Sievert: Neck Flashcards
All muscles except (blank) are invested by cervical investing fascia. There are basically (blank) compartments.
platysma; four
What are the 4 fascial compartments?
- cervical investing fascia
- prevertebral fascia
- pretracheal fascia
- carotid sheath
The platysma muscle is (blank) to the compartments of the neck. It lies (blank) to the investing fascia and (blank) to the superficial fascia
superficial; superior; deep
The cervical investing fascia runs from above the (blank) muscle of the face superiorly to the (blank) inferiorly
temporalis; clavicle
**Investing fascia goes all the way down to the clavicle and continues up to the zygomatic arch and then goes up to temporalis muscle and attaches above it. This is a tough fascia.
What layer of fascia surrounds everything in the neck, except for the platysma?
cervical investing fascia
What layer of fascia surrounds all muscles associated with the vertebra (including the intrinsic back muscles and muscles anterior to the vertebral body)
prevertebral fascia
As the prevertebral fascia comes anterior to the vertebral body, it splits into to layers to form what compartment? What is significant about this compartment?
retropharyngeal space; makes up the danger space because of the potential for spread of infection
What layer of fascia surrounds the supra and infrahyoid muscles, as well as the visceral compartment of the thyroid gland, trachea, and esophagus?
pretracheal fascia
What is the layer of fascia directly behind the esophagus?
buccopharyngeal fascia
What layer of fascia has components of lots of different fascias, and contains the common carotid artery, internal carotid, IJV, vagus, branches of CN 9, and deep nodes?
carotid sheath
What is contained in the carotid sheath?
common carotid internal carotid IJV vagus branches of CN 9 deep nodes
The retropharyngeal space runs from the base of the skull to the (blank). What does it allow for? What does this space constitute?
superior mediastinum of the thorax;
allows for movement of the esophagus and laryngeal apparatus during swallowing;
constitutes the danger space because potential for spread of infection
What are the superficial veins of the neck?
external jugular
internal jugular
anterior jugular
facial vein *drains to internal jugular
Superficial veins are potentially easy to cut, which can cause air to enter. Why is this dangerous?
large volume of air entering the heart will cause immediate block to blood flow
How can something potentially enter the danger space?
puncture the back of the pharynx and the buccopharyngeal fascia
The superficial veins of the neck have heavy (blank) between them. Both the anterior and external jugular drain into the (blank), while the main drainage of the facial vein is the (blank)
anastomoses;
subclavian vein;
internal jugular vein
What are the borders of the posterior triangle of the neck?
SCM (posterior side)
trapezius
clavicle
What important structures pass through the posterior triangle?
spinal accessory nerve cervical plexus nerves scalene muscles suprascapular artery transverse cervical artery subclavian artery external jugular vein roots of brachial plexus
What are the borders of the anterior triangle of the neck?
mandible
anterior midline
SCM
What important structures pass through the anterior triangle?
carotid sheath and its contents ansa cervicalis thyroid gland supra and infrahyoid muscles viscera
This curly nerve will be coming down to the trapezius muscle through the posterior triangle, and will be imbedded in investing fascia
spinal accessory nerve
These muscles cross along the lower portion of the posterior triangle
scalene muscles
*anterior, middle, posterior
Between what two muscles will you observe roots of the brachial plexus coming through? What artery is also found between these muscles?
anterior and middle scalene;
subclavian artery
The posterior triangle has what muscle running across it?
omohyoid
What are the four triangles of the anterior triangle?
carotid
submandibular
submental
muscular
What are the borders of the carotid triangle?
posterior belly of digastric
anterior border of SCM
omohyoid muscle
What is important about the submandibular triangle?
contains the submandibular gland
What makes up the muscular floor of the posterior triangle?
Levator scapulae
Three (3) scalene muscles
Inferior belly of omohyoid
Brachial plexus between anterior and middle scalenes
What 2 important structures pass between the anterior and middle scalene muscles?
brachial plexus
subclavian artery
What things can cause compression of the brachial plexus or the subclavian artery as they pass through the anterior and middle scalene muscles?
compression from the cervical rib
increased tone of the muscles
Subclavian artery and brachial plexus pass between the anterior and middle scalene and can be compressed causing numbness and ischemia.
scalenus anticus syndrome
What is the difference between scalenus anticus syndrome and thoracic outlet syndrome?
both compress the subclavian artery, but thoracic outlet syndrome involves compression between the first rib and the clavicle, while scalenus anticus syndrome involves compression between the muscles
List the cutaneous branches of the cervical plexus from superior to inferior
lesser occipital *posterolateral head and a bit of ear
greater auricular *supplies a bit of the ear
transverse cervical *to anterolateral neck
supraclavicular *down to innervate shoulder, etc
the cutaneous branches of the cervical plexus originate beneath which muscle
sternocleidomastoid
The lesser occipital nerve supplies the psoterolateral side of the head and a bit of the ear. It is a (blank) ramus of a spinal nerve.
ventral
Which cutaneous nerve from the cervical plexus basically goes straight across the neck and innervates the anterolateral part of the neck
transverse cervical
Why are the cutaneous branches of the cervical plexus important?
in anesthesia, they must all be taken care of
What cervical nerves comprise the cervical plexus?
