Torticollis Case Scenario: Clinical Anatomy

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30 Questions

What is the most likely diagnosis for a 3-month-old girl whose head is flexed to the right and rotated to the left?

Torticollis

Which muscle is affected in a patient with Torticollis?

Sternocleidomastoid muscle

How many cervical vertebrae form the skeleton of the neck?

7

What is the name of the first cervical vertebra?

Atlas

What is the purpose of the lecture on the anatomy of the neck?

To teach the surface anatomy of the neck region

What is the name of the block that includes the larynx?

Pharynx-larynx block

What is the name of the first cervical vertebra?

Atlas vertebra

How many elongated vertebrae support the giraffe's neck?

Seven

What is the anatomical formation of Adam's Apple?

Thyroid cartilage

What is the difference in the laryngeal prominence between males and females?

Angle of the thyroid cartilage

Which cervical vertebra is responsible for bearing the head?

C1 (Atlas vertebra)

What is the significance of the laryngeal prominence in the neck?

Important surface anatomy

At which level of the cervical vertebrae is the thyroid cartilage located?

C4,5

What is the shape of the hyoid bone?

U-shaped

What attaches the hyoid bone to the styloid process?

Stylohyoid ligaments

How many muscles are attached to the hyoid bone?

About a dozen

What can be felt by deep palpation between the angle of the mandible and the tip of the mastoid process?

Tip of the transverse processes of the Atlas (C1 vertebra)

At which level of the cervical vertebrae is the cricoid cartilage located?

C6 and below

What is the trachea palpable just superior to?

Jugular notch

Which of the following forms the superior limit of the neck?

Inferior margin of the mandible, mastoid process, and external occipital protuberance

What is the name of the fascia that binds the musculo-vertebral block together?

Prevertebral fascia

What is the name of the compartment that includes the pharynx and larynx?

Pharynx-larynx block

What is the relation between the cervical nerves and the vertebrae in the cervical region?

Each cervical nerve is located above the vertebra with the same number

What is the function of the foramina transversaria in the cervical vertebrae?

To allow the vertebral artery to run vertically

What is the location of the scalenus anterior muscle in the neck?

Anterior to the vertebral bodies

What is the name of the muscle that is located posterior to the vertebral bodies in the neck?

Splenius capitis

How many cervical nerves are there in the human body?

8

What is the name of the compartment that contains the internal jugular vein, the common or internal carotid arteries, and the vagus nerve?

Carotid sheath

What is the name of the muscle that is responsible for spasms and headaches?

Levator scapulae

What is the name of the muscle that is located immediately in front of the vertebral bodies in the neck?

Longus colli

Study Notes

Neck Anatomy

  • 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.

Surface Anatomy of the Neck

  • 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.

Bony Landmarks

  • 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.

Plan of the Neck

  • 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.

Muscles of the Neck

  • 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.

Cervical Nerves

  • 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.

A 3-month-old girl's head is flexed to the right and rotated to the left, with a non-tender mass in the right anterior neck region. Identify the most likely diagnosis and anatomical structure affected.

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