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Netter's Atlas Of Human Anatomy (5th Ed.).pdf
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4 Neck

STUDYAIMS

At the end of your study, you should be able to:

Outline the gross structure of the neck

Describe the anterior and posterior triangles of the neck: boundaries and contents

Know the smaller triangles of the neck within the posterior and anterior triangles: boundaries and content

Know the fascial layers of the neck

Know the contents of the compartments the fascial layers create

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GUIDE

Head and Neck: Neck

Neck-General Description

[Plate 32, Nerves and Vessels of Neck (Continued)]

Junction between head and thorax

Extends from base of skull superiorlyto thoracic inlet inferiorly Supports head

Skeleton

Bones to which muscles of neck attach

Seven cervical vertebrae

Hyoid bone

Manubrium of the sternum

Clavicle Contains

Blood vessels, nerves, and lymphatics traversing to and from the head and supplying muscles and viscera of the neck

Segments of digestive system: pharynxand esophagus

Segments of respiratorysystem: larynxand trachea Endocrine glands: thyroid and parathyroid glands

Triangles of the Neck

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[Plate 129, Autonomic Nerves in Neck]

page 20 page 21

Sternocleidomastoid (SCM) on each side of neck divides each side into two triangles:

Anterior

Posterior

Facilitates description of anatomyof the neck

Posterior Triangle

Boundaries

Posterior-anterior border of trapezius

Anterior-posterior border of SCM

Inferior-medial third clavicle

Roof-investing layer of deep cervical fascia

Floor-muscles

Muscles of the floor

Splenius capitis

Levator scapulae

Middle scalene

Posterior scalene

Vessels in triangle

External jugular vein

Subclavian vein

Third part of subclavian artery

Transverse cervical artery(from thyrocervical trunk)

Suprascapular artery(from thyrocervical trunk)

Occipital artery(from external carotid)

Nerves in the triangle

Accessorynerve (cranial nerve [CN] XI)

Ventral rami (roots) of brachial plexus

Cutaneous branches of cervical plexus

Suprascapular nerve

Phrenic nerve

Subdivided byinferior bellyof omohyoid

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Occipital triangle

Larger triangle superiorly Crossed byaccessorynerve

Supraclavicular triangle Smaller inferior triangle

Contains external jugular vein, suprascapular artery, and subclavian artery Anterior Triangle

Boundaries

Lateral-anterior border of SCM

Anterior-anterior midline of neck

Superior-inferior mandible

Divided into four smaller triangles for descriptive purposes

Submandibular triangle (1)

Between inferior mandible and anterior and posterior bellies of the digastric muscle

Contains submandibular gland

Submandibular duct

Submandibular lymph nodes

Submental triangle (2)

Between bodyof hyoid bone and right and left anterior bellies of the digastric muscles

Apexis mandibular symphysis

Contains submental lymph nodes

Carotid triangle (3)

Bounded byanterior bellyof omohyoid, posterior bellyof digastric, and anterior border of SCM

Contains carotid sheath, with common carotid artery, internal jugular vein, and vagus nerve

Bifurcation of common carotid to internal and external carotid arteries

Carotid sinus

Carotid body

Muscular triangle (4)

Bounded byanterior border of SCM, superior bellyof omohyoid, midline of neck Contains infrahyoid muscles, thyroid, parathyroid

[Plate 33, Carotid Arteries]

page 21

page 22

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Fascial Layers of Neck

Superficial fascia

Between dermis and investing layer of deep fascia

Contains

Cutaneous nerves and vessels

Lymphatics

Fat

Platysma muscle anteriorly

Deep fascia

Consists of three layers

Investing

Pretracheal

Prevertebral

Also includes carotid sheath: condensation of deep fascia around carotid vessels

Investing layer of deep fascia

Surrounds entire neck, beneath superficial fascia

Inferior attachments

Manubrium

Superior border clavicle

Acromion

Spine scapula

Superior attachments

Superior nuchal line

Zygomatic arches

Angle mandible

Mastoid process

Spinous processes of cervical vertebrae

Splits to enclose sternocleidomastoid and trapezius muscles

Encloses parotid and submandibular glands

Forms roof of anterior and posterior triangles neck

Pretracheal fascia

Onlyin anterior neck, from hyoid bone to fibrous pericardium

Invests infrahyoid muscles

Visceral layer invests

Trachea

Thyroid and parathyroid glands

Esophagus

Attaches inferiorlyto adventitia of great vessels

Attaches superiorly

Thyroid cartilage

Buccopharyngeal fascia of pharynx

Blends laterallywith carotid sheath

Prevertebral fascia

Sheath for C1-T3 vertebrae and associated muscles

Longus colli and capitis

Anterior, middle, and posterior scalenes

Deep cervical muscles

Described as having two laminae: anterior and posterior

Superior attachment of both laminae to base of skull

Inferior attachment

Anterior lamina to anterior longitudinal ligament and posterior esophagus anteriorly

Posterior lamina to fascia over thoracic vertebral column posteriorly

Extends laterallyas axillarysheath around axillaryarteryand brachial plexus

page 22 page 23

Carotid sheath

Condensation of fascia around great vessels of the neck

Extends from base of skull to root of neck

United mediallywith prevertebral fascia

Contains

Common carotid artery

Internal carotid artery

Internal jugular vein

Vagus nerve (CN X)

Deep cervical lymph nodes

Sympathetic fibers

Communicates inferiorlywith mediastinum

Facial spaces

Retropharyngeal space

Largest and most significant space in neck

Potential space between prevertebral layer of deep fascia and buccopharyngeal fascia

From base of skull to posterior mediastinum

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Permits movement of pharynx, larynx, trachea, and esophagus during swallowing

Infection originating in pharyngeal area can spread to retropharyngeal space and inferiorlyinto superior mediastinum Pretracheal space

Space between investing fascia and pretracheal fascia

Limited byattachments of fascia to thyroid cartilages superiorly

Can spread into thoraxanterior to pericardium Space between laminae of prevertebral fascia

Critical space

Extends from base of skull and through thorax

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