Head And Neck Final - Neck

Front 1

Name the fascia that surrounds entire neck and envelops the trapezius, SCM and parotid glands

Back 1

Investing fascia

Front 2

Cervical fascia consists of: (4 fascial planes)

Back 2

Investing

Carotid

Pretrachial

Preverterbral

Front 3

Name the fascia: anterior aspect of neck; encloses thyroid, trachea, esophagus and infrahyoid (strap) muscles

Back 3

Pretracheal Fascia

Front 4

Name the fascia: surrounds the vertebral column and surrounding muscles

Back 4

Prevertebral fascia

Front 5

Name the facia: contains common carotid and internal carotid arteries, internal jugular vein and vagus nerve

Back 5

Carotid sheath

Front 6

In what fascia would you find the parotid gland?

Back 6

Investing fascia

Front 7

What fascia encloses the thyroid gland?

Back 7

Pretracheal fascia

Front 8

Why are the cervical fascia important?

Back 8

They are a route of infection.

eg. if inflammation occurs in the parotid gland, the investing fascia would stretch and this can become painful

Front 9

In what fascia would you find the muscles surrounding the vertebral column?

Back 9

Prevertebral fascia

Front 10

Which fascia encloses the vagus nerve?

Back 10

Carotid sheath

Front 11

What fascia encloses the internal jugular vein?

Back 11

Carotid sheath

Front 12

Function of the hyoid bone?

Back 12

1. attachment for anterior neck muscles

2. prop to keep airways patent

Front 13

Name the bones and cartilages of the neck

Back 13

Cervical vertebrae

Hyoid bone

Thyroid cartilage

Cricoid cartilage

Tracheal rings

Front 14

These parts are characteristic of which cervical vertebrae?

posterior tubercle, superior articular facet, facet for dens, transverse ligament

Back 14

Atlas (C1)

* recall Atlas has no body

Front 15

These parts are characteristic of which cervical vertebrae?

Spinous process, transverse process, transverse foramen, body

Back 15

Typical cervical vertebrae C3-C6

Front 16

These parts are characteristic of which cervical vertebrae?

Spinous process, Superior articular facet, body of axis, facet for atlas, dens

Back 16

Axis (C2)

Front 17

Function of dens on Axis?

Back 17

attaches to body of axis

Front 18

Facet of dens on Atlas facilitates what motion?

Back 18

shaking head "no" motion

Front 19

Superior articular facet facilitates what motion?

Back 19

shaking head "yes" motion

Front 20

What "special joint" facilitates nodding "yes"?

Back 20

atlanto-occipital joint

Front 21

What "special joint" facilitates nodding "no"?

Back 21

atlanto-axial joint

Front 22

What structures would you find in the upper portion of the carotid sheath?

Back 22

internal carotid

internal jugular

vagus sandwiched between the above

(external carotid has branched off, not here)

Front 23

What structures would you find in the lower portion of the carotid sheath?

Back 23

common carotid

internal jugular

vagus sandwiched between the above

Front 24

Which sheath would you find the vessels in your neck?

Back 24

Carotid sheath

Front 25

What is a possible clinical implication of the fascial planes of the neck?

Back 25

keeps things within fascial plane, but nothing stopping it vertically… connection between neck and mediastinum

Front 26

What happens in mediastinitis?

Back 26

Massive dental infections can track into retropharyngeal and alar spaces down to mediastinum...

Front 27

Mediastinitis can occur between what spaces?

Back 27

Retropharyngeal and alar "danger" spaces

- once an infection gets to these spaces, there is nothing stopping it from going to the heart

Front 28

What are the large branches of the carotid?

Back 28

Common carotid

Carotid sinus

Internal carotid

External carotid

Front 29

What are the branches of the external carotid?

Back 29

1. posterior auricular

2. occipital

3. superficial temporal

4. maxillary

5. facial

6. lingual

7. superior thyroid

8. ascending pharyngeal

Front 30

Superior thyroid meets with what artery from the subclavian subdivision?

Back 30

inferior thyroid artery from the thyrocervical trunk

Front 31

What part of the carotid arteries has the following properties?

- mechanoreceptors for blood pressure
- chemoreceptors for O2 concentration
- adjust heart rate/work accordingly
- all innervated by CN IX (glossopharyngeal)

Back 31

Carotid body of the carotid sinus bulge

Front 32

Name the subclavian arteries and branches

Back 32

Subclavian has

1. a branch to common carotid from brachiocephalic

2. vertebral artery

3. thyrocervical trunk with branch to....

