Bones of the Neck, Cervical Fascia, Triangles of the Neck, Prevertebral Muscles and Arteries & Veins of the Neck Flashcards
(113 cards)
1
Q
- Typical cervical vertebrae (C3-C6) have: (3)
A
o Small vertebral body
- Concave superiorly and convex inferiorly
o Large and triangular vertebral foramen
o Transverse foramina in the transverse processes
- Where vertebral arteries run towards the head
2
Q
- Typical cervical vertebrae (C3-C6) have:
o Superior facets of articular processes directed
_________
o Inferior facets of articular processes directed
_________
o Short _______ processes
A
superoposteriorly
inferoposteriorly
spinous
3
Q
- Atlas (C1): (4)
A
o Ring-like and kidney-shaped
o Lacks a spinous process and body
o Consists of 2 lateral masses connected by anterior and posterior arches
o Concave superior articular facets receive the occipital condyles
4
Q
- Axis (C2):
A
o A peg-like dens projects superiorly from its body (odontoid process)
5
Q
- Vertebra prominens (C7): (2)
A
o Has a long spinous process that is not bifid
o Has large transverse processes but small transverse foramina
6
Q
What is the hyphoid? (4)
A
- Lies anteriorly at the level of C3 between mandible and thyroid cartilage
- Has no articulations with any other bone
- Suspended from the styloid process of temporal bones by the stylohyoid ligaments
- Firmly bound to the thyroid cartilage
7
Q
What is the Superficial Cervical Fascia? (2)
A
- Layer of fatty connective tissue lying between the dermis of the skin and the investing layer of the deep cervical fascia
- Thinner than superficial fascia in other regions of the body, especially anteriorly
8
Q
Superficial Cervical Fascia:
Contents: (4)
A
o Cutaneous nerves, blood and lymphatic vessels
o Superficial lymph nodes
o Variable amounts of fat
o Platysma
9
Q
Cutaneous and superficial muscles of the neck:
Platysma
Origin:
Insertion:
Innervation:
Main action:
A
- Inferior border of mandible.
Skin and subcutaneous tissue. - Deep fascia covering superior parts of deltoid and pectoralis major
- Cervical branch of facial nerve
- Draws corners of mouth inferiorly
Tenses skin of the neck
10
Q
Cutaneous and superficial muscles of the neck:
SCM
Origin:
Insertion:
Innervation:
Main action:
A
11
Q
Cutaneous and superficial muscles of the neck:
Trapezius
Origin:
Insertion:
Innervation:
Main action:
A
12
Q
Layers of deep fascia: (4)
A
- Investing
- Pretracheal
- Prevertebral
- Carotid
13
Q
What is the Investing layer of the Deep Cervical Fascia? (3)
A
- Most superficial layer of deep fascia
- Surrounds the entire neck deep to the skin and subcutaneous tissue
- At the 4 corners of the neck, it splits into superficial and deep layers to enclose the trapezius and sternocleidomastoid muscles
o These muscles are both innervated by accessory nerve (CN XII)
14
Q
Relevance of the deep cervical fasciae: (3)
A
- Natural cleavage planes allowing tissues to be
separated during surgery - Limit the spread of abscesses resulting from infection
- Allows structures in the neck to move freely over one another without difficulty
15
Q
Deep cervical fasciae
* Superior attachments: (6)
A
o Superior nuchal lines of occipital bone
o Mastoid processes of temporal bones
o Zygomatic arches
o Inferior border of mandible
o Hyoid bone
o Spinous processes of cervical vertebrae
16
Q
Deep cervical fasciae
* Inferior attachments: (3)
A
o Manubrium of sternum
o Clavicles
o Acromions and spines of scapulae
17
Q
Deep cervical fasciae
* Contents: (4)
A
o Sternocleidomastoid
o Trapezius
o Submandibular gland
o Parotid gland (forms its fibrous capsule)
18
Q
What is the deep cervical fascia continuous with? (4)
A
- Continuous with the periosteum of C7 spinous process and with the nuchal ligament
- Splits into 2 above the manubrium to enclose sternocleidomastoid
o One layer attaches to the anterior and the other to the posterior surface of the manubrium
o Suprasternal space- lies between these layers and encloses
19
Q
What does the Suprasternal space enclose? (4)
A
- Anterior jugular veins
- Jugular venous arch
- Fat
- Deep lymph nodes
20
Q
What is the 1. Pretracheal layer?
