Lecture 1

Question 1

Compartments in neck

Answer 1

Neuromuscular:
Muscles
Cervical plexus
Brachial plexus

Viscerovascular:
Organs
Blood vessels
Cranial nerves

Subdivided by fascial sheaths

Question 2

Triangles in neck

Answer 2

Anterior
Posterior
Separated by Sternocleidomastoid m

Question 3

Connection between neck and thorax

Answer 3

Between infrahyoid muscle and thyroid gland

Allows infection to pass through

Question 4

Fascial space

Answer 4

Between prevertebral and pretracheal space

Infection causes friction in throat and pain in swallowing

Question 5

Between anterior and middle scalene muscles

Answer 5

Brachial plexus

3rd part of subclavian artery

Question 6

Lower down on anterior surface of anterior scalene

Answer 6

Phrenic nerve

Question 7

Pretracheal fascia

Answer 7

Anterior and posterior layers

Buccopharyngeal fascia is posterior portion

Question 8

Retropharyngeal space

Answer 8

Allows smooth swallowing

Question 9

Preracheal and fascial space in prevertebral layer

Answer 9

Connects with thoracic cavity (danger)

Question 10

Roof of posterior triangle

Answer 10

Deep investing fascia & skin

Question 11

Borders of posterior triangle

Answer 11

Posterior = Trapezius m
Anterior = Sternocleidomastoid m
Inferior (base) = middle 1/3 clavicle

Question 12

Posterior triangle floor

Answer 12

Prevertebral fascia over (superior to inferior)

1. M splenius capitis
2. M levator scapulae
3. M scalenius posterior
4. M scalenius medius
5. M scalenius anterior

Question 13

What is floor of posterior triangle crossed by?

Answer 13

Inferior belly of M omohyoid

Question 14

Inferior belly of M omohyoid subdivides posterior triangle into

Answer 14

Occipital triangle(superiorly)
Supraclavicular triangle(inferiorly)

Question 15

Posterior triangle divided into careful and carefree areas by

Answer 15

Accessory nerve (CN XI)

Question 16

Contents of posterior triangle

Answer 16

1. Occipital artery
   Through apex of triangle
2. External Jugular v
   From retromandibular and posteriorauricular vv –ends in subclavian v
3. 3rd part of subclavian artery
   Pressure point against 1st rib
4. Transverse cervical a

Question 17

Nerves of posterior triangle

Answer 17

1. Lesser occipital n (Carefree)
2. Accessory n (CN XI)
3. Cervical plexus (Careful)
4. Phrenic n on anterior scalene
5. Supraclavicular part of brachial plexus (Upper and middle trunks)

Question 18

Cervical plexus

Answer 18

Around post border of SCM

From C1–C4

• Lesser occipital n–C2(3)
• Great auricular n–C2,3
• Transverse cervical–C2,3
• Supraclavicular nn–C3,4

Question 19

Ventral rami C1 - C4

Answer 19

Superficial branches at posterior edge of SCM are all sensory:

• Lesser occipital n –C2(3)
• Great auricular n –C2,3
• Transverse cervical –C2,3
• Supraclavicular nn –C3,4

Deep branches pass anteromedially and are motor:

• Phrenic –C3-C5
• Ansa Cervicalis –C1-C3

Question 20

Ventral rami C1 - C3

Answer 20

Superior root (C1) accompanies Hypoglossal nerve
Inferior root (C2-C3)
Forms loop over IJV
Supplies the ‘Strap’ muscles (ant triangle)
1. Nn. to geniohyoidand thyrohyoid
2. N. to omohyoid
3. Nn. to sternothyroid and sternohyoid

Question 21

Structures deep to fascia layer

Answer 21

Trunks of brachial plexus
3rd part of subclavian a
Subclavian v
Long thoracic n (C5-7) exits through scalenius medius (to serratus ant m)
Nerve to levator scapulae (C3-4)
Dorsal scapular n(C5) pass between scalenius medius and levator scapulae
Phrenic n(C3-5)
Occipital a at apex of triangle
Transverse cervical and suprascapular aa
Subclavian n (C5-6) – Erb’s point lies anterior to the brachial plexus

Question 22

Carotid triangle borders

Answer 22

1. Post - Sternocleidomastoid (SCM)
2. Anterosuperior - Posterior belly of digastric
3. Antero-inferior - Superior belly of omohyoid

Question 23

Floor of carotid triangle

Answer 23

1. Parts of middle & inferior constrictors
2. Thyrohyoid
3. Part of hyoglossus

Question 24

Contents of carotid triangle

Answer 24

1. Ansa cervicalis
2. Common carotid a (CCA)
3. CCA bifurcation into Internal carotid a(ICA) & External carotid a (ECA)
4. Branches of ECA
5. Internal jugular vein (IJV)
6. CN XII (Hypoglossal)
7. CN X (Vagus)
8. Superior cervical ganglion
9. Sympathetic trunk

