Anatomy of The Neck

Anatomy of the
Neck
Learning Objectives
Identify different types of cervical fascia

Identify neck triangles and their subdivisions with their
boundaries
Identify different levels of lymph nodes and their
drainage
Cervical facia
Superficial cervical fascia

Deep cervical fascia: subdivided into:
1. superficial layer
2. Middle layer
3. Deep layer
Superficial cervical fascia
very thin, delicate fascia found just deep to the skin

envelopes the muscles of the head and neck
including platysma and the muscles of facial
expression.
It is so thin that it may be difficult to identify when
incising the neck
contains fat, vessels (e.g. anterior and external jugular
veins), nerves and lymphatics
Abscesses located either superficial to or /
immediately deep to the superficial fascia are
treated by simple incision and drainage.
Deep Cervical Fascia
Superficial Layer of the
Deep Cervical Fascia
Envelopes:
Sternocleidomastoid muscle
Trapezius muscle
Submandibular gland
Parotid gland
Forms floor of submandibular space
Contributes to carotid sheath
Middle (pretracheal)Layer
of the Deep Cervical Fascia
spans between the hyoid bone superiorly and the thorax
inferiorly
Visceral division: covers:
Thyroid
Trachea
Esophagus
Pharynx
Larynx
Muscular division: covers infrahyoid strap muscles:
sternohyoid, sternothyroid, thyrohyoid and omohyoid
muscles
Contributes to carotid sheath
Deep Layer of Deep (vertebral/
prevertebral )
Cervical Fascia
Envelopes vertebral bodies and deep muscles of the
neck
It extends from the base of the skull to T3
It covers the floor of the posterior triangle of the neck
Contributes to the carotid sheath
Carotid sheath
paired structures on either side of the neck, which enclose

an important neurovascular bundle of the neck.
• Contents are:
1. Common carotid artery
2. Internal jugular vein.
3. Vagus nerve.
4. Accompanying cervical lymph nodes.
The fascia of the carotid sheath is formed by contributions
from all layers of deep cervical fascia
Triangles of the neck
Anterior
triangle
SCM
muscle
Posterior
triangle
Boundaries:
Anterior Triangle:
Superiorly: inferior border of the mandible
Posteriorly: anterior border of the sternocleidomastoid
Medially: midline of the neck
Posterior triangle:
Anterior: posterior border of the sternocleidomastoid.

Posterior: anterior border of the trapezius muscle.
Inferior: middle 1/3 of the clavicle.
Subdivisions
Some contents of the
anterior triangles
Carotid triangle contains the common carotid artery
(which bifurcates within it into the external and
internal carotid arteries), the internal jugular vein, and
the hypoglossal and vagus nerves.
Submental triangle contains the submental LN which
drain floor of the mouth and parts of the tongue
Submandibular triangle contains the submandibular
gland (salivary), and lymph nodes. The facial
artery and vein
Muscular triangle (has 4 boundaries). Contains the
infrahyoid muscles, the pharynx, and the thyroid,
parathyroid glands.
Some contents of the
posterior triangle
accessory nerve (CN XI) crosses the posterior triangle.
Lies superficial
Cervical plexus
Trunks of the brachial plexus
Distal part of the subclavian artery
Cervical Lymph Nodes
Divided into 2 groups:

superficial
deep
Superficial Cervical L.N.
arranged like a ring from under the chin to the

posterior aspect of the neck
Drain the scalp, face and neck
Drain eventually into the deep nodes
types: submental, submandibular, parotid,
preauricular, post auricular, mastoid, occipital, facial,
superficial cervical (anterior and posterior)
What do they drain?
Submental: central lower lip, the floor of the mouth,

tip of tongue
Submandibular: cheeks, nose, upper and lower lips
Preauricular: superficial areas of face
Post auricular (mastoid): posterior neck, external ear
Parotid: nose, external ear, middle ear
Facial: mucus membranes (nose, cheeks, conjunctiva)
Occipital: occipital area of the scalp
Superficial cervical: superficial surfaces of the neck
(anterior and posterior)
Deep Cervical LN.
surround the internal jugular vein and extend from

base of the skull to the root of neck.
Subdivided into 2 groups by the intermediate tendon
of omohyoid:
-Upper deep cervical nodes.
-Lower deep cervical nodes
Both groups are deep to the sternocleidomastoid
muscles
They include: prelaryngeal, pretracheal, paratracheal,
retropharyngeal, infrahyoid, jugulodigastric (tonsilar),
jugulo-omohyoid and supraclavicular nodes.
Jugulo-Digastric Nodes
member of upper deep cervical group.

Located below the posterior belly of digastric muscle.
Principle node of the tonsil
AFFERENTS- from
Palatine tonsils.
Posterior 1/3rd of tongue.
EFFERENTS- into
Lower deep cervical nodes.
VIRCHOW’S NODES
Left supraclavicular nodes or left scalene nodes.

(troiser’s Sign)
Enlarged in malignancy of stomach.
Levels of cervical LN
divided into at least six anatomic neck lymph node

levels for the purpose of head and neck cancer
staging and therapy planning:
1. Level I: submental and submandibular

2. Level II: upper internal jugular (deep cervical) chain
3. Level III: middle internal jugular (deep cervical) chain
4. Level IV: lower internal jugular (deep cervical) chain
5. Level V: posterior triangle
6. Level VI: central (anterior) compartment
The End

Anatomy of The Neck

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Anatomy of the

Identify different types of cervical fascia

Superficial cervical fascia

very thin, delicate fascia found just deep to the skin

paired structures on either side of the neck, which enclose

Anterior: posterior border of the sternocleidomastoid.

Divided into 2 groups:

arranged like a ring from under the chin to the

Submental: central lower lip, the floor of the mouth,

surround the internal jugular vein and extend from

member of upper deep cervical group.

Left supraclavicular nodes or left scalene nodes.

divided into at least six anatomic neck lymph node

1. Level I: submental and submandibular

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