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Anatomy > Neck - Anterior Triangle, Deep NV > Flashcards

Neck - Anterior Triangle, Deep NV Flashcards

1
Q

Borders of the anterior triangle of the neck?

A

Anterior - midline of the neck
Posterior - anterior border of SCM
Superior - inferior border of mandible
Floor - pharynx, larynx and thyroid

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2
Q

What are the 4 sub-triangles found in the anterior triangle?

Which one is unpaired?

A

Submental (unpaired)
Submandibular
Carotid
Muscular

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3
Q

What are the borders of the submental triangle?

A

Lateral - anterior bellies of digastric muscles
Base - body of hyoid bone
Apex - symphysis of mandible
Floor - mylohyoid muscles

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4
Q

What is found in the submental triangle?

A

submental lymph nodes

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5
Q

What are the boundaries of the submandibular triangle?

A

Anterior/Posterior - A & P bellies of the digastric muscle
Superior - inferior border of mandible
Floor - mylohyoid and hyoglossus muscles, middle pharyngeal constrictor

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6
Q

What is found in the submandibular triangle?

A

Submandibular gland
Hypoglossal nerve (CN XII)
Nerve to mylohoid (branch of trigeminal CN V)
Facial artery (*deep to submandibular and the posterior belly of digastric)
Stylohyoid muscle

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7
Q

What is the relationship with the facial artery and vein found in the submandibular triangle?

A

Facial artery is deep to the submandibular gland

Facial vein is superficial to the submandibular gland

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8
Q

What are the boundaries of the carotid triangle?

A

Anterior - superior belly of omohyoid
Posterior - anterior border of SCM
Superior - posterior belly of digastric
Floor - ?

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9
Q

What is found in the carotid triangle?

A

Common, external, and internal carotid arteries
Carotid sinus (dilation of proximal ICA)
Carotid body
IJV
Vagus nerve (CN X)
Ansa cervicalis - motor to infrahyoid muscles (except thyrohyoid)

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10
Q

What are the boundaries of the muscular triangle of the anterior neck?

A

Medial - midline of the neck
Superolateral - superior belly of omohyoid
Inferolateral - anterior border of SCM

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11
Q

What is found in the muscular triangle of the neck?

A

Infrahyoid muscles

Neck viscera

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12
Q

Functions of the suprahyoid muscles?

A

Superior to the hyoid
Attach hyoid to cranium and elevate hyoid and larynx
Form floor of mouth and support the tongue

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13
Q

What are the suprahyoid muscles?

A

Mylohyoid
Geniohyoid
Stylohyoid
Digastric

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14
Q

Origin and insertion of mylohyoid?

A

O - inner mandibular body

I - body of hyoid, midline

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15
Q

What innervates the mylohyoid?

A

Nerve to mylohyoid (branch of trigeminal nerve - CN V)

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16
Q

Where is the geniohyoid muscle found in relation to mylohyoid?

A

Deep to mylohyoid

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17
Q

Origin and insertion of geniohyoid?

A

O - inner mandiular apex

I - body of hyoid

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18
Q

What innervates the geniohyoid muscle?

A

Ventral ramus of C1

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19
Q

Origin and insertion of stylohyoid?

A

O - styloid process

I - body of hyoid

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20
Q

Relationship of stylohyoid to digastric muscle?

A

Wraps around posterior digastric

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21
Q

What innervates the stylohyoid?

A

Stylohyoid branch of facial nerve - CN VII

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22
Q

The digastric muscle is made of up _______ and _______ bellies and is jointed by ________________.

A

Anterior and posterior

intermediate tendon

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23
Q

Why do the digastric bellies have different origins and nerve innervations?

A

Embryologically, they were separate

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24
Q

Origin(s) and insertion of the digastric muscle?

A

O - inferior mandibular apex (anterior); mastoid process (posterior)
I - sling at body of hyoid

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25
Q

What allows the intermediate tendon to slide?

A

The sling found at the body of the hyoid (the insertion of the digastric muscle)

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26
Q

What nerve(s) innervate the digastric muscle?

A

Anterior - nerve to mylohyoid (branch of CN V)

Posterior - digastric branch of CN VII

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27
Q

The infrahyoid muscles are also known as “___” muscles.

