bellys: anterior and posterior
anterior belly innervated by mylohyoid branch of V3
posterior belly is innervated by CN VII
Why is digastric muscle innervated by 2 separated nerves?
think about pharyngeal arches
anterior belly comes from 1st pharyngeal arch (CN V)
posterior belly comes from 2nd pharyngeal arch (CN VII)
What is the action of mylohyoid muscle?
mylohyoid m is a suprahyoid m
supports and elevates floor of mouth
and elevates hyoid
What is the innervation of mylohyoid muscle?
mylohyoid is a suprahyoid m
mylohyoid branch of V3
What is the action of geniohyoid muscle?
geniohyoid is a suprahyoid muscle
action depends on which is fixed mandible or hyoid bone
if mandible is fixed –> it elevates and pulls hyoid forward
if hyoid is fixed –> pulls mandible of downward and inward
What is the innervation of geniohyoid muscle?
geniohyoid is a suprahyoid muscle
branch from anterior ramus of C1 carried by CN XII hypoglossal nerve
What is the action of omohyoid muscle?
omohyoid is an infrahyoid muscle
it depressed and fixes the hyoid bone
What is the innervation of omohyoid muscle
omohyoid is an infrahyoid muscle
innervated by anterior ramus of C1-C3 via ANSA CERVICALIS
What is the action of sternohyoid muscle?
sternohyoid is an infrahyoid muscle
action: depressed hyoid after swallowing
What is the innervation of sternohyoid muscle?
sternohyoid muscle is an infrahyoid muscle
innervated by anterior rami of C1-C2 via ANSA CERVICALIS
What is the action of thyrohyoid muscle?
thyrohyoid is an infrahyoid muscle
action: depressed hyoid bone
when hyoid is fixed –> relaxes the larynx
What is the innervation of thyrohyoid muscle?
thyrohyoid is an infrahyoid muscle
fibers from anterior ramus of C1 carried via hypoglossal nerve
specifically the “NERVE TO THYROHYOID MUSCLE”
What is the action of the sternothyroid muscle?
sternothyroid is an infrahyoid muscle
action: draws larynx (thyroid cartilage) downard
What is the innervation of sternothyroid muscle?
anterior rami of C1-C3 via ANSA CERVICALIS
What does ansa cervicalis innervated?
3 infrahyoid muslces
sternothyroid muscle, sternohyoid muscle, omohyoid muscle
What veins are found in the anterior cervical triangle?
- facial vein
- retromandibular vein
- communicating branch
- anterior jugular vein
- internal jugular vein
- external jugular vein
Where does the facial vein originate?
angle of the eye
Facial vein receives tributaries from _____
veins that are draining the face
Facial vein joins with _____ to drain into ____
facial vein joins with part of retromandibular vein to create common facial vein
this drains into internal jugular vein
Retromandibular vein is formed from ____ and ____
superficial temporal vein and maxillary vein
Retromandibular vein divides into _____
2 parts:
anterior division of retromandibular vein
posterior division of retromandibular vein
Anterior retromandibular vein is joined by ____ to drain into ____
Anterior portion of retromandibular vein is joined by facial vein to create common facial vein
drains into internal jugular vein
Posterior retromandibular vein is joined by ____ to drain into ___
Posterior retromandibular vein is joined by auricular vein
drains into external jugular vein
Anterior jugular vein drains what?
drains anterior neck
Anterior jugular vein is found where?
midline of the neck
Anterior jugular vein drains into _____
external jugular vein
What do the communicating branch veins connect?
communicating branch nerves connect common facial vein and anterior jugular vein
Internal jugular vein drains what?
entire anterior face, brain and cervical viscera
External jugular vein is formed by what coming together?
posterior auricular vein, posterior branches of retromandibular vein
What are the arteries found in the anterior cervical triangle?
common carotid, internal carotid (branch-less in the neck), and external carotid and it’s branches
Left/right common carotid:
What comes off as a direct branch from the arch of aorta?
left common carotid
Left/right common carotid:
What comes off of arch of aorta indirectly? How?
