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Questions and Answers
What is the primary effect of a surgical phrenic nerve crush?
What does the superior cervical ganglion form a plexus around?
Which structures do the cervical sympathetic trunk lie in relation to?
Which symptom is NOT characteristic of Horner's syndrome?
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Horner's syndrome results from an interruption of which anatomical structure?
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Enophthalmos in Horner's syndrome refers to which condition?
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Which ganglion forms a plexus around the inferior thyroid artery?
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What causes ptosis in Horner's syndrome?
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What is the role of the cervical sympathetic trunk?
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Anhidrosis in Horner's syndrome is characterized by which condition?
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What is the primary distinguishing characteristic of the superficial fascia?
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Which muscle is primarily associated with the superficial fascia of the neck?
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What is the function of the platysma muscle?
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Which layer of fascia surrounds the sternocleidomastoid and trapezius muscles?
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What is the main role of the deep fascia in the neck?
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Which of the following muscles is NOT covered by the investing layer of deep fascia?
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From where does the investing layer of the deep fascia extend superiorly?
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What is one of the functional roles of the deep cervical fascia?
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Which nerve supplies the platysma muscle?
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Where does the platysma muscle extend from?
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Which component is NOT found in the superficial fascia of the neck?
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What structure is NOT covered by deep cervical fascia?
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Which movement is NOT facilitated by the deep fascia of the neck?
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What role does the superficial fascia play in relation to blood vessels?
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What is the inferior boundary of the neck?
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Which structures are primarily found in the anterior region of the neck?
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What is the significance of Langer's lines in surgical operations?
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Which layers comprise the cervical fascia?
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What structure can be palpated in the posterior region of the neck?
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Which of the following is NOT identified as a structure in the lateral regions of the neck?
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What is the role of the cervical plexus in the neck?
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Which of the following is a key component of the neck's anterior region?
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Which structure is NOT typically part of the cervical plexus?
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What can typically be found in the lateral regions of the neck during palpation?
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Which of the following best describes the neck?
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Which cranial nerves are typically found in the anterior region of the neck?
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What is the primary purpose of the deep fascia in the neck?
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Which spinal segments are primarily responsible for the cutaneous innervation of the neck?
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The phrenic nerve is formed from the anterior rami of which spinal segments?
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What area does the lesser occipital nerve (C2) supply?
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The supraclavicular nerves arise from which spinal segments?
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Which of the following nerves supplies the lateral neck and upper thoracic region?
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Which nerve is the thickest cutaneous nerve in the body?
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Which branches of the cervical plexus are primarily sensory?
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What is the primary function of the ansa cervicalis?
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What is the consequence of a cervical plexus block regarding the diaphragm?
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Which nerve supplies the skin over the auricle and parotid gland?
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Which nerve provides innervation to the diaphragm?
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Which fascia surrounds the visceral organs in the neck?
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What is the main concern when performing a cervical plexus block on patients with pulmonary conditions?
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What does the deep cervical plexus block anesthetize?
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What is the function of the prevertebral fascia?
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Which of the following structures is located within the carotid sheath?
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What does the term 'musculofascial collar' refer to?
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What is a major clinical significance of fascial spaces in the neck?
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The retropharyngeal space is bound anteriorly by which structure?
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In which compartment would you find pharyngeal and laryngeal structures?
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Which of the following compartments contains lymphatic vessels and nerves?
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The pretracheal fascia is primarily involved with which structures?
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Which structure is closely related to the parapharyngeal space?
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What is the primary role of the investing fascia?
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Which layer of fascia is involved in allowing carotid sheath structures to glide during neck movement?
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The retropharyngeal space extends from which region to the diaphragm?
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Study Notes
Learning Outcomes
- Understand surface and sectional anatomy of the neck.
- Describe layers of deep cervical fascia and fascial spaces, noting their clinical significance.
- Explain cutaneous supply and cervical plexus of the neck, including cervical plexus block.
Anatomy of the Neck
- The neck extends from the base of the skull to the inferior border of the mandible and the superior thoracic aperture.
