GA2 - cervical triangles Flashcards
6 superficial structures of the neck
skin superficial fascia platysma cutaneous nerves superficial veins superficial lymph nodes
___ embedded in superficial fascia
platysma
___ - thin flapped facial muscle
platysma
origin of the platysma
deep fascia covering the pectoralis major and deltoid muscle
insertion of the platysma
lower margin of the body of mandible blending with the muscle at the angle of the mouth
nerve supply of the platysma
cervical branch of facial nerve
action of the platysma
depresses the mandible and draws the lower lip and angle of the mouth
cutaneous nerves arise from ___ border of the SCM
posterior
___ ___ (C_) derived from dorsal ramus of C2
greater occipital (C2)
___ ___ nerve is between the semispinalis capitis and splenius capitis
greater occipital
___ ___ (C_) runs along the post border of the SCM
lesser occipital (C2)
_____ ___ (C_, C_) accompanies external jugular vein
great auricular (C2, C3)
____ ___ (C_, C_) crosses the SCM
transverse cervical (C2, C3)
____ (C_, C_) has a lot going down toward the clavicle
supraclavicular (C3, C4)
4 cutaneous nerves that are branches of the cervical plexus - ventral rami
lesser occipital (C2) greater auricular (C2, 3) transverse cervical (C2, 3) supraclavicular (C3, 4)
___ __ vein drains most of the scalp and side of the face
external jugular
____ ____ vein begins at the angle of the mandible
external jugular vein
external jugular vein begins at the ___ of ___
angle of mandible
external jugular vein begins where the ___ ___ vein and __ division of the ____ vein join
post auricular
posterior
retromandibular
external jugular vein ends at the ___ vein
subclavian
external jugular vein is seen in patients with ___ ___ ____
congestive heart failure
___ ___ vein arises near the hyoid bone from small veins underneath the chin
anterior jugular
anterior jugular vein terminates into the ___ ___ vein or the ___ vein
external jugular
subclavian
just above the suprasternal notch, the left and right anterior jugular veins may be united by the ___ ___ ___
jugular venous arch
what muscle divides the neck into anterior and posterior triangles of the neck?
SCM
origin of the SCM
manubrium and medial third of clavicle
insertion of the SCM
mastoid process of tempral bone
nerve supply of the SCM
spinal part of accessory nerve (C2, C3)
action of the SCM
bilaterally, it extends the head at the atlanto-occipital joint and flexes the neck at the cervical vertebrae; unilaterally, it laterally bends the neck ipsilaterally and rotates head contralaterally
a clinical condition resulting from shortening of the SCM (congenital) or spasmodic contraction of the SCM
torticollis (wryneck)
torticollis irritates the nerve, can happen during ___, can be ___ and you can try to put in an ___
delivery
permanent
implant
anterior boundary of the posterior triangle of the neck
SCM
posterior boundary of the posterior triangle of the neck
trapezius
inferior boundary of the posterior triangle of the neck
middle third of the clavicle
____ belly of the ___ muscle divides the posterior triangle into 2 smaller triangles
inferior
omohyoid
occipital
supraclavicular
boundaries of the occipital triangle
SCM
trapezius
inferior belly of omohyoid
boundaries of the supraclavicular triangle
SCM
inferior belly of omohyoid
middle third of clavicle
4 arteries of the posterior triangle of the neck
subclavian
superficial (transverse) cervical
suprascapular
occipital
2 veins of the posterior triangle of the neck
external jugular and its tribitaries
subclavian
3 nerves of the posterior triangle of the neck
brachial plexus
spinal accessory
branches of the cervical plexus
suprascapular artery is the blood supply to what 2 muscle?
infraspinatus
supraspinatus
what are the 2 arteries that branch off the thyrocervical artery?
