Neck Flashcards by Niamh Sands

What divides the neck anteriorly and posteriorly

STERNOCLEIDOMASTOID

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What is the neck

The junction between head and thorax

Superior limit is mandible and base of skull

Inferior limit is the thoracic inlet

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Where is the thoracic inlet

Lies through the first rib and is higher posteriorly than anterior. It is bounded by the first thoracic vertebra posteriorly, first ribs laterally and the manubrium anteriorly

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What is another name for the thoracic inlet

Superior thoracic aperture

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What are the proximal and distal attachments in the neck

PROXIMAL
-mastoid process

DISTAL
-sternum and clavicle

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Where poses a risk of damage to the facial nerve due to an absence of this at birth

Mastoid process - starts to grow about the age of 1, prominent at about the age of 2 and continues until the first permanent teeth appear at about 6yrs old

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Where does the blood from the internal jugular vein lead

internal jugular
subclavian
brachiocephalic
superior vena cava
right atrium
right ventricle
lungs

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What are the boundaries of the anterior triangle

Sternocleidomastoid muscle

The midline

The lower border of the mandible

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What are the boundaries of the posterior triangle

Sternocleidomastoid

Trapezius muscle

Middle third of the clavicle

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What muscles are found within the anterior triangle

MYLOHYOID – forms the floor of the mouth like a hammock. Arises from the mandible and attaches onto the hyoid bone. It raises the hyoid bone and floor of mouth

ANT. BELLY OF DIAGSTRIC – One of two muscles (posterior one also). Arises from mandible and passes to the mastoid process. It pulls down the mandible and raises the hyoid bone

STRAP MUSCLES – named after where they attach. These depress the hyoid bone and also the larynx, or pull it down, during swallowing (deglutition) and speaking

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What skeletal elements would you find in the anterior triangle

THYROID CARTILAGE – Largest of the laryngeal cartilages

CRICOID CARTILAGE – Below the thyroid cartilage just above the trachea

HYOID BONE

TRACHEA

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What supplies the thyroid gland

Superior and inferior thyroid arteries

superior - external carotid
inferior - thyrocervical trunk

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What are the 3 single laryngeal cartilages

Thyroid
Cricoid - complete ring
Epiglottis - elastic

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What are the paired laryngeal cartilages

Arytenoid
Corniculate
Cuneiform

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What glands are found in the anterior triangle

Thyroid gland
Parathyroid gland
Submandibular gland

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What type of gland is the thyroid gland

Endocrine - secretes hormones into the bloodstream

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How can the thyroid gland be examined clinically

Asking the patient to swallow, when lightly pressing on the neck from behind the patient, will allow you to see if it is enlarged

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What is the pyramidal lobe

Embryological remnant of where the thyroid gland developed from in the floor of the mouth – at the foramen caecum of the tongue

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What connects the two lobes of the thyroid gland

Isthmus (narrow piece of tissue between 2 larger parts of a structure)

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What is the purpose of thyroid hormones

Raise the basal metabolic rate, influences synthesis of proteins, and are responsible for nerve growth/development. They are essential for the development of cells in the body

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What hormones does the thyroid gland secrete

T3 and T4

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How does PTH increase blood calcium

PTH increases blood calcium by:

Increasing absorption from the gut

Increasing absorption from the kidney

Increased activity of osteoblasts – break down bone and release calcium.

