Objectives 3.4 Pharynx, larynx, neck

Osteology

• Review osteology of the cervical vertebrae and skull
• Hyoid bone
  • Greater horns of hyoid bone

 

Cartilages, Ligaments, and Membranes of the Larynx

• Epiglottis (epiglottic cartilage)
• Thyrohyoid membrane
• Thyroid cartilage
  • Lamina
  • Laryngeal prominence
  • Superior and inferior horn
• Cricothyroid joint
• Cricoid cartilage
• Arytenoid cartilages
• Cricothyroid ligament
• First tracheal ring

 

Arteries

• Common carotid artery and its bifurcation
  • Carotid sinus & body
• Internal carotid artery
• Branches of External Carotid artery:
  • Superior thyroid artery
    • Superior laryngeal artery
  • Lingual artery
  • Facial artery
  • Occipital artery
  • Posterior auricular artery
  • Ascending pharyngeal artery
  • Maxillary
  • Superficial temporal
• Subclavian artery & branches
  • Vertebral artery
  • Internal thoracic artery
  • Thyrocervical trunk
    • Inferior thyroid artery
    • Transverse cervical artery
    • Suprascapular artery
  • Costocervical trunk
  • Dorsal scapular artery

 

Veins

• Subclavian veins
• Internal jugular veins
• Brachiocephalic veins
• External jugular veins
• Retromandibular veins
• Posterior auricular veins
• Anterior jugular veins

 

Nerves

• Cervical plexus of nerves:
  • Lesser occipital nerve
  • Great auricular nerve
  • Transverse cervical nerve
  • Supraclavicular nerves (medial, intermediate & lateral branches)
• Accessory nerve (CN XI)
• Hypoglossal nerve (CN XII)
• Ansa cervicalis
• Vagus nerve (CN X)
  • Superior laryngeal nerve
    • Internal laryngeal nerve (internal branch of superior laryngeal nerve)
    • External laryngeal nerve (external branch of superior laryngeal nerve)
    • Recurrent laryngeal nerves (understand name change after passing
    • cricothyroid joint)
      • Inferior laryngeal nerve (understand name change after passing cricothyroid joint)
• Pharyngeal plexus: glossopharyngeal nerve, vagus nerve and sympathetic fibers from the superior cervical ganglion
• Glossopharyngeal nerve (CN IX)
• Brachial plexus (observe the trunks in the root of the neck)
• Sympathetic trunk
• Superior, middle and inferior cervical sympathetic ganglia
• Stellate (cervicothoracic) ganglion
• Phrenic nerve

 

Lymphatic Drainage

• Thoracic duct- drainage into left venous angle
• Right lymphatic duct- drainage into right venous angle

 

Muscles

• Platysma muscle
• Scalene muscles (anterior, middle and posterior)
  • Interscalene triangle
• Cricothyroid muscle
• Lateral cricoarytenoid muscle
• Posterior cricoarytenoid muscle
• Arytenoid muscle
• Sternohyoid
• Sternothyroid
• Thyrohyoid
• Omohyoid
• Digastric
• Stylohyoid muscle
• Mylohyoid muscle
• Longus capitis muscle
• Longus colli muscle
• Superior pharyngeal constrictor muscle
• Middle pharyngeal constrictor muscle
• Inferior pharyngeal constrictor muscle

 

Cervical Viscera

• Thyroid gland
  • Right and left lobes
  • Isthmus
• Parathyroid glands
• Submandibular gland
• Pharynx
• Esophagus
• Larynx
• Trachea

 

Retropharyngeal Space

• True (proper) retropharyngeal space
• Danger space

 

Cervical fascia

• Buccopharyngeal fascia
• Prevertebral fascia
• Alar
• Carotid sheath

 

Nasopharynx

• Posterior nasal aperture (choana)
• Opening (ostium) of the pharyngotympanic tube (auditory tube, eustachian tube)
• Torus tubarius
• Salpingopharyngeal fold
• Pharyngeal recess
• Pharyngeal tonsil (adenoid)

 

Oropharynx

• Palatoglossal fold
• Palatopharyngeal fold
• Palatine tonsil (located in the tonsillar bed)

 

Laryngopharynx

• Epiglottis
• Esophagus
• Inlet of the larynx
• Piriform recess and borders
  • Medial – larynx
  • Lateral – thyroid cartilage
  • Posterior – inferior pharyngeal constrictor

Boundaries of the Anterior Triangle

• • Anterior: midline of neck
  • Posterior: anterior border of sternocleidomastoid muscle
  • Superior: inferior border of mandible
  • Superficial (roof): deep cervical fascia

 

Boundaries of the Muscular Triangle

• • Superolateral: superior belly of omohyoid m.
  • Inferolateral: anterior border of sternocleidomastoid m.
  • Medial: median plane of neck

 

Boundaries of the Submandibular Triangle

• • Superior: inferior border of the mandible
  • Anteroinferior: anterior belly of the digastric muscle
  • Posteroinferior: posterior belly of the digastric muscle
  • Superficial (roof): investing layer of deep cervical fascia
  • Deep (floor): mylohyoid and hyoglossus muscles

 

Boundaries of the Submental Triangle

• • Right and left: anterior bellies of the right and left digastric muscles
  • Inferior: hyoid bone
  • Superficial (roof): investing layer of deep cervical fascia
  • Deep (floor): mylohyoid muscle

 

Boundaries of the Carotid Triangle

• • Superior: posterior belly of the digastric muscle
  • Inferolateral: anterior border of sternocleidomastoid m.
  • Inferomedial: superior belly of omohyoid m.

 

Boundaries of the Posterior triangle of the neck

• • Anterior: posterior border of sternocleidomastoid muscle
  • Posterior: superior border of trapezius muscle
  • Inferior: middle one-third of the clavicle
  • Superficial (roof): investing layer of deep cervical fascia
  • Deep (floor): muscles of the neck covered by prevertebral fascia

 

Spaces, Folds and Openings of the Larynx

• Vestibule
• Ventricle
• Infraglottic cavity
• Vestibular fold (false vocal fold)
• Vocal fold (true vocal fold)
• Rima glottidis
• Glottis

 

Clinical Correlations

• Subclavian and internal jugular venous puncture
• Right cardiac catheterization
• Cranial nerve XI injury
• Recurrent laryngeal nerve damage
• Internal laryngeal nerve damage
• External laryngeal nerve damage
• Torticollis
• Tonsillitis and tonsillectomy
• Danger space infections
  • Peritonsillar abscess
• Pharyngoesophageal diverticulum or Zenker’s diverticulum
• Laryngoscopy
• Piriform recess injury
• Tracheostomy
• Cricothyrotomy (= coniotomy)
• Goiter
• Thyroidectomy
• Internal jugular pulse/catheter
• Pancoast tumor
• Lesion of the sympathetic trunk