Neck Flashcards
anterior triangle of neck
-superior border- mandible
-medial- midline
-lateral- anterior border of SCM
-muscles are divided based on relationship with hyoid
-suprahyoid and infrahyoid (strap) muscles
-divided into subdivisions by digastric (anterior/posterior belly) and superior belly of omohyoid
-4 triangles: submental, submandibular, carotid, muscular
submental triangle
-base of triangle is hyoid bone
-apex towards jaw symphysis
-submental muscles
-submental lymph nodes
-anterior jugular vein
submandibular triangle
-inferior border- mandible
-anterior- digastric muscle
-floor- mylohyoid
-submandibular gland (salivary) - can get infected
-fascial artery and vein
carotid triangle
-carotid system (common carotid, internal carotid and external carotid)
-glossopharyngeal nerve
-vagus nerve
-internal jugular vein
muscular triangle
-midline of neck
-superior- omohyoid muscle
-anterior- SCM
-infrahyoid muscles
-omohyoid
-sternohyoid
-sternothyroid
-thyrohyoid
-work on hyoid bone for respiration and swallowing
infrahyoid muscles- strap muscles
-omohyoid- ansa cervicalis (C1, C2, C3)
-sternohyoid- ansa cervicalis (C1, C2, C3)
-sternothyroid- ansa cervicalis (C1, C2, C3)
-thyrohyoid- thyrohyoid branch of hypoglossal nerve
-depress hyoid - help with swallowing and speech
suprahyoid
-digastric (posterior belly)- facial n
-digastric (anterior belly)- nerve to mylohyoid
-mylohyoid- nerve to mylohyoid
-geniohyoid- C1 via hypoglossal n
-stylohyoid- facial n
-elevated hyoid
posterior triangle of the neck
-medial- posterior border of SCM
-inferior- middle portion of clavicle
-lateral- anterior border of trap
-2 triangles- supraclavicular and occipital triangles
subclavian/supraclavicular triangle
-omohyoid inferior belly, clavicle, SCM
-subclavian artery and vein
-external jugular vein at most superficial location
occipital triangle
-inferior belly of omohyoid, trap, SCM
-spinal accessory nerve
-brachial plexus between scalene medius and posterior
-occipital lymph nodes
posterior neck muscles
-anterior, middle, posterior scalenes
-deep muscles- anterior surface of cervical and thoracic vertebrae :
-longus capitis and longus colli- origin on transverse process of lower cervical vertebrae and into C1 (atlas) and occipital bone -> flex and rotate neck and head
-rectus capitis anterior and lateralis - postural muscles that flex and rotate the head
superficial fascia
-platysma muscle anteriorly
-neurovascular supply to skin
-superficial veins (external jugular vein)
-superficial lymph nodes
-fat
-contains infections -> once infection gets through it spread rapidly bc it doesnt have protection
retropharyngeal space
-between pre tracheal and pre vertebral fascia
-T1-T2
-potential space
-anterior- visceral fascia surrounds pharynx and trachea
-posterior- prevertebral fascia surrounds the prevertebral muscles
-lateral- carotid sheath surrounds carotid artery and internal jugular vein
-infection -> can seep into deeper part of neck -> not going to be blocked until superior mediastinum
-danger space- continuous with mediastum and up until diaphragm -> posterior mediastinum infection spread
ludwigs angina
-medical emergency
-infection spreads to retropharyngeal space
-usually due to infected dentition
-can comprise airway- tongue blocks airway
-immunocompromised adults, children
-area swells quickly
-red neck
-dysphagia
-hot potato voice
deep fascia
-investing layer- encloses entire neck -> splits to encapsulate trap and SCM
-carotid sheath- jugular vein, carotid artery, vagus
-pre-tracheal fascia- encloses trachea, thyroid, esophagus
-prevertebral fascia- scalenes, vertebral column, prevertebral muscles
surface anatomy
-most superior- angle of mandible
-most inferior- clavicles
-midline from mandible to jugular fossa -> straight through laryngeal prominence (adams apple)
-greater supraclavicular fossa
-between trap and SCM - external jugular vein
external jugular vein
-gauges if pt is having disease processes
-internal barometer
-measures venous pressure