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What percentage of the popn have more than 4 parathyroid glands

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Where are the parathyroid glands

Located on the posterior surface of the thyroid gland and appear flat and oval in shape

Superior x 2 – found roughly in the middle of the posterior border of the thyroid lobes

Inferior x 2 – at inferior poles of thyroid gland, although can be a little variable

What nerves are found in the anterior triangle

Vagus Phrenic Hypoglossal

What does the vagus nerve control and give sense to

Motor – innervates the muscles of the larynx, pharynx and soft palate Parasympathetic – smooth muscle of the trachea, bronchi (slows breathing), slows heart rate and increases gut motility Special sensory fibres – innervation for taste sensation in the epiglottis and root of the tongue General sensory – internal aspect of larynx and the ear canal. Also provides visceral sensory innervation to the heart and abdominal structures

Where does the phrenic nerve supply and what does it anchor to the heart

Found in the anterior triangle C3 – 5 Supplies the diaphragm Used to be surgically divided as a treatment for T.B Motor to innervate the skeletal muscle of the diaphragm. Sensory innervation to the diaphragm also, specifically the central tendon, as well as the layer around the heart called the pericardium. This structure anchors the heart to the diaphragm

What vessels are found within the anterior triangle

Common carotid artery Jugular veins

What nerves are found in the posterior triangle

Accessory Parts of brachial plexus Cutaneous cervical nerves

What is the purpose of the sternocleidomastoid muscle

Lateral flexion of neck when acting on its own and flexion of neck when acting both left and right sides

What supplies the sternocleidomastoid and trapezius

Accessory nerve

What are the sections of the trapezius

It is divided into three parts – upper, middle and lower fibres. The upper fibres elevate the scapula, and also rotate during abduction of the arm. Middle fibres pull back the scapula (retraction) and lower fibres go inferiorly

Where is the brachial plexus found

Posterior triangle C5 - T1

What are lymph nodes

Small oval to bean shaped structures They filter lymph Offer defence against the spread of infection Returned to larger veins Many sites of lymph nodes

What do the superficial lymph nodes do

Drain face, neck and scalp and pass to the superficial ring of lymph nodes at the junction of head and neck

Where do the deep lymph nodes drain to

Deep cervical lymph nodes. Left jugular lymphatic trunk passes to the thoracic duct ->left subclavian vein Right jugular lymphatic trunk passes to the right subclavian vein

What is the purpose of the brachial plexus

Sensory and motor innervation to the upper limb

What are the terminal branches of the brachial plexus

Musculocutaneous, axillary, median, ulnar, radial nerves

When may the brachial plexus be commonly injured

Upper roots can be damaged during child birth while lower ones can be torn during overstretching of the opper limv e.g. falling and reaching to grab something to save you

What is torticollis

Excess contraction or shortening of sternocleidomastoid

What nerve supplies the diaphragm

Phrenic nerve | Motor to diaphragm and sensory to the mediastinal pleura

What are the nerve roots of the phrenic nerve

C3-5

Why is the phrenic nerve no longer sectioned for TB

Paralysis of the diaphragm resulted in excessive secretions in the lung due to poor respiration resulting in pneumonia

What are the two main branches of the common carotid artery

External and internal

Where does the internal carotid artery supply

The brain

At what cervical level does the common carotid artery bifurcate

approx C4/5

Why does stenosis occur at the bifurcation

Due to the change of direction of blood hitting against the superior aspect of the split damaging the intimal lining

What does the hypoglossal nerve supply

Genioglossus, hypoglossus and styloglossus

When may the hypoglossal nerve be partially sectioned toreinnervate another nerve close by

Facial paralysis less than 1 year unresolved

What problem occurs when partially sectioning the hypoglossal nerve

Contraction of both facial and tongue muscles

What type of gland is the thyroid gland

Endocrine

What is the arterial supply of the thyroid gland

Superior and inferior thyroid arteries

What comprises the 'strap' muscles

Sternohoid, thyrohoid, omohyoid, sternothyroid

What is the function of the strap muscles

Depression of the hyoid bone in swallowing

What is the function of the diagastric muscle

Opens the jaw

Where does the submandibular gland open into the oral cavity

Opposite the lingual frenulum

What does the vagus nerve supply

Pharyngeal musculature and parasympathetic innervation to the heart, lungs and GI tract

What are the main branches of the vagus nerve

Superior laryngeal and the recurrent laryngeal nerves

What nerve fibres types are in the vagus nerve

Motor and parasympathetic