1. Regional II Anatomy
Review

3. Muscle Groups of the Anterolateral Neck
superficial muscles
infrahyoid muscles
suprahyoid muscles
lateral vertebral muscles
anterior vertebral muscles
Superficial Muscles
platysma
sternocleidomastoid

5. Infrahyoid Muscles sternohyoid omohyoid sternothyroid thyrohyoid
thin, strap-like muscles

7. Suprahyoid Muscles
digastric
stylohyoid
mylohyoid
geniohyoid

12. Lateral Vertebral Muscles
scalenus anterior
scalenus medius
scalenus posterior

15. Supraclavicular triangle
Occipital triangle
Supraclavicular triangle
(inferior belly)

19. Arteries of the Face
derived from branches of external and internal carotid arteries
terminal branches of arteries supplying face anastomose freely
many arteries accompany cutaneous nerves and have same name as nerves
facial branches of ophthalmic artery (branch of internal carotid artery):
lacrimal artery
supraorbital artery
supratrochlear artery
dorsal nasal artery (accompanies infratrochlear nerve)
external nasal artery

20. Arteries of the Face facial branches of ophthalmic artery (cont.):
zygomaticofacial artery
zygomaticotemporal artery
facial branches of maxillary artery (larger terminal branch of external carotid artery):
infraorbital artery
buccal artery
mental artery (originates from inferior alveolar artery)
facial branches of superficial temporal artery (smaller terminal branch of external carotid artery):
transverse facial artery
zygomaticoorbital artery

21. Arteries of the Face facial artery:
main source of blood supply to face  branch of external carotid artery  arches over submandibular gland in submandibular triangle  curves around inferior border of body of mandible, just anterior to masseter muscle, to enter face (place to feel its pulse)  ascends in tortuous course toward medial angle of eye
its branches anastomose freely with branches of maxillary and ophthalmic arteries and with branches of facial artery of opposite side
branches (in face):
superior and inferior labial arteries
lateral nasal artery
angular artery (terminal part of facial artery at medial angle of eye)  anastomoses with dorsal nasal artery (branch of ophthalmic artery)

24. Veins of the Face
veins of face follow similar pattern as arteries  facial branches of ophthalmic, maxillary and superficial temporal arteries are accompanied by corresponding veins
facial vein:
begins as angular vein at medial angle of eye by union of supraorbital and supratrochlear veins
descends posterior to facial artery to inferior border of mandible  crosses superficial to submandibular gland  joins anterior branch of retromandibular vein  drains into internal jugular vein (after joining anterior branch of retromandibular vein it is known as common facial vein)
communicates with cavernous sinus via ophthalmic veins, deep facial vein, and infraorbital vein  these connections represent pathways for spread of infections from face to cavernous sinus

25. Veins of the Face retromandibular vein:
formed within parotid gland by union of superficial temporal and maxillary veins
descends posterior to ramus of mandible, inside parotid gland  at level of angle of mandible divides into anterior and posterior branches
anterior branch joins facial vein to form common facial vein
posterior branch joins posterior auricular vein to form external jugular vein

29. Muscles of the Face (of Facial Expression)
muscles of orbital opening:
orbicularis oculi  sphincter muscle of eyelids  palpebral part (centrally located) lightly approximates eyelids in blinking and sleep  eyelids are more forcibly brought together by orbital part (peripherally located) to protect from intense light or foreign bodies
corrugator supercilii  lies deep to orbicularis oculi and frontalis muscles  draws eyebrow medially  produces vertical wrinkles in supranasal part of forehead

30. Muscles of the Face (of Facial Expression)
muscles of nose:
procerus  located over root of nose  produces transverse wrinkles across root of nose
nasalis muscle (transverse and alar parts)  dilates nasal aperture (nose is flattened and widened)
muscles of mouth:
orbicularis oris  fibers encircle oral orifice within substance of lips  most fibers are derived from buccinator and other muscles around mouth  sphincter muscle of lips  compresses lips together and protrudes them
levator labii superioris alaeque nasi

