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H&N > Lecture 1 - Neck Anatomy and Physiology > Flashcards

Lecture 1 - Neck Anatomy and Physiology Flashcards

1
Q

What are the anatomical contents of the neck?

A 
Arteries, veins, nerves
Lymph nodes and lymphatic channels
Thyroid and parathyroid glands
Muscles
Trachea, larynx, swallowing oesophagus
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2
Q

What are the boundaries of the neck?

A

Superior - mandible
Inferior - clavicle
Anterior - anterior midline
Posterior - trapezius

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3
Q

What boundaries form the anterior triangle?

A

Anterior - midline of the neck
Posterior - anterior border of the sternocleidomastoid
Superior - mandible
Can be divided into submandibular, muscular, submental and carotid triangle

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4
Q

What are the boundaries forming the posterior triangle?

A

Anterior - posterior border of the sternocleidomastoid
Posterior - anterior border of trapezius
Inferior - middle third of clavicle

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5
Q

What are the contents of the anterior triangle?

A

Common carotid artery, facial artery, hypoglossal nerves, vagus nerves, glossopharyngeal nerves, submandibular nodes, submental nodes, internal carotid artery, internal jugular vein, facial vein, accessory nerves, laryngeal nerves

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6
Q

What are the contents of the posterior triangle?

A

Accessory nerve, occipital artery, lymph nodes, cervical nerve plexus, external jugular vein

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7
Q

What are the main arteries of the neck and from which common artery do they branch? (At what level?)

A

Common carotid artery splits into the internal and external carotid arteries at C4 in the neck

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8
Q

How can you differentiate between the ICA and ECA?

A

ICA lies more laterally than the ECA initially, and the ECA is the only one that will give off branches in the neck - the ICA supplies intracranially

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9
Q

What branches does the ECA give off in the neck?

A 
Superior thyroid
Ascending pharyngeal 
Lingual
Occipital 
facial 
Posterior auricular
Maxillary 
Superficial temporal
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10
Q

What are the main veins in the neck?

A

Internal and external jugular

Internal is much larger than the external

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11
Q

Why is it important to understand the anatomy of the veins in the head and neck?

A

Useful for venous access
Can also be involved in bleeding, tumour spread, venous thrombosis which can track to the brain so must be careful when operating in the neck

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12
Q

What are the indications for central line use?

A 
Struggling to get arterial or venous line in 
Central venous pressure
Drug administration 
Cardiac pacing
Blood sampling
Fluid resuscitation 
Haemodialysis
IV nutrition
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13
Q

What are the possible complications of using central lines?

A 
Pneumothorax
Air embolism
Thrombosis
Sepsis
Chylothorax
Haemotoma 
Cardiac tamponade
False passage
Line blockage
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14
Q

Are there many lymph nodes in the neck? What is their use?

A

600 lymph nodes in the head and neck
Receive lymph/tissue waste product
Drain to cisterna chyli
the drain to thoracic duct on left

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15
Q

How are the lymph nodes in the neck described?

A

In groups
In levels (I-VI)
Level I - under mandible
Level II, III, IV - thirds of sternocleidomastoid
Level V - posterior triangle
Level VI - anterior/central compartments of the neck

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16
Q

Describe the lymph node drainage of the parotid, occipital, superficial cervical, deep cervical, submandibular, submental and supraclavicular nodes.

A

Parotid - scalp, face, parotid gland
Occipital - scalp
Superficial cervical - breast and solid viscera
Deep cervical - final drainage pathway to thoracic duct
Submandibular - tongue, nose, paranasal sinuses, submandibular glands, oral cavity
Submental - lips, floor of mouth
Supraclavicular - breast, oesophagus, solid viscera

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17
Q

What are three most common causes of lymphadenopathy?

A

Infective
Malignant
Inflammatory

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18
Q

What is the thyroid gland?

What substances does it produce and what are the actions of these substances in the body?

A

Endocrine gland
2 lobes joined by isthmus
Produces thyroid hormone (triiodothyronine (t3) and its pro hormone thyroxine (T4) - responsible for regulation of metabolism) and calcitonin (acts to lower Ca and raise phosphate)

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19
Q

What is hypothyroidism?

A

Patient not producing enough hormones from their thyroid - patient feels very tired and lethargic

Rx - thyroxine

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20
Q

What are the possible appearances of thyroid masses?

A

Solitary nodule
Diffuse enlargement
Multi-nodular goitre (large lumps)

21
Q

In which group of people are thyroid masses more common?

A

Females

22
Q

What can cause a solitary thyroid nodule? Who is most likely to get a solitary thyroid nodule?

A 
Cyst - due to localised haemorrhage
Adenoma - benign follicular tissue
Carcinoma
Lymphoma 
Women between the age of 30-40
23
Q

What sort of questions do you want to be asking someone presenting with a solitary thyroid nodule?

A

Red flag symptoms

  • Pain (pain going to ear very sensitive marker of malignancy)
  • Weight loss
  • Voice hoarseness
  • Haematemesis
24
Q

How do you investigate a solitary thyroid nodule?

