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NeuroEndo Test 1 > Triangles of Neck and Larynx > Flashcards

Triangles of Neck and Larynx Flashcards

1
Q

What features of the neck are at the C3-C4 level?

A

Body of the Hyoid Bone
Upper margin of Thyroid Cartilage
Bifurcation of Common Carotid artery

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2
Q

What features of the neck are at the C5-C6 level?

A

Arch of cricoid cartilage
Superior end of the esophagus
Superior end of the trachea

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3
Q

What are the borders of the Posterior Triangle?

A

Sternocleidomastoid M.
Trapezius M.
Clavicle

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4
Q

What are the borders of the Anterior Triangle?

A

Midline of the neck
Sternocleidomastoid M.
Lower border of the mandible

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5
Q

What are the 4 subdivisions of the anterior triangle? What are their borders?

A

Submandibular: anterior and posterior belly of the digastric m., inferior border of the mandible

Submental: midline of neck, anterior belly of digastric m., body of hyoid

Carotid: posterior belly of digastric, superior belly of omohyoidm., sternocleidomastoid

Muscular: body of hyoid, superior belly of omohyoid m., sternocleidomastoid m.

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6
Q

What makes up the floor of the Posterior Triangle?

A 
Covered by prevertebral deep fascia
Semispinalis capitis m.
Splenius capitis m.
Levator scapula m.
Posterior, middle, and anterior scalene Ms.
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7
Q

What covers the Posterior Triangle from superficial to deep?

A

skin -> superficial fascia -> platysma -> investing layer of deep fascia

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8
Q

What arteries are found in the Posterior Triangle?

A 
Subclavian a.
Thyrocervical trunk
Transverse cervical a. 
Dorsal Scapular a. 
Suprascapular a.
part of the occipital a.
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9
Q

How does the transverse cervical a. run in the posterior triangle?

A

Branches off thyrocervical trunks and runs superficially and laterally across phrenic n. and anterior scalene m.

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10
Q

How does the suprascapular a. run in the posterior triangle?

A

Branches off thyrocervical trunk and runs inferolaterally across ant. scalene m. and phrenic n.
Travels with suprascapular n.

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11
Q

What veins are found in the posterior triangle and what are their courses?

A

External jugular v.: begins inferior to angle of mandible by union of post. retromandibular v. with post. auricular v. anterior to SCM, drains into subclavian v.

Subclavian v.: anterior to anterior scalene m., joins internal jugular v. to form brachiocephalic v.

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12
Q

Why is the external jugular v. clinically relevant?

A

if you can see it on a patient you know there is an increase in venous pressure which can indicate heart failure or an IVC issue

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13
Q

Why is the subclavian v. clinically relevant?

A

For putting in central lines, ports for drugs/cancer

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14
Q

What nerves are found in the posterior triangle?

A

Cutaneous branches of the cervical plexus
Spinal accessory m. (CN XI): deep to SCM, enters trapezius
Roots and trunks of the brachial plexus
Phlenic n (C3, C4, C5): anterior to anterior scalene, supplies diaphragm
Ansa cervicalis (superior and inferior roots): in fascia of carotid sheath

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15
Q

What are the 4 cutaneous branches of the cervical plexus, nerve roots, and what do they innervate?

A 
Lesser Occipital (C2): skin of scalp and neck posterior to auricle
Great Auricular (C2,C3): skin and sheath over parotid gland, mastoid process, auricle and angle of the mandible
Transverse Cervical (C2,C3): skin of anterior cervical region
Supraclavicular (C3, C4): skin over the clavicle and shoulder
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16
Q

What is the course of the spinal accessory n.?

A 
Jugular foramen
Anterior Triangle
SCM
Posterior Triangle
Trapezius
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17
Q

What is Torticollis:

A

Contraction or shortening of the SCM that can cause the head to tilt towards and the face to turn away from the affected side

Can also be caused by tumor/hematoma that compresses spinal accessory

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18
Q

What are the two subtriangles of the posterior triangle? How are they divided?

