~ 24 ~

Musculoskeletal system for National License I by Med 38 KKU

Structure

Surface anatomy of neck lower mandible Jugular notch

C3

C4

C5

C6

~ 25 ~

Musculoskeletal system for National License I by Med 38 KKU

Laryngeal prominence surface landmark quadrilateral laminae thyroid cartilage midline Tracheal ring trachea Hyoid bone - body of C3 Thyroid cartilage body of C4-5Cricoid cartilage body C6Isthmus of thyroid tracheal ring 2

C6

- Junction larynx Trachea - Junction Pharynx Esophagus - Inferior Thyroid artery Common Carotid artery Thyroid - Middle Cervical sympathetic ganglion inf thyroid a.(Thyrocervical trunk)

Vertebral a. Foramen Transversarium - Recurrent laryngeal nerve Larynx - Landmark Tracheostomy

Superficial Nerve

cutaneous nerves(plexus) 4 Sternocleidomastoid m. 1. Lesser occipital n., 2. Great auricular n., 3. Transverse cervical n. 4. Supraclavicular n.

C2

C7

Vertebral prominens

~ 26 ~

Musculoskeletal system for National License I by Med 38 KKU

Superficial Vein

-Exernal Jugular vein Sternocleidomastoid m. Drain Posterior Auricular v. Retromandibular v.( facial v.) -Anterior Jugular v. External Jugular v. Transcervical v. Suprascapular v. External Jugular v. -jugular vein engorgement External Jugular v. obstruction right atrium congestive heart failure

Superficial Lymph nodes Superficial lymph nodes drain deep lymph nodes Submental node drain Submandibular node drain Ant. Jugular node ant. Jugular v. Ext. Jugular node ext. jugular v.

Lymph node

Post auricular v.

External jugular v.

Retromandibular v.

Ant jugular v.

external jugular v.

~ 27 ~

Musculoskeletal system for National License I by Med 38 KKU

Triangle of Neck

-Submental triangle

-Submandibular (Digastric) triangle landmark submandibular duct facial a.

-Muscular triangle landmark thyroidectomy and tracheostomy ()

-Carotid triangle common carotid a. internal jugular v. landmark carotid angiography

hyoid bone

Anterior cervical triangle

~ 28 ~

Musculoskeletal system for National License I by Med 38 KKU

Posterior clavicular triangle

-Omoclavicular triangle(Supraclavicular triangle) Subclavian a

Fascia of neck

-occipital triangle cutaneous nerve 4 nerve 11

-Superficial fascia (skin,fat)

-Deep fascia 5

~ 29 ~

Musculoskeletal system for National License I by Med 38 KKU

1. Investing layer Superficial deep cervical fascia

2. Prevertebral fascia Musculoskeleton compartment

3. Cervical visceral fascia pretracheal fascia buccopharyngeal fascia visceralcompartment

4. Carotid sheath Carotid a.,Vagus n.,Internal jugular v.,ansa celvicalis

5. Alar fascia Buccopharyngeal fascia Prevertebral fascia retropharyngeal space 2 Buccopharyngeal fascia True retropharygeal space Prevertebral

fascia Danger sapce

~ 30 ~

Musculoskeletal system for National License I by Med 38 KKU

Vagus N.

Vagus n.

Vagus n. Ganglion 2 Superior ganglion inferior ganglion

Superior Laryngeal n. inf ganglion 2

internal laryngeal nerve sensory supply & vocal cord

-external laryngeal nerve superior thyroid a. inferior constrictor m. motor supply cricothyroid pitched sound(Monotonus voice)

** Recurrent laryngeal n. Horseness voice 2

*** Cricothyroid Ext laryngeal n (intrinsic) Recurrnet laryngeal n.

~ 31 ~

Musculoskeletal system for National License I by Med 38 KKU

Recurrent (inferior) laryngeal nerve

-motor n. intrincsic m. cricothyroid m.external laryngeal n. -sensory n. supply vocal cord trachea - vagus n. arch aorta - vagus nerve subclavian a.

(Tracheosopharygeal groove)Internal Jugular v.

Sigmoid sinus carotid sheath

Common carotid a.

Rt. brachiocephalic trunk

sternoclavicular joint

Lt. arch of aorta superior mediastinum

Bifurcation Thyroid cartilage

Carotid sinus

Baroreceptor bifurcation

Carotid body Bifurcation common carotid a. chemoreceptive cell pH

~ 32 ~

Musculoskeletal system for National License I by Med 38 KKU

Lymph Node Deep cervical Lymph nodes

internal jugular v. superior belly of omohyoid m. Superior Inferior

1. Jugulo-digastric node posterior belly digastric palatine submandibular retro-auricular superficial cervical lymph node

2. Juguloomohyoid node intermediate tendon omohyoid

deep cervical lymph node jugular lymph trunk thoracic duct right lymphatic duct

Inferior deep cervical nodes superior deep cervical nodes superior belly omohyoid supraclavicular middle third ** thoracic duct Virchow's node Signal node Sentinel node virchow's node [Gastric Cancer]

Superior deep cervical lymph node

~ 33 ~

Musculoskeletal system for National License I by Med 38 KKU

Cervical plexus

Anterior rami C1-4

1. Cutaneous n. - lesser occipital n. - great auricular n. - transverse cervical - supraclavicular 2. Muscular branches3.Ansa Cervicalis C1-3 infrahyoid m. Thyrohyoid m.

-superior root C1

-inferior root C2-3

~ 34 ~

Musculoskeletal system for National License I by Med 38 KKU

4.Phrenic n. C3-5 . Cervical sympathetic trunk and ganglion - inf . cervical ganglion T1 >> Stellate ganglion Lesion Cervical Sympathetic trunk Horner syndrome

Miosis Ptosis Enophthalmos Anhydrosis

Scalenus anterior

NL MS by MED38KKU 26NL MS by MED38KKU 27NL MS by MED38KKU 28NL MS by MED38KKU 29NL MS by MED38KKU 30NL MS by MED38KKU 31NL MS by MED38KKU 32NL MS by MED38KKU 33NL MS by MED38KKU 34NL MS by MED38KKU 35NL MS by MED38KKU 36