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Review Lecture

The material thats included in the exam is:

The Sku
The Neck
The Face


**We w start by takng about the man topcs n the neck whch are:
and deep superficial ascial coverings of the neck f the -

of the triangle erior and ant erior and the post s The muscle -
neck

k , the nec that covers fascia ficial super the s start wth Let =>
there are specfc structures n t that you shoud know:
1) &8TANEO86 NERVE6 :
they are four nerves ,for each one you shoud know the orgn and the
areas t provdes sensaton to):
-* ln the posterior aspect of the neck:
greater occipital n that arses from the dorsal ramus of &

*ln the anterolateral aspect of the neck:
1- Lesser occipital n
y arises from ant ramus of C2
y gives sensation to the skn behnd the aurcen the externa
ear)

-Great auricular n
y arises from ant Ram of C2 & C3
y Gives sensation to the:
,nf aspect of the aurce, specay the obue fat bag)
Skn over the parotd gand
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$nge of mandbe

3-Transverse cutaneous(or cervical) n.
y Arises from ant Ram of C2 & C3
y Gives sensation to skn over ant ( of the neckfrom the ower
border of the mandbe to the sternum)

4- 6upraclavicular n 'vded nto 3 branchesmed ,ntermedate, at))
y Arises from ant Ram of C3 & C4
y Gives sensation to:
The 6kin over the clavicle all the way down to sternal angle of
manubrium (second rib)
The 6kin over the upper 1} of the shoulder ,(deltoid muscle)
all 6kin in the lower 1} of the post. ( of the neck.


) 3latysma muscle :
,t attaches superory to the nferor border of mandbe and anges of
mouth, and nferory t attaches to the deto-pectora fascawhch s a
deep fasca over pectoras ma|or and detod musce
3)EXTERNAL ]8G8LAR VElN (E]V)
***,t starts behnd the ange of the mandbe
***,ts Formed by the fuson of two vens whch are the :
1-post $urcuar ven
2- post dvson of retromandbuar ven
**note : the ant. dvson of retromandbuar ven drans nto the faca ven
,t drans nto: ***
1- subcavan ven
2- nterna |uguar ven

4)Lymph Nodes (superficial L.N)
-LN n upper 1/2of the neck aong E]V caed sup. superficial L.N.
- LN n ower 1/2of the neck aong l]V caed nf deep fascial L.N

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Now we are going to talk about the deep Fascia
Note : a the ayers of deep Fascia are snges except the &AROTlD
6+EAT+
**Layers of deep fascia are:
1-carotid sheath, its contents are:
1- &ommon carotid artery internal carotid a most meda
structure)

2- lnternal jugular v(l]V)most atera structure)

3- Vagus n. (X) most post structure) whchs man functon s
parasympathetc nnervaton to nterna vscera neck, thorax,
abdomen)
4- Deep cervical L.N whch accompany the l]V


-lnvesting layer:
,t surrounds the neck, and Contans 2 muscles . whch are?? 6&0 at ant-
** what do we mean by common carotid??
At the level of thyroid cartilage (Adams apple) C3- C4, the common carotid artery
divides into 2 arteries:-
1-internal carotid a. : which continues with the carotid sheath all the way to the
skull to provide blood supply to the ant sup part of the brain while the post.
inf. Part is provided by the vertebral a.
2- external carotid a. : leaves the carotid sheath to provide blood supply to most of
the structures in the head and neck region.
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3: 3retracheal layer
,t conssts of two parts, muscuar and vscera:

** Muscuar part covers nfrahyod musces ,whch are:
1:omohyoid
:sternohyoid(from sternum to hyoid bone)
3:sternothyroid(from sternum to thyroid)
4:thyrohyoid(from thyroid to hyoid)
$ of these musces are nnervated by $NS$ cervcas, except the
Thyrohyoid which is innervated by the ant. ramus of &1
**Vscera part covers whch viscera organs) ? thyrod & parathyrod
gand& trachea & esophagus aso we have the arynx & pharynx superory
unt the eve of C6 as we move beow C6 the arynx becomes trachea &
the pharynx becomes esophagus)
$s we move down the trachea & esophagus descend nto thorax and bend
with fibrous pericardium



