Post on 02-Mar-2018
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Anatomy Reviewer
SCALPSCALP
Layers of soft tissues covering the cranial vault
Top 3 layers joined together
2 deeper layers
o Skin 1 1.5 mm thick
Thin epidermal layers and thick dermis
Abundant hair follicles and sebac eous glands
o Cutaneous Tissue
Small fat lobules held in plac e by short fibrous septa Binds the dermis to the deeper epicranial layer
Rich network of nerves and blood vessels in inelastic fibers
Prevents vessels from retracting and narrowing when parted due to injuries
Copious bleeding wounds in scalp
o Aponeurosis
Spreads over parietal bones and extends posteriorly over part of the oc cipital bone
o Loose Areolar Connective Tissue
Separates the above 3 layers from the pericranium of the skull but allows the gliding movement
Emissary veins (parietal, mastoid and oc cipital)
Pass through foraminae to communicate with diploic veins
Diploic veins communica te with the dural sinuses
Dangerous layer of the scalp Infection could pass through straight to the c avernous sinus (cavernous sinus thrombosis)
o Pericranium
The periosteal covering of the skull bones
Loosely attac hed to the covered bone except at the sutural junctions where it may blend with intersuturalfibrous tissue which continues internally to join the dura mater.
TEMPORAL REGION
Lateral surface of the scalp
Overlying the fan-shaped temporal fossa
Muscle Origin Insertion Action Innervation
Occipito-frontalis
Oc cipital belly Highest nuchal line of the
occipital bone
Aponeurosis Raises the eyebrows Facial nerve (post.
auricular branch)
Frontal belly Anterior edge of the
aponeurosis
Skin over the eyebrows
(orbicularis occuli &
corrugator supercilii)
Raises the eyebrows Facial nerve (temporal
branch)
Temporalis Temporal fossa &
covering fascia
Coronoid process &
anterior border of theramus of the mandible
Elevates the jaw Mandibular nerve
NEUROVASCULAR SUPPLY
Neurovascular Origin Commencement Termination Branches
Supraorbital and
supratrochlear
Terminal branches of
ophthalmic arteries and
nerves
Orbital cavities Veins join to form
angular vein then
continues as facial vein
Common vein join the
superior ophthalmic vein
w/c drains into the
cavernous sinus
Superficial temporal
artery (terminal branch
of external carotid
artery)
External carotid artery In front of the external
auditory meatus
Lateral pa rt of the scalp
to the vertex
Principa l artery that
supplies blood to the
greater part of the scalp
Oc cipital branch of the
external c arotid artery
External carotid artery Occipital part of the
scalp
Accompanied by
sensory branc hes from
C2, C3 (lesser and
greater occipitaland
greater auricular nerves)
Retromandibular vein Union of superficial
temporal and maxillary
vein
Below the zygomatic
arch
Parotid gland
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FACE
Eyelids (Palpebrae)
Palpebral fissure (rima palpebrarum)
o Separate superior and inferior eyelids
Cillae
o Margins of each eyelid are lined by two rows of eyelasheso
Lateral and medial palpebral c ommisures
more movable and larger superior eyelid unites with the inferior, smaller and less movable inferior at the angula
corners
Epicanthus
Charac teristic overlapping skin fold of the superior over the inferior margin at the tip of the medialcanthus
Distinguishes the Mongolian fac ies
Carruncula lacrimales Pinkish island of epithelial tissue at the medial canthus
Lined by stratified squamous epithelium
Plica semilunaris Whitish, thin semilunar fold lying deeper and extending slightly beyond the lateral edge of the
carruncula
o Layers
Skin Thin, almost translucent, flexible/distensible
Superficial fascia Thein, elastic, devoid of fat; laced y palpebral vessels and nerves
Muscular Palpebral fibers of the orbicularis oc uli
Fibers arise from the medial palpebral ligament extending towards the lateral canthus where thesuperior and inferior fibers interlace to form the lateral palpebral raphe
Cilliary muscle of Riolan
o Tiny fasicles along the borders of the eyelids behind the row of eyelashes
Tarsal Plate Elliptical dense fibrous tissue layer
10 mm (upper), 5 mm (lower) Medially and laterally
o J oins the corresponding palpebral ligament at the canthi
o Attached to the frontal process of the maxilla and zygomatic bones
o Superior tarsal plate
Receives inserted fibers of the levator palpebra superioris muscle
Fuses with the orbital periosteum to form an orbital septum
o Tarsal glands
Embedded in deep surface of eac h plate
Membranous
A thin, delicate, transparent layer of stratified olumnar epithelium
Supplied by numerous neuro-vascular structures
o Branches of ophthalmic vessels and nerves
o Reflec ted (superiorly and inferiorly) to line the outer surfac e of the eyeba ll at the sclero-
corneal junction (bulbar conjunctiva)
o Fornix(ces) in foldings
Lac rimal Apparatus
o Lac rimal Gland
Above the lateral angle of each upper eyelid
Lodged in a shallow fossa at the roof of the orbital cavity
Excretory tubules from eac h gland open into the superior conunc tival fornix
o Punctum Lacrimale
Small openings at the border of eac h eyelid near the medial canthus
Openings of the superior and inferior lacrimal canaliculi
Drains into the lac rimal sac loca ted in the lac rimal fossa of each lacrimal bone
Naso-lac rimal ducto Extends inferiorly through a canal
o Communicated with the inferior meatus below the inferior turbinate
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FACIAL MUSCULATURE Bony origins
All inserted to the dermis of the overlying skin
Movements of the eyelids, lips, nostrils and forehead
Innervated by facial nerves
