Neck Flashcards
Why is the neck considered a conduit
It is the portion of the body connecting the head and thorax
Give the borders of the neck posteriorly and anteriorly
Posterior: from base of skull to top of T1 vertebra
Anterior: from mandible to top of manubrium and 1st costal cartilage
What is the fundamental differences between the neck and trunk
Neck does not contain a coelomic cavity
Where does the oesophageal striated muscle come from embryologically
Occipital somites
Which abdominal organs are protected by the ribs
Liver
Stomach
Spleen
Kidneys
What innervates the diaphragm
Phrenic nerve from the cervical plexus
Which bronchus is more likely to received an inhaled foreign body
Why
Right main bronchus
It is more vertically oriented
What produces a pneumothorax
What do you call blood in the pleural cavity
Puncturing the lung
Haemothorax
What are the compartments of the fasciae of the neck
Cervical fascia
Prevertebral fascia
Carotid sheath
Pretracheal fascia
Describe the cervical fascia
Attached posteriorly to ligamentum nuchae
Continuous around the neck
Encloses sternocleidomastoid, trapezius and parotid glands
Describe the prevertebral fascia of the neck
A transverse septum anterior to prevertebral muscles and posterior to pharynx and oesophagus
Covers cervical and brachial plexuses as well as muscles in the floor of the posterior triangle
Describe the carotid sheath
Consists of areolar tissue which is strong over the carotid arteries and weak over the jugular vein
Why is the carotid sheath weak over the jugular veins
To allow for expansion
Describe the pretracheal fascia
Attached to thyroid and cricoid cartilages and time the 2nd-4th tracheal rings
Invests the thyroid gland and passed down into the thorax and pericardium
What are the boundaries of the anterior triangle
Posterior: anterior border of sternocleidomastoid
Anterior: midline, between Mentum and suprasternal notch
Superior: inferior aspect of mandible, rising to an ape at the mastoid process of the temporal bone
What are the major structures passing through the anterior triangle of the neck (10)
Pharynx Larynx Trachea Oesophagus Thyroid Common, internal and external carotid arteries Jugular veins Vagus
Where is the posterior triangle of the neck
Lateral
It spirals around the neck
Where is the apex of the posterior triangle
Near the mastoid process
What are the boundaries of the posterior triangle of the neck
Posterior: anterior border of trapezius
Anterior: posterior border of sternocleidomastoid
Inferior: middle third of clavicle
What passes through the posterior triangle of the neck
Most structures supplying upper limb as well as spinal accessory nerve
Where is the fleshy insertion of sternocleidomastoid
Is there another?
Fleshy insertion on medial clavicle
Tendinous insertion on anterior manubrium
What does sternocleidomastoid do
Rotated face in opposite direction and tilts ear towards same shoulder
Acting bilaterally the muscles both flex lower cervical spine and extend upper cervical spine
How does trapezius affect the head when acting
a) bilaterally
b) unilaterally
a) extend cervical spine
b) rotates head to other side
What are the insertions (3) and origins (4) of trapezius
Origin: superior nuchal line
External occipital protuberance
Ligamentum nuchae
Spines and supraspinous ligaments of all T vertebrae
Insertion: lateral 1/3 of posterior clavicle, medial acromion, upper border of spine of scapula
True or false sternocleidomastoid and trapezius are supplied by the same nerve
True! The spinal accessory nerve
Where does the accessory nerve emerge and how does it reach trapezius
What is characteristic about its appearance
1/3 of the way down posterior sternocleidomastoid and crosses posterior triangle to supply trapezius
Wavy and superficial
What forms the floor of the posterior triangle
What covers this floor
Scalene muscles and levator scapulae
Prevertebral fascia
What is the origin of the scalenes
Which direction do the fibres run in
Arise from transverse processes of cervical vertebrae
Inferolaterally
What are the attachments of the scalenes
Scalenus anterior and medius: first rib
Scalenus posterior: second rib
What is the structure of the hyoid bone
U shaped with a body and greater and lesser horns
What is the hyoid particularly important for
Important support for the floor of the mouth and tongue
Intimately associated with pharynx and larynx
What is important for control of the muscles controlling the tongue
Hyoid
What are the suprahyoid muscles
Digastric
Stylohyoid
Mylohyoid
Geniohyoid
Describe the digastric muscle
What is its function
Has 2 bellies and an intermediate tendon
Anterior belly arises from digastric fossa on the back of the mandible while the posterior belly descends from deep to the mastoid process
Elevate the hyoid in swallowing and depress mandible when chewing
What are the strap muscles
Infrahyoid muscles
They include: sternohyoid, sternothyroid, omohyoid, thyrohyoid
Which infrahyoid muscle has 2 bellies
Omohyoid
Extending from scapula to hyoid
What are all infrahyoid muscles used in
Also
Chewing
Swallowing
Speech
They also stabilise the hyoid for the suprahyoid muscles
