H&N - Neck Flashcards
Anterior surface marking of C1 to C7
C1 Hard palate
C2 Angle of mandible
C3 Hyoid bone
C4 Thyroid notch
C5 Thyroid
C6 Cricoid
C7 Upper tracheal rings
Level of common carotid bibfurcation
C3-C4
Level of end of pharynx/larynx start of oesophagus/trachea
C5/6
Where do you do a tracheostomy
Emergency situation: Cricothyroid membrane
Normally: 2nd tracheal ring
Fascia in neck
Investing
Prevertebral
Pretracheal
Carotid sheath
Layers that cut through for a tracheostomy
Skin
Subcut fat
Platysma
Investing fascia
Strap musclues (usually pulled away: eg sternohyoid and thyrohyoid)
Pretracheal fascia
Trachea
Fascial spaces
Pretracheal
Retropharyngeal
Prevertebral layer
Which vessels form external jugular vein
Posterior retromandibular and posterior auricular
Course of external jugular vein
Passes down in the superficial fascia, superficial to sternocleidomastoid
Pierces invesiting fascia, superior to clavicle, posterior to sternocleidomastoid
Enters subclavian
Vessels tributing to external jugular vein
Posterior external jugular
Transverse cervical
Supra scapular
Anterior jugular vein
Form at hyoid level,
Pierces investing fascia
Drains into subclavian
Anterior neck triangles
Submental
Submandibular
Carotid
Muscular
Submental triangle boundaries
Mandibular symphysis
Anterior belly of digastric
Body of hyoid bone
Content of submental triangle
Submental nodes
Tributaries forming anterior jugular vein
Submandibular triangle boundaries
Lower border of mandible
Anterior belly of digastric
Posterior belly of digastric
Submandibular triangle content
Submandibular gland
Submandibular lymph nodes
Hypoglossal nerve
Mylohyoid nerve
Facial artery and vein
Carotid triangle boundaries
Posterior belly of digastric
Superior belly of omohyoid
Anterior border of sternocleidomastoid
Carotid triangle content
Common, internal and external carotid arteries
Internal jugular vein, Common facial vein
Cervical branch of facial, CN10,11,12, ansa cervicalis transverse cervical nerve
Muscular triangle boundaries
Midline
Sternocleidomastoid
Superior belly of omohyoid
Muscular triangle content
Muscles: Sternohyoid, omohyoid, thyrohyoid
Thyroid, Parathyroid
Pharynx
Suprahyoid muscles
Stylohyoid
Digastric
Mylohyoid
Geniohyoid
Function of suprahyoid muscles
elevate hyoid bone
Innervation of stylohyoid
Facial
Innervation of digastric muscle
Anterior: mylohyoid (V3)
Posterior: facial nerve
Innervation of mylohyoid
Mylohyoid nerve (V3)
Innervation of geniohyoid
C1 ( carried along CN11)
Infrahyoid muscles
AKA strap muscles
Sternohyoid
Omohyoid
Thyrohyoid
Sternothyroid
Attachment of omohyoid muscle
hyoid to scapula
Has an intermediate tendon which runs through a sling attached to clavicle
Action of infrahyoid muscles
depresses hyoid
Strap muscles blood supply
Segmental supply from both superior and inferior thyroid arteries
Innervation of infrahyoid muscles
Ansa cervicalis (C1-C3)
Ansa cervicalis roots
C1-C3
Which muscles does ansa cervicalis innervate
GHost THought SOmeone Stupid Shot Irene
GenioHyoid
ThyroidHyoid
Superior Omohyoid
SternoThyroid
SternoHyoid
Inferior Omohyoid
Ansa cervicalis relations
Superior part crosses internal carotid
Inferior part crosses internal jugular
Vertebral level of hyoid
C3
Vertebral level of thyroid
C4
Vertebral level of cricoid
C5
Lower border of cricoid landmark significance
Junction of:
Larynx and trachea
Pharynx and oesophagus
Inferior thyroid artery and thyroid gland
Thyroid gland relations
Enclosed in pretracheal fascia with trachea and recurrent laryngeal nerve
Lateral: carotid sheath Internal carotid, Internal jugular, Vagus
Accessory lobe: pyramidal from isthmus
Arterial supply to thyroid gland
Superior thyroid artery (external carotid artery)
Inferior thyroid artery (thyrocervical trunk artery)
10% of people: Thyroid ima a. (branch of brachiocephalic)
Venous drainage of thyroid
Superior and middle thyroid veins (Into IJV)
Inferior thyroid vein (into brachiocephalic vein)
Path of the recurrent laryngeal nerve
On right: loops around subclavian
On left: loops around aortic arch
Posterior traingle subdivisions
Occipital triangle
Omoclavicular triange
Nerves of posterior triangle
Accessory nerve
Phrenic nerve
Three trunks of the brachial plexus
Branches of the cervical plexus: Supraclavicular nerve, transverse cervical nerve, great auricular nerve, lesser occipital nerve
Blood vessels of posterior triangle
External jugular vein
subclavian artery
Cervical plexus
Termination of lymphatic trunks
Subclavian vein
Lymph nodes of the neck
Atlas Axis articulation
Dens inserts anterior to spinal cord
Which cranial nerve lies anterior to the carotid sheath
CN12
Position of cervical sympathetic chain
between carotid sheath and prevertebral fascia
Muscles of the back of neck
Note splenius (from spinous process c7 to t3 to posterior mastoid process)
What is Erb’s point
Half way along the length of sternocleoidmastoid where cervical plexus emerges through the prevetebral fascia
The point used to find accessory nerve: great auricular disappears behind this point and CN11 is found 1cm above it (need to identify in level 5 neck dissection)
How many neck dissection levels
7
Omohyoid a useful landmark in neck dissection
Between level 3 and 4
Unilateral vs bilateral damage to recurrent laryngeal nerve?
Unilateral: Difficulty speaking
Bilateral: stridor/difficulty breathing
Consequence of damage to the external laryngeal nerve
Loss of low pitch voice
Parathyroid gland position
Both usually lie posterior
Superior found at level of 1st tracheal ring posterior to thyroid
Inferior position less reliable. Sometimes behind inferior pole, sometimes within thyroid gland itself sometimes within the mediastinum
Parathyroid gland arterial supply
All 4 glands receive blood from the inferior thyroid arteries
Superior glands also receive from superior thyroid arteries
Parathyroid venous drainage
Superior middle and inferior thyroid veins.
