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Anatomy > Neck > Flashcards

Neck Flashcards

1
Q

Superficial fascia of the neck

A

Contains platysma

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2
Q

Deep cervical fascia

A

Found deep to the superficial fascia of the neck

Organised into several layers

  • Investing fascia that surrounds the structures within the neck
  • Prevertebral layer which surrounds vertebral column and deep muscles of the back
  • Pretracheal layer which encloses viscera of neck
  • Carotid sheath which recieve contribution from other fascial layers and sourround neurovascular bundle
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3
Q

Investing layer fascia of the neck

A

Division of the deep cervical fascia
-Surrounds structures within the neck

Completely surrounds neck
Attaches posteriorly to ligamentum nuchae and spinous process of C7

Splits as it passes forwards enclosing trapezius, then reunites
Forms roof of posterior triangle
Splits again to enclose sternocleidomastoid and reunites

Attachments:
Superiorly: occipital protuberance and nuchal line
Laterally: mnastoid process and zygomatic arch
Inferiorly: spine of scapula, acromion, clavicle, manubrium

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4
Q

Prevertebral fascia of the neck

A

Division of deep cervical fascia
-Surrounds vertebral column and deep muscles of the back

Cyclindrical layer of fascia
Surrounds prevertebral muscles, anterior, middle and posterior scalene muscles
And deep muscles of the back

Attachments:

  • Posteriorly along ligamentum nuchae
  • Superiorly: contiuous circular line to base of skull
  • Anteriorly attached to anterior surface of vertebrak bodies CI - CVII

Extends to surround brachial plexus and subclavian artery to form axillary sheath

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5
Q

Pretracheal fascia of the neck

A

Division of deep cervical fascia
-Encloses viscera of the neck

Surrounds trachea, oesophagus and thyroid gland

Begins superiorly at hyoid bone –> ends in upper thoracic cavity

Posteriorly, referred to as the buccopharyngeal fascia: separates the pharynx/oesophagus from the prevertebral layer

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6
Q

Carotid sheaths

A

Division of deep cervical fascia

Recieve contribution from other fascia in neck

Surround neurovascular bundle on either side of the neck

  • Common carotid artery
  • Internal carotid artery
  • Internal jugular vein
  • Vagus nerve
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7
Q

Axillary sheath

A

Continuation of prevertebral fascia

Containing subclavian arteyr and brachial plexus

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8
Q

Fascial spaces of the neck

A

Pretracheal space

Retropharyngeal space

Third space

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9
Q

Pretracheal space of the neck

A

Space between investing layer of cervical fascia covering the posterior surface of infrahyoid muscles

AND

Pretracheal fascia covering anterior surface of trachea and thyroid

space = neck and anterior superior mediastinum

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10
Q

Retropharyngeal space of the neck

A

Space between the buccopharyngeal fascia on the posterior pharynx and oesophagus

AND

Prevertebral fascia on the anterior surface of the transverse process and bodies of cervical vertebrae

Space = base of skull to posterior mediastinum

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11
Q

Third space of the neck

A

Space within the prevertabral later covering anterior processes of cervical vertebrae as the fascia divides into two laminae

Extends from base of skull down to diaphragm

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12
Q

Formation of external jugular vein

A

Formed behind angle of mandible as posterior auricular and retromandibular vein join

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13
Q

Formation and divisions of retromandibular vein

A

Superficial temporal vein and maxillary vein join in substance of parotid gland –> retromandibular vein

Then divides into anterior and posterior branches

Anterior branch of retromandibular vein joins the facial vein to form the common facial vein

Posterior branch of retromandibular vein joins posterior auricular vein to form EXTERNAL JUGULAR VEIN behnd angle of mandible

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14
Q

Common facial vein

A

Formed by union of anterior branch of retromandibular vein and facial vein

Passes deep to drain into internal jugular vein

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15
Q

Course of external jugular vein

A

Passes downwards in superficial fascia anteriorly to sternocleidomastoid crossing it diagonally

Joined by:

  • Posterior extenral jugular vein
  • Transverse cervical vein
  • Suprascapular veins

At end of sternocleidomastoid, the external jugular passes posteriorly to pierce investing fascia, pass deep to clavicle, and join subvlavian vein

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16
Q

Anterior jugular veins

A

Drain into subclavian vein after piercing investing layer of fascia

Often communicate via jugular venous arch around suprasternal notch

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17
Q

Subdivisions of the anterior triangle of the neck

A

Submandibular triangle

Submental triangle

Muscular triangle

Carotid triangle

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18
Q

Borders of the anterior triagnle of the neck

A

Laterally : Anterior border of sternocleidomastoid

Superiorly: border of mandible

Medially: midline

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19
Q

Borders of the submandibular triangle

A

Superiorly: Inferior border of mandible

Inferiorly: Anterior and posterior bellies of digastric

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20
Q

Borders of the submental triangle

A

Inferiorly: hyoid bone

Laterally: anterior belly of digastric

Medially: midline

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21
Q

Borders of the muscular triangle

A

Superiorly: hyoid bone

Laterally: superior belly of omohyoid muscle and anterior border of distal sternocleidomastoid

