JIGJIGA UNIVERSITY

Human Anatomy
FOR MEDICINE STUDENTS

ANATOMY OF NECK
 Introduction
• The neck is the transitional area between the
cranium superiorly and the clavicles inferiorly.
joins the head to the trunk.
• Several important organs with unique functions
are located here: the larynx, the thyroid gland,
parathyroid glands, etc.
Introduction cont…
• The neck is a well-known region of vulnerability
• Several vital structures, including the trachea,
esophagus, and thyroid gland, lack the bony
protection afforded other parts of the systems
• The main arterial blood flow to the head and neck
(the carotid arteries) and
• The principal venous drainage (the jugular veins)
lie anterolaterally in the neck
• The brachial plexuses of nerves originate in the
neck.
 Bones of the Neck
• The skeleton of the neck is formed by the
• Cervical vertebrae
• Hyoid bone
• Manubrium of the sternum, and
• Clavicles
• These bones are parts of the axial skeleton
except the clavicles
 Cervical Vertebrae
• Seven cervical vertebrae form the cervical
region of the vertebral column.
• Encloses the spinal cord and meninges.
Classified as:
Atypical: the 1st, 2nd and the 7th cervical
vertebrae.
Typical: the 3rd, 4th, 5th and the 6th cervical
vertebrae.
 Cervical Vertebrae cont…
• The four typical cervical vertebrae (3rd to 6th)
have the following characteristics:
The vertebral body is small and longer from side
to side than anteroposteriorly;
The superior surface is concave, and the inferior
surface is convex.
The vertebral foramen is large and triangular.
 Typical Cervical Vertebrae cont…
The transverse processes of all cervical vertebrae
include transverse foramina for the vertebral vessels
(the vertebral vein and, the vertebral artery except
C7).
The superior facets of the articular processes are
directed superoposteriorly, and
The inferior facets are directed inferoposteriorly.
Their spinous processes are short and bifid.
• 3rd, 4th, 5th, & 6th cervical
vertebrae.
1. Body
2. Pedicle
3. Foramen for vertebral artery
4. Superior articular process
5. Lamina
6. Bifid spinous process
7. Vertebral canal
8. Transverse process (consists of a
groove for a cervical spinal nerve
& foramen for vertebral artery)

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 Atypical Cervical Vertebrae
• There are three atypical cervical vertebrae
The C1 vertebrae or atlas:
A ring-like, kidney-shaped bone
Lack a spinous process or body and
It articulates with occipital condyles of skull above
it & with superior articular processes of the axis
below it.
It also articulates with the dens of axis below
 Atypical Cervical Vertebrae cont…
The C2 vertebrae or axis:
A peg-like dens (odontoid process) projects
superiorly from its body.
The C7 vertebra or vertebra prominens:
So named because of its long spinous
process, which is not bifid.
There is no foramen for vertebral artery
Vertebral artery, arising from subclavian
artery, enters transverse foramen of 6th
cervical vertebra, bypassing the 7th.
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Atlas and axis, atlantoaxial joint

12/01/23 16
 Atlas

• viewed from above, you can identify the following parts of the atlas:
1. Anterior arch
2. Anterior tubercle
3. Superior articular process (articulate with occipital condyle of skull)
4. Transverse Foramen
5. Transverse process
6. Posterior arch
7. Posterior tubercle
8. Vertebral canal (continuous with foramen magnum at base of skull).
The brain stem continues inferiorly as spinal cord at foramen magnum.

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1.dens
Axis
2.body
3.superior articular process
4.transverse process with its
vertebral foramen
5.pedicle
6.lamina
7.bifid spine (spinous process)

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 Hyoid Bone
• U-shaped
• Lies in the anterior part of the neck at the level
of the C3 vertebra in the angle between the
mandible and the thyroid cartilage
• Suspended by muscles that connect it to the
mandible, styloid processes, thyroid cartilage,
manubrium, and scapulae.
• Does not articulate with any other bone
(A) Lateral view
 Hyoid cont…
• The hyoid consists of a body and two greater
and lesser horns .
• Functionally:
Serves as an attachment for anterior neck
muscles.
It provides a movable base for the tongue
and attachment for the middle part of the
pharynx.
It also maintains the patency of the pharynx,
required for swallowing and respiration.
 Injuries of Cervical Vertebral Column
•Fractures and dislocations of the cervical
vertebra may injure the spinal cord and/or the
vertebral arteries and sympathetic plexuses.
 Fascia of the Neck

• Structures in the neck are surrounded by a layer

of:
Subcutaneous tissue (superficial fascia) and
Deep cervical fascia.

• The fascial planes determine the direction in

which an infection in the neck may spread.
Cervical Subcutaneous Tissue and Platysma
The subcutaneous tissue of the neck
(superficial cervical fascia) lies between the
dermis of the skin and the investing layer of
deep cervical fascia.
It contains cutaneous nerves, blood and
lymphatic vessels, superficial lymph nodes, and
variable amounts of fat.
Anterolaterally it contains the platysma
 Platysma
• A broad, thin sheet of muscle in the
subcutaneous tissue of the neck
• Supplied by the cervical branch of CN VII
• Covers the anterolateral aspect of the neck
O: Deep fascia covering the superior parts of the
deltoid and pectoralis major muscles
I: Inferior border of the mandible
A: Draws corners of mouth inferiorly and widens
it as in expressions of sadness and fright.
• Draws skin of neck superiorly when teeth are
clenched
 Deep Cervical Fascia
• Consists of three fascial layers (sheaths):
• Investing
• Pretracheal and
• Prevertebral
 Investing layer of Deep Cervical Fascia
• The most superficial deep fascial layer.
• Surrounds the entire neck deep to subcutaneous
tissue.
• Enclose (invest) the trapezius and
sternocleidomastoid (SCM) muscles.
Pretracheal Layer of Deep Cervical Fascia

