Anterolaterally the

neck appears as a
quadrilateral area
This quadrilateral
area is divided into
anterior and
posterior triangles
by
sternocleidomastoid
, which passes
obliquely from the
sternum and clavicle
to the mastoid
process and
occipital bone.

The ANTERIOR TRIANGLE lies

anterior to the
sternocleidomastoid muscle,
while the POSTERIOR TRIANGLE
lies posterior to the
sternocleidomastoid muscle.

Sternocleidomastoid
muscle

Triangles of THE Neck

AND ROOT OF THE NECK

1ST

KIMAIGA H.O
YEAR MBChB(UoN)

THE ANTERIOR TRIANGLES

ANTERIOR TRIANGLE OF THE NECK

BOUNDARIES
Anteriorly- median line of the neck,
Posteriorly-anterior margin of
sternocleidomastoid.
Base -inferior border of the mandible
and its projection to the mastoid
process,
and its apexis at the manubrium
sterni.
Made of suprahyoid and infrahyoid areas
above and below the hyoid bone,
TRIANGLES HERE ARE:
Digastric/submandibular
Submental
Muscular

Table of Muscles
Muscle

Origin

Insertion

Action

Nerve Supply

Sternohyoid

sternum

hyoid

ansa

Omohyoid

Suprascapular
notch

hyoid

ansa

Sternothyroid

Below
sternohyoid on
manubrium

Thyroid
cartilage
oblique line

ansa

Thyrohyoid

Thyroid
cartilage
oblique line

hyoid

C1-C2 (ansa)

Anterior Belly
Digastric

----intermediate
tendon------

Inner surface of
mandile

Trigeminal
nerve

Posterior Belly
Digastric

Medial aspect
of the mastoid
process

-intermediate
tendon-

Facial nerve

Mylohyoid

Mylohyoid line
of mandible

Hyoid bone

Trigeminal
nerve

Hyoglossus

Hyoid bone

Lateral side of
tongue

hypoglossal

Stylohyoid

Styloid process

hyoid

Facial nerve

suprahyoid muscles
MUSCLE

ORIGIN

INSERTION

ACTION

Digastric

Digastric

Digastric

Depress

Stylohyoid

Mylohyoid

Geniohyoid

notch,
medial surface
of base of
mastoid process
Back

of styloid
process near the
base of skull

Whole

length of
mylohyoid line of
its own side on
the inner aspect
of the mandible
from medial to
the third molar
tooth to below the
mental spines
Inferior

spine

mental

fossa

INNERVATION
the

mandible

By

two slips into

the junction
between the
greater horn and
body of hyoid
bone
Anterior

: into
each other
(interdigitation)
Posterior :
anterior surface
of the body of
hyoid bone

Upper

border of
the body of hyoid
bone.

ELevate

hyoid

Posterior

belly:
facial nerve
Anterior
belly:nerve to
mylohyoid
Facial

nerve

bone

Forms

a mobile
but stable floor of
the mouth

Protracts

and
elevates the
hyoid bone in
swallowing or if
the hyoid is fixed

Mylohyoid

nerve

C1(superior

root
of ansa cervicalis)

PLATYSMA

Platysma is a broad sheet of muscle of varying

prominence.
arises from the fascia covering the upper parts of
pectoralis major and deltoid.
Its fibres cross the clavicle and ascend medially in
the side of the neck.
Anterior fibres interlace across the midline with the
fibres of the contralateral muscle, below and behind
the symphysis menti.
Other fibres attach to the lower border of the
mandible or to the lower lip or cross the mandible to
attach to skin and subcutaneous tissue of the lower
face.
22

Platysma

Origin fascia overlying the pectoralis

major & deltoid muscle
Insertion
depression muscles of the corner
mouth
the mandible
lower face

Function
wrinkles the neck
depresses the corner of the mouth
increases the diameter of the neck
assists in venous return

of the

25

PLATYSMA

Vascular supply
Platysma receives its blood supply from
the submental branch of the facial artery
and the suprascapular artery from the
thyrocervical trunk of the subclavian artery.
Innervation
Platysma is innervated by the cervical
branch of the facial nerve which descends
on the deep surface of the muscle close
to the angle of the mandible

PLATYSMA Action

Contraction diminishes the concavity

between the jaw and the side of the
neck and produces tense oblique
ridges in the skin of the neck.
Platysma may assist in depressing the
mandible, and via its labial and
modiolar attachments it can draw
down the lower lip and corners of
the mouth in expressions of horror
or surprise.

Sternocleidomastoid Muscle
(SCM)

Origin
medial third of the clavicle (clavicular head)
manubrium (sternal head)

Insertion

Nerve supply

mastoid process
spinal accessory nerve (CNXI)

Blood supply

occipital a. or direct from ECA

superior thyroid a.
transverse cervical a.

SCM

Function turns head toward opposite

side & tilts head toward the ipsilateral
shoulder
Surgical considerations
Leave overlying fascia (superficial layer of
deep cervical fascia down)
Lateral retraction exposes the submuscular
recess

30

Omohyoid muscle

Origin

upper border of the scapula

Insertion
via the intermediate tendon onto the clavicle
and first rib
hyoid bone lateral to the sternohyoid muscle

Blood supply

Inferior thyroid a.

Function
depress the hyoid
tense the deep cervical fascia

31

The INFERIOR
BELLY OF THE
OMOHYOID
MUSCLE crosses
the posterior
triangle as it spans
from the hyoid
bone to the
scapula.

32

Omohyoid

Surgical considerations
Absent in 10% of individuals
Landmark demarcating level III from IV
Inferior belly lies superficial to the
brachial plexus
Phrenic nerve transverse cervical vessels
Superior belly lies superficial to IJV

Digastric muscle

Origin

digastric fossa of the mandible (at the

symphyseal border)

Insertion
hyoid bone via the intermediate tendon
mastoid process

Function
elevate the hyoid bone
depress the mandible (assists lateral
pterygoid)

34

Digastric

Surgical considerations
Posterior belly is superficial to
ECA
Hypoglossal nerve
ICA
IJV
Anterior belly
Landmark for identification of mylohyoid
for
dissection of the submandibular triangle
35

36

Muscles of neck

37

Origins and insertions on the mandible and

hyoid

Origins and insertions on the mandible and

hyoid

Omohyoid muscle (surgical landmark)

Junction with IJV

LEFT
ANTERIOR
TRIANGLE

Submandibular
triangle/Digastric triangle

Boundaries:

Inferomedially: Anterior
belly of digastric.
Anterosuperiorly: Inferior
border of the mandible.
Inferolaterally: Posterior
belly of digastric.
Floor;
Mylohyoid (forms
diaphragm oris)
hyoglossus

middle constrictor muscle of

the pharynx

47

ROOF OF
SUBMANDIBULAR
TRIANGLE:
The skin.
Superficial fascia
Platysma
Deep fascia containing
branches of the
facial and transverse
cutaneous cervical
nerves e.g. cervical
branch of facial
nerve

Removal of the superficial

structures displays the
submandibular salivary
gland itself.

