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Neck Flashcards

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1
Q

What is the common carotid artery?

A

Artery that provides the blood supply to the head and neck
Left and Right have different origins
Runs in the carotid sheath with the IJV + vagus N
Sits lateral to the pharynx

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2
Q

What is the gross anatomy of the carotid artery?

A

Runs in the carotid sheath, with the IJV laterally and vagus N between the two

IJV -> vagus N -> CCA

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3
Q

What is the origin and course of the common carotid artery?

A

Origin - Left - comes off the aortic arch. Right comes off the brachiocephalic trunk.
Courses up - behind sternocleidomastoid in the carotid sheath,
lateral to the trachea and thyroid and (superiorly) lateral to the pharynx
Splits into terminal branches ECA + ICA at the level of C3 / C4

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4
Q

What are the relations of the carotid artery?

A

runs in carotid sheath, vein, nerve, artery

anterior - sternocleidomastoid
posterior - prevertebral fascia, sympathetic ganglion, transverse process of C4-C6
medial - thyroid, trachea, pharynx
lateral - Vagus N, IJV, SCM (anterolateral)

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5
Q

What are the anatomical variants associated with the carotid artery?

A

can birfurcate earlier into ICA + ECA
bovine arch -
left CCA / left subclavian A have common origins

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6
Q

What is the external carotid artery?

A

It is a branch of the common carotid artery
Supplies the structures to the face and neck

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7
Q

Where does the external carotid artery sit?

A

90 percent of the time, the ICA will sit posteromedially to the ECA
Styloglossus and stylopharyngeus will divide the ICA and ECA

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8
Q

What is the gross anatomy of the external carotid artery?

A

It is distinguishable from the ICA as it has branches, while the ICA does not have branches. The ICA courses posteromedially.

origin of the external carotid artery is the bifurcation at C3-C4.

ascends in the neck, lateral to the larynx and pharynx

Ends as the maxillary artery, as superficial temporal artery in the parotid

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9
Q

What are the branches of the external carotid artery?

A

T - superior thyroid artery
P - ascending pharyngeal artery
L - lingual artery
F - facial artery
O - occipital artery
P - posterior auricular artery
T - superficial temporal artery
M - maxillary artery

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10
Q

What are the relations of the external carotid artery?

A

Terminal division of ECA is in the parotid gland as maxillary artery , superficial parotid artery

Medial - internal carotid artery (posteromedial), pharynx, larynx
Anterior - sternocleidomastoid
Lateral - sternocleidomastoid
Inferior - Common carotid bifurcation is at C3- C4

Styloglossus and stylopharyngeus will divide the ICA and ECA into two parts.

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11
Q

What are the common anatomical variants associated with the external carotid artery?

A

All branches of the external carotid artery can come off the common carotid.
Can have common trunks of:
- lingual and facial - linguofacial trunk
- superior thyroid and lingual artery - thyrolingual trunk
- superior thyroid and lingual and facial - thyrolingualfacial trunk
- occipital and posterior auricular - occipitoauricular trunk

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12
Q

What is the gross anatomy and function of the cervical portion of the internal carotid artery?

A
  • runs in the carotid sheath with the internal jugular vein and the vagus N
  • divided from the external carotid artery by the stylopharyngeus and styloglossus
  • Differentiate between the ICA and ECA as the ICA does not have any branches in the neck, the ICA starts more lateral and then moves posteromedial, divided from ECA by muscles of styloid process
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13
Q

What is the origin, course, and termination of the internal carotid artery?

A

Begins at the common carotid bifurcation - C3/C4.
ascends in neck lateral to pharynx

Runs in the carotid sheath, will be postero - vagus, medial - IJV both from the jugular foramen

terminates in the carotid canal in the petrous temporal bone

no branches

supplies the brain

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14
Q

What are the relations of the internal carotid artery?

A

anterior: ECA - anterolateral
sternocleidomastoid

Posterior:
sympathetic trunk
transverse processes of C4-C1

Superior:
carotid canal (for ICA)
Jugular foramen (for IJV and vagus)

Inferior:
bifurcation at C3-C4

Medial:
pharynx and larynx

Lateral:
Styloglossus and stylopharyngeus

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15
Q

What is the thyroid gland?

