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NE Exam 1 > Triangles Of The Neck > Flashcards

Triangles Of The Neck Flashcards

1
Q

What is the subcutaneous layer of the superficial fascia of the neck?

A

Thin CT lying between the dermis and investing layer of deep cervical fascia

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2
Q

What are the contents of the subcutaneous layer of superficial fascia of the neck?

A

Sensory nerves, blood and lymph vessels, superficial LNs, fat, and playsma muscle

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3
Q

Describe the playsma muscle

A

Muscle of facial expression

Innervation: facial nerve

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4
Q

What are some landmarks in the neck?

A 
Vertebra prominens (C7) 
Hyoid bone 
Thyroid and cricoid cartilages (level of C6) 
Clavicle and sternum 
Mandible
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5
Q

Describe the hyoid bone

A

Body at C3-4 axial level
Suspended by muscles
Body plus greater and lesser horns

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6
Q

What is the retromandibular vein?

A

Junction of superficial temporal vein and maxillary vein (runs deep within parotid gland)

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7
Q

What is the external jugular vein?

A

Crosses over upper 2/3 SCM muscle

May even be absent

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8
Q

What is the anterior jugular vein?

A

Runs just off the midline to the root of the neck and connects with subclavian

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9
Q

The superficial veins of the neck overly what?

A

The surface of investing fascia

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10
Q

The superficial cutaneous nerves of the neck all originate from what?

A

The cervical plexus and emerge from posterior margin of mid-sternocleidomastoid muscle

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11
Q

What are the superficial cutaneous nerves of the neck?

A

Lesser occipital, transverse cervical, greater auricular and supraclavicular nerves

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12
Q

What is the lesser occipital nerve?

A

C2-3

Runs along border of SCM relaying scalp sensory information

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13
Q

What is the transverse cervical nerve?

A

C2-3
Supplies skin overlying anterior triangle of neck
Crosses SCM

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14
Q

What is the greater auricular nerve?

A

C2-3 anterior rami from cervical plexus
Runs with EJV on surface of SCM muscle
Supplies posterior auricle and area extending from mandibular angle to mastoid process

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15
Q

What is the supraclavicular nerve?

A

C3-4

Supplies root of neck in the area of clavicle, acromion and sternum

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16
Q

What is the nerve point of the neck?

A

Site of application of anesthetic (mid-SCM)

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17
Q

What is investing fascia?

A

Most superficial

Surround entire neck and encloses SCM and trapezius muscles and parotid and submandibular glands

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18
Q

What is the pretarcheal fascia?

A

Located in anterior of neck and blends with pericardium

Contains infrahyoid muscles and buccopharyngeal fascia

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19
Q

What is prevertebral fascia?

A

Encloses vertebral column and associated muscles

Extends laterally as axillary sheath into arm

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20
Q

What is the carotid sheath?

A

Fascia covering the carotids, IJV and vagus nerve
Runs along and then under the anterior border of SCM
IJV most lateral
Vagus nerve most posterior

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21
Q

What is the retrhopharyngeal space?

A

Posterior to pharynx and esophagus
Bounded by buccopharyngeal and prevertebral fascia and carotid sheath
Extends from base of skull to mediastinum
Permits movement of pharynx, larynx and esophagus during swallowing
Easy route for upper respiratory or oral infections to spread

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22
Q

What are the different fascia of the neck?

A

Investing fascia, pretracheal fascia, prevertebral fascia, carotid sheath, retropharyngeal space

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23
Q

What is torticollis?

A

Pathology of the SCM causing head to turn to side and the face to turn away from affected side

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24
Q

What is congenital torticollis?

A

Fibrous tissue tumor within SCM that develops in utero

Causes head to turn to side and the face to turn away from affected side - shortens SCM

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25
Q

What is muscular torticollis?

