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1The Neck by Prof. S. Malik, ProF. Wagner+ Dr. AyatCompartment:1-vertebral ;cervical vertebrae, postural muscles.2-viscera;thyroid, parathyroid, larynx ,pharynx, trachea & esophagus.3-vessels,two common carotid, two internal& external carotids+ two vagi& accessory nerves. Three V.M.C.Qs.The neck compartment are all the following except one sentence is wrong ?A-vertebral compartment. B visceral compartmentC-vessels compartment & trigeminal nerve.D-vessels compartment with vagi..,

Answer The neck compartment are all the following except one sentence is wrong ?A-vertebral compartment. B visceral compartmentC-vessels compartment & trigeminal nerve.D-vessels compartment with vagi. c vessels &trigeminal nerve

M.C.Qs.The superior boundaries of the neck including the following except one wrong ?A-inferior boundary of the mandibleB- mastoid processC-highest nucheal lineD-external occipital protuberanceAnswer The superior boundaries of the neck including the following except one wrong ?A-inferior boundary of the mandibleB- mastoid processC-highest nucheal lineD-external occipital protuberance

. The neck (L. collum, cervix) is the transitional area between the head superiorly and the clavicles inferiorly that joins the head to the trunk and limbs.82. It serves as a major passage for structures passing between them.3. In addition, several important organs with unique functions are located here: the larynx and the thyroid and parathyroid glands, for example.

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Skin of the neck and its contentsM.C.Qs.The innervations of the skin of neck including the following which all are correct except one is wrong?A-greater auricular & lesser occipital nerves.B-greater occipital& transverse cervical .C-supraclavicular nerves &third occipital D-transverse cervical &ophthalmic nerveAnswerThe innervations of the skin of neck including the following which all are correct except one is wrong?A-greater auricular & lesser occipital nerves.B-greater occipital& transverse cervical .C-supraclavicular nerves &third occipital D-transverse cervical & ophalamic nerves

Superficial fascia and its contentsPlatysma muscle: muscle of depression of mandible& gravity +other musclesOrigin: skin of pectoral regionInsertion: lower border of the mandible and angle of mouseN.S: facial nerveAction: depress angle of the lips second branchial arche

External jugular vein

Superficial veins

Begin: just behind angle of the mandible by union of posterior auricular vein and post.division of the retromandibular veinEnd: drain into subclavian tributaries vein1-Suprascapular &transverse cervical 2. ant. Jugular veinM.C..Qs.The platysma muscle the following are correct except one sentence is wrong?A-it is origin from pectoral regionb- inserted to the lower border of the mandible.C-innervated by facial nerved-it s action is elevation of the mandible.Answer

The platysma muscle the following are correct except one sentence is wrong?A-it is origin from pectoral regionb- inserted to the lower border of the mandible.C-innervated by facial nerved-it s action is elevation of the mandible.

M.C.Qs.The external jagular vein is a vein of the neck it is uesd for intravenous infusion the following are true except one sentence?A-it is formed by union of facial vein with anterior division of the retromandibular vein.B-it s blood reach to the heartC-The wall attached to the roof of the posterior triangleD-the tributeries are anterior jagular vein, transverse cervical &suprscapular veins. AnswerThe external jagular vein is a vein of the neck it is uesd for intravenous infusion the following are true except one sentence?A-it is formed by union of facial vein with anterior division of the retromandibular vein.B-it s blood reach to the heartC-The wall attached to the roof of the posterior triangleD-the tributeries are anterior jagular vein, transverse cervical &suprscapular veinsTributaries of E.J.V and ant. J.V.

M.C.Qs.The previous picture showing the following are true except one is wrong?A-anterior jaguar veinsB-sternomastoid musclesC-suprahyoid musclesD- buccinator muscles.Answer

The previous picture showing the following are true except one is wrong?A-anterior jaguar veinsB-sternomastoid musclesC-suprahyoid musclesD- buccinator muscles.Deep cervical fascia

Important notesLayers of deep cervical fascia: investing layer, pretracheal, prevertebral and carotid sheathInvesting layer of deep fascia encloses sternomastoid and trapezius musclesContents of carotid sheath: CCA and ICA, IJV and vagus nerveM.C.QsThe fascia of the neck showing the following are true except one sentence is wrong? a- investing layer surrounding the sterrnocleidomastoid & trapezius. b- the carotid sheath containing common carotid ,internal jugular vein & vagus nerve c- the prevertebral fascia surrounding the prevertebral muscles.. d- the pretracheal fascia does not ensheathing the thyroid gland .

