Neck - Anterior Triangle, Deep NV Flashcards by Rachel Manuele

Borders of the anterior triangle of the neck?

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

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

Which one is unpaired?

Submental (unpaired)
Submandibular
Carotid
Muscular

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What are the borders of the submental triangle?

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

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What is found in the submental triangle?

submental lymph nodes

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What are the boundaries of the submandibular triangle?

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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What is found in the submandibular triangle?

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

Facial artery is deep to the submandibular gland

Facial vein is superficial to the submandibular gland

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What are the boundaries of the carotid triangle?

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

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What is found in the carotid triangle?

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

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

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What is found in the muscular triangle of the neck?

Infrahyoid muscles

Neck viscera

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Functions of the suprahyoid muscles?

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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What are the suprahyoid muscles?

Mylohyoid
Geniohyoid
Stylohyoid
Digastric

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Origin and insertion of mylohyoid?

O - inner mandibular body

I - body of hyoid, midline

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What innervates the mylohyoid?

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

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Where is the geniohyoid muscle found in relation to mylohyoid?

Deep to mylohyoid

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Origin and insertion of geniohyoid?

O - inner mandiular apex

I - body of hyoid

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What innervates the geniohyoid muscle?

Ventral ramus of C1

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Origin and insertion of stylohyoid?

O - styloid process

I - body of hyoid

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Relationship of stylohyoid to digastric muscle?

Wraps around posterior digastric

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What innervates the stylohyoid?

Stylohyoid branch of facial nerve - CN VII

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

Anterior and posterior

intermediate tendon

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

Embryologically, they were separate

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Origin(s) and insertion of the digastric muscle?

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

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What allows the intermediate tendon to slide?

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

What nerve(s) innervate the digastric muscle?

Anterior - nerve to mylohyoid (branch of CN V) | Posterior - digastric branch of CN VII

The infrahyoid muscles are also known as "___" muscles.

Strap muscles

What do the infrahyoid muscles do?

Attach hyoid to manubrium, clavical and scapula Depress hyoid and larynx

What are the infrahyoid muscles?

Sternohyoid Omohyoid Sternothyroid Thyrohyoid

Origin and insertion for sternohyoid?

O - manubrium | I - body of hyoid

What innervates the sternohyoid muscle?

Ansa cervicalis

Omohyoid has ________ and _____ bellies that are joined by ___________

Superior and inferior | Intermediate tendon

Origin and insertion of omohyoid muscle?

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

What nerve innervates omohyoid?

Ansa cervicalis

Origin and insertion of sternothyroid?

O - manubrium | I - thyroid cartilage

What nerve innervates sternothyroid?

ansa cervicalis

Origin and insertion of thryohyoid?

O - thyroid cartilage | I - body of hyoid

What nerve innervates thyrohyoid?

Ventral ramus of C1

The R common carotid originates from where?

Brachiocephalic trunk

The L common carotid originates from where?

aortic arch

The common carotids ascend to the level of?

superior border of thyroid cartilage

Where is the common carotid enclosed in?

Carotid sheath

The common carotid bifurcates into?

Internal and external carotids

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

How does the internal carotid get into the cranium?

Via carotid canal of temporal bones

What is the main artery of the brain and orbits?

Internal carotids

The external carotids bifurcate into what?

Maxillary and superficial temporal arteries within parotid gland

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

6 (3 pairs)

