QS Study

The neck works with the shoulders to give support for the head and facilitates rotation of the head about its axis. Knowledge of clinical anatomy in the neck region is useful for the diagnosis of primary tumors and metastatic lymph nodes. Here are the features of the neck: Sternocleidomastoid muscle, Thyroid gland, Parathyroid glands, Larynx, Pharynx, and Trachea.

Clinical anatomy of the Neck –

(1) The most common swelling in the posterior triangle is the clue to enlargement of the supraclavicular lymph nodes. A swelling in this region may also be caused by a lipoma, cystic hygroma (lymphangioma), pharyngeal pouch, or a cervical rib.

Supraclavicular lymph nodes (Virchow’s or Scalene nodes) are also involved in malignant growths of distant organs e.g., the stomach, the testis, and other abdominal organs. They are, therefore; known as signal nodes, scalene node biopsy is very helpful in the early diagnosis of such malignancies. This is to be correlated with the vast territory drained by the thoracic duct.

(2) Block dissection of the neck for malignant diseases is the removal of cervical lymph nodes along with other structures involved in the growth. This procedure does not endanger those nerves of the posterior triangle which lie deep to the prevertebral fascia i.e., the brachial and cervical plexuses and their muscular branches.

Clinical anatomy of the Neck 1

Fig: Clinical anatomy of the Neck

(3) The applied anatomy of the arteries of the neck has been discussed along with the arteries concerned. The following additional points may be noted.

  1. A cervical rib may compress the subclavian artery. In these cases, the radial pulse is diminished or obliterated on turning the patient’s head upwards and to the affected side after a deep breath (Adson’s test).
  2. Dysphagia caused by compression of the oesophagus by an abnormal subclavian artery is called dysphagia lusoria.
  3. In Blalock’s operation for Fallot’s tetralogy, the right subclavian artery is anastomosed end to side to short circuit the pulmonary stenosis.
  4. Elective arterial surgery of the common carotid artery is done for aneurysms, AV-fistulae or arteriosclerotic occlusions. It is better to expose the common carotid artery in its upper part where it is superficial. While ligating the artery care should be taken not to include the vagus nerve or the sympathetic chain.
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