Deep Neck and Viscera Flashcards
1
Q
The deep structures of the neck are the (…), located posterior to the cervical viscera and anterolateral to the vertebral column, and structures located on the cervical side of the (…), the root of the neck
A
- prevertebral muscles
- superior thoracic aperture
2
Q
What lies directly posterior to the retropharyngeal space?
A
- anterior and lateral vertebral muscles (or prevertebral muscles)
3
Q
- What do the lateral vertebral muscles consist of?
- Generally, what is their function?
- What do the scalene muscles (anterior, middle, posterior) help do?
A
- rectus capitis lateralis, splenius capitis, levator scapulae, middle and posterior scalene muscles
- stabilize the cervical vertebrae; flex the neck
- help elevate the rib cage; laterally flex neck
4
Q
Which lateral vertebral muscles like posterior to the neurovascular plane of the cervical and brachial plexuses and subclavian artery?
A
- splenius capitis
- levator scapulae
- middle and posterior scalene muscles
5
Q
Which lateral vertebral muscle lies in the floor of the lateral cervical region?
A
rectus capitis lateralis
6
Q
- What are the anterior vertebral muscles of the neck?
- What are their actions?
A
- longus colli: flex neck; bending of C2-C7
- longus capitis: flexion of head on neck; bending head relative to vertebral column at the atlanto-occipital joints
- rectus capitis anterior: flexion of head on neck; bending head relative to vertebral column at the atlanto-occipital joints
- anterior scalene: flexes neck laterally; elevates 1s ribs during forced inspiration
7
Q
What is the innervation of the anterior vertebral neck muscles?
A
- longus colli: anterior rami C2-C6 spinal nn
- longus capitis: anterior rami C1-C3 spinal nn
- rectus capitis anterior: branches from loop b/w C1-C2 spinal nn
- anterior scalene: cervical spinal nerves C4-C6
8
Q
What muscles are the lateral vertebral neck muscles?
A
- rectus capitis lateralis
- splenius capitis
- levator scapulae
- middle scalene
- posterior scalene
9
Q
- What is the action of splenius capitis?
- What is the action of levator scapulae?
- What is the action of rectus capitis lateralis?
- What is the action of middle scalene?
- What is the action of psoterior scalene?
A
- splenius capitis: laterally flexes and rotates head/neck to same side; acting bilaterally, extends head and neck
- levator scapulae: elevates scapula and tilts glenoid cavity inferiorly by rotating scapula
- rectus capitis lateralis: flex head, helps stabilize it
- middle scalene: flex neck laterally, forced inspiration, elevate 1st rib
- posterior scalene: flex neck laterally, elevates 2nd rib during forced inspiration
10
Q
What is the innervation of the splenius capitis and levator scapulae muscles?
A
- splenius capitis: posterior rami of middle cervical spinal nerves
- levator scapulae: dorsal scapular nerve and cervical spinal nn C3 and C4
11
Q
- What is the action of the rectus capitis lateralis?
- What is the action of middle scalene?
- What is the action of posterior scalene?
A
- flexes head, helps stabilize it
- flexes neck laterally, forced inspiration, elevates rib 1
- flexes neck laterally, elevates 2nd rib during forced inspiration
12
Q
Label
A
13
Q
What nerve goes through the scalene muscles?
A
phrenic n
14
Q
- What is the junctional area between the thorax and the neck?
- Why is this an important area?
A
- root of the neck
- it lies superior to the superior thoracic aperture and all structures that pass between the head and thorax (upper limb and thorax) must pass through the root of the neck
15
Q
What are the boundaries of the root of the neck (anterior, posterior, inferior)?
A
- anterior: manubrium of sternum
- posterior: body of T1 vertebra
- inferior: laterally by 1st pair of ribs and their costal cartilages
16
Q
- What is the brachiocephalic trunk covered by?
- What does it divide into?
- What is its pathway?
- What is the largest branch of the aorta?
A
- sternohyoid and sternothyroid muscles
- right common carotid and right subclavian artery
- arises in midline, posterior to manubrium, passes superolaterally to the right
- brachiocephalic trunk
17
Q
- What do the subclavian arteries supply?
- What does the right subclavian artery arise from?
- What about the left subclavian artery?
A
- upper limbs; send branches to neck and brain
- brachiocephalic trunk
- arch of the aorta
18
Q
- What muscle divides the subclavian artery into 3 parts?
- What is the position of these parts in relation to the muscle?
A
- anterior scalene muscle
- first mart is medial to m, second is posterior to m, third is lateral to m
19
Q
What arises off the different parts of the subclavian artery?