A

Occipital: EJV, post. cervical plexus n., spinal acessory, trunks of brachial olexus, cerviocodrsal trunk, cervical lymph nodes

Omoclavicular (subclavian): subclavian artery, verin, supraclvaicular lymph nodes

Divided by inferior belly of the omohyoid m.

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19
Q

What are the suprahyoid muscles of the anterior triangle?

A

Mylohyoid
Stylohyoid
Digastric (ant. and post. bellies)
Geniohyoid

Form floor of oral cavity, stabilize tongue and hyoid bone, elevate larynx and hyoid when swallowing and talking

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20
Q

What are the infrahyoid/strap muscles of the anterior triangle?

A

Sternohyoid
Omohyoid
Sternothyroid
Thyrohyoid

depress hyoid and larynx

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21
Q

What arteries and branches are found in the anterior triangle?

A

Common carotid –> internal and external carotid at C3-C4
- internal carotid does not branch in neck

External carotid –> superior thyroid a., lingual a, facial a, ascending paryngeal a, occiptial a, posterior auricular a, maxillary a, superficial temporal a.

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22
Q

What are the roles of the carotid sinus and body? What are they innervated by?

A

Carotid sinus= baroreceptor (BP), in proximal part of ICA
Body= Chemoreceptor (oxygen levels), in cleft between ICA and ECA

innervated by carotid sinus nerve (branch of glossopharyngeal n. CN IX) and branches of vagus

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23
Q

What are the borders, floor, and content of the submandibular triangle?

A

Borders: inferior mandible, ant. and post. bellies of digastric

Floor: mylohyoid, hyoglossus, middle pharyngeal constrictor

Contents: submandibular gland, LNs, hypoglossal n, n. to mylohyoid, parts of facial a. and v.

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24
Q

What are the borders, floor, and content of the submental triangle?

A

Borders: body of hyoid, right and left anterior belly of digastric

Floor: mylohyoid muscles

Contents: submental LNs, small veins that unite to form anterior jugular v.

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25
Q

What are the borders, floor, and content of the muscular triangle?

A

Borders: superior belly of omohyoid, SCM, median plane of neck

Muscles: sternohyoid, sternothyroid, thyrohyoid

Contents: thyroid gland, parathyroid gland, larynx, trachea, esophagus, common carotid, superior thyroid, inferior thyroid, anterior jugular, thyroid veins, ansa cervicalis n., external laryngeal n, recurrent laryngeal n.

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26
Q

What are the borders, floor, and content of the carotid triangle?

A

Borders: superior belly of omohyoid, posterior belly of digastric, SCM

Floor: thyrohyoid, hygoglossus, middle and inferior constrictor muscles of the pharynx

Contents: carotid sheath, branches of external carotid a., internal and external laryngeal n., hypoglossal n., spinal accessory n, ansa cervicalis n.
- nerves exit through jugular foramen

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27
Q

What is contained in the carotid sheath and what makes up the borders?

A

Common Carotid a.: most anterior medial
Internal jugular vein: slightly posterior lateral
Vagus n: posterior, between artery and vein

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28
Q

What does the hypoglossal n. wrap around?

A

Wraps adjacent to occipital a. when comes out of hypoglossal canal

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29
Q

What are the branches of the Vagus n. (CN X)

A

Pharyngeal
Superior laryngeal –> Internal (sensory) and external (motor)
Carotid body branch

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30
Q

What are the branches of the external carotid artery in the carotid triangle?

A

Superior Thyroid a. -> superior laryngeal a. -> thyroid gland
Ascending Pharyngeal a. (medial branch)
Lingual a.
Facial a. –> ascending palatine a. and tonsillar a.
Occipital a.
Posterior auricular a.
Terminate into maxillary and superficial temporal in face

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31
Q

Where is the lingual a. found?

A

anterior to middle pharyngeal constrictor, deep to hypoglossal n., stylohyoid m., and post belly of digastric m., disappears deep to hyoglossus m.

