The structure of the muscles of the neck and shoulders. Neck muscles: anatomy

Under the muscles of the neck refers to a large array of superficial and deep muscles.

They perform several functions: keeping the head in balance, helping with swallowing and pronouncing sounds, providing movement of the neck and head.

Pain in the muscles of the neck can be a symptom of diseases such as myositis, fibromyalgia, myofascial syndrome.

For those who care about their health, it will be useful to familiarize themselves with the anatomy of the neck muscles.

In medical practice cervical muscles divided into superficial and deep.

Both groups include several muscles, each of which is responsible for performing certain functions.

Superficial muscles

This muscle group consists of 2 parts: subcutaneous, as well as sternocleidomastoid muscles.

Sternocleidomastoid

Represents long belt muscle with two heads. At birth, this muscle may be damaged and partially replaced by fibrous tissue. The latter shrinks and form torticollis (a disease associated with the curvature of the neck).

Muscle departs from the sternal head(anterior surface of the manubrium of the sternum) and clavicular head(upper surface of the middle third of the clavicle). The place of its attachment is the mastoid process of the temple bone, or rather the outer surface of this process.

If both halves contract, the muscle pulls the head forward and flexes the neck(for example, this happens when you try to tear your head off the pillow). With a deep breath - raises the ribs and sternum up. If one half contracts, the muscle tilts its head forward on the side of the contraction. Responsible for the rotation of the head up and in the opposite direction.

Subcutaneous

Specified muscle lies just under the skin, is flat and thin. It begins in the chest area below the collarbone, passes medially and upwards, occupying almost the entire anterolateral portion of the neck. Only a small area in the form of a triangle, located above the jugular notch, remains open.

The bundles of the subcutaneous muscle rise to the facial region, are woven into the masticatory fascia. Some of them attach to the laughing muscle and the muscle that lowers the lower lip.

This muscle pulls the skin and protects the veins from being squeezed.. She can also pull the corners of her mouth down, which is important for human facial expressions.

Middle muscles

Medium or median muscles necks are suprahyoid and sublingual.

Maxillofacial muscle

Has the shape of an irregular triangle, is flat. Starts in the area mandible where the maxillary-hyoid line is located. The muscle bundles go in the direction from top to bottom, as well as from back to front.

When they reach the midline, they connect with the bundles of the same muscle of the opposite side and form the suture of the maxillohyoid muscle. The posterior bundles are attached to the anterior portion of the hyoid bone. The left and right maxillohyoid muscles form the floor of the mouth and are called the diaphragm of the mouth.

The main task of the maxillofacial muscle is to lift the hyoid bone up.. If the muscle is fixed, it helps to lower the mobile (lower) jaw and is an antagonist of the masticatory muscles. If the muscle contracts while eating, it lifts and presses the tongue against the palate, allowing the food bolus to pass into the throat.

Digastric

The digastric muscle is a tendon that connects the posterior and anterior abdomen, is attached to the large horn and the body of the hyoid bone using a fascial loop.

The digastric muscle helps with active opening of the oral cavity (with resistance, for example), lowering the lower jaw with a fixed hyoid bone.

When swallowing, she elevates the hyoid bone to the mastoid process and mandible(if the latter is fixed by chewing muscles). The muscle is capable of displacing the hyoid bone backward with contraction of the posterior abdomen. Since the hyoid bone does not form joints with other bones, we can say that it is displaced relative to the soft tissues.

Video: "Neck Triangles"

Stylohyoid muscle

Has a thin flattened abdomen, starting in the region of the styloid process of the temporal bone, going forward and down, located along the digastric muscle (anterior surface of its posterior abdomen). The distal end of the muscle splits, covers the tendon of the digastric muscle with legs, is attached to the large horn, the body of the hyoid bone.

Like the rest of the muscles located above the hyoid bone, the stylohyoid muscle is a constituent element of a complex apparatus. This apparatus includes the hyoid bone, mandible, trachea, larynx and plays an important role in the process of articulate speech.

sternohyoid

located deep. The function of the muscle is to lower the hyoid bone. When the suprahyoid muscles (located between the movable jaw and the hyoid bone) contract, the sternohyoid muscle, together with the jaw, sternothyroid, sets the lower jaw in motion.

This function is not included in the table of antagonists and synergists, since this function does not have a direct effect on the temporomandibular joint.

Geniohyoid

It starts in the region of the mental axis of the lower jaw, then goes down and back. It is located above the jaw-hyoid muscle, attached to the body of the hyoid bone (its anterior surface).

Raises the hyoid bone upward. To a fixed state, it helps to lower the mobile jaw, which makes it an antagonist of the masticatory muscles.

Scapular-hyoid

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Included in the group of infrahyoid muscles and is a paired muscle of the anterior surface of the neck. It has a long flattened shape and a tendon that divides it into two bellies.

The scapular-hyoid muscle pulls the hyoid bone down, provides tension on the pretracheal plate of the cervical fascia.

Sternothyroid

The sternothyroid muscle has a flat shape. She originates from rear surface the first cartilage and the handle of the sternum, goes up and is attached to the thyroid cartilage of the larynx (oblique line of its lateral surface). The main task of this muscle is to lower the larynx.

Thyrohyoid

It starts from the oblique line of the thyroid cartilage. Attaches to the greater horn, the body of the hyoid bone. Raises the larynx with a fixed hyoid bone.

Muscles deep

The deep muscles of the neck are a complex of lateral and medial (prevertebral) muscles. The list of deep tissues includes the anterior, posterior, middle scalene muscles, the long muscle of the neck; lateral rectus, anterior rectus and long muscles of the head.

Scalenus anterior

Originates from the anterior tubercles of the third and fourth cervical vertebrae, goes down and forward, attached to the anterior scalene muscle of the first rib in front of the groove of the subclavian artery.

This muscle occupies an important place in the functioning of the body. She provides elevation of the upper rib during breathing, turning the neck into different sides forward flexion of the cervical spine.

Middle staircase

It starts in the region of the posterior tubercles of the six lower vertebrae of the neck, goes down behind the anterior scalene muscle and is attached to the upper surface of the 1st rib, behind the groove of the subclavian artery.

Above this groove, between the middle and anterior scalene muscles, there is a triangular gap in which the nerve trunks of the brachial plexus pass, as well as the subclavian artery.

Scalenus mediaus acts as an inspiratory muscle(raises the first upper rib). With fixed ribs, it contracts on both sides and bends forward the cervical part of the spinal column. With a unilateral contraction, it bends the same section of the spine and turns it to the left or right.

Back staircase

It originates from the transverse processes of the 6th, 5th, 4th and 3rd cervical vertebrae, moves down behind the middle scalene muscle, attaches to the outer surface of the second rib.

The posterior scalene muscle acts as an inspiratory muscle. With fixed ribs, it flexes the cervical spine anteriorly (because it contracts on both sides). With a unilateral contraction, it bends, turns this department in a certain direction.

long neck muscle

Takes up all anteriorly side surface vertebral bodies, from the atlas, ending with the 3rd and 4th thoracic vertebrae. The middle sections of the muscle are slightly expanded. The length of the muscle bundles varies, therefore, it is customary to distinguish three parts in the muscle: the upper oblique, the medial-vertical, and the lower oblique.

long head muscle

Located in front of the long muscle of the neck. The place of discharge is the transverse processes from 3 to 6 cervical vertebrae. The place of attachment is the occipital bone (the muscle is located in front of the large occipital foramen of this bone).

The function of the longus muscle is to tilt the head and flex the upper half of the cervical spine..

Anterior rectus capitis

This muscle of the neck is short. It begins where the lateral mass of the atlas and the anterior surface of the transverse process are located. From here, the muscle goes up and is attached to the bottom of the basilar part of the occipital bone, in front of the large hole.

The task of the muscle is to tilt the head in one direction or another.(one-sided contraction) or tilt the head forward (two-sided contraction).

Lateral rectus capitis

The origin of the muscle is the anterior part of the transverse process of the atlas.. From here, the bundles are directed outwards and upwards. The muscle ends in the region of the paramastoid process of the jugular process of the occipital bone.

The function of the lateral rectus muscle depends on the type of contraction. With unilateral contraction, it provides a tilt of the head to the side, and with bilateral contraction - forward.

What are the diseases of the neck muscles?

The most common diseases of the neck muscles include:

• Myofascial Syndrome. The disease is widespread in clinical practice. May be accompanied by neck pain, numbness of the hands and other unpleasant symptoms. Usually observed in people who have to be in the same position for a long time. Prolonged stress leads to muscle spasms. Spasmodic areas are converted into bumps and seals (trigger points).
• Myositis. Occurs due to a long stay in a draft. The peak incidence occurs in summer and spring, when windows are open in most houses and offices or air conditioners are working. Cold air irritates the nerve endings located in the skin. The latter send a nerve impulse to the brain, thereby starting a chain reaction, a painful muscle contracture appears.
• fibromyalgia. Is a chronic disease. It is characterized by increased sensitivity and soreness of muscles, tendons, joints.

Video: "Anatomy of the muscles of the neck"

Conclusion

Thus, neck muscles is a complex mechanism consisting of several muscle groups. These include deep, superficial, median muscles. Each group is responsible for performing certain functions. When the muscles are exposed to the negative effects of the environment (cold) or are in the same position for a long time, various diseases occur. Knowledge of the anatomy of the neck muscles and the implementation of preventive recommendations will help to avoid the development of diseases and their complications.

The neck is one of the most complex parts of the body from an anatomical point of view. On this relatively small area many vital organs are compactly located, surrounded by layers of connective tissue and muscles.

In anatomy, the neck is a part of the body bounded from above by the lower edge of the lower jaw, and from below by a line passing through the jugular notch of the sternum and clavicle. Behind the borders of the neck pass along the external occipital tubercle of the skull (top) and the line connecting the acromial process of the scapula with the spinous process of the VII cervical vertebra.

The outer layer of the neck is the skin. It contains the sensitive endings of the second, third and fourth cervical nerves. Numerous natural folds can be observed on the skin, going around the neck. When skin is cut during surgery, the incision is made along these folds to minimize scarring.

External jugular veins

Just under the skin is a thin layer of subcutaneous fat and connective tissue called the superficial fascia. This layer contains blood vessels such as the external jugular veins and their branches. These veins carry blood away from the face, scalp, and neck. Near the external jugular veins lie the superficial lymphatic vessels of the neck.

Another important structure found in this layer at the front of the neck is the very thin subcutaneous muscle of the neck, which helps to lower the lower jaw.

The lymph nodes

Located inside the neck, the lymph nodes are part of the lymphatic system, which plays a critical role in protecting the body from infections. In addition to the neck, lymph nodes are located in the connective tissue in various parts of the body, especially in the groin, armpits and neck. They are also present in the lymphatic organs - the spleen and tonsils.

The function of the nodes is to cleanse the lymph - a fluid that carries lymphocytes (one of the types of white blood cells) throughout the body.

Lymphocytes located in the lymph nodes are also essential for the body's defense, as they produce antibodies that play an important role in fighting infection.

Lymphatic disorders are serious diseases. These include, in particular, the following.

• Lymphedema (lymphedema) - occurs as a result of the outflow of lymph from the tissues. The cause may be some helminthic infestations, trauma to the lymphatic system, or hereditary diseases such as Milroy's disease.
• Lymphangitis is an acute inflammation of the lymphatic vessels caused by a streptococcal infection.

Cross section of the neck

The deeper layers of the neck are interconnected layers of tissues. They connect and protect numerous structures.

Under the superficial fascia is the cervical fascia, which is divided into three connective tissue plates. These plates surround various groups muscles, blood vessels and nerves, allowing them to move relative to each other with minimal friction.

The first of these is the superficial plate of the cervical fascia. It covers the entire neck and is attached to the spinous processes of the cervical vertebrae. The superficial plate forms the sheath of the sternocleidomastoid muscles in the anterolateral part of the neck and the trapezius muscles in the back. These muscles are essential for head and neck movement.

Larynx and trachea

A thin pretracheal plate forms the sheath of the thyroid gland and connects it to the larynx and trachea at the front of the neck. It is also connected to the cricoid cartilage, allowing it to move when swallowing. The inferior processes form the carotid sheath, protecting the carotid artery, internal jugular vein, and vagus nerve.

Behind the trachea is the esophagus, and behind the larynx is the pharynx, a muscular tube that connects the mouth to the esophagus. Most deep layer connective tissue - prevertebral plate covering the remaining muscles of the neck, spine and spinal cord, located in the center of the neck for maximum protection.

retropharyngeal space

Between the fascial layers are areas of much less dense connective tissue and cavities, such as the pharyngeal space, located between the back of the pharynx and the prevertebral fascia. They can become ways of spreading the infection. Thus, an infection from the oral cavity can enter the pharyngeal space and penetrate into the chest through the prevertebral fascia.

When an infection enters the oral cavity and nasopharynx into the pharyngeal space, a pharyngeal abscess (purulent inflammation of the tissues) may develop.

Most often, abscesses occur in children. An additional risk factor is microtrauma of the posterior wall of the larynx, which children can inflict on themselves with the most unexpected objects, such as a lollipop. Symptoms of a retropharyngeal abscess are high fever, pain when swallowing, difficulty breathing, and an unnatural head position. X-ray examination is performed to confirm the diagnosis. The treatment is most often surgical - the abscess is opened and a drain is installed to allow the accumulated pus to flow out. At the same time, antibiotic therapy is carried out:; to kill the infection.

12.1. BORDERS, AREAS AND TRIANGLES OF THE NECK

The borders of the neck area are from above a line drawn from the chin along the lower edge of the lower jaw through the top of the mastoid process along the upper nuchal line to the external occipital tubercle, from below - a line from the jugular notch of the sternum along the upper edge of the clavicle to the clavicular-acromial joint and then to the spinous process of the seventh cervical vertebra.

