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N 15A
MA 584C
NECK- I
Lateral (Posterior) ! and Suboccipital !
Reading: Moore and Agur 583-596
M.Pizzimenti, Ph.D.
OBJECTIVES:
Identify the special characteristics of cervical vertebrae and describe the function of the
hyoid bone.
Outline the borders and components of the triangles of the neck.
Name and describe the muscles found in the posterior and anterior (sub) triangles of the
neck.
Describe the principal sensory cutaneous nerves of the neck; describe area of cutaneous
innervation by these nerves; identify on a diagram the site of local anesthetic injection
that will produce the best results.
Outline the layers of fascia of the neck, describe their location, function and contents.
Describe the suboccipital triangle: List its borders and trace the course of the vertebral
a.,v.
Describe and outline the clinical presentations of: torticollis, CN XI lesion, phrenic nerve
block, carotid endarterectomy, IJV jugular pulse, IJV puncture

Superficial Fascia

Deep to the skin and contains variable amount of fat, lymph vessels and nodes, nn., and platysma
m.

The Bony Skeleton of
the Neck

Cervical vertebrae:
Seven in number
Typical features:
lamina, pedicle,
transverse process,
bifid spinous process
(C3-C6), foramina
transversarium

Atypical features:
Atlas (C1): anterior and posterior tubercles, no spinous process
Axis (C2): odontoid (dens) process

The hyoid bone:
U-shaped bone at C3 vertebral level
Body, and horns serve as the base for tongue and larynx.
Infrahyoid mm. attach here

Clavicle
See notes on upper extremity


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MA 584

Cranium
Mastoid process of temporal bone
Nuchal lines
External occipital protuberance

Muscular Triangles (Regions) of the Neck

Sternocleidomastoid
Attaches from the mastoid process to clavicle and sternum
Ipsilateral action:
Bilateral action:
Supplied by CN XI and transverse cervical a.

Lateral region (Posterior !)
Posterior !
- Borders: posterior
sternocleidomastoid (SCM), ant.
border of trapezius, and clavicle.
- Investing fascia contributes to roof
- Deep cervical mm. contribute to floor
Occipital & Omoclavicular (subclavian) !
- Constituents of posterior !
- Defined by the omohyoid m.
- Borders
! Occipital !
! Omoclavicular !

Anterior region (Anterior !)
Borders: Anterior SCM, inf. Mandible, median line of neck
Superficial fascia and platysma contribute to roof
Pharynx, larynx, and thyroid gland contribute to floor
Contains smaller constituent triangles (e.g.,
carotid, submental, submandibular, and muscular)


Superficial Structures within the Posterior !
Vasculature
External Jugular v. (EJV)
- Travels vertically along SCM to drain into
the internal jugular v. (IJV) deep to SCM:
drains eventually into subclavian v.
- Formed by the joining of the retromandibular
and post. auricular v.




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MA 588
MA 584

Nerves
Spinal accessory (CN XI)
- Motor supply to trapezius and
SCM
- Crosses ! approximately 1/3
of length of SCM from
mastoid process, runs along
levator scapulae
Cutaneous branches of cervical
plexus
! Transverse cervical n. (C2 &
3): passes anterior to SCM,
deep to platysma and EJV;
sensory from anterior neck
! Great auricular n. (C2 &C3): ascends vertically, with the EJV, on SCM up to parotid
gland; sensory from post. auricle, skin over angle of mandible to mastoid process
! Lesser occipital n. (C2); travels along post. border of SCM; sensory from
posterior neck and scalp
! Supraclavicular nn. (C3 & C4); travels as a trunk deep to SCM and emerges
to send branches to shoulder and clavicle; sensory from this area.

! What would be the result of injecting an anesthetic agent at the point
where these nn. emerge? What would be lost?


! What would be the result of a lesion to the right CN XI?