transverse cervical
suprascapular
___ ___ nerve crosses over the posterior triangle to innervate the SCM and trapezius
spinal accessory
occipital artery is a branch of the ___ ___ artery
external carotid
internal carotid artery is more __ than external carotid artery
posterior
anterior scalenes syndrome
compresses brachial plexus and subclavian vein
anterior scalenes causes ____ , ___ BP, ___ pulse
numbness
decreased
weak
nerve roots of brachial plexus come out between ___ ___ and ____ ____
anterior scalene
middle scalene
floor of the posterior triangle of the neck is made up of 6 things
prevertebral fascia splenius capitis levator scapulae middle scalene posterior scalene anterior scalene, occasionally
origin of the anterior scalene
anterior tubercles of TPs of C3-C6
insertion of the anterior scalene
first rib
nerve supply of the anterior scalene
ventral rami of C4-C6
action of the anterior scalene
bilaterally, elevate 1st rib
unilaterally, laterally flex and rotate neck
accessory muscle of respiration
3 things lie anterior to the anterior scalene
subclavian vein
transverse cervical and suprascapular a
phrenic nerve
2 things lie posterior to the anterior scalene
subclavian artery
brachial plexus
2 things lie medial to the anterior scalene
vertebral a and v
thyrocervical trunk
1 thing lies lateral to the anterior scalene
roots of the brachial plexus
___ vein and ____ ____ vein to make the brachiocephalic vein
subclavian
external jugular
origin of the middle scalene
post tubercles of TPs of C2-C7
insertion of the middle scalene
upper surface of first rib behind groove for subclavian artery
nerve supply of middle scalene
ventral rami of C3-C8
action of middle scalene
bilaterally - elevates 1st rib
unilaterally - laterally flex neck
origin of the posterior scalene
posterior tubercles of TPs of C4-C6 or C5-C7
insertion of the posterior scalene
outer surface of second rib
nerve supply of the posterior scalene
ventral rami of C6-C8
action of posterior scalene
bilaterally - elevates second rib
unilaterally - laterally flexes neck
brachial plexus is formed from ___ rami of __-___
ventral
C5-T1
roots of the brachial plexus enter the posterior triangle of the neck between the __ __ and ___ ___ muscles
anterior scalene
middle scalene
brachial plexus is covered by a fascial sheath derived from the deep cervical fascia called the ___ ___
axillary sheath
upper trunk of the brachial plexus formed by what roots?
C5-C6
middle trunk of the brachial plexus formed by what root?
C7
lower trunk of the brachial plexus formed by what roots?
C8-T1
divisions are formed by each trunk dividing into ___ and ___ branches
anterior
posterior
divisions are formed in the ____ triangle
supraclavicular
all 3 posterior divisions from each trunk join to form the ____ cord
posterior
erb duchenne’s palsy
upper trunk is damaged
delivery of a baby (traction)
stretch neck
signs of erb duchenne’s palsy
cannot abduct and ER
waiters tip position - IR and adduction
trouble with flexion
Klumpky’s palsy
damage to lower trunk
breached delivery (traction)
fall from revine and grab tree to stop self
signs of Klumpky’s palsy
claw hand deformity
cervical plexus is formed from the ___ rami of __ - __
ventral
C1-C4
cervical plexus is related to the ___ ___ vein within the ___ sheath
internal jugular
carotid
4 cutaneous branches of the cervical plexus
lesser occipital
great auricular
transverse cervical
supraclavicular
motor branches of the cervical plexus go 5 places
prevertebral muscles SCM levator scapulae trapezius infrahyoid muscles through the ansa cervicalis
ansa cervicalis comes from what nerve roots?
C1-C3
infrahyoid muscles are supplied by the___ ___, except the ____
ansa cervicalis
thyrohoid
ansa cervicalis lies ____ and ___ to internal jugular vein
anterior
inferior
5 infrahyoid muscles
geniohyoid thyrohyoid omohyoid sternohyoid sternothyroid
phrenic nerve is the only motor nerve supply to the ___
diaphragm
phrenic nerve is considered to be a branch of the ___ plexus
cervical
ansa cervicalis is a nerve ___ formed by 2 roots
loop
superior
inferior
superior root of ansa cervicalis is a branch of ___ that joins the ___ nerve and then separates from it to form the superior root
C1
hypoglossal
inferior root of ansa cervicalis is made up of the ___ ___ nerve with carries ___ and __ fibers
descending cervical
C2-C3
anterior boundary of the anterior triangle
midline of the neck
posterior boundary of the anterior triangle
anterior border of SCM
superior boundary of the anterior triangle
lower margin of mandible
anterior triangle can be subdivided into smaller triangles by __ and __ belies of ___ muscle and __ belly of ___ muscle
anterior belly of digastric
posterior belly of digastric
superior belly of omohyoid
medial boundary of the submental triangle
midline of the neck
lateral boundary of the submental triangle
anterior belly of digastric muscle
inferior boundary of the submental triangle
body of hyoid bone
contents of the submental triangle
lymph nodes
beginning of anterior jugular v
medial boundary of the digastric/submandibular triangle
anterior belly of digastric
lateral boundary of the digastric triangle
posterior belly of digastric
superior boundary of the digastric triangle
lower border of mandible
11 contents of the digastric triangle
submandibular gland facial a and v lymph nodes hypoglossal n mylohyoid nerve carotid a IJV vagus stylohyoid glossopharyngeal n lower part of parotid gland
medial boundary of the carotid triangle
superior belly of omohyoid
lateral boundary of the carotid triangle
anterior border of SCM
superior boundary of the carotid triangle
posterior belly of digastric
11 contents of the digastric triangle
CCA ECA ICA branches of ECA IJV and tributaries internal laryngeal nerve external laryngeal nerve IX, X, XII cranial nerves deep cervical lymph nodes