The sagittal plane drawn through the midline of the neck and the spinous processes of the cervical vertebrae divides the neck region into right and left halves, and the frontal plane drawn through the transverse processes of the vertebrae into the anterior and posterior regions.

Each anterior region of the neck is divided by the sternocleidomastoid muscle into internal (medial) and external (lateral) triangles (Fig. 12.1).

The boundaries of the medial triangle are from above the lower edge of the lower jaw, behind - the anterior edge of the sternocleidomastoid muscle, in front - the median line of the neck. Within the medial triangle are internal organs neck (larynx, trachea, pharynx, esophagus, thyroid and parathyroid glands) and distinguish a number of smaller triangles: submental triangle (trigonum submentale), submandibular triangle (trigonum submandibulare), sleepy triangle (trigonum caroticum), scapular-tracheal triangle (trigonum omotra - cheale).

The boundaries of the lateral triangle of the neck are from below the clavicle, medially - the posterior edge of the sternocleidomastoid muscle, behind - the edge of the trapezius muscle. The lower belly of the scapular-hyoid muscle divides it into the scapular-trapezius and scapular-clavicular triangles.

Rice. 12.1.Neck triangles:

1 - submandibular; 2 - sleepy; 3 - scapular-tracheal; 4 - scapular-trapezoid; 5 - scapular-clavicular

12.2. FASCIA AND CELLULAR SPACES OF THE NECK

12.2.1. Fascia of the neck

According to the classification proposed by V.N. Shevkunenko, 5 fasciae are distinguished on the neck (Fig. 12.2):

Superficial fascia of the neck (fascia superficialis colli);

Superficial sheet of own fascia of the neck (lamina superficialis fasciae colli propriae);

Deep sheet of own fascia of the neck (lamina profunda fascae colli propriae);

Intracervical fascia (fascia endocervicalis), consisting of two sheets - parietal (4 a - lamina parietalis) and visceral (lamina visceralis);

prevertebral fascia (fascia prevertebralis).

According to the International Anatomical Nomenclature, the second and third fascia of the neck, respectively, are called proper (fascia colli propria) and scapular-clavicular (fascia omoclavicularis).

The first fascia of the neck covers both its posterior and anterior surfaces, forming a sheath for the subcutaneous muscle of the neck (m. platysma). At the top, it goes to the face, and below - to the chest area.

The second fascia of the neck is attached to the front surface of the handle of the sternum and collarbones, and at the top - to the edge of the lower jaw. It gives spurs to the transverse processes of the vertebrae, and is attached to their spinous processes from behind. This fascia forms cases for the sternocleidomastoid (m. sternocleidomastoideus) and trapezius (m.trapezius) muscles, as well as for the submandibular salivary gland. The superficial sheet of fascia, which runs from the hyoid bone to the outer surface of the lower jaw, is dense and durable. The deep leaf reaches significant strength only at the borders of the submandibular bed: at the place of its attachment to the hyoid bone, to the internal oblique line of the lower jaw, during the formation of cases of the posterior belly of the digastric muscle and the stylohyoid muscle. In the area of ​​the maxillo-hyoid and hyoid-lingual muscles, it is loosened and weakly expressed.

In the submental triangle, this fascia forms cases for the anterior bellies of the digastric muscles. Along the midline, formed by the suture of the maxillohyoid muscle, the superficial and deep sheets are fused together.

The third fascia of the neck starts from the hyoid bone, goes down, having the outer border of the scapular-hyoid muscle (m.omohyoideus), and below is attached to the back surface of the handle of the sternum and collarbones. It forms fascial sheaths for the sternohyoid (m. sternohyoideus), scapular-hyoid (m. omohyoideus), sternothyroid (m. sternothyrcoideus) and thyroid-hyoid (m. thyreohyoideus) muscles.

The second and third fasciae along the midline of the neck grow together in the gap between the hyoid bone and a point located 3-3.5 cm above the sternum handle. This formation is called the white line of the neck. Below this point, the second and third fasciae diverge, forming the suprasternal interaponeurotic space.

The fourth fascia at the top is attached to the outer base of the skull. It consists of parietal and visceral sheets. Visceral

the leaf forms cases for all organs of the neck (pharynx, esophagus, larynx, trachea, thyroid and parathyroid glands). It is equally well developed in both children and adults.

The parietal leaf of the fascia is connected by strong spurs to the prevertebral fascia. The pharyngeal-vertebral fascial spurs divide all the tissue around the pharynx and esophagus into the retro-pharyngeal and lateral pharyngeal (peri-pharyngeal) tissue. The latter, in turn, is divided into anterior and posterior sections, the boundary between which is the stylo-pharyngeal aponeurosis. The anterior section is the bottom of the submandibular triangle and descends to the hyoid muscle. The posterior section contains the common carotid artery, the internal jugular vein, the last 4 pairs of cranial nerves (IX, X, XI, XII), deep cervical lymph nodes.

Of practical importance is the spur of the fascia, which runs from the posterior wall of the pharynx to the prevertebral fascia, extending from the base of the skull to the III-IV cervical vertebrae and dividing the pharyngeal space into the right and left halves. From the borders of the posterior and lateral walls of the pharynx to the prevertebral fascia, spurs (Charpy's ligaments) stretch, separating the pharyngeal space from the posterior part of the peripharyngeal space.

The visceral sheet forms fibrous cases for organs and glands located in the region of the medial triangles of the neck - the pharynx, esophagus, larynx, trachea, thyroid and parathyroid glands.

The fifth fascia is located on the muscles of the spine, forms closed cases for the long muscles of the head and neck and passes to the muscles starting from the transverse processes of the cervical vertebrae.

The outer part of the prevertebral fascia consists of several spurs that form cases for the muscle that lifts the scapula, scalene muscles. These cases are closed and go to the scapula and I-II ribs. Between the spurs there are cellular fissures (prescalene and interscalene spaces), where the subclavian artery and vein pass, as well as the brachial plexus.

Fascia takes part in the formation of the fascial sheath of the brachial plexus and the subclavian neurovascular bundle. In the splitting of the prevertebral fascia, the cervical part of the sympathetic trunk is located. In the thickness of the prevertebral fascia are the vertebral, lower thyroid, deep and ascending cervical vessels, as well as the phrenic nerve.

Rice. 12.2.Topography of the neck on a horizontal cut:

1 - superficial fascia of the neck; 2 - superficial sheet of the own fascia of the neck; 3 - deep sheet of the own fascia of the neck; 4 - parietal sheet of the intracervical fascia; 5 - visceral sheet of the intracervical fascia; 6 - capsule of the thyroid gland; 7 - thyroid gland; 8 - trachea; 9 - esophagus; 10 - neurovascular bundle of the medial triangle of the neck; 11 - retrovisceral cellular space; 12 - prevertebral fascia; 13 - spurs of the second fascia of the neck; 14 - superficial muscle of the neck; 15 - sternohyoid and sternothyroid muscles; 16 - sternocleidomastoid muscle; 17 - scapular-hyoid muscle; 18 - internal jugular vein; 19 - common carotid artery; 20 - vagus nerve; 21 - border sympathetic trunk; 22 - scalene muscles; 23 - trapezius muscle

12.2.2. Cellular spaces

The most important and well-defined is the cellular space surrounding the inside of the neck. In the lateral sections, the fascial sheaths of the neurovascular bundles adjoin to it. The fiber surrounding the organs in front looks like a pronounced adipose tissue, and in the posterolateral sections - loose connective tissue.

In front of the larynx and trachea, there is a pretracheal cellular space, bounded from above by the fusion of the third fascia of the neck (a deep sheet of the own fascia of the neck) with the hyoid bone, from the sides by its fusion with the fascial sheaths of the neurovascular bundles of the medial triangle of the neck, behind by the trachea, down to 7-8 tracheal rings. On the anterior surface of the larynx, this cellular space is not expressed, but downward from the isthmus of the thyroid gland there is fatty tissue containing vessels [the lowest thyroid artery and veins (a. et vv. thyroideae imae)]. The pretracheal space in the lateral sections passes to the outer surface of the lobes of the thyroid gland. At the bottom, the pretracheal space along the lymphatic vessels connects with the tissue of the anterior mediastinum.

The pretracheal tissue posteriorly passes into the lateral paraesophageal space, which is a continuation of the parapharyngeal space of the head. The periesophageal space is bounded from the outside by the sheaths of the neurovascular bundles of the neck, from behind by the lateral fascial spurs extending from the visceral sheet of the intracervical fascia, which forms the fibrous sheath of the esophagus, to the sheaths of the neurovascular bundles.

The retroesophageal (retrovisceral) cellular space is limited in front by the visceral sheet of the intracervical fascia on the posterior wall of the esophagus, in the lateral sections - by the pharyngeal-vertebral spurs. These spurs delimit the periesophageal and posterior esophageal spaces. The latter passes at the top into the pharyngeal tissue, divided into the right and left halves by a fascial sheet extending from the posterior pharyngeal wall to the spine in the sagittal plane. Down, it does not descend below the VI-VII cervical vertebrae.

Between the second and third fascia, directly above the handle of the sternum, there is a suprasternal interfascial cellular space (spatium interaponeuroticum suprasternale). Its vertical size is 4-5 cm. To the sides of the median line is

the space communicates with Gruber's bags - cellular spaces located behind the lower sections of the sternocleidomastoid muscles. Above, they are delimited by adhesions of the second and third fascia of the neck (at the level of the intermediate tendons of the scapular-hyoid muscles), below - by the edge of the notch of the sternum and the upper surface of the sternoclavicular joints, from the outside they reach the lateral edge of the sternocleidomastoid muscles.

The fascial cases of the sternocleidomastoid muscles are formed by the superficial sheet of the neck's own fascia. At the bottom, they reach the attachment of the muscle to the clavicle, sternum and their articulation, and at the top - to the lower border of the formation of the tendon of the muscles, where they fuse with them. These cases are closed. To a greater extent, layers of adipose tissue are expressed on the back and inner surfaces of the muscles, to a lesser extent - on the front.

The anterior wall of the fascial sheaths of the neurovascular bundles, depending on the level, is formed either by the third (below the intersection of the sternocleidomastoid and scapular-hyoid muscles), or by the parietal sheet of the fourth (above this intersection) fascia of the neck. The posterior wall is formed by a spur of the prevertebral fascia. Each element of the neurovascular bundle has its own sheath, thus, the common neurovascular sheath consists of three in total - the sheath of the common carotid artery, the internal jugular vein and the vagus nerve. At the level of the intersection of the vessels and nerve with the muscles coming from the styloid process, they are tightly fixed to the back wall of the fascial sheaths of these muscles, and thus Bottom part the sheath of the neurovascular bundle is delimited from the posterior part of the peripharyngeal space.

The prevertebral space is located behind the organs and behind the pharyngeal tissue. It is delimited by the common prevertebral fascia. Inside this space there are cellular gaps of fascial cases of individual muscles lying on the spine. These gaps are delimited from each other by the attachment of cases along with long muscles on the bodies of the vertebrae (below, these spaces reach the II-III thoracic vertebrae).

The fascial sheaths of the scalene muscles and trunks of the brachial plexus are located outward from the bodies of the cervical vertebrae. The plexus trunks are located between the anterior and middle scalene muscles. Interscalene space along the branches of the subclavian

The artery connects with the prevertebral space (along the vertebral artery), with the pretracheal space (along the inferior thyroid artery), with the fascial case of the neck fat between the second and fifth fascia in the scapular-trapezoid triangle (along the transverse artery of the neck).

The fascial case of the neck fat pad is formed by the superficial sheet of the own fascia of the neck (in front) and the prevertebral (behind) fascia between the sternocleidomastoid and trapezius muscles in the scapular-trapezius triangle. Downward, the fatty tissue of this case descends into the scapular-clavicular triangle, located under the deep sheet of the own fascia of the neck.

Messages of the cellular spaces of the neck. The cellular spaces of the submandibular region have direct communication with both the submucosal tissue of the floor of the mouth and with the fatty tissue that fills the anterior peripharyngeal cellular space.

The post-pharyngeal space of the head passes directly into the tissue located behind the esophagus. At the same time, these two spaces are isolated from other cellular spaces of the head and neck.

The adipose tissue of the neurovascular bundle is well demarcated from neighboring cellular spaces. It is extremely rare that inflammatory processes spread to the posterior peripharyngeal space along the internal carotid artery and internal jugular vein. Also, a connection between this space and the anterior peripharyngeal space is rarely noted. This may be due to underdevelopment of the fascia between the stylohyoid and stylo-pharyngeal muscles. Downward, the fiber extends to the level of the venous angle (Pirogov) and the place of origin of its branches from the aortic arch.

The periesophageal space in most cases communicates with fiber located on the anterior surface of the cricoid cartilage and the lateral surface of the larynx.

The pretracheal space sometimes communicates with the periesophageal spaces, much less often with the anterior mediastinal tissue.

The suprasternal interfascial space with Gruber's bags are also isolated.

The fiber of the lateral triangle of the neck has messages along the trunks of the brachial plexus and branches of the subclavian artery.

12.3. FRONT REGION OF THE NECK

12.3.1. Submandibular triangle

The submandibular triangle (trigonum submandibulare) (Fig. 12.4) is limited by the anterior and posterior belly of the digastric muscle and the edge of the lower jaw, which forms the base of the triangle at the top.

Leathermobile and flexible.

