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Anatomy of the neck By Dr. Rasha Sabry.

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Presentation on theme: "Anatomy of the neck By Dr. Rasha Sabry."— Presentation transcript:

1 Anatomy of the neck By Dr. Rasha Sabry

2 ”وفي أنفسكم أفلا تبصرون“
بسم الله الرحمن الرحيم ”وفي أنفسكم أفلا تبصرون“

3 The anterolateral part of the neck is quadrilateral area which is divided by sternomastoid muscle into 2 large triangular areas ( anterior and posterior ) . The investing layer of deep fascia roofs both triangles .

4

5 Sternomastoid muscle :
1- action :when one muscle acts alone , it bends the head to its same side and rotates it to the opposite side ( the face looks to the opposite side As you want to approximate the mastoid process to the manubrium of the sternum ). When the two muscles act together , they flex the head . 2-Nerve supply : 1- the spinal root of the accessory nerve (motor ) 2- the cervical nerves C2&C3 (proprioceptive )

6 Omohyoidmuscle Sternomastoid muscle

7 Relations of the sternomastoid
1- superficial relations : 1- the lower end of the parotid gland . 2- the great auricular nerve . 3- anterior cutaneous nerve of the neck . 4- external jugular vein .

8 Parotid gland Great auricular nerve Transverse cutaneous nerve of the neck External jugular vein

9 Deep relations : A- Deep relations to its upper half : 1- posterior belly of digastric muscle . 2- spinal accessory nerve . 3- splenius capitis 4- occipital artery

10 B- Deep relations to its lower half :
1- intermediate tendon of omohyoid muscle . 2- transverse cervical artery . 3- suprascapular artery 4- anterior jugular vein 5- scalenous anterior 6- phrenic nerve 7- carotid sheath and its contents

11 Stucture emerging from its posterior border (they appear in the posterior triangle )
1- branches of the cervical plexus 2- trunks of brachial plexus 3- spinal accessory nerve 4- transverse cervical artery &suprascapular arteries 5- the 3rd part of subclavian artery 6- deep cervical lymph nodes

12 Clinical importance of the sternomastoid muscle :
1- congenital torticollis : (wry neck ), it is a fibrous tissue tumour or injuiry of the muscle during birth . 2- spasmodic torticollis : abnormal tonicity in the muscle .

13 apex trapeziusmuscle Investing layer of deep fascia roof Sternomastoid muscle Middle 1/3 of clavicle – base

14 The posterior triangle
the posterior triangle lies behind the sternomastoid muscle , it has an apex , base and 2 borders . The outlines of the posterior triangle : 1- the posterior border of the sternomastoid muscle (infront ) 2- the anterior border of trapezius muscle(behind ) 3- the middle one third of the clavicle forms the base of the triangle . 4- the meeting of the sternomastoid muscle and trapezius muscle forms the apex of the triangle .

15 Roof : It consists of the following layers (from outwards inwards ) 1-the skin 2- the superficial fascia containing : 1- the platysma muscle (very thin sheet of muscle layer ) 2- the external jugular vein 3- the deep fascia of the roof ( part of the general investing layerof the deep fascia of the neck ) .

16 Floor : The deep fascia of the floor ( prevertebral fascia ) which cover the muscles of the floor . The muscles of the floor ( arranged from below upwards ) 1- scalenus medius 2- levator scapulae 3- splenius capitis 4- semi- spinalis capitis ( at the apex of the triangle )

17 The posterior triangle is subdivided by the inferior belly of omohyoid into 2 smaller triangles :
1- the occipital triangle ( above ) 2- the subclavian triangle ( below )

18 Contents of the posterior triangle
1- nerves, remember that the main contents of the posterior triangle are nerves . 2- vessels ( arteries and veins ) 3- the inferior belly of the omohyoid muscle

19 Nerves in posterior triangle
1-Cervical plexus 2-Brachial plexus 3- spinal root of accessory nerve (11th cranial nerve ) 1- four muscular branches 2- four cutaneous branches Roots , trunks and their branches 1- dorsal scapular nerve –c5(nerve to rhomboids ) 2- nerve to subclavius – c5 &c6 3- nerve to serratus anterior –c5,6 &7 Suprascapular nerve –c5&6 It is the most important structure in the occipital triangle

20 Spinal part of accessory nerve

21 Cervical plexus : It is formed by the anterior 1ry rami of the upper 4 cervical nerves . It gives off 4 muscular branches : 1- nerve to sternomastoid muscle ( C2&C3 proprioceptive) 2- nerve to trapezius muscle ( C3&C4 proprioceptive) 3- nerve to levator scapulae muscle ( C3&C4) 4- roots to the phrenic nerve . (C3&C4 & C5)

22 Cutaneous branches of the cervical plexus :
1- lesser occipital nerve (C2) 2- great auricular nerve (C2&C3). 3- transverse cervical nerve (C2&C3) 4- supraclavicular nerves (C3&C4)

23 Arteries : 1- 3rd part of subclavian artery . 2- two branches which come from the 1st part of the subclavian artery ( transverse cervical artery and suprascapular artery ) Veins : 1- subclavian vein 2- transverse cervical vein 3- suprascapular vein

24 The anterior triangle of the neck
It lies in front of the sternomastoid muscle . It is bounded by : 1- anterior border of sternomastoid muscle .(behind) 2- anterior midline of the neck ( in front ) 3- lower border of the mandible (base ) It is subdivided into 4 triangles by means of the superior belly of omohyoid muscle , the anterior and posterior bellies of digastric muscle as follows :

