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65 Cards in this Set
- Front
- Back
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cervical pain
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inflamed LN - enlarged = cancer
muscle strain protruding IV disc chronic - bony abnormalities or trauma |
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fracture of hyoid bone
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or fracture of the styloid process of the temporal bone
occurs in ppl who are manually strangled by compression of the throat - results in depression of the body of the hyoid onto the throid cart - inability to elevate hyoid and move it ant beneath the tongue - makes swallowing and maintenance of the separation of the alimentary and respiratory tracts difficult may result in aspiration pneumonia |
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paralysis of platysma
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results from injury to the cervical branch of the facial n causes skin to falll away from neck in slack folds
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retropharangeal abcess
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when pus from an abscess post to the prevertebral layer of deep cervical fascia my extend laterally in the neck and form a swelling post to the SCM the pus may perforate the prevert layer of deep cervical fascia and enter the retropharyngeal space producing a bulge inthe pharynx
causes difficulty swallowing and speaking |
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torticollis
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(twisted neck) - contraction or shortening of cervical mm that produces twisting of the neck and slanting of the head
most common type (wry neck) results from a fibrous tissue tumor that develops in the SCM before or shortly after birth = causes head to til toward and face to turn away from affected side if happens prematureally - then breech delivery |
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muscular torticolis
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if infant's head is pulled too much during difficult birth tearing the fibers of SCM - hematoma develops into a fibrootic mass that entraps a branch of the spinal accessory nerve - denervates SCM = stiffenes and twisting of neck - surgical release of SCM from iinf attachments ot manubrium and clavicle to level of CN XI may be nec to enable the person to hold and rotate head normally
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spasmodic torticolis
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aka cervical dystonia (abn tonicity of cervical m)
begins in adulthood any bilateral neck mm - especially SCM and trap sustained turning, tilting, flexing, or extending of neck 0 shifting head lat or ant involuntarily shoulder elevated and displaced ant on side where chin turns |
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prominant EJV
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a rise in venous pressure causes EJV to be prominant over the neck
routine observation - heart failure, SVC obstruction, enlarged supraclavicular LN or increased intrathoracic pressure |
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severed EJV
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the investing layer of deep cervical fascia holds it open and the neg intrathoracic pressure air will suck air into the vien
- causes churning noise in the thorax, cyanosis from reduced hemoglobin - venous air embolism produced from this will fill the right side of the heart w/froth which stops blood flow through it resulting in dyspnea application of firm pressure keep it from bleeding and air from getting in |
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lessions of spinal accessory n
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penetrating trauma
surgical procedures tumors at cranial base or cancerous cervical LN fractures of jugular foramen where CN XI leaves cranium weakness in turning head to opposite side against resistance weakness and atrophy of trapezius imparing neck mvmts unilateral paralysis of trapezius - evident by pt inibility to elevate and retract shoulder and by difficult in elevating the upper limb sup to horizontal level another sign is drooping of the shoulder most common iatrogenic nerve injury (done by a surgeon) |
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severance of phrenic nerve
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parallysis of the corresponding half of the diaphragm
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phrenic nerve block
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produces short period of paralysis of the diaphragm on one side (used for a lung operation)
anesthetic injected around the nerve near the ant surface of the middle 1/3 of the ant scalene m. surgical phrenic nerve crush - compressing the nerve injuriously w/forceps produces a longer period of paralysis - weeks - used to repair diaphragmatic hernia |
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cervical plexus block
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inhibits nerve impulse conduction - injected at several points along post border of SCM mainly at jnct of sup and middle thirds (nerve pt of neck)
bc phrenic n is also usually paralyzed it is not used on ppl w/pulmonary or cardiac dx |
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supraclavical brachial plexus block
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inj around the supraclavicular part of the brachial plexus - for anesthesia of upper limb
- superior to the midpoint of the clavical |
