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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
Q

What are some important features on the thyroid cartilage?

A

The thyroid notch
The thyroid prominence
The oblique line

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26
Q

What is an important feature of the cricoid cartilage?

A

The arch of the cricoid cartilage

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27
Q

Describe the mobility of the isthmus?

A

Relativly immobile
Is attahced to the 2-4 tracheal ring by connective tissue

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28
Q

What are the different branches of the superior thyroid artery?

A

Anterior branch - supplies the anterior surface of lobes
Posterior branch - supplies medial and lateral surface of thyroid
Runs behind the thyrohyoid membrane

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29
Q

What is the superior larnygeal nerve?

A

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

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30
Q

What are the four different ways to distinguish between the carotid artery and the internal jugular vein on ultrasound?

A

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

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31
Q

What is the carotid sinus?
How does is appear on ultrasound?

A

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.

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32
Q

How can you distinguish between the internal and external carotid artery on ultrasound?

A

Internal tends to be more laterally located
External more medial

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33
Q

Identify green structures

A
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34
Q

Red structures

A

Cricoidthyroid ligament
Arch of cricoid

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35
Q

Identify the black structures

A

Right lobe
Left lobe
Isthmus
Of thyroid gland

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36
Q

Identify the palpable features if the neck

A
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37
Q

Identify the parathyroid glands

A
38
Q

Draw a transverse section diagram of the thyroid gland and it’s surrounding structures

A
39
Q

What is identifiable in this ultrasound of the thyroid gland?

A
40
Q

What is identifiable in this ultrasound image?
Tala en in the neck thyroid Gland is seen in the right of the image

A

Muscle is lilkey sternocladomasotid

41
Q

What can be identified in this ultrasound image?
Thyroid gland to the left taken at level c3

A

The swearing of the artery is the carotid sinus - this is just before the bifurcation

42
Q

What can be seen in this ultrasound image?
Longitudinal plane at around c3

A
43
Q

What can be seen in the following ultrasound image?
Longitudinal in neck at c3

A
44
Q

What are the different fascia layers found in the neck?

A

Subcutaneous fascia
Deep investing fascia
Pretracheal fascia
Prevertebral fascia
Carotid sheath
Infrahyoid muscle

45
Q

Where is the subcutaneous fascia of the neck and what does it contain?

A

Found in the subcutaneous tissue, contains the platysma muscle and the subcutaneous VAN

46
Q

What are the boundaries/locations of the deep investing fascia?

A

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
Q

What structures are contained within the deep investing fascia?

A

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
Q

What is the location/boundaries of the pretracheal fascia?

A

Surrounds the viscera within the neck
Ant: hyoid, larynx and pericardial sac
Posterior: skull to mediastinum

49
Q

What are the different components of the pretracheal fascia?

A

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
Q

What is contained within the pretracheal fascia?

A

Visceral components
Thyroid, trachea, oesophagus/larynx, parathyroid gland, recurrent laryngeal nerve

51
Q

What are the contents of prevertebral fascia?

A

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
Q

What are the additional features associated with the prevertebral fascia?

A

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
Q

What forms the carotid sheat?

A

Formed by the fusion of adjacent fascial sleeves - prevertebral, pretracheal and deep investing fascia.

54
Q

What features are contained within the carotid sheath? detailed answer

A

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
Q

What is the infrahyoid fascia?

A

Surrounds the infrahyoid muscles in the neck
Is sometimes described as a subset of the pretracheal fascia.

56
Q

What are the different anatomical spaces in the cervical fascia?

A

The retropharyngeal fascia space
The danger space

57
Q

Where is the retropharangeal fascia space found?

A

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
Q

Why is the retropharyngeal fascia space important clinically?

A

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
Q

Where is the danger space (potential space in the cervical fascia) located?

A

Between the alar fascia and the prevertebral fascia.
These do not fuse together and eventually open up into the posterior mediastinum

60
Q

Why is the danger space
(The potential space in the cervical fascia) important clinically?

A

Allos infection to spread from the just below the skull to the posterior mediastinum.

61
Q

What is the pink fascia?

A

The deep investing fascia

62
Q

What is the red fascia?

A

The infrahyoid fascia

63
Q

What is the blue/organge fascia?

A

The pretracheal fascia including the orange buccopharyngeal fascia

64
Q

What is the green fascia?

A

The carotid sheath

65
Q

What is the purple fascia?

A

The prevertebral fascia

66
Q

What is the white fascia?

A

The subcutaneous cervical fascia

67
Q

What is the blue fascia and what is indicated by the three labels?

A

Blue = carotid sheath
1 - common carotid artery
2 - internal jugular vein
3 - vagus nerve

68
Q

What is indicated by the green line and what are the two labels?
What are the yellow structures shown in the image?

A

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
Q

What is shown by the blue line and what do the two arroes indicate?

A

Blue line is the deep investing fascia
Label 1 is the sternocleidomastoid muscle
Label 2 is the trapezius muscle

70
Q

What does the pink line indicate?
What are the different labels?

A

Pink line - prevertebral fascia
1 - trachea
2 - oesophagus
3 - thyroid
4 - recurrent laryngeal nerve

71
Q

What is the red line and what to the arrows indicate?

A

Red line is the infrahyoid fascia
The arrows indicate the infrahyoid muscles

72
Q

Label the image

A

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
Q

What is different in origin between the two common carotid arteries?

A

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
Q

At what level do the common carotid arteries bifurcate?

A

Near the superior edge of the thyroid cartilage level near C4 or C3

75
Q

Label the image

A

Thyroid cartilage
Cricoid cartilage
Trachea
Oesophagus
Common carotid artery
Internal carotid artery
External carotid artery

76
Q

Label the image
(start just under the chin)

A

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
Q

What are the branches of the external carotid artery?

A

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
Q

How do the branches of the external carotid artery relate to the parotid gland?

A

Travel deep to the inferior border of the parotids or may enter into the border.

79
Q

Label the branches of the arteries
1 = just under the chin

A

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
Q

Label the relevant branches of the external carotid artery

A

Facial artery
Lingual artery
External carotid artery
Maxillary artery
Superficial temporal artery

81
Q

Where does most of the venous return of the neck drain back into?

A

The internal jugular vein

82
Q

What are some of the tributaries of the internal jugular vein?

A

Inferior petrosal vein
The facial vein
The lingual vein
The pharyngeal vein
The occipital vein
The superior thyroid vein
The middle thyroid vein

83
Q

Describe the course of the internal jugular vein

A

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
Q

What are the key tributaries of the external jugular vein?

A

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
Q

Label the relevant structures starting with the muscle

A

Sternocladomastoid muscle
Retromandibular vein
Posterior auricular vein
Anterior jugular
External jugular

86
Q

Label the relevant structures
Staring on the upper left

A

Retromandibular vein
Anterior jugular vein
Sternocleidomastoid muscle
Trapezius muscle
External jugular vein
Posterior auricular vein

87
Q

What three cranial nerves are found in the neck?
Where are the found?

A

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
Q

What is the cervical plexus and what does it supply?

A

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
Q

What are the nerve routs of the brachial plexus?

A

C5 to T1

90
Q

What are the different roots of ansa cervicalis?

A

Superior root from C1/C2
Inferior root from C2/C3
Both join to form a loop like structure

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