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What makes up the skeletal component of the neck?
Seven cervical vertebrae
hyoid bone
manubrium of the sternum
clavicles
Why is the hyoid bone special?
only bone in the body that is not articulated by another bone
What is significant about cervical vertebrae 3-6?
- their transverse processes include foramen transversarium where the vertebral vessels run through
Who had bifid spinous processes?
people of european descent
Which of the cervical vertebrae are "atypical"?
1st, 2nd, and 7th
What do the superior articular facets of the atlas articulate with?
The occipital condyles
What is another name for the dens?
odontoid process
What is significant about the C7 vertebrae?
- it is the vertebra prominens
- no bifid spinous process
- foramen transversaria are small
What does the hyoid bone function in?
attachment site for many muscles of the neck
keeps airway open
Where is the hyoid bone found?
anterior part of neck, at level of C7 vertebra
What can result from a hyoid fracture (such as in strangulation)?
Inability of hyoid to elevate and move anteriorly beneath tongue, can lead to aspiration pneumonia.
What layer of tissue in neck surrounds the entire outside?
subcutaneous fascia (as opposed to the deep cervical fascia
What is the outermost layer of deep fascia, and what does it cover?
the investing layer, it splits to enclose the trapezius and sternocleidomastoid (SCM) muscles at the four corners of the neck.
What deep fascie encloses encloses muscles and viscera in anterior neck?
pretracheal
What deep fascia surrounds vertebra column and associated muscles?
prevertebral fascia
What are the carotid sheaths?
fascia that combiine the carotid and some other neural conduits
What layer of CT lies between the dermis and the investing layer of deep cervical fascia?
subcutaneous layer
Where is the Platysma muscle located, what is its function, and what innervates it?
Located in subcutaneous layer of neck
functions in facial expression
Innervated by facial nerve (VII)
What does the investing layer of the neck fascia enclose?
sternocleidomastoid and trapezius muscle
parotid and submandibular glands
What does the pretracheal fascia enclose?
It is continuous with pericardium and has two layers:
1) Muscular layer - encloses infrahyoid muscles
2) Viscera layer - encloses thyroid gland, trachea, esophagus
What layer of neck fascia extends laterally as the axillary sheath into arm?
prevertebral layer
Where does the investing fascia attach?
superiorly - cranium
inferiorly - pectoral girdle
What is contained in the carotid sheath?
carotid artery
internal jugular
vagus nerve
What surrounds the retropharyngeal space?
it's posterior to the pharynx, bound:
- anteriorly by buccopharyngeal fascia
- posteriorly by prevertebral fascia
- laterally by carotid sheaths
- extends superiorly to base of skull, posteriorly to mediastinum
What space in neck can fill with puss drainage from secondary infection and inhibit swallowing and breathing.
Retropharyngeal abscess
What are the 4 main "triangles" or regions of the neck?
- Sternocleidomastoid region
- posterior cervical region
- lateral cervical region (sometimes considered part of posterior)
- anterior cervical region
What is the lateral triangle split up into?
Occipital triangle
supraclavicular triangle
What is the anterior triangle split up into?
- submandibular
- submental
- carotid
- muscular
What are the two heads of the sternocleidomastoid region?
sternal attachment to manubrium

and clavicular attachment attached to medial third of clavicle
What nerve innervates the sternocleidomastoid muscle?
spinal accessory nerve (CN XI)
Bilateral action of both SCM muscles does what?
flexes or extend the neck
What is the disease caused by contraction/shortening of muscles that twist neck, most common cause being a fibrous tumor developing in SCM muscle b4 birth.
Torticollis
What surrounds the lateral cervical triangle of the neck?
superior apex - superior nuchal line of occipital bone
posterior - anterior border of trapezius
anterior - posterior border of SCM muscle
inferior - middle 1/3 of clavicle
"roofed" - investing layer of deep fascia
What muscles are located in the lateral cervical triangle, and what do they do?
Scalenes - (post/ant/mid) - help flex neck laterally and elevate ribs in forces inspiration
Levator scapulae - elevates and rotates scapula
Splenius - laterally flexes and rotates head and neck to same side
Omohyoid - depresses, retracts, and steadies the hyoid bone.
