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H&N Anatomy > Neck > Flashcards

Neck Flashcards

1
Q

What are the anterior & posterior borders of the neck?

A

anterior - lower border of mandible to upper surf of manubrium (of sternum)

posterior - superior nuchal line of occipital to intervertebral disc b/w C7 & T1

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2
Q

What are the borders of the anterior triangle of the neck?

A
  • anterior border of sternocleidomastoid
  • inferior border of mandible
  • midline of neck
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3
Q

What are the borders of the posterior triangle of the neck?

A
  • posterior border of sternocleidomastoid
  • anterior border of trapezius
  • middle 1/3 of clavicle
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4
Q

What are the 4 compartments that give the neck a longitudinal organization? Briefly describe each.

A
  1. VISCERAL
    - anterior
    - contains parts of digestive & respiratory syst + endocrine glands
  2. VERTEBRAL
    - posterior
    - contains vertebrae, SC, cervical nerves + muscles of vertebral column
  3. & 4. 2 VASCULAR
    - 1 each side
    - lateral
    - contain major vessels & vagus (X) n
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5
Q

What are the different neck fascias?

A
  1. superficial fascia

2. deep cervical fascia

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6
Q

What are the main features of the superficial fascia of the neck?

A

Contains a thin sheet of muscle –> PLATYSMA

  • starts in superficial fascia of thorax –> runs up & attaches to mandible + blends w/ facial muscles
  • innervated by cervical branch of facial (VII) n
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7
Q

What are the 4 layers of the deep cervical fascia?

A
  1. Investing layer - surrounds all struc.s in neck
  2. Prevertebral layer - “ vertebral column & deep back muscles
  3. Pretracheal layer - encloses viscera of neck
  4. Carotid sheaths - surround the 2 major neurovascular bundles (on both sides)
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8
Q

Describe the investing layer of the deep cervical fascia.

A
  • completely surrounds the neck
  • posterior attachment = LIGAMENTUM NUCHAE & SPINOUS PROCESS of C7
  • splits up –> encloses TRAPEZIUS –> reunites & forms roof of POSTERIOR TRIANGLE –> splits again to surround STERNOCLEIDOMASTOID –> reunites again
  • anteriorly –> surrounds infra hyoid muscles
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9
Q

Describe the pre-vertebral layer of the deep cervical fascia.

A
  • surrounds VERTEBRAL COLUMN & MUSCLES associated

- muscles –> PREVERTEBRAL muscles, ANTERIOR + MIDDLE + POSTERIOR scalene & DEEP back muscles

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10
Q

The pre-vertebral fascia b/w attachment pts on transverse processes is UNIQUE –> it splits in 2 layers –> creating __________ fascial space containing CT that EXTENDS FROM ____ of the skull THRU THE ______

A

longitudinal
base
thorax

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11
Q

Describe the pre-tracheal layer of the deep cervical fascia.

A
  • collection of fascias that surround: TRACHEA, ESOPHAGUS & THYROID
    anteriorly –> crosses neck just posterior to infra hyoid muscles + covers trachea & thyroid
  • begins at HYOID & ends in upper THORACIC CAVITY
  • laterally –> covers THYROID & ESOPHAGUS
  • posteriorly–> called BUCCOPHARYNGEAL FASCIA & separates pharynx & oesophagus from PREVERTEBRAL layer
  • Buccopharyngeal fascia –> begins at BASE OF SKULL & ends in THORACIC CAVITY
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12
Q

Describe the carotid sheath layer of the deep cervical fascia.

A
  • each sheath = column of fascia that surrounds: CCA, ICA, IJV & VAGUS NERVE
  • receives contributions from the other 3 layers
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13
Q

What are the 4 triangles found in the anterior triangle of the neck? What are the boundaries of each?

A
  1. Submandibular
    - superior border = inf border of mandible
    - inferior “ = anterior & posterior bellies of digastric
  2. Submental
    - inferior border = hyoid
    - lateral “ = ant belly of digastric
  3. Muscular
    - superior border = hyoid
    - lateral borders = superior belly of omohyoid & anterior border of sternocleidomastoid
  4. Carotid
    - anterior inferior border =
    - superior “ =
    - posterior “ =
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14
Q

Muscles are grouped according to location relative to the hyoid bone:
____hyoid muscles & ____hyoid muscles.

A

SUPRAhyoid

INFRAhyoid

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15
Q

List the 4 suprahyoid muscles.

A
  1. stylohyoid
  2. digastric
  3. mylohyoid
  4. geniohyoid
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16
Q

List the 4 infrahyoid muscles.