A
- Limited to the anterior part of the neck
21
Q
- Pretracheal layer:
* Extent:
A
o inferiorly from the hyoid to thorax where it
blends with the pericardium
22
Q
- Pretracheal layer:
* Has 2 parts:
A
o Thin muscular part
- Encloses infrahyoid muscles
o Visceral part
- Encloses thyroid gland, trachea and oesophagus
23
Q
What is the 1. Pretracheal layer continuous with? (2)
A
- continuous posteriorly and superiorly with the buccopharyngeal fascia of the pharynx
- blends laterally with the carotid sheaths
24
Q
What is the 2. Prevertebral layer?
A
- Forms a tubular sheath for the vertebral column and the muscles associated with it
25
2. Prevertebral layer:
o Anteriorly-
o Laterally-
o Posteriorly-
o Anteriorly- longus colli and longus capitis
o Laterally- scalenes
o Posteriorly- deep cervical muscles
26
2. Prevertebral layer:
* Extent:
o Superiorly-
o Inferiorly-
o Laterally-
o Superiorly- attached to cranial base
o Inferiorly- blends with the endothoracic fascia peripherally and fuses with the anterior longitudinal ligament centrally at the T3 vertebra
o Laterally- continuous with the axillary sheath
27
3. Carotid layer:
* Extent:
cranial base to root of the neck
o Communicates with mediastinum and cranial base- pathways for spread of infection and
extravasated blood
* Blends anteriorly with investing and pretracheal layers and posteriorly with the prevertebral layer
28
3. Carotid layer:
* Contents: (6)
o Common and internal carotid arteries
o Internal jugular vein
o Vagus nerve
o Carotid sinus nerve
o Sympathetic nerve fibers (carotid periarterial plexuses)
o Deep cervical lymph nodes
29
What is the Retropharyngeal space?
* Potential space consisting of loose connective tissue
30
Retropharyngeal space:
* Extent: (2)
o Superiorly- between the prevertebral layer (deep) and buccopharyngeal fascia (superficial)
o Inferiorly- the buccopharyngeal fascia is continuous with the pretracheal layer
31
What is the Alar fascia? (2)
* Subdivides the retropharyngeal space (into anterior and posterior)
* Attached along the midline of the buccopharyngeal fascia from the cranium to C7 vertebral level
o Extends laterally and terminated in the carotid sheath
32
Alar fascia:
* Closed superiorly by the _____ ______ and on each side by the carotid layer
* Opens inferiorly into the ________
cranial base
mediastinum
33
What does the Alar fascia allow movement of?
* Allows movement of the pharynx, oesophagus, larynx and trachea
34
Spread of infections in the neck:
35
Anterior Triangles of the Neck:
Mylohyoid
Origin:
Insertion:
Innervation:
Main action:
Mylohyoid line of mandible
Mylohyoid raphe and body of hyoid
n. to mylohyoid from CN V3
Elevates hyoid, floor of mouth and tongue
36
Anterior Triangles of the Neck:
Geniohyoid
Origin:
Insertion:
Innervation:
Main action:
Inferior mental spine of mandible
Body of hyoid
C1 via CN XII
Pulls hyoid anterosuperiorly Shortens floor of mouth and widens pharynx
37
Anterior Triangles of the Neck:
Stylohyoid
Origin:
Insertion:
Innervation:
Main action:
Styloid process of temporal
Body of hyoid
Stylohyoid n. from CN VII
Elevates and retraces hyoid- elongates floor of mouth
38
Anterior Triangles of the Neck:
Digastric (Anterior)
Origin:
Insertion:
Innervation:
Main action:
Anterior belly: digastric fossa of mandible
Intermediate tendon to body and greater horn of hyoid
n. to mylohyoid from CN V3
Depresses mandible against resistance
39
Anterior Triangles of the Neck:
Digastric (Posterior)
Origin:
Insertion:
Innervation:
Main action:
Posterior belly: mastoid notch of temporal bone
Intermediate tendon to body and greater horn of hyoid
Digastric br. of CN VII
Elevates and steadies hyoid during swallowing/speaking
40
What are the Suprahyoid Muscles? (4)
41
What are the Infrahyoid Muscles? (4)
42
Anterior Triangles of the Neck:
Sternohyoid
