1
Q
What are the anterior & posterior borders of the neck?
A
anterior - lower border of mandible to upper surf of manubrium (of sternum)
posterior - superior nuchal line of occipital to intervertebral disc b/w C7 & T1
2
Q
What are the borders of the anterior triangle of the neck?
A
- anterior border of sternocleidomastoid
- inferior border of mandible
- midline of neck
3
Q
What are the borders of the posterior triangle of the neck?
A
- posterior border of sternocleidomastoid
- anterior border of trapezius
- middle 1/3 of clavicle
4
Q
What are the 4 compartments that give the neck a longitudinal organization? Briefly describe each.
A
- VISCERAL
- anterior
- contains parts of digestive & respiratory syst + endocrine glands - VERTEBRAL
- posterior
- contains vertebrae, SC, cervical nerves + muscles of vertebral column - & 4. 2 VASCULAR
- 1 each side
- lateral
- contain major vessels & vagus (X) n
5
Q
What are the different neck fascias?
A
- superficial fascia
2. deep cervical fascia
6
Q
What are the main features of the superficial fascia of the neck?
A
Contains a thin sheet of muscle –> PLATYSMA
- starts in superficial fascia of thorax –> runs up & attaches to mandible + blends w/ facial muscles
- innervated by cervical branch of facial (VII) n
7
Q
What are the 4 layers of the deep cervical fascia?
A
- Investing layer - surrounds all struc.s in neck
- Prevertebral layer - “ vertebral column & deep back muscles
- Pretracheal layer - encloses viscera of neck
- Carotid sheaths - surround the 2 major neurovascular bundles (on both sides)
8
Q
Describe the investing layer of the deep cervical fascia.
A
- completely surrounds the neck
- posterior attachment = LIGAMENTUM NUCHAE & SPINOUS PROCESS of C7
- splits up –> encloses TRAPEZIUS –> reunites & forms roof of POSTERIOR TRIANGLE –> splits again to surround STERNOCLEIDOMASTOID –> reunites again
- anteriorly –> surrounds infra hyoid muscles
9
Q
Describe the pre-vertebral layer of the deep cervical fascia.
A
- surrounds VERTEBRAL COLUMN & MUSCLES associated
- muscles –> PREVERTEBRAL muscles, ANTERIOR + MIDDLE + POSTERIOR scalene & DEEP back muscles
10
Q
The pre-vertebral fascia b/w attachment pts on transverse processes is UNIQUE –> it splits in 2 layers –> creating __________ fascial space containing CT that EXTENDS FROM ____ of the skull THRU THE ______
A
longitudinal
base
thorax
11
Q
Describe the pre-tracheal layer of the deep cervical fascia.
A
- collection of fascias that surround: TRACHEA, ESOPHAGUS & THYROID
anteriorly –> crosses neck just posterior to infra hyoid muscles + covers trachea & thyroid - begins at HYOID & ends in upper THORACIC CAVITY
- laterally –> covers THYROID & ESOPHAGUS
- posteriorly–> called BUCCOPHARYNGEAL FASCIA & separates pharynx & oesophagus from PREVERTEBRAL layer
- Buccopharyngeal fascia –> begins at BASE OF SKULL & ends in THORACIC CAVITY
12
Q
Describe the carotid sheath layer of the deep cervical fascia.
A
- each sheath = column of fascia that surrounds: CCA, ICA, IJV & VAGUS NERVE
- receives contributions from the other 3 layers
13
Q
What are the 4 triangles found in the anterior triangle of the neck? What are the boundaries of each?
A
- Submandibular
- superior border = inf border of mandible
- inferior “ = anterior & posterior bellies of digastric - Submental
- inferior border = hyoid
- lateral “ = ant belly of digastric - Muscular
- superior border = hyoid
- lateral borders = superior belly of omohyoid & anterior border of sternocleidomastoid - Carotid
- anterior inferior border =
- superior “ =
- posterior “ =
14
Q
Muscles are grouped according to location relative to the hyoid bone:
____hyoid muscles & ____hyoid muscles.
A
SUPRAhyoid
INFRAhyoid
15
Q
List the 4 suprahyoid muscles.
A
- stylohyoid
- digastric
- mylohyoid
- geniohyoid
16
Q
List the 4 infrahyoid muscles.
