1. Parts and regions of the neck
Boundaries
Superior－ a line joining inferior border of mandible, angle of mandible, tip of mastoid process, superior nuchal line and external occipital protuberance
Inferior－ a line joining jugular notch, sternoclavicular joint, superior border of clavicle, acromion and spinous processes of C7

2. Regions of neck Neck Anterior region of neck
Sternocleidomastoid region
Lateral region of neck
Nape

3. Triangles of anterior region of neck
Suprahyoid region
Submental triangle
Submandibular triangle
Infrahyoid region
Carotid triangle
Muscular triangle

4. Triangles of lateral region of neck
Omohyoid muscle
Occipital triangle
supraclavicular triangle (greater supraclavicular fossa)

5. Skin of the neck
The natural line of cleavage of the skin are constant and run almost horizontally around the neck

6. 2. Reflect the skin to the anterior border of the trapezius muscle.
SKIN INCISIONS
1. Make a skin incision from the mastoid process (E) to the medial end of the clavicle (F).
2. Reflect the skin to the anterior border of the trapezius muscle.
3. Reflect the skin to the midline.
STRUCTURES IN THE POSTERIOR TRIANGLE
1. The platysma muscle is in the superficial fascia. It covers the lower part of the posterior
triangle. It is innervated by the facial nerve.
2. Raise the posterior border of the platysma muscle and reflect it superiorly.
3. The external jugular vein crosses the superficial surface of the sternocleidomastoid muscle.
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7. Transverse cervical nerve • Supraclavicular nerves
4. The skin of the neck is innervated by cutaneous nerves. They are branches of the cervical
plexus. They enter the superficial fascia at the midpoint of the posterior border of the
sternocleidomastoid muscle. Identify: • Lesser occipital nerve • Great auricular nerve •
Transverse cervical nerve • Supraclavicular nerves
5. The accessory nerve (XI) courses from superior to the midpoint of the posterior border of the
sternocleidomastoid muscle to the anterior border of the trapezius muscle. It innervates the
sternocleidomastoid muscle and the trapezius muscle.
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8. Anterior Triangle of the Neck Dissection Instructions
SUPERFICIAL FASCIA
1. Follow the external jugular vein superiorly and observe that it is formed by the joining of the
retromandibular vein and the posterior auricular vein.
2. In the superficial fascia near the anterior midline, note the anterior jugular vein. It join the
externaljugular vein in the root of the neck.
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9. Superficial fascia Contents Platysma Superficial veins
Anterior jugular v.
External jugular v.
Cutaneous nerves
Lesser occipital n.
Greet auricular n.
Transverse nerve of neck
Supraclavicular n.
Cervical branch of facial n.

10. ★Cervical fascia
Superficial layer of cervical fascia (investing fascia)
Encloses trapezius, sternocleidomastoid, posterior belly of digastric and parotid and submandibular glands.

11. ★Cervical fascia Pretracheal layer Lies deep to the infrahyoid muscle
Encloses viscera of neck: pharynx, larynx, trachea, esophagus, thyroid gland and parathyroid glands
Completely surrounds thyroid gland, forming a sheath, and bind the gland to larynx to form suspensory ligament of thyroid gland

12. ★ Cervical fascia Prevertebral layer
Lies anterior to bodies of cervical vertebrae and prevertebral muscles; extends from base of skull downward into the superior mediastinum, continuous with anterior longitudinal lig. and endothoracic fascia
Covers subclavian vessels and roots of brachial plexus
Extends into upper limb as axillary sheath

13. Carotid sheath
Formed by components of all three layers of deep cervical fascia
Contains common and internal carotid arteries, internal jugular vein, and vagus nerve

14. Fascia spaces
Between the two layer of deep cervical fascia exist the interspace such as :
Suprasternal
Pretracheal
Retropharyngeal
Prevertebral

15. Anterior region of neck

16. Carotid Triangle
This triangle is bound by the superior belly of the omohyoid, posterior belly of the digastric, and anterior border of the sternocleidomastoid.

