OVERVIEW OF THE HEAD & NECK

Reynaldo V. Lopez, M.D.

Senior Faculty
Department of Anatomy
School of Medicine
Angeles University Foundation
Learning Objectives
At the end of the lecture, the student should be able
to:
1. Describe the components of the head & neck.
2. Enumerate the boundaries of the neck.
3. Discuss the functions of the head & neck.
4. Describe the bones of the head & neck.
5. Discuss the muscles of the head & neck: origin,
insertion, nerve supply & action.
Learning Objectives
6. Enumerate the triangles of the neck, their
boundaries & content.
7. Describe the fascia of the neck, its layers,
functions & attachments.
8. Describe the fascial compartments & tissue spaces
of the neck & their clinical importance.
9. Discuss the scalp, its layers, muscles, blood &
nerve supply.
HEAD
Head
The head is composed of a series of compartments,
which are formed by bone and soft tissues:
• cranial cavity
• two ears
• two orbits
• two nasal cavities
• oral cavity
HEAD
Cranial Cavity
The cranial cavity is the largest compartment and
contains the brain and associated membranes
(meninges).
HEAD
Ear
• Most of the ear
apparatus on each side is
contained within one of
the bones forming the
floor of the cranial cavity.
• The external parts of the
ears extend laterally from
these regions.
HEAD
Orbits
• The two orbits contain
the eyes.
• They are cone-shaped
chambers immediately
inferior to the anterior
aspect of the cranial
cavity, and the apex of
each cone is directed
posteromedially.
HEAD

Orbits
• The walls of the orbits
are bone whereas the
base of each conical
chamber can be opened
and closed by the eyelids.
HEAD
Nasal Cavities
• The nasal cavities are the
upper parts of the
respiratory tract and are
between the orbits.
• They have walls, floors,
and ceilings, which are
predominantly composed
of bone and cartilage.
HEAD
Nasal Cavities
• The anterior openings to the nasal cavities are
nares (nostrils), and the posterior openings are
choanae (posterior nasal apertures).
HEAD
Oral Cavity
• The oral cavity is inferior
to the nasal cavities, and
separated from them by
the hard and soft palates.
• The floor of the oral
cavity is formed entirely
of soft tissues.
HEAD
Oral Cavity
• The anterior opening to the oral cavity is the oral
fissure (mouth), and the posterior opening is the
oropharyngeal isthmus.
• Both of these can be opened and closed by
surrounding soft tissues.
HEAD
Other anatomically
defined regions

1. The infratemporal fossa

is an area between the
ramus of the mandible
and the lateral plate of
the pterygoid process just
posterior to the upper jaw
(maxilla).
HEAD
Other anatomically
defined regions

• This fossa is a conduit for

one of the major cranial
nerves-the mandibular
nerve (the mandibular
division of the trigeminal
nerve [V3]), which passes
between the cranial and
oral cavities.
HEAD
Other anatomically
defined regions

2. The pterygopalatine
fossa on each side is
just posterior to the
upper jaw.
HEAD
Other anatomically
defined regions

• This communicates with

the:
▫ cranial cavity
▫ infratemporal fossa
▫ orbit
▫ nasal cavity
▫ oral cavity
HEAD
Other anatomically
defined regions

• Major structure passing

through the
pterygopalatine fossa is
the (maxillary division of
the trigeminal nerve)
maxillary nerve [V2].
HEAD
Other anatomically defined regions

3. The face is the anterior aspect of the head and

contains a unique group of muscles that move
the skin relative to underlying bone and control
the anterior openings to the orbits and oral
cavity.
HEAD
Other anatomically defined regions

4. The scalp covers the superior, posterior, and

lateral regions of the head.
NECK
• The neck extends from the base of the skull to the
thoracic inlet.
NECK
• It is the transitional area between the cranium
superiorly and the clavicles inferiorly that joins
the head to the trunk and limbs.
NECK
• It serves as a major conduit for structures passing
between them.
• Several important organs with unique functions
are located here: the larynx and the thyroid and
parathyroid glands, for example.
Boundaries
Bony landmarks forming the
superior boundary of the
neck are:
1- inferior margin of
mandible
2- mastoid process
3- external occipital
protuberance
Boundaries
Posteriorly:
• The spinous process of axis (C2) and vertebra
prominence (C7) can be palpated in the midline.

Laterally:
• The transverse process of atlas (C1) lies between
angle of mandible and mastoid process.
Boundaries
Anteriorly:

• The hyoid bone is at the level of C3 vertebra

• The laryngeal prominence, formed by the

thyroid cartilage, is more prominent in males
than in females.

• The cartilage is at the level of C4 and C5

vertebrae.
Boundaries
Anteriorly:

• The cricoid cartilage lies level with C6 vertebra.

