In previous lecture, we talk about the skeleton of neck, we have 7 cervical .

vertebra In addition to them , we have bone in midline ( specialy in the root of (neck We called Hyoid Bone which part of axial skeleton( not aperpendicular)which Border of mandible , U in shaped located at lower . :It has two main extension We refer to larger extension as greater horn, smaller one as lesser horns , these extension (elevation)to allow ligament & muscular attachment, so hyoid bone its auniqe ,if we look to it doesnot make any articulation with other bone , instead of that its suspended in position by ligament & muscular attachment :So it has three part

Body greater horns 2 lesser horns 2 Note : its form abase of tongu because the largest muscle of the tongu called hyglossus .Which extend from hyoid bone toward the tongu

14 Page 1 of

The muscular attachment of hyoid bone consider importane because these muscle suspended by hyoid bone, So we will go back to it after .we study the muscle in next lecture to easier distinguish them So we finished hard tissue part in head and neck which include skull ,cervical vertebra and hyoid bone So we start with soft tissue compartment specially in the neck down then .we will move up to head when speak about soft tissue in the neck , first to know where is the** ??area of the neck

:The neck latin word that mean columns according shaps and called .cervical region in anatomical book :So the neck is the region of body that extend btw

(Sup:* inf .border of mandible(ant Sup nuchle line (post) which promenint * .line at occipital region
14 Page 2 of

(Inf:* sprasternal notch(jugular notch .clavicle *

:The neck divided into 2 part post .aspect of the neck: covered by large muscle called-1
trapezius muscle which we have be taken previously and .(classified as part of the back(not part of head and neck anterolateral aspect : there is another important muscle -2 which extend from the sternum & clavical all the way up mastoid prosses( behind ears) we called .sternocleiodomastoid muscle **:(Sternocleiodomastoid muscle(SCM sterno : origin from sternum cleiodo: origin from medial third of clavical mastoid: inserted up of mastoid prosses Sternocleiodomastoid muscle(SCM) divided anterolateral aspect :of neck into two triangle Area which resemble inverted triangle ant to * Sternocleiodomastoid muscle(SCM) called anterior triangle of neck Area post (behind) Sternocleiodomastoid * muscle(SCM)which represent other triangle later aspect of the neck called post triangle of neck :So we have two reference muscle to determin where you are in (Sternocleiodomastoid muscle(SCM -1 trapezius muscle -2

:Fascial coverings of the neck (skin(black line-(Superficial layer is the fatty layer (yellowish area -Muscle(green area) Deep muscle fasci
- Muscle *(Along these structures will find the vans( vein ,artery ,nerve*

14 Page 3 of

:: We have several structures within the superficial layer

i. Platysma m :is a greek word mean: flat muscular sheet, these

muscle represent by bundles (vesicles) of muscle fibers which represent when depressed your angle of mouth and elevate fascia .above pectoralis muscle

14 Page 4 of

f muscle located in the face providing experission by move the skin( not move the bone) like in the smile ,sa So Platysma one of the muscle in the fascial exp : From the book

:Attachment of Platysma m .sup inf. border of mandible & angles of mouth Inf delto-pectoral fascia (deep fascia over pectoralis major (.& deltoid m

:CUTANEOUS NERVES Superficia fascia * CUTANEOUS .N: is nerve going to skin to provide (sensation(doesly Superficia In previous term , we said artery always in the deep fascia,but in upper limp we have Superficia vein as(cephalic and basilica vein)and deep vein as(ulnar ,radial,brachial vein),in lower limb we called saphenous vein Now ,Most vein in the neck called jugular vein(mean the vein in the neck speacilly in cervical region so its depend in theres :location If the vein located in Superficial layer called external jugular** ( vein( which the most important vein **If the vein located in deep fascia called internal jugular vein
14 Page 5 of

If the vein located in ant .part of the neck called ant jugular vein ** :CUTANEOUS NERVES When we study the CUTANEOUS NERVES we have cranial .n that arise from the brain and 12 in number , also we have spinal .n that arise from spinal cord 31 in number as part of them brachial .(plexus(C5,C6,C7 Spinal.n leave intervertebra foreaman(go out verterbra column ) to .distribut in the body :(We divided it into 2 branchs (ramus smaller branch go post to the trunk to provide (motor-1 innervation) to the back of body called post ramus larger branch go ant-lateral of the trunk called ant ramus-2

#:So, the sensation to post aspect of the neck come from Post ramus of C2,C3,C4,C5*greater occipital n. that arise from. dorsal ramus of C2 *the sensation to ant-lateral aspect of the #:neck come from Ant ramus of C2,C3,C4* -

utaneous( sensation) nerve branchs?? because the first cervical neck is solitary motor ( just muscular), so

So these nerves when they leave make which we called cervical plexus to give 4 nerve (we must know there origin :(and sensition Lesser occipital n. ant. ramus of C2 , give sensation to-1 (area(skin) behind auricular(in the external ear
14 Page 6 of

