The Neck by Prof. S. Malik, ProF. Wagner+ Dr. Ayat

Compartment: 1-vertebral ;cervical vertebrae, postural muscles. 2-viscera;thyroid, parathyroid, larynx ,pharynx, trachea & esophagus. 3-vessels,two common carotid, two internal& external carotids+ two vagi& accessory nerves. Three V.

. The neck compartment are all the following except one M.C.Qs. The neck compartment are all the following except one sentence is wrong ? A-vertebral compartment. B –visceral compartment C-vessels compartment & trigeminal nerve. D-vessels compartment with vagi. .

, Answer The neck compartment are all the following except one sentence is wrong ? A-vertebral compartment. B –visceral compartment C-vessels compartment & trigeminal nerve. D-vessels compartment with vagi. c vessels &trigeminal nerve

M.C.Qs. The superior boundaries of the neck including the following except one wrong ? A-inferior boundary of the mandible B- mastoid process C-highest nucheal line D-external occipital protuberance

Answer The superior boundaries of the neck including the following except one wrong ? A-inferior boundary of the mandible B- mastoid process C-highest nucheal line D-external occipital protuberance

. The neck (L. collum, cervix) is the transitional area between the head superiorly and the clavicles inferiorly that joins the head to the trunk and limbs.

2. It serves as a major passage for structures passing between them. 3. In addition, several important organs with unique functions are located here: the larynx and the thyroid and parathyroid glands, for example.

Skin of the neck and its contents

M.C.Qs. The innervations of the skin of neck including the following which all are correct except one is wrong? A-greater auricular & lesser occipital nerves. B-greater occipital& transverse cervical . C-supraclavicular nerves &third occipital D-transverse cervical &ophthalmic nerve

Answer The innervations of the skin of neck including the following which all are correct except one is wrong? A-greater auricular & lesser occipital nerves. B-greater occipital& transverse cervical . C-supraclavicular nerves &third occipital D-transverse cervical & ophalamic nerves

Superficial fascia and its contents Platysma muscle: muscle of depression of mandible& gravity +other muscles Origin: skin of pectoral region Insertion: lower border of the mandible and angle of mouse N.S: facial nerve Action: depress angle of the lips second branchial arche

External jugular vein Superficial veins Begin: just behind angle of the mandible by union of posterior auricular vein and post.division of the retromandibular vein End: drain into subclavian tributaries vein 1-Suprascapular &transverse cervical 2. ant. Jugular vein

M.C..Qs. The platysma muscle the following are correct except one sentence is wrong? A-it is origin from pectoral region b- inserted to the lower border of the mandible. C-innervated by facial nerve d-it’ s action is elevation of the mandible.

Answer The platysma muscle the following are correct except one sentence is wrong? A-it is origin from pectoral region b- inserted to the lower border of the mandible. C-innervated by facial nerve d-it’ s action is elevation of the mandible.

M.C.Qs. The external jagular vein is a vein of the neck it is uesd for intravenous infusion the following are true except one sentence? A-it is formed by union of facial vein with anterior division of the retromandibular vein. B-it’ s blood reach to the heart C-The wall attached to the roof of the posterior triangle D-the tributeries are anterior jagular vein, transverse cervical &suprscapular veins.

Answer The external jagular vein is a vein of the neck it is uesd for intravenous infusion the following are true except one sentence? A-it is formed by union of facial vein with anterior division of the retromandibular vein. B-it’ s blood reach to the heart C-The wall attached to the roof of the posterior triangle D-the tributeries are anterior jagular vein, transverse cervical &suprscapular veins

Tributaries of E.J.V and ant. J.V.

A-anterior jaguar veins B-sternomastoid muscles C-suprahyoid muscles M.C.Qs. The previous picture showing the following are true except one is wrong? A-anterior jaguar veins B-sternomastoid muscles C-suprahyoid muscles D- buccinator muscles.

Answer The previous picture showing the following are true except one is wrong? A-anterior jaguar veins B-sternomastoid muscles C-suprahyoid muscles D- buccinator muscles.

