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Cylindrical region connecting Head and Trunk
EXTENT LAYERS Skin, Superficial fascia with cutaneous vessels nerves and Platysma Deep fascia is cervical fascia Above - lower border of body of mandible, line joining angle of Mandible to Mastoid process, Mastoid process, Superior Nuchal line, External occipital protuberance. Below - Suprasternal notch of Manubrium sterni, Clavicle, Acromion Process, C7.
CUTANEOUS NERVES Branch Lesser Occipital Great auricular n Transverse cervical Ansa cervicalis Phrenic Supraclavicular CERVICAL FASCIA The deep fascia of the neck, divided into three layers – Investing, Pretracheal and Prevertebral These form natural lines of cleavage through which tissues may be separated, and limit the spread of pus from infections in the neck. Origin C2 C2, C3 C2, C3 --C3 - C5 C3, C4 Muscles innervated Skin of neck, scalp posterosuperior to auricle Skin over parotid gland, posterior auricle, angle of mandible to mastoid process Skin of anterior triangle Infrahyoid (MAHE-95) Diaphragm Skin over shoulder
Investing layer of Deep Cervical Fascia Forms a collar around the neck, located between the superficial fascia and the muscular layer Attachments Superiorly: external occipital protuberance, superior nuchal line, mastoid process, lower border of the mandible Inferiorly: spine of the scapula, acromion process, clavicle, manubrium Posteriorly: ligamentum nuchae, C7 spine Anteriorly: symphysis menti, body of hyoid Pretracheal layer of Deep Cervical Fascia Attachments Superiorly: hyoid bone, oblique thyroid cartilage, cricoid cartilage Features Lies deep to Infrahyoids, splits to enclose thyroid, trachea and esophagus
© BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE
Features The investing layer splits to enclose 2 muscles – Trapezius, Sternocleidomastoid 2 salivary glands – Parotid, Submandibular 2 spaces – Suprasternal, Supraclavicular 2 pulleys to bind tendons – Digastric and Omohyoid
runs from base of skull to sup mediastinum Retropharyngeal Space: Potential space between the pretracheal fascia and prevertebral fascia. 9. MIDLINE STRUCTURES OF THE NECK Features Forms part of a fascial sleeve for the prevertebral 1. Cricothyroid muscle Cricoid cartilage 1st tracheal ring Isthmus and pyramidal lobe of the thyroid gland Inferior thyroid veins 10. Anterior triangle with apex directed downwards Posterior triangle with apex directed upwards ANTERIOR TRIANGLE OF THE NECK (AIPG-2003) Boundaries Base: lower border of mandible. ansa cervicalis embedded in ant wall. 96) 1. 4. 2. 7.HUMAN ANATOMY Neck Inferiorly: arch of the aorta (superior mediastinum) Laterally: fuses with the carotid sheath 94 Prevertebral layer Attachments Superiorly: base of the skull Inferiorly: body of T4 vertebrae muscles The cervical plexus and proximal parts of the brachial plexus are deep to it. 95. 8. 3. Derived from 4th and 6th branchial arches Cricothyroid ligament. 6. axillary sheath is extension of this fascia Carotid sheath Completely enclosed within investing fascia. Fibrous raphe of insertion of Mylohyoid extending from symphysis menti to hyoid bone-derived from 1st branchial arch Body of the hyoid bone-derived from 2nd. forms floor of posterior triangle of neck. 3rd branchial arches Median thyrohyoid ligament and Thyrohyoid membrane pierced by Internal Laryngeal nerve and Superior Laryngeal vessels Laryngeal prominence. line from the angle of mandible to mastoid process Apex: Jugular notch Anterior border: midline of neck extending from Symphysis menti to Suprasternal notch Posterior border: anterior border of sternocleidomastoid © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE . internal jugular vein and Vagus nerve (KCET-2010) The sympathetic chain is located posterior to (and outside) the sheath. on either side of the pretracheal fascia Encloses the common and internal carotid arteries. Jugular venous arch (joins the two anterior jugular veins) TRIANGLES OF NECK Side of the neck is divided by Sternocleidomastoid into (AIPG-94. 5. 2.
