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ANATOMY: POSTERIOR NECK

Borders of the Posterior Triangle of the Neck:

Anteriorly posterior border of the SCM

Posteriorly anterior border of the trapezius
Inferiorly Middle third of the clavicle
Floor muscular floor composed of:
o Semispinalis capitis
o Splenius capitis
o Levator scapulae
o Scalenus medius

The muscular floor is covered by the prevertebral layer of

the deep cervical fascia

The 3 cervical sympathetic ganglia which forms the

superior rend of the sympathetic trunk are located in front
of the transverse processes of the cervical vertebrae

The posterior triangle is covered by (superficial to deep):

Skin
Superficial fascia
Platysma
Investing layer of the deep cervical fascia

Contents of the Posterior Triangle:

3rd part of the subclavian artery

Superficial cervical artery
Suprascapular artery
Occipital artery
Subclavian vein
Brachial plexus

Occipital triangle
Supraclavicular triangle

Occipital Triangle
Contents of the Occipital Triangle:

Supraclavicular nerve
Spinal Accessory Nerve
Superior end of the sympathetic trunk
o Superior cervical sympathetic ganglion
o Middle cervical sympathetic ganglion
o Inferior cervical sympathetic ganglion
Cervical plexus
Semispinalis capitis muscle
Levator scapula muscle
Scalenus posterior muscle
Scalenus medius muscle
Scalenus anterior muscle

NERVES IN THE OCCIPITAL TRIANGLE

Supraclavicular Nerve
o Part of the cervical plexus
o Formed by the union of C2, C3 and C4
o Course: It descends along the posterior
border of the SCM to the superficial fascia
above the clavicle which the divides into
medial, middle and lateral branches along
the length of the clavicle
o Ivolved in the phenomena referred pain
in pathological abdominal conditions
! Referred pain " pain perceived

Superior Cervical sympathetic ganglion

o Largest of the 3 cervical ganglia
o Located deep to the upper end of the SCM
(at the level of the hyoid bone)
o The superior end tapers to an inferior end
to continue as the first interganglionic
cord
Middle cervical sympathetic ganglion
o Found at the level of the cricoids cartilage
Inferior cervical sympathetic ganglion
o Frequently fused with the first thoracic
ganglion
! It forms the stellate ganglion
o Found at the level of the 7th cervical or
first thoracic vertebrae

Their postganglionic fibers are distributed as follows:

The posterior belly of the omohyoid muscle divides the

posterior triangle of the neck into the smaller triangles:

upper third of the SCM to cross the lateral

surface of the levator scapula. It then
descends obliquely, coursing the anterior
surface of the trapezius.
Innervates:
! SCM
! Trapezius

From the superior ganglion

o Internal carotid nerve
! Forms the internal carotid plexus
! Reaches the intrinsic muscles of
the eye
o Arterial branches
! Fibers form a plexus around the
ECA
! Distributes its branches to the
smooth muscles of the glands in
the scalp and face
o Superior Cardiac branch
! Participates in the cardiac plexus
o Cranial Nerve branches
! Communicating branches to the
vagus, glossopharyngeal and
cervical spinal nerves and the
pharyngeal plexus
From the middle ganglion
o Middle cardiac branch
! Participated in the cardiac plexus
o Nerves that form plexuses around the
subclavian and vertebral arteries
From the inferior ganglion
o Cardiac branch

Cervical Plexus:

Located deep to the SCM

Formed by the anterior rami of C1, C2, C3 and C4
Branches:
o Sensory cutaneous branches C1,C2,C3
o Motor branches (C3 and C4)
! Innervates the SCM, trapezius,
levator scapula, scalene muscles
! Ansa
cervicalis
innervates
infrahyoid muscles

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subclavian artery to enter
the thorax

**Scalene fxn " lifts 1st and 2nd rib to expand the thorax
during inspiration phase; also helps in the antero-lateral
flexion and slight rotation of the cervical vertebrae

MUSCLES IN THE OCCIPITAL TRIANGLE

**All muscles are innervated by branches of the cervical
plexus

Semispinalis capitis muscle

Levator scapula muscle
Scalenus posterior muscle
Scalenus medius muscle
Scalenus anterior muscle

ORIGIN

INSERTION

ACTION

INNERVATION

Splenius Capitis

Ligamentum nuche
and vertebral spines
of C4, C5, C6 and C7

Superior nuchal line

and mastoid process

Primary extensor of the head;

also allows lateral rotation
and flexion of cervical
vertebrae

Motor nerves of C3
and C4

Levator Scapula

Transverse processes
of C1, C2, C3 and C4

Medial
border
of
scapula (superior to
root of scapular spine)

Elevates the scapula

Dorsal
Scapular
Nerve (C5) and C3,
C4 nerves

Scalenus Posterior

C4,C5
and
vertebrae

Shaft of the 2nd rib

Scalenus Medius

Transverse processes
of all the cervical
vertebrae

Superior surface of the

1st rib

Lifts the 1st and 2nd rib to

expand the thorax during
inspiration and assists in
antero-lateral flexion and
slight rotation of cervical
vertebrae

