24 1 2 3 4 5 6 7 8 9 10 11 11 12 13 14 15 16 17 18 19 20 21 22 23 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 43 44 45 46 18 16 1 Accessory nerve 2 Anterior longitudinal ligament 3 Ascending cervical vessels 4 Ascending pharyngeal artery 5 Brachiocephalic trunk 6 Glossopharyngeal nerve 7 Inferior thyroid artery 8 Inferior vagal ganglion 9 Internal carotid artery 10 Internal carotid nerve (sympathetic) 11 Internal jugular vein 12 Internal thoracic artery 13 Jugular lymphatic trunk 14 Left brachiocephalic vein 15 Left common carotid artery 16 Left subclavian artery 17 Levator scapulae 18 Longus capitis 19 Longus colli 20 Mastoid process 21 Meningeal branch of ascending pharyngeal artery 22 Middle cervical ganglion 23 Occipital artery 24 Oesophageal branch (large) of the inferior thyroid artery 25 Oesophagus 26 Phrenic nerve 27 Posterior belly of digastric 28 Recurrent laryngeal nerve 29 Scalenus anterior 30 Scalenus medius 31 Spine of sphenoid bone 32 Sternocleidomastoid 33 Subclavian vein 34 Superficial cervical artery 35 Superior cervical ganglion 36 Suprascapular artery 37 Sympathetic trunk 38 Thoracic duct 39 Thyrocervical trunk 40 Trachea 41 Tympanic part of temporal bone 42 Upper trunk of brachial plexus 43 Vagus nerve 44 Ventral ramus of third cervical nerve 45 Vertebral artery 46 Vertebral vein Cervical sympathectomy, see p. 89. 47 Root of the neck 3 4 10 6 3 4 10 6 5 13 7 1 11 14 9 8 12 3 4 10 14 9 12 2 A B C Dissection of puncture of the right internal jugular vein between the two heads of sternocleidomastoid, with the needle directed backwards and slightly laterally. Dissection of puncture of the right internal jugular vein at the posterior border of sternocleidomastoid, with the needle directed towards the jugular notch of the sternum. Dissection of puncture of the right brachiocephalic vein, with the needle directed towards the sternal angle. A B C 1 Brachial plexus 2 Brachiocephalic vein 3 Clavicle 4 Clavicular head of sternocleidomastoid 5 External jugular vein 6 Internal jugular vein 7 Omohyoid 8 Phrenic nerve 9 Scalenus anterior 10 Sternal head of sternocleidomastoid 11 Subclavian artery 12 Subclavian vein 13 Superficial cervical artery 14 Suprascapular artery 2 6 6 4 7 1 3 9 5 8 1 1 2 3 3 B A C D Dissection of infraclavicular puncture of the subclavian vein, from below the midpoint of the clavicle on a line directed to just above the jugular notch. Part of pectoralis major is detached from the clavicle and the clavipectoral fascia divided to show the subclavian vein deep to it and passing under cover of the clavicle. 1 Cephalic vein 2 Clavicle 3 Clavipectoral fascia 4 Deltoid 5 Lateral pectoral nerve 6 Pectoralis major 7 Pectoralis minor 8 Subclavian vein 9 Thoraco-acromial vessels Root of neck surface anatomy. A, B, C and D are the puncture sites as shown above. 1 Clavicle 2 Sternum 3 Sternocleidomastoid Root of the neck D D E E Internal jugular vein catheterization, subclavian vein catheterization, see pp 90, 91.