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Neuro Exam 1 > Neck I and II Surface anatomy, fascias and spaces > Flashcards

Neck I and II Surface anatomy, fascias and spaces Flashcards

1
Q

where can you palpate the body and greater horn of the hyoid

A

anteriorly immediatley superior to the prominence of the thyroid cartilage (opposite the third cervical vertebra)

laterally its greater horn is palpable

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2
Q

where is the thyroid cartilage located

A

opposite the 4th and 5th CV

superior thyroid notch and laryngeal prominence area easily palpable anteriorly

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3
Q

where is the cricoid cartilage located

A

anterior to the 6th cervical vertebra

this “signet” ring shaped cartilage is palpable directly inferior to the thyroid cartilage

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4
Q

what are the tracheal rings

A

d shaped cartilages

their open areas face posteriorly

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5
Q

where is the thyroid isthmus palpable

A

across the level of the 2nd, 3rd and 4th tracheal rings

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6
Q

in which fascial layer is the platysma located

A

within the superficial fascia layer

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7
Q

what are the attachments of the platysma

A

Origin–> superficial fascia covering the pectoralis major and deltoid

insertion–> inferior margin of mandible, skin and subcutaneous tissues of the lower portion of the face and corner of the mouth

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8
Q

what is the action of the platysmus

A

draws corner of mouth downward, depresses mandible, elevates skin of chest

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9
Q

what is the innervation of the platysmus

A

cervical branch of facial nerve (CNVII) - derivative of 2nd arch

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10
Q

what are the fascial layers of the cervical region

A 
superficial 
deep: 
investing 1
infrahyoid 2 (superficial, deep)
cervical visceral (pre-tracheal 3, buccopharyngeal 4)  
Prevertebral 5 --> alar 6 
specializations of pre vertebral (sibson's and axillary) 
carotid sheath
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11
Q

what are the superior and posterior attachments of the investing fascia

A

superior –> external occiptal protuberance, superior nuchal line, mastoid porcess and inferior margin of the mandible

posterior –> external occipital protuberence, spinous processes of CV1- CV7 via the nuchal ligament

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12
Q

what is the inferior attachment of the investing fascia

what is the suprasternal space

A

line connecting inferior attachment–> spinous process of CV7, spine of scapula, acromion, clavicle and manubrium,

blends with inferior attachments of SCM and trapezius and attaches to the invervening middle on-third of the clavicle

where the laminae from both surfaces of the SCM fail to fuse anteriorly and inferiorly they form a small suprasternal space which is normally filled with fat and contains a vein which communicates with the inferior portion of the anterior jugular veins

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13
Q

what does the investing facia surround

A

SCM and trapezius

also forms a CT capsule for the submandibular gland

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14
Q

where does the infrahyoid fascia begin (2nd layer of deep fascia) and what are the two layers

A

beginning at the hyoid bone and thyroid cartilage , this facial forms two definite layers which invest the infrahyoid muscles

superficial and deep layers

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15
Q

what does the superficial layer of infrahyoid fascia surround
where does it attach inferiorly

what does it fuse with laterally and what other structure does it form

A

invests sternohyoid and omohyoid

inferiorly attaches to the posterior surface of the manubrium

latearlly it fuses with the periosteum of the clavicle and first rib –> forms a sling for the intermeidate tendon of the omohyoid muscle

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16
Q

what does the deep infrahyoid fascia layer invest and where does it attach inferiorly

A

invests sternothyroid and thyrohyoid muscles

attaches inferiorly to the posterior surface of the manubrium

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17
Q

inferiorly where do the two layers of infrahyoid fascia fuse and laterally where do they fuse

A

inferirly –> adventitia of the brachiocephalic veins and fibrous pericardium via the sternopericardial ligament

laterally with the carotid sheath

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18
Q

what are the two layers of cervical visceral fascia

A

pre-tracheal (3)

buccopharyngeal (4th layer) b

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19
Q

what are the superoir and anterior attachments of prevertebral fascia

A

superior – base of skull

anterior - covers the pre-vertebral musculature and extends inferiorly into the posteiror mediastinum

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20
Q

what are the attachments of alar fascia

A

anteriorly the pre-vertebral fascai bifurcates to form the alar fascia

attaches midline of the buccopharyngeal fascia
bilaterally blends with the carotid sheath and inferiorly blends with the adventitia of the esophagus in the superior mediastinum between CV7 and TV3

