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158 Cards in this Set
- Front
- Back
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What is at the level of C3?
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Hyoid bone
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What is at level of C4-C5?
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Thyroid cartilage
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What is at level of C6?
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Cricoid cartilage
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What is at the level of 2-4th tracheal rings?
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Isthmus of thyroid gland
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What are the two main divisions of cervical fascia?
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Superficial cervical fascia
Deep cervical fascia |
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What is in the superficial fascia?
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Cutaneous nerves, blood vessels, lymphatic vessels, fat, platysma muscles, Jugular vein
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What is in the deep cervical fascia?
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(Investing fascia)
Wraps around SCM, Infrahyoid muscles (anteriorly) and trapezius muscles (posteriorly). |
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What are the 4 longitudinal compartments of the neck?
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Visceral
Vertebral Two vascular |
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What is in the visceral compartment?
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Digestive, respiratory, endocrine glands
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What is in the vertebral compartment?
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Cervical vertebrae, spinal cord, nerves, muscles
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What is in the vascular compartments?
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Major blood vessels
Vagus nerve |
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What surrounds the visceral compartment?
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Pretracheal fascia
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What are the compartments in the deep fascia?
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Investing - around both
Pretracheal Prevertebral |
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What layer of deep fascia is made up of contributions from other layers?
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Carotid sheath
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What is the pretracheal fascial space?
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Between the investing layer of cervical fascia and the pretracheal fascia, which passes between the neck and the anterior part of the superior mediastinum
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What is the retropharyngeal facial space?
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Between the buccopharyngeal fascia and the prevertebral fascia, which extends from the base of the skull to the upper part of the posterior mediastinum
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What is the third space "danger space"?
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Within the prevertebral layer covering the anterior surface of the transverse processes and bodies of the cervical vertebrae. This layer splits into two laminae to create a fascial space that begins at the base of the skull and extends through the posterior mediastinum to the diaphragm.
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What is the fascia on the posterior part of the pretrachial fascia?
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Buccopharyngeal fascia
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What does the deep cervical fascial layer split to enclose?
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The investing layer splits to enclose the sternocleidomastoid and trapezius muscles.
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What is the superior attachment of the deep cervical fascia?
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ext. occipital protuberance, ligamentum nuchae, sup. nuchal line, hyoid bone.
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What is the inferior attachment of the deep cervical fascia?
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Manubrium, clavicles, acromions and spines of the scapula
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What is the lateral attachment of the deep cervical fascia?
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Mastoid processes and zygomatic arches
It splits at the manubrium to create the suprasternal space |
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What are the attachments of the platysma?
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Superior attachment - blends with the muscles of facial expression
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What is the innervation of the platysma?
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Innervated by the cervical branch of the facial nerve
Supraclavicular nerves (from C3 & C4 cervical plexus) pierce it to innervate skin (sensory) |
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What fascia does the platysma lie in?
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Platysma muscle lies in the superficial cervical fascia
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What are the divisions of the anterior neck triangle?
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Submandibular/digastric triangle
Superior carotid triangle Submental triangle (unpaired) Inferior carotid/Muscular triangle |
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What do the suprahyoid muscles include?
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Stylohyoid
Diagastric Mylohyoid Geniohyoid |
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What do the infrahyoid muscles include?
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Omohyoid
Sternohyoid Thyrohyoid Sternothyroid |
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What suprahyoid muscles are innervated by the facial nerve?
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Stylohyoid
Posterior belly of digastric |
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What are the sternohyoid, omohyoid, and sternothyroid innervated by?
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Innervated by anterior rami of C1-3 via ansa cervicalis
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What is thyrohyoid innervated by?
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Receives anterior rami of C1 via hypoglossal nerve
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What do the infrahyoid muscles do?
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Depress the hyoid bone
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What do the suprahyoid muscles do?
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Muscles elevated the hyoid, some lower mandible when hyoid is fixed from below.
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What suprahyoid muscles are innervated by the mylohyoid nerve from V3?
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Anterior belly of digastric
Mylohyoid |
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What is geniohyoid innervated by?
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C1 anterior ramus branch via hypoglossal
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What is the location of the common carotid?
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posterolateral to the larynx
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What is the location of the external carotid?
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immediately lateral to the pharynx midway between the superior margin of the thyroid cartilage below and the greater horn of the hyoid bone above.
