Triangles of the Head and Neck

Question 1

What is present at vertebral level C3-C4?

Answer 1

Body of hyoid bone, upper margin thyroid cartilage, bifurcation of common carotid artery

Question 2

What is present at vertebral level C5-C6?

Answer 2

Arch of cricoid cartilage, superior end of esophagus, superior end of trachea

Question 3

What is another name for the posterior triangle?

Answer 3

Lateral cervical region

Question 4

What are the borders of the posterior triangle?

Answer 4

SCM, trapezius, clavicle

Question 5

What are the borders of the anterior triangle?

Answer 5

SCM, midline of neck, lower border of mandible

Question 6

What triangles are found in the anterior triangle?

Answer 6

Submandibular, submental, carotid, muscular

Question 7

What are the borders of the submandibular triangle?

Answer 7

Anterior belly of digastric, posterior belly of digastric, inferior border of mandible

Question 8

What are the borders of the submental triangle?

Answer 8

Midline of neck, anterior belly of digastric, body of hyoid

Question 9

What are the borders of the carotid triangle?

Answer 9

Posterior belly of digastric, superior belly of omohyoid, SCM

Question 10

What are the borders of the muscular triangle?

Answer 10

Body of hyoid, superior belly of omohyoid, SCM

Question 11

What muscles make up the floor of the posterior triangle?

Answer 11

Splenius capitus, levator scapulae, posterior/middle/anterior scalene

Question 12

What are the branches off the subclavian artery?

Answer 12

Vertebral a, internal thoracic a, thyrocervical trunk (suprascapular a, transverse cervical a, inferior thyroid a), costocervical trunk (supreme intercostal a, deep cervical a), dorsal scapular a

Question 13

What are the divisions of the subclavian artery?

Answer 13

I - vertebral a, internal thoracic a
II - (under anterior scalene m) costocervical trunk
III - dorsal scapular a

Question 14

What arteries off the subclavian are located in the posterior triangle?

Answer 14

Transverse cervical a and suprascapular a (both off the thyrocervical trunk)

Question 15

What veins are located in the posterior triangle?

Answer 15

External jugular vein (retromandibular v + posterior auricular v) and subclavian vein (joins with internal jugular vein to form brachiocephalic vein)

Question 16

Clinically, what does it mean if you can see the external jugular vein?

Answer 16

Increased venous pressure = heart failure or obstruction of SVC

Question 17

Why is the subclavian vein clinically relevant?

Answer 17

Used for central lines

Question 18

What cutaneous nerves are located in the posterior triangle? What is this location called clinically?

Answer 18

Cervical plexus cutaneous nerves - lesser occipital, great auricular, transverse cervical, supraclavicular. Erb’s point.

Question 19

What are the nerve roots of the posterior triangle cutaneous nerves?

Answer 19

Lesser occipital - C2
Great auricular - C2, C3
Transverse cervical - C2, C3
Suprascapular - C3, C4

Question 20

What other nerves are located in the posterior triangle?

Answer 20

Spinal accessory nerve (CN XI), phrenic nerve, roots of brachial plexus, ansa cervicalis

Question 21

What is the most common nerve that is accidentally cut?

Answer 21

Spinal accessory nerve (CN XI)

Question 22

What does CN XI innervate?

Answer 22

SCM and trapezoid m

Question 23

Where does CN XI lie?

Answer 23

Deep to SCM

Question 24

What are the nerve roots of phrenic nerve?

Answer 24

C3, 4, 5 keep the diaphragm alive

Question 25

Where does the phrenic nerve lie?

Answer 25

Anterior to anterior scalene m

Question 26

Where does the brachial plexus exit?

Answer 26

Between anterior and middle scalene muscles

Question 27

What arteries lie superficial to the phrenic nerve?

Answer 27

Transverse cervical a and suprascapular a

Question 28

What does the ansa cervicalis n innervate?

Answer 28

Infrahyoid muscles

Question 29

Where does the ansa cervicalis lie?

Answer 29

In the fascia of the carotid sheath

Question 30

What is torticollis?

Answer 30

Contraction of SCM causing head to tilt and face to turn AWAY from affected side

Question 31

What are the triangles located in the posterior triangle?

Answer 31

Occipital triangle and omoclavicular (subclavian) triangle

Question 32

What are the suprahyoid muscles and what do they do?

Answer 32

Anterior/posterior bellies of digastric m, mylohyoid m, stylohyoid m (straddles posterior belly of digastric m), and geniohyoid muscle. Elevate the hyoid bone and larynx during swallowing and phonation

Question 33

What are the infrahyoid (strap) muscles?

Answer 33

Sternohyoid m, omohyoid m, sternothyroid m, thyrohyoid m

Question 34

What innervates the infrahyoid muscles?

Answer 34

Branches of the ansa cervicalis

Question 35

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

Answer 35

Superior thyroid a, lingual a, facial a, ascending pharyngeal a, occipital a, posterior auricular a (Seven Angry Ladies Fighting Over PMS)

Question 36

What are the contents of the submandibular triangle?