The first fascia forms the sheath of the subcutaneous muscle of the neck (m. p1atysma), the fibers of which are directed from bottom to top and from outside to inside. The muscle starts from the thoracic fascia below the clavicle and ends on the face, partly connecting with the fibers of the facial muscles in the corner of the mouth, partly weaving into the parotid-masticatory fascia. The muscle is innervated by the cervical branch facial nerve(r. colli n. facialis).

Between the back wall of the vagina of the subcutaneous muscle of the neck and the second fascia of the neck, immediately under the edge of the lower jaw lies one or more superficial submandibular lymph nodes. In the same layer, the upper branches of the transverse nerve of the neck (n. transversus colli) pass from the cervical plexus (Fig. 12.3).

Under the second fascia in the region of the submandibular triangle are the submandibular gland, muscles, lymph nodes, vessels and nerves.

The second fascia forms the capsule of the submandibular gland. The second fascia has two leaves. Superficial, covering the outer surface of the gland, is attached to the lower edge of the lower jaw. Between the angle of the lower jaw and the anterior edge of the sternocleidomastoid muscle, the fascia thickens, giving inward a dense septum separating the bed of the submandibular gland from the bed of the parotid. Heading towards the midline, the fascia covers the anterior belly of the digastric muscle and the maxillohyoid muscle. The submandibular gland partially adjoins directly to the bone, the inner surface of the gland adjoins the maxillo-hyoid and hyoid-lingual muscles, separated from them by a deep sheet of the second fascia, which is significantly inferior in density to the surface sheet. At the bottom, the capsule of the gland is connected to the hyoid bone.

The capsule surrounds the gland freely, without growing together with it and without giving processes into the depths of the gland. Between the submandibular gland and its capsule there is a layer of loose fiber. The bed of the gland is closed from all

sides, especially at the level of the hyoid bone, where the superficial and deep leaves of its capsule grow together. Only in the anterior direction, the fiber contained in the gland bed communicates along the gland duct in the gap between the maxillohyoid and hyoid-lingual muscles with the fiber of the floor of the mouth.

The submandibular gland fills the gap between the anterior and posterior belly of the digastric muscle; it either does not go beyond the triangle, which is characteristic of old age, or is large and then goes beyond its limits, which is observed at a young age. In older people, the submandibular gland is sometimes well contoured due to partial atrophy of the subcutaneous tissue and the subcutaneous muscle of the neck.

Rice. 12.3.Superficial nerves of the neck:

1 - cervical branch of the facial nerve; 2 - large occipital nerve; 3 - small occipital nerve; 4 - posterior ear nerve; 5 - transverse nerve of the neck; 6 - anterior supraclavicular nerve; 7 - middle supraclavicular nerve; 8 - posterior supraclavicular nerve

The submandibular gland has two processes extending beyond the gland bed. The posterior process goes under the edge of the lower jaw and reaches the place of attachment to it of the internal pterygoid muscle. The anterior process accompanies the excretory duct of the gland and, together with it, passes into the gap between the maxillofacial and hyoid-lingual muscles, often reaching the sublingual salivary gland. The latter lies under the mucous membrane of the bottom of the mouth on the upper surface of the maxillohyoid muscle.

Around the gland lie the submandibular lymph nodes, adjacent mainly to the upper and posterior edges of the gland, where the anterior facial vein passes. Often, the presence of lymph nodes is also noted in the thickness of the gland, as well as between the sheets of the fascial septum that separates the posterior end of the submandibular gland from the lower end of the parotid gland. The presence of lymph nodes in the thickness of the submandibular gland makes it necessary to remove not only the submandibular lymph nodes, but also the submandibular salivary gland (if necessary, from both sides) in case of metastases of cancerous tumors (for example, the lower lip).

The excretory duct of the gland (ductus submandibularis) starts from the inner surface of the gland and stretches anteriorly and upward, penetrating into the gap between m. hyoglossus and m. mylohyoideus and further passing under the mucous membrane of the bottom of the mouth. The indicated intermuscular gap, which passes the salivary duct, surrounded by loose fiber, can serve as a path along which pus, with phlegmon of the bottom of the mouth, descends into the region of the submandibular triangle. Below the duct, the hypoglossal nerve (n. hypoglossus) penetrates into the same gap, accompanied by the lingual vein (v. lingualis), and above the duct it goes, accompanied by the lingual nerve (n. lingualis).

Deeper than the submandibular gland and the deep plate of the second fascia are muscles, vessels and nerves.

Within the submandibular triangle, the superficial layer of muscles consists of the digastric (m. digastricum), stylohyoid (m. stylohyoideus), maxillary-hyoid (m.mylohyoideus) and hyoid-lingual (m. hyoglossus) muscles. The first two limit (with the edge of the lower jaw) the submandibular triangle, the other two form its bottom. The posterior belly muscle of the digastric muscle starts from the mastoid notch of the temporal bone, the anterior one - from the fossa of the lower jaw of the same name, and the tendon connecting both abdomens is attached to the body of the hyoid bone. To the back belly

The digastric muscle adjoins the stylohyoid muscle, which starts from the styloid process and attaches to the body of the hyoid bone, while covering the tendon of the digastric muscle with its legs. The maxillohyoid muscle lies deeper than the anterior belly of the digastric muscle; it starts from the line of the same name of the lower jaw and is attached to the body of the hyoid bone. The right and left muscles converge in the midline, forming a seam (raphe). Both muscles make up an almost quadrangular plate that forms the so-called diaphragm of the mouth.

The hyoid-lingual muscle is, as it were, a continuation of the jaw-hyoid muscle. However, the maxillary-hyoid muscle is connected with the lower jaw with its other end, while the hyoid-lingual muscle goes to the lateral surface of the tongue. The lingual vein, the hypoglossal nerve, the duct of the submandibular salivary gland and the lingual nerve pass along the outer surface of the hyoid-lingual muscle.

The facial artery always passes in the fascial bed under the edge of the mandible. In the submandibular triangle, the facial artery makes a bend, passing along the upper and posterior surfaces of the posterior pole of the submandibular gland near the pharyngeal wall. In the thickness of the superficial plate of the second fascia of the neck passes the facial vein. At the posterior border of the submandibular triangle, it merges with the posterior mandibular vein (v. retromandibularis) into the common facial vein (v. facialis communis).

In the gap between the maxillohyoid and hyoid-lingual muscle, the lingual nerve passes, giving off branches to the submandibular salivary gland.

A small area of ​​​​the area of ​​\u200b\u200bthe triangle, where the lingual artery can be exposed, is called Pirogov's triangle. Its borders: the upper one is the hypoglossal nerve, the lower one is the intermediate tendon of the digastric muscle, the anterior one is the free edge of the maxillohyoid muscle. The bottom of the triangle is the hyoid-lingual muscle, the fibers of which must be separated to expose the artery. Pirogov's triangle is revealed only on condition that the head is thrown back and strongly turned in the opposite direction, and the gland is removed from its bed and pulled upward.

Submandibular lymph nodes (nodi lymphatici submandibulares) are located on top, in the thickness or under the surface plate of the second fascia of the neck. They drain lymph from the medial

Rice. 12.4.Topography of the submandibular triangle of the neck: 1 - own fascia; 2 - angle of the lower jaw; 3 - posterior belly of the digastric muscle; 4 - anterior belly of the digastric muscle; 5 - hyoid-lingual muscle; 6 - maxillofacial muscle; 7 - Pirogov's triangle; 8 - submandibular gland; 9 - submandibular lymph nodes; 10 - external carotid artery; 11 - lingual artery; 12 - lingual vein; 13 - hypoglossal nerve; 14 - common facial vein; 15 - internal jugular vein; 16 - facial artery; 17 - facial vein; 18 - mandibular vein

parts of the eyelids, external nose, buccal mucosa, gums, lips, floor of the mouth and middle part of the tongue. Thus, during inflammatory processes in the area of ​​the inner part of the lower eyelid, the submandibular lymph nodes increase.

12.3.2. sleepy triangle

The sleep triangle (trigonum caroticum) (Fig. 12.5), is bounded laterally by the anterior edge of the sternocleidomastoid muscle, from above by the posterior belly of the digastric muscle and the stylohyoid muscle, from the inside by the upper belly of the scapular-hyoid muscle.

Leatherthin, mobile, easily taken in a fold.

Innervation is carried out by the transverse nerve of the neck (n. transverses colli) from the cervical plexus.

The superficial fascia contains the fibers of the subcutaneous muscle of the neck.

Between the first and second fascia is the transverse nerve of the neck (n. transversus colli) from the cervical plexus. One of its branches goes to the body of the hyoid bone.

The superficial sheet of the own fascia of the neck under the sternocleidomastoid muscle fuses with the sheath of the neurovascular bundle formed by the parietal sheet of the fourth fascia of the neck.

In the sheath of the neurovascular bundle, the internal jugular vein is located laterally, medially - the common carotid artery (a. carotis communis), and behind them - the vagus nerve (n.vagus). Each element of the neurovascular bundle has its own fibrous sheath.

The common facial vein (v. facialis communis) flows into the vein from above and medially at an acute angle. In the corner at the place of their confluence, a large lymph node may be located. Along a vein in her vagina is a chain of deep lymph nodes in the neck.

On the surface of the common carotid artery, the upper root of the cervical loop descends from top to bottom and medially.

At the level of the upper edge of the thyroid cartilage, the common carotid artery divides into external and internal. The external carotid artery (a.carotis externa) is usually located more superficial and medial, and the internal carotid is lateral and deeper. This is one of the signs of the differences between the vessels from each other. Another distinguishing feature is the presence of branches in the external carotid artery and their absence in the internal carotid. In the bifurcation area, there is a slight expansion that continues to the internal carotid artery - the carotid sinus (sinus caroticus).

On the posterior (sometimes on the medial) surface of the internal carotid artery is the carotid tangle (glomus caroticum). In the fatty tissue surrounding the carotid sinus and carotid tangle, lies the nerve plexus, formed by the branches of the glossopharyngeal, vagus nerves and the border sympathetic trunk. This is a reflexogenic zone containing baro- and chemoreceptors that regulate blood circulation and respiration through the nerve of Hering, together with the nerve of Ludwig-Zion.

The external carotid artery is located in the angle formed by the trunk of the common facial vein from the inside, by the internal jugular vein laterally, by the hypoglossal nerve from above (Farabeuf's triangle).

At the place where the external carotid artery is formed, there is the superior thyroid artery (a.thyroidea superior), which goes medially and downwards, going under the edge of the upper abdomen of the scapular-hyoid muscle. At the level of the upper edge of the thyroid cartilage, the superior laryngeal artery departs from this artery in the transverse direction.

Rice. 12.5.Topography of the carotid triangle of the neck:

1 - posterior belly of the digastric muscle; 2 - upper abdomen of the scapular-hyoid muscle; 3 - sternocleidomastoid muscle; 4 - thyroid gland; 5 - internal jugular vein; 6 - facial vein; 7 - lingual vein; 8 - superior thyroid vein; 9 - common carotid artery; 10 - external carotid artery; 11 - superior thyroid artery; 12 - lingual artery; 13 - facial artery; 14 - vagus nerve; 15 - hypoglossal nerve; 16 - superior laryngeal nerve

Slightly above the outlet of the superior thyroid artery at the level of the large horn of the hyoid bone, directly below the hyoid nerve, on the anterior surface of the external carotid artery, there is the mouth of the lingual artery (a. lingualis), which is hidden under the outer edge of the hyoid-lingual muscle.

At the same level, but from the inner surface of the external carotid artery, the ascending pharyngeal artery departs (a.pharyngea ascendens).

Above the lingual artery departs the facial artery (a.facialis). It goes up and medially under the posterior belly of the digastric muscle, pierces a deep sheet of the second fascia of the neck and, making a bend in the medial side, enters the bed of the submandibular salivary gland (see Fig. 12.4).

At the same level, the sternocleidomastoid artery (a. sternocleidomastoidea) departs from the lateral surface of the external carotid artery.

On the posterior surface of the external carotid artery, at the level of the origin of the facial and sternocleidomastoid arteries, there is the mouth of the occipital artery (a.occipitalis). It goes back and up along the lower edge of the posterior belly of the digastric muscle.

Under the posterior belly of the digastric muscle anterior to the internal carotid artery is the hypoglossal nerve, which forms an arc with a bulge downwards. The nerve goes forward under the lower edge of the digastric muscle.

The superior laryngeal nerve (n. laryngeus superior) is located at the level of the large horn of the hyoid bone behind both carotid arteries on the prevertebral fascia. It is divided into two branches: internal and external. The internal branch goes down and forward, accompanied by the superior laryngeal artery (a.laryngeа superior), located below the nerve. Further, it perforates the thyroid-hyoid membrane and penetrates the wall of the larynx. The external branch of the superior laryngeal nerve runs vertically downward to the cricothyroid muscle.

The cervical region of the borderline sympathetic trunk is located under the fifth fascia of the neck immediately medially from the palpable anterior tubercles of the transverse processes of the cervical vertebrae. It lies directly on the long muscles of the head and neck. At the level of Th n -Th ni is the upper cervical sympathetic node, reaching 2-4 cm in length and 5-6 mm in width.

12.3.3. Scapulotracheal triangle

The scapular-tracheal triangle (trigonum omotracheale) is bounded above and behind by the upper abdomen of the scapular-hyoid muscle, below and behind by the anterior edge of the sternocleidomastoid muscle, and in front by the median line of the neck. The skin is thin, mobile, easily stretched. The first fascia forms the sheath of the subcutaneous muscle.

The second fascia fuses along the upper border of the region with the hyoid bone, and below it is attached to the anterior surface of the sternum and clavicle. In the midline, the second fascia fuses with the third, however, for about 3 cm upwards from the jugular notch, both fascial sheets exist as independent plates, delimit the cellular space (spatium interaponeuroticum suprasternale).