Medially: midline

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22
Q

Borders of the carotid triangle

A

Anteroinferiorly: Superior belly of omohyoid muscle

Superiorly: Stylohyoid muscle and posterior belly of digastric

Posteriorly: anterior border of sternocleidomastoid (middle)

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23
Q

Suprahyoid muscles

A

Stylohoid

Digastric

Mylohyoid

Geniohyoid

ALL IN SUBMENTAL AND SUBMANDIBUALR TRIANGLE

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24
Q

Infrahyoid muscles

A

Omohyoid

Sternohyoid

Thyrohyoid

SternoTHYROID

ALL IN MUSCULAR COMPARTMENT

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25
Q

Innervation of stylphyoid muscle

A

Innervated by the faical nerve

O: Base of styloid process
I: Lateral area of body hyoid
F: Pulls hyoid posterosuperior

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26
Q

Innervation of digastric muscle

A

Anterior belly: Mylohyoid nerve from inferior alveolar branch of mandibular branch of trigeminal V3

O: Digastric fossa on inside of lower mandible
I: Attachment tendon
F: Opens mouth, raises hyoid

Posterior belly: Facial nerve VII

O: Mastoid notch on medial mastoid
I: Attachment tendon
F: Pulls hyoid back superoposterior

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27
Q

Innervation of mylohyoid

A

Innervated by the mylohyoid nerve from alveolar branch of the mandibular division of the trigmeinal nerve V3

O: Myohyoid line of mandinle
I: Body of hyoid and midline convergence
F: Support elevation of floor of mouth + elevation of hyoid

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28
Q

Innervation of geniohyoid

A

Innervated by C1 anterior ramus, carried in hypoglossal nerve XII

O: Inferior mental spine on inner surface of manidble
I: Anterior surface of body of hyioid
F: Pulls mandible downards, elevates hyoid

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29
Q

Innervation of sternohyoid

A

Innervated by anterior rami of C1 - C3 ansa cervicalis

O: Posterior aspect of sternoclavicular joint and manubrium
I: Body of hyoid bone medial to omohyoid muscle
F: Depresses hyoid bone after swallowing

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30
Q

Innervation of omohyoid

A

Innervated by anterior rami of C1 - C3 ansa cervicalis

O: Superior border of scapula medial to suprascapular notch
I: Lower border of body of hyoid lateral to sternohyoid attachment
F: Depresses hyoid

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31
Q

Innervation of thyrohyoid

A

Innervated by anterior rami of C1 carried along hypoglossus nerve XII

O: Oblique line of thyroid cartilage
I: Greater horn and adjacent body of hyoid
F: Depresses hyoid or raises larynx

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32
Q

Innervation of sternothyroid

A

Innervated by anterior rami of C1 - C3 ansa cervicalis

O: Posterior surface of manubrium
I: Oblique line of lamina of thyroid cartilage
F: Draws larynx downwards

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33
Q

Innervation of carotid sinus

A

Glossopharyngeal nerve IX

= changes in blood pressure

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34
Q

Innnervation of carotid body

A

Glossopharyngeal nerve XI

AND

Vagus nerve X

= changes in blood chemistry and PO2

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35
Q

Branches of the external carotid artery

A

Superior thyroid artery

Ascending pharyngeal artery

Lingual artery

Facial artery

Occipital artery

Posterior auricular artery

Superficial temporal artery

Maxillary artery

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36
Q

Superior thyroid artery

A

Branch of external carotid artery

Supplies:

  • Thyrohyoid muscle
  • Larynx
  • Sternocleidomastoid
  • Cricothyroid muscle

-Thyroid gland

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37
Q

Ascending pharyngeal artery

A

Branch of external carotid artery

Supplies:

  • Pharyngeal constrictors
  • Stylopharyngeus muscle
  • Palate
  • Tonsil
  • Pharyngotympanic tube
  • Posterior cavity meninges
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38
Q

Veins draining into internal jugular veins

A

(Inferior petrosal sinus)

Facial vein

Lingual vein

Pharyngeal vein

Occipital vein

Superior thyroid vein

Middle thyroid vein

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39
Q

Facial nerve innervates to muscle in anterior triangle

A

Stylohyoid

Posterior belly digastric

(+platysma)

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40
Q

Stylohyoid nerve

A

Facial nerve

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41
Q

Posterior belly of digastric nerve

A

Facial nerve

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42
Q

Glossopharyngeal innervates structures in anterior triangle

A

Stylopharyngeus muscle

Carotid body and sinus

Sensory branch to pharynx

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43
Q

Path of glossopharyngeal IX in anterior triangle

A

Exits cranial cavity through jugular Forman

Between internal carotid and internal jugular vein

Descends deep to styloid process

Passes in between internal carotid and internal jugular towards stylopharyngeus

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44
Q

Orientation of vagus nerve in carotid sheath

A

Medial to internal jugular vein

Posterior to internal carotid artery

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45
Q

Path of the accessory nerve

A

Most posterior nerve leaving jugular foramen

Begins descent medial to internal jugular vein

Then passes over lateral surface of internal jugular vein and pierces sternocleidomastoid

