Side of the neck Question And Answers

Question 1. Describe the boundaries & contents of Subclavian Triangle
Answer:

Boundaries of Subclavian Triangle:

Anteriorly: Posterior border of sternocleidomastoid

Posteriorly: Inferior belly of omohyoid

Inferiorly base: Middle 1/3 of clavicle

Apex: Lies where inferior belly of omohyoid crosses sternocleidomastoid

Roof: Investing layer of deep cervical fascia

Read And Learn More: BDS Previous Examination Question And Answers

Floor: Scalenus medius.

Subclavian Triangle Contents:

1. Subclavian Triangle Contents Nerves:

• Three trunks of branchial plexus
  • It emerges between the scalenus anterior & medius
  • It carries axillary sheath along with it which contains branchial plexus & subclavian artery
• Nerve to serratus anterior
  • It arises by roots of C5, C6, C7
  • The nerve passes behind the branchial plexus & descends over the serratus anterior
• Nerve to subclavius
  • It descends in front of branchial plexus & subclavian vessels
  • It sometimes give off the accessory phrenic nerve which joins the phrenic nerve in front of the scalenus anterior
• Suprascapular nerve
  • It arises from the upper trunk of the branchial plexus & crosses the lower part of the posterior triangle
  • It supplies the supraspinatus & infraspinatus muscles

2. Subclavian Triangle Contents Vessels:

• Third part of subclavian artery & subclavian vein
  • The subclavian artery passes behind the tendon of the scalenus anterior
  • Subclavian vein passes in front of the tendon
• Suprascapular artery & vein
  • Suprascapular artery is a branch of the thyrocervical trunk
• Commencement of transverse cervical artery & termination of the corresponding vein. It is a branch of the thyrocervical trunk
  • It crosses

1. 1. 1. Scalenus anterior
      2. Phrenic nerve
      3. Upper trunks of the branchial plexus
      4. The nerve to the subclavius
      5. Suprascapular nerve
      6. Scalenus medius

• • It divides into superficial & deep branches
• Lower part of external jugular vein
  • It lies deep to the platysma
  • It is formed by union of the posterior auricular vein & posterior division of retromandibular vein
  • It opens into the subclavian vein

3. Subclavian Triangle Contents  Lymph Nodes:

• A few members of the supraclavicular chain
• Posteroinferior group of deep cervical lymph node

Subclavian Triangle Contents Applied Anatomy:

• Enlargement of inferior group of deep cervical lymph nodes on left occurs in malignant growth of stomach
• Superficial incision to open subcutaneous abscess may injure the accessory nerve
• Any external injury may cause damage to upper trunk of branchial plexus
• This results in Erb’s palsy

Question 2. Classify deep fascia of neck. Add a note on its applied anatomy (or) General investing layer of deep cervical fascia (or) Pretracheal fascia
Answer:

Deep Fascia of Neck Layers:

• Investing layer
• Pretracheal layer
• Prevertebral layer
• Carotid sheath
• Buccopharyngeal fascia
• Pharyngobasilar fascia

Deep Fascia of Neck Layers:

Deep Fascia of Neck Layers Applied Anatomy:

1. Investing Layer:
   • Parotid swellings are very painful due to the unyielding nature of parotid fascia
2. Supraclavicular Space:
   • It is pierced by the external jugular vein to drain into subclavian vein
   • Division of external jugular vein may cause air embolism
3. Pretracheal Fascia:
   • The thyroid gland & all thyroid swellings move with deglutition because the thyroid is attached to the larynx by the suspensory ligament of Berry
   • Neck infections in front of it may bulge in the suprasternal area or extend down into the anterior mediastinum
4. Prevertebral Fascia:
   • Neck infections behind it arise usually from tuberculosis of the cervical vertebrae or cervical caries
   • The pus formed may travel

• • 1. Forward resulting in chronic retropharyngeal abscess in posterior wall of pharynx
    2. Laterally into posterior triangle through the axillary sheath
    3. Downward into superior mediastinum
  • Neck infections in front of it usually arise from retropharyngeal lymph nodes resulting in acute retropharyngeal abscess

