1
Q
What are the bony landmarks of the neck?
A
The external occipital protruberance
Mastoid process
Transverse process of C2
Hyoid bone: C3-4
Inferior border of circoid cartilage: C6
2
Q
When we have a unilateral contraction of the sternocleidomastoid mm., which way will the head turn?
A
Towards the opposite side
3
Q
What are the actions fo the sternocleidomastoid?
A
Unilateral
- Lateral flexion and contralateral rotation
Bilateral
- Extend the atlanto-occipital joint (if neck is fixed)
- Flex the neck (if the atlanto-occipital joint is fixed)
4
Q
Which muscles can mask paresis of the sternocleidomastoid?
A
Semispinalis
Splenius capitus
Splenius cervicis
5
Q
T/F: during delivery, the sternocleidomastoid mm fibers can be turned and damaged as the baby’s body is being removed too vigorously while the head remains in the birth canal
A
True
* If muscle is damaged, it becomes scar tissue and won’t heal
6
Q
What happens when there is damage to the sternocleidomastoid during birth? What is the name of this condition?
A
-If damaged, scar tissue will form which won’t allow the muscle to stretch
- this will inhibit the neck to lengthen on the side that is damaged
- that will lead to the head twisting permanently towards the opposite side
- this is called Torticollis Congenital or wry neck
7
Q
What is Spasmotic torticollis?
A
- An extremely painful chronic neurological movement disorder causing the neck to involuntarily turn to one side or the other
- It is caused by the involuntary sustained contraction of the sternocleidomastoid mms. And other muscles of the neck
8
Q
Which vein crosses the sternocleidomastoid?
A
External jugular vein
9
Q
Where is the external jugular vein located and where does it terminate?
A
-Superficial vein on top of sternocleidomastoid
- Pierces the deep cervical fascia
- Terminates in the subclavian vein
10
Q
Are there any arteries running with the external jugular vein?
A
No
*Arteries don’t run with superficial veins
11
Q
The external jugular vein should be _________ when a patient is doing the valsava maneuver.
A
Distended
12
Q
What is a sign of right heart failure?
A
Dilation the right external jugular vein, during relaxation
13
Q
What would happen if the external jugular vein were to be cut as it is traveling through the deep cervical fascia?
A
- The fascia would hold the vein open allowing the heart to suck in an air embolism filling the right heart and cause right heart failure
14
Q
T/F: The external jugular vein can’t serve as an internal barometer.
A
False
- it is a great vein to measure heart rate because it is visible in the neck
- this can be seen in a heavy lifter straining to lift weights
15
Q
What is superior vena cave syndrome?
A
- blockage of the superior vena cava by a tumor
- it may cause the external jugular to become distended
*The superior vena cava is being pushed onto aorta, leading to a pooling of blood in vessels in upper limb, neck, and head
16
Q
How does the external jugular vein come in handy when administering a drug through IV?
A
- It is monitored for distention (ballooning)
- This helps in the prevention of administering the IV fluids too quickly
17
Q
Where is the “nerve point of the neck” found?
A
- Found along the middle 1/3 of the posterior border of the sternocleidomastoid
- The lesser occipital (runs parallel to the the sternocleidomastoid muscle), greater auricular (next to the jugular vein), transverse cervical (goes across the neck), and supraclavicular (Inferior) nerves
18
Q
Injections of anestetics at the “nerve point of the neck” produces ____________
A
“Cervical plexus block”
19
Q
Most of the cervical plexus is sensory but some is motor. Which nerves are motor?
A
Hypoglossal
Nerve to genohyoid and thyrohyoid
Ansa cervicalis
20
Q
What nerves arises rom the cervical plexus?
A
Cutaneous (4 branches):
Great auricular nerve - C2&C3
Transverse cervical nerve -C2&C3
Lesser occipital - C2
Supraclavicular nerves - C3,C4
Muscular
Ansa cervicalis (loop formed from C1-C3)
- geniohyoid- C1 only
- thyrohyoid C1 only
Phrenic C3-C5 (primarily C4)
Segmental branches (C1-C4)
21
Q
From which nerves is the ansa cervicalis formed?
