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ANATOMY S2 U2 > Lecture 1 = Neck and Facial Layers: Compartments of Posterior triangle of the neck > Flashcards

Lecture 1 = Neck and Facial Layers: Compartments of Posterior triangle of the neck Flashcards

1
Q

What is fascia?

A

is a band of CT that surround structures (such as enveloping muscles), giving rise to potential tissue spaces and pathways that allow infection to spread.
In the neck, this extends from the base of the skull to the upper thorax.

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2
Q

What are the two layers of fascia?

A

Superficial and Deep

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3
Q

What is the superficial fascia layer?

A
  • immediately deep to skin - is subcutaneous tissue
  • comprised of loose CT and fat
  • will find the platysma m. here
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4
Q

What is the deep fascia layer?

A
  • deep to superficial fascia
  • dense, organized connective tissue layer (multiple layers of deep tissue)
  • devoid of fat
  • envelops most body structures deep to skin and subcutaneous tissue
  • aids in muscle movements, provides passageways for nerves and vessels and provides attachment for some muscles
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5
Q

What’s the neck and what are the 4 longitudinal compartments?

A

the neck is a tube that provides continuity from the head to trunk
within this tube, there are 4 longitudinal compartments:
1) visceral component (anterior)
2) vertebral component (posterior)
3) vascular components (on each side of neck - lateral)
4) carotid sheath

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6
Q

What does the visceral component contain?

A

contains digestive and respiratory systems as well as some endocrine glands

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7
Q

What does the vertebral component contain?

A

contains cervical vertebrae, spinal cord, cervical nn and mm, and associated with vertebral column.

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8
Q

What does the vascular component contain?

A

contains major vessels and vagus nerve

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9
Q

What does the carotid sheath contain?

A

includes the carotid artery, internal jugular vein, and the vagus nerve.

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10
Q

What are the layers of the deep fascia?

A 
(from superficial to deep)
investing fascia 
pre-tracheal fascia
buccopharyngeal fascia
alar fascia 
pre-vertebral fascia 
carotid sheath
I Poop Brown At Parties Cuzzz
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11
Q

What is the investing fascia?

A
  • surrounds the trapezius and SCM and infrahyioid mm
  • located below the hyoid bone
  • outermost layer of deep fascia
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12
Q

What is the pre-tracheal fascia ?

A
  • surrounds the thyroid, trachea and esophagus and posterior surface of infrahyoid mm
  • has 2 portions = muscular and visceral fascia
    • muscular pre-tracheal fascia = surrounds the infrahyoud mm
    • visceral pre-tracheal fascia = surrounds thyroid, trachea, and esophagus

*this including the buccopharyngeal fascia are one layer - this is the anterior component

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13
Q

What is the buccopharyngeal fascia?

A
  • is the deep component

- surrounds pharynx posteriorly

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14
Q

What is the alar fascia?

A

-anterior layer of pre-vertebral fascia and runs behind buccopharyngeal fascia

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15
Q

What is the pre-vertebral fascia?

A
  • surrounds pre-vertebral and deep back muscles
  • in the anterolateral position, extends from the anterior and middle scalene mm to surround the brachial plexus and subclavian artery as these structures pass into the axilla so it’s forming the axillary sheath
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16
Q

What is the carotid sheath?

A
  • compilation of pre-vertebral and buccopharynx fascia

- column of fascia that surrounds the CCA, ICA, ISV, and vagus nerve.

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17
Q

What are the fascial spaces?

A

-carotid sheath
-pretracheal space
-retropharyngeal space (between buccopharyn and alar space)
-prevertebral “danger” space
CPR Department

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18
Q

Where is the carotid sheath and what’s included in it?

A
  • between SCM and preverterbral mm.
  • formed by condensations of deep cervical fascia (all 3 fascia layers)
  • encase carotid aa., IJV, and vagus nn.
  • infections or blood may spread with sheaths from skull down into middle mediastinum (stuff in the middle of cavity of thoracic)
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19
Q

Where is the pretracheal space and what’s included in it?

A
  • between trachea and infra hyoid mm.
  • from thyroid cartilage down into anterior mediastinum
  • infections here can spread between these two regions –> in anterior to visceral compartment.
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20
Q

What are the layers of the fascia?

A

From superficial to deep:

  • buccopharyngeal fascia
  • retropharyngeal space
  • alar fascia
  • dangerous space
  • prevertebral fascia
21
Q

What’s mediastinum?

A

a membranous partition between two body cavities or two parts of an organ. is the central compartment of the thoracic cavity surrounded by loose connective tissue, as an undelineated region that contains a group of structures within the thorax.

22
Q

Where is the retropharyngeal space and what’s in it?

A
  • between buccopharyngeal fascia and alar fascia
  • from skull base down in to superior mediastinum
  • infection here can spread between these 2 regions
23
Q

Where is the prevertebral “danger” space and what’s in it?

A
  • between alar and prevertebral fascia
  • infections here can spread from skull base into posterior mediastinum (through entire thoracic cavity till very base of thoracic cavity @T12)
  • notorious for interior spread of infections here
  • aka “third space”
24
Q

What is the neck?

A

is a vertical conduit for structure entering or leaving the head.

25
Q

What are the horizontal zones of the neck?

A

Zone I
Zone II
Zone III
These are useful in clinical assessment of neck trauma

26
Q

What is in Zone I?

A

thoracic inlet to cricoid cartilage - it most inferior

27
Q

What is in Zone II?

