Neck Flashcards
At what vertebral levels is the larynx found
C3 - C6
What can the larynx be broadly divided into
Supraglottis
Glottis
Subglottis
How many cartilages make up the larynx and how many of these are paired
11
4 paired
What are the 4 paired cartilages of the larynx
Arytenoid
Corniculate cartilages of Santorino
Cuneiform cartilages of Wrisberg
Posterior sesamoid cartilage
What are the 3 unpaired cartilages of the larynx
Thyroid
Cricoid
Epiglottis
What is the laryngeal inlet and what are its borders
Laryngeal inlet connects the larynx to pharynx
Anterior/Superior borders - epiglottis
Lateral - aryepiglottic folds
Posterior - Intraarytenoid
What is the quadrangular membrane
Connective tissue layer that spans from the lateral aspect of the epiglottis to the arytenoids
The quadrangular membrane thickens inferiorly and forms what structure
Inferior margin thickens to form the vestibular ligament - which form the vestibular folds (false vocal cords)
Laryngeal ventricles are found where
In the space between the vestibular ligaments and the vocal cords
Where do the vocal cords extend to
From the midline surface on the inside of the thyroid cartilage (anterior commissure)
To the vocal process of the arytenoid cartilage
What is the anterior commissure
Midpoint between the thyroid notch and the lower border of thyroid
Describe the cricothyroid joint
Inferior horn of the thyroid cartilage articulates with the cricoid cartilage
At an encapsulated synovial joint
What movements are facilitated at the cricothyroid joint
Rotation
Gliding
What does contraction of the cricothyroid muscles
Forward and downwards tilting of the thyroid cartilage
Simultaneous upward movement of the cricoid
Describe the cricoarytenoid joint
Synovial articulation between the base of the arytenoid and the lamina of the cricoid cartilage
Surrounded by a loose joint capsule which inserts at a distance from the cartilage articulator surface margin allowing a wider range of movement
What movements are facilitated by the cricoarytenoid joint
Arytenoid cartilage can glide forwards and backwards over the cricoid lamina, rock medially and laterally and rotate around its axis.
What reinforces the cricoarytenoid joint capsule
Posterior cricothyroid ligament
The ligament fibres extend above the level of the articulation to insert to insert at the arytenoid process and vocal process
Where does the thyrohyoid membrane extend
Upper border of the thyroid cartilage to the hyoid bone
The thickenings of the thyrohyoid membrane form what
Median and lateral thyrohyoid ligaments
Which structures pierce the thyrohyoid membrane
Superior laryngeal vessels
Internal branch of the superior laryngeal nerve
What are the 2 free margins of the quadrangular membrane
Superior margin - forms the aryepiglottic fold (less defined)
Inferior margin - forms the vestibular ligament
What is the conus elasticas and where does it attach
Submucosal membrane originates from the upper border of the arch of the cricoid cartilage
Extends superiorly to attach to the inner plate of the thyroid cartilage anteriorly and the vocal process of the arytenoid posterirly
What is the conus elasticas also known as
Cricothyroid ligament
The conus elasticas is thickening laterally to form what structure
Vocal ligament
What forms the thyroid notch
A seperation at the superior aspect of the thyroid lamina
Describe the cricoid cartilage
Complete cartilaginous ring
Narrow cricoid arch anteriorly
Wider quadrate lamina posteriorly
Where are the facets of the cricoid cartilage found and what do they articulate with
At the junction of the arch and the lamina - small round facet that articulates with the lower horn of the thyroid
The superior margin of the lamina has 2 facets, which articulate with the base of the arytenoid cartilage
The arytenoids are what shape and what do they articulate with
Pyramidal
Apex - articulates with the corniculate cartilage
Base - articulates with the cricoid cartilage
Vocal process - directed forward and gives attachment for the vocal ligament
Describe the epiglottis
Thin leaf shaped fibrocartilage which lies in the upper part of the larynx
Petiole - pointed inferior stalk
Attached to the inner surface of the thyroid cartilage via the thyroepiglottic ligament and anchored to the posterior surface of the hyoid by the hyoepiglottic ligament
What do the corniculate cartilages articulate with and where are they found
Articulate with the apex of the arytenoid
Located in the aryepiglottic fold
Other than the corniculate cartilage what is found in the aryepiglottic fold
Cuneiform cartilage
What is the function of the corniculate and cuneiform cartilage
