1. Neck
山东大学医学院 解剖教研室
李振华

2. The muscles of neck Superficial group
Platysma 颈阔肌，a thin sheet-like muscle of facial expression
Sternocleidomastoid 胸锁乳突肌

3. Suprahyoid muscles Elevate (raise) hyoid bone and depress mandible.
Digastric 二腹肌
Stylohyoid 茎突舌骨肌
Mylohyoid 下颌舌骨肌
Geniohyoid 颏舌骨肌
Elevate (raise) hyoid bone and depress mandible.

4. Infrahyoid muscle Depress hyoid or larynx after elevation
Sternohyoid 胸骨舌骨肌
Sternothyroid 胸骨甲状肌
Thyrohyoid 甲状舌骨肌
Omohyoid 肩胛舌骨肌
Depress hyoid or larynx after elevation

5. Deep group Lateral Medial Flex the head, bends the neck forward
Scalenus anterior 前斜角肌
Scalenus medius 中斜角肌
Scalenus posterior 后斜角肌
Medial
longus capitis 头长肌
longus colli 颈长肌
Flex the head, bends the neck forward

6. Major muscles of the neck
Sternocleidomastoid
Origin: manubrium and sternal end of clavicle
Insertion: mastoid process of temporal bone
Action: contraction of one muscle draws head toward the same side, and turn face to opposite side; both muscles act together to draw head backward

7. Scalenus anterior
Origin: transverse processes of C3-C6.
Insertion: tubercle for scalenus anterior
Action: unilateral, bends neck laterally; bilateral, elevate first rib, an accessory muscle of inspiration; if rib is fixed, flex neck anteriorly
Scalene fissure 斜角肌间隙 Above the first rib, there is a triangular space between scalenus anterior and midius. The brachial plexus and the subclavine a. emerge from this space.

8. The arteries of neck Common carotid artery 颈总动脉
Origin (arises from)
Brachiocephalic trunk on the right
Aortic arch on the left
Ascends in neck to upper border of thyroid cartilage; bifurcates into internal and external carotid arteries

9. Carotid sinus 颈动脉窦(baroreceptor), located at a localizes dilation of terminal part of common carotid artery or beginning of internal carotid artery, sensitive to blood pressure changes
Carotid glomus 颈动脉小球 (chemoreceptor), lies posterior to the point of bifurcation of common carotid artery, senses changes in blood carbon dioxide (oxygen) levels

10. Branches of external carotid a.
Superior thyroid a 甲状腺上动脉－descends to supply upper pole of thyroid gland and larynx
Lingual a. 舌动脉
Facial a. 面动脉
Occipital a.枕动脉
Posterior auricular a 耳后动脉
Maxillary a. 上颌动脉
Superficial temporal a 颞浅动脉

11. Subclavian artery 锁骨下动脉
Origin (arises from)
Brachiocephalic trunk on right
Aortic arch on left
Becomes axillary artery at lateral border of first rib
Branches
Vertebral a. 椎动脉
Internal thoracic a. 胸廓内动脉
Thyrocervical trunk 甲状颈干
Inferior thyroid artery 甲状腺下动脉－supplies inferior pole of thyroid gland
Costocervical trunk 肋颈干

12. Veins Draining the neck
Internal jugular vein 颈内静脉
Begin at jugular foramen, descending to join the subclavian vein to form brachiocephalic vein
Lies lateral first to internal and then to common carotid a. within carotid sheath
Chief extracranial tributaries
Common facial vein 面总静脉
Lingual v. 舌静脉
Pharyngeal v. 咽静脉
Superior thyroid v.甲状腺上静脉
Middle thyroid v. 甲状腺中静脉

13. Subclavian vein
It is an continuation of axillary vein at the lateral border of first rib
Joins internal jugular vein to form the brachiocephalic vein. Angle of union is termed venous angle 静脉角

