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Anatomy of Neck and Blood Supply of Brain
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Lines of greatest tension in the neck are termed ‘relaxed skin tension lines’. The next layer is superficial cervical fascia, which consists of the adipose tissue and platysma. The deep cervical fascia surrounds the muscles and other structures of the neck to varying extent. The carotid sheath is a condensed part of deep fascia that encloses the structures like carotid arteries, vagus nerve and internal jugular vein. In health, the tissues within these spaces are either closely applied to each other or are filled with relatively loose connective tissue. However, they offer potential routes by which unchecked infection may spread within head and neck and between the face and the mediastinum.
Respiratory system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Thin-section CT is therefore used to examine the skull base, the larynx and the cervical course of the recurrent nerves. The vagus nerves run in the carotid sheath, and the recurrent laryngeal nerves branch off the vagus on the left to pass under the aortic arch and on the right under the subclavian artery, before ascending again to the larynx. CT should therefore extend from the skull base to below the aortic arch.
Thyroid nodules and multinodular goiter
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
Poorani N. Goundan, Stephanie L. Lee
US of the thyroid gland is not complete without a visualization of the central and lateral neck nodes. An abnormal lymph node with metastatic disease is characterized by a rounded appearance (AP: longitudinal dimensions >0.5), presence of microcalcification, cystic appearance, and/or peripheral vascularity. The use of anatomic landmarks to identify the central and lateral compartments of the neck will ensure accurate localization for longitudinal observation of growth or development of abnormal sonographic characteristics and communication with surgeons regarding the location of abnormal lymph nodes if surgery is required. Level I compartment nodes include the submental and submandibular nodes. Levels II, III, and IV represent the area from superior to inferior that is bordered by the lateral edge of the carotid sheath medially and the lateral edge of the sternocleidomastoid muscle laterally. The carotid sheath contains the common carotid artery and the internal jugular vein. Level V is the area posterior to the lateral edge of the sternocleidomastoid muscle, also known as the posterior triangle. Level VI, which contains the thyroid gland, is bordered superiorly by the hyoid bone, inferiorly by the brachiocephalic artery, and laterally on either side by the medial edge of the carotid sheath. Inferior to the sternal notch are the level VII nodes (52).
Upgraded hydrodissection and its safety enhancement in microwave ablation of papillary thyroid cancer: a comparative study
Published in International Journal of Hyperthermia, 2023
Zhen-Long Zhao, Ying Wei, Li-Li Peng, Yan Li, Nai-Cong Lu, Jie Wu, Ming-An Yu
In the present study, a total of three anatomical perithyroidal fascial spaces were hydrodissected with an improved protocol for separating thyroid lobes far from adjacent vital structures and guaranteeing a safe procedure. These spaces included: (1) the anterior cervical space (ACS), which is located between the infrahyoid muscles (infrahyoid fascia) and thyroid (visceral fascia), and could protect infrahyoid muscles and the carotid sheath from heat injury after hydrodissection; (2) the visceral space (VS), which is between the thyroid and trachea and could protect the trachea, esophagus, RLN, and superior laryngeal nerve (SLN) after hydrodissection; and 3) the post-thyroid space (POTS), which is posterior to the thyroid and carotid sheath and includes the retropharyngeal space and/or danger space (surrounded by the alar fascia, buccopharyngeal fascia, and prevertebral fascia); this space could protect the carotid sheath, RLN and stellate ganglion. The VS at the level of the suspensory ligament of the thyroid gland could not be hydrodissected because of the suspensory ligament. A schematic of the spaces is shown in Figure 2.
Forget-me-not: Lemierre’s syndrome, a case report
Published in Journal of American College Health, 2023
Benjamin Silverberg, Melinda J Sharon, Devan Makati, Mariah Mott, William D Rose
Anatomically, Lemierre’s syndrome is initially an infectious process of two areas: an anterior portion consisting of sternocleidomastoid (SCM), platysma, suprahyoid and infrahyoid muscles; and a posterior region containing the carotid sheath. The carotid sheath, composed of three separate fascial layers, covers the common carotid artery, internal carotid artery, IJV, vagus nerve, and deep cervical lymph nodes. The bacterial infection spreads from the peritonsillar region, through blood and/or lymph, to the carotid sheath, where it penetrates the IJV.27 It is at this point that thrombophlebitis occurs, causing septic emboli and cytokine-induced sepsis. The elements of Lemierre’s syndrome are listed in Table 3. Interestingly, some authors group thrombophlebitis with septicemia or, separately, metastasis. Revisions to Lemierre’s original description have made FN pathognomonic with Lemierre’s syndrome, though the bacterium has been implicated in other infections in older patients.16
Endotracheal Tube Electrode Neuromonitoring for Placement of Vagal Nerve Stimulation for Epilepsy: Intraoperative Stimulation Thresholds
Published in The Neurodiagnostic Journal, 2022
Gennadiy A. Katsevman, Darnell T. Josiah, Joseph E. LaNeve, Sanjay Bhatia
Once the carotid sheath is opened, a nerve stimulator is used to test any structure appearing to be a nerve within the sheath. The ansa cervicalis and its branches may then be identified by observable contractions of the infrahyoid muscles. These branches are dissected and preserved, and the dissection is then deepened between the IJV and the CCA. If the vagal trunk is then identified, it is stimulated and the minimal stimulation intensity that produces a detectable response in the vocal cords is recorded. If vocal cord stimulation is seen, then the nerve is confirmed to be the vagus nerve. If no nerve is identified between the CCA and the IJV, the stimulation intensity is increased up to 2 mA and stimulation is performed posterior to the CCA or IJV to locate the nerve. Once vocal cord stimulation is identified, then further dissection is performed in the area of stimulation to fully isolate the nerve. This technique reduces the amount of dissection necessary in the posterior aspect of the carotid sheath and can avoid injury to the phrenic nerve and the sympathetic trunk, which are located posterior to the carotid sheath. Once the vagus nerve is correctly identified and dissected free, minimum stimulating intensity is again recorded. The nerve is then tented up with a yellow vessel loop and stimulated again at the middle to cranial end of the dissection. The minimum stimulation intensity is again recorded. The VNS electrodes are then placed in usual fashion and the nerve is allowed to lay flat. The minimum stimulating intensity proximal to the spiral electrodes is again recorded.