• Limited to the anterior part of the neck

• Limited to the anterior neck; invests the
infrahyoid muscles, thyroid gland, trachea,
and esophagus.
• Posteriorly called the buccopharyngeal fascia,
as it covers the buccinator and pharyngeal
constrictor muscles
 Prevertebral Layer of Deep Cervical Fascia

• Forms a tubular sheath for the vertebral column

and the muscles associated with it.
• It encloses longus colli and longus capitis
anteriorly, the scalenes laterally, and the deep
cervical muscles posteriorly.
• The prevertebral fascia extends laterally as the
axillary sheath.
 The Carotid Sheath
A tubular fascial investment that extends from
the cranial base to the root of the neck.
The carotid sheath contains
(1) The common and internal carotid arteries
(2) The internal jugular vein
(3) The vagus nerve (CN X)
(4) Some deep cervical lymph nodes
(5) Nerve to carotid sinus, and
(6) Sympathetic nerve fibers (carotid peri-
arterial plexuses)
 The Carotid Sheath cont…
• The carotid sheath and pretracheal fascia
communicate freely with the mediastinum of
the thorax inferiorly and the cranial cavity
superiorly.
• These communications represent potential
pathways for the spread of infection and
extravasated blood.
 Retropharyngeal Space
• It is a potential space between the prevertebral fascia
and the buccopharyngeal fascia surrounding the
pharynx superficially.
• The retropharyngeal space permits movement of the
pharynx, esophagus, larynx, and trachea relative to
the vertebral column during swallowing.
• This space is closed superiorly by the cranial base and
on each side by the carotid sheath.
• It opens inferiorly into superior mediastinum
 Spread of Infections in Neck

• If an infection occurs b/n the investing fascia

and the muscular part of the pretracheal
fascia, the infection will usually not spread
beyond the superior edge of the manubrium
of the sternum.
• However, if the infection occurs between the
investing fascia and the visceral part of
pretracheal fascia,
fascia it can spread into the
thoracic cavity anterior to the pericardium.
pericardium
 Spread of Infections cont…

• Abscess (pus) posterior to the prevertebral

fascia may extend laterally in the neck and form
a swelling posterior to the SCM.
SCM
• Infections in the retropharyngeal space may
extend inferiorly into the superior mediastinum.
 The Neck Region
• To allow clear communications
regarding the location of structures,
injuries, or pathologies, the neck is
divided into 4 regions.
1. Sternocleidomastoid region (A)
2. Posterior cervical region (B)
3. Lateral cervical region (C)
4. Anterior cervical region (D)

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 1. Sternocleidomastoid region
Sub-division
Lesser supraclavicular fossa (1): Contain
inferior part of internal jugular vein
2. Posterior cervical region
Sub-division
•Sub-occipital region or triangle (E) lies deep
to superior part of this region

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A. Sternocleidomastoid region
B. Posterior cervical region
C. Lateral cervical region
D. Anterior cervical region
E. Sub-occipital region or
triangle
1. Lesser supraclavicular
fossa
2. Occipital triangle
3. Omoclavicular triangle
4. Submandibular triangle
5. Sub mental triangle
6. Carotid triangle
7. Muscular (omotracheal)
triangle
 3. Lateral cervical region (posterior triangle)
Sub-division
Occipital triangle (2)
Omoclavicular (subclavian) triangle (3)

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 4. Anterior cervical region
Sub-division
Submandibular (digastric) triangle (4)
Sub mental triangle (5)
Carotid triangle (6)
Muscular (omotracheal) triangle (7)

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 Sternocleidomastoid region
• Sternocleidomastoid (SCM) muscle:
muscle is a key
landmark that divides the neck into the anterior
and lateral cervical regions (anterior and
posterior triangles).
O: two heads: sternal head attaches to the
manubrium & clavicular head attaches to the
superior surface of the clavicle.
clavicle
• The two heads of the SCM are separated
inferiorly by the lesser supraclavicular fossa.
I: Mastoid process of the temporal bone and the
superior nuchal line of the occipital bone.
bone
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Sternocleidomastoid (SCM) muscle cont…
Innervation:
Spinal accessory nerve (CN XI)
Action:
Unilateral contraction: tilts head to same side
(i.e., laterally flexes neck) and rotates it.
Bilateral contraction:
•Extends neck at atlanto-occipital joints
•Flexes cervical vertebrae so that chin approaches
manubrium
•To test the SCM, the head is turned to the
opposite side against resistance
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 Posterior cervical region
Trapezius
•Have Ascending, Middle & Descending fibers
O: Superoir nuchal line, spinous processes of vertebrae
C7-T12
I: Clavicle and acromion & spine of scapula
Innervation: Spinal accessory (XI).
Action
–descending (sup.) part elevates scapula
–ascending (inf.) part depresses scapula
–middle part (or all parts together) retracts scapula
To test the trapezius, the shoulder is shrugged against
resistance.
 Lateral Cervical Region
• The lateral cervical region (posterior triangle)
is bounded:
Anteriorly: by the posterior border of the SCM.
Posteriorly: by the anterior border of the trapezius.
Inferiorly: by the middle third of the clavicle
between the trapezius and the SCM.
Roof: formed by the investing fascia.
fascia
Floor: formed by muscles covered by prevertebral
fascia.
 Muscles in lateral cervical region
Contain four muscles covered by prevertebral
fascia:
•Splenius capitis
•Levator scapulae
•Middle scalene
•Posterior scalene
•Sometimes the inferior part of the anterior
scalene
 Muscles in lateral cervical region cont…
• Form floor of the triangle
Splenius capitis
Origin – lower half of ligamentum nuchae, spines of C7,
T1-6
Insertion – lateral third of superior nuchal line and
mastoid process
Innervation – dorsal rami of middle cervical spinal
nerves
Action – Laterally flexes and rotates head and neck to
same side; acting bilaterally, extends head and neck.

