Anatomy wk2exam

hyoid level

hyoid level

c3

hyoid tethered by

stylohyloid ligament

cricoid cartilage level

C4-5

trachea level

C6

what does superficial cervical fascia cover

Superficial cervical fascia – loose CT + platysma muscle (thin muscle layer used in facial

expressions)

Deep cervical fascia – surrounds the neck and creates divisions to create a

visceral and somatic compartment

• Superficial deep cervical layer – around the

• whole neck

• Superficial deep cervical layer – encloses the

• SCM, trapezius, infra-hyoid muscles (also called “investing fascia”)

• Middle deep cervical layer – surrounds the

• thyroid, larynx, pharynx, esophagus

• Middle deep cervical layer – anterior in front of

trachea

(pretracheal fascia)

• Middle deep cervical layer – posterior

buccopharyngeal fascia

• Deep deep cervical layer – goes around the

• vertebral column + its muscles, creating the somatic neck portion

• Deep deep cervical layer – goes around the vertebral column + its muscles, creating the ____ neck portion

• somatic

• Deep deep cervical layer – Anterior portion splits into:

• o Alar layer

  o Prevertebral layer

The 3 layers of ____ also create a carotid sheath that surrounds carotid

artery, internal jugular vein, vagus nerve

deep cervical fascia

The 3 layers of deep cervical fascia also create a ____ that surrounds carotid

artery, internal jugular vein, vagus nerve

carotid sheath

The 3 layers of deep cervical fascia also create a carotid sheath that surrounds ____

carotid

artery, internal jugular vein, vagus nerve

Cervical spaces are compartments made by the

deep cervical layers of fascia

3 cervical spaces

Pre-tracheal

retropharyngeal

danger

Pre-tracheal space – anterior to the ___, surrounding the trachea + thyroid gland,

going into the superior mediastinum

esophagus

Pre-tracheal space – anterior to the esophagus, surrounding the ____,

going into the superior mediastinum

trachea + thyroid gland

Pre-tracheal space – anterior to the esophagus, surrounding the trachea + thyroid gland,

going into the ____

superior mediastinum

Infection of the pretracheal space can spread to the

suprasternal space or the

superior mediastinum

Retropharyngeal space – behind the ____, anterior to alar fascia, going into posterior mediastinum

oropharynx + esophagus

Retropharyngeal space – behind the oropharynx + esophagus, anterior to ___, going into posterior mediastinum

alar fascia

Retropharyngeal space – behind the oropharynx + esophagus, anterior to alar fascia, going into ____

posterior mediastinum

Infection of the retropharyngeal space can spread to the

thoracic mediastinum

Danger space – behind the ____, between alar and prevertebral fascia

retropharyngeal space

Danger space – behind the retropharyngeal space, between ___

alar and prevertebral fascia

Danger space - infection can spread

anywhere from the base of the skull to the abdomen

1. Anterior cervical region with the

1. submandibular triangle, submental triangle, muscular triangle, and carotid triangle

1. Lateral cervical region (posterior triangle) with the

1. omoclavicular triangle and occipital triangle

Posterior cervical region

Platysma

• ▪  Fxn:

• ▪  Nerve:

• ▪  Fxn: depresses, wrinkles skin of lower face/mouth, tenses neck skin

• ▪  Nerve: facial nerve (cranial nerve 7)

SCM

fcn:

nerve:

• Fxn: unilateral motion causes neck tilt (ipsilateral) or neck rotation (contralateral).

  Bilateral motion causes neck flexion.

• ▪  Nerve: motor innervation from spinal accessory nerve (cranial nerve 11) and cutaneous

  innervation from cervical plexus

Trapezius

0. fcn

1. nerve

• Fxn: elevate/depress/retract scapula

• ▪  Nerve: motor innervation from spinal accessory nerve (cranial nerve 11) and cutaneous

  innervation from cervical plexus

Superficial muscles of posterior cervical and lateral cervical regions

platysma

scm

trapezius

Deep muscles of the lateral region (posterior triangle)

o Scalene (anterior, middle, posterior)

o Levator scapulae

nfrahyoid muscles (below the hyoid bone) in the

anterior triangle

infrahyoid fcn

they all depress the hyoid, elevate the larynx for speaking and swallowing

infrahyoid

nerve

all except 1 are innervated by the ansa cervicalis (c1-c3) of the cervical plexus

infrahyoid

muscles

o Omohyoid (from scapula notch to hyoid bone)
o Sternohyoid (from sternum to hyoid bone)
o Sternothyroid (from sternum to thyroid cartilage)
o Thyrohyoid (from hyoid bone to thyroid cartilage)

