Superficial Anterior Neck Flashcards
1
Q
- What layer of cervical fascia is a thin layer of subQ tissue?
- What does this fascia lie between?
- What does this fascia contain?
A
- superficial cervical fascia
- between the dermis of the skin and the deep cervical fascia
- platysma, fat
2
Q
- What is the innervation of the platysma muscle?
- What does this muscle do?
A
- cervical br. of facial n. (CN VII)
- draws corners of mouth inferiorly; draws skin of neck superiorly when teeth are clenched, indicating tension
3
Q
What are the different layers of the deep cervical fascia?
A
- investing (superficial) layer
- pretracheal layer/fascia (middle layer)
- prevertebral layer/fascia (deep layer)
4
Q
- Which deep cervical fascia layer encircles the neck like a collar?
- What does this layer invest/wrap around?
- What does this layer form the roof of?
A
- investing (superficial) layer
- SCM, trapezius m
- anterior and posterior triangles of the neck
5
Q
- What is the sternocleidomastoid muscle innervated by?
- What does the sternocleidomastoid muscle do?
A
- spinal accessory n (CN XI)
- unilaterally: laterally flexes neck and rotates it
- bilaterally: extension of neck, flexes cervical vertebrae so chin approaches manubrium, extends superior cervical vertebrae while flexing inferior vertebrae
6
Q
What triangle is the spinal accessory nerve found in?
A
posterior triangle (and anterior)
7
Q
- Which deep cervical fascia layer is the muscular division that invests the strap muscles?
- What are the names of the strap muscles?
A
- pretracheal layer/fascia (middle layer)
muscles: - sternohyoid
- sternothyroid
- omohyoid
- thyrohyoid
8
Q
- What is the action of sternohyoid?
- What is the action of omohyoid?
- What is the action of sternothyroid?
- What is the action of thyrohyoid?
A
- depresses hyoid
- depresses and retracts hyoid
- depresses thyroid cartilage and larynx
- depresses hyoid and elevates the thyroid cartilage and larynx
9
Q
- What infrahyoid muscles does the ansa cervicalis (C1-C3) innervate?
- What infrahyoid muscles does C1 via the hypoglossal n (CN XII) innervate?
A
- sternohyoid, omohyoid, sternothyroid
- thyrohyoid
10
Q
Label
A
11
Q
What are the distal attachments of the sternocleidomastoid muscle?
A
- sternal head: anterior manubrium
- clavicular head: medial third of clavicle
12
Q
- What are the levels of the cervical plexus?
- What nerves come off the cervical plexus?
A
- anterior rami C1-C5
nerves: - lesser occipital n
- great auricular n
- transverse cervical n
- supraclavicular n
- ansa cervicalis
- phrenic n
13
Q
What do these nerves innervate:
- lesser occipital n
- great auricular n
- transverse cervical n
- supraclavicular n
- ansa cervicalis
- phrenic n
A
- lesser occipital n: skin of neck and scalp posterosuperior to clavicle
- great auricular n: skin over parotid gland, posterior aspect of auricle, skin extending from angle of mandible to mastoid process
- transverse cervical n: skin covering anterior triangle of the neck
- supraclavicular n: skin over neck and shoulder
- ansa cervicalis: infrahyoid muscles
- phrenic n: diaphragm, mediastinal pleura, pericardium
14
Q
- Which nerves of the cervical plexus provide sensory innervation?
- What’s a mnemonic to remember this?
A
- lesser occipital n, great auricular n, transverse cervical n, supraclavicular n
- “Lets Go To Sleep”
15
Q
What vertebral levels does the ansa cervicalis come from?
A
C1-C3
16
Q
What are the two divisions of the pretracheal layer of the deep cervical fascia?
A
- muscular division
- visceral division
17
Q
- What does the visceral division of the pretracheal fascia of the deep cervical fascia cover?
- What does it invest?
- What other fascia is also included in this layer?
A
- larynx, trachea, esophagus
- invests thyroid gland (false capsule)
- buccopharyngeal fascia
18
Q
- What fascia fuses with the adventitia of the pharynx?
- Where is this found?
A
- buccopharyngeal fascia
- pretracheal layer
19
Q
- The pretracheal layer includes a thin muscular part, which encloses the (…), and a visceral part, which encloses the (…).
- The pretracheal layer is continuous posterosuperiorly with the (…) and blends laterally with the (…).