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What are the branches of the external carotid artery?
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Superior thyroid
Ascending pharyngeal Lingual Facial Occipital Posterior auricular Superficial temporal Maxillary |
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What does the glossopharyngeal nerve emerge deep to?
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Emerges deep to the styloid process, passes between internal and external carotid arteries
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What does the IX nerve pass across laterally?
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Passes across lateral border of stylopharyngeus and innervates it.
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What does the IX nerve continue anteriorly to?
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Continues anteriorly, deep to hyoglossus, to reach base of tongue and palatine tonsil
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What does IX send sensory branches to?
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Sends sensory branches to carotid sinus and to pharynx
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What is the path of the vagus nerve?
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The vagus nerves enters the carotid sheath and descend through the neck medial to internal jugular and posterior to the internal and common carotid arteries
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What does the vagus send branches to?
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Branches sent to pharynx (motor), carotid body, superior laryngeal n, possibly a cardiac branch
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What are the baroreceptors of the carotid sinus innervated by?
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It is primarily innervated by the glossopharyngeal nerve (CN IX) via the carotid sinus nerve & also receives innervation from the vagus nerve (CN X)
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What is the carotid body?
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The carotid body is a mass located on the deep side of the bifurcation near the carotid sinus that is a chemoreceptor that monitors the level of oxygen in the blood.
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What is the carotid body innervated by?
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It is innervated by the glossopharyngeal nerve (CN IX) via the carotid sinus nerve & also the vagus (CN X)
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What is the path of the accessory nerve?
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Accessory nerve descends medial to the internal jugular vein then crosses its lateral surface deep to SCM m.
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What does the accessory nerve innervated by?
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Innervates SCM and trapezius muscles
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What is the path of the hypoglossal nerve?
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Crosses between the internal jugular v. and the internal carotid a., hooks around the occipital a.
Passes deep to posterior belly of diagastic and stylohyoid m. Crosses hyoglossus, disappears deep to mylohyoid. No branches in anterior triangle on route to the tongue |
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What is in the transverse cervical nerve?
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The transverse cervical nerve is a branch of the cervical plexus containing C2,3 fibers
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What does the transverse cervical nerve innervate?
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Loops around SCM to provide sensory innervation to the skin of the anterior triangle
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What are the boundaries of the submandibular triangle?
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Superiorly – inferior border of mandible
Posteriorly – posterior belly of the digastric muscle Anteriorly – anterior belly of the digastric muscle Floor – mylohyoid & hyoglossus muscles Mylohyoid muscle innervated by the mylohyoid nerve Hyoglossus muscle innervated by the hypoglossal nerve |
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What are the boundaries of the carotid triangle?
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Boundaries are the posterior belly of the digastric muscle, the superior belly of the omohyoid muscle & the anterior border of the sternocleidomastoid muscle
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What is the superior root of the ansa cervicalis made up of?
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In general the superior root of the ansa cervicalis is from branches of the 1st & 2nd cervical nerves that travel with the hypoglossal nerve for a short distance & then form the superior root
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What is the inferior root of the ansa cervicalis made up of?
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The inferior root is from branches of the 2nd & 3rd cervical nerves
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What are the boundaries of the submental triangle?
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Boundaries are the hyoid bone inferiorly and anterior bellies of both digastric muscles
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What are the contents of the submental triangle?
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Contents: submental lymph nodes & tributaries of the anterior jugular vein
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What are the contents of the muscular triangle?
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Infrahyoid muscles
Thyroid gland Parathyroid glands Pharynx |
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What are the boundaries of the muscular triangle?
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The boundaries of the muscular triangle are the hyoid bone superiorly, the superior belly of the omohyoid m. and the anterior border of the SCM, and midline of the neck
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What is the blood supply to the thyroid gland?
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Blood supply is by superior and inferior thyroid artery
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What are the two lobes of the thyroid connected by?
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Isthmus, sometimes a pyramidal lobe exists
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What nerves are very close to the thyroid and parathyroid glands?
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Recurrent laryngeal
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Where are the parathyroid glands?
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The parathyroid glands typically lie on the posterior aspect of the thyroid gland
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What are the boundaries of the posterior triangle?
