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What can the neck be thought of as?
- a strut for the head
- a conduit for nerves, respiratory and dgestive organs
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Which endocrine organs reside in the neck?
- thyroid
- parathyroid glands
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What connects the back of the face into the neck?
pharynx
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What is the airway called?
trachea
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Where is the trachea found?
anterior in the inferior neck
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What is the part of the GI tract found in the neck?
esophagus
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Where is the esophagus located?
posteriorly below the larynx
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What is the larynx?
the organ that separates respiratory from gustatory
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Where is the posterior triangle?
lies in front of trapezius and posterior to sternomastoid muscle
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What forms the base of the posterior triangle?
clavicle inferiorly
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What does the inferior portion of the posterior triangle supply?
transition from neck to upper extremity so that nerves and arteries stream distally to limb under protection of clavicle
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Where is the anterior triangle of the neck?
from midline of neck to anterior border of sternocleidomastoid muscle
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What is the superior limit of the anterior triangle?
body of mandible
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What is the inferior limit of the anterior triangle?
suprasternal notch of manubrium of the sternum
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How are subtriangles named?
based on what structures reside in each subdivision
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Wht does the carotid triangle contain?
branches of external carotid artery
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What does the muscular triangle contain?
infrahyoid or strap muscles of neck
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What separates the carotid and muscular triangles?
superior belly of omohyoid muscle
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Where is the submandiblular triangle?
below mandible and is occupied by submandibular gland
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Where is the submental triangle?
superior to hyoid bone and located between anterior bellies of right and left digastric mm.
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What is another name for the submental triangle?
suprahyoid triangle
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What is found between the anterior and posterior triangle?
carotid sheath
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What is between the two carotid sheaths (right and left)?
a potential space behind the visceral tubes of the anteror triangle --the retropharyngeal space
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What commonly occurs in the retropharyngeal space?
infections can travel through this space from neck to thoracic cavity
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What forms the cervical plexus?
ventral rami of C1-4
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Which muscle does the cerical plexes orginate deep to?
sternocleidomastoid muscle
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What does the cervical plexus provide?
general sensation to neck and posterior head and motor innervation to infra-hyoid mm.
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What types of fibers does the cervical plexus contain?
sensory, motor, and postganglionic sympathetic fibers
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Each cervical nerve (1-4) of the cervical plexus receives a gray ramus communicans from:
superior cervical ganglion of the sympathetic trunk
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What do the sympathetic fibers innervate?
sweat glands, vessel walls, etc
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What are the 4 major sensory branches that arise from the cervical plexus?
- lesser occipital n.
- great auricular n.
- transverse cervical n.
- supraclavicular nn.
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Which cervical nerves contribute to the formation of the 4 sensory branches of the cervical plexus?
cervical nerves 2-4
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Which triangle do the sensory components of the cervical plexus emerge from?
posterior triangle of neck at midpoint of posterior border of sternocleidomastoid muscle
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What are the motor nerves of the cervical plexus?
- ansa cervicalis
- phrenic nn.
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What does "ansa" mean?
handle (loop)
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What are the roots of the ansa cericalis?
superior and inferior
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What does the superior root of the ansa cervicalis contain?
fibers from C1 and C2
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Which nerve does the proximal portion of the superior root of the ansa cervicalis run with?
hypoglossal n. (CN XII)
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What fibers make up the inferior root of the ansa cervicalis?
fibers from C2 and C3
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What does the ansa cervicalis provide?
motor innervation to anterior neck "strap" muscles or infrahyoid muscles
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What are the infrahyoid muscles?
- omohyoid (both bellies)
- sternothyroid
- sternohyoid
- thyrohyoid
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Which of the infrahyoid muscles in not innervated by the ansa cervicalis?
thyrohyoid
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What innervates thyrohyoid?
C1
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What are the boundaries of the posterior cervical triangle?
