neck Flashcards

1
Q

what muscle separates the anterior and posterior triangles of the neck

A

sternocleidomastoid

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2
Q

boundaries of the anterior triangle:
anterior border
posterior border
base

A

midline of neck
anterior border of sternocleidomastoid
mandible

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3
Q

name the divisions of the anterior triangle

A

submandibular
submental
carotid
muscular

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4
Q

what is within the submandibular division of the anterior triangle

A
submandibular salivary gland
lymph nodes
facial artery and vein
carotid sheath
hypoglossal nerve
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5
Q

what is within the submental division of the anterior triangle

A

submental lymph nodes

beginning of the anterior jugular vein

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6
Q

what is within the carotid division of the anterior triangle

A
carotid sheath
branches of external carotid artery
internal jugular vein
hypoglossal nerve
accessory nerve
vagus nerve
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7
Q

what is within the muscular division of the anterior triangle

A

sternohyoid + sternothyroid form floor

beneath thyroid gland, larynx, trachea and oesophagus

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8
Q

what are the different layers of fascia in the anterior neck

A

pre-tracheal layer (visceral) - covers trachea
pre-tracheal layer (muscular) - covers muscles surrounding the trachea
pre-vertebral layer
carotid sheath

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9
Q

what is the layer of fascia extending above the pectoral is major and clavicle to lateral neck onto the mandible

A

platysma

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10
Q

what innervates the platysma

A

facial nerve (CN VII)

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11
Q

location of the external jugular vein

A

anterior to the SCM in the posterior triangle

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12
Q

location of the internal jugular vein

A

posterior to the SCM in the anterior triangle

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13
Q

if the anterior jugular vein is present where is it located

A

midline

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14
Q

muscles of the anterior triangle of the neck

A

supra hyoid and infra hyoid muscles

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15
Q

role of supra hyoid muscles

A

raise hyoid bone and depress mandible

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16
Q

name the supra hyoid muscles (chin area)

A

mylohyoid
anterior and posterior digastric belly
stylohyoid
geniohyoid

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17
Q

name the infra hyoid muscles (neck area) and classify superficial and deep

A

superficial:
superior and inferior omohyoid belly
sternohyoid

deep:
thyrohyoid
sternothyroid

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18
Q

what nerves supply the supra hyoid muscles

A

mylohyoid + anterior digastric belly - mandibular division of trigeminal (CN V3)
stylohyoid + posterior digastric belly - facial nerve (CN VII)
geniohyoid - C1 (via hypoglossal CN XII)

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19
Q

role of the infra hyoid muscles

A

depress hyoid body

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20
Q

what nerves supply the infra hyoid muscles

A
ansa cervicalis(C1-C3)
thyrohyoid - C1 (via hypoglossal CN XII)
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21
Q

root value of the cervical plexus and type of innervation

A

anterior rami C1-C4

somatic motor and sensory (plus sympathetic)

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22
Q

position of the cervical plexus

A

joined into loops anterior to levator scapulae and scalenus medius
covered by pre-vertebral layer of deep cervical fascia

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23
Q

what does internal carotid supply

A

brain

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24
Q

contents of carotid sheath

A

internal jugular vein
common carotid artery
vagus nerve

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25
Q

what branches off the external carotid artery

A

superior thyroid artery
lingual artery
facial artery

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26
Q

branches of the subclavian artery

A

internal thoracic
vertebral artery
thyrocervical trunk

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27
Q

what branches off the thyrocervical trunk

A

supra scapular
transverse cervical
inferior thyroid

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28
Q

what cranial nerve is the vagus

A

CN X

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29
Q

location of the recurrent laryngeal branches (internal and external) of the vagus and what they supply