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Anteriorly - Posterior border of the sternocleidomastoid muscle
Posteriorly - Anterior border of the trapezius muscle Inferiorly - Middle third (1/3) of the clavicle Superiorly – occipital bone posterior to the mastoid process Roof - Investing layer of cervical fascia Floor - Prevertebral layer of deep cervical fascia covering deep neck muscles |
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What are the muscles of the posterior triangle?
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Splenius capitus
Levator scapulae Posterior scalene Middle scalene Anterior scalene Omohyoid inferior belly |
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What are the muscles of the posterior triangle covered by?
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Prevertebral fascia
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What does the omohyoid divide the posterior neck triangle into?
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occipital and subclavian supraclavicular triangles (omoclavicular or supraclavicular triangle are also names for this triangle)
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What is the origin and insertion of the omohyoid muscle?
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The omohyoid muscle originates on the sup. border of the scapula and inserts on the inf. border of the hyoid bone
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What are the two parts of the omohyoid muscle?
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The omohyoid has two bellies connected by a tendon and separated by a sling made up of investing fascia
The sup. belly is in the anterior triangle The inf. belly is in the post. triangle |
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What innervates the omohyoid muscle?
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Innervated by the ansa cervicalis (anterior rami from C1 to C3)
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What is the action of the omohyoid muscle?
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Depresses and stabilizes the hyoid bone
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What are the attachments of the scalene muscles?
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The anterior & middle scalene muscles are attached to the 1st rib, the posterior is attached to the 2nd rib.
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What is the innervation and action of the scalene muscles?
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Innervated by anterior rami C3-7
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What is the relationship of the subclavian vein to the scalene muscles?
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The subclavian vein lies anterior scalene muscle & the artery lies posterior
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What arises from the subclavian artery?
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The dorsal scapular artery may arise from the 3d part of the subclavian a.
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What arteries cross the base of the posterior triangle?
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The transverse cervical and the suprascapular arteries cross the base of the posterior triangle
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What are the nerves of the posterior triangle?
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Spinal accessory
Transverse cervical nerve (C2 - C3) |
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What is the path of the spinal accessory nerve?
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Passes deep to or through the sternocleidomastoid muscle to innervate it. Then, it crosses the triangle to innervate the trapezius muscle
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What does the transverse cervical nerve innervate?
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Supplies skin over the anterior triangle
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What does the great auricular nerve innervate?
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Supplies skin over the parotid gland and around the auricle
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What do the supraclavicular nerves innervate?
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Pierce the platysma m. to supply skin over clavicle, shoulder, as far as rib 2
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What fascia does the brachial plexus bring with it into the limb?
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Prevertebral fascia
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What lies on the anterior surface of the levator scapulae muscle?
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Spinal accessory nerve
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What lies on the anterior surface of the anterior scalene muscle?
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Phrenic nerve
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What nerves form the cervical plexus?
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Formed by anterior rami of C2 to C4, with contributions from C1.
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What does C5 contribute to?
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Phrenic nerve which is a branch of the cervical plexus
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What are the two roots of ansa cervicalis?
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Superior root is formed by C1 & C2. It loops down within the carotid sheath from the hypoglossal nerve
Inferior root is formed by C2 & C3. It joins the superior root |
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What muscles are innervated by ansa cervicalis?
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Branches from the ansa cervicalis innervate the sternohyoid, sternothyroid, and omohyoid muscles
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What do the prevertebral muscular branches of the cervical plexus innervate?
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Prevertebral muscular branches supplying the rectus capitis anterior, rectus capitis lateralis, longus colli, and longus capitis mm.
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Where does the brachial plexus emerge and what does it cross?
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Between the anterior and middle scalenes, crosses the base of the posterior triangle
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What is the stellate ganglion?
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The inferior cervical & 1st thoracic ganglia are sometimes fused and called the cervicothoracic or stellate ganglion
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What are the branches of the brachial plexus that appear in the posterior triangle?
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The dorsal scapular n.
Long thoracic n. Nerve to subclavius Suprascapular n. |
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What are the components of the occipital portion of the posterior triangle?
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External jugular vein
Posterior branches of cervical plexus of nerves Accessory nerve Trunks of the brachial plexus Transverse cervical artery Cervical lymph nodes |
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What are the components of the subclavian part of the posterior triangle?
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Subclavian artery
Part of subclavian vein Suprascapular artery Supraclavicular lymph nodes |
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What is the root of the neck?
