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258 Cards in this Set

  • Front
  • Back
sagittal plane
divides body into left and right
frontal/coronal plane
divides body into anterior and posterior
transverse/horizontal plane
divides body into superior and inferior (axial-medical imaging)
dorsiflexion
pulling foot up
plantar fexion
pushing foot down
retraction and protrustion
pull in; push out (aka jaw)
T3 spinous process
at the level of the greater tubercle of humerus
T7 spinous process
at the inferior angle of the scapula
L4 spin process
at the level of the iliac crest
trapezius
superficial, extrinsic, anterior rami, CNXI motor and C3-C4 sensory nerves; superficial branch of transverse cervical artery; attachments: clavicle, acromion, scapula spine, occipital bone; elevates lateral scapular
latissimus dorsi
attaches to intertubercular groove, thoracodorsal nerve (aka middle subscapular, C6-C8) and artery; adduct, extend, medial rotation
levator scapulae and rhomboids
dorsal scapular (C5) motor and sensory; levator= elevates, attaches to posterior tubercles of C1-C4 and superior scapula; rhomboids= adducts (retracts)
Serratus posterior superior and inferior
ventral primary rami; upper and lower intercostal nerves, proprioception, inspiratory mvmts
Splenius
bandage, unilateral- bend/rotate neck; bilateral- extend head, capitus attaches on mastoid; ligamentum nuchae and spinous processes
Spinalis
capitis (blends with semispinalis capitis), cervicis (often absent), thoracic (constant); posterior primary rami
Strain vs Sprain
strain= muscle, tendon; sprain= ligament
Longissimus
capitis, cervicis, thoracic
Iliocostalis
cervicis, thoracic, lumborum
Transversospinalis
Semispinalis (C,C,T, spans 4-6); multifidus (C, T, L, spans 2-4); rotatores (C, T, L, spans 1-2); posterior primary rami; attach: transverse processes; extend and rotate column
deep vertebral muscles
intertransversarius (C, L)=bends laterally; Interspinales (C, L)=extends/rotates column; levator costarum=trans process to rib
suboccipital triangle boundaries
roof-trapezium and semispinalis capitis; floor-atlandooccipital, atlantoaxial, rectus capitis post. minor
suboccipital triangle walls
medial=rectus capitis post. major and minor, C1 arch and C2 SP; lateral=superior oblique, C1 TP; inferior=inferior oblique, C2 SP and C1
suboccipital triangle contents
dorsal ramus of C1 (suboccipital nerve), vertebral artery; others:: dorsal ramus of C2 (greater occipital nerve), C3 (least occipital n.), occipital artery and vein, lesser occipital nerve (anterior rami of C2-C3)
triangle of ascultation
trapezius, lat dorsi, medial border of scapula, rhomboid major (floor), intercostal space 6 for listening
lumbar triangle
lat dorsi, external oblique, internal oblique (floor), Petit's hernia (inferior lumbar)
erector spinae
3 muscle groups; bilateral- extends head, unilateral- lateral bending; main extensor; attach: broad tendom, sacroiliac ligaments, spinous processes
conventional radiography
film radiography, computed radiography, digital radiography, fluoroscopy
cross-sectional imaging techniques
CT, MRI, Ultrasonography; interrogate 3D volume to produce 2D image
nuclear radiology
nuclear medicine images relfect not only biodistribution of radiopharmacuetical but the anatomic, pathologic, and artifact overlays
film radiography
screen-film system within film cassette as x-ray detector, white bones
computed radiography