Right common carotid comes off of arch of aorta indirectly
Brachiocephalic trunk (off of aorta) splits into right common carotid and right subclavian artery
Brachiocephalic trunk is a branch of _____
Brachiocephalic trunk splits into __ and ___
brachiocephalic trunk is a DIRECT branch off of arch of aorta
brachiocephlic trunk divides into right common carotid artery and subclavian artery
The common carotids bifurcate at what vertebral level?
C3-C4
What are internal carotid artery branches in the neck?
Internal carotid artery only branches in the brain
No branches in the neck
What are the external carotid artery branches in the neck?
3 anterior
- superior thyroid artery
- facial artery
- lingual artery
3 posterior
- ascending pharyngeal artery
- occipital artery
- posterior auricular artery
What is the first branch off of the external carotid artery?
superior thyroid artery
Superior thyroid artery arises on the ___ surface of external carotid artery near the ____
anterior surface
near bifurcation
Superior thyroid artery gives off a branch: _____
superior laryngeal artery
Superior laryngeal artery is a branch of what?
superior laryngeal artery is a branch of superior thyroid artery which is the first branch off of external carotid artery
Superior thyroid artery supplies: _____
superior aspect of thyroid gland
What is the second branch off of the anterior aspect of external carotid artery?
lingual artery
Lingual artery arises just above ____ artery, at the level of the ______
lingual artery arises just above superior thyroid artery
at the level of the greater horn of the hyoid bone
Lingual artery passes deeply to supply _____
muscles of the tongue
What is the third branch off of the anterior aspect of the external carotid artery?
facial artery
Facial artery arises just superior to ____ artery
lingual artery
Facial artery crosses ____ (structure) to supply ____
facial artery crosses inferior border of mandible
to supply face
What is the first posterior branch of external carotid artery?
ascending pharyngeal artery
Ascending pharyngeal artery supplies ____
pharynx and tonsils
it ASCENDS in order to reach these
What is the second posterior branch off of external carotid artery?
occipital artery
Occipital artery arises near the level of _____ artery
facial
Occipital artery ascends to supply ____
neck and scalp
Occipital artery sends of ____ branch to supply ____
muscular branches to supply SCM
hooks over CN 12 in order to do this
What branch of occipital artery hooks around CN 12 in order to supply SCM?
muscular branch occipital artery
What is the 3rd posterior branch of external carotid artery?
posterior auricular artery
Posterior auricular artery supplies ____
scalp posterior to the ear
Nerves of the anterior cervical triangle are broken up into 2 groups of nerves. What are they?
spinal nerve branches and cranial nerves
What are the cranial nerves found in the anterior cervical triangle?
(as opposed to the spinal nerves found in the anterior cervical triangle)
CN 7 (facial) CN 9 (glossopharyngeal) CN 10 (vagus) CN 11 (accessory) CN 12 (hypoglossal)
What are the spinal nerves found in the anterior cervical triangle?
(as opposed to the cranial nerves found in anterior cervical triangle)
transverse cervical nerve (C2-C3)
ansa cervicalis (C1-3)
Transverse cervical nerve is at ___ vertebral levels
C2-C3
Ansa cervicalis is at ____ vertebral levels
C1-C3
Describe the general course of transverse cervical nerve
Arises at Erb’s point (along with nerves from posterior cervical triangle)
Runs transversely across midline of SCM
Transverse cervical nerve supplies ____
skin of anterior triangle and lateral neck
What is ansa cervicalis?
nerve loops formed from anterior rami of cervical nerves C1-C3
What does ansa cervicalis innervate?
all infrahyoids (except for thyrohyoid)
Ansa cervicalis is composed of ___ and ___
superior and inferior root
What is the superior root of ansa cervicalis composed of?
mainly C1 anterior rami fibers
What is inerior root of ansa cervicalis composed of?
mainly C2-C3 anterior rami fibers
What sub-triangles can be found in the anterior cervical triangle?
submental triangle
submandibular triangle
carotid triangle
muscular triangle
What are the borders of the submental triangle?
inferior border: hyoid bone
lateral border: anterior belly of digastric
What are the contents of the submental triangle?
mylohyoid muscle
submental lymph nodes
small veins
What are the borders of the submandibular triangle?
superior border: inferior border of mandible
anterior/inferior border: anterior belly of digastric
posterior/inferior border: posterior belly of digastric muscle
What are the contents of the submandibular triangle?