A

It is a midline neck gland
Single endocrine gland

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16
Q

Where does the thyroid gland sit?

A

Sits in the visceral space of the neck
Enveloped in deep cervical fascia
From C5-T1, infront of the 3 tracheal rings

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17
Q

What is the gross anatomy of the thyroid gland?

A

Is made of an superior + inferior pole
2 lobes joined by an isthmus
Parathyroid glands posterior

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18
Q

How many parathyroid glands are there?

A

4 parathyroid glands
However can be less than 3 or greater than 4
Found in different positions

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19
Q

What are the relations to the thyroid gland?

A

Anterior: strap muscles; sternohyoid, sternothyroid

Posterior: trachea, oesophagus, tracheooesophageal groove, recurrent laryngeal N, parathyroid glands

Lateral: common carotid A, internal jugular vein

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20
Q

What is the arterial supply of the thyroid gland?

A

Superior thyroid artery (First branch of the external carotid artery, with the superior laryngeal N)

Inferior thyroid artery (thyrocervical trunk, w recurrent laryngeal N)

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21
Q

What is the venous drainage of the thyroid gland?

A

Superior thyroid vein (drains to IJV)
Middle thyroid vein (drains to IJV)
Inferior thyroid vein (drains to BCV)

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22
Q

What is the lymphatic drainage of the thyroid gland?

A

first drains to perithyroid lymph nodes, then to level 6 lymph nodes

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23
Q

What is the nerve supply to the thyroid gland?

A

Superior laryngeal N - related superior thyroid A
Inferior laryngeal N - related to inferior thyroid A

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24
Q

What are the muscles/ligaments / fascia involved with the thyroid?

A

sternohyoid, sternothyroid
sternocleidomastoid
is all sheathed in deep cervical fascia

