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Gross Anatomy > Neck: Cervical Fascia, Triangles of the Neck, and Thyroid Gland > Flashcards

Neck: Cervical Fascia, Triangles of the Neck, and Thyroid Gland Flashcards

1
Q

Bony Framework of Neck

A
  • Cervical vertebrae
  • Inferior/Posterior skull
  • Mandible
  • Clavicle and Manubrium
  • Hyoid bone
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2
Q

Hyoid Bone

A
  • C3 vertebral level
  • Fractured during strangulation
  • No bony articulation
  • Suspended by muscle attachment
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3
Q

Hyoid Bone Ligament Attachment

A
  • Stylohyoid ligament

- Thyrohyoid membrane

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4
Q

Cervical Superficial Fascia Contains

A
  • Fatty connective tissue
  • Nerves
  • Vasculature
  • Platysma muscle
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5
Q

Platysma Innervation

A
  • Innervated by CN VII
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6
Q

Platysma Function

A
  • Facial expression

- Depress mandible

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7
Q

Platysma Muscle Attachment

A
  • Deep fascia over upper chest

- Mandible

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8
Q

Deep Cervical Fascia

A
  • Fascial layers
  • Encircle neck structures
  • Form anatomic compartments
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9
Q

3 Deep Cervical Fascial Layers (Superficial to Deep)

A
  1. Investing
  2. Pretracheal
  3. Prevertebral
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10
Q

Investing Cervical Fascial Layer Attachments

A
  • Superior: skull and mandible

- Inferior: scapular spine, clavicle, acromion, manubrium

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11
Q

Investing Cervical Fascial Layer Envelopes

A
  • Trapezius
  • Sternocleidomastoid
  • Parotid/submandibular salivary glands
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12
Q

Paratracheal Cervical Fascial Layer Attachments

A
  • Hyoid bone (superior)

- Fibrous pericardium (inferior)

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13
Q

Paratracheal Cervical Fascial Layer Envelopes

A
  • Infrahyoid muscles
  • Thyroid gland
  • Esophagus
  • Trachea
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14
Q

Buccopharyngeal Fascia Located

A
  • Posterior to pharynx/esophagus
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15
Q

Prevertebral Cervical Fascial Layer is a Sheath for

A
  • Vertebral column

- Deep muscles

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16
Q

Prevertebral Cervical Fascial Layer Attachments

A
  • Cranial base (superior)

- Endothoracic fascia (inferior)

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17
Q

Alar Fascia

A
  • Anterior to prevertebral fascia

- Fuses with buccopharyngeal fascia around T4

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18
Q

Carotid Sheath

A
  • Formed by all 3 deep cervical fascial layers

- Cranial base > root of the neck

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19
Q

Carotid Sheath Contents

A
  • Common and internal carotid arteries (medial)
  • IJV (lateral)
  • Vagus nerve (posterior)
  • Deep cervical lymph nodes
  • Carotid sinus nerve
  • Sympathetic nerves
  • sometimes ansa cervicalis is embedded in the sheath*
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20
Q

Fascial Spaces of the Neck

A
  • Pretracheal space
  • Retropharyngeal space
  • Danger space
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21
Q

Pretracheal Space

A
  • Posterior to infrahyoid muscles
  • Surrounds trachea
  • Infection: superior > anterior mediastinum
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22
Q

