Neck Region Flashcards
True or false: The atlas (C1 vertebra) does not have a body or spinous process.
True
Which of the following is a unique feature of the axis (C2 vertebra)?
A. Body
B. Dens
C. Transverse process
B
How many processes does a typical cervical vertebra have?
7
The articulations of which two structures form the atlanto-occipital joint?
A. Articulations between the superior articular processes of the atlas with the occipital bone
B. Articulations between the lateral masses of C1 and the superior articular facets of C2
C. Articulation between the dens of C2 and the anterior arch and transverse ligament of C1
A
Which joint is considered a joint of the vertebral arches?
A. Intervertebral joints
B. Uncovertebral joints
C. Zygapophysial (facet) joints
C
Which of the following joints is considered a cartilaginous joint?
A. Intervertebral joints
B. Uncovertebral joints
C. Zygapophysial (facet) joints
A
True or false: Small degrees of freedom between the synovial joints of the cervical region combined to produce 2 degrees of freedom: flexion/extension and rotation.
FALSE
There are 3 degrees of freedom:
Flexion/extension
Lateral flexion
Rotation
Which structure forms a prominence in the anterior aspect of the neck and is easily palpated?
Thyroid cartilage
The carotid pulse can be located between which two structures?
The sternocleidomastoid and the trachea
What are the origin sites for the sternocleidomastoid muscle?
Manubrium of the sternum
Medial 1/3 of the clavicle
Which of the following muscles is considered a prevertebral muscle? (List all that apply)
A. Scalenes
B. Longus colli
C. Rectus capitus posterior major
D. Splenius capitus
E. Rectus capitus obliques inferior
A, B, D
Which muscle’s primary action is to flex the neck?
A. Scalenes
B. Longus colli
C. Longus capitus
B
Which of the following muscles inserts into the second rib?
A. Anterior scalene
B. Middle scalene
C. Posterior Scalene
C
True or false: Rectus capitus posterior major and minor both insert into the inferior nuchal line of the occipital bone.
True
What are the bones of the neck region?
Atlas (C1), Axis (C2), and C3-C7 vertebrae
What are the features of TYPICAL vertebrae?
Body
Vertebral arch
7 processes:
- Superior articular processes (2)
- Inferior articular processes (2)
- Transverse processes (2)
- Spinous Process
(NOTE: Cervical vertebrae have uncinate processes…no other vertebrae do!)
Label the parts of this typical vertebra.
(See image)
Which cervical vertebra is this? Label its parts.
Atlas (C1) - see image
What cervical vertebra is this? Label its parts.
Axis (C2) - see image
Where is the hyoid bone located and what is its purpose?
Anterior neck, held in place by anterior neck muscles.
Functions to keep the airway open
What are the 3 parts of the hyoid bone?
(See image)
What are the craniovertebral joints of the neck?
Atlanto-occipital joint
Atlanto-axial joint (lateral atlanto-axial joints, median atlanto-axial joint)
What is the atlanto-occipital joint?
An articulation between the superior articular processes of the atlas with the occipital condyles.
What are the 3 atlanto-axial joints?
(2) lateral atlanto-axial joints: articulations between the lateral masses of C1 and the superior articular facets of C2
(1) median atlanto-axial joint: articulation between the dens of C2 and the anterior arch and the transverse ligament of C1
Classify the following joints as craniovertebral joints, cervical joints, or vertebral arches:
- Zygapophysial joints
- Atlanto-occipital joint
- Atlanto-axial joint
- Intervertebral joints
- Uncovertebral joints
- Vertebral arch
- Craniovertebral joint
- Craniovertebral joint
- Cervical joint
- Cervical joint
What is an intervertebral joint?
A cervical joint which has articulations between the bodies of adjacent vertebrae and intervening intervertebral discs
What is an uncovertebral joint?
A cervical joint in which articulations between the uncinate processes and the inferolateral surfaces of the vertebral bodies that are superior to them
What is a zygapophysial (“facet”) joint?
A vertebral arch; articulations between the superior and inferior articular processes of adjacent vertebrae.
The neck has how many degrees of freedom? What are they?
3 degrees of freedom: flexion/extension, lateral flexion, rotation
What are the four regions of the neck?
Sternocleidomastoid
Posterior cervical
Anterior cervical
Lateral cervical
How many superficial muscles of the neck are there? How many deep?
1 superficial
13 deep (9 prevertebral, 4 sub-occipital)
Which muscle is presented here?
Name it and provide its origin, insertion, innervation, and action.
NAME: Sternocleidomastoid
ORIGIN: (Sternal head) surface of manubrium of sternum (clavicular head) superior surface of medial 1/3 of clavicle
INSERTION: lateral surface of mastoid process of temporal bone and lateral Hal of superior nuchal line of occipital bone
INNERVATION: Accessory Nerve (CN XI)
ACTION: lateral flexion of the neck; rotates neck so face is turned superiorly toward opposite side; working bilaterally produces chin thrust forward
Which muscle is presented here?
