LECTURE 6

MUSCLES OF THE NECK

Dr. Laura Grigorita

• The anterolateral muscles of the neck may be arranged
into the following groups:

A. Superficial cervical
B. Lateral cervical
C. Suprahyoid
D. Infrahyoid
E. Anterior vertebral
F. Lateral vertebral
 A. Superficial cervical muscle
1. Platysma
• It is a thin quadrilateral broad sheet of muscle in
the superficial fascia of the side of the neck.
• It ascends onto the face from the front of the
neck.
Origin:
• The platysma arises from skin and deep fascia
covering the upper parts of the pectoralis major
and anterior part of the deltoid muscle.
Trajectory
• After origin, the fibres sweep upwards and
forwards superficial to the clavicle and
sternocleidomastoid.
• It passes upwards to reach the lower border of
the mandible, where anterior fibres decussate
with the corresponding fibres of the opposite
side across the midline for about 2.5 cm below
and behind the symphysis menti
Insertion:
• Most of the fibres (intermediate and posterior)
are inserted into the lower border of the body of
the mandible.
• Some posterior fibres pass superficial to the
angle of the mandible and masseter muscle and
then turn medially to insert into the skin of angle
of the mouth through risorius.
 Platysma muscle

Actions
• Depresses mandible and
angle of mouth,
• Tenses skin of lower face
and anterior neck.
Innervation:
• Cervical branch of facial
nerve (CN VII)
 B. Lateral cervical muscles

1. Trapezius
2. Sternocleidomastoid
 2. Sternocleidomastoid muscle
• It is the key muscle of the neck which
extends obliquely across the side of the
neck, dividing it into posterior and
anterior triangles.
Origin:
• Sternal head, is tendinous and arises by a
rounded tendon from the superolateral
part of the front of the manubrium sterni,
below the suprasternal notch and passes
upwards, backwards, and laterally in front
of the sternoclavicular joint.
• Clavicular head, is flat and
musculoaponeurotic. It arises from the
medial third of the superior surface of the
clavicle. It passes vertically upwards deep
to the sternal head with which it unites to
form a fusiform belly.

• A small triangular gap exists between

the two heads above the sternoclavicular
joint. It is called lesser supraclavicular
fossa. It contains the terminal part of the
internal jugular vein.
 2. Sternocleidomastoid muscle
Insertion
• By a thick tendon on the lateral surface of the mastoid process extending from its
tip to its base,
• By a thin aponeurosis into the lateral half of the superior nuchal line of the occipital
bone.
Innervation:
• Accessory nerve (CN XI),
• Branches of cervical plexus (C2-C3)
 2. Sternocleidomastoid muscle
Actions:
• When muscle contracts, it tilts
the head towards the shoulder
on the same side and rotates the
head so that chin turns to the
opposite side This movement
occurs during an upward
sideways glance.
• When muscles of both sides
contract together they draw the
head forwards as in lifting the
head from the pillow or bending
the head during eating food .
• If the head is fixed by
prevertebral muscles, the two
sternocleidomastoid muscles act
as accessory muscles of
respiration during forced
inspiration.
 C. Suprahyoid muscles
• The suprahyoid muscles participate in improving the flexion movement of the
neck.
• The supra-hyoid muscles are between the two bony landmarks, the base of the
mandible above and the hyoid bone below.
• They are in pairs of four present on each side of the midline of the neck.