SUBMANDIBULAR gland SUBMANDIBULAR lymph nodes Marignal MANDIBULAR branch of facial nerve (CN 7) HYPOGLOSSAL nerve (CN 12) MYLOHYOID nerve (from CNV3) FACIAL artery/vein
Submandibular triangle aka ____
digastric triangle
What is another name for the digastric triangle?
submandibular triangle
What are the borders of the muscular triangle?
superior border: hyoid bone
lateral border: superior belly of omohyoid muscle and anterior border of SCM
medial: midline of the neck
What are the contents of the muscular triangle?
MUSCLES: omohyoid muscle (border and content) sternohyoid muscle sternothyroid muscle thyrohyoid muscle
VISCERA: thyroid gland parathyroid gland trachae esophagus common carotid artery internal jugular vein
What are the borders of the carotid triangle?
superior border: stylohypod muscle, posterior belly of digastric muscle
posterior border: anterior border of SCM
anteroinferior border: superior belly of omohyoid muscle
What nerves are found in the carotid triangle?
CN XI (accessory) CN X (vagus) CN XII (hypoglossal) Ansa Cervicalis (C1-C3) Laryngeal nn (branch of CN X)
What arteries are found in the carotid triangle?
common carotid artery
internal carotid artery
external carotid artery
- and all 6 branches from external carotid artery
What veins are found in the carotid triangle
all veins that are accompanying the arteries (common, internal, external carotid aa and external 6 branches)
all veins –> drain into IJV
What is the carotid sheath?
Column of fascia that surrounds the common carotid artery, internal carotid artery, internal jugular vein, CN X (vagus)
What does the carotid sheath surround?
common carotid artery, internal carotid artery, internal jugular vein, CN X (vagus)
Carotid sheath receives contributions from what deep cervical fascia?
investing fascia
pretrachael fascia
prevertebral fascia
What is the carotid sinus?
Where is it?
What does it do?
Carotid sinus is a dilation of INTERNAL CAROTID ARTERY near the bifurcation of the common carotids
Walls of the carotid sinus contain BARRORECEPTORS to monitor blood pressure change
Root of neck is the junction between ____ and ____
thorax and neck
Root of neck is ___ to the thoracic aperture
superior
What extensions of the thoracic cavity project upwards into the neck?
projection of the pleural cavity such as:
- cervical part of parietal pleura
- apical part of superior lobe of each lung
What main arteries are found in the root of the neck?
subclavian a. and it’s 2 main branches:
(1) vertebral artery
(2) thyrocervical trunk and it’s 3 branches (inferior thyroid*, trasnverse cervical artery, suprascapular artery)
(Root of neck)
What is the first branch off of subclavian artery?
vertebral artery
(Root of neck)
What is the course of vertebral artery relative to anterior scalene muscle?
vertebral artery is the first branch off of subclavian artery
it courses superiorly, medial to anterior scalene muscle
(Root of neck)
What foramen does vertebral artery enter?
vertebral artery is the first branch off of subclavian artery
Enters transverse foramen of C6 and courses upward to C1
(Root of neck)
Thyrocervical trunk is a branch off of _____
subclavian artery!
(Root of neck)
What are the branches of thyrocervical trunk?
