Triangles of Neck & Larynx (Part 2) Flashcards by Staci Thomas

This is what anatomists may reference as the Superior Thoracic Aperture and is where food and air may enter.

Thoracic Inlet

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This is what clinicians reference as the Superior Thoracic Aperture where arteries and nerves emerge.

Thoracic Outlet

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What are the contents of the Thoracic Outlet or Inlet?

Apex of lung
Subclavian A. and V. 
Brachial Plexus
Vagus N.
Phrenic N.
Thoracic Duct
Right Lymphatic Duct 
Sympathetic Chain
Trachea 
Esophagus

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This is the term for when the Inferior Trunk of the Brachial Plexus is affected because it is compressed on the 1st rib. It can cause pain in hands (sensory via C8 and T1).

Thoracic Outlet Syndrome

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Explain why you have to be careful when inserting a central IV line.

The central is normally placed into the Subclavian V. If you go deep to this, you’ll hit the Subclavian A. and if you go even deeper than that you can hit the lung. This can cause a pneumothorax.

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Why could I get a pneumothorax is someone stabs me right above my clavicle?

Because the lungs extend 2 inches into the root of the neck, so you could hit a lung.

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What nerve supplies the thorax and abdomen?

Vagus N. (CN X)

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What nerve supplies the diaphragm for breathing and must be identified carefully during thoracic surgery and preserved?

Phrenic N.

***C3, 4, and 5 keep the diaphragm alive!

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Why can a person who suffered a spinal cord injury in the thoracic vertebrae or lower still be able to breathe?

Because the Phrenic N. arises from the neck, so injuries below this point will still allow the person to breathe despite any paralysis of the lower limbs.

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What does the Phrenic N. lie superior to?

Anterior Scalene M.

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What rami are involved in the Cervical Plexus?

Anterior rami of C1-C4

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Superficial branches of the Cervical Plexus are (MOTOR/SENSORY) while the deep branches are (MOTOR/SENSORY).

Sensory

Motor

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What nerve is the Cervical Plexus running directly next to?

Hypoglossal N. (CN XII)

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This extends superiorly all the way to C1 or the base of the skull. In the cervical region, it has Superior, Middle, and Inferior Cervical Ganglion.

Sympathetic Trunk

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This cervical ganglion is located at C1-C2.

Superior Cervical Ganglion (C2-3)

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The Middle Cervical Ganglion (C6) is located at ______ at the level of the _______ _______. This is the smallest of the cervical ganglion and may be absent.

Cricoid Cartilage

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The Inferior Cervical Ganglion (C7-T1) is located anterior to what?

Transverse process of C7

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In 80 percent of people, the Inferior Cervical Ganglion fuses with the 1st Thoracic Ganglion and is called the…

Stellate Ganglion

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Sympathetics from the cervical ganglion travel on these because they lie very close to the ganglion.

Carotid arteries

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This disease is caused by damage to the sympathetic nerves of the face. It results in constriction of the pupils, ptosis, and anhidrosis (no sweating) on the face.

Horner’s Syndrome

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This is a thin CT layer that lies between the dermis and investing layer of deep cervical fascia.

Subcutaneous Layer

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What are the contents of the Subcutaneous Layer?

Cutaneous Nerves
Blood and Lymphatic vessels 
Superficial LNs
Fat
Platysma M.

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This is a muscle of facial expression that is innervated by the Facial N. (CN VII). It lies within the Subcutaneous Layer.

Platysma M.

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What are the three layers of the Deep Cervical Fascia?

Investing Layer
Pretracheal Layer
Prevertebral Layer

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This is the most superficial layer of the Deep Cervical Fascia and surrounds the entire neck.

Investing Layer

This layer of the Deep Cervical Fascia is located only in the anterior region of the neck and blends with the pericardium of the heart to the mediastinum.

Pretracheal Layer

What does the Investing Layer of Deep Cervical Fascia enclose?

SCM Trapezius M. Parotid Glands Submandibular Glands

This disease is very painful because it can cause swelling in the cheek region with glands. The fascia around these glands is unrelenting and causes a lot of pain because of the pressure.

Mumps

This layer of the Deep Cervical Fascia has a muscular layer over infrahyoid muscles, buccopharyngeal fascia, and a visceral layer.

Pretracheal Layer

This layer of the Deep Cervical Fascia encloses the vertebral column and its associated muscles.

Prevertebral Layer

The Prevertebral Layer of the Deep Cervical Fascia extends laterally as the _______ _______ into the arm, and extends from the cranial base to the mediastinum (heart).

