The Neck Flashcards
Submandibular/Digastric Triangle Borders
Anterior Digastric
Posterior Digastric
Inferior border of mandible
Submandibular/Digastric Triangle Floor
Mylohyoid
Hyoglossus
Middle Constrictor
Submandibular/Digastric Triangle Roof
Skin
Superficial fascia with platysma
Deep cervical fascia
Submandibular/Digastric Triangle
Arteries
Facial Artery
Submental Artery
Lingual Artery (small portion)
Submandibular/Digastric Triangle
Veins
Facial Vein
Submental Vein
Lingual Vein (small portion)
Submandibular/Digastric Triangle
Nerves
Mylohyoid n.
CN XII Hypoglossal
Submandibular/Digastric Triangle
Structures
***Submandibular salivary gland (occupies most of triangle)
Submandibular lymph nodes
Inferior portion of Parotid salivary gland
Submental Triangle (there's only 1) Borders
Left anterior digastric
Right anterior digastric
Body of Hyoid bone
Submental Triangle
Floor
Mylohyoid
Submental Triangle
Roof
Skin
Superficial fascia w/ Platysma
Superficial/Investing layer of deep fascia
Submental Triangle
Major contents
no MAJOR contents
Submental Triangle
Veins
Anterior jugular (has poor drainage, little vasculature, infections here do not heal well)
Submental Triangle
Structures
Submental lymph nodes
Muscular Triangle
Borders
Anterior border of Sternocleidomastoid
Superior belly of omohyoid muscle
Midline
Muscular Triangle
Floor
Sternohyoid
Sternothyroid
Muscular Triangle
Roof
Skin
Superficial fascia w/ Platysma
Superficial/Investing layer of deep fascia
Muscular Triangle
Arteries
Superior Thyroid artery
What’s in the carotid space?
IC 10 CC's in the IJ (I see 10 cc's in the IV) Internal carotid artery (superior) Common carotid artery (inferior) CN 10 Vagus Internal Jugular vein Cervical lymph nodes
Define Fascial Planes
Bands of connective tissue (dense irregular) that surrounds and protects structures.
The solid, colored lines in the cross-section
Define Tissue Spaces
Spaces & Pathways that allow infection to spread (from head and neck down to your heart)
The most superficial muscle on the back of the neck?
Trapezius
When you cut past the skin layer, what’s the first thing you’ll see?
Superficial fascia (aka subcutaneous tissue)
Surrounds our entire body
If being asked about fascia etc, it’s called superficial fascia.
If being asked about skin stuff, it’s called subcutaneous tissue.
What does superficial fascia contain?
Fat & the
Platysma is embedded in this layer
Contains sensory branches to the neck
Deep to the Superficial fascia
The layers of Deep fascia which also surround the whole body….Deep to this are the actual muscles (other than the platysma) and organs.
Is there any deep fascia in the face?
No deep fascia in face
This allows for free spread of fluid and therefore infections around there
Purpose of deep fascia?
Protects muscles and organs
Reduces friction of muscle movements
Passageways for nerves and vessels
Provides attachment for some muscles
BD*Which 2 muscles are surrounded by the investing/superficial layer of deep cervical fascia?
SCM
Trapezius
Layers of Deep Cervical Fascia & what kind of fascia does each contain?
Superficial/Investing layer Middle layer (pretracheal fascia: muscular & visceral, buccopharyngeal fascia) Deep layer (prevertebral fascia, alar fascia) Carotid sheath (=superficial,middle,deep combined)
Superficial/Investing Layer
Surrounds entire neck
Encloses SCM & Trapezius
*not so important…Surrounds: Clavicle, Manubrium, Acromion, Zygomatic Arch to Scapular Spine, Mastoid Process, Occipital Bone
in the Middle Layer the Muscular Pretracheal Fascia encloses what?
the 4 infrahyoid muscles:
omohyoid
sternohyoid,
sternothyroid,
thyrohyoid
in the Middle Layer the Visceral Pretracheal Fascia surrounds….like a horseshoe…
Pharynx
Larynx
Thyroid + Trachea + Esophagus
in the Middle Layer the Buccopharyngeal Fascia lies where?
in the back of the esophagus where you can see it
in the Deep fascia’s deep layer, the Prevertebral Fascia
Surrounds what?
Envelopes what?
*And what does it have to do with innervation?
Cervical vertebral column
Deep neck muscles, including prevertebral scalenes & deep back muscles
*CN XI travels along it to the SCM and Trapezius
in the Deep Cervical Fascia, the Carotid Sheath is made of
Contributions of the superficial/investing, middle, and deep layers of fascia
the carotid sheath travels from where to where?
aortic arch up to the base of the skull
what is the space called that’s within the carotid sheath?
and what
carotid space
what is embedded in the wall of the carotid sheath?
ansa cervicalis.
