1 - scalp,face,neck,cv,axilla,mammary

7/26/2019 1 - Scalp,Face,Neck,CV,Axilla,Mammary

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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


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


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


18/24

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


19/24

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


20/24

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


21/24

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


22/24

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


23/24

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


24/24

1 - scalp,face,neck,cv,axilla,mammary

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