14. External jugular vein 颈外静脉
Formed behind angle of mandible by union of posterior auricular, posterior branch of retromandibular and occipital vein
Crossing sternocleidomastoid to enter subclavian vein
Anterior jugular vein 颈前静脉
Drains submandibular and anterior neck regions
Descends near midline, runs posterior to sternal end of sternocleidomastoid to drain into external jugular vein or subclavian vein

15. Lymph nodes of neck Anterior cervical lymph nodes
Superficial anterior cervical lymph nodes
Deep anterior cervical lymph nodes
Lateral cervical lymph node
Superficial lateral cervical lymph nodes－lie along the external jugular vein

16. Deep lateral cervical lymph nodes
Extend along the internal jugular vein from the base of skull to the root of neck, divided into superior deep lateral cervical lymph nodes and inferior deep lateral cervical lymph nodes
Receive lymphatic vessels from head, neck, tongue, larynx, cervical parts of esophagus and trachea, thyroid gland, upper parts of the thoracic wall and breast
Efferent vessels form the jugular trunk－the left jugular trunk joins the thoracic duct and right may joint the right lymphatic duct

17. Superior deep lateral cervical lymph nodes 颈外侧上深淋巴结
Jugulodigastric lymph node 颈内静脉二腹肌淋巴结: lies at the junction of posterior belly of digastric and internal jugular vein
Inferior deep lateral cervical lymph nodes 颈外侧下深淋巴结
Juguloomohyoid lymph node 颈内静脉肩胛舌骨肌淋巴结: lies at the junction of the intermediate tendon of omohyoid and internal jugular vein
Supraclavicular lymph nodes 锁骨上淋巴结: lie along the subclavian artery

18. Right lymphatic duct 右淋巴导管
Formed by union of right jugular, subclavian, and bronchomediastinal trunks
Ends by entering the right venous angle
Receives lymph from right half of head, neck, thorax and right upper limb
Thoracic duct 胸导管
At the roof of the neck, it turns laterally and arches forwards and descends to enter the left venous angle
Just before termination, it receives the left jugular, subclavian and bronchomediastinal trunks

19. Cervical plexus
Formation: formed by anterior rami of C1-C4 spinal nerves
Position: lies in front of the origin of levator scapulae and scalenus medius and deep to the superior part of the sternocleidomastoid

20. Branches
Cutaneous branches: emerge around middle of posterior border of sternocleidomastoid, to supply skin of neck and scalp between auricle and external occipital protuberance
Lesser occipital n. 枕小神经
Greet auricular n. 耳大神经
Transverse nerve of neck 颈横神经
Supraclavicular n. 锁骨上神经

21. Muscular branches: supply the deep muscles of neck
Phrenic nerve 膈神经(anterior rami of C3-C5)
Lies on anterior scalene, deep to fascia
To diaphragm (motor and sensory)
Ansa cervicalis 颈袢:
Hypoglossal nerve gives off superior root of ansa (descendens hypoglossi), composed of fibers picked up from nerve C1
Joins inferior root of ansa (descendens cervicalis, C2and C3) to form a loop, the ansa cervicalis, which supplies infrahyoid muscles

22. Vagus nerve (Ⅹ)
Leaves skull via jugular foramen
Descends in the neck in carotid sheath between internal (or common) carotid artery and internal jugular vein

23. Branches
Superior laryngeal nerve 喉上神经 passes down side of pharynx and given rise to
Internal branch 内支 which pierces thyrohyoid membrane to innervates mucous membrane of larynx above fissure of glottis
External branch 外支 which innervates cricothyroid
Cervical cardiac branches 颈心支 : descending to terminate in cardiac plexus
Recurrent laryngeal nerves 喉返神经
Ascend in tracheo-esophageal groove
Enter larynx posterior to cricothyroid joint, the nerve is now called inferior laryngeal nerve
Innervations: laryngeal mucosa below fissure of glottis , all laryngeal laryngeal muscles except cricothyroid

