Neck G48 Flashcards

1
Q

Organizing the neck into UNITS

A

Boundaries defined by fascia

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2
Q

Organizing the neck into TRIANGLES

A

Boundaries defined by muscles and bones

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3
Q

Layers of cervical fascia

A

Superficial cervical fascia and deep cervical fascia

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4
Q

Functions of fascia

A

fascial planes determine direction of infection and form natural cleavage planes that give slipperiness for structures to move passed another, limit spread of abscesses

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5
Q

Superficial Cervical Fascia

A

Between dermis and investing layer of deep cervical fascia, contains: cutaneous nerves, blood and lymph vessels, superficial lymph nodes, FAT, and platysma m. anterolaterally

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6
Q

Deep Cervical Fascia layers

A

Investing layer, pretracheal layer, prevertebral layer, and carotid sheath

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7
Q

Investing layer of deep cervical fascia

A

Most superficial, surrounds entire neck, ENCLOSES TRAPEZIUS, STERNOCLEIDOMASTOID, PAROTID and SUBMANDIBULAR GLANDS

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8
Q

Muscular unit is surrounded by

A

investing layer of deep cervical fascia

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9
Q

Stylomandibular ligament

A

thickened modification of the investing deep cervical fascia

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10
Q

Pretracheal layer of deep cervical fascia

A

Anterior portion of neck, thin, ENCLOSES THYROID GLAND, TRACHEA, and ESOPHAGUS (INFRAHYOID M.)

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11
Q

Visceral unit is surrounded by…

A

pretracheal layer of deep cervical fascia

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12
Q

What layer forms the fascial slings for the digastric and omohyoid muscles?

A

pretracheal fascia

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13
Q

Prevertebral layer of deep cervical fascia

A

tubular sheath for the vertebral column and associated muscles, sympathetic trunks are embedded in this layer

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14
Q

Sympathetic trunks are embedded in what fascial layer of the neck

A

prevertebral layer of deep cervical fascia

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15
Q

Vertebral unit is surrounded by

A

prevertebral layer of deep cervical fascia

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16
Q

Carotid sheath of deep cervical fascia

A

tubular from base of skull to root of neck, containing: common and internal carotid arteries, internal jugular vein, vagus n, deep cervical lymph nodes, carotid sinus n, sympathetic fibers

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17
Q

Carotid unit is surrounded by

A

carotid sheath of deep cervical fascia

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18
Q

Which fascial layer is a potential pathway for spread of infection because it allows communication with the mediastinum and cranial cavity?

A

Carotid sheath

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19
Q

What muscle divides each side of the neck into two large triangles?

A

sternocleidomastoid

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20
Q

Anterior boundary of the posterior triangle

A

Sternocleidomastoid

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21
Q

Posterior boundary of the posterior triangle

A

Trapezius muscle

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22
Q

Inferior boundary of the posterior triangle

A

middle 1/3 of the clavicle

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23
Q

Apex of the posterior triangle

A

behind the ear at the level of the superior nuchal line of occipital bone

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24
Q

Roof of the posterior triangle

A

investing fascia, platysma, and skin

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25
Q

Floor of the posterior triangle

A

Prevertebral fascia and Splenius Capitis, Levator Scapulae, Middle scalene, Anterior scalene, and Posterior scalene

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26
Q

Posterior triangle can be divided into two smaller triangles… by the…

A

Occipital triangle and subclavian triangle… inferior belly of omohyoid m.

