CHAPTER 20: NECK

Neck: Region of the body between head and thorax. Eight bones
Bones: 8.
 7 cervical vertebrae: atlas (CV1), axis (CV2), CV3-6, vertebra prominens (CV7).
 Hyoid bone: lies in anterior portion of neck between mandible and larynx. U-shaped bone with opening
posteriorly. Body anteriorly. Posteriorly present projections, larger greater horns & smaller lesser horns.
Does not articulate with any other bone, suspended by attaching muscles.

Cartilages
 Larynx: voice box. Cartilaginous organ located at upper end of trachea. Consists of several cartilages,
largest of which is thyroid cartilage.
 Trachea: windpipe. Extends inferiorly from larynx through neck into thorax.

Glands
 Thyroid gland: endocrine gland located on either side of trachea just below larynx. Two lobes connected
across trachea by isthmus.
 Parathyroid gland: 2-4 endocrine glands located on posterior surface of thyroid gland.
**thyroid/parathyroid gland blood supplied by superior & inferior thyroid arteries.

Muscles of the Neck: platysma (subq muscle), sternocleidomastoid, infrahyoid muscles, suprahyoid
muscles, scalene muscles, and prevertebral muscles.
A. Platysma (subq muscle)
Origin Skin over deltoid & pectoralis major
Insertion Lower border of mandible
Action Elevation of skin of neck
Innervation CN VII – facial nerve

B. Sternocleidomastoid
Origin Sternal head: manubrium. Clavicular head: medial
third of clavicle
Insertion Mastoid process of skull
Action Unilateral: opposite side rotation of head. Bilateral:
flexion of head at neck.
Innervation CN XI – accessory nerve
C. Infrahyoid/strap muscles
a. Thyrohyoid
Origin Thyroid cartilage
Insertion Hyoid bone
Action Elevation of larynx and depression of hyoid during
speech & swallowing
Innervation C1 via CN XII – hypoglossal nerve

b. Sternohyoid
Origin Manubrium of sternum
Insertion hyoid bone
Action Depression of larynx and hyoid during speech &
swallowing
Innervation Ansa cervicalis
 c. Sternothyroid
Origin Manubrium of sternum
Insertion Thyroid cartilage
Action Depression of larynx and hyoid during speech &
swallowing
Innervation Ansa cervicalis

d. Omohyoid
Origin Superior border of scapula
Insertion Hyoid bone
Action Depression of larynx and hyoid during speech &
swallowing
Innervation Ansa cervicalis

D. Suprahyoid muscles: digastric, stylohyoid, mylohyoid, geniohyoid.

E. Scalene muscles
a. Scalene triangle: scalene anterior(anterior), scalene medius(posterior), first rib(inferior)
b. relationships to scalene anterior
i. anterior to scalene anterior: phrenic n., vagus n., common carotid a., internal carotid a.,
internal jugular v., subclavian v.
ii. posterior to scalene anterior: subclavian a., brachial plexus

c. Scalene anterior
Origin Cervical vertebrae
Insertion First rib
Action Lateral flexion of neck, elevation of first rib
Innervation Ventral rami

d. Scalene medius
Origin Cervical vertebrae
Insertion First rib
Action Lateral flexion of neck, elevation of first rib
Innervation Ventral rami

e. Scalene posterior
Origin Cervical vertebrae
Insertion Second rib
Action Lateral flexion of neck, elevation of 2nd rib
Innervation Ventral rami

F. Prevertebral muscles: longus capitis & longus cervicis (colli)

Nerves of the Neck

A. Cervical plexus: spinal nerve plexus formed by ventral rami of CV1-4. Arranged as irregular series of loops
from which the branches of the plexuses arise. Branches supply scalene and prevertebral muscles and give
off two named branches: phrenic nerve and ansa cervicalis.
 a. Phrenic nerve: arises from ventral ramus C4 (C3, C5). Courses neck anterior to scalene anterior.
Courses thorax anterior to root of lung. Innervates diaphragm.
b. Ansa cervicalis: loop of nervous tissue, lies anterior to carotid sheath. Possesses two roots:
superior (connects with hypoglossal n., derived from C1) and inferior root (derived from C2 &
C3). Supplies all infrahyoid muscles EXCEPT thyrohyoid.
Superficial branches of cervical plexus: provide cutaneous supply to neck region and superior chest.
I. Lesser occipital (C2, C3)
II. Greater auricular (C2, C3)
III. Transverse cervical (C2, C3)
IV. Supraclavicular (C3, C4)

B. CN X, vagus nerve: arises from brain, courses through a foramen in the case of skull>>through neck in
carotid sheath anterior to scalene anterior>>through thorax posterior to root of lung>>through
esophageal opening of diaphragm>>enters abdomen where it supplies abdominal organs.
C. Sympathetic trunk: part of autonomic nervous system. Located in neck posterior to carotid sheath.
Superficial branches of cervical plexus: provide cutaneous supply to neck region and superior chest.
V. Lesser occipital (C2, C3)
VI. Greater auricular (C2, C3)
VII. Transverse cervical (C2, C3)
VIII. Supraclavicular (C3, C4)

Vessels of the Neck: common carotid a.s & their branches, subclavian a.s & their branches, subclavian v.s,
jugular v.s.
*Arch of aorta has 3 main branches: brachiocephalic trunk, left common carotid a., left subclavian a.
*Brachiocephalic trunk divides into right subclavian a., right common carotid a. In general, subclavian a.s
supply upper limbs and carotid a.s supply head and neck.
A. Common carotid a.s: right common carotid a. arises from brachiocephalic trunk. Left common carotid a.
arises from arch of aorta. Each ascends through neck in its respective carotid sheath. Each terminates at
upper border of respective thyroid cartilage, dividing into its terminal branches.
a. Internal carotid a.: ascends within its respective carotid sheath. Enters cranial cavity through
carotid canal to supply brain. Does not give off any branches in the neck.
b. External carotid a.: ascends toward its respective ear. Each gives off 8 named branches that supply
all structures of the neck on its respective side.
i. Superior thyroid a.: first branch.
B. Subclavian a.s: right subclavian a. arises as branch of brachiocephalic trunk. Left subclavian a. arises as
branch of arch of aorta. Each courses through neck on its respective side posterior to scalene anterior. Each
courses over first rib and becomes axillary a. at lateral border. Each has branches, one is vertebral a.
a. Each vertebral a. ascends through transverse foramen of CV. Enters cranial cavity through foramen
magnum, joints with vertebral a. of opposite side to form basilar a. Basilar a. supplies brain and is
part of Circle of Willis.
C. Subclavian v.s: each arises as continuation of its respective axillary v. at lateral border of first rib. Each
courses through its respective side of the neck anterior to scalene anterior which separates each subclavian
v. from its subclavian a. Each terminates by joining with its respective internal jugular v. to form
brachiocephalic vein.
D. External jugular v.s: each arises on its respective side from veins draining the scalp and face. Each courses
superficially on its side across sternocleidomastoid. Terminates by joining its respective subclavian v.
E. Internal jugular v.s: each arises as a continuation of the dural sinuses that drain the brain. Courses through
neck within its respective carotid sheath. Terminates by joining its respective subclavian v. to form
brachiocephalic v.
Fascia of neck: carotid sheath. Condensation of fascia on each side of the neck that surrounds three structures:
common carotid or internal carotid a., internal jugular v., and CN X, Vagus nerve.