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25
What are the anatomical variants associated the thyroid?
thyroid ima pyramidal lobe thyroglossal duct cyst ectopic thyroid tissue lingual thyroid thyroid lobe hemiagenesis
26
What are the parathyroid glands?
paired endocrine glands, involved in calcium homeostasis with the thyroid gland
27
Where do the parathyroid glands sit?
In the tracheooesophageal groove In the visceral space of the neck in the tracheooesohgaeal groove posterior to the thyroid (can be intra capsular or extra capsular)
28
What is the gross anatomy of the parathyroid gland?
usually two pairs - superior pair and inferior pair bean shaped variation in terms of location, from carotid bifurcation down to anterior mediastinum - BUT USUALLY SIT posterior to thyroid in the tracheooesphageal groove
29
What are the relations to the parathyroid gland?
Anterior - trachea, thyroid Posterior - oesphagus superior - cricopharyngeus, inferior constrictor inferior - anterior mediastinum, cervical oesophagus Medial - tracheooesophageal groove (with recurrent laryngeal N and paratracheal lymph nodes) Lateral - common carotid artery
30
What is the arterial supply of the parathyroid artery?
Superior thyroid artery (for superior pair) - comes off external carotid artery Inferior thyroid artery (for inferior pair) - thyrocervical trunk
31
What is the venous drainage of the parathyroid gland?
Superior / middle / inferior thyroid veins
32
What is the lymphatic drainage of the parathyroid glands?
Perithyroid veins - level 6 lymph nodes
33
What is the nerve supply of the parathyroid gland?
superior laryngeal N (with superior thyroid artery) recurrent laryngeal N (with inferior thyroid artery) - also in tracheooesophageal groove
34
What are the anatomical variants associated with the parathyroid gland?
ectopic parathyroid greater than > 4 glands Less than < 3 glands can be intracapsular vs extracapsular postition - can be from carotid bifurcation to anterior mediastinum
35
What is the sternocleidomastoid muscle?
It is responsible for dividing the neck into anterior and posterior triangles of the neck
36
What is the motion of the sternocleidomastoid?
To allow for lateral flexion + forward flexion of the neck
37
What is the gross anatomy of the sternocleidomastoid?
Has two heads which meld into one insertion Sternal head Clavicular head Between two heads of sternocleidomastoid can access the IJV Insert onto the mastoid process of the temporal bone
38
What is the nerve supply of the sternocleidomastoid?
Cranial N XI - accessory N
39
What is the action of the sternocleidomastoid?
Lateral flexion, forward flexion
40
What are the relations involved with the sternocleidomastoid?
is the anterior border of the posterior triangle is the posterior border of the anterior triangle SCM divides the internal and external jugular veins Cervical plexus comes out behind SCM
41
What are the relations involved with the sternocleidomastoid?
Anterior - external jugular vein platysma Posterior - internal jugular vein cervical plexus - transverse cervical N, greater auricular N, accessory N, dorsal scapular N Inferior - clavicle Medial - STRAP muscles, ICA/ECA/CCA, vagus N, IJV Superior - mastoid process of temporal bone, mandible
42
What is the sternocleidomastoid arterial supply?
superior thyroid artrery
43
What is the nerve supply of sternocleidomastoid?
the accessory N
44
What are the borders of the posterior triangle of the neck?
anterior border of trapezius posterior border of sternocleidomastoid middle 1/3 of clavicle
45
What is the roof of the posterior triangle?
investing fascia platysma external jugular vein spinal accessory nerve crosses obliquely
46
What is the floor of the posterior triangle?
prevertebral fascia - covers scalenus anterior, medius, posterior levator scapulae, splenius fascia forms axillary sheath subclavian artery branches of brachial plexus + cervical plexus
47
What are the contents of the posterior triangle of the neck?
Arteries - occipital, superficial cervical, suprascapular, 3rd part of the subclavian A Veins - suprascapular, external jugular, transverse cervical Nerve - branches of cervical plexus: lesser occipital N, greater auricular N, transverse nerve of neck, supraclavicular N, spinal accessory N, supraclavicular branches of the brachial plexus: dorsal scapular N, long thoracic N, nerve to subclavius Muscle - omohyoid with its sling; divides the triangle into upper and lower Lymph nodes - occipital nodes, supraclavicular nodes
48
What is the oesophagus?
Muscular tube from oropharynx down to the stomach Function is to propel food bolus down via peristalsis to stomach
49
What are the parts of the oesophagus?
Cervical - from cricopharygngeus C6 to superior thoracic aperture T1 Thoracic - superior thoracic aperture T1 to oesophageal hiatus in diagphram T10 Abdominal - from oesophageal hiatus of diagphram to GOJ
