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Neuro 1 > Neck: Area under the SCM > Flashcards

Neck: Area under the SCM Flashcards

1
Q

what is contained in carotid sheath?

A

common and internal jugular aa.
internal jugular v.
vagus. n
superior root of ansa cervicalis (inferior root is on its lateral surface)

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2
Q

where are things located in the carotid sheath?

A
  • within the sheath the artery is medial and anterior, vein is lateral and posterior
  • vagus n. descends posterior groove between the two vessels
  • ansa cervicalis
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3
Q

common carotid aa.

A
  • left side is longer than the right side and comes directly off of aorta
  • right side originates at brachiocephalic split from arch of aorta
  • splits into internal and external carotid aa.
  • has no branches, though sometimes the superior thyroid a. will slide down to common carotid during development
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4
Q

carotid sinus

A

located at dilated distal common carotid and proximal internal carotid; pressure receptor
- increase in P = decrease in HR

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5
Q

carotid body

A

located at the carotid bifurcation; chemoreceptor

  • senses changes in O2
  • decrease in O2=> increase in rate and depth of respiration
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6
Q

internal carotid artery

A
  • enters base of skull at carotid canal
  • has no branches before the brain
  • in brain it supplies the orbit and the brain
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7
Q

external carotid artery : 8 branches?

A
  • gives off first four branches near the bifurcation:
    1. superior thyroid
    2. ascending pharyngeal a.
    3. lingual a.
    4. facial a.
  • ascends and crosses laterally by posterior belly of digastric and stylohyoid where gives off two more branches:
    5. occipital a.
    6. posterior auricular a.
  • terminates near neck of mandible:
    7. maxillary a.
    8. superficial temporal a.
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8
Q

how do surgeons gain access to carotid bifurcation?

A

access via carotid triangle: anterior border of SCM, post. border of sup. belly of omohyoid, inferior border of post. belly digastric
- this approach can be used to remove atherosclerotic plaque “ carotid endarterectomy”

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9
Q

superior thyroid a.

A 
1st branch
- courses along superior medial margin of thyroid gland, gives off: 
superior laryngeal a. 
anterior branch
posterior branch
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10
Q

ascending pharyngeal a.

A

2

  • arises from medial aspect of externa carotid usually near bifurcation
  • travels straight to base of skull
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11
Q

lingual artery

A 
#3
usually arises opposite greater horn of hyoid
- passes deep to hypoglossus muscle to enter tongue and give branches
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12
Q

facial a.

A 
#4 may arise off common trunk with lingual a. 
- courses obliquely and around inferior border of mandible at anterior edge
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13
Q

occipital a.

A 
#5 passes posteriorly to external carotid artery at inferior border of posterior belly of digastric to pass between transverse process of atlas and mastoid process 
- pierces cervical fascia where trapezius and SCM come togetherto enter the scalp

Note: hypoglassal n. crosses the occipital a. at its origin from external carotid

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14
Q

posterior auricular a.

A

passes psoteriorly to external carotid a. at superior border of posterior belly of digastric to course posterior to auricle

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15
Q

what are two final branches of external carotid a?

A

maxillary and superficial temporal aa.

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16
Q

internal jugular vv.

A
  • largest v. of head and neck
  • receives blood from brain, face, neck via dural venous sinuses
  • begins as superior jugular bulb at jugular foramen
  • as it descends the carotid sheath it lies superiorly and posterolaterally.
  • ends in inferior bulb where it joins subclavian v. to form brachiocephalic v.
17
Q

what does vagus nerve supply?

A

CN X
SVE, SVA, GVA, GSA, GVE-P: largest cranial n.
- PS to heart, lungs and digestive (GVE-P)
- motor to striated muscles of pharynx, palate, larynx, prox 1/3 esophagus (SVE)
- general sensation (GVA) to carotid body epiglottis, larynx, resp. system and GI
- special sensation (GSA) to external ear, TM and posterior cranial fossa dura mater
- special taste to epiglottic portion of tongue (SVA)

18
Q

where does vagus originate and course?

A
  • originates at medulla
  • exits skull via jugular foramen
  • courses in carotid sheath, in between carotid a. and IJV
  • while in retropharyngeal region it communicates with CN IX, XI, and XII and spinal nerves C1 and C2
19
Q

what are branches of the vagus nerve?

A
  • meningeal branch (goes to dura of posterior cranial fossa, gives GSA)
  • auricular : (GSA) - to pinna and auditory canal and TM
  • pharyngeal: (SVE) muscles of pharynx and soft palate
  • nerve to carotid body: (GVA): from chemoreceptors
  • superior laryngeal n.
  • cervical cardiac branches
  • recurrent laryngeal n
20
Q

superior laryngeal n.