The third fascia has a limited extent: at the top and bottom it is connected with the bone borders of the region, and from the sides it ends along the edges of the scapular-hyoid muscles connected to it. Merging in the upper half of the region with the second fascia along the midline, the third fascia forms the so-called white line of the neck (linea alba colli) 2-3 mm wide.

The third fascia forms the sheath of 4 paired muscles located below the hyoid bone: mm. sternohyoideus, sternothyroideus, thyrohyoideus, omohyoideus.

The sternohyoid and sternothyroid muscles originate most of the fibers from the sternum. The sternohyoid muscle is longer and narrower, lies closer to the surface, the sternothyroid muscle is wider and shorter, lies deeper and is partially covered by the previous muscle. The sternohyoid muscle is attached to the body of the hyoid bone, converging near the midline with the same muscle of the opposite side; the sternothyroid muscle is attached to the thyroid cartilage, and, going up from the sternum, it diverges from the same muscle of the opposite side.

The thyroid-hyoid muscle is, to a certain extent, a continuation of the sternothyroid muscle and stretches from the thyroid cartilage to the hyoid bone. The scapular-hyoid muscle has two abdomens - lower and upper, the first being connected with the upper edge of the scapula, the second with the body of the hyoid bone. Between both abdomens of the muscle there is an intermediate tendon. The third fascia ends along the outer edge of the muscle, firmly fuses with its intermediate tendon and the wall of the internal jugular vein.

Under the described layer of muscles with their vaginas there are sheets of the fourth fascia of the neck (fascia endocervicalis), which consists of a parietal sheet covering the muscles and a visceral one. Under the visceral sheet of the fourth fascia are the larynx, trachea, thyroid gland (with parathyroid glands), pharynx, esophagus.

12.4. TOPOGRAPHY OF THE LARYNX AND CERVICAL TRACHEA

Larynx(larynx) form 9 cartilages (3 paired and 3 unpaired). The basis of the larynx is the cricoid cartilage, located at the level of the VI cervical vertebra. Above the anterior part of the cricoid cartilage is the thyroid cartilage. The thyroid cartilage is connected with the hyoid bone by the membrane (membrana hyothyroidea), from the cricoid cartilage to the thyroid cartilage go mm. cricothyroidei and ligg. cricoarytenoidei.

Three sections are distinguished in the cavity of the larynx: upper (vestibulum laryngis), middle, corresponding to the position of false and true vocal cords, and the lower one, called the subglottic space in laryngology (Fig. 12.6, 12.7).

Skeletotopia.The larynx is located in the range from the upper edge of the V cervical vertebra to the lower edge of the VI cervical vertebra. The upper part of the thyroid cartilage can reach the level of the IV cervical vertebra. In children, the larynx lies much higher, reaching the level of the III vertebra with its upper edge, in the elderly it lies low, located with its upper edge at the level of the VI vertebra. The position of the larynx changes dramatically in the same person depending on the position of the head. So, with the tongue sticking out, the larynx rises, the epiglottis takes a position close to vertical, opening the entrance to the larynx.

Blood supply.The larynx is supplied by branches of the superior and inferior thyroid arteries.

innervationThe larynx is carried out by the pharyngeal plexus, which is formed by the branches of the sympathetic, vagus and glossopharyngeal nerves. The superior and inferior laryngeal nerves (n. laringeus superior et inferior) are branches of the vagus nerve. At the same time, the superior laryngeal nerve, being predominantly sensitive,

innervates the mucous membrane of the upper and middle sections of the larynx, as well as the cricothyroid muscle. The inferior laryngeal nerve, being predominantly motor, innervates the muscles of the larynx and the mucous membrane of the lower larynx.

Rice. 12.6.Organs and blood vessels of the neck:

1 - hyoid bone; 2 - trachea; 3 - lingual vein; 4 - upper thyroid artery and vein; 5 - thyroid gland; 6 - left common carotid artery; 7 - left internal jugular vein; 8 - left anterior jugular vein, 9 - left external jugular vein; 10 - left subclavian artery; 11 - left subclavian vein; 12 - left brachiocephalic vein; 13 - left vagus nerve; 14 - right brachiocephalic vein; 15 - right subclavian artery; 16 - right anterior jugular vein; 17 - brachiocephalic trunk; 18 - the smallest thyroid vein; 19 - right external jugular vein; 20 - right internal jugular vein; 21 - sternocleidomastoid muscle

Rice. 12.7.Cartilages, ligaments and joints of the larynx (from: Mikhailov S.S. et al., 1999) a - front view: 1 - hyoid bone; 2 - granular cartilage; 3 - upper horn of the thyroid cartilage; 4 - left plate of the thyroid cartilage;

5 - lower horn of the thyroid cartilage; 6 - arc of the cricoid cartilage; 7 - cartilage of the trachea; 8 - annular ligaments of the trachea; 9 - cricoid joint; 10 - cricoid ligament; 11 - upper thyroid notch; 12 - thyroid membrane; 13 - median thyroid ligament; 14 - lateral thyroid-hyoid ligament.

6 - rear view: 1 - epiglottis; 2 - large horn of the hyoid bone; 3 - granular cartilage; 4 - upper horn of the thyroid cartilage; 5 - right plate of the thyroid cartilage; 6 - arytenoid cartilage; 7, 14 - right and left cricoarytenoid cartilages; 8, 12 - right and left cricoid joints; 9 - cartilage of the trachea; 10 - membranous wall of the trachea; 11 - plate of the cricoid cartilage; 13 - lower horn of the thyroid cartilage; 15 - muscular process of the arytenoid cartilage; 16 - vocal process of the arytenoid cartilage; 17 - thyroid-epiglottic ligament; 18 - corniculate cartilage; 19 - lateral thyroid-hyoid ligament; 20 - thyroid membrane

Lymph drainage.With regard to lymph drainage, it is customary to divide the larynx into two sections: the upper one - above the vocal cords and the lower one - below the vocal cords. Regional lymph nodes of the upper larynx are mainly deep cervical lymph nodes located along the internal jugular vein. Lymphatic vessels from the lower part of the larynx end in nodes located near the trachea. These nodes are associated with deep cervical lymph nodes.

Trachea - is a tube consisting of 15-20 cartilaginous half-rings, making up approximately 2/3-4/5 of the circumference of the trachea and closed behind by a connective tissue membrane, and interconnected by annular ligaments.

The membranous membrane contains, in addition to the elastic and collagen fibers running in the longitudinal direction, also smooth muscle fibers running in the longitudinal and oblique directions.

From the inside, the trachea is covered with a mucous membrane, in which the most superficial layer is a stratified ciliated cylindrical epithelium. A large number of goblet cells located in this layer, together with the tracheal glands, produce a thin layer of mucus that protects the mucous membrane. The middle layer of the mucous membrane is called the basement membrane and consists of a network of argyrophilic fibers. The outer layer of the mucous membrane is formed by elastic fibers located in the longitudinal direction, especially developed in the region of the membranous part of the trachea. Due to this layer, folding of the mucous membrane is formed. Between the folds, the excretory tubules of the tracheal glands open. Due to the pronounced submucosal layer, the mucous membrane of the trachea is mobile, especially in the area of ​​the membranous part of its wall.

Outside, the trachea is covered with a fibrous sheet, which consists of three layers. The outer leaflet is intertwined with the outer perichondrium, and the inner leaflet is intertwined with the inner perichondrium of the cartilaginous semirings. The middle layer is fixed along the edges of the cartilaginous semirings. Between these layers of fibrous fibers are adipose tissue, blood vessels and glands.

Distinguish between the cervical and thoracic trachea.

The total length of the trachea varies in adults from 8 to 15 cm, in children it varies depending on age. In men, it is 10-12 cm, in women - 9-10 cm. The length and width of the trachea in adults depend on the type of physique. So, with a brachymorphic body type, it is short and wide, with a dolichomorphic body type, it is narrow and long. In children

For the first 6 months of life, the funnel-shaped form of the trachea predominates; with age, the trachea acquires a cylindrical or conical shape.

Skeletotopia.Start cervical depends on age in children and body type in adults, in which it ranges from the lower edge of the VI cervical to the lower edge of the II thoracic vertebrae. The boundary between the cervical and thoracic regions is the upper thoracic inlet. According to various researchers, the thoracic trachea can be 2/5-3/5 in children of the first years of life, in adults - from 44.5 - 62% of its total length.

Syntopy.In children, a relatively large thymus gland is adjacent to the anterior surface of the trachea, which in small children can rise to the lower edge of the thyroid gland. The thyroid gland in newborns is located relatively high. Its lateral lobes with their upper edges reach the level of the upper edge of the thyroid cartilage, and the lower ones - 8-10 tracheal rings and almost come into contact with the thymus gland. The isthmus of the thyroid gland in newborns is adjacent to the trachea for a relatively large extent and occupies a higher position. Its upper edge is located at the level of the cricoid cartilage of the larynx, and the lower one reaches the 5-8th tracheal rings, while in adults it is located between the 1st and 4th rings. The thin pyramidal process is relatively common and is located near the midline.

In adults top part The cervical trachea is surrounded in front and on the sides by the thyroid gland, behind it is the esophagus, separated from the trachea by a layer of loose fiber.

The upper cartilages of the trachea are covered by the isthmus of the thyroid gland, in the lower part of the cervical part of the trachea are the lower thyroid veins and the unpaired thyroid venous plexus. Above the jugular notch of the manubrium of the sternum in people of the brachymorphic body type, the upper edge of the left brachiocephalic vein is quite often located.

The recurrent laryngeal nerves lie in the esophageal-tracheal grooves formed by the esophagus and trachea. In the lower part of the neck, the common carotid arteries are adjacent to the lateral surfaces of the trachea.

The esophagus is adjacent to the thoracic part of the trachea, in front at the level of the IV thoracic vertebra immediately above the bifurcation of the trachea and to the left of it is the aortic arch. On the right and in front, the brachiocephalic trunk covers the right semicircle of the trachea. Here, not far from the trachea, are the trunk of the right vagus nerve and the upper hollow

vein. Above the aortic arch lies the thymus gland or its replacement fatty tissue. To the left of the trachea is the left recurrent laryngeal nerve, and above it is the left common carotid artery. To the right and left of the trachea and below the bifurcation are numerous groups of lymph nodes.

Along the trachea in front are the suprasternal interaponeurotic, pretracheal and peritracheal cellular spaces containing the unpaired venous plexus of the thyroid gland, the inferior thyroid artery (in 10-12% of cases), lymph nodes, vagus nerves, cardiac branches of the border sympathetic trunk.

blood supplythe cervical part of the trachea is carried out by branches of the lower thyroid arteries or thyroid trunks. The blood flow to the thoracic trachea occurs due to the bronchial arteries, as well as from the arch and descending part of the aorta. Bronchial arteries in the amount of 4 (sometimes 2-6) most often depart from the anterior and right semicircle of the descending part of the thoracic aorta on the left, less often - from 1-2 intercostal arteries or the descending part of the aorta on the right. They can start from the subclavian, inferior thyroid arteries and from the costal-cervical trunk. In addition to these constant sources of blood supply, there are additional branches extending from the aortic arch, brachiocephalic trunk, subclavian, vertebral, internal thoracic and common carotid arteries.

Before entering the lungs, the bronchial arteries give parietal branches in the mediastinum (to the muscles, spine, ligaments and pleura), visceral branches (to the esophagus, pericardium), adventitia of the aorta, pulmonary vessels, unpaired and semi-unpaired veins, to the trunks and branches of the sympathetic and vagus nerves and also to the lymph nodes.

In the mediastinum, the bronchial arteries anastomose with the esophageal, pericardial arteries, branches of the internal thoracic and inferior thyroid arteries.

venous outflow.The venous vessels of the trachea are formed from intra- and extra-organ venous networks of the mucous, deep submucosal and superficial plexuses. Venous outflow is carried out through the lower thyroid veins, which flow into the unpaired thyroid venous plexus, the veins of the cervical esophagus, and from thoracic- into the unpaired and semi-unpaired veins, sometimes into the brachiocephalic veins, and also anastomose with the veins of the thymus gland, mediastinal tissue, and the thoracic esophagus.

Innervation.The cervical part of the trachea is innervated by tracheal branches of the recurrent laryngeal nerves with the inclusion of branches from the cervical cardiac nerves, cervical sympathetic nodes and internodal branches, and in some cases from the thoracic sympathetic trunk. In addition, sympathetic branches to the trachea also come from the common carotid and subclavian plexuses. Branches from the recurrent laryngeal nerve, from the main trunk of the vagus nerve, and to the left, from the left recurrent laryngeal nerve, approach the thoracic trachea on the right. These branches of the vagus and sympathetic nerves form closely interconnected superficial and deep plexuses.

Lymph drainage.Lymph capillaries form two networks in the mucosa of the trachea - superficial and deep. The submucosa contains a plexus of efferent lymphatic vessels. In the muscular layer of the membranous part, the lymphatic vessels are located only between individual muscle bundles. In the adventitia, the efferent lymphatic vessels are located in two layers. Lymph from the cervical part of the trachea flows into the lower deep cervical, pretracheal, paratracheal, and pharyngeal lymph nodes. Part of the lymphatic vessels carry lymph to the anterior and posterior mediastinal nodes.

The lymphatic vessels of the trachea are connected with the vessels of the thyroid gland, pharynx, trachea and esophagus.