Nourished by branches of facial and infraorbital arteries
Muscle Origin Insertion Action Innervation
PeriorbitalOrbicularis oculi
(palbepral muscle)
Medial border of
lac rimal fossa
Skin around the eyes Open & close the
eyelids, winking reflex
facial nerve
Corrugator supercilli Supero-medial angle of
the orbital magin
Skin at the midpoint of
the eyebrow
Pulls the skin & eyebrows
infero-medially(frown)
facial nerve
Perinasal
Procerus Inferior ends of the nasal
bones
Skin at the root of the
nose
Wrinkles the root of the
nose
facial nerve
Nasalis muscle
Compressor na res
Dilator nares
Maxilla Internal pa rt of the lower
margin of the ala of the
nose
Move the nostrils in
response to respiratory
emotions or exigenc ies
Fac ial nerve
Perilabial
Levator labii superioris
Ala que nasi
Frontal process of maxilla Ala of the skin and
muscle of the upper lip
Dilates the nostrils and
raises and everts the
upper lips
Fac ial nerve
Levator lab ii superioris Ma xilla immediately
superior to the
infraorbital foramen
Orbicularis oris in the
upper lip
Raises and everts lips Fac ial nerve
Zygomaticus minor Anterior surfac e of the
zygomatic arch
Skin and muscle of the
upper lip
Raises the lips Fac ial nerve
Zygomaticus major Zygomataic arch Skin and orbicularis oris Raises and pulls laterally
the angle of the mouth
(laugh)
Fac ial nerve
Risorius Parotid fascia Angle of the lips Pulls the angle of the
mouth laterally (sardonic
grin)
Fac ial nerve
Depressor anguli oris Mandible Labial angle Pulls the mouth
downwards
Fac ial nerve
Depressor labii inferioris Mandible Median plane of the
margin of the lip
Pulls the mouth
downwards
Fac ial nerve
Mentalis Side of symphsis mentiBelow the lower incisor
Skin of the chin Pulls the skin of the chinupwards (drinking and
pouting); produces
either a cleft or dimple
Fac ial nerve
Orbicularis oris Maxilla, mandible,
bucc inator (deep);
sorrounding fac ial
muscles (superficia l)
Deep; buccinators
middle; posterolateral at
the angle of the mouth
Compresses the lips
against teeth; protrude
lips; alters shape of the
mouth, mastication and
enuciation
Fac ial nerve
Bucc inator Lateral surface mandible
and maxilla; ptery
gomandibular ligament
(pterygoid process of
sphenoid)
Angle of the lips and
orbicularis oris
Compresses the cheek
against the teeth and
alveolar processes
(suckling, pouting, and
placing of morsels of
food between the
molars)
Fac ial nerve
Masseter Zygomatic arch Lateral surfac e of ramus
of mandible
Strong elevator of the
mandible
Mandible nerve
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PAROTID GLAND Largest of the salivary gland
Located below zygomatic a rch, in front of the ear auricle
Covers the posterior half of the masseter
Extending inferio-prosteriorly behind the anlge of the mandible below the lobule of the ear
Covered by the parotideo-masseteric fasciao extension of the investing layer of the deep cervical fascia
Sec retory activity regulated by autonomic nerves
parasympathetic branches of the otic ganglion
sympathetic brac hes from the c ervical ganglia
Blood supply: branches of facial and external carotid arteries
Parotid or Stensens ducto emerges from the anterior border of the gland
o pass through the following before it terminates
buccinator
buccal pad of fat
buccal mucosa
Termination at the level of upper second molar tooth
Structures closely related to the pa rotid gland:
o Transverse facial vessels
just below the inferior border of the zygomatic arch superior and parallel to the parotid duc t
artery: branc h of the superficial temporal artery (terminal branc h of ECA)
o External carotid artery
medial (deep) to the gland
8 branches:
superior thyroid given off in the carotid triangle
ascending pharengeal, fac ial and lingual g iven off in the submandibular triangle
occipital and posterior auricalr behind the ramus of mandible maxillary and superficial temporal terminal branches at the level of the neck of the mandbile
o Retromandibular vein
maxillary and superficia l veins
receives tributaries from the descending c ourse external carotid artery
anterior divison which is joined from the common facial vein that drains into internal jugular vein
posterior division from the posterior auricular vein to form external jugular vein then drains to the
subclavian vein.
o Two small sensory nerves
auriculo-temporal branch of the mandibular
great auricular branch of c ervical p lexus.
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FACIAL ARTERIES
Artery Origin Commencement Termination Branches/ Tributaries
Facial artery Facial artery Above the lingual at thelevel of the hyoid bone Medial angle of the eyeas the angular artery Deep Branches:Ascending palatine
Tonsillar branch
Glandular
Submental
Ascending artery Facial artery Along the pha rynx Pharynx
Soft plate
Auditory tube
Tonsillar Fac ial artery Superior constrictor of
the pharynx
Palatine tonsil
Glandular Facial artery Submandibular salivary
gland
Submental Facial artery Lower border of the
mandible
Skin of the chin and
lower lip
Facial Branches:
Labial Branches
Lateral nasal branches
Superior labial Facial artery Near the angle of the
mouth
Septum & ala of the
nose
Inferior labial Facial artery Near the angle of the
mouth
Lower lip
Lateral nasal Facial artery Alongside of the nose Skin on the side of the
nose
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FACIAL VEINS
Vein Origin Commencement Termination Branches/ Tributaries
Facial vein Union of the
supratrochear &
supraorbital veins
Medial angle of the eye
(Angular Vein)
Angle of the mandible;
unite with the
retromandibular to form
the common facial vein
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FACIAL NERVES
