Deep Neck Flashcards
The root of the neck is the area immediately superior to…
superior thoracic aperture and axillary inlet
What is the anterior boundary of the root of neck?
Superior margin of manubrium, sternum, and clavicle
What is the posterior boundary of the root of neck?
Body of T1
What is the lateral boundary of the root of neck?
Superior margins and costal cartilages of ribs 1 and 2
Name four prevertebral muscles of the root of neck that are posterior to retropharyngeal space and medial to neurovascular plane
- Longus coli
- Longus capitis
- Rectus capitus anterior
- Anterior scalene
Name five prevertebral muscles of the root of neck that are posterior to neurovascular plane
- Rectus capitus lateralis
- Splenius capitus
- Levator scapulae
- Middle scalene
- Posterior scalene
What is the superior attachment of longus colli?
Anterior tubercle of C1, bodies of C1-C3 and transverse processes of C3-C6
What is the inferior attachment of longus colli?
Bodies of C5-T3, transverse processes of C3-C5
What is the superior attachment of longus capitis?
Basilar part of occipital bone
What is the inferior attachment of longus capitis?
Anterior tubercles of C3-C6 transverse processes
What is the superior attachment of rectus capitis anterior?
Base of cranium, just anterior to occipital condyle
What is the inferior attachment of rectus capitis anterior?
Anterior surface of lateral mass of C1
What is the superior attachment of anterior scalene?
Transverse processes of C3-C6
What is the inferior attachment of anterior scalene?
1st rib
What innervates longus colli?
Anterior rami of C2-C6 spinal nerves
What are the main actions of longus colli?
Flex neck with rotation to opposite side if acting unilaterally
What innervates longus capitis?
Anterior rami of C1-C3 spinal nerves
What is the main action of longus capitis?
Flex head
What innervates rectus capitis anterior?
Branches from loop between C1 and C2 spinal nerves
What is the main action of rectus capitis anterior?
Flex head
What innervates anterior scalene?
Cervical spinal nerves C4-C6
What is the main action of anterior scalene?
Flex head
Longus colli, longus capitis, rectus capitis anterior, and anterior scalene are muscles of which cervical triangle?
Posterior triangle
Rectus capitis lateralis, splenius capitis, levator scapulae, middle scalene, and posterior scalene are muscles of which cervical triangle?
Posterior triangle
What is the superior attachment of rectus capitis lateralis?
Jugular process of occipital bone
What is the inferior attachment of rectus capitis lateralis?
Transverse process of C1
What is the inferior attachment of splenius capitis?
Inferior half of nuchal ligament and spinous processes of superior six thoracic vertebrae
What is the superior attachment of splenius capitis?
Lateral aspect of mastoid process and lateral third of superior nuchal line
What is the superior attachment of levator scapulae?
Posterior tubercles of transverse processes of C2-C6
What is the inferior attachment of levator scapulae?
Superior part of medial border of scapula
What is the superior attachment shared between middle and posterior scalenes?
Posterior tubercles of transverse processes of C5-C7
What is the inferior attachment of middle scalene?
Superior surface of 1st rib, posterior to groove for subclavian artery
What is the inferior attachment of posterior scalene?
External border of 2nd rib
What innervates rectus capitis lateralis?
Branches from loop between C1 and C2 spinal nerves
What are the main actions of rectus capitis lateralis?
Flexes head and helps stabilize it
What innervates splenius capitis?
Posterior rami of middle cervical spinal nerves
What are the main actions of splenius capitis?
Laterally flexes and rotates head and neck to same side; acting bilaterally, extends head and neck
What innervates levator scapulae?
Dorsal scapular nerve C5 and cervical spinal nerves C3 and C4
What are the main actions of levator scapulae?
Downward rotation of scapula and tilts its glenoid cavity inferiorly by rotating scapula
What innervates middle scalene?
Anterior rami of cervical spinal nerves
What are the main actions of middle scalene?
Flexes neck laterally; elevates first rib during forced inspiration
What innervates posterior scalene?
Anterior rami of cervical spinal nerves C7 and C8
What are the main actions of posterior scalene?
Flexes neck laterally; elevates second rib during forced inspiration
The right subclavian artery branches from…
brachiocephalic trunk
The left subclavian artery branches from…
arch of the aorta
What are the three parts of the subclavian artery in relation to anterior scalene?
- Medial to anterior scalene
- Deep to anterior scalene
- Lateral to anterior scalene
What will branch from the subclavian artery medial to anterior scalene?
- Vertebral artery
- Internal thoracic artery
- Thyrocervical trunk
What will branch from the subclavian artery deep to anterior scalene?
Costocervical trunk
What will branch from the subclavian artery lateral to anterior scalene?
Dorsal scapular artery
The vertebral artery will branch from the subclavian medial to anterior scalene
What are the parts of the vertebral artery?
- Cervical part
- Vertebral part
- Suboccipital part
- Cranial part
The cervical part of the vertebral artery ascends between…
scalenes and longus coli muscles
The vertebral part of the vertebral artery passes through…
transverse foramen of C6-C1
The suboccipital part of the vertebral artery passes over ___ to enter ___
the groove for vertebral artery on C1 posterior arch to enter foramen magnum
The right and left cranial parts of the vertebral artery join to form…
basilar artery
The thyrocervical trunk branches off the subclavian artery medial to anterior scalene
What branches from the thyrocervical trunk?
