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MBBCh 2- ANAT2020A > Bones of the Neck, Cervical Fascia, Triangles of the Neck, Prevertebral Muscles and Arteries & Veins of the Neck > Flashcards

Bones of the Neck, Cervical Fascia, Triangles of the Neck, Prevertebral Muscles and Arteries & Veins of the Neck Flashcards

1
Q
  • Typical cervical vertebrae (C3-C6) have: (3)
A

o Small vertebral body
- Concave superiorly and convex inferiorly
o Large and triangular vertebral foramen
o Transverse foramina in the transverse processes
- Where vertebral arteries run towards the head

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2
Q
  • Typical cervical vertebrae (C3-C6) have:
    o Superior facets of articular processes directed
    _________
    o Inferior facets of articular processes directed
    _________
    o Short _______ processes
A

superoposteriorly
inferoposteriorly
spinous

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3
Q
  • Atlas (C1): (4)
A

o Ring-like and kidney-shaped
o Lacks a spinous process and body
o Consists of 2 lateral masses connected by anterior and posterior arches
o Concave superior articular facets receive the occipital condyles

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4
Q
  • Axis (C2):
A

o A peg-like dens projects superiorly from its body (odontoid process)

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5
Q
  • Vertebra prominens (C7): (2)
A

o Has a long spinous process that is not bifid
o Has large transverse processes but small transverse foramina

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6
Q

What is the hyphoid? (4)

A
  • Lies anteriorly at the level of C3 between mandible and thyroid cartilage
  • Has no articulations with any other bone
  • Suspended from the styloid process of temporal bones by the stylohyoid ligaments
  • Firmly bound to the thyroid cartilage
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7
Q

What is the Superficial Cervical Fascia? (2)

A
  • Layer of fatty connective tissue lying between the dermis of the skin and the investing layer of the deep cervical fascia
  • Thinner than superficial fascia in other regions of the body, especially anteriorly
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8
Q

Superficial Cervical Fascia:
Contents: (4)

A

o Cutaneous nerves, blood and lymphatic vessels
o Superficial lymph nodes
o Variable amounts of fat
o Platysma

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9
Q

Cutaneous and superficial muscles of the neck:
Platysma
Origin:
Insertion:
Innervation:
Main action:

A
  1. Inferior border of mandible.
    Skin and subcutaneous tissue.
  2. Deep fascia covering superior parts of deltoid and pectoralis major
  3. Cervical branch of facial nerve
  4. Draws corners of mouth inferiorly
    Tenses skin of the neck
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10
Q

Cutaneous and superficial muscles of the neck:
SCM
Origin:
Insertion:
Innervation:
Main action:

A
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11
Q

Cutaneous and superficial muscles of the neck:
Trapezius
Origin:
Insertion:
Innervation:
Main action:

A
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12
Q

Layers of deep fascia: (4)

A
  • Investing
  • Pretracheal
  • Prevertebral
  • Carotid
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13
Q

What is the Investing layer of the Deep Cervical Fascia? (3)

A
  • Most superficial layer of deep fascia
  • Surrounds the entire neck deep to the skin and subcutaneous tissue
  • At the 4 corners of the neck, it splits into superficial and deep layers to enclose the trapezius and sternocleidomastoid muscles
    o These muscles are both innervated by accessory nerve (CN XII)
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14
Q

Relevance of the deep cervical fasciae: (3)

A
  • Natural cleavage planes allowing tissues to be
    separated during surgery
  • Limit the spread of abscesses resulting from infection
  • Allows structures in the neck to move freely over one another without difficulty
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15
Q

Deep cervical fasciae
* Superior attachments: (6)

A

o Superior nuchal lines of occipital bone
o Mastoid processes of temporal bones
o Zygomatic arches
o Inferior border of mandible
o Hyoid bone
o Spinous processes of cervical vertebrae

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16
Q

Deep cervical fasciae
* Inferior attachments: (3)

A

o Manubrium of sternum
o Clavicles
o Acromions and spines of scapulae

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17
Q

Deep cervical fasciae
* Contents: (4)

