Neck Superficial Triangle And Cervical Viscera Flashcards
Bones and cartilages of the neck
C1-C7
Mastoid process Styloid process Stylohyoid L Mandible Angle of mandible Hyoid
Thyroid cartilage
Cricoid cartilage
What are the parts of the hyoid bone?
Greater horn
Lesser horn
Fibrocartilage
Body of hyoid
What are the four main regions of the superficial neck structures?
What two regions are on either side of the SCM?
Sternocleidomastoid
Posterior cervical region (trapezius)
Lateral cervical/posterior triangle
Anterior cervical/anterior triangle
Anterior and posterior triangles
What is the fx of the platysma m?
What CN supplies it?
What is its origin and insertion?
Muscle of facial expression
Cervical branch of facial N (CN VII)
Dermis of skin (superficial over SCM and other superficial muscles)
What two muscles are innervated by the spinal accessory N (CN XI)?
SCM
Trapezius
What are three fx of the SCM?
What is its origin and insertion?
Lateral flexion with rotation (rotate to opposite side)
Extension at atlanto-occipital joint
Flexion cervical vertebrae
Sternum, clavicle; skull
What usually causes muscular torticollis (“Wry neck”)?
What nerve can be affected?
What muscle is affected?
How can you treat it?
Birth trauma (congenital); benign fibrous tumor
Spinal accessory N
SCM -> causes bent neck
Physical therapy
What are the five fascia layers of the neck and what do they contain?
Superficial fascia: skin, fat, loose CT, platysma m
Investing layer: deep fascia
Pretracheal layer: around esophagus, trachea, and thyroid; muscular and visceral layer
Prevertebral layer: around deeper neck muscles
Carotid sheath: fascia tubes in neck; protects neck as it moves; alar fascia runs between carotid sheath
Zone I of penetrating trauma is the horizontal area between the ____ and the ____ encompassing the thoracic outlet structures including the _____.
Zone I contains what 7 structues?
Clavicle/suprasternal notch; cricoid cartilage; cupola of the lung
Proximal common carotid and vertebral A coming off the subclavian A, trachea, esophagus, thoracic duct, and thymus.
Zone II of penetrating trauma is the area between the _____ and _____.
What eleven structures does it contain?
Cricoid cartilage; angle of the mandible
Internal carotid A, external carotid A, jugular veins, pharynx, larynx, esophagus, recurrent laryngeal N, spinal cord, trachea, thyroid, and parathyroid glands
Zone III of penetrating trauma is the area that lies between the _____ and the _____.
It contains what three structures does it contain?
Angle of the mandible; base of the skull
Distal extracranial carotid A, vertebral A, upper segments of jugular vein
Where does a nerve block go in the lateral cervical region?
Where is this point located?
Erb’s point
In the lateral cervical region (posterior triangle) half way between the mastoid process and the clavicle
The bulk of the anteriolateral cutaneous innervation of the neck comes from branches of ____.
Erb’s point
What are the branches of Erb’s point that do cutaneous innervation of the head?
Where do they come from?
What other nerves come from the dorsal rami (not Erb’s point) and also do cutaneous innervation of the head?
Lesser occipital N (C2)
Great auricular N (C2, C3)
Transverse cervical N (C2, C3)
Lateral, intermediate, and medial supraclavicular N (C3, C4)
Ventral rami
Greater occipital N (C2)
Third occipital N (C3)
Lesser occipital N (C2)
Cutaneous branches of posterior rami (C4-C8)
What 7 structures are deep to the investing fascia?
Accessory N (CN XI) Dorsal scapular N Nerve to levator scapulae Roots of brachial plexus Phrenic N (C3-C5) Scalene muscles Splenius capitis
The ____ is a loop of nerves from the cervical plexus that carry somatomotor innervation to most of the _____ muscles in the neck.
Ansa cervicalis
Infrahyoid
What nerve roots feed the ansa cervicalis?
What muscles does this innervate?
C1-C3
Inferior belly of omohyoid m Sternohyoid m Sternothyroid m Superior belly of omohyoid m Thyrohyoid m Geniohyoid m
What are the anterior vertebral muscles and what is their fx?
Longus coli: flex neck, rotate opposite unilaterally
Longus capitis: flex neck
Rectus capitis anterior: flex neck
Anterior scalene: flex neck
What are the lateral vertebral muscles and what is their fx?
Rectus capitis lateralis: flex and stabilize head
Splenius capitis: laterally flex and rotate head to same side; bilaterally extend head
Levator scapulae: elevate scapula and tilt glenoid cavity inferiorly
Middle and posterior scalenes: flex neck laterally; elevate 2nd rib
____ is the space between the clavicle and first rib. This space contains subclavian A and V, brachial plexus, and scalenes and subclavius muscles.
What causes this?
