Triangles of the neck

Question 1

What are the 4 types of fascia in the neck?

Answer 1

Investing layer of deep cervical fascia

Prevertebral fascia

Carotid sheath

Pretracheal fascia

Question 2

Where is the investing layer of deep cervical fascia located?

Answer 2

Attached posteriorly to the ligamentum nuchae and is continuous around the neck

Question 3

What is enclosed by the investing layer of deep cervical fascia?

Answer 3

sternocleidomastoid, trapezius and parotid glands

Question 4

What are the parotid glands?

Answer 4

Largest of the salivary glands, 1 present either side of the mouth in front of the ears

Question 5

Where is the prevertebral fascia located?

Answer 5

Anterior to the prevertebral muscles and posterior to the pharynx and oesophagus

Question 6

What is covered by the prevertebral fascia?

Answer 6

Cervical and brachial plexuses and muscles in the floor of the posterior triangle

Question 7

What is the carotid sheath made from?

Answer 7

Areolar tissue

Question 8

How does the composition of the carotid sheath vary over the vessels it covers?

Why is this variation necessary?

Answer 8

Strong over the carotid arteries and weak over the jugular vein to allow for expansion

Question 9

Where does the pretracheal fascia attach?

Answer 9

Thyroid and cricoid cartilages and the 2nd-4th tracheal rings

Question 10

What is enclosed by the pretracheal fascia?

Answer 10

Invests the thyroid gland and passes down into the thorax to the pericardium

Question 11

What forms the posterior border of the anterior triangle of the neck?

Answer 11

The anterior border of the sternocleidomastoid

Question 12

What forms the anterior border of the anterior triangle of the neck?

Answer 12

The midline between the mentum and the suprasternal notch

Question 13

What forms the superior border of the anterior triangle of the neck?

Answer 13

Inferior aspect of the mandible, rising to an apex at the mastoid process of the temporal bone

Question 14

What are the major structures passing through the anterior triangle of the neck?

Answer 14

Pharynx

Larynx

Trachea

Oesophagus

Thyroid gland

Common carotid

Internal and external carotid arteries

Jugular veins

Vagus nerves

Question 15

Does the shape of the posterior triangle of the neck remain constant?

Answer 15

No, it changes shape as the position of the head is altered

Question 16

What forms the posterior border of the posterior triangle of the neck?

Answer 16

Anterior border of the trapezius

Question 17

What forms the anterior border of the posterior triangle of the neck?

Answer 17

Posterior border of the sternocleidomastoid

Question 18

What forms the inferior border of the posterior triangle of the neck?

Answer 18

Middle third of the clavicle

Question 19

Which structures pass through the posterior triangle of the neck?

Answer 19

Most structures supplying the upper limb and the spinal accessory nerve

Question 20

Where is the origin of the sternocleidomastoid?

Answer 20

The mastoid process and lateral third of the superior nuchal line

Question 21

What direction does the sternocleidomastoid run?

Answer 21

Inferomedially

Question 22

Where is the insertion of the sternocleidomastoid?

Answer 22

Fleshy insertion on the medial end of the clavicle

Tendinous insertion on the anterior aspect of the manubrium

Question 23

What is the function of the sternocleidomastoid?

Answer 23

Rotates face in opposite direction and tilts ear towards same shoulder

Acting bilaterally, the muscles cause both flexion of the lower cervical spine and extension of the upper cervical spine

Question 24

Where is the origin of the trapezius?

Answer 24

Superior nuchal line

External occipital protuberance

Ligamentum nuchae

The spines and supraspinous ligaments of all of the thoracic vertebrae

Question 25

Where is the insertion of the trapezius?

Answer 25

Lateral third of the posterior border of the clavicle Medial border of the acromion Upper border of the spine of the scapula

Question 26

What is the function of the trapezius?

Answer 26

Elevation of the shoulder (shrugging) Bracing of the shoulder Rotation of the scapula (with serratus anterior) so that the glenoid cavity faces upwards in full abduction of the upper limb

Question 27

What is the action performed by the trapezius when acting unilaterally?

