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Anatomy Tables - Larynx and Neck
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Anatomy Tables - Larynx and Neck |
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Osteology | |||
|---|---|---|---|
| Bone | Structure | Description | Notes |
| occipital (N8, N9, N11, TG7-05, TG7-06, TG7-07) |
the bone forming the posterior surface of the skull | it articulates superolaterally with the parietal bones through the lambdoid suture, anteroinferiorly with the temporal bone and anteriorly with the body of the sphenoid bone | |
| pharyngeal tubercle (N6, N8, TG7-06) |
projection located anterior to the foramen magnum | attachment site for the superior pharyngeal constrictor m. | |
| jugular notch | a notch located on the anterolateral edge of the lateral part of the occipital bone | it forms the posterior margin of the jugular foramen; the temporal bone forms the anterior margin of the jugular foramen | |
| temporal (TG7-04, TG7-06, TG7-07) | bone forming the lateral side of the skull | (Latin, temporis = of time. Temporal refers the passage of time, which is marked by the appearance of gray hair on the side of the head) | |
| carotid canal (TG7-06) | a canal which courses through the petrous part of the temporal bone | it transmits the internal carotid a. and the internal carotid plexus of nerves into the cranial cavity | |
| styloid process (TG7-06) | the spike of bone that projects inferiorly from the petrous part of the temporal bone | it is the attachment site for the stylohyoid, styloglossus and stylopharyngeus mm. and the stylomandibular and stylohyoid ligaments | |
| mastoid process | the process located posteroinferior to the external acoustic meatus | it projects inferiorly from the junction of the petrous and squamous parts of the temporal bone; it contains the mastoid air cells that open into tympanic cavity through the mastoid antrum (Greek, mastoid = resembles the breast/nipple-like structure) | |
| mandible (N15, TG7-04A) | mental protuberance | forms bone of chin anteriorly | |
| cervical vertebrae (N18, TG1-04) | the seven vertebrae of the neck | cervical vertebrae have the features of the typical vertebra plus all have transverse foramina (for passage of the vertebral artery); C2-C6 have bifid spinous processes; cervical vertebrae have relatively small bodies; several cervical vertebra are named: atlas, axis, vertebra prominens | |
| hyoid (N13, N77, TG7-01, TG7-09, TG7-25, TG7-26) |
a "U"-shaped bone consisting of several parts: body, 2 greater horns, 2 lesser horns | the hyoid bone ossifies completely in middle life; the body articulates with the greater horns via cartilage and with the lesser horns via fibrous joints prior to ossification; an important site for muscle attachments (suprahyoid and infrahyoid muscle groups) (Greek, hyoid = U-shaped) | |
| body | the middle portion of the "U"-shaped bone | the body of the hyoid bone articulates with the greater horns posteriorly | |
| greater horn (cornu) | posteriorly directed limbs of the "U"-shaped bone | each greater horn articulates with the body and lesser horns anteriorly; origin of middle pharyngeal constrictor m. and hyoglossus m. | |
| lesser horn (cornu) | articulates with the greater horn at its junction with the body | the inferior end of the stylohyoid ligament attaches to the lesser horn | |
| thyroid cartilage (N77, N81, TG7-01, TG7-09, TG7-22, TG7-25, TG7-26, TG7-27, TG7-28) |
the large anterior cartilage of the larynx; it has several parts: laminae (2), superior horns (2), inferior horns (2), oblique line, superior thyroid notch, | connected above to the hyoid bone via the thyrohyoid membrane; connected below to the cricoid cartilage via the inferior horn of the thyroid cartilage; connected posteriorly: to the arytenoid cartilage via the vocal ligament and thyroarytenoid m., to the epiglottic cartilage via the thyroepiglottic ligament; it tilts anteriorly to increase the length of the vocal ligament and raise the pitch of the voice | |
| lamina | a broad flat plate of cartilage forming one side of the thyroid cartilage; two laminae fuse anteriorly in the midline to form the thyroid cartilage | the laryngeal prominence is the line of fusion of the two laminae; each lamina is connected superiorly to the hyoid bone by the thyrohyoid membrane (Latin, lamina = a thin plate) | |
| superior horn | the rounded, superior projection of the posterior border of the thyroid lamina | it is connected superiorly to the greater horn of the hyoid bone by the lateral thyrohyoid ligament | |
| inferior horn | the rounded, inferior projection of the posterior border of the thyroid lamina | it is connected inferiorly to the cricoid cartilage by the cricothyroid articulation (a synovial joint) | |
| oblique line | ridge which descends diagonally from superior to inferior on the lateral surface of the thyroid lamina | a line of muscle attachment | |
| laryngeal prominence | the line of fusion of the thyroid laminae | known to the lay person as the "Adam's apple"; the laryngeal prominence is a secondary sexual characteristic - in postpuberal males the angle of the laryngeal prominence is approximately 90o and in females the angle is approximately 120o | |
| superior thyroid notch | the notch at the superior end of the laryngeal prominence | it is connected to the hyoid bone by the median thyrohyoid ligament | |
| cricoid cartilage (N77, N81, TG7-01, TG7-09, TG7-22, TG7-25, TG7-27, TG7-28) |
