Neck Flashcards
Platysma
Innervation: cervical branch of facial nerve 7
Origin: skin over lower neck and upper lateral chest
Insertion: with several muscles of facial expression into skin around the chin and mouth
Action: Depresses and wrinkles skin of lower face and mouth. Aids forced depression of mandible
Investing layer of dense connective tissue
a sleeve binding all strucrtures in the neck
surrounds sternocleidomastoid and trapezius
Infrahyoid fascia
covering supra and infrahyoid muscles (strap muscles)
Stylohyoid
Origin: base of styloid process
Insertion: base of greater cornu of hyoid bone. wraps around intermediate tendon of digastric
Action: elevates and retracts hyoid bone. Aids swallowing and elevates larynx
Nerve: mandibular branch of facial nerve VII
Geniohyoid
Origin: inferior mental spine on posterior surface of symphysis menti
Insertion: superior border of body of hyoid bone
Action: elevatse and protracts hyoid bone. Depresses mandible.
Nerve: C1 fibers carried by hypoglossal nerve XII
deep to mylohyoid
thyrohyoid
Origin: oblique line of lamina of thyroid cartilage
Insertion: inferior border of body of hyoid bone
Action: elevates larynx or depresses hyoid bone
Nerve: C1 fibers carried by hypoglossal nerve XII
sternothyroid
Origin: medial posterior aspect of manubrium
Insertion: oblique line of lamina of thryoid cartilage
Action: depresses lyarnx
Nerve: anza cerivcalis C1,2,3
deep to sternohyoid and omohyoid
Omohyoid fibrous sling
omohyoid intermediate tendon that attaches to clavicle
divides omohyoid into superior and inferior bellies
Omohyoid:
Origin: suprascapular ligament and adjacent scapula
Insertion: inferior border of body of hyoid bone
Action: depresses hyoid bone and hence larynx
Nerve: ansa cervialis nerve C1,3,3
Digastric fascial sling
tendon divides digastric into anterior and posterior bellies
Digastric fascial sling
tendon divides digastric into anterior and posterior bellies
What are the branches of the external carotid artery?
SALFOP SuperT Max
superior thyroid ascending pharyngeal lingual facial occipital posterior auricular superficial temporal maxillary
What pierces the thyrohyoid membrane?
superior laryngeal artery (from superior thyroid) and internal laryngeal nerve (branch of superior laryngeal from vagus)
Where is the lingual artery?
Deep to hypoglosses muscle
Where is fascial artery?
deep to submandibular gland
What “holds” the occipital artery?
Held against the external cartid artery by the hypoglossal nerve (CN XII)
What “holds” the occipital artery?
Held against the external carotid artery by the hypoglossal nerve (CN XII) criss crossed
What are the three branches of the aortic arch?
1) brachiocephalic trunk
Gives right carotid common and right subclavian
2) left common carotid
3) left subclavian
What are the boundaries of the anterior triangle?
Anterior: ant med line Posterior: SCM Superior: inferior border of mandible Apex: jugular notch Roof: sub cut fascia and platysma Floor: pharynx, larynx, thyroid
What are the boundaries of the submandibular triangle?
Anteroinferior: anterior belly of the digastric
Posteroinferior: posterior belly of the digastic
Superior: inferior border of the mandible
What are the boundaries of the submental triangle?
left and right borders: left and right anterior belly of the digastric muscles
Inferior: hyoid bone
floor: mylohyoid
only unpaired triangle
What are the boundaries of the carotid triangle?
anteroinferior: superior bely of the omohyoid
anterosuperior: posterior belly of the digastric
posterior: SCM
What are the boundaries of the muscular triangle?
anterior: anterior median line
posteriorsuperior: superior bely of the omohyoid
posteroinferior: SCM
What is in the submandibular triangle?
Submandibular gland
mylohyoid nerve V3
facial artery (deep to gland) and vein (superficial to gland)
lingual artery
lingual nerve V3 and submandibular ganglion
hypoglossal nerve XII
What is in the submandibular triangle?
Submandibular gland
mylohyoid nerve V3
facial artery (deep to gland) and vein (superficial to gland)
lingual artery
lingual nerve V3 and submandibular ganglion
hypoglossal nerve XII
What is the submental triangle?
Lymph nodes
small veins that unite to form anterior jugular vein
What is in the carotid triangle?
Vagus nerve CN X (all viscera)
Spinal accessory nerve CN XI
Hypoglossal nerve XII
Cervical sympathetic trunk (chain)
What is in the carotid sheath?
