Gross Anatomy

Deep Structures of the Neck, Viscera of the Neck


Anatomy Tables for Today's Topic


Muscles
Nerves
Arteries
Veins
Lymphatics
Viscera

Muscles

Muscle Origin Insertion Action Innervation Artery Notes
scalene, anterior anterior tubercles of the transverse processes of vertebrae C3-C6 scalene tubercle of the first rib elevates the first rib; flexes and laterally bends the neck brachial plexus, C5-C7 ascending cervical a., a branch of the thyrocervical trunk a muscle of inspiration; an important landmark of the neck; it is located between the subclavian vein and the subclavian artery; the roots of the brachial plexus pass posterior to it; the phrenic nerve crosses its anterior surface
scalene, middle posterior tubercles of the transverse processes of vertebrae C2-C7 upper surface of the first rib behind the subclavian artery elevates the first rib; flexes and laterally bends the neck brachial plexus, C3-C8 ascending cervical a. a muscle of respiration (inspiratory); also called scalenus medius; penetrated by the dorsal scapular n. and long thoracic n.
scalene, posterior posterior tubercles of the transverse processes of vertebrae C5-C7 lateral surface of the second rib elevates the second rib; flexes and laterally bends the neck brachial plexus, C7-C8 ascending cervical a. a muscle of respiration (inspiratory); it is the longest of the scalene muscles

Nerves

Nerve Source Branches Motor Sensory Notes
brachial plexus ventral primary rami of C5-8 and T1 dorsal scapular, long thoracic, n. to subclavius, suprascapular, lateral and medial pectoral, medial brachial and antebrachial cutaneous, upper, middle and lower subscapular, musculocutaneous, ulnar, median, axillary, radial muscles of the upper limb, excluding trapezius skin of the upper limb plexus is a latin word meaning "braid"; axons from spinal cord levels C5-T1 are mixed (braided) in the brachial plexus and repackaged into terminal branches so that each branch contains axons from several spinal cord segmental levels
C1 ventral primary ramus C1 spinal n. contributes to the superior root of the ansa cervicalis; brs. to: rectus capitis anterior and lateralis mm., longus capitis m. rectus capitis anterior and lateralis, longus capitis, omohyoid, sternohyoid, sternothyroid, thyrohyoid, geniohyoid none C1 contributes to the cervical plexus
C2 ventral primary ramus C2 spinal n. contributes to: superior and inferior roots of the ansa cervicalis, lesser occipital n., great auricular n., transverse cervical n.; brs. to: longus capitis & colli, sternocleidomastoid omohyoid, sternohyoid, sternothyroid, thyrohyoid, longus capitis and longus colli skin behind the ear and on the neck below the mandible; proprioception from the sternocleidomastoid m. C2 contributes to the cervical plexus
C3 ventral primary ramus C3 spinal n. contributes to: inferior root of the ansa cervicalis, great auricular n., transverse cervical n., supraclavicular nn., phrenic n.; brs. to: longus capitis & colli, scalenus medius, levator scapulae, trapezius omohyoid, sternohyoid, sternothyroid, longus capitis & colli, scalenus medius, levator scapulae, respiratory diaphragm skin of the anterolateral neck; proprioception from the sternocleidomastoid m. and the trapezius m C3 contributes to the cervical plexus
C4 ventral primary ramus C4 spinal n. contributes to: supraclavicular nn., phrenic n.; brs. to: longus colli, scalenus medius, levator scapulae, trapezius longus colli, scalenus medius, levator scapulae, respiratory diaphragm skin of the root of the neck and the upper shoulder; proprioception from the trapezius m. C4 contributes to the cervical plexus
