Week 5: Lymphatics and Fascia of head and neck

Question 1

What are the branches of the external carotid artery in the head and neck?

Answer 1

1. superior thyroid artery (anterior)
2. ascending pharygeal artery (posterior, don’t need to know)
3. Lingual (anterior)
4. Facial artery (anterior)
5. Occipital (posterior)
6. Maxillary (anterior)
7. Superficial temporal (what external carotid becomes)
8. Posterior auricular artery (don’t need to know)

Question 2

What are the viscera located in the neck?

Answer 2

• Pharynx and esophagus
• Larynx and trachea
• Thyroid and parathyroid glands

Question 3

What are the nerves located in the neck?

Answer 3

1. Cranial nerves: IX, X, XI, XII
2. cervical plexus
3. sympathetic trunk
4. brachial plexus
5. phrenic nerve

Question 4

What are the compartments of the neck? What are its components?

Answer 4

1. Visceral: in anterior part of the neck; contains the larynx, trachea, pharynx, esophagus, thyroid
2. Structural or skeletal: in posterior part of the neck; contains the cervical spine & muscles
3. Carotid sheaths: located anterolaterally; contain carotid artery, internal jugular vein and vagus nerve

Question 5

What are the fascia layers of the neck?

Answer 5

1. Superficial fascia (includes platysma muscle).
2. Deep fascia (multiple layers)
   - Investing: surrounds entire neck, splits to enclose SCM and trapezius mms.
   - Pretracheal: surrounds visceral structures in anterior neck. Thyroid, trachea, esophagus, recurrent laryngeal nerves
   - Prevertebral: surrounds the posterior skeletal and muscular parts of the neck. Cervical sympathetic trunk
   - Carotid sheath: contains carotid artery, internal jugular vein, vagus nerve.

Question 6

What is the retropharyngeal space? Why is it important clinically?

Answer 6

• Space between pre tracheal and pre vertebral layers which extends to the superior and posterior mediastina (behind the pharynx–>esophagus)
• infections originating adjacent to the pharynx can potentially spread via this space to the mediastinum
• could have retropharyngeal abscess

Question 7

Describe the organization of the lymphatic drainage of the head and neck.

Answer 7

• follows a peripheral to central pattern

- divided into 2 main groups: superficial and deep nodes

Question 8

Describe the pericervical collar of lymph nodes.

Answer 8

• superficial lymph nodes which drain the head, located at the junction of the head and neck
  1. buccal
  2. submental
  3. submandibular
  4. parotid
  5. retroauricular
  6. occipital

Question 9

Describe the deep cervical lymph nodes of the neck.

Answer 9

• along course of internal jugular

- receive lymph from superficial nodes, viscera of the head and neck, and other deep nodes

Question 10

Where does lymph from the tongue drain to? Why is this important clinically?

Answer 10

• may drain to nodes on the same side (ipsilateral) or to the opposite side (contralateral) depending on lesion location
• submental node, submandibular node, to jugulodigastric node and other deep cervical nodes
• mid-sagittal region of the tongue has bilateral lymph drainage