Surface anatomy of the neck Flashcards
Name the columns of the neck with their fascia
1 - Neuro-muscular skeletal column with prevertebral fascia.
2- Visceral column with pretracheal and buccopharyngeal fascia.
3 - Carotid neurovascular bundle with carotid sheath
what is the most superficial of the deep fascia?
investing fascia
what does the pretrachael fascia become?
buccopharyngeal fascia
Name the fascial layers
- Investing/superficial fascia.
- Pretracheal fascia.
- Carotid sheath.
- Prevertebral fascia
What potential space allows for the movement of pharynx, larynx, trachea and oesophagus? Where does it extend too?
Retropharyngeal space, this permits movement for swallowing. It extends from the base of the skull to the diaphragm via the posterior mediastinum.
it allows the columns to move against each other.
What fascia further divides the retropharyngeal space and what is this space called and its clinical significance?
The alar fascia, forming the Danger space which is a major pathway for spread of infection (extends between the carotid sweats) creating a danger space and a true retropharyngeal space.
What is the clinical significance of dental abscesses?
It can spread mediastinum
where are potential spaces for infection in the neck?
- true retropharyngeal space (permits movement during swelling of the pharynx, oesophagus, trachea and larynx)
- danger space (major pathway for the spread of infection tot eh mediastinum)
Name the boarders of the anterior triangle?
Superiorly - inferior boarder of mandible,
Laterally - anterior boarder of sternocleidomastoid,
Medially - Sagittal line down the midline of the neck
Name the boarders of the Posterior triangle
Anterior - posterior boarder of sternocleidomastoid,
Posterior - anterior boarder of trapezius muscle,
Inferior - Middle 1/3 of clavicle
What is the clinical relevance of the triangles of the neck?
It can help give clues for the reasons of neck lumps, along with other signs like; Tenderness, heat, size, pulsatile, solitary/multiple and is they move when swallowing or sticking out tounge.
Where is the mastoid landmark?
It is the boney prominence directly behind the ear.
what are the bony landmarks of the skull?
- transverse process of C1
- angle of mandible
- mastoid process
- styloid process
Where can you palpate the position of the transverse process of Atlas?
It is midway between the mastoid and angel of the mandible
Where is the Hyoid bone?
Superior to thyroid cartilage, it is suspended in the muscles of the neck.
What does the thyroid cartilage articulate with?
The cricoid cartilage, this allows for rotation and gliding of thyroid cartilage and change in length of vocal cords.
Anteriorly, what is the brachiocephalic trunk covered by?
Sternohyoid and sternothryroid muscles.
where will the brachiocephalic trunk pass superolaterallly too?
- to the right and divides into the right common carotid and right subclavian
- posterior to the strenoclavicular joint
Name the three parts of the subclavian artery and its branches
1st part has 3 branches (vertebral artery, thyrocervical trunk and internal thoracic artery).
2nd part has 1 branch (costocervical trunk) and the 3rd part has 1 branch (dorsal scapular artery)
Where does the common carotid artery bifurcate and what does it turn into?
Bifurcation at the level of the superior thyroid cartilage and turns into the internal and external carotid artery. C3
Where is the location of the carotid body and sinus and what is its nerve innervation
Found at bifurcation of common carotid artery. Innervated by afferent glossopharyngeal and its branch carotid sinus nerve
- efferent vagus nerve
WHAT is the common carotid artery covered by?
- proximmaly= muscles
- distally exposed allowing palpitation for pulse
- normally internal carotid artery
What are the functions of the carotid sinus and carotid body?
Sinus - Has baroreceptors which react to changes in arterial blood pressure. Carotid body has chemoreceptors that monitor the partial pressure of CO2
What does the internal carotid artery supply?
Intercrainal structures
1- where does the carotid artery bifurcate?
2- into what
3- why is it never palpable bilaterally?
1 - level of the superior border of the thyroid gland into:
2 - external carotid artery
- internal carotid artery
3- it is never palpable laterally because there are baroreceptors which detect changes in blood pressure artificially increasing the blood pressure = bad because the body will decrease heart rate and therefore blood pressure.
What does the carotid sheath surround?
Internal jugular vein
internal carotid artery
vagus nerve
What are the branches of the external carotid artery
(Some Anatomist Like Freaking Out Poor Medical Students)
- Superior Thyroid a.
- Ascending pharyngeal a.
- Lingual a.
- Facial a.
- Occipital a.
- Posterior auricular a.
- Maxillary a.
- Superficial temporal a.
What are the facial veins?
Superficial and deep veins
What are the cranial veins?
Cerebral veins
Dural venous sinuses
Diplopic veins
Emissary veins
What are the cervical veins?
External jugular veins
anterior jugular veins
vertebral veins
What are the cranial veins drained by?
Dural venous sinus
What is the most common vein use for Central Venous Catheterisation? and what are the complications of CVC?
Most commonly used is IJV. Some of the complications are pneumothorax, puncture the subclavian artery and nerve injury
What is the EJV route?
Crosses SCM, deep to platysma and enters the anterio-inferior part of posterior triangle. Finally it terminates as subclavian vein
Where does the anterior jugular vein drain into?
What will it join with?
It drains into external jugular or subclavian veins. Both anterior jugular veins join at the jugular venous arch.
What is Erb’s point, the nerves here and the clinical relevance
This is the point at which the
-Lesser occipital nerve
- the Great auricular nerve
- transverse cervical nerve
- supraclavicular nerve become superficial.
Local anaesthetics can be injected here to numb a large area.
what does the internal jugular vein drain?
drains the intracranial structure, superficial parts of the face and neck.
what is within the carotid sheath
vagus and internal carotid artery
where is the jugular venous pulse wave visible?
along the trajectory of the internal jugular vein.
where does the internal jugular vein lie?
initially posterior to the internal carotid artery, moves laterally then anterior to the common carotid.
for central venous asess, where do you want to stab?
internal jugular vein measuring the venous pressure
what is a normal central venous pressure?
<8cm H20
WHAT ARE COMPLICATIONS OF THE CENTRAL Venus access?
- pneumothorax
- puncture of subclavian artery
- nerve injury
describe the position of the external jugular vein and what is it formed by?
- descends the angle of the mandible to the middle of the clavicle
- formed by posterior division of the retromandibular vein and posterior auricular vein
describe the position and drainage of the anterior jugular vein?
- inferior to the hyoid bone
- drains into external jugular or subclavian veins.
- anterior jugular veins of both sides join to become the jugular venous arch.
describe the nerves in the neck?
- there are cuteness branches of the cervical plexus
- erbs points (4 cutaneous branches)
- accessory nerve
describe the accessory nerve in the neck?
- motor control of trapezius and SCM
- passes across the posterior triangle
what is the lymphatic system like in face and scalp?
there’s no lymph nodes in the face and scalp.
- the lymph drains into the superficial cerviacal (alongside external jugular) and deep cervical (alongside the internal jugular)
what is the dural venous sinus made from?
- superior sagital sinus
- inferior sagital sinus
- sinus rectus
- sigmoid sinus
THEY WILL ALL BECOME THE INTERNAL JUGULAR VEIN.
at what level does the common carotid bifurcate?
- C3
- level of the superior border of the thyroid cartilage
