· underlies subcutaneous fat
· surrounds neck like collar
· splits to enclose
· sternomastoid
· trapezius
· meets ligamentum nuchae posteriorly
· attached to hyoid bone
· attached superiorly to
· base of skull to tip of mastoid process
· lower border of mandible
· splits to enclose parotid between
· attached inferiorly to
· spine of scapula
· clavicle
· sternum
· splits to enclose anterior jugular veins, omohyoid and subclavius
· covers trachea
· lies deep to infrahyoid strap muscles
· attached superiorly to hyoid
· splits to enclose thyroid
· fuses laterally with carotid sheath
· blends inferiorly with adventitia of aortic arch
Carotid sheath
· dense feltwork of areolar tissue
· surrounds
· common and internal carotid arteries
· internal jugular vein
· vagus nerve
· attached to base of skull at margins of carotid canal
· continued downwards along vessels to aortic arch
· attached to deep surface of sternomastoid
· here pretracheal fascia blends with it
· lies in front of prevertebral muscles
· extends
· from base of skull (in front of longus capitis and rectus capitis lateralis)
· down to T3 (lower limit of longus colli)
· out over scalenus anterior, medius and levator scapulae
· deep to it are
· cervical roots
· 3rd part of subclavian artery
· superficial to it are
· oesophagus and trachea
· accessory nerve
· subclavian vein
· piercing it are cutaneous branches of cervical plexus
· anterior ramus of C1 passes between and supplies them
Rectus capitis anterior
· from lateral mass of atlas
· to front of foramen magnum
Rectus capitis lateralis
· from lateral mass of atlas
· to jugular process of occipital bone
Origin
· anterior tubercles of C3-C6
· via 4 tendons
Path
· ribbon muscle passes upwards and medially
Insertion
· basiocciput
Nerve supply
· segmentally by anterior rami of C1-4
Upper fibres
· from anterior tubercle of atlas
· to anterior tubercles of C3-5
Lower fibres
· from bodies of T1-3
· to anterior tubercles of C5-6
Triangle
· lateral border makes triangle with medial border of scalenius anterior
· apex is Chassiagnac’s tubercle
· base is 1st part of subclavian artery
· contains
· vertebral artery
· cervical sympathetic trunk
· stellate ganglion
Middle fibres
· from bodies of C2-4
· to anterior tubercles of C5-T3
Nerve supply
· segmentally by anterior rami
· see below
· extends upwards
· across neck of 1st rib (medial to supreme intercostal vein)
· medial to vertebral artery
· in front of pretracheal fascia
· behind carotid sheath
· to superior cervical gangilon
Superior cervical
· large (3 cm long)
· in front of lateral mass of atlas and axis
Middle cervical
· small and inconstant
· medial to carotid tubercle
Inferior cervical
· usually fused to 1st thoracic (see below)
Stellate
· cervicothoracic
· fusion of inferior cervical and 1st thoracic
· large (1 x 0.5 cm)
· lies in front of neck of 1st rib
· connected to middle cervical by ansa subclavia
· passes in front of subclavian artery
Somatic
· as grey rami to C1-C8
Visceral
· to cardiac plexuses
Vascular
· superior ganglion gives branch to internal carotid artery
· called internal carotid nerve
· supplies eyeball (Horner’s syndrome)
Origin
· anterior tubercles of C3-6
· via 4 tendons
· tendons end-to-end with longus capitis
Path
· passes forwards and laterally
· covered by prevertebral fascia
Insertion
· 1st rib
· on scalene tubercle on inner border
Nerve supply
· segmentally by anterior rami of C3-C8
Anterior relations
Deep to prevertebral fascia
· phrenic nerve
· plastered to front by prevertebral fascia
· leaves medial border
· passes between subclavian artery and vein
· ascending cervical artery
· branch of thyrocervical trunk
Superficial to prevertebral fascia
· transverse cervical and suprascapular arteries
· behind carotid sheath
· vagus nerve
· in carotid sheath
· passes in front of subclavian artery
· right gives off recurrent laryngeal branch which hooks around artery
· internal jugular vein
· subclavian vein
· lies in groove on 1st rib
· in front of (medial to) insertion of scalenius anterior
· joins internal jugular vein at medial border of scalenius anterior
· at angle of confluence is thoracic duct
Medial relations
Triangle
· formed by
· medial edge of scalenius anterior
· lateral edge of longus colli
· superior edge of subclavian artery and neck of 1st rib
· apex is Chassaignac’s tubercle
· crossed by common carotid artery
· contains
· stellate ganglion
· vertebral artery and vein
· crossed by
· inferior thoracic artery
· thoracic duct
Posterior relations
· scalenius medius
· separated from it by
· 2nd part of subclavian artery
· anterior rami of C5-T1
· T1 occupies subclavian groove on 1st rib
Lateral relations
· emerging from lateral border
· trunks of brachial plexus
· 3rd part of subclavian artery
· lie behind prevertebral fascia
· in front of prevertebral fascia
· axillary and subclavian veins
Origin
· posterior tubercles and intertubercular lamellae of C1-7
Insertion
· 1st rib
· quadrangular area between neck and subclavian groove
Origin
· posterior tubercles of C3-7
Path
· passes across outer border of 1st rib
Insertion
· 2nd rib
· arises from
· brachiocephalic trunk on right
· directly from aortic arch on left
· part from origin to medial border of scalenius anterior
· arches over suprapleural membrane
· disappears behind scalenius anterior
Branches
Vertebral artery
· arises at apex
· enters triangular space
· disappears at apex
· enters foramen transversalis of C6
· medial to it
· superiorly is middle cervical ganglion
· inferiorly is inferior cervical (or stellate) ganglion
· connected by ansa subclavius in front of subclavian artery
Thyrocervical trunk
· arises lateral to apex
· divides into
· transverse cervical
· suprascapular
· inferior thyroid
Internal thoracic artery
· arise from lower surface
· enters thorax
· part behind scalenius anterior
Branches
Costocervical trunk
· divides into
· superior intercostal artery
· deep cervical artery
· part from lateral border of subclavius to outer border of 1st rib