A
  • passes obliquely from superior portion of vagus to larynx traveling medial to carotid sheath
  • provides internal branch (SVA, GVA, GVE-P)- and external branch (SVE)
21
Q

external branch of laryngeal n.

A

(SVE)- courses lateral to pharynx and larynx on inferior constrictor muscle along with superior thyroid artery. courses medially at thyroid cartilage to innervate cricothyroid muscle and inferior constrictor muscle.

22
Q

internal branch of laryngeal n.

A

(SVA, GVA, GVE-P)- pierces the thyrohyoid membrane to provide sensory fibers (taste and general sensation) and PS to the base of tongue (mucous glands), epiglottic and internal portion of larynx above true vocal fold

23
Q

cervical cardiac branches

A

branches of vagus nerve (GVE-P, GVA)

  • superior cardiac nn: arise near origin of superior laryngeal n. and descend medial to carotid sheath
  • inferior cardiac nn: arise from vagus in root of neck near first rib
  • both superior cardiac nn.and rt inferior cardiac nn. form the deep cardiac plexus. left inferior cardiac n. joins the superficial cardiac plexus.
24
Q

recurrent laryngeal n.

A

(SVE, GVE-P, GVA) - recurs near root of neck

  • on right side recurs around subclavian, on left it recurs around the aortic arch at the ligamentum arterioosum
  • both will go to the larynx
  • motor innervation to larynx (SVE)
  • secretory mucous (GVE-P)
  • sensory to mucosa inferior to vocal folds (GVA)
25
Q

drainage of lymph around carotid sheath superior to omohyoid muscle?

A

superior deep cervical lymph nodes, located in carotid triangle superior to superior belly of omohyoid

  • composed of retropharyngeal, deep parotid, jugulodigastric and juguloomohyoid nodes
  • receive lymph from superficial nodes of face and neck as well
  • drain to inferior deep nodes and into jugular lymph trunks
26
Q

drainage of lymph around carotid sheath inferior to omohyoid muscle?

A

located inferior to superior belly of omohyoid muscle

  • composed of nervers in supraclavicular position
  • receive lymph from superficial cervical, superior deep cerical, accessory chain of posterior triangle, transverse cervical nodes and juxtavisceral nodes of anterior triangle
27
Q

jugular lymph trunks?

A

formed by efferents of superior and inferior deep cervical nodes

  • on left side, drains to thoracic duct
  • on right side, joins the subclavian and right broncho-mediastimnal lymph trunks to form the right lymphatic duct which evters venous circulation at right jugulovenous angle formed by subclavian and internal jugular vv.
28
Q

hypoglossal n.

A

CNXII - GSE is only component

  • exits via hypoglassal canal posteriorly and courses between internal jugular v. and external carotid a.
  • enters submandibular triangle deep to posterior belly of digastric muscle above hyoid bone
  • enters the tongue to innervate it
29
Q

what makes up the cervical plexus?

A

ventral rami C1-4

  • innervates deep cervical muscles of vertebral column, infrahyoid and the diaphragm
  • provides sensory to lateral head, neck and superolateral shoulder
30
Q

lesser occipital n.

A

C2 and C3 - sensory

- scalp above and behind ear, upper portion of dorsum of ear

31
Q

great auricular n.

A

C2,3- sensory

- cutaneous innervation over superior portion of sternovleidomastoid muscl, angle of mandible and parotid region

32
Q

transverse cervical

A

C2,3- sensory

skin over the anterior triangle of neck

33
Q

supraclavicular n.

A

C3,4- sensory
medial, intermediate and lateral
- skin at base of neck, anterior upper thorax, lateral and superior shoulder
- sternoclavicular and AC joints

34
Q

phrenic n.

A

C3,4,5- sensory

- sensory innervation to pericardium, central portion of inferior diaphragm, superior surface of liver and gallbladder

35
Q

sensory fibers from C1 and C2

A

join the hypoglassal n (XII) and follow it retrograde into cranial vault to innervate dura mater of posterior cranial fossa
- note: these may also join the vagus n.

36
Q

proprioceptive fibers from C2,3,4

A

travel within the spinal accessory nerve

37
Q

Ansa Cervicalis

A
  • motor fibers
    C1/2: provide fibers which form a superior root and travel with hypoglossal XII
    C2,3 provide fibers which form an inferior root
  • from ansa, individual branches are distributed to infrahyoid muscles
  • fibers from C1 continue “disguised” within the hypoglossal n. and diverge from it to innervate geniohyoid and thyrohyoid muscles
38
Q

phrenic n.

A

C3,4,5

- each phrenic n. innervates its corresponding hemidiaphragm

Neuro 1 (14 decks)

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