• The lobes of the thyroid gland lie on each side of

trachea connected by an isthmus that usually lies
anterior to the 2nd and 3rd tracheal rings.
Boundaries

hyoid bone, thyroid cartilage, cricoid bone, and the thyroid gland
(from top to bottom)
 Boundaries
Anteriorly:

• The suprasternal or
jugular notch lies above
manubrium sterni, while
supraclavicular fossa is
above the middle part of
clavicle.
 Boundaries
Anteriorly:

• The anterior border of

trapezius muscle marks
the posterior limit of the
side of the neck.
• Sternocleidomastoid
muscle (SCM) divides the
lateral side of the neck
into anterior and
posterior triangles.
Boundaries
Compartments
The neck has 4 major compartments which are
enclosed by an outer musculofascial collar.
• vertebral compartment
▫ cervical vertebrae
▫ postural muscles
• visceral compartment
▫ important glands (thyroid, parathyroid, and thymus)
▫ parts of the respiratory and digestive tracts that pass
between the head and thorax.
• two vascular compartments
▫ major blood vessels
▫ vagus nerve
NECK COMPARTMENTS
Specialized Structures

The neck contains two

specialized structures associated
with the digestive and
respiratory tracts-
• larynx
• pharynx
Larynx

• The larynx is the upper part of

the lower airway and is
attached below to the top of
the trachea and above, by a
flexible membrane, to the
hyoid bone, which in turn is
attached to the floor of the oral
cavity.
Larynx

• A number of cartilages form a

supportive framework for the
larynx, which has a hollow
central channel.
Larynx
• The upper opening of the larynx (laryngeal inlet) is
tilted posteriorly, and is continuous with the
pharynx.
Pharynx
• The pharynx is a half cylinder
of muscle and fascia attached
above to the base of the skull,
and below to the margins of
the esophagus.
• On each side, the walls of the
half cylinder are attached to
the lateral margins of the
▫ nasal cavities
▫ oral cavity
▫ larynx
Pharynx

Parts of the pharynx:

• nasopharynx - posterior to the
nasal cavities
• oropharynx - posterior to the
oral cavity
• laryngopharynx – posterior to
the larynx
FUNCTIONS
1. Protection

• The head houses and protects the brain and all

the receptor systems associated with the special
senses-the nasal cavities associated with smell,
the orbits with vision, the ears with hearing and
balance, and the oral cavity with taste.
FUNCTIONS
2. Contains upper parts of respiratory and
digestive tracts

• The head contains the upper parts of the

respiratory and digestive systems-the nasal and
oral cavities-which have structural features for
modifying the air or food passing into each
system.
FUNCTIONS
3. Communication

• The head and neck are involved in communication.

• Sounds produced by the larynx are modified in
the pharynx and oral cavity to produce speech.
• In addition, the muscles of facial expression
adjust the contours of the face to relay non-verbal
signals.
FUNCTIONS
4. Positioning the head

• The neck supports and positions the head.

• Importantly, it enables an individual to position
sensory systems in the head relative to
environmental cues without moving the entire
body.
FUNCTIONS
5. Connects the upper and lower respiratory
and digestive tracts

• The neck contains specialized structures (pharynx

and larynx) that connect the upper parts of the
digestive and respiratory tracts (nasal and oral
cavities) in the head, with the esophagus and
trachea, which begin relatively low in the neck and
pass into the thorax.
Skull

• The many bones of the

head collectively form
the skull.

• 2 groups:
1. Cranial bones
2. Facial bones
Skull
• Most of these bones are interconnected by sutures,
which are immovable fibrous joints.
Skull
• In the fetus and newborn, large membranous and
unossified gaps (fontanelles) between the bones of
the skull, particularly between the large flat bones
that cover the top of the cranial cavity, allow:
▫ the head to deform during its passage through the
birth canal
▫ postnatal growth.
Skull
• Most of the fontanelles
close during the first
year of life.
• Full ossification of the
thin connective tissue
ligaments separating the
bones at the suture lines
begins in the late
twenties, and is
normally completed in
the fifth decade of life.
The Cranium

• The cranium serves to:

§ Enclose brain
§ Provide attachment sites for some head and neck
muscles
Overview of Skull Geography
• Facial bones form anterior aspect
• Cranium is divided into:
▫ cranial vault
▫ base
• Internally, prominent bony ridges divide skull into
3 distinct fossae:
▫ Anterior
▫ Middle
▫ Posterior
Overview of Skull Geography
• The skull contains smaller cavities
§ Middle and inner ear cavities – in lateral aspect of
cranial base
§ Nasal cavity – lies in and posterior to the nose
§ Orbits – house the eyeballs
§ Air-filled sinuses – occur in several bones around
the nasal cavity
Overview of Skull Geography
• The skull contains approximately 85 named
openings
§ Foramina, canals, and fissures
§ Provide openings for important structures
o Spinal cord
o Blood vessels serving the brain
o 12 pairs of cranial nerves
Cranial Bones
• Formed from 8 large
bones
§ Paired bones include
oTemporal bones
oParietal bones
§ Unpaired bones
include
oFrontal bone
oOccipital bone
oSphenoid bone
oEthmoid bone
Frontal Bones
• Forms the forehead and roofs of the orbits
• Forms superciliary arches
• Internally, it contributes to the anterior cranial fossa
• Contains frontal sinuses
Frontal Bones
• Articulates posteriorly with the parietal bones via
the coronal suture
• Major markings include the:
▫ supraorbital margins
▫ anterior cranial fossa
▫ frontal sinuses (internal and lateral to the glabella)
Parietal Bones
• Form most of the superior and lateral aspects of
the skull
Parietal Bones and Sutures
• Four sutures mark the articulations of the parietal
bones
1. Coronal suture – located where parietal bones
meet the frontal bone
2. Squamous suture – occurs where each parietal
bone meets a temporal bone inferiorly
Parietal Bones and Sutures