-normally visible superior to clavicle
-distention of this vein -> heart failure, obstruction of vena cava, lymph node compression, increased intrathoracic pressure
left supraclavicular node
-Virchow’s node
-left supraclavicular fossa
-thoracic duct empties all the lymphatics here
-enlarged- high suspicious of abdominal cancer
-right side- right lymphatic duct - right arm, right breast, right neck
midline neck
-hyoid bone
-laryngeal prominence- cartilage coming off thyroid (adams apple)
-circothyroid ligament
-cricoid cartilage
-tracheal rings
-thyroid- wraps around trachea -> isthmus (problem in emergency airways)
cervical plexus
-divided into muscular and sensory branches
-muscular branches: deeper, supply muscles of neck, back and diaphragm
-travel anteromedial (different to cutaneous sensory branches- travel posteriorly)
-phrenic nerve- anterior rami C3-C5 -> innervate diaphragm
-C1 gives rise to nerves that innervates glenohyoid and thyrohyoid muscles -> travel with hypoglossal
-ansa cervicalis- loop of nerves -> roots C1-C3 -> 4 branches - innervate superior/inferior belly of omohyoid, sternohyoid, sternothyroid
-segmental branches to rectus capitis, longus capitis, pre vertebral muscles, SMC, levator scapulae, trap, scalenes
-medius scalane C3-C4*
-indirect innervation for the rest of scalenes from cervical plexus
superficial branches of cervical plexus (she didnt talk ab it but this was on slide)
-sensory
-lesser occipital -C2- skin of scalp posterior and superior to ear
-great auricular- C2-C3- skin anterior, inferior, and over ear and over parotid gland
-transverse cervical- C2-C3- skin over anterior aspect of neck
-supraclavicular- C3-C4 - skin over superior portion of chest and shoulder
carotid
-in carotid sheath
-common carotid artery divides into external and internal carotid artery
-internal- continue up into cranium before it branches
-right after internal and external split -> carotid sinus - from common carotid to proximal internal carotid artery
-carotid sinus- specialized sensory cells- baroreceptors that detect stretch (BP)- receives nerve impulses from glossopharyngeal -> regulate BP
-baroreceptor can be hypersensitive- any pressure -> trigger -> slows heart and decrease BP -> syncope
-between external and internal- cluster of nerve cells -> carotid bodies -> chemoreceptor - detect O2 content in blood -> relay to brain -> control breathing rate
external carotid branches
-Some Attending’s Like Freaking Out Potential Medical Students
-no internal carotid artery branches until up into neck
-superior thyroid artery- almost right after bifurcation
-ascending pharyngeal artery
-lingual artery
-facial artery
-occipital artery
-posterior auricular artery
-maxillary artery
-superficial temporal artery
venous branches
-external jugular connects with subclavian vein
-internal jugular
-thoracic duct connects to subclavian -> virchow
-if virchow node is large enough -> compression of nerves and vessels
superior vena cava syndrome
-tumor pressing up against superior vena cava
-prevents draining
-dilated veins in neck- external jugular
-obstructed collateral veins - chest
-cant drain blood from face -> flushing on face
-pemberton’s sign- put hands up facial plethera -> increase erythema on face
-lymphoma, lung cancer
thyroid gland
-endocrine
-below larynx
-wraps around trachea
-butterfly
-connected in middle by isthmus
-access to trachea can be complicated by isthmus
-during embryology- thyroid tissue migrates down from posterior to pharynx -> traverse anteriorly -> lands at anterior trachea -> this tract is supposed to be obliterated
-thyroglossal duct cyst- patent thyroglossal duct (never obliterated) develops cyst
-anterior mass
-pyramidal lobe of thyroid +
emergency airways
-tube entering trachea
-below the cricocartilage
-in between tracheal rings
-2nd tracheal space
-division of isthmus needed
-in emergency -> cricothyrotomy - tube through cricothyroid membrane
-incision above cricocartilage (just below adams apple) -> enter through cricothyroid membrane
