Neck

The neck is bounded from above the lower edge of the lower jaw, bottom - jugular notch sternum, clavicle and a line drawn through the spinous process of VII cervical vertebra.
Frontal plane, carried out through the transverse processes of the cervical spine, Neck conventionally divided into front (actually neck and back, or occipital, departments.
On the neck distinguish five sheets fascia, forming cases for muscles, blood vessels and nerves of the neck. In the anterior neck topographically there are two large side of the triangle on each side, the boundary between them is the sternocleidomastoid muscle, allocated in a separate area of the neck. Average triangles right and left parties form one single quadrilateral, occupying the front surface of the neck. Last bordered on either side of the inner edges of the sternocleidomastoid muscle, top - chin and the edge of the lower jaw, bottom-jugular notch sternum and the collarbones. The hyoid bone divides the average quadrangle on two areas: suprahyoid and podhodyaschuyu.
In the area median quadrangle are lower part of the pharynx, esophagus, larynx, trachea, thyroid and parathyroid glands. Within great domestic cervical triangle distinguish the field sleepy and blade-tracheal triangles are smaller. In the large outer triangle also allocate two triangles smaller: vane-clavicle and blade-trapezoid. In the lower Department sternocleidomastoid area, behind the relevant muscles, outward from the neck organs allocate stair-vertebral triangle. Within this triangle are subclavian artery and the radiating branches, the confluence of internal jugular and subclavian veins flowing into formed by merging the left venous corner - thoracic lymphatic duct, wandering and phrenic nerves of the sympathetic trunk. In the field of carotid triangle possible access to neurovascular bundle (internal jugular vein, outer, inner, and common carotid artery, the vagus nerve). Midway between the lower edge of the lower jaw and the collarbone, in the inner edge of the sternocleidomastoid muscle, you can define a bump on cross Appendix VI cervical vertebra - sleepy tubercle. In this place the common carotid artery can be pressed at a bleeding from its branches.
Innervation neck is carried out by branches of the cervical plexus, sympathetic trunks, cranial nerves (V, VII, IX, X, XI and XII), and blood - branches of the external carotid and subclavian arteries; venous outflow through the inner, outer and front jugular vein. Superficial lymph nodes are located along the superficial veins and nerves, deep - during the internal jugular vein.

