Neck II Lecture Flashcards
What is the posterior triangle?
Trianngel formed between the sternocleidomastoid muscle, clavical, and trapezius muscle.
What are the two triangles withing the posterior triangle?
- Occipital triangle (sup)
- Omnoclvicular triangle
What are the two posterior triangles divided by?
They are divided by the omohyloid muslces (inferior bell)
What is the occipital triangle surrounded by?
- Sternocleidomastoid (medially)
- Trapezius (laterally)
- Inferior bellly of the omhyoid.
What is the subclavian omnoclavicular triangle surrounded by?
- Sternocleidomastoid (medially)
- Clavicle inferiorly
- Inferior belly of omohyoid muscle
What are the nerves in the posterior triangle ?
- Acessory N. (CN11)
- Cutaneuous branches of Cervical Plexus
- Brachial Plexus.
Explain the path of the acessory nerve (CN 11) in the posterior triangle.
What does it innervate?
- Passes out from the skull
- Goes uner the sternocleidomastoid m. 2/3 way the
- Heads toward the **trapezius **
What are the 4 cutaneous branches of the cervical plexus?
Sensory!
- Lesser occispital n
- Great Auricular n
- Transverse Cervical n
- Supraclavicular n
Superficial Sensory!
Alll come out of one point an then spread out
What Cutaneous Branch
nerves goes back up to the head
lesser occipital n.
What Cutaneous Branch
Nerve goes behind the ear
Great Auricular n.
What Cutaneous Branch
Nerve comes across the neck and toward the anterior part of neck
Transverse Cervical n.
What Cutaneous Branch
Comes out with many branches above the clavical and back shoulder.
Supraclavicular N.
What cervical nerves contribute ot the cervical plexus?
C1,C2,C3,C4
** Explain which cervical nerve each come off of:**
Lesser occipital n.
Great auricular n.
Transverse cervical n.
Supraclavicular n.
- Lesser occipital n. = C2
- Great auricular n.= C2/C3
- Transverse cervical n.= C2/C3
- Supraclavicular n.= C3/C4
What prominant nerve comes off the cervical plexus?
Phrenic Nerves
C3,C4, C5
Loops that comes off C1, C2 contributes, and C3.
In the cervical Plexus.
Ansa Cervicalis
Superior and Inferor root
Post. Triangle
Explan the sternocleidomastoid muscles.
Innervation?
Function?
- Has a clavicular head and a sternal head
- Innervated by Acessory nerve CN 11 & anterior rami of C2-C3
Function:
Unilaterally: tilt head to shoulder (same side) turn face (opposite)
Bilaterally: draw head forward
Post. Triangle
Explain the Omohyoid muscles.
Innervation?
Function?
- Laterally on superior boarder of the scapula
- Superiorly attached on the inferior boarder of the hyoid bone
- Has a mid way tendenous structure forming inferior & superior belly
Innervated: Ansa Cervicalis (C1-C3)
Function:
Contract-> depress hyoid bone
Post. Triangle
Explain the Anterior Scalene muscles.
Innervation?
Function?
- Attaches to the transverse process of vertebrae C3-6
- Rib 1 upper surface
Innervated: Anterior rami nerves C4-C7
Function:
Contract-> Elevate rib 1
Floor of triangle.(more posterior)
Post. Triangle
Explain the Middle Scalene muscles.
Innervation?
Function?
- Attaches to the transverse process of vertebrae C2-C7
- Rib 1 upper surface
Innervated: Anterior rami nerves C3-C7
Function:
Contract-> Elevate rib 1
Post. Triangle
Explain the Posterior Scalene muscles.
Innervation?
Function?
- Attaches to the transverse process of vertebrae C4-C6
- Rib 2 upper surface
Innervated: Anterior rami nerves C5-C7
Function:
Contract-> Elevate rib 2
Explain the relationship of the subclavian artery and scalene muscles
The subclavian artery passes between the anterior and middle scalene muscles on rib 1.