Sides Base Apex Floor muscles Hyoid bone Symphysis menti Mylohyoid muscle (KCET-03. prevertebral fascia 95 The superior belly of Omohyoid and Digastric muscles divide the anterior triangle into 4 further triangles BOUNDARIES 1. superficial fascia. Anterosuperiorly Posterior belly of Digastric Stylohyoid CAROTID TRIANGLE Muscles --Common Carotid Artery and its two terminal branches Branches of External Carotid Artery – Anteroinferiorly Superior belly of Omohyoid Arteries Superior Thyroid Lingual Facial Ascending pharyngeal Occipital Posteriorly Anterior border of Sternocleidomastoid Veins Internal tributaries Jugular Vein and © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE . Anterior Anterior belly of Digastric CONTENTS SUB MENTAL TRIANGLE – MEDIAN TRIANGLE Muscles Arteries & Veins Nerves Miscellaneous ------Sub mental lymph nodes Anterior bellies of Digastric DIGASTRIC TRIANGLE Anterior part Muscles Arteries & Veins Nerves --Facial artery Facial vein Mylohyoid vessels Mylohyoid nerve Superficial Miscellaneous part of Submandibular gland Submandibular lymph nodes Posterior part Muscles Arteries & Veins Nerves Miscellaneous Stylopharyngeus Internal carotid artery Internal jugular vein Hypoglossal nerve (AIPG-99) Vagus nerve Lower pole of parotid gland Posterior Posterior belly of Digastric Stylohyoid Base of mandible Base Line from angle to mastoid process Skin Roof Superficial fascia Deep fascia Mylohyoid Floor Hyoglossus Middle constrictor of pharynx 3. larynx. investing layer of deep cervical fascia Floor: pharynx.HUMAN ANATOMY Neck Roof: skin. AIPG-99) 2.
cessation of heart beat Carotid body – chemoreceptor posterior to the bifurcation of the common carotid. internal jugular vein. trachea and esophagus (deep to this triangle) Miscellaneous --- Importance of Carotid triangle Carotid sinus – baroreceptor at the bifurcation of the common carotid. cervical sympathetic trunk Carotid pulse – absence indicates cardiac arrest © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE . Pressure on the carotid sinus syncope.These are all innervated by the Ansa cervicalis except Thyrohyoid.HUMAN ANATOMY Neck Hypoglossal Ansa cervicalis Skin Roof Superficial fascia Deep fascia Nerves Vagus External laryngeal Internal laryngeal 96 Cervical part of Sympathetic trunk Thyrohyoid Floor Hyoglossus Middle and Inferior constrictors of pharynx 4. larynx. reflex change in respiration Important surgical approach for carotid arteries. vagus nerve. hypoglossal nerve. innervated by the sinus branch of IX cranial nerve. which is innervated by C1 nerve Surgical approach for thyroid. Behind Infront and above Infront and below Medial Anterior border Sternocleidomastoid Posterior belly of Digastric Stylohyoid Superior belly of Omohyoid Midline MUSCULAR TRIANGLE of Infrahyoid muscles .
gap at insertion of Stylohyoid INNERVATION Inferior alveolar C1 (via XII) Facial (VII) Anterior belly: inferior alveolar (Mandibular branch of V3) (APPSC-99.HUMAN ANATOMY Neck 103 REGION MUSCLE Mylohyoid Geniohyoid Stylohyoid ORIGIN Mylohyoid line of mandible Inferior genial tubercle of INSERTION Body of hyoid Body of hyoid Body of hyoid Intermediate tendon-in position by sling of deep fascia. Lower border of body of hyoid Suprahyoid Digastric 2 bellies Anterior.Mastoid notch of Temporal bone to fascial sling (PGI2003) Sternohyoid Infrahyoid (AIIMS-06) Thyrohyoid Omohyoid – 2 belliesSuperior (near insertion) Inferior (near origin) Hyoglossus is not included in Suprahyoid muscles Sternothyroid Sternoclavicular manubrium sterni Posterior surface of manubrium sterni Oblique line on Thyroid cartilage Inferior belly from superior border of scapula –near suprascapular notch Oblique cartilage Lower border of Body and greater horn of hyoid Superior belly into inferior Ansa cervicalis (C1-C3) C1 (via XII) line on Thyroid Ansa cervicalis (C1-C3) joint. AIPG-99. clavicle. AIIMS03) Posterior belly: facial (VII) (COMEDK-2006) branch of FUNCTION Elevate hyoid and floor of mouth (KCET-98) Pull hyoid antero-superiorly Elevate and retract hyoid Depress mandible (AIIMS-90) Elevate hyoid Mandibular nerve (V3) Symphysis menti of mandible Styloid process Anterior belly . MAHE-94) Ansa cervicalis (C1-C3) Depress hyoid Depress hyoid Depress hyoid Depress hyoid border of body of hyoid © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE . (AIIMS-93.digastric fossa of Mandible Posterior Posterior belly .