Vagus nerve CN X (all viscera)
Spinal accessory nerve CN XI
Hypoglossal nerve XII
Cervical sympathetic trunk (chain) behind sheath NOT inside it
What is in the carotid sheath?
Vagus nerve CN X (all viscera)
Spinal accessory nerve CN XI
Hypoglossal nerve XII
Cervical sympathetic trunk (chain) behind sheath NOT inside it
What are the important branches of the vagus nerve?
Superior laryngeal (sensory only) - internal laryngeal and external laryngeal
Recurrent laryngeal
- right (sensory only) and left
What do the right and left recurrent laryngeal nerves do?
Right- loops around subclavian artery in tracheoesophageal groove
motor innervation to all msucles of vocalization EXCEPT cricothyroid
Left- wraps around the arch of the aorta
What nerve supplies all sympathetic innervation in the head?
Superior C1-C4 cervical sympathetic ganglia
Middle (C5-C6)
Inferior (C7-C8)
What is Horner’s syndrome?
Result of interruption of the sympathetic chain in the neck
Ptosis of affected eyelid, miosis of the affected pupil, andhydrosis on affected side, redding of the skin of the face on affected side
What are the boundaries of the superior thoracic aperture?
Posterior: first thoracic vertebra
Laterally: first ribs
Anteriorly: superior aspect of the sternum, (manubrum)
What is in the superior thoracic aperture?
apices of left and right lungs with pleurual coerings subclavian arteries and veins vagus nerve phrenic nerve sympathetic chain recurrent laryngeal n thoracic duct common carotid arteries
what are the branches of the subclavian?
Related to anterior scalene
1st- medial to AS
2nd- posterior to AS
3rd- lateral to AS turns into axillary artery after crossing first rib
VIT C and sometimes D
Vertebral a internal throacic a thyrocervical trunk-(inf thyroid, transverse cervical, suprascapular, ascending cervical) Costocervical trunk Dorsal scapular
Where do lymphatics of the face and head drain?
Pericervical lymphatic collar
- occipital nodes
- postauricular nodes
- preauricular nodes
- buccal nodes
- submandibular nodes
- submental nodes
Eventually drain into deep cervical lymph nodes
empty into thoracic duct on the left and lymphatic duct on the right
Where do lymphatics of the face and head drain?
Pericervical lymphatic collar
- occipital nodes
- postauricular nodes
- preauricular nodes
- buccal nodes
- submandibular nodes
- submental nodes
Eventually drain into deep cervical lymph nodes
empty into thoracic duct on the left and lymphatic duct on the right
What is the thoracic duct?
Located on LEFT side only
receives drainage from entire body EXCEPT right head and neck, right upper extremity, right thorax
enters neck through superior thoracic aperture
drains where left subclavian vein meets left internal jugular vein
What is the right lymphathic duct?
drainage for right head and neck, right upper extremity, right thorax
empties into right internal jugular or right subclavian vein
Are the lungs in the neck?
Yes!
extend 1 inch above medial third of the clavicle
pleura is membranous covering of lung
cervical pleura = cupula
Describe the structure of the thyroid
right and left lobe
midline isthmus
sometimes pyramidal lobe can be a small triangle gland tissue coming out of isthmus
touches inferior larynx and superior trachea anterolaterally
Where did the pyramidal lobe come from?
remnant of embryological thyroglossal duct
if muscle fibers there called levator glandulae thyroidea
What supplies blood to the thyroid?
superior and inferior thyroid artries
What innervates the thyoid gland?
Sympathetics= middle cervical ganglion
Parasympathetics- laryngeal branches of the vagus nerve
How many parathyroid glands are there?
2 pairs of 4
2 on each side in posterior aspect of thyroid gland
small and darker
What does the parathyroid gland secrete?
parathyroid hormone- helps control calcium and phosphorous, bone growth and metabolism
calcium- most important
without PTH the nervous and muscular systems could not function properly
What are the anterior group of prevertebral muscles?
anterior group
- longus coli
- longus capitis
- recrus capitis anterior
- anterior scalene
What are the lateral group of prevertebral muscles?
Lateral group
- rectus capitis lateralis
- splenius capitis
- levator scapulae
- middle and posterior scalenes
Where are the prevertebral muslces located?
deep to prevertebral layer of deep cervical fascia
directly posterior to the retropharyngeal space
How many parathyroid glands are there?
2 pairs of 4
superior and inferior
2 on each side in posterior aspect of thyroid gland
small and darker
Sternohyoid
Origin: superior lateral posterior aspect of manubrium
Insertion: inferior border of body of hyoid bone
Action: depresses hyoid bone and hence larynx
Nerve: ansa cervialis nerve C1,3,3
