AN35.1-10 | Deep structures in the neck — Summary & Reflection

REFLECT

KEY TAKEAWAYS

Deep Structures in the Neck — Key Points:

1. Deep cervical fascia layers: investing (encloses SCM + trapezius), pretracheal visceral (tethers thyroid to trachea → moves on swallowing), prevertebral (axillary sheath), carotid sheath (CCA + IJV + CN X + ansa cervicalis)
2. Fascial spaces: retropharyngeal (→ danger space → posterior mediastinum); Ludwig's angina from submandibular space
3. Thyroid: relations — RLN in tracheo-oesophageal groove, inferior thyroid artery crosses RLN (variable); parathyroids on posterior surface; inferior thyroid veins drain to brachiocephalic
4. Subclavian artery: 3 parts relative to scalenus anterior; Part 1 gives vertebral + internal thoracic + thyrocervical trunk; Part 2 gives costocervical trunk
5. IJV: in carotid sheath lateral to CCA; drains to brachiocephalic with subclavian vein
6. Cervical sympathetic chain: superior/middle/inferior ganglia; Horner = ptosis + miosis + anhidrosis (sympathetic interruption)
7. RLN: right loops under subclavian; left loops under aortic arch — both ascend in tracheo-oesophageal groove → injury in thyroid surgery
8. Cervical rib: compresses lower trunk (C8, T1) → wasting of intrinsic hand muscles; vascular TOS from subclavian artery compression
9. Cervical lymph nodes: Levels I–VI; jugulodigastric = tonsil; Virchow's = gastric/lung cancer