A

Occasionally SCM may be injured during difficult childbirth, tearing its fibers leading to hematoma that develops into fibrotic mass that entraps part of CN 11 effectively denervating it
Stiffness of neck then results from fibrosis and shortening of SCM
May require surgical detaching of SCM

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26
Q

Describe the innervation of the sternocleidomastoid

A

Innervated by spinal accessory nerve (CN 11) and with propiosensory information returning via C2-4
CN 11 exits via jugular foramen and lies posterior to the SCM
Then emerges about 1/3 does along posterior margins of SCM to cross the posterior triangle to innervate the trapezius

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27
Q

What is the cervical plexus?

A

From ventral rami of C1-4
Each divides into ascending and descending branches (except C1) that forms a loop with the next one
Loops like anterolateral to levator scapulae and middle scalene muscles
Forms cutaneous nerves of posterior triangle but also supplies adjacent prevertebral muscles, phrenic nerve and strap muscles (Ansa cervicalis)

28
Q

What is the course of the phrenic nerve in the neck?

A

Runs anterior to the surface of the anterior scalene muscle
Descends obliquely with IJV deep to prevertebral fascia and posterior to suprascapular and transverse cervical artery off the thyrocervical trunk
Runs posterior to the subclavian vein but anterior to internal thoracic artery as it enters the thorax

29
Q

What forms the phrenic nerve?

A

Roots of C3 and C4 of cervical plexus + ventral rami of C5

30
Q

What occurs with severance of the phrenic or phrenic nerve block?

A

Paralysis of that side of the diaphragm

31
Q

Describe the first part of the subclavian artery

A

Lies medial to anterior scalene and at apex of lung and cervical pleura
Branches include internal thoracic and vertebral arteries and thyrocervical trunk (inferior thyroid, transverse scapular, suprascapular)

32
Q

Describe the second part of the subclavian artery

A

Behind anterior scalene gives off costocervical trunk (superior intercostal and deep cervical arteries)

33
Q

Describe the third part of the subclavian artery

A

Lateral to the anterior scalene lying anterior to brachial plexus within the posterior triangle
In contact with the first rib
Dorsal scapular artery often off this segment

34
Q

Compression of the subclavian artery against the rib can control what?

A

Bleeding in upper limb

35
Q

What is the Ansa cervicalis?

A

Consists of anterior branches off ventral rami of cervical plexus forming a loop innervating infrahyoid muscles and geniohyoid muscles
Loops vary in length

36
Q

Branches off the Ansa cervicalis supply which muscles?

A

Sternohyoid, sternothyroid, thyrohyoid and omohyoid muscles

37
Q

Describe the superior part of the loop of Ansa cervicalis

A

Originates from C1 of the cervical plexus that soon joins hypoglossal nerve
Fibers run with hypoglossal nerve and then leave to descend in front of internal carotid arteries are superior limb/loop
This loop/limb gives off a nerve to thyrohyoid (C1) and geniohyoid muscle (c1)
Then swings down to meet the inferior limb giving off a branch to superior omohyoid belly

38
Q

Describe the inferior part of the loop of Ansa cervicalis

A

Formed by branches of C2 and C3
Descends behind carotid sheath and then winds lateralward and emerges from behind carotid sheath to joint the superior limb

39
Q

What is the carotid sheath?

A

Fascia covering surrounding IJV, carotid artery and vagus nerve
?????

40
Q

What are the arteries of the anterior triangle?

A

Carotid sinus, internal carotid and external carotid

41
Q

Describe the carotid sinus

A

Located at the site of bifurcation of common carotid

Contains chemoreceptors and baroreceptors for monitory O2 and BP levels

42
Q

Does the internal carotid artery have any branches in the neck?

A

No

43
Q

Describe the external carotid artery

A

Terminates by dividing into maxillary and superficial temporal arteries
Branches include ascending pharyngeal, superior thyroid, lingual, facial, occipital, and posterior auricular

44
Q

Describe the thyroid gland

A

Lies deep to sternothyroid and sternohyoid muscles from levels C5-T1
Consists of two lobes that are anteriolateral to larynx and trachea
Has isthmus uniting lobes overlying trachea at 2nd/3rd tracheal rings

45
Q

What are the unpaired laryngeal cartilages?

