Note: all the slides related to this lecture are included in this script but you can go back

to it to see the pictures. By the end of the last lecture we have finished speaking about the hard tissue of the head (skull) then the cervical vertebrae, today we will start speaking about the soft tissue of the neck at first then the soft tissue of the head. Firstly we should learn basic principles in human anatomy: There are three coverings in the human body: Skin from outside and two types of fascia covering the muscles and bones *fascia is a connective tissue and its 2 types: > the one which is the most outside closer to the skin is the superficial fascia and it’s consist of adipose tissue just a fat (subcutaneous fat) and we know that adipose tissue is part of the connective tissue Cutaneous is adjective of the skin, sub means below (subcutaneous fat=superficial fascia) >After the fat we have tough connective tissue dance fascia very tough membranous layer covering the muscles, the deep fascia of the human body (the muscle fascia because it’s covering the muscle) So the three basic covering in the human body 1-The skin 2-The superficial fascia (a fat layer) 3-Deep fascia (tough membranous layer) After that we have the muscles and the bones

Now in the nick we will speak about the covering (skin and the fascia) the next lecture will be about the muscles.

Neck: The region of body that extends superiorly: from the inferior border
of the mandible and the nuchal line Inferiorly: suprasternal notch and the clavicle Another principle we have to learn is how to divide the neck anatomically When we speak about the neck we speak about the anterior and lateral aspect only because in anatomy the neck is divided into 2 parts: 1- The anteriolateral aspect which we have in this course 2- Posterior aspect which considered a part of the back which we will not have it in details just briefly in the neck 2 reference muscles we use them to distinguish the borders between the anteriolateral and posterior aspect: 1- Sternocleidomastoid muscle (SCM): sterno from the sternum, cleido from the clavicle, mastoid the way up to the mastoid process of temporal bone behind the auricle SCM divide the anterior aspect from the lateral one, anterior to SCM the anterior aspect looks like an inverted triangle (anterior triangle of the neck, anterior because its anterior to the reference muscle the SCM) and posterior to it the lateral aspect looks like triangle in a normal position (the posterior triangle of the neck, posterior because its behind the reference muscle the SCM but its actually in the lateral aspect of the neck).


2- Trapezius muscle (‫ :)المعينية‬demarcating the end of the lateral aspect of the neck and start of the posterior part of the neck which is part of the back>>>to summarize The neck divided into 1- Anteriolateral aspect. 2- Posterior aspect the superior part of the back that covered by the trapezius muscle. Now the anteriolateral aspect is dividing by the SCM into anterior triangle and posterior triangle.

Going back to the covering of the neck just like any part in the human body (the skin, superficial fascia, and the deep fascia) we can see them in across section. 1- The skin is consist of layers just like what we learn in histology 2- The superficial fascia (the fat layer) we can see in it:

a) 4 cutaneous nerves: nerves going to the skin so it’s a sensory one
not motor (note the motor go to the muscle so it’s called muscular nerve) and we should know their names, origin and the area they provide sensory innervations to. Cutaneous nerves at the posterior aspect coming from the posterior rami of C2-C5 (C2 is the greater occipital nerve), while the cutaneous nerve at the anterior aspect coming from the anterior rami of C2-C4 (C1 has no cutaneous branches, muscular only), we have 4 cutaneous nerves at each aspect


1-lesser occipital nerve

the area they provide sensory innervations to anterior ramus of C2 -skin in the area behind the auricle second cervical spinal nerve -skin in the area over the mastoid process -even provide supply to the medial surface of the auricle origin

anterior rami of C2 and C3

2- Great auricular nerve

-the skin over the parotid gland -the lower part of auricle (lobule of auricle the fat part) -the skin over the angle of the mandible

From C2 and C3 3- transverse cervical nerve from C3 and C4

4- supraclavicular nerve

-it goes in transverse direction anteriorly to provide innervations to the skin over the anterior triangle of the neck from the mandible to the sternum this nerve has three branches to cover a very wide area at the root of the neck (the branches are median, intermediate and lateral) so its innervate: -the skin of the lower lateral aspect of the neck which is the lower posterior triangle -the skin over the clavicle and sometimes goes to the level of the first rib in the thoracic region -the skin over the upper half of the shoulder