3. Sagittal suture –
occurs where right
and left parietal
bones meet
superiorly
4. Lambdoid suture –
occurs where the
parietal bones meet
the occipital bone
posteriorly
Sutural Bones
• Small bones that occur within sutures
• Irregular in shape, size, and location
• Not all people have sutural bones
Occipital Bone
• Forms the posterior portion of the cranium and
cranial base
• Articulates with the temporal bones and parietal
bones
Occipital Bone
• Forms the posterior cranial fossa
• Foramen magnum located at its base
• These structures pass thru the foramen magnum:
§ Brainstem
§ CN XI
§ Vertebral Arteries
§ Meninges
Occipital Bone
• Features and structures
§ Occipital condyles
§ Hypoglossal canal
oCN XII passes here
§ External occipital
protuberance
§ Superior nuchal lines
§ Inferior nuchal lines
Inferior Aspect of the Skull
Temporal Bones
• Lie inferior to parietal bones
• Form the inferolateral portion of the skull
• Term “temporal” comes from Latin word for time
Temporal Bones
• Specific regions of temporal bone:
§ squamous
§ temporal
§ petrous
§ mastoid
Temporal Bones
• Major markings
include the:
§ zygomatic
process
§ styloid process
§ mastoid process
§ mandibular
fossa
§ middle cranial
fossa
§ internal
auditory meatus
- CNs VII &VIII
§ external
auditory meatus
The Sphenoid Bone
• Spans the width of the middle cranial fossa
• Resembles a butterfly or bat
• Forms the central wedge that articulates with all
other cranial bones
• Consists of a:
▫ central body
▫ greater wings
▫ lesser wings
▫ pterygoid processes
Sphenoid Bone
• Major markings:
▫ sella turcica
▫ hypophyseal fossa
▫ pterygoid processes
Sphenoid Bone
• Major openings
include the:
§ superior orbital fissure
- CNs III, IV, V1 , VI &
ophthalmic veins
§ foramina rotundum -
CN V2
§ foramina ovale - CN V3
§ foramina spinosum -
middle meningeal
artery
§ optic foramen - CN II
The Ethmoid Bone
• Deepest of the skull
bones
• Lies between nasal
and sphenoid bones
• Forms most of the
medial bony region
between the nasal
cavity and orbits
• Olfactory foramina -
CN I
Ethmoid Bone

• Major markings
include:
▫ cribriform plate
▫ crista galli
▫ perpendicular plate
▫ nasal conchae
▫ ethmoid sinuses
The Face

• Facial bones serve to:

§ Form framework of the face
§ Form cavities for the sense organs of sight, taste,
and smell
§ Provide openings for the passage of air and food
§ Hold the teeth
§ Anchor muscles of the face
Facial Bones
• Formed from 14 bones
▫ Unpaired
 mandible
 vomer
▫ Paired bones
 maxillae
 zygomatics
 nasals
 lacrimals
 palatines
 inferior conchae
Mandible
• The lower jawbone is the largest and strongest
facial bone
• Composed of two main parts
§ Horizontal body
§ Two upright rami
Mandible and Its Markings
• Major markings
include the:
§ coronoid process
§ mandibular condyle
§ alveolar margin
§ mandibular
foramina
§ mental foramina
Maxillary Bones
• Medially fused bones that make up the upper jaw and the
central portion of the facial skeleton
• Articulate with all other facial bones except the mandible
• Contain maxillary sinuses – largest paranasal sinuses
• Forms part of the inferior orbital fissure
Maxillary Bones
• Major markings include:
▫ palatine process
▫ frontal process
▫ zygomatic processes
▫ alveolar margins
▫ inferior orbital fissure
▫ maxillary sinuses
Zygomatic Bones

• Irregularly shapes bones (cheekbones) that form

the prominences of the cheeks and the
inferolateral margins of the orbits
Other Facial Bones
• Nasal bones (dark blue)– thin medially fused
bones that form the bridge of the nose
• Lacrimal bones (light green) – contribute to the
medial walls of the orbit and contain a deep groove
called the lacrimal fossa that houses the lacrimal
sac
Other Facial Bones
• Palatine bones (gray) – two bone plates that form
portions of the hard palate, the posterolateral
walls of the nasal cavity, and a small part of the
orbits
Other Facial Bones
• Vomer (light blue) – forms the inferior part of the
nasal septum
• Inferior nasal conchae (green)
§ thin, curved bones that project medially to form the
lateral walls of the nasal cavity
Cervical Vertebrae
• Seven vertebrae (C1-C7) -
smallest, lightest vertebrae
• C3-C7 are distinguished with
▫ oval body
▫ short spinous processes
▫ large, triangular vertebral
foramina
• Each transverse process
contains a transverse foramen
• Superior articular facets face
superoposteriorly
Typical Cervical Vertebra

C3 to C6
Characteristics
• uncinate process
• spinal foramina
• transverse foramina
• bifid spinous process
Cervical Vertebrae
Typical Cervical Vertebra
Uncinate process
• hook-shaped process
on the lateral borders
of the superior
surface of the
vertebral bodies of
the 3rd to the 7th
cervical vertebrae and
1st thoracic vertebra
Typical Cervical Vertebra
Uncinate process
• prevents a vertebra
from sliding
backwards off the
vertebra below it
• limits lateral flexion
Typical Cervical Vertebra
Luschka’s joints
• also called
uncovertebral joints
• are formed between
uncinate processes
above, & uncus below
• allow for flexion and
extension
• limit lateral flexion in
the cervical spine
Typical Cervical Vertebra
Transverse foramina
• pierces the transverse
processes of the 7
cervical vertebrae
• in the upper 6
vertebrae, it allows
passage to the
▫ vertebral artery
▫ vertebral vein
▫ plexus of sympathetic
nerves
Typical Cervical Vertebra

