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Anatomy Unit 2 > Posterior Neck Triangle > Flashcards

Posterior Neck Triangle Flashcards

1
Q

What is the anterior border of the neck?

A

Lower border of the mandible to the upper surface of the manubrium of the sternum

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2
Q

What is the posterior border of the neck?

A

Superior nuchal line on the occipital bone to the intervertebral disc below CV7

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3
Q

What is the superficial fascia of the neck?

A

Composed of loose, sometimes fat filled non-contractile connective tissue, which is located between the skin and the deep fascia.

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4
Q

What is the platysma?

A

Thin sheet of muscle attached from the superficial fascia of the thorax to the margin of the mandible

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5
Q

What is the deep fascia of the neck?

A

Provide cleavage planes, slippery surfaces to facilitate movement of structures, limit spread of infections. The deep fascia is organized into 5 distinct tubes

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6
Q

What is the investing layer of fascia?

A

Encloses the neck in a continuous layer of deep fascia. Attached to bone above and below. Splits to enclose the parotid and submandibular glands, sternocleomastoid, and trapezius muscles. Also binds the intermediate tendons of the digastric and omohyoid muscles

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7
Q

What is the sternocleidomastoid muscle (SCM)? Attachments, actions, and innervation?

A

Superior attachment to superior nuchal line and mastoid process, inferior attachment to manubrium and clavicle.

Actions: Acting alone it rotates the face to the opposite side while bending to the same side. Acting together the muscles flex the head and neck backwards

Innervation: Innervated by spinal accessory nerve pierces it on the way to trapezius

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8
Q

What is torticollis?

A

Wry neck - SCM is injured during childbirth due to aggressive pulling on the head, resulting in a flexion deformity of the neck

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9
Q

What is the pretracheal layer?

A

Deep fascia enclosing visceral organs: trachea, esophagus, thyroid gland, and pharynx
Superior attachment: Laryngeal cartilages and hyoid bone
Inferior attachment: Descends anterior to the trachea to fuse with the fibrous pericardium

Causes thyroid to move with larynx during swallowing

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10
Q

What is the prevertebral layer?

A

Located anterior to the cervical vertebrae and the muscles arising from them (scalenes). It prolongs into the axilla as a sheath for the brachial plexus! Remember the axillary sheath was a continuation of the prevertebral fascia

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11
Q

What is the carotid sheath?

A

Sheath enclosing neurovascular bundle on either side, it is continuous with the investing, pretracheal, and prevertebral layers. Encloses common and internal carotid arteries, the internal jugular vein and the vagus nerve, nerve lies behind and between the artery and vein.

The fascia is thick over the artery and thin over the vein which allows for venous dilatation

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12
Q

What is the buccopharyngeal fascia?

A

It is the name for the posterior pretracheal fascia. It separates the pharynx and esophagus from the prevertebral fascia. Attaches to base of skull and ends in the thoracic cavity

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13
Q

What is the retropharyngeal space?

A

It is a potential space filled with loose connective tissue between the buccopharyngeal fascia and the prevertebral fascia. Facilitates movement of pharynx and larynx during swallowing, opens inferiorly into the posterior mediastinum.

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14
Q

How can dysphagia be caused?

A

Abscess posterior to prevertebral fascia can enter retropharyngeal space and impinge on the esophagus, and can also extend into the posterior mediastinum

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15
Q

What is the pretracheal space?

A

Potential space between the investing layer covering posterior sides of infrahyoid muscles and anterior sides of pretracheal fascia

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16
Q

What is the anterior boundary of the posterior triangle?

A

Posterior border of SCM

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17
Q

What is the posterior boundary of the posterior triangle?

A

Anterior border of trapezius

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18
Q

What is the inferior boundary of the posterior triangle?

A

Clavicle

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19
Q

What is the superior boundary of the posterior triangle?

A

Angle where SCM and trapezius meet on superior nuchal line

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20
Q

What is the roof of the posterior triangle?

A

Investing layer of cervical fascia, platysma, external jugular vein

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21
Q

What is the floor of the posterior triangle?

