Superficial Structures of the Neck 4

Question 1

What does the retromandibular vein divide into?

Answer 1

It divides into the anterior and posterior divisions. .

Question 2

How does the posterior branch of the retromandibular vein form the external jugular vein form?

Answer 2

It joins the posterior auricular vein to form the external jugular vein.

Question 3

What does the external jugular vein empty into?

Answer 3

It empties into the subclavian vein.

Question 4

Describe the path of the external jugular vein until it empties into the subclavian vein.

Answer 4

• proceeds down through the subcutaneous tissue of the neck on the surface of the sternoclediomastoid muscular
• pierces the investing layer of deep cervical fascia towards the base of the posterior triangle
• travels deeply and empties into the subclavian vein

Question 5

What does the anterior branch of the retromandibular vein join?

Answer 5

It joins the facial vein.

Question 6

How does the facial vein enter the internal jugular vein?

Answer 6

It pierces the cervical fascia.

Question 7

Which veins drains the superficial tissues of the floor of the mouth and the front of the neck?

Answer 7

We have 2 veins called the anterior jugular veins.

Question 8

Describe the path of the anterior jugular veins.

Answer 8

• drain down and pierce the fascia of the anterior triangle just above the manubrium
• enter the suprasternal fascial space
  
  • the 2 veins are joined together in this space

Question 9

How are the 2 internal jugular veins joined?

Answer 9

They are joined across the midline by the jugular venous arch.

Question 10

When we expose the thyroid gland or upper trachea during surgery, what do we encounter?

Answer 10

We encounter the suprasternal space and the jugular arch.

Question 11

What is the size of the jugular arch?

Answer 11

This is large.

Question 12

After the 2 anterior jugular veins are joined across the midline by the jugular venous arch, what is their path?

Answer 12

They continue laterally deep to the sternocleidomastoid and join the external jugular veins which have already pierces the deep fascia.

Question 13

Where do the cutaneous branches of the cervical ventral rami appear?

Answer 13

They appear subcutaneuosly along the posterior border of the sternocleidomastoid muscle.

Question 14

How do the cutaneous branches of the cervical ventral rami enter the tissues of the neck?

Answer 14

They radiate like the spokes of a wheel into the neck.

Question 15

Describe the path of the lesser occipital nerve.

Answer 15

Passes up to the skin over the back of the ear and the scalp behind the ear.

Question 16

Describe the great auricular nerve.

Answer 16

It spreads out into skin over the front and back of the ear.

Question 17

What does the transverse cervical nerve supply?

Answer 17

It supplies the skin on the front and side of the neck.

Question 18

How do the supraclavicular nodes supply the front of the chest?

Answer 18

Pass down over the clavicle as medial, intermediate and lateral nerves to supply the front of the chest.

They can be palpated in the living as they pass over the bony clavicle.

Question 19

What are midline swellings in the neck associated wiht?

Answer 19

They are associated with the thyroid gland and often reflect its development.

Question 20

What is an enlarged thyroid called?

Answer 20

Goitre.

Question 21

How is the goitre able to expand?

Answer 21

It can expand down into the thoracic inlet but it cant rise any higher in the neck than the oblique line of the thyroid cartilage because the attachement of the thyrohyoid muscle prevents the gland from expanding upwards.

Question 22

Why does the thyroid move up and down during swallowing?

Answer 22

Because the thyroid is tied to the trachea by the pretracheal fascia.

Question 23

Where do thyroglossal cysts occur?

Answer 23

They occur anywhere along the developmental path of migration of the thyroid gland.

These are another cause of midline swellings in the neck.

Question 24

Why are lymph nodes often enlarged in the neck?

Answer 24

• tonsilitis
• tuberculosis
• carcinoma

Question 25

Where do chains of lymph nodes lie?

Answer 25

They lie along the internal jugular vein and can be felt at the anterior border of the sternocleidomastoid muscle.

Question 26

Where do we have a ring of smaller lymph nodes around the neck like a collar?

Answer 26

This is like a collar from the occipital region to the submandibular region and to the submental region.

Question 27

How do brachial cysts occur?

Answer 27

• They occur development when the rapidly growing second arch overlaps the lower pharyngeal arches but then the ectoderm of the second arch fails to fuse higher up and fuses with the lowermost arches.
• Leaves a cervical sinus with ectodermal walls which then slowly fill with fluid and present as discrete swellings in the neck during childhood
• These cysts protrude from the anterior border of the sternocleidomastoid muscle just below the angle of the mandible.

Question 28

What is a tracheostomy?

Answer 28

This is an elective procedure that is performed to reduce the dead space in the airway of a weak patient or to facilitate the prolonged artificial ventilation of patients.

Question 29

Describe the process of the tracheostomy.

Answer 29

1. transverse incision is made in the neck through skin and platysma midway between the cricoid cartilage and the suprasternal notch (same direction as the skin creases)
2. strap muscles are retrated to each side
3. isthmus of the thyroid gland is identified
   
   1. extremely vascular therefore it is clamped, ligatured and divided
4. trachea is opened below the 1st tracheal ring
5. a flap is raised and hinged over inferiorly
6. free edge is sewn to the skin to ensure that there is clear access to the airway.