Root of Neck, Fascia, and Spaces of Neck Region Flashcards
Boundaries of Root of Neck
Anterior - manubrium of sternum
Lateral - 1st ribs, which slope upwards as they pass posterioly to articulate with vertebra T1
Posterior - vertebra T1
Plueral Cavity of Root of Neck?
Plueral cavities and apex of lungs extend into root of neck
cervical pleura
part of pleura on lungs that extend up into the root of the neck
lie POSTERIOR to the FIRST PART OF THE SUBCLAVIAN ARTERIES
cervical pleura, apices of the lung, and sympathetic trunk all..
lie POSTERIOR to the FIRST PART OF THE SUBCLAVIAN ARTERIES in root of neck
vessels in root of neck
subclavian artery and vein
Nerves in root of neck
Phrenic
Vagus
Recurrent laryngeal
Components of teh sympathetic nervous system
Right Subclavian artery -general
Terminal Branch of brachiocephalic trunk
Left Subclavian artery -general
direct branch off of the aortic arch
Pathway of R and L subclavian arteries
Anterior to pleural cavity in root
Posterior to anterior scalene muscle (Divides each into three parts)
Become AXILLARY ARTERIES as they cross the lateral border of the first rib
Subclavian artery reference to anterior scalene
first part is medial to the muscle
second part is POSTERIOR to muscle
third part is LATERAL to muscle
what comes off the right subclavian artery?
Vertebral artery, internal thoracic artery, and thyrocervical trunk off of FIRST PART
Costocervical trunk arises from SECOND PART
dorsal scapular artery arises from THIRD PART
vertebral artery and where it travels
comes off FIRST part of the subclavian artery and travels in the TRANSVERSE FOREMEN of the cervical vertebrae as it enters the foramen magnum
internal thoracic artery
comes off first portion of the subclavian artery and we saw this in lab - goes inferiorly on posterior aspect of the thoracic cage
thyrocervical trunk
off of the FIRST aspect of the subclavian artery
coming off of the thyrocervical trunk
suprascapular artery
transverse cervical artery
inferior thyroid artery–> gives off the ascending cervical artery
suprascapular artery
crosses anterior scalene muscle, enters into posterior triangle and passes posteriorly to suprascapular region of the back
transverse cervical artery
crosses the scalenus anterior muscle to enter the posterior triangle to supply the lateral structures of the neck
inferior thyroid artery
ascend in the neck and arches MEDIALLY and DOWNWARD to enter and supply the inferior portion of the thyroid gland
large musclular branch from the inferior thyroid artery –> ASCENDING CERVICAL ARTERY travels STRAIGHT UPWARD
anastemosis in the shoulder
dorsal scapular artery and the suprascapular artery
IMPORTANT THAT A HIGHLY MOBILE JOINT HAS GOOD BLOOD SUPPLY
costocervical trunk gives rise to…
deep cervical artery and the supreme intercostal artery
dorsal scapular artery passage if branch of the subclavian artery
from the third part of the subclavian artery and passes LATERALLY through the trunks of the brachial plexus, anterior to the middle scalene –> then is runs DEEP to the levator scapulae and rhomboid muscles, supplying both and participating in the arterial ANASTEMOSES around the scapuls
subclavian vein
axillary vein –> into root of neck now at the LEVEL OF THE LATERAL BORDER OF THE FIRST RIB is the subclavian vein
will cross the first rib anterior to the insertion of the anterior scalene muscle
ANTERIOR to the subclavian artery becuase need to remove to see the arteries
subclavian vein receives blood from?
- external jugular vein
- vertebral vein
- internal thoracic vein
phrenic nerve
descends obliquely with internal jugular vein across the anterior scalene
deep to the transverse cervical and suprascapular arteries
both sides it runs POSTERIOR to the subclavian vein and ANTERIOR to the internal thoracic artery
left phrenic course vs. right phrenic course
left phrenic lies on the anterior scalene muscle and crosses to the FIRST PART of the subclavian artery
the right phrenic also lies anterior to the anterior scalene muscle but it crosses anterior to the SECOND part of the subclavian artery
right vagus
crosses anterior to the right subclavian artery and gives off the right recurrent laryngeal nerve which passes MEDIALLY to reach the trachea and esophagus
inferior cervical ganglion
FOUND JUST ABOVE THE SUBCLAVIAN ARTERY
usually fused with ganglion of T1 and forms the stellate ganglion
sympathetic trunk
passes upward from the superior mediastinum through the thoracic inlet and continues up the neck outside and POSTERIOR TO THE CAROTID ARTERY
Eight sympathetic ganglia in cervical region?
