Superficial fascia

of the neck

is rich in fat and contains

- cutaneous nerves
- Superficial vessels
anterior and external
jugular veins
- platysma muscle.
Platysma muscle
It is a broad thin sheet of muscle
situated in the superficial fascia in
the side of
the neck.
Origin: from deep fascia covering
Insertion
the upper part of pectoralis major
muscle. Cervical branch of facial n.

Insertion: into the lower border of

mandible. It also blends with the
superficial muscles of the angle of
the mouth.
Nerve supply: cervical branch of
facial nerve. Origin

Action: corrugation of the skin of

Deep fascia (cervical fascia):
1. General investing fascia:
- It surrounds the neck and Encloses
2 glands: parotid and submandibular
2 muscles: sternomastoid and trapezius

- It forms the roof of the anterior and posterior triangles.

- It forms: stylomandibular ligament
suprasternal space
2. Prevertebral fascia:
It encloses the prevertebral muscles.
3. Pretracheal fascia:
It envelops the thyroid gland and is attached above to the cricoid and
thyroid cartilages and sides of trachea. This is the reason why the thyroid
moves up and down with deglution.
4. The pharyngeal fascia:
It consists of:
Buccopharyngeal fascia: covers the pharynx and buccinator muscle.
Pharyngobasilar fascia: fills gap between pharynx and base of skull.
Retropharyngeal fascia: lies behind the pharynx and oesophagus.
General investing fascia

Pretracheal fascia
Carotid sheath

Prevertebral fascia

Fig. 50: Deep fascia of the neck

Sternomastoid Muscle
Origin:Sternal head: Anterior surface of
manubrium sterni
Clavicular head: Medial 1/3 of
upper surface of clavicle.
Insertion: Lateral surface of mastoid
process.
Lateral ½ of superior nuchal line.
Nerve supply:-Spinal root of accessory
nerve (motor)
- C2 (proprioception)
Action:One head: bends the head
towards its side.
Rotates the head so that the face
is turned to the opposite side.
Both heads: Flex the cervical part
of cervical column,in forced inspiration.
 Triangles in the neck
- The side of the neck is divided by
sternomastoid muscle into anterior and
posterior triangles.

Anterior Triangle
- Boundaries:
Anterior: midline of neck
Posterior : sternomastoid
Base : lower border of mandible and
line from angle of mandible to mastoid
process.
- Subdivisions:
by digastric and superior belly of
omohyoid into 3 ½ triangles ( carotid ,
digastric, muscular and ½ submental)
 POSTERIOR TRIANGLE
-Boundaries:
Anterior: posterior border of
sternomastoid
Posterior: anterior border of
trapezius
Base: middle 1/3 of clavicle
Apex: meeting of muscles at
sup.nuchal line
-Floor: formed of the following
muscles from below upwards:
scalenus medius- levator
scapulae- splenius capitis-
semispinalis capitis
-Roof: 1-skin
2- superficial fascia containing
platysma, cutanous nerves, ext
jug vein. 3- deep fascia
Contents:
1- one muscle: inferior belly
of omohyoid divides the
posterior triangle into
subclavian and occipital
2- 2 sets of vessels:
- Arteries(subclavian-
suprascapular-transverse
cervical- occipital)
- veins (subclavian-
suprascapular-
transverse cervical-
external jugular)
3- 3 sets of nerves : spinal
accessory n , roots and
trunks of brachial plexus,
cervical plexus
4- Lymph nodes
 Anterior triangle:
subdivided into 3 and 1/2
The Carotid Triangle:
- Boundaries:
Post: sternomastoid
Superior: post belly of
digastric
Inferior: sup belly of
omohyoid