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Scalenus medius
Origin - transverse process of C2 to C7
Insertion – superior surface of first rib
Innervation – ventral rami of cervical spinal nerves
(C3-C8)
Action – flex neck laterally and elevates first rib
Scalenius posterior
Origin - transverse process of C4 to C7
Insertion – external border of second rib
Innervation – ventral rami of cervical spinal nerves
(C3-C8)
Action – flex neck laterally and elevates second rib

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Scalenius anterior
Origin - Transverse processes of 3rd, 4th, 5th, and
6th cervical vertebrae
Insertion – 1st rib
Innervation – C4, 5, and 6
Action – Elevates 1st rib; laterally flexes and
rotates cervical part of vertebral column

59
60
 Lateral Cervical Region cont…
• The lateral cervical region is divided into a:
Large occipital triangle superiorly and
Small omoclavicular triangle inferiorly by the
inferior belly of the omohyoid.
Occipital triangle: is so called because the
occipital artery appears in its apex.
• The most important nerve crossing the occipital
triangle is the spinal accessory nerve (CN XI).
 Lateral Cervical Region cont…
Omoclavicular (subclavian) triangle: is indicated
on the surface of the neck by the supraclavicular
fossa.
•The inferior part of the EJV crosses this triangle
superficially;
•The third part subclavian artery lies deep in it.
Because of this, the omoclavicular triangle is often
called the subclavian triangle
 Arteries in Lateral Cervical Region

• The arteries in the lateral cervical region includes:

A.The lateral branches of the thyrocervical trunk

B.The third part of the subclavian artery

C.Part of the occipital artery

 A. Thyrocervical trunk
• It is a branch of subclavian artery
Give rise to:
Suprascapular artery
Cervicodorsal trunk
Terminate as ascending cervical and inferior
thyroid artery
 1. Suprascapular artery
• Passes across the anterior scalene muscle,
phrenic nerve, third part of the subclavian
artery and the cords of the brachial plexus.
• It passes posterior to the clavicle to supply
muscles on the posterior aspect of the scapula.
• Occasionally, the suprascapular artery may arise
from the third part of the subclavian artery.
artery
 2. Cervicodorsal trunk
• Sometimes known as the transverse cervical
artery.
• Further bifurcates into the superficial cervical
artery and the dorsal scapular artery.
• These branches run across the phrenic nerve
and anterior scalene muscle.
• Then, they cross or pass through the trunks of
the brachial plexus, supplying branches to their
vasa nervorum (blood vessels of nerves).
 B. Occipital artery
• It is a branch of the external carotid artery.
• Supply the posterior half of the scalp
 C. Subclavian artery
• It supplies blood to the upper limb.
• The third part begins superior to the clavicle.
• It lies on the 1st rib, and its pulsations can be felt
in the omoclavicular triangle.
triangle
• The artery is in contact with the 1st rib as it
passes posterior to the anterior scalene muscle.
• The branches that occasionally arise from the
third part (suprascapular artery, dorsal
scapular artery).
• Continue as axillary artery.
Subclavian artery: its parts and branches. There are three parts of the subclavian
artery: medial (1), posterior (2), and lateral (3) to the anterior scalene muscle. The
cervicodorsal trunk (transverse cervical artery) and suprascapular artery occasionally
arise directly (or via a common trunk) from the second or third parts of the
subclavian artery
 Veins in lateral cervical region
External jugular vein (EJV)
•Begins near the angle of the mandible (just
inferior to the auricle)
•Formed by the union of the posterior division
of the retromandibular vein with the posterior
auricular vein.
 External jugular vein (EJV) cont…
• The EJV crosses the SCM obliquely, deep to
the platysma.
• The EJV terminates in the subclavian vein.
• It drains most of the scalp and side of the face.
Tributaries:
• Cervicodorsal
• Suprascapular
• Anterior jugular veins.
76
 Subclavian vein
• It is the major venous channel draining the upper
limb.
• It passes anterior to the anterior scalene muscle
and phrenic nerve.
• Unites with the IJV to form the brachiocephalic
vein.
 Nerves of lateral cervical region
a. The spinal accessory nerve (CN XI)
•Passes deep to the SCM, supplying it before
entering the lateral cervical region.
•The nerve passes postero-inferiorly, within or
deep to the investing fascia, running on the
levator scapulae.
•CN XI then disappears deep to the anterior
border of the trapezius.
 Nerves of lateral cervical region cont…
b. The roots of the brachial plexus: (anterior
rami of C5–C8 and T1) appear between the
anterior and the middle scalene muscles.
•The five rami unite to form the three trunks of
the brachial plexus.
•The plexus then passes between the 1st rib,
clavicle, and superior border of the scapula to
enter the axilla.
•Providing innervation for the upper limb.
 Nerves of lateral cervical region cont…
c. Cervical plexus
•The anterior rami of C1–C4 make up the roots
of the cervical plexus.
•Each participating ramus, except the first,
divides into ascending and descending branches
•These unite with the branches of the adjacent
spinal nerve to form the loops.
•The cervical plexus lies anteromedial to the
levator scapulae and middle scalene muscles
and deep to the SCM.
 Cervical plexus cont…
• The superficial branches of the plexus that
initially pass posteriorly are cutaneous
(sensory) branches.
• The deep branches passing anteromedially
are motor branches, including the roots of the
phrenic nerve to the diaphragm and the ansa
cervicalis
 Branches of the cervical plexus
1. Ansa cervicalis
•The superior root of the ansa cervicalis, conveying
fibers from spinal nerves C1 and C2.
•The inferior root of the ansa cervicalis arises from
spinal nerves C2 and C3.
•The superior and inferior roots unite, forming a
secondary loop called ansa cervicalis.
•It consist of fibers from the C1–C3 spinal nerves.
•It gives branch to supply the infrahyoid muscles,
including the omohyoid, sternothyroid, and sternohyoid.
 Branches of the cervical plexus cont…