24. Accessory n. (Ⅺ ) 副神经
Deep to posterior belly of digastric
Supplies sternoclidomastoid and trapezius muscle
Hypoglossal n.(Ⅻ) 舌下神经
Descends between internal carotid a. and internal jugular v., hooks around external carotid a., to lie on the hyoglossus before entering tongue
Supplies muscles of tongue

25. Cervical part of sympathetic trunk 颈交感干
Formed by superior , middle and inferior cervical ganglia and interganglionic branches
Superior cervical ganglion: largest, situated in front of transverse processes of C1~C3 vertebra
Middle cervical ganglion: smallest, is at level of transverse processes of C6 vertebra
Inferior cervical ganglion: situated at level of C7 vertebra, and may be fused with first thoracic ganglion to form cervicothoracic ganglion 颈胸神经节

26. Regional anatomy of neck
山东大学医学院 解剖教研室
李振华

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

28. Landmarks Hyoid bone Thyroid cartilage Cricoid cartilage
Catotid tubercle
Sternocleidomastoid
Suprasternal fossa
Greater supraclaviclar fossa

29. Regions Neck 颈 Nape 项部 Anterior region of neck Lateral region of neck
Sternocleidomastoid region
Nape 项部

30. Anterior region of neck Suprahyoid region 舌骨上区
Submental triangle 颏下三角
Submandibular triangle 下颌下三角
Infrahyoid region 舌骨下区
Carotid triangle 颈动脉三角
Muscular triangle 肌三角

31. Lateral region of neck
Occipital triangle 枕三角
supraclavicular triangle 锁骨上三角 (greatsupraclavicular fossa) 锁骨上大窝

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

33. Consists of fat and connective tissue Contents
Superficial fascia
Consists of fat and connective tissue
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.

34. Cervical fascia 颈筋膜－three layers
Superficial layer (investing fascia 封套筋膜)
Encloses trapezius, sternocleidomastoid, posterior belly of digastric and parotid and submandibular glands
Attached to bony landmarks of upper and lower boundaries of neck and zygomatic arch of face

35. Prevertebral layer 气管前层
Encloses viscera of neck: pharynx, larynx, trachea, esophagus, thyroid gland and parathyroid glands
Completely surrounds thyroid gland, forming a sheet for it, and bind the gland to larynx
Extends from hyoid bone to fibrous pericardium of superior mediastinum

36. Prevertebral layer 椎前层
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

37. Carotid sheath 颈动脉鞘
Formed by components of all three layers of deep cervical fascia
Contains common and internal carotid arteries, internal jugular vein, and vagus nerve
Ansa cervicalis located on its anterior surface

38. Suprasternal space 胸骨上间隙
Over the lower part of the anterior triangle, the inversting fascia splits into two layers, which are attached to the anterior and posterior margins of the upper border of the manubrium, between these two layers is a slitlike space, called the suprasternal space
Contains connective tissue, and sometimes a lymph node

39. Pretracheal space 气管前间隙
Lies between pretracheal layer and cervical part of trachea
Contains arteria thyroidea ima, inferior thyroid v., unpaired thyroid venous plexus, brachiocephalic trunk and left brachiocephalic v.

40. Retropharyngeal space 咽后间隙
Lies between prevertebral layer and buccopharyngeal fascia
Prevertebral space 椎前间隙
Lies between prevertebral muscles, cervical part of vertebral column and prevertebral layer

41. Suprahyoid region Submental triangle 颏下三角
Lies below the chin and is bounded laterally by anterior bellies of digastric, and inferiorly by the body of hyoid bone
Covered by skin, superficial fascia and investing fascia
Floor－mylohyoid muscles
Contents－submental lymph nodes

42. Submandibular triangle 下颌下三角
Bounded by anterior and posterior bellies of digastric and 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. and v., lingual n., submandibular ganglion and submandibular lymph nodes

43. Infrahyoid region Carotid triangle 颈动脉三角
Bounded by anterior border of sternocleidomastoid, superior belly of omohyoid and posterior belly of digastic muscles
Covered by skin, superficial fascia, platysma and investing fascia
Floor－prevertebral fascia and lateral wall of pharynx
Contents－common carotid a. and its branches, internal jugular v. and its tributaries, hypoglossal n. with its descending branches, the accessory and vagus nerves, and part of the chain of deep cervical lymph nodes