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injury to suprascapular n
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vulerable to inj in fracture of middle 1/3 of clavicle
inj results in loss of lat rotation of humerous at glenohumeral joint -> waiters tip position ability to initiate abduction of limb also affected |
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ligation of external carotid artery
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nec to control bleeding from one if its inaccessible branches - dec blood flow through the arty and branches but doesnt eliminate it
blood flows in a retrograde direction into artery from ext carotid on the other side through communications btw its branches and across midline descending branch of occipital a provides main collateral circulation anastomosing w/the vertebral and deep cervical a |
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worries during surgery involving carotid triangle
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damage or compression of vagus and or recurrent laryngeal n may produce an alteration in the voice bc these nerves supply laryngeal mm
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transient ischemic attack
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TIA
- partial occlusion of int carotid a - sudden focal loss of neurological fn (dizziness and disorientation) - disappear w/in 24 hrs |
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minor stroke
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arterial occlusion of int carotid a
loss of neurological fn such as weakness or sensory loss on one side of the body tha exceeds 24 hrs but dissapears w/in 3 weeks |
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dopplor color study
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can be used to obaserve obstruction of blood flow
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carotid occlusion
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causing stenosis in otherwise healthy person can be relieved by opening the artery at its origin and stripping off the arthosclerotic plaque with the intima - procedure called carotid endarterectomy
aftter the operation drugs that inhibit clot formation are administered until the endothelium has regrown risk of CN inj IX, X, XI, XII |
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carotid pulse
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in neck is easily felt by palpating the carotid a on the side of neck where it lies in a groove btw trachea and the infrahyoid m
palpetated deep to ant border of SCM at level of sup border of thyroid cart - absence = cardiac arrest |
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carotid sinus hypersensitivity
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exceptional responsiveness of the carotid sinus in various types of vascular disease
ext pressure on the carotid a may cause slowing of heart rate, a fall in BP, andcardiac ischemia resulting in fainting use other sites to check pulse in ppl w/cardiac or vascular dx |
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role of caotid bodies
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monitor O2 content before it reaches brain
dec in partial pressure of O2 activates aortic and carotid chemoreceptors inc alveolar ventilation inc CO2 tension or free H ions glossopharyngeal n conducts info centrally resulting in reflexive stimulation of respiratory centers of brain that inc the depth and rate of blood |
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internal jugular v pulse
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provides info abt heart activity coresponding to ECG recordings and the right atrial pressure
not palpable - transmitted through the surrounding tis and may be observed beneath SCM sup to medial end of clavicle no valves in brachiocephalic v or superior vena cava a wave of contraction passes up thse vessels to the inferior bulb of the IJV the pulsations are especilally visible when person's head is inf to the lower limbs (trendelenburg position) increases considerably in cont such as mitral valve dx, which inc pressure in pulmonary circulation and the right side of the heart rt is examined b/c straighter more direct course |
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IJ veinpuncture
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30 degree angle late to common carotid aiming at apex of triangle btw sternal and clavicular heads of SCM
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cervicothoracic ganglion block
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anesthetic injected around the large cervicothoracic ganglion blocks transmission of stimuli through the cervical and sup throacic ganglia
relieve vascular spasms involving brain and upper limp useful when deciding if a surgical resection of the ganglion would be beneficial to a perosn w/excess vasoconstriction in the ipsilateral limb |
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horner syndrome
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lesion of a sympathetic trunk in the neck
contraction of pupil (miosis) - paralysis of dilator pupilae ddrooping of superior eyelid (ptosis) - paralysis of smooth tarsal mm intermingled w/levator palpebrae superioris sinking in of the eye - enophthalmos - vasodilation and absence of sewating on the face and neck (anhydrosis) |
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thyroid Ima artery
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in 10% of ppl
