MRCS Part –A Course

TOPIC

Head-Neck Anatomy
HEAD & NECK ANATOMY: Topic List
SL. No. Topic Name
1. Triangles of neck
2 Carotid sheath
3 Subclavian artery
4 Carotid vessels
5 Trigeminal nerve
6 Facial nerve
7 Foramina of skull
8 lacrimal apparatus
9 Tongue
10 Salivary glands
11 Tonsils
12 Larynx
13 Vagus Nerve
14 External ear
15 Middle ear cavity
16 Cervical Lymph nodes
17 Thyroid gland
18 Parathyroid glands
19 Cervical Plexus
20 Pharyngeal arch & pouches
Triangles of Neck
Anterior Triangle
• Boundaries: Is bounded by the anterior
border of the sternocleidomastoid, the
anterior midline of the neck, and the
inferior border of the mandible. Has a
roof formed by the platysma and the
investing layer of the deep cervical
fascia.
• Subdivision: Is further divided by the
omohyoid anterior belly and the
digastric anterior and posterior bellies
into the digastric (submandibular),
submental (suprahyoid), carotid, and
muscular (inferior carotid) triangles.
• Contents:
• Submental triangle: Submental lymph
node, commencement of anterior
jugular vein
• Submandibular / Digastric triangle:
Submandibular gland, submandibular
LN, facial vein & artery, Mylohoid
vessels & nerve, part of hypoglossal
nerve
• Carotid triangle: Carotid sheath
contents
• Muscular triangle: Muscles; beneath
its floor lies thyroid, larynx, trachea &
esophagus
 Posterior Triangle

• Boundaries: bounded by the posterior • Contents: Contains the accessory

border of the sternocleidomastoid nerve, cutaneous branches of the
muscle, the anterior border of the cervical plexus, external jugular vein,
trapezius muscle, and the superior transverse cervical and suprascapular
border of the clavicle. vessels, subclavian vein (occasionally)
and artery, posterior (inferior) belly of
the omohyoid, and roots and trunks of
• Has a roof formed by the platysma and the brachial plexus
the investing (superficial) layer of the
deep cervical fascia.
• Has a floor formed by the splenius
capitis and levator scapulae muscles and
the anterior, middle, and posterior
scalene muscles.
4 main layers of deep cervical
fascia
1. Investing layer
2. Prevertebral layer
3. Pre tracheal layer
4. Carotid sheath
Carotid Sheath
Subclavian artery
• Is a branch of the brachiocephalic trunk
on the right but arises directly from the
arch of the aorta on the left.

• Is divided into three parts by the

anterior scalene muscle: the first part
passes from the origin of the vessel to
the medial margin of the anterior
scalene; the second part lies behind this
muscle; and the third part passes from
the lateral margin of the muscle to the
outer border of the first rib.
Subclavian Artery: Branches

•VITamin • Vertebral Artery

• Internal Thoracic Artery
• 3.Thyrocervical Trunk
-Inferior Thyroid Artery
•C -Transverse Cervical Artery
• 4.Costocervical Trunk
•D - Deep Cervical artery
- Superior Intercostal artery
• 5.Dorsal (Descending) Scapular Artery
 ECA
 Extends from the level of
the upper border of the
thyroid cartilage at C 4
vertebral level to the neck
of the mandible
 Ends in the parotid gland
by dividing into the
maxillary and superficial
temporal arteries.
 Supplies neck structures
External Carotid artery:Branches
Facial artery
• The facial artery arises from the external carotid artery .
• Having arched upward and over the submandibular salivary gland, it
curves around the inferior margin of the body of the mandible at the
anterior border of the masseter muscle.
• It is here that the pulse can be easily felt
• It runs upward in a tortuous course toward the angle of the mouth and is
covered by the platysma and the risorius muscles.
• It then ascends deep to the zygomaticus muscles and the levator labii
superioris muscle and runs along the side of the nose to the medial angle
of the eye, where it anastomoses with the terminal branches of the
ophthalmic artery
Facial artery
Trigeminal Nerve
Facial Nerve
Facial Nerve Innervation:
• 1.sensory: small area over concha of auricle , taste
sensation from anterior 2/3rd of tongue

• 2.motor: muscle of facial expression, posterior belly of

digastric, stylohyoid , stapedius, posterior auricular
branch to muscles of auricle & occipitalis muscle

