1. The Neck

2. Lecture Objectives Define the boundaries of the neck.
Describe the fasciae of the neck.
Summarize the main arteries, veins, nerves and lymph nodes of the neck.
List the muscles of the neck.
Describe the neck triangles.
Describe the key muscles creating the triangles, mainly, sternomastoid, omohyoid and digastric.
Study the boundaries and content of each triangle.

3. Boundaries of the Neck Superior margin Inferior margin
Root of the neck

4. Cervical Vertebral Muscles
Suboccipital and deep neck muscles
Mainly extends head and neck
Rectus capitis posterior major m.
Rectus capitis posterior minor m.
Oblique capitis inferior m.
Oblique capitis superior m.

5. Cervical Prevertebral Muscles
Anterior vertebral muscles
Mainly flexes head and neck
Longus coli m.
Longus capitis m.
Rectus capitis anterior m.
Anterior scalene m.
Lateral vertebral muscles
Mainly laterally flex head and neck
Rectus capitis lateralis m.
Splenius capitis m.
Levator scapulae m.
Middle scalene m.
Posterior scalene m.

7. Cervical fascia Superficial fascia Deep fascia: Investing layer
Pretracheal layer
Prevertebral layer
Carotid sheath

8. Cervical Fascia Superficial fascia Deep fascia: platysma
Investing layer
Trapezius & SCM
Pretracheal layer
Visceral part ‐ Thyroid & parathyroid
Buccopharyngeal fascia ‐ pharynx
Muscular part ‐ Infrahyoid mm.

9. Cervical Fascia Deep fascia (continue…) Prevertebral layer
Posterior to pharynx & esophagus
Vertebral mm.
Continue as axillary sheath
Carotid sheath
Thickening of the other layers
Common & internal carotid aa.
Intrnal jugular v.
Vagus n.
Deep cervical lymph nodes

10. Cervical Fascia: Extensions
Alar fascia
Division from prevertebral fascia
From skull to T2 (merge with buccopharyngeal fascia)
Buccopharyngeal fascia
Superior & posterior continuation of the pretracheal fascia

11. Cervical Fascia: Spaces
Retropharyngeal space
Between buccopharyngeal fascia and prevertebral fascia
Spread of infections
(Real) Retropharyngeal space
Between the alar fascia and buccopharyngeal fascia
Allow movement of pharynx, larynx, and trachea during swallowing
Continuous with superior mediastinum to T2
Danger space
Between the alar fascia and the prevertebral fascia
Continuous with mediastinum

12. Neck Triangles: Boundaries
Anterior triangle
Anterior to SCM
Carotid triangle
Digastric triangle
Submental triangle
Muscular triangle
Posterior triangle
Posterior to SCM
Anterior to trapezius
Occipital triangle
Supraclavicular triangle

13. Neck Triangles: Content

14. Sensory Innervations of the Neck

15. Root of the Neck

16. Arteries of the Head and Neck

17. Veins of the Head and Neck

18. Principal groups of lymph nodes Lymph drainage of Head and neck
Regional lymph nodes
Occipital
Retroauricular
Parotid
Buccal
Submandibular
Submental
Anterior cervical
Laryngeal
Tracheal
Superficial cervical
Deep cervical
Jugular trunk

19. Occipital Triangle Above the inferior belly of omohyoid m.
Spinal accessory nerve (XI)
Junction of the superior & middle thirds of the posterior border of SCM → junction between middle & lower thirds of the anterior border of trapezius
Injury

20. Anterior Triangle Carotid triangle Submandibular (digastric) triangle
Carotid sheath
Between sternocalvicular joint and the mid point between mastoid and angle of mandible
Hypoglossal nerve
Cervical sympathetic trunk
Submandibular (digastric) triangle
Submandibular gland
Submandibular lymph nodes

21. Surface Anatomy of the Neck
Hyoid bone – C3
Posterior to the mandible
Laryngeal prominence (Adma’s apple)‐ tip (C4)
Vocal cords – at the middle
Cricoid cartilage – C6
Cricothyroid ligament
Cricothyrotomy
First tracheal cartilage
Tracheostomy
Thyroid gland
Isthmus – 2nd – 4th tracheal rings

22. Tracheostomy