Lecture Notes - Larynx and Neck
The Lab Overview, a narrated PowerPoint presentation, is available on the web (password protected).
  1. Bony landmarks and Surface Anatomy
    • Cranial base
      • Foramen magnum
      • Jugular foramen
      • Carotid canal
      • Occipital condyles
      • Hypoglossal canal
      • Styloid process
      • Pharyngeal tubercle
      • Mastoid process
    • Mandible
      • Mental protuberance
      • Angle
    • Hyoid bone
    • Thyroid cartilage, laryngeal prominence
    • Cricoid cartilage
    • Trachea
    • Jugular notch
    • First rib
      • Grooves for subclavian artery and vein
  2. Cervical triangles:
    • Anterior - Sternocleidomastoid, trapezius, mandible and midline
      • Muscular - midline, sup. belly omohyoid, sternocleidomastoid
      • Carotid - post. belly digastric, sup. belly omohyoid, sternocleidomastoid
      • Submandibular - ant. and post. bellies of digastric, body of mandible
      • Submental - both ant. bellies of digastrics, hyoid bone
    • Posterior - Trapezius, sternocleidomastoid, clavicle
      • Subclavian (Omoclavicular) - inf. belly omohyoid, clavicle, sternocleidomast.
      • Occipital - trapezius, sternocleidomastoid, inf. belly omohyoid
  3. Organization of fascial layers:
    • Superficial - subcutaneous tissue - contains platysma muscle and cutaneous veins and nerves
    • Deep cervical fascia:
      • Superficial (investing) layer of deep cervical fascia - encloses trapezius and sternocleidomastoid.
      • Infrahyoid (muscular) fascia - deep to sup. layer of deep, encloses infrahyoid (strap) muscles
      • Carotid sheath - encloses carotid arteries, int. jugular v. and vagus n.
      • Visceral fascia - encloses trachea, esophagus & thyroid
        • Pretracheal - anterior, encloses thyroid and parathyroids
        • Buccopharyngeal - back of pharynx
      • Retropharyngeal space - interfascial plane between visceral and prevertebral
      • Prevertebral fascia - encloses vertebral column and associated. m. (scalenes, etc.) roots of brachial and cervical plexi, sympathetic trunk.
  4. Muscles:
    • Platysma: subcutaneous, muscle of facial expression
    • Sternocleidomastoid and trapezius muscles
    • Infrahyoid (strap): act on larynx and pharynx
      • Omohyoid (superior & inferior bellies)
      • Sternohyoid
      • Sternothyroid
      • Thyrohyoid
    • Scalene muscles & Interscalene Triangle
      • Anterior scalene
      • Middle scalene
      • Posterior scalene
    • Cricothyroid (laryngeal muscle)
  5. Nerves:
    • Cervical plexus:
      • Roots (C1-4)
      • Sensory (cutaneous): all emerge from posterior border of sternocleidomastoid m.
        • Lesser occipital
        • Great auricular
        • Transverse cervical
        • Supraclavicular
      • Motor branches
        • Ansa cervicalis
        • Phrenic
    • Cervical branch of facial n. (CN VII) to platysma
    • Vagus nerve (X) branches
      • External branch of superior laryngeal n. to cricothyroid
      • Internal branch of superior laryngeal n. goes to interior of larynx
      • Recurrent laryngeal (right and left)
    • Hypoglossal nerve (XII) - motor to tongue
    • Accessory (XI)
    • Cervical sympathetic trunk
      • Superior cervical ganglion
      • Middle cervical ganglion
      • Carotid nn. (internal & external, plexus)
    • Brachial plexus
      • Roots (C5-T1)
        • Dorsal scapular n.
        • Long thoracic n.
      • Trunks
        • Suprascapular n.
  6. Blood Vessels:
    • Superficial veins
      • External jugular
      • Anterior jugular
      • Communicating
      • Jugular venous arch
    • Deep veins
      • Internal jugular v. - in carotid sheath
      • Subclavian
    • Common & external carotid arteries
      • Superior thyroid a.
    • Subclavian artery (3 parts)
      • 1st part (3 branches)
        • Vertebral
        • Thyrocervical trunk
          • Inferior thyroid
          • Transverse cervical
          • Suprascapular
        • Internal thoracic
      • 2nd part (1 branch)
        • Costocervical trunk
      • 3rd part (1 branch)
        • Dorsal scapular (variable origin)
  7. Lymphatics:
    • Deep cervical lymph nodes
    • Jugular trunk
    • Thoracic duct
  8. Thyroid gland: endocrine glands control general metabolism, secrete thyroxin
    • Right and left lobes
    • Isthmus - connection between lobes
    • Pyramidal lobe
  9. Parathyroid glands - endocrine glands, spatially related to thyroid gland (NOT functionally)
  10. Cross section of the neck
  11. Carotid sheath, cervical sympathetic trunk, cranial nerves exiting skull base
  12. Pharynx
    • Definition and functions
    • Interior of pharynx (pharyngeal cavity)
      • Nasopharynx
      • Oropharynx
      • Laryngopharynx:
        • laryngeal inlet
        • piriform recesses
    • Musculature of pharynx:
      • Constrictors: superior, middle, inferior
    • Nerve and arterial supply
  13. Larynx
    • Definition and functions
    • Interior of larynx (laryngeal cavity):
      • laryngeal inlet
      • vestibule
      • vestibular folds
      • ventricles
      • infraglottis
    • Quadrangular membrane, conus elasticus
    • Glottis, vocal folds, rima glottidis
    • Cartilages, membranes, joints
    • Intrinsic muscles of larynx
    • Nerve and arterial supply
  14. Clinical Terms:
    • Goiter - enlargement of thyroid gland
    • Tracheostomy - creation of an airway in the trachea, usually an elective procedure
    • Cricothyrotomy - creation of an emergency airway between thyroid an cricoid cartilages
    • Thyroidectomy - removal of thyroid
    • Thyroglossal duct cyst - a cyst along the tract of descent of the thyroid gland
    • Torticollis - torsion or twisting of the neck and elevation of the chin due to shortening of sternocleidomastoid m.