17. nerve (X). The boundaries of the carotid triangle are:
1. The contents of the carotid triangle are the carotid arteries (common, internal, and external),
the branches of the external carotid artery, the hypoglossal nerve, and branches of the vagus
nerve (X). The boundaries of the carotid triangle are:
• Inferomedial – superior belly of the omohyoid muscle
• Inferolateral – anterior border of the sternocleidomastoid muscle
• Superior – posterior belly of the digastric muscle
2. Transect the sternocleidomastoid muscle. Do not damage the cutaneous branches of the
cervical plexus. Reflect it superiorly.
3. Find the accessory nerve (XI). It crosses the deep surface of the sternocleidomastoid muscle.
Trace it superiorly.
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18. 4. Cut the facial vein. It empties into the internal jugular vein.
5. Find the hypoglossal nerve superior to the tip of the greater horn of the hyoid bone. A
muscular branch of the occipital artery crosses superior to the hypoglossal nerve. The
hypoglossal nerve passes medial to the posterior belly of the digastric muscle.
6. The superior root of the ansa cervicalis travels with the hypoglossal nerve. It is mainly
composed of fibers from C1. The inferior root of the ansa cervicalis (C2, C3) join the superior
root. Thus, a loop is formed.
7. Clean the ansa cervicalis and trace its delicate branches to the lateral borders of the infrahyoid
muscles.
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19. membrane. It supplies the mucosa of the larynx with sensory fibers.
8. Find the internal branch of the superior laryngeal nerve. It passes through the thyrohyoid
membrane. It supplies the mucosa of the larynx with sensory fibers.
9. Trace the external branch of the superior laryngeal nerve distally. It innervates the
cricothyroid muscle.
10. Open the carotid sheath. It contains the common carotid artery, internal carotid artery,
internal jugular vein, and vagus nerve (X).
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20. Remove the tributaries of the internal jugular vein.
11. Internal jugular vein is located lateral to the common carotid or internal carotid artery. Its
largest tributaries: common facial vein, superior thyroid vein, and middle thyroid vein.
Remove the tributaries of the internal jugular vein.
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21. 12. At the level of the superior horn of the thyroid cartilage, find the origin of the external
carotid artery..
13. The external carotid artery has six branches in the carotid triangle. Identify: • Superior
thyroid artery • Lingual artery • Facial artery • Occipital artery • Posterior auricular artery
14. Observe the carotid sinus and carotid body. They are innervated by the glossopharyngeal
nerve (IX).
15. Identify the internal carotid artery and note that it has no branches in the neck.
16. Identify the vagus nerve (X). It lies between and posterior to the vessels.
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22. Carotid Triangle
Clean the carotid bifurcation and note the dilated proximal portion of the internal carotid artery. This is the carotid sinus region.
In the bifurcation, closely adherent to the internal carotid artery is the carotid body, another specialized receptor (chemoreceptor) which monitors blood O2 and CO2 levels, and pH (innervated by a small branch of CN.Ⅸ).

23. Submendibular gland
Digastric
Accessory n.
Hypoglossal n.
Superior thyroid a.
Cervical plexus
Ansa cervicalis
Sternothyroid
Phrenic n.
Sternohyoid
Omohyoid
Vagus n.

24. Hypoglossal n.
Vagus n.
Internal branch
Superior thyroid a.
External branch
Vertebral a.
Inferior thyroid a.

25. Infrahyoid region ★ Muscular triangle
Bounded by midline of the neck, superior belly of the omohyoid and anterior border of the sternocleidomastoid.
Covered by skin, superficial fascia, platysma, anterior jugular v., coutaneous n. and investing fascia
Deep－prevertebral fascia

26. Infrahyoid region Muscular triangle Contents
Superior belly of omohyoid
Sternohyoid
Sternothyroid
Thyrohyoid
Thyroid gland
Parathyroid gland
Cervical part of trachea and esophagus

