Neck Flashcards
Suprahyoid muscles
- Name them
- Action
- Vascular supply
- Innervation
1.1.
Stylohoid, mylohyoid, geniohyoid, digastric
- Elevate hyoid bone
- 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
Infrahyoid muscles
- Name them
- Action
- Vascular supply
- Innervation
1.1.
Thyrohyoid, omohyoid, sternohyoid, sternothryoid
- Depresses hyoid bone
- Superior and inferior thyroid arteries
- Anterior rami C1-3 - branches of ansa cervicalis
Thyrohyoid - C1 carried by hyoglossal nerve
Scalene muscles
- Name them
- Action
- Attachments
- Innervation
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
Brachial plexus exits via which anatomical structure?
It is accompanied by which anatomical structure?
Anterior and middle scaleni muscles
Subclavian artery
Which anatomical structure(s) pass anterior to anterior scaleni
Subclavian vein and phrenic nerve
Name the borders of the anterior triangle of the neck?
Superior - Inferior border mandible
Medial - line drawn down the midline of the neck
Lateral - Anterior border of SCM
Roof - investing fascia
Which anatomical structures lie within the anterior triangle of the neck
Common carotid artery bifurcates into ECA + ICA
IJV - venous drainage of head and neck
CN 9-12
Infra and suprhyoids
Name the subdivisions within the anterior triangle of the neck and their borders
- Carotid triangle
Superior - Posterior belly digastric
Lateral - Anterior border SCM
Inferior - Omohyoid
- Submental
Inferiorly - hyoid bone
Medially - midline neck
Laterally - anterior belly digastric
Floor - mylohyoid
- Submandibular
Anterior - anterior belly digastric
Posterior - posterior belly digastric
Superiorly - body of mandible
Contents of the carotid triangle
Common carotid artery
IJV
Vagus and hyoglossal nerves
Name the boundaries of the posterior triangle of the neck
Anterior - posterior border SCM
Posterior - anterior border upper trapezius
Inferior - middle 1/3 clavicle
List the layers of fascia from superficial to deep in the neck
Superficial cervical fascia Deep cervical fascia - Investing layer - Pretracheal layer (muscular and visceral part) - Prevertebral layer - Carotid sheath
Define the retropharyngeal space
Located between the buccopharyngeal fascia (posterior aspect of the visceral pretracheal fascia) and the prevertebral fascia.
Extends from BOS to posterior mediastinum
Anatomical relations of the thyroid gland
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
Name the arterial supply of the thyroid gland
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
Lymphatic drainage of thyroid gland
Paratracheal and deep cervical nodes
Which embryological structure are the superior parathyroid glands derived from?
4th pharyngeal pouch
Which embryological structure are the inferior parathyroid glands derived from?
3rd pharyngeal pouch
Vascular supply of the thyroid gland
Inferior thyroid artery
Superior thyroid and thyroid ima artery - collateral supply
Venous drainage
Superior, middle and inferior thyroid vein
The pharynx is a muscular tube that connects the oral and Nasal cavity to the larynx and oesophagus.
- Describe it’s divisions and anatomical locations
- Contents
- Lined with which cell type
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 -
The muscles of the pharynx are innervated by vagus with the exception of one.
- Name this muscle
- Innervation
- Stylopharyngeus muscle
1. 2. Glossopharyngreal nerve
The pharynx consist of longitudinal and circular muscles
- Name the longitudinal muscles
- Collective action
- Stylopharyngeus, palatopharyngeus, salpingooharyngeus
1. 2. Shorten and widen the pharynx, elevate the larynx during swallowing
Innervation of the pharynx
- Sensory
- Motor
1.1. Glossopharyngreal muscle
Additionally:
Anterior and superior - V2
Inferior aspect - internal branch Vagus nerve
1.2.
Vagus nerve except stylopharyngeus (IX)
Innervation of the pharynx
- Sensory
- Motor
1.1. Glossopharyngreal muscle
Additionally:
Anterior and superior - V2
Inferior aspect - internal branch Vagus nerve
1.2.
Vagus nerve except stylopharyngeus (IX)
Vasculature of the pharynx
- Arterial
- Venous
1.1. ECA branches -
Ascending pharyngeal artery, branches of facial, lingual and maxillary arteries
1.2.
Pharyngeal venous plexus - drains into IJV
Name the anatomical relations of the larynx
Suspended from the hyoid bone spanning between C3-6
Anterior - infrahyoid muscles
Lateral - lobes of thyroid gland
Posterior - oesophagus
Name the anatomical divisions of the larynx and it’s contents
- Supraglottis - inferior surface of epiglottis to the vestibular folds (false vocal cords)
- Glottis - contains the vocal cords 1cm below the glottis
- Subglottis - inferior border of glottis to inferiro border of cricoid cartilage
Vasculature of the larynx
- Arterial
- Venous
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
Name the cartilaginous structures of the larynx
- Unpaired
- Paired
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
The muscles of the larynx can be divided into extrinsic and intrinsic muscle groups
- Name the muscles of extrinsic group
- Name their function
- Supra- and infrahyoid muscles, stylopharyngeus
1. 2. Act to elevate or depress the larynx
The muscles of the larynx can be divided into extrinsic and intrinsic muscle groups
- Name the muscles of the intrinsic group
- Function
- Innervation
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)
The cervical plexus is made up of the anterior rami of which spinal nerves?