C5 ventral primary ramus C5 spinal n. contributes to: phrenic n., long thoracic n. respiratory diaphragm, scalene mm., muscles of the shoulder and upper arm skin of the ventral arm and ventral forearm joins the ventral primary ramus of C6 to form the superior trunk of the brachial plexus
C6 ventral primary ramus C6 spinal n. contributes to: long thoracic n. scalene mm., muscles of the lower shoulder and arm skin of the lateral side of the upper limb joins the ventral primary ramus of C5 to form the superior trunk of the brachial plexus
C7 ventral primary ramus C7 spinal n. contributes to: long thoracic n. muscles of the lower shoulder, arm forearm skin of the posterior side of the upper limb continues as the middle trunk of the brachial plexus
C8 ventral primary ramus C8 spinal n. no named branches muscles of the forearm and hand skin of the medial side of the upper limb joins the ventral primary ramus of T1 to form the inferior trunk of the brachial plexus
dorsal scapular n. brachial plexus (br. of C5 ventral primary ramus) no named branches rhomboideus major and minor mm.; levator scapulae m. none dorsal scapular n. passes through the scalenus medius m.
great auricular n. cervical plexus (contributions from the ventral primary rami of spinal nerves C2&C3) mastoid n., auricular n. none skin of the ear and skin below the ear the great auricular n. crosses the superficial surface of the sternocleidomastoid m.
ventral primary rami of C3-C5 (cervical plexus) pericardial brs. diaphragm pericardium; mediastinal, diaphragmatic & costal pleura crosses the anterior surface of the anterior scalene m.
phrenic n. ventral primary rami of spinal nerves C3-C5 (cervical plexus) no named branches skeletal muscle of the respiratory diaphragm diaphragmatic pleura; some fibers contributed to the pericardium and to the adjacent mediastinal and costal pleurae phrenic n. crosses the anterior surface of the anterior scalene m.
sympathetic chain ganglia, cervical preganglionic sympathetic fibers arrive via white rami communicantes of ventral primary rami of spinal nerves T1-T5 postganglionic sympathetic depart via gray rami communicans to cervical spinal nn.; internal and external carotid nn.; cervical cardiac brs. dilator pupillae m.; vascular smooth muscle; arrector pili muscles and sweat glands of head and neck; heart and lungs pain from viscera located parallel to the vertebral bodies in the neck; there are no white rami communicantes at cervical levels
T1 ventral primary ramus spinal nerve T1 joins the ventral primary ramus of C8 to form the inferior trunk of the brachial plexus muscles of the forearm and hand skin of the ventral arm and ventral forearm T1 is the highest spinal nerve to have a white ramus communicans
vagus n. medulla: dorsal motor nucleus (GVE preganglionic parasympathetic); inferior ganglion (GVA); nucleus ambiguus (SVE); superior ganglion (GSA); inferior ganglion(SVA) auricular br., pharyngeal br., superior laryngeal, superior and inferior cervical cardiac brs., recurrent laryngeal n., thoracic cardiac brs., brs. to the pulmonary plexus, brs. to the esophageal plexus, anterior and posterior vagal trunks SVE: intrinsic muscles of the larynx, pharynx (except stylopharyngeus), and palate (except tensor veli palatini); GVE: smooth muscle of the respiratory tree & gut (proximal to the left colic flexure), heart; secretomotor: mucous glands of the larynx, respiratory tree, pharynx and gut; secretomotor to digestive glands GSA: skin of the external auditory meatus; GVA: viscera of head, neck, thorax & abdomen proximal to the left colic flexure; SVA: taste from the epiglottis also known as: CN X, 10th cranial nerve; the vagus n. passes through the jugular foramen to exit the posterior cranial fossa; vagus means "wanderer" in reference to its extensive distribution to the body cavities

