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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
Q

Sternocleidomastoid Attachments

A
  • 2 heads (inferior attachments/origins):
  • Sternal: attaches to manubrium
  • Clavicular: medial 1/3 of clavicle
  • Superior attachment (insertion): mastoid process and superior nuchal line
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26
Q

Sternocleidomastoid Sternal Attachment

A
  • Manubrium
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27
Q

Sternocleidomastoid Clavicular Attachment

A
  • Medial 1/3 of clavicle
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28
Q

Sternocleidomastoid Superior Attachment (Insertion)

A
  • Mastoid process

- Superior nuchal line

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29
Q

Sternocleidomastoid Innervation

A
  • Spinal accessory nerve
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30
Q

Sternocleidomastoid Function

A
  • Bilateral contraction: flexion of cervical spine
  • Unilateral: lateral flexion with rotation
  • Accessory muscle of respiration
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31
Q

Lateral cervical region (Posterior Triangle of the Neck) Boundaries

A
  • 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)
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32
Q

Inferior Belly of Omohyoid Muscle Divides Posterior Triangle into

A
  • Occipital triangle

- Omoclavicular (subclavian) triangle

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33
Q

Anterior Cervical Region (Anterior Triangle) Boundaries

A
  • 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
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34
Q

Blood Vessels of Posterior Triangle

A
  • 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
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35
Q

Nerves of Posterior Triangle

A
  • Spinal accessory nerve (CNXI)
  • Roots and trunks of brachial plexus
  • Suprascapular nerve
  • Cutaneous branches of cervical plexus
  • Phrenic nerve
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36
Q

Omohyoid Muscle Located in this Triangle

A
  • Posterior triangle
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37
Q

Omoclavicular (Subclavian) Triangle Content

A
  • Subclavian vessels
  • External jugular vein
  • Trunks of the brachial plexus
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38
Q

External Jugular Vein Formed by

A
  • Posterior division of retromandibular vein

- Posterior auricular vein

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39
Q

Tributaries of External Jugular Vein

A
  • Anterior jugular vein
  • Cervicodorsal vein
  • Suprascapular veins
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40
Q

Spinal Accessory Nerve (CN XI) Pathway

A
  • 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
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41
Q

Cervical Plexus

A
  • Formed by the anterior rami of C1-4

- Cutaneous (sensory branches) are in the posterior triangle

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42
Q

Roots of Brachial Plexus

A
  • Anterior rami (C5-T1)

- Pass between anterior and middle scalene

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43
Q

Trunks of Brachial Plexus

A
  • Anterior rami unite to form trunks

- Pass through cervico-axillary canal enter axilla (we will pick up in Upper Extremity)

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44
Q

Branches of Brachial Plexus in Posterior Triangle

A
  • Suprascapular nerve

- Nerve to subclavius

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45
Q

Cutaneous (Sensory) Branches of Cervical Plexus

A
  • 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)
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46
Q

Nerve Point of the Neck

A
  • Posterior border of SCM

- Mid-belly

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47
Q

Supraclavicular (C3,4) Branch of Cervical Plexus Originates

A
  • From similar spinal cord segments as phrenic nerve
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48
Q

Anterior Cervical Region (Anterior Triangle) Boundaries

A
  • 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
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49
Q

Anterior Cervical Muscles

A
  • Suprahyoid muscles
  • Infrahyoid muscles
  • Stabilize and move the hyoid bone and larynx
  • Named based on attachment points
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50
Q

Suprahyoid Muscles Functions

A
  • Connect hyoid bone and cranium

- Elevate the hyoid (swallowing)

51
Q

Mylohyoid Muscle Attachments

A
  • Mylohyoid line

- Body of hyoid

52
Q

Geniohyoid Muscle Attachments

A
  • Inferior mental spine of mandible

- Body of hyoid

53
Q

Stylohyoid Muscle

A
  • Styloid process of temporal bone

- Body of hyoid

54
Q

Anterior Belly of Digastric Muscle Attacements

A
  • Digastric fossa

- Hyoid bone

55
Q

Posterior Belly of Digastric Muscle

A
  • Mastoid notch of temporal bone

- Body and greater horn

56
Q

Digastric Muscle Functions

A
  • Depress the mandible and elevate the hyoid
  • Joined by intermediate tendon
  • Passes through fibrous sling, anchoring it to hyoid bone
57
Q

Infrahyoid Muscles (Strap Muscles)

