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