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Brain and Behaviour > Anatomy of the Neck > Flashcards

Anatomy of the Neck Flashcards

1
Q

what are the two main triangles in the neck

A

posterior and anterior triangle

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2
Q

describe the borders of the posterior triangle

A
  • Posterior border of sternocleidomastoid
  • Anterior border of trapezius
  • Middle 1/3 of clavicle
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3
Q

describe the borders of the anterior triangle

A

– Midline of neck from chin to jugular notch
– Anterior border of sternocleidomastoid
– Lower border of mandible and beyond to mastoid process

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4
Q

what are the important structures inside the posterior triangle

A
  • Spinal accessory nerve (CN XI)
  • External jugular veins runs superficially over SCM
  • Lymph nodes
  • Part of subclavian artery
  • Brachial plexus, cervical plexus, phrenic nerve
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5
Q

where is the prominence of the external jugular vein

A
  • usually visible above the clavicle for short distances - less than 4cm above the sternal angle
  • it disappears as it runs over the SCM
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6
Q

when does the external jugular vein become more prominent

A

• Become more prominent when you have Heart failure, SVC obstruction, enlarged supraclavicular lymph nodes, raised intra-thoracic pressure

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7
Q

what does the external jugular vein helps assess

A

• The EJV helps assess mean right arterial pressure which is identical to central venous pressure

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8
Q

what does the spinal accessory supply

A

• Somatic motor fibres to accessory muscles of breathing (SCM and trapezius)

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9
Q

where is the spinal accessory

A
  • nerves forms from C1-5 spinal cord rootlets
    • Ascend into cranial cavity via foramen magnum
    • Exit through the jugular foramen
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10
Q

the spinal accessory nerve is a purely..

A

motor neurone

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11
Q

recent evidence regarding the spinal accessory nerve

A

Recent evidence suggests that the accessory nerves lacks a cranial root and has no connection to the vagus nerve but needs confirmation

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12
Q

what happens if there is spinal accessory nerve damage

A
  • Weakened shrugging shoulder, atrophy of trapezius, drooping of shoulder
  • Passive shoulder movements within normal range
  • Uni-lateral lesion usually does not produce an abnormal head position
  • Weakeness in turning head to opposite side against resistance
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13
Q

what can cause spinal accessory nerve damage

A
  • Subcutaneous course – injury lymph node surgery
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14
Q

where is the cervical plexus to and from

A

C1-C4

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15
Q

what is the anasa cervicalis

A
  • prat of the cervical plexus
  • C1-C3
  • it is the motto to the infra hyoid muscles
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16
Q

describe the branching of the cervical plexus

A
  • Cutaneous branches emerge around middle of the posterior border of SCM
  • Phrenic nerve C3-C4) picks up additional C5 roots
  • Descend down obliquely with IVJ cross the anterior scalene and passes into thorax
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17
Q

what are the 4 parts of the anterior triangle

A

submandibular, carotid, muscular and submental

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18
Q

describe the 4 parts of the anterior triangle

A

a. Submandibular (digastric) -submandibular gland fills most of triangle, hypoglossal nerve, parts of facial artery and vein
b. Carotid – anatomically important with a lot of structures
c. Muscular – sternohyoid, thyrohyoid and sternothyroid (infrahyoid muscles). Thyroid and parathyroid glands
d. Submental – floor of mouth – mylohyoid

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19
Q

what is the hyoid bone

A

– attachment point for infrahyloid muslces and muscles that are supporting the jaw of the mouth

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20
Q

what are the boundaries of the carotid triangle

A
  • Posterior belly of digastric
  • Superior belly of omohyoid
  • Anterior border of SCM
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21
Q

what goes through the carotid triangle

A

Blood vessels

  • Common carotid artery
  • Internal and external carotid arteries
  • Intenral jugular vein
Nerves 
•	Glossopharyngeal 
•	Vagus
•	Spinal accessory
•	Hypoglossal
•	Cervical sympathetic trunk
•	Ansa cervicalis
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22
Q

what are the carotid carotid triangle contents

A
  • Common carotid – at anterior border of SCM at level of the thyroid cartilage
  • Carotid bifurcation – superior border thyroid cartilage
  • Carotid sinus (IX) baroreceptors
  • Carotid body (IX X) chemoreceptors – carry the information via glossophargenal and vagus to measure carbon dioxide and oxygen content of the blood
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23
Q

the internal carotid has..

A

no branches until it enters the skull

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24
Q

what does the external carotid supply

A

blood supply to the face, neck and skull, inside of the skull and the dura

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25
Q

what are the branches of the external carotid

A 
– some anatomists like freaking out poor medical students 
–	Sup. Thyroid a
–	Ascending pharyngeal
–	Lingual
–	Facial
–	Occipital 
–	Posterior auricular
–	Superficial temporal
–	Maxillary
26
Q

what is in the carotid sheath

A
  • Common and internal carotid arereis, internal jugular vein and CNX
27
Q

what leaves the carotid sheath

A
  • Escaping upper sheath are CN IX, superior laryngeal N, spinal root of CN XI and CN XIII
28
Q

