Anatomy III: Blood and the Cardiovascular and Respiratory Systems

Terminology and Macroscopic Anatomy of Neck and Thoracic Cavity

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Anatomy III: Blood and the
Cardiovascular and Respiratory
Systems
Dr. José Luis Monroy Antón
6 CM
Lesson 1
Terminology and macroscopic
anatomy of neck and thoracic cavity

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2Neck
. Part of the body between the base of the cranium
and the clavicles
· The neck joins the head to the trunk, so the
structures between them have to pass through it:
nerves, vessels, lymphatic trunks ...
· But the neck is not a simply link ... it also have
very important and unique organs: larynx, thyroid
or parathyroid
· The muscles are much more powerful in the
posterior part than the anterior, due to the weight
of the cranium

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Neck
· Neck is very thin and has to be very
flexible to allow the sensory organs
achieve almost all the angles: sight, smell,
hearing ...
· A restriction of neck movements limits the
perception of the senses
- Example: The Klippel-Feil syndrome
involves the fusion of some cervical
vertebrae, limiting severely the
movement of the neck
SCM
3

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4Neck
Due to the thinness of the neck:
· All the structures must be packed in a very
reduced space
· The neck should bear an inadequate bone
protection, making it very vulnerable
· Carotid arteries and jugular veins are
anterolateral structures that are usually
injured in the neck wounds, putting in
serious risk the live of the patient
Some animals can turn the neck
in angles impossible for humans

Bones of the Neck

Cervical Vertebrae

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Bones of the neck
Cervical vertebrae
· Segmented axial skeleton that
provides flexibility thanks to the
intervertebral joints
· The uppermost joint (crania-
vertebral) is the most flexible
· The vertebrae provide
protection for the spinal cord
and the vertebral arteries, but
they are unable to protect the
other structures of the neck
Mastoid process
Styloid process
Stylohyoid ligament
Angle of mandible
Hyoid bone
Thyroid cartilage
Mandible
Trachea
Clavicle
Manubrium
of sternum

Hyoid Bone

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6Bones of the neck
Hyoid bone
. The only isolated bone of the skeleton. It is suspended between the mandible
(superiorly) and the sternal manubrium (inferiorly)
. This bone is important for the attachment of the tongue and the pharynx, and
allows its permanent opening
Greater horn
Lesser horn
Lesser
horn
Geniohyoid
Fibrocartilage
Omohyoid
Body
Mylohyoid
Sternohyoid

Cervical Fascia

Superficial Cervical Fascia

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Cervical fascia
· The fascial layers and
compartments are a path for the
spread of cancer and infections
· We have a superficial and a
deep cervical fascia
· Superficial cervical fascia:
very thin in the neck. It contains
a muscle that is very useful for
facial expression: platysma
Platysma
Mentalis
Depressor labii
inferioris
Depressor anguli oris
Platysma
Branches of transverse
cervical nerve (C2 and C3)
Clavicle deep
to platysma
Supraclavicular nerves
(C3 and C4)
Deep fascia
Copyright @ 2014 Walter Kvar Health | Lippincott Williams & Wilkins
Middle pharyngeal
constrictor
Hyoglossus
Greater
horn
Chondro-
glossus
Stylohyoid
Genio-
glossus
Thyrohyoid
Body of hyoid bone
7

Deep Cervical Fascia

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8Cervical fascia
Nuchal ligament
Vertebral arch of
cervical vertebra
Trapezius
*Buccopharyngeal fascia is a component of
the pretracheal layer
Middle scalene
Deep lymph
node
Retropharyngeal
space
Anterior scalene
Skin
Longus colli
Carotid sheath
Alar fascia
C7
Vagus nerve
Omohyoid
Internal jugular vein
Sternocleido-
mastoid (SCM)
Common carotid artery
Esophagus
Sternothyroid
Platysma
Sternohyoid
Thyroid gland
Trachea

