Neck Flashcards
Vertebral level C3-C4
Body of hyoid bone
Upper margin of thyroid cartilage
Bifurcation of Common carotid a
Vertebral Level of C5-C6
Arch of cricoid cartilage, superior esophagus and superior trachea
Posterior Triangle Boarders
SCM, Trapezius, and Clavicle
Posterior Triangle Floor
Splenius Capitis, semispinalis capitis, Scalenes, Levator scapula
Posterior Triangle Arteries
Thyrocervical gives off two branches:
Transverse Cervical A
- deep (dorsal scapular s)
- superficial
Suprascapular A
Posterior Triangle Veins
External Jugular Vein
-blood from posterior retromandibular v and posterior auricular v anterior to SCM
—drains into subclavian v
Subclavian v
-combines with internal jugular v to form brachiocephlaic v
Posterior Triangle Cutaneous N
Lesser Occipital:
-Skin of neck and scalp behind ear
Great Auricular:
-jaw muscle and ear
Transverse Cervical:
-skin of anterior neck
Suprascapular:
-skin over clavicle and shoulder
Posterior Triangle Motor N
Spinal Accessory N (CN XI)
-SCM and Trapezius M
Phrenic
-in front of ant. Scalene m, supplies diaphragm (C3, C4, C5)
Roots of Brachial Plexus
Ansa Cervicalis: in fascia over carotid sheath
Most commonly damaged nerve in posterior triangle?
Spinal Accessory N.
-most commonly accidentally cut during surgery
Torticollis
Shortening of SCM; head tilts toward, and turns face away from affected side
Submandibular Triangle (boarders, floor, contents)
Boarders: mandible above, a and p bellies of digastric m
Floor: mylohyoid, hypoglossus m, and middle pharyngeal constrictor m
Content:
- Submandibular gland and LN
- Hypoglossal N and N to mylohyoid m
- Part of Facial A and V
Submental Triangle (boarders, floor, contents)
Boarders: Most anterior and middle!
-hyoid, midline of neck, anterior belly of digastric m
Floor: mylohyoid m
Contents:
- submental LN
- Veins that form anterior jugular v
Muscular Triangle Boarders
Omohyoid, SCM, and Median plane of neck
Muscular Triangle Muscles
Sternohyoid (from sternum to hyoid)
Sternothyroid (sternum to thyroid)
Thyrohyoid: from thyroid to hyoid
Muscular Triangle Contents: viscera
Thyroid glands, parathyroid glands, larynx, trachea, and espophagus
Muscular Triangle Contents: Arteries
Common carotid a, superior thyroid a (from external carotid), inferior thyroid a (from throcervical trunk)
Muscular Triangle Contents: Nerves
Ansa cervicalis, external laryngeal n (from superior laryngeal n), recurrent laryngeal n (from vagus, forms inferior laryngeal n)
Carotid Triangle Boarders
Superior Belly of omohyoid, posterior belly of digastric, and SCM
Carotid Triangle Floor
thyrohyoid, hypoglossus, middle and inferior constrictor muscles of pharynx
Carotid Triangle: Carotid Sheath
Common and internal carotid arteries, internal jugular v, vagus n, deep cervical LN, carotid sinus n, sympathetic n fibers
Ansa cervicalis anterior or embedded within
Carotid Triangle Contents: Arteries
Branches of external carotid a
Carotid Triangle N
Internal and external laryngeal n, hypoglossal n, spinal accessory n, and ansa cervicalis
Carotid Triangle Vasculature
Superior Thyroid: gives rise to superior laryngeal a, supplies thyroid
Ascending Pharyngeal: only medial branch
Lingual A:anterior to middle pharyngeal constrictor, deep to hypoglossal n and stylohyoid m
Facial A: gives rise to ascending palatine a and tonsillar a, found deep to submandibular glands
Occipital A: passes superficial to ICA and hypoglossal n
Posterior auricular A: ascends between external acoustic meats and mastoid process
External carotid terminates as..
