deep structures (root of neck) Flashcards
vertebral artery
- arises from first part of subclavian artery
- ascends medially behind the carotid sheath to reach the foramen transversarium of C6
- ascends thru foramina transverseria of C6-C1
- enters foramen magnum
- joins its fellow at lower border of pons to form the basilar artery
course of vertebral artery
- scalenovertebral triangle
- foramina transcersaria
- posterior arch of atlas
- cranial cavity
branches of vertebral artery
- anterior spinal artery
- posterior spinal artery
- posterior superior cerebellar artery
- medullary branches
branches of thyrocervical trunk
- inferior thyroid artery
- transverse cervical
- suprascapular
what forms an anastomosis around the scapula?
- subclavian artery
- axillary artery
- descending thoracic aorta (posterior intercostal arteries
clinical importance of scapular anastomosis
- provides collateral circulation
- allows for blood to continue circulating if the subclavian is obstructed
- securing blood supply to upper limb in case of obstruction of the artery
what does the inferior thyroid artery supply?
- thyroid
- parathyroid glands
- cervical part of trachea and esophagus
- close to recurrent laryngeal nerve close to the posterior surface of thyroid gland
veins in the lateral cervical region
- retromandibular vein
- facial vein
- external jugular vein
jugular veins
- retromandibular
- facial vein
- posterior auricular vein
- external jugular vein
- trans cervical vein
- suprascapular vein
- subclavian vein
- common facial vein
- submental plexus
- internal jugular vein
- anterior jugular vein
clinical significance of external jugular vein
- venous line
- central venous pressure
- transvenous pacemaker and pulmonary wedge catheter
- may cause fatal bleeding and air embolism
beginning, termination, and tributaries of external jugular vein
- begin: union of posterior auricular with posterior division of retromandibular vein
- term: into subclavian vein
- tributaries: post. auricular vein, post. retro, anterior jugular vein, transverse cervical suprascapular
beginning, termination, and tributaries of internal jugular vein
- begin: continuation of segmoid sinus
- term: ends by joining subclavian to form brachiocephalic vein
- tributaries: inferior petrosal sinus, common facial vein, lingual vein, superior and middle thyroid veins, pharyngeal veins
anterior jugular vein beginning, termination, tributaries
- begin: submental plexus of veins
- termination: into external jug vein
- tributaries: submental vein
the subclavian vein is a continuation of the _____
axillary vein
where does the subclavian vein run?
from outer border of the first rib to the medial border of anterior scalene muscle
how is the innominate vein formed?
subclavian vein joins the internal jugular vein to form the brachiocephalic vein
where do the subclavian vein and artery lie?
subclavian vein lies anterior to the anterior scalene
-subclavian artery lies posterior to the anterior scalene (and anterior to the middle scalene)
what is the subclavian vein puncture used for?
right cardiac catheterization and IV line (chemo)
origin of sternocleidomastoid muscle
- sternal head from front of manibrium sterni
- clavicular head from superior surface of medial third of clavicle
insertion of sternocleidomastoid muscle
mastoid process and superior nuchal line
nerve supply of sternocleidomastoid
spinal accessory nerve (motor)
C2 and C3 (proprioception)
action of sternocleidomastoid
turns face to opposite side and neck to same side
origin of trapezius
from superior nuchal line, external occipital protuberance, ligamentum nuchae, and thoracic spines
insertion of trapezius
into lateral third of clavicle and into acromion and spine of scapula
nerve supply of trapezius
spinal accessory nerve (motor)
C3 and C4 (proprioception)
action of trapezius
- retracts and elevates the scapula
- extension of neck (bilateral contraction with shoulder fixed)
- lateral flexion of neck (unilateral contraction)
scalene anterior
- origin: anterior tubercles of transverse processes of C3-C6
- insertion: scalene tubercle of first rib anterior to subclavian atery
- nerve supply: C5-C7
- action: elevates first rib and flexion of neck anteriorly and laterally
scalene medius
- origin: posterior tubercle of C2-C7
- insertion: upper surface of 1st rib behind subclavian artery
- C3-C8
- elevates first rib and flexion of neck anteriorly and laterally
scalene posterior
- origin: posterior tubercles of C5-C7
- insertion: upper surface of 2nd rib
- nerve supply: C7-C8
- elevates 2nd rib and flexion of neck anteriorly and laterally
important relations of scalenus anterior
- phrenic nerve
- carotid sheath
- subclavian artery and its branches
- subclavian vein
- brachial plexus
- sympathetic trunk
symptoms of thoracic outlet syndrome (TOS)
pain, numbness, tingling, weakness in arm and hand due to pressure against nerves or blood vessels that supply the arm
causes of thoracic outlet syndrome
hyperextension neck injuries
auto accidents and repetitive stress
people born with what makes that 10 times more likely to develop symptoms of TOS
cervical rib
an extra rib in the neck occurs in less than ____ of the population
1%
what compresses the subclavian artery?
