EXAM 2 - Regional Neck Anatomy
spasmodic torticollis
- can be adult onset - treat with botox - sustained contraction in the SCM - causing turn/tilt and flexion on the impaired side
Action of Vocal Cords - adult males
- longer and thicker - vibrate more slowly - produce lower pitched sounds
Fibromatosis colli
- most common - develop in SCM - prenatal - generally occurs in a breached delivery - results in a twisted neck from unilateral action of SCM
Thyroid Gland - comprised of
- right and left lobe - isthmus - connection between lobes
Carotid Sheath - contents (must know all 7)
1. CCAs (L&R) 2. internal carotid artery 3. IJV 4. vagus n 5. cervical lymph nodes 6. carotid sinus 7. sympathetic n fibers
what does the subclavian vv drain
1. EVJ 2. left thoracic duct 3. right lymphatic duct
Anterior cervical triangle borders
1. anterior border of SCM 2. inf. margin of mandible 3. inferomedial line of neck
Common Carotids Continued ► Above upper border of thyroid cartilage they divide into
1. external carotid a 2. internal carotid a
Internal Jugular vv (IJV) - major tributaries
1. facial v 2. inferir petrosal sinuns
posterior cervical triangle borders
1. posterior border of SCM 2. anterior border of traps 3. middle 1/3 of clavicle
External Carotid aa - branches
1. superficial thyroid 2. ascending pharyngeal 3. lingual 4. facial 5. occipital 6. postauricular 7. superficial temporal 8. maxillary
Parathyroid Glands - comprised of
2 superior and 2 inferior glands can have ectopic glands as well
Epiglottis
A flap of tissue that seals off the windpipe and prevents food from entering.
sternohyoid A&N
A: depress hyoid N: C1-C3
Omohyoid A&N
A: depress hyoid N: C2-C3 There is an superior and inferior belly
thyrohyoid A&N
A: depress hyoid and elevate thyroid cartilage N: hypoglossal n and C1
sternothyroid A&N
A: depress thyroid cartilage N: C1-C3
Stylohyoid - A & N
A: elevate hyoid and raise the floor of the mouth and tongue N: Facial N
mylohyoid - A & N
A: elevate hyoid and raise the floor of the mouth and tongue N: V3 - trigeminal
Longus Colli A&N
A: flex vertebral column N: C2-C7
geniohyoid A&N
A: protrude hyoid and tongue N: hypoglossal n (CN XII) and C1 nerve
Additional Actions of anterior and lateral cervical vertebrae
Bilateral: flexion of the vertebral column (cervical vert) Unilateral: ipsilateral neck flexion
Subclavian vv
Continuation of axillary vv at level of 1st rib
Brachiocephalic vv (R & L) - major tributaries
IJV Subclavian v
Laryngeal Muscles - intrinsic m
Move individual larynx parts ● 1. alter length & tension - of vocal cords ● 2. size & shape - rim glottidis
Laryngeal Muscles - Extrinsic m
Move larynx as a whole ◦ 2 groups ● 1. Depressors ● A. Examples: infra hyoids ● 2. Elevators ● A. Examples: suprahyoids
Internal Carotid aa - branches
NO BRANCHES IN THE NECK Branches in the head: 1. opthalmic 2. posterior communicating 3. anterior cerebral 4. middle cerebral
middle scalene OIAN
O: TP of C2-C7 I: First rib A: elevate rib 1 N: C2-C3
anterior scalene OIAN
O: TP of C3-C6 I: First rib A: elevate rib 1 N: C2-C3
longus capitis OIAN
O: TP of C3-C6 I: occipital bone A: flex cervical vert N: C1-C3
Posterior scalene OIAN
O: TP of C5-C7 I: second rib A: elevate rib 2 N: C3-C5
rectus capitis lateralis OIAN
O: atlas I: occipital bone A: lateral flexion of neck N: C2-C3
Rectus Capitis Anterior OIAN
O: atlas I: occipital bone A: neck flexion N: C2-C3
Digastric (anterior) O I A INN
O: inferior border of mandible I: tendon attached to hyoid A: elevate hyoid and lower mandible INN: V3 - trigeminal N
Digastric (posterior) O I A INN
O: mastoid I: tendon attached to hyoid A: move hyoid posteriorly INN: facial N - Cervical branch
Subclavian steal syndrome
Occurs to retrograde flow in the vertebral artery occurs when the subclavian artery is occluded - between the common carotid and vertebral artery - , and blood flow is diminished, or obstructed, to the upper extremities. Causes someone to pass out when they raise their arm above their head It is most common on the right side of the body.