A
The hypoglossal nerve is right behind the hyoid bone.
- Some of the branches from C1 will leave hypoglossal nerve and descend
- The descending hypoglossus will join the descending cervicalis (from C3)
- When they anastomose it is the ansa cervicalis
22
Q
The descending hypoglossus is also known as the ____________
A
Superior limb of the anterior cervicalis
23
Q
Which endocrine glands are found in the neck?
A
Thyroid
Parathyroid
24
Q
What are the borders of the posterior triangle?
A
- Sternocleidomastoid- Anterior
- Trapezius- Posterior
- Clavicle- Inferior
25
What are the borders of the anterior triangle?
Sternocleidomastoid- Posterior
Mandible- Superior
Midline- Anterior
26
The posterior triangle is subdivided by the posterior belly of the omohyoud muscle into ________ and \_\_\_\_\_\_\_\_\_\_\_\_
Occipital triangle
Subclavian triangle
27
What important nerve travels down the sternocleidomastoid and innervates it?
CN XI- Accessory nerve
28
What other muscle does CNXI innervates?
Trapezius mm.
29
Why is CNXI named the "care free" nerve by surgeons?
It can be easily cut through since it travels superficially through the occipital triangle of the neck as it is going from the SCM to the trapezius
## Footnote
**NOTE**: Accessory lymp nodes swelling can put pressure on nerve causing paresis
30
What structures form the boundaries of the occipital triangle?
- SCM
- trapezius
- posterior belly of omohyoid
31
What structures form the boundaries of the subclavian triangle?
- Posterior belly of omohyoid
- SCM
- Clavicle
32
What muscles make up the floor of the Posterior triangle?
Scalene muscles
33
The subclavian triangle contains:
The subclavian triangle contains:
1. 3rd part of subclavian artery
2. brachial plexus
3. suprascapular artery
4. supraclavicular lymph nodes
34
Clinicians refer to the left supraclavicular (Virchow's) nodes as the "sentinel nodes". Why?
Becuase they signal "deep internal carcinomas", including from the stomach, pancreas, uterus, and esophagus.
\*Usually nodal enlargement is cause by metastatic gastric carcinoma, although supraclavicular nodal involvement can also be seen i other gastrointestinal, thoracic, and pelvic cancers
35
Which structures transverse the sublavian (supraclavicular) fossa?
Subclavian artery
Brachial plexus
\*Anesthesia can be injected in the sublavian fossa becuase the subclavian artyery can be compressed against the first rib and the brachial plexus is found there as well.
36
Which rib does the anterior scalene muscle attach to?
Inserts into inner border of the 1st rib **and** into the ridge of the upper surface of 2nd rib
37
Which rib does the middle scalene muscle attach to?
1st rib
38
Which rib does the posterior scalene muscle attach to?
2nd
39
Does the subclavian vein pass through the scalene triangle along with the subclavian artery and brachial plexus?
NO
40
Thoracic Outlet Syndrome
A cervical rib can grow into the scalene triangle, obstructing the artery and compressing the brachial plexus
Symptoms:
* Coldness
* Paresthesia
41
Scalene anticus syndrome
LIke cervical rib syndrome but due to hypertonic scalene muscles
42
The anterior scalen divides the subclavian artery into 3 parts. What are the branches of the first part?
1. vertebral artery
2. thyrocervical trunk
3. internal thoracic artery
43
The ____________ is the main blood supply to the brainstem
vertebral artery
44
Turning the head can produce _____________ if the vertebral artery is partially obstructed
syncope (fainting)
\*Vertebral artery can be obstructed by plaque formation
45
Orthopnea
Shortness of breath that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair
\*Requires use of accessory respiratory muscles in respiratory distress (like the anterior scalene muscle)
46
Phrenic nerve
* Runs anteriorly on the anterior sclene
* Originates from C3, C4, C5
* Provides GSE innervation to the diaphragm
47
The anterior triangle is subdivided into 4 subtriangles. What are they?
