Neck Flashcards

1
Q

Suprahyoid muscles

    1. Name them
    1. Action
    1. Vascular supply
    1. Innervation
A

1.1.
Stylohoid, mylohyoid, geniohyoid, digastric

    1. Elevate hyoid bone
    1. Facial, occipital and lingual artery

1.4.
Stylohyoid - Stylohyoid branch facial
Mylohyoid - inferior alveolar branch - V3
Digastric anterior belly - inferior alveolar branch - V3
Geniohyoid - C1 nerve root that run within hyoglossal

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2
Q

Infrahyoid muscles

    1. Name them
    1. Action
    1. Vascular supply
    1. Innervation
A

1.1.
Thyrohyoid, omohyoid, sternohyoid, sternothryoid

    1. Depresses hyoid bone
    1. Superior and inferior thyroid arteries
    1. Anterior rami C1-3 - branches of ansa cervicalis

Thyrohyoid - C1 carried by hyoglossal nerve

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3
Q

Scalene muscles

    1. Name them
    1. Action
    1. Attachments
    1. Innervation
A

1.1.
Anterior, Middle and Posterior

1.2.
Flexion of the neck, ipsilateral SF
Accessory muscles of respiration

1.3.
Anterior scalene - scalene tubercle (inner border 1st rib)
Middle - as above
Posterior - second rib

1.4.
C5-6, C3-8 and C6-8 respectively

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4
Q

Brachial plexus exits via which anatomical structure?

It is accompanied by which anatomical structure?

A

Anterior and middle scaleni muscles

Subclavian artery

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5
Q

Which anatomical structure(s) pass anterior to anterior scaleni

A

Subclavian vein and phrenic nerve

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6
Q

Name the borders of the anterior triangle of the neck?

A

Superior - Inferior border mandible
Medial - line drawn down the midline of the neck
Lateral - Anterior border of SCM
Roof - investing fascia

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7
Q

Which anatomical structures lie within the anterior triangle of the neck

A

Common carotid artery bifurcates into ECA + ICA
IJV - venous drainage of head and neck
CN 9-12
Infra and suprhyoids

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8
Q

Name the subdivisions within the anterior triangle of the neck and their borders

A
  1. Carotid triangle

Superior - Posterior belly digastric
Lateral - Anterior border SCM
Inferior - Omohyoid

  1. Submental

Inferiorly - hyoid bone
Medially - midline neck
Laterally - anterior belly digastric
Floor - mylohyoid

  1. Submandibular

Anterior - anterior belly digastric
Posterior - posterior belly digastric
Superiorly - body of mandible

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9
Q

Contents of the carotid triangle

A

Common carotid artery
IJV
Vagus and hyoglossal nerves

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10
Q

Name the boundaries of the posterior triangle of the neck

A

Anterior - posterior border SCM
Posterior - anterior border upper trapezius
Inferior - middle 1/3 clavicle

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11
Q

List the layers of fascia from superficial to deep in the neck

A
Superficial cervical fascia
Deep cervical fascia
- Investing layer
- Pretracheal layer (muscular and visceral part) 
- Prevertebral layer
- Carotid sheath
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12
Q

Define the retropharyngeal space

A

Located between the buccopharyngeal fascia (posterior aspect of the visceral pretracheal fascia) and the prevertebral fascia.

Extends from BOS to posterior mediastinum

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13
Q

Anatomical relations of the thyroid gland

A

Anterior - pretracheal fascia (visceral layer), infrahyoid muscles
Posterior - cricoid cartilage, trachea rings, C5-T1 vertebrae
Lateral - Carotid sheath
Medial - larynx, pharynx, trachea, oesophagus, external and recurrent laryngeal nerves

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14
Q

Name the arterial supply of the thyroid gland

A

Superior thyroid artery - branch of ECA - lies in close proximity to external branch of superior laryngeal nerve

Inferior thyroid artery - thyrocervical trunk - branch of subclavian - close proximity to recurrent laryngeal nerve

Thyroid ima artery - 10% of people - supplies isthmus (anterior surface)

Venous drainage
Superior, middle thyroid artery - drains into IJV
Inferior thyroid arteries - drains into branchiocephalic vein

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15
Q

Lymphatic drainage of thyroid gland

A

Paratracheal and deep cervical nodes

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16
Q

Which embryological structure are the superior parathyroid glands derived from?

