Neck Region Flashcards
greatest mobility in the vertebral column?
in the neck region
boundaries of the neck
mandible
superior nachal line - posterior
top of sternum along clavicle
spinous process of C7 - posterior
functions of neck region
important organs involved in speech and endocrine
supports head and allows for positioning for environmental stimuli without turning the whole body
superior thoracic aperture aka thoracic inlet
opens directly into the base of the neck - allowing passageway of important structures from the thorax region into the neck region
axillary inlet
on each side of the superior thoracic aperture that opens to the upper limb
brachial plexus going into arm and lymph moving out
what supports the hyoid bone?
muscualr attachments and ligaments - there are no bony articulations
thyroid cartilage
contributes to cartilage of the larynx too
cervical vertebrae and the associated nerve
There are 7 vertebra but 8 nerves because at C1 - the atlas we have C1 coming out ABOVE AND BELOW
then C2 has nerve coming out below that - 8 total nerves
cervical plexus
atypical cervical vertebrae
C1 - atals
C2 - a
C7 - very long spinous process
C3-C6
typical vertebrae canal body - smaller transverse foramen - where vertebrae artery and vein will run except C7 - only vein spinous process = BIFID
C7 IS CALLED?
what is unique about it
VERTEBEA PROMINENS
only has vertebral vein running in the SMALLER vertebral forament
LONG SPINOUS PROCESS THAT IS NOT BIFID
C1 is called? fucntion?
whats different
atlas
lacks body
lacks spinous process
forms the atlanto-occipital joint
allows for flexion and extension (some lateral flexion)
anterior and posterior atlanto-occipital membranses provides broad support and limit excessive movement
membrane on joint - prevents over movement
C2 is called? fucntion?
whats different
AXIS
has a body, bifid process and the DENS
DENS / ODONTOID process articulating with c1 and forms a pivot joint - rotation- often called the no joint
C1 articulates with?
the occipital bone of the skull
often called the ‘yes’ joint when forming the atlanto-occipital joint because it allows for flexion and extension
extension = away from the chest
atlanto-occipital joint and membrane
provides broad support and limits over/excessive movement in the atlanto-occipital joint
Dens function and aka
Odontoid process
Atlantoaxial joint with C1
articulating with the anterior aspect of the atlas and also has a strong ligament that prevetns hypermoevment and holds the dens into place
often called the no joint and is a PIVOT JOINT and allows for rotation
if something happens to the odontoid process?
very bad because the spinal cord is directly posterior and an injusry here results in extreme disability and high chance of death
phrenic nerve severed - cannot breath on own
paralysis?
alar ligaments
side of dens to foramen magnum
transverse ligament
extends between tubercles on the medial aspect of the C1 vertebra
cruciate ligament
formed by the transverse ligament and its superior/inferior extensions
Atlantoaxial joint
C2 forms this with C1
three articulations with the atlas
right and left lateral atlanto-axial, and median atlanto-axial joint
location of the phrenic nerve
descends on the anterior scalene
Sternocleidomastoid
Attachments
Innervation
Action
Attachments
Innervation
Action
Sternocleidomastoid
Attachments
Innervation
Action
Attachments - (1) Lateral superior nachal line and mastoid process to 2. Anterior surface of manubrium 3. Medial third of clavicle
Innervation - Motor - accessory nerve CN XI
Sensory - C2 and C3
Action - unilateral action - lateral flexion to same side and rotation to OPPOSITE side
Bilateral Action - cervical-flexion
These fibers are dorsal to ventral
Forms boundary of the posterior triangle being the ANTERIOR portion
Trapezius
Attachments
Innervation
Action
Attachments - Skull, scapula, and clavicle
Innervation - Motor - CN XI = ACCESSORY
Sensory - C2 and C3
Action
Forms border of the posterior triangle - posterior part
anterior scalene
Attachments
Innervation
Action
Attachments - transverse processes of C4-C6 to first rib
Innervation- cervical spinal nerves c4-c6
Action - f;ex the neck and elevate first rib
because it is more anterior - contributing more to flexion
- when working with the middle scalene - they can do lateral flexion together
middle scalene
Attachments
Innervation
Action
Attachments -,transverse processes of C4-C6
Innervation- ventral rami of cervical nerves
Action - flex the neck and elevate the first rib
posterior scalene
Attachments
Innervation
Action
Attachments - transverse processes of C4-C6 to second rib
Innervation - ventral rami of C6 and C7
Action - lateral flexion and elevate 2nd rib
Thoracic outlet syndome
numbness and wealness in upper extrememty - pressure onto the brachial plexus of nerves and can cause the anterior scalened to atrophy
What is in the ansa cervicalis and what does it innervate?
