Superficial Structures of the Neck 1

Question 1

Where does the first pair of cervical nerves leave the spinal cord and the vertebral column?

Answer 1

Above the 1st cervical vertebrae, between the first cervical vertebrae and the base of the skull.

Question 2

How do the 7 remaining cervical vertebrae leave the cervical vertebrae?

Answer 2

Through their corresponding intervertebral foramina.

Question 3

What happens to the spinal nerve after leaving the intervertebral foramina?

Answer 3

Immediately after, they divide into dorsal and ventral ramus.

Question 4

What do the dorsal rami of the spinal nerves supply?

Answer 4

They supply the extensor muscles at the back of the neck and the skin overlying them.

Question 5

In the cervical region, what happens to the upper 4 cervical ventral rami?

Answer 5

They branch and mix with each other before they pass onwards to skin and muscles.

Question 6

What is the path of the lower 4 cervical ventral rami?

Answer 6

They stream towards the upper limb.

Question 7

What do the lower 4 cervical ventral rami join with?

Answer 7

They join with the 1st thoracic ventral ramus and they form a plexus that supplies the arm.

Question 8

What is the cervical plexus formed off?

Answer 8

It is formed off the upper 4 ventral rami.

Question 9

What is the brachial plexus formed off?

Answer 9

It is formed of the lower 4 rami together with the 1st thoracic ramus.

Question 10

What do each of the transverse processes of the cervical vertebrae have?

Answer 10

They have a foramen in them for the vertebral arteries.

Question 11

What do each of the transverse processes end in?

Answer 11

They end in 2 tubercules – an anterior and a posterior tubercule.

Question 12

How do the cervical ventral rami pass out over the transverse processes?

Answer 12

They pass out in a shallow gutter between the anterior and posterior tubercules.

Question 13

Where do the scalene muscles originate from?

Answer 13

They originate from the 2 tubercules of the transverse processes of the cervical vertebrae.

Question 14

Where do the scalene muscle run to?

Answer 14

They run from the cervical vertebral column to the 1st and 2nd ribs.

Question 15

Where do the scalene muscles lie?

Answer 15

They lie at the sides of the vertebral column.

Question 16

Where do the scalenus anterior muscles attach to?

Answer 16

They attach to the anterior tubercules.

Question 17

Where does the scalenus medius attach to?

Answer 17

They attach to the posterior tubercules.

Question 18

Other than the scalenus medius, what other muscles attach to the posterior tubercules?

Answer 18

• scalenus posterior
• levator scapulae

Question 19

How do the ventral rami of the cervical spinal nerves emerge into the neck?

Answer 19

They emerge between the scalenus anterior and the scalenus medius.

Question 20

What do the upper 4 ventral rami give branches to supply?

Answer 20

Their branches supply many muscles in the neck and also the skin of the sides and the front of the neck.

Question 21

What do a few muscular branches from the 1st cervical ventral ramus hitch hike along?

Answer 21

They enter the hypoglossal nerve and hitch hike along it.

Question 22

How do the muscular fibres from the first cervical ventral ramus leave the hypoglossal nerve?

Answer 22

They leave the nerve in the front of the neck as the superior root of the ansa cervicalis and as the thyrohyoid nerve.

Question 23

What do muscular branches from the 2nd and 3rd ventral rami form?

Answer 23

They form the inferior root of the ansa cervicalis.

Question 24

Where do fine branches from the loop of the ansa go to?

Answer 24

They pass to the muscles at the front of the neck.

Question 25

What does a muscular branch from the 4th ventral ramus supply?

Answer 25

It supplies muscles that originally developed in the neck but which later migrated to the thorax = **diaphragm**

Question 26

What is the muscular branch of the 4th cervical ventral ramus called?

Answer 26

This is called the PHRENIC NERVE

Question 27

Where does the phrenic nerve recieve some filaments from on its way to the surface of the scalenus anterior muscle?

