TRIANGLES OF NECK. Part I. I.

OVERVIEW OF NECK
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A. Neck can be thought of as compartmentalized (Snell Fig. 11-4; Atlas Fig. 8.1) 1. Posterior compartment contains a. Vertebrae of neck = cervical vertebrae b. Many muscles which move cervical vertebrae and neck; in general - posterior to vertebrae, muscles are continuations of muscles of back and suboccipital region; laterally, muscles are called Scalenes; anteriorly muscles are called Prevertebral muscles; Prevertebral muscles are located directly anterior to vertebrae. 2. Anterior compartment contains a. Viscera - in lower part of neck, trachea, thyroid gland and esophagus. b. Pharynx - in upper part of neck; pharynx is a tube composed of muscles and fascia; the esophagus and the larynx open into the pharynx; the pharynx is continuous anteriorly with the oral and nasal cavities; the esophagus is part of the upper end of the GI tract; the larynx contains structures that make sounds in speech; the larynx is the upper end of the respiratory system. c. Hyoid bone - bone in anterior part of neck; attached to skull and skeleton only by muscles and ligaments; attachments also go to larynx, tongue and skull; muscles which move hyoid bone produce movement of larynx and tongue (which occurs during swallowing and talking) 3. Lateral compartment (lateral and posterior to pharynx) contains blood vessels (Carotid arteries and Internal Jugular veins) and Vagus nerve. II. MUSCLES OF NECK - see attached chart A. Muscles not attached to hyoid bone 1. Sternocleidomastoid muscle 2. Scalenus anterior and medius B. Infrahyoid muscles - all muscles act to depress hyoid bone Note: Hyoid bone has parts: body (central part), greater and lesser horns (cornu) (lateral parts) (Atlas Figure page 740); all infrahyoid and suprahyoid muscles (except sternothyroid) attach to body of hyoid; greater horns can be palpated in neck above thyroid cartilage and used as landmarks to locate surrounding structures. 1. Omohyoid 2. Sternohyoid

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8. NERVES OF NECK A. (Atlas Fig.at root of neck. some fibers leave the Ansa Cervicalis and innervate neck muscles (that are described above). 8. Geniohyoid III. Ansa cervicalis . Thyrohyoid C. Transverse Cervical nerve (C2.also opens mouth 2.forms muscular floor of mouth 4. 8.innervates skin behind ear and skin of upper lateral neck 2.9. Great Auricular nerve (C2.10A) IV.innervates skin over parotid gland and skin located inferior to ear. which emerge from posterior border of sternocleidomastoid (near its mid-point).formed from ventral primary rami of spinal nerves C2-C4. Snell Fig. other fibers of C1 travel further with the Hypoglossal nerve.C3) . they don't. Suprahyoid muscles . 4. only fibers from C1-C3 actually innervate those muscles. Stylohyoid . Digastric . 11-1) 1. (Atlas Figs. ARTERIES OF HEAD AND NECK A. Subclavian artery .5) provides motor innervation to the diaphragm. posterior 2 . all of this forms a loop known as the Ansa Cervicalis. they join the Hypoglossal nerve (cranial nerve XII) as "hitchhiking fibers". Sternothyroid 4. most branches are cutaneous: (Atlas Fig. Cervical plexus . the result is that the Hypoglossal nerve has branches that look like they innervate neck muscles.(C3. Lesser Occipital nerve (C2) . 1.innervate skin of lower lateral neck and shoulder 5. Supraclavicular nerves (C3. crosses anterior to Scalenus Anterior muscle.innervates skin of anterior neck. 8. artery passes laterally toward arm.note: splits to surround digastric tendon 3. Mylohyoid .3.3A.C3) .fibers from anterior ramus of C1 do something devious.all act to elevate the hyoid bone.4. 3. some of these fibers leave the Hypoglossal nerve in the neck and descend down and join other nerves of anterior rami of C2 and C3.C4) .3C) B. Phrenic nerve . those fibers then leave the Hypoglossal nerve to innervate the Thyrohyoid and Geniohyoid muscles.