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21
Q

what are the inferior and posterior attachments of pre-vertebral fascia

A

lateral-> attaches to the cervical transverse processes and forms the floor of the posterior cervical triangle where it covers the scaliness, levator scapulae, splenius, and semispinalis muscles

posterior–> from the nuchal lines and mastoid processes to cervical spinous processes
inferiorly it fuses with the thoracolumbar fascia of the deep back

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22
Q

what are the two specializatons of prevertebral fascai

A

sibson’s fascia (suprapleural membrane)
underside of the scalene muscle

axillary sheath–> reflected laterally along the subclavian and axillary vessels and brachial plexus

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23
Q

what is the carotid sheath

what does it surround

where does it attach

A

neurovascular component of deep fascia, surrounds the:
common and internal carotid arteries
internal jugular vein
vagus n.

attaches superiorly to base of skull
inferiorly fuse with the adventitias of the great vessels and fibrous pericardium

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24
Q

what attaches to the carotid sheath

A

all deep fascias of the neck blend laterally and attach to this

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25
Q

what is space 1

A

suprasternal space

26
Q

what is space 2

A

pre-tracheal or visceral space

located between the deepest layer of infrahyoid fascia and the pre-tracheal fascia

extends from the level of the attachment of the infrahyoid muscles to the thyroid cartilage above
to the attachment of the pericardium to the roots of the major vessels in the superior mediastiunum below

27
Q

what is space 3

A

retropharyngeal space or retrovesical

a smaller more anterior space between the buccopharyngeal and alar fascias

extends from base of skull above to a point approximately opposite CV7-TV3 where the alar fascia blends with the esophagus in the neck or as far inferior as the superior mediastinum

28
Q

what is space 4

A

Danger space
retropharyngeal space

a larger more posterior space
located b/w the prevertebral and alar/buccopharyngeal fascias extending from the base of the skull to the DIAPHRAGM b/w the vertebral column and esophagus

i

29
Q

infection in the pretracheal space

A

can dissect into the superior mediastinum leading to inflammation of the brachiocephalic veins, aorta, and pericardium

30
Q

infection in the danger space and what does this have to do with chronic tonsillitis

A

can lead to retropharygneal abscess which can lead to dysphagia and dysarthria and can dissect into the posterior aspect of the superior and posterior mediastinum

chronic tonsillitis can lead to mediastinal abscess thereby leading to inflammation of the esophagus as far distally as the diaphragm

31
Q

what are the anterior and posterior general boundaries of the neck

superior and inferior ?

A

anterior - line from symphysis menti to the sternal notch

posterior
trapezius (anterior) border

superior- line that connects the superior nuchal line, mastoid process and inferior margin of the mandible to the symphysis menti

inferior - superior margin of the clavicle, sternoclavicular joint and sternal notch

32
Q

what are the attachments of the sternocleidomastoid

A

Origin-
sternal head- manubrium
clavicular head- proximal 1/3 of clavicle

inseration - mastoid process and superior nuchal line (lateral half)

33
Q

what is the action of the SCM

A

unilaterally acting- rotates head toward side opposite while elevating chin

bilaterally acting - flexes head, limited extension of the atlanto-occiptial joint

34
Q

what is the innervation of the SCM

A 
Spinal accessory (CN XI) 
cervical spinal nerves C2 and C3
35
Q

torticollis (wry neck)

A

congenital or acquired

results in shortening of the SCM which places the patients head in a positition side bent to the same side and rotated to the side opposite the affected muscle

36
Q

what are the boundaries of the posterior triangle

A 
posterior - trapezius
anterior- SCM 
inferior - clavicle 
subdivided by the passage of the inferior belly of the omohyoid muscle into: 
occipitlal triangle
omoclavicular triangle
37
Q

occipital triangle

A

larger, more superior triangle bounded by the trapezius, SCM and inferior belly of omohyoid

38
Q

omoclavicular triagnle (subclavian or supraclavicular triangle)

A

small, more inferior

bounded by inferior belly of omohyoid, clavicle and SCM

39
Q

what are the boundaries of the anterior triangle

A

bound by SCM posteriorly
angle of the mantle superiorly and an imaginary line mid-sagitally

subdivided by the passage of the digastric and omohyoid muscles to form: digastric triangle and submental triangle, carotid triangle, muscular triangle

40
Q

digastric triangle

A

bounded superiorly by the inferior margin of the mandible

inferiorly by the two bellies of the digastric muscle

41
Q

submental triangle

A

bounded laterally by the two opposing anterior bellies of the digastric muscles and the hyoid bone

