Neck and Prevertebral

Question 1

neck is divided into _____ and _____ cervical triangles

-these triangles have several ____

Answer 1

anterior and posterior

subtriangles

Question 2

what is the division between the anterior and posterior cervical triangle

Answer 2

sternocleidomastoid

• anterior boundary of the posterior triangle
• posterior boundary of anterior triangle

Question 3

posterior cervical triangle boundaries

Answer 3

anterior
-posterior border of SCM
posterior
-anterior border of trapezius
inferior
-middle 1/3 of clavicle
apex
-insertion of SCM and trapezius on the superior nuchal line
roof
-deep fascia overlying platysma muscle
floor
-prevertebral fascia overlying several muscles

Question 4

which muscles form the floor of the posterior cervical triangle

Answer 4

splenius capitis
levator scapulae
posterior scalene
middle scalene
anterior scalene

Question 5

posterior cervical triangle subdivisions

-division marked by…

Answer 5

subdivisions
-occipital triangle
-supraclavicular triangle
division
-marked by inferior belly of omohyoid muscle as it crosses inferior ends of posterior and middle scalenes

Question 6

occipital triangle

-contains…

Answer 6

occipital artery (near apex)
-branch of external carotid artery
spinal accessory nerve as it crosses muscles of the floor of the posterior triangle between trapezius and SCM
subclavian artery and vein

Question 7

what arteries cross the posterior triangle

Answer 7

transverse cervical

suprascapular artery

Question 8

external jugular vein

• where is it located in the posterior triangle
• what does it empty into?

Answer 8

lies in the superficial fascia of the roof of the posterior triangle until it approaches the base
near the base it goes through the deep fascia to empty into the subclavian vein deep to the SCM

Question 9

what nerves are located in the posterior triangle

Answer 9

ventral rami of brachial plexus

branches of the cervical plexus of nerves (ventral rami of C1-C4)

Question 10

nerves of the cervical plexus

Answer 10

lesser occipital
great auricular
transverse cervical
supraclavicular nerves
phrenic

Question 11

lesser occipital nerve

• segments
• function

Answer 11

C2

supplies skin of neck and scalp posterior to ear

Question 12

great auricular nerve

• segments
• function

Answer 12

C2, C3

supplies skin of neck and part of ear

Question 13

transverse cervical nerve

• segments
• function

Answer 13

C2, C3

skin over anterior triangle of neck

Question 14

supraclavicular nerves

• segments
• function

Answer 14

C3, C4

skin of the chest over the clavicle and to SC and AC joints

Question 15

phrenic nerve

• segments
• function
• identified…

Answer 15

C3-C5
enters thorax to innervate diaphragm
identified lying on anterior scalene

Question 16

anterior cervical triangle (oriented upside down with respect to its base)
-boundaries

Answer 16

medial
-anterior median line of neck
lateral
-anterior border of SCM
base
-inferior border of mandible
apex
-jugular (suprasternal) notch of sternum
floor
-next slide
roof
-platysma and fascia

Question 17

what forms the floor of the anterior cervical triangle

Answer 17

pharynx
larynx
thyroid gland
deep to these
-prevertebral fascia covering the prevertebral muscles of the neck
–continuous with deep cervical fascia covering muscular floor of the posterior cervical traingle

Question 18

anterior triangle subdivisions

-how are these divisions defined?

Answer 18

divisions
-submandibular
-submental
-carotid
-muscular
how
-relation to omohyoid and digastric muscles

Question 19

submandibular triangle

• location
• floor formed by…
• contains

Answer 19

location
-between inferior border of mandible and anterior and posterior bellies of digastric muscle
floor
-mylohyoid
-hyoglossus
-middle constrictor
contains
-submandibular gland
-hypoglossal nerve (CN XII)

Question 20

carotid triangle

• boundaries
• contains

Answer 20

boundaries
-superior belly of omohyoid
-posterior belly of digastric
-anterior border of SCM
contains
-common carotid artery and branches
-internal jugular vein
-vagus nerve (CN X)
-hypoglossal nerve (CN XII)
-ansa cervicalis

Question 21

vessels and vagus nerve in carotid triangle enclosed by…

Answer 21

fascial sheath, called the carotid sheath, from the base of the skull to the root of the neck

Question 22

ansa cervicalis

• innervation segments
• location

Answer 22

C1-C3

draped over carotid sheath

Question 23

what lies behind the carotid sheath on the surface of the prevertebral muscles

• what does this contain
• function

Answer 23

sympathetic chain
contains
-axons from T1-L2 region of spinal cord and travel throughout body
at this point, this nerve plexus is supplying sympathetic innervation to the head and neck

Question 24

muscular triangle

• boundaries
• contains

Answer 24

boundaries
-superior belly of omohyoid
-anterior border of SCM
-midsagittal plane of neck
contains
-infrahyoid muscles
-thyroid gland
-parathyroid gland

Question 25

submental triangle | -"unpaired" suprahyoid region boundaries

Answer 25

suprahyoid region boundaries - inferiorly: hyoid bone - laterally: anterior bellies of right and left digastrics - floor: mylohyoid

Question 26

torticollis - what is it - result is...

