Anatomy Tables - Larynx and Neck

Osteology

BoneStructureDescriptionNotes
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 protuberanceforms 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

MuscleOriginInsertionActionInnervationNotesImage
platysma (TG7-29) fascia overlying the pectoralis major and deltoid musclesinferior border of mandible and skin of lower facedraws corners of mouth down; aids in depression of the mandiblefacial nerve (VII), cervical branch(Greek, platysma = flat plate)
digastric (TG7-33) anterior belly: digastric fossa of mandible; posterior belly: mastoid notch of temporal bonebody of hyoid via fibrous loop over intermediate tendonelevates hyoid; depresses mandibleanterior 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 processsplits around intermediate tendon of digastric to insert on the body of the hyoid boneelevates and retracts hyoidfacial 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 mandiblemidline raphe and body of hyoid boneelevates hyoid bone and tongue; depresses mandiblemylohyoid 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 tendoninferior belly: intermediate tendon; superior belly: lower border of hyoid lateral to sternohyoid insertiondepresses/stabilizes hyoid boneansa cervicalisthe 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 claviclelower border of hyoid bone, medial to omohyoid insertiondepresses/stabilizes hyoid boneansa cervicalissternohyoid overlies sternothyroid and thyrohyoid
sternothyroid (TG7-12, TG7-13)posterior surface of manubrium below sternohyoid originoblique line of thyroid cartilagedepresses/stabilizes thyroid cartilage of larynxansa cervicalissternothyroid lies deep to sternohyoid
thyrohyoid
(N28,N29,N31, TG7-12, TG7-13)
oblique line of thyroid cartilagelower border of hyoid boneelevates larynx; depresses/stabilizes hyoid boneC1&2 fibers running with hypoglossal nerve that leave XII anterior to the superior root of ansa cervicalisthyrohyoid lies deep to the sternohyoid
sternocleidomastoid (TG7-12, TG7-13)sternal head: anterior surface of manubrium; clavicular head: medial 1/3rd of claviclemastoid process and lateral 1/2 of superior nuchal linedraws mastoid process down to same side; turns chin up toward opposite sidespinal 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-C6scalene tubercle of first ribelevates first rib; flexes and laterally bends the neckbrachial plexus, C5-C7a 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-C7upper surface of first rib behind subclavian arteryelevates first rib; flexes and laterally bends the neckbrachial plexus, C3-C8a 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-C7lateral surface of second ribelevates second rib; flexes and laterally bends the neckbrachial plexus, C7-C8a 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
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

NerveSourceBranchesMotorSensoryNotes
cervical plexus (TG7-17)ventral primary rami of C1-C4 spinal nervesbrs. 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, diaphragmskin of neck anterolaterally; skin of ear & behind earclose 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 eararises from a ventral primary ramus
ansa cervicalis (N36, N135, TG7-12, TG7-13) superior root (C1&C2) & inferior root (C2&C3) of ansa cervicalisto infrahyoid musclesomohyoid, sternohyoid, sternothyroid, thyrohyoid, geniohyoidsuperior & 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 cordcranial root joins vagus; spinal root ascends through foramen magnumGSE: 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 nucleusbranches of C1 carried by this nerve are not considered to be branches of the hypoglossal nerveintrinsic 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 ganglionauricular br., pharyngeal br., superior laryngeal, superior & inferior cervical cardiac brs., recurrent laryngeal, thoracic cardiac brs., brs. to pulmonary plexus, esophageal plexus, anterior & posterior vagal trunksSVE: 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 glandsGSA: skin of external auditory meatus; GVA: viscera of head, neck, thorax & abdomen proximal to splenic flexure; SVA: taste to epiglottisalso 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.diaphragmpericardium; mediastinal, diaphragmatic & costal pleuracrosses 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-T5postganglionic 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 & lungspain from visceralocated 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-T5postganglionic 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 & lungspain from visceralocated 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-T5postganglionic 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 & lungspain from visceralocated 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-T5postganglionic 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 & lungspain from visceralocated 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-T5postganglionic 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 & lungspain from visceralocated 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 & T1dorsal scapular, long thoracic, n. to subclavius, suprascapular, lateral & medial pectoral, medial brachial & antebrachial cutaneous, upper, middle & lower subscapular, musculocutaneous, ulnar, median, axillary, radialmuscles of upper limb, excluding trapeziusskin of upper limbplexus 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