- posterior border of sternocleidomastoid muscle
- anterior border oftrapezius
- middle 1/3 of clavicle
- inferior belly of omohyoid muscle divides triangl into omoclavicular and occipital sub-triangles
- floor is formed by muscles
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Which muscles make up the floor of the posterior triangle?
- splenius capitus
- levator scapulae
- scalene muscles
-
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Which artery supplies splenius capitus?
- deep cervical artery
- posterior intercostal aa.
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Which artery supplies the levator scapulae muscle?
dorsal scapular artery
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Which scalene muscles form part of the floor of the posterior triangle?
middle and posterior
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What normally hides the anterior scalene muscle?
the SCM, but sometimes appears in the floor of the posterior triangle
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What is the overall function of the scalene muscles?
inspiratory muscles and act to laterally flex neck (during unilateral contraction)
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What innervates the scalene muscles?
ventral rami of C3-8
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What forms the interscalene triangle?
the attachment of anterior and middle scalene muscles to first rib
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What is the interscalene triangle?
a small space through which the proximal brachial plexus and subclavian artery pass on their way to the upper limb
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What clinical issue is caused by compression of the interscalene triangle?
thoracic outlet syndrome
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What does the omohyoid muscle separate the posterior triangle into?
superior occipital triangle and inferior praclavicular triangle
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Which artery supplies the omohyoid muscle?
transverse cervical artery
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What type of nerves are found in the posterior triangle?
- posteriorly directed motor nerves of cervical plexus
- anteriorly directed sensory nerves of cervical plexus (supraclavicular nn)
- trunks of brahial plexus
- cranial nerve XI
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What is cranial nerve XI?
spinal accessory n.
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Where is the spinal accessory nerve?
superifical structure of posterior triangle
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Where does the spinal accessory n. enter the posterior triangle?
at the junction of supeiror and middle thirds of posterior border of SCM
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The spinal accessory n. passes postero-inferiorly, and then disappears where?
deep to he anterior border of the trapezius between sperior 2/3 and inferior 1/3 of the muscle
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What is the function of the spina accessory n.?
provides motor innervation to trapezius and sternocleidomastoid
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Why is the spinal accessory n. susceptible to injury?
because ofits superficial position
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Which vessels cross through the posterior triangle?
- subclavian artery
- transverse cervical artery
- suprascapular artery
- occipital artery
- external jugular vein
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Which part of the posterior triangle does the subclavian artery pass through?
the base
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Where is the subclavian artery headed as it passes through the base of the posterior triangle?
the arm
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Which branches of the subclavian artery also cross the posterior triangle?
- transverse cervical
- suprascapular
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What is the transverse cervical artery a branch of?
thyrocervical trunk
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What does the transverse cervical artery supply?
trapezius and other structures
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What is the suprascapular artery a branch of?
thyrocervical trunk
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What does the suprascapular artery supply?
posterior scapular muscles
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What is the occipital artery a branch of?
external carotid a.
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What does the occipital a. supply?
posterior scalp
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Where does the external jugular vein begin?
near the angle of the madible by the union of the retromandibular ad posterior auricular veins
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Where does the external jugular vein terminate?
in the subclavian vein
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What are the boundaries of the anterior triangle?
- anterior border of sternocleidomastoid muscle
- midline of the neck
- inferior border of the mndible
- suprasternal notch
- roof is platysma muscle and investing layer of deep cervical fascia
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What are the muscles of the anterior triangle?
- mylohyoid
- geniohyoid
- stylohyoid
- digastric
- sternohyoid
- omohyoid
- sternothyroid
- thyrohyoid
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What are the nerves of the anterior triangle?
- ansa cervicalis
- lesser occipital nerve, great auricular nerve, transverse cervial nerve and supraclavicular nn.
- hypoglossal nerve
- vagus nerve
- cervical branch of facial n. (CN VII)
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What is the function of the ansa cervicalis?
motor to infrahyoid mm.
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What is the function of the lesser occipital n., great auricular n., transverse cervical n., and supraclavicular nn.?
sensory to skin on neck and around ear
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What cranial nerve is the hyoglossal nerve?
