Anatomy: Neck (Cervical Region)

Front 1

Sternocleidomastoid m.

Back 1

Actions: Laterally flexes neck and rotates head.

- accessory muscle of inspiration

Front 2

Torticollis (wry neck)

Back 2

Cause: by injury to the sternocleidomastoid m., causing possible damage to accessory n. innervating it.

Results: Tilt and rotation of the head to one side and restricted motion to the other side. Stiffness of the neck results from fibrosis and shortening of the SCM m.

Front 3

Anterior Cervical Triangle

Back 3

Boundaries include anterior border of SCM m., midline of neck and lower border of mandible.

4 Subdivisions: Submental triangle, Submandibular triangle, Carotid triangle, and Muscular triangle.

Front 4

Submental Triangle (Boundaries)

Back 4

anterior digastric mm., mandible, hyoid bone and mylohioid m. (floor)

Front 5

Submental Triangle (Contents)

Back 5

submental blood vessels and lymph nodes receiving lymph from chin and tip of tongue

Front 6

Submandibular Triangle (Boundaries)

Back 6

anterior and posterior digastric mm. and lower border of mandible

Front 7

Submandibular Triangle (Contents)

Back 7

submandibular gland and facial artery

Front 8

Carotid Triangle (Boundaries)

Back 8

posterior digastric m., superior omohyoid m. and anterior margin of SCM m.

Front 9

Carotid Triangle (Contents)

Back 9

-Carotid aa.(common,internal,external) -carotid sinus
-internal jugular v.
-carotid sheath
-vagus and hypoglossal nn.
- triad of common carotid a., internal jugular v. and vagus n. are surrounded by carotid sheath deep to SCM m. in lower 2/3 of neck.
Significant features: site to listen for carotid sinus (Carotid Bruit), site to take carotid pulse, site to massage for alleviating cardiac arrhythmias, palpation may induce fainting in elderly.

Front 10

Muscular Triangle (Boundaries)

Back 10

Anterior margin of SCM m., superior omohyoid m., midline of neck from hyoid bone to jugular notch of sternum

Front 11

Muscular Triangle (Contents)

Back 11

- Strap mm.
- thyroid and parathyroid glands
-larynx
- laryngeal nn.
(internal,external,recurrent) and accompanying vessels

Significant features: area for palpating thyroid gland and cricothyrotomy procedure.

Front 12

Posterior Cervical Triangle

Back 12

Boundaries: SCM m., trapezius m., and clavicle.

Features: subclavian triangle and careful and carefree zones.

Front 13

Venous Drainage to Head and Neck

Back 13

mainly to internal jugular v.

Front 14

Superficial vein in neck usually visible through skin that becomes engorged and prominent in congestive heart failure.

Back 14

External jugular v.

Front 15

Cutaneous Nerves of Head and Neck

Back 15

Cervical Plexus: Lesser Occipital n., Great Auricular n., Transverse Cervical n., and Supraclavicular n.

Trigeminal: Opthalmic (V1), Maxillary (V2), and Mandibular (V3)

Front 16

Thyroid Gland (Structure)

Back 16

- two lateral lobes contacting larynx/upper trachea and covered by sternothyroid mm.
-two lobes connected by an isthmus at level of trachea.

Front 17

Thyroid Gland (Blood Supply)

Back 17

1.) Superior thyroid a. descends from external carotid a. to gland.
2.) Inferior thyroid a. ascends from thyrocervical trunk of subclavian a.

An unpaired artery (thyroidia ima) present in ~ 10% of population may be present----- ascends anterior to trachea from arch of aorta to isthmus of gland. (must be considered during tracheosteomy when isthmus is separated).

Front 18

Thyroid Gland (Associated Structures)

Back 18

-parathyroid glands (superior and inferior) located on posterior aspect of each thyroid lobe.

-external laryngeal n.----descends with superior thyroid a.----supplies cricothryoid m.----injury impairs production of high pitched sounds

-internal laryngeal n.(main sensory nerve to larynx)---passes w/ superior laryngeal a.(branch of sup. thyroid a.)---pierces thyrohyoid membrane and enters larynx---injury impairs cough reflex.

