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Ppt of anatomy of neck & ML imp

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Ppt of anatomy of neck & ML imp

  1. 1. Anatomy of Neck & its Medicolegal importance. Presenter Dr Gopal G Hargi PG in FM& T
  2. 2.  Neck is a very prominent & vital part .Even trivial injuries can cause death without showing any signs. There are very vital structures in a relatively small & unprotected anatomic region making it very vulnerable to fatal injuries.  Moreover the Neck is an area which can be easily grasped and immobilized
  3. 3. Anatomy and Physiology
  4. 4.  Lower border of mandible lies b/w C2 & C3.  The front of the lower pharynx & upper oesophagus lie the larynx & trachea.  On each side of the pharynx is the carotid sheath,containing the common & internal carotid arteries & the IJV with the cervical sympathetic trunk behind it.  The Platysma –a broad flat sheet of muscle lies superficial to the layers of fascia.
  5. 5.  Coll’s fascia :The space among the structures of neck are filled with loose areolar tissue.The structures of the neck are mostly supplied to move up & down  .This fascia is a laminar condensation of loose areolar tissue in neck produced by the movements of these structures.  These laminar condensations take different names in different regions & are continuous with each other or indirectly.  These loose areolar tissue form sheaths which enclose muscles and their moving structures
  6. 6. MODIFICATIONS/ LAMINAE/EXTENSIONS OF DEEP CERVICAL FASCIA HAS 7 MODIFICATIONS 1. INVESTING LAYER 2. PRETRACHEAL LAYER 3. PREVERTEBRAL LAYER 4. CAROTID SHEATH 5. BUCCOPHARYNGEAL FASCIA 6. TEMPORAL FASCIA 7. PHARYNGOBASILAR FASCIA
  7. 7. INVESTING LAYER  ATTATCHMENTS  ABOVE- EXTERNAL OCCIPITAL PROTUBERANCE,MASTOID PROCESS, EXTERNAL ACOUSTIC MEATUS, BASE OF THE MANDIBLE  BELOW- SPINE OF SCAPULA, ACROMION PROCESS, CLAVICLE, MANUBRIUM STERNI  FRONT- HYOID BONE & CONTINUOUS WITH THE FASCIA OF THE FASCIA OF THE OPPOSITE SIDE  BEHIND- 7TH CERVICAL VERTEBRA, LIGAMENTUM NUCHAE
  8. 8.  CCA ,arises from the left side of AOA.  It lies in the medial part of carotid sheath .  Upper border of C4 the CCA bifurcates.  The carotid pulse can be felt by pressing against the anterior tubercle of the tranverse process of C6 vertebra.  ICA ,at its commencment there is a bulge ,  here the arterial wall is thin & contains the baroreceptors which is supplied by the 9th & 10th nerves which control the CVS .  carotid body is a small structure behind the bifurcation of CCA & contains baroreceptors which maintain oxygen saturation.
  9. 9.  IJV forms a jugular arch in the suprasternal space i.e between the sternal & clavicular head of sternocleadomastoid tendon.  Larynx lies below the hyoid bone in the midline of the neck at the level of C4-C6 vertebra.
  10. 10.  The AJV commences beneath the chin & passes downwards ,side by side beneath the platysma to the suprasternal region.Here they pierce the deep fascia & come to lie in the suprasternal space.  Carotid sheath consists of a network of areolar tissue that surrounds the carotid arteries(c&i),IJV,Vagus nerve & some deep cervical lymph nodes.  It is thin where it overlies the IJV ,allowing the vein to dilate during increased blood flow.
  11. 11.  The thyroid gland is situated low down at the front of the neck.The 2 symmetrical lobes are connected by isthmus which lie in front of 2nd,3rd & 4th tracheal rings.  Trachea begins at the level of C6 vertebra in continuity of the larynx,The cervical part lies in the midline of the neck ,in contact with the front of the oesophagus.  Oesophagus commences in continuity with the pharynx at the level of lower border of the cricoid cartilage(C6).
  12. 12.  Hyoid bone lies free ,suspended by muscles & so very mobile .Above its attached to floor of mouth & tongue,larynx below,behind to epiglottis & pharynx.It lies at the level of C3 vertebra.  Vertebral artery arises from subclavian artery & passes up to traverse the foramen of transverse process of upper 6 cervical vertebras.On emerging from foramen the artery enters the skull through foramen magnum  .It pierces the spinal dura mater & archnoid and at the lower border of pons forms the basillar artery.
  13. 13.  For judging the severity of the injuries to the neck its divided into 3 zones.  Zone I • highest mortality  Zone II • most frequent site of injury • lower mortality  Zone III • neurological • distal carotids • pharyngeal injuries
  14. 14. Zones of the Neck
  15. 15.  (Zone 1)Thoracic inlet (clavicle)to cricoid cartilage significant injury in the zone I region may be hidden from inspection of the chest or the mediastinum.  subclavian vessels  brachiocephalic veins  common carotid artery  jugular vein  aortic arch  Trachea  esophagus  Lung apices  c spine  spinal cord  CN roots
  16. 16. Zone 2  Carotid and vertebral arteries  jugular veins  pharynx  larynx  trachea  esophagus  c spine  spinal cord Cricoid cartilage to angle of mandible