4: 3revertebral layer: t encoses cervca vertebra musces,whch are:
atera ange of the neck) & trapezius post) musces
,t aso Covers 2 savary gands parotid & superficial part of
submandibular) you shoud be specfc and say superficial part of
submandibular , because as you know the submandbuar gand has two
parts , one n the neck we ca t deep and the other one s n the ora cavty
we ca t superfca
Note: n the Thckened part from styod process part of tempora bone) to
the mandbe post border of ange of mandbe) there s an mportant
gament whch heps n supportng the TM|t mts the protruson of the
mandbe) stylomandibular g whch s a thckenng of the deep fasca of
parotid capsule.

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The root of the neck
y the area of the neck that es mmedatey above the superor thoracc
openng
boundares of the superor thoracc openng are :
y anterory => manubrum
y Lateray => frst rb
y posterory => T1

structures found in the root of the neck :
1- subclavian a. whch s the most mportant structure n the root of the
neck ,ts dvded by scaenus anteror musce nto 3 parts :
y first part :
-from ts orgn to scaenus anteror, and t w gve me 3 branches :
vertebra a goes above superory)
thyrocervca trunck goes forward anterory ), ts branches are:
*nferor thyrod a
* transversesuperfca) cervca a
*suprascapuar a
nterna thoracc a goes downward nferory )

* Ant. group Longus muscles :1) Longus &apitis and ) Longus
&ervicis
* Lat. group 6calene muscles:1) 6c. anterior ) 6c. medius 3) 6c.
posterior
* 3ost. group 1) splenius capitis ) semispinalis capitis and 3)
Levator 6capulae

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y second part :es behnd the scaenus anteror and t gves me one
branch:
costocervca trunk, goes backward posterory )

y third part : es atera to scaenus anteror, to the outer border of the
frst rb to become axary a The thrd part has no branches, but
sometmes n very rare cases t may have one branch
36 : pay attention for these branches they are important in the
exam and you will be asked about them..
- thoracic duct whch s the argest ymph vesse n the body
3- roots and trunks of the brachial plexus the roots from C5-T1 are
wthn the scaene hatus , but the trunks are wthn the posteror trange of
the neck ,then the trunks eave behnd the cavce and become dvsons
,beneath the cavce ,n the axa,the dvsons become cords )
%oundaries of the scalene hiatus :
y $nterory : scaenus anteror
y 3osterory : scaenus medus
y ,nferory : frst rb
&ontents of the scalene hiatus :
o roots of bracha pexus
o second part of the subcavan artery

- scaenus anteror s reated anterory to the subcavan ven
- scaenus anteror s reated anterory to phrenc nerve C4-C5)
- scaenus anteror s reated posterory to subcavan artery
3osterior triangle of the neck :

boundries :
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y anterory :posteror border of the SCM
y posterory : anteror border of trapezus
y nferory : mdde 1/3 of the cavce
you need to know whch musce makes the boundares and ts
nerve suppy ,see the questons at the end)

contents :
4 arteries :
1- occpta a : arses from the posteror aspect of the externa carotd
artery from the apex of the trange)
2- thrd part of the subcavan : ocated at the base of the trange
3- transverse cervca artery
4- suprascapuar artery

5 veins :
1- occpta ven there are 3 dfferent scenaros for ts dranage),so:
- t mght go deep to the suboccpta trange to dran nto the
vertebra ven
- or t goes to the nterna |uguar ven
- or t goes to the posteror aurcuar ven to make the externa |uguar
ven

2- transverce cervca ven
3- suprascapuar ven
4- subcavan ven
5- externa |aguar ven


6uboccipital triangle has three main structures :
y vertebra artery
y vertebra ven
y supoccpta nerve posteror branch of c1 )
** you shoud know the name,orgn,nserton and nnervaton of each musce
that forms the suboccpta trange
anterior triangle of the neck : we have 4 sub triangles
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( you should know each sub triangle and its boundaries)
y submenta trange
y submandbuar trange ganduar regon )
y carotd trange vascuar trange )
y muscuar trange