What is the treatment?
What are the neurogenic and vascular symptoms?
What is a symptom in pitchers?
Thoracic outlet
Poor posture, repetitive motion
PT, surgery
Numbness of limb, pain, weakness, weak pulse, blood clots, pallor, coldness, pain in region
Hypertrophy of anterior scalene m -> blocks subclavian A
What arteries are in the root of the neck?
Subclavian A
Thryocervical trunk: inferior thyroid, cervicodorsal trunk, suprascapular A
What sympathetic innervation is in the root of the neck?
Parasympathetic innervation?
Superior cervical ganglion, middle cervical ganglion, inferior cervical ganglion
Vagus N (CN X)
What are the three parts of the thyroid gland?
What veins drain the thyroid?
What arteries supply the thyroid?
R lobe, L lobe, isthmus
Superior and middle thyroid V -> internal jugular V -> brachiocephalic V -> SVC
L and R Inferior thyroid V -> both drain into L brachiocephalic V
External carotid -> superior thyroid A
Subclavian A -> thyrocervical trunk -> inferior thyroid A
Brachiocephalic trunk -> thyroid ima A
The L vagus N becomes the L recurrent laryngeal N and wraps around the _____.
The R vagus N gives off the R recurrent laryngeal N and wraps around the ____.
What nerve is of concern when removing the thyroid because is sits deep to the thyroid in the tracheoesophageal groove? Fx?
Arch of the aorta
Brachiocephalic trunk
L recurrent laryngeal N: moves laryngeal muscles; critical for speech; helps closes airway
The presence of _____ must be considered before a tracheotomy as a potential source of bleeding.
Where can this artery branch from?
Where does this artery travel?
Thyroid ima artery
Branch off the brachiocephalic trunk, arch of aorta, R common carotid, R subclavian, or internal thoracic A
Travels along the anterior surface of the trachea and continues to thyroid isthmus
_____ refers to the presence of thyroid tissue in locations other than the normal anterior neck region between the ____ and ____ tracheal cartilages.
It is the most common form of ______.
Ectopic thyroid
2nd; 4th
Thyroid dysgenesis
The ____ is the point of entry to the venous system for central line placement, such as a pulmonary A catheter.
What is this called?
Where is the needle entered?
R or L subclavian V
Subclavian venous puncture
Needle punctures skin inferior to the center of clavicle, advanced medially towards the jugular notch until needle enters venous angle posterior to the sternoclavicular joint
A needle catheter may be inserted into the ____ for diagnostic of therapeutic reasons because it is larger and straighter.
What is this called?
Where is the needle entered?
R internal jugular V
Internal jugular venous puncture
Clinician palpate common carotid A and inserts the needle into the IJV just lateral at a 30 degree angle; aiming into the lesser supraclavicular fossa; needle directed inferolaterally toward the ipsilateral nipple
A tumor near or inferior to the sigmoid sinus can cause _____.
This causes what symptoms due to the involvement of what three cranial nerves?
Jugular foramen syndromes
Loss of taste in posterior third of the tongue (glossopharyngeal N)
Paralysis of vocal cords and palate and anesthesia of larynx and pharynx (vagus N)
Ipsilateral trapezius and sternocleidomastoid m weakness and atrophy (accessory N)
What cranial nerves are affected in Collet-Sicard syndrome?
Vernet’s syndrome?
Why?
IX, X, XI, XII
IX, X, XI
These syndromes are causes by a lesion near the jugular foramen/sigmoid sinus… IX, X, XI go through jugular foramen; XII goes through hypoglossal canal
What does the carotid sheath cover?
Internal jugular V, internal/external carotid A, vagus N, ansa cervicalis
The strap muscles of the neck lie in the _____ layer of the _____ fascia; superficial to the thyroid.
Muscular; pretracheal
What is the innervation of the mylohyoid m?
Fx?
Nerve to mylohyoid from inferior alveolar N (trigeminal)
Elevate hyoid and tongue
What is the innervation of the geniohyoid m?
Fx?
C1 via hypoglossal N
Shorten mouth floor
What is the innervation of the digastric m?
Fx?
Anterior belly: mandibular division of trigemnial N (V3);
Posterior belly: facial N
Depress mandible; steady hyoid
What is the innervation of the sternohyoid and omohyoid m?
Fx?
Ansa cervicalis
Depress and steady hyoid
What is the innervation of the sternothyroid m?
Fx?
Ansa cervicalis
Depress hyoid and larynx
What is the innervation of the thyrohyoid m?
Fx?
C1 via hypoglossal N
Depress hyoid and elevate larynx
The thoracic duct is on the ____ side and drains into _____.
Left
L subclavian V
What are the pharyngeal constrictor muscles?
Superior, middle, and inferior constrictor m
Stylopharyngeus m
