Clinical correlations

Question 1

torticollis

Answer 1

aka wry neck
congenital or acquired, results in a shortening of the SCM

Sidebent to the opposite side

Question 2

enlarged ext jugular v.

Answer 2

could indicate increased resistance to flow in conditions like heart failure, SVC obstruction, enlarged supraclavicular nodes, or increased Intrathoracic pressure (think singing)

Question 3

laceration of external jubular v

Answer 3

along the posterior border of the SCM can cause an air embolism due to negative IT pressure

audible bruits, cyanosis, reduced flow thru RA, dypnea

Question 4

Internal jugular vein occlusion (at its origin)

Answer 4

blood from the skull can be re-routed thru the emissary vv. and opthalaic vv. —>retromandibular vv. and facial vv.—>commmon facial v.—>internal jugular vv. distal to the occlusion

Question 5

cervical n. block

Answer 5

anesthesia applied to superficial cervical nn that arise behind the SCM

**will also cause paralysis of the ipsilateral diaphragm due to phrenic n. sharing the same cord levels (C345)

Question 6

Thyroglossal duct cysts

Answer 6

ectopic glandular tissue that mark the descent from oral epithelium

Question 7

tracheotomy

Answer 7

care must be taken not to cut the thyroid ima a. if present

Question 8

surgery into the carotid triangle

Answer 8

care must be made not to damage the vagus and recurrent laryngeal as they can lead to vocal changes

Question 9

carotid endarterectomy

Answer 9

surgical technique (thru the triangle) 
remove atherosclerotic plaque that gathers int eh branch point 

to prevent a possible TIA

Question 10

radical neck dissection

Answer 10

removal en bloc of all deep cervical nodes and surrounding tissue when metastatic cancer cells have been discovered in supraclavicular nodes

superficial structures (cervical plexus) are removed

deep ( brachial plexus, vagus, phrenic n. are spared)

Question 11

thoracic outlet syndrome

Answer 11

the brachial plexus and the subclavian a. pass b/w the anterior and middle scalenes within the SCALENE TRIANGLE and can be compressed when the scalenes under go tonic contraction or there is a cervical rib

causes pain numbness, tingling in the neck, medial forearm, 4th and 5th fingers, paresis of the hand and poor circulation

Question 12

Raynaud’s phenomenon

Answer 12

injection of anesthetic around the cervicothoracic ganglion blocks synaptic transmission thru the ganglion and thru the trunk

relieves vasospasms of aa. supplying the upper limb and brain

used to reduce VC of aa. in the ipsilateral limb