Transverse foramina
• in the 7th vertebrae,
allows passage to the
▫ vertebral vein
▫ sympathetic nerves
C1 - Atlas
Characteristics:
• absent body & spinous process
• just a bony ring
• supports the skull
§ superior articular facets receive the occipital condyles
• allows flexion and extension of neck
§ nodding the head “yes”
C2 - Axis
Characteristics
• odontoid process (dens)
- expanded body of the
atlas
- projects superiorly
from the body and is
cradled in the anterior
arch of the atlas
• short articular processes
▫ upper facets face upwards &
backwards
▫ lower facets face
downwards & forwards
C2 - Axis
• The dens is a
pivot for the
rotation of the
atlas and skull
• Participates in
rotating the head
from side to side
§ Shaking the
head to
indicate “no”
Atlanto - Axial Complex

Made up of the
• atlas
• axis
Atlanto - Axial Complex
Atlanto - Axial Complex
Cervical 7

Known as the vertebra

prominens because
its spinous process is
easily palpated
Cervical Spinal Segment
Cervical AP & Lateral X-rays
Cervical (R) & (L) Oblique
X-rays
Cervical MRI
Hyoid Bone

• Shaped like a horseshoe

• Suspended from the tips of the
styloid processes of the temporal
bones by the stylohyoid
ligaments.
Hyoid Bone

• Does not articulate directly with

any other skeletal elements in
the head and neck.
• Highly movable and strong bony
anchor for a number of muscles
and soft tissue structures in the
head and neck.
Hyoid Bone
• Significantly, it is at the
interface between 3
dynamic compartments.
• It is attached:
▫ superiorly- floor of the
oral cavity
▫ inferiorly- larynx
▫ posteriorly- pharynx
Hyoid Bone
• Made up of five segments:
▫ a body
▫ two greater cornua (horn)
▫ two lesser cornua  (horn)
Body
• Quadrilateral form
• Have the following parts
▫ Anterior surface
▫ Posterior surface
▫ Upper border
▫ Lower border
▫ Transverse ridge
Body
• Anterior surface is convex
and directed forward and
upward.

• Crossed in its upper half by

a well-marked transverse
ridge with a slight
downward convexity, and
in many cases a vertical
median ridge divides it into
two lateral halves.
Body
• The posterior surface is smooth, concave, directed
backward and downward, and separated from the
epiglottis by the thyrohyoid membrane and a
quantity of loose areolar tissue.
• A bursa intervenes between it and the thyrohyoid
membrane.
Body
• The upper border is rounded, and gives
attachment to the thyrohyoid membrane and
some aponeurotic fibers of the Genioglossus.
Body
• The lower border affords insertion medially to the
Sternohyoideus and laterally to the Omohyoideus
and occasionally a portion of the Thyrohyoideus.
The Greater Cornua
• Project backward from the lateral borders of the
body
• They are flattened from above downward and
diminish in size from before backward
• Each ends in a tubercle to which is fixed the lateral
hyothyroid ligament
The Lesser Cornua

• Two small, conical

eminences, attached by
their bases to the angles of
junction between the body
and greater cornua.
The Lesser Cornua

• Connected to the body of

the bone by fibrous tissue,
and occasionally to the
greater cornua by distinct
diarthrodial joints
Thyroid Cartilage

• Largest of the nine

cartilages that make up the
laryngeal skeleton
• Cartilage structure in and
around the trachea that
contains the larynx.
Thyroid Cartilage

• Composed of two plate-like

laminae that fuse on the
anterior side of the cartilage
to form a peak, called the
laryngeal prominence or
“Adam’ s apple”.
Thyroid Cartilage
• This is more prominent in
adult male than female
because of the difference in
the size of the angle: 90° in
male and 120° in female.
Thyroid Cartilage
2 notches
• superior thyroid notch - lip of the thyroid cartilage
just superior to the laryngeal prominence
• inferior thyroid notch - notch inferior to the
thyroid angle
Thyroid Cartilage
Its posterior border is elongated both inferiorly and
superiorly to form:
• superior horn of thyroid cartilage
• inferior horn of thyroid cartilage
Cricoid Cartilage

• The cricoid cartilage, or

simply cricoid, is the
only complete ring of
cartilage around the
trachea.
Cricoid Cartilage

• Inferior to the thyroid

cartilage in the neck
• Joined to the thyroid
cartilage
▫ medially - median
cricothyroid ligament
▫ postero-laterally -
cricothyroid joints
Cricoid Cartilage

• Inferior to it are the

rings of cartilage
around the trachea.
Cricoid Cartilage
Parts:
• lamina - posterior part
that is slightly broader
than the anterior and
lateral parts
• band - anterior part

• This may be the reason

for the common
comparison made
between the cricoid
and a signet ring.
Cricoid Cartilage
Clinical Significance
• When intubating a patient
under GA prior to surgery,
the anesthesiologist will
press on the cricoid
cartilage to compress the
esophagus behind it so as
to prevent gastric reflux
from occurring: this is
known as the Sellick
manoeuvre.
Cricoid Cartilage
Clinical Significance
• Cricoid pressure is often
used to improve the view
of the glottis during
laryngoscopy and tracheal
intubation, rather than to
prevent regurgitation, and
this is also known as the
"BURP" (Backwards
Upwards Rightwards
Pressure) manoeuvre.
Cricoid Cartilage
Clinical Significance