Retropharyngeal Space

A
  • Between alar/buccopharyngeal fascia

- Infection: superior mediastinum

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23
Q

Danger Space

A
  • Between alar/prevertebral fascia

- Communicates with the posterior mediastinum

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24
Q

Regions of the Neck

A
  • Posterior cervical and sub-occipital regions: (covered with back)
  • Lateral cervical region (Posterior triangle) *
  • Anterior cervical region (Anterior triangle) *
  • Sternocleidomastoid separates Anterior and Posterior triangles
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25
Sternocleidomastoid Attachments
- 2 heads (inferior attachments/origins): - Sternal: attaches to manubrium - Clavicular: medial 1/3 of clavicle - Superior attachment (insertion): mastoid process and superior nuchal line
26
Sternocleidomastoid Sternal Attachment
- Manubrium
27
Sternocleidomastoid Clavicular Attachment
- Medial 1/3 of clavicle
28
Sternocleidomastoid Superior Attachment (Insertion)
- Mastoid process | - Superior nuchal line
29
Sternocleidomastoid Innervation
- Spinal accessory nerve
30
Sternocleidomastoid Function
- Bilateral contraction: flexion of cervical spine - Unilateral: lateral flexion with rotation - Accessory muscle of respiration
31
Lateral cervical region (Posterior Triangle of the Neck) Boundaries
- Anterior: posterior border of SCM - Posterior: anterior border of trapezius - Inferior: clavicle (middle 1/3) - Superior (Apex): where trap and SCM meet - Roof: overlying fascia - Floor: scalenes, splenius capitis, levator scapulae (covered by prevertebral fascia)
32
Inferior Belly of Omohyoid Muscle Divides Posterior Triangle into
- Occipital triangle | - Omoclavicular (subclavian) triangle
33
Anterior Cervical Region (Anterior Triangle) Boundaries
- Anterior: midline of neck - Posterior: anterior border of SCM - Superior: inferior border of mandible - Inferior (Apex): jugular notch - Roof: overlying fascia - Floor: pharynx, larynx, thyroid gland
34
Blood Vessels of Posterior Triangle
- Occipital artery (branch of external carotid) - 3rd part of subclavian artery/vein (subclavian artery pulse is palpable) - Suprascapular artery/vein - Transverse cervical artery/vein (cervicodorsal) - Arteries are branches of thyrocervical trunk - External jugular vein
35
Nerves of Posterior Triangle
- Spinal accessory nerve (CNXI) - Roots and trunks of brachial plexus - Suprascapular nerve - Cutaneous branches of cervical plexus - Phrenic nerve
36
Omohyoid Muscle Located in this Triangle
- Posterior triangle
37
Omoclavicular (Subclavian) Triangle Content
- Subclavian vessels - External jugular vein - Trunks of the brachial plexus
38
External Jugular Vein Formed by
- Posterior division of retromandibular vein | - Posterior auricular vein
39
Tributaries of External Jugular Vein
- Anterior jugular vein - Cervicodorsal vein - Suprascapular veins
40
Spinal Accessory Nerve (CN XI) Pathway
- Enters posterior triangle at jxn of middle and superior 1/3s of SCM - Deep to investing cervical fascia - Passes deep to SCM and trapezius - Innervates: SCM and trapezius
41
Cervical Plexus
- Formed by the anterior rami of C1-4 | - Cutaneous (sensory branches) are in the posterior triangle
42
Roots of Brachial Plexus
- Anterior rami (C5-T1) | - Pass between anterior and middle scalene
43
Trunks of Brachial Plexus
- Anterior rami unite to form trunks | - Pass through cervico-axillary canal enter axilla (we will pick up in Upper Extremity)
44
Branches of Brachial Plexus in Posterior Triangle
- Suprascapular nerve | - Nerve to subclavius
45
Cutaneous (Sensory) Branches of Cervical Plexus
- Posterior border of SCM, mid-belly (nerve point of the neck) - Lesser occipital (C2) - Great auricular (C2,3) - Transverse cervical (C2,3) - Supraclavicular (C3,4)
46
Nerve Point of the Neck
- Posterior border of SCM | - Mid-belly
47
Supraclavicular (C3,4) Branch of Cervical Plexus Originates
- From similar spinal cord segments as phrenic nerve
48
Anterior Cervical Region (Anterior Triangle) Boundaries
- Anterior: midline of neck - Posterior: anterior border of SCM - Superior: inferior border of mandible - Inferior (Apex): jugular notch - Roof: overlying fascia - Floor: pharynx, larynx, thyroid gland