Some notes related the previous cutaneous nerves: -Great auricular nerve named great not greater because there is no lesser it’s just one auricle -parotid gland (the largest salivary gland located between the mandible and the mastoid process) -since the Great auricular nerve provides sensory innervations to the skin over the angle of the mandible now this is a facial region not cervical to provide sensation there that’s why it’s great - transverse cervical nerve has another name: transverse cutaneous nerve as in our book but our doctor.Alloh not prefer this name because there is many nerves in our body going transversely and providing sensation to the skin so to specify this from all other transverse cutaneous nerves we add cervical but since the name is used in our book the two names are correct)

>>all the sensory innervations of the face coming from the fifth cranial nerve (Trigeminal nerve by its branches: ophthalmic, maxillary and mandibular nerve) except the area over the angle of the mandible the sensation come from the great auricular nerve so at the maxillofacial surgeon or a plastic surgeon they have to anaesthetize the trigeminal nerve but also they shouldn’t forget to anaesthetize the great auricle nerve (below the angle of the mandible) >> Motor innervations to the muscles of facial expressions by the seventh cranial nerve (facial nerve).

The second thing we can find in the superficial fascia of the neck:

b) Platysma muscle
Specific kind of muscle not covered with a deep fascia it’s located in the superficial fascia, platysma muscle considered a muscle of facial expression, specific group of skeletal muscle "its skeletal because we can control it but they are attached to bone at one end and to the skin on the other end so they have to pass throw the superficial fascia. When they contract they move the skin of the face produce the expressions (like smiling and closing eye).
(Skeletal muscle called skeletal because it’s attached to bone when they contract they move they produce emotion like the biceps that’s why platysma is specific one because it’s doesn’t produce movement)

muscles of facial expressions located in the face and neck once it located in the neck we call it platysma muscle, when we look to platysma muscle it’s just straps - bundles of muscle fibers that goes from the deep fascia that covering the pectoralis and deltoid muscle (deltopectoral fascia) and going up to the inferior border of the mandible and medially to angles of the mouth when this muscle contract it will depress the angle of the mouth. >>All muscles of facial expression are innervated by the seventh cranial nerve (facial nerve) is providing motor innervations to all muscles of facial expressions.


The third thing we can find in the superficial fascia of the neck:

c) superficial veins : we refere to it as an external jugular vein (jugular
mean related to the neck) now going back to our reference muscle the SCM, any vein superficial to it is an external (superficial) jugular vein, and any vein deep to the SCM is an internal (deep) jugular vein. external jugular vein start from the angle of the mandible all the way down to the middle third of the clavicle, its located in the superficial fascia, its formed by tow veins one of them come from behind the auricle (posterior auricular vein) and the other behind the mandible(retromandibular vein) the retromandibular vein when it reach the angle of the mandible it divide into anterior and posterior divisions the anterior branches goes anteriorly towards the facial vein and the posterior division will join the posterior auricular vein to form the external jugular vein >> so the external jugular vein formed by the posterior jugular vein and the posterior division of the retromandibular vein, then its descend external to the SCM all the way across the neck to the middle third of the clavicle there it perforates the deep fascia to go and drain into a deep vein (either the internal jugular or in the subclavian vein, the one is closer to its root)
Venous system differ from the arterial system: veins are two types superficial veins in the superficial fascia (we can see them specifically in the limbs, face and in the neck region) and deep veins covered by the deep fascia but the arteries always deep covered by the deep fascia there is no superficial artery because the blood pressure is high and we need to protect them more because the injury in the artery is very serious