filmless eliminated chemical processing; substitutes a phosphor imaging plate; digital images transferred to PACS (pic. archiv and comm sys); looks inside for landmarks, multislice, lots of radiation
digital radiography
film and cassette free; fixed electronic detector-direct read out immediate image
fluoroscopy
continuous x-ray passes through patient onto screen; real-time radiographic visualization; interventional, active
Computed tomography (CT)
computer reconstructs image from measurment of x-ray transmission; only a single tissue parameter; density; fast, lots info, radiation
US (ultrasonography)
heardest, cheap, 0 radiation; interrogate tissue with multiple pulses, real-time images
CT density measurements
bone 400 to 1000H, soft tissue 40 to 80, fat -60 to -100, lung -400 to -600, air -1000, water 1 to 10
CT artifacts
volume averagine, beam-hardening, motion, streak (shotgun)
MR (magnetic resonance)
analyzes multiple tissue char, hydrogen (proton) density, blood flow, T1 (fat) and T2 (water); expensive, nonmotile things
MR pros and cons
good soft tissue resolution, images in any plane, absence of radiation; limited demonstration of dense bone detail, chemical shift misregistration (artifact)
US artifacts
acoustic shadowing (gallstone) and enhancement (cyst)
nuclear rad. function
inject radioisotope; PET imagine- beta particle (florine) attaches to glucose to look for meta. activity
primary scoliosis of thoracolumbar region
lateral deviation in thoracic/lumbar region; there will be compensatory curve of cervicothoracic region in other direction
atlas/C1
no body, no spinous process but does have posterior tubercle; facet joint (pivot), small transverse process and foramen; lateral mass articulates with occipital condyle
axis/C2
dens-damaged in hanging, bifid SP, transverse foramen for vertebral artery
transverse ligament of atlas
torn if dens separates (behind dens)
cruciate ligament
superior, transverse, and inferior bands; behind dens
cervical vertebrae
3-6 are bifid SP,small kidney-shaped body, 7 vertebral prominens, uncus; carotid tubercle of C6 is pressure point to control bleed from carotid
thoracic vertebrae
no trans foramen, ribs attach by facet joings, heart-shaped body, round hole; vert. notches for IV foramen; plane of articulation-frontal with bending/rotation
lumbar vertebrae
mamillary (multifidus) and accessory (longissimus) processes; kidney-shaped body, plane of articultion-sagittal with flexion/extension & lat. bending
sacrum
promontory, reduces TP and SP, superior articular facet; posteriorly- palpate cornua and median crest to find sacral hiatus; sacral foramena (ventral rami of S1-S4 and arteries)
IV disk
anulus fibrosus- longit. ligaments; nucleus pulposus-cartilaginous, elastic, posterior, absorb shock
facet joint
aka zygapophyseal joint, synovial
atlantoccipital joint
btw occipital condyle and superior articular facet of C1; has anterior and post. membranes; holes for vertebral a. and C1 nerve; flexion and extension (no rotation)
uncovertebral joint (of Luschka)
formed postnatally, assoc. with bone spurs (osteophytes), synovial, between uncinate processes, C2-C4
subluxation
atlantoaxial dislocation, may be associated with Down syndrome
vertebral col. ligaments
1. interspinjous ligament (ant.)= limits flexion, joings SPs; 2. supraspinous ligament (post.)= limits flexion, expands and forms ligamentum nuchae; 3. ligamentum flavum= limits flex., joins laminae; 4. posterior long. ligament= limit flexion, weak, direct IV disk posterolaterally, nociceptive n; 5. ant. long. ligament=- limits extension, strong, whiplash
movements of vert. col.