the inferior and posterior cartilage of the larynx; it forms a complete cartilaginous ring; its arch projects anteriorly and its lamina is broad and flat posteriorly | connected: above to the thyroid cartilage via the inferior horn of the thyroid cartilage, to the conus elasticus, to the arytenoid cartilages which sit atop the lamina; connected below to the first tracheal ring via the cricotracheal ligament (Greek, cricoid = a ring form) | |
| arytenoid cartilage (N77, N81, TG7-27, TG7-28) |
a pyramid shaped cartilage located on the superior margin of the cricoid lamina | paired; each is connected to the epiglottis above via the aryepiglottic m. and to the thyroid cartilage anteriorly via the vocal ligament; paired arytenoid cartilages are pulled together (adducted) by the arytenoid m. (Greek, arytenoid = pitcher appearence, in certain animals, these two cartilages were noted to resemble the mouth of a pitcher with a large spout) | |
| vocal process | projects anteriorly to provide attachment for the vocal ligament | ||
| epiglottis (N77, N81, TG7-22, TG7-25, TG7-27, TG7-28) |
the superior part of the larynx | epiglottic cartilage is covered by a mucous membrane (Greek, epiglottis = the mouth of the windpipe) | |
| sternum (N1, N185, TG4-04) | jugular notch | located in the manubrium of the sternum in the fossa between the sternal heads of the SCM | the suprasternal space and jugular venous arch are located superior to the jugular notch |
| rib 1 (N186, TG4-04) | the most cephalic rib | it is the broadest, shortest and widest of the ribs; the scalene tubercle marks its superior surface and is an elevation between grooves for the subclavian vein & artery; the scalene tubercle is the attachment site of the scalenus anterior m. |
Joints of the Larynx |
||
|---|---|---|
| Joint or ligament | Description | Notes |
| cricoarytenoid joint (TG7-27, TG7-28) |
located between the bases of the arytenoid cartilages and the superolateral surfaces of the cricoid lamina | allows the arytenoid cartilages to slide toward or away from one to another, to tilt anteriorly and posterorly, and to rotate |
| cricothyroid joint (TG7-28) |
located between the inferior horn of the thyroid cartilage and the cricoid cartilage | point of movement for the cricothyroid m., which flexes the larynx |
Muscles | ||||||
|---|---|---|---|---|---|---|
| Muscle | Origin | Insertion | Action | Innervation | Notes | Image |
| platysma (TG7-29) | fascia overlying the pectoralis major and deltoid muscles | inferior border of mandible and skin of lower face | draws corners of mouth down; aids in depression of the mandible | facial nerve (VII), cervical branch | (Greek, platysma = flat plate) | ) |
| digastric (TG7-33) | anterior belly: digastric fossa of mandible; posterior belly: mastoid notch of temporal bone | body of hyoid via fibrous loop over intermediate tendon | elevates hyoid; depresses mandible | anterior belly: mylohyoid nerve, from mandibular division of trigeminal nerve (V); posterior belly: facial nerve (VII) | forms two sides of the submandibular triangle | ) |
| stylohyoid (TG7-21, TG7-34) | posterior border of styloid process | splits around intermediate tendon of digastric to insert on the body of the hyoid bone | elevates and retracts hyoid | facial nerve (VII) | facial nerve innervates both stylohyoid and posterior belly of digastric shortly after exiting from the stylomastoid foramen | ) |
| mylohyoid (TG7-21,TG7-33) | mylohyoid line of mandible | midline raphe and body of hyoid bone | elevates hyoid bone and tongue; depresses mandible | mylohyoid nerve from inferior alveolar nerve, a branch of mandibular division of trigeminal nerve (V) | the nerve to mylohyoid also innervates anterior belly of digastric m. | ) |
| omohyoid (TG7-10, TG7-12) | inferior belly: upper border of scapula medial to scapular notch; superior belly: intermediate tendon | inferior belly: intermediate tendon; superior belly: lower border of hyoid lateral to sternohyoid insertion | depresses/stabilizes hyoid bone | ansa cervicalis | the intermediate tendon of omohyoid is tethered to the clavicle by a fascial sling | ) |
| sternohyoid (TG7-12, TG7-13) | posterior surfaces of manubrium and sternal end of clavicle | lower border of hyoid bone, medial to omohyoid insertion | depresses/stabilizes hyoid bone | ansa cervicalis | sternohyoid overlies sternothyroid and thyrohyoid | ) |
| sternothyroid (TG7-12, TG7-13) | posterior surface of manubrium below sternohyoid origin | oblique line of thyroid cartilage | depresses/stabilizes thyroid cartilage of larynx | ansa cervicalis | sternothyroid lies deep to sternohyoid | ) |
| thyrohyoid (N28,N29,N31, TG7-12, TG7-13) | oblique line of thyroid cartilage | lower border of hyoid bone | elevates larynx; depresses/stabilizes hyoid bone | C1&2 fibers running with hypoglossal nerve that leave XII anterior to the superior root of ansa cervicalis | thyrohyoid lies deep to the sternohyoid | ) |
| sternocleidomastoid (TG7-12, TG7-13) | sternal head: anterior surface of manubrium; clavicular head: medial 1/3rd of clavicle | mastoid process and lateral 1/2 of superior nuchal line | draws mastoid process down to same side; turns chin up toward opposite side | spinal accessory nerve (XI), with sensory supply from C2 & C3 (for proprioception) | carotid sheath structures lie deep to it | ) |
| scalene, anterior (N28, N30, N32, TG7-15A, TG7-15B, TG7-17, TG7-18) | anterior tubercles of transverse processes of vertebrae C3-C6 | scalene tubercle of first rib | elevates first rib; flexes and laterally bends the neck | brachial plexus, C5-C7 | a muscle of inspiration; anterior scalene inserts behind the subclavian vein, and anterior to the subclavian artery and roots of the brachial plexus (Greek, skalenos = uneven, having sides of unequal length) | ) |