4) Rhomboids (C5) Upper part of Brachial plexus 2. investing cervical fascia Floor: prevertebral fascia (over splenius capitis. Upper larger Occipital triangle Lower Supraclavicular / Subclavian triangle BOUNDARIES 1. medius. scalenus anterior.HUMAN ANATOMY Gross Anatomy POSTERIOR TRIANGLE OF THE NECK Boundaries Apex: superior nuchal line Base: middle 1/3 of clavicle Anteriorly: posterior border of sternocleidomastoid Posteriorly: anterior border of trapezius Roof: skin. Apex Superior nuchal line OCCIPITAL TRIANGLE Muscles --- CONTENTS Transverse cervical artery Anteriorly Posterior border of Sternocleidomastoid Arteries & Veins Occipital artery External Jugular Vein Posteriorly Anterior border of Trapezius Spinal accessory nerve Cutaneous branches of Cervical plexus – Lesser Occipital nerve Great Auricular nerve Transverse Cervical nerve Nerves Base Inferior belly of Omohyoid Supra Clavicular nerves Muscular branches – Levator Scapulae Trapezius(C3. posterior) Posterior triangle is divided by inferior belly of Omohyoid into 104 1. levator scapulae. Apex SUB CLAVIAN TRIANGLE Muscles --3rd part of Subclavian artery with its Anteriorly Lower part of posterior border of branches Arteries & Veins Subclavian vein Suprascapular artery (thyrocervical trunk) Posteriorly Anterior border of Trapezius Nerves Base Middle 1/3 of clavicle 3 trunks of brachial plexus Nerve to Serratus anterior Nerve to Subclavius Suprascapular nerve (last two are branches of upper trunk of brachial plexus) © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE At junction of sternocleidomastoid and inferior belly of Omohyoid Sternocleidomastoid . superficial fascia. 2.
It can fill and become visible from holding breath. BRACHIAL PLEXUS Forms from the anterior rami of cervical nerves C5 to C8 and thoracic nerve T1 The contributions of each of these nerves. clavicle and anterior shoulder Phrenic nerve (C3-C4-C5) Caries motor. As the roots emerge from between these muscles . Branches from upper trunk are nerve to Subclavius.C6 roots joining to form upper trunk. Suprascapular nerve. Transverse Cervical (from back of danger zone) and Supra scapular veins drain into External Jugular vein. Lesion of this region (forceps delivery. Erb’s point . are the roots of the brachial plexus.C5.the anterior rami of C5 and C6 form the upper trunk. suprascapular nerve to the supra spinatus and infra spinatus muscles. anterior and posterior branches of upper trunk branches of upper trunk . which are between the anterior and middle scalene muscles. or from congestive heart failure. fascia prevents it from closing and can cause intravenous air embolus. and Diaphragm. the anterior rami of C8 and T1 form the lower trunk. All come of Cervical Plexus and penetrate investing fascia of the posterior triangle Cutaneous nerves Lesser occipital nerve (C2-3) – supplies skin of the neck and the scalp posterosuperior to the auricle Great auricular nerve (C2-3) – supplies skin over the parotid gland.nerve to Subclavius. posterior aspect of the auricle and skin extending from the angle of the mandible to the mastoid process Transverse cervical nerve (C2-3) – skin covering the anterior triangle Supra Clavicular nerve (C2-4) – skin of the neck. nerve to the Subclavius muscle. Branches from the roots are dorsal scapular nerve to the rhomboid muscles.6 nerves meet at this point . supplies skin. CERVICAL PLEXUS – C1-C4 Formed from ventral primary rami of upper four cervical nerves. sensory and sympathetic fibers. Most of the facial veins drain into the External Jugular Vein. © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE . mediastinal pleura and pericardium. Suprascapular nerve.HUMAN ANATOMY Gross Anatomy EXTERNAL JUGULAR VEIN (EJV) Formed by the union of the Retromandibular and Posterior Auricular Veins (KCET-2000) 105 Pierces and fuses with investing cervical fascia about 5 cm above clavicle. innervates diaphragm. The trunks cross the base of the posterior triangle. if cut. the anterior ramus of C7 forms the middle trunk. muscles of neck. forced expulsion of fetal head in breech delivery) causes Erb’s paralysis. long thoracic nerve to the Serratus anterior muscle.