2. Cutaneous branches of the cervical plexus

•They emerge around the middle of the posterior
border of the SCM, often called the nerve point
of the neck.
•They supply the skin of the neck, superolateral
thoracic wall, and scalp between the auricle and
the external occipital protuberance.
 Branches of the cervical plexus cont…

3. Lesser occipital nerve (C2): supplies the skin

of the neck and scalp posterosuperior to the
auricle.
4. Great auricular nerve (C2 and C3): ascends
vertically across the oblique SCM to the inferior
pole of the parotid gland.
•Supply the skin and the sheath surrounding the
parotid gland, the mastoid process, and both
surfaces of the auricle and an area of skin
extending from the angle of the mandible to the
mastoid process.
90
 Branches of the cervical plexus cont…
5. Transverse cervical nerve (C2 and C3):
supplies the skin covering the anterior cervical
region.
•It curves around the middle of the posterior
border of the SCM and passes anteriorly deep to
the EJV and platysma.
6. Supraclavicular nerves (C3 and C4): emerge
as a common trunk under cover of the SCM
•Supply the skin of the neck that cross the
clavicle and supply the skin over the shoulder.
 Branches of the cervical plexus cont…
7. Phrenic nerves (C3, C4 and C5)
•Provide motor supply to the diaphragm as well
as sensation to its central part.
•In the thorax, each phrenic nerve supplies the
mediastinal pleura and pericardium.
•Forms at the superior part of the anterior
scalene muscle at the level of the superior
border of the thyroid cartilage.
Phrenic nerves (C3, C4 and C5) cont…
•On the left: the phrenic nerve crosses anterior to
the first part of the subclavian artery.
•On the right: it lies on the anterior scalene
muscle and crosses anterior to the second part of
the subclavian artery.
•On both sides: the phrenic nerve runs posterior
to the subclavian vein and anterior to the
internal thoracic artery as it enters the thorax.
 Lymph nodes in lateral cervical region
• Lymph from superficial tissues in the lateral
cervical region enters the superficial cervical
lymph nodes that lie along the EJV.
• Efferent vessels from these nodes drain into the
deep cervical lymph nodes that lie along the
IJV.
 Anterior cervical region(anterior triangle)
of the neck
Boundaries
Anterior- median line of the neck
Posterior- anterior border of the
sternocleidomastoid
Base (superior) - inferior border of mandible
and plane connecting angle of the mandible
to mastoid process
Apex – at jugular notch
Floor - formed by pharynx, larynx and thyroid
gland

96
 Muscles in anterior cervical region
• The muscles in the anterior triangle of the neck
can be grouped according to their location
relative to the hyoid bone:
A. Suprahyoid muscles – include
• Stylohyoid,
• Digastric
• Mylohyoid, and
• Geniohyoid
1. Mylohyoid muscle
• Forms the floor of the mouth below tongue
Origin – mylohyoid line of the mandible
Insertion – body of hyoid
Nerve supply – mylohyoid nerve from V3
Action - Elevate the hyoid bone

101
2. Geniohyoid muscle
• Superior to mylohyoid; reinforce floor of
mouth
Origin – from inferior genial tubercle of
mandible
Insertion – into the anterior surface of the
body of the hyoid bone
Nerve supply – C1 through the hypoglossal
nerve
Action – pull the hyoid bone up and forward,
shorten mouth floor and widens pharynx

102
3. Stylohyoid muscle
• Lies above the posterior belly of the digastric
muscle
Origin – styloid process
Insertion – body and greater horn of the hyoid
Nerve supply – suprahyoid branch of facial
nerve
Action – pull the hyoid bone back & upward
during swallowing

103
4. Digastric Muscle
• Has 2 bellies connected by tendon
Origin
• Anterior belly - digastric fossa of mandible
• Posterior belly – mastoid notch
Insertion – intermediate tendon, connected to the body
and greater horn of the hyoid bone
Nerve supply
• Anterior belly – nerve to mylohyoid ( branch of
mandibular nerve)
• Posterior belly – suprahyoid (branch of facial nerve)
Action – two bellies elevate hyoid bone; the anterior
belly also depress the mandible

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105
106
B. Infrahyoid Muscles
• Depressors of the larynx and the hyoid bone
• 4 muscles arranged into two layers
Superficial layer
• Medially - Sternohyoid
• Laterally- Omohyoid
Deep layer
• Superiorly - Thyrohyoid
• Inferiorly- Sternothyroid

107
1. Sternohyoid
Origin – posterior surface of the manubrium
of sternum and the medial end of clavicle
Insertion – lower border of body of hyoid
Innervation – ansa cervicalis
Action – depress hyoid

111
2. Omohyoid
• Has two bellies united by tendon connected
to clavicle
Origin
• Superior – lower border of body of hyoid
bone
• Inferior – suprascapular ligament and notch
Insertion – intermediate tendon which is held
in place by loop of deep fascia which
connects the tendon to the clavicle and 1st rib
Innervation – ansa cervicalis
Action – depress, retract and steadies hyoid
bone.