Thyrohyoid (from hyoid bone to thyroid cartilage)

nerve

c1 (exception to ansa cervicalis c1-c3 infrahyoids)

Suprahyoid muscles (above the hyoid bone) in the

anterior triangle

Suprahyoid muscles (above the hyoid bone)

list

mylohyoid

geniohyoid

stylohyoid

digastric

suprahyoid fcns:

mylohyoid

geniohyoid

stylohyoid

digastric

mylohyoid: elev hyoid

geniohyoid: protract hyoid

stylohyoid: elevate, retract hyoid

digastric: elev hyoid

suprahyoid nerves:

mylohyoid

geniohyoid

stylohyoid

digastric

mylohyoid: trigeminal cn5

geniohyoid: c1

stylohyoid: facial nerve cn7

digastric:

• ant: trigeminal cn5

• post: facial nerve cn7

• Ventral rami of cervical nerves 􏰀 cervical plexus (___)

• C1-C4

cutaneous and muscular

Cutaneous cervical plexus: emerge into the ___ region of the neck @ the posterior border of the SCM, going from C2-C4

lateral

Cutaneous cervical plexus: emerge into the lateral region of the neck @ the posterior border of the ____, going from C2-C4

SCM

Cutaneous cervical plexus: emerge into the lateral region of the neck @ the posterior border of the SCM, going from

C2-C4

Cutaneous cervical plexus:

• Lesser occipital nerve (C_) – inferolateral parts of the scalp

• ▪  Greater auricular nerve (C_) – lateral region of scalp

• ▪  Transverse cervical nerve (C_) – anterior triangle of neck

• ▪  Supraclavicular nerve (C_) – dermatomes of shoulder + upper chest

• Lesser occipital nerve (C2) – inferolateral parts of the scalp

• ▪  Greater auricular nerve (C2-C3) – lateral region of scalp

• ▪  Transverse cervical nerve (C2- c3) – anterior triangle of neck

• ▪  Supraclavicular nerve (C3-C4) – dermatomes of shoulder + upper chest

Cutaneous cervical plexus:

• Lesser occipital nerve (C2) – ___

• ▪  Greater auricular nerve (C2-C3) – ___

• ▪  Transverse cervical nerve (C2- c3) – ___

• ▪  Supraclavicular nerve (C3-C4) – ____

• Lesser occipital nerve (C2) – inferolateral parts of the scalp

• ▪  Greater auricular nerve (C2-C3) – lateral region of scalp

• ▪  Transverse cervical nerve (C2- c3) – anterior triangle of neck

• ▪  Supraclavicular nerve (C3-C4) – dermatomes of shoulder + upper chest

Muscular cervical plexus: makes up the ____ from C1-C3 which is a nerve anastomosis, superficial to the carotid sheath that innervates the infrahyoid muscles

ansa cervicalis

Muscular cervical plexus: makes up the ansa cervicalis from ___ which is a nerve anastomosis, superficial to the carotid sheath that innervates the infrahyoid muscles

C1-C3

Muscular cervical plexus: makes up the ansa cervicalis from C1-C3 which is a nerve anastomosis, superficial to the ____ that innervates the infrahyoid muscles

carotid sheath

Muscular cervical plexus: makes up the ansa cervicalis from C1-C3 which is a nerve anastomosis, superficial to the carotid sheath that innervates the ___

infrahyoid muscles

Phrenic nerve innervating the diaphragm, coming off branches of ___ beneath the prevertebral fascia to the superior mediastinum

C3-C4-C5

Phrenic nerve innervating the diaphragm, coming off branches of C3-C4-C5 beneath the ____ to the superior mediastinum

prevertebral fascia

Superior accessory nerve (Cranial nerve 11)

Will innervate the

trapezius, SCM, intrinsic musculature of the larynx

Superior accessory nerve (Cranial nerve 11)

Paralysis of spinal accessory nerve: inability to

shrug the shoulder

Superior accessory nerve (Cranial nerve 11)

Torticollis:

can be due to spinal accessory nerve injury (or other causes) 􏰀 SCM is tight, so the

head is tilted to one side and the chin is turned away to the other side

Cervical plexus block relieves pain in the

neck/shoulder area
o Local anesthetic is injected at the lateral region of the neck, along the posterior border of the SCM

Cervical plexus block relieves pain in the neck/shoulder area
o Local anesthetic is injected at the lateral region of the neck, along the

posterior border of the SCM

Neck arteries:

subclavian, carotid

On the right,

right: brachiocephalic artery —>

left: aortic arch —>

right: brachiocephalic artery —> subclavian artery and common carotid

left: aortic arch —> subclavian artery and

aortic arch —> common carotid

The subclavian branches into:

• ▪  Vertebral branch to supply the

• brain

The subclavian branches into:

• Internal thoracic branch to enter the

• thorax

The subclavian branches into:

• ____ to give rise to the inferior thyroid/transverse cervical/suprascapular artery

• Thyrocervical trunk

• The subclavian branches into:

• Thyrocervical trunk to give rise to the

• inferior thyroid/transverse cervical/suprascapular

  artery

The subclavian branches into:

• Costocervical branch to give rise to the

• deep cervical/superior intercostal arteries

The subclavian branches into:

• Dorsal scapular branch goes below the ___ to create anastomosis (circumflex

  scapular, subscapular arteries)

• rhomboids

At ____, the right and left common carotid’s will split at the carotid bifurcation into their respective internal and external carotids

C4

At C4, the right and left common carotid’s will split at the ___ into their respective internal and external carotids

carotid bifurcation

Carotid ___ monitors blood pressure (baroreceptor). Carotid ____ monitors Po2, blood pH and Pco2 (chemoreceptor)

sinus, body

Common carotids split into:

internal carotid artery

external carotid artery

• External carotid artery 􏰀 supplies the face/visceral neck with 8 branches:

• ●  Superior thyroid branch (in the neck) supplying thyroid, larynx, infrahyoid

• ●  Ascending pharyngeal branch (in the neck) supplying pharyngeal region,

  middle ear, meninges, prevertebral muscles

• ●  lingual branch supplying the tongue

• ●  facial branch supplying the face

• occipital branch (in the neck) supplying the SCM, deep back muscles, posterior scalp

• ●  posterior auricular branch (in the neck) supplying behind the ear

external jugular vein (EJV) is superficial, formed @

the angle of the jaw

external jugular vein (EJV)

drains

drains retromandibular vein, posterior auricular vein, suprascapular vein, superficial cervical

vein, anterior jugular vein, posterior jugular vein

internal jugular vein (IJV) drains venous blood from the ____, carried in the carotid sheath

head and neck

internal jugular vein (IJV) drains venous blood from the head and neck, carried in the ___

carotid sheath

IJV drains what veins

facial vein, lingual vein, superior/middle thyroid veins

IJV joins with Joins with ___ behind the sternoclavicular joint —> brachiocephalic vein

subclavian veins

IJV joins with Joins with subclavian veins behind the sternoclavicular joint —> ____

brachiocephalic vein

Thyroid gland
o 2 lobes connected by an isthmus

• ▪  ___ to tracheal rings

• ▪  ___ to cricoid cartilage

• ▪  Occasionally has a pyramidal lobe (superior to isthmus)

• ▪  Anterior to tracheal rings

• ▪  Caudal to cricoid cartilage

Thyroid gland

around the

trachea, esophagus

Thyroid gland

Partially covered by

sternothyroid, sternohyoid muscles

Thyroid

arterial supply

• superior thyroid artery (branch of external carotid), inferior thyroid artery (branch of subclavian —> thyrocervical trunk)

• Thyroid

  arterial supply:

• superior thyroid artery (branch of ___ carotid), inferior thyroid artery (branch of ___—> ___ trunk)

• superior thyroid artery (branch of external carotid), inferior thyroid artery (branch of subclavian 􏰀 thyrocervical trunk)

• Thyroid

  venous drainage

• goes over the surface of the gland and trachea, draining the

• superior/middle/inferior thyroid veins

Superior parathyroid glands

• ▪  Posterior to apex of thyroid lobes

• ▪  Derived from ___ pharyngeal pouch

• 4th

Inferior parathyroid glands

• ▪  at the base of thyroid lobes

• ▪  derived from __ pharyngeal pouch

• 3rd

Removing all the parathyroid glands
—>

o Drop in blood calcium levels —> tetany (can be fatal)

injuring recurrent vs superior laryngeal nerve

Injuring recurrent laryngeal nerve
o (which is close to the inferior thyroid artery) 􏰀 permanent damage of vocal cord 􏰀 hoarseness

● Injuring superior laryngeal nerve
o Loss of voice strength/range, inability to create high-pitch sounds

hoarseness

Injuring recurrent laryngeal nerve (it is close to the inferior thyroid artery)

nerve close to the inferior thyroid artery

left recurrent laryngeal

Submental/submaxillary nodes beneath the chin
a. Receives lymph from the

oral cavity, submandibular/sublingual glands