It is not “inside the sheath” nor in the “carotid space”
It IS embedded inside “the wall” of the sheath
Buccopharyngeal fascia will be asked on bds in
- it’s relationship to the oropharynx
- in regards to the spaces infections spread through….
- you’ll see it when your patient opens his/her mouth…it’s the back of th oropharynx
- it serves as a border to the spaces infections can spread through….right behind it is the danger space
What fascia lies btwn the buccopharyngeal & prevertebral fascias, and why is this fascia important?
the alar fascia.
It divides 2 spaces where infections spread…which 2?
What are the 3 Fascial Spaces
Spaces in between the individual fascial layers where disease can spread.
Different from the Cervical Triangles
What are the Fascial Spaces that will be on the boards
Retropharyngeal space
Danger space
Carotid space
Boundaries of the Retropharyngeal space
Located btwn buccopharyngeal fascia and alar fascia
Lateral boundaries are the carotid sheaths
Extends from Clivus down to T2
Retropharyngeal space’s inferior portion is sometimes also called what?
Retrovisceral space
Why is Retropharyngeal space so significant re infections?
What is the significant infection here called?
An absess tooth infection can travel down it, down into our entire neck.
It’s called a
A RETRO-PHARYNGEAL ABSESS
Describe the danger space
Btwn Alar Fascia and Pre-vertebral Fascia
From clivus to diaphragm
*An infection can travel from Pharynx down to the mediastinum where the heart is.
When an infection builds up in the fascial spaces it will push what?
it will push tongue forward and upward***
Can also lead to edema of vocal cords and airway obstruction
How many cervical triangles are there and what are their names
3: Anterior and Posterior and Suboccipital triangles (2 of each
Divided into 11 divisions (5 paired, 1 single)
Posterior:
Occipital & Subclavian/Supraclavicular/Omoclavicular
Anterior:
Submandibular, Submental (single)
Carotid, Muscular
Anterior Triangle borders
Anterior border of SCM
Inferior border of mandible
Midline of the neck
T/F: The roof is the same for all the cervical triangles
True!
Muscular Triangle
Veins
Inferior thyroid v.
Anterior jugular v.
*Muscular Triangle
Nerves
*Ansa cervicalis
Muscular Triangle
(Major) Structures
Pharynx, Larynx, Trachea (top), Esophagus (top)
Thyroid, Parathyroid
Sternothyroid, Sternohyoid, Thyrohyoid
Carotid Triangle
Borders
Ant border of SCM
Post Digastric
Superior border of omohyoid m.
Carotid Triangle
Floor
Hyoglossus
Thyrohyoid
Middle constrictor (of pharynx)
Inferior constrictor (of pharynx)
Carotid Triangle
Roof
Skin
Superficial fascia w/ Platysma
Superficial/Investing layer of deep fascia
Carotid Triangle
Arteries
Common Carotid a. w/ Carotid Body
Internal Carotid a. w/ Carotid Sinus
External Carotid a. w/ its following branches:
Superior thyroid a.
Lingual a.
Facial a.
Ascending pharyngeal a
Occipital a.Carotid Triangle
Veins
Internal Jugular v. w/ its following branches:
Common facial v.
Lingual v.
Superior thyroid v.
Middle thyroid v.Carotid Triangle
Nerves
Vagus CN X
External laryngeal n.
Internal laryngeal n.
Accessory CN XI
Hypoglossal CN XII
Ansa Cervicalis' superior limb
Superior cervical ganglion of sympathetic trunkCarotid Triangle
Structures
Carotid sheath
Which triangle has 3 different names and what are they
Supraclavicular
Omoclavicular
Subclavian
Posterior Triangle
Borders
Posterior border of SCM
Anterior border of Trapezius
Clavicle
Posterior Triangle
Roof
Skin
Superficial fascia w/ Platysma
Superficial/Investing layer of deep fascia
Posterior Triangle
Floor
Splenius capitis
Semispinalis capitis
Scalenes
Levator scapulae
Omohyoid
Prevertebral fascia
SSSLOPWhat divides the Posterior Triangle into 2 smaller triangles, and what are those 2 sub-triangles?
Inferior belly of the Omohyoid muscle divides it up.
- Occipital Triangle (on top)
- Omoclavicular/Supraclavicular/Subclavian Triangle (on bottom)
Occipital Triangle
Borders
- Superior to the
omohyoid’s inferior belly - Posterior to SCM
- Anterior to Trapezius m.
Occipital Triangle
Arteries
Thyrocervical trunk
and a branch off it:
Transverse cervical n.
