Block 4: GL 28 Learning Objectives--Overview of Neck, Vasculature, Lymphatics

Question 1

Describe the fascial layers of the neck

Answer 1

superficial fascia: contains the platysma muscle; located deep to the dermis and superficial to the investing layer of deep fascia

deep fascia: deep to the superficial fascia and platysma muscle with 3 layers

Question 2

What are the layers of the deep fascia of the neck

Answer 2

investing layer of fasica
pretracheal fascia
prevertebral fascia

all 3 of these fascias combine to form the carotid sheath

Question 3

Describe the investing layer of fascia in the neck

Answer 3

the most superficial fascial layer; surrounds all structures and fascial layers in the neck

Question 4

What is the investing layer of fascia pierced by?

Answer 4

external and internal jugular veins
lesser occipital, great auricular, cervical & supraclavicular nerves
all branches of the cervical plexus

Question 5

Describe the pretracheal layer of fascia

Answer 5

collection of fascia surrounding the trachea, esophagus, thyroid gland & infrahyoid muscles

2 parts: visceral, muscular

Question 6

Differentiate between the visceral and muscular parts of the pretracheal fascia

Answer 6

visceral: surrounds the esophagus, trachea, and thyroid gland
muscular: surrounds the infrahyoid muscles

Question 7

Describe the prevertebral layer of fascia

Answer 7

surrounds the vertebral column and associated muscles

muscles: scalene’s, prevertebral & deep muscles of the back

Question 8

Describe the carotid sheath (formation & contents)

Answer 8

formed by contributions from the pretracheal, prevertebral & investing fascial layers

contents: vagus nerve, common carotid artery, internal jugular vein, cervical lymph noes

Question 9

Describe the clinical significance of the structure of the carotid sheath

Answer 9

it is a column that runs from the base of the skull to the thoracic mediastinum; it’s an easy path for the spread of infection

Question 10

What are the compartments of the neck?

Answer 10

visceral compartment
vertebral compartment
vascular compartments (2)

Question 11

Describe the visceral compartment of the neck

Answer 11

located anteriorly; contains parts of the digestive, respiratory systems & endocrine glands

Question 12

Describe the vertebral compartment of the neck

Answer 12

located posteriorly; contains: cervical vertebrae, spinal cord, cervical nerves & muscles of the vertebral column

Question 13

Describe the vascular compartment of the neck

Answer 13

located bilaterally, carotid spaces

contain: major vessels & vagus nerve

Question 14

Describe the spaces of the neck and their significance

Answer 14

spaces: pretracheal (visceral space), retropharyngeal, carotid space

spaces of the neck are located b/w the fascial layers and may provide a conduit for the spread of infection from the neck to the mediastinum

Question 15

Describe the clinical significance and location of infection spread from the retropharyngeal space to surrounding structures

Answer 15

the retropharyngeal space extends from the base of the skull to the upper part of the posterior mediastinum.

the anterior (true) and posterior (danger) retropharyngeal spaces are separated by alar fasia

the “danger space” is the posterior retropharyngeal space, meaning infections from the head and neck can spread into the retropharyngeal space and pass inferiorly to the posterior mediastinum

Question 16

What are the subdivisions of the anterior triangle?

Answer 16

carotid triangle
submental triangle
submandibular triangle
muscular triangle

Question 17

List the contents of the carotid triangle

Answer 17

common carotid artery
internal jugular vein
hypoglossal & vagus nerves

Question 18

Hyoid Bone Landmark

Answer 18

C3

Question 19

Thyroid Cartilage Landmark

Answer 19

C4-C5

Question 20

Criothyroid Membrane Landmark

Answer 20

C6

Question 21

Carotid Bifurcation Landmark

Answer 21

C4, near the superior edge of the thyroid cartilage

Question 22

Thyroid Gland Landmark

Answer 22

C5-T1

Question 23

Trachea Landmark

Answer 23

begins @ C1

Question 24

Location of Parathyroid Glands

Answer 24

deep to the lateral lobes of the thyroid glands

Question 25

List the boundaries of the anterior triangle

Answer 25

superior: inferior margin of the mandible medial: median vertical line of neck lateral: anterior margin of sternocleidomastoid muscle

Question 26

List the branches of the carotid artery

Answer 26

"Some anatomists like freaking out poor medical students" ``` Superior Thyroid Ascending Pharyngeal Lingual Facial Occipital Posterior Auricular Maxillary Superficial temporal ```

Question 27

Describe carotid insufficiency

Answer 27

carotid insufficiency: occlusion of the internal carotid artery and of the common carotid and vertebral vessels most common site: internal carotid just above the carotid sinus

Question 28

Describe the significance of the carotid sinus

Answer 28

dilated opening of the internal carotid artery that contains receptors that monitor changes in the blood pressure, innervated by the glossopharyngeal nerve

