The Neck Bones, Ligaments, and Joints: Bones



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The Neck

Bones, Ligaments, and Joints:

Bones:

  • Typical Cervical Vertebrae: small bodies, transverse foramen, bifid spinous process, groove for spinal nerve on transverse process

  • Atlas, C1: anterior arch with tubercle and facet for dens, posterior arch with tubercle and sulcus for vertebral artery, lateral mass (with superior and inferior articular processes), transverse foramen

  • Axis, C2: dens (odontoid process), transverse foramen

  • Hyoid Bone: at the level of C3, does not articulate with any other bone. It attaches to the floor of the oral cavity (superiorly), the larynx (inferiorly), and the pharynx (posteriorly)

Joints:

  • Atlanto-occipital Joints: between occipital bone and atlas, allows head to nod

  • Atlanto-axial Joints: between atlas and axis, allows rotation of head

  • Zygapophyseal joints: between superior and inferior articular processes, form posterior part of intervertebral foramen wall

Ligaments:

  • Nuchal Ligament: prevents excessive flexion of head/neck, attaches to back of occipital bone and runs along spinous processes, eventually becoming the supraspinous ligament

  • Alar Ligaments: prevent excessive rotation of head and atlas relative to the axis, attaches dens to medial surfaces of occipital condyles

  • Transverse Ligament: holds dens in position, attaches posterior dens to medial surfaces of lateral masses of atlas

  • Apical Ligament of Dens: attaches dens to foramen magnum

  • Cruciform Ligament: connects foramen magnum, atlas, and axis

Fascia of the Neck: Involved in spread of infection.

Fascia

Location

Contents

Superficial

From superficial fascia of thorax to the mandible

Platysma

Investing

Surrounds all structures of the neck

Trapezius, SCM, all of neck

Pierced by external and anterior jugular veins, and lesser occipital, great auricular, transverse cervical, and supraclavicular nerves

Prevertebral

Surrounds vertebral column and deep muscles of back

Cervical vertebrae, scalene muscles, deep muscles of back. Extends to form axillary sheath.

Pretracheal

Anterior neck, surrounds viscera

Trachea, esophagus, thyroid

Carotid Sheaths

Surround the 2 neurovascular bundles on either side of anterior neck

Common carotid artery, internal carotid artery, internal jugular vein, and the vagus nerve

Muscles of the Neck:

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Muscle

Attachments

Innervation

Action

Platysma

Superficial fascia of upper thorax and fascia of mandible

Facial nerve [VII]

“scary face”

Sternocleidomastoid

Manubrium and medial clavicle to mastoid process and lateral superior Nuchal line

Accessory nerve [XI] and C2-C3 (proprioception)

Lateral flex to same side, rotate to opposite side, and flex head (bilat.)

Trapezius

Superior Nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes C7-T12 to clavicle, acromion, and spine of scapula

Accessory nerve [XI] and C3-C4 (proprioception)

Rotate scapula, elevate, adduct, and depress scapula

Splenius Capitis

Ligamentum nuchae, spinous processes C7-T4 to mastoid process, skull below lateral superior nuchal line

Posterior rami of middle cervical nerves

Extend head, draw and rotate head to same side (unilaterally)

Levator Scapulae

Transverse process of C1-C4 to upper part of medial border of scapula

C3, C4, and dorsal scapular nerve (C4, C5)

Elevate scapula

Anterior Scalenes

Transverse processes of C3-C6 to scalene tubercle and rib 1

Anterior rami of C4-C7

Elevate rib 1

Middle Scalenes

Transverse processes of C2-C7 to rib 1

Anterior rami of C3 to C7

Elevate rib 1

Posterior Scalenes

Transverse processes of C4-C6 to rib 2

Anterior rami of C5 to C7

Elevate rib 2

Omohyoid

Superior border of scapula medial to suprascapular notch to body of hyoid lateral to sternohyoid

Anterior rami of C1 to C3 through the ansa cervicalis

Depresses and fixes hyoid bone

Sternothyroid

Posterior manubrium to oblique line on lamina of thyroid cartilage

Anterior rami of C1 to C3 through the ansa cervicalis

Draws larynx (thyroid cartilage) downward

Sternohyoid

Posterior sternoclavicular joint and adjacent manubrium to body of hyoid medial to omohyoid attachment

Anterior rami of C1 to C3 through the ansa cervicalis

Depresses hyoid after swallowing

Thyrohyoid

Oblique line on lamina of thyroid cartilage to greater horn and adjacent body of hyoid

Anterior rami fibers of C1 (carried along [XII])