- inferior thyroid artery
- transverse cervical artery
- suprascapular artery
(Root of neck)
Inferior thyroid artery runs posterior to ____
carotid sheath and thyroid gland
(Root of neck)
Inferior thyroid artery gives off a branch _____
ascending cervical artery
ascending cervical artery can also come directly off of thyrocervical trunk
(Root of neck)
Describe transverse cervical artery’s course relative to transverse cervical nerve
transverse cervical artery goes posteriorly while transverse cervical nerve goes anteriorly
(Root of neck)
Describe transverse cervical artery relative to anterior scalene muscle and phrenic nerve?
transverse cervical artery courses anteriorly over anterior scalene muscle and phrenic nerve
(Root of neck)
Describe suprascapular artery relative to anteiror scalene muscle and phrenic nerve?
Suprascapular artery courses anteriorly over anterior scalene muscle and phrenic nerve
What are the two main lymphatic ducts at the root of the neck?
right lymphatic duct
and thoracic duct
Thoracic Duct drains _____
left upper limb, head, neck, thorax, abdomen, LL
Thoracic duct is posterior to esophagus, between ___ and ____
azygos and thoracic aorta
Thoracic duct drains into _____
left venous angle
Right lymphatic duct drains _____
right UL, head, neck, thorax
Right lymphatic duct drains into ___
right venous angle
right/left venous angles are located between right/left ___ and right/left ___
venous angles are between
internal jugular veins and subclavian veins
What main nerves are found in the root of the neck?
Phrenic nerve (C3-C5)
Vagus nerve CN X
Sympathetics
How does the vagus nerve CN X travel through the neck?
travels through carotid sheath
What is the main branch of CN X (Vagus) for the root of the neck?
recurrent laryngeal nerve (right/left)
What provides all of the parasympathetics for the neck?
vagus nerve
What provides the sympathetics for the neck?
sympathetic trunk/chain
How many sympathetic ganglia are found in the cervical region? Name them
3
superior cervical ganglion
middle cervical ganglion
inferior cervical ganlgion
Where is the superior cervical ganglion located?
high in neck - near level of mastoid process in temporal bone
Where is the middle cervical ganglion located?
posterior to the thyroid gland
Inferior cervical ganglion combines with ____ to form ____
inferior cervical ganglion combines with 1st thoracic ganglion to form the CERVICOTHORACIC (STELLATE) GANGLION
What is the cervicothoracic (stellate) ganglion?
a combination of the inferior cervical ganglion and the first thoracic ganglion
What cervical viscera are found in the ENDOCRINE layer?
thyroid and parathyroid gland
What cervical viscera are found in the RESPIRATORY layer
larynx and trachae
What cervical viscera are found in the ALIMENTARY layer
pharynx and esophagus
What 3 layers are cervical viscera found in? name them
endocrine layer - thyroid / parathyroid glands
respiratory layer - larynx / trachae
alimentary layer - esophagus / pharynx
What arteries supply the thyroid gland?
superior thyroid artery
inferior thyroid artery
thyroid ima artery
Superior thyroid artery is the first branch off of ____
It supplies ____
first branch off of external carotid artery
supplies superior pole of lateral lobe of thyroid gland
Inferior thyroid artery is a branch off of _____
It supplies ____
branch off of thyrocervical trunk (which is a branch off of subclavian artery)
supplies inferior pole of lateral lobes of thyroid gland
Thyroid ima artery is a small artery occasionally found as a branch off of _____
Supplies ____
off of brachiocephlic trunk or arch of aorta
supplies thyroid gland (generally)
What veins are associated with the thyroid gland?
superior thyroid vein
middle thyroid vein
inferior thyroid vein
Which thyroid vein(s) drains the area supplied by superior thyroid artery?
superior thyroid vein
Which thyroid vein(s) drains all the rest of the thyroid gland not supplied by superior thyroid artery?
middle thyroid vein and inferior thyroid vein
Which thyroid vein(s) drain into IJV?
superior thyroid vein
middle thyroid vein
Which thyroid vein(s) drain into brachiocephalic vv?
inferior thyroid vein
Prevertebral muscles lie directly posterior to the _____ space
retropharyngeal
