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Anatomy class > Unit 10: Neck and thyroid > Flashcards

Unit 10: Neck and thyroid Flashcards

1
Q

What vertebral level can the thyroid gland be found?

A

C5-T1

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2
Q

What are some important palpable fearures in the neck?

A

Hyiod bone
Thyroid notch
Thyroid prominence
Arch of cricoid cartilage
Jugular notch
Sternocladomastoid

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3
Q

What are the gross features of the thyroid gland?

A

Right and lieft lobe connected by an isthmus
Each lobe can be divided into a superior and an inferior pole

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4
Q

What is the relationship between the thyroid cartilage and the thyroid gland?

A

Thyroid gland beigns roughly at the level of the oblique line of the thyroid cartilage
Is anterior and inferior to the thyroid cartilage

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5
Q

What level is the isthmus of the thyroid?

A

Between the 2nd and 4th tracehal rings

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6
Q

How does the thyoird glnad relate to the larynx?

A

Is attached to the larynx by the thyroid fascia and the surrounding pre-tracheal fascia
This means the thyroid is elevated with the larynx when swallowing

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7
Q

What are the different divisions of the pre-tracheal fascia?

A

Found in the anterior neck between the hyoid bone and the thorax where is fuses with the pericardium
Is split into a muscular part that surrounds the infrahyoid muscles
And a visceral part that surrounds the thyroid gland, trachea and the oesophagus.

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8
Q

What is the pyramidal lobe of the thyroid?

A

Rare
projects superiorly from the isthmus, varies in height
Embryological remnant of the thyroglossal duct, the thyroid descends through he thyroglassoal duct from the floor of the primordial pharynx (near the base of the tongue) to its adult position.

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9
Q

What are thyroglossal cysts?

A

Where embryological remnants of the thyroglossal duct fill with fluid

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10
Q

What is the thyroglossal duct?

A

The embryological structure that the thyroid gland descended down in from the primordial pharnyx near the base of the tongue to its anatomical position in adults.

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11
Q

What glands are associated with the thyroid gland?
Where are they located?

A

Parathyroid gland (x4)
Located on the posterior aspect of the thyroid
Superior: typically in the middle of each lobe
Inferior: on inferior pole

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12
Q

What structures are important to recognise and avoid during a thyroidectomy?

A

Parathyroid gland (x4) located on the posterior aspect of the thyroid gland
Right and left recurrent laryngeal nerves

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13
Q

Describe the anatomical of the thyroid in relation to other structures?

A

Anterolateral to the larynx and the trachea
Lateral portion of lobes may be covered by sternthyroid and sternohyoid muscles and overlap with the carotid sheath

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14
Q

What structures are found withiin the carotid sheat?

A

The common carotid artery
The internal jugular vein
The vagus nerve

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15
Q

Describe the anatomy of the right recurrent laryngeal nerve?

A

Branch of the vagus nerve
Loops behind the subclavian artery and travels towards the larynx, deep to the posterior aspect of the thyroid gland

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16
Q

What is the anatomy of the left recurrent laryngeal nerve?

A

Branch of the left vagus nerves
Loops behind the arch of the aorta
Travels towards the larynx, passes deep to the posterior aspect of the thyroid gland

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17
Q

What are some of hte potential consequences of damage to the recurrent laryngeal nerves during a thyroidectomy?

A

Difficulty in swallowing
Difficulty in breathing
Hoarsness of voice
Paralysis of the voice box.

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18
Q

What is the vascular supplt to the thyroid gland?

A

Superior thyroid arteries - second branch of the external carotid artery
Inferior thyroid artery - branch of the thyrocervical trunk (subclavian artery)

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19
Q

What branch is variable in supplying vasculature to the thyroid gland?

A

The thyroid IMA artery - a branch from the brachiocephalic trunk

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20
Q

What is the venous drainage of the thyroid gland?

A

Superior thyroid vein - Drains into the internal jugular vein
Middle thyroid vein - drains into the internal jugualr vein
Inferior thyroid vein - drains into the brachiocephalic vein

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21
Q

What innervates the thyroid gland?

A

Branches of the cervical ganglia of the sympathetic trunk
Accompany the thyroid arteries

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22
Q

What is the lymphatic drainage of the thyroid gland?

A

The deep cervical nodes
These are split into the pre-laryngeal nodes, pre-tracheal (anterior to thyroid) and paratracheal (lateral to thyroid) nodes
These all then drain into the superior and inferior dep cervical lymph nodes

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23
Q

What structure connects the thyroid cartilage and the hyoid bone?

A

The thyrohyoid membrane

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24
Q

What connects the cricoid cartilage and the thyroid cartilage?