A
  1. omohyoid
  2. sternohyoid
  3. thyrohyoid
  4. sternothyroid
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17
Q

Function & innervation of the STYLOHYOID.

A

Function - pulls hyoid up in posterosuperior direction

Innervation - facial/VII

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18
Q

Function & innervation of the DIGASTRIC (anterior & posterior bellies).

A

Anterior:

  • Function = opens mouth by lowering mandible; raises hyoid
  • Innervation = mylohyoid n from inferior alveolar branch of mandibular/V3

Posterior:

  • Function = pulls hyoid up & back
  • Innervation = facial/VII
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19
Q

Function & innervation of the MYLOHYOID.

A

Function - support & elevate floor of mouth; elevate hyoid

Innervation - mylohyoid n from inf alveolar branch of mandibular/V3

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20
Q

Function & innervation of the GENIOHYOID.

A

Function - fixed mandible elevates & pulls hyoid front; fixed hyoid pulls mandible down & inward
Innervation - branch from anterior ramus of C1

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21
Q

Function & innervation of the STERNOHYOID.

A

Function - depresses hyoid bone after swallowing

Innervation - anterior rami of C1-C3 thru ansa cervicalis

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22
Q

Function & innervation of the OMOHYOID.

A

Function - depresses & fixed hyoid

Innervation - anterior rami of C1-C3 thru ansa cervicalis

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23
Q

Function & innervation of the THYROHYOID.

A

Function - depress hyoid, but when hyoid is fixed –> raises larynx
Innervation - fibers from anterior ramus of C1 carried along hypoglossal (XII)

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24
Q

Function & innervation of the STERNOTHYROID.

A

Function - draws larynx down

Innervation - anterior rami of C1-C3 thru ansa cervicalis

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25
Q

Function & innervation of STERNOCLEIODMASTOID.

A
    • sternal head
    • clavicular head

Function - individually –> tilt head to shoulder on same side rotating head to turn face to opposite side
together –> draw head forward

Innervation - accessory n (XI) & branches from anterior rami C2-C3

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26
Q

Function & innervation of TRAPEZIUS.

A

Function - assists in rotating scapula during abduction of humerus
upper fibers – elevate scapula
middle “ – adduct “
lower “ – depress “

Innervation -
motor – accessory/XI
proprioception – C3 & C4

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27
Q

Function & innervation of SPLENIUS CAPITIS.

A

Function -
individually –> draw & rotate head to 1 side
together –> draw head back

Innervation - posterior rami of middle cervical nerves

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28
Q

Function & innervation of LEVATOR SCAPULAE.

A

Function - elevate scapula

Innervation - C3, C4; dorsal scapular n

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29
Q

Function & innervation of POSTERIOR SCALENE.

A

Function - elevate rib II

Innervation - anterior rami of C5-C7

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30
Q

Function & innervation of MIDDLE SCALENE.

A

Function - elevate rib I

Innervation - anterior rami of C3-C7

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31
Q

Function & innervation of ANTERIOR SCALENE.

A

Function - elevate rib I

Innervation - anterior rami of C4-C7

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32
Q

Why is clinically important to know the location of the omohyoid muscle?

A

because it is superficial (in front of) the INTERNAL JUGULAR V

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33
Q

What are the primary venous channels for the superficial venous drainage of the neck?

A

internal jugular v (IJV)

anterior “ “

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34
Q

Which 2 veins join to form the external jugular vein?

A

posterior to angle of mandible the posterior auricular vein & retromandibular vein join

35
Q

What territories does the posterior auricular vein drain?

A

scalp behind & above ear

36
Q

The retromandibular vein is formed when the _________ temporal & _______ veins join and descends to the angle of mandible where it divides into an ______ & a ______ division

A

superficial temporal
maxillary
anterior
posterior

37
Q

The ______ division of the retromandibular vein joins the posterior auricular vein to form the _______ jugular vein

A

posterior

external

38
Q

The ______ division of the retromandibular vein joins the facial vein to form the _______ facial vein, which passes deep & becomes a tributary to the ______ jugular vein

A

anterior
common
internal

39
Q

Why is it clinically important to know that: the external jugular v pierces the investing layer of the cervical fascia, passes deep to the clavicle & enters the subclavian vein?

A

it determines the passage of the vein from the neck to thorax –> imp for NECK DISSECTIONS –> sometimes need to remove the fascia from the sternocleidomastoid muscle & in the process, must LIGATE THE EXTERNAL JUGULAR V (to prevent bleeding from subclavian v)

40
Q

Where do the anterior jugular veins from each side come together?

A

at or just superior to the hyoid

41
Q

What are the 2 anterior jugular veins separated by ?