27. • Superolateral – superior belly of the omohyoid muscle
MUSCULAR TRIANGLE
1. The contents of the muscular triangle of the neck are the infrahyoid muscles, the thyroid
gland, and the parathyroid glands. The boundaries of the muscular triangle are:
• Superolateral – superior belly of the omohyoid muscle
• Inferolateral – anterior border of the sternocleidomastoid muscle
• Medial – median plane of the neck
2. Identify the sternohyoid muscle. The inferior attachment is the sternum and its superior
attachment is the body of the hyoid bone.
3. Identify the superior belly of the omohyoid muscle.
4. Transect the sternohyoid muscle close to the hyoid bone and reflect it inferiorly.
5. Transect the superior belly of the omohyoid muscle close to the hyoid bone and reflect it
inferiorly.
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28. 6. Identify the sternothyroid muscle and thyrohyoid muscle.
7. The ansa cervicalis innervates the infrahyoid muscles.
8. Retract the right and left sternothyroid muscles to identify:
• Laryngeal prominence • Cricothyroid ligament • Cricoid cartilage • • Isthmus of the
thyroid gland
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29. ★ Thyroid gland Shape and position H-shape
Left and right lobes: lie on either side of inferior part of larynx and superior part of trachea, extend from middle of thyroid cartilage to level of sixth trachea cartilage
Isthmus: overlies 2nd to 4th tracheal cartilage
Pyramidal lobe: some times arises from isthmus

30. ★ Thyroid gland Coverings of the thyroid gland
False capsule: a sheath of pretracheal fascia which is attached to arch of cricoid and thyroid cartilages to form the suspensory ligament of thyroid gland, hence, the thyroid gland moves with larynx during swallowing and oscillates during speaking
True capsule: fibrous capsule
Space between sheath and capsule of thyroid gland: there are loose connective tissue, vessels, nerves and parathyroid glands

31. ★ Thyroid gland Relations of the thyroid gland Anteriorly:
Skin
superficial fascia
investing fascia
Infrahyoid muscles and pretracheal fascia
Posteromedially:
Larynx and trachea
Pharynx and esophagus
Recurrent laryngeal nerve
Posterolaterally:
Carotid sheath with common carotid a., internal jugular v., and vagus n.
Cervical sympathetic trunk

32. ★ Arteries of the thyroid gland
Superior thyroid a.
Branch of external carotid a.
Runs superficial and parallel to the external branch of superior laryngeal n. to reach the upper pole of thyroid gland
Gives off superior laryngeal a. in company with internal branch of superior laryngeal n.

33. ★ Arteries of the thyroid gland
Inferior thyroid artery
Branch of thyrocervical trunk of subclavian a.
Turns medially and downward, reaches the posterior border of the thyroid gland, where it is closely related to the recurrent laryngeal n.
Supplies inferior pole of thyroid gland

34. ★ Arteries of the thyroid gland
Arteria thyroidea ima
May arise (4%) from the brachiocephalic a. or aortic arch
lowest thyroid artery

35. ★ Nerves of the larynx Superior laryngeal n.
Internal branch：which pierces thyrohyoid membrane to innervates mucous membrane of larynx above fissure of glottis
External branch：is fine n., which descends in company with the superior thyroid a. and supplies cricothyroid

36. ★ Nerves of the larynx Recurrent laryngeal nerves
Ascend in tracheo-esophageal groove
Pass deep to the lobe of the thyroid gland and come into close relationship with the inferior thyroid a.
Cross either in front of or behind the artery of may pass between its branches
Nerves enter larynx posterior to cricothyroid joint, the nerve is now called inferior laryngeal nerve
Innervations: laryngeal mucosa below fissure of glottis , all laryngeal muscles except cricothyroid

37. Venous drainage of the thyroid gland
Superior thyroid veins drain into internal jugular vein
Middle thyroid veins drain into internal jugular vein
Inferior thyroid veins of two sides anastomose with one another as they descend in front of the trachea to form unpaired thyroid venous plexus. They drain into brachiocephalic veins.

38. ★ Parathyroid gland Yellowish-brown, ovoid bodies Position
Two superior parathyroid glands: lie at junction of superior and middle third of posterior border of thyroid gland
Two inferior parathyroid glands: lie near the inferior thyroid artery, close to the inferior poles of thyroid gland
Function: regulate calcium and phosphate balance and is therefore essential for life

39. Root of neck At thoracic inlet Formed by Anteriorly－manubrium sterni
Posteriorly－body of first thoracic vertebra
Laterally－first rib and costal cartilage
Central markers－scalenus anterior

40. Root of neck
Contents
Cupula of pleura－extends up into the neck, over the apex of lung, 2～3cm above the medial third of clavicle
Subclavian v.
Thoracic duct and right lymphatic duct
Subclavian a.
Vagus n.
Phrenic n.