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46
Q

Branches of vagus nerve in anterior triangle

A

Motor branch to pharynx

Branch to carotid body

Superior laryngeal nerve –> divides into external and internal laryngeal nerves

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47
Q

Path of hypoglossus in anterior neck

A

No branches

Exits cranial cavity through hypoglossal canal

Medial to internal jugular

Then passes outwards and then hooks around occipital artery

Continues deep to posterior belly of digastric

Passes over surface of hyoglossus muscle

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48
Q

Transverse cervical nerve

A

C2 - C3

Emerges from border of sternocleidomastoid

Cutaneous innervation to anterior neck

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49
Q

Ansa cervicalis

A

Loop of nerve C1 - C3

Innervate strap muscles

C1 joins hypoglossus nerve XII as it leaves skull through hypoglossal canal

Superior root: As hypoglossus passes forward across internal and external carotid arteries –> fibres pass out

  • -> descend between internal jugular and common carotid
  • -> innervates superior belly of omohyoid + sternohyoid + sternothyroid

C2-C3 branches complete loop
=inferior root

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50
Q

Superior root of ansa cervicalis

A

C1 and hypoglossus

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51
Q

Inferior root of ansa cervicalis

A

C2 - C3

innervates inferior belly of omohyoid + lower sternohyoid + sternothyroid

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52
Q

Location of isthmus

A

Covers 2nd - 3rd TRACHEAL rings

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53
Q

Pyramidal lobe of thyroid

A

Vairant in which lobe extnds up from thyroid glan din thyroglossal duct

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54
Q

Lingual thyroid

A

Variant in which there is a functional thyroid lobe at base of tongue

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55
Q

Superior thyroid artery

A

Branch of external carotid artery

Descends passing along lateral margin of thyrohyoid muscle to superior pole of thyroid

Divides into anterior and posterior superior thyroid branches

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56
Q

Anterior glandular branch of superior thyroid artery

A

Passes along superior border of thyroid gland and anastomoses with its paired artery across the isthmus

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57
Q

Posterior glandular branch of superior thyroid artery

A

Passes posteriorly to thyroid and may anastomose with inferior thyroid artery

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58
Q

Inferior thyroid artery

A

Branch of thyrocervical trunk, brancch of first part of subclavian

Ascends on medial margin of anterior scalene muscle

Passes posteriorly to carotid sheath

At inferior pole of thyroid divides into inferior and ascening branches

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59
Q

Inferior branch of inferior thyroid artery

A

Superior branch of inferior thyroid artery, which in turn is a branch of the thyrocervical trunk of the first part of the subclavian artery

Supplies lower thyroid and anastomoses with inferior glandular branch of superior thyroid artery

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60
Q

Ascending branch of inferior thyroid artery

A

Branch of inferior thyroid artery, which in turn is a branch of the thyrocervical trunk of the first part of the subclavian artery

Supplies parathyroid glands

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61
Q

Thyroid ima artery

A

Variant arteyr in 10% of population

Branch of brachiocephalic trunk or arch of aorta

Ascends on anterior surface of trachae to supply thyroid

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62
Q

Venous drainage of thyroid

A

3 veins

Superior thyroid vein: drains upper 1/2
–> drains to internal jugular vein

Middle and inferior thyroid veins: drain lower 1/2
Middle vein –> drains to internal jugular vein
Inferior vein –> drains braciocephalic vein

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63
Q

Recurrent laryngeal nerves and thyroid

A

Recurrent laryngeal nerves ascend in groove between trachea and oesophagus

Pass under posteromedial surface of lateral lobes of thyroid gland and enter larynx
–> pass through lower margin of inferior pharyngeal constrictor

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64
Q

Posterior triangle boundaries

A

Anterior: posterior edge of sternocleidomastoid

Posterior: anterior edge of trapezius

Inferior: middle third of clavicle

Superior / apical: posterior to mastoid process where attachments of trapezius and sternocleidomastoid merge

Roof: investing layer of cervical fascia

Floor: pre-vertebral fascia covering splenius capitus, levator scapulae, posterior, middle and anterior scalene muscle

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65
Q

Division of posterior triangle of neck

A

Omohyoid passes from posterior triangle –> anterior triangle

Divides posterior triangle with inferior belly:

  • Above = occipital triangle
  • Below = omoclavicular or subclavian
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66
Q

Innervation of omohyoid

A

Ansa cervicalis, anterior rami of C1 - C3

O: Superior border of the scapula, medial to sc

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67
Q

Dorsal scapular artery

A

Only branch of the third part of the subclavian artery

Branches at base of posterior triangle of neck

Passes to superior angle of scapula
Passes down medial edge of scapula

Supplies rhomboid muscles

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68
Q

Transverse cervical artery

A

Middle branch of the thyrocervical trunk of first part of subclavian artery

Passes anterior to anterior scalene muscle into base of posterior triangle

Passes to trapezius, divides:

