ANATOMY OF NECK

Dr. SHASHIKANT
SR, ENT
 Development

 The skin of the neck is derived from cervical

dermatomes which arise from the second to
the sixth cervical segments.

 The sternocleidomastoid, strap muscles and

trapezius originate from cervical myotomes.
 Branchial arch derivatives

Arch Muscles Nerves Skeletal

structures
First Mylohyoid, digastric V1 mandible
Second Stylohyoid, digastric, 7 Styloid process,
platysma hyoid
Third stylopharyngeus 9 Hyoid, epiglottis
Fourth & sixth Cricothyroid, 10 Laryngeal cartilages
constrictors of
pharynx, intrinsic
muscles of larynx
Anterior triangle :
 The boundaries of this triangle are
sternocleidomastoid, the inferior ramus of the
mandible and the midline.

 Contents

 Muscles – diagastric, stylohyoid, mylohyoid, sup belly of

omohyoid, strap muscles.
 Vessels – external carotid branches ( except post auricular ),
internal & anterior jugular vein & tributaries.
 Nerves – internal & external laryngeal, nerve to mylohyoid,
hypoglossal nerve.
 Viscera – thyroid & larynx, submental & sub mandibular glands.
 Other – jugular chain of lymph nodes
Submental triangle
 The boundaries are the anterior belly of
the digastric, midline and hyoid bone.

 contains lymph nodes and the submental

salivary gland.
Sub mandibular triangle

 The boundaries are the inferior margin of

the mandible and the anterior and posterior
bellies of the digastric muscle.
 The deep boundary consists of the
stylohyoid and mylohyoid muscles.

 Contains the submandibular salivary gland,

deep fascia, lymph nodes, anterior facial vein,
facial artery and the marginal mandibular
branch of the facial nerve
Carotid triangle

 The boundaries are the anterior border

sternocleidomastoid, posterior belly
digastric and the superior belly of omohyoid.

 It contains the upper carotid sheath and

lymph nodes.
Muscular triangle

 The boundaries are the lower anterior

border sternocleidomastoid, anterior
belly omohyoid, the hyoid bone and the
midline.

 Contains the lower carotid sheath, the

infrahyoid strap muscles, upper aero
digestive tract, the thyroid and
parathyroid glands.
 Posterior triangle
 The posterior triangle can be divided into two
by the omohyoid, which forms the lateral neck
triangle and the subclavian triangle.

 Contents

 Muscles – omohyoid
 Vessels – occipital, transverse cervical, suprascapular, subclavian
arteries & transverse cervical, suprascapular external jugular
veins.
 Nerves – cervical & branchial plexus
 Other – lymph nodes
 Lateral neck triangle
 The boundaries are the posterior border of
the sternocleidomastoid, the anterior
border of the trapezius and the superior
border of the inferior belly of the omohyoid
muscle.

 Contains the cervical plexus, fibrofatty

tissue, lymph nodes and the accessory
nerve.
Subclavian triangle
 The boundaries are the lower border of the
inferior belly of omohyoid, the clavicle and
the posterior border sternocleidomastoid.

 Contents are fibrofatty tissue, the scalene

muscles, the brachial plexus and the
subclavian vesseIs, including the thyrocervical
trunk.
 Also included are Sibson's suprapleural fascia
and the pleura.
FASCIAL LAYERS
 Superficial cervical fascia

 Deep facsia –
superficial layer
middle or visceral layer
deep layer
Superficial cervical fascia
 This is a thin layer that invests the platysma
muscle.

 It is closely associated with adipose tissue.

 This fascia is penetrated by the blood vessels

that supply the neck skin.

 The subplatysmal flap therefore protects the

blood supply to the skin.
Deep cervical fascia
 Superficial or investing layer :
 This arises from the ligamentum nuchae and the spinous
processes of the cervical vertebrae and invests the entire
neck.
 It splits to enclose the trapezius, the omohyoid,
sternocleidomastoid, the strap muscles and the parotid gland.
 Attachments –

Superiorly to the external occipital protuberance, the

superior nuchal lines, the mastoid tip and the zygomatic arch.
Anteriorly this is attached to the hyoid.
Inferiorly attachted to the acromium, the clavicle and the
sternum
Middle or visceral layer
 Derived from the superior layer of the deep
cervical fascia

 Passes deep to the strap muscles and

encircles the trachea, thyroid and the
oesophagus.

