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Neuroanatomy and Clinical Neurology > iscera and deep structures of the neck including vasculature > Flashcards

iscera and deep structures of the neck including vasculature Flashcards

1
Q

What are the 3 parts the pharynx is divided into?

A

Nasopharynx – Posterior to nose and superior to the soft palate.
Oropharynx – Posterior to mouth
Laryngopharynx – Posterior to larynx

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2
Q

Where is the pharynx?

A

Extends from base of skull to inferior border of the cricoid cartilage anteriorly and the inferior border of C6 vertebra posteriorly

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3
Q

What is the pharynx?

A

Part of the digestive system
Widest (5cm) opposite the hyoid bone
Narrowest ( 1.5cm) at its inferior end, where it is continuous with the oesophagus
The flat posterior wall of pharynx lies against the prevertebral layer of deep cervical fascia.

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4
Q

What is the nasopharynx?

A

Respiratory function

Lies posterior to the nose and superior to the soft palate

Nose opens to nasopharynx through two chaonae

Lymphoid tissue – pharyngeal tonsil - adenoids

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5
Q

What is the oropharynx?

A

Digestive function

Lies inferior to soft palate and

superior to the base of the tongue and the superior border of the epiglottis

Palatine tonsils each side

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6
Q

What is the Laryngopharynx?

A

Lies posterior to the larynx, extending from the superior border of the epiglottis to the inferior border of the cricoid cartilage, where it narrows and becomes continuous with the oesophagus

Communicates with the larynx through the inlet of the larynx on its anterior wall

Posteriorly, it is related to the bodies of C4-C6 vertebrae

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7
Q

What are the pharyngeal muscles?

A

Longitudinal voluntary deep layer of muscles:
Palatopharyngeous - CN X pharyngeal branch and pharyngeal plexus
Stylopharyngeous - CN IX
Salpingopharyngeous - CN X pharyngeal branch and pharyngeal plexus

These muscles elevate the larynx and shorten the pharynx during swallowing and speaking.
Innervation:
Innervation: Pharangeal branch of vagus nerve CN X

CN X – All muscles of soft palate and pharynx, except stylopharyngeus (CN IX).

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8
Q

What is the oesophagus?

A

Digestive function

Muscular tube
Striated (voluntary muscle) in its upper third,

Smooth involuntary muscle in its lower third,

Mixture of striated and smooth muscle in-between

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9
Q

What are the course and relations for the oesophagus?

A

Course and Relations
Continuous with the laryngopharynx, posterior to cricoid cartilage
Inclines slightly towards the left
Through the superior mediastinum
Through the posterior mediastinum
Pierces the diaphragm
Enters stomach at the cardiac orifice

Anterior: Trachea
Posterior: Cervical vertebral column
Right: Cervical pleura in root of neck
Left: Thoracic duct lies between the pleura and the oesophagus
Left and Right: Recurrent laryngeal nerve lies in the tracheoesophageal groove
Lobes of the thyroid gland
Carotid sheaths and their contents

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10
Q

What is the larynx?

A

Guards the air passages, especially during swallowing, and maintains a patent airway

Lies in the anterior neck (level of the bodies of C3-C6)
Connects the laryngopharynx with the trachea

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11
Q

What are the intrinsic muscles of the larynx?

A
  1. Transverse and Oblique Arytenoid Muscles
  2. Posterior Cricoarytenoid Muscle
  3. Lateral Cricoarytenoid Muscle
  4. Cricothyroid Muscle
  5. Vocal Ligament
  6. Vocalis Muscle
  7. Thyroarytenoid Muscle
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12
Q

What is the innervation of the larynx?

A

Innervation – Vagus Nerve X - Recurrent laryngeal nerve with exception of Cricothyroid – Superior laryngeal nerve.

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13
Q

What is the trachea?

A

Fibrocartilaginous tube supported by incomplete cartilaginous tracheal rings
These rings, which keep the trachea patent, are deficient posteriorly where the trachea is adjacent to the oesophagus

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14
Q

What is the course and relations of the trachea?