31. Muscles of the Face (of Facial Expression)
muscles of mouth (cont.):
levator labii superioris
levator anguli oris
zygomaticus minor  elevates upper lip
zygomaticus major  draws angle of mouth upward and backward (smiling)
risorius  retracts angle of mouth (grinning)
depressor anguli oris
depressor labii inferioris
mentalis  draws up and puckers skin of chin (assists in protrusion and eversion of lower lip)

32. Muscles of the Face (of Facial Expression)
buccinator:
originates from outer surfaces of alveolar processes of maxilla and mandible, opposite molar teeth, and from pterygomandibular raphe (thin fibrous band that extends from pterygoid hamulus to posterior end of mylohyoid line of mandible)
muscle fibers pass forward and form muscle layer of cheek  at angle of mouth fibers enter upper and lower lips and become continuous with orbicularis oris
pierced by parotid duct
compresses cheek against molar teeth (aids in mastication, together with tongue, by pushing food between teeth), assists in expelling air from oral cavity (whistling, blowing, playing wind instruments)

33. Muscles of the Scalp occipitofrontalis (epicranius):
consists of 4 bellies (2 frontal and 2 occipital) connected by a broad, intermediate fibrous sheet  epicranial aponeurosis (galea aponeurotica)
occipital bellies originate from occipital bone above superior nuchal lines and terminate in epicranial aponeurosis
frontal bellies originate from epicranial aponeurosis and terminate in skin of forehead above eyebrows
draws scalp back; frontal bellies raise eyebrows (surprise), producing transverse wrinkles in forehead
auricular muscles: anterior, superior and posterior  provide little movement in man

36. Facial Nerve
leaves cranial cavity via internal acoustic meatus at lateral end of meatus enters facial canal (bony canal within petrous part of temporal bone) It exits temporal bone via stylomastoid foramen to enter parotid gland and pass forward within it (superficial to retromandibular vein and external carotid artery) to divide into terminal branches within parotid gland
2 groups of branches: intrapetrosal (branches that facial nerve gives off within facial canal) and extrapetrosal (branches facial nerve gives off distal to stylomastoid foramen
extrapetrosal branches innervate the muscles of facial expression
posterior auricular nerve: supplies occipital belly of occipitofrontalis and posterior and superior auricular muscles
nerves to posterior belly of digastric and stylohyoid

37. Facial Nerve 5 terminal branches:
temporal branches: supply anterior and superior auricular muscles, frontal belly of occipitofrontalis, orbicularis oculi and corrugator supercilii
zygomatic branches: supply orbicularis oculi and zygomaticus major and minor
buccal branches: supply buccinator and muscles of upper lip and nose
marginal mandibular branch: supplies muscles of lower lip and chin
cervical branch: supplies platysma

41. Parotid Gland largest of major salivary glands
located anterior and inferior to external acoustic meatus in deep hollow between ramus of mandible and sternocleidomastoid muscle
wedge-shaped on lateral view (base above, toward zygomatic arch, and apex below, posterior to angle of mandible)
wedge-shaped in horizontal section (base lateral and apex medial, toward pharyngeal wall)
parotid duct  originates from anterior part of gland  passes anteriorly, superficial to masseter and inferior to zygomatic arch  at anterior border of masseter turns medially and pierces buccal pad of fat and buccinator  opens into vestibule of oral cavity opposite upper 2nd molar tooth

42. Parotid Gland
structures within parotid gland from lateral (superficial) to medial (deep):
facial nerve
retromandibular vein
external carotid artery
anatomic relations:
superficial (lateral): skin, superficial fascia, branches of great auricular nerve
posterior: mastoid process, sternocleidomastoid, posterior belly of digastric, styloid process with attached muscles, carotid sheath with its contents
anterior: ramus of mandible, masseter, medial pterygoid
deep (medial): pharynx

45. Blood supply of the Neck

47. Common Carotid Artery
right common carotid artery originates from brachiocephalic trunk (artery), posterior to right sternoclavicular joint
left common carotid artery originates from aortic arch in superior mediastinum
common carotid artery ascends in neck within carotid sheath to upper border of thyroid cartilage, where it divides into external and internal carotid arteries
within carotid sheath, internal jugular vein lies lateral to common carotid artery and vagus nerve lies between common carotid artery and internal jugular vein, posteriorly

