BIOL2275

LECTURE SUMMARY – NECK REGION

• Contains many important structures – muscles, glands, arteries, veins, nerves,

lymphatics, trachea, esophagus & vertebrae
• Blood vessels & nerves are commonly injured in penetrating wounds of neck
• Cervix & collum = neck

BONES
• Revise anatomy of cervical vertebrae & hyoid bone

FASCIA OF NECK

Cervical fascia – in planes,

1. Superficial cervical fascia – a thin layer containing platysma, cutaneous nerves,
superficial veins & lymph nodes
2. Muscular/deep cervical fascia – support viscera, muscles, vessels & deep lymph
nodes. 3 fascial layers
• Investing – splits to enclose sternocleidomastoid & trapezius, forms roof of
anterior & posterior triangles
• Pretracheal – thin, surrounds thyroid gland & binds to larynx, invests
infrahyoid muscles
• Prevertebral – covers the prevertebral muscles – longus capitus & longus
cervicis, covers scalenes, levator scapulae, splenius capitus & semispinalis
capitus

MUSCLES OF NECK
• Support & move head or are
• Attached to structures within the neck region such as hyoid bone & larynx

Superficial & lateral neck muscles

3 superficial & lateral muscles:
1. trapezius – posterolateral neck & thorax – muscle of back, neck & shoulder girdle
2. platysma – anterolateral neck, from superficial fascia near deltoid & pectoralis
major to mandible
3. sternocleidomastoid – broad, underneath platysma, divides neck into anterior &
posterior triangles, 2 heads:
• Rounded sternal head attaches to manubrium
• Thick fleshy clavicular head attaches to medial clavicle
• 2 heads join & insert on mastoid process of temporal bone
• Unilateral – lateral flexion on same side & rotation of head to face upwards to the
opposite side
• Bilateral – extend head at atlanto-occipital joint, flex cervical part of VC
• Can be injured during childbirth – may result in torticollis – a flexion deformity of
the neck

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Posterior Muscles:

Splenius capitus
• Broad, deep to trapezius,
O: ligamentum nuchae & spines of C7, T1-3
I: posterior skull & on mastoid process of temporal bone
• Unilateral – head rotation & extension to one side
• Bilateral – extension of head at neck, hyperextension

Semispinalis capitus – broad, sheet-like

O: C7, T1-6
I: occipital bone
• Bilateral – head extension at neck
• Unilateral – rotation of head to that side

Longissimus capitus
O: C4-7, T1-5
I: mastoid process of temporal bone
• Head extension at neck, flexion to one side or slight rotation

TRIANGLES OF NECK

• Anterior & posterior by SCM

Posterior triangle
• Between SCM & trapezius
• Inferior border – clavicle
• Apex – superiorly where SCM & trapezius meet
• Roof – skin, superficial fascia, platysma, investing layer of deep cervical fascia
• Floor – muscles covered by prevertebral layer of deep cervical fascia. Muscles
are: semispinalis capitus, splenius capitus, levator scapulae & scalenus medius

• Also divided into 2 by inferior belly of omohyoid muscles – into:

Ø Supraclavicular triangle
Ø Occipital triangle
• Contents of posterior triangle (major ones) – subclavian artery, external jugular
vein & tributaries, sometimes subclavian vein, brachial plexus, branches of
cervical plexus

Anterior triangle
• Between midline of neck & SCM
• Superior boundary – mandible
• Apex – jugular notch
• Roof - subcutaneous tissue containing platysma
• Floor – pharynx, larynx, thyroid gland

• Subdivided by anterior & posterior bellies of digastric muscle & superior belly of
omohyoid muscle into:
Ø Submental triangle – unpaired, below chin, contains lymph nodes

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 Ø Submandibular/digastric triangles (2) – below mandible, contains
submandibular salivary glands, lymph nodes, carotid sheath, part of
parotid gland
Ø Carotid triangles (2) – behind hyoid bone, contains carotid sheath, deep
cervical lymph nodes
Ø Muscular triangles (2) – below the hyoid bone, beneath the floor lie the
thyroid gland, larynx, trachea, esophagus.