fibers of above protuberance. proprioception the scapula during abduction humerus horizontal Upper elevate. acromion. of skull below lateral superior nuchal line Posterior middle nerves rami cervical draw head back-wards Individually .will tilt head towards shoulder on same side rotating head to turn face together to opposite side Acting draw forwards Assists in rotating head anterior surface of manubrium sternum Superior surface of medial one-third of clavicle Superior line. fibers lower Ansa to C3 cervicalis. fibers middle adduct.draw and rotate head to one side (turn face to same side) CIV tubercles transverse of to Upper surface of rib II Anterior rami of C5 to C7 Elevation of rib II CII of to Upper surface of rib I between tubercle and groove for subclavian artery Anterior rami of C3 to C7 Elevation of rib I CIII tubercles transverse of to Scalene tubercle and upper surface of rib I Anterior rami of C4 to C7 Elevation of rib I Inferior border of body of hyoid bone anterior rami of C1 Depress the hyoid bone ligamentum nuchae. spine of scapula Motor-accessory nerve C3 and C4 [XI]. spinous processes of vertebrae TIV CVII to © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE . ligamentum nuchae. spinous processes of vertebrae TXII Superior border of CVII to depress scapula Omohyoid scapula medial to scapular notch Anterior of Anterior scalene the processes vertebrae CVI Transverse Middle scalene processes vertebrae CVII Posterior of Posterior scalene processes vertebrae CVI Lower Splenius capitis half of Together Mastoid one-third process.HUMAN ANATOMY Gross Anatomy Muscle Upper Sternal head Sternocleido mastoid (AIPG-09) Clavicular head Origin part of Lateral one-half of superior nuchal line Lateral surface of mastoid process Accessory nerve [XI] and branches from anterior rami of C2 to C3 (C4) of Insertion Innervation Function 106 Individually . occipital Trapezius nuchal external Lateral one-third of clavicle.
Vertebral artery. pharyngotympanic tube. submandibular gland (AIPG-92. meninges in posterior cranial fossa Branches from Anterior aspect of external carotid artery Superior artery Lingual artery (APPG-1994. mastoid cells. floor of mouth. sublingual gland All structures in the face from the inferior border of the mandible anterior to the masseter muscle to the medial corner of the eye. palatine tonsil.HUMAN ANATOMY Gross Anatomy SUB OCCIPITAL GROUP OF BACK MUSCLES Muscle Rectus capitis Origin Spinous process of axis (C2) Spinous atlas (C1) Transverse process of atlas (C1) Spinous process of axis (C2) process of Lateral Insertion portion of Innervation Posterior ramus of C1 Posterior ramus of C1 Posterior ramus of C1 Posterior ramus of C1 Function Extension of head 107 posterior major Rectus capitis occipital bone below inferior nuchal line Medial portion of occipital bone below inferior nuchal line Occipital bone between superior and inferior nuchal lines Transverse process of atlas (CI) Rotation of face to same side as muscle Extension of head Extension side Rotation of face to same side of head posterior minor Obliquus capitis superior Obliquus capitis inferior and bends it to same The sub occipital muscles are innervated by the posterior ramus of the first cervical nerve. The vascular supply to the muscles in this area is from branches of the vertebral and occipital arteries Contents of Sub Occipital Triangle Sub occipital nerve. palatine tonsil. pharyngotympanic tube. deep muscles of the back. tonsil. Vertebral plexus of veins BRANCHES OF THE EXTERNAL CAROTID ARTERY (KCET-97. 98. internal structures of the larynx. AIIMS-2001) Branches from Posterior aspect of external carotid artery Occipital artery Posterior artery auricular Sternocleidomastoid muscle. soft palate. posterior scalp (MAHE-99) Parotid gland and nearby muscles. soft palate. external ear and scalp posterior to ear. which enters the area between the vertebral artery and the posterior arch of the atlas. AIPG-2001) Arteries Supplies Branches from Medial aspect of external carotid artery Ascending pharyngeal (AIPG-2003) artery Pharyngeal constrictors and Stylopharyngeus muscle. epiglottis. meninges in posterior cranial fossa. 2001) Facial artery thyroid Thyrohyoid muscle. middle and inner ear structures © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE . thyroid gland Muscles of the tongue. palate. sternocleidomastoid and cricothyroid muscles.
