Neck - Anatomy/Physiology Flashcards
What are the Anatomical Contents of the Neck? (There are a lot)
- Arteries
- Veins
- Nerves
- Lymph nodes
- Lymphatic channels
- Thyroid gland
- Parathyroid glands
- Muscles
- Trachea
What is the superior boundary of the neck?
Mandible
What is the inferior boundary of the neck?
Clavicle
What in the anterior boundary of the neck?
Anterior midline
What is the Posterior boundary of the neck?
Trapezius
What are the boundaries of the anterior triangle of the neck?
- Anterior: midline of the neck
- Posterior: anterior border of sternocleidomastoid
What are the boundaries of the posterior triangle of the neck?
- Anterior: posterior border of sternocleidomastoid
- Posterior: anterior border of trapezius
What are the contents of the anterior triangle of the neck?
Arteries
- Common carotid artery
- Internal carotid artery
- External carotid artery
- Facial artery
Veins
- Internal jugular vein
- Facial vein
Nerves
- Hypoglossal nerves
- Accessory nerves
- Vagus nerves
- Laryngeal nerves
- Glossopharyngeal nerves
Lymph Nodes
- Submandibular nodes
- Submental nodes
What are the contents of the Posterior Triangle of the Neck?
Arteries
- Occipital artery
Veins
- External jugular vein
Nerves
- Accessory nerve
- Cervical nerve plexus
Lymph nodes
- Lymph nodes
What are the main artieries of the neck?
Draw the distribution of these arteries.
Common carotid (which divides at C4)
Giving the internal and external carotid.
The external carotid branches and gives:
- Superior thyroid
- Ascending pharyngeal
- Lingual
- Occipital
- Facial
- Posterior auricular
- Maxillary
- Superficial temporal
What are the main veins of the neck?
(13)
Draw them.
- External jugular vein
- Anterior jugular vein
- Posterior jugular vein
- Jugular arch
- Communicating vein
- Maxillary vein
- Facial vein
- Oblique jugular vein
- Retromandibular vein
- Post auricular vein
- Supratrochlear vein
**Insert Picture from slide 12**
- Supra-orbital vein
- Superficial termporal vein
Where is a central line inserted?
What are the indications for the insertion of a central line?
**needs answered**
Can be put in Sub Clavian vein
(can be used to cannulate if access cannot be gained via limbs etc)
Central venous pressure
Fluid resuscitation
Drug administration
Haemodialysis
Cardiac pacing
Intravenous nutrition
Blood sampling
What are the complications of a central line?
Pneumothorax
Air embolism
Thrombosis
Haematoma
Chylothorax
Sepsis
Cardiac tamponade
False passage
Line blockage
How many lymph nodes are there in the neck?
600
What do the lymph nodes drain in the head and neck?
Where does this go?
Receive lymph/ tissue waste product
Drain to cisterna chyli
Then drain to thoracic duct on left
How are lymph nodes desrcibed?
Can be described in terms of groups. But levels can also be used, particularly in cancer.
What are the lymph nodes of the head and neck?
Draw where these are found.
Parotid salivary gland
Parotid lymph glands
Submental lymph glands
Submandibular lymph glands
Supraclavicular lymph glands
Cervical lymph glands
Occipital lymph glands
**Image slide 16**
What are the lymph node levels? (where are they?
**Draw if easier**
What do the parotid glands drain?
Scalp, face and parotid glands.
What do the occipital nodes drain?
Scalp
Where do the superficial cervical nodes drain?
Breast and solid viscera
What do deep cervical nodes drain?
Final drainage pathway to thoracic duct.
Where do the submandibular nodes drain?
- Tongue
- Nose
- Paranasal sinuses
- Submandibular gland
- Oral cavity
What do the submental nodes drain?
Lips
Floor of Mouth
What do the supraclavicular nodes drain?
Breast
Oesophagus
Solid viscera
What are the main reasons causing lymphadenopathy?