A

Levator scapulae and scalene muscles, covered by prevertebral fascia. Scalene muscles attach to transverse processes of ribs. There are anterior, middle, and posterior

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22
Q

What divides the posterior triangle?

A

The omohyoid muscle’s inferior belly, which divides it into the subclavian (inferior) and occipital (superior) triangles

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23
Q

What structures generally travel in the posterior triangle?

A

generally things travelling to upper limb

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24
Q

Where do the brachial plexus roots course through?

A

emerge between the scalenus anterior and scalenus medius muscles, and enter the posterior triangle where the trunks are formed.

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25
Q

What branches of the brachial plexus are in the posterior triangle?

A
  1. Dorsal scapular nerve
  2. Long thoracic nerve
  3. Suprascapular nerve
  4. Nerve to subclavius
    You can use a nerve block here to anesthetize the upper limb

Phrenic nerve does not enter posterior triangle -> anterior triangle

26
Q

Where does the accessory nerve run? (CN XI / spinal branch)

A

emerges below the upper 1/3 of SCM, crosses obliquely across the posterior triangle superficial to the prevertebral fascia, and enters deep to the anterior border of the trapezius above the lower 1/3.

27
Q

What is the function of the accessory nerve and why is it important?

A

Supplies the SCM and trapezius
It is rather superficial so it is vulnerable to injury
Paralysis of trapezius -> drooping of shoulder, inability to shrug affected side, and difficulty abducting arm above 120 degrees

28
Q

What is the cervical plexus?

A

Formed by ventral rami of C1-4, located in upper part of the neck deep to SCM and thus not in the posterior triangle. It has many cutaneous branches that course through, however

29
Q

What sensory nerves are in the nerve point of the neck?

A

Good site for local anesthestic -> medial posterior border of SCM

  1. Lesser occipital (C2, C3)
  2. Greater auricular (C2, C3)
  3. Transverse cervical (C2, C3)
  4. Supraclavicular (C3, C4)
30
Q

What is the phrenic nerve?

A

Motor innervation from C3-5 to the diaphragm

31
Q

What is the ansa cervicalis?

A

Ansa = circle
It is a nerve with superior root from C1 (coursing with CNXII) and inferior root from C2, C3.
Gives off motor branches to the sternothyroid and omohyoid muscles
Also gleno and thyro-hyoid muscles, but they travel with CN12 from C1

32
Q

What is the external jugular vein? What forms it?

A

Formed by the union of the posterior auricular and retromandibular veins. Crosses SCM obliquely and deep to the platysma. It will pierce the investing layer of fascia at the antero-inferior angle of the posterior triangle to drain into the subclavian vein

33
Q

What are the three parts of the subclavian artery?

A

Divided by scalenus anterior muscle

  1. From origin to medial border of the scalenus anterior
  2. Posterior to muscle
  3. From lateral border of muscle to outer border of the first rib

3rd part is in the posterior triangle, before disappearing behind the middle of the clavicle.

34
Q

Where does the subclavian vein go?

A

Typically does not enter posterior triangle, vein crosses anterior to anterior scalene. Central lines can be placed in this area of the vein

35
Q

What are the branches from the first part of the subclavian artery?

A 
From first part:
1. Vertebral (passes through vertebral foramen)
2. Internal thoracic (dives down)
3. Thyrocervical trunk
On the left side
4. Costocervical trunk
36
Q

What are the branches from the second part of the subclavian artery?

A

Usually on right side: Costocervical trunk

Dorsal scapular artery may also arise here

37
Q

What is the dorsal scapular artery?

A

Arising on the 2nd or 3rd part of the subclavian, it passes through the trunks of the brachial plexus to supply the rhomboids

38
Q

What are the branches of the thyrocervical trunk?

A
  1. Inferior thyroid artery (to thyroid)
  2. Transverse cervical artery (runs anterior to brachial plexus, supplies trapezius). Deep branch may be called dorsal scapular
  3. Suprascapular artery

Transverse cervical and suprascapular will cross the posterior triangle

39
Q

What is the occipital artery?