ArterySourceBranchesSupplyNotes
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 neckcommon 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 carotidnone in the neck; in the head: ophthalmic, post. communicating, ant. & middle cerebral (terminal brs.)brain, eye, foreheadprimary blood supply to the brain; anastomoses with vertebral aa.
external carotid (N31, N32, N33, N34, N69, N136, TG7-19, TG7-71)common carotidsuperior thyroid, ascending pharyngeal, lingual, facial, occipital, post. auricular, maxillary & superficial temporal (terminal brs.)upper neck, face & scalpprimary blood supply to face & superficial head
superior thyroid (N31, N32, N33, N34, N74,N75, N76, TG7-13, TG7-14) external carotidinfrahyoid 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 trunkascending cervical, inferior laryngeal, esophageal brs., tracheal brs., glandular brs.thyroid gland, lower larynx, upper trachea & esophagus, neck muscles
thyroidea imabrachiocephalic a. or aortic archno named branchesisthmus of thyroid gland, upper tracheapresent 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 thyroidupper 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 1neck, spinal cord, thyroid gland & larynx, shoulder, chest muscles, upper limbant. 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, hindbrainanastomoses 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 partinferior thyroid, transverse cervical, suprascapularlower neck, posterior shoulder, thyroid glanda short thick trunk
cervical, transverse (N33, N184, TG1-13, TG7-14, TG7-15A, TG7-15B)thyrocervical trunkmusculartrapezius muscle & surrounding musclesmay give off the dorsal scapular a. (30%)
suprascapular (N33, N427, TG2-15, TG7-14, TG7-15A, TG7-15B) thyrocervical trunkmuscularsupraspinatus & infraspinatus, shoulder jointanastomoses with circumflex scapular, dorsal scapular & deep br. of transverse cervical
thyroid, inferior (N33, N136, TG7-14, TG7-15A,TG7-15B)thyrocervical trunkascending 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 partanterior intercostal aa., musculophrenic, superior epigastricanterior chest wall, anterior portion of intercostal spacescommonly called "internal mammary" in clinical settings
costocervical trunk (N33, N130, TG7-14, TG7-15A, TG7-15B) subclavian, 2nd partdeep cervical & supreme intercostalmuscles of neck posteriorly; first 2 posterior intercostal spaceslocated between anterior & middle scalene muscles
scapular, dorsal (N33, N410, TG2-09, TG7-14, TG7-15A, TG7-15B)subclavian, end of 3rd partmuscularlevator scapulae, rhomboideus major & minor mm.anasotmoses with suprascapular & subscapular aa.; a branch of the transverse cervical a. in 30% of cases

Veins

VeinTributariesDrains IntoRegion Drained Notes
anterior jugular (N31,N74, TG7-11)submental, communicatingexternal jugularanterior 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 jugularsubclavian 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 necklargest 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 imaleft brachiocephalic veininferior 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 cavahead, neck, upper limb, anterior chest wall at its origin, left brachiocephalic receives thoracic duct, right receives right lymphatic duct

Topographic Anatomy

Structure/SpaceBoundaries/DescriptionSignificance
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

StructureLocationAfferents fromEfferents toRegions drainedNotes
nodes, deep cervical (N72, TG7-74) in and around carotid sheathlymphatic vessels from head & neckjugular trunkhead & necksuperior and inferior subdivisions are delineated by the crossing of the omohyoid m.
nodes, superficial cervicalin superficial fascia and along superficial vessels of the head & necklymphatic vessels from superficial structures in head & neckvaries by group; ultimate destination is the jugular trunkhead & neckseveral groups are designated by location: occipital, retroauricular, anterior auricular, superficial parotid, facial, submental, submandibular, external jugular, anterior jugular
submental nodesunder mandible on mylohyoid m.juguloomohyoid node, submandibular nodestip of tongue, lower lip, floor of mouthimportant 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 bodiesunion of lumbar lymph trunks, sometimes dilated to form cisterna chylijunction 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 diaphragmthe 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

OrganLocation/DescriptionNotes
thyroid gland (N74, TG7-13, TG7-14) lies anterolateral to lower part of larynx & upper tracheatwo 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 thyroidlies anterior to tracheal rings 2-4
parathyroid glands (N75, TG7-14) two pair, located posteriorly on lateral lobes of thyroid gland
pharynxconnects 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.
trachealies anterior to esophagus; extends from vertebral level C6 to T4/5 disc; connects above to cricoid via cricotracheal ligamentbifurcation 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

FasciaLocation/DescriptionNotes
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 thoraxcloses & 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 neckcovers 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