What are the branches of the external carotid?

``` Ascending pharyngeal Occipital Posterior auricular Superior Thyroid Lingual Facial ```

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

Ascending pharyngeal

What are the posterior branches of the external carotid artery?

Occipital | Posterior auricular

What are the anterior branches of the external carotid?

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

The superior thyroid gives off what branch?

Superior laryngeal artery

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

Lingual

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

SCM

Where does the external jugular vein form?

Near the angle of mandible

Where is the external jugular vein found deep to?

Platysma

The _______ pierces the investing fascia posterior to SCM

external jugular vein

External jugular vein empties into the _______?

Subclavian vein

Where is the anterior jugular vein formed?

Near hyoid

Where does the anterior jugular vein descend between?

SCM and the midline of the neck

Where does the anterior jugular vein empty into?

EJV or subclavian vein

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

Where does the internal jugular vein begin?

Jugular foramen of the temporal bone

Where does the internal jugular vein descend in?

Carotid sheath

Order of neurovasculature in the carotid sheath?

Artery - medial Vein - lateral Nerve - posterior

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

F - it passes deep

How is the IJV accessible?

In the lesser supraclavicular fosa

The IJV and the subclavian vein merge to form what?

Brachiocephalic vein

Superior and middle thyroid veins are tributaries from what vein?

IJV

C2-C3 cervical plexus loop makes up what nerve?

Transverse cervical nerve

Transverse cervical nerve provides innervation to what?

Sensory innervation to the skin

Ansa cervicalis is made up of what?

C1-C2, C2-C3 cervical plexus loops

Ansa cervicalis provides innervation to what?

Motor to infrahyoid (except thyrohyoid) muscles

Hypoglossal nerve descends between what?

External carotid artery and internal jugular vein

The hypoglossal nerve is found deep to what?

posterior belly of digastric

The hypoglossal nerve provides innervation to what?

Motor to the muscles of the tongue

The vagus nerve is found where in the neck?

In the carotid sheath with carotids and IJV

Vagus nerve innervates what in the neck?

Pharyngeal and laryngeal (except cricothyroid) muscles

Deep neurovasculature passes through where?

The "root" of the neck, where the neck becomes thorax

Where is the root of the neck found?

Above superior thoracic aperture

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

Superolaterally

The subclavian artery descends over ______ and posterior to ________.

1st rib | Clavicle

When does the subclavian artery become axillary?

When it crosses the lateral side of the 1st rib

There are how many parts of the subclavian artery?

3 parts

Boundares of the first part of the subclavian artery?

Medial to anterior scalene

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

Vertebral Internal thoracic (mammary) Thyrocervical

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

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

Into the thorax

What are the branches of the thyrocervical trunk?

Inferior thyroid Transverse cervical Suprascapular

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

Inferior thyroid

The transverse cervical artery supplies which muscles?

Trapezius Levator scapulae Rhomboid

What does the suprascapular artery supply?

supra/infraspinatus

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

posterior to anterior scalene

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

Costocervical trunk

What does the costocervical trunk supply?

1st and 2nd intercostal spaces and posterior cervical muscles

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

Lateral to anterior scalene

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

Dorsal scapular

What does the dorsal scapular artery supply?

Medial scapular border muscles

The dorsal scapular artery passes between what?

trunks of the brachial plexus

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

Transverse cervical artery (deep branch)

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

External carotid - anterior | Internal carotid - posterior

Usually, where does the common carotid bifurcate?

At the level of the hyoid bone, but not always

When does the axillary vein become subclavian vein?

lateral aspect of the 1st rib

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

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

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

Venous angle

the subclavian vein and the IJV unite to form?

Brachiocephalic vein

Major lymphatic trunks empty into what?

Venous angle, the merging of subclavian and IJV

The vagus nerve descends within what?

Carotid sheath

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

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

The R recurrent laryngeal nerve recurs around what artery?

R subclavian artery

The L recurrent laryngeal nerve recurs around what?

The aortic arch

What do the recurrent laryngeal ascend in?

tracheoesophageal groove

The phrenic nerve is motor or sensory?

Motor

Where is the phrenic nerve formed?

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

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

Anterior to the anterior scalene

What arteries "strap down" the phrenic nerve?

Transverse cervical | Suprascapular

Where does the phrenic nerve enter the thorax?

Between the subclavian artery and vein

The phrenic nerve supplies what?

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

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

Posterior

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

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

Where are the three main sympathetic ganglion found?

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

Postganglionic sympathetic neurons can go what ways?

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)

What makes up the brachial plexus roots?

Ventral rami C5-T1

What are the 4 supraclavicular branches of the brachial plexus?

Dorsal scapular Long thoracic Suprascapular Subclavian

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

The scalene triangle Subclavian artery

What makes up the superior trunk of the brachial plexus?

C5 and C6 - suprascapular

What makes up the middle trunk of the brachial plexus?

What makes up the inferior trunk of the brachial plexus?

C8 and T1

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

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

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

Subclavian Internal jugular Femoral

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

at the superior vena cava and R atrium junction

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

The sternal notch, the midpoint of hte clavicle

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

Pneumothorax and a subclavian artery puncture

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

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

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

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

Pneumothorax and internal carotid artery puncture

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

Vein is more posterior

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

Have the pt turn their head, arms by their sides For an IJ approach, raise the head off the head of the bed

Where does plaque build up in the arteries most often?

Bifurcations

When is a patient symptomatic with carotid artery disease?

When it's high grade or bilateral

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

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

What is a carotid endarterectomy?

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

Risks of carotid endarterectomy?

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