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Questions and Answers
Where does the common carotid artery typically bifurcate?
Which artery is typically more posterior after the bifurcation of the common carotid artery?
What structure should you follow to find the superior laryngeal nerve?
Which nerve branches off the hypoglossal nerve (CN XII)?
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Which arteries are expected to be found as branches of the external carotid artery?
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Which muscle is located superior to the sternothyroid?
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What structure lies lateral to the common carotid artery within the carotid sheath?
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What is the primary action of the digastric muscle?
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Which nerve is part of the ansa cervicalis?
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Which muscle is found deep to the anterior belly of the digastric muscle?
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What vessel arises from the internal jugular vein?
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What is the relationship of the vagus nerve within the carotid sheath?
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During dissection, which muscle should be preserved to maintain cervical plexus branches?
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What anatomical structure serves as the anteromedial border of the anterior cervical triangle during dissection?
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Which muscle should be identified, cleaned, and preserved during the neck dissection?
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What is the recommended technique for incising the skin in the anterior neck?
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Where are the anterior jugular veins located in relation to the sternocleidomastoid?
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During dissection, which structure should not be removed to avoid damaging vascular integrity?
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What should be done to the platysma before cleaning it?
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Which anatomical landmark is found just superior to the laryngeal prominence of the thyroid cartilage?
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What is the initial step in preparing for an anterior neck dissection?
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Study Notes
Anterior Neck Dissection Overview
- Surface anatomy landmarks include clavicle, sternoclavicular joint, jugular notch, manubrium, and associated muscles such as sternocleidomastoid and platysma.
- Key structures to palpate: mastoid process, ramus of the mandible, angle and body of the mandible, mental protuberance, hyoid bone, thyroid cartilage, cricoid cartilage, zygomatic arch.
Skin Incision and Reflection
- Make a midline incision from the mental protuberance to the jugular notch to define the borders of the anterior cervical triangle.
- Reflect skin flap towards the inferior border of the mandible to expose deeper structures.
Platysma Muscle
- Identify and clean the platysma; review attachments, actions, and innervation.
- Loosen and reflect the platysma superiorly from the investing fascia.
Sternocleidomastoid Muscle
- Identify the sternocleidomastoid and its attachments, actions, and innervation.
- Recognize the external jugular vein and cutaneous branches of the cervical plexus passing anterior to this muscle, preserving them during dissection.
Superficial Veins and Muscle Identification
- Anterior jugular veins may be present on the investing fascia; remove superficial veins to reveal infrahyoid and suprahyoid muscles.
- Locate the hyoid bone above the laryngeal prominence and clean infrahyoid muscles including sternohyoid, sternothyroid, and omohyoid, noting their relationships and innervations.
Suprahyoid Muscles
- Identify the anterior and posterior bellies of the digastric muscle, noting associations with mylohyoid and stylohyoid.
- Observe the submandibular gland lateral to the anterior belly of the digastric.
Carotid Sheath and Related Structures
- Loosen the sternocleidomastoid from the investing fascia and detach it for better access to the carotid sheath.
- Identify the common carotid artery, internal jugular vein, and vagus nerve within the carotid sheath.
- Note that the internal jugular vein is lateral to the common carotid artery, with the vagus nerve positioned between them.
Arterial Supply and Nerves
- The common carotid bifurcates at the C4-C5 level into the external and internal carotid arteries.
- Important branches of the external carotid artery include the superior thyroid, lingual, facial, and occipital arteries.
Nerve Identification
- Locate the superior laryngeal nerve branching from the vagus nerve near the superior thyroid artery.
- Find the hypoglossal nerve (CN XII) coursing anterolateral to the carotid arteries, which gives off the superior root of the ansa cervicalis.
Facial Artery
- The facial artery crosses the mandible into the face after entering the submandibular gland, essential for blood supply to facial structures.
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Description
This quiz focuses on the surface anatomy of the anterior neck during head and neck dissection. It includes palpation of key anatomical landmarks such as the clavicle, sternocleidomastoid, hyoid bone, and thyroid cartilage. Prepare to apply your understanding of these structures in a practical setting.