41. Triangle of the vertebral a.
Boundaries
Medially－longus colli
Laterally－scalenus anterior
Inferiorly－first part of subclavian a.
Apex－transverse process of C6
Posteriorly－cupula of pleura, transverse process of C7, anterior rami of C8 spinal nerves, costal neck of 1st rib
Anteriorly－carotid sheath, phrenic n. and arch of thoracic duct (left)
Contents
Vertebral a. and v.
Inferior thyroid a.
Cervical part of sympathetic trunk
Cevicothoracic ganglion

42. Base of the Neck
Look for the thoracic duct, Which enters the angle between the left internal jugular vein and left subclavian vein .
Next find the vertebral artery, the first and largest branch of the subclavian. This artery usually passes through the transverse foramen of C6.
Finally, identify the sympathetic trunk and its chain ganglia posterior to the carotid sheath.

43. Sympathetic trunk
Inferior thyroid a.
Vagus n.
Recurrent laryngeal n.
Thoracic duct

44. Inferior thyroid a.
Vertebral a.
Transvers cervical a.
Thyrocervical trunk
Costocervical trunk
Suprascapular a.
Internal thoratic a.

45. Lateral region of neck 颈外侧区
Bounded by posterior border of sternocleidomastoid, anterior border of trapezius and middle third of clavicle
Divided by inferior belly of omohyoid into occipital triangle and supraclavicular triangle

46. Occipital triangle 枕三角
Bounded by posterior border of sternocleidomastoid, anterior border of trapezius and superior border of inferior belly of omohyoid
Covered by skin, superficial fascia, and investing fascia
Deep－prevertebral fascia and scalenus anterior, scalenus medius, scalenus posterior, splenius capitis and levator scapulae
Conents
Accessory n.－emerges above the middle of the posterior border of sternocleidomastoid and crosses the occipital triangle to trapezius
Cervical and brachial plexuses

47. Supraclavicular triangle 锁骨上三角
Bounded by posterior border of sternocleidomastoid, inferior belly of omohyoid and middle third of clavicle
Covered by skin, superficial fascia, and investing fascia
Deep－prevertebral fascia and inferior parts of scalenus
Conents
Subclavian v. and venous angle
Subclavian a.
Brachial plexus

48. Muscular Triangle
This triangle includes the “strap” muscles that lie anterior to the trachea. The superficial layer of strap muscles consists of the superior belly of the omohyoid and sternohyoid.
Deep to these are the sternothyroid and short thyrohyoid muscles. Spread the infrahyoid muscles apart and identify the cricothyroid membrane stretching between the thyroid and cricoid cartilages.

49. Thyroid Gland
Expose the thyroid gland and verify that it consists of right and left lobes and an intervening isthmus. Sometimes, a pyramidal lobe is found ascending from the isthmus.
Examine the gland’s blood supply: superior and inferior thyroid arteries, and three veins (superior, middle and inferior). The inferior thyroid artery often is looped and is a branch of the thyrocervical trunk of the subclavian artery.
Cut the isthmus of the gland to turn the lobes laterally and probe for the recurrent laryngeal nerves that ascend on each side posterior to the gland and often lie in the groove between the trachea and esophagus .

