M1 Anterior Neck Learning Objectives

1. Describe the integumentary and fascial layers

one encounters when dissecting from superficial to
deep.
During any early dissection, the first step is typically the removal of the most 
superficial layers, starting with the skin. 

The s
​ kin​ (or ​integumentary​ system) is composed of two divisions: 

■ Epidermis 

■ Most superficial (we can see the most superficial components of the 
epidermis) 
■ Avascular 
■ Mostly composed of dead, keratinized, flattened cells 
■ Contains a
​ fferent nerve endings 
■ Afferent nerve endings conduct signals back to the central 
nervous system; cutaneous sensation (sensations include pain, 
temperature, pressure, etc.) 
■ Dermis 
■ The larger division & deep to the epidermis 
■ Highly vascular 
■ Supplies blood to deep portions of the epidermis 
■ Significantly more contents than epidermis, including: 
■ Afferent nerve endings 
■ Sudoriferous (sweat) glands 
■ Complexes of hair follicles, sebaceous (oil) glands, and arrector 
pili mm. (smooth muscle) 

 
Fascia​ is the term for grossly visible connective tissue collections or sheaths deep to 
the skin. 

The s
​ uperficial fascia ​(i.e.​ hypodermis, subcutaneous tissue​) is deep to the dermis. 
This layer is often colloquially referred to as the fatty layer due to high loose areolar 
connective tissue content. The thickness of the layer varies between individuals and 
different areas of the body. 

■ Functions: 

■ Principal site of energy storage 

■ Layer of insulation 

Deep fascia​ is more dense than superficial fascia, and is devoid of adipose tissue (fat). 
This fascia is important in surrounding and supporting muscles, organs (viscera), and 
neurovasculature (​investing fascia​). 

 
2. Describe ‘anatomical position.’ Define
anatomical terms of spatial relationships (based on
anatomical position).
To best communicate and understand relationships of body parts and structures, one 
must understand ​anatomical position​. All anatomical, relational terminology is based 
on the visualization of the patient or donor in anatomical position, even when they are 
supine ​(lying on back), p
​ rone​ (lying face-down), or on their side. 

 
  

3. Describe anatomical planes used to describe the

human body.
There are four types of imaginary planes that intersect the body in the 
anatomical position: median, sagittal, frontal, & transverse. 
Median plane​: vertical plane passing longitudinally through the body (or 
structure) midline, divides right and left halves. 

Sagittal planes​: vertical planes passing through the body parallel to the median 
plane, divides right and left portions. 

Frontal (coronal) planes​: vertical planes passing through the body at right 
angles to the median plane, divides anterior and posterior portions. 

Transverse (horizontal) planes​: planes passing through the body 

perpendicular to any of the vertical planes, divides superior and inferior 
portions. 

4. What are attachment sites for muscles?

Understand the terms origin, insertion, and
proximal/superior & distal/inferior attachments.
Bones may have numerous ​attachment sites​ (bone markings) that are attachment 
points for t​ endons​ (connecting muscle to bone), ​ligaments​ (connecting bone to bone), 
and fascia. The size and shape of attachments sites will change throughout life based 
on the activity (or lack thereof) at these points. 

When describing the anatomy of a muscle, attachment points are commonly included. 
Knowing these attachment points gives the learner an understanding of what joint(s) 
the muscle crosses (and thus can directly affect) and a basic understanding of what 
types of actions can occur due to a muscle when ​concentrically contracting (​ muscle 
shortening). 

Traditional terminology relating to muscle attachments 

Origin 

■ Typically proximal or superior end of muscle 

■ Typically fixed (does not move during contraction) 

Insertion 

■ Typically distal or inferior end of muscle 

■ Typically kinetic (will often move towards the origin of the muscle) 

It is important to note that although the proximal or superior end of a muscle is 
typically fixed, this is not always the case. There has been a movement towards the 
usage of the more descriptive and accurate terms: ​proximal or superior attachments and 
distal or inferior attachments​. You still may see the terms origin and insertion in other 
resources, but we will not use that terminology. 

5. Describe the difference between afferent and

efferent innervation.
Most of the nerves have both afferent and efferent fibers packaged together. In fact if 
not explicitly stated as a purely afferent or efferent nerve, assume that any named 
nerve has both types of fibers. 

When thinking of a
​ fferent (sensory) innervation​, think carrying information ​away 
from an organ or sensory receptor or information a
​ rriving a
​ t the central nervous 
system (CNS). 

