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MRCS Anatomy COPY > Neck > Flashcards

Neck Flashcards

1
Q

Boundaries of the anterior triangle of the neck

A

Superior border = Inferior part of mandible

Medial border = Saggital midline of the neck

Laterall border = Anterior border of SCM

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2
Q

Name the four further subdivision triangles of the anterior triangle

A

Carotid

Muscular

Submandibular

Submental

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3
Q

Describe borders of carotid triangle and contents

A

Superiorly = Digastric muscle

Medially = Omohyoid

Laterally = SCM

Contents = Has the common carotid which bifuricates here into internal + externals

-Also internal jugular, hypoglossal and vagus nerve

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4
Q

Borders and contents of submental triangle

A

Under the chin

Inferiorly = hyoid

Laterally = Digastric

Medially = Midline

Contents = Lymph nodes

Floor = Mylohyoid muscle

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5
Q

Borders and contents of submandibular triangle

A

Below the mandible

Superior = Mandible

Medial = Anterior belly of digastric

Lateral = Posterior belly of digastric (digastric has two parts)

Contents = The submandibular gland + Facial artery and vein

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6
Q

Borders and contents of muscular triange

A

Most inferior anterior triangle

Medially = Midline

Supero laterally = Omohyoid

Infero laterally = SCM

Superiorly = Hyoid

Contents = Infrahyoid muscles, pharynx, thyroid, gland parathyroid glands

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7
Q

Borders of the posterior triangle

A

Medially = SCM

Laterally = Trapezius

Infeior = Middle 1/3 of clavicle

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8
Q

Subdivisions of the posterior triange

A

Split in 2 by the omohyoid muscle that runs horizontally

Occipital triangle on top

Subclavian triangle at bottom = Has the distal portion of the subclavian artery

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9
Q

Contents of the posterior triangle

A

Muscles = Omohyoid, levaetor scapulae, scalene muscles, Splenius capitis

Vessels = External jugular crosses the SCM and enters the top of the posterior triangle, it travels down and drains into the subclavian vein below.

Nerves = CN11 innervates SCM and passes through post triange, phrenic nerve, and also top part of brachial plexus, accessory nerve

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10
Q

Motor innervation of pharynx muscles

A

All motor is provide by the vagus

EXCEPT = stylopharyngeus which is innervaated by glossopharyngeal CN9

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11
Q

Innervation of larynx (motor + sensation)

A

Everything is done by different branches of the vagus nerve

Recurrently laryngeal = Sensation to infraglottis

-Motor to all internal muscles of larynx EXCEPT cricothyroid (REMEMBER intrinsic muscles are a differenet annoying group from the other supra/infra hyoid ones you know)

Superior laryngeal = Sensation to supraglottis

-Motor only to cricothyroid

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12
Q

General anatomy of the cartialge and membranes in the thyroid/cricoid

A

Hyoid bone at top

Thyrohyoid membrane

Thyroid cartilage

Cricothyroid ligament

Cricoid cartilage

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13
Q

What is cut in cricothyrodotomy (airway)

A

The cricothyroid cartialge = Below thyroic artialge, above the cricoid

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14
Q

Describe the laryngeal muscles

A

Divided up into supra and infra hydoid

Supra = Elevates the hyoid. Infra = Depresses the hyoid

Suprahyoid = Digastric, Mylohyoid, Stylohyoid, Geniohyoid

Infrahyoid = Thyrohyoid, Sternohyoid, Omohyoid, Sternothyroid (THESE ARE ALL NAMED AFTER CRICOID/THYROID CARTILAGES)

NEXT PAGE HAS INFRAHYOID MUSCLE PICTURES

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15
Q

Name the infrahyoid muscles

A

See diagram

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16
Q

Name the vasculature of the thyroid gland

A

Superior thyroid artery = First branch of external carotid

Inferior thyroid artery = Actually a branch of subclavian artery

Superior + Middle thyroid veins = Into internal jugular

Inferior thyroid vein = Into brachiocephalic vein

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17
Q

Brances of the external carotid in order

A

Some angry lady figured out PMS

Superior thyroid

Ascending pharyngeal

Lingual

Facial

Occipital

Posterior auricular

Maxillary

Superficial temporal

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18
Q

What does the tensor tympani do and what innervates it

A

Similar to stapedius to dampen noise

BUT it is innervated by trigeminal nerve

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19
Q

Nerve+vessel that can be damaged in submandibular gland surgery

A

Lingual nerve = Sensation to anterior 2/3 of tongue (branch of V3)