 Movement of the hyoid and strap muscles

during swallowing elevates the fascia so that
thyroid lumps characteristically move on
deglutition.
Deep or prevertebral layer
 Arises from the ligamentum nuchae and the
spinous processes of the cervical vertebrae.

 It splits to enclose the postvertebral

muscles, passes laterally around the scalene
muscles and then forms a layer over the
vertebrae.

 It forms the floor of the posterior triangles

and allows the pharynx to glide during
deglutition.
Neck spaces
 Knowledge of potential neck spaces is
important in the understanding of the
spread of infection and tumours in the
neck.

 Contain only loose areolar fascia.

 Submental
 Sub mandibular
 Peri tonsillar
 Para pharyngeal
 Retro pharyngeal
 Pre tracheal
 Pre vertebral
 Sub mental space - a midline space that
lies between the anterior bellies of the
digastric muscles.

 Submandibular space - superficial

boundary is the submandibular gland and
digastric muscle, the deep boundary is the
mylohyoid muscle.
 Communicates with the floor of mouth
around the posterior border of the
mylohyoid.
 Peritonsilar space

 This lies between the tonsil and superior

constrictor.

 It communicates through the fibres of the

superior constrictor with retropharyngeal
and parapharyngeal spaces.
Parapharyngeal space
 This space is the most complex and clinically most important
space.

 It is shaped like an inverted pyramid, the top of which is the base

of skull and the inferior part is the greater cornu of the hyoid
bone.

 Bounded medially by the superior constrictor and laterally by

the pterygoid muscles, the mandible and deep lobe of the parotid
gland.

 Divided by the styloid process and its attachments into the

prestyloid and poststyloid spaces.

 The prestyloid space contains ectopic salivary tissue, while the

poststyloid contains carotid arteries, internal jugular vein, cranial
nerves 9-12, cervical sympathetic chain and lymph nodes.
Retropharyngeal space

 This sits between the two parapharyngeal spaces and is

continuous with both.

 Its superior boundary is the skull base, while the

anterior boundary is the musculature of the pharynx.

 The posterior limit is the prevertebral fascia and the

contents are only lymph nodes.

 It continues inferiorly behind the oesophagus and

eventually communicates with the posterior
mediastinum.
Pre tracheal space
 This lies anterior and lateral to the
thyroid cartilage and deep to the strap
muscles.
 It contain the delphian node and
communicates with the superior
mediastinum.
 Pre vertebral space
 This is the potential space that lies between
the cervical vertebrae and anterior
longitudinal ligament posteriorly and the
prevertebral fascia anteriorly.
 It extends down to the third thoracic
vertebra where the fasica is bound to the
vertebra.
 The prevetebral fascia is thin and infections
in this space can rupture directly through
into the posterior mediastinum.
Muscles
 Sternocledomastoid :

 attachments - inferior attachment is onto the sternum and

clavicle,The superior attachment is to the lateral aspect of
the mastoid tip, as well as the lateral half of the superior
nuchal line.
 The motor nerve supply is the spinal accessory motor and
the anterior rami of C234 segments provides sensory and
proprioceptive function.
 Actions - tilts the head to the shoulder on the same side,
rotates the head to the opposite side and assists longus
coli in neck flexion.
Trapezius
 Has wide origin from the medial third of the superior nuchal line,
the ligamentum nuchae down to the seventh cervical vertebra,
and all the spinous processes and interspinal ligaments down to
the 12th thoracic vertebra.

 The superior fibres insert into the clavicle and acromium and the
inferior fibres from the thoracic vertebrae insert into the spine
of the scapular.

 Action of this muscle is to rotate the scapular so that the glenoid

fossa points up. The trapezius is the major antigravity muscle of
the shoulder girdle.
 The motor nerve supply is the spinal part of the accessory nerve
from roots Cl to C6.
 Proprioceptive information occurs via branches from the cervical
plexus, some motor fibres also innervate the trapezius through
the cervical plexus.
omohyoid

 The proximal attachment is to the hyoid

bone just lateral to the attachment of
sternohyoid.

 It is a useful landmark for the internal jugular

vein.

 The nerve supply is the ansa cervicalis.

 The function of this muscle is obscure.

Digastric
 It arises from the digastric ridge, which is on the medial aspect of
the mastoid tip.

 The posterior belly runs anteroinferiorly and becomes a tendon,

which runs through a sling that is attached to the lesser cornu of
the hyoid.

 The anterior belly then runs anterosuperiorly to insert into the

digastric fossa on the inner surface of the mandible.