A
- omohyoid
- sternohyoid
- thyrohyoid
- sternothyroid
17
Q
Function & innervation of the STYLOHYOID.
A
Function - pulls hyoid up in posterosuperior direction
Innervation - facial/VII
18
Q
Function & innervation of the DIGASTRIC (anterior & posterior bellies).
A
Anterior:
- Function = opens mouth by lowering mandible; raises hyoid
- Innervation = mylohyoid n from inferior alveolar branch of mandibular/V3
Posterior:
- Function = pulls hyoid up & back
- Innervation = facial/VII
19
Q
Function & innervation of the MYLOHYOID.
A
Function - support & elevate floor of mouth; elevate hyoid
Innervation - mylohyoid n from inf alveolar branch of mandibular/V3
20
Q
Function & innervation of the GENIOHYOID.
A
Function - fixed mandible elevates & pulls hyoid front; fixed hyoid pulls mandible down & inward
Innervation - branch from anterior ramus of C1
21
Q
Function & innervation of the STERNOHYOID.
A
Function - depresses hyoid bone after swallowing
Innervation - anterior rami of C1-C3 thru ansa cervicalis
22
Q
Function & innervation of the OMOHYOID.
A
Function - depresses & fixed hyoid
Innervation - anterior rami of C1-C3 thru ansa cervicalis
23
Q
Function & innervation of the THYROHYOID.
A
Function - depress hyoid, but when hyoid is fixed –> raises larynx
Innervation - fibers from anterior ramus of C1 carried along hypoglossal (XII)
24
Q
Function & innervation of the STERNOTHYROID.
A
Function - draws larynx down
Innervation - anterior rami of C1-C3 thru ansa cervicalis
25
Function & innervation of STERNOCLEIODMASTOID.
- - sternal head
- - clavicular head
Function - individually --> tilt head to shoulder on same side rotating head to turn face to opposite side
together --> draw head forward
Innervation - accessory n (XI) & branches from anterior rami C2-C3
26
Function & innervation of TRAPEZIUS.
Function - assists in rotating scapula during abduction of humerus
upper fibers -- elevate scapula
middle " -- adduct "
lower " -- depress "
Innervation -
motor -- accessory/XI
proprioception -- C3 & C4
27
Function & innervation of SPLENIUS CAPITIS.
Function -
individually --> draw & rotate head to 1 side
together --> draw head back
Innervation - posterior rami of middle cervical nerves
28
Function & innervation of LEVATOR SCAPULAE.
Function - elevate scapula
| Innervation - C3, C4; dorsal scapular n
29
Function & innervation of POSTERIOR SCALENE.
Function - elevate rib II
| Innervation - anterior rami of C5-C7
30
Function & innervation of MIDDLE SCALENE.
Function - elevate rib I
| Innervation - anterior rami of C3-C7
31
Function & innervation of ANTERIOR SCALENE.
Function - elevate rib I
| Innervation - anterior rami of C4-C7
32
Why is clinically important to know the location of the omohyoid muscle?
because it is superficial (in front of) the INTERNAL JUGULAR V
33
What are the primary venous channels for the superficial venous drainage of the neck?
internal jugular v (IJV)
| anterior " "
34
Which 2 veins join to form the external jugular vein?
posterior to angle of mandible the posterior auricular vein & retromandibular vein join
35
What territories does the posterior auricular vein drain?
scalp behind & above ear
36
The retromandibular vein is formed when the _________ temporal & _______ veins join and descends to the angle of mandible where it divides into an ______ & a ______ division
superficial temporal
maxillary
anterior
posterior
37
The ______ division of the retromandibular vein joins the posterior auricular vein to form the _______ jugular vein
posterior
| external
38
The ______ division of the retromandibular vein joins the facial vein to form the _______ facial vein, which passes deep & becomes a tributary to the ______ jugular vein
anterior
common
internal
39
Why is it clinically important to know that: the external jugular v pierces the investing layer of the cervical fascia, passes deep to the clavicle & enters the subclavian vein?
it determines the passage of the vein from the neck to thorax --> imp for NECK DISSECTIONS --> sometimes need to remove the fascia from the sternocleidomastoid muscle & in the process, must LIGATE THE EXTERNAL JUGULAR V (to prevent bleeding from subclavian v)
40
Where do the anterior jugular veins from each side come together?
at or just superior to the hyoid
41
What are the 2 anterior jugular veins separated by ?
