Superficial Structures of the Neck 2

Question 1

Which blood vessels do fibres from the superior ganglion climb?

Answer 1

They climb the internal and external carotids.

Question 2

What blood vessels do fibres from the middle ganglion climb?

Answer 2

They climb along the inferior thyroid arteries.

Question 3

What blood vessels do fibres from the lower ganglion climb?

Answer 3

They climb along the vertebral artery.

Question 4

What are cardiac branches?

Answer 4

These are postganglionic fibres that descend from the ganglion onto the prevertebral fascia and back into the thorax.

Question 5

Where are the cardiac branches destined to go?

Answer 5

They are destined to go to the cardiac plexus and then into the heart.

Question 6

How are some postganglionic fibres distributed to the skin of the neck and upper limb?

Answer 6

They pass from the ganglia back into the cervical ventral rami and then they are distributed to the skin of the neck and upper limb.

Question 7

What is the ansa subclavius?

Answer 7

This is a slender branch from the middle ganglion that loops around the subclavian artery and then regions the cervicothoracic ganglion.

Question 8

What does the ansa cervicalis give some sympathetic branches to?

Answer 8

It gives some sympathetic branches to the subclavian artery which is destined for the upper limb.

Question 9

What structure is on the left side of the neck and completes our picture of the root of the neck?

Answer 9

The thoracic duct.

Question 10

Describe the path of the thoracic duct.

Answer 10

• ascends from the thorax behind the oesophagus on top of the prevertebral fascia
• arches forwards in the root of the neck
• enters the venous system at the junction of the left jugular and left subclavian vein

Question 11

Where is the platysma muscle?

Answer 11

This is a thin sheet of muscle that is found in the subcutaneous fat of the neck.

Question 12

What is the function of the platysma muscle?

Answer 12

It is the muscle of facial expression.

Question 13

What is the platysma muscle supplied by?

Answer 13

It is supplied by the facial nerve (7)

Question 14

Where do fibres of the platysma muscle arise from?

Answer 14

They arise from the deep fascia and the skin on on the front of the chest and shoulder.

Question 15

Describe the path of the platysma muscle to its insertion.

Answer 15

It sweeps over the front and sides of the neck to their insertion.

Question 16

Where do the fibres of the platysma muscle insert?

Answer 16

• deep fascia of the neck
• lower border of mandible
• deep fascia of lower face

Question 17

What are the 2 muscles that are deep to the subcutaneous fat and the platysma muscle?

Answer 17

The sternocleidomastoid and the trapezius muscle.

Question 18

What are the sternoclediomastoid and trapezius muscle enclosed within?

Answer 18

They are enclosed in an investing fascia.

Question 19

Where does the sternocleidomastoid muscle arise from?

Answer 19

• Front of the manubrium by a round tendon.
• Medial third of clavicle as a flat muscular sheet.

Question 20

What happens to the 2 sets of fibres that the sternocleidomastoid arises from?

Answer 20

They FUSE on their way upwards to the mastoid process of the skull and the superior nuchal line on the back of the occiptal bone.

Question 21

What is the deep surface of the sternocleidomastoid muscle pierced by?

Answer 21

It is pierced by the spinal part of the accessory nerve (11) which supplies motor neurones to the muscle.

Question 22

What action occurs when one sternocleidomastoid muscle acts alone?

Answer 22

It flexes the cervical column laterally and draws the head down to that side. It also rotates the head on the cervical column so that the face is turned to the opposite side.

Question 23

What happens when both of the sternocleidomastoid muscles work together?

Answer 23

They flex the cervical column and head forwards.

Question 24

Can we see the trapezius muscle from the front?

Answer 24

We can only see the anterior edge of the trapezius muscle.

Question 25

How is the trapezius muscle best seen?

Answer 25

It is best seen from the side and back.

Question 26

Where does the trapezius muscle arise from?

Answer 26

It arises from the middle of the superior nuchal line and from the spines of the cervical and thoracic vertebrae

Question 27

Where does the trapezius muscle insert?

Answer 27

The fibres of the trapezius muscle sweep towards the shoulder where they are inserted into the lateral third of the clavicle, acromion process of scapula and the spine of the scapula.

Question 28

What is the nerve supply to the trapezius muscle?

Answer 28

The trapezius muscle is supplied by the accessory nerve (11th)

Question 29

What does the trapezius muscle act on?

Answer 29

It acts on the shoulder.

Question 30

How can we test the trapezius muscle?

Answer 30

We can test it by asking the patient to shrug their shoulders.

Question 31

What are the anterior and posterior triangles of the neck?

Answer 31

These are 2 triangular windows that we can see in the investing layer of fascia.

Question 32

Where is the base of the anterior triangle of the neck?

Answer 32

The base is at the top and it forms the lower border of the mandible.

Question 33

Where is the base of the posterior triangle of the neck?

Answer 33

The base is below in the form of the middle third of the clavicle.

Question 34

What are the anterior and posterior triangles covered with?

Answer 34

They are covered with deep investing cervical fascia.

Question 35

What is the most important structure in the posterior triangle of the neck?

Answer 35

The accessory nerve (11)

Question 36

How does the accessory nerve enter the sternocleidomastoid muscle?

Answer 36

It enters the deep aspect of the sternocleidomastoid muscle close to the mastoid process

Question 37

When does the accessory muscle leave the sternocleidomastoid muscle?

Answer 37

It leaves the substance of the sternocleidomastoid muscle about a third of the way down its posterior border.

Question 38

Describe the path of the accessory nerve to its entry into the trapezius the muscle.

Answer 38

Travels obliquely downwwards and backwards across the posterior triangle to enter the trapezius muscle.

As the accessory nerve crosses the posterior triangle the accessory nerve lies deep within the deep investing fascia of the neck.

Question 39

Where does the accessory nerve enter the trapezius muscle?

Answer 39

It enters the trapezius muscle about a third of the way up its anterior border.

Question 40

Describe the deep fascia around the neck?

Answer 40

It is complete around the neck and invests the neck from the mandible to the clavicle.

Question 41

What muscles does the deep fascia of the neck enclose?

Answer 41

It encloses the sternocleidomastoid, trapezius and extends around the back of the neck to cover the extensor muscles in that region as well.

Question 42

What happens to the deep fascia of the neck in the midline below?

Answer 42

It splits into 2 layers that are attached to the front and back of the manubrium.

Question 43

What is the suprasternal space?

Answer 43

This is between the 2 layers of the deep fascia that splits and attaches to the front and back of the manubrium.

Question 44

What is present in the suprasternal space?

Answer 44

There is fatty connective tissue and a vein that passes through it from side to side.

Question 45

What can we see when the deep investing fascia and the sternoclediomastoid muscles are removed?

Answer 45

Several small strap like muscles are present underneath.

Question 46

Where do the strap muscles lie?

Answer 46

• 3 lie to the side of the midline in the front of the neck
• 2 run across the sides of the neck
• They lie on either side of the midline below the hyoid and in front of the laryngeal cartilages and the thyroid gland.

Question 47

Where does the sternohyoid muscle run from?

Answer 47

It runs from the back of the manubrium to the hyoid bone.

Question 48

What can we see if the sternocleidomastoid and sternohyoid muscles are removed?

Answer 48

We can see a deeper set of thyroid muscles

• sternothyroid
• thyrohyoid

Question 49

Where does the sternothyroid pass from, to?

Answer 49

It passes from the back of the manubrium to the oblique line on the thyroid cartilage.

Question 50

Where does the thyrohyoid muscle pass from, to?

Answer 50

They pass from the oblique line on the thyroid cartilage to the lower border of the hyoid.