Axillary Sheath

Depending on its location, this can blend with any of the layers of the Deep Cervical Fascia. It houses the IJV, Common Carotid A., and Vagus N.

Carotid Sheath

What structures are located directly outside the Carotid Sheath?

Phrenic N. | Sympathetic Trunk

This is embedded in within the sheath of the Carotid Sheath.

Ansa Cervicalis

This component within the Carotid Sheath lies the most anterior and medial.

Common Carotid A.

This component within the Carotid Sheath lies anterior and lateral.

Internal Jugular V.

This component within the Carotid Sheath lies posteriorly.

Vagus N.

This lies posterior to the Pharynx, bound by the Buccopharyngeal Fascia anteriorly, the Prevertebral Fascia posteriorly, and the Carotid Sheaths laterally.

Retropharyngeal Space

T/F. The Retropharyngeal Space extends superiorly to the base of the skull and inferiorly to the mediastinum. If an infection occurs within this space, it can spread all the way superiorly or inferiorly to these areas.

True

Retropharyngeal abscesses develop secondary to what?

Lymphatic drainage | Spread of upper respiratory or oral infections

What can swelling in the Retropharyngeal Space from an abscess cause?

Difficulty in swallowing and speaking | Life threatening

This structure lies deep to the Sternothyroid M. and Sternohyoid M. at vertebral levels C5-T1.

Thyroid Glands

The Thyroid Glands are connected via the ________ which lies anterior to the 2nd-3rd tracheal rings.

Isthmus

What arteries supply the Thyroid Gland?

Superior Thyroid A. Inferior Thyroid A. Thyroid Ima A.

This artery is from the External Carotid A. and supplies the anterior-superior aspects of the gland.

Superior Thyroid A.

This artery is from the Thyrocervical Trunk and supplies the posterior-inferior aspects of the gland.

Inferior Thyroid A.

This artery is found in 10 percent of people, and is located anterior to the trachea.

Thyroid Ima A.

What veins are involved with the Thyroid Gland?

Superior Thyroid V. Middle Thyroid V. Inferior Thyroid V.

The Superior, Middle, and Inferior Thyroid Vs. form what?

Thyroid Venous Plexus

The Superior Thyroid V. and Middle Thyroid V. drain into what?

Internal Jugular V.

The Inferior Thyroid V. drains into what?

Brachiocephalic V.

These nerves ascend in a groove between the trachea and esophagus, and pass deep to the posteromedial surface of the lateral lobes of the Thyroid Gland. Have to be very careful of this nerve when performing Thyroid surgery.

Recurrent Laryngeal Ns.