- Contents:
1- Arteries: CCA, ICA ,
ECA and 5 of its branches.
2- Veins: IJV
3- Nerves: XII, XI, X ,
sympathetic chain and ansa
cervicalis.
4- Deep cervical lymph
Carotid sheath
It is a condensation of general
investing fascia of the neck.
Contents:
•Common carotid artery then the
internal carotid artery above C4.
•Internal jugular vein lateral to
both arteries.
•Vagus nerve between and
behind internal jugular and the
arteries.
N.B.
* Embedded in its anterior
surface: ansa cervicalis.
* Embedded in its posterior
surface: sympathetic chain.
Submental Triangle

It is bounded by:
On each side: the anterior
bellies of digastric muscle
Apex: at the symphysis menti
Base: the body of hyoid bone
Roof: lower surface of parts
of the two mylohyoid muscles
Contents:
•Submental lymph nodes (1-
2)
•Nerve to mylohyoid muscle
•Submental vessels
•Beginning of anterior jugular
vein
 Digastric Triangle:
- Boundaries: Two bellies
of digasric and lower border
of mandible

- Floor: mylohyoid and

hyoglossus
- Contents:
1- Submandibular gland and
lymph nodes.
2- facial and submental
artery.
3- Facial and submental
veins.
4- Hypoglossal and
mylohyoid nerves.
5- Lingual nerve
 Muscular Triangle:
- Boundaries
- Contents:
It contains 4
infrahyoid muscles in
2 layers:
Superficial:
1- sternohyoid
2- Omohyoid
Deep:
1- sternothyroid
2- Thyrohyoid
•Sternohyoid: takes origin from back of
manubrium sterni, inserted into hyoid bone.
•Omohyoid: superior belly arises from hyoid
bone, inferior belly from suprascapula notch. Both
attached to intermediate tendon.
•Sternothyroid: takes origin from back of
manubrium sterni and inserted into oblique line of
thyroid cartilage.
•Thyrohyoid: takes origin from oblique line of
thyroid cartilage and inserted into hyoid bone.
All infrahyoid muscles are supplied by ansa
cervicalis (C1, 2, 3) except thyrohyoid which is
innervated directly from hypoglossal nerve (C1).
 C1 Nerve to geniohyoid

C2

C3
Nerve to thyrohyoid

Descendens cervicalis Descendens hypoglossi

Nerve to sternothyroid

Nerve to omohyoid

Nerve to sternohyoid
 Thyroid Gland

Site: lower part of neck.

Extent: from C5 to T1
Capsules:
- True capsule
- False capsule: derived
from pretracheal fascia
which is attached to oblique
line of thyroid cartilage and
cricoid cartilage.
Shape:
- It consists of 2 lobes and
isthmus.
 Relations:
Isthmus:
- It lies opposite 2,3,4
tracheal rings

Lobes:
- Each is conical in shape
has three surfaces:
medial, lateral and
posterior.
- Each extends from
oblique line of thyroid
cartilage to 5th or 6th
tracheal rings.
 Blood supply of the
gland:
- Arterial supply:
1- Superior thyroid artery:
from external carotid ,
closely related to external
laryngeal nerve away from
the gland.
2- Inferior thyroid artery:
from thyrocervical trunk of
1st part subclavian artery ,
closely related to recurrent
laryngeal nerve close to the
gland.
3- Thyroidae ima artery
may be present from
innominate or arch of aorta.
- Venous drainage:
1- Superior thyroid vein: to IJV.
2- Middle thyroid v : to IJV.
3- Inferior thyroid v : to left
brachiocephaliv veins.
 Submandibular Region

- It lies between body of mandible and hyoid bone.

- It contains suprahyoid muscles and submandibular
salivary gland.
- The suprahyoid muscles are:
1- digastric
2- mylohyoid
3- hyoglossus
4- stylohyoid
5- geniohyoid
 Digastric Muscle
- Origin:
Anterior belly: from
digastric fossa in mandible.
Posterior belly: from
digastric notch in mastoid
process
- Insertion:
the 2 bellies connected
by intermediate tendon
hold by fibrous loop to
hyoid bone.
- Nerve Supply:
Anterior belly:
mylohyoid nerve.
Posterior belly: facial
nerve
 Stylohyoid Muscle
- Origin:back of styloid
process
- Insertion:its tendon
splits to surround the
tendon of digastric and
inserted in hyoid bone.
- Nerve supply: facial
nerve

