Triangles of the Neck 2 Flashcards
What nerves are found in the carotid triangle?
Glossopharyngeal IX vagus X accessory XI Hypoglossal XII Ansa Cervicalis Transverse Cervical
What makes up the muscular triangle? (anterior neck)
thyroid and parathyroid glands and the hyoid bone
This nerve found in the carotid triangle exits though the jugular foramen and descends between IJV and ICA, deep to the styloid process and muscles attached to it. It then proceeds forwards between ECA and ICA and curves around the lateral border of stylopharyngess muscles anterior and deep to hypoglossus until it reaches the base of the tongue
Glossopharyngeal nerve IX
Glossopharyngeal nerve provides 3 branches. What are they?
motor: stylopharyngeus muscle
sensory: pharynx
carotid sinus
This nerve found in the carotid triangle exits through the jugular foramen between IX and XI cranial nerves. In the carotid sheath, it descends medial to IJV and posterior to ICA and CCA.
Vagus nerve X
The vagus nerve provides 4 branches in the anterior triangle. What are they?
motor to pharynx
carotid body
superior laryngeal nerve
cardiac branch
This nerve found in the carotid triangle exits through jugular foramen and descends medial to IJV and then travels between IJV and ICA then crosses lateral to IJV to pass downwards and backwards to disappear under sternomastoid muscle traversing the floor of the posterior triangle and then disappearing under the trapezius. It provides no branches in the anterior triangle.
Accessory Nerve XI
This nerve exits the cranial cavity through the hypoglossal canal. At first it lies medial to IJV and ICA and then it travels outward between IJV and ICA and then courses forwards hooking around occipital artery, crossing lateral to ICA, ECA and Lingual artery. It then goes deep to posterior belly of digastric and stylohyoid muscle and then superficial to hypoglossus and then deep to mylohyoid muscles. It provides no branches in the anterior triangle. It supplies the tongue.
hypoglossal nerve XII
This is a loop of nerve fibers in front of the carotid sheath. It arises form C1-3 and innervates strap muscles except thyrohyoid muscle
ansa cervicalis
The superior root of ansa cervicalis supplies what?
upper parts of sternohyoid and sternothryoid; superior belly of omohyoid
note: inferior root supplies lower parts of sternohyoid and sternothryoid and inferior belly of omohyoid
This nerve found in the carotid triangle arises from anterior rami of C2-C3. It emerges from the posterior border of sternomastoid in the posterior triangle. It then loops around it to cross its anterior surface in a transverse direction to the anterior triangle giving cautious innervation to such are of skin.
Transverse Cervical nerve
The thyroid gland lies in the __ compartment of the neck together with trachea, esophagus. It is covered by ____ fascia
3rd (visceral); pretraceal
The thyroid gland is connected to the hyoid bone by an embryological remnant made of fibromuscular band called what?
levator glandulae thryoidae
The isthmus of the thyroid gland lies opposite the ___ and ___ tracheal rings
2nd; 3rd
In regards to arterial supply to the thyroid gland, the superior thyroid artery from the ECA is accompanied by the ___ ____ nerve to the superior pole of the lateral lobes of the thyroid gland
external laryngeal
The superior thyroid artery branches into what?
anterior and posterior glandular branches
In regards to arterial supply to the thyroid gland, the inferior thyroid artery is from the thyrocervical trunk and is accompanied by the ___ ____ nerve
recurrent laryngeal
The inferior thyroid artery branches into what?
inferior branch: supplies inferior pole and lateral lobes; anastomoses with posterior branch of superior thyroid
ascending branch: supplies parathyroid glands
In regards to arterial supply to the thyroid gland, the ___ ___ artery is form the arch of aorta or brachiocephalic trunk and supplies the isthmus
thryoida ima
The superior thyroid vein joins IJV and cranes the area supplied by what artery?
superior thyroid artery
The middle thyroid vein joins IJV and drains what?
the rest of the thyroid gland
The inferior thyroid vein joins left innominate vein and drains what?
the isthmus
The thyroid gland is an endocrine gland that developed as pharyngeal floor outgrowths at the base of ___
tongue - migrates caudally to front of neck
The ___ ___ indicates the thyroid gland’s site of origin and the ___ duct marks its way of passage during migration
foramen cecum; thyroglossal
The thyroglossal duct usually disappears during development but abnormal arrest of migration may leave remnants which form cysts, fistulas, or aberrant thyroid tissue anywhere through the path of migration form ___ to ___ lobe
tongue; pyramidal
During a thyroidectomy, which nerve needs to be considered with caution
recurrent laryngeal - found near the gland
injury causes hoarseness
When is a thyroidectomy needed?