A

LINEA ALBA (which cuts the entire body in 2)

42
Q

Exam Q: What is the layer pierced by the anterior jugular veins ?

A

investing layer of cervical fascia (they pierce it to enter the subclavian vein)

43
Q

How do the R & L anterior jugular veins communicate?

A

jugular venous arch (in area of suprasternal notch)

44
Q

Which venous arch is an exception to no vessels crossing the medial line of our body?

A

jugular venous arch

45
Q

What is the clinical significance of the jugular venous arch crossing the midline of our body?

A

TRACHEOSTOMY

- trachea lies in the midline –> jugular venous arch may be accidentally cut

46
Q

Where do the common carotid arteries & their branches (external & internal carotid) pass thru? What do they supply?

A

anterior triangle of neck

all structures of head & neck

47
Q

Where do the R & L common carotid arteries originate? (imp in exam)

A

R - form brachiocephalic trunk immediately posterior to R sternoclavicular joint & is entirely in neck thru its course

L - begins in thorax as direct branch of aortic arch & passes superiorly to enter neck near the L sternoclavicular joint

48
Q

Do the R & L common carotid arteries have branches? (exam Q)

A

NO

they divide into internal & external carotid arteries but have NO BRANCHES

49
Q

Where does the internal jugular vein receive blood from? (exam Q)

A

all structures of H&N

50
Q

Where does each common carotid bifurcate/divide & into which arteries?

A

at the superior edge of thyroid cartilage

into external & internal carotid arteries

51
Q

What is found at the level of the bifurcation of common carotid arteries?

A

CAROTID SINUS & CAROTID BODY (innervated by glossopharyngeal & vagus)

52
Q

What is LYRE tumour?

A

benign tumour of carotid body

53
Q

How can one differentiate the external from the internal carotid artery?

A

no branches come off the internal in the neck, is more lateral

external is more medial at the level of bifurcation (of common carotid) & has branches in neck

54
Q

How many branches does the external carotid artery give off?

A
  • 3 anterior
  • 3 posterior

6 total

55
Q

Which are the 3 anterior branches of the external carotid artery? (note: must memorise)

A
  1. SUPERIOR THYROID
  2. LINGUAL
  3. FACIAL
  4. SUPERIOR THYROID
    - 1st branch, arises from ant. surf
    - passes down & forward –> to superior pole of thyroid gland
  5. LINGUAL
    - arises “ “ just above superior thyroid artery
    - passes DEEP to hypoglossal (XII) –> then b/w middle constrictor & hyoglossus muscles
    - goes to TONGUE
  6. FACIAL
    - 3rd branch
    - arises just above lingual, passes DEEP to stylohyoid & POSTERIOR BELLY OF DIGASTRIC –> goes b/w submandibular gland & mandible –> anterior to masseter muscle –> enters face
56
Q

When doing surgery at the base of the tongue, remember the _____ artery is located nearby, at the level of the ____ bone. It must be ligated
during surgery to prevent massive bleeding at the level of the pharynx.

A

lingual

hyoid

57
Q

A little pulsation can be felt on the mandible, which artery is this most likely to be?

A

facial artery

58
Q

Exam Q: Usually arteries and veins parallel each other but this is an exception. The facial artery goes _____ to the submandibular gland and emerges at the level of the bone.
The facial ____ is by the ________ and the posterior belly of the digastric muscles , it is superficial to these muscles and to the submandibular gland.

A

deeper
vein
sternohyoid

(Just remember: the facial artery runs deeper)

59
Q

Which are the 3 posterior branches of the external carotid artery? (note: must memorise)

A
  1. ASCENDING PHARYNGEAL
  2. OCCIPITAL
  3. POSTERIOR AURICULAR
60
Q

Which are the 2 terminal branches of the external carotid artery?

A
  1. SUPERFICIAL TEMPORAL
  2. MAXILLARY
  3. SUPERFICIAL TEMPORAL
    - UPWARD continuation of external carotid a.
    - starts posterior to neck of mandible –> passes anterior to ear –> crosses zygomatic process of temporal –> divides into anterior & posterior branches
  4. MAXILLARY
    - larger one
    - starts post. to “ “ “ –> passes thru parotid gland –> goes medial to neck of mandible –> into infra-temporal fossa –> into pterygopalatine fossa
61
Q

Can you feel the pulsations of the superficial temporal artery?

A

touch at the temple close to your ear and feel the pulsations

62
Q

The thyrocervical trunk is the ____ part of the _______ artery

A

first

subclavian

63
Q

Which are the 4 branches of the THYROCERVICAL TRUNK?