• The American Heart

Association still advocates
the use of cricoid pressure
during resuscitation using
a bag valve mask, and
during emergent oral
endotracheal intubation.
Cricoid Cartilage
Clinical Significance
• A cricothyrotomy (emergency
airway puncture) is an incision
made through the skin and
cricothyroid membrane to
establish a patent airway
during life-threatening
situations, such as
▫ airway obstruction by a
foreign body
▫ angioedema
▫ massive facial trauma.
Cricoid Cartilage
Clinical Significance
• A scalpel is used to create
a 1 cm vertical incision
through the skin and the
cricothyroid membrane,
and the resulting hole is
opened by either inserting
the scalpel handle into the
wound and rotating 90
degrees or by using a
clamp.
Cricoid Cartilage
Clinical Significance
• A tracheostomy tube or endotracheal tube with a 6
or 7 mm internal diameter is then inserted, the cuff
is inflated, and the tube is secured.
Head Muscles

• The muscle groups in the head include:

▫ extraocular muscles (move the eyeball and open the
upper eyelid)
▫ muscles of the middle ear (adjust the movement of
the middle ear bones)
▫ muscles of facial expression (move the face)
▫ muscles of mastication (move the jaw- TMJ)
▫ muscles of the soft palate (elevate and depress the
palate)
▫ muscles of the tongue (move and change the
contour of the tongue)
Neck Muscles

• In the neck, major muscle groups include:

▫ muscles of the pharynx (constrict and elevate the
pharynx)
▫ muscles of the larynx (adjust the dimensions of the
air pathway)
▫ strap muscles (position the larynx and hyoid bone
in the neck
▫ muscles of the outer cervical collar (move the head
and upper limb)
▫ postural muscles in the muscular compartment of
the neck (position the neck and head).
Platysma Muscle
Broad thin subcutaneous
sheet of muscle, superficial
to the external jugular vein
(EJV) and the main
cutaneous nerves of the neck.

Attachment:
• Superiorly – inferior border
of mandible and tissues of
lower face.
• Inferiorly – fascia covering
pectoralis major and deltoid
muscles.
Platysma Muscle

Nerve supply:
• cervical branch of facial nerve

Action:
• tenses skin as in shaving the
neck or easing a tight collar
• depresses mandible and
corners of mouth as in
expression of sadness or
fright
Platysma Muscle

Clinical point:
• Care should be taken during neck surgery –
paralysis of this muscle causes skin to fall into
folds.
• In addition, improper suturing of platysma
causes an ugly scar.
Sternocleidomastoid Muscle

• paired muscle in the

superficial layers of the
anterior portion of the
neck
• passes obliquely across
the side of the neck
• thick and narrow at its
central part
• but broader and thinner at
either end
Sternocleidomastoid Muscle
Origin
Anterior and superior
manubrium and superior
medial third of clavicle.
Insertion
Lateral aspect of mastoid
process and anterior half of
superior nuchal line.

Nerve supply:
Spinal accessory nerve (lateral
roots C1-5).
 Sternocleidomastoid Muscle
Action:
1. flexes and laterally rotates cervical spine
2. protracts head when acting together
3. extends neck when neck already partially extended
Anterior Neck Muscles
Collectively, they are referred to as the strap
muscles, because the muscles are long and flat
much like a strap.

2 groups:
1. Suprahyoid muscles
2. Infrahyoid muscles
Suprahyoid & Infrahyoid Muscles
The term suprahyoid
refers to the region
above (superior) the
hyoid bone in the neck.

The suprahyoid muscles

include:
▫ digastric
▫ stylohyoid
▫ geniohyoid
▫ mylohyoid
Suprahyoid & Infrahyoid Muscles
The term infrahyoid
refers to the region
below (inferior) the
hyoid bone in the neck.

The infrahyoid muscles

include:
▫ sternothyroid
▫ sternohyoid
▫ thyrohyoid
▫ omohyoid
Suprahyoid Muscles
A group of four pairs of muscles in the anterior
part of the neck above the hyoid bone.

Muscle Origin Insertion

intermediate tendon
digastric mastoid process mandible
(hyoid bone)
greater cornu of hyoid
stylohyoid styloid process
bone

geniohyoid symphysis menti hyoid bone

mylohyoid mylohyoid line of mandible median raphe

 Suprahyoid Muscles

Muscle Innervation Action

1. elevate the hyoid when

anterior belly - mandibular division
mandible is fixed
digastric (V3)
2.opens the jaw when the
posterior belly - facial nerve (CN VII)
hyoid is fixed
elevate the hyoid during
stylohyoid facial nerve
swallowing
carry hyoid bone and the
geniohyoid C1 via hypoglossal nerve tongue upward during
deglutition

raises oral cavity floor,

mylohyoid nerve from mandibular
mylohyoid elevates hyoid, depresses
nerve
mandible
Suprahyoid Muscles
The Digastric muscle (named digastric as it has
two bellies) connected by a tendon, which
attaches to the body of the hyoid bone.
Suprahyoid Muscles
The Stylohyoid muscle is a slender muscle, lying
in front of, and above the posterior belly of the
digastric muscle.
It is perforated, near its insertion, by the tendon of
the Digastric muscle.
Geniohyoid Muscles
The Geniohyoid muscle is a narrow muscle
situated superior to the medial border of the
mylohyoid muscle.
It forms, with its fellow of the opposite side, a
muscular floor for the cavity of the mouth.
Mylohyoid Muscles
The Mylohyoid muscle is flat and triangular,
and is situated immediately above the anterior
belly of the digastric muscle.
It forms, with its fellow of the opposite side, a
muscular floor for the cavity of the mouth.
Infrahyoid Muscles
A group of four pairs of muscles in the anterior
part of the neck below the hyoid bone.
Muscle Origin Insertion