Geniohyoid muscle
- Origin: inferior genial
tubercle
-Insertion: hyoid bone
- Nerve supply: C1 via
hypoglossal nerve
 Mylohyoid Muscle
- Origin: mylohyoid line of
mandible.
- Insertion: mylohyoid raphe
and hyoid bone
- Nerve supply: mylohyoid
nerve.
- Relations:
Superficial:
1- ant belly of digastric
2- superficial part of
submandibular gland
Deep:
1- Hyoglossus with
structures on it
2- styloglossus
3- genioglossus and
geniohyoid
 Hyoglossus
Muscle

- Origin:
greater horn of
hyoid bone
- Insertion: side
of tongue
- Nerve supply:
Hypoglossal
Relations of hyoglossus
muscle:
a) Superficial (lateral):
. 2 muscles: styloglossus
& mylohyoid.
. 2 nerves: lingual n. +
submandibular ganglion +
hypoglossal nerve.
. Gland: deep part of
submandibular gland. +
submandibular duct.
. Vessel: deep lingual vein

Anatomy Department 52
b) Deep: genioglossus, stylohyoid ligament, IX, lingual artery.

Anatomy Department 53
Submandibular Gland
- Site: in the digastric triangle
- Parts: consists of superficial
part and deep part
Extensions:
• Superiorly: to the mylohyoid
muscle.
• Inferiorly: overlaps digastric
muscle reaching the hyoid
bone.
• Anteriorly: to the mental
foramen.
• Posteriorly: to the angle of
mandible.
It is enclosed by deep fascia
(general investing) of the neck
separated from the parotid gland
by stylomandibular ligament.
 - Relations: it has 3 surfaces:
1- lateral surface: related to
mandible, medial pterygoid and
facial artery.
2- inferolateral surface:
covered by skin, superficial and
deep facia.
Crossed by: - cervical branch
of facial nerve
- facial vein
- submandibular lymph nodes
3- Medial surface:
- ant. Part: rests on mylohyoid
- middle part: rests on
hyoglossus separated from it by
structures
- posterior part: styloglossus.
Stylohyoid lig, IX nerve
 Deep part of the gland:
- lies between mylohyoid and
hyoglossus.
- On hyoglossus it lies between
lingual nerve above and
hypoglossal nerve below.
Submandibular duct:
- 5 cm long.
- arises from medial surface of
the gland and extends into the
floor of the mouth deep to
mylohyoid traversing the deep
part of the gland
- then passes between
sublingual gland and
genioglossus muscle
- the lingual nerve has tripple
relation with it
 Deep part
Superficial part
Posterior free border
of mylohyoid muscle
 Relation between
lingual nerve &
Submandibular duct

1.Lingual nerve is
lateral to the duct.
2.Then inferior.
3.Finally medial.

Anatomy Department 63
 Nerve supply of the gland:
- Sensory: from lingual nerve.
- Sympathetic: from plexus around
facial artery
- Parasympathetic: postganglionic fibers
from submandibular ganglion
Facial n.
Lingual n.
Submandibular ganglion:
- Superior salivary nucleus
fibers pass with facial nerve then Chorda tympani
through chorda tympani which joins
lingual nerve to relay in submandibular
ganglion postganglionic fibers to
sublingual and submandibular glands.

Blood supply : branches from facial

artery.
Facial n.

Lingual n.

Chorda tympani

Plexus around facial a.

