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Gross Anatomy > Exam 4 Triangles of the Neck > Flashcards

Exam 4 Triangles of the Neck Flashcards

1
Q

What are the bony and cartilaginous landmarks of the neck and what vertebral levels are they at?

A
  • Atlas: C1
  • Hyoid bone: C3
  • Thyroid cartilage: C4/5
    • Cricoid cartilage
    • Tracheal rings
  • Jugular notch: T2
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2
Q

Anterior cervical triangle

  • Boundaries
A
  • Superior border: Inferior margin of mandible
  • Inferior border: Jugular notch
  • Medial border: Anteriomedian line of neck
  • Lateral border: Anterior margin of sternocleidomastoid
  • Anterior border (roof): Platysma and investing layer of deep cervical fascia
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3
Q

Subtriangles of Anterior Cervical Triangle

  • Boundaries of each triangle
  • Contents of each triangle
  • Triangles:
    • Muscular triangle
    • Carotid triangle
    • Submandibular triangle
    • Submental triangle
A
  • Muscular triangle:
    • Boundaries: Superior belly of omohyoid
      • Inferomedial edge of sternocleidomastoid
      • Anterior medial line of neck
      • Hyoid bone
    • Contents: Infrahyoid muscles
      • Thyroid gland
      • Contains NO vessels (except to thyroid)
  • Carotid triangle:
    • Boundaries: Posterior belly of digastric m
      • Superior belly of omohyoid
      • Superiomedial margin of sternocleidomastoid
    • Contents: Common carotid a
      • Carotid sinus
      • Internal jugular v
      • CN X and CN XII
  • Submandibular triangle:
    • Boundaries: mandible
      • 2 bellies of digastric m
    • Contents: Submandibular gland
      • Facial a
      • Facial v
  • Submental (suprahyoid) triangle:
    • Boundaries: Anteriomedial line of neck
      • Anterior belly of digastric m
      • Hyoid bone
    • Contents: Lymph nodes
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4
Q

Sternocleidomastoid

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Manubrium and medial 1/3 of clavicle
  • Distal Attachment: Mastoid process and lateral 1/2 of superior nuchal line
  • Action: Singly turns face toward opposite side of contraction; Together flex head and raise thorax
  • Innervation: Spinal accessory nerve (CN XI)
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5
Q

Torticollis (wryneck)

  • What is it?
  • What causes it?
  • Symptoms?
A
  • Contracted state of cervical muscles, especially sternocleidomastoid muscle
  • Caused by injury to sternocleidomastoid (SCM) muscle (unilateral SCM fibrosis) or avulsion of CN XI at birth
    • Congential torticollis caused by SCM fibrosis resulting in no lengthening during development
  • Symptoms:
    • Twisting of neck and protrusion of chin to side opposite of lesion/contracture
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6
Q

Digastric muscle

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment:
    • Anterior belly: Digastric fossa of mandible
    • Posterior belly: Mastoid notch
  • Distal Attachment: Intermediate tendon attached to body of hyoid
  • Action: Elevates hyoid and depresses mandible
  • Innervation:
    • Anterior belly: Nerve to mylohyoid (CN V3)
    • Posterior belly: Facial nerve (CN VII)
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7
Q

Mylohyoid

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Mylohyoid groove of mandible
  • Distal Attachment: Median raphe and body of hyoid bone
  • Action: Elevates hyoid and depresses mandible
  • Innervation: Nerve to mylohyoid (CN V3)
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8
Q

Stylohyoid

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Styloid process
  • Distal Attachment: Body of hyoid
  • Action: Elevates hyoid
  • Innervation: Facial nerve (CN VII)
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9
Q

Geniohyoid

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Genial tubercle of mandible
  • Distal Attachment: Body of hyoid
  • Action: Elevates hyoid and tongue
  • Innervation: C1 via hypoglossal nerve (CN XII)
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10
Q

Thyrohyoid

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Oblique line of thyroid cartilage
  • Distal Attachment: Body and greater horn of hyoid
  • Action: Depresses and retracts hyoid and larynx
  • Innervation: C1 via hypoglossal nerve (CN XII)
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11
Q

Omohyoid

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Intermediate tendon
  • Distal Attachment: Body of hyoid
  • Action: Depresses and retracts hyoid and larynx
  • Innervation: Ansa cervicalis
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12
Q