• 3. Parasympathetic: submandibular, sublingual,

lacrimal, nasal platine gland.
 7. MUSCLES OF MASTICATION
Muscle Nerve supply Action on mandible
Temporalis Trigeminal Elevates , retracts
Masseter Trigeminal Elevates ( superficial part),Retracts ( deep part)
Lateral pterigoid Trigeminal Depresses, protracts
Medial pterigoid Trigeminal Elevates, protracts
FORAMINA OF SKULL
• Anterior Cranial Fossa
• Cribriform plate: Olfactory nerves.
• Foramen cecum : Occasional small emissary vein from nasal mucosa to superior sagittal sinus.
• Anterior and posterior ethmoidal foramina: Anterior and posterior ethmoidal nerves, arteries, and veins.

• Middle Cranial Fossa

• Optic canal: Optic nerve, ophthalmic artery, and central artery and vein of the retina.
• Superior orbital fissure: Oculomotor, trochlear, and abducens nerves; ophthalmic division of trigeminal nerve; and
ophthalmic veins.
• Foramen rotundum: Maxillary division of trigeminal nerve.
• Foramen ovale: Mandibular division of trigeminal nerve, accessory meningeal artery, and occasionally lesser petrosal
nerve.
• Foramen spinosum: Middle meningeal artery.
• Foramen lacerum: Nothing passes through this foramen, but the upper part is traversed by the internal carotid
artery and greater and deep petrosal nerves en route to the pterygoid canal.
• Carotid canal: Internal carotid artery and sympathetic nerves (carotid plexus).
• Hiatus of facial canal: Greater petrosal nerve.
Posterior Cranial Fossa
• Internal auditory meatus: Facial and vestibulocochlear nerves and
labyrinthine artery.
• Jugular foramen: Glossopharyngeal, vagus, and spinal accessory nerves and
beginning of internal jugular vein.
• Hypoglossal canal: Hypoglossal nerve and meningeal artery.
• Foramen magnum: Spinal cord, spinal accessory nerve, vertebral arteries,
venous plexus of vertebral canal, and anterior and posterior spinal arteries.
• Condyloid foramen: Condyloid emissary vein.
• Mastoid foramen: Branch of occipital artery to dura mater and mastoid
emissary vein.
Foramina in the Front of the Skull
• Zygomaticofacial foramen: Zygomaticofacial nerve
• Supraorbital notch or foramen: Supraorbital nerve and vessels.
• Infraorbital foramen: Infraorbital nerve and vessels.
• Mental foramen: Mental nerve and vessels.
• Foramina in the Base of the Skull
• Petrotympanic fissure: Chorda tympani and often anterior tympanic artery.
• Stylomastoid foramen: Facial nerve.
• Incisive canal: Nasopalatine nerve and terminal part of the sphenopalatine or greater palatine
vessels.
• Greater palatine foramen: Greater palatine nerve and vessels.
• Lesser palatine foramen: Lesser palatine nerve and vessels.
• Palatine canal Descending palatine vessels and the greater and lesser palatine nerves.
• Pterygoid canal: Runs from the anterior wall of the foramen lacerum to the pterygopalatine
fossa and transmits the nerve of the pterygoid canal (vidian nerve).
• Sphenopalatine foramen: Sphenopalatine vessels and nasopalatine nerve
Muscles of the Tongue:two types: intrinsic and
extrinsic.
• Intrinsic Muscles These muscles
are confined to the tongue and
are not attached to bone. They
consist of longitudinal,
transverse, and vertical fibers.
• Nerve supply: Hypoglossal nerve
• Action: Alter the shape of the
tongue
• Extrinsic Muscles These muscles
are attached to bones and the
soft palate
• They are the genioglossus, the
hyoglossus, the styloglossus, and
the palatoglossus
• Nerve supply: Hypoglossal nerve
Sensory Innervation

