Week 3 hitchhiker's guide

Question 1

Where is the platysma m. found and what is the motor innervation and major action of these muscles?

Answer 1

1) Found within the superficial fascia (of the neck); thin, all over neck and onto mandible.
2) Innervation: CN7 motor for facial expression
3) Contract the muscles of the neck when teeth are clenched

Question 2

Where are the sternocleidomastoid muscles found and what is the motor innervation and major action of these muscles?

Answer 2

1) Goes from occipital bone to medial part of clavicle
2) Innervation: motor by CN 11
3) Tilts head side to side and rotates the neck.

Question 3

Note the location of the retropharyngeal space and its relationship with the pharynx

Answer 3

-It is the middle layer of the deep cervical fascia that surrounds the pharynx.
-Between prevertebral facia and pretracheal fascia, & the alar fascia crosses through

Question 4

Where does retropharyngeal abscess develop, why is it bad, and how might this infection spread?

Answer 4

1) In the retropharyngeal space (a thin space in the back of the throat b/t the esophagus and prevertebral muscles)
2) Can compromise airway and ability to swallow b/c abscess is pushing everything forward, compressing it. Can happen from swallowing a fish bone.
3) Can spread by getting into the upper respiratory tract, or other spaces (parapharyngeal, submandibular, prevertebral)

Question 5

Name the 4 cervical regions from anterior to posterior

Answer 5

1) Anterior cervical region
2) SCM region
3) Lateral cervical region
4) Posterior cervical region

Question 6

1) What cervical region visibly divides the anterior and lateral regions?
2) Name 4 things found within it

Answer 6

1) Sternocleidomastoid (SCM) region (A)
2) SCM muscle, superior portion EJV, greater auricular nerve, transverse cervical nerve

Question 7

What does the posterior cervical region (B) contain? (3 things)

Answer 7

1) Descending part of trapezius muscle
2) Cutaneous branches of posterior rami of cervical spinal nerves
3) Suboccipital region lies deep to superior part of this region

Question 8

What does the lateral cervical region (C) contain? (7 things)

Answer 8

1) Part of EJV
2) Posterior branches of cervical plexus nerves
3) CN 11
4) Cervical lymph nodes
5) Third part of subclavian artery
6) Suprascapular artery
7) Supraclavicular lymph nodes

Question 9

What does the anterior cervical region (D) contain? (8 things)

Answer 9

1) Submandibular gland
2) Submandibular lymph nodes
3) CN 12
4) Parts of facial artery & vein
5) Common carotid artery & its branches
6) Thyroid gland
7) Larynx and pharynx
8) Deep cervical lymph nodes

Question 10

What cranial nerve courses through the lateral cervical region (c)? What does it innervate?

Answer 10

CN 11, innervates the trapezius and SCM

Question 11

1) What forms the roots of the cervical plexus? Where is this?
2) Which part of this cervical plexus forms sensory nerves?
3) What is the nerve point of the neck?

Answer 11

1) Anterior rami of C1-C5; lateral cervical region
2) Superficial branches of plexus
3) The superficial part of the cervical plexus; along posterior border of the SCM jct superior and middle 3rds

Question 12

Which part of the cervical plexus forms the motor nerves: phrenic n. and ansa cervicalis? What does each do?

Answer 12

1) Deep branches of plexus.
2) Phrenic: sole motor to diaphragm
3) Ansa cervicalis: swallowing, vocalization, and neck stabilization

Question 13

Where would you expect to find the internal jugular vein?

Answer 13

Superficial and lateral to the carotid artery; between the clavicular heads of the sternocleidomastoid.

Question 14

1) What is the function of the hyoid bone?
2) What innervates the suprahyoid muscles?
3) What innervates the infrahyoid muscles?

Answer 14

1) Support and move larynx
2) Mainly by CNs 3, 7, 12
3) Spinal nerves

Question 15

What do the suprahyoid muscles do? (3 things)

Answer 15

1) Support the hyoid bone (providing a base from which the tongue functions.
2) Elevate the hyoid bone & larynx (needed for swallowing).
3) Play a role in chewing & opening the mouth (depresses the mandible).

Question 16

What do the infrahyoid muscles do? (2 things)

Answer 16

1) Stabilize the hyoid bone to the sternum, clavicle & scapula.
2) Depress hyoid & larynx during swallowing & speaking.

Question 17

What major vessels are found in the anterior cervical region? (3 things)

Answer 17

1) Carotid system (common, internal, and external carotid)
2) Internal jugular vein
3) Anterior jugular veins

Question 18

1) Right common carotid comes off what?
2) Left common carotid artery comes directly off _____________

Answer 18

1) Brachiocephalic trunk.
2) Aorta

Question 19

Name 3 things found within the carotid sheath

Answer 19

1) Common carotid artery
2) IJV
3) CN 10 (vagus)

Question 20

1) Where is the carotid body found?
2) What function does this structure perform?
3) What innervates it?

