introduction to neck Flashcards
bones of the neck
cervical vertebrae, hyoid bone, manubrium and clavicle
the hyoid is positioned at vertebral level ____
C3
functions of the hyoid bone
maintain patency of pharynx
required for swallowing and respiration
the hyoid is suspended by muscles that connect it to the ___, _____, ____, ____ and ____
mandible
styloid processes
thyroid cartilage
manubrium
scapulae
the neck extends from _____ superiorly and ___ inferiorly
base of the cranium
clavicles
anterior compartment that contains parts of the digestive and respiratory systems and several endocrine glands
visceral compartment
posterior compartment that contains the cervical vertebrae, spinal cord, cervical nerves and the muscles associated with the vertebral column
vertebral compartment
lateral compartments that contain major blood vessels and the vagus nerve
vascular compartment
superficial cervical fascia of the neck contains ____, ____ and _____
cutaneous nerves
superficial lymph nodes
platysma muscle
tenses the skin, producing vertical skin ridges
platysma
the platysma helps ______ and convey ____
depress the mandible
convey tension or stress
paralysis of platysma from an injury to the _____ causes the skin to fall away from the neck in slack folds
cervical branch of facial nerve
investing SCM and trapezius
investing layer of deep cervical fascia
surrounds thyroid and parathyroid glands, trachea, esophagus and recurrent laryngeal n.
pre-tracheal fascia
contains common and internal carotid a., internal jugular v., vagus n., and deep cervical lymph nodes
carotid sheath
surrounds vertebral column and associated muscles, phrenic n., sympathetic trunk and vertebral a.
pre-vertebral fascia
continuous with pre-tracheal fascia
buccopharyngeal fascia
between more dense layers of deep fascia in the neck is loose connective tissue that forms clinically important potential spaces
retropharyngeal space
parapharyngeal spaces
prevertebral space
pre-vertebral space ends inferiorly at ____ where the fascia blends with ____
T3
anterior longitudinal ligament
the deep fascia and the fascial spaces are important because organisms originating in ___, ___, ___, and ____ can spread among the fascial planes and spaces and the tough fascia determines ________ and _______
mouth
teeth
pharynx
esophagus
the direction of spread of infection
path taken by pus
the retropharyngeal space extends from _____ to _____ and lies posterior to ____ and ____ and is anterior to _____
base of skull
upper mediastinum
pharynx
esophagus
prevertebral musculature
the retropharyngeal space is bounded by ____ anteriorly, ____ posteriorly, and _____ laterally
buccopharyngeal fascia
prevertebral fascia
carotid sheath
retropharyngeal space is open inferiorly with ______
superior mediastinum
parapharyngeal space is located in lateral neck and is shaped like an inverted cone with its base at ____ and its apex at ____
the skull
the hyoid bone
parapharyngeal space infections are potentially life threatening because of the possibility of _______
involving the carotid sheath and its vital contents
propensity for airway impingement
spread of infection
infection may also spread to other spaces particularly to the ____ and “danger” spaces possibly reaching ____ inferiorly and ____ superiorly
retropharyngeal space
mediastinum
skull
collection of pus located between the capsule of the palatine tonsil and pharyngeal muscles
peritonsillar abscess
most common deep neck infection is a complication of ____
acute tonsilitis
complications of peritonsillar abscesses
airway obstruction
aspiration pneumonia if the abscess ruptures into the airway
internal jugular vein thrombosis
carotid artery rupture
typical presentation of peritonsillar abscesses
severe sore throat and fever
hot potato or muffled voice
pooling of saliva
trismus (lock jaw)
typical presentation of parapharyngeal abscesses
trismus
swelling below angles of the mandible
medial bulging of the pharyngeal wall
system toxicity with fever and rigors
prevertebral space extends from ____ to ____ and is situated between ____ anteriorly, ____ posteriorly and _____ laterally
base of skull
coccyx
prevertebral fascia
vertebral bodies
carotid sheaths
infections including prevertebral abscess and cellulitis may be caused by ______, _______ or _______
URI or teeth infections
hematogenous spread
local inflammatory diseases (discitis and tendonitis)
SCM extends from ____ to ____ and _____
mastoid process of temporal
sternum
clavicle
SCM innervation
CN XI
SCM action unilaterally and bilaterally
unilaterally: tilts head to same side and rotates face superiorly and oppositely
bilaterally: extends neck at atlanto-occipital joints and flexes cervical vertebrae
the anterior triangle of the neck boundaries
anterior: midline of neck
posterior: SCM
superior: mandible
floor: larynx, pharynx, and thyroid gland
posterior triangle of the neck boundaries
anterior: SCM
posterior: trapezius m.