  17. 17. Zone 3  Salivary glands  parotid gland  esophagus  trachea  c spine  Carotid arteries  jugular veins  CN IX - XII Angle of mandible to base of skull
  18. 18.  Injury above the level of C4 –rapid death  Due to disruption of CV centre.  Causes- Hyperextension & hyperflexion Atlanto-occipital injury---fatal: widening of space with some blood palpated as ‘loosening ‘ Of the junction with widening.Severe form the articulating condyles of atlas can be seen within foraen magnum. C1-C2 injury-- neurogenic shock ,odontoin is # C2-C3 #( HANGMAN #) rapid
  19. 19.  Injuries over the region of neck  A) Homicidal:  a)strangulation  i)Ligature ii) Manual  c)bansdola  e)mugging  f)penetrating injuries  a) knife b) gunshot  g)cut throat injuries  h)blunt force impact  i) homicidal ii) accidental
  20. 20.  Blunt force impact to the side of neck  Shearing  excessive rotation/ hyperextension ◦ distention and stretching  Tearing of Vertebral Artery  The carotids too get dissected ,veins damaged   Blood tracks along upper part of vessel & enters the cranial cavity producing massive SAH  .
  21. 21. Impact Anterior Neck  Impact Anterior Neck  Crush larynx or trachea; cricoid ring  compress esophagus against spinal column  sudden increased intratracheal pressure against closed glottis (seatbelt), crush bruise (clothesline tackle)  rapid acceleration/ deceleration results in tracheal injury
  22. 22.  B) Suicidal a)Hanging b)postural asphyxiation ◦ children with neck over object and body weight produces compression  C)Accidental i)carotid sleepers ii)bar arm control  a)choking  b)RTA : rapid deceleration  hyperflexion, hyperextension, and rotation  vascular structures are stretched over the cervical spine  shearing forces create intimal tears in the vessel wall c)toxic gas inhalation  D)Judicial or justified hanging
  23. 23. Cause of death in hanging  Asphyxia  Venous congestion  Cerebral oedema  # vertebra  Significant cervical spine and spinal cord damage can occur in hangings that involve a fall from a distance greater than the body height. Cause of death in strangulation  Vagal inhibition  Asphyxia  Cerebral anoxia & Venous congestion
  24. 24.  Other consequences of Neck Trauma Subcutaneous emphysema  Tension pneumothorax  Traumatic asphyxia ◦ Penetrating Trauma  Esophagus or Trachea  Vagus nerve disruption ◦ Tachycardia & GI disturbances  Thyroid & Parathyroid glands ◦ High vascular
  25. 25.  More than 95% of penetrating neck wounds result from guns and knives, with the remainder resulting from motor vehicle accidents, household injuries, industrial accidents, and sporting events  gun shot wound (GSW) sustain greater injury than those with stab wounds because of a bullet's ability to penetrate deeper and cause cavitation, thus damaging structures lying outside the tract of the missile.  Injury to the blood vessels can also result from external compression or mural contusion.  Thrombosis is the most common complication of blood vessel injury, occurring in 25-40% of patients.
  26. 26.  Blunt trauma to the neck typically results from motor vehicle crashes but also occurs with sports- related injuries (eg, clothesline tackle), strangulation, blows from the fists or feet, and excessive manipulation  In motor vehicle crashes, thrusting forward with the head extended, forcing the anterior neck against the steering column. Cerebral vessel and laryngeal injuries secondary to shoulder strap compression have occurred.  Direct forces can shear the vasculature producing shearing damage and resultant thrombosis
  27. 27.  Laryngotracheal Injuries in BNT  Although not prevalent, it is second to only intracranial injury as the most common cause of death among patients with head and neck trauma and is a clinically important injury. ◦ ◦ 60% of all external laryngotracheal traumas are due to blunt neck trauma.  The final common pathway of laryngotracheal injury is compressive force on the larynx leads to injury. This is modified by the degree of laryngeal calcification present;
  28. 28.  Dissection of neck  Before exploring the neck the thorax and the skuull should be opened and the viscera removed  After cutting the skin ,the ant cervical strap muscles are cut and examined  Expose the thyroid cartilage & trachea  Following this ,the tongue ,hyoid bone & the larynx are removed as unit.  Examine the hyoid bone after separating from thyroid cartilage & soft tissues removed  See for periosteal haemorrhages & #  .Palpate the sup horn of thyroid cartilage .Examine lamina of thyroid cartilage & cricoid cartilage for injury.  Open thyroid cartilage posteriorly & examine mucosa of larynx
  29. 29.  Triticeous cartilage are little cartilaginous nodules embedded in the thyroidhyoid ligsment .These may be confused with a # of superior horn of thyroid cartilage  Thank You

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  • The anatomy of the neck.

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