Anatomy Of The Neck I

Front 1

What are 3 anatomical words for neck?

Back 1

collum cervix nucha

Front 2

What are the superior boundaries of the neck?

Back 2

1. mental symphsis
2. mandible (body & angle)
3. external acoustic meatus
4. mastoid process
5. superior nuchal line of occipital bone

Front 3

What are the inferior boundaries of the neck?

Back 3

1. manubrium
2. clavicus
3. acromium process
4. line throught disk b/t C7 & T1

Front 4

List the structures at C3.

Back 4

hyoid bone, the common carotid usually divides between C3 and C4

Front 5

List the structures at C4-5.

Back 5

The superior thyroid notch and laryengeal prominence aka: adam's apple (both are part of thyroid cartillage), and the junction of the pharynex/esophagus (can be felt just above the cricoid cart.)

Front 6

List the structures at C6.

Back 6

Cricoid cart., junction of the larynx/traches, vertebral artery enters the transverse foramen here, and the recurrent laryngeal nerves enter the larynx.

Front 7

List the structures at C7.

Back 7

the thoracic duct reaches its highest point (this is where lymph enteres venous flow), isthmus of the thyroid gland.

Front 8

List important structures between C7 and T2.

Back 8

tracheal rings

Front 9

At what level would one find the suprasternal (jugular) notch?

Back 9

T2

Front 10

Describe torticollis

Back 10

contraction of muscles on one side of the neck, producing twisting into unusal positions, usually involving sternocleidomastoid musc.

Front 11

What is the orgin and insertion of the sternocleidmastoid musc?

Back 11

Org: manubrium of sternum and medial 1/3 of clavical
Ins: mastoid process of temp bone and superior nuchal line of occip bone

Front 12

What is the innervation of the sternocleidomastoid?

Back 12

CN XI

Front 13

What are the action of the sternocleidomastiod mucs?

Back 13

retates head and neck

Front 14

What are the boundaries of the anteriors cervial triangle?

Back 14

ant: midline of the neck from mental symphasis to jugular notch.
super: inferior border of mandible
post: sternocleidomastoid

Front 15

What are the boudaries of the posterior cervial triangle?

Back 15

ant: sternocleidmastoid.
infer: middle 1/3 of claviale
post: trapezius musc

Front 16

Name the infrahyoid musc (aka strap musc.)

Back 16

1. sternohyoid-sternum to hyoid
2. omohyoid- omo (scapula) to hyoid
3. thyiohyoid-short musc up from thyroid to hyoid
4. sternothyroid-sternum to thyroid

("SOT")

Front 17

What are the innervations of the infrahyoid musc?

Back 17

C1 and ansa cervicallis ( the loop of C1-3)

Front 18

List the suprahyoid muscles and give their innervation.

Back 18

1. Stylohyoid-VII
2) Posterior belly of the digastric-VII
3. Anterior belly of the digastric-V3 from inferior alverolar nerve
4. mylohyoid-a little branch of V3's inferior alveolar nerve
5. geniohyoid-C1

(Some Doctors Make the Grade)

Front 19

List the nerves associated with the anterior cervical triangle.

Back 19

1. V3's myohyoid nerve
2. VII-marginal mandibular and cervical branch
3. IX-carotid sinus branch
4. X-superior laryngeal n.(external and internal)
5. XII
6. ansa cervicalis from C1-3 plexus
7. sympathetic chain-med/lat to carotid sheath

Front 20

List the branches of the external carotid found in the anterior cervical triangle.

Back 20

1. superior thyroid
2. ascending pharyngeal
3. lingual
4. facial
5. occipital

"superman and lois fly on..."(mars)

Front 21

What are the main vessels found in the anterior cervical triangle?

Back 21

The external carotid (5 of its branches) and the facial vein.

Front 22

List the structures found within the carotid sheath.

Back 22

the common carotid, the internal carotid (above C3), the internal jugular vein, CN X

Front 23

List the non muscl/non vessel things found within the anterior cervical triangle.

Back 23

-carotid sheath
-thyroid gland
-parathyroid gland (2)
-trachea
-esophagus
-submandibular gland/duct
-cervical and submandibular lymph nodes.

Front 24

What composes the floor of the posterio cervial triagle?

Back 24

the 5 musc of the triangle and prevertebral fascia

Front 25

What are the musc associated with the posterior cervical triangle?

Back 25

1. scalens (ant, post, middle)
2. levator scapula
3. inferior belly of omohyoid
4. splenius capitus
5. semipinalis capitis

Front 26

Can the phrenic nerve be asociated with the anterior or posterior cervical triangle?

Back 26

post

Front 27

How is the phrenic nerve responsible for referred pain from the diaphragm?

Back 27

Its affarent fibers supply the diaphragm, pericardium, pleura, & peritoneum of diaphragm. When stim., pain can be preceived in the low neck and shoulder and is explained as a CNS misinterpretation.

Front 28

List the nerves associated with the posterior cervical triangle.