A

left around arch of aorta
right around subclavian
muscles of the larynx

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30
Q

vagus nerve supplies

A

parasympathetic innervation to thorax and abdomen

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31
Q

type of gland and role of thyroid gland

A

endocrine

regulates metabolic rate

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32
Q

features of the thyroid gland

A

2 lobes
isthmus
capsule

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33
Q

location of thyroid gland

A

lamina of thyroid cartilage down to 6th tracheal ring

isthmus over tracheal ring 2 or 3

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34
Q

arterial supply to the thyroid gland

A

inferior thyroid artery from the thyrocervical trunk on the subclavian
superior thyroid from the external carotid

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35
Q

nerve supply to the thyroid gland

A

recurrent laryngeal nerve of the vagus

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36
Q

venous drainage of the thyroid gland

A

superior thyroid and middle thyroid to the internal jugular and inferior thyroid to left brachiocephalic vein

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37
Q

location of submandibular gland

A

inferior to mylohyoid

part in floor of mouth (superior to mylohyoid)

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38
Q

features of submandibular gland

A

one duct opening between first and secondlower incisor

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39
Q

nerve supply to the submandibular gland

A

facial nerve (CN VII)

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40
Q

where does the thoracic duct drain into

A

near the origin of the internal jugular vein from the subclavian vein

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41
Q

boundaries of the posterior triangle
anterior
posterior
base

A

posterior sternocleidomastoid
anterior trapezius
clavicle

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42
Q

contents of the posterior triangle

A

external jugular vein
roots of the brachial plexus
accessory nerve (CN XI)
cervical and supraclavicular nodes

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43
Q

superficial nerves that emerge from the posterior triangle

A
lesser occipital (C2)
greater auricular C2-C3)
lateral supraclavicular (C3-C4)
medial supraclavicular (C3-C4)
transverse cervical (C2-C3)
intermediate supraclavicular (C3-C4)
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44
Q

veins that can be seen in the posterior triangle

A

superficial cervical

external jugular vein

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45
Q

cutaneous innervation to the head/lateral neck:
neck posterior to anterior
behind ear to below nose
top oh head posterior to anterior

A

posterior rami (C3-C5)
supraclavicular (C3-C4)
transverse cutaneous of neck (C2-C3)

lesser occipital
greater auricular
buccal mental
infra-orbital

greater occipital
supra-trochlear and supra-orbital

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46
Q

what branches off the external jugular vein

A

posterior auricular

retromandibular

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47
Q

what branches of the internal jugular vein

A

middle and superior thyroid
lingual
facial vein
pharyngeal plexus

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48
Q

what arteries cross the posterior triangle

A

thyrocervical trunk (at very anterior edge)
with branches -
transverse cervical
suprascapular artery (runs with nerve)

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49
Q

what nerve crosses obliquely over the anterior scalene muscle

A

phrenic nerve

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50
Q

what travels between the anterior and middle scalene muscles

A

brachial plexus

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51
Q

attachments of the sternocleidomastoid

A

mastoid process and superior nuchal line to
clavicular head - clavicle
sternal head - sternum

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52
Q

innervation of the sternocleidomastoid and trapezius:
motor
pain and proriception

A
spinal accessory nerve (CN XI)
cervical plexus (C2-C3)
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53
Q

actions of the sternocleidomastoid

A

lateral flexion and rotation
extension at atlanto-occipital joints
flexion of cervical vertebra (from supine)

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54
Q

attachments of the trapezius

A

superior nuchal line to scapular spine and to T12

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55
Q

actions of the trapezius:
ascending bit
transverse bit
descending bit

A

depress scapula
retract scapula
elevate scapula and rotate glenoid cavity

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56
Q

floor of the posterior triangle

A

omohyoid
splenius wapitis
levator scapula
scalenes

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57
Q

action and innervation of the splenius capitis

A

extend and rotate the neck

dorsal rami middle cervical

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58
Q

attachment of the levator scapulae

A

transverse process of atlas and axis and 3rd-4th cervical vertebrae to medial scapular border (superior angle and medial end of scapular spine)