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32
Q

What are the thoracic inlet and outlet? What are the contents?

A

Inlet: superior thoracic aperture where food and air may enter

Outlet: superior thoracic aperture where arteries and nerves emerge

Contents: apex of lung, subclavian a and v, brachial plexus, vagus n., phrenic n, thoracic duct, right lymphatic duct, sympathetic chain, trachea, exsophagus

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33
Q

What is the importance of the phrenic n.?

A

Sole motor supply of the diaphragm
Must be identified during thoracic surgery
Arises from the neck so patients who suffer spinal cord injuries below the beack can still breathe despite paralysis of lower limb

Lies superficial to anterior scalene

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34
Q

What makes up the cervical plexus?

A

Anterior rami C1-C4
superficial branches= sensory
- transverse cervical, great auricular, lesser occipital, supraclavicular
deep branches= motor
- hypoglossal n, phrenic n., superior (C1, C2 run with hypo) and inferior (C2, C3, innervate strap) ansa cervialis

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35
Q

What makes up the sympathetic trunk?

A

Superior cervical ganglion: C1-C2
Middle cervical ganglion: At C6 and cricoid cartilage
Inferior cervical ganglion: often fuses with 1st thoracic= stellate ganglion, anterior to transverse process of C7

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36
Q

What is in the superficial fascia?

A

Subcutaneous layer= thin connective tissue layer that lies between the dermis and investing layer of deep fascia

Contents: cutaneous nerves, blood and lymph vessels, superficial LNs, fat, and platysma m.

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37
Q

What is the action and innervation of platysma m.?

A

Facial expression

Facial N. (CN VII)

38
Q

What are the 3 layers of the deep cervical fascia?

A

Investing
Pretracheal
Prevertebral
(Carotid Sheath)

39
Q

What does the investing layer surround? What are its attachments?

A

Surrounds entire neck

Encloses SCM and trapezius muscles

Parotid and submandibular glands

Attaches to occipital and temporal bones, zygomatic arches, inferior border of mandible, hyoid bone and spinous processes of cervical vertebrae

Extends to manubrium of sternum, clavicles, and acromions and spines of the scapula

Clinically: mumps pain

40
Q

Where is the pretracheal layer found? What does it surround?

A

Only in anterior neck

Blends with pericardium of heart

Muscular layer (infrahyoid muscles), buccopharyngeal fascia, and visceral layer

41
Q

What does the prevertebral layer enclose? Where does it extend?

A

vertebral column and associated muscles

Extends laterally as axillary sheath

Extends cranial base to mediastinum

42
Q

What is the retropharyngeal space? What is its clinical significance?

A

Posterior to pharynx bound by buccopharyngeal fascia anterior, prevertebral fascia posteriorly, and carotid sheath laterally

Abscess develop secondary to lymph drainage or continuous spread of URI or oral infections –> difficulty swallowing speaking, life threatening

43
Q

Where is the thyroid located?

A

Deep to sternothyroid and sternohyoid muscles

Vertebral levels C5-T1

Isthmus anterior to 2nd-3rd tracheal rings

44
Q

What arteries supply the different parts of the thyroid gland?

A

Superior thyroid a.: anterior-superior aspects of gland

Inferior thyroid a.: posterior-inferior aspects of gland

Thyoid ima a: in 10% of people, located anterior to trachea

45
Q

What veins make up the thyroid plexus?

A

Superior, middle, and inferior thyroid veins

46
Q

What nerves are associated with the thyroid gland? What is their path?

A

Recurrent laryngeal nerves ascend in a groove between trachea and esophagus
Pass deep to the posteromedial surface of the lateral lobes of the thyroid gland

47
Q

What is the thyroid gland bound to?

A

Ligaments bind gland to trachea and cricoid cartilage of larynx

48
Q

Where is the larnyx located? What is it connected to? What is its function?

