CC2 - Anatomy

Question 1

Torticollis-Congenital

Answer 1

• a contraction or shortening of the cervical muscles → twisting of the neck and slanting of the head
• most commonly from a fibrous tissue tumor that develops in the SCM before/shortly after breath
• lesion causes head to tilt toward, and the face to turn away from, the affect side
• SCM can be injured when an infants head is pulled too much during birth → hematoma forms that entraps CN XI → denervates part of the SCM → twisting and stiffness of neck resulting from fibrosis and shortening of the SCM

Question 2

Torticollis-Spasmodic

Answer 2

cervical dystonia

• begins in adulthood
• usually affects the SCM and trapezius
• sx: sustained turning, tilting, flexing, or extending of the neck

Question 3

Spread of infections in the neck

Answer 3

• investing layer of the deep cervical fascia helps prevent the spread of abscesses
• if an infection occurs between the investing layer and the muscular part of the pretracheal fascia → infection wont spread
• if an infection occurs between the investing fasic and the visceral part of the pretracheal fascia → can spread to the thoracic cavity and pericardium
• infections in head may also spread inferiorly posterior to the esophagus and enter mediastinum or trachea

Question 4

Paralysis of Platysma

Answer 4

• results from injury to the cervical branch of the facial nerve
• causes skin to fall away from the neck in slack folds
• be careful to this area during surgery (preserve cervical branch)
• when suturing → carefully suture around the edges of the platysma
• if not done → skin will be distracted → ugly scar

Question 5

Prominence of the External Jugular Vein

Answer 5

• serves as an internal barometer
• normal venous pressure → EJV is visible above the clavicle for a short distance
• venous pressure rises → vein is prominent throughout its course along the side of the neck

Question 6

Severance of the External Jugular Vein

Answer 6

• if severed along the posterior border of the SCM (knife slash) → negative intrathoracic pressure will suck air into the vein
• causes a churning noise in the thorax
• venous air embolism can form this way → stop blood flow to right side of heart

Question 7

Subclavian Vein Puncture

Answer 7

• often the site for central line placement
• not inserted carefully → may puncture the pleura and lung → pneumothorax (air between lungs and chest wall)
• needle may also enter subclavian artery

Question 8

Right Cardiac Catherization

Answer 8

• used to make measurements of pressures in the right chambers of the heart
• puncture IJV to get catheter into superior vena cava and R side of heart

Question 9

Ligation of External Carotid Artery

Answer 9

• used to make measurements of pressures in the right chambers of the heart
• puncture IJV to get catheter into superior vena cava and R side of heart
• blood flows backwards into the artery from external carotid artery on the other side
• when ligated → descending branch of the occipital artery provides the main collateral circulation

Question 10

Carotid Occulsion and Endarterectomy

Answer 10

• atherosclerotic thickening of the internal carotid artery may obstruct blood flow
• partial occlusion →cause a transient ischemic attack (TIA) (a sudden focal loss of neurological function that disappears within 24 hours) OR cause a minor stroke (a loss of neurological function that exceeds 24 hr but disappears within 3 weeks)
• obstruction can be observed in a Doppler color study
• carotid endarterectomy- opening the artery at its origin and stripping off the atherosclerotic plaque with the intima

Question 11

Carotid Pulse

Answer 11

• easily felt by palpating the common carotid artery in the side of the neck
• lies in groove between the trachea and the infrahyoid muscle
• felt deep to the anterior border of the SCM at the level of the the superior border of the thyroid cartilage

Question 12

Carotid Sinus Hypersensitivity

Answer 12

• external pressure on the carotid artery may cause slowing of the heart rate, fall in BP and cardiac ischemia → fainting
• don’t check pulse in this area for people with cardiac or vascular disease

Question 13

Role of Carotid Bodies

Answer 13

• in an ideal position to monitor the oxygen content of the blood before it reaches the brain
• A decrease in PO2 (partial pressure of oxygen) → activates the aortic and carotid chemoreceptors → increasing alveolar ventilation
• also respond to increased CO2 tension or free H+ in the blood
• CN IX conducts info centrally → stimulation of respiratory centers → increase breathing

Question 14

Thyroid Ima Artery

Answer 14

• small, unpaired artery that arises from the brachiocephalic trunk
• in 10% of people
• must be considered when performing procedures in the midline

Question 15

Thyroglossal Duct Cysts

Answer 15

• remnants of the epithelium may remain in the thyroid gland → form cyst
• usually close to the hyoid bone and forms a swelling in the anterior part of the neck

Question 16

Goiter

Answer 16

Pathological enlargement of the thyroid gland

Question 17

Recurrent Laryngeal Nerve Injury

Answer 17

in thyroidectomy, great care must be taken to avoid the recurrent laryngeal nerves that travel deep to the thyroid gland in route to the larynx

Question 18

Parathyroid Gland Removal

Answer 18

-inadvertent removal of all parathyroid tissues in a thyroidectomy → severe convulsive disorder called tetany (due to decreased serum Ca2+ levels)

Question 19

Lesions of the Spinal Accessory Nerve

Answer 19

• uncommon (stab wound, fracture, tumor)
• will have weakness in turning the head to the opposite side
• produce weakness and atrophy trapezius
• will be evident by pt inability to elevate and retract shoulder
• drooping shoulder

Question 20

Severance of the Phrenic Nerve

Answer 20

• results in paralysis of the corresponding half of the diaphragm
• phrenic nerve block produces a short period of paralysis of the diaphragm on one side

Question 21

Nerve Blocks in Lateral Cervical Region

Answer 21

• cervical plexus block inhibits nerve impulse conductions during neck surgery
• injected at several points along the posterior border of the SCM
• not performed on people with pulmonary or cardiac disease (because phrenic nerve is usually paralyzed during this procedure)
• for anesthesia of the upper limb, the anesthetic agent in a supraclavicular brachial plexus block is injected superior to the midpoint of the clavicle.

Question 22

Injury to the Subscapular Nerve

Answer 22

• vulnerable to injury in fractures of the middle third of the clavicle
• results in loss of lateral rotation of the humerus at the genohumeral joint
• waiter’s tip position

Question 23

Cervicothoracic Ganglion Block

Answer 23

• anesthetic injected around the large cervicothoracic ganglion blocks transmission of stimuli through the cervical and superior thoracic ganglia
• may relieve spasms involving the brain and upper limb

Question 24

Lesion of Cervical Sympathetic Trunk

Answer 24

• results in Horner Syndrome
  sx: contraction of the pupil (paralysis od the dilator muscle), drooping of the eyelid, sinking in of the eye, vasodilation and absence of sweating on the face and neck