 The posterior belly is supplied by the facial nerve, and the

anterior belly receives a branch from the nerve to mylohyoid,
from the mandibular division of the trigeminal nerve, reflecting
its first and second branchial arch embryology.

 It elevates the hyoid during swallowing and assists the lateral

pterygoid in opening the mouth.
Strap muscles
 This group of muscles comprises the
sternohyoid, omohyoid, thyrohyoid and
sternothyroid muscles.

 They move the larynx and depress the

mandible.

 They are supplied segmentally from Cl, 2 and 3

via the ansa cervicalis.

 The strap muscles are retracted to access the

trachea and thyroid gland and also form the
anterior boundaries of the neck levels.
Cervical lymphatics
 Superficial
 Deep

 Superficial - The superficial perforate the

cervical fascia and drain into the deep.
 Deep nodes
 Submental group

 These nodes are situated in the midline, inferior to the

mandible and between the anterior bellies of the digastric
muscles.They drain the anterior floor of the mouth.
 Submandibular

 These nodes are divided into six groups.

 They are preglandular, prevascular, retrovascular,
retroglandular, intraglandular and deep nodes.
 These nodes can best be described as those related to the
submandibular gland and those related to the facial vessels.
 Jugular chain –

 Eighty percent of lymph nodes in the neck are closely

associated with the internal jugular vein.
 The lymphatic channels are found within the loose areolar
tissue that exists around the internal jugular vein and
within the carotid sheath.
 The nodes occur anterior posterior and lateral to the vein.
 The most superior segment of the vein extends from the
skull base to the level of the carotid bifurcation.
 They are the first echelon node for the drainage of the
posterior faucial region, especially the palatine tonsil.
( jugulodigastric ).
 The middle jugular nodes are found
between the carotid bifurcation and the
level at which the omohyoid tendon
crosses the internal jugular vein.
 They are first echelon nodes for the
larynx midhypopharynx and upper thyroid
gland.
 The lower jugular nodes are those between
the tendon of omohyoid and down to the
thoracic inlet.
 They form an important confluence
between the mediastinal node group, the
axillary group and the neck.
 This communication can be a reason why
neck nodes may appear secondary to
disease outside the neck.
Posterior nodes
 The posterior triangle contains lymph nodes
that are arranged into two groups: those that
are found along the accessory nerve and
those related to the thyrocervical vessels.

 The nodes along the accessory are the first

echelon for the nasopharynx and second
echelon for the areas drained by the anterior
neck nodes are related to the thyrocervical
vessels
Major blood vessles
 Common Carotid artery

 This arises from the brachiocephalic artery on the right and

the arch of the aorta on the left.
 It usually has no branches, but may give off the vertebral,
superior thyroid, laryngeal branches of the superior thyroid,
the ascending pharyngeal, inferior thyroid or the occipital
artery.
 The important relations are the internal jugular vein where
it runs medial and deep, while the vagus nerve runs
between the two in the carotid sheath.
 The sympathetic trunk runs deep to the sheath.
Internal & external carotid artery
 Both of these originate at the common carotid
bifurcation artery.

 This division is usually at the level of the hyoid bone,

although it may be higher but rarely lower.

 The internal carotid runs from the upper border of

thyroid cartilage to the carotid canal in petrous
temporal bone passing deep to the posterior belly
of the digastric muscle.

 It is normally straight and unbranched, though in 15

percent of cases it may be coiled or kinked.
Relations
 The internal jugular vein lies anterolateral through almost the
entire course of the internal carotid.

 Posteriorly lies the superior cervical sympathetic ganglion, the

sympathetic chain and superior laryngeal nerve.

 Medially lies the wall of pharynx, with loose connective tissue,

pharyngeal veins, ascending pharyngeal artery and the superior
laryngeal nerve.

 The sternocleidomastoid is anterolateral throughout its course.

 The other important lateral relations of the internal carotid

artery are the hypoglossal nerve, the superior root of the ansa
cervicalis, as well as the lingual and facial veins.
 External carotid artery
 It courses in a straight line from the greater cornu of the hyoid to a
point between the mastoid and ascending ramus of the mandible.

 They supply the deep face, the nose and scalp.

 Before entering the deep surface of the parotid gland, the artery gives
off six branches.

 From the anterior surface - the superior thyroid, lingual and facial
arteries, which supply the thyroid, tongue, superficial face and nose.

 The deep branch - ascending pharyngeal. It supplies the hypopharynx

and oropharynx, skull base and posterior fossa dura through
perforating branches.