&ontents :
y superfca part of submandbuar gand
y faca artery and ven n submandbuar trange theres a dfference
between faca artery and ven ,the artery s ocated deep to the gand
$nd the vens s ocated superfca to the gand, and t drans nto the
nterna |uguar ven )
y hypogossa nerves Crana nerve number12)
*O: $ of the foowng statements are true regardng the hypogossa
nerve ,except:
1-ts ocated n the carotd trange 2-t passes superfca to
hypogossus musce
3-t passes deep to the dgastrc musce 4- t goes deep to the
myohyod musce
5-non of the above
*$: 5
&arotid triangle contents :
y we have the carotd sheath wth ts contents
y ansa cervcas s attached anteror to the sheath orgn C1,C2,C3 )
y sympathetc chan s attached posteror to the carotd sheath

External &arotid Artery (E&A )
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** t has 8 branches ,you shoud know them and ther order
*one 0EDlALLY :
1- ascendng pharyngea artery : suppes the wa of the pharynx
*three ANTERlORLLY :
- faca artery the most superor of the anteror arteres )
3- ngua artery
4- superor thyrod artery the most nferor of the anteror arteres )
*two 3O6TERlORLLY
5- posteror aurcuar
6- occpta artery
*Two terminations :
7-Maxary artery
8-Superfca tempora artery
Areas of pulse sensation :
1- tempora
2-faca
3-carotd

These are the questions that the doctor asked during the
lecture ,they might help you know what type of questions
youll have in the exam..
* : what is the muscle that separates the carotid from the
submandibular triangle ?
$:posteror bey of dgastrc
*: what is the motor nerve supply to the muscle that separates the
carotid from the submandibular triangle 7
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$: cervca branch of faca nervethe musce s pos bey of dgastrcs)
* : what is the motor nerve supply for the muscle that separates
between the carotid and the muscular triangle 7
$:ansa cervcas superor bey of omohyod m )

*: what is the nerve supply for these muscles 7
-styohyod => cervca branch of faca nerve
-genohyod => branch from C1 va hypogossa nerve
-myohyod => nerve to myohyod
-ant Bey of dgastrc => nerve to myohyod
* :the motor nerve supply for the anterior boundary of the
posterior triangle is 7
$:accessory nerve C11 because the ant Boundary s SCM)
*: what is the motor nerve supply for the muscle that forms the
posterior boundary of the neck 7
$:accessory nerve C11 because the pos boundary s Trapezus musce)
**SCM and Trapezus musces are nnervated by the same nerve

*: what is the motor nerve supply for the muscle that divides the
posterior triangle into two sub triangles 7
$:ansa cervcas because the musce that dvdes t s the nf Bey of
Omohyod)

*: what is the medial boundary of the submandibular (digastric)
triangle 7
$:ant Bey of dgastrc

*:which muscle separates between the carotid and the muscular
triangles 7
$: sup Bey of omohyod
*1:All of the following are found in the superficial fascia except
the
$: Lesser occpta n C: 3atysma m
B: E|V ': accessory nerve
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*: all of following are covered by the investing layer except:
$: SCM C: parotd
B:trapezus ': submandbuar
E: non of above
*3: All of the above receive innervation from - 6upraclavicular n.
$: Skn over the cavce

B:Skn over upper 1/2 of the shouder,detod musce

C: a Skn n the ower 1/2 of the post (

': a of above

*4: which of these pairs are incorrect related to the carotid sheath
7

$: ,|V MOST at b: carotd artery most post

C: Vagus nerve most ant d: deep cervca around ,|V

*5 : all of the following muscles receive motor innervation from the
cervical branch of facial n except :
a: patysma b: styohyod
c:postbey of dgastrc d: none of the above
E: a of the above







*1: : accessory nerve ,N the deep ayer
*2: the 'r sad you shoud be specfc ,t shoud be superficial part of
submandibular


OUEST,ON 1* 2* 3 4 5
$NSWER ' ' ' C '
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The End
wish you all the best in the Exam
forgive us if there is any mistake
Done by :
Haitham Oweis & Rmz Rabadi