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65 Cards in this Set

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  • Back
Superior border of the neck
mandible, mastoid process, inferior nuchal line, external occipital protuberance.
Inferior borders of the neck
Manubrium(jugular notch), clavicle, Acromion process of the scapula.
Anterior aspects of the neck
•At its midline is comprised of the following bone and cartilages from superior to inferior:
oHyoid bone
oThyroid cartilage with thyroid notch (Adam’s Apple)
oCricoid Cartilage
oTracheal Cartilages
Sternocleidomastoid muscle
Origin: manubrium of the sternum, medial 1/3 of the clavicle.
Insertion:Mastoid process of the temporal bone and superior nuchal line.
Posterior triangle
Boundaries: Sternocleidomastoid, trapezius, and middle third of clavicle
-The posterior triangle is also subdivided into the occipital triangle and the supraclavicular (subclavian) triangle
the inferior head of the omohyoid muscle
seperates the occipital triangle and the supraclaivical triangles.
The floor (deepest portion) of the posterior triangle
formed by the following prevertebral muscles and prevertebral fascia: Splenius capitis, levator scapulae, and scalene muscles (anterior, middle, and posterior)
The roof (most superficial portion) of the posterior triangle
formed by investing fascia (superficial layer of deep cervical fascia)
Nerves and BV found in the posterior triangle
-Accessory Nerve (XI) – the only real structure passing through this triangle, between investing and prevertebral fascias
-Brachial Plexus – formed by ventral primary rami of spinal nerves C5,C6,C7,C8 and T1
-Cervical Plexus – cutaneous branches
-Subclavian artery and branches
-Subclavian vein and tributaries
Anterior triangles
4: submandibular, submental, muscular and caratoid triangles. All bilateral except the submental. Boundaries: midline, mandibular and SCM.
Mandibular (digastric) triangle
The boundaries of the submandibular (diagastric) triangle are:
-Anterior and posterior bellies of diagastric muscle
-Mandible
-The floor of the submandibular triangle is the mylohyoid muscle
-The contents in the submandibular triangle are: submandibular gland, submandibular lymph nodes, submandibular ganglion and lingual nerve, facial artery and vein, and hypoglossal nerve
Submental
The boundaries of the submental triangle are:
Anterior bellies of both digastric muscles, Hyoid bone
-The floor is also the mylohyoid muscle
-Submental lymph nodes are found in this area
Muscular triangle
-The muscular triangle is bounded by:
Median plane of neck, Superior belly of omohyoid muscle, Sternocleidomastoid muscle
•The following are found in the muscular triangle:
oInfrahyoid muscles
oThyroid and parathyroid glands
oCarotid sheath and contents
oRecurrent laryngeal nerves
oThyroid and cricothyroid cartilages (2 major cartilages of the larynx)
oPharynx and esophagus
oTrachea
Carotid
•The carotid triangle is bounded by:
-Posterior belly of digastric muscle
-Sternocleidomastoid muscle
-Superior belly of omohyoid muscle
The contents of the carotid triangle are the:
Carotid sheath and contents,
-Common carotid artery and internal carotid artery
-Internal jugular vein
-Vagus nerve
-Cervical sympathetic chain
-Hypoglossal nerve and superior root of ansa cervicalis
-External carotid artery and five of its branches
Innervation of the skin of the neck
innervated (cutaneous innervation) by sensory branches of the cervical plexus (ventral primary rami of spinal nerves C2 to C4). These branches are named:
oLesser occipital nerve (C2)
oGreat auricular nerve (C2, C3)
oTransverse cervical nerve (C2,C3)
oSupraclavicular nerve (C3,C4)
External jugular
formed in region of the parotid gland and then crosses sternocleidomastoid to end in the posterior triangle by piercing investing fascia (**always found in relation to the great auricular nerve).
Its formed by the union of 2 veins: Posterior auricular (drains back of ear, Retromandibular.
Anterior jugular
begins in the submental triangle and then travels inferiorly in anterior triangle
Omohyoid muscle
-Origin: superior part of scapula just medial to the scapular notch
-Insertion: inferior border of the body of the hyoid
-Inferior belly and superior belly are joined by a tendinous structure
Occipital triangle
Boundaries: -Inferior belly of omohyoid
-Anterior surface of trapezius.
Main Contents:
-Part of external jugular brain
-Posterior branches of cervical plexus of nerves
-Accessory nerve
-Trunks of brachial plexus
-Transverse cervical artery
-Cervical lymph nodes