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27
Q

Occipital triangle

A

Accesory n. (CN XI) crosses this triangle within the investing layer of deep cervical fascia

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28
Q

Posterior border of anterior triangle

A

Sternocleidomastoid

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29
Q

Anterior border of anterior triangle

A

Median line of neck

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30
Q

Superior border of anterior triangle

A

inferior margin of mandible

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31
Q

Apex of anterior triangle

A

jugular (suprasternal) notch

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32
Q

Roof of anterior triangle

A

investing fascia, platysma, and skin

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33
Q

Floor of anterior triangle

A

pharynx, larynx, and thyroid gland (covered by pretracheal fascia)

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34
Q

The anterior triangle can be subdivided into 4 triangles…

A

Submental, submandibular (digastric), carotid, and muscular triangle

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35
Q

Location of anterior scalene

A

deep to sternocleidomastoid, anterior to middle scalene (in posterior triangle)

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36
Q

Origin of anterior scalene

A

C4-C6 transverse processes

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37
Q

Insertion of anterior scalene

A

1st rib

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38
Q

Action of anterior scalene

A

Elevates 1st rib, laterally flexes and rotates neck

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39
Q

Innervation of anterior scalene

A

C4, C5, C6 spinal nerves

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40
Q

Origin of middle scalene

A

C2-C7 transverse processes

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41
Q

Insertion of middle scalene

A

1st rib

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42
Q

Action of middle scalene

A

Elevates 1st rib during forced inspiration, laterally flexes neck

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43
Q

Innervation of middle scalene

A

Ventral rami of C3-C7

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44
Q

Location of posterior scalene

A

posterior to middle scalene and anterior to levator scapulae (in posterior triangle)

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45
Q

Origin of posterior scalene

A

C5-C7 transverse processes

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46
Q

Insertion of posterior scalene

A

superior border of 2nd rib

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47
Q

Action of posterior scalene

A

Elevates 2nd rib during forced inspiration, laterally flexes neck

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48
Q

Innervation of posterior scalene

A

ventral rami of C7-C8

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49
Q

Omohyoid

A

two muscle bellies united by a tendon

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50
Q

The inferior belly of the omohyoid passes through

A

the posterior triangle posterior to the sternocleidomstoid

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51
Q

Omohyoid inferior belly Insertion

A

intermediate tendon (held to clavicle by CT pretracheal fascia loop)

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52
Q

Omohyoid inferior belly origin

A

superior border of scapula

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53
Q

Omohyoid superior belly origin

A

intermediate tendon

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54
Q

Omohyoid superior belly insertion

A

inferior border of hyoid bone

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55
Q

Innervation to both bellies of omohyoid

A

Ansa Cervicalis (C1-C3)

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56
Q

Action of Omohyoid

A

depresses, retracts, and steadies hyoid bone

57
Q

What muscles are found in the anterior triangle superior to the hyoid (supra hyoid)?

A

Digastric, stylohyoid, mylohyoid, geniohyoid, hyoglossus

58
Q

Digastric M Action

A

Has two belles that work to raise the hyoid bone; steady it during speaking and swallowing, acting posteriorly - open mouth, depresses mandible

59
Q

Posterior Belly of digastric m insertion

A

intermediate tendon (loop of CT connected to the hyoid bone)

60
Q

Posterior Belly of digastric m origin

A

mastoid notch of temporal bone

61
Q

Posterior Belly of digastric m innervation

A

Facial n (CN VII)

62
Q

Anterior Belly of Digastric m origin

A

digastric fossa of mandible

63
Q

Anterior Belly of Digastric m insertion

A

intermediate tendon

64
Q

Anterior Belly of Digastric m innervation

A

mylohyoid n. (CN V-3)

65
Q

Stylohyoid origin

A

styloid process of the temporal bone

66
Q

Stylohyoid insertion

A

body of hyoid bone; surrounds the tendon of digastric m

67
Q

Stylohyoid action

A

elevates and retracts hyoid bone

68
Q

Stylohyoid innervation

A

Facial n (CN VII)

69
Q

Infrahyoid muscles “strap muscles” of the anterior triangle

A

Omohyoid, Sternohyoid, Thyrohyoid, sternothyroid, sternocleidomastoid, and platysma

70
Q

Which part of the Omohyoid crosses the anterior triangle?