A
  • Hyoid
  • Sternum
  • Clavicle
  • Scapula
58
Q

Sternohyoid Muscle Attachments

A
  • Manubrium and medial end of clavicle

- Hyoid body

59
Q

Omohyoid Muscle Attachments

A
  • Superior border of scapula to hyoid body

- 2 bellies connected by an intermediate tendon

60
Q

Sternothyroid Muscle Attachments

A
  • Manubrium of sternum

- Oblique line of thyroid cartilage

61
Q

Thyrohyoid Muscle Attachments

A
  • Oblique line of thyroid cartilage

- Inferior border of hyoid and greater horn

62
Q

Motor of Cervical Plexus

A
  • Ansa cervicalis (C1-3):
  • Superior root C1
  • Inferior root C2,3
  • Innervates infrahyoid muslces (except for thyrohyoid)
63
Q

Submental Triangle Boundaries

A
  • Inferior (Base): body of hyoid bone
  • Laterally: anterior bellies of digastric muscle
  • Apex: mandibular symphysis
  • Floor: mylohyoid muscles
64
Q

Submental Triangle Contents

A
  • Submental lymph nodes (Drains central portion of lower lip, floor of mouth, tongue)
  • Apex (tip)
  • Small veins
65
Q

Submandibular (Digastric) Triangle Boundaries

A
  • Superior: inferior border of the mandible
  • Anterior: anterior belly of the digastric
  • Posterior: posterior belly of the digastric/stylohyoid muslces
  • Floor: mylohyoid, hyoglossus
66
Q

Submandibular (Digastric Triangle) Contents

A
  • Submandibular gland
  • Facial artery and vein
  • Submental artery
  • Submandibular lymph nodes
  • Nerve to the mylohyoid
  • Hypoglossal nerve
  • Lingual artery
67
Q

Submandibular Gland

A
  • Salivary gland innervated by facial nerve
68
Q

Muscular Triangle Boundaries

A
  • Posteroinferior: anterior border of the SCM
  • Posteriosuperior: superior belly of omohyoid
  • Medial: midline of neck (hyoid bone to jugular notch)
69
Q

Muscular Triangle Content

A
  • Infrahyoid muscles

- Thyroid and parathyroid glands

70
Q

Carotid Triangle Boundaries

A
  • Infero-medial: superior belly of the omohyoid
    Superior: posterior belly of the digastric
    Posterior: anterior border of SCM
71
Q

Carotid Triangle Contents

A
  • Carotid sheath structures
  • External carotid artery (some ECA branches)
  • Ansa cervicalis
  • Hypoglossal nerve
72
Q

Carotid Sheath Structures in Carotid Triangle

A
  • 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
Q

Common Carotid Arteries

A
  • Within the carotid sheath

- Bifurcates at the level of the thyroid cartilage (C4 vertebral level)

74
Q

Internal Carotid Arteries

A
  • No neck branches (supplies intra-cranial structures)
75
Q

External Carotid Arteries

A
  • Neck, orbit, face, scalp

- Passes through parotid gland (btwn ramus/neck of mandible)

76
Q

External Carotid Artery Branches

A
  • Superior thyroid artery
  • Ascending pharyngeal
  • Lingual artery
  • Facial artery
  • Occipital artery
  • Posterior auricular artery
  • Maxillary
  • Superficial temporal
77
Q

External Carotid Artery Anterior Branches

A
  • Superior thyroid artery
  • Lingual artery
  • Facial artery
78
Q

Superior Thyroid Artery Supplies

A
  • Supplies thyroid gland
  • SCM
  • Strap muscles
79
Q

Lingual Artery

A
  • Supplies the tongue
80
Q

Facial Artery

A
  • Supplies face (and other things)
  • Deep to digastric/stylohyoid muscles
  • Hooks around mandible, deep to submandibular gland
81
Q

Facial Artery Branches

A
  • Ascending palatine
  • Tonsillar
  • Submental
82
Q

Superior Thyroid Artery Branches

A
  • Superior laryngeal artery
83
Q

Superior Laryngeal Artery

A
  • Supplies the larynx
84
Q

External Carotid Artery Medial Branch

A
  • Ascending pharyngeal artery
85
Q

Ascending Pharyngeal Artery

A
  • Supplies pharynx and meninges
86
Q

External Carotid Artery Posterior Branches

A
  • Occipital artery

- Posterior auricular artery

87
Q

Occipital Artery

A
  • Supplies posterior scalp

- Arises above facial

88
Q

Posterior Auricular Artery

A
  • Supplies scalp, temporal bone, adjacent muscles
  • Last pre-terminal branch
  • Passes between external acoustic meatus and mastoid process
89
Q

External Carotid Artery Terminal Branches

A
  • Superficial temporal: supplies scalp

- Maxillary: supplies infratemporal fossa, meninges, masticatory muscles, etc.

