Neck Flashcards
What is a pancoast tumour?
where does it normally spread?
cancers that start in the apex of lung
upper ribs of thorax
nerves in upper thorax and neck
bundles of nerves close to spinal cord
blood vessels that supply blood to the upper limb
what are pancoast tumours normally called?
what type of cancer are they normally?
non small cell cancer
squamous cell cancer
symptoms of pancoast tumours
may put pressure/ damage brachial plexus
this can cause severe pain in shoulder or scapula
pain in arm and weakness of hand
what is Horner syndrome and what is it characterised by?
lesion of a sympathetic trunk in the neck
pupillary constriction resulting from paralysis of dilator pupillae muscle
ptosis: paralysis of levator palpebrae superioris
sinking in of eyeball
vasodilation and absence of sweating on face and neck: lack of sympathetic nerve supply to blood vessels and nerve glands
X is for carotid pulse and bifurction to external and internal branches
what bone is this?
clavicle
locate: mandible- body, angle, rammus
mastoid process
structures penetrated in emergency cricothyroidotomy
what are the dangers in performing this operation on a child?
cricothyroid membrane into trachea
small neck can accidentally penetrate oesophagus
structures penetrated in a tracheotomy
infrahyoid muscles and isthmus (tissue joining two lobes of thyroid gland)
opening made between 1st and 2nd tracheal rings
what are langer’s lines, why are they clinically important and how are they arranged in the neck?
lines to correspond to natural orientation of underlying muscle fibres
- incisions made parallel may produce less scarring
they run along the circumference in the neck
the other name for posterior triangle of neck
lateral cervical region
borders of posterior triangle
anterior: SCM
lateral: trapezius
inferior: middle 1/3 clavicle
floor and covering of posterior triangle
preverebral fascia and investing fascia
muscles in the posterior triangle
splenius capitis
levator scapulae
middle scalene
posterior scelene
(sometimes anterior scalene)
major contents of posterior triangle
spinal accessory nerve CN XI (passes deep to SCM)
trunks of brachial plexus ( roots are between anterior and middle scalene muscles)
phrenic nerve
posterior branches of cervical plexus
lymph nodes: cervical, suprascapular
arteries: suprascapular, transverse cercival, subclavian,
veins: external jugular, subclavian
carefree and careful areas for surgery in posterior triangle
area above spinal accessory nerve is carefree
area careful is careful due to EJV, subclavian artery and vein, and brachial plexus
why is a knowledge of fascia layers important in the neck clinically?
tracking of infections and spread of tumours in the neck
finding planes of separation during surgery
what structures are located in the carotid sheath?
common and internal carotid arteries
IJV
vagus nerve
deep cervical lymph nodes
carotid sinus nerve
sympathetic nerve fibres
what happens when there is an infection between investing layer of deep cervical fascia and the muscular part of pretracheal fascia?
does not spread beyond superior edge of manubrium
if the infection is between investing layer and visceral part then it can spread to thoracic cavity anterior to pericardium
anterior triangle: muscles
suprahyoid: stylohyoid, digastric, mylohyoid, geniohyoid
infrahyoid: omohyoid, sternohyoid, thryohyoid, sternothyroid
anterior triangle: vascular structures
common carotid artery and bifurcation into external and internal carotid
internal jugular veins
cranial nerves: facial, glossopharyngeal (IX), vagus, accessory, hypoglossal (XII)
borders of anterior triangle of neck and subdivisions
superior: inferior border of mandible
lateral: anterior border of SCM
medial: midline of neck
carotid, submental, submandibular and muscular triangles
rami of cervical plexus
C1-4
deep branch makes up root of ansa cervicalis and phrenic
where is the carotid sinus located
in between common carotid and internal carotid
superior thyroid artery is a branch of
external carotid artery
inferior thyroid artery is a branch of
thyrocervical artery (from subclavian)
where does thyroid ima arise from
what does it supply
brachiocephalic trunk
thyroid and thymus gland
what does costocervical trunk arise from
subclavian artery
what is the carotid body
small mass of epitheloid cells and nerve endings located above bifurcation of common carotid and next to carotid sinus
chemoreceptor organ (detects changes in pO2 pCO2 and pH)
where do the jugular veins arise from
internal: brachiocephalic vein
external: subclavian vein
anterior: external jugular vein
what is the atlas
C1
what is the axis
c2
vasculare supply of thyroid gland
superior and inferior thyroid artery
thyroid plexus of veins
superior -> IJV
middle -> IJV
inferior-> brachiocephalic
why do thyroid gland and lumps embedded in it move on swallowing?
