Compartments of the neck Flashcards
Level of hyoid bone
C3
Level of thyroid notch
C4
Level of cricoid cartilage
C6
Level of suprasternal notch
T2
Level of angle of Louis
T4/5
Lower border of cricoid C6
- 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
4 regions of neck
- A: sternocleidomastoid region
- B: posterior cervical region
- C: lateral cervical region
- D: anterior cervical region
Anterior triangle borders
- Superior border: inferior border of mandible
- Lateral border: anterior border of sternocleidomastoid
- Medial border: sagittal line down middle of neck to SSN
Contents of anterior triangle
- 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
Anterior triangle subdivisions
- 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
Borders of carotid triangle
- Sup border: posterior digastric muscle
- Lat border: sternocleidomastoid
- Inf border: omohyoid
Contents of carotid triangle
- 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
Borders of posterior triangle
- Ant: sternocleidomastoid
- Post border: trapezius
- Inf: clavicle
Contents of posterior triangle
external jugular vein, subclavian artery and vein, spinal accessory nerve, BP and CP
What are the four deep fascias?
Investing, pretracheal, prevertebral, carotid sheath
Where is investing fascia?
Surrounds neck
Where is pretracheal fascia?
Surrounds oesophagus, thyroid, infra hyoid
Where is prevertebral fascia?
Surrounds vertebral column
Where will infection in the neck drain to?
Mediastinum and thorax
Contents of axillary sheath
- Prevertebral fascia
- Contains axillary artery, part of BP
- BP nerve block can be used here
Why can’t infection spread to the trachea?
Fascias
Subcutaneous emphysema
- 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
Carotid sheath
- 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
Erb’s point
- Posterior border of sternocleidomastoid between sup and mid thirds
- 4 superficial branches of cervical plexus emerge
- Local anaesthetic
Lymph drainage of head and neck
- 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
Troisier’s sign for gastric cancer
Enlarged Virchow’s node