48. Subclavian Artery
right subclavian artery is a branch of brachiocephalic trunk (artery)  begins posterior to right sternoclavicular joint
left subclavian artery is a branch of aortic arch  begins in superior mediastinum
subclavian artery is divided into 3 parts by scalenus anterior muscle:
1st part  from origin to medial border of scalenus anterior
2nd part  posterior to scalenus anterior
3rd part  from lateral border of scalenus anterior to lateral border of 1st rib, where it becomes continuous with axillary artery

49. Subclavian Artery branches of 1st part: vertebral artery
thyrocervical trunk
internal thoracic artery
branches of 2nd part:
costocervical trunk (may originate from 1st part)
3rd part gives rise to dorsal scapular artery or may have no branches

51. Vertebral Artery originates from 1st part of subclavian artery
course is divided into 4 parts:
1st (prevertebral) part  runs superiorly and posteriorly from subclavian artery to transverse foramen of C6, between longus colli muscle (medial to artery) and scalenus anterior muscle (lateral to artery)  inferior cervical sympathetic ganglion (or cervicothoracic/stellate ganglion) lies posterior to 1st part of vertebral artery
2nd (cervical) part  ascends through transverse foramina of C6 to C1, anterior to ventral rami of corresponding spinal nerves

52. Vertebral Artery parts (cont.):
3rd (atlantic) part  runs medially, posterior to lateral mass of atlas, and enters vertebral canal passing under posterior atlanto-occipital membrane  it lies in a groove on superior surface of posterior arch of atlas and it is a content of suboccipital triangle
4th (intracranial) part  pierces dura mater and arachnoid, and ascends into cranial cavity (within subarachnoid space) via foramen magnum  anastomoses with vertebral artery of opposite side to form basilar artery
4th (intracranial) part gives off major branches of vertebral artery
2nd (cervical) part gives off small muscular and spinal branches

53. Interval through which 1st part of vertebral artery ascends from subclavian artery to transverse foramen of C6

54. 1st (prevertebral) part

55. 4th (intracranial) part
3rd (atlantic) part
2nd (cervical) part
1st (prevertebral) part

56. 3rd (atlantic) part
2nd (cervical) part

57. Thyrocervical Trunk
originates from 1st part of subclavian artery, just medial to scalenus anterior muscle, and opposite origin of internal thoracic artery
after a short course, it divides into inferior thyroid, superficial (transverse) cervical and suprascapular arteries
inferior thyroid artery:
contributes to supply larynx, trachea, pharynx, esophagus, thyroid and parathyroid glands
ascends to level of cricoid cartilage and then arches medially, posterior to carotid sheath, to reach lower part of lobe of thyroid gland  as it approaches thyroid gland, it is closely related to recurrent laryngeal nerve

58. Thyrocervical Trunk inferior thyroid artery (cont.):
ascending cervical artery  originates from inferior thyroid artery as it arches medially  ascends on scalenus anterior muscle  supplies adjacent muscles and gives 1 or 2 spinal branches
superficial (transverse) cervical artery  runs laterally and posteriorly, passing anterior to scalenus anterior, phrenic nerve, and brachial plexus  supplies superficial muscles of upper back
suprascapular artery  runs parallel and inferior to superficial (transverse) cervical artery  as it approaches scapula, it is joined by suprascapular nerve  supplies muscles on posterior aspect of scapula

60. Thyrocervical Trunk
originates from 1st part of subclavian artery, just medial to scalenus anterior muscle, and opposite origin of internal thoracic artery
after a short course, it divides into inferior thyroid, superficial (transverse) cervical and suprascapular arteries
inferior thyroid artery:
contributes to supply larynx, trachea, pharynx, esophagus, thyroid and parathyroid glands
ascends to level of cricoid cartilage and then arches medially, posterior to carotid sheath, to reach lower part of lobe of thyroid gland  as it approaches thyroid gland, it is closely related to recurrent laryngeal nerve

