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Triangles of the Neck & Larynx Flashcards

1
Q

What are the boundaries of the posterior triangle?

A

Anterior - sternocleidomastoid M
Posterior - trapezius M.
Inferior - clavicle
Floor - splenius capitis M.; levator scapulae M.; posterior, middle, and anterior scalene M.

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2
Q

What are the arteries within the posterior triangle?

A

vertebral A.,
internal thoracic A.
thyrocervical trunk [suprascapular A., transverse cervical A. (deep and superficial), inferior thyroid A.]
costocervical trunk

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3
Q

What are the veins within the posterior triangle?

A

external jugular V.

subclavian V.

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4
Q

What are the nerves within the posterior triangle?

A 
spinal accessory N.
cervical plexus (lesser occipital N., great auricular N., transverse cervical N., supraclavicular N.)
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5
Q

What are the boundaries of the anterior triangle?

A

superior - inferior border of the mandible
anterior - midline of the neck
posterior - sternocleidomastoid M.

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6
Q

What are the muscles within the anterior triangle?

A 
digastric M.
mylohyoid M. 
sternohyoid M.
omohyoid M. 
stylohyoid M. 
thryohyoid M.
sternothyroid M.
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7
Q

What are the arteries within the anterior triangle?

A

common carotid A. and internal carotid A.
external carotid A.
-superior thyroid A., superior laryngeal A., ascending pharyngeal A., lingual A., facial A., occipital A.,
superficial temporal A.,

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8
Q

What other triangles are within the anterior triangle?

A

submandibular
submental
carotid
muscular

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9
Q

What other triangles are within the posterior triangle?

A

occipital

subclavian

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10
Q

What are the neurovascular and lymphatic contents of the submandibular triangle?

A

submandibular gland
submandibular lymph nodes
hypoglossal N. and mylohyoid N.
facial A. and facial V.

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11
Q

What are the boundaries of the submandibular triangle?

A

superior - inferior border of the mandible
posterior - posterior belly of the digastric M.
anterior - anterior belly of the digastric M.

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12
Q

What are the boundaries of the submental triangle?

A

posterior - hyoid

lateral - medial border of the anterior belly of the digastric M.

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13
Q

What are the lymphatic contents of the submental triangle?

A

submental lymph nodes

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14
Q

What are the boundaries of the muscular triangle?

A

medial - midline of the neck
superolateral - superior belly of the omohyoid M.
inferolateral - anterior border of the sternocleidomastoid M.

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15
Q

What are the muscular contents of the muscular triangle?

A

sternohyoid M.
sternothyroid M.
thyrohyoid M.

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16
Q

What are the boundaries of the carotid triangle?

A

anterior - superior belly of the omohyoid M.
posterior - anterior border of the sternocleidomastoid M.
superior - posterior belly of the digastric M.

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17
Q

What are the neurovascular and lymphatic contents of the carotid triangle?

A 
common carotid A.
internal & external carotid A.
carotid sinus and carotid body
glossopharyngeal N.
vagus N.
carotid sinus N.
internal jugular V.
deep cervical lymph nodes
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18
Q

What are the fascial layers in the neck?

A

superficial fascia
deep cervical fascia
carotid sheath
retropharyngeal space

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19
Q

What is the superficial fascia of the neck?

A

thin connective tissue layer that lies b/w the dermis and investing layer of deep cervical fascia

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20
Q

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

A

cutaneous nerves, arteries and veins
superficial lymph nodes and lymphatic vessels
fat
platysma M. = muscle of facial expression (innervated by facial N.)

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21
Q

What are the layers of the deep cervical fascia?

A

Investing Layer
Pretracheal Layer
Prevertebral Layer

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22
Q

What is the investing layer of the deep cervical fascia?

A

surrounds entire neck
encloses sternocleidomastoid M. and trapezius M.
encloses parotid and submandibular glands

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23
Q

What is the pretracheal layer of the deep cervical fascia?