Name it and provide its origin, insertion, innervation, and action.
NAME: Scalenes
ORIGIN: (anterior) anterior tubercles of transverse processes of C3-C6; (middle) posterior tubercles of transverse processes of C2-C7; (posterior) posterior tubercles of transverse processes of C4-C6
INSERTION: (Anterior & middle) 1st rib; (posterior) 2nd rib
INNERVATION: Central rami of cervical spinal nerves
ACTION: lateral flexion of the neck; (anterior & middle) elevates 1st rib; (posterior) elevates 2nd rib during forced inspiration
Which muscle is presented here?
Name it and provide its origin, insertion, innervation, and action.
NAME: Longus colli
ORIGIN: bodies of C5-T3 vertebrae and traverse processes of C3-C5
INSERTION: anterior tubercle of C1, bodies of C1-C3, transverse processes of C3-C6
INNERVATION: ventral rami of cervical spinal nerves (C2-C6)
ACTION: flexion of the neck at C2-C7
Which muscle is presented here?
Name it and provide its origin, insertion, innervation, and action.
NAME: Longus capitus
ORIGIN: anterior tubercles of transverse processes of C3-C6
INSERTION: Basilar part of the occipital bone
INNERVATION: ventral rami of the cervical spinal nerves (C1-C3)
ACTION: flexes head on neck primarily at Atlanto-occipital joint
Which muscle is presented here?
Name it and provide its origin, insertion, innervation, and action.
NAME: Splenius capitus (SPLEH-NEE-ISS)
ORIGIN: ligamentum nuchae and spinous processes of T1-T6
INSERTION: lateral aspect of mastoid process and occipital bone
INNERVATION: DORSAL RAMI of the cervical spinal nerves (C3-C5)
ACTION: laterally flexes and rotates head and neck to same side; acts bilaterally to extend the head and neck
Which muscle is presented here?
Name it and provide its origin, insertion, innervation, and action.
NAME: Rectus capitus anterior
ORIGIN: anterior surface of lateral mass of C1
INSERTION: base of cranium; anterior to occipital condyle
INNERVATION: branches from loop formed between C1 and C2 spinal nerve roots
ACTION: flexes head on neck primarily at Atlanto-occipital joint
Which muscle is presented here?
Name it and provide its origin, insertion, innervation, and action.
NAME: Rectus capitus lateralis
ORIGIN: transverse process of C1
INSERTION: jugular process of occipital bone
INNERVATION: branches from loop formed by C1-C2 spinal nerve roots
ACTION: flexes head on neck primarily at atlanto-occipital joint
True or false: the prevertebral muscles of the neck are all innervated by the ventral rami of cervical spinal nerves.
FALSE
All but the SPLENIUS CAPITUS—the Splenius capitus is innervated by DORSAL rami of the cervical spinal nerves
As a group the sub-occipital muscles produce two movements: _________________ and _______________.
Extension of the head at the atlanto-occipital joint
Rotation of the head at the atlanto-axial joint
The 4 sub-occipital muscles are…
Rectus capitus posterior major
Rectus capitus posterior minor
Rectus capitus obliques inferior
Rectus capitus obliques superior
The sub-occitpial muscles are innervated by the __________ rami of the _______ spinal nerve.
Dorsal
C1
Which muscles are presented here?
Name them and provide their origins and insertions.
RECTUS CAPITUS POSTERIOR MAJOR
ORIGIN: spinous process of C2
INSERTION: lateral part of inferior nuchal line
RECTUS CAPITUS POSTERIOR MINOR
ORIGIN: posterior tubercle on posterior arch of C1
INSERTION: medial part of inferior nuchal line
Which muscles are presented here?
Name them and provide their origins and insertions.
RECTUS CAPITUS OBLIQUES INFERIOR
ORIGIN: spinous process of C2
INSERTION: transverse process of C1
RECTUS CAPITUS OBLIQUES SUPERIOR
ORIGIN: transverse process of C1
INSERTION: occipital bone between the superior and inferior nuchal lines
What condition is presented here? How does it happen?
Torticollis
Contraction of the cervical muscles that produce twisting of the neck and slanting off the head
There are TWO TYPES:
1. Congenital torticollis
2. Cervical dystonia
What are the four suprahyoid muscles? What do they have in common?
Mylohyoid, geniohyoid, stylohyoid, digastric (anterior and posterior bellies)
They are all ELEVATORS and originate SUPERIORLY to the hyoid (“supra”)
What are the four infrahyoid muscles? What do they have in common?