What supplies the infrahyoid muscles
The ansa cervicalis (C1-3)
Where is the thyroid
Within the pretracheal fascia, deep to the strap muscles
How are the lobes of the thyroid connected
By an isthmus lying across the 2nd-4th tracheal rings
How high can the thyroid rise
Why
What does this mean in thyroid expansion
Cannot ascend high than the oblique line
Overlying sternothyroid attached to thyroid cartilage
An enlarged thyroid must expand laterally and downwards even into superior mediastinum
What produces calcitonin
What does it do
Thyroid gland
Lowers serum calcium
Which arteries supply the thyroid
Superior thyroid (from external carotid) and inferior thyroid (from thyrocervical trunk from subclavian) arteries
What is the venous drainage of the thyroid
Via superior, middle and inferior thyroid veins
What produces parathormone
What does it do
Parathyroid glands
Raises serum calcium by mobilising it from skeleton
True or false: upper parathyroid glands are more variable in position
No - lower parathyroid are more variable
What arteries supply the parathyroid
Anastomoses between Superior and inferior thyroid arteries
Which nerves are associated with the thyroid
Superior laryngeal
Recurrent laryngeal
Where does the carotid sheath attach to the skull
The margins of the carotid foramen
Where is the vagus nerve in the neck
Posterior to IJV and common carotid
Where is the phrenic nerve in the neck
Under the prevertebral fascia on scalenus anterior
How is the EJV formed
Where does it enter the subclavian
Union of the posterior division of retro-mandibular vein with posterior auricular vein
Midpoint of clavicle
The EJV is superficial to what
Sternocleidomastoid
Where does the IJV join the subclavian
Behind the Sternoclavicular joint to form the brachiocephalic vein
How are the deep cervical nodes divided
Into superior and inferior groups lying among the IJV
Describe the superior deep cervical nodes
From Where do they receive (6)
Contain jugulodigastric nodes associated with afferents from the palatine tonsils
They receive from sub mandibular nodes, cranium, tongue, larynx, lower pharynx, and thyroid gland
Which nodes are associated with tongue drainage
Jugulo-omohyoid nodes (inferior group of deep cervical nodes)
Where does the inferior group of deep cervical nodes receive from
Tongue
Lower neck
Where does lymph from deep cervical nodes go
Forms as single trunk (the jugular lymphatic trunk) which opens into the thoracic duct or right lymphatic duct
Where does the IJV run
Why is this important
How is the IHV accessed
From lobe of ear to Sternoclavicular joint
For insertion of central venous lines
Between sternal and clavicular heads of sternocleidomastoid or deep to posterolateral border of the muscle
Where does the EJV run
From lobe of ear to mid clavicle
What valves are between IJV and right atrium
What does this mean
Why is this not true or EJV
None
The height of the column of blood provides a direct measure of right atrial pressure
EJV has valves and passage through musculo- fascial layers
How can IJV pulsation be seen
double wave flutter
By positioning patient at 45 degree angle to horizontal and shining a light across the neck
Where is IJV pressure measured
Above manubrio-sternal angle (<3cm)
What can be seen in the neck if right upper abdomen if compressed
What is this called
Why is this important clinically
Temporary rise in Jugular vein pressure
Hepatojugular reflex
Elevation of jugular vein pressure is a sign of heart failure and excessive infusion of IV fluids
What is torticollis
Wryneck
When spinal accessory nerve is irritated by surrounding lymph nodes
There is excessive contraction of sternocleidomastoid and trapezius in that side
Face is rotated in opposite direction
What can cause torticollis in babies
A tear during birth
What is the danger of lymph node biopsy in posterior triangle
Injury to spinal accessory nerve
Complete loss of function leads to droopy shoulder due to paralysis of trapezius and unopposed action of opposite sternocleidomastoid
What is important to remember in thyroid surgery
Superior and inferior thyroid arteries can be ligated
If this happens great care must be taken to avoid damage to external branch of superior laryngeal nerves and recurrent laryngeal nerves
What is tracheostomy
Division of the vascular thyroid isthmus and incision of 2nd and 3rd tracheal rings for passage of a tube
What do you do if the airway is blocked above the larynx
Emergency access to the airway can be gained via an incision in the cricothyroid membrane
What is enlarged in tonsilitis
Jugulo omohyoid nodes
What can a stab wound in the posterior triangle damage
Trunks of the brachial plexus
Where does the thyroid develop
Lower end of the thyroglossal duct which begins at the developing tongue
Where can thyroglossal cysts form
What is the sign
Anyway along the thyroglossal duct
Midline swelling that move up on protrusion of the tongue
What is a lingual thyroid
Remnants of thyroid tissue found on the surface of the tongue
What are brachial cysts
Lateral swellings resulting from a failure of normal pharyngeal development