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59
Q

innervation and action of elevator scapulae

A

direct C3-C5 via dorsal scapular nerve

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60
Q

scalenes innervation and action:
middle
anterior
posterior

A
C3-C7
C4-C7
C5-C7
flex neck (bilateral)
tilt head (unilateral)
elevate upper ribs
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61
Q

attachment of the scalenes

A
transverse process of:
C2-C7 (anterior) 
C3-C6 (middle)
C4-C6 (posterior)
to:
rib 1 behind subclavian artery (middle)
rib 1's scalene tubercle (anterior)
rib 2 (posterior)
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62
Q

order of posterior triangle neck muscles from superior to inferior

A
trapezius
splenius wapitis
levator scapulae
anterior scalene
middle scalene
posterior scalene
omohyoid
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63
Q

superficial and intermediate muscles of the sub occipital region and innervation

A

splenius cervicis
splenius capitis
semispinalis capitis
longissimus capitis

posterior rami C1-C6

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64
Q

attachment of splenius capitis

A

ligamentum nuchae and C7-T3 spinous process to occipital bone (superior nuchal) and mastoid process

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65
Q

attachments of splenius cervicis

A

T3-T6 spinous processes to C1-C2 transverse processes

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66
Q

action of the splenius capitis and cervicis

A

extend neck and head (bilateral)

flexes and rotates (unilateral)

67
Q

attachments of semispinalis capitis

A

C4-T7 transverse processes to occipital bone (between nuchal lines)

68
Q

attachments of longissimus capitis

A

T1-T3 plus C4-C7 transverse process to mastoid process

69
Q

action of semispinalis capitis

A

extend cervical spine
bends to same side
rotates to other

70
Q

action of longissimus capitis

A

extends head (both)
flexes to same side
rotates to same side

71
Q

the suboccipital muscles of the region and innervation

A

rectus capitis posterior minor
rectus capitis posterior major
obliquus capitis superior
obliquus capitis inferior

suboccipital nerve (posterior rami of C1)

72
Q

attachment of rectus capitis posterior minor and major

A

C1 posterior tubercle to inferior nuchal line

C2 spinous process to inferior nuchal line

73
Q

attachment of obliquus capitis superior and inferior

A

C1 transverse process to occipital bone (above inferior nuchal line)
C2 spinous process to C1 transverse process

74
Q

action of rectus capitis posterior minor and major

A

extend head and rotate to same side

75
Q

actions of obliquus capitis superior and inferior

A

superior - extend head, tilt head to same side, rotate to opposite
inferior - extend head, rotate to same side

76
Q

dorsal rami of the suboccipital region

A

subocciptial nerve (C1)
greater occipital nerve (C2)
third occipital nerve (C3)

77
Q

what arteries do the subclavian and external carotid give rise to in the sub occipital region

A

vertebral -> basilar

occipital

78
Q

what branches of the deep cervical vein and what does it drain into

A

occipital vein runs off it with the sub occipital nerve

drains into vertebral vein at transverse process of C7

79
Q

what are the vertebral veins

A

small vein s of internal vertebral plexuses which form vessel through foramen transversarsium (atlas) to C6
here it leaves foramen to join braciocephalic vein

80
Q

what actions occur a the base of the skull

A

extension
flexion
lateral flexion
axial rotation

81
Q

what type of joint is between the atlas and axis

A

synovial pivot

82
Q

type of joint between intervertebral discs

A

2o cartilagenous

83
Q

type of joints at IV discs articular surface

A

plane synovial

84
Q

at what point does the pharynx join the oesophagus

A

C6

85
Q

linings of the pharynx

A

mucous membrane (nasal, mouth, larynx, tympanic cavity)
ciliated columnar epithelium (superiorly)
stratified squamous epithelium (inferiorly)
fibrous layer under (base of skull to submucous coat oesophagus
muscular layer under fibrous layer - inner circular and outer longitudinal muscle

86
Q

divisions of the pharynx and location

A

nasopharynx - behind nasal cavity
oropharynx - soft palate of epiglottis
laryngopharynx - behind larynx and laryngeal opening

