Neck: Fascias, Spaces, Triangles, Superficial Structures Flashcards
occiput
external occipital protuberance and superior nuchal lines
mastoid process
of temoral bone
mandible
ramus, angle, inferior margin to midline
midline - symphysis menti
hyoid bone
superior to thyroid cartilage
opposite CV3
greater horn - palpable laterally
thyroid cartilage
opposite CV4 CV5
palpable superior thyroid notch and laryngeal prominence
cricoid cartilage
anterior to CV6
thyroid isthmus
usually palpable across level of 2,3,4 tracheal rings
platysma
neck cutaneous muscles seen anterior and lateral when straining
superficial fascia
CT and fat between skin and deep fascia
contains platysma
attachments of platysma
O: superficial fascia covering pec major and deltoid
I: inferior margin of mandible, skin and subQ of lower portion of face and corner of mouth
action of platysma
draws corners of mouth down
depresses mandlble
elevates skin of chest
innervation of platysma
cervical branch of CN VII (facial)
investing fascia
first layer of deep fascia
around entire neck
invests SCM and trapezius
attachments of investing fascia
superior - external occipital protuberance, superior nuchal line, mastoid process, inferior margin of mandible
posterior - external occipital protuberance, spinous processes of CV1-7 via nuchal ligament
inferior - scapula, acromion, clavicle, manubrium
suprasternal space
where the laminae of investing fascia from both surfaces of SCM fail to fuse anteriorly and inferiorly
contains fat and a vein
infrahyoid fascia
begins at hyoid bone and thyroid cartilage
forms two layers - superficial and deep
invest infrahyoid muscles
superficial layer of infrahyoid fascia
invests sternohyoid and omohyoid
attaches posterior to manubrium
lateral fusion with periosteum of clavicle and first rib
forms sling for intermediate tendon of omohyoid muscle
deep layer of infrahyoid fascia
invests sternohyoid and thyrohyoid
inferior to posterior surface of manubrium
inferior lamina of infrahyoid fascia
both layers fuse with adventitia of brachiocephalic veins and fibrous pericardium
-via superior sternopericardial ligament
laterally with carotid sheath
cervical visceral fascias
enclose viscera of neck
pre-tracheal and buccopharyngeal
pre-tracheal fascia
anterior to larynx and trachea
attached to hyoid bone superiorly
blends laterally with buccopharyngeal fascia
splits to enclose thyroid gland
inferiorly - attaches with adventitia of aortic arch
-fuses with fibrous pericardium
buccopharyngeal fascia
attaches superior to base of skull
-covers buccinator and pharyngeal constrictor muscles
fuses laterally with the pre-tracheal fascia at muscle attachment sites of pharyngeal constrictor and at posteromedial border of thyroid gland
inferior - fuse with adventitia of esophagus
pre-vertebral fascia
encircles vertebral column
bifurcates anteriorly alar fascia
alar fascia
attaches to midline of buccopharyngeal fascia
from bifurcation of pre-vertebral fascia
floor of posterior cervical triangle
pre-vertebral fascia attaches to cervical transverse processes
covers scalenes, levator scapulae, splenius and semispinalis muscles
sibsons fascia
prevertebral fascia continues on underside of scalene muscles
axillary sheath
prevertebral fascia reflected from scalene muscles latearally along subclavian and axillary veins and brachial plexus as they pass through scalene triangles
carotid sheath
surrounds common and internal carotid arteries, internal jugular vein, and vagus nerve
superior - attaches to margins of jugular foramen
inferiorly - fuses with adventitia of great vessels
form from all deep fascias fusing
infections in pretracheal, retrovisceral, and danger space
can go to carotid sheath
-and go inferiorly to involve aorta (aortitis)
pretracheal space
between deep layer of infrahyoid fascia and pre-tracheal fascia
extends from level of attachment of infrahyoid muscles to thyroid cartilage above to attachment of pericardium to roots of major vessels in superior mediastinum below
retropharyngeal spaces
2x
between buccopharyngeal, pre-vertebral, and alar fascias
extend from base of skull to posterior mediastinum
closed laterally - carotid sheath
retrovisceral space
between buccopharyngeal and alar fascias
more anterior
base of skull to where alar blends with esophagus
danger space
bewteen pre-vertebral and alar/buccopharyngeal fascias