inferior: clavicle
floor: splenius capitis, levator scapulae, and middle and posterior scalene muscles
submandibular triangle boundaries
roof: deep cervical fascia
floor: mulohyoid and hypoglossus muscles, inferior border of mandible, anterior and posterior bellies of digastric muscle
_____ and ____ merge forming the retromandibular vein
superficial temporal vein
maxillary vein
posterior division of retromandibular vein unites with ____ to form ____
posterior auricular vein
external jugular vein
anterior division of retromandibular vein unites with ____ which empties into _____
facial vein
internal jugular vein
cervical plexus is formed by the ____ spinal nerves
anterior rami C1-4
cervical plexus lies anteromedial to ____ and ____ and deep to ____
levator scapulae m.
middle scalene m.
SCM
superficial branches of the cervical plexus are ____ and include: ____, ___, ___ and ____
sensory
great auricular
lesser occipital
transverse cervical
supraclavicular
deep branches of the cervical plexus are ____ which are roots of ____ and _____
motor
phrenic n.
ansa cervicalis
cutaneous branches of the cervical plexus emerge at the posterior middle border of the SCM and is called _____
the nerve point of the neck
suprahyoid muscles
digastric (anterior belly V3, posterior belly VII)
mylohyoid (V3)
stylohyoid (VII)
geniohyoid (C1 via CN XII)
infrahyoid muscles
omohyoid (ansa cervicalis)
thyrohyoid (C1 via CN XII)
sternohyoid (ansa cervicalis)
sternothyroid (ansa cervicalis)
depresses mandible against resistance; elevates and steadies hyoid during swallowing and speaking
digastric
elevates hyoid, floor of mouth, and tongue during swallowing and speaking
mylohyoid
elevates and retracts hyoid, thus elongating floor of mouth
stylohyoid
pulls hyoid anterosuperiorly; shortens floor of mouth; widens pharynx
geniohyoid
depresses, retracts and steadies hyoid
omohyoid
depresses hyoid after elevation during swallowing
sternohyoid
depresses hyoid and larynx
sternothyroid
depresses hyoid and elevates larynx
thyrohyoid
the deep muscles of the neck are encased by ____
prevertebral fascia
deep muscles of the neck
scalene (anterior, middle and posterior)
splenius capitis
flex head
anterior scalene
flexes neck laterally; elevates 1st rib during forced respiration
middle and posterior scalenes
laterally flexes and rotates head and neck to same side; acting bilaterally extends head and neck
splenius capitis
3 layers of viscera of the neck
endocrine layer (thyroid and parathyroid)
respiratory (larynx and trachea)
alimentary (pharynx and esophagus)
embedded on posterior surface of thyroid gland
parathyroid glands
thyroid is deep to ___ and anterior to ___
infrahyoid muscles
trachea
thyroid gland spans vertebral levels ____
C5-T1
the nerves of the thyroid gland are derived from ______
superior, middle and inferior cervical sympathetic ganglia
nerves reach the thyroid gland through _______ that accompany the thyroid arteries and are ____ fibers
cardiac and superior and inferior thyroid peri-arterial plexuses
vasomotor
thyroid gland produces ___ and ____
thyroid hormone
calcitonin
the thyroid gland affects all areas of the body except _______
itself
spleen
uterus
testes
parathyroid gland produces _____
parathyroid hormone (controls metabolism of phosphorus and calcium)
parathyroid targets
skeleton
kidneys
intestine
blood supply to thyroid and parathyroid glands
inferior thyroid a.
superior thyroid a.
superior thyroid artery is a branch off the _____
external carotid a.
inferior thyroid artery is a branch of _____
thyrocervical trunk via subclavian a.
carotid sheath located lateral to _____ and deep to _____
pharynx
SCM
carotid sheath contains
common and internal carotid a.
internal jugular v.
vagus n.
deep cervical lymph nodes
sympathetic nerve fibers
usually lies on the anterolateral aspect of the carotid sheath
ansa cervicalis
carotid a. ___, the IJV ____ and vagus n. ____
medially
laterally
posteriorly
all peritonsillar abscesses are potential ____
parapharyngeal or retropharyngeal abscesses
ansa cervicalis branches are found deep to ____ and embedded in _____
pre-vertebral fascia
carotid sheath
ansa cervicalis supplies ____ innervation to ____, _____, and ____
motor
omohyoid
sternohyoid
sternthyroid
the superior root of the ansa cervicalis conveys fibers from spinal nerves _____ briefly joins and then descends from the hypoglossal nerve as it transverses the _____ region
C1-2
lateral cervical region
the inferior root of ansa cervicalis arises from a loop between spinal nerves ___ and ___
C2
C3
the superior and inferior roots of the ansa cervicalis unite forming a secondary loop consisting of fibers from ____
C1-3
the vagus nerve exits the cranial cavity through ____ and enters the carotid sheath and descends through the neck enclosed in this structure medial to ____ and posterior to _____
jugular foramen
internal jugular vein
common and internal carotid a.