Nerve Origin Commencement Termination Branches / TributariesFacial Nerve Internal acoustic meatus Superor surface of the
petrous part of the
temporal bone
Greater petrosal
Small branch to the
tympanic plexus of the
CN IX
Greater petrosal Geniculate region of the
fac ial nerve
Superior surfac e of the
petrous part of the
temporal bone
Foramen lacerum Preganglionic
sympathetic fibers
(pterygo-palatine
ganglion) and sensory
and tase fibers to the
palate
Mastoid Small branc h to the
Stapedius muscle
(middle ea r)
Chorda tympani nerve
(taste fibers for ant 2/3 of
tongue)Med ial surface of the
posterior belly of the
digastric
Muscular branches
(digastic & stylohyoid
muscles)
posterior a uricular
branch occipital branch
(occipital belly of the
scalp muscle)
small branc hes
(rudimenta ry intrinsic
and post. Auricular
muscles)
Parotid gland Temporal branch
Zygomatic branc hes
Buccal branch
Mandibular branch
cervica l branch
Temporal branch Fac ial nerve Upper border of the
parotid gland
Zygomatic arch Frontalis and periorbital
muscles
Zygomatic branc hes Facial nerve Anterior border of the
gland
Infraorbital fibers of the
orbicularis oculi
Orbicularis oc uli and
muscles that move the
upper lip
Bucc al branch Fac ial nerve Anterior border of the
gland below the parotid
duct
Buccinator muscle Buccinator muscle
Mandibular branch Fac ial nerve Anterior border of the
gland
Muscles of the lower lip Muscles of the lower lip
Cervical branch Fac ial nerve Lower border of the
gland
Below the angle of the
mandible
Platysma muscle in the
neck
Opthalmic Nerve Trigeminal nerve Lacrimal
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Supraorbital
Supratrochlear
Infratrochlear
External nasal
Supraorbital Ophthalmic nerve Upper margin of the orbit
at the supraorbital notch
Skin and conjunctiva on
the central part of the
upper eyelid; skin of the
forehead
Supratrochlear Opthalmic nerve Upper margin of the orbit
medial to the
supraorbital nerve
Skin and conjunctiva on
the medial part of the
upper eyelid; skin on the
lower part of theforehead
Maxillary Nerve Trigeminal nerve Zygomatico-
temporal
Zygomatico-facial
Infraorbital
Zygomatico-temporal Maxillary nerve Temporal fossa on the
lateral side of the
zygomatic bone
Anterior part of the
temporal region of the
scalp
Zygomatico-facial Maxillary nerve Internal side of the
zygomatic bone
Skin around the
zygomatic arch
Infraorbital Terminal extension of
Maxillary nerve
Infraorbital foramen Skin of the surrounding
area
Mandibular Nerve Trigeminal nerve Auriculo-temporal
Buccal branch
Inferior alveolar
nerveAuriculo-temporal Mandibular nerve Mental foramen of the
mandible
Parotid gland
Temporo
mandibular joint
External ac oustic
meatus
Lateral surface of
the auricle
Middle portion of
the scalp
Bucc al branch Mandibular nerve Beneath the anterior
border of the masseter
Lower half of the c heek
down to the level of the
angle of the mouth
Inferior alveolar Mandibular nerve Mental foramen of the
mandible
Lower teeth and gums
(mental branch); skin of
the jaw
NECK
Description- region of the neck that lies between the lower margin of the
mandible above and the suprasternal notch and the upper border of
the clavicle below
Skin- natural lines of cleavage of the skin are constant and run almost
horizontally around the neck (heals fast when cut along the lines)
Cutaneous Nerves
Nerve Branches Supplies
Posterior Rami of Cervical
Nerves 2-5
Greater Occipital Nerve Skin overlying the trapezius muscle on the back of the neck, and
on the back of the scalp
Anterior Rami of Cervica l
Nerves 2-4
Cervical Plexus (beneath
posterior border of
sternocleidomastoid)
Skin on the front and sides of the neck
C2 Lesser Occipital Nerve Hooks around the ac cessory nerve; supplies the skin over the
lateral pa rt of the occipital region and the medial surface of the
auricle
Great auricular nerve Ascends ac ross the sternocleidomastoid; divides into:
- mandible
- parotid gland
- surfaces of the auricleCervicalNerves2-5
(from
facialnerve)
C2 and 3
Transverse cutaneous nerve From behind the posterior border of sternocleidomastoid;
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Supplies:
- skin on the a nterior and lateral surfaces of the nec k
- from the body of the mandible to the sternum
C3 and 4 Suprac lavicular Nerves From posterior border of sternocleidomastoid and descend
across the side of the neck
- medial: skin as far as the median plane
- intermediate: supplies skin of the chest wall
- lateral: skin over the shoulder and the upper half of the
deltoid muscle and posterior aspec t of shoulder (spine
of scapula)
Superficial Fascia- forms a thin layer that encloses the platysma muscle; where the cutaneous nerves, superficial veins and lymph nodes are embedded
Platysma
- a thin muscular sheet embedded in the superficial fascia
- can be seen as a thin sheet of muscle just beneath the skin by having the pa tient clench his or her jaws firmly
- extends from the body of the mandible downward over the c lavicle onto the anterior chest wall
- in surgical inc isions, its tone can pull on the scar tissue which can result into broad and unsightly scars
- nerve supply may cause facial distortions when lacerated
Origin Insertion Nerve Supply Action
Deep fascia of pectoralis
major and deltoid muscles
Lower margin of the body of the
mandible; some enter the face at
the angle of the mouth (posterior)
and chin (anterior)
Cervical branch of the facial
nerve (emerges from the
lower end of the parotid
gland; a lso supplies the
depressor anguli oris muscle)
Depresses the mandible and
draws down the lower lip and
the angle of the mouth