A

Thyroid (thyroid prominence and superior thyroid notch), epiglottis (elastic cartilage), cricoid (located at C6)

46
Q

What are the paired laryngeal cartilages?

A

Arytenoid (vocal cords attached), comiculate and cuneiform

47
Q

What are the ligaments/membranes of the laryngeal cartilages?

A

Vocal ligament (lies under vocal cord), thyrohyoid membrane and cricothyroid membrane

48
Q

What are the vocal folds?

A

Contain elastic vocal ligaments running between the thyroid and arytenoid cartilages
Generates sound by vibrating air passing by
Force of air control the volume; tension of folds determines pitch

49
Q

Describe the laryngeal innervation

A

Superior laryngeal nerve (internal/sensory and external/motor to cricothyroid muscle)
Inferior laryngeal nerve which is the terminal branch of recurrent laryngeal nerve and provides motor innervation to intrinsic laryngeal muscles

50
Q

Describe the thyroid blood supply

A

Superior to thyroid from external carotid
Inferior thyroid from thyrocervical trunk
Parallel veins
May have thyroid ima artery—branch directly off brachiocephalic trunk to inferior thyroid gland

51
Q

Describe the laryngeal blood supply

A

Superior laryngeal artery off superior thyroid artery

Inferior laryngeal artery off inferior thyroid artery

52
Q

Injury to what nerve causes loss of vocalization?

A

Recurrent laryngeal nerve

53
Q

Describe the cervical sympathetic chain

A

No white rami in neck (presynaptic fibers from superior thoracic spinal nerves)
Fibers pass to cervical spinal nerves via gray rami or leave as visceral branches (splanchnic) into thorax
Branches to head run via vascular plexus

54
Q

What are the three cervical ganglia of the cervical sympathetic chain?

A

Superior ganglia, middle ganglia, and inferior ganglion

55
Q

Describe the superior ganglia

A

Level C1/2
Post synaptic fibers form an internal carotid periarterial plexus that enters cranium
Also sends fibers to cervical plexus as well as cardiopulmonary branches

56
Q

Describe the middle ganglia

A

May be absent
Lies over inferior thyroid artery at level of cricoid cartilage and transverse processes of C6
Distributed via periarterial plexes and cardiopulmonary splanchnic nerves

57
Q

Describe the inferior ganglion

A

Lies anterior transverse process of C7 just superior to neck of 1st rib
Some post-ganglionic fibers enter the brachial plexus, run to heart (inferior cervical cardiac nerve)
Others go to periarterial plexus of vertebral artery

58
Q

Describe the superficial cervical LNs

A

Located along EJV draining superficial tissues of neck

59
Q

Describe the inferior deep cervical LNs

A

Drain lateral cervical area and run along path of CN XI

60
Q

Describe the lymphatics of the neck

A

All drain into nodes and lymphatics running along IJV
Lymphatics join to form lymphatic trunks that then join to form lymphatic ducts that empty into subclavian vein near its junction with IJV

61
Q

The prevertebral muscles are all posterior to what?

A

Retropharyngeal space and innervated by cervical plexus and/or brachial plexus

62
Q

Describe the structures of the thyroid gland

A

Dense CT attaches it to cricoid cartilage and superior tracheal rings
Parathyroid glands lie on posterior aspect of thyroid gland in own capsule

63
Q

What regulates tension in the vocal folds?

A

Intrinsic muscles innervated y the vagus nerve (CN X)

64
Q

What are ventricular folds?

A

False cords
Brought together when holding your breath while straining
Do not contain vocal ligaments

65
Q

What is dysphonia?

A

Disorder of the voice
Hoarseness-inflammation of the vocal cords
Laryngitis-inflammation of vocal cords where they no longer vibrate

NE Exam 1 (20 decks)

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