C1-4
The ansa cervicalis is a loop of nerves formed by which nerve roots?
Name it’s muscular branches
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
Name the sensory branches of the cervical plexus
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
Name the muscular branches of the cervical plexus
Phrenic nerve
Nerve to Geniohyoid and Thyrohyoid (C1)
Ansa Cervicalis
Other muscular branches
Cervical plexus block - Where is Erb’s point?
Middle and posterior border of SCM
The phrenic nerve originates from C3-5. In relation to which anatomical structure in the neck does the phrenic nerve arise?
Lateral border of anterior scalene muscle then passes it anteriorly deep to prevertebral layer of cervical fascia
Runs posterior to subclavian vein
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.
Superior cervical ganglia
Middle cervical ganglia
Inferior cervical ganglia
The ganglia of the sympathetic chain are related to specific arteries.
Name the arteries and their anatomical relation
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
The superior cervical ganglia has several important post-ganglionic nerves
Name the post-ganglionic nerves and the structures they innervate.
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
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.
Ciliary ganglion
Otic
Pterygopalatine
Submandibular
Regarding the ciliary ganglion - describe
- Location
- Pre-ganglionic fibres
- Post-ganglionic fibres
- Target organs
- Lies within bony orbit anterior to superior orbital fissure
- Fibres from Edinger-Westphal nucleus - associated with CN III
- Short ciliary nerves
1.4.
Sphincter pupillae - constricts the pupil
Ciliary muscles - accommodates near vision
Regarding the pterygopalatine (aka sphenopalatine) ganglion is the largest of the 4 parasynpathetic ganglion - describe
- Location
- Pre-ganglionic fibres
- Post-ganglionic fibres
- Target organs
- Pterygopalatine fossa
1. 2.
Regarding the sphenopalatine (AKA pterygopalatine ganglion - describe
- Location
- Pre-ganglionic fibres
- Post-ganglionic fibres
- Target organs
- Pterygopalatine fossa
- Superior salivatory nucleus - associated with CN 7
- Hitch-hikes along V2
1.4. Secretomotor to - Lacrimal gland Mucous gland of posterosuperior nasal cavity Nasopharynx Palate
Regarding the submandibular ganglion - describe
- Location
- Pre-ganglionic fibres
- Post-ganglionic fibres
- Target organs
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
- Travel directly to submandibular and sublingual glands
- Secretomotor to submandibular and sublingual salivatory gland
The muscles to the tongue can be divided into intrinsic and extrinsic muscles.
The intrinsic group consists of 4 paired muscles.
- Name the intrinsic muscles of the tongue
- Innervation
1.1. Superior longitudinal Inferior longitudinal Transverse Vertical
1.2. Hypoglossal nerve
Name the extrinsic muscles of the tongue and their innervation
Genioglossus
Hypoglossus
Styloglossus
Palatoglossus
ALL innervated by the Hypoglossus nerve EXCEPT palatoglossus - CN X
Innervation regarding the tongue - name the nerves responsible for
- General sensation
- Special sensation
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
Name the layers of the eyeball from superficial to deep
What do each of these layers consist of?
Fibrous layer - sclera and cornea
Vascular layer - choroid, ciliary body, iris
Inner layer - retina - inner pigmented, outer neural
The frontal sinuses are located within the frontal bone
- Drainage is via the frontonasal duct into which structure?
- Sensory innervation is derived from which nerve?
- Arterial supply
- Middle meatus of nasal cavity
- Supraorbital nerve - V1
- Inferior ethmoidal artery - branch ICA
The sphenoid sinuses are located within the body of the sphenoid bone
- Drainage is via which structure?
- Sensory innervation is derived from which nerve?
- Arterial supply
- Spheno ethmoidal recess - superior and posterior to the superior concha
- Posterior ethmoidal nerve - V1 and branches of V2
- Pharyngeal branches of maxillary artery
There are 3 ethmoidal sinuses located within the ethmoid bone
- Drainage is via which structure?
- Sensory innervation is derived from which nerve?
- Arterial supply
1.1.
Anterior ethmoidal sinus - middle meatus
Middle ethmoidal sinus - middle meatus
Posterior ethmoidal sinus - superior meatus
- Anterior and posterior ethmoidal branches - nasociliary nerve - V2
- Anterior and posterior ethmoidal arteries
