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