12.5. THYROID TOPOGRAPHY

AND PARATHYROID GLANDS

The thyroid gland (glandula thyroidea) consists of two lateral lobes and an isthmus. In each lobe of the gland, the upper and lower poles are distinguished. The upper poles of the lateral lobes of the thyroid gland reach the middle of the height of the plates of the thyroid cartilage. The lower poles of the lateral lobes of the thyroid gland descend below the isthmus and reach the level of the 5th-6th ring, 2-3 cm short of the notch of the sternum. Approximately in 1/3 of cases, there is a presence of a pyramidal lobe extending upward from the isthmus in the form of an additional lobe of the gland (lobus pyramidalis). The latter may not be associated with the isthmus, but with the lateral lobe of the gland, and often reaches the hyoid bone. The size and position of the isthmus is highly variable.

The isthmus of the thyroid gland lies in front of the trachea (at the level of the 1st to 3rd or 2nd to 5th cartilage of the trachea). Sometimes (in 10-15% of cases) the isthmus of the thyroid gland is absent.

The thyroid gland has its own capsule in the form of a thin fibrous plate and a fascial sheath formed by the visceral sheet of the fourth fascia. From the capsule of the thyroid gland into the depths of the parenchyma of the organ, connective tissue septa extend. Allocate partitions of the first and second orders. In the thickness of the connective tissue partitions, intraorganic blood vessels and nerves pass. Between the capsule of the gland and its vagina there is loose fiber, in which arteries, veins, nerves and parathyroid glands lie.

In some places denser fibers depart from the fourth fascia, which have the character of ligaments passing from the gland to neighboring organs. The median ligament is stretched transversely between the isthmus, on the one hand, and the cricoid cartilage and the 1st cartilage of the trachea, on the other. The lateral ligaments run from the gland to the cricoid and thyroid cartilages.

Syntopy.The isthmus of the thyroid gland lies in front of the trachea at the level from the 1st to the 3rd or from the 2nd to the 4th of its cartilage, and often covers part of the cricoid cartilage. The lateral lobes through the fascial capsule come into contact with the fascial sheaths of the common carotid arteries with their posterolateral surfaces. The posterior medial surfaces of the lateral lobes are adjacent to the larynx, trachea, tracheoesophageal groove, and also to the esophagus, and therefore, with an increase in the lateral lobes of the thyroid gland, its compression is possible. In the gap between the trachea and the esophagus on the right and along the anterior wall of the esophagus on the left, recurrent laryngeal nerves rise to the cricoid ligament, lying outside the fascial capsule of the thyroid gland. Front cover the thyroid gland mm. sternohyoidei, sternothyroidei and omohyoidei.

blood supplyThe thyroid gland is carried out by branches of four arteries: two aa. thyroideae superiores and two aa. thyroideae inferiores. In rare cases (6-8%), in addition to these arteries, there is a. thyroidea ima, extending from the brachiocephalic trunk or from the aortic arch and heading towards the isthmus.

A. thyroidea superior supplies blood to the upper poles of the lateral lobes and the upper edge of the isthmus of the thyroid gland. A. thyroidea inferior departs from the truncus thyrocervicalis in the stair-vertebral gap

and rises under the fifth fascia of the neck along the anterior scalene muscle up to the level of the VI cervical vertebra, forming a loop or arc here. Then it descends downward and inwards, perforating the fourth fascia, to the lower third of the posterior surface of the lateral lobe of the gland. The ascending part of the inferior thyroid artery runs medially from the phrenic nerve. At the posterior surface of the lateral lobe of the thyroid gland, branches of the inferior thyroid artery cross the recurrent laryngeal nerve, being anterior or posterior to it, and sometimes envelop the nerve in the form of a vascular loop.

The arteries of the thyroid gland (Fig. 12.8) form two systems of collaterals: intraorganic (due to the thyroid arteries) and extraorganic (due to anastomoses with the vessels of the pharynx, esophagus, larynx, trachea and adjacent muscles).

venous outflow.Veins form plexuses around the lateral lobes and isthmus, especially on the anterolateral surface of the gland. The plexus lying on and below the isthmus is called the plexus venosus thyreoideus impar. The inferior thyroid veins arise from it, flowing more often into the corresponding innominate veins, and the lowest thyroid veins vv. thyroideae imae (one or two), flowing into the left innominate. The superior thyroid veins drain into the internal jugular vein (directly or through the common facial vein). The inferior thyroid veins are formed from the venous plexus on the anterior surface of the gland, as well as from the unpaired venous plexus (plexus thyroideus impar), located at the lower edge of the isthmus of the thyroid gland and in front of the trachea, and flow into the right and left brachiocephalic veins, respectively. The thyroid veins form numerous intraorgan anastomoses.

Innervation.The thyroid nerves arise from the border trunk of the sympathetic nerve and from the superior and inferior laryngeal nerves. The inferior laryngeal nerve comes into close contact with the inferior thyroid artery, crossing it on its way. Among other vessels, the inferior thyroid artery is ligated when the goiter is removed; if the ligation is performed near the gland, then damage to the lower laryngeal nerve or its involvement in the ligature is possible, which can lead to paresis of the vocal muscles and phonation disorder. The nerve passes either in front of the artery or behind, and on the right it often lies in front of the artery, and on the left - behind.

Lymph drainagefrom the thyroid gland occurs mainly in the nodes located in front and on the sides of the trachea (nodi lymphatici

praetracheales et paratracheales), partially - in the deep cervical lymph nodes (Fig. 12.9).

Closely related to the thyroid gland are the parathyroid glands (glandulae parathyroideae). Usually in the amount of 4, they are most often located outside the own capsule of the thyroid

Rice. 12.8.Sources of blood supply to the thyroid and parathyroid glands: 1 - brachiocephalic trunk; 2 - right subclavian artery; 3 - right common carotid artery; 4 - right internal carotid artery; 5 - right external carotid artery; 6 - left upper thyroid artery; 7 - left lower thyroid artery; 8 - the lowest thyroid artery; 9 - left thyroid trunk

Rice. 12.9. Lymph nodes of the neck:

1 - pretracheal nodes; 2 - anterior thyroid nodes; 3 - chin nodes, 4 - mandibular nodes; 5 - buccal nodes; 6 - occipital nodes; 7 - parotid nodes; 8 - posterior nodes, 9 - upper jugular nodes; 10 - upper pull-out nodes; 11 - lower jugular and supraclavicular nodes

glands (between the capsule and the fascial sheath), two on each side, on the back surface of its lateral lobes. Significant differences are noted both in the number and size, and in the position of the parathyroid glands. Sometimes they are located outside the fascial sheath of the thyroid gland. As a result, finding the parathyroid glands during surgical interventions presents significant difficulties, especially due to the fact that next to the parathyroid

prominent glands are very similar in appearance to formations (lymph nodes, fatty lumps, additional thyroid glands).

To establish the true nature of the parathyroid gland removed during surgery, a microscopic examination is performed. To prevent complications associated with the erroneous removal of the parathyroid glands, it is advisable to use microsurgical techniques and tools.

12.6. sternocleidomastoid region

The sternocleidomastoid region (regio sternocleidomastoidea) corresponds to the position of the muscle of the same name, which is the main external landmark. The sternocleidomastoid muscle covers the medial neurovascular bundle of the neck (common carotid artery, internal jugular vein, and vagus nerve). In the carotid triangle, the neurovascular bundle is projected along the anterior edge of this muscle, and in the lower one it is covered by its sternal portion.

At the middle of the posterior edge of the sternocleidomastoid muscle, the exit point of the sensitive branches of the cervical plexus is projected. The largest of these branches is the large ear nerve (n. auricularis magnus). Pirogov's venous angle, as well as the vagus and phrenic nerves, are projected between the legs of this muscle.

Leatherthin, easily folded together with subcutaneous tissue and superficial fascia. Near the mastoid process, the skin is dense, inactive.

Subcutaneous adipose tissue loose. At the upper border of the area, it thickens and becomes cellular due to connective tissue bridges connecting the skin with the periosteum of the mastoid process.

Between the first and second fascia of the neck are the external jugular vein, superficial cervical lymph nodes and cutaneous branches of the cervical plexus of the spinal nerves.

The external jugular vein (v. jugularis extema) is formed by the confluence of the occipital, ear and partially mandibular veins at the angle of the lower jaw and goes down, obliquely crossing m. sternocleidomastoideus, to the top of the angle formed by the posterior edge of the sternocleidomastoid muscle and the upper edge of the clavicle.

Rice. 12.10.Arteries of the head and neck (from: Sinelnikov R.D., 1979): 1 - parietal branch; 2 - frontal branch; 3 - zygomatic-orbital artery; 4 - supraorbital artery; 5 - supratrochlear artery; 6 - ophthalmic artery; 7 - artery of the back of the nose; 8 - sphenoid palatine artery; 9 - angular artery; 10 - infraorbital artery; 11 - posterior superior alveolar artery;

12 - buccal artery; 13 - anterior superior alveolar artery; 14 - superior labial artery; 15 - pterygoid branches; 16 - artery of the back of the tongue; 17 - deep artery of the tongue; 18 - lower labial artery; 19 - chin artery; 20 - lower alveolar artery; 21 - hyoid artery; 22 - submental artery; 23 - ascending palatine artery; 24 - facial artery; 25 - external carotid artery; 26 - lingual artery; 27 - hyoid bone; 28 - suprahyoid branch; 29 - sublingual branch; 30 - superior laryngeal artery; 31 - superior thyroid artery; 32 - sternocleidomastoid branch; 33 - cricoid-thyroid branch; 34 - common carotid artery; 35 - lower thyroid artery; 36 - thyroid trunk; 37 - subclavian artery; 38 - brachiocephalic trunk; 39 - internal thoracic artery; 40 - aortic arch; 41 - costal-cervical trunk; 42 - suprascapular artery; 43 - deep artery of the neck; 44 - superficial branch; 45 - vertebral artery; 46 - ascending artery of the neck; 47 - spinal branches; 48 - internal carotid artery; 49 - ascending pharyngeal artery; 50 - posterior ear artery; 51 - awl-mastoid artery; 52 - maxillary artery; 53 - occipital artery; 54 - mastoid branch; 55 - transverse artery of the face; 56 - deep ear artery; 57 - occipital branch; 58 - anterior tympanic artery; 59 - masticatory artery; 60 - superficial temporal artery; 61 - anterior ear branch; 62 - middle temporal artery; 63 - middle meningeal artery artery; 64 - parietal branch; 65 - frontal branch

Here, the external jugular vein, piercing the second and third fascia of the neck, goes deep and flows into the subclavian or internal jugular vein.

The large ear nerve runs along with the external jugular vein posterior to it. It innervates the skin of the mandibular fossa and the angle of the mandible. The transverse nerve of the neck (n. transversus colli) crosses the middle of the outer surface of the sternocleidomastoid muscle and at its anterior edge is divided into the upper and lower branches.

The second fascia of the neck forms an isolated case for the sternocleidomastoid muscle. The muscle is innervated by the external branch of the accessory nerve (n. accessories). Inside the fascial case of the sternocleidomastoid muscle, along its posterior edge, the small occipital nerve (n. Occipitalis minor) rises up, innervating the skin of the mastoid region.

Behind the muscle and its fascial sheath is the carotid neurovascular bundle, surrounded by the parietal layer of the fourth fascia of the neck. Inside the bundle, the common carotid artery is located medially, the internal jugular vein - laterally, the vagus nerve - between them and behind.

Rice. 12.11.Veins of the neck (from: Sinelnikov R.D., 1979)

1 - parietal veins-graduates; 2 - superior sagittal sinus; 3 - cavernous sinus; 4 - supratrochlear vein; 5 - naso-frontal vein; 6 - superior ophthalmic vein; 7 - external vein of the nose; 8 - angular vein; 9 - pterygoid venous plexus; 10 - facial vein; 11 - superior labial vein; 12 - transverse vein of the face; 13 - pharyngeal vein; 14 - lingual vein; 15 - lower labial vein; 16 - mental vein; 17 - hyoid bone; 18 - internal jugular vein; 19 - superior thyroid vein; 20 - front

jugular vein; 21 - lower bulb of the internal jugular vein; 22 - inferior thyroid vein; 23 - right subclavian vein; 24 - left brachiocephalic vein; 25 - right brachiocephalic vein; 26 - internal thoracic vein; 27 - superior vena cava; 28 - suprascapular vein; 29 - transverse vein of the neck; 30 - vertebral vein; 31 - external jugular vein; 32 - deep vein of the neck; 33 - external vertebral plexus; 34 - retromandibular vein; 35 - occipital vein; 36 - mastoid venous graduate; 37 - posterior ear vein; 38 - occipital venous graduate; 39 - superior bulb of the internal jugular vein; 40 - sigmoid sinus; 41 - transverse sinus; 42 - occipital sinus; 43 - lower stony sinus; 44 - sinus drain; 45 - superior stony sinus; 46 - direct sine; 47 - a large vein of the brain; 48 - superficial temporal vein; 49 - lower sagittal sinus; 50 - crescent of the brain; 51 - diploic veins

The cervical sympathetic trunk (truncus sympathicus) is located parallel to the common carotid artery under the fifth fascia, but deeper and medial.

