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(OMS1) Neuro Exam 1 > Triangles of the neck and larynx > Flashcards

Triangles of the neck and larynx Flashcards

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1
Q

What is found in vertebral level c3-c4?

A

Body of hyoid bone
Upper margin of the thyroid cartilage
Bifurcation of common carotid artery

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2
Q

What is found in vertebral level C5-c6?

A

Arch of cricoid cartilage
Superior end of esophagus
Superior end of trachea

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3
Q

Draw the anterior and posterior triangles:

A

Refer to your drawings

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4
Q

Anterior triangle borders

A

Midline of the neck
Sternoclediomastoid
Lower border of the mandible

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5
Q

Posterior triangle/lateral cervical borders

A

Sternocleidomastoid
Trapezius
Clavicle

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6
Q

What divides the anterior and posterior triangles?

A

SCM (sternocleidomastoid m.)

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7
Q

Divisions of the Anterior triangle:

Submandibular triangle borders

A

Anterior belly of digastric
Posterior belly of digastric
Inferior border of mandible

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8
Q

*Divisions of the anterior triangle:

Carotid triangle borders:

A

Posterior belly of digastric
Superior belly of omohyoid
Sternocleidomastoid

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9
Q

Divisions of the anterior triangle:

Submental triangle borders:

A

Midline of the neck
Anterior belly of digastric
Body of hyoid

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10
Q

*Divisions of the anterior triangle:

muscular triangle borders

A

Body of hyoid
Superior belly of omohyoid
Sternocleidomastoid

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11
Q

Draw the anatomical relationships of the different divisions of the anterior triangle:

A

Refer to your drawings

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12
Q

What makes up the floor of the posterior triangle?

A 
Splenius capitis
Levator scapulae
Omohyoid 
Posterior scalene
Middle scalene
Anterior scalene
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13
Q

Arteries in the posterior triangle:

A

Transverse Cervical A.
Thyrocervical Trunk
Suprascapular A.

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14
Q

Draw the arteries of the neck including:

Vertebral artery 
Transverse Cervical A. (deep and superficial) 
Inferior thyroid 
Suprascapular 
Thyrocervical trunk 
Costocervical trunk 
Internal thoracic
A

Refer to your drawings

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15
Q

*What forms the external jugular vein?

A

Retromandibular v. and posterior auricular v. coming together

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16
Q

*The subclavian vein meets the () to form the …

What drains into the venous system in this part of the body?

A
  • Internal jugular vein … brachiocephalic vein

- Lymphatic ducts (right lymphatic and thoracic ducts on the left draining into the venous system)

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17
Q

*If you External Jugular vein is visible on a patient, what does it mean?

A

Increased venous pressure - possible heart failure or obstruction of superior vena cava

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18
Q

Draw the relevant veins of the posterior triangle:

A

Refer to your drawings

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19
Q

Cutaneous nerves of the posterior triangle (coming off the cervical plexus):

A

Lesser Occipital N.
Greater Auricular N.
Transverse Cervical N.
Supraclavicular N.

*all come from the cervical plexus

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20
Q

What do you call the point behind the sternocleidomastoid where the cutaneous nerves of the posterior triangle exit?

A

Erb’s point/Nerve point of the neck. Relevant in Erb’s palsy

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21
Q

*Lesser occipital N.
Origin
Cutaneous innervation

A

C2

Skin to scalp and posterior neck

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22
Q

*Great auricular N.
Origin
Cutaneous innervation

A

C2-C3

Parts of the ear, part of the carotid area, angle of the mandible, mastoid process, bit of the neck

