Head & Neck Surgery Course

Surgical anatomy of the

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neck: muscles
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w Dr Pierfrancesco PELLICCIA
Pr Benjamin LALLEMANT
Service ORL et CMF
CHU de Nîmes
CH de Arles
Summary (anterior & lateral view)

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 Platysma
Origin

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– fascia overlying the pectoralis

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major and deltoid

Insertion
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– depression muscles of the corner of the mouth

– the mandible

– the SMAS layer of the face

 Platysma

Surgical considerations
– Increases blood supply to

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skin flaps

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– Absent in the midline of
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– Fibers run in an opposite
direction to the SCM
 Sternocleidomastoid Muscle (SCM)
Origin
• Medial 1/3 of the clavicle
• manubrium

Insertion
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• mastoid process

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Nerve supply
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• spinal accessory nerve (XI)

Blood supply
• occipital a. or direct from ECA
• superior thyroid a.
• transverse cervical a.
 Sternocleidomastoid Muscle (SCM)

Function
– turns head toward opposite

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side and tilts head toward
the ipsilateral shoulder
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Surgical considerations
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– Leave overlying fascia
(superficial layer of deep
cervical fascia down)
– Lateral retraction exposes
the submuscular recess
 Trapezius
Origin
– medial 1/3 of the sup. Nuchal
line
– external occipital protuberance
– ligamentum nuchae

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– spinous process of C7+T1-T12

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Insertion

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• lateral 1/3 of the clavicle
• acromion process
• spine of the scapula

Function
• elevate and rotate the scapula and
stabilize the shoulder
 Trapezius

Surgical considerations

– Posterior limit of Level V neck

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dissection

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– Denervation results in shoulder
drop and winged scapula
Infrahyoid muscles

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 Omohyoid
Origin
– upper border of the scapula

Insertion
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– hyoid bone lateral to the

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sternohyoid muscle

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Blood supply
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– Inferior thyroid a.

Function
– depress the hyoid
– tense the deep cervical fascia
 Omohyoid
Surgical considerations
– Absent in 10% of individuals

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– Surgical landmark demarcating level III from IV

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– Inferior belly lies superficial to

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• The brachial plexus
• Phrenic nerve
• Transverse cervical vessels

– Superior belly lies superficial to

• IJV
Suprahyoid muscles

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Suprahyioid muscles and extrinsic tongue
muscles in Level I

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 Digastric

Origin
– digastric fossa of the mandible (at
the symphyseal border)

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Insertion

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– hyoid bone via the intermediate

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tendon

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– mastoid process

Function
– elevate the hyoid bone
– depress the mandible (assists lateral
pterygoid)
 Digastric
Surgical considerations

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– Posterior belly is superficial to:
• ECA
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• ICA
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• IJV

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• Hypoglossal & spinal nerves

– Anterior belly w
• Landmark for identification of
mylohyoid for dissection of level Ib
Muscles of the floor of posterior
triangle of the neck

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 Muscles of the floor of posterior
triangle of the neck

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1: SCM 1: splenius capitis

4: splenius cervicis 2: splenius cervicis (SCM resected)
5: levator scapulae