HYOID BONE
• Does not articulate with any other bone
• Yet it has 8 paired muscles attached to it
• 2 for tongue movements, one lowers the jaw, one elevates the floor of the mouth,
four depress the hyoid bone or elevate the thyroid cartilage of the larynx

SUPRAHYOID MUSCLES
Above the hyoid bone
1. Digastric (2 bellies) – posterior belly from mastoid process of temporal bone,
intermediate tendon, anterior belly to lower, median mandible. Depresses
mandible, elevates hyoid bone.
2. Mylohyoid – mandible to hyoid, elevation of floor of mouth & hyoid or depresses
mandible
3. Stylohyoid – styloid process of temporal bone to hyoid, pierced by intermediate
tendon of digastric near insertion. Elevates hyoid.
4. Geniohyoid – mandible to hyoid, elevates hyoid or depresses mandible

INFRAHYOID MUSCLES
Thin, strap-like, below the hyoid
1. Sternohyoid – from posterior manubrium & clavicle, upward & medial to lower
hyoid bone. Depresses hyoid.
2. Sternothyroid – from posterior manubrium, upward deep to sternohyoid, to thyroid
cartilage. Depresses larynx.
3. Thyrohyoid – from thyroid cartilage, upwards to lower border of hyoid. Depresses
hyoid or elevates larynx.
4. Omohyoid – inferior belly from upper margin of scapula, passes deep to SCM,
intermediate tendon, superior belly inserts into lower hyoid. Depresses hyoid.

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 BIOL2275

LECTURE – NECK REGION II

ROOT OF NECK
• Immediately above inlet of thorax
• Scalenes & prevertebral muscles

Scalenus anterior – deep

O: transverse processes of C3-6, downward & lateral
I: scalene tubercle of 1st rib & upper surface of 1st rib
• Assists in elevation of rib 1
• Also, acting from below it laterally flexes & rotates cervical VC

Scalenus medius
O: transverse process of atlas & C2-6, downward & laterally
I: upper surface of rib 1
• Behind the roots of the brachial plexus, behind subclavian artery
• Assists in elevation of rib 1
• Also, acting from below it laterally flexes & rotates cervical VC

Scalenus posterior
O: transverse processes of lower cervical vertebrae
I: outer surface of 2nd rib
• May be absent or blended with scalenus medius
• Elevates 2nd rib
• When active from below, laterally flexes cervical VC

ANTERIOR PREVERTEBRAL MUSCLES OF NECK

1. Longus cervicis/colli (long muscle of neck)
O: anterior tubercle of C1, C1-3 bodies, C3-6 transverse processes
I: bodies of C5-T3, transverse processes of C3-5.
• Unilaterally – flexes neck with rotation to opposite side
2. Longus capitus (long muscle of head) - occipital bone to transverse processes
C3-C6. Flexes head.
3. Rectus capitus anterior – base of skull to anterior lateral masses of C1, flexes
head.
4. Rectus capitus lateralis – occipital bone to transverse process of C1, flexes
head, helps stabilize it

POSTERIOR SUBOCCIPITAL REGION OF NECK

• Suboccipital region – triangular area inferior to occipital area, posterior to C1 & C2
• Suboccipital triangle – deep to trapezius & semispinalis capitus muscles
• 4 muscles, postural, they act on the head directly or indirectly
• They extend the head on C1 rotate the head and C1 on C2.
1. Rectus capitus posterior major
From C2 spine to lateral inferior nuchal line of occipital bone.