A
- first part: vertebral a., internal thoracic a., thyrocervical trunk
- second part: costocervical trunk
- third part: dorsal scapular a.
20
Q
What vertebral level does the vertebral artery start?
A
C6
21
Q
- The cervical part of the vertebral artery arises from (…)
- It then scends in the pyramidal space formed between the (…) and (…) muscles
- The artery then passes through foramina of the transverse processes of (…)
A
- first part of the subclavian artery
- scalene and longus muscles
- C1-C6
22
Q
- What are the terminal branches of the thyrocervical trunk?
- What do these supply
A
- inferior thyroid artery
- primary visceral artery of neck
- ascending cervical artery
- lateral muscles of the upper neck
23
Q
- What arises posteriorly from the second part of the subclavian artery? (posterior to the (…) on the right side and usually just medial to (…) on the left side)
- What does this divide into?
- What do they supply?
A
- costocervical trunk
- anterior scalene muscle
- this muscle (scalene)
- superior intercostal and deep cervical arteries
- first 2 intercostal spaces and posterior deep cervical muscles
24
Q
What supplies the deep cervical muscles?
A
costocervical trunk
25
What are the 2 veins that terminate in the root of the neck?
- external jugular vein
- anterior jugular vein
26
- What does the external jugular vein drain?
- What veins unite across the midline to form the jugular venous arch in the suprasternal space?
- scalp, face, anterior jugular vein
- anterior jugular veins
27
What are the layers of the cervical viscera in the deep neck and what do they contain?
1. endocrine layer: thyroid and parathyroid
2. respiratory layer: larynx and trachea
3. alimentary layer: pharynx and esophagus
28
Parathyroid glands are not normally stimulated by (...) innervation, they are (...) stimulated
- cranial innervation
- endocrine stimulated
29
- What do the thyroid and parathyroid like deep and superficial to?
- What vertebral levels do these glands extend from?
- deep: infrahyoid muscles
- superficial: larynx and trachea
- C5-T1
30
What unites the lobes of the thyroid glands over the trachea and is usually anterior to the second and third tracheal rings?
isthmus
31
What is the thyroid gland surrounded by and what does it send deep into the gland?
- thin fibrous capsule; sends septa deep into the gland
32
- What supplies blood to the thyroid gland?
- What do these vessels lie between?
- paired superior and inferior thyroid arteries
- b/w fibrous capsule and loose fascial sheath
33
- What is the first branch off of the external carotid artery?
- What does it supply?
- What is the largest branch of the thyrocervical trunks?
- What does it supply?
- superior thyroid aa
- thyroid gland
- inferior thyroid aa
- thyroid gland
34
- What pairs of veins drain the thyroid plexus of veins on the anterior surface of the thyroid gland and trachea?
- What parts of the thyroid do these veins drain?
- superior thyroid veins: superior poles of thyroid gland
- middle thyroid veins: middle lobes of the thyroid gland
- inferior thyroid veins: inferior poles of thyroid gland
35
- What do the superior and middle thyroid veins drain into?
- What does the inferior thyroid vein drain into?
- internal jugular veins
- brachiocephalic veins posterior to the manubrium
36
What is the passage of lymphatic vessels of they thyroid gland (drainage) in the deep neck?
- lymphatic vessels communicate w/ capsular network of lymphatic vessels
- pass initially to prelaryngeal nodes
- pretracheal nodes
- taratracheal nodes
- superior deep cervical nodes
- inferior deep cervical nodes
37
- What are the nerves of the thyroid gland derived from?
- These vessels reach the gland through (...) and (...) that accompany the thyroid arteries
- What are these fibers and what do they cause?
- superior, middle, and inferior cervical sympathetic ganglia
- cardiac and superior and inferior thyroid peri-arterial plexuses
- vasomotor, causing constriction of blood vessels
38
The thyroid gland does not have (...) fibers because it is (...) regulated
- secretomotor
- endocrine regulated
39
- What lies external to the fibrous capsule of the thyroid gland on the medial half of the posterior surface of each lobe?
- How many do most people have? What percentage has more? Some only have (...)
- parathyroid glands
- 4; 5%; 2
40
- The two superior parathyroid glands are usually at the level of the inferior border of the (...)
- The inferior parathyroid glands are usually near the inferior poles of the (...)
- cricoid cartilage
- thyroid gland
41
- What artery supplies both the superior and inferior parathyroid glands?
- What do the parathyroid glands drain into?
- The lymphatic vessels from the parathyroid glands drain with those of the thyroid gland into the (...) and (...) lymph nodes
- The nerves of the parathyroid glands are derived from thyroid branches of the (...)
