Chapter 8 pt 2: Head and Neck Flashcards
- a parasympathetic ganglion of CN III
- receives sensory fibers from the nasociliary (ophthalamic) nerve
ciliary ganglion
innervate sphincter pupillae muscles and the ciliary muscle
postganglionic fibers
pass through and innervate the eyeball
Sensory fibers from nasociliary
may pass through the ganglion and innervate dilator pupillae muscle
sympathetic fibers
occupies the anterior part of the orbit
globe shaped eyeball
divided into anterior and posterior chambers both are filled with aqueous humor
eyeball
directly posterior to the cornea and anterior to the iris
anterior chamber
posterior to the iris
posterior chamber
- filled with vitreous humor
- posterior to the lens
postremal chamber
Made up of- choroid, ciliary body, iris
vascular layer
posterior, thin, highly vascular layer that is firmly attached to the retina
choroid
Anterior to the border of the choroid made up of ciliary muscle and process
ciliary body
smooth muscle that decreases the size of the ring formed by ciliary body
ciliary muscle
longitudinal ridges projecting from the inner surface of the body
ciliary process
projects off ciliary body, smooth muscle fibers (sphincter pupillae and dilator pupillae muscles) control size of pupil
iris
- consists of optic part and nonvisual part
- inner layer of the eye
retina
- part of retina
- posterior and lateral and is sensitive to light
optic part
- part of retina
- covers the internal part of the ciliary body and iris
nonvisual part
the junction between the optic part and nonvisual parts of retina
ora serrata
what are the 3 parts of the ear?
- external
- middle
- internal
separates the outer and middle ear
tympanic membrane
where sound gets turned into an electrical impulse
inner ear
what are the 2 parts of the external ear?
- auricle (pinna)
- external acoustic meatus
- helps capture sound and is composed of cartilage covered in skin
- The helix, concha, tragus, lobule, antitragus, and antihelix
auricle
innervate the extrinsic and intrinsic muscles of the auricle
CN VII
innervated by the mandibular (V3) and the cervical plexus
outer more superficial surfaces of the auricle
innervated by the vagus (X) and facial nerve (VII)
deeper parts sof auricle
comes from the external carotid which supplies the posterior auricular, superficial temporal, and occipital artery
blood supply of auricle
-Extends between the deepest part of the auricle to the tympanic membrane, about 1 inch (2.5 cm)
external acoustic meatus
Contains modified sweat glands that produce cerumen (ear wax)
external acoustic meatus
Major sensory input is through the mandibular (V3) and vagus (X)
external acoustic meatus
separates the external acoustic meatus from middle ear
tympanic membrane
- Made up of- fibrocartilaginous ring, handle of malleus, umbo of tympanic membrane
- Innervated by CN V3, X, VII, IX
tympanic memrane
an air-filled, mucous membrane lined space in the temporal bone
middle ear
immediately adjacent to the tympanic membrane
tympanic cavity
superior to tympanic membrane
epitympanic recess
what are the 3 bones that span the tympanic cavity?
- malleus (articulates with the tympanic membrane)
- incus
- stapes (articulates with the cochlea)
connects to the throat, allows equalization of pressure (popping ears on an aero plane)
Pharyngotympanic tube
what are the boundaries of the middle ear?
- tegmental wall (roof)
- jugular wall (floor)
- membranous wall (tympanic membrane)
- mastoid wall (posterior)
- anterior wall
- labyrinthine wall (medial)
- promontory
formed by the basal coil of the cochlea
promontory
continuous with the aditus to the mastoid antrum
epitympanic recess
Connects the middle ear to the nasopharynx and equalizes air pressure
Pharyngotympanic Tube
is 1/3 nearest middle ear
boney part of Pharyngotympanic Tube
the remaining 2/3
cartilaginous part of the Pharyngotympanic Tube
comes from the ascending pharyngeal artery which is a branch of the external carotid
blood supply of pharyngotympanic tube
through the pterygoid plexus
venous drainage of pharyngotympanic tube
form a bony chain across the middle ear
3 ear ossicles
largest of the 3 ossicles, with the handle that attaches to the tympanic membrane
malleus
the 2nd bone of the ossicles connecting the malleus to the stapes
incus
the smallest ossicle with a base that articulates with the cochlea
stapes
what are the 3 ossciles?
- malleus
- incus
- stapes
what are the 2 muscles associated with the ear ossicles?