Origin:
Insertion:
Innervation:
Main action:
Manubrium of sternum and medial end of clavicle
Body of hyoid
C1-C3 by a br. of ansa cervicalis
Depresses hyoid after elevation during swallowing
43
Anterior Triangles of the Neck:
Omohyoid
Origin:
Insertion:
Innervation:
Main action:
Superior border of scapula near suprascapular notch
Inferior border of hyoid
C1-C3 by a br. of ansa cervicalis
Depresses, retracts and steadies hyoid
44
Anterior Triangles of the Neck:
Sternothyroid
Origin:
Insertion:
Innervation:
Main action:
Posterior surface of manubrium
Oblique line of thyroid cartilage
C2 -C3 by a br. of ansa cervicalis
Depresses hyoid and larynx
45
Anterior Triangles of the Neck:
Thyrohyoid
Origin:
Insertion:
Innervation:
Main action:
Oblique line of thyroid cartilage
Inferior border of body and greater horn of hyoid
C1 via CN XII
Depresses hyoid and elevates larynx
46
Submental Triangle:
Boundaries:
* Lateral:
* Inferior:
* Apex:
* Floor:
* Lateral: Anterior bellies of digastric
muscle
* Inferior: Hyoid bone
* Apex: Mandible
* Floor: Mylohyoid muscle
47
Submental Triangle:
Contents: (2)
* Anterior jugular veins
* Submental lymph nodes
48
Submandibular Triangle
Boundaries:
* Superior:
* Inferior anterior and posterior:
* Floor:
* Roof:
* Superior: Ramus of mandible
* Inferior anterior and posterior:
o Anterior belly of digastric muscle
o Posterior belly of digastric muscle
* Floor
o Mylohyoid muscle
o Hyoglossus muscle
o Middle constrictor muscle of the
pharynx
* Roof: Investing fascia
49
Submandibular Triangle
Contents: (5)
* Submandibular gland
* Submandibular lymph nodes
* Hypoglossal nerve (CN XII)
* Nerve to mylohyoid
* Parts of facial artery and vein
50
Muscular Triangle
Boundaries:
* Superior:
* Inferior:
* Medial:
* Floor:
* Superior: Superior belly of omohyoid
* Inferior: Anterior border of SCM
* Medial: Midline
* Floor: pretracheal fascia
51
Muscular Triangle
Contents: (3)
* Infrahyoid muscles
* Thyroid and parathyroid glands
* Recurrent laryngeal nerve
52
Carotid Triangle
Boundaries:
* Superior:
* Inferior:
* Lateral:
* Floor:
* Superior: posterior belly of digastric
muscle
* Inferior: superior belly of omohyoid
* Lateral: anterior border of SCM
* Floor
o thyrohyoid muscle
o middle constrictor muscle of the
pharynx
o inferior constrictor muscle of the
pharynx
53
Carotid Triangle
Contents: (13)
* Common carotid artery
* Internal and external carotid artery
* Carotid sinus and carotid body
* Internal jugular vein
* Glossopharyngeal nerve
* Vagus nerve
* Spinal accessory nerve
* Hypoglossal nerve
* Superior root of ansa cervicalis
* Branches of cervical plexus
* Thyroid gland
* Larynx and pharynx
* Deep cervical lymph nodes
54
Boundaries of the posterior triangle of the neck:
* Anterior:
* Posterior:
* Inferior:
* Apex:
* Roof:
* Floor:
* Anterior: Posterior border of SCM
* Posterior: Anterior border of trapezius
* Inferior: Middle 1⁄3 of the clavicle
* Apex: At superior attachments of SCM and
trapezius
* Roof: Investing fascia
* Floor: Prevertebral fascia and muscles
o Splenius capitis, levator scapulae and
middle, posterior and anterior scalene
55
Posterior Triangle of the Neck:
Divisions:
(divided by inferior belly of omohyoid)
* Occipital triangle
* Omoclavicular triangle
56
Occipital Triangle:
Superficial contents: (4)
* Cutaneous branches of cervical plexus (C1-4)
* External jugular vein
* Superficial branch of transverse cervical artery
* Superficial cervical lymph nodes
57
What are the cutaneous branches of cervical plexus (C1-4)? (4)
o Great auricular nerve
o Lesser occipital nerve
o Supraclavicular nerve
o Transverse cervical nerve
58
Occipital Triangle
Deep contents: (5)
* Spinal accessory nerve (CN XI)
* Phrenic nerve
* Trunks and roots of brachial plexus
* Occipital artery
* Thyrocervical truck (1st part of subclavian a.)
