Neck anatomy and physiology Flashcards
What are the anatomical contents of the neck?
Arteries Veins Nerves Lymph nodes Lymphatic channels Thyroid gland Parathyroid gland Muscles Trachea
What are the boundaries of the neck?
Superior- mandible
Inferior- clavicle
Anterior- anterior midline
Posterior- trapezius
What are the 2 triangles of the neck?
Anterior and posterior triangles
What are the borders of the anterior triangle of the neck?
Anterior- midline
Posterior- anterior border of sternocleidomastoid
Superior- mandible
What are the borders of the posterior triangle of the neck?
Anterior- posterior boxer of sternocleidomastoid
Posterior- anterior border of trapezius
Inferior- clavicle
What structures are in the anterior triangle of the neck?
Common carotid artery External and internal carotid artery Facial artery Internal jugu;ar vein Facial vein Hypoglossal nerves Vagus nerves Glossopharyngeal nerves Accessory nerves Laryngeal nerves Submandibular and submittal nodes
What are the contents of the posterior triangle of the neck?
Accessory nerve Cervical nerve plexus Occipital artery External jugular vein Lymph nodes
At what level does the common carotid divide?
C4
What are the branches of the external carotid?
Superior thyroid Ascending pharygeal Lingual Occipital Facial Posterior auricular Maxillary Superficial temporal
What are the main veins of the head and neck?
External jugular Anterior jugular Communicating Maxillary Facial Suprotrochlear Supraorbital Posterior external jugular Oblique jugular Retromandibular Posterior auricular
What are the lymph node levels?
I= submandibular;ar and submental II-IV= Upper, middle and lower jugular V= posterior triangle VI= Midline nodes
What do the parotid nodes drain?
Scalp, face and parotid gland
What do the occipital nodes drain?
Scalp
What do the superficial and cervical nodes drain?
Breast and solid viscera
What do the deep cervical nodes drain?
Final drainage pathway to the thoracic duct
What do the submandibular nodes drain?
Tongue, nose, paranasal sinuses, submandibular gland, oral cavity
What do the submental nodes drain?
Lips, floor of mouth
What dot he supraclavicular nodes drain?
Breast, oesophagus, solid viscera
What are the causes of lymphadenopathy?
Infective
Inflammatory
Malignant
What is the structure of the thyroid gland?
2 lobes connected by isthmus
What does the thyroid gland produce?
Thyroid hormones and calcitonin
What does calcitonin do?
Acts to lower calcium and raise phosphate
What is a thyroglossal cyst?
Dilation of the thyroglossal duct remnant
What are the causes of a solitary thyroid nodule?
Cyst
Adenoma
Carcinoma
Lymphoma
What causes a thyroid cyst?
Localised haemorrhage
How is a solitary thyroid mass investigated?
Fine needle aspiration cytology and ultrasound scanning
What causes diffuse thyroid enlargement?
Colloid gotre
Grave’s disease
Thyroiditis
What is Colloid goitre and what is the cause?
Iodine deficiency due to gland hyperplasia
Can be caused by puberty, pregnancy, lactation
What is Grave’s disease?
Autoimmune disease resulting in hyperthyroidism
What does Grave’s disease cause?
Thyroid eye disease
Acrophachy/clubbing
Pre tibial myxoedema
What is the treatment of Grave’s disease?
anti-thyroids
Beta blockade
Radio-iodine
Surgery
What causes multi nodular goitre?
Grave’s disease or toxic goitre
What investigations are carried out for multi-nodular goitre?
TFTs
Fine needle aspration cytology
CXR
What are the forms of thyroid cancer?
Papillary
FollicularMedullary
Anaplastic
What are the indications for a thyroidectomy?
Airway obstruction Malignancy/suspected malignancy Thyrotoxicosis Cosmesis Retrosternal extension
What are the possible complications of a thyroidectomy?
Bleeding Voice hoarseness Thyroid storm Infection Hypoparathyroidism Hypothyroidism Scar
How many parathyroid glands are there?
4 usually
What is the function of the parathyroid glands?
Regulate calcium and phosphate levels
Where are the parathyroid glands located?
Posterior to the poles of the thyroid
What are the signs and symptoms of parathyroid disease?
Renal canaliculi, polyuria, renal failure
Pathological fractures, osteropososis, bone pain
Abdo pain, constipation, peptic ulceration, pancreatitis, weight loss
Anxiety and depression, confusion, paranoia
What investigations are carried out for parathyroid disease?
U+E, creatinine, Ca, phosphate Parathyroid hormone, bicarb Vit D Ultrasound CT/MRI Isotope scanning
What is the treatment for hyperparathyroidism?
Surgery
Medical treatment
What is the treatment for parathyroid disease, excluding hyperparathyroidism?
Medical treatment
What surgical treatments can be done for hyperparathyroidism?
Removal of single or multiple adenomas or hyper plastic glands
Removal of carcinomas with thyroid glands and lymph nodes
What ar he 4 fascial layers of the neck?
Pre-tracheal
Pre-vertebral
Deep cervical
Carotid sheath
What are the indications for tracheostomy?
Airway obstruction
Airway protection
Poor ventilation to reduce dead space
What are the causes of inspiratory stridor?
Laryngeal
What are the causes of expiratory stridor?
Tracheobronchial
What are the causes of biphasic stridor?
Glottic/subglottic
How is stridor terated
O2
adrenaline (neb)
IV dexamethasone
Definitive airway management
What is a brachial cyst?
Remnant of fusion failure of brachial arches or lymph node cystic degeneration
Where do brachial cysts arise?
Anterior to sternocleidomastoid at junction between upper and middle thirds of trachea
What is the treatment for a brachial cyst?
Excision
What is a pharyngeal pouch?
Herniation of pharyngeal mucosa through thyropharyngeus and cricopharynxgeus muscles of the inferior constrictor of the pharynx
What are the signs and symptoms of a pharyngeal pouch?
Voice hoarseness Regurgitation Dysphagia Weight loss Aspiration pneumonia Neoplasia
What investigations are done for a pharyngeal pouch?
Barium swallow
How is a pharyngeal pouch treated?
Excision
Dilation