Types of afferent (sensory) fibers: 

■ Somatic afferent 

■ Most commonly discussed afferent fiber 

■ Sensation from skin 
■ Pain, touch, pressure, and temperature 
■ Dermatome maps​ depict the different conceptual areas of skin 
afferently innervated by a single cranial or spinal nerve. 
■ Proprioception 
■ Conveys information to CNS regarding positioning of a joint or the 
degree of tension in muscle tendons 
■ When discussing afferent innervation of a muscle, this is what one 
is describing 
■ Visceral afferent 
■ Conveys information from hollow viscera (organs) and blood vessels 
■ Pain or reflex sensations, such as pressure (e.g. blood) or organ 
distension 
■ Special afferent ​(typically described as special sensory) 
■ Associated with special senses (vision, olfaction, hearing, taste, & 
equilibrium) 
■ Fibers of certain cranial nerves 

 
With e
​ fferent (motor) innervation​, think of carrying information from the CNS to an 
effector organ​, to create an ​effect​ (such as muscle contraction or glandular secretion). 

Types of efferent (motor) fibers: 

■ Somatic efferent 

■ Impulses from the CNS to ​skeletal muscle​ (can lead to contraction) 

■ When discussing what nerve innervates a muscle, often considering this 
aspect of innervation 
■ However, most named, somatic nerves have both efferent and 
afferent fibers, particularly those derived from plexuses. 
■ Visceral efferent 
■ Impulses from the CNS to glands and smooth muscle 
■ Associated with autonomic nervous system 

6. Describe the typical contents of a neurovascular

bundle.
All visceral structures, including muscle and skin, require four things to 
function properly: 
 ■ Blood supply via a
​ rteries 

■ Drainage of low-oxygen blood to heart via v

​ eins 
■ Drainage of fluids, proteins, and cellular debris via l​ ymphatics 
■ Innervation (communication with the CNS) via n
​ erves 

These structures often travel together in a n

​ eurovascular bundle​. These 
bundles are often wrapped or enveloped in deep investing fascia. When 
considering muscle, the neurovascular bundle typically are located deep to the 
muscle. 
7. Identify and detail the muscles of the anterior
thorax: pectoralis major m., pectoralis minor m.,
and serratus anterior m.
Pectoralis major m. 

■ Proximal attachments: 

■ 2 heads: 
■ Clavicular (​ clavicle) 
■ Sternocostal ​(sternum and costal cartilages) 
■ Distal attachment: 
■ Shared tendon on proximal humerus 
■ Crosses the glenohumeral (shoulder) joint 
■ Action(s): 
■ Both heads contracting simultaneously: 
■ Adduction & medial rotation of glenohumeral joint 
■ Clavicular head independently: 
■ Flexion of glenohumeral joint 
■ Sternocostal head contracting independently 
■ Extension of glenohumeral joint (from flexed position) 

Action videos 

■ Innervation: 

■ Two nerves derived from the brachial plexus 

■ Lateral pectoral n. 
■ Medial pectoral n. 
■ Dominant arterial supply: 
■ Thoraco-acromial a. (branch of axillary a.) branches 
■ Clinical considerations: 
 ■ Breast pathology & surgery 
■ Due to the close anatomical relationship, pectoral fascia and 
muscle can be affected or resected. 

Pectoralis minor m. 

■ Proximal attachments:​ anterior ribs 3-5 

■ Distal attachment:​ coracoid process of scapula 

■ Actions 
■ Stabilization of scapula to allow for efficient movements at other joints, 
specifically the glenohumeral joint 
■ Protraction​ (moving the scapula anteriorly) 
■ Innervation:​ medial pectoral n. 
■ Dominant arterial supply:​ thoraco-acromial a. (branch of axillary a.) branches 
 ■ Anatomical relationships: 
■ Medial pectoral n. pierces the pectoralis minor m. 
■ Important anatomical landmark locating branches of the axillary a. both 
in the lab, in imaging, and in surgeries 
■ Subdivides the artery into 3 parts based on relationship to the 
muscle (medial, deep, or lateral to) 

Serratus anterior m. 