XII
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What is the function of the hypoglossal nerve?
motor to most mm. of tongue
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Where is the hyoglossal nerve?
passes over carotid sheath and deep to posterior belly of digastric
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Which tongue muscle is not innervated by the hypoglossal nerve?
palatoglossus
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Which cranial nerve is the vagus nerve?
X
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What is the function of the vagus nerve?
motor and sensory in neck region
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What are important branches of the vagus nerve in the neck?
- recurrent laryngeal n.
- superior laryngeal n.
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Where is the recurrnet laryngeal n. on the left?
around aorta
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Where is the recurrent laryngeal n. on the right?
around subclavian a.
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What structure does the recurrent laryngeal n. ascend in?
tracheoesophageal groove
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What is the function of the recurrent laryngeal n.?
supplies intrinsic mm. of larynx and sensation inferior to vocal folds as inferior laryngeal n.
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What are the branches of the superior laryngeal n.?
external and internal
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What is the function of the external laryngeal n.?
motor supplyto cricothyroid m.
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What is the function of the internal laryngeal n.?
sensation in larynx above vocal folds
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What is the function of the facial n.?
motor to platysma
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Which cranial nerve is the facial n.?
CN VII
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What are the contents of the carotid sheath?
- common carotid a.
- internal jugular v.
- vagus n.
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Where does the right common crotid a. begin?
at brachiocephalic a.
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Where does the left common carotid artery begin?
aortic arch
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What structure does the common carotid a. ascend in?
carotid sheath
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What does the common carotid artery bifurcate into?
external and internal carotidd aa.
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Where does the common carotid a. bifurcate?
at the level of the superior horn of the thyroid cartilage (in carotid triangle)
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What is the carotid body?
a chemoreceptor
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What is the carotid sinus?
a baroreceptor
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Do the internal carotid aa. have branches in the neck?
no
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What does the internal carotid a. supply?
structures within the skull
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How many arteries supply the brain with blood?
4
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Do the internal carotid aa. supply the brain with blood?
yes
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Where do the internal carotid aa. enter the cranium?
through carotid canals
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What does the external carotid a. supply?
structures outside of the skull
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What artery does the exteral cartid a. terminate as?
maxillary a. and superficial temporal a.
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Where are the branches of the external carotid a.?
both inside and outside the carotid triangle
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What are the branches of the external carotid a. within the carotid triangle?
- superior thyroid a.
- lingual a.
- facial a.
- ascending pharyngeal a.
- occipital a.
- posterior auricular a.
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Where do the branches of the supeiror thyroid a. go?
to sternocleidomastoid and infrahyoids, superior pole of thyroid gland
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Superior laryngeal a. is a branch of what?
superior thyroid a.
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Where does the lingual artery arise?
superior to greater horn of hyoid bone
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Which structures does the lingual a. travel deep to?
- hypoglossal n. (CN XII)
- stylohyoid m.
- posterior belly of digastric m.
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Where does the lingual a. dive deep?
deep to hyoglossus m.
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What is a frequent way for the lingual a. to branch instead of from the external carotid a.?
- arise from a common trunk with facial a.
- (sometimes off common trunk with supeior thyroid a.)
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Where does the facial artery branch from?
external carotid a. in carotid triangle
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Which triangle does the facial a. pass into?
submandibular triangle
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The facial artery passes deep to which gland?
submandibular gland
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In relationship to the submandibular gland, where does the facial v. pass?
superficial to the gland
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What are branches of the facial a. in the neck?
tonsilar ad submental branches
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Where does the ascending pharyngeal a. ascend in relationship to the internal carotid a.?
deep to the internal carotid a.
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Which branch off the external carotid a. is the ascending pharyngeal a.?
1st or 2nd
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Where can the ascending pharyngeal a. sometimes arise from?
directly from bifurcation of common carotid a.