112
3. Sternothyroid
Origin – posterior surface of the manubrium
of the sternum and the 1st costal cartilage
Insertion – oblique line of lamina of the
thyroid cartilage
Innervation – ansa cervicalis
Action – depress larynx

113
4. Thyrohyoid
Origin – oblique line of lamina of the thyroid
cartilage
Insertion – body and greater horn of the hyoid
bone
Innervation – C1 through hypoglossal nerve
Action – depress hyoid and elevates larynx

114
115
 Subdivisions of the anterior triangle
• By digastric muscle and superior belly of
omohyoid anterior triangle is divided into 4
triangles
• Submandibular triangle
• Submental triangle
• Muscular triangle
• Carotid triangle
The Submandibular (Digastric) Triangle
Boundaries:
Superiorly:
•Mandible
Anteriorly :
•anterior belly of digastric:
(abd)
Posteriorly
•Posterior belly of digastric
(pbd) & stylohyoid (sh)
Floor:
•Mylohyoid (mh), hyoglossus
(hg) & middle constrictor of
Pharynx
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 Contents of Submandibular Triangle
•Contents of submandibular
triangle are:
•Submandibular gland + lymph
nodes & structures passing
through:
•Facial artery (fa): deep to smg;
•Lingual nerve &
submandibular ganglion (ln)
•Submandibular duct (smd)
•Lingual artery (la)
•Hypoglossal nerve (XII)
•Facial vein (sup. to smg) &
•Cervical branch of facial nerve
118
 Submandibular Triangle cont…

•The lingual nerve &

submandibular duct pass
thru a gap b/n hyoglossus
(hg) & mylohyoid (mh)
muscles
•Hypoglosal nerve
superficial to hyoglossus
(hg) & deep to mylohyoid .
•The lingual artery passes
deep to hyoglossus muscle.
119
 The Submental Triangle
•The submental triangle is
located b/n the two anterior
digastric muscles (abd).
Boundaries:
Anterior - chin
Lateral - anterior border of
right and left digastric
muscles
Inferior – body of hyoid
bone
Floor – mylohyoid muscle
120
 Content of Submental Triangle

1. The submental lymph node(s) (ln) drain

the floor of the mouth.
2. The mylohyoid muscle (mh) arise from the
body of the hyoid bone & insert into the
mandible.
 Mylohyoid aids in swallowing & in
depressing the mandible.
121
122
 Carotid triangle
Boundaries
• Superior –posterior belly of the digastric and
stylohyoid
• Anteroir - superior belly of the omohyoid
• Posterior - anterior border of
sternocleidomastoid muscle
• Roof – skin, superificial fascia, deep fascia
• Floor – thyrohyoid, hyoglossus, middle and
inferior constrictors of pharynx

123
124
 Contents of the carotid triangle
1. Internal jugular vein
2. Common carotid artery
3. Internal carotid artery
4. External carotid artery (supplies the neck & facial
region);
5. Cranial nerves X, XI, & XII
6. Ansa Cervicalis (sup. root);
7. Deep cervical lymph nodes
8. Carotid body & carotid sinus

125
 Contents of the carotid triangle cont…

• The common carotid artery divides at the upper

border of thyroid cartilage (Level of C4) into an
internal & external carotid artery.

• The internal carotid artery has no braches in the

neck.

126
 Carotid sinus
• A dilation of the proximal part of the internal
carotid artery.
• Innervated principally by the glossopharyngeal
nerve (CN IX) through the carotid sinus nerve
as well as by the vagus nerve (CN X).
• It is a baroreceptor (pressure receptor) that
reacts to changes in arterial blood pressure.
 Carotid body
• A small, reddish brown ovoid mass of tissue that
lies on the medial (deep) side of the bifurcation
of the common carotid artery.
• Supplied mainly by the carotid sinus nerve (CN
IX) and by CN X.
• It is a chemoreceptor that monitors the level of
oxygen in the blood.
• It is stimulated by low levels of oxygen and
• Thus, initiates a reflex that increases the rate and
depth of respiration, cardiac rate and blood
pressure.
129
 Common carotid artery
• Right CCA begins from brachiocephalic trunk
posterior to sternoclavicular joint

• Left CCA begins from arch of aorta

• Lie within carotid sheath

• Divides at the level of superior border of the thyroid

cartilage into internal and external carotid arteries

130
131
 Internal carotid
• Has no branches in the neck
In the skull it gives:
• Ophthalmic Artery
• Posterior Communicating Artery
• Anterior Cerebral Artery
• Middle Cerebral Artery

132
 External carotid artery
• Begin at superior border of thyroid cartilage
• Lie deep or superficial to the posterior belly of
the digastric
• Anteromedial to internal carotid artery
Branches
1. Superior thyroid artery – It curves downward
to the upper pole of the thyroid gland.
• It is accompanied by the external laryngeal
nerve, which supplies the cricothyroid muscle.

133
134
2. Lingual artery- It loops upward and forward
and supplies the tongue
•Gives branch to sublingual gland
3. Ascending pharyngeal artery
• Ascends deep to the internal carotid artery
Branches – to the pharynx, prevertebral
muscles, middle ear, and cranial meninges

135
4. Facial artery
• Covered by posterior belly of digastric, stylohyoid
muscles & angle of mandible
• Mark deep groove on submandibular salivary gland
before hooking the inferior border of the mandible to
join the face (pulse can be felt)
Branches – tonsillar art, palatine art and submandibular
art

136
5. Occipital artery
• Run along the inferior border of the posterior belly of
the digastric muscle superficial to the internal
carotid, CN IX, X & XI
• Crosses apex of posterior triangle and supplies the
scalp
6. Posterior auricular artery
• supply back of auricle, mastoid and posterior scalp

137
 Memory device for the six branches of the
carotid artery (1-2-3):
• One branch arises medially (ascending
pharyngeal),
• Two branches arise posteriorly (occipital
and posterior auricular), and
• Three branches arise anteriorly (superior
thyroid, lingual, and facial)
Terminal branches of ECA
1. Superficial temporal artery: ascends over the
zygomatic arch, where it may be palpated just in front
of the auricle.
•It is accompanied by the auriculotemporal nerve, and
it supplies the scalp.
2. Maxillary artery: The maxillary artery runs forward
medial to the neck of the mandible and enters the
pterygopalatine fossa of the skull.
•Its branches supply the upper and the lower jaws, the
muscles of mastication, the nose, the palate, and the
meninges inside the skull.

