My Neck Notes

• The main arterial blood flow to the head and neck (the carotid arteries) and the principal venous
drainage (the jugular veins). Carotid & jugular blood vessels are the major structures commonly
injured.

• The skeleton of the neck is formed by the cervical vertebrae, hyoid bone, manubrium of the
sternum, and clavicles. All these parts are parts of the axial skeleton Except the clavicles.

• The 3-6 cervical vertebrae have several common characteristics:

- Small vertebral body with superior concave surface and inferior convex surface.

- Vertebral Foramen is large and triangular.

- The transverse processes of all cervical vertebrae have transverse foramens for the vertebral
veins to pass through (Except for C7, the vertebral arteries).

- Their spinous processes are short & bifid.

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• The hyoid bone is located in the anterior part of the neck at the level of C3 vertebra between the
mandible and the thyroid cartilage.

• Hyoid bone is connected to the mandible, styloid processes, thyroid cartilage, manubrium of the
sternum, and scapulae by muscles.

• Hyoid bone does not articulate with any other bone. It is suspended from the styloid processes
by the stylohyoid ligaments and is bound to the thyroid cartilage.

• Hyoid bone helps keeping the airway passage open.

• Each end of the body of the hyoid bone is connected to a greater horn. In young people it's
connected by fibrocartilage & in adults by bone.

• Lesser horns (may be partly or completely cartilaginous in some adults) are connected to the
body of the hyoid bone by fibrous tissues superiorly near the greater horns.

• Platysma is a superficial muscle found in the neck. It overlaps the sternocleidomastoid muscle. It
covers most of the anterior and lateral aspect of the neck. The platysma is a broad muscle which
arises from the fascia that covers the upper segments of the deltoid and pectoralis muscles.

• Platysma muscle is considered part of the facial muscles because it is supplied by branches of
the facial nerve (CN 7).

CERVICAL REGIONS

• The location of the neck lies between the cranium ( mandible anteriorly and occipital bone
posteriorly) and the clavicles.

Sternocleidomastoid Region

• The Sternocleidomastoid (SCM) Muscle is a key landmark in the neck.

• It divides each side of the neck into the anterior and lateral cervical regions resulting in anterior
and posterior triangles.

• X (Carotid
bifurcation -

take pulse
inferior to

this point)

• SCM has 2 heads:

① Sternal Head: its rounded tendon attaches to the manubrium.

② Clavicular Head: it's thick & fleshy and attaches to the superior surface of the medial third of the
clavicle.

• The 2 heads of the SCM are separated inferiorly by a space, visible as a small triangle, called the
lesser Supraclavicular Fossa.

• The superior attachment of the SCM is the mastoid process of temporal bone and the superior
nuchal line of the occipital bone.

Sagara

• Contraction of the SCM at the neck will extend the head at the atlanto-occipital joint, elevating
the chin.

• Flexion of the SCM at the neck will either bend the head at the atlanto-occipital joint only or bend
the head totally until the chin reaches the manubrium of the sternum.

• Lateral Flexion of the SCM at the neck bends the neck sideways and rotates the head.

• If the head and neck are fixed, bilateral contraction of the SCM elevates the clavicles,
manubrium, and so the ribs. In this way, the SCMs act as accessory muscles of respiration.

Posterior Cervical Region

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• The posterior cervical region corresponds to the area of the trapezius. The suboccipital region is
deep to the superior part of this region.

• The trapezius is a large, flat triangular muscle that covers the posterolateral aspect of the neck
and thorax. It is a superficial muscle of the back. It is a posterior axio-appendicular muscle that
acts on the pectoral girdle (shoulder). It is a cervical muscle that can produce movement of the
cranium. It attaches the pectoral girdle to the cranium and the vertebral column.

• If the Trapezius muscle is paralyzed, the shoulder droops (bends or hangs downward); however,
the combined actions of the levator scapulae and superior fibers of the serratus anterior help
support the shoulder and may compensate for the paralysis to some degree.

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Lateral Cervical Region

Superior Nuchal line of Occipital Bone

Apex

Posterior Border of SCM
Anterior Border of Trapezius

Roof

Floor

Middle Third of Clavicle

• Lateral cervical region is bounded anteriorly by the posterior border of the SCM, posteriorly by
the anterior border of the trapezius, inferiorly by the middle third of the clavicle between the
Trapezius and the SCM, by an apex where the SCM and the Trapezius meet on the superior
nuchal line of the occipital bone, by a roof formed by the investing layer of deep cervical fascia,
and by a floor formed by muscles covered by the prevertebral layer of deep cervical fascia.

Muscles in the Lateral Cervical Region

• Muscles in the Lateral Cervical Region include: splenius capitis, levator scapulae, middle scalene,
posterior scalene, and Sometimes the inferior scalene (the smallest scalene - usually hidden by
SCM which attaches to the 1st rib).

