Head and neck
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Transcript of Head and neck
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1. Posterior Compartment -Vertebrae and muscles which support and move head & neck
2. Anterior Compartment- Viscera and rostral continuation GI & Respiratory Systems
3. Lateral Compartment-Blood vessels & nerve
I. OVERVIEW OF NECK - neck is compartmentalized
Plane of section
HORIZONTAL SECTION THROUGH NECK
POST.
LAT.
ANT.
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- muscles move head and neck
Post side - Deep Muscles (like back)- extensor & SuboccipitalMuscles
Lateral side -Scalene muscles - flex neck laterally
Anterior side -Prevertebral Muscles -directly anterior to vertebrae - flex head & neck
1. POSTERIOR COMPARTMENT
BACK+ SUBOCCIPMUSCLES
SCALENEMUSCLES
PRE-VERTEBRALMUSCLES
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In thorax, trachea is anterior to esophagus
2. ANTERIOR COMPARTMENT - VISCERA
Trachea
Esophagus
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Anterior Compartment -Larynx is part of upper end of respiratory system-specialized for sound production; also acts as ‘sphincter’ of respiratory system-Thyroid cartilage is Adam's apple
Larynx
Trachea
ANTERIOR COMPARTMENT - VISCERA
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SAYAAHH!
PHARYNX
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1) Larynx & Esophagus open into pharynx
2) Pharynx - a tube of muscles & fascia that opens to nasal and oral cavities
Nose
Nasal Cavity
Oral cavity
Larynx
Trachea
Pharynx
Esophagus
ANTERIOR COMPARTMENT -VISCERA
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HYOID BONE- parts: body, greater & lesser horns – All Infrahyoid & Suprahyoid attach to Body of Hyoid (except Sternothyroid-> thyroid cartilage)
Palpable in neck
BODY
LESSERHORNS
GREATERHORNS
Hyoid means"U" shaped
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HYOID BONE
Hyoid- means "U" shaped
Hyoid Bone –attached to larynx, pharynx & tongue; free floating; attached by ligaments and moved by muscles
Pharynx
esophagustrachea
ANTERIOR COMPARTMENT - moveable, changesshape in swallowing, speech
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- muscles that move hyoid bone move larynx & tongue, for Swallowing, Talking
Hyoid Bone
Larynx
HYOID BONE
TONGUE
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Lateral Compartment-lateral and posterior to pharynx
Contained in Carotid Sheath
1) Common and Internal Carotid arteries; 2) Int. jugularvein, 3) Vagus nerve
3. LATERAL COMPARTMENT - CAROTID SHEATH
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OUTLINEII. MUSCLES
III. NERVES
IV. ARTERIES
V. VEINS
VI. FASCIA
VII. LYMPHATICS
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II. MUSCLES OF NECK
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A. MUSCLES OF NECK - NOT ATTACHED TO HYOID -move head & neck
1. STERNO-CLEIDOMASTOID
0 - Two heads 1) manubrium of sternum 2) clavicle- medial 1/3
I - mastoid process of temporal bone
Act - bilateral - flex head unilateral rotate head, face to directed opposite side
Inn - CN XI Accessory n.TORTICOLLIS –Contracture ofSternocleidomastoid
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2. SCALENUS ANTERIOR AND SCALENUS MEDIUS
O - vertebrae-trans processes upper cervical
I - rib 1
A - flex neck & elevate rib 1
Inn - ventral rami of cervical spinal nerves
MUSCLES OF NECK - NOT ATTACHED TO HYOID
THESE MUSCLES ARE IMPORTANT LANDMARKS IN NECK
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1. OMOHYOID (omo = greek for shoulder) - Two bellies -Inf. Belly- Scapula- medial to suprascapular notch
B. INFRAHYOID MUSCLES - all depress hyoid
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2. STERNOHYOID O- Manubrium & clavicle
1. OMOHYOIDintermediate tendon to clavicle, rib 1; Sup. belly to hyoid
4. THYROHYOID - O -thyroid cartilage; also elevates larynx
3. STERNOTHYROID --O - manubrium I -thyroid cartilage; also depresses larynx
INFRAHYOID MUSCLES - all depress hyoid
deeperNOSE
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SUPRAHYOID MUSCLES - all elevate hyoid
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1. DIGASTRIC - two bellies / two cranial nerves -insert to hyoid via intermediate tendon
Post Belly-Temp. Bone, mastoid notch (medial to mastoid process)
Inn - CN VII
Ant. Belly-Mandible
Inn- CN V
Act- Depress mandible;
- MAJOR EFFECT is to OPEN Mouth
SUPRAHYOID MUSCLES - all elevate hyoid
NOSE
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2. STYLOHYOID
O-styloid process of temp bone
tendon splits to surround digastric tendon
Inn - CN VII
SUPRAHYOID MUSCLES - all elevate hyoid
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SUPRAHYOID MUSCLES - all elevate hyoid3. MYLOHYOID - forms muscular floor of mouth
O - mylohyoid line on inner side of mandible
Act - Elevates floor of mouth in swallowing
Inn - CN V - from V3
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SUPRAHYOID MUSCLES - all elevate hyoid
4. GENIOHYOID -O - inner side of mandibleabove mylohyoid
A - Elevates hyoidand draws forward
Inn - C1 branchhitch-hiking withHypoglossal nerve (CN XII)
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from C2-C4 ventral primary rami
III. NERVES OF NECK
A. CERVICAL PLEXUS
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emerge from post border of sternocleidomastoid m.
