Neck Lecture Flashcards
What are the 2 boundrys of the neck?
Superior and the Inferior boundry
What are the borders of the superior boundry?
Starts anterior at the mandible then posterior across lateral edge of the mandible to the base of the skull.
Bilaterally.
What are the borders of the inferior boundry?
Starts in the front at the manubrium, move laterally across the clavical to the acromium, (tip) of the scapula and then posterior to the line btwn spinous process of C7
Similar ot thoracic aperature
What are the 4 comparments of the neck?
Encapsulated by fascia!
- Vertebral
- Visceral
- Vascular
- Musculofacial
What does the vertebral compartment contain? Where?
Located posteriorly in neck
* Verterbal Bodys
* Spinal Cord
* Spinous/Transverse processes
* All posture/deep back & neck muscles
What does the Visceral compartment contain? Where?
Located anteriorly and centered.
* Trachea
* Esophagus
* Thyroid gland
* On Posterior side of TG is the parathyroid gland
* The superior extension of the thymus (potentially)
What does the vascular compartment contain? Where?
Located bilaterally to the visceral comparment (anterior) VAN
* Internal Jugular Vein
* Common Carotid A. then branches Int/Ext
* Vagus Nerve (C10)
What is the Musculofascial collar?
Myo-Facial collar
A deep facia that forms a collar around the neck, deep investing facia.
Explain this funny thing
Anterior superior:
1. Nasal Cavity
2. Oral Cavity
Anterior Inferior:
1. Larygeal Inlet
2. Larynx
3. Trachea
Posterior Superior to inferior= Pharynx -> Esophagus
1. Nasopharynx
2. Ornopharynx
3. Larygopharynx
4. Esophagus
What are the 3 components of the pharynx?
- Nasopharynx
- Ornopharynx
- Larygopharynx
All continuous!
What divides the largyngealpharyx (to esophagus) and the Larynx (to trachea) ?
Eppiglottis!
WHat is the large prominant cartilage that you can feel on your neck? What vertebrae?
Thyroid Cartilage on the trachea.
C3-C4
In larynx
What is below the thyroid cartilage after gap? What Vertebrae?
Cricoid Cartilage
C5-C6
In larynx
Explain the landmark on neck at C3-C4
Line from Spinous process C3-C4 level going anteriorly to the superior boarder of the thyroid cartilage
Where bifrucation of the common carotid artery occurs.
If you want to place a stethascope and listen for plaques in the common carotid artery, where do you place it?
Look for larygeal prominance (anterior neck adams apple), move posteior laterally= bifrucation of common carotid artery.
Explain the landmark on the neck at C5-C6
Line from Spinous process C5-C6 level going anteriorly to the arch of the cricoid cartilage
Posterior this is where the boundry from pharynx to superior esophagus occurs.
Anterior this is the transition from Larynx to trachea.
Where does the transition from Pharynx to esophagus and larynx to trachea occur?
C5-C6 level
Semicircular bone, superior to the thyroid notch, important for muscle attachment. When you swallow it goes up and down.
Hyloid Bone
Explain the Larygeal Prominance
It is the protrusion on the thyroid cartilage, a distinguishing characteristic between men and women.
Inferior to the laryngeal prominance, is is a ligmanet that runs from thethyroid cartilage to the cricoid cartilage.
Median crycothyroid ligament
What is immediatley inferior to median crycothyroid ligamnet then explain thickness anterior and posterior.
Cricoid cartilage; anteriorly it is called the Arch of th Cricoid and is is thinner, posterior thicker (like a class ring)
What sits below the arch of the cricoid? On either side?
Thyroid Gland.
Explain parts of thyroid gland and ocasional abnormality that can occur
Left lobe, isthmus (center), Right lobe
Occasionally you can have a Pyramidal (4th lobe) that comes off the isthmus and extends superiorly over the median cricoidthyroid ligament.
What issue can the pyramidal lobe of the thyroid gland cause when preforming a tracheotomy?
It blocks the acess point, can puncture it, lots of blood loss.
All of the laryngeal structures are poterior to what 2 muscles?
- Omohyoid
- Sternohyoid
WHat are the two triangles of the neck?
Anterior and posterior triangles
What are the boarders of the anterior triangle of the neck?
Starts at the chin and funs posteior laterally to the anterior boarder the sternocleidomastoid muscles and comes down along it to its attachment at the manubrium of the sternum
What structures are found in the anterior triangle of the neck?
Things that go into the thorax
* esophagus
* Trachea
* R/L Common Carotid artery
* R/L Internal Jugular veins
* Vagus N (C10), Phrenic N.
What are the boarders of the posterior triangle of the neck?
Starts at the superior posterior boarder of the sternocleidomastoid muscle, running inferior along it to the middle 1/3rd of the clavical and the laterally to the trapezius and the back up its anterior boarder.
What structures are found in the posterior triangle of the neck?
Things that go into the Arms
* Brachial plexus
* Subclavian artery & Vein
Most superficial musle in the neck, behind layer of fatty tissue, thin, comes down from jaw across clavical and to the deltoid.
Platysma
What are the function of the platysma?
Frowing and neck definition. Too much fat= saggy neck. Neck lift!
What are the 4 fasica of the neck?
- Pre-tracheal
- Deep investing Fasica
- Prevertebral fasica
- Carotid Sheath
Explain the Investing Fasica Layer
Muscolofacial collar
A deep facia , continues all the way around, attaches to posterior spinous process
* Splits and ecases the **trapezius muscles **
* Then comes anterior and split/encase Sternocleidomastoid muscles + Infrahyoid muscles
Explaint Prevertebral layer of fascia
Fascia wrapping around vertebral compartment
* On the anterior space the layer splits into an anteiror and posterior layer in front of vertebral body
Explaint the pre-tracheal fascia of the neck
Facia that wraps around visceral compartment.
