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Neuro > Triangles Of The Neck And Larynx > Flashcards

Triangles Of The Neck And Larynx Flashcards

1
Q

What are the borders of the anterior triangle?

A

Midline of neck
SCM
Inferior border of mandible

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2
Q

What are the 4 triangles found within the anterior triangle?

A

Submental
Submandibular
Carotid
Muscular

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3
Q

What are the borders of the Submandibular Triangle?

A

Anterior belly of Digastric M.
Posterior belly of digastric m.
Inferior border of mandible

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4
Q

What are the border of the Submental triangle?

A

Midline of neck
Ant belly of digastric m.
Body of hyoid bone

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5
Q

What are the borders of the muscular triangle?

A

SCM
Superior belly of omohyoid m.
Body of hyoid bone

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6
Q

What are the borders of the Carotid Triangle?

A

Posterior belly of digastric m.
SCM
Superior belly of omohyoid m.

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7
Q

What are the borders of the posterior triangle?

What is the floor of this triangle covered by?

A

SCM
Trapezius m.
Clavicle bone

Prevertebral layer of Deep Fascia

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8
Q

What is the floor of the posterior triangle?

A

Splenius capitis M .
levator scapulae m.
Scalenes
Semispinalis capitis

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9
Q

What makes the occipital triangle and omoclavicular triangle from the posterior triangle?

A

Made by the inferior belly of Omohyoid m.

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10
Q

Contents of occipital triangle?

A 
EJV
Cervical plexus
Spinal accessory n. 
Brachial plexus trunks 
Cervicodorsal trunk
Cervical lymph nodes
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11
Q

Contents of omoclavicular triangle ?

A

Subclavian a. And v.
Suprascapular a.
Supraclavicular lymph nodes

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12
Q

Contents of the Posterior triangle?

A 
Thyrocervical trunk 
      Suprascapular a. 
      Transverse cervical a. 
Costocervical trunk
       Deep cervical a. —> paraspinal a. 
       Supreme intercostal a. 
EJV 
Subclavian v. 
Cervical plexus 
Spinal accessory
Phrenic n. 
Roots of brachial plexus 
Ansa cervicalis
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13
Q

What muscles are found in the anterior triangle?

What are their actions?

A

Suprahyoid: elevate hyoid and larynx during swallowing and phonation

Infrahyoid: depress hyoid and larynx

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14
Q

What arteries do you find in the anterior triangle?

A

Common Carotid A.

Internal and external carotid a.

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15
Q

Contents of submandibular triangle?

A

Myohyoid
Hyoglossus
Middle and inferior pharyngeal constrictor m.
(Sometimes the parotid gland if it is big enough)

Submandibular gland
Submandibular lymph nodes 
Hypoglossal n. (CN 12) 
N. To Mylohyoid 
Facial a. And v.
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16
Q

Contents of carotid triangle?

A

Thyrohyoid m.
Hyoglossus .
Middle and inferior constrictor Ms. of pharynx

Carotid sheath (with all its contents) 
Branches of ext. Carotid a.

Internal and external laryngeal ns.
Hypoglossal n.
Spinal accessory n.
Ansa cervicalis

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17
Q

What is in the carotid sheath?

A 
Common and internal carotid a. 
Internal jugular v. 
Vagus n. 
     Pharyngeal branch 
     Superior laryngeal n. (Int. And ext. branch) 
    Carotid body branch 
Deep cervical lymph nodes 
Carotid sinus n. 
Sympathetic nerve fibers
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18
Q

Contents of muscular triangle?

A

Sternothyroid.
Sternohyoid

Thyroid 
Parathyroid glands
Larynx
Trachea
Esophagus

Common carotid a.
Superior thyroid a.
Inferior thyroid a.

Anterior jugular v.
Thyroid Vs.

Ansa cervicalis
External laryngeal
Recurrent laryngeal

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19
Q

Contents of Submental Triangle?

A

Mylohyoid M.
Submental lymph nodes
Small veins that unite to form AJV.

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20
Q

What does the superificial branch of transverse cervical a. Run with?

A

Spinal accessory n.

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21
Q

What does the deep branch of transverse cervical a. Replace?