Neck (the word " Collum"). The upper outer border of the neck are the edge of the lower jaw, the lower edge of the bone of the ear canal, the tip of the mastoid process and upper neck line. The lower bound neck goes for the jugular clipping of a breast bone, top edge of the collar bone and a line drawn between the two Agromalim processes of the blades through the spinous process CVII.
Anatomy. Neck shape is varied and depends on the Constitution, sex, age, status, subcutaneous tissue and organs at various pathologies. The skin of the neck is thin, flexible forms a series of folds and furrows of some importance when conducting cosmetic incisions in surgical interventions on the neck. Subcutaneous fat layer expressed in stronger chin and occipital areas. In the anterior neck fiber loose and lively. In the subcutaneous tissue are exterior and front jugular vein, sometimes median (vv. jugulares ext., ant., med.). The most constant external jugular vein. Wall subcutaneous veins are closely connected with the subject fascia neck and transection not zadayutsya. Subcutaneous nerves of the neck are the branches of the cervical plexus. These include: small occipital nerve (n. occipitalis minor), big ear nerve (n. auricularis magnus), the lateral nerve neck (n. transversus colli), supraclavicular nerves (nn. supraclaviculars).
Fascia neck study usually classification A. A. Bobrov (three fascia) and B. N. Shevkunenko (five fascia). Most authors distinguish three fascia. First fascia (fascia cervicalis)or surface plate (lamina superficialis), various connective tissue density plate surrounds the neck from all sides. On top fascia is fixed to the bone basis upper outer border of the neck, bottom, front to front surface of the bone border and back, forming the vagina for trapezius muscles (m. trapezius), fascia goes together with the latest on the back. Above the edge of the lower jaw fascia gives spur on the face, forming the bed of the parotid gland. The angle of the mandible fascia thickened and firmly fixed to the sternoclavicular-liners muscle (m. sternocleidomastoideus). Fascia forms vagina for this muscle and submandibular gland. On the front surface of the neck fascia tightly connected with the body of the hyoid bone. The second fascia neck (fascia colli media), or medium plate (lamina pretrachealis), is fixed at the top to the hyoid bone, down to the inner surface of the jugular notch and collarbone with acromial process. In the lateral parts of the fascia included clavicle-subclavian muscles (mm. omohyoidei), in the middle of Department - sternum-sublingual (mm. sternohyoidei), sternum-thyroid (mm. sternothyreoidei).
In the middle of the neck fascia is fused with the overlying fascia for the hyoid bone to the lower edge of the larynx, forming a white line. Third deep fascia (fascia colli profunda), or predposlednee plate (lamina prevertebralis), is located in front of the vertebral bodies, covering here long muscles of the neck and head mm. longi colli et capitis), which have a bone-fibrous vagina. At the top of the fascia is fixed at pharyngeal tubercle, and extending to ThIII - the place of fixation of the muscles. In the lateral parts of the fascia gives spurs, forming the vagina for stair muscles (mm. scaleni). C. N. Shevkunenko highlights on the neck, in addition to the three fascia, even subcutaneous fascia, including hypodermic muscle (platysma), and vnutrennemu (fascia endocervicalis), which consists of the parietal and visceral leaves. Parietal sheet lines the cavity of the neck and forms the vagina for neurovascular bundle. Visceral sheet around the inside of the neck. For thyroid the paper forms the outer capsule. At the top of the fascia becomes peripharyngeal the fascia, goes down into the mediastinum.
Fascia neck form a series megfelelnek cellular tissue areas and lodges or sheaths of importance in inflammatory processes. In the lower part of the neck between the first and second fascia has two fiber space: nadgradnje (spatium interaponeuroticum suprasternale) and supraclavicular (spatium supraclaviculare). Nadgradnje space on both sides form a blind bags (sacci ceci retrosternocleidomastoidei), which are located behind the front parts of the sternoclavicular-sokovyh muscles. In nagrudnom fiber space is jugular venous arc, sometimes the final sections of the front jugular vein (vv. jugulares ant.), the inferior thyroid artery (a. thyreoidea ima). Fascial lodges formed their own fascia neck, two: the bed of the submandibular gland (saccus hyomandibularis) and the bed of the parotid gland. Between the second fascia neck and entrails allocated prednamerennoe period (spatium praeviscerale), bounded on the sides of the vagina neurovascular bundle. Down this period passes in front of the mediastinum. In the tissue of the gap is unpaired thyroid plexus (plexus venosus thyreoideus impar) and lymph vessels and nodes. Posadisgetroots period (spatium retroviscerale) is located between the rear surface of the neck organs and predposlednii fascia. At the bottom of the period reported with back mediastinum, laterally - with neurovascular the vagina and prednamerennoe fiber space, and in the course of buccal-pharyngeal fascia (fascia buccopharyngea) - deep region of the face. Between the vertebral bodies and long muscles of the head and neck is fiber slot, which apply the so-called atechnique arising from the collapse of the vertebral tuberculosis.
The lymphatic system of the neck is divided into superficial and deep. To surface include the lymph nodes under your own fascia of the neck to the top border and in the lateral area of the triangle. Deep lymph nodes include: deep side host group, ecologically group and General lymph trunks.
For practical purposes neck divided into separate areas. A line drawn from the top of the mastoid processes to acromelanic or on the leading edge of the trapezius muscle, divide the neck in two divisions: rear, or occipital, and front-side, or neck. Spur own fascia running from the front edge of the trapezius muscle to transverse processes of the bodies of the cervical vertebrae, separates these two areas. In anterior-lateral part of the neck are three triangle: the middle and two lateral. The median is limited to the front edges of the sternoclavicular-sokovyh muscles and the edge of the lower jaw. The middle line of the neck divides this triangle on two symmetric - right and left. The side triangles limited to the outer edges of the sternoclavicular-sokovyh muscles, front edges of the trapezoid and the top of the collarbones. The hyoid bone (os hyoideum) divides the average triangle on two areas: suprahyoid (regio suprahyoidea) and podhodyaschuyu (regio infrahyoidea). Depending on the position of the head suprahyoid region changes its position. This helps the examination of this area and some operational interventions. On the fascia of this area is cervical branch of the facial nerve (ramus colli n. facialis)which control subcutaneous muscle. At the edge of the lower jaw passes the regional branch of the facial nerve (ramus marginalis mandibulae). In suprahyoid triangle in turn are three triangle: podporovany (trigonum submentale) and two submandibular (trigonum submaxillare).
Podporovany triangle limited front belly digastric muscle and body hyoid bone. Submandibular triangles limited by both abdomens digastric muscle (m. digastricus) and the edge of the lower jaw. The bottom podvodnogo triangle formed small pair muscles connected to the middle line of the tendon seam (raphe). In submandibular triangle is located submandibular gland with its outlet duct, lymph nodes, facial artery and vein (a. et v. facialis), hypoglossal nerve (n. hypoglossus). At the top of the submandibular triangle is a triangle Pirogov (see Pirogov triangle).
Sleepy triangle (trigonum caroticum), which is the site for access to neurovascular bundle neck, limited front edge of the sternoclavicular-liners muscles, back, abdomen digastric muscle and upper abdomen vane-sublingual muscles (m. omohyoideus). Below this triangle between midline of the neck media, top-outside - the upper abdomen vane-sublingual muscles on the outside bottom front edge of the sternoclavicular-liners muscle - defined vane-tracheal triangle (trigonum omotracheale).
Region sternoclavicular-liners muscles (regio sternocleidomastoidea) is limited by the position of the muscles. It is located neurovascular bundle neck (printing. table, Fig. 1-3). It includes: common carotid artery (a. carotis communis), internal jugular vein (v. jugularis interna), vagus nerve (n. vagus). On the front surface of vascular vagina is neck loop (ansa cervicalis).