Answer 27

Rotates the head to the opposite side

Question 28

What is the action performed by the trapezius when acting bilaterally?

Answer 28

Extends the cervical spine

Question 29

Which nerve supplies sternocleidomastoid?

Answer 29

Spinal accessory nerve

Question 30

Which nerve supplies the trapezius?

Answer 30

Spinal accessory nerve

Question 31

Describe the path taken by the spinal accessory nerve to supply the sternocleidomastoid and trapezius

Answer 31

Emerges one third of the way down the posterior border of the sternocleidomastoid and crosses the posterior triangle to supply trapezius by entering its anterior border at the junction between its lower third and upper 2 thirds

Question 32

Is the spinal accessory nerve superficial or deep? Why is it said to have a characteristic appearance?

Answer 32

Superficial Characteristic 'wavy' appearance

Question 33

Which muscles form the floor of the posterior triangle?

Answer 33

Scalenes and levator scapulae

Question 34

Which type of fascia covers the scalenes? What movement does this enable?

Answer 34

Prevertebral fascia Movement between scalenes and structures lying anteriorly

Question 35

Where is the origin of the scalenes?

Answer 35

The transverse processes of the cervical vertebrae

Question 36

Which direction do the scalenes run?

Answer 36

Inferolaterally

Question 37

Where do the scalenes attach?

Answer 37

Scalenus anterior and medius: -first rib Scalenus posterior: -second rib

Question 38

What are the main parts of the hyoid bone?

Answer 38

Body with greater and lesser horns

Question 39

What is the significance of the hyoid bone?

Answer 39

Supports the floor of the mouth and the tongue Intimately related to the larynx and pharynx

Question 40

What functions are related to the hyoid bone?

Answer 40

Chewing, swallowing and speech

Question 41

What are the suprahyoid bones?

Answer 41

Diagrastic Stylohyoid Mylohyoid Geniohyoid

Question 42

Where is the origin of the diagrastic?

Answer 42

ANTERIOR BELLY: diagrastic fossa on the back of the body of the mandible POSTERIOR BELLY: deep to the mastoid process

Question 43

What are the components of the diagrastic muscle?

Answer 43

2 bellies and an intermediate tendon

Question 44

Where does the tendon of the diagrastic run?

Answer 44

Through a pulley attached to the hyoid bone

Question 45

What is the function of the diagrastics?

Answer 45

Elevate the hyoid in swallowing and depress the manible in chewing

Question 46

What are the 4 infrahyoid strap muscles ?

Answer 46

Sternohyoid Sternothyroid Omohyoid Thyrohyoid

Question 47

Where is the origin of the sternohyoid?

Answer 47

Behind the manubrium and the clavicle

Question 48

What direction does the sternohyoid run?

Answer 48

Upwards

Question 49

Where is the insertion of the sternohyoid?

Answer 49

Hyoid bone

Question 50

Where is the insertion of the sternothyroid?

Answer 50

Manubrium

Question 51

What is more anterior, the sternohyoid or the sternothyroid?

Answer 51

Sternohyoid

Question 52

Where is the insertion of the sternothyroid?

Answer 52

Oblique line on the thyroid cartilage

Question 53

Where does the thyrohyoid originate?

Answer 53

Oblique line on the thyroid cartilage

Question 54

Where does the thyrohyoid insert?

Answer 54

Hyoid

Question 55

Describe the structure of the omohyoid

Answer 55

2 bellies united by an intermediate tendon

Question 56

Where is the origin of the omohyoid?

Answer 56

Upper border of the scapula

Question 57

Where is the insertion of the omohyoid?

Answer 57

Hyoid bone

Question 58

What is the function of the infrahyoid muscles?

Answer 58

Chewing, swallowing and speech They fix the hyoid so that the suprahyoid muscles have a fixed point from which to act

Question 59

What is the innervation of the infrahyoid muscles?