Branches of the cervical plexus (plexus cervicalis) emerge from under the sternocleidomastoid muscle. It is formed by the anterior branches of the first 4 cervical spinal nerves, lies on the side of the transverse processes of the vertebrae between the vertebral (back) and prevertebral (front) muscles. The branches of the plexus include:

Small occipital nerve (n. occipitalis minor), extends upward to the mastoid process and further into the lateral parts of the occipital region; innervates the skin of this area;

The large ear nerve (n.auricularis magnus) goes up and anteriorly along the anterior surface of the sternocleidomastoid muscle, covered by the second fascia of the neck; innervates the skin of the auricle and the skin above the parotid salivary gland;

The transverse nerve of the neck (n. transversus colli), goes anteriorly, crossing the sternocleidomastoid muscle, at its anterior edge it is divided into upper and lower branches that innervate the skin of the anterior region of the neck;

Supraclavicular nerves (nn. supraclaviculares), in the amount of 3-5, spread fan-shaped downwards between the first and second fascia of the neck, branch in the skin of the posterior lower part of the neck (lateral branches) and the upper anterior surface of the chest to the III rib (medial branches);

The phrenic nerve (n. phrenicus), predominantly motor, goes down the anterior scalene muscle into the chest cavity, where it passes to the diaphragm in front of the roots of the lungs between

mediastinal pleura and pericardium; innervates the diaphragm, gives off sensitive branches to the pleura and pericardium, sometimes to the cervicothoracic nerve plexus;

The lower root of the cervical loop (r.inferior ansae cervicalis) goes anteriorly to the connection with the upper root arising from the hypoglossal nerve;

Muscular branches (rr. musculares) go to the vertebral muscles, the muscle that lifts the scapula, the sternocleidomastoid and trapezius muscles.

Between the deep (back) surface lower half sternocleidomastoid muscle with its fascial case and the anterior scalene muscle, covered with the fifth fascia, a prescalene space (spatium antescalenum) is formed. Thus, the prescalene space is limited in front by the second and third fascia, and in the back by the fifth fascia of the neck. The carotid neurovascular bundle is located medially in this space. The internal jugular vein lies here not only lateral to the common carotid artery, but also somewhat anterior (more superficial). Here, its bulb (lower extension; bulbus venae jugularis inferior) connects to the subclavian vein that is suitable from the outside. The vein is separated from the subclavian artery by the anterior scalene muscle. Immediately outward from the confluence of these veins, called Pirogov's venous angle, the external jugular vein flows into the subclavian vein. On the left, the thoracic (lymphatic) duct flows into the venous angle. United v. jugularis intema and v. subclavia give rise to the brachiocephalic vein. The suprascapular artery (a. suprascapularis) also passes through the pre-scalene gap in the transverse direction. Here, on the anterior surface of the anterior scalene muscle, under the fifth fascia of the neck, the phrenic nerve passes.

Behind the anterior scalene muscle under the fifth fascia of the neck is the interstitial space (spatium interscalenum). The interscalene space behind is limited by the middle scalene muscle. In the interscalene space, the trunks of the brachial plexus pass from above and laterally, below - a. subclavia.

The stair-vertebral space (triangle) is located behind the lower third of the sternocleidomastoid muscle, under the fifth fascia of the neck. Its base is the dome of the pleura, the apex is the transverse process of the VI cervical vertebra. Posteriorly and medially it is limited by the spine

lump with the long muscle of the neck, and in front and laterally - by the medial edge of the anterior scalene muscle. Under the prevertebral fascia is the contents of the space: the beginning of the cervical subclavian artery with branches extending from it here, the arch of the thoracic (lymphatic) duct, ductus thoracicus (left), the lower and cervicothoracic (stellate) nodes of the sympathetic trunk.

Topography of vessels and nerves. The subclavian arteries are located under the fifth fascia. The right subclavian artery (a. subclavia dextra) departs from the brachiocephalic trunk, and the left (a. subclavia sinistra) - from the aortic arch.

The subclavian artery is conditionally divided into 4 sections:

Thoracic - from the place of discharge to the medial edge (m. scalenus anterior);

Interstitial, corresponding to the interstitial space (spatium interscalenum);

Supraclavicular - from the lateral edge of the anterior scalene muscle to the clavicle;

Subclavian - from the collarbone to the upper edge of the small chest muscle s. The last section of the artery is already called the axillary artery, and it is studied in the subclavian region in the clavicular-thoracic triangle (trigonum clavipectorale).

In the first section, the subclavian artery lies on the dome of the pleura and is connected with it by connective tissue cords. On the right side of the neck anterior to the artery is Pirogov's venous angle - the confluence of the subclavian vein and the internal jugular vein. On the anterior surface of the artery, the vagus nerve descends transversely to it, from which the recurrent laryngeal nerve departs here, enveloping the artery from below and behind and rising upward in the angle between the trachea and esophagus. Outside of the vagus nerve, the artery crosses the right phrenic nerve. Between the vagus and phrenic nerves is the subclavian loop of the sympathetic trunk (ansa subclavia). The right common carotid artery passes medially from the subclavian artery.

On the left side of the neck, the first section of the subclavian artery lies deeper and is covered by the common carotid artery. Anterior to the left subclavian artery is the internal jugular vein and the origin of the left brachiocephalic vein. Between these veins and the artery are the vagus and left phrenic nerves. Medial to the subclavian artery are the esophagus and trachea, and in the groove between them is the left

recurrent laryngeal nerve. Between the left subclavian and common carotid arteries, bending around the subclavian artery behind and above, the thoracic lymphatic duct passes.

Branches of the subclavian artery (Fig. 12.13). The vertebral artery (a. vertebralis) departs from the upper semicircle of the subclavian medially to the inner edge of the anterior scalene muscle. Rising upward between this muscle and the outer edge of the long muscle of the neck, it enters the opening of the transverse process of the VI cervical vertebra and further upwards in the bone canal formed by the transverse processes of the cervical vertebrae. Between the 1st and 2nd vertebrae, it exits the canal. Further, the vertebral artery enters the cranial cavity through the large

Rice. 12.13.Branches of the subclavian artery:

1 - internal thoracic artery; 2 - vertebral artery; 3 - thyroid trunk; 4 - ascending cervical artery; 5 - lower thyroid artery; 6 - lower laryngeal artery; 7 - suprascapular artery; 8 - costocervical trunk; 9 - deep cervical artery; 10 - the uppermost intercostal artery; 11 - transverse artery of the neck

hole. In the cranial cavity at the base of the brain, the right and left vertebral arteries merge into one basilar artery (a. basilaris), which is involved in the formation of the circle of Willis.

Internal thoracic artery, a. thoracica interna, is directed downward from the lower semicircle of the subclavian artery opposite the vertebral artery. Passing between the dome of the pleura and the subclavian vein, it descends to the posterior surface of the anterior chest wall.

The thyroid trunk (truncus thyrocervicalis) departs from the subclavian artery at the medial edge of the anterior scalene muscle and gives off 4 branches: the lower thyroid (a. thyroidea inferior), the ascending cervical (a. cervicalis ascendens), the suprascapular (a. suprascapularis) and the transverse artery of the neck ( a. transversa colli).

A. thyroidea inferior, rising upward, forms an arc at the level of the transverse process of the VI cervical vertebra, crossing the vertebral artery lying behind and the common carotid artery passing in front. From the lower medial part of the arch of the inferior thyroid artery, branches depart to all organs of the neck: rr. pharyngei, oesophagei, tracheales. In the walls of the organs and the thickness of the thyroid gland, these branches anastomose with the branches of other arteries of the neck and the branches of the opposite inferior and superior thyroid arteries.

A. cervicalis ascendens goes up the anterior surface of m. scalenus anterior, parallel to n. phrenicus, inside of it.

A. suprascapularis goes to the lateral side, then with the vein of the same name is located behind the upper edge of the clavicle and together with the lower abdomen m. omohyoideus reaches the transverse notch of the scapula.

A. transversa colli can originate from both the truncus thyrocervicalis and the subclavian artery. The deep branch of the transverse artery of the neck, or dorsal artery of the scapula, lies in the cellular space of the back at the medial edge of the scapula.

Costocervical trunk (truncus costocervicalis) most often departs from the subclavian artery. Having passed up the dome of the pleura, it is divided at the spine into two branches: the uppermost - the intercostal (a. intercostalis suprema), reaching the first and second intercostal spaces, and the deep cervical artery (a. cervicalis profunda), penetrating into the muscles of the back of the neck.

The cervicothoracic (stellate) node of the sympathetic trunk is located behind the internal

semicircle of the subclavian artery, the vertebral artery medially extending from it. It is formed in most cases from the connection of the lower cervical and first thoracic nodes. Passing to the wall of the vertebral artery, the branches of the stellate ganglion form the periarterial vertebral plexus.

12.7. LATERAL NECK

12.7.1. Scapular-trapezoid triangle

The scapular-trapezoid triangle (trigonum omotrapecoideum) is bounded from below by the scapular-hyoid muscle, in front by the posterior edge of the sternocleidomastoid muscle, and behind by the anterior edge of the trapezius muscle (Fig. 12.14).

Leatherthin and mobile. It is innervated by the lateral branches of the supraclavicular nerves (nn. supraclaviculares laterals) from the cervical plexus.

Subcutaneous adipose tissue loose.

The superficial fascia contains the fibers of the superficial muscle of the neck. Under the fascia are skin branches. The external jugular vein (v. jugularis externa), crossing from top to bottom and outwards the middle third of the sternocleidomastoid muscle, exits to the lateral surface of the neck.

The superficial sheet of the own fascia of the neck forms a vagina for the trapezius muscle. Between it and the deeper prevertebral fascia is an accessory nerve (n. accessorius), which innervates the sternocleidomastoid and trapezius muscles.

The brachial plexus (plexus brachialis) is formed by the anterior branches of the 4 lower cervical spinal nerves and the anterior branch of the first thoracic spinal nerve.

In the lateral triangle of the neck is the supraclavicular part of the plexus. It consists of three trunks: upper, middle and lower. The upper and middle trunks lie in the interstitial fissure above the subclavian artery, and the lower trunk lies behind it. Short branches of the plexus depart from the supraclavicular part:

The dorsal nerve of the scapula (n. dorsalis scapulae) innervates the muscle that lifts the scapula, the large and small rhomboid muscles;

Long thoracic nerve(n. thoracicus longus) innervates the serratus anterior;

The subclavian nerve (n. subclavius) innervates the subclavian muscle;

The subscapular nerve (n. subscapularis) innervates the large and small round muscles;

Rice. 12.14.Topography of the lateral triangle of the neck:

1 - Sternocleidomastoid muscle; 2 - trapezius muscle, 3 - subclavian muscle; 4 - anterior scalene muscle; 5 - middle scalene muscle; 6 - posterior scalene muscle; 7 - subclavian vein; 8 - internal jugular vein; 9 - thoracic lymphatic duct; 10 - subclavian artery; 11 - thyroid trunk; 12 - vertebral artery; 13 - ascending cervical artery; 14 - lower thyroid artery; 15 - suprascapular artery; 16 - superficial cervical artery; 17 - suprascapular artery; 18 - cervical plexus; 19 - phrenic nerve; 20 - brachial plexus; 19 - accessory nerve

Thoracic nerves, medial and lateral (nn. pectorales medialis et lateralis) innervate the large and small pectoral muscles;

The axillary nerve (n.axillaris) innervates the deltoid and small round muscles, capsule shoulder joint and skin of the outer surface of the shoulder.

12.7.2. Scapular-clavicular triangle

In the scapular-clavicular triangle (trigonum omoclavicularis), the lower border is the clavicle, the front is the posterior edge of the sternocleidomastoid muscle, the upper-posterior border is the projection line of the lower abdomen of the scapular-hyoid muscle.

Leatherthin, mobile, innervated by supraclavicular nerves from the cervical plexus.

Subcutaneous adipose tissue loose.

The superficial fascia of the neck contains fibers of the subcutaneous muscle of the neck.

The superficial sheet of the own fascia of the neck is attached to the anterior surface of the clavicle.

A deep sheet of the own fascia of the neck forms a fascial sheath for the scapular-hyoid muscle and is attached to the posterior surface of the clavicle.

Adipose tissue is located between the third fascia of the neck (in front) and the prevertebral fascia (rear). It spreads in the gap: between the 1st rib and the clavicle with the subclavian muscle adjacent from below, between the clavicle and sternocleidomastoid muscle in front and the anterior scalene muscle behind, between the anterior and middle scalene muscle.

The neurovascular bundle is represented by the subclavian vein (v. subclavia), which is located most superficially in the prescalene space. Here it merges with the internal jugular vein (v. jugularis interna), and also receives the anterior and external jugular and vertebral veins. The walls of the veins of this area are fused with the fascia, therefore, when injured, the vessels gape, which can lead to an air embolism with a deep breath.

The subclavian artery (a. subclavia) lies in the interstitial space. Behind it is the posterior bundle of the brachial plexus. The upper and middle bundles are located above the artery. The artery itself is divided into three sections: before entering the interscalene

space, in the interstitial space, at the exit from it to the edge of the 1st rib. Behind the artery and the lower bundle of the brachial plexus is the dome of the pleura. In the prescalene space, the phrenic nerve passes (see above), crossing the subclavian artery in front.

The thoracic duct (ductus thoracicus) flows into the venous jugular angles, formed by the confluence of the internal jugular and subclavian veins, and the right lymphatic duct (ductus lymphaticus dexter) flows to the right.

The thoracic duct, leaving the posterior mediastinum, forms an arc on the neck, rising to the VI cervical vertebra. The arc goes to the left and forward, is located between the left common carotid and subclavian arteries, then between the vertebral artery and the internal jugular vein and before flowing into the venous angle forms an extension - the lymphatic sinus (sinus lymphaticus). The duct can flow both into the venous angle and into the veins that form it. Sometimes, before confluence, the thoracic duct breaks into several smaller ducts.

The right lymphatic duct has a length of up to 1.5 cm and is formed from the confluence of the jugular, subclavian, internal thoracic and bronchomediastinal lymphatic trunks.