C1 - C4
*C1 to a lesser extent
What is Sievert’s way of thinking about the branches of the cervical plexus?
C2 and C3 come together and travel up
C3 goes across
C3 and C4 go down and combine to form supraclaviculars
A branch of C1 travels along with the (blank) nerve to the geniohyoid muscle
hypoglossal
What are the motor parts of the cervical plexus?
nerve to geniohyoid and thyrohyoid from C1
ansa cervicalis superior and inferior limbs to all infrahyoid muscles
phrenic
What cervical roots does the phrenic arise from? What does this nerve supply? What is unique about this nerve? Why do you have to be especially careful with anesthesia and the phrenic nerve?
C3, 4, and a bit of 5
supplies the diaphragm
it is not in the anterior or posterior triangle (it’s behind the SCM)
don’t want to paralyze the diaphragm
The superior limb of the ansa cervicalis comes from (blank), jumps on the (blank) nerve, then gives off branches to which two muscles?
C1; hypoglossal; geniohyoid and thyrohyoid
What does the ansa cervicalis lie just on top of?
the internal jugular vein
An inflammed gallbladder can irritate the peritoneum on the undersurface of the diaphragm. Pain from the diaphragm enters the dorsal horns of which cervical nerves? Supraclaviular nerves arise from which cervical nerves and innervate the skin of the shoulder? What does this mean in terms of referred pain?
C3, C4, C5;
C3 and 4;
anything close to the diaphragm (i.e. the gallbladder) can cause referred pain to the shoulder
The hypoglossal nerve leaves the hypoglossal nucleus (in the medulla) and leaves through the (blank). It provides motor innervation to all (blank) muscles - any muscle with the name glossus except for the (blank)
hypoglossal canal;
tongue;
palatoglossus
The hyoid bone is essentially (blank) and has muscles attaching both superior and inferior to aid in elevation and depression during what two actions?
floating;
vocalization and swallowing
Does the hyoid bone articulate with any other bone?
no, it’s floating
When can you palpate the greater horn on one side of the hyoid bone?
when it is steadied on the other side
What is a dysarthria? What can cause it?
speaking problems associated with the muscular apparatus;
can be caused by damage to CN 12, paralysis of facial muscles, damage to muscles of mastication
This muscle comes down and makes a sling-like structure with a midline seam that connects them to the mandible and the hyoid bone. It makes up the floor of the mouth
mylohyoid muscle
What innervates the mylohyloid muscle?
mylohyoid nerve off of the inferior alveolar nerve off of posterior division of V3
What are the suprahyoid muscles?
mylohyoid
stylohyoid
digastric
geniohyoid
What are the 4 infrahyoid muscles?
sternohyoid
thryrohyoid
sternothyroid
omohyoid
What innervates the anterior belly of the digastric muscle? What innervates the posterior belly?
CN 5; CN 7
What muscles goes from the hyoid to the styloid process and runs in between the sling of the digastric bellies?
stylohyoid muscle
This muscle goes from omohyoid tubercle to hyoid bone, has an inferior and superior belly, and is held down by a fascial sling
omohyoid
What innervates suprahyoid muscles?
cranial nerves *except for geniohyoid from C1
What innervates the infrahyoid muscles?
cervical plexus *these are known as the strap muscles
3 muscles that arise from the styloid process
stylohyoid
styloglossus
stylopharyngeus
Which muscle comes from the posterior aspect of the styloid process, splits around the digastric, is from branchial arch 2, and is innervated by CN 7?
stylohyoid
Which muscle comes from the anterior portion of the styloid process, is derived from postotic somites and is innervated by CN 12?
styloglossus
Which muscle comes from the medial surface of the styloid process, is derived from branchial arch 3 and is innervated by CN 9?
stylopharyngeus
What muscle runs from the genial tubercle of the mandible inferior and posterior to the hyoid bone (branch of C1 traveling w hypoglossal)
geniohyoid
The carotid triangle has the (blank) running on top of the carotid sheath, which contains what three things?
ansa cervicalis;
common carotid artery
internal jugular vein
vagus nerve
Which carotid artery has no branches until it enters the cranial cavity?
internal carotid
Which carotid artery only has branches to the face and neck?
external carotid
T/F: Internal and external carotid arteries form anastomotic connections.
true
The internal carotid artery passes through the (blank) and has a relation to the (blank) sinus
carotid canal; cavernous sinus
This vertebral artery comes off of the (blank) artery, passes through (blank) transverse foramina, through the foramen (blank), and becomes the (blank) artery
subclavian; C6-C1; magnum; basilar
The internal carotid artery passes OVER this opening, but does not pass through it
foramen lacerum
The carotid canal has both a (blank) and a (blank) opening
internal; external
A swelling at the origin of the carotid artery
Innervated by CN 9
Is a baroreceptor
carotid sinus
Is a mass of tissue at the bifurcation of the common carotid artery
Innervated by CN 9
Is a chemoreceptor
carotid body
Where do afferents from CN 9 from the carotid sinus and body go?
to the nucleus solitarius
Baroreceptors send info in on which cranial nerve and out on which?
in on 9; out on 10
What components does CN 9 have?
general sensory
viscerosensory
visceromotor
branchiomotor
What are the branches of the external carotid artery?