The anterior and middle scalene muscles can therefore act as a consrictor point of the subclavian artery if they have too much tension. Pinch it off!
What are the 4 triangular divisions of the Anterior triangle?
- Submental : below chin
- Submandibular : Jaw
- Muscular : ant. portion of neck
- Carotid: posterior lateral
Ant. Triangle
Explpaint the boundry, floor, and contens of the submental triangle
Boundaries:
Anterior belly of digastric
Hyoid bone (inferiory)
Floor:
Mylohyoid muscle
Contents:
Submental nodes
Beginning of anterior jugular vein
Submental Triangle
AExplain the Anterior belly Digastric muscles.
Innervation?
Function?
- Attaches to the mandible
- Inferiorly attaches to the hyoid bone via a tendon
Innervated: Mylohyoid n. (from inferior alveolar branch of mandibular nerve V3 from CN5.
Function:
* Fix hyoid bone, open mandible
* Raise hyoid bone, close mandible
Explain the Mylohyoid muscles.
Innervation?
Function?
Behind Digastric
* Attaches to the mandible at the mylohyoid line
* Attaches to at the hyoid bone and muscle fibers opposite (posterior) to the hyoid.
Innervated: Mylohyoid n. (from inferior alveolar branch of mandibular nerve V3 from CN5 trigeminal nerve)
Function:
* Support and elevation of the oral cavity
*Contact, elevate hyoid and elevate floor of oral cavity
Explain the Geniohyoid muscles.
Innervation?
Function?
not part of submental triangle
Behind Mylohyoid m.
* Attaches to the inferior mental spine of the mandible
* Attaches to at the hyoid bone (ant surface) .
Innervated: Branch from anterior ramus of C1 (Carried along Hypoglossal n. CN12)
Function:
* Fix mandible, hyoid bone forwards
* Fix hyoid, pulls mandible downward and inwards
Explain the boundary, floor, and contents of the Submandibular triangle
Boundaries:
Mandible
Posterior & anterior digastric m
Floor:
Mylohyoid m.
Hyoglossus m.
Superior Constrictors of the pharynx
Contents:
Submandibular salivary glands
Submandibular nodes
Facial artery and vein
Hypoglossus and Stylohyoid mm.
Carotid sheet (Internal carotid, Internal jugular, Vagus n.)
Explain the Digastric post. belly muscles.
Innervation?
Function?
- Attaches to the mastoid process (next and below ext. auditory meatus)
- Tendon attachment to hyoid (loop)
Innervated: Facial N (CN7)
Function:
* Pull hyoid upward and back
Explain the Stylohyoid muscles.
Innervation?
Function?
- Attaches to the styloid process
- Attached to hyoid bone laterally
Innervated: Facial N (CN7)
Function:
* Pulls hyoid bone upward in a posterosuperior direction
Explain the boundary, floor, and contents of the Muscular Triangle
Boundaries:
Omohyoid
Sternocleidomastoid
midline of neck
Floor:
Sternohyoid
Sternothyroid
Thyrohyoid mm.
Contents:
Thyroid gland
Larynx
Trachea
Esophagus
Explain the Sternohyoid muscles.
Innervation?
Function?
- Attaches to the manubrium + sternoclavicular joint
- Attaches to hyoid bone (inferior border)
Innervated: Ansa Cervicalis; Anterior Rami C1-C3
Function:
* Depresses hyoid bone after swallowing when it contracts.
Explain the Sternothyroid muscles.
Innervation?
Function?
- Attaches to the manubrium (post surface )
- Attached to thyroid cartilage (superiorly)
Innervated: Ansa Cerivcals (ant. Rami C1-C3)
Function:
* Draw Larynx (thyroid cartilage) downward
What the two muscles that sit directly beneath the sternohyoid muscle and omohyloid in the neck?
- Sternothyroid
- Thyrohyoid
Explain the Thyrohyoid muscles.