 The posterior branches - occipital, posterior auricular.Along with the

superior thyroid branches, they supply the sternocleidomastoid and
contribute to the external ear and occiput.
Internal Jugular Vein
 The internal jugular vein is a continuation of the
sigmoid sinus.

 It exits the skull in the posterior compartment of

the jugular foramen.

 The vein runs in the carotid sheath and joins the

subclavian vein to form the brachiocephalic vein at
the sternal end of the clavicle.

 Tributaries - inferior petrosal vein, facial, lingual,

pharyngeal, superior and middle thyroid veins.
 Relations

 The posterior relations - prevertebral

muscles, the transverse process of atlas, the
phrenic nerve and the thyrocervical trunk.
 The medial relations - vagus nerve,
common and internal carotid arteries while
the sternocleidomastoid lies superficially
along its entire course.
External Jugular Vein

 This vein along with the posterior external

jugular vein and the anterior jugular vein
forms a variable superficial system of veins,
which drains blood from the face and scalp.

 The external jugular vein has a node, the

external jugular node, which drains the
parotid gland and is important in malignancy.
Nerves
 GLASSOPHARYNGEAL NERVE
 Nerve of third branchial arch.
BRANCHES & DISTRIBUTION
 Tympanic nerve - forms tympanic plexus & supply ME,ET, mastoid
antrum & air cells. Lesser petrosal nerve – preganglionic secretomotor fibers to
parotid

 Carotid branch - to ICA & supply carotid sinus & carotid body
 Pharyngeal branch – forms pharyngeal plexus along with vagus &
sympathetic , distributed over mucosa of pharynx

 Muscular branch – to stylopharyngeus

 Tonsillar branch – to tonsil , join to lesser palatine nerve to form
plexus from which fibers are distributed to soft palate & to palatoglossal arches

 Lingual branch – taste & general sensation posterior one third of

tongue including circumvallate papillae.
VAGUS NERVE
 Vagus = (vague ) , extensive course
Two ganglia

 Superior ganglion –

1. Rounded , lies in jugular foramen .

2. Gives meningeal & auricular branches .
3. Connected to IX , XI , & superior cervical ganglion of sympathetic chain .

 Inferior ganglion –

1. Cylindrical , lies near base of skull

2. Gives pharyngeal , carotid , superior laryngeal branches .
3. Connected to XII , superior cervical ganglion , & the loop betn first &
second cervical nerve
BRANCHES IN HEAD & NECK

 In jugular foramen :
1. Meningeal – supplies dura of posterior cranial fossa & fibers derived
from sympathetic & upper cervical nerves
2. Auricular – supplying concha & root of auricle, posterior half of
EAC, outer surface of TM
BRANCHES IN HEAD & NECK

 In neck :
1. Pharyngeal – contains chiefly the fibers of cranial root of accessory
nerve. Forms pharyngeal plexus distributing to the muscles of
pharynx & soft palate ( except tensor veli palatini )
2. Carotid – supply carotid body & sinus.
 Cont..

3 . Superior laryngeal – runs downwards & forwards on superior

constrictor deep to ICA , reaches middle constrictor & divides into
external & internal laryngeal nerves.
External – thin , accompanies superior thyroid artery , pierces the
inferior constrictor & ends by supplying the cricothyroid muscle ,
also gives branches to the inferior constrictor & to pharyngeal
plexus
Internal – thick , passes downwards & forwards, pierces the thyrohyoid
membrane & enters the larynx, supplies the mucous membrane of
larynx upto the level of vocal folds.
4. Recurrent laryngeal nerve –

supplies all intrinsic muscles of larynx except cricothyroid , sensory

nerve to larynx below the level of vocal cords, cardiac branches to
deep cardiac plexus , branches to trachea & esophagus , inferior
constrictor
ACCESSORY NERVE

 Has two roots – cranial & spinal

 Cranial root is accessory to vagus & is
distributed through the branches of it
 Spinal root has more independent course.
 Supplies –

1. Sternocleidomastoid
11. Trapezius
111.Cervical nerves – proprioceptive to muscles
 HYPOGLOSSAL NERVE
 Course & distribution –

1. Intranural –
.. fibers pass forwards & lateral to medial longitudinal bundle ,
medial lemniscus , pyramidal tract & medial to reticular formation
& olivary nucleus

.. Nerve attaches to anterolateral sulcus of medulla betn pyramid &

olive by 10 -15 rootlets

.. Leaves skull through hypoglossal canal ( anterior condylar )

