Plan Of Neck

Plan Of Neck

Bony landmark of the neck:
1. Upper Limit
  1. Inferior border of the mandible
  2. Mastoid process of the temporal bone
  3. External occipital protuberance
2. InferiorlY
  1. Upper border of manubrium sterni
  2. Clavicle
IMPORTANT MIDLINE SURFACE LANDMARKS
1. Hyoid Bone
  1. U-shaped with a body, lesser and greater horns.
  2. Is the first resistant structure that can be felt in the midline inferior to the chin.
  3. Level of C3 vertebra.
  4. Moves during swallowing.
  5. Is suspended from the styloid process by stylohyoid ligaments.
  6. Muscles connect the hyoid bone to the tongue, mandible, sternum, larynx, and pharynx.
  7. Consequently, following fracture of the hyoid bone the fine balance of these muscles would be disturbed, causing problems in breathing, speaking, and swallowing
2. Laryngeal Prominence
  1. Formed by the thyroid cartilage.
  2. More prominent in the male & rises with swallowing
  3. Lies at the level of the C4 & 5 vertebrae.
  4. It rises during swallowing.
3. Cricoid Cartilage
  1. Can be felt inferior to the laryngeal prominence.
  2. Level of C6 vertebra.
  3. At C6- pharynx continues - esophagus and the larynx - trachea
Respiratory-Digestive Block
1. Located anteriorly.
2. Contains the pharynx and larynx which form the esophagus and trachea at the level of C6.
3. The contents are partially enclosed in a much thinner sheath of fascia called the PRE-TRACHEAL FASCIA
4. Trachea in front and the esophagus behind together enclosed in the thin pre-tracheal fascia, which also encloses the thyroid gland.
5. The recurrent laryngeal nerve occupies the groove between the trachea and esophagus.
Musculo-Vertebral Block
1. Located posteriorly.
2. Consists of the cervical vertebrae and the muscles around them.
3. Plastered by a dense layer of PREVERTEBRAL FASCIA
4. The whole neck is enclosed in a musculo-fascial tube composed of :
  1. Sternomastoid muscle
  2. Trapezius muscle
  3. Investing Layer of Deep Fascia of the neck
5. Carotid sheath: Fills in the angle between the vertebral block and the respiratory-digestive block
6. Longus colli: Immediately in front of the vertebral bodies.
7. Scalenus anterior: Arises from the anterior tubercles of transverse processes.
8. Scalenus medius & posterior: Arises from the posterior tubercles.
9. Levator scapulae and deep muscles of the neck arise further posteriorly.
Deep Fascia of Neck
1. Investing layer.
2. Pre-tracheal fascia
3. Carotid Sheath
4. Prevertebral Fascia
MUSCLES!!
1. Sternocleidomastoid muscle
2. Digastric muscle
3. Omohyoid muscle
Subdivisions of Neck
1. Posterior Triangle
  1. Anteriorly: Sternomastoid
  2. Posteriorly: Trapezius
  3. Apex: Meeting between trapezius & sternomastoid at the back of the skull.
  4. Base: Middle third of the clavicle, between the attachment of sternomastoid and trapezius.
2. Anterior Triangle
  1. Boundaries
    1. Anterior: Median line
    2. Posterior: Sterno cleidomastoid
    3. Base: Mandible + Line from angle to mastoid
    4. Apex: Suprasternal notch
  2. Subdivisions
    1. Submandibular triangle.
    2. Carotid triangle.
    3. Muscular triangle.
    4. Submental triangle.
  3. Suprahyoid muscles
    1. Digastric muscle
    2. Stylohyoid
      1. Above post belly of digastric muscle.
      2. Extends between styloid process & hyoid bone.
    3. Mylohyoid
      1. Extends between mandible and hyoid bone.
      2. Is attached to a midline raphe.
    4. Geniohyoid: Extends between mandible and hyoid bone.
    5. Hyoglossus: Extends between hyoid bone & tongue.
  4. Infrahyoid Muscles
    1. Sternohyoid: Superficial to sternothyroid & thyrohyoid. Between the manubrium & hyoid bone.
    2. Omohyoid
    3. Sternothyroid:Extends between the manubrium and the oblique line of thyroid cartilage.
    4. Thyrohyoid: From the oblique line of the thyroid cartilage to the hyoid bone.
  5. Ansa Cervicalis
    1. Superficial to the carotid sheath
    2. A loop formed by 2 components:
      1. Superior Loop C1 (Descending Hypoglossi)
      2. Inferior Loop from cervical plexus C2 and C3
        Innervation: All infrahyoid muscles except thyrohyoid (C1 through hypoglossal nerve

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	Created by Farah Mansour over 7 years ago