Question 3. Describe the boundaries and contents of posterior triangle of the neck. (or) Describe posterior triangle under following headings.
Boundaries Subdivisions Contents in detail (d) Applied aspect.
Answer:

Posterior Triangle Boundaries:

• Anterior – posterior border of sternocleidomastoid
• Posterior – anterior border of trapezius
• Inferior or base – middle third of clavicle
• Apex – lies on the superior nuchal line where trapezius and sternocleidomastoid meet
• Roof – investing layer of deep cervical fascia
• Floor – splenius capitus, levator scapulae, scalenus medius

Posterior Triangle Applied aspects:

• The most swelling in the posterior triangle is due to enlargement of supraclavicular lymph nodes These lymph nodes are enlarged in Hodgkin’s disease, malignant growth of breast, arm or chest
• Cervical rib may compress the second part of subclavian artery
• Second part of subclavian artery may also gets pressed by the scalenus anterior muscle
• Dysphagia caused by compression of oesophagus by abnormal subclavian artery is called dysphagia lusoria

Question 4. Carotid sheath (or) Brief account of carotid sheath & its contents (or) Formation, attachments, relation & contents of carotid sheath
Answer:

Carotid sheath is a condensation of the fibroaerolar tissue around the main vessels of the neck

Carotid Sheath  Formation:

• Its anterior wall is formed by pretracheal fascia
• While posterior wall is formed by Prevertebral fascia

Carotid Sheath Extend:

• From base of skull to arch of aorta

Carotid Sheath Contents:

• Common carotid arteries present medially
• Internal carotid artery present medially
• Internal jugular vein present laterally
• Vagus nerve present between above artery & vein

Carotid Sheath Relations:

• The ansa cervicalis is embedded in its anterior wall
• The cervical sympathetic chain lies behind it
• The carotid sheath is overlapped by the anterior border of the sternocleidomastoid
• It is fused to the first three layers of the deep cervical fascia.

Question 5. What is torticolis?
Answer:

Torticolis Synonym:

Wry neck Description:

• It is a deformity in which head is bent on one side & chin points to the other side

Torticolis Causes and Types:

• Spasm or contracture of sternocleidomastoid or trapezius Cold exposurerheumatic torticolis
• Inflamed or suppurating cervical lymph nodeReflex torticolis
• Birth injuryCongenital torticolis
• Central irritationSpasmodic torticolis

Question 6. Boundaries & contents of posterior triangle
Answer:

Posterior Triangle Boundaries:

• Anterior – posterior border of sternocleidomastoid
• Posterior – anterior border of trapezius
• Inferior or base – middle third of clavicle
• Apex – lies on the superior nuchal line where trapezius & sternocleidomastoid meet
• Roof-investing layer of deep cervical fascia
• Floor-
  • Splenius capitis
  • Levator scapulae
  • Scalenus medius

Posterior Triangle Contents:

Question 7. Attachments, relation, nerve supply & action of sternocleidomastoid (or) Sternocleidomastoid (or) Sternocleidomastoid muscle, nerve supply & action
Answer:

Sternocleidomastoid Origin:

• The tendinous sterna head arises from the superolateral part of the front of the manubrium sterni
• The musculotendinous clavicular head arises from the medial one-third of the superior surface of the clavicle

Sternocleidomastoid Insertion:

• By thick tendon into the lateral surface of mastoid process
• By thin aponeurosis into the lateral half of the superior nuchal line of occipital bone

Sternocleidomastoid Relations:

Sternocleidomastoid Nerve Supply:

• The spinal accessory nervemotor supply
• Branches from ventral rami of C2proprioceptive

Sternocleidomastoid Actions:

1. Unilaterally the muscle
   • Turns the chin on opposite side
   • Tilt the head towards shoulder on opposite side
2. Bilaterally muscles
   • Draw the head forward for eating
   • Lift the head from pillow
3. With longus colli
   • Flex neck against resistance
   • It helps in forced inspiration

Question 8. Give the formation, course & termination of external jugular vein
Answer:

External Jugular Vein Formation:

• By union of the posterior auricular vein & posterior division of retromandibular vein