medial boundary of the muscular triangle
midline of the neck
inferior boundary of muscular triangle
anterior border of SCM
superior boundary of muscular triangle
superior belly of omohyoid
7 contents of muscular triangle
sternohyoid sternothyroid thyroid gland larynx trachea esophagus recurrent laryngeal nerve
digastric muscle has ant and post bellies connected by an ___ tendon
intermediate
origin of the digastric muscle
post belly from medial surface of mastoid process
insertion of the digastric muscle
ant belly into the digastric fossa of the mandible
nerve supply of the digastric muscle
post -
ant -
post belly - facial
ant belly - n to mylohyoid
action of the digastric muscle
depresses the mandible or elevates the hyoid bone
origin of the stylohyoid
styloid processof temporal bone
insertion of the stylohyoid
muscle passes downward and forward along the upper border of the post belly of digastric muscle and inserts into the hyoid bone at the jxn of the body and greater cornu. it is pierced near its insertion by the intermediate tendon of digastric muscle
nerve supply to the stylohyoid
facial
action of the stylohyoid
elevates the hyoid bone
origin of the mylohyoid
mylohyoid line of the mandible
insertion of the mylohyoid muscle
post fibers - body of the hyoid
ant fibers - fibrous raphe, extends from the symphysis menti to the body of the hyoid
nerve supply of the mylohyoid
mylohyoid nerve
mylohyoid is a branch of the ___ ___
inferior alveolar
inferior alveolar is a branch of the ___ nerve
mandibular
action of the mylohyoid
elevates the hyoid bone when the mandible is fixed
depresses the mandible when the hyoid bone is fixed
origin of the geniohyoid
inferior mental spine of the mandible
insertion of the geniohyoid
body of the hyoid bone
nerve supply of the geniohyoid
branch from the ant ramus of C1 carried along the hypoglossal nerve
action of the geniohyoid
elevates and pulls forward the hyoid bone when the mandible is fixed and depresses the mandible when the hyoid bone is fixed
4 suprahyoid muscles
digastric
stylohyoid
mylohyoid
geniohyoid
origin of the omohyoid
through inf belly from the upper margin of the scapula and suprascapular ligament
insertion of the omohyoid muscle
sup belly into the inferior border of the body of hyoid bone
intermediate tendon is held in position at an angle through a loop of deep fascia that slings the tendon to the clavicle and first rib
nerve supply of the omohyoid
ansa cervicalis (C1-C3)
action of the onohyoid
depresses the hyoid bone
origin of the sternohyoid
post surface of manubrium sterni and adjoining medial portion of the clavicle
insertion of the sternohyoid
lower border of body of the hyoid bone
nerve supply to the sternohyoid
ansa cervicalis (C1-C3)
action of the sternohyoid
depresses the hyoid bone
origin of the sternothyroid
post surface of manubrium streni and adjoining portion of the clavicle
insertion of the sternothyroid
oblique line of thyroid cartilage
nerve supply of the sternothyroid
ansa cervicalis (C1-C3)
action of the sternothyroid
depresses the larynx
origin of the thyrohyoid
oblique line of thyroid cartilage
insertion of the thyrohyoid
lower border of body of hyoid bone
nerve supply of the thyrohyoid
C1 nerve through hypoglossal nerve
action of the thyrohyoid
depresses the hyoid bone or elevates the larynx
4 infrahyoid muscles
omohyoid
sternohyoid
sternothyroid
thyrohyoid
R common carotid artery is a branch of the ___ artery
brachiocephalic
L common carotid artery is a branch of the ____ ___
aortic arch
the CCA divides into the ___ ____ and ___ ____
ECA
ICA
CCA splits at the level of the ___ border of the ___ cartilage
superior
thyroid
ECA and ICA ascend within a fascial sheath called the ___ sheath
carotid
found within the carotid sheath are the ___ and ____ ____
IJV
vagus nerve
at the beginning of the ICA is a localized dilation called the __ ___
carotid sinus
the tunica adventitia of the carotid sinus contains numerous nerve endings derived from the ___ nerve
glossopharyngeal
the carotid sinus contains ____
baroreceptors
baroreceptors are sensory receptors that monitor changes in ___ ___
blood pressure
lying post to the point of bifurcation of the CCA is a small reddish brown structure called the ___ ___
carotid body
the carotid body is a ____
chemoreceptor
carotid body is innervated by the ___ nerve
glossopharyngeal
chemoreceptors monitor ___ and ___ concentration
CO2
pH
baroreceptors are used to treat ____
tachycardia
the ICA has ___ ___ in the neck
no branches
ICA enters the skull through the ___ ___ in the petrous portion of the temporal bone
carotid canal
the carotid canal is located on the ___ part of the ____ bone
petrous
temporal
the ICA is the main arterial supply for the ___ and structures of the ___ cavity
brain
orbital
ECA ascends in the neck and ends within the substance of the __ gland dividing into 2 terminal branches
parotid
superficial temporal
maxillary
8 branches of the ECA
superior thyroid ascending pharyngeal lingual facial occipital post auricular superficial temporal maxillary
1st branch of the EVA
superior thyroid
2nd branch of the ECA
lingual
lingual arises at the level of the ___ of the __ ___ of hyoid bone
tip
greater horn
___ artery is medial to angle of the mandible and hooks around
facial
___ artery arises from post of ECA artery and the level of the mandible
occipital
____ ___ artery behind the ext auditory meatus
post auricular
2nd terminal branch of the ECA
maxillary
1st terminal branch of the ECA
superficial temporal
___ ___ a infront of external auditory meatus
superficial temporal
___ a runs ant/med to neck of mandible
maxiallary
superficial temporal has the ___ __ branch that comes off at the zygomatic arch
transverse facial
where does the superior thyroid artery end?
