Clinical Anatomy of the Neck

Triangles of the Neck

anterior, sternocleidomastoid, and posterior

Posterior triangle boundaries

anterior: sternocleidomastoidposterior: trapeziusinferior: clavicle

Posterior Triangle Contents

roots and trunks of brachial plexus, subclavian artery, cervical plexus, scalene muscles, levator scapulae, splenius capitits muscle

Splenius capitis _____ the head and unilaterally __________ it to one side

extends, rotates

Semispinalis Capitis _____ the head


Anterior pre vertebral muscles

rectus capitis anterior, longus colli, anterior scalene, longus capitis

Anterior pre vertebral muscles ____ the neck


Rectus capitis anterior and longus capitis flex at

alanto-occipital joint

Scalenes are from____ to _____

cervical transverse processes to first and second ribs

Scalenes ___ and ____ neck or _____ upper two ribs

flex and rotate, elevate

The scalenes are innervated by

cervical nerves

Rectus capitis anterior is the base of

occipital bone to anterior lateral atlas

Origin of Longus Colli

C5-T3 transverse porcesses vertebral bodies

Insertion of longus colli

C1 anterior tubercle, C2-3 bodies and transverse process

Longus capitis is ______ to _________

occipital bone to C3-C6 transverse processes

Cervical plexus is the ____ and ____ nerves to much of the neck and upper shoulder regions from the cervical spinal cord

cutaneous and motor

Nerves of the cervical plexus

CNXII, superior root of ansa cervicalis, transverse cervical, inferior root of Sansa cervicalis, phrenic, greater auricular, lesser occipital, supraclavicular

Greater auricular is cutaneous to skin near

external acoustic meatus, concha, auricle

Lesser occipital is cutaneous to

lateral occipital region

Supraclavicular is cutaneous to

supraclavicular, shoulder, upper thoracic regions

Transverse cervical is cutaneous to

anterior neck

Phrenic nerve is motor to ______


Phrenic nerve is sensory to ____

anterior mediatstinum, parietal pleura, somatic pericardium, upper abdomen

The ansa cervicalis innervates most of the ____________ EXCEPT _____

infrahyoid muscles, thyrohyoid muscles

sternocleidomastoid region contents

sternocleidomastoid, carotid artery, jugular vein, vagus nerve, jugular lymph nodes

The sternocleidomastoid is from ______

mastoid process

Sternocleidomastoid is _____ and a _____ head

sternal, clavicular

When contracted bilaterally the sternocleidomastoid ____ the head


Posterior fibers of the sternocleidomastoid have been found to ____ the neck


Unilaterally the sternocleidomastoid bends the neck to

one side

sternocleidomastoid is innervated by


anterior triangle boundaries

anterior: median line of neckposterior: sternocleidomastoidsuperior: mandible

anterior triangle contents

submandibular triangle, submental triangle, carotid triangle, muscular triangle

Muscles of the anterior triangle

thyroid gland and parathyroid glands, recurrent laryngeal nerve, larynx, trachea, infrahyoid strap muscles

Borders of the muscular triangle of the anterior neck

medial: midlinesuperior: hyoid boneposterior: superior belly omohyoid, inferior SCM

Superficial muscular triangle is covered by

skin, fascia, platysma

Hyoid muscles all attach to the

hyoid bone

Hyoid muscles assist in

mastication and swallowing

Hyoid muscles are divided into

infrahyoid and supra hyoid

Infrahyoid muscles ___ the hyoid


Nerves to the infrahyoid muscles

ansa cervicales C1 to C3

Infrahyoid muscles

sternohyoid, sternothyoid, thryohyoid, omohyoid

Sternohyoid action

depresses hyoid

Sternothyoid action

depresses thyroid

Thyrohyoid action

elevate thyroid, depress hyoid

Omohyoid action

depresses thyroid and larynx

Hyoid bone is attachment for

tongue, mouth, pharynx, strap muscles

hyoid bone increases range of

tongue, mouth, pharyngeal movements

The hyoid is the only bone that doesn't _____ with other bone


Thyroid gland function

secretes hormones responsible for basal metabolic rate

Thyroid gland innervation:

sympathetics from middle and inferior cervical ganglia

Thyroid artery is supplied by

superior thyroid artery from external carotid, inferior thyroid artery from thyrocervical trunk

parathyroid glands function

secrete parathormone, regulation of blood calcium ion, phosphate ion concentration

parathyroid supply

inferior thyroid arteries

How many parathyroid glands


Recurrent laryngeal nerve is branch of

vagus nerve

Recurrent laryngeal nerve loops around

subclavian artery on right, aortic arch on left

recurrent laryngeal nerve travels between

esophagus and trachea

Recurrent laryngeal nerve innervates

most larynx muscles

Submandibular triangular of the anterior neck contents

submandibular gland, facial artery, facial vein, hypoglossal nerve, submandibular lymph nodes, stylohyoid muscle

Borders of submandibular triangle

superior: mandibleanterior: anterior belly digastricposterior: posterior belly digastric

Submandibular gland function

secretes saliva

Submandibular gland innervation

parasympathetics from facial nerve that travel on mandibular branch of trigeminal nerve

Submandibular gland supply

facial artery

Suprahyoid muscles

mylohyoid, anterior belly of digastric, geniohyoid, posterior belly of digastric, stylohyoid