| scalene, middle (N28, N30, N32, TG7-15A, TG7-15B, TG7-17, TG7-18) | posterior tubercles of the transverse processes of vertebrae C2-C7 | upper surface of first rib behind subclavian artery | elevates first rib; flexes and laterally bends the neck | brachial plexus, C3-C8 | a muscle of respiration (inspiratory); also called scalenus medius; penetrated by the dorsal scapular n. and long thoracic n. (Greek, skalenos = uneven, having sides of unequal length) | ) |
| scalene, posterior (N28, N30, N32, TG7-15A, TG7-15B, TG7-17, TG7-18) | posterior tubercles of the transverse processes of vertebrae C5-C7 | lateral surface of second rib | elevates second rib; flexes and laterally bends the neck | brachial plexus, C7-C8 | a muscle of respiration (inspiratory); the longest of the scalene muscles (Greek, skalenos = uneven, having sides of unequal length) | ) |
| stylopharyngeus (N65, N67, TG7-19, TG7-21, TG7-24) |
medial side of styloid process | superior border of thyroid cartilage and also into the pharyngeal wall | elevates the larynx | glossopharyngeal nerve (IX) | stylopharyngeus, the only muscle innervated by IX, is the only pharyngeal muscle NOT innervated by vagus (X) nerve | ) |
| constrictor, superior pharyngeal (N65, N75, TG7-19, TG7-21, TG7-22, TG7-24) |
medial pterygoid plate, pterygoid hamulus, pterygomandibular raphe, mylohyoid line of mandible | pharyngeal tubercle and midline pharyngeal raphe | constricts the pharyngeal cavity | vagus (X), via pharyngeal plexus | none | ) |
| constrictor, middle pharyngeal (N65, N75, TG7-19, TG7-21, TG7-22, TG7-24) |
lesser and greater horns of hyoid bone and inferior part of the stylohyoid ligament | midline pharyngeal raphe | constricts the pharyngeal cavity | vagus, via pharyngeal plexus | none | ) |
| constrictor, inferior pharyngeal (N65, N75, TG7-19, TG7-21, TG7-22, TG7-24) |
oblique line of thyroid cartilage, lateral surface of cricoid cartilage | midline pharyngeal raphe | constricts pharyngeal cavity | vagus (X), via pharyngeal plexus, with aid from superior laryngeal and recurrent laryngeal nerves | most external of the three pharyngeal constructor mm. | ) |
| cricothyroid ( N82, TG7-26) |
arch of the cricoid cartilage | inferior border of the thyroid cartilage | draws the thyroid cartilage forward, lengthening the vocal ligaments | external branch of superior laryngeal nerve, a branch of the vagus nerve (X) | this is the only intrinsic muscle of the larynx that is not supplied by the recurrent laryngeal n.; ALL other laryngeal muscles are innervated by recurrent laryngeal nerve, via its inferior laryngeal branch | ) |
| cricoarytenoid, posterior ( N82, TG7-28) |
posterior surface of the lamina of the cricoid cartilage | muscular process of arytenoid cartilage | draws the muscular process posteriorly, abducting vocal folds | inferior laryngeal nerve, from recurrent laryngeal nerve, a branch of the vagus nerve (X) | posterior cricoarytenoid is the sole ABductor of the vocal cords | ) |
| arytenoid, transverse ( N82, TG7-28) |
posterior surface of arytenoid cartilage | posterior surface of contralateral arytenoid cartilage | draws arytenoid cartilages together, adducting vocal folds | inferior laryngeal nerve, from recurrent laryngeal nerve, a branch of the vagus nerve (X) | arytenoideus is considered one muscle with oblique and transverse parts | ){kind=spacer} |
| arytenoid, oblique ( N82, TG7-28) |
muscular process of arytenoid | posterior surface of contralateral arytenoid cartilage, near apices | draws arytenoid cartilages together, adducting vocal folds | inferior laryngeal nerve, from recurrent laryngeal nerve, a branch of the of vagus (X) | arytenoideus is often considered one muscle with oblique and transverse fibers | ) |
| thyroarytenoid ( N82, TG7-27) |
inner surface of the thyroid cartilage anteriorly | lateral border of the arytenoid cartilage | draws the arytenoid cartilage forward, relaxing and adducting the vocal folds | inferior laryngeal nerve, from recurrent laryngeal nerve, a branch of the vagus nerve (X) | its subsidiary parts are the thyroepiglottic m. and the vocalis m.; the medial most fibers of thyroarytenoid that insert along the vocal ligament are called the vocalis muscle | ) |
| lateral cricoarytenoid ( N82, TG7-27) |
arch of the cricoid cartilage | muscular process of the arytenoid cartilage | draws the muscular process of the arytenoid cartilage anteriorly, which pivots the arytenoid cartilage and adducts the vocal folds | inferior laryngeal nerve, from the recurrent laryngeal nerve, a branch of the vagus nerve (X) | an antagonist of the posterior cricoarytenoid m.; the arteries that supply the larynx anastomose within the larynx to supply the mucous membranes and muscles | ) |
Nerves | |||||
|---|---|---|---|---|---|
| Nerve | Source | Branches | Motor | Sensory | Notes |
| cervical plexus (TG7-17) | ventral primary rami of C1-C4 spinal nerves | brs. to: longus colli & capitis, sternocleidomastoid, trapezius, levator scapulae, scalenus medius, rectus capitis anterior & lateralis: superior & inferior root of ansa cervicalis, n. to thyrohyoid, n. to geniohyoid, lesser occipital, great auricular, transverse cervical, supraclavicular nn. (medial, intermediate & lateral), contribution to phrenic n. | longus colli & capitis, rectus capitis anterior & lateralis, infrahyoid mm., thyrohyoid, geniohyoid, diaphragm | skin of neck anterolaterally; skin of ear & behind ear | close association of supraclavicular nn. to phrenic n. results in pain from diaphragm referred to shoulder (Latin, plexus = a braid) |
