NECK. REGIONAL ANATOMY

Neck

BoundariesLandmarksRegions

NeckLandmarks

Neck

Landmarks

Organ projections

Subcutaneous layer

PlatysmaV. jugularis anteriorV. jugularis externaPl. cervicalis

n. occipitalis minorn. auricularis magnusn. transversus collinn. supraclaviculares

Neck fascia

Lamina superficialis- Covers entire neck

- Fascia masseterica

- Fascia parotidea

- Fascia gl. submandibularis

Lamina pretrachealis- Between os hyoideum, strenum & clavicula, and m. omoh yoideus

- Linea alba - from os hyoideum to isthmus tracheae

- Spatium interaponeuroticum suprasternale

- Arcus venosus juguli

- Recessus Gruberi - behind m. sternocleidomastoideus

Lamina prevertebralis

- Skull base - bodies Т3-Т4 (fascia endothoracica)

- Fascia mm. longi capitis et cervicis

- Fascia mm. scaleni, m. levator scapulae

- Spatium prevertebrale – extends to proc. transversi

Fascia endocervicalis- Lamina visceralis – covers neck organs

- Lamina parietalis – apart from the visceral- Vagina carotica - from lamina parietalis

- Spatium pretracheale - between the two layers

- Extends to mediastinum superius

- Spatium retropharyngeum - between fascia endocervicalis & lamina prevertebralis

- Extends to mediastinum posterius

Regions of the neck

Anterior region� Tr. submentale� Tr. submandibulare� Tr. musculo-viscerale� Tr. Caroticum

Sternocleidomastoid region

Lateral region� Tr. omotrapezoideum� Tr. omoclaviculare

Boundaries�Basis mandibulae�M. digastricus

– venter anterior et posterior�M. mylohyoideus/m.hyoglossus�Lamina superficialis

Trigonum submandibulare

Superficial structures

M. platysmaV. facialisR. coli nervi facialis

Trigonum submandibulare

Gl. submandibularis – in sheath of lamina superficialis

- Posterior process - extends to m. pterygoideus medialis

- Anterior process – extends to gl. sublingualis - ductus submandibularis – from the inner

surface

- lndd. submandibulares – lateral to the capsule

- A.v. facialis – give off a.v. submentalis- N. mylohyoideus – branch of n.

mandibularis- N. hypoglossus- N. lingualis- Gangl. submandibulare- Trigonum Pirogovi – approach to a.

lingualis- m. mylohyoideus- tendo m. digastrici- n. hypoglossus

Trigonum submandibulare

Trigonum submandibulare

- A.v. facialis – give off a.v. submentalis- N. mylohyoideus – branch of n.

mandibularis- N. hypoglossus- N. lingualis- Gangl. submandibulare- Trigonum Pirogovi – approach to a.

lingualis- m. mylohyoideus- tendo m. digastrici- n. hypoglossus

Trigonum caroticum

Boundaries- m. digastricus, venter posterior

- m. omohyoideus, venter superior

- m. sternocleidomastoideus

Trigonum caroticum

Trigonum caroticumA. carotis communis – at the upper margin ofcart. thyroidea divides into:A. carotis externa

- a. thyroidea superior, a. lingualis, a. facialis

- a. occipitalis, a. sternocleidomastoidea, a. pharyngea ascendens

A. carotis interna

V. jugularis interna

Ansa cervicalis ( С1-С3)

- Radix superior ( С1,2) – anterior to a. carotis communis

- Radix inferior ( С2,3) – lateral to v. jugularis interna

Variations in the bifurcation ofa. carotis communis

Trigonum caroticum - cont.

