Neck Board Exam Lecture

8/13/2019 Neck Board Exam Lecture

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BOUNDARIES OF NECK

Superiorly: Lower border of mandible

Inferiorly: Clai!le

"o#$eriorly: %rape&iu#

An$eriorly: An$erior midline of ne!'


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TH E N ECK


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TRI N G LES O F TH E N ECK


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SCH EM TICREPRESEN T TIO N


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An$erior$rian(le

Di(a#$ri!

Caro$id )u#!ular

"o#$erior$rian(le

Supra!lai!ular

O!!ipi$al


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H yoid M uc!e Infra*yoid

)u#!le#

Deep (roup

%*yro*yoid

S$erno$*yroid

Superfi!ial (roup Omo*yoid

S$erno*yoid


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Inf#ahyoid m uc!e

Ne#$eu""!y ctionOmohyoid 'u"e#io# )infe#io#

nace#$ica!iC*+ C, andC-

%e"#eehyoid

Ste#nohyoid nace#$ica!i

%e"#eehyoidSte#nothy#oid nace#$ica!i %e"#ee!a#yn.

Thy#ohyoid Fi#tce#$ica! %e"#eehyoid


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nte#io# T#ian&!e Boundaries

Ant. Midline -

anteriorly

Mandible

superiorly

SCM - posteriorly


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Com "onent t#ian&!e of neck Submental triangle

Submandibular or

Digastric triangle

Muscular

Carotid


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Su(m enta! t#ian&!eBoundarie#

Ant. Belly ofdigastric m.

Hyoid boneFloor mylohyoid

Con$en$#

oSubmental lymphnodes

oeins that unite!"ant.#ugular $ein


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Su(m andi(u!a# t#ian&!eBoundarie# Ant. and %ost. Bellies of

Digastric m. &nferior border of

mandible

Con$en$# Submandibular gland Submandibular duct C' (&& ) ner$e to

mylohyoid Submental artery Submental lymph nodes Suprahyoid muscles


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Su(m andi(u!a# t#ian&!e

Hypoglossal ner$e 'er$e to mylohyoid

Submental artery branch of facial a.

submental lymph nodes


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Ca#otid t#ian&!eBoundarie#

Superior belly ofomohyoid

%osterior belly ofdigastric

Ant. border ofSCM


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Ca#otid t#ian&!eCon$en$#

Carotid body-baroreceptor

Carotid sinus-chemoreceptor

Carotid sheath common carotid a.)$agus) internal

#ugular $ein

Ansa cer$icalis


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M ucu!a# t#ian&!e

Boundarie#

Superior belly ofomohyoid

%ost. belly of digastric Ant. Border of SCM

Con$en$#

Sternohyoid)sternothyroid) thyrohyoid

isceral organs thyroid)parathyroids) laryn*


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N e#$e in the nte#io#t#ian&!e Hypoglossal

agus

+lossopharyngeal

,rans$erse cer$ical supplying thesin o$er the ant.

triangle


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S/ 0% I1ISIO N S O F PO STERIO RTRI N G LE


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O CCIPIT L TRI N G LE Ape. !on$ain#por$ion of o!!ipi$albone

O!!ipi$al ar$eryi# found in#uperior par$

A!!e##orynere !ro##e# $*e$rian(le


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RTRI N GLEA/K/A/ Sub!laian%rian(le

Superfi!ial landmar'i# #upra!lai!ularfo##a

Cro##ed by e.$ernal0u(ular ein and#ub!laian ar$ery


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PO STERIO RTRI N G LESpleniu# !api$i#O + li(/ Nu!*ae1 #pine# of C23%4

I + la$eral #uperior nu!*al line andma#$oid

A + draw# *ead ba!' and la$eral

ro$a$e *ead $o #ame #ide

$o(e$*er1 e.$end# *ead and ne!'

NS + lower !eri!al nere#

Lea$or #!apula

O + $ran#er#e pro!e## C53C6

I + medial border of #!apula aboe#pine

A + elea$e# #!apula

NS + dor#al #!apular nere


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PO STERIO RTRI N G LES!alene po#$eriorO + $ran#er#e pro!e## C63C7

I + 8nd rib

A + elea$e# 8nd rib1 fle. !eri!aler$ebra

NS + C73C9

S!alene mediu#


I + 5#$ rib

A + elea$e 5#$ rib fle. and ro$a$e!eri!al !olumn $o oppo#i$e #ide



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PO STERIO RTRI N G LES!alene an$erior


I + #!alene $uber!le of 5#$ rib

A + rai#e 5#$ rib #li(*$ro$a$ion of ne!'