1) Lesser OccipitalC2 behind ear
4) Supraclavicular -C3, C4 lower neck & shoulder
2) Great Auricular -(C2, C3) skin over parotid, inf. to ear
3) Transverse Cervical - C2, C3 ant. neck
A. CERVICAL PLEXUSNOSE
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CERVICAL PLEXUS
NOSE
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B. ANSA CERVICALIS- fibers from C1 join Hypoglossal Nerve (XII)
- some leave & join fibers of C2 & C3 to form ANSA (loop) Cervicalis
- other fibers continue with XII to innervate Thyrohyoid & Geniohyoid
(Looks like XII innervates neck muscles; actually C1-C3 do)
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CN XII Receives hitchhiking fibers
ANSA CERVICALIS
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At root of neck-passes to arm -becomes Axillary a. ( rib 1)- Scalenus Anteriormuscle divides Subclavian into 3 parts
A. SUBCLAVIAN ARTERY
SUBCLAVIAN A.
IV. ARTERIES OF HEAD AND NECK
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Part 1- medial to scal. ant,
1) Vertebral a. 2) Int. thoracic a. 3) Thyrocervical trunk: branches -
Part 2- post to scal. ant.
1) Costocervical trunk - branches a) Superior intercostal a. first two int spaces; b) Deep cervical a. - deep neck
Part 3 - lat to scalenus ant. No Branches
SUBCLAVIAN ARTERY - divided into 3 parts by scalenus ant. muscle
a) Inf. thyroid b) Trans. cervical c) Suprascapular
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Sterno-cleidomastoid
NOSE
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Transverse cervical artery
Supra-scapular artery
Scalenus Ant. M.
Phrenic n.
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4. FACIAL A- BELOW THEN ON SURFACE OF MANDIBLE
3. LINGUAL A-TONGUE
2. ASCENDING PHARYNGEAL A-ASCENDS TO PHARYNX
1. SUPERIOR THYROID A-DESCENDS TO THYROID
5. OCCIPITAL A-POST SCALP
6. POST. AURICULAR A-POST TO EAR
B. EXTERNAL CAROTID ARTERY
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Superficial temporal-scalp & temporalis
Post auricular- post. ear & scalp
Occipital- post. scalp
Ascending pharyngeal-pharynx
Lingual- tongue
Superior thyroid- br. is Sup laryngeal
Maxillary
EXTERNAL CAROTID ARTERY
Facial
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Reflect sterno-cleidomastoid
Common carotid divides -> int & ext carotid at upper border thyroid cartilage
EXTERNAL CAROTID ARTERY
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Post side Ant side
SUP. THYROID
LINGUAL
FACIAL
OCCIPITAL
POST.AURICULAR
SUP. TEMPORAL
MAXILLARY
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1. Superficial Temporal & Maxillary vv. form Retromandibular V. (RM)
2. Retromand. V. Divides Ant. (AD) and Post. (PD) divisions
3. Ant. Division joins Facial V. to form Common Facial V. -> Int. jugular V.
4. Post. Division joins Post. Auricular V. to form External Jugular V-> Subclavian V.
5. Ant. Jugular from veins below mandible -> Ext. Jugular above clavicle
Sup. Temp.
Max
Post. Auricular
External Jugular
Common facial
Facial
Ant jug
V. VEINS OF NECK
RMAD
PD
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VEINS OF NECK
Pattern of Venous Drainage
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A. Superficial fascia:
- connective tissue below dermis - completely surrounds neck -thin and hard to demonstrate - contains Platysma & Superficial veins
VI. FASCIA OF NECK
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B. Deep Cervical fascia- one layer surrounds neck, other layers form tubes (names poorly chosen)
2. Prevertebral Layer
1. Investing layer
4. Carotid sheath
3. Pre-tracheal layer
FASCIA OF NECK
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1. Investing layer of deep cervical fascia- surrounds neck, splits around sternocleid., trap, supra & infrahyoid 2. Prevertebral Layer- surrounds vert. column & muscles back of neck, prevertebral, lateral vertebral and suboccipital m.3. Pretracheal Layer- surrounds
trachea, esophag. & thyroid continues to mediastinum 4. Carotid Sheath- surrounds common & int carotid, int jugular and X (not: Symp. Chain) Retropharyngeal Space- between PreTrach & Pre Vert layers -infection from head (tonsillitis) can spread to mediastinum
Pretracheal layer
Prevertebral layer
Carotid Sheath
NOSE
FASCIA OF NECK
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RETROPHARYNGEAL ABSCESS
Infection in retropharyngealspace can spread unimpededto mediastinum
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FASCIA OF NECK
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three groups (two arranged as rings; drain to chain)
A. Superficial Ring; Submental, Submandibular, Buccal, Parotid, Retro-auricular & Occipital nodes
B. Deep Ring: Pretracheal, Retropharyngeal nodes
C. Deep cervical chain-along Internal Jugular vein; receive lymph from all above nodes
D. Jugular lymph trunk - to Right lymphatic duct or Thoracic duct
VII. LYMPHATICS OF HEAD AND NECK
SMenSMan
B
PRA
O
PT
DeepCerv.Chain
RP