Reinforce and support the aryepiglottic folds, helping the arytenoids move
Which muscles elevate the larynx
Mylohyoid
Digastric
Geniohyoid
Thyrohyoid
Stylopharyngeus
Palatopharyngeus
Salpingopharyngeus
Inferior constrictor
Where is the hyoid bone found and what suspends it
Anterior neck
Suspended by suprahyoid and tongue muscle
What are the subsites of the hypopharynx
Postcricoid area
Piriform sinus
Posterior pharyngeal wall
Describe the postcricoid area
Phayngooesophageal junction
Extends from the level of arytenoid and connecting folds to the inferior border of the cricoid cartilage
Forms the anterior wall of the hypopharynx
What area extends from the pharyngoepiglottic fold to the upper end of the oesophagus
Piriform sinus
What are the boundaries of the posterior pharyngeal wall
Superior level of hyoid bone
Level of inferior border of the cricoid cartilage
What are the intrinsic muscles of the larynx
Transverse arytenoid
Thyroarytenoid
Posterior cricoarytenoid
Lateral cricoarytenoid
Cricothyroid
Which is the only intrinsic muscles of the larynx to be innervated by the external branch of the superior laryngeal nerve
Cricothyroid
Describe the course of the superior laryngeal nerve
Arises from the inferior ganglion of the vagal nerve, contains both motor and sensory fibres
Passes downwards along the sides of the pharynx, medial to the carotid artery
Divides into internal and external branches
Where does the internal superior laryngeal nerve pass
Between the middle and inferior constrictor muscles
Pierces the thyrohyoid membrane with the superior laryngeal artery
Describe the course of the external laryngeal nerve
Continues on the external surface of the larynx beneath the sternothyoid muscle
Gives motor innervation to cricothyroid
How does the course of the right recurrent laryngeal nerve differ to the left
Right RLN - originates at the right subclavian artery, passes below and behind the artery
Left RLN - originates from the vagus in the chest, passes around the aortic arch
They then ascend running in the tracheooesophageal groove
Which muscles does the recurrent laryngeal nerve innervate
All intrinsic muscles other than cricothyroid
The recurrent laryngeal nerve provides sensory innervation for which area of the larynx
Subglottic region
Which branches of the vagus nerve are involved with the larynx
Superior laryngeal nerve
Inferior laryngeal nerve
Recurrent laryngeal nerve
Carotid artery surgery may risk which nerve
Superior laryngeal nerve
Thyroid or parathyroid surgery may risk which nerve
Inferior laryngeal nerve
Which branches of the carotid artery supply the larynx
Superior laryngeal artery which is a branch of the superior thyroid artery
Cricothyroid artery is a branch of which artery
Superior thyroid artery (common carotid)
the inferior laryngeal artery is a branch of which artery
Branch of the inferior thyroid artery which is a branch fo the inferior thyroid artery
What are the circular extrinsic muscles of the larynx
Superior, middle and inferior pharyngeal constrictor
What are the longitudinal extrinsic muscles of the larynx
Stylopharyngeus
Palatopharyngeus
Salpingopharyngeus
The extrinsic muscles of the larynx are innervated by which nerve and which is the exception
Vagus nerve
Stylopharngeus is innervated by glossopharyngeal nerve
What is the sensory innervation of the pharynx
Glossopharyngeal
Maxillary nerve innervates the anterior and superior aspect of the nasopharynx
Inferior aspect of the laryngopharynx (start of larynx) - innervated by vagus
What are the borders of the anterior triangle of the neck
Superior - inf aspect of the mandible
Lateral - anterior border of sternocleidomastoid
Medial - Sagittal line down the midline of the neck
What forms the roof of the anterior triangle
Investing fascia
Which supra hyoid muscles are found in the anterior triangle
Stylohyoid
Digastric
Mylohyoid
Geniohyoid
Which infrahyoid muscles are found in the anterior triangle
Omohyoid
Sternohyoid
Thyrohyoid
Sternohyoid
Which artery bifurcates in the anterior triangle
Common carotid
What vasculature is found in the anterior triangle
Common carotid - birfucates into internal and external carotid
Internal Jugular vein
Which cranial nerves are found in the anterior triangle
Facial - 7
Glossopharyngeal - 9
Vagus - 10
Accessory - 11
Hypoglossal - 12
What subdivides the anterior triangle into four further triangle
Hyoid bone
Suprahyoid
Infrahypid
What are the boundaries of the carotid triangle
Superior - posterior belly of digastric
Lateral - medial border of sternocleidomastoid
Inferior - superior border of omohyoid
What is the contents of the carotid triangle
Common carotid - bifurcates into internal and external