 Branches & distribution
 Branches containing fibers of hypoglossal proper
supply
all extrinsic & intrinsic muscles of tongue , styloglossus ,
genioglossus , superior inferior longitudinal , transverse , vertical
except palatoglossus
 Branches & distribution

 Branches of hypoglossal containing C1 fibers

.. meningeal branch – contains sensory & sympathetic fibers , supplies
bone & meninges in ant part of PCF
.. descending branch –as descendens hypoglossi or upper root of
ansa cervicalis
.. Branches to thyrohyoid & geniohyoid
MUSCLES OF THE
HEAD AND NECK
Myology
Types of Muscles
Skeletal striated muscle
 voluntary somatic muscle
 make up the skeletal muscles
Cardiac striated muscle
 involuntary visceral muscle
 forms most of the walls of the heart and adjacent parts of the
great vessels
Smooth muscle (unstriated)
 involuntary visceral muscle
 forms part of the walls of most vessels and hollow organs
Muscle attachment sites
 Tendon - attachment site to bones
 Origin - relatively fixed during muscular contraction (generally a
more proximal location)
 Insertion - moveable during the contraction
 Belly - fleshy portion of the muscle in between attachment sites
Connective tissues
 Ligament - fibrous tissue that connects bones to other bones
 Aponeurosis - layer of flat broad tendon
 Tendon - tough band of fibrous connective tissue that usually
connects the muscle to bone
Fascia
 layer of fibrous tissue that surrounds muscles, groups of
muscles, blood vessels and nerves,
nerves, binding those structures
together
 allow the muscles to slide upon each other during movement
Coordination among muscles
 body movements are often the result of multiple muscles
working groups
 Agonist or prime mover
doing the contracting and creating the movement
 Antagonist
is relaxing and letting the movement take place
 Synergist
support the agonist in creating movement
 Fixator
allows the agonist to work, stabilizing the origin
Muscles of the Head
 Muscles of eye Origin Insertion Action Innervation

M. orbicularis oculi circularly around the orbit, is attached to

closing the eyelid
pars palpebralis and orbitalis ligamentum palpebrale mediale

M. orbicularis oculi crista lacrimalis enlarges saccus

margins of the eye-lids
pars lacrimalis posterior lacrimalis

N.facialis

middle and lateral part vertical furrowing over

M. corrugator supercilii sutura nasofrontalis
of the eyebrows radix nasí

transversal skin folds

M. procerus radix nasi glabella
above radix nasí
Muscles of the mouth Origin Insertion Action Innervation

juga alveolaria of incisors, mouth closing, labial

M. orbicularis oris inferior part of apertura labial skin constriction, labial
piriformis puckering

M. levator labii inferior edge of aditus

labium superius elevation of upper lip
superioris orbitae

M. levator labii superioris angulus medialis orbitae elevation of upper lip and
sulcus nasolabialis
alaeque nasi et dorsum nasi enlargement of nostril

N.facialis

M. levator anguli oris fossa canina angulus oris elevates angulus oris

M. zygomaticus pulls angulus oris

os zygomaticum sulcus nasolabialis
minor laterocranially

M. zygomaticus pulls oral angle

os zygomaticum sulcus nasolabialis
major laterocranially
Muscles of the
Origin Insertion Action Innervation
mouth

traction of oral angle

M. risorius fascia masseterica angulus oris
laterocranially

processus alveolaris of the compresses cheeks

M. buccinator posterior teeth et raphe angulus oris againts molar teeth;
buccopharyngeum sucking and blowing

M. depressor traction of angulus oris

basis mandibulae angulus oris N.facialis
anguli oris caudally

M. depressor traction of lower lip

basis mandibulae labium inferius
labii inferioris caudally

juga alveolaria of lower pulls chin skin cranially,

M. mentalis skin of the chin
incisors protrudes lower lip
 Muscles of
Origin Insertion Action Innervation
epicranium

traction of the head skin

M. occipitofrontalis
linea nuchae suprema galea aponeurotica dorsally, and erases forehead
venter occipitalis
wrinkles

contraction causes
M. occipitofrontalis margo anterior of galea skin of forehead transversal forehead wrinkles,
N.facialis
venter frontalis aponeurotica and eyebrow and elevation of palpebra
superior