INFECTIVE
INFLAMMATORY
MALIGNANT
What type of gland is the thyroid gland? What does it produce?
Endocrine gland
Produce thyroid hormone AND calcitonin
What is the general structure of the thyroid gland?
2 lobes joined by the isthmus
What is the function of Calcitonin?
Calcitonin acts to lower calcium and raise phosphate.
What is the anatomical location of the thyroid?
The thyroid gland is located in the anterior neck, spanning between the C5 and T1 vertebrae.
It lies behind the sternohyoid and sternothyroid muscles, wrapping around the cricoid cartilage and superior tracheal rings. It is inferior to the thyroid cartilage of the larynx
What is the Arterial supply of the thyroid?
Blood supply is achieved by two main arteries; the superior and inferior thyroid arteries. These are paired arteries arising on both the left and right.
The superior thyroid artery is the first branch of the external carotid artery. After arising, the artery descends toward the thyroid gland. As a generalisation, it supplies the superior and anterior portions of the gland.
The inferior thyroid artery arises from the thyrocervical trunk (which in turn is a branch of the subclavian artery). The artery travels superomedially to reach the inferior pole of the thyroid. It tends to supply the postero-inferioraspect.
What is the venous drainage of the Thyroid?
Venous drainage is carried out by the superior, middle and inferior thyroid veins, which form a venous plexus. The superior and middle veins drain into the internal jugular veins, whereas the inferior drains into the brachiocephalic vein.
What is a thyroglossal cyst?
Dilatation of thyroglossal duct remnant, (the thyroid decends from the tongue in vitro, when the tract here is not obliterated it may become infected).
The tract is known as the foramen caecum.
(Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages.)
Can be excised but there can still be chance of recurrence.
What are some of the causes of a thyroid mass?
Solitary nodule
Diffuse enlargement
Multi-nodular goitre (enlarged thyroid appears with a number of separate lumps (nodules))…
What are the causes of a solitary thyroid nodule?
Need to think if it is or is not cancer.
Causes can include:
- Cyst: due to localised haemorrhage
- Adenoma: benign follicular tissue
- Carcinoma
- Lymphoma - cancer of the lymph nodes.
- Prominent nodule in multi-nodular goitre
What are the more commonly effected people with solitary thyroid nodule?
F>M
30-40 years
10% malignant in middle-aged, 50% malignant in young
What are the investigations of Solitary Thyroid Nodule?
Initialy there is an ultrasound scan, and then if required there will be fine-needle aspiration cytology (FNAC).
What is the limitation of the Fine Needle Aspiration Cytology? Therefore…
FNAC CANNOT distinguish between a follicular adenoma AND a follicular carcinoma.
Therefore tissue required for histological diagnosis.
What is a Thyroid Lobectomy?
Operation involving removal of the half of the thyroid gland that has the nodule. It is sometimes called a “diagnostic lobectomy
Lobectomy - removal of half the thyroid” because the preoperative diagnosis may be uncertain and part of the reason for the operation is to make a diagnosis of cancer or no cancer.
(remember that FNAC cant distinguish between adenoma and carcinoma)
What are the 4 types of thyroid cancer?
- Papillary
- Follicular
- Medullary
- Anaplastic
What is papillary thyroid cancer?
The most common type of thyroid cancer.
Most commonly due to lymphatic spread.
What is follicular thyroid cancer?
Cancer in the follicular cells. Follicular cells are the thyroid cells responsible for the production and secretion of thyroid hormones.
Commonly spread via haematogenous metastasis.
What is Medullary Thyroid Cancer?
Medullary thyroid cancer (MTC) is a form of thyroid carcinoma which originates from the parafollicular cells (C cells), which produce the hormone calcitonin.Medullary tumors are the third most common of all thyroid cancers.
What is Anaplastic thyroid cancer?