it is the innervation to the infrahyoid muscles and is made up from c1 c2 and c3 - wraps around the internal jugular vein
exception - the thyrohyoid is not innervated by this but directly from c1 via the hypoglossal nerve (CN XII)
Strap muscles =
infrahyoid muscles
omohyoid
Attachments
Innervation
Action
Attachments - superior scapula to hyoid bone
TWO BELLIES
SUPERIOR AND INFERIOR - and connected by a tendon
Innervation - ansa cervicalis (C1-C3)
Action
sternohyoid
Attachments
Innervation
Action
Attachments - Manubrium and medial clavicle to hyoid
Innervation - ansa cervicalis
Action
sternothyroid
Attachments
Innervation
Action
Attach - manubrium to thyroid
Innervation - ansa cervicalis
action - depress the hyoid during swallowing and speaking
thyrohyoid
Attachments
Innervation
Action
Attachments - thyroid cartilage to hyoid
Innervation - c1 via they hypoglossal nerve
Action - depress the hyoid while speaking and swallowing
CAN ELEVATE THE LARYNX
function of the strap/infrahydoid muscles
DEPRESS the hyoid during speaking and swallowing
the thyrohyoid can also elevate the larynx - see different innervation in this muscle - so makes sense there is an additoinal function
suprahyoid muscles
above the hyoid - but still attaching to hyoid
MYLOHYOID
mylohyoid
from mylohyoid line of the MADIBLE to the hyoid bone
FORMS FLOOR OF ORAL CAVITY
innervation - CN5
Geniohyoid
Attachments
Innervation
Action
deep to the mylohyoid muscle
Attachments - mental spine of the mandible - to hyoid
Innervation -C1 - via the hypoglossal nerve
Action
Digastric muscle
Attachments
Innervation
Action
This has an anterior and posterior belly - the innervation differs between them
ANTERIOR - note relationship to the mylohyoid muscle
Attachments - digastric fossa of the mandible to the intermediate tendon
Innervation - nerve to mylohyoid CN 5-v3
POSTERIOR - note relationship to the mastoid process
Attachments - mastoid notch to the intermediate tendon
Innervation - CN VII - facial nerve
these will meet at the tendon
Action
stylohyoid
Attachments
Innervation
Action
Attachments - styloid process of the temporal bone to hyoid
Innervation - facial nerve - cranial nerve VII
Action
action of the suprahyoid muscles
they make up a significant portion to the floor of the oral cavity and elevate the hyoid and larynx
cervical plexus
formed by the anterior rami of C1-C4
lies DEEP to sternocleodomastoid muscle (SCM)
cutaneous region = superficial branches and deep branches doing the motor innervation
superficial branches of cervical plexus
cutaneous region /innervation
deep branches of cervical plexus
motor innervation (ansa cervicalis) C1-c3
Cutaneous nerves of cervical plexus
lesser occipital nerve
great auricular
transverse cervical nerve
supraclavicular
lesser occipital nerve
innervating the skin of the scalp BEHIND the ear
from C2
Great auricular nerve
slightly anterior to the lesser occipital
skin of the parotid gland and over the ear
branches from c2-c3
transverse cervical nerve
skin over the anterior neck
C2-C3 region
supraclavicular nerve
from c3 and c4
supplies skin across the clavicles and shoulder to the second rib
Hypoglossal nerve
CN XII
- motor innervation of the tongue
- exiting skull through the hypoglossal canal then passing between the external carotid artery and jugular vessels
- contributing to the thyrohyoid muscle and the geniohyoid muscle
Spinal Accessory Nerve (aka)
describe location
CNXI - accessory nerve innervation to the sternocleidomastoid and the trapezius
CN XI descends along the internal carotid artery
roots of the spinal accessory nerve
CN XI
spinal root - cell bodies in the anterior horn of the upper cervical segments of the spinal cord - rootles sscend into the cranial cavity via the foramen magnum
cranial root - part of cranial nerve X - vagus nerve
these unite at the jugular foramen then seperate
where is the junction of the right lymphatic duct and the thoracic duct
both ducts enter into the subclavian vein at the junction of the internal jugular vein
lymphatic vascular system - describe function + contents
Blind-ended vessels converge to larger vessel that converge with large veins in the root of the neck
FUNCTION: collect fluid lost from capillary beds (during exchange)
IF fluid draining into capillaries can include cells of the lymphatic system, cell products, cell debris, and PATHOGENS
larger lymph vessels form
lymphatic trunks
lymphatic trunks give rise to
right lymphatic trunk and thoracic duct - coming together at the junction of the subclavian vein and internal jugular vein
right lymphatic duct
draining right upper quadrant and right arm
thoracic duct
does remainder of body (besides right upper quadrant)
what joins with the thoracic duct?
