Neck Triangles

Question 1

What is hyoid greek for?

Answer 1

“U shaped”

Question 2

What are the anterior muscles of the neck ?

Answer 2

infrahyoid muscle

suprahyoid muscle

trapezius muscle

sternocleinomastoid muscle

anterior, middle, and posterior scalene msucles

Question 3

What fascia encloses the trachea?

Answer 3

the pre-trachea fascia

Question 4

The carotid sheath surrounds what?

Answer 4

• common carotid artery (medial)
• internal jugular veins (lateral)
• vagus nerve (posterior)

Question 5

what does the prevertebral fascia enclose?

Answer 5

the vertebrae and the scalene muscles

Question 6

why does the pre-tracheal fascia have a relationship to the thyroid gland?

Answer 6

the entrance into the airway is at the atoms apple - when you swallow, you don’t want that to enter the trachea, so it moves out of the way when you swallow -

The thyroid gland is attached to this fascia - so if you have a tumour of the thyroid, you would feel it move when you swallow

Question 7

what are the different fascial layers of the neck?

Answer 7

• deep investing fascia
• carotid sheath
• pretracheal fascia
• prevertebral fascia

Question 8

the posterior traingle is bounded by what?

Answer 8

anterior border = posterior border of the sternocleidomastoid muscle

posterior border = anterior border of trapezius

base= middle third of the clavicle

Roof = deep investing fascia

Floor = prevertebral fascia

(over splenius, levator scapulae and scalenes)

Question 9

what are the attachments of the sternocleidomasotoid muscle?

Answer 9

sternum and the medial part of clavicle

and the mastoid process of the skull

Question 10

the internal jugular vein runs between where?

Answer 10

it runs medial to the sternocleidomastoid muscle

Question 11

where do the sternocleidomastoid heads attach?

Answer 11

2 lower heads

• medial part of clavicle

sternum

Question 12

which nerve supplies SCM and trapezius?

Answer 12

the 11th cranial nerve (spinal part()

Question 13

what are the attachments of the trapezius muscles?

Answer 13

superior nuchal line and down spine of vertebrae to T12

and down to the lateral clavicle and cromion and spine of scapula and also the lower fibres to medial end of spine to scapula (important for raising arm over head)

*someone with an issue with trapezius- might not be able to rotate scapula, so they couldnt move arm all the way above their head*

Question 14

what are the contents of the posterior triangle?

Answer 14

• lymph nodes (supraclavicular and occipital)
• cervical plexus - cutaneous branches
• arteries and veins - subclavian vessels, transverse cerical, suprascapular
• spinal accessory nerve
• trunks of brachial plexus
• apex of lung

Question 15

if supraclavicular lymph nodes are swollen- what could be the indication?

Answer 15

if they are swollen and there is another indication of GI issue- could be secondary deposit of cancer of the GI

Question 16

does the internal jugular vein sit in the posterior triangle?

Answer 16

no - it’s medial to the SCM muscle

Question 17

the thyrocervical trunk branches to what organ?

Answer 17

branches to the thyroid gland-

Question 18

describe the lymph nodes of the head and neck

Answer 18

• all drain into the deep cervical chain - which follows the internal jugular vein so evaluate via this jugular vein
• submental nodes, submandibular nodes, pre-auricular nodes, jugulodigastric node, mastoid nodes, and occipital nodes
  *

Question 19

is the mastoid process present at birth?

Answer 19

no it only forms when the child begins to turn their head - pulled by the SCM muscle to form a prominence

Question 20

which nerve supplies the SCM muscle?

Answer 20

accessory nerve

Question 21

how do you find the position of the accessory?

Answer 21

from 1/3 way down SCM to 2/3 way down trapezius

• always note the position of the nerve if you’re going to incise this region - if you cut this area, you could potential damage the nerve and the trapezius muscle will be weak

Question 22

what happens when when you damage the accessory nerve?

Answer 22

weakens trapezius - weight of the arm is held by the brachial plexus - leads to damage of the superior trunk - C5,6 - test via dermatomes

Question 23

what are the branches of the cervical plexus ?

Answer 23

–Lesser occipital C2 – skin neck and scalp posterior to ear

–Great auricular C2,3 – Lower part of ear

Skin over parotid region

–Transverse cervical C2,3 – chin to sternum

–Supraclavicular C3,4 - Skin over shoulder

To angle of Louis/ spine of scapula

Question 24

what nerve innervates motor of your tongue?

Answer 24

hypoglossal nerve

Question 25

the ansa cervicalis is the nerve supply to what muscles?

Answer 25

the infrahyoid muscles

Question 26

the sublcavian vein and artery are related to the scalenus anterior how?

Answer 26

• Phrenic nerve (cervical plexus) lies on SA= scalenus anterior
• Subclavian vein anterior to SA
• Subclavian artery posterior to SA

Question 27

where do you find the external jugular vein?

Answer 27

runs very superficially across the posterior triangle and it enters the deep fascia about 1cm above the middle clavicle

Question 28

Describe the surface anatomy of the jugular veins

Answer 28

•External jugular

–angle of mandible

–1 cm above middle of clavicle

•

•Internal jugular

–Just in front of mastoid process

–To sternoclavicular joint

Question 29

the anterior triangle is divided into what?

Answer 29

the submandibular triangle, the carotid triangle

cubmental triangle and the muscular triangle

Question 30

how long can you live without oxygen?

Answer 30

3-4 minutes - until the cerebral nerves are destroyed - … unfortunately the brain stem dies later, so you’re still ‘alive’ but you’re not there anymore

Question 31

how many ganglia are in the sympathetic cervical trunk?

Answer 31

•3 ganglia

–Superior - In front of axis

–Middle – on C6

–Inferior –often Fuses with first thoracic ganglion= stellate ganglion