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Questions and Answers
Which of the following muscles is NOT part of the suprahyoid group?
What is the anatomical significance of the anterior jugular veins?
Which muscle has two bellies and is associated with the intermediate tendon and fibrous sling?
What is the most common cause of goitre worldwide?
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Which of the following muscles of the larynx primarily acts as an abductor of the vocal cords?
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What is a typical sign of unilateral recurrent laryngeal nerve injury?
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What is the primary function of the cricothyroid muscle in the larynx?
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In the context of surgical procedures involving the larynx, what signifies a laryngectomy?
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The thyroid gland is anatomically structured into how many lobes typically?
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Which structure in the neck is primarily affected in a recurrent laryngeal nerve injury?
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Which anatomical feature may pose a risk during neck surgery, potentially causing problems with voice production?
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What is NOT a typical symptom associated with recurrent laryngeal nerve injury?
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Aspiration of foreign bodies can primarily affect which part of the anatomical structure in the neck?
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What is the primary function of the superior laryngeal nerve?
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What imaging technique is most useful for visualizing thyroid tumors and potential displacement of the trachea?
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Which vascular structure can often be confused with thyroid pathologies in imaging studies?
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Which structures are innervated by the superficial branches of the cervical plexus?
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What is the primary function of the ansa cervicalis?
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A deep cervical plexus block is typically used for which type of surgery?
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Which cervical spinal nerves contribute to the ansa cervicalis?
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What role does cartilage play in the upper airways?
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Which nerve injury could lead to hoarseness and vocal cord dysfunction?
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Which of the following structures is primarily responsible for motor innervation to the diaphragm?
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What is the significance of Erb's point in the cervical plexus?
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Which anatomical structure serves as the medial boundary of the anterior triangles in the neck?
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What demarcates the submandibular triangle?
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Which of the following sub-triangles does NOT belong to the anterior triangle of the neck?
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What structure encases all of the infrahyoid muscles and forms the superficial boundary of the anterior triangle?
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Which triangle is NOT one of the inferior divisions of the anterior triangle?
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What is the primary function of the platysma muscle in the neck?
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Which triangle of the neck contains the major neurovascular structures, including the carotid artery and jugular vein?
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Which of the following accurately describes the fascial layers of the neck?
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The intrinsic and extrinsic muscles of the larynx primarily contribute to which function?
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Understanding the divisions of the neck into triangles helps in which aspect of clinical practice?
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What is the anatomical relationship of the anterior jugular veins in relation to the deep cervical fascia?
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Which muscles are included in the suprahyoid group?
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What is the typical clinical sign of unilateral recurrent laryngeal nerve injury?
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What is a prominent feature of the goitre?
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Which structure connects the sternocleidomastoid and trapezius muscles?
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Which of the following best describes the composition of the thyroid gland?
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In which anatomical region are many vessels and nerves relatively superficial, allowing access during surgery?
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What role do the hyoid muscles serve with respect to the hyoid and larynx?
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Which of the following is a common cause of goitre around the world?
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What is the function of the intermediate tendon associated with the digastric muscle?
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Study Notes
Inferior of the Larynx
- The inferior part of the larynx connects to the trachea, which is the windpipe.
Muscles and Nerves of the Larynx
- The larynx contains both intrinsic and extrinsic muscles.
- Intrinsic muscles are responsible for the movements of the larynx itself and the vocal cords.
- Extrinsic muscles are responsible for the positioning of the larynx and they attach to the hyoid bone.
Variations of the Rima Glottidis
- The rima glottidis is the opening between the vocal cords.
- It can be conical, oval, or elliptical.
- The shape of the rima glottidis is important for voice production.
Intrinsic Muscles of the Larynx
- The intrinsic muscles of the larynx are divided into adductors, abductors, sphincters, tensors, and relaxers.
- The adductors bring the vocal cords together.
- The abductors pull the vocal cords apart.
- The sphincters close the airway tightly.
- The tensors stretch the vocal cords.
- The relaxers relax the vocal cords.
Vessels, Nerves, and Lymph Nodes of the Larynx
- The larynx is supplied by blood vessels and nerves.
- The superior laryngeal nerve innervates the cricothyroid muscle and the sensory innervation above the vocal cords.
- The recurrent laryngeal nerve supplies motor innervation to all of the intrinsic muscles of the larynx, except the cricothyroid, and sensory innervation below the vocal cords.
Clinical Pictures
- Coniotomy (Cricothyrotomy) is a surgical procedure to create an opening in the cricothyroid membrane, which is the membrane between the cricoid and thyroid cartilages.
- Tracheotomy is a surgical procedure to create an opening in the trachea to allow airflow.
- Tracheostomy is a procedure to create an opening in the trachea and insert a breathing tube for long-term ventilation.
- Laryngectomy is a surgical procedure to remove the larynx, sometimes also called a "laryngeal ablation."
- Laryngoscopy is a procedure to examine the larynx with a scope.
CT and MRI of Thyroid Tumor
- Computed tomography (CT) and magnetic resonance imaging (MRI) are useful imaging tools for diagnosing thyroid tumors.
- A thyroid tumor can displace the trachea from the midline.
Anterior Neck Lipoma Mimicking a Goiter
- A lipoma is a benign growth of fatty tissue, and can be mistaken for a goiter.