  • Superficial: supplies trapezius
  • Deep: continues to supply rhomboids
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69
Q

Suprascapular artery

A

Branch of thyrocervical trunk of first part of subclavian artery

Passes into base of posterior triangle

Passes over superior transverse scapular ligament

Supplies muscles on posterior scapula

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70
Q

Course of accessory nerve in posterior triangle

A

Accessory nerve XI exits cranial cavity through the jugular foramen

Descends through the neck in a posterior direction –> sternocleidomastoid
–> Passes deep or through sternocleidomastoid innervating it

Continues to descend obliquely in posterior triangle to reach trapezius
–> continues on deep surface of trapezius, innervating it

Superficial course of accessory nerve within the investing layer of the cervical fascia as it passes in posterior triangle between sternocleidomastoid to trapezius leaves it susceptible to injury

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71
Q

Formation of cervical plexus

A

Anterior rami of C2 - C4
+/- contribution from C1

Forms in muscles making up the floor of the posterior triangle within PREVERTEBRAL fascia

  • Muscular (deep) branches
  • -> Superior root of ansa cervicals
  • ->Inferior root of ansa cervicalis
  • -> Phrenic nerve (needs contribution from C5)
  • Superficial (sensory) branches
  • -> Lesser occipital nerve
  • ->Great auricular nerve
  • ->Transverse cervical nerve
  • ->Supraclavicular nerve
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72
Q

Motor branches of cervical plexus

A
  • -> Superior root of ansa cervicals
  • ->Inferior root of ansa cervicalis
  • -> Phrenic nerve (needs contribution from C5)
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73
Q

Sensory branches of cervical plexus

A

Lesser occipital nerve

  • C2
  • Skin of neck and scalp posterior to ear

Great auricular nerve

  • C2 and C3
  • Skin to parotid region, ear and mastoid region

Transverse cervical nerve

  • C2 and C3
  • Lateral and anterior neck

Supraclavicular nerve

  • C3 and C4
  • Skin over clavicle and down to rib II
74
Q

Lesser occipital nerve

A
  • C2

- Skin of neck and scalp posterior to ear

75
Q

Great auricular nerve

A
  • C2 and C3

- Skin to parotid region, ear and mastoid region

76
Q

Transverse cervical nerve

A
  • C2 and C3

- Lateral and anterior neck

77
Q

Supraclavicular nerve

A
  • C3 and C4

- Skin over clavicle and down to rib II

78
Q

Vertebral artery

A

First branch of subclavian artery

Branches medial to anterior scalene

Ascends and passes through foramen of transverse process CVI

At C1, turns and passes over posterior arch of C1 –> foramen magnum

79
Q

Thyrocervical trunk

A

Second branch of subclavian artery

Arises from first part, medial to anterior scalene

Divided into three branches:

  • Superior: Inferior thyroid
  • Middle: Transverse cervical
  • Inferior: Suprascapular
80
Q

Ascending cervical artery

A

Branch of the inferior thyroid artery, a branch of the thyrocervical trunk

As the inferior thyroid artery turns medially, crossing posteriorly to carotid sheath –> branches ascending cervical artery

Ascending cervical artery ascends anterior to prevertebral muscle

81
Q

Internal thoracic artery

A

Third branch of the subclavian artery

Branches from inferior edge and descends

Passes posterior to clavicle

Enters thoracic cavity anterior to transversus thoracis muscle

82
Q

Costovcervical trunk

A

Final branch of subclavian artery

Left side: arises first part of subclavian medial to anterior scalene

Right side: arises from second part of subclavian artery

Then ascends and passes posteriorly over dome pleural cavity
–> behind anterior scalene

Divides into two branches:

  • deep cervical artery
  • supreme intercostal artery
83
Q

Deep cervical artery

A

Branch of the costocervical trunk after it passes posteriorly to anterior scalene

Ascends in back of neck and anastomoses with descending branch of occipital artery

84
Q

Supreme intercostal artery

A

Branch of the costocervical trunk after it passes posteriorly to anterior scalene

Descends, anterior to rib I
–> forms posterior intercostal arteries for intercostal spaces I and II

85
Q

Only 1 tributary to subclavian vein

A

External jugular vein

86
Q

Course of the phrenic nerve in the neck

A

Arise from the cervical plexus (C2 - C4) and then additional C5

Passes around upper lateral border of anterior scalene

Descends on anterior surface of anterior scalene within the prevertebral layer of cervical fascia

Leaves lower end anterior scalene, passes between subclavian vein and artery

Enters thorax

87
Q

Course of vagus nerve in the neck

A

Vagus nerve descends through the neck in the carotid sheath

Posterior (and in-between) common carotid and internal jugular vein

Passes anterior to subclavian artery, in between subclavian vein and artery

88
Q

Right recurrent laryngeal nerve

A

Arises as the right vagus nerve passes in front of subclavian artery

It loops around the subclavian artery and ascends in the neck in a groove between trachea and oesophagus
–> larynx

89
Q

Left recurrent laryngeal nerve

A

Arises as the left vagus nerve crosses the arch of the aorta in the superior mediastinum

