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(OMS1) Neuro Exam 1 > Triangles of the neck and larynx > Flashcards

Triangles of the neck and larynx Flashcards

1
Q

What is found in vertebral level c3-c4?

A

Body of hyoid bone
Upper margin of the thyroid cartilage
Bifurcation of common carotid artery

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2
Q

What is found in vertebral level C5-c6?

A

Arch of cricoid cartilage
Superior end of esophagus
Superior end of trachea

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3
Q

Draw the anterior and posterior triangles:

A

Refer to your drawings

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4
Q

Anterior triangle borders

A

Midline of the neck
Sternoclediomastoid
Lower border of the mandible

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5
Q

Posterior triangle/lateral cervical borders

A

Sternocleidomastoid
Trapezius
Clavicle

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6
Q

What divides the anterior and posterior triangles?

A

SCM (sternocleidomastoid m.)

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7
Q

Divisions of the Anterior triangle:

Submandibular triangle borders

A

Anterior belly of digastric
Posterior belly of digastric
Inferior border of mandible

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8
Q

*Divisions of the anterior triangle:

Carotid triangle borders:

A

Posterior belly of digastric
Superior belly of omohyoid
Sternocleidomastoid

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9
Q

Divisions of the anterior triangle:

Submental triangle borders:

A

Midline of the neck
Anterior belly of digastric
Body of hyoid

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10
Q

*Divisions of the anterior triangle:

muscular triangle borders

A

Body of hyoid
Superior belly of omohyoid
Sternocleidomastoid

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11
Q

Draw the anatomical relationships of the different divisions of the anterior triangle:

A

Refer to your drawings

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12
Q

What makes up the floor of the posterior triangle?

A 
Splenius capitis
Levator scapulae
Omohyoid 
Posterior scalene
Middle scalene
Anterior scalene
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13
Q

Arteries in the posterior triangle:

A

Transverse Cervical A.
Thyrocervical Trunk
Suprascapular A.

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14
Q

Draw the arteries of the neck including:

Vertebral artery 
Transverse Cervical A. (deep and superficial) 
Inferior thyroid 
Suprascapular 
Thyrocervical trunk 
Costocervical trunk 
Internal thoracic
A

Refer to your drawings

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15
Q

*What forms the external jugular vein?

A

Retromandibular v. and posterior auricular v. coming together

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16
Q

*The subclavian vein meets the () to form the …

What drains into the venous system in this part of the body?

A
  • Internal jugular vein … brachiocephalic vein

- Lymphatic ducts (right lymphatic and thoracic ducts on the left draining into the venous system)

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17
Q

*If you External Jugular vein is visible on a patient, what does it mean?

A

Increased venous pressure - possible heart failure or obstruction of superior vena cava

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18
Q

Draw the relevant veins of the posterior triangle:

A

Refer to your drawings

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19
Q

Cutaneous nerves of the posterior triangle (coming off the cervical plexus):

A

Lesser Occipital N.
Greater Auricular N.
Transverse Cervical N.
Supraclavicular N.

*all come from the cervical plexus

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20
Q

What do you call the point behind the sternocleidomastoid where the cutaneous nerves of the posterior triangle exit?

A

Erb’s point/Nerve point of the neck. Relevant in Erb’s palsy

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21
Q

*Lesser occipital N.
Origin
Cutaneous innervation

A

C2

Skin to scalp and posterior neck

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22
Q

*Great auricular N.
Origin
Cutaneous innervation

A

C2-C3

Parts of the ear, part of the carotid area, angle of the mandible, mastoid process, bit of the neck

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23
Q

*Transverse Cervical N.
Origin
Cutaneous innervation

A

C2-C3

Anterior triangle area

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24
Q

*Supraclavicular N.
Origin
Cutaneous innervation

A

C3-C4

Skin over clavicle and shoulder

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25
Q

Draw the innervations of the posterior triangle:

A

Refer to your drawings

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26
Q

Spinal Accessory N.