A

cricoid cartilage to angle of mandible

28
Q

What is in Zone III?

A

angle of mandible to base of skull

29
Q

What are the triangles of the neck?

A

These are divided into posterior and anterior triangles (which his broken down even further)

30
Q

What are the boundaries of the posterior cervical triangle?

A

SCM: anterior boundary
trapezius: posterior boundary
middle 1/3 of clavicle: inferior boundary

31
Q

What are the contents of the PCT?

A
  • platysma m. = not a thick layer, superficial
  • external jugular vein = on superficial surface of SCM, oriented vertical
  • cutaneous nn.
  • motor nn.
  • transverse cervical and supra scapular aa.
  • deep muscles
32
Q

What are the cutaneous nerves of the PCT?

A

From superior to inferior
-lesser occipital (C2-C3)
-great auricular (C2-C3)
-transverse cervical nn (C3-C4)
* All of these are branches of the cervical plexus
* All arise from the same point - they emerge deep to SCM @ erb’s point (lateral nerve point of the neck)
* These are important for anestization
NOTE: accessory n (CN XI) runs with these nerves but it’s not a cutaneous but a motor n. that supplies the SCM and trapezius.

33
Q

What is the lesser occipital nerve (what does it supply)?

A

C2-C3

  • runs spuriously along the posterior border of SCM
  • crosses over portion of occipital a.
  • supplies skin of scalp at apex of triangle
34
Q

What is the great auricular nerve (what does it supply)?

A

C2-C3

  • ascends vertically on surface of SCM
  • runs with EJV superiorly toward ear
  • supplies lobe and skin posterior to auricle
  • also supplies angle of mandible to mastoid process
35
Q

What is the transverse cervical nerve (what does it supply)?

A

C2-C3

  • runs transversely (horizontally) across middle surface of SCM
  • supplies skin go anterior cervical triangle and lateral neck
36
Q

What is the supraclavicular nerves (what does it supply and what are it’s branches?)

A

C3-C4

  • Generally 3 main branches
    • medial, intermediate, and lateral (posterior) nn.
  • runs superficial to clavicle and deep to platysma
  • supply skin of clavicular region
37
Q

What are the motor nerves of the PCT?

A
  • accessory n. (CN XI)

- phrenic n. (C3-C5)

38
Q

What is the accessory nerve (what does it supply and where does it emerge from)?

A
  • emerges (exits from) from jugular foramen of skull
  • runs diagonally thru triangle deep to investing fascia
  • supplies both SCM and trapezius mm.
    • also receives proprioceptive fibers from C3-C4
39
Q

What is the phrenic nerve (explain the phenomenon between this nerve and suprascapular nn and what does it supply)?

A
  • descends vertically along anterior scalene m.
  • crossed anteriorly by transverse cervical a. and supra scapular a.
  • enters thorax between subclavian v. and a.
  • travels along pericardial sac to supply diaphragm
  • phrenic n. and supra scapular nn. share similar origins
    • phrenic n. (C3-C5) vs. supraclavicular nn. (C3-C4)
    • explains phenomenon of referred pain in pleurisy
    • irritation of phrenic n. referred from diaphragm to supra scapular nn. in clavicular region
40
Q

What are the vessels of the PCT?

A
  • external jugular v. (EJV): drains into subclavian v.
  • transverse cervical a. : from thyrocervical trunk
  • suprascapular a.: from thyrocervical trunk
41
Q

What is the external jugular vein?

A
  • after crossing the sternocleidomastoid m., the EJV enter the posterior triangle and continues it’s vertical descent
  • in the lower part of the posterior triangle, the EJV pierces the investing layer of cervical fascia and ends in the subclavian v.
42
Q

What is the transverse cervical a?

A

after branching from the thyrocervical trunk, the transverse cervical a. passes laterally and slightly posteriorly across the base of the posterior triangle anterior to the anterior scalene muscle and the brachial plexus. This goes in the opposite direction of the suprascapular a.

43
Q

What are the suprascapular arteries?

A

the supra scapular a. passes laterally in a slightly downward direction across the lowest part of the posterior triangle, and ends posterior to the clavicle. This goes in the opposite direction of the transverse cervical a.

44
Q

What are the deep muscles of the PCT?

A
  • splenius capitis m.
  • levator scapulae m.
  • 3 scalene mm.
  • omohyoid m. (inferior belly)
45
Q

What is the action and innervation of the splenius capitis m?

A

Action: extend and laterally rotate head and neck
Innervation: Dorsal rami of spinal nn.

46
Q

What is the action and innervation of the levator scapulae m.?

A

Action: elevate scapula
Innervation: dorsal scapular n. (C5)

47
Q

What is the action and innervation of the 3 scalene mm?

A

Action: tilt neck laterally
Inn: ventral rami nn. (C3-C8)

48
Q

What is the interscalene triangle?

A
  • elongated triangle deep to posterior cervical triangle
  • formed by anterior scalene, middle scalene and first rib
  • brachial plexus and subclavian a. pass thru it
  • subclavian v. passes anterior to anterior scalene m.
  • clinical notes:
    • anatomical variations cause narrowing of triangle
    • extra muscle slops, cervical ribs or cartilage outgrowths
    • may compress brachial plexus or subclavian a.
    • leads to nerve dysfunction or ischemia or UL
    • may contribute to thoracic outlet syndrome
    • compromise of nn. or aa. between neck base and axilla

ANATOMY S2 U2 (15 decks)

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