- tensor tympani
- stapedius muscles
lies in a bony canal above the pharyngotympanic tube and when contracted it tenses the tympanic membrane to reduce the force of vibration
tensor tympani
pulls the stapes posteriorly to reduce excessive oscillation
stapedius
- a branch off the glossopharyngeal (CN IX)
- forms the tympanic plexus which innervates the mucous membrane of the middle ear, pharyngotympanic, and mastoid area
tympanic nerve
-Consists of the bony labyrinth and the membranous labyrinth
~All these structures are found in the petrous part of the temporal bone
inner ear
exits through the internal acoustic meatus
vestibulocochlear nerve
made up of the vestibule, 3 semicircular canals, and the cochlea and all are filled with perilymph
bony labyrinth
made up of semicircular ducts, cochlear ducts and 2 sacs (utricle and saccule) and all are filled with endolymph
membranous labyrinth
the organ of hearing
cochlear ducts
organs of balance
- semicircular ducts
- utricle
- saccule
travel to the brain via vestibulocochlear nerve (CN VIII)
hearing and balance information
innervates cochlea (hearing)
cochlear nerve
innervates vestibule (balance)
vestibular nerve
contains the oval window, which is where sound vibrations enter the bony labyrinth via the stapes
vestibule of the bony labyrinth
leaves the vestibule and passes through the temporal bone
vestibular aqueduct
project posteriorly from the vestibule
3 semiciruclar canals (posterior, anterior, lateral)
extends anteriorly
cochlea
structure that coils around a central modiolus
cochlea
- holds the cochlear duct in place
- Spirals around and extends out from the modiolus
lamina of the modiolus (spiral lamina)
what are the two canals created because the cochlear duct attaches peripherally?
- scala vestibule
- tympani
continuous at the heliocotrema
Scala vestibule and tympani
A continuous system of ducts and sacs in the bony labyrinth filled with endolymph
The Cochlea- Membranous Labyrinth
in cochlea bony labyrinth
cochlear duct
in semicircular bony labyrinth
3 semicircular ducts
within vestibule of bony labyrinth
saccule and utricle
has a central position in the cochlea of the bony labyrinth
~divides the bony labyrinth into 2 canals (scala vestibule and tympani both filled with perilymph)
cochlea duct
attaches the basilar membrane to the outer wall
spiral ligament
separates the endolymph from the perilymph
vestibular membrane
has the spiral organ on it and plays a role hearing
basilar membrane
supplied by the same vessels that supply the surrounding temporal region: e.g. tympanic branch, maxillary, and stylomastoid
bony labyrinth
supplied by the labyrinthine artery
membranous labyrinth
divided into the cochlear and vestibular branches
labyrinthine artery
- passes through the internal and middle ear
- enters through the internal acoustic meatus with the vestibulocochlear nerve and exists through the stylomastoid foramen
facial nerve (CN VII)
branch off the facial nerve
Nerve to stapedius and chorda tympani
innervates stapedius muscles
Stapedius nerve
joins lingual nerve in infratemporal fossa
chorda tympani
-hit the tympanic membrane and cause the handle of malleus to move laterally
~moves the head of the incus latereally too
sound waves
moves the stapes medially which causes the wave to enter the cochlea
long process of the incus
moves through the perilymph and causes an outward bulge at a particular point on the basilar membrane
sound wave
- interconnected through the gap deep to the zygomatic arch
- surrounded and occupied by the muscles of mastication: masseter, temporalis, medial and lateral pterygoid
temporal and infratemporal fossae
what do the temporal and infratemporal fossae consist of?
- Squamous part of temporal bone
- greater wing of sphenoid, posterior surface of maxilla
- zygomatic bone (frontal, maxillary
- temporal process)
- ramus of mandible
- has medial and lateral surfaces
- Posterior and inferior borders meet to form the angle of the mandible
- The superior border is formed by the mandibular notch
- medial surface has the mandibular foramen, lingual, and mylohyoid groove
ramus of mandible
formed by the condylar and coronoid processes
mandibular notch
formed by the head and neck of the mandible
condylar process
a synovial joint with fibrocartilage covering the articular surfaces (not hyaline
Temporomandibular Joint (TMJ)
divides the TMJ into 2 parts
articular disc
accommodates hinge-like movement (depression)
lower part of TMJ
accommodates translocation (protrusion)
upper part of TMJ
lines all non-articular surfaces and attaches to the margins of the articular discs
synovial membrane
encloses the TMJ complex
fibrous membrane of joint capsule
what are the extracapsular ligaments of the joint capsule?
- lateral ligament
- sphenomandibular ligament
- stylomandibular ligament
what are the movements of the mandible?
- depression
- elevation
- retraction
- protrusion/protraction
digastric, geniohyoid, and mylohyoid muscles
depression of mandible
powerful- temporalis, mandible, and medial pterygoid muscles
elevation of mandible
posterior fibers of temporalis, deep part of masseter, and geniohyoid and digastric
retraction of mandible
lateral; pterygoid and medial pterygoid muscles
protrusion/protraction of mandible
- Powerful muscle of mastication that overlies the lateral side of the ramus of the mandible
- Made up of superficial and deep parts
masseter muscle
- innervated by the masseteric nerve
- blood supplied from masseteric artery
masseter muscle
fan shaped space on the lateral side of the skull
temporal fossa
forms the lateral boundary of the temporal fossa
temporal fascia
continuous with the infratemporal fossa
temporal fossa
muscle found in the temporal fossa
temporalis muscle
- extends from the superior and inferior temporal lines and the temporal fascia
- inserts on to the coronoid process of the mandible, extending down the anterior surface of the coronoid process almost to the last molar tooth
- a powerful elevator of the mandible
temporalis msucle
arise from the mandibular (V3) and move superiorly
2 deep temporal nerves
arises from the maxillary nerve (V2)
zygomaticotemporal nerve
arise from the maxillary artery
2 deep temporal arteries
arises from the superficial temporal artery
middle temporal artery
- *Formed by:
- sphenoid and temporal bone (roof)
- medial surface of the ramus of the mandible (lateral wall)
- pterygoid process and soft pallet (medial wall)
- posterior surface of maxilla (anterior wall)
infratemporal fossa
an extracapsular ligament of the TMJ
sphenomandibular ligament
- has 2 heads- deep and superficial
- mainly elevates the mandible
- innervated by the mandibular nerve (V3)
medial pterygoid muscle
- has 2 heads- and upper and lower
- Originate from the sphenoid bone and are innervated by the mandibular (V3)
- protrudes the lower jaw
lateral pterygoid muscle
what are the muscles of mastication?