External Jugular Vein Course:

• It begins within the lower part of the parotid gland
• It crosses the sternocleidomastoid obliquely
• Pierces the anteroinferior angle of the roof of the posterior triangle
• Its margins are adherent to the fascia

External Jugular Vein Termination:

• It terminates into subclavian vein

External Jugular Vein Branches:

• The posterior external jugular vein
• Transverse cervical vein
• Suprascapular vein
• Anterior jugular vein

Question 9. Lymphatic drainage of head & neck
Answer:

• The entire lymph from the head & neck drains ultimately into the deep cervical nodes or through peripheral nodes
• It is grouped as anterosuperior, anteroinferior, posterosuperior & posteroinferior

1. Deep Cervical Nodes:

1. Jugulodigastric Nodes:
   • Member of the anterosuperior group
   • It lies below the posterior belly of the digastrics
   • It is bounded by the posterior belly of digastrics, the facial vein & internal jugular vein
   • It is main node draining the tonsil
2. Jugulo-Omohyoid Node:
   • Member of the posteroinferior group
   • It lies above intermediate tendon of the omohyoid
   • It is main lymph node of the tongue
3. Efferent of Deep Cervical Lymph Nodes:
   • They join together to form the jugular lymph trunks
   • The left jugular trunks opens into thoracic duct
   • The right jugular trunk opens into right lymphatic duct

2. Lymphatic drainage of head & neck Peripheral Nodes:

• They are arranged in two circles

1. Superficial:
   • Submental
   • Submandibular Buccal
   • Preauricular
   • Post auricular Occipital
   • Anterior cervical Superficial cervical
2. Deepe:
   • Prelaryngeal
   • Pretracheal
   • Paratracheal
   • Retropharyngeal
   • Waldeyer’s ring

Question 10. Pretracheal fascia
Answer:

Pretracheal fascia Features:

• The posterior layer becomes thick and forms a suspensory ligament called Ligament Of Berry
• It supports the thyroid gland and prevents it from sinking
• It provides a slippery surface for free movements of trachea during swallowing

Pretracheal fascia Attachments:

• Superiorly
  • Hyoid bone in median plane
  • Oblique line thyroid cartilage
  • Cricoid cartilage
• Inferiorly
  • Encloses inferior thyroid veins
  • This passes behind branchiocephalic veins
  • Blends with the arch of aorta
• On each side
  • Fuses with carotid sheath

Pretracheal fascia Applied aspect:

• The thyroid gland and all thyroid swellings move with deglutition because the thyroid is attached to the larynx by the suspensory ligament of Berry
• Neck infections in front of it may bulge in the suprasternal area or extend down into the anterior mediastinum

Question 11. Ansa cervicalis
Answer:

• It is a thin nerve loop lying embedded in the anterior wall of the carotid sheath

Ansa cervicalis Formation:

• Ansa cervicalis is formed by
  • Superior root called descendens hypoglossi
    • Derived from first cervical nerve
    • C1 & C2 joins hypoglossal nerve to form it
    • Descends between internal carotid artery and common carotid artery
  • Inferior root
    • Derived from second and third cervical nerve
    • Descends and wind around the internal jugular vein and joins the superior root

Ansa cervicalis Distribution:

• Superior root
  • Superior belly of omohyoid
• Inferior root
  • Sternohyoid, sternothyroid, inferior belly of omohyoid

Question 12. Suprasternal space
Answer:

Syonym: Space of Burn’s

• It is enclosed by the investing layer of deep cervical fascia
• The inferior part of the fascia split to enclose it
• It contains

1. 1. The sterna heads of the right & left sternocleidomastoid muscles.
   2. The jugular venous arch communicate two anterior jugular veins
   3. A lymph node
   4. The interclavicualr nerves
   5. Suprasternal ossicles

Question 13. Occipital artery
Answer:

It arises from the posterior aspect of the external carotid artery, opposite the origin of facial artery

Occipital artery Branches:

