Neck I and II Flashcards
what is the occiput
external occipital protuberance and superior nuchal lines
where is the hyoid bone palpated
anteriorly immediately superior to the prominence of thyroid cartilage, its greater horn is palpable laterally
where is the thyroid cartilage located
opposite to 4th and 5th cervical vertebrae
superior thyroid notch and laryngeal prominence palpated anteriorly
where is the cricoid cartilage located
anterior to the 6th cervical vertebrae
palpated inferior to thyroid cartilage
where is the open face side of traceal rings
posteriorly
where is the thyroid isthmus palpated
2nd 3rd and 4th tracheal rings
what is the cutaneous muscle in the neck
platysma
where is the platysma located
within superficial layer
what is origin and insertion of platysma m
o: superficial fascia covering pectoralis major and deltoid
i: inferior margin of mandible, skin and subcut tissue of lower portion face and corner of mouth
action and inn platysma
action: draws corner of mouth downward, depresses mandible, elevates skin of chest
inn: cervical branch of facial N CN VII
what is the 1st layer of deep fascia
investing fascia
cylinder of fascia around entire neck
invests trapezius and SCM mm
what are the superior and posterior attachments of deep investing fascia of neck
sup: external occipital protuberance, superior nuchal line, mastoid process and inferior margin of the mandible
post: external occipital protuberance, spinous processes CV1-CV7 via nuchal ligament
what is the inferior attachment of deep investing fascia
connects spinous process CV7, spine of scapula, acromion, clavicle, manubrium
blends with SCM and trapezius and attaches to middle 1/3 clavicle
What is the suprasternal space
created form laminae of SCM surfaces which fail to fuse. contains a vein that communicates with inferior portion of anterior jugular vv
what forms a CT tissue capsule for submandibular gland
deep investing fascia of neck
what is the 2nd layer of deep fascia
infrahyoid fascia
where is the infrahyoid fascia
begins at hyoid bone and thyroid cartilage
describe the 2 layers of infrahyoid fascia
superficial: invests sternohyoid and omohyoid mm and inferiorly to attach to post manubrium. laterally fuses with periosteum of clavicle and first rib
deep: invests the sternothyroid and thyrohyoid mm and is prolonged inferiorly to post manubrium
what layer of infrahyoid fascia forms a sling for intermediate tendon of omohyoid m
the superficial layer
where do the fascia layers of the infrahyoid fascias fuse
inferiorly to adventitia of brachiocephalic vv, fibrous pericardium via superior sternopericardial ligament
laterally with carotid sheath
What fascia encircle the visceral structures of neck like the pharynx, esophagus, larynx trachea and thyroid gland
cervical visceral fascias: pre-tracheal and buccopharyngeal
describe the 3rd layer of deep fascia of the neck
pre-tracheal anterior to larynx and trachea
attaches to hyoid bone superiorly and blends laterally with buccopharyngeal fascia
encloses thyroid gland and also attaches to adventitia of aortic arch
describe 4th layer of deep fascia of the neck
buccopharyngeal attaches superiorly to base of skull, covers buccinator and pharyngeal constrictor mm
fuse laterally with pre-tracheal fascia
fuses with adventitia of esophagus
describe the 5th layer of deep fascia in the neck
pre-vertebral continuous with nuchal fascia posteriorly
encircles vertebral column and its assoc mm
what are the attachments of the pre-vertebral fascia
superior: base of skull and laterally to vertebral column
anterior: covers pre-vertebral mm and extends inferiorly into posterior mediastinum
what is the alar fascia
pre-vertebral fascia bifurcates for form 6th deep layer of fascia and attaches to midline buccopharyngeal fascia, bilaterally blends with carotid sheath and inferiorly blends with adventitia of esophagus between CV7 and TV3
what forms the floor of the posterior cervical triangle
the lateral parts of alar fascia that attach to cervical transverse processes
what does the floor of posterior cervical triangle cover
scalenes, levator scapulae, splenius and semispinalis
the alar fascia posteriorly and inferiorly fuses with what fascia
thoracolumbar fascia of deep back
what are the specializations of pre-vertebral fascia
sibsons fascia, underside of scaliness and reinforce dome of cervical pleura
axillary sheath laterally along subclavian and axillary vessels and brachial plexus
what does the carotid sheath envelope
common and internal carotids
internal jugular v
vagus n
where does the carotid sheath attach
superiorly to base of skull at jugular foramen and carotid canal
inferiorly with adventitious of aorta, pulm trunk superior vena cava and fibrous pericardium
how many of the deep fascias of the neck blend with carotid sheath
all
where is the pre-tracheal space of visceral space
located between deepest layer of infrahyoid fascia and pre-tracheal fascia
extends from infrahyoid mm to thyroid cartilage to attachment of pericardium and roots of major vessels
infections in the pre-tracheal space can go where and cause what
can go into superior mediastinum leading to inflammation of brachiocephalic vv, aorta and pericardium
where are the retropharyngeal spaces
2: between buccopharyngeal, pre-vertebral and alar fascias
extend from base of skull to posterior mediastinum and close laterally to carotid sheath
where is the retrovesisceral, retropharyngealm retroesophageal space
anterior between buccopharyngeal and alar fascias
where is the “danger space” of the retropharyngeal spaces
larger, more posterior between pre-vertebral and alar/buccopharyngeal fascia extending from base of skull to diaphragm between vertebral column and esophagus
infections in the “danger space” can lead into where and cause what
retropharyngeal abscess leading to dysphagia and dysarthria
can dissect into poster area of mediastinum and cause chronic tonsillitis and lead to mediastinal abscess leading to inflammtion of esophagus even to diaphragm
