Download Évidements ganglionnaires cervicaux

Head & Neck Surgery Course
Surgical anatomy of the
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neck: muscles
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Dr Pierfrancesco PELLICCIA
Pr Benjamin LALLEMANT
Service ORL et CMF
CHU de Nîmes
CH de Arles
Summary (anterior & lateral view)
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Platysma
Origin
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– fascia overlying the pectoralis
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major and deltoid
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Insertion
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– depression muscles of the corner of the mouth
– the mandible
– the SMAS layer of the face
Platysma
Surgical considerations
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– Increases blood supply to
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skin flaps
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– Absent in the midline of
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– Fibers run in an opposite
direction to the SCM
Sternocleidomastoid Muscle (SCM)
Origin
• Medial 1/3 of the clavicle
• manubrium
Insertion
• mastoid process
Nerve supply
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• spinal accessory nerve (XI)
Blood supply
• occipital a. or direct from ECA
• superior thyroid a.
• transverse cervical a.
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Sternocleidomastoid Muscle (SCM)
Function
– turns head toward opposite
side and tilts head toward
the ipsilateral shoulder
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Surgical considerations
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– Leave overlying fascia
(superficial layer of deep
cervical fascia down)
– Lateral retraction exposes
the submuscular recess
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Trapezius
Origin
– medial 1/3 of the sup. Nuchal
line
– external occipital protuberance
– ligamentum nuchae
– spinous process of C7+T1-T12
Insertion
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• lateral 1/3 of the clavicle
• acromion process
• spine of the scapula
Function
• elevate and rotate the scapula and
stabilize the shoulder
Trapezius
Surgical considerations
– Posterior limit of Level V neck
dissection
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– Denervation results in shoulder
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drop and winged scapula
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Infrahyoid muscles
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Omohyoid
Origin
– upper border of the scapula
Insertion
– hyoid bone lateral to the
sternohyoid muscle
Blood supply
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– Inferior thyroid a.
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Function
– depress the hyoid
– tense the deep cervical fascia
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Omohyoid
Surgical considerations
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– Absent in 10% of individuals
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– Surgical landmark demarcating level III from IV
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– Inferior belly lies superficial to
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• The brachial plexus
• Phrenic nerve
• Transverse cervical vessels
– Superior belly lies superficial to
• IJV
Suprahyoid muscles
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Suprahyioid muscles and extrinsic tongue
muscles in Level I
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Digastric
Origin
– digastric fossa of the mandible (at
the symphyseal border)
Insertion
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– hyoid bone via the intermediate
tendon
– mastoid process
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Function
– elevate the hyoid bone
– depress the mandible (assists lateral
pterygoid)
Digastric
Surgical considerations
– Posterior belly is superficial to:
• ECA
• ICA
• IJV
• Hypoglossal & spinal nerves
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– Anterior belly
• Landmark for identification of
mylohyoid for dissection of level Ib
Muscles of the floor of posterior
triangle of the neck
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Muscles of the floor of posterior
triangle of the neck
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1: SCM
4: splenius cervicis
5: levator scapulae
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1: splenius capitis
2: splenius cervicis (SCM resected)