Arteries

Artery Source Branches Supply to Notes
carotid, common brachiocephalic trunk (right), aortic arch (left) external carotid a., internal carotid a. most of the head and upper neck common carotid a. bifurcates at the level of the superior border of the thyroid cartilage; the internal carotid a. and the external carotid a. are its terminal brs.; the carotid sinus and carotid body are located at the bifurcation
cervical, transverse thyrocervical trunk unnamed muscular branches, possibly the dorsal scapular a. trapezius muscle and surrounding tissues transverse cervical a. gives rise to the dorsal scapular a. ~30% of the time
costocervical trunk subclavian a., 2nd part deep cervical a., highest intercostal a. deep muscles of the posterior neck; posterior ends of the first 2 intercostal spaces costocervical trunk is located between the anterior scalene m. and the middle scalene m.; it arches posteriorly over the cervical parietal pleura
dorsal scapular subclavian a., 3rd part unnamed muscular branches levator scapulae m., rhomboideus major m., rhomboideus minor m. dorsal scapular a. anastomoses with the suprascapular a. and the subscapular a. to form the scapular anastomosis; dorsal scapular a is a branch of the transverse cervical a. in ~30% of cases
subclavian brachiocephalic a. (right), aortic arch (left) 1st part: vertebral a., thyrocervical trunk, internal thoracic a.; 2nd part: costocervical trunk; 3rd part: dorsal scapular a. (70%) neck, brain, spinal cord, thyroid gland, larynx, shoulder, chest muscles, upper limb subclavian a. is continuous with the axillary a., the name change occurs at the lateral border of the first rib; anterior scalene muscle passes anterior to the subclavian a., dividing it into 3 parts
suprascapular thyrocervical trunk muscular supraspinatus & infraspinatus, shoulder joint anastomoses with the circumflex scapular a. and the dorsal scapular a. to form the scapular anastomosis
thyrocervical trunk subclavian a., 1st part inferior thyroid a., transverse cervical a., suprascapular a. lower neck, posterior shoulder, thyroid gland thyrocervical trunk does not give rise to the ascending cervical a.- it is a branch of the inferior thyroid a.
thyroid, inferior thyrocervical trunk ascending cervical a., inferior laryngeal a., esophageal brs., tracheal brs., glandular brs. thyroid gland, lower larynx, upper trachea, upper esophagus, deep neck muscles inferior thyroid a. gives rise to the ascending cervical a. as it arches medially
thyroid, superior external carotid a. infrahyoid br., sternocleidomastoid br., superior laryngeal a., cricothyroid br., glandular brs. thyroid gland, upper part of the larynx, infrahyoid mm., sternocleidomastoid m. superior thyroid a. is usually the first branch of the external carotid a.
thyroidea ima brachiocephalic a. or aortic arch no named branches isthmus of the thyroid gland, upper trachea thyroidea ima a. is present in 10% of individuals; it is clinically significant because it is a midline artery in the region of tracheostomy; ima means "lowest"
thoracic, internal subclavian a. (1st part) pericardiocophrenic a., perforating brs., anterior intercostal aa., mediastinal brs., thymic brs., musculophrenic a., superior epigastric a. mediastinum, anterior thoracic wall, anterior abdominal wall, respiratory diaphragm internal thoracic a. is also known as: internal mammary a.
vertebral subclavian a.(1st part) spinal brs., muscular brs., anterior spinal a., posterior inferior cerebellar a., medullary brs., meningeal brs., basilar a. deep neck, cervical spinal cord, spinal cord; medulla (dorsal motor nucleus of cranial nerve X, nucleus ambiguus, spinal accessory nucleus and hypoglossal nucleus) vertebral a. anastomoses with the internal carotid a. in the cerebral arterial circle (of Willis); it courses through the transverse foramina of vertebrae C1-C6

Veins

Vein Tributaries Drains Into Regions Drained Notes
auricular, posterior small veins of the subcutaneous tissues behind the ear, stylomastoid v. it unites with the posterior division of the retromandibular v. to form the external jugular region behind the ear posterior auricular v. communicates with the occipital v. behind the ear
brachiocephalic v. formed by the union of the subclavian v. and the internal jugular v.; tributaries: vertebral v., thymic v., inferior thyroid v., internal thoracic v., 1st posterior intercostal v., left superior intercostal v. (to the left brachiocephalic v.) the left and right brachiocephalic vv. unite to form the superior vena cava head; neck; upper limb; anterior chest wall at its origin, the left brachiocephalic v. receives the thoracic duct; at its origin, the right brachiocephalic v. receives the right lymphatic duct
jugular, external formed by the joining of the retromandibular and posterior auricular vv.; tributaries: posterior external jugular v., transverse cervical v., suprascapular v., anterior jugular v. subclavian v. head & neck, shoulder external jugular v. contains valves that may not be fully functional
inferior thyroid v. numerous tributaries from the thyroid gland, esophageal v, tracheal v., inferior laryngeal v. left and right brachiocephalic vv. inferior part of the thyroid gland inferior thyroid vv. descend on the anterior surface of the trachea
jugular, internal formed at the base of the skull where the sigmoid sinus ends; tributaries: pharyngeal vv.; lingual v., common facial v., sternocleidomastoid v., superior thyroid v, middle thyroid v. brachiocephalic v. brain, cranial cavity, skull, face, viscera of the neck internal jugular is the largest vein of the nead and neck
middle thyroid v. numerous tributaries from the thyroid gland internal jugular v. lateral aspect of the thyroid gland middle thyroid v. crosses superficial to the common carotid a.
retromandibular v. formed by the union of the superficial temporal v. and maxillary v. anterior and posterior divisions of the retromandibular v. side of the head and scalp; deep face retromandibular v. is contained within the parotid gland; anterior division unites with the facial v. to form the common facial v.; posterior division unites with the posterior auricular v. to form the external jugular v.
superior thyroid v. sternocleidomastoid v., superior laryngeal v., infrahyoid v., cricothyroid v. internal jugular v. superior portion of the thyroid gland and surrounding structures superior thyroid v. is the only thyroid v. to accompany an artery; it crosses superficial to the common carotid a.