Depresses hyoid bone, raises larynx when hyoid is fixed

Stylohyoid

Styloid process to lateral hyoid body

Facial Nerve [VII]

Pulls hyoid upward posterosuperiorly

Mylohyoid

Mylohyoid line on mandible to body of hyoid

Anterior: mylohyoid nerve from inferior alveolar branch of mandibular nerve [V3]


Support and elevate floor of mouth, elevate hyoid bone

Geniohyoid

Inferior mental spine on inner mandible to anterior body of hyoid

Branch from anterior ramus of C1 (carried along [XII])

Fixed mandible elevates and pulls hyoid forward; fixed hyoid pulls mandible downward and inward

Digastric

Anterior: digastric fossa on lower inside of mandible to shared tendon on hyoid body

Posterior: medial mastoid process to shared tendon



Anterior: mylohyoid nerve from inferior alveolar branch of mandibular nerve [V3]

Posterior: Facial Nerve [VII]



Anterior: opens mouth by lowering mandible, raises hyoid

Posterior: pulls hyoid upward and back



Rectus Capitis Anterior

Atlas to basilar part of occipital bone

Anterior rami of C1, C2

Flex Atlanto-occipital joint

Rectus Capitis Lateralis

Atlas to jugular process of occipital bone

Anterior rami of C1, C2

Lateral flexion to same side

Longus Colli

Transverse processes of C3-C5, bodies of C5-C7 and T1-T2 to atlas, transverse processes of C5 and C6, and bodies of C2-C4

Anterior rami of C2 to C6

Flex neck anteriorly and laterally, slight rotation to opposite side

Longus Capitis

Transverse processes of C3-C6 to basilar part of occipital bone

Anterior rami of C1 to C3

Flex head

Triangles of the Neck:

Triangle

Borders

Vessels and Nerves

Other Contents

Anterior Triangle

Anterior border of SCM (laterally), inferior border of mandible (superiorly), and midline of the neck (medially)

Common carotid arteries and their branches: the external and internal carotids

Internal jugular vein and its tributaries



Cranial Nerves [VII], [IX], [X], [XI], and [XII], Transverse Cervical Nerve (from cervical plexus), and upper and lower roots of the ansa cervicalis

Thyroid and parathyroid glands, cricoid cartilage, esophagus, trachea

Submandibular

Inferior border of mandible, anterior and posterior digastric bellies

[XII], mylohyoid nerve, facial artery and vein

Suprahyoid muscles, submandibular gland, submandibular lymph nodes

Submental

Hyoid, anterior digastric belly, and midline

Tributaries to anterior jugular vein

Suprahyoid muscles, submental lymph nodes

Muscular

Hyoid bone, superior omohyoid belly, anterior border of SCM, and midline




Infrahyoid muscles, thyroid and parathyroid glands, pharynx

Carotid

Superior omohyoid belly , stylohyoid, posterior digastric belly, and anterior border of SCM

Tributaries to common facial vein, cervical branch of [VII], common carotid artery, external and internal carotid arteries, superior thyroid a., ascending pharyngeal a., facial and lingual aa., occipital a., internal jugular vein, [X], [XI], [XII], superior and inferior roots of ansa cervicalis, and transverse cervical nerve




Posterior Triangle

SCM (anteriorly), trapezius (posteriorly), middle 1/3 clavicle (basally), occipital bone (apically)

External jugular vein, posterior external jugular vein, subclavian artery and vein, transverse cervical artery, suprascapular artery, [XI], branches of cervical plexus, brachial plexus

Inferior belly of omohyoid

Subclavian

SCM, omohyoid, clavicle

Subclavian branches, phrenic nerve

Anterior scalene

Major Arteries of the Neck:

http://www.rci.rutgers.edu/~uzwiak/anatphys/blood_vessels_files/image024.jpg

  • Subclavian: 3 parts

    • 1st Part: ascends to medial border of anterior scalene, gives off vertebral artery (enters transverse foramen of C6), thyrocervical trunk (gives rise to inferior thyroid, transverse cervical, and suprascapular arteries), internal thoracic artery, left costocervical trunk

    • 2nd Part: passes between anterior and middle scalene muscles, gives off right costocervical trunk (gives rise to deep cervical and supreme intercostal arteries)

    • 3rd Part: emerges from lateral border of anterior scalene and crosses base of posterior triangle to rib 1, becoming the axillary artery, gives off dorsal scapular artery



  • Common Carotid: the right one originates from brachiocephalic trunk while the left originates from the aortic arch, both pass through carotid sheaths to give off 2 terminal branches: internal and external carotid arteries. The carotid sinus (dilation at bifurcation) contains blood pressure receptors ([IX]). The carotid body contains oxygen receptors ([IX] and [X]).