M. temporoparietalis galea aponeurotica auricular cartilage pulls auricula cranially

Nasal muscle Origin Insertion Action Innervation

juga alveolaria of the

M. nasalis ala nasi narrowing of nostril N.facialis
upper anterior teeth
 Masticatory
Origin Insertion Action Innervation
muscles

planum temporale (as far

as linea temporalis inf.) and processus coronoideus elevation and
M. temporalis
internal surface of temporal mandibulae retrusion
fascia

corpus ossis zygomatici et

M. masseter elevation and
arcus zygomaticus tuberositas masseterica
pars superficialis protrusion
(anterior ⅔)

M. masseter arcus zygomaticus external surface of

retrusion
pars profunda (posterior ⅓) ramus mandibulae

M. pterygoideus
medialis fossa pterygoidea tuberositas pterygoidea N.trigeminus
pars medialis
elevation
M. pterygoideus
medialis tuber maxillae tuberositas pterygoidea
pars lateralis

M. pterygoideus
facies infratemporalis alae discus articularis et
lateralis
majoris ossis sphenoidalis fovea pterygoidea
pars superior
protrusion and
M. pterygoideus depression
lateralis processus discus articularis et
lateralis
pterygoidei fovea pterygoidea
pars inferior
Muscles of the Neck
 Superficial muscles Origin Insertion Action Innervation

fascia pectoralis et skin over basis n. facialis -

M. platysma stretches cervical skin
deltoidea mandibulae cervical branch

bilateral: dorsiflexion of the

processus head and neck; unilateral:
manubrium sterni et n. accessorius,
M. sternocleidomastoideus mastoideus et linea lateroflexion of the head
clavicula (medial ⅓ ) plexus cervicalis
nuchae superior and neck; auxiliary
inspiratory m.

Scalene muscles Origin Insertion Action Innervation

M. scalenus anterior processus transversi of

and medius cervical vertebrae
processus transversi of
M. scalenus posterior
cervical vertebrae
first rib
unilateral: lateroflexion and
rotation of neck; bilateral:
Plexus cervicalis
flexes neck; auxiliary
inspiratory muscles
second rib
 Suprahyoid
Origin Insertion Action Innervation
muscles

mandibular depression;
corpus ossis hyoidei et
M. mylohyoideus linea mylohyoidea fixed mandible: elevates the n. mylohyoideus
raphe mylohyoidea
hyoid bone

M. digastricus fixed mandible: elevation of r. digastricus n.

incisura mastoidea os hyoideum
venter posterior the hyoid bone facialis

fixed hyoid bone:

M. digastricus mandibular depression;
os hyoideum fossa digastrica n. mylohyoideus
venter anterior fixed mandible: elevation of
the hyoid bone

elevates the hyoid bone and

M. stylohyoideus processus styloideus os hyoideum n. facialis
pulls it dorsally

mandibular depression;
brach from C1 and
M. geniohyoideus spina mandibulae os hyoideum fixed mandible: elevation of
C2
the hyoid bone
 Infrahyoid
Origin Insertion Action Innervation
muscles

manubrium sterni et depresses of hyoid

M. sternohyoideus os hyoideum
art. sternoclavicularis bone and larynx

manubrium sterni et cartilago thyroidea

M. sternothyroideus depresses larynx
first rib (linea obliqua)

lateral part of body

cartilago thyroidea depresses of hyoid
M. thyrohyoideus and greater horn of Plexus cervicalis
(linea obliqua) bone
hyoid bone

margo superior scapulae

M. omohyoideus
(area nearby ligamentum intermediate tendon
venter inferior
transversum scapulae)
depresses of hyoid
bone and larynx
M. omohyoideus
intermediate tendon os hyoideum
venter superior
 Prevertebral
Origin Insertion Action Innervation
muscles

The muscle is located in front of body and
M. longus colli
transverse processes of cervical vertebrae
unilateral: lateroflexion of
the head and neck; bilateral:
flexes head and neck

unilateral: lateroflexion of
processus transversi pars basilaris ossis
M. longus capitis the head and neck; bilateral:
of cervical vertebrae occipitalis
flexes head and neck
Plexus cervicalis
unilateral: lateroflexion of
M. rectus capitis processus transversi pars basilaris ossis
the head and neck; bilateral:
anterior of atlas occipitalis
flexes head and neck

