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  <head>
    <title>080-02 Neck triangles, fascia, pharynx, larynx, thyroid, and deep spaces</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Neck, pharynx, larynx, thyroid, and deep spaces">
      <outline text="Triangles and fascia">
        <outline text="Sternocleidomastoid divides anterior and posterior triangles">
          <outline text="Anterior: submental, submandibular, carotid, muscular"/>
          <outline text="Posterior: divided by inferior omohyoid"/>
        </outline>
        <outline text="Investing layer encloses sternocleidomastoid, trapezius"/>
        <outline text="Pretracheal fascia: thyroid, trachea, oesophagus"/>
        <outline text="Prevertebral fascia extends as axillary sheath"/>
        <outline text="Carotid sheath: carotid, internal jugular, vagus">
          <outline text="Sympathetic trunk behind, in prevertebral fascia"/>
        </outline>
        <outline text="Retropharyngeal and danger spaces">
          <outline text="Infection descends to mediastinum"/>
        </outline>
      </outline>
      <outline text="Muscles and cervical roots">
        <outline text="Sternocleidomastoid turns face contralaterally"/>
        <outline text="Accessory nerve supplies sternocleidomastoid, trapezius"/>
        <outline text="Suprahyoids elevate hyoid or depress mandible"/>
        <outline text="Infrahyoids stabilise and depress hyoid">
          <outline text="Ansa cervicalis C1 to C3"/>
        </outline>
        <outline text="Mylohyoid, anterior digastric: mandibular nerve"/>
        <outline text="Posterior digastric, stylohyoid: facial nerve"/>
        <outline text="Plexus and subclavian artery between scalenes">
          <outline text="Subclavian vein anterior to anterior scalene"/>
          <outline text="Phrenic nerve descends on anterior scalene"/>
        </outline>
      </outline>
      <outline text="Pharynx and swallowing">
        <outline text="Skull base to cricoid near C6"/>
        <outline text="Constrictors propel, longitudinal muscles elevate"/>
        <outline text="Vagus supplies most muscles">
          <outline text="Stylopharyngeus glossopharyngeal"/>
        </outline>
        <outline text="Sensation: maxillary, glossopharyngeal, vagus by region"/>
        <outline text="Swallowing sequence">
          <outline text="Palate closes, hyoid and larynx elevate"/>
          <outline text="Vocal folds close, upper sphincter relaxes"/>
          <outline text="Protection needs timing and sensation"/>
        </outline>
        <outline text="Piriform recess traps foreign bodies">
          <outline text="Removal can injure internal laryngeal nerve"/>
        </outline>
      </outline>
      <outline text="Laryngeal skeleton">
        <outline text="C3 to C6, suspended from hyoid"/>
        <outline text="Cricoid complete ring, narrow in children"/>
        <outline text="Cricothyroid joint tilt changes fold tension"/>
        <outline text="Cricoarytenoid joint positions vocal process"/>
        <outline text="Internal laryngeal nerve pierces thyrohyoid membrane"/>
        <outline text="Cricothyroid membrane: emergency airway access"/>
      </outline>
      <outline text="Laryngeal muscles and nerves">
        <outline text="Posterior cricoarytenoid: only major abductor"/>
        <outline text="Lateral cricoarytenoid and arytenoids adduct"/>
        <outline text="Cricothyroid lengthens and tenses folds"/>
        <outline text="Recurrent nerve supplies all but cricothyroid">
          <outline text="Sensation below folds"/>
        </outline>
        <outline text="Internal superior laryngeal: sensation above folds"/>
        <outline text="Left recurrent loops under aortic arch">
          <outline text="Longer course exposed to mediastinal disease"/>
        </outline>
        <outline text="Unilateral palsy: dysphonia, paramedian fold"/>
        <outline text="Bilateral injury threatens airway"/>
        <outline text="External branch injury impairs pitch"/>
      </outline>
      <outline text="Thyroid, parathyroids, and trachea">
        <outline text="Isthmus anterior to second to fourth rings"/>
        <outline text="Pretracheal sheath links gland to larynx">
          <outline text="Thyroid moves with swallowing"/>
        </outline>
        <outline text="Superior thyroid artery near external laryngeal nerve"/>
        <outline text="Inferior thyroid artery varies with recurrent nerve"/>
        <outline text="Inferior parathyroids vary from thymic descent">
          <outline text="Ectopic glands from jaw to mediastinum"/>
        </outline>
        <outline text="Tracheostomy: cricoid, isthmus, vessels, pleura"/>
      </outline>
      <outline text="Oesophagus and major vessels">
        <outline text="Oesophagus begins at cricopharyngeus near C6"/>
        <outline text="Killian region: weak site for diverticulum"/>
        <outline text="Carotid bifurcation near upper thyroid cartilage">
          <outline text="Carotid sinus senses pressure"/>
          <outline text="Carotid body senses blood gases"/>
        </outline>
        <outline text="Internal carotid has no neck branches"/>
        <outline text="Internal jugular joins subclavian behind joint"/>
        <outline text="Open neck veins can entrain air"/>
      </outline>
      <outline text="Deep neck infection and airway">
        <outline text="Mylohyoid divides submandibular space">
          <outline text="Bilateral cellulitis elevates tongue"/>
        </outline>
        <outline text="Submandibular duct crossed by lingual nerve"/>
        <outline text="Stones favour long ascending submandibular duct"/>
        <outline text="Parotid: nerve, vein, artery from superficial">
          <outline text="Secretomotor via otic ganglion"/>
        </outline>
        <outline text="Peritonsillar infection causes trismus"/>
        <outline text="Parapharyngeal space near carotid sheath"/>
        <outline text="Danger signs: stridor, drooling, secretions">
          <outline text="Plan airway before manipulation"/>
        </outline>
      </outline>
      <outline text="Clinical synthesis">
        <outline text="Longitudinal conduits crossed by mobile structures"/>
        <outline text="Know the expanding space and route to airway"/>
      </outline>
    </outline>
  </body>
</opml>