25 1- Digastric triangle 2- carotid triangle 3- Muscular triangle 4- Submental triangle

26 Posterior belly of digastric
Stylohyoid Anterior belly of digastric muscle Sternohyoid muscle

27 Digastric triangle Outlines : Above : the lower border of the mandible
Below & infront : the anterior belly of Digastric muscle Below & behind : the posterior belly of Digastric and stylohyoid muscles . Floor : Anteriorly : the mylohyoid muscle Posteriorly : part of hyoglossus muscle

28 Contents of the Digastric triangle
1- submandibular salivary gland 2- the submandibular lymph nodes lie on the surface of the gland 3- facial artery deep to posterior end of submandibular salivary gland 4- facial vein lies superficial to submandibular salivary gland 5- hypoglossal nerve 6- nerve to mylohyoid muscle

29 d Anterior belly of digastric Digastric triangle
Posterior belly of digastric Carotid triangle Mylohyoid muscle forms the floor of the mouth Muscular triangle

30 Carotid triangle Outlines : Behind : the sternomastoid muscle
Infront and above : the posterior belly of digastric muscle Infront and below : the superior belly of omohyoid muscle Floor : infont : the hyoglossus muscle ( above ) and the thyrohyoid muscle (below) Behind: the middle constrictor muscle of the pharynx (above ) and the inferior constrictor muscle of the pharynx (below )

31 Internal carotid artery
External carotid artery Common carotid artery

32 Contents of the Carotid triangle
1- The carotid sheath and its contents : - common carotid artery : in the lower part of the triangle . - internal carotid artery : in the upper part of the triangle . Internal jugular vein : lateral Vagus nerve : between the artery and the vein but in a more posterior plane .

33 2- the external carotid artery : gives most of its branches in the carotid triangle ( superior thyroid artery ,lingual artery ,facial artery , ascending pharyngeal artery and occipital artery ) 3- hypoglossal nerve 4- Descendes cervicalis (C2,3) anterior to carotid sheath. 5- sympathetic trunk adherent to the posterior wall of carotid sheath

34 Muscular triangle Outlines : Infront : midline of the neck
Behind and above :superior belly of omohyoid muscle Behind and below : the sternomastoid muscle

35 Contents of the Muscular triangle
It contains the infrahyoid muscle

36 Submental triangle Outlines :
Infront : symphysis menti of the mandible On each side : the anterior belly of digastric muscle Behind ( base ) : the hyoid bone Floor : parts of the mylohyoid muscles as they meet each other in the median plane

37 Contents of the Submental triangle
1- submental lymph nodes 2- beginning of the anterior jugular vein

38 The infrahyoid muscles
They are strap like muscles occupy each side of the midline of the neck , from the hyoid bone to the manubrium sterni . They consist of 4 muscles arranged into 2 layers : 1- superficial layer : a- sternohyoid B- omohyoid 2- deep layer: a- sternothyroid B- thyrohyoid

39 The Hyoid Bone The only bone that does not articulate with another bone Serves as a moveable base for the tongue Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

40

41 The infrahyoid muscles
Nerve supply : All The infrahyoid muscles are supplied by Ansa cervicalis except thyrohyoid muscle supplied by fibres from C1 through hypoglossal nerve .

42 Ansa cervicalis Ansa = loop
It is a loop of cervical nerve fibres derived from C1,2,3 which lies below the carotid sheath below the middle of the neck . It consists of 2 roots : 1- descendes hypoglossi C1: derived from hypoglossal nerve 2- descendes cervicalis : C2,3 : from the cervical plexus

43 Action of the infrahyoid muscles
1- superficial layer : a- sternohyoid : depress the hyoid bone after it has been elevated during swallowing . B- omohyoid : depresses , retracts and steadies the hyoid bone . 2- deep layer: a- sternothyroid : depress the hyoid bone and the larynx B- thyrohyoid : depress the hyoid bone and elevate the larynx

44 Suprahyoid muscles 1- digastric muscle 2- mylohyoid muscle
3- hyoglossus muscle 4- geniohyoid muscle 5- stylohyoid muscle

45 Geniohyoid muscle Hyoglossus

46 Digastric muscle It consists of 2 bellies anterior and posterior , that connected together by an intermediate tendon . Nerve supply : 1- anterior belly : from nerve to mylohyoid which is a branch of mandibular nerve . 2- posterior belly : the facial nerve Action : When the mandible is fixed , it raises the hyoid bone during swallowing . When the hyoid bone is fixed , the anterior belly can depress the mandible

47 mylohyoid muscle : Formed of superoir and inferior bellies . Nerve supply : nerve to mylohyoid , which is a branch of the mandibular nerve . Action : When the 2 bellies contract they elevate the hyoid bone and the floor of the mouth as well as the root of the tongue during swallowing . If the hyoid bone is fixed , the 2 bellies depress the mandible and open the mouth .

48 Hyoglossus muscle Nerve supply :
Hypoglossal nerve ( 12th cranial nerve ) Action : It draws the tongue downwards and thus help suckling .

49 Geniohyoid muscle : Nerve supply : Hypoglossal nerve ( via fibres from C1 ) Action : It pulls the hyoid bone upwards and forwards , if the hyoid bone is fixed , it depresses the mandible .

50 Stylohyoid muscle Nerve supply : Facial nerve Action : Raises the hyoid bone upwards


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