AnswerThe fascia of the neck showing the are true except one sentence is wrong? a- investing layer surrounding the sterrnocleidomastoid & trapezius. b- the carotid sheath containing common carotid ,internal jugular vein & vagus nerve c- the prevertebral fascia surrounding the prevertebral muscles.. d- the pretracheal fascia does not ensheathing the thyroid gland

29Sternomastoid muscleMajor muscles of the neckTrapezius

Recall of relevant structuresLateral muscles of the neckSternomastoid muscleOrigin : a) Sternal head: Rounded and tendinous from front of manubrium.b) Clavicular head: Thin and fleshy from upper surface of med. ofclavicle.Insertion : Mastoid process and lateral of the superior nuchal line.Action : 1- Unilateral contraction directs the face to opposite side.2- Bilateral contraction tilt the head backwards.Nerve Supply : spinal accessory n.* Injury to the muscle leads to it contracture and shortening Torticollis.The oblique position of the sternomastoid divides the side of the neck into anterior and posterior triangle.Sternomastoid muscle .origin, insertion, nerve supply & action

A note about the scalene muscles :Scalenus anteriorScalenus mediusScalenus posteriorOrigin : transverse processes of cervical vertebrae .Insertion : first and second ribs .Action : 1- Lateral flexion of neck .2- Fixation of ribs during forced inspiration .Nerve supply : cervical and brachial plexuses .. The subclavian vein passes infront the of scalenus anterior . The subclavian artery and brachial plexus pass between scalenus anterior and scalenus medius .Muscluar triangles of the neck

POSTERIOR TRIANGLE BOUNDARIES

Trapezius muscleSternomastoid muscleclaviclePOSTERIOR TRIANGLEBoundaries:- In front Posterior border of sternomastoid m.- Behind Anterior border of trapezius m.- Apex Middle of superior nuchal line.- Base Middle of the clavicle.Roof- Skin.- Superficial fascia.- Deep (investing) fascia of the neck.The superficial fascia of the posterior triangle contains the following :(1) Platysma m. : (a subcutaneous m.)(2) External Jugular vein (3)The cutaneous branches of the cervical plexusFloor: From upwards below :a) Splenius capitis. b) Levator scapulae. c) Scalenus medius.Posterior triangle, roof , floor, bounderies & contentsM.C.Qs.TrueThe roof of the posterior triangle containing the following which is except one structure ? A-skinb-fascia superficial& investing cervical fascia.c- omohyoid muscle.D-platysema muscle AnswerThe roof of the posterior triangle containing the following which is correct except one structure ? A-skinb-fascia superficial& investing cervical fascia. c- omohyoid muscle.D-platysemaContents:Arteries 1- Third part of subclavian a. 2- Suprascapular a.3- Superficial (or transverse) cervical a.4- Occipital a. (near the apex).Veins 5- Subclavian v., receiving its only tributary, the external jugular v.Nerves 6- Roots and trunks of brachial plexus.7- Spinal accessory n. (runs on levator scapulae).L.Ns. 8- Occipital L.N. (at the apex with the occipital a.).9- Supraclavicular L.N. (at base with the subclavian a.).Ms. 10- Inferior belly of omohyoid .

Accessory nerve (Primarily a motor nerve)Formed from a cranial root emerging from the medulla and a spinal root arising from the superior region of the spinal cordThe spinal root passes upward into the cranium via the foramen magnumThe accessory nerve leaves the cranium via the jugular foramen and divided again into cranial root join the vagus nerve and spinal root

Cranial root: Supplies fibers to the larynx, pharynx, and soft palateSpinal root: Innervates the trapezius and sternocleidomastoid, which move the head and neck

M.C.QsThe accessory nerve showing the following are true except one sentence is wrong ?A- supply larynx& pharynx.B-soft palateC-spinal root supply sternomastoid &trapezius musclesD-anterior belly of the digastric muscle.

