base of face, extends to C6 --> oesophagus
Neck viscera consists of pharynx, oesophagus, larynx and trachea; carotid sheaths on either side
Above larynx is hyoid; connected to mandible
CNs IX-XII enter neck.
Surrounding the neck is the deep cervical fascia, containing trapezius and SCM
Cervical cutaneous nerves (171)
From C2-4 nerves, on posterior surface of SCM
4 of them fan out to supply the neck
1. Lesser occipital nerve (C2) --> up and back post to ear
- supplies skin from auricle to occiptial region.
2. Great auricular nerve (C2,3) passes up immediately behind external jugular
- to supply auricle and preauricular region.
- gives posterior auricular nerve br. behind ear.
3. Transverse cervical nerve (C2,3), passes over SCM
- to supply the anterior neck
4. Supraclavicular nerve (C3,4) passes down
- and divides into branches that pass over
the vlacicle supplying the more lateral neck.
Fascia is a relative term, some are convincing, others less so.
Subcut tissue but includes platysma and
fascial muscles in head and neck
Anterior and external jugular veins, and cervical cutaneous nerves lie in this.
Deep Cervical Fascia
Overstated; some have surgical significance
Surrounds the neck like collar
1. Investing layer (24 in 3rd)
Boundaries: SCM, trapezius, clavicle
Contents: 4 arteries: occipital,
transverse cervical, suprascapular, subclavian (29)
- 3 veins: transverse cervical, suprascapular and external jugular
- lots of nerves: accessory nerve, cervical plexus branches and brachial plexus trunks
- 1 muscle: omohyoid
- lymph nodes
Boundaries: SCM, mandible, midline
Subdivided into: carotid, digastric, submental,
muscular triangles (24)
Boundaries: SCM, posterior digastric, superior
omohyoid belly (most lateral strap)
Contents: arteries: bifurcation of common carotid, branches of external (except posterior auricular)
- veins: lingual, facial, superior thyroid
- nerves: hyoglossal, internal and external laryngeal, superior root of ansa cervicalis
- lymph nodes.
Anterior body from midline of mandible (n to mylohyoid), back and down to intermediate tendon;
Posterior body back and up to medial
mastoid; (facial nerve)
Boundaries: Mandible, anterior and posterior bellies digastric
Contents: submandibular gland, lymph nodes, submental, facial and mylohyoid vessels.
- hypoglossal and mylohyoid nerves
Boundaries: anterior digastric belly, body of hyoid bone
Contents: anterior jugular veins, lymph nodes
Boundaries: SCM, superior belly omohyoid, midline from hyoid bone to jugular notch
Contents: larynx, trachea, pharynx, oesophagus, thyroid, parathyroid (and their vessels & nerves), and lymph nodes
From front of manubrium and medial
-> obliquely back to outer surface of mastoid and anterior part of superior nuchal line.
EJV courses across it from below the ear lobe to midpoint of clavicle; vein then plunges deep to join subclavian.
Great auricular nerve and transverse cervical
emerge behind and travel across it
Parotid lower portion may lie on top of its upper extent
Lies over the carotids, IJV and deep
cervical lymph nodes
Nerve Accessory; at deep surface 5cm from mastoid; emerges from posterior border constrant relation to great auricular nerve here (erbs point)
- useful landmark for ID of nerve.
Pushes chin to one side against resistance --> tenses the opposite side.
Common incision for neck is at its anterior
Infrahyoid Straps (27)
Sternohyoid and omohyoid = superficial
Sternothyroid and thyrohyoid = deep
- from back of manubrium coming medial (join in midline over thyroid) --> hyoid
From back of manubrium (inferior to sternohyoid) over thyroid to
oblique line of thyroid cartilage
Superior belly inserts lateral to sternohyoid on hyoid, passes downwards
--> intermediate tendon behind SCM (suspended by a fascial condensation attached to clavicle)
Then passes to upper border of scapula near notch
Lies in front of internal jugular ¨ branches to infrahyoid muscles.
- usually imbedded in anterior sheath \ classed as a content.
Superior root = contains only C1 fibres, hitch-hike along XII.
- runs down on front of internal jugular --> branch to superior belly omohyoid
Inferior root = union of C2,C3 ant rami branches --> joins superior --> single nerve
- this forms a wide loop on lower IJV --> branches to sternohyoid, sternothyroid, inf omohyoid
- sometimes inferior root passes forward b/n IJV and ICA.