limited by IV disk, plane of articulation
cervical vert. mvmts
horizont. orientation; thick discs; flexion, extension. lat bending, rotation
thoracic vert. mvmts
frontal orientation, thin discs, all mvmts limited, 4 sites of articulation (ribs)
lumbar vert. mvmts
sagittal orient., thick discs and body, flexion and extension, limited rotation
Spondylolysis
fracture of pars interarticularis (region btw sup and inf facets); defect lamina formation at L5
filum terminale
pia mater continum
epidural anesthesia and lumbar puncture
EA= into epidural space btw L3-L4; LP= into subarachnoid space btw L4-L5
Herniated disk straight leg test
positive if pain in lower limb when leg lifted, also if increase pain with dorsiflexion or if pain relieved when knee flexes (sciatica L4-S3)
paravertebral venous drainage
pathway for tumor cells to get to brain; post. and ant. external plexus as well as a internal plexus
scotty dog
region btw superior and inferior articulating facets; ear- sup. articular facet, collar- pars interarticularis, leg- inf. articular facet
stenosis
pressure on nerves, narrowing of vertebral foramen, IV disk bulging
transverse foramen
passage of vertebral artery and vein, vertebral flexus (sympathetic)
atlantoaxial joint
3 articulations; rotation of head, held in place by transverse ligament
radicular arteries
branches from vertebral, cervical, deep cervical, post. intercostals; follow nerves through IV foramenand form an anastomosis
denticulate ligament
supports spinal cord with IV foramen
cranial nerves
1 and 2 are direct extensions of the brain; 11 is dervied from spinal nerves C1-5; myelin by schwann cells/neurilemma
neuron types
multipolar=motor; biopolar=special sensory, interneurons; unipolar/psuedounipolar= sensory
motor neurons
located in ventral horn gray matter and intermediolateral cell column (lateral horn)
primary rami
there is a ventral (back) and dorsal (lateral and ventral sides) rami but they are both mixed because they come from a mixed spinal nerve
plexuses
from ventral primary rami; give spinal nerve a wider distribution; cervical (C1-C5), brachial (C5-T1), lumbar (L1-L4), sacral (L4-S4)
spinal nerve modalities
GSA (sensory input from surface, tendons, joints), GVA (sensory from viscera), GSE (motor to skeletal m.), GVE (motor to viscera, salivary, arrector pili, bv, sweat, autonomic)
Dermamyotome derivatives
all PNS ganglia from neural crest; spinal cord from neural tube
Dermatome levels
T4-nipple, sternal-T2, C6-C8=fingers, T10-umbilicus, L3-knee, L5-medial foot, S1-lateral foot
sympathetic NS
from T1-L3; 1st neuron=IML cell column; 2nd neuron=paravertebral (chain) or prevertebral ganglion; acetylcholernergic, acetylcholine and norepi NT
parasympathetic NS
from CN 3, 7, 9, 10 and S2-S4; cholernergic, acetylcholine NT
prevertebral ganglion
celiac, superior mesentary, and inf. mesentary ganglia; splanchnic nerves lead to this
rami communicans
white= myelinated, faster, preganglionic nerves; gray, postganglionic nerves
superficial reflex
abdominal (upper-T7-T9, lower-T10-T12); cremasteric (L1-L2); plantar reflex (scratch sole of foot, L5-S1); anal (S2-S4)
deep tendon reflexes
muscle spindles and tendon organs; biceps (C5-C6); brachioradialis (C5-7); tricep (C6-8); quadriceps (patellar tendon L2-4); anchilles tendon (S1-2)
blastocyst formation
fertilization causes mitosis of zygote to form blastomeres; solid mass of cells within zona pellucida-morula; cavity (blastocoel) develops and now is a blastocyste
meiosis
1st meiosis is before ovulation; 2nd meiosis is at fertilization
blastocyst
outer cell mass= placenta/trophoblast; inner cell mass= embryo
implantation factors
L-selectins=carb binding proteins on trophoblast initiates capture to the endometrium; integrin= expressed by trophoblast and attach via receptors on laminin mlcs in ECM of endometrium; fibronectin= migration of blastocyst into endometrium
placenta formation