Goiter or malignancies
During a thyroidectomy, the part of the thyroid gland in which parathyroid glands are embedded, should be left in place so as not to disturb ___ metabolism
calcium
During a thyroidectomy, injury of ____ trunk or nerves in the carotid sheath should be avoided
sympathetic
What indicates a diagnosis for ectopic thyroid tissue?
feeling midline mass and an ultrasound
Thyroid pathology should show thyroid function - secretion of T3 and T4 hormones. Describe what happens to the levels of these hormones in Myxedema and Grave’s disease
Myxedema: atrophy of gland (decreased secretion)
Grave’s disease: increased secretion
In regards to enlargement of the gland, ____ ____ is the most common. It presents as a diffuse mass in the neck and thyroid hormone levels are usually normal
multinodular goiter
Describe what happens in Hashimoto Disease
body produces antibodies against thyroid tissue
What artery supplies the superior and inferior parathyroid gands
Inferior thyroid artery
The larynx is found ___ to the hyoid. The pharynx is found ___ to the hyoid.
inferior; posterior
What are the boundaries of posterior triangle of the neck? anterior: posterior: inferior: apex:
anterior: sternomastoid
posterior: trapezius
inferior: middle 1/3 of clavicle
apex: occipital bone
The posterior triangle is divided by the inferior belly of omohyoid muscles into 2 smaller triangles. What are they?
occipital triangle, supraclavicular triangle
What vein pierces the roof of the posterior triangle of the neck?
external jugular vein
The external jugular vein is formed near the angle of the mandible by the union of the posterior branch of the ____ vein with the ____ ____ vein
retromandibular; posterior auricular
The external jugular vein terminates in the ___ vein
subclavian
The suprascapular vein, transverse cervical vein, and anterior jugular vein are all tributaries for what vein?
external jugular vein
For the following neck muscle, give the origin, insertion, innervation and function: sternocleidomastoid
origin: manubrium
insertion: lateral half of superior nuchal line
innervation: accessory nerve
function: tilts head toward shoulder on same side; draw head forward (both sides)
For the following neck muscle, give the origin, insertion, innervation and function: posterior scalene
origin: posterior tubercles of TPs of C4-C6
insertion: upper surface of 2nd rib
innervation: anterior rami of C5-C7
function: elevation of 2nd rib
For the following neck muscle, give the origin, insertion, innervation and function: middle scalene
origin: TPs of C2-C7
insertion: upper surface of first rib
innervation: anterior rami of C3-C7
function: elevation of first rib
For the following neck muscle, give the origin, insertion, innervation and function: anterior scalene
origin: anterior tubercles of the TPs of C3-C6
insertion: scalene tubercle and upper surface of first rib
innervation: anterior rami of C4-C7
function: elevation of first rib
For the following neck muscle, give the origin, insertion, innervation and function: omohyoid
origin: superior border of scapula medial to scapular notch
insertion: inferior border of hyoid bone
innervation: ansa cervicalis; anterior rami of C1-C3
function: depress the hyoid bone
For the following muscle, give the origin, insertion, innervation and function: rectus capitis anterior
origin: anterior surface of lateral part of atlas and its TPs
insertion: inferior surface of basilar part of occipital bone
innervation: branches from anterior rami of C1-C2
function: flexes head at atlanto-occipital joint
What causes Torticollis (twisted neck)?
difficult delivery; interfering with the profuse arterial supply within the bulk of the muscle or venous occlusion leading to muscle necrosis
Describe the phases of examination of toriollis:
early after delivery
few months later
late
early after delivery: neck swelling
few months later: cord-like sternomastoid
late: child unable to straighten head; head is drawn down towards affected sternomastoid and chin is towards opposite side
Describe the phases of examination of a whiplash injury (cervical syndrome)
immediately after
next few days
later
immediately after: intense neck pain
next few days: increased intensity of pain
later: decreased pain but increased rigidity of head
When palpating a whiplash energy, you should feel tenderness over TPs of ___-___
C4-C5
Radiographs of whiplash injuries show what?
disappearance of normal cervical lordosis with absence of any signs of fracture of cervical vertebrae
For the following muscle, give the origin, insertion, innervation and function: rectus capitis lateralis
origin: TPs of atlas
insertion: occipital bone
innervation: anterior rami of C1-C2
function: flexes head laterally to same side
For the following muscle, give the function: longus coli
flexes neck anteriorly and laterally and slight rotation to opposite side
For the following muscle, give the origin, insertion, innervation and function: longus capitis
origin: tendinous slip to TPs of C3-C6
insertion: occipital bone
innervation: anterior rami of C1-C3
function: flexes the head
