Cervical Triangles/Submandibular

Question 1

fractures and dislocations of the cervical vertebra can injure which important structures?

Answer 1

• spinal cord

- vertebral arteries and sympathetic plexuses that pass through foramen transversarium

Question 2

manual strangulation causes?

Answer 2

fracture of the hyoid and styloid process of temporal bone

Question 3

inability to move the hyoid results in?

Answer 3

difficulty swallowing and separating the alimentary and respiratory tracts —> aspiration pneumonia

Question 4

which nerve if injured leads to paralysis of platysma?

Answer 4

cervical branch of CN VII

Question 5

why do the edges of platysma have to be sutured when repairing neck wounds?

Answer 5

wound can be “distracted” aka pulled in different directions and the contracting platysma can cause an ugly scar to develop

Question 6

the deep cervical fascia functions to?

Answer 6

prevent the spread of abscesses (purulent infections)

Question 7

if an infection occurs between the deep cervical fascia and the muscular part of pretracheal fascia surrounding infrahyoid muscles, how far does the infection spread?

Answer 7

not beyond superior edge of manubrium

Question 8

infection between deep cervical fascia and visceral part of pretracheal fascia, how far can infection spread?

Answer 8

thoracic cavity anterior to pericardium

Question 9

how can an abscess end up posterior to sternocleidomastoid?

Answer 9

infection posterior to prevertebral layer of deep cervical fascia can extend laterally into neck

Question 10

where else can pus from prevertebral layer spread to?

Answer 10

retropharyngeal space (retropharyngeal abscess)

Question 11

a retropharyngeal abscess can cause?

Answer 11

difficulty swallowing (dysphagia) and speaking (dysarthria)

Question 12

how can an infection spread into the mediastinum?

Answer 12

infection in retropharyngeal space or in head

Question 13

what is pneumomediastinum?

Answer 13

air from ruptured trachea, bronchus, or esophagus; can pass into neck

Question 14

what is torticollis?

Answer 14

contraction or shortening of cervical muscles that causes twisting of neck and slanting the head

Question 15

how does torticollis most commonly develop?

Answer 15

fibrous tissue tumor in the SCM before or shortly after birth

Question 16

if torticollis develops prenatally, what usually occurs?

Answer 16

breech delivery

Question 17

how can muscular torticollis occur?

Answer 17

during a difficult birth –> hematoma around CN XI becomes fibrotic and entraps nerve

Question 18

how can muscular torticollis be fixed?

Answer 18

surgical release of SCM inferior attachments

Question 19

what is cervical dystonia?

Answer 19

abnormal tonicity of the cervical muscles or aka spasmodic torticollis

Question 20

what are some characteristics of spasmodic torticollis?

Answer 20

• shifting head laterally or anteriorly unintentionally

- shoulder is elevated and displaced anteriorly on the side to which the chin turns

Question 21

where do you place a central line?

Answer 21

subclavian vein

Question 22

what is a central line used for?

Answer 22

• used to administer fluids and medications

- measure central venous pressure

Question 23

what is the hand placement for an infraclavicular subclavian vein approach to a central line placement?

Answer 23

thumb of one hand is placed on the middle clavicle and the index finger is placed on the jugular notch in the manubrium

Question 24

what can happen from a poorly placed central line?

Answer 24

• puncture the pleura and lungs, resulting in pneumothorax

- needle may enter subclavian artery

Question 25

what is right cardiac catheterization used for?

Answer 25

to measure pressures in right chambers of heart

Question 26

how do you get a catheter into the right chambers of the heart?

Answer 26

puncture of inferior jugular vein to right brachiocephalic to SVC to right atrium

Question 27

what is an alternate puncture point for a right cardiac catheterization?

Answer 27

external jugular vein

Question 28

which vessel serves as an internal barometer?

Answer 28

EJV

Question 29

what happens to EJV when venous pressure rises?

Answer 29

EJV can be seen along its course in the side of the neck (normally only visible slightly above clavicle)

Question 30

what happens if EJV is severed at posterior border of SCM?

Answer 30

lumen of EJV is held open by investing layer of deep cervical fascia & cause air to be sucked into the vessel

Question 31

air in a vein (venous air embolism) causes?

Answer 31

- churning noise in thorax - cyanosis - right side of heart fills with "froth" --> lower blood flow and dypsnea

Question 32

patients with CN XI injuries will have problems doing what motion?

Answer 32

turning their head to the opposite side of the lesion against resistance

Question 33

what is an obvious sign of a CN XI injury?

Answer 33

drooping of the shoulder

Question 34

what is a phrenic nerve block used for?

Answer 34

short paralysis of hemidiaphragm for surgery

Question 35

if an accessory phrenic nerve is present, what does this indicate?