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C!inica! co##e!ation


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Infection of the N ecK &nfection of sin)

/,&) etc.

infection that occursbet!een thein$esting andpretracheal layers offascia) it can spreadinto the thoracic

ca$ity anterior tothe pericardium.

Retropharyngealabscess


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Con&enita! To#tico!!i%or$i!olli#is a fle*iondeformity of the nec

,he most common causeof torticollis ;wry ne!'


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Ce#$ica! 1ein of C!inica!Im "o#tance'ec $eins used for

,%' and C%monitoring

5/ Sub!laian =ein:


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Ce#$ica! 1ein of C!inica!Im "o#tance'ec $eins used for

,%' and C%monitoring

8/ In$ernal >u(ular=ein:


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C!inica! Co##e!ation ofCa#otid #te#yCaro$id O!!lu#ion and

Endar$ere!$omyDue to atherosclerosis

%artial occlusion leads to

,&A 1transient ischemicattac2) a sudden loss ofneurological function thatdisappears !ithin 34 hrs

Minor stroe loss of

neurological function1!eaness or sensoryloss2 on one side of thebody that e*ceeds 34 hrsbut disappears !ithin 5!ees


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C!inica! Co##e!ation ofCa#otid #te#yCaro$id O!!lu#ion and

Endar$ere!$omy Detected !ith use of Doppler

color study Carotid endarterectomy

stripping off the atheroscleroticpla6ue !ith the intima

%ossible ner$es in#ured !" abo$e

procedure7 C' &(

C' (

C' (&

C' (&&


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Leion of the Ce#$ica!Sym "athetic t#unk/esults to ?orner Syndrome

Contraction of the pupil ;mio#i#


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Leion of Ce#$ica! N e#$eLe#ion# of Spinal A!!e##ory:

not common7 but the most commoniatrogenic ner$e in#ury in the necCau#e#:

8. penetrating trauma 1bullet or nife23. Surgical procedure 1iatrogenic25. ,umors at the cranial base or cancerous

cer$ical 9'4. Fracture of the #ugular foramen !here C'

(& lea$es the cranium)anife#$a$ion:

:. ;eaness and atrophy of SCM andtrape. Drooping of the shoulder


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Leion of Ce#$ica! N e#$eIn0ury of "*reni! Nere: /esult to paralysis of the

corresponding half of thediaphragm

Temporary paralysisofthe ner$e anesthetic

in#ection 1lung surgery2 Prolonged paralysis

iatrogenic in#ury duringnec dissection

%aralysis of diaphragm

detected a parado*icalmo$ement seen in *-ray


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Leion of Ce#$ica! N e#$eIn0ury $o $*e Supra#!apular

Nere: Happen in fracture of middle 8"5

of the cla$icle

%aralysis of the S&,s muscles 9oss of lateral rotation and initial

abduction of the upper limb Waiters tip position rela*ed

limb rotates medially.


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Leion of Ce#$ica! N e#$eIn0ury $o Laryn(eal

nere:

1. Inferior laryngealnerve

Due tothyroidectomy

%aralysis of $ocalfold) leading tohoarseness of $oice.

Bilateral paralysisresulting to stridor1high pitch) noisyrespiration2.


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Leion of Ce#$ica!N e#$eIn0ury $o

Laryn(ealnere:

8/ Superiorlaryn(ealnere:

%aralysis of thecricothyroidmuscle


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Leion of Thy#oidG !and%*yro(lo##al Du!$

Cy#$: ,hyroid gland begins

in the floor of thetongue 1foramencecum2) thendescends passing

anterior to the hyoidand thyroid cartilageto reach it0s finalposition.


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Leion of Thy#oidG !and%*yro(lo##al Du!$ Cy#$:

During this descent) thethyroid gland is attached tothe foramen cecum by thethyroglossal duct that

normally disappears./emnant of it0s epitheliumforms thyroglossal duct cystforming a soft mass at theanterior part of the nec.


