the neck Flashcards
attachment sites for muscles and soft structures above and anterior
mandible
attachment sites for muscles and soft structures above and lateral
mastoid and styloid processes
attachment sites for muscles and soft structures above and psoterior
occipital bone, external occipital protuberance
attachment sites for muscles and soft structures inferior
the sternum (manubrium) and clavicle
attachment sites for muscles and soft structures inferior and posterior
spinous processes and transverse processes of cervical vertebra
anterior of the neck
“plumbing and wiring”
blood vessels of the neck
carotid arteries, jugular veins, vertebral arteries
nerves of the neck
vagus nerve, glossopharyngeal nerve, phrenic nerve, sympathetic trunk, spinal cord
glands of the neck
thyroid, parathyroid, submandibular
investing fascia
surrounds the entire neck; it is an extension of the deep fascia on the most external muscles, sternocleidomastoid and trapezius
carotid sheath
deep to the investing fascia; surrounds the carotid artery, jugular vein, and vagus nerve on each side
how does the internal carotid artery enter the skull
via the opening to the carotid canal
how do the vagus nerve and the jugular vein leave the skull
via the adjacent jugular foramen
what do the pretracheal fascia and buccopharyngeal fascia surround
the pharynx and larynx and their continuations as the trachea and esophogus; this facia also encloses the thyroid gland
preverterbral fascia
covers the vertebral column and its associated muscles
alar fascia location
between the buccopharyngeal and prevertebral fascias
retropharyngeal space location
lies behind teh buccopharyngeal fascia
“danger space”
the space behind the alar fascia; is continuous with the mediastinum and can allow the spread of infection (upper respiratory infections in children, abscessed teeth) from the pharynx into the thorax
number of cerviccal vertebra
7
features of vertebra 3-7
small body (relatively less weight to support than in remainder of column) large vertebral canal (accomodates a large spinal cord cross-section containing fibers going to all the rest of the body; also a wide range of movement of the neck) transverse foraminae in the transverse processes allow passage of the vertebral arteries bifid (double-tipped) spinous processes form additional attachemtn area for back muscles spinous processes are linked by the strong ligament of the neck (ligamentum nuchae)
second vertebra
the axis
axis features
relatively heavy body a prominent “tooth” or dens (odontoid process); the dens has facets for articulation with the anterior arch of the atlas (anteriorly) and its transverse ligament (posteriorly).
shaking of head “no”
dens facets for articulation on the anterior arch and transverse ligament of the axis
first vertebra
atlas (the god who holds up the world); it has no body, but has lateral masses and anterior and posterior arches
anterior arch of the atlas
has a facet for articulation with the axis, allowing rotation of the head around a vertical axis (shaking your head no)
nodding yes
facets of the atlas articulate with the occipital condyles to allow flexion-extension of the head
posterior arch of the atlas
has grooves for the vertebral arteries that pass upward through the foramen magnum
function of posterior back muscles
stabilize and extend the vertebral column
where does the trapezius attach
to the inion (external occipital protuberance), the spine of the scapula and spinous processes of thoracic vertebrae
what is deep to the trapezius
the rhomboids, major and minor, and levator scapulae
superfical layer of deep back muscles, called erector spinae; these hold the head up and resist flexion of the cervical vertebral column
medial to lateral points of attachment of the erector spinae
spinous processes, transverse processes, and the angles of the ribs
where are the spinalis and semispinalis captitis attached
to the spinous processes
where is longissims (longest) attached
to the transverse processes
where are the iliocostalis attached
to the rib angles
where does the semispinalis cpaitis insert?