CONTENTS OF
SUBMANDIBULAR TRIANGLE:

Submandibular gland

Hypoglossal nerve.XII

Mylohyoid nerve.

Facial artery and vein.

Submandibular lymph nodes

Lingual nerve and submandibular

ganglion (ln)
Submandibular duct (smd)
Lingual artery (la)

The lingual nerve and

submandibular duct pass
through a gap between the
hypoglossal (hg) and
mylohyoid (mh) muscles
the lingual artery passes deep
to the hyoglossus muscle.

Applied anatomy of
submandibular triangle

Infection in submandibular region is

limited to a triangular region.
Posteriorly; hyoid bone and
anterolaterally on each side by halves of
mandibular base
Because the layer of deep fascia is
attached to these bones.
Triangular swelling= Ludwigs Angina
The swelling may push tongue upwards

Submental triangle
BOUNDARIES
Apex Inferior end of
symphysis menti

Laterally: Right and left

anterior bellies of digastric.

Base inferiorly -Body of the

hyoid bone

Floor - mylohyoid muscles.(mh)

Arise from the body of the hyoid
bone and insert into the
mylohyoid line of the inside of
the mandible.

Aids in swallowing and in

depressing the mandible.

The Submental Triangle

CONTENTS OF SUBMENTAL
TRIANGLE
Submental lymph nodes.
These receive lymph from the
following areas:
Tip of the tongue.
Floor of the mouth.
Mandibular incisor teeth
and associated gingivae
Central part of the lower
lip.
Skin of the chin.
Lymph from here drains into
submandibular and deep cervical
lymph nodes.
Submental veins and arteries.
The submental veins unite to form

Applied anatomy of
Submental triangle

In infections or cancer from any of the areas of

drainage of the submental nodes, especially the
tip of tongue and lip, the first nodes to be
involved are submental nodes. Subsequently, the
submandibular and deep cervical get involved.
A discharging sinus on the point of the chin often
results from an abscess of a mandibular incisor
tooth. The pus from the infected tooth passes
from the apex of the submental triangle located
at the inferior end of the symphysis menti where
it forms a sinus from which pus escapes.

Muscular triangle
BOUNDARIES
Anteriorly -median line
of the neck from the
hyoid bone to the
sternum,
Inferoposteriorly by the
anterior margin of
sternocleidomastoid,
Posterosuperiorly by
the superior belly of
omohyoid.
Apex-jugular notch
(3)

CONTENTS OF MUSCULAR TRIANGLE

1) Infrahyoid muscles (strap
muscles).
Sternohyoid 1
Sternothyroid
Thyrohyoid
Omohyoid* 2forming part of
the boundary.
NOTE: These muscles are
innervated by ansa cervicalis (c1c3) except thyrohyoid that is
innervated by C1 via Hypoglossal
nerve. They depress the hyoid
bone and larynx during
swallowing and speaking,
anchoring it in position
2) The anterior jugular veins,
run in both sides of the midline.
They are joined by the jugular
arch at the suprasternal notch.

1-Sternohyoid
2-Omohyoid
3-Sternal head of
sternocleidomastoid

Carotid triangle
BOUNDARIES
Superomedially
Posterior belly of the
digastric
Laterally:
Anterior border of
the
sternocleidomastoid
muscle
Inferomedially:
superior belly of
omohyoid

The Carotid Triangle

Roof of the Carotid Triangle

Skin and
superficial fascia
Platysma
Deep fascia;
ramifying in which
are branches of
the facial and
cutaneous cervical
nerves.

Floor of the carotid triangle

The muscles, at this level, are

Thyrohyoideus, hyoglossus,
the middle and inferior
pharyngeal constrictors (mpc
and ipc).
The structures seen passing
through this level are:
superior laryngeal nerve, a
branch of the vagus its 2
terminal branches
internal laryngeal (ilb)sensory to upper part of the
larynx
external laryngeal (elb)motor to the Cricoid
muscle)

Veins of the Carotid

Triangle

common facial vein (cf)

(within carotid triangle)

Other structures near by:

retromandibular vein (rm)

posterior auricular vein
(pav)
facial vein (fv)
external jugular vein (ej)
anterior jugular vein (aj)

Nerves within the Carotid

Triangle

The nerves that enter

the carotid triangle and
that lie superficial to
the internal jugular
vein, internal and
external carotid arteries
are:

hypoglossal (XII)
C1 root of ansa cervicalis
(C1)
C1 fibers running with
hypoglossal nerve (nerve
to thyrohyoid muscle (nth)
C2-C3 root of ansa
cervicalis
ansa cervicalis (ac)

Nerves within the Carotid Triangle

Reflection of sternomastoid and

removal of common facial vein

cca-common
carotid artery
eca-external
carotid artery
sta-supterior
thyroid artery
oa-occipital
artery
la-lingual artery
fa-facial artery
ica-internal
carotid artery

1.masseter muscle
2.
5.parotid gland
8.facial artery
28.common carotid artery
29. internal carotid artery
30.external carotid artery
31. Superior thyroid artery
32. Ansa cervicalis

THE CAROTID
SHEATH:
Location:
Longitudinal interval
between cervical viscera
(pharynx, esophagus,
larynx, trachea and
thyroid gland) medially,
and prevertebral
muscles posteriorly
Formation:
Prevertebral fascia
behind

Mnemonics Of Carotid Sheath

Contents
"I SEE(I.C)10 CC's IN THE IV"
I SEE (I.C) = Internal carotid artery
10 = 10 cranial nerve (vagus nerve)
CC = Common carotid artery
IV = Internal juglar vein

CONTENTS OF CAROTID SHEATH

1. Common and Internal Carotid arteries medially.
2. Internal jugular vein laterally.
3. Vagus nerve posteriorly and between the above two.
4. Ansa cervicalis embedded in the carotid sheath(anteriorly).
5. Deep cervical lymph nodes.
Note:
1. Common carotid artery divides at superior border of thyroid
gland (C3,4).
2) The carotid sinus (the baroreceptor) is a slight dilatation at the
proximal part of the internal carotid artery. It is innervated by:
Carotid sinus nerve, a branch of
glossopharyngeal.
1.A branch of vagus nerve.
2.Sympathetic division of ANS.
3) The carotid body, is a small reddish brown, ovoid mass of tissue
located at the carotid bifurcation. The same nerves that go to the
carotid sinus innervate it.

