Triangles of neck Flashcards
2 types of fascia and differences or key charactristics
Superficial: Immediately deep to skin/subcutaneous tissue, comprised of loose connective tissue and fat, contains platysma in neck
Deep: Deep to superficial fascia, dense, organized connective tissue, no fat, covers most body structures(muscles/organs)
Where does platysma originate and insert(generally), and what is it innervated by?
From fascia above pec major and clavicle to lateral neck and onto mandible
- Very variable- changes per person where starts and ends
-Innervated by CN 7 (facial n).
Innervation of Platysma
CN 7 (facial n)
Why is it important to isolate different triangles of neck
if you have an infection in one area, prevents it from getting to other areas
- Specifically, neck connects to mediastinum (heart, esophagus, trachea)
What are the deep fascia of the neck
Investing
Pre-Tracheal
- Visceral, muscular, and buccoparyngeal
Carotid sheath
Alar fascia
Prevertebral fascia
What does investing fascia sourround
Trapezius and SCM
What does pretracheal fascia sourround
Visceral: Thyroid, trachea, esophagus
Muscular: Wraps infrahyoid muscle
Buccopharyngeal: Sourrounds pharynx posteriorly
What does carotid sheath sourround
Column of fascia that sourrounds Common carotid a, Internal carotid artery, Internal jugular vein, and vagus nerve
What does Alar fascia sourround
Anterior layer of prevertebral fascia, runs behind buccopharyngeal fascia
What does prevertebral fascia sourround
Sourrounds prevertebral and deep back muscles
Where is pretracheal space(between what)
Where do infections spread here?
Between trachea and infrahyoid muscle
- From thyroid cartilage to anterior mediastinum
Infections here can spread between these 2 regions (infection of thyroid cartilage can go to anterior mediastinum (thymus)).
What is the “danger”space
Prevertebral space
Where does the Prevertebral space run
DANGER zone
Between alar and prevertebral fascia
Infections can spread from scull base down to posterior mediastinum ( has thoracic duct, azygous, sympathetic chain)
Common place for inferior spread of infections.
Eating food that cuts through pharynx can go down into this space
Which muscles is the carotid sheath between
Between SCM and prevertebral muscle
What is the carotid sheath formed by
Condensations of deep cervical fascia
What does the carotid sheath encase
Carotid artery, Internal jugular veins, vagus nerves
Where do infections in the carotid sheath spread
From skull to middle mediastinum (heart)
If you have an infection in the middle mediastinum, where is it possible this began?
Carotid sheath (base of skull) can run to mid mediastinum
If you have an infection in your anterior mediastinum, where is it possible this began?
In your thyroid cartilage in the pretracheal space (runs thyroid to anterior mediastinum)
If you have an infection in your posterior mediastinum, what space is it possible this started in
The prevertebral space (runs from skull base to post mediastinum)
What is the Retropharyngeal space and what is it inbetween
Between buccopharyngeal and alar fascia
From scull base to superior mediastinum
If you have an infection in the superior mediastinum, where is it possible this began?
In the skull base in the retropharyngeal space
Where is zone 1 of the neck
Thoracic inlet to cricoid cartilage
Where is zone 2 in the neck
Cricoid cartilage to angle of mandible
Where is zone 3 in the neck
Angle of mandible to base of scull
Which muscle seperates the anterior and posterior triangles of the neck
SCM
What are the boundaries of the posterior triangle
Anterior: posterior border of SCM
Posterior: Anterior border of trapezius
Base: Clavicle
Contents: IJV, Roots of brachial plexus, accessory nerve, cervical and supraclavicular lymph nodes
Which vein is anterior to the SCM
External jugular vein
Which vein is posterior to the SCM
Internal jugular vein
Which muscle sits inbetwen the Interior and External jugular vein
SCM
Which nerve goes through the parotid gland
Facial nerve (cervical branch of facial nerve descends on anterior neck over anterior triangle)
Which superficial cutaneous nerve runs ascending directly inferior to posterior of the ear
Great auricular (C2-C3)
In the posterior triangle of the neck, describe the 5 superficial cutaneous nerves and where they travel
2 go up, 3 go down
Up:
1. Lesser occipital (C2)
2. Great auricular (C2-3)
Down:
1. Lateral supraclavicular (C3-C4).
2. Intermediate supraclavicular (C3-C4)
3. Medial supraclavicular (C3-C4)
The Transverse cervical also originates at Erb’s point, but travels transverse-anteriorly.
