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Neck
山东大学医学院 解剖教研室李振华
The muscles of neck Superficial group
Platysma 颈阔肌, a thin sheet-like muscle of facial expression
Sternocleidomastoid 胸锁乳突肌
Suprahyoid muscles 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.
Infrahyoid muscle 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
Deep group Lateral
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
Major muscles of the neck Sternocleidomastoid Origin: manubrium and ster
nal end of clavicle Insertion: mastoid process o
f temporal bone Action: contraction of one m
uscle draws head toward the same side, and turn face to opposite side; both muscles act together to draw head backward
Scalenus anterior Origin: transverse processes of
C3-C6. Insertion: tubercle for scalenus
anterior Action: unilateral, bends neck l
aterally; 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.
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 bo
rder of thyroid cartilage; bifurcates into internal and external carotid arteries
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
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
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
Veins Draining the neck Internal jugular vein
颈内静脉 Begin at jugular foramen, desce
nding 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
Subclavian vein It is an continuation of axil
lary 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
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
Lymph nodes of neckAnterior cervical ly
mph nodes Superficial anterior cerv
ical lymph nodes Deep anterior cervical l
ymph nodes
Lateral cervical lymph node
Superficial lateral cervical lymph nodes - lie along the external jugular vein
Deep lateral cervical lymph nodes Extend along the internal jugular vei
n 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
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
Right lymphatic duct 右淋巴导管 Formed by union of right jugular, subcl
avian, and bronchomediastinal trunks Ends by entering the right venous angl
e 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
Cervical plexusFormation: formed by ant
erior 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
Branches Cutaneous branches: em
erge 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
Muscular branches: supply the deep muscles of neck
Phrenic nerve 膈神经 (anterior rami of C3-C5) Lies on anterior scalene, de
ep to fascia To diaphragm (motor and s
ensory) 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
Vagus nerve ( )Ⅹ Leaves skull via jugula
r foramen Descends in the neck i
n carotid sheath between internal (or common) carotid artery and internal jugular vein
Branches Superior laryngeal nerve 喉上神经 pass
es 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, t
he nerve is now called inferior laryngeal nerve
Innervations: laryngeal mucosa below fissure of glottis , all laryngeal laryngeal muscles except cricothyroid
Accessory n. ( ) Ⅺ 副神经 Deep to posterior belly of digas
tric Supplies sternoclidomastoid a
nd trapezius muscle
Hypoglossal n.( ) Ⅻ 舌下神经 Descends between internal car
otid a. and internal jugular v., hooks around external carotid a., to lie on the hyoglossus before entering tongue
Supplies muscles of tongue
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
Regional anatomy of neck
山东大学医学院 解剖教研室李振华
Parts and regions of the neckBoundaries 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
Landmarks Hyoid bone Thyroid cartilage Cricoid cartilage Catotid tubercle Sternocleidomastoid Suprasternal fossa Greater supraclaviclar f
ossa
Regions Neck 颈
Anterior region of neck Lateral region of neck Sternocleidomastoid regi
on Nape 项部
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
Lateral region of neck Occipital triangle 枕三角 supraclavicular triangle 锁骨上三角 (greatsupraclavi
cular fossa) 锁骨上大窝
Skin The natural line of cleavage of the skin are constant
and run almost horizontally around the neck
Superficial fascia Consists of fat and connec
tive 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.
Cervical fascia 颈筋膜- three layers Superficial layer (investing fascia 封套筋膜 ) Encloses trapezius, sternocleidomastoid, posterior belly of digastri
c and parotid and submandibular glands Attached to bony landmarks of upper and lower boundaries of nec
k and zygomatic arch of face
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
Prevertebral layer 椎前层 Lies anterior to bodies of cervical vertebrae and prevertebral muscle
s; 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
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, a
nd vagus nerve Ansa cervicalis located on its anterior surface
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
Pretracheal space 气管前间隙 Lies between pretracheal layer and cervical part of trachea Contains arteria thyroidea ima, inferior thyroid v., unpaired thyro
id venous plexus, brachiocephalic trunk and left brachiocephalic v.
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 prever
tebral layer
Suprahyoid region
Submental triangle 颏下三角 Lies below the chin and is bo
unded 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
Submandibular triangle 下颌下三角 Bounded by anterior and posterior bellies of digastric and lower borde
r 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., li
ngual n., submandibular ganglion and submandibular lymph nodes
Infrahyoid regionCarotid triangle 颈动脉三角 Bounded by anterior border of st
ernocleidomastoid, 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
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.
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
Thyroid gland 甲状腺Shape and position H-shape Left and right lobes: lie on either si
de 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 att
ached to arch of cricoid and thyroid cartilages, hence, the thyroid gland moves with larynx during swallowing and oscillates during speaking
Relations Anteriorlly - skin , superficial fascia, i
nvesting 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
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.
Superior laryngeal nerve Internal branch which pierce
s 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
Inferior thyroid artery 甲状腺下动脉 Branch of thyrocervical trunk off subclav
ian 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 glandRecurrent laryngeal nerves 喉返神经 Ascend in tracheo-esophageal groove Pass deep to the lobe of the thyroid gla
nd 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
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
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
Cervical part of trachea 气管颈部 Begins at lower end of larynx - level of
C6 vertebra Consists of a series of incomplete cartila
ge rings Extends into thorax Relations in the neck
Anteriorly The skin , superficial fascia, investing fasc
ia, 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
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
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, lo
ngus colli, and vertebral column Laterally Lobe of the thyroid gland and caroti
d sheath
Sternocleidomastoid region 胸锁乳突肌区 Covered by sternocleid
omastoid Contents
Ansa cervicalis Carotid sheath Cervical plexus Cervical part of synpathe
tic trunk
Root of neck 颈根部
Formed at thoracic inlet by Anteriorly - manubrium ster
ni Posteriorly - body of first th
oracic vertebra Laterally - first rib and costa
l cartilage
Contents Cupula of pleura - exten
ds 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.
Lateral region of neck 颈外侧区 Bounded by posterior b
order of sternocleidomastoid, anterior border of trapezius and middle third of clavicle
Divided by inferior belly of omohyoid into occipital and supraclavicular triangles
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, trans
vese 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
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 abov
e the middle of the posterior border of sternocleidomastoid and crosses the occipital triangle to trapezius
Cervical and brachial plexuses
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 angl
e Subclavian a. Brachial plexus
Dissection
Platysma
Cutaneous nerves and superficial veins
External jugular vein
Anterior jugular vein
Lesser occipital n.
Greet auricular n.Transverse nerve of neck
Supraclavicular n.
Submendibular gland
OmohyoidSternohyoid
Sternothyroid
Superior thyroid a.
Cervical plexus
Phrenic n.
Ansa cervicalis
Vagus n.
Hypoglossal n.
Accessory n.Digastric
Superior thyroid a.
External branch
Internal branch
Hypoglossal n.
Vagus n.
Vertebral a.
Inferior thyroid a.
Inferior thyroid a.
Recurrent laryngeal n. Thoracic duct
Vagus n.
Vertebral a.
Thyrocervical trunk
Inferior thyroid a.
Internal thoratic a.
Transvers cervical a.
Costocervical trunk
Suprascapular a.