Superficial Lymph Nodes- superficial cervical lymph nodes lie along the external jugular vein superficial to the sternoc leidomastoid muscle
- receive lymph vessels from the occipital and mastoid lymph nodes
- drains into the deep cervical lymph nodes
Superficial Veins
Vein Branches/Tributaries Drains Notes
External J ugular Vein (union
of posterior auricular vein
and posterior division of
retromandibular vein)
- posterior auricular vein
- posterior div. of retromandibular
vein
- posterior external jugular vein
(scalp)
- transverse cervical vein- suprascapular vein
- anterior jugular vein
Subclavian
vein
- begins just behind the angle of the mandible
- descends obliquely across the
sternocleidomastoid
and just above the clavicle in the posterior
triangle,
pierces the deep fascia- less obvious in women and c hildren (thick
subcutaneous layer)
- large in professional singers due to increased
intrathorac ic pressure
- serves as a useful venous manometer
- can be used for catheterization (right external
jugular vein is continuous with superior vena
cava)
between the cricoid cartilage and clavicle;
should
be done during inspiration when the valves are
open
Anterior J ugular Vein External
jugular
vein
- begins just below the c hin by the union of several
small veins
- unites (above suprasternal notch) to form the
jugular
arch
- passes deep to the sternocleidomastoid
- runs down the neck close to the midline
Deep Cervical Fascia
- consists of areolar tissue that supports the muscles, vessels and viscera of the nec k
- forms spaces with the face: visceral , retropharyngeal, submandibular, masticatory spaces (important in preventing infections to spread
among the
facial planes and spaces direc tion of the spread of infec tion and pus can be determined by the fascia )
1. Acute Infections
Dental infections lower molar teeth; spread medially into the submandibular and masticatory spaces (may spread to the
visceral
space causing edema of voca l cords and airway obstruction)
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Ludwigs Angina acute infection of the submandibular fascia space; secondary to dental infection
2. Chronic Infections
Tuberculous infections of the deep cervical lymph nodes results in liquefaction and destruction of one or more lymph nodes
Layers Notes Splits Special Structure Formed
Investing layer - completely enc ircles the nec k,
splitting to enclose the
sternoc leidomastoid and
trapezius
muscles; roofs over the anterior
and posterior triangles of the
neck
- attachments:posteriorly to the ligamentum
nuchae
inferiorly to the acromion,
clavicle and manubrium sterni
- posteriorly:
submandibular and
parotid glands
- stylomandibular ligament: thickened ligmanet
between the angle of the mandible and styloid process
of the temporal bone
Pretracheal
Layer
- thin; completely surrounds the
thyroid gland and binds it to the
larynx
- encloses the parathryroid glands
and ivests the infrahyoid muscles
*** dangerous area ***
Goes down to the
grea t vessels of the
hear (Aorta & S.V.
Cava)
- Carotid Sheath
condensation of deep fascia in which are
embedded the
common and internal carotid arteries, the internal
jugular vein, and the vagus nerve
where the deep cervical group of lymph nodes is
also
embedded
PrevertebralLayer
- covers the prevertebral muscles(longus capitis and longus
cervicis)
- passes around the nec k to be
attached to the ligamentum
nuchae
- has retropharyngea l space
(between the pharynx and
prevertebral fascia )
- fascial floor of posterior triangle- Axillary sheath
where the anterior rami of cervical nerves emerge
sheath from the interval of the sca lenus anterior and
scalenus medius muscles to the axilla
where the subc lavian artery & brac hial plexus
emerge
Sternocleidmastoid- muscle that divides the neck into its anterior and posterior triangles; from the sternum and clavicle
- strap like muscle that descends obliquely across the side o f the neck
- torticollis
1. Congenital torticollis result of excessive stretching of the muscle during a difficult labor
- hemorrhage oc curs and is invaded by fibrous tissue (contracts and shortens the muscle)
- can cause asymmetrical growth changes in the face wedging of the cervical vertebrae
2. Spasmodic torticollis results from repeated chronic contractions of the sternocleidomastoid & trapezius muscles; psychogenic
in origin
Origin Insertion Nerve Supply Action Clinical Importance
- by a rounded tendon
from
the front of the upper
part
of the manubrium sterni
- by a muscular head
from
the medial third of the
upper surface of the
clavicle
- mastoid process of
the
temporal bone and
- lateral part of the
superior nuchal line of
the oc cipital bone
- spinal part (of C1-C5)
of
the accessory nerve
and
the anterior rami of the
second and third
cervical
nerves
- sensory /
proprioceptive
- extends the head a t the
atlanto-occipital joint
- flexes the cervical part of
the
vertebral column (sideways)
- pulls the ear down to the tip
of
the shoulder
- rotates the head
- the pair of muscles
can
ac t as ac cessory
muscles of inspiration
- protec ts underlying
soft
structures from blunt
trauma
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Anterior Triangle
- boundaries
anteriorly: midline of the neck
posteriorly: anterior border of the sternoc leidomastoidsuperiorly: lower margin of the body of the mandible
- covered by skin, superficial fascia, platysma and investing layer
of
deep fascia
- where cervical branch of the fac ial nerve and the transverse
cutaneous nerve passes
- subdivided into smaller triangles by:anterior and posterior bellies of the digastric muscle