Aspiration of Foreign Bodies
- Foreign bodies can become lodged in the larynx which can be a medical emergency.
- The larynx often has to be intubated to retrieve a foreign object.
Neck MRI
- MRI can be used image the following structures in the neck:
- Nasal cavity
- Nasopharynx
- Pharynx
- Larynx
- Tongue
- Spinal column
- Spinal cord
- Epiglottis
- Cricoid cartilage
Indirect Laryngoscopy
- Indirect laryngoscopy is a procedure to examine the larynx using a mirror.
Endotracheal Intubation
- Endotracheal intubation is a procedure to place a tube in the trachea, which is commonly done to provide airway support during surgery.
The Upper Airways
- The upper airways are the structures of the respiratory system above the chest.
- The structures of the upper airways allow and effect the gas exchange of respiration.
Anterior Cervical Region - Extrinsic Muscles of the Larynx
- The extrinsic muscles of the larynx are responsible for the positioning of the larynx in the neck.
- The suprahyoid muscles are located above the hyoid bone and the infrahyoid muscles are located below the hyoid bone.
- The suprahyoid muscles include:
- Mylohyoid
- Geniohyoid
- Stylohyoid
- Digastric
- The infrahyoid muscles include:
- Sternohyoid
- Omohyoid
- Sternothyroid
- Thyrohyoid
Thyroid Gland
- The thyroid gland is a butterfly-shaped endocrine gland located in the neck.
- It produces hormones that regulate metabolism.
- The thyroid gland is made up of two lobes connected by an isthmus.
- Occasionally, a pyramidal lobe may be present.
Clinical Relevance:
- The neck contains important anatomical structures that often need to be addressed in medical settings:
- Central line insertion into the jugular vein
- Carotid triangle - A region in the neck containing the carotid artery, internal jugular vein, and vagus nerve, which can be accessed for medical intervention.
- Cervical plexus - A network of nerves that innervate the muscles of the head and neck - can be blocked to provide both superficial and deep regional anaesthesia.
- Erb's Point - A point in the neck that is used to perform a type of nerve block
- Ansa cervicalis - A loop of nerves that can be identified during certain neck surgeries.
Take Home Message
- An understanding of human anatomy is crucial for successful surgery and good quality patient care.
- Surgeons need to be aware of the location of important structures in the neck to avoid injury during surgery.
- All medical professionals should have strong anatomical knowledge to understand and treat patients efficiently.
Neck Anatomy
- The neck is divided into four regions based on the sternocleidomastoid and trapezius muscles.
- The anterior triangle of the neck is bounded by the sternocleidomastoid muscle, the mandible, and the midline of the neck.
- The anterior triangle is further subdivided into the submandibular, submental, muscular, and carotid triangles.
- The posterior triangle of the neck is bounded by the sternocleidomastoid muscle, the trapezius muscle, and the clavicle.
- The posterior triangle is further subdivided into the occipital, omoclavicular, and subclavian triangles.
Neck Muscles
- The hyoid bone provides attachments for the suprahyoid and infrahyoid muscles.
- The suprahyoid group muscles include the mylohyoid, geniohyoid, stylohyoid, and digastric.
- The infrahyoid group muscles include the sternohyoid, omohyoid, sternothyroid, and thyrohyoid.
Thyroid Gland
- The thyroid gland consists of two lobes joined by an isthmus.
- A pyramidal lobe may also be present.
- Enlarged thyroid gland can result in a goiter.
Larynx
- The larynx is made of cartilage pieces including the thyroid, cricoid, and arytenoid.
- The epiglottis is a leaf-shaped cartilage that protects the airway during swallowing.
- The larynx is responsible for voice production.
- Intrinsic muscles of the larynx include the posterior cricoarytenoid, lateral cricoarytenoid, transverse arytenoid, thyroarytenoid, and oblique arytenoid.
- The cricothyroid muscle tenses the vocal cords.
Trachea
- The trachea is about 12 cm long and 2.5 cm in diameter.
- It lies in front of the esophagus and transports air to and from the lungs.
- It ends at the level of the sternal angle or the T4-T5 IV disc.
- The trachea divides into the right and left primary bronchi at the spinal level of T5.
- The tracheal cartilages are C-shaped and keep the trachea patent.
- Smooth muscle, the trachealis muscle, bridges the gap at the back of the trachea.
Clinical Relevance
- The carotid triangle provides access to a number of vessels and nerves.
- Injury to the recurrent laryngeal nerve can cause hoarseness.
- A goiter is a swelling in the neck resulting from an enlarged thyroid gland.
- The risk of injury to the recurrent laryngeal nerves is ever present during neck surgery.
- Goiters are usually caused by iodine deficiency.
- Central venous lines are inserted in the neck.
- Aspiration of foreign bodies can occur in the larynx.
Imaging
- CT and MRI are used to visualize thyroid tumors, tracheal displacement, and other neck structures.
- High-resolution T1-weighted MRI is used to visualize the larynx.
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Description
Explore the intricacies of the larynx, including its inferior structure, muscle types, and variations of the rima glottidis. This quiz will test your knowledge on the intrinsic and extrinsic muscles that govern voice production and laryngeal function.