Back 28

1. phrenic nerve (C3-5)
2. branches of the cervical plexus (from anterior prim rami of C1-4)-this has both cutaneous and muscular branches
3. brachial plexus
4. CN XI

Front 29

List the cutaneous branches of the cervical plexus and tell their fiber types.

Back 29

1. lesser occipital (c2-3)
2. greater ariular (c2-3)
3. transvers cervical (c2-3)
4. supraclavical (c3-4)
They all contain afferent and post ganglionic efferect (sym) fibers

Front 30

What is the nerve point of the neck?

Back 30

The midpoint of the posterior borner of sternocleidoid musc, where CN XI and the 3 cutaneous branches of cervical plaxus can be found just deep to the investing fascia.

Front 31

List the muscular branches of the Cervical plexus, what they supply and what fiber types they contain.

Back 31

1. asna cervicalis c1-3: infrahyoid musc
2. phrenic c3-5: diaphragm musc
Both branches have aff, eff to skel musc, and post gang (symp) fibers.

Front 32

What are the vessels associated with the posterior cervical triangle?

Back 32

-Subclavian artery/vein
-Thyrocervical trunk:
a) transverse cervical artery
b) suprascapular artery
-Dorsal scapular artery (sometimes)

Front 33

What are the branches of the brachial plexus in the posterior cervical triangle?

Back 33

a. roots
1) dorsal scapular nerve (C5)
2) long thoracic nerve (C5 – C7)
b. trunks ( upper, middle, lower )
1) suprascapular nerve (0 = upper trunk)
2) nerve to the subclavius muscle (0 = upper trunk)
c. divisions ( anterior and posterior )
d. cords ( medial, lateral, and posterior ) – named in reference to their association
to the axillary artery
e. terminal branches

"Randy travis drinks cold texas beer"

Front 34

Overall, what are the nerves found in the posterior cervical triangle?

Back 34

1) PHRENIC NERVE
2) CERVICAL PLEXUS
a) cutaneous
-lesser occipital
-greater auricular
-transverse cervical
-supraclavicular
b) muscular
-ansa cervicalis
-phrenic
) BRACHIAL PLEXUS
--roots
dorsal scapular
long thoracic
--trunks
suprascapular
nerve to subclavius
--divisions
anterior/posterior
--cords
medial, lateral, posterior
--terminal branches
"randy travis drinks cold, texas beer"
4) ACCESSORY NERVE

Front 35

describe autonomic nervous system in the neck

Back 35

-Sympathetic trunks begin at C1
-Cervical sympathetic trunk is composed of cords, which connect THREE cervical sympathetic ganglia. Sometimes, inferior ganglia will fuse with lower ganglia to form STELLATE GANGLION.
-ANSA SUBCLAVIA--loop formed by part of the cervical cord b/w middle and inferior ganglia--this goes around subclavian artery and may hold vertebral artery.

Front 36

What is horner's syndrome?

Back 36

-damage to the cervical sympathetic trunk
OR
-damage to postgang. fibers that supply structures in the head

Front 37

What are the main types of fascia in the neck?

Back 37

SUPERFICIAL
1)Tela subcutanea

DEEP
1) Prevertebral
2) Investing
3) Carotid Sheath
4) Alar
5) Visceral
6) Infrahyoid

(**PICAVI)

Front 38

What is investing cervial fascia? Where is it?

Back 38

-Roof of posterior AND anterior cervical triangles.
-Encloses: trapezius, sternocleidomastoid.

Front 39

What is prevertebral fascia? Where is it?

Back 39

-deep to trapezius and sternocleidomastoid
-external to scalenes
-anterior to vertebral bodies
-contributes to floor of post. cervical triangle
-extends into base of neck as axillary sheath.

Front 40

What is carotid sheath? Where is it?

Back 40

-Sheath enclosing common carotid artery, internal carotid artery, internal jugular vein, and vagus nerve.

Front 41

What is alar fascia? Where is it?

Back 41

-Thin layer b/w carotid sheaths.
-Divides "danger spaces" 3 and 4.

Front 42

What is visceral fascia? Where is it?

Back 42

-Pretracheal (anterior) and buccopharyngeal (posterior) portions.
-Surrounds thyroid gland, trachea, esophagus.

Front 43

What is infrahyoid fascia? Where is it?

Back 43

-Encloses infrahyoid muscles.

Front 44

What are the fascia SPACES in the neck?

Back 44

1) Retrovisceral
-B/w pharynx and esophagus.
-Extends from skull-->thru neck-->diaphragm.
-Alar fascia divides this into danger zones 3 and 4.

2) Pretracheal Space
-B/w trachea and infrahyoid muscles.
-Connects to retropharyngeal space.
Extends from thyroid cartilage-->fibrous pericardium.

Front 45

What are the "danger spaces" in the neck?

Back 45

There are two of them. Danger spaces 3 and 4.

1)Danger space 3
--B/W alar and visceral fascia.
--continuous w/ fascial spaces of neck and face.

2) Danger space 4
-B/W alar and prevertebral fascia.
-Extends to diaphragm.

Front 46

What are the groups of muscles in the anterior cervical triangle?

