Gross: Root of the Neck & Prevertebral Neck Muscles: Dr. Banez 6.

Brachiocephalic artery
From the lecture (including the contents of the slides): 7. Scalene
8. Vagus nerve
Root of the Neck: Posteriorly:
*Boundaries: 1. Apex of Lungs
Post: Body of T1 vertebra 2. Cupula
Ant: Manubrial Notch 3. Cervical dome of pleura
1st rib
Branch of the Second Part of Subclavian Artery:
Note: 1. Costocervical trunk
Clavicle: Has 2 terminal branches:
o an important structure that protects the structures that Deep cervical artery Supreme/Superior thoracic/ Superior
enter the thorax Intercostal Artery
o Structure that connects the UE to the trunk Goes up to the neck
just outside the Goes down
Contents: foramen, just beside
1. Beginning of subclavian artery & its branches prevertebral Has branches:
2. R Innominate / brachiocephalic artery structures 1 & 2 Posterior Intercostal Arteries
st nd

3. Innominate / brachiocephalic vein (thoracic aorta starts at the 3rd

4. Subclavian vein intercostal space branches into 3rd
5. CCA intercostal artery)
6. L Thoracic duct Note:
7. R lymphatic duct The ant & post intercostal arteries anastomose when they
8. Trachea reach the midline
9. Esophagus
Third Part of the Subclavian Artery
Subclavian Artery Usually has no branch
Becomes axillary artery as it passes through the 1st rib Enters antero-inferior angle of the posterior triangle &
Longer on the LEFT side disappears at the middle clavicle
Shorter on the RIGHT as it goes down, it has to cross the clavicle and the
3 parts: (Anterior Scalene as the landmark)* presence of the post and mid scalene presses the vessel
o Ant scalene: aneurysm might compress the subclavian vein (check on
inserted to the 1st rib this!!!)
lies anterior to the suvclavian artery usual occurrence of aneurysm compressing the subclavian
vein edema
Part 1: from origin to brachiocephalic up to the part that is
medial to the medial border of the Ant scalene Subclavian Vein
o Has 3 branches: Starts from the axillary vein 1st rib subclavian vein
1. Vertebral Artery United with IJV to become innominate vein
2. Thyrocervical Trunk o SV + IJV = innominate vein
3. Internal Mammary / Internal Thoracic Artery Loc just posterior to the clavicle
Receives EJV
Part 2: behind the ant scalene Anterior: clavicle & subclavius
o Has 1 branch Posterior: ant scalene & phrenic nerve
1. Costocervical Trunk Catheter can be inserted here for:
o Monitoring central venous pressure (CVP)
Part 3: lateral to ant scalene o Parenteral nutrition
o No branch To locate this vein, divide the clavicle into 3 parts:
o Between the lat & middle parts insert the needle
Branches of the First Part of Subclavian Artery: guide the needle posteriorly towards the inner surface
1. Vertebral Artery: of the clavicle enters subclavian vein (+) venous
Between ant scalene & longus coli blood insert catheter SVC
Very short bec it enters the transverse foramen of the o Before inserting the catheter make a landmark
cervical vertebra (6th / 7th cervical vertebra) f. magnum angle of Louie to area bet lat and middle clavicle
unite together to become the basilar artery COW No tributaries
Enters transverse foramen C6-C1
Attached to subclavian artery
Supplies SC % muscles of the neck Innominate / Brachiocephalic Vein
Covered by sternothyroid & sternohyoid
2. Thyrocervicalo trunk Separated from clavicle by:
Short 1. Sternohyoid
Has 3 branches: 2. sternothyroid
a. Inferior thyroid artery The names of the branches of the subclavian artery
b. Superficial / transverse cervical artery : posterior to corresponds to the names of the tributaries of the
SCM but ant to lateral ms of the neck (scalenes), innominate vein:
supplying these structures 1. Mammary Vein
c. Suprascapular artery: anastomoses with the ant & 2. Vertebral Vein
post humoral circumflex to save BS for the UE 3. Superior intercostal vein
4. Deep cervical vein
3. Internal mammary / internal thoracic artery 5. Inferior thyroid vein
Goes down & supplies ant thoracic wall & has mammary
branches *Left Thoracic Duct (prax)
Branches: Look for the aortic hiatus in the diaphragm, it is where the
1. Anterior intercostal artery thoracic duct enters retract the aorta 3rd ICS lateral
drain to IJV
Structures Related to First part of Subclavian Artery: Arises from cisterna chyli passes through aortic hiatus
Anteriorly: along left of esophagus
1. Subclavian vein At TP of C7, it bends behind the carotid sheath
2. Clavicle Drains:
3. Platysma 1. R and L LE
4. Strap muscles of the neck 2. L UE
5. IJV 3. L head and neck

