Neck

•
The
Superficial group
muscles of neck
– Platysma ， a thin sheet-like muscle of facial expression
– Sternocleidomastoid
• Suprahyoid muscles
– Digastric
– Stylohyoid
– Mylohyoid
– Geniohyoid
Elevate (raise) hyoid bone and
depress mandible.
• Infrahyoid muscle
– Sternohyoid
– Sternothyroid
– Thyrohyoid
– Omohyoid
Depress hyoid or larynx
after elevation
• Deep group
– Lateral
• Scalenus anterior
• Scalenus medius
• Scalenus posterior

– Medial
• longus capitis
• longus colli
Flex the head, bends the neck
forward
 Major muscles of the neck
Sternocleidomastoid
• Origin: manubrium and sternal
end of clavicle
• Insertion: mastoid process of
temporal bone
• Action: contraction of one
muscle draws head toward the
same side, and turn face to
opposite side; both muscles
act together to draw head
backward
Scalenus anterior
• Origin: transverse processes of C3-
C6.
• Insertion: tubercle for scalenus
anterior
• Action: unilateral, bends neck
laterally; bilateral, elevate first rib,
an accessory muscle of inspiration;
if rib is fixed, flex neck anteriorly
Scalene fissure
Above the first rib, there is a
triangular space between scalenus
anterior and midius. The brachial
plexus and the subclavine a.
emerge from this space.
 The arteries of neck
Common carotid artery
• Origin (arises from)
– Brachiocephalic trunk on
the right
– Aortic arch on the left
• Ascends in neck to upper
border of thyroid cartilage;
bifurcates into internal and
external carotid arteries
• Carotid sinus (baroreceptor),
located at a localizes dilation
of terminal part of common
carotid artery or beginning of
internal carotid artery,
sensitive to blood pressure
changes
• Carotid glomus
(chemoreceptor), lies
posterior to the point of
bifurcation of common carotid
artery, senses changes in
blood carbon dioxide (oxygen)
levels
Branches of external carotid
a.
• Superior thyroid a.
descends to supply upper pole of
thyroid gland and larynx
• Lingual a.

• Facial a.
• Occipital a.
• Posterior auricular a.

• Maxillary a.

• Superficial temporal a.
Subclavian artery

• Origin (arises from)

– Brachiocephalic trunk on right
– Aortic arch on left
• Becomes axillary artery at lateral
border of first rib
• Branches
– Vertebral a.
– Internal thoracic a.
– Thyrocervical trunk
• Inferior thyroid artery －
supplies inferior pole of thyroid gland
– Costocervical trunk
 Veins Draining the neck
Internal jugular vein
• Begin at jugular foramen,
descending to join the subclavian
vein to form brachiocephalic vein
• Lies lateral first to internal and then
to common carotid a. within carotid
sheath
• Chief extracranial tributaries
– Common facial vein
– Lingual v.
– Pharyngeal v.
– Superior thyroid v.
– Middle thyroid v.
Subclavian vein
• It is an continuation of
axillary vein at the lateral
border of first rib
• Joins internal jugular vein to
form the brachiocephalic
vein. Angle of union is
termed venous angle
External jugular vein
• Formed behind angle of mandible
by union of posterior auricular,
posterior branch of
retromandibular and occipital
vein
• Crossing sternocleidomastoid to
enter subclavian vein

Anterior jugular vein

• Drains submandibular and
anterior neck regions
• Descends near midline, runs
posterior to sternal end of
sternocleidomastoid to drain into
external jugular vein or
subclavian vein
 Lymph nodes of neck
Anterior cervical
lymph nodes
• Superficial anterior
cervical lymph nodes
• Deep anterior cervical
lymph nodes
Lateral cervical lymph
node
• Superficial lateral cervical
lymph nodes － lie along
the external jugular vein
Deep lateral cervical lymph nodes
• Extend along the internal jugular vein
from the base of skull to the root of
neck, divided into superior deep lateral
cervical lymph nodes and inferior deep
lateral cervical lymph nodes
• Receive lymphatic vessels from head,
neck, tongue, larynx, cervical parts of
esophagus and trachea, thyroid gland,
upper parts of the thoracic wall and
breast
• Efferent vessels form the jugular trunk
－ the left jugular trunk joins the
thoracic duct and right may joint the
right lymphatic duct
Superior deep lateral cervical lymph
nodes
• Jugulodigastric lymph node :
lies at the junction of posterior belly
of digastric and internal jugular vein

