Neck Fascia

Fascia of the Neck Layers Location Contents

Super cial Mandible to super cial 1. Platysma

fascia of thorax 2. CNVII

Deep Cervical 1. Investing

2. Pretracheal

3. Carotid Sheath

4. Prevertebral

1. Investing Envelopes:

- Sternocleidomastoid

- Trapezius
2. Pretracheal 1. Muscular Layer

2. Visceral Layer

3. Buccopharyngeal
Fascia

a. Muscular Layer Envelopes:

- infrahyoid muscles

b. Visceral Layer Envelopes:

- Pharynx

- Larynx

- Trachea

- Esophagus

- Thyroid Gland

- Parathyroid Gland

- Buccinator

- Pharyngeal constrictor
muscles
3. Carotid Sheath - common carotid
artery

- Internal jugular vein

- Vagus Nerve

- Deep cervical lymph

nodes

4. Prevertebral Alar Fascia

Envelopes:

(anterior extension) - vertebral column

muscles

- Phrenic Nerve

Alar Fascia Between

buccopharyngeal fascia
& prevertebral fascia
proper
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Anterior Triangle of the Neck:

Base: Mandible

Lateral: Sternocleidomastoid

Medial: Midline of Neck

Anterior Triangle Divisons Borders Contents

Submental - Hyoid
- Anterior Jugular Vein
- Mylohyoid

- Anterior Diagastric Belly

Submandibular - Mandible
- Submandibular Gland

- Anterior Digastric
- CNXII Hypoglossal Nerve

- Posterior Digastric - Mylohyoid Nerve

- Facial Artery

- Facial Vein

Carotid - Posterior Digastric

- Common Carotid Artery

- Omohyoid
- External Carotid Artery

- Sternocleidomastoid - Internal Carotid Artery

- Internal Jugular Vein

- CNX Vagus Nerve

- CNXI Spinal Accessory

- CNXII Hypoglossal Nerve

Muscular - Midline of Neck

- Omohyoid

- Omohyoid
- Sternothyroid

- Sternocleidomastoid - Sternohyoid

- Thyroid Gland

- Parathyroid Gland

- Larynx

- Trachea

Posterior Triangle of the Neck:

Base: Lateral 1/3 clavicle

Medial: Sternocleidomastoid

Lateral: Trapezius

Posterior Triangle Divisons Borders Contents

Occipital - Omohyoid
CNXI Spinal Accessory

- Trapezius
- Roots of Brachial Plexus ?
- Sternocleidomastoid
Subclavian - Clavicle
Subclavian Artery
- Sternocleidomastoid

- Omohyoid
 Infrahyoid & Suprahyoid Muscles:

Infrahyoid Mucles Innervation Function

Thyrohyoid C1 Carried by CNXII Depress hyoid; when

hyoid xed, raises
pharynx

Omohyoid Ventral Rami C1-C3 Through Ansa Cervicalis Depresses & xes hyoid

Sternohyoid Ventral Rami C1-C3 Through Ansa Cervicalis Depresses hyoid after
swallowing

Sternothyroid Ventral Rami C1-C3 Through Ansa Cervicalis Draws larynx downward

Suprahyoid Muscles Innervation Function

Anterior Belly of CNV3 Mandibular division of Opens mouth; lowers

Digastric Trigeminal Nerve mandible, raises hyoid

Posterior Belly of CNVII Facial Nerve Pulls hyoid upward &

Digastric back

Stylohyoid CNVII Facial Nerve Pulls hyoid upward &

postero-superior

Mylohyoid CNV3 Mandibular division of Support & elevate oor

Trigeminal Nerve of mouth; elevates hyoid

Geniohyloid C1 Carried by Hypoglossal Elevates & pulls hyoid

Nerve (CN XII) forward; xed hyoid
pulls mandible
downward & inward
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Nerves of the Neck: The Cervical

Plexus

-Ventral rami C1-C4

-Posterior triangle oor

-Deep & Super cial (cutaneous)

branches

-Cutaneous branches are visible in the

posterior triangle beneath the posterior
border of the sternocleidomastoid

Cutaneous Branches of
Cervical Plexus (GSA)