Answer 36

Submandibular gland, submandibular lymph nodes, hypoglossal n (CN XII), nerve to mylohyoid, facial a/v

Question 37

Where does the hypoglossal n lie?

Answer 37

On the hyoglossus m

Question 38

What are the contents of the submental triangle?

Answer 38

Submental lymph nodes, veins that unite to form anterior jugular vein

Question 39

What are the contents of the muscular triangle?

Answer 39

Thyroid , parathyroid glands, larynx, trachea, esophagus, common carotid a, superior thyroid a, inferior thyroid a, anterior jugular v, thyroid veins, ansa cervicalis, external laryngeal n, recurrent laryngeal n

Question 40

What are the contents of the carotid triangle?

Answer 40

Carotid sheath, external carotid a branches, internal/external laryngeal n, hypoglossal n, spinal accessory n, ansa cervicalis

Question 41

What does the carotid sheath contain (and in what order)?

Answer 41

Internal/common carotid arteries (medial) IJV (lateral) Vagus n (posterior) Ansa cervicalis (anterior/embedded in sheath) (plus deep cervical lymph nodes, carotid sinus n, and sympathetic nerve fibers)

Question 42

Where does the carotid sheath go?

Answer 42

Base of skull to mediastinum in thorax

Question 43

Hypoglossal n wraps around what artery in the carotid triangle?

Answer 43

The occipital a

Question 44

What does the superior laryngeal n branch into?

Answer 44

Internal laryngeal n and external laryngeal n (in the carotid triangle)

Question 45

What innervates the carotid sinus and carotid body?

Answer 45

Carotid sinus n (and vagus n)

Question 46

What structures exit the jugular foramen?

Answer 46

Glossopharyngeal n (CN IX), vagus n (CN X), and spinal accessory n (CN XI)

Question 47

With thoracic outlet syndrome, if the brachial plexus is compressed what happens?

Answer 47

Sensory loss to hand (ulnar n: C8-T1) (inferior trunk of brachial plexus)

Question 48

How far does the lung extend into the root of the neck?

Answer 48

About 2 inches

Question 49

What innervates the carotid sinus?

Answer 49

The superior cervical ganglion///the carotid sinus n from the glossopharyngeal n (CN IX)

Question 50

What layer of fascia does the platysma muscle lie in?

Answer 50

Subcutaneous layer between the dermis and investing layer of deep cervical fascia

Question 51

What are the layers of the deep cervical fascia?

Answer 51

1. Investing layer 2. Pretracheal layer 3. Prevertebral layer

Question 52

Which layer of fascia blends with the pericardium of the heart?

Answer 52

The pretracheal layer of deep cervical fascia

Question 53

Which layer of fascia extends laterally as the axillary sheath into the arm?

Answer 53

The prevertebral layer of deep cervical fascia

Question 54

What are the borders of the retropharyngeal space?

Answer 54

Buccopharyngeal fascia (anterior), prevertebral fascia (posterior), carotid sheaths (laterally)

Question 55

Within the carotid sheath, where are the vagus nerve, IJV, and common carotid artery usually located?

Answer 55

Vagus nerve - posterior IJV - anterior/lateral Common carotid artery - anterio/medial

Question 56

What artery and nerve run into the thyrohyoid membrane together?

Answer 56

Internal branch of superior laryngeal nerve and superior laryngeal artery

Question 57

Which muscle of the larynx is an abductor? Which are adductors?

Answer 57

Posterior crico-arytenoid muscle is an abductor. | Transverse arytenoid, oblique arytenoid, and lateral crico-arytenoid muscles are adductors.

Question 58

What do the two branches of superior laryngeal nerve do?

Answer 58

Internal laryngeal nerve (sensory) innervates sensory above vocal folds. External laryngeal nerve (motor) innervates the cricothyroid muscle

Question 59

Where does larynx end and trachea begin?

Answer 59

At cricoid cartilage

Question 60

Line through laryngeal ventricle at vocal folds separates lymph, blood supply, and innervation how? (above vs below)

Answer 60

Above: lymph = superior deep cervicals, blood = superior laryngeal a, sensory = internal branch of superior laryngeal n Below: lymph = pretracheal and prelaryngeal to inferior deep cervicals, blood = inferior laryngeal a, sensory = inferior laryngeal n (from recurrent laryngeal n)

Question 61

What are the five groups of lymph nodes in the head?

Answer 61

Occipital, mastoid, pre-auricular/parotid, submandibular, submental

Question 62

Where are the superficial cervical LNs found vs the deep cervical LNs?

Answer 62

Superficial cervical LNs are along the EJV, deep cervical LNs are along the IJV

Question 63

What does the R lymphatic duct drain?

Answer 63

R head, R neck, R chest, RUE

Question 64

What does the thoracic duct drain?

Answer 64

L head, L neck, L chest, LUE, abdomen, pelvis, perineum, BLE