Neck Flashcards
deep cervical fascia of neck
investing layer, pretracheal layer, prevertebral layer, carotid sheath, buccopharyngeal, retropharyngral space
Superficial fascia of neck
cervical subcutaneous tissue
what is the purpose of fascia of neck?
contain infection, abscess , pathology
what does the cervical subcutaneous tissue contain?
platysma muscle
what does the investing layer contain?
SCM & trapezius muscles
what does the pretracheal layer contain?
muscle: infrahyoid and suprahyoid muscles
visceral: larynx, trachea, pharynx
what does the prevertebral layer contain?
prevertebral muscles & scalenes
what does the carotid sheath contain?
common carotid a.
internal carotid a.
internal jugular v.
CN 10 vagus nerve
what is retropharyngeal space?
protective space essential for swallowing and potential space for swelling
area btwn prevertebral and pretracheal visceral fascia
what does buccopharyngeal fascia create?
retropharyngeal space
it is continuous with pretracheal fascia visceral portion
4 neck views radiologically
lateral
AP view
AP open mouth
R/L oblique
neural foramen is also called
intervetebral foramen
Describe the CN that supplies larynx
CN 10 vagus - 3 portions
- superior laryngeal nerve breaks into internal and external
- recurrent laryngeal nerve continues down and loops under (R subclavian artery) or (L aortic arch)
- inferior laryngeal nerve is a continuation of the recurrent loop and supplies all muscles of larynx except cricoid thyroid
describe top middle bottom of esophagus
top 1/3 striated voluntary muscle
middle mixed
bottom 1/3 smooth involuntary muscle
Most common CN injury during surgery
CN 11
Most common birth defect
tracheo-esophageal fistula with esophageal atresia (TEF)
bottom of esophagus ends in pouch and superior end ends in trachea
define dysphagia
problems swallowing
most common complaint of esophageal cancer
dysphagia
most common diagnostic tool (referring to esophageal issues)
esophagoscopy
Most common area of of neck for injury
zone II cricoid cartilage-mandible
CN 5 supplies
mylohyoid and digastric anterior
CN 7 supplies
platysma, stylohyoid, digastric posterior
CN 11 supplies
SCM, trapezius
Ansa cervicalis supplies
sternohyoid, sternothryoid, omohyoid
CN 12 supplies
thyrohyoid, geniohyoid
CN 10 supplies
larynx
structures of posterior neck
upper trap
sub occipital region
c7 spinous process
structures of lateral neck
upper trap scm (sternal/clavicular attachments) external jugular vein supraclavicular fossa subclavian artery
structures of anterior neck
scm hyoid bone laryngeal prominence thyroid cartilage thyroid notch cricoid cartilage thyroid gland (and isthmus) jugular notch/suprasternal notch
keystone of the neck is called the
hyoid bone
cervical spine is evaluated as “__” exam vs “__” exam
upper back / neck
name and movement of C1
atlas- NODDING “YES”
Name and movement of C2
axis SHAKING head NO
landmarks of hyoid
greater horn/cornu
lesserhorn cornu
no articulation with other bones *
special landmark of c1 and c2
c1 has posterior arch
c2 has dens
landmarks of AP view radiograpy
spinous process
tracheal shadow
landmarks of lateral view radiography
c1-c7, posterior arch, c2-c7 spinous processes
landmarks of ap open mouth view radiography
dens
body of c2
landmark of oblique view radiography
neural foramen/intervertebral foramen
superficial muscles of neck
platysma, scm, upper trapezius
infrahyoid muscles of neck
sternohyoid, sternothyroid, thyrohyoid, omohyoid (superior and inferior)
suprahyoid muscles of neck
mylohyoid, geniohyoid, stylohyoid, digastric (anterior and posterior)
prevertebral muscles of the neck
scalenes, splenius capitis, levator scapula, longus colli/capitis, rectus capitis anterior and lateralis
Platysma:
attachment
action
innervation
face muscle in cutaneous layer of skin
facial expressions
CN 7 facial nerve
SCM
attachment
action
innervation
mastoid process to clavicle and sternum
unilateral contraction and bilateral contraction (tilt and look up, chin into chest, Egyptian movement)
CN 11
Upper Trap
attachment
action
innervation
n/a
similar to SCM move shoulders up and down and around (tilt head, Egyptian)
CN 11
Sternohyoid
attachment
action
innervation
“strap muscles”-very flat
sternum to hyoid and is most superficial
depress hyoid
ansa cervicalis c1-c3 loop of nerve
Sternothyroid
attachment
action
innervation
sternum to thyroid
depress hyoid
ansa cervicalis
Thyrohyoid
attachment
action
innervation
thyroid cartilage to hyoid
depress hyoid
CN 12 c1 hypoglossal nerve
Omohyoid
attachment
action
innervation
scapula to hyoid superior/inferior bellies
depress hyoid
ansa cervicalis
Mylohyoid
attachment
action
innervation
mandible to hyoid (floor)
elevate hyoid
CN 5
Geniohyoid
attachment
action
innervation
mandible to hyoid sits on myohyoid in 2 strips
elevates hyoid
CN 12
Stylohyoid
attachment
action
innervation
styloid process to hyoid bone- splits over digastric
elevates hyoid
CN 7
Digastric
attachment
action
innervation
mastoid process to hyoid (slings here) to mandible
elevates hyoid
anterior belly = CN 5 posterior belly = CN 7
attachment of scalenes: anterior middle posterior action of scalenes: anterior middle posterior
1st rib
1st rib
2nd rib
flexes head
flexes head laterally
flexes head laterally
describe Brachial plexus and Phrenic nerve
brachial plexus is a network of nerves comes thru anterior and middle scalenes
phrenic nerve supplies diaphragm comes thru anterior and middle scalenes
splenius capitis - ID deferred until module 4
V in back of neck
levator scapula deferred until module 4
floor of posterior triangle
longus colli/capitis
attachment
action
vertebrae to vertebrae
deep neck flex
rectus capitis ID
anterior and lateralis
location and function of thyroid gland
deep to infrahyoid muscles - growth, metabolism and calcium homeostasis
function and location of parathyroid gland
calcium/phosphate regulation
2 pairs = 4 on posterior thyroid lobes
palatopharyngeal and constrictor pharyngeals - ID ?