A

The cricothyroid ligamanet

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25
What are some important features on the thyroid cartilage?
The thyroid notch The thyroid prominence The oblique line
26
What is an important feature of the cricoid cartilage?
The arch of the cricoid cartilage
27
Describe the mobility of the isthmus?
Relativly immobile Is attahced to the 2-4 tracheal ring by connective tissue
28
What are the different branches of the superior thyroid artery?
Anterior branch - supplies the anterior surface of lobes Posterior branch - supplies medial and lateral surface of thyroid Runs behind the thyrohyoid membrane
29
What is the superior larnygeal nerve?
A branch from the right and left vagus nerve Has an internal branch which travels deep to the thyrohyoid membrane And a external branch that travels superficial to the thyroid gland
30
What are the four different ways to distinguish between the carotid artery and the internal jugular vein on ultrasound?
1.Carotid artery tends to be more medial 2. Apply pressure with the probe and the internal jugular vein will be compresses the artery will not 3. Ask patient to do the valsalva manesouvre - the vein will dilate in size. 4. confirm the direction of blood flow using the doppler scan
31
What is the carotid sinus? How does is appear on ultrasound?
Is a dilation at the carotid bifurcation/ into the internal carotid Contains baroreceptors May also be known as the carotid bulb Innverated by a branch of the glassopharyngeal nerve.
32
How can you distinguish between the internal and external carotid artery on ultrasound?
Internal tends to be more laterally located External more medial
33
Identify green structures
34
Red structures
Cricoidthyroid ligament Arch of cricoid
35
Identify the black structures
Right lobe Left lobe Isthmus Of thyroid gland
36
Identify the palpable features if the neck
37
Identify the parathyroid glands
38
Draw a transverse section diagram of the thyroid gland and it’s surrounding structures
39
What is identifiable in this ultrasound of the thyroid gland?
40
What is identifiable in this ultrasound image? Tala en in the neck thyroid Gland is seen in the right of the image
Muscle is lilkey sternocladomasotid
41
What can be identified in this ultrasound image? Thyroid gland to the left taken at level c3
The swearing of the artery is the carotid sinus - this is just before the bifurcation
42
What can be seen in this ultrasound image? Longitudinal plane at around c3
43
What can be seen in the following ultrasound image? Longitudinal in neck at c3
44
What are the different fascia layers found in the neck?
Subcutaneous fascia Deep investing fascia Pretracheal fascia Prevertebral fascia Carotid sheath Infrahyoid muscle
45
Where is the subcutaneous fascia of the neck and what does it contain?
Found in the subcutaneous tissue, contains the platysma muscle and the subcutaneous VAN
46
What are the boundaries/locations of the deep investing fascia?
Encircles the entire neck, from the nuchal ligament posteriorly. Attaches from the zygomatic arch and mastoid process, external occipital protuberance and superior nuchal line to the spine of the scapulae, clavicle and sternum.
47
What structures are contained within the deep investing fascia?
Forms the roof of the posterior triangle Layers wrap around the trapezius muscle, the sternocladomastoid muscle and the submandibular and parotid gland. Pierces by the cutaneous branches of the cervical plexus and the external jugular vein.
48
What is the location/boundaries of the pretracheal fascia?
Surrounds the viscera within the neck Ant: hyoid, larynx and pericardial sac Posterior: skull to mediastinum
49
What are the different components of the pretracheal fascia?
The buccopharangeal fascia (most posterior layer), seperated from the other layers by the pharnyx, trachea and oesophagus The pretracheal fasica layer that wraps around the the thyroid gland.
50
What is contained within the pretracheal fascia?
Visceral components Thyroid, trachea, oesophagus/larynx, parathyroid gland, recurrent laryngeal nerve
51
What are the contents of prevertebral fascia?
Contains the muscular and vertebral compartments. Also contains the phrenic nerve and cervical/brachial plexus roots. Forms the floor of the posterior triangle of the neck
52
What are the additional features associated with the prevertebral fascia?
Axillary sheath - extension of fascia pulled out by the brachial plexus as it leaves Alar fascia - a second layer found most anteriorly (from transverse process level medially) fuses with the buccopharyngeal fascia at T1 level.
53
What forms the carotid sheat?
Formed by the fusion of adjacent fascial sleeves - prevertebral, pretracheal and deep investing fascia.
54
What features are contained within the carotid sheath? detailed answer
The main content: internal jugular vein, common carotid artery and the vagus nerve Also contains the deep cervical nodes the carotid sinus nerve Ansa cervicalis (neuro) is found in the sheath walls.
55
What is the infrahyoid fascia?
Surrounds the infrahyoid muscles in the neck Is sometimes described as a subset of the pretracheal fascia.
56
What are the different anatomical spaces in the cervical fascia?
The retropharyngeal fascia space The danger space
57
Where is the retropharangeal fascia space found?
Between the buccopharangeal fascia (part of the pretracheal fascia) and the alar (part of the prevertebral fascia) These fascia eventually fuse at around T1 level
58
Why is the retropharyngeal fascia space important clinically?
Functionally they allow movement of the pharynx,larynx and the oesophagus in swallowing. Patholigically if this potential space enlarges due to infection etc it can press forward on to the oesophagus or even the trachea causing difficulties swallowing and in severe cases breathing.
