Triangles of Neck Brauer Flashcards
Subcutaneous layer of fascia
Thin CT btw dermis and investing layer of deep cervical fascia. Contains: Sensory nerves Blood and lymph Superficial lymph nodes fat platysma
What are the major land marks in the neck?
- C7
- Hyoid bone at level C3-4
- Thyroid and Cricoid cartilages C6 is cricoid level
- Clavicle sternum and manubrium are also landmarks
What are the superficial cutaneous nerves arising from the cervical plexus?
- Lesser occipital C2,C3
- Runs along border of SCM relaying scalp sensory info
- Transverse Cervcial C2,C3
- supplies skin over anterior triangle crosses SCM
- Greater Auricular C2, C3
- runs with EJV on SCM supplies posterio auricle and area from mandiblular angle to mastoid process
- Supraclavicular C3,C4
- supplies root of neck in clavicle acromnion and sternum
Investing fascia of the neck?
Most superficial layer surrounding the entire neck enclosing the SCM and traps as well as parotid gland and submandibualr gland
Pretracheal fascia?
In anterior neck and blends with pericardium. It contains the infrahyoid muscles and buccopharyngeal fascia
Prevertebral fascia?
Encolses vertebral column and associated muscles. Extends laterally as axillary sheath
Carotid sheath?
Covers carotids IJV and vagus
Retropharynegeal space?
Posterio to pharynx and esophagus bounded by buccopharyngeal and prevertebral fascia and carotid sheath. Extends from base of skull to mediastinum. Permits movemnt of pharynx larynx and esophagus during swallowing.
Easy route for upper respiratory infections or oral infections to spread
Posterior triangle borders and division of the triangle and contents?
- Anterior border is posterior border of the SCM
- Posterior border is anterior border of trapezius
- Inferior border is clavicle
Contents:
- Spinal accessory
- Lesser occipital
- Greater Auricular
- Transverse cervical
- Suprascapular
- EJV and suprascapular artery
- Subclavian artery
- Occipital artery
Broken into two triangles
- Occipital triangle: inferior belly of omohyoid is inferior border, Anterior and posterior border is same as post triangle
- Supraclavicular triangle: Inferior belly of omohyoid is superior border, SCM is anterior border and inferior border is clavicle
Prevertebral muscles
- Posterior scalene: posterior tubercles of C5-C7 to 2nd rib elevate ribs during inspiration
- Middle scalene: posterior tubercles of C2-C7 to superior 1st rib elevate ribs inspiration
- Anterior scalene: anterior C3-C6 to 1st rib
- Longus capitis and coli: btw verte4bral bodies and TP of cervical vertebrae
- Recctus capitis lateralis and anterior: complememtary to rectus capitis posterior and obliquus capitis
- All of these are posterior to retropharyngeal space and innervated by cervical plexus or brachial
SCM actions
- Bilaterally flexes the neck
- With neck extensors protrudes head and thrusts it forwared
- Uniliaterally laterally flexes head rotates head and neck so ears go to shoulders on same side, turns chin opposite tilts head one side
Congenital torticollis
fibrous tissue tumor within SCM that develops in utero. It will cause the head to turn to the side and face to turn away from the affected side shortening the SCM.
Muscular torticollis?
SCM Injured during birth tearing the fibers leading to hematoma which develops into a fibrotic mass entrapping CN11. May require surgical detaching of SCM.
Where does CN 11 exit and travel
Exits jugular foramen and lies posterior to SCM nad then emerges along posterior margin of SCM to cross posterior triangle to innervate trapezius.
What makes up the inferior root of the ansa cervicalis and superior root?
Where is the root located?