A

o Sternocleidomastoid
o Trapezius
o Submandibular gland
o Parotid gland (forms its fibrous capsule)

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18
Q

What is the deep cervical fascia continuous with? (4)

A
  • Continuous with the periosteum of C7 spinous process and with the nuchal ligament
  • Splits into 2 above the manubrium to enclose sternocleidomastoid
    o One layer attaches to the anterior and the other to the posterior surface of the manubrium
    o Suprasternal space- lies between these layers and encloses
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19
Q

What does the Suprasternal space enclose? (4)

A
  • Anterior jugular veins
  • Jugular venous arch
  • Fat
  • Deep lymph nodes
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20
Q

What is the 1. Pretracheal layer?

A
  • Limited to the anterior part of the neck
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21
Q
  1. Pretracheal layer:
    * Extent:
A

o inferiorly from the hyoid to thorax where it
blends with the pericardium

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22
Q
  1. Pretracheal layer:
    * Has 2 parts:
A

o Thin muscular part
- Encloses infrahyoid muscles
o Visceral part
- Encloses thyroid gland, trachea and oesophagus

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23
Q

What is the 1. Pretracheal layer continuous with? (2)

A
  • continuous posteriorly and superiorly with the buccopharyngeal fascia of the pharynx
  • blends laterally with the carotid sheaths
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24
Q

What is the 2. Prevertebral layer?

A
  • Forms a tubular sheath for the vertebral column and the muscles associated with it
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25
Q
  1. Prevertebral layer:
    o Anteriorly-
    o Laterally-
    o Posteriorly-
A

o Anteriorly- longus colli and longus capitis
o Laterally- scalenes
o Posteriorly- deep cervical muscles

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26
Q
  1. Prevertebral layer:
    * Extent:
    o Superiorly-
    o Inferiorly-
    o Laterally-
A

o Superiorly- attached to cranial base
o Inferiorly- blends with the endothoracic fascia peripherally and fuses with the anterior longitudinal ligament centrally at the T3 vertebra
o Laterally- continuous with the axillary sheath

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27
Q
  1. Carotid layer:
    * Extent:
A

cranial base to root of the neck
o Communicates with mediastinum and cranial base- pathways for spread of infection and
extravasated blood
* Blends anteriorly with investing and pretracheal layers and posteriorly with the prevertebral layer

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28
Q
  1. Carotid layer:
    * Contents: (6)
A

o Common and internal carotid arteries
o Internal jugular vein
o Vagus nerve
o Carotid sinus nerve
o Sympathetic nerve fibers (carotid periarterial plexuses)
o Deep cervical lymph nodes

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29
Q

What is the Retropharyngeal space?

A
  • Potential space consisting of loose connective tissue
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30
Q

Retropharyngeal space:
* Extent: (2)

A

o Superiorly- between the prevertebral layer (deep) and buccopharyngeal fascia (superficial)
o Inferiorly- the buccopharyngeal fascia is continuous with the pretracheal layer

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31
Q

What is the Alar fascia? (2)

A
  • Subdivides the retropharyngeal space (into anterior and posterior)
  • Attached along the midline of the buccopharyngeal fascia from the cranium to C7 vertebral level
    o Extends laterally and terminated in the carotid sheath
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32
Q

Alar fascia:
* Closed superiorly by the _____ ______ and on each side by the carotid layer
* Opens inferiorly into the ________

A

cranial base
mediastinum

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33
Q

What does the Alar fascia allow movement of?

A
  • Allows movement of the pharynx, oesophagus, larynx and trachea
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34
Q

Spread of infections in the neck:

A
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35
Q

Anterior Triangles of the Neck:
Mylohyoid
Origin:
Insertion:
Innervation:
Main action:

A

Mylohyoid line of mandible

Mylohyoid raphe and body of hyoid

n. to mylohyoid from CN V3

Elevates hyoid, floor of mouth and tongue

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36
Q

Anterior Triangles of the Neck:
Geniohyoid
Origin:
Insertion:
Innervation:
Main action:

A

Inferior mental spine of mandible

Body of hyoid

C1 via CN XII

Pulls hyoid anterosuperiorly Shortens floor of mouth and widens pharynx

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37
Q

Anterior Triangles of the Neck:
Stylohyoid
Origin:
Insertion:
Innervation:
Main action:

A

Styloid process of temporal

Body of hyoid

Stylohyoid n. from CN VII

Elevates and retraces hyoid- elongates floor of mouth

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38
Q

Anterior Triangles of the Neck:
Digastric (Anterior)
Origin:
Insertion:
Innervation:
Main action:

A

Anterior belly: digastric fossa of mandible

Intermediate tendon to body and greater horn of hyoid

n. to mylohyoid from CN V3

Depresses mandible against resistance

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39
Q

Anterior Triangles of the Neck:
Digastric (Posterior)
Origin:
Insertion:
Innervation:
Main action:

A

Posterior belly: mastoid notch of temporal bone

Intermediate tendon to body and greater horn of hyoid

Digastric br. of CN VII

Elevates and steadies hyoid during swallowing/speaking

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40
Q

What are the Suprahyoid Muscles? (4)

A
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41
Q

What are the Infrahyoid Muscles? (4)

A
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42
Q

Anterior Triangles of the Neck:
Sternohyoid
Origin:
Insertion:
Innervation:
Main action:

A

Manubrium of sternum and medial end of clavicle

Body of hyoid

C1-C3 by a br. of ansa cervicalis

Depresses hyoid after elevation during swallowing

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43
Q

Anterior Triangles of the Neck:
Omohyoid
Origin:
Insertion:
Innervation:
Main action:

A

Superior border of scapula near suprascapular notch

Inferior border of hyoid

C1-C3 by a br. of ansa cervicalis

Depresses, retracts and steadies hyoid

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44
Q

Anterior Triangles of the Neck:
Sternothyroid
Origin:
Insertion:
Innervation:
Main action:

A

Posterior surface of manubrium

Oblique line of thyroid cartilage

C2 -C3 by a br. of ansa cervicalis

Depresses hyoid and larynx

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45
Q

Anterior Triangles of the Neck:
Thyrohyoid
Origin:
Insertion:
Innervation:
Main action:

A

Oblique line of thyroid cartilage

Inferior border of body and greater horn of hyoid

C1 via CN XII

Depresses hyoid and elevates larynx

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46
Q

Submental Triangle:

Boundaries:

  • Lateral:
  • Inferior:
  • Apex:
  • Floor:
A
  • Lateral: Anterior bellies of digastric
    muscle
  • Inferior: Hyoid bone
  • Apex: Mandible
  • Floor: Mylohyoid muscle
47
Q

Submental Triangle:

Contents: (2)

A
  • Anterior jugular veins
  • Submental lymph nodes
48
Q

Submandibular Triangle

Boundaries:
* Superior:
* Inferior anterior and posterior:
* Floor:
* Roof:

A
  • Superior: Ramus of mandible
  • Inferior anterior and posterior:
    o Anterior belly of digastric muscle
    o Posterior belly of digastric muscle
  • Floor
    o Mylohyoid muscle
    o Hyoglossus muscle
    o Middle constrictor muscle of the
    pharynx
  • Roof: Investing fascia
49
Q

Submandibular Triangle

Contents: (5)

A
  • Submandibular gland
  • Submandibular lymph nodes
  • Hypoglossal nerve (CN XII)
  • Nerve to mylohyoid
  • Parts of facial artery and vein
50
Q

Muscular Triangle

Boundaries:
* Superior:
* Inferior:
* Medial:
* Floor:

A
  • Superior: Superior belly of omohyoid
  • Inferior: Anterior border of SCM
  • Medial: Midline
  • Floor: pretracheal fascia
51
Q

Muscular Triangle

Contents: (3)

A
  • Infrahyoid muscles
  • Thyroid and parathyroid glands
  • Recurrent laryngeal nerve
52
Q

Carotid Triangle

Boundaries:

  • Superior:
  • Inferior:
  • Lateral:
  • Floor:
A
  • Superior: posterior belly of digastric
    muscle
  • Inferior: superior belly of omohyoid
  • Lateral: anterior border of SCM
  • Floor
    o thyrohyoid muscle
    o middle constrictor muscle of the
    pharynx
    o inferior constrictor muscle of the
    pharynx
53
Q

Carotid Triangle

Contents: (13)

A
  • Common carotid artery
  • Internal and external carotid artery
  • Carotid sinus and carotid body
  • Internal jugular vein
  • Glossopharyngeal nerve
  • Vagus nerve
  • Spinal accessory nerve
  • Hypoglossal nerve
  • Superior root of ansa cervicalis
  • Branches of cervical plexus
  • Thyroid gland
  • Larynx and pharynx
  • Deep cervical lymph nodes
54
Q

Boundaries of the posterior triangle of the neck:

  • Anterior:
  • Posterior:
  • Inferior:
  • Apex:
  • Roof:
  • Floor:
A
  • Anterior: Posterior border of SCM
  • Posterior: Anterior border of trapezius
  • Inferior: Middle 1⁄3 of the clavicle
  • Apex: At superior attachments of SCM and
    trapezius
  • Roof: Investing fascia
  • Floor: Prevertebral fascia and muscles
    o Splenius capitis, levator scapulae and
    middle, posterior and anterior scalene
55
Q

Posterior Triangle of the Neck:
Divisions:

A

(divided by inferior belly of omohyoid)
* Occipital triangle
* Omoclavicular triangle

56
Q

Occipital Triangle:
Superficial contents: (4)

A
  • Cutaneous branches of cervical plexus (C1-4)
  • External jugular vein
  • Superficial branch of transverse cervical artery
  • Superficial cervical lymph nodes
57
Q

What are the cutaneous branches of cervical plexus (C1-4)? (4)

A

o Great auricular nerve
o Lesser occipital nerve
o Supraclavicular nerve
o Transverse cervical nerve

58
Q

Occipital Triangle
Deep contents: (5)

A
  • Spinal accessory nerve (CN XI)
  • Phrenic nerve
  • Trunks and roots of brachial plexus
  • Occipital artery
  • Thyrocervical truck (1st part of subclavian a.)
59
Q

What are the sub-divisions of the Thyrocervical truck (1st part of subclavian a.)? (5)

A

o Suprascapular artery
o Transverse cervical trunk
o Dorsal scapular artery
o Ascending cervical artery
o Inferior thyroid artery

60
Q

Omoclavicular Triangle
Superficial contents: (2)

A
  • Inferior part of external jugular vein
  • Superficial cervical lymph nodes
61
Q

Omoclavicular Triangle
Deep contents: (5)

A
  • 3rd part of subclavian artery and vein
  • Suprascapular artery, vein and nerve
  • Phrenic nerve
  • Supraclavicular lymph nodes
  • Trunks of brachial plexus
62
Q

What are the Anterior vertebral muscles? (4)

A
63
Q

What are the Lateral vertebral muscles? (5)

A
64
Q

Prevertebral Muscles:
Longus colli
Innervation:
Main action:

A

Anterior rami of C2-C6

Flexes neck with rotation contralaterally if unilateral contraction

65
Q

Prevertebral Muscles:
Longus capitis
Innervation:
Main action:

A

Anterior rami of C1-C3

Flex head

66
Q

Prevertebral Muscles:
Rectus capitis anterior
Innervation:
Main action:

A

C1-C2

Flex head

67
Q

Prevertebral Muscles:
Anterior scalene
Innervation:
Main action:

A

C4-C6

Flex head

68
Q

Prevertebral Muscles:
Rectus capitis lateralis
Innervation:
Main action:

A

C1-C2

Flexes and stabilises head

69
Q

Prevertebral Muscles:
Splenius capitis
Innervation:
Main action:

A

Posterior rami of middle cervical spinal nn.

  • Lateral flexion and rotation of head on the same side
  • Extends head and neck
70
Q

Prevertebral Muscles:
Levator scapulae
Innervation:
Main action:

A

Dorsal scapular n. (C5) & C3-C4

Downward rotation of scapula

71
Q

Prevertebral Muscles:
Middle scalene
Innervation:
Main action:

A

Anterior rami of cervical spinal nn.

