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6/9/2017

DR. VIJAYALAKSHMI S B
Email id: vijayalakshmi@imu.edu.my
Ext. no. 2320

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At the end of the plenary, the students should be able to

1. describe the groups of the muscles of the neck.

2. discuss the attachments, nerve supply and actions of


the muscles of the neck.

3. describe the triangles formed by the neck muscles.

4. explain the main contents of the triangles of the neck


and their clinical applications.

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Investing layer

Deep fascia
Investing layer of
fascia
Superficial fascia Pretracheal fascia
Prevertebral fascia
Carotid sheath

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Contents :
Platysma
Superficial veins – External
jugular vein, Anterior jugular
vein
Superficial cervical lymph
nodes
Cutaneous nerves

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Platysma
Broad, thin sheet of muscle in the subcutaneous
tissue of the neck
Supplied by cervical branch of facial nerve (7th
CN)
Actions - draws corner of mouth inferiorly and
widens it
- draws skin of neck superiorly when
teeth are clenched

• Superior attachment- the inferior


border of mandible, skin and
subcutaneous tissues of lower face
• Inferior attachment- fascia
covering superior parts of
pectoralis major and deltoid
muscles

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11 cranial nerve

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Lateral cervical region


• Splenius capitis
• Levator scapulae
• Scalenus medius
• Scalenus posterior

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Muscles Superior Inferior attachment Innervation Main Action(s)


attachment

Levator Transverse Medial border of C3-C4 and Elevates scapula


scapulae processes of C1- scapula dorsal and tilts glenoid
C4 vertebrae scapular (C5) cavity inferiorly
nerve

Splenius Nuchal ligament Mastoid process of Middle Bilaterally:


capitis and spinous temporal bone and cervical extends head
process C7-T3 lateral third of nerves Unilaterally:
superior nuchal line laterally bends
(flexes) and
rotates face to
same side
Middle Posterior Superior surface of Cervical Flexes neck
scalene tubercles of first rib spinal nerves laterally; elevates
transverse C3-C8 first rib
processes of C2-
C7 vertebrae
Posterior Posterior External border of Cervical Flexes neck
scalene tubercles of second rib spinal nerves laterally; elevates
transverse C6-C8 second rib
processes of C4-
C6 vertebrae

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Anterior cervical region


Divided into:
• Suprahyoid muscles
• Infrahyoid muscles

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Mylohyoid – nerve to mylohyoid from mandibular branch of CN V (trigeminal nerve)


Stylohyoid – CN VII (facial nerve)
Geniohyoid – C1 via hypoglossal nerve (CN XII)

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Prevertebral fascia overlies four muscles –


splenius capitis, levator scapulae, middle scalene and
posterior scalene

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Divided into upper large


occipital triangle and lower
small supra-clavicular/
omoclavicular/ subclavian

Inferior belly of triangle by inferior belly of


Omohyoid
omohyoid

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28 year old man inability to shrug shoulder after


surgery in the neck

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A 40 year old woman presented to


A 18 month old baby presented to the
Neurology outpatient clinic for an
pediatric clinic by his mother. Mother told
evaluation of her neck. On examination,
that the baby was born with small mass
there was marked torticollis with tilting of
on the left side of his neck and head
head to the left and chin facing upwards
turned to the right side.
and to the right
• Which structure is affected in both the case?
• Which side of the neck is abnormal in both the case?

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• Cervical plexus block middle SCM

• Carotid pulse
• Carotid sinus hypersensitivity
• Internal jugular pulse
• Internal jugular vein puncture
• External jugular vein prominence
Differentiate Carotid & Internal Jugular Pulse
1) Jugular pulsation can be seen and felt but not carotid

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mandible anterior belly of digastric


mastoid
porcess posterior belly of
submental digastric
triangle
submandibular
carotid triangle
triangle Sternocleidomastoid
superior belly
of omohyoid muscular occipital triangle
triangle
posterior

inferior belly
anterior of omohyoid
supraclavicular triangle

sternum

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Anterior vertebra region


• Longus colli
• Longus capitis
• Rectus capitis anterior
• Anterior scalene

Nerve supply: from cervical plexus;


Action: flexes neck and head

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References

• Snell’s Clinical Anatomy by Regions – 9th edition


• Clinically oriented Anatomy by Keith L. Moore –
7th edition

Acknowledgement

• Google images
• http://teachmeanatomy.info/lowerlimb/muscles/thigh/hamstrings/
• Dr. Htar Htar

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