Neck: root of the neck

Question 1

boundaries of thoracic inlet?

Answer 1

posterior: body of T1, head and neck of first rib
lateral: body of first rib
anterior: distal portion of first rib

Question 2

anterior scalene

Answer 2

O: transverse processes of Cv3-6
I: 1st rib
A: elevates first rib, side bends and rotates cervical column to opposite side. both sides acting flexes vertebral column
N: ventral rami of cervical nn.

Question 3

middle scalene m.

Answer 3

o: transverse processes of CV2-7
I: 1st rib
A: elevates first rib, side bends and rotates cervical column, both sides acting flexes column
N: ventral rami of cervical nn.

Question 4

thoracic outlet syndrome

Answer 4

brachial plexus and subclavian a. pass between the anterior and middle scalene muscles at “scalene triangle”
- compression by the scalene muscles undergoing tonic contraction causes pain, numbness and tingling in neck, medial 4th/5th fingers, paresis of intrinsic muscles of hand and poor circulation

Question 5

posterior scalene

Answer 5

O: transverse processes of CV5-7
I: outer surface of 2nd rib
A: elevates second rib, side bends and rotates cervical column - both sides acting flexes vertebral column
n: ventral rami from brachial plexus C7-8

• note: often times this muscle is fused with the middle scalene *

Question 6

longus capitis

Answer 6

O: anterior tubercles of transverse processes VC3-6
I: occipital bone
A: flexes head and neck
N: ventral rami of spinal nn C1-4

Question 7

Longus Colli

Answer 7

O & I: upperio portion: from anterior surface of vertebral body above to transverse process of vertebrae below
lower portion: extends from anterior surface of vertebral bodies to transverse processes of vertebrae above
A: flexes neck and assists in its rotation (upper fibers rotate to same side while lower fibers rotate to side opposite)
n: ventral rami of cervical spinal nn.

Question 8

where do common carotids originate?

Answer 8

right common carotid splits from brachiocelphalic trunk, posterior to sternoclavicular joint, into right subclavian and common carotid

left common carotid comes directly from arch of aorta

Question 9

subclavian a.

Answer 9

courses over the cupola of lung to lateral border of 1st rib
- divided into three parts by anterior scalene muscles:
Part 1: medial to anterior scalene
Part 2: behind anterior scalene
Part 3: lateral to anterior scalene

Question 10

branches of Part I of subclavian a

Answer 10

Part 1: medial to anterior scalene

• vertebral a.
• thyrocervical trunk: inferior thyroid, transverse cervical a, suprascapular, ascending cervical a.
• internal thoracic. a.

Question 11

Part II branches of subclavian a.

Answer 11

underneath anterior scalene m.

- costocervical trunk: gives deep cervical a. and highest posterior intercosta a.

Question 12

Part III branches of subclavian.

Answer 12

lateral to anterior scalene m.

- gives dorsal scapular artery

Question 13

branches superiorly and ascends between longus colli and anterior scalene muscle to enter the transverse cervical foramen of CV6, ascends through cervical vertebrae and up through to foramen magum. supplies muscular branches and spinal branches of vertebrae and spinal cord and anastomoses with ascending cervical.

Answer 13

vertebral artery

first branch off of subclavian artery, Part I

Question 14

arises from anterior-superior surface of subclavian a. medial to anterior scalene and opposite internal thoracic artery

Answer 14

thyrocervical trunk: provides -

inferior thyroid a. transverse cervical a. suprascapular a. ascending cervical a.

Question 15

branch from thyrocervical trunk medial to acend the medial border of anterior scalene

Answer 15

Inferior thyroid a.

• passes BEHIND the carotid sheath and symp. trunk at level of thyroid cartilage
• provides branches to pharynx, larynx, trachea and esophagus before going to inferior thyroid.
• anastomoses with posterior branches of superior thyroid a.

Question 16

• brahcnes from thyrocervical trunk laterally
• crosses posterior triangle inferiorly, medial to inferior belly of omohyoid m.
• exits posterior triangle by passing deep to trapezius m. which it supplies

Answer 16

transverse cervical a.

Question 17

branches from thyrocervical trunk laterally and inferior to the origin of the transverse cervical
- crosses posterior triangle inferiorly, medial and deep to the inferior belly of omohyoid muscle

Answer 17

suprascapular a.
- paralleled by accompanying v. is joined by suprascapular n. as it passes out of the posterior triangle laterally to enter the scapular region

Question 18

arises from subclavian opposite the thyrocervical trunk to descend inferiorly into the thorax posteriot o the sternal end of the clavicle and junction of the subclavian and internal jugular vv. it is crossed anteriorly by the phrenic n.

