Download The Neck [9-29

The Neck
Bones, Ligaments, and Joints:
Bones:
-
-
Typical Cervical Vertebrae: small bodies, transverse foramen, bifid spinous process, groove for
spinal nerve on transverse process
Atlas, C1: anterior arch with tubercle and facet for dens, posterior arch with tubercle and sulcus
for vertebral artery, lateral mass (with superior and inferior articular processes), transverse
foramen
Axis, C2: dens (odontoid process), transverse foramen
Hyoid Bone: at the level of C3, does not articulate with any other bone. It attaches to the floor
of the oral cavity (superiorly), the larynx (inferiorly), and the pharynx (posteriorly)
Joints:
-
Atlanto-occipital Joints: between occipital bone and atlas, allows head to nod
Atlanto-axial Joints: between atlas and axis, allows rotation of head
Zygapophyseal joints: between superior and inferior articular processes, form posterior part of
intervertebral foramen wall
Ligaments:
-
Nuchal Ligament: prevents excessive flexion of head/neck, attaches to back of occipital bone
and runs along spinous processes, eventually becoming the supraspinous ligament
Alar Ligaments: prevent excessive rotation of head and atlas relative to the axis, attaches dens
to medial surfaces of occipital condyles
Transverse Ligament: holds dens in position, attaches posterior dens to medial surfaces of
lateral masses of atlas
Apical Ligament of Dens: attaches dens to foramen magnum
Cruciform Ligament: connects foramen magnum, atlas, and axis
Fascia of the Neck: Involved in spread of infection.
Fascia
Superficial
Location
From superficial fascia of thorax to
the mandible
Investing
Surrounds all structures of the neck
Prevertebral
Surrounds vertebral column and
deep muscles of back
Contents
Platysma
Trapezius, SCM, all of neck
Pierced by external and anterior jugular veins,
and lesser occipital, great auricular,
transverse cervical, and supraclavicular
nerves
Cervical vertebrae, scalene muscles, deep
muscles of back. Extends to form axillary
sheath.
Pretracheal
Carotid Sheaths
Anterior neck, surrounds viscera
Surround the 2 neurovascular
bundles on either side of anterior
neck
Trachea, esophagus, thyroid
Common carotid artery, internal carotid
artery, internal jugular vein, and the vagus
nerve
Muscles of the Neck:
Muscle
Platysma
Sternocleidomastoid
Trapezius
Attachments
Superficial fascia of
upper thorax and fascia
of mandible
Manubrium and medial
clavicle to mastoid
process and lateral
superior Nuchal line
Superior Nuchal line,
external occipital
protuberance,
ligamentum nuchae,
Innervation
Action
Facial nerve [VII]
“scary face”
Accessory nerve [XI]
and C2-C3
(proprioception)
Lateral flex to same
side, rotate to opposite
side, and flex head
(bilat.)
Rotate scapula, elevate,
adduct, and depress
scapula
Accessory nerve [XI]
and C3-C4
(proprioception)
Splenius Capitis
Levator Scapulae
Anterior Scalenes
Middle Scalenes
Posterior Scalenes
Omohyoid
Sternothyroid
Sternohyoid
Thyrohyoid
Stylohyoid
Mylohyoid
Geniohyoid
spinous processes C7T12 to clavicle,
acromion, and spine of
scapula
Ligamentum nuchae,
spinous processes C7T4 to mastoid process,
skull below lateral
superior nuchal line
Transverse process of
C1-C4 to upper part of
medial border of
scapula
Transverse processes of
C3-C6 to scalene
tubercle and rib 1
Transverse processes of
C2-C7 to rib 1
Transverse processes of
C4-C6 to rib 2
Superior border of
scapula medial to
suprascapular notch to
body of hyoid lateral to
sternohyoid
Posterior manubrium to
oblique line on lamina
of thyroid cartilage
Posterior
sternoclavicular joint
and adjacent
manubrium to body of
hyoid medial to
omohyoid attachment
Oblique line on lamina
of thyroid cartilage to
greater horn and
adjacent body of hyoid
Styloid process to
lateral hyoid body
Posterior rami of middle
cervical nerves
Extend head, draw and
rotate head to same
side (unilaterally)
C3, C4, and dorsal
scapular nerve (C4, C5)
Elevate scapula
Anterior rami of C4-C7
Elevate rib 1
Anterior rami of C3 to
C7
Anterior rami of C5 to
C7
Elevate rib 1
Anterior rami of C1 to
C3 through the ansa
cervicalis
Depresses and fixes
hyoid bone
Anterior rami of C1 to
C3 through the ansa
cervicalis
Draws larynx (thyroid
cartilage) downward
Anterior rami of C1 to
C3 through the ansa
cervicalis
Depresses hyoid after
swallowing
Anterior rami fibers of
C1 (carried along [XII])