The left subclavian lymph trunk - from upper limn and the left jugular trunk - lymph from left side of head and neck
emptying into junction between right internal jugular vein and right subclavian vein
right jugular trunk and right subclavian trunk
- same for left side - except joining with the thoracic duct from below as well
overall pattern of drainage of lymphatic vessels in head/ neck region
Lyphatic vessels –> superficial around the head –> superifical cervical (more neck) –> DEEP cervical nodes–> Right and left jugular trunks
deep cervical nodes
the ones that lead into the right and left jugular nodes - draining the head and neck region
superficial lymph nodes around the head
occipital nodes mastoid nodes pre-auricular and parotid nodes submandibular nodes submental nodes
occipital nodes
drains posterior scalp and neck
mastoid nodes
drains posterolateral half of scalp
pre-auricular and parotid nodes
drain anteriolateral scalp, upper half of face
submandibular nodes
follows facial vein drainage- anterior face, gingiva, teeth, and tongue
submental nodes
lower lip, chin floor of mouth, tip of tongue and lower incisor teeth
superficial cervical lymph nodes
found along the external jugular vein - along the SCM and send lymphatic vessels toward the deep cervical nodes
deep cervical nodes
divided into superior and inferior groups that form a chain on the IJV (not IJV for deep and External JV for superficial cervical lymph)
Jugulodigastric node
superior deep cervical lymph node - at level of posterior digastric
Jugulo-omohyoid node
inferior deep cervical lymph node
inferior to tendon of omohyoid
where do the lymphatic vessels from the pharynx drain? where do all of them drain?
retropharngeal nodes, paratracheal nodes, and infrahyoid nodes
all of the above drain into the deep cervical nodes
where does the palatine tonsil drain?
directly into the deep jugulodigastric nodes
lymphatic vessels from the teeth and gingivae drain where?
draining mainly into the submandibular, submental, and deep cervical nodes
lymph drainage from the tongue…
takes four paths
lymph from root of tongue
drains to superior deep cervical nodes - the jugulodigastric
lymph from the medial body of tongue
drains to the inferior deep cervical nodes - juguloomohyoid node
right and left lateral parts of the tongues lymph drains
into submandibular nodes
lymph drainage from the tip of the tongue and frenulum drain..
into submental nodes
anterior triangle divided into..
four smaller triangels
- muscular triangle
- carotid triangle
- submandibular triangle
- submental triangle
boundaries of anterior triangle
middle of neck - medially
anterior border of SCM - laterally
inferior border of the mandible - superiorly
down to the clavicle
boundaries of posterior triangle
Posterior margin of SCM
Anterior margin of trapezius
middle 1/3 of clavicle
contents in the posterior triangle
Accessory nerve - undersurface of SCM coming right acorss cervical plexus brachial trunks external jugular bein subclavian artery/vein suprascapular artery cervical lymph nodes
muscular triangle
anterior border of SCM
suoerior belly of omohyoid
midline of neck
contains the infrahyoid muscles, thyroid gland, and parathyroid gland
carotid triangle
anterior border of SCM
superior belly of the omohyoid
posterior digastric
contains the carotid sheath, hypoglossal nerve, accessory nerve, ansa cervicalis, deep cervical lymph nodes
submandibular triangle
anterior and posterior bellies of the digastric
inferior border of the mandible
contains the submandibular gland, hypoglossal nerve, submandibular lymph nodes, nerve to the mylohyoid, and facial artery and vein
submental triangle
right and left anterior body of the digastric and hyoid bone
contains the submental lymph nodes and veins