Lesser Occipital Nerve C2 Skin of neck & posterosuperior to

ear

Greater Auricular Nerve C2, C3 Skin over parotid gland, mastoid

process, inferior ear, angle of
mandible to mastoid process

Transverse Cervical Nerve C2, C3 Skin of anterior cervical region

Supraclavicular Nerves C3, C4 Skin over lateral neck & shoulder

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Cranial Nerves In the Neck

Cranial Nerves Exits Skull Innervates

Glossopharyngeal Nerve CNIX Jugular Foramen Stylopharyngeus

Vagus Nerve CNX Jugular Foramen Larynx & Pharyngeal Muscles

Spinal Accessory Nerve CNXI Jugular Foramen Sternocleidomastoid &

Trapezius

Hypoglossal Nerve CNXII Hypoglossal Canal Intrinsic & Extrinsic Tongue

Muscles EXCEPT: Palatoglossus

External Carotid Branches

“ Some Asshole Likes Farting On People
Making Sex”

Bones of the Face

Facial Muscle Innervation

- All innervated by Facial Nerve CNVII

- Facial muscles are derived from Pharyngeal Arch II

1.Temporal

2.Zygomatic

3.Buccal

4.Marginal Mandibular

5.Cervical

Sensory Innervation of the Face

- Innervated by the 3 branches of the Trigeminal Nerve
CNV

Green = V1: Ophthalmic Nerve

Blue = V2: Maxillary Nerve

Red = V3: Mandibular Nerve

Venous Drainage from the Face

- Facial vein is the major vein that drains the face

- Cavernous Sinus

The SCALP

SCALP Layers Characteristics Blood Supply Clinical

Skin Sweat glands, hair Common site for

follicles, sebaceous cysts

Dense Connective Vascularized, fatty tissue Supratrochlear

In ammation = more
Tissue Supraorbital
pain; wounds heal fast;
Super cial Temporal
scalp injuries bleed
Occipital profusely

Aponeurosis of Occipiofrontalis muscle

Occipitofrontalis - frontal belly: temporal

branches of CNVII

- Posterior belly:
auricular branches of
CNVII

- Epicranial
aponeurosis

Loose Connective Collect uid from injury Danger area of scalp;

Tissue or infection - black eye formation

from emissary veins

- Caput Succedaneum
Periosteum On skull Collection of uid
beneath produces
localized swellings
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 Parotid Gland

Parotid Region Parotid Gland Parotid Duct

Boundaries Masseter
Wedged between Over masseter, pierces
Sternocleidomastoid
mandibular ramus & buccinator and enters
Zygomatic arch
mastoid process mouth lateral to the 2nd
Mandible molar

Contents - Parotid gland & duct

1. Facial nerve

- Parotid plexus
2. Retromandibular vein

- Retromandibular vein
3. External carotid
- Super cial temporal artery
artery

- Masseter

Parotid Gland Innervation Preganglionic Postganglionic

Sympathetic (GE) Spinal Cord T1 Superior cervical ganglion travel

along external carotid

Parasympathetic (GE) Brainstem travel on lesser Otic ganglion travel along

petrosal nerve (glossopharyngeal auriculotemporal nerve
nerve) to otic ganglion
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Muscles of Mastication

Muscles of Innervation Origin Action Insertion

Mastication

Temporalis CN V3: Deep Temporal Fossa Elevate, retract & Caronoid process
Temporal Branches side to side of mandible
motions of
mandible (close
mouth)

Masseter CN V3: Masseteric Elevate mandible Angle & lateral

Branches surface of
mandibular ramus

Medial Pterygoid CN V3: Medial Medial side of Closes jaw Medial surface of
Pterygoid Nerve lateral pterygoid mandibular ramus
process

Lateral Pterygoid CN V3: Lateral Base of sphenoid & Protrudes & opens Upper head = joint
Pyerygoid Nerve lateral pterygoid mandible capsule of TMJ

process
Lower head = neck
of condyloid
process of
mandible
Mandibular Nerve V3

Mandibular Nerve Sensory Parasympathetic Motor

Branches

Lingual Sensation to anterior 2/3 Sublingual &

tongue;
submandibular glands
Joins chorda tympani
from CNVII = taste
anterior 2/3 tongue

Inferior Alveolar Enters mandibular Mylohyoid

foramen to supply teeth Anterior Diagastric

& skin of the chin
(through mental nerve)

Auriculotemporal Supplies:
Parotid gland
- Skin auricle

- anterior wall of
external auditory
meatus

- tympanic membrane

- Temporal region

- TMJ

Infratemporal Fossa

Infratemporal Fossa Entry Foramen Exit Branches

Maxillary Nerve (V2) Foramen Rotundum inferior orbital ssure Pterygopalatine ganglion

Mandibular Nerve (V3) Foramen Ovale Pterygopalatine Fossa Anterior & posterior
trunks
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Pterygopalatine Fossa
—> distributes the branches of the maxillary
nerve V2 & maxillary artery

- communicates with:

- Oral Cavity

- Nasal Cavity

- Infratemporal Fossa

- Pharynx

- Middle Cranial Fossa

Pterygopalatine Ganglion Branches:

1. Nasopalatine Nerve

2. Greater Palatine Nerve

3. Nasal Branches

4. Lesser Palatine Nerve

5. Pharyngeal Nerve

6. Orbital Branches

Longitudinal Muscles of the Pharynx

Elevating the pharynx will shorten & widen it!