Facial Nerve [VII]
Elevate rib 2
Depresses hyoid bone,
raises larynx when
hyoid is fixed
Pulls hyoid upward
posterosuperiorly
Mylohyoid line on
mandible to body of
hyoid
Anterior: mylohyoid
nerve from inferior
alveolar branch of
mandibular nerve [V3]
Support and elevate
floor of mouth, elevate
hyoid bone
Inferior mental spine on
inner mandible to
Branch from anterior
ramus of C1 (carried
Fixed mandible elevates
and pulls hyoid forward;
Digastric
Rectus Capitis Anterior
Rectus Capitis Lateralis
Longus Colli
Longus Capitis
anterior body of hyoid
along [XII])
Anterior: digastric fossa
on lower inside of
mandible to shared
tendon on hyoid body
Posterior: medial
mastoid process to
shared tendon
Atlas to basilar part of
occipital bone
Atlas to jugular process
of occipital bone
Transverse processes of
C3-C5, bodies of C5-C7
and T1-T2 to atlas,
transverse processes of
C5 and C6, and bodies
of C2-C4
Transverse processes of
C3-C6 to basilar part of
occipital bone
Anterior: mylohyoid
nerve from inferior
alveolar branch of
mandibular nerve [V3]
Posterior: Facial Nerve
[VII]
Anterior rami of C1, C2
Anterior rami of C1, C2
Anterior rami of C2 to
C6
Anterior rami of C1 to
C3
fixed hyoid pulls
mandible downward
and inward
Anterior: opens mouth
by lowering mandible,
raises hyoid
Posterior: pulls hyoid
upward and back
Flex Atlanto-occipital
joint
Lateral flexion to same
side
Flex neck anteriorly and
laterally, slight rotation
to opposite side
Flex head
Triangles of the Neck:
Triangle
Anterior
Triangle
Submandibular
Submental
Muscular
Borders
Anterior border of
SCM (laterally),
inferior border of
mandible
(superiorly), and
midline of the neck
(medially)
Inferior border of
mandible, anterior
and posterior
digastric bellies
Hyoid, anterior
digastric belly, and
midline
Hyoid bone, superior
omohyoid belly,
anterior border of
Vessels and Nerves
Common carotid arteries and their
branches: the external and internal
carotids
Internal jugular vein and its
tributaries
Cranial Nerves [VII], [IX], [X], [XI], and
[XII], Transverse Cervical Nerve (from
cervical plexus), and upper and lower
roots of the ansa cervicalis
[XII], mylohyoid nerve, facial artery
and vein
Tributaries to anterior jugular vein
Other Contents
Thyroid and
parathyroid glands,
cricoid cartilage,
esophagus, trachea
Suprahyoid muscles,
submandibular gland,
submandibular lymph
nodes
Suprahyoid muscles,
submental lymph
nodes
Infrahyoid muscles,
thyroid and
parathyroid glands,
SCM, and midline
Carotid
Posterior
Triangle
Subclavian
Superior omohyoid
belly , stylohyoid,
posterior digastric
belly, and anterior
border of SCM
SCM (anteriorly),
trapezius
(posteriorly), middle
1/3 clavicle (basally),
occipital bone
(apically)
SCM, omohyoid,
clavicle
Major Arteries of the Neck:
pharynx
Tributaries to common facial vein,
cervical branch of [VII], common
carotid artery, external and internal
carotid arteries, superior thyroid a.,
ascending pharyngeal a., facial and
lingual aa., occipital a., internal
jugular vein, [X], [XI], [XII], superior
and inferior roots of ansa cervicalis,
and transverse cervical nerve
External jugular vein, posterior
external jugular vein, subclavian
artery and vein, transverse cervical
artery, suprascapular artery, [XI],
branches of cervical plexus, brachial
plexus
Subclavian branches, phrenic nerve
Inferior belly of
omohyoid
Anterior scalene
-
Subclavian: 3 parts
o 1st Part: ascends to medial border of anterior scalene, gives off vertebral artery (enters
transverse foramen of C6), thyrocervical trunk (gives rise to inferior thyroid, transverse
cervical, and suprascapular arteries), internal thoracic artery, left costocervical trunk
o 2nd Part: passes between anterior and middle scalene muscles, gives off right
costocervical trunk (gives rise to deep cervical and supreme intercostal arteries)
o 3rd Part: emerges from lateral border of anterior scalene and crosses base of posterior
triangle to rib 1, becoming the axillary artery, gives off dorsal scapular artery
-
Common Carotid: the right one originates from brachiocephalic trunk while the left originates
from the aortic arch, both pass through carotid sheaths to give off 2 terminal branches: internal
and external carotid arteries. The carotid sinus (dilation at bifurcation) contains blood pressure
receptors ([IX]). The carotid body contains oxygen receptors ([IX] and [X]).