- masseter
- temporalis
- medial pterygoid
- lateral pterygoid
origin: Zygomatic arch and maxillary process of the zygomatic bone
masseter
insertion: Lateral surface of ramus of mandible
masseter
innervation: Messeteric nerve from anterior trunk of mandibular (V3)
masseter
function: Elevation of mandible
masseter
origin: Bone of temporal fossa and temporal fossa
temporalis
insertion: Coronoid process of mandible margin of ramus of mandible almost to last molar
temporalis
innervation: Deep temporal nerves from anterior trunk of mandibular (V3)
temporalis
function: Elevation and retraction of mandible
temporalis
origin: Deep head- medial surface of lateral plate of pterygoid process and pyramidal process of palatine bone; Superficial head- tuberosity of the maxilla and pyramidal process of palatine bone
medial pterygoid
insertion: Medial surface of mandible near angle
medial pterygoid
innervation: Nerve to medial pterygoid from the mandibular nerve (V3)
medial pterygoid
function: Elevation and side-side movements of the mandible
medial pterygoid
origin: Upper head- roof of infratemporal fossa; lower head- lateral surface of lateral plate of pterygoid process
lateral pterygoid
insertion: Capsule of temporomandibular joint in the region of attachment to the articular disc and to the pterygoid fovea on the neck of the mandible
lateral pterygoid
innervation: Nerve to lateral pterygoid directly from the anterior trunk of the mandibular (V3)
lateral pterygoid
function: Protrusion and side-side movements of the mandible
lateral pterygoid
- protrudes into the infratemporal fossa through the foramen ovale
- both motor and sensory
mandibular nerve (V3)
branches off anterior trunk of mandibular nerve
- buccal
- masseteric
- deep temporal
- nerve to lateral pterygoid
gives rise to: auriculotemporal, lingual, and inferior alveolar nerves
posterior branch off mandibular nerve (V3)
- a major sensory branch of the posterior trunk
- provides sensation from anterior 2/3 of tongue, oral mucosa, and lingual gingiva of lower teeth
- innervates the submandibular ganglion
lingual nerve
supplies branches to 3 molars and 1 premolar
inferior alveolar nerve
where preganglionic parasympathetic fibers from infratemporal fossa synapse with postganglionic fibers in the floor of the mouth
submandibular ganglion
branches from the 2 cranial nerves join the mandibular nerve
Chorda Tympani and Lesser Petrosal Nerve
from the facial (CN VII)
chorda tympani
from the glossopharyngeal (CN IX)
lesser petrosal nerve
carried to the submandibular and otic ganglia in the chorda tympani and lesser petrosal
Parasympathetic preganglionic fibers
the largest branch of the external carotid and is a major blood source for the nasal cavity, oral cavity, all teeth, dura mater in cranial cavity
maxillary artery
branches of the maxillary artery
- middle meningeal
- inferior alveolar
- deep temporal
- buccal
a network of veins that drains- nasal cavity, oral cavity, all teeth, muscles of infratemporal fossa, paranasal sinuses, and nasopharynx
pterygoid plexus
connects: maxillary, retromandibular, and deep facial veins
pterygoid plexus
- Inverted tear drop shaped fossa on the lateral side of skull immediately posterior to the maxilla
- Communicates with: middle cranial fossa, infratemporal fossa, floor of orbit, lateral wall of nasal cavity, oropharynx, roof or oral cavity
- Maxillary nerve (V3) and pterygopalatine ganglion are found there
Pterygopalatine Fossa
Formed from parts of maxilla (anterior wall), palatine bone (medial wall), sphenoid bone (lateral wall)
Pterygopalatine Fossa
provides 2 openings for maxillary nerve (V3) (foramen rotundum) and greater petrosal (from VII) (pterygoid canal)
pterygoid process of sphenoid
provide gateways for structures to move through the Pterygopalatine Fossa
7 foramina and fissures
what are the 7 foramina and fissures of the Pterygopalatine Fossa?