4. inferior thyroid

Front 33

Name the veins of the neck

Back 33

Subclavian

External jugular

Internal jugular

brachiocepalic

Front 34

Thyrocervical trunk gives a branch to which artery?

Back 34

inferior thyroid

Front 35

The subclavian artery has which branches?

Back 35

thrycervical trunk with branch to inferior thryoid

vertebral artery

Front 36

The SCM is sandwiched between which two veins?

Back 36

internal jugular (deep) and external jugular (superficial)

... both of these go to brachiocephalic and then to the superior vena cava

Front 37

The neck is a transitional region, serving as conduit from the head to the rest of the

body. What is a disadvantage of this setup?

Back 37

vessels are vulnerable to injury

Front 38

Which artery would most likely be damaged in a cut to the mid neck?

Back 38

Common carotid

Front 39

What does the thoracic duct drain?

Back 39

it collects most of the lymph in the body, other than the right thorax, arm, head
and neck, which are drained by the right lymphatic duct

Front 40

The thoracic duct is the largest lymphatic vessel in the body, and is also known as the left lymphatic duct. Where does it drain?

Back 40

the thoracic duct drains to the left subclavian vein

Front 41

What does the right lymphatic duct drain?

Back 41

right thorax, arm, head
and neck

Front 42

The cervical plexus consists of?

Back 42

- ventral rami of C1-C4

- cutaneous nerves to neck, posterior scalp, upper part of thoracic wall

- motor nerves to infrahyoid (strap) muscles

- phrenic nerve to diaphragm

- is deep to SCM and branches emerge from posterior triangle

Front 43

The cutaneous nerves in the neck are all sensory. Name the 4 branches of cutaneous nerves.

Back 43

Lesser occipital

Greater auricular

Transverse cervical

Supraclavicular

Front 44

Name the 3 muscular branches of the cervical plexus.

Back 44

Ansa cervicalis (C1-4)

Phrenic nerve (C3-5, mainly C4)

Segmental branches (C1-4)

Front 45

What does the ansa cervicalis (C1-4) innervate?

Back 45

- for C1 only - geniohyoid and thyrohyoid

C1-3 - sternothyroid, sternohyoid, omohyoid

superior root = C1

inferior root = C2 + C3

Front 46

What does the phrenic nerve (C3-5) innervate?

Back 46

- motor only to diaphragm

- also supplies sensory and sympathetic branches along the way down

- ventral rami of C3-5

Front 47

What do the segmental nerves (C1-4) innervate?

Back 47

Anterior and middle scalenes

Front 48

What makes up the LOOP of the ansa cervicalis?

Back 48

Front 49

What does the phrenic nerve travel along?

Back 49

anterior scalene muscle

Front 50

What 3 cranial nerves are found in the neck?

Back 50

Hypoglossal (CN XII) (motor to tongue)

Spinal accessory (CN XI) (SCM and trapezius muscles)

Vagus (CN X) (in carotid sheath sandwiched between internal carotid and internal jugular - goes to larynx, pharynx, heart, gut)

Front 51

What 3 sympathetic ganglions will you find in the neck?

Back 51

Superior cervical ganglion (anything that goes to the head and neck will synapse here!)

Middle cervical ganglion

Inferior cervical ganglion

Front 52

What does the hypoglossal nerve (CN XII) innervate?

Back 52

Hypoglossal (CN XII) (motor to tongue)

Front 53

The spinal accessory nerve (CN XI) innervates what muscles?

Back 53

Spinal accessory (CN XI) (SCM and trapezius muscles)

Front 54

The vagus nerve (CN X) in the neck goes on to innervate what?

Back 54

Vagus (CN X) (in carotid sheath sandwiched between internal carotid and internal jugular - goes to larynx, pharynx, heart, gut)

Front 55

Pupillary constriction, ptosis (drooping of eyelid), sunken eye, vasodilation and lack of sweating on face and neck are characteristic of what syndrome?

Back 55

Horner's syndrome.... lack of sympathetic supply to head and neck

Front 56

Which of the following nerves are not found in the neck?
a. auriculotemporal
b. vagus
c. great auricular
d. supraclavicular

Back 56

a. auriculotemporal <— innervates TMJ, symp to parotid

Front 57

What are the 2 landmark muscles of the neck and what nerve innervates them?