sternothyroid sternum thyroid cartilage

sternohyoid sternum hyoid bone

thyrohyoid thyroid cartilage hyoid bone

superior border of
omohyoid hyoid bone
scapula
Infrahyoid Muscles
The Sternohyoid muscle is a thin, narrow
muscle attaching the hyoid bone to the sternum .
Infrahyoid Muscles
The Sternothyroid muscle is shorter and wider
than the Sternohyoid, beneath which it is
situated.
Infrahyoid Muscles
The Thyrohyoid muscle is a small,
quadrilateral muscle appearing like an upward
continuation of the Sternothyroid.
Infrahyoid Muscles
The Omohyoid muscle is a muscle at the front
of the neck that consists of two bellies separated
by an intermediate tendon.
 Infrahyoid Muscles
• The inferior belly of the
Omohyoid divides the
posterior triangle of the
neck into an upper or
occipital triangle and a
lower or supraclavicular
triangle.
• Its superior belly divides
the anterior triangle
into an upper or carotid
triangle and a lower or
muscular triangle.
Infrahyoid Muscles
Nerve Supply:

All of the infrahyoid muscles

are innervated by ansa
cervicalis from the cervical
plexus(C1-3) EXCEPT for
the thyrohyoid muscle,
which is innervated by only
C1.

Action:
- to depress the hyoid bone
and larynx during
swallowing and speaking
Sternocleidomastoid Muscle
It divides the neck into anterior and posterior
triangles.
Triangles of the neck
Subdivisions:
• Anterior Triangle
▫ Submandibular
triangle
▫ Submental triangle
▫ Muscular triangle
▫ Carotid triangle
• Posterior Triangle
▫ Occipital triangle
▫ Supraclavicular
triangle
 Anterior triangle

The anterior triangles are

associated with structures
such as the airway and
digestive tract, and nerves
and vessels that pass
between the thorax and
head.
They are also associated
with the thyroid and
parathyroid glands.
 Anterior triangle
Submandibular triangle

Boundaries:
• mastoid & mandible above
• anterior belly of digastric
anteriorly (abd)
• posterior belly of digastric
(pbd)
• stylohyoid posteriorly (sh)
Anterior triangle
Submandibular
triangle

The superficial (roof)

structures are:
• platysma
• facial vein (fv)
• cervical branch of facial
nerve (cbf)
Anterior triangle
Submandibular
triangle
Contains the following
structures:
• external and internal carotid
artery
• internal jugular vein
• deep cervical lymph nodes
• vagus nerve
• submandibular gland
• submandibular lymph nodes
• facial artery and vein
• hypoglossal nerve
Anterior triangle
Submental triangle

The submental triangle is

located between the two
anterior digastric muscles
(abd).

Structures found here are

the submental lymph
node(s) (ln) that drain the
floor of the mouth.
Anterior triangle
Muscular triangle

Boundaries:
• mid line of neck (1)
• superior belly of
omohyoid (2)
• sternocleidomastoid (3)
Anterior triangle
Muscular triangle

Muscles within are called

strap muscles:
• superficial layer
▫ sternohyoid
▫ superior belly of
omohyoid
• deep layer
▫ thyrohyoid
▫ sternothyroid
Anterior triangle
Carotid triangle

Boundaries:
• posterior belly of digastric
muscle
• superior belly of the
omohyoid muscle
• anterior border of
sternocleidomastoid
muscle
Anterior triangle
Carotid triangle

Arteries within:
• common carotid
• external carotid
• internal carotid
• superior thyroid
• occipital
• lingual
• facial
Posterior triangle

The posterior triangle of

the neck is on the
lateral aspect of the
neck in direct
continuity with the
upper limb.
It is associated with
nerves and vessels
that pass into and out
of the upper limbs.
Posterior triangle

Boundaries of
Posterior Triangle

• anterior--
sternocleidomastoid
• posterior--trapezius
• inferior--middle third
of clavicle
Posterior triangle

Further subdivided
into:
• Occipital triangle
• Supraclavicular
triangle
by the inferior belly of
the omohyoid muscle
Posterior triangle

Roof of Posterior
Triangle

• skin
• superficial fascia
• platysma inferiorly
 Posterior triangle
Structures Superficial to Sternocleidomastoid

• external jugular vein (blue)

• superficial cervical lymph
nodes (green)
• lesser occipital nerve (lc)
• great auricular nerve (ga)
• transverse cervical nerve (tc)
• supraclavicular nerves (sc)
• spinal accessory nerve (sa)
Posterior triangle

Other Structures in
Posterior Triangle

• spinal accessory (sa)

• brachial plexus (bp)
• transverse cervical artery
(tc)
• suprascapular artery (ss)
Root of the neck

The root of the neck is

the area immediately
superior to the
superior thoracic
aperture and axillary
inlets.
Root of the neck
It is bounded:
• Anteriorly
▫ top of the manubrium of
sternum
▫ superior margin of the
clavicle
• Posteriorly
▫ top of the thoracic vertebra T1
▫ superior margin of the
scapula to the coracoid
process
Root of the neck
It contains structures passing between the neck,
thorax, and upper limb.
1. Blood vessels
Root of the neck
2. Nerves
Root of the neck
3. Sympathetic Nerves
Root of the neck
4. Thoracic Duct
Root of the neck
5. Lymphatics
Root of the neck
There is also an extension of
the thoracic cavity
projecting into the root of
the neck.
This consists of an upward
projection of the pleural
cavity, on both sides, and
includes the cervical part of
the parietal pleura (cupola),
and the apical part of the
superior lobe of each lung.
Fascia of the Neck
Classification

1- Superficial

2- Deep – consists of 4 parts:

A. Investing layer

B. Pretracheal layer C
D
B
C. Prevertebral layer
A

D. Carotid sheath
Fascia of the Neck
Superficial Cervical Fascia

- Thin layer of subcutaneous tissue.