Answer 35

it must also be given an anesthetic to completely paralyze the diaphragm

Question 36

what is a cervical plexus block used for?

Answer 36

regional anesthesia before neck surgery

Question 37

where is a cervical plexus block injected?

Answer 37

several locations along posterior border of SCM @ junction of superior and middle thirds

Question 38

what is the junction of the superior and middle thirds of the SCM called?

Answer 38

nerve point of the neck

Question 39

a cervical nerve block usually causes what other side effect?

Answer 39

paralysis of phrenic nerve

Question 40

because of paralysis of phrenic nerve, cervical nerve blocks aren't used on which kind of patients?

Answer 40

those with pulmonary or cardiac disease

Question 41

fractures of the middle third of the clavicle can damage which nerve?

Answer 41

suprascapular nerve

Question 42

damage to suprascapular nerve results in?

Answer 42

loss of lateral rotation of humerus at glenohumeral joint ---> waiter's tip position

Question 43

when is ligation of the external carotid artery necessary?

Answer 43

to control bleeding from one of its inaccessible branches

Question 44

what artery provides collateral circulation when the external carotid or subclavian arteries are ligated?

Answer 44

descending branch of occipital artery (anastomoses with vertebral and deep cervical arteries)

Question 45

what is a main side effect of surgical dissection of the carotid triangle?

Answer 45

alteration in the voice due to recurrent laryngeal nerve supplying the laryngeal muscles

Question 46

a partial occlusion of the ICA can cause?

Answer 46

transient ischemic attach

Question 47

what are symptoms of a TIA?

Answer 47

sudden focal loss of neurological function (dizziness & disorientation)

Question 48

what is a minor stroke?

Answer 48

arterial occlusion causing neurological functions that last longer than 24 hours but less than 3 weeks

Question 49

how is obstruction in the ICA visualized?

Answer 49

doppler color study

Question 50

what is a carotid endarterectomy?

Answer 50

opening the ICA and stripping it of atherosclerotic plaque

Question 51

what kind of drugs are given after a carotid endarterectomy?

Answer 51

drugs that inhibit clot formations

Question 52

which CNs can be injured during a carotid endarterectomy?

Answer 52

IX, X (superior laryngeal nerve), XI, & XII

Question 53

where is a carotid pulse felt?

Answer 53

- where the common carotid lies in a groove between the trachea and infrahyoid muscles on the side of the neck - deep to anterior border of SCM at superior border of thyroid cartilage

Question 54

what is the carotid pulse important for?

Answer 54

- checked during CPR | - absent in cardiac arrest

Question 55

what is carotid sinus hypersensitivity?

Answer 55

exceptional responsiveness of carotid sinus in vascular diseases

Question 56

external pressure on the carotid artery can cause?

Answer 56

slowing of heart rate, fall in blood pressure, cardiac ischemia ---> fainting (syncope)

Question 57

checking the carotid pulse is not recommended for which patients?

Answer 57

elderly and those with cardiac or vascular diseases

Question 58

which pulse is checked in people with carotid sinus hypersensitivity?

Answer 58

radial pulse

Question 59

what is used to monitor oxygen content of blood before it reaches the brain?

Answer 59

carotid bodies

Question 60

a decrease in partial pressure of oxygen occurs from?

Answer 60

increase in altitude or pulmonary diseases

Question 61

a decrease in partial pressure of oxygen causes?

Answer 61

activation of aortic and carotid chemoreceptors which increases alveolar ventilation

Question 62

which nerve(s) send information from the carotid bodies to the brain?

Answer 62

CN IX and maybe CN X

Question 63

what happens when the brain receives info from carotid body about a decrease in partial pressure of oxygen?

Answer 63

- the brain increases the depth and rate of breathing - pulse rate and blood pressure increases - intake more oxygen to reduce CO2 level

Question 64

pulsations of the IJV are important for monitoring?

Answer 64

ECG recordings and right atrial pressure

Question 65

how can the pulsations of IJV be monitored?

Answer 65

can't be palpated directly, but it can be observed beneath SCM superior to medial end of clavicle by transmission of it's pulsations through surrounding structures

Question 66

where do the pulsations of IJV come from?

Answer 66

no valves in SVC or brachiocephalic vein, so "waves of contraction" pass up into IJV

Question 67

what position are the IJV pulsations seen best?

Answer 67

when the person's head in inferior to lower limbs (Trendelenburg position)

Question 68

what disease increases IJV pulse?

Answer 68

mitral valve disease (increases pressure in pulmonary circulation and right side of heart)

Question 69

why is the right IJV examined instead of the left?

Answer 69

the right has a straighter and direct course to the right atrium than the left does

Question 70

where is an IJV puncture placed?

Answer 70

apex of triangle between sternal and clavicular heads of SCM (less supraclavicular fossa)