syncytiotrophoblast= amorphous multinucleate erodes into endometrium and maternal bv; cytotrophoblast= mononucleated; extraembryonic mesodern adds to inner surface to become 3rd layer
bilaminar germ disc (hypo and epi blast)
hypoblast= give rise to exocoelomic (Heuser's) mem and forms primary yolk sac; epiblast= gives rise to 3 germ layers and extraembryonic mesoderm
bilaminar germ disc
amnioblasts=from epiblast, form amniotic mem; extraembryonic mesoderm= from yolk sac and epiblast, fills blastocyst cavity; chorionic cavity= divides into splanchnopleuric and somotopleuric extraembryo. mem. except at connecting stalk
primitive streak
at caudal end within the epiblast; cells move through streak to replace hypoblast and form endoderm and intraembryonic mesodern
primitive node
cells move through this to form prechordal plate, notochord, paraxial mesodern
gastrulation
in 3rd week; form primitive streak, germ layers, allantois; all formed by epiblast
notochord
prechordal plate= cluster of mesodermal cells that cause forebrain in ectoderm; prenotochordal cells= form notochord; neurenteric canal= brins amniotic and yolk sacs together
teratomas
remnants of primitive streak persist and cause tumors- sacrococcygeal teratomas; also from primordial germ cells that don't go to gonads
mesoderm fate map
intraembryonic= primitive node and streak; prechordal plate= cranial portion of node; notochord= cranial portion of node; paraxial= node and cranial primitive streak; intermediate= mid-primitive streak; lateral plate= caudal prim streak; extraembryonic= most caudal prim streak
body axes
anterior visceral endoderm= transcription factors for head formation; nodal= prim streak; BMP-4 and fibroblastic growth factor (FGF)= ventralize mesoderm; noggin/chordin/follistatin= prim node, antagonize BMP for dorsalization
Brachyury (T) gene
regulates dorsal mesoderm in caudal region; absence causes sirenomelia (caudal dysgenesis; mermaid)
body axes cont.
hepatic nuclear factor (HNF-3B)= forebrain and midbrain differentiation; FGF-8= exp. of nodal and lefty2 genes and upreg of PITX for left side; Lefty1= prevents left side going right; SHH= supresses left side from the right, from notochord; Snail=downreg of genes det. right side
amniotic sac
growth gets rid of chorionic cavity; amniotic fluid by diffusion then fetal urine; body folds and compresses yolk sac against connecting stalk (umbilical)
poly and oligohydramnios
poly= too much fluid; anencephalia, GI atresia, diabetes; oligo= too little, renal atresia, hypoplasia, polycystic kidneys
amniotic fluid
symmetrical growth, prevents amnion adherence, maintains temp, prevents trauma, allow mvmt, fluid wedge and parturition (dilate cervix), estimate maturity
yolk sac
limited role in metabolism; disappears or become Meckel's diverticulum; site of hematopoiesis and serum protein; primordial germ cell differentiation
allantois
from wall of yolk sac; induction of vitelline and umblilical vessels; persists as urachus (medial umbilical ligament) from bladder to abdominal wall
end of 3rd week
3 germ layers and 3 fetal membranes
secondary/definitive yolk sac
endodermal cells from hypoblast replace primary yolk sac
ectoderm
CNS, PNS and ganglia, sensory epi, epi of skin (sweat and mammary glands), pituitary gland, tooth enamel
mesoderm
CT, muscle, blood, lymph, vessel walls, kidney, gonads, suprarenal gland cortex, spleen
endoderm
lining of gut and assoc organs, lining of resp, lining of bladder, thyroid, parathyroids, lining of auditory and tympanic cavity
bone window
could be brain, soft tissue, etc
cervical and thoracic SP
C7- directed inferolaterally; T1- directed superolaterally
articular "pillars"
formed by articulation btw sup and inf articular processes
prevertebral soft tissue "shelf"
at C4/5 where esophagus begins
T2 weighted
Water, shows CSF brightly, hyrdated disk
T1 weighted
Fat, bright in vertebrae b/c of marrow
lateral sagittal MRI
can see neural foramen (big in lumbar v.)