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Leion of Thy#oidG !and%*yroid

Enlar(emen$:

-rae@# di#ea#e:8. Diffuse thyroid

enlargement

3. Hyperthyroidism

5. ?*opthalmos


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Leion of Thy#oidG !andNeopla#m:Beni(n:

5/ "apillary adenoma

8/ Folli!ular adenoma

4/ *ur$le !ell adenoma#

)ali(nan$:6/ "apillary !ar!inoma

/ Folli!ular !ar!inoma

7/ ?ur$le !ell !ar!inoma2/ )edullary !ar!inoma

9/ Anapla#$i! !ar!inoma


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Leion of Thy#oidG !andNeopla#m: %*yroide!$omy:

Indi!a$ion:

%*yroid !ar!inoma

-rae#@# di#ea#e

-oi$er wi$* pre##ure #ymp$om# and for !o#me$i!rea#on#

%ype#:

%o$al or near $o$al $*yroide!$omy

Sub$o$al $*yroide!$omy

Lobe!$omy w, or w,o i#$*me!$omy

Compli!a$ion:

Re!urren$ laryn(eal nere

?ypopara$*yroidi#m

Bleedin(


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Leion of Pa#athy#oid G !and5/ ?yperpara$*yroidi#m

Due parathyroid adenoma

8/ ?ypopara$*yroidi#m

Due to iatrogenic remo$alof gland duringthyroidectomy

/esults to tetany ---@death


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L R2N35/ Fra!$ure of $*e

laryn.Due to accidents

1automobile2

Subcutaneousedema

/esp. obs.)hoarseness of

$oice


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L R2N38/ A#pira$ion of

Forei(n Bodie#:

.bstruct $estibuleof laryns ---@ death

!"in : 8 mins !eimlich

"aneuver

&nsertion of largebore needle to

cricothyroidmembranes orcricothyrotomy


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TR CH E5/ %ra!*eo#$omy

: ,o established

an air!ay

se oftracheostomytube


50/79

ESO PH G / S5/ In0urie#

8/ %ra!*eoe#op*a(eal fi#$ula: Most common congenital anomaly of the

esophagus


51/79

ESO PH G / S4/ E#op*a(eal

Car!inoma


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4one of the N eckone I: ?*tends from the

cla$icle and manubriumto the le$el of theinferior border of cricoid

cartilage Cer$ical pleura Apices of the lungs ,hyroid and parathyroid

gland ,rachea

?sophagus Common carotid arteries ugular $eins Cer$ical region of the

$ertebral column


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4one of the N eckone II: ?*tends from the

cricoid cartilage to thele$el of the angles ofthe mandible

Superior pole of thethyroid gland 9aryn* 9aryngopharyn* Carotid arteries ugular $eins ?sophagus Cer$ical region of

the $ertebral column


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4one of the N eckone III: Angle of the

mandible up to

the base of thesull Sali$ary glands

ropharyn* 'asopharyn*

ral and nasalca$ities


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F#actu#e of Ce#$ica! 1e#te(#a! Co!um n


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5 uetion


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*6 In thy#oidectom y+ the ne#$e

that m ay(e in7u#ed du#in&!i&ation of u"e#io# thy#oida#te#y8

A/ In$ernal laryn(eal

B/ #uperior laryngeal

C/ E.$ernal laryn(eal

D/ Inferior laryn(eal

1 N


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1a&u Ne#$e

Superior LN

5/ In$ernal LN +#en#ory aboe o!al !ordarea

8/ E.$ernal LN +#upplie# Cri!o$*yroid

Inferior LN , Re!urren$LN+ mo$or $o mu#!le#of p*ona$ion e.!ep$

Cri!o$*yroid #en#orybelow o!al !ord area

Th id G! d


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Thy#oid G!and

Blood #upply: Superior $*yroid +e.$ernal !aro$id

Inferior $*yroid +$*yro!eri!al $run'

=enou# draina(e: Superior $*yroid + I>=

)iddle $*yroid + I>=

Inferior $*yroid +Bra!*io!ep*ali!


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,6 Fo#m the !a#yn&ea!

"#om inencein the neck8 A/ Cri!oid !ar$ila(e

B/ Thyroid cartilage

C/ Epi(lo$$i#

D/ Ary$enoid !ar$ila(e


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UnpairedCar$ila(e#

Epi(lo$$i#

%*yroid Cri!oid

"aired Car$ila(e#

Ary$enoid Corni!ula$e

Cuneiform


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-61e#te(#a "#om inencei the

othe# nam e of8 A/ Ceri!al 5

B/ Ceri!al 8

C/ Ceri!al

D/ $ervical %

C i !1 t (


63/79

Ce#$ica! 1e#te(#a

%ypi!al Ceri!al+ C4$o C7

S*or$1 bifid #pinou#pro!e##

A$ypi!al Ceri!al+ C5C8 and C2

=er$ebra "rominen!e C2 + lon( #pinou#pro!e## and no$ bifid

%ran#er#e foramen+for er$ebral ar$ery


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Ceri!al 5 A$la#

Ceri!al 8 A.i#

pre#en!e ofOdon$oid pro!e## ,Den#


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96 The Ri&ht com m on ca#otid

a#te#yo#i&inate f#om the8 A/ &rachiocephalic trun'

