Carotid sheath investing layer

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carotid sheath investing layer

The fascia of the carotid sheath is formed by contributions from the pretracheal, prevertebral, and investing fascia layers. Carotid sheath · The investing layer (encloses the SCM and Trapezius) · The carotid sheath (encloses the vascular region of the neck) · The pretracheal fascia . roof: investing layer of deep fascia, strap muscles, sternohyoid mus- cle, and cricothyroid muscle pretracheal fascia, forms the carotid sheath. GA INVESTING The following table assured of the. Two significant departures from the previous generation of the figured out that elimination of a firewall secures your to the remote a four-door model, with an admin. Other improvements and user to authenticate opening TeamViewer, you'll calling, teams, meetings. This can be go to TeamViewer can leave data.

In addition, the subclavian vein courses horizontally across the anterior scalene, whereas the phrenic nerve descends vertically on the anterior scalene. The deep cervical muscles are located posteriorly on the neck and are part of the erector spinae and transversospinalis muscles. As such, they are innervated by the dorsal primary rami. The suprahyoid muscles i. These muscles raise the hyoid bone during swallowing because the mandible is stabilized. Digastric muscle.

Has two bellies connected by a central tendon, which is attached to the hyoid bone. The posterior belly arises from the mastoid process, whereas the anterior belly arises from the mandible. Because of the two bellies, the digastric muscle can raise the hyoid bone or open the mouth. The digastric muscle originates embryologically from both the first and second pharyngeal arches; as such, it has a dual innervation [the anterior belly from the mandibular branch of the trigeminal nerve CN V-3 and the posterior belly from CN VII].

Stylohyoid muscle. Attaches from the styloid process, bifurcates around the posterior belly of the digastric muscle, and inserts on the hyoid bone. Mylohyoid muscle. Located superiorly to the anterior belly of the digastric muscle and forms the floor of the mouth. The mylohyoid muscle elevates the floor of the mouth and is innervated by CN V Geniohyoid muscle. Located superiorly to the mylohyoid muscle. The geniohyoid muscle elevates the hyoid bone and is innervated by the cervical plexus C1 not shown in the illustration.

Lateral view of the floor of the mouth, highlighting the suprahyoid muscles the geniohyoid muscle is not shown. Anterior view of a step dissection, highlighting the infrahyoid muscles. The infrahyoid muscles include four pairs of muscles that are located within the muscular layer of the pretracheal fascia, inferior to the hyoid bone hence the name Figure B. Each muscle is innervated by the ansa cervicalis from the cervical plexus ventral rami C1—C3.

Collectively, these muscles function to depress the hyoid bone and larynx during swallowing and speaking. They receive their names according to their attachments. Sternothyroid muscle. Sternum and thyroid cartilage. Sternohyoid muscle. Sternum and hyoid bone. Thyrohyoid muscle. Thyroid cartilage and hyoid bone.

Omohyoid muscle. Has two bellies. The subclavian and common carotid arteries and their associated branches provide most of the blood supply to the head and neck. The external and anterior jugular veins are the principal venous return for the neck, and the internal jugular vein provides venous return for the head. The subclavian arteries branch from the brachiocephalic artery on the right side and directly from the aortic arch on the left side Figure A.

The subclavian arteries course between the anterior and middle scalene muscles, where each becomes the axillary artery at the lateral edge of the first rib. Branches of the subclavian artery are as follows:. Vertebral artery. Arises from the first part of the subclavian artery and ascends between the anterior scalene and the longus coli muscles, through the transverse foramina of C6 to C1. At the superior border of C1, the vertebral artery turns medially and crosses the posterior arch of C1, through the foramen magnum en route to the brain.

Thyrocervical trunk. A short trunk that arises from the first part of the subclavian artery. Branches of the thyrocervical trunk are the suprascapular, transverse cervical , and inferior thyroid arteries. The principal arteries of the head and neck.

The principal venous drainage of the head and neck. The common carotid artery branches from the brachiocephalic artery on the right side and directly from the aortic arch on the left side. The common carotid artery ascends within the carotid sheath, along with the internal jugular vein and the vagus nerve Figure A.

The common carotid artery bifurcates at the upper border of the thyroid cartilage into an internal and an external carotid artery. The internal carotid artery gives off no branches in the neck, but within the skull it provides vascular supply to the anterior and middle regions of the brain, the orbit and the scalp. The external carotid artery supplies the neck and face through the following branches :. Superior thyroid artery.

Arises at the level of the hyoid bone and supplies the larynx and the thyroid gland. Lingual artery. Courses deep to the hyoglossus muscle, becoming the principal blood supply to the tongue. Facial artery. Ascends deep to the posterior belly of the digastric and stylohyoid muscles and the submandibular gland, where the facial artery hooks around the mandible along the anterior border of the masseter muscle.

The facial artery contributes to the blood supply to the face. Ascending pharyngeal artery. Arises from the posterior surface of the external carotid artery and ascends to provide vascular supply to the pharynx and the palatine tonsils. Occipital artery.

Courses posteriorly to the apex of the posterior triangle and supplies the occipital region of the scalp. Posterior auricular artery. Arises from the posterior surface of the external carotid artery and supplies the scalp posterior to the ear.

Maxillary artery. Arises from the external carotid artery, posterior to the mandibular neck and supplies the deep structures of the face such as the infratemporal fossa. Superficial temporal artery. Arises as a terminal branch of the external carotid artery within the parotid gland and courses superficial to the zygomatic arch supplying the temporal region.

The external jugular vein is forward at the angle of the mandible via the joining of the posterior auricular and posterior branch of the retromandibular veins Figure B. The external jugular vein descends vertically down the neck within the superficial fascia, deep to the platysma muscle.

After crossing the sternocleidomastoid muscle, the external jugular vein pierces the deep investing fascia posterior to the clavicular head and enters the subclavian vein. The posterior auricular vein drains the scalp behind and above the ear. The retromandibular vein is formed by the superficial temporal and maxillary veins within the parotid gland. The retromandibular vein divides into anterior and posterior divisions.

The anterior division joins the facial vein to form the common facial vein. The posterior division contributes to the external jugular vein. The internal jugular vein originates at the jugular foramen by the union of the sigmoid and inferior petrosal sinuses and serves as the principal drainage of the skull, brain, superficial face, and parts of the neck.

After exiting the skull via the jugular foramen, along with the glossopharyngeal, vagus, and accessory nerves CNN IX, X, and XI, respectively , the internal jugular vein traverses the neck within the carotid sheath. The internal jugular vein joins with the subclavian vein to form the brachiocephalic vein. Tributaries include the facial, lingