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MRCS part B > Neck anatomy > Flashcards

Neck anatomy Flashcards

1
Q

What is the blood supply to the pharynx

A

Arterial supply to the pharynx is via branches of the external carotid artery:
* Ascending pharyngeal artery
* Branches of the facial artery
* Branches of the lingual and maxillary arteries.
Venous drainage is achieved by the pharyngeal venous plexus, which drains into the internal jugular vein.

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2
Q

What is the blood supply to the larynx

A

The arterial supply to the larynx is via the superior and inferior laryngeal arteries:
* Superior laryngeal artery – a branch of the superior thyroid artery (derived from the external carotid). It follows the internal branch of the superior laryngeal nerve into the larynx.
* Inferior laryngeal artery – a branch of the inferior thyroid artery (derived from the thyrocervical trunk). It follows the recurrent laryngeal nerve into the larynx.
Venous drainage is by the superior and inferior laryngeal veins. The superior laryngeal vein drains to the internal jugular vein via the superior thyroid, whereas the inferior laryngeal vein drains to the left brachiocephalic vein via the inferior thyroid vein.

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3
Q

Vocal cord histology

A
  • Non-keratinised stratified squamous epithelium – Stratified layer provides extensive protection against foreign bodies which may accidentally enter the larynx.
  • Reinke’s space – This watery, amorphous layer is rich in glycosaminoglycans. Due to its fluidity, the epithelium is able to vibrate freely above it to create sound.
  • Vocal ligament – Lies at the free upper edge of the cricothryoid ligament.
  • Vocalis muscle – Exceptionally fine muscle fibres that lie lateral to the vocal ligaments.
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4
Q

What is the vocal ligament a part of

A

Its the upper free edge of the conus elasticus

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5
Q

What are the contents of the pre-tracheal fascia

A

The trachea, the thyroid gland and the oesophagus lie in the pre-tracheal fascia

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6
Q

What muscles are contained in the pre-vertebral fasciA

A

Scalenes, levetor scapulae, splenu capitus

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7
Q

Describe the contents of the posterior triangle of the neck

A

Vessels: subclavian artery, transverse cervical artery , suprascapular artery and vein, occipital artery, external jugular vein
Nerves: CN11 and phrenic plus roots of the brachial plexus
Muscles: Omohyoid
Lymph nodes

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8
Q

What is the surface anatomy of the spinal accessory nerve

A

Posterior triangle of the neck, 1/3rd of the way down SCM to 1/3rd of the way up the anterior border of the trapezius

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9
Q

Describe how the anterior triangle can be further divided

A
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10
Q

How do you prevent recurrence of a thyroglossal cyst

A

Excise the middle one third of the hyoid bone as well

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11
Q

WHat is the sensory supply to the larynx

A

Superior laryngeal nerve above the level of the vocal cords and rec lar below

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12
Q

Where do the neck cartilages lie (What levels) and what arches are they derived from

A

C3 is hyoid, C4 is thyroid and C6 is cricoid

This helps us remember that the hyoid is 3rd arch derivative, thyroid is 4th and the cricoid is 5th

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13
Q

\What muscles abduct and adduct the vocal corts

A

posterior Cricoartenoids abduct and lateral adduct

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14
Q

Where do the superior and inf parathyroids originate

A

Sup is 4th pharyngeal pouch and the inf is 3rd

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15
Q

Which pharyngeal arch does the mylohyoid develop from

A

1st

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16
Q

How does the submandibular duct run

A

It lies deep to the mylohyoid and superficial to hyoglossus, it is 5cm long and opens on the floor of the mouth on either side of the lingual frenulum

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17
Q

How are the fascial layers of the neck divided

A

superficial and deep fascia

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18
Q

Superficial fascia

A

Lies deep to the dermis and surrounds the platysma and muscles of facial expression

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19
Q

Deep cervical fascia

A

Superficial layer: External investing layer
Middle: Pre-tracheal fascia and the carotid sheath
Internal layer: Prevertebral fascia

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20
Q

Investing fascial layer

A

Wraps around the submandibular gland, parotid, SCM, trap and muscles of mastication

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21
Q

What are the components of the pre-tracheal fascia

A

Muscular part: Encloses infrahyoid muscles
VIsceral: Thyroid and parathyroid
Buccopharyngeal fascia: Encompasses the pharynx and the oesophagus

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22
Q

Pre-vertebral fascia

A

Contains muscles and associated vertebrae

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23
Q

What is the retropharyngeal space and why is it important

A

Space between the pre-tracheal and the pre-vertebral fascia. Extends from the skull base and can hence increase spread of infection to and from the medastinum

The danger area is posterior to the retropharyngeal space and can get infected very quickly due to the presence of loose areolar tissue

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24
Q

Levels of lymph nodes

A

1a submental space
1b submandibular space
2a: superiorly there is the skull base, inferiorly there is the hyoid bone, laterally the anterior border of the SCM and medially the submandibular gland
2b: Sup and inf same as 2a but medially there is ant border of SCM and laterally post border of SCM. Seperated from 2a by the posterior border of the internal jugular vein
3: Hyoid to cricoid and basically on SCM, anterior border is the common carotid and posterior border is the posterior border of the SCM
4: cric to clavicle and on SCM and same borders as level 3
5a: posterior to scm and above cric
5b: 5a but below cric
6: pretracheal
7: sternal notch

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25
Q

What kind of neck dissections are there

A

Radical: Levels 1-5 and sacrificing the spinal accessory, IJV and the SCM
Modified: Preserving one or more of the above
Selective: One or more levels of lymph nodes removed and nothing sacrificed
Extended: Taking out structures that are not usually taken out in a neck dissection.

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26
Q

What are the contents of the occipital triangle of the neck

A

Transverse cervical artery, EJV, Spinal accessory, lymph nodes, upper trunk of the BP, cutaneous branches of the cervical plexus

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27
Q

What are the contents

A

Subclavian artery and vein, lymph nodes, SUprascapular arter, lower trunks of the brachial plexus, spex of the lung, phrenic nerve and thoracic duct.

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28
Q

How do patients with a carotid body tumour often present

A

Palpable neck lump and no other symptoms. They can also have a fever of unknown origin but this is uncommon.
Some can also present with hypotension, TIAs, signs of hypoglossal, rec lar, glossopharyngeal nerve palsy

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29
Q

What are the indications for a carotid endarterectomy

A
30
Q

Name the anatomy of the cervical plexus

A

C1-C4
Located laterally to the transverse processes and emerge for the posterior triangle and emerge midway on the posterior border of the sternocleidomastoid
Anastomose with accessory and hypoglossal nerves and sympathetic
There is muscular and cutaneous components

31
Q

Name the cutaneous branches of the cervical plexus

A

Lesser occipital (C2 only)
Greaterauricular (C2,C3)
Transverse cervical (C2,C3)
Supraclavicular (C3,C4)

32
Q

Name the muscular branches of the cervical plexus

A

Ansa cervicalis (C1-C3): Infrahyoid strap muscles
Phrenic (C3-C5)
Communicating branches (C1) supplies genio and thyrohyoid
Segmental (C1-C4): Supplies ant and middle scalene

33
Q

Name the supra and infrahyoid strap muscles of the neck

A
34
Q

Erbs point

A

Halfway along the posterior border of the SCM at the level of the cricoid. Used for cervical nerve root blocks

35
Q

Where are the superior and inferior thyroid glands normally found

A

The superior are the most consistent in position and are found at the inferior border of the cricoid cartilage, 1cm superior to the point of entry of the inferior thyroid arteries
Arise from the 4th pharyngeal arch

Inferior thyroid usually near the inferior pole >1cm below the inferior thyroid artery entry. 3rd pharyngeal arch origin

36
Q

What is the pharynx

A

It is a fibromuscular tube extending from the base of the skull to the cricoid cartilage

37
Q

What is the function of the pharyngeal muscles

A

The internal long muscles shorten the pharynx while speaking and swallowing
The external circular ones help in swallowing as well

38
Q

Name the structures that pass between the middle and the inferior constrictors

A

Internal laryngeal nerve and superior laryngeal vessels

39
Q

Name the structures that pass below the inferior constrictor

A

Inferior laryngeal vessels and rec lar

40
Q

What is the blood supply to the pharynx

A

Ascending pharyngeal
Facial
inferior thyroid

41
Q

Vertebral positioning of the larynx

A

C3 to C6

42
Q

What are the cartilages of the larynx

A

Thyroid cricoid and epiglottic are unpaired

Paired: Arytenoid, cuneiform and corniculate

43
Q

What is the blood supply to the larynx

A

Superior and inferior thyroid.