Answer 26

injury to SCM or irritation of spinal accessory nerve result -constant contracture of SCM -consequent flexion of neck to same side and turning to the opposite side

Question 27

traumatic injury to the spinal accessory nerve - where is it most likely to occur - results in

Answer 27

as it crosses posterior triangle results in -slumped shoulder -inability to fully rotate scapula superiorly

Question 28

inability to fully rotate scapula superiorly | -can be seen as...

Answer 28

inability to "abduct" the arm above the horizontal against resistance

Question 29

if you had a traumatic injury to the spinal accessory nerve that prevents inability to fully rotate the scapula superiorly, you could still have true abduction of the GH joint - why - what would be lacking during the movement?

Answer 29

scapulohumeral rhythm allows for true abduction | would occur without complete scapular rotation (serratus anterior can perform some of the upward rotation)

Question 30

why isn't SCM affected when the spinal accessory nerve is injured?

Answer 30

innervated first before the nerve crosses the posterior triangle

Question 31

longus colli - can be divided into... - appearance based on orientation - arrangement explains...

Answer 31

can be divided into -superior (upper) oblique -inferior (lower) oblique -vertical parts orientation assumes somewhat of a diamond appearance overlying the bodies of the cervical vertebrae 3-part arrangement explains differing actions

Question 32

longus colli action | -action is opposed by action of...

Answer 32

longissimus cervicic (cervical component of middle erector spinae muscle)

Question 33

rectus capitis lateralis action | -why is it questionable?

Answer 33

thought to laterally flex AO joint -action allowed at this joint is primarily flexion-extension muscle may be homologous to posterior intertransversarii -provides lateral stability of AO joint

Question 34

prevertebral muscles - what are they - covered by...

Answer 34

``` muscles -longus colli (longus cervicis) -longus capatis -rectus capitis anterior -rectus capitis lateralis covered by prevertebral fascia ```

Question 35

prevertebral fascia - continues laterally to... - infections that are located within this area can reach _____ via ______

Answer 35

continues laterally to cover muscles forming floor of posterior cervical triangle infections can reach thoracic cavity via the superior thoracic aperture

Question 36

cervical vertebrae | -unique characteristics

Answer 36

transverse foramen for passage of the vertebral artery (may be diminished or absent in C7 bifid spinous process; C1 only has a posterior arch spinous process of C7 - vertebra prominens C1 has no body, only an anterior arch C2 has the odontoid process (dens); developmentally formed from the body of C1

Question 37

craniovertebral joints | -names

Answer 37

atlanto-occipital joint | atlanto-axial joint

Question 38

atlanto-occipital joint - primary movement allowed - type of joint - how is atlas fixed to base of skull

Answer 38

flexion-extension condylar synovial joint atlas fixed to base of skull by -anterior and posterior atlanto-occipital membranes

Question 39

anterior and posterior atlanto-occipital membranes | -attachment sites

Answer 39

come off outside surfaces of anterior and posterior arches of C1 attach to foramen magnum

Question 40

tectorial membrane - continuation of... - attaches...

Answer 40

continuation of posterior longitudinal ligament | attaches to inside of foramen magnum

Question 41

Atlanto-axial joint | -fixed by...

Answer 41

series of ligaments that are attached to the dens

Question 42

transverse ligament of atlas (AA joint) - what part of the arch? - encompasses the...

Answer 42

anterior part of arch | encompasses the dens

Question 43

superior and inferior branch of cruciform ligament (AA joint) - orientation in relation to transverse ligament of atlas - where do they insert?

Answer 43

``` run longitudinally across it inferior -base of dens superior -occipital bone ```

Question 44

alar ligaments (paired) - origin - where do they travel? - function

Answer 44

origin -tip of dens extend superolaterally to foramen magnum check side-to-side movement of occiput on atlas

Question 45

altanto-axial joint | -function

Answer 45

allows rotation of skull and C1 as a unit

Question 46

what type of joint is the articular surface of the dens against the anterior arch of C1?

Answer 46

synovial joint, pivot type

Question 47

visceral components of the neck - lie anterior to... - what are the structures? - all structures pass through...

Answer 47

``` anterior to prevertebral muscles structures -trachea -esophagus -carotid sheath -sympathetic chain and ganglia all pass through superior thoracic aperture ```