50
What are the narrowings of the oesophagus?
cricopharyngeus (C6) Arch of Aorta at T3 + left main bronchus at T4 Oesophageal hiatus of diagphram at T10
51
What is the course of the oesophagus?
Continuous with oropharynx + cricopharyngeus Courses through the posterior mediastinum Through oesophageal hiatus, Blends with cardia / GOJ of stomach
52
What is the arterial supply of the oesophagus?
Cervical - inferior thyroid artery Thoracic - oesophageal branches of aorta Abdominal - left gastric artery (oesophageal branches)
53
What is the venous drainage of oesophagus?
Cervical - inferior thyroid vein (to brachiocephalic vein) thoracic - to azygos vein abdominal - left gastric vein (to portal vein)
54
What is the lymphatic drainage of the oesophagus?
Cervical - To deep cervical chain Thoracic - to posterior mediastinal nodes Abdominal - to left gastric + coeliac nodes
55
What is the nerve supply of the oesophagus?
upper 1/3 - recurrent laryngeal N lower 2/3 - oesophageal plexus (from vagus N) Left vagus becomes anterior vagal plexus Right vagus becomes posterior vagal plexus
56
What are the muscles involved with the oesophagus?
the diagphramatic crus - left and right
57
What is the anatomical variation associated with the oesophagus?
oesophageal atresia oesophageal bronchus abberant right subclavian artery
58
What is the nasopharynx?
Area posterior to the choanae But before lower limit of soft palate Links the nasal cavity to the oropharynx
59
What is the gross anatomy / boundaries of the nasopharynx?
Anterior: Nasopharynx Posterior: adenoids pharyngeal constrictor longus capiitis/collis, clivus of occiput, C1/C2 Lateral: torous tubarius (cartilaginous top of eustachian tube) tensor veli palatini lateral pharyngeal recess parapharyngeal space Superior: sphenoid sinus Inferior: soft palate oropharynx
60
What are the contents of the nasopharynx?
Adenoid Torus tubarius lateral pharyngeal recess
61
What are the relations of the nasopharynx?
Laterally - parapharyngeal space Eustachian tube - torus tubarius opens in the lateral nasopharynx
62
What is the arterial supply of the nasopharynx?
Pharyngeal A Sphenopalatine A Greater palatine A (from maxillary)
63
What is the venous drainage of the nasopharynx?
ptyergoid venous plexus
64
What is the lymphatic drainage of the nasopharynx?
The adenoids (part of waldyers ring) Drains to level 2 nodes
65
What is the nerve supply of the nasopharynx?
The nasopharynx is innervated by the pharyngeal plexus except for tensor veli palatini (CN V)
66
What are the muscles / ligaments / fascia involved with the nasopharynx?
tensor veli palatini Levator veli palatini - both accompany eustachian tube - tensor anterior, levator posterior Both will raise the soft palate during swallowing, stopping reflux of food in the nose
67
What is the larynx?
The entrance to the airway Protects the airway and produces voice
68
What is the gross anatomy of the larynx?
1 bone 4 cartilages Hyoid bone - U shaped, greater cornu, lesser cornu, joined to thyroid by cricothyroid membrane
69
What is the gross anatomy of the epiglottis?
epiglottis leaf shaped divided into suprahyoid and infrahyoid
70
What is the gross anatomy of the thyroid cartilage?
thyroid cartilage shield shaped 2 lamina - each lamina has a superior horn / cornu and inferior horn/ cornu oblique attachment - (this is where muscles attach), cricothyroid ligament joins the cricoid and thyroid anteriorly *it is the aim in emergency tracheostomy
71
What is the gross anatomy of the arytenoid cartilage?
pyramid shaped attachment of vocal ligament
72
What are the key sinuses / recesses of the larynx?
Vallecula - between the epiglottis and hyoid bone Vestibular fold Ventricle / sinus of larynx (between vestibule and true vocal fold) piriform sinus - either side of laryngeal recess
73
What is the course of the larynx?
Continuous superiorly with oropharynx, and inferiorly with trachea
74
What are the relations of the larynx?
Anterior - thyroid gland Lateral - great vessels of the neck, CCA/ICA/ECA, IJV Posterior - pharynx/oesophagus, tracheooesophageal groove (RLN, PT, LN)
75
What is the arterial supply of the larynx?
Superior thyroid A - superior laryngeal A (with superior laryngeal N) Inferior thyroid A - inferior laryngeal A (with recurrent laryngeal N)
76
What is the venous drainage of the larynx?
Superior laryngeal vein - drains to superior thyroid vein Inferior laryngeal vein - drains to inferior thyroid vein
77
What is the lymphatic drainage of the larynx?
level 6 lymph nodes
78
What is the nerve supply of the larynx?
Superior laryngeal N + Recurrent laryngeal N - both come off vagus N
79
What does the superior laryngeal N supply in the larynx?
