6. Cervical Region
Terms
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- What 5 structures are superficial in the cervical region?
-
1. External jugular vein
2. Cutaneous nerves
3. Platysma muscle
4. Sternocleidomastoidmuscle
5. Trapezius muscle - What 4 cutaneous cervical nerves can be seen superficially? What are their cervical roots?
-
-Transverse cervical (C2/C3)
-Great auricular (C2/C3)
-Supraclavicular nerves (C3/C4)
-Lesser Occipital nerve (C2/C3) - What innervates the platysma?
- CN VII - facial
- What is the 'laryngeal prominence'? What cervical level?
- Adams apple - C4/C5
- What cervical level is the hyoid bone?
- About c3
- What is the cricoid cartilage?
- The first complete ring of the trachea; just below the thyroid cartilage
- What forms the external jugular vein?
-
-Posterior auricular vein
-Retromandibular vein
-Come together to form EJV - What is a useful feature of the EJV?
- -Its prominence can suggest intrathoracic pressure, tumors, or congestive heart failure.
- What type of nerves are the cutaneous cervical nerves?
- Sensory
- In what region does the transverse cervical nerve receive sensory info?
- Anterior triangle; curves around from the mid-posterior StrnCMst border then crosses over it. Deep to the platysma
- Where does the Great Auricular Nerve recieve sensory info from?
-
-Skin over parotid gland
-Backside of the ear
-Skin from mandibular angle to mastoid process - Where does the lesser occipital nerve provide innervation?
-
-Neck skin
-Scalp behind the ear - Where do the supraclavicular nerves innervate?
- Small branches spread across the neck skin and shoulder (it emerges as one trunk from SCM)
- What is the platysma also called?
- The shaving muscle
- What is the function of the platysma?
- Assists in mastication; but inervated by CN VII (not V3!)
- How is the platysma classified (w/ ref to grouping)?
- As a muscle of facial expression.
- What innervates the SCM (sternocleidomastoid)?
- The spinal accessory n. CN XI
- What is the origin/insertion of SCM?
-
Origin: mastoid process of temporal bone
Insertions: sternal manubrium + clavicle -
How does the SCM act when contr.
-Alone
-Both sides -
Alone: turns head to opposite side
Together: flexion - What does CN XI also innervate?
- Trapezius
- What is the proper name for the strap muscles of the neck?
- Infrahyoid muscles
- What are the strap muscles in general; what is their function?
- Ribbon like muscles that assist in Speech, Swallowing, and Stability of Hyoid bone and Thyroid cartilage.
- What are all of the strap muscles innervated by?
- Ansa cervicalis (C1-C3)
- List the 4 strap muscles:
-
-Omohyoid
-Sternohyoid
-Sternothyroid
-Thyrohyoid -
Omohyoid:
-origin
-insertion -
Origin = shoulder
Insertion = hyoid bone - What vascular structure is just beneath the omohyoid?
- Common carotid
- What strap muscle is most medial?
- Sternohyoid
- What strap muscle lies beneath sternohyoid?
- Sternothyroid
- What lies just above sternothyroid?
- Thryohyoid
-
Sternohyoid:
-origin
-insertion -
origin = sternum
insertion = hyoid bone -
Sternothyroid:
-origin
-insertion -
origin = manubrium (post border)
insertion = thyroid cartilage -
Thyrohyoid:
-origin
-insertion -
origin = thyroid cartilage
insertion = hyoid bone - What exactly innervates the Thyrohyoid muscle?
- C1 thru Hypoglossal nerve
- What is the main function of the thyrohyoid muscle?
- To close the laryngeal orifice during swallowing - prevents food from entering the larynx.
- what are the roots of the cervical plexus?
- C1-C5
- What do the cervical nerves do?
- Provide sensry and motor innervation to the NECK.
- What are the sensory nerves of the cervical plexus?
-
-Lesser occipital
-Greater auricular
-Transverse cervical
-Supraclavicular - What are the motor nerves of the cervical plexus?
-
-Ansa cervicalis
-Phrenic
-Spinal accessory - What are the roots of ansa cervicalis?
- C1-C3
- What does ansa run with?
- hypoglossal nerve; lies within carotid sheath.
- what does the ansa cervicalis innervate?
- strap muscles - motor
- What are the nerve roots of the phrenic nerve, and what muscle does it lay right next to?
-
C3,4,5 keep diaphragm alive..