Loops below and behind the arch of the aorta

Ascends beside the trachea –> larynx

90
Q

Cervical part of the sympathetic trunk

A

Anterior to longus colli and longus capitis muscle

Posterior to common carotid artery in the carotid sheath

Connected to each spinal nerve by grey ramus communicans
- there are no white rami communicantes in the cervical region

NOTE: grey ramus commincuans carry post-ganglionic sympathetically fibres
Hence, there are no pre-ganglionic fibres leaving the cervical region and therefore no white rami communicantes

91
Q

Ganglia of cervical sympathetic trunk

A

Superior cervical ganglion: level of C1 - C2

Middle cervical ganglion: level of C6

Inferior cervical ganglion: combined with first thoracic ganglion to firm cervicothoracic ganglion (stellate ganglion)

92
Q

Superior cervical ganglion

A

Anatomically lies adjacent to C1 - C2

Branches to:

  • Internal and external carotid arteries
  • Cervical spinal nerve C1-C4 through grey rami communicantes
  • Pharynx
  • Superior cardiac nerves
93
Q

Middle cervical ganglion

A

Anatomically adjacent to C6

Branches:

  • Cervical spinal nerves C5 - C6 through grey rami communicantes
  • Middle cardiac nerves
94
Q

Inferior cervical ganglion

A

Combines with first throacic ganglion to form cervicothoracic ganglion
=Stellate ganglion

Anterior to neck of 1st rib and transverse process of C7

Posterior to first section of subclavian artery + origin of vertebral artery

Branches

  • Spinal nerve C7 - T 1 through grey rami communicants
  • Vertebral artery - forming plexus
  • Inferior cardiac nerves
95
Q

Thoracic duct

A

Major lymphatic channel

Begins in abdomen

Passes superiorly

  • Thoracic aorta on left
  • Azygous vein on right
  • Oesophagus anteriorly

At T5, thoracic duct passes to the LEFT

Continues to ascend left of the oesophagus

Passes laterally posterior to carotid sheath turns inferiorly

IN FRONT OF thyrocervical trunk, phrenic nerve and vertebral artery

Terminates in junction between left internal jugular and left subclavian vein

96
Q

Thoracic duct terminates…

A

Terminates in junction between left internal jugular vein

AND

Left subclavian vein

97
Q

Tributaries to thoracic duct

A

Left jugular trunk

Left subclavian trunk

Left bronchomediastinal trunk

98
Q

Pharyngeal raphe

A

Connect tissue midline that marks the fusion of both sides of the phrarynx

Extends from pharyngeal tubercle on base of skull to C6 where raphe blends with posterior wall of oesophagus

99
Q

Pterygomandibular raphe

A

Linear cord-like connective tissue

Ptreygoid hammulus –> posterior mandible

Joins superior constrictior / lateral pharyngeal wall with buccinator muscle

100
Q

Points of attachment of lateral pharyngeal wall

A
  1. pterygomandibular raphe
  2. lower stylohyoid ligament + hyoid bone
  3. superior and inferior tubercle of thyroid cartilage extending onto cricoid cartilage
101
Q

Innervation of superior constrictor of pharynx

A

Innervated by the pharyngeal branch of vagus nerve

O: pharyngeal raphe

I: pterygomandibular rapge and adjacent bone on mandible and pterygoid hammulus

F: constricts pharynx, circular muscle fibres

102
Q

Innervation of middle constrictor of pharynx

A

Innervated by the pharyngeal branch of vagus nerve

O: pharyngeal raphe

I: upper margin of greater horn of hyoid bone and adjacent margins of lesser horn and stylohoid ligament

F: constricts pharynx, circular muscle fibres

103
Q

Innervation of lower constrictor of pharynx

A

Innervated by the pharyngeal branch of vagus nerve

O: pharyngeal raphe

I: cricoid cartilage, oblique line of thyroid cartilage, and ligament that spans superior inferior tubercle of thyroid cartilage

F: constricts pharynx, circular muscle fibres

104
Q

Palatopharyngeal sphincter

A

Band of muscle originates from anterolateral surface of soft palate

Circles inner aspect of pharyngeal wall and blends with superior constrictor

Seals pharyngeal isthmus between naropharynx and oropharynx

105
Q

Innervation of stylopharyngeus

A

Innervated by glossopharyngeal nerve IX

O: medial side of styloid process

I: descends between upper and middle constrictors –> pharyngeal wall

F: elevation of pharynx

106
Q

Innervation of salplingopharyngeus

A

Innervated by vagus nerve X

O: inferior aspect of pharyngeal end of pharyngotympanic tube

I: pharyngeal wall

F: elevates pharynx

107
Q

Innervation of palatopharyngeus

A

Innervated by vagus nerve X

O: upper surface of palatine aponeurosis

I: pharyngeal wall
Forms palatopharyngeal arch

F: elevates pharynx and closes oeopharyngeal isthmus

108
Q

Buccopharyngeal fascia

A

Thin layer of fascia that coat soutside of muscular wall of pharynx

Component of pretracheal layer of cervical fascia

109
Q

Pharyngobasilar fascia

A

Thick layer of fascia that lines innfer surface of pharynx

110
Q

Pharyngeal fascia

A

Buccopharyngeal fascia

  • Thin
  • Outside

Pharyngobasilar fascia

  • Thick
  • Inside
111
Q

Reinforcement of superior wall of pharynx

A

Superior constrictor leaves large deficiency superiorly

This is reinforced with fascia (pharyngobasilar) and muscles of the soft palate
-levator veli palatini

