Neck Flashcards
Give the important anatomical structures of C3,C4,C6.
C3: Hyoid bone
C4: Thyroid cartilage, bifurcation of the CCA
C6: Cricoid cartilage, esophagus + trachea begin, vertebral artery enters transverse foramen
What is the clinical significance(s) of carotid tubercle?
- anterior tubercle of the cotransverse process
1. press CCA to slow bleeding
2. landmark for injection of anesthesia to block spinal nerves/ sympathetic ganglia
Give the 8 branches of the ECA.
x4 in neck x4 in head
"Some anatomists love freaking out poor medical students" Neck - superior thyroid artery - ascending pharyngeal artery - lingual artery - facial artery Head - occipital artery - posterior auricular artery - maxillary artery - superficial temporal artery
What do carotid sinus and carotid body detect respectively?
Carotid sinus: BP change
Carotid body: CO2 change
What are the contents in the carotid sheath from a lower position to a higher position?
CCA + IJV + vagus
> ICA + IJV + CN9,10,11,12
Give the anatomical relationships of the different parts of the subclavian artery.
1st part: give out most branches, anterior: sternoclavicular joint, IJV, left phrenic nerve, thoracic duct
2nd part: anterior: scalenus anterior, right phrenic, subclavian vein
3rd part: posterior: 1st rib (most superficial part)
What is the clinical significance of lesser supraclavicular fossa?
Find IJV, between the 2 heads of SCM
Infrahyoid muscles move larynx in phonation and singing.
State all the suprahyoid and infrahyoid muscles.
- Suprahyoid muscles: mylohyoid, digastric, stylohyoid, geniohyoid
- Infrahyoid muscle: thyrohyoid, sternohyoid, sternothyroid and omohyoid
Which structure carries the brachial plexus and separates the subclavian artery and vein?
Scalenus anterior
Content of cervical plexus?
Ventral rami of C1-C4
Content of brachial plexus?
Ventral rami of C5-T1 (between anterior and medial scalene)
What are the 4 triangles in the anterior neck?
Carotid, digastric, submental, muscular
Content of the carotid triangle? (blood supply, nerves, muscle)
Carotid artery, IJV
CN 10,11,12, sympathetic trunk
Digastric muscles (posterior)
Content of the muscular triangle?
Viscera, strap muscles
Triangles in the posterior triangle?
Occipital triangle
supraclavicular triangle
Borders of the posterior triangle?
Trapezius, SCM, clavicle
The floor of the posterior triangle?
- levator scapulae
- back muscles
- scalene muscles
Nerves in the posterior triangle?
What do they supply?
CN11 brachial plexus cervical plexus (C1-C4) - C1: no C1 ganglion, no C1 sensory - C2-C4: to shoulder (supraclavicular nerve), head, neck
Ansa cervicalis (C1-C3)
- C1 runs along CN12, on carotid sheath
- supply strap muscles, geniohyoid muscle, levator scapulae, longus coli
State where does the 2 recurrent laryngeal nerves wind around.
Right recurrent laryngeal nerve: subclavian artery
Left recurrent laryngeal nerve: carotid arch between trachea and esophagus
Relationship of CN11?
Anterior: SCM and trapezius
Posterior: it crosses IJV superficially
Sympathetic trunk form loops (e.g. as ansa subclavius)
What type of fibers does it carry and where does it lie on?
Postganglionic fibers join spinal nerves and cranial nerves
Lies on longus muscle
List all the fascia in the neck.
- Investing fascia
- Prevertebral fascia
- pretracheal fascia
- carotid sheath
- alar fascia
List all the spaces in the neck.
- pretracheal space
- retropharyngeal space (to superior mediastinum)
- danger space (to diaphragm, mediastinum)
- prevertebral space (to coccyx)
What is the spinal level of the thyroid gland?
C5-C7
List all the arteries (big and small branches) related to the thyroid gland.
- ECA > superior thyroid artery
- Subclavian artery > Thyrocervical trunk > inferior thyroid artery
- Brachiocephalic trunk: thyroidea ima artery
List all the veins related to the thyroid gland. (and also their drainage)
- Superior and middle thyroid vein > IJV
- Inferior thyroid vein > brachiocephalic vein
Briefly describe the lymphatic drainage of the head and neck regions.
- Superficial nodes (around head and neck region and external, anterior jugular vein)
»> - Deep cervical nodes (along IJV)
- retropharyngeal, accessory, supraclavicular, outposts
> thoracic + right lymphatic duct
Most of the lymph nodes are ipsilateral.
State all the bilateral lymph nodes. (x4)
Soft palate, tonsil, tongue base, nasopharynx
At which 3 locations there are only a few lymph nodes?
true vocal cord,
middle ear,
paranasal sinus
Lymph from which structures drain to submandibular nodes?
- receive from submental, facial lymph nodes
- face, gum, floor of mouth, sublingual, submandibular glands
Lymph from which structures drain to deep cervical nodes?
from jugulodigastric + jugulo-omohyoid
- palatine tonsil (jugulodigastric), tongue, nasal cavity
Lymph from which structures drain to supraclavicular nodes?
enlarged on left = Virchow-Troiser’s node
Communicates with axillary nodes with breast lymph vessels, retrograde flow from thorax and abdomen
Lymph from which structures drain to retropharyngeal nodes?
upper lateral: node of Rouviere
-middle ear, auditory tube, nasal cavity (paranasal sinus), soft palate, nasopharynx, sometimes thyroid
Lymph from which structures drain to outposts around larynx and trachea?
Larynx, trachea, esophagus, thyroid
What possible consequences of cervical ribs (the transverse process of C7 may develop a floating rib?
compression on brachial plexus below it
Which 3 veins are considered to use for central venous catheterization?
- IJV
- Subclavian vein
- Femoral vein
How is the IJV located for central venous catheterization?
Puncture at the lesser supraclavicular fossa, lateral to the carotid pulse
- possible pneumothorax
- may damage thoracic duct at left, RA at right
How is the subclavian vein located for central venous catheterization?
Puncture at the middle of clavicle
- direct towards the sternal notch
- for obese people, possible pneumothorax