A

USS
If USS shows nothing, reassure and discharge them
If shows something, do fine needle aspiration cytology
FNAC cannot distinguish between a follicular adenoma and a follicular carcinoma - therefore tissue required for histology diagnosis (graded 1-5: 1 - unsure; didn’t get enough tissue, 2 - normal tissue, 3 - dysplasia, 4 - most likely cancer, 5 - carcinoma)

25
Q

How would you treat a solitary thyroid nodule that is going to cause problems?

A

Thyroid lobectomy

26
Q

What are the four types of thyroid cancer?

A

Papillary - lymphatic metastasis
Follicular - haematogenous metastasis
Medullary - familial agression, 10% arises from parafollicular C cells
Anaplastic - aggressive, local spread, very old, poor prognosis

27
Q

What are the types of diffuse thyroid enlargement?

A

Colloid goitre
Grave’s disease
Thyroiditis

28
Q

What can cause colloid goitre?

A

Gland hyperplasia
Iodine deficiency
Puberty, pregnancy, lactation

29
Q

What is goitre?

How do you test for retrosternal goitre?

A

Swelling in the neck cause by an enlarged thyroid gland (can cause compressive neck symptoms (dysphagia, stridor if compression of trachea)

Retrosternal goitre test - if choking after lifting arms (Pemberton’s sign)

30
Q

What is Grave’s disease?
Who gets it most commonly?
What does it cause?
How is it treated?

A

Body creates auto-antibodies against thyroid stimulating hormone receptor - hyperthyroidism results

Most common in middle aged women

Causes thyroid disease, acropachy/clubbing, pre-tibial myxoedema

Rx - anti-thyroids, beta-blockage, radio-iodine, surgery

31
Q

What are the indications for a thyroidectomy?

A 
Airway obstruction 
Malignancy or suspected malignancy
Thyrotoxicosis
Cosmesis
Retrosternal extension
32
Q

What are the complication of thyroidectomy?

A 
Bleeding (primary or secondary)
Voice hoarseness
Thyroid storm
Infection 
Hypothyroidism
Scar (keloid/hypertrophic (excess collagen in scar, causes raised scar)
33
Q

What does multi-nodular goitre tend to be due to?

A

Grave’s disease or toxic goitre

34
Q

What is toxic goitre?

A

Tends to be in older people
No eye signs
Atrial fibrillation

35
Q

What tests do you do when a patient presents with multi-nodular goitre?

A

Thyroid function tests, FNAC, chest X-Ray

36
Q

How many parathyroid glands are there? Where are they? What are their functions?

A

Usually 4
Regulate calcium and phosphate levels
Located posterior to poles of thyroid

Can be injured in neck surgery

37
Q

What are the symptoms involved in parathyroid disease?

A

Painful stones - renal calculi, polyuria, renal filaure
Aching bones - pathological fractures, osteoporosis, bone pain
Psychic moans - anxiety, depression, confusion, paranoia
Abdominal groans - weight loss, abdominal pain, constipation, peptic ulceration, pancreatitis

38
Q

What tests do you do if you suspect parathyroid disease?

A 
U&Es, creatinine, calcium, phosphate
Parathyroid hormone, bicarbonate
Vitamin D deficiency common 
USS
CT/MRI (to identify ectopic glands)
Isotope scanning - detects diseased glands
39
Q

How do you treat parathyroid disease?

A

Surgery for hyperparathyroid disease only
Medical treatment
Surgery easier if patient is fit - removal of single/multiple adenomas
Remove 3 or 3.5 hyperplastic glands through neck exploration
Carcinomas removed with thyroid gland and lymph nodes

40
Q

What disease can affect the parathyroid gland?

A

Adenomas (80% hyperparathyroidism)
Hyperplasia (12% hyperparathyroidism) - common in secondary hyperparathyroidism due to low Ca levels, e.g. renal failure
Malignancy (rare)

41
Q

What are the four fascial layers of the neck?

A

Sheaths surrounding the necks

  1. pre-tracheal
  2. pre-vertebral
  3. deep cervical
  4. carotid sheath
42
Q

What are the indications for tracheostomy?

A 
Airway obstruction 
Airway protection 
Poor ventilation to reduce dead space
Need suctioning
Need humidification
Need long-term care
43
Q

What is stridor? What are the three types of stridor and what do they indicate?

A

Clinical sign of airway obstruction
Inspiratory - laryngeal
Expiratory - tracheobronchial
Biphasic - glottis/subglottis

44
Q

How is stridor treated?

A

Oxygen, nebulised adrenline, IV dexamethasone, (heliox), (definitive) airway management

45
Q

What is a branchial cyst? How is it treated?

A

Remnant of fusion failure of branchial arches or lymph node cystic degeneration
Transilluminates
Anterior to the sternocleidomastoid at junction between upper and middle thirds
Becomes infected, enlarging

Rx - excision to prevent further infection

46
Q

What is a pharyngeal pouch?

A

Herniation of pharnygeal mucosa between thyropharnygeus and cricopharnygeus muscles of the inferior constrictor of the pharynx

47
Q

What are the signs and symptoms associated with a pharyngeal pouch?

A 
Voice hoarseness
Dysphagia
Aspiration pneumonia
Regurgitation 
Weight loss
Neoplasia (1%)
48
Q

How is a pharyngeal pouch treated?

A

Barium swallow, excision (open or endoscopic), dilatation

H&N (4 decks)

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