* The posterior aspect of it from carotid sheath to another it is buccoharygeal fasica.
What is the posterior aspect of the pretracheal layer of fascia called?
Buccopharyngeal Fascia
Rus posterior to the esophagus (longitudinaly from base of skull to neck
Explaint the carotid sheath
Bilaterally, derived from all 3 fasica (connect) forming the caroitd sheath. Holds VAN.
What layer of fascia?
Anteriorly, running from the manudrium up to the hyoid bone is what?
Posteriorly runs **superfical to the vertebral layer **
Investing layer
What layer of fascia?
What facia runs anterior to trachea and goes down and runs posterior to the esophagus
Pre-tracheal fascia
What is the space between the investing layer (anterior) and pretracheal fasica (anterior to the trachea) called?
Where is it located?
Pre-tracheal space
Anterior-superior mediastinal; Inferior to the neck , and superior to the heart and its large blood vessels.
What happens if you get an infection in the pre-tracheal space?
Infection can descend to the heart.
What is the importance of fascia?
Prevents movment of fluid, and infection.
What layer of fascia?
Runs anteior to the vetebrae, splits into two layers= 2 spaces( retropharyngeal space + prevertebral space)
Pre-vertebral fasica
What anterior space is posterior to the buccopharyngeal fasica and anterior to the prevertebral layer (ant.)
Retropharyngeal Space
What posterior space is between the 2 prevertebral layers?
Fasical Space
____ can transverse all the way from the base of the skull to the thorax. Posterior mediastinum.
Infection
What joint on the Atlas C1 is where you go in to uncover the head.. and view all fasia.
Atlanto Occipital Joint
What superfical Vein?
What veins runs down the centerline of the neck, next to thyroid cartilage and trachea?
Anterior Jugular veins
What superfical Vein?
What veins run over sternocleidomastoid muscles?
External Jugular Vein
Where does the external jugular vein empty into?
Emptys into the internal jugular/subclavian vein junction.
What vein come off the external jugular vein on the head?
- Posterior auricular vein
What superfical Vein?
Comes of the external jugular, runs behind ear.
Posterior auricular vein
What vein runs under and behind the madible, joins with post. division to form internal jugular vein
Retromandibular vein
What superfical Vein?
Comes off face, runs anteriorly, descends under the madible funses with retromandibular vein and goes into the internal jugular.
Facial Vein
Arch between the anterior jungular veins, connecttion btwn R/L side. Variable location.
Jugular Venous Arch
What are the 2 superfical nodes in the neck that drain superficially?
- Occipital Nodes
- Mastoid Nodes
Posteiror nodes
WHat are the 4 superfical nodes that drain deep?
- Pre-auricular / Parotid nodes
- Sub parotid nodes
- Sub mandibular nodes
- Submental nodes
Explain the occipital node
Posterior node, drains the posterior scalp superficially.
Goes to the external jugular nodes
Superficial cervical Node
Explain the Mastoid nodes
Located next to the auditory meatus on the mastoid bone. Drains the posterior lateral side of the head superficially.
Goes to the external jugular nodes
Superficial cervical Node
Explain the Pre-auricular/Parotid Node
Sits anteriorly next to the auditory meatus on the parotid glad.
Drain the
* anterior lateral side of the gland
* Parotid glad
* Lateral inferior portion of the face.
Drains into deep cervical node; jugulodigastric node.
What are the 2 deep cervical nodes located on the internal jugular vein?
- Jugulodigastric node
- Jugulo-omohyloid Node
Explain the submandibular nodes
Across the lateral bottom of the mandible
Drains the:
* Rest of inferor portionof the face, same location as facial artery
* gingiva,
* some teeth (posterior)
* some part of tongue.
Drains into the deep cervical nodes on the internal jugular vein.
Explain the submental nodes
Across the anteiror portion of the madible
Drains the:
* Lower lip
* Incisors
* Tip of tongue
Drains into the deep cervical nodes on the internal jugular vein.
The vertical group of nodes along the external jugular vein are?
Superficial cervical nodes
Explain the jugulodigastric node
Deep cervical node on the internal jugular vein
* Large; can be palpated if infected
* Superior
* Digastric musle passes next to it.
Explain the Juglo-omohyloid node
Located next to the crossing of the omohyloid muscle, on the internal jugular vein. Inferior.
Where do all nodes eventually drain?
Superficial nodes eventrually drain deep, and then all deep cervical nodes empty at the jugular/subclavian venous angel (thoracic duct) and back to blood supply.
Where is the brachial plexus located and where does it innervate?
C5-T1
Upper limb
Where is the Cervical plexus located and where does it innervate?
**C1-C4 **
Innervate Superficial cutaneuous (sensory) and a motor component as well.
Explain the cutaneous nerves of the cervical plexus
Dermatomes C2,C3,C4
* Posterior Rami
* Superfical Sensory
Innervaton:
* Back of the head C2
* Neck C3
* Top of shoulder and back of neck C4
Where do the rami of C2 go?
Posterior= back of head
Anterior= Ear, come down into neck
What does the rest of the face, anteriorly, innervated by?
Trigeminal Nerve C5;
1. Opthamalic n.
2. Maxillary n.
3. Mandibular n.
Where do the rami of C3 go?
Posterior= back of neck
Anterior= front of neck
Where do rami of C4 go?
Posterior= back of shoulders
Anterior= superior thoraci aperature, across the clavicle.
Middle cervical ganglia
- Spinal nerves C5 to C6
- Heart (Middle cardiac nerves)