A

located only in anterior region of the neck
blends with pericardium of the heart
muscular layer (infrahyoid muscles), buccopharyngeal fascia, and visceral layer

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24
Q

What is the prevertebral layer of the deep cervical fascia?

A

encloses vertebral column and associated muscles

extends laterally as the axillary sheath into the arm

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25
Q

What are the neurovascular contents of the carotid sheath?

A

vagus N.
internal jugular V.
common carotid A.

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26
Q

What are the boundaries of the retropharyngeal space?

A 
anterior - buccopharyngeal fascia
posterior - prevertebral fascia
lateral - carotid sheaths
superior - base of skull
inferior - mediastinum
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27
Q

What is a retropharyngeal abscess and what are the symptoms?

A

develops secondary to lymphatic drainage or spread of oral or upper respiratory infections

can cause difficulty swallowing/speaking
can be life-threatening

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28
Q

What nerves exit the jugular foramen?

A

Glossopharyngeal N. (CN IX)
Vagus N. (CN X)
Spinal Accessory N. (CN XI)

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29
Q

What is the nerve most commonly injured during lateral cervical neck surgery?

A

Spinal Accessory Nerve (XI), b/c of its superficial location

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30
Q

What are the nerve roots to the phrenic N.?

A

C3, C4, C5

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31
Q

What does the phrenic N. innervate?

A

diaphragm

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32
Q

What nerve relays information from the carotid body?

A

Carotid sinus N.

branch of glossopharyngeal N CNIX and vagus N CNX

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33
Q

Does the external jugular V lie deep or superficial to the SCM?

A

superficial

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34
Q

What does the carotid body do?

A

Chemoreceptor that detects oxygen levels

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35
Q

What does the carotid sinus do?

A

Baroreceptor that detects BP

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36
Q

What the branches of the external carotid A.?

A 
Superior thyroid A.
Ascending pharyngeal A.
Lingual A.
Occipital A.
Superficial Temporal A.
Facial A.
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37
Q

What nerve root supplies the geniohyoid branch and the thyrohyoid branch of the cervical plexus?

A

C1

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38
Q

What nerve roots supply the Great Auricular N?

A

C2 and C3

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39
Q

What does the Great Auricular N. innervate?

A

Skin over parotid gland
Skin over posterior auricle
Skin over the region b/w mandible and mastoid

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40
Q

What nerve root supplies the Lesser Occipital N.?

A

C2

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41
Q

What does the Lesser Occipital N. innervate?

A

Skin of the neck and scalp posterior to auricle

42
Q

What nerve roots supply the Transverse Cervical N?

43
Q

What does the Transverse Cervical N. innervate?

A

Skin over the anterior triangle

44
Q

What nerve roots supply the superior and inferior branches of the ansa cervicalis?

A

Superior - C1

Inferior - C2 and C3

45
Q

What does the ansa cervicalis innervate?

A

Sternohyoid M.
Omohyoid M.
Sternothyroid M.

46
Q

What nerve roots supply the supraclavicular N.?

47
Q

What does the supraclavicular N. innervate?

A

Skin over lateral neck and shoulder

48
Q

What are the major branches of the vagus N (CN X)?

A 
pharyngeal branch and plexus
superior laryngeal N. 
-internal and external laryngeal N's.
superior and middle cardiac branches
recurrent laryngeal N. (becomes inferior laryngeal N.)
49
Q

What does the pharyngeal branch of the vagus N. innervate?

A

pharyngeal constrictor M.

50
Q

What does the internal laryngeal N. innervate?

A

laryngeal mucosa, everything in the superior compartment of the larynx

51
Q

What does the external laryngeal N. innervate?

A

cricothyroid M.

52
Q

What path does the left recurrent laryngeal N. take before it becomes the inferior laryngeal N.?

A

loops around the aortic arch

53
Q

What does the inferior laryngeal N. innervate?