Inferior deep lateral cervical lymph

nodes
• Juguloomohyoid lymph node :
lies at the junction of the
intermediate tendon of omohyoid
and internal jugular vein
• Supraclavicular lymph nodes : lie
along the subclavian artery
Right lymphatic duct
• Formed by union of right jugular,
subclavian, and bronchomediastinal
trunks
• Ends by entering the right venous angle
• Receives lymph from right half of head,
neck, thorax and right upper limb
Thoracic duct
• At the roof of the neck, it turns laterally
and arches forwards and descends to
enter the left venous angle
• Just before termination, it receives the left
jugular, subclavian and
bronchomediastinal trunks
Subgroups
• Ia Submental
• Ib Submandibular

• IIa Upper jugular (Anterior to XI)

• IIb Upper jugular (Posterior to XI)

• III Middle jugular

• IVa Lower jugular (Clavicular)

• IVb Lower jugular (Sternal)

• Va Posterior triangle (XI)

• Vb Posterior triangle (Transverse cervical)

• VI Central compartment
 Level I
• Ia
– Chin
– Lower lip
– Anterior floor of mouth
– Mandibular incisors
– Tip of tongue

• Ib
– Oral Cavity
– Floor of mouth
– Oral tongue
– Nasal cavity (anterior)
– Face
 Level II
• Oral Cavity
• Nasal Cavity
• Nasopharynx
• Oropharynx
• Larynx
• Hypopharynx
• Parotid
 Level III
• Oral cavity
• Nasopharynx
• Oropharynx
• Hypopharynx
• Larynx
 Level IV
• Hypopharynx
• Larynx
• Thyroid
• Cervical esophagus
 Level V
• Nasopharynx
• Oropharynx
• Posterior neck and scalp
 Level VI
• Thyroid
• Larynx (glottic and subglottic)
• Pyriform sinus apex
• Cervical esophagus
 Cervical plexus
Formation: formed by
anterior rami of C1-C4
spinal nerves
Position: lies in front of the
origin of levator scapulae
and scalenus medius and
deep to the superior part
of the
sternocleidomastoid
Branches
• Cutaneous branches: emerge
around middle of posterior
border of
sternocleidomastoid, to
supply skin of neck and scalp
between auricle and external
occipital protuberance
– Lesser occipital n.
– Greet auricular n.
– Transverse nerve of neck
– Supraclavicular n.
• Muscular branches: supply the
deep muscles of neck
• Phrenic nerve (anterior
rami of C3-C5)
– Lies on anterior scalene, deep
to fascia
– To diaphragm (motor and
sensory)
• Ansa cervicalis :
– Hypoglossal nerve gives off
superior root of ansa
(descendens hypoglossi),
composed of fibers picked up
from nerve C1
– Joins inferior root of ansa
(descendens cervicalis, C2and
C3) to form a loop, the ansa
cervicalis, which supplies
infrahyoid 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 which
pierces thyrohyoid membrane to innervates
mucous membrane of larynx above fissure of
glottis
• External branch which
innervates cricothyroid
– Cervical cardiac branches : descending to
terminate in cardiac plexus
– Recurrent laryngeal nerves
• Ascend in tracheo-esophageal groove
• Enter larynx posterior to cricothyroid joint,
the nerve is now called inferior laryngeal
nerve
• Innervations: laryngeal mucosa below fissure
of glottis , all laryngeal laryngeal muscles
except cricothyroid
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
• Superior cervical ganglion:
largest, situated in front of
transverse processes of C1~C3
vertebra
• Middle cervical ganglion:
smallest, is at level of transverse
processes of C6 vertebra
• Inferior cervical ganglion:
situated at level of C7 vertebra,
and may be fused with first
thoracic ganglion to form
cervicothoracic ganglion
TERIMA KASIH