-recurrent laryngeal n.---main motor nerves to muscles of larynx---closely associated w/ inferior thyroid aa.----injury leads to hoarseness of the voice.

Front 19

Carotid Sinus

Back 19

-site indicated by bulge in wall of carotid bifurcation and initial part of internal carotid a.
-role in regulating blood pressure.

Front 20

External Carotid a. branches

Back 20

-Superior Thyroid a.
-Ascending Pharyngeal a.
-Lingual a.
-Facial a.
-Occipital a.
-Posterior Auricular a.
-Maxillary a.
-Superficial temporal a.

Front 21

Pulse Sites

Back 21

-Carotid aa.--- Carotid Triangle
-Facial a.--- Lower border of mandible and corner of mouth.
-Superficial Temporal a.---Front of ear.

Front 22

Increased pressure on Carotid Sinus receptors leads to:

Back 22

-increased firing rate of an associated nerve CN IX (Hering's Nerve)
-produces reflexive slowing of the heart (parasymp. response) and decrease in in sympathetic tone of blood vessels, lowering BP.

Front 23

Two deep Cervical lymph nodes

Back 23

Jugulodigastric node:
- palpated for tenderness below angle of mandible.
-drains tonsillar region of throat

Jugulo-omohyoid node:
- drains deep cervical lymph nodes above, some from submental area, and tip of tongue.

Front 24

Thoracic Duct

Back 24

-gathers lymph from body below diaphragm and upper left half of body.
- merges with internal jugular vein.

Front 25

Right lymphatic duct

Back 25

- drains right upper half of body
- both thoracic duct and right lymphatic duct empty into venous system at root of neck.

Front 26

Left supraclavicular nodes (sentinel nodes of Virchow)

Back 26

- sample lymph from thoracic duct
- enlargement may be indicative of a malignancy in the thorax or abdomen.

Front 27

Cervical Sympathetics

Back 27

Usually three cervical ganglion along course of each sympathetic trunk.

- Large superior cervical ganglion @ level of C2 (axis) vertebra.
-Middle cervical ganglion @ level of cricoid cartilage of larynx near inferior thyroid a.
- Inferior cervical ganglion (Stellate Ganglion), contains cervical ganglia and thoracic ganglia---Located: posteromedial to vertebral a. @ junction of cervical and thoracic column curvatures.

Front 28

Common features of three cervical ganglia

Back 28

- Gray communicantes and cardiac nerves

-superior cervical ganglion provide sympathetic innervation of pharynx and head---- Give rise to internal carotid and external carotid nn., which travel to form plexus around carotid aa.

Front 29

Structures supplied by postganglionic sympathetic nerve fibers in the carotid nn.

Back 29

-sweat glands/blood vessels of the face
-Mueller's m./ dilator pupillae m.of orbit

-interruption of sympathetic chain in upper thorax/neck or injury to superior cervical ganglion--- leads to Horner's Syndrome.

Front 30

Horner's Syndrome

Back 30

-injury to symp. pathway between thoracic spinal cord to superior cervical ganglion

-Results in ptosis, miosis and anhydrosis.

Front 31

Lingual Nerve contains:

Back 31

- Nerve Fibers for general sensation (V3) for anterior 2/3 of tongue
- Nerve Fibers for taste sensation (VII, facial n.)) for anterior 2/3 of tongue.
- Parasympathetic nerve fibers (VII) to submandibular and sublingual salivary glands.

Front 32

Inferior Alveolar nerve contains:

Back 32

Nerve fibers for sensation for mandibular teeth via mental branch for skin of chin, lower lip and labial gingiva (V3)

Front 33

Parasympathetic innervation to Parotid gland

Back 33

CN IX, glossopharyngeal nerve.

Front 34

Gustatory sweating, Frey's Syndrome

Back 34

Sweating brought on while eating, thinking, or talking about food also producing strong salivation.