scotty dog
in oblique section; shows pars interarticularis
block BMP4
form neural plate in middle of ectoderm
Pax 3 and 7
bipolar sensory neurons, from neural crest
Shh signaling
from notochord, form floor plane, invagination of nueral plant into embryo
Pax 6
determines motor portion of CNS, by Shh
Somites
from paraxial mesoderm, 3 a day, leaves cranial and caudal neuropore, cranial closes first
folding of cranial end of neural tube
cephalic and cervical flexure and then pontine flexure
NS cells
neural epithelium= oligodendrocytes, astrocytes, ependymal cells of ventricles; mesodern= microglial cells; neural crest= schwann cell, ganglia, meninges, melanocytes, pharyngeal arches
mantle and marginal layer
mantle= nuerons/gray matter; marginal= white matter
alar and basal plate
alar= dorsal horn; basal= ventral horn
epimeric and hypomeric
muscles; epimeric=dorsally; hypomeric= ventrally
spinal cord levels
8 weeks (whole canal); 24 weeks (S1/S2); newborn (L3/L4); adult (L1/L2)
spina bifita
occulta= no closing of vertebral arch, hairs; cystica= herniation of meninges and/or brain (meningocele, meningomyelocele); apera=neural plate didn't form, no Shh
Arnold-Chiari Malformation
aka myeloschisis, can cause hydroencephalis; brain (cerebral tonsils) pulled through foramen magnum
hydrocelphalus
aqueductal stenosis or tethering of nueral tube derivates
cranium bifidum
herniation at the level of the skull; meningocele; meningoencephalocele; meningohydroencephalocele (meninges, brain, CSF fluid)
exencephaly
cranial neural tube doesn't close, results in anencephaly
craniorachischisis
skull failed to form
pituitary gland
oralectoderm and neuralectoderm; Rathke's Pouch-adenohypophysis(anterior), pars tuberalis, pars intermedia; Infundibulum- stalk, pars nervosa
rhombomeres
molecular signaling from occipital somites; motor nuclei develop within (C5, 6, 7, 9, 10, 12)
ectodermal placodes
form from surface ectoderm and then are populated by neural crest that form neurons; nasal, otic, epibranchial (ganglia to CN 5, 7, 9, 10 that supply pharyngeal arches)
proencephalon
forms telencephalon (cerebral hemisphere, lateral ventricles) and diencephalon (thalmus, third ventricle)
mesencephalon
forms midbrain, aqueduct, CN 3 and 4
rhombencephalon
forms metencephalon (pons, cerebellum, upper fourth ventricle) and myelencephalon (medulla, lower fourth ventricle)
intraembryonic cavity
formed from splitting of lateral ectoderm
mesoderms in embryo
splanchnic=around yolk sac, form gut tube; somatic= form body cavity, CT
somite
from paraxial mesoderm; sclerotome-migrate to nueral tuve and notochord, form mesenchyme, form vertebrae; dermamyotome- skin and muscles (4 occip. 8 cerv. 12 thor. 5 lumb. 5 sacral 8-10 coccy)
membranous neurocranium
mesenchyme to osteoblasts; intermembraneous ossification
cartilaginous neurocranium (chondrocranium)
sphenoid and ethmoid (prechoral, neural crest); parachordal cartilage, occip sclerotomes (chordal, paraxial mesoderm); wings of sphenoid, temporal bone (mesenchymal
neural crest contribution
to head from cranial end of neural tube; frontal, face bones, hyoids
paraxial mes. contribution
parietal, back of skull
visceral cranium
bones of face, hearing, first 2 pharyngeal arches (1-maxilla, zygomatic, squamous temporal, malleus, incus, mandible; 2-styloid, hyoid, stapes)
craniosynostosis
early closing of sutures; scaphocephaly= sagittal, brain moves ant and post; acrocephaly= coronal; plagiocephaly= coronal and lamboid on 1 side
forming limbs
upreg FGF10 to create limbs; BMP-4 form AER (apical ectodermal ridge and FGF8 (division) and FGF4 (keeps it going) work
craniocaudal limb form.
ZPA (zone of polarizing avtivity) has Shh expression (retinoic acid) that make correct order of digits; BMP-4 causes cell death btw digits
dorsoventral limb form.