Where do all of the superficial nerves in the posterior triangle of the neck originate from
Erb’s point (Posterior to SCM in the posterior triangle)
Which foramen does the accessory nerve (CN 11) emerge from
jugular foramen
Which nerve emerges from the jugular foramen
Accessory nerve (CN 11)
Which nerve innervates the SCM and trapezius
Accessory nerve
Which muscles does the Accessory nerve innervate
SCM and Trapezius
Which fascia does the accessory nerve run deep to
investing fascia
Which nerve descends vertically along the anterior scalene muscle
Phrenic nerve (c3-C5)
Which 2 arteries cross the phrenic nerve anteriorly
transverse cervical a and suprascapular a
What structures are on either side of the phrenic nerve as it enters the thorax
Phrenic nerve enters thorax between the subclavian artery and vein
What does the phrenic nerve travel along to supply the diaphragm
The pericardial sac
Which nerve innervates the diaphragm
Phrenic n
Describe where vagus vs phrenic nerves are
Both run vertically down neck
Vagus is inside carotid sheath between carotid artery and carotid vein, phrneic is on top of anterior scalene (not in carotid sheath)
Vagus is slightly more anteriorly
What is inside the carotid sheath
Carotid a/v, vagus nerve between
Which nerves run deep to the anterior scalene muscle
Brachial plexus (between anterior and middle sxalene muscle)
The brachial plexus runs between which 2 muscles in the anterior triangle of the neck
Anterior and middle scalene
Which muscle does the accessory nerve run on top of
Levator scapulae
How are scalene muscles classified and when are they activated
They are secondary muscles of respiration, activated when we take a deep breath
Boundaries of anterior triangle
Anterior: Midline of neck
Posterior: Anterior border of SCM
Base: Mandible on either side
What are the boundaries of the submental triangle
Inferior: Hyoid bone
Lateral (right): Anterior belly of digastric
Lateral (Left): Anterior belly of digastric
Contents of submental triangle
Mylohyoid, submental lymph nodes
Which muscle and lymph nodes are in the submental triangle
Submental lymph nodes, mylohyoid muscle
What are the borders of the submandibular (digastric) triangle
Superior: Inferior border of mandible
Anterior/Inf: Anterior belly of Digastric
Posterior/inf: Posterior belly of digastric
Contents of Submandibular/Digastric triangle
Submandibular gland, Submandibular lymph nodes, Marginal mandibular branch of facial nerve (CN 7), Hypoglossal nerve ( CN 12), Mylohyoid n.(off mandibular branch of trigeminal), Facial artery and vein
Which triangle is the submandibular gland in
Submandibular (digastric triangle)
Borders of muscular triangle
Anterior: Midline of neck
Inferoposterior: Anterior margin of SCM
Posterosuperior: Superior belly of omohyoid
Contents of muscular triangle
Omohyoid, sternohyoid, sternothyroid, thyrohyoid
Viscera in muscular triangle
Thyroid and parathyroid glands, trachea and esophagus, common carotid/internal jugular v
Carotid triangle borders
Superior: Stylohyoid and posterior belly of digastric
Posterior: Anterior border of scm
Anterioinferior:Superior belly of omohyoid
Contents of carotid triangle
Nerves: Accessory (CN 11), Vagus (CN 10), Hypoglossal (CN 12), Ansa cervicalis (C1-C3), Laryngeal (CN 10 branches). (10+ laryngeal branches, 11, 12, C1-C3)
Arteries: Common, internal, external carotid arteries, 6 branches of external carotid (3 internal, 3 external)
Veins: All draining into IJV
Is external jugular vein anterior or posterior triangle
posterior
Which vein drains most of the face
Retromandibular vein
Which veins form the retromandibular vein
Superficial temporal (superior) and maxillary vein (face)
What makes up the anterior division of the retromandibular vein/ which vein does this drain into
Anterior division+facial vein =common facial vein, drains into internal jugular vein
What makes up the posterior division of the retromandibular vein/what does it drain into
Posterior division+posterior auricular vein= drain into external jugular vein
Which veins drain into external jugular vein
Posterior division of retromandibular vein and posterior auricular vein
What veins drain into the internal jugular vein
Anterior division of retromandibular vein and facial vein (form common facial vein and then go into internal jugular)
Which veins run superficially on top of the SCM and where do they come from
External jugular vein run superficially, Posterior division and posterior auricular make up EJ
If you have an infection in the face, how does it travel to the brain?