49
Anterior Cervical Muscles
- Suprahyoid muscles - Infrahyoid muscles - Stabilize and move the hyoid bone and larynx - Named based on attachment points
50
Suprahyoid Muscles Functions
- Connect hyoid bone and cranium | - Elevate the hyoid (swallowing)
51
Mylohyoid Muscle Attachments
- Mylohyoid line | - Body of hyoid
52
Geniohyoid Muscle Attachments
- Inferior mental spine of mandible | - Body of hyoid
53
Stylohyoid Muscle
- Styloid process of temporal bone | - Body of hyoid
54
Anterior Belly of Digastric Muscle Attacements
- Digastric fossa | - Hyoid bone
55
Posterior Belly of Digastric Muscle
- Mastoid notch of temporal bone | - Body and greater horn
56
Digastric Muscle Functions
- Depress the mandible and elevate the hyoid - Joined by intermediate tendon - Passes through fibrous sling, anchoring it to hyoid bone
57
Infrahyoid Muscles (Strap Muscles)
- Hyoid - Sternum - Clavicle - Scapula
58
Sternohyoid Muscle Attachments
- Manubrium and medial end of clavicle | - Hyoid body
59
Omohyoid Muscle Attachments
- Superior border of scapula to hyoid body | - 2 bellies connected by an intermediate tendon
60
Sternothyroid Muscle Attachments
- Manubrium of sternum | - Oblique line of thyroid cartilage
61
Thyrohyoid Muscle Attachments
- Oblique line of thyroid cartilage | - Inferior border of hyoid and greater horn
62
Motor of Cervical Plexus
- Ansa cervicalis (C1-3): - Superior root C1 - Inferior root C2,3 - Innervates infrahyoid muslces (except for thyrohyoid)
63
Submental Triangle Boundaries
- Inferior (Base): body of hyoid bone - Laterally: anterior bellies of digastric muscle - Apex: mandibular symphysis - Floor: mylohyoid muscles
64
Submental Triangle Contents
- Submental lymph nodes (Drains central portion of lower lip, floor of mouth, tongue) - Apex (tip) - Small veins
65
Submandibular (Digastric) Triangle Boundaries
- Superior: inferior border of the mandible - Anterior: anterior belly of the digastric - Posterior: posterior belly of the digastric/stylohyoid muslces - Floor: mylohyoid, hyoglossus
66
Submandibular (Digastric Triangle) Contents
- Submandibular gland - Facial artery and vein - Submental artery - Submandibular lymph nodes - Nerve to the mylohyoid - Hypoglossal nerve - Lingual artery
67
Submandibular Gland
- Salivary gland innervated by facial nerve
68
Muscular Triangle Boundaries
- Posteroinferior: anterior border of the SCM - Posteriosuperior: superior belly of omohyoid - Medial: midline of neck (hyoid bone to jugular notch)
69
Muscular Triangle Content
- Infrahyoid muscles | - Thyroid and parathyroid glands
70
Carotid Triangle Boundaries
- Infero-medial: superior belly of the omohyoid Superior: posterior belly of the digastric Posterior: anterior border of SCM
71
Carotid Triangle Contents
- Carotid sheath structures - External carotid artery (some ECA branches) - Ansa cervicalis - Hypoglossal nerve
72
Carotid Sheath Structures in Carotid Triangle
- Common and internal carotid arteries (medial) - Carotid sinus and body - IJV (lateral) - Vagus nerve (posterior) - Deep cervical lymph nodes - Carotid sinus nerve - Sympathetic nerves
73
Common Carotid Arteries
- Within the carotid sheath | - Bifurcates at the level of the thyroid cartilage (C4 vertebral level)
74
Internal Carotid Arteries
- No neck branches (supplies intra-cranial structures)
75
External Carotid Arteries
- Neck, orbit, face, scalp | - Passes through parotid gland (btwn ramus/neck of mandible)
76
External Carotid Artery Branches
- Superior thyroid artery - Ascending pharyngeal - Lingual artery - Facial artery - Occipital artery - Posterior auricular artery - Maxillary - Superficial temporal
77
External Carotid Artery Anterior Branches
- Superior thyroid artery - Lingual artery - Facial artery
78
Superior Thyroid Artery Supplies
- Supplies thyroid gland - SCM - Strap muscles
79
Lingual Artery
- Supplies the tongue
80
Facial Artery
- Supplies face (and other things) - Deep to digastric/stylohyoid muscles - Hooks around mandible, deep to submandibular gland
81
Facial Artery Branches
- Ascending palatine - Tonsillar - Submental
82
Superior Thyroid Artery Branches
- Superior laryngeal artery
83
