Download Anatomy of the Neck

2017.Spring
Anatomy of the Neck
Lecture
Lab
2/21(二) PM 1‐5
Posterior triangle , 2 Hours
+ 2 Hours
3/07(二) AM 8‐12
Anterior triangle, 1.5 Hours
+ 3.5 Hours
3/14(二) AM 8‐12
Deep structure of the neck, 1.5 Hour + 2.5 Hours
3/21(二) PM 1‐6
Face and scalp, 2 Hours
+ 3 Hours
參考書: Anatomy of the Head and Neck, by George H. Paff
網站 Acland’s Video Atlas of Human anatomy
http://aclandanatomy.com/MultimediaPlayer.aspx?multimediaId=10528463
賴逸儒
[email protected]
Outline
The Neck: neurovascular structure/viscera
The triangles of the neck
• Posterior triangle
• Anterior triangle
Fascia and spaces of the neck
Triangles of the neck
‐ Sternocleidomastoid muscle (胸鎖乳突肌)
‐ Posterior triangle / anterior triangle
1= SCM
2= Trapezius
3= Clavicle
4= Omohyoid, PB
5= Mandible
6= Digastric, AB
7= Digastric ,PB
8= Hyoid
9= Omohyoid, AB
The fascia of the neck
• Superficial fascia‐ between skin and deep fascia
• Deep fascia
Superficial cervical fascia
(continuous, loose subcutaneous tissue)
 Skin   Deep fascia (investing layer)
 Nerves, vessels, lymph‐ supply skin
 Fatty connective tissue (except: eyelid)
 Scalp – thorax, upper extremity
Deep fascia:
•Investing
 Platysma: through the superficial fascia
Platysma
• Broad, thin muscle



Deltoid and pectoris major (skin, Inferior)
Mandible, lower face
Depressor muscles of mouth
• Shaving, grimace
• branch of facial nerve (CN. VII)
Deep Cervical Fascia
(muscular fascia)
• Investing • Pretracheal
• Prevertebral
• Carotid sheath
• Retropharyngeal
space
Tr
#
posterior
I.F
Investing Layer of Deep Cervical Fascia
•
•
‐
‐
Superficial
Split: SCM and Trapezius
Manubrium (Suprasternal space)
Tr
#
•Continue posteriorly
‐Periosteum of spinous process, C7
‐Nuchal ligament (#)
Suprasternal space
jugular arch Pretracheal layers
Deep Cervical Fascia
Muscular portion
Visceral portion
carotid sheath
Th
Tr
V
Buccopharyngeal fascia
limited to anterior part of neck; Thin
• Superiorly: hyoid bone
• Inferiorly: blends with fibrous pericardium
• Posteriorly: buccopharyngeal fascia
• Laterally: blends with carotid sheath
Prevertebral layer
• Tubular sheath for vertebral column and muscles
• Cervical sympathetic trunks
Roof/Floor of posterior triangle Sympathetic trunk
Prevertebral fascia
Superiorly: cranial base
Inferiorly:
• blends w/ endothoracic fascia
• fuses w/ ant. longitudinal lig.
Prevertebral
(Scalene) fascia
Laterally:
extends as axillary sheaths
10
Carotid sheath
from cranial base to root of neck
• Common and internal carotid artery
• Internal jugular vein
• Vagus nerve
•
•
Carotid sinus nerve
Sympathetic nerve fibers (periarterial plexus)
 Carotid sheath and pretracheal fascia communicate freely with the mediastinum inferiorly
Retropharyngeal space *
skull base ‐‐‐ superior mediastinum
(movement of esophagus, larynx during swallowing)
Buccopharyngeal fascia
alar fascia (post. lamina of pretracheal fascia; cranium to C7)
*
*
Prevertebral fascia
Clinical box: Fascia planes and the spread of infection
Buccopharyngeal fascia
Prevertebral fascia
Esophagus
Infra‐hyoid muscle
Investing layer of deep fascia
Supra‐sternal space
Pretracheal layer of deep fascia
pericardium
Sternocleidomastoid muscle (SCM)
Posterior cervical triangle/Anterior cervical triangle
•Mastoid process
•Superior nuchal line
•Lesser supraclavicular fossa
Action of SCM
• Unilateral contraction
• Bilateral contraction
Sternal head
Motor: CN XI, spinal accessory nerve
Clavicular head
Action of SCM
Unilateral contraction:
‐lateral flexion with rotation
‐ tilts head to same side
Trapezius
1.
2.
3.
4.
Muscle of the back
Act on pectoral girdle
Produce movement of cranium
Motor: CN XI, spinal accessory nerve
Trapezius test
•
Shrug the shoulder
Posterior triangle
(= occipital triangle+ omoclavicular triangle)
Boundary
‐SCM, Trapezius, mid‐clavicle
Roof:
SC
Floor
•Splenius capitis (SC)
•Levator scapulae (LS)
•Posterior scalene
•Middle scalene
•Anterior scalene
LS
PS
MS AS
Posterior triangle
Content of the posterior triangle
‐ cutaneous nerves of the neck
•Branches of cervical plexus: anterior rami, C2,3,4
•Nerve point of neck: midpoint of posterior border of the SCM
•Skin of the neck, sup.-lat. thoracic wall, scalp (auricle- occipital protuberance)
(C2)
(C2,C3, parotid sheath, auricle)
(C2,C3, ant.triangle of the neck)
(C3,C4)
Lesser occipital n.