Back 57

SCM (sternocleidomastoid)

Trapezius

Innervated by spinal accessory nerve (CN XI)

Front 58

Name the infrahyoid (strap) muscles

Back 58

sternohyoid

sternothyroid

thyrohyoid

superior belly of omohyoid

inferior belly of omohyoid

Front 59

Which two infrahyoid muscles have attachments on the oblique line of the thyroid cartilage?

Back 59

sternothyroid and thyrohyoid

Front 60

Why are omohyoid muscles given this name?

Back 60

They insert on the scapula of the shoulder (omo = shoulder)

Front 61

Is the sternohyoid deep or superficial?

Back 61

superficial and medially located

Front 62

Are the thyrohyoid and sternothyroid deep or superficial?

Back 62

deep and medially located

Front 63

Name the triangles of the neck.

Back 63

anterior

posterior

submental

submandibular

muscular

carotid

Front 64

What are the borders of the anterior triangle?

Back 64

inferior border of the mandible

anterior border of SCM

midline of neck

Front 65

What are the roof and floor of the anterior triangle?

Back 65

Roof: subcutaneous fascia (contains platysma)

Floor: pharynx, larynx and thyroid gland

Front 66

What are the borders of the posterior triangle?

Back 66

posterior border of SCM

anterior border of trapezius

clavicle

Front 67

What are the roof and floor of the posterior triangle?

Back 67

Roof: investing fascia

Floor:

- prevertebral muscles (lower, from cervical vertebrae): levator scapulae, scalenus medius, scalenus anterior

-splenius capitis and semispinalis capitis - intrinsic muscles of the back (upper)

- fascia (deep fascia, distinct from investing fascia)

Front 68

What muscle emerges deep from SCM and crosses the lower part of the posterior triangle en route to the scapula?

Back 68

inferior belly of omohyoid

Front 69

What nerves are found in the posterior triangle?

Back 69

- Accessory nerve (CN XI)

- branches of Cervical plexus - sensory nerves, as they emerge deep to the SCM (lesser occipital, greater auricular, transverse cervical, supraclavicular)

- phrenic nerve (C3-5) - crosses ant surface of scalenus anterior, deep to SCM (not strictly within triangle)

- brachial plexus - roots (C5-T1) emerge between scalenus anterior and medius - trunks (upper, middle, lower) are in lower part of triangle

Front 70

What vessels are found in the posterior triangle?

Back 70

arteries - subclavian and its suprascapular (with nerve supplies arm) and transverse cervical branches

veins - subclavian - receives external jugular before leaving triangle... external jugular receives suprascapular and transverse cervical veins

Front 71

What nerve travels along the levator scapulae and pierces the trapezius muscle, and what does it innervate?

Back 71

spinal accessory (CN XI) - trapezius and SCM

Front 72

What nerve travels along the anterior scalene?

Back 72

Phrenic nerve

Front 73

You hit your friend on the neck just posterior to the SCM. He says he can't breathe, why?

Back 73

Could have hit the phrenic nerve that controls diaphragm, and cutaneous nerves there too that could produce numbness.

Front 74

Which triangle is not found bilaterally (on the midline)?

Back 74

submental triangle

Front 75

What are the borders of the submental triangle?

Back 75

anterior belly of the digastric (left and right)

hyoid bone

Front 76

What makes up the floor of the submental triangle?

Back 76

mylohyoid muscles (that attach to the inner aspect of the mandible and hyoid bone)

Front 77

What are the main contents of the submental triangle?

Back 77

submental lymph nodes

Front 78

What are the smaller divisions of triangles of the anterior triangle?

Back 78

submental

submandibular

muscular triangle

carotid triangle

Front 79

What are the borders of the submandibular triangle?

Back 79

inferior border of mandible

digastric (anterior belly)

digastric (posterior belly)

Front 80

What does the submandibular triangle contain?

Back 80

stylohyoid muscle - attaches to styloid process (projection on base of skull) and inserts into the hyoid bone

superficial part of submandibular gland

submandibular lymph nodes

facial artery and vein

Front 81

What are the borders of the muscular triangle?

Back 81

midline

superior belly of omohyoid

anterior border of SCM

Front 82

What does the muscular triangle contain?