A-Vagus nerve
B-Comon carotid artery

COMMON CAROTID ARTERY

ORIGIN
Right:
Brachio cephalic trunk- behind right
sternoclavicular joint
Left:
Aortic arch behind manubrium sterni
Course
Extends from sternoclavicular joint to upper
border of thyroid gland c3/ c4
Anterolateral neck in the carotid sheath
lateral to trachea/ esophagus and larynx/
pharynx
Palpable between sternocleidomastoid and
angle of the mandible
Divides in the carotid triangle into internal
and external carotid arteries
Innervation
Parasympathetic: Submandibular ganglion
Sympathetic: superior cervical ganglion

BRANCHES OF EXTERNAL CAROTID ARTERY

From the
ventral
side:

Superior
thyroid
artery. [5]
Lingual

artery. [4]
Facial

artery. [3]
Ascending

pharyngeal
(may form
from medial
side).

From the
dorsal
side:

Occipital
artery. [7]

Terminates by
dividing into:

Superficial
temporal artery
[1]

Posterior

auricular.
[6]

Maxillary

[2]

artery.

INTERNAL JUGULAR VEIN

Origin
Union of sigmoid and inferior petrosal sinuses
Extent
Base of skull to sternoclavicular joint
Landmark
Between sternal and clavicular heads of sterno cleido
mastoid muscles
Tributaries
Pharyngeal veins
Lingual
Common facial
Superior thyroid
Middle thyroid
Termination:
Joins subclavian vein to form brachio-cephalic vein

VAGUS NERVE
COURSE
1. Emerges through jugular foramen
2. Two ganglia- superior and inferior cervical
ganglia
3. Runs straight down in the carotid sheath
4. Between and behind carotid artery and internal
jugular veins
5. At the root of the neck, it passes infront of the
subclavian artery to enter mediastinum

BRANCHES AND DISTRIBUTION

Branch
Meningeal
Auricular

Carotid body branch

Pharyngeal branch
Superior laryngeal
External Laryngeal
Internal Laryngeal
Recurrent Laryngeal

Cardiac branches

Distribution
Dura of posterior cranial fossa
Postero inferior quadrant of external surface of
tympanic membrane
Floor of external auditory meatus
Skin on the cranial auricular canal
Carotid

body
Carotid sinus
Muscles of pharynx except stylopharyngeus
Muscles of soft palate except tensor palate

Cricothyroid muscle
Inferior pharyngeal constrictors
Pharyngeal mucosa
Laryngeal mucosa above vocal folds
Trachea and Esophagus
Cricopharyngeus
Laryngeal muscles except cricothyroid
Laryngeal mucosa below vocal folds

Heart

SCALENUS ANTERIOR
SYNDROME
The scalene triangle/ gap
is bounded by:
1. Posteriorly: Scaleneus
medius
2. Anteriorly: Scaleneus
anterior
3. Base: First rib
Through this gap, pass
the subclavian artery
and the brachial
plexus.
Compression of these
structures causes the
scalenus anterior

THE POSTERIOR
TRIANGLES

A. Posterior triangle
Boundaries

Posterior : anterior border of trapezius

Base : middle 3rd of clavicle

Apex : meeting point of sternocleidomastoid

& trapezius at superior nuchal line.

The inferior belly of omohyoid mscle, divides
the posterior triangle into two;
Occipital triangle
Supraclavicular/ omoclavicular triangle.

The floor of the posterior triangle consists

of four muscles, covered by the
prevetebral layer of the deep cervical
fascia. The splenius capitus, levator
scapulae, ane the three scalenus
muscles.

The anterior free

edge of the
TRAPEZIUS MUSCLE
forms the posterior
border of the
posterior triangle.

The LEVATOR
SCAPULAE MUSCLE
forms a portion of
the floor of the
posterior triangle.

The SCALENE
MEDIUS AND
POSTERIOR
MUSCLES complete
the floor of the
posterior triangle

The SCALENE
ANTERIOR MUSCLE
appears in the
lower anterior
corner of the
triangle, often
under the cover of
the
sternocleidomastoi
d muscle.

The PHRENIC
NERVE can be
observed on the
anterior surface of
the scalene
anterior muscle.

The ROOTS AND

TRUNKS OF THE
BRACHIAL PLEXUS
emerge from the
interval between
the scalene
anterior and
scalene medius &
posterior muscles.

B. Posterior triangle Roof

a.

Skin

b.

Superficial facia

c.

Investing layer of deep cervical facia

d.

Roof is pierced by :
1. Nerves :
i.

Lesser occipital

ii.

Great auricle

iii.

Transverse cutaneous nerves of neck

iv.

Supraclavicular nerves

2. Veins : external jugular veins and its tributaries.

3. Lypmh vessels

1. external jugular vein (blue)

2. superficial cervical lymph nodes (green)
3. lesser occipital nerve (lc)
4. great auricular nerve (ga)
5. transverse cervical nerve (tc)
6. supraclavicular nerves (sc)
7. spinal accessory nerve (sa)

C. Posterior triangle Floor

Mainly form by 2nd layer of muscle of neck

1. Splenius capitis.
2. Levator scapulae.
3. Occasionally by semispinalis capitis at apex.
4. Scaleneus medius.
5. Scaleneus posterior.
6. Muscular floor is carpeted by preverterbral facia.

The external jugular vein

This vein is formed near the angle of the mandible by

the union of the posterior branch of retromandibular
and posterior auricular veins .
It crosses sternocleidomastoid muscle, runsover the
roof of the triangle and joins the subclavian veins
The vein drains most of the scalp and face on the
same side.
This vein dilates and becomes visible in fluid
overload, in heart failure in SVC obstruction,
prolonged raised intrathoracic pressure, e.t.c.
The walls of the vein are attached to the deep
fascia. If the vein is lacerated, the fascia pulls the vein
open and blleding is severe. Also, air embolism could
follow.