A

A branch of the external carotid artery, it crosses the posterior triangle at its superior angle, ascends back of scalp with greater occipital nerve

40
Q

How do the cervical lymph nodes orient themselves?

A

Superficial cervical lymph nodes form chain along external jugular vein
Deep cervical lymph nodes form chain along internal jugular vein

41
Q

How does lymph drain from the cervical lymph nodes?

A

Superficial drains into deep. Deep cervical nodes receive lymph from head and neck then drain it to lymphatic duct on right side, or directly into thoracic duct on left side

42
Q

What is the jugulo-digasteric lymph node?

A

Located where posterior belly of digastric crosses the internal jugular vein

43
Q

What is the jugulo-omohyoid lymph node?

A

Located inferior to intermediate tendon of the omohyoid and internal jugular vein

44
Q

What does the thyroid gland develop from?

A

The thyroid diverticulum, which arises in the ventral midline of the pharynx between the first and second pouches. It migrates forward down the tongue during caudal migration, expanding and bifurcating to form the lobes and the isthmus

45
Q

What is the pyramidal lobe?

A

The embryological remnant of the thyroglossal duct (the distal part of it) which will not always be present in the gland. It would exist as a small prominence on the superior border called the pyramidal lobe, usually on left side.

46
Q

What is the foramen cecum?

A

Structure of the tongue that persists as embryological remnant of thyroid gland development

47
Q

What are the true and false capsule of the thyroid?

A

True fibrous capsule - intimately attached to the gland

False capsule - formed by pre-tracheal fascia

48
Q

How is the thyroid held up?

A

Suspended by ligaments anchoring the gland to the thyroid and cricoid cartilages. Cricoid cartilage goes all the way around the larynx and is more inferior

49
Q

How large is the thyroid?

A

The isthmus sits over the cricoid cartilage from the 2-4th rings, while the lobes sit from the oblique line of the thyroid cartilage to the 6th cricoid / tracheal ring. Lobes are prevented from upward enlargement by the sternothyroid muscles

50
Q

What covers the thyroid anterolaterally?

A

Strap muscles (infra-hyoid) and overlapping SCM

51
Q

What covers the thyroid posteromedially?

A

Recurrent and external laryngeal nerves. Posterior aspect bears the parathyroid glands

52
Q

What is the blood supply to the thyroid gland?

A

Superior thyroid artery - related to external laryngeal nerve
Inferior thyroid artery - supplies most of glandular tissue, related to recurrent laryngeal nerve
Inconstant supply from thyroidea ima

53
Q

What is the venous drainage of the thyroid gland?

A

Superior thyroid vein - to IJV
Middle thyroid vein - to IJV
Inferior thyroid vein - to brachiocephalic vein (very large)

54
Q

What’s the lymphatic drainage of the thyroid?

A

To deep cervical nodes, pre-laryngeal and pre-tracheal nodes

55
Q

What is the nervous supply to the thyroid?

A

Sympathetic fibers are vasomotor to the blood vessels.

56
Q

What is an ectopic or lingual thyroid?

A

Descent of thyroglossal duct is arrested, leading to thyroid basically being stuck in throat

57
Q

What nerves are vulnerable during thyroidectomy and why is this important?

A

Recurrent laryngeal nerve - hoarseness of voice
External laryngeal nerve - monotonous voice
Unilateral damage can cause this

58
Q

Where are the parathyroid glands?

A

Posterior aspect of thyroid between capsule and pre-tracheal fascia, near inferior thyroid artery

59
Q

Where does the innervation and blood supply for paraythyroid come from?

A

Inferior thyroid artery is major blood supply. Innervation is sympathetic vasomotor fibers

60
Q

What is an aberrant parathyroid?

A

Since PT develops from third pharyngeal pouch which also gives rise to the thymus, occasionally parathyroid glands remain in the thymus and are called ectopic / aberrant. But they still secrete hormones

Anatomy Unit 2 (13 decks)

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