Deep cervical fascia

Important notes Layers of deep cervical fascia: investing layer, pretracheal, prevertebral and carotid sheath Investing layer of deep fascia encloses sternomastoid and trapezius muscles Contents of carotid sheath: CCA and ICA, IJV and vagus nerve

M.C.Qs The fascia of the neck showing the following are true except one sentence is wrong? a- investing layer surrounding the sterrnocleidomastoid & trapezius. b- the carotid sheath containing common carotid ,internal jugular vein & vagus nerve c- the prevertebral fascia surrounding the prevertebral muscles. . d- the pretracheal fascia does not ensheathing the thyroid gland .

Answer The fascia of the neck showing the are true except one sentence is wrong? a- investing layer surrounding the sterrnocleidomastoid & trapezius. b- the carotid sheath containing common carotid ,internal jugular vein & vagus nerve c- the prevertebral fascia surrounding the prevertebral muscles. . d- the pretracheal fascia does not ensheathing the thyroid gland

Major muscles of the neck Trapezius Sternomastoid muscle

Recall of relevant structures Lateral muscles of the neck

Sternomastoid muscle Origin : a) Sternal head: Rounded and tendinous from front of manubrium. b) Clavicular head: Thin and fleshy from upper surface of med. ⅓ of clavicle. Insertion : Mastoid process and lateral ⅓ of the superior nuchal line. Action : 1- Unilateral contraction → directs the face to opposite side. 2- Bilateral contraction → tilt the head backwards. Nerve Supply : → spinal accessory n. * Injury to the muscle leads to it contracture and shortening → Torticollis. The oblique position of the sternomastoid divides the side of the neck into anterior and posterior triangle.

Sternomastoid muscle .origin, insertion, nerve supply & action

A note about the scalene muscles : Scalenus anterior Scalenus medius Scalenus posterior Origin : transverse processes of cervical vertebrae . Insertion : first and second ribs . Action : 1- Lateral flexion of neck . 2- Fixation of ribs during forced inspiration . Nerve supply : cervical and brachial plexuses . . The subclavian vein passes infront the of scalenus anterior . The subclavian artery and brachial plexus pass between scalenus anterior and scalenus medius .

Muscluar triangles of the neck

POSTERIOR TRIANGLE BOUNDARIES Trapezius muscle Sternomastoid muscle clavicle

POSTERIOR TRIANGLE Boundaries: - In front → Posterior border of sternomastoid m. - Behind → Anterior border of trapezius m. - Apex → Middle ⅓ of superior nuchal line. - Base → Middle ⅓ of the clavicle. Roof - Skin. - Superficial fascia. - Deep (investing) fascia of the neck. The superficial fascia of the posterior triangle contains the following : (1) Platysma m. : (a subcutaneous m.) (2) External Jugular vein (3)The cutaneous branches of the cervical plexus Floor: From upwards below : a) Splenius capitis. b) Levator scapulae. c) Scalenus medius.

Posterior triangle, roof , floor, bounderies & contents M. C. Qs Posterior triangle, roof , floor, bounderies & contents M.C.Qs. True The roof of the posterior triangle containing the following which is except one structure ? A-skin b-fascia superficial& investing cervical fascia. c- omohyoid muscle. D-platysema muscle

Answer The roof of the posterior triangle containing the following which is correct except one structure ? A-skin b-fascia superficial& investing cervical fascia. c- omohyoid muscle. D-platysema

Contents: 7- Spinal accessory n. (runs on levator scapulae). Arteries 1- Third part of subclavian a. 2- Suprascapular a. 3- Superficial (or transverse) cervical a. 4- Occipital a. (near the apex). Veins 5- Subclavian v., receiving its only tributary, the external jugular v. Nerves 6- Roots and trunks of brachial plexus. 7- Spinal accessory n. (runs on levator scapulae). L.Ns. 8- Occipital L.N. (at the apex with the occipital a.). 9- Supraclavicular L.N. (at base with the subclavian a.). Ms. 10- Inferior belly of omohyoid .

Accessory nerve (Primarily a motor nerve) Formed from a cranial root emerging from the medulla and a spinal root arising from the superior region of the spinal cord The spinal root passes upward into the cranium via the foramen magnum The accessory nerve leaves the cranium via the jugular foramen and divided again into cranial root join the vagus nerve and spinal root Cranial root: Supplies fibers to the larynx, pharynx, and soft palate Spinal root: Innervates the trapezius and sternocleidomastoid, which move the head and neck

M.C.Qs The accessory nerve showing the following are true except one sentence is wrong ? A- supply larynx& pharynx. B-soft palate C-spinal root supply sternomastoid &trapezius muscles D-anterior belly of the digastric muscle.