LMXI and Wnt7a cause dorsalization; ventral caused by blocking Wnt
bones in limb
HOX genes 9-13 expression causes differentiation; 9-scapula, +10-humerous, +11-forearm, +12-wrist, +13-digits
limb deformities
amelia (limb absence), meromelia (partial absence), polydactyly (too many digits), ectrodactyly (missing digit), syndactyly (fusion of digits)
vertebrae formation
sclerotome cells attain intersegmental position; spinal nerve is above vertebrae; mesenchyme contain intersegmental arteries
formation of transverse foramina
CERVICALLY= costal processes fuse with transverse processes
ribs and sternum formation
ribs from mesenchymal; true- first 7 with sternum; false- last five; sternum from sternal bars in mmesenchyme of mesoderm; endochondral ossification bones
muscle formation
paraxial mesoderm- skeletal; splanchnic mesoderm- smooth and cardiac;
lower boundary of neck
superior thoracic aperature=T1, manubrium, 1st ribs (not clavicle)
external occip. protuberance
attachment of nuchal ligament
hyoid
floating, suspended by suprahyoid m., at level of C3
thryoid cartilage
thyroid notch, 2 quadrilateral laminae, lengthens vocal cords
cricoid cartilage
at C6, wide part- lamina, on posterior
superficial investing layer of deep fascia
splits to enclose SCM, trap, parotid gland, omohyoid, anterior and posterior of sternum (suprasternal space for ant. jugular vein), continuous with ligamentum nuchae
pretracheal fascia
wraps around back to viscera, forms buccopharyngeal in posterior
prevertebral fascia
scalenes, intrinsic, transverse processes
cervicoaxillary shealth
prevertebral fascia enveloping brachial plexus and axillary vessels
Sibson's fascia
at cervicothoracic aperature, prevertebral fasica over lung to form diaphragm
retropharyngeal space
infection place, between prevertebral and buccopharyngeal, air in space from injury to pharynx
pretracheal space
in front, thyroid cart to sup. mediastinum
triangles of neck
anterior triangle, posterior triangle (lateral cervical triangle)-bound by SCM, clavicle, trap.
SCM
innervated by CN X1, ventral rami C2-C4, makes lesser supraclavicular fossa (end of internal jugular), bilaterally- chin to chest, protude chin; unilaterally- rotate ear to shoulder
Torticollis "wry neck"
lesion of accessory nerve, pulls head forwards or ear on shoulder
roof of posterior cervical triangle
superficial deep fascia, pierced by cutaneous nerves of cervical plexus, external jugular vein
floor of post. cervical triangle
prevertebral fascia, semispinalis capitus, splenius capitis, levator scapulae, 3 scalenes, brachial plexus, omohyoid
levator scapulae
inn. by C3, C4, and dorsal scapular n. (C5); accessory nerve lies on top of it
scalenes
posterior= 2nd rib, C5-8 ventral rami; middle= 1st rib, C3-8 ventral rami; anterior=C4-6 ventral rami; flex neck, head forward, to one side, inspiration
veins of posterior cervical triangle
external jugular vein emptying into subclavian vein (drains upper limb); subclavian and internal jugular make up brachiocephalic
Accessory nerve and cervical plexus
Accessory nerve:: cranial root-attaches to vagus in medula; spinal root- C1-5, innervates SCM and trap.