| transverse cervical (N33, N184, TG1-13, TG7-14, TG7-15A, TG7-15B) | cervical plexus (C2&C3) | skin of neck anteriorly | |||
| supraclavicular, intermediate (TG7-16A, TG7-16B) | cervical plexus (C3&C4) | skin of root of neck & upper chest near mid-clavicle | |||
| supraclavicular, lateral (TG7-16A, TG7-16B) | cervical plexus (C3&C4) | skin of root of neck & upper shoulder | pain from respiratory diaphragm is referred to the shoulder | ||
| supraclavicular, medial (TG7-16A, TG7-16B) | cervical plexus (C3&C4) | skin of root of neck& upper chest anteriorly | |||
| great auricular (N24,N31,N32,N129, TG7-11, TG7-16A, TG7-16B) | cervical plexus (C2&C3) | mastoid; auricular | skin of ear & below ear | ||
| occipital, lesser (N24,N31,N32,N129, TG7-11, TG7-16A, TG7-16B) | cervical plexus (C2) | skin behind ear | arises from a ventral primary ramus | ||
| ansa cervicalis (N36, N135, TG7-12, TG7-13) | superior root (C1&C2) & inferior root (C2&C3) of ansa cervicalis | to infrahyoid muscles | omohyoid, sternohyoid, sternothyroid, thyrohyoid, geniohyoid | superior & inferior roots also known as anterior & posterior roots (Latin, ansa = handle or loop) | |
| accessory (N71, N127, TG7-18, TG7-51, TG7-52, TG7-53, TG7-93) | cranial root: nucleus ambiguus; spinal root: spinal nucleus of upper cervical spinal cord | cranial root joins vagus; spinal root ascends through foramen magnum | GSE: sternocleidomastoid and trapezius mm. | also known as: CN XI, 11th cranial nerve; passes through jugular foramen; accessory n. is motor only; proprioceptive fibers reach sternocleidomastoid via C2&C3 and trapezius via C3&C4 (subtrapezial plexus) | |
| hypoglossal (N32, N71, N128, TG7-13, TG7-18) | medulla: hypoglossal nucleus | branches of C1 carried by this nerve are not considered to be branches of the hypoglossal nerve | intrinsic and extrinsic muscles of the tongue (except palatoglossus m.) | also known as: CN XII, 12th cranial nerve; passes through the hypoglossal canal; superior root of ansa cervicalis travels with the hypoglossal n. | |
| vagus (N126, TG7-14, TG7-20, TG7-21, TG7-91, TG7-92) | medulla: dorsal nucleus (GVA & GVE preganglionic parasympathetic) from inferior ganglion, nucleus ambiguus (SVE); spinal trigeminal nucleus (GSA) from superior ganglion; nucleus solitarius (SVA) from inferior ganglion | auricular br., pharyngeal br., superior laryngeal, superior & inferior cervical cardiac brs., recurrent laryngeal, thoracic cardiac brs., brs. to pulmonary plexus, esophageal plexus, anterior & posterior vagal trunks | SVE: intrinsic muscles of larynx, pharynx (except stylopharyngeus), & palate (except tensor veli palatini); GVE: smooth muscle of respiratory tree & gut (proximal to splenic flexure), heart; secretomotor: mucous glands of larynx, respiratory tree, pharynx & gut, digestive glands | GSA: skin of external auditory meatus; GVA: viscera of head, neck, thorax & abdomen proximal to splenic flexure; SVA: taste to epiglottis | also known as: CN X, 10th cranial nerve; passes through jugular foramen; (Latin,vagus = wanderer, because of its wide distribution to the body cavities) |
| pharyngeal plexus | motor contributed by the vagus n. (X); sensory contributed by the glossopharyngeal n. (IX), vasomotor contributed by the superior cervical sympathetic ganglion | no named branches | vagus: all muscles of the pharynx except stylopharyngeus; sympathetic: smooth muscle in the pharyngeal vasculature | glossopharyngeal: mucous membrane lining the pharynx | the muscles of the pharyngeal wall are skeletal m. derived from the mesenchyme of the 4th pharyngeal arch (Latin, plexus = a braid) |
| cardiac (N130, TG7-15, TG7-95) | vagus (X); cervical sympathetic trunk | heart (parasympathetic: decreases rate & force of contraction; sympathetic: increases rate & force of contraction); bronchial tree & lungs via pulmonary plexus | heart, bronchial tree & lungs | vagus has 2 (superior & inferior) cervical cardiac brs. & 1 or more thoracic br.; cervical sympathetic trunk usually gives 3 (superior, middle & inferior) cardiac brs. | |
| to carotid body | vagus (X) & glossopharyngeal (IX) | chemoreception (blood pH) in carotid body; blood pressure recerptors in carotid sinus; both located near bifurcation of common carotid a. | |||
| superior laryngeal (N74, N75, N76, TG7-13, TG7-14, TG7-20, TG7-21, TG7-26) |
vagus (X) | internal & external brs. | cricothyroid, inferior pharyngeal constrictor, secretomotor to mucous glands of larynx above vocal folds | mucous lining of larynx above vocal folds | external br. supplies cricothyroid m.; all other intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve |
| recurrent laryngeal (N74, N75, N76, N232, TG7-21, TG7-26) |
vagus (X) | esophageal brs., tracheal brs., cardiac brs., pharyngeal brs., inferior laryngeal n. | upper esophagus, lower pharynx, laryngeal ms. (except cricopharyngeus); smooth muscle of trachea; secretomotor to mucous glands in upper esophagus, lower pharynx, larynx below vocal fold, trachea; cardiac muscle of heart (slows rate, decreases force of contraction) | upper esophagus, lower pharynx, larynx below vocal folds, GVA from heart | right recurrent loops posteriorly around right subclavian a.; left recurrent loops posteriorly around aortic arch & ligamentum arteriosum; inferior laryngeal br. supplies all intrinsic muscles of the larynx EXCEPT cricothyroid m. |