- Foramen rotundum
- pterygoid canal
- palatovaginal canal
- palatine canal
- pterygomaxillary
- inferior orbital fissure
- sphenopalatine foramen
- primarily sensory
- gives the following branches: zygomatic, posterior superior alveolar, infra-orbital, and 2 ganglionic branches
maxillary nerve (V2)
branches off Pterygopalatine ganglion:
orbital, palatine, nasal, pharyngeal
-reach the ganglion by the nerve of the pterygoid canal
preganglionic fibers
leave the pterygopalatine ganglion through all other branches
postganglionic fibers
enters the pterygopalatine fossa via the pterygomaxillary fissure
maxillary artery
- Branches off the maxillary:
- All provide blood to: nasal, oral cavities, and teeth
- posterior superior alveolar
- infra-orbital
- greater palatine
- pharyngeal
- sphenopalatine
- artery to pterygopalatine ganglion
coalesce in the pterygopalatine fossa and pass through the pterygopalatine fossa and join pterygoid plexus
veins of pterygopalatine fossa
may pass directly to the pterygoid plexus
infra-orbital vein
- tube that connects the head to the trunk
- divided into the visceral, vertebral, and 2 vascular compartments
neck
parts of digestive and respiratory tracts
Visceral compartment of neck
cervical verts., spinal cord, spinal nerves
vertebral compartment of neck
major blood vessels and vagus nerves (X)
vascular compartments of neck
contained by unique fascial compartments
compartments of neck
divided into anterior and posterior triangles
neck
formed by anterior border of sternocleidomastoid, inferior border of mandible, and midline of neck
anterior triangle of neck
formed by posterior border of sternocleidomastoid, anterior border of trapezius, and middle 1/3 of clavicle
posterior triangle of neck
contains the platysma muscle
superficial fascia (neck)
- divided into 4 distinct layers
- investing layer
- prevertebral layer
- pretracheal layer
- carotid layer
deep cervical fascia (neck)
surrounds all structures in neck
investing layer
surrounds vertebral column, brachial plexus, associated muscles
Prevertebral layer
surrounds trachea, esophagus, thyroid gland
Pretracheal layer
surrounds common and internal carotids, internal jugular vein, and vagus nerve
carotid layer
primary superficial drainage of neck
External jugulars and anterior jugular veins
formed by posterior auricular and retromandibular veins and drains into the subclavian
external jugular of neck
small and inconsistent, drain anterior aspect of neck and are often joined by jugular venous arch
anterior jugular of neck
divided into:
- Submandibular
- Submental
- Muscular
- Carotid triangles
anterior triangle of neck
grouped by position relative to the hyoid bone
Muscles in the anterior compartment of neck
4 pairs that pass from hyoid superiorly to skull or mandible, that raise the hyoid during swallowing
Suprahyoid muscles
between hyoid and styloid process
Stylohyoid muscle
2 bellies
Digastric muscle
floor of mouth
Mylohyoid muscle
can move both attachment points depending which one is fixed
Geniohyoid muscle
what are the 4 pairs of suprahyoid muscles?
- Stylohyoid muscle
- Digastric muscle
- Mylohyoid muscle
- Geniohyoid muscle
4 pairs of strap-like muscles that attach the hyoid bone to inferior structures and depress the hyoid
infrahyoid muscles
what are the 4 pairs of infrahyoid muscles?
- sternohyoid muscle
- omohyoid muscle
- thryohyoid muscle
- sternothryoid muscle
thin muscle between hyoid and sternum
Sternohyoid
has 2 bellies (superior and inferior) attaches hyoid inferiorly to border of scapula
Omohyoid muscle
attaches thyroid cartilage to hyoid
Thyrohyoid muscle
attaches sternum to thyroid cartilage
Sternothyroid muscle
what are the anterior muscles of the neck?
- Stylohoid
- Digastric- anterior belly
- Digastric- posterior belly
- Mylohyoid
- Geniohyoid
- Sternohyoid
- Omohyoid
- Thyrohyoid
- Sternothyroid
origin: Base of styloid process
Stylohoid
insertion: Lateral area of body of hyoid
Stylohoid
innervation: Facial nerve (VII)
Stylohoid
function: Pulls hyoid upward in posterosuperior direction
Stylohoid
origin: Digastric fossa on lower inside of mandible
Digastric- anterior belly
insertion: Attachment of tendon between 2 bellies to body of hyoid bone
Digastric- anterior belly
innervation: Mylohyoid nerve from inferior alveolar branch of mandibular (V3)
Digastric- anterior belly
function: Opens moth by lowering mandible; raises hyoid bone
Digastric- anterior belly
origin: Mastoid notch on medial side of mastoid process
Digastric- posterior belly
insertion: Same side as anterior belly
Digastric- posterior belly
innervation: Facial nerve (VII)
Digastric- posterior belly
function: Pulls hyoid upward and back
Digastric- posterior belly
origin: Mylohyoid line of mandible
Mylohyoid
insertion: Body of hyoid bone and fibers from muscle on opposite side
Mylohyoid
innervation: Mylohyoid nerve from inferior alveolar branch of mandibular (V3)
Mylohyoid
function: Support and elevation of floor of mouth; elevation of hyoid
Mylohyoid
origin: Inferior mental spine on inner surface of mandible
Geniohyoid
insertion: Anterior surface of body of hyoid bone
Geniohyoid
innervation: Branch from anterior ramus (C1)
Geniohyoid
function: Fixed mandible elevates and pulls hyoid forward; fixed hyoid pulls mandible down and in
Geniohyoid