1. Sternocleidomastoid branches
   1. Upper branch accompany accessory nerve
   2. Lower branch arises near the origin of the occipital artery
2. Mastoid branches
3. Meningeal branch
4. Muscular branch
   • One of its large branch is descending branch
   • It has superficial & deep branches
     1. The superficial branches anastomoses with the superficial branch of the transverse cervical artery
     2. The deep branches anastomoses with the vertebral & deep cervical arteries

Question 14. Four components of deep cervical fascia
Answer:

• Investing layer
• Pretracheal layer
• Prevertebral layer
• Carotid sheath
• Buccopharyngeal fascia
• Pharyngobasilar fascia

Question 15. Formation of external jugular vein
Answer:

By union of the posterior auricular vein & posterior division of retromandibular vein

Question 16. Contents of carotid sheath
Answer:

• Common carotid arteries
• Internal carotid artery
• Internal jugular vein
• Vagus nerve

Question 17. Root value of branchial plexus
Answer:

Branchial plexus is a network of nerves to supply the upper limb

Root value of branchial plexus Formation:

Ventral rami of C5, C6, C7, C8 & TI nerves join the plexus

Side Of The Neck ansa cervicalis and branches of the first cervical nerve distributed through the hypoglossal nerve

Branches are formed from root, trunk & cord

Question 18. Spinal part of accessory nerve
Answer:

• Accessory nerve has a spinal root & cranial root
• The spinal root arises from a long spinal nucleus & extends from C1-C5 segments of spinal cord
• The nerve enters the cranium through the foramen magnum lying behind the vertebral artery
• Within cranium, it crosses jugular tubercle & reaches the jugular foramen
• The nerve leaves the skull through the middle part of the jugular foramen & fuses with the cranial root
• In the extracranial course, the nerve descends vertically between internal jugular vein & internal carotid artery & reaches to a point between angle of mandible & mastoid process
• The nerve enters posterior triangle of neck through posterior border of sternocleidomastoid & leaves by passing deep to the anterior border of the trapezium

Structures Supplied by it:

• Sternocleidomastoid
• Trapezius

Question 19. Ansa cervicalis
Answer:

It is a thin nerve loop lying embedded in the anterior wall of the carotid sheath

Ansa cervicalis Formation: It is formed by

1. Superior root also called descendens hypoglossi
   • Derived from first cervical nerve
   • C1 & C2 joins hypoglossal nerve to form it
   • Descends between internal carotid artery & common carotid artery
2. Inferior root
   • Derived from second & third cervical nerve
   • Descends & winds around internal jugular vein & joins superior root

Ansa cervicalis Distribution:

1. Superior root
   • Superior belly of omohyoid
2. Inferior root
   • Sternohyoid, sternothyroid, inferior belly of omohyoid

Question 20. Name four tributaries of external jugular vein
Answer:

• The posterior external jugular vein
• Transverse cervical vein
• Suprascapular vein
• Anterior jugular vein

Question 21. Name the tributaries of internal jugular vein
Answer:

• Inferior petrosal sinus
• Common facial vein
• Lingual vein
• Pharyngeal vein
• Superior thyroid vein
• Middle thyroid vein

Question 22. Buccopharyngeal fascia
Answer:

• It covers the superior constrictor muscle externally
• It extends on the superficial aspect of the buccinators muscle

Question 23. Contents of suprasternal space
Answer:

• Sterna heads of the right and left sternocleidomastoid muscles
• Jugular venous arch communicating two anterior jugular vein
• A lymph node
• The interclavicular nerves
• Suprasternal ossicles

Question 24. Formation of ansa cervicalis
Answer:

• Ansa cervicalis is formed by
  • Superior root called descendens hypoglossi
    • Derived from first cervical nerve
    • C1 & C2 joins hypoglossal nerve to form it
    • Descends between internal carotid artery and common carotid artery
• Inferior root
  • Derived from second and third cervical nerve
  • Descends and wind around the internal jugular vein and joins the superior root

Question 25. Name any four nerves related to the posterior border of sternocleidomastoid muscle.
Answer:

Nerves related to posterior border of sternocleidomastoid are:

• Spinal accessory nerve
• Branches of cervical plexus
• Roots and trunks of branchial plexus
• Phrenic nerve.