  • Internal Carotid: ascends toward base of skull giving no branches in neck, and enters the carotid canal in the petrous part of the temporal bone. It supplies the cerebral hemispheres, eyes and contents of the orbits, and the forehead.

  • External Carotid: branches include (SomeAngryLadyFiguredOutPMS)

    • Superior Thyroid: thyrohyoid muscle, internal larynx, SCM and cricothyroid muscles, thyroid gland

    • Ascending Pharyngeal: pharyngeal constrictors and stylopharyngeus muscle, palate, tonsil, pharyngotympanic tube, meninges in posterior cranial fossa

    • Lingual: muscles of tongue, palatine tonsil, soft palate, epiglottis, floor of mouth, sublingual gland

    • Facial: all face strictures from inferior border of mandible to the masseter muscle to the medial corner of the eye, soft palate, palatine tonsil, pharyngotympanic tube, submandibular gland

    • Occipital: SCM muscle, meninges in posterior cranial fossa, mastoid cells, deep muscles of back, posterior scalp

    • Posterior Auricular: parotid gland and nearby muscles, external ear and scalp posterior to ear, middle and inner ear structures

    • Superficial Temporal: parotid gland and duct, masseter muscle, lateral face, anterior external ear, temporalis muscle, parietal and temporal fossae

    • Maxillary: external acoustic meatus, lateral and medial tympanic membrane, TMJ, dura mater of lateral wall of skull and inner table of cranial bones, trigeminal ganglion and dura in vicinity, mylohyoid muscle, mandibular teeth, skin on chin, temporalis muscle, outer table of skull bones in temporal fossa, infratemporal fossa structures, maxillary sinus, upper teeth and gingival, infra-orbital skin, palate, roof of pharynx, nasal cavity

Major Veins of the Neck:

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Superficial and Deep Drainage: all returns to the jugular system to enter subclavian veins



  • External Jugular Vein: passes within superficial fascia and is superficial to SCM, formed by:

    • Posterior external jugular vein

    • Transverse cervical vein

    • Suprascapular vein

    • Posterior auricular vein

    • Retromandibular vein (posterior division) : formed in parotid gland by

  • Anterior Jugular: connect to form jugular venous arch before entering subclavian veins

  • Internal Jugular Vein: Begins as a dilated continuation of the sigmoid sinus (dural venous sinus) and receives blood from the inferior petrosal sinus. It leaves the jugular foramen of the skull and descends in the carotid sheath, joining with the subclavian veins to form the brachiocephalic veins. Its tributaries include:

    • Inferior Petrosal Sinus

    • Facial

    • Lingual

    • Pharyngeal

    • Occipital

    • Superior Thyroid

    • Middle Thyroid

Nerves in the Anterior Triangle of the Neck:

http://www.becomehealthynow.com/images/organs/nervous/cut_nrvs_head_neck.gif

  • [VII] Facial: from stylomastoid foramen, innervates posterior belly of digastric, stylohyoid, and platysma

  • [IX] Glossopharyngeal: from jugular foramen, innervates stylopharyngeus, carotid sinus, and sensory for pharynx

  • [X] Vagus: from jugular foramen, enters carotid sheath, innervates pharynx (motor), carotid body, superior laryngeal nerve

  • [XI] Accessory: from jugular foramen, no branches in anterior triangle

  • [XII] Hypoglossal: from hypoglossal canal, supplies tongue, no branches in anterior triangle

  • Transverse Cervical nerve: branch of cervical plexus from C2 and C3 anterior rami, loops around SCM and supplies cutaneous area of anterior triangle

  • Ansa Cervicalis: loop of fibers from C1-C3 that innervate the “strap muscles” (infrahyoids). It begins as branches from C1 join [XII]. C1 makes up superior root while C2 and C3 make up the inferior root.

http://en.academic.ru/pictures/enwiki/71/gray795.png

Nerves in the Posterior Triangle of the Neck:

  • [XI] Accessory: from jugular foramen, innervates the trapezium and the SCM.