50. SUBMANDIBULAR TRIANGLE
1. The contents of the submandibular triangle are the submandibular gland, facial artery, facial
vein, stylohyoid muscle, hypoglossal nerve (XII), and lymph nodes.
The boundaries of the submandibular triangle are:
• Superior – inferior border of the mandible
• Anteroinferior – anterior belly of the digastric muscle
• Posteroinferior – posterior belly of the digastric muscle
2. Identify the submandibular gland. It extends deep to the mylohyoid muscle.
3. Separate the facial artery and vein from the submandibular gland. Facial vein passes superficial
to the submandibular gland and the facial artery courses deep to the gland.
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51. 4. Remove the superficial part of the submandibular gland
4. Remove the superficial part of the submandibular gland. Do not disturb the deep part of the
gland.
5. Identify the anterior and posterior bellies of the digastric muscle.
6. Identify the tendon of the stylohyoid muscle. It attaches to the body of the hyoid bone.
7. Follow the hypoglossal nerve (XII) into the submandibular triangle. It passes deep to the
mylohyoid muscle.
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52. triangle is an unpaired triangle. The boundaries are:
SUBMENTAL TRIANGLE
1. The contents of the submental triangle are the submental lymph nodes. The submental
triangle is an unpaired triangle. The boundaries are:
• Right and left – anterior bellies of the right and left digastric muscles
• Inferior – hyoid bone
• Floor – mylohyoid muscle
2. Clean the superficial fascia from the surface of the right and left mylohyoid muscles.
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53. Thyroid and Parathyroid Glands Dissection Instructions
1. Loosen the sternothyroid muscle from deeper structures and transect it near the sternum and
reflect it superiorly.
2. Observe the thyroid gland. It is located at vertebral levels C5-T1. Laterally, it is in contact
with the carotid sheath.
3. Identify the right lobe and left lobe of the thyroid gland. The two lobes are connected by the
isthmus. It crosses the anterior surface of tracheal rings 2 and 3.
4. The thyroid gland has a pyramidal lobe. It extends superiorly from the isthmus. The
pyramidal lobe is a remnant of development.
5. Identify the superior thyroid artery. It is a branch of the external carotid artery.
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54. tracheal ring. Spread the lobes widely apart.
6. The superior and middle thyroid veins are tributary to the internal jugular vein. The right
and left inferior thyroid veins drain into the right and left brachiocephalic veins, respectively.
7. Cut the isthmus of the thyroid gland. Detach the capsule of the thyroid gland from the 1st
tracheal ring. Spread the lobes widely apart.
8. Display the recurrent laryngeal nerve. It ascends immediately posterior to the thyroid gland
in the groove between the trachea and esophagus.
9. Examine the posterior aspect of the left lobe of the thyroid gland and attempt to identify the
parathyroid glands. Usually, there are two parathyroid glands on each side.
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55. Dissection Instructions
Root of the Neck
Dissection Instructions
1. The clavicle has been cut at its midlength during dissection of the thorax.
2. Reflect the sternohyoid muscle and sternothyroid muscle.
3. Cut the internal thoracic artery close to the subclavian artery. Remove the anterior thoracic
wall.
4. Clean the omohyoid muscle.
5. Identify the subclavian vein. Loosen it from structures that lie deep to it. Remove the
tributaries of the subclavian vein.
6. Follow the subclavian vein proximally. It is joined by the internal jugular vein to form the
brachiocephalic vein.
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56. trunk and the left subclavian artery is a branch of the aortic arch.
7. Identify the subclavian artery. The right subclavian artery is a branch of the brachiocephalic
trunk and the left subclavian artery is a branch of the aortic arch.
8. The subclavian artery has three parts. They are defined by the presence of the anterior scalene
muscle:
• First part – from its origin to the medial border of the anterior scalene muscle
• Second part – posterior to the anterior scalene muscle
• Third part – between the lateral border of the anterior scalene muscle and the lateral border of
the first rib
9. The first part of the subclavian artery has three branches:
• Vertebral artery • Internal thoracic artery • Thyrocervical trunk.
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57. Inferior thyroid artery.
The thyrocervical trunk has three branches: Transverse cervical artery; Suprascapular artery;
Inferior thyroid artery.
Trace the inferior thyroid artery toward the thyroid gland and it passes posterior to the cervical
sympathetic trunk. The ascending cervical artery is a branch of the inferior thyroid artery.
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58. 10. The second part of the subclavian artery has one branch, the costocervical trunk. It
divides into the deep cervical artery and the supreme intercostal artery. The supreme
intercostal artery gives rise to posterior intercostal arteries 1 and 2.
11. The third part of the subclavian artery has one branch, the dorsal scapular artery. It
passes between the superior and middle trunks of the brachial plexus to supply the muscles of the
scapular region.
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59. subclavian and right internal jugular veins.
12. Find the thoracic duct. It ascends from the thorax into the neck. It is posterior to the
esophagus at the level of the superior thoracic aperture, then arches anteriorly and to the left to
join the venous system near the junction of the left subclavian vein and the left internal jugular
13. On the right side of the neck, right lymphatic duct drains into the junction of the right
subclavian and right internal jugular veins.
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60. trachea and esophagus. Trace them as far as the first tracheal ring.