61. Thyrocervical Trunk inferior thyroid artery (cont.):
ascending cervical artery  originates from inferior thyroid artery as it arches medially  ascends on scalenus anterior muscle  supplies adjacent muscles and gives 1 or 2 spinal branches
superficial (transverse) cervical artery  runs laterally and posteriorly, passing anterior to scalenus anterior, phrenic nerve, and brachial plexus  supplies superficial muscles of upper back
suprascapular artery  runs parallel and inferior to superficial (transverse) cervical artery  as it approaches scapula, it is joined by suprascapular nerve  supplies muscles on posterior aspect of scapula

62. Costocervical Trunk
usually originates from 2nd part of subclavian artery
passes posteriorly, over cervical pleura, toward neck of 1st rib, where it divides into supreme (superior) intercostal and deep cervical arteries
supreme (superior) intercostal artery  descends in front of neck of 1st and 2nd ribs  gives off posterior intercostal arteries of upper 2 intercostal spaces
deep cervical artery  passes posteriorly, between transverse process of C7 and neck of 1st rib  ascends between semispinalis capitis and semispinalis cervicis muscles  ends by anastomosing with a branch of occipital artery  it supplies deep muscles of back of neck

63. Costocervical Trunk
usually originates from 2nd part of subclavian artery
passes posteriorly, over cervical pleura, toward neck of 1st rib, where it divides into supreme (superior) intercostal and deep cervical arteries
supreme (superior) intercostal artery descends in front of neck of 1st and 2nd ribs  gives off posterior intercostal arteries of upper 2 intercostal spaces
deep cervical artery passes posteriorly, between transverse process of C7 and neck of 1st rib supply deep muscles of back of neck

66. Subclavian Vein
begins at lateral border of 1st rib, as a continuation of axillary vein
passes over 1st rib, anterior and slightly inferior to subclavian artery (separated from it by scalenus anterior muscle)
ends posterior to sternoclavicular joint by joining internal jugular vein to form brachiocephalic vein
has only one constant tributary the external jugular vein

67. External Carotid Artery
begins at upper border of thyroid cartilage  ascends in carotid triangle  leaves carotid triangle as it passes deep (medial) to posterior belly of digastric and stylohyoid  terminates within substance of parotid gland, posterior to neck of mandible, dividing into superficial temporal and maxillary arteries
branches:
anterior branches: superior thyroid, lingual and facial arteries
posterior branches: occipital and posterior auricular arteries
medial branch: ascending pharyngeal artery
terminal branches: superficial temporal and maxillary arteries

70. Internal Jugular Vein collects most venous blood from head and neck
begins in jugular foramen, as a continuation of sigmoid sinus  ends posterior to corresponding sternoclavicular joint, where it joins subclavian vein to form brachiocephalic vein
lies within carotid sheath, lateral to internal carotid artery (in upper neck), and lateral to common carotid artery (in lower neck)
deep cervical lymph nodes lie alongside internal jugular vein
upper and lower ends of internal jugular vein are dilated (superior and inferior bulbs)

71. Internal Jugular Vein tributaries:
inferior petrosal sinus  leaves cranial cavity via jugular foramen and drains into superior bulb
lingual vein(s)
pharyngeal veins
facial vein
superior and middle thyroid veins
occipital vein (sometimes)

74. External Jugular Vein
begins posterior to angle of mandible by union of posterior auricular vein and posterior branch of retromandibular vein
posterior auricular vein  drains scalp posterior and superior to auricle
retromandibular vein  formed within parotid gland by union of superficial temporal and maxillary veins  at lower end of gland it divides into anterior and posterior branches  anterior branch joins facial vein  posterior branch joins posterior auricular vein to form external jugular vein
EJV descends obliquely, superficial to sternocleidomastoid, toward middle of clavicle  pierces investing layer of deep cervical fascia  drains into subclavian vein
tributaries: transverse cervical, suprascapular, and anterior jugular veins

75. Anterior Jugular Vein
begins in submental region by union of several small veins
descends close to anterior midline  superior to jugular (suprasternal) notch of sternum it turns laterally and passes posterior (deep) to sternocleidomastoid  drains into external jugular vein
right and left anterior jugular veins are usually joined across midline by jugular venous arch