Fascia Of The Neck & Posterior Triangle Till Last 4 CN Flashcards
Mention tributaries of EJV
AJV
Transverse cervical vein
Suprascapular vein
Posterior external jugular vein
……LN accompany EJV. It acts as….in clinical settings.
Superficial cervical
Vebous manometer
Investing layer of deep fascia encoles……..muscles and……glands and…….spaces
Trapezius , sternocleidomastoid
Parotid , submandibular
Supraclavicular , suprasternal
Describe superior attachment of investing layer
External occipital protuberance, superior nuchal line, mastoid process, base of mandible
Describe inferior attachment of investing layer of deep fascia
Spine of scapula, acronmion, clavicle, manubrium
Describe attachments of prevertebral layer of deep fascia
Superior, attached to base of the skull
Inferior, extends in superior mediastinum till level of anterior longitudinal ligament of T3, T4
Laterally, deficient below trapezius
Ant, separated from pharynx and buccopharyngeal fascia by retropharyngeal space
Describe relations of prevertebral fascia
Behind it, are prevertebral and scalene muscles, brachial and cervical plexus in addition to subclavian artery
In front of it are pharynx, larynx , esophagus, trachea, carotid sheath, sympathetic chain and subclavian vein.
Describe attachments of pretracheal fascia
Sup, hyoid bone in midline the oblique line of tgyroid and crcoid cartialges.
Inf: descends to enclose thyroid vein, infrahyoid muscles and descend in thorax behind bracheocephalic vein to blend with adventitia of aortic arch and fibrous pericardium
…..surrounds brachial plexus and subcalvian art
Axillary sheath
Neck infection behind prevertebral fascia may pass
A) Forward in median plane pushing pharyngeal wall
B) laterally to bulge into posterior triangle
C) inferiorly to superior mediastinum
Neck infection in front of pretracheal fascia can estend to……
Anterior mediastinum/ superasternal area
Neck infection in front of prevertebral fascia extends to…..
Posterior mediastinum
Retropharyngeal space is closed superiorly by…..and on each side by…..and opens inferiorly into…..c
Cranial base
Carotid sheath
Superior mediastinum
Mention contents of carotid sheath
- Common or ICA , med
- IJV lat
- Vagus nerve in between
….lies in front of carotid sheath while….lies behind
Ansa cervicalis
Sympathetic trunk
…….LN lie along carotid sheath
Deep cervical
Describe origin and insertion of sternocelido mastoid
O, sternal head, superolateral aspect of ant surface of manubrium. Clavcular head, medial 1/3 of clavicle
I, mastoid process and lat 1/3 of superior nuchal line.
Describe nerve supply of scm m
Motor, spinal accessory n
Sensory: ventral rami of C2 and C3 proprioceptive
Relations of scm m
Covered by:
1. Skin amd superficial fascia containing platysma EJV, 3 nerves great auricular, trsanverse cervical amd medial supraclavicular and superficial cervical LN
2. Deep fascia
Describe action of scm m
- On one side, tilts head towards its own side and turns face to opposite side
- Both together, forward neck flexion
- Act from above in forced inspiration
Describe roof amd floor of posterior triangle of neck
Roof, skin, superficial fascia, investing layer of deep cervical facscia
Floor, prevertebral layer of deep cervical fascia, and muscles from above downwards: semispinalis capitits, splenius capitis, levator scapulae, scalenus medius, scalenus ant (hidden behind scm m)
The superior part of posterior triangle is…..while its inferior part is…..they are divided by….
Occipital triangle
Supraclavicular triangle
Inferior belly of omohyoid muscle
Mention nerves of posterior triangle if neck
- Spinal part of accessory nerve
- Roots & trunks of brachial plexus
- Cutaneous nerves of cervical plexus
- Muscular branches to muscles of floor & boundaries
Mention vessels of posterior triangle of neck
- 3rd part of subclavian artery
- Subclavian vein
- Suprascapular artery & vein
- Transverse cervical artery & vein
- External jugular vein
- Occipital artery
Mention cutaneous branches of cervical plexus with root values
Great auricular(C2&3), lesser occipital(C2), transverse cervical(C2&3) & supraclavicular (C3&4)
Roots & trunks of brachial plexus lie between……along with…..art.
Scalenus anterior & medius
Subclavian
3rd part of subclavian artery is separated from vein by……
Scalenus anterior
Mention branches of 3rd part of subclavian art
Deep branch of transverse cervical (in 65% of subjects)
Suprascapular & transverse cervical are branches of…….which arises from……
Thyrocervical trunk
1st part of subclavian artery
The transverse cervical artery passes deep to….
Trapezius
With regards posterior triangle of neck, lower part drains to….., while upper part drains to…..