SALFOPMS superior thyroid ascending pharyngeal lingual facial occipital posterior auricular maxillary superficial temporal
Which branch off the external carotid DIVES into the oral cavity???
lingual
Which branch off the external carotid catches CN 12?
occipital
Again, what’s in the carotid sheath?
common carotid artery
internal jugular vein
vagus nerve
What is a very important branch off the vagus nerve? What does it supply? Why is it important to take note of?
recurrent laryngeal nerve;
motor to all muscles of the larynx (except the cricothyroid -_-);
can be damaged during thyroid surgery
This is a branch off of the vagus.
It’s internal branch is sensory above the vocal cords.
External branch is motor to cricothyroid.
superior laryngeal nerve
This is a branch off of the vagus.
It is sensory below the vocal cords.
It is motor to all other muscles of the larynx besides the cricothyroid.
It recurs around the subclavian artery or the aortic arch.
recurrent laryngeal nerve
What are the components of CN 10?
general sensory
viscerosensory *carotid body and sinus
visceromotor *to all structures as far as the left colic flexure
branchiomotor *to muscles from 4th and 6th arch (cricothyroid, etc)
What reflexes is the vagus nerve involved in?
carotid body and sinus
cough
Where do preganglionic parasympathetics on CN 10 from the heart, thorax, and abdomen synapse?
in the dorsal motor nucleus of X
Where does sensory from ear and lower pharyn traveling on CN 10 synapse?
in the superior ganglion of X
Where does taste from the epiglottis traveling on CN 10 synapse?
inferior ganglion of X
Where does info from the thorax and abdomen traveling on CN 10 synpase?
inferior ganglion of X
From what nucleus are there projections to striated muscle, the soft palate, the pharynx, larynx and upper esophagus?
nucleus solitarius
This nerve can be damaged in thyroid surgery which is dangerous due to the number of muscles it innervates
recurrent laryngeal nerve
Where do the superior thyroid arteries originate from? Where do the inferior thyroid arteries originate from?
external carotid arteries;
subclavian arteries via the thyrocervical trunk
T/F: There are anastomoses between the superior and inferior thyroid arteries
true
Superior thyroid veins drain into (blank) veins
Middle thyroid veins drain into (blank) veins
Inferior thyroid veins drain into (blank) veins
internal jugular;
internal jugular;
brachiocephalic
This is a remnant on the thyroid gland from the descent of the tongue
pyramidal lobe
3 important landmarks of the thyroid gland
thyrohyoid membrane
cricothyroid cartilage
crcothyroid ligament
What is the thyorid gland surrounding?
the trachea
What are these? lingual intralingual thyroglossal tract prelaryngeal intratracheal substernal
these are all places where remnants of thyroid tissue can be found due to its origin at the base of the tongue
Preganglionic fibers of the sympathetic trunk ascend from the (blank) and synapse in one of 3 ganglia. What are they? What happens to the postganglionic fibers?
thorax; superior, middle, inferior cervical ganglion; postganglionic fibers join cervical spinal nerves to their targets or travel on blood vessels to the head
What does Horner’s syndrome cause?
ptosis
flushed face
dry face
constricted pupils **due to overriding parasympathetic tone
What are the branches of the subclavian artery?
vertebral
internal thoracic *diving inferior
thyrocervical trunk (inferior thyroid, transverse cervical, suprascapular)
costocervical trunk
- Can occur by cutting sympathetic chain above T1
- By damaging T1-T3 preganglionic neurons in the lateral horn
- By damaging outflow to head that is traveling on internal carotid
- By damaging the input to preganglionic sympathetics
Horner’s syndrome
**can occur in multiple ways, not just damage at sympathetic trunk
These nodes are associated with the internal jugular vein
deep cervical nodes
What are the nodes in pericervical collar?
occipital retro-auricular parotid buccla submandibular submental
What is unique about the submental lymph nodes from the median part of the tongue?
they drain lymph to both the right and left side, so lymph can cross over, which provides an easy route for spread of cancer/infection from one side to the other
Nodes of the neck ultimately drain to the (blank) nodes and then to the lymphatic or thoracic ducts
deep cervical
Lie along the course of the internal jugular vein
deep cervical lymph nodes
Which of the deep cervical nodes is most clinically important? Why?
supraclavicular nodes;
can indicate pathology in the head, neck or thoracic cage
Where does the thoracic duct enter?
enters the junction of the subclavian and internal jugular veins
*courses up posterior to the junction
