Boston Marathon Suspect Hospitalized With Neck Injury

It’s been a week since the horrific bomb blasts at the Boston Marathon.

Things are beginning to settle into what will become the “new normal” for those of us who live in the Boston metropolitan area.

Many of the victims remain in the hospital, recuperating from their injuries. Among them, however, is a 19-year-old, Dzhokhar Tsarnaev, who, along with his older brother, 26-year-old Tamerlan, are said to be the persons who placed those bombs and are responsible for such carnage. Tamerlan was killed in nearby Watertown, MA last Friday morning in a standoff with police.

Dzhokhar lies in a hospital bed at Beth Israel Deaconess Hospital in “serious but stable condition” and under tight security. He was captured Friday night, hiding in a boat in the backyard in Watertown. The owner’s noticed some blood on his boat, peeked inside, and seeing a man called the police. After a brief standoff, Dzhokhar surrendered and was taken to the hospital by ambulance.

Although the specifics of his injury have not been revealed, it is said that he has an injury to his neck. It has not been reported whether this injury occurred in the early morning standoff with police, or whether as some have stated, that it was self-inflicted in an attempt to avoid capture.

Although originally heavily sedated, he now appears to be more alert. He is still unable to speak, although it is not clear whether this is due to the injury, or because he has a breathing tube in his trachea. He has been answering some questions by nodding and writing answers.

The Neck

The neck is a very busy place in terms of the anatomy of the area. Many vital structures pass through it. A brief review of the anatomy may be helpful as more specifics come out about Tsarnaev’s injuries.

This is a video from anatomyzone.com that shows a 3-D version of the neck. It’s a little technical, but I’ll define some of the terms the instructor is using below:

First a few words about anatomical positions:

The most obvious extremes of an organism are the “top” and the “bottom”. In human standard anatomical position, these correspond to the head and feet, respectively . The head end is referred to as the superior end while the feet are referred to as the inferior end.

Anterior refers to the “front” of the individual, Similarly, posterior, refers to the “back” of the subject.

Definitions:

Platysma: The platysma is a superficial muscle that lays over the sternocleidomastoid. Its anterior portion, the thickest part of the muscle, depresses the lower jaw; it also serves to draw down the lower lip and angle of the mouth in the expression of melancholy, i.e. grimacing. Here’s an example of the platysma in action (look at the expression on Robert De Niro).

Sternocleidomastoid muscle: The sternocleidomastoid muscles (SCM) are a pair muscles in the superficial layers of the front of the neck. When acting together it flexes the neck and extends the head. When acting alone it rotates to the opposite side (contralaterally) and slightly (laterally) flexes to the same side.

Clavicle: The clavicle is the collarbone and is considered part of the shoulder, connecting the arm to the body.

Anterior, and posterior triangles of the neck: Classically the neck is arbitrarily organized into anterior and posterior triangles - they are separated by the sternocleidomastoid (SCM) muscle.

Mastoid process: The mastoid process is a protruding bony area in the lower part of the skull that is located behind the ear in humans and serves as a site of muscle attachment. The mastoid process contains small air-filled cavities called mastoid cells that communicate with the middle ear.

Mandible: The mandible is the jaw bone.

Hyoid bone: The hyoid bone is a horseshoe-shaped bone. It is anchored by muscles from the anterior, posterior and inferior directions, and aids in tongue movement and swallowing. The hyoid bone provides attachment to the muscles of the floor of the mouth and the tongue above, the larynx below, and the epiglottis and pharynx behind.

Infrahyoid muscles: The infrhyoid muscles are also called the strap muscles, based on their shape. They are a group of four pairs of muscles in the front of the neck. The infrahyoid muscles function to depress the hyoid bone and larynx during swallowing and speech.

Thyroid gland: The thyroid is a small, butterfly-shaped gland in the front of the neck below the larynx, or voice box. The thyroid gland makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.

Parathyroid glands: The parathyroid glands are small endocrine glands in the neck that produce parathyroid hormone. Humans usually have four parathyroid glands, which are usually located on the rear surface of the thyroid gland. Parathyroid glands control the amount of calcium in the blood and within the bones.

Trachea: The trachea is known by most people as the windpipe.

Larynx: The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages. It is a tube lined with cartilage that connects the pharynx and larynx to the lungs

Carotid arteries: are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries.

Jugular veins: The jugular veins are veins that bring deoxygenated blood from the head back to the heart via the superior vena cava.

Vagus nerve: A nerve that supplies nerve fibers to the pharynx (throat), larynx (voice box), trachea (windpipe), lungs, heart, esophagus, and intestinal tract, as far as the transverse portion of the colon. The vagus nerve also brings sensory information back to the brain from the ear, tongue, pharynx, and larynx.