Clinical Anatomy: Torticollis Diagnosis

Study Notes

A 3-month-old girl's head seems to be flexed to the right and her head rotated to the left, indicating a possible case of Torticollis, which is caused by tightness of the Sternocleidomastoid (SCM) muscle.

The laryngeal prominence (Adam's Apple) is an important surface feature in the anterior part of the neck, formed by the thyroid cartilage.
In males, the angle between the two laminae of the thyroid cartilage is narrow, while in females, the angle is wider.
The thyroid cartilage lies at the level of the fourth and fifth cervical vertebrae (C4,5) and rises during swallowing.
The hyoid bone lies superior to the thyroid cartilage, at the level of the body of the third cervical vertebra (C3), and moves during swallowing.
The hyoid bone is U-shaped, with a body and lesser and greater horns.

The transverse process of the atlas (C1 vertebra) can be felt by deep palpation between the angle of the mandible and the tip of the mastoid process.
The cricoid cartilage, part of the laryngeal skeleton, is located at the level of the 6th cervical vertebra, where the pharynx joins the esophagus and the larynx and trachea join each other.
The trachea can be palpated just superior to the jugular notch (Abiva) between the medial ends of the clavicle and the external occipital protuberance.

The neck can be divided into two main blocks: the musculo-vertebral block and the pharynx-larynx block.
The musculo-vertebral block consists of the cervical vertebrae and the muscles grouped around them, bound together by a dense layer of prevertebral fascia.
The pharynx-larynx block is placed in front of the musculo-vertebral block, composed of the pharynx and larynx, partially enclosed in a thin sheath of fascia called the pre-tracheal fascia.
The carotid sheath is a vascular compartment that fills in the angle between the vertebral block and the larynx-pharynx block, containing the internal jugular vein, the common or internal carotid arteries, and the vagus nerve.

The longus colli, scalenus anterior, scalenus medius, scalenus posterior, levator scapulae, and splenius capitis are muscles that make up the musculo-vertebral block.
The semispinalis capitis is a muscle that can cause spasms and headaches.

There are eight cervical nerves, but only seven cervical vertebrae in the cervical region.
Each spinal nerve is located above the vertebra with the same number, except that the nerve C8 is below the 7th cervical vertebra.
The vertebral artery runs vertically through the foramina transversaria.