what uses the internal carotid artery for support

A
  • Ascending sympathetic firbes use internal carotid artery for support
29
Q

where is the anasa cerviclis

A
  • it is over the internal jugular vein
30
Q

the internal jugular is…

A

usually larger on one side than the other

31
Q

no cranial nerves have…

A

sympathetic innervation

32
Q

how do you get sympathetic innervation to the head

A
  • Therefore the sympathetic information has to come through the symaptehtic trunk, there are 3 cervical ganglia, they get presynaptic firbes via superior thoracic nerves
  • Synapse in ganglia to send fibres to – cervical spinal nerves, thoracic viscera, head and neck viscera
  • Use the internal carotid artery as a guide into the skull
33
Q

what do you get if you damage the cervical sympathetic trunk

A

Horner’s syndrome or descending fibres in brainstem

34
Q

what are the symptoms of Horner’s syndrome

A

– Contraction of pupil (miosis)
– Drooping of superior eyelid (paralysis of smooth muscle in levator palpebrae superioris – ptiosis )
– Sinking of eye (enophthalmos)
– Vasodilation and absence of sweating – there is no innervation to the sweat glands so the skin is warm and dry

35
Q

how do you differnate Horner’s syndrome from cranial III damage

A

Differentiate it form cranial nerve III – degree of ptosis is not as great and Crnaial nerve IiI innervates extraoclular eye muscles so the eyes would look down and out

36
Q

what happens if you damage the vagus

A
  • can damage it in dissection of the carotid triangle
  • Damage or compression of the vagus or recurrent laryngeal nerves during sugery of carotid triangle and may produce an alternation in voice as these nerves supply the laryngeal muscles
37
Q

what is an IVJ puncture used for

A
  • used for access through the brachiocephalic vein into the svc
38
Q

What do pulsations of the IVJ tell us

A
  • internal jugular pulse

- tells us about rich atrial pressure

39
Q

what shows that there is an increase in the IVJ

A

usually the same as 2cm of water, if it is above that then this shows that there is an increase in pressure

40
Q

when can blood travel up the internal jugular vein

A
  • No valves in brachiocephalic vein and superior vena cava so blood can travel up vein when at ~45o
41
Q

what causes the Internal Jugular vein pulse to rise

A
  • mitral valve disease,
  • increased pressure in pulmonary circulation
  • right side of heart problems
42
Q

what are the muscles in the cervical region divided into

A

supra hyoid and infrahyoid

43
Q

what do the suprhyoid do

A
  • Suprahyoid muscles constitute floor of mouth, providing a base for tongue and elevating hyoid and larynx
    – swallowing and tone production
44
Q

what muscles makes up the supra hyoid

A

 Mylohyoid, digastric, stylohyoid

45
Q

what does the infrayoid do

A
  • Infrahyoid (strap) muscles depress hyoid and larynx during swallowing and speaking
46
Q

what muscles make up the infrhyoid

A

o Sternohyoid, thyrohyoid(undenegat sternothyoid), sternothyroid, omohyoid

47
Q

what innervates the infrahyoud

A

by annus cerviculars of the cervical plexus

48
Q

what do the extrinsic muscles of the larynx do and what muscles make up them

A
  • Extrinsic muscles move the larynx as a whole

* Supra and infrahyoid muscles

49
Q

what do the intrsic muscles of the larynx do

A

• Intrinsic muscles move the laryngeal components, altering the length and tension of the vocal folds and size and shape of rima glottides

50
Q

what innervates the muscles of the larynx

A
  • Cricothyroid - superior laryngeal N (CN X)

* All others - recurrent laryngeal N (CN X)

51
Q

what is the rima glottis

A

this is the aperture between the vocal folds and how tight it is

52
Q

what happens to the rima glottidis in normal respiration

A

laryngeal muscles released and rima glottides narrow slit

53
Q

what happens to the rima glottidis in deep respiration

A

vocal ligaments abducted by contraction of posterior cricoarytenoid muscles – rima glottides opens widely to allow more air in

54
Q

describe how phonation happens

A

o Arytenoid muscles adduct arytenoid cartilages at same time lateral cricoarytenoids moderately adduct vocal ligaments
o Air forced between vocal ligaments = sound

55
Q

describe how whispering happens

A

o Vocal ligaments strongly adducted but relaxed arytenoids

56
Q

what is the two nerves that innervate the larynx

A

both from the vagus

  • superior laryngenal nerve
  • recurrent laryngeal nerve
57
Q

what does the superior laryngeal split into

A

internal laryngeal nerve

external laryngeal nerve

58
Q

what does the superior laryngeal nerve do

A
  • Internal laryngeal (sensory + autonomic) to larynx above vocal folds
  • External laryngeal nerve (motor to cricothyroid) – loss ability of pitch
59
Q

what does the recurrent laryngeal nerve do

A
  • Motor to all other intrinsic muscles of the larynx and sensory to area below vocal folds
  • On left recurrent laryngeal loops under the arch of the aorta
  • On right recurrent laryngeal loops under the right subclavian artery
60
Q

How can paralysis of the superior laryngeal nerve happen

A
  • Any surgery to the thyroid or growth of the thyroid can compress it and damage it
  • Can occur during thyroidectomy or through compression
  • Goitre
61
Q

what does paralysis of the superior laryngeal nerve do

A

Anaesthesia of superior laryngeal mucosa
- Cough reflex (an important protective mechanism)
A monotonous voice
- Paralysed cricothyroid (unable to vary length and tension – but may go unnoticed)

62
Q

what happens when there is injury to the recurrent laryngeal nerve

A
  • Paralysed vocal folds

- Causes hoarseness/dysphonia

Brain and Behaviour (34 decks)

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