Sternohyoid

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Manubrium and medial end of clavicle
  • Distal Attachment: Body of hyoid
  • Action: Depresses hyoid and larynx
  • Innervation: Ansa cervicalis
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13
Q

Sternothyroid

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Manubrium and 1st costal cartilage
  • Distal Attachment: Oblique line of thyroid cartilage
  • Action: Depresses thyroid cartilage and larynx
  • Innervation: Ansa cervicalis
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14
Q

Carotid Sinus

  • What is it?
  • Where is it located?
  • What does it contain?
  • Innervation
A
  • Dilation in proximal portion of internal carotid artery
  • Located just distal to bifurcation
  • Contains pressure receptors activated by changes in BP
  • Innervated by cartoid sinus branch of CN IX
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15
Q

Carotid Sinus Hypersensitivity

  • Symptoms
  • Cause
A
  • Symptoms: Dizziness and maybe falling
  • Can be caused by taking carotid pulse, head turning, garments with tight collars
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16
Q

Carotid Body

  • What is it?
  • Where is it located?
  • What does it contain?
  • Innervation
A
  • Ovoid body consisting of cells of neural crest origin
  • Location: Rests on bifurcation of common carotid artery
  • Contains chemoreceptors that sense pH, O2, and CO2 levels
  • Innervated by CN X; highly vascularized
17
Q

Branches of external carotid artery (8)

A
  1. Superior thyroid: Arises below level of greater horn of hyoid bone
  2. Lingual: Arises at level of tip of greater horn of hyoid bone
  3. Facial: Above lingual artery; ascends forward, deep to posterior belly of digastric m
  4. Ascending pharyngeal: From posterior surface; ascends between internal carotid a and wall of pharynx
  5. Occipital: From posterior surface above hyoid bone
  6. Posterior auricular: From posterior surface above posterior belly of digastric
  7. Maxillary (terminal branch): Arises behind neck of mandible; larger terminal branch
  8. Superficial temporal (terminal branch): Arises behind neck of mandible; smaller terminal branch
18
Q

Retromandibular vein

  • What forms it?
  • What do its branches join?
  • What do these branches drain into?
A
  • Retromandibular vein
    • Formed by superficial temporal and maxillary vv
  • Anterior branch of retromandibular vein
    • Joins facial v to form common facial v
    • Empties into internal jugular v
  • Posterior branch of retromandibular vein
    • Joins posterior auricular v
    • Forms external jugular v
19
Q

External juglar vein

  • What drains into it?
  • What does it drain into?
A
  • Suprascapular v, transverse cervical v, and anterior jugular v drain into it.
  • Drains into subclavian vein OR internal jugular v
20
Q

Internal jugular venipuncture

  • Which jugular vein is used?
  • How is the vein accessed?
A
  • Right internal juglar vein
  • Punctured by aiming at apex of triangle between sternal and clavicular heads of SCM
21
Q
  • What nerve gives off motor innervation to anterior cervical triangle?
    • What spinal levels does it arise from?
  • What are its branches?
A
  • Ansa cervicalis: Formed by superior root of C1 and/or C2 and inferior root of C2/3
  • Branches:
    • Nerve to omohyoid (superior belly)
    • Nerve to sternothyroid
    • Nerve to sternohyoid
    • Nerve to omohyoid (inferior belly)
22
Q
  • What nerves give of sensory fibers in the anterior cervical triangle?
    • What spinal levels do they arise from?
  • What do they supply?
A
  • Great auricular (C2-C3): Supplies inferior aspect around ear
  • Transverse cervical (C2-C3): Supplies anterior skin of neck
  • Supraclavicular (C3-C4): Supplies skin above clavicle
23
Q

Lymphatics of anterior and posterior cervical triangles

  • Where are lymph nodes located?
  • What do they drain into?
  • What trunks drain into thoracic duct or right lymphatic duct?
A
  • Superficial nodes of head: Located near ear
    • Drain into occipital, retroauricular, submandibular, and superficial cervical nodes
  • Superficial cervical nodes: Lie along anterior jugular v
    • Superficial cervical nodes and nodes of head drain into superior or inferior deep cervical nodes
  • Superior/Inferior deep cervical nodes:
    • Superior: located along internal jugular v in carotid triangle
  • Inferior: Located on internal jugular v near subclavian v
  • Superior/Inferior cervical nodes drain into:
    • On left side: Thoracic duct
    • On right side: Right lymphatic duct
    • Drain into these ducts via:
      • Left/Right jugular trunk
      • Left/Right subclavian trunk
      • Thoracic/Right lymphatic duct entering left/right subclavian vein
      • Left/Right bronchomediastinal trunk
24
Q