origin: Posterior aspect of sternoclavicular joint and adjacent manubrium of sternum
Sternohyoid
insertion: Body of hyoid bone medial to attachment of omohyoid
Sternohyoid
innervation: Anterior rami of C1-C3 through the ansa cervicalis
Sternohyoid
function: Depresses hyoid bone after swallowing
Sternohyoid
origin: Superior border of scapula medial to suprascapular notch
Omohyoid
insertion: Lower border of body of hyoid bone just lateral to attachment of sternohyoid
Omohyoid
innervation: Anterior rami of C1-C3 though the ansa cervicalis
Omohyoid
function: Depresses and fixes hyoid bone
Omohyoid
origin: Oblique line on lamina of thyroid cartilage
Thyrohyoid
insertion: Greater horn and adjacent aspect of body of hyoid
Thyrohyoid
innervation: Fibers from anterior ramus of C1 carried along hyoglossal nerve (XII)
Thyrohyoid
function: Depresses hyoid bone but when hyoid bone is fixed raises larynx
Thyrohyoid
origin: Posterior surface of manubrium of sternum
Sternothyroid
insertion: Oblique line on lamina of thyroid cartilage
Sternothyroid
innervation: Anterior rami of C1-C3 though the ansa cervicalis
Sternothyroid
function: Draws larynx (thyroid cartilage) downward
Sternothyroid
are the beginning of the carotid system
common carotids
arise from the brachiocephalic trunk
right common carotid
arise from the aortic arch
left common carotid
This occurs in the carotid triangle
Near the superior edge of the thyroid cartilage the common carotids split into external and internal carotids
contains the carotid sinus near the bifurcation
internal carotid
contain receptors that monitor blood pressure and pH respectively
carotid sinus and carotid body
ascends into the head giving of no branches on the way
internal carotid
immediately begins giving off branches
external carotid
supplies Thyroid muscles, internal structures of larynx, sternocleidomastoid, cricothyroid muscles, thyroid gland
superior thryoid of external carotid
supplies Pharyngeal constrictors, and stylopharyngeus muscle, palate, tonsils, pharyngotympanic tube, meninges in posterior cranial fossa
Ascending pharyngeal of external carotid
supplies Muscles of tongue, palatine tonsils, soft palate, epiglottis, floor of mouth, sublingual gland
Lingual branch of external carotid
supplies All structures in the face from inferior border of mandible anterior to masseter muscle to the medial corner of the eye, the soft palate, palatine tonsils, pharyngotympanic tube, submandibular gland
facial branch of external carotid
supplies Sternocleidomastoid muscle, meninges in posterior cranial fossa, mastoid cells, deep muscles of the back, posterior scalp
occipital branch of external carotid
supplies Parotid gland and nearby muscles, external ear and scalp posterior to ear , middle and inner ear structures
posterior auricular branch of external carotid
supplies Parotid gland and duct, masseter muscle, lateral face, anterior part of external ear, temporalis muscle and temporal fossae
Superficial temporal branch of external carotid
supplies extensive
maxillary branch of external carotid
-begins as sigmoid sinus which is part of the dural sinus
internal jugular
- initial dilated part of internal jugular
- exits the skull through the jugular foramen and descends down the neck within the carotid sheath
superior bulb of jugular
meets the subclavian from their respective sides and form the brachiocephalic trunks
each internal jugular
tributaries of internal jugular vein that join
facial, lingual, pharyngeal, occipital, superior thyroid, and middle thyroid veins
cranial nerves that pass through the triangle of the neck
- facial (VII)
- glossopharyngeal (IX)
- vagus (X)
- accessory (XI)
- hypoglossal (XII)
branches of spinal nerves that pass through the triangle of the neck
- transverse cervical spine
- cervical plexus
- upper and lower roots of ansa cervicalis
exits the skull through the jugular foramen and passes downward and backward deep to the sternocleidomastoid
accessory nerve (XI)
- exits the skull through the hypoglossal canal and descends with the jugular
- passes forward over the carotid and disappears into the mylohyoid
hypoglossal nerve
- arises from the anterior rami of cervical nerve C2 and C3
- emerges from the posterior border of the sternocleidomastoid and passes over it and provides cutaneous innervation of this area
transverse cervical nerve
a looping nerve from cervical spines C1-C3 that innervate strap-like muscles of anterior triangle
Ansa cervicalis nerve
contains the trachea, esophagus, pharynx, larynx, thyroid, and parathyroid glands
visceral compartment
joins the larynx and esophagus to the mouth
pharynx
is bi-lobed and supplied by superior and inferior thyroid arteries and drained by superior, middle, and inferior thyroid veins
thryoid gland
pass superiorly after leaving the vagus nerve (X)
recurrent laryngeal nerves
found on the posterior surface of the thyroid gland
parathyroid glands
- on the lateral side of the neck and is continuous with the arm
- bordered by the sternocleidomastoid, trapezius, and the clavicle
posterior triangle of the neck
defined by the sternocleidomastoid, trapezius, splenius capitis, levator scapulae, posterior, anterior and middle scalene, and the omohyoid
posterior triangle
what are the muscles of the posterior compartment?