Answer : The accessory nerve showing the following are true except one sentence is wrong ? A- supply larynx& pharynx. B-soft palate C-spinal root supply sternomastoid &trapezius muscles D-anterior belly of the digastric muscle

OMOHYOID MUSCLE

DIVISION OF POSTERIOR TRIANGLE Occipital triangle Supra (sub) clavicular

ANTERIOR TRIANGLE

ANTERIOR TRIANGLE □ Boundaries : • Anteriorly → Middle line of the neck. • Posteriorly → Ant. border of sternomastoid. • Base (above) → Lower border of mandible. • Apex (below) → Suprasternal notch. □ Roof: 1- Skin. 2- Superficial fascia (+ its contents). 3- Investing ( deep ) fascia. Contents of the Superficial Fascia of the Roof: a- Platysma muscle. b- Transverse cervical n. c- Anterior jugular v. : It is formed by the union of the submental veins → descends in the superficial fascia near the middle line → pierces the deep fascia above the sternum → passes deep to the sternomastoid → ends in the external jugular v. The deep parts of both anterior jugular veins are connected together by jugular arch. □ Subdivisions : 3 ½ triangles . See the table .

M.C.Qs. The boundaries of the anterior triangle consisted of the following all incorrect except one sentence is correct? A-anterior border of the trapezius muscle. B—anterior border of the sternomastoid muscle. C-upper border of the mandible ;alveolar process .D-inferior belly of omohyoid muscle

answer The boundaries of the anterior triangle consisted of the following all incorrect except one sentence is correct? A-anterior border of the trapezius muscle. B—anterior border of the sternomastoid muscle. C-upper border of the mandible ;alveolar process .D-inferior belly of omohyoid muscle

DIGASTRIC MUSCLE Muscle Origine Insertion Nerve supply action post. belly: Mastoid process of temporal bone ant. belly: Body of mandible Intermediate tendon is held to hyoid by fascial sling post. belly: facial nerve ant belly: nerve to mylohyoid Depresses mandible or elevates hyoid bone

Mylohyoid muscle Muscle Origine Insertion Nerve supply action Mylohyoid line of body of mandible Body of hyoid bone and fibrous raphe Inferior alveolar nerve Elevates floor of mouth and hyoid bone or depresses mandible

2- geniohyoid 3- stylohyoid muscles Origine Insertion Nerve supply action Geniohyoid Genial tubercle of the mandible Body of hyoid bone Hypoglossal nerve Depresses mandible or elevates hyoid bone Styloyoid Styloid process Hyoid bone Facial nerve with post. Belly of digastric Elevate hyoid bone Inferior mental spine

Mylohyoid Geniohyoid Hyoglossus

Recall of relevant structures The suprahyoid muscles the muscles of the floor of the mouth

Suprahyoid muscles Muscle Origine Insertion Nerve supply action Digastric muscle post. belly: Mastoid process of temporal bone ant. belly: Body of mandible ,digastric fossa Intermediate tendon is held to hyoid by fascial sling ;2nd pharyngeal archpost. belly: facial nerve ant belly: nerve to ;mylohyoid First pharyngeal arche Depresses mandible or elevates hyoid bone Mylohyoid muscle Mylohyoid line of body of mandible Body of hyoid bone and fibrous raphe , nerve to mylohyoid from Inferior alveolar nerve Elevates floor of mouth and hyoid bone or depresses mandible Hyoglossus muscle Hyoid bone Post. ½ of the side of the tongue Hypoglossal nerve Draw the tongue downwards and help suckling Genoglossus Geniohyoid Upper genial tubercle Genial tubercle of the mandible Anterior part of the tongue Body of hyoid bone C1 via Hypoglossal nerve Protrude the tongue. Styloyoid Styloid process Facial nerve with post. Belly of digastric Elevate hyoid bone