A
- infrahyoid muscles
- thyroid gland, trachea, and esophagus
- buccopharyngeal fascia
- carotid sheaths
20
Q
- Describe the false capsule of the thyroid.
- What does this form?
- Describe the true capsule of the thyroid.
A
- pretracheal fascia attached to cricoid and thyroid cartilages
- forms suspensory ligament of thyroid (ligament of Berry)
- condensation of CT of the thyroid gland
21
Q
The (…) is a tubular fascial investment that extends from the cranial base to the root of the neck
A
carotid sheath
22
Q
What is found in the carotid sheath?
A
- common carotid arteries
- internal carotid arteries
- internal jugular v
- vagus n (CN X)
- ansa cervicalis
23
Q
The prevertebral layer of deep cervical fascia forms a tubular sheath for the vertebral column and the muscles associated with it, such as the (…) anteriorly, the (…) laterally, and the (…) posteriorly
A
- longus colli and longus capitis
- scalenes
- deep cervical muscles
24
Q
What are the 2 divisions of the prevertebral layer of the deep cervical fascia?
A
- prevertebral division
- alar division
25
- What division of the prevertebral layer of the deep cervical fascia merges with the anterior longitudinal ligament?
- This covers the anterior surface of what muscles?
- This attaches to what parts of the vertebrae?
- prevertebral division
- longus capitis and colli mm
- spinous processes of vertebrae
26
- What division of the prevertebral layer of the deep cervical fascia attaches to the transverse process of cervical vertebrae?
- Where does this division end?
- What does it fuse with when it ends?
- alar division
- ends at T2 (C6-T4)
- fuses with visceral layer of pretracheal fascia
27
- What is the innervation of the longus colli muscle?
- What does the longus colli muscle do?
- What is the most common way to injury the longus colli muscle?
- bilateral: neck flexion
- unilateral: neck contralateral rotation, neck lateral flexion
- anterior rami of spinal nerves C2-C6
- whiplash
28
- What is the carotid sheath found deep to?
- Fibers from (...) blend with the carotid sheath
- SCM
- all 3 deep cervical fascial layers
29
- What are the deep spaces of the neck?
- Which one is a real space?
- Where do these spaces begin?
- retropharyngeal space, danger space, prevertebral space
- retropharyngeal space
- base of the skull
30
- What does the retropharyngeal space lie between?
- What does it extend from?
- What does this space consist of?
- What do the lymph nodes drain?
- What is the function of this space?
- posterior pretracheal layer and the alar division
- skull to tracheal bifurcation around T2
- fatty areolar tissue, lymph nodes
- pharynx, nose, and middle ear
- permits movement of the aerodigestive tract during swallowing
31
- What does the danger space lie between?
- What does it extend from?
- Infections here occur rapidly because it is filled with (...) and leads to (...)
- alar division and prevertebral divisions of deep layer of deep cervical fascia
- skull base to diaphragm (involves mediastinum/heart)
- minimal loose CT; mediastinal involvement
32
The danger space is (...) from the true retropharyngeal space on imaging
indistinguishable
33
- What does the prevertebral space like anterior and posterior to?
- What is it bounded laterally to?
- What does it extend from?
- What muscles are posterior to this space?
- lies anterior to vertebral bodies, posterior to prevertebral division of deep layer of deep cervical fascia
- transverse processes
- base of skull to coccyx
- longus collis and capitis
34
What complication can result from prevertebral soft tissue swelling?
- airway obstruction
- hematoma
35
- (...) is the largest and most clinically important interfascial space in the neck because it is the major pathway for the spread of infection
- The investing layer of deep cervical fascia helps prevent the spread of (...)
- If an infection occurs between the (...) and the (...), the infection usually does not spread beyond the superior edge of the manubrium
- If the infection occurs between the (...) and the (...), it can spread into the thoracic cavity anterior to the pericardium
- retropharyngeal space
- abscesses
- investing layer of deep cervical fascia
- pretracheal fascia muscular part surrounding the infrahyoid muscles
- investing fascia
- visceral part of the pretracheal fascia
36
What are the bones of the neck?