139
140
 Internal jugular vein
• The internal jugular vein is a large vein that
receives blood from the brain, face, and neck.
• It starts as a continuation of the sigmoid sinus
and leaves the skull through the jugular foramen.
• It then descends through the neck in the carotid
sheath lateral to the vagus nerve and the internal
and common carotid arteries.
• It ends by joining the subclavian vein behind the
medial end of the clavicle to form the
brachiocephalic vein

141
Tributaries
• Inferior petrosal sinus,
• Facial vein
• Lingual vein
• Pharyngeal vein
• Superior & middle thyroid vein
• Occipital vein

142
143
 Muscular or Visceral Triangle

•The muscular triangle has

the following boundaries:
•Medially: mid line of neck
•Laterally: superior belly of
omohyoid
•Superiorly: hyoid bone
•Inferiorly: jugular notch
•Floor: sternohyoid &
sternothyroid muscles
Beneath the floor lie:
•sh, st, oh, & th (strap muscles)
thyroid gland, larynx, trachea innervated by Ansa cervicalis (C1,
& esophagus C2 & C3) & are depressors of
hyoid & Larynx.
144
 Contents of muscular triangle:
•Infrahyoid muscles (strap muscles):
(i). Superficial layer:
•Sternohyoid (sh)
(ii). Deep layer:
•Sternothyroid (st)
•Thyrohyoid (th)
2. Thyroid & parathyroid glands.
•Suprahyoid muscles – found in submental &
submandibular triangles.
• raise the hyoid bone & larynx as in swallowing &
talking.

146
Deep structures in the neck

147
 Prevertebral muscles
• Extend from skull base to superior
mediastinum,
mediastinum covering vertebral column.
• Covered by prevertebral fascia.
• Are flexors of head and neck
• Supplied by ventral rami of cervical nerves

148
This muscles includes:
Longus colli (cervicis)
Longus Capitis
Rectus Capitis Anterior
Rectus Capitis Lateralis

149
150
151
 Root of the neck
• Junction area between thorax and neck
• Boundaries
• Laterally - first rib & their costal cartilage
• Anteriorly - manubrium of sternum
• Posteriorly - body of T1

152
 Arteries in the root of neck
Brachiocephalic trunk
•Covered anteriorly by the right sternohyoid
and sternothyroid muscles
•It arises in the midline from the beginning of
the arch of the aorta.
•Behind sternoclavicular joint divide into right
common carotid and subclavian artery
•Has no branch but a variable artery called
thyroid ima artery may be found

153
Subclavian artery
•Arise from brachiocephalic artery on right side
and from arch of aorta on left side
•Runs over the apex of the lung, posterior to
the scalene anterior and superior to first rib
• It can be divided into 3 parts relative to
scalenus anterior:
1st part: Medial to scalenus anterior
2nd part: Posterior to scalenus anterior
3rd part: Lateral to scalenus anterior

154
Branches of subclavian artery
• Vertebral artery:
• Internal thoracic artery
• Thyrocervical trunk
• Costocervical trunk and
• Dorsal scapular artery

155
156
 Veins in the root of neck
Anterior jugular vein
• Arise in submental region from submental
venous plexus
• Descends between anterior medial line and
anterior border of SCM.
• At root of neck turns laterally and opens into
external jugular vein
• Superior to sternum right and left veins are
connected by jugular venous arch

157
158
 Veins in the root of neck cont…
Subclavian vein
• Continuation of axillary vein from lateral
border of first rib
• Joins internal jugular vein at medial border of
scalenus anterior to form brachiocephalic vein
Tributaries
• External jugular vein
• Dorsal scapular vein
• Thoracic duct in the left
• Right lymphatic duct in the right
• Bronchomediastnal trunk

159
160
 Sympathetic trunk
• The cervical portion located anterolateral to the
vertebral column, in front of prevertebral
muscles
• Contains three pairs of cervical ganglia
(superior, middle & inferior)

161
 Sympathetic trunk cont…
• The ganglia receive preganglionic fibers from:
Superior 4 thoracic spinal nerves through white
rami communicantes
• Postganglionic fibers passes to:
1. Cervical spinal nerves via gray rami
communicantes.
2. Thoracic viscera via cardiopulmonary splanchnic
nerves.
3. Head and viscera of the neck via cephalic arterial
branches (rami).
• The fibers accompany arteries as sympathetic periarterial
nerve plexuses, especially the vertebral and internal and
external carotid arteries

162
 Inferior cervical ganglion
• Mostly (80%) fused with first thoracic ganglion to form
large ganglion called cervicothoracic (stellate) ganglion
• This star-shaped (L. stella, a star) ganglion lies anterior
to the transverse process of the C7 vertebra.
Postganglionic fibers passes to:
• Ventral rami of C7 & C8 nerves via gray rami
communicantes
• Vertebral artery – form plexus around vertebral artery
• Subclavian artery – form plexus around subclavian
artery
• Heart:- via the inferior cervical cardiac nerve
(cardiopulmonary splanchnic nerve)

164
165
 Middle cervical ganglion
• The smallest, at the level of transverse process
of C6 on the anterior aspect of inferior thyroid
artery
• Postganglionic fibers passes via:
Gray rami communicantes to the anterior rami of
the C5 and C6 spinal nerves,
Middle cervical cardiac (cardiopulmonary
splanchnic) nerve to the heart and
Arterial branches to form the peri-arterial plexuses
to the thyroid gland