A

Vertebral levels C3-C6

Connected to the pharynx and trachea

Phonation and patent airway

49
Q

What types of cartilage makes up the laryngeal skeleton?

A 
Thyroid
Cricoid
Epiglottic
Arytenoid
Corniculate
Cuneiform
50
Q

What are the features/characteristics of thyroid cartilage?

A 
Located at C4 
Laminae
Laryngeal porminence aka Adam's apple
Superior thyroid notch
Superior and inferior thyroid horn
51
Q

What are the features/characteristics of cricoid cartilage?

A

Located at C6
Signet ring shaped
Laminae
Arch

52
Q

What are the 2 membranes of the larynx?

A

Thyrohyoid= aperture for internal branch of superior laryngeal n. and superior laryngeal a.

Cricothyroid= lateral and medial membranes

53
Q

What membrane do you go through for a cricothyrotomy?

A

Cricothyroid membrane, used to establish an airway

54
Q

What are the 2 ligaments of the larynx?

A

Thyroepiglottic (run obliquely)

Vocal (transverse)

55
Q

Describe the location of laryngeal cavity

A

Extends from the laryngeal inlet through which it communicates with the laryngopharynx to the inferior border of the cricoid cartilage

Continuous with the trachea

56
Q

Describe the location of the laryngeal vestibule

A

Between the laryngeal inlet and vestibular folds

57
Q

Describe the location of the laryngeal ventricle

A

between the vestibular and vocal folds

58
Q

Describe the location of the infraglottic cavity

A

between the vocal folds and the inferior border of the cricoid cartilage

59
Q

Describe the location of the rima glottidis

A

Space between the vocal folds

60
Q

What is the innervation and action of the cricothyroid m.?

A

External laryngeal n. (CN X)

Stretches and tense vocal ligament (especially when making high pitch)

61
Q

What is the innervation and action of the thyro-arytenoid m.?

A

Inferior laryngeal n. (from CN X, terminal part of recurrent laryngeal)

Relaxes vocal ligament (low pitch)

62
Q

What is the innervation and action of the posterior cricoarytenoid?

A

Inferior laryngeal n. (from CN X, terminal part of recurrent laryngeal)

ABducts vocal folds

63
Q

What is the innervation and action of the lateral crico-arytenoid?

A

Inferior laryngeal n. (from CN X, terminal part of recurrent laryngeal)

ADducts vocal folds

64
Q

What is the innervation and action of the transverse and oblique arytenoids?

A

ADduct arytenoid cartilages, closing posterior rima glottidis

65
Q

What muscles are involved in phonation? Whispering?

A

Lat, oblique, and transverse ADducters

Lateral and oblique ADducters

66
Q

What are the courses of the superior and inferior laryngeal arteries? What do they supply?

A

Superior: accompanies internal branch of superior laryngeal n.
Supplies superior larynx above vocal folds

Inferior: accompanies inferior laryngeal n.
supplies larynx below vocal folds

67
Q

What are the branches of the superior laryngeal n.? What do they innervate?

A

Internal branch= sensory above the vocal folds

External branch= motor, cricothyroid muscle

68
Q

What are the innervations of the internal laryngeal n.?

A

Terminal branch of recurrent laryngeal

Innervates all intrinsic muscles of the larynx except cricothyroid
Sensory below vocal folds

69
Q

How does the course of the left and right recurrent laryngeal nerves differ?

A

Left: loops under aortic arch

Right: loops under subclavian

70
Q

Where are the superficial lymph nodes found? What are the five groups?

A

Form a ring around the head

Occipital
Mastoid
Pre-auricular and parotid
Submandibular: 
Submental
71
Q

What does the occipital superficial lymph node drain?

A

posterior scalp and neck

72
Q

What does the mastoid (retro-auricular/posterior auricular) LN drain?

A

posteroalteral half of scalp

73
Q

What does the pre-auricular and parotid LNs drain?

A

anterior auricle, anterolateral scalp, upper half of face

74
Q

What does the submandibular LN drain?