Postganglionic fibres

Fig. 86: Submandibular ganglion

 Sublingual gland
-It lies under the mucous membrane of the mouth
occupying sublingual fossa.
-Relations:
Superiorly: mucous membrane of mouth
Inferiorly: mylohyoid muscle
anterolateral: sublingual fossa
Medially: genioglossus separated from it by lingual
nerve and submandibular duct.
- Ducts: 10- 12 open in submandibular duct or in
the mucous membrane of the floor of mouth
- Blood supply : sublingual and submental a
- Nerve supply: from submandibular ganglion
 VESSELS OF HEAD AND
NECK
Subclavian Artery
- Origin:
Rt side: branch from
brachiocephalic artery
Lt side: from arch of aorta
- Begins: at the sternoclavicular joint
- Ends: at outer border border of 1st
rib by becoming axillary artery.
- Course: it has arched course at the
root of the neck above the apex of the
lung.
Scalenus anterior muscle divides it
into 3 parts:
1st part:medial to it
2nd part: behind it
3rd part : lateral to it
Branches:
From 1st part:
1- Vertebral a: consists of 4 parts:
2- Internal thoracic a : descends into the thorax
3- Thyrocervical trunk: divides into 3 branches
- Inferior thyroid
- Suprascapular
- Transverse cervical
From 2nd part:
- Costocervical trunk: arches backwards and divides into:
1- Superior intercostal
2- Deep cervical
3rd part :
-In 35% has no branches
- In 65% gives dorsal scapular
 The Carotid System
Formed of common carotid and its
terminal branches
Common Carotid Artery
- Origin:
Rt side: from brachiocephalic artery
Lt side: from arch of aorta
Enter the root of the neck behind
sternoclavicular joint
- Ends: at upper border of thyroid
cartilage ( disc between C3 and C4) by
dividing into external and internal carotid.
- Course: It ascends inside the carotid
sheath upwards and slightly laterally on the
side of trachea and oesophagus (below)
and larynx and pharynx (above)
- It has carotid body and sinus at its
end.
 Internal Carotid Artery
- Begins: at upper border of thyroid cartilage
- Ends: inside the cranial cavity by dividing into
middle and anterior cerebral arteries
- Course: it has 4 parts:
1- cervical part: present inside the carotid
sheath with IJV and vagus n lateral to it
2- Intra petrous part: enters the carotid canal
passing through it and enters the cranial cavity
through f lacerum
3- Intracavernous part: enters the cavernous
sinus passing on its floor then upwards to pierce
its roof
4- Intracranial part
 External Carotid Artery
- Begins: at upper border of
thyroid cartilage
- Ends: inside parotid gland
opposite the neck of mandible
by dividing into superficial
temporal and maxillary.
- Course: - It asscends lateral
to pharynx outside carotid
sheath
- Finally it enters the
posteromedial surface of
parotid gland where it ends.
 Branches of external
carotid artery:
1- Ascending pharyngeal
2- Superior thyroid: below
greater horn of hyoid bone
3- Lingual: opposite greater
horn of hyoid bone
4- Facial: above greater horn
of hyoid bone
Branches in face: sup and inf
labial, nasal, angular
5- Occipital
6- Posterior auricular
7- Superficial temporal
8- Maxillary
 Veins In The Neck
1- Subclavian vein:
Begins: at outer border of 1st rib as continuation
of axillary vein
Ends: at medial border of scalenus anterior by
joining IJV to form brachiocephalic vein
Tributaries: EJV
2- Jugular Veins:
1- Ext J V :formed by
union of post auricular
and posterior division of
retromandibular, passes
superficial to
sternomastoid, pierces
deep fascia in post
triangle and ends in
subclavian V.
Tributaries: ant. Jug,
post. Ext. J., transverse
cervical, suprascapular
2- Ant J V: begins in
submental triangle and
ends by passing deep to
sternomastoid and
drains in Ext. J. V.
3- Internal jugular vein:
Begins: in post comp of jugular
foramen as continuation of sigmoid
sinus
Ends: by joining subclavian v
Course: it descends in carotid
sheath lateral to int carotid and
common carotid artery with vagus
nerve
It has sup and inf bulbs
Tributaries:
1- Inferior petrosal sinus
2- Pharyngeal veins
3- common facial v
4- lingual v
5- superior thyroid v
6- middle thyroid v