Great auricular n. ant. rami C2 & C3.-2 -:Innervates(sensation)?? 3 regions . (Inf. aspect of auricle lobule (fat bag Skin over parotid gland Angle of mandible (so providing sensation to a (!!region in the face Be careful: great( not greater) because no lesser auricular n, but .we have Lesser occipital n because there is greater occipital n Q: Which of the following the spinal orgin of Great auricular ??n a-post rami of C2,C3 b- ant rami C2 c-ant rami C3,C4 d- non of the above :parotid gland is.the** largest salivary gland in the body which located btw ramus of mandible and (Answer: d (ant rami C2,C3 Transverse cutaneous(or cervical) n. ant. -3 rami C2 & C3 .Innervates?? skin over ant. of the neck (from the lower border of the (mandible to the sternum Supraclavicular n. ant. rami C3 & C4. , -4 Divided into 3 branch(med ,intermediate, lat) ??Innervates Skin over the clavicle all the way down to sternal angle of manubrium (second (rib

Skin over upper 1/2 of the shoulder,deltoid muscle .all Skin in the lower 1/2 of the post. Pay attention: the 4 main cutaneous.n arise post to** (the midpoint of Sternocleiodomastoid muscle (SCM

14 Page 7 of

(EXTERNAL JUGULAR VEIN (EJV Formed opposite to the angle of the mandible & ends at the .middle 1/3 of the clavicle ??Formed by which veins post. Auricular .v: against mandible angle post. division of retromandibular v. ( retromandibular v. at the angle of mandible goes to form EJV ends at the .middle 1/3 of the clavicle EJV) Pass superficial to SCM then extend to deep fasci) :::Drains into subclavian v -1 internal jugular v -2

14 Page 8 of

:LYMPH NODES * Accompany to EJV & for this ,we called superficial .L.N Q- lymph nodes in the cervical region that related to EJV ???are called .Superficial cervical L.N Accompany to IJV& for this we called deep fasci L.N Q- lymph nodes in the cervical region that related to IJV ???are called deep fascia L.N .L.N in upper 1/2of the neck along EJV called sup. superficial L.NL.N in lower 1/2of the neck along IJV called inf . deep fascia L.N :SCM use as reference to external- deep fascia ***

So any thing external to SCM called superficial and any thing deep to SCM called deep fascia
:SCM use as reference to external-internal-1
14 Page 9 of

ant-post -2

DEEP cervical FASCIA

:It's four parts *** Investing layer: all around the neck , Contains 2 muscle . which-1 (are?? SCM( at ant-lateral angle of the neck) & trapezius (post (Also Cover 2 salivary glands (parotid & submandibular Note: Thickening part from styloid process (part of temporal bone) to the mandible (post. border of angle of mandible) there is an important lig. stylomandibular lig. which is thickening of deep fascia of parotid capsule :Pretracheal layer: surrounding group of muscular. & visceral (2 .Which kind of. muscular? infrahyoid muscles* Which visceral (organ) ? thyroid & parathyroid gland& trachea* & esophagus ( also we have the larynx & pharynx sup until level of C6 "sixth cervical vertebra as we move down will become, trachea ("& esophagus in the order

14 Page 10 of

As we move down the trachea & esophagus descend into thorax these fascia will move down into thorax which terminat (blend) (with fibrous pericardium ) so if there any infection(bus .spread) ,the Pretracheal layer will spread it with thorax area Prevertebral layer: surrounding vertebral column and muscle -3 attachment to it. .How many groups do we have? 3 which are ?depend on there location Ant.group Longus m * Lat. group scalene m * Post. group splenius & semispinalis * Fascia extention: axillary sheath CAROTID SHEATH *-4 The most important .m because its enclosed blood (vessels ,nerve(not muscles and bones We have 2 caroti d sheat :h

axillary sheath: t scalenus to form a triangle called scalenus heatus ,so axillary sheath involve:" 1-branch(cord)of braichal plexus 2- axillary artrey *Axillary vein in some individual

Right and left, each caroti d sheat h have vital struct ure respo .nsible to provide blood supply to the head and neck

14 Page 11 of

common carotid. a: what we mean in ??common carotid At level thyroid cartilage (adams apple) C3- C4, common carotid divided into 2 ::artery internal carotid .a :-1 which continu with cartoid sheath all the way to the skull to provide blood supply to ant sup part of the brain while post inf part provided by veretbra .a external carotid .a: -2 leave2 carotid sheath ::So its enclosed Common carotid a. & ??? internal-1 .(carotid a (medial structure Internal jugular v(IJV)(lateral-2 (structure Vagus n. (X)(post structure) which-3 main function? parasympathitic innerveition to intrernal visceral (neck, (thoracic,abdomanl Deep cervical L.N which company-4 with IJV

:Retropharyngeal Space The interval between (Post) of the pharynx fascia & prevertebral fascia The largest space in the neck** Allows movement of pharynx & esophagus during (swallowing(not swelling

:Clinically
speacilly during old ages, these space Provides major pathway for spread of infection into thorax to make retro pharyngeal abscess which lead to tonsillitis, so if there abscess we can find different : sign as

i-dysphagia: difficult in the swallowing prosses ii-dysphonia : difficult in voice production

14 Page 12 of

iii-dyspnea: shortness in the breath

, Finally I wish success and excellence to my friend Halaotoom in the new specialization -Sorry for any mistake Your colleages: Rahaf Al-Ibrahim GOOD LUCK

14 Page 13 of

14 Page 14 of