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2. Rectus capitus posterior minor
From posterior arch of C1 to medial third of inferior nuchal line
3. Obliquus capitus inferior (inferior oblique of head)
From C2 spine to transverse process of C1
The only “capitus” muscle with NO attachment to cranium
4. Obliquus capitus superior (superior oblique of head)
From C1 transverse process to occipital bone between superior & inferior nuchal
lines

VISCERA OF THE NECK

• Thyroid gland
• Parathyroid glands
• Larynx & trachea
• Esophagus

ARTERIES OF NECK

Right common carotid artery – from brachiocephalic artery

Left common carotid from arch of aorta
Runs up from sternoclavicular joint to upper thyroid cartilage, then divides into:
External carotid artery – to neck, face, scalp, tongue & maxilla, branches include
Facial A. & superficial temporal A.
Internal carotid artery – to brain, eye, forehead, & part of nose.

VEINS OF THE NECK

Superficial veins – external jugular & anterior jugular.

• External jugular – drains into subclavian vein, from angle of mandible to middle of
clavicle.
• Anterior jugular – from below the mandible, close to midline, turns laterally, drains
into external jugular vein
Internal jugular vein – receives blood from brain, face & neck, in carotid sheath,
joins subclavian vein behind medial clavicle to form brachiocephalic vein.

MAIN LYMPH NODES OF THE NECK

• Deep cervical lymph nodes
• Along anterolateral surface of internal jugular vein

INNERVATION
• Skin on back of neck – posterior branches of cervical spinal nerves
• Skin on anterior & lateral neck – by anterior branches of cervical spinal nerves via
cervical plexus, branches emerge from beneath the posterior border of the
sternocleidomastoid muscle
• Other nerves seen in neck:
Ø Vagus nerve (CN X) – in carotid sheath
Ø Accessory nerve (CN XI) – to trapezius
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 Ø Hypoglossal nerve (CN XII) – motor to tongue muscles
Ø Cervical part of sympathetic trunk
Ø Cervical plexus – anterior branches of C1-C4. Muscular branches to many
neck muscles, diaphragm through phrenic nerve.

• Anterior branches of spinal nerves emerge between scalenus medius and anterior
• Subclavian artery & brachial plexus – emerge between scalenus anterior &
scalenus medius

CAROTID SHEATH
• Deep fascia containing common & internal carotid arteries, internal jugular vein,
vagus nerve (CNX) & deep cervical lymph nodes.

BIOL2275

LECTURE 3 – CERVICAL PLEXUS

• Cervical plexus is formed by the anterior rami of cervical nerves C1-C4

• It lies posterior to the internal jugular vein and the SCM muscles.
• It supplies the back and sides of the head, and front of the neck
• Phrenic nerve –supplies the diaphragm.
• Consists of several branches, including a superficial cervical plexus, which
supplies the cervical fascia, the head and neck skin and parts of the ear and face.
• A deep set of plexus nerves reaches the neck muscles and the upper back.
• Each except 1st cervical nerve divides into ascending and descending branches

BRANCHES OF THE CERVICAL PLEXUS

• muscular and cutaneous branches arising from the plexus

A. SUPERFICIAL OR CUTANEOUS BRANCHES

1. Ascending branches:

• lesser occipital nerve (C2)

Ø Comes from the second cervical ventral ramus and sometimes also from
the third

Ø curves around the accessory nerve and ascends along the posterior border
of the sternocleidomastoid.

Ø supplies the skin on the upper third of the medial auricular aspect

Ø connects with the posterior branch of the great auricular nerve.

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• great auricular nerve C2-C3
Ø This is the largest ascending branch.

Ø It arises from the second and third cervical rami, encircles the posterior
border of the sternocleidomastoid.

Ø supplies the skin over the mastoid process and on the back of the auricle,
the lobule and concha. .

Ø communicates with the lesser occipital, the auricularbranch of the vagus

and the posterior auricular branch of the facial nerve

• transverse cervical nerves C2-C3

Ø This arises from the second and third cervicalrami, curves round the
posterior border of the sternocleidomastoid

Ø It perforates the deep cervical fascia, dividing under theplatysma into

ascending and descending branches distributed to the anterolateral areas
of the neck.

