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Boundaries Landmarks Regions Neck Landmarks Neck Landmarks Organ Projections Subcutaneous Layer

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Boundaries Landmarks Regions Neck Landmarks Neck Landmarks Organ Projections Subcutaneous Layer NECK. REGIONAL ANATOMY Neck Boundaries Landmarks Regions Neck Landmarks Neck Landmarks Organ projections Subcutaneous layer Platysma V. jugularis anterior V. jugularis externa • retro mandibular vein posterior division • posterior auricular vein. Pl. cervicalis n. occipitalis minor n. auricularis magnus n. transversus colli nn. supraclaviculares Cervical plexus Cutaneous (4 branches) . Great auricular nerve (C2,C3)- skin near auricle, external acoustic meatus . Transverse cervical nerve (C2,C3)- anterior region of neck . Lesser occipital (C2)- skin and scalp posterosuperior to the auricle . Supraclavicular nerves (C3,C4)- skin above and below the clavicle Muscular . Ansa cervicalis (C1-C3) geniohyoid (C1), thyrohyoid (C1), sternothyroid, sternohyoid, omohyoid) . Phrenic (C3-C5 (primarily C4))- diaphragm and the pericardium . Segmental branches (C1-C4)- anterior and middle scalenes Two branches from the posterior roots of spinal nerves: . Preauricular nerve (from the posterior roots of C2–C3) . Postauricular nerve (from the posterior roots of C3–C4) Neck fascia Lamina superficialis - Covers entire neck - Fascia masseterica - Fascia parotidea - Fascia gl. submandibularis Lamina pretrachealis - Between os hyoideum, strenum & clavicula, and m. omohyoideus - Linea alba - from os hyoideum to isthmus tracheae - Spatium interaponeuroticum suprasternale - Arcus venosus juguli - Recessus Gruberi - behind m. sternocleidomastoideus Lamina prevertebralis - Skull base - bodies Т3-Т4 (fascia endothoracica) - Fascia mm. longi capitis et cervicis - Fascia mm. scaleni, m. levator scapulae - Spatium prevertebrale – extends to proc. transversi Fascia endocervicalis - Lamina visceralis – covers neck organs - Lamina parietalis – apart from the visceral - Vagina carotica - from lamina parietalis - Spatium pretracheale - between the two layers - Extends to mediastinum superius - Spatium retropharyngeum - between fascia endocervicalis & lamina prevertebralis - Extends to mediastinum posterius Regions of the neck Trigonum anterior Tr. submentale Tr. submandibulare Tr. musculo-viscerale Tr. caroticum Trigonum posterior Tr. omotrapezoideum Tr. omoclaviculare Posterior triangle Apex: Btwn sternocleidomastoid and trapezius muscles at the superior nuchal line of the occipital bone Anterior: Posterior border of sternocleidomastoid muscle Posterior: Anterior border of the trapezius Base: Middle one third of the clavicle Roof: Investing layer of the deep cervical fascia Divisions Crossed at 2.5 cm above the clavicle by the inferior belly of the omohyoid muscle, which Divides the region into two triangles: – Upper or occipital triangle – Lower or subclavian triangle (or supraclavicular triangle) Contents Nerves Spinal accessory nerve (Cranial Nerve XI) Branches of cervical plexus Roots and trunks of brachial plexus Phrenic nerve (C3,4,5) Vessels Subclavian artery (Third part) Transverse cervical artery Suprascapular artery Terminal part of external jugular vein Contents Lymph Nodes Occipital Supraclavicular Muscles Inferior belly of omohyoid muscle Anterior Scalene Middle Scalene Posterior Scalene Levator Scapulae Muscle Splenius Regio infrahyoidea Boundaries - Os hyoideum, sternum, m. sternocleidomastoideus Content Lamina pretrachealis Muscles а) depresses os hyoideum and larynx in swallowing: - M. sternohyoideus, m. thyrohyoideus, m. sternothyroideus & m. omohyoideus. b) straightens the vocal folds - M. cricothyroideus Regio infrahyoidea Vessels - V. jugularis anterior - Arcus venosus juguli - in the suprasternal space - A.v. thyroidea superior - V. thyroidea inferior Lymph nodes - Prelaryngeal - Pretracheal - Paratracheal Organs а) Endocrine system - Gl. Thyroidea - Gll. Parathyroideae b) Respiratory system - Larynx - C4-C6 - Trachea - C6-Th4 c) Digestive system - Pharynx - basis cranii - C6 - Esophagus - C6 - Th11 Regio infrahyoidea. Larynx, trachea, gl. thyroidea Trigonum submandibulare Boundaries Basis mandibulae M. digastricus – venter anterior et posterior M. mylohyoideus/m.hyoglossus Lamina superficialis Superficial structures M. platysma V. facialis R. coli nervi facialis Trigonum submandibulare Gl. submandibularis – in sheath of lamina superficialis - Posterior process - extends to medial pterygoid muscle - Anterior process – extends to sublingual gland - submandibular duct – on the inner surface - lndd. submandibulares – lateral to the capsule Trigonum submandibulare - A.v. facialis – give off a.v. submentalis - N. mylohyoideus – branch of n. mandibularis - N. hypoglossus - N. lingualis - Gangl. submandibulare - Trigonum Pirogovi – approach to a. lingualis - m. mylohyoideus - tendo m. digastrici - n. hypoglossus Trigonum submandibulare - A.v. facialis – give off a.v. submentalis - N. mylohyoideus – branch of n. mandibularis - N. hypoglossus - N. lingualis - Gangl. submandibulare - Trigonum Pirogovi – approach to a. lingualis - m. mylohyoideus - tendo m. digastrici - n. hypoglossus Trigonum caroticum Trigonum caroticum Boundaries - m. digastricus, venter posterior - m. omohyoideus, venter superior - m. sternocleidomastoideus Trigonum caroticum A. carotis communis – at the upper margin of cart. thyroidea divides into: - A. carotis externa - - a. thyroidea superior, a. lingualis, a. facialis - - a. occipitalis, a. sternocleidomastoidea, a. pharyngea ascendens - A. carotis interna V. jugularis interna Ansa cervicalis (С1-С3) - Radix superior (С1,2) – anterior to a. carotis communis - Radix inferior (С2,3) – lateral to v. jugularis interna Variations in the bifurcation of a. carotis communis Trigonum caroticum - cont. N. vagus – in the groove btw a. carotis comm. & v. jugularis interna - N. laryngeus superior - In the upper part, medial to a. carotis externa et interna - Enters the larynx thru membr. thyrohyoidea with a. laryngea superior N. hypoglossus - beneath venter posterior m. digastrici - Crosses lateral to a. carotis externa et interna - enters trig. submandibulare between vent. post. m. digastrici & m. hyoglossus Plexus cervicalis (С1-С4) – over deep cervical muscles Truncus sympaticus - behind lamina prevertebralis Truncus sympaticus - behind lamina prevertebralis - behind a. carotis communis/interna close to n. vagus - gangl. cervicale superior - over m. longus colli (C2-3) - ganl. cervicale medius – at the levbel of a. thyroidea inferior (C6) - gangl. сervicale inferior (С7 head of І rib) - Innervates upper limb arteries & a. vertebralis - Contact with cupula pleurae, d. thoracicus (on the left side), a. subclavia, a. vertebralis Midline structures • Hyoid bone • Thyrohyoid membrane • Thyroid cartilage • Cricothyroid membrane • Cricoid cartilage • Crico-tracheal ligament • Thyroid gland isthmus • Tracheal rings • Important to identify these important midline structures. Midline structures • Thymus – upper poles • Parathyroid glands (inferior) • Jugular venous arch. • Inferior thyroideae veins (plexus venosus) • Esophagus (pars cervicalis) • Longus coli muscle Midline structures Root of the neck Transitional area btwn neck and thorax. Opens in the superior thoracic inlet. Bounded: First ribs - laterally Manubrium sterni - anteriorly Body of Т1 - posteriorly Topographic structures Spatium antescalenum Spatium interscalenum Trigonum scalenovertebrale Structures at the root of the neck • Brachio cephalic trunk • Subclavian artery and its branches • Subclavian vein • Termination of internal jugular vein • Thoracic duct • Apex of lung • Phrenic nerve • Vagus nerve Contents 1)The arteries: • The brachiocephalic trunk. • Right common carotid. • Right subclavian. • May also give thyroidea ima. Subclavian artery Divided into 3 parts by scalenus anterior muscle. Part 1: Medial to the muscle and gives 3 branches: • Vertebral artery : Enters foramen transversarium at C6 • Thyrocervical trunk : Inferior thyroid artery, transverse cervical artery and suprascapular artery. • Internal thoracic artery. Part 2: Posterior to the muscle and gives 1 branch, – the costocervical trunk which gives – superior intercostal and deep cervical arteries. Part 3: Lateral to the muscle, usually giving one branch (dorsal scapula). It may also occasionally give the suprascapular artery. 2)The veins: • External jugular veins. • Anterior jugular veins: – drain into the external jugular or subclavian vein. – joined by the jugular venous arch, but could unite to form a single trunk in the midline of the neck. These veins have no valves. • The subclavian vein: – A continuation of the axillary vein. – has only one named tributary, the external jugular vein. • The internal jugular vein, in the carotid sheath. – The internal jugular vein and subclavian veins unite to from the brachiocephalic vein. Vagus nerve Btwn common carotid and the internal jugular vein. Branches in the neck: • Meningeal nerve: Recurrent to the dura. • Auricular nerve: – supplies the pinnae and external auditory meatus. • Pharyngeal nerves: Join the pharyngeal plexus. • Superior laryngeal nerve: – Divides into internal laryngeal and external laryngeal. • Recurrent laryngeal nerve • Cardiac branches: Cardiac plexus. Spatium antescalenum Boundaries - Anteriorly - mm. sternocleidomastoideus, sternohyoideus, sternothyroideus - Posteriorly - m. scalenus anterior. Content - angulus venosus juguli - v. jugularis interna - v. subclavia - ductus thoracicus/ductus lymphaticus dexter - a. suprascapularis - a. cervicalis superficialis - n. phrenicus (C3-5) - ndd. lymphaticae, around - v. jugularis interna - a. transversa cervicis Root of neck Spatium antescalenum Spatium antescalenum
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