Gross: Root of the Neck & Prevertebral Neck Muscle rich uy (rgau) Page 1
 4. L thorax PREVERTEBRAL NECK MUSCLES AND IMMEDIATE ADJACENT STRUCTURES
5. Abdomen except superior surface of liver o All these muscles are innervated by the cervical plexus
Drains into the beginning of left brachiocephalic vein
ANTERIOR / PREVERTEBRAL NECK MUSCLES
Right Lymphatic Duct 1. LONGUS COLI:
Smaller than thoracic duct o Cannot flex the head, it can only flex or move the
Formed by R jugular & bronchomediastinal trunk cervical vertebra ?? as stated (pls check on this)
Enters right brachiocephalic vein 3 parts:
Drains: a. Superior Oblique:
1. R head and neck O Trans of C3-C5
2. R thorax I Ant. Arch of atlas
3. R UE A flexes neck laterally
4. Upper surface of the liver
b. *Inferior Oblique:
Cervical Fascia: Smallest
1. Superficial cervical fascia Only fiber that can rotate the vertebra
2. Pretracheal fascia Contract the r and l flexion of cervical
3. Prevertebral fascia vertebra
4. Carotid sheath If only one turns vertebra to opposite side

1. Superficial cervical fascia O body of T1-T2 or T1-T3

attached to spinous process and ligamentum I transverse process of C5-C6
nuchae A flexes neck laterally; rotates the neck opposite side
enclosed the trapezius and sternocleidomastoid
Forms the roof of posterior triangle c. Vertical part:
its superficial and deep fascia forms suprasternal O bodies of C5-T3
space of Burns near the clavicle I bodies of C2-C4
2. Pre-tracheal fascia A flexes neck forward (similar to superior oblique)
attached to the oblique line of thyroid cartilage & Can flex the neck even if only one of the
inferiorly to the post. sternum. muscles contract
Enclosed structures:
1. Thyroid gland (false capsule) 2. LONGUS CAPITIS:
2. Parathyroid gland O transverse process of C3-C6
3. Infrahyoid muscles I basilar part of occipital bone
3. Carotid Sheath NS anterior rami of C1-C3
Extends from the base of skull to the root of the neck A flexes the head
It blend w/ the superficial and prevertebral fascia
Contents: o To see the two next muscles identify the atlas bec
1. Common & internal carotid artery there are 2 muscles that are attached to the atlas
2. Internal jugular vein RCanterior & RClateralis:
3. Vagus nerve
4. Superior root of ansa cervisalis 3. RECTUS CAPITIS ANTERIOR:
5. Deep cervical LN O transverse of atlas
4. Prevertebral fascia I basilar part of occipital bone
starts at the spinous process posteriorly and is NS anterior rami of C1- C2
attached to the transverse process of cervical vert. A flexes the head at
serves as a floor of the posterior triangle atlanto-occipital joint
it covers:
1. Posterior muscles of the cervical vertebra 3. RECTUS CAPITIS LATERALIS:
2. Scalene muscles O transverse of atlas
3. Prevertebral cervical muscles I jugular process of occipital bone
NS anterior rami of C1- C2
Lateral Vertebral Neck Muscles A flexes the head laterally at the same side
1. Scalenus Anterior
O - transverse process of C3 C6
I Scalene tubercle of 1st rib
NS ant rami of C4-C6
A elevates 1st rib
- lateral flexes & rotates cervical part of vertebral column
2. Scalenus Medius
O - transverse process of axis,
C2-C6
I 1st rib
NS ant rami of C4-C6
A elevates 1st rib
- laterally flexes & rotates cervical part of vertebral
column
3. Scalenus Posterior
O - transverse process of lower cervical vertebra
I Scalene tubercle of 2nd rib
NS ant rami of C5-C8
A elevates 2nd rib
- lateral flexes & rotates cervical part of vertebral column