87
Q
boundaries of the nasopharynx:
roof
floor
anterior
posterior
lateral
A

roof - sphenoid, occipital and pharyngeal tonsil
floor - soft palate - pharyngeal isthmus
anterior - nasal passages
posterior - roof and CI level
lateral - auditory tube and salpingopharyngeal fold

88
Q
boundaries of the oropharynx:
roof
floor
anterior
posterior
lateral
A

roof - soft palate
floor - posterior 1/3 tongue, lingual tonsil, glossoepiglottic folds
anterior - mouth
posterior - C2-C3 level
lateral - platoglossal and palatopharyngeal folds with palatine tonsil

89
Q

boundaries of laryngopharynx:
anterior
posterior
lateral

A

anterior - larynx
posterior - C3-C6 vertebrae
lateral - thyroid cartilage, aryepiglottic fold and thyrohyoid membrane

90
Q

attachment of superior constrictor

A

posterior medial pterygoid plate, hamulus, pterygomandibular ligament, mandible, side of tongue to pharyngeal tubercle of occipital bone, fibrous raphe and middle constrictor

91
Q

action of constrictors

A

superior - (upper fibres - pull posterior pharyngeal wall anteriorly to close off nasopharynx) and propel food to middle constrictor
middle - propel food towards inferior constrictor
inferior - propel food towards oesophagus

92
Q

attachment of middle constrictor

A

lower stylohyoid ligament to greater and lesser horn of hyoid bone to fibrous raphe (superior and inferior constrictor)

93
Q

attachment of inferior constrictor

A

lamina of thyroid cartilage to fibrous raphe, middle constrictor and oesophagus

94
Q

innervation of constrictors

*inferior constrictor

A
pharyngeal plexus (vagus)
inferior constrictor circopharyngeus supplied by external laryngeal nerve (sphincter like)
95
Q

longitudinal muscles of pharynx and action

A

salpingopharyngeus
palatopharyngeus
stylopharyngeus

elevate pharynx
*stylopharyngeus also elevates larynx

96
Q

attachment of salpingopharyngeus

A

cartilage of auditory tube to blend with palatopharyngeus

97
Q

attachment of palatopharyngeus

A

hard palate and palatine aponeurosis to lamina of thyroid cartilage

98
Q

attachment of stylopharyngeus

A

base of styloid process of temporal bone to posterior border of thyroid cartilage

99
Q

innervation of longitudinal muscles of pharynx

A
pharyngeal plexus (vagus CN X)
*stylopharyngeus is only innervated by glossopharyngeal nerve (CN IX)
100
Q

name the pre-vertebral anterior muscles

A

rectus capitis anterior
rectus capitis lateralis
longus capitis
longus colli

101
Q

innervation of the rectus capitis anterior and rectus capitis lateralis

A

ventral rami of cervical nerves C1-C2

102
Q

attachment of rectus capitis anterior and rectus capitis lateralis

A

transverse process of atlas (anterior surface and root) to occipital bone
transverse process of atlas to occipital bone (crossed by internal jugular vein)

103
Q

action of rectus capitis anterior

A

flex atlanto-occipital joint

104
Q

action of rectus capitis lateralis

A

lateral flexion of head

105
Q

attachment of longus capitis

A

transverse process of cervical vertebrae C3-C6 (anterior tubercles) to occipital bone

106
Q

attachment of longus coli:
inferior oblique
superior oblique
vertical

A

general - atlas to T3
inferior oblique - T2/T3 to anterior tubercle of cervical transverse processes C5-C6
superior oblique - anterior tubercle of C3-C5 to atlantal anterior tubercle
vertical - anterior T1-T3 to C4-C6