superior belly of the omohyoid muscle
- infrahyoid muscles: sternohyoid, omohyoid, sternothyroid,
thyohyoid
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Triangles Muscles Origin Insertion/ termination Nerve Supply Action
posterior belly
- from the medial
surface of the
mastoid
process of the
temporal bone
- stylohyoid
- held in position by a loop of
deep
fascia which binds the tendon
down to the junction of the
body
and greater cornu of the hyoid
Fac ial nerveDigastric
Anterior belly - lower border of the body of the
mandible, near the medial plane
Nerve to the
mylohyoid
(mandibular
division of thetrigeminal nerve)
- Depresses the
mandible
- elevates the
hyoid
bone
Stylohyoid Styloid proc ess of the
temporal bone
J unction of the body with the
greater cornu of the hyoid bone
(pierced by the intermediate
tendon of the digastric muscle)
Facial nerve - elevates the
hyoid
Bone
*Mylohyoid Mylohyoid line of the
body of mandible
Body of hyoid bone and fibrous
raphe
Inferior alveolar
nerve
- Elevates floor of
Mouth, hyoid
bone
- depresses
Mandible
*Hyoglossus Hyoglossus nerve
Digastric or
Submandibular
- lies below the body of the mandible; where lower part of parotid gland is projected
- boundaries:
anteriorly: anterior belly of digastric posteriorly: posterior belly of digastric
superiorly: lower border of the body of the mandible
-anterior part contains the submandibular salivary gland with the facial artery deep and the fac ial vein and
submandibular lymph nodes superficial to it
- posterior pa rt contains carotid sheath with arteries, internal jugular vein, and vagus nerve
*Mylohyoid Mylohyoid line of the
body of mandible
Body of hyoid bone and fibrous
raphe
Inferior alveolar
nerve
- Elevates floor of
Mouth, hyoid
bone
- depresses
Mandible
Submental
- contains submental lymph nodes
- boundaries:anteriorly: midline of the neck laterally: anterior belly of digastric inferiorly: body of
hyoid bone
Thyrohyoid Oblique line on
lamina of thyroid
cartilage
Lower border of body of hyoid
bone
First cervical nerve
via the branch of
the hypoglossal
nerve
- Depresses hyoid
Bone
- elevates larynx
Hyoglossus Hyoglossus nerveMiddle and
Inferior
Constrictor of
Pharynx
Carotid
- lies beyond the hyoid bone
- boundaries
superiorly: posterior belly of digastric inferiorly: superior belly of omohyoid
posteriorly: anterior border of the sternocleidomastoid process
- contains the carotid sheath with the common carotid artery (internal and external), internal jugular vein and
its tributaries (hidden from view), hypoglossal nerve & descending branch, internal and external laryngeal
nerves, ac cessory and vagus nerves, part of the chain of deep cervical lymph nodes
Sternohyoid Posterior surfac e of
manubrium sterni
Lower border of the body of the
hyoid bone
Ansa cervicalis
(loop formed by
C1-3)
Depresses the
hyoid bone
Sternothyroid Posterior surface ofthe manubrium sterni Oblique line on the lamina of thethyroid cartilage Ansa cervicalis Depresses thelarynx
Muscular
- lies below the hyoid bone
- boundaries
anteriorly: midline of the neck superiorly: superior belly of omohyoid
inferiorly: anterior border of the sternoc leidomastoid muscle
- beneath the floor (muscles) lie the thyroid gland, larynx, trac hea and esophagus
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Posterior Triangle- boundaries:
anterior: posterior border of the sternocleidomastoid
posterior: anterior border of trapezius
inferior: middle third o f the clavicle
- covered by skin, superficial fascia, platysma, and the investing
layer of deep fascia
- where the suprac lavicular nerves run
- muscular floor covered by the prevertebral layer of deep fascia
- muscles: semispinalis capitis, levator scapulae, sca lenus medius
Submandibular di astric
Supraclavicular/Subclavian
Muscula
Sub-Mental
Carotid
Occi ital
Su erior Bell of Omoh oid
Inferior Bell of Omoh oid
Occi ital
- subdivided by the inferior belly of omohyoid
Muscles Branches ofMuscles
Origin Insertion Nerve Supply Action
Inferior belly Upper margin of the
scapula and the
suprascapular
ligament
Intermediate tendon
Intermediate
tendon
Deep fascia Clavicle and first rib
Omohyoid
Superior belly Lower border of body
of hyoid bone
Lower border of the body of the
hyoid bone
Ansa C ervicalis;
C1-3
Depresses hyoid
bone
Anterior Transverse processes
of 3rd
-6th
cervicalvertebrae
First rib C4-6 - elevates 1strib
- laterally flexes androtates cervical
part
of vertebral
column
Medius Transverse processes
of upper 6thcervical
vertebrae
First rib Anterior rami of
cervical nerves
- elevates 1strib
- laterally flexes and
rotates cervical
part
of vertebral
column
Scalenus
posterior Transverse processes
of lower cervical
vertebrae
Sec ond rib Anterior rami of
cervical nerves
- elevates 2ndrib
- laterally flexes and
rotates cervical
part
of vertebral
column
Contents Example Subdivisions Notes Branches Notes Relations
Arteries
Subclavian
(subdivided by
scalenus anterior
into the right and
left subclavian
artery)
- right: from the
First part - Extends from its
origin to the
medial border
of
the scalenus
anterior
- anterior
relation:
Vertebral artery
- spinal branch
- muscular branch
- Arises from the upper
margin of the
subclavian artery
- ascends in the neck
b/n the longus colli and
the sca lenus anterior
- passes in front of the
transverse process of
- anterior:
common
carotid artery
and left
thoracic duct
- posterior:
transverse
process of
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the 7thvertbera, enters
the foramen in the 6th
cervical vertebra
- curves backward
behind the lateral mass
of the atlas
- pierces the dura mater
and enters vertebral
canal