Answer 27

It recieves filaments from the 3rd and 5th ventral rami which pass onto the surface of the scalenus anterior muscle.

Question 28

What is the path of the scalenus anterior muscle?

Answer 28

* crosses the scalenus anterior muscle obliquely * passes in front of the subclavian artery * passes through the superior aperture of the thorax

Question 29

Why is the broken neck above the level of C4 fatal?

Answer 29

Because the diaphragm is completely paralysed.

Question 30

Where do the cutaneous branches from the cervical plexus emerge?

Answer 30

They emerge at the side of the neck and then radiate into the skin like the spokes of a wheel.

Question 31

What are the cutaneous branches of the cervical plexus called?

Answer 31

* lesser occipital * great auricular * transverse cervical * supraclavicular nerves

Question 32

Where do the 5th, 6th, 7th and 8th ventral emerge?

Answer 32

They emerge low in the neck between the scalenus anterior and scalenus medius.

Question 33

How are 3 trunks formed from the brachial plexus?

Answer 33

* 5th and 6th ventral rami join together --\> upper trunk * 7th ventral rami stays single --\> middle trunk * 8th cervical ventral rami + 1st thoracic ramus --\> lower trunk

Question 34

How do the 3 trunks enter the upper limb?

Answer 34

They stream over the first rib with the subclavian artery and into the upper limb.

Question 35

What covers the prevertebral and scalene muscles?

Answer 35

A sheet of prevertebral fascia.

Question 36

When they first emerge from the intervertebral foramina, where does the cervical ventral rami lie in relation to the prevertebral fascia?

Answer 36

They first lie deep to this fascia.

Question 37

What do the cervical ventral rami have to do in order to make sure that they can reach the structures that they supply?

Answer 37

They have the pierce the prevertebral fascia.

Question 38

What part of the prevertebral fascia do the brachial plexus and subclavian artery pierce?

Answer 38

They pierce a triangular area that lies between the scalenus anterior and the scalenus medius.

Question 39

What is the axillary sheath?

Answer 39

The subclavian artery carries with it a sheat of the prevertebral fascia into the upper limb and here it is called the axillary sheath.

Question 40

Does the subclavian vein pierce the prevertebral fascia?

Answer 40

No - it passes over the first rib in front of the scalenus anterior and therefore it does not pierce the prevertebral fascia.

Question 41

Where does the cervical part of the sympathetic extend from, to?

Answer 41

It extends from the base of the skull to the superior aperture of the thorax.

Question 42

Where is the cervical part of the sympathetic trunk continuous with the thoracic part of the sympathetic trunk?

Answer 42

It is continuous through the superior aperture of thorax.

Question 43

Describe the preganglionic neurones in the trunk.

Answer 43

They have all ascended from the thoracic region. There is no preganglionic outflow from the cervical part of the spinal cord.

Question 44

Where do sympathetic neurones from the thoracic region ascend to?

Answer 44

The ascend to 1 of 3 cervical sympathetic ganglia on the trunk.

Question 45

What are the 3 cervical sympathetic ganglia on the trunk called?

Answer 45

They are called the superior, middle and inferior cervical sympathetic ganglia.

Question 46

What is the inferior cervical sympathetic ganglion fused with?

Answer 46

It is fused with the first thoracic ganglion to form a large **cervicothoracic ganglion**.

Question 47

What is the cervicothoracic ganglion sometimes called?

Answer 47

It is sometimes called the stellate ganglion because it has a flattened star like appearance.

Question 48

Where does the stellate ganglion lie?

Answer 48

It lies on the neck of the first rib.

Question 49

Where do postganglionic sympathetic fibres arise from?

Answer 49

They arise from all 3 cervical sympathetic ganglia.

Question 50

How do postganglionic sympathetic ganglia reach their targets in the head and neck?

Answer 50

Many of them climb along blood vessels to reach their destination in the head and the neck.