112
Q

Triangular aperture of pharyngeal wall

A

Deficiency between:

  • superior constrictor
  • middle cosntrictor
  • posterior border of mylohyoid

-stylopharyngeus muscle passes through to inset on pharynx

Structures passing through gap to enter larynx from pharynx:

  • internal layrngeal vessels
  • nerve to aperture in thyrohyoid membrane
  • recurrent laryngeal nerve
113
Q

Pharyngeal tonsils

A

Previosuly described when enlarged as adenoids

Located at mucosa covering roof of nasopharynx
-enlargement may occlude breathing

114
Q

Torus levatorius

A

Broad fold /elevation emerging from base of opening of pharyngotympanic tube
-> continues medially on upper surface of soft palate

Fold overlies levator veli palatinin

115
Q

Torus tubarius

A

Elevation / bulde from posterior rim of pharyngotympanic tube

Pharyngeal recess formed behind the bulge

116
Q

Valleculae

A

Mucosal pouches

Located anteriorly, one on each side of the midline in the laryngopharynx
–> form base of tongue to epiglottis

117
Q

Piriform fossae

A

Channels that direct solids and liquids from oral cavity around raised laryngeal inlet into oesophagu s

Located between central part of larynx and lateral lamina of thyroid certilage

118
Q

Location of palatine tonsils

A

Each side of oropharynx between palatglossal arch and palatopharyngeal arch

Just posterior to oropharyngeal isthmus

119
Q

Lingual tonsil

A

Lymphoid nodules on posterior 1/3 of tongue

120
Q

Arterial supply to pharynx

A

Ascending pharyngeal artery, branch of external carotid artery

Ascending palatine and tonilsar branches of facial artery

Maxillary and lingual arteries

121
Q

Blood supply to palatine tonsil

A

Tonsilar branch of facial artery

–> penetrates superior constrictor

122
Q

Lymphatic drainage of the palatine tonsil

A

Drains into jugulodigastric nodes

123
Q

Components of the pharyngeal plexus

A

Pharyngeal branch of vagus nerve X

External laryngeal nerve branches, from superior laryngeal nerve of the vagus nerve X

Pharyngeal branches of the glossopharyngeal nerve IX

124
Q

Motor supply to the pharynx

A

All innervated by vagus nerve

with exception of stylopharyngeal muscles which is innervated by glossopharyngeal nerve

125
Q

Pharyngeal branch of the vagus nerve

A

Originates form inferior ganglion of vagus nerve

above origin of superior latryngeal nerve

126
Q

Sensory innervation to nasopharynx

A

Pharyngeal branch of maxillary nerve V2 of trigmeinal nerve

Originated in pterygopalatine fossa –> palatovaginal canal in sphenoid –> roof of pharynx

127
Q

Sensory innervation to oropharynx

A

Innervated by glossopharyngeus IX via pharyngeal plexus

128
Q

Sensory innervation to laryngopharynx

A

Innervated by vagus nerve X via its internal branch of the superior laryngeal nerve

129
Q

Path of glossopharyngeus nerve in pharynx

A

Exits cranial cavity through jugular foramen

Descends on posterior aspect of stylopharyngeus

Passes on lateral aspect of stylopharyngeus –> passes anteriorly through gap betweeen superior and middle constrictors

As it passes under free edge of superior constrictor, lies inferior to palatine tonsil

Here it branches, sensory arm for gag reflex and palatine tonsil

130
Q

Carilages of the larynx

A

Unpaired:

  • cricoid
  • thyroid
  • epiglottis

Paired:

  • arytenoid
  • corniculate
  • cuneiform
131
Q

Laryngeal prominence

A

Superior margin of fusion of broad laminae of thyroid cartilage

Acute angle 90 in males = adam’s apple

Broaded angle 120 in females

132
Q

Lateral thyroid ligament

A

Posterior end of greater horn of hyoid bone –> superior horn of thyroid cartilage

133
Q

Aperture in lateral thyrohyoid memrbane

A

Superior laryngeal artery and internal branch of superior laryngeal nerve pass through

134
Q

Hypo-epiglottic ligament

A

Midline of epiglottis –> body of hyoid

135
Q

Cricothyroid ligament

A

Arch of cricoid cartilage –> thyroid cartilage anteriorly and arytenoid cartilages vocal processes

136
Q

Quadrangular membrane

A

Lateral margin of epiglottis –> anterolateral surface of arytenoid cartilages

Forms vestibular ligament (false cords)