12.8. TESTS

12.1. The composition of the anterior region of the neck includes three paired triangles from the following:

1. Scapular-clavicular.

2. Shoulder-tracheal.

3. Scapular-trapezoid.

4. Submandibular.

5. Sleepy.

12.2. The composition of the lateral region of the neck includes two triangles from the following:

1. Scapular-clavicular.

2. Shoulder-tracheal.

3. Scapular-trapezoid.

4. Submandibular.

5. Sleepy.

12.3. The sternocleidomastoid region is located between:

1. Front and back of the neck.

2. Anterior and lateral region of the neck.

3. Lateral and back region of the neck.

12.4. The submandibular triangle is limited:

1. Top.

2. Front.

3. Back and bottom.

A. The posterior belly of the digastric muscle. B. The edge of the lower jaw.

B. Anterior belly of digastric muscle.

12.5. The sleepy triangle is limited:

1. Top.

2. Bottom.

3. Behind.

A. Upper abdomen of the scapular-hyoid muscle. B. The sternocleidomastoid muscle.

B. Posterior belly of the digastric muscle.

12.6. The scapular-tracheal triangle is limited:

1. Medially.

2. Above and laterally.

3. From below and laterally.

A. The sternocleidomastoid muscle.

B. The upper abdomen of the scapular-hyoid muscle.

B. Midline of the neck.

12.7. Determine the sequence of location from the surface to the depth of 5 fasciae of the neck:

1. Intracervical fascia.

2. Scapular-clavicular fascia.

3. Superficial fascia.

4. Prevertebral fascia.

5. Own fascia.

12.8. Within the submandibular triangle, there are two fascia of the following:

1. Superficial fascia.

2. Own fascia.

4. Intracervical fascia.

5. Prevertebral fascia.

12.9. Within the carotid triangle, there are 4 fascia of the following:

1. Superficial fascia.

2. Own fascia.

3. Scapular-clavicular fascia.

4. Parietal sheet of the intracervical fascia.

5. Visceral sheet of the intracervical fascia.

6. Prevertebral fascia.

12.10. Within the scapular-tracheal triangle, there are the following fasciae from those listed:

1. Superficial fascia.

2. Own fascia.

3. Scapular-clavicular fascia.

4. Intracervical fascia.

5. Prevertebral fascia.

12.11. Within the scapular-trapezoid triangle there are 3 fascia of the following:

1. Superficial fascia.

2. Own fascia.

3. Scapular-clavicular fascia.

4. Intracervical fascia.

5. Prevertebral fascia.

12.12. Within the scapular-clavicular triangle there are 4 fascia of the following:

1. Superficial fascia.

2. Own fascia.

3. Scapular-clavicular fascia.

4. Intracervical fascia.

5. Prevertebral fascia.

12.13. The submandibular salivary gland is located in the fascial bed formed by:

1. Superficial fascia.

2. Own fascia.

3. Scapular-clavicular fascia.

4. Intracervical fascia.

5. Prevertebral fascia.

12.14. In a patient with cancer of the lower lip, a metastasis was found in the submandibular salivary gland, which was the result of metastasis of cancer cells:

1. Through the excretory duct of the gland.

2. Along the tributaries of the facial vein, into which venous blood flows from both the lower lip and the gland.

3. Through the lymphatic vessels of the gland through the lymph nodes located near the gland.

4. Through the lymphatic vessels to the lymph nodes located in the substance of the gland.

12.15. When removing the submandibular salivary gland, a complication is possible in the form of severe bleeding due to damage to the artery adjacent to the gland:

1. Ascending pharyngeal.

2. Facial.

3. Submental.

4. Lingual.

12.16. The suprasternal interaponeurotic space is located between:

1. Superficial and own fasciae of the neck.

2. Own and scapular-clavicular fascia.

3. Scapular-clavicular and intracervical fascia.

4. Parietal and visceral sheets of the intracervical fascia.

12.17. In the fatty tissue of the suprasternal interaponeurotic space are located:

1. Left brachiocephalic vein.

2. External jugular vein.

4. Jugular venous arch.

12.18. Performing a lower tracheostomy, the surgeon, passing the suprasternal interaponeurotic space, must beware of damage to:

1. Arterial vessels.

2. Venous vessels.

3. Vagus nerve.

4. Phrenic nerve.

5. Esophagus.

12.19. The previsceral space is located between:

2. Scapular-clavicular and intracervical fascia.

4. Intracervical and prevertebral fascia.

12.20. The retrovisceral space is located between:

3. Prevertebral fascia and spine.

12.21. A seriously ill patient with purulent posterior mediastinitis as a complication of pharyngeal abscess was delivered to the hospital. Determine the anatomical pathway for the spread of purulent infection into the mediastinum:

1. Suprasternal interaponeurotic space.

2. Previsceral space.

3. Prevertebral space.

4. Retrovisceral space.

5. Vascular-nervous sheath.

12.22. The pretracheal space is located between:

1. Own and scapular-clavicular fascia.

2. The scapular-clavicular fascia and the parietal leaf of the intracervical fascia.

3. Parietal and visceral sheets of the intracervical fascia.

4. Intracervical and prevertebral fascia.

12.23. When performing a lower tracheostomy by median access after penetration into the pretracheal space, severe bleeding suddenly occurred. Identify the damaged artery:

1. Ascending cervical artery.

2. Inferior laryngeal artery.

3. Inferior thyroid artery.

4. Inferior thyroid artery.

12.24. In the pretracheal space there are two of the following formations:

1. Internal jugular veins.

2. Common carotid arteries.

3. Unpaired thyroid venous plexus.

4. Inferior thyroid arteries.

5. Inferior thyroid artery.

6. Anterior jugular veins.

12.25. Behind the larynx are adjacent:

1. Throat.

2. Share of the thyroid gland.

3. Parathyroid glands.

4. Esophagus.

5. Cervical spine.

12.26. On the side of the larynx are two anatomical formations of the following:

1. Sternohyoid muscle.

2. Sternothyroid muscle.

3. Share of the thyroid gland.

4. Parathyroid glands.

5. Isthmus of the thyroid gland.

6. Thyrohyoid muscle.

12.27. In front of the larynx there are 3 anatomical formations of the following:

1. Throat.

2. Sternohyoid muscle.

3. Sternothyroid muscle.

4. Share of the thyroid gland.

5. Parathyroid glands.

6. Isthmus of the thyroid gland.

7. Thyrohyoid muscle.

12.28. In relation to the cervical spine, the larynx is located at the level of:

12.29. The sympathetic trunk on the neck is located between:

1. Parietal and visceral sheets of the intracervical fascia.

2. Intracervical and prevertebral fascia.

3. Prevertebral fascia and long muscle of the neck.

12.30. The vagus nerve, being in the same fascial sheath with the common carotid artery and the internal jugular vein, is located in relation to these blood vessels:

1. Medial to the common carotid artery.

2. Lateral to the internal jugular vein.

3. Anteriorly between artery and vein.

4. Behind between artery and vein.

5. Anterior to the internal jugular vein.

12.31. The paired muscles located in front of the trachea include two of the following:

1. Sternocleidomastoid.

2. Sternohyoid.

3. Sternothyroid.

4. Scapular-hyoid.

5. Thyrohyoid.

12.32. The cervical part of the trachea contains:

1. 3-5 cartilage rings.

2. 4-6 cartilage rings.

3. 5-7 cartilage rings.

4. 6-8 cartilage rings.

5. 7-9 cartilaginous rings.

12.33. Within the neck, the esophagus is closely adjacent to the posterior wall of the trachea:

1. Strictly along the median line.

2. Speaking somewhat to the left.

3. Speaking somewhat to the right.

12.34. The parathyroid glands are located:

1. On the fascial sheath of the thyroid gland.

2. Between the fascial sheath and the capsule of the thyroid gland.

3. Under the capsule of the thyroid gland.

12.35. With subtotal resection of the thyroid gland, the part of the gland containing the parathyroid glands should be left. Such part are:

1. Upper pole of the lateral lobes.

2. The posterior part of the lateral lobes.

3. The posterior part of the lateral lobes.

4. Anterior part of the lateral lobes.

5. Anterolateral part of the lateral lobes.

6. Lower pole of the lateral lobes.

12.36. During a strumectomy operation performed under local anesthesia, when applying clamps to the blood vessels of the thyroid gland, the patient developed hoarseness due to:

1. Violations of the blood supply to the larynx.

2. Compression of the superior laryngeal nerve.

3. Compression of the recurrent laryngeal nerve.

12.37. In the main neurovascular bundle of the neck, the common carotid artery and the internal jugular vein are located relative to each other as follows:

1. The artery is more medial, the vein is more lateral.

2. The artery is more lateral, the vein is more medial.

3. Artery in front, vein in the back.

4. Artery behind, vein in front.

12.38. The victim has severe bleeding from the deep parts of the neck. In order to ligate the external carotid artery, the surgeon exposed in the carotid triangle the place of division of the common carotid artery into external and internal. Determine the main feature by which these arteries can be distinguished from each other:

1. The internal carotid artery is larger than the external one.

2. The beginning of the internal carotid artery is located deeper and outside the beginning of the external.

3. Lateral branches depart from the external carotid artery.

12.39. The anterior space is located between:

1. Sternocleidomastoid and anterior scalene muscle.

2. The long muscle of the neck and the anterior scalene muscle.

3. Anterior and middle scalenus.

12.40. In the preglacial period pass:

1. Subclavian artery.

2. Subclavian vein.

3. Brachial plexus.

4. Vertebral artery.

12.41. Directly behind the collarbone are:

1. Subclavian artery.

2. Subclavian vein.

3. Brachial plexus.

12.42. The interstitial space is located between:

1. Anterior and middle scalene muscles.

2. Middle and posterior scalene muscles.

3. Scalene muscles and spine.

12.43. In relation to the phrenic nerve, the following statements are correct:

1. It is located on the sternocleidomastoid muscle above its own fascia.

2. It is located on the sternocleidomastoid muscle under its own fascia.

3. It is located on the anterior scalene muscle over the prevertebral fascia.

4. Located on the anterior scalene muscle under the prevertebral fascia.

5. It is located on the middle scalene muscle over the prevertebral fascia.

6. It is located on the middle scalene muscle under the prevertebral fascia.

12.44. In the interstitial space pass:

1. Subclavian artery and vein.

2. Subclavian artery and brachial plexus.

The human neck is the part of the body that connects the head and body. Its upper border begins at the edge of the lower jaw. In the trunk, the neck passes through the jugular notch of the manubrium of the sternum and passes through the upper surface of the clavicle. Despite its relatively small size, there are many important structures and organs that are separated by connective tissue.

Form

If the anatomy of the neck is general view is the same for any person, then its shape may differ. Like any other organ or part of the body, it has its own individuality. This is due to the peculiarities of the constitution of the body, age, gender, hereditary characteristics. Cylindrical shape - standard view neck. In childhood and young age, the skin in this area is firm, elastic, tightly fits cartilage and other protrusions.

When tilting the head on the midline of the neck, the horns and body of the hyoid bone are clearly defined, the cartilages of the thyroid gland are cricoid, tracheal. Below the body, a fossa is visible - this is the jugular notch of the sternum. In people of medium and thin build, muscles are clearly visible on the sides of the neck. It is easy to notice and located near the skin.

Neck anatomy

This part of the body contains large vessels and nerves inside, it is made up of organs and bones that are important for human life. Developed muscular system allows you to make a variety of movements of the head. The internal structure of the neck consists of such departments as:

• pharynx - taking part in the oral speech of a person, which is the first barrier to pathogenic microorganisms, performs a connecting function for the digestive system;
• larynx - plays a significant role in the speech apparatus, protects the respiratory organs;
• trachea - a conductor of air to the lungs, an important component of the respiratory system;
• thyroid gland - an organ of the endocrine system that produces hormones for metabolic processes;
• esophagus - part of the digestive chain, pushes food to the stomach, protects against reflux in the opposite direction;
• the spinal cord is an element of the highest person, responsible for the mobility of the body and the activity of organs, reflexes.

In addition, nerves, large vessels and veins pass through the neck area. It consists of vertebrae and cartilage, connective tissue and fat layer. This is a part of the body that is an important connecting link "head - neck", thanks to which the spinal cord and brain are connected.

neck parts

Allocate the anterior and posterior regions of the neck, as well as many "triangles", which are limited to the lateral edges of the trapezius muscles. The front part looks like a triangle with the base turned upside down. It has limitations: from above - by the lower jaw, from below - by the jugular notch, on the sides - by the edges of the sternocleidomastoid muscle. The middle line divides this part into two medial triangles: right and left. The lingual triangle is also located here, through which access to the lingual artery can be opened. It is limited in front by the hyoid muscle, above by the hyoid nerve, behind and below by the tendon of the digastric muscle, next to which the carotid triangles are located.

The scapular-tracheal region is limited by the scapular-hyoid and sternocleidomastoid muscles. In the scapular-clavicular triangle, which is part of the paired lateral triangle, there is a jugular vein, suprascapular vein and artery, thoracic and lymphatic ducts. In the scapular-trapezoid part of the neck there is an accessory nerve and a cervical superficial artery, and a transverse artery passes through its medial part.

The region comprises the interscalene and prescalene spaces, within which both the suprascapular and phrenic nerves pass.

The posterior section is limited by the trapezius muscles. Here are the internal carotid artery and the jugular vein, as well as the vagus, hypoglossal, glossopharyngeal, accessory nerves.

Neck bones

It also consists of 33-34 vertebrae that pass through the entire body of a person and serve as a support for him. Inside is the spinal cord, which connects the periphery with the brain and provides higher reflex activity. The first section of the spine is just inside the neck, thanks to which it has high mobility.

The cervical region consists of 7 vertebrae, in some of them rudiments have been preserved, which are fused with the transverse processes. Their front part, which is the boundary of the hole, is a rudiment of the rib. The body of the cervical vertebra is transversely elongated, smaller than its counterparts and has a saddle shape. This provides the cervical region with the greatest mobility compared to other parts of the spinal column.

