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Spinous process of the axis first bony prominence that can be felt in the median plane Spinous process of the vertebra prominens (C7) easily palpable when the neck is flexed Thyroid cartilage (Adams apple) at the level of C4; contains 2 quadrilateral plates called laminae Hyoid bone u-shaped bone at the level of the body of C3; lie superior to the thyroid cartilage Transverse process of the atlas felt by deep palpation between the angle of the mandible and a point about 1cm anteroinferior to the tip of the mastoid process
Cricoid cartilage inferior to the thyroid cartilage; lies at the level of C6 Tracheal rings palpable in the inferior part of the neck; moves superiorly during swallowing Jugular notch depression in the manubrium of the sternum; easily palpable between the medial ends of the clavicle Sternocleidomastoid muscle has sternal and clavicular heads; divides lateral side of the neck into anterior and posterior triangles Supraclavicular fossa triangular depression between the sternal and clavicular heads of the SCM; contains the pressure point for the subclavian artery
Superficial Structures
Superficial Fascia contains the platysma Platysma wide, thin subcutaneous sheet of striated muscle that ascends to the face from the anterior part of the neck - covers the superior part of the anterior cervical triangle and the anteroinferior part of the posterior cervical triangle
Inferior Attachment fascia and skin over the pectoralis major (second rib) and deltoid muscles Superior Attachment inferior border of mandible and skin of the lower face Innervation cervical branch of CN VII Action muscle of facial exrpression; tense the subcutaneous tissue of the neck and assist in depressing the lower lip - produces skin ridges in the neck, releasing pressure of the skin on the the underlying veins
Superficial Structures
1. Superficial or Enveloping Layer - surrounds the whole neck - starts off at the back where it is attached to the ligamentum nuchae - encloses the trapezius and SCM muscles - contains the accessory nerve as it passes posteriorly and inferiorly from the SCM to the trapezius
Superficial Structures
2. Prevertebral Fascia - part of the fascia that envelopes the vertebral column - envelopes the prevertebral and postvertebral muscles of the neck - covers the subclavian vessels and the roots of the brachial plexus - drawn into the axilla on the brachial plexus and subclavian artery as the axillary sheath
* provides an anatomical course for infections within the posterior compartment of the neck to travel into the axilla
Superficial Structures
3. Carotid Sheath - anterior to the prevertebral fascia - invests the common and internal carotid arteries, the internal jugular vein and the vagus nerve
Superficial Structures
5. Infrahyoid Fascia - encloses the infrahyoid muscles (sternothyroid, sternohyoid, thyrohoid and cricohyoid m.) - attaches above either into the hyoid or thyroid muscles and below into the posterior aspect of the manubrium
Fascial Layers
Superficial Structures
4. Pretracheal Fascia - has 2 layers, the anterior and posterior layers
a. anterior layer superiorly attached to the hyoid bone up to the border of the mandible - inferiorly found anterior to the larynx, trachea and thyroid gland and end in front of the great vessels b. posterior layer posterior to the pharynx and esophagus - covers the posterior aspect of the esophagus - the anterior and posterior layers are both attached the the skull
* Important Relationships Around the Subclavian A. 1. Inferiorly 1st rib and pleura of apex of lung 2. Posteriorly scalenus medius and lower trunk of brachial plexus 3. Anteriorly scalenus anterior
* posterior cord 3 posterior divisions * lateral cord anterior divisions of the upper and middle trunks * medial cord anterior division of the lower trunk
*Branches from the roots of the brachial plexus innervate the following: 1. Rhomboids dorsal scapular nerve, C5 2. Serratus anterior long thoracic n., C5,6,7 3. Diaphragm - phrenic n., C3,4,5 4. Adjacent prevertebral muscles 5. * subclavius muscle branch from the upper trunk of the brachial plexus in the posterior triangle
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