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23
Q

*Transverse Cervical N.
Origin
Cutaneous innervation

A

C2-C3

Anterior triangle area

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24
Q

*Supraclavicular N.
Origin
Cutaneous innervation

A

C3-C4

Skin over clavicle and shoulder

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25
Draw the innervations of the posterior triangle:
Refer to your drawings
26
Spinal Accessory N.
Aka CN XI Most common nerve that is accidentally cut, usually resulting in trap paralysis (sternocleidomastoid is innervated proximal to this area of common trauma so it is intact)
27
Phrenic N.
Responsible for diaphragm C3-C5 Anterior to the anterior scalene
28
Where does the Brachial plexus come out?
Between the anterior and middle scalene m.
29
Torticollis: Cause Clinical
SCM shortening/contraction. Could also be caused by Spinal Accessory N. issue Head tilt toward and face to turn away from affected side
30
Course of the spinal accessory n.
Cervical region of spinal cord > foramen magnum > enters cranial cavity > exits jugular foramen with CN IX and XI (glossopharyngeal and vagus) > appears in Anterior triangle > innervates SCM > appears in posterior triangle (area of common damage) > through the fascia > trapezius
31
Occipital triangle and omoclavicular (subclavian) triangle are divided by….
Inferior belly of the omohyoid
32
What are the suprahyoid muscles? What do they form? Function?
Anterior and posterior belly of the digastric m. Myologhyoid M. Stylohyoid M. Geniohyoid M. (in the oral cavity) - form- the floor of the oral cavity - elevate the hyoid and larynx during swallowing and talking
33
What are the infrahyoid muscles?
Sternohyoid Omohyoid Sternothryoid Thyrohyoid
34
What are the branches of the external carotid a. | What branches are seen in the anterior triangle?
``` Posterior Auricular A. Occipital A. Facial A. Lingual A. Ascending pharyngeal A. Superior Thyroid A. External Carotid A. Internal Carotid A. Common Carotid A. ```
35
Draw the branches of the ECA
Refer to your drawings
36
*Floor of the submandibular triangle:
Mylohyoid Hyoglossus Mid constrictor m.
37
*Contents of the submandibular triangle:
``` Facial A. and V Hypoglossal N. Nerve to Mylohyoid M. Submandibular gland Lingual A. ```
38
Draw the submandibular triangle
Refer to your drawings
39
*Contents of the submental triangle:
Mylohyoid M. (floor) Submental lymph nodes Veins forming the anterior jugular v.
40
*Contents of the muscular triangle:
Thyroid gland and parathyroid Thyroid cartilage Larynx Trachea Esophagus Common carotid, inferior and superior thyroid a. Anterior jugular v., thyroid v. (superior, middle, inferior) Ansa cervicalis n., external laryngeal n., recurrent laryngeal n.
41
*Contents of the carotid triangle
Carotid sheath Branches of the common carotid a. External and internal laryngeal n. Hypoglossal n. and spinal accessory n.
42
*Carotid sheath contents
``` Internal jugular v. Common carotid a. Vagus N. Deep cervical lymph nodes Carotid sinus n. Sympathetic n. fibers Ansa cervicalis ```
43
*Relationship between occipital a. and hypoglossal n.
Hypoglossal N. wraps around the Occipital A.
44
Which nerve dives into the larynx in the Carotid triangle?
Internal laryngeal N.
45
What is the carotid sinus? | *Innervation?
Dilation in the proximal part of the internal carotid a. Acts as a baroreceptor (blood pressure) Innervation: cartoid sinus nerve (branching from the glossopharyngeal N. and vagus N. (IX and X))
46
What is the carotid body? | Innervation?
Located at the bifurcation of the carotid artery. Tissue that acts as chemoreceptor and senses oxygen levels Innervation: carotid sinus nerve (branching from the glossopharyngeal N. and vagus N (IX and X))
47
Draw the carotid triangle innervation:
Refer to your drawings
48
``` Thoracic inlet/outlet clinical correlations: Lungs Central Line *Nerves *Esophagus and Trachea ```
- superior thoracic/inferior thoracic aperture (diaphragm area) - Lungs extend about 2 inches into the root of the neck. Trauma above the collar (e.g. stabbing) affects the lung and results in pneumothorax. - Subclavian V. (most superficial) is site for central line. Could puncture the subclavian a. if you got too deep. Can puncture lung if you go too posterior. XR done after central line to ensure lung was not punctured/collapsed - Brachial plexus, esophagus, trachea, vagus and phrenic are also in this region. So trauma to these structures can affect things further away due to continuity between respiratory and digestive systems
49
Thoracic outlet syndrome
Compressing the nerves and arteries leading to the upper limb = upper limb issues
50
Anatomical position and importance of the phrenic nerve:
-Lies superficial to the anterior scalene m. Sole motor supply to the diaphragm. Phrenic nerve needs to be preserved during surgery. Arises at the neck level, so spinal cord damage below the neck preserves breathing despite paralysis of limbs
51
Cervical plexus goes from … to…
C1 - C4
52
Motor nerves coming off of the cervical plexus Draw this innervation
Hypoglossal (CN XII, not cervical plexus) - tongue Superior root of the ansa cervicalis (C1-C2) - geniohyoid, thyrohyoid Inferior root of the ansa cervicalis (C2-C3) - infrahyoid muscles Phrenic N. (C3-C5) - diaphragm
53
*Sympathetic trunk origins: Superior Cervical Ganglion Middle Cervical Ganglion Inferior Cervical Ganglion What is located close to the sympathetic ganglion and what is the significance of this?