A
  1. SUPRA-SCAPULAR
  2. CERVICAL
  3. ASCENDING CERVICAL
  4. THYROID (most imp)
  5. SUPRA-SCAPULAR
    - 1st branch
    - imp for flap reconstruction
  6. CERVICAL
    - 2nd branch
    - anatomical landmark for lower limit of neck dissection (lymphatics don’t go lower than that)
  7. ASCENDING CERVICAL
  8. THYROID
    - MOST IMP –> supplies all 4 parathyroid glands (imp to rmr during surgery)
64
Q

Where does the internal jugular vein originate?

A

begins as a dilated continuation of sigmoid sinus (a dural venous sinus)

initial dilated part = SUPERIOR BULB OF INTERNAL JUGULAR VEIN

65
Q

What is the initial dilated part of the internal jugular vein called? Where does it receive blood from?

A

= SUPERIOR BULB OF INTERNAL JUGULAR VEIN

from INFERIOR PETROSAL SINUS

66
Q

Other than via the _______ triangle of the neck, it is very difficult to resect the carotid artery.

A

anterior

67
Q

The jugular vein always runs _______, except at the level of the jugular foramen, where it runs more _______

A

laterally

posterior

68
Q

The paired internal jugular veins join w/ the subclavian veins posterior to the sternal end of the clavicle to form the R & L ____________ veins

A

brachiocephalic

69
Q

What are the tributaries to each internal jugular vein?

A
  • inferior petrosal sinus
  • pharyngeal v
  • facial v
  • lingual v
  • occipital v
  • superior thyroid veins
  • middle “ v

Note: I don’t think this needs to be memorised

70
Q

Even though we have a middle thyroid vein, we do NOT have a middle thyroid artery. True or false?

A

True

human body is just weird

71
Q

What are the 3 divisions of lymph nodes in the head?

A
  1. superficial nodes
  2. superficial cervical “
  3. deep “ “
72
Q

Which are the superficial nodes of the head?

A

These 2 drain from posterior 1/2 of scalp:

  • Occipital nodes: assoc w. occipital artery, drainage from posterior scalp & neck
  • Mastoid nodes: “ “ posterior auricular artery, drainage from postero-lateral 1/2 of scalp
  • Pre-auricular & parotid nodes: anterior to ear, assoc w/ superficial temporal & transverse facial arteries
  • Submandibular nodes: “ “ facial artery
  • Submental nodes: inferior & posterior to chin
73
Q

What are the superficial cervical nodes ?

A

collection of lymph nodes along external jugular v on superficial surf of sternocleidomastoid muscle

74
Q

What are the deep cervical nodes? Where do they drain into?

A

collection of lymph nodes along external jugular v
- lymphatic vessels form R & L jugular & subclavian trunks drain lymph coming from deep cervical nodes into the R lymphatic duct & THORACIC DUCT

75
Q

What is lymphoria?

A

= build-up of lymph in neck of 500ml - 1L

76
Q

What are the 5 lymph node chains?

A
  1. superior horizontal
  2. inferior “
  3. anterior vertical
  4. posterior “
  5. jugular
77
Q

What is the superficial subfascial lymph node system?

A

circular system b/w chin & occipit & along course of external jugular v

78
Q

What is the deep lymph node system?

A
  • has bilateral triangular arrangement
  • anterior border = lymph nodes adjacent to internal jugular v
  • posterior “ = spinal lymph node chain w. supraclavicular node

the nodes that ARE excised during surgery

79
Q

Which nodes make up the the perivisceral lymph node system?

A

they are close to median viscera

  • retropharyngeal
  • pre laryngeal
  • prethyroidean
  • pre tracheal
  • recurrent (for recurrent laryngeal n)
80
Q

What is the topographical classification of lymph nodes based on?

A

6 levels & 6 sub-levels

81
Q

What are the 6 levels of lymph nodes?

A
  • Level I: submental & submandibular triangles
  • Level II: upper jugular
  • Level III: medium jugular
  • Level IV: lower jugular
  • Level V: posterior triangle
  • Level VI: anterior compartment
82
Q

What are the 6 sublevels of lymph nodes?

A
  • Sublevel IA & IB – divided by anterior belly of digastric
  • Sublevel IIA & IIB – “ “ spinal accessory n (XI)
  • Sublevel VA & VB – “ “ lateral projection of inferior border of cricoid cartilage
83
Q

What is the division of lymph nodes into levels important for?

A

NECK DISSECTIONS

usually in cancer pts

84
Q

Facial artery: A little pulsation can be felt on the mandible, which artery is this most likely to be?

A

H&N Anatomy (5 decks)

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