LATERAL REGION

 Lateral region is bounded by the ff:

oAnteriorly by posterior border of SCM
oPosteriorly by the anterior border of the
trapezius
oInferiorly by the middle third of the clavicle
(between the trapezius and the SCM).
oBy an apex, where the SCM and trapezius
meet on the superior nuchal line of the
occipital bone.
oBy a roof, formed by the investing layer of
deep cervical fascia.
oBy a floor, formed by muscles covered by the
prevertebral layer of deep cervical fascia.

MUSCLES IN LATERAL CERVICAL REGION

 The floor usually formed by the prevertebral fascia Figure: Subclavian artery and its branches
overlying 4 muscles
o Splenius capitis
o Levator scapulae
o Middle scalene
o Posterior scalene
 occipital triangle
o given its name bec. occipital artery appears
in its apex.
o Spinal accessory nerve (CN XI) - most impt
nerve crossing this trangle
 Omoclavicular (subclavian) triangle
o indicated on the surface of the neck by the
supraclavicular fossa
o vessels crossing this triangle
 Inferior part of EJV (external
jugular vein) - superficially
 Subclavian artery – deep in it Figure: Deeper dissection of inferior part of lateral
(hence the name “subclavian cervical region
triangle”)

ARTERIES IN LATERAL REGION  Suprascapular artery

1. Branches of thyrocervical trunk
o Branch of subclavian artery
o Gives rise to
 Lateral aspect: Suprascapular and
cervicodorsal trunk ( transverse
cervical a.)
 Terminal branches: ascending
cervical and inferior thyroid artery
2. 3rd part of the subclavian artery
3. Part of occipital artery
 Cervicodorsal trunk (transverse cervical artery)
o passes inferolaterally across the anterior
scalene muscle and phrenic nerve
o then crosses the third part of the
subclavian artery and the cords of the
brachial plexus
o then passes posterior to the clavicle to
supply muscles on the posterior aspect of
the scapula.
Note: Alternately, the suprascapular artery
may arise directly from the third part of the
subclavian artery
bifurcates into :
o Superficial cervical artery(superfi
cialbranch of transverse cervical artery)

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 deep (anterior) to the trapezius
accompanying the spinal accessory nerve
(CN XI).
o dorsal scapular artery (deep branch of
transverse cervical artery) may arise
independently, directly from the third (or,
less often, the second) part of the
subclavian artery
- runs deep to the levator scapulae and
rhomboid muscles, supplying both and
participating in the arterial anastomoses
around the scapula
 3rd part of subclavian artery
o opposite the lateral border of the anterior
scalene muscle
o hidden in the inferior part of the lateral
cervical region,
o longest and more superficial part of
subclavian
o lies on the first rib
o pulsations can be felt by applying deep
pressure in the omoclavicular triangle
o in contact with the 1st rib as it passes
posterior to the anterior scalene muscle
note: compression of this part can control
bleeding in the upper limb
note: Inferior trunk of brachial plexus lies
posterior to it
note: branches that arise from this part
(suprascapular & dorsal scapular artery) are
aberrant form – meaning typically hindi sila dito
nagmumula
VEINS IN THE LATERAL REGION
 Retromandibular Vein
o Is formed by the superficial temporal and
maxillary veins.
o Divides into an anterior branch, which joins the
facial vein to form the common facial vein, and
a posterior branch, which joins the posterior
MEJILLA, VILLA, ALUNAN, BON, RUIDEREA, MAÑAGO
auricular vein to form the external jugular
vein.
 External Jugular Vein
o Is formed by the union of the posterior
auricular vein and the posterior branch of the
retromandibular vein.
o Crosses the sternomastoid obliquely under the
platysma and ends in the subclavian (or
sometimes the internal jugular) vein.
o Receives the suprascapular, transverse
cervical, and anterior jugular veins.
 Internal Jugular Vein (Figure 8.7)
o Begins in the jugular foramen as a
continuation of the sigmoid sinus, descends in
the carotid sheath, and ends in the
brachiocephalic vein.
o Has the superior bulb at its beginning and the
inferior bulb just above its termination.
o Receives the facial, lingual, and superior and
middle thyroid veins
 Subclavian vein
o major venous channel draining the upper limb
o passes anterior to the anterior scalene muscle
and phrenic nerve and unites at the medial
border of
o the muscle with the IJV to form the
brachiocephalic vein
NERVES IN THE LATERAL REGION
o Accessory Nerve (CN X1)
o Is formed by the union of cranial and spinal
roots.
o Has cranial roots that arise from the medulla
oblongata below the roots of the vagus.
o Has spinal roots that arise from the lateral
aspect of the cervical segment of the spinal
cord betweenC1 and C3 (or C1 and C7) and
unites to form a trunk that ascends between
the dorsal and ventral roots of the spinal
nerves in the vertebral canal and passes
through the foramen magnum.
o Has both spinal and cranial portions, which
traverse the jugular foramen, where they
interchange fibers. The cranial portion contains
motor fibers that join the vagus nerve and
innervate the soft palate, pharyngeal
constrictors, and larynx. The spinal portion
innervates the sternocleidomastoid and
trapezius muscles.
o Lies on the levator scapulae in the posterior
cervical triangle and then passes deep to the
trapezius.
o Cervical Plexus
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 o Is formed by the ventral primary rami of C1 to
C4.
1. Cutaneous Branches
(a) Lesser Occipital Nerve (C2)
o Ascends along the posterior border of the
sternocleidomastoid to the scalp behind
the auricle.
(b) Great Auricular Nerve (C2–C3)
o Ascends on the sternocleidomastoid to
innervate the skin behind the auricle and
on the parotid gland.
(c) Transverse Cervical Nerve (C2–C3)
o Turns around the posterior border of the
sternocleidomastoid and innervates the
skin of the anterior cervical triangle.
(c) Twigs From the Plexus
o Supply the longus capitis and cervicis or
colli, sternocleidomastoid, trapezius,
levator scapulae, and scalene muscles.
(d) Accessory Phrenic Nerve (C5)
o Occasionally arises as a contribution of C5
to the phrenic nerve or a branch of the
nerve to the subclavius (C5), descends
lateral to the phrenic nerve, enters the
thorax by passing posterior to the
subclavian vein, and joins the phrenic
nerve below the first rib to supply the
diaphragm.