90
Q

Superficial Temporal Artery

A
  • Supplies scalp
91
Q

Maxillary Artery

A
  • Supplies infratemporal fossa
  • Meninges
  • Masticatory muscles
  • Etc.
92
Q

Carotid Body

A
  • Located in adventitia of the CCA bifurcation

- Chemoreceptor

93
Q

Carotid Sinus

A
  • In the adventitia of the carotid bulb (dilation in the proximal IC)
  • Baroreceptor
94
Q

Carotid Body and Sinus Innervation

A
  • Both innervated by CN IX via carotid sinus (Hering’s nerve)
95
Q

Veins in the Neck

A
  • External jugular vein
  • Anterior jugular vein
  • Internal jugular vein
96
Q

Hyoid Bone Level

97
Q

Thyroid Cartilage Level

98
Q

Cricoid Cartilage Level

99
Q

Thyroid Gland (Endocrine Organ)

A
  • 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
Q

Thyroid Arterial Supply

A
  • Superior thyroid artery (paired)
  • Inferior thyroid artery (paired)
  • Thyroid ima artery (unpaired)
101
Q

Superior Thyroid Artery (Paired)

A
  • From external carotid

- Enters antero-superiorly

102
Q

Inferior Thyroid Artery (Paired)

A
  • From thyrocervical trunk

- Travels posterior to carotid sheath

103
Q

Thyroid Ima Artery (Unpaired)

A
  • From brachiocephalic trunk (or neighboring vessel)
  • Present in ~10% of people
  • Travels across trachea toward the thyroid isthmus
104
Q

Venous Drainage in Thyorid

A
  • Superior thyroid vein –> IJV
  • Middle thyroid vein –> IJV
  • Inferior thyroid vein –> brachiocephalic veins
105
Q

Lymphatic Drainage of Thyroid

A
  • Pretracheal, paratracheal lymph nodes –> deep cervical nodes
106
Q

Important Anatomical Relationships of Thyroid

A
  • 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
Q

Parathyroid Gland

A
  • 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
Q

Parathyroid Gland Arterial Supply

A
  • Primarily inferior thyroid artery
109
Q

Parathyroid Nerve, Venous, and Lymphatic Drainage

A
  • Follows thyroid gland
110
Q

Inadvertent Parathyroid Gland Removal

A
  • Decreased serum calcium resulting in muscle tetany

- Serious because can involve respiratory and laryngeal muscles

111
Q

Mylohyoid Muscle Innervation

A
  • Nerve to mylohyoid (CN V, mandibular division of trigeminal)
112
Q

Mylohyoid Muscle Function

A
  • Elevates hyoid, floor of mouth
113
Q

Geniohyoid Muscle Innervation

A
  • C1 fibers traveling in hypoglossal nerve
114
Q

Geniohyoid Muscle Function

A
  • Pulls hyoid anterosuperiorly
115
Q

Stylohyoid Muscle Innervation

A
  • Facial nerve (CN VII)
116
Q

Stylohyoid Muscle Function

A
  • Elevates and retracts hyoid
117
Q

Anterior Belly of Digastric Muscle Innervation

A
  • Nerve to mylohyoid (CN V, mandibular division of trigeminal)
118
Q

Posterior Belly of Digastric Muscle Innervation

A
  • Facial nerve (CN VII)
119
Q

Infrahyoid Muscles Function

A
  • Depress the hyoid and larynx
120
Q

Infrahyoid Muscles Innervation

A
  • Ansa cervicalis (except thyrohyoid)
121
Q

Thyrohyoid Muscles Innervation

A
  • C1 branches traveling with hypoglossal nerve
122
Q

External Jugular Vein Pathway

A
  • Crosses superficial to SCM
  • Deep to platysma
  • Pierces investing cervical fascia posterior to SCM
  • Drains into subclavian vein
123
Q

Irritation of the Structures Innervated by Phrenic (Sensory) Causes

A
  • Referred shoulder pain

Gross Anatomy (50 decks)

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