A

Course and Relations
Extends from the inferior end of the larynx at the level of the 6th thoracic vertebra to the level of the sternal angle or the T4/T5 intervertebral disc, where it divides into the right and left main bronchi

Anterior: Sternothyroid and sternohyoid muscles, thyroid isthmus (2nd& 3rd rings)
Posterior: Oesophagus
Right: Brachiocephalic trunk in the root of the neck
Lateral: Common carotid arteries, Thyroid lobes

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15
Q

What is the thyroid gland?

A

Two lobes (left and right), united by an isthmus over the trachea usually anterior to the 2nd and 3rd tracheal rings

Surrounded by a thin fibrous capsule, which sends septa deeply into the gland
External to the capsule is a loose sheath formed by the visceral layer of the pretracheal deep cervical fascia

Dense connective tissue attaches the capsule of the thyroid gland to the cricoid cartilage and the superior tracheal rings

Extends from the level of C5 to T1 vertebrae

Deep to the sternothyroid and sternohyoid muscles
Anterolateral to the larynx and trachea

Hormonally regulated by the pituitary gland

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16
Q

What is the nerve supply to the thyroid gland via?

A

Nerve supply is via superior, middle and inferior cervical sympathetic ganglia

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17
Q

What are the parathyroid glands?

A

Most people have four parathyroid glands

Small ovoid glands

Lie external to the fibrous thyroid capsule on the medial half of the posterior surface of each lobe of the thyroid gland

Nerve supply is from cervical sympathetic ganglia

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18
Q

What is the nerve supply for the parathyroid glands?

A

Nerve supply is from cervical sympathetic ganglia

19
Q

What is the first part of the subclavian artery?

A

From aorta/brachiocephalic trunk to medial border of anterior scalene muscle

20
Q

What are the branches of the first part of the subclavian artery?

A

Vertebral artery
Thyrocervical trunk
Internal thoracic artery

21
Q

What is the course of the vertebral artery?

A

Arises from the first part of the subclavian artery

Foramina of the transverse processes of C6 through to C1

Turns 90º posteriorly to run in a groove on the posterior arch of the atlas
and again 90º medially behind the lateral mass of atlas and then 90º superiorly to enter the cranial cavity through the foramen magnum

At inferior border of the pons the vertebral arteries join to form the basilar artery that participates in the formation of the circle of Willis

Supplies the posterior part of the brain

22
Q

Where does the vertebral artery supply?

A

Supplies the posterior part of the brain

23
Q

What is the Thyrocervical trunk?

A

Branches:
1. Inferior thyroid artery
(viscera of the neck)

  1. Transverse cervical artery
    (muscles of the posterior cervical triangle, trapezius and medial scapula muscles)
  2. Suprascapular artery
    (posterior scapula muscles)
24
Q

Where does the internal thoracic artery go?

A

Descends into the thorax posterior to the clavicle and first costal cartilage

25
Q

Where is the second part of the subclavian artery?

A

Posterior to anterior scalene muscle
Branches:
Costocervical trunk

26
Q

What are the branches costocervical trunk?

A

Branches:
1. Deep cervical artery
(posterior deep cervical muscles)

  1. Superior intercostal artery
    (first two intercostal spaces)
27
Q

Where is the third part of the subclavian artery?

A

From lateral border of anterior scalene muscle to lateral border of first rib
Becomes the axillary artery

28
Q

What are the branches of the third part of the subclavian artery?

A

Dorsal scapular artery

29
Q

Where are the common carotid arteries?

A

Each common carotid artery ascends with in the carotid sheath with the internal jugular vein and vagus nerve to the level of the superior border of the thyroid cartilage, where it divides into the internal and external carotid arteries

30
Q

What is the carotid body?

A

Small ovoid mass of tissue on the medial deep side of the bifurcation of the common carotid artery in close relation to the carotid sinus
Is a chemoreceptor that monitors the level of oxygen in the blood

31
Q

What is the internal carotid artery?

A

No branches in the neck

Direct continuation of the common carotids
Enter the skull through the carotid canals of the temporal bones

Become the main arteries of the brain and orbits

32
Q

What are the external carotid arteries?