Muscle Innervation Function Pharyngeal Arch

Stylopharyngeus Glossopharyngeal Nerve Elevates pharynx Arch III

(CNIX)

Salpingopharyngeus Vagus Nerve (CNX) Elevates pharynx; Arch IV

Opening of auditory tube

Palatopharyngeus Vagus Nerve (CNX) Elevates pharynx; Arch IV

Closure of
oropharyngeal isthmus

The Pharyngeal Plexus of Nerves

Formed by:

- Vagus Nerve CNX

- Glossopharyngeal Nerve CNIX

- Sympathetic Trunk (via superior cervical ganglion)

The Vagus nerve innervates ALL muscles of the pharynx via pharyngeal plexus EXCEPT:

1. Stylopharyngeus = CNIX

2. Tensor Veli Palatini = CN V3

Features of the Larynx

1. Thyroid Membrane
- Pierced by internal laryngeal nerve & superior laryngeal artery

2. Cricothyroid Membrane
—> cut/punctured to open airway in an emergency

Intrinsic Muscles of the Pharynx

Muscles Innervation Function

Lateral Cricoarytenoid Recurrent laryngeal Adduct vocal folds

Posterior Cricoarytenoid Recurrent laryngeal Abduct vocal folds

Oblique Arytenoid / Recurrent laryngeal Close rima glottidis

Aryepiglottic

Transverse Arytenoid Recurrent laryngeal Close rima glottidis

Thyroarytenoid Recurrent laryngeal Shortens to relax vocal cords

Vocalis Recurrent laryngeal Tenses anterior vocal ligament;

Relaxes posterior vocal ligament

Cricothyroid External laryngeal Lengthens & Tenses vocal

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Superior Thyroid Artery runs with External Laryngeal Nerve

Inferior Thyroid Artery runs with Recurrent Laryngeal Nerve

Superior Laryngeal Artery runs with Internal Laryngeal Nerve

PARANASAL SINUSES: assist in humidifying & warming inhaled air

- increase resonance of speech; aid in changing voice tone during puberty

- Lighten the weight of the skull bones

- Aid in facial trauma

1. Frontal Sinus
Innervation: supraorbital nerve from CN V1

2. Ethmoid
Innervation: ethmoidal branches of nasociliary nerve from
CN V1

3. Sphenoid —>*** Surgical access to pituitary tumors

Innervaton: ethmoidal branches of nasociliary nerve from
CN V1

4. Maxillary
Innervation: anterior, middle, posterior alveolar nerves from
CN V2

Sinuses Drain into

Sphenoid sinus Spheno-ethmoidal recess

Frontal sinus Semilunar hiatus of MM

Maxillary sinus Semilunar hiatus of MM

Anterior ethmoidal sinus Semilunar hiatus of MM

Posterior ethmoidal sinus Superior meatus

Middle ethmoidal sinus Middle meatus

Nasolacrimmal duct Inferior meatus

Pharyngeal Arches:
1,2,3,4,6 (6 is not counted)

- Clefts = External indentations

(ectoderm)

- Pouches = Internal indentations

(endoderm)

Pharyngeal Cranial Nerve First Cleft First Pouch Embryological Muscles

arches and Origins
associated
cranial nerves

Arch 1 Trigeminal External Auditory Tube - Cranial - Muscles of

Nerve Auditory maxillary mastication

Canal process
- Mylohyoid

- Caudal - Anterior
Mandibular digastric

Process - Tensor tympani

- Tensor veli
palatini

Arch 2 Facial Nerve Obliterated Palatine Tonsil - Stapes

- Muscles of
(Hyoid Arch - Styloid facial
OR Riechert’s Process
expression

Cartilage) - Stlyohyoid - Stapedius

ligament
- Posterior
- Superior digastric
Hyoid Bone

Arch 3 Glossopharyng Obliterated Inferior Inferior Hyoid Stylopharyngeus

eal Nerve Parathyroid & Bone
Thymus

Arch 4 & Arch Vagus Nerve Obliterated Superior - C cells

- Circothyroid

6 Parathyroid & - Laryngeal - Levator veli

Ultimobranchi Cartilages palatini

al Body - Pharyngeal
constrictor
muscles

“That Faggot Gets Vagina”

