Neck Clinical Supplement Flashcards
Where are infections between the investing/infrahyoid fascia and pretracheal fascia, and where can they spread?
Pretracheal space
Spreads inferiorly into the superior mediastinum
Where are infections deep to prevertebral fascia, and how can they extend?
Laterally, protrude along the posterior border of the sternocleidomastoid muscle (+ posterior triangle)
Where are the infections between buccopharyngeal fascia and alar fascia, and where can they spread?
Inferiorly, up to lower cervical levels, however, the space extends superiorly to the base of the skull
Where are the infections between the alar/buccopharyngeal fascia and prevertebral fascia, and how can they extend?
Inferiorly to the diaphragm and superiorly to the base of the skull
What is the Danger space?
Space between alar/buccopharyngeal and prevertebral fascia
What occurs in the Danger space?
Air from a ruptured airway/esophagus which results in a pneuomomediastium
What is a retropharyngeal abscess?
Infection between cervical vertebrae and pharyngeal wall
Where are retropharyngeal abscess more common in?
Children under 6 years of age and immunocompromised adults
How can a retropharyngeal abscess spread?
Oral cavity (dental abscess) and nasopharynx (tonsillitis and peritonsillar abscess)
What are the signs and symptoms of a retropharyngeal abscess?
Fever, sore throat, dysphagia, odynophagia, neck pain, back pain
What are the complications of a retropharyngeal abscess?
Airway obstruction, sepsis, mediastinitis, pneumonia, empyema, jugular vein thrombosis, carotid artery erosion
What are the complications of a retropharyngeal abscess?
Airway obstruction, sepsis, mediastinitis, pneumonia, empyema, jugular vein thrombosis, carotid artery erosion
What is torticollis?
Shortening of muscle due to trauma or spasms
What is the congenital cause of torticollis?
Difficult birth, causes possible hemorrhage and subsequent fibrotic changes
What is the spasmodic cause of torticollis?
Disease in basal nuclei, involves other muscles usually
What can cause injury to the subclavian artery?
Trauma/fracture along first rib
What does the collateral network with scapular arteries prevent?
Ischemic injury to upper limb
Where is the subclavian vein punctured?
Inferior to the clavicle
What can be inserted during a subclavian venipuncture?
Central line
What must be avoided in a subclavian venipuncture?
First rib, phrenic nerve, subclavian artery, and cupula of the lung
What becomes distended during a Valsalva maneuver, heart failure, tricuspid stenosis, SVC obstruction, and enlarged supraclavicular nodes?
External jugular vein
What can happen if the external jugular vein is lacerated?
Can be held open by investing fascia, causes negative thoracic pressure and air being sucked into vein -> cyanosis, air embolism + dyspnea
What has pulsations when mitral valve disease or right ventricular failure occurs?
Interal jugular vein
What gives rise to glomus jugulare tumors?
Jugular body
What does glomus jugulare tumor impact?
CN IX, X, XI > XII
Where can the IJV be punctured?
Lateral to pulsations of common carotid artery
What spinal cord levels make up phrenic nerve?
C3, C4, C5
Where does the phrenic nerve course?
Anterior surface of the anterior scalene muscle
What runs parallel with the phrenic nerve?
Ascending cervical artery
What is an accessory phrenic nerve?
60% of individuals have the accessory phrenic nerve that arise from nerve to subclavius -> can be damaged in cervical/thoracic procedure
How is the cervical plexus applied?
Anesthesia is injected along the posterior edge of the middle 1/3 of the SCM, this is the punctum nervosum or nerve point of the neck
What is an important cervical plexus note?
All cutaneous branches from the cervical plexus (C2-4) emerge from the posterior aspect of the SCM to reach their target skin; anesthesia injected along the posterior border of the mid-SCM will result in anesthesia of these nerves – great auricular, lesser occipital, transverse cervical and all supraclavicular n
How is the brachial plexus applied?
Anesthesia is injected above the clavicle towards the scalene triangle; also known as “supraclavicular brachial plexus block”
What is a stellate ganglion?
Impacts sympathetic function of ipsilateral head, neck and upper limb
What can damage suprascapular nerve?
Fracture of the middle 1/3 of clavicle
What occurs when injury to suprascapular nerve happens?
