The Neck Flashcards
What is a characteristic feature of a cervical vertebrae?
Foramen Transversarium, form transverse foramina
What is the best place for carotid compression hemostasis?
THe carotid tubercle of C6 which can be palpated
What are the nick names for C1 and C2 and what keeps them in place
C1- atlas, C2-Axis, C2 fits into C1 via dens (odontoid process) held in place by ligaments and supports the “no” head rotation
What is the main function of the hyoid bone and where is its location. What is a unique feature different from any other bone?
Superior to thyroid cartilage and inferior to floor of mouth and root of the tongue. In front of C3-C4. Serves as main attachment site for muscles that help to keep the airways open. Only bone that does not articulate with another bone!
Name the three hard structures of the throat in descending order and name about the level that the superior border of each lies. Which of these forms a complete ring?
The hyoid bone (C3/C4) the thyroid cartilage (C4) the Cricoid Cartilage (C6) forms a complete ring
Where is an emergency tracheotomy performed?
The Cricothyroid membrane/ligament
Platysma (function, innervation, location)
Muscle of facial expression, embedded in SQ tissue on anterolateral neck. Motor= CN7 (facial Nerve) Sensory = cervical plexus. Helps draw down lower lip
Sternocleidomastoid (function, innervation)
2 heads (Clavicular and sternal) form an inverted Y. Heads unite to insert into mastoid process (Bony protuberance behind ear) Motor = CNXI (accessory) Sensory= C2-C3 ventral rami. Bends head to same side and rotates face to opposite side. When acting together they flex head forward.
Trapezius
Motor= CNXI (accessory) Sensory = C3-C4 ventral rami. When acting together draws head back. Also rotates scapula
What are the four suprahyoid muscles? What do they do? What is their individual innervation?
Digastric (anterior and posterior belly) innervated by nerve to myohyloid (CN V3), Geniohyoid innervated by C1 via CN XII, mylohyoid innervated by nerve to mylohyoid, and stylohyoid innervated by nerve to stylohyoid CN VII. Together they open the jaw, depress the mandible, and elevate the hyoid bone
What are the four Infrahyoid muscles? What do they do?
Sternohyoid, Thyrohyoid, Omohyoid, and sternothyroid. Together they depress and stabilize the hyoid bone and oppose actions of suprahyoid muscles
Longus Colli
Applied to anterior of vertebral column from C1-T3. Flexes neck forward or laterally (inferior portion also rotates head to opposite side) Innervated by C2-C6 ventral rami
Anterior scalene
Attaches C3-C6 to 1st rib. Innervated by C4-C6, flexes neck laterally and elevates 1st rib
Middle Scalene
Attaches C4-C7 to 1st rib. Innervated by C4-C6, flexes neck laterally and elevates 1st rib
Posterior Scalene
Attaches C4-C6 to 2nd rib, Innervated by C7-8, flexes neck laterally and elevates 2nd rib.
Describe how the subclavian arteries and veins, brachial plexus and phrenic nerve travel wrt to the scalene muscles.
The Subclavian vein travels over 1st rib and anterior to anterior scalene. The artery and brachial plexus travels over the 1st rib and between the anterior and middle scalene. The phrenic nerve emerges between the anterior and middle scalene and travels on the anterior surface of the anterior scalene
What are the borders of the anterior triagle of the neck?
medial- midline of the neck, lateral- anterior margin of the sternocleidomastoid, superior- inferior margin of the mandible
What are the borders of the posterior triangle of the neck?
Medially- posterior border of the sternocleidomastoid, laterally- the anterior border of the trapezius, inferiorly- the clavicle
What are the borders of the carotid triangle?
Medial- superior belly of the onohyoid, Lateral- the anterior belly of the sternocleidomastoid, Superiorly, the inferior aspect of the stylohyoid and digastric muscles
What structures lie within the carotid triangle?
Common Carotid, Internal Jugular and tributaries, vagus nerve, branches of brachial plexus, hypoglossal and accessory nerves, parts of thyroid, larynx, pharynx, and deep cervical lymph nodes
What is contained in the carotid sheath?
The carotid artery (medially), internal jugular (laterally)and vagus nerve (posterior and in the middle)
Where does common carotid bifurcate?
Around C4
What are the branches of the external carotid artery?
Seven Angry Ladies Fight Over PMS
Superior thyroid, Ascending Laryngeal, Lingual (least conserved), Facial(tortuous, Occipital, Posterior Auricular, Maxillay, Superficial Temporal
What membranes does the superior laryngeal artery pierce?
The thyrohyoid membrane
Where is the 1st segment of the subclavian and what branches does it give?
origin to medial border of anterior scalene gives off the internal thoracic, the thyrocervical trunk, and the vertebral.
Where is the 2nd segment of the subclavian and what branches does it give?
Behind anterior scalene and gives off the costocervical trunk
Where is the 3rd segment of the subclavian and what branches does it give off?
From lateral border of anterior scalene to lateral border of the first rib renamed axillary after it passes over first rib. (no branches in this segment)
What are the branches of the thyrocervical trunk, and what does it turn into?
suprascapular, transverse cervical, ascending cervical, ends as inferior thyroid
What are the branches of the costocervical trunk?
Deep cervical and the supreme intercostal
At what vertebral level does the vertebral artery enter the transverse foramina?
C6
What are the four anastomoses between the carotid and subclavian aa?