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There is an upward projection of the pleural cavity and cervical part of the parietal pleura (cupula) and the apical part of the superior lobe of the lung on each side
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What comes off the first part of the subclavian artery?
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1st part gives off vertebral artery, internal thoracic artery, thyrocervical trunk. It gives rise to the costocervical trunk on the left.
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What does the thyrocervical trunk give off?
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Thyrocervical trunk gives off transverse cervical suprascapular, and inferior thyroid, and approximately 30% of the time the descending/dorsal scapular a.
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What comes off the second part of the subclavian artery?
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2nd part is behind the anterior scalene muscle. Gives off costocervical trunk on the right.
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What comes off of the third part of the subclavian artery?
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3rd part may gives rise to the dorsal scapular a.
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Where does the dorsal scapular artery come from 30% of the time?
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Transverse cervical artery, called the deep descending branch of the transverse cervical artery in this case.
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What is the first branch of the subclavian artery?
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Vertebral artery
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Where does the vertebral artery enter the transverse foramen?
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The ascends and enters the foramen in the transverse process of vertebra C6, continues up to C1.
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What does the vertebral artery do at C1?
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The artery turns medially and crosses the posterior arch of the atlas (C1) and passes through the foramen magnum
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What is the second branch of the subclavian artery?
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Thyrocervical trunk
arising from its first part medial to the anterior scalene muscle. |
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What are the phrenic and vagus nerves between?
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The subclavian artery and vein as they descend into the thoracic cavity.
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What are the prevertebral muscles?
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Rectus capitis ant. flexes head
Rectus capitis lateralis flexes head laterally Longus capitus flexes head Longus colli flexes neck anteriorly, laterally, slight rotation to opposite side |
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Where is the cervical part of the sympathetic trunk?
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Anterior to longus coli and capitis muscles, and posterior to the common carotid artery
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How is the sympathetic trunk connected to the spinal nerves?
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Connected to spinal nerves via gray rami communicantes
(no white rami) |
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Where does the superior cervical ganglion send gray rami to?
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C1-C4 spinal nerves
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What are the other branches of the superior cervical ganglion?
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Internal carotid a.
Carotid body and sinus Pharynx Heart as superior cardiac nerves |
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What is the location of the superior cervical ganglion?
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Lies anterior to C1-2 vertebrae
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What does the middle cervical ganglion supply?
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Supplies C5 & C6 spinal nerves and lies anterior to C6 vertebrae
Heart as middle cardiac nerves |
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What does the inferior cervical ganglion supply?
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Very large when fused to 1st thoracic as cerviothoracic or stellate ganglion
Supplies C7 & T1 spinal nerves Vertebral artery Heart as inferior cardiac nerves |
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What does ansa SUBCLAVIA loop around?
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Ansa subclavia loops around subclavian artery from middle to inferior ganglia
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What unites the anterior jugular veins?
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Jugular venous arch
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When does the external jugular vein begin?
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By union of the posterior division of the retromandibular and the posterior auricular veins
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What is the location of the external jugular vein?
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It descends on the superficial surface of the sternocleidomastoid m. within the superficial fascia.
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Where does the external jugular vein drain?
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It drains to subclavian v.
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Where does the external jugular vein terminate?
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It terminates in the subclavian vein after piercing the investing layer of fascia in the lower part of the posterior triangle
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What are the tributaries of the external jugular while traversing the posterior triangle?
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Transverse cervical, suprascapular, and anterior & posterior jugular veins
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What is at vertebral level C3-C4?
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Upper margin of thyroid cartilage
Bifurcation of common carotid artery |
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What is at vertebral level C6?
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Arch of cricoid cartilage
Superior end of esophagus Superior end of trachea |
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What triangle is used to asses major structures of the head and neck?
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Anterior triangle
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What is the posterior triangle associated with?
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Structures that pass to the upper limb
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What does the visceral layer of the pretracheal layer enclose?
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Thyroid gland, trachea, and esophagus
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What are the boundaries of the pretrachial layer?
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Extends from the hyoid bone inferiorly to blend with the fibrous pericardium of the heart
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What does the carotid sheath contain?
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common (inferiorly) and internal (superiorly) carotid arteries, internal jugular vein, vagus nerve, deep cervical lymph nodes, sympathetic nerve fibers
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What forms the ligaments that suspend the digastric and omohyoid muscles?
