Neck: Root of the Neck Flashcards
Root of the Neck
- Area immediately above superior thoracic aperture
- Contains structures passing between thorax and upper extremity or the head/neck
Arteries in the Root of the Neck
- Subclavian and branches
- Common carotid
Veins in the Root of the Neck
- EJV
- AJV
- IJV
- Subclavian
Nerves in the Root of the Neck
- Vagus
- Recurrent laryngeal
- Phrenic
- Sympathetic trunk and ganglia
- Brachial Plexus
Deep Neck Muscles
- Longus colli
- Longus capitis
Scalene Muscle
- Flex and laterally bend neck
- Elevate the ribs (accessory muscle of inspiration)
Scalene Muscle Innervation
- Ventral rami of cervical spinal nerves
Scalene Anterior Attachments
- C3-6 TPs
- 1st rib, anterior to subclavian artery groove
Scalene Middle Attachments
- C2-7 TPs
- 1st rib, posterior to subclavian artery groove
Scalene Posterior Attachments
- C4-6 TPs
- 2nd rib
Interscalene Triangle
- Formed by anterior and middle scalene
Subclavian Artery
- Ends at lateral border of 1st rib
- Supplies upper limb, neck, brain, vertebral column
- 3 parts
1st Part of Subclavian Artery (Medial to Anterior Scalene)
- Vertebral artery
- Internal thoracic
- Thyrocervical trunk
Vertebral Artery
- Travels through transverse foramina C6-C1
Inferior Thyroid Artery
- Supplies thyroid
- Parathyroid glands
- Trachea
- Esophagus
- Ascending cervical artery
Cervico Dorsal (Transverse Cervical) Artery
- Branches into superficial branch and dorsal scapular (sometimes)
Suprascapular Artery
- Travels to posterior scapula
2nd Part of Subclavian Artery
- Posterior to anterior scalene
- Costocervical trunk
- Superior intercostal artery
- Deep cervical artery
Superior Intercostal Artery
- 1st and 2nd posterior intercostal arteries
Deep Cervical Artery
- Supplies muscles
3rd Part of Subclavian Artery
- Lateral to anterior scalene (up to lateral border of 1st rib)
- Dorsal scapular artery
- Can also branch from transverse cervical
Subclavian Artery (3rd Part) Location
- 1 finger width above clavicle
- Lies on the 1st rib
Subclavian Vein Drainage/Location
- Drains upper limb
- Lies on 1st rib
Thoracic Outlet
- 3 distinct spaces between neck and axilla
- Interscalene triangle
- Costoclavicular space
- Retropectoralis minor space (subcoracoid space)
Interscalene Triangle Location
- Between anterior and middle scalenes
- Rib 1 is inferior
Interscalene Triangle Content
- Brachial plexus roots/trunks
- Subclavian artery
Costoclavicular Space Location
- Between clavicle, first rib, and upper scapula
Costoclaviuclar Space Content
- Brachial plexus divisons
- Subclavian artery and vein
Retropectoralis Minor (Subcoracoid) Space Location
- Inferior to coracoid
- Posterior to pectoralis minor
Retropectoralis Minor (Subcoracoid) Space Content
- Brachial plexus cords
- Axillary artery and vein
Thoracic Outlet Syndrome
- Neurovascular disorder
- Results from compression of brachial plexus and/or subclavian vessels
Causes of Thoracic Outlet Syndrome
- Scalene muscle abnormalities
- Scalenus minimus
- Pancoast tumors
- Cervical rib
- Chronic overuse
Scaleneus Anticus Syndrome
- Scalene muscle abnormalities
Scalenus Minimus
- Accessory muscle from C7 TP to 1st rib or suprapleural membrane
Pancoast tumors
- Tumors of lung apex
Vagus Nerve (CN X)
- Exits skull through jugular foramen
- Content of carotid sheath
Branches of Vagus Nerve (CN X)
- Superior laryngeal nerves
- Internal laryngeal nerve
- External laryngeal nerve
- Recurrent laryngeal nerves
Right Vagus Nerve
- Passes anterior to 1st part of subclavian artery
- Passes posterior to brachiocephalic vein and SC joint
- Gives off right recurrent laryngeal
Left Vagus Nerve
- Passes between left CCA and left subclavian
- Passes posterior to left brachiocephalic vein and SC joint
- Gives off left recurrent laryngeal
Recurrent Laryngeal Nerves
- Ascend in trachea-esophageal groove
- Posterior to thyroid gland, travel next to inferior thyroid artery
- Supplies trachea and all laryngeal muscles (except 1)
Cervical Portion of Sympathetic Trunk
- No white rami communicantes
Sympathetic Presynaptic (Preganglionic) Nerve Fibers
- Originate upper thoracic spine
- Synapse cervical sympathetic ganglia
3 Cervical Ganglia
- Superior
- Middle
- Inferior
Superior Cervical Ganglia
- Large
- Located at the C1,2,3 level
Middle Cervical Ganglia
- Small
- Anterior to inferior thyroid artery
- Located at the C5,6 level (level of cricoid cartilage)
Inferior Cervical Ganglia
- Typically fuses with the T1 ganglia forming the stellate ganglion (cervicothoracic ganglion)
- Anterior to C7 TP
- Superior to 1st rib neck
- Posterior to vertebral artery
Stellate Ganglion
- Cervicothoracic ganglion
Postsynaptic Fibers from Superior Cervical Ganglia
- Internal and external carotid arterial plexuses
- Some of the cranial nerves
- Gray rami to C1-4 spinal nerves
- Superior cardiac nerve
Postsynaptic Fibers from Middle Cervical Ganglia
- Gray rami to C5 and 6 spinal nerves
- Middle cardiac nerve
- Thyroid gland (via peri-arterial plexus following inf. thyroid a.)
Postsynaptic Fibers from Inferior Cervical Ganglia
- Gray rami to C7, 8, and T1 spinal nerves
- Arterial plexuses (vertebral, subclavian, internal thoracic)
- Inferior cardiac nerve to cardiac plexus
Arterial Plexuses
- Vertebral
- Subclavian
- Internal thoracic
Lesion of Sympathetic Trunk in the Neck
- Pancoast tumor (lung apex)
- Carotid artery aneurysm
- Neck trauma or postsurgical
Can Cause a Horner Syndrom
- Miosis
- Ptosis
- Enopthalmos
- Anhydrosis
Thyrocervical Trunk
- Inferior thyroid artery (becomes ascending cervical)
- Cervico dorsal (transverse cervical) artery
- Suprascapular artery