Triangles of the neck Flashcards
Why are the triangles of the neck relevant to lung cancer?
pancoast tumours start in the apex of the lung
usually spreads into one or more structure is the upper thorax and neck
Where in the upper thorax and neck might a pancoast tumour spread to?
upper ribs
nerves in upper thorax and neck
bundles of nerves close to spinal cord
blood vessels that supply blood to the upper limb
Attachments of the sternocleidomastoid muscle
sternum - manubrium
clavicle - medial
mastoid process
What are two main triangles of the neck?
posterior and anterior
Describe the location of the posterior triangle
from trapezius to SCM
Describe the location of the anterior triangle
SCM to the midline down the neck
inverted triangle
What are the sub triangles?
1) SCM region
2) lateral cervical region
3) anterior cervical region
4) posterior cervical region
5) suboccipital region
What is the lateral cervical region separated into?
occipital triangle
omoclavicular triangle
What is the anterior cervical region separated into?
carotid triangle
muscular triangle
What can the lesser supraclavicular fossa be used for?
location of the where the heads of the sternocleidomastoid come in
landmark for canulation of veins
What will be found at the omoclavicular triangle?
roots of the brachial plexus
Where is the carotid bifurcation?
when the common carotid becomes the internal and external carotid
point where SCM region, muscular triangle and carotid triangle intersect
What muscle has an angle in it?
omohyoid
What attaches to the hyoid bone?
strap muscles
omohyoid, thyroid cartilage (thyrohyoid), sternohyoid, sternothyroid
Fascial layers of the neck
outside in subcutaneous/superficial cervical fascia investing layer pretracheal layer prevertebral layer alar fascia and carotid sheath
What may be found between the subcutaneous fascia
platysma
Which muscles are wrapped in the investing layer of fascia?
SCM and trapezius
Why is the pretracheal named this?
goes infront of the trachea
traps the thyroid gland, trachea and oesophagus
Location of the prevertebral layer
infront of vertebrae
traps spinal cord and postural muscles - erector spinae
What is found within the carotid sheath?
common corotid
IJV
lymphatics
vagus nerve
Why is the disposition of fascial layers in the neck important?
track infections and spread of tumours
planes of separation during surgery
Describe the platysma
most superficial structure of the neck
linear, thin layer
curves to upper limbs
blends into other smaller muscles in the chin for facial expression
What can be palapted from the investing and pretracheal layers of fascia?
hyoid bone thyroid cartilage (Adam's apple) cricoid cartilage thyroid glands (if swollen) 1st tracheal ring
What can cause a swollen thyroid?
low iodine
Where does the EJV run?
over the top of the SCM
sits in the the investing layer
Name the scalene muscles
anterior
middle
posterior
Attachments of anterior scalene
scalene tubercle on first rib
Attachments of middle scalene
first rib
Attachements of posterior scalene
2nd rib
Importance of anterior scalene as a landmark
subclavian veins - anterior subclavian arteries - posterior 5 nerve roots to form brachial plexus - posterior to subclavian arteries (VAN) phrenic nerve - anterior
What innervates the scalene muscles?
cervical spinal nerves
What is a function of the scalene muscles?
accesory muscles of respiration
Where are the infrahyoid muscles?
pre-tracheal fascial layer
anterior triangle
Attachments of the infrahyoid muscles
thyrohyoid - thyroid cartilage and hyoid
sternohyoid - hyoid and manubrium
sternothyroid - back of manubrium to thyroid cartilage
Attachments of omohyoid
hyoid to shoulder
What causes the angle in the omohyoid?
fascial sling off the clavicle
Attachments of the cricothyroid? and location
cricoid to the thyroid
lateral to midline
Nerve supply of strap muscles
ansa cervicalis
Which suprahyoid muscle has a sling?
digastric
Spinal accessory nerve name
cranial nerve XI
What does the spinal accessory nerve innervate and where does it run?
innervates SCM and trapezius
runs under SCM, across posterior triangle, to the trapezius
How to define the internal carotid artery?
no branches in the neck
Structure of the thyroid gland
butterfly shape
central part which crosses the midline
Arterial supply of the thyroid gland
superior thyroid artery - off external carotid
inferior thyroid artery - off subclavian via thyrocervical trunk
10% have thyroid ima artery - up the midline off brachiocephalic trunk
Which cervical vertebrae are atypical?
C1 - atlas
C2 - axis
Where does C1 articulate on the skull?
occipital area, behind mastoid process
Where does C2 articulate with C1?
odontoid process articulates with the anterior arch of the atlas bone, where they form a pivot join
What is penetrated in a cricothyroidotomy?
cricothyroid membrane (between thyroid and cricoid cartilage)
What is cricothyroidotomy used for?
temporary relief for when the airways are blocked
What is penetrated in a tracheotomy?
subcutaneous fascia, investing and pre-tracheal
space between cartilage of trachea
What is tracheotomy used for?
semi/permanent access to airways
Danger of cricothyroidotomy on children?
solution?
increased risk to cutting vocal folds
needle cricothyroidotomy
Use of Langer’s lines
cut along them, reduce scarring
What to look out for
reccurent laryngeals
Main sites for central venous catheterisation
right subclavian vein - midline of clavicle
vena cava - omaclavicular triangle
Imaging
larger structures of cross-sections
at what level
use trachea as landmark
Major groups of lymphatic vessels/nodes
superficial
deep
SCM functions
lateral flexion with rotation
extension at atlanto-occipital joints
flexion of cervical vertebrae - supine position
List the superficial nodes with location
occipital mastoid pre-auricular parotid submental submandibular facial superficial cervical
From where does fluid drain into the superficial nodes and where does this fluid then go?
from: scalp, face, neck
goes to: deep lymph nodes
Main groups of deep lymph nodes
superior
inferior
Location of superior deep cervical nodes
under the SCM in close relation to the accessory nerve and IJV
Location of inferior deep cervical nodes
omiclavicular triangle
behind SCM
Location of occipital node
back of the head, lateral border of the trapezius muscle
Location of mastoid node
insertion of SCM into mastoid process
Location of pre-auricular node
anterior to the auricle of the ear
Location of parotid node
superficially to parotid gland
Location of submental node
superficially to mylohoid gland
Location of submandibular node
inferior to mandible, in submandibular triangle
Location of superficial cervical node
close to anterior jugular vein