44
Q

Describe the anatomy of the parotid gland

A

Superiorly: The zygomatic arch
Inferiorly: ramus of the mandible
Posteriorly: EAC and SCM + mastoid
Anteriorly: anterior border of the masseter

45
Q

Where does the parotid duct lie

A

Opposite the upper second molar and pierces the buccinator muscle

46
Q

What is the arterial and venous blood supply

A

Arterial: Branches of the external carotid artery and via superficial temporal and and posterior auricular
Venous: Retromandibular vein

47
Q

Nerve supply of the parotid

A

Sensory: Auriculotemporal
Secretions: glossopharyngeal

48
Q

What are the structures within the substance of the parotid gland

A

Superficial to deep

49
Q

What is Freys syndrome

A

Auriculotemporal nerve misdirected regeneration and they wrongly join the sympathetic fibers which supply the sweat glands and vessels

Hence, this results in facial sweating while talking or thinking about food instead of salivation

50
Q

What is the blood supply to the submandibular gland

A

lingual artery and submental branch of the facial artery

51
Q

Why are stones more common in the submandibular gland as opposed to the parotid

A

Higher Ca concentration.
The Wartons duct is also longer and the saliva also has to flow against gravity

52
Q

FACT

A

C2 vertebrae does not have a bifid spinous process and has dens

C1 has the superior articular facet to join the occipital condyles

53
Q

Which joint permits flexion and extension of the neck

A

Atlanto-occipital joint, it is a synovial type joint surrounded by a loose capsule

54
Q

Why is a fracture to the dens significant

A

Can severe the spinal cord and cause quadriplegia

55
Q

What is a hangman’s fracture

A

Fracture of pars intercularis of C2 caused by hyperextension injury

56
Q

FACT

A

The marginal mandibular nerve runs with the facial artery and is next to it as they both cross the mandible (The palpable area on the mandible).

57
Q

What nerve runs close to the parotid duct

A

Buccal branch of the facial nerve

58
Q

What are the landmarks of the cervical vertebrae

A

C1 = hard palate
C2 = angle of mandible
C3 = hyoid bone
C4 = superior thyroid notch
C5 = thyroidcatilage
C6 = cricoidcartilage
C7 = upper tracheal rings.

59
Q

Name the structures

A

This is at the C4/C5 level as the carotids have not bifurcated yet and the vocal cords are just visible

60
Q

Describe the larynx anatomy from this picture

A

The epiglottis is superior, arising from the anterior surface. The tracheal rings are inferior. The specimen shown is therefore viewed from the incised posterior side, i.e. we are looking at the front of the larynx from the inside.

A is the epiglottis
B aryepiglottic folds
C vallecula
D Piriform fossae
E Posterior cricoartenoid muscle
G is the vestibular fold - have a blood flow
H is the vocal fold - Do not have a blood flow

61
Q

What nerve passes anterior to the external carotid artery

A

Hypoglossal nerve

62
Q

What age do cranial sutures ossify

A

18-24 months
It is called craniosynostosis

63
Q

By what age does the mastoid develop

A

2 years

64
Q

What are the contents of the anterior triangle

A
65
Q

What are the contents of the posterior triangle of the neck

A
66
Q

What is the embryology of the thyroid gland

A

The thyroid gland develops from the foramen caecum (⅔ along the length of tongue from the tip) to pass forward and loop around beneath the hyoid bone. Incomplete descent → lingual or pyramidal thyroid Incomplete closure of the pathway of descent → thyroglossal cyst

67
Q

What is the embryology of the parathyroid gland

A

Embryology? * Inferior parathyroid from the 3rd branchial arch with the thymus * Superior parathyroid from the 4th branchial arch

68
Q

What is the muscle responsible for tensing the vocal cords

A

Muscles responsible for tensing vocal cords? By the 2 cricothyroid muscles

69
Q

What veins are involved in oesophageal varicies

A

Left gastric vein and azygous vein

70
Q
A

MRCS part B (10 decks)

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