Back 82

infrahyoid (strap) muscles:

superior belly of omohyoid

sternohyoid

sternothyroid

thryohyoid

Front 83

The superior belly of the omohyoid, sternohyoid and sternothyroid are involved in what action/movement?

Back 83

depression (lowering) of the pharynx and larynx during swallowing

supply: cervical plexus

Front 84

What action/movement does the thyrohyoid do?

Back 84

shortens the distance between the hyoid bone and thyroid cartilage, so it can either depress the hyoid bone or elevate the thyroid cartilage

supply: cervical plexus

Front 85

the sternohyoid and sternothyroid muscles lie over what structures?

Back 85

larynx, trachea and thyroid gland

Front 86

The borders of the carotid triangle are?

Back 86

posterior belly of digastric

anterior border of SCM

superior belly of omohyoid

Front 87

What are the contents of the carotid triangle?

Back 87

carotid sheath: common and internal carotid arteries, internal jugular vein, vagus nerve (CN X), part of the external carotid artery and some of its branches

Nerves:

sympathetic truck is deep to this** - superior cervical ganglion
hypoglossal nerve here too
C1 from ansa cervicalis (cervical plexus) joins up with hypoglossal
and first little bit of spinal accessory nerve

Front 88

which tri is bounded by ant and post bellies of
digastric and inf border of mandible?

what is in that triangle?

Back 88

submandibular triangle

submandibular gland, submandibular lymph nodes, stylohyoid muscles, facial artery and facial vein

Front 89

subclavian vein puncture and internal jugular vein punctures are performed on which side of the body?

Back 89

right side - because superior vena cava is on right side

Front 90

In a subclavian vein puncture, what else do you worry about potentially puncturing?

Back 90

brachioplexus, apex of lung (pleura), subclavian artery... too deep, could get pneumothorax

Front 91

Why would you preferentially puncture the right internal jugular vein instead of the subclavian?

Back 91

Internal jugular is large and straight down, use SCM as reference.... can get into right side of heart if needed… use catheter for this after the needle.

Front 92

A cervical rib is a super-numary rib and can occur on the R/L or both sides. What can be squished here?

Back 92

subclavian artery is here and could get squished… brachioplexus gets squished

.. for these people, arm can go numb if they put arm up/can't put arm up very high

Front 93

Where is the thyroid gland?

Back 93

found between the thyroid cartilage and the 5th tracheal cartilage

Front 94

This gland in the neck is responsible for cellular metabolism, and has two lobes joined in the anterior midline by an isthmus. What gland is it?

Back 94

thyroid

Front 95

What vessels supply the thyroid gland?

Back 95

superior thyroid artery (from external carotid)

superior thyroid vein (from internal jugular)

inferior thyroid artery (from subclavian artery)

inferior thyroid vein (from brachiocephalic vein)

- plexus of veins most at risk!

Front 96

How many parathyroid glands are there and where are they located?

Back 96

2 pairs - superior and inferior

Front 97

The parathyroid glands are endocrine glands (calcium and inorganic phosphate metabolism) on the posterior aspect of the thyroid glands... what vessels are they supplied by?

Back 97

same vessels as thyroid!

superior thyroid artery (from external carotid)

superior thyroid vein (from internal jugular)

inferior thyroid artery (from subclavian artery)

inferior thyroid vein (from brachiocephalic vein)

Front 98

What might be compressed by an enlarged thyroid (goiter)?

Back 98

surrounding trachea, so could compress airway, and other vessels

Front 99

Describe where a cricothyrotomy is performed...

Back 99

between rings 1 and 2

- in particular danger with veins that form plexus if you nick the thyroid gland

….eg. trach done around 7th ring is close to the arch of the aorta — if you get a bleed there… you are worried about carotid and subclavians

Front 100

The esophagus is a continuation of the pharynx... what level does it begin at?

Back 100

The cricoid cartilage

- rests on prevertebral fascia, posterior to trachea

- nerve supply and blood supply similar to the trachea

Front 101

Where does the trachea begin?

Back 101

lower border of cricoid cartilage

Front 102

what covers the trachea?

Back 102

pretracheal fascia (deep fascia) - attaches to laryngeal cartilages and below it merges with the pericardium

Front 103

What supplies the trachea (vessels and nerves)?

Back 103

inferior thyroid arteries

inferior thyroid veins - front of trachea - makes a plexus before entering left brachiocephalic vein in thorax

recurrent laryngeal nerve