• The Lateral Cervical Region is divided into a large occipital triangle superiorly and a small
omoclavicular triangle inferiorly by the inferior belly of the omohyoid muscle.

• It is called the occipital triangle because the occipital artery appears at its apex.

• The most important nerve crossing the occipital triangle is the spinal accessory nerve (CN 11).

• The omoclavicular (subclavian) triangle is on the surface of the neck by the supraclavicular fossa
(the subclavian artery lies deep in it).

Anterior Cervical Region

• The Anterior Cervical Region has an anterior boundary formed by the median line of the neck, a
posterior boundary formed by the anterior border of the SCM, a superior boundary formed by the
inferior border of the mandible, an apex located at the jugular notch in the manubrium, a roof
formed by subcutaneous tissue containing the platysma, and a floor formed by the pharynx,
larynx, and thyroid gland.

• The Anterior Cervical Region is subdivided into 4 smaller triangles by the digastric and omohyoid
muscles: unpaired (connected) submental triangle & 3 small paired triangles: submandibular
(Digastric) triangle, carotid triangle, and muscular triangle.

• The Submental Triangle lies interior to the chin. It is a suprahyoid area bounded inferiorly by the
body of the hyoid and laterally by the right & left anterior bellies of the digastric muscles.

• The floor of the submental triangle is formed by the 2 mylohyoid muscles, which meet in a
median fibrous raphe.

• The apex of the submental triangle is at the mandibular symphysis.

• The base of the submental triangle is at the hyoid bone.

Mandibular Symphysis

• The Submandibular (Digastric) Triangle is a glandular area between the inferior border of the
mandible and the anterior & posterior bellies of the digastric muscle.

• The floor of the submandibular triangle is formed by the mylohyoid and hyoglossus muscles and
the middle pharyngeal constrictor.

• The submandibular gland nearly fills this triangle.

Hyoglossus

• The Carotid Triangle is a vascular area bounded by the superior belly of the omohyoid, the
posterior belly of the digastric, and the anterior border of the SCM.

• This triangle is important because the common carotid artery ascends into it.

• At the level of the superior border of the thyroid cartilage, the common carotid artery divides into
internal and external carotid arteries.

• Located within the carotid triangle are carotid sinus and carotid body.

Muscles in Anterior Cervical Region

• In the anterolateral part of the neck, the hyoid bone attaches to the suprahyoid muscles (superior
to it) and to the infrahyoid muscles (inferior to it). These hyoid muscles steady or move the hyoid
bone and the larynx.

• The Suprahyoid Group of Muscles includes the mylohyoid, geniohyoid, stylohyoid, and digastric
muscles. Together, these muscles make up the floor of the mouth. They support the hyoid in
providing a base for the tongue and they elevate the hyoid & larynx in relation to swallowing and
tone production.

• The Digastric Muscle has 2 bellies joined by an intermediate tendon that descends toward the
hyoid bone.

• The Infrahyoid Muscles (often called strap muscles because of their ribbon-like appearance) are
inferior to the hyoid bone.

• The Infrahyoid Muscles hold the hyoid, sternum, clavicle, and scapula. They also depress the
hyoid and larynx during swallowing & speaking.

• Together, the Infrahyoid Muscles work with the Suprahyoid Muscles to hold the hyoid bone,
providing a firm base for the tongue.

• The Infrahyoid group of muscles are arranged in 2 planes: ① A Superficial Plane made up of the
sternohyoid and omohyoid muscles. ② A Deep Plane made up of the sternothyroid and
thyrohyoid muscles.

• Like the Digastric Muscle, the Omohyoid muscle has 2 bellies (superior and inferior) united by an
intermediate tendon.

• The Sternothyroid is wider than the Sternohyoid, under which it lies (Sternothyroid bottom,
Sternohyoid top).

Deep Structures of the Neck - Prevertebral Muscles

• The deep structures of the neck (Prevertebral Muscles) are located posterior to the cervical
viscera and anterolateral to the cervical vertebral column.

• The Anterior Vertebral Muscles inculde the longus colli, longus capitis, rectus capitis anterior, and
anterior scalene muscles.

• The Lateral Vertebral Muscles include the rectus capitis lateralis, splenius capitis, levator
scapulae, middle scalene, and posterior scalene muscles.

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Torticollis

• Known as “Wryneck”, is a disorder in which the muscles of the neck are flexed, extended, or
twisted in an abnormal position.

• Sternocleidomastoid muscle is the most commonly affected.

• The neck twists to one side leading to abnormal movements and postures of the head.

• The bent side of the neck has a tight Sternocleidomastoid muscle.

• Early treatment is important.

• Certain drugs, such as neuroleptic agents, can cause dystonia - a condition in which involuntary
muscle contraction occurs in the neck, back, and trunk.