42
Q

Carotid triangle

A

bounded superiorly by the posterior belly of the digastric

anteriorly by the superior belly of the omohyoid and posteriorly by the SCM

43
Q

muscular triangle

A

bounded posterior superiorly by the usperior belly of the omohyoid
posterior inferiorly by the SCM
anteriorly by the median line of the neck to the hyoid bone

44
Q

what veins form the external jugular vein

A

union of posterior division of the retromandibular and the posterior auricular veins at the angle of the mandible

45
Q

what is the course of the External jugular vein

A

descends from its formation superficial to the SCM

pierces the investing fascia to gain the root of the neck behind the claivcle where it terminates in the subclavian vein

46
Q

what are the tributaries of the external jugular vein (4)

A

posterior external jugular
transverse cervical
suprascapular
anterior jugular

47
Q

what does increased filling of the external jugular vein reveal

A

heart failure
SVC obstruction
enlarged supraclavicular lymph nodes or increased intrathoracic pressure

48
Q

what causes air embolism

A

laceration of external jugular vein along the poseterior border of the SCM can lead to this due to negative intrathoracic pressure which sucks air into the open vein
see notes

49
Q

what is the formation of the anterior jugular veins

A

small veins in the submental and submandibular regions coalesce at the level of the hyoid bone to form the anterior jugular vein

50
Q

what is the course of the anterior jugular vein

A

from hyoid bone to medial inferior most extent of the anterior triangle
pierces investing fascia and continues inferiorly within the suprasternal space where it communicates with its opposite fellow via the jugulovenous arch!!!

then it turns laterally coursing deep to the SCM to join the external jugular vein

51
Q

what forms the common facial vein

A

anterior division of the retromandibular vein and facial vein

the common facial vein then pierce the carotid sheath and joins the internal jugular

52
Q

what forms the communicating vein

A

the union of the retromandibular and facial veins

the communicating vein then follows the anterior border of the SCM to communicate with the anterior jugular system

53
Q

where do a portion of the superficial cervical lymph nodes lie in the neck

A

along the path of the external jugular vein

54
Q

what are the dorsal rami that are the cutaneous contribution to the neck

A

C1 spinal nerve-> has no dorsaal root in 50% of individuals

C2 greater occipital n.

C3-C6

55
Q

what are the ventral rami (cutaneous nerves) that are involved in the innervation of the neck

A

C2-C4 in general

Lesser occipital C2, C3
Greater auricular C2, C3
Transverse cervical C2, C3
Supraclavicular C3, C4

the above nerves emerge from beneath the posterior border of the SCM in the posterior triangle

56
Q

lesser occiptial

A

C2 C3
posterior border of SCM (ascends)

innervates medial surface of the ear as well as the skin behind the ear

57
Q

greater auricular nerve

A

C2, C3

ascends towards the angle of the mandible paralelleing the external jugular vein

provides branches to mastoid process
lower portion of both surfaces of the ear and the inferior portion of the angle of the mandible and parotid region

58
Q

transverse cervical nerve

A

C2, C3

crosses lateral surface of SCM inferior to the great auricular nerve and deep to external jugular vein

travels deep to the platysma where it divides into two branches (superior and inferior) which pierce the platysma to innervate the skin and subcutaneous tissue of the anterior triangle from the mandible to the sternum

59
Q

supraclavicular nerve and its branche

A

C3 C4

medial supraclavicular
-base of neck, upper sternum, and sternoclavicular joint

intermediate- crosses the clavicle to innervate skin over pectoralis major as far inferior as third rib

lateral
-crosses the clavicle in the area of the acromioclavicular joint and provides cutaneous innervation to the prominence of the shoulder

60
Q

cervical nerve block

what are the consequences (b/c of other nerves)

A

includes the supraclavicular, lesser occ, greater auricular, transverse cervical

anesthetized during the normal course of surgical approaches to superficial or deeper areas of the neck

however, the phrenic nerve shares spinal cord levels of innervation (C3-C4) with the spinal cord levels of origin of the cervical plexus and therefore the ipsilateral hemidiaphragm will also be paralyzed

don’t use this on patients with significant respiratory or cardiac disease

61
Q

cervical plexus cord levels

A

C1=C4

62
Q

what are the 4 major superficial cervical lymph nodes

where do they drain

A

submental
submandibular
external jugular
anterior jugular

drain to deep cervical lymph nodes

receive lymph from:
lower portion of ear and parotid region
facial region
portions of the oral cavity
submandibular and sublingual salivary 
skin of the anterior neck and muscles of the infrahyoid region

Neuro Exam 1 (9 decks)

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