Lecture 1 Neck Flashcards
Name the anatomical contents of the neck
- Arteries
- Veins
- Nerves
- Lymph Nodes
- Lymphatic Channels
- Thyroid Gland
- Parathyroid Glands
- Muscles
- Trachea
Name the boundaries of the neck
- Superior- Mandible
- Inferior- Clavicle
- Anterior- Anterior midline
- Posterior- Trapezius
Name the boundaries of the anterior triangle
- Anterior: midline of the neck
- Posterior: anterior border of sternocleidomastoid
- Superior: Mandible
Name the boundaries of the posterior triangle
- Anterior: posterior border of sternocleidomastoid
- Posterior: anterior border of trapezius
- Inferior: Clavicle
Anterior triangle contents
- CCA
- ECA
- Facial artery
- Hypoglossal nerves
- Vagus nerves
- Glossopharyngeal nerves
- Submandibular nodes
- Submental nodes
- ICA
- IJV
- Facial vein
- Accessory nerves
- Laryngeal nerves
Posterior Triangle contents
- Accessory nerve
- Occipital artery
- Lymph nodes
- Cervical nerve plexus
- External jugular vein
Where do the common carotid arteries divide into the internal and external arteries
C4
External carotid artery branches in the neck
o Superior thyroid o Ascending pharyngeal o Lingual o Occipital o Facial o Posterior auricular o Maxillary o Superficial temporal
Main veins
- Posterior auricular
- Retromandibular
- External Jugular vein
- Oblique jugular vein
- Posterior external jugular vein
- Superficial temporal vein
- Supra orbital vein
- Supratrochlear vein
- Facial vein
- Maxillary vein
- Communicating vein
- Anterior jugular vein
- Jugular arch
Why would someone need a central line inserted
- Central venous pressure
- Drug administration
- Cardiac pacing
- Blood sampling
- Fluid resuscitation
- Haemodialysis
- Intravenous nutrition
What are the complications of central line insertion
- Pneumothorax
- Haematoma
- Cardiac tamponade
- Air embolism
- Chylothorax
- False passage
- Thrombosis
- Sepsis
- Line blockage
How many lymph nodes are in the head and neck
~600
Where do the lymph nodes from the head and new drain
Cisterna chyli
Thoracic duct on left
What nodes drain the scalp, face and parotid gland
Parotid nodes
What nodes drain the scalp only
Occipital nodes
What nodes drain breast and solid viscera
Superficial cervical nodes
What is the final drainage pathway to thoracic duct
Deep cervical nodes
What nodes drains tongue, nose, paranasal sinuses, submandibular gland, oral cavity
Submandibular nodes
What nodes drain the lips and floor of mouth
Submental nodes
What noes drain the breast, oesophagus and soli viscera
Supraclavicular nodes
How many lymph node levels are there
6
What is lymphadenopathy
Disease of the lymph node where they are abnormal size or consistency
What type of gland is the thyroid gland
Endocrine
Describe the structure of the thyroid gland
2 lobes joined by isthmus
What does the thyroid gland produce and what are there functions
Thyroid and calcitonin
Calcitonin- lower calcium
Raise phosphate
What is a Thyroglossal Cyst
Dilatation of thyroglossal duct remnant
Moves on tongue protrusion
What type of thyroid masses can there be
Solitary Nodule
Diffuse Enlargement
Multi-nodular goitre
Give examples of solitary nodules
o Cyst due to localised haemorrhage
o Adenoma- benign follicular tissue
o Carcinoma
o Lymphoma
Give examples of diffuse enlargement
o Colloid goitre: due to gland hyperplasia, iodine deficiency, puberty, pregnancy and lactation
o Grave’s disease: more common in female. Autoantibodies against thyroid-stimulating hormone receptor resulting in HYPERTHYROIDISM
Give an example of a multi-nodular goitre
Due to graves disease or toxic goitre
What are the indications for a Thyroidectomy
- Airway obstruction
- Malignancy or suspected malignancy
- Thyrotoxicosis
- Cosmesis
- Retrosternal extension
What are the complications of a thyroidectomy
- Bleeding primary or secondary
- Voice hoarseness
- Thyroid storm
- Infection
- Hypoparathyroidism
- Scar (keloid/hypertrophic)
Describe the parathyroid gland and its function
Usually 4 glandsRegulates calcium &phosphate levels
Located posterior to poles of thyroid
Name symptoms of parathyroid disease
Name any of these: • Painful stones • Aching bones • Psychic moans • Abdominal groans • Renal calculi • Polyuria • Renal failure • Pathological fractures • Osteoporosis • Bone pain • Abdominal pain • Constipation • Peptic ulceration • Pancreatitis • Weight loss • Anxiety & Depression • Confusion • Paranoia
How do you diagnose parathyroid disease
- U&E
- Creatinine
- Calcium
- Phosphate
- Parathyroid hormone
- Bicarbonate
- Vitamin D
- US Scan
- CT/MRI: identify ectopic glands (any thyroid tissue not located in its usual position)
- Isotope scanning: detect diseased glands
What are the 2 causes of Hyperparathyroidism
Adenoma
Hyperplasia
Malignancy
Name the 4 fascia layers of the neck
- Pre-tracheal
- Pre-vertebral
- Deep cervical (investing)
- Carotid Sheath
Indications of Tracheostomy
- Airway obstruction
- Airway protection
- Poor ventilation to reduce dead space
- Need suctioning
- Need humidification
- Need long-term care
How do you treat stridor
• Treat with O2, nebulised adrenaline, IV dexamethasone, (Heliox), (definitive) airway management
What is a Branchial Cyst
• Remnant of fusion failure of branchial arches or lymph node cystic degeneration
What is a Pharyngeal Pouch
• Herniation of pharyngeal mucosa between thryopharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx
Symptoms and Signs of Pharyngeal Pouch
• Voice hoarseness, dysphagia, aspiration pneumonia, regurgitation, weight loss, neoplasia (1%)
Investigation of Pharyngeal Pouch
barium swallow, excision (endoscopic/open), dilate
