neck Flashcards
what are the 5 regions of the neck
posterior:
vertebral region, posterior triangle, sternocleidomastoid (over SCM muscle)
anterior:
anterior triangle, root of the neck (bottom of SCM region)
what important structures pass through the posterior triangle region of the neck
the brachial plexus the cervical plexus subclavian artery accessory nerve
what are the three compartments of the neck
vertebral
visceral
vascular
what does the vertebral region of the neck consist of
the cervical vertebra and the associated postural muscles
what does the visceral region of the neck consist of
trachea, oesophagus, the thyroid gland, the parathyroid glands and thymus
what does the vascular region of the neck consist of
the fascia that surround the common carotid artery, internal jugular vein and the vagus nerve
what are the 5 fascial layers of the neck
superficial fascia
investing layer
pretracheal layer
prevertebral layer
carotid sheath
where is the superficial fascia layer of the neck
between the skin and the first layer of deep fascia
where is the investing fascial layer of the neck
surrounds the sternocleidomastoid muscles and the trapezius muscles (passes both infront and behind them)
where is the prevertebral fascial layer of the neck
completely surrounds the posterior compartment of the neck surrounding the vertebra and all surrounding muscles
where is the carotid sheath
fascia surrounding the vascular compartment of the neck
what is the clinical relevance of the difference compartments of the neck
it allows a pathway for pus/blood/infective material to track up and down
which cervical vertebra contribute to the lordosis of the cervical spine
C1-5
which muscles of the neck extend the head on the neck and help maintain cervical lordosis
postvertebral muscles
why is it that when you are tired, you tip your head forward
because the centre of gravity of the head lies in front of the centre of rotation
which cervical vertebra are “typical” vertebra
C3-6
what typical features to C3-6 vertebra show
- body
- articular column
- pedicle
- lamina
- spinous process
what differences are there in C3-6 vertebra compared to thoracic vertebra, but are common between vertebra C3-6
- transverse foramen
- anterior and posterior tubercles
- bifid spinous process
- uncinate process
what is specific to vertebra C7
has the longest spinous process
what is the importance of the transverse foramen in the cervical vertebra
bony protection for the vertebral artery
what is the significance of the bifid spnous process of the cervical vertebra
allows many muscles to to attach to it (increases the surface area for attachment)
what are the 3 lateral muscles of the neck
scalenus medius
scalenus anterior
scalenus posterior
where does the scalenus anterior extend from/to
from the anterior tubercle to the first rib
what is the importance of the scalenes muscles
between the anterior and medius scalenus muscle is where the subclavian artery and brachial plexus are
- also phrenic nerve lies on scalenus anterior
where are the prevertebal muscles
located deep to prevertebral fascia
which prevertebral muscle maintains the lordosis of the cervical spine
longus colli
what is a cervical rib
elongation of the anterior tubercle of C7 that attaches to the sternum
what is the significance of a cervical rib
can lead to nerve entrapment of T1 elements on movement (axilla sensation, and hand numbness)
which cervical rib has the longest transverse processlas
atlas
what is the distinguishing feature of C2 (axis)
has the dens - articulates with the facet on the anterior arch of the atlas
where do the nerve roots pass out of the vertebra
C1+C2 = behind the facet joint below
C3-7 = infront of the facet joint
how can you tell which is internal and which is external carotid artery
external gives off branches and is more anterior while internal has no branches and is more posterior
at what cervical level does the common carotid artery bifurcate
C4 vertebra
through which cervical vertebra does the vertebral artery run through
C6-C1
what is the importance of the thick intervertebral discs in the cervical spine
prevents forward slip and rotation
what direction causes cervical disc prolapse
AP direction
how many joints at the atlanto-occipital joint
2 lateral synovial joints
how many joints at the atlanto-axial joint
3 synovial joints
what is the function of the transverse ligament in the cervical spine
stabilises the dens and prevents posterior translation of dens into vertebral canal
