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A10: Anatomy of the neck (HIGH YIELD) Salman Zulfiqar Year 3Learning Objectives At the end of todays session you should be able to: • State the boundaries of the neck. • Understand the surface anatomy of the neck • State the boundaries of the anterior and posterior triangles of the neck and their sub- triangles, and list the contents of each • Brief run through of the Branches of the External Carotid Artery Palpable Structures Hyoid Bone – C3 Thyroid Cartilage –C4 Cricoid Cartilage –C6 Thyroid Gland isthmus – C7 Suprasternal notch –T2/T3 Sternocleidomastoid The Sternocleidomastoid consists of: 1) Sternal head that arises from manubrium of Sternum 2) Clavicular head that arises from medial third of Clavicle The muscle inserts into the mastoid process of the temporal bone and the superior nuchal line of the occipital bone It can separate the neck into two triangles: Anterior and Posterior triangles What are the Anterior Triangles? 1. Submental 2. Submandibular 3. Carotid 4. Muscular Boundaries of the Anterior Triangle Anterior Boundary – Midline of the Neck Posterior Boundary – Anterior part of SCM Superior Boundary - Mandible Submental Triangle -It’s located beneath the Chin Inferior Boundary: Hyoid Bone Medial Boundary: Midline of Neck Lateral Boundary :Posterior Belly of Digastric Submandibular Triangle -Located Underneath the Mandible Superior Boundary - Inferior Border of Mandible Anterior Boundary - Anterior Belly of Digastric Posterior Boundary - Posterior Belly of Digastric Carotid Triangle - Located Lateral to the Larynx Superior – Posterior Belly of Digastric Lateral – Medial part of SCM Inferior – Superior Belly of Omohyoid Muscular Triangle - It’s situated more inferiorly than the other subdivisions Superior Boundary – Hyoid Bone Medial Boundary – Medial Boundary of Neck Superolateral Boundary – Superior Belly of Omohyoid Muscle Inferolateral Boundary - Inferior Belly of Omohyoid Muscle Boundaries of the Posterior Triangle Posterior Boundary – Trapezius Anterior Boundary – Posterior Border of SCM Inferior Boundary - Clavicle Occipital Triangle Boundaries Anterior – Posterior Border of SCM Posterior – Trapezius Inferior - Inferior Belly of Omohyoid Supraclavicular/Subclavian Triangle Boundaries Anterior Boundary – SCM Posterior Boundary – Inferior Belly of Omohyoid Inferior Boundary- Clavicle Contents of the Anterior Triangle Nerves (2) Phrenic (?) and Vagus Nerve Arteries (3) Common CCA,ICA, ECA Veins (1) Internal Jugular Vein Glands (3) Submandibular,Thyroid and Parathyroid Others (3) Trachea, Oesophagus and Infrahyroid Muscles Disclaimer: Phrenic nerve is widely regarded as being in Posterior triangle but wrap-up has it in Anterior Contents of the Posterior Triangle Muscles (2) Inferior belly of Omohyoid,Suprahyoid Muscles Arteries (1) Subclavian Artery Veins (1) External Jugular Vein Nerve (1) CN Xl Plexus’ (2) Trunks of Brachial Plexus, Branches of Cervical Plexus Vessels (2) Suprascapular and Transverse Cervical Vessels Suprahyoid muscles - The suprahyoid muscles are a group of four muscles located superior to the hyoid bone of the neck. They all act to elevate the hyoid bone – an action involved in swallowing - The four Suprahyoid muscles are: 1. Digastric (Anterior and Posterior Belly) 2. Geniohyoid 4. Stylohyoid Infrahyoid Muscles - Contraction of the infrahyoid muscles depresses the hyoid bone - It can be split into 4 Groups: 1. Omohyoid (Superior and Inferior Belly) 2. Sternohyoid 3. Sternothyroid 4. Thyrohyoid External Carotid Artery - The Common Carotid Bifurcates into ICA and ECA at level C4 at Upper border of Thyroid Gland (Adams Apple level). - - The External Carotid has various branches that can be split into the following groups: • Terminal Branches – Maxillary and Superficial Temporal • Anterior Branches – Facial,Lingual and Superior Thyroid • Medial Branch – Ascending Pharyngeal • Posterior Branches - Occipital and Posterior AuricularExternal Carotid Artery BranchesAny Questions?