Clinical Case - Anterior Triangle of the Neck

What are the most likely complications that may arise from such subtotal thyroidectomy operation?

Bleeding is possible due to the rich blood supply to the thyroid. Injury to the recurrent laryngeal nerve may result in temporary hoarseness of the voice, permanent loss of voice, or even death due to laryngeal spasm. Another possible complication of thyroidectomy is the inadvertent removal of the parathyroid glands, which may cause a severe convulsive disorder known as tetany.

The superior branch of ansa cervicalis runs with the hypoglossal nerve until the When superior branch separates, it runs anterior to which artery?

Carotid Triangle; Anterior to the Carotid Artery

The internal jugular vein is found in the carotid triangle, ?

Carotid triangle

carotid triangle, a space bounded

Laterally by the sternocleidomastoid muscle, Superiorly by the posterior belly of the digastric, and Anteriorly by the superior belly of omohyoid.

Omoclavicular Triangle has what specific vein? That vein is vulnerable to injury how and why?

External Jugular Vein It is vulnerable to superficial wounds to the lateral neck and omohyoid triangle. Why? Because its superficial and most vulnerable to stabs. in the superficial fascia, so it could be easily injured by a superficial wound

Carotid Triangle is bounded?

Medially by omohyoid, Laterally by sternocleidomastoid, and Superiorly by the posterior belly of digastric.

To create an emergency airway, describe the cut that needs to be made? So the opening is made between? This area is below the?] Which is usual place where ?

Midline cut can be made through cricothyroid ligament and membrane. So the opening is created between the thyroid cartilage and the cricoid cartilage. Below the glottis and tracheal inlet Food gets lodged

Which of the following statements about the cervical plexus is true? It comprises spinal segments C1-C3 It consists solely of cutaneous nerves It consists solely of ventral rami of spinal nerves It supplies motor innervation to platysma

It consists solely of ventral rami of spinal nerves

What structures can be damaged during thyroidectomy if the surgeon is not careful?

1. Superior Thyroid artery runs with External Laryngeal nerve 2. Inferior Thyroid artery runs with Recurrent Laryngeal Nerve

Inferior thyroid arteries are from Superior thyroid arteries are from?

thyrocervical trunk; External Carotid Arteries

How did the tumor cause breathlessness?

Since the thyroid is anterior to the trachea, an abnormal mass can push on the trachea and partially occlude the lumen, causing breathlessness.

You are called on to do a venous catheterization to measure central venous pressure in the heart. Which muscle of the neck would provide the best area of approach to the internal jugular vein?

Sternocleidomastoid

The layer of encircling cervical fascia that splits to enclose sternocleidomastoid and trapezius muscles is the:

Superficial layer of deep fascia

Any irritation of the diaphragm (e.g. infection, tumor) may create referred pain that seems (to the patient) to originate in the area atop the shoulder. This is due to the fact that the phrenic nerve shares spinal segments with what cutaneous nerve in the shoulder region?

Supraclavicular Nerve

Why would patients with goiter be likely to have shortness of breath and dysphagia? Enlarged thyroid will press initially on what? Pressure will increase when what? What muscle is pushed down into superior mediastinum? What are the two structures that then get compressed?

The enlarged thyroid will press initially on the trachea. Pressure will increase when it reaches a large size since the sternothyroid muscle will be forced down to the superior mediastinum, and the trachea and esophagus will be compressed.

The muscular triangle is found in the ________ triangle of the neck

Anterior Triangle of the neck

Post-operatively, the surgeon carefully ensured that the patient was speaking properly. Why?

Damage to the external laryngeal nerve can result in the inability to tense the vocal folds, producing weakness of the voice; the cricothyroid muscle is unable to contract. Bilateral damage to the recurrent laryngeal nerves may cause the patient to lose speech completely and cause difficulty in breathing.

Which vessels should be ligated before doing lower subtotal thyroidectomy?

INFERIOR THYROID ARTER and Middle and Inferior Thyroid Veins

A 47-year-old woman is diagnosed as having a thyroid tumor. Surgery to remove the cancerous growth is undertaken. In which triangle of the neck will the surgeon make an incision to gain access to the gland?

Muscular Triangle

These structures are all located in the superficial fascia of the neck EXCEPT External jugular vein Platysma muscle Cervical branch of the facial nerve Omohyoid muscle Transverse cervical nerve

Omohyoid muscle

Which structure should be carefully protected from injury during such subtotal thyroidectomy operation?

The recurrent laryngeal nerve, because of its intimate relation to the inferior thyroid artery, is susceptible for injury during thyroidectomy.

Which lymph nodes should the physician examine for metastases if a malignant tumor is suspected?

The thyroid gland is drained primarily by the deep cervical lymph nodes.

Why did the tumor move upward when the patient swallowed? Thyroid gland is invested by? It does what? Which causes whay? Any pathological swelling of the thyroid will do what that makes it distinguished from a mass in some other part of the neck?

The thyroid gland is invested in a sheath derived from the pretracheal fascia. This holds the gland onto the larynx and the trachea, so the thyroid follows the movements of the larynx during swallowing. Any pathological swelling of the thyroid will move upwards with swallowing, distinguishing it from a mass in some other part of the neck.

What is the gross form and location of the thyroid gland? R & L lobes connected by? Isthmus extends from thyroid cartilage to where? Isthmus lies where? Pyramidal lobe is present or not? Course?

The thyroid has left and right lobes connected by an isthmus. It extends from the thyroid cartilage to about the fourth or fifth tracheal ring. The isthmus lies anterior to the second, third and fourth tracheal rings. A pyramidal lobe may or may not be present, extending superiorly from the region of the isthmus.

1. What structures can be damaged during thyroidectomy if the surgeon is not careful? What does the 1st nerve supply? 2. What happens if its severed? 3. What happens if the second nerve is severed?

The two main arteries supplying the gland are accompanied by nerves that can be damaged druing thyroidectomy: 1. The superior thyroid artery is related to the external laryngeal nerve. This nerve supplies the cricothyroid and cricopharyngeus muscles. If severed, it will result in weakness of voice due to inability to tense vocal folds (INABILITY to contract cricothyroid muscle) The inferior thyroid arteries are related to the recurrent laryngeal nerve. 3. Inability to speak and possibly difficulty to breath

The supraclavicular nerves come from

c3 c4 in the cervical plexus

Function of Omohyoid muscles?

depresses and stabilizes the hyoid bone.

The inferior thyroid arteries are closely associated with the ? and supply?

middle cervical sympathetic ganglia and supply the inferior poles of the thyroid.

Surgeon suggests doing bilateral subtotal thyroidectomy to relieve symptoms particularly of the lower parts of the gland. The patient needs to be put on what before the operation? Whats their purpose?

put on a two-week course of iodine and antithyroid drugs before the operation to reduce the vascularity of the thyroid.