1. Submental
2. Submandibular
3. Carotid
4. Muscular
48
What are the bounderies and contents of the submental triangle?
**_Boundaries_**
* anterior bellies of digastric
* hyoid bone
**_Contents_**
* Submental nodes
* Origin of anterior jugular vein
49
What parts of the body are drained by the submental nodes?
* Central lower lip
* Chin
* Tip of tongue
* Anterior floor of the mouth
50
What are the bounderies and contents of the submandibular triangle?
**_Bounderies_**
* Lower border of the body of the mandible
* Posterior belly of the Digastric m.
**_Contents_**
* Submandibular nodes (superficial)
* Submandibular gland (superficial)
* Facial artery
* Lingual artery
* CN XII
51
What parts of the body are drained by the sybmandibular nodes?
Oral and nasal cavities
52
What are bounderies and contents of the carotid triangle?
**_Bounderies_**
* Posterior belly of digastric
* Superior belly of omohyoid
* Sternocleidomastoid
**_Contents_**
* Carotid artery
* Vagus nerve
* Internal jugular vein
\*Note that the vagus nerve is between the artery and vein
53
What are the branches of the external carotid artery?
* Superior thyroid
* Lingual
* Facial
* Ascending pharyngeal
* Occipital
* Posterior auricular
* Maxillary
* Superficial temporal
54
What two major components of the internal carotid artery?
Carotid Sinus (baroreceptor)
Carotid Body (Chemoreceptor)
* Monitors partial pressure of O2 and CO2
55
Carotid Endarterctomy
A surgical procedure performed by vascular surgeons used to r**educe the risk of stroke** by correcting stenosis (narrowing) in the common carotid artery or internal carotid artery. Endarterectomy is the removal of material on the inside of an artery.
\*plaque may be removed
56
Deep cervical lymph nodes run with the internal jugular vein. What structures drain into these lymph nodes?
All structures of the head & neck drain into these nodes.
**Note:** Lymph nodes tend to follow blood vessels. Deep cervical lymph nodes are closely related to artery and vein, so it is a challenge to remove when they need to be removed in cases of cancer.
57
In Horner's syndrome the __________ is damaged.
Sympathetic trunk
\*Usually results from disease
58
What are the signs of Horner's syndrome?
1. palpebral pseudoptosis (drooping eyelid)
2. miosis (constricted pupil)
3. enophthalmos (sinking of eye into orbit)
4. anhidrosis (dry skin)
\*Signs and symptoms are **ipsilateral**
59
The sympathetic chain is located within or deep to the carotid sheath. True or False.
True
60
What are the compoents of the sympathetic chain\>
Superior cervical ganglion
Middle cervical ganglion
Inferior cervical (stellate) ganglion
61
How do sympathetic fibers reach structures of the head and neck?
* The sympathetic fibers to the head and neck begin in the spinal cord. They originate from regions T1-L2 and therefore need to ascend to reach structures of the head and neck.
* After leaving the spinal cord, the fibers enter the sympathetic chain. This structure span is from the base of the skull to the coccyx, and is formed by nerve fibers and ganglia.
* There are three ganglia with in this chain that are of interest.
* **To get to the head and neck, the sympathetic fibers synapse with these ganglia, with postganglionic branches continuing into the head and neck. Each of the three ganglion are rlated to specific arteries in the head and neck. The postganglionic fibers "hitch-hike" along these arteries (and their branches) in order to reach their target organs.**
62
Where do preganglionic sympathetic fibers that innervate the head and neck originate?
1. There are no pre-ganglionic sympathic fibers going to the H&N.
2. Cranial nerves
3. Brainstem and cranial nerves
4. Thoracic spinal cord
5. Sympathic chain
63
What are the ounderies and contents of the muscular triangle?
**_Boundaries_**
* Midline
* Sternocleidomastoid
* Omohyoid, superior belly
**_Contents_**
* Larynx
* Thyroid and parathyroid glands
64
The connection point between two lobes of the thyroid is called?