166
 Superior cervical ganglion
• The largest, 2-3 cm long, at the level of atlas
and axis
• Communicate with 9th, 10th and 12th cranial
nerves
• Postganglionic fibers passes:
Via gray rami comm. to upper 4 cervical nerves
Via superior cervical cardiac (cardiopulmonary
splanchnic) nerve to the heart and
Internal carotid plexus
External carotid plexus

167
168
169
 Clinical correlation
• Injury to sympathetic trunk in the neck
interrupts sympathetic supply to the head and
neck a condition known as Horner’s syndrome,
results in
• Moisis - pupillary constriction
Result from paralysis of the dilator pupillae
muscle
• Ptosis – drooping of the upper eyelid
Result from paralysis of the smooth (tarsal)
muscle intermingled with the striated muscle of
the levator palpebrae superioris.
170
 Horner’s syndrome cont…
• Anophthalmos - sinking of the eye ball
Caused by paralysis of the rudimentary smooth
(orbital) muscle in the floor of the orbit.
• Anhydrosis - absence of sweating in the head
and neck
Caused by lack of a sympathetic (vasoconstrictive)
nerve supply to the blood vessels and sweat glands.

171
 Cervical viscera
• Disposed into three layers
• Superficial - endocrine layer composed of
thyroid & parathyroid gland
• Middle - respiratory layer containing larynx
and trachea
• Deep - alimentary layer contains esophagus
and pharynx

172
 Thyroid gland
• The thyroid gland lies deep to the sternothyroid
and sternohyoid muscles.
• Located anteriorly in the neck at the level of the
C5–T1 vertebrae.
• It consists primarily of right and left lobes,
anterolateral to the larynx and trachea.

173
 Thyroid gland cont…
• A relatively thin isthmus unites the lobes over
the trachea, usually anterior to the second and
third tracheal rings.
• The thyroid gland is surrounded by a thin
fibrous capsule.
• Dense connective tissue attaches the capsule to
the cricoid cartilage and superior tracheal
rings.

174
Arterial supply
Superior thyroid artery
• A branch of external carotid artery
• Runs downwards and forwards accompanied by
external laryngeal nerve
• Supply mainly the anterosuperior aspect of the gland.
• At upper pole divide into anterior and posterior
branches
• Anterior branch descends on anterior border and
along upper border of isthmus
• Posterior branch descends on posterior border and
anastomose with ascending branch of inferior
thyroid artery, supply parathyroid gland

176
Inferior thyroid artery
• A branch of thyrocervical trunk
• Runs upwards and medially and downwards to
lower pole
• Supply the posteroinferior aspect, including the
inferior poles of the gland
• Divided into 4 or 5 glandular branches
• Terminal part related to recurrent laryngeal
nerve
• Ascending branch anastomoses with posterior
branch of superior thyroid

177
thyroid artery cont…
•Superior thyroid artery supplies upper 1/3 of
lobes and upper half of isthmus and inferior
thyroid supplies the rest; but they anastomoses
freely

178
179
Thyroid ima artery (lowest thyroid artery)
• Variable, in approximately 10% of people, a
small, unpaired.
• Usually arises from brachiocephalic trunk
• May arise from the arch of aorta or from the
right common carotid, subclavian, or internal
thoracic arteries
• Ascends on the anterior surface of the trachea,
which supplies it.
• Continues to the isthmus of the thyroid gland,
where it divides into branches that supply it.

181
Veins of Thyroid Gland
•Three pairs of thyroid veins usually form a thyroid plexus
of veins on the anterior surface of the thyroid gland and
anterior to the trachea.
1.Superior thyroid veins accompany the superior thyroid
arteries; they drain the superior poles of the thyroid gland;
2.Middle thyroid veins run parallel with the inferior
thyroid arteries; they drain the middle poles.
3.Inferior thyroid veins drain the inferior poles.
•The superior and middle thyroid veins drain into the
IJVs; the inferior thyroid veins drain into the
brachiocephalic veins.

183
184
Lymphatic drainage
• Upper part - drains to upper deep cervical
lymph nodes
• Lower part - drains to lower deep cervical
lymph nodes
Nerve supply - from the 3 cervical ganglia, reach
through cardiac and laryngeal branch of vagus.

185
 Thyroidectomy
• A thyroidectomy is a relatively common surgical
procedure which usually involves excision of part or
most of the gland, leaving some gland behind.
• Usually carried out for benign diseases such as
multinodular goiter & thyroid carcinoma.
• Posterior part is preserved to avoid removal of
parathyroids gland.
• Because of location of thyroid gland there is a
possibility of damaging other structures during
thyroidectomy:  parathyroid glands; recurrent
laryngeal nerve, sympathetic trunk, & rarely,
nerves of the carotid sheath.

186
 Parathyroid glands
• Small & pea shaped
• Two in each lobe; superior & inferior
• Embedded in the posterior wall of the fibrous
capsule of thyroid gland
• Superior one is more constant, present near
middle of posterior surface
• Inferior is more variable, near or below the
inferior pole

187
 Parathyroid glands cont…
Arterial supply – branches from anastomoses
between superior & inferior thyroid arteries.
Venous drainage – plexus of veins on the anterior
surface of thyroid gland and trachea.
Lymphatic drainage – with thyroid and thymus
into deep cervical lymph nodes and paratracheal
groups
Nerve supply – from middle and superior cervical
ganglia

188
189
 The Larynx
• Located anterior to laryngopharynx
Function:
 vocalizing (voice box).
 Provides passageway for air.
Laryngeal Skeleton
• It is composed of three paired & three unpaired
cartilages:
Paired Cartilages:
• Arytenoid, corniculate & cuneiform
Unpaired Cartilages:
Thyroid, cricoid & epiglottis
Thyroid cartilage
The thyroid cartilage is
made up of two laminae that
fuse anteriorly to form the
laryngeal prominence
(Adam's apple).
The angle that they make
is usually more acute in
males & thus, more
prominent.
•The inferior horns articulate
with the sides of the cricoid
Anterolateral View
cartilage and form the
cricothyroid joint.
192
Cricoid cartilage
•The cricoid cartilage is the only
complete cartilage of the larynx.
•Anteriorly is the cricoid arch
•The cricoid arch expands
posteriorly where it forms a
square-shaped lamina.