Question 29

Describe the current (and outdated) practice of central venous line insertion and why each one was good or bad

Answer 29

current: identify major vessels using ultrasound & obtain central venous access under direct vision to avoid any complications previous: "blind puncture: of subclavian and jugular veins was used, but subclavian vein puncture can be problematic b/c misplacement of the needle can puncture the apical pleura, leading to a pneumothora

Question 30

Describe emergency airway management

Answer 30

cricoid cartilage can help with emergency airways b/c it's a complete ring, and it's one of the best places for an emergency airway

Question 31

Describe the position of the thyroid glands

Answer 31

located anteriorly in the neck from C45-T1, inferolateral to the thyroid cartilage and in contact with the carotid sheath; located within the visceral sheath

Question 32

Describe the anatomy of the thyroid gland

Answer 32

2 lobes with an isthmus connecting the lateral lobes sometimes there is a pyramidal lobe that's a remnant of embryological development

Question 33

Describe the arterial supply to the thyroid gland

Answer 33

superior and inferior thyroid artery (however inferior is mainly to parathyroid glands) thyroid has to be very vascular b/c it releases hormones directly into the blood stream

Question 34

Describe the lymphatic drainage of the thyroid glands

Answer 34

paratracheal nodes, then to deep cervical nodes

Question 35

What is the location of the parathyroid glands?

Answer 35

deep to the lateral lobes of the thyroid gland inferior parathyroids are anterior to the recurrent laryngeal nerve, superior parathyroids are posterior to the recurrent laryngeal nerve

Question 36

What is the arterial supply to the parathyroid glands? Why is this significant?

Answer 36

inferior thyroid arteries | significant b/c these arteries can help you identify the recurrent laryngeal nerve

Question 37

Describe the course of the recurrent laryngeal nerve

Answer 37

runs in the tracheoesophageal groove and enters into the cricothyroid joint

Question 38

Describe the difference b/w the right and left recurrent laryngeal nerves

Answer 38

right: descends into the chest and hooks around the subclavian artery left: descends into the chest and hooks around the arch of the aorta

Question 39

Describe the relationship b/w the recurrent laryngeal nerve and the thyroid gland

Answer 39

the laryngeal nerve passes through ligaments that bind the thyroid to the trachea. Manipulation of the thyroid or thyroidectomy needs to remember this

Question 40

Brachial plexus course (in the posterior triangle)

Answer 40

runs between the anterior and middle scalene muscles; the trunks cross the base of the posterior triangle & several branches are visible in the posterior triangle, including: dorsal scapular nerve long thoracic nerve suprascapular nerave

Question 41

External Jugular Vein (in the posterior triangle)

Answer 41

enters the posterior triangle after crossing the sternocleidomastoid muscle

Question 42

Subclavian artery (in the posterior triangle)

Answer 42

passes the base of the posterior triangle

Question 43

Describe the route of the accessory nerve

Answer 43

descends posteriorly through the neck to reach the anterior border of the sternocleidomastoid muscle, then passes to reach the posterior triangle within the investing layer of fascia superficial location of the nerve as it crosses the posterior triangle makes it susceptible to injury

Question 44

Describe the characteristics of the hyoid bone

Answer 44

U shaped, can be palpated and moved side to side since it's located superiorly to the larynx f(x); attachment for muscles & soft tissue structures in the neck

Question 45

Cricothyroid Ligament significance

Answer 45

artificial penetration of this membrane during emergency situations can provide access to the lower airway when the upper airway above the level of the vocal folds is blocked

Question 46

Occipital Nodes

Answer 46

lymphatic drainage from posterior scalp & neck

Question 47

Mastoid Nodes

Answer 47

drainage from posterolateral half of the scalp

Question 48

Pre-Auricular and Parotid Nodes

Answer 48

drainage from the anterior surface of the auricle, anterolateral scalp, upper half of face, eyelids and cheeks

Question 49

Submandibular Nodes

Answer 49

drainage from structures along the path of the facial artery, as well as the gingivae, teeth, and tongue

Question 50

Submental Nodes

Answer 50

drainage is from the center part of the lower lip, chin, floor of the mouth, tip of th etongue & lower incisor teeth

Question 51

Drainage from occipital nodes passes to

Answer 51

superficial cervical nodes

Question 52

Drainage from mastoid nodes passes to

Answer 52

superficial cervical nodes

Question 53

Drainage from pre-auricular nodes and parotid nodes

Answer 53

deep cervical nodes

Question 54

Drainage from submandibular nodes

Answer 54

deep cervical nodes

Question 55

Drainage from submental nodes

Answer 55

deep cervical nodes

Question 56

Deep Cervical Nodes

Answer 56

run along the internal jugular veins & eventually receive lymphatic drainage from the head and neck either directly or through regional lymph node groups