! Describe torticollis


Deep Structures within the Posterior !
Muscles
Splenius capitus m.
Levator scapulae m.
Anterior and Middle scalene mm.
- form interscalene triangle
- attach on transverse processes of C4-6 and on 1
st
rib
Posterior scalene mm
- attach on transverse processes of C4-6 and on 2
nd
rib
! How might scalene mm. contribute to
respiration?





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MA 584
MA 598C
MA 584
Vasculature
Arteries: transverse cervical, suprascapular,
subclavian (3
rd
part), occipital a.
Subclavian a.

Thyrocervical trunk: branch of subclavian a.
- Transverse cervical a.

- Suprascapular a.
- Inferior thyroid a. (later)

Occipital a.
- Recall posterior neck dissection
Veins
External Jugular v.
! Recall course
! Can serve as an internal barometer to
detect increased venous pressure:
becomes distended along its course

Internal Jugular v.
- Inferior portion just deep to SCM at junction of sternal and clavicular heads
- Drains into subclavian v.
- Access point

Subclavian v.
- Travels ant. to ant. scalene m.
- Access point

Nerves
Spinal accessory (CN XI)
- Motor supply to
Ventral Rami of brachial plexus
- Contribution from spinal nn.
?
- Passes through interscalene !
with subclavian a.
Suprascapular n.

Long Thoracic n.

Dorsal scapular n.
- Usually pierces middle scalene m.
Phrenic n.
- Runs vertically and anterior to ant. scalene m.
- C3-C5 supplies _____________
Sensory nn. from cervical plexus already studied

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MA 584

Deep Cervical Fascia of the Neck:

Overview
Acts as a barrier to prevent spread of
infection; lies deep to superficial
fascia and divides into layers to
enclose specific components of the
neck.
Support viscera
Provides cleavage planes through
which tissues may be separated during
surgery
Limits spread of infection
Facilitates movement of structures of neck.


Layers of the Deep Fascia

Investing Layer:
! Surrounds the cervical
vertebrae and all the viscera
and muscles of the neck.
! Restricts abscesses
immediately deep to it from
spreading to the surface.
! Superiorly attached to
zygomatic arch and inferiorly
to the clavicle. Posteriorly
continuous with ligamentum
nuchae.

Prevertebral Layer:
- Extends from the base of the
skull down to the level of 3
rd

thoracic vertebra.
- It envelops the cervical
vertebrae, the scalene
muscles, and the prevertebral and postvertebral muscles of the
neck.
- It forms floor of the post triangle.

Pretracheal Layer:
- envelops the thyroid gland and covers larynx, trachea and part
of esophagus
- extends from the hyoid bone to the fibrous pericardium.


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Retropharyngeal Space
! Lies between ___________ and ____________ layers
! permits movement of the pharynx, esophagus, larynx and trachea during swallowing.

Carotid Sheath:
- sheath of deep cervical fascia that envelops the common and internal carotid arteries, the
internal jugular vein, the vagus nerve
- Cervical part of the sympathetic trunks lie embedded in loose connective tissue directly
posterior to the carotid sheath


Suboccipital Triangle

Deep to splenius and semispinalis capitus mm.


Muscles that comprise borders
Rectus capitus posterior major
Inferior oblique (capitus)
Superior Oblique (capitus)

Actions

Innervation


Other structures related to the area:
Greater occipital n (C2)


Vertebral a.



Rectus capitus posterior minor m.



MA = Moore, KL and Agur, AMR. 2007. Essential Clinical
Anatomy (3rd Ed), Lippincott Williams & Wilkins
MD = Moore, KL and Dalley, A. 1999. Clinically Oriented Anatomy (4th Ed), Lippincott Williams & Wilkins
GD = Tank, PW. 2005. Grants Dissector (13th Ed), Lippincott Williams & Wilkins
GA = Agur AMR and Dalley, A 2005. Grants Atlas of Anatomy (11th Ed), Lippincott Williams & Wilkins
N = Netter, FH. 2003, Atlas of Human Anatomy (3
rd
Ed), Icon Learning Systems
Unlabelled images LifeArt