neck

Question 1

functions of neck and fascia DIAGRAM

Answer 1

structural- support and move head, with muscles inside prevertebral fascia most posterior visceral- separates mouth from GI tract and thorax- structures associated with pretracheal fascia most anterior pathway for blood vessels+ nerves (jugular vein, vagus and common carotid) structures in carotid sheaths

Question 2

transverse slice through neck DIAGRAM

Answer 2

scalene muscles in prevertebral sheath near visceral part and vascular part is infrahyoid muscles and sternoclastoid muscles, with trapezium posteriorly

Question 3

important levels of neck

Answer 3

C1- level of open mouth C2- superior cervical ganglion C3- body of hyoid (has suprahyoid and infrahyoid muscles) C4- thyroid cartilage+ bifurcation of common carotid C6- cricoid cartilage+ middle cervical ganglion C7- inferior cervical ganglion

Question 4

importance of superior, middle and inferior cervical ganglion

Answer 4

SNS innervation to head- SNS only thoracolumbar, so ganglion needed

Question 5

importance of thyroid and cricoid cartilage

Answer 5

airway can be opened in between the two if there is eg trauma to pharynx

Question 6

triangles of neck DIAGRAM

Answer 6

anterior and posterior triangles are formed by sternoclastoid muscles- needed to look over should (ie left muscle helps look over right shoulder) sternoclastoid muscle goes from clavicle to mastoid process, and trapezius behind posterior formed by sternoclastoid, trapeziuz and middle 3rd of clavicle anterior formed by mandible, anterior border of sternoclastoid and midline down to sternum

Question 7

anterior triangle- what it consists of

Answer 7

mainly muscles that control movement of head- platysma, mylohyoid, digastric and infrahyoid also contains carotid arteries and internal jugular vein

PLEASE MAKE DINNER IN TIME

Question 8

muscles in anterior triangle DIAGRAM

Answer 8

attached to hyoid bone is posterior and anterior belly of digastric muscles also mylohyoid muscle and stylohyoid muscle which goes up to styloid process

Question 9

muscles of anterior 2

Answer 9

there is thyrohyoid (from hyoid bone to thyroid), sternothyroid (from sternum to thyroid), sternohyoid (from sternum to hyoid) and omohyoid (from shoulder to hyoid), hence all names logical

Question 10

side view of anterior triangle DIAGRAM

Answer 10

internal carotid, internal jugular (mainly covered by sternoclastoid- so hard to palpate) and accessory nerve seen, which innervates sternoclastoid and trapezius, hence damage prevents looking over shoulder and shrugging

Question 11

posterior triangle DIAGRAM

Answer 11

mainly blood vessels/nerves rather than muscles external jugular vein (over sternoclastoid- pulse here indicator of right heart function), subclavian artery/vein, trunks of brachial plexus, phrenic, accessory and vagus nerve

Question 12

posterior triangle sternoclastoid removed DIAGRAM

Answer 12

different nerves, many present between anterior and middle scalene muscles brachial plexus from C5-T1, and subclavian vein where you put central venous lines (canuli- tube) to drain blood out/get rid of infection

Question 13

root of neck DIAGRAM

Answer 13

recurrent laryngeal goes around right subclavian/aortic arch, vulnerable to damage from eg surgery also subclavian vein, common carotid, vertebral arteries, scalene anterior muscles, phrenic nerve, brachial plexus and thoracic duct

Question 14

lymphatic drainage DIAGRAM

Answer 14

lymph drainage occurs either side of sternocleidomastoid, also beneath mandilbe as well tumours from below eg thorax can spread via this route and go up to neck and head

Question 15

holes of skull DIAGRAM

Answer 15

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Question 16

superfiscial fascia of neck

Answer 16

skin, fat, and platysma muscle (innervated by CN 7)

Question 17

compartments of neck DIAGRAM

Answer 17

vertebral- vertebrae and muscles visceral- trachea, oesophagus+ thyroid vascular- internal jugular, cartoid and CN 10