- cervical vertebrae (C1-C7)
- hyoid bone
- manubrium of sternum
- clavicles
37
What are the associated vertebral levels of these structures:
- hard palate
- lower border mandible
- hyoid bone
- thyroid cartilage
- cricoid cartilage
- carotid tubercle
- hard palate: anterior arch C1 (axis)
- lower border mandible: C2, 3
- hyoid bone: C3
- thyroid cartilage: C4-5
- cricoid cartilage: C6
- carotid tubercle: C6 anterior tubercle of transverse process
38
What nerve do you risk cutting when dividing the platysma?
facial nerve - cervical branch
39
In superficial dissection of the neck, what structures do you risk severing?
superficial veins:
- external jugular
- anterior jugular
- jugular venous arch
40
- What is the innervation of the posterior cricoarytenoid?
- Loss of unilateral abduction of this muscle causes the vocal cord to assume a (...) position
- The voice will be (...) and (...)
- Airway is (...) due to intact contralateral muscle
- recurrent laryngeal nerve
- paramedian position
- breathy; weak
- adequate
41
What is at risk when splitting the longus colli muscles longitudinally at the midline and then retracting each portion laterally?
sympathetic chain
42
- Describe what happens in Horner's syndrome?
- What is this caused by?
- meiosis (constricted pupil), lid ptosis, anhidrosis (ipsilateral)
- damage to sympathetic trunk/stellate ganglion
43
After getting through to the prevertebral space during surgery, what structure is vulnerable?
C6 region of cervical esophagus (anterior to C6 vertebral body)
44
The vertebral artery usually enters (...) transverse foramina
C6
45
Which part of the vertebral artery is most commonly affected during traumatic injuries?
2nd part
46
In surgery, what part of the vertebral artery is at risk when doing the posterior approach and why?
- second part
- pedicle screw fixation
47
A high vertebral artery entry point into the transverse foramen above C6 could (...) the risk of iatrogenic vascular injury in anterior approaches to the cervical spine
increase
48
What are the vulnerable structures if performing a high cervical approach in surgery?
- SLN (superior laryngeal nerve)
- hypoglossal n
49
What does the external branch of the superior laryngeal nerve innervate?
cricothyroid m (important for singing)
50
- Which nerve traverses the surgical field and resembles a blood vessel?
- What can happen if the superior laryngeal nerve is damaged?
- hypoglossal nerve
- laryngeal sensory impairment (aspiration, dysphagia); patient may have problems with high notes in singing due to damaged cricothyroid m
51
- What are the suprahyoid muscles?
- What are their actions?
- digastric: elevates hyoid and depresses mandible
- stylohyoid: elevates hyoid
- mylohyoid: supports floor of oral cavity
52
What is the innervation of the suprahyoid muscles?
- digastric: n to mylohyoid (CN V3)-anterior belly; facial n (CN VII)-posterior belly
- stylohyoid: facial n (CN VII)
- mylohyoid: n to mylohyoid (CN V3)
53
Label
54
What are the boundaries of the anterior triangle of the neck (anterior, posterior, superior, inferior, roof, floor)?
- anterior: midline of neck
- posterior: anterior border of SCM
- superior: inferior border of mandible
- inferior: superior sternum
- roof: subcutaneous tissue, platysma
- floor: pharynx, larynx, thyroid gland
55
What are the boundaries of the posterior triangle of the neck (anterior, posterior, superior, inferior, roof, floor)?
- anterior: posterior border of SCM
- posterior: anterior border of trapezius
- superior: merging of SCM and trapezius
- inferior: clavicle (b/w SCM and trapezius)
- roof: investing layer of deep cervical fascia, platysma
- floor: muscles covered by prevertebral layer of deep cervical fascia
56
What are the contents of the posterior triangle of the neck?
- external jugular v
- posterior branches of cervical plexus
- spinal accessory n
- lymph nodes
- third part of subclavian artery and vein
- cervicodorsal trunk
- suprascapular a
57
What are the contents of the anterior triangle of the neck?
- submandibular gland, lymph nodes
- hypoglossal n
- mylohyoid n
- parts of facial a and v (and n)
58
What are the boundaries of the carotid triangle (part of anterior triangle)?
- anterior: superior belly of omohyoid m
- posterior: anterior border of SCM
- superior: posterior belly of digastric m
- floor: hyoglossus, thyrohyoid, inferior and middle pharyngeal constrictor mm
59
What are the contents of the carotid triangle?
- common carotid a and branches (external and internal carotid aa)
- internal jugular v
- vagus n
- hypoglossal n
- spinal accessory
- superior root of ansa cervicalis
- thyroid, larynx, pharynx