-lays next to anterior scalene muscle. - what cervical nerve roots does the accesory nerve CN XI pick up?
- C2,3,4
- What is the Posterior Triangle divided into?
-
1. Occipital triangle
2. Supraclavicular triangle - What are the borders of the posterior triangle overall?
-
Ant: Sternocleidomastoid
Post: Trapezius
Inferior: mid 1/3 clavicle - What structures lie within the posterior triangle?
-
1. External jugular v.
2. Occipital artery (apex)
3. Spinal accessory n.
4. Portion of Subclavian artery - Structure separating Ant/Post triangles:
- Sternocleidomastoid
-
Where in posterior triangle is:
-Safe area
-No man's land -
Safe = above posterior omohyoid belly; few important structures
Danger = below post omohyoid belly - watch out! - What is in No man's land of the posterior triangle?
-
-Brachial plexus
-Cervical plexus
-Subclavian artery/vein
-Thyrocervical trunk - Anterior triangle borders:
-
-Midline of neck
-Inferior mandible border
-Anterior SCM border - 2 triangles within Anterior tri:
-
-Carotid
-Muscular - Carotid triangle borders:
-
-Omohyoid superior belly
-Digastric posterior belly
-SCM anterior border - Important structures in Carotid triangle:
-
-Carotid sheath (includes sinus)
-Ansa cervicalis
-Hypoglossal nerve - What is a bruit?
- Turbulent sound resulting from bloodflow through artery at faster rate than normal.
- What will a Bruit heard in the carotid triangle indicate?
- Arteriosclerosis
- Muscular triangle borders:
-
-Omohyoid Superior belly
-Midline of neck
-Anterior SCM border - Important structures in the Muscular Triangle:
- Strap muscles + Thyroid gland and cartilage
- What will a Bruit heard in the Muscular triangle indicate?
- Hyperthyroidism
- 3 Main branches of the Aortic Arch:
-
RIGHT: Brachiocephalic trunk
LEFT: Subclavian a. + Common Carotid a. - What nerve is blocked in a lip laceration? Why?
- Infraorbital - to prevent swelling and make sutures easier
- Temporal Arteritis
- Pathological thicken/hardening of Superfic. Temporal artery due to autoimmune inflammation of the vessel lining
- Symptoms associated with Temporal arteritis:
-
-Pain in palpating temporal area
-Unilateral vsion loss
Common in 60-70 yr olds mostly - 3 Sections of Subclavian A:
-
1. Medial to Anterior Scalene
2. Behind Anterior scalene
3. Lateral to Ant. scalene - Branches of Section 1:
-
-Vertebral
-Thyrocervical trunk - Vertebral artery supplies:
- Circle of Willis
- Subclavian Steal Syndrome:
-
-Occlusion of Subclavian between Common Carotid/Vertebral branchs
-Diminished bloodflow to arm - What is a symptom of subclavian steal syndrome?
- When pt lifts arm, faints
- Reason for fainting when lifting arm in Subcl. Steal Syndrome:
-
Blood flows up ICA -> Circle of Willis -> down Vertebral
to supply subclavian on other side of occlusion.
-Insufficient blood to brain - Vessel commonly used for bypass:
- Internal thoracic
- EJV is formed by:
-
-Retromandibular
-Posterior auricular -
Swollen Nodes in Ant triangle:
Swollen Nodes in Post & Ant triangles: -
Ant = Bacterial (Strep)
Both = Viral (mono) - What 4 arteries anastomose around the scapula?
-
-Transverse cervical
-Suprascapular
-Subscapular
-Circumflex Scapular - What are the deep muscles in the cervical region?
-
-Longus Capitus
-Longus colli - Where are the o/i of longus capitis?
-
O = Bodies and Transverse processes of cervical vertebrae
I = occipital bone of skull - What innervates longus capitis and colli?
- Cervical nerves
- What is the action of longus capitis and colli together?
- Flexion of neck
- Action of Scalenes:
- Accessory muscles of breathing
- O and I of Scalenes:
-
O = cervical vertebrae transverse processes
I = 1st and 2nd ribs - 4 Structures Surround Anterior Scalene Muscle:
-
Subclavian vein = anterior
Subclavian artery = posterior
Brachial plexus = posterior
Phrenic nerve = along belly - Stellate ganglion:
- Coalescence of Inferior cervical ganglion with 1st Thoracic ganglion - occasional.