pre tracheal fascia enclosing it moves
which nerves are closely related to inferior and superior thyroid arteries?
inferior: recurrent layngeal
superior: external laryngeal nerves
surgical importance of thyroid ima
small size and exists in 10% of people
potential source of bleeding during surgery in midline of neck
How are parathyroid glands related to the thyroid?
what is their blood supply?
why must they be considered when contemplating a thyroidectomy
four glands on medial half of posterior surface of each lobe
two superior, two inferior
inferior thyroid arteries and (superior, thyroid ima, laryngeal, tracheal and oeseophageal)
parathyroid veins drain into thyroid plexus of veins
during thyroidectomy (excision of malignant thyroid gland)- they are in danger of being damaged or removed
these glands are safe during subtotal thyroidectomy becuase most posterior part of thyroid is preserved
if removed, patients suffer from tetany- convulsive disorder due to fall in blood calcium levels
where else my thyroid and parathyroid tissue be found and why?
acessory thyroid tissue may develop in neck lateral to thyroid cartilage on thyrohyoid muscle
pyramidal lobe (extension of thyroid tissue superior to isthmus)- remnants of thyroglossal duct (carries thyroid forming tissue)
what is the retropharyngeal space and why is it clinically important?
space between buccopharyngeal fascia (cont. with pretracheal layer) and prevertebral layer
alar fascia crosses it
permits movement of the pharnx, oesophagus, larynx and trachea relative to vertebral column when swallowing
largest and most clinically important interfascial space in neck
pathway of spread of infection
closed by cranium and carotid sheaths
what does the pretracheal fascia enclose
thyroid gland, trachea, oesophagus
muscular part covers infrahyoid muscles
visceral part does the organs
what do deep cervical lymph nodes form
L jugular lymphatic trunk: joins thoracic duct at root of neck
R jugular lymphatic trunk: empties into right lymphatic duct at root of neck
deep lymph nodes are close to IJV
where do superficial lymph vessels drain
superficial ring of lymph nodes at junction of head and neck
subdivisions of anterior triangle
submandibular triangle
submental triangle
carotid triangle
muscular triangle
submandibular triangle: boundaries and contents
between mandibular line and posterior and anterior belly of digastric
main content: submandibular gland
facial artery and veins
submental triangle boundaries and contents
Inferiorly – hyoid bone.
Medially – midline of the neck.
Laterally – anterior belly of the digastric
base- mylohyoid muscle
contains submental lymph nodes
beginning of anterior jugular vein
carotid triangle boundaries and contents
Superior – posterior belly of the digastric muscle.
Lateral – medial border of the sternocleidomastoid muscle.
Inferior – superior belly of the omohyoid muscle.
contains common carotid artery, internal jugular vein, hypoglossal nerve and vagus nerves
muscular triangle boundaries and contents
Superiorly – hyoid bone.
Medially – imaginary midline of the neck.
Supero-laterally – superior belly of the omohyoid muscle.
Infero-laterally – inferior portion of the sternocleidomastoid muscle.
contains; the infrahyoid muscles, the pharynx, and the thyroid,
does the internal carotid artery give branches
no
what is the main vein of the neck and what does it travel with
internal jugular vein
common carotid artery and vagus nerve
