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REVEWI LECTURE THE

So we will start talking about main topics in the neck which are the: superfacial and deepscial coverings of the neckThe muscle and the post and ant triangle

k , there is specificthe necthat coversfascialuperfaciatheLets start with=>structures in it that you have to know

1: CUTANEOUS NERVES : for each nerve u should know the origin and the Innervations :-* greater occipital n. that arise from. dorsal ramus of C2 to the ant-lateral aspect ofthe neck

1- Lesser occipital n.ant. ramus of C2 , give sensation to area(skin) behindauricular(in the external ear).

2-Great auricular n. ant. rami C2 & C3. Innervates(sensation)?? 3 regions:- Inf. aspect of auricle lobule (fat bag) . Skin over parotid gland Angle of mandible (so providing sensation to a region in the face!!)

3- Transverse cutaneous(or cervical) n. ant. rami C2 & C3 .Innervates?? skin overant. of the neck (from the lower border of the mandible to the sternum)

4-Supraclavicular n. ant. rami C3 & C4. , Divided into 3 branch(med,intermediate, lat) Innervates??

Skin over the clavicle all the way down to sternal angle of manubrium (second rib) Skin over upper 1/2 of the shoulder,deltoid muscle all Skin in the lower 1/2 of the post. .

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2: i. Platysma m :is a greek word mean: flat muscular sheet . yor u should know theorigin and insertion for it

3: EXTERNAL JUGULAR VEIN (EJV)Formed opposite to the angle of the mandible

Formed by fusion of two division viens :

-post. Auricular .

- post. division of retromandibular v.

note : the ant . division of retromandibular v. form facial vien

EJV drain into :

1- subclavian v

2- internal jugular v

Sup attachment: lower border of mandible

Inf attachment : delto-pectoral fascia

Neve : cervical branch of VII 7 facisal nerve Action : draws mouth corners inf.

draws skin of the neck sup

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4 : * LYMPH NODES: superficial L.N.-L.N in upper 1/2of the neck along EJV called sup.superficial L.N.- L.N in lower 1/2of the neck along IJV called inf . deepfascia L.N

Now we are going to talk about the deep FascialNote : all the deep Fascial are singles exept : CAROTIDSHEATH

1- Common carotidinternal carotid a (medialstructure).

2- Internal jugular v(IJV)(lateral structure)3- Vagus n. (X)(post structure) which main function?

parasympathitic innerveition to intrernal visceral

(neck, thoracic,abdomanl)

4- Deep cervical L.N which company with IJV

common carotid. a: what we

mean in common carotid??

At level thyroid cartilage (adams

apple) C3- C4, common carotid

divided into 2 artery::

1-internal carotid .a : which

continu with cartoid sheath all

the way to the skull to provide

blood supply to ant sup part of

the brain while postinf part

provided by veretbra .a

2- external carotid .a: leave2

carotid sheath to provide blood

supply to the most structure of

the head and neck

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2: -Investing layer:: all around the neck , Contains 2 muscle . which are??SCM( at ant-lateral angle of theneck) & trapezius (post)Also Cover 2 salivary glands (parotid & submandibular) you should be specific and saysuperfacial part of submandibular because as you know the submandibular glandhas two part one in the neck we call it deep the other in oral cavity we call itsuperfacial

Note: Thickening part from styloid process (part of temporal bone) to the mandible(post. border of angle of mandible) there is an important lig. stylomandibular lig.

which is thickening of deep fascia ofparotid capsule

3: Pretracheal layersurrounding group of muscular. & visceral:

Which kind of. muscular? infrahyoid muscles.Note : all infrahyoid muscles. Innervated by ANSA cervicalis except the Thyrohyoidwhich innervate by ant ramus of c1The Dr said there are 4 muscle innervate by post ramus of C1 which are :1:2:3:4:

*Which visceral (organ) ? thyroid & parathyroid gland& trachea & esophagus ( alsowe have the larynx & pharynx sup until level of C6 "sixth cervical vertebra as we move

down will become, trachea & esophagus in the order")As we move down the trachea & esophagus descend into thorax these fascia will move

down into thorax which terminat (blend) (with fibrous pericardium)

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4: 3- Prevertebral layer: surrounding vertebral column and muscle attachment to it

The root of the neck the area of the neck that lies immediately above the superior thoracix opening

* Ant.group Longus m Longus Capitis and Longus Cervicis only you should knowthe name* Lat. group scalene mSc. Ant.

Sc. MediusSc. Posterior

* Post. group splenius & semispinalis and Levator Scapulae

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boundries of the superior thoracix opening : anteriorly => manubrium Laterally => first rib posteriorly => T1 structures found in the root of the neck :

1- subcalvian a. which is the most important structure : divided by the scalenus anteriorinto 3 parts :

first part :from its origin to scalenus anterior . and it will give me 3 branches :

-vertebral a. goes above ( superiorly) . -thyrocervical trunck goes forward (anteriorly ): gives me

infrathyroid a.

trancsverce cervical a.

suprascapular a.