The openings of the vertebrae together form a canal that serves as protection for the vein. The passage of the spinal cord is formed by the arcs of the cervical vertebrae, it is quite wide and resembles a triangular shape. The spinous processes are bifurcated, due to which many muscle fibers are attached here.

Vertebra "Atlant"

The first two cervical vertebrae differ in structure from the other five. It is their presence that allows a person to make a variety of head movements: tilts, turns, rotations. The first vertebra is a ring of bone tissue. It consists of an anterior arch, on the convex part of which the anterior tubercle is located. On inside the glenoid fossa for the second odontoid process of the cervical vertebra is distinguished.

The atlas vertebra on the posterior arch has a small protruding part - the posterior tubercle. The superior articular processes on the arc replace the oval articular fossae. They are articulated with the condyles of the occipital bone. The lower articular processes are pits that connect to the next vertebra.

Axis

The second cervical vertebra - the axis, or epistrophy - is distinguished by a developed odontoid process located in the upper part of its body. On each side of the processes are articular surfaces of a slightly convex shape.

These two structurally specific vertebrae are the basis of neck mobility. In this case, the axis plays the role of the axis of rotation, and the atlas rotates together with the skull.

Muscles of the neck

Despite its relatively small size, the human neck is rich in muscles. different kind. The superficial, middle, lateral deep muscles, as well as the medial group, are concentrated here. Their main purpose in this area is to hold the head, provide conversational speech and swallow.

Surface and deep muscles neck

Name of the muscle	Location	Functions performed
long neck muscle	Anterior spine, extending from C1 to Th3	Allows flexion and extension of the head, antagonist of the back muscles
long head muscle	Originates on the tubercles of the transverse processes C2-C6 and inserts on the inferior basilar part of the occiput
Staircase (front, middle, back)	It starts at the transverse processes of the cervical vertebrae and is attached to the I-II rib	Involved in flexion of the cervical spine and raises the ribs when inhaling
sternohyoid	Comes from the sternum and attaches to the hyoid bone	Pulls the larynx and hyoid bone down
Scapular-hyoid	Scapula - hyoid bone
Sternothyroid	Attaches to the sternum and thyroid cartilage of the larynx
Thyrohyoid	Located in the region of the larynx to the hyoid bone
Geniohyoid	Begins on the lower jaw and ends at the attachment to the hyoid bone
Digastric	It originates at the mastoid process and attaches to the lower jaw	Pulls the larynx and hyoid bone up and forward, lowers the lower jaw while fixing the hyoid bone
Maxillofacial	Starts on the lower jaw and ends on the hyoid bone
stylohyoid	Located on the styloid process of the temporal bone and attaches to the hyoid bone
Subcutaneous cervical	It originates from the fascia of the deltoid and pectoralis major muscles and is attached to the fascia masseter muscle, edge of the lower jaw and facial muscles faces	Tightens the skin of the neck, prevents squeezing of the saphenous veins
Sternocleidomastoid	Attaches from the upper edge of the sternum and the sternal end of the clavicle to the mastoid process of the temporal bone	Its contraction on both sides is accompanied by pulling the head back, unilateral - by turning the head in the opposite direction.

Muscles allow you to hold your head, make movements, reproduce speech, swallow and breathe. Their development prevents cervical osteochondrosis and improves blood flow to the brain.

Fascia of the neck

Due to the variety of organs passing through this area, the anatomy of the neck suggests the presence of a connective sheath that limits and protects organs, vessels, nerves and bones. This is an element of the "soft" skeleton that performs trophic and support functions. Fascia grow together with numerous veins of the neck, thereby preventing them from intertwining with each other, which would threaten a person with a violation of the venous outflow.

Their structure is so complex that the anatomy is described in different ways by the authors. Consider one of the generally accepted classifications, according to which the connecting sheaths are divided into fascia:

1. Superficial - a loose, thin structure that limits the subcutaneous muscle of the neck. It passes from the neck to the face and chest.
2. Own - attached from below to the front of the sternum and collarbone, and from above to the temporal bone and lower jaw, then goes to the face. On the back of the neck, it connects to the spinous processes of the vertebrae.
3. Aponeurosis scapular-clavicular - looks like a trapezoid and is located between the sides of the scapular-hyoid muscle and the hyoid bone, and from below divides the space between the surface of the sternum from the inside and two collarbones. It covers the anterior part of the larynx, thyroid gland and trachea. Along the midline of the neck, the scapular-clavicular aponeurosis fuses with its own fascia, forming a white line.
4. Intracervical - envelops all the internal organs of the neck, while it consists of two parts: visceral and parietal. The first closes each organ separately, and the second together.
5. Prevertebral - provides cover for the long muscles of the head and neck and merges with the aponeurosis.

Fascia separate and protect all parts of the neck, thereby preventing the "confusion" of blood vessels, nerve endings and muscles.

blood flow

The vessels of the neck provide the outflow of venous blood from the head and neck. They are represented by the external and internal jugular vein. Blood in the external vessel comes from the back of the head in the ear area, the skin over the shoulder blade and the front of the neck. A little earlier than the clavicle, it connects to the subclavian and internal jugular veins. The latter eventually develops into the former at the base of the neck and divides into two brachiocephalic veins: the right and left.

The vessels of the neck, and especially the internal jugular vein, play an important role in the processes of hematopoiesis. It originates at the base of the skull and serves to drain blood from all vessels of the brain. Its tributaries in the neck are also: superior thyroid, lingual facial, superficial temporal, occipital vein. The carotid artery passes through the neck region, which has no branches in this area.

Nerve plexus of the neck

The nerves of the neck make up diaphragmatic, skin and muscle structures, which are located at the level of the first four cervical vertebrae. They form plexuses that originate from the cervical spinal nerves. Muscular innervates nearby muscles. The neck and shoulders are set in motion with the help of impulses. The phrenic nerve influences the movements of the diaphragm, pericardial fibers, and pleura. The cutaneous branches give rise to the auricular, occipital, transverse, and supraclavicular nerves.

The lymph nodes

The anatomy of the neck also includes part of the body's lymphatic system. In this area, it is made up of deep and superficial nodes. The anterior ones are located near the jugular vein on the superficial fascia. The deep lymph nodes of the anterior part of the neck are located near the organs from which the outflow of lymph comes, and have the same name with them (thyroid, preglottal, etc.). The lateral group of nodes is pharyngeal, jugular and supraclavicular, next to which is the internal jugular vein. In the deep lymph nodes of the neck, lymph is drained from the mouth, middle ear and pharynx, as well as the nasal cavity. In this case, the fluid first passes through the occipital nodes.

The structure of the neck is complex and thought out to every millimeter by nature. The totality of plexuses of nerves and blood vessels connects the work of the brain and the periphery. In one small part of the human body, all possible elements of systems and organs are located at once: nerves, muscles, blood vessels, lymphatic ducts and nodes, glands, spinal cord, the most “mobile” section of the spine.

Low bow, comrades-in-arms! Today we are waiting for another Nudnyakovskaya note. On the agenda is the anatomy of the neck muscles. We will thoroughly analyze the structure of this muscle group and find out what exercises it is most effective to work out.

So, take your seats, I give the third call, let's go.

Anatomy of the neck muscles: what, why and why?

Well, let's start with the fact that the neck muscles are the most “loading” muscle group, and it is she who is given the least time in training process. And really, remember when was the last time you deliberately shook your neck? Do not remember ... the same thing. In general, if you go to any fitness club and ask the question: do you do neck exercises, you can catch a very impartial look, which means - are you completely crazy, don’t pump it :).

However, it is worth working out the neck (and not only for guys, but also for girls), and that's why:

• rule ideal proportions reads: neck volume = biceps volume = lower leg volume. So if you have biceps 40 cm, and it corresponds to a chicken neck in 30 see, it looks extremely undignified;
• a powerful neck reduces the chances of the enemy to take you by surprise with various grabs and chokes. In addition, it will be very problematic to pinch you from behind if you are the owner of an impressive neck thickness;
• a strong neck can reduce the risk of day-to-day pain and stiffness. Often in the morning a person wakes up with pain in the neck;
• a strong neck will help avoid mild and reduce the effects of severe concussions;
• a strong neck can reduce the risk of neck injury under a variety of circumstances (shocks, falls, etc.);
• a strong neck in a man looks brutal, it is synonymous with power and commands respect;
• a beautiful neck looks advantageous with open dresses, and for some men it is one of the most “turning on” parts of the body.

In my opinion, an impressive list of pros, worthy of highlighting a few exercises, is for the muscle group.

Note:

It is important to understand that the body is a kinetic chain and one weak link will compromise the entire body.

Neck Muscle Anatomy: A Detailed Atlas

The main function of the neck muscles is to move the head, they also contribute to maintaining blood flow to the brain and keeping the head upright.

At the neck it is customary to distinguish:

• muscles of the anterior part (anterior);
• muscles that move the head
• muscles of the back (posterior).

According to the degree of occurrence, the muscles of the neck are divided into:

• deep location;
• superficial.

Let's take a closer look at each type of muscle, and start by looking at ...

No. 1. Muscles of the front of the neck

Helps in swallowing and speech by controlling the position of the larynx and hyoid bone. The muscles of the neck are divided according to their position in relation to the hyoid bone. Muscles Suprahyoid - upper, infrahyoid - lower muscles larynx. The chewing muscles are responsible for the body's ability to close the mouth, bite and chew food.

We will not delve into the anatomical functions of each of the muscles, otherwise we will fall asleep on the spot, we will simply note for ourselves which muscles of the front of the neck are and what they are responsible for.

No. 2. Muscles that move the head

The head is attached to the top of the spinal column (although looking at some personalities, you understand that this is not always the case, because they think in the opposite place :)), it is balanced, moved and rotated by the muscles of the neck. When these muscles act unilaterally, the head turns; when bilaterally, it flexes / extends. The muscles that provide lateral (lateral) tilt and rotation of the head are nodding muscles. In addition, both muscles, working together, are head flexors. Place your fingers on both sides of your neck and turn your head left and right. You will feel the movement of these muscles. These muscles, when viewed from the side, divide the neck into anterior and posterior triangles.

The superficial and deep muscles of the neck are responsible for the movements of the head, cervical vertebrae and shoulder blades.

No. 3. Muscles of the back of the neck and back

back muscles the necks are connected primarily with the retraction of the head. The muscles of the back provide stabilization and movement of the spinal column, they are grouped according to the length and direction of the bundles.

Anatomy of the neck muscles: how to train it correctly

We all know that the greatest increase muscle mass give basic exercises in general and multi-joint for a specific muscle group, in particular. So, the neck muscles are an exception, they must be trained directly, resorting to special exercises.

A study published in The European Journal of Applied Physiology and Occupational Physiolog found that subjects who purposefully exercised their neck at least 1 once a week, increased its cross-sectional area by 13% and strength to 34% (behind 12 weeks) in comparison with the subjects who trained her with non-core exercises of a general nature.

From a training point of view, the neck has 4 main functions:

1. flexion - tilting the head forward, bringing the chin closer to the chest;
2. extension - movement of the head up;
3. lateral tilt - bringing the ear to the shoulder;
4. turn - moving the head from side to side.

No. 1. Flexion (neck flexion)

The flexor muscles work when a weight is placed on the forehead, and the head leans forward, overcoming the resistance. In other words, it is necessary to perform a movement against resistance. (for example, a belt or a hand).

No. 2. Extension (neck extension)

Movement of the chin action in the direction away from the chest. One of the best exercises is to overcome the resistance of the tourniquet, when the partner pulls it towards you, and you are stubborn like a ram.

No. 3. Lateral flexion (neck lateral flexion)

Head tilt to the side. Movement consists in overcoming lateral resistance with the head (away from resistance towards your shoulder).

No. 4. Rotation

The movement consists in turning the head to the side. Turn your head to the side, trying to look over your shoulder. Do this in both directions. Use hands/bands to overcome resistance.

We examined the so-called home exercises, in the hall the best exercises for the development of strength and thickness of the neck muscles can be called:

1. extension of the neck with weight with weights from a position hanging down lying down;
2. neck extension with a special bandage with weights (“head clamp”).
3. neck flexion with weights lying on a bench;
4. lateral head lifts.

Olympia champions of the golden era of bodybuilding believed that the neck cannot be pumped up with direct exercises, classic power movements are needed like - bench press / lying, deadlift and different kinds traction, army press, squats with limit weights. For regular visitors gyms these calculations will not work, because absent main component- critical weights, so it is better to use isolation exercises and, as you train, progress in the working weights of multi-joint exercises.

Well, actually, that's all according to theory, now let's summarize all this information and draw the appropriate conclusions.

FAQ on neck muscles

• neck muscles must be kneaded at each workout - this will help saturate the brain with blood;
• neck warm-up should proceed in a calm mode without sudden movements;
• try, whenever possible, to load the muscles of the neck in exercises, for example, when performing a pullover lying down, you can not put your head on the bench, but rather hang it and hold it statically;
• most neck pain/tightness can be relieved by applying heat/ice, light stretching and massage;
• if you want to become the owner of a massive scruff, then train it in isolation at least 1 once a 2 weeks.

Afterword

Today we got acquainted with what constitutes the anatomy of the muscles of the neck. Now you know what and how it is arranged, which means that the swing process will proceed much faster and better.

Like this, in this spirit, in this section, until we meet again!

PS. Friends, do you shake your neck or, like many people, don't care about it?

P.P.S. Did the project help? Then leave a link to it in the status of your social network - plus 100 points to karma, guaranteed.

With respect and gratitude, Dmitry Protasov.