cervical rib
what nerve would be injured in posterior neck triangle operations?
spinal accessory nerve – would cause paralysis of trapezius muscle
*test by asking patient to shrug their shoulder
what other structures should be considered when operating in the posterior neck triangle?
- upper and middle trunks of the brachial plexus
- third part of subclavian artery
- subscapular nerve and artery
- branches of cervical plexus
- in left side thoracic duct
what innervates smooth and cardiac muscle, uses a two neuron system, and has ganglia between neurons?
autonomic nervous system
each sympathetic pathway from the cord to the stimulated tissue is composed of ______
two neurons, a preganglionic neuron and a postganglionic neuron
where is the source of all preganglionic sympathetic fibers ?
in the lateral horn of the spinal cord between T1 and L2 and leave the spinal cord via the ventral rootlet
cervical sympathetic trunk
some of the higher thoracic preganglionic fibers ascend into the neck without synapsing to form the cervical sympathetic trunk
cervical sympathetic chain ganglia
superior
middle
inferior
superior cervical ganglion
- C1-C4
- arteries involved: common, external, internal carotid
- organs: eye, face, nasal, pharynx, palate and nasal cavity, saliva, heart, etc
middle cervical ganglion
- C6
- inferior thyroid artery
- organs: larynx, trachea, pharynx, upper esoph, heart
inferior cervical ganglion
- C7
- vertebral and subclavian arteries
- heart, artery smooth muscle
all sympathetics to the head are derived from the?
superior cervical ganglion
where are preganglionic sympathetics located?
in the lateral gray horn (interomedial gray columns) of the upper thoracic spinal cord (T1 and T2)
most fibers synapse in the _______ and send fibers along the external and internal carotid arteries
superior cervical ganglion
what supplies all areas of distribution of the external carotid arteries including sweat glands of the face and neck and salivary glands?
external carotid (external and common carotid plexus)
what two main groups leave the internal carotid plexus in the cavernous sinus?
sympathetic root of the ciliary ganglion
deep petrosal nerve
sympathetic root of the ciliary ganglion
part of internal carotid plexus that runs through the ganglion without synapsing and enters the short ciliary nerves and is distributed to the dilator and vasculature of the eye
deep petrosal nerve
- of internal carotid plexus
- joins the greater petrosal to form the nerve of the pterygoid canal
- postganglionic sympathetic fibers pass thru the pterygopalatine ganglion and are distributed with the branches of the maxillary division of the trigeminal nerve
stimulation of sympathetic in head leads to
- dilation of pupil
- elevation of eyelid
- vasoconstriction of the blood vessels
- sweating of the face
interruption of sympathetic chain leads to
horner syndrome (lung tumor at apex can compress the chain---> unilateral dry skin, pupillary constriction, hotness, blushing of the face (ptosis, myosis, anhydrosis)
