area under SCM Flashcards
contents of carotid sheath
common and internal carotid aa internal jugular v vagus ansa cervicalis, superior root inside sheath, inferior root on its lateral surface deep cervical lymph nodes
relationships of carotid sheath
deep to SCM following its ant border
a anteromedial and v posterolateral
X descends in post groove btwn vessels
ansa cervisalis
lat to common and internal carotid aa (sup root)
crosses the internal jugular v ant adn courses sup, lat, and post on its surface (inf root)
common carotid a
left side longer then right
extends to sup horn of thyroid cartilage opposite CV3 to terminate as internal and external carotids
carotid sinus
dilated distal common and proximal carotids
pressure receptor
carotid body
at carotid bifurcation
chemoreceptor
internal carotid a
ascends w/in sheath to base of skull to enter carotid canal to supply orbit and brain
external carotids
originates in carotid triangle near sup horn of thyroid cartilage
gives off 4 brr
crossed lat by post belly of diagastric and stylohyoid mm to give off 5th and 6th brr
crossed lat by XII
terminates near neck of mandible by bifurcating into maxillary and superficial temporal aa
brr of external carotids
superior thyroid (sometimes comes from common) ascending pharyngeal lingual facial occipital posterior auricular
carotid triangle boundaries
SCM
sup belly omohyoid
post diagastic
contents of carotid triangle
carotid bifurcation internal jugular v X XI sympathetic trunk all at risk during surgery
superior thyroid a
1st br external carotid courses along sup medial margin of thyroid brr: -sup laryngeal -ant br -post br
superior laryngeal a
pierces thyrohyoid membrane w/internal laryngeal n (X) to provide brr to interior larynx
ant br of superior thyroid a
brr to ant portion of thyroid and anastomoses w/contralateral counterpart
post brr of superior thyroid a
brr to posterior portion of gland and anastomoses brr of inferior thyroid a
ascending pharyngeal a
arises from medial aspect of the external carotid near bifurcation
travels in CT lateral to pharyngeal wall medial to internal carotid a and courses straight to base of skull
brr of ascending pharyngeal a
pharyngeal a
palatine a
inferior tympanic a
meningeal a
lingual a
may arise from common trunk w/facial a usually opposite greater horn of hyoid
passes deep to hypoglossus m to enter tongue
brr of lingual a
dorsal lingual
deep lingual
sublingual
facial a
may arise from common trunk w/lingual or above it
courses obliquely ant deep to posterior diagastric and stylohyoid crosses submandibular gland
leaves submadibular region by coursing around sharp inf border mandible at ant edge of masseter and enter face
brr of facial a
tonsillar ascending palatine galndular muscular submental
occipital a
passes post from external carotid at inf border of post belly of diagastric to pass btwn the transverse process of atlas and mastoid
superficial at superior extent of post triangle to pierce cervical fascia where SCM and Trap come together then parallels greater occipital n
XI crosses it at origin
occipital a brr
SCM br menigeal a auricular a mastoid a descending br
internal jugular v
largest vv of head and neck
receives blood from face, neck, and brain via dural sinuses
begins as dilation (sup jugular bulb) at jugular foramen
ends as inferior bulb post to SC joint to join subclavian forming brachiocephalic v
internal jugular v relation to carotid aa
sup- posterolateral
mid- lateral
iinf-anterolateral
tributaries of internal jugular v
occipital vv pharyngeal vv lingual v common facial v sup and middle thryoid vv
X- SVE
motor to striated mm of pharynx, palate, larynx, and proximal esophagus
X- SVA
taste to epiglottic portion of tongue
X- GVE
para to heart, lungs, fore and mid gut
X-GVA
Cartotid body, epiglottis, larynx, resp system, GI
X-GSA
external ear, external auditory meatus, tympanic membrane, post cranial fossa dura
X origin and sheath
exits brainstem at medulla
exits skull via jugular foramen
courses in carotid sheath post btwn carotids and internal jugular v
enters thorax on R btwn subclavian a and right brachiocephalic c