- Serves as a conduit for structures between the head and trunk.
Divisions of the Neck
- Divided into four regions:
- Anterior region: Contains strap muscles, visceral structures (pharynx, larynx, trachea, esophagus), vascular elements, cranial nerves, thyroid, and parathyroid glands.
- Right and Left Lateral regions: Include superficial muscles and cervical lymph nodes, with palpation points like the mastoid process, clavicle, and the sternocleidomastoid muscle.
- Posterior region (nucha): Involves the cervical vertebral column, spinal cord, and is palpated via features like the external occipital protuberance and the 7th cervical vertebra.
Key Structures in the Neck
- Anterior region palpation points: Hyoid bone, thyroid cartilage, cricoid cartilage, tracheal rings, isthmus of the thyroid gland, thyroid lobes, suprasternal notch, and common carotid artery.
- Lateral region palpation points: Sternocleidomastoid muscle, trapezius muscle, external jugular vein, and transverse process of the atlas vertebra.
Langer's Lines
- Langer's lines (tension or cleavage lines) indicate the natural orientation of collagen fibers in the dermis.
- Surgical incisions aligned with these lines promote better healing and reduced scarring.
Skin Characteristics
- The neck skin is thin and under tension, corresponding with wrinkle lines and Langer’s lines, making incisions along these lines preferable for healing.
Fascia of the Neck
- Two main layers of cervical fascia:
- Superficial fascia: Thin, subcutaneous tissue that contains the platysma muscle and various nerves, blood, and lymphatic vessels.
- Deep fascia: Covers muscles, viscera, and neurovascular structures; consists of several layers including the investing layer.
Muscles and Functions
- Platysma helps in depressing the mandible and releases pressure in underlying veins for venous return.
- Investing layer encases sternocleidomastoid and trapezius muscles, creating a musculofascial collar that facilitates head rotation and neck flexion.
Attachments of the Investing Layer
- Superiorly connects to the superior nuchal line, lower border of the mandible, ligamentum nuchae, mastoid process, and the 7th cervical spine.### Fascial Structures of the Neck
- External occipital protuberance located anteriorly to the symphysis menti.
- Hyoid bone serves as an inferior landmark, alongside the manubrium, clavicle, acromion process, and spine of the scapula.
Pretracheal Fascia
- Forms the visceral compartment surrounding neck organs.
- Located deep to the infrahyoid strap muscles within the anterior triangle of the neck.
- Provides an upward attachment to the hyoid bone and thyroid cartilage.
- Encloses the thyroid gland and blends with the aorta's adventitia and carotid sheath.
Prevertebral Fascia
- Encloses intrinsic neck muscles, forming the vertebral compartment.
- Extends from the base of the skull down to the level of the T3 vertebra.
- Prolonged laterally towards the axillary sheath.
- Allows movement of the pharynx and esophagus during swallowing and neck movements.
Carotid Sheath
- Surrounds crucial neurovascular structures including the internal jugular vein, carotid arteries, and vagus nerve.
- Formed from a blend of connective tissues associated with investing and pretracheal fascia.
- Contains sympathetic trunk situated behind the carotid sheath.
Compartmentalization of the Neck
- Musculofascial collar: Involves muscles and fascia that aid in head rotation.
- Muscular compartment: Holds muscles regulating swallowing and speaking.
- Visceral compartment: Encloses pharynx, larynx, esophagus, trachea, and thyroid glands.
- Neurovascular compartment: Contains major arteries, veins, and nerves.
- Vertebral compartment: Houses vertebrae and intrinsic neck muscles facilitating neck movement.
Fascial Spaces and Infection Spread
- Fascial spaces prevent adherence of structures and allow organ movement.
- Facilitate the spread of infections from the mouth to neck spaces and potentially into the mediastinum.
Parapharyngeal Space
- Lies postero-lateral to the pharynx, extending forward into the sublingual region.
- Connected to interfascial spaces and drains lymph from the nose, throat, and jaw.
- Clinical significance includes the risk of infection spreading from the mouth to the pharynx and neck.
