DE VERA, ANGELICA JOY T.

1B, Table 1
DR. DE JESUS July 5, 2012

SDG 3
Posterior Triangle of the Neck

1. Identify with illustration the boundaries of the posterior triangle and its
subdivisions.




















Bound by:
o The posterior margin of the sternocleidomastoid, the anterior margin of
the trapezious muscle, and the superior margin of the clavicle
Divided into:
o Bigger occipital triangle
o Smaller supraclavicular (subclavian) triangle by the inferior belly of the
omohyoid muscle

2. Describe the contents of the subclavian and occipital triangles.
Occipital Triangle
o Includes:
semispinalis capitis, splenius capitis, levator scapulae, and
scalenous medius
Subclavian triangle
o Includes:
scalenus anterior

3. Discuss the muscles of the posterior triangle.

Muscle Origin Insertion Action Neurovascular
Supply
Inferior belly
of the
Omohyoid
Upper margin of
the scapula and
suprascapular
ligament
Intermediate
tendon
Depresses
the hyoid
bone
Ansa cervicalis;
C1, 2, and 3
Scalenus
Anterior

Transverse
process of the
third, fourth, fifth
First rib
Elevates the
first rib;
laterally
flexes and
C4, 5, and 6
and sixth
cervical
vertebrae to the
first rib
rotates
cervical part
of vertebral
column
Scalenus
Medius

Transverse
process of the
sixth cervical
vertebra
First rib
Elevates first
rib; laterally
flexes and
rotates
cervical part
of vertebral
column
Anteriro rami of
cervical nerves
Scalenus
Posterior

Transverse
process of the
lower cervical
vertebrae
Second rib
Elevates
second rib;
laterally
flexes and
rotates
cervical part
of vertebral
column
Anterior rami of
cervical nerves


Splenius
capitis

Lower portion of
ligamentum
nuchae and
spinous
processes of
C3-T3(4)


Superior
nuchal line
And mastoid
process of
temporal
bone


Bilateral
contraction:
extend head
& neck;
unilateral
contraction:
rotate and
laterally bend
head & neck
to the
contracted
(same) side


Blood: muscular
branches of the
aorta

Nerve: dorsal
rami of spinal
nerves

Semispinalis
capitis
transverse
processes
upper T
vertebrae
occipital bone extension of
vertebral
column (C1-
T12),
contralateral
rotation
primary dorsal
rami
Levator
scapulae
transverse
processes of
C1-C3 or C4
superior
angle of
scapula
toward the
scapular
spine
elevates the
scapula and
extends
and/or
laterally
flexes the
head

Blood: transverse
cervical artery

Nerve:
nerves of cervical
plexus, C3,4;
dorsal scapular
nerve, C5











4. Illustrate the cervical plexus, its formation, branches, and areas of distribution.






















Formed by
o The anterior rami of the first four cervical nerves.
Rami are joined by the connecting branches, which form loops that
lie in front of the origins of the levator scapulae and the scalenus
medius muscles
The plexus is covered in front by the prevertebral layer of deep cervical fascia
The cervical plexus supplies the skin and the muscles of the head, the neck and
the shoulders
Includes cutaneous branches, muscular branches to the neck muscles, and
muscular branches to the diaphragm.

5. Illustrate the formation of the brachial plexus, its branches found in the neck
including their positions and relationships to other structures.



Formed by
o The union of the anterior rami of the fifth, sixth, seventh, and eighth
cervical and the first thoracic spinal nerves.
Divided into roots, trunks, divisions, and cords
o Roots of C5 and 6 unite to form the upper trunk
o Root of C7 continues as the middle trunk
o Root of C8 and T1 unite to form the lower trunk
o Each trunk then divides into anterior and posterior divisions
Anterior divisions of the upper and middle trunks unite to form the
lateral cord
Anterior division of the lower trunk continues a the medial cord
Posterior divisions of all three trunks join to form the posterior cord
Roots of the brachial plexus enter the base of the neck between the scalenus
anterior and the scalenus medius muscles.
The trunk and divisions cross the posterior triangle of the neck and the cords
become arranged around the axiallaryartery
Branches
o Dorsal scapular nerve, long thoracic nerve, suprascapular nerve, lateral
pectoral nerve, musculocutaneous nerve, lateral root of median nerve,
upper subscapular nerve, thoracodorsal nerve, lower subscapular nerve,
axillary nerve, radial nerve, middle pectoral nerve, medial cutaneous nerve
of the arm, medial cutaneous nerve of the forearm, ulnar nerve, medial
root of median nerve
6. Trace the course of the spinal accessory nerve in the neck.































