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