Occipital Triangle
Nerves
- Cervical Plexus: All portions of cervical plexus have a component there
- Accessory CN XI, which travels along fascia to innrvte the SCM and Trapezius
Subclavian/Omoclavicular/Supraclavicular triangle
Borders
Inferior to the Omohyoid’s inferior belly
Posterior to the SCM
Superior to the Clavicle
Subclavian/Omoclavicular/Supraclavicular triangle
Arteries
Subclavian a.
Thyrocervical trunk & it’s branch: Suprascapular a.
Subclavian/Omoclavicular/Supraclavicular triangle
Veins
External jugular
Subclavian/Omoclavicular/Supraclavicular triangle
*Nerves
Bd *Brachial plexus
Subclavian/Omoclavicular/Supraclavicular triangle
Roof
Skin
Superficial fascia w/ Platysma
Superficial/Investing layer of deep fascia
Suboccipital triangle
Borders
Obliquus capitis superior
Obliquus capitis inferior
Rectus capitis posterior major
Suboccipital triangle
Roof
Skin
Superficial fascia w/ Platysma
Superficial/Investing layer of deep fascia
(All roofs are Dense Connective Tissue, fyi :)
Suboccipital triangle
Floor
Posterior arch of atlas (C1)
Suboccipital triangle
Artery
Vertebral
Suboccipital triangle
Vein
Vertebral
Suboccipital triangle
Nerves
Greater occipital
Suboccipital
Suboccipital triangle
Muscles
Obliquus capitis superior
Obliquus capitis inferior
Rectus capitis posterior major
Rectus capitis posterior minor
In what triangle are the visceral structures of the neck found?
Muscular triangle (of the anterior triangle)
List the visceral structures of the neck
Pharynx Larynx Trachea + Esophagus Thyroid Parathyroid
How many parathyroid glands are there and where are they located?
What do they make?
Several (usually 4)
They’re embedded in the back of the Thyroid gland.
They make parathyroid hormone
What does the thyroid make?
Calcitonin T3 (Triiodothyronine) T4 (Tetraiodothyronine or Thyroxine)
Name the lobes of the thyroid
Left and Right lobes
Sometimes a Pyramidal lobe
What connects the left and right lobes,
and where is it in relation to the trachea
the Isthmus of the thyroid
It crosses anterior to the 2nd and 3rd tracheal rings, lies right up against them
Is the Thyroid highly vascular or not?
Yes highly vascular
which is why cancer grows well in that area
Where is the Thyroid located relative to the vertebrae
Btwn
C6 and
T1
What vessels bring blood to the Thyroid?
Which ones take blood away from Thyroid?
To:
Superior Thyroid a.
Inferior Thyroid a.
From:
Superior thyroid v.
Middle thyroid v.
Inferior thyroid v.
So thyroid gland is highly vascular!
Where’s the “root of the neck”?
And what does it consist of?
What is the Superior thoracic aperture?
What are this aperture’s borders
and what does it contain sometimes?
where neck attaches to thorax It's where the Superior Thoracic Aperture is, this is the top opening of the thoracic cage, a circle. It's bounded by: 1st rib and cartilage, L and Right 1st thoracic vertebrae Manubrium
During full inhalation it contains the Lung’s apex which inflates up into it
List contents of the “root of the neck”
Just think, what arteries, veins, nerves, and other structures are located in both the thoracic cage and head/neck Rely on your basic anatomical knowledge. Here's the list anywy: Arteries=== Aortic Arch Common carotid Subclavian Vertebral Transverse cervical Veins=== Internal jugular Subclavian Brachiocephalic Inferior thyroid Vertebral Nerves=== Vagus Recurrent laryngeal Phrenic Sympathetic trunk Brachial plexus Structures=== Trachea Esophagus Thoracic duct Right lymphatic duct
List the layers of the Scalp
(superficial to deep)
S=kin
C=onnective tissue
Dense CT
Distributes neurovascular supply to scalp
A=poneurosis (a tough layer of dense fibrous tissue)
Consists of Occipitalis, Galea Aponeurotica, & Frontalis
L=oose CT
P=eriosteum
What does the CT of the scalp do?
distributes neurovascular supply to the scalp
*What blood sources come up and feed the scalp
Why is this a beneficial arrangement?
*Internal and external carotid arteries both feed the scalp. Internal primarily feeds the brain, external primarily does everything else….but the scalp is one place where they actually both work together.
Anastomosis occurs here (they’re interconnected), so if one of these blood sources gets blocked another source can still supply the same tissue/scalp. A built-in back up plan.
Cutaneous innervation of the scalp
Which nerves do this?
CN V1 CN V2 CN V3 and Cervical plexus branches, C2 n C3 The scalp is a great meeting place for arteries, veins, and nerves.
Why is danger space more dangerous than the neighboring retropharyngeal space?
danger space goes farther down, all the way to the diaphragm