Inferior thyroid (thryrocervical trunk) with superior thyroid(external Carotid). Ascending cervical(thyrocervical trunk) with occipital (External Carotid). Transverse Cervical(thyrocervical trunk) with occipital (external Carotid). Deep Cervical (costocervical trunk) with Occipital (external Carotid).
What are the Anastomoses between the subclavian and the vertebral aa?
Ascending Cervical with vertebral.
Ascending cervical with anterior spinal (branches of vertebral)
Where do the carotid and vertebral arteries anastomose?
Circle of Willis
Where does the external jugular vein drain?
Subclavian vein
Where does the anterior neck drain?
Anterior jugular veins
Where do the scalp and face drain?
Drained by veins of same name as accompanying artery and ultimately into external and internal jugulars
Where do the brain and meninges drain?
Dural sinuses collect deoxygenated blood and ultimately drain into the internal jugular veins
What forms the anterior jugular veins, and how do they drain? When are anterior jugulars injured?
Formed from teh submandibular and submental veins. right and left branches combine to form the jugular arch which then drains into both external jugulars or subclavian. Size is inversely proportional to EJV size. Commonly injured during emergency laryngotomy or attempted suicide by hanging
What veins combine to form external jugulars?
posterior branch of retromandibular and posterior auricular
What is the drainage pattern of the lymph form the head and neck?
Superficial Cervical Lymph nodes –> Deep Cervical lymph nodes –> Efferent Lymph vessels –> Jugular trunk –> Thoracic duct on left and right lymphatic duct (NO LYMPH NODES IN UPPER HEAD!)
What are the 3 major lymph groups in the neck and what does inflammation of each indicate.
Superior Deep Cervical indicate disease of head and neck, Middle indicate thyroid, supraclavicular indicate something below the diaphragm
Describe the location of the cervical sympathetic chain and name the three ganglia
Lies anterior to transverse processes of cervical vertebrae, near posterior surface of carotid sheath, but medial to vagus. Inferior , middle and superior (largest C2 only one that innervates the head via internal carotid plexus) cervical sympathetic ganglia.
What are the three major signs of Horners Syndrome?
ptsois (droopy eyelids), myosis ( inability to dialate the pupil), anhydrosis (inability to sweat). flushing (inability to vasoconstrict)
Name some possible preganglionic and postganglionic impairments that lead to horners
Preganglionic- pancoast tumor, subclavian aneurysm, Thyroid tumor, jugular vein cannulation, chest tube placement. Postganglionic - superior cervical ganglion lesion, extracranial interal carotid artery dissection, ICA lesion at cavernous sinus.
name some possible causes of jugular venous distension
Blockage of SVC, CHF, constrictive pericarditis, cardiac tamponade
What glands are located in the neck?
Thyroid and parathyroid
What are the boundaries of the neck?
From the superior border of the 1st rib to the inferior border of the mandible
What bones are contained within the neck?
Cervical vertebrae C1-C7 and the Hyoid bone
Describe the location of the hyoid bone
C3, between the root of the tongue and they thyroid caritlage
What cervical level is the thyroid cartilage located at?
The C4
What level does the cricoid cartilage sit?
C6
What connect the cricoid cartilage to the thyroid cartilage?
The cricothyroid ligament
What connects the cricoid cartilage to the first tracheal ring?
The Cricotracheal ligament
What other significant anatomical “events” Take place at the level of the cricoid cartilage (Hint 5)
Junction of the larynx and trachea, junction of the pharynx and esophagus, recurrent branch of vagus enters trachea, the middle cervical sympathetic ganglion. Region where the inferior thyroid artery enters the thyroid gland
What region does the isthmus of the thyroid cover?
2nd-4th tracheal rings
What level does the suprasternal notch sit at?
T2
What two branches of the external carotid does the hypoglossal nerve run between?
The facial and lingual
What do the two vertebral arteries combine to form in the skull?
The Basilar artery
What vein is most commonly cannulated in emergency situations in which the peripheral veins are collapsed?
The external jugular vein (especially the right)
Where do the jugular lymph trunks terminate on the right and on the left?
the right jugular lymphatic trunk drains into the junction of the subclavian and internal jugular. Th eleft drains directly into the thoracic duct
Where is Virchows node? If enlarged, what does it indicate?
Located just above the the middle third of the clavicle near the thoracic duct end and often indicated a tumor below the diaphragm
What type of fibers and communications does they cervical sympathetic chain contain?
Preganglionic fibers, postganglionic cell bodies, and gray rami communicans
What spinal nerves do each of the cervical sympathetic ganglion communicate with?
Superior C1-C4
Middle C5-C6
Inferior C7-C8
What connects the middle and inferior cervical sympathetic ganglion?
The Ansa Subclavia
What do the anterior cervical nodes drain?
internal throat and part of posterior pharynx, tonisls, and thyroid glands
What do the posterior cervical nodes drain?
skin on back of head (often enlarges dural viral systemic illness (mono)
What do the tonsilar nodes drain?
drain the tonsilar and posterior pharyngeal
What do the submandibular nodes drain?
structure on the floor of mouth
What do the submental nodes drain?
The teeth and intra-oral cavity
What do the supraclavicular nodes drain?
part of thoracic cavity and abdomen
What sympathetic plexus lays over thyroid gland and what ganglion does it originate from?
The periarterial plexus from the MCG