What arteries do you find in the lateral cervical triangle?
Transverse cervical
suprascapular
subclavian
Occipital
In the lateral cervical triange, what arteries branch off subclavian?
thyrocervical trunk branches off, and then it has some sub branches -
- transverse cervical - cuts across lateral triangle
- suprascapular - going over scapula
describe branches of arteries in lateral cervical triangle?
the subclavian artery branches into the thryocervical trunk, which in turn branches into the suprascapular and transverse cervical arteries

occipital branches from carotid
Where does the suprascapular artery pass in the lateral cerivical triangle?
inferolaterally across anterior scalene and phrenic nerve
What happens to the third part of the subclavian artery when leaving the lateral cervical triangle of the neck?
supplies blood to upper limb
What are two important veins in the lateral cervical triangle?
The external jugular vein and the subclavian vein
The union of what two vines forms the external jugular?
retromandibular vein and the posterior auricular vein
What does the external jugular vein drain into?
The subclavian
Where is the brachiocephalic vein found?
Posterior to the medial end of clavicle, where the subclavian and internal jugular vein meet.
What vein drains most of scalp and side of the fase?
external jugular vein
Where is a central line normally administered?
internal jugular vein
subclavian vein
femoral vein
What makes up the roots of the cervical plexus, found in the lateral cervical triangle?
C1-C4 anterior rami
What is the cervical plexus in the lateral cervical triangle?
an irregular series of nerve loops and the branches that arise, formed from C1-C4 anterior rami
What are the branches of the cervical plexus
- sensory branches (cutaneous, easy to see)
- loops are really never seen
- motor branches (including phrenic nerve and ansa cervicalis)
What are the cutaneous branches of the cervical plexus, and where do they emerge?
- emerge from posterior wall of SCM
lesser occipital nerve (C2)
Greater auricular nerve (C2/C3)
Transverse cervical nerve (C2/C3)
Supraclavicular nerve (C3/C4)
What do the cutaneous branches of the cervical plexus innervate?
skin of neck
superolateral thoracic wall
scalp between auricle and ex occipital protuberance
What nerve branches of the cervical plexus supply the skin of the neck and scalp posterosuperior to auricle (behind ear)?
lesser occipital nerve
What nerve branches of the cervical plexus supply innervation of ear and parotid gland?
greater auricular nerve
What cutaneous nerve of the lateral cervical triangle that cross clavicle and supply skin around shoulder?
supraclavicular nerve (C3/C4)
What nerve supplies the skin around the anterior triangle, even though it comes out lateral triangle?
Transverse cervical nerve
What does the greater auricular nerve innervate
innervates the skin and sheath surrounding parotid, mastoid process, and both surfaces of auricle
Where do fibers of ansa cervicalis come from?
superior root - spinal nerve from C1/C2 and
inferior root - loop between C2/C3
These two roots come together to form ansa
What does the ansa cervicalis innervate?
The infrahyoid muscles
What nerves does the phrenic nerve orginiate?
mainly C4, but some of C3 and C5 (3,4,5 keep the diaphragm alive)
What does the phrenic nerve innervate, where does it run?
sole motor supply of diaphragm
runs superior to anterior scalene
What muscles does the spinal accessory nerve (CN XI) innervate?
sternocleidomastoid
trapezius
Where does the spinal accessory nerve run
- spinal cord segment merge and ascend into cranial cavity via foramen magnum, and exits through jugular foramina
- crosses lateral cervical region inferior to mastoid proces
From under the SCM, and dives under trapezius
What does the spinal accesory nerve arise from?
C1-C5/6 cervical segments,
how do you test spinal accessory nerve?
ask patient to shrug shoulder, test for assymetry in strength
Brachial plexus has many branches, but we only see trunk in the lateral cervical region. What are the trunks?
superior trunk, middle trunk, inferior trunk
What does the greater auricular nerve innervate
innervates the skin and sheath surrounding parotid, mastoid process, and both surfaces of auricle
Where do fibers of ansa cervicalis come from?
superior root - spinal nerve from C1/C2 and
inferior root - loop between C2/C3
These two roots come together to form ansa
What does the ansa cervicalis innervate?