Answer 18

internal thoracic artery

Question 19

passes posterior from the subclavian a. over the cupola of lung underneath the anterior scalene

Answer 19

costocervical trunk (Part II)

Question 20

ascends dorsal to the brachial plexus between the semispinalis cervicis and capitis mm. will anastomose witih the descending branch of the occipital a.

Answer 20

deep cervical a.

Question 21

descends anterior to the head of the 1st rib, provides the posterior intercostal a. to the first intercostal space and terminates forming the 2nd posterior intercostal a.

Answer 21

highest intercostal a.

Question 22

may rise from part II or part III. passes dorsal through the brachial plexus when present, reaches levator scapulae and descends under the rhomboid muscles to participate in scapular anastomosis

Answer 22

dorsal scapular a.

Question 23

what forms the brachiocephalic beins?

Answer 23

internal jugular v. and subclavian v.

Question 24

central venous line placement

Answer 24

the subclavian v. is often used as point of entry for placement. technically you are sticking axillary v. with needle, but it travels to reach the subclavian v.

Question 25

superior cervical ganglion

Answer 25

represents the fused cervical ganglia of C1-4

• located on anterior surface of longus capitis
• *** PROVIDES ALL POSTGANGLIONIC SYMP FIBERS TO THE HEAD, THEREFORE, THERE ARE NO GREGANGLIONIC SYMPATHETIC FIBERS IN THE HEAD **

provides:
1. internal carotid n .
2. postganglionic gray rami communicantes to spinal nn. C1-4
3. external carotid n.
4. pharyngeal branches
5. superior cervical cardiac n.

Question 26

internal carotid n.

Answer 26

postganglionic fibers that exit the superior cervical ganglion that forms a plexus on the internal carotid artery, superior to the ganglia.
- goes to form caroticotympanic plexus
- deep petrosal nerve
cavernous plexus

Question 27

caroticotympanic plexus

Answer 27

plexus on the promontory of the middle ear in conjunction with CNS VII and IX
- formed from internal carotid n.

Question 28

deep petrosal nerve

Answer 28

formed from internal carotid nerve
- this nerve along with greater petrosal nerve forms the nerve of pterygoid canal (Vidian n.). the symp. portion of the nerve, after passing through the tperygopalatine ganglion WITHOUT synapsing distributes branches of V2 to the mucosa of nasal cavicites, palate and upper pharynx

Question 29

cavernous plexus

Answer 29

comes from internal carotid nerve

• located on carotid siphon
• provides fibers to CN III, which forms the symp. root of ciliary ganglion.
• these fibers continue WITHOUT synapsing, course with the short ciliary nn. and gain the globe where they innervate the dilator puillae m. and blood vessels

Question 30

external carotid n.

Answer 30

comes from superior cervical ganglion
- forms plexus on external carotid artery and its branches therby delivering postganglionic symp innervation to blood vessels, salivary, oral and labial glands and carotid body

Question 31

pharyngeal branches

Answer 31

from superior cervical ganglion
- join the pharyngeal branches of CNs IX and X to form the pharyngeal plexus which innervates the mucosa and blood vessels of pharynx and larynx

Question 32

superior cervical cardiac n.

Answer 32

comes from cervical ganglion

- sympathetic nerve that descneds in neck to join cardiac plexus

Question 33

middle cervical ganglion

Answer 33

• represents the fused cervical ganglion of C5/6
• located near inferior thyroid a. as it arches posterior to the carotid sheath
• provides:
  1. gray rami to spinal nn C5/6
  2. middle cervical cardiac n. (largest of symp cardiac nn. to cardiac plexus)
  3. ansa subclavia: fibers from the middle cervical/vertebral ganglion which wrap around the anterior surface of the subclavian a. medial to thyrocervical trunk and vagus to rejoin the inferior cervical ganglion

Question 34

vertebral ganglion

Answer 34

located near base of vertebral a.
- participates with the inferior cervical ganglion in providing Postganglionic fibers to form the vertebral plexus which courses superiorly on the vertebral a. and also may provide the ansa subclavia

Question 35

inferior cervical ganglion

Answer 35

represents fused ganglia of C7/8

• may be fused with the first thoracic ganglion to form a cervicothoracic or stellate ganglion
• provides: gray rami to spinal nn. C7-T1
• inferior cardiac n.

Question 36

how do you block cervical sympathetic trunk in order to relieve vasospasms of aa. from upper limb and brain?

Answer 36

injection of anesthetic around the cervicothoracic ganglion
- in cases involving raynaud’s phenomenon, such injections are important in determining the course of treatment to reduce/eliminate excess vasoconstriction of aa. of ipsilateral limb