upper pole of the thyroid
what two branches does the superior thyroid give off?
branch to the SCM
superior laryngeal
____ ___ artery arises from the EVA between it and the ICA
ascending pharyngeal
_____ artery arises from the posterior of the ECA and passes upward and backward to supply the back of the scalp
occipital
___ ____ artery arises from the post of ECA and passes upward and backward at the sup border of post belly of digastric to supply the back of the scalp and the auricle of the ear
post auricle of the ear
superficial temporal artery ascends in front of the auricle accompanied by the ___ nerve and gives off 3 branches
auriculotemporal
transverse facial
frontal
temporal
____ artery courses ant/med to the neck of the mandible entering the infratemporal fossa
maxillary
R subclavian a arises from the ___ artery, post to the R ____ joint
brachiocephalic
SC
L subclavian a arises from the ___ ___ entering the root of the neck post to the left ___ joint
aortic arch
SC
both subclavian aa arch superiorly, posteriorly, and laterally passing posterior to the ___ ___ muscle
ant scalene
ant scalene divides the subclavian a into ___ parts
3
first part of the subclavian a gives off 3 branches
vertebral a
thyrocervical a
internal thoracic a
most medial branch of the first part of the subclavian a
vertebral a
thyrocervical a gives off 3 main branches
inferior thyroid
transverse cervical
suprascapular
inferior thyroid branches ___ from the 2nd part of the subclavian a and supplies the __ muscle
thyrohyoid
what artery sometimes comes off the thyrocervical artery?
ascending cervical
___ ___ artery arises from inferior surface of the subclavian artery
internal thoracic
internal thoracic artery gives off 4 arteries
pericardiacophrenic
anterior intercostals
musculophrenic
superior epigastric
which part of the subclavian is directly behind the anterior scalene?
2nd part
2nd part of the subclavian a gives off 1 branch
costocervical trunk
costocervical trunk has 2 branches
deep cervical
superior intercostal artery
third part of the subclavian usually has ___ ___ but can sometimes give off the dorsal scapular or subscapular
no branches
3rd part of the subclavian artery is directly ___ to the ant scalenes
lateral
dorsal scapular a is usually a branch of the ___ ___
transverse cervical
____ vein is direct continuation of the axillary vein
subclavian
subclavian vein starts at ….
passing ant to ___ ___
lateral border of the 1st rib
ant scalene
subclavian v ends where it unites with the ___ to form the ____ vein
IJV
brachiocephalic
1 named tributary of the subclavian vein
EJV
___ ___ is at the jxn of the IJV and subclavian
thoracic duct
left brachiocephalic v is longer than the right because…
SVC is located to the R of the vertebral column
IJV recieves blood from the ___, ___ and ___
brain
face
neck
IJV begins at the ___ ___ in the skull as a direct continuation of the __ ___
jugular foramen
sigmoid sinus
IJV descends in the neck within the ___ ___ and ends by uniting with the ___ vein to form the ___ vein
carotid sheath
subclavian
brachiocephalic
7 tributaries of the IJV
inf petrosal sinus common facial pharyngeal lingual superior thyroid middle thyroid occipital (sometimes)
lymph of the head and neck ultimately join the R and L ___ lymph trunks
jugular
jugular lymph trunks –> R ___ duct and ___ ___
lymphatic
thoracic duct
jugular lymph trunks can sometimes drain into the corresponding _____ vein
brachiocephalic
which lymph nodes are the 1st to inflame when there is an infection in the tonsils
tonsillar
which lymph nodes are over the SCM
superficial cervical
which lymph are the first to be affected when there is an infection/tumor at the apex of the lung?
supraclavicular/sentinal nodes