So we will start talking about main topics in the neck which are the:  - fascial coverings of the neck” superfacial and deep -The muscle and the post and ant triangle => Lets start with the superfacia fascial that covers the neck , there is specific structures in it that you have to know 1: CUTANEOUS NERVES : for each nerve u should know the origin and the Innervations : -* greater occipital n. that arise from…. dorsal ramus of C2 to the ant-lateral aspect of the neck 1- Lesser occipital n. ant. ramus of C2 , give sensation to area(skin) behind auricular(in the external ear). 2-Great auricular n.  ant. rami C2 & C3. Innervates(sensation)?? 3 regions: Inf. aspect of auricle lobule (fat bag) .  Skin over parotid gland  Angle of mandible (so providing sensation to a region in the face!!) 3- Transverse cutaneous(or cervical) n. ant. rami C2 & C3 .Innervates?? skin over ant.  of the neck (from the lower border of the mandible to the sternum) 4- Supraclavicular n.  ant. rami C3 & C4. , Divided into 3 branch(med ,intermediate, lat) Innervates??  Skin over the clavicle all the way down to sternal angle of manubrium (second rib)  Skin over upper 1/2 of the shoulder,deltoid muscle  all Skin in the lower 1/2 of the post. .

2: i. Platysma m :is a greek word mean: flat muscular sheet . yor u should know the origin and insertion for it

Sup attachment: lower border of mandible Inf attachment : delto-pectoral fascia Neve : cervical branch of VII 7 “ facisal nerve “ Action : draws mouth corners inf. draws skin of the neck sup

3: EXTERNAL JUGULAR VEIN (EJV) Formed opposite to the angle of the mandible Formed by fusion of two division viens : -post. Auricular . - post. division of retromandibular v. note : the ant . division of retromandibular v. form facial vien EJV drain into : 1- subclavian v 2- internal jugular v

4 : * LYMPH NODES: superficial L.N. -L.N in upper 1/2of the neck along EJV called sup. superficial L.N. - L.N in lower 1/2of the neck along IJV called inf . deep fascia L.N common carotid. a: what we mean in common carotid?? At level thyroid cartilage (adams apple) C3- C4, common carotid divided into 2 artery:: 1-internal carotid .a : which continu with cartoid sheath all the way to the skull to provide blood supply to ant – sup part of the brain while post –inf part provided by veretbra .a 2- external carotid .a: leave2 carotid sheath to provide blood supply to the most structure of the head and neck

Now we are going to talk about the deep Fascial Note : all the deep Fascial are singles exept : CAROTID SHEATH 1- Common carotid  internal carotid a (medial structure). 2- Internal jugular v(IJV)(lateral structure) 3- Vagus n. (X)(post structure) which main function? parasympathitic innerveition to intrernal visceral (neck, thoracic,abdomanl)

4- Deep cervical L.N which company with IJV

2: -Investing layer: : all around the neck , Contains 2 muscle . which are?? SCM( at ant-lateral angle of the neck) & trapezius (post) Also Cover 2 salivary glands (parotid & submandibular) you should be specific and say superfacial part of submandibular “ because as you know the submandibular gland has two part one in the neck we call it deep the other in oral cavity we call it superfacial” Note: Thickening part from styloid process (part of temporal bone) to the mandible (post. border of angle of mandible) there is an important lig.  stylomandibular lig. which is thickening of deep fascia of parotid capsule

3: Pretracheal layer surrounding group of muscular. & visceral: Which kind of. muscular?  infrahyoid muscles. Note : all infrahyoid muscles. Innervated by ANSA cervicalis except the Thyrohyoid which innervate by ant ramus of c1 The Dr said there are 4 muscle innervate by post ramus of C1 which are : 1: 2: 3: 4: *Which visceral (organ) ?  thyroid & parathyroid gland& trachea & esophagus ( also we have the larynx & pharynx sup until level of C6 "sixth cervical vertebra as we move down will become, trachea & esophagus in the order") As we move down the trachea & esophagus descend into thorax these fascia will move down into thorax which terminat (blend) (with fibrous pericardium)

4: 3- Prevertebral layer: surrounding vertebral column and muscle attachment to it * Longus m “Longus Capitis and Longus Cervicis” only you should know the name * Lat. group  scalene m Sc. Ant. Sc. Medius Sc. Posterior * Post. group  splenius & semispinalis and Levator Scapulae

 The root of the neck  the area of the neck that lies immediately above the superior thoracix opening

 boundries of the superior thoracix opening :    anteriorly => manubrium Laterally => first rib posteriorly => T1  structures found in the root of the neck : 1- subcalvian a. which is the most important structure : divided by the scalenus anterior into 3 parts :  first part :

from its origin to scalenus anterior . and it will give me 3 branches :   -vertebral a. goes above ( superiorly) . -thyrocervical trunck goes forward (anteriorly ): gives me infrathyroid a. trancsverce cervical a. suprascapular a.   -internal thoracix a. goes downward ( inferiorly ) . -costocervical trunk goes backward (posteriorly ).

second part : behind the scalenus anterior and it gives me one branch

third part : lateral to scalenus anterior to the outer border of the first rib to become axillary a. the third part has no branches but some times in very rare cases it may have one branch

PS : pay attention for these branches they are important in the exam and you will be asked about it . 2- thoracix duct which is the largest lymohatic vessel in the body . 3- roots and trunks of the brachial plexus C5-T1 ( roots withen the scalene hiatus , trunks withen the posterior triangle of the neck ).