137
Q

Surgical approach to large goitre

A

Ansa cervicalis runs in lower 1/2 of strap muscles

Strap muscles ar edivided in upper 1/2 to avodi ansa cervicalis

138
Q

Level of division of common carotid

A

At upper border of throid cartilage

= C3

139
Q

Structures in between internal and external carotid

A

Stylopharyngeus
Styloid prcoess

Glossopharyngeal nerve

Pharyngeal branch of vagus nerve

140
Q

Relative position of internal jugular vein

A

Formed by continuation of sigmoid sinus

Initally lies posterior to internal carotid

As it descends, it lies lateral to internal carotid and common carotid artery

Contained within the carotid sheath, which is thinner
over the vein, allowing it to distend

The deep cervical chain of lymph nodes is found
along the internal jugular vein —> In block dissection of the neck, the internal jugular vein is removed to facilitate removal of the nodes

141
Q

Internal jugular vein cannulation

A

High approach: C6
-palpated lateral to common carotid at anterior border of sternocleidomatoid

Low approach
-need inserted near apex of triangular gap between the sternal and clavicular heads of sternocleidomastoid

142
Q

Arterial supply to thyroid

A

Superior thyroid artery: branch of external carotid
-related close to external branch of superior laryngeal nerve clos eto gland

Inferior thyroid artery: branch of thyrocervical trunk (1st part of subclavian)
-related close to recurrent laryngeal nere close to gland

143
Q

Venous drainage of thyroid gland

A

Superior thyroid vein –> internal jugular vein

Middle thyoid vein –> internal jugular vein

Inferior thyoird vein –> brachiocephalic vein

144
Q

Incision for thyroidectomy

A

Transverse incision in skin crease two fingers breadth
ABOVE
supersternal notch

145
Q

Structures encountered during thyroidectomy

A

Skin

Platysma

Investing fascia: opended longitudinally between strap muscle and anterior jugular vein

Strap muscles, which may be divided in their upper half to preserve their nerve supply from ansa cervicalis

Pretracheal fascia
–> exposes thyroid gland

Care must be taken in dividing the:

Superior thyroid artery - divide close to the gland, to avoid the external branch of the superior laryngeal nerve

Inferior thyroid artery - divide far away from the gland, to avoid the recurrent laryngeal nerve

146
Q

Position of superior parathyroid glands

A

Lie at the middle of the posterior border of the lobe
of the thyroid above the level at which the inferior
thyroid artery crosses the recurrent laryngeal nerve.

147
Q

Posterior cricoarytenoid

A

Abducts cords

Cricothyroid tenses the vocal cord

All other muscles adduct the cords, i.e. sphincter action

148
Q

Cricothyoird

A

Tenses cords

Posterior cricoarytenoid abducts cords

All other muscles adduct the cords, i.e. sphincter action

149
Q

Blood supply to larynx

A

Superior laryngeal artery

Inferior laryngeal artery

Accompany the superior laryngeal nerve and the recurrent laryngeal nerves, respectively

150
Q

Lymphatic drainage of the larynx

A

Above the vocal cords to the upper deep cervical nodes

Below the vocal cords to the lower deep cervical nodes

Vocal cords separate the two areas of drainage anteriorly but posteriorly there is cross-communication.

151
Q

Nerve supply to larynx

A

Superior laryngeal nerve

  • branch of vagus nerve
  • divides into internal and external branches
  • –> internal branch pierces thyrohyoid membrane and supplies sensory innervation above vocal cords
  • –> etxenral branch supplies cricothyroid muscle

Recurrent laryngeal nerve

  • branch of vagus nerve
  • -> supplies all muscle of larynx except cricothyroid
  • -> supplies sensory innervation to mucosa below vocal cords
152
Q

Nerve injury during thyroidectomy

A

Superior laryngeal nerve –> external laryngeal nerve

  • close to superior thyroid artery
  • ligation of superior thyrid close to gland minimises risk

Recurrent laryngeal nerve

  • -> lies close to inferior thyroid artery
  • this should be ligated well laterally to avoid damage to recurrent laryngeal
153
Q

Palatine arches

A

Anterior pillar = palatoglossal arch
–> formed by palatglossal muscle

Posterior pillar = palatopharyngeal arch
–> palatopharyngeus muscle

154
Q

Pharyngobasilar fascia

A

Lines inner surface of superior constrictor and forms capsule of palatine tonsil

155
Q

Paratonsilar vein

A

= troublespme bleeding during tonsillectomy

Paratonsilar vein extends from soft palate to lie on lateral surface of tonsil –> then pierces superior constrictor

Tonsillectomy involves removal of the tonsil and the
fascial capsule separating it from the loose areolar
tissue clothing the superior constrictor.

