Download Neck Fourm 2011

Neck Forum – 2011
1. Injury to sympathetic chain in the neck…syndrome?...Sx…anatomical rationale for Sx?
- Horner’s Syndrome, parasympathetics take over; causes miosis – dilation of pupils, ptosis (slight) –
drooping eyelids (superior tarsal m.); anhydrosis – no sweating (no sympathetics)
2. All postganglionic sympathetics to the head come from? Carried into head by the?
Course on top of the?
- Superior cervical ganglion; carried by the internal carotid n.; courses on top of internal carotid a.
- External carotid n.  external carotid a. (outside the head)
3. Be ready to discuss the fascial layers of the neck and the compartments they form.
Where are the “spaces” found? What are the fascial layers bordering the “spaces”
and what is their extent?
- (lateral to medial) skin; superficial fascia (includes platysma); investing layer surrounds musculature
(SCM, strap mm., trapezius m.); pretracheal layer (esophagus, trachea, thyroid gland); carotid sheath (IJV,
Vagus n., common carotid a.); prevertebral fascial layer (spine)
- Spaces: posterior layer of investing fascia and pretracheal fascia (pretracheal space; goes all the way
down to superior mediastinum); posterior layer of pretracheal fascia (buccopharyngeal fascia) and
prevertebral fascial layer (retropharyngeal space); between two layers of anterior prevertebral fascia,
most anterior sometimes called alar fascia (danger space/3 rd space; goes all the way down to diaphragm)
4. Thyroidectomy…what nerves are in danger? What Sx would present with their injury?
What vessels may be damaged?
- Recurrent laryngeal and external laryngeal (innervates cricothyroid m.; causing you to not be able to
raise the pitch in your voice which cricothyroid is responsible for) nn. could be damaged; cause
hoarseness; vessels possibly damaged superior thyroid a., inferior thyroid a. (thyroid ima a.; if present),
and any veins
5. Stab wound to area indicated with star below…structures at risk? Findings if they are
damaged?
- Posterior belly of digastric m., sylohyoid m., hypoglossal n. (CN XII), external carotid a. or branches
(lingual and fascial), SCM m., superior rot of ansa cervicalis, C1  thyrohyoid m., internal and external
jugular vv., (running with jugular v.) great auricular n., common fascial v. (possibly)
6. Describe torticollis.
- inhibits flexion/extension of mm. in neck, so neck twists to one side; can be caused by genetics,
medication, trauma; typically a problem with sternocleidomastoid m. (SCM)
7. Mm. innervated by ansa cervicalis? By C1?
- Sternohyoid, sternothyroid, and omohyoid; C1 -thyrohyoid and geniohyoid
8. Collateral blood supply allowing subclavian to be ligated proximal to anterior scalene?
- Deep cervical a. from costocervical trunk  descending branch of occipital a.