It contains:

1- Cutaneous nerves

2- Blood vessels and lymphatics

3- Superficial lymph nodes and fat

4- Platysma muscle
Superficial Cervical Fascia
Fascia of the Neck
Deep Cervical Fascia

Functions:

1. Surrounds viscera and vessels forming cleavage

planes between them during surgery
2. Limits spread of abscess
3. Provides slippery surface for movement of neck
viscera, e.g. during swallowing

• The attachment of deep fascia to hyoid bone

prevents formation of dewlap.
Deep cervical fascia
Organized into several distinct layers:
1. investing layer - surrounds all structures in the
neck
2. pretracheal layer - encloses the viscera of the
neck
3. prevertebral layer - surrounds the vertebral
column and the deep muscles associated with
the back
4. carotid sheaths - receive a contribution from the
other 3 fascial layers and surround the 2 major
neurovascular bundles on either side of the neck
Deep Cervical Fascia
I- Investing Layer 
• Surrounds the entire neck deep to the superficial
fascia.

The investing layer splits to envelope 2 muscles:

1. Sternocleidomastoid
2. Trapezius

It also splits to envelope 2 salivary glands:

1. Submandibular
2. Parotid

Deep to the parotid gland, the investing layer

thickens to form the stylomandibular ligament.
Deep Cervical Fascia
Deep Cervical Fascia
Inferiorly, the investing layer splits above 2
bones:

1- above manubrium sterni to form the

suprasternal space that contains:
▫ inferior end of anterior jugular veins
▫ jugular venous arch
▫ lymph nodes and fat
Deep Cervical Fascia

2- above middle 1/3 of clavicle

▫ posterior layer surrounds the inferior belly of
omohyoid muscle
▫ below the clavicle, the investing layer is
represented by the clavi-pectoral fascia

• Posteriorly, the investing layer is continuous

with the ligamentum nuchae
a- investing layer of deep cervical fascia

b- platisma muscle
 Deep Cervical Fascia
II- Pretracheal Layer 

- lies anterior to the trachea

- consists of 2 parts:
1. thin muscular layer
enclosing the infrahyoid
muscles
2. visceral layer enclosing
- thyroid gland
- trachea
- esophagus
Deep Cervical Fascia

Attachments:
Superiorly - hyoid bone
- thyroid cartilage
- cricoid cartilage
Inferiorly - arch of aorta
Laterally - blends with the
carotid sheath
Infrahyoid Cross-
Section Showing
Layers of Deep
Cervical Fascia
(a)- middle layer of deep cervical fascia
(b)- strap muscles
Deep Cervical Fascia
III- Prevertebral Layer
 
Tubular layer around the vertebral column and
associated muscles.

Attachments:
Superiorly - base of skull
Inferiorly - body of T3 vertebra
Deep Cervical Fascia

• It extends laterally as the

axillary sheath around the
axillary vessels and
brachial plexus.

• It is continuous inferiorly
with the anterior
longitudinal ligament.

• The sympathetic trunks are

embedded in the
prevertebral layer.
Begins from cervical spinous processes(a)
and the ligamentum nuchae(b).

The prevertebral layer of fascia attaches to

the tranverse processes(c) and divides into
two layers/laminae as it passes behind the
esophagus and in front of the vertebral
column.
Deep Cervical Fascia
IV- Carotid Sheath 

Tubular sheath containing:

1- common and internal carotid arteries
2- internal jugular vein (IJV)
3- vagus nerve
4- carotid sinus nerve – a branch from
glossopharyngeal nerve
5- carotid sympathetic plexus
6- deep cervical lymph nodes
Deep Cervical Fascia
Attachments:
Superiorly - base of skull around carotid foramen
Inferiorly - arch of aorta

The carotid sheath blends:

Anteriorly - with the investing layer
Medially - with the pretracheal layer
Posteriorly - with the prevertebral layer
Deep Cervical Fascia
Fascial Compartments
The arrangement of the
various layers of cervical
fascia organizes the neck
into 4 longitudinal
compartments:
1. 1st compartment
§ largest
§ includes the other three
§ consists of the area
surrounded by the
investing layer
Fascial Compartments
2. 2nd compartment
consists of:
§ vertebral column
§ deep muscles associated
with this structure
§ area contained within the
prevertebral layer
Fascial Compartments
3. 3rd compartment (the
visceral compartment)
contains:
§ pharynx
§ trachea
§ esophagus
§ thyroid gland
§ surrounded by the
pretracheal layer
Deep Cervical Fascia
4. 4th compartment (the
carotid sheath) consisting
of the:
§ neurovascular structures
that pass from the base of
the skull to the thoracic
cavity
§ sheath enclosing these
structures receives
contributions from the
other cervical fascias
Tissue Spaces of the Neck
• Between the fascial layers in the neck are spaces
that may provide a conduit for the spread of
infections from the neck to the mediastinum.
• Four spaces could be involved in this process.
Tissue Spaces of the Neck