Retropharyngeal Space
- Located between the vertebral column and visceral compartment of the neck, extending from the skull base to the diaphragm.
- Functions allow expansion during swallowing.
- Routes infections from the mouth to the superior mediastinum, primarily from first and third molars.
Ludwig’s Angina
- Condition characterized by bilateral swelling of the submental, sublingual, and submandibular spaces.
- Usually results from tooth abscesses that spread pus through lingual plates.
- Symptoms include hardening of the floor of the mouth, elevated tongue, and potential airway obstruction.
- Requires prompt medical attention to prevent severe complications, including asphyxia and pneumonia.### Cutaneous Innervation of the Neck
- Cutaneous nerves supply skin of the neck, upper thorax, scalp, and ear.
- Derived from spinal segments C2, C3, and C4; C1 has no cutaneous branch.
- Erb’s Point (nerve point of the neck) is located at the posterior border of the sternocleidomastoid muscle.
- Anterolateral skin of the neck is supplied by ventral rami of C2, C3, and C4.
- Posterior aspect of the neck is supplied by dorsal rami of C2, C3, C4, and C5.
Cutaneous Nerves of the Neck
- The front and sides of the neck receive supply from four cutaneous nerves from C2, C3, and C4.
- Lesser Occipital Nerve (C2): Innervates the posterosuperior scalp, posterior auricle, and upper middle neck.
- Great Auricular Nerve (C2 and C3): Supplies skin over auricle, parotid gland area, and angle of the mandible.
- Transverse Cervical Nerve (C2 and C3): Supplies anterior and lateral aspects of the neck.
- Supraclavicular Nerves (C3 and C4): Provide sensation to skin over the suprascapular fossa and upper thoracic region.
Cervical Plexus
- The cervical plexus is a network of nerve fibers formed by the anterior rami of spinal nerves C1-C4, located in the posterior triangle of the neck.
- Divided into superficial (sensory) and deep (motor) branches.
Superficial Branches
- Formed from C1-C4:
- Lesser occipital nerve (C2)
- Great auricular nerve (C2 and C3)
- Transverse cervical nerve (C2 and C3)
- Supraclavicular nerves (C3 and C4)
Deep Branches
- Communicating branch (C1): Merges with hypoglossal nerve, innervates thyrohyoid and geniohyoid muscles.
- Ansa cervicalis: A loop formed by C1 and C2-C3 roots, innervates infrahyoid muscles (omohyoid, sternohyoid, sternothyroid).
- Phrenic nerve (C3-C5): Provides motor innervation to diaphragm and sensory innervation to diaphragmatic pleura and pericardium.
Muscular Branches
- Innervates prevertebral muscles, sternocleidomastoid, trapezius, and scalene muscles.
Cervical Plexus Block
- Used in surgical procedures such as thyroid surgery and neck operations.
- Administered at the midpoint of the posterior border of sternocleidomastoid (Erb’s point).
- Superficial block anesthetizes skin; deep block anesthetizes neck muscles.
- Phrenic nerve blockade is avoided in pulmonary or cardiac disease patients.
Cervical Sympathetic Trunk
- Located on either side of the cervical vertebral column, behind carotid sheaths.
- Consists of three ganglia:
- Superior Cervical Ganglion: Forms plexus around internal and external carotid arteries.
- Middle Cervical Ganglion: Forms plexus around inferior thyroid artery.
- Inferior Cervical Ganglion: Forms plexus around vertebral and subclavian arteries.
Horner’s Syndrome
- Results from interruption of sympathetic trunk, usually in upper thoracic or lower cervical regions.
- Characterized by:
- Miosis (constricted pupil)
- Ptosis (drooping of upper eyelid)
- Anhidrosis (absence of sweating on face)
- Enophthalmos (sinking of eye into bony cavity)
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Description
Test your knowledge on the surface and sectional anatomy of the neck in this Head and Neck Anatomy II quiz. Explore the structures, layers of deep cervical fascia, and their clinical implications to enhance your understanding of the neck's complex anatomy.
