Lateral Cervical Region

Question 0

The skeleton of the neck includes what?

Answer 0

Cervical vertebrae C1-C7, hyoid, manubrium of the sternum and the clavicles.

Question 1

What important organs are located in the neck?

Answer 1

The larynx, thyroid, and parathyroid glands.

Question 2

Function of the hyoid?

Answer 2

Attachment for anterior neck muscles and a prop to keep the airway open.

Question 3

What is the subcutaneous tissue of the neck and where can you find it?

Answer 3

It is the superficial cervical fascia composed of a thin layer of connective tissue. It lies between the dermis and the deeper layer of the deep cervical fascia.

Question 4

Anterolaterally the superficial cervical fascia contains the platysma, what is the platysma?

Answer 4

A muscle of facial expression that arise from the subcutaneous tissue covering the superior parts of the deltoid and pec. major. It runs from these muscles superomedially over the clavicle to the inferior border of the mandible.

Question 5

The deep cervical fascia contains three layers which are what?

Answer 5

Investing, pretracheal, and prevertebral (these fascial layers allow the muscles in the neck to move and slide over each other easily)

Question 6

Investing layer of deep cervical fascia is the most superficial of the three deep cervical layers, what neck muscles does it “invest”, or cover, and where does it attach? (Several attachments)

Answer 6

At the four corners of the neck it splits into superficial and deep layers of fascia to “invest” the sternocleidomastoid and the trapezius. It attaches superiorly to the superior nuchal line, mastoid process, zygomatic arches, inferior border of the mandible, hyoid and spinous processes of the cervical vertebrae.
Inferiorly it attaches to the manubrium of the sternum, clavicles, acromions and spines of the scapulae.

Question 7

Pretracheal layers of deep cervical fascia is thin and is limited to the anterior part of the neck, where does this deep cervical fascial layer attach?

Answer 7

Extends inferiorly from the hyoid into the thorax where it blends with the fibrous pericardium that covers the heart.

Question 8

The pretracheal layers has a muscular layer and a visceral layer, what is included in each of these divisions of the pretracheal layer?

Answer 8

The muscular part encloses the infrahyoid muscles. The visceral layer encloses the thyroid gland, trachea, esophagus and is continuous posterosuperiorly with the buccopharyngeal fascia.

Question 9

The carotid sheath is a tubular fascial investment that extends from the base of the cranium and runs to the root of the neck. Anteriorly it blends with the investing and pretracheal layers of fascia and posteriorly with the prevertebral fascial layer. What is enclosed in this carotid sheath?

Answer 9

• Common and internal carotid arteries
• Internal jugular vein
• Vagus nerve (CN 10)
• Some deep cervical lymph nodes
• Carotid sinus nerve
• Sympathetic nerve fibers (carotid periarterial plexuses)

Question 10

The prevertebral layer of deep cervical fascia is the deepest layer of the deep cervical fascia and forms a tubular sheath for the vertebral column and the muscles associated with it, what muscles are associated with it?

Answer 10

Anteriorly - longus colli and longus capitis
Laterally - scalenes
Posteriorly - deep cervical muscles

(Fused at cranial base and the anterior longitudinal ligament at about T3)

Question 11

The retropharyngeal space is located between the visceral part of the prevertebral layer and the buccopharyngeal fascia. The alar fascia crosses this retropharyngeal space and is attached where?

Answer 11

Along the midline of the buccopharyngeal fascia from the cranium to C7, then extends laterally to blend with the carotid sheath. This space permits movement of the pharynx, esophagus, larynx, and trachea during swallowing.

Question 12

What are the four major regions of the neck?

Answer 12

1) Sternocleidomastoid region
2) Posterior cervical region
3) Lateral cervical region
4) Anterior cervical region

Question 13

SCM region divides the neck into anterior and lateral cervical regions. What are the two heads of the SCM and where do they attach?

Answer 13

• Sternal head attaches to the manubrium of the sternum.

- Clavicular head attaches to the superior surface of the medial third of the clavicle.

Question 14

Platysma Origin? Insertion? Innervation? Action?

Answer 14

O: Fascia covering superior parts of pectoralis major and deltoid muscles.

I: Inferior border of mandible, skin, and subcutaneous tissues of lower face.

Innervation: Cervical branch of facial nerve (CN 7)

Action: Draws corners of mouth inferiority and widens it as in expressions of sadness and fright; draws skin of neck superiorly when teeth are clenched indicating tension

Question 15

Sternocleidomastoid Origin? Insertion? Innervation? Action?

Answer 15

O: Sternal head - anterior surface of the manubrium of the sternum Clavicular head - superior surface of medial third of clavicle

I: Lateral surface of mastoid process of temporal bone and lateral half of superior nuchal line.

Innervation: Spinal accessory nerve (CN11; motor); C2 and C3 nerves (pain and proprioception)

Action:
Unilateral - Tlts head to same side (lateral flex neck) and rotates it so face is turned superiorly toward opposite side.