Greater auricular n.
Occipital triangle
1. Occipital artery at apex
2. Spinal accessory nerve(CN XI)
3. Cutaneous nerves of the cervical plexus
Occipital a.
Spinal accessory n.
Subclavian triangle
(Omoclavicular triangle; supraclavicular fossa)
•
‐
Omohyhoid
‐Anterior belly
‐ Intermediate tendon
‐Posterior belly
•
‐
‐
Boundary:
SCM, Omohyhoid (posterior belly),
Clavicle
Content:
Ext. jugular vein (inferior part)
Subclavian artery (3rd part; deep)
‐Brachial plexus (supraclavicular part)
‐Subclavian artery (3rd part)
‐thyrocervical trunk (lateral branches) Transverse cervical a.
Remark: branches of subclavian artery
B
3
2
1
*
Thyrocervical trunk
Common carotid a.
Transverse cervical a.
Suprascapular a.
Anterior scalene muscle
Middle
Anterior
Posterior
• 3rd‐6th transverse processes
• 1st rib, scalene tubercle
• Lift 1st rib in respiration
• Landmark: 1. Subclavian artery, 3 segments
2. Phrenic nerve, on it
3. Brachial plexus: between ant.‐middle scalene ms.
Surface anatomy
Veins in Posterior cervical triangle
1. External jugular vein
‐Angle of mandible  subclavian vein
‐Retromandibular vein + posterior auricular vein
‐drain most scalp and side of face
2.Subclavian vein
‐Join Int. jugular vein brachiocephalic vein
‐Main draining of the upper limb ‐ across SCM and enter the triangle
‐ Parallels the greater auricular nerve
‐ Pierce investing layer
Subclavian vein
Passes anterior to anterior scalene muscle and phrenic nerve; join with IJV
Central Venous Catheterization
Anatomical consideration
Nerves associated with the Posterior triangle
1. CN XI: spinal accessory nerve
2. Brachial plexus (spinal nerves, C5‐T1)
3. Cervical plexus
Spinal accessory nerve (CN XI)
‐ Superior ‐ middle third SCM
‐ Run on levator scapulae
‐ Deep to Trapezius
‐ Supply SCM and Trapezius
Trunk of XI
Injury of spinal accessory nerve
The cervical and Brachial plexi
Each spinal nerve divides into an anterior and posterior ramus.
The anterior rami of C1 to C8, and T1 form 2 plexi in the neck.
anterior ramus
2.Root of brachial plexus (C5‐T1)
Phrenic nerve
‐ Between anterior and middle scalene
‐ Cervicoaxillary canal (1st rib, clavicle, sup. border of scapula)  axilla
Cervicoaxillary canal 2
3. Roots of cervical plexus
Cervical nerves
• C1‐C4 spinal nerves: supply the neck region
• Posterior ramus (C1‐3): posterior neck and scalp
• Anterior ramus (C1‐4): cervical plexus
Suboccipital n. (C1)
Greater occipital n. (C2)
Cervical plexus
Anterior rami of , C1,2,3 and most C4, spinal nerve
• Series of nerve loops , branches from the loops
• Ascending and descending branches (except C1 )
1.
2.
3.
4.
Branches to the skin
Nerve to diaphragm (phrenic nerve)
Nerves to strap muscles of anterior triangle
Nerves to muscles of floors at posterior triangle
Cervical plexus: branches to the skin
Appear at nerve point
G. Auricular n. (C2,3): ear lobe
L. Occipital n. (C2): parallel SCM
T. Cervical n. (C2,3): anterior triangle of the neck
• Supraclavicular nerves (C3,4) : medial, intermediate and lateral
•
•
•
•
Lesser occipital n.
Greater auricular n.
Transverse cervical n.
Supraclavicular n.
Nerve to diaphragm : Phrenic nerve
•Chiefly C4 (C3~C5)
•Motor, sensory, and sympathetic
•Lies on: anterior scalene muscle
•Descend obliquely with internal jugular vein
Phrenic n.
C3 spinal nerve
Anterior scalene muscle
Phrenic nerve
C5 spinal nerve
Nerves to strap muscles of anterior triangle: Ansa Cervicalis (hypoglossi)
Superior root
‐C1 and C2
‐Briefly join hypoglossal nerve (CN XII)
‐Pass superficial to the external carotid artery
Sup.root
Inf.root
Inferior root
‐C2 and C3
gh: branch to geniohyoid
th: branch to thyrohyoid
St: sternothyroid
Sh: sternohyoid
Oh: omohyoid
Ansa cervicalis : Supply 3 of 4 infrahyoid muscles
Hypoglossal nerve
Thyrohyoid muscle
‐Receives C1 fiber
‐Independently descend from
hypoglossal nerve
Thyrohyoid muscle
Sternohyoid muscle
Sternothyoid muscle
Omohyoid muscle
38
Motor innervation of the anterolateral neck
Gilroy, Atlas of Anatomy