what are the general boundaries of the neck
anterior: line from symphysis menti to sternal notch
posterior: trapezius
superior: from superior nuchal line, mastoid process and infeiror margin of mandible to symphysis menti
inferior: superior margin of clavicle, sternoclavicular joint and sternal notch
what is the origin and insertion of SCM
o: sternal head- anterior surface manubrium
clavicular head- proximal 1/3 clavicle (superior surface)
i: mastoid process on lateral side and superior nuchal line on lateral half
what are the actions of SCM and inn
unilaterally- rotates head toward opposite while elevating chin
bilaterally- flexes head, limited extension of atlanto-occipital joint
inn: Spinal Accessory N CN XI, cervical spinal nn C2-3
What is torticollis (wry neck)
congenital or acquired, shortening of SCM which places patients head in position side bent to same side and rotated to opp side of affected m
what triangles of the neck are formed by SCM
anterior and posterior
what are the borders of the posterior triangle of neck
posterior: trapezius
anterior: SCM
inferior: clavicle
subdivided by inferior belly of omohyoid m
what two triangles are within posterior triangle of neck
occiptal- larger and more superior trapeze, SCM and inferior belly omohyoid
omoclavicular (subclavicular)- smaller inferior, inferior belly omohyoid, clavicle and SCM
what are the borders of the anterior triangle of the neck
posterior: SCM
superior: angle of mandible
imaginary line mid sagittally
subdivided by passage of digastric and omohyoid mm
what are the triangles in the anterior triangle of neck
digastric (submandibular)- inferior margin mandible, 2 bellies of digastric m
submental- laterally by 2opposing anterior bellies of digastric mm and hyoid bone
carotid- post belly digastric, sup belly omohyoid and SCM
muscular- sup belly omohyoid, SCM, median line of neck to hyoid bone
What are the superficial vv in neck
external jugular vv and the anterior jugular vv
what forms the external jugular v
posteiror division of retromandibular and posterior auricular vv
join at angle of mandible
is the external jug v deep or superficial to SCM
superficial
where does external jugular v terminate
subclavian v
what are tributaries to external jugular v
posteiror external jugular v
transverse cervical v
suprascapular v
anterior jugular v
increased filling of external jugular v can be an indication of what
heart failure, SVC obstruction, enlarged supraclavicular lymph nodes or increased intrathoracic pressure
laceration of external jugular v along posterior border of SCM can lead to what
air embolism due to negative intrathoracic pressure which sucks air through open vein
how is an air embolism detected
bruit upon auscultation of thoracic wall, cyanosis of mucous membranes and reduced flow through right atrium from increased air
also have dyspnea
What vv form the anterior jugular vv
small vv in submental and submandibular regions join at level of hyoid bone
where does the anterior jugular v course
descends anterior triangle, pierces investing fascia and continues into suprasternal space where it communicates with opp anterior jugular v via jugulovenous arch then course laterally to SCM to join external jugular v
what vv also communicate with anterior jugular vv
the retromandibular and facial vv join to form common facial v and give off communicating v
which v do some of the superficial cervical lymph nodes lay along
external jugular v
what provides path if the internal jugular v is occluded preventing increased intracranial pressure
emissary vv and opthalmic vv draining through scalp and orbit provide blood to retromandibular and facial vv
then distally to occlusion posterior auricular and external jugular thorugh facial v and anterior retromandibular v return blood to internal jugular
What are the cutaneous nn coming from dorsal rami in neck
C1 spinal n has no DRG- taken over by C2 greater occipital n
C2(greater occipital n) pierces semispinalis capitis and trapezius ascends to inn skin over posteriolateral skull
C3-C6 pierce deep mm to reach sub cut areas near dorsal midline and extend laterally to cutaneous areas over trapezius
what ventral rami contribute to cutaneous nn of neck
C1-C4 to cervical plexus
C2-C4 inn pinna and area behind and in front of ear, lateral and ant neck, upper ant thorax and prominence of shoulder
What are the names of cutaneous nn that emerge in the posterior triangle of neck
lesser occipital (c2-c3)
great auricular C2-C3
transverse cervical n C2-C3
supraclavicular nn C3C4
what does the lesser occipital n inn
medial surface of ear as well as skin behind ear
what does the great auricular n inn
skin over mastoid process, lower portion of ear and inferior portion of angle of mandible and parotid region
parallels external jug v
what does the transverse cervical n inn
deep to external jugular v
deep to platysma it splits into superior and inferior
skin and subcut of anterior triangle from mandible to sternum
where does supraclavicular n pass
cross inferior portion of posterior triangle and divides into 3 branches
what are the 3 branches of supraclacivular n and what do they inn
medial supraclavicular- skin at base of neck, upper sternum and sternoclavicular joint
intermediate “”- skin over pectoralis major to third rib
lateral “”- prominence of shoulder
what type of nerve block is given for surgeries of neck
what is dangerous about this
cervical nerve block
(also paralyzes diaphragm on ipsi side) because phrenic is C3-5
what are the superficial cervical lymph nodes, where do they drain to
submental, submandibular, external jugular and anterior jugular
drain to deep cervical lymph nodes that parallel internal jugular v
what structures of face is drained to superficial lymph nodes
lower portion ear, parotid region, facial region, portions of oral cavity, submandibular and sublingual glands, skin of ant neck and mm of infrahyoid