what is the function of the alar ligaments in the cervical spine
“checks” the range of rotation of atlas around the dens
what is the clinical relevance of osteophytes forming from the uncinate processes and facet surfaces of the cervical vertebra
may cause irritation of the nerve roots and occlude the vertebral artery
what is the hangmans fracture
extension fracture of the cervical spine through both the pedicles
where does the neck extend from/to, both anteriorly and posteriorly
anterioly: from the lower border of the mandible to the manubrium
posteriorly - from the superior nuchal line down to C7-T1 disc
where is the superior nuchal line
the little lines that extend out either side from the external occipital protrubrence
which structures are contained in the superficial fascia
platysma - thin sheet of muscle that blends with the facial muscles
anterior and external jugular vein
what are the two fascia of the pretracheal fascia
pretracheal fascia
buccopharyngeal fascia
what is the importance of the pretracheal fascia
it extends up to the hyoid bone - everything that is in the pretracheal fascia will move up and down with swallowing
what is contained within the carotid sheath
common carotid
vagus nerve
internal jugular vein
what are the borders of the anterior triangle
- SCM infront
- the inferior border of the mandible
- the midline of the neck
what are the borders of the posterior triangle
- behind SCM
- infront of trapezius
- above the middle third of the neck
what are the anterior muscles of the neck
suprahyoid and infrahyoid muscles
in what compartment are the suprahyoid and infrahyoid muscles
lie between the investing fascia and the pretracheal fascia
what is the function of the suprahyoid muscles
elevation of the hyoid and the larynx
what is the function of the infrahyoid muscles
anchor the hyoid bone above down to the sternum or clavicle or scapula = function to depress the hyoid and larynx
what innervates the suprahyoid and infrahyoid muscles
the anterior rami of cervical nerves
at what cervical level does the common carotid bifurcate
C3/4 - upper border of thyroid cartilage
what are the 6 branches of the external carotid artery
- superior thyroid artery (ant)
- lingual artery (ant)
- facial artery (ant)
- posterior auricular artery (post)
- occipital artery (post)
- ascending pharyngeal artery (deep)
internal jugular vein… - is it medial or lateral to the external carotid artery in the carotid sheath?
lateral
at what cervical level is the isthmus
runs anterior to tracheal cartilages 2, 3 and 4
is the thyroid gland anterior or deep to the strap muscles
deep
what clinical presentations can goitre cause
- respiratory obstruction
- dysphagia
- hoarse voice
- venous distention
explain the arterial supply of the thyroid
paired superior thyroid arteries and paired inferior thyroid arteries (single thyroid ima artery in 10% of people)
what are the origins of the superior and inferior thyroid arteries
superior - 1st branch of the external carotid artery
inferior - branch of subclavian artery
explain the venous drainage of the thyroid
superior, middle and inferior thyroid veins
the foramen caecum on the tongue marks..
the site of origin of the thyroid gland
what is accessory thyroid tissue
can have nodules anywhere along the migration path of the thyroid gland
what are the main branches of the subclavian artery in the neck
vetebral artery
thyrocervical trunk
which nerve roots form the cervical plexus
C1-4
lymph drainage of the neck
superficial cervical nodes
deep cervical nodes
4 nerves of the anterior triangle
CNIX, CNX, CNXI, (through jugular foramen) and CNXII (Through hypoglossal canal)
how can you tell which nerve is which in the anterior triangle
CNIX - passes forwards after giving off a branch to the carotid sinus
CNX - descends in the carotid sheath
CNXI - heads backwards
CNXII - passes forwards between carotid artery and jugular vein
if the hypoglossal nerve is damaged, which way does the tongue deviate
towards the affected side
what columns of the vagus nerve innervate the neck
somatic sensory - mucous membrane of the larynx
branchial motor - muscles of pharynx, larynx and soft palate
what is the ligament called between the atlas and the occipital bone
posterior atlnato-occipital membrane
what are the ligaments between the axis and the occipital bone
- membrana tectoria
- anterior atlanto-occipital membrane
what is the posterior ligament of the cervical spine
ligamentum nucahe