A

Strap muscles

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28
Q

What do the infrahyoid muscles do?

A

Attach hyoid to manubrium, clavical and scapula

Depress hyoid and larynx

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29
Q

What are the infrahyoid muscles?

A

Sternohyoid
Omohyoid
Sternothyroid
Thyrohyoid

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30
Q

Origin and insertion for sternohyoid?

A

O - manubrium

I - body of hyoid

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31
Q

What innervates the sternohyoid muscle?

A

Ansa cervicalis

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32
Q

Omohyoid has ________ and _____ bellies that are joined by ___________

A

Superior and inferior

Intermediate tendon

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33
Q

Origin and insertion of omohyoid muscle?

A

O - body of hyoid (superior); superior border of scapula (inferior)
I - sling arising from clavicle

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34
Q

What nerve innervates omohyoid?

A

Ansa cervicalis

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35
Q

Origin and insertion of sternothyroid?

A

O - manubrium

I - thyroid cartilage

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36
Q

What nerve innervates sternothyroid?

A

ansa cervicalis

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37
Q

Origin and insertion of thryohyoid?

A

O - thyroid cartilage

I - body of hyoid

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38
Q

What nerve innervates thyrohyoid?

A

Ventral ramus of C1

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39
Q

The R common carotid originates from where?

A

Brachiocephalic trunk

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40
Q

The L common carotid originates from where?

A

aortic arch

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41
Q

The common carotids ascend to the level of?

A

superior border of thyroid cartilage

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42
Q

Where is the common carotid enclosed in?

A

Carotid sheath

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43
Q

The common carotid bifurcates into?

A

Internal and external carotids

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44
Q

T or F: There are branches of the internal carotid in the neck.

A

F

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45
Q

How does the internal carotid get into the cranium?

A

Via carotid canal of temporal bones

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46
Q

What is the main artery of the brain and orbits?

A

Internal carotids

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47
Q

The external carotids bifurcate into what?

A

Maxillary and superficial temporal arteries within parotid gland

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48
Q

How many branches of the external carotid are found in the neck?

A

6 (3 pairs)

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49
Q

What are the branches of the external carotid?

A 
Ascending pharyngeal
Occipital
Posterior auricular
Superior Thyroid
Lingual
Facial
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50
Q

What is the only medial branch from the external carotid artery?

A

Ascending pharyngeal

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51
Q

What are the posterior branches of the external carotid artery?

A

Occipital

Posterior auricular

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52
Q

What are the anterior branches of the external carotid?

A

Superior thyroid (first)
Lingual (second)
Facial (third)

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53
Q

The superior thyroid gives off what branch?

A

Superior laryngeal artery

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54
Q

The facial artery may share a common trunk with which artery?

A

Lingual

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55
Q

As the external jugular vein descends, what muscle does it cross?

A

SCM

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56
Q

Where does the external jugular vein form?

A

Near the angle of mandible

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57
Q

Where is the external jugular vein found deep to?

A

Platysma

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58
Q

The _______ pierces the investing fascia posterior to SCM

A

external jugular vein

59
Q

External jugular vein empties into the _______?

A

Subclavian vein

60
Q

Where is the anterior jugular vein formed?

A

Near hyoid

61
Q

Where does the anterior jugular vein descend between?

A

SCM and the midline of the neck

62
Q

Where does the anterior jugular vein empty into?

A

EJV or subclavian vein

63
Q

T or F: There are variable communicaing veins between EJV and AJV

A

T

64
Q

Where does the internal jugular vein begin?

A

Jugular foramen of the temporal bone

65
Q

Where does the internal jugular vein descend in?

A

Carotid sheath

66
Q

Order of neurovasculature in the carotid sheath?

A

Artery - medial
Vein - lateral
Nerve - posterior

67
Q

T or F: The internal jugular vein passes superficial to SCM

A

F - it passes deep

68
Q

How is the IJV accessible?

A

In the lesser supraclavicular fosa

69
Q

The IJV and the subclavian vein merge to form what?

A

Brachiocephalic vein

70
Q

Superior and middle thyroid veins are tributaries from what vein?

A

IJV

71
Q

C2-C3 cervical plexus loop makes up what nerve?