Internal jugular vein
Hypoglossal nerve
Vagus nerve
What are the boundaries of the submental triangle and what does it contain
Inferior - hyoid bone
Medial - midline of the neck
Lateral - anterior body of digastric
Submental lymph nodes
What are the boundaries of the submandibular triangle and what does it contain
Superior - body of mandible
Anterior - Anterior belly of digastric
Posterior - posterior belly of digastric
Submandibular gland, lymph nodes, facial artery and vein
What are the borders of the posterior triangle
Anterior - posterior border of sternocleidmastoid
Posterior -anterior border of trapezius
Inferior - middle 1/3 of the clavicle
What is the floor of the posterior triangle formed from
Prevertebral fascia
What are the contents of the posterior triangle
Omohyoid
External jugular vein
Subclavian vein
Transverse cervical and supra scapular veins
Subclavian, transverse cervical, suprascapular arteries and veins
Accessory nerve
Cervical plexus
Phrenic nerve
Trunks of the brachial plexus
Why is the accessory nerve vulnerable to injury in the posterior triangle
Lies superficial
Where do the common carotids originate from
Left common carotid - branch of the aorta
Right common carotid - from the bifurcation of the subclavian trunk
Do the common carotids give off any branches in the neck
No
Where does the common carotid bifurcate and into what
And what else is found here
At the carotid triangle
Carotid sinus - site of baroreceptors which detect stretch as a measure of BP
What are the 6 branches of the common carotid artery
Superior thyroid artery
Lingual artery
Facial artery
Ascending pharyngeal artery
Occipital artery
Posterior auricular artery
What does the external carotid terminate into
Superficial temporal artery
Maxillary artery
Which three arteries supply the scalp
Superficial temporal
Occipital
Posterior auricular
The middle meningeal artery is a branch of which artery
Branch of the maxillary artery
Which is a branch of the external carotids
Does the internal carotid artery give off any branches in the neck
No
Through which structure in which bone does the internal carotid artery enter the cranial cavity
Via the carotid canal
In the petrous part of the temporal bone
The vertebral arteries are a branch of which main artery
Subclavian
The vertebral arteries enter the cranial cavity through which structure and what do they combine to form
Forman Magnum
Converge to form basilar artery
What forms the thyrocervical artery and what does this then branch to form
Right and left subclavian arteries give rise to the thyrocervical artery
Branches to give:
Inferior thyroid artery
Ascending cervical artery
Transverse cervical artery
Suprascapular artery
Which 2 veins form the external jugular vein
Posterior auricular vein
Retromandibular vein
Where does the external jugular vein form
Immediately posterior to the angle of mandible, and inferior to the outer ear
The posterior external jugular, transverse cervical and suprascapular veins drain into which main vein
External jugular vein
The external jugular vein terminates by draining into which vein
Subclavian vein
What is the internal jugular vein a continuation of
Sigmoid sinus
In the neck where is the internal jugular vein found
In the carotid sheath
The facial, lingual, occipital, superior and middle thyroid veins drain into which main vein
Internal jugular vein
The internal jugular terminates by combining with what to form what
Combines with the subclavian vein to form the brachiocephalic vein
Where are the cavernous sinus found
At the lateral aspect of the sphenoid bone
Which structures are found within the cavernous sinus
Internal carotid artery
Abducens nerve (CN VI)
Oculomotor never (CN III)
Trochlear nerve (CN IV)
Opthalmic nerve (V1)
Maxillary nerve (V2)
What connects the facial vein to the cavernous sinus
Superior ophthalmic vein
Which are the superficial lymph node groups of the head and neck
Occipital
Mastoid
Pre-auricular
Parotid
Submental
Submandibular
Facial
Superficial cervical
What are the deep lymph node groups of the head and neck
Prelaryngeal
Pretracheal
Paratracheal
Retropharyngeal
Infrahyoid
Jugulodigastric (tonsilar)
Jugulo-omohyoid
Supraclavicular
What is Virchows node and what does it suggest
Enlarged supraclavicular node
Troisiers sign - highly suggestive of cancer in the abdomen, particularly gastric cancer
What makes up Waldeyers ring
Tonsillar ring
Made up of - lingual tonsil, palatine tonsil, tubal tonsil, pharyngeal tonsil
Where is the superficial cervical fascia found
Between the dermis and the deep cervical fascia
What is contained in the superficial cervical fascia