107
Q

action of longus capitis and longus coli

A

flex head

flex neck *inferior oblique - rotation to opposite side via inferior oblique

108
Q

innervation of longus capitis and longus coli

A

ventral rami of cervical spinal nerves:
C1-C3
C2-C6

109
Q

fascia surrounding auditory tube

A

pharyngobasilar fascia

110
Q

nerve running alongside stylopharyngeus

A

glossopharyngeal nerve

111
Q

pierces through the fascia between hyoid bone and thyroid cartilage

A

superior laryngeal VAN

112
Q

passes under the constrictor muscles

A

recurrent laryngeal nerve

113
Q

what supplies the pharyngeal muscles

A

pharyngeal branches of the inferior thyroid

114
Q

branches of the external carotid artery

A

superior thyroid artery
lingual artery
facial artery

ascending pharyngeal
superficial temporal
maxillary artery

115
Q

branches of the internal jugular vein

A

facial
retromandibular
superficial temporal

anastomose as pterygoid plexus

116
Q

lymph nodes and drainage of the neck (superior to inferior)

A

retropharyngeal nodes
jugulogastric node
infra hyoid nodes (jugular drunk reaches to here and inserts at the base of the external jugular vein)
paratracheal nodes

117
Q

pharyngeal plexus includes which nerves

A

glossopharyngeal CN IX
vagus CN X
sympathetic

118
Q

vagus nerve branches in pharyngeal plexus (superior to inferior)

A

inferior ganglion
pharyngeal branch
superior laryngeal branch -> external laryngeal branch

119
Q

what division of the trigeminal nerve has a pharyngeal branch

A

mandibular division (CN V2) has pharyngeal branch

120
Q

expansion of the sympathetic ganglia

A

from base of skull to join thoracic
chain forms behind internal and common carotid arteries
medial to vagus nerve

121
Q

fascia covering the sympathetic ganglia

A

deep fascia between carotid sheath and fascia over surface of longus capitis and longus colli

122
Q

superior cervical ganglia gives which branches

A

internal carotid nerve -> internal carotid plexus (in carotid canal)
plexus of common and external carotid arteries
cranial nerve branches CN IX, X, XII
superior cardiac plexus in thorax

123
Q

superior cervical ganglia location and has grey rami communicantes to which ventral rami

A

immediately below skull

C1-C4

124
Q

middle cervical ganglia gives which branches to where

A

thyroid branches to gland
middle cardiac branch to cardiac plexus

from middle to inferior cervical ganglia there are usually 2 or more nerve bundles:
anterior bundle in front of 1st part subclavian and then behind = ansa subclavia

125
Q

middle cervical ganglia location and has grey rami communicantes to which ventral rami

A

at level of thyroid cartilage - related to loop of inferior thyroid artery
C5-C6

126
Q

inferior cervical ganglia gives which branches to where

A

arterial branches to subclavian and vertebral arteries

inferior cardiac braches to cardiac plexus

127
Q

middle cervical ganglia location and has grey rami communicantes to which ventral rami

A

sometimes fused with 1st thoracic ganglion to form stellate ganglion
behind vertebral artery between transverse process of C7 and head of 1st rib

128
Q

function and location of the larynx

A

voice production

between thyroid and cricoid cartilage

129
Q

formed of what and what joints connect the larynx

A

hyaline cartilage

plane synovial joints

130
Q

what attaches at the oblique line of the thyroid cartilage

A

sternothyroid
thyrohyoid
inferior constrictor

131
Q

what articulates with the facet on the inferior horn of the thyroid cartilage

A

cricoid

132
Q

what facets are present on the cricoid cartilage

A

facet for arytenoid cartilage

facet for inferior horn of thyroid

133
Q

what are the processes of the arytenoid cartilages associated with:
muscular process
vocal process

A

muscular - posterior and lateral cricoarytenoid

vocal - vocal fold

134
Q

composition of the epiglottis and attachments:
anterior connections
lateral connections

A

elastic cartilage
anteriorly - body of hyoid bone and post laryngeal prominence of thyroid cartilage
laterally - arytenoid cartilages via pharyngoepiglottic folds

135
Q

what does the mucous membrane covering on the interior epiglottis form

A

median glossoepiglottic fold

lateral pharyngoepiglottic fold

136
Q

purpose of the corniculates and cuneiforms

A

corniculates attach aryepiglottic folds to arytenoid cartilage
cuneiforms are within the aryepiglottic fold to support them