A

Transverse cervical nerve

72
Q

Transverse cervical nerve provides innervation to what?

A

Sensory innervation to the skin

73
Q

Ansa cervicalis is made up of what?

A

C1-C2, C2-C3 cervical plexus loops

74
Q

Ansa cervicalis provides innervation to what?

A

Motor to infrahyoid (except thyrohyoid) muscles

75
Q

Hypoglossal nerve descends between what?

A

External carotid artery and internal jugular vein

76
Q

The hypoglossal nerve is found deep to what?

A

posterior belly of digastric

77
Q

The hypoglossal nerve provides innervation to what?

A

Motor to the muscles of the tongue

78
Q

The vagus nerve is found where in the neck?

A

In the carotid sheath with carotids and IJV

79
Q

Vagus nerve innervates what in the neck?

A

Pharyngeal and laryngeal (except cricothyroid) muscles

80
Q

Deep neurovasculature passes through where?

A

The “root” of the neck, where the neck becomes thorax

81
Q

Where is the root of the neck found?

A

Above superior thoracic aperture

82
Q

The aortic arch is located where in relationship with the anterior scalene?

A

Superolaterally

83
Q

The subclavian artery descends over ______ and posterior to ________.

A

1st rib

Clavicle

84
Q

When does the subclavian artery become axillary?

A

When it crosses the lateral side of the 1st rib

85
Q

There are how many parts of the subclavian artery?

A

3 parts

86
Q

Boundares of the first part of the subclavian artery?

A

Medial to anterior scalene

87
Q

What are the branches from the first part of the subclavian artery?

A

Vertebral
Internal thoracic (mammary)
Thyrocervical

88
Q

At what level does the vertebral branch of the subclavian artery enter the transverse foramen?

A

C6

89
Q

The internal thoracic (mammary) artery branch of the subclavian artery descends where?

A

Into the thorax

90
Q

What are the branches of the thyrocervical trunk?

A

Inferior thyroid
Transverse cervical
Suprascapular

91
Q

Which branch off the thyrocervical trunk is the major visceral artery?

A

Inferior thyroid

92
Q

The transverse cervical artery supplies which muscles?

A

Trapezius
Levator scapulae
Rhomboid

93
Q

What does the suprascapular artery supply?

A

supra/infraspinatus

94
Q

What are the boundaries of the 2nd part of the subclavian artery?

A

posterior to anterior scalene

95
Q

What branch comes off the second part of the subclavian artery?

A

Costocervical trunk

96
Q

What does the costocervical trunk supply?

A

1st and 2nd intercostal spaces and posterior cervical muscles

97
Q

What are the boundaries of the 3rd part of the subclavian artery?

A

Lateral to anterior scalene

98
Q

What branch comes off the 3rd part of the subclavian artery?

A

Dorsal scapular

99
Q

What does the dorsal scapular artery supply?

A

Medial scapular border muscles

100
Q

The dorsal scapular artery passes between what?

A

trunks of the brachial plexus

101
Q

Besides the 3rd part of the subclavian artery, where else could the dorsal scapular artery arise from?

A

Transverse cervical artery (deep branch)

102
Q

Which branch of the common carotid is more anterior/posterior?

A

External carotid - anterior

Internal carotid - posterior

103
Q

Usually, where does the common carotid bifurcate?

A

At the level of the hyoid bone, but not always

104
Q

When does the axillary vein become subclavian vein?

A

lateral aspect of the 1st rib

105
Q

Where does the subclavian vein course in relationship to the artery and the anterior scalene muscle?

A

The vein crosses anterior to the anterior scalene muscle, whereas the arter crossed posterior to the muscle

106
Q

The merging of the subclavian and the internal jugular vein is called what?

A

Venous angle

107
Q

the subclavian vein and the IJV unite to form?

A

Brachiocephalic vein

108
Q

Major lymphatic trunks empty into what?

A

Venous angle, the merging of subclavian and IJV

109
Q

The vagus nerve descends within what?

A

Carotid sheath

110
Q

In the carotid sheath, the vagus nerve enters where in relation to the veins and arteries?

A

Enters the carotid sheath posterior to the veins and anterior to the arteries

111
Q

The R recurrent laryngeal nerve recurs around what artery?