on the occiput between the superior and inferior nuchal lines
deep to the erector spinae
transversospinalis muscles that lie in the groove between the spinous and transverse processes; these are semispinalis, multifundus and rotatores (from superficial to deep)
splenius (bandage) location
is superfical to semispinalis captisi and run upward and lateralyl to attach to spinous processes, the superior nuchael line and the mastoid processes
how do splenius fibers run
nearly at a right angle to the upper fibers of trapezius that overlie it
longus colli (long muscles of the neck) location and attachment
on the anterior side of the vertebral column, attaching to vertebral bodies
muscles that allow you to bow your head (flex the vertebral column anteriorly and laterally)
longus colli
suboccipital triangle location
lies just inferior to the occipital bone; lies deep and inferior to the attachment of the semisplinalis capitis
where do the muscles of the suboccipital triangle attach
to the bony points on the atlas, axis, and occiput
suboccipital triangle muscles
4 muscles on each side; rectus muscles are more medial, while the oblique muscles are more lateral; rectus capitis posterior minor extends from the posterior tubercle fo the atlast o the inferior nuchal line; rectus capitis posterior major extends from the spinous process of the axis to the infeiror nuchal line; obliquus capitis inferior extends from the spinous process of the axis to the transverse process of the atlas; obliquus capitis superior extends from the transverse process of the atlas to the occipital bone between the nuchal lines
upward part of nodding your head “yes”; rotate the skull around a horizontal axis by causing sliding at the atlanto-occipital joints
contraction of obliquus captitis superior
contraction of onliquus captiis inferior
will rotate the skull and atlas on a vertical axis at the atlanto-axial joint (shaking your head “no”)
greater occipital nerve (C2)
cutaneous nerve that emerges at the inferior border of obliquus capitis inferiror; it then passes superficial to the triangle and through the semispinalis muscle to reach the skin and supply it
suboccipital nerve (C1)
also contained in the suboccipital traingle; the nerve supplies the msucles of the triangle, but has no cutanoues distrubtion
vertebral artery
lies deep to the muscles on its way to the foramen magnum
stermocleidomastoid muscle (or just sternomastoid)
attaches to the mastoid process and the sternum; an additional head attaches to the clavicle
location of facial expression mucles
lie in the superficial fascia and attach to this fascia as well as to the bones
motor innervation for facial expression muscles
facial nerve, cranial nerve VII
visceral tube
in the anterior portion of the neck; contains a visceral tube, consisting of the pharynx, larynx, trachea and esophagus whose vertical position is controlled by a set of muscles
hyoid bone
U shape; opening posteriorly; it has a body, two lesser horns, and two greater horns for attachments of muscles; it has no joints with any other bone
where is the hyoid bone attached
it’s attached to the thyroid cartilage via the thyrohyoid ligament; therefore, controlling the vertical position of the hyoid bone also controls the vertical position of the thyroid cartilage, and with it the positions of the pharynx and larynx
posterior belly of the digastric muscles
attaches to the digastric groove ont eh medial side of the mastoid process, and is supplied by the facial nerve
anterior belly attaches to the inside of the mandible at the digastric fossa
supplied by the motor branch of the trigeminal nerve (V3: a convenient mnemonic for this motor branch is MAST MATT, for muscles of MASTication plus mylohyoid, anterior digastric, tensor tympani (tensor of the eardrum) and tensor veli palatini (tensor of the soft palate)
tendon between anterior and posterior digastric muscles
attached to the hyoid bone via a sling in the tendon of the sylohyoid muscle
stylohyoid muscle
is attached to the styloid process of the skull and to the hyoid bone; like the posterior digastric muscle, the stylohyoid muscle is innervated by the facial nerve; this processes, the attachment sites for these muscles
mylohyoid muscle
attaches to the mylohyoid line of the mandible and to the hyoid bone; its fibers run medial-lateral; it is innervated by teh motor root of the cranial nerve V3
when the digastrics, stylohyoid and mylohyoid contract
the hyoid bone is lifted up and presses the tongue upward against the hard palate
strap muscles
below they hyoid; pull the hyoid bone downward; all are named for their attachments
omohyoid muscle
two-bellied muscle attaching the hyoid to the scapula just medial to the scapular notch (“omo means shoulder); it also pulls the hyoid bone downward
geniohyoid
runs anteriorly from the hyoid to the genial tubercle on the inside of the mandible; this muscle is part of the floor of the mouth, which supports the tongue
innervation of strap muscles