C2-C3 C6 C7-T1 -Arteries. The sympathetic fibers follow these vessels to get to their target areas
54
Superficial fascia:
- Subcutaneous layer lies between dermis and investing layer of the deep cervical fascia - contains platysma muscle, cutaneous n., blood and lymphatic vessels, superficial lymph nodes and fat
55
Platysma muscle
Muscle of facial expression | Innervated by the facial N. (CN VII)
56
``` Deep cervical fascia: 3 layers (superficial to deep) ```
Investing Pretracheal Prevertebral
57
Investing layer
Encloses the SCM and the trapezius | Forms the sheath around the carotid and submandibular glands
58
Mumps and investing layer:
Parotid gland swelling against unrelenting investing layer causing pain during mumps
59
Pretracheal layer
Goes around the thyroid, trachea and esophagus (only on anterior side) Extends to the mediastinum where the heart is
60
Prevertebral layer
Encircles the prevertebral muscles
61
Carotid sheath blends with which fascia?
All layers, depending on location
62
Anatomical relationships of the carotid sheath Draw the fascia of the neck
- Common carotid artery (most anterior and medial) - Internal jugular vein (most anterior and lateral) - Vagus N. ( most posterior structure) - Sympathetic trunk and phrenic n. are located medial and posterior to the carotid sheath respectively
63
Retropharyngeal space anatomical position and borders:
-posterior to the pharynx Anterior border: buccopharyngeal fascia Posterior border: prevertebral fascia Lateral border: carotid sheaths
64
Retropharyngeal abscess:
Develops secondary to lymphatic drainage or contiguous spread of upper respiratory or oral infections Swelling can cause difficulty in swallowing/speaking and can be life threatening
65
Anatomical position of the thyroid gland:
Deep to the sternohyoid and sternothyroid muscles Extends from C5 - T1 Isthmus is located anterior to the trachea and found on tracheal rings 2 and 3
66
Draw the thyroid gland and neurovasculature
Refer to your drawings
67
Blood supply of the thyroid gland:
Superior thyroid artery (from external cartoid a.) - superior and anterior portions of the gland Inferior thyroid artery (from thyrocervical trunk) - inferior and posterior portions of the gland
68
Parathyroids | What is the blood supply of the parathyroid?
Embedded in the posterior lateral lobes of the thyroid | Usually supplied by the inferior thyroid artery
69
Thyroid ima artery | Where does it branch from?
Present in 10% of patients Usually branches from thyrocervical trunk or subclavian Need to be careful not to puncture during tracheostomies
70
Thyroid veins | Where do they drain?
Superior thyroid v. and middle thyroid v. Drain to the Internal jugular v. Inferior thyroid v. Drain to the brachiocephalic trunk
71
Right recurrent laryngeal and left recurrent laryngeal nerves
RCLN branches from Right vagus N. and wraps around the subclavian a. LRLN branches from the left vagus N. and wraps around the aortic arch
72
Thyroid movement during swallowing due to …. | Do lymph nodes move with swallowing?
Connections to fascia. | Lymphatics do not move however
73
Draw the anatomical organization of the larynx relative to other throat structures:
Refer to drawings
74
Vertebral level of the thyroid cartilage? | Vertebral level of the cricoid cartilage?
C4 | C6
75
Function of the vocal ligament
Produces sound and speech
76
Laryngeal cavity anatomical position
Extends from the laryngeal inlet to the inferior boundary of the cricoid cartilage
77
Laryngeal vestibule anatomical position
Laryngeal inlet to vestibular fold
78
What is the conus elasticus made of?
Cricothyroid membrane and vocal ligament
79
Internal branch of the SLN is () | External branch of the SLN is ()
Sensory | Motor (cricothyroid m.)
80
Inferior laryngeal n. does (sensory or motor) innervation?
both
81
Sensory innervation above the vocal fold is the … | Sensory innervation below the vocal fold is the …
Internal branch of the superior laryngeal nerve | Inferior laryngeal nerve (terminal branch of the left recurrent laryngeal N.)
82
Blood supply above the vocal fold is the … | Blood supply below the vocal fold is the …
Superior laryngeal a. | Inferior laryngeal a.
83
Lymphatics above the vocal fold go … | Lymphatics below the vocal fold go …
With the superior laryngeal a. and to the superior deep cervical nodes To the pretracheal/prelaryngeal and to the inferior deep cervical nodes
84
Superficial Cervical Lymph nodes are located … | They follow which vessel?
On the superficial face/neck area | External Jugular Vein
85
Deep Cervical Lymph nodes are located …. | They follow which vessel?
On the deeper face/neck area | Internal Jugular vein
86
Two types of deep cervical lymph nodes: Jugulo-digastric Location? Drains from?
C4, deep to posterior belly of digastric m. | Lymph from throat and tonsils
87
Two types of deep cervical lymph nodes: Jugulo-omohyoid Location?
C6, deep to the omohyoid muscle
88
What are the major lymphatic ducts of the head and neck? | Where are these located?
Left: Thoracic Duct RIght: lymphatic duct Located at the junction of IJV and SV
89
right Lymphatic duct drains…
Right side of the head, neck, chest and right upper extremity
90
Left thoracic duct drains…
(everything else) Left side of the head, neck, chest, left upper extremity, abdomen, pelvis and perineum, both lower extremities

(OMS1) Neuro Exam 1 (18 decks)

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