Answer :

The accessory nerve showing the following are true except one sentence is wrong ?A- supply larynx& pharynx.B-soft palateC-spinal root supply sternomastoid &trapezius musclesD-anterior belly of the digastric muscle

OMOHYOID MUSCLE

DIVISION OF POSTERIOR TRIANGLE

Occipital triangleSupra (sub) clavicularANTERIOR TRIANGLE

ANTERIOR TRIANGLE Boundaries : Anteriorly Middle line of the neck. Posteriorly Ant. border of sternomastoid. Base (above) Lower border of mandible. Apex (below) Suprasternal notch. Roof:1- Skin.2- Superficial fascia (+ its contents).3- Investing ( deep ) fascia.Contents of the Superficial Fascia of the Roof:a- Platysma muscle.b- Transverse cervical n.c- Anterior jugular v. : It is formed by the union of the submental veins descendsin the superficial fascia near the middle line pierces the deep fascia above thesternum passes deep to the sternomastoid ends in the external jugular v. Thedeep parts of both anterior jugular veins are connected together by jugular arch. Subdivisions : 3 triangles . See the table .M.C.Qs.The boundaries of the anterior triangle consisted of the following all incorrect except one sentence is correct?A-anterior border of the trapezius muscle.Banterior border of the sternomastoid muscle.C-upper border of the mandible ;alveolar process.D-inferior belly of omohyoid muscleanswerThe boundaries of the anterior triangle consisted of the following all incorrect except one sentence is correct?A-anterior border of the trapezius muscle.Banterior border of the sternomastoid muscle.C-upper border of the mandible ;alveolar process.D-inferior belly of omohyoid muscle

DIGASTRIC MUSCLE

Muscle OrigineInsertionNerve supply actionDigastric musclepost. belly: Mastoid process of temporal bone ant. belly: Body of mandible

Intermediate tendon is held to hyoid by fascial slingpost. belly: facial nerveant belly: nerve to mylohyoid

Depresses mandible or elevates hyoid boneMylohyoid muscle

Muscle OrigineInsertionNerve supply actionMylohyoid muscle Mylohyoid line of body of mandibleBody of hyoid bone and fibrous rapheInferior alveolar nerveElevates floor of mouth and hyoid bone or depresses mandible2- geniohyoid 3- stylohyoid muscles

Inferior mental spineMuscle OrigineInsertionNerve supply actionGeniohyoid Genial tubercle of the mandible Body of hyoid boneHypoglossal nerveDepresses mandible or elevates hyoid boneStyloyoid Styloid process Hyoid boneFacial nerve with post. Belly of digastricElevate hyoid bone

Mylohyoid

Geniohyoid

Hyoglossus

The suprahyoid musclesthe muscles of the floor of the mouthRecall of relevant structuresMuscle OrigineInsertionNerve supply actionDigastric musclepost. belly: Mastoid process of temporal bone ant. belly: Body of mandible ,digastric fossa

Intermediate tendon is held to hyoid by fascial sling;2nd pharyngeal archpost. belly: facial nerveant belly: nerve to ;mylohyoidFirst pharyngeal arche Depresses mandible or elevates hyoid boneMylohyoid muscle Mylohyoid line of body of mandibleBody of hyoid bone and fibrous raphe, nerve to mylohyoid from Inferior alveolar nerveElevates floor of mouth and hyoid bone or depresses mandibleHyoglossus muscleHyoid bonePost. of the side of the tongueHypoglossal nerveDraw the tongue downwards and help sucklingGenoglossus Geniohyoid Upper genial tubercleGenial tubercle of the mandible Anterior part of the tongueBody of hyoid boneHypoglossal nerveC1 via Hypoglossal nerveProtrude the tongue.Depresses mandible or elevates hyoid boneStyloyoid Styloid process Hyoid boneFacial nerve with post. Belly of digastricElevate hyoid boneSuprahyoid musclesRecall of relevant structuresExternal muscles of the tongue