EXTERNAL JUGULAR VEIN

Applied anatomy of
external jugular vein

External Jugular Vein is relatively

superficial therefore:
It can be easily lacerated
Can be used to draw blood, infuse drugs or
catheterize the heart
is visible when distended in heart failure
It pierces investing fascia therefore, when
lacerated
Can bleed profusely
Predispose to air embolism

Arteries
The subclavian artery
(third part) -B
Transverse cervical
artery from thyrocervical
trunk to supply muscles in
scapular region.
Suprascapular artery
from the thyrocervical
trunk.
Occipital artery, from the
external carotid artery.

Note the boundaries:

A: Anterior scalene muscle
B: Middle scalene muscle

The TRANSVERSE
CERVICAL ARTERY
crosses the posterior
triangle. It divides into
a deep branch which
enters the floor of the
triangle, and a
superficial branch
which passes laterally,
deep to the trapezius
muscle to travel with
the spinal acessory
nerve.

The
SUPRASCAPULAR
ARTERY AND VEIN
crosses the lower
portion of the
posterior triangle
just beneath the
clavicle.

D. Content

The spinal accessory nerve and the lymph nodes

are the true contents of the posterior triangle .
All others are behind or in front of the facial
floor.
a. Muscle : inferior belly of omohyoid
b. Nerves :
1. Accessory nerves
2. Root, trunks of brachial plexus and their branches :
i. Nerves to rhomboideus
ii. Nerves tomserratus anterior
iii. Nerves to subclavius
iv. Suprascapular nerve

3. Cervical nerves :
i.
ii.
iii.
iv.
v.

Greater occipital nerve emerges from the apex to

pass on the scalp.
Great auricle nerve
Lesser occipital nerve
Transverse cervical nerve of neck
Supraclavicular nerve

3rd and 4th cervical nerves supplying

trapezius

Nerves
Spinal accessory nerve to the
sternocleidomastoid muscle
and the trapezius muscle.

Cervical plexus and its

cutaneous branches from up
downwards.
Lesser occipital nerve (c2)
Great auricular nerve (c2 c3)
Transverse cervical nerve (c2
c3)

Suprascapular nerves (c3c4)

Supraclavicular part of the

brachial plexus

GREAT AURICULAR NERVE

runs upward over
the
sternocleidomast
oid muscle to
supply the skin of
neck and angle
of the mandible.

TRANSVERSE CERVICAL
CUTANEOUS NERVES
traverses across the
sternocleidomastoid muscle to supply
the skin over the anterior triangle.

LESSER OCCIPITAL
NERVE crosses the
upper posterior
edge of the
sternocleidomastoi
d muscle to
distribute to the
scalp posterior to
the ear.

The ANTERIOR and

INTERMEDIATE
SUPRACLAVICULAR
NERVES are
cutaneous
branches of the
cervical plexus over
the anterior border
of the clavicle.

POSTERIOR
SURPACLAVICULAR
NERVES

The SPINAL
ACCESSORY NERVE
(CRANIAL NERVE IX)
passes from behind
the
sternocleidomastoid
muscle from slightly
higher than the nerves
of the cervical plexus.
It innervates both the
sternocleidomastoid
and trapezius muscles.

The spinal accessory nerve (Cranial Nerve

XI) pierces the anterior border of the
sternomastoid muscle nerar its upper
attachment and leaves the muscle at
about the midpoint of its posterior border.
The nerve then passes obliquely downward
and laterally across the posterior triangle,
but within a sleeve of the investing layer
of deep cervical fascia. It enters the
trapezius muscle at the inferolateral corner
of the psoterior triangle.

What is the course of the accessory

nerve as it relations to the posterior
trinagle?
What is its clinical significance in the
The spinal accessory nerve runs in a very
posterior triangle?
superficial position within the deep cervical
fascai and may be injuried during surgical
procedures of the superficial neck. It is at
risk during surgery of the deep cervical
lymph nodes, particularly to those of the
jugulo-omohyoid group. Damage to the
nerve will paralyze the trapezius muscle
and cause severe limitations of upward
rotation of the scapula such that the arm
cannot be abducted beyond 90 degrees.

Spinal Accessory Nerve

Originates in the spinal nucleus

Extend to the fifth cervical segment
Union of motor neurons
Passes through two foramen
Foramen Magnum enters the skull posterior
to the vertebral artery
Jugular Foramen exits the skull with CN IX,

X and the IJV

Spinal Accessory Nerve

CN XI Relationship with the
IJV

122

Spinal Accessory Nerve

Crosses the IJV

Crosses lateral to the transverse process

of the atlas

Occipital artery crosses the nerve

Descends obliquely in level II (forms
Level IIa and IIb

123

4. Arteries
i.

Occipital artery emerges from apex

ii.

3rd part of subclavian artery and branches of subclavian artery

a. Branches of thyrocervical trunk 1 st part of subclavian-Transverse
cervical, Suprascapular
b.

Transverse cervical artery divides into acending and descending

branch anterior border of sternocleidomastoid.

5. Veins
External jugular veins and its tributaries.
Subclavian vein is lower down and not include in the
triangle.
6. Lymph nodes :
a.

Supraclavicular lymph nodes along the posterior border of

sternomastoid.

b.

Occipital lymph nodes

124

Transverse cervical and suprascapular arteries branch

from the thyrocervical trunk, a branch of the 1st part
of the subclavian artery.
What is their location with respect to the scalenus
anterior muscle?

The transverse cervical

and suprascapular arteries
arise medial to the
scalenus anterior muscle.
To reach the posterior
triangle they pass from
medial to lateral, anterior
to the scalenus anterior
muscle. They cross the
posterior triangle to reach
the trapezius and scapular
muscles respectively.

Dorsal scapular artery usually arises from 2nd

or 3rd part of subclavian. It is often seen
emerging bewteen the trunks of the brachial
plexus
What is its relation to the deep branch of the
cervical
artery?
The dorsal transverse
scapular artery
passes
posteriorly
through the brachial plexus to supply the posterior
muscles of the back, specifically the rhomboids. It
is usaully present in approximately 75% of
individuals. In the remaining 25%, the dorsal
scapular artery is absent. In these cases, the
transverse cervical artery, while in route to the
trapezius muscle, will give rise to a deep branch
which will pass posterior to the scapula to supply
the rhomboids. Once behind the scapula, the
terminology of dorsal scapular artery applies
regardless of its origin.