Weakness in lateral rotation of shoulder and initiation of abduction
Ligation of external carotid artery anastomoses
a. across the midline (e.g. facial to facial anastomoses)
b. the descending branch of the occipital artery (forms an anastomotic network that involves the vertebral, deep cervical and ascending cervical arteries)
What is carotid endarterectomy?
Surgical removal of plaque within the internal carotid artery
What are iatrogenic injury risks during a carotid endarterectomy?
Cutaneous branches from cervical branches, CN IX, CN X, CN XI, CN XII, ansa cervicalis + C1, sympathetic trunk
What occurs when there is injury to CN IX?
Dysphagia, diminished gag reflex
What occurs when there is a carotid sinus nerve injury?
Irregular blood pressure and heart rate
What occurs when CN X is injured?
Hoarseness»_space; dysphagia, diminished gag reflex
What occurs when CN XI is injured?
Weakness in shoulder shrugging, turning head against resistance
What occurs when CN XII is injured?
Tongue paralysis
What occurs when ansa cervicalis +C1 is injured?
Difficulty stabilizing hyoid
What occurs when sympathetic trunk is injured?
Horner syndrome
Where can you find carotid pulse?
Between trachea and anterior border of SCM
What is carotid body and sinus innervated by?
CN IX, sometimes CN X
What is the carotid sinus?
Baroreceptor -> pressure!
What are the baroreceptors along aortic arch innervated by?
CN X
What is the carotid body?
Chemoreceptor -> chemicals
What is the origin of the carotid body?
Neural crest cells
What can rise from the carotid body?
Preganglionic tumors
What is carotid sinus syncope?
Hypersensitivity of the carotid sinus resulting in episodes of diminished cerebral blood
flow and fainting spells
What is sympathetic innervated to head and neck?
Spinal cord levels T1-T4
Excessive vasoconstriction in the upper limb or head may be relieved by block of…
The stellate/inferior
cervical ganglion
What is Horner’s syndrome?
Lesions of the cervical sympathetic trunk (amongst other etiologies, e.g. brainstem stroke, spinal cord injury)
What is F PAM of Horner Syndrome
- Flushing of the face (loss of vascular tone)
- mild Ptosis (paralysis of superior tarsal muscle) **
- Anhydrosis (from denervation of sweat glands) *
- Miosis (unopposed constrictor pupillae) **
What is being impacted if Horner’s syndrome presents without anhydrosis and flushing?
Lesion affecting the internal carotid nerve
10% of people have a thyroid ima artery, at risk of injury…
During tracheostomy
What is the most common midline neck mass in children?
Thyroglossal duct cysts
What is a common site of ectopic tissue?
Pyramidal lobe
What is a remnant of thyroglossal duct?
Pyramidal lobe
Where can the ectopic thyroid tissue be located?
Along the midline course of thyroglossal duct as high as the tongue
In a thyroidectomy, ligation of the … endangers …
Superior thyroid artery, external laryngeal nerve
Ligation of inferior thyroid artery endangers…
Recurrent laryngeal nerve
What anchors the thyroid gland to the trachea?
Suspensory ligament of Berry
What runs lateral to the suspensory ligament of Berry?
Recurrent laryngeal nerve
What is the tubercle of Zuckerkandl?
In close
approximation of the inferior thyroid artery where it crosses the recurrent laryngeal nerve
What is the lymph drainage of the isthmus?
relaryngeal/tracheal → paratracheal → deep cervical (superior and inferior)
What is the lymph drainage of the lateral lobes?
directly to superior and inferior deep cervical
What is the local spread of thyroid cancer?
Trachea, vagus nerves, recurrent laryngeal nerves
What is the venous drainage of thyroid cancer?
Lungs, vertebra > liver (via Batson’s Plexus)
How many parathyroid glands are there?
Typically 4 in number, but can be 2 - 6 glands ranging in location from the hyoid bone to the superior
mediastinum
What is Chvostek’s sign?
Tapping of the facial nerve anterior to the tragus results in twitching of facial muscles (because of hyperexcitability)
Inadvertent removal of parathyroid glands can cause…
Hypocalcemia (=hyperexcitability of nerves), paranesthesia around the mouth, hands, and feet, muscle cramps (tetany), and hyperactive muscle stretch reflexes