A 
thyroarytenoid M
oblique arytenoid M.
transverse arytenoid M.
lateral cricoarytenoid M.
posterior cricoartytenoid M.
vocalis M.
54
Q

What does the spinal accessory N. (CN XI) innervate?

A

SCM

Trapezius M.

55
Q

In what specific triangle is the thyroid gland?

56
Q

Where is the thyroid located?

A

Superficial to the trachea
Medial to the carotid sheaths
Spans C5-T1 vertebral levels

57
Q

What is the central part of the thyroid called?

58
Q

At what tracheal levels is the isthmus located?

A

Rings 2 and 3

59
Q

Does the thyroid gland move during speech/swallowing?

60
Q

Where are the parathyroid glands located?

A

On the posterior aspect of the thyroid gland

  • superior
  • inferior
61
Q

What is the blood supply to the thyroid?

A

superior thyroid A. (from external carotid A.)

inferior thyroid A. (from thyrocervical trunk)

62
Q

What innervates the thyroid?

A

parasympathetic fibers of the vagus N. (CN X)

63
Q

What is the pyramidal lobe of the thyroid?

A

remnant of embryonic development

64
Q

During a tracheostomy, what must a surgeon beware of?

A

a potential thyroid ima A., located in 10% of the population … could cause hemorrhage

65
Q

At what vertebral level is the thyroid cartilage located?

66
Q

At what vertebral level is the cricoid cartilage located?

67
Q

What is the action of the thyroarytenoid M.?

A
  • relax vocal L.

- lower pitch

68
Q

What is the action of the oblique and transverse arytenoid M’s?

A

adduct arytenoid cartilage

69
Q

What is the action of vocalis M.?

A

relax posterior vocal L. while increasing/maintaining tension of the anterior part

70
Q

What is the action of the lateral cricoarytenoid M.?

A

aDduct vocal folds

71
Q

What is the action of the posterior cricoarytenoid M.?

A

aBduct vocal folds

72
Q

What is the anatomical relationship b/w the oblique and transverse arytenoid muscles?

A

Oblique arytenoid M. is superficial to the transverse arytenoid M.

73
Q

What is the action of the cricothyroid M.?

A
  • stretch/tense vocal L.

- increase pitch

74
Q

What are the neurovascular and lymph components of the superior laryngeal compartment?

A

Sensory: internal laryngeal N.
Blood: superior laryngeal A.
Lymph: travels with superior laryngeal A. into the superior deep cervical LN

75
Q

What are the neurovascular and lymph components of the inferior laryngeal compartment?

A

Sensory: inferior laryngeal N.
Blood: inferior laryngeal A.
Lymph: pretracheal and prevertebral LN into the inferior deep cervical LN

76
Q

What vein do the superficial cervical LN’s follow?

A

external jugular V.

77
Q

What vein do the deep cervical LN follow?

A

internal jugular V.

78
Q

What are the jugulo-digastric LN’s?

A

Deep cervical LN located ~C4, deep to the posterior belly of the digastric M.
drain fluids from throat and tonsils

79
Q

What are the jugulo-omohyoid LN’s?

A

Deep cervical LN located ~C6, deep to the omohyoid M.

80
Q

What does the right lymphatic duct drain?

A

R side of the head
R side of the neck
R side of the chest
R upper extremity

81
Q

What does the thoracic duct drain?

A

everything on the L side of the body
abdomen
pelvic/perineal area
R lower extremity

82
Q

Blue Box: Fx of Hyoid B.