sml and unpaired arises from brachiocephalic trunk but may arise from arch of aorta or rt commmoon carotid, subclavian, or int throacic arteries. ascends on ant surface of trachea to the isthmus of the thyroid gland supplying branches to both structures possible presence considered when performing procedures in midline of neck and inf to isthmus |
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thyroglossal duct cyst
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dev begins at the foramen cecum at the dorsum of the postnatal tounge - relocates into neck by passing ant to hyoid and thyroid cart to reach final position anterolateral to the superior part of the trachea
during relocation the thyroid is connected to the foramen cecum by the thyroglossal duct p whcih norm disappears but remnants of epithelium may remain as a thyroglossal duct cyst along any point of its path - usually clos or just inf to the body of they hyoid bone - swelling of ant part of neck - surgical excision may be nec |
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aberrant thyroid gland
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thyroid gland tis any where along the path of the embryonic thyroglossal duct
duct may fail to relocate gland to its definitive position in neck - may be in the root of tounge post foramen cecum = lingual thyroid gland or in neck inf to hyoid may become a cyst or may just be an undescended thyroid - radioisotope scaning ectopic thyroid - only thyroid present |
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accessory thyroid glandular tis
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portions of thyroglossal duct may persist to form thyroid tis
anywhere along course in neck lat to thyroid cart usually on the thyrohyoid m may be fn often insufficient size to maintain norm fn if thyroid gland is removed |
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aberrant thyroid gland
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thyroid gland tis any where along the path of the embryonic thyroglossal duct
duct may fail to relocate gland to its definitive position in neck - may be in the root of tounge post foramen cecum = lingual thyroid gland or in neck inf to hyoid may become a cyst or may just be an undescended thyroid - radioisotope scaning ectopic thyroid - only thyroid present |
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accessory thyroid glandular tis
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portions of thyroglossal duct may persist to form thyroid tis
anywhere along course in neck lat to thyroid cart usually on the thyrohyoid m may be fn often insufficient size to maintain norm fn if thyroid gland is removed |
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pyramidal lobe of thyroid
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50% of thyroid glands have this
love varies in size extends sup from isthmus usually to the left of median plane - isthmus may be incomplete -band of CT containng accessory thyroid tis may continue from the apex of pyramidal lobe to hyoid dev from remnants of epithelium and CT of thyroglossal duct |
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goiter
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enlargement of thyroid gland
may occur during menstration and pregnancy - results from a lack of iodine common in certain parts of the world where the soil and water are deficient in iodine causes swelling in the neck and my compresss trachea, esophagus, and recurrent laryngeal nerves may enlarge ant, post, inf, or lat NOT sup b/c attachments of sternothyroid and sternohyoid mm |
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pyramidal lobe of thyroid
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50% of thyroid glands have this
love varies in size extends sup from isthmus usually to the left of median plane - isthmus may be incomplete -band of CT containng accessory thyroid tis may continue from the apex of pyramidal lobe to hyoid dev from remnants of epithelium and CT of thyroglossal duct |
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goiter
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enlargement of thyroid gland
may occur during menstration and pregnancy - results from a lack of iodine common in certain parts of the world where the soil and water are deficient in iodine causes swelling in the neck and my compresss trachea, esophagus, and recurrent laryngeal nerves may enlarge ant, post, inf, or lat NOT sup b/c attachments of sternothyroid and sternohyoid mm |
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thyroidectomy
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excision of malignant tumor of thyroid gland
surgical tx of hyperthyroidism - post part of each lobe usually perserved called near total thyroidectomy to protect the recurrent and superior laryngeal n and spare parathyroid glands hemorraging after surgery may compress trachea |
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thyroidectomy
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excision of malignant tumor of thyroid gland
surgical tx of hyperthyroidism - post part of each lobe usually perserved called near total thyroidectomy to protect the recurrent and superior laryngeal n and spare parathyroid glands hemorraging after surgery may compress trachea |
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injury to recurrent laryngeal n
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inf pole of thyroid gland intimately related to inf thyroid a and its branches
so inf thyroid a ligated at a distance lateral to thyroid gland hoarsness usual sign of unilateral recurrent n injury - or temp aphonia (disturbance of phonation (voice production) and laryngeal spasm may occur) result from bruising the n during surgery or from pressure of accumulation of blood and serous exudate after operation |