14. Find the vagus nerve in the carotid sheath and follow it into the thorax. It passes posterior to
the root of the lung.
15. The right vagus nerve passes anterior to the subclavian artery. It gives off the right recurrent
laryngeal nerve. The left recurrent laryngeal nerve is given off as the left vagus nerve passes
the aortic arch.
16. Follow the right and left recurrent laryngeal nerves superiorly along the lateral surface of the
trachea and esophagus. Trace them as far as the first tracheal ring.
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61. 17. Verify that the phrenic nerve crosses the anterior surface of the anterior scalene muscle.
Follow the phrenic nerve into the thorax and confirm that it passes anterior to the root of the lung.
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62. thoracic sympathetic trunk.
18. Identify the cervical portion of the sympathetic trunk. Inferior cervical sympathetic ganglion
is located in the root of the neck. Verify that the cervical sympathetic trunk is continuous with the
thoracic sympathetic trunk.
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63. 19. Identify the anterior, middle, and posterior scalene muscles.
20. Define the borders of the anterior scalene and middle scalene muscles. They attach to the
first rib. The first rib and the adjacent borders of the anterior and middle scalene muscles form
the boundaries of the interscalene triangle. The subclavian artery and the roots of the
brachial plexus pass through the interscalene triangle.
• The subclavian vein cross the anterior surface of the anterior scalene muscle. • The phrenic
nerve descends vertically across the anterior surface of the anterior scalene muscle.
21. Clean the roots of the brachial plexus at the level of the interscalene triangle. Identify the
parts of the supraclavicular portion of the brachial plexus: roots, trunks, and divisions.
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64. superficial to the temporal fascia.
TEMPORAL FOSSA
1. The superficial temporal vessels and the auriculotemporal nerve are located in the scalp,
superficial to the temporal fascia.
2. The temporal fascia is attached to the superior temporal line and was cut. Cut the temporal
fascia along the superior border of the zygomatic arch and remove the fascia completely.
3. Identify the temporalis (temporal) muscle.
• Inferior attachment of the temporalis muscle is the coronoid process of the mandible.
• Fibers of the anterior portion of the temporalis muscle have a vertical direction (important for
elevation of the mandible).
• Fibers of the posterior portion of the temporalis muscle have a more horizontal direction
(important for retrusion of the mandible).
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65. coronoid process to the probe.
INFRATEMPORAL FOSSA
1. The ramus of the mandible must be removed to view the contents of the infratemporal fossa.
2. Insert a probe through the mandibular notch and push it anteroinferiorly (arrow 1). Keep the
probe in close contact with the deep surface of the mandible. Use a saw to cut through the
coronoid process to the probe.
3. Reflect the coronoid process together with the temporalis muscle in the superior direction.
Release the temporalis muscle from the skull and the temporal nerves enter the muscle from its
deep surface. The temporal nerves are accompanied by deep temporal arteries.
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66. of the mandible to the probe.
4. Insert a probe medial to the neck of the mandible (arrow 2). Use a saw to cut through the neck
of the mandible to the probe.
5. Insert the handle of a probe medial to the neck of the mandible and slide it inferiorly until it
catches on the lingula (arrow 3). Use a saw to cut down to the probe and remove the superior part
of the ramus of the mandible.
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67. depresses the mandible (opens the jaw).
6. Deep to the mandible, identify the lateral pterygoid muscle. It has two heads.
The anterior attachment of the superior head is the infratemporal surface of the greater wing of
the sphenoid bone. The anterior attachment of the inferior head is the lateral surface of the lateral
plate of the pterygoid process. The posterior attachments are the neck of the mandible and the
articular disc within the capsule of the temporomandibular joint. The lateral pterygoid muscle
depresses the mandible (opens the jaw).
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68. 7. Identify the medial pterygoid muscle
7. Identify the medial pterygoid muscle. The proximal attachments are the maxilla and the
medial surface of the lateral plate of the pterygoid process. The distal attachment is the inner
surface of the ramus of the mandible. It elevates the mandible (closes the jaw).
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69. 8. On the superficial surface of the medial pterygoid muscle, identify the inferior alveolar nerve
and vessels. Clean the inferior alveolar nerve and follow it to the mandibular foramen.
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70. through the mental foramen to innervate the chin and lower lip.
9. The inferior alveolar nerve and vessels enter the mandibular foramen and pass distally in the
mandibular canal. The mental nerve is a branch of the inferior alveolar nerve. It passes
through the mental foramen to innervate the chin and lower lip.
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71. 10. Identify the lingual nerve
10. Identify the lingual nerve. It emerges between the lateral and medial pterygoid muscles just
anterior to the inferior alveolar nerve. It passes medial to the third mandibular molar tooth and it
innervates the mucosa of the anterior 2/3 of the tongue and floor of the oral cavity.
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72. 11. Identify the maxillary artery
11. Identify the maxillary artery. It arises from the bifurcation of the external carotid artery. It
crosses either the superficial surface (2/3) or the deep surface (1/3) of the lateral pterygoid muscle.
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温州医学院人体解剖学教研室