- supplies the brain
the
7thcervical
vertebra, the
cervicothoraci
c
sympathetic
ganglion,
anterior rami
of the 7th& 8t
cervical
nervesInferior thyroid
artery
- ascends along the
medial border of the
scalenus anterior to the
level of the c ricoid
cartilage
- passes behind the
carotid sheath
- reaches the posterior
border of the thyroid
gland
Superficial
cervical arteryThryocervicalartery
Suprascapular
artery
- pass laterally across
the
scalenus anterior to
enter the posterior
triangle of the neck
- - - - - - - - - - -
common
carotid
artery, vagus
nerve, internal
jugular vein,
cardiac
branches
of the vagus
nerve and
sympathetic
nerves
- posterior reln:dome of the
cervical pleura,
apex of the
lung,
right recurrent
laryngeal nerve
Internal thoracic artery - arises from the lower
border of the first part
of
the subc lavian artery
- enters the thorac
- crossed obliquely by
the
phrenic nerve
- - - - - - - - - - - -
axillary artery - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Superior
intercostal
artery
Gives rise to the
posterior intercostals
arteries of the 1stand 2nd
intercostals spaces
- - - - - - - - - - -
Second pa rt - Lies posterior to
the scalenus
anterior
- Extends from
the
lateral border of
the scalenusanterior to the
outer border of
the 1strib
(cervical pleura
to
the apex of the
lung)
Costcocervical
Trunk(from
2nds
ubclavia
nartery)
Deep c ervica l
artery
Passes backward to
supply the muscles ofthe back of the neck - - - - - - - - - - -
Superficial Cervical
Artery
- Branch of the
thyroc ervical trunk
which
is a branch of the
subc lavian artery
- disappears deep to
the
Trapezius muscle
Suprascapular Artery - branc h of thethryocervical trunk
- follows the
suprascapular nerve
and
supraspinous gossa
and takes plac e in the
arterial anastomosis
around the scapula
brachiocephalic
artery, becomes
axillary artery
Third part - enters the
anterioinferior
angle of the
posterior
triangle,
disappears
behind the
middle
of the clavicle- has axillary
Sheath
- Usually has no
branches
- Extends from
the
lateral border of
the scalenus
anterior to the
outer border of
the first rib
Occipital Artery - branch of the external
carotid artery
- acc ompanied by the
occipital nerve
- anterior:
sternocleidom
astoid muscle,
clavicle,
external
jugular vein
- posterior:
lower trunk of
the brac hialplexus and the
scalenus
medius
- superior:
upper and
middle trunks
of the brachia
plexus
- inferior: uppe
surface of 1st
rib
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Posterior Auricular Vein
Posterior division of
retromandibular vein
Posterior external jugular vein
Transverse cervical vein
Suprascapular vein
External J ugular
Vein
Anterior jugular vein
- drains into the subclavian veinVeins
Subc lavian Vein Brac hioceph
alic vein
Internal jugular
vein + subc lavian
vein
- subclavian begins at the outer
border
of the 1strib as a continuation of the
axillary vien
- anterior: clavicle
- posterior: scalenus anterior
- inferior: upper surfac e of 1s
rib
Root - enter the posterior triangle of the neck through the interval between the scalenusanterior and scalenus medius
- has axillary sheath
Upper - 5thand 6throots - - - - - - - - - - -
Middle - 7thcervical roots - - - - - - - - - - -
Trunk
- - - - - - - - - - - - - -Lower - 8thcervica l and 1st
thorac ic roots
- bec omes
part of the 3rd
subclavian
artery
Lateral Union of the anterior
divisions of the upper
and middle trunks
Posterior Union of the posterior
divisions of the upper,
middle and lower trunks
Brachial plexus- formed from the
anterior rami of
the 5th-8thcervical
nerves from the
1stthorac ic nerve
Cords
- - - - - - - - - - - - -
Medial Formed from the anteriordivision of the lower
trunk
- leaves the
posterior
triangle by
descending
behind the
clavicle and
entering theaxilla
Spinal part of
accessory nerve
5thcervical
root
Dorsal scapular nerve Pierces the scalenus
medius and supplies the
levator scapulae and
rhomboid muscles
Branc hes of
cervical plexus
5th-7th
cervical roots
Long thorac ic nerve Descends behind the
brachial plexus and the
subc lavian vessels and
crosses the outer border
of the first rib to enter the
axilla
Supplies the
serratus
anterior
muscle
Suprascapular nerve Passes laterally and
downward and enters
the supraspinous fossa of
the scapula through the
suprascapular notch
Supplies the
supraspiunatus
and
infraspinatus
muscles
Nerves
Branches from
the trunk
upper trunk
of brachial
plexus
Nerve to the subc lavius passes downward in
front of the brachial
plexus and the 3rdpa rt of
the subclavian artery
- supplies the
subclavius
muscle
- contains
accessory
phrenic fibers
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Main Arteries of the Neck
Artery Notes Branches Notes Relations
external carotid
arteries
Common
Carotid Artery
- arises from the
brachiocephalic
artery (right) and aorta (left)- runs upward through the
neck,
from the sternoclavicular joint
to
the upper border of the
thyroid
cartilage
- has carotid sinus and body
innervated by
glossopharyngeal
nerve (chemoreceptor to
excessive oxygen and co2)
- embedded in the carotid
sheath
- closely related to the internal
jugular vein and vagus nerve
internal carotidarteries - begins at the carotid sinus(thin
tunica media, thick
adventitia); a
reflex pressoc eptor
mechanism
(blood pressure: vbasodilation
of
the arterioles)
- has numerous nerve endings
derived from the
glossopharyngeal nerve
- anterolaterally: skin,
fascia,
sternocleidomastoid,sternohyoid,
sternothyroid,
superior belly of
omohyoid
- posteriorly: transverse
processes of the lower
four cervical vertebrae,
prevertebral muscles,
sympathetic trunk
- medially: larynx,