-Posterior surface of SCM
Subclavian triangle
Boundaries:
-Inferior belly of Omohyoid
-Middle third of clavicle
-Posterior surface of SCM
oMain Contents:
-3rd part of subclavian artery
-Part of subclavian vein
-Supraclavicular lymph nodes
Greater Auricular nerve
-Receives nerve fibers from ventral primary rami of C2 and C3
-Travels from the posterior margin of the SCM and obliquely across to the angle of the mandible (where the body and ramus meet)
Divides into: Facial, auricular and mastoid.
Lesser Occipital nerves
o Follows the posterior margin of the SCM and ends up on occipital scalp
o Innervates (sensory) auricle and occipital scalp
o Originates from C2
Transverse cervical nerves
Goes transversely across the neck
-Crosses SCM transversely and divides into ascending and descending branches
Supplies skin of neck
-Originates from C2 to C3
-Mainly deep to the platysma
Supraclavical nerves
o Originates from C3 and C4 ventral primary rami
o Travels inferiorly as trunk and divides into usually 3 branches:
 Medial branch  supplies surface of manubrium
 Intermediate branch  supplies 2nd rib
 Lateral branch  supplies shoulder area (deltoid)
Anza cervicalis
o Motor nerve complex formed from fibers of ventral primary ramus of C1-C3 (part of cervical plexus
o Innervates infrahyoid muscles
o This ansa is in the wall of the carotid sheath
o The superior rami is composed of nerve fibers of the ventral primary rami of C1 and C2.
o It travels with the hypoglossal nerve (cranial nerve XII) for a short distance but does not become a functional part of the nerve.
Infrahyoid muscles
four pairs of strap like muslces: sternohyoid, sternothyroid, thyrohyoid and omohyoid. They fix and or depress the hyoid bone during mastication, deglutination and speech.
Splenius capitis
origin: ligamentum nuchae,spinous process of C7-T4. Attaches: mastoid process of temporal bone n lateral 1/3 of superio rnuchal line of occipital bone. innervated dorsal prim rami, located immediately deep tpt he trapezius.
Levator scapula
origin: transversus process of c1-c4. inserts medial border of spine of scapula, innervated by c3-c5.
Anterior scalene
origin: transverse process of c3-c6. inserts: ridge n scalene tubercle of 1st rib,innervated: ventral prim rami c4-c6. found just deep to clav head of SCM.
Middle scalene
origin: transverse process of c2-c7.
inserts: 1st rib btwn tubercle and groove for subclavian artery.
innervation: ventral prim rami of c3-c8
Posterior scalene
origin:transverse process of c4-c6.
inserts:outer surface of 2nd rib.
innervation: ventral prim rami c5-c7.
Ligamentem nuchae
strong band of collagenous and elastic fibers along spines of cervical vertebrae.
External Jugular Vein
lies nxt to greater auricular nerve. begins in parotid and terminates in subclavian. it is formed from union of retromandibular and posterior auricular.
Subclavian artery
is divided into 3 parts by the anterior scalene. The 1st part is btwn origin and ant scalene. 2nd part: posterior to the anterior scalene. 3rd part: lateral to the anterior scalene and extends to the 1st rib.
Part 1
contents: internal thoracic artery(supplies thorax, lat to manubrium), vetebral artery(supplies brain, sp , c1-c7), thyrocervical trunk.
Thyrocervical trunk
supplies neck and thyroid and splits into 3 branches. Suprascapular: muscle and tissue of scapula, goes lat n post.
Transverse cervical: trapezium and scapula, goes posteriorly.
Inferior thyroid artery:vascularizes thyroid gland, esophagus, trachea,
pharynx, and larynx; gives off inferior laryngeal artery, ascending cervical artery, glandular branches,
tracheal, esophageal and pharyngeal branches.
Part 2
part tht travels deep into ant scalene muscle. called costocervical trunk- it branches off into superior intercostal(passes under the subclavian artery and descends inferiorly and gives off the 1st 2 posterior intercostal arteries) and deep cervical artery(ascends superiorly and vascularizes the posterior neck muscles. It anastamoses with the occipital artery).
Part 3
travels laterally and gets off more branch called dorsal scapular. travels thru brachial plexus then to scapula.
Subclavian vein
passes anterior to the ant scalene. joins int jugular to form brachiocephalic vein. The main tributary of the subclavian vein is the external jugular vein, although it can also receive the dorsal scapular and anterior jugular veins.
Clavicle
site of attachment for trapezius and sternocleiodmastoid muscle.
Hyoid Bone
small u shaped bone, consists of body, greater and lesser horn. suspended by ligaments and muscles btwn temporal bones and sternum.
Typical cervical vetebra
1.transverse process
2.transverse foramen
3.articular facets (superior and inferior)
4.Lamina
5.pedicle
6.body
7.vertebral foramen
8.spines (bifid)
Atlas C1
1.transverse process
2.transverse foramen
3.anterior and posterior arches
4.anterior and posterior tubercles
5.articular facets (superior and inferior)
6.facets for dens
Axis C2
1.dens
2.articular facets (superior and inferior)
3.transverse foramen
4.lamina
5.spinous process
6.vertebral foramen
7.body
Viscera of the anterior neck
larynx(thyroid cartilage, cricoid cartilage, thyrohyoid membrane n cricohyoid membrane), thyroid gland (left and right lobe, isthmus, pyrimidal lobe), parathyroid, trachea, esophagus.
Common carotid artery
• Main blood supply to brain
• When the common carotid artery reaches the highest point of the thyroid cartilage, the artery branches into its 2 terminal branches: the internal and external carotids. the bifurcation occurs at the carotid triangle.
carotid sinus
 The carotid sinus is a pressure receptor innervated by the glossopharyngial nerve (CN IX)
carotid body
oThe carotid body is a small oval-shaped structure located in the internal carotid artery immediately after this bifurcation
 The carotid body is a chemoreceptor that checks O2 and CO2 and is innervated by the glossopharyngeal and vagus nerves.
Internal carotid artery
• The internal carotid artery ascends the rest of the length of the neck WITHOUT giving off any branches until it reaches the skull
External carotid artery
oSuperior Thyroid Artery
oAscending Pharyngeal Artery
oLingual Artery
oFacial Artery
oOccipital Artery
Superior thyroid artery
o Infrahyoid artery  it travels just inferior to the hyoid bone, deep to the infrahyoid muscle and serves to vascularize the area.
oSternocleidomastoid branch  travels along the carotid sheath and supplies the SCM
oSuperior Laryngeal Artery  pierces through a small opening in the thyrohyoid membrane and enters the larynx
oCricothyroid Artery  a small branch that travels along and supplies the cricothyroid ligament and muscle.
 Anastamoses with its counterpart on the other side of the body and the inferior thyroid artery
oGlandular Branches  supply the thyroid and parathyroid
Internal jugular vein
oThe IJV drains blood from the brain, anterior face, cervical viscera, and deep muscles of the neck
oIt runs inferiorly through the neck in the carotid sheath with the internal carotid artery and the common carotid artery and vagus nerve
Sternohyoid
oLocation: Anteriolateral aspect of neck
oOrigin: manubrium and clavicle, sternoclavicular joint
oInsertion: medial to omohyoid and into body of hyoid
oFunction: depresses and stabilizes hyoid bone
oInnervation: Ansa Cervicalis
Sternothyroid
oDeep to sternohyoid
oOrigin: deep aspect of manubrium
oInsertion: Oblique line of thyroid cartilage
oFunction: depress the larynx by pulling thyroid cartilage down