Genioglossus muscleM.C.QsSuddivisions of ANTERIOR TRIANGLE

Enumerate main contents of submandibular (digastric) triangule and give short account on one of them Muscles: suprahyoid muscles (mylohyoid muscle), geniohyoid, stylohyoid, digastric and hyoglossus musclesGlands: submandibular salivary glands & L.N.Nerves: nerve to mylo-hyoid muscle, hypoglossal nerves and Submandibular ganglionVessels: facial artery& veinOther structure deep to diaphragma oris (mylohyoid muscle)Muscles: geniohyoid, hyoglossus musclesgenioglossusGlands: deep part of submandibular gland&Sublingual salivary glandNerves: Submandibular ganglionLingual nerveVessels: lingual vessels

Facial vesselsSubmandibular ganglionLingual nerveSublingual salivary glandHypoglossal nerveLingual vesselsNerve to mylohyoid muscleSubmandibular salivary glandAs regard the mylohyoid muscle there is one true sentence ?A-two salivary gland above three below.B-innervated by facial.C-forming the diaphragma orisD-digastric muscle lying above.

As regard the mylohyoid muscle there is one true sentence ?A-two salivary gland above three below.B-innervated by facial.C-forming the diaphragma orisd-digastric muscle lying above or deep to the mylohyoid muscleMuscle OrigineInsertionNerve supply actionDigastric musclepost. belly: Mastoid process of temporal bone ant. belly: Body of mandible

Intermediate tendon is held to hyoid by fascial slingpost. belly: facial nerveant belly: nerve to mylohyoid

Depresses mandible or elevates hyoid boneMylohyoid muscle Mylohyoid line of body of mandibleBody of hyoid bone and fibrous rapheInferior alveolar nerveElevates floor of mouth and hyoid bone or depresses mandibleHyoglossus muscleHyoid bonePost. of the side of the tongueHypoglossal nerveDraw the tongue downwards and help sucklingGeniohyoid Genial tubercle of the mandible Body of hyoid boneHypoglossal nerveDepresses mandible or elevates hyoid boneStyloyoid Styloid process Hyoid boneFacial nerve with post. Belly of digastricElevate hyoid bonesuprahyoid musclesEnumerate main contents of carotid triangule and give short account on one of them ? Carotid sheath: CCA, ICA, IJV and vagus nerveExternal carotid arteryHypoglossal nerveAnsa cervicalis Sympathetic trunkThe ansa cervicalis lying over the carotid sheath.Mention the contents of the carotid sheath?

ANSA CERVICALIS It is a nervous loop situated in front of the carotid sheath. It is formed by union of 2 limbs :A) Superior limb : Descending from the hypoglossal n. and containing fibers of C1 spinal nerve .B) Inferior limb : From C2 and C3 spinal nerves . Branches : arise from the tip supply all infrahyoid muscles (near their lower ends) except thyrohyoid.innervated by C1 via hypoglossal nerve.

M.C.Qs.As regards the ansa cervicalis showing the following all correct except a-formed by two loops.B-innervate the infrahyoid muscle except the thyrohyoid muscle.C-it is inside the corotid sheath.D-Its root value c1 -3 Answer

As regards the ansa cervicalis showing the following all correct except a-formed by two loops.B-innervate the infrahyoid muscle except the thyrohyoid muscle.C-it is inside the corotid sheath.D-Its root value c1 -3 Enumerate main contents of muscular triangule and give short account on one of them Infra hyoid muscles

M.C.Qs.The following sentence all are correct except one is incorrect?A- the infrahyoid muscles are innervated by the ansa cervicalis c1-3.b-depress the hyoid bone down.

C-the omohyoid muscle make the roof of the posterior triangle tight so help the internal jagular vein open(patency).D-the thyrohyoid muscle inverted directly from the ansa cervicalis

AnswerThe following sentence are correct except one sentence is incorreta-the infrahyoid muscles innervated by anasa cervicalis b- all infrahyoid muscles depress the hyoid bone.C-the omohyoid muscle make the roof of the posterior triangle tight so help the internal jagular vein open(patency).D-the thyrohyoid muscle inverted directly from the ansa cervicalis

Enumerate main contents of submental triangule and give short account on one of them Submental LNAnterior jugular vein