Scalenus Anterior

Transverse processes
of C3, C4, C5 and C6

Scalene tubercle
the 1st rib

C6

Branches of the
branchial plexus

of

IMPORTANCE OF THE ANTERIOR SCALENE MUSCLE:

**The anterior scalene is a key muscle because of its relation to the many neurovascular structures identified within the
posterior triangle of the neck.
Relations:
Anteriorly: carotid artery, vagus nerve, IJV, deep cervical lymph nodes
Inferiorly: Pleura, origin of the brachial plexus, 2nd part of the sublclavian artery
Medial: Vertebral artery, sympathetic trunks, medial border of the thoracic duct
Lateral: emerging branch of the cervical plexus, roots of the brachial plexus, 3rd part of the subclavian artery
**The anterior scalene also divides the subclavian artery into 3 parts.
Supraclavicular Triangle
Contents of the Supraclavicular Triangle:

Subclavian Artery
Subclavian Vein
Apex of the lung

Roots of the brachial plexus

Deep cervical lymph nodes

SUBCLAVIAN ARTERY
RIGHT SUBCLAVIAN ARTERY
Commencement

LEFT SUBCLAVIAN ARTERY

Behind the right sternoclavicular junction

Termination

Behind the manubrium sterni

Outer border of the first rib

Origin

Brachiocephalic trunk

Arch of the aorta

Course

It passes upward and lateral as a gentle curve

behind the RIGHT scalenus anterior

Ascends to the root of the neck then arches laterally

as a gentle curve behind the LEFT scalenus anterior

Branches

Internal Thoracic Artery

Vertebral Artery

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The Scalenus Anterior divides the subclavian artery into 3 parts:

First Part of the Subclavian Artery

o
from its origin up to the medial border of the scalenus anterior
o
gives of the following branches:
Internal Thoracic Artery
Vertebral Artery
Second Part of the Subclavian Artery
o
Lies behind the scalenus anterior muscle
o
Gives of the following branches:
! Thyrocervical trunk
! Costo-cervical trunk
Third Part of the Subclavian Artery
o Extends from the lateral border of the scalenus anterior up to the outer border of the 1st rib
o The third part of the subclavian artery has no branches

**After the subclavian artery passes over the 1st rib, the subclavian artery will change its name to axillary artery.
Branches of the Subclavian Artery:
COURSE OF THE ARTERY
Commencement: at the level of
the sternoclavicular junction
Course: It descends close to the
lateral border of the sternum
Internal Thoracic Artery

BRANCHES
Anterior Intercostal
which then divides:

BLOOD SUPPLY
Artery

Superior epigastric
artery
Musculo-phrenic
artery

-Anterior
Intercostal
artery
supplying
the
upper
6
intercostals
-Superior Epigastric Artery (along
with the Inferior Epigastric Artery
supplies the anterior abdomen
-Musculo-phrenic Artery supplies
the 7th, 8th and 9th ICS plus the
diaphragm

Commencement: 6th cervical vertebrae (1st part)

Vertebral Artery

-2nd part: through the successive transverse foraminae up to the atlas

-3rd part: leaving the atlas to enter the foramen magnum
-4th part: ascends to the inferior pons, contributing to the formation of the Circle of Willis

Thyrocervical trunk

Commencement: medial border of the scalenus anterior

Asccends along the anterior border of the scalenus anterior to the
level of the cricoids cartilage. It then passes behind the carotid
sheath, reaching the posterior border of the thyroid grand

Inferior Thyroid Artery

Supplies the inferior portion of

the thyroid gland

It is closely related with the recurrent laryngeal nerve

Passes:

Transverse Cervical Artery

Behind the IJV

Anterior to the anterior scalene
Superficial to phrenic nerve

Supplies the neck and scapula

It descends with the posterior belly of the omohyoid to reach the

scapula
Suprascapular Artery

Travels almost parallel to the transverse cervical artery to reach and distribute branches to the
scapula

Costo-cervical trunk

Branches behind to scalenus anterior

Deep Cervical Artery

Courses backwards and upwards to the level of C7

Supplies
muscles
tissues

the deep cervical

and
surrounding

Superior Intercostal Artery

Courses deep and posterior to reach the neck of the 1st rib

Supplies
spaces

first

SUBCLAVIAN VEIN

Commencement: outer border of the 1st rib

intercostal

Tributaries:
o External Jugular Vein drains blood from

Right subclavian vein receives the right lymphatic duct which carries lymph from the right side of the head and neck

APEX OF THE LUNG

Lies deep above the subclavian artery and subclavian vein

Covered by partietal pleura which is protected by the Sibson;s Fascia/ Suprapleural membrane
o Sibsons Fascia attached to the vertebral and sterna ends of the 1st rib
Lies 3-4cm above the anterior costal cartilage

BRACHIAL PLEXUS

Formed by the anterior rami of C5, C6, C7, C8 and T1 spinal nerves

Roots
o C5, C6, C7, C8, T1
Trunk
o Superior trunk, Middle trunk, Lower trunk
Divisions
o Anterior divisions, Posterior division
Cords
o Lateral cord, Posterior cord, Medial cord
Terminal branches
o Musculocutaneous nerve
o Axillary nerve
o Median nerve
o Radial nerve
o Ulnar nerve