Innervation?
Function?
- Attaches to the thyroid cartilage (inferiorly, larynx.)
- Attaches to greater horn of the hyoid bone
Innervated: Anterior ramus C1 (along Hypoglossal CN 12)
Function:
* Depress hyoid bone, if larynx is fixed
* Raise larynx when hyoid bone is fixed
What are the two parts of the Hyoid bone?
- Greater horn (sides)
- lesser horn (little poke ups)
Explain the boundary, floor, and contents of the Carotid Triangle
Boundaries:
* Posterior digastirc m
* Sternocleidomastoid m
* Superior belly of omohyoid
Floor:
* Portion of thyrohyoid m
* Hypoglossus m
* Middle constrictor & inferior m
Contents:
* Carotid sheath:
Internal carotid a.,
Internal jugular v.,
* Vagus n.,
* external carotid branches,
* deep cervical nodes
Explain the carotid Sinus
- At bifurcation of common carotid artery (C3/C4)
- It is the widening of the internal carotid artery
- Tunica intima (inner wall) gets thinner, tunic adventitia (outer layer) thicker.
- Tunica Adventita contain nerve endings from CN 9
functions as a baroreceptor; determining blood pressure for the rest of the body
What functions as a baroreceptor for the body?
Carotid Sinus
Explain the Carotid Body
- At bifurcation of common carotid artery (C3/C4)
- Vascular organ; redish brown mass o cells
- Arterial chemoreceptor innervated by CN 9/ CN10.
- Checks CO2 and O2 levels in blood.
What functions as an aterial chemoreceptor that Checks CO2 and O2 levels in blood?
Carotid Body
What is innervation of the carotid body?
-CN9 & CN10
-Pre-ganglionic sympathetic.
post-ganglionic is in the carotid body
Artery that branches off carotid and goes straight up to the head?
Internal carotid artery
What are the 8 arteries that come of the external carotid artery?
Supply a lot of blood
TOP
1. Maxillary a.
2. Superficial temporal a.
3. Posterior auricular a.
4. Occipital a.
5. Facial a
6. Lingual a.
7. Ascending pharyngeal a.
8. Superior thyroid a.
BOTTOM
Artery that that comes off carotid, goes down to supply thyroid gland?
Superior thyroid artery
Artery that comes off external carotid artery, posteriorly at same spot as superior thyroid artery and then goes to supply the pharynx (tiny artery)
Ascending phalangeal artery
Artery that comes off external carotid artery anteriorly, moving forward into the geoglossal muscles and supply the oral cavity ?
Lingual Artery
Artery that comes off external carotid artery superior to the lingual artery, goingunder the mandible, doing a loop and come over lateral edge of the mandible and supply * the lips, alongside nose, and underneath eye.*
Facial Artery
Artery that comes off external carotid artery posteriorly passing posteriorly by mastoid and supplying the back of the head.
Occipital artery
Artery that comes off external carotid artery superior to the occipital artery, behind the external auditory meatus. Head/scalp behind ear.
Posterior auricular artery
What are the 2 artery’s that come off the external common carotid that are terminal branches?
- Superficial temporal artery
- Maxillary artery
Artery that comes off external carotid artery up on the side of the head. (angry artery), terminal branch ?
Superficial temporal artery
Artery that comes off external carotid artery across deep in the face. Terminal branch.
Maxillary artery
What is Cranial Nerve 9?
Glossopharyngeal Nerve
Glossopharyngeal Nerve CN9; leaves cranial cavity via? Innervates?
Leaves vias
jugular foramen
Innervates:
Stylopharyngeus m. (pierces)
Carotid sinus
Pharynx (sensory)
What is Cranial Nerve 10?
Vagus Nerve CN10
Vagus CN10; leaves cranial cavity via? Innervates?
Leaves vias
jugular foramen
Innervates:
* Motor branches to the pharynx
* Carotid body branch
* Superior laryngeal n.