on left btwn jnx of left common carotid w/left subclavian a and left brachiocehpalic
brr of X
menigeal- GSA auricular- GSA pharyngeal- SVE n to carotid body- GVA superior laryngeal n cervical cardiac brr recurrent laryngeal n
superior laryngeal n brr
internal and external
internal br of superior laryngeal n
SVA, GVA, GVE, pierces thyrohyoid membrane w/superior laryngeal br of superior thyorid a to provide sensory fibers and parasympathetics to base of tongue, epiglottis, aryepiglottic folds and internal portion of larynx ABOVE true vocal fold
external brr of superior laryngeal n
SVE
courses lat to pharynx and larynx on inf constrictor m accompanied by superior thyroid a
innervates cricothyroid m and inf constictor m
cervical cardiac brr
GVE, GVA
superior cardiac nn
inf cardiac nn
deep cardiac plexus
superior cardiac n and r inf cardiac n
superficial cardiac plexus
L ing cardiac n
recurrent laryngeal n
SVE, SVE, GVA
R wraps under subclavian
L around aortic arch at ligamentum arteriosum
both reach larynx by coursing btwn trachea and esophagus
motor to intrinsic mm of larynx, secretory to mucous glands, and sensory to mucosa BELOW to true vocal cords
once in larynx called inf laryngeal n
brr of recurrent laryngeal
cardiac brr to deep cardiac plexus
brr to mm and glands of trachea and esophagus
pharygeal brr to inf constrictor m
laryngeal brr to all mm of larynx except cricothryroid
deep cervical lymph nodes
associated w/carotid sheath along course of internal jugular v
divided into 2 grps by passage of omohyoid m sup and inf
superior deep cervical nodes
located in carotid triangle sup to superior belly of omohyoid
composed of retropharyngeal, deep parotid, jugulodigastric and jugulo-omohyoid
superior deep cervical nodes receive lymph from and drains to
sup lymph nodes of face and neck
drainage from deeper areas of head
drains to inferior deep nodes
inferior deep cervical nodes
inf to sup belly omohyoid m
only a few nodes located in supraclavicular may extend into omo-clavicular triangle
inferior deep cervical nodes receive lymph from
superficial cervical and superior deep nodes, accessory chain of post triangle,
transverse cervical nodes
juxtavisceral nodes of ant triangle
jugular lymph trunks
from sup and inf deep cervical nodes
left drain to thoracic duct
right joins w/subclaivan and right broncho-mediastinal trunks to form RIGHT LYMPHATIC DUCT
XII
exits skull via hypoglossal canal medial to internal jugular v and internal carotid a invested in carotid sheath
descends post to X and passes lat to trransverse process of atlas btwn internal jugular v and external carotid a
at origin of occipital a enters submandibular triangle deep to post belly diagastric aboce hyoid
passes btwn mylohyoid and hypoglossal mm to tongue
XII communicates with
X, sup cervical ganglion, and ventrla rami C1-2
cervical plexus
ventral rami C1-4
innervates deep cervical mm of VC, infrahyoid mm and diaphragm
sensory dermatomes of lateral head, neck, superolateral shoulder and upper ant thorax
distributes postganglionic symp
lesser occipital n
C2,3
scalp above and behind ear, upper portion of dorsum of ear
great auricular n
C2,3
cutaneous innervation over superior portion of SCM, angle of mandible, and parotid region
transverse cervical n
C2,3
skin over ant triangle neck
supraclavicular nn
C3,4
medial, intermediate, and lat
skin at base of neck, ant upper thorax, lat and sup shoulder
sternoclavicular and acromioclavicular joints
phrenic n- sensory
C3,4,5,
sensory innervation to pericardium, central portion of inf diaphragm, sup liver and gallbladder
Sensory from C1,2
follow XII and X retrograde to innervate dura of posterior cranial fossa
proprioceptive from C2-4
travel w/XI and leave again as they pass thru SCM and trap
ansa cervisalis- sup root
C1,2
provides fibers which travel w/XII
to parallels carotid sheath internally btwn a and v
ansa cervisalis inf root
C2,3 pass from behind carotid sheath wraps around internal jugular v and joins superior root to form ansa which sends brr to innervate infrahyoids
C1
travel w/XII and diverge to innervate geniohyoid and thyrohyoid mm
C1-4
pre-vertebral mm
phrenic n- motor
diaphragm
