Penetrating neck injuries

Question 1

Can you describe the boundaries of PT

Answer 1

boundaries
-the posterior border of the sternocleidomastoid muscle
-anterior border of the trapezius muscle,
-and middle third of the clavicle.

Question 2

What are the divisons of PT

Answer 2

• Occipital
• Supraclavicular/Subclavian

Question 3

What are the borders of the occiptal triangle

Answer 3

anterior: posterior margin of sternocleidomastoid
posterior: anterior margin of trapezius muscle
inferior: inferior belly of omohyoid muscle

Question 4

What are the contents of the occpital triangle

Answer 4

Accessory nerve (CN XI),
branches of the cervical plexus,
Roots of brachial plexus, supraclavicular nerve

Question 5

What are the boundaries of the supraclavicualr triangle

Answer 5

Superior - inferior belly of omohyoid muscle
Anterior - posterior edge of sternocleidomastoid muscle
Inferior - clavicle

Question 6

What are the contents of the supraclavicular triangle

Answer 6

Third part of the subclavian artery,
brachial plexus trunks,
nerve to subclavius muscle,
lymph nodes

Question 7

Subclavian artery

origins,parts, branches

Answer 7

1st : from origin to Scalene anterior
branches: thyrocervical trunk, vertebral, internal thoracic

2nd : between Scalene anterior and middle
branches: costocervical trunk

3rd : lateral to Scalene anterior . At lateral border of 1 st rib –axillary artery

branch: dorsal scapular

Question 8

where does subclavian vein rise from

Answer 8

Subclavian vein develops at lateral border of 1st rib,
lies anterior and
inferior to subclavian artery
passes anterior to Scalene anterior muscle

Question 9

Divisons of AT

Answer 9

• Submental
• Submandibular
• Carotid
• Muscular

Question 10

Submental

borders

Answer 10

• Borders
  superior: Mandible (mental symphysis
  lateral: Digastric (anterior belly)
  inferior: body of Hyoid bone

Question 11

submental

contents

Answer 11

Submental lymph nodes
Anterior jugular vein

Question 12

Muscular triangle

borders

Answer 12

anterior: Median vertical line
posterior: Omohyoid (superior belly) &
Sternocleidomastoid
superior: Hyoid

Question 13

Muscular triangle

contents

Answer 13

Muscles: thyrohyoid, sternothyroid, sternohyoid

Vessels: superior and inferior thyroid arteries, anterior jugular veins

Viscera: thyroid gland, parathyroid glands, larynx, trachea, oesophagus

Question 14

Carotid triangle

borders

Answer 14

anterior: Omohyoid (superior belly)
posterior: Sternocleidomastoid
superior: Digastric (posterior belly) & Stylohyoid

Question 15

Carotid triangle

contents

Answer 15

Arteries: common carotid, internal carotid and external carotid (and ECA branches except terminal branches)

Veins: internal jugular, common facial, lingual, superior thyroid, middle thyroid

Nerves: vagus nerve (CN X), hypoglossal nerve (CN XII), ansa cervicalis, sympathetic trunk

Question 16

Carotid sheath

extent

Answer 16

Carotid sheath extends from base of skull to aortic
arch (merges with adventitia)
Ansa cervicalis anteriorly
Sympathetic chain posteriorly

Question 17

contents of carotid sheath

Answer 17

CCA, ICA IJV & Vagus nerve

Question 18

Structures exiting carotid sheath

Answer 18

Hypoglossal
* External carotid
* Pharyngeal br. of vagus nerve
* Superior laryngeal br. of vagus nerve

Question 19

Describe the course of the external carotid and the branches given off

Answer 19

arises from the common carotid artery

branches
superior thyroid artery
asecnding pharengyl
lingual artery
facial artery
occiptal
posterior auricular
maxillary artery
superficial temporal artery

idk if your meant to know what they supply

Question 20

IJV

continuation of,

Answer 20

continuation of sigmoid dural

find our more abour vein

Question 21

What is the ansa cervicalis

Answer 21

Formed by spinal roots C1-4

send motor info to infrahyoid muscles

sternohyoid, sternothyroid, thyrohyoid and omohyoid muscles.

Question 22

Describe course of accessory nerve

Answer 22

descends along the posterior triangle of the neck, innervating the sternocleidomastoid and trapezius muscles

Question 23

Describe course of vagus nerve

Answer 23

descends vertically within the carotid sheath
posterolateral to the internal and common carotid arteries
and medial to the internal jugular vein (IJV) at the root of the neck

iving off branches to structures such as the larynx and pharynx

Question 24

Describe course of phrenic nerve

Answer 24

arises from cervical nerves C3-C5 and descends along the anterior surface of the scalene muscles to innervate the diaphragm.

Question 25

what is a high velocity neck injury due to

Answer 25

gunshot

Question 26

what is a low velocity penetrating neck injury due to

Answer 26

stabbing

Question 27

what are the hard and soft signs of penetrating neck injury

why are they important

Answer 27

Hard signs
-active bleeding
-large haemotoma
-bruit/thrilk
-reduced GCS
-shock
-haemoptsus
-air bubbles in wound

soft signs
-minor bleeding
-small haematoma
-dysphagia
-dysphonia
-

Patients with Hard signs require operative management
Patients with Soft signs (if stable) require a CT angiogram
Patients with No signs can be observed

All wounds deep to the platysma, should be discussed with the ENT team.

Question 28

How do we approach neck trauma

Answer 28

• A: voice, air exchange, patency, cervical
  spine, ETT, tracheostomy
• B: breath sounds, chest wall movements
• C: mentation, skin color, HR, BP, neck
  veins
• D: pupils, extremities movements
• E: exposure

Question 29

When do people with neck trauma need to go to the operating theater

Answer 29

• Severe active bleeding
• Hemodynamic instability
• Expanding or pulsatile neck
  hematoma
• Massive subcutaneous air
• Air bubbling wound

Question 30

How can we image the neck

Answer 30

Ultrasound
X-ray
CT

Question 31

Function of accessory nerve

Answer 31

supply sternocleidomastoid and trapezius muscles,

Rotation of head
Tilting of the head
Flexion of the neck .

Question 32

Know what nerves innervate what

Question 33

wheres the danger space in the neck

Answer 33

The danger space is posterior to the retropharyngeal space

increase risk of infection