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Cervical fascia
Deep cervical fascia:
. It contains the muscles and
viscera in compartments and
allow them to slide over each
other
. It serves as a path for the
nerves and vessels
· Layers:
- Investing layer
- Pretracheal layer
- Prevertebral layer
- Carotid sheaths: they
contain the internal
jugular vein, carotid
artery, vagus nerve
Nuchal ligament
Vertebral arch of
cervical vertebra
Trapezius
Middle scalene
Deep lymph
node
Retropharyngeal
space
Anterior scalene
Skin
Longus colli
Carotid sheath
Alar fascia
C7
Vagus nerve
Omohyoid
Internal jugular vein
Sternocleido-
mastoid (SCM)
Common carotid artery
Esophagus
Sternothyroid
Platysma
Sternohyoid
Anterior
Thyroid gland
Trachea
Check the carotid sheaths highlighted
Fascial layers:
-
Subcutaneous tissue of neck
(superficial cervical fascia)
Layers of deep cervical fascia
Investing layer
Pretracheal layer *
Prevertebral layer
-
Alar fascia and carotid sheath

Investing Layer

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10Investing layer:
Nuchal ligament
Vertebral arch of
cervical vertebra
Trapezius
Middle scalene
Deep lymph
node
Retropharyngeal
space
Anterior scalene
Skin
Longus colli
Carotid sheath
Alar fascia
C7
-Vagus nerve
Omohyoid
Internal jugular vein
Sternocleido-
mastoid (SCM)
Common carotid artery
Esophagus
Sternothyroid
Platysma
Sternohyoid
Anterior
Thyroid gland
Trachea

Pretracheal Layer

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Pretracheal layer:
.
It surrounds the cervical viscera, the suprahyoid and
infrahyoid muscles
Nuchal ligament
. It is anterior to retropharyngeal space
Vertebral arch of
. It allows to maintain the negative pressure of the thorax
cervical vertebra
Trapezius
Middle scalene
Deep lymph
node
Retropharyngeal
space
Anterior scalene
Skin
Longus colli
Carotid sheath
Alar fascia
C7
Vagus nerve
Omohyoid
Internal jugular vein
Sternocleido-
mastoid (SCM)
Common carotid artery
Esophagus
Sternothyroid
Platysma
Sternohyoid
Anterior
Thyroid gland
Trachea

Prevertebral Layer

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· Most superficial layer of the deep
fascia
. It goes from the cranium to the
pectoral muscle
It contains the trapezius and SCMPrevertebral layer:
Nuchal ligament
. It is posterior to retropharyngeal space
Trapezius
Middle scalene
Deep lymph
node
Retropharyngeal
space
Anterior scalene
Skin
Longus colli
Carotid sheath
Alar fascia
C7
Vagus nerve
Omohyoid
-
Internal jugular vein
Sternocleido-
Common carotid artery
mastoid (SCM)
Esophagus
Sternothyroid
Platysma
Sternohyoid
Anterior
Thyroid gland
Trachea

Cervical Region: Superficial Structures

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Cervical region: superficial structures
· Sternocleidomastoideopezius:
same embryological origin, so they are
innervated by the same nerve: XI spinal
- Both closed by the investing layer of deep
cervical fascia
- SCM: movements of the head and neck
- Trapezius: movements of the scapula
· Lateral cervical region: in some books is
called posterior cervical triangle. It is delimited
by both muscles and clavicle. Its floor is
constituted by the deep cervical muscles
- Here we can find the external jugular vein
and the XI spinal nerve
Trapezius
Sternocleidomastoid
Clavicle

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. It surrounds the vertebrae and their muscles
Vertebral arch of
cervical vertebraCervical region: superficial structures
Posterior
belly
Digastric
Anterior
belly
Mandible
Sternocleidomastoid
Submandibular
(digastric) triangle
Superior belly of omohyoid
Submental triangle
Sternohyoid
Carotid triangle
Trapezius
Spinal accessory
nerve (CN XI)
Muscular (omotracheal)
triangle
Inferior belly of omohyoid
Occipital triangle
Omoclavicular (subclavian)
triangle

