Lecture 1: Triangles of Neck and Larynx (Part 2) Flashcards
What important structures are found in the Thoracic Inlet/Outlet?
- APEX OF LUNGS
- Subclavian Artery and Vein
- Brachial Plexus
- Thoracic Duct
- Esophagus
- Trachea
What is Thoracic Outlet Syndrome?
Compression of Subclavian Artery, Subclavian Vein or Brachial Plexus (especially inferior portion)
- Can cause loss of hand movement (maybe shoulder and arm)
- Loss of dermatome sensation in C8 and T1
How can a pneumothorax happen?
When inserting a central line into the Subclavian Vein, there is a chance the catheter can be threaded into the pleura of the lung, resulting in a pneumothorax.
What are the nerve roots for the Cervical Plexus?
C1-C4
In the cervical plexus, what do the superficial and deep branches do?
Superficial: Sensory
Deep: Motor
What are the nerve roots for the Ansa Cervicalis?
What does it innervate?
Superior Ansa Cervicalis: C1/C2
Inferior Ansa Cervicalis: C2/C3
Innervates strap muscles of neck (infrahyoid muscles)
Where is the superior cervical ganglion?
C1/C2
Where is the middle cervical ganglion?
C6 at the level of cricoid cartilage
Where is the inferior cervical ganglion?
Anterior to transverse process of C7
-Can fuse w/ thoracic ganglion and known as Stellate Ganglion
What two structures is the subcutaneous layer between?
Between dermis and investing layer of deep cervical fascia
What is found in the subcutaneous layer?
- Cutaneous Nerves
- Blood and Lymphatic Vessels
- Superficial Lymph Nodes
- Fat
- Platysma Musle
What is found in the investing layer of the deep cervical fascia?
- SCM and Trapezius Muscles
- Parotid and Submandibular Glands
Why is mumps so painful?
Mumps infect the parotid gland, causing it to swell. However, the investing layer of the deep cervical fascia does not allow the gland to swell, causing a lot of pain.
Where is the pretracheal layer of the deep cervical fascia located?
Anterior region of the neck around the thyroid and trachea
What is found in the prevertebral layer of the deep cervical fascia?
Encloses the vertebral column and associated muscles
What does the prevertebral layer of the deep cervical fascia extend to?
Axillary Sheath
Where is the retropharyngeal space?
- Posterior to pharynx
- Buccopharyngeal Fascia is anterior
- Prevertebral fascia is posterior
- Carotid Sheath is lateral
What is the clinical significance of the retropharyngeal space?
The space extends from the base of the skull to the mediastinum. Abscess that develop can cause contiguous spread or infections and the swelling can cause difficulty in swallowing and speaking (can be life threatening).
Where is the thyroid located?
- Deep to sternothyroid and sternohyoid muscles
- At vertebral levels C5-T1
- Isthmus anterior to the 2nd and 3rd tracheal rings
What are the two main arteries that supply the thyroid?
Where do the arteries come from?
Superior Thyroid Artery from ECA
Inferior Thyroid Artery from Thyrocervical Trunk
In 10% of the population, an additional artery can supply the thyroid. What is this artery and what is its clinical significance?
Thyroid Ima Artery (anterior to trachea)
During surgery, have to be careful to avoid hemorrhage
Where does the superior and middle thyroid veins drain into?
Internal Jugular Vein
Where does the inferior thyroid veins drain into?
Brachiocephalic Vein
Where is the recurrent laryngeal nerve on each side of the body?
Right: Around Subclavian Artery
Left: Around Aortic Arch
What is the clinical significance of the left recurrent laryngeal nerve?
During surgery or even an MI, the nerve can be damaged leading to hoarseness.
Where is the larynx found?
Located at vertebral levels C3-C6
Connected to the pharynx and trachea
What does the larynx do?
Phonation and Patent airway
Where is the thyroid cartilage located?
C4
What is the proper name for Adam’s Apple?
Laryngeal Prominence
Where is the cricoid cartilage?
C6
What can you find in the aperture of the thyrohyoid membrane?
Internal branch of Superior Laryngeal Nerve
Superior Laryngeal Artery
What structure allows speech?
Vocal Ligament
How are the laryngeal spaces organized?
Laryngeal Cavity: Whole thing
Part 1: Laryngeal Vestibule
—separated by Vestibular Fold–
Part 2: Laryngeal Ventricle
—separated by Vocal Fold–
Part 3: Infraglottic Cavity
What is Rima glottidis?
Space between vocal folds
What muscle enables high pitch sounds?
Cricothyroid muscle
What muscle allows low pitch sounds?
Thyro-arytenoid muscle
What muscle abducts vocal folds?
Posterior crico-arytenoid muscle
What muscles adduct vocal folds?
- Lateral crico-arytenoid muscle
- Transverse and oblique arytenoids
- Vocalis muscle
What does the Superior Laryngeal Artery run with?
External Branch of Superior Laryngeal Nerve
What does the Inferior Laryngeal Artery run with?
Inferior Laryngeal Nerve
Where does the Superior Laryngeal Nerve come off of?
Vagus Nerve
Where does the Inferior Laryngeal Nerve come off of?
Recurrent Laryngeal Nerve
Superior Part of Larynx (Above Vestibular Fold)
What provides sensory portion?
What is the blood supply?
What is the lymphatic drainage?
Internal Branch of Superior Laryngeal Nerve
Superior Laryngeal Artery
Superior Deep Cervical Lymph Nodes
Inferior Part of Larynx (Below Vestibular Fold)
What provides sensory portion?
What is the blood supply?
What is the lymphatic drainage?
Inferior Laryngeal Nerve
Inferior Laryngeal Artery
Inferior Deep Cervical Lymph Nodes
What is the conus elasticus?
Vocal Ligament
Lateral Cricothyroid Ligament
Where does the superficial cervical lymph drain to?
External Jugular Vein
Where does the deep cervical lymph drain to?
Internal Jugular Vein
Where can you find jugulo-digastric lymph nodes?
C3
Collects lymph from tonsils and throat
Where can you find jugulo-omohyoid lymph nodes?
C6