unilateral: lateroflexion of
M. rectus capitis processus transversi pars basilaris ossis
the head and neck; bilateral:
lateralis of atlas occipitalis
flexes head and neck
Cervical Fascias
 Superficial fascia
immediately deep to the skin
 Deep cervical fascia
deep investing fascia
visceral (pretracheal) fascia
prevertebral fascia
alar fascia
Deep investing fascia
 wraps around the entire circumference of the neck
 splits to pass around SCM and trapezius
 Superior attachment
inf. border of mandible, inf. border of the body of hyoid bone,
angle of mandible, inf. border of zygomatic arch, mastoid
process, styloid process and attachments of SCM and
trapezius to the skull
 Inferior attachment
manubrium sterni, clavicles and spine of the scapula
Visceral/pretracheal fascia
 deep to the deep investing fascia
 forms a sheath around the visceral unit of the neck
 Superior attachment
hyoid bone and base of the skull
 Inferior attachment
superior mediastinum → pericardium of the heart
Prevertebral fascia
 surrounds the cervical vertebral unit
 Superior attachment
base of the skull
 Inferior attachment
blends with the investing fascia of the musculature of the
back and with the anterior longitudinal ligament of the
thoracic vertebrae
Alar fascia
 formed by a division of the anterior componemt of the
prevertebral fascia
 binds to the transverse processes laterally
Head and Neck Anatomy
Yang Chai, DDS, PhD Mikel Snow, PhD
University Professor Professor
George and MaryLou Boone Keck School of Medicine
Chair in Craniofacial Biology USC
Ostrow School of Dentistry
USC

June 28, 2021

 Dissection Videos
https://vimeo.com/showcase/7264128

Password: HeadNeckVideos
Head and Neck Anatomy
Mandibular
block and
potential
clinical
complications
Anatomy and facial trauma
Odontogenic infection
Spread of Odontogenic Infection
Intraoral
I&D
Extraoral
I&D
I&D

Potential
damage to
the facial
nerve
(mandibular
branch)
Pericoronitis and the spread of odontogenic infection
Maxillary sinus and dental implants
Alignment of posterior implants
Alignment of posterior implants
Anatomy of the Posterior Mandible

Mylohyoid shelf

Submandibular
(submylohyoid)
fossa
 Important Anatomy
for the Posterior Mandible
Lingual Nerve
Submandibular Fossa
Mandibular Canal
Mental Foramen
Neck Anatomy
Learning objectives
1. Learn the anatomy of the neck, anterior & posterior triangles, cervical fascia and
the associated clinical considerations
2. Identify and describe all branches of the external carotid artery, identify internal
and common carotid arteries. Know the function and innervation of the carotid body
and the carotid sinus.
3. Describe all venous structures and nerves in the neck.
4. Describe all muscles in the anterior and posterior triangles of the neck, know their
innervations and functions.
5. Identify submandibular and sublingual glands, describe nerve innervations to these
salivary glands
6. Learn the lymphatic drainage of the head and neck. Describe the spread of
infection in the head and neck region.
7. Describe arteries, veins, nerves and muscles at the root of the neck.
 Boundaries of the Neck
•Anterior Aspect:
Superior: Inferior border of the mandible
Inferior: Superior surface of the
manubrium and clavicle
•Posterior Aspect:
Superior: Superior nuchal line
Inferior: Horizontal line between C7 and
T1
Boundaries of the Neck
Neck
anatomy
 Platysma
! Covers mainly anterior aspect of the neck.
! Origin: deltoid and pectoralis fasciae.

! Insertion: inferior border of mandible and

skin as well as hypodermis in this region.

! Function: assist depression the lower lip and

corner of mouth.
! Innervation: cervical br. of facial N. (VII).
Sensory Innervation of Neck
! C1, C2, C3, and most of C4 form the
cervical plexus (Somatosensory)
! Front of neck:
1. Great aruicular N. (C2 & C3)
2. Transverse cervical N. (C2 & C3)
3. Supraclavicular N. (C2 & C4)
a. Anterior (medial)
b. Middle (intermediate)
c. Posterior (lateral)
Posterior Aspect of Neck
! Greater occipital N. (C2)
! Lesser occipital N. (C2)
! Third occipital N. (C3)
! C4 and C5
 Ansa Cervicalis
! Two roots
(formed by C1,
C2, and C3)
- Superior root
(travels with CN
XII)
- Inferior root
(from cervical
region)

Function: Motor innervation of infrahyoid muscles

 Accessory Nerve (CN XI)
Two components of fibers
1. Cranial root
2. Spinal root

Function: motor innervation of

1. Sternocleidomastoid muscle
(SCM)
2. Trapezius muscle
 Phrenic Nerve (C3, C4, and C5)
! Motor: Diaphragm

! Sensory:
Mediastinal pleura
and pericardium of
the heart
Cervical
Plexus
1. Motor
2. Sensory