-
Internal Carotid: ascends toward base of skull giving no branches in neck, and enters the carotid
canal in the petrous part of the temporal bone. It supplies the cerebral hemispheres, eyes and
contents of the orbits, and the forehead.
External Carotid: branches include (SomeAngryLadyFiguredOutPMS)
o Superior Thyroid: thyrohyoid muscle, internal larynx, SCM and cricothyroid muscles,
thyroid gland
o Ascending Pharyngeal: pharyngeal constrictors and stylopharyngeus muscle, palate,
tonsil, pharyngotympanic tube, meninges in posterior cranial fossa
o Lingual: muscles of tongue, palatine tonsil, soft palate, epiglottis, floor of mouth,
sublingual gland
o Facial: all face strictures from inferior border of mandible to the masseter muscle to the
medial corner of the eye, soft palate, palatine tonsil, pharyngotympanic tube,
submandibular gland
o Occipital: SCM muscle, meninges in posterior cranial fossa, mastoid cells, deep muscles
of back, posterior scalp
o Posterior Auricular: parotid gland and nearby muscles, external ear and scalp posterior
to ear, middle and inner ear structures
o Superficial Temporal: parotid gland and duct, masseter muscle, lateral face, anterior
external ear, temporalis muscle, parietal and temporal fossae
o Maxillary: external acoustic meatus, lateral and medial tympanic membrane, TMJ, dura
mater of lateral wall of skull and inner table of cranial bones, trigeminal ganglion and
dura in vicinity, mylohyoid muscle, mandibular teeth, skin on chin, temporalis muscle,
outer table of skull bones in temporal fossa, infratemporal fossa structures, maxillary
sinus, upper teeth and gingival, infra-orbital skin, palate, roof of pharynx, nasal cavity
-
Major Veins of the Neck:
Superficial and Deep Drainage: all returns to the jugular system to enter subclavian veins
-
-
External Jugular Vein: passes within superficial fascia and is superficial to SCM, formed by:
o Posterior external jugular vein
o Transverse cervical vein
o Suprascapular vein
o Posterior auricular vein
o Retromandibular vein (posterior division) : formed in parotid gland by
 superficial temporal vein
 maxillary vein
Anterior Jugular: connect to form jugular venous arch before entering subclavian veins
Internal Jugular Vein: Begins as a dilated continuation of the sigmoid sinus (dural venous sinus)
and receives blood from the inferior petrosal sinus. It leaves the jugular foramen of the skull and
descends in the carotid sheath, joining with the subclavian veins to form the brachiocephalic
veins. Its tributaries include:
o Inferior Petrosal Sinus
o Facial
o
o
o
o
o
Lingual
Pharyngeal
Occipital
Superior Thyroid
Middle Thyroid
Nerves in the Anterior Triangle of the Neck:
-
[VII] Facial: from stylomastoid foramen, innervates posterior belly of digastric, stylohyoid, and
platysma
[IX] Glossopharyngeal: from jugular foramen, innervates stylopharyngeus, carotid sinus, and
sensory for pharynx
[X] Vagus: from jugular foramen, enters carotid sheath, innervates pharynx (motor), carotid
body, superior laryngeal nerve
[XI] Accessory: from jugular foramen, no branches in anterior triangle
[XII] Hypoglossal: from hypoglossal canal, supplies tongue, no branches in anterior triangle
Transverse Cervical nerve: branch of cervical plexus from C2 and C3 anterior rami, loops around
SCM and supplies cutaneous area of anterior triangle
Ansa Cervicalis: loop of fibers from C1-C3 that innervate the “strap muscles” (infrahyoids). It
begins as branches from C1 join [XII]. C1 makes up superior root while C2 and C3 make up the
inferior root.