from C1-C3; the nerves form a loop that looks like the handle of a pitcher (ansa), so it is called the ansa cervicalis; it is located just lateral to the internal jugular vein; fibers of C1 travel with the hypoglossal nerve (CN XII), then form the superior limb of the ansa; fibers from C2 and C3 form the inferior limb; fibers that leave the loop to supply the sternohyoid, omohyoid, and sternothyroid msucles (SOS)
uppermost strap muscles
thyrohyoid and geniogyoid; innervated by branches of C1 that travel with CN XII but are not part of the ansa
where do the strap mucles lie
between the investing fascia and the pretracheal fascia
thryoid gland lcoation
anterior to the trachea below the thyroid cartilage
thyroid gland
consists of two lobes conencted by an isthmus across the midline; the thyroid is supplied with blood by the superior thyroid artery, the first branch of the external cartotid artery and the inferior thyroid artery from the thyrocervical trunk, in turn a branch of the subclavian artery; the gland is drained by superior, middle and inferior thyroid veins
parathyroid glands
on the posterior surface of the thyroid gland lie the parathyroid glands, two on each side, generally one superior and one inferior; parathyroid glands can’t be identified in cadavers
carotid sheath
encloses the common carotid artery, the internal jugular vein, and the vagus nerve; lateral to the pretracheal fascia
common carotid artery
divides into the internal and external occipital arteries; the internal carotid goes upward to the carotid canala dn supplies the brain; the external carotid has a number of branches named for the areas they supply
larger branches of the external carotid artery
superior thyroid, lingual (to tongue), facial (to face), maxillary (structures associated with the maxilla), superficial temporal (skin of temples)
smaller branches of the external carotid artery
ascending pharyngeal (to pharynx), occipital (to skin of occiput
thyrocervical trunk of the subclavian artery
usually arises more medially and has branches that supply the thyroid gland and neck
vertebra artery
runs upward through the transverse formaina of the vertebrae to supply the posterior brain
internal thoracic artery
runs downward on the inside of the ribs close to the sternum;
the costocervical trunk
usually arises more laterally; its branches supply cervical muscles and the upper intercostal spaces
the internal jugular vein
leaves the skull via the jugular foramen and receives the facial and retromandibular veins as wellas the superiod thyroid vein; exact pattern varies from one person to antoher; internal jugular vein lies internal (deep to) the sternomastoid muscle
lymph drainage
typically follows venous drainage
deep cervical lymph nodes
lie along the internal jugular vein and drain the face, mouth, and tongue
they are named for their location, either the area or for the muscle crossing the internal jugular
the jugulo-omohyoid node
receives lymph from the tongue
lymph from the body (axillary nodes on the right, the throacic duct on the left)
enters the venous system at the junction between the subclavian vein and the internal jugular vein
the phrenic nerve
carries somatic innervation from C3 to C5 to the diaphragm, a skeletal muscle (C#,4,5 keeps your diaphragm alive); the phrenic nerve lies anterior to the anterior scalene muscle and is “bound down” to it by branches of the thyrocervical trunk
pharynx and larynx
are innervated by branches of the glossopharyngeal and vagus nerves; the vagus nerve carries somatic motor fibers to the pharynx and larynx; the latter are given off as the superior and recurrent larygeal nerves; the vagus also carries parasympathetic and sensory supply to the thorax (heart, lungs) and abdomen (derivatives of the foregut and midgut)
glossopharyngeal nerves
the sensory nerve of the pharynx; it also supplies the posterior 1/3 of the tongue with taste and general sensation, and innervates the carotid body and carotid sinus; these measure O2 and CO2 content of the blood and blood pressure, respectively
sympathetic chain
typically lies just anterior to or embedded in the prevertebral fascia; it receives input from T1-T4 via white rami communicantes; synapses occur in the cervical ganglia and postgnaglionic fibers travel with all the blood vessels to regulate blood flow in teh vessesl
postganglionic nerves
from the superior cervical ganglion travel with branches of the internal and external carotid arteries to regulate blood supply to the brain and the face; the other ganglia are must less prominent; postganglionic nerves from these ganglia control blood supply to structures in the limb and upper thorax
anterior triangle
anterior to sternmastoid, contains: submental traingle, digastric triangle, carotid triangle, muscular triangle
submental triangle
ant. jugular vein, submental lymph nodes
digastric triangle
submandibular gland, lymph nodes, hypoglossal nerve, facial artery and vein
carotid triangle
carotid artery and bifurcation, vagus nerve, hypoglossal nerve
muscular triangle
strap muscles, thyroid and parathyroid glands