- These nerves are (...) but not (...)
- inferior thyroid arteries
- thyroid plexus of veins of thyroid gland and trachea
- deep cervical and paratracheal lymph nodes
- cervical sympathetic ganglia
- vasomotor but not secretomotor
42
- What vertebral levels is the larynx located at?
- Its height varies during what activities?
- The skeleton of the larynx is responsible for what? What does it consist of?
- C3-C6
- speech and swallowing
- responsible for maintaining a patent airway; consists of a series of articulated cartilages united by thin membranes
43
What is a valve-like opening in the larynx and serves as the dual function of controlling the airway and producing sound during phonation?
glottis
44
What is the function of the glottis?
- controlling airway
- producing sound during phonation
45
- What muscle controls the glottis?
- What muscles control the position of the larynx in the neck?
- intrinsic muscles of the larynx
- extrinsic muscles of the larynx (infrahyoid, suprahyoid, stylopharyngeus)
46
- The laryngeal skeleton consists of (...) cartilages joined by ligaments and membranes
- How many of these are single (not paired)?
- What are the names of these cartilages?
- How many are paired?
- What are their names?
- 9
- 3 single
- thyroid, cricoid, epiglottic
- 3 paired
- arytenoid, corniculate, cuneiform
47
- What is the largest of the cartilages in the laryngeal skeleton?
- Its superior border lies opposite of the (...) vertebra
- thyroid cartilage
- C4
48
What laryngeal cartilage is this describing:
Two hyaline laminae and laryngeal prominence (Adam’s apple)
thyroid cartilage
49
What laryngeal cartilage is this describing:
Signet ring-shaped hyaline cartilage just inferior to the thyroid
cricoid
50
What laryngeal cartilage is this describing:
spoon-shaped elastic plate attached to thyroid cartilage
epiglottis
51
What laryngeal cartilage is this describing:
Paired pyramidal cartilages that rotate on cricoid cartilage
arytenoid
52
What laryngeal cartilage is this describing:
Paired cartilages that lie on the apex of arytenoid cartilages
corniculate
53
What laryngeal cartilage is this describing:
Paired cartilages in aryepiglottic folds that have no articulations
cuneiform
54
What is the function of the intrinsic skeletal muscles of the larynx?
- adjust tension on the vocal folds (ligaments, cords)
- open/close the rima glottidis (space b/w vocal fold)
- open/close the rima vestibuli (space b/w vestibular folds - false folds)
55
The opening/closing of the rima vestibuli (false) folds is importing during what actions?
- swallowing
- preventing aspiration into trachea
- adjusting size of vestibule during phonation, enhancing the quality of sound
56
- What are the intrinsic skeletal muscles of the larynx innervated by?
- What is the exception?
- What is the exception innervated by?
- recurrent laryngeal branch of CN X
- cricothyroid m
- superior laryngeal n (CN X)
57
- What is located between the bases of the arytenoid cartilages and the superolateral surfaces of the lamina of the cricoid cartilage?
- What do these allow for/permit?
- What are these movements important in?
- crico-arytenoid joints
- permit arytenoid cartilages to slide toward/away from one another, to tilt anteriorly and posteriorly, and to rotate
- important in approximating, tensing, and relaxing vocal folds
58
What extends from the junction of the laminae of the thyroid cartilage anteriorly to the vocal process of the arytenoid cartilage posteriorly?
vocal ligaments
59
Label
60
The (...) cartilage is not really functional, it just keeps everything today?
cuneiform
61
- What are the intrinsic muscles of the larynx?
- What are their actions?
- cricothyroid: stretches/tenses vocal ligament
- thyro-arytenoid: relaxes vocal ligament
- posterior crico-arytenoid: abducts vocal folds
- lateral crico-arytenoid: adducts vocal folds
- transverse and oblique arytenoids: adduct arytenoid cartilages (adduct vocal folds, closing posterior rima glottidis)
- vocalis: relaxes posterior vocal ligament while maintaining/increasing tension of anterior part
62
- What common action should you think of when thinking about intrinsic muscles of the larynx?
- What is the exception and what does it do?
- adduction
- crico-arytenoid - abduction
63
What is the innervation of the intrinsic muscles of the larynx?
all innervated by inferior laryngeal n (terminal part of recurrent laryngeal) from CN X except for cricothyroid which is innervated by external laryngeal n from CN X
64
Which intrinsic muscle of the larynx helps with singing?
vocalis
65
Label
66
- The vocal folds (vocal ligaments covered with mucosa) control (...).