A

R subclavian artery

112
Q

The L recurrent laryngeal nerve recurs around what?

A

The aortic arch

113
Q

What do the recurrent laryngeal ascend in?

A

tracheoesophageal groove

114
Q

The phrenic nerve is motor or sensory?

A

Motor

115
Q

Where is the phrenic nerve formed?

A

Apex of scalene triangle (C3-C4 loop and C5)

116
Q

The phrenic nerve is found where in relation to the anterior scalene?

A

Anterior to the anterior scalene

117
Q

What arteries “strap down” the phrenic nerve?

A

Transverse cervical

Suprascapular

118
Q

Where does the phrenic nerve enter the thorax?

A

Between the subclavian artery and vein

119
Q

The phrenic nerve supplies what?

A

Motor supply to the hemidiaphragm and visceral afferents (pericardium, pleura, etc.)

120
Q

Where is the sympathetic chain located in relation to the carotid sheath?

A

Posterior

121
Q

The sympathetic chain is made up of how many ganglia and what are they called?

A

3 (most often)
Superior (largest)
Middle (sometimes absent)
Inferior (often fusted with 1st thoracic ganglion - stellate)

122
Q

Where are the three main sympathetic ganglion found?

A

Superior - level of C1, C2
Middle - level of C6
Inferior - level of C7

123
Q

Postganglionic sympathetic neurons can go what ways?

A
  1. Cervical spinal nerves (via gray rami communicantes)
  2. thoracic viscera (via cardiopulmonary splanchnic nerves)
  3. head/viscera of the neck (via cephalic/cervical arterial branches)
124
Q

What makes up the brachial plexus roots?

A

Ventral rami C5-T1

125
Q

What are the 4 supraclavicular branches of the brachial plexus?

A

Dorsal scapular
Long thoracic
Suprascapular
Subclavian

126
Q

Where does the brachial plexus emerge through? What accompanies it?

A

The scalene triangle

Subclavian artery

127
Q

What makes up the superior trunk of the brachial plexus?

A

C5 and C6 - suprascapular

128
Q

What makes up the middle trunk of the brachial plexus?

A

C7

129
Q

What makes up the inferior trunk of the brachial plexus?

A

C8 and T1

130
Q

What are some reasons why you would use a central line?

A

Parenteral nutrition
Medications (like chemo)
CV monitoring (central venous pressure, or pulmonary artery)

131
Q

What are the three veins where you can place a central line?

A

Subclavian
Internal jugular
Femoral

132
Q

Where should the catheter tip lie when placing a central line in either the subclavian or IJ approach?

A

at the superior vena cava and R atrium junction

133
Q

Where should you aim your needle for a subclavian approach for a central line?

A

The sternal notch, the midpoint of hte clavicle

134
Q

What are the risks of a subclavian approach to a central line?

A

Pneumothorax and a subclavian artery puncture

135
Q

What side is preferred for a IJ approach to a central line?

A

R

136
Q

Where do you insert your needle and aim your needle for a IJ approach to a central line?

A

You insert in the apex of teh supraclavicular fossa and you aim toward the ipsilateral nipple

137
Q

What are the risks of a IJ approach to a central line?

A

Pneumothorax and internal carotid artery puncture

138
Q

In the carotid sheat, where is the vein in relation to the artery?

A

Vein is more posterior

139
Q

What are some things to keep in mind when placing a central line?

A

Have the pt turn their head, arms by their sides

For an IJ approach, raise the head off the head of the bed

140
Q

Where does plaque build up in the arteries most often?

A

Bifurcations

141
Q

When is a patient symptomatic with carotid artery disease?

A

When it’s high grade or bilateral

142
Q

Why is a pt asymptomatic with carotid artery disease for so long?

A

Because there is a lot of collarteral blood flow to the brain

143
Q

What is a carotid endarterectomy?

A

Stripping of thickened intima and plaque, you repair the artery or with vein patch, a shunt can be used to preserve cerebral flow

144
Q

Risks of carotid endarterectomy?

A

CN IV-VII injury
Ansa cervialis injury
Bradycardia/hypotension (carotid sinus)
High bifurcation (under the mandible)

Anatomy (4 decks)

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