Question 25

NB carotid triangle

Answer 25

1. CCA, IJV & CN X in carotid sheath 2. CCA bifurcates at C4 3. ECA leaves carotid sheath 4. Carotid sinus (baroreceptor) 5. Carotid body (chemoreceptor –monitors acid-base status of blood) 6. Both 4 & 5 innervated by CN IX

Question 26

Muscular triangle borders

Answer 26

1. Midline of neck 2. Superior belly of omohyoid 3. Lower portion of anterior border of SCM

Question 27

Contents of muscular triangle

Answer 27

1. Infrahyoid mm 2. Thyroid gland 3. Parathyroid glands 4. Vessels & nn to area

Question 28

Thyroid gland

Answer 28

In muscular triangle Below & lateral to thyroid cartilage 2 lateral lobes joined by isthmus Isthmus crosses 2nd to 3rd(4th) tracheal cartilages Deep to sternohyoid, sternothyroid & omohyoid Invisceral compartmentof neck (with pharynx, trachea and oesophagus & RL nn) surrounded by pretracheal fascia Arises from median outgrowth at base of tongue Foramen caecum of tongue indicates site of origin Thyroglossal duct marks path of migration to final adult location. Disappears early in development, but remnants may persist as a cystor as a connection with foramen caecum (fistula) Remains of gland may be found: Associated with tongue (lingual thyroid) Along path of migration Upward from gland (pyramidal lobe)

Question 29

Thyroid gland arteries

Answer 29

1. Superior thyroid a (from ECA) Anterior glandular br (may anastomose with artery from other side across isthmus) Posterior glandular br (may anastomose with inferior thyroid a) ``` 2. Inferior thyroid a (from thyrocervical trunk ofsubclavian a) - ascends on medial edge of ant scalene m Inferior br (anastomose with post glandular br ofsuperior thyroid a) Ascending br (supplies parathyroid glands) ``` 3. Thyroidea ima a (from brachiocephalic trunk or arch of aorta)

Question 30

Thyroid gland veins

Answer 30

Superior thyroid v (to IJV) Drains area supplied by superior thyroid a Middle thyroid v (to IJV) Inferior thyroid v (to brachiocephalic v) Drains rest of gland

Question 31

Thyroid gland | Lymphatic drainage

Answer 31

Paratracheal nodes | Deep cervical nodes - inferior to omohyoid along IJV

Question 32

Thyroid gland | Recurrent laryngeal nerve

Answer 32

Branch from Vagus n L = loops around lig. arteriosum of aortic arch R = loops around subclavian a Ascends in groove between trachea & oesophagus Enters larynx deep to lower margin of inferior constrictor of pharynx

Question 33

Parathyroid glands

Answer 33

2 pairs of small, yellowish, ovoid structures on deep surface of lateral lobes of thyroid Superior parathyroids Inferior parathyroids Supplied by inferior thyroid aa Venous & lymphatic drainage as for thyroid

Question 34

Applied anatomy (relating to thyroid)

Answer 34

``` Ectopic tissue along path of descent(rare) Thyroglossal cysts (presents as a midline mass, may involve anterior portion of hyoid bone, must be surgically removed) Thyroglossal fistulae Thyroidotomy (possibility of damage to parathyroids, recurrent laryngeal n, sympathetic trunk, sometimes nerves of carotid sheath) Goiter(increase exophthalmos, nail changes, decrease myxoedema) ```

Question 35

Borders of submandibular triangle

Answer 35

1. Ramus of mandible 2. Ant belly of digastric (CN V3) 3. Post belly of digastric (CN VII)

Question 36

Floor of submandibular triangle

Answer 36

1. Anterior = mylohyoid | 2. Posterior = hyoglossus (on deeper level) & small part of sup pharyngeal constrictor

Question 37

Contents of submandibular gland

Answer 37

1. Submandibular gland 2. Marginal mandibular branch of CN VII 3. Lingual n (branch of CN V3) 4. CN XII 5. Lingual v 6. Submandibular duct 7. Plexus of vvdraining to facial v 8. Lymph nodes

Question 38

Submental triangle borders

Answer 38

1. Hyoid bone 2. Anterior belly of digastric 3. Midline of neck

Question 39

Floor of submental triangle

Answer 39

1. Medial portions of mylohyoid & fibrous raphe | 2. Geniohyoid & genioglossus mm (both deep to (1))

Question 40

Submental triangle contents

Answer 40

Fat and lymph nodes