A

Superior belly

71
Q

Sternohyoid origin

A

Manubrium sterni and medial end of clavicle

72
Q

Sternohyoid insertion

A

Body of hyoid

73
Q

Sternohyoid action

A

Depressed hyoid bone and larynx

74
Q

Sternohyoid innervation

A

Ansa Cervicalis C1-C3

75
Q

Thyrohyoid is deep to

A

sternohyoid

76
Q

Thyrohyoid origin

A

oblique line of thyroid cartilage

77
Q

Thyrohyoid insertion

A

body and greater horn of hyoid bone

78
Q

Thyrohyoid action

A

depresses hyoid bone; elevates thyroid cartilage

79
Q

Thyrohyoid innervation

A

C1 via hypoglossal n (contributes to ansa cervicalis)

80
Q

Sternothyroid origin

A

manubrium sterni and 1st costal cartilage

81
Q

Sternothyroid insertion

A

oblique line of thyroid cartilage

82
Q

Sternothyroid action

A

depresses hyoid bone and larynx

83
Q

Sternothyroid innervation

A

Ansa Cervicalis C1-C3

84
Q

Sternocleidomastoid origin

A

Sternal head - manubrium sterni, clavicular head - medial 1/3 of clavicle

85
Q

Sternocleidomastoid insertion

A

mastoid process of temporal bone, occipital bone

86
Q

Sternocleidomastoid actions

A

unilaterally - laterally flexes neck, rotates head to opposite side, bilaterally - flexes neck

87
Q

Sternocleidomastoid innervation

A

Accessory n. (CN XI) and sensory fibers from C2/C3 ventral rami

88
Q

Platysma origin

A

fascia and skin over pectoralis major and deltoid muscles

89
Q

Platysma insertion

A

inferior border of mandible and skin of lower face

90
Q

Platysma action

A

tenses skin of neck, draws corners of mouth inferior

91
Q

Platysma innervation

A

cervical branch of FACIAL N (CN VII)

92
Q

Branches of cervical plexus seen in posterior triangle (C1-C4)

A

Cutaneous nerves: lesser occipital n., great auricular n., transverse cervical n., and supraclavicular n.

93
Q

Phrenic n. is a branch of the cervical plexus

A

motor innervation to diaphragm C3-C5 over anterior surface of anterior scalene m.

94
Q

Brachial plexus C5-T1

A

Neck: roots and trunks and dorsal scapular n and suprascapular n.

95
Q

Dorsal scapular n.

A

C5 in posterior triangle penetrating the middle scalene

96
Q

Suprascapular n.

A

upper trunk of brachial plexus and courses across triangle to innervate supraspinatus and infraspinatus

97
Q

Spinal accessory n.

A

exits via jugular foramen, innervates trap and sternocleidomastoid, within investing fascia

98
Q

Vagus n.

A

jugular foramen, in carotid sheath posterior to jugular and carotid, gives off superior laryngeal n. (to thyroid), recurrent laryngeal nerve (branches after carotid meets subclavian and loops around and back up), and cardiac nerves

99
Q

Cardiac nerves of vagus n.

A

PREGANGLIONIC PARASYMPATHETIC terminate near heart wall

100
Q

Hypoglossal n.

A

hypoglossal canal, innervates tongue musculature, on superficial surface of hyoglossus muscle (carries superior root of ansa cervicalis)

101
Q

Ansa Cervicalis

A

C1-C3 (C1 superior root ride along hypoglossal n, joins C2-C3 to form a loop) superficial surface of carotid sheath, supply strap muscles (thyrohyoid, omohyoid, stylohyoid, sternohyoid)

102
Q

Sympathetic trunk

A

preganglionic fibers run in prevertebral fascia along longus colli, synapse in three cervical ganglia

103
Q

Inferior cervical ganglion

A

posterior to vertebral a. as it branches from subclavian

104
Q

Stellate ganglion

A

cervicothoracic ganglion: fusion of inferior cervical ganglion and first thoracic ganglion

105
Q

Middle cervical ganglion

A

anterior aspect of inferior thyroid a. near level of cricoid cartilage

106
Q

Superior cervical ganglion

A

large - 2-3cm in length, level of the atlas/axis

107
Q

Cardiac branches of the sympathetic trunk

A

carry POSTGANGLIONIC fibers to the heart

108
Q

Horner’s Syndrome

A

interruption of sympathetics (injury to Upper plexus, facial n.) pupil constriction, ptosis, warm and dry to touch, loss of sympathetics

109
Q

Subclavian a. branches

A

vertebral a., internal thoracic a., thyrocervical trunk, and the costocervical trunk

110
Q

Vertebral a.