Supraclavicular nodes
Occipital nodes
Describe superior border of anterior triangle
Inferior border of mandible and line joining angle of mandible to mastoid process
Mention bounds of submental triangle
Base(inf): body of hyoid bone
Lat: ant belly of digastric
Apex: symphsis menti
Floor: two mylohyoid muscles with their median raphe
Mention contents of submental triangle
Submental LN, artery, vein & mylohyoid nerve and vessels & small veins that unit to form AJV
Mention bounds of digastric triangle
Ant: anterior belly of digastric
Post: post belly if digastric & stylohyoid
Base: same as base of ant triangle
Roof: skin, superficial fascia, deep fascia (splits to enclose submandibular gland)
Floor: mylohyoid & hyoglossus muscle
Mention contents of anterior part of digastric
Submandibular gland with its LNs & facail vein (superficial) & facial artery (deep)
Structures superficial to mylohyoid (sunmental artery, vein & LNs) & mylohyoid nerve & vessels
Structures superficial to hyoglossus (SM gland (deep part), SM duct, SM ganglion, lingual & hypoglossal nerves)
Mention contents of posterior part of digastric triangle
- Lower part of Parotid gland
- External carotid artery
- Carotid sheath & its contents
Mention bounds of carotid triangle
Sup: post belly of digastric
Ant: sup belly of omohyoid
Post: ant border of scm m
Floor: ant, hyoglossus & thyrohyoid. Post, middle & inf constrictors of pharynx
Mention arterial contents of carotid triangle
CCA, ICA, ECA (branches: superior thyroid, ascending pharyngeal, lingual, facial & occipital arts) also carotid sinus & body.
Mention veins & lymph nodes of carotid triangle
Internal jugular vein with 4 tributaries (pharyngeal, lingual, common facial, superior thyroid veins)
Mention nerves of carotid triangle
Last 3 cranial nerves
Ansa cervicalis (ant to sheath) & sympathetic chain (post to sheath)
Mention bounds of muscular triangle
Ant: midline of the neck
Postero-sup: superior belly of omohyoid
Postero-inf: ant border of scm m
Roof: skin, superficial fascia & investing layer of deep cervical fascia
Floor: pretracheal fascia
Describe origin & insertion of
1.sternohyoid &
2.sternothyroid
- O, back of manubrium + medial end of clavicle. I, lower border of hyoid bone
- O, back of manubrium and back of 1st costal cartilage. I, oblique line of thyroid cartilage
Describe origin & insertion of
1.thyrohyoid &
2.omohyoid
- O, olique line of thyroid cartilage. I, lower border of the body and greater cornu of hyoid bone
- O, sup belly, lower border of body of hyoid bone, inf belly, upper border of scapula & suprascapular ligament. I, intermediate tendon held in position by fascial sling connected to clavicle.
Describe nerve supply of infrahyoid muscles
All are supplied by ansa cervicalis ex thyrohyoid supplied by C1 fibers joining hypoglossal nerve.
Describe movements of infrahyoid muscles
All depress larynx ex thyrohyoid which elevate or depress larynx
Sternohyoid: depress hyoid bone after its elevation during swallowing and vical movements
Sternothyroid: depress larynx after its elevation in swallowing & vocal movements
Thyrohyoid: depress hyoid bone + elevate larynx
Omohyoid: depress hyoid in prolonged inspiratory efforts & tenses the lower deep cervical fascia
Describe origin & insertion & nerve supply of
1.digastric &
2.stylohyoid
- O, Ant belly, digastric fossa of mandible. Post belly, digastric notch on medial surface of mastoid process. I, intermediate tendon held to hyoid by fibrous loop. N, ant belly, n. to mylohyoid (1st pharyngeal arch) & post belly: facial n. (2nd pharyngeal arch)
- O, posterior surface of styloid process. I, hyoid bone where its tendon is perforated by posterior belly of digastric m. N,: facial n. (2nd pharyngeal arch)
Describe origin & insertion & nerve supply of
1.mylohyoid &
2.geniohyoid
- O, mylohyoid line of mandible. I, ant & mid fibers inserted into the mylohyoid raphe (from symphsis menti to body of hyoid bone). Post fibers into hyoid fibers. Nerve to mylohyoid (1st pharyngeal arch)
- O, inferior genial tubercle of body of mandible. I, body of hyoid bone. N, C1 via hypoglossal n.
Describe actions of suprahyoid muscles
- Digastric, depresses mandible if hyoid is fixed, or elevate hyoid during swallowing
- Stylohyoid, pulls hyoid upwards and backwards
- Mylohyoid, supports floor of mouth, helps in depression of mandible, elevates the mandible during early stage of swallowing.
Geniohyoid, elevates hyoid or depress mandible
Describe exit of cervical plexus roots from bone
Between ant and post tubercles of cervical transverse process
…..is ant to cervical plexus while….is post to it.