Thyroid Gland - lymphatic drainage
Prelaryngeal node, pretrachial node, and paratrachial node
SCM - OIAN
Sternal head O: manubrium of sternum Clavicular head O: clavicle Common I: mastoid process Bilateral A: flex neck, elevate chin, draw head vertically, and sternum superiorly Unilateral A: lateral flexion of neck, rotation of head contralaterally Common N: C2-C3
Thyroid Gland - location
anterior aspect of neck spans between C5 and T1
what muscles does the R Subclavian aa run though
anterior scalene and the middle scalene
Lateral Cervical Vertebral Group
anterior, middle and posterior scalene
where does the Brachiocephalic vv begin
at the medial end of the clavicle
External Jugular vv (EJV) - Formed
behind the angle of the mandible by the union of the posterior auricular vein and the retromandibular vein
Internal Jugular vv (IJV) - drains
brain, face, scalp, and neck
Parathyroid Glands - lymphatic drainage
cervical and paratrachial nodes
Carotid Triangle - contents
common carotid arteries internal and external carotid arteries internal jugular vein vagus nerve spinal accessory n hypoglossal nerve thyroid gland larynx deep cervical lymph nodes
Action of Vocal Cords - intrinsic muscles
control vocal cords
what forms sound? what forms words?
cords produce crude sounds that are formed into words by the pharynx, oral cavity, tongue & lips
Internal Jugular vv (IJV) - path
descends through the neck within the carotid sheath lateral to the vagus n and internal common carotid artery joints the subclavian vv behind the medial end of the clavicle to form the brachiocephalic vv
Action of Vocal Cords - loudness
determined by how much air is forced through between the vocal cords
Suprahyoid Group
digastric, geniohyoid, mylohyoid, stylohyoid
superior vestibular folds
false vocal cords close the larynx during swallowing play no role in speech
vestibular folds
false vocal cords - also keep food out of airway
Action of Vocal Cords - taut cords
high pitched sounds
Walls of the Larynx - 2 folds
interior wall has 2 folds on each side - superior and inferior vestibular folds
Internal Jugular vv (IJV) - leaves the skull through what foramen
jugular foramen
where does the R Subclavian aa become the axillary a
level of the first rib
Anterior Cervical Vertebral Group
longus colli longus capitis rectus capitis anterior rectus capitis lateralis
Action of Vocal Cords - slack cords
lower pitched sounds
R Subclavian aa arises
off the brachiocephalic artery arches up and laterally over the lung pleura and runs between two muscles
Infrahyoid Group
omohyoid, sternohyoid, thyrohyoid, sternothyroid
rima glottidis
opening between vocal folds
External Carotid aa - supplies
outside of the face and skull
Parathyroid Glands - location
posterior surface of the thyroid gland
Action of Vocal Cords - innervation
recurrent laryngeal n - off of vagus n
muscular torticollis
result of difficulty in delivery of baby - use of forceps usually - treatment with a surgical release of the SCM from the origin
path of the subclavian vv
runs through a groove (along with the subclavian a) on the superior surface of rib 1 - anterior groove is for the vein - posterior groove is for the artery it runs the most anteriorly to the scalene muscle joins with the IVJ to form the brachiocephalic v
Superficial Group of neck
sternocleidomastoid
Thyroid Gland - arterial supply
superior and inferior thyroid aa
Thyroid Gland - venous drainage
superior and inferior thyroid veins
carotid triangle borders
superior belly of omohyoid posterior belly of digastric anterior border of SCM
Thyroid Gland -innervation
superior, middle, and inferior cervical sympathetic ganglia - vasomotor: constriction of blood vessels to inhibit the blood flow
Parathyroid Glands - innervation
superior, middle, and inferior cervical sympathetic ganglia - vasomotor: constriction of blood vessels to inhibit the blood flow important in surgery of a thyroidectomy to leave the parathyroid glands behind and the nerves and blood supply
Both CCAs run cranially in neck through __________________ just deep to ant border of ______
the carotid sheath and SCM
glottis
the vocal apparatus of the larynx - opening to larynx
Parathyroid Glands - arterial supply
thyroid aa
Parathyroid Glands - venous supply
thyroid vv
inferior vestibular folds
true vocal cords produce the sound when air is passing through contains the vocal ligaments
Congenital Torticollis & Types
twisted neck - present at birth 3 major types - Fibromatosis colli - muscular torticollis - spasmodic torticollis
External Carotid aa - path
upper boarder of thyroid cartilage - parotid gland being the mandible - emerges at ant border of SCM (with the carotid triangle)
Internal Carotid aa - path
upper border thyroid cartilage throughout the neck - enters the cranial cavity via the carotid canal (temporal bone) - terminates into anterior and middl cerebral arteries
can you palpate the External Carotid aa
yeah - its not within the carotid sheath
clinical application of EJV
you can visually see the pressure above the clavicle in the EJV and the IJV
Brachiocephalic a
► Arises directly off of the aortic arch (1st branch ► A single vessel that gives rise to: ◦ 1. R subclavian ◦ 2. R CCA
Larynx - functions
► Cartilagenous chamber about 4cm ► Primary fxn - keeping things out of airway ► Secondary fxn - phonation
Common Carotids (CCA)
► Right CCA ◦ Arises from the brachiocephalic artery ► Left CCA ◦ Arises from the aortic arch - the second branch
Platysma (O, I, A, innervation)
► Superficial & Large ► O: subcutaneous fascia of chest ► I: fascia into muscles of chin and jaw ► A: depress and draw lower lip laterally & draw up skin of chest ► N: facial n - cervical branch
Muscles of the Hyoid/Larynx - general groups and actions
► Suprahyoid Group ◦ General action - elevate ► Infrahyoid Group ◦ General action - depress
Major Vessels of the Neck ► Arterial
◦ Brachiocephalic a ◦ L/R Common carotid aa (CCA) ◦ External carotid aa ◦ Internal carotid aa ◦ L/R Subclavian aa
Major Vessels of the Neck ► Venous
◦ L & R subclavian vv ◦ External Jugular vv (EJV) ◦ Internal Jugular vv (IJV) ◦ L & R brachiocephalic vv
