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Region 11: Pectoral Region Cutaneous Vessels --Cephalic vein *From: lateral dorsal venous network up lateral border of wrist and anterolateral surface of forearm and arm, enters deltopectoral triangle and joins into terminal part of axillary vein Cutaneous Peripheral Nerves --Supraclavicular nerves (C3, C4) *Supplies: skin over clavicle and superolateral aspect of pectoralis major --Anterior Perforating branches *From: intercostal nerves *Supplies: anterior skin of thorax --Lateral Perforating branches *From: intercostal nerves *Supplies: lateral skin of thorax Deep Fascia --Pectoral Fascia *Surrounds: pectoralis major *Continuous with: fascia of anterior abdominal wall and at lateral border of pectoralis major becomes axillary fascia --Clavipectoral Fascia (deep to pectoral fascia and pec. major) *Surrounds: subclavius and pectoralis minor *Continuous with axillary fascia *Costocoracoid Membrane: attaches pectoralis minor and subclavius --Costocoracoid Ligament: slightly thickening of deep fascia just below the subclavius muscle *Suspensory ligament of axilla: inferior to pec. minor, supports axillary fascia and pulls it and skin inferior to upward to form axillary fossa Deltopectoral Triangle --Boundaries: clavicular head of pectoralis major (inferior), deltoid (lateral), clavicle (medial) --Contents: cephalic vein, deltoid branch of thoracoacromial trunk Movement of Rib Cage During Inspiration --Bucket Handle: middle parts of lower ribs romve laterally to elevate --Water Pump: manubrium shifts anterior, increasing A-P diameter Breast --Superficial fascia/subcutaneous fat: defines contour and volume --Areolar/nipple: T4 dermatome --Retromammary space: between breast and deep pectoral fascia --Suspensory/Cooper’s Ligaments: connect mammary gland to dermis of overlying skin and supports the mammary gland lobules *Lobules: 15-20, each drained by a lactiferous duct with a dilated portion (lactiferous sinus) deep to the areolar --Arterial Supply *Medial mammary aa. from interal thoracic/intercostal aa. *Lateral mammary from lateral thoracic a. --Nerve Supply *4th through 6th intercostal nerve (VPR T4-T6) Muscles of the Superficial Fascia of the Pectoral Region: platysma Platysma O Inferior border of mandible, skin, and subcutaneous tissues of lower face I Fascia covering superior parts of pectoralis major and deltoid muscles Inn. Cervical branch of facial nerve (CN VII) Draws corners of mouth inferiorly and widens it as in expressions of sadness and Act. fright; draws skin superiorly when teeth are clenched BS Facial artery Anterior Axioappendicular (Pectoral) Muscles: pectoralis major, pectoralis mino, subclavius, serratus anterior Pectoralis Major Clavicular head: anterior surface of medial half of clavicle O Sternocostal head: anterior surface of sternum, superior six costal cartilages, aponeurosis of external oblique muscle I Lateral lip of intertubercular groove of humberus Lateral and medial pectoral nerves; clavicular head (C5, C6), sternocostal head Inn. (C7, C8, T1) ADDucts, and medial rotates humerus; draws scapula anteriorly and Act. inferiorly Acting Alone: clavicular head flexes humerus and sternocostal head extends it from the flexed position Pectoral branches of thoracoacromial trunk, perforating branches of anterior BS intercostal arteries Pectoralis Minor 3rd-5th ribs near their costal cartilages Medial border and superior surface of coracoid process of scapula Medial pectoral nerve (C8, T1) (pierces through it to go to major) Stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall Pectoral branches of thoracoacromial trunk, perforating branches of anterior BS intercostal arteries Not Brachial plexus and axillar vessels pass POSTERIOR O I Inn. Act. Subclavius Junction of 1st rib and its costal cartilage Inferior surface of middle third of clavicle n. to subclavius Anchors and dpresses clavicle BS Clavicular branches of thoracoacromial trunk O I Inn. Act. Serratus Anterior (Boxer’s Muscle) External surfaces of lateral parts of 1st-8th ribs (interdigitation with external oblique muscle) I Anterior surface of medial border of scapula Inn. Long thoracic nerve (C5, C6, C7) Act. Protracts scapula and holds it against thoracic wall; rotates scapula BS Lateral thoracic artery O Nerve Supplies of Region 11 --Lateral Pectoral n. *From: side branch of lateral cord (C5, C6, C7) --Medial Pectoral n. *From: side branch of medial cord (C8, T1) --N. to subclavius *From: superior trunk (C5, C6) --Long thoracic n. *From: posterior aspect of anterior rami of C5, C6, C7 --Intercostal nn. *From: VPR of T1-T11 --Subcostal n. *From: VPR of T12 --CN VII: cervical branch of facial nerve Blood Supplies of Region 11 --Facial artery *From: external carotid artery --Perforating anterior intercostal aa. *From: internal thoracic arteries (intercostal spaces 1-6) and musculophrenic arteries (intercostal spaces 7-9) (Internal thoracic from 1st part of subclavian) --Pectoral branches of thoracoacromial trunk *From: Thoracoacromial trunk (From 2nd part of axillary artery//first branch) --Clavicular branches of thoracoacromial trunk *From: Thoracoacromial trunk (From: 2nd part of axillary artery//first branch) --Lateral thoracic artery *From: 2nd part of axillary atery//second branch Region 12: Posterior Triangle of the Neck/Lateral Cervical Region Cutaneous Vessels --External Jugular Vein *Begins: near angle of mandible (inf. to ear) by union of retromandibular vein with posterior auricular vein *Ends: subclavian vein Cutaneous Peripheral Nerves (from cervical plexus) --Lesser Occipital Nerve *From: spinal nerves C2 and C3 via cervical plexus *To: comes out behind SCM, runs post. border to behind ear --Great Auricular Nerve *From: spinal nerves C2 and C3 via cervical plexus *To: skin over angle of mandible and inferior lob of ear, parotid sheath (crosses over SCM en route to ear lobe) --Transverse Cervical Nerve *From: C2 and C3 *To: skin covering anterior cervical region/anterior triangle --Supraclavicular Nerves (Medial, intermediate, lateral) *From: C3, C4 *Supplies: skin over clavicle and superolateral aspect of pectoralis major Deep fascia --Investing layer of deep cervical fascia *deep to skin around entire neck *Surrounds trapezius, and sternocleidomastoid, Posterior Triangle --Boundaries: SCM (anterior), Trapezius (posterior), Clavicle (inferior) --Subdivisions: Occipital triangle (SCM, trapezius, inferior belly of omohyoid) Omoclavicular/Subclavian triangle (SCM, clavical, inf. belly of omohyoid) --Roof: skin, subcutaneous fascia, investing layer of deep cervical fascia --Floor: prevertebral fascia overlying splenius capitis, levator scapulae, middle scalene, posterior scalene, sometimes anterior scalene --Contents: *Occipital Triangle: external jugular vein, posterior branches of cervical plexus of nerves; spinal accessory nerve, trunks of brachial plexus, transverse cervical artery, cervical lymph nodes *Omoclavicular Triangle: subclavian artery (third part), subclavian vein, suprascapular artery, supraclavicular lymph nodes --Communicates with axilla via cervicoaxillary canal Muscles of the Superficial Fascia of the pectoral region: platysma Platysma O Inferior border of mandible, skin, and subcutaneous tissues of lower face I Fascia covering superior parts of pectoralis major and deltoid muscles Inn. Cervical branch of facial nerve (CN VII) Draws corners of mouth inferiorly and widens it as in expressions of sadness and Act. fright; draws skin superiorly when teeth are clenched BS Facial artery Not In investing layer of cervical fascia Muscle that divides the neck into anterior and posterior triangles: Sternocleidomastoid Sternocleidomastoid Lateral surface of mastoid process of temporal bone and lateral half of superior nuchal line Sternal head: anterior surface of manubrium of sternum I Clavicular head: superior surface of medial third of clavicle Inn. Spinal accessory nerve (CN XI; motor), C2, C3 nerves (proprioception and pain) O Unilateral: tilts head to same side and rotates it so face is turned superiorly toward opposite side Bilateral: Extends neck at atlanto-occipital joints C1/C2 Flexes the cervical vertebrae Act. Protrusion of the head Fixed cervical vertebrae: elevate manubrium and medial end of clavicles, assisting pump-handle action of deep respiration BS Occipital artery Muscles of floor of posterior triangle: splenius capitis, levator scapulae, posterior scalene, middle scalene, anterior scalene (sometimes) Anterior Scalene O Anterior tubercles of transverse processes of C3-C6 vertebrae st I 1 rib Inn. Cervical spinal nerves C4-C6 Act. Flexes head BS Ascending cervical branch of inferior thyroid artery Suprascapular and transverse cervical aa. pass ANTERIOR Not Subclavian a. and brachial plexus passes between anterior and middle scalene Subclavian v. passes ANTERIOR to anterior scalene Middle Scalene O I Inn. Act. BS Not Posterior tubercles of transverse processes of C2-C7 vertebrae Superior surface of first rib; posterior groove for subclavian artery Anterior rami of cervical spinal nerves Flexes neck laterally; elevates 1st rib during forced inspiration Ascending cervical branch of inferior thyroid artery Dorsal scapular n. and long thoracic n. passes through the muscle Posterior Scalene O I Inn. Act. BS Posterior tubercles of Transverses processes of C4-C6 vertebrae External order of 2nd rib Anterior rami of cervical spinal nerves C7 and C8 Flexes neck laterally; elevates 2nd rib during forced inspiration Ascending cervical branch of inferior thyroid artery Blood Supply of Region 12 --Facial artery *From: external carotid artery --Occipital Artery *From: external carotid artery --Ascending cervical branch of inferior thyroid artery *From: thyrocervical trunk (from subclavian artery) --Subclavian Artery: Parts named based on relationship to anterior scalene *1st part: medial to scalene *2nd part: posterior to scalene *3rd part: lateral to scalene *Becomes axillary artery at lateral border/inferior border of first rib