Can also damange marginal mandibular (branch of facial nerve)

And hypoglossal nerve (would cause weakness)

Can damage the facial artery, and also the lingual artery if operating deeper such as when mobilising the whartons duct

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20
Q

Vertebral level and structure that common carotid bifuricates, and the course

A

C4 = Bifurification

Course = Passes behind sternoclavicular joints to upper border of thyroid cartilage

Divides here into external + internal

DIVIDES at upper thyroid cartiage

Remember Hypoid = C3

Cricoid = C6

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21
Q

What is contained in Waldeyer’s ring

A

The various tonsils

Pharyngeal tonsil

Tubal tonsils (x2)

Palatine tonsils (x2)

Lingual tonsil

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22
Q

Vessel most likely to be damaged in tonsillectomy

A

External palatine vein = Immediately lateral to the tonsils

23
Q

Blood supply tonsils

A

Tonsillar artery a branch of the facial artery

24
Q

Lymphatic drainage of the larynx

A

Supraglottic = To upper cervical nodes

Glottic (the vocal cords) = No lymphatic drainage

Subglottic = Pre-laryngeal, pre-tracheal, and inferior deep cervical nodes

25
Q

What sort of laryngeal cancer will not metastasise to cervical lymph nodes

A

Glottic/Cancers at the vocal cords = As these have no lymphatic drainage

26
Q

name all the layers of the neck fascia

A

Superficial cervical fascia

(from here below all the layers make up the deep cervical fascia)

Investing layer

Pretracheal layer

Prevertebral layer

Carotid sheath

27
Q

What makes up the sueprficial cervical fascia

A

Contents = Superficial lymph nodes, cutaneous nerves, fat, superficial veins including the external jugular

It also contains the Platysma muscle

Innervated by the facial nerve

28
Q

Describe the investing layer of neck fascia

A

This is the most sueprficial layer of the deep cervical fascia

Sorrounds all the structures in the neck

It spilts to engulf and sorround both the SCM and trapezius muscles

29
Q

Describe the prevertebral fascial layer in the neck including what it contains

A

Contents = Sorrounds the vertebral column and associated muscles, scalene muscles, prevertebral muscles, deep muscles of the back

Posterior portion = Also sorrounds brachial plexus

30
Q

Describe the pretracheal fascial layer in the neck

A

Only in the anterior neck

Runs from the hyoid bone above, down to the thorax where it fuses with pericardium

Contents = Trachea, oesophagus, thyroid gland, infrahyoid gland

31
Q

Describe the carotid sheath fascial layer of the neck including what it contains

A

Contents = Common carotids, Internal jugular veins, Vagus nerves, Cervical lymph nodes

Carotid sheath = Actually formed from fascial contributions of each of the other fascial layers

32
Q

What is the innervation of the digastric muscle

A

Anterior belly = V3 via mylohyoid

Posterior belly = Facial nerve (can remember as the facial nerve is more posterior in the parotid gland)

33
Q

What is the ansa cervicalis, where is it, and what does it innervate

A

A loop of nerves that are part of the cervical plexus

Location = Just anterior of the carotid sheath adjacent to the carotid artery

Therefore may be exposed by division of the pretracheal fascia (anterior)

Innervation = All the infraglottic extrinsic muscles + geniohyoid (supraglottic)

34
Q

What is the innervation of the supraglottic extrinsic laryngeal muscles

A

Digastric anterior belly = V3

Digastric posterior belly = Facial nerve

Stylohyoid = Facial nerve

Mylohyoid = V3

Geniohyoid = C1 (ansa cervicalis)

35
Q

Innervation of the infraglottic extrinsic laryngeal muscles

A

Sternothyroid = Ansa cervicalis

Sternohyoid = Ansa cervicalis

Thyrohyoid = C1

Omohyoid = Ansa cervicalis

36
Q

Describe the pharyngeal arches/clefts/pouches

A

Clefts = There are initially 4 = Only the 1st one gives rise to something, the external auditory meatus

Arches = There are 6 initially. 5th one regresses early.