- Sternocleidomastoid sternal head
- clavicular head
- Trapezius
- Splenius capitus
- Levator scapulae
- Posterior scalene
- Middle scalene
- Anterior scalene
- Omohyoid
origin: Upper part of surface of manubrium
Sternocleidomastoid sternal head
insertion: Lateral 1/3 of superior nuchal line
Sternocleidomastoid sternal head
innervation: Accessory (XI) and branches from anterior rami of C2-C3
Sternocleidomastoid sternal head
function: Individually will tilt head towards shoulder turn face to other side; together draw head back
Sternocleidomastoid sternal head
origin: Superior part of medial 1/3 of clavicle
clavicular head
insertion: Lateral surface of mastoid process
clavicular head
origin: Superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous process of CVII to TXII
trapezius
insertion: Lateral 1/3 of clavicle, acromion, spine of scapula
trapezius
innervation: Motor- accessory nerve (XI)
Proprioception- C3 and C4
trapezius
function: Assists in rotating the scapula during abduction of humerus above horizontal, upper fibers elevate, middle fibers adduct, lower fibers depress scapula
trapezius
origin: Lower half of ligamentum nuchae, spinous processes of CVII to TIV
Splenius capitus
insertion: Mastoid process, skull below lateral one third of superior nuchal line
Splenius capitus
innervation: Posterior rami of middle cervical plexus
Splenius capitus
function: Together- draw head backward, extending neck; individually- draw and rotate head to one side (turn face to same side)
Splenius capitus
origin: Transverse process of CI to CIV
Levator scapulae
insertion: Upper portion medial border of scapula
Levator scapulae
innervation: C3 to C4 and dorsal scapular nerve (C4, C5)
Levator scapulae
function: Elevates scapula
Levator scapulae
origin: Posterior tubercles of the transverse processes of CVII to TIV
Posterior scalene
insertion: Upper surface of rib 2
Posterior scalene
innervation: Anterior rami of C5 to C7
Posterior scalene
function: Elevation of rib 2
Posterior scalene
origin: Transverse process of CII to CVII
middle scalene
insertion: Upper surface of rib 1 posterior to groove for the subclavian artery
middle scalene
innervation: Anterior rami of C3 to C7
middle scalene
function: elevation of rib 1
middle scalene
origin: Anterior tubercles of the transverse processes of CII to CVI
Anterior scalene
insertion: Scalene tubercle and upper surface of rib 1
anterior scalene
innervation: Anterior rami of C4 to C7
anterior scalene
function: Elevation of rib 1
anterior scalene
origin: Superior border of scapula medial to suprascapular notch
omohyoid
insertion: Lower border of body of hyoid bone just lateral to attachment of sternohyoid
omohyoid
innervation: Anterior rami of C1-C3 though the ansa cervicalis
omohyoid
function: Depresses and fixes hyoid bone
omohyoid
- most superficial vein in the posterior triangle of the neck
- forms at the angle of the mandible
- forms from the retromandibular and posterior auricular veins
- dives into the cervical fascia and joins the subclavian inferiorly
external jugular vein
arteries found in the posterior triangle
The 1st, 2nd, and 3rd parts of the subclavian, thyrocervical, suprascapular, and transverse cervical arteries
nerves that pass through the posterior triangle
the accessory (VI), and nerves from the cervical plexus (transverse cervical, lesser occipital and greater auricular nerves)
supply cutaneous innervation
Nerves from the cervical plexus
Consists of cutaneous and muscular branches
cervical plexus
major muscular nerve that innervates the diaphragm
phrenic nerve
innervates the infrahyoid muscles
inferior and superior roots of ansa cervicalis
- innervated by the cervical plexus
- generally flex and laterally flex the head
Prevertebral and lateral vertebral muscles
what are the muscles innervated by the cervical plexus?
- Rectus capitus anterior
- Rectus capitus lateralis
- Longus coli- superior oblique part
- Longus coli- inferior oblique part
- Longus coli- vertical part
- Longus capitis
origin: Anterior surface of lateral part of atlas and its transverse process
Rectus capitus anterior
insertion: Inferior surface of basilar part of occipital bone
Rectus capitus anterior
innervation: Branches from anterior rami of C1, C2
Rectus capitus anterior
function: Flexes head at atlanto-occipital joint
Rectus capitus anterior
origin: Superior surface of transverse process of atlas
Rectus capitus lateralis
insertion: Inferior surface of jugular process of occipital bone
Rectus capitus lateralis
innervation: Branches from anterior rami of C1, C2
Rectus capitus lateralis
function: Flexes head laterally to same side
Rectus capitus lateralis
origin: Anterior tubercle of transverse process of CIII-CV
Longus coli- superior oblique part
insertion: Tubercle of anterior arch of atlas
Longus coli- superior oblique part
innervation: Branches from anterior rami of C2-C6
Longus coli- superior oblique part
function: Flexes neck anteriorly and laterally and slight rotation to opposite side
Longus coli- superior oblique part
origin: Anterior surface of bodies of TI-TIII
Longus coli- inferior oblique part
insertion: Anterior tubercle of transverse processes of CV and CVI
Longus coli- inferior oblique part
origin: Anterior surface of bodies of TI-TIII, CV-CVII
Longus coli- vertical part
insertion: Anterior surface of bodies of CII-CIV
Longus coli- vertical part
origin: Tendinous slips to transverse processes of CIII to CVI
Longus capitis
insertion: Inferior surface of basilar part of occipital bone
Longus capitis
innervation: Branches from anterior rami of C1 to C3
Longus capitis
function: flexes head
longus capitis
- contains structures that pass from the neck to the thorax and upper limb
- bounded by: the manubrium, clavicle, T1 and superior margin of scapula
- This includes: projections of the pleural cavities, trachea, esophagus, and vessels
root of neck
arch up and out of the thorax and enter the root of the neck on both sides
subclavian arteries
what are the 3 parts of the subclavian arteries?
