Surface Anatomy of the Neck

Question 1

What are the four fascial layers in the neck

Answer 1

1. Investing (superficial) fascia
2. pretracheal fascia
3. carotid sheath
4. prevertebral fasciae

Question 2

“True” Retropharyngeal Space

Answer 2

permits movement during swallowing of pharynx, oesophagus, trachea and larynx

Question 3

Danger space

Answer 3

major pathway for the spread of infection to mediastinum

Question 4

 Retropharyngeal abscesses

Answer 4

– Nasopharynx, paranasal sinuses or middle ear infections

Question 5

what are the borders of the posterior triangle

Answer 5

anterior: posterior border of the SCM
posterior: anterior border of the trapezius muscle
inferior: middle 1/3 of the clavicle

Question 6

what are the borders of the anterior triangle

Answer 6

superiorly: inferior border of the handle
laterally: anterior border of SCM
Medially: sagittal line down the midline of the neck

Question 7

What do you need to consider when identifying neck lumps

Answer 7

 Location
– Anterior triangle 
– Posterior triangle 
– Midline
 Tenderness
 Heat/Inflammation
 Size/Depth
Pulsatile
 Solitary or multiple lumps 
Movement
-  Swallowing
-  Sticking out tongue

Question 8

THYROID CARTILAGE

Answer 8

• there are two lamina the lesser and greater horns
• there are laryngeal prominence (composed of the fusion of the inferior 2/3 of two lamina - ADAMS APPLE)
• thyroid cartilage articulates with the cricoid cartilage (rotation and gliding thyroid cartilage which changes the length and sound of the vocal cords)

Question 9

BRACHIOCEPHALIC TRUNK

Answer 9

anteriorly covered by the right sternothyoid and sternothyroid muscles
- passes superolaterally to the right and divides:
right common carotid and right subclavian arteries which run posterior to the sternoclavicular joint

Question 10

SUBCLAVIAN ARTERY

Answer 10

 Passes Rib 1 on way to upper limb

 3 parts, according to the subclavian artery

Question 11

1st part of the subclavian artery

Answer 11

– Vertebral artery
– Thyrocervical trunk
– Internal thoracic artery

Question 12

2nd part of the subclavian artery

Answer 12

– Costocervical trunk

Question 13

3rd part of the subclavian artery

Answer 13

– Dorsal scapular artery

Question 14

COMMON CAROTID ARTERY

Answer 14

 Bifurcates at the level of superior border of thyroid cartilage
– Internal carotid artery
– External carotid artery
 Superiorly covered by muscles
 Distally exposed allowing palpation of pulse
– Normally internal carotid artery

Question 15

CAROTID BIFURCATION

Answer 15

• Level of the superior border of the thyroid cartilage
• External carotid artery
• Internal carotid artery
  – Dilatation of proximal internal carotid artery

Question 16

CAROTID BODY & CAROTID SINUS - Nerve supply

Answer 16

• afferent glossopharyngeal (carotid sinus nerve)

- efferent vagus nerve

Question 17

Carotid Sinus receptors

Answer 17

Baroreceptor

– Reacts to change in arterial blood pressure

Question 18

Carotid Body receptors

Answer 18

Chemoreceptor

– Monitors the partial pressure of CO2

Question 19

INTERNAL CAROTID ARTERY

Answer 19

covered by the carotid sheath , this sheath carries the:

• internal jugular
• internal carotid
• vagus nerve

supplies the intracranial structures

Question 20

EXTERNAL CAROTID ARTERY

Answer 20

 Some
 Anatomists
 Like
 Freaking
 Out
 Poor
 Medical
 Students

 Superior thyroid artery
 Ascending pharyngeal artery 
 Lingual artery
 Facial artery
 Occipital artery
 Posterior auricular artery
 Maxillary artery
 Superficial temporal artery

Question 21

venous drainage of the cervical veins

Answer 21

– External jugular vein – Anterior jugular vein – Vertebralvein

Question 22

venous drainage fo the cranial veins

Answer 22

– Cerebralveins
– Dural venous sinuses – Diplopic veins
– Emissary veins

Question 23

CRANIAL VEINS

Answer 23

Drained by
– Dural venous sinus
• Superior sagittal sinus • Inferior sagittal sinus
• Sinus rectus
– Sigmoid sinus
• Becomes internal jugular vein

Question 24

INTERNAL JUGULAR VEIN

Answer 24

 Drains intracranial structures, superficial parts of face and neck
 Within the carotid sheath
– Vagus and internal carotid artery
 Initially lies posterior to the internal carotid artery, moves laterally then anterior of the common carotid
 Jugular Venous Pulse Wave is visible along the trajectory of the IJV

Question 25

Central Venous Access or Central Venous Catheterisation

Answer 25

 Most commonly inserted in the internal jugular vein (sometimes subclavian)
 Measure central venous pressure (CVP)
– Normal CVP is <8 cm H2O
 Administration of fluids, medications
 Complications
– Pneumothorax
– Puncture of subclavian artery
– Nerve injury

Question 26

what is the risk if you catheterise through the external jugular vein

Answer 26

air embolism

Question 27

EXTERNAL JUGULAR VEIN

Answer 27

 Descends from the angle of the mandible to the middle of the clavicle

• Crosses the SCM obliquely, deep to the platysma, and enters the antero- inferior part of the posterior triange.
• Pierces the investing fascia at the posterior border of the SCM.
• Descends and terminates in the subclavian vein.
• Drains most of the scalp and side of the face.

Question 28

what is the external jugular veins formed by

Answer 28

– Posterior division of

the retromandibular vein – Posterior auricular vein

Question 29

ANTERIOR JUGULAR VEIN

Answer 29

 Inferior to the hyoid bone
• Drains into external jugular or
subclavian veins
• Anterior jugular veins of both sides join
• Jugular venous arch

Question 30

NERVES IN THE NECK

Answer 30

 Cutaneous branches of the cervical plexus

 Erb's point – four cutaneous branches become superficial
 – Lesser occipital
– Greatauricular nerve 
– Transverse cervical 
– Supraclavicular

• Accessory nerve
– Motor control of
trapezius and SCM
– Passes across the posterior triangle

Question 31

LYMPH NODES IN THE NECK

Answer 31

• No lymph nodes in the scalp or face

* Except parotid/buccal region