The Eye
Extraocular Muscles Action Innervation

Superior Rectus Elevate, Adducts, rotates eyeball Oculomotor CNIII

medially Superior Branch

Inferior Rectus Depresses, Adducts, rotates Oculomotor CNIII

eyeball laterally Inferior Branch

Medial Rectus Adducts eyeball Oculomotor CNIII

Inferior Branch

Lateral Rectus Abducts eyeball Abducens CNVI

Inferior Oblique Abducts, elevates, laterally Oculomotor CNIII

rotates eyeball Inferior Branch

Superior Oblique deppreses, abducts, medially Trochlear CNIV

"Down & Out” rotates eyeball

Intrinsic Eye Muscles Action Sympathetic Parasympathetic

Innervation Innervation

Ciliary Muscle Ring of smooth muscle; Inhibits: Activates:

controls accommodation 1. Superior cervical Short ciliary nerves from
for viewing objects at galion
Ciliary ganglion to
varying distances; 2. Internal carotid Oculomotor nerve
changes shape of the plexus

lens within the eye 3. Ophthalmic plexus

4. Nasociliary nerve V1

5. Long ciliary nerves

Dilator Pupillae Smooth muscle of the 1. Superior Cervical

eye; contracts to dilate Ganglion (T1)

the pupil 2. Internal carotid

plexus

3. Ophthalmic plexus

4. Nasociliary nerve V1

5. Long ciliary nerves

Intrinsic Eye Muscles Action Sympathetic Parasympathetic
Innervation Innervation

Sphincter Pupillae Contracts to constrict Oculomotor nerve

the pupil (CNIII):

Preganglionic
GVE from brainstem to
ciliary ganglion
(SYNAPSE)

Postganglionic
Travel to sphincter
pupillae via short ciliary
nerves from ciliary
ganglion

Eyelid Function Innervation

Levator Palpebrae Superioris Raises the eyelid; inserts onto Oculomotor CNIII

superior tarsal Superior branch

Superior Tarsal Keep upper eyelid raised after Sympathetic:

elevator superioris has raised it Superior cervical ganglion travel

on internal carotid plexus to
ophthalmic plexus to oculomotor
nerve

Muscles of The Eyelid

Bones of
The Orbital

Cranial Sutures

Cranial Sutures (Joints) Connects

Lamboid Parietal to Occipital

Squamous Temporal to Parietal

Coronal Parietal to Frontal

Sagittal Parietal to Parietal

Bregma = Where Coronal & Sagittal sutures meet

Lambda = Where Lamboid & Sagittal sutures meet

Wormian = extra bone pieces that can form at a suture of the

skull

Fontanelles

Sphenoid

Mastoid

Anterior

Posterior

Fontanelles: membrane covered areas “soft spots” in immature skulls between two bones where
a suture will form later; close by 18 months

Sunken Fontanelle indicates dehydration

Bulging Fontanelle indicates intracranial pressure

Cranial Cavity Formed by Houses Foramen Structures

Divisons Passing Through
Foramen
Anterior Cranial - Frontal
Frontal Lobes
Formen Cecum
Emissary Veins
Fossa - Sphenoid
from nasal cavity

- Ethmoid Olfactory Bulb &

Tract Olfactory Foramen CNI

Middle Cranial - Temporal

Temporal lobes
Optic Canal
CNII & Ophthalmic
Fossa - Sphenoid
a.

- Parietal Pituitary Gland Superior Orbital

Fissure
CNIII, CNIV,
CNV1,CNVI &
ophthalmic veins

Foramen
Rotundum
Maxillary division
CNV2

Foramen Ovale

Mandibular division
CNV3 & lesser
petrosal nerve

Foramen Spinosum

Middle Meningeal
Greater Petrosal a.

Nerve Hiatus

Greater Petrosal n.

Lesser Petrosal
Nerve Hiatus
Lesser Petrosal n.
Posterior Cranial - Temporal
Cerebellum
Formen Magnum
End of brain stem/
Fossa - Occipital
start of spinal cord;
- Sphenoid
Pons
vertebral arteries;
- Parietal CNXI spinal roots;
Medulla meninges

Internal acoustic CNVII, CNVIII &

meatus
labyrinthine a.

Jugular foramen
CNIX, CNX, CNXI,
Inferior petrosal
sinus & sigmoid
sinus

Hypoglossal canal
CNXII, meningeal
branch of
ascending
pharyngeal a.

Condylar canal Emissary vein