ID?
what are the endocrine viscera of neck?
thyroid and parathyroid
what are the alimentary viscera of neck?
pharynx and esophagus
what are the muscles of the pharynx
constrictor pharyngeal superior, middle, inferior
palatopharyngeal
nasopharynx location
superior to soft palate
oropharynx location
soft palate to epiglottis
Laryngopharynx location
epiglottis to cricoid cartilage
structures of pharynx
nasopharynx, oropharynx, laryngropharynx
esophagus, epiglottis, uvula, nasal septum
structures of respiratory viscera
larynx
trachea
structures of the larynx
thyroid cartilage lamina thyroid notch laryngeal prominence cricoid cartilage thyroid membrane epiglottis
Branches of aortic arch
brachiocephalic trunk
left common carotid
left subclavian
branches of common carotid artery
external common carotid
internal common carotid
4 of 8 branches of the external common carotid artery
superior thyroid
facial artery
maxillary artery
superficial temporal
3 of 4 branches of subclavian srtery
vertebral artery
thyrocervical trunk
costocervical trunk
structures involved in venous circulation of neck
internal jugular vein
external jugular vein
anterior jugular vein
subclavian vein
lymph node pathway of head/neck
drain into junction IJV and brachiocephalic vein (R - right lymphatic duct) (L - thoracic duct)
what are the 2 nerve plexuses of cervical region?
cervical plexus (c1-c4) brachial plexus (c5-t1)
3 subdivisions of the cervical plexus
cutaneous branches
phrenic nerve
ansa cervicalis
4 cutaneous branches of cervical plexus
lesser occipital
greater auricular
transverse cervical
suprascapular
2 motor branches of cervical plexus
phrenic nerve (c3-c5) ansa cervicalis
ansa cervicalis supplies..
directly
indirectly
omohyoid, sternohyoid, sternothyroid
thyrohyoid
which CN descend in the neck?
CN 10 vagus
CN 11 accessory
CN 12 hypoglossal
Identify pathway to get to internal skull/CNS
internal carotid artery
identify pathway to external skull
external carotid artery ->superficial temporal
identify structures in carotid sheath
IJV ICA CCA vagus CN 10
what are the branches of the aortic arch?
brachiocephalic trunk
L common carotid A
L subclavian A
we find _ and _ at the bifurcation of CCA into internal and external carotid arteries
carotid sinus (baroreceptors) (IJV) carotid body (chemoreceptors)
describe vertebral artery
enters skull at foramen magnum where it loops and meets with ICA to form basal artery at the circle of willis (ICA supplies anterior and Vertebral A supplies posterior)
branches of thyrocervical trunk
inferior thyroid
ascending cervical
transverse cervical
suprascapular
branches of costocervical trunk
deep cervical artery
what drains into brachiocephalic vein?
Lsubclavian and R IJV
what drains into subclavian vein?
AJV and EJV
what drains into IJV?
face and internal skull/cns veins
what drains into AJV?
facial and neck veins
what drains into EJV
facial and scalp veins
what do the brachiocephalic trunks drain into?
Superior vena cava
where do lymphnodes from head and neck drain into?
R- right lymphatic duct
L- thoracic duct
^ these drain into the junction of the IJV and brachiocephalic vein
list the major lymph nodes of the neck
occipital post auricular pre auricular /parotid jugulodigastric submandibular submental lateral superficial cervical anterior superficial cervical lateral deep cervical anterior deep cervical supraclavicular/transverse cervical
identify 2 nerve plexuses of neck
cervical nerves (c1-4) brachial plexus (c5-t1)
where do we see the brachial plexus exit?
btwn anterior and middle scalenes
brachial plexus supplies…
motor/sensory UE (idk what ue is)
phrenic nerve exits
anterior to anterior scalenes
phrenic nerve supplies
diaphragm
phrenic nerve C#-c#
c3 c4 c5 to survive
what are 3 divisions of the cervical plexus?
cutaneous, phrenic, ansa cervicalis
what are 4 branches of cutaneous
lesser occipital
greater auricular
transverse cervical
suprascapular
what does the cutaneous branch of cervical plexus supply?
skin of neck/lower head
identify two roots of ansa cervicalis
inferior and superior
how many muscles does the ansa cervicalis supply - directly? indirectly? name them
direct: omohyoid (superior and inferior), sternohyoid, sternothyroid (3)
indirect: thyrohyoid
ID cranial nerves in neck
vagus CN10
accessory CN11
hypoglossal CN12
arterial circulation starting with aorta (after first branch just do R side)
aorta-brachiocephalic trunk R (or L CCA and L subclavian)-R subclavian and R CCA:
Subclavian-costocervical-deep cervical
Subclavian-thyrocervical-supra scapular cervical or transverse cervical or ascending cervical or inferior thyroid
subclavin-vertebral A
CCA- internal or external carotid artery internal-goes to cns ECA: superior thyroid ECA:facial ECA:maxillary ECA:superficial temporal
venous circulation of neck (R side until u get to last two branches)
face&scalp->EJV-
+–subclavin
face&neck->AJV-
\+---> R brachiocephalic trunk + L b.trunk--> face&internalskull/cns->IJV
-->superior vena cava!
which vein is major drainage and where is it located?
under SCM is the IJV