A

Main supply to structures external to the skull

Each artery runs to the region between the neck of the mandible and the lobule of the auricle, where it is embedded in the parotid gland

Terminates by dividing into the maxillary and superficial temporal arteries

33
Q

What are the branches of the external carotid artery?

A

Branches:
1. Superior thyroid artery
2. Ascending pharyngeal artery
3. Lingual artery
4. Facial artery
5. Occipital artery
6. Posterior auricular artery

34
Q

What is the internal jugular vein?

A

Largest vein in the neck
Drains the brain, anterior face, cervical viscera, and deep muscles of the neck
Starts at jugular foramen as the continuation of the sigmoid sinus

IJV runs inferiorly in the carotid sheath, lateral to the internal carotid artery (medial), then the common carotid artery (medial) and the vagus nerve (posteriorly between vessels)

Leaves anterior triangle by passing deep to the SCM

Inferior end of the IJV dilates to form the inferior bulb of the IJV

Posterior to the sternal end of the clavicle, the IJV unites with the subclavian vein to form the brachiocephalic vein

35
Q

What is the anterior jugular vein?

A

Smallest of the jugular veins
Arises near the hyoid bone from the confluence of superficial submandibular veins
Descends in subcutaneous tissue between anterior median line and anterior border of SCM
At the root of the neck it turns laterally, posterior to the SCM
Opens into the external jugular/subclavian veins

36
Q

What is the jugular venous arch?

A

Commonly found superior to the manubrium as a union across the midline of the right and left anterior jugular veins

37
Q

What is the subclavian vein?

A

Drains upper limb

Continuation of axillary vein

Begins at lateral border of 1st rib
Passes over the 1st rib anterior to the scalene tubercle parallel to the subclavian artery
Passes anterior to the anterior scalene muscle and phrenic nerve

Ends when it unites with IJV to form brachiocephalic vein at medial border of anterior scalene, posterior to medial end of clavicle

38
Q

What is the phrenic nerve? C3 C4 C5

A

Formed at the lateral borders of the anterior scalene muscles at the level of superior border of the thyroid cartilage

Descends in front of anterior scalene muscle, under cover of IJV and SCM
Pass deep to the prevertebral layer of deep cervical fascia and the transverse cervical and suprascapular arteries
Courses between the subclavian arteries and veins
Proceed to the thorax to supply the diaphragm

Sole motor supply to the diaphragm, sensation to central part of diaphragm
In the thorax, they supply the mediastinal pleura and pericardium

39
Q

What is the superior cervical ganglion?

A

At the level of C1 and C2 vertebrae
Largest of the ganglion

40
Q

What is the middle cervical ganglion?

A

Smallest and is often absent
Lies on anterior aspect of inferior thyroid artery at the level of the cricoid cartilage and transverse process of C6 vertebra, just anterior to the vertebral artery

41
Q

What is the inferior cervical ganglion?

A

In around 80% of people this ganglion fuses with the 1st thoracic ganglion to form the large stellate ganglion
Lies anterior to the transverse process of C7 vertebra, just superior to the neck of the 1st rib and posterior to the origin of the vertebral artery

42
Q

What is the cervical plexus?

A

Ventral rami of first four cervical nerves

Lies deep to IJV and SCM

Each nerve except the first one, divides into ascending & descending branches that unite with the branches of the adjacent spinal nerves to form loops which compose the cervical plexus

43
Q

What are the branches of the cervical nerves?

A

Branches:
1. Lesser occipital nerve (C2)
Skin of neck & scalp posterosuperior to auricle

  1. Great auricular nerve (C2/3)
    Skin over parotid gland, posterior aspect of auricle & skin from angle of mandible to mastoid process
  2. Transverse cervical nerves (C2/3)
    Skin covering anterior triangle
  3. Supraclavicular nerves (C3/4)
    skin of neck & shoulder
  4. Phrenic nerve (C3/4/5)
    motor to diaphragm & sensation to central part
44
Q

What spinous level does the subclavian artery enter the neck?

A

C6

Neuroanatomy and Clinical Neurology (16 decks)

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