59
What are the sub-divisions of the Thyrocervical truck (1st part of subclavian a.)? (5)
o Suprascapular artery
o Transverse cervical trunk
o Dorsal scapular artery
o Ascending cervical artery
o Inferior thyroid artery
60
Omoclavicular Triangle
Superficial contents: (2)
* Inferior part of external jugular vein
* Superficial cervical lymph nodes
61
Omoclavicular Triangle
Deep contents: (5)
* 3rd part of subclavian artery and vein
* Suprascapular artery, vein and nerve
* Phrenic nerve
* Supraclavicular lymph nodes
* Trunks of brachial plexus
62
What are the Anterior vertebral muscles? (4)
63
What are the Lateral vertebral muscles? (5)
64
Prevertebral Muscles:
Longus colli
Innervation:
Main action:
Anterior rami of C2-C6
Flexes neck with rotation contralaterally if unilateral contraction
65
Prevertebral Muscles:
Longus capitis
Innervation:
Main action:
Anterior rami of C1-C3
Flex head
66
Prevertebral Muscles:
Rectus capitis anterior
Innervation:
Main action:
C1-C2
Flex head
67
Prevertebral Muscles:
Anterior scalene
Innervation:
Main action:
C4-C6
Flex head
68
Prevertebral Muscles:
Rectus capitis lateralis
Innervation:
Main action:
C1-C2
Flexes and stabilises head
69
Prevertebral Muscles:
Splenius capitis
Innervation:
Main action:
Posterior rami of middle cervical spinal nn.
- Lateral flexion and rotation of head on the same side
- Extends head and neck
70
Prevertebral Muscles:
Levator scapulae
Innervation:
Main action:
Dorsal scapular n. (C5) & C3-C4
Downward rotation of scapula
71
Prevertebral Muscles:
Middle scalene
Innervation:
Main action:
Anterior rami of cervical spinal nn.
Flexes neck laterally
72
Prevertebral Muscles:
Posterior scalene
Innervation:
Main action:
Anterior rami of C7-C8
Flexes neck laterally
73
Boundaries of the root of the neck:
* Inferior-
* Lateral-
* Anterior-
* Posterior-
* Inferior- superior thoracic aperture
* Lateral- 1st pair of ribs and their costal
cartilages
* Anterior- manubrium of the sternum
* Posterior- T1 vertebra
74
Suboccipital Triangle:
Boundaries:
* Superomedial-
* Superolateral-
* Inferior-
* Floor-
* Roof-
* Superomedial- rectus capitis posterior major
* Superolateral- obliquus capitis superior
* Inferior- obliquus capitis inferior
* Floor- posterior atlantooccipital membrane and posterior arch of C1 vertebra
* Roof- semispinalis capitis
75
Suboccipital Triangle
Contents: (2)
* Vertebral artery
* Suboccipital nerve
76
What is the Carotid arterial system?
* At the level of the superior border of the thyroid cartilage, the common carotid divides into the internal and external carotid arteries.
77
What is the carotid sinus? (3)
o A dilation of the proximal part of the internal carotid artery
o Innervated mostly by the glossopharyngeal n. via the carotid sinus n., but also the vagus n.
o Baroreceptor that reacts to changes in arterial blood pressure
78
What is the Carotid body? (3)
o Small reddish-brown ovoid mass lying in a septum on the medial side of the bifurcation
o Innervated mainly by the carotid sinus n. and vagus n.
o Chemoreceptor that monitors the levels of oxygen in the blood
- Initiates a reflex that increases the rate and depth of respiration, cardiac rate and blood pressure
79
What is the Internal carotid artery? (2)
* Direct continuation of the common carotid a. superior to the origin of the external carotid a.
* Enters the cranium through carotid canal in the petrous part of the temporal bone
80
What are the branches of the External carotid artery?
