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Anatomy > Neck 4-6 > Flashcards

Neck 4-6 Flashcards

1
Q

Cervical Nerves of Neck

A
  • cervical plexus: anterior rami of C1-C4
  • Posterior rami: C2–C5 -> innervate intrinsic (deep) back muscles + skin (dermatomes)
  • greater occipital nerve – back of scalp
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2
Q

Cranial Nerves of neck

A
  • CN V (Trigeminal): mylohyoid, anterior digastric
  • CN VII (Facial): facial muscles, platysma, posterior digastric, stylohyoid
  • CN IX (Glossopharyngeal): carotid body + sinus
  • CN X (Vagus): branches supply larynx + pharynx
  • CN XII (Hypoglossal): passes thru/over carotid -> oral cavity + tongue
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3
Q

Damage in Post/Ant Root/Rami

A
  • Post root - Lose sensory in body wall/skin (dermatomes) = numbness
  • Ant root - Lose motor = muscles weakness
  • Post ramus (GSA + GSE) - Lose sensory + motor – muscle weakness, dermatome affected
  • Ant ramus - Lose sensory + motor in the antero-lateral parts of trunk and limbs – muscles weak, loss of sensation
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4
Q

Spinal Nerves

A
  • ant rami - has GSE (motor fibers to skeletal muscle) in all 31 levels
  • GVE = T1-L2
  • ant + post rami mixed, contain all - GSA, GSE, GVA, GVE
  • gray rami = postgang symp, unmyelinated neurons
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5
Q

Loops/interconnections btwn C1-C2, C2-C3, etc. of cervical plexus

A
  • C1 axons go down, join axons from C2
  • overlap – any of nerves has more than 1 spinal level
  • effects of damage (lesion) at C1 minimized
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6
Q

Sensory nerves of cervical plexus

A
  • 4 cutaneous nerves = lesser occipital, greater auricular, transverse cervical, supraclavicular nerve -> innervate skin
  • Proprioceptive axons = subtrapezial plexus (follows spinal accesory to traps) -> tell brain position/status of trapezius
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7
Q

Motor Nerves of cervical plexus

A
  • innervate skeletal msucles
  • derived from ansa cervicalis - has axons from C1-3 (innervates strap muscles), hitchhikes with CN XII
  • C1 -> thyrohyoid
  • phrenic nerve (C3-C5) - ant scalene muscle
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8
Q

Nerve Point

A
  • on post SCM border, middle 1/3
  • 4 cutaneous nerves (C1-4 of cervical plexus) go from behind muscle to their locations
  • Transverse cervical goes thru platysma (post to ant) but doesn’t innervate it -> facial nerve
  • numb all nerves w/one shot of anesthesia
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9
Q

Scalene Triangle + Brachial Plexus

A
  • TCA = front to back; TCN = back to front
  • Phrenic nerve + accessory phrenic nerve = on top of ant. Scalene.
  • brachial plexus + subclavian artery go thru scalene triangle
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10
Q

Superior laryngeal nerve

A
  • in neck above digastric muscles
  • divides into ext + int laryngeal (one inside larynx, one outside)
  • both branches + recurrent laryngeal innervate larynx
  • int laryngeal also innervates root of tongue, epiglottis
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11
Q

Axon Types of CN X (Vagus)

A
  • pregangs in brainstem, postgangs in organ wall (larynx, esophagus, trachea - very short)
  • SVE = motor [skeletal muscle]
  • GVE = parasympathetic
  • SVA = taste
  • GVA = visceral afferent - return to brain, monitor viscera + mucosa
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12
Q

Recurrent/Inferior Laryngeal

A
  • goes under subclavian art (on right) or under aortic branch (on left) and gets picked back up
  • At trachea, have same relationship
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13
Q

3 Neurovascular Pairs of Larynx

A
  • Superior Laryngeal artery + Internal branch of superior laryngeal nerve
  • Superior thyroid artery + external branch of superior laryngeal nerve
  • Inferior laryngeal artery + Recurrent Laryngeal nerve
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14
Q

Lesions of Vagus Nerve

A 
brain stem lesion (hemorrhage, neoplasm)
skull base tumors
carotid/thyroid surgery 
aortic aneurysm
bronchial carcinoma
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15
Q

Cervical Symp Chain Patterns

A
  • T1- T4 IML -> white ramus -> symp chain -> go up chain -> postgang axons leave chain -> airway (esophagus, pharynx) + head (lacrimal glands, etc.)
  • postgangs also leave via gray rami at every spinal level, go to ant + post rami -> skin, etc.
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16
Q

Parasymp vs Symp

A
  • parasymp from CN X (Vagus), specific -> stay in body cavities, don’t innervate skin
  • symp go everywhere -> all cutaneous sensory nerves, glands
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17
Q