Cervical sympathetic trunk,

vagus nerve, and
glossopharyngeal nerve
have been cut. The dashes
line indicates a segment of
the epineurium of the
hypoglossal nerve.
 Anterior Triangle of Neck
Boundaries:
Superior: Inferior border of mandible
Posterior: Anterior border of SCM
Anterior: Midline of the neck
 Subdivisions of anterior triangle of the neck
1. Muscular Triangle
2. Carotid Triangle
3. Submandibular Triangle
4. Submental Triangle 2
3 4

1
 Subdivisions of anterior triangle of the neck
1. Muscular Triangle
Boundaries:
Superior: Superior belly of omohyoid
Inferior: Anterior border of SCM
Anterior: Midline
Contents:
a. sternohyoid (ansa)
b. sternothyroid (ansa)
c. thyrohyoid (C1 via CN XII)
d. omohyoid (ansa)
2. Carotid Triangle

Boundaries:
Superior: Posterior belly of digastric
muscle
Inferior: Superior belly of omohyoid
Posterior: Anterior border of SCM
28. Common carotid artery
29. Internal carotid artery
30. External carotid artery
31. Superior thyroid artery
32. External branch of the
superior laryngeal nerve
33. Thyrohyoid
34. Superior laryngeal artery
35. Internal branch of the
superior laryngeal nerve
36. Thyrohyoid membrane
Carotid triangle continued:

Contents:
a. common carotid
- internal carotid artery
- external carotid artery
b. internal jugular vein
c. vagus N (CN X)
d. ansa cervicalis

Carotid Sinus and Carotid Body

-Carotid sinus: BP regulator, CN IX
-Carotid body: Chemoreceptor, CN IX
Branching of the superior laryngeal nerve (SLN)
3. Submandibular Triangle

Boundaries:
Superior: Inferior border of mandible
Anterior: Anterior belly of digastric muscle
Posterior: Posterior belly of digastric muscle
Contents:
a. SMG (submandibular gland)
b. lymph nodes (submandibular group)
c. facial artery
d. facial vein
Innervation of submandibular and sublingual glands
SS

Para pre &

taste

SS, Para pre

& taste
4. Submental Triangle
Boundaries:
Lateral: both anterior bellies of digastric
muscle
Inferior:hyoid bone
Branches of
the external
carotid
artery
Branches of External Carotid Artery
1. Superior Thyroid Artery
2. Ascending Pharyngeal Artery
3. Lingual Artery
4. Facial Artery
5. Occipital Artery
6. Posterior Auricular Artery
7. Maxillary Artery
8. Superficial Temporal Artery
Branches of External Carotid Artery
Superior thyroid artery
Ascending pharyngeal artery (#3)
a. pharyngeal
b. meningeal
c. inferior tympanic (to tympanic cavity)

Lingual artery (#4)

travels deep to hypoglossal nerve (CN XII) to the muscles of
tongue.

Facial artery (#5)

Occipital artery (#6)
Posterior auricular artery (#7)
Maxillary artery Terminal branches of the
Superficial temporal artery external carotid artery
Common
facial vein
 Retromandibular vein
Posterior
auricular vein

Posterior
auricular and
retromandibular
External jugular veins contribute
vein to the external
jugular vein
Root of the neck
 Review of lymph formation:
! Blood passes through
capillaries
! Net loss of fluid into
extracellular space
! Fluid moves into tiny lymph
capillaries, bringing cellular
debris and antigenic
material into lymphatic
circulation, where it is
captured in the lymph
Keck School of Medicine USC
nodes
 Lymphatics in the head & neck

Keck School of Medicine USC

Lymphatics: Thoracic duct
R. Lymphatic duct
Thoracic duct receives lymph
from the lower extremities,
abdomen, left upper extremity,
left chest, left side of the head
& neck.
Lymph nodes
Right lymphatic duct receives
lymph from the right chest,
right upper extremity and right
side of the head and neck

Keck School of Medicine USC

Lymphatics of Head & Neck
Superficial Lymphatics

Pericervical
collar
(encircling
Internal Jugular vein the cranial
base)
Deep Cervical Lymphatics

Internal Jugular
vein
 Cervical Fasciae
A. Superficial
1. Superficial cervical fascia
B. Deep
1. Superficial layer of deep cervical fascia
2. Cervical visceral fascia (pretracheal fascia)
3. Alar fascia
4. Carotid sheath
5. Prevertebral fascia