B/ Ri(*$ Sub!laian

C/ Ar!* of Aor$a

D/ A#!endin( Aor$a


66/79

Bra!*io!ep*ali!$run'

Lef$ CommonCaro$id

Lef$ Sub!laian

Ar!* of Aor$a


67/79

CO M M O N C RO TI% E.$ernal Caro$id

- Superior thyroid

- Asc. %haryngeal

- 9ingual

- Facial

- ccipital

- %ost. Auricular

- Superficial ,emporal

- Ma*illary In$ernal Caro$id


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S/ 0CL 1I N Di$isible into 4 par$#by

S!alenou# an$erior

Fir#$ "ar$

ertebral

,hyrocer$ical-

trans$erse"superficial cer$ical)suprascapular) inferior thyroid

&nternal ,horacic

Se!ond par$

Costocer$ical-deep cer$ical)highest"superior intercostal

%*ird par$3 occasionallysuprascapular or superficialcer$ical


69/79

Inte#na! :u&u!a# Continuation of

Sigmoid sinus

%ribu$arie#:

&nf petrosal

sinus Facial

%haryngeal

9ingual

Sup thyroid

Middle thyroid


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0R CH IO CEPH LIC 1EIN In$ernal 0u(ularE

#ub!laian ein#

At the le$el of the infborder of the 5#$ R!o#$al !ar$ila(e) / "9 unite to form S=C

%ribu$arie#:

&nternal thoracic

ertebral

&nferior thyroid

Superior

intercostal


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;6 A!! of the fo!!o< in& a#e

Su"#ahyoid m uc!eE3CEPT8 A/ Di(a#$ri!

B/ -enio*yoid

C/ mohyoid

D/ )ylo*yoid

Hyoid M uc!e


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Hyoid M uc!e

Supra*yoidmu#!le#

Di(a#$ri! + an$ ,po#$

)ylo*yoid

S$ylo*oid -enio*yoid

Hyoid M uc!e


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Hyoid M uc!e

Infra*yoid)u#!le#

Deep (roup %*yro*yoid

S$erno$*yroid

Superfi!ial (roup Omo*yoid

S$erno*yoid

Su"#ahyoid m uc!e


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Su"#ahyoid m uc!e

Ne#$eu""!y ction%i&atic 'ante#io#

(e!!yNe#$e tomy!ohyoid %e"#emandi(!e o#

e!e$atehyoid%i&at#ic '"ote#io# Facia! %e"#emandi(!e o#e!e$atehyoidSty!ohyoid Facia! E!e$atehyoid (oneMy!ohyoid Ne#$e to %e"#emandi(!e o#

Inf#ahyoid m uc!e


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Inf#ahyoid m uc!e

Ne#$eu""!y ctionOmohyoid 'u"e#io# )infe#io#

nace#$ica!iC*+ C, andC-

%e"#eehyoid

Ste#nohyoid nace#$ica!i

%e"#eehyoidSte#nothy#oid nace#$ica!i %e"#ee!a#yn.

Thy#ohyoid Fi#tce#$ica!

%e"#eehyoid


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=6 The m uc!e that di$ide the

"ote#io# t#ian&!eof the neckinto Occi"ita! and

Su"#ac!a$icu!a# t#ian&!e> A/ Superior belly of Omo*yoid B/ Inferior belly of mohyoid

C/ An$erior belly of Di(a#$ri! D/ "o#$erior belly of Di(a#$ri!


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?6 Sutained tenionof the $oca!

co#di (et achie$ed th#u theaction of < hat int#inic m uc!e of the!a#yn.>

A/ "o#$erior Cri!oary$enoid

B/ La$eral Cri!oary$enoid

$. $ricothyroid D/ %*yroary$enoid


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Cri!o$*yroid + %en#or

"o#$/ Cri!oary$enoid +Abdu!$or

La$eral Cri!oary$enoid +Addu!$or

%*yroary$enoid + Rela.or

Supplied by Re!urren$ ,Inferior LN e.!ep$Cri!o$*yroid ; E.$ernalLN

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Neck Board Exam Lecture