Neurovascular supply to the skin
Superficial veins
Superficial lymph nodes
Fat
Platsyma
Describe the platysma muscle
Paper thin muscle
Originates from the fascia of pec major and deltoid
Inserts into the mandible
What innervates platysma
Facial nerve
What are the three layers of the deep cervical fascia
Investing layer
Pretracheal layer
Prevertebral layer
What does the investing fascia cover
All structures in the neck
Over trapezius and sternocleidomastoid, it splits, covering them completely
What are the attachments of the investing fascia
Superior - attaches to the external occipital protuberance, and the superior nuchal line of the skull
Anterior - hyoid bone
Inferior - Spine and acromion of the scapule, the clavicle and the manubrium of the sternum
Posterior - nuchal line of the vertebra
Where is the pretracheal fascia found in the neck
Anteriorly
What does the pretracheal fascia fuse with
The pericardium
What are the two parts of the pretracheal fascia
Visceral
Muscular
What does the visceral part of the pretracheal fascia enclose
thyroid gland, trachea and oesophagus
The visceral pretracheal fascia receives contributions from which structure
Bucopharyngeal fascia
What does the muscular part of the pretracheal fascia enclose
Infrahyoid muscles
What does the prevertebral fascia surround
Vertebral column and its associated muscles - scalene muscles, prevertebral muscles, and the deep muscles of the back
What forms the axillary sheath
The prevertebral fascia
What are the contents of the carotid sheath
Common carotid artery
Internal jugular vein.
Vagus nerve.
Accompanying cervical lymph nodes.
What is the retropharygneal space between
Buccopharyngeal fascia (posterior aspect of the visceral pretracheal fascia) and the prevertebral fascia.
Extends from the base of the skull to the posterior mediastinum
The phrenic nerve arises at which border of which muscle
Lateral border of the anterior scalene muscle
Where is the cervical plexus found
In the posterior triangle of the neck
Halfway up the sternocleidomastoid muscle
Within the prevertebral fascia
What forms the cervical plexus
Anterior rami of C1 - C4
What muscular branches arise from the cervical plexus
Phrenic nerve
Nerve to geniohyoid and thryohyoid
Ansa cervicalis
What branches arise from the ansa cervicalis
Superior belly of the omohyoid muscle
Inferior belly of omohyoid muscle
Sternohyoid
Sternothyroid
What sensory branches arise from the cervical plexus
Greater auricular nerve
Transverse cervical nerve
Lesser occipital nerve
Supraclavicular nerve
What muscles attach to the hyoid bone
Middle pharyngeal constrictor, hyoglossus, genioglossus
Digastric, stylohyoid, geniohyoid, mylohyoid
Thyrohyoid, omohyoid, sternohyoid
Which 3 ligaments attach to the hyoid bone
Stylohyoid ligament
Thyrohyoid ligament
Hyoepiglottic ligament
What are the 4 suprahyoid muscles
Stylohyoid
Digastric
Mylohyoid
Geniohyoid
What is the nerve Innervation of the stylohyoid muscle
Stylohyoid branch of the facial nerve (CN VII)
Describe the innervation of digastric
Anterior belly - innervated by inferior alveolar nerve (branch of CN V)
Posterior belly - innervated by CN VII
Which suprahyoid muscle would be defined as a thin strap muscle
Stylohyoid
What does mylohyoid form the floor of
The mouth
What is the innervation of mylohyoid
Inferior alveolar nerve (branch of mandibular branch of CN V)
Geniohyoid is found deep to which muscle
Mylohyoid
What innervates geniohyoid
C1 nerve roots running with hypoglossal nerve
What is the arterial supply to the hyoids
Facial artery
Occipital artery
Lingual artery
What are the superficial infrahyoid muscles
Omohyoid
Sternohyoid
What are the deep infra hyoid muslces
Sternothyroid
Thyrohyoid
All of the infrahyoid muscles are supplied by the ansa cervicalis other than
Thyrohyoid
Supplied by Anterior ramus of C1 carried by hypoglossus
Which infrahyoid muscle is found in both the anterior and posterior triangle
Hypoglossal nerve
How many scalene muscles are there
3 paired muscles
Anterior, middle and posterior
What is the action of the scalene muscles
Accessory muscles of respiration
Flexion of the neck
Which structures pass between the anterior and middle scalene
Brachial plexus
Subclavian arteyr
Which structures pass between the anterior and middle scalene
Brachial plexus
Subclavian artery
What structures pass anterior to the anterior scalene
Subclavian vein
Phrenic nerve
Where is the subclavian artery in relation to the anterior scalene
Posterior to the anterior scalene
What is an interscalene block
Local anaesthetic injected into the brachial plexus at the point where it is between the anterior and middle scalene muscles.
