“Root of Neck”

By
Dr. Shoukat Ali Memon
MBBS M.Phil.

Department of Anatomy
Faculty of Medicine and Allied Medical Sciences
Isra University, Hyderabad
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 THE ROOT OF THE NECK
The root of the neck is the area immediately
superior to the superior thoracic aperture and
axillary inlets.
It is bounded by:
the top of the manubrium of sternum and
superior margin of the clavicle anteriorly;
the top of the thoracic vertebra TI and the
superior margin of the scapula to the coracoid
process posteriorly.
 THE ROOT OF THE NECK
It contains structures passing between the
neck, thorax, and upper limb. There is
also an extension of the thoracic cavity
projecting into the root of the neck. This
consists of an upward projection of the
pleural cavity, on both sides, and includes
the cervical part of the parietal pleura
(cupula), and the apical part of the
superior lobe of each lung.
 THE ROOT OF THE NECK

Anteriorly, the pleural cavity extends

above the top of the manubrium of
sternum and superior border of rib one,
while posteriorly, due to the downward
slope of the superior thoracic aperture the
pleural cavity remains below the top of the
vertebra TI
 Scalenus Anterior Muscle
The scalenus anterior muscle is a key muscle in
understanding the root of the neck. It is deeply
placed and it descends almost vertically from
the vertebral column to the first rib.
Important Relations
 Anteriorly: Related to the carotid arteries, the
vagus nerve, the internal jugular vein, and
the deep cervical lymph nodes. The
transverse cervical and suprascapular arteries
and the prevertebral layer of deep cervical
fascia bind the phrenic nerve to the muscle.
 Scalenus Anterior Muscle
 Posteriorly: Related to the pleura, the origin of
the brachial plexus, and the second part of the
subclavian artery. The scalenus medius muscle
lies behind the scalenus anterior muscle.
 Medially: Related to the vertebral artery and
vein and the sympathetic trunk. On the left side,
the medial border is related to the thoracic duct.
 Laterally: Related to the emerging branches of
the cervical plexus, the roots of the brachial
plexus, and the third part of the subclavian
artery
Cross section of
the neck
showing the
visceral space.
B. Sagittal
section of the
neck showing
the positions of
the
retropharyngeal
and
submandibular
spaces.
C. Vertical
section of the
body of the
mandible close
to the angle
showing the
masticatory
space
Subclavian arteries
The subclavian arteries on both sides arch
upwards out of the thorax to enter the root
of the neck.
The right subclavian artery begins posterior
to the sternoclavicular joint as one of two
terminal branches of the brachiocephalic
trunk. It arches superiorly and laterally to
pass anterior to the extension of the pleural
cavity in the root of the neck and posterior
to the anterior scalene muscle. Continuing
laterally across first rib, it becomes the
axillary artery as it crosses its lateral border.
The left subclavian artery begins lower in the
thorax than the right subclavian artery as a
direct branch of the arch of the aorta. Lying
posterior to the left common carotid artery
and lateral to the trachea, it ascends and
arches laterally, passing anterior to the
extension of the pleural cavity and posterior
to the anterior scalene muscle. It continues
laterally over rib I, and becomes the axillary
artery as it crosses the outer border of rib I.
 Both subclavian arteries are divided into
three parts by the anterior scalene muscle:
 The first part extends from the origin of the
artery to the anterior scalene muscle;
 The second part is the part of the artery
posterior to the anterior scalene muscle;
 The third part is the part lateral to the
anterior scalene muscle before the artery
reaches the lateral border of rib I. All
branches from the right and left subclavian
arteries arise from the first part of the
artery. They include the vertebral artery,
the thyrocervical trunk, the internal
thoracic artery, and the costocervical trunk
Vertebral artery
The vertebral artery is the first branch of the
subclavian artery as it enters the root of the
neck
The second branch of the subclavian artery is
the thyrocervical trunk (Inferior Thyroid
Artery)
The third branch of the subclavian artery is
the internal thoracic artery

The final branch of the subclavian artery in the root of the

neck is the costocervical trunk
 Nerve
Several nerves and components of the
nervous system pass through the root of
the neck
1. Phrenic Nerve
2. Vagus Nerve
3. Recurrent laryngeal Nerve (Right and
Left)
4. Sympathetic Ganglion
 Phrenic nerve
(anterior rami of C3-
C5)
 Lies on anterior
scalene, deep to
fascia
 To diaphragm
(motor and
sensory)
 Ansa cervicalis :
 supplies
infrahyoid muscles
 The ansa cervicalis (or
ansa hypoglossi in older
literature) is a loop of
nerves that are part of the
cervical plexus. It lies
superficial to the internal
jugular vein in the carotid
sheath.
 Branches from the ansa
cervicalis innervate three
of the four infrahyoid
muscles: the sternohyoid
muscle, the sternothyroid
muscle, and the omohyoid
muscle. It does not
innervate the thyrohyoid
muscle, which receives its
innervation from the
ventral root of C1
 Ansa cervicalis (ROOTS)
 Two roots make up the ansa cervicalis.
 Superior root of ansa cervicalis: The superior root of the
ansa cervicalis is formed by branch of Cervical spinal
nerve 1 (C1) . The nerve fibers travel with the hypoglossal
nerve and leaves it to form the superior root. It sends off
branches to the superior belly of the Omohyoid muscle,
then joined by the inferior root of ansa forming ansa
cervicalis.
 Inferior root of ansa cervicalis : The inferior root of the
ansa cervicalis, also known as descendents cervicalis, is
formed by fibers from spinal nerves C2 and C3.
 The ansa cervicalis gives off branches to the inferior belly
of the Omohyoid muscle, Sternothyroid and Sternohyoid
muscles
Vagus nerve (Ⅹ)
 Leaves skull via
jugular foramen
 Descends in the
neck in carotid
sheath between
internal (or
common) carotid
artery and internal
jugular vein
 Branches
 Superior laryngeal
nerve passes down side
of pharynx and given rise
to
Internal branch
External branch
 Cervical cardiac branches :
descending to terminate
in cardiac plexus
 Recurrent laryngeal
nerves
Accessory n. (Ⅺ )
 Deep to posterior belly of
digastric
 Supplies sternoclidomastoid
and trapezius muscle

Hypoglossal n.(Ⅻ)
 Descends between internal
carotid a. and internal
jugular v., hooks around
external carotid a., to lie on
the hyoglossus before
entering tongue
 Supplies muscles of tongue
CERVICAL PART OF SYMPATHETIC
TRUNK
 Formed by superior , middle and
inferior cervical ganglia and
interganglionic branches
1. Superior cervical ganglion:
largest, situated in front of
transverse processes of C1~C3
vertebra
2. Middle cervical ganglion:
smallest, is at level of transverse
processes of C6 vertebra
3. Inferior cervical ganglion:
situated at level of C7 vertebra,
and may be fused with first
thoracic ganglion to form
cervicothoracic ganglion
THANKS