1- Behind the prevertebral fascia is a closed space

extending from base of skull to T3 vertebra.
Tissue Spaces of the Neck
2- In front of the pretracheal fascia is a space
communicating with the superior mediastinum
(pretracheal space)
Tissue Spaces of the Neck
3- Between the prevertebral and pretracheal layers
is the retropharyngeal space.
Tissue Spaces of the Neck
Boundaries:
Superiorly - base of skull
Laterally - carotid sheath
Inferiorly - continuous with the superior
mediastinum

Clinical Point:
• Pus may spread from the retropharyngeal space
to the superior and posterior mediastina, or may
pass laterally to the posterior triangle of the neck.
Tissue Spaces of the Neck

4- The submandibular
space extends above
investing layer of deep
cervical fascia between
the hyoid bone &
mandible to mucus
membrane.
Tissue Spaces of the Neck
Clinical Point:

• The term Ludwig angina describes inflammation

and cellulitis of the submandibular space, usually
starting in the submaxillary space and spreading to
the sublingual space via the fascial planes, not the
lymphatics.
Tissue Spaces of the Neck
Clinical Point:
• As the submandibular
space is expanded by
cellulitis or abscess, the
floor of the mouth
becomes indurated, and
the tongue is forced
upward and backward,
causing airway
obstruction.
• This is a life-threatening
condition that requires
tracheostomy for airway
control.
Scalp

• The scalp is the part of

the head that extends
from the superciliary
arches anteriorly to the
external occipital
protuberance and
superior nuchal lines
posteriorly.
• Laterally it continues
inferiorly to the
zygomatic arch.
Layers of the scalp
It is usually described as having 5 layers, which
can be remembered with the mnemonic
"SCALP":
Layers of the scalp
• Examining the layers of
the scalp reveals that the
first three layers are tightly
held together, forming a
single unit.
• This unit is sometimes
referred to as the scalp
proper and is the tissue
torn away during serious
'scalping' injuries.
Layers of the scalp
• Skin on the head from which head hair grows;
richly supplied with blood vessels.
• Connective tissue; a thin layer of fat and fibrous
tissue lies beneath the skin
Layers of the scalp

• Aponeurosis called
epicranial aponeurosis
(or galea aponeurotica); a
tough layer of dense
fibrous tissue which runs
from the frontalis muscle
anteriorly to the
occipitalis posteriorly
connecting the two.
Layers of the scalp
• Loose areolar connective tissue layer provides an
easy plane of separation between the upper three
layers and the pericranium;
• referred to as the "Danger Zone" because of the
ease by which infectious agents can spread
through it to emissary veins which then drain into
the cranium;
• contains the major blood vessels of the scalp,
which bleed profusely upon injury, partly due to
the absence of venous valves found in the
circulation below the neck.
Layers of the scalp
• Pericranium is the periosteum of the skull bones
and provides nutrition to the bone and the
capacity for repair; may be lifted from the bone to
allow removal of bone windows (craniotomy).

• The clinically important layer is the aponeurosis.

Scalp lacerations through this layer mean that the
"anchoring" of the superficial layers is lost and
gaping of the wound occurs; this requires suturing.
Layers of the scalp
Muscles of the scalp
Epicranial aponeurosis
The epicranial aponeurosis
(also known as
"epicranius"), is the muscle
of the scalp.

Action:
- frontal portion lies across
the forehead and raises the
eyebrows and wrinkles the
forehead.
- occipital portion is located
at the base of the skull and
draws the scalp backwards.
Muscles of the scalp
Frontalis
The frontalis (sometimes
also referred to as the
"frontal portion") is a thin
quadrilateral muscle that
is intimately adherent to
the superficial fascia.
Action:
Draws the scalp forward,
raises eyebrows, and
wrinkles the skin of the
forehead horizontally.
Blood supply of the scalp
The blood supply of the scalp is via 5 pairs of
arteries, 2 from the internal carotid and 3 from the
external carotid :
• internal carotid
1. supratrochlear artery to the midline forehead;
is a branch of ophthalmic branch of the internal
carotid artery.
2. supraorbital artery to the lateral forehead and
scalp as far up as the vertex; is a branch of
ophthalmic branch of the internal carotid artery.
Blood supply of the scalp
• external carotid
1. superficial temporal artery which gives
frontal and parietal branches to supply much of
the scalp
2. occipital artery which runs from posteriorly to
supply much of the back of the scalp.
3. posterior auricular artery , a branch of the
external carotid artery , ascends behind the auricle
to supply the scalp above and behind the auricle.
Blood supply of the scalp
Blood supply of the scalp
In the clinic
Scalp laceration
• The scalp has an extremely rich blood supply from
the external carotid arteries, so lacerations of the
scalp tend to bleed profusely.
• Importantly, scalp bleeding is predominantly
arterial, because of two reasons:
▫ in the erect position the venous pressure is
extremely low
▫ the vessels do not retract when lacerated because the
connective tissue in which they are found prevents
retraction
Innervation of the scalp
The scalp is innervated by the following:

• Supratrochlear nerve and the supraorbital

nerve from the ophthalmic division of the trigeminal
nerve
• Greater occipital nerve (C2) posteriorly up to the
vertex
• Lesser occipital nerve (C3) behind the ear.
• Zygomaticotemporal nerve from the maxillary
division of the trigeminal nerve supplying the hairless
temple
• Auriculotemporal nerve from the mandibular
division of the trigeminal nerve
Innervation of the scalp