Flexes neck laterally

72
Q

Prevertebral Muscles:
Posterior scalene
Innervation:
Main action:

A

Anterior rami of C7-C8

Flexes neck laterally

73
Q

Boundaries of the root of the neck:

  • Inferior-
  • Lateral-
  • Anterior-
  • Posterior-
A
  • Inferior- superior thoracic aperture
  • Lateral- 1st pair of ribs and their costal
    cartilages
  • Anterior- manubrium of the sternum
  • Posterior- T1 vertebra
74
Q

Suboccipital Triangle:
Boundaries:

  • Superomedial-
  • Superolateral-
  • Inferior-
  • Floor-
  • Roof-
A
  • Superomedial- rectus capitis posterior major
  • Superolateral- obliquus capitis superior
  • Inferior- obliquus capitis inferior
  • Floor- posterior atlantooccipital membrane and posterior arch of C1 vertebra
  • Roof- semispinalis capitis
75
Q

Suboccipital Triangle

Contents: (2)

A
  • Vertebral artery
  • Suboccipital nerve
76
Q

What is the Carotid arterial system?

A
  • At the level of the superior border of the thyroid cartilage, the common carotid divides into the internal and external carotid arteries.
77
Q

What is the carotid sinus? (3)

A

o A dilation of the proximal part of the internal carotid artery
o Innervated mostly by the glossopharyngeal n. via the carotid sinus n., but also the vagus n.
o Baroreceptor that reacts to changes in arterial blood pressure

78
Q

What is the Carotid body? (3)

A

o Small reddish-brown ovoid mass lying in a septum on the medial side of the bifurcation
o Innervated mainly by the carotid sinus n. and vagus n.
o Chemoreceptor that monitors the levels of oxygen in the blood
- Initiates a reflex that increases the rate and depth of respiration, cardiac rate and blood pressure

79
Q

What is the Internal carotid artery? (2)

A
  • Direct continuation of the common carotid a. superior to the origin of the external carotid a.
  • Enters the cranium through carotid canal in the petrous part of the temporal bone
80
Q

What are the branches of the External carotid artery?

A

Branches of external carotid artery: Some Anatomists Like Freaking Out Poor Medical Students

81
Q

External carotid artery
Superior thyroid branch
Direction:
Distribution:

A

Anterior

Thyroid gland, infrahyoid muscles and SCM and larynx

82
Q

External carotid artery
Ascending pharyngeal branch
Direction:
Distribution:

A

Medial

Pharynx, prevertebral muscles, middle ear and cranial meninges

83
Q

External carotid artery
Lingual branch
Direction:
Distribution:

A

Anterior

Tongue

84
Q

External carotid artery
Facial branch
Direction:
Distribution:

A

Anterior

Palatine tonsils, soft palate, pterygoid, mylohyoid, and digastric muscles, the submandibular gland, and all of the face

85
Q

External carotid artery
Occipital branch
Direction:
Distribution:

A

Posterior

Posterior scalp

86
Q

External carotid artery
Occipital branch
Direction:
Distribution:

A

Posterior

Posterior scalp

87
Q

External carotid artery
Posterior auricular branch
Direction:
Distribution:

A

Posterior

Adjacent muscles, parotid gland, facial nerve, structures in the temporal bone, auricle and scalp

88
Q

Maxillary =
Superficial temporal =

A

Maxillary = (Terminal branch)
Superficial temporal = (Terminal branch)

89
Q

Subclavian Artery:
* Course: (2)

A

o Arch superolaterally, reaching an apex as they pass posterior to anterior scalene muscles
o As the descend, they lie posterior to the middle of the clavicles

90
Q
  • The parts of the subclavian artery are described relative to the anterior scalene:

o 1st part-
o 2nd part-
o 3rd part-

A

o 1st part- medial to anterior scalene
o 2nd part- posterior to anterior scalene
o 3rd part- lateral to anterior scalene

91
Q

What are the branches of the Subclavian Artery? (5)

A
92
Q

Subclavian Artery:
Vertebral artery
Distribution:

A

Medulla, spinal cord, cerebellum, deep muscles of the neck, dura mater of PCF

93
Q

Subclavian Artery:
Internal thoracic
Distribution:

A

First 6 intercostal spaces

94
Q

Subclavian Artery:
Thyrocervical trunk - Suprascapular
Distribution:

A

May arise independently. Supplies muscles on the posterior aspect of scapula.