Thyroid isthmus
65
Foramen cecum
Point where the embrological thyroid begins to descend
66
Thyroglossal duct
* An embryological anatomical structure forming an open connection between the inital area of development of the thyroid gland (foramen cecum) to its final position.
* Duct is suppost to atrophy before birth but does not in some people and can lead to the formation of **thyroglossal duct cyst**
67
Goiter
* Enlarged and/ or overactive thyroid gland
* may be removed by a “partial thyroidectomy” or radiation
* Radiation can be done since iodine can concentrate there
68
If thyroid doesn't descend, lingual thyroid can obstruct \_\_\_\_\_\_\_\_\_.
Larynx
69
What hormones are secreted by the parathyroid gland?
**Parathyroid hormone**
## Footnote
\*Elevates blood calcium levels. Henceforth, removal of the parathyroid glands result in a fall of blood calcium, tetany, and death.
70
Which nerves are closely related to the thyroid gland?
External and recurrent laryngeal nerves
\* These nerves help us speak, so damage to either of these nerves by direct surgical trauma or post surgical edema produces **dysphonia.**
71
Tracheostomy
* Inserting breathing ring
* First isthmus of the thyroid has to be cut
* May be performed between the 2nd and 3rd tracheal rings
\*Inferior thyroid vein and thyroid ima artery may be in the way
72
What are the 3 zones of penetrating neck trauma?
Zone 1: Root of neck (a.k.a thoracic inlet a.k.a superior thoracic aperture)
Zone 2: Cricoid cartilage (C6)
Zone 3: Angle of jaw
73
Damage to which zone presents the greatest risk for morbidity and mortality? Which zone is most commonly injured?
Zones I & III: greatest risk of morbidity and mortality
Zone II: most commonly injured
74
What are the major contents of zone 1?
Major Contents of Zone I
**A Viscera**
1 trachea
2 esophagus
3 cupula and apex of lungs
**B Glands**
1 thyroid
2 parathyroid
**C Nerves**
1 vagus
2 recurrent laryngeal
3 phrenic
4 sympathetic chain
5 brachial plexus
**D Blood vessels**
1 common carotid
2 subclavian artery & vein
3 jugular veins
**E Vertebral column**
75
Pancoast's Syndrome
* Typically results when a malignant neoplasm of the superior sulcus of the lung leads to destructive lessions of the **thoracic** **inlet** and involvement of the brachial plexus and cervical sypathetic nervous system
\*CN X, brachial plexus, and phrenic nerve can be damaged
76
What some signs of Pancoast's Syndrome (thoracic inlet tumor)?
1. Horner’s syndrome
2. parathesia & paresis of arm & hand
3. superior vena cava syndrome
4. dyspnea
5. dysphonia
6. dysphagia
7. paralysis of ½ of the diaphragm
77
What are the 4 major fascias in the neck?
* Investing layer of deep cervical
* Prevertebral fascia
* Carotid sheath
* Pretracheal fascia
78
The \_\_\_\_\_\_\_\_\_is a potential space between the prevertebral & pretrachial fascias
retropharyngeal space
\*Extends from the base of the skull and into the thorax, spefically T4 (where the trachea ends)
79
What can result from infections that enter the retropharyngeal space?
* Edema (and an abscess) that obstructs swallowing (dysphagia) and/or breathing.
* Infections may also enter the thorax producing **mediastinitis**
Structure and Function 2- Exam 1
flashcards
Decks in class (13)
# Cards
-
Gross Brain COPY84
-
Cranial Nerves125
-
Neck79
-
Histo of NS71
-
ANS76
-
Neuroradiology60
-
Anatomy of the Face101
-
Foramens and what goes through them14
-
Skull-Wilson47
-
Face, Development, and Pharyngeal Arches117
-
Development of the Central Nervous System109
-
Lymphattics of the Head and Neck85
-
Neurotransmitters and Neuromodulator52