Applied anatomy of posterior

triangle

Nerve point of the neck: is the region around the midpoint of the
posterior border of the sternocleidomastoid muscle. Several nerves lie
superficially here, deep to the platysma. This point is important
because: Slash wounds of the neck may severe these relatively superficial
nerves , resulting in loss of cutaneous sensation in the neck, and
posterior part of the scalp.
Anaesthetic agent can be injected here.
Brachial plexus block . Local anaesthetic solution is injected around
the brachial plexus, superior to the midpoint of the clavicle. Be careful to
locate the subclavian artery by palpation so it is not damaged.
Subclavian artery, can be pressed in the suprascapular fossa, to
control bleeding in the upper limb.
Block dessection, is sometimes done in this region for the removal of
lymph nodes. The accessory and Phrenic nerves, together with the other
structures should be saved.
Safe/ danger sides. The accessory nerve may be used to divide the
posterior triangle into a carefree area superiorly and a danger area
inferiorly, which has major nerves and blood vessels

scalene hiatus

The scalene hiatus is

the trianglular gap in
which rami and trunks
of the brachial plexus
and the subclavian
artery pass between
the scalenus anterior
and medius muscles. It
is bounded by the
anterior and medial
scalene muscles and
the first rib to which
the muscles attach.

APPLIED ANATOMY
1)

Left supracavicular (Virchows) lymph nodes are enlarge

in malignancy of testis, stomach and other abdominal
organs.

2)

The pressure in the external jugular vein can be recorded

in the recumbent position. It is increased in right sided
heart failure and in the obstruction of the superior vena
cava.

3)

The retropharyngeal abscess maybe expressed in the

lower part of posterior triangle.

CERVICAL PLEXUS

Horner's syndrome

Results from damage to the cervical

sympathetic chain.
Therefore it presents with
Ptosis
Myosis
Facial flushing on the affected site

Prevertebral and lateral muscles

Prevertebral and lateral vertebral

muscles supplied by cervical plexus

Fascial planes of the neck

Fascial planes of the Neck

a) Investing layer
b) Pretracheal layer
c) Prevertebral

Fascia of the neck, sagittal

view

Fascia of neck, transverse

view

The fascia of the neck has a number of unique features.

The superficial fasciain the neck contains a thin sheet of muscle
(the platysma),
Platysma begins in the superficial fascia of the thorax,
runs upwards to attach to the mandible
and blend with the muscles on the face,
is innervated by the cervical branch of the facial nerve [VII], and is
only found in this location.
FUNCTIONS
Affords the slipperiness which enables structures to move and pass over one
another , without difficulty, e.g. during swallowing.
Allows twisting of the neck without it creaking like a manilla rope.
It allows a looseness that provides the easiest pathways for vessels and
nerves to reach their destinations.

Investing layer
ATTACHMENTS
Proximal

External occipital protuberances

Superior nuchal line

Ligamentum nuchae

Spines of cervical vertabra

Mastoid process

Lower border of the mandible

Zygomatic arch

Styloid process

Hyoid bone
Distal

Acromion

Clavicle

Manubrium sterni

structures enclosed/
surrounded

Encloses

Sternomastoid muscle (1)

Trapezius (2)

Omohyoid muscle

Parotid

Submandibular gland
Roofs

Posterior triangle of the

neck

Anterior triangle of the

neck

Covers

Infrahyoid muscles

Suprasternal space (of Burns)

In the Suprasternal notch, the

investing fascia splits into two
layers:
One attaches to the anterior
border of the manubrium
The other to the posterior
border
This leaves a small
suprasternal space containing:
A little fat
A lymph node
Lower sections of the
anterior jugular veins
Jugular venous arch
Sternal heads of
sternomastoid

Structures piercing the

investing fascia

External jugular vein

Cervical plexus
Lymphatics

Pretracheal layer
Attachments

From hyoid bone to the

superior mediastinum.

Oblique lines of thyroid

cartilage

Cricoid cartilage

The pericardium, and T.

adventitia of the bases
of great vessels.

Becomes continous with

bucopharyngeal fascia
covering constrictor
muscles behind

Structures sorrounded/
enclosed

Thyroid gland (1)

Infrahyoid muscles
Air and food
passages

Modifications of the
pretracheal fascia

The fascia at the back of the thyroid lobe is

thickened to form a lateral ligament or
ligament of Berry which gains attachment to
the cricoid cartilage.
At the level of the thyroid isthmus a looser
attachment of the pretracheal fascia occurs
infront of trachea.

The prevertebral layer

Attachments

Base of the skull

Transverse process
of cervical
vertebrae

Extends further
down into the
abdomen

Structures covered

Prevertebral muscles
Scalene muscles
Phrenic nerve
Thus, it covers the
floor of the posterior
triangle of the neck

Vertebral artery

Modifications

In front of the subclavian artery, it is prolonged

laterally as the cervico-axillary(axillary) sheath
which invests the brachial pexus and the
vessels.
The carotid sheath said to be derived from
fusion or pretracheal and prevertebral fascia.
Surrounds the
Common and the internal carotid arteries.
Internal jugular vein
vagus nerve

Applied anatomy of cervical

fascia
Investing Fascia: Forms a tight sheath for the glands especially the
parotid, restricting swelling. Iinflammation of this glands causes pain due
to high pressure.
Pretracheal Fascia:

The thyroid is completely enclosed in pretracheal fascia. The

attachments to the larynx and trachea result in movement of the thyroid
gland with larynx during swallowing. When a neck swelling moves in this
way, it is almost certain to be associated with the thyroid gland.

The Spaces around the pretracheal fascia provides for spread of

infection. Thus infections from the head and neck can spread infront of
the trachea or behind the esaophagus and reach the superior
mediastinum .
Prevertebral Fascia:

The retropharyngeal space between pharynx and pre-vertebral fascia

is clinically important because it frequently becomes infected secondary
to upper respiratory tract infrections in childhood. The swelling appears
on one side of the posterior pharyngeal wall and may obstruct the
airway. In adults such infections are usually secondary to tuberculosis of
the cervical vertebral column.