N. vagus – in the groove btw a. carotis comm. & v. jugularis internaN. laryngeus superior

- In the upper part, medial to a. carotis externa et interna

- Enters the larynx thru membr. thyrohyoidea with a. laryngea superior

N. hypoglossus - beneath venter posterior m. digastrici

- Crosses lateral to a. carotis externa et interna

- enters trig. submandibulare between vent. post. m. digastrici & m. hyoglossus

Plexus cervicalis ( С1-С4) – over the deep cervical muscles

Truncus sympaticus - behind lamina prevertebralis

Truncus sympaticus - behind lamina prevertebralis

- behind a. carotis communis/interna close to n. vagus

- gangl. cervicale superior - over m. longus colli (C2-3)

- ganl. cervicale medius – at the levbel ofa. thyroidea inferior (C6)

- gangl. сervicale inferior ( С7 head of І rib)

- Innervates upper limb arteries & a. vertebralis

- Contact with cupula pleurae, d. thoracicus (on the left side), a. subclavia, a. vertebralis

Regio infrahyoideaBoundaries

- Os hyoideum, sternum, m. sternocleidomastoideus

ContentLamina pretrachealisMusclesа) M. sternohyoideus, m. thyrohyoideus,

m. sternothyroideus & m. omohyoideus- depress os hyoideum and larynx in swallowing.

b) M. cricothyroideus

-straightens the vocal folds

Regio infrahyoidea

Vessels - V. jugularis anterior

- Arcus venosus juguli - in spatium suprasternale

- A.v. thyroidea superior

- V. thyroidea inferior

Lymph nodes- Lndd. prelaryngeales

- Lndd. pretracheales

- Lndd. paratracheales

Organsа) Endocrine system

- Gl. Thyroidea

- Gll. Parathyroideae

b) Respiratory system- Larynx - C4-C6

- Trachea - C6-Th4

c) Digestive system- Pharynx - basis cranii - C6

- Esophagus - C6 - Th11

Regio infrahyoidea.Larynx, trachea, gl. thyroidea

Root of the neck Transitional area btw neck and thorax. Opens in apertura thoracica superior . Bounded:

� First ribs - laterally

� manubrium sterni - anteriorly

� Body of Т1 - posteriorly

Topographic structures

� Spatium antescalenum

� Spatium interscalenum

� Trigonum scalenovertebrale

Midline structures

Thymus – upper poles

Gl. Thyroidea (lobus dexter/sinister)

Gll. parathyroideae (inferiores)

Vv. thyroideae inferiores (plexus venosus)

Trachea (pars cervicalis)

Esophagus (pars cervicalis)

M. longus coli

Midline structures

Root of neck

Boundaries - mm. sternocleidomastoideus, sternohyoide us, sternothyroideus anteriorly and m. scalenus anteriorposteriorly.

Content- angulus venosus juguli

- v. jugularis interna

- v. subclavia

- ductus thoracicus/ductus lymphaticus dexter

- a. suprascapularis

- a. cervicalis superficialis

- n. phrenicus (C3-5)

- ndd. lymphaticae, around - v. jugularis interna

- a. transversa cervicis

Spatium antescalenum

Spatium antescalenum

Spatium antescalenum (right)

Boundaries – three-wall slit btw m. scalenus anterior anteriorly, m. scalenus medius posteriorlyand first rib (sulcus a. subclaviae) below.

Content

- a. subclavia (middle, interscalenous part), gives

off

- truncus costocervicalis

- a. cervicalis profunda – for neck muscles

- a. intercostalis suprema - for І & ІІ costal interspaces

- pl. brachialis - truncus superior, medius and

inferior.

Spatium interscalenum

Trigonum scalenovertebraleBoundaries - m. scalenus anterior laterally, m. longus coli and neckvertebrae medially and cupula pleurae below. The apex coincides with the transverse process of С6.

Content- a. subclavia, prescalenous part- a. vertebralis

- truncus thyrocervicalis

- a. thyroidea inferior

- a. cervicalis ascendens

- a. cervicalis superficialis

- a. suprascapularis

- a. thoracica interna

- ductus thoracicus

- n. vagus- n. laryngeus recurrens

- truncus sympaticus - ganglion inferior/stellatum- ansa subclavia

Trigonum scalenovertebrale

Ductus thoracicus