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Re: T/F cervical fascia

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Posted by lae2 on September 25, 2013 at 05:40:10:

In Reply to: T/F cervical fascia posted by Caitlin McMenamin on September 24, 2013 at 22:34:45:

: 1. The superficial cervical fascia, but not the prevertebral or the pretracheal fascia, envelops the strap muscles.

: false- the strap muscles are not "enveloped" by any fascia. they are deep to the superficial cervical fascia and superficial to the pretracheal fascia

Said to be True. Although I did not draw the superficial cervical fascia enveloping the strap muscles; anatomists have contended that this is the case. In past years, I have drawn superficial cervical fascia passing both deep and superficial to the strap muscles. Then I qualify the drawing by saying that there is some debate about whether the strap muscles are enveloped. For whatever reason, I decided to avoid the debate this year.

: 2. The axillary artery, but not the subclavian vein passes through the interscalene triangle.

: false- the subclavian artery passes deep to the anterior scalene muscle to then exit through the interscalene triangle, but the subclavian vein does not pass through the triangle
Agree. It is the subclavian artery that passes through the interscalene triangle to then become the axillary artery. Note that because the subclavian vein does not pass through the interscalene triangle; it does not evaginate the prevertebral fascia with the subclavian artery. You may have read differing accounts about the contents of the axillary sheath. Some accounts, Hollinshead, omit the axillary vein from the axillary sheath. The axillary vein has its own sheath derived from prevertebral fascia. Nevertheless, this is not easily demonstrated on dissection and many accounts ignore the nuance.

: 3. The posterior scalene muscle is the posterior boundary of the interscalene triangle.

: false- the middle scalene is the posterior boundary od the interscalene triangle
Agree.

: 4. The superficial cervical fascia has a superior attachment at the superior nuchal line.

: true- its superficial borders are the scalp posterior (more specifically nucal line) and the mandible anteriorly.
Agree. Except you may mean superior attachment rather than superficial border.

: 5. Posterior to the buccopharyngeal fascia and anterior to the alar layer of prevertebral fascia is the "danger" space.

: false- this space would be the retropharyngeal space
Agree.

: 6. Immediately anterior to the alar layer of prevertebral fascia is the retropharyngeal space.

: true
Agree.

: 7. The carotid sheath receives contributes from each of the named deep cervical fasciae.

: true
Agree.

: 8. The vagus nerve, within the carotid sheath, lies anterior to the common carotid artery.

: false- it lies posterior to the common carotid and the internal jugular vein
Agree.

: 9. The internal jugular vein, within the carotid sheath, lies lateral to the common carotid artery.

: true
Agree.

: 10. The prevertebral fascia splits in either side of the manubrium and forms the suprasternal space.

: false- this would be the superficial cervical fascia that splits and makes the suprasternal space
Agree.

: 11. The superficial cervical fascia is deep cervical fascia.

: true
Agree. Unfortunate name. A constant source of confusion.

: 12. The long thoracic nerve typically pierces the posterior scalene muscle inferior to the dorsal scapular nerve.

: true-?
False. Both typically pierce the middle scalene. Consider the relationships of the interscalene triangle to the intervertebral foramina and to the roots/trunks of the brachial plexus. The posterior scalene is too far posterior to be a likely candidate.

: 13. The most inferior attachment of the superficial cervical fascia at the vertebral spines is the to spine of the second thoracic vertebra.

: false- it extends down to vertebrae prominens (c7)
Agree. A matter of definition. The thorax begins at the first rib. The inferior attachments include the acromion and clavical. You can remember this by knowing that the superficial cervical fascia envelops the trapezius and the sternocleidomastoid.

: 14. The tracheoesphageal groove is within the pretracheal fascia.

: true- ?
Agree. We drew the pretracheal fascia and labeled the recurrent laryngeal nerves within the tracheoesophageal groove. The pretracheal fascia surrounds the cervical viscera - trachea and esophagus.

: 15. The spinal accessory nerve enters the posterior triangle superior to the supraclavicular nerves.

: true
Agree. The supraclavicular nerves emerge into the posterior triangle near the midpoint of the sternocleidomastoid. The spinal accessory nerve does this near the upper 1/3 of the sternocleidomastoid.

: 16. The phrenic nerve crosses the anterior scalene deep to pretracheal fascia.

: true- danger in anesthesia
False. Deep to prevertebral fascia.

: 17. The inferior thyroid artery passes the posterior aspect of the carotid sheath.

: true-?
Agree. Please take another look at the inferior thyroid artery that I tagged in the laboratory. Your dissection if I remember. The artery is tagged crossing the posterior surface of the carotid sheath. This is kind of interesting. You might think the "normal" anatomy would put the artery at risk secondary to compression.

: 18. The suprascapular and transverse cervical arteries cross the anterior scalene superficial to the prevertebral fascia.

: true
Agree. Know the ant/post relationships of the crossing arteries, prevertebral fascia, phrenic nerve, and anterior scalene proper.

: 19. The axillary sheath is a diverticulum of the prevertebral fascia.

: true
Agree. See above discussion about axillary vein.

: 20. The external jugular vein is formed by the confluence of the retromandibular vein and the facial vein.

: false- the external jugular is formed by the retromandibular and the posterior auricle vein
Agree. Auricular vein. This is the traditional definition. What was your source for this?

: 21. The maxillary vein, by way of the pterygoid venous plexus, communicates with the cavernous sinus.

: true
Agree. More to come about this.

: 22. Veins of the orbit provide communication between the region of the face and the cavernous sinus.

: true- can spread infection
Agree. More to come.

: 23. The facial vein and its tributaries are considered to be valveless.

: true- can spread infection
Agree. More to come

: 24. The interval between the heads of origin of the sternocleidomastoid muscle provides a surface landmark for accessing the subclavian artery.

: false- for accessing the phrenic nerve
True. The placement of central lines involves defining this interval. You can palpate this on yourself. More easily if you tense the SCM.

: 25. Infection within the pretracheal space may spread to the superior mediastinum.

: true- the pretracheal spaces inferior border is the superior mediastinum
Agree.

: 26. Infection within the retropharyngeal space may spread to the posterior mediastinum.

: true- this is where the buccopharyngeal fascia and the alar layer meet
Agree.

: 27. Infection within the "danger" space may spread throughout the abdominopelvic cavity.

: true- the danger space runs all the way down the poterior thorax, abdomen and stops in the pelvic cavity
Agree.

: 28. An intraoral object (toothbrush or pencil) that penetrates the "throat" might sever the internal carotid artery, introduce infection into the retropharyngeal space, and introduce infection into the "danger" space.

: true- ouch!
Agree. Brush your teeth while standing in a stationary position. Do not run to answer the phone and certainly do not answer the door.




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