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DEPARTMENT OF ANATOMY. Dr. SREEKANTH THOTA. Neck. WINDSOR UNIVERSITY SCHOOL OF MEDICINE. Neck. The neck is a tube providing continuity from the head to the trunk.

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Dr sreekanth thota

DEPARTMENT OF ANATOMY

Dr. SREEKANTH THOTA

Neck

WINDSOR UNIVERSITYSCHOOL OF MEDICINE


Windsor university school of medicine

Neck

  • The neck is a tube providing continuity from the head to the trunk.

  • It extends anteriorly from the lower border of the mandible to the upper surface of the manubrium of sternum, and posteriorly from the superior nuchal line on the occipital bone of the skull to the intervertebral disc between the CVII and TI vertebrae.


Objectives

Objectives

  • 1. To study Compartments of the neck.

  • 2. Fascia and Fascial spaces of the neck

  • 3. Anterior triangle of the neck

  • 4. Posterior triangle of the neck

  • 5. Bones of the Neck

  • 6. Vasculatur of the neck

  • 7. Nerves of the neck.

  • 8. Lymphatics of the neck


Compartments of the neck

Compartments of the neck

  • Within the tube four compartments provide longitudinal organization

  • 1. visceral compartment is anterior and contains parts of the digestive and respiratory systems, and several endocrine glands

  • 2. vertebral compartment is posterior and contains the cervical vertebrae, spinal cord, cervical nerves, and muscles associated with the vertebral column

  • 3. Two vascular compartments are lateral and contain the major blood vessels and the vagus nerve [X].


Fascia

Fascia

  • Superficial fascia: contains a thin sheet of muscle (the platysma)

  • Deep cervical fascia: organized into several distinct layers

  • 1. Investing layer

  • 2. Prevertebral layer

  • 3. Pretracheal layer

  • 4. Carotid sheath


Fascial spaces

Fascial spaces

  • Between the fascial layers in the neck are spaces that may provide a conduit for the spread of infections from the neck to the mediastinum.

  • 1. Pretracheal space: passes between the neck and the anterior part of the superior mediastinum

  • 2. Retropharyngeal space : extends from the base of the skull to the upper part of the posterior mediastinum


Triangles of the neck

Triangles of the neck

  • For descriptive purposes the neck is divided into anterior and posterior triangles

  • 1.The anterior triangle of the neck is outlined by the anterior border of the sternocleidomastoid muscle laterally, the inferior border of the mandible superiorly, and the midline of the neck medially.

  • 2. boundaries of the posterior triangleare the posterior border of the sternocleidomastoid muscle, the anterior border of the trapezius muscle, and the middle one-third of the clavicle


Windsor university school of medicine

Submental Triangle

Submandibular Triangle

Anterior Triangle

Carotid Triangle

Posterior Triangle

  • Anterior Triangle subdivided into smaller triangles by

    • Digastric muscle

    • Omohyoid muscle


Anterior triangle of the neck

Anterior triangle of the neck

  • Subdivided into four smaller triangles

  • 1. Submandibular triangle: outlined by the inferior border of the mandible superiorly and the anterior and posterior bellies of the digastric muscle inferiorly

  • 2. Submental triangle: outlined by the hyoid bone inferiorly, the anterior belly of the digastric muscle laterally, and the midline


Windsor university school of medicine

  • 3.Muscular triangle: outlined by the hyoid bone superiorly, the superior belly of the omohyoid muscle, and the anterior border of the sternocleidomastoid muscle laterally, and the midline

  • 4.Carotid triangleis outlined by the superior belly of the omohyoid muscle anteroinferiorly, the stylohyoid muscle and posterior belly of the digastric superiorly, and the anterior border of the sternocleidomastoid muscle posteriorly.


Contents of ant triangle

Contents of ant triangle


Posterior triangle of the neck

Posterior triangle of the neck


Bones of the neck

Bones of the Neck

  • The skeleton of the neck is formed by the cervical vertebrae and hyoid bone


Cervical vertebrae

Cervical Vertebrae

  • Seven cervical vertebrae form the cervical region of the vertebral column, which encloses the spinal cord and meninges.


C1 vertebrae or atlas

C1 vertebrae or atlas

  • Ring-like, kidney-shaped bone lacking a spinous process or body and consisting of two lateral masses connected by anterior and posterior arches.