Anterolateral View
Arytenoid cartilages
•The arytenoid cartilages sit on top of cricoid lamina
posteriorly & articulate there at the cricoarytenoid joints.
•Arytenoid cartilages is pyramidal in shape, with the
base being triangular in shape, has 3 processes:
 The vocal process (extends anteriorly),
 The muscular process lies laterally and
 The third process is not well defined.
• The vocal ligament (vocal
cord) extends from vocal
process to the back side of
the thyroid cartilage.
• Any movement of the
arytenoid cartilage will have
an effect on placement of the
vocal cords (making them
loose or taut, bring them
together or spreading them
apart).
196
Epiglottis
•The epiglottis is attached inferiorly to the thyroid
cartilage by a small stem.
•Its lateral & superior borders are free.
•Superior border of epiglottis can be seen thru the oral
cavity.
Corniculate and cuneiform cartilages
•Appear as small nodules in the posterior part of the
ary-epiglottic folds.
•The corniculate cartilages attach to the apex of the
arytenoid cartilages
•The cuneiform cartilages do not directly attach to
other cartilages.
 Membranes and Ligaments of the Larynx
Extrinsic ligaments:
1. Thyrohyoid membrane:
•Extends from upper border of thyroid cartilage to
greater wing of hyoid bone.
•It is pierced by internal laryngeal nerve & superior
laryngeal artery.
•In the midline, it is thickened to form the median
thyrohyoid ligament.
2. Cricotracheal ligament: This connects the cricoid
cartilage to the first ring of the trachea
 Ligaments of the Larynx cont…
Intrinsic ligaments
• composed of two parts:
1). A lower cricothyroid ligament and
2). An upper quadrangular membrane.
Cricothyroid ligament: The lower margin is attached to
the upper border of the cricoid cartilage.
Its upper free margin, composed almost entirely of elastic
tissue, forms the important vocal ligament on each side
Quadrangular membrane: This extends between the
epiglottis and the arytenoid cartilages
• Its thickened inferior margin forms the vestibular
ligament

200
 Muscles of the Larynx
• The muscles of the larynx may be divided into two
groups:
• Extrinsic and intrinsic.
Extrinsic Muscles
• These muscles move the larynx up and down during
swallowing.
• Elevation: The digastric, stylohyoid, mylohyoid,
geniohyoid, stylopharyngeus, salpingopharyngeus, and
the palatopharyngeus muscles
• Depression: The sternothyroid, the sternohyoid, and the
omohyoid muscles
 Intrinsic Muscles
Two muscles modify the laryngeal inlet
•Narrowing the inlet: The oblique arytenoid
muscle
•Widening the inlet: The thyroepiglottic
muscle
Muscles of the Larynx

204
206
 Intrinsic Muscles cont…
Five muscles move the vocal folds (cords):
•Tensing the vocal cords: The cricothyroid
muscle
•Relaxing the vocal cords: The thyroarytenoid
(vocalis) muscle
•Adducting the vocal cords: The lateral
cricoarytenoid muscle
•Abducting the vocal cords: The posterior
cricoarytenoid muscle
•Approximates the arytenoid cartilages: The
transverse arytenoid muscle
Anterior view
 Nerve Supply of the Larynx
Sensory Nerves
Above the vocal cords: The internal laryngeal
branch of the superior laryngeal  branch of the vagus
Below the level of the vocal cords: The recurrent
laryngeal nerve.
Motor Nerves: All the intrinsic muscles of the larynx
except the cricothyroid muscle are supplied by the
recurrent laryngeal nerve.
•The cricothyroid muscle is supplied by the external
laryngeal  branch of the superior laryngeal  branch
of the vagus.
Blood Supply of the Larynx
•Upper half of the larynx: The superior
laryngeal  branch of the superior thyroid
artery
•Lower half of the larynx: The inferior
laryngeal  branch of the inferior thyroid
artery
Lymph Drainage of the Larynx
•The lymph vessels drain into the deep cervical
group of nodes.
 Trachea (cervical portion)
• Non collapsible fibrocartilagenous tube, extends
from larynx to lung roots
• Kept patent by C- shaped cartilaginous rings
• The posterior deficient part is covered by
trachealis muscle.
• Whole length =12 cm
• Extend from the level of cricoid cartilage (C6) to
level of T4/T5.
• Descends in the midline of the neck as a
continuation of the larynx

212
Arterial supply- The upper two thirds is supplied
by the inferior thyroid arteries and the lower third
is supplied by the bronchial arteries.
Veins – inferior thyroid vein
Lymph Drainage of the Trachea
•Into the pretracheal and paratracheal lymph
nodes and the deep cervical nodes
Nerve supply
• Parasympathetic - recurrent laryngeal
• Sympathetic – cervical ganglion

213
 Applied anatomy
Tracheotomy
• Surgical incision through anterior wall of
trachea in case of laryngeal obstruction
• Done b/n 2nd and 3rd rings (covered by
isthmus).
• Because supra isthmus is liable to stricture and
infra isthmus is dangerous due to thyroid
vessels

214
Thank you!!!