3-deep fascia is dividing into 4 different types according to which parts they are covering (specification in the neck): a) Investing Layer of the Deep Cervical Fascia: the largest one because it invest the all neck from anterior to posterior, it covers two muscles(the two reference muscles: SCM and trapezius), two salivary glands(the parotid and the submandibular gland) and the jugular venous arch, its attach to the: inferior border of the mandible, hyoid bone, zygomatic arch, base of the skull, mastoid and styloid process, nuchal ligament, manubrium, clavicle, acromion and spine.  The third salivary gland is the sublingual gland located in the oral cavity, the investing layer (deep cervical fascia covering anything in the neck) doesn’t cover it because it doesn’t reach it.  Mylohyoid muscle: flat muscle going from one side of the mandible to the hyoid bone then to the author side of the mandible, separating the neck from the mouth (we refere to it as the floor of the mouth because anything above it is in the oral cavity and anything below it is in the neck), mylo means molar because it’s coming from the molar teeth to the hyoid bone.  There is a thickening in the investing layer we refere to it as a ligament between the area of the styloid process and the mandible called the stylomandibular ligament and its important in supporting the TMJ (this ligament is one of the accessory ‘secondary supporting ligament) its determine and limit the anterior movement of the mandible (the anterior movement of the mandible called protrusion while the posterior movement called retrusion)


b) Pretracheal Layer: two parts: 1- muscular part covering muscles (infrahyoid muscles below the hyoid bone) 2- Visceral part (from viscous: Latin word means internal organ) Covering organs (thyroid, parathyroid glands, larynx, pharynx, and down: trachea and oesophagus) Attachments: Superiorly: thyroid and cricoid cartilages Laterally: carotid sheath Inferiorly: extends into thorax and blend with the fibrous pericardium

There are very important organs in the neck the larynx and behind it the pharynx, at the level of C6 (the root of the neck) the larynx anteriorly becomes the trachea, and the pharynx behind it becomes the oesophagus. then these structures descend down to the thorax and the Pretracheal layer follow it till this layer merges or blends in the fibrous pericardium (the fibrous covering of the heart), this is considered a very dangerous thing because any infection within the Pretracheal layer can lead to a distribution down to the thorax affecting the thoracic cavity and the heart.

c) Prevertebral Layer: the second largest layer, extend from the base of the skull to T3, Covering the vertebral muscles ( we know that the Vertebral Column has muscles to move it' anterior, lateral and posterior groups the same as the neck: it has anterior cervical vertebral muscles, lateral and posterior muscles all of them are covered together by the prevertebral layer), also covered spinal and phrenic nerves Attachments: Anteriorly: anterior longitudinal ligament Posteriorly: nuchal ligament


d) Carotid Sheath: the smallest but the most dangerous and most important layer (carotid refere to the carotid artery and sheath means covering), extend from skull base to the root of the neck Attachments: investing & pretracheal fasciae (ant.) Prevertebral fascia (post.) Covered: Common carotid artery, external jugular vein, vagus nerve, deep cervical lymph nodes.

Cervical lymph node
lymph nodes which are superficial to our reference muscle the SCM called superficial cervical lymph nodes if it deep of the SCM called deep cervical lymph nodes, if it in the upper half of the neck called superior and if in the lower half called inferior, so we have 4 region for the lymph nodes regarding the SCM and the middle of the neck: Superior superficial , inferior superficial, superior deep, inferior deep lymph nodes. >>In anatomy you should always remember that lymph nodes are always joining or around the venous system (exe. deep cervical lymph nodes are around the internal jugular vein and the superficial lymph nodes are around the external jugular vein. The last two slides the doctor didn’t mentioned them but I put it if you like to read:


Retropharyngeal Space The interval between the pharynx fascia (buccopharyngeal fascia) & prevertebral fascia The largest space in the neck Allows movement of pharynx & esophagus during swallowing *Clinically: Provides major pathway for spread of infection into thorax Ret. Abscess  dysphagia, dysphonia, dyspnea

Muscles of Cervical Region 3 groups 1. Superficial muscles: platysma, SCM, Trapezius 2. Hyoid related muscles: supra & infra hyoid 3. Cervical vertebral muscles: ant., lat. & post.


I apologize if there are any mistakes your colleague: Lina Hasan