A

enters transverse foramen of C6 and enters foramen magnum

111
Q

Internal thoracic a.

A

descends posterior to ribs

112
Q

Thyrocervical trunk branches

A

inferior thyroid a.(superiorly, anterior to anterior scalene, posterior to carotid sheath, to thyroid), suprascapular a. (posterior and lateral, deep to sterno and trap), and the transverse cervical a. (extends laterally)

113
Q

Common carotid a.

A

within the carotid sheath, at level of thyroid cartilage it bifurcate into internal and external carotid

114
Q

Carotid body

A

at carotid bifurcation, small brownish mass of tissue that is a blood chemoreceptor (CO2, O2) innervated by CN9 and CN10

115
Q

Carotid sinus

A

dilated area of the proximal part of the internal carotid artery, BP regulatory area, innervated by the sinus n. of Hering (CN9)

116
Q

External Carotid branches

A

Superior thyroid a., ascending pharyngeal a., lingual a, facial a, occipital a, posterior auricular a, maxillary a, and superficial temporal a.
SALFOPMS

117
Q

Terminal branches of the external carotid?

A

superficial temporal a and maxillary a

118
Q

Thyroid gland

A

bilobed endocrine gland, isthmus crosses 2nd-4th tracheal ring

119
Q

Blood supply to the thyroid gland

A

superior (external carotid) and inferior thyroid a. (subclavian - thyrocervical trunk)

120
Q

Veins from thyroid gland

A

Superior and middle thyroid veins (internal jugular v), and inferior thyroid vein (brachiocephalic v)

121
Q

Parathyroid gland

A

small paired endocrine glands embedded in the posterior surface of the thyroid gland, essential for life

122
Q

Superior thoracic apertyre

A

T1 vertebra, first ribs, and manubrium

123
Q

Compression of inlet syndrome

A

Compression of nerves - irritation, arteries - ischemia or necrosis, vein - dilation, cyanosis, edema

124
Q

What structures pass through the interscalene triangle?

A

brachial plexus trunks and subclavian a.

125
Q

Costocervical trunk

A

last branch of subclavian, passes posteriorly to supply 1st ICS and deep back muscles

126
Q

Superior Thyroid a.

A

(external carotid branch) courses inferior to supply thyroid, sternocleidomastoid, strap muscles, and larynx

127
Q

Ascending pharyngeal a.

A

(external carotid branch) arises at bifurcation and ascends to supply pharynx, pre vertebral m. and inner ear

128
Q

Lingual a

A

(external carotid branch) courses superiorly and anteriorly deep to hyoglossus to supply the tongue

129
Q

Facial a.

A

(external carotid branch) over inferior border of mandible (anterior to masseter) supplies face, tonsil, palate, and submandibular gland

130
Q

Occipital a.

A

(external carotid branch) posterior side of carotid courses posterior to supply posterior scalp

131
Q

Posterior auricular a.

A

(external carotid branch) courses posteriorly to external auditory meatus and supply ear area

132
Q

Maxillary a

A

terminal branch to infratemporal fossa

133
Q

Superficial temporal a.

A

terminal branch to scalp and temporalis

134
Q

Internal jugular v is found where in the carotid sheath

A

LATERAL to the internal carotid artery

135
Q

External jugular v.

A

arises from a branch of the retromandibular v. beginning at the angle of the mandible, empties into subclavian

136
Q

Subclavian veins orientation in respect to anterior scalene

A

anterior to anterior scalene

137
Q

Pyramidal lobe of thyroid

A

extension upward from the isthmus to the hyoid bone, representing a persistent thyroglossal duct (opening into back of tongue in embyo and descends to become the thyroid)

138
Q

Blood supply to parathyroid glands

A

superior and inferior thyroid artery