Posterior cervical triangle

  • Boundaries
  • Subtriangles
A
  • Anterior border: Posterior margin of SCM
  • Posterior border: Anterior margin of trapezius
  • Inferior border: Middle 1/3 of clavicle
  • Roof: Platysma and investing layer of deep cervical fascia
  • Floor: Splenius capitus, levator scapulae, and scalenius mm
  • Subtriangles: Occipital triangle, Supraclavicular triangle
25
Q

Splenius capitus muscle

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Spinous process of C7-T3
  • Distal Attachment: Mastoid process, superior nuchal line
  • Action: Extends neck and head
  • Innervation: Dorsal rami of C2-C6
26
Q

Levator scapulae

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Transverse process of C1-C4
  • Distal Attachment: Medial border of scapula
  • Action: Elevates scapula
  • Innervation: Nerves to levator scapulae (C3/4), dorsal scapular nerve
27
Q

Scalenus Anterior

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Transverse processes of C3-C6
  • Distal Attachment: Scalene tubercle of first rib
  • Action: Elevates first rib, bends neck
  • Innervation: C5-C8
28
Q

Scalenus medius

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Transverse processes of C2-C7
  • Distal Attachment: Upper surface of first rib
  • Action: Elevates first rib, bends neck
  • Innervation: C5-C8
29
Q

Scalenus posterior

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Transverse processes of C4-C6
  • Distal Attachment: Outer surface of second rib
  • Action: Elevates second rib, bends neck
  • Innervation: C6-C8
30
Q

Inferior belly of Omohyoid

  • Proximal Attachment
  • Distal Attachment
  • Action
  • Innervation
A
  • Proximal Attachment: Medial lip of suprascapular notch
  • Distal Attachment: Intermediate tendon
  • Action: Depresses and retracts hyoid/larynx
  • Innervation: Ansa cervicalis
31
Q

What are the arteries found in the posterior cervical triangle?

A
  • Subclavian (red): gives rise to thyrocervical trunk (green)
  • Suprascalene (purple): 1st branch from thyrocervical trunk; passes in front of ant. scalene
  • Transvere cervical (orange): 2nd branch for thyrocervical trunk; passes in front of phrenic n on ant. scalene; dives deep to trapezius m.
32
Q

What are the veins of the posterior cervical triangle?

A
  • External jugular vein
  • Transverse cervical vein
  • Suprascapular vein
33
Q

What are the motor nerves found within the posterior cervical triangle?

What do they supply?

A
  • Spinal accessory nerve (CN XI): Innervates trapezius and SCM
  • Dorsal scapular nerve (from C5 root of brachial plexus): Emerges from behind anterior scalene; Innervates levator scapulae
  • Long thoracic nerve (from C5-7 roots of brachial plexus): Pierces through middle scalene to innervate lateral thoracic muscle
34
Q
  • What are the sensory nerves found within the posterior cervical triangle?
    • What spinal levels do they arise from?
  • What do they supply?
A
  • Lesser occipital nerve (C2): Supplies scalp behind auricle
  • Supraclavicular nerve (C2-3): Supplies skin over clavicle and shoulder
35
Q

Danger area (nerve point) of the neck

  • What is it?
  • Why is it clinically relevant?
A
  • Area susceptible to injury due to superficial location of multiple cutaneous nerves
  • Clinically important for cervical nerve block for local anesthesia
36
Q

Cervical/Supraclavicular plexus block

  1. How would you achieve regional cutaneous anesthesia through this?
  2. How would you provide anesthesia to the upper limb?
A
  1. By injecting agent into nerve point of neck (posterior margin of SCM, approx. at superior and middle 1/3 of muscle)
  2. By injecting agent into the supraclavicular portion of brachial plexus (at superior to midpoint of clavicle)

Gross Anatomy (21 decks)

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