the vagus nerve passes through the anterior triangle of the neck giving off: ____, ___, ___, and ____
motor branch to pharynx
branch to carotid body
superior laryngeal nerve (divides into external and internal)
recurrent laryngeal nerve
the right recurrent laryngeal nerve passes around ____ and the left recurrent laryngeal nerve passes ____ both ascend in _____
subclavian a.
behind arch of aorta
tracheoesophageal groove
near inferior pole of the thyroid gland you can find ____
recurrent laryngeal nerves
common surgical procedure involving the excision of part of most of the thyroid gland
thyroidectomy
given the location of the thyroid gland, there is a possibility of damaging ____ and ____
parathyroid glands
recurrent laryngeal n.
common carotid artery bifurcates near the level of _____ into internal and external carotid a.
superior border of thyroid cartilage (C4)
the external carotid a. ascends anterior to internal carotid and gives off: _______________
superior thyroid
ascending pharyngeal
lingual
facial
occipital
posterior auricular
maxillary
superficial temporal
the internal carotid a. contains the ____ which has baroreceptors
carotid sinus
dilation of the proximal part of internal carotid a.
carotid sinus
innervation of carotid sinus
glossopharyngeal n. through carotid sinus nerve
vagus n.
the carotid sinus is a ____ that reacts to changes in arterial blood pressure
baroreceptor
small, reddish brown ovoid mass of tissue on the medial side of the bifurcation of the common carotid a. close to the carotid sinus
carotid body
innervation of carotid body
carotid sinus n. (CN IX) and CN X
the carotid body is a _____ that monitors the level of oxygen in the blood
chemoreceptor
first part of subclavian a. branches
vertebral
internal thoracic
thyrocervical trunk (suprascapular, transverse cervical [superficial branch to trapezius and deep branch to rhomboids] and inferior thyroid [ascending cervical])
second part of subclavian a. branches
costocervical trunk (deep cervical and supreme intercostal)
third part of subclavian a. branches
dorsal scapular
flow reversal in vertebral artery on ipsilateral side of obstructive lesion in subclavian artery
subclavian steal syndrome
subclavian steal syndrome results from severe proximal _____ resulting in retrograde flow in the ipsilateral vertebral artery
subclavian a. stenosis or occlusion
glossopharyngeal nerve exits the cranial cavity through ___ and lies deep to _____
jugular foramen
styloid process and muscles associated with the styloid process
glossopharyngeal nerve passes forward between _____ and curves around the lateral border of _____
internal and external carotid a.
stylopharyngeus muscle
the hypoglossal nerve courses over the top of _____ and then medial/deep to _____
internal and external carotid a.
posterior belly of digastric m.
hypoglossal nerve travels with _____
lingual a.
hypoglossal n. can get injured during the carotid endarterectomy causing tongue to point to _____
side of lesion
phrenic nerves crosses _____ , anterior to ____ and passes deep to _______ where it enters the thorax and travel with _____ to the diaphragm
anterior scalene m.
subclavian a.
subclavian v.
pericardiophrenic vessels
the superior, middle and inferior cervical ganglion lie anterior to ___ and posterior to ___ where the transmit ___ innervation to head and neck
deep muscles of the neck
carotid sheath structures
sympathetic
structures in posterior triangle of the neck
accessory n.
transverse cervical a.
trunks of brachial plexus
subclavian a. and suprascapular a.
external jugular v.
posterior branches of cervical plexus
lymphatic drainage is from the posterior neck and scalp
occipital nodes
lymphatic drainage is from the anterior surface of the auricle, the anterolateral scalp, the upper half of the face, the eyelids and the cheeks
parotid nodes
lymphatic drainage is from structures along the path of the facial artery as well as the gingivae, the teeth, and lateral parts of the tongue
submandibular nodes
lymphatic drainage is from the center part of the lower lip, the chin, the floor of the mouth, the tip of the tongue
submental nodes
drainage from occipital nodes pass to _____
superficial cervical nodes
drainage from parotid nodes, submandibular nodes and submental nodes pass to _____
deep cervical nodes
where are the superficial cervical lymph nodes?
located along external jugular vein
primarily receive lymph from posterior and posterolateral regions of the scalp
superficial lymph nodes
where are the deep cervical lymph nodes?
form a chain along the internal jugular vein