59
Where is the danger space (potential space in the cervical fascia) located?
Between the alar fascia and the prevertebral fascia. These do not fuse together and eventually open up into the posterior mediastinum
60
Why is the danger space (The potential space in the cervical fascia) important clinically?
Allos infection to spread from the just below the skull to the posterior mediastinum.
61
What is the pink fascia?
The deep investing fascia
62
What is the red fascia?
The infrahyoid fascia
63
What is the blue/organge fascia?
The pretracheal fascia including the orange buccopharyngeal fascia
64
What is the green fascia?
The carotid sheath
65
What is the purple fascia?
The prevertebral fascia
66
What is the white fascia?
The subcutaneous cervical fascia
67
What is the blue fascia and what is indicated by the three labels?
Blue = carotid sheath 1 - common carotid artery 2 - internal jugular vein 3 - vagus nerve
68
What is indicated by the green line and what are the two labels? What are the yellow structures shown in the image?
Green - prevertebral fascia 1 - anterior scalenes 2- middle scalene Yellow structures are the roots of the cervical and brachial plexus brachial is between the anterior and middle scalenes
69
What is shown by the blue line and what do the two arroes indicate?
Blue line is the deep investing fascia Label 1 is the sternocleidomastoid muscle Label 2 is the trapezius muscle
70
What does the pink line indicate? What are the different labels?
Pink line - prevertebral fascia 1 - trachea 2 - oesophagus 3 - thyroid 4 - recurrent laryngeal nerve
71
What is the red line and what to the arrows indicate?
Red line is the infrahyoid fascia The arrows indicate the infrahyoid muscles
72
Label the image
Infrahyoid muscles Thyroid pretracheal layer of fascia Sternocladomastoid Carotid sheath Buccopharyngeal fascia Investing layer of fascia Trapezius muscle Prevertebral layer of fascia Scalene muscle Vagus nerve Common carotid artery Internal jugular vein Oesophagus Trachea
73
What is different in origin between the two common carotid arteries?
The right common carotid artery arises from the brachiocephlaic trunk at the level of the right sternoclavicular joint. The left common carotid artery arises direct from the arch of the aorta in the thorax then transverse superiorly into the neck near the left sternoclavicular joint
74
At what level do the common carotid arteries bifurcate?
Near the superior edge of the thyroid cartilage level near C4 or C3
75
Label the image
Thyroid cartilage Cricoid cartilage Trachea Oesophagus Common carotid artery Internal carotid artery External carotid artery
76
Label the image (start just under the chin)
Carotid triangle Superior belly of omohyoid muscle Common carotid artery Sternocleidomastoid muscle Carotid sinus External carotid artery Internal carotid artery Posterior belly of digastric muscle
77
What are the branches of the external carotid artery?
Superior thyroid artery Ascending pharyngeal artery Lingual artery Facial artery Occipital artery Posterior auricular artery Maxillary artery Superficial temporal artery Some anatomists Like Freaking Out Poor Medical Students
78
How do the branches of the external carotid artery relate to the parotid gland?
Travel deep to the inferior border of the parotids or may enter into the border.
79
Label the branches of the arteries 1 = just under the chin
Facial artery Lingual artery External carotid artery Common carotid artery Subclavian artery THyrocervical trunk Inferior thyroid artery Internal carotid artery Ascending pharangeal artery Superficial temporal artery Maxillary artery
80
Label the relevant branches of the external carotid artery
Facial artery Lingual artery External carotid artery Maxillary artery Superficial temporal artery
81
Where does most of the venous return of the neck drain back into?
The internal jugular vein
82
What are some of the tributaries of the internal jugular vein?
Inferior petrosal vein The facial vein The lingual vein The pharyngeal vein The occipital vein The superior thyroid vein The middle thyroid vein
83
Describe the course of the internal jugular vein
Beings as a dilated continuation of the sigmoid sinus. (a dural venous sinus) Exits the skull via the jugular foramen and enters the carotid sheath In the sheet travels lateral to the common carotid artery and anterior to the vagus nerve Joins with the subclavian veins posterior to the sternal ends of the clavicle to form the right and left brachiocephalic veins
84
What are the key tributaries of the external jugular vein?
The retromandibular vein and the posterior auricular vein More proximal is also drained into by the anterior jugular vein (the anterior jug also drain directly into the subclavian)
85
Label the relevant structures starting with the muscle
Sternocladomastoid muscle Retromandibular vein Posterior auricular vein Anterior jugular External jugular
86
Label the relevant structures Staring on the upper left
Retromandibular vein Anterior jugular vein Sternocleidomastoid muscle Trapezius muscle External jugular vein Posterior auricular vein
87
What three cranial nerves are found in the neck? Where are the found?
The accessory nerve - posterior triangle, from sterno to trap The vagus nerve - carotid sheath The glassopharangeal nerve - nerve external acoustic meatus corner of neck
88
What is the cervical plexus and what does it supply?
C1 to C4 Supply the strap muscles, the diaphragm, skin on anterior and lateral neck, skin on anterior thoracic wall and skin on inferior head
89
What are the nerve routs of the brachial plexus?
C5 to T1
90
What are the different roots of ansa cervicalis?
Superior root from C1/C2 Inferior root from C2/C3 Both join to form a loop like structure

Anatomy class (42 decks)

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