95
Q

Subclavian Artery:
Thyrocervical trunk - Ascending cervical
Distribution:

A

Lateral muscles of the upper neck and spinal branches into the intervertebral foramina

96
Q

Subclavian Artery:
Thyrocervical trunk - Ascending cervical
Distribution:

A

Lateral muscles of the upper neck and spinal branches into the intervertebral foramina

97
Q

Subclavian Artery:
Thyrocervical trunk - Inferior thyroid
Distribution:

A

Larynx, trachea, oesophagus, thyroid and parathyroid glands and adjacent muscles

98
Q

Subclavian Artery:
Thyrocervical trunk - Transverse cervical
Distribution:

A

Bifurcates into superficial cervical and dorsal scapular*. Supplies rhomboids, levator scapulae, trapezius and trunks of the brachial plexus

99
Q

Subclavian Artery:
Costocervical trunk - Superior intercostal
Distribution:

A

First two intercostal spaces

100
Q

Subclavian Artery:
Costocervical trunk - Deep cervical
Distribution:

A

Posterior deep cervical muscles

101
Q

Subclavian Artery:
Costocervical trunk - Deep cervical
Distribution:

A

Posterior deep cervical muscles

102
Q

Subclavian Artery:
Dorsal scapular* -
Distribution:

A

May arise from thyrocervical trunk. Participates in scapular arterial anastomosis

103
Q

What are the parts of the vertebral artery? (4)

A
  • Cervical part
  • Vertebral part
  • Suboccipital part
  • Cranial part
104
Q

Vertebral artery
* Cervical part:

A

o Ascends into the pyramidal space between the scalene and longus colli & capitis muscles

105
Q

Vertebral artery
* Vertebral part:

A

o At the apex of the pyramidal space the artery passes deep to course through the foramina transversaria of vertebrae C1-C6

106
Q

Vertebral artery
* Suboccipital part:

A

o Courses in a groove on the posterior arch of the atlas and through the suboccipital triangle before entering the cranium through foramen magnum

107
Q

Vertebral artery:
* Cranial part:

A

o At the inferior border of pons, the right and left arteries join to form the basilar artery

108
Q

What is the Internal jugular vein?

A
  • Commences at the jugular foramen in the posterior cranial fossa as the direct continuation of the sigmoid sinus
109
Q

Internal jugular vein:
* Superior bulb-
* Inferior bulb-

A
  • Superior bulb- dilation at its origin
  • Inferior bulb- dilation at the inferior end that has a bicuspid valve to prevent backflow into the vein
110
Q

Internal jugular vein:
Branches: (7)

A

o Occipital vein
o Facial vein
o Lingual vein
o Superior laryngeal vein
o Superior thyroid vein
o Middle thyroid vein
o Pharyngeal vein

111
Q

What is the external jugular vein? (5)

A
  • Begins near the angle of the mandible
  • Posterior division of the retromandibular vein unites with posterior auricular vein
  • Crosses the SCM obliquely and pierces investing fascia at the posterior border
  • Receives the cervicodorsal, suprascapular and anterior jugular veins
  • Terminates in the subclavian vein
112
Q

What is the Subclavian vein? (2)

A
  • Passes anterior to the anterior scalene muscle and phrenic nerve
  • Unites at the medial border of anterior scalene with internal jugular vein to form the brachiocephalic vein
113
Q

What is the Anterior Jugular vein? (2)

A
  • Arises near the hyoid from confluence of the superficial submandibular veins
  • Superior to the manubrium they unite across the midline to form the jugular venous arch in the suprasternal space

MBBCh 2- ANAT2020A (60 decks)

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