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inadvertent removal of parathyroid glands
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sup- may be as far sup as thyroid cart
inf - far inf as sup mediastinum |
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parathyroid adenoma
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ordinarily benign tumor of epithelial tis assoc w/hyperparathyroidism
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tetany
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a result of atrophy or inadvertent surgical removal of parathyroid glands
a severe neurological syndrome characterized by m twitches and cramps generalized spasms caused by decreased serum calcium levels b/c laryngeal and resp mm involved - failure to respond immediately w/appropriate therapy = death can be transplanted to arm so not damaged by future surgeries or radiation |
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fractures of laryngeal skeleton
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may result from blows recieved in sports such as kick boxing and hockey or from compression by shoulder strap during car accidnent
frequent injury produce submucous hemorrhage and edema, resp obstruction, hoarsness, and sometimes temp inability to speak |
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Valsalva maneuver
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any forced exporatory effort against a closed arway - cough, sneeze, strain during a bowel mvmt or weight lifting - sphincteric actions of vestibular and vocal folds abduct widely as lungs inflate during deep inspiration and then during this they are tightly adducted at the end of deep inspiration
anterolateral abd mm then contract strongly to inc the intrathroacic and intra-abd pressures the relaxed diaphragm passively transmits the inc abdominopelvic pressure to the thoracic cavity bc high intrathoracic presure impededs venus return to right atrium is used to study cardiovascular effects of raised peripheral venous pressure and decreased cardiac filling and cardiac output |
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aspiration of foreign bodies
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through the larngeal inlet into vestibule of the larynx where it becomes trapped sup to vestibular folds and the laryngeal mm go into spasm tensing the vocal folds
the rima glottidis closes and no air enters the trachea - seal off larynx asphyziation and will die in 5 min from lack of O2 |
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needle cricothyrotomy
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in exteme cases of chocking
large bore needle through cricothyroid lig to permit fast entery of air later a surgical cricothyrotomy may be performed which iinvolves an incision through the skin and cricothyroid lig and insertion of a sml tracheostomy tube into the trachea |
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tracheostomy
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transverse incision through the skin of the neck and ant wall of the trachea = establishes an airway in pt w/upper airway obstruction or resp failure
infrahyoid mm are retracted lat and isthmus is either divided or retracted sup. openning in trachea btw 1st and 2nd tracheal rings or through the 2nd and 4th tracheal rings \\tracheostomy tube inserted into trachea and secured to avoid complications: 1. inferior thyroid veins arise from venous plexus on thyroid glands and descend ant to trachea 2. sml thyroid ima artery present in 10% 3. left brachiocephalic v, jugular venous arch and pleuirae may be encountered, particulary in infants and kids 4. thymus covers inf part of trachea in infants and kids 5. trachea is sml and mobile and soft in infants - making easy to cut through post wall and damage esophagus |
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injury to laryngeal n
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innervatees mm moving vocal fold - paralysis of vocal fold results when the n is injured - inf or reccurent laryngeal - other fold will compensate and move across midline if unilateral
bilater - voice almost absent b/c vocal folds are motionless - stridor - high pitched noisy respiration accompanied by anxiety or asthmatic episode if sup laryngeal n paralys0 anesthesia to superior laryngeal mucosa -so no protective method of keeping foreiign bodies out - monotonous voice b/c paralyzed cricothyroid m supplied by its unable to vary length and tension of vocal fold |
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superior laryngeal n block
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endotracheal intubation in conscious pt
- peroral endoscopy, transesopjageal echocardiography, laryngeal and esophageal instrumentation needle btw thyroid cart and hyoid 1-5cm ant to greater horn of hyoid - passes through thyrohyoid membrane ` |
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cancer of larynx
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high in ppl who smoke or chem
present w/persistent hoarseness often assoc w/ otalgia (ear ache) and dysphagia enlarged pretracheal or paratracheal lymph nodes laryngectomy - removal of the larynx may be performed in severe cases of laryngeal cancer vocal rehab can be done by the use of electrolarynx - a tracheo =esophageal prosthesis or esophageal speech ) regurgitation of ingested air |
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age changes in larynx