External laryngeal n.
Internal laryngeal n.
* Cardiac branch (parasympathetic innervation of the heart)
What is located in the jugular foramen that is the vagus nerve?
Inferior ganglion
Explain the superior laryngeal N branches
Internal branch= pierces the internal structures of the larynx and innervates
External branch= stay outside
Where does the cardiac branch of the the vagus n do?
Goes down into the thorax and provides parasympathetic innervation to the heart.
What is Cranial Nerve 11?
Acessory Nerve CN11
Acessory Nerve CN11; leaves cranial cavity via? Innervates?
Leaves Via:
* Jugular foramen
Innervates:
* Sternocleidomastoid
* Trapezius
What is Cranial Nerve 12?
Hypoglossal Nerve CN12
Hypogolaasal CN12; leaves cranial cavity via? Innervates?
Leaves Via:
* Hypoglossal Canal , passes inferior and anteriorly.
Innervates:
* All intrinsic muscle of the tongue
* All extrinsic BUT 1 muscle of the tongue.
Found in the visceral compartment, sits on the trachea, has 2 lobes.
Thyroid Gland
Where does the thyroid gland sit in relationshio to the internal jugular vein and common carotid artery, and trachea.
- Sits anterior to the trachea
- Common carotid arterys sits more posterior and medial to it
- Internal jugular veins sits more anterior and lateral to the thryroid gland
**great blood supply*
What are the two main blood supplys of the thyroid?
- Superior thyroid artery (from external carotid artery)
- Inferior thyroid artery (from R/L subclavian)
What are the 3 main venous drainage of the thryoid?
- Superior thyroud vein (goes to internal jugular)
- Middle thyorid vein (goes to internal jugular)
- Inferior thyroid vein (into right brachiocephalic vein/ left subclavian vein)
What is posterior to the thyroid? Dots embededed into the thyroid gland
Parathyroid glands
What nerve runs down laterally next to the int/ex caroitid arterts and then down next to the common carotides before branching?
Vagus Nerve CN10
The Right and Left reccurent largengeal nerves pass where?
Both medial to the thyroid gland and up to the larynx.
inferior thyroid artery runs closely by
Tube to the stomach. Posterior. Transition from pharynx.
What are the 2 bain branches of the subclavian artery that supply blood to the neck?
- verterbal artery (R/L)
- Thyrocervical Trunk
Where do the vertebral arterys travel through when going up the neck into the skull?
Passes through the transverse processes of the cervical vertebrae.
What two arterys come off the thyrocervical trunk?
- Inferior thyroid artery
- Transverse Cervical artery (supplys anterior neck)
Where do sympathetics originate?
The lateral horn of the T1-L2
No white rami in the Cervical vertebrae.
The sympathetic trunk travels where?
Up through the neck, tightly associated with the vertebrae.
WHat are the 3 ganglia in the neck?
- Superior cervical ganglion
- Middle cervical ganglion
- Inferior cervical ganglion
Ganglion located at the bifrucation of the common carotid artery CV3/CV4
Superior cervical ganglion
What contributes to the superior cervical ganglion?
- **C1-C4 **(Grey rami communicans)
When neron exits the grey rami communicans it is __ ganglionic.
Pre-ganglionic!
It will synapse in the Superior Cervical Ganglion
What Superior cervical ganglion signals go to?
- Carotid Plexus
- Carotid sinus & body
- Superior cardiac nerve
- Spinal nerves C1-C4
- Pharynx
All 3 ganglion in the neck have corresponding what?
Cardiac nerves!
Superior, middle inerior
All run down and innervate the heart.
Signals that entere the internal carotid plexus go where?
Sympathetics of the skull!
Middle cervical ganglia
- Spinal nerves C5 to C6
- Heart (Middle cardiac nerves)
Inferior cervical ganglia
- Spinal nerves C7 to T1
- Vertebral artery
- Heart (Inferior cardiac nerves)