Deep to the superficial

fascia

the deep cervical fascia is organized into

several distinct layers
1.an investing layer, which surrounds all
structures in the neck;
2.the prevertebral layer, which surrounds the
vertebral column and the deep muscles
associated with the back;
3.the pretracheal layer, which encloses the
viscera of the neck;
4.the carotid sheaths, which receive a
contribution from the other three fascial layers
and surround the two major neurovascular
bundles on either side of the neck

Prevertebral layer

The prevertebral layer is a cylindrical layer of

fascia that surrounds the vertebral column and
the muscles associated with it (Fig. 8.152).
Muscles in this group include the prevertebral
muscles, the anterior, middle, and posterior
scalene muscles, and the deep muscles of the
back.
The prevertebral fascia is attached posteriorly
along the length of the ligamentumnuchae, and
superiorly forms a continuous circular line
attaching to the base of the skull. This circle
begins

Prevertebral layer

anteriorly as the fascia attaches to the basilar part

of the occipital bone, the area of the jugular
foramen, and the carotid canal;
continues laterally, attaching to the mastoid
process;
continues posteriorly along the superior nuchal
line ending at the external occipital protuberance,
where it associates with its partner from the
opposite side.
Anteriorly, the prevertebral column of fascia is
attached to the anterior surfaces of the transverse
processes and bodies of vertebrae CI to CVII.

Prevertebral layer

The prevertebral fascia passing between the

attachment points on the transverse processes is
unique. In this location, it splits into two layers,
creating a longitudinal fascial space containing
loose connective tissue that extends from the base
of the skull through the thorax.
There is one additional specialization of the
prevertebral fascia in the lower region of the neck.
The prevertebral fascia in an anterolateralposition
extends from the anterior and middle scalene
muscles to surround the brachial plexus and
subclavian artery as these structures pass into the
axilla. This fascial extension is the axillarysheath.

Pretracheal layer

The pretracheal layerconsists of a collection of

fascias that surround the trachea, esophagus, and
thyroid gland (Fig. 8.152). Anteriorly, it consists of a
pretracheal fascia that crosses the neck, just
posterior to the infrahyoid muscles, and covers the
trachea and the thyroid gland. The pretracheal
fascia begins superiorly at the hyoid bone and ends
inferiorly in the upper thoracic cavity. Laterally, this
fascia continues and covers the thyroid gland and
the esophagus.
posteriorly, the buccopharyngeal fascia forms the
pretracheal layer and separates the pharynx and the
esophagus from the prevertebral layer.
The buccopharyngeal fascia begins superiorly at the base
of the skull and ends inferiorly in the thoracic cavity.

Fascial compartments

The arrangement of the various layers of cervical fascia

organizes the neck into four longitudinal compartments:
the first compartment is the largest, includes the other three,
and consists of the area surrounded by the investing layer;
the second compartment consists of the vertebral column,
the deep muscles associated with this structure, and is the
area contained within the prevertebral layer;
the third compartment (the visceral compartment) contains
the pharynx, the trachea, the esophagus, and the thyroid
gland, which are surrounded by the pretracheal layer;
finally, there is a compartment (the carotid sheath)
consisting of the neurovascular structures that pass from the
base of the skull to the thoracic cavity, and the sheath
enclosing these structures receives contributions from the
other cervical fascias

FASCIAL SPACES

Between the fascial layers in the neck are spaces that may provide a
conduit for the spread of infections from the neck to the mediastinum.
Three spaces could be involved in this process:
1.pretracheal space the first is the pretracheal spacebetween the
investing layer of cervical fascia (covering the posterior surface of
the infrahyoid muscles) and the pretracheal fascia (covering the
anterior surface of the trachea and the thyroid gland), which passes
between the neck and the anterior part of the superior mediastinum;
2.the second is the retropharyngeal spacebetween the
buccopharyngeal fascia (on the posterior surface of the pharynx and
esophagus) and the prevertebral fascia (on the anterior surface of
the transverse processes and bodies of the cervical vertebrae),
which extends from the base of the skull to the upper part of the
posterior mediastinum
3.the third spaceis within the prevertebral layer covering the anterior
surface of the transverse processes and bodies of the cervical
vertebrae. This layer splits into two laminae to create a fascial space
that begins at the base of the skull and extends through the
posterior mediastinum to the diaphragm

Review Questions
1) Describe the boundaries, sub divisions
and their respective contents of the
posterior triangle of the neck
2) Write short notes on:
External jugular vein
Cervical plexus
Pretracheal fascia

3) Describe the attachments, extents,

enclosures and applied anatomy of the
investing cervical fascia

THYROID GLAND
POSITION:

Antero- inferior part of the neck

Isthmus is midline between
second and fourth tracheal rings
The lobes are antero-lateral
between C4 and C6
Lobes are between trachea and
esophagus medially and carotid
sheath laterally.
Deep to platysma and strap
muscles.

1.
2.
3.
4.
5.

Isthmus
Left lobe of thyroid gland
Right lobe of thyroid gland
Cricothyroid
Right common carotid
artery
6. Vagus nerve
7. Thyroid cartilage
8. Cricoid cartilage

Relations of thyroid gland:

ISTHMUS

Anteriorly- Strap muscles, anterior jugular vein

Posterior -Second to fourth tracheal rings
Laterally -Continous with lobes
Superiorly -Anastomosis of superior thyroid
artery
Inferiorly -Anastomosis of inferior thyroid artery

Relations of thyroid gland:

LOBES

Antero laterally -Strap muscles,

anterior jugular veins
Posterior -Parathyroid glands,
prevertebral muscles.
Postero-laterally Carotid sheath
and its contents

common carotid artery (4),

internal jugular vein (5) ,
vagus nerve (6). The
sympathetic chain is nearby.
Medially Larynx(1) pharynx and
external laryngeal nerve above,
trachea,
oesophagus(2) and recurrent
laryngeal nerve below.

Blood supply:
Arterial

Inferior thyroid artery 2

from the thyrocervical trunk

Superior thyroid artery

1from the external carotid
artery.

Occasional (unpaired)
thyroidea ima (middle thyroid)
from brachiocephalic trunk .

Several unnamed twigs from

pharyngeal and tracheal
vessels.

All these arteries anastomose

with each other.

Venous

Superior thyroid vein

(A) Internal jugular vein
Middle thyroid vein
(B) Internal jugular vein
Inferior thyroid vein
(C) Brachio cephalic
vein.
The inferior thyroid veins
cover the trachea inferior
to the thymus. They
constitute potential
sources of haemorrhage in
tracheostomy

Lymphatic drainage:

Inferior deep cervical

lymph nodes [1].
Prelaryngeal lymph
nodes[2]

Paratracheal lymph
nodes[3].

Pretracheal lymph nodes.

[4]
Parasternal lymph nodes.
Some may empty directly
into the thoracic duct.