Cervical Symp Chain

A
  • symp chain from skull base to coccyx, btwn carotid sheath + prevertebral fascia
  • thorax symp ganglion at every thorax level - beads on string, but cervical chain pregangs from T1-T4
  • embryologically same in neck -> 3-4 ganglia in neck for 8 nerves
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18
Q

Cervical Symp Ganglia

A
  • Superior cervical ganglia (mega ganglia) - C1-C4
  • middle ganglia - C5-C6
  • Inferior Cervical - C7-C8
  • Cervicothoracic (stellate) - C8-T1 (spinal nerve lvls, not spinal cord
  • sometimes vertebral gang on vertebral art
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19
Q

Carotid Nerves

A
  • internal + external carotid nerves follow BVs to head for symp innervation (hitchhiking, facial nerve does same)
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20
Q

Laryngopharyngeal branches

A

come off of ganglia

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21
Q

Cervical Symp Cardiac Nerves

A
  • down neck -> chest cavity -> heart (multiple nerves)

- due to dvlpt -> heart started in front of head, w/growth heart descends w/nerves

22
Q

Lesion of Cervical Symp Trunk

A
  • lose control to sweat glands – skin dries
  • lose vascular tone – vessels dilated = flushing (Red) in skin on neck and face
  • affects on eyelid + pupils
  • Horner’s syndrome
23
Q

Lesser Occipital Nerve

A

GSA (sensory to skin)
GVE (motor to sweat glands, blood vessels)
GVA

24
Q

Inferior root of ansa cervicalis

A

Motor – innervating skeletal muscle (omohyoid muscle)
GSE + GSA - muscle
GVE + GVA – blood vessels

25
Q

Neck Viscer

A
  • Pharynx (behind nasal + oral cavity) - nasopharynx, oropharynx, laryngopharynx (guards entrance to esophagus + pharynx)
  • esophagus
  • larynx
  • trachea
  • thyroid + parathyroid glands
26
Q

Esophagus cervical portion

A
  • upper 1/3 = skeletal muscle, middle 1/3 = mixed, lower 1/3 = smooth muscle
  • innervated by vagus nerve
27
Q

Laryngeal Cartilages

A
  • Hyoid bone – anchors, support laryngeal structures
  • Adam’s apple – thyroid cartilage, C shaped, incomplete in back
  • below = crycoid cartilage = complete ring – thin in front, tall in back, below it are C shaped rings
  • Arytenoid cartilage – pyramidal shaped, processes extending forward and back for muscle attachments
  • Epiglottis
28
Q

Laryngeal Cartilages Articulations

A
  • articulations btwn cartilage -> form synovial joints w/each other
  • Thyroid cartilage articulates w/facet on cricoid cartilage, allows thyroid cartilage to rock back and forth.
  • Arytenoid cartilage also articulate w/cricoid cartilage – allows them to swivel around + adduct (pull together)
29
Q

Laryngeal Membranes - thyrohyoid membrane

A
  • dense fibroCT that connects hyoid bone to thyroid cartilage -> whenever hyoid bone moves, rest of larynx does also
  • has opening/aperature transmitting travelling pair btwn sup laryngeal art + int laryngeal nerve
  • has diff thickenings, like in front
30
Q

Laryngopharynx

A
  • Larynginelal inlet – spoon shaped part of epiglottis, rest is aryepiglottic fold -> connects arytenoid cartilages up to epiglottic cartilage.
  • Vestibule (space inside)
  • On either side = piriform recess.
  • in swallow, food goes over piriform recess on sides, then to esophagus (things can get stuck there, need to be pulled out - fishbone)
31
Q

Laryngeal Spaces + Folds

A
  • vestibule (synonymous w/laryngeal introitus), vestibular fold on top
  • vocal fold on bottom (vocal cord)
  • btwn both folds = laryngeal ventricle
  • Rima vestibuli + rima glottis = space btwn folds from left to right
32
Q

Laryngeal membranes - quadrangular mem + cricothyroid lig

A
  • Folds = mucosa + CT bands
  • Quadrangular membrane = CT band btwn epiglottis, end inferiorly as vestibular ligament, gives support
    Cricothyroid ligament = ends superiorly as vocal lig/cord (skeleton of vocal fold)
33
Q

Infections of Laryngeal Saccule (Ventricle)

A
  • infections in laryngeal ventricle spread along sup recess. - hole in thyroid mem -> infection moves out to neck, deep to pretracheal fascia (spread in tube of pretracheal and buccopharyngeal fascia)
  • Laryngocoele = inflated, enlarged saccule
34
Q