Maxiallary a and superficial temporal a in the face
Carotid Sinus
Bulge in the internal carotid A
-acts as baroreceptor for BP
Carotid Body
Mass of tissue that receives inner action from Glossopharyngeal N (CN XI)
-acts as chemoreceptor
Vagus N Branches
Pharyngeal Branch
Superior laryngeal
- internal branch
- external branch
Thoracic Inlet
Superior thoracic aperture where food and air enter INTO
Thoracic Outlet
Clinician reference where arteries and nerves come OUT of
Contents of Thoracic Outlet/Inlet
Apex of lung, subclavian a and v, brachial plexus, vagus n, phrenic n, thoracic duct, right lymphatic duct, sympathetic chain, trachea and esposphagus
CN: Phrenic N
Sole supplier of diaphragm
- MUST be identified during surgery
- arises in neck, so if injury below the neck then person can still breath
Cervical Plexus
Anterior Rami of C1-C4
Superficial-Sensory
-Lesser Occipital, Great Auricular, Supraclavicular, Transverse Cervical
Deep-motor
-Phrenic and Ansa Cervicalis
Sympathetic Trunk
Extends to C1 or base of Skull
Made up of three ganglion:
Superior C1-C2
Middle C6, smallest
Inferior C7 T process
-80% fuses with stellate ganglion
Superficial Fascia and Platysma
Subcutaneous layer
-contains cutaneous n, blood and lymph vessels, LN, fat
Platysma M
Muscle of Facial expression, therefore innervated by Facial N (CN VII)
Investing Layer of Deep Cervical Fascia
Most Superficial, incloses SCM and Trapezius
- encloses parotid and submandibular glands
- attaches to occipital and temporal bones, zygomatic arches
- extends into manubrium
Pretracheal Layer of Deep Cervical Fascia
Located anterior neck region only, blends with pericardium of heart
Prevertebral Layer of Deep Cervical Fascia
Encloses vertebral Column and muscles
-extends laterally as axillary sheath and from cranial base into mediastinum
Retropharyngeal Space
Posterior to pharynx, bound by buccopharyngeal fascia, prevertebral fascia, and carotid sheaths laterally
-extends from skull to mediastinum
Retropharyngeal Abscess
Develops secondary to lymphatic drainage, or contiguous spread of upper respiratory infections
- can cause swelling, difficultly in swallowing and speech
- can be life threatening
Thyroid Gland Location
Deep tp sternothyroid and sternohyoid m
-C5-T1 level
Thyroid Gland Arterior and Venous Supply
Arteries:
- superior and inferior thyroid
- thyroid ima artery: found in 10%; be aware during tracheotomy
Veins:
-superior, middle and inferior thyroid veins from thyroid plexus of veins
Larynx
At C3-C6, connected to pharynx and trachea
-helps talk and breath
Thyroid Cartilage Features
Located at C4
- laminae in front,
- laryngeal prominence (Adams apple)
- superior thyroid notch
- superior and inferior thyroid horns
Cricoid cartilage features
Located at C6
- signet ring in front with laminae in back
- arch above signet ring
Laryngeal Spaces: laryngeal Cavity
Extends laryngeal inlet, communicates w laryngopharynx, to inferior boarder of cricoid cartilage;
-continuous w trachea
Laryngeal Spaces: laryngeal vestibule
Between laryngeal inlet and vestibular folds
Laryngeal Spaces: Laryngeal Ventricle
Between vestibular and vocal folds
Laryngeal Spaces: Infraglottic cavity
Between vocal folds and inferior boarder of cricoid cartilage
Laryngeal Spaces: Roma glottidis
Between vocal folds
Cricothyroid (innervation and action)
Innervated by external laryngeal n
Stretches and tenses vocal ligament
Thyro-arytenoid M (innervation and action)
Innervated by inferior laryngeal n
Relaxes vocal ligament
Posterior crico-arytenoid Ligament (innervation and action)
Innervated by inferior laryngeal n
ONLY ABDUCTOR OF VOCAL FOLDS
Lateral Crico-arytenoid M (innervation and action)
Innervated by inferior laryngeal N
Adducts vocal folds
Transverse and oblique arytenoids (innervation and action)
Innervated by inferior laryngeal n
Adducts vocal folds
Vocalis M (innervation and action)
Innervated by inferior pharyngeal N
Relaxes posterior vocal ligament, while maintaining tension on anterior part
Superior laryngeal A
Supplies superior larynx above vocal folds
Inferior Laryngeal a
Accompanies inferior laryngeal nerve
-supplies inferior larynx below vocal folds
Superior Laryngeal N
Branches into internal and external branches
Internal branch:
-sensory above folds
external branch
-innervated cricothyroid m
Inferior laryngeal N
Terminal branch of recurrent laryngeal n
Sensory and Motor
-all intrinsic muscles besides cricothyroid
Sensory below vocal folds
Occipital LN
Drain posterior scalp and neck
Passes to superficial cervical LN
Mastoid LN
Posterolateral half of scalp
Passes to superficial cervical nodes
Pre-auricular LN and Parotid LN
Drains anterior ear, anterolateral scalp, upper half of face
Passes to deep cervical nodes
Submandibular LN
Follows facial artery, drains parties of mouth
Passes to deep cervical nodes
Submental LN
Drains lower lip, floor of mouth, tip of tongue and lower incisor teeth
Passes to deep cervical nodes
Superficial Cervical LN
Receive lymph from occipital and mastoid LN, will pass to deep cervical LN
Deep Cervical LN
Jugulodigastric: most superior of deep LN
Jugular-omohyoid: associated w lower deep cervical LN
Right Lymph Duct
Right side of chest, UE, neck, and head
Thoracic Duct
Left side of head, chest, and neck, and UE and both LEs