1. Digastric
2. Stylohyoid
3. Mylohyoid
4. Geniohyoid
1. Digastric muscle
• Digastric is a small paired muscle located in the anterior, suprahyoid compartment of
the neck.
• It has two bellies – posterior and anterior, united by an intermediate tendon
Origin:
• Anterior belly: digastric fossa of mandible
• Posterior belly: mastoid notch of temporal bone
Insertion:
• The two bellies end in an intermediate tendon which perforates the stylohyoid muscle.
• The intermediate tendon is connected to the greater horn of the hyoid bone by a fibrous
loop.
Actions:
• Depresses mandible
• Elevates hyoid bone during
chewing, swallowing
Innervation:
• Anterior belly: mylohyoid
nerve (of inferior alveolar
nerve) (CN V3)
• Posterior belly: digastric
branch of facial nerve (CN VII)
 2. Stylohyoid muscle
Origin:
• Near the base of the styloid process
of temporal bone
Insertion:
• Body of hyoid bone, at its junction
with the greater horn, just above the
omohyoid muscle.
• It is perforated near its insertion , by
the tendon of the digastric muscle.
Actions:
• Elevates and draws hyoid bone
posteriorly
Innervation:
• Stylohyoid branch of facial nerve (CN
VII)
 3. Mylohyoid muscle
• It is a triangular muscle, situated
superior to the anterior belly of the
digastric.
• It forms, together with its fellow of the
opposite side, the muscular floor of the
oral cavity.
Origin:
• Mylohyoid line of mandible
Insertion:
• The posterior fibers pass medially and
downward, to be inserted into the body
of the hyoid bone.
• The middle and anterior fibers are
inserted into a median fibrous raphe,
extending from the symphysis menti to
the hyoid bone
Actions:
• Forms floor of oral cavity,
• Elevates hyoid bone and floor of mouth,
• Depresses mandible
Innervation:
• Nerve to mylohyoid (of inferior alveolar
nerve (CN V3).
 4. Geniohyoid muscle
It is a narrow muscle, situated above
the medial border of mylohyoid.
Origin:
• Inferior mental spine (inferior
genial tubercle)
Insertion:
• Body of the hyoid bone,
• It lies in contact with its fellow of
the opposite side.
Actions:
• Elevates and draws hyoid
bone anteriorly,
• Shortens the mouth floor,
• Widens pharynx.
Innervation:
• Anterior ramus of spinal
nerve C1 (via hypoglossal
nerve)
 D. Infrahyoid muscles
1. Sternohyoid
2. Sternothyroid The superficial layer includes sternohyoid and omohyoid,
3. Thyrohyoid while the deep layer is made up of sternothyroid and
thyrohyoid.
4. Omohyoid
 1. Sternohyoid muscle
• It is a paired, narrow strap muscle.
Origin:
• Posterior surface of manubrium of
the sternum
• Posterior surface of the medial end
of the clavicle
• Posterior sternoclavicular ligament
Insertion:
• Medial part of the lower border of
the hyoid bone
Actions:
• Depresses hyoid bone following its
elevation during swallowing
Innervation:
• Anterior rami of C1-C3 (via the ansa
cervicalis)
 2. Sternothyroid muscle

• It is a paired, strap
muscle, situated immediately
deep to sternohyoid muscle.
Origin:
• Posterior surface of
manubrium of sternum,
• Costal cartilage of rib 1
Insertion:
• Oblique line of thyroid cartilage
Actions:
• Depresses the larynx following
its elevation during deglutition
Innervation:
• Anterior rami of C1-C3 (via the
ansa cervicalis)
 3. Thyrohyoid muscle
• It is a small, quadrilateral muscle
which appears to be an upward
continuation of the sternothyroid
muscle.
Origin:
• Oblique line of thyroid cartilage
Insertion:
• Inferior border of the greater horn
of the hyoid bone
Actions:
• Depresses the hyoid bone during
deglutition,
• Elevates the larynx when hyoid
bone is fixed by suprahyoid
muscles.
Innervation:
• Anterior ramus of spinal nerve C1
via hypoglossal nerve (CN XII)
 4. Omohyoid muscle
• It consists of two bellies united by a
central tendon.
Origin:
• Inferior belly: superior border of scapula
near the suprascapular notch
• Superior belly: intermediate tendon
Insertion:
• Inferior belly: intermediate tendon
• Superior belly: body of hyoid bone
Actions:
• Depresses and retracts hyoid and larynx
• Tenses carotid sheath
Innervation:
• Anterior rami of C1-3 (via the ansa
cervicalis)
 E. Anterior vertebral muscles

1. Longus colli
2. Longus capitis
3. Rectus capitis
anterior
4. Rectus capitis
lateralis
 1. Longus colli muscle
• It is also known as longus cervicis muscle.
• It is situated along the anterior surface of the
vertebral column, between the atlas and the
third thoracic vertebra.
• It consists of three portions: superior
oblique, inferior oblique and vertical
portions.
Origin:
• Superior oblique part: anterior tubercles of
transverse processes of vertebrae C3-C5
• Inferior oblique part: anterior surface of
bodies of vertebrae T1-T2 or T1-T3
• Vertical part: anterolateral surface of the
bodies of C5-T3
Insertion:
• Superior oblique part: anterior tubercle of
vertebra C1
• Inferior oblique part: anterior tubercles of
transverse processes of vertebrae C5-C6
• Vertical part: Anterior surface of bodies
of vertebrae C2-C4
 1. Longus colli muscle
Actions:
• Bilateral contraction: neck flexion
• Unilateral contraction: neck
contralateral rotation, neck
lateral flexion (ipsilateral)
Innervation:
• Anterior rami of spinal nerves C2-
C6

Ipsilateral means 'on the

same side of the body',
whereas contralateral
means 'on opposite sides
of the body’!
 2. Longus capitis muscle