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Pretracheal layer
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What are the boundaries of the prevertebral layer?
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Extends from the base of the cranium to T3 vertebra – fuses with the anterior longitudinal ligament
Extends laterally surrounding the brachial plexus and axillary vessels (axillary sheath) |
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What are the boundaries of the carotid sheath?
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Tubular sheath extending from the cranial base to the root of the neck
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What are the boundaries of the submental triangle?
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Mandibular symphysis
Anterior belly of digastric m. Body of hyoid bone |
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What are the contents of the submental triangle?
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Submental lymph nodes
Tributaries forming the anterior jugular vein |
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What are the boundaries of the submandibular triangle?
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Lower boarder of mandible
Anterior belly of digastric m. Posterior belly of digastric m. |
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What are the contents of the submandibular triangle?
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Submandibular gland
Submandibular lymph nodes Hypoglossal nerve Mylohyoid nerve Facial artery and vein |
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What are the boundaries of the carotid triangle?
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Posterior belly of digastric m.
Superior belly of omohyoid m. Anterior boarder of SCM |
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What are the contents of the carotid triangle?
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Tributaries to common facial vein
Cervical branch of facial nerve Common carotid Ext/int carotids Superior thyroid, ascending pharyngeal, lingual, facial, and occipital arteries Internal jugular vein Vagus Accessory Hypoglossal Superior and inferior roots of ansa cervicalis Transverse cerfical nerve |
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What are the boundaries of the muscular triangle?
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Midline of neck
Superior belly of omohyoid m Anterior boarder of SCM |
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What are the contents of the muscular triangle?
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Sternohyoid
Omohyoid Thyrohyoid Thyroid and parathyroid glands Pharynx |
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What is the roof of the anterior triangle?
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Superficial fascia and platysma muscle
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What is the floor of the anterior triangle?
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Fascia covering pharynx, larynx, and thyroid gland
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Where do the superior & inferior roots of the ansa cervicalis usually lie?
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Within the carotid sheath or is embedded in the anterolateral sheath
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Where does the vagus nerve lie in the carotid sheath?
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The vagus nerve lies posteriorly between the internal jugular vein & common carotid artery.
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What does the external laryngeal nerve innervate?
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Cricothyroid muscle
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What does the internal laryngeal nerve innervate?
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Sensory fibers to laryngeal mucous membrane superior to the vocal folds
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What does the inferior laryngeal nerve innervate?
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Remaning intrinsic muscles of larynx
Terminal continuation of recurrent laryngeal nerve |
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What is the floor of the submental triangle?
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Mylohyoid m.
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What muscles are innervated by the ansa cervicalis?
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Strap infrahyoid muscles
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What are the branches of the thyrocervical trunk?
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Transverse cervical, inferior thyroid, suprascapular
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What does the inferior thyroid branch of the thyrocervical trunk give off?
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Ascending cervical artery which ascends on the anterior surface of the prevertebral muscles supplying them and the spinal cord.
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What is the third branch of the subclavian artery?
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Internal thoracic --> decends anterior to the pleura
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Where does the costocervical trunk arise from?
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Costocervical trunk arises from the 1st part of the subclavian a. on the left and from the 2nd part on the right.
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What does the costocervical trunk give rise to?
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The costocervical trunk gives rise to the deep cervical artery and the supreme intercostal artery (supplies the 1st and 2nd intercostal spaces posteriorly)
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What is the flow of lymph through the neck?
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Occipital and mastoid nodes ---> superficial cervical nodes --> external jugular vein
Pre-auricular, parotid, submandibular, submental --> deep cervical nodes |
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How does the lymphatic system join the venous system on the right side of the neck?
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Jugular trunk + subclavian trunk --> right lymphatic duct --> subclavian v
Bronchomediastinal trunk --> subclavian v |
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How does the lymphatic system joint the venous system on the left side of the neck?
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Jugular trunk + subclavian trunk --> thoracic duct --> subclavian v
Bronchomediastinal trunk --> subclavian v |
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What level does the thoracic duct cross the midline?
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T5
Right to left |
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What does the thoracic duct pass through when it crosses the midline?
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Superior mediastinum and enters the root of the neck to the left of the esophagus
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