| inferior laryngeal (N74, N75, N76, TG7-21, TG7-26B, TG7-26C, TG7-28) |
recurrent laryngeal br. of vagus (X) | all muscles of larynx except cricothyroid: thyroarytenoid, oblique & transverse arytenoid, posterior & lateral cricoarytenoid, aryepiglottic, thyroepiglottic, vocalis; secretomotor to mucous glands of larynx below vocal fold | mucous lining of larynx below vocal fold | continuous with recurrent laryngeal at inferior border of cricopharyngeus | |
| phrenic (N30, N193, TG4-18, TG7-15) | ventral primary rami of C3-C5 (cervical plexus) | pericardial brs. | diaphragm | pericardium; mediastinal, diaphragmatic & costal pleura | crosses the anterior surface of the anterior scalene m. (Greek, phrenic = diaphragm) |
| sympathetic trunk, cervical (N129, N130, TG7-15, TG7-95) | preganglionic sympathetic via ascending fibers from T1-T5 | postganglionic sympathetic via gray rami communicans to cervical spinal nn.; internal & external carotid nn.; cervical cardiac brs. | dilator pupillae m.; vascular smooth muscle; arrector pili muscles & sweat glands of head and neck; heart & lungs | pain from viscera | located parallel & lateral to vertebral bodies in neck; there are no white rami communicans at cervical levels |
| sympathetic chain ganglia, cervical (N129, N130, TG7-15, TG7-95) | preganglionic sympathetic via ascending fibers from T1-T5 | postganglionic sympathetic via gray rami communicans to cervical spinal nn.; internal & external carotid nn.; cervical cardiac brs. | dilator pupillae m.; vascular smooth muscle; arrector pili muscles & sweat glands of head and neck; heart & lungs | pain from viscera | located parallel & lateral to vertebral bodies in neck; there are no white rami communicans at cervical levels |
| ganglion, superior cervical (N129, N130, TG7-15, TG7-95) | preganglionic sympathetic via ascending fibers from T1-T5 | postganglionic sympathetic via gray rami communicans to cervical spinal nn. C1-4; internal & external carotid nn.; cervical cardiac br. | dilator pupillae m.; superior tarsal m.; vascular smooth muscle; arrector pili muscles & sweat glands of head and neck; heart & lungs | pain from viscera | located lateral to vertebral bodies C1-3 in neck; there are no white rami communicans at cervical levels |
| carotid plexus, external (N129, N130, TG7-15, TG7-95) |
superior cervical ganglion of the sympathetic trunk, via external carotid n. | distributes along external carotid artery brs. | vascular smooth muscle, arrector pili muscles, sweat glands of face & upper neck | postganglionic sympathetic nerve fibers use arteries as roadways to enter the head and neck (Latin, plexus = a braid) | carotid plexus, internal (N129, N130, TG7-15, TG7-95) |
superior cervical ganglion of sympathetic trunk, via internal carotid n. | most distribute along the internal carotid artery brs., although deep petrosal n. is an exception | vascular smooth muscle of brain, orbit, forehead, upper nasal cavity; arrector pili muscles of forehead & ant. scalp; sweat glands of forehead; dilator pupillae & superior tarsal mm. | postganglionic sympathetic nerve fibers use arteries as roadways to enter the head and neck (Latin, plexus = a braid) |
| ganglion, middle cervical (N129, N130, TG7-15, TG7-95) | preganglionic sympathetic via ascending fibers from T1-T5 | postganglionic sympathetic via gray rami communicans to cervical spinal nn. C5-6; cervical cardiac br. | vascular smooth muscle; arrector pili muscles & sweat glands of neck and upper limb; heart & lungs | pain from viscera | located lateral to vertebral body C5 or 6 in neck; there are no white rami communicans at cervical levels; often lies near inferior thyroid artery |
| ganglion, inferior cervical (N129, N130, TG7-15, TG7-95) | preganglionic sympathetic via ascending fibers from T1-T5 | postganglionic sympathetic via gray rami communicans to cervical spinal nn. C7-8; cervical cardiac br. | vascular smooth muscle; arrector pili muscles & sweat glands of upper limb; heart & lungs | pain from viscera | located lateral to vertebral body C7 in neck, or fuses with 1st thoracic ganglion to form cervicothoracic or stellate ganglion |
| brachial plexus (N30, N430, TG7-14, TG2-14) | ventral primary rami of C5-8 & T1 | dorsal scapular, long thoracic, n. to subclavius, suprascapular, lateral & medial pectoral, medial brachial & antebrachial cutaneous, upper, middle & lower subscapular, musculocutaneous, ulnar, median, axillary, radial | muscles of upper limb, excluding trapezius | skin of upper limb | plexus is a latin word meaning "braid"; axons from spinal cord levels C5-T1 are mixed (braided) in the brachial plexus and repackaged into terminal branches so that each branch contains axons from several spinal cord levels (Latin, plexus = a braid) |
Arteries | ||||
|---|---|---|---|---|
| Artery | Source | Branches | Supply | Notes |
| common carotid (N31,N32,N33,N34, N69, N136, TG7-19, TG7-71) | brachiocephalic trunk (right), aortic arch (left) | external & internal carotid (terminal brs.) | most of head & upper neck | common carotid a. bifurcates at the level of the superior border of the thyroid cartilage; carotid sinus & body located at bifurcation |
| internal carotid (N69, N136, TG7-19, TG7-72) | common carotid | none in the neck; in the head: ophthalmic, post. communicating, ant. & middle cerebral (terminal brs.) | brain, eye, forehead | primary blood supply to the brain; anastomoses with vertebral aa. |
