Neck Anatomy & Physiology Flashcards
What are some of the anatomical contents of the neck?
- Arteries
- Veins
- Nerves
- Lymph nodes
- Lymphatic channels
- Thyroid gland
- Parathyroid glands
- Muscles
- Trachea
What are the following boundaries of the neck:
- superior
- inferior
- anterior
- posterior
- Superior
- Mandible
- Inferior
- Clavicle
- Anterior
- Anterior midline
- Posterior
- Trapezius
What triangles can the neck be split into?
- Anterior triangle
- Anterior boundary
- Midline of the neck
- Posterior boundary
- Anterior border of sternocleidomastoid
- Anterior boundary
- Posterior triangle
- Anterior boundary
- Posterior border of sternocleidomastoid
- Posterior boundary
- Anterior border of trapezius
- Anterior boundary
What are the following boundaries of the anterior triangle::
- anterior
- posterior
- Anterior triangle
- Anterior boundary
- Midline of the neck
- Posterior boundary
- Anterior border of sternocleidomastoid
- Anterior boundary
What are the following boundaries of the posterior triangle:
- anterior
- posterior
- Posterior triangle
- Anterior boundary
- Posterior border of sternocleidomastoid
- Posterior boundary
- Anterior border of trapezius
- Anterior boundary
What is the contents of the anterior triangle?
- Common carotid artery
- External carotid artery
- Facial artery
- Hypoglossal nerves
- Vagus nerves
- Glossopharyngeal nerves
- Submandibular nodes
- Submental nodes
- Internal carotid artery
- Internal jugular vein
- Facial vein
- Accessory nerves
- Laryngeal nerves
What is the contents of the posterior triangle?
- Accessory nerve
- Occipital artery
- Lymph nodes
- Cervical nerve plexus
- External jugular vein
What is the main artery in neck?
- Divides at C4 level
- External carotid is the only artery with branches in the neck
- Superior thyroid
- Ascending pharyngeal
- Lingual
- Occipital
- Facial
- Posterior auricular
- Maxillary
- Superficial temporal
What level does the common carotid artery divide?
C4
Does the internal or external carotid branch in the neck?
- External carotid is the only artery with branches in the neck
- Superior thyroid
- Ascending pharyngeal
- Lingual
- Occipital
- Facial
- Posterior auricular
- Maxillary
- Superficial temporal
What are some branches of the external carotid artery?
- Superior thyroid
- Ascending pharyngeal
- Lingual
- Occipital
- Facial
- Posterior auricular
- Maxillary
- Superficial temporal
What are the main veins of the neck?
What are indications for a central venous line?
- Central venous pressure
- Drug administration
- Cardiac pacing
- Blood sampling
- Fluid resuscitation
- Haemodialysis
- Intravenous nutrition
What are possible complications of central venous line?
- Pneumothorax
- Haematoma
- Cardiac tamponade
- Air embolism
- Chylothorax
- False passage
- Thrombosis
- Sepsis
- Line blockage
Where do lymph nodes of the neck drain to?
- 600 lymph nodes in the head and neck
- Receive lymph/tissue waste product
- Drain to cisterna chyli
- Then drain to thoracic duct on left
- Descried in groups and levels
What are some lymph node groups of the neck?
- Parotid nodes
- Scalp, face and parotid gland
- Occipital nodes
- Scalp
- Superficial cervical nodes
- Breasts and solid viscera
- Deep cervical nodes
- Final drainage pathway to thoracic duct
- Submandibular nodes
- Tongue, nose, paranasal sinuses, submandibular gland and oral cavity
- Submental nodes
- Lips and floor of mouth
- Supraclavicular nodes
- Breast, oesophagus and solid viscera
What are the different lymph node levels?
What do the following lymph nodes drain:
- parotid
- occipital
- superficial cervical
- deep cervical
- submandibular
- submental
- supraclavicular
- Parotid nodes
- Scalp, face and parotid gland
- Occipital nodes
- Scalp
- Superficial cervical nodes
- Breasts and solid viscera
- Deep cervical nodes
- Final drainage pathway to thoracic duct
- Submandibular nodes
- Tongue, nose, paranasal sinuses, submandibular gland and oral cavity
- Submental nodes
- Lips and floor of mouth
- Supraclavicular nodes
- Breast, oesophagus and solid viscera
Aetiology of lymphadenopathy?
- Infective
- Inflammatory
- Malignant
What does the thyroid hormone produce?
- Produces thyroid hormone and calcitonin
What are the 2 lobes of the thyroid gland joined by?
Isthmus
What does calcitonin do?
- Calcitonin acts to lower calcium and raise phosphate
Thyroglossal cyst - pathology
- Dilation of the thyroglossal duct remnant
Thyroglossal cyst - complications
- May become infected
Thyroglossal cyst - clinical features
- Moves on tongue protrusion
Thryglossal cyst - investigations
Need ultrasound scan prior to removal to ensure functioning thyroid tissue elsewhere
Thyroglossal cyst - treatment
- Excised but chance of recurrence
What are different kinds of thyroid mass?