 Boundries for the scalene hiatus :    Anteriorly : scalene anterior Posteriorly : scalene medius Inferiorly : first rib

 Contents : o roots of brachial plexus o second part of the subclavian - scalene hiatus is related anterior to the subclavian vein . - scalene hiatus is related anterior to phrenic nerve ( C4-C5). - scalene hiatus is related posterior to subclavian artery .

 Posterior triangle of the neck :  boundries :    anteriorly :posterior border of the SCM posteriorly : anterior border of trapezius inferiorly : middle 1/3 of the clavicle

 contents : 4 arteries : 1- occipital a : at the apex of the triangle origenated from the posterior aspect of the external carotid artery . 2- third part of the subclavian : located at the base of the triangle . 3- transvece cervical artery . 4- suprascapular artery . 5 veins : 1- occipital vein : can be drain to 3 areas : - goes deep to the suboccipital triangle to drain into the vertebral veain . - or it goes to the internal jugular vein . - or it goes to the posterior auricular vein which willa make the external jugular vein . 2- transverce cervical vein . 3- suprascapular vein . 4- subclavian vein. 5- external jagular vein .

 Suboccipital triangle has three main structures :    vertebral artery vertebral vein supoccipital nerve ( posterior branch of c1 )

 anterior triangle of the neck : we have 4 subtriangles :    submental triangle submandibular triangle ( glandular region ) carotid triangle ( vascular triangle )

muscular triangle

 Contents :   superfacial part of submandibular glands . fascial arteries and veins ( arteries deep to the gland , veins superfascial to the gland and its draining into the internal jagular vein ).  hypoglossal nerves C12 .

 according to the carotid triangle contents :    we have the carotid sheath withen its contenttached anteriorlys ansa cervecalis is attached anteriorly to the sheath ( origin C1,C2,C3 ) sympathetic chain attached posteriorly to the carotid sheath

 External Carotid Artery ECA : 8 arteries in number (you have to know the order of them ) one MEDIALLY : 1- assending pharyngial artey : supplys the wall of the pharynx three ANTERIORLLY : 2- facsial artery (the most superior of the anterior arteries ) 3- lingual artery 4- superiorthyroid artery (the most inferior of the anterior arteries ) two POSTERIORLLY 5- posterior auricular

6- occipital artery Two terminations : the doctor gave it to us as a homework

 the puls AReas : 1- temporal 2-facsial 3-carotid

Here some question from the dr : Q : whatis the muscle that seperates the carotid from the submandibular triangle ? posterior belly of digastric get motor innervation from the cervical branch of the facsial nerve .

Q : what is the motor nerve supply for the muscle that seperates between the carotid and the muscular triangle ? ansa cervicalis ( superior belly of omohyiod m )

Q: what is the nerve supply for these muscles ? -stylohyiod => cervical branch of facsial nerve -genohyiod => branch from C1 via hypoglossal nerve -mylohyiod => nerve to mylohyiod ant. Belly of digastric => nerve to mylohyiod

Q :the motor nerve supply for the anterior boundry of the posterior triangle ? accessory nerve C11

Q: what is the motor nerve supply for the muscle that forms the posterior triangle of the neck ? accessory nerve C11 Q: what is the motor nerve supply for the muscle that devide the posterior triangle into two subtriangles ? ansa cervicalis Q: what is the medial boundary for submandibular (digastric) triangle ? ant. Belly of digastric

Q:which muscle is seperating between the carotid and the muscular triangles ? sup. Belly of omohyoid

1:All of these following found in the superfacial fascial except the A: Lesser occipital n B: EJV C: Platysma m D: accessory nerve

2: all of above are covered by investing layer except A: SCM B:trapezius E: non of above 3: all of above receive innervations from - Supraclavicular n A: Skin over the clavicle B:Skin over upper 1/2 of the shoulder,deltoid muscle C: all Skin in the lower 1/2 of the post. . D: all of above 4: which of the pairs incorrect related to the carotid sheath A: IJV MOST lat C: vagus nerve most ant b: carotid artery most post d: deep cervical around IJV C: parotid D: submandibular

5 : all of the fallowing muscles are receiving motor innervation from cervical branch of fascial n except : a: platysma b: stylohyoid c:post.belly of digastrik d: none of the above E: all of the above


1 D

2 E

3 D

4 C

5 E

1: : accessory nerve IN the deep layer 2: the dr said u should be specific and he answer “ E “ BUT I think it is “ E “ when “D” not submandibular it should be “superfacial submandibular : so ask the DR Th exam will include : the skull the neck the face

The End wish you all the luck in the Exam forgive us for anymistake Done by :

Haitham Owes & Rmz Rabadi

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