■ Proximal attachments: R
​ ibs 1-8 

■ Distal attachment:​ anterior surface of scapula 

■ Actions: 
■ Protraction of scapula 
■ Upward rotation of glenoid fossa 
 ■ Important for allowing full range of motion for the glenohumeral 
(shoulder) joint, particularly in abduction and flexion 
■ Stabilization of scapula 
■ Innervation:​ long thoracic n. 
■ The placement of this nerve is unique in that it is superficial to the 
muscle 
■ Clinical considerations: 
■ With injury to the long thoracic n., the scapula may develop a wing-like 
appearance (‘winged scapula’) 
■ The medial border of the scapula is displaced posteriorly and 
laterally in comparison to the uninjured side. This is particularly 
evident when the shoulder joint is flexed (as in pushing against a 
wall with the upper limb). 
■ This affects scapular motion, but (more importantly) prevents full 
range of motion at the glenohumeral joint 
8. Identify and detail the muscles of the anterior
neck: sternocleidomastoid m., infrahyoid mm.
 ■ Sternocleidomastoid m. 
■ Superior attachments: 
■ Mastoid process of temporal bone & occipital bone 
■ Inferior attachments: 
■ Manubrium of sternum 
■ Medial clavicle 
■ Actions: 
■ Bilateral contractions: flexes cervical vertebrae 
■ Unilateral contraction: lateral flexes the neck & rotates the head in the 
opposite direction 
■ Innervation: 
■ Efferent: Accessory n. (CN XI) 
■ Afferent: C2 & C3 fibers 
■ It is uncommon that separate nerves provide afferent and efferent 
innervation to a muscle. 
■ Anatomical relationships: 
■ Prominently visible and palpable landmark in the neck 
■ External jugular v. typically runs anterior/superficial to this muscle 
Infrahyoid mm. 

The infrahyoid muscles are a set of 4 muscles (​sternohyoid, omohyoid, 

sternothyroid, and thyrohyoid mm.)​ located inferior to the hyoid bone. This set of 
muscles is often referred to as strap muscles due to their ribbon/strap-like 
shape. 

■ The names of the muscles indicate the a

​ ttachment points: 

■ Omo-: means shoulder (in this case, attached on the scapula) 

■ Thyro(id): indicates the thyroid cartilage, not thyroid gland 
■ Actions 
■ Stabilization or depression of hyoid 
■ Dependent on muscles, will pull larynx either superiorly, or inferiorly 
■ Innervation 
■ Ansa cervicalis (cervical plexus) for 3 of the 4 muscles 
■ Anatomical relationships: 
■ Arranged in two layers 
■ Superficial: sternohyoid & omohyoid 
■ Deep: sternothyroid & thyrohyoid 
■ To access the thyroid gland, these muscles have to be reflected or moved 
9. Describe the location of the thyroid and
parathyroid glands. Understand details regarding
function and vascular supply and drainage of these
glands.
The thyroid gland has two lobes connected by a central isthmus, and sits 
between the C5-T1 vertebra. Nearly 50% of people have an accessory 
(pyramidal) lobe, which varies in size and typically connects the isthmus of the 
thyroid gland to the hyoid bone (Moore et al., 7th edition). 
The thyroid gland is an endocrine gland - meaning it secretes hormones and is 
ductless. The thyroid gland secretes thyroid hormones (controls rates of tissue 
metabolism) and calcitonin (important in calcium homeostasis). 

Arterial supply of the thyroid gland 

■ Superior thyroid a. 

■ Typically the first branch of the external carotid a. 

■ Inferior thyroid a. 
■ Branch of thyrocervical trunk of the 1st part of the subclavian a. 
■ Typically crosses the recurrent laryngeal n. deep to the thyroid gland in 
the vicinity of the larynx 
■ Clinical consideration: when ligating this artery during a 
thyroidectomy, care must be taken to not damage the recurrent 
 laryngeal n., which innervates most intrinsic laryngeal muscles 
and inferior larynx. 

Venous drainage of the thyroid gland 

■ Superior thyroid v. 

■ Middle thyroid v. 

■ Inferior thyroid v. 
Parathyroid glands may be found in a variety of locations, but are typically on the 

posterior aspect of the thyroid gland. There are typically four parathyroid glands (a 
superior pair and inferior pair), but there may be more or fewer. The superior 
parathyroids are the most constant in size and position. Parathyroid glands may be 
supplied by either set of thyroid arteries (as determined by location), but typically the 
inferior thyroid aa. supply the parathyroids. The parathyroid glands are also 
endocrine, and produce parathyroid hormone (PTH).  
  

10.​ ​Locate and explain the relevant anatomical

relationships and clinical significance of the linked
anatomical structures​.
Review an atlas (like BlueLink and/or other illustrations) of the list of structures as 
pre-work. Majority of exploration for this learning objective will occur during 
laboratory scheduled time.