- 1st part
- 2nd part
- 3rd part
between origin of artery and anterior scalene muscle
1st part of subclavian
posterior to anterior scalene muscle
2nd part of subclavian
lateral to anterior scalene muscle, before it reaches the lateral border of rib 1
3rd part of subclavian
from the cervical plexus descends within the prevertebral layer of fascia
phrenic nerve
descends in the carotid sheath
vagus nerve (X)
ascend along the trachea to the larynx
right and left recurrent laryngeal nerves
- The cervical parts of the sympathetic trunk that are punctuated with ganglia
- The cardiac nerves that branch off the sympathetic trunk
Nerves of the Root of the Neck
anterior to longus coli and capitis muscles and posterior to the common carotid
cervical part of the sympathetic trunk
sends branches to carotids, pharynx, heart
large superior ganglion
sends branches to the heart and cervical nerves
middle ganglion
sends branches to the vertebral artery and heart
inferior ganglion
- enters the root of the neck and passes to the left, posterior to the carotid sheath
- enters the venous system at the junction between the subclavian and internal jugular
- joined by the left jugular and left subclavian trunks near its junction with the venous system
thoracic duct
empty into the venous system
right jugular trunk, right subclavian, and bronchomediastinal trunks
drain into nodes along the jugular veins in the neck
Nodes from the head and face
drain into the superficial cervical nodes (along external jugular)
occipital and mastoid nodes
drain into the deep cervical nodes (along internal jugular
pre-auricular, parotid, submental, and submandibular nodes
The most superior internal cervical node
the large jugulodigastric node
- a musculofascial half cylinder that connects the oral and nasal cavities to the larynx and esophagus
- a common pathway for food and air
pharynx
open into the nasopharynx
Posterior openings of nasal cavity (choanae)
opens into oropharynx
Posterior opening of oral cavity (oropharyngeal isthmus)
opens into laryngopharynx
Superior aperture of larynx (laryngeal inlet)
attach to bone, cartilage, and ligaments
superior and anterior margins of the pharyngeal wall
attaches to the base of the skull in an irregular C-shaped pattern
pharynx
what are the attachment points of the pharyngeal walls?
1st part, 2nd part, 3rd part
medial plate of pterygoid process and pterygomandibular raphe
1st part of Pharyngeal Walls
stylohyoid ligament and lesser horn of hyoid bone
2nd part of Pharyngeal Walls
from inferior tubercle of thyroid cartilage along the oblique line to the cricoid cartilage
3rd part of Pharyngeal Walls
attach to the pharyngeal raphe posteriorly
Attachment Points of Pharyngeal Walls
formed by skeletal muscle and fascia
pharyngeal wall
divided in 2 types based on fiber orientation
Muscles of the pharynx
- indicated by their position (superior, middle, inferior
- have their fibers oriented in a circular direction
constrictor muscles
what are the constrictor muscles of the pharynx?
- superior constrictor
- middle constrictor
- inferior constrictor
posterior attachment: pharyngeal raphe
superior constrictor
anterior attachment: Pterygomandibular raphe and adjacent bone on the mandible and pterygoid Hamulus
superior constrictor
innervation: vagus nerve (X)
superior constrictor
function: constriction of pharynx
superior constrictor
posterior attachment: pharyngeal raphe
middle constrictor
anterior attachment: Upper margin of greater horn of hyoid bone and adjacent margins of lesser horn and stylohyoid ligament
middle constrictor
innervation: vagus nerve (X)
middle constrictor
function: constriction of pharynx
middle constrictor
posterior attachment: pharyngeal raphe
inferior constrictor
anterior attachment: Cricoid cartilage, oblique line of thyroid cartilage, and a ligament that spans between these attachments and across the cricothyroid muscles
inferior constrictor
innervation: vagus nerve (X)
inferior constrictor
function: constriction of pharynx
inferior constrictor
what are the muscles innervated by the cervical plexus?