A

4th pharyngeal pouch

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17
Q

Which embryological structure are the inferior parathyroid glands derived from?

A

3rd pharyngeal pouch

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18
Q

Vascular supply of the thyroid gland

A

Inferior thyroid artery
Superior thyroid and thyroid ima artery - collateral supply

Venous drainage
Superior, middle and inferior thyroid vein

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19
Q

The pharynx is a muscular tube that connects the oral and Nasal cavity to the larynx and oesophagus.

    1. Describe it’s divisions and anatomical locations
    1. Contents
    1. Lined with which cell type
A

1.1.
Nasopharynx - BOS and soft palate

Oropharynx - soft palate and superior border of the epiglottis

Laryngopharynx - superior border of the epiglottis to C6 - continuous inferior with the oesophagus

1.2.
Nasopharynx - adenoids tonsils (enlarge between ages 3-8 and then regress)

Oropharynx - posterior 1/3 tongue, lingual tonsils, palatine tonsils (between the palatoglossal and palatopharyngeal arches), superior constrictor muscle

Laryngopharynx - middle and inferior constrictor muscles

1.3.
Nasopharynx - ciliated pseudostratified columnar epithelium
Oropharynx -

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20
Q

The muscles of the pharynx are innervated by vagus with the exception of one.

    1. Name this muscle
    1. Innervation
A
    1. Stylopharyngeus muscle

1. 2. Glossopharyngreal nerve

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21
Q

The pharynx consist of longitudinal and circular muscles

    1. Name the longitudinal muscles
    1. Collective action
A
    1. Stylopharyngeus, palatopharyngeus, salpingooharyngeus

1. 2. Shorten and widen the pharynx, elevate the larynx during swallowing

22
Q

Innervation of the pharynx

    1. Sensory
    1. Motor
A

1.1. Glossopharyngreal muscle
Additionally:
Anterior and superior - V2
Inferior aspect - internal branch Vagus nerve

1.2.
Vagus nerve except stylopharyngeus (IX)

23
Q

Innervation of the pharynx

    1. Sensory
    1. Motor
A

1.1. Glossopharyngreal muscle
Additionally:
Anterior and superior - V2
Inferior aspect - internal branch Vagus nerve

1.2.
Vagus nerve except stylopharyngeus (IX)

24
Q

Vasculature of the pharynx

    1. Arterial
    1. Venous
A

1.1. ECA branches -
Ascending pharyngeal artery, branches of facial, lingual and maxillary arteries

1.2.
Pharyngeal venous plexus - drains into IJV

25
Q

Name the anatomical relations of the larynx

A

Suspended from the hyoid bone spanning between C3-6

Anterior - infrahyoid muscles
Lateral - lobes of thyroid gland
Posterior - oesophagus

26
Q

Name the anatomical divisions of the larynx and it’s contents

A
    1. Supraglottis - inferior surface of epiglottis to the vestibular folds (false vocal cords)
    1. Glottis - contains the vocal cords 1cm below the glottis
    1. Subglottis - inferior border of glottis to inferiro border of cricoid cartilage
27
Q

Vasculature of the larynx

    1. Arterial
    1. Venous
A

1.1.
Superior laryngeal artery - branch of superior thyroid - branch of ECA

Inferior laryngeal artery - branch of inferior thyroid - branch of thyrocervical artery
Runs with recurrent laryngeal nerve

1.2. As per arterial

28
Q

Name the cartilaginous structures of the larynx

    1. Unpaired
    1. Paired
A

1.1.
Thyroid
Cricoid - only complete ring of cartilage in larynx and trachea - level of C6
Epiglottis

1.2.
Arytenoid cartilage - provides attachment for vocal ligament

Corniculate - articulates with arytenoid

Cuneiform

29
Q

The muscles of the larynx can be divided into extrinsic and intrinsic muscle groups