Answer 20

1) Next to the trachea where carotid artery splits
2) Chemoreceptor that detects low PO2 in blood; increases rate and depth of respiration & HR, BP
3) CNs 9 and 10 (visceral afferent)

Question 21

1) Where is the carotid sinus found?
2) What function does this structure perform?
3) What innervates it?

Answer 21

1) At the beginning of the internal carotid where the common carotid splits
2) A baroreceptor that monitors systemic BP; stimulated by increases in BP
3) CNs 9 and 10 (visceral afferent)

Question 22

1) Describe the relationship of the vagus nerve with the recurrent laryngeal nerve
2) Compare right and left.
3) What is the function of the recurrent laryngeal nerve?

Answer 22

1) The recurrent laryngeal nerve comes off the vagus nerve.
2) Right recurrent loops around right subclavian artery; left recurrent laryngeal nerve loops around aortic arch and has a longer path.
3) Recurrent: innervates all intrinsic muscles of larynx except for the cricothyroid muscle.
-Supplies sensation to the larynx below the vocal cords.

Question 23

Where are the thyroid gland, trachea, and esophagus?

Answer 23

In visceral part of neck bound to the pretracheal fascia

Question 24

Where are the parathyroid glands found in relation to the thyroid gland?

Answer 24

Directly posterior to thyroid gland

Question 25

Based on the anatomy, where would you expect to find a thyroid gland cyst vs. a thyroglossal duct cyst?

Answer 25

1) Thyroglossal duct cyst: in the front of the neck near hyoid bone
2) Thyroid gland cyst: in the thyroid gland (lower neck)

Question 26

What forms the superficial landmarks for the larynx and what is the function of the larynx?

Answer 26

1) Thyroid cartilage & its laryngeal prominence
2) Protect the airway by closing during swallowing and produce vocal sounds

Question 27

Observing an endotracheal tube pass through the _____________ is important to ensure the correct structure is intubated.

Answer 27

vocal cords

Question 28

What structure is posterior to the trachea that can be intubated by mistake?

Answer 28

Esophagus

Question 29

Differentiate the location of an emergent placement of a surgical cricothyroid airway with a more permanent tracheal airway.

Answer 29

1) Emergent: median cricothyroid ligament (b/t thyroid and cricoid cartilages)
2) Permanent: below cricoid cartilage at the 1st,2nd,3rd tracheal cartilage

Question 30

Differentiate the nasopharynx, oropharynx, and laryngopharynx

Answer 30

1) Nasopharynx: posterior to nose above soft palate
2) Oropharynx: back of mouth
3) Laryngopharynx: inferior to mouth, near larynx

Question 31

Predict how a right sided peritonsillar abscess would distort the normal anatomy you observe of the palatine tonsils

Answer 31

1) Right palatine tonsil would swollen, may be pushed medially.
2) Uvula would be pushed medially, right side of soft palate may be pushed higher and be swollen.
3) Right side of palatoglossal and palatopharyngeal arches would be pushed medially
4) Oropharyngeal space would narrow on right side

Question 32

Predict how a retropharyngeal abscess would distort the normal anatomy

Answer 32

1) Pushes the trachea forward, making it difficult to swallow or breathe.
2) Can also push tongue and throat forward, making it difficult to swallow.

Question 33

Why does a tonsillectomy often cause significant bleeding?

Answer 33

The tonsils have a rich blood supply.
-Bleeding commonly comes from the large external palatine vein.
-Less commonly the tonsillar artery can cause bleeding.
-The internal carotid artery is also as risk bc it lies directly lateral to the tonsil.

Question 34

Swallowing dysfunction can lead to aspiration, a common concern after a stroke. Swallowing evaluation is usually perform by who?

Answer 34

Speech therapists

Question 35

What type of muscle is the esophagus?

Answer 35

Esophagus is made up of different muscles:
1) Upper third: Striated (voluntary) muscle
2) Lower third: Smooth (involuntary) muscle
With a mixture of striated and smooth in-between.

Question 36

Articulate the general layout and flow of lymph from the head and neck back into the systemic circulation through the thoracic duct (2 steps)

Answer 36

1) Duct begins in the abdomen (cisterna chyli) and ascends through the thorax and enters junction of left IJV and left subclavian vein (aka left venous angle).
2) From there it enters the left brachiocephalic vein and flows through the superior vena cava.

Question 37

Articulate the general layout and flow of lymph from the head and neck back into the systemic circulation through the right lymphatic duct (4 steps)

Answer 37

1) From the head, lymph drains into the jugular lymphatic trunk.
2) Lymph from the right UE and thorax enters the left subclavian lymphatic trunk.
3) The jugular and subclavian lymphatic trunk meet and enter the right lymphatic duct.
4) From here, the lymph flows into the right venous angle, into the right brachiocephalic vein, into the superior vena cava.