• The anterior two-thirds of the tongue receives general sensory

innervation from the lingual nerve and taste sensation from the
chorda tympani.
• The posterior one-third of the tongue and the vallate papillae receive
both general and taste innervation from the glossopharyngeal nerve.
• The epiglottic region of the tongue and the epiglottis receive both
general and taste innervation from the internal laryngeal branch of
the vagus nerve.
Anatomy of salivary glands
• Two parotid glands
• Two submandibular
glands
• Two sublingual glands
• Approximately ~800
minor salivary glands
 PAROTID GLAND
• Is the largest of the three glands and occupies the retromandibular space between
the ramus of the mandible in front and the mastoid process and the
sternocleidomastoid muscle behind.
• Invested with a dense fibrous capsule, the parotid sheath, derived from the
investing layer of the deep cervical fascia.
• Is separated from the submandibular gland by a facial extension and the
stylomandibular ligament, which extends from the styloid process to the angle of
the mandible. (Therefore, pus does not readily exchange between these two
glands.)
• Blood supply : Branches from the external carotid artery supply the gland.
• Venous return is to the retromandibular vein.
• Lymph drainage : Lymph drains to the preauricular (parotid) nodes and thence to
nodes of the upper group of deep cervical nodes.
• Nerve supply: Secretomotor fibres of the glossopharyngeal nerve arise from cell
bodies in the otic ganglion and reach the gland by ‘hitch-hiking’ along the
auriculotemporal nerve.
• Several important structures run through
the parotid gland. These include:
• the facial nerve trunk that divides into its
major five branches;
• the terminal branch of the external
carotid artery that divides into the
maxillary artery and the superficial
temporal artery;
• the retromandibular vein;
• intraparotid lymph nodes.
Complications of parotid gland surgery include:
• haematoma formation; infection;
• deformity: unsightly scar and
retromandibular hollowing;
• temporary facial nerve weakness;
• transection of the facial nerve and
permanent facial weakness;
• sialocele;
• facial numbness;
• permanent numbness of the ear lobe
associated with great auricular nerve
transection;
• Frey’s syndrome.
Parotid Duct • The parotid duct (of Stensen), about 5
cm long, passes forwards across the
masseter and turns around its anterior
border to pass through the buccal fat
pad and pierce the buccinator
• It lies on the middle third of a line
between the intertragic notch of the
auricle and the midpoint of the philtrum
(the vertical midline groove between the
nasal septum and the upper lip) and is
palpable on the clenched masseter
muscle.
• The duct opens on the mucous
membrane of the cheek opposite the
second upper molar tooth
 THE SUBMANDIBULAR GLANDS
• The submandibular glands are paired salivary glands that lie below the mandible on either
side.
• They consist of a larger superficial and a smaller deep lobe that are continuous around the
posterior border of the mylohyoid muscle.
• Important anatomical relations include the anterior facial vein and artery running over the
surface of the gland in close association with the ramus mandibularis (marginal
mandibular) of the facial nerve.
• The deep part of the gland lies on the hyoglossus muscle closely related to the lingual
nerve and inferior to the hypoglossal nerve
• The gland is drained by a single submandibular duct (Wharton’s duct) that emerges from its
deep surface drains into the anterior floor of the mouth at the sublingual papilla.
• There are several lymph nodes immediately adjacent and sometimes within the superficial
part of the gland
INCISION AND EXPOSURE OF GLAND
The incision should be marked at least 3–4 cm below the lower border of the
mandible to avoid damage to the marginal mandibular branch of the facial nerve.
The incision should be sited within thenearest skin crease and should be
approximately 4 cm long.
Ranula
 TONSILS
Are masses of lymphoid tissue located in the posterior wall of the pharynx (throat), trap bacteria
and viruses entering through the throat, and produce antibodies to help protect from infection.
• Pharyngeal Tonsil: Is found in the posterior wall and roof of the nasopharynx and is called an
adenoid when enlarged.

• Palatine Tonsil: Lies on each side of the oropharynx in an interval between the palatoglossal and
palatopharyngeal folds.
• Is highly vascular, receiving blood from the ascending palatine and tonsillar branches of the facial
artery, the descending palatine branch of the maxillary artery, a palatine branch of the ascending
pharyngeal artery, and the dorsal lingual branches of the lingual artery.
• Is innervated by branches of the glossopharyngeal nerve and the lesser palatine branch of the
maxillary nerve.
• Tubal (Eustachian) Tonsil: Is a collection of lymphoid nodules near the pharyngeal opening of the
auditory tube.

• Lingual Tonsil: Is a collection of lymphoid follicles on the posterior portion of the dorsum of the
tongue.
Palatine tonsillectomy
• is surgical removal of a palatine tonsil.
• During tonsillectomy, the glossopharyngeal nerve may be injured,
causing loss of general sensation and taste sensation of the posterior
one-third of the tongue.
• It may cause severe hemorrhage, which may occur from the branches
of the facial, ascending pharyngeal, maxillary, and lingual arteries or
paratonsillar veins
Palatine tonsillectomy
LARYNX:CARTILAGES
• Thyroid Cartilage: Is a single hyaline cartilage that forms a median elevation called the laryngeal
prominence (Adam's apple), which is particularly apparent in males.