- Inferior thyroid artery
- Ascending cervical artery
- Suprascapular artery
- Transverse cervical artery
The dorsal scapular artery is a deep branch of…
transverse cervical artery which branches off the thyrocervical trunk (which branches from subclavian artery)
…or it can come directly from the subclavian
The costocervical trunk branches from the subclavian artery deep to anterior scalene
What branches from the costocervical trunk?
- Superior intercostal artery
- Deep cervical artery
What are the main veins of the root of neck?
- External jugular vein
- Anterior jugular vein
- Internal jugular vein
The internal jugular vein is deep to…
SCM
The internal jugular vein terminates at what spinal level?
T1
The internal jugular vein unites with subclavian vein at venous angle to form…
brachiocephalic vein
What two veins unite to form the brachiocephalic vein?
Internal jugular vein and subclavian vein at venous angle
The subclavian vein is separated from the artery by…
anterior scalene muscle
What are the pericervical lymph nodes?
- Submental
- Submandibular
- Parotid
- Mastoid
- Occipital
Superficial lymph vessels follow…
veins
Deep lymph vessels follow…
arteries
All lymphatics of the neck drain into…
deep cervical lymph nodes along internal jugular vein
In the carotid triangle, the internal jugular vein lies lateral to the ___ artery
common carotid
The bifurcation of the common carotid artery into the internal and external carotid arteries occurs at what spinal level?
C3-C4
The external carotid artery lies ___ to the posterior belly of the digastric
deep
In the carotid sheath, the vagus nerve lies between…
internal jugular vein and common carotid artery
Vagus nerve is in the ___ part of carotid sheath
posterior
The right vagus passes anterior to ___ to enter thorax
passes anterior to 1st part of subclavian artery to enter thorax
The left vagus passes between ___ and ___ to enter thorax
passes between left common carotid and left subclavian to enter thorax
Where is the right recurrent laryngeal nerve?
Loops around right subclavian artery (T1-T2)
Where is the left recurrent laryngeal nerve?
Loops around arch of aorta (T4-T5)
Both recurrent laryngeal nerves ascend in ___ to supply ___
ascend in tracheo-esophageal groove to supply trachea, esophagus, and larynx
Where is the inferior nodose ganglion (sensory ganglion)?
At jugular foramen
Does the cervical sympathetic trunk receive white rami communicantes?
No
What spinal level is the superior cervical ganglion?
C1-C2
Which ganglion is associated with postganglionic fibers for internal carotid plexus?
Superior cervical ganglion
Which ganglion is associated with arterial branches to external carotid artery branches?
Superior cervical ganglion
Which ganglion is associated with gray rami to C1-C4 spinal nerves?
Superior cervical ganglion
Which ganglion is associated with superior cervical cardiac nerve?
Superior cervical ganglion
Which ganglion is associated with postganglionic fibers for gray rami of C5-C6 spinal nerves?
Middle cervical ganglion
Which ganglion is associated with middle cervical cardiac nerve?
Middle cervical ganglion
Which ganglion is associated with arterial plexus to thyroid gland?
Middle cervical ganglion
Which cervical ganglion is the smallest and may be absent?
Middle cervical ganglion
Where is the middle cervical ganglion?
At level of cricoid cartilage and TP of C6
In 80% of individuals, inferior cervical ganglion fuses with ___ to form ___
inferior cervical ganglion fuses with T1 ganglion to form cervicothoracic ganglion (stellate ganglion)
Where is the inferior cervical ganglion?
Anterior to TP of C7 and posterior to vertebral artery
Which ganglion is associated with postganglionic fibers for gray rami of C7-C8 spinal nerves?
Inferior cervical ganglion
Which ganglion is associated with inferior cervical cardiac nerve?
Inferior cervical ganglion
Which ganglion is associated with arterial branches to vertebral artery?
Inferior cervical ganglion
What is ansa subclavia?
Nerve loop that connects middle and inferior cervical ganglia
Loops around the subclavian artery (each of them)
What viscera is within the endocrine layer of the neck?
Thyroid and parathyroid glands
What viscera is within the respiratory layer of the neck?
Larynx and trachea
What viscera is within the alimentary layer of the neck?
Pharynx and esophagus
What is the largest endocrine gland?
Thyroid gland
Where is the thyroid gland?
At level of C5-T1 anterolateral to larynx and trachea
Right and left lobes of the thyroid gland are connected by…
isthmus (at 2nd -3rd tracheal rings)
The thyroid gland is surrounded by…
fibrous capsule
What arteries supply the thyroid gland and where do they branch from?
- Superior thyroid (external carotid artery branch)
- Inferior thyroid (thyrocervical trunk branch)
Where are the parathyroid glands?
External to thyroid capsule on posterior surface of thyroid gland
How many parathyroid glands are there?
Bilateral pairs: superior and inferior glands
Parathyroid hormone excretion regulates…
serum calcium
What artery supplies the parathyroid glands?
Inferior thyroid artery