73. enter the deep surface of the temporalis muscle.
12. Trace the maxillary artery through the infratemporal fossa. Identify:
• Middle meningeal artery –passes through the foramen spinosum to supply the dura mater.
• Deep temporal arteries (anterior and posterior)– pass across the infratemporal fossa and
enter the deep surface of the temporalis muscle.
• Inferior alveolar artery – enters the mandibular foramen with the inferior alveolar nerve.
• Buccal artery – passes anteriorly to supply the cheek.
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温州医学院人体解剖学教研室

74. and the articular disc. Remove the muscle.
13. Cut the lateral pterygoid muscle close to its posterior attachments to the neck of the mandible
and the articular disc. Remove the muscle.
14. Follow the inferior alveolar nerve and the lingual nerve to the foramen ovale in the roof of
the infratemporal fossa. Identify the chorda tympani. It joins the posterior side of the lingual
nerve.
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温州医学院人体解剖学教研室

75. 15. Follow the maxillary artery toward the pterygopalatine fossa
15. Follow the maxillary artery toward the pterygopalatine fossa. Within the pterygopalatine
fossa, identify only the posterior superior alveolar artery. It enters the infratemporal surface of
the maxilla.
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温州医学院人体解剖学教研室

76. TEMPOROMANDIBULAR JOINT
1. Identify the capsule of the temporomandibular joint. The joint capsule is loose and its lateral
surface is reinforced by the temporomandibular ligament.
2. Insert scalpel into the temporomandibular joint close to the mandibular fossa and open the
superior synovial cavity of the joint. Remove the head of the mandible along with the articular
disc.
3. Cut the articular capsule to open the inferior synovial cavity and observe the shape and
variable thickness of the articular disc.
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温州医学院人体解剖学教研室

77. Suprahyoid region Submental triangle 颏下三角 Lies below the chin
Boundaries
Laterally by anterior bellies of digastric
Inferiorly by the body of hyoid bone
Covered by skin, superficial fascia and investing fascia
Floor－mylohyoid muscles
Contents－submental lymph nodes

78. Suprahyoid region Submandibular triangle Boundaries
Anterior and posterior bellies of digastric
Lower border of the body of the mandible
Covered by skin, superficial fascia, platysma and investing fascia
Floor－ mylohyoid, hyoglossus and middle constrictor of pharynx
Contents－submandibular gland, facial a., v., hypoglossal n. lingual a. v. and n., submandibular ganglion and submandibular lymph nodes

79. Infrahyoid region Boundaries
★ Carotid triangle
Boundaries
Anterior border of sternocleidomastoid
Superior belly of omohyoid
Posterior belly of digastic
Covered by skin, superficial fascia, platysma and investing fascia
Deep－prevertebral fascia
Medial － lateral wall of pharynx

80. Infrahyoid region ★ Carotid triangle Contents
Common carotid a. and its branches
Internal jugular v. and its tributaries
Hypoglossal n. with its descending branches
Vagus nerve
Accessory nerve
Deep cervical lymph nodes

81. Infrahyoid region Relations of posterior belly of digastic Superficial
great auricular n.
retromandibular v.
cervical branch of facial n.
Deep
internal and external carotid a.
internal jugular v.
Ⅹ～Ⅻ cranial n.
cervical part of sympathetic trunk
Superiorly
posterior auricular a.
facial a.
glossopharyngeal n.
Infeiorly
occipital a.
hypoglossal n.