Ø distributed to the skin of the upper anterior areas ofthe neck and
anterolaterally to the skin of the neck, as low as the sternum.

2. Descending Branches

supraclavicular nerves C3-C4 - These arise by a common trunk from the third and
fourth cervical ventral rami and emerge from the posterior border of the
sternocleidomastoid, to descend under the platysma and the deep cervical fascia;

• The medial supraclavicular nerves - supply the skin as far as the midline and as
low as the second rib. They supply the sternoclavicular joint.

• The intermediate supraclavicular nerves -cross the clavicle to supply the skin
over the pectoralis major and deltoid down to the level of the second rib

• The lateral supraclavicular nerves - supply the skin of the upper and posterior
parts of the shoulder.

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B. DEEP BRANCHES OR MUSCULAR COMMUNCIATING BRANCHES

1. LATERAL BRANCHES:

• Muscular branches to SCM, trapezius, levator scapulae, scalenius medius,

scalenius posterior.
• Communicating branches to spinal accessory nerves.

2. MEDIAL BRANCHES
a. Muscular branches to prevertebral muscles, infrahyoid muscles through the ansa
cervicalis
b. communicating branches to the vagus, hypoglossal and sympathetic nerves
c. phrenic nerve is the most important branch because it supplies the diaphragm
which is the chief muscle for respiration. It is dervived from cervical nerves 3, 4, 5.

ANSA CERVICALIS
• Formed by spinal nerves C1, C2, C3.
• Loop of nerves superficial to internal jugular vein in the carotid sheath

3 parts:
1. superior root
• formed by branch of C1,
• travels with cranial nerve XII but never integrates with it
• nerve fibres travel in the hypoglossal nerve before leaving to form the superior root
• goes around occipital artery, descends in carotid sheath
• branches to superior belly of omohyoid, upper sternothyroid and sternohyoid,
joined by inferior root.

2. inferior root – “descendens cervicalis”

• Formed by branches of C2, C3
• Descends either lateral or medial to the internal jugular vein
• Branches to inferior belly of omohyoid, lower sternothyroid and sternohyoid.

3. loop of ansa cervicalis

• innervates sternothyroid, sternohyoid, inferior belly omohyoid

• Thyrohyoid and geniohyoid muscles innervated by C1 only.

Greater occipital nerve

• Spinal nerve from medial branch of dorsal rami of C2
• Between C1 and C2 vertebrae
• Ascends to innervate skin on posterior scalp to vertex (upper surface of head).

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• Innervates scalp at top of head, over ear and over parotid glands.
• Disorders of his nerve cause occipital neuralgias (headaches).

Third occipital nerve (least occipital nerve)

• Medial branch of posterior division of C3.
• Pierces trapezius, ends in skin on lower back of head.
• Medial to greater occipital, communicates with it.

THE PHRENIC NERVE

• C3, C4, and C5.

• Sole motor supply to the diaphragm and pericardium, contains widespread
sensory fibres.
• Enters diaphragm through the thorax, breaking into more branches, which pierce
the muscle and spread out under the surface
• Supply motor fibres to the diaphragm and sensory fibres to the fibrous
pericardium, mediastinal pleura, and diaphragmatic peritoneum.
• Pain arising from structures served by the phrenic nerve is often "referred" to other
somatic regions served by spinal nerves C3-C5.
• For example, a subphrenic abscess beneath the right diaphragm might cause a
patient to feel pain in the right shoulder.
• Irritation of the phrenic nerve (or the tissues supplied by it) leads to the hiccough
reflex.
• A hiccough is a spasmodic contraction of the diaphragm, which pulls air against
the closed folds of the larynx.
• The phrenic nerve arises from the neck (C3-C5) and innervates the diaphragm,
which is much lower.
• Hence, patients suffering spinal cord injuries below the neck are still able to
breathe effectively, despite any paralysis of the lower limbs.