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By Dr. Adel Sahib Al-Mayaly سنة مباركة عليكم وندعو هللا ان تكون سنة خير وامن وامان على بلدنا واهلنا انه سميع الدعاء It emerges from the base of skull via the jugular foramen. It lies behind the ICA at the base of skull It receives the inferior petrosal vein. It descends lateral to the ICA & CCA then anterolateral to the carotid artery during its descent in the neck . At the root of neck; it joins the subclavian vein to form the brachiocephalic vein . It leaves the cranial cavity through the jugular foramen with cranial root of accessory n. In the foramen the nerve is swollen to form the superior ganglion. A short distance below the foramen it bears the larger inferior ganglion. Superior ganglion:- carries the cutaneous neurons which travel through the auricular nerve (Arnold nerve). Inferior ganglion:- contains the taste & visceral sensory neurons. Below the inferior ganglion; is joined by cranial root of accessory n. Vagus n. descends vertically down within the carotid sheath first between ICA & IJV then between the IJV & CCA. In the root of neck; •The right vagus nerve passes anterior to the subclavian artery and posterior to the sternoclavicular joint, entering the thorax. •The left vagus nerve passes inferiorly between the left common carotid and left subclavian arteries, posterior to the sternoclavicular joint, entering the thorax. 1- superior ganglion:A- meningeal branch:- to dura of post. Cranial cavity. B- auricular branch:- cutaneous n. To external auditory canal 2- inferior ganglion:A- pharyngeal branch:- it joins the pharyngeal branch of GPN to form the pharyngeal plexus. Pharyngeal plexus:- motor fibres from the cranial root of accessory nerve to the muscles of pharynx & soft palate. 2- superior laryngeal nerve:It descends on the side of pharynx deep to ICA It divides 1-Internal laryngeal nerve:- it pierces the thyrohyoid membrane to supply mucosa of larynx above vocal cords. 2-External laryngeal nerve:- motor to inferior constrictor & cricothyroid m. +3- Minute branches to the carotid body. 4- Recurrent laryngeal nerve:Right side:- neck by hooking around R subclavian a. It ascends in the neck in the groove between the trachea & esophagus. Left side:- stems from the vagus in front of arch of aorta It ascends in the neck to reach side of trachea Upon reaching the lower pole of thyroid lobe the n. Is closely related to the inferior thyroid artery. The n. usually passes behind but infrequently between or in front the recurrent laryngeal nerve. Superior & Inferior cardiac branches:- they supply the parasympathetic of the heart They join CARDIAC PLEXUS. They convey parasympathetic fibres to the heart. 12345- Mylohyoid muscle Hyoglossus muscle Genniohyoid muscle Digastric muscle Stylohyoid muscle. Roof:- investing layer. Floor:- Infrahyoid muscle. Superior;-superior belly of omohyoid muscle. Inferior;- anterior border of SCM Anterior;- midline of neck. 1234- superior belly of omohyoid. sternohyoid muscle. thyrohyoid muscle. sternothyroid muscle. They are supplied by ansa cervicalis nerve except thyrohyoid which supplied by C1via hypoglossal n. Muscle Origin Insertion Innervation sternohyoid Posterior surface of manubrium muscle sterni Medial part of lower border of hyoid bone Ansa cervicalis Sternothyroid Posterior surface of manubrium sterni Oblique line of thyroid cartilage Ansa cervicalis Thyrohyoid Oblique line of thyroid cartilage Lower border of the body and the greater cornu of the hyoid bone Cervical spinal nerve 1 via the hypoglossal nerve Omohyoid (superior belly) Intermediate tendon Hyoid bone Superior root of ansa cervicalis (C1) Omohyoid (inferior belly Superior border of scapula Intermediate tendon Ansa cervicalis (C1-C3) Muscle Digastric (anterior belly) Digastric ( posterior belly) Origin Insertion Digastric Intermediate fossa of Tendon Mandible Innervation Mylohyoid nerve branch of CN V3 (Mandibular division of Trigeminal nerve • • • • 4 muscles 1- sternohyoid muscle. 2- omohyoid muscle. 3- sternothyroid muscle. 4- thyrohyoid muscle.