Recall of relevant structures External muscles of the tongue Genioglossus muscle

M.C.Qs

Suddivisions of ANTERIOR TRIANGLE

Enumerate main contents of submandibular (digastric) triangule and give short account on one of them Muscles: suprahyoid muscles (mylohyoid muscle), geniohyoid, stylohyoid, digastric and hyoglossus muscles Glands: submandibular salivary glands & L.N. Nerves: nerve to mylo-hyoid muscle, hypoglossal nerves and Submandibular ganglion Vessels: facial artery& vein

Other structure deep to diaphragma oris (mylohyoid muscle) Muscles: geniohyoid, hyoglossus muscles genioglossus Glands: deep part of submandibular gland&Sublingual salivary gland Nerves: Submandibular ganglion Lingual nerve Vessels: lingual vessels

Facial vessels Submandibular ganglion Lingual nerve Sublingual salivary gland Hypoglossal nerve Lingual vessels Nerve to mylohyoid muscle Submandibular salivary gland

As regard the mylohyoid muscle there is one true sentence As regard the mylohyoid muscle there is one true sentence ? A-two salivary gland above three below. B-innervated by facial. C-forming the diaphragma oris D-digastric muscle lying above.

As regard the mylohyoid muscle there is one true sentence As regard the mylohyoid muscle there is one true sentence ? A-two salivary gland above three below. B-innervated by facial. C-forming the diaphragma oris d-digastric muscle lying above or deep to the mylohyoid muscle

suprahyoid muscles Muscle Origine Insertion Nerve supply action Digastric muscle post. belly: Mastoid process of temporal bone ant. belly: Body of mandible Intermediate tendon is held to hyoid by fascial sling post. belly: facial nerve ant belly: nerve to mylohyoid Depresses mandible or elevates hyoid bone Mylohyoid muscle Mylohyoid line of body of mandible Body of hyoid bone and fibrous raphe Inferior alveolar nerve Elevates floor of mouth and hyoid bone or depresses mandible Hyoglossus muscle Hyoid bone Post. ½ of the side of the tongue Hypoglossal nerve Draw the tongue downwards and help suckling Geniohyoid Genial tubercle of the mandible Body of hyoid bone Styloyoid Styloid process Facial nerve with post. Belly of digastric Elevate hyoid bone

Enumerate main contents of carotid triangule and give short account on one of them ? Carotid sheath: CCA, ICA, IJV and vagus nerve External carotid artery Hypoglossal nerve Ansa cervicalis Sympathetic trunk

The ansa cervicalis lying over the carotid sheath The ansa cervicalis lying over the carotid sheath. Mention the contents of the carotid sheath?

ANSA CERVICALIS • It is a nervous loop situated in front of the carotid sheath. • It is formed by union of 2 limbs : A) Superior limb : Descending from the hypoglossal n. and containing fibers of C1 spinal nerve . B) Inferior limb : From C2 and C3 spinal nerves . • Branches : arise from the tip → supply all infrahyoid muscles (near their lower ends) except thyrohyoid.innervated by C1 via hypoglossal nerve.

M.C.Qs. As regards the ansa cervicalis showing the following all correct except a-formed by two loops. B-innervate the infrahyoid muscle except the thyrohyoid muscle. C-it is inside the corotid sheath. D-Its root value c1 -3

Answer As regards the ansa cervicalis showing the following all correct except a-formed by two loops. B-innervate the infrahyoid muscle except the thyrohyoid muscle. C-it is inside the corotid sheath. D-Its root value c1 -3

Enumerate main contents of muscular triangule and give short account on one of them Infra hyoid muscles

M.C.Qs. The following sentence all are correct except one is incorrect? A- the infrahyoid muscles are innervated by the ansa cervicalis c1-3. b-depress the hyoid bone down. C-the omohyoid muscle make the roof of the posterior triangle tight so help the internal jagular vein open(patency). D-the thyrohyoid muscle inverted directly from the ansa cervicalis

Answer The following sentence are correct except one sentence is incorret a-the infrahyoid muscles innervated by anasa cervicalis b- all infrahyoid muscles depress the hyoid bone. C-the omohyoid muscle make the roof of the posterior triangle tight so help the internal jagular vein open(patency). D-the thyrohyoid muscle inverted directly from the ansa cervicalis

Enumerate main contents of submental triangule and give short account on one of them Submental LN Anterior jugular vein