156
Q

Lymphatic drainage of palatine tonsil

A

Jugular digastric lymph nodes

behind angle of mandible

157
Q

Blood supply to palatine tonsil

A

Tonsillar branch of facial artery
-> pierces superior constrictor at lower pole of tonsil

Additional branches from: lingual, ascending pharyngeal and ascending palatine arteries

158
Q

Piriform fossa

A

= common place for foreign bodies lodged

Good lymphatic drianage –> fast tumour seeding to depp cervicla nodes

159
Q

Nasopharynx epithelium

A

Pseudostratified columnar ciliated

Rest of phayrnx has stratified squamous

160
Q

Killian’s dehiscence

A

Posterior midline: thyropharyngeus and cricopharyngeus

161
Q

Sensory innervation to the pharynx

A

Nasopharynx: maxillary division of trigeminal nerve

Orophaynx: glossopharyngeal nerve

Laryngopharynx: internal branch of superior laryngeal nerve (of vagus nerve)

162
Q

Contents of posterior triangle of neck

A

3rd part of subclavian artery

Transverse cervical artery

Suprascapular artery

Occipital artery

External jugular vein: courses in the superficial fascia obliquely

SPINAL ACCESSORY NERVE

163
Q

Course of spinal accessory nerve in the posterior triangle

A

Exits the cranial cavity through jugular foramen

passes eep to sternocleidomastoid (at this point enters posterior triangle)

Lies superficially embedded in deep fascia roof

Enters under surface of trapezius

Supplies: sternocleidomastoid and trapezius

It lies on the levator scapulae.

164
Q

Biopsy of node in posterior triangle

A

=accessory nerve injury

–> inability to shrug shoulder on affected side

165
Q

Superficial branches of cervical plexus

A

Lesser occipital nerve

Greater auricular nerve

Transverse cervical nerve

Supraclavicular nerve

166
Q

Deep branches of cervical plexus

A

Supply:

  • prevertebral muscles
  • infrahyoid muscles - ansa cervicalis.
  • diaphrgam -phrenic nerve
167
Q

Ansa cervicalis

A

Loop formed anterior to carotid sheath

Branch of C1 after it has joined with hypoglossal nerve

AND

Branch from union of C2 and C3 nerve roots

168
Q

Right phrenic nerve

A

Anterior to vagus nerve at mediastinum

Descends on lateral side of SVC

–> down the right surface of the pericardium to pierce the diaphragm in company with the inferior vena cava

169
Q

Left phrenic nerve

A

In superior mediastinum: lies between left subclavian artery posteriorly and common carotid anteriorly

Crosses left side of arch of aorta to pass anteriorly to root of lung

Travels down on the left surface of the pericardium
to pierce the diaphragm

170
Q

Sibson’s fascia

A

Suprapleural membrane

Attached to inner border of 1st rib and transverse process of C6

Prevents lung rising further into neck during inspiration

Structure lieing on it:

  • Subclavian artery
  • Subclavian vein
  • Brachial plexus
171
Q

Branches of subclavian artery

A

Vertebral artery

Internal mammary (thoracic) artery

Thyrocervical trunk

Costocervical trunk

172
Q

Thoracic duct

A

Carries lymph from the whole body except right hemithorax, arm, head and neck

Commences at costerna chyli - between abdominal aorta and rigth crus

Passes through aortic opening in diapgrahm and T12

Ascends behind oesophagus up to T5
-at T5 it inclines to the LEFT

At root of neck, arches laterally
-lying between carotid sheath and vertebral artery

Enters the junction between internal jugular and subclavian vein

173
Q

Location of stellage ganglion

A

Lies anterior to neck of 1st rib

174
Q

Vertical chain deep cervical nodes

A

Lies in fascia of carotid sheath

Can be divided:
-superior deep cervical nodes
–> tonsils, tongue (posterior 1/3rd)
=posterior belly of digastric crosses internal jugular vein

  • inferior deep cervical nodes
    –> anterior 2/3rd tongue, oral cavity, trachea, oesophagus, thyroid gland
    =omohyoid cross internal jugular vein
175
Q

Block dissection of the neck

A

Block dissection of the neck extends from the mandible
above to the clavicle below and the midline anteriorly
to the anterior border of trapezius posteriorly

= Leaving only the carotid arteries, the vagus nerve, the sympathetic trunks, and the lingual and hypoglossal nerves

All structures from platysma to pretracheal fascia
are removed

Sternocleidomastoid, posterior belly of digastric and
omohyoid are all removed, along with the internal
jugular and external jugular veins, submandibular
gland and lower part of the parotid gland.

The accessory nerve, to which lymph nodes are
related in the posterior triangle, is also sacrificed.

176
Q

Foramen transversarium

A

Transmits:

  • vertebral artery (NOT C7)
  • vertebral vein
  • sympathetic fibres
177
Q

C1 and C7

A

Don’t have bifid spines

178
Q

Movements around C1-C2

A

Nodding (agreement) and lateral flexion occur
at the atlanto-occipital joint

Rotation of the skull (disagreement) occurs at
the atlantoaxial joint

179
Q

Paracentral slipped disc L4 / L5

A

Impinges L5

  • -> weakness of dorsiflexion
  • -> weakness bog toe extension

Numbness over:

  • lower lateral leg
  • medial side of foot
180
Q

Paracentral slipped disc L5 / S1

A

Impinges S1

  • -> absent / weak ankle jerk reflex
  • -> weakness foot eversion

Numbness over lateral foot

Anatomy (22 decks)

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