LINEA ALBA (which cuts the entire body in 2)
42
Exam Q: What is the layer pierced by the anterior jugular veins ?
investing layer of cervical fascia (they pierce it to enter the subclavian vein)
43
How do the R & L anterior jugular veins communicate?
jugular venous arch (in area of suprasternal notch)
44
Which venous arch is an exception to no vessels crossing the medial line of our body?
jugular venous arch
45
What is the clinical significance of the jugular venous arch crossing the midline of our body?
TRACHEOSTOMY
| - trachea lies in the midline --> jugular venous arch may be accidentally cut
46
Where do the common carotid arteries & their branches (external & internal carotid) pass thru? What do they supply?
anterior triangle of neck
all structures of head & neck
47
Where do the R & L common carotid arteries originate? (imp in exam)
R - form brachiocephalic trunk immediately posterior to R sternoclavicular joint & is entirely in neck thru its course
L - begins in thorax as direct branch of aortic arch & passes superiorly to enter neck near the L sternoclavicular joint
48
Do the R & L common carotid arteries have branches? (exam Q)
NO
| they divide into internal & external carotid arteries but have NO BRANCHES
49
Where does the internal jugular vein receive blood from? (exam Q)
all structures of H&N
50
Where does each common carotid bifurcate/divide & into which arteries?
at the superior edge of thyroid cartilage
into external & internal carotid arteries
51
What is found at the level of the bifurcation of common carotid arteries?
CAROTID SINUS & CAROTID BODY (innervated by glossopharyngeal & vagus)
52
What is LYRE tumour?
benign tumour of carotid body
53
How can one differentiate the external from the internal carotid artery?
no branches come off the internal in the neck, is more lateral
external is more medial at the level of bifurcation (of common carotid) & has branches in neck
54
How many branches does the external carotid artery give off?
- 3 anterior
- 3 posterior
6 total
55
Which are the 3 anterior branches of the external carotid artery? (note: must memorise)
1. SUPERIOR THYROID
2. LINGUAL
3. FACIAL
1. SUPERIOR THYROID
- 1st branch, arises from ant. surf
- passes down & forward --> to *superior pole of thyroid gland*
2. LINGUAL
- arises " " just above superior thyroid artery
- passes DEEP to hypoglossal (XII) --> then b/w middle constrictor & hyoglossus muscles
- goes to TONGUE
3. FACIAL
- 3rd branch
- arises just above lingual, passes DEEP to stylohyoid & POSTERIOR BELLY OF DIGASTRIC --> goes b/w submandibular gland & mandible --> anterior to masseter muscle --> enters face
56
When doing surgery at the base of the tongue, remember the _____ artery is located nearby, at the level of the ____ bone. It must be ligated
during surgery to prevent massive bleeding at the level of the pharynx.
lingual
| hyoid
57
A little pulsation can be felt on the mandible, which artery is this most likely to be?
facial artery
58
Exam Q: Usually arteries and veins parallel each other but this is an exception. The facial artery goes _____ to the submandibular gland and emerges at the level of the bone.
The facial ____ is by the ________ and the posterior belly of the digastric muscles , it is superficial to these muscles and to the submandibular gland.
deeper
vein
sternohyoid
(Just remember: the facial artery runs deeper)
59
Which are the 3 posterior branches of the external carotid artery? (note: must memorise)
1. ASCENDING PHARYNGEAL
2. OCCIPITAL
3. POSTERIOR AURICULAR
60
Which are the 2 terminal branches of the external carotid artery?
1. SUPERFICIAL TEMPORAL
2. MAXILLARY
1. SUPERFICIAL TEMPORAL
- UPWARD continuation of external carotid a.
- starts posterior to neck of mandible --> passes anterior to ear --> crosses zygomatic process of temporal --> divides into anterior & posterior branches
2. MAXILLARY
- larger one
- starts post. to " " " --> passes thru parotid gland --> goes medial to neck of mandible --> into infra-temporal fossa --> into pterygopalatine fossa
61
Can you feel the pulsations of the superficial temporal artery?
touch at the temple close to your ear and feel the pulsations
62
The thyrocervical trunk is the ____ part of the _______ artery
first
| subclavian
63
Which are the 4 branches of the THYROCERVICAL TRUNK?