C2 Flex neck Tendinous slips Longus capitis basilar part of occipital bone transverse processes of vertebrae CIII to CVI Branches from anterior rami of C1 to C3 Flexes the head LYMPH NODES AND THE LYMPHATIC DRAINAGE OF THE HEAD AND NECK Location Area of drainage-From To Superior Horizontal Chain Sub mental nodes Sub mental triangle Skin of chin. roof of pharynx. medial Mastoid process Between mastoid process Occipital nodes and external occipital protuberance Vertical chain Posterior Superficial Along exterior jugular vein Sub parotid nodes. nasal cavity (MAHE-2002) Muscles Rectus anterior Rectus lateralis Longus colli capitis capitis Inferior bone Inferior jugular Origin surface of Insertion Anterior surface of Innervation Branches from anterior rami of C1. temporalis muscle. face. anterior part of external ear. trigeminal ganglion and dura in vicinity. external auditory meatus Deep cervical nodes Submandibular nodes or jugular chain Intermediate jugular nodes. C1-C3 Inferior surface of Branches from anterior rami of C1. infra-orbital skin. dura mater on lateral wall of skull and inner table of cranial Maxillary (AIPG-94. mylohyoid muscle. parietal and temporal fossae External acoustic meatus. maxillary sinus. mandibular teeth. skin on chin. C2 Function Flexes joint Flexes head laterally to same side head at basilar part of occipital surface process of of lateral part of atlas and its transverse process Superior atlas Anterior tubercle axis of to surface of transverse process of Atlanto-occipital occipital bone Body T3. tip of tongue Sub mental nodes. structures in infratemporal fossa. upper teeth and gingiva. outer table of bones of skull in temporal fossa.HUMAN ANATOMY Gross Anatomy Terminal Branches of external carotid artery (KCET-2001) Superficial temporal artery 108 Parotid gland and duct. oral Submandibular nodes Pre auricular (parotid) nodes Post auricular (mastoid) nodes Submandibular triangle cavity. temporomandibular joint. temporalis muscle. palate. jugular Supraclavicular and Back of scalp Deep cervical nodes surface of pinna. lip. 95) artery bones. lateral and medial surface of tympanic membrane. side of scalp Temporal scalp. except forehead and part of lower lip In front of tragus Lateral surface of pinna. deep posterior cervical nodes Deep cervical nodes © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE . masseter muscle. lateral face. floor of mouth.
cervical pleura and scalenus anterior muscle. Vagus nerve and recurrent laryngeal nerve Sympathetic chain Phrenic nerve (on scalenus anterior. esophagus Thyroid gland. and mastoid area deep cervical nodes 109 Lymphatic trunks to left and right thoracic ducts ROOT OF THE NECK The root of the neck is the junction between the neck and thorax Important structures are the superior thoracic aperture. trachea. occipital. Boundaries of the thoracic inlet Posterior: T1 vertebra Lateral: 1st rib and costal cartilage Anterior: Manubrium Contents of the Root of the Neck Nerves 1. near parotid nodes Junction of common facial and internal jugular veins Bifurcation of common carotid artery close to carotid body Crossing of Omohyoid and internal jugular vein Tip of tongue Tongue.HUMAN ANATOMY Gross Anatomy cervical (posterior triangle) nodes Intermediate (jugular) nodes Juguloparotid (subparotid) nodes Jugulodigastric (subdigastric) nodes Jugulocarotid (bifurcation) nodes Juguloomohyoid (Omohyoid) nodes Anterior (visceral) nodes Parapharyngeal nodes Paralaryngeal nodes Paratracheal nodes Prelaryngeal (Delphian) nodes Pretracheal nodes Lateral and posterior wall of pharynx Lateral wall of larynx Lateral wall of trachea Cricothyroid ligament Anterior wall of trachea below isthmus of thyroid gland Deep face and esophagus Larynx and thyroid gland Thyroid gland. deep to prevertebral fascia) © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE . except tip Palatine tonsils All other nodes of neck Deep Along spinal accessory nerve chain. 2. esophagus Intermediate nodes Deep cervical nodes Deep cervical and mediastinal nodes Deep cervical nodes Deep cervical and mediastinal nodes Angle of mandible. 3. trachea. pharynx Thyroid gland.
2. thyrocervical trunk Costo cervical trunk (from 1st part on the left) iii. Viscera Left side – thoracic duct Right side – Jugular. 2.HUMAN ANATOMY Gross Anatomy Arteries 110 1. Suprascapular and/or dorsal scapular arteries Veins (unite posterior to Sternoclavicular joint) 1. Broncho mediastinal lymph trunks (right lymphatic duct) 1. 2. Muscles Trachea Oesophagus Apex of the lung (and pleural cupula) 1. Longus colli Sternal ends of sternocleidomastoid. 2. Subclavian. 4. posterior and lateral parts by scalenus anterior) i. internal thoracic artery. ii. 2. 3. Subclavian vein Internal jugular vein Lymphatics 1. right common carotid posterior to Sternoclavicular joint) Left Subclavian artery Left common carotid artery Subclavian artery (medial. 3. Sternohyoid. Sternothyroid Scalene muscles (marginal) ***** © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE . 3. Right brachiocephalic trunk (right subclavian. Vertebral artery.
HUMAN ANATOMY Gross Anatomy 104 © BRIHASPATHI ACADEMY ׀SUBSCRIBER’S COPY ׀NOT FOR SALE .
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