  • Each one innervated by a cranial nerve
  • Also each part has a vascular, muscular, skeletal, cartilaginous component also
  • Each arch is associated with a specific structure in the head/neck

Puches = There are 5, but only 4 give rise to structures

37
Q

Describe the cranial nerve and structure associated with each pharyngeal arch

A

First = Has two parts that forms the future maxilla + manidible = Trigeminal nerve

Second = Internal carotid + styloid process = Facial nerve

Third = Common carotid = Glossopharyngeal

NOTE THE CRANIAL NERVES GO IN TWOS ABOVE THEN AORTIC, THEN PA

Fourth = Proximal subclavian and aortic arch = Superior laryngeal branch of vagus

Fifth = Regresses early

Sixth = Proximal pulm arteries + ductus arteriosus = Recurrent laryngeal branch of vagus

38
Q

Describe what each pharyngeal pouch forms

A

First = Eustachian tube + Middle ear

Second = Lining of palatine tonsils

Third = Inferior parathyroid glands + Thyroid

Fourth = Superior parathyroid glands and C cells

(NOTE the third and fourth seem like they are switched by parathyroids)

39
Q

What nerve may be damaged in thyroid surgery

A

Recurrent laryngeal = In 1-2% of cases

The nerve passes close to the bifurification of the right inferior thyroid artery (from subclavian)

40
Q

What nerve runs posterior to the medial aspect of the first rib

A

Phrenic nerve

Above this is lies on scaleneus anterior

41
Q

Anatomical relations of the scalene muscles

A

Remember there are 3 scalene muscles = Ant, Mid, Post

Brachial plexus + Subclavian artery = Pass between anterior and middle scalene

Subclavian vein + Phrenic nerve = Anterior to anterior scalene

42
Q

vertebral level of the hyoid bone

Notch of thyroid cartilage

Cricoid cartilage termination (end)

A

C3

C4

C6

43
Q

You are doing a thyroid surgery and need better access

You need to divide the ifnrahyoid strap muscles

Where will you divide them and why

A

Divide them in the upper half

This is because the ansa cervicalis enters in the lower half

44
Q

Nerves most at risk in carotid endarterectomy

A

Hypoglossal

Greater auricular nerve

Superior laryngeal nerve

45
Q

Most superficial structures encountered in submandibular gland surgery

A

Facial vein + submandibular lymph nodes first

Deeper = Lingual nerve around Wharton’s duct, Maringal mandibular branch of facial nerve

46
Q
A
47
Q

Bleeding during trachestomy, which vessels

A

Likely to be the:

Anterior jugular veins draining into external jugular

Inferior thyroid veins (Draining into brachiocephalic)

48
Q

When doing thyroiectomy

What structures lie adjacent to inferior and superior thyroid arteries

A

Superior thyoid artery = Superior laryngeal

Inferior thyroid artery = Recurrent laryngeal

SO WATCH OUT FOR THESE WHEN LIGATING

NOTE = they are paired, superior and inferiorly

49
Q

Best method to find location of parathyroid glands

A

Surgical bilateral neck exploration

Actually this is best way, more then MRI/or USS currently

50
Q

If recurrently laryngeal is paralysed where will vocal cord be on laryngoscopy

A

Will be in the ‘paralysed’ position

Slightly lateral from midline and it will not move on phonation.

51
Q
A
52
Q

What is carotid sinus nerve and what nerve does it form part of

Where does it also travel to

A

Nerve that innervates carotid sinus

Part of the glossopharyngeal nerve CN9

Goes through the tractus solitaris to the vasomotor centre in brainstem

53
Q

Arterial and venous supply of parathyroid glands

A

Arterial = mainly inferior thyroid artery (off the throcervical of subclavian)

Venous = Sup, mid, inf thyroid veins

Sup + mid thyroid vein = IJV

Inf thyroid vein = Brachiocephalic

MRCS Anatomy COPY (10 decks)

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