- Rectus capitus anterior
- Rectus capitus lateralis
- Longus coli- superior oblique part
- Longus coli- inferior oblique part
- Longus coli- vertical part
- Longus capitis
origin: Anterior surface of lateral part of atlas and its transverse process
Rectus capitus anterior
insertion: Inferior surface of basilar part of occipital bone
Rectus capitus anterior
innervation: Branches from anterior rami of C1, C2
Rectus capitus anterior
function: Flexes head at atlanto-occipital joint
Rectus capitus anterior
origin: Superior surface of transverse process of atlas
Rectus capitus lateralis
insertion: Inferior surface of jugular process of occipital bone
Rectus capitus lateralis
innervation: Branches from anterior rami of C1, C2
Rectus capitus lateralis
function: Flexes head laterally to same side
Rectus capitus lateralis
origin: Anterior tubercle of transverse process of CIII-CV
Longus coli- superior oblique part
insertion: Tubercle of anterior arch of atlas
Longus coli- superior oblique part
innervation: Branches from anterior rami of C2-C6
Longus coli- superior oblique part
function: Flexes neck anteriorly and laterally and slight rotation to opposite side
Longus coli- superior oblique part
origin: Anterior surface of bodies of TI-TIII
Longus coli- inferior oblique part
insertion: Anterior tubercle of transverse processes of CV and CVI
Longus coli- inferior oblique part
origin: Anterior surface of bodies of TI-TIII, CV-CVII
Longus coli- vertical part
insertion: Anterior surface of bodies of CII-CIV
Longus coli- vertical part
origin: Tendinous slips to transverse processes of CIII to CVI
Longus capitis
insertion: Inferior surface of basilar part of occipital bone
Longus capitis
innervation: Branches from anterior rami of C1 to C3
Longus capitis
function: flexes head
longus capitis
- contains structures that pass from the neck to the thorax and upper limb
- bounded by: the manubrium, clavicle, T1 and superior margin of scapula
- This includes: projections of the pleural cavities, trachea, esophagus, and vessels
root of neck
arch up and out of the thorax and enter the root of the neck on both sides
subclavian arteries
what are the 3 parts of the subclavian arteries?
- 1st part
- 2nd part
- 3rd part
between origin of artery and anterior scalene muscle
1st part of subclavian
posterior to anterior scalene muscle
2nd part of subclavian
lateral to anterior scalene muscle, before it reaches the lateral border of rib 1
3rd part of subclavian
from the cervical plexus descends within the prevertebral layer of fascia
phrenic nerve
descends in the carotid sheath
vagus nerve (X)
ascend along the trachea to the larynx
right and left recurrent laryngeal nerves
- The cervical parts of the sympathetic trunk that are punctuated with ganglia
- The cardiac nerves that branch off the sympathetic trunk
Nerves of the Root of the Neck
anterior to longus coli and capitis muscles and posterior to the common carotid
cervical part of the sympathetic trunk
sends branches to carotids, pharynx, heart
large superior ganglion
sends branches to the heart and cervical nerves
middle ganglion
sends branches to the vertebral artery and heart
inferior ganglion
- enters the root of the neck and passes to the left, posterior to the carotid sheath
- enters the venous system at the junction between the subclavian and internal jugular
- joined by the left jugular and left subclavian trunks near its junction with the venous system
thoracic duct
empty into the venous system
right jugular trunk, right subclavian, and bronchomediastinal trunks
drain into nodes along the jugular veins in the neck
Nodes from the head and face
drain into the superficial cervical nodes (along external jugular)
occipital and mastoid nodes
drain into the deep cervical nodes (along internal jugular
pre-auricular, parotid, submental, and submandibular nodes
The most superior internal cervical node
the large jugulodigastric node
- a musculofascial half cylinder that connects the oral and nasal cavities to the larynx and esophagus
- a common pathway for food and air
pharynx
open into the nasopharynx
Posterior openings of nasal cavity (choanae)
opens into oropharynx
Posterior opening of oral cavity (oropharyngeal isthmus)
opens into laryngopharynx
Superior aperture of larynx (laryngeal inlet)
attach to bone, cartilage, and ligaments
superior and anterior margins of the pharyngeal wall
attaches to the base of the skull in an irregular C-shaped pattern
pharynx
what are the attachment points of the pharyngeal walls?
1st part, 2nd part, 3rd part
medial plate of pterygoid process and pterygomandibular raphe
1st part of Pharyngeal Walls
stylohyoid ligament and lesser horn of hyoid bone
2nd part of Pharyngeal Walls
from inferior tubercle of thyroid cartilage along the oblique line to the cricoid cartilage
3rd part of Pharyngeal Walls
attach to the pharyngeal raphe posteriorly
Attachment Points of Pharyngeal Walls
formed by skeletal muscle and fascia
pharyngeal wall
divided in 2 types based on fiber orientation
Muscles of the pharynx
- indicated by their position (superior, middle, inferior
- have their fibers oriented in a circular direction
constrictor muscles
what are the constrictor muscles of the pharynx?
- Superior constrictor
- middle constrictor
- inferior constrictor
posterior attachment: Pharyngeal raphe
superior, middle, and inferior constrictor muscles
anterior attachment: Pterygomandibular raphe and adjacent bone on the mandible and pterygoid Hamulus
`
superior constrictor muscle
innervation: vagus nerve (X)
superior, middle, and inferior constrictor muscles
function: constriction of pharynx
superior,inferior, middle constrictor muscles
anterior attachment: Upper margin of greater horn of hyoid bone and adjacent margins of lesser horn and stylohyoid ligament
middle constrictor muscle
anterior attachment: Cricoid cartilage, oblique line of thyroid cartilage, and a ligament that spans between these attachments and across the cricothyroid muscles
inferior constrictor muscle
