Cross-section Of The Neck

Question 1

Which cervical vertebrae are typical and atypical?

Answer 1

Typical - C3-C6

Atypical - C1-2, C7

Question 2

Features of the atypical vertebrae?

Answer 2

C1 - no spinous process or body
C2 - peg-like dens projecting superiorly from its body
C7 - long spinous process, not bifid. Large transverse processes with small transverse foramen

Question 3

Where does the hyoid bone lie?

Answer 3

At the level of C3

Between the mandible and thyroid cartilage

Question 4

Muscles which suspend the hyoid bone connect to where?

Answer 4

Mandible
Styloid process
Thyroid cartilage
Manubrium of sternum
Scapulae

Question 5

What is the purpose of the hyoid bone?

Answer 5

Attachment for anterior neck muscles

Prop to keep airway open

Question 6

Name the suprahyoid muscles and their innervation

Answer 6

Stylohyoid: facial nerve

Digastric

• anterior belly: trigeminal
• posterior belly: facial

Mylohyoid
-trigeminal

Geniohyoid
-C1 roots

Question 7

Overall action of the suprahyoid muscles?

Answer 7

Elevate the hyoid bone, which initiates swallowing

Question 8

Which suprahyoid muscle forms the floor of the mouth?

Answer 8

Mylohyoid

Question 9

Name the infrahyoids and their innervation

Answer 9

Sternohyoid
-anterior rami of C1-3

Omohyoid
-anterior rami of C1

Sternothyroid
-ant rami of C1-3

Thyrohyoid
-ant ramus of C1-3

Question 10

Attachments of the sternocleidomastoid?

Answer 10

Medial head from manubrium of sternum
Lateral head from medial third of clavicle
Mastoid process of temporal bone

Question 11

Innervation of the sternocleidomastoid?

Answer 11

Accessory nerve - C2-3

Question 12

Attachments of the trapezius?

Answer 12

Skull and spinous process of C7-T12

Attaches to clavicle, acromion and spine of scapula

Question 13

Actions of the trapezius?

Answer 13

Elevates scapula and rotates it during abduction
Middle fibres retract the scapula
Lower fibres pull it inferiorly

Question 14

Borders of the anterior triangle in the neck?

Answer 14

Superior - inferior border of mandible
Lateral - medial border of SCM
Medial - sagittal line down body

Question 15

Structures in the anterior triangle?

Answer 15

Common carotid artery which bifurcates here
Internal jugular vein
Cranial nerves
-facial
-glossopharyngeal
-vagus
-accessory
-hypoglossal

Question 16

What are the subdivisions of the anterior triangle?

Answer 16

Carotid triangle
Submental triangle
Submandibular triangle
Muscular triangle

Question 17

Contents of the carotid triangle?

Answer 17

Carotid artery which bifurcates
Internal jugular vein
Hypoglossal and vagus nerves

Question 18

Clinical relevance of the carotid triangle?

Answer 18

Structures in the triangle are easily accessible here for surgery as they are more superficial
Carotid sinus is here which contains baroreceptors - carotid rub

Question 19

Which nerve feeds info from the carotid triangle to the brain about blood pressure?

Answer 19

Glossopharyngeal nerve

Question 20

What does the submental triangle contain?

Answer 20

Submental lymph nodes which filter from floor of mouth and tongue

Question 21

What does the submandibular triangle contain?

Answer 21

Submandibular gland
Lymph nodes
Facial artery and vein

Question 22

What does the muscular triangle contain?

Answer 22

Infrahyoid muscles
Pharynx
Thyroid gland
Parathyroid gland

Question 23

Borders of the posterior triangle?

Answer 23

Anterior - posterior border of SCM
Posterior - anterior border of trapezius
Inferior - Middle third of clavicle
Roof -investing layer of fascia
Floor - prevertebral fascia

Question 24

Contents of the posterior triangle?

Answer 24

Muscles

• omohyoid
• splenius captitis
• levator scapulae
• anterior, middle and posterior scalene

Vasculature

• external jugular vein which drains into the subclavian vein here
• transverse cervical artery
• subclavian artery and vein

Nerves

• accessory nerve
• cervical plexus
• trunks of brachial plexus

Question 25

What are the subdivisions of the posterior triangle?

Answer 25

Occipital triangle superiorly Subclavian triangle inferiorly Split by omohyoid muscle

Question 26

What injury can happen in the posterior triangle?

Answer 26

Severance of the external jugular vein Fascia maintains the lumen - air is drawn in - froth in right atrium and ventricle - cyanosis Therefore pressure needs to be applied

Question 27

What numbing thing can happen in the posterior triangle?

Answer 27

Cervical plexus nerve block - injected along posterior border of the SCM Not carried out on patients with pulmonary or cardiac problems because it can damage the phrenic nerve

Question 28

What structures does the carotid sheath contain?

Answer 28

Internal jugular vein Common carotid artery Vagus nerve Deep cervical lymph nodes

Question 29

What does the pre-vertebral fascia contain?

Answer 29

Muscles surrounding the vertebrae | Base of skull to T2/3

Question 30

What does the pre-tracheal fascia contain?

Answer 30

Thyroid Trachea Oesophagus

Question 31

What are the two main layers which surround the whole neck called?

Answer 31

Superficial cervical fascia | Deep investing fascia

Question 32

If there is an infection posterior to the pre-vertebral fascia, what can happen?

Answer 32

Erode through the pre-vertebrae fascia and drain into the retropharyngeal space

Question 33

Where can infection spread if it begins between the investing fascia and visceral part of the pre-tracheal fascia?

Answer 33

Can spread inferiorly into the chest and cause an infection of the anterior mediastinum

Question 34

What structures does the superficial cervical fascia contain?

Answer 34

``` Neurovascular supply to the skin Superficial veins eg external jugular vein Superficial lymph nodes Fat Playtysma muscle ```

Question 35

Innervation of the platysma muscle?

Answer 35

Facial nerve

Question 36

Importance of fascia in the neck?

Answer 36

Allows structures to slide over one another Puts them into compartments Helps us to determine where infection and cancer can spread

Question 37

Name the three layers of the deep cervical fascia

Answer 37

Deep investing Pretracheal Prevertebral

Question 38

Function of the deep cervical fascia?

Answer 38

Supports viscera, muscles, vessels and deep lymph nodes Limits the spread of abscesses resulting from infection Allows structures in the neck to pass over each other during breathing and turning the head and neck

Question 39

Which structures does the investing layer of fascia enclose?

Answer 39

SCM Trapezius Submandibular and parotid salivary glands

Question 40

Structures in the occipital triangle?

Answer 40

``` Spinal accessory nerve Trunks of brachial plexus Parts of external jugular vein Posterior branches of the cervical plexus Cervicodorsal trunk Cervical lymph node ```

Question 41

Contents of the omoclavicular/subclavian triangle?

Answer 41

Subclavian artery Part of subclavian vein Suprascapular artery Supraclavicular lymph nodes

Question 42

Features of the typical cervical vertebrae?

Answer 42

Large and triangular vertebral foramen Transverse processes have transverse foramen Spinous processes are short and bifid