Nerves in the Posterior Triangle of the Neck:
-
-
[XI] Accessory: from jugular foramen, innervates the trapezium and the SCM.
Cervical Plexus: Anterior rami of C2-C4 with muscular and cutaneous branches. The muscular
branches include the phrenic nerve, the ansa cervicalis, and innervations to prevertebral and
lateral vertebral muscles. Cutaneous branches include:
o Transverse cervical nerve: lateral and anterior neck
o Lesser occipital nerve: neck and scalp posterior to the ear
o Great auricular nerve: skin of parotid area, ear, and mastoid process
o Supraclavicular nerves: skin of clavicle and shoulder down to rib 2
Brachial Plexus: C5-T1
Sympathetic Trunk:
-
Cervical part of sympathetic trunk lies anterior to longus colli and capitis muscles and posterior
to common carotid artery and is connected to each cervical nerve by a gray ramus
communicans. Three ganglia are associated with the cervical aspect of the sympathetic trunk:
o Superior Cervical Ganglion: located between C1 and C2 vertebrae, its branches go to
internal and external carotid arteries, C1-C4, pharynx, and to the heart as superior
cardiac nerves
o Middle Cervical Ganglion: located at vertebra C6, its branches go to C5-C6 and to the
heart as middle cardiac nerves
o Inferior Cervical Ganglion (Stellate Ganglion): located at vertebra C7, its branches go to
C7-T1, vertebral artery, and to the heart as inferior cardiac nerves
Lymphatics of the Neck:
-
-
Thoracic Duct: empties into the junction of the left internal jugular and left subclavian veins. It is
joined by the left jugular trunk, left subclavian trunk, and the left bronchomediastinal trunk
On the right the right jugular trunk, right subclavian trunk, and the right bronchomediastinal
trunk empty into the junction of the right internal jugular and right subclavian veins
Superficial Lymph Nodes: drain face and scalp, follow patterns of arterial system in this area
o Occipital Nodes: associated with occipital artery, drain posterior scalp and neck
o Mastoid Nodes: associated with posterior auricular artery, drain posterolateral scalp
o Pre-auricular and Parotid Nodes: associated with superficial temporal and transverse
facial arteries, drain anterior auricle, Anterolateral scalp, upper half of face, the eyelids,
and the cheeks
o Submandibular Nodes: associated with facial artery, drain forehead, gingivae, teeth, and
tongue
o Submental Nodes: drain center part of lower lip, chin, floor of mouth, tip of tongue, and
lower incisor teeth
Superficial Cervical Lymph Nodes: located along external jugular vein on the surface of the SCM,
drain occipital and mastoid nodes
Deep Cervical Lymph Nodes: located along internal jugular vein, divided into upper and lower
groups based on the intermediate tendon of the omohyoid muscle, receive all lymph drainage
from the head and nearby lymph vessels form the jugular trunks
o Jugulodigastric Node: drains tonsils
o Jugulo-omohyoid Node: drains tongue
Thyroid and Parathyroid Glands:
-
-
Thyroid: anterior in the neck and lateral to thyroid cartilage, made up of 2 lateral lobes, 2
pyramidal lobes that touch the hyoid, and a central isthmus (2nd and 3rd tracheal cartilages),
surrounded by pretracheal fascia.
o Supplied by the superior thyroid artery (external carotid) which divides into anterior and
posterior glandular branches and the inferior thyroid artery (thyrocervical trunk) which
divides into inferior and ascending branches.
o Drained by the superior thyroid vein (internal jugular), middle thyroid vein (internal
jugular), and inferior thyroid vein (brachiocephalic)
o Lymph drains to paratracheal and deep cervical nodes
o The recurrent laryngeal nerves run closely along the posterolateral aspects of the
thyroid gland
Parathyroid: 4 small, ovoid glands located on the posterior surface of the lateral lobes of the
thyroid gland, designated as superior and inferior.
o Supplied by inferior thyroid arteries and the venous and lymphatic drainage follows that
of the thyroid gland