A

Aka CN XI
Most common nerve that is accidentally cut, usually resulting in trap paralysis (sternocleidomastoid is innervated proximal to this area of common trauma so it is intact)

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27
Q

Phrenic N.

A

Responsible for diaphragm
C3-C5
Anterior to the anterior scalene

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28
Q

Where does the Brachial plexus come out?

A

Between the anterior and middle scalene m.

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29
Q

Torticollis:
Cause
Clinical

A

SCM shortening/contraction. Could also be caused by Spinal Accessory N. issue
Head tilt toward and face to turn away from affected side

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30
Q

Course of the spinal accessory n.

A

Cervical region of spinal cord > foramen magnum > enters cranial cavity > exits jugular foramen with CN IX and XI (glossopharyngeal and vagus) > appears in Anterior triangle > innervates SCM > appears in posterior triangle (area of common damage) > through the fascia > trapezius

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31
Q

Occipital triangle and omoclavicular (subclavian) triangle are divided by….

A

Inferior belly of the omohyoid

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32
Q

What are the suprahyoid muscles?
What do they form?
Function?

A

Anterior and posterior belly of the digastric m.
Myologhyoid M.
Stylohyoid M.
Geniohyoid M. (in the oral cavity)

  • form- the floor of the oral cavity
  • elevate the hyoid and larynx during swallowing and talking
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33
Q

What are the infrahyoid muscles?

A

Sternohyoid
Omohyoid
Sternothryoid
Thyrohyoid

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34
Q

What are the branches of the external carotid a.

What branches are seen in the anterior triangle?

A 
Posterior Auricular A. 
Occipital A. 
Facial A. 
Lingual A. 
Ascending pharyngeal A. 
Superior Thyroid A. 
External Carotid A. 
Internal Carotid A. 
Common Carotid A.
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35
Q

Draw the branches of the ECA

A

Refer to your drawings

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36
Q

*Floor of the submandibular triangle:

A

Mylohyoid
Hyoglossus
Mid constrictor m.

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37
Q

*Contents of the submandibular triangle:

A 
Facial A. and V
Hypoglossal N. 
Nerve to Mylohyoid M.
Submandibular gland
Lingual A.
38
Q

Draw the submandibular triangle

A

Refer to your drawings

39
Q

*Contents of the submental triangle:

A

Mylohyoid M. (floor)
Submental lymph nodes
Veins forming the anterior jugular v.

40
Q

*Contents of the muscular triangle:

A

Thyroid gland and parathyroid
Thyroid cartilage
Larynx
Trachea
Esophagus
Common carotid, inferior and superior thyroid a.
Anterior jugular v., thyroid v. (superior, middle, inferior)
Ansa cervicalis n., external laryngeal n., recurrent laryngeal n.

41
Q

*Contents of the carotid triangle

A

Carotid sheath
Branches of the common carotid a.
External and internal laryngeal n.
Hypoglossal n. and spinal accessory n.

42
Q

*Carotid sheath contents

A 
Internal jugular v. 
Common carotid a. 
Vagus N. 
Deep cervical lymph nodes
Carotid sinus n. 
Sympathetic n. fibers
Ansa cervicalis
43
Q

*Relationship between occipital a. and hypoglossal n.

A

Hypoglossal N. wraps around the Occipital A.

44
Q

Which nerve dives into the larynx in the Carotid triangle?

A

Internal laryngeal N.

45
Q

What is the carotid sinus?

*Innervation?

A

Dilation in the proximal part of the internal carotid a.
Acts as a baroreceptor (blood pressure)
Innervation: cartoid sinus nerve (branching from the glossopharyngeal N. and vagus N. (IX and X))

46
Q

What is the carotid body?

Innervation?

A

Located at the bifurcation of the carotid artery.
Tissue that acts as chemoreceptor and senses oxygen levels
Innervation: carotid sinus nerve (branching from the glossopharyngeal N. and vagus N (IX and X))

47
Q

Draw the carotid triangle innervation:

A

Refer to your drawings

48
Q 
Thoracic inlet/outlet clinical correlations:
Lungs 
Central Line 
*Nerves 
*Esophagus and Trachea
A
  • superior thoracic/inferior thoracic aperture (diaphragm area)
  • Lungs extend about 2 inches into the root of the neck. Trauma above the collar (e.g. stabbing) affects the lung and results in pneumothorax.
  • Subclavian V. (most superficial) is site for central line. Could puncture the subclavian a. if you got too deep. Can puncture lung if you go too posterior. XR done after central line to ensure lung was not punctured/collapsed
  • Brachial plexus, esophagus, trachea, vagus and phrenic are also in this region. So trauma to these structures can affect things further away due to continuity between respiratory and digestive systems
49
Q

Thoracic outlet syndrome

A

Compressing the nerves and arteries leading to the upper limb = upper limb issues

50
Q

Anatomical position and importance of the phrenic nerve:

A

-Lies superficial to the anterior scalene m.
Sole motor supply to the diaphragm. Phrenic nerve needs to be preserved during surgery.
Arises at the neck level, so spinal cord damage below the neck preserves breathing despite paralysis of limbs

51
Q

Cervical plexus goes from … to…

A

C1 - C4

52
Q

Motor nerves coming off of the cervical plexus

Draw this innervation

A

Hypoglossal (CN XII, not cervical plexus) - tongue
Superior root of the ansa cervicalis (C1-C2) - geniohyoid, thyrohyoid
Inferior root of the ansa cervicalis (C2-C3) - infrahyoid muscles
Phrenic N. (C3-C5) - diaphragm

53
Q

*Sympathetic trunk origins:
Superior Cervical Ganglion
Middle Cervical Ganglion
Inferior Cervical Ganglion

What is located close to the sympathetic ganglion and what is the significance of this?

A

C2-C3
C6
C7-T1

-Arteries. The sympathetic fibers follow these vessels to get to their target areas

54
Q

Superficial fascia:

A
  • Subcutaneous layer lies between dermis and investing layer of the deep cervical fascia
  • contains platysma muscle, cutaneous n., blood and lymphatic vessels, superficial lymph nodes and fat
55
Q

Platysma muscle

A

Muscle of facial expression

Innervated by the facial N. (CN VII)

56
Q 
Deep cervical fascia: 
3 layers (superficial to deep)
A

Investing
Pretracheal
Prevertebral

57
Q

Investing layer

A

Encloses the SCM and the trapezius

Forms the sheath around the carotid and submandibular glands

58
Q

Mumps and investing layer:

A

Parotid gland swelling against unrelenting investing layer causing pain during mumps

59
Q

Pretracheal layer

A

Goes around the thyroid, trachea and esophagus (only on anterior side)
Extends to the mediastinum where the heart is

60
Q

Prevertebral layer

A

Encircles the prevertebral muscles

61
Q

Carotid sheath blends with which fascia?

A

All layers, depending on location

62
Q

Anatomical relationships of the carotid sheath

Draw the fascia of the neck

A
  • Common carotid artery (most anterior and medial)
  • Internal jugular vein (most anterior and lateral)
  • Vagus N. ( most posterior structure)
  • Sympathetic trunk and phrenic n. are located medial and posterior to the carotid sheath respectively
63
Q

Retropharyngeal space anatomical position and borders:

A

-posterior to the pharynx
Anterior border: buccopharyngeal fascia
Posterior border: prevertebral fascia
Lateral border: carotid sheaths

64
Q

Retropharyngeal abscess:

A

Develops secondary to lymphatic drainage or contiguous spread of upper respiratory or oral infections
Swelling can cause difficulty in swallowing/speaking and can be life threatening

65
Q

Anatomical position of the thyroid gland:

A

Deep to the sternohyoid and sternothyroid muscles
Extends from C5 - T1
Isthmus is located anterior to the trachea and found on tracheal rings 2 and 3

66
Q

Draw the thyroid gland and neurovasculature

A

Refer to your drawings

67
Q

Blood supply of the thyroid gland:

A

Superior thyroid artery (from external cartoid a.) - superior and anterior portions of the gland
Inferior thyroid artery (from thyrocervical trunk) - inferior and posterior portions of the gland

68
Q

Parathyroids

What is the blood supply of the parathyroid?

A

Embedded in the posterior lateral lobes of the thyroid

Usually supplied by the inferior thyroid artery

69
Q

Thyroid ima artery

Where does it branch from?

A

Present in 10% of patients
Usually branches from thyrocervical trunk or subclavian
Need to be careful not to puncture during tracheostomies

70
Q

Thyroid veins

Where do they drain?

A

Superior thyroid v. and middle thyroid v.
Drain to the Internal jugular v.

Inferior thyroid v.
Drain to the brachiocephalic trunk

71
Q

Right recurrent laryngeal and left recurrent laryngeal nerves

A

RCLN branches from Right vagus N. and wraps around the subclavian a.
LRLN branches from the left vagus N. and wraps around the aortic arch

72
Q

Thyroid movement during swallowing due to ….

Do lymph nodes move with swallowing?

A

Connections to fascia.

Lymphatics do not move however

73
Q

Draw the anatomical organization of the larynx relative to other throat structures:

A

Refer to drawings

74
Q

Vertebral level of the thyroid cartilage?

Vertebral level of the cricoid cartilage?

A

C4

C6

75
Q

Function of the vocal ligament

A

Produces sound and speech

76
Q

Laryngeal cavity anatomical position

A

Extends from the laryngeal inlet to the inferior boundary of the cricoid cartilage

77
Q

Laryngeal vestibule anatomical position

A

Laryngeal inlet to vestibular fold

78
Q

What is the conus elasticus made of?

A

Cricothyroid membrane and vocal ligament

79
Q

Internal branch of the SLN is ()

External branch of the SLN is ()

A

Sensory

Motor (cricothyroid m.)

80
Q

Inferior laryngeal n. does (sensory or motor) innervation?

A

both

81
Q

Sensory innervation above the vocal fold is the …

Sensory innervation below the vocal fold is the …

A

Internal branch of the superior laryngeal nerve

Inferior laryngeal nerve (terminal branch of the left recurrent laryngeal N.)

82
Q

Blood supply above the vocal fold is the …

Blood supply below the vocal fold is the …

A

Superior laryngeal a.

Inferior laryngeal a.

83
Q

Lymphatics above the vocal fold go …

Lymphatics below the vocal fold go …

A

With the superior laryngeal a. and to the superior deep cervical nodes
To the pretracheal/prelaryngeal and to the inferior deep cervical nodes

84
Q

Superficial Cervical Lymph nodes are located …

They follow which vessel?

A

On the superficial face/neck area

External Jugular Vein

85
Q

Deep Cervical Lymph nodes are located ….

They follow which vessel?

A

On the deeper face/neck area

Internal Jugular vein

86
Q

Two types of deep cervical lymph nodes:
Jugulo-digastric
Location?
Drains from?

A

C4, deep to posterior belly of digastric m.

Lymph from throat and tonsils

87
Q

Two types of deep cervical lymph nodes:
Jugulo-omohyoid
Location?

A

C6, deep to the omohyoid muscle

88
Q

What are the major lymphatic ducts of the head and neck?

Where are these located?

A

Left: Thoracic Duct
RIght: lymphatic duct

Located at the junction of IJV and SV

89
Q

right Lymphatic duct drains…

A

Right side of the head, neck, chest and right upper extremity

90
Q

Left thoracic duct drains…

A

(everything else) Left side of the head, neck, chest, left upper extremity, abdomen, pelvis and perineum, both lower extremities

(OMS1) Neuro Exam 1 (18 decks)

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