Branches of external carotid artery: Some Anatomists Like Freaking Out Poor Medical Students
81
External carotid artery
Superior thyroid branch
Direction:
Distribution:
Anterior
Thyroid gland, infrahyoid muscles and SCM and larynx
82
External carotid artery
Ascending pharyngeal branch
Direction:
Distribution:
Medial
Pharynx, prevertebral muscles, middle ear and cranial meninges
83
External carotid artery
Lingual branch
Direction:
Distribution:
Anterior
Tongue
84
External carotid artery
Facial branch
Direction:
Distribution:
Anterior
Palatine tonsils, soft palate, pterygoid, mylohyoid, and digastric muscles, the submandibular gland, and all of the face
85
External carotid artery
Occipital branch
Direction:
Distribution:
Posterior
Posterior scalp
86
External carotid artery
Occipital branch
Direction:
Distribution:
Posterior
Posterior scalp
87
External carotid artery
Posterior auricular branch
Direction:
Distribution:
Posterior
Adjacent muscles, parotid gland, facial nerve, structures in the temporal bone, auricle and scalp
88
Maxillary =
Superficial temporal =
Maxillary = (Terminal branch)
Superficial temporal = (Terminal branch)
89
Subclavian Artery:
* Course: (2)
o Arch superolaterally, reaching an apex as they pass posterior to anterior scalene muscles
o As the descend, they lie posterior to the middle of the clavicles
90
* The parts of the subclavian artery are described relative to the anterior scalene:
o 1st part-
o 2nd part-
o 3rd part-
o 1st part- medial to anterior scalene
o 2nd part- posterior to anterior scalene
o 3rd part- lateral to anterior scalene
91
What are the branches of the Subclavian Artery? (5)
92
Subclavian Artery:
Vertebral artery
Distribution:
Medulla, spinal cord, cerebellum, deep muscles of the neck, dura mater of PCF
93
Subclavian Artery:
Internal thoracic
Distribution:
First 6 intercostal spaces
94
Subclavian Artery:
Thyrocervical trunk - Suprascapular
Distribution:
May arise independently. Supplies muscles on the posterior aspect of scapula.
95
Subclavian Artery:
Thyrocervical trunk - Ascending cervical
Distribution:
Lateral muscles of the upper neck and spinal branches into the intervertebral foramina
96
Subclavian Artery:
Thyrocervical trunk - Ascending cervical
Distribution:
Lateral muscles of the upper neck and spinal branches into the intervertebral foramina
97
Subclavian Artery:
Thyrocervical trunk - Inferior thyroid
Distribution:
Larynx, trachea, oesophagus, thyroid and parathyroid glands and adjacent muscles
98
Subclavian Artery:
Thyrocervical trunk - Transverse cervical
Distribution:
Bifurcates into superficial cervical and dorsal scapular*. Supplies rhomboids, levator scapulae, trapezius and trunks of the brachial plexus
99
Subclavian Artery:
Costocervical trunk - Superior intercostal
Distribution:
First two intercostal spaces
100
Subclavian Artery:
Costocervical trunk - Deep cervical
Distribution:
Posterior deep cervical muscles
101
Subclavian Artery:
Costocervical trunk - Deep cervical
Distribution:
Posterior deep cervical muscles
102
Subclavian Artery:
Dorsal scapular* -
Distribution:
May arise from thyrocervical trunk. Participates in scapular arterial anastomosis
103
What are the parts of the vertebral artery? (4)
* Cervical part
* Vertebral part
* Suboccipital part
* Cranial part
104
Vertebral artery
* Cervical part:
o Ascends into the pyramidal space between the scalene and longus colli & capitis muscles
105
Vertebral artery
* Vertebral part:
o At the apex of the pyramidal space the artery passes deep to course through the foramina transversaria of vertebrae C1-C6
106
Vertebral artery
* Suboccipital part:
o Courses in a groove on the posterior arch of the atlas and through the suboccipital triangle before entering the cranium through foramen magnum
107
Vertebral artery:
* Cranial part:
o At the inferior border of pons, the right and left arteries join to form the basilar artery
108
What is the Internal jugular vein?
* Commences at the jugular foramen in the posterior cranial fossa as the direct continuation of the sigmoid sinus
109
Internal jugular vein:
* Superior bulb-
* Inferior bulb-
* Superior bulb- dilation at its origin
* Inferior bulb- dilation at the inferior end that has a bicuspid valve to prevent backflow into the vein
110
Internal jugular vein:
Branches: (7)
o Occipital vein
o Facial vein
o Lingual vein
o Superior laryngeal vein
o Superior thyroid vein
o Middle thyroid vein
o Pharyngeal vein
111
What is the external jugular vein? (5)
* Begins near the angle of the mandible
* Posterior division of the retromandibular vein unites with posterior auricular vein
* Crosses the SCM obliquely and pierces investing fascia at the posterior border
* Receives the cervicodorsal, suprascapular and anterior jugular veins
* Terminates in the subclavian vein
112
What is the Subclavian vein? (2)
* Passes anterior to the anterior scalene muscle and phrenic nerve
* Unites at the medial border of anterior scalene with internal jugular vein to form the brachiocephalic vein
113
What is the Anterior Jugular vein? (2)
* Arises near the hyoid from confluence of the superficial submandibular veins
* Superior to the manubrium they unite across the midline to form the jugular venous arch in the suprasternal space