| external carotid (N31, N32, N33, N34, N69, N136, TG7-19, TG7-71) | common carotid | superior thyroid, ascending pharyngeal, lingual, facial, occipital, post. auricular, maxillary & superficial temporal (terminal brs.) | upper neck, face & scalp | primary blood supply to face & superficial head |
| superior thyroid (N31, N32, N33, N34, N74,N75, N76, TG7-13, TG7-14) | external carotid | infrahyoid br., sternocleidomastoid br., sup. laryngeal, cricothyroid br., ant., post. & lat. glandular brs. | thyroid gland, upper larynx, infrahyoid muscles, sternocleidomastoid | |
| inferior thyroid (N74, N75, N76, TG7-13, TG7-14) | thyrocervical trunk | ascending cervical, inferior laryngeal, esophageal brs., tracheal brs., glandular brs. | thyroid gland, lower larynx, upper trachea & esophagus, neck muscles | |
| thyroidea ima | brachiocephalic a. or aortic arch | no named branches | isthmus of thyroid gland, upper trachea | present in 10% of individuals; clinically significant because it is a midline artery in the region of tracheostomy; ima means "lowest" |
| superior laryngeal (N31, N32, N33, N34, TG7-13, TG7-14, TG7-25) | superior thyroid | upper larynx internally | ||
| inferior laryngeal (N74, N75, N76, TG7-21, TG7-26) |
inferior thyroid | lower larynx internally | ||
| subclavian (N33, N136, TG7-15A, TG7-15B) | brachiocephalic (right), aortic arch (left) | 1st part: vertebral, thyrocervical trunk, internal thoracic; 2nd part: costocervical trunk; 3rd part: dorsal scapular (70%); axillary a. is the continuation at lat. border of rib 1 | neck, spinal cord, thyroid gland & larynx, shoulder, chest muscles, upper limb | ant. scalene muscle passes anterior to subclavian, dividing it into 3 parts |
| vertebral (N33, N136, TG7-15, TG7-72) | subclavian (1st part) | spinal brs., muscular brs., ant. spinal, post. inf. cerebellar, medullary brs., meningeal brs., basilar (fusion of paired vertebrals) | deep neck, cervical spinal cord, hindbrain | anastomoses with internal carotid in cerebral arterial circle (of Willis); courses through transverse foramina of vertebrae C1-C6 |
| thyrocervical trunk (N33, N136, TG7-15A, TG7-15B) | subclavian, 1st part | inferior thyroid, transverse cervical, suprascapular | lower neck, posterior shoulder, thyroid gland | a short thick trunk |
| cervical, transverse (N33, N184, TG1-13, TG7-14, TG7-15A, TG7-15B) | thyrocervical trunk | muscular | trapezius muscle & surrounding muscles | may give off the dorsal scapular a. (30%) |
| suprascapular (N33, N427, TG2-15, TG7-14, TG7-15A, TG7-15B) | thyrocervical trunk | muscular | supraspinatus & infraspinatus, shoulder joint | anastomoses with circumflex scapular, dorsal scapular & deep br. of transverse cervical |
| thyroid, inferior (N33, N136, TG7-14, TG7-15A,TG7-15B) | thyrocervical trunk | ascending cervical, inferior laryngeal, esophageal brs., tracheal brs., glandular brs. | thyroid gland, lower larynx, upper trachea & esophagus, neck muscles | |
| thoracic, internal (N33, N136, TG7-15A, TG7-15B, TG4-09) | subclavian, 1st part | anterior intercostal aa., musculophrenic, superior epigastric | anterior chest wall, anterior portion of intercostal spaces | commonly called "internal mammary" in clinical settings |
| costocervical trunk (N33, N130, TG7-14, TG7-15A, TG7-15B) | subclavian, 2nd part | deep cervical & supreme intercostal | muscles of neck posteriorly; first 2 posterior intercostal spaces | located between anterior & middle scalene muscles |
| scapular, dorsal (N33, N410, TG2-09, TG7-14, TG7-15A, TG7-15B) | subclavian, end of 3rd part | muscular | levator scapulae, rhomboideus major & minor mm. | anasotmoses with suprascapular & subscapular aa.; a branch of the transverse cervical a. in 30% of cases |
Veins |
|||||
|---|---|---|---|---|---|
| Vein | Tributaries | Drains Into | Region Drained | Notes | |
| anterior jugular (N31,N74, TG7-11) | submental, communicating | external jugular | anterior neck superficially | (Latin, jugulum = throat) | |
| external jugular (N31,N74, TG7-11) | formed by the union of the retromandibular & posterior auricular vv.; tributaries: posterior external jugular, transverse cervical, suprascapular, anterior jugular | subclavian v. | head & neck, shoulder | (Latin, jugulum = throat) | |
| internal jugular (N31, TG4-19, TG7-13) | formed by the union of the sigmoid & inferior petrosal sinuses; tributaries: pharyngeal vv.; lingual, common facial, sternocleidomastoid, superior & middle thyroid vv. | brachiocephalic v. | brain & skull, face, viscera of neck | largest vein of the head and neck (Latin, jugulum = throat) | |
| superior thyroid (N74,N75,N76, TG7-13, TG7-14) | superior laryngeal v. | internal jugular v. | superior portion of thyroid gland and surrounding structures | cross the common carotid a. | |
| middle thyroid (N74, TG7-13) | internal jugular v. | thyroid gland laterally | |||
| inferior thyroid (N74, N75, N76, TG7-13, TG7-14) | left and right brachiocephalic vv. | thyroid gland inferiorly | |||
| thyroidea ima | left brachiocephalic vein | inferior portion of thyroid gland | an occasional branch formed by the union of the left and right inferior thyroid vv.; a midline structure which is in danger during tracheostomy | ||
| brachiocephalic (N70,N74, TG4-19) | union of subclavian & internal jugular; vertebral, thymic, inferior thyroid, internal thoracic, 1st post. intercostal, left superior intercostal (to left brachiocephalic) | left & right brachiocephalic vv. unite to form superior vena cava | head, neck, upper limb, anterior chest wall | at its origin, left brachiocephalic receives thoracic duct, right receives right lymphatic duct |