CN X1 damage
commonly damaged iatrogenically (lymph node biopsies); cannot abduct above horizontal, shoulder dropped
Sensory of cervical plexus
C2-C4; lesser occipital nerve C2 some C3- skin behind ear; great auricular n. C2&3- ear, jaw, parotid; transverse cervical C2&3- anterior neck; supraclavicular C3&4- over clavicle, shoulder, upper thoracic (3 branches)
Erb's point
where sensory components of cervical plexus originate, not assoc w/ CNX1
brachial plexus
are ventral rami, roots of brachial plexus are C5-A1 (merge into trunks), between middle and anterior scalene
dorsal scapular nerve
C5, from middle scalene; inn. rhomboids and levator scapulae
long thoracic nerve
C5, C6, 42% C7; from middle scalene, inn serratus anterior
phrenic nerve
C3-C5, from on anterior scalene, from cervical plexus, innervates diaphragm, may have accessory from C5 (on top of brachial plexus)
nerve to subclavius
C5-C6
suprascapular n
to supra/infraspinatus by going under transverse scapular ligament
arteries of posterior triangle
subclavian a.; thryrocervical branch (transverse cervical a and suprascapular artery); occipital artery
suprascapular a
supplies supra/infraspinatus, SCM, subclavius
transverse cervical a
deep branch or dorsal scapular artery (from thyrocervical trunk or 3rd part of subclavian a)
aortic arch
left subclavian, left common carotid, brachiocephalic trunk on right (branches into right subclavian and right common carotid)
branches from subclavian artery part 1
vertebral a; thyrocervical trunk; internal thoracic a.
vertebral a
ascends and enters transverse foramen of C6, turns medially on posterior arch of C1, turns superiorly into foramen magnum, vertebral arteries combine and form basilar artery (from aortic arch in 1.2%)
thyrocervical trunk
interior thyroid a, ascending cervical a, transverse cervical a, suprascapular a
ascending cervical a
ascends on anterior scalene; supplies anterior scalene, longus capitis, spinal cord, and meninges
branches from subclavian artery part 2
usually only one branch: costocervical (branch into deep cervical a. and highest intercostal a.)
deep cervical a.
supples prevertebral m., epaxial m, anastamoses in suboccipital triangle
branches of subclavian a part 3
usually no branches; occasionally suprascapular or dorsal scapular
neurologic thoracic outlet syndrome
compression of brachial plexus; occurs with cervical rib, weight-lifting, or slumping
thyroid ima artery
from aortic arch or brachiocephalic trunk, ascends anterior to trachea, 10%
carotid sheath
deep fascial layer; common carotid a, internal jugular vein, vagus nerve, deep cervical lymph nodes, superior ramus of ansa cervicalis
carotid sinus
dilation at point to bifurcation of common carotid into external and internal (C3/C4); baroreceptors senses bp changes
carotid body
at bifurcation of carotids; chemoreceptor senses changes in O2 and CO2
branches of external carotid
superior thyroid a, ascending pharyngeal a, lingual, facial, occipital, posterior auricular, maxillary, superficial temporal
superior thyroid artery
deep to infrahyoid muscles; descends to give off superior laryngeal a.
lingual
deep to hypoglossal n and hyoglossus m; lies on middle pharyngeal constrictor m and arches to hyoid bone
fascial
deep to digastric and stylohyoid and submandibular gland
ascending pharyngeal a
branches to pharynx, prevertebral m, middle ear, meninges
internal jugular vein
united with subclavian to from brachiocephalic vein; tributaries: facial, lingual, pharyngeal, superior, 2 middle thyroid (occipital?) [inferior thyroid goes into brachiocephalic]
cervical pleura
lung into superior thoracic aperature and into supraclavicular fossae; "cupula"
thoracic duct
left side only, lymph from lower parts of body, empties into left brachiocephalic vein
right lymphatic drainage
variable; 3 separate connections to veins: right jugular trunk, right subclavian trunk, right bronchomediastinal trunk
deep cervical nodes
prelaryngeal, pretracheal, paratracheal flow to inferior deep cervical nodes and passes to supraclavicular nodes (also: submental, submandibular, upper/middle/lower lateral jugular)