arises opposite external auditory meatus.Common carotid artery arises from aorta on left. to scalenus ant. carotid which supplies posterior ear and adjacent scalp. 3. VEINS OF HEAD AND NECK 3 . Superior Thyroid artery . 2.no branches.small branch which arises on posterior side of ext. Deep Cervical Artery to deep neck muscles.) .descends to thyroid gland . 8. brachiocephalic artery on right. and Suprascapular arteries.) .to Scalenus Anterior muscle (Atlas Figs. Scalenus Anterior muscle is used as a landmark to divide the artery into three parts: 1. (2) Internal Thoracic artery which descends into thorax posterior to sternum. Internal Carotid artery ascends to skull without branching. Ascending Pharyngeal artery . Superior Intercostal artery to supply first two intercostal spaces with Posterior Intercostal arteries and b. it ascends into neck and divides at level of upper border of thyroid cartilage into Internal and External Carotid arteries. 7. 8. Occipital artery . 4. Posterior Auricular artery . Transverse (or Superficial) Cervical. branches are (from inferior to superior): 1.gives off Superior Laryngeal artery which courses to larynx. V.second large terminal branch of External Carotid.arises below mandible. External Carotid branches supply face and scalp (Atlas Fig. crosses over surface of mandible to supply face. Part III (lat.6A). External Carotid artery . many branches (considered in lecture on Infratemporal region).small branch which ascends to pharynx.one branch: Costocervical trunk . Maxillary artery . lips and nose. Part II (post. to scalenus ant.small branch from posterior side of ext. Facial artery .three branches: (1) Vertebral artery. 2.7A). 6. which ascends into neck and enters foramina transversaria of vertebra C1-C6.which branches into a. ascends to supply scalp and Temporalis muscle. carotid (opposite Facial artery) and supplies posterior scalp. 5. 3. B.ascends to supply tongue. (3) Thyrocervical trunk branches into Inferior Thyroid. 8.large terminal branch of External Carotid. Superficial Temporal artery . 8.6A. Lingual artery . Part I (medial to scalenus anterior) .

4. "Prevertebral" layer of deep cervical fascia .1) 1. 3. Anterior division joins Facial Vein to form Common Facial vein which drains into Internal Jugular vein. trachea. Anterior Jugular vein forms from small veins below mandible.most arterial branches have accompanying veins (venae comitantes). descends to join Ext. Atlas Fig. Investing layer of Deep cervical fascia . Jugular vein above clavicle.forms a tube which completely surrounds vertebral column. Superficial Temporal and Maxillary veins unite to form Retromandibular vein.4. Note: Retropharyngeal space . B.actually completely surrounds cervical viscera. and esophagus. splits into 2 layers to enclose trapezius and sternocleidomastoid muscles and suprahyoid and infrahyoid muscles. in neck generally thin and hard to demonstrate. VI. FASCIA OF NECK A.5A): 1. inferiorly it enters mediastinum. External Jugular vein descends across Sternocleidomastoid muscle to drain into Subclavian vein. Posterior division joins Posterior Auricular vein to form External Jugular vein. 6.loose connective tissue below dermis. one layer completely surrounds neck. infection can spread from head (as in tonsillitis) and neck via retropharyngeal 4 .layers of connective tissue.completely surrounds neck. contains platysma muscle and superficial veins. 5. other layers form tubes contained within that layer. 2. Retromandibular vein divides at angle of mandible into Anterior and Posterior divisions. 8. prevertebral. 8. 2. normally (Atlas Figs. names of some layers poorly chosen and confusing (Snell Fig. 8. "Pretracheal" (visceral) layer of deep cervical fascia . lateral vertebral and suboccipital muscles (not trapezius).A. Deep cervical fascia . 11-4. Overview . branching pattern is variable. Superficial fascia .potential space between "prevertebral" and "pretracheal" layers. including thyroid gland. 3. muscles of back of neck.

infections tend to remain localized within the sheath. and Deep Cervical lymph nodes (sympathetic chain is posterior to carotid sheath). George Washington may have died from this. Deep Ring of nodes .chain of nodes along Internal Jugular vein. VII. 4. 11-25) A. Superficial Ring of nodes . Right Lymphatic Duct (on right). Deep Cervical Chain of lymph nodes (Atlas Fig.88. 11-25) . Carotid sheath . on each side surrounds Common and Internal Carotid arteries. Snell Fig. 5 .described as three groups of lymphatics and nodes: Superficial and Deep Rings of nodes and Deep Cervical chain (Snell Fig. Jugular lymph trunk .consist of Retropharyngeal and Pretracheal nodes.space into mediastinum. Parotid. LYMPHATICS OF HEAD AND NECK . B. D. C. receive lymph vessels from all nodes of head and neck.drain areas adjacent to their location: consist of Submental. Retroauricular and Occipital nodes. Internal Jugular vein.paired. these drain into Brachiocephalic veins (at junction of Internal Jugular and Subclavian Veins). 7. Vagus nerve. Buccal. Submandibular.efferent lymph vessels from deep cervical nodes drain into Thoracic Duct (on left).

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