Innervation of thyroid:

Autonomic innervation from the cervical

sympathetic ganglia and vagus. This
innervation is vasomotor and affects the
gland indirectly through the action on
blood vessels.

Thyroid gland and

its arterial supply

When the strap

muscles are
reflected, you can
see the thyroid gland
(tg) with its arteries
(superior thyroid
artery from the
external carotid (sta)
and the inferior
thyroid artery from
the thyrohyoid trunk
from the subclavian
(ita).

If the thyroid gland is

reflected laterally,
the structures
making up the larynx
and trachea are
seen:
thyrohyoid membrane
(thm)
thyroid cartilage
(Adam's apple)(tc)
cricothyroid
membrane and
ligament (ctm)
cricoid cartilage (cc)
tracheal rings (tr)

Cartilages and membranes

Anterior View of Thyroid Gland

The thyroid gland is

hidden under the
sternohyoid and
sternothyroid muscles
and consists of two
lobes and an isthmus.
An occasional pyramidal
lobe extends upward
near the mid line.
The inferior thyroid
artery is closely
associated with the
recurrent laryngeal
nerve (rln).

Deep Surface of Thyroid

Gland

Four small reddishbrown pea-sized glands

may be seen on the
deep surface of the
thyroid gland.
These are the superior
and inferior parathyroid
glands (ptg).
Also note the close
relationship of the
recurrent laryngeal
nerves to the thyroid
gland and inferior
thyroid artery (rln, ita).

Applied anatomy of thyroid

gland
Thyroglossal duct cysts (TDC): May develop
from a persistent thyroglossal duct anywhere
along the course of the duct. The cysts may be
in the tongue in the midline of the neck or
retrosternal. TDC move up with protrusion of
the tongue
Thyroglossal duct sinuses: Are openings
into the skin from a patent part of the
thyroglossal duct. They usually open in the
neck and could be due to perforation of the
cyst following infection.
Ectopic thryoid gland: Could be in the
tongue, larynx, retrosternal or hyoid region.

 Goitre:
This is an enlargement of the thyroid gland. It
could be due to iodine deficiency, hormone or
enzyme defect, infection or tumor. May be
associated with hyperfunction or
hypofunction .
(What are the features of each?)
Besides, goitre causes compression of the
following:
Trachea: affecting breathing.
Oesophagus: affecting swallowing.
Recurrent laryngeal nerve: affecting voice.
A retrosternal goitre is worse for there is no
space for expansion.

Thyroid gland in its capsule is enclosed by

pretracheal fascia, which attaches inter alia to
the hyoid bone. Thus, the thyroid gland moves
upwards with swallowing and speech. This is a
good test for masses in the neck.
Thyroglossal cysts move when the tongue is
protuded due to the attachment of the
thyroglossal duct to the tongue.
The inferior thyroid artery runs close to
the recurrent laryngeal nerve near the gland.
Thus, the artery should be ligated further
laterally to avoid injury to the nerve.

The superior thyroid artery is closer to the

external laryngeal nerves superiorly than near
the gland. Thus, this artery can be ligated as
close to the gland as possible without danger
of injury to the nerve.
In thyrodectomy, the recurrent laryngeal
nerve must be preserved. The parathyroids
must be identified and at least one spared.
Since colossal sizes of goitre may damage
the recurrent laryngeal nerve, it is good habit
to do laryngoscopy before thyroidectomy, so
that pre-operative damage can be
distinguished from post-operative damage.

Clinical Considerations

The cricothyroid ligament and membrane

are frequently pierced in emergency
situations to open the airway.
It has been known that an empty ballpoint pen or a hollow stem has been used
in the field to save lives, where an air
passage has been closed above this
region.

ROOT OF THE NECK

STRUCTURES AT THE ROOT OF THE NECK
Brachio cephalic trunk
Subclavian artery and its branches
Subclavian vein
Termination of internal jugular vein
Thoracic duct
Apex of lung
Phrenic nerve
Vagus nerve

Contents:1)The arteries:

The brachiocephalic trunk.

Right common carotid.
Right subclavian.
May also give thyroidea ima.

Left subclavian artery.

Divided into 3 parts by scalenus anterior muscle.

Part 1:
Medial to the muscle and gives 3 branches:
Vertebral artery : Enters foramen transversarium at C6
Thyrocervical trunk : Inferior thyroid artery, transverse cervical
artery and suprascapular artery.
Internal thoracic artery.

Part 2:
Posterior to the muscle and gives 1 branch, the costocervical trunk
which gives superior intercostal and deep cervical arteries.

Part 3:
Lateral to the muscle, usually giving one branch (dorsal scapula). It
may also occasionally give the suprascapular artery.

1.
2.

3.
4.

5.
6.
7.
8.

Vertebral
Transverse
cervical
Inferior thyroid
Transverse
cervical
Costocervical
Suprascapular
Deep cervical
Highets
intercostal

Relevance of subclavian
artery branches to respiration
Branch
Vertebral

Distribution relevant to
respiration
Respiratory

center in the midbrain

Cervical cord segments that give
phrenic nerve

Internal thoracic

Intercostal

muscles
Ribs and sternum
Thoracic diaphragm
Phrenic nerve
Abdominal wall

Supreme Intercostal

1st

Inferior thyroid

Trachea

two ribs

Larynx
Cervical

portion of spinal cord

Transverse Cervical

Trapezium

Suprascapular artery

Clavicle

and Scapula muscles

and scapula to which

accessory muscles are attached

Contents: 2)The veins:

External jugular veins.

Anterior jugular veins: These either drain into the
external jugular or subclavian vein.
The two veins are joined by the jugular venous arch, but
could unite to form a single trunk in the midline of the
neck. These veins have no valves.
The subclavian vein: A continuation of the axillary
vein. This vein usually has only one named tributary, the
external jugular vein. The veins that correspond to the
arterial branches either drain into the external jugular or
brachiocephalic vein.
The internal jugular vein, in the carotid sheath. The
internal jugular vein and subclavian veins unite to from the
brachiocephalic vein.

Contents 2:Nerves
The Vagus Nerve:

This is cranial nerve 10. Located

between common carotid and the
internal jugular vein. This nerve gives
the following branches in the neck:
1.
Meningeal nerve: Recurrent to the
dura.
2.
Auricular nerve: Anastomoses with
similar branches from the
glossopharyngeal and facial nerves and
supplies the pinnae and external
auditory meatus.
3.
Pharyngeal nerves: Join the
pharyngeal plexus.
4.
Superior laryngeal nerve: Divides into
internal laryngeal and external
laryngeal.
5.
Recurrent laryngeal nerve:
6.
Cardiac branches: Cardiac plexus.