  • Its concave superior articular facets receive the occipital condyles.


C2 vertebrae or axis

C2 vertebrae or axis

  • Peg-like dens (odontoid process) projects superiorly from its body


Four typical cervical vertebrae 3 rd to 6th

Four typical cervical vertebrae (3rd to 6th)

  • Spinous processes are short and bifid.

  • Transverse processes of all cervical vertebrae (typical or atypical) include transverse foramina for the vertebral vessel(except for C7, the vertebral artery).


C7 vertebra or vertebra prominens

C7 vertebra or vertebra prominens

  • So-named because of its long spinous process, which is not bifid.

  • Its transverse processes are large, but its transverse foramina are small.


Hyoid bone

HYOID BONE

  • Anterior neck C3

  • Suspended from the styloid process of the temporal bone by the stylohyoid ligament

  • Serves as an attachment for suprahyoid and infrahyoid muscles and the investing deep fascia

  • It serves as a prop to keep the airway open


Important muscles of neck

Important Muscles of Neck


Superficial muscles of the neck

Superficial Muscles of the Neck

  • 1. Sternocleidomastoid Muscle

  • Origin:Sternal head: anterior surface of manubrium of sternumClavicular head: superior surface of medial third of clavicle

  • Insertion :Lateral surface of mastoid process of temporal bone and lateral half of superior nuchal line

  • N. supply:Spinal accessory nerve (CN XI, motor)

  • Action:Two muscles acting together extend head and flex neck; one muscle rotates head to opposite side


Congenital torticollis

Congenital Torticollis

  • Torticollis is a contraction of the cervical muscles that produces twisting of the neck and slanting of the head.

  • The lesion, like a normal unilateral SCM contraction, causes the head to tilt toward, and the face to turn away from, the affected side


Spasmodic torticollis

Spasmodic Torticollis

  • Cervical dystonia commonly known as spasmodic torticollis, usually begins in adulthood.

  • Characteristics of this disorder are sustained turning, tilting, flexing, or extending of the neck .


Muscles

Muscles

  • The muscles in the anterior triangle of the neck can be grouped according to their location relative to the hyoid bone:

  • 1. Muscles superior to the hyoid are classified as suprahyoid muscles.

  • 2. Muscles inferior to the hyoid are infrahyoid muscles.


Suprahyoid muscles

Suprahyoid muscles

  • Digastric

    (post belly by facial nerve, ant belly by n. to mylohyoid from V3)

  • Stylohyoid

    • Styloid process to hyoid bone(facial)

  • Geniohyoid

    • Inferior mental spine (on back of symphysismenti) to hyoid bone( c1 via hypoglossal)

  • Mylohyoid

    • Mandible to hyoid bone(n. to mylohyoid from V3 also ant. belly of digastric)


Infrahyoid muscles

Infrahyoid Muscles

Strap muscles

  • Sternothyroid

    • Sternum to thyroid cartilage

  • Sternohyoid

    • Sternum to hyoid bone

  • Thyrohyoid

    • Thyroid cartilage to hyoid bone (hypoglossal)

  • Omohyoid

    • Superior border of scapula to hyoid bone


Action of supra infrahyoid muscles

Action of Supra & Infrahyoid Muscles


Scalene muscles

Scalene Muscles

  • Anterior, middle, and posterior scalene muscles

  • Attach to transverse processes of cervical vertebrae and to rib 1 and 2

  • Action

  • Elevation of rib I and II


Subclavian artery common carotid artery ica eca

Subclavian artery

Common carotid artery

ICA

ECA

Arteries of the Neck


Subclavian

Subclavian

  • Arises from

    • Right side- brachiocephalic trunk

    • Left side- arch of aorta

  • Arches laterally over cervical pleura and apex of lung and grooves on 1strib between anterior and middle scalene muscles

  • Divided into three parts in relation to anterior scalene muscle

  • Becomes axillary artery at lateral border of 1st rib


First part of subclavian artery

First part of Subclavian artery

  • The first part extends from the origin of the artery to the anterior scalene muscle.

  • 1. Vertebral artery

  • 2. Thyrocervical trunk

  • 3. Internal thoracic artery

  • Thyrocervical trunk

  • Inferior thyroid artery

  • Transverse cervical artery

  • Suprascapular artery


Second part of the subclavian artery

Second part of the subclavian artery.

