Posterior Triangle of the Neck

Question 1

Which muscle attaches to the posterior skull in between the inferior and superior nuchal lines?

Answer 1

The trapezius

Question 2

What is the posterior skull bone called?

Answer 2

Occipital bone

Question 3

How does the mastoid process form?

Answer 3

After birth from the sternocleidomastoid pulling on it.

Question 4

The hyoid bone is located inferior to the _______ and has a greater and lesser horn. What muscles attach to it?

Answer 4

Located inferior to the mandible. Suprahyoid muscles and the infrahyoid muscles attach to it.

Question 5

Name the five axial planes of the cervical region.

Answer 5

Occlusal plane at C1 - a plane between the upper and lower teeth.
Angle of the mandible at C2.
Hyoid bone at C3.
Thyroid cartilage at C4/C5.
Cricoid cartilage at C6.

Question 6

What is the thing called that attaches the inferior hyoid bone to the thyroid cartilage?

Answer 6

The thyrohyoid membrane.

Question 7

How many cervical vertebrae are there? How many cervical nerves are there? How does that work?

Answer 7

7 cervical vertebrae, 8 cervical nerves. C1 nerve passes above the C1 vertebra, C8 nerve passes below the C7 vertebrae. All the thoracic nerves pass below their corresponding thoracic verbetrae.

Question 8

Which vertebrae has a bifid spinous process?

Answer 8

C4

Question 9

What are the transverse foramina of the cervical vertebrae for?

Answer 9

The vertebral arteries run through them - beginning with C6 usually.

Question 10

What part of the skull articulates with atlas? What is this joint called?

Answer 10

Occipital condyles. Joint is called the atlanto-occipital joint.

Question 11

What are the primary motions of the atlanto-occipital joint? What motion is restricted?

Answer 11

Flexion, extension, and some lateral bending. Rotation does not happen.

Question 12

Rotation at the head primarily occurs at which joint?

Answer 12

The atlanto-axial joint.

Question 13

What is the superior protuberance of axis (C2) called? What is its function?

Answer 13

Dens. It is the pivot point around which the skull can rotate.

Question 14

What ligaments attach dens to atlas? What do they do?

Answer 14

The transverse ligament wraps around dens posteriorly and prevents anterior displacement of the atlas and skull on C2.

The alar ligaments are on the anterolateral portion of dens and prevent excessive side-to-side motion.

Question 15

What does the anterior longitudinal ligament do? What about the posterior longitudinal ligament?

Answer 15

Anterior prevents hyperextension.

Posterior prevents hyperflexion.

Question 16

What is a hangman’s fracture?

Answer 16

Bilateral fracture of the posterior arch of C2 with anterior subluxation of C2 on C3 from hyperextension/distraction.

Question 17

What is a Clay Shoveler’s fracture?

Answer 17

When the tips of the spinous processes of C6-T1 avulse from constant flexion and extension of the neck.

Question 18

What is a Jefferson fracture?

Answer 18

Compression fracture of C1 anterior and/or posterior arches – lateral masses split and the transverse ligament tears.

Question 19

What is a mental process?

Answer 19

Butt-chin

Question 20

What are the three compartments of the neck?

Answer 20

1. Visceral compartment (anterior to the vertebrae)
2. Bony-muscular compartment posteriorly
3. 2 neurovascular compartments laterally (carotids, IJV, vagus nerve)

Question 21

Name the five fascial layers found in the neck.

Answer 21

1. Investing fascia
2. Prevertebral fascia
3. Carotid sheath (2 of them)
4. Pretracheal fascia
5. Alar fascia (anterior part of the prevertebral fascia)

Question 22

What structures are found within the pretracheal fascia?

Answer 22

Esophagus, trachea, thyroid gland.

Question 23

What is the pretracheal space?

What is the retropharyngeal space?

What is the danger space?

Answer 23

Pretracheal space is between the pretracheal fascia and the trachea.

Retropharyngeal space is between the retropharyngeal fascia and the alar fascia.

Danger space is between the alar and prevertebral fascia and infection in this space can get down to the posterior mediastinum.

Question 24

Which two veins join to form the external jugular vein?

Answer 24

The posterior auricular vein and the retromandibular vein

Question 25

What do the two branches of the retromandibular vein do?

Answer 25

The posterior one joins with the posterior auricular vein to form the external jugular vein, the anterior branch joins with the facial vein.

Question 26

What does a distended external jugular vein tell you?

Answer 26

Elevated central venous pressure (at the IVC just before the right heart) - indicative of right heart failure

Question 27

From what does the platysma muscle originate from inferiorly?

Answer 27

The deep fascia surrounding the deltoid and pectoralis muscles.

Question 28

What is torticollis aka wry neck?

Answer 28

When a SCM on one side is shorter than the opposite side, pulling the head towards that side and rotating the face to the opposite side. Can be congenital or acquired.

Question 29

What are the two triangles of the neck and what are their borders?

Answer 29

Anterior triangle: posterior border is the posterior edge of the SCM, inferior edge of the mandible, and the superior clavicle and manubrium.

Posterior triangle: anterior border is the posterior edge of the SCM, posterior border is the anterior border of the trapezius. Inferior border is the middle third of the clavicle. The roof is the skin, superficial fascia, platysma, and investing deep layer of fascia. The floor is the muscles covered by prevertebral fascia (scalenes and some others).

Question 30

What are the two triangles of the posterior neck triangle?

Answer 30

Occipital triangle is within the borders of the trapezius, SCM, and omohyoid mucle inferiorly. The supraclavicular triangle is within the omohyoid, clavicle, and SCM.

Question 31

What is the “nerve point” of the neck?

Answer 31

A spot on the posterior edge of the SCM about halfway up where a bunch of cutaneous nerves from the cervical plexus and the spinal accessory nerve comes out.

Question 32

What makes up the cervical plexus?

Answer 32

Connections between ventral primary rami of C1-C4

Question 33

What nerve provides cutaneous sensation for the anterior head and face?

Answer 33

Trigeminal nerve (CN V)

Question 34

Cutaneous innervation for the posterior head and neck is supplied by the _____ _____ of cervical spinal nerves.

Answer 34

dorsal rami

Question 35

What are the three parts of the trigeminal nerve and what do they do?

Answer 35

V1 is the opthalmic division and supplies cutaneous sensation for the anterior head down to the nose.

V3 is the mandibular division and supplies cutaneous sensation for the lower lip, chin and up the side of the face to the temples.

V2 supplies cutaneous sensation in between V1 and V3.

Question 36

Which scalene muscles attach to the first rib and which attach to the 2nd?

Answer 36

Anterior and middle attach to rib 1 and posterior attaches to rib 2.

Question 37

What two important structures run between the anterior and middle scalene muscles? What structure does NOT?

Answer 37

Brachial plexus and subclavian artery run between the scalenes. The subclavian vein does NOT (it runs anterior to the anterior scalene).

Question 38

What is scalene compression syndrome?

Answer 38

A type of thoracic outlet syndrome - compression of the brachial plexus and subclavian artery due to hypertrophy or fibrosis of the anterior and middle scalene muscles, causing pain, muscle weakness and low BP in the upper limb.

Question 39

Central line catheterization is often performed by ________ vein puncture.

Answer 39

subclavian