Sensory - all sensation above the vocal cords (internal branch of superior laryngeal N) Motor - cricothyroid only (external branch of superior laryngeal N)
80
What does the recurrent laryngeal N supply in the larynx?
Sensory - sensation below the vocal cords Motor - all intrinsic muscles of the larynx except cricothyroid Including the posterior cricoarytenoid - which is the adductor of the vocal cords
81
What are the muscles / ligaments / fascia involved with the larynx?
vocal ligaments - true cords vestibular folds - false cords
82
What is the most key muscle of the larynx?
posterior cricoarytenoid This is a key muscle in the larynx Adductor of the vocal folds If it gets damaged during neck surgery e.g. thyroidectomy bilaterally - bad!
83
What is the anatomical variant associated with the larynx?
laryngomalacia - immature cartilage which collapses with inspiration, causing stridor
84
What is the mucosa of the larynx?
pseudostratified ciliated columnar Mucus glands in the sinus
85
What is the lymphatic drainage of the larynx?
above cords: upper deep cervical nodes below cords: lower deep cervical nodes
86
What are the pharyngeal constrictor muscles?
They are muscle slings which are superior and continuous with the oesophagus Function is to deliver a food bolus to the oesophagus
87
What is the gross anatomy of the pharyngeal constrictor muscles?
3 slings - designed to interdigitate with the next
88
What is the origin and insertion of the superior pharyngeal constrictor?
origin: ptyergoid hamulus ptyergomandibular raphe insertion: pharyngeal raphe middle constrictor
89
What is the origin and insertion of the middle pharyngeal constrictor?
origin: greater cornu of hyoid stylohyoid ligament insertion: pharyngeal raphe + inferior constrictor
90
What is the origin and insertion of the inferior pharyngeal constrictor?
origin: oblique line of thyroid, cricoid (fibrous arch) insertion: pharyngeal raphe cricopharyngeus
91
What is the course of the pharyngeal constrictor muscles?
Continuous with the oropharynx superiorly Continuous with cricopharyngeus and oesophagus inferiorly
92
What are the relations of the pharyngeal constrictor muscles?
anterior - nasopharynx, oropharynx, laryngopharynx posterior - retropharyngeal fascia, prevertebral space lateral - CCA, ICA, ECA, vagus, IJV in carotid sheath
93
What is the arterial supply of the pharyngeal constrictor muscles?
ascending pharyngeal A (comes off the ECA)
94
What is the venous drainage of the pharyngeal constrictor muscles?
drain to superior, middle and thyroid veins and eventually to IJV
95
What is the lymphatic drainage to the pharyngeal constrictor muscles?
deep cervical -> drain to level 3 + 4 nodes
96
What is the nerve supply to the pharyngeal constrictor muscles?
vagus / pharyngeal plexus superior laryngeal nerve - external branch
97
What is the muscles / ligaments / fascia involved with the pharyngeal constrictor muscles?
posterior pharyngeal raphe has contributions from all the constrictor muscles
98
What is the vagus N?
It is the 10th cranial N. Is responsible for the parasympathetic supply of the body
99
What is the function of the vagus N?
Responsible for parasympathetic supply to GIT + heart Motor + Sensory supply to pharynx (pharyngeal constrictors) + larynx (RLN, SLN)
100
Where does the vagus nerve sit?
In the posterolateral medulla -> perimedullar cistern-> jugular foramen -> carotid sheath -> posterior mediastinum -> oesophageal hiatus -> anterior + posterior vagal plexus
101
What is the origin, course and termination of the vagus N?
Origin: medulla (posterolateral medulla) Though premedullar cistern / pre pontine cistern jugular foramen (with internal jugular vein) In carotid sheath - ICA medial, IJV lateral - anterior scalene is posterior Anterior to subclavian A - left vagus goes lateral to aortic arch and gives off RLN which hooks under - right vagus goes anterior to right subclavian and gives off RLN which hooks under - Both then travel to midline, and course posterior to lung hilum - Wraps around esophagus -travels through oesophageal hiatus (with left gastric A+V) - terminate as anterior + posterior vagal trunk
102
What does the vagus N supply?
larynx pharynx oesophagus GIT parasympathetics
103
What are the branches of the vagus N?
Superior laryngeal N - sensation above vocal folds - only supplies cricothyroid, sup-mid-inf constrictors Recurrent laryngeal N - sensation below vocal folds - all muscles of the larynx except cricothyroid
104
What are the core relations of the vagus N?