A form of thyroid cancer which has a very poor prognosis due to its aggressive behavior, local spread and resistance to cancer treatments.
Usually occurs in the very old.
What are the causes of diffuse thyroid enlargement (over entire thyroid)?
Colloid goitre:
- due to gland hyperplasia
- iodine deficiency
- puberty, pregnancy, lactation
Grave’s disease
Thyroiditis
What is Grave’s Disease?
An autoimmune disease that affects the thyroid.It frequently results in and is the most common cause of hyperthyroidism. It also often results in an enlarged thyroid. (MULTI NODULAR GOITRE)
If left untreated there can be many different consequences, including impact on heart and eye function.
Treatment can be through: anti-thyroids, B-blockers, radio-iodine & surgery.
What is Thyroidectomy?
What are the indications of thyoidectomy?
Airway obstruction
Malignancy or suspected malignancy
Thyrotoxicosis
Cosmesis
Retrosternal extension
What are the complications of thyroidectomy?
Bleeding-primary or secondary
Voice hoarseness
Thyroid storm - look this up
Infection
Hypoparathyroidism - from parathyroid glands
Hypothyroidism -
Scar (keloid/ hypertrophic)
Who does Graves Disease most commonly effect?
Women
Middle-aged
Parathyroid glands.
How many are there?
What are their function?
Where are they located?
Usually there are 4 parathyroid glands.
They regulate calcium and phosphate levels.
Located posterior to poles of thyroid.
As the parathyroid glands are in the posterior part of the thyroid, what is the artery that supplies them?
Inferior thyroid artery ( as this artery supplies the posterior).
What is the major parathyroid disease?
The single major disease of parathyroid glands is overactivity of one or more of the parathyroid lobes, which make too much parathyroid hormone, causing a potentially serious calcium imbalance. This is called hyperparathyroidism; it leads to hypercalcemia, kidney stones, osteoporosis, and various other symptoms.
What are the investigations that can be used in parathyroid disease?
U&E, Ca, Phosphate
Parathyroid Hormone
Vit D
Ultrasound
CT/MRI - Identify ectopic glands
Isotope scanning - detect diseased glands
What are the 2 main types of parathyorid disease?
Hyper
Hypo
What are some of the causes of Hyperparatyroidism?
Adenoma (single or multiple) - 80% of Hyperparathyrodism
Hyperplasia
Malignancy (rare)
What is the management of Parathyroid disease?
Medical management
Surgical in hyperparathyroidism only. (removal of adenomas)
What are the layers of the fascia of the neck?
Draw these layers roughly….
4 faschial layers
- Pre-tracheal
- Pre-vertebral
- Deep cervical
- Carotid sheath
Look at slide 45 and see if there is anything to ask questions on
What is a tracheostomy?
Is a surgicalprocedure which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea(windpipe).
What are the indications for a tracheostomy?
Airway obstruction
Airway protection
Poor ventilation to reduce dead space
What is stridor?
¨Clinical sign of airway obstruction
Inspiratory stridor = ???
Laryngeal airway obstruction
Expiratory stridor = ???
tracheobronchial airway obstruction
Biphasic airway obstruction = ???
glottic/subglottic airway obstruction
How is Stridor treated?
- ¨Treat with O2
- Nebulised Adrenaline
- IV Dexamethasone
- (Heliox)
- (Definitive) airway management
Slide 51
What is a Branchial Cyst?
dont forget the rest
Remnant of fusion failure of branchial arches OR lymph node cystic degeneration. Enlarging when infected. Excision performed to prevent infection.
Usually found anterior to SCM muscle.
What is a Pharyngeal pouch?
Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx.
What can the presence of a pharyngeal pouch result in? (symptoms)
- Voice hoarseness
- Regurgitation
- Dysphagia
- Weight loss
- Aspiration pneumonia
- Neoplasia 1%
Investigations and treatment of a pharyngeal pouch?
Barium swallow; excision (endoscopic or open); dilate
