NECK. REGIONAL ANATOMY
Neck
BoundariesLandmarksRegions
NeckLandmarks
Neck
Landmarks
Organ projections
Subcutaneous layer
PlatysmaV. jugularis anteriorV. jugularis externaPl. cervicalis
n. occipitalis minorn. auricularis magnusn. transversus collinn. supraclaviculares
Neck fascia
Lamina superficialis- Covers entire neck
- Fascia masseterica
- Fascia parotidea
- Fascia gl. submandibularis
Lamina pretrachealis- Between os hyoideum, strenum & clavicula, and m. omoh yoideus
- Linea alba - from os hyoideum to isthmus tracheae
- Spatium interaponeuroticum suprasternale
- Arcus venosus juguli
- Recessus Gruberi - behind m. sternocleidomastoideus
Lamina prevertebralis
- Skull base - bodies Т3-Т4 (fascia endothoracica)
- Fascia mm. longi capitis et cervicis
- Fascia mm. scaleni, m. levator scapulae
- Spatium prevertebrale – extends to proc. transversi
Fascia endocervicalis- Lamina visceralis – covers neck organs
- Lamina parietalis – apart from the visceral- Vagina carotica - from lamina parietalis
- Spatium pretracheale - between the two layers
- Extends to mediastinum superius
- Spatium retropharyngeum - between fascia endocervicalis & lamina prevertebralis
- Extends to mediastinum posterius
Regions of the neck
Anterior region� Tr. submentale� Tr. submandibulare� Tr. musculo-viscerale� Tr. Caroticum
Sternocleidomastoid region
Lateral region� Tr. omotrapezoideum� Tr. omoclaviculare
Boundaries�Basis mandibulae�M. digastricus
– venter anterior et posterior�M. mylohyoideus/m.hyoglossus�Lamina superficialis
Trigonum submandibulare
Superficial structures
M. platysmaV. facialisR. coli nervi facialis
Trigonum submandibulare
Gl. submandibularis – in sheath of lamina superficialis
- Posterior process - extends to m. pterygoideus medialis
- Anterior process – extends to gl. sublingualis - ductus submandibularis – from the inner
surface
- lndd. submandibulares – lateral to the capsule
- A.v. facialis – give off a.v. submentalis- N. mylohyoideus – branch of n.
mandibularis- N. hypoglossus- N. lingualis- Gangl. submandibulare- Trigonum Pirogovi – approach to a.
lingualis- m. mylohyoideus- tendo m. digastrici- n. hypoglossus
Trigonum submandibulare
Trigonum submandibulare
- A.v. facialis – give off a.v. submentalis- N. mylohyoideus – branch of n.
mandibularis- N. hypoglossus- N. lingualis- Gangl. submandibulare- Trigonum Pirogovi – approach to a.
lingualis- m. mylohyoideus- tendo m. digastrici- n. hypoglossus
Trigonum caroticum
Boundaries- m. digastricus, venter posterior
- m. omohyoideus, venter superior
- m. sternocleidomastoideus
Trigonum caroticum
Trigonum caroticumA. carotis communis – at the upper margin ofcart. thyroidea divides into:A. carotis externa
- a. thyroidea superior, a. lingualis, a. facialis
- a. occipitalis, a. sternocleidomastoidea, a. pharyngea ascendens
A. carotis interna
V. jugularis interna
Ansa cervicalis ( С1-С3)
- Radix superior ( С1,2) – anterior to a. carotis communis
- Radix inferior ( С2,3) – lateral to v. jugularis interna
Variations in the bifurcation ofa. carotis communis
Trigonum caroticum - cont.