A

follow facial a., drains part of gingivae, teeth, tongue, upper lip, lateral lower lip

75
Q

What does the submental LN drain?

A

part of lower lip, chin, floor of mouth, tip of tongue, lower incisor teeth

76
Q

What superficial LNs pass superficial to the cervical nodes along EJV? What pass deep?

A

Occipital and mastoid nodes

preauricular, parotid, submandibular, and submental LNs

77
Q

What are the superficial cervical LNs? What do they receive lymph from? What do they drain into?

A

Collection of nodes along the external jugular veins

Receive from posterior and posterolateral regions fo the scalp

Drain into deep cervical nodes

78
Q

What are the deep cervical LNs? How are they divided?

A

Collection of nodes along internal jugular vein

Divided into upper (superior) and lower (inferior)

  • most superior= jugulodigastric, located C3,C4 by posterior belly of digastric
  • inferior= Jugulo-omohyoid= located C6, inferior to tendon of omohyoid m.
79
Q

What does the right lymphatic duct receive lymph from? What foes the thoracic duct receive lymph from?

A

Right= right hand, forearm, arm, abdomen, neck, head

Thoracic duct= everything else including all lower limb

80
Q

What are causes of cervical pain?

A

Inflamed lymph nodes: malignant tumor in head, primary cancer in thorax or abdomen
Muscle strain
Protruding IV discs
Cervical osteoarthritis

81
Q

How can a hyoid bone be fractured? What deficits are seen?

A

Manually strangled by compression of throat
Depression of the body of the hyoid onto the thyroid cartilage –> inability to elevate the hyoid and move it anteriorly between the tongue –> swallowing and maintenance of the separation of the alimentary –> aspiration pneumonia

82
Q

What can cause paralysis of the platysma?

A

Injury to the cervical branch of the facial nerve –> cause the skin to fall away from the neck in slack folds
Need to be careful to preserve when suturing neck, have to make sure platsyma fibers aren’t contracted in different directions

83
Q

What is the course of the needle for a central line?

A

Needle punctures the skin inferior to thumb (middle of clavicle) and advance medially toward tip of index finger (jugular notch) until tip enters the right venous angle posterior to sternoclavicular joint

Need to be careful can puncture the pleura and lung causing pneumothorax
If too posterior can enter subclavian artery

84
Q

How do you preform a right cardiac catheterization?

A

Puncture IJV so can enter right brachiocephalic vein into the SVC

Sometimes have to enter EJV, not ideal because angle of subclavian vein

85
Q

How can you damage the spinal accessory nerve? What are symptom?

A

Stab, bullet, surgical procedures in lateral cervical region, tumors at the cranial base or cancerous cervical LNs, fractures of the jugular foramen

Weakness in turning head to side opposite of damage
Drooping of the shoulder because innervates trapezius

86
Q

What provides blood when the external carotid or subclavian arteries are ligated?

A

Descending branch of the occipital artery which anastomoses with the vertebral and deep cervical arteries

87
Q

What is carotid sinus hypersensitivity?

A

Exceptional responsiveness of carotid sinuses –> external pressure on carotid sinus cause slowing of heart rate, fall in BP, and cardiac ischemia –> fainting

88
Q

How do you palpate for the IJV? What side is preferred?

A

Palpate common carotid and insert the needle into IJV lateral to it at a 30 degree angle and direct inferolaterally toward the ipsilateral nipple

89
Q

What is vertebra-basilar insufficiency?

A

Blood flow to the vertebral and basilar arteries is restricted, thereby providing transient insufficient blood flow to the posterior portions of the brain
Can result in stroke or death

90
Q

What is subclavian steal syndrome?

A

Occlusion of the subclavian artery causing retrograde blood flow in the vertebral artery or the internal thoracic artery,

Arm may be supplied by blood flowing in a retrograde direction down the vertebral artery at the expense of the vertebrobasilar circulation. This is called the subclavian steal.

NeuroEndo Test 1 (14 decks)

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