- base of skull to diaphragm
- between vertebral column and esophagus
infection of pre-tracheal space
to superior mediastinum
-inflammation of brachiocephalic veins, aorta, pericardium
infection in danger space
retropharyngeal abscess
- dysphagia/dysarthria
- can dissect into posterior aspect of superior and posterior mediastinum
chronic tonsillitis
mediastinal abscess
inflammation of esophagus as far inferior as the diaphragm
attachments of SCM
O: sternal head - manubrium
clavicular head - proximal 1/3 clavicle
I: mastoid process, superior nuchal line
action of SCM
unilateral - rotates head opposite while elevating chin
bilateral - flexes head and limits extension of AO joint**
innervation of SCM
spinal accesory nerve CN XI
cervical spinal nerves C2 and C3
torticollis
wry neck
congenital or acquired
shortening of SCM
patients head sidebent to same side and rotated opposite of muscle**
posterior triangle
bounded by trap, SCM, and clavicle
subdivision of posterior triangle
by omohyoid division
occipital - larger superior
omoclavicular - smaller inferior
anterior triangle
bounded by SCM, angle of mandible, imaginary midline
subdivision of anterior triangle
by omohyoid and digastric muscles
digastric (submandibular) triangle
submental triangle
carotid triangle - posterior lower
muscular triangle - anterior lower
formation of external jugular vein
posterior division of retromandibular v.
posterior auricular vv.
extends SUPERIOR to SCM -then pierces investing fascia
terminates in the subclavian vein
tributaries to external jugular vein
posterior external jugular vein
transverse cervical vein
suprascapular vein
anterior jugular vein
prominence of external jugular vein
heart failure, SVC obstruction, enlarged supraclavicular lymph nodes, or increased intrathoracic pressure
laceration of external jugular vein
air embolism
negative intrathoracic pressure sucks air in
reduced blood through right atrium
-accumulated air/dyspnea
anterior jugular vein formation
from small veins in submental and submandibular regions that coalesce at hyoid bone area
has jugulovenous arch and then joins external jugular vein
jugulovenous arch
communication of right and left anterior jugular veins
common facial vein formation
facial veins join with anterior division of retromandibular vein
pierces carotid sheath to join internal jugular vein
also might get communicating vein
-to communicate with anterior jugular veins
blockage of internal jugular vein?
emissary veins and opthalmic vein drain blood to retromandibular and facial veins
anastomose with posterior auricular v to form external jugular vein
common facial vein from anastomosis facial vein with anterior division of retromandibular vein returns blood to internal jugular vein distal to blockage
dorsal rami of cervical nerves?
C1 - rare
C2 - greater occipital nerve
C3-6 - pierce uscle - cutaneous over trapezius
greater occipital nerve
C2 dorsal rami
pierce semispinalis capitis and trapezius and ascends to innervate skin over vertex and posterolateral skull
ventral rami of cervical nerves?
C1-4 cervical plexus
C2-4 of cervical plexus - to pinna of ear and in front of and behind ear
lesser occipital nerve
ventral rami C2,3
greater auricular nerve
ventral rami C2,3
transverse cervical nerve
ventral rami C 2,3
supraclavicular nerve
ventral rami C 3, 4
branches of supraclavicular nerve
medial, intermediate, and lateral supraclavicular nerve
medial supraclavicular nerve
crosses SCM to skin at base of neck, upper sternum, and SC joint
intermediate supraclavicular nerve
cross clavicle to innervate skin over pectoralis major as far inferior as third rib
lateral supraclavicular nerve
cross clavicle at AC joint and cutaneous to prominence of shoulder
cervical nerve block
anesthetize the cutaneous nerves during surgical approach to neck
ex. radical neck dissection of cancerous lymph nodes
phrenic nerve - shares SC levels of innervation
-will get ipsilateral hemidiaphragm paralysis
don’t do this procedure on patient with respiratory or cardiac disease
superficial cervical lymph nodes
submental, submandibular, external jugular, anterior jugular
drain to deep cervical lymph nodes that parallel internal jugular
lymph drainage of head and neck
superficial - superficial cervical to deep cervical
deep and visceral - to deep cervical