The Phrenic Nerve:(C3, 4, 5 )

Root value :

C3, C4, C5
Course

Descends obliquely on the anterior surface of scalenus anterior

muscle

Crosses first part of sub clavian artery on the left

Crosses posterior to sub clavian vein on both sides

Lies anterior to the internal thoraci artery

Goes through thoracic inlet

Distribution

Parietal pericardium

Parietal pleura

Thoracic diaphragm

Biliary apparatus

4)Sympathetic Trunk

From T1 to T4. There are 3 ganglia, lies on pre-vertebral fascia behind

carotid sheath
Inferior cervical ganglion: At the level of the superior border of the
neck of the first rib. It is commonly fused with the first thoracic ganglion
to form cervicothoracic ganglion (Stellate ganglion).
Middle cervical ganglion: On the anterior aspect of the inferior thyroid
artery , at the level of cricoid cartilage pm the posterior aspect of
inferior thyroid.
Superior cervical ganglion: Located at the level of the axis and atlas /
(C1/ C2) / angle of mandible.
From these ganglia, postganglionic fibres reach their targets in four
principal ways:

Joining spinal nerves.

Joining cranial nerves.
Forming plexuses on blood vessels
Directly.
Provides secretomotor innervation to blood vessels and glands of the head and neck

Lymphatics

There are lymph nodes within the carotid

sheath, along the internal jugular vein.
Another group runs along the transverse
cervical artery. These, deep cervical lymph
nodes are divided into superior and inferior,
relative to the omohyoid muscle.
The efferents drain into the jugular lymph
trunk, which drains into the right lymphatic
duct, or the thoracic duct. Both of these ducts
enter the venous system, at the junction of the
subclavian and the internal jugular veins.

The parathyroid glands

They are small, yellowishbrown endocrine glands

Located posterior to the
thyroid, in their own
capsule, but sharing the
same fascial investment.
The superior are thought to
originate in the 4 th
pharyngeal pouch.
The superior ones are
consistent in position.
The inferior are inconsistent
and could be found in the
anterior mediastinum.

Blood supply

Usually by the inferior thyroid arteries but may be

supplied by the superior thyroid arteries or from
longitudinal anastomosis between superior and
inferior thyroid arteries.

The veins drain into the thyroid plexus of the veins on

the anterior surface of the thyroid.
Lymphatics of the Parathyroid glands
Inferior deep cervical lymph nodes.
Paratracheal lymph nodes.

The lymph vessels from here end in the thoracic duct.

Innervation of the parathyroid glands
Autonomic from the cervical sympathetic chain (and
vagus). These are vasomotor.

Functions of parathyroid
glands

The parathyroid glands are essential for

regulation of blood calcium.
(What are the functions of calcium in the
body?)
They are in danger of being destroyed or
removed during thyroidectomy. Surgeons
usually leave bits of the thyroid
posteriorly or identify and preserve at
least one of them.

The Midline of the Neck

Hyoid bone
Thyrohyoid membrane
Thyroid cartilage
Cricothyroid membrane
Cricoid cartilage 2
Crico-tracheal ligament
Thyroid gland isthmus
Tracheal rings
Jugular venous arch.
It is important to identify these
important midline structures.
(When and where is
tracheotomy and
laryngectomy done? What
structures may be injured?)

Cervical esophagus
Position
Continuous with
laryngopharynx at
pharyngo esophageal
junction
Starts at lower border of
cricoid cartilage (C6
vertebrae) and ends at
thoracic inlet
In the median plane
Inclines slightly to the left

Relations Cervical
esophagus
Anterior

Trachea
Recurrent
laryngeal nerve
in
tracheoesophag
eal groove

Posterior

Longus coli
Body of C7

Right

Right lobe of
thyroid
Right carotid
sheath
Apex of right
pleura

Left

Left lobe of
thyroid
Left carotid
sheath
Left
subclavian
artery
Apex of left
pleura
Thoracic duct

Musculature
Voluntary muscle
Outer longitudinal and inner muscle
Cricopharyngeal fibres of inferior constrictor act as a
sphincter
Blood supply
Segmental anastomosing esophageal branches of inferior
thyroid artery
Veins drain into inferior thyroid vein
Lymphatic drainage
Para tracheal nodes
Inferior deep cervical lymph nodes
Innervation
Somatic motor and sensory: Recurrent laryngeal nerve
Vasomotor: Inferior cervical sympathetic ganglion
through plexus on inferior thyroid artery

Cervical trachea
Position
Found in the midline of
the lower neck
Continues from larynx
into thoracic trachea
Extends from lower edge
of cricoid cartilage (C6)
to thoracic inlet at T1
Inclines backwards as it
descends

Relations
Anterior
Isthmus

of thyroid gland occassionaly

pyramidal lobe and thyroidea ima if present
Inferior thyroid vein
Jugular venous arch
Sternohyoid and sternothyroid muscles
In babies left brachiocephalic vein and
pleurae

Posterior

Esophagus
Recurrent laryngeal nerve and inferior
thyroid artery
Lateral
Lobes of thyroid gland
Carotid sheath and its contents
Brachiocephalic trunk on the right side

Blood supply
Inferior thyroid artery
Inferior thyroid vein
Lymphatic drainage
Pre tracheal nodes
Paratracheal nodes
Inferior deep cervical nodes
Innervation

Sensory - Recurrent laryngeal nerve

Sympathetic- Inferior cervical ganglion

Diagnosis (metastatic lymph node)

Lymph node groups with the most
likely sites of the primary lesion.

Review Questions
1.

2.

3.

4.

5.

6.

Give an account of the boundaries , contents and applied

anatomy of the various subdivisions of the anterior triangle of
the neck
Describe the location , extents , relations , blood supply and
lymphatic drainage of the thyroid gland. Add notes on the
clinical importance of the topographic relations of the arteries
and nerves of the thyroid
State the boundaries , contents and clinical relevance of the
scalene triangle and the triangle of the vertebral artery
Give an account of the course ,origin,relations and distribution
of the vagus nerve in the neck
Describe the origin , course and distributions of the vertebral
artery . Add a note on the clinical importance.
Discuss the distribution of the first part of the subclavian artery