Sternohyoid, omohyoid (superior and inferior bellies), sternothyroid, thyrohyoid
They all DEPRESS the hyoid and originate INFERIOR to the hyoid (“infra”)
Name the action of the following suprahyoidal muscles:
- Mylohyoid:
- Geniohyoid:
- Stylohyoid:
- Digastric (anterior and posterior belly):
- Mylohyoid: elevates hyoid, floor of mouth and tongue during swallowing and speaking
- Geniohyoid: pulls hyoid anteroposteriorly, shortens floor of mouth and widens pharynx
- Stylohyoid: elevates and retracts hyoid, elongating floor of mouth
- Digastric (anterior and posterior belly): depresses mandible, elevates and steadies hyoid during swallowing and speaking
Name the action of the following infrahyoidal muscles:
- Sternohyoid:
- Omohyoid (superior and inferior belly):
- Sternothyroid:
- Thyrhyoid:
- Sternohyoid: depresses hyoid bone after elevation during swallowing
- Omohyoid (superior and inferior belly): depresses, retracts, and steadies hyoid bone
- Sternothyroid: depresses hyoid bone and larynx
- Thyrohyoid: depresses hyoid bone and elevates larynx
The ___________ supply the skin of the posterior neck with sensory innervation
Dorsal rami
The anterior part of the neck is supplied by the __________ rami of ______________ and ______________ of ____________.
Ventral; C2 and C3
Ventral; C3 and C4
The blood supply to the structures of the neck region arise from branches of _________________ and ________________.
External carotid arteries
Subclavian arteries
The subclavian artery is divided into how many parts? What are they called?
3 parts
Part 1: Vertebral artery (tunnels through foramen magnum), internal thoracic (runs inferior toward thoracic region), thyrocervical trunk (tiny trunk supplying structures of the neck)
Part 2: Costocervical trunk (extends posteriorly)
Part 3: Dorsal scapular artery (leads laterally)
The venous return from the structures of the neck lie ___________ to the arterial pathways. These structures arise from multiple veins that empty into the _____________, _________________ and _________________.
Anterior
Internal jugular; external jugular; subclavian vein.
True or false: The external jugular terminates in the subclavian vein.
True
True or false: the internal and external jugular veins unite to form the brachiocephalic vein.
FALSE
The SUBCLAVIAN and INTERNAL jugular unite to form the brachiocephalic vein
Which of the following are considered paired laryngeal cartilages?
Arytenoid
Thyroid
Cuneiform
Epiglottic
Corniculate
Arytenoid
Cuneiform
Corniculate
Which of the following laryngeal cartilages is connected to the hyoid bone?
Thyroid cartilage
Cricoid cartilage
Epiglottic cartilage
Thyroid
It’s connected via the thyrohyoid membrane
Which of the following is instrumental in protecting the airway during swallowing?
Thyroid cartilage
Cricoid cartilage
Epiglottic cartilage
Epiglottic cartilage
Which cartilages articulate to form joints that allow movement of the vocal folds?
A. Thyroid and Epiglottic cartilages
B. Cricoid and Arytenoid cartilages
C. Arytenoid and cuneiform cartilages
B
The innervation of the larynx is provided by branches of which of the following nerves?
A. Glossopharyngeal
B. Vagus
C. Trigeminal
D. Facial
B
Which of the following nerves provides innervation to the majority of the intrinsic muscles of the larynx?
A. Superior laryngeal nerves
B. External laryngeal nerves
C. Inferior laryngeal nerves
C
Which part of the pharynx extends from the soft palate to the superior border of the epiglottis?
Oropharynx
Which parts of the pharynx serve digestive functions?
Oropharynx and laryngopharynx
True or false: The pharynx receives motor and sensory innervation from the pharyngeal plexus of nerves which is formed by CNS IX and X.
True
Which stage of swallowing involves placing food or liquid on the tongue?
Stage 1
The larynx is an organ of ___________.
Voice production
True or false: The larynx is posterior to the esophagus.
FALSE
It’s anterior to the esophagus
True or false: The trachea is connected to the hyoid bone.
True
What are the 9 cartilages of the larynx?
Thyroid
Cricoid
Epiglottis
Arytenoid (2)
Corniculate (2)
Cuneiform (2)
If the vagus nerve is injured, what can happen to the vocal folds in the larynx?
Vocal fold paralysis
What is the innervation of the larynx?
CN X (Vagus nerve); laryngeal nerve (superior and inferior)
Describe the location of the nasopharynx, oropharynx, and laryngopharynx.
Nasopharynx: Nasal cavity to top of soft palate
Oropharynx: soft palate to tip of epiglottis
Laryngopharynx: Epiglottis to esophagus
True or false: The pharynx is innervated by the CN XI nerve.
FALSE
Motor innervation - CN X (except the stylopharyngeus - CN IX)
Sensory innervation: CN IX
What are the stages of deglutition?
Stage 1: Voluntary; bolus is compressed against palate and pushed from the mouth into the oropharynx
Stage 2: involuntary; soft palate is elevated sealing off nasopharynx. Suprahyoids elevate the larynx and epiglottis seals off airway; pharynx widens to receive bolus
Stage 3: involuntary; sequential contractions of pharyngeal constrictors forces food bolus into esophagus
What is dysphagia?
Difficulty swallowing
What is aspiration?
Food entering the laryngeal inlet or lungs
What is a tracheostomy?
Incision made through the anterior wall of the trachea to establish an airway in case of obstruction or respiratory failure