Geniohyoid action

elevated hyoid during swallowing

Stylohyoid action

elevated hyoid during swallowing

Posterior belly of digastric action

opens the jaw, elevates hyoid

Submental triangle contents

submental lymph nodes, mylohyoid muscle, mylohyoid nerve

Borders of submental triangle

sides: anterior diagastricsposterior: hyoid

Attachment of mylohyoid

mylohyoid line of mandible, body of hyoid bone

HYpoglossal nerve innervates most

tongue muscles

C1 fibers hitchhike along ____ then leave it to

CN XII, form superior root of ansa cervicalis and innervate thyrohyoid and geniohyoid muscle

Accessory nerve exits skull via

jugular foramen

Accessory nerve innervates

sternocleidomastoid muscle, trapezius muscle

Carotid triangle and sheath contents

common carotid artery, external and internal branches, internal jugular vein, vagus nerve, carotid body and sinus, hypoglossal nerve, accessory nerve, ansa cervicalis, the superior laryngeal nerve

Borders of the carotid triangle and sheath

posterior: SCMinferior: superior belly omohyoidsuperior: posterior belly digastric

Vagus nerve gives off branches to

pharyngeal plexus and a superior laryngeal branch

Superior laryngeal branch has an internal branch that is sensory to

superior aspect of the laryngeal muscosa

Superior laryngeal branch has an external branch that is motor to the

circothyroid muscle

The vagus nerve further innervates part of the _____ and is motor to the muscle in the ____ and ____ a=

epiglottis , palate and larynx

The vagus nerve is parasympathetic motor to

thoracic organs and much of the abdominal viscera

Parts of the common carotid artery

external carotid, internal carotid, common carotid

External carotid artery supplies

face, oral and nasal cavities, scalp, pharynx, etc.

Branches of the external carotid artery

superficial temporal, maxillary, facial, lingual posterior auricular, occipital, superior thyroid

External carotid artery posterior branches

superficial temporal, posterior auricular, occipital

Superficial temporal artery supplies the

temporal region

Posterior auricular artery supplies the

external ear and the scalp behind it, meninges

Occipital artery supplies the

sternocleidomastoid and deep muscles of the neck, gives of stylomastoid artery to supply facial nerve

External carotid artery anterior branches

maxillary, facial, lingual, superior thyroid

Maxillary artery supplies

muscles of mastication, TMJ, nasal cavity, etc.

Facial artery supplies the


Lingual artery supplies

oral cavity and tongue

Superior thyroid artery supplies

larynx and thyroid gland

Ascending pharyngeal artery supplies

oropharynx, nasopharynx, middle ear, skull base, hypoglossal canal, mutiple cranial nerves

Carotid body chemoreceptor monitors

blood O2 and CO2 levels

Carotid body innervated mainly by


Carotid body located at the

bifurcation of the carotid

Carotid sinus baroreceptor monitors

changes in arterial blood pressure

Carotid sinus innervated by


Carotid sinus located at

base of internal carotid artery

Internal carotid artery supplies

brain, eye, pituitary gland

ophthalmic artery supplies the

eye and orbit

Basilar artery anastomoses with

vertebral artery

Jugular venous system consists of

facial, common facial, pterygoid plexus, external jugular, internal jugular

Internal jugular drains

brain, face, and neck

External jugular drains

external head and deep face

Facial veins drains the


Pterygoid plexus communicates with

cavernous sinus and maxillary vein

Zone 1

between clavicle/suprasternal notch and cricoid cartilage

Zone 1 thoracic outlet structures

common carotid, vertebral/subclavian arteries, trachea, esophagus, thoracic duct, thymus

Zone 2

between cricoid cartilage and angle of mandible

Zone 2 thoracic outlet structures

internal/external carotids, jugular veins, pharynx, larynx, esophagus, recurrent laryngeal nerve, spinal cord, trachea, thyroid, parathyroids

Zone 3

between angle of mandible skull base

Zone 3 thoracic outlet structures

extra cranial carotid/vertebral parties, superior jugular veins

Neck fracture

fracture of a cervical vertebra, shallow water dive, hanging, serve blow to neck


injuries related to sudden disruption of neck, car accidents, fall


enlarged thyroid compensate for poor hormone production

Thyroid palpation

move being patient, use left hand to push trachea to right, put hand between triage and sternocleidomastoid, have patient sip a glass of water, thyroid moves up with swallow. Normal thyroid is not palpable

Brachial cyst

cystic mass between SCM and pharynx, failed obliteration of 2nd brachial cleft

Patent thyroglassal duct

duct fails to atrophy, connects tongue to thyroid, cyst gets fluid filled

Carotid body tumor

tumor formed by chemoreceptor cells

Carotid stenosis

narrowing of carotid lumen, athersosclerosis-inflammatory plaque, emboli-plaque breaks off and travels to brain, stroke


surgical procedure to open direct airway by making incision through trachea, -ostomy is actually making the opening

Lymphatic draining

the deep chain of lymph nodes receive most of the lymph from the head and neck including submental and submandibular nodes and parapotid nodes. Lymph from the tongue, face, and other head regions drain directly into the deep cervical nodes

Selective neck dissection

surgery for lymph node metastasis, remove nodes from one side

Radial neck dissection

surgery for lymph node metastasis, remove nodes from one side, removal of all node groups I-V