-
Solitary nodule
- Cyst due to localised haemorrhage
- Adenoma
- Carcinoma
- Lymphoma
- Females more than males
- 30 to 40 years
- 10% malignant in middle-aged men, 50% malignant in young
- Investigate by fine-needle aspiration cytology (FNAC) and ultrasound scanning
- FNAC cannot distinguish between a follicular adenoma and a follicular carcinoma, therefore tissue required for histological diagnosis
- Done by thyroid lobectomy
-
Diffuse enlargement
- Colloid goitre
- Due to gland hyperplasia
- Iodine deficiency
- Puberty, pregnancy, lactation
- Grave’s disease
- Females more than males
- Auto-antibodies against thyroid stimulating hormone receptor stimulate receptor
- Hyperthyroidism results
- Thyroid eye disease, acropachy/clubbing, pre-tibial myxoedema
- Treatments are anti-thyroids, beta-blockade, radio-iodine and surgery
- Thyroiditis
- Colloid goitre
-
Multi-nodular goitre
- Due to Grave’s disease or toxic goitre
- Toxic goitre occurs in older, no eye signs, atrial fibrillation, investigations are thyroid function tests, FNAC, chest x-ray
Solitary nodule - pathology
- Cyst due to localised haemorrhage
Solitary nodule - aetiology
- Adenoma
- Carcinoma
- Lymphoma
Solitary nodule - epimiology
(sex, age)
- Females more than males
- 30 to 40 years
- 10% malignant in middle-aged men, 50% malignant in young
Solitary nodule - investigations
- Investigate by fine-needle aspiration cytology (FNAC) and ultrasound scanning
- FNAC cannot distinguish between a follicular adenoma and a follicular carcinoma, therefore tissue required for histological diagnosis
- Done by thyroid lobectomy
Diffuse enlargement - aetiology
-
Colloid goitre
- Due to gland hyperplasia
- Iodine deficiency
- Puberty, pregnancy, lactation
-
Grave’s disease
- Females more than males
- Auto-antibodies against thyroid stimulating hormone receptor stimulate receptor
- Hyperthyroidism results
- Thyroid eye disease, acropachy/clubbing, pre-tibial myxoedema
- Treatments are anti-thyroids, beta-blockade, radio-iodine and surgery
- Thyroiditis
Colloid goitre - aetiology
- Due to gland hyperplasia
- Iodine deficiency
- Puberty, pregnancy, lactation
Graves’ disease - pathology
- Auto-antibodies against thyroid stimulating hormone receptor stimulate receptor
- Hyperthyroidism results
Graves’ disease - clinical features
- Thyroid eye disease, acropachy/clubbing, pre-tibial myxoedema
Graves’ disease - treatment?
- Treatments are anti-thyroids, beta-blockade, radio-iodine and surgery
Graves’ disease - epidemiology?
(sex)
- Females more than males
Multi-nodular goitre - aetiology?
- Due to Grave’s disease or toxic goitre
Toxic goitre - investigations?
- Toxic goitre occurs in older, no eye signs, atrial fibrillation, investigations are thyroid function tests, FNAC, chest x-ray
What are different kinds of thyroid cancer?
- Papillary-lymphatic metastasis
- Follicular-haematogenous metastasis
- Medullary-familial association
- Arise from parafollicular C cells
- Anaplastic aggressive, local spread, very old, poor prognosis
Indications for thyroidectomy?
- Airway obstruction
- Malignancy or suspected malignancy
- Thyrotoxicosis
- Cosmesis
- Retrosternal extension
Complications of thyroidectomy?
- Bleeding
- Primary or secondary
- Voice hoarseness
- Thyroid storm
- Infection
- Hypoparathyroidism
- Hypothyroidism
- Scar
What do the parathyroid glands do?
- Regulate calcium and phosphate levels
How many parathyroid glands do people normally have?
- 4 (usually)
What is the presentation of parathyroid disease?
- Renal calculi, polyuria, renal failure
- Pathological fractures, osteoporosis, bone pain
- Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss
- Anxiety and depression, confusion, paranoia
What investigations are done for parathyroid disease?
- Urea & electrolytes, creatinine, calcium, phosphate
- Parathyroid hormone, bicarbonate
- Vitamin D
- Ultrasound scan
- CT/MRI to identify ectopic glands
- Isotope scanning to detect diseased glands
When is surgery used to treat parathyroid disease?
Surgery is only done for hyperparathyroidism
Hyperparathyroidism - aetiology
- Adenoma
- 80% of the time is the cause
- Single or multiple
- Hyperplasia
- 12% of the time is the cause
- Common in secondary hyperparathyroidism due to low calcium
- Calcium levels normal but phosphate levels high
- Malignancy (rare)
Parathyroid disease - management
- Medical treatment
- Surgery if patient fit
- Remove single or multiple adenomas
- Remove 3 or 3.5 hyperplastic glands through neck exploration
- Carcinomas removed with thyroid gland and lymph nodes
What are the 4 layers of fascia in the neck?
- Pre-tracheal
- Pre-vertebral
- Deep cervical
- Carotid sheath
What are indications for tracheostomy?
- Airway obstruction
- Airway protection
- Poor ventilation to reduce dead space
What is stridor?
- Clinical sign of airway obstruction
- Inspiratory is laryngeal
- Expiratory is tracheobronchial
- Biphasic is glottis/subglottic
- Treat with oxygen, nebulised adrenaline, IV dexamethasone
Treatment for stridor?
- Treat with oxygen, nebulised adrenaline, IV dexamethasone
Where is the aetiology of stridor in the following:
- inspiratory
- expiratory
- biphasic
- Inspiratory is laryngeal
- Expiratory is tracheobronchial
- Biphasic is glottis/subglottic
Branchial cyst - pathology
- Remnant of fusion failure of bronchial arches or lymph node cystic degeneration
Branchial cyst - complications
- Becomes infected, enlarging
Branchial cyst - treatment
- Excised to prevent further infection
Pharyngeal pouch - pathology
- Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx
Pharyngeal pouch - signs and symptoms
- Voice hoarseness
- Dysphagia
- Aspiration pneumonia
- Regurgitation
- Weight loss
Pharyngeal pouch - investigations
- Barium swallow
- Excision (endoscopic or open
- Dilate