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Cervical region: superficial structures
Trapezius
Middle scalene
Sternocleidomastoid
Levator scapulae
Anterior ramus C5
C5 and C3/4 roots of phrenic nerve
Branches of anterior
ramus C5
Anterior ramus C6
Posterior scalene
Anterior scalene
Dorsal scapular
artery
Cervicodorsal trunk
Branch of anterior
ramus C6
External jugular vein
Serratus anterior
Anterior ramus C8
Suprascapular nerve
Brachiocephalic vein
Brachial plexus
Subclavian artery
Clavicle
Suprascapular
Subclavian vein
Deltoid
Subclavius
Trunks of brachial plexus
Axillary artery
Axillary vein
Lateral pectoral nerve
Pectoralis minor
Right anterolateral view
Copyright @ 2014 Walter Kluwer Health | Lippincott Williams & Wilkins

Omoclavicular or Supraclavicular or Subclavian Triangle

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Omoclavicular or
Supraclavicular or
Subclavian triangle:
.
Clavicle
· SCM
· Omohyoid
Content:
.
Subclavian artery
· Subclavian vein (not
always)
· Brachial plexus,
between the anterior
and middle scalene
The phrenic nerve is
anterior to the muscles
16
Anterior ramus C7
Internal jugular vein
Artery
Vein
Pectoralis major
(sternal head)Cervical region: superficial structures
Cervical plexus: superior to the brachial. Its branches arise from the posterior border of
SCM and go to the scalp, anterior neck and shoulder
Great auricular nerve
Spinal accessory nerve
(CN XI)
- Hypoglossal nerve (CN XII)
Lesser occipital nerve
Geniohyoid muscle
C1
C2
Nerve point of neck
Anterior rami
forming roots of
cervical plexus
C3
C4
Thyrohyoid muscle
Innervation:
C5
Transverse cervical nerve
Loops between
adjacent anterior
rami of spinal
nerves C1-C5
Sensory branches
Omohyoid muscle
-
Motor branches
Supraclavicular
nerves
Phrenic nerve
Sternohyoid muscle
Clavicle
Sternothyroid muscle

Anterior Cervical Region

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Cervical region: superficial structures
Anterior cervical region:
below the body of the
mandible, from the SCM to the
middle line. Here we can find:
· The submandibular
salivary gland
· Submandibular lymph
nodes
· Facial artery
. Common carotid artery
dividing into internal and
external carotid
· Internal jugular vein
Great auricular nerve
Facial vein
Spinal accessory nerve
(CN XI)
Facial artery
Sternocleidomastoid
branch of occipital artery
Facial nerve,
marginal
mandibular
branch
Superior deep
cervical lymph nodes
Submandibular lymph nodes
Retromandibular vein
Submandibular gland
"Common" facial vein
Thyrohyoid
Sternohyoid
Internal jugular vein
Superior thyroid vein
Superior root
Inferior root
of ansa cervicalis
SCM
Sternocleidomastoide
of superior thyroid artery
Omohyoid

Deep Structures in the Neck

Prevertebral Muscles: Anterior Vertebral Muscles

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Ansa cervicalis
Cranial nerves
(CN XI & XII)
Digastric, anterior bellyDeep structures
in the neck
Prevertebral muscles:
· Anterior vertebral
muscles: the most
important is the longus
capitis.
· From occipital bone to
transverse processes
of cervical vertebrae
. It initiates the anterior
flexion movement of
the neck against
resistance
. This movement will be
continued by the strong
SCM
Rectus capitis lateralis
Rectus capitis
anterior
Longus capitis
Middle scalene
Middle scalene
Posterior scalene
Posterior scalene
Anterior scalene
Longus colli

Prevertebral Muscles: Lateral Vertebral Muscles

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Deep structures
in the neck
Prevertebral muscles:
· Lateral vertebral
muscles: the most
important are the
scalene muscles
· They go from the
cervical vertebrae to
the two first ribs
· They produce
movements of lateral
flexion and rotation of
the neck
· They can also elevate
the ribs during
inspiration
Rectus capitis lateralis
Rectus capitis
anterior
Longus capitis
Middle scalene
Middle scalene
Posterior scalene
Posterior scalene
Anterior scalene
Longus colli
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