82. Skin incisions Make the skin incisions shown in figure
Reflect the skin posteriorly to well behind the ear.

83. Dissection of Superficial Structures
Note the underlying platysma muscle, a muscle of facial expression, which has migrated onto the neck. Beneath the platysma lie the supraclavicular cutaneous nerves (C3-4) (medial，intermediate and lateral). Slightly superior to the middle of the posterior border of the sternocleidomastoid muscle, locate the spinal accessory nerve coursing downward toward the trapezius muscle.
Platysma

84. Dissection of Superficial Structures
Using your scissors incise and spread the tough fascial covering of the posterior triangle and locate the lesser occipital nerve (C2-3) emerging close to CN.Ⅺ, note the direction that each nerve takes as it traverses the posterior triangle.
Next locate the great auricular nerve (C2-3) which ascends posterior and parallel with the external jugular vein on the sternoclidomastoid.
Try to identify the small transverse cervical nerve (C2-3) supplying skin over the anterior neck.
Look for the facial vein, retromandibular vein and, if present, the small anterior jugular vein, and review the external jugular system.

85. Cutaneous nerves and superficial veins
Lesser occipital n.
External jugular vein
Greet auricular n.
Transverse nerve of neck
Supraclavicular n.
Anterior jugular vein

86. Cervical part of trachea
Begins at lower end of larynx－level of C6 vertebra
Consists of a series of incomplete cartilage rings
Extends into thorax

87. Relations of cervical part of trachea
★ Anteriorly
Skin
Superficial fascia
Investing fascia
Suprasternal space and jugular arch
Infrahyoid muscles and pretracheal fascia
Isthmus of thyroid gland ( in front of the 2nd to 4th tracheal cartilage)
Inferior thyroid v. and unpaired thyroid venous plexus
Arteria thyroid ima ( if present)
Thymus, left brachiocephalic v. and aortic arch in child

88. Relations of cervical part of trachea
Superolaterally
lobes of the thyroid gland ( down as far as the sixth ring)
Posteriorly
Esophagus
R. & L. recurrent laryngeal nerves
Posterlaterally
Cervical sympathetic trunk
Carotid sheath

89. Cervical part of esophagus
Extending from pharynx at level of C6 vertebra
Descends through the neck, it inclines to the left side
Relations of the cervical part of esophagus
Anteriorly
Trachea
Recurrent laryngeal nerves
Posteriorly
Prevertebral layer of cervicl fascia
Longus colli
Vertebral column
Laterally
Lobe of the thyroid gland
Carotid sheath with common carotid a., internal jugular v., and vagus n.

90. Sternocleidomastoid region 胸锁乳突肌区
Covered by sternocleidomastoid
Contents
Ansa cervicalis
Carotid sheath
Cervical plexus
Cervical part of sympathetic trunk

91. Carotid Triangle
Palpate and locate the tip of the greater horn of the hyoid bone. Just superior to the tip, find the hypoglossal nerve where it crosses the carotid sheath anteriorly and lataerally.
Now try to find the superior root of the ansa cervicalis which is composed mainly of fibers from C1 that run with the CN. Ⅻ. The inferior root (C2-3) descends from the more posterior superior neck region to join the superior root, together forming a loop overlying the carotid sheath. The ansa innervates the infrahyoid muscles and often is enmeshed in the carotid sheath.

92. Carotid Triangle
Find the vagus nerve by carefully opening the carotid sheath. It lies within the carotid sheath between the common carotid artery and internal jugular vein.
Relax the neck, and then sever the omohyoid, sternohyoid, and thyrohyoid muscles close to the hyoid bone. This exposes the thyrohyoid membrane and the internal laryngeal nerve can be seen piercing this membrane. The other portion of the superior laryngeal nerve is its very small external laryngeal nerve.

93. Carotid Triangle
Identify the common carotid artery, internal carotid artery and the closely applied internal jugular vein.
Identify the external carotid artery and its first five branches.
Superior thyroid a.: Supplies the upper part of the thyroid gland and gives off the superior laryngeal artery, which pierces the thyrohyoid membrane with the internal laryngeal nerve.
Lingual a.
Facial a.
Occipital a.
Ascending pharyngeal a.