  • Cervical Plexus: Anterior rami of C2-C4 with muscular and cutaneous branches. The muscular branches include the phrenic nerve, the ansa cervicalis, and innervations to prevertebral and lateral vertebral muscles. Cutaneous branches include:

    • Transverse cervical nerve: lateral and anterior neck

    • Lesser occipital nerve: neck and scalp posterior to the ear

    • Great auricular nerve: skin of parotid area, ear, and mastoid process

    • Supraclavicular nerves: skin of clavicle and shoulder down to rib 2

  • Brachial Plexus: C5-T1

Sympathetic Trunk:

  • Cervical part of sympathetic trunk lies anterior to longus colli and capitis muscles and posterior to common carotid artery and is connected to each cervical nerve by a gray ramus communicans. Three ganglia are associated with the cervical aspect of the sympathetic trunk:

    • Superior Cervical Ganglion: located between C1 and C2 vertebrae, its branches go to internal and external carotid arteries, C1-C4, pharynx, and to the heart as superior cardiac nerves

    • Middle Cervical Ganglion: located at vertebra C6, its branches go to C5-C6 and to the heart as middle cardiac nerves

    • Inferior Cervical Ganglion (Stellate Ganglion): located at vertebra C7, its branches go to C7-T1, vertebral artery, and to the heart as inferior cardiac nerves

Lymphatics of the Neck:

  • Thoracic Duct: empties into the junction of the left internal jugular and left subclavian veins. It is joined by the left jugular trunk, left subclavian trunk, and the left bronchomediastinal trunk

  • On the right the right jugular trunk, right subclavian trunk, and the right bronchomediastinal trunk empty into the junction of the right internal jugular and right subclavian veins

  • Superficial Lymph Nodes: drain face and scalp, follow patterns of arterial system in this area

    • Occipital Nodes: associated with occipital artery, drain posterior scalp and neck

    • Mastoid Nodes: associated with posterior auricular artery, drain posterolateral scalp

    • Pre-auricular and Parotid Nodes: associated with superficial temporal and transverse facial arteries, drain anterior auricle, Anterolateral scalp, upper half of face, the eyelids, and the cheeks

    • Submandibular Nodes: associated with facial artery, drain forehead, gingivae, teeth, and tongue

    • Submental Nodes: drain center part of lower lip, chin, floor of mouth, tip of tongue, and lower incisor teeth

  • Superficial Cervical Lymph Nodes: located along external jugular vein on the surface of the SCM, drain occipital and mastoid nodes

  • Deep Cervical Lymph Nodes: located along internal jugular vein, divided into upper and lower groups based on the intermediate tendon of the omohyoid muscle, receive all lymph drainage from the head and nearby lymph vessels form the jugular trunks

    • Jugulodigastric Node: drains tonsils

    • Jugulo-omohyoid Node: drains tongue

Thyroid and Parathyroid Glands:

  • Thyroid: anterior in the neck and lateral to thyroid cartilage, made up of 2 lateral lobes, 2 pyramidal lobes that touch the hyoid, and a central isthmus (2nd and 3rd tracheal cartilages), surrounded by pretracheal fascia.

    • Supplied by the superior thyroid artery (external carotid) which divides into anterior and posterior glandular branches and the inferior thyroid artery (thyrocervical trunk) which divides into inferior and ascending branches.

    • Drained by the superior thyroid vein (internal jugular), middle thyroid vein (internal jugular), and inferior thyroid vein (brachiocephalic)

    • Lymph drains to paratracheal and deep cervical nodes

    • The recurrent laryngeal nerves run closely along the posterolateral aspects of the thyroid gland

  • Parathyroid: 4 small, ovoid glands located on the posterior surface of the lateral lobes of the thyroid gland, designated as superior and inferior.

    • Supplied by inferior thyroid arteries and the venous and lymphatic drainage follows that of the thyroid gland

Directory: Anatomy%20Course -> Folder%20-%208%20-%20Head%20and%20Neck
Folder%20-%208%20-%20Head%20and%20Neck -> The Cranial Nerves
Folder%20-%208%20-%20Head%20and%20Neck -> The Skull Cranium: Anterior View
Folder%20-%208%20-%20Head%20and%20Neck -> The Face Muscles of the Face
Folder%20-%208%20-%20Head%20and%20Neck -> Gross Anatomy 2008 Triangles and Associated Structures of the Neck- part 1
Folder%20-%208%20-%20Head%20and%20Neck -> Objectives for the Head (Chapter 8) Gray’s Anatomy for Students
Folder%20-%208%20-%20Head%20and%20Neck -> What is the function of arachnoid granulations? Where are they located? Arachnoid granulations
Folder%20-%208%20-%20Head%20and%20Neck -> Neck Forum – 2011 Injury to sympathetic chain in the neck…syndrome? Sx…anatomical rationale for Sx?
Folder%20-%208%20-%20Head%20and%20Neck -> Objectives for the Neck (Chapter 8) Gray’s Anatomy for Students
Folder%20-%208%20-%20Head%20and%20Neck -> Triangle Borders Vessels and Nerves
Folder%20-%208%20-%20Head%20and%20Neck -> The Neck Bones, Ligaments, and Joints: Bones


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