Superior Laryngeal Artery
- Supplies the larynx
84
External Carotid Artery Medial Branch
- Ascending pharyngeal artery
85
Ascending Pharyngeal Artery
- Supplies pharynx and meninges
86
External Carotid Artery Posterior Branches
- Occipital artery | - Posterior auricular artery
87
Occipital Artery
- Supplies posterior scalp | - Arises above facial
88
Posterior Auricular Artery
- Supplies scalp, temporal bone, adjacent muscles - Last pre-terminal branch - Passes between external acoustic meatus and mastoid process
89
External Carotid Artery Terminal Branches
- Superficial temporal: supplies scalp | - Maxillary: supplies infratemporal fossa, meninges, masticatory muscles, etc.
90
Superficial Temporal Artery
- Supplies scalp
91
Maxillary Artery
- Supplies infratemporal fossa - Meninges - Masticatory muscles - Etc.
92
Carotid Body
- Located in adventitia of the CCA bifurcation | - Chemoreceptor
93
Carotid Sinus
- In the adventitia of the carotid bulb (dilation in the proximal IC) - Baroreceptor
94
Carotid Body and Sinus Innervation
- Both innervated by CN IX via carotid sinus (Hering’s nerve)
95
Veins in the Neck
- External jugular vein - Anterior jugular vein - Internal jugular vein
96
Hyoid Bone Level
- C3
97
Thyroid Cartilage Level
- C4-6
98
Cricoid Cartilage Level
- C6
99
Thyroid Gland (Endocrine Organ)
- Level of C5-T1 - 2 lobes connected by an isthmus - Pyramidal lobe may be present, ~ 30% of population - Surrounded by a fibrous capsule attaching posteriorly to laryngoskeleton/trachea (Berry’s ligament)
100
Thyroid Arterial Supply
- Superior thyroid artery (paired) - Inferior thyroid artery (paired) - Thyroid ima artery (unpaired)
101
Superior Thyroid Artery (Paired)
- From external carotid | - Enters antero-superiorly
102
Inferior Thyroid Artery (Paired)
- From thyrocervical trunk | - Travels posterior to carotid sheath
103
Thyroid Ima Artery (Unpaired)
- From brachiocephalic trunk (or neighboring vessel) - Present in ~10% of people - Travels across trachea toward the thyroid isthmus
104
Venous Drainage in Thyorid
- Superior thyroid vein --> IJV - Middle thyroid vein --> IJV - Inferior thyroid vein --> brachiocephalic veins
105
Lymphatic Drainage of Thyroid
- Pretracheal, paratracheal lymph nodes --> deep cervical nodes
106
Important Anatomical Relationships of Thyroid
- Superior thyroid artery and external branch of superior laryngeal nerve - Superior laryngeal artery and internal branch of superior laryngeal nerve - Inferior thyroid artery and recurrent laryngeal nerve
107
Parathyroid Gland
- Usually 4 in number - 2 superior: more consistent location - 2 inferior: more variation in location - Small, beanlike shape - Endocrine organ that produce parathyroid hormone (calcium homeostasis)
108
Parathyroid Gland Arterial Supply
- Primarily inferior thyroid artery
109
Parathyroid Nerve, Venous, and Lymphatic Drainage
- Follows thyroid gland
110
Inadvertent Parathyroid Gland Removal
- Decreased serum calcium resulting in muscle tetany | - Serious because can involve respiratory and laryngeal muscles
111
Mylohyoid Muscle Innervation
- Nerve to mylohyoid (CN V, mandibular division of trigeminal)
112
Mylohyoid Muscle Function
- Elevates hyoid, floor of mouth
113
Geniohyoid Muscle Innervation
- C1 fibers traveling in hypoglossal nerve
114
Geniohyoid Muscle Function
- Pulls hyoid anterosuperiorly
115
Stylohyoid Muscle Innervation
- Facial nerve (CN VII)
116
Stylohyoid Muscle Function
- Elevates and retracts hyoid
117
Anterior Belly of Digastric Muscle Innervation
- Nerve to mylohyoid (CN V, mandibular division of trigeminal)
118
Posterior Belly of Digastric Muscle Innervation
- Facial nerve (CN VII)
119
Infrahyoid Muscles Function
- Depress the hyoid and larynx
120
Infrahyoid Muscles Innervation
- Ansa cervicalis (except thyrohyoid)
121
Thyrohyoid Muscles Innervation
- C1 branches traveling with hypoglossal nerve
122
External Jugular Vein Pathway
- Crosses superficial to SCM - Deep to platysma - Pierces investing cervical fascia posterior to SCM - Drains into subclavian vein
123
Irritation of the Structures Innervated by Phrenic (Sensory) Causes
- Referred shoulder pain

Gross Anatomy (50 decks)

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