Clinical Anatomy Notes

Suprahyoid Region
BOUNDARIES
• Superiorly: Inferior margin of the mandible
• Inferiorly: Line which goes through the hyoid bone on each side
• Laterally: Anterior border of the sternocleidomastoid (SCM) muscle

COVERED BY:
1. Skin
2. Super cial Fascia
3. Platysma
4. Super cial Layer of Proper Fascia

CONTAINS:
• Cervical branch of facial nerve (7th cranial nerve)
• Transverse Cutaneous Nerve
• Submental ∆
• Submandibular ∆

SUBMENTAL ∆
• Lies below the chin
• Bounded laterally by anterior bellies of digastric muscles
• Bounded inferiorly by the body of hyoid bone
• Floor made by Mylohyoid muscle
• Contains submental lymph nodes and beginning of anterior jugular vein

SUBMANDIBULAR ∆
• Bounded by inferior border of mandible, anterior & posterior bellies of
digastric muscle
• Floor is formed by mylohyoid and hyoglossus muscles
• Contains: Submandibular Salivary glands & Facial artery and vein
• Hypoglossal nerve runs on hyoglossus muscle
• Sheath of submandibular gland formed by 2nd fascia of neck which
divides into 2 layers
• These layers are attached to the inferior border of the mandible
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 Infrahyoid Region
BOUNDARIES:
• Superiorly: Line which goes through the hyoid bone
• Inferiorly: Suprasternal notch
• Laterally: Anterior border of the SCM muscle

COVERED BY:
1. Skin
2. Subcutaneous Tissue
3. Super cial Fascia
4. Platysma
5. Super cial Layer of Proper Fascia
6. Deep Layer of Proper Fascia
7. Infrahyoid muscles
8. Parietal and visceral layers of the endocervical fascia

CONSISTS OF:
• 2 x Carotid ∆s
• 2 x Omotracheal ∆s (muscular ∆s)

OMOTRACHEAL ∆
• Bounded anteriorly by midline of neck
• Bounded superiorly by superior belly of the omohyoid
• Bounded inferiorly by anterior border of the SCM muscle
• Floor formed by Sternohyoid and Sternothyroid muscles
• Beneath the oor and the endocervical fascia are the neck organs:
• Thyroid gland, Larynx, Trachea, Pharynx and Oesophagus

SCM Region
• Bounded superiorly by mastoid process of temporal bone
• Bounded inferiorly by manubrium
• Separates the lateral ∆ from anterior medial ∆
• Covers the carotid sheath
COVERED BY:
1. Skin
2. Subcutaneous Tissue
3. Super cial Fascia
4. Platysma
5. Super cial Layer of Proper Fascia

• External jugular vein begins behind mandibular angle and descends

obliquely across the SCM and just above the clavicle in lateral ∆
• Sheath of SCM is formed by super cial layer of proper fascia
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 Carotid ∆ LIES BEHIND HYOID BONE
BOUNDARIES:
• Superior: Posterior belly of digastric
• Inferiorly: Superior belly of omohyoid
• Posteriorly: anterior border of SCM muscle

COVERED BY:
1. Skin
2. Super cial fascia
3. Platysma
4. Super cial layer of proper fascia
5. Parietal layer of endocervical fascia
6. 5th fascia

CONTAINS:
• Carotid sheath containing common carotid arteries which divide into
internal and external carotid arteries
• Internal Jugular vein
• Internal and external laryngeal nerves
• Hypoglossal, Accessory and Vagus nerve

CAROTID ARTERIES AND SHEATH

• Common carotid artery lies medial and deep to the internal jugular vein
• Vagus nerve lies between the common carotid artery and internal jugular vein
• On the LHS, common carotid artery rises from the aortic arch and enters the
neck behind the left sternoclavicular joint and deep to the SCM. Ascends on the
side of neck to the upper border of thyroid cartilage. Here, it bifurcates into
internal and external carotid arteries
• On the RHS, common carotid artery rises behind the right sternoclavicular joint.
Course in the neck is similar to the LHS
• External carotid artery lies anteromedially to the internal

JUGULAR VEINS
• Internal jugular vein receives blood from the brain, face and neck
• Begins at jugular foramen of skull. Descends thru the neck and unites with
subclavian artery
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Deep Intermuscular Spaces
• Located in inferior part of SCM region and behind SCM. Lateral to neck organs
• There are 3 spaces
• Antescalene
• Interscalene
• Scalenovertebral Triangle

ANTESCALENE SPACE
• Bounded anteriorly & medially by sternohyoid and sternothyroid muscles
• Bounded anteriorly & laterally by SCM muscle
• Bounded posteriorly by Scalenus Anterior Muscle
• Contains (from lateral to medial): bulb of internal jugular vein, vagus nerve
and initial part of common carotid artery. Also contains phrenic nerve

INTERSCALENE SPACE
• Located between scalenus anterior and scalenus medius (medium)

SCALENOVERTEBRAL TRIANGLE
• Bounded laterally by scalenus anterior muscle
• Bounded medially by Longus Colli muscle
• Base forms cervical pleura
• Apex of this ∆ is the Carotid Tubercle on C6 transverse process

CONTAINS:
• 1st part of subclavian artery with its branches
• Arch of thoracic duct
• Inferior cervical ganglion

• Thoracic duct enters the neck behind left subclavian artery. It then arches
laterally over the pleura and crosses anterior to the vertebral artery/vein
before opening into the junction of left subclavian and internal jugular veins

Lateral ∆ of the Neck

• Subdivided into omotrapezius and supraclavicular ∆s.

BOUNDARIES:
• Anteriorly: posterior border of SCM muscle
• Posteriorly: anterior border of trapezius muscle
• Inferiorly: by the clavicle
• Inferior belly of digastric muscle divides the lateral ∆ into omotrapezius and
supraclavicular
 OMOTRAPEZIUS ∆
• 1st, 2nd and 5th fascias are located
• 3rd fascia is only located in supraclavicular ∆
• Bounded anteriorly by SCM muscle
• Bounded posteriorly by trapezius muscle
• Bounded inferiorly by omohyoid muscle

SUPRACLAVICULAR ∆
• Bounded superiorly by inferior belly of omohyoid muscle
• Bounded inferiorly by clavicle
• Bounded medially by SCM muscle
• Super cial fascia is beneath the skin
• 2nd fascia attached to the anterior surface of the clavicle
• 3rd fascia is located only beneath the inferior belly of the omohyoid muscle
in the suprahyoid muscle in supraclavicular ∆

WHAT PASSES THRU?

• Brachial plexus
• Anteriorly-inferiorly behind clavicle is subclavian vein
• Posteriorly-superiorly is subclavian artery

LYMPH NODES OF THE NECK

• divided into 5 groups:
• Submandibular nodes
• Submental
• Anterior Cervical
• Lateral Cervical
• Deep Cervical (also called the retropharyngeal lymph nodes)
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