Back 46

INFRAHYOID
-sternohyoid (S)
-omohyoid (O)
-thyrohyoid (T)
-sternothyroid
("SOT" from class)
SUPRAHYOID
-stylohyoid
-digastric (anterior, posterior bellies)
-mylohyoid
-geniohyoid
(Some Doctors Make the Grade)

Front 47

Does the accessory nerve cross the posterior
triangle?

Back 47

Yes

Front 48

What is the nerve supply to the
sternocleidomastoid and the trapezius?

Back 48

CN XI

Front 49

What important structures are found in the
posterior triangle cranial to the accessory
nerve?

Back 49

None

Front 50

What types of fibers are found in the
accessory nerve?

Back 50

Efferent fibers to skeletal muscle which arise
from cells in the ventral gray column of the
cervical spinal cord. In the neck the
accessory nerve also receives proprioceptive
afferent fibers from upper cervical nerves.

Front 51

How is the platysma related to the investing
fascia of the neck?

Back 51

The platysma is superficial to the cervical
investing fascia.

Front 52

What is the name of the fascial layer covering
the floor of the posterior triangle?

Back 52

This layer is the prevertebral layer (M1 1049-
1053). However, this layer is continuous with
the thoracolumbar fascia of the back and
could be referred to as the cervical portion of
that fascia.

Front 53

How is the external jugular vein related to the
platysma? to the investing fascia of the neck?

Back 53

The external jugular is deep to the platysma
and superficial to the investing fascia until it
perforates it near its termination.

Front 54

How is the external jugular vein related to the
sternocleidomastoid?

Back 54

It passes across the external surface of the
sternocleidomastoid

Front 55

Name the muscles which form the floor of the
posterior triangle.

Back 55

From superior to inferior – the semispinalis
capitis, the splenius capitis, the levator
scapulae, the posterior scalene, the middle
scalene, and the anterior scalene (A697,
G8.3B, 8.3C).

Front 56

What structures pass between the anterior
and middle scalene muscles?

Back 56

The roots of the brachial plexus and the
subclavian artery.

Front 57

How are the subclavian artery and the brachial plexus related to the fascia
covering the floor of the posterior triangle?

Back 57

This fascia (prevertebral fascia, scalene fascia,
cervical portion of thoracolumbar fascia)
covers the subclavian artery and the roots of
the brachial plexus and extends outward
along them as the axillary sheath.

Front 58

Which anterior primary rami make up the
cervical plexus? the brachial plexus?

Back 58

The anterior primary rami of C1 through C4
make up the cervical plexus. The brachial
plexus is made up by the anterior primary
rami of C5 through T1.

Front 59

Locate the cell bodies of all the nerve fibers
in the cervical plexus.

Back 59

The dorsal root ganglia of the first four
cervical nerves, the ventral gray column of
the upper cervical spinal cord, and the
superior cervical ganglion.

Front 60

What structures are innervated by the
cervical plexus?

Back 60

The skin of the anterior and lateral parts of the
neck, the lower part of the external ear, and
the skin just posterior to the external ear, the
skin of the upper anterior chest wall and the
upper and lateral areas of the shoulder, the
pericardium, pleura, and peritoneum in
relation to the central portion of the
diaphragm. Muscular branches innervate the
diaphragm, the infrahyoid muscles, and some
of the deep neck muscles.

Front 61

How is the phrenic nerve related to the prevertebral
fascia in the neck?

Back 61

The phrenic nerve is deep to the prevertebral
fascia in the neck.

Front 62

What is the name of the space between
the esophagus and the prevertebral fascia?
What are its cranial and caudal limits?

Back 62

The space behind the esophagus, between it
and the prevertebral fascia, is called the
retrovisceral or retropharyngeal space. It
extends upward to the base of the skull, and
therefore is located behind the esophagus
(retroesophageal) as well as behind the
pharynx (retropharyngeal). This space has
been called the "danger space" since it
extends caudally throughout the thorax all the
way to the diaphragm. Through this space,
infections that originate in the neck can easily
pass down into the posterior mediastinum.

Front 63

How is the sternocleidomastoid related to
the investing fascia of the neck (superficial layer
of the deep cervical fascia)?

Back 63

It lies within the Investing Fascia and superficial to the infrahyoid fascia.

Front 64

Does the facial vein drain primarily into the iternal or external jugular?

Back 64

It usually either joins the anterior branch of the retromandibular vein to form the common facial vein, or drains directly into the internal jugular vein.

Front 65

Describe Horner's syndrome.

Back 65

caused by damage to the cervical sympathetic trunk or postgang fibers supplying the head. Symptoms: pupil constriction/inability to dialate pupil, ptosis (b/c of non-func super tarsal musc), vasodialation (often are flushed), no sweating.

Front 66

Describe the autonom nerve system in the neck.

Back 66

The bilateral sym trunk begins at c1, is composed of 3 gang (1. superior, 2. middle...aka thyroid, 3. inferior which sometimes fuses w/lower gang to make stellate gang) these gang are connected by cords, the ansa subclavia is a loop formed by a cord connecting the middle & inf gang that sometimes goes around the subclavian art and may encompass the vertebral art.