pharyns,
trachea and esophagus,lobe of thyroid
- laterally: internal jugular
vein, vagus nerve
sternocleidomastoid musclesuperior thyroid
superior laryngeal artery
- pierces the thyrohyoid
membrane with the
internal laryngeal nerve
maxillary maxilla
anterior & posterior frontalsuperficial temporal
anterior & posterior temporal
ascending
pharyngeal
pharynx
lingua l tongue - submandibular region
facial face
occipital back of the scalp - opposite fac ial artery
external
carotid artery
- one of the terminal branches
of
the common carotid a rtery
- supplies the neck, fac e and
scalp, tongue and maxilla
- begins at the level of the
upper
border of the thyroid c artilage
- terminates in the substanc e of
the parotid gland
- lies within the triangle
- crossed by the posterior bellyposterior auricular auricle - until the upper border of
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of
the digastric and the
stylohyoid
the posterior belly of the
digastric
Internal
Carotid artery
- deeper and more lateral
- one of the terminal branches
of
the common carotid a rtery
- supplies the brain, eye,
forehead, pa rt of the nose
- enters the cranial cavity
through
the carotid canal in thepetrous
part of the temporal bone
NO BRANCHES IN THE
NECK
- anterolateral:
below digastric: skin,
fascia, anterior
border
of the
sternocleidomastoid,
hypoglossal nerve
above digastric:
stylohyoid muscle,stylopharngeus
muscle,
glossopharyngeal
nerve, pharyngea l
branch of the vagus,
parotid gland,
external
carotid artery
- posterior: sympathetic
trunk, longus capitis,
transverse process of C1-
C3
- medial: pharyngeal wall,
superior laryngeal nerve
- lateral: internal jugular
vein, vagus nerve
Main Veins of the Nec k
Veins Notes Branches Notes Relations
inferior petrosal sinus - assists in draining the
cavernous
sinus
- joins the internal jugular vein
at
the superior bulb
fac ial vein - leaves the face and crosses
superficially over the
submandibular salivary gland
- joined by the anterior divisionof
the retromandibular vein
pharyngea l vein - drains the pharyngeal venous
plexus and join the internal
jugular vein
lingua l vein - drains into the internal jugular
vein
superior thyroid vein - leaves the superior pole of the
thyroid gland and drains into
the
internal jugular vein
middle thyroid vein - leaves the lobe of the thyroid
gland and drains into the
internal
jugular vein
Internal
J ugular Vein
- receives blood from the brain,
face and neck
- begins at the jugular fossa as
a
continuation of the sigmoid
sinus
- unites with the subc lavian
vein
behind the medial end of the
clavicle to form thebrachiocephalic vein
- has a dilatation: superior and
inferior bulb
occipital vein - drains into the internal jugular
vein
- joins the vertebral or posterior
auricular veins
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CERVICAL VERTEBRAEVertebral Columnis composed of 33vertebrae (Sne ll):
Cervical: 7
Thoracic : 12
Lumbar: 5
Sacral: 5 (fused to form the scarum)
Coccygeal: 4 (the lower 3 are commonly fused)
Interverteb ral Disc s:flexible structure found between the vertebrae
form about the length of the co lumn
thickestin the cervical and lumbar regions, where the movements of thevertebral column are greatest
Cylindrical Neck:links the head and thorax in 2 waysa) structu rally: articulations of the skull with the cervical vertebra which unite with the
thorax
b) as a c ondu i tfor important neurovascular structures and parts o the respiratory and
digestive system
CHARACTERISTICS OF VERTEBRAL SEGMENTS:
Typical Atypical
Component C3,C4,C5,C6 C1 C2 C7 (vertebraprominens)
Spine (posteriorly
oriented)
Small and bifid None Small and bifid
(1stpa lpable
spinous proc ess)
Longest spinous
process and notbifid (most palpable
spinous process)
Body (found anteriorly
with the vertebral arch
found posteriorly)
Small and broad from
side to side
None Fused w/ odontoidprocessordens
(+)
Vertebral Foram en Large and triangular Larger (+) (+)
Sup erior Artic ular
Proc ess
Facets (concave and
kidney-shaped) faceupwardandbackward
w/ lateral masson
eac h side w/surfac es for the
occipital condyle
(+) (+)
Inferior Articu lar
Proc ess
Facets (round and
almost flat) fac e
downwardandforward
Surfaces for
articulation w/ axis
(+) Facets fac e
laterally
Tran sverse Proc ess
(laterally oriented)
w/ transverse
foramenfor thepassage of vertebral
artery and vein
(+); all cervical
vertebra have a
foramen in each
transverse proc ess
Large w/ small
transverse foramen
w/ large transverse
process that
transmit vertebral
vein, but notthevertebral artery;
foramen is small
Ped ic les (+) ( - ) none (+) (+)
Lamina (+) ( - ) (+) (+)
Others Anterior arch isstraighter and shorter
than the posterior;
Onlyvertebra that
has no body
w/ anterior andposterior arch;
w/ dens,
representing the
body of the atlas
w/ odontoidprocess or dens
C7 starts toresemble the
thorac ic vertebrae
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Vertebral Structure: (Sim plif ied)1. BODY
E
L SPINEESS
1. JOINTS: (Cervica l Reg ion)ing)
condyles
ANTERIOR 2. PEDICL 3. LAMINA
4. VERTEBRA5. TRANSVERSE PROC
ss
YES Joint (nodd Between the occipital and the atlas
bending of the neck);no Movements : Flexion, extension, lateral flexion (side rotation
OINT (rotating head from side to side)masses of the bone (2)
The rem ainder of the mo bi le ve rtebrae ar t icu la te wi th ea ch other by me ans of c ar t ilag inous jo in ts b / w the i r bo d ies and by synov ia l
PECTORAL REGION
Origin Termination Branches / Tributaries
2. Atlanto-axia l :
NO J 3 synovial joints: odontoid-atlas (1) and lateral
jo in ts b / w the ir a rtic u la r p ro c e sse s.