-internal thoracix a. goes downward ( inferiorly ) . -costocervical trunk goes backward (posteriorly ).

second part : behind the scalenus anterior and it gives me one branch

third part : lateral to scalenus anterior to the outer border of the first rib tobecome axillary a. the third part has no branches but some times in very rare

cases it may have one branch

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PS : pay attention for these branches they are important in the exam and you will beasked about it .2- thoracix duct which is the largest lymohatic vessel in the body .3- roots and trunks of the brachial plexus C5-T1 ( roots withen the scalene hiatus ,trunks withen the posterior triangle of the neck ).

Boundries for the scalene hiatus : Anteriorly : scalene anterior Posteriorly : scalene medius Inferiorly : first rib Contents :

o roots of brachial plexuso second part of the subclavian

- scalene hiatus is related anterior to the subclavian vein .

- scalene hiatus is related anterior to phrenic nerve ( C4-C5).

- scalene hiatus is related posterior to subclavian artery .

Posterior triangle of the neck :

boundries : anteriorly :posterior border of the SCM posteriorly : anterior border of trapezius inferiorly : middle 1/3 of the clavicle

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contents :4 arteries :1- occipital a : at the apex of the triangle origenated from the posterior aspect of

the external carotid artery .

2- third part of the subclavian : located at the base of the triangle .

3- transvece cervical artery .

4- suprascapular artery .

5 veins :1- occipital vein : can be drain to 3 areas :

- goes deep to the suboccipital triangle to drain into the vertebral veain .

- or it goes to the internal jugular vein .

- or it goes to the posterior auricular vein which willa make the external jugular

vein .

2- transverce cervical vein .

3- suprascapular vein .

4- subclavian vein.

5- external jagular vein .

Suboccipital triangle has three main structures : vertebral artery vertebral vein supoccipital nerve ( posterior branch of c1 )

anterior triangle of the neck : we have 4 subtriangles : submental triangle submandibular triangle ( glandular region ) carotid triangle ( vascular triangle )

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muscular triangle

Contents : superfacial part of submandibular glands . fascial arteries and veins ( arteries deep to the gland , veins superfascial to the

gland and its draining into the internal jagular vein ).

hypoglossal nerves C12 .

according to the carotid triangle contents : we have the carotid sheath withen its contenttached anteriorlys ansa cervecalis is attached anteriorly to the sheath ( origin C1,C2,C3 ) sympathetic chain attached posteriorly to the carotid sheath

External Carotid Artery ECA : 8 arteries in number (you have to know the order ofthem )

one MEDIALLY :1- assending pharyngial artey : supplys the wall of the pharynx

three ANTERIORLLY :2- facsial artery (the most superior of the anterior arteries )

3- lingual artery

4- superiorthyroid artery (the most inferior of the anterior arteries )

two POSTERIORLLY5- posterior auricular

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6- occipital artery

Two terminations : the doctor gave it to us as a homework

the puls AReas :1- temporal

2-facsial

3-carotid

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Here some question from the dr :

Q : whatis the muscle that seperates the carotid from the submandibular triangle ?

posterior belly of digastric get motor innervation from the cervical branch of the facsial

nerve .

Q : what is the motor nerve supply for the muscle that seperates between the carotid

and the muscular triangle ?

ansa cervicalis ( superior belly of omohyiod m )

Q: what is the nerve supply for these muscles ?

-stylohyiod => cervical branch of facsial nerve

-genohyiod => branch from C1 via hypoglossal nerve

-mylohyiod => nerve to mylohyiod

ant. Belly of digastric => nerve to mylohyiod

Q :the motor nerve supply for the anterior boundry of the posterior triangle ?

accessory nerve C11

Q: what is the motor nerve supply for the muscle that forms the posterior triangle of the

neck ?

accessory nerve C11

Q: what is the motor nerve supply for the muscle that devide the posterior triangle into

two subtriangles ?

ansa cervicalis

Q: what is the medial boundary for submandibular (digastric) triangle ?

ant. Belly of digastric

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Q:which muscle is seperating between the carotid and the muscular triangles ?

sup. Belly of omohyoid

1:All of these following found in the superfacial fascial except theA: Lesser occipital n C: Platysma m

B: EJV D: accessory nerve

2: all of above are covered by investing layer exceptA: SCM C: parotid

B:trapezius D: submandibular

E: non of above

3: all of above receive innervations from - Supraclavicular nA: Skin over the clavicle

B:Skin over upper 1/2 of the shoulder,deltoid muscle

C: all Skin in the lower 1/2 of the post. .

D: all of above

4: which of the pairs incorrect related to the carotid sheath

A: IJV MOST lat b: carotid artery most post

C: vagus nerve most ant d: deep cervical around IJV

5 : all of the fallowing muscles are receiving motor innervation from cervical branch of

fascial n except :

a: platysma b: stylohyoid

c:post.belly of digastrik d: none of the above

E: all of the above

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QUESTION 1 2 3 4 5

ANSWER D E D C E

1: : accessory nerve IN the deep layer

2: the dr said u should be specific and he answer E BUT I think it is E when D not

submandibular it should be superfacial submandibular : so ask the DR

Th exam will include :

the skull

the neck

the face

The End

wish you all the luck in the Examforgive us for anymistake

Done by :

Haitham Owes & Rmz Rabadi