LECOM Clinical Supplement - NECK

where do you inject anesthesia for the brachial plexus?

above the clavicle at "Erb's Point" toward the scalene triangle

60% of individuals have __________ __________ __________, which arise from what?

accessory phrenic nerves --> arise from subclavius **can be damaged in cervical/thoracic procedures

where do you inject a nerve block for the cervical plexus?

along the posterior ridge of the middle 1/3 of the SCM "nerve point of the neck" - all cutaneous branches from the cervical plexus (C1-C4) emerge --> will anesthetize greater auricular, lesser occipital, transverse cervical, and all supraclavicular nerves

what is a retropharyngeal abscess? s/s? complications?

an infection b/w cervical vertebrae and pharyngeal wall s/s - fever, sore throat, dysphagia, neck/back pain complications - airway obstruction, sepsis, mediastinitis, pneumonia, empyema, jugular vein thrombosis, carotid artery erosion

what does the suspensory ligament of Berry do? what nerve passes lateral to this?

anchors thyroid gland to trachea recurrent laryngeal nerve

what muscle does the phrenic nerve course along?

anterior surface of anterior scalene **with ascending cervical artery

where can ectopic thyroid tissue be located?

anywhere along midline of course of thyroglossal duct as high as tongue

what is the function of the carotid sinus?

baroreceptor

what is a subclavian venipuncture? what must be avoided in this procedure?

central line placement inferior to clavicle into subclavian vein must avoid: 1. first rib 2. phrenic nerve - can cause partial paralysis of diaphragm 3. subclavian artery 4. cupula of lung - can cause pneumothorax, hemothorax

what is the function of the carotid body?

chemoreceptor

what does inadvertent removal of parathyroid glands result in?

hypercalcemia and tetany

what is carotid sinus syncope?

hypersensitivity of the carotid sinus resulting in episodes of diminished blood flow and random fainting

what would a nerve block to the stellate ganglion result in?

impacted sympathetic function of the ipsilateral head, neck, and upper limb

when might you be able to see pulsations of the internal jugular vein on the right side?

in mitral valve disease and/or right ventricular failure

where can infections between the buccopharyngeal fascia and alar fascia spread?

inferiorly only as far as lower cervical levels

where can infections between the buccopharyngeal fascia and prevertebral layer (aka retropharyngeal space) spread?

inferiorly to the diaphragm and superiorly to base of skull ***danger space

what is congenital torticollis?

injury to SCM before or shortly after birth resulting in shortening of the muscle

what can result from a lacerated external jugular vein?

it can be held open by investing fascia resulting in negative thoracic pressure and air being sucked into vein --> cyanosis, air embolism, dyspnea

what is Horner syndrome without anhydrosis and flushing?

just a lesion affecting the internal carotid nerve ***spares external carotid nerve

where can you puncture the right internal jugular vein?

lateral to pulsations of common carotid artery in between the heads of the SCM just superior to clavicle

what is Horner syndrome? what does it result in?

lesions of the sympathetic trunk results in F PAM: F - flushing of face P - mild Ptosis (paralysis of superior tarsal muscle) A - anhydrosis (denervation of sweat glands) M - miosis (unopposed constrictor pupillae)

what is the jugular body?

like the carotid body (a chemoreceptor) but located along the bulb of the internal jugular vein in jugular foramen

explain spread of thyroid cancer

local spread - tracheal, vagus nerves, recurrent laryngeal nerves lymph - deep cervical nodes ultimately veins - lungs, vertebra, sometimes liver

where are parathyroid glands located?

posterior to thyroid ranging in location from hyoid bone to superior mediastinum may be located outside of thyroid capsule --> allows cancer spread to fascia compartments of neck

what is the significance of the tubercle of Zuckerandl?

projection of the lateral thyroid lobe --> close to inferior thyroid artery where it crosses recurrent laryngeal nerve

in a thyroidectomy, what does ligation of the inferior thyroid artery endanger?

recurrent laryngeal nerve

what is a pyramidal lobe?

remnant of thyroglossal duct --> common in midline of neck

how many parathyroid glands are there?

typically 4, but can range from 2-6

what significant anastomoses of the external carotid artery allow for its ligation in surgery?

1. across the midline via facial artery to facial anastomoses 2. descending branch of occipital artery anastomosing with thyrocervical trunk - vertebral a., deep cervical a. (aka descending occipital), and ascending cervical arteries

explain lymph drainage of the thyroid gland

1. isthmus - prelaryngeal/tracheal --> paratracheal --> deep cervical (inferior and superior) 2. lateral lobes - directly to superior and inferior deep cervical

what vein of the neck becomes distended during elevated intrathoracic pressure (ex. - valsalva maneuver)?

external jugular vein

in a thyroidectomy, what does ligation of the superior thyroid artery endanger?

external laryngeal nerve

what are the carotid body and carotid sinus innervated by?

mainly CN IX (more so than CN X) and preganglionic sympathetics

what is spasmodic torticollis?

shortening of SCM due to disease of basal nuclei **can also involve other muscles

what is a carotid endarterectomy? what is at risk of iatrogenic injury?

surgical removal of plaque within internal carotid artery structures at risk: 1. cutaneous branches of cervical plexus (sensory loss @ neck) 2. CN IX - dysphagia, diminished gag reflex 3. CN X - hoarseness, dysphagia, diminished gag reflex 4. CN XI - weakness in shoulder shrugging and turning head 5. CN XII - tongue paralysis 6. ansa cervicalis - difficulty stabilizing hyoid bone 6. sympathetic trunk - Horner syndrome

what spinal cord levels provide sympathetic innervation to the head and neck?

t1-t4

where can infections deep to prevertebral layer spread?

they can spread laterally along posterior border of SCM into posterior triangle

where can infections between investing fascia and pretracheal fascia spread?

this is within the pretracheal space and spread to superior mediastinum