Question 18

importance of hyoid

Answer 18

all anterior neck muscles relate to hyoid

Question 19

muscles of anterior triangle+ pneumonic

Answer 19

suprahyoid muscles- mylohyoid, stylohyoid, geniohyoid and digastric infrahyoid (strap muscles)- sternohyoid, omohyoid, sternothyroid and thyrohyoid TOSS MY GRAVE SPOON DARLING- TOSS is infrahyoid muscles, rest in suprahyoid muscles

Question 20

innervation of suprahyoid muscles

Answer 20

ANTERIOR INNERVATION- mylohyoid and anterior belly of digastric- mandibular nerve of trigeminal POSTERIOR INNERVATION- stylohyoid and posterior belly of digastric- facial nerve geniohyoid- C1 fibres via hypoglossal nerve

Question 21

mylohyoid , geniohyoid and anterior belly of digastric attachements and function DIAGRAM

Answer 21

ALL 3- body of mandible and hyoid

mylohyoid depresses mandible, elevates hyoid and support floor of oral cavity

geniohyoid depresses mandible, protracts hyoid

digastric depresses mandible and elevates hyoid

Question 22

function of geniohyoid

Answer 22

depress mandible

Question 23

stylohyoid and posterior belly of digastric attachment and function DIAGRAM

Answer 23

styloid process and hyoid vs mastoid process and hyoid BOTH- retract and elevate hyoid

Question 24

innervation of muscles summary

Answer 24

anterior suprahyoid muscles innervated by V3 (mandibular), posterior by V11, and infrahyoid by ansa cervicalis (c1-3) EXCEPT geniohyoid and thyrohyoid (C1 fibres via hypoglossal nerve)

Question 25

contents of posterior triangle

Answer 25

external jugular, subclavian artery+ vein brachial plexus, accessory, phrenic and vagus nerve

Question 26

2 structures in front of and behind anterior scalene muscle

Answer 26

subclavian vein and phrenic nerve vs brachial plexus and subclavian artery

Question 27

accessory nerve- susceptibility and testing of nerve

Answer 27

test by raising shoulders superficial in posterior triangle, so vulnerable to damage

Question 28

path of vagus and test for it

Answer 28

travels in carotid sheath- test via gag reflex

Question 29

path of phrenic nerve

Answer 29

enters thorax between subclavian artery and vein

Question 30

blood supply of thyroid gland

Answer 30

supplied by superior and inferior thyroid artery drained by superior, middle and inferior thyroid veins

Question 31

course of carotid artery

Answer 31

right CC branch of brachiocephalic, left directly from aortic arch go behind sternoclavicular joints, up carotid sheath and bifurcates at C4

Question 32

branches of subclavian artery with pathways of them

Answer 32

vertebral artery internal thoracic artery- forms anterior intercostal arteries inferior thyroid artery

Question 33

types of centra venous lines

Answer 33

catheter placed in neck (internal jugular) or thorax (subclavian)

Question 34

why right internal jugular preferred than left

Answer 34

larger and straighter, so easier to access

Question 35

insertion into internal jugular vein and landmarks DIAGRAM

Answer 35

find common carotid artery, and insert needle laterally at 45 degree angle landmarks- apex of triangle of sternal and clavicular head of sternocleidomastoid (in triangle is where internal jugular is)

Question 36

use of central venous lines

Answer 36

monitors central and jugular venous pressure, delivers toxic drugs eg antibiotics and dialysis

Question 37

problems with central venous lines

Answer 37

can puncture common carotid, damage nerves, cause infection and thrombosis

Question 38

lymph nodes DIAGRAM

Answer 38

there are submental,submandibular, parotid and occipital, which drain into deep cervical nodes lying along internal jugular vein thus parotid glands palpated next to ears, submental on middle of chin, submandibular on lateral sides of neck, occipital behind ear

Question 39

what can cause lymphoedema