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grows steadily until 3 grows little until 12
before puberty but w/testosterone the walls of the larynx strengthen and laryngeal cavity enlarges - only slight inc in size in girls the anteroposterior diameter of the rima glottidis almost doubles vocal folds lengthen and thickening cart - thyroid cricoid and arythenoid - ossify as you age - commencing at 25 in thyroid cart and by 65 freq visible |
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foriegn bodies in the laryngopharynx
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when food passes through the laryngopharynx during swallowing some enters the piriform fossae - if something sharp gets stuck here could pierce the mucous membrane and injur the int. laryngeal n
sup laryngeal n and its int laryngeal branch are vulerable to inj during removal of the object result in anesthesia of the laryngeal mucous membrane as far inferiorly as vocal folds usually removed by pharyngoscope |
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sinus tract from piriform fossa
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uncommmon but may pass from piriform fossa to thyroid gland becoming pot site for recurrent thyroiditis
develops from remnant of thyroglossal duct that adheres to the developing laryngopharynx involves a partial thyroidectomy bc poroform fossa lies deep to superior pole of gland |
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tonsillectomy
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removal of tonsil and fascial sheet covering tonsillar bed
rich blood supply bleeding commonly arise from large external palatine v from tonsillar a glossopharyngeal n accompanies tonsillar a on the lat wall of pharynx bc wll is thin n is vulnerable int carotid is esp vulerable when iti s tortuous and lies directly lat to tonsil |
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adenoiditis
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inflamation of pharyngeal tonsils (adenoids)
obstruct passage of air from nasal cavities through the choanane into the nasopharynx making mouth breathing nec inf spread to tubal tonsils causing swelling and closure of the pharyngotympanic tubes - imp of hearing may result from nasal obstruction and blockage - otitis media results |
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branchial fisutla
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abn canal that opens internally int the tonsillar fossa and ext on the side of neck
saliva may drip from it or it may become infected results from persistence of remnants of the 2nd pharyngeal pouch and 2nd pharyngeal grppve ascends from cervical opening along ant border of SCM in inf 1/3 of neck through subcu tis, platysma, and fascia of neck to enter carotid sheath and passes btw int and ext carotid arteries on way to opening in tonsillar fossa |
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brachial sinus/ cyst
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when embryonic cervical sinus fails to disappear retain connection w/lateral surface of neck by this - a narrow cannal
opening anywhere along ant border of SCM if not connected w/surface may form branchial cyst located inf to the angle of the mandible - may be present in infants and kids but may not enlarge until early adulthood usually excised pass close to hypoglossal, glossopharyngeal, and spinal accessory n |
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esophageal inj
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rarest kinds of penetrating neck trauma
offten hidden unrecognized esophageal perforation causes death who don't have surgery and 1/2 of those who do |
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esophageal cancer
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most common present complaint 0 dysphagia
not recognized until lumen is reduced by 30-50% esophagoscopy to diagnose painful swallowing may suggest ext of tumor to periesophageal tis enlargment of inf deep cervical nodes may compress recurrent laryngeal n and cause hoarsnes |
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zones of penetrating neck trauma
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3 zones common clinical guide to seriousness of trauma
injuries in zone 1 and 3 obstruct airway and have greatest risk of morbidity and mortality - inj structures are difficult to visualize and repair and vascular damage hard to control zone 2 - most common - morbidiity and mortality are lower bc physcians can control vascular damage by direct pressure and surgeons can visualize and tx injured structures more easily |
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zone 1 of penetrating neck trauma
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includes root of neck extends from clavicles and manubrium to level of inf border of cricoid cart
structuresL 1. cercival pleurae 2. apices of lung 3. thyroid and parathyroid glands 4. trachea 5. esophagus 6. common carotid a 7. jugular v 8. cervical region of vertebral column |
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zone 2 of penetrating neck trauma
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extends from cricoid cart to level of angles of mandible
structures: 1. superior poles of thyroid 2. thyroid cart 3. cricoid cart 4. larynx 5. laryngopharynx 6. carotid a 7. jugular v 8. esophagus 9. cervical region of vertebral colum |
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zone 3 of penetrating neck trauma
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angles of mandiples superiorly
structures - salivary glands oral and nasal cavities, oropharynx, and nasopharynx |