LA is injected between these muscles at the level of the cricoid cartilage (C6)
What are the four sub occipital muscles
Rectus capitis posterior major
Rectus capitis posterior minor
Obliquus capitis inferior
Obliquus capitis superior
What does the sub occipital triangle contain
Vertebral artery
What movements are facilitated by the sub occipital muscles
Extend and rotate the head
What is the atlas
C1
What is the axis
C2
Which ligaments support the Atlanto-axial joint
Lateral atlanto-axial joint x 2
Medial atlanto-axial joint
Which 4 ligaments are present throughout the vertebral column
Anterior and posterior longituidnal ligaments
Ligamentum flavum
Interspinous ligament
Which 2 ligaments are just present in the cervical spine
Nuchal ligament
Transverse ligament of the atlas
Describe the nuchal ligament
A continuation of the supraspinous ligament
Attaches to C1-C7
Proximal attachment for rhomboids and trapezius
The ondontoid process of C2 articulates with which part of C1
The anterior arch of atlas
What is a Jeffersons fracture
Compression of the lateral masses of the atlas between the occipital condyles and the axis.
This causes them to be driven apart, fracturing one or both anterior/posterior arches.
What is a hangmans fracture
Fracture of the pars interarticularis (bony column between the superior and inferior articular facets of the axis).
Fracture of the odontoid process accounts for what % of C2 fractures
40%
How long is the oesophagus and where does it start and end
25cm
C6 - T11
The external muscular layer of the oesophagus changes with each third of the oesophagus
Describe the external muscular layer in the superior, middle and inferior third
Superior third - voluntary striated muscle
Middle third - voluntary striated and smooth muscle
Inferior third - smooth muscle
The internal muscular layer of the oesophagus is what type of muscle
Circular
What produces the upper oesophageal sphincter
Cricopharyngeus muscle
What 4 factors maintain the lower oesophageal sphincter
Oesophagus enters the stomach at an acute angle.
Walls of the intra-abdominal section of the oesophagus are compressed when there is a positive intra-abdominal pressure.
Prominent mucosal folds at the gastro-oesophageal junction aid in occluding the lumen.
Right crus of the diaphragm has a “pinch-cock” effect.
At what 4 points is the oesophagus externally compressed
Arch of aorta
Bronchus (left main stem)
Cricoid cartilage
Diaphragmatic hiatus
What is the arterial supply of the oesophagus
Thoracic oesophagus - thoracic aorta, inferior thyroid artery
Abdominal oesophagus - left gastric vein
What is the venous drainage of the oesophagus
Thoracic oesophagus - azygos veins and inferior thyroid veins
Abdominal oesophagus
Portal circulation - via left gastric vein
Systemic circulation - azygos vein
The nucleus ambiguus controls which oesophageal sphincter
Upper oesophageal sphincter
The lower oesophageal sphincter is innervated by
Fibres from dorsal motor nucleus.
What is the lymphatic drainage of the oesophagsu
Superior third - Deep cervical lymph nodes
Middle third - Superior and posterior mediastinal lymph nodes
Inferior third - Left gastric and coeliac nodes
At what vertebral level is the thyroid found
C5-T1
What fascial layer covers the thyroid gland
Pretracheal fascia
Which muscles are anteriorly related to the thyroid
Sternohyoid
Superior belly of omohyoid
Sternohyoid
What is the origin of the superior thyroid artery compared to the inferior thyroid artery
Superior - first branch of the external carotid
Inferior - from the thyrocervical trunk
In what % of people is the thryoidae ima artery present and where does it arise from
10%
From the brachiocephalic trunk
What pharyngeal pouch is are the parathyroid glands from
Superior parathyroid gland - 4th pharyngeal pouch
Inferior parathyroid gland - 3rd pharyngeal pouch
What is the blood supply of the parathyroid glands
Inferior thyroid artery
Superior, middle and inferior thyroid veins
What is the lymphatic drainage of the parathyroids
Paratracheal and deep cervical nodes