N. vagus – in the groove btw a. carotis comm. & v. jugularis internaN. laryngeus superior
- In the upper part, medial to a. carotis externa et interna
- Enters the larynx thru membr. thyrohyoidea with a. laryngea superior
N. hypoglossus - beneath venter posterior m. digastrici
- Crosses lateral to a. carotis externa et interna
- enters trig. submandibulare between vent. post. m. digastrici & m. hyoglossus
Plexus cervicalis ( С1-С4) – over the deep cervical muscles
Truncus sympaticus - behind lamina prevertebralis
Truncus sympaticus - behind lamina prevertebralis
- behind a. carotis communis/interna close to n. vagus
- gangl. cervicale superior - over m. longus colli (C2-3)
- ganl. cervicale medius – at the levbel ofa. thyroidea inferior (C6)
- gangl. сervicale inferior ( С7 head of І rib)
- Innervates upper limb arteries & a. vertebralis
- Contact with cupula pleurae, d. thoracicus (on the left side), a. subclavia, a. vertebralis
Regio infrahyoideaBoundaries
- Os hyoideum, sternum, m. sternocleidomastoideus
ContentLamina pretrachealisMusclesа) M. sternohyoideus, m. thyrohyoideus,
m. sternothyroideus & m. omohyoideus- depress os hyoideum and larynx in swallowing.
b) M. cricothyroideus
-straightens the vocal folds
Regio infrahyoidea
Vessels - V. jugularis anterior
- Arcus venosus juguli - in spatium suprasternale
- A.v. thyroidea superior
- V. thyroidea inferior
Lymph nodes- Lndd. prelaryngeales
- Lndd. pretracheales
- Lndd. paratracheales
Organsа) Endocrine system
- Gl. Thyroidea
- Gll. Parathyroideae
b) Respiratory system- Larynx - C4-C6
- Trachea - C6-Th4
c) Digestive system- Pharynx - basis cranii - C6
- Esophagus - C6 - Th11
Regio infrahyoidea.Larynx, trachea, gl. thyroidea
Root of the neck Transitional area btw neck and thorax. Opens in apertura thoracica superior . Bounded:
� First ribs - laterally
� manubrium sterni - anteriorly
� Body of Т1 - posteriorly
Topographic structures
� Spatium antescalenum
� Spatium interscalenum
� Trigonum scalenovertebrale
Midline structures
Thymus – upper poles
Gl. Thyroidea (lobus dexter/sinister)
Gll. parathyroideae (inferiores)
Vv. thyroideae inferiores (plexus venosus)
Trachea (pars cervicalis)
Esophagus (pars cervicalis)
M. longus coli
Midline structures
Root of neck
Boundaries - mm. sternocleidomastoideus, sternohyoide us, sternothyroideus anteriorly and m. scalenus anteriorposteriorly.
Content- angulus venosus juguli
- v. jugularis interna
- v. subclavia
- ductus thoracicus/ductus lymphaticus dexter
- a. suprascapularis
- a. cervicalis superficialis
- n. phrenicus (C3-5)
- ndd. lymphaticae, around - v. jugularis interna
- a. transversa cervicis
Spatium antescalenum
Spatium antescalenum
Spatium antescalenum (right)
Boundaries – three-wall slit btw m. scalenus anterior anteriorly, m. scalenus medius posteriorlyand first rib (sulcus a. subclaviae) below.
Content
- a. subclavia (middle, interscalenous part), gives
off
- truncus costocervicalis
- a. cervicalis profunda – for neck muscles
- a. intercostalis suprema - for І & ІІ costal interspaces
- pl. brachialis - truncus superior, medius and
inferior.
Spatium interscalenum
Trigonum scalenovertebraleBoundaries - m. scalenus anterior laterally, m. longus coli and neckvertebrae medially and cupula pleurae below. The apex coincides with the transverse process of С6.
Content- a. subclavia, prescalenous part- a. vertebralis
- truncus thyrocervicalis
- a. thyroidea inferior
- a. cervicalis ascendens
- a. cervicalis superficialis
- a. suprascapularis
- a. thoracica interna
- ductus thoracicus
- n. vagus- n. laryngeus recurrens
- truncus sympaticus - ganglion inferior/stellatum- ansa subclavia
Trigonum scalenovertebrale
Ductus thoracicus