Commencement
Lateral c uta ous nerve Interc osta 2ndine ls nerves ntercostals space
Perforating branches
from the intercostals
arteries
Each intercostals space se
with the anterior
cutaneous nerves
Intercostals spaces clo
to the sternal border
External mammary artery y Lateral border of the Lateral quadrants of theLater thorac ic arter
pectoralis major mammary glands
Muscle Origin InnervationInsertion Action
Platysma Anterior c ll; 2nd
Skin of th Pull angle ips Cervic thehest warib level e lower lip of the l al branch of7thc ranial nerve
MAMMARY GLAND
Limits
Superiorly 2ndrib level
or midsternal line
tension
elling
nterior axillary fold and upper arm
At the apex of the gland
ostals space
mal glands15-20 lactiferous ducts
Usually pigmented
ic/genetic factors
e skin of the areola
he superficial layer beneath the skin
rs the pectoralis major muscle
eep pec toral fascia
unding skin (Suspensory Ligaments of Cooper)
o
o Inferiorly 6thrib level
o Medially parasternal
o Laterally midaxillary line
Axillary tail of Spenc e
o Glandular ex
o Appears as a sligh sw
o At the angle between the a
Nipple
o
o At the level of the 4thinterc
o
May be displaced in pendulous or abnoro Normally perforated by the individual openings of the
Areola
o
o Tint depends on ethn
o Sebaceous glands of Montgomery dot th
Superficial position
o Occupies t
o Anterior to the deep pectoral fascia which cove
o Fibrous trabecular glands
Extend from the d
Attached to the areolar area and surro
Divide the gland in 15-20 lobes
POST IORER
Spinalcanal
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Lactiferous duc t
ents, emerges from the glandular units
merge from a glandular unit in one lobule
ac inar gland
ches of the external mammary
als arteries
pectoral muscles)
s found alongside veins
al mammary and lateral thoracic veins
icular nodes
De
with nodes alongside the subscapular vein
long the internal thoracic vein
Nerve Supply
ry filaments
rom intercostals nerves
n the areola and nipple areas
by the intercostals nerves
veoli and lactiferous duc ts
eola and blood vessels
Deep Pectoral Fascialy to the c lavicle
axillary fascia
scia
s
o Tiny filam
o Converges toward the nipples
o 15-20 lac tiferous ducts; 1 duc t e
o Each glandular unit is made up of a c ompound branched tubular or tubulo
Blood supply
o Bran
o Perforating branches of the intercost
o Ranches of the pectoral arteries (that supply the
Lymphatic d rainage afferent vessels from the gland communicating with lymph node
o Pectoral group of nodes
Along the extern Afferent vessels communicate with axillary nodes
Linked with infrac lavicular and suprac lav
eper lymph vesselso
Communicate
Penetrate the chest wall to reach the intrathorac ic nodes a
Communicate with subdiaphragmatic nodes (abdominal cavity)
o Senso
Derived f
Abundance of sensory receptors i
o Sympathetic fibers
Conveyed
Distributed to myoepithelial cells
Surround the glandular a
As well as smooth muscle fibers around the nipple, ar
Important role during the lactation period
Attached superior
Extends to the axilla; blends with the
Forms a sheath for the pectoralis major
Blends with the deeper clavi-pectoral fa
o Ensheathes the pec toralis minor
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AXILLA
Pyramid-shaped space between the upper part of the arm and e side of the chest
pper limb)
of neck
e
th
Important passage for nerves, blood and lymph vessels (from root of the nec k to the u
Apex- upper end of axilla
direc ted into root
bounded in front by clavicl
behind: upper border of scapula
medially: outer border of the first rib
d in front by anterior axillary fold (formed by lower border of pectoralis
Base- lower end
bounde
o
major muscle) behind: Posterior axillary fold (tendon of Latissimus dorsi and Teres major
o muscle)
medially: Chest wall
Wa lls o f A xilla
Anterior Wall Pectoralis Major
Subclavius
Pec toralis Minor
Posterior Wall Subscapularis
Latissimus dorsi
Teres Major Muscles
Medial Wall Upper 4 or 5 ribs
sIntercostal space
Lateral Wall CoracobrachialisBiceps muscles in
bicipital groove of
humerus
Base
hing between theskin stretc
anterior and
posterior walls
Muscle Origin Insertion Nerve supply Action
Pectorali medial ha vicle, lateral li media adductss Major lf of cla p of the l and lateral the arm,
th ick tr ian gu la r musc le fsternum, bic ipita l groove o pec tora l nerves from rota tes it med ia lly,upper 6 costal cartilages humerus medial and lateral clavicular fibers flex
cords of brachial the arm
plexus
Subclavius st costal cartilage terior surfac e of the subc lavius presses clavicle,fir in nerve to de the clavicle from upper trunk of steadies clavicle
brac hial plexus during movements
of shoulder girdle
Pectoralis minor d, 4th and 5th ribs rac oid process edial pectoral nerve3r co m pulls the shoulderth in triang ular mu sc le ard,downward or upw
fixed shoulder-elevates
the ribs of origin
Clavipectoral Fascia
en c loses the subc lavius
musc le and is at ta che d
to the c lav ic le .co n t inues do wnw ard as
suspe nsory l iga m ent of
a xil la
Subscapularis bscapular fossa on sser tuberosity per and lower edially rotates armsu le up m
of humerus subscapular nerves,anterior surface of
scapula
branches of posterior
cord of brac hial plexus
Latissimus Dorsi
sterior part of iliac
floor of bic ipital thoracodorsal nerve, extends
po
crest,
large , flat, triang ular r fascia, slumba groove of humeru branch of posterior adducts
musc le that extend s ove r us tates armspines of lower 6 cord of brachial plex medially ro
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thoracic
lumb ar reg ion a nd lowe r vertebrae,
of thorax lower 3 or 4 ribs,inferior angle of scapula
Teres Major medial lip of lower subscapular nerve medially rotates armlower 3rd of lateral
border
of sca pula e ofbic ip ita l groov from posterior cord of adduc ts a rm
humerus brac hial plexus
Serratus Anterior
ter surfac e of upper
medial bnorder of long thorac ic nerve from draws scapula forward
ou
8ribs
large, thin m usc le that scapula, c5,6,7 of brachial plexus around thorac ic wall,
c ove rs lateral ch est w al l region of inferior forward punc hangle
AXILLARY ARTERY
Anteriorly Posteriorly Laterally Medially
1st part of Axillary Artery pectora long th 3 cords l axillary vlis major oracic nerve of brachia eincovering of fascia plexus
and skin
2nd part of Axillary
pec toralis minor posterior cord of lateral cord of brachial medial cord of brachialArterypectoralis major brac hial plexus, plexus plexus and axillary vein
covering of fascia scle,subscapularis mu
and skin shoulder joint
3rd part of Axillary Artery r, uscle, racobrachialis, nar nervepectoralis majo subscapularis m co ul
medial root of latissimus dorsi, biceps, axillary vein
median nerve teres major, humerus, medial cutaneous
axillary and radial t of medianlateral roo nerve of arm
nerves and musculocutaneous
nerves
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