A
  • manual strangulation
  • cannot elevate hyoid or move it anteriorly
  • aspiration pneumonia
83
Q

Blue Box: Cervical Fascia

A
  • injury to cervical branch of facial N. (CN VII)
  • skin falls away from neck in slack folds
  • careful w/ platysma and skin when suturing
  • disfiguring scars
84
Q

Blue Box: Congenital Torticollis

A
  • fibrous tumor in infancy
  • head tilts toward, face tilts away from affected side
  • injury to SCM during birth = hematoma and CN XI injury
85
Q

Blue Box: Spasmodic Torticollis

A
  • abnormal tonicity of SCM or trapezius M.
  • agonist and antagonist actions
  • sustained tilting/turning/flexing/extending neck
  • involuntary shifting of head
86
Q

Blue Box: Subclavian V. Puncture

A
  • central line placement
  • may accidentally puncture lung … pneumothorax
  • may puncture subclavian A. if too far posterior
87
Q

Blue Box: R Cardiac Catheterization

A
  • puncture of IJV
  • into brachiocephalic V.
  • into superior vena cava
  • into R side of heart
  • EJV not idea b/c of junction angle
88
Q

Blue Box: Prominence of EJV

A
  • internal barometer

- prominent when venous pressure rises (heart failure)

89
Q

Blue Box: Severance of EJV

A
  • investing layer of deep cervical fascia opens lumen
  • negative pressure sucks in air
  • churning noise in thorax
  • cyanosis
  • venous air embolism = froth stops blood flow = SOA
90
Q

Blue Box: Lesions of Spinal Accessory N.

A
  • penetrating trauma
  • tumors at cranial base
  • Fx of jugular foramen
  • weakness in turning head against resistance
  • drooping shoulder
91
Q

Blue Box: Severance/Block/Crush of Phrenic N.

A
  • paralysis in corresponding 1/2 of diaphragm
  • block for short term lung operation
  • crush for long term healing of diaphragm hernia repair
  • sometimes there’s an accessory phrenic N.
92
Q

Blue Box: Nerve Block of Cervical Plexus

A
  • injection along posterior border of SCM
  • Nerve Point of the Neck
  • half of diaphragm is usually paralyzed
  • cannot do in pt.’s w/lung or heart disease
93
Q

Blue Box: Nerve Block of Upper Extremity

A
  • supraclavicular brachial plexus

- superior to midpoint of the clavicle

94
Q

Blue Box: Injury to Suprascapular N.

A
  • loss of lateral rotation of humerus
  • waiter’s tip position
  • cannot initiate abduction of limb
95
Q

Blue Box: Ligation of External Carotid A.

A
  • control bleeding from inaccessible branch
  • doesn’t stop flow b/c of retrograde flow
  • external carotid A. on other side across midline of face
  • occipital A. provides collateral circulation
  • anastamose w/vertebral and deep cervical A.
96
Q

Blue Box: Sugical Dissection of Carotid Triangle

A
  • IJV
  • carotid system of arteries
  • CN X and CN XII
  • cervical sympathetic trunk
  • damage to X or recurrent laryngeal = voice altered
97
Q

Blue Box: Carotid Occlusion and Endarterectomy

A

Partial occlusion may cause TIA (less than 24 hrs)
Full Occlusion may cause minor stroke
-symptoms last b/w 24 hrs and 3 wks
Endarterectomy = open A., strip off plaque
Risk injury to CN IX-CNXII

98
Q

Blue Box: Carotid Pulse

A
  • checked during CPR
  • absence = cardiac arrest
  • shouldn’t check in pt.’s with cardiac/vascular disease
99
Q

Blue Box: Carotid Sinus Hypersensitivity

A
  • external pressure slows HR, drops BP, cause fainting

- shouldn’t check carotid pulse

100
Q

Blue Box: Internal Jugular Pulse

A
  • can provide information about heart activity
  • R atrial pressure by an ECG
  • pulsations visible in Trendelenburg position
  • pulsations increase w/mitral valve disease
  • R IJV runs a straighter/direct path to R atrium
101
Q

Blue Box: IJV Puncture

A
  • diagnostic/therapeutic
  • R side usually straighter and larger
  • insert at 30 degrees, just lateral to common carotid A.
  • aim between sternal and clavicular heads of SCM
  • then direct inferolaterally to ipsilateral nipple

Neuroendocrine (8 decks)

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