cervical sentinal nodes
cancer spreading to these nodes and enlarges them
external jugular vein
from retromandiubular and posterior auricular veins
muscles of anterior triangle
suprahyoid (digastric, stylohyoid, mylohyoid, geniohyoid) and infrahyoid (omohyoid, sternohyoid, thyrohyoid, sternothyroid)
infrahyoid muscles
depress hyoid, "strap muscles" because develop in long. sheet, "rectus cervicis"; innervated by C1/2/3 ansa cervicalis n
digastric
mastoid notch, depresses mandible, facial n and CN V3
stylohyoid
facial nerve
mylohyoid
depresses mandible, CN V3
geniohyoid
inn by C1 (coursing with hypoglossal n); found uner mylohyoid
cricoidthyroid
not an infrahyoid muscle; of the larynx, speech
hypoglossal nerve (CN X11)
extrinsic and intrinsic m of tongue
prevertebral muscles
longus colli/capitis; rectus capitis anterior/lateralis; scalene muscles; flex neck and head; ventral primary rami; in vertebral fascia
longus colli
anterior tubercles of C5/6 to bodies T1/2/3; bodies C5-T3 to C2-4; TP C3-5 to anterior arch of C1
longus capitis
anterior tubercles C3-6 to occipital bone
rectus capitis anterior
lateral mass of atlas to skull
rectus capitis lateralis
TP of atlas into occipital bone
scalenes
supplied by ascending cervical artery; anterior C4-C6; middle C3-C8; posterior C5-8
thyroid gland
two lateral lobes and isthmus; pyramidal lobe in 50% from thyroglossal duct; in pretracheal fascia;
thyroid veins
superior and middle (to internal jugular) and inferior (to brachiocephalic)
recurrent laryngeal n
branch of vagus n, talking, control muscles of larynx, not bilaterally sym
parathyroid glands
supplied by inferior thyroid artery or from anastomosis; drained by thryoid plexus of veins; superior-midpoint, at cricoid cart
tracheostomy
cricothyrotomy (in children, higher left brachiocephalic vein), high, or low
esophagus
begins at inferior of cricoid cartilage; btw trachea and ant long ligament; contacts right cervical pleua and left subclavian a; covered by vagus n.; supplied by inferior thyroid a. and v.
cervical plexus general
ventral primary rami C1-4 (C5 contributes to phrenic); ansa cervicalis (motor); contributes to spinal accessory
cervical plexus sensory
C2-4; middle posterior border of SCM-Erb's point; lesser occipital, great auricular, transverse cervical, supraclavicular
ansa cervicalis
motor; supples infrahyoids and geniohyoid; superior (C1/2, within carotid sheath) and inferior (C2/3)
phrenic nerve
C3-5; on anterior scalene, motor and sensory to diaphragm
cervical propioception
C2-4 from trapezius and SCM
rectus capitis lateralis/anterior innervation
C1-2 loop
longus capitis/colli innervation
capitis: C1-2 loop; colli: C2-4
levator scapulae innervation
C3-C4
brachial plexus
accessory phrenic n (C5); nerve to subclavius (C5-6); suprascapular (C5-6)
branches of vagus nerve
superior laryngeal, pharyngeal, meningeal, auricular, carotid, cardiac, recurrent laryngeal
superior laryngeal n
internal-sensory to larynx; external-motor to cricothyroid
recurrent laryngeal n
loops around rt subclavian a. and lt aortic arch, posterior to thryoid, ascend to larynx; supply intrinsic larynx muscles
glossopharyngeal nerve (IX)
branches: muscular, pharyngeal, carotid sinus, tympanic, lesser petrosal n
muscular branch of CN IX
innervates stylopharyngeus m
lesser petrosal n
extension of tympanic n., synapses in otic ganglion, parasym. to parotid gland
cervical sympathetic trunk
posterior to carotid sheath, lies on prevertebral fascia; splits into ansa subclavia
superior cervical ganglion
C1-4; CN9,10,12; internal/external carotids; pharyngeal plexus
middle cervical ganglion
branches to C5/6, at level of cricoid cartilage
cervicothoracic ganglion
inferior cervical and first thoracic ganglia; form vertebral plexus
Horner's syndrome
damage to cervical sym trunk; pupillary constriction, ptosis of upper eyelid, sinking of eye, vasodilation (redness), no sweating (anhidrosis), hypopigmentation of iris (in congentital cases)