Larynx attachment to skeleton

A
  • Stylohyoid (muscle + lig), digastric
  • Geniohyoid and mylohyoid
  • Infrahyoid muscles
35
Q

Cricothyroid Muscle

A
  • on outside, innervated by external laryngeal nerve (all others innervated by recurrent laryngeal nerve).
  • rocks thyroid cartilage fwd, tightens vocal liga and vocal cord (voice goes higher).
36
Q

Thyroarytenoid

A
  • attaches to thyroid cartilage, goes back to arytenoid.
  • Pulls arytenoid + thyroid closer together
  • Creates less tension in vocal ligs = Voice goes deep
37
Q

Vocalis Muscle

A

smaller, precise changes on vocal ligs

38
Q

Lateral Cricoarytenoid + Posterior Cricoarytenoid

A
  • Antagonistic muscles, but both go from cricoid cartilage to arytenoid cartilage.
  • Change width/size of rima glottis.
  • Posterior cricoarytenoid opens rima glottis by pulling muscles to midline
  • Lateral - pulls muscles forwards, closes rima glottis
  • Both nnervated by recurrent lar. n.
39
Q

Transverse Arytenoid
Oblique Arytenoid
Aryepiglotticus

A
  • all assist in closing rima glottis
  • Transverse arytenoid pulls arytenoids together, closing rima glottis more.
  • Aryepiglotticus – transverse + more oblique, doing same thing – pulling vocal folds together “trap door” -> Helps to close.
40
Q

Larynx Innvervation

A
  • internal superior laryngeal nerve -> Iarynx glands (mucosa)
  • external superior laryngeal nerve -> mainly motor
  • Recurrent laryngeal nerve – muscles/mucosa, epithelium
  • vocal folds = dividing line btwn internal + recurrent
41
Q

Cough reflex

A
  • If dental loop above fold -> internal laryngeal nerve

- if below/tumor on vocal cord -> afferent response from recurrent laryngeal nerve

42
Q

Larynx Vasculature

A
  • Superior laryngeal art + branches from inferior thyroid
  • Supply from subclavian + superior thyroid art
  • Return blood in venous system thru thyroid veins (superior thyroid vein, sup laryngeal vein, middle thyroid vein)
43
Q

Lymph drain of larynx

A
  • Above vocal cords - Supraglottic – upper deep cervical nodes (jugulodigastric – C2)
  • Below vocal cords - Infraglottic – pretracheal, lower deep cervical (Juguloomohyoid – C4)
  • Laryngeal tumor – dictates what nodes to affect – cord + below = deeper nodes; higher = superior deep nodes
44
Q

Thyroid gland

A
  • doesnt completely surround larynx/trachea (C-shape from above)
  • has isthmus = narrow band in front w/R+L lobes
  • 10-20% have pyramidal lobe (in middle)
  • endocrine gland - secretes hormones into blood -> dense vasculature (significant arts + veins)
45
Q

Parathryoid gland

A
  • back of lateral lobes of thyroid glands, usually 4, but range from 2-7
  • position variable -> not always in thyroid gland, stuck in fascia outside gland)
  • position imp for determining tumor spread
  • **variable in number + location
46
Q

Vasculature of thyroid + PTH

A
  • 10% of ppl have thyroid ima artery – extra vessel in midline, comes from below from thorax
  • crosses superior aperture, goes to gland.
  • in tracheostomy, if you cut this, will bleed a lot b/c its a branch off aorta (paramital wont be supplied)
  • Venous drainage = superior/middle/inferior thyroid veins -> 1 or 2 vessels that go to either branch of cephalic, 5-6 vessels draining.
  • Very vascularized**
47
Q

IV disc between CIII & CIV

A
  • same horizontal plane as bifurcation of common carotid art into internal/external carotid arts
  • approx at upper margin of thyroid cartilage)
48
Q

Vertebral level VCI

A
  • transition from pharynx to esophagus and larynx to trachea
  • marks superior ends of esophagus + trachea
  • approx. at level of inferior margin of cricoid cartilage.
49
Q

Anterior triangles

A
  • base each triangle = inf margin of mandible
  • anterior margin =neck midline
  • posterior margin = anterior border of SCM
  • apex points inferiorly, at suprasternal notch
  • triangles assoc w/airway, digestive tract, nerves, vessels btwn thorax + head – also assoc. w/thyroid + PTH
50
Q

Posterior triangles

A
  • Base = middle 1/3 of clavicle
  • Medial margin = posterior border of SCM
  • Lateral margin = anterior border of traps
  • Apex points superiorly, immediately posteroinferior to MP
  • Posterior triangles assoc w/nerves + vessels that pass in/out of upper limbs.

Anatomy (10 decks)

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