• Cricoid Cartilage: Is a single hyaline cartilage that is shaped like a signet ring. Is at the level of CV 6
and articulates with the thyroid cartilage. Its lower border marks the end of the pharynx and larynx.
• Epiglottis: Is a single elastic cartilage. Is a spoon-shaped plate that lies behind the root of the
tongue and forms the superior part of the anterior wall of the larynx. Its lower end is attached to
the back of the thyroid cartilage.

• Arytenoid Cartilages: Are paired elastic and hyaline cartilages. Are shaped liked pyramids, with
bases that articulate with and rotate on the cricoid cartilage. Have vocal processes, which give
attachment to the vocal ligament and vocalis muscle, and muscular processes, which give
attachment to the thyroarytenoid muscle and the lateral and posterior cricoarytenoid muscles.

• Corniculate Cartilages Are paired elastic cartilages that lie on the apices of the arytenoid
cartilages.Are enclosed within the aryepiglottic folds of mucous membrane.

• Cuneiform Cartilages: Are paired elastic cartilages that lie in the aryepiglottic folds anterior to the
corniculate cartilages.
LARYNX: CAVITIES AND FOLDS
• The laryngeal cavity is divided into three portions by the vestibular and vocal folds: the vestibule,
ventricle, and infraglottic cavity.
• Vestibule : Extends from the laryngeal inlet to the vestibular (ventricular) folds.
• Ventricles: Extend between the vestibular fold and the vocal fold.
• Infraglottic Cavity: Extends from the rima glottidis to the lower border of the cricoid cartilage.
• Rima Glottidis : Is the space between the vocal folds and arytenoid cartilages. Is the narrowest
part of the laryngeal cavity.

• Vestibular Folds (False Vocal Cords) : Extend from the thyroid cartilage above the vocal ligament
to the arytenoid cartilage.
• Vocal Folds (True Vocal Cords) : Extend from the angle of the thyroid cartilage to the vocal
processes of the arytenoid cartilages. Contain the vocal ligament near their free margin and the
vocalis muscle, which forms the bulk of the vocal fold. Are important in voice production because
they control the stream of air passing through the rima glottidis.
 VAGUS NERVE
Recurrent laryngeal nerve
• Innervates all of the intrinsic muscles of the larynx except the cricothyroid, which is innervated by the external
laryngeal branch of the superior laryngeal branch of the vagus nerve.
• Supplies sensory innervation below the vocal cord. Has a terminal portion above the lower border of the cricoid
cartilage called the inferior laryngeal nerve.
• Lesion of the recurrent laryngeal nerve could be produced during thyroidectomy or cricothyrotomy or by aortic
aneurysm and may cause respiratory obstruction, hoarseness, inability to speak, and loss of sensation below the vocal
cord.
Superior Laryngeal Nerve
• Is a branch of the vagus nerve and divides into the internal and external laryngeal branches.

Internal Laryngeal Nerve

• Innervates the mucous membrane above the vocal cord and taste buds on the epiglottis.Is accompanied by the
superior laryngeal artery and pierces the thyrohyoid membrane.
• Lesion of the internal laryngeal nerve results in loss of sensation above the vocal cord and loss of taste on the
epiglottis.
External Laryngeal Nerve
• Innervates the cricothyroid and inferior pharyngeal constrictor (cricopharyngeus part) muscles.Is accompanied by the
superior thyroid artery.
 EXTERNAL EAR
Auricle
• The visible part is called the auricle, also known as the pinna, especially in other animals. It is composed of a thin plate of yellow
elastic cartilage, covered with integument, and connected to the surrounding parts by ligaments and muscles. Has the following
features:

External Acoustic (Auditory) Meatus

• Is approximately 2.5 cm long, extending from the concha to the tympanic membrane.
• Its external one-third is formed by cartilage, and the internal two-thirds is formed by bone. The cartilaginous portion is wider than
the bony portion and has numerous ceruminous glands that produce earwax.
Tympanic Membrane (Eardrum)
• Lies obliquely across the end of the meatus sloping medially from posterosuperiorly to anteroinferiorly; thus, the anterior–inferior
wall is longer than the posterior–superior wall.
• Consists of three layers: an outer (cutaneous), an intermediate (fibrous), and an inner (mucous) layer.
• Has a thickened fibrocartilaginous ring at the greater part of its circumference, which is fixed in the tympanic sulcus at the inner end
of the meatus.
• Has a small triangular portion between the anterior and posterior malleolar folds called the pars flaccida (deficient ring and lack of
fibrous layer). The remainder of the membrane is called the pars tensa.
• Contains the cone of light, which is a triangular reflection of light seen in the anterior–inferior quadrant.
• Contains the most depressed center point of the concavity, called the umbo (Latin for “knob”).
• Its external (lateral) concave surface is covered by skin and is innervated by the auriculotemporal branch of the trigeminal nerve and
the auricular branch of the vagus nerve.
• Its internal (medial) surface is covered by mucous membrane, is innervated by the tympanic branch of the glossopharyngeal nerve,
and serves as an attachment for the handle of the malleus.
MIDDLE EAR CAVITY
• Consists of the tympanic cavity with its ossicles and is located within the petrous
portion of the temporal bone.
• Transmits the sound waves from air to auditory ossicles and then to the inner ear
• Tympanic (Middle Ear) Cavity Includes the tympanic cavity proper (the space internal to the
tympanic membrane) and the epitympanic recess (the space superior to the tympanic
membrane that contains the head of the malleus and the body of the incus).
• Communicates anteriorly with the nasopharynx via the auditory (eustachian) tube and
posteriorly with the mastoid air cells and the mastoid antrum through the aditus ad antrum.
• Is traversed by the chorda tympani and lesser petrosal nerve.

• Oval Window (Fenestra Vestibuli): Is pushed back and forth by the footplate of the stapes
and transmits the sonic vibrations of the ossicles into the perilymph of the scala vestibuli in
the inner ear.
• Round Window (Fenestra Cochlea or Tympani: Is closed by the secondary tympanic
(mucous) membrane of the middle ear and accommodates the pressure waves transmitted
to the perilymph of the scala tympani.
 Boundaries of the Tympanic Cavity
• Roof : tegmen tympani.
• Floor : jugular fossa.
• Anterior : carotid canal.
• Posterior : mastoid air cells and mastoid antrum through the aditus ad
antrum.
• Lateral : tympanic membrane.
• Medial : lateral wall of the inner ear, presenting the promontory formed
by the basal turn of the cochlea, the fenestra vestibuli (oval window), the
fenestra cochlea (round window), and the prominence of the facial
canal.
Cervical Lymph Nodes : Levels
LYMPHATIC DRAINAGE OF THE HEAD AND NECK
• The lymph nodes of the head and neck are divided into two groups: a circular chain of nodes around the base of the skull,
and the deep and superficial cervical chains accompanying the large veins of the neck
• The circular chain consists of seven groups of nodes lying along the upper attachment of the deep cervical ‘polo neck’
fascia. All are palpable when enlarged.
● Occipital – around the occipital artery; drain the posterior scalp and adjacent neck.
● Posterior auricular – on the mastoid process; drain the external acoustic meatus, the posterior auricle and the adjacent
scalp.
● Superficial parotid – in front of the tragus; drain the external meatus, the front of the auricle and the adjacent scalp.
● Deep parotid – within the parotid gland; drain the anterior scalp, infratemporal region, orbit, lateral eyelids, upper molar
teeth, external acoustic meatus and parotid gland.
● Retropharyngeal – between the pharynx and the upper cervical vertebrae; drain the upper pharynx and adjacent
structures.
● Submandibular – between the mandible and submandibular gland; drain the anterior nasal cavities, tongue, teeth and
gums, submandibular and sublingual glands, and all the face apart from the lateral eyelids and the medial part of the lower l ip
and chin.
● Submental – behind the chin on mylohyoid; drain the tip of the tongue, the floor of the mouth and the lower lip and chin
 The deep cervical chain lies around the internal
jugular vein
Named nodes in the chain are the:
● Jugulodigastric – behind the mandible;
drains the tonsil and lateral part of the
tongue.
● Jugulo-omohyoid – between the internal
jugular vein and the superior belly of
omohyoid; drains the tongue via the
submental and submandibular nodes.
● Para- and pretracheal – lie along the
inferior thyroid vessels; drain the trachea
and thyroid gland. Efferent vessels may
pass to mediastinal tracheobronchial
nodes.
Deep Cervical Nodes