The infrahyoid muscles
What nerves does the phrenic nerve orginiate?
mainly C4, but some of C3 and C5 (3,4,5 keep the diaphragm alive)
What does the phrenic nerve innervate, where does it run?
sole motor supply of diaphragm
runs superior to anterior scalene
What nerve branches of the brachial plexus, in the lateral cervical triangle?
suprascapular nerve
T/F - the suprascapular artery can branch directly from subclavian, instead of from thyrocervical trunk?
True.
What are the boundaries for the anterior triangle?
- anterior: median line of neck
- posteiror - anterior border of SCM
- superior - border of mandible
- apex (inferior) - jugular notch in manubrium
roofed by subcutaneous tissue containing platysma
floored by pharynx, larynx, and thyroid
What are the 4 pairs of triangles within anterior triangle?
submandibular
submental (unpaired)
carotid
muscular
What borders the submandibular triangle?
The inferior border of the triangle
The two bellies of the digastric muscle
Floor- mylohyoid and hyoglossus, middle pharyngeal constrictor
What does the digastric muscle do?
depresses mandible and elevates hyoid (suprahyoid muscles)
What innervates the digastric muscle?
anterior belly - nerve to the mylohyoid
posterior - facial nerve
What does the myohyoid do, and what innervates it?
It elevates hyoid, floor of mouth and tongue
innervated by branch of inferior alveolar nerve (CN V3)
What does the hypoglossus do, what innervates it?
depresses tongue
innervated by CN XII
What are the nerves in the submandibular triangle?
Hypoglassal nerve
nerve to mylohyoid muscle
What does the hypoglossal nerve (CN XII) innervate?
intrinsic/extrinsic muscles of the tongue (part of submandibular triangle)
What are the functions and innervations of the muscles in the submandibular triangle?
Digastric - depresses mandible and elevates hyoid; ant innervated by nerve to mylohyoid, post innervated by facial nerve

mylohyoid - elevates hyoid, floor of mouth and tongue. Innverv by inferior alveolar nerve

Hypoglossus - depresses tongue. Innervated by CN XII hypolglossal
What arteries and veins do you see in the submandibular triangle?
facial artery/vein
submental artery ( branch of facial)
What fills the submandibular triangle?
The submandibular glands, and the submandibular lymph nodes lie on each side
What binds the submental triangle?
inferiorly - hyoid
laterally - Right and Left anterior digastrics
floor - two mylohyoid muscles, which meet at median fibrous raphe
What is found in the submental triangle?
the submental lymph nodes
small veins which unite to eventually form anteiror jugular vein
Where does the anterior jugular vein run?
begins near the hyoid bone, descending between median line and anterior border of SCM, and eventually passed underneath it to drain into external jugular
What binds the carotid triangle?
superior belly of omohyoid
posterior belly of the digastric
anterior border of the SCM
Where does the common carotid divide into internal and external arteries?
around the level of the superior border of thyroid
What is the significant of the slight dilation in the internal carotid?
It is the carotid sinus - innervated by glossopharyngeal nerve (9), as well as vagus - baroreceptor
What is the carotid body?
a chemoreceptor that monitors level of oxygen in blood
What is the procedure where plaque is removed from cartotid artery?
carotid endarterectomy
What are the branches of the ECA?
Superior thyroid artery
ascending pharyngeal artery
ligual artery
facial artery
occipital artery
posterior auricular artery
terminates --> maxillary artery and superficial temporal artery
What binds the muscular triangel?
- superior belly of omohyoid
- anteiror border of the SCM
-
What does the muscular triagnle contain?
infrahyoid muscles and viscera (e.g. thyroid and parathyoid)
What are the infrahyoid muscles in the muscular trianlge?
superficial - sternohyoid and omohyoid
deep plane - sternothyroid and and thyrohyoid
What do infrahyoid muscles do?
they depress the hyoid
What is included in the suprahyoid?
mylohyoid, geniohyoid, stylohyoid, digastric (make up the floor of the mouth essentially)