Surface Anatomy of the Neck

Question 1

Investing (superficial fascia)

Answer 1

• covers sternocleidomastoid muscle, trapezius, suprahyoid and infrahyoid muscle
• covers parathyroid and submandibular gland

Question 2

Pretracheal fascia

Answer 2

• surrounds trachea and oesophagus
• covers thyroid and parathyroid gland
• superiorly buccopharyngeal fascia

Question 3

Prevertebral fascia

Answer 3

• covers vertebral column including cervical nerves and muscles in the front and back of the column
• 2 layers, prevertebral fascia closest to vertebral bodies and alar fascia
• extends from base of skull to superior mediastinum at level T3

Question 4

What are the potential spaces in the neck?

Answer 4

• retropharyngeal space

- danger space

Question 5

What is the function of the retropharyngeal space?

Answer 5

• allows movement of oesophagus, pharynx, larynx and trachea relative to the vertebral column during breathing and swallowing

Question 6

What are the open and closed borders of the retropharyngeal space?

Answer 6

• closed superiorly by cranial base
• closed on each side by carotid sheath
• open inferiorly into superior mediastinum

Question 7

What is the retropharyngeal space?

Answer 7

the space between the alar fascia and the pretracheal fascia and buccopharyngeal fascia

Question 8

What is the danger space?

Answer 8

between the prevertebral fascial layer and the alar fascial layer

Question 9

What is the clinical relevance of the danger space?

Answer 9

it is a major pathway where infection can spread to the mediastinum

Question 10

What is the clinical relevance of the retropharyngeal space?

Answer 10

• retropharyngeal abscesses from infections in the nasopharynx/paranasal sinuses/middle ear
• dental abscesses can spread to mediastinum

Question 11

What are the borders of the anterior triangle of the neck?

Answer 11

• superior: inferior border of mandible
• lateral: anterior border of sternocleidomastoid muscle
• medial: sagittal line down the midline of the neck

Question 12

What are the borders of the posterior triangle of the neck?

Answer 12

• anterior: posterior border of sternocleidomastoid muscle
• posterior: anterior border of trapezius
• inferior: middle 1/3 of clavicle

Question 13

What things needed to be checked if a patient comes in with a neck lump?

Answer 13

• location (which neck triangle)
• tenderness
• heat/inflammation
• size/depth
• pulsatile
• on its own/many
• movement ( can patient swallow/stick out tongue)

Question 14

Where does the facial nerve pass through

Answer 14

stylomastoid process

Question 15

Where would you feel to find the transverse process of the atlas?

Answer 15

between the mastoid process and posterior to the angle of the mandible

Question 16

What is the laryngeal prominence?

Answer 16

• the angle between the 2 laminae (lesser and greater horns) of the thyroid cartilage
• fusion of inferior 2/3 of 2 lamina
• adam’s apple

Question 17

What does the thyroid cartilage articulate with?

Answer 17

• cricoid cartilage
• rotational movement
• change length/sound of vocal cords

Question 18

What is the largest branch of the arch of aorta?

Answer 18

brachiocephalic trunk

Question 19

What muscles cover the brachiocephalic trunk anteriorly?

Answer 19

• right sternohyoid

- sternohyoid muscles

Question 20

What are the divisions of the brachiocephalic trunk?

Answer 20

• right common carotid artery

- right subclavian artery

Question 21

What are the branches of the 3 parts of the subclavian artery?

Answer 21

1st part:

• vertebral artery
• thyrocervical trunk
• internal thoracic artery

2nd part:
- costocervical trunk

3rd part:
- dorsal scapular artery

Question 22

Where does the common carotid artery divide and into what?

Answer 22

bifurcates at level of superior border of thyroid cartilage into:

• internal carotid artery
• external carotid artery

Question 23

Where would you find the carotid sinus?

Answer 23

at the origin of the internal carotid artery/carotid bifurcation where there is a swelling

Question 24

What innervates the carotid body and sinus?

Answer 24

• afferent glossopharyngeal nerve (to brain)

- efferent vagus nerve (to cause change)

Question 25

What is the carotid sinus?

Answer 25

- baroreceptor | - reacts to change in arterial blood pressure

Question 26

What is the carotid body?

Answer 26

- chemoreceptor | - monitors partial pressure of CO2 (so pH level)

Question 27

What does the internal carotid artery supply?

Answer 27

the intracranial structures

Question 28

What vessels are in the carotid sheath?

Answer 28

- internal jugular vein - internal carotid artery - vagus nerve

Question 29

What are the branches of the external carotid artery?

Answer 29

- superior thyroid artery - ascending pharyngeal artery - lingual artery - facial artery - occipital artery - posterior auricular artery - maxillary artery - superficial temporal artery (Some Anatomists Like Freaking Out Poor Medical Students)

Question 30

What is the dural venous sinus and what are its divisions?

Answer 30

- space between 2 layers of meninges that act like veins - superior sagittal sinus - inferior sagittal sinus - sinus rectus

Question 31

What drains the cranium?

Answer 31

- dural venous sinus - sigmoid sinus - all merge to become internal jugular vein

Question 32

What structures is the internal jugular vein closely related to?

Answer 32

- vagus nerve - phrenic nerve - brachial plexus

Question 33

What is the clinical relevance of the IJV?

Answer 33

- central venous access/central venous catheterisation - most commonly inserted in IJV (can be subclavian) - complications include pneumothorax/puncture of subclavian artery/nerve injury

Question 34

What is a risk of central venous access?

Answer 34

if the external jugular vein is used then there is risk of air embolism

Question 35

What forms the external jugular vein?

Answer 35

- posterior division of the retromandibular vein | - posterior auricular vein

Question 36

What does the external jugular vein drain?

Answer 36

most of scalp and side of face

Question 37

Describe the position of the external jugular vein

Answer 37

- descends from angle of mandible to middle of clavicle - crosses SCM and enters antero-inferior part of posterior triangle - pierces superficial fascia at posterior border of SCM - descends and terminates in subclavian vein

Question 38

Where is the anterior jugular vein found?

Answer 38

inferior to hyoid bone

Question 39

Where does the anterior jugular vein drain to?

Answer 39

- external jugular vein - subclavian vein - both sides join together to form jugular venous arch

Question 40

What are the nerves in the neck?

Answer 40

- cutaneous branches of cervical plexus - Erb's point - accessory nerve

Question 41

What is Erb's point?

Answer 41

Where the 4 cutaneous branches of the cervical plexus (lesser occipital, great auricular nerve, transverse cervical and supraclavicular) become superficial

Question 42

What is the control of the accessory nerve?

Answer 42

motor control of trapezius and SCM