Cranial root emerges from the anterior surface of the medulla oblongata between the
olive and the inferior cerebellar peduncle
o Nerve runs laterally in the posterior cranial fossa and joins the spinal root
Spinal root arises from the nerve cells in the anterior gray column of the upper five
segments of the cervical part of the spinal cord
o Nerve ascends alongside the spinal cord and enters the skull through the
foramen magnum then turns laterally to join the cranial root
The two roots unite and leave the skull through the jugular foramen
o The roots then separate:
Cranial root joins the vagus nerves and is distributed in its branches to
the muscles of the soft palate and pharynx to the muscles of the larynx
Spinal root runs downward laterally and enters the deep surface of the
sternocleidomastoid muscle, which it supplies, then crosses the
posterior triangle of the neck to supply the trapezius muscle

7. Compare the origin, commencement, course, branches, and termination of the
subclavian artery on each side

Right subclavian artery
o Arises from the brachiocephalic artery, behind the right spernoclavicular joint
o It arches upward and laterally over the pleura and between the scalenous
anterior and medius muscles.
o At the outer border of the first rib, it becomes the axillary artery.
Left subclavian artery:
o Arises from the arch of the aorta in the thorax.
o It ascends to the root of the neck and then arches laterally in a manner similar
to that of the right subclavian artery.
o The scalenus anterior muscle passes anterior to the artery on each side and
divides into three parts
PART BRANCHES COURSE
FIRST PART
From its origin to the medial
boarder of the scalenus
anterior
Vertebral artery Runs cranially in
the transverse foramina of
the cervical vertebrae, joins
the vertebral artery on the
contralateral side, forming
the basilar artery and joins
the circle of Willis.

Internal thoracic artery Runs caudally behind the
ribs, giving off anterior
intercostal branches,
perforating vessels to
the breast and terminating
in the superior epigastric
artery and the
musculophrenic artery

Thyrocervical trunk Very short. Divides
into inferior thyroid
artery, suprascapular
artery and transverse
cervical artery

SECOND PART
Lying behind scalenus
anterior
Costocervical trunk

Splits into highest
intercostal artery and deep
cervical artery
THIRD PART
Between the lateral border
of scalenus anterior and the
outer border of the first rib

Dorsal scapular artery

From either second or third
part. Passes backwards to
supply levator scapulae and
rhomboids.


8. Describe the formation of the subclavian vein, course, commencement,
termination and tributaries.





Subclavian vein
o Continuation of the axillary vein and begins at the lateral boarder of rib 1
o As it crosses the base of the posterior triangle, the external jugular, and
possibly the suprascapular and transverse cervical veins enter it
o It ends by joining with the internal jugular vein to form the brachiochephalic
vein near the sternoclavicular joint
o In the posterior triangle, it is anterior to and slightly lower than, the subclavian
artery and passes anterior to the anterior scalene muscle

9. Discuss the scalene muscles and explain why it is the key muscles in the area.
Scalene muscle
o Key muscle in understanding the root of the neck
o It is deeply placed and it descends vertically from the vertebral column to the
first rib
Anteriorly
o Related to the carotid arteries, the vagus nerve, the internal jugular vein,
and the deep cervical lymph nodes
o The transverse cervical and suprascapular arteries and the prevertebral
layer of deep cervical fascia bind the phrenic nerve to the muscle
Posteriorly
o Related to the pleura, the origin of the brachial plexus, and the second
part of the subclavian artery
Medially
o Related to the vertebral artery and vein and the sympathetic trunk
10. Illustrate the superficial and deep cervical lymph nodes and explain their
significance.


























The enlargement of superficial cervical lymph nodes may be caused by inflammation
or neoplasia in the area drained by the nodes. The superficial cervical lymph nodes
are primary drainage locations for lymph from adjacent areas or organs.
Deep lymph nodes in the neck consist of collecting nodes. They have major clinical
importance as potential sites of metastasis from head and neck tumors.

11. Discuss the cervical sympathetic trunk and ganglia.

The cervical portion of the sympathetic trunk consists of three ganglia, distinguished,
according to their positions, as the superior, middle, and inferior ganglia, connected
by intervening cords. This portion receives no white rami communicantes from the
cervical spinal nerves; its spinal fibers are derived from the white rami of the upper
thoracic nerves, and enter the corresponding thoracic ganglia of the sympathetic trunk,
through which they ascend into the neck.
Superior cervical ganglion (ganglion cervicale superius)
o Largest
o Opposite the second and third cervical vertebr
o It is of a reddish gray color, and usually fusiform in shape; sometimes broad
and flattened, and occasionally constricted at intervals; it is believed to be
formed by the coalescence of four ganglia, corresponding to the upper four
cervical nerves
o It is in relation, in front, with the sheath of the internal carotid artery and
internal jugular vein; behind, with the Longus capitis muscle
Middle cervical ganglion (ganglion cervicale medium)
o Smallest of the three cervical ganglia
o Opposite the sixth cervical vertebra, usually in front of, or close to, the inferior
thyroid artery
o Formed by the coalescence of two ganglia corresponding to the fifth and sixth
cervical nerves
o Sends gray rami communicantes to the fifth and sixth cervical nerves, and
gives off the middle cardiac nerve
Inferior cervical ganglion (ganglion cervicale inferius)
o Between the base of the transverse process of the last cervical vertebra and
the neck of the first rib, on the medial side of the costocervical artery
o Its form is irregular; it is larger in size than the preceding, and is frequently
fused with the first thoracic ganglion.
o Formed by the coalescence of two ganglia which correspond to the seventh
and eighth cervical nerves.
o It is connected to the middle cervical ganglion by two or more cords, one of
which forms a loop (ansa subclavia)
o Sends gray rami communicantes to the seventh and eighth cervical nerves
o It gives off the inferior cardiac nerve, and offsets to blood vessels