Answer 59

First 3 cervical nerves via a loop of nerves called the ansa cervicalis

Question 60

Where is the thyroid gland located?

Answer 60

Within the pretracheal fascia, deep to the strap muscles

Question 61

How by the left and right lobes of the thymus gland connected?

Answer 61

Via an isthmus lying across the 2nd-4th tracheal rings

Question 62

Why can the thyroid gland not ascend any higher than the oblique line?

Answer 62

The sternothyroid attaches to the thyroid cartilages

Question 63

In what direction does an enlarged thyroid expand?

Answer 63

Laterally and downwards, even into the superior mediastinum

Question 64

What is produced by the thyroid gland?

Answer 64

Thyroxine and calcitonin

Question 65

What is the function of thyroxine?

Answer 65

Maintains the basal metabolic rate

Question 66

What is the function of calcitonin?

Answer 66

Lowers serum calcium

Question 67

Which arteries supply the thyroid gland?

Answer 67

Superior thyroid and inferior thyroid

Question 68

The superior thyroid is a branch of which artery?

Answer 68

External carotid

Question 69

The inferior thyroid is a branch of which artery?

Answer 69

Thyrocervical trunk from the subclavian

Question 70

Which vessels control venous drainage from the thyroid gland?

Answer 70

Superior, middle and inferior thyroid veins

Question 71

Where do the superior and middle thyroid veins drain to?

Answer 71

Internal jugular

Question 72

Where does the inferior thyroid vein drain to?

Answer 72

Left brachiocephalic vein

Question 73

How many parathyroid glands are there?

Answer 73

4 2 upper and 2 lower

Question 74

Where are the parathyroid glands located?

Answer 74

The back of the lateral lobes of the thyroid gland

Question 75

What is secreted by the parathyroid glands? What is the function of this?

Answer 75

Parathormone Raises serum calcium by mobilising it from the skeleton

Question 76

Is the position of the parathyroid glands constant or variable?

Answer 76

Variable particularly inferior ones

Question 77

How is blood supplied to the parathyroid glands

Answer 77

Via branches arising from anastomotic channels between superior and inferior arteries

Question 78

Where does the carotid sheath attach?

Answer 78

The base of the skull at the margins of the carotid foramen

Question 79

Where does the vagus nerve lie in the neck?

Answer 79

Posterior between the internal jugular vain and common carotid artery

Question 80

Where does the phrenic nerve lie in the neck?

Answer 80

Under the prevertebral fascia on scalenus anterior, lateral to the sympathetic chain

Question 81

Where is the sympathetic chain located in the neck?

Answer 81

Medial to the phrenic nerve, anterior to the prevertebral fascia

Question 82

How is the external jugular vein formed?

Answer 82

The union of the posterior division of the retro-mandibular vein with the posterior auricular vein

Question 83

Where is the external jugular vein located?

Answer 83

Superficial to sternocleidomastoid

Question 84

Where does the external jugular enter the subclavian vein?

Answer 84

Just above the midpoint of the clavicle

Question 85

How is the brachiocephalic vein formed?

Answer 85

The internal jugular vein joins the subclavian vein behind the sternoclavicular joint

Question 86

What groups are the deep cervical lymph nodes divided into?

Answer 86

Superior and inferior

Question 87

Which group of the deep cervical lymph nodes are jugulodigrastic nodes found in? What are these nodes especially associated with?

Answer 87

Superior Afferents from the palatine tonsils

Question 88

Where do jugulodigrastic nodes receive lymph from?

Answer 88

Submanibular nodes, cranium, tongue, larynx, lower pharynx and thyroid gland

Question 89

Do afferents or efferents drain into the inferior deep cervical lymph node?

Answer 89

Efferents

Question 90

Which group of the deep cervical lymph nodes are the jugulo-omohyoid nodes found in?

Answer 90

Inferior

Question 91

What happens to efferents of the deep cervical lymph nodes?

Answer 91

Form a single trunk, the jugular lymphatic trunk, which opens into the thoracic duct on the left and the right lymphatic duct on the right