Gross: Root of the Neck & Prevertebral Neck Muscle rich uy (rgau) Page 2
CERVICAL PLEXUS Thyrohyoid muscle
*Geniohyoid muscle (not part of the strap
muscles), a suprahyoid muscle

6. Phrenic Nerve: (C3-C5)

The most important branch
Mixed nerve:
Sensory: Superiorly: parietal pleura
Inferiorly: parietal peritoneum
Sympathetic fibers(motor): diaphragm

Phrenic Nerve(C3,C4,C5): largest branch of cervical plexus

long enters the thoracic duct, accompanies beside
pericardium and touches the diaphragm
Inflammation of the pleura painful upon breathing due
to the phrenic nerve
* (prax) Phrenic nerve lies on the anterior scalene
* (prax) phrenic nerve function: mixed nerve

Note:
o The SCM and trapezius (that are inn by CN11) are also
innervated by muscular branches of the cervical plexus
(C2, C3, C4) there are fibers from c.plexus that
connect with the CN11 Spinal Accessory Nerve
o Sig:
If there is an injury to CN11 nerve supply to SCM and
Formed by anterior rami of C1-C4 trapezius will come from the cervical plexus
Mixed nerve purely sensory and purely motor
Covered anteriorly by prevertebral fascia Upper branch of Ansa Cervicalis:
- Geniohyoid
BRANCHES: - Thyrohyoid
1. Cutaneous Nerves 1 branch supplies:
st

2. Muscular branches - Sup and inf belly of omohyoid

3. Phrenic nerve - Sternohyoid
- Sternothyroid
*Cutaneous Nerves: (prax model) purely sensory
a. Lesser occipital nerve
Anterior ramus of C2
b. *Great auricular nerve
Anterior ramus C2-C3
c. Transverse cervical nerve
Anterior ramus C2-C3
d. Supraclavicular nerve
Anterior ramus C3-C4

CERVICAL PART OF THE SYMPATHETIC TRUNK

Sympathetic: purely motor
Muscular Branches: elevates scapula From base of skull to 1st rib
1. Sternocleidomastoid (C2-C3) Along posterior the carotid vessels
2. Trapezius (C3-C4) Between the carotid and prevertebral fascia covering the
3. Levator scapula (C3-C4) longus coli
4. Prevertebral muscles (C1-C6) Has 3 ganglia:
5. Anterior Strap Muscles 1. Superior cervical ganglion
a. Branches from ansa cervisalis (C1,2,3) has 2. Middle cervical ganglion
superior and inferior roots innervating: 3. Inferior cervical ganglion
Sternohyoid muscle
Sternothyroid muscle
Omohyoid muscle

Gross: Root of the Neck & Prevertebral Neck Muscle rich uy (rgau) Page 3
 3. Inferior cardiac branch
Ends in cardiac plexus

*What cervical ganglion sends fibers to form the cardiac plexus?

*Superior, Middle and Inferior cervical ganglion

SUPERIOR CERVICAL GANGLION

Below the skull
Largest
Branches:
1. Internal carotid nerve
Postganglionic fibers
Divides into branches forming
internal carotid plexus
2. Gray ramus communicantes
To anterior rami of C1-C4
3. Arterial branches
To common & external carotid arteries
4. Cranial nerve branches
Joins CN IX, X and XII

Note: CN11 has a communication with

cervical plexus
5. Pharyngeal branches
Joins CN IX & CN X forming pharyngeal
plexus
6. Superior cardiac branch
Ends cardiac plexus
Has a communication with the cardiac
plexus of nerves

MIDDLE CERVICAL GANGLION

Level of the cricoid cartilage
Smallest
Branches:
1. *Gray rami communicantes
Anterior rami of C5-C6
2. Thyroid branch (thyroid gland)
Fxn controlled by TSH
3. Middle cardiac branch
Ends in cardiac plexus

INFERIOR CERVICAL GANGLION

Between transverse process of C7 & neck of the 1st rib
Costothoracic (Stellate) Ganglion hourglass
appearance
thoracic inlet
Branches:
1. Gray rami communicantes
Anterior rami of C7-C8
2. Arterial branch
Subclavian & vertebral arteries,
thyrocervical, internal mammary
Costocervical trunk
Innominate artery
Beginning of R and L CCA

Gross: Root of the Neck & Prevertebral Neck Muscle rich uy (rgau) Page 4