  • Costocervical trunk

  • 1. Deep cervical artery

  • 2. Supreme intercostal artery


Common carotid artery

Arises from

Brachiocephalic trunk on right

Arch of aorta on left

Divides into internal & external carotid arteries

At superior border of thyroid cartilage (C4)

Common carotid artery


Carotid pulse

Important site for pulse taking

Pulsation in common carotid artery are felt just below its bifurcation

Bifurcation happens at the level of superior border of thyroid cartilage

Against transverse process of 6th cervical vertebra (carotid tubercle)

Carotid Pulse


Windsor university school of medicine

  • Internal carotid artery

    • No branches in neck

  • External carotid artery

    • Gives eight branches

      • Four or five arise in carotid triangle

    • Ends within parotid gland by dividing into maxillary and superficial temporal arteries


Branches of external cartotid artery

BRANCHES OF EXTERNAL CARTOTID ARTERY

  • MENMONIC:

  • SOME

  • ANATOMISTS

  • LIKE

  • FREAKING

  • OUT

  • POOR

  • MEDICAL

  • STUDENSTS


Superficial venous drainage

Superficial venous drainage

  • The external jugular and anterior jugular veins are the primary venous channels for superficial venous drainage of the neck


Nerves

Nerves

  • Several nerves and components of the nervous system pass through the neck.

  • 1. Cervical plexus

  • 2.Phrenic nerves

  • 3. Vagus nerves [X]

  • 4. Recurrent laryngeal nerves

  • 5. Sympathetic nervous system


Cervical plexus

Cervical plexus

  • The cervical plexus is formed by the anterior rami of cervical nerves C2 to C4, and possibly a contribution from the anterior ramus of cervical nerve C1.

  • Muscular (or deep) branches

  • Cutaneous (or superficial) branches


Phrenic nerve

Phrenic nerve

  • The phrenic nerves are branches of the cervical plexus and arise on each side as contributions from the anterior rami of cervical nerves C3 to C5 come together.


Vagus nerves x

Vagus nerves [X]

  • The vagus nerves [X] descend through the neck within the carotid sheath, posterior to and just between the common carotid artery and the internal jugular vein.

  • In the root of the neck, each vagus nerve [X] passes anterior to the subclavian artery and posterior to the subclavian vein as it enters the thorax


Recurrent laryngeal nerves

Recurrent laryngeal nerves

  • The right recurrent laryngeal nerve is a branch of the right vagus nerve [X] on reaching the lower edge of the first part of the subclavian artery in the root of the neck

  • The left recurrent laryngeal nerveis a branch of the left vagus nerve [X] as it crosses the arch of the aorta in the superior mediastinum. It passes below and behind the arch of the aorta and ascends beside the trachea to the larynx.


Sympathetic nervous system

Sympathetic nervous system

  • Various components of the sympathetic nervous system are visible as they pass through the root of the neck. These include:

  • 1. cervical part of the sympathetic trunk;

  • 2. ganglia associated with the cervical part of the sympathetic trunk;

  • 3.cardiac nerves branching from the cervical part of the sympathetic trunk


Lymphatics

Lymphatics

  • Thoracic duct

  • The thoracic duct is a major lymphatic channel that begins in the abdomen, passes superiorly through the thorax, and ends in the venous channels in the neck.


Termination of lymphatic trunks in the root of the neck

Termination of lymphatic trunks in the root of the neck.

  • 1.Jugular trunkfrom the head and neck

  • 2.Subclavian trunkfrom the right upper limb

    3.Bronchomediastinal trunk


Lymphatics of the neck

Lymphatics of the neck

  • 1. occipital nodes

  • 2. mastoid nodes (retroauricular/posterior auricular nodes)

  • 3. pre-auricular and parotid nodes

  • 4. submandibular nodes

  • 5. submental nodes

  • Superficial cervical lymph nodes

  • Deep cervical lymph nodes


Deep cervical lymph nodes

Deep cervical lymph nodes

  • From the deep cervical nodes, lymphatic vessels form the right and left jugular trunks, which empty into the right lymphatic duct on the right side or the thoracic duct on the left side.


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