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Anatomy - BB Exam 3 > Viscera of Neck > Flashcards

Viscera of Neck Flashcards

1
Q

thyroid ima artery

A
  • 10% of people
  • arises from brachiocephalic trunk or arch of aorta, etc.
  • supplies trachea and thyroid
  • clinically important for surgical procedures in midline to prevent bleeding - bleeding can be very bad since right off a great vessel
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2
Q

during development/relocation of the thyroid, what attaches it to the foramen cecum?

A

thyroglossal duct

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3
Q

what is a thyroglossal duct cyst?

A

when remnants of duct remain and fluid accumulates at any point along it (but most in neck near hyoid)

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4
Q

where can you find aberrant thyroid glandular tissue?

A

anywhere along the path of embryonic thyroglossal duct

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5
Q

what is a lingual thyroid gland?

A

aberrant thyroid tissue in the root of the tongue, just posterior to the foramen cecum

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6
Q

where will an accessory thyroid gland usually develop?

A

in neck lateral to the thyroid cartilage, lying on thyrohyoid muscle

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7
Q

what is a pyramidal lobe of the thyroid?

A
  • 50% of people
  • extends from isthmus of thyroid gland usually to left of median plane
  • isthmus incomplete or absent
  • develop from remnants of epithelium and CT of thyroglossal duct
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8
Q

what is a goiter?

A

a non-neoplastic, noninflammatory enlargement of the thyroid gland resulting from lack of iodine

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9
Q

what may a goiter compress?

A
  • trachea
  • esophagus
  • recurrent laryngeal nerves
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10
Q

with a goiter, the thyroid gland can expand in all directions except which one?

A

superiorly b/c of superior attachments of the overlying sternothyroid and sternohyoid muscles

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11
Q

what is near-total thyroidectomy?

A

posterior part of each lobe of enlarged thyroid is preserved -> used in surgical treatment of hyperthyroidism
-to protect the recurrent and superior laryngeal nerves and spare parathyroids

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12
Q

what does injury to the recurrent laryngeal nerves cause?

A
  • hoarseness
  • aphonia or disturbance of phonation (voice production)
  • laryngeal spasm
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13
Q

what does atrophy or inadvertent surgical removal of all the parathyroid glands cause?

A

-tetany (severe neuro syndrome w/ muscle twitches and cramps caused by low serum Ca2+)

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14
Q

if parathyroids are transplanted, where are they moved?

A

usually to arm

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15
Q

what do laryngeal fractures cause?

A
  • submucous hemorrhage and edema
  • respiratory obstruction
  • hoarseness
  • sometimes temporary inability to speak
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16
Q

what is the purpose of laryngoscopy?

A

to examine interior of larynx

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17
Q

indirect vs. direct laryngoscopy

A

indirect: using a mirror, pull tongue out of way
direct: using a laryngoscope

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18
Q

what is the valsalva maneuver?

A
  • any forced expiratory effort against a close airway (cough, sneeze, strain during bowel movement/lifting)
  • vestibular and vocal folds tightly adducted
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19
Q

what is the valsalva maneuver used to study?

A

cardiovascular effects of raised peripheral venous pressure and decreased cardiac filling and cardiac output - b/c high intrathoracic pressure impedes venous return to RA

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20
Q

what is the Heimlich maneuver?

A

sudden compression of the abdomen that causes the diaphragm to elevate and compress the lungs, expelling air from trachea into larynx -> to dislodge foreign objects trapped in larynx

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21
Q

what is a needle cricothyrotomy/coniotomy?

A

insertion of a large-bore needle through the cricothyroid ligament to permit fast entry of air

22
Q

what is a surgical cricothyrotomy?

A

incision through the skin and cricothyroid ligament to insert a small tracheostomy tube into trachea

23
Q

describe the incision for a tracheostomy

A
  • infrahyoid mm retracted laterally
  • isthmus of thyroid either divided or retracted superiorly
  • opening in trachea b/w 1st and 2nd tracheal rings or through 2nd-4th rings
24
Q

to avoid complications during a tracheostomy, what anatomical relationships are important to know? (5)

A
  1. inferior thyroid vv. from venous plexus on thyroid, descend anterior to trachea
  2. thyroid ima a. ascends from brachiocephalic trunk
  3. L brachiocephalic v, jugular venous arch (kids)
  4. thymus covers inferior part of trachea in kids
  5. trachea in kids is small, mobile, soft, making it easy to cut through and hit esophagus
25
Q

what does injury to laryngeal nerves cause?

