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WEEK 21:
Introduction to the neck:
| Question | Answer |
|---|---|
| features of 1st rib | true, atypical, short and broad attaching to T1 |
| scalene tubercle anchors | anterior scalene muscle |
| 2 grooves on the 1st rib are for | subclavian artery (lower trunk of brachial plexus), and subclavian vein |
| important structures on superior surface of 1st rib | scalenus medius, brachial plexus, subclavian artery, scalenus anterior, and subclavian vein |
| thoracic outlet syndrome (TOS) | VAN squashed by extra rib and clavicle |
| parts of the cervical fascia | superficial cervical fascia and deep cervical fascia (fascia colli) |
| superficial cervical fascia | layer of fatty connective tissue between dermis (skin) and deep cervical fascia made of subcutaneous tissue and platysma |
| deep cervical fascia (fascia colli) | form compartments in neck |
| platysma | muscle of facial expression supplied by facial nerve (CN7) making up part of the superficial cervical fascia |
| layers of the deep cervical fascia (4) | investing layer, prevertebral layer, carotid sheath, and pretracheal layer |
| investing layer of deep cervical fascia | most superficial of the 4 which surrounds all structures in neck and splits into 2 to surround the trapezius and sternocleidomastoid (SCM) muscles |
| retracheal layer of deep cervical fascia | structure enclosing many structures situated in the anterior neck and spans between the hyoid bone superiorly, thorax inferiorly (to fuse with pericardium), and posteriorly formed by parts of the buccopharyngeal fascia |
| structures found in the pretracheal layer (4) | trachea, oesophagus, thryoid gland and infrahyoid muscles |
| prevertebral fascia of deep cervical fascia | surrounds vertebral column and its associated muscles (scalene, prevertebral and deep muscles of the back) with the anterolateral portion forming the floor of the posterior triangle of the neck |
| what muscles do the prevertebral muscle of deep cervical fascia surround | scalene, prevertebral and deep muscles of the back |
| carotid sheath of deep cervical fascia | paired structures on each side of the neck which enclose the neurovascular bundle of the neck. The sheath is formed by contributions from pretracheal, prevertebral and investing fascia |
| carotid sheath encloses neurovascular bundle of the neck and (4) | It contains common carotid artery, internal jugular vein, vagus nerve, and accompanying cervical lymph nodes. |
| retropharyngeal space location | located between buccopharyngeal fascia and prevertebral fascia extending from base of skull to posterior mediastinum, posterior to pharynx and oesophagus |
| retropharyngeal space | space filled with loose connective tissue and lymph nodes which drain pharynx, nose and middle ear |
| clinical importance of the retropharyngeal space | susceptible to infections which originate in Waldeyer's tonsillar ring and can potentially spread infections to thorax through danger space |
| causes of enlarged lymph nodes | obstruction, inflammation (painful), and neoplasia (painless) |
| superficial cervical lymph nodes | receives lymph from scalp, face and neck |
| deep cervical lymph nodes | receive all lymph from head and neck and lymph from superficial layer and directs it into the right and left jugular trunks then into right lymphatic duct and thoracic duct. These lymph nodes lies close to internal jugular vein |
| examples of superficial cervical lymph nodes (7) | Occipital Mastoid Parotid Preauricular/ retroauricular Submental Submandibular Superficial cervical |
| examples of deep cervical lymph nodes (2) | jugulodigastric and jugulo-omohyoid |
| how to handle nodes with malignancy | surgery |
| levels of deep cervical nodes (from 1-6) | Submental and submandibular Upper jugular Middle jugular Lower jugular Posterior triangle Anterior cervical area (picture on the top right slide 24) |
| virchows node | left sided supraclavicular lymph node |
| troisier sign | enlarged virchows node suggesting intra-abdominal cancer (mainly gastric and pancreatic cancer) |
| sternocleidomastoid muscle (SCM) landmarks (3) | sternal head, clavicular head, and borders of the anterior and posterior triangles of the neck |
| trapezius | broad triangular muscle covering upper back and shoulders with surface landmarks including clavicle, SCM, and accessory nerve |
| carotid sheath | located posterior to SCM and is part of the deep cervical fascia of neck. Superiorly, it encircles margins of the carotid canal and jugular fossa at the skull base then extends downwards ending at the aortic arch |
| accessory nerve | found proximal to nerve point as it enters the posterior cervical triangle from posterior border of SCM |
| hyoid bone | bone has central body (U) with 2 smaller protruding structures on superior surface (lesser horns) and 2 larger bony protrusions from body (greater horns) |
| larynx cartilages | 3 unpaired midline cartilages (epiglottis, thyroid and cricoid cartilage) and four pairs of smaller cartilages (arytenoids, corniculates, cuneiforms, and tritiates) |
| unpaired midline cartilages in larynx (3) | epiglottis, thyroid and cricoid cartilage |
| paired cartilages of larynx (4) | arytenoids, corniculates, cuneiforms, and tritiates |
| external jugular vein | found on angle of mandible starting just below parotid gland then runs obliquely across SCM in superficial fascia and ends in subclavian vein near middle of clavicle |
Created by:
kablooey
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