The neck
Rogan J Corbridge in Essential ENT, 2011
There are two main compartments of the neck, which are separated by the prevertebral fascia (Figure 8.3): Posterior, skeletal compartment: contains the cervical spine and its musculature. This need concern us no further.Anterior, visceral compartment: contains all the other structures and organs. This contains bundles of structures, each of which is enclosed by a fascial envelope (Figure 8.4). The most important of these are: Pretracheal fascia – this is clinically relevant since it encloses the thyroid gland and binds it to the trachea. Thus, when the larynx and trachea move with swallowing, the thyroid gland also ascends and descends.Carotid sheath – a fascial bundle that encloses the carotid, internal jugular vein and vagus nerve.
Examination of the Nervous System
Julian L Burton, Guy Rutty in The Hospital Autopsy, 2010
The first muscle encountered is the sternomastoid. This, supplied by its spinal accessory nerve, is divided at the mid-point. Samples may be taken and the cut ends then reflected upwards and downwards, thus exposing the carotid sheath. At this point, if required, the two bellies of the digastric muscle can be dissected out and sampled. The anterior belly is innervated by the trigeminal nerve and the posterior belly by the facial nerve. The carotid sheath containing the common and internal carotid arteries, internal jugular vein and the vagus nerve can now be explored. The internal carotid artery and vagus nerve are dissected upwards up to their point of entry into the skull. The swelling of the vagus nerve below the skull denotes the position of its inferior ganglion. The hypoglossal and accessory nerves emerge close to the vagus at this point. The glossopharyngeal nerve is to be found between the internal carotid artery and the internal jugular vein running towards the pharynx.
Developmental Anatomy of the Thyroid and Parathyroid Glands
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
The thyroid gland is situated in the lower anterior neck straddling the upper trachea. It is the largest endocrine organ in the body. It weighs 15–20g in adulthood.12, 13 It is a highly vascular, reddish-brown, bi-lobed structure with each lobe joined together by a narrow isthmus (Figure 53.1). Each lobe is pear-shaped, measuring approximately 5 cm in length, 3 cm in width and 1.5 cm in depth. The apex of each lobe is narrow and extends beneath the sternothyroid muscle up to its insertion on the oblique line of the thyroid cartilage. The more rounded lower pole extends down to the level of the fourth or fifth tracheal ring. It lies lateral to the trachea and oesophagus and medial to the carotid sheath. The isthmus overlies the second to fourth tracheal rings.
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
Vertebral artery injury caused by glass remnants in the neck: A case report
Published in Acta Oto-Laryngologica Case Reports, 2019
Keisuke Mizuno, Shogo Shinohara, Yoshihiro Omura, Hirotoshi Imamura, Masashi Shigeyasu, Tetsuhiko Michida, Kiyomi Hamaguchi, Shinji Takebayashi, Keizo Fujiwara, Yasushi Naito
Five days after embolization, we performed the neck surgery. We opened the wound and detected numerous granulomatous tissues around the right carotid sheath. We incised the right sternocleidomastoid muscle to obtain a better operating field. The carotid and jugular systems were explored, and the repaired internal jugular vein was detected. No damage was found to the carotid artery or vagal nerve. We dissected the granulomatous tissue on the lateral side of the carotid sheath by pulling the carotid sheath medially. A hematoma was detected on the right of the C4-5 vertebral body, and the right sympathetic trunk was apparently transected. We found the larger glass piece piercing between the C4 and C5 transverse processes (Figure 3A) and carefully pulled it off without any bleeding. The smaller piece was detected on the lateral side of the larger piece and was removed without damaging the adjacent organs (Figure 3B). There was no bleeding after the operation, and the patient enjoyed his daily meal without dysphagia, although the right vocal cord paralysis was not recovered within the observation period. The patient was discharged on postoperative day 5.
Transient anisocoria after a traumatic cervical spinal cord injury: A case report
Published in The Journal of Spinal Cord Medicine, 2020
Paul Overdorf, Gary J. Farkas, Natasha Romanoski
The sympathetic innervation to the eye is from the superior cervical ganglion (Fig. 1). The superior cervical ganglion lies anterior to the transverse processes of the second and third cervical vertebra. Anterior to the ganglion lies the carotid sheath with the internal carotid artery, internal jugular vein, and vagus nerve, while the longus capitis muscle is found posterior to the ganglion. Postganglionic sympathetic fibers from the superior cervical ganglion are distributed onto the internal carotid artery and help to form the internal carotid nerve plexus, which ascends on the internal carotid artery into the carotid canal to enter the cranial cavity (Fig. 1).11 Once in the cranial cavity, postganglionic fibers from the internal carotid nerve plexus travel on the nasociliary nerve of the ophthalmic division of the trigeminal nerve, while other fibers continue from the internal carotid nerve plexus as the sympathetic root of the ciliary ganglion.12 The sympathetic root of the ciliary ganglion traverses the ciliary ganglion without synapsing (Fig. 1). These nerves then travel on the short ciliary nerves of the ciliary ganglion to the eye where they innervate the dilator pupillae muscle. Some of these postganglionic sympathetic fibers also travel on the long ciliary nerve, a nerve branch of the nasociliary nerve, to reach the eye (Fig. 1). Sympathetic activation of the dilator pupillae muscle dilates the pupil.11,12
Related Knowledge Centers
- Ansa Cervicalis
- Aortic Arch
- Axillary Sheath
- Carotid Canal
- Common Carotid Artery
- Deep Cervical Fascia
- Internal Carotid Artery
- Internal Jugular Vein
- Jugular Foramen
- Vagus Nerve