137
Q

ligament from hyoid bone to superior thyroid horn

A

lateral thyroid ligament

138
Q

ligament from hyoid bone to laryngeal prominence

A

median thyroid ligament

139
Q

ligament from base of thyroid cartilage to arch of cricoid

A

median cricothyroid ligament

140
Q

ligament from base of arch of cricoid to tracheal cartilage ring

A

cricotracheal ligament

141
Q

quadrangular membrane attachments

A

arytenoid cartilages to epiglottis

142
Q

what is the vestibular ligament/ fold

A

free edge of the quadrangular membrane (false vocal fold)

143
Q

attachments of the cricothyroid membrane

A

cricoid thyroid and arytenoid

144
Q

what forms the vocal ligament/ fold

A

free upper border of cricothyroid membrane

145
Q

role of vocal folds and movement

A

change air flow through the larynx to produce sound only - phonation (individual sounds and words via lips, cheeks and tongue)

partially open - quite respiration
wide open - forced inspiration
slit in middle - phonation

146
Q

extrinsic muscles of the larynx and purpose

A

supra and infra-hyoid muscles

attach to hyoid or thyroid cartilage and move larynx - swallowing

147
Q

extrinsic muscles involved in elevation of the larynx

A
digastric
stylohyoid
mylohyoid
geniohyoid
(stylopharyngeus, salpingopharyngeus, plataopharyngeus)
148
Q

extrinsic muscles involved in depression of the larynx

A

sternothyroid
sternohyoid
omohyoid
(elastic recoil of trachea)

149
Q

intrinsic muscles of the larynx and purpose

A
pass between elements of the larynx and move cartilages / vocal folds
cricothyroid
thyroarytenoid
posterior cricoarytenoid
lateral cricoarytenoid
oblique arytenoid
transverse arytenoid
150
Q

innervation of the intrinsic muscles of the larynx

A

recurrent laryngeal vagus (CN X)

*cricothyroid supplied by the external laryngeal branch of the vagus

151
Q

attachment of the cricothyroid

A

cricoid cartilage to lamina and inferior horn of the thyroid cartilage

152
Q

action of the cricothyroid

A

tense and elongate vocal folds - move thyroid forward and cricoid tilted backward

153
Q

attachments the thyroarytenoid

A

inner surface of angle of thyroid to anterolateral surface of arytenoid cartilages
*upper fibres - run along vocal folds

154
Q

action of the thyroarytenoid

A

pull arytenoids forward to thyroid cartilage - shorten and relax vocal folds

155
Q

posterior cricoarytenoid attachment

A

posterior of lamina of cricoid to muscular process of arytenoid cartilage

156
Q

action of posterior cricoarytenoid

A

pulls muscular process of the arytenoid backward - abduction of the vocal cords

157
Q

attachment of lateral cricoarytenoid

A

upper ridge of arch cricoid cartilage to muscular process of arytenoid cartilage

158
Q

action of lateral cricoarytenoid

A

pulls muscular process of arytenoid forward - adduction of vocal folds

159
Q

attachment of oblique arytenoid

A

muscular process of arytenoid to apex of opposite cartilage

160
Q

action of oblique arytenoid

A

fibres form aryepiglottic muscles in aryepiglottic fold - sphincter of laryngeal inlet

161
Q

attachment of transverse arytenoid

A

posterior and medial surfaces of arytenoid cartilages to opposite arytenoid cartilage

162
Q

action of transverse arytenoid

A

closes posterior part of prima glottidis (space between the vocal folds)

163
Q

what branches does the vagus nerve give that supply the larynx and pharynx (superior to inferior)

A
inferior vagal ganglion gives:
pharyngeal branch
superior laryngeal nerve
internal laryngeal branch
external laryngeal branch

recurrent laryngeal

164
Q

what do the superior and inferior laryngeal veins drain into

A

the superior thyroid vein and inferior thyroid vein (both drain into internal jugular)