    1. Name the muscles of extrinsic group
    1. Name their function
A
    1. Supra- and infrahyoid muscles, stylopharyngeus

1. 2. Act to elevate or depress the larynx

30
Q

The muscles of the larynx can be divided into extrinsic and intrinsic muscle groups

    1. Name the muscles of the intrinsic group
    1. Function
    1. Innervation
A

1.1. Cricothyroid, thyroarytenoid, posterior and lateral cricoarytenoid, transverse and oblique arytenoids

1.2.
Cricothyroid - stretches and tenses vocal ligament

Thyroarytenoid - relaxes vocal ligament

Posterior cricoarytenoid - abducts vocal folds

Lateral cricoarytenoid - adducts vocal folds

Transverse and oblique arytenoids - adducts arytenoid cartilage

1.3. ALL innervated by inferior laryngeal nerve (branch of recurrent laryngeal) EXCEPT cricothyroid - innervated by external laryngeal nerve (branch of superior laryngeal)

31
Q

The cervical plexus is made up of the anterior rami of which spinal nerves?

A

C1-4

32
Q

The ansa cervicalis is a loop of nerves formed by which nerve roots?

Name it’s muscular branches

A

C1-3

Muscular branches:

Superior belly of omohyoid
Inferior belly of omohyoid
Sternohyoid
Sternothryoid

Other muscular branches:

C1-2: Rectus capitus anterior and lateralis

C1-3: Longus capitis

C2-3: Prevertebral muscles and SCM

C3-4: Levator scapula, trapezius and scalenus medius

33
Q

Name the sensory branches of the cervical plexus

A

Greater auricular nerve C2, 3 - sensation to external ear and skin over parotid

Transverse Cervical Nerve C2, 3 - sensation to anterior neck

Lesser occipital nerve - C2, 3 - sensation to pisterosuperior scalp

Supraclavicular C3, 4 - sensation to Supraclavicular fossa, upper thoracic region and SC joint

34
Q

Name the muscular branches of the cervical plexus

A

Phrenic nerve
Nerve to Geniohyoid and Thyrohyoid (C1)
Ansa Cervicalis
Other muscular branches

35
Q

Cervical plexus block - Where is Erb’s point?

A

Middle and posterior border of SCM

36
Q

The phrenic nerve originates from C3-5. In relation to which anatomical structure in the neck does the phrenic nerve arise?

A

Lateral border of anterior scalene muscle then passes it anteriorly deep to prevertebral layer of cervical fascia

Runs posterior to subclavian vein

37
Q

Sympathetic innervation for the head an neck originate in the SC in the thoracic region T1-6.

After leaving the SC the fibres enter the sympathetic chain spanning from the BOS to coccyx.

The nerve fibres form ganglia - name them.

A

Superior cervical ganglia
Middle cervical ganglia
Inferior cervical ganglia

38
Q

The ganglia of the sympathetic chain are related to specific arteries.

Name the arteries and their anatomical relation

A

Superior cervical ganglia -
Posterior to the common carotid artery
Anterior to the C1-4

Middle cervical ganglia - absent in some individuals
Anterior to the inferior thyroid artery and C6

Inferior cervical ganglia -
Vertebral and subclavian arteries - anterior to C7

39
Q

The superior cervical ganglia has several important post-ganglionic nerves

Name the post-ganglionic nerves and the structures they innervate.

A

Internal carotid nerve - innervates structures in the eye, pterygopalatine artery and ICA

External carotid nerve - hitch-hikes along common carotid and ECA

Nerve to pharyngeal plexus

Superior cardiac branch

Nerves to CN 2, 3, 4, 6 and 9

Gray rami communicates - sympathetic fibres to anterior rami of C1-4

40
Q

The Parasympathetic fibres of the head and neck are situated within 4 nuclei in the brainstem.

Each nuclei is related to a CN and there a 4 parasynpathetic ganglia located in the head - name them.

