Neck Osteology & Fascia

Question 1

Unique Identifying Characteristics of Cervical Vertebrae

Answer 1

• Thin bodies
• Large vertebral foramen
• Articular facets nearly horizontal
• Transverse foramen (C1-C6 only)
• Bifid Spinuous Process

Question 2

Alar Ligament

Answer 2

Attach Dens of C2 to lateral margins of foramen magnum of occipital bone

Question 3

Apical Ligament of the Dens

Answer 3

Runs from Apex of Dens to the anterior internal margin of the Foramen Magnum

Question 4

Components of Cruciate Ligament

Answer 4

• Transverse Ligament of Atlas
• Longitudinal Fasicles

Question 5

Transverse Ligament of Atlas

Answer 5

• Goes around the Odontoid Process of the Dens and attaches to the tubercle of transverse ligament of the Atlas to contralateral tubercle of transverse ligament of the Atlas
• Forms the Horizontal band of the Cruciate Ligament

Question 6

Longitudional Fascicles

Answer 6

• Superior Longitudional Band attaches occipital bone to transverse ligament; the Inferior Longitudional band attaches from C2 to the transverse ligaments
• Forms the vertical bar of the cruciate ligament

Question 7

Cervical Rib

Answer 7

• The supernumerary (extra) rib or a fibrous connection extending from its tip to the first thoracic rib may elevate and place pressure on structures that emerge from the superior thoracic aperture, notable the subclavian A or inferior trunk of the brachial plexus, and may cause Thoracic Outlet Syndrome

Question 8

Characteristics of Cervical Vertebral Body

Answer 8

• Small and wider from side to side than anteroposteriorly
• Superior surface concave with Uncus of body (Uccinate Process)
• Inferior surface convex

Question 9

Characteristics of Cervical Vertebral Foramen

Answer 9

Large and triangular

Question 10

Characteristics of Cervical Transverse Processes

Answer 10

• Foramina Transversarii (transverse foramen) and anterior and posterior tubercles
• Vertebral arteries and accompanying venous and sympathetic plexuses pass through foramina transversarii of all cervical vertebrae except C7, which transmits only small accessory vertebral veins

Question 11

Characteristics of Cervical Articular Processes

Answer 11

• Superior facets directed superoposteriorly
• Inferior facets directed infero-anteriorly
• Obliquely placed facets are most nearly horizontal in this region

Question 12

Characteristics of Cervical Spinous Processes

Answer 12

• Short (C3-C5) and bifid (C3-C6)
• Spinous process of C6 is long, but spinous process of C7 is longer (C7 is called Vertebra Prominens)

Question 13

Transverse Foramen of Cervical Spine Transmit:

Answer 13

Vertebral Arteries

Question 14

Intervertebral Foramen of Cervical Spine Transmit:

Answer 14

Spinal Nerves

Question 15

Four Stages of Dislocation of Cervical Vertebrae

Answer 15

• Stage I: flexion sprain
• Stage II: anterior subluxation with 25% anterior translation
• Stage III: anterior subluxation with 50% anterior translation
• Stage IV: complete dislocation

Question 16

Dislocation of Cervical Vertebrae

Answer 16

• Cervical Vertebrae are less tightly interlocked than other vertebrae because of their more horizontally oriented articular facets
• Cervical Vertebrae can be dislocated in neck injuries with less force than is required to fracture them
• Slight dislocation can occur in this region without damaging the spinal cord due to the large vertebral canal
• Severe dislocations or dislocations combined with fractures (fracture-dislocations), injure the spinal cord
• If the dislocation does not result in “facet jumping” with locking of the displaced articular processes, the cervical vertebrae may self-reduce so that a radiograph may not indicate that the cord has been injured; an MRI may reveal the resulting soft tissue damage

Question 17

Hyoid Bone

Answer 17

• This bone does not articulate with any other bone; it is suspended from the Styloid Process of the Temporal bones by the stylohyoid Ligaments and is firmly bound to the Thyroid Cartilage
• Consists of a body, and greater and lesser horns
• Function: serves as an attachment for anterior neck muscles and a propr to keep the airway open

Question 18

Components of Superficial Cervical Fascia

Answer 18

• Platysma
• External Jugular Vein

Question 19

Components of Depp Cervical Fascia

Answer 19

• Investing Fascia
• Pretrachael Fascia
• Prevertebral Fascia
• Carotid Sheath

Question 20

Investing Fascia

Answer 20

• Outermost layer of deep cervical fascia
• Envelops the SCM and Trapezius

Question 21

Pretrachael Fascia

Answer 21

• Anterior, extends inferiorly from hyoid bone to the thorax where it blends with the fibrous pericardium covering the heart
• Contains a Visceral and Muscular layer

Question 22

Visceral Layer of Pretracheal Fascia

Answer 22

• Surrounds Larynx, Trachea, Thyroid Gland, Esophagus
• Continuous posteriorly and superiorly with the Buccopharyngeal Fascia of the Pharynx

Question 23

Muscular Layer of Pretracheal Fascia

Answer 23

Encircles the vertebral column and associated muscles

Question 24

Carotid Sheath

Answer 24

Contains:
- Internal Jugular Vein
- Common Carotid Artery
- Internal Carotid Artery
- Vagus Nerve
- Carotid Sinus Nerve
- some deep Cervical Lymph Nodes
- Sympathetic Nerve Fibers (Carotid Peri-Arterial Plexuses)

Question 25

Retropharyngeal Space

Answer 25

- Potential space that consists of loose connective tissue between the superior part of the prevertebral layer of deep cervical fascia and the buccopharyngeal fascia surrounding the Pharynx superficially - Inferiorly the Buccopharyngeal Fascia is continuous with the Pretracheal layer of deep cervical fascia - Permits movement of the Pharynx, Esophagus, Larynx and Trachea relative to the vertebral column during swallowing

Question 26

Alar Fascia

Answer 26

- Forms a further subdivision of the Retropharyngeal Space - Attached along the midline of the Buccopharyngeal Fascia from the cranium to the level of C7, it extends laterally and terminates in the Carotid Sheath - Closed superiorly by the Cranial BAse and on each side by the Carotid Sheath; it opens inferiorly into the Superior Mediastinum

Question 27

The ___ Layer of Deep Cervical Fascia helps prevent the spread of infection in the neck caused by tissue destruction

Answer 27

Investing

Question 28

Infections of the Investing Layer of Fascia will typically not spread beyond the inferior border of the ___

Answer 28

Manubrium

Question 29

Infections between the Investing and Pretracheal layers can spread into the ___ cavity into the Anterior ___

Answer 29

- Thoracic - Mediastinum

Question 30

Infections in the Retropharyngeal Space between the Alar Fascia and the Prevertebral Fascia can spread to the posterior ___ and cause difficulty swallowing and speaking

Answer 30

Mediastinum

Question 31

Infections of the head can also spread inferiorly into the ___ traveling through the Retropharyngeal Space

Answer 31

Mediastinum