- Inferior root: C2-C3
- Superior root: C1
Loop lies anterolateral to levator scapuolae and middle scalenes
Describe the phrenic nerves route
- Runs anterior to surface of anteior scalene
- Descends obliquely with IJV deep to prevertebral fascia
- Posterior to suprascapular and transverse cervicacl artery
- Runs posterior to subclavian vein and anterior to internal thoracic
Subclavian artery
- First part is medial to anterior scalene
- Branches into internal thoracic and avertebral arteryies and thyrocervical trunk
- Thyrocervical trunk is anterior to phyrenic nerve
- Branches into internal thoracic and avertebral arteryies and thyrocervical trunk
- Second part is behind anterior scalene
- gives off costocervical trunk superior interecostal and deep cervical arteries
- Third part is lateral to anterior scalene anterior to brachial plexus wihitinn post triangle
- dorsal sscapular artery
Anterior triangle borders and contents?
- Midline mandible and SCM
Submandibular triangle suprahyoid region within the anterior triangle borders and contnents?
- Myohyoid
- Mylohyoid nerve branch of V3
- Geniohyoid
- Innervated by C1
- Digastric
- Submandibular gland
Contents of submandibular digastric triangle?
- submandibiular lymph nodes hypoglossal nerve facial artery vein and subman gland
Submental triangle contents?
- submental lymphnodes and small veins that form anterior jugular
carotid triangle contents?
- carotid artery
- IJV
- ECA
- hypoglossal nerve and spinal accessory
- Superior root ansa cervicalis
- thyorid gland larynx pharyonx deep cervical llymph nodes
- brachial plexus branches
Muscular omotracheal triangle contents
sternothyroid and sternohyoid muscles thyoroid and parathyroid glands
Wht are the infrahyyoid muscles?
- Sternohyoid: depresses hyoid after elevation due to swallowing innervated by ansa cervicalis
- Omohyoid: depress retract and steady hyoid, innervated ansa ccervicalis
- Sternothyroid: depress thyroid cartilage and pulls hyoid down
- Thyroihyoid: depress hyoid elevates larynx inervated by C1 via hypoglossal
What does the ansa cervicalis innervate?
Infrahyoid muscles and geniohyoid muscle
Superior loop from C1 and inferior loop from C2-3
What arteries are found in the Anterior triangle
- ICA
- ECA
- Carotid sinus which is found at the bifurcation of the two
What are the branches of the ECA?
- Superior thyroid
- Ascending pharyngeal
- Lingual
- Facial
- Occipital
- Posterior Auricular
- Maxillary
- Superficial temporal
What are the paired layngeal cartilages?
- Arytenoid vocal cords attach here
- Corniculate
- Cuneiform
What are the unpaired laryngeal cartilages?
- Thyroid
- Epiglottis
- Cricoid
Where do vocal cords run? How is sound produced, how is tension regulated?
Betwee nthyroid and arytenoid cartilages and generate sound by vibrating when air passes
Vagus nerve regulates tension
Ventricular folds?
False vocal folds brought together when holding breath
Laryngeal innervation?
- Superior laryngeal nerve from the vagus
- Inferior laryngeal nerve which is a terminal branch of the recurrent laryngeal nerve, gives motor to intrinsic mucsles
Thyroid blood supply?
- Superior thyroid from ECA
- Inferior thyroid from thyrocervical trunk
- Parallel veins
Laryngeal blood suppply?
- Superior laryngeal artery from superior thyroid artery
- Inferior laryngeal artery from inferior thyroid artery
Describe the superior cervical ganglia?
- Level of c1/2 post synaptic fibers form internal carotid periarterial plexus to the head
- Sends fibers to cervical plexus also cardiopulmonary
Middle cervical ganglia?
- May be absent
- lies over inferior thyroid artery at level of cricoid cartilage
- Distributed by the periarterial plexes and cardiopuolmomary splanchnic nerves
INfeior ganglion?
- Lies anterior to TP of C7 supeior to neck of 1st rib
- Some post gang fibers enter brachial plexus others go to heart some go to periarterial plexus of vertebral artery
There IS/IS NOT white rami in the neck?
Is not
FIbers will pass to cervical spinal nerves via gray rami or leave as splanchnic into thorax