- Vibrations of the folds produce sounds as air passes through the (...).
- The (...) are important because they are the only laryngeal muscles that (...) the vocal folds and maintain the opening of the (...).
- The (...) have a primarily protective function but can slightly alter the quality of sound
- phonation
- rima glottidis
- posterior cricoarytenoid muscles
- abduct
- rima glottides
- vestibular folds
67
- What does each fold of the vocal folds contain?
- Which consists of thickened elastic tissue that is the medial free edge of the conus elasticus?
- Which is composed of exceptionally fine muscle fibers immediately lateral to and terminating at intervals relative to the length of the vocal ligaments?
- vocal ligament, vocalis muscle
- vocal ligament
- vocalis muscle
68
- What is the function of the extrinsic laryngeal muscles?
- Which muscles are depressors of the hyoid bone and larynx?
- Which muscles are elevators of the hyoid bone and larynx?
- All of the extrinsic muscles are (...)
- move the entire larynx; control position of the larynx in the neck
- infrahyoid mm
- suprahyoid and stylopharyngeus mm
- paired
69
- What arteries supply the larynx?
- What do they accompany?
- What part of the larynx do they supply?
- laryngeal arteries (superior/inferior), branches of the superior and inferior thyroid arteries
- superior laryngeal a accompanies internal branch of superior laryngeal n; supplies internal surface of larynx
- inferior laryngeal a accompanies inferior laryngeal n; supplies mucous membrane and mm in the inferior part of the larynx
70
- The laryngeal veins accompany the (...).
- The superior laryngeal vein usually joins the superior thyroid vein and through it drains into the (...).
- The inferior laryngeal vein joins the inferior thyroid vein or the thyroid plexus of veins on the anterior aspect of the trachea, which empties into the (...)
- laryngeal arteries
- internal jugular vein
- left brachiocephalic vein
71
- The lymphatic vessels of the larynx superior to the vocal folds accompany the superior laryngeal artery through the thyrohyoid membrane and drain into the (...).
- The lymphatic vessels inferior to the vocal folds drain into the (...), which drain into the (...)
- superior deep cervical lymph nodes
- pretracheal or paratracheal lymph nodes
- inferior deep cervical lymph nodes
72
- What are the nerves of the larynx?
- Which one divides into two terminal branches within the carotid sheath?
- What are the 2 terminal branches it divides into?
- Which one does sensory/autonomic?
- Which one does motor?
- superior and inferior laryngeal branches of the vagus n
- superior laryngeal n
- internal laryngeal nerve (sensory/autonomic)
- external laryngeal nerve (motor)
73
- Which terminal branch of the superior laryngeal nerve is the larger branch and pierces the thyroid membrane?
- What types of fibers does this nerve provide?
- What does it supply these fibers to?
- internal laryngeal nerve
- sensory fibers
- laryngeal mucous membrane of laryngeal vestibule and middle meningeal cavity, including superior surface of vocal folds
74
- Which terminal branch of the superior laryngeal nerve descends posterior to the sternothyroid muscle?
- At first, it lies on the (...) muscle of the pharynx
- Then it pierces the (...) muscle, contributing to its innervation, and continues to supply the (...) muscle
- external laryngeal n
- inferior constrictor muscle
- sternothyroid muscle
- cricothyroid muscle
75
- The inferior laryngeal n is a continuation of the (...)
- What does it supply?
- What does it supply sensory fibers to?
- recurrent laryngeal n
- all intrinsic mm of the larynx except cricothyroid
- mucosa of the infraglottic cavity
76
- The pharynx is a superior expanded part of the alimentary system posterior to (...)
- What does the pharynx extend from?
- Where is the pharynx widest?
- Where is it narrowest?
- What is it continuous with?
- The flat posterior wall of the pharynx lies against what?
- nasal, oral, and laryngeal cavities
- extends from the cranial base to inferior border of cricoid cartilage anteriorly and inferior border of C6 posteriorly
- opposite the hyoid bone
- inferior end of hyoid
- esophagus
- prevertebral layer of deep cervical fascia
77
- How many parts is the pharynx divided into?
- What are these parts and where are they located?
3 parts:
- nasopharynx: posterior to nose, superior to soft palate
- oropharynx: posterior to mouth
- laryngopharynx: posterior to larynx
78
- The nasopharynx, the posterior extension of the (...), has a (...).
- The nasal cavities open into the nasopharynx through two (...) (paired openings between the nasal cavity and nasopharynx).
- The roof and posterior wall of the nasopharynx form a continuous surface that lies inferior to the body of the (...) and (...).
- nasal cavities
- respiratory function
- choanae
- sphenoid bone
- the basilar part of the occipital bone
79
The (...) (commonly called adenoids when enlarged) are concentrations of aggregated lymphoid tissue in the mucous membrane of the roof and posterior wall of the nasopharynx
pharyngeal tonsils
80
- (...) covers the salpingopharyngeus muscle, which opens the pharyngeal orifice of the (...) during (...).
- The collection of lymphoid tissue in the submucosa of the pharynx near the pharyngeal orifice of the pharyngotympanic tube is the (...)
- Salpingopharyngeal fold
- pharyngotympanic tube
- swallowing
- tubal tonsil
81
- The oropharynx has a (...).
- It is bounded by the (...) superiorly, the (...) inferiorly, and the (...) laterally.
- It extends from the (...) to the superior border of the (...)
- digestive function
- soft palate
- base of the tongue
- palatoglossal and palatopharyngeal arches
- soft palate
- epiglottis
82
- The laryngopharynx (hypopharynx) lies posterior to the (...), extending from the superior border of the (...) and the pharyngo-epiglottic folds to the inferior border of the (...), where it narrows and becomes continuous with the (...)
- larynx
- epiglottis
- cricoid cartilage
- esophagus
83
- The superior openings into the pharynx (nasal and oral cavities) are “guarded” by a ring of lymphoid tissue in the mucosa that composes (...)
- This includes what?
- Waldeyer’s tonsillar ring
- tubal tonsils, pharyngeal tonsils, palatine tonsils, lingual tonsils
84
What is diffuse lymphoid tissue adjacent to the opening of the auditory tube that may be continuous with the pharyngeal tonsils?
tubal tonsils
85
What lie in the posterior wall and roof of the nasopharynx and are called adenoids when enlarged?
pharyngeal tonsils
86
What guard the oropharynx and lie between the palatoglossal and palatopharyngeal folds and receive a rich blood supply from branches of facial, lingual, ascending pharyngeal, and maxillary arteries of the external carotid?
palatine tonsils
87
What are collections of lymphoid nodules on the posterior third of the tongue?
lingual tonsils
88
- The wall of the pharynx has a muscular layer composed entirely of (...) muscle arranged mainly into an external (...) and an internal (...) layer.
- In most of the alimentary canal, the muscular layer consists of (...) muscle
- voluntary
- circular
- longitudinal
- smooth
89
What does the external layer of the pharynx consists of what?
3 pharyngeal constrictor muscles:
- superior
- middle
- inferior
90
What does the internal, mainly longitudinal, layer of muscles of the pharynx consist of?
- palatophayngeus
- stylopharyngeus
- salpingopharyngeus
91
What do the muscles of the phaynx allow for?
- elevation of the larynx
- shorten the pharynx during swallowing and speaking
92
- What are the muscles in the external layer of the pharynx?
- What are the main actions?
- What are they innervated by?
- superior, middle, and inferior pharyngeal constrictor
- constricts walls of pharynx during swallowing
- pharyngeal branch of vagus n and pharyngeal plexus (middle and inferior: plus br. of external and recurrent laryngeal nn of vagus)
93
- What are the muscles of the internal layer of the pharynx?
- What are the main actions?
- What are they innervated by?
- palatopharyngeus, salpingopharyngeus, stylopharyngeus
- elevate (shorten and widen) pharynx and larynx during swallowing and speaking
- palatopharyngeus and salpingopharyngeus innervated by pharyngeal branch of vagus and pharyngeal plexus; stylopharyngeus innervated glossopharyngeal nerve
94
- The blood supply to the pharynx is via the branches of the (...), especially the (...) and (...)
- Venous drainage is via what?
- What do the veins drain into?
- thyrocervical trunk; ascending cervical a., external carotid artery
- pharyngeal venous plexus, pterygoid plexus of veins, facial, lingual, superior thyroid veins
- internal jugular veins
95
- Sensory innervation of the nasopharynx is by the (...)
- Sensory innervation to the oropharynx is by (...)
- Sensory innervation of the laryngopharynx is by (...)
- pharyngeal branch of CN V2
- CN IX
- CN X
96
What is the gag reflex innervation?
in by CN IX (sensory), out by CN X (motor)
97
- The tonsillar lymphatic vessels pass laterally and inferiorly to the lymph nodes near the angle of the mandible and the (...)
- This node is referred to as the (...) because of its frequent enlargement when the tonsil is inflamed (tonsillitis)
- jugulodigastric node
- tonsillar node