Bilateral - 1) extends neck at atlanto-occipital joints 2) flexes cervical vertebrae so that chin approaches manubrium 3) extends superior cervical vertebrae while flexing inferior cervical vertebrae so chin is thrust forward while keeping head level. With cervical vertebrae fixed, may elevate manubrium and medial end of clavicles, assisting pump-handle action of deep respiration.

Question 16

The roots of the brachial plexuses appear between the anterior and middle scalene muscles, what is the segmental innervation for this plexus?

Answer 16

Anterior rami of C5-C8 and T1 (these 5 rami unite to form the superior, middle and inferior trunks of the brachial plexus). This plexus travels between the clavicle, first rib and superior border of scapula to make its way to the axilla, innervation most of the upper limb

Question 17

The suprascapular nerve arises from the superior trunk of the brachial plexus and innervates what muscles?

Answer 17

The supraspinatus and infraspinatus of the posterior aspect of the scapula.

Question 18

Cervical plexus has superficial branches and deep branches, what kind of nerve fibers are involved with each branch? What is the segmental innervation?

Answer 18

Superficial branches that initially pass posteriorly are cutaneous branches (sensory). The deep branches passing anteromedially are motor branches (these include the root of the phrenic nerve and the ansa cercicalis).

Question 19

Cutaneous branches of the cervical nerve plexus emerge around the middle posterior border of the SCM (nerve point of neck)…what do these branches of the cervical nerve plexus supply?

Answer 19

• Skin of neck
• Superolateral thoracic wall
• Scalp between auricle and the EOP

Question 20

Lesser occipital nerve Innervates? Segmental innervation?

Answer 20

Supplies the skin of the neck and scalp posterosuperior to the auricle (C2)

Question 21

Great auricular nerve innervates? Segmental innervation?

Answer 21

Supplies the skin over the parotid gland, the posterior aspect of the auricle, and the area of skin extending from the angle of the mandible to the mastoid process (C2-C3)

Question 22

Transverse cervical nerve innervates? Segmental innervation?

Answer 22

Supplies the skin covering the anterior cervical region (C2 and C3)

Question 23

Supraclavicular nerves innervates? Segmental innervation?

Answer 23

Superficial - small branches to the skin of the neck and cross the clavicle to supply the skin over the shoulder (anterior rami of C3-C4)

Deep - the motor branches supplying the rhomboids (dorsalscapular C4-C5), serratus anterior-long thoracic nerve (C5-C7) and nearby prevertebral muscles.

Question 24

Phrenic nerve innervation? Segmental innervation?

Answer 24

The sole motor supply for the diaphragm and sensation for central part of diaphragm. In the thorax, these nerves supply the mediastinal pleura and the pericardium (All originate chiefly from C4, but receive communications from C3 and C5).

Question 25

External jugular vein originates where? Terminates where?

Answer 25

Originates near the angle of the mandible (just inferior to auricle of the external ear) by the union of the posterior retromandibular vein with the posterior auricular vein.
Terminates in the subclavian vein.

Question 26

Subclavian vein drains? Joins the IJV to form the what?

Answer 26

Subclavian vein is the major channel draining the upper limb.
It joins the IJV to form the brachiocephalic vein posterior to the medial end of the clavicle.
EJV receives the cervicodorsal, suprascapular, and anterior jugular veins.

Question 27

Cervicodorsal trunk originates? Supplies?

Answer 27

Originates from the thyrocervical trunk (a branch of the subclavian artery) and divides into the superficial cervical and dorsal scapular arteries.
Supplies branches to the vasa nervorum of the brachial plexus then pass deep to the trapezius.

Question 28

Suprascapular artery originates? Supplies?

Answer 28

Suprascapular artery originates from the thyrocervical trunk or the subclavian artery.
Supplies the muscles on the posterior aspect of the scapula.

Question 29

Occipital artery originates? Supplies?

Answer 29

Originates from the external carotid artery.

Supplies the posterior half of the scalp.

Question 30

Third part of the subclavian artery originates? Supplies?

Answer 30

Originates approximately a fingers width superior to the clavicle opposite the lateral border of the anterior scalene muscle.
Supplies blood to the upper limb.

Question 31

Anterior scalene Origin? Insertion? Innervation? Action?

Answer 31

O: Anterior tubercles of transverse processes of C3-C6 vertebrae

I: 1st rib

Innervation: Spinal nerves C4-C6

Action: Flexes neck laterally; elevates 1st rib during forced respiration

Question 32

Middle scalene Origin? Insertion? Innervation? Action?

Answer 32

O: Posterior tubercles of transverse processes of C4-C7 vertebrae

I: Superior surface of 1st rib; posterior groove for subclavian artery

Innervation: Anterior rami of cervical spinal nerves

Action: Flexes neck laterally; elevates 1st rib during forced inspiration

Question 33

Posterior scalene Origin? Insertion? Innervation? Action?

Answer 33

O: Posterior tubercles of transverse processes of C4-C6 vertebrae

I: External border of 2nd rib

Innervation: Anterior rami of spinal nerves C7 and C8

Action: Flexes neck laterally; elevates 2nd rib during forced inspiration