Origin:
• Anterior tubercles of transverse
processes of C3-C6.
Insertion:
• Inferior surface of the basilar
part of occipital bone (lateral to
the pharyngeal tubercle).
Actions:
• Bilateral contraction - head
flexion;
Unilateral contraction –
ipsilateral head rotation
Innervation:
• Anterior rami of spinal nerves
C1-C3
 3. Rectus capitis anterior muscle
• It is situated immediately deep to
the superior part of the longus
capitis muscle.
Origin:
• Anterior surface of lateral mass
and transverse process of atlas.
Insertion:
• Inferior surface of basilar part of
occipital bone, immediately
anterior to foramen magnum.
Actions:
• Flexes the head,
• Helps to stabilize the atlanto-
occipital joint.
Innervation:
• Anterior rami of spinal nerves C1,
C2 (possibly).
 4. Rectus capitis lateralis muscle

Origin:
• Superior surface of the
transverse process of atlas.
Insertion:
• Inferior surface of the jugular
process of the occipital bone.
Actions:
• Head lateral flexion (ipsilateral),
• Stabilizes the atlanto-occipital
joint.
Innervation:
• Anterior rami of C1-C2 spinal
nerves.
 F. Lateral vertebral muscles
1. Scalenus anterior
2. Scalenus medius
3. Scalenus posterior
The scalenus medius is the largest
and scalenus posterior is the
smallest!
 1. Scalenus anterior muscle
• It is most superficial and lies deep to
sternocleidomastoid muscle.
• It is the key muscle at the root of neck because of
its intimate relations to many structures in this
region.
• It provides a useful surgical landmark.
Origin:
• From anterior tubercles of transverse processes of
C3-C6 vertebrae
Insertion:
• The fibres converge and descend almost vertically
to be inserted by a narrow, flat tendon to the
scalene tubercle on the inner border of the 1st rib
and to the ridge on the upper surface of the rib
anterior to the groove for the subclavian artery
Actions:
• Bilateral contraction - neck flexion
• Unilateral contraction - neck lateral flexion
(ipsilateral), neck rotation (contralateral),
• Elevates rib 1
Innervation:
• By ventral rami of C4, C5, and C6 spinal nerves.
 1. Scalenus anterior muscle - relations
Anterior:
a. Phrenic nerve runs downward across the
anterior surface of the muscle deep to
prevertebral fascia.
b. Two arteries: transverse cervical and
suprascapular— cross the anterior surface
of muscle from medial to lateral side.
c. Two veins:
- Anterior jugular vein crosses the
muscle from above downwards.
- Subclavian vein crosses the anterior
surface near insertion from lateral to medial
side.
d. Two muscles:
- Inferior belly of omohyoid crosses the
anterior surface from medial to lateral side.
- Sternocleidomastoid (clavicular head)
overlaps the muscle.
e. Carotid sheath lies vertically in front of the
muscle.
f. Clavicle crosses from medial to lateral side.
 1. Scalenus anterior muscle - relations
Posterior:
a. Roots of brachial plexus separates
the scalenus anterior from scalenus
medius.
b. Subclavian artery passes deep to
scalenus anterior near its insertion
from medial to lateral side,
separating it from scalenus medius.
c. Scalenus medius muscle (medial
part).
d. Cervical pleura.
e. Suprapleural membrane.
 1. Scalenus anterior muscle - relations

Other relations:
• The medial border of
scalenus anterior forms the
lateral boundary of the
scalenovertebral triangle or
triangle of the vertebral
artery.
• The lateral border of the
scalenus anterior is related to
trunks of brachial plexus, Boundaries of the scalenovertebral
triangle:
which emerge underneath it. Medial: lower oblique part of the longus
• The upper part of scalenus colli.
anterior is separated from Lateral: Medial border of scalenus
longus capitis by the anterior.
ascending cervical artery. Apex: Transverse process of C6 vertebra.
Base: First part of the subclavian artery.
 2. Scalenus medius muscle
Origin:
• From posterior tubercles of the
transverse processes of C2– C6
cervical vertebrae.
Insertion:
• On to the upper surface of the first
rib between the tubercle of the rib
and groove for subclavian artery.
Actions:
• When first rib is fixed, it bends the
neck to the same side.
• When upper end is fixed, it elevates
the first rib and thus acts as an
accessory muscle of respiration.
Innervation:
• By ventral rami of C3–C8 spinal
nerves.
 3. Scalenus posterior muscle
• It is smallest and most deeply
situated.
Origin:
• From posterior tubercles of the
transverse processes of C4, C5, and
C6 vertebrae.
Insertion:
• On to the outer surface of second rib,
behind the tubercle for serratus
anterior.
Actions:
• When the 2nd rib is fixed, it bends
the cervical vertebral column
ipsilateral.
• When upper attachment is fixed, it
helps to elevate the 2nd rib and thus
acts as an accessory muscle of
respiration.
Innervation:
• By ventral rami of the lower three
cervical (C6, C7, and C8) spinal
nerves.