A
  • paralysis of vocal fold

- bilateral can cause stridor

26
Q

what is stridor?

A

high pitched, noisy respiration

27
Q

what does injury to the superior laryngeal nerve cause?

A

anesthesia of the superior laryngeal mucosa -> lose protective mechanism for keeping foreign bodies out of larynx

28
Q

what does injury to the external branch of superior laryngeal nerve cause?

A

monotone voice b/c paralyzed cricothyroid cannot vary length and tension of vocal fold

29
Q

superior laryngeal nerve block

A
  • done w/ endotracheal intubation
  • needle inserted midway b/w thyroid cartilage and hyoid, passes through thyrohyoid membrane, bathes internal laryngeal nerve
  • anesthesia of the laryngeal mucosa superior to vocal folds
30
Q

presentation of patients w/ cancer of larynx

A
  • smokers/tobacco chewers
  • hoarseness
  • otalgia (earache)
  • dysphagia
  • enlarged pretracheal or paratracheal nodes
31
Q

what is laryngectomy?

A

removal of larynx

32
Q

what happens to the larynx in boys due to testosterone?

A
  • walls strengthen
  • laryngeal cavity enlarges
  • all laryngeal cartilages enlarge
  • vocal folds lengthen and thicken
33
Q

where might foreign bodies entering the pharynx lodge?

A

piriform recess

34
Q

what is the narrowest part of the alimentary canal?

A

inferior end of the laryngopharynx

35
Q

sinus tract from piriform recess

A
  • develops from remnant of thyroglossal duct that adheres to the developing laryngopharynx
  • can be a site for recurrent thyroiditis
  • passes from piriform recess to thyroid gland
36
Q

how is tonsillectomy done?

A

either by dissecting the palatine tonsil from the tonsillar bed or by a guillotine or snare operation

37
Q

what structures are at risk of injury during a tonsillectomy?

A
  • glossopharyngeal nerve
  • external palatine vein
  • internal carotid artery
38
Q

what is adenoiditis?

A

inflammation of the pharyngeal tonsils/adenoids

-can obstruct airway from nasal cavities through the choanae into the nasopharynx -> necessitates mouth breathing

39
Q

what is a branchial fistula?

A

abnormal canal that opens internally into the tonsillar sinus/fossa and externally on the side of the neck

40
Q

what causes branchial fistula?

A

persistence of remnants of the 2nd pharyngeal pouch and 2nd pharyngeal groove

41
Q

describe course of a branchial fistula

A

cervical opening -> ascends along anterior border of SCM -> through subQ -> platysma -> neck fascia -> enters carotid sheath -> passes b/w the internal and external carotid aa. into tonsillar sinus

42
Q

what is a branchial sinus?

A

when embryonic cervical sinus retains connection w/ lateral surface of neck

43
Q

what is a branchial cyst?

A

if a remnant of cervical sinus is not connected with the surface, it can fill w/ fluid
-usually just inferior to angle of mandible

44
Q

what nerves are at risk during excission of branchial sinus/cyst?

A
  • hypoglossal
  • glossopharyngeal
  • spinal accessory
45
Q

what are the rarest kind of penetrating neck trauma?

A

esophageal injuries - but cause most complications after surgery or other treatment

46
Q

what is the most common presenting complaint w/ esophageal cancer?

A

dysphagia

47
Q

how is esophageal cancer diagnosed?

A

esophagoscopy

48
Q

zone 1 for determination of seriousness of neck trauma

A
  • root of neck from clavicles/manubrium to inferior border of cricoid cartilage
  • at risk: cervical pleurae, apices of lungs, thyroid, parathyroids, trachea, esophagus, common carotids, jugulars, cervical vertebra
49
Q

zone 2 for determination of seriousness of neck trauma

A
  • from cricoid cartilage to level of angles of the mandible
  • at risk: superior poles of thyroid, thyroid and cricoid cartilages, larynx, laryngopharynx, carotids, jugulars, esophagus, cervical vertebra
50
Q

zone 3 for determination of seriousness of neck trauma

A
  • from angles of mandible superiorly

- at risk: salivary glands, oral and nasal cavities, oropharynx, nasopharynx

51
Q

which zone(s) have the greatest risk for morbidity and mortality? why?

A

1 and 3 b/c:

  • injured structures difficult to visualize and repair
  • vascular damage hard to control
52
Q

injuries to which zone(s) is/are the most common?

A

2

Anatomy - BB Exam 3 (13 decks)

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