Thyroid cartilage is the major cartilage of the larynx
oInnervation: Ansa Cervicalis
Thyrohyoid
oDeep to sternothyroid
oOrigin: Oblique line of thyroid cartilage
oInsertion: Greater horn and body of hyoid bone
oFunction: if hyoid is fixed, it elevates larynx
oInnervation: C1, via hypoglossal nerve
THIS IS THE ONLY INTRAHYOID muscle tht is NOT innervated by the ansa cervicalis.
Omohyoid
oLocation: posterior and anterior triangles of neck
oOrigin: Superior border of scapula
oInsertion: inferior border of body of hyoid bone
oInnervation: Ansa Cervicalis
oFunction: pulls down hyoid bone (depresses) and stabilizes it
Right recurrent laryngeal nerve.
•A branch of the right vagus,
which loops around the right subclavian and goes deep to the common carotid artery. It then goes behind the thyroid gland to enter the larynx from its inferior posterior aspect where it is called the inferior laryngeal nerve
Inferior langeal nerve
o Before it goes behind the thyroid, it reaches the tracheoesophageal groove and therefore it supplies the esophagus and the trachea
o This nerve provides sensory innervation infraglottic area and motor innervation to the intrinsic muscles except the cricothyroid
o This nerve also supplies the inferior constrictor muscle and the pharynx
o Surgeons must be careful not to incise the right recurrent laryngeal nerve when removing the thyroid because it is often embedded into the fascia around the parathyroid gland
Superior langeal nerve
mixed nerve tht gives 2 branches, internal laryngeal and external laryngeal.
Internal laryngeal nerve
Internal laryngeal nerve (sensory) which passes posterior to the external carotid artery and ALWAYS accompanies the superior laryngeal artery through the hole in the thyrohyoid membrane.
Thick nerve that innervates the larynx from the epiglottis to the vocal cord
External laryngeal nerve
 External Laryngeal Nerve (motor) follows the superior thyroid artery to innervate the cricothyroid muscle and the inferior constrictor muscle
 ** Cricothyroid is the only intrinsic muscle of the larynx to be innervated by a motor nerve
Superior Ganglion
periarterial: Internal Carotid Nerve ->carotid plexus on internal carotid artery
-External carotid nerve: plexus on external carotid artery , innervates everywhere the artery supplies

direct: Pharyngeal Nerve-> direct branch to pharyngeal plexus
Superior Cardiac Branch: direct branch to cardiac plexus

gray rami communicantes:
-gray rami c1- c4 rami spinal nerve.
Middle ganglion
C6 level, at level of cricoid cartilage
oDirect branches to trachea and esophagus
oMiddle Cardiac nerve
oGray rami to C5-C6 spinal nerves
Inferior ganglion
C7 level
oVertebral Branch  periarterial plexus around vertebral artery
oInferior Cardiac Nerve
oGray rami to C7-C8 spinal nerves
Stellate gangion
Sometimes inferior cervical ganglion fuses with the 1st thoracic ganglion to form a larger, star shaped ganglion