vessels and nerves of the neck
anatomy neck
neck anatomy
Fig. 1-3. Vessels and nerves of the neck.

Fig. 1. Surface vessels and nerves of the neck (platysma turned).

Fig. 2. Deep vessels and nerves of the neck (platysma and submandibular gland turned, part of the parotid gland is removed, the sternoclavicular-nipple muscle partially removed and turned, superficial nerves and vessels partially removed).

Fig. 3. Deep vessels and nerves of the neck (in addition to the above entities, partially removed the front neck muscles, carotid artery and the internal jugular vein, submandibular gland, platysma and collarbone):

1 - platysma;
2 - ramus colli n. facialis;
3 - glandula parotis;
4 - n. auricularis magnus;
5 - n. occipitalis minor;
6 - v. jugularis ext.;
7 - n. accessorius;
8 - m. trapezius;
9 - m. omohyoideus;
10 - plexus brachialis;
11 - nn. supraclavicularis anteriores;
12 - m. sternocleidomastoideus;
13 - v. jugularis ant.;
14 - lamina superficial fasciae cervicalis;
15 - venter ant. musculi digastrici;
16 - gl. submandibularis;
17 m. stylohyoideus;
18 - n. hypoglossus;
19 - plexus cervicalis (nerves trimmed);
20 - v. jugularis int.;
21 - m. scalenus ant.;
22 - a. transversa colli;
23 - n. phrenicus;
24 - a. subclavia;
25 - a. suprascapularis;
26 - a. carotis communis;
27 - n. vagus;
28 - a. thyreoidea sup.;
29 - a. carotis ext.;
30 - a. carotis int.;
31 - a. lingualis;
32 - a. facialis;
33 - v. subclavia;
34 - v. thyreoidea ima;
35 - a. thyreoidea inf.;
36 - truncus sympathicus (ganglion cervicale medius);
37 - n. laryngeus sup.;
38 - m. mylohyoideus;
39 - n. suprascapularis.

In the lower part of the neck at the front staircase cracks (spatium antescalenum) allocated stair-vertebral triangle (trigonum scalenovertebrale). The borders are: outside - front scalenus (m. scalenus anterior), inside - long neck muscle (m. longus colli). The top of the triangle is at the level of tubercle transverse process CVI. The base of the triangle is the dome of the pleura covers the first rib. Within the triangle are brachial plexus, the initial division of subclavian artery and the radiating branches, arc thoracic lymphatic duct (left), the bottom node of the sympathetic trunk.
On the front staircase muscle passes phrenic nerve (n. phrenicus). On the right it lies between the subclavian artery and vein, left - between subclavian artery and the initial Department shoulder-head of Vienna (v. brachiocephalica sin.). Return nerve right around subclavian artery to the left - an arch of the aorta.
Under predposlednii plate or thicker it is located cervical sympathetic trunk. He often has three nodes. The top node lies on the levelII. From this node depart nn. carotici externi, n. caroticus internus, rami laryngopharingei and n. cardiacus cervicalis sup. The average site, less constant, is at the rate of CVI behind the inferior thyroid artery (a. thyreoidea inf.). From him are the branches of the common carotid artery, the thyroid gland and n. cardiacus cervicalis med. In the absence of this node specified branches depart from the sympathetic trunk. The lower the site is located on level CVII, behind the vertebral artery (a. vertebralis), and to the left close to the thoracic lymphatic duct. This node is often merges with the first breast node, forming a star site (ganglion stellatum).
Side triangle of the neck is limited in front of the lateral edge of the sternoclavicular-liners muscles, behind - the front edge of the trapezius muscle and below the collarbone. The bottom of the triangle are the muscles of the neck. Vane-sublingual muscle divides this triangle into two. Top (trigonum omotrapezoidum) is located between the front edge of the trapezius muscle and the rear edge sternoclavicular-liners. The lower triangle (trigonum omoclaviculare), or supraclavicular fossa, located between the collar bone and the rear edge sternoclavicular-liners muscles.