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Where do branches of the ascending pharyngeal a. go?
pharynx, prevetebral mm., middle ear and meninges
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Where does the occipital a. arise?
from posterior surface of external carotid a.
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Where does the occipital a. arise from the external carotid a.?
where CN XII crosses the external carotid a. (corresponding to inferior border of posterior belly of digastric m.)
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Which triangles is the occipital a. found in?
carotid triangle and posteior triangle
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Which CN run superficial to the occipital a.?
CN IX, X and XI
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Where does the posterior auricular a. arise?
- from posterior aspect of external carotid a.
- at supeior border of posterior belly of digastric m.
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Where does the posterior auricular a. ascend?
posterior to external acoustic meatus
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What does the posterior auricular a. supply?
adjacent musculature, facial n., parotid gland, auricle and scalp
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What does the internal jugular vein drain?
brain and superficial head and neck
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Where does the internal juguar vein travel?
in carotid sheath in lateral position
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What accompanies the internal jugular vein?
deep cervical lymph nodes
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How is the internal jugular vein formed?
by union of posterior auricular vein and posterior division of retromandibular vein
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How is the anterior jugular vein formed?
by confluence of several superficial veins from submandibular region
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What does the anterior jugular vein drain into?
external jugular (sometimes directly into subclavian)
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What are the boundaries of the submandibular triangle?
- anterior belly of digastric m
- posterior belly of digastric m.
- lower border of mandible
- floor = mylohyoid m.
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What are the boundaries of the submental triangle?
- anterior belly of digastric m.
- midline of the area
- inferior body of hyoid bone
- floor = mylohyoid m.
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What are the contents of the submental and submandibular triangles?
- submandibular glnad
- cranial nn. in region
- suprahyoid mm.
- vessels
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How many salivary glands are there?
3
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Where does the submandibular gland secrete product?
into submandibular duct
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What supplies autonomic innervation of the submandibular gland?
CN VII via chorda tympani
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Where is the superficial lobe of the submandibular gland prominent?
in submandibular triangle
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What cranial nn. are in the submental and submandibular triangles?
- vagus
- hypoglossal (with C1)
- facial
- nerve to mylohyoid (V3)
- glossopharyngeal
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What is the function of the suprahyoid muscles?
- act on hyoid bone
- -stabilization
- -elevation
- -retraction
-
-
What is an added function of the digastric muscles?
depress mandible
-
What are the suprahyoid muscles?
- digastric
- mylohyoid
- stylohyoid
- geniohyoid
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What innervates the anterior belly of the digastric m.?
nerve to mylohyoid (branch of V3)
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What innervates the posterior belly of the digastric m.?
CN VII
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What innervates the mylohyoid?
nerve to mylohyoid (branch of V3)
-
What innervates stylohyoid?
CN VII
-
What innervates geniohyoid?
C1 via hyoglossal
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Which vessels are contained in the submental and submandibular triangles?
parts of facial a. and v.
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What are the boundaries of the carotid triangle?
- superior belly of omohyoid
- posterior belly of digastric
- anterior border of SCM
-
What are the contents of the carotid triangle?
- carotid sheath
- common carotid arter
- external carotid artery and branches
- internal jugular v.
- Nerves
- -vagus (CN X)
- -superior root of ansa cervicalis
- -spinal accessory (CN XI)
- -branches of cervical plexus
- thyroid gland, larynx, and pharynx
- deep cervical lymph nodes
-
Which artery is in the carotid triangle?
- common carotid artery
- external carotid artery and branches
-
Which vein is in the carotid triangle?
internal jugular vein
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Which nerves are in the carotid triangle?
- vagus (CN X)
- superior root of ansa cervicalis
- hypoglossal (CN XII)
- spinal accessory (CN XI)
- branches of cervical plexus
-
What are the boundaries of the muscular triangle?
- superior belly of omohyoid m.
- anterior borer of SCM
- median plane of neck
-
What are the contents of the muscular triangle?
- infrahyoid mm.
- throid and parathyroid glands
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