Could travel via retromandibular vein
Where does the transverse cervical nerve start and where does it supply superficial cutaneous innervation
Arises from erb’s point and travels anteriorly- supples skin of anterior cervical neck and lateral neck
Where does C1 go of the cervical plexus/ansa cervicalis
Joins the hypoglossal nerve and travels with it, and then splits off to let superior root join with inferior root that arose from C2/C3
Where do C2/C3 from the cervical plexus ansa cervicalis go
C2/C3 (anterior rami) make inverior root that joins superior root
What is the relationship between vagus and ansa cervicalis descending from the head?
The vagus nerve runs inside of the sheath
The ansa cervicalis runs on top of the sheath
Which muscle does the phrenic nerve run on top of in the anterolateral neck
anterior scalene
Where does the common carotid artery arise from on the L and R side
R side: Branch of brachiocephalic trunk
L side: Branch of aortic arch
What does the common carotid split into and where do those branches go?
Internal carotid: Towards brain and to circle of willis
External carotid: Many branches that go different places (3 anterior, 3 posterior)
What are the 3 anterior external carotid arteries and where do they go
Superior Thyroid- to thyroid gland
Lingual- to tongue
Facial-to mandible
What are the 3 posterior external carotid arteries
Ascending pharyngeal
occipital
posterior auricular
What does external carotid a terminate as
Superficial temporal artery and maxillary artery
Which nerve runs on top of the lingual artery
Hypoglossal crosses from posterior over it to go to anterior face
The external carotid artery branches are deep to which muscles
Deep to stylohyoid and posterior belly of digastric
What groups of muscles does the hyoid bone seperate
The suprahyoid muscles and infrahyoid muscles
What are the suprahyoid muscles
Stylohyoid
digastric
mylohyoid
geniohyoid
What are the infrahyoid muscles
omohyoid
sternohyoid
thyrohyoid
sternothyroid
What are the right and left lobes of the thyroid connected by
isthmus
Which lobe of the thyroid extends superiorly from isthmus
pyramidal lobe
Where are the parathyroid glands in relation to the thyroid gland
4 glands within the posterior surface of the thyroid
Where does R recurrent laryngeal nerve run
Under Right subclavian artery and ascends to Right lobe of thyroid
Where does the L recurrent laryngeal nerve run
Loops under aortic arch and up to L thyroid lobe
What nerve do the R and L recurrent laryngeal nerves arise from
from Vagus nerve
- R goes under subclavian to R thyroid gland
- L goes under aortic arch to L thyroid gland
If you are looking from the anterior side, are you able to see the L or R recurrent laryngeal nerve
Can see the Right side- Vagus nerve loops in front of aortic arch and when it splits it gives off branch
Left side is posterior to internal jugular and subclavian
Where does vertebral artery cross a foramen
Enters transverse foramen of C6 and superior
Runs posterior to vertebral vein and deep in the neck
Which structure runs directly posterior to the vertebral vein
Vertebral artery
Which structure arises from the subclavian artery prior to the thyrocervical trunk
the vertebral artery
What is the sympathetic chain located inbetween
Anterior to prevertebral muscle, posterior to cervical viscera
What are the 3 sympathetic ganglia found in cervical region
Superior cervical ganglion- anterior to longus capitis muscle
middle cervical ganglion- posterior to thyroid gland
cervicothoracic (stellate) ganglion ( inside thoracic inlet
Which sympathetic ganglion is anterior to longus capitus
superior cervical
which sympathetic ganglion is posterior to thyroid gland
middle cervical
which sympathetic ganglion is inside the thoracic inlet
cervicothoracic (stellate) ganglion
Which structure is the superior cervical ganglion in relation to
anterior to longus capitus m
which structure is middle cervical ganglion in relation to
sits posterior to thyroid gland
which structure is cervicothoracic (stellate) ganglion in relationship to
inside of thoracic inlet