1. SUPRA-SCAPULAR
2. CERVICAL
3. ASCENDING CERVICAL
4. THYROID (most imp)
1. SUPRA-SCAPULAR
- 1st branch
- imp for flap reconstruction
2. CERVICAL
- 2nd branch
- anatomical landmark for lower limit of neck dissection (lymphatics don't go lower than that)
3. ASCENDING CERVICAL
4. THYROID
- MOST IMP --> supplies all 4 parathyroid glands (imp to rmr during surgery)
64
Where does the internal jugular vein originate?
begins as a dilated continuation of sigmoid sinus (a dural venous sinus)
initial dilated part = SUPERIOR BULB OF INTERNAL JUGULAR VEIN
65
What is the initial dilated part of the internal jugular vein called? Where does it receive blood from?
= SUPERIOR BULB OF INTERNAL JUGULAR VEIN
from INFERIOR PETROSAL SINUS
66
Other than via the _______ triangle of the neck, it is very difficult to resect the carotid artery.
anterior
67
The jugular vein always runs _______, except at the level of the jugular foramen, where it runs more _______
laterally
| posterior
68
The paired internal jugular veins join w/ the subclavian veins posterior to the sternal end of the clavicle to form the R & L ____________ veins
brachiocephalic
69
What are the tributaries to each internal jugular vein?
- inferior petrosal sinus
- pharyngeal v
- facial v
- lingual v
- occipital v
- superior thyroid veins
- middle " v
Note: I don't think this needs to be memorised
70
Even though we have a middle thyroid vein, we do NOT have a middle thyroid artery. True or false?
True
human body is just weird
71
What are the 3 divisions of lymph nodes in the head?
1. superficial nodes
2. superficial cervical "
3. deep " "
72
Which are the superficial nodes of the head?
These 2 drain from posterior 1/2 of scalp:
- Occipital nodes: assoc w. occipital artery, drainage from posterior scalp & neck
- Mastoid nodes: " " posterior auricular artery, drainage from postero-lateral 1/2 of scalp
- Pre-auricular & parotid nodes: anterior to ear, assoc w/ superficial temporal & transverse facial arteries
- Submandibular nodes: " " facial artery
- Submental nodes: inferior & posterior to chin
73
What are the superficial cervical nodes ?
collection of lymph nodes along external jugular v on superficial surf of sternocleidomastoid muscle
74
What are the deep cervical nodes? Where do they drain into?
collection of lymph nodes along external jugular v
- lymphatic vessels form R & L jugular & subclavian trunks drain lymph coming from deep cervical nodes into the R lymphatic duct & THORACIC DUCT
75
What is lymphoria?
= build-up of lymph in neck of 500ml - 1L
76
What are the 5 lymph node chains?
1. superior horizontal
2. inferior "
3. anterior vertical
4. posterior "
5. jugular
77
What is the superficial subfascial lymph node system?
circular system b/w chin & occipit & along course of external jugular v
78
What is the deep lymph node system?
- has bilateral triangular arrangement
- anterior border = lymph nodes adjacent to internal jugular v
- posterior " = spinal lymph node chain w. supraclavicular node
the nodes that ARE excised during surgery
79
Which nodes make up the the perivisceral lymph node system?
they are close to median viscera
- retropharyngeal
- pre laryngeal
- prethyroidean
- pre tracheal
- recurrent (for recurrent laryngeal n)
80
What is the topographical classification of lymph nodes based on?
6 levels & 6 sub-levels
81
What are the 6 levels of lymph nodes?
- Level I: submental & submandibular triangles
- Level II: upper jugular
- Level III: medium jugular
- Level IV: lower jugular
- Level V: posterior triangle
- Level VI: anterior compartment
82
What are the 6 sublevels of lymph nodes?
- Sublevel IA & IB -- divided by anterior belly of digastric
- Sublevel IIA & IIB -- " " spinal accessory n (XI)
- Sublevel VA & VB -- " " lateral projection of inferior border of cricoid cartilage
83
What is the division of lymph nodes into levels important for?
NECK DISSECTIONS
usually in cancer pts
84
Facial artery: A little pulsation can be felt on the mandible, which artery is this most likely to be?
H&N Anatomy
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