Topographic Anatomy | ||
|---|---|---|
| Structure/Space | Boundaries/Description | Significance |
| cervical triangle, anterior (N28, TG7-02A, TG7-02B) | boundaries: medial - midline; lateral - anterior border of sternocleidomastoid m.; superior - lower border of mandible | |
| cervical triangle, posterior (N28, TG7-02A, TG7-02B) | boundaries: anterior - sternocleidomastoid m.; posterior - trapezius m.; inferior - clavicle | |
| muscular triangle (N28, TG7-02A, TG7-02B) | boundaries: medial - midline; superolateral - superior belly of omohyoid m.; inferolateral - sternocleidomastoid m. | |
| submandibular triangle (N28, TG7-02A, TG7-02B) | boundaries: anterior - anterior belly of digastric m.; posterior - posterior belly of digastric m.; superior - lower border of mandible | |
| submental triangle (N28, TG7-02A, TG7-02B) | boundaries: lateral - both digastric muscles (anterior bellies); inferior - hyoid bone | |
| carotid triangle (N28, TG7-02A, TG7-02B) | boundaries: lateral - sternocleidomastoid m.; superior - posterior belly of digastric m.; anterior - superior belly of omohyoid m. | carotid artery branches here |
| omoclavicular triangle (N28, TG7-02A, TG7-02B) | boundaries: superior - inferior belly of omohyoid m.; anterior - sternocleidomastoid m.; inferior - clavicle | |
| occipital triangle (N28, TG7-02A, TG7-02B) | boundaries: anterior - sternocleidomastoid m.; posterior - trapezius m.; inferior - omohyoid m. | |
| carotid bifurcation (N69, N136, TG7-19, TG7-71) | point at which the carotid artery splits into external and internal carotids | location of carotid body |
Lymphatics | |||||
|---|---|---|---|---|---|
| Structure | Location | Afferents from | Efferents to | Regions drained | Notes |
| nodes, deep cervical (N72, TG7-74) | in and around carotid sheath | lymphatic vessels from head & neck | jugular trunk | head & neck | superior and inferior subdivisions are delineated by the crossing of the omohyoid m. |
| nodes, superficial cervical | in superficial fascia and along superficial vessels of the head & neck | lymphatic vessels from superficial structures in head & neck | varies by group; ultimate destination is the jugular trunk | head & neck | several groups are designated by location: occipital, retroauricular, anterior auricular, superficial parotid, facial, submental, submandibular, external jugular, anterior jugular |
| submental nodes | under mandible on mylohyoid m. | juguloomohyoid node, submandibular nodes | tip of tongue, lower lip, floor of mouth | important nodes to examine in cases of oral cancer caused by use of tobacco products | |
| thoracic duct (N238, N239, N264, TG4-44, TG5-37) | between esophagus & thoracic vertebral bodies | union of lumbar lymph trunks, sometimes dilated to form cisterna chyli | junction of the left subclavian and left internal jugular vv. | all of the body and limbs below the diaphragm; the left side of the body, limbs, head and neck above the diaphragm | the largest lymph vessel; passes up through aortic hiatus on right side of aorta, swings to left side of esophagus at T4-T5 intervertebral disc (at the level of the sternal angle) |
Viscera | ||
|---|---|---|
| Organ | Location/Description | Notes |
| thyroid gland (N74, TG7-13, TG7-14) | lies anterolateral to lower part of larynx & upper trachea | two lateral lobes joined across midline by isthmus; may have pyramidal lobe extending superiorly near midline; supplied by superior & inferior thyroid aa.; produces thyroxine |
| thyroid isthmus (N74, TG7-13, TG7-14) | constricted midline connection between lateral lobes of thyroid | lies anterior to tracheal rings 2-4 |
| parathyroid glands (N75, TG7-14) | two pair, located posteriorly on lateral lobes of thyroid gland | |
| pharynx | connects nasal & oral cavities with larynx & esophagus | divided into 3 parts: nasopharynx, oropharynx & laryngopharynx |
| nasopharynx (TG7-22, TG7-23) |
connects nasal cavity with oropharynx; located posterior to posterior nasal apertures and superior to pharyngeal isthmus (soft palate & posterior wall of pharynx) | contains torus tubarius, pharyngeal recess, pharyngeal tonsil |
| oropharynx (TG7-22, TG7-23) |
connects: anteriorly with oral cavity through oropharyngeal isthmus (palatoglossal arch), superiorly with nasopharynx through pharyngeal isthmus (posterior margin of soft palate), inferiorly with laryngopharynx at superior margin of epiglottis | contains palatine tonsil in tonsilar bed between palatoglossal & palatopharyngeal arches |
| laryngopharynx (N70, TG7-22, TG7-23) |
connects: superiorly with oropharynx at superior border of epiglottis, anteriorly with larynx through laryngeal inlet (epiglottis, aryepiglottic folds, arytenoid cartilages), inferiorly with esophagus at lower border of cricoid cartilage | contains piriform recesses lateral to aryepiglottic folds |
| lateral glossoepiglottic fold (TG7-39) |
located between base of tongue & epiglottis lateral to valleculae epiglottica | |
| median glossoepiglottic fold (TG7-39) |
located between base of tongue & epiglottis | separates the paired valleculae epiglottica |
| piriform recess (N70, TG7-22, TG7-23) |
located lateral to aryepiglottic folds | (Latin, pirum = pear + forma = form) |
| esophagus (N70, TG7-22, TG7-23) |
connects: superiorly with laryngopharynx at lower border of cricoid cartilage, inferiorly through diaphragm at t10 vert. level to reach stomach; upper third is skeletal muscle innervated by recurrent laryngeal | lower 2/3rds is smooth muscle innervated by vagus via esophageal plexus |