In the head - runs through the jugular foramen with internal jugular vein In carotid sheath - runs with internal carotid artery + internal jugular vein In the neck, carotid sheath - runs anterior to anterior scalene In superior thoracic aperture - - Right goes anterior to R subclavian A - Right RLN will hook under R subclavian A to enter tracheooesophageal groove - left goes lateral to aortic arch - left RLN hooks under aortic arch, lateral to ligamentum arteriosum, and enters tracheooesophageal groove Mediastinum will be posterior to pulmonary hilum - phrenic N is the N which runs anterior to lung hilum At oesophageal hiatus, vagal trunks travel through T10 with LEFT GASTRIC A + VEIN Left vagus - anterior trunk, Right vagus - posterior trunk
105
What is the phrenic nerve?
It is the motor and sensory supply to the diagphram
106
What is the origin, course and termination of the phrenic N?
Origin: C3, C4, C5 Course: descends on anterior scalene, all relations of left phrenic are arterial, right phrenic are venous Terminates - left pierces the hemidiapghram independently RIGHT PHRENIC TRAVELS THROUGH VENA CAVAL FORAMEN AT T8
107
What are the relations of the left phrenic N?
anterior to subclavian A lateral to aortic arch lateral to left auricle anterior to lung hilum lateral to left ventricle pierces dome of left diagphram (through entire course, runs with pericardiophrenic A + V)
108
What are the relations of the right phrenic N?
posterior to subclavian V lateral to superior vena cava lateral to right atrium anterior to lung hilum lateral to right ventricle passes through vena caval foramen of diaphgram at T8 (through entire course runs with pericardiophrenic A + V)
109
What does the phrenic N supply?
The diaphragm - motor function and sensory function Mediastinal pleura Pericardium
110
Where are the level 1 lymph nodes of the neck?
Under mylohyoid: submental (1A) + submandibular (1B)
111
What are the level 2 lymph nodes of the neck?
internal jugular chain - deep cervical adjacent to posterior belly of digastric / upper 1/3 of sternocleidomastoid
112
What are the level 3 lymph nodes of the neck?
internal jugular chain related to middle 1/3 of sternocleidomastoid
113
What / where are the level 4 lymph nodes of the neck?
internal jugular chain related to lower 1/3 of sternocleidomastoid
114
Where / what are the level 5 lymph nodes of the neck?
Posterior triangle / spinal accessory nodes Runs with spinal accessory N 5A (upper) + 5B (lower)
115
What / where are the level 6 lymph nodes of the neck?
pre tracheal lymph nodes delphian node
116
What / where is the level 7 lymph nodes of the neck?
Superior mediastinal nodes Adjacent to the carotid arteries
117
What are the additional lymph nodes involved in the spaces of the neck?
Parotid lymph nodes (in the parotid space) Retropharyngeal lymph nodes (in retropharyngeal space, above hyoid) Supraclavicular lymph node (final common channel of lymphatic pathway) Contains virchows node on the left side
118
What are the boundaries of the anterior triangle?
anterior border of the sternocleidomastoid Midline
119
What are the subdivisions in the anterior triangle?
Carotid =============== Posterior belly of digastric Superior belly of omohyoid Anterior border of sternomastoid Roof is skin - superficial fascia Floor is pretracheal fascia (over larynx + pharynx) Deep to posterior digastric belly / submandibular / submental / muscular
120
What are the contents of the anterior triangle?
Carotid sheath Common internal/ external carotid sinus Internal jugular vein / upper and deep nodes Vagus N External laryngeal N Recurrent laryngeal N Accessory N Ansa cervicalis Sympathetic trunk
121
What are the contents of the anterior triangle deep to the posterior belly of digastric?
Deep to digastric posterior belly - large NV bundle which runs between head + neck - Structures include - carotid sheath, internal + external carotid arteries, ascending pharyngeal artery, internal jugular vein Nerves - vagus N - superior layrngeal N - accessory N - hypoglossal N - sympathetic trunk
122
What are the boundaries in the submandibular triangle?
Contained within the anterior triangle of the neck Boundaries: Lower border of mandible anterior border of digastric posterior border of digastric floor - styloglossus, omohyoid
123
What are the contents of the submandibular triangle?
superficial part of submandibular gland facial vessels submandibular lymph node hypoglossal N N to mylohyoid
124
What are the boundaries of the submental triangle?
Located in the anterior triangle of the neck Boundaries Midline - body of hyoid bone Anterior belly of digastric Floor is mylohyoid Roof is skin, superficial fascia
125
What are the contents of the submental triangle?
submental lymph nodes anterior jugular vein origins
126
What are the boundaries of the muscular triangle?
Located within the anterior triangle Boundaries: C6 level midline Roof is skin/ fascia Superior belly omohyoid Floor is larynx
127
What is contained in the muscular triangle?
infrahyoid muscles
128

Abdomen (8 decks)

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