(d) Supraclavicular Nerve (C3–C4)

o Emerges as a common trunk from under the
sternocleidomastoid and then divides into
anterior, middle, and lateral branches to
the skin over the clavicle and the shoulder.

2. Motor Branches

(a) Ansa Cervicalis

o Is a nerve loop formed by the union of the
superior root (C1 or C1 and C2; descendens
hypoglossi) and the inferior root (C2 and
C3; descendens cervicalis).
o Lies superficial to or within the carotid
sheath in the anterior cervical triangle.
o Innervates the infrahyoid (or strap)
muscles, such as the omohyoid,
sternohyoid, and sternothyroid muscles,
with the exception of the thyrohyoid
muscle, which is innervated by C1 via the
hypoglossal nerve.

(b) Phrenic Nerve (C3–C5)

o Arises from the third, fourth, and fifth
cervical nerves but chiefly from the fourth
cervical nerve; contains motor, sensory,
and sympathetic nerve fibers; and provides
the motor supply to the diaphragm and
sensation to its central part.
o Descends on the anterior surface of the
anterior scalene muscle under cover of the
sternocleidomastoid muscle.
o Passes between the subclavian artery and
vein at the root of the neck and enters the
 Brachial Plexus
thorax by crossing in front of the origin of
o Is formed by the union of the ventral primary
the internal thoracic artery, where it joins
rami of C5 to T1 and passes between the
the pericardiacophrenic branch of this
anterior scalene and middle scalene muscles.
artery.
o Passes anterior to the root of the lung and
1. Its Roots Give Rise to the:
between the mediastinal pleura and fibrous
(a) Dorsal Scapular Nerve (C5)
pericardium to supply sensory fibers to
these structures.

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 o Emerges from behind the anterior scalene
muscle and runs downward and backward
through the middle scalene muscle and
then deep to the trapezius.
o Passes deep to or through the levator
scapulae and descends along with the
dorsal scapular artery on the deep surface
of the rhomboid muscles along the medial
border of the scapula, innervating the
levator scapulae and rhomboid muscles.

(b) Long Thoracic Nerve (C5–C7)

o Pierces the middle scalene muscle,
descends behind the brachial plexus, and
enters the axilla to innervate the serratus
anterior.

2. Its Upper Trunk Gives Rise to the: Sources:

(a) Suprascapular Nerve (C5–C6) Moore - Clinically Oriented Anatomy 7th Ed

o Passes deep to the trapezius and joins the BRS Gross Anatomy 5th Ed
suprascapular artery in a course toward the
shoulder.
o Passes through the scapular notch under
the superior transverse scapular ligament.
o Supplies the supraspinatus and
infraspinatus muscles.

(b) Nerve to the Subclavius Muscle (C5)

o Descends in front of the plexus and behind
the clavicle to innervate the subclavius.
o Communicates with the phrenic nerve as
the accessory phrenic nerve in many
cases.

LYMPHATICS OF THE LATERAL REGION

 Superficial lymph nodes

o Lie along the external jugular vein in the
posterior triangle and along the anterior
jugular vein in the anterior triangle.
o Drain into the deep cervical nodes.

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Itong part na to ay para sa gluconeogenesis

Viel, yung nakared is for the main title or yung una

before nung mga processes…
For fasting state itong mga ito….

Gluconeogenesis

 Metabolic production of glucose from non-

carbohydrate precursors (not from glycogen)
 Happens during periods of starvation (fasting
state) or intense exercise
 Main goal (together with glycogenolysis) is to
↑glucose serum level.
 Activator: Glucagon, cortisol, epinephrine
stimulate/increase gluconeogenesis by the
following mechanism

o They increase protein catabolism in muscle

and decrease protein synthesis, thereby
providing more amino acids to the liver for
gluconeogenesis.
o They decrease glucose utilization and insulin
sensitivity of adipose tissue.
o They increase lipolysis, which provides more
glycerol to the liver for gluconeogenesis
o Note: this is inhibited/decreased by↑FA at pag
↑insulin

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