44. Posterior belly of digastic muscle
Superficial－great auricular n., retromandibular v., cervical branch of facial n.
Deep－internal and external carotid a., internal jugular v., Ⅹ～Ⅻ cranial n. and cervical part of sympathetic trunk
Superior－posterior auricular a., facial a. and glossopharyngeal n.
Infeior－occipital a. and hypoglossal n.

45. Muscular triangle 肌三角
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
Floor－prevertebral fascia
Contents－sternohyoid, superior belly of omohyoid, sternothyroid, thyrohyoid, thyroid gland, parathyroid gland, cervical part of trachea and esophagus

46. Thyroid gland 甲状腺 Shape and position Fibrous capsule: 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
Fibrous capsule:
A sheath of pretracheal fascia which is attached to arch of cricoid and thyroid cartilages, hence, the thyroid gland moves with larynx during swallowing and oscillates during speaking

47. Relations
Anteriorlly－skin , superficial fascia, investing fascia, infrahyoid muscles and pretracheal layer
Posteromedialy－ larynx and trachea, pharynx and esophagus, recurrent laryngeal n.
Posterolateraly－carotid sheath and cervical part of sympathetic trunk

48. Arteries of thyroid gland and nerves of larynx
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.

49. Superior laryngeal nerve
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

50. Inferior thyroid artery 甲状腺下动脉
Branch of thyrocervical trunk off subclavian a.
Turns medially and downward, reaches the posterior border of the thyroid gland and is closely related to the recurrent laryngeal n.
Supplies inferior pole of thyroid gland
Recurrent laryngeal nerves 喉返神经
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 laryngeal muscles except cricothyroid

51. Arteria thyroid ima 甲状腺最下动脉
May arise (4%) from the brachiocephalic a. or aortic arch
Venous drainage
Superior and middle thyroid veins into internal jugular vein
Inferior thyroid veins to left brachiocephalic vein

52. Parathyroid gland 甲状旁腺
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

53. Cervical part of trachea 气管颈部
Begins at lower end of larynx－level of C6 vertebra
Consists of a series of incomplete cartilage rings
Extends into thorax
Relations in the neck
Anteriorly
The 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), and left brachiocephalic v. in child

54. Laterally
The lobes of the thyroid gland ( down as far as the sixth ring) and the carotid sheath
Posteriorly
The right and left recurrent laryngeal nerves, the esophagus

55. Cervical part of esophagus 食管颈部
Connecting the pharynx at level of C6 vertebra
Consists of smooth muscle tube
Relations of the neck
Anteriorly
Trachea , recurrent laryngeal nerves ascend, one on each side, in the groove between the trachea and esophagus
Posteriorly
Prevertebral layer of cervicl fascia, longus colli, and vertebral column
Laterally
Lobe of the thyroid gland and carotid sheath

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

57. Root of neck 颈根部 Formed at thoracic inlet by
Anteriorly－manubrium sterni
Posteriorly－body of first thoracic vertebra
Laterally－first rib and costal cartilage

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

59. 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 and supraclavicular triangles

60. Triangle of the vertebral a. 椎动脉三角
Boundaries
Medially－longus colli
Laterally－scalenus anterior
Inferiorly－first part of subclavian a.
Apex－transvese procss of C6
Posteriorly－cupula of pleura, transvese procss 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.
Inferior thyroid a.
Cervical part of sympathetic trunk
Cevicothoracic ganglion

61. 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
Floor－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

62. 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
Floor－prevertebral fascia and inferior parts of scalenus
Conents
Subclavian v. and venous angle
Subclavian a.
Brachial plexus

63. Dissection
Platysma

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

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

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

67. Inferior thyroid a.
Vagus n.
Recurrent laryngeal n.
Thoracic duct

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