• The deep cervical nodes form a vertical chain along the course of the
internal jugular vein within the carotid sheath .They receive lymph
from all the groups of regional nodes. The jugulodigastric node, which
is located below and behind the angle of the jaw, is mainly concerned
with drainage of the tonsil and the tongue. The juguloomohyoid
node, which is situated close to the omohyoid muscle, is mainly
associated with drainage of the tongue. The efferent lymph vessels
from the deep cervical lymph nodes join to form the jugular trunk,
which drains into the thoracic duct or the right lymphatic duct
THYROID GLAND
• Consists of right and left lobes connected by the isthmus, which usually crosses the
second and third (or second, third, and fourth) tracheal rings.
• An inconstant pyramidal lobe, a remnant of the thyroglossal duct, extends upward
from the isthmus, usually to the left of the midline, and may be anchored to the
hyoid bone by a fibrous or muscular band known as the levator glandulae
thyroideae.
• Artery Supply: supplied by the superior and inferior thyroid arteries and
sometimes the thyroid ima artery, an inconsistent branch from the brachiocephalic
trunk.
• Venous Drainage: Drains via the superior and middle thyroid veins to the internal
jugular vein and via the inferior thyroid vein to the brachiocephalic vein.
• Lymph drainage: The lymphatics from the thyroid gland drain to deep cervical
nodes. A few pass into prelaryngeal, pre- and paratracheal nodes, and a few drain
directly into the thoracic duct.
• Nerve supply Sympathetic (vasoconstrictor) nerves from the superior, middle and
inferior cervical ganglia accompany the thyroid arteries.
 Clinical Notes :
• Swellings of the Thyroid Gland and Movement on Swallowing

• The thyroid gland is invested in a sheath derived from the pre tracheal
fascia, This tethers the gland to the larynx and the trachea and explains why
the thyroid gland follows the movements of the larynx in swallowing. This
information is important because any larynx in swallowing. This information
is important because any pathologic neck swelling that is part of the thyroid
gland will move upward when the patient is asked to swallow.

• Thyroidectomy is a surgical removal of the thyroid gland, and during surgery

the thyroid arteries, related nerves and inferior thyroid veins are vulnerable
to injury. Potential complications may include hemorrhage from injury of the
anterior jugular veins; nerve paralysis, particularly of the recurrent laryngeal
nerves.
 THE PARATHYROID GLANDS
• The parathyroid glands are four small endocrine
glands situated behind the lateral lobes of the
thyroid gland and within its capsule.
• There is a superior and an inferior gland on each
side. Whereas the superior glands are relatively
constant in position, behind the middle of the
thyroid lobe, the lower glands, although usually
located behind the lower lobe, may occasionally
be found outside the pretracheal fascia in the
neck or even in the superior mediastinum.
• Each gland is oval and about 3–6 mm in length.
• They have a rich blood supply from the inferior
thyroid arteries.
• The superior and inferior glands develop from
the fourth and third pharyngeal arches,
respectively.
• They secrete parathormone and play an
important role in calcium metabolism.
THE PARATHYROID GLANDS
• There are two types of cells within
the parathyroid gland, the chief cells
and the oxyphil cells.
• Chief cells- The role of this cell type
is to secrete parathyroid hormone.
They contain prominent Golgi
apparatus and endoplasmic
reticulum to allow for the synthesis
and secretion of parathyroid
hormone
• The function of the oxyphil cells is
unknown
CERVICAL PLEXUS
The cervical plexus is formed by loops
between the anterior rami of the
upper four cervical nerves, after each
has received a grey ramus
communicans from the superior
cervical ganglion. It lies in series with
the brachial plexus, on the scalenus
medius, behind the prevertebral
fascia
 Summary of the Branches of the Branches of the Cervical Plexus and Their Distribution
Branches Distribution
Cutaneous Skin of scalp behind ear
Lesser occipital Skin over parotid salivary gland, auricle, and angle of jaw
Greater auricular

Muscular Prevertebral muscles, levator scapulae

Segmental Omohyoid, sternohyoid, sternothyroid
Ansa cervicalis (C1, 2, 3)

C1 fibers via Hypoglossal nerve Thyrohyoid, geniohyoid

Phrenic nerve (C3, 4, 5) Diaphragm (most important muscle of respiration)

Sensory Phrenic nerve (C3, 4, 5) Pericardium, mediastinal parietal pleura, and pleura and
peritoneum covering central diaphragm
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