A

Ciliary ganglion
Otic
Pterygopalatine
Submandibular

41
Q

Regarding the ciliary ganglion - describe

    1. Location
    1. Pre-ganglionic fibres
    1. Post-ganglionic fibres
    1. Target organs
A
    1. Lies within bony orbit anterior to superior orbital fissure
    1. Fibres from Edinger-Westphal nucleus - associated with CN III
    1. Short ciliary nerves

1.4.
Sphincter pupillae - constricts the pupil
Ciliary muscles - accommodates near vision

42
Q

Regarding the pterygopalatine (aka sphenopalatine) ganglion is the largest of the 4 parasynpathetic ganglion - describe

    1. Location
    1. Pre-ganglionic fibres
    1. Post-ganglionic fibres
    1. Target organs
A
    1. Pterygopalatine fossa

1. 2.

43
Q

Regarding the sphenopalatine (AKA pterygopalatine ganglion - describe

    1. Location
    1. Pre-ganglionic fibres
    1. Post-ganglionic fibres
    1. Target organs
A
    1. Pterygopalatine fossa
    1. Superior salivatory nucleus - associated with CN 7
    1. Hitch-hikes along V2
1.4. Secretomotor to -
Lacrimal gland
Mucous gland of posterosuperior nasal cavity
Nasopharynx
Palate
44
Q

Regarding the submandibular ganglion - describe

    1. Location
    1. Pre-ganglionic fibres
    1. Post-ganglionic fibres
    1. Target organs
A

1.1. Suspended from lingual nerve

1.2. Superior salivatory nucleus - associated with CN 7
Carried by chorda tympani - hitch-hikes along lingual branch of V3

    1. Travel directly to submandibular and sublingual glands
    1. Secretomotor to submandibular and sublingual salivatory gland
45
Q

The muscles to the tongue can be divided into intrinsic and extrinsic muscles.

The intrinsic group consists of 4 paired muscles.

    1. Name the intrinsic muscles of the tongue
    1. Innervation
A
1.1.
Superior longitudinal
Inferior longitudinal
Transverse
Vertical

1.2. Hypoglossal nerve

46
Q

Name the extrinsic muscles of the tongue and their innervation

A

Genioglossus
Hypoglossus
Styloglossus
Palatoglossus

ALL innervated by the Hypoglossus nerve EXCEPT palatoglossus - CN X

47
Q

Innervation regarding the tongue - name the nerves responsible for

    1. General sensation
    1. Special sensation
A

1.1.
Anterior 2/3 - CN 5 - lingual nerve - V3 branch

1.2.
Anterior 2/3 - chorda tympani - CN 7 branch
Posterior 1/3 - general and special - CN IX

48
Q

Name the layers of the eyeball from superficial to deep

What do each of these layers consist of?

A

Fibrous layer - sclera and cornea

Vascular layer - choroid, ciliary body, iris

Inner layer - retina - inner pigmented, outer neural

49
Q

The frontal sinuses are located within the frontal bone

    1. Drainage is via the frontonasal duct into which structure?
    1. Sensory innervation is derived from which nerve?
    1. Arterial supply
A
    1. Middle meatus of nasal cavity
    1. Supraorbital nerve - V1
    1. Inferior ethmoidal artery - branch ICA
50
Q

The sphenoid sinuses are located within the body of the sphenoid bone

    1. Drainage is via which structure?
    1. Sensory innervation is derived from which nerve?
    1. Arterial supply
A
    1. Spheno ethmoidal recess - superior and posterior to the superior concha
    1. Posterior ethmoidal nerve - V1 and branches of V2
    1. Pharyngeal branches of maxillary artery
51
Q

There are 3 ethmoidal sinuses located within the ethmoid bone

    1. Drainage is via which structure?
    1. Sensory innervation is derived from which nerve?
    1. Arterial supply
A

1.1.
Anterior ethmoidal sinus - middle meatus
Middle ethmoidal sinus - middle meatus
Posterior ethmoidal sinus - superior meatus

    1. Anterior and posterior ethmoidal branches - nasociliary nerve - V2
    1. Anterior and posterior ethmoidal arteries