Neck: Area Under the SCM

Question 1

contents of carotid sheath

Answer 1

common and internal carotid arteries
internal jugular vein
vagus nerve
ansa cervicalis
deep cervical lymph nodes

Question 2

relationships in carotid sheath

Answer 2

artery - medial and anterior
vein - lateral and posterior
vagus - posterior groove between vessels

Question 3

ansa cervicalis location

Answer 3

lateral to arteries

crosses internal jugular vein anteriorly and courses superiorly and medial on its surface

Question 4

common carotid artery

Answer 4

left side longer than right

• right from brachiocephalic split
• left from arch of aorta

Question 5

bifurcation of common carotid artery

Answer 5

level of CV3

Question 6

carotid sinus

Answer 6

dilated distal common carotid and proximal internal carotid artery

pressure receptor

increased pressure, decreased HR

Question 7

carotid body

Answer 7

at carotid bifurcation
chemoreceptor
decreased O2 - increased rate and depth of breathing

Question 8

afferents from carotid body and sinus

Answer 8

carotid sinus nerve (CN IX)

Question 9

internal carotid artery

Answer 9

enters carotid canal

• no branches prior to entering canal
• supplies orbit and brain

Question 10

external carotid artery

Answer 10

not in sheath
branches in carotid triangle
-has lots of branches

Question 11

surgery in carotid triangle

Answer 11

access to carotid bifurcation, internal jugular vein, vagus/hypoglossal nerves, sympathetic trunk

can affect voice - vagus and recurrent laryngeal nn.

Question 12

carotid endarterectomy

Answer 12

often at bifurcation

access via carotid triangle

Question 13

superior thyroid artery

Answer 13

1st branch external carotid artery

Question 14

branches of superior thyroid artery

Answer 14

superior laryngeal artery - pierces thyrohyoid membrane with internal laryngea nerve to interior of larynx

anterior branch - to gland - anastomose with opposite counterpart

posterior branch - posterior gland - anastomose with inferior thyroid artery

Question 15

ascending pharyngeal artery

Answer 15

arises medially off of external carotid artery
-close to bifurcation

courses straight to base of skull

Question 16

lingual artery

Answer 16

branch of external carotid artery

deep to posterior border of hypoglossus muscle to enter tongue

Question 17

facial artery

Answer 17

branch of external carotid artery - either common trunk or just above lingual artery branch

courses to deep surface of submandibular gland
goes around mandible and comes around anterior edge of masseter muscle to enter face

Question 18

occipital artery

Answer 18

branch of external carotid artery

posterior to external carotid at border of posterior belly of digastric

passes between transverse process of atlas and mastoid process

pierces cervical fascia where trapezius and SCM come together

enters scalp and courses with great occipital nerve

Question 19

mnemonic for external carotid artery branches

Answer 19

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superior thyroid
ascending pharyngeal
lingual
facial
occipital
posterior auricular
maxillary
superficial temporal

Question 20

posterior auricular artery

Answer 20

branch of external carotid artery
passes posteriorly
to ear and external acoustic meatus and anterior to mastoid process

Question 21

final branches of external carotid artery

Answer 21

maxillary artery

superficial temporal artery

Question 22

external carotid ligation

Answer 22

needed to stem flow of blood from deeper branches which are not surgically accessible without damaging their major structures

ex/ carotid endarterectomy

Question 23

internal jugular veins

Answer 23

begins as dilation - superior jugular bulb
-at jugular foramen

ends at dilation - inferior bulb

• joins subclavian vein
• forms brachiocephalic vein

Question 24

tributaries to internal jugular vein

Answer 24

occipital vein
pharyngeal vein
lingual vein
facial and common facial veins
superior and middle thyroid veins

Question 25

right internal jugular access

Answer 25

insert needle inferiorly at apex of triangle between clavicular and sternal heads of SCM -inserted finger width lateral to carotid pulse at 30 degree angle inferiorly toward ipsilateral nipple

Question 26

branches of vagus and fiber type

Answer 26

meningeal - to dura sensory (GSA) auricular - to pinna, auditory canal, external tympanic membrane (GSA) pharyngeal - muscles of arch 4 (SVE) nerve to carotid body (GVA) superior laryngeal nerve - internal and external branches cervical cardiac branches recurrent laryngeal nerve

Question 27

internal branch of superior laryngeal nerve

Answer 27

pierces thyrohyoid membrane -with superior laryngeal branch of superior thyroid artery sensory - taste and general sense parasympathetic - to base of tongue (glands), epiglottis, internal larynx (above vocal fold)

Question 28

fiber types of superior laryngeal nerve

Answer 28

SVA, GVA, GVE-P

Question 29

external branch of superior laryngeal nerve

Answer 29

innervates cricothyroid muscle | SVE

Question 30

recurrent laryngeal nerve

Answer 30

SVE, GVE-P, GVA right - around subclavian artery left - around aortic arch both reach larynx motor to intrinsic muscles of larynx sensory to mucosa inferior to vocal folds

Question 31

above vocal folds

Answer 31

internal branch of superior laryngeal nerve

Question 32

below vocal folds

Answer 32

recurrent laryngeal nerve

Question 33

laryngeal nerve fibers

Answer 33

SVA, GVA, GVE-P | for recurrent and superior laryngeal nerves

Question 34

inferior laryngeal nerves

Answer 34

once recurrent passes into larynx | -becomes inferior

Question 35

deep cervical lymph nodes

Answer 35

associated with carotid sheath - superior and inferior groups - split by omohyoid

Question 36

superior deep cervical lymph nodes

Answer 36

receive from superificial of face and neck

Question 37

inferior deep cervical lymph nodes

Answer 37

get lymph

Question 38

jugular lymph trunks

Answer 38

left - to thoracic duct | right - to right lymphatic duct

Question 39

radical neck dissection

Answer 39

remove all deep cervical lymph nodes and surrounding tissue

Question 40

hypoglossal canal

Answer 40

near carotid sheath | -descends to submandibular triangle

Question 41

cervical plexus

Answer 41

ventral rami of C1-4

Question 42

branches of cervical plexus

Answer 42

``` greater auricular lesser occipital transverse cervical supraclavicular phrenic ansa cervicalis ```

Question 43

ansa cervicalis

Answer 43

C1 and C2 - superior root C2 and C3 - inferior root branches to infrahyoid muscles