Prevertebral fascia
Scalenus medius
Mention communicating branches of cervical plexus
- Grey rami from superior cervical ganglion to all roots
- C1 fibers joining hypoglossal n
- From C2 to sternomastoid & C2,3 & 4 to trapezius (sensory)
List muscular branches of cervical plexus
- Infrahyoid muscles by ansa cervicalis
- Prevertebral & scalene muscles
- Levator scapulae
- Diaphragm by phrenic nerve
Describe structure of ansa cervicalis
Superior limb (descending hypoglossi): formed of C1 fibers joining hypoglossal nervethen leave & descend in front of carotid sheath
Inferior limb (descending cervicalis): formed of fibers C2&3 that descend in front of IJV then joint sup limb infront of sheath
The sympathetic chain lies between…….
Prevertebral fascia (post) & carotid sheath (ant)
List the groups of postganglionic parasympathetic fibers
A- 1st group acts as communicant rami to nearest nerve
B-2nd group forms plexus around nearest artery
C- 3rd group sends vesceral branches to nearest viscera
Fibers connecting middle & inferior ganglia are called…..
Ansa subclavia
Preganglionic fibers from cervical symp chain is from……
Upper thoracic ganglia
The largest cervical ganglion is….while smallest is….
Superior
Middle
Describe site of each cervical ganglion
Sup: between ECA & longus capitis at C2,3 level
Mid: related to inf thyroid at level of C6& C7
Inf: at level of transverse process of C7 & neck of 1st rib
Mention branches of sup cervical ganglion
A) Communicating with upper 4 cervical +lower 4 cranial nerves
B) Vascular plexus arounf ECA & ICA
C)Visceral branches (pharyngeal branch to pharyngeal plexus, superior cervical cardiac to superficial cardiac plexus, thyroid nerves)
Mention branches of middle cervical ganglion
A) Communicating with C5&6
B) Ansa subclavia & plexus around inf thyroid art
C) visceral branches: to thyroid plexus, middle cardaic cervical to deep cervical plexus, tracheal & esophageal branches
Mention branches of inf cervical ganglion
A) communicating to C7&8
B) Vascular plexus around vertebral artery
C) Visceral branches: inf cervical cardiac to deep cardiac plexus
At fisrt CN IX passes between……while later passes between…..
IJV & ICA
ECA & ICA
CN IX passes between …..muscles
Superior constrictor & middle constrictor
CN IX has …..ganglia, exits from…..in skull
2 (sup & inf)
Middle part of jugular foramen
Enumerate branches if CN IX
Tympanic branch
Carotid branch (carotid sinus & body)
Pharyngeal: share in phraygeal plexus
Muscular to stylopharyngeus
Tosillar (tonsillar plexus to supply tonsil & soft palate)
Lingual to mucosa of post 1/3 of tongue & vallate papillae
CN IX is tested by…….
Gentle tickling of posterior wall of pharynx
CN IX is affected in combination with….
CN X
Describe course of tympanic branch of CN IX
Enters middle ear via tympanic canaliculus shares in tympanic plexus gives fibers to greater & lesser petrosal nerves for parotid gland + sensory supply to mucosa of middle ear, auditory tube & mastoid air cells
Cranial accessory n joining vagus has most of its fibers distributed through……
Pharyngeal & recurrent laryngeal nerves
Vagus passes at first between…..then between…..
IJV & ICA
IJV & CCA
Enumerate branches of vagus nerve from superior vagal ganglion
- Meningeal nerve -supplies dura of posterior cranial fossa
- Auricular nerve: get outside via tympano-mastoid fissure to supply concha & root of auricle + post 1/2 of external auditory meatus & tympanic membrane
Mention branches of vagus from inferior vagal ganglion
- Pharyngeal nerve passes between ICA & ECA to reach mid contrictor & share in pharyngeal plexus
- Superior laryngeal nerve: passes behind ICA on pharyngeal constrictors where it divides into 2 branches:
-External laryngeal nerve pierces inferior constrictor supplying it & cricothyroid m
-Internal laryngeal nerve: passes downwards, pierces thyrohyoid membrane to supply laryngeal mucosa above vocal cord
Mention branches of vagus in neck
- Carotid nerve to carotid body
- Cardiac nerves (superior & inferior) from each vagus, the left inferior end in superficial cardiac plexus while the rest end in deep cardiac plexus
- Rt recurrent laryngeal arise from vagus in front of subclavian a then turns around & ascends in tracheo-esophageal groove to pass with inferior thyroid a to supply larynx
Enumerate branches of vagus in thorax
Left recurrent laryngeal nerve
Pulmonary & cardiac branches
Mention results of vagal paralysis
Nasal regurgitation, hoarseness of voice, flattened palatal arches, cadaveric position of vocal cords & dysphagia
Irritation of auricular branch of vagus n leads to….
Reflex cough
In case of vagal paralysis uvula is….
Deviated to opposite side
Irritation of 11th nerve leads to
Torticollis
Mention branches of hypoglossal nerve
1st group: Fibers from C1 related anatomically to hypoglossal
1. Meningeal branch to post cranial fossa
2. Geniohyoid
3. Thyrohyoid
4. Descending hypoglossi or upper roots of ansa cervicalis
2nd group: from hypoglossal itself:
Styloglossus, genioglossus, hyoglossus + all intrinsic muscle
