Compartments of the neck

Question 1

Level of hyoid bone

Answer 1

C3

Question 2

Level of thyroid notch

Answer 2

C4

Question 3

Level of cricoid cartilage

Answer 3

C6

Question 4

Level of suprasternal notch

Answer 4

T2

Question 5

Level of angle of Louis

Answer 5

T4/5

Question 6

Lower border of cricoid C6

Answer 6

• Junction of larynx with trachea
• Junction of pharynx with oesophagus
• Vertebral artery enters transverse foramen in C6 to supply spinal cord and brain
• Can compress carotid artery
• Line of carotid sheath: mark point midway between mastoid tip and angle of jaw. Draw vertical line to sternoclavicular joint. Along here, common carotid splits into external and internal carotids

Question 7

4 regions of neck

Answer 7

• A: sternocleidomastoid region
• B: posterior cervical region
• C: lateral cervical region
• D: anterior cervical region

Question 8

Anterior triangle borders

Answer 8

• Superior border: inferior border of mandible
• Lateral border: anterior border of sternocleidomastoid
• Medial border: sagittal line down middle of neck to SSN

Question 9

Contents of anterior triangle

Answer 9

• Vessels: carotid sheath (common carotid artery, internal jugular vein, vagus nerve, deep cervical lymph nodes, sympathetic fibres)
• Glands: submandibular gland, thyroid and parathyroid glands
• Nerves: hypoglossal nerve (CN 7), glossopharyngeal and vagus, spinal accessory nerve
• Lymph nodes: submandibular, submental and tonsillar

Question 10

Anterior triangle subdivisions

Answer 10

• Submental triangle: submental LN (from floor of mouth and parts of tongue)
• Submandibular triangle: submandibular gland (salivary), LN, facial artery, facial vein
• Muscular triangle: infrahyoid muscles, pharynx, thyroid, parathyroid
• Carotid triangle

Question 11

Borders of carotid triangle

Answer 11

• Sup border: posterior digastric muscle
• Lat border: sternocleidomastoid
• Inf border: omohyoid

Question 12

Contents of carotid triangle

Answer 12

• Contains carotid arteries, internal jugular vein, hypoglossal and vagus nerves
• Carotid sinus - baroreceptors which detect stretch (transmitted to brain by glossopharyngeal nerve)
• Pressure on sinus = underperfusion of brain

Question 13

Borders of posterior triangle

Answer 13

• Ant: sternocleidomastoid
• Post border: trapezius
• Inf: clavicle

Question 14

Contents of posterior triangle

Answer 14

external jugular vein, subclavian artery and vein, spinal accessory nerve, BP and CP

Question 15

What are the four deep fascias?

Answer 15

Investing, pretracheal, prevertebral, carotid sheath

Question 16

Where is investing fascia?

Answer 16

Surrounds neck

Question 17

Where is pretracheal fascia?

Answer 17

Surrounds oesophagus, thyroid, infra hyoid

Question 18

Where is prevertebral fascia?

Answer 18

Surrounds vertebral column

Question 19

Where will infection in the neck drain to?

Answer 19

Mediastinum and thorax

Question 20

Contents of axillary sheath

Answer 20

• Prevertebral fascia
• Contains axillary artery, part of BP
• BP nerve block can be used here

Question 21

Why can’t infection spread to the trachea?

Answer 21

Fascias

Question 22

Subcutaneous emphysema

Answer 22

• Gas under skin
• Gas travels along fascial layers from chest to face
• May be due to pneumothorax or blocked chest tube
• Sx: crackle to touch

Question 23

Carotid sheath

Answer 23

• Pretracheal, prevertebral and investing fascia
• Carotid fascia organised into column - runs from skull to mediastinum
• Carotid artery, IJV, vagus, cervical lymph nodes
• Internal carotid artery = brain
• External carotid artery = face and neck

Question 24

Erb’s point

Answer 24

• Posterior border of sternocleidomastoid between sup and mid thirds
• 4 superficial branches of cervical plexus emerge
• Local anaesthetic

Question 25

Lymph drainage of head and neck

Answer 25

• Submental
• Submandibular
• Pre-auricular
• Posterior-auricular
• Anterior cervical chain
• Posterir cervical chain
• Supraclavicular
• Superficial lymph nodes along EJV
• Deep lymph nodes along IJV
• Superficial drains to dee

Question 26

Troisier’s sign for gastric cancer

Answer 26

Enlarged Virchow’s node