Clinical Terms

Term Definition
goiter enlargement of the thyroid gland. A goiter is not cancerous. A goiter can be associated with normal, elevated (hyperthyroidism) or decreased (hypothyroidism) thyroid hormone levels in the blood.
tracheostomy The surgical creation of an artificial airway in the trachea (windpipe) on the anterior surface of the neck.
cricothyrotomy an emergency procedure where a cut or passageway is made in the cricothyroid membrane.
thyroidectomy surgery to remove part or all of the thyroid gland. This might be done to remove a tumor or treat hyperthyroidism or goiter (enlarged thyroid gland). The goal of surgery in hyperthyroidism is to remove just enough thyroid gland so that a normal amount of thyroid hormone is produced. If too much thyroid is removed, the patient will produce too little thyroid hormone (hypothyroidism) and need treatment to return the thyroid status to normal (euthyroid). The complications of surgery can include vocal cord paralysis (if the recurrent laryngeal n. is cut) and accidental removal of the parathyroid glands (located behind the thyroid gland), resulting in low calcium levels (the parathyroid glands regulate calcium).
thyroglossal duct cyst a thyroglossal cyst is a fluid-filled sac that is present at birth and located in the midline of the neck. A thyroglossal cyst is a result of incomplete closure of a segment of a tube-like structure (the thyroglossal duct) that is present, and normally closes, as the embryo develops. A thyroglossal cyst is also called a thyrolingual cyst.
torticollis a wry neck, a contracted state of the cervical muscles, producing twisting of the neck and an unnatural position of the head. (Latin, tortus = twisted + collum = neck)
subclavian "stick"/central venous line catheterization the right subclavian vein is often the point of entry to the venous system for central line placement to administer parenteral (nutritional) fluids and medications and to measure central venous pressure. When using the infraclavicular approach, the physician inserts the needle along the inferior surface of the middle part of the clavicle and moves it medially toward the jugular notch in the manubrium and along the posterior surface of the clavicle where the subclavian vein ascends. If the needle is not inserted carefully, it may tear the subclavian vein and parietal pleura, resulting in hemothorax (bleeding into the pleural cavity). Furthermore, if the needle goes too far posteriorly, it may enter the subclavian artery. Once the needle is inserted, a soft, flexible catheter is inserted into the subclavian vein to be used as a guide.
thoracic outlet syndrome condition due to compromise of blood vessels or nerve fibers between the armpit (axilla) and base of the neck.
cervical rib a rib which arises from the seventh cervical vertebrae (above the normal first rib). Occurs in only about 0.5% of people. May cause nerve and artery problems
scalenus anticus syndrome a syndrome in which the nerves and vessels (lower brachial plexus and subclavian artery) passing between the anterior scalene muscle and a cervical rib are compressed causing pain over the shoulder and radiating down the arm or over the back of the neck.
subclavian steal syndrome aortic arch syndrome, also referred to by many as vertebral-basilar artery disease, carotid artery occlusive syndrome and subclavian steal syndrome is characterized by a constellation of signs and symptoms which occur secondary to abnormalities in the major arteries which extend off of the aortic arch. These abnormalities are structural and most often secondary to the effects of atherosclerosis, blood clots, trauma or a congenital abnormality. Symptoms of this condition include various neurologic symptoms, reduction in pulse and changes in blood pressure.
Virchow's node also called a signal node. An enlarged supraclavicular lymph node, usually on the left side, which is often the first sign of an abdominal tumor (such as stomach cancer).
carotid stenosis & endarterectomy carotid stenosis is a result of atherosclerotic thickening of the intima of the carotid artery. Partial occlusion of this artery may cause transient ischemic attack - a sudden focal loss of neurological function (e.g., dizziness and disorientation) that disappears within 24 hours. Arterial occlusion can also lead to a minor stroke - loss of neurological function such as weakness or sensory loss on one side of the body that exceeds 24 hours but disappears within 3 weeks. The symptoms resulting from carotid stenosis depend on the degree of bloodflow obstruction. To help the situation endarterectomies are performed in which part of the athersclerotic plaque on the intima is stripped off. The common site for this procedure is the internal carotid artery just superior to its origin. Drugs are administered after the procedure to inhibit clot formation. Cranial nerve injury can occur during this procedure to the following nerves: glossopharyngeal, vagus, accessory, hypoglossal, and superior laryngeal nerves. (Greek, stenosis = a narrowing)
radical neck dissection the most commonly performed major operation for head and neck malignancies, most of which are squamous cell carcinomas. The neck is opened laterally, the majority of the sternocleidomastoid muscle is removed, as are the regional cervical lymph nodes, the jugular vein, the spinal accessory nerve, the submaxillary gland and most of the parotid gland. There are several modifications.
Horner's syndrome nerve condition which involves a drooping eyelid (ptosis), constricted pupil (miosis), enophthalmos and lack of sweating on one side of the face. Often seen in association with injury (for example neck fracture, penetrating injury) to the cervical sympathetic nerve trunk in the neck or a Pancoast tumor (tumor of the cupula region) involving both the upper and lower brachial plexus.
tonsillitis inflammation of the palatine tonsil
quinsy an extension of a tonsillar infection that leads to a peritonsillar abscess formation behind and above the tonsil
tonsillectomy surgical removal of the palatine tonsils. Lingual tonsils are also taken. Indications include airway obstruction or recurrent tonsillitis. Complete recovery is in two weeks. Adults have a significantly longer period of recovery and a much higher complication rate than children.
adenoidectomy surgical removal of adenoids or inflamed pharyngeal tonsils. Indications include airway obstruction, nasal obstruction, sleep apnea and chronic ear infections
laryngectomy surgical removal of the larynx. Most often performed in cases of laryngeal cancer
Zenker's diverticulum herniation of the mucosa of the laryngopharynx or esophagus through a defect in the wall of the muscular portion. The location is usually in the lowest portion of the laryngopharynx or upper one-third of the esophagus
Heimlich maneuver an emergency, lifesaving procedure whereby the rescuer delivers a sharp upward and inward abdominal thrust on the victim (usually from behind) in an effort to expel a foreign object from the airway

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.