Ligaments bind the Thyroid Glands to what?

``` Trachea Cricoid Cartilage (of Larynx) ```

Why does the Thyroid move when swallowing?

Because it's attached to the cartilage via fascia, so it moves up and down with it when you swallow. ***LNs do NOT move when swallowing!!!

What do we need to watch out for when placing a Tracheostomy?

Thyroid Venous Plexus and the Thyroid Ima A. because they lie anterior to the Isthmus and trachea, and can be injured.

These lie within the posterior lateral lobes of the Thyroid Glands.

Parathyroids

This is located at vertebral levels C3-6 and is connected to the Pharynx and Trachea. It functions in phonation and patent airway.

Larynx

This part of the Larynx is located at C4 and contains the Laryngeal Prominence (Adam's Apple).

Thyroid Cartilage

This part of the Larynx is located at C6 and is shaped like a signet ring.

Cricoid Cartilage

The Thyrohyoid Membrane (stretches from Thyroid Cartilage to Hyoid Bone) contains an aperture for what?

Internal Laryngeal N. (branching off Superior Laryngeal N.) | Superior Laryngeal A.

The Cricothyroid Membrane has a medial and lateral aspect. The lateral aspect stretches up to what ligament?

Vocal Ligament

Air passes in through the nasal cavities to the _________, and air, food, and liquids pass in through the oral cavity to the _________. If it's air, it'll continue into the _________ via the inlet. If it's food it'll continue into the _________ then the esophagus.

Nasopharynx Oropharynx Larynx Laryngopharynx

This extends from the Laryngeal Inlet, through which it communicates with the Laryngopharynx, to the inferior border of the Cricoid Cartilage. It is continuous with the Trachea.

Laryngeal Cavity

This lies between the Laryngeal Inlet and the Vestibular Folds.

Laryngeal Vestibule

This lies between the Vestibular and Vocal Folds.

Laryngeal Ventricle

This is between the Vocal Folds and the inferior border of the Cricoid Cartilage.

Infraglottic Cavity

This is the open space between the Vocal Folds.

Rima Glottidis

This is made of the lateral Cricothyroid membrane and Vocal Ligament, and gives structure and flexibility.

Conus Elasticus

The Vestibular Folds consist of the _______ _______ coated in mucosa. They are also known as the _______ Vocal Cords.

Vestibular Ligament | False

The Vocal Folds consist of the _______ _______ coated in mucosa. They are also known as the _______ Vocal Cords.

Vocal Ligament | True

This muscle abducts the Vocal Folds, and if it doesn't work you won't be able to breathe.

Posterior Cricoarytenoid M.

This muscle pulls the Thyroid Cartilage anteriorly and tenses the Vocal L., causing a high-pitched voice.

Cricothyroid M.

What innervates the Cricothyroid M.?

External Laryngeal N. ***Branch of Superior Laryngeal N. off of CN X

This muscles relaxes the Vocal L., creating a low-pitched voice.

Thyroarytenoid M.

What innervates the Thyroarytenoid M.?

Inferior Laryngeal N. ***Terminal part of Recurrent Laryngeal N. from CN X

These muscles adduct the Vocal Folds, which is important during phonation.

Lateral Cricoarytenoid M. Transverse Arytenoid M. Oblique Arytenoid M. ***All innervated by Inferior Laryngeal N.

What Laryngeal muscles are used for whispering?

Lateral Cricoarytenoid M. | Oblique Arytenoid M.

What Laryngeal muscles are used for forced respiration?

Posterior Cricoarytenoid M.

This artery accompanies the Internal Laryngeal N. and supplies the superior Larynx above the Vocal Folds.

Superior Laryngeal A. ***Remember, this and the Internal Laryngeal N. go through aperture in the Thyrohyoid Membrane!

This artery accompanied the Inferior Laryngeal N. and supplies the inferior Larynx below the Vocal Folds.

Inferior Laryngeal A.

The Superior Laryngeal N. branches into what? What are their functions?

Internal Laryngeal N. -- sensory above Vocal Folds | External Laryngeal N. -- motor to Cricothyroid M.

This is the terminal branch of the Recurrent Laryngeal N. and is sensory and motor. It is motor to all intrinsic muscles of the Larynx except the Cricothyroid M., and is sensory below the Vocal Folds.

Inferior Laryngeal N.

In the superficial LNs of the head, there are five groups that form a ring around the head. They drain the face and scalp. What are they?

``` Occipital LNs Mastoid (Retro-auricular/Posterior Auricular) LNs Pre-auricular and Parotid LNs Submandibular LNs Submental Las ```

Drainage from the Occipital LNs and Mastoid LNs pass to what LNs?

Superficial Cervical LNs (along the EJV)

Drainage from the Pre-auricular LNs and Parotid LNs, Submandibular LNs, and Submental LNs pass to what LNs?

Deep Cervical LNs

These LNs drain the posterior scalp and neck.

Occipital LNs

These LNs drain the posterolateral half of the scalp.

Mastoid LNs

These LNs drain the anterior auricle, anterolateral scalp, and upper half of the face.

Pre-auricular and Parotid LNs

These LNs follow the Facial A. and drains part of the gingivae, teeth, tongue, upper lip, and lateral lower lip.

Submandibular LNs

These LNs drain the center part of the lower lip, chin, floor of mouth, tip of tongue, and lower incisor teeth.

Submental LNs

This is a collection of LNs along the EJVs. They receive lymph from the posterior and posterolateral regions of the scalp and will eventually empty into the Deep Cervical LNs.

Superficial Cervical LNs

This is a collection of LNs along the IJVs. They are divided into upper (superior) and lower (inferior) nodes.

Deep Cervical LNs

This is the most superior node in the Upper Deep Cervical LNs. It is located at C3-4 near the Posterior Belly of Digastric M.

Jugulodigastric LN ***Receives a lot of lymph from throat and tonsils!

This node is associated with the Lower Deep Cervical LNs. It is located at C6 inferior to the tendon of Omohyoid M.

Jugulo-omohyoid LN

All lymph draining from the right side of the head, right chest, and right arm will all eventually go into the ________ ________ ________, while everything else will eventually go into the ________ ________.

Right Lymphatic Duct | Thoracic Duct