| laryngeal inlet (N70, TG7-22, TG7-23) |
pathway through which the laryngopharynx communicates with the larynx | |
| larynx (N70, TG7-22, TG7-23) |
located anterior to laryngopharynx at level of C4-6 vert.; composed of thyroid, cricoid, epiglottic, arytenoid, cuneiform & corniculate cartilages | contains vocal ligaments |
| vestibular fold (N67, N80, N81, N82, TG7-22, TG7-27, TG7-28) |
mucosal fold located between laryngeal vestibule & ventricle | also known as: false vocal fold |
| vocal folds (N67, N80, N81, N82, TG7-22, TG7-27, TG7-28) |
mucosal covering of vocal ligament & thyroepiglottic muscle (vocalis part) | located inferior to laryngeal ventricle |
| laryngeal ventricle (N67, N80, N81, N82, TG7-22, TG7-27, TG7-28) |
lateral diverticulum of larynx located between false & true vocal folds (or vestibular fold & vocal fold) | |
| laryngeal vestibule (N67, N80, N81, N82, TG7-22, TG7-27, TG7-28) |
part of larynx, located below epiglottis between aryepiglottic & vestibular folds | lateral wall contains quadrangular membrane (submucosa) |
| quadrangular membrane (N67, N80, N81, N82, TG7-22, TG7-27, TG7-28) |
submucosal lining of the laryngeal vestibule | |
| glottis | the opening or space between the vocal folds | glottis and rima glottidis are used interchangeably |
| infraglottic cavity | the portion of the laryngeal cavity that lies inferior to the vocal folds; it is bounded superiorly by the glottis and opens inferiorly into the trachea | receives sensory innervation from inferior laryngeal n. |
| supraglottic cavity | the portion of the laryngeal cavity that lies superior to the vocal folds; it is bounded inferiorly by the glottis and opens superiorly to the laryngopharynx at the laryngeal inlet | receives sensory innervation from the internal branch of superior laryngeal n. |
| aryepiglottic fold (N67, N80, N81, N82, TG7-22, TG7-27, TG7-28) |
cover aryepiglottic muscles between lateral margin of epiglottis & arytenoid cart. | |
| conus elasticus (N67, N80, N81, N82, TG7-22, TG7-27, TG7-28) |
elastic submucous membrane attaching on upper margin of arch of cricoid cart. | thickened upper margin is vocal ligament (Latin/Greek, conus elasticus = elastic cone-shaped structure) |
| vocal ligaments (N67, N80, N81, N82, TG7-22, TG7-27, TG7-28) |
located in larynx within (true) vocal folds; connect inner anterior surface of thyroid cart. to vocal process of arytenoid cart.; represents thickened superior margin of conus elasticus | vibration creates sound; brought together by arytenoid & lateral cricoarytenoid ms., moved apart by posterior cricoarytenoid ms. |
| thyrohyoid membrane (N29, TG7-14, TG7-25, TG7-26) |
connects the superior border of the thyroid cartilage to the hyoid bone, suspending the larynx | penetrated by the internal branch of superior laryngeal n. & superior laryngeal a. |
| trachea | lies anterior to esophagus; extends from vertebral level C6 to T4/5 disc; connects above to cricoid via cricotracheal ligament | bifurcation into primary bronchi is marked by carina |
| carotid body | small reddish-brown ovoid mass that lies on the medial side of the carotid bifurcation | serves as a chemoreceptor that monitors the amount of oxygen in the blood |
| carotid sinus | a slight dilation of the internal carotid artery | serves as a baroreceptor that reacts to changes in arterial pressure |
Fascia | ||
|---|---|---|
| Fascia | Location/Description | Notes |
| carotid sheath | fascial investment that extends from the base of the skull to the root of the neck | blends anteriorly with the investing and pretracheal layers of fascia and posteriorly with the prevertebral layer of deep cervical fascia |
| fascia, alar (TG7-10B) | anterior lamina of prevertebral fascia, attaching anteriorly to visceral fascia behind esophagus in upper thorax | closes & separates retropharyngeal space above from "danger space" below |
| fascia, buccopharyngeal (TG7-10A, TG7-10B, TG7-23AB) | posterior part of visceral fascia of neck; lies behind pharynx & esophagus | |
| fascia, infrahyoid (TG7-10A, TG7-10B, ) | sheet over the midline that covers the strap muscles | deep to superficial cervical fascia, superior to pretracheal fascia |
| fascia, pharyngobasilar (TG7-19, TG7-21, TG7-23B) | submucosa of pharynx; attached to base of skull | |
| fascia, pretracheal (TG7-10A, TG7-10B, TG7-11) | anterior part of visceral fascia of neck | covers thyroid gland & larynx/trachea |
| fascia, prevertebral (N35, TG7-10A, TG7-10B) | deep fascia surrounding vertebral column and associated muscles, including scalene ms. (scalene fascia) | |
| fascia, scalene (N35, TG7-10A,TG7-10B) | part of prevertebral fascia covering scalene mm. | reinforces cervical pleura (known there as Sibson's fascia) |
| fascia, superficial layer of deep cervical (TG7-10A, TG7-10B, TG1-12) | deep fascia extending between trapezius & sternocleidomastoid in posterior triangle and between the paired sternocleidomastoid mm. in anterior triangle | |
| fascia, visceral (TG7-10B) | deep fascia enclosing the visceral structures of the neck (thyroid gland, larynx/trachea, esophagus) | anterior part also known as pretracheal fascia, posterior part also known as buccopharyngeal fascia |
|
The material presented in these tables is contained in the book: MedCharts Anatomy by Thomas R. Gest & Jaye Schlesinger Published by ILOC, Inc., New York Copyright © 1995, unauthorized use prohibited. |
The excellent editorial assistance of Dr. Pat Tank, UAMS is gratefully acknowledged. |