Lymphatics

Structure Location Afferents from Efferents to Regions drained Notes
cervical nodes, deep in and around carotid sheath posterior and lateral to the internal jugular v. lymphatic vessels and numerous node groups from the head and neck jugular trunk head and neck superior and inferior subdivisions of deep cervical nodes are delineated by the crossing of the omohyoid m.
cervical nodes, superficial in superficial fascia and along superficial vessels of the head & neck lymphatic vessels from superficial structures in head & neck varies by group; ultimate destination is the jugular trunk head & neck several groups are designated by location: occipital, retroauricular, anterior auricular, superficial parotid, facial, submental, submandibular, external jugular, anterior jugular
jugular lymphatic trunk carotid sheath in root of neck deep cervical nodes left: thoracic duct near its termination; right: right lymphatic duct or junction of right subclavian and right internal jugular vv. head & neck jugular trunk carries most of the lymph from the head and neck
right lymphatic duct root of neck on the right side formed by the union of the right jugular trunk,the right subclavian trunk, and the right bronchomediastinal trunk junction of the right subclavian v. and right internal jugular v. right half of the head and neck; right upper limb; right side of the chest right lymphatic duct has a valve near its termination; the three trunks that form right lymphatic duct may drain separately into the venous system
subclavian trunk along the course of the subclavian v. apical axillary nodes; infraclavicular nodes drains into the junction of the internal jugular v. and the subclavian v. upper limb, most of breast, anterolateral chest wall subclavian lymphatic trunk occasionally drains into the thoracic duct on the left side; on the right it occasionally drains into the right lymphatic duct
supraclavicular nodes in and around carotid sheath below level of omohyoid superior deep cervical nodes, transverse cervical nodes, spinal accessory nodes efferents form the jugular lymphatic trunk head and neck also known as: inferior deep cervical nodes
thoracic duct between the esophagus anteriorly and the thoracic vertebral bodies posteriorly formed by the union of the lumbar lymph trunks, sometimes dilated to form a cisterna chyli junction of the left subclavian v. and the left internal jugular v. all of the body and limbs below the respiratory diaphragm; the left side of the chest, left upper limb and the left side of the head and neck above the diaphragm thoracic duct is the largest lymphatic vessel; it passes through the aortic hiatus on the right side of aorta; it swings to the left side of the esophagus at the T4-T5 intervertebral disc (at the level of the sternal angle)

Viscera of the Neck

Organ Location/Description Notes
esophagus the portion of the gastrointestinal tract between the pharynx and the stomach connects: superiorly with laryngopharynx at lower border of cricoid cartilage; inferiorly it passes through diaphragm at the T10 vertebral level to reach the stomach; the upper 1/3 is skeletal muscle innervated by the recurrent laryngeal, the lower 2/3rds is smooth muscle innervated by the vagus nn. via the esophageal plexus
larynx located anterior to the laryngopharynx at level of C4-6 vertebrae composed of: thyroid, cricoid, epiglottic, arytenoid, cuneiform & corniculate cartilages; contains the vocal ligaments; controls the airway
parathyroid glands four small endocrine glands located on the posterior surface of the lateral lobes of the thyroid gland two pair of glands that develop from the 3rd and 4th pharyngeal pouches; they produce parathormone which is important in regulating serum calcium levels
pharynx the space posterior to the nasal cavity, oral cavity and larynx divided into 3 parts: nasopharynx, oropharynx and laryngopharynx; the airway and the pathway of ingested foods and liquids cross at this location
thyroid gland a large endocrine bland that lies anterolateral to the lower part of the larynx and upper trachea thyroid gland consists of two lateral lobes joined across the midline by the isthmus; it may have a pyramidal lobe extending superiorly near midline which is a remnant of development that marks its route of migration from a primordium that originates at the foramen cecum or the tongue; thyroid gland is supplied by superior and inferior thyroid aa.; it produces thyroxin
thyroid isthmus constricted midline connection between the lateral lobes of the thyroid gland thyroid isthmus lies anterior to tracheal rings 2-4
trachea main airway that lies anterior to the esophagus trachea extends from vertebral level C6 to the level of the T4/5 intervertebral disc; superiorly it is connected to the cricoid cartilage via the cricotracheal ligament; it bifurcates into two primary bronchi


Other Tables of Interest:

All Anatomy Tables

Tables Organized by System Tables Organized by Region


Some of the material presented in these tables is contained in the book:
MedCharts Anatomy by Thomas R. Gest and Jaye Schlesinger
Published by ILOC, Inc., New York. Copyright 1995.

Content of these tables has been edited for use in this course by Patrick W. Tank, Ph.D.
Copyright 2007, Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences.

Unauthorized use is prohibited.