coalesce as THREE MAJOR SWELLINGS :
- inferior cervical ganglion
- middle cervical ganglion
- superior cervical ganglion
middle cervical ganglion
found at vertebral level C6 opposite the cricoid cartilage
superior cervical ganglion
long, fusiform ganglion about 2-3 cm long, stretching from vertebral level C1 to C2/C3
superficial cervical fascia
thin layer of subcutaneous connective tissue that lies between the dermis of the skin and the investing layer of deep cervical fascia
it contains cutaneous nerves, blood and lymphatic vessels, superficial lymph nodes, and variable amounts of fat - anterolaterally = the platysma muscle
platsyma muscle
anteriorlaterally of the subcutanous/ superficial cervical fascia
muscle of facial expression
three layers of deep cervical fascia
investing
pretracheal
prevertebral
investing layer of fascia
superficial layer of the deep cervical fascia
surrounds the entire neck deep to the skin and superficial fascia
splits into superficial and deep layers to ENCLOSE/INVEST the trapezius and sternocleidomastois (SCM) muscles
suprasternal space
created by the investing layer of the deep cervical fascia
one layer attaches to the anterior part of the manubrium and the other to the posterior which creates this suprasternal space
pretracheal layer of fascia
limited to anterior part of the neck
extends inferiorly from hyoid bone into thorax where it BLENDS IN WITH THE FIBROUS PERICARDIUM OF THE HEART
DIVIDED INTO TWO DIVISIONS - MUSCULAR AND VISCERAL
muscular layer of the pretracheal fascia
encloses the infrahyoid muscle
visceral layer of the pretracheal fascia
encloses the thyroid gland and trachea
buccopharyngeal fascia
basically an extension of the visceral portion of the pretracheal fascia that extends posterior
separating the esophagus from the prevertebral fascia
prevertebral fascia
encloses the scalenes, deep back muscles, vertebrae
anterior portion of the prevertebral fascia
attaches to the ANTERIOR TUBERCLE of the vertebrae
alar fascia
ANTERIOR lamina of the split of the prevertebral fascia when it crosses midline immediately deep to the buccopharyngeal fascia of the posterior visceral wall
location of carotid sheath
tubular fascial investment from base of skull to the root of the neck
carotid sheath blends with?
anteriorly with the investing layer and the pretracheal fascia and posteriorly with the prevertebral fascia
what is inside the carotid sheath?
common and internal carotid arteries the internal jugular vein the vagus nerve (CN X) some deep cervical lymph nodes carotid sinus nerve sympathetic nerve fibers known as the carotid periarterial plexuses
potential spread of infection and blood?
communications - the carotid sheath and the pretracheal fascia communicate freely with the mediastinum of the thorax inferiorly and the cranial cavity superiorly
fascial spaces
the loose areolar connective tissue fills spaces BETWEEN the various layers of deep cervical fascia
they are POTENTIAL spaces only when invaded and displaces by infective material (pus) or occasionally by air (surgical emphysema)
retropharyngeal space
located posterior to the pharynx, larynx, and trachea
boundaries of the retropharyngeal space
anterior: buccopharyngeal fascia (visceral) posterior : alar (prevertebral fascia) lateral: carotid sheath superior: base of skull inferior : mediastinum
parapharyngeal space
DOES NOT INCLUDE THE CAROTID SHEATH BUT THE AREAS AROUND IT
AKA : lateral pharyngeal space
superior: skull
Inferior: hyoid bone
lateral border - medial pterygoid muscle (in the head) or sternocleidomastoid (in the neck)
medial and anterior borders - superior contrictor (head) and buccophayrngeal fascia
posterior border - alar fascia and carotid sheath
infections in the paraphayrngeal space..?
are often and primarily spread to the retropharyngeal space
prevertebral space AKA
Danger space number 4
associated with immeditaley behind the alar fascia and anterior to the prevertebral space
it is continuous to the base of the skull through the neck and into the thorax to end at the diaphragm
since it extends into the thorax region - it is a large potential space and thus a big risk for infection
cervicofacial emphysema
link to dentistry - emphysema of the head and neck can occur when air gains entry into facial spaces and becomes trapped - as these are POTENTIAL spaces
inappropriate use of the air turbine or high speed handpiece use
AIR UNDER PRESSURE ENTERS THE TISSUES AND INFLATES THE POTENTIAL SPACE
