DEEP STRUCTURES OF THE NECK

Question 1

What are the two major layers of the cervical fascia?

Answer 1

The superficial cervical fascia and the deep cervical fascia

Question 2

What does the superficial cervical fascia enclose and contain?

Answer 2

It encloses the platysma muscle and contains cutaneous nerves, superficial veins and lymph nodes.

Question 3

What are the four subdivisions of the deep cervical fascia?

Answer 3

Investing layer of the Deep cervical fascia
Pretracheal fascia
Prevertebral fascia
Carotid Sheath

Question 4

What does the Investing layer of the deep cervical fascia enclose?

Answer 4

The Sternocleidomastoid (anteriorly) and the trapezius (posteriorly)

Question 5

What does the the pretracheal fascia enclose?

Answer 5

The thyroid gland, trachea and esophagus

Question 6

What does the prevertebral fascia enclose?

Answer 6

ther vertebral column and the deep muscles of the back

Question 7

Describe the carotid sheath and what is contained within the sheath

Answer 7

Cylinder of fascia that extends from the base of the skull to the root of the neck 
It contains the:
Common carotid artery
Internal carotid Artery
Internal Jugular vein
Vagus Nerve
Deep cervical lymph nodes

Question 8

What is the function of the fascial layers?

Answer 8

to provide a slippery surface to reduce friction during:

1. gross movements of the head and neck
2. swallowing

Question 9

What is the clinical significance of the Fascial layers?

Answer 9

1. May serve as a channel for infection
   - pretracheal fascia may allow and infection to spread from the head and neck to the mediastinum directly.
2. Cancer involving the deep cervical lymph nodes can compress the internal jugular vein.
   - Fascial layers do not stretch due to collagen fibers. First thing to get compromised is the internal jugular vein. This will create excess pressure in the brain.

Question 10

What is the superior thoracic aperture (thoracic inlet)?

Answer 10

an opening through which structures of the neck pass into the thorax.

Question 11

What are the boundaries of the superior thoracic aperture?

Answer 11

first thoracic vertebra
first ribs and their cartilages
manubrium of sternum

Question 12

What is the shape of the superior thoracic aperture?

Answer 12

Kidney shaped (reniform)

Question 13

What are the arteries that pass through the superior thoracic aperture?

Answer 13

Brachiocephalic Trunk
Left common carotid Artery
Left subclavian Artery
Internal thoracic Artery

Question 14

What is the vein that pass through the superior thoracic aperture?

Answer 14

Brachiocephalic Vein

Question 15

What are the nerves that pass through the superior thoracic aperture?

Answer 15

Phrenic Nerve
Vagus Nerve
Recurrent Laryngeal Nerve
Sympathetic Trunk

Question 16

What are the visceral structures that pass through the superior thoracic aperture?

Answer 16

Trachea
Esophagus
Cervical Pleura
Apex of Lung
Thymus

Question 17

Describe why there is a potential for lung collapse with Neck injury

Answer 17

The cervical pleura and Apex of the lung pass through the superior thoracic aperture immediately posterior to the origin of the sternocleidomastoid. A penetrating wound to the neck or a broken first rib may cause a lung collapse.

Question 18

What is the clinical term for lung collapse?

Answer 18

Atelectasis

Question 19

What organ system is the thymus a part of?

Answer 19

Immune system

Question 20

What does the thymus produce?

Answer 20

T-lymphocytes

Question 21

What is the blood supply to the thymus?

Answer 21

Internal thoracic artery

Question 22

What is the nerve supply of the thymus?

Answer 22

stellate ganglion of the sympathetic trunk and vagus

Question 23

Describe the thyroid gland

Answer 23

Endocrine organ which produces thyroxine and calcitonin
Lies at the level of C5-T1
H-shaped or U-shaped

Question 24

What are the three parts of the thymus?

Answer 24

Left lobe
Right lobe
Isthmus (connects right and left lobes)

Question 25

What are the anatomical variations of the thyroid?

Answer 25

50% of thyroid glands will have a pyramidal lobe, which extends upward from the isthmus as a finger of glandular tissue.
Another common variation is the levator glandulae thyroideae muscle, which connects the isthmus of the thyroid gland with the hyoid bone. (innervated by ansa cervicalis)

Question 26

What arteries supply blood to the thyroid?

Answer 26

Superior thyroid artery (from external carotid artery)
Inferior thyroid artery (from thyrocervical trunk)
Thyroid ima artery: inconstant branch to the thyroid gland, from the brachicephalic trunk. Present in 10% of individuals

Question 27

What veins drain blood from the thyroid?

Answer 27

Superior Thyroid Vein (to internal jugular vein)
Middle Thyroid Vein (to internal jugular vein)
Inferior Thyroid Vein (to brachiocephalic vein)

Question 28

What is the nerve supply of the thyroid?

Answer 28

From the superior, middle and inferior cervical sympathetic ganglia

Question 29

What is goiter?

Answer 29

An abnormal enlargement of the thyroid gland. Produces swelling in the neck

Question 30

What is endemic goiter?

Answer 30

Goiter due to dietary deficiency of iodine. Iodine is necessary to produce thyroxine.
Glands enlarge to increase output. Hormone is largely inactive. Symptoms are those of hypothyroidism.

Question 31

What is Exopthalamic Goiter?

Answer 31

Goiter due to an autoimmune disease. Thyroid stimulating immunoglobins bind to receptor sites. Causing over-activity of the gland. Hormone is active.
Symptoms are those of hyperthyroidism.
Known as Graves disease. (eyes bulge out)