A

Replaces dorsal scapular a. To supply levator scapulae and rhomboid Ms.

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22
Q

What is EJV made from?

What does it drain to?

A

Union of posterior retromandibular v. With posteiror auricular v.

Subclavian v.

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23
Q

When will EJV be visible?

A

Increased venous pressure due to heart failure or obstruction of superior vena cava

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24
Q

What makes the Brachiocepahlic v.?

Clinical relevance of brachiocephalic v.?

A

Subclavian v. Joining with IJV

Central line placement done in Brachiocephalic v.

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25
Q

What is Erb’s Point; what does it contain?

A

Cervical plexus emerges halfway down SCM

Used to a cervical plexus nerve block for anesthesia

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26
Q

What is the most common nerve that is accidentally cut?

A

Spinal accessory nerve

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27
Q

What does the phrenic n. Supply?

A

Diaphragm

3, 4,5, keep the diaphragm alive

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28
Q

Where is ansa cervicalis located?

What does it supply?

A

In fascia of carotid sheath;

Most infrahyoid muscles

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29
Q

What is Torticollis?

A

Contraction or shortening of SCM that causes the head to tilt toward and the face to turn away from the affected side

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30
Q

Where and what are the carotid sinus and body?

A

From internal carotid a.

Carotid sinus - baroreceptor used to detect b.p.

Carotid body - chemoreceptors that can monitor O2, ph, etc.

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31
Q

Where does the common carotid a. Bifurcate?

A

At vertebral levels C3-c4

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32
Q

What are the suprahyoid muscles?

A

Mylohyoid
Stylohyoid
Digastric
Geniohyoid

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33
Q

What innervates mylohyoid?

A

N. To mylohyoid

Can be seen branching off from inferior alveolar n.

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34
Q

What innervates stylohyoid?

A

Facial n.

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35
Q

What innervates the anterior belly of digastric?

What innervates the posterior belly of digastric?

A

Ant. Belly: n. To Mylohyoid

post. Belly: facial n.

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36
Q

What innervates Geniohyoid?

A

C1 via hypoglossal n.

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37
Q

What are the infrahyoid Ms. ?

A

Thyrohyoid
Sternothyroid
Sternohyoid
Omohyoid

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38
Q

What innervates thyrohyoid?

A

C1 via the hypoglossal n.

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39
Q

What innervates sternothyroid m.?

A

Ansa cervicalis

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40
Q

What innervates Sternohyoid M.?

A

Ansa Cervicalis

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41
Q

What innervates omohyoid m.?

A

Ansa cervicalis

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42
Q

What are the branches of the external carotid a.

A 
Facial 
Lingual
Superior thyroid a. 
Ascending pharyngeal a. 
Occipital 
Posterior auricular 
Superficial temporal a. 
Maxillary a.
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43
Q

What are the branches of the superior laryngeal n.?

A

Internal and external

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44
Q

What does the hypoglossal n. Wrap adjacent to?

A

Occipital a.

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45
Q

What is the Platysma? What innervates it?

A

Muscle of facial expression

Cervical branch of facial n.

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46
Q

What is the Thoracic outlet?

A

Superior thoracic aperture where arteries and nerves emerge

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47
Q

Contents of Thoracic outlet?

A 
Apex of lungs (extend 2 in. Into neck) 
Subclavian a. And v. 
Brachial plexus 
Vagus n. 
Phrenic n. 
Thoracic duct 
Right lymphatic duct 
Sympathetic chain/trunk
Trachea
Esophagus
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48
Q

What can result from a stab right above the collarbone?

A

Stab the lung (extends 2 inches into the neck)- causing a pneumothorax

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49
Q

What happens if you go too deep for a central line placement?

A

Vein is the most superficial so it is good for central line placement

If you go deeper than that, you puncture the artery

Deeper than the artery you can puncture and collapse the lungs

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50
Q

What is thoracic outlet syndrome?

A

Compression of brachial plexus on 1st rib
Causes injury to inferior trunk (C8, T1 - injury to hand)

Vasculature issues and ischemia down hand

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51
Q

What is the sole motor supply to diaphragm?

What does this imply if there is spinal cord issue?

A

Phrenic n.

If spinal cord issues, patient can still breathe bc phrenic nerve is in neck

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52
Q

Where is the sympathetic chain/trunk?

A

Extends superior to C1 or base of skull

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53
Q

Where are the superior, middle and inferior cervical ganglion of the sympathetic chain located?

A

Superior: C1-2
Middle: C6
inferior: C7

54
Q

What is the smallest of the cervical ganglion? And what level is it at?

A

Middle; C6; at level of cricoid cartilage

May even be absent

55
Q

What is a Stellate (cervicothoracic) ganglion?

A

A fused inferior cervical ganglion with a 1st thoracic ganglion
(80% of inferior cervical ganglion present like this)

56
Q

What are the superficial branches of the cervical plexus for? And what are they?

A 
Sensory 
Great auricular 
Lesser occipital 
Supraclavicular
Transverse cervical
57
Q

What are the deep branches of the cervical plexus for? And what are they?

A

Motor

Ansa cervicalis
Phrenic n.
Hypoglossal N.

58
Q

What does the lesser occipital do? and what spinal root is it from?

A

C2

Skin of neck and scalp posterior to auricle

59
Q

What does the greater auricular do? and what spinal root is it from?

A

C2,3

Skin and sheath over parotid gland, mastoid process, auricle, and angle of mandible

60
Q

What does the transverse cervical do? and what spinal root is it from?

A

C2,3

Skin of anterior cervical region

61
Q

What does the supraclavicular n. do? and what spinal root is it from?

A

C3, 4

Skin over clavicle and over the shoulder

62
Q

What are the different fascial layers in the neck?

A 
Superficial fascia 
Deep cervical fascia
           Investing
           Pretracheal 
           Prevertebral
Carotid sheaths
Retropharyngeal space
63
Q

Where is the superficial fascia and what are its contents?

A

Subcutaneous layer of thin CT layer b/w dermis and investing layer of deep cervical fascia

Cutaneous n. 
Blood and lymphatic vessels
Superficial lymph nodes
Fat
Platysma m.
64
Q

Where is the investing layer of deep cervical fascia?

A

Most superficial; deep to superficial fascia
Surrounds the entire neck

Encloses SCM and Trapezius M.
Parotid and submandibular glands

65
Q

Why is the investing layer of deep cervical fascia important clinically?

A

for Mumps

Painful in cheek region due to swelling of parotid and submandibular glands that lie in the investing layer

66
Q

Where does the investing layer of deep cervical fascia extend to?

A

Manubrium of sternum, clavicles and acromion and spines of scapula

67
Q

Where is the Pretracheal layer of deep cervical fascia?

A

In anterior region of neck, around trachea, thyroid, and esophagus

68
Q

What does the Pretracheal layer of deep cervical fascia blend with?

A

Pericardium of heart to mediastinum

69
Q

What are the three sub layers Pretracheal layer of deep cervical fascia?

A

Muscular layer
Buccopharyngeal fascia layer
Visceral layer

70
Q

Where is the Prevertebral Layer of deep cervical fascia?

A

Encloses vertebral column and associated muscles.

71
Q

Where does the prevertebral layer of deep cervical layer extend into?

A

Extends laterally as the axillary sheath into the arm

From cranial base to mediastinum

72
Q

What does the Carotid sheath blend with?

A

Blends with prevertebral and Pretracheal layers of deep cervical fascia

73
Q

What nerve is directly in the Carotid sheath? Not surrounding it

A

Vagus N.

74
Q

Where is the Retropharyngeal space?

What is the Retropharyngeal space bound by?

A

Posterior to pharynx

Bound by buccopharyngeal fascia (anteriorly)
Prevertebral fascia (Posteriorly) 
Carotid sheath (laterally)
75
Q

Where does the Retropharyngeal Space extend to?

A

Extends superiorly to base of skull and inferiorly to mediastinum

76
Q

What is a Retropharyngeal abscess?

A

Develops secondary to lymphatic drainage or continuous stress of an Upper Repiratory or Oral infections

Causes swelling and difficulty in swallowing and speaking

Can be life threatening

Infection or abscess in the retropharyngeal space could travel toward the mediastinum

77
Q

What does the facial a. Give rise to?

A

Ascending palatine a.

Tonsillar a.

78
Q

Where is the cervical plexus located? (Triangle, muscle, fascia)

A

Posterior triangle of neck
Halfway up the SCM
prevertebral layer of cervical fascia

79
Q

Where do the paired spinal nerves leave the spinal cord to give the cervical plexus?

What do they do after they leave?

A

Paired spinal nerves leave the spinal cord via the intervertebral foramina of the vertebral column

Divide into anterior and posterior nerve fibers

80
Q

What is the Ansa Cervicalis?

A

Loop of nerves

C2-3 nerve roots

81
Q

What innervates Rectus Capitis Anterior and Lateralis?

A

C1-C2

82
Q

What innervates Longus Capitis?

A

C1-C3

83
Q

What innervates prevertebral muscles?

A

C2-C3

84
Q

What does C3-C4 of the cervical plexus innervate?

A

Levator Scpaulae, Scalenus Medius, (plus middle and anterior scalenus Ms. also receive innervation from cervical plexus

85
Q

What does Greater Auricular N. Communicate with/

A

Auricular branch of Vagus N.

Posterior AUricular branch of facial n.

86
Q

What does the transverse cervical n. Pierce?

A

Deep cervical fascia

87
Q

What does the lesser occipital n. Communicate with?

A

Posterior branch of the greater auricular n.

88
Q

When and how is a cervical plexus block done?

A

Used to provide regional anaesthesia for surgery in the neck region

Needle inserted midway up the posterior border of the SCM

Can also affect the phrenic n. So don’t perform on those with co-existing cardiac or respiratory diseases

89
Q

Where is the thyroid located?
(Triangle and vertebral levels)

Where is the isthmus located?

A

in muscular triangle
C5-T1

Anterior to 2nd and 3rd tracheal rings

90
Q

What Arteries supply the thyroid?

A

Superior thyroid (ant-sup. Aspect of gland)

Inferior thyroid (post-inf. Aspects of gland)

Thyroid ima a.

91
Q

Clinical importance of thyroid ima a.?

A

In 10 % of patients, anterior to trachea

Clinically relevant for tracheostomies
Have to perform them below thyroid but must be careful for thyroid ima a. And venous plexus

92
Q

What forms the Thyroid Plexus of veins?

What do each of them drain into?

A

Superior, Middle, and Inferior thyroid veins

Superior and middle —> IJV

Inferior —> Brachiocephalic V.

93
Q

What does the right and left recurrent laryngeal n. Each wrap around?

A

Right: around subclavian a.

Left: around arch of aorta

94
Q

Why is the thyroid alble to move?

A

Ligament bind thyroid gland to trachea and cricoid cartilage of larynx

Allows it to be able to move

95
Q

If you feel nodule move while swallowing, what does it imply?

A

It is in the thyroid

NOT in the lymph nodes

96
Q

What supplies the Parathyroid?

A

Inferior Thryoid a.

97
Q

Where is the larynx located (vertebral level)?

A

C3-C6

98
Q

What is the function of the larynx?

A

Phonation and patent airway

99
Q

Where is the Thyroid cartilage located?

A

C4

100
Q

Where is the Cricoid Cartilage located?

A

C6

101
Q

What is found going into the Thyrohyoid membrane?

A

Internal branch of Superior Laryngeal N.

Superior Laryngeal A.

102
Q

Where do you establish a patent airway during life thretening situations?

A

thru the Cricothyroid membrane

“Cricothyrotomy”

103
Q

What innervates Cricothyroid M. ?

Action?

A

External Laryngeal N.

Does high voice (increase in pitch)

104
Q

What innervates Thyro-Arytenoid M.?

Action?

A

Inferior laryngeal N. (From Recurrent Laryngeal n.)

Low pitch

105
Q

Which intrinsic muscle of the larynx is the only abductor?

A

Posterior Crico-Arytenoid

106
Q

What innervates Posterior Cricoartyenoid m?

Action?

A

Inferior Laryngeal n. (From Recurrent laryngeal n.)

Only abductor

107
Q

What are the adductors of the larynx?

What are they important during?

A

Lateral cricoarytenoid
Transverse arytenoid
Oblique arytenoid

Important during phonation

108
Q

Which intrinsic laryngeal m. Does forced respiration?

A

Posterior Cricoarytenoid

109
Q

Which laryngeal msucles are involved with phonation?

A

Lateral, transverse, and oblique arytenoid

110
Q

What laryngeal msucles are involved in whispering?

A

Lateral and oblique arytenoids

111
Q

What arteries supply the larynx above adn below the vocal folds?

A

Above: Superior laryngeal a.

Below: inferior laryngeal a.

112
Q

What nerves innverate the larynx above and below vocal folds?

A

Sensory Above: internal branch of superior laryngeal n.

Sensory below: inferior laryngeal n.

Motor: Inferior Laryngeal n.
(Except for cricothyroid m. done by external branch of superior laryngeal n.)

113
Q

What are the lymphatics for above and below the vocal folds?

A

Above: superior deep cervical

Below: Inferior deep cervical

114
Q

What is the laryngeal cavity?
What does it communicate with?
What is it continuous with?

A

From laryngeal inlet to inferior border of cricoid cartilage

Communicates with laryngopharynx thru laryngeal inlet

Continuous w/ trachea

115
Q

What is the laryngeal vestibule?

A

Between laryngeal inlet and vestibular folds

116
Q

What are the false vocal cords?

A

Vestibular folds

117
Q

What is the laryngeal ventricle?

A

Between vestibular and vocal folds

118
Q

What is the infraglottic cavity?

A

Between vocal folds and inferior border of the cricoid cartilage

119
Q

What is the rima glottidis?

A

Space between vocal folds

Air move between here to cause vibrations (i.e. voice)

120
Q

What makes up the Conus Elasticus/

A

Lateral cricothyroid L.

Vocal ligament

121
Q

What does the right lymphatic duct drain?

A

Right side of face, neck, chest, upper extr.

122
Q

What does the thoracic duct drain?

A

Drains left side of face, neck, chest, upper extremity,

Bilaterally: abdomen, pelvis and perineum, and lower extremity

123
Q

What do the superficial lymphatic vessels drain? And where do they drain into?

A

Drain lymph from scalp, face and neck

Drain into superficial ring of lymph nodes at the junction of hte neck and head

124
Q

What are the deep lymphatic vessels? What do they follow?

What do they converge to form?

A

From deep cervical lymph nodes
Follow the internal jugular v.

Converge to form the left and right jugular lymphatic trunks

125
Q

What does the left jugular lymphatic trunk combine with and empty into?

A

Combines w/ the thoracic duct at root of neck

Empties into the venous system via the left subclavian v.

126
Q

What does the right jugular lymphatic trunk form and empty into?

A

Forms the right lymphatic duct

Empties into the venous system via the right subclavian v.

127
Q

What are the superficial lymph nodes?

What do they drain into?

A

Lymph nodes arranged in ring shape that receive lymph from scalp, face and neck

Drain into deep lymph nodes

Include:
Mastoid
Occipital —> Superior Cervical L.N.s —> EJV

Pre-Auricular
Parotid
Submental
Submandibular —> Deep Cervical L.N.s—> IJV

128
Q

What do the superior cervical lymph nodes drain into?

A

EJV

129
Q

What do the deep cervical lymph nodes drain into?

A

IJV

130
Q

What are the Upper and Lower deep cervical L.N.s?

A

Upper: Jugulodigastric at C4
Receives lymph form thorax and tonsils

Lower: Juguloomohyoid at C6

131
Q

What is Waldeyer’s Tonsillar Ring?

A

Collection of lymphatic tissue surrounding superior pharynx, responses to pathogens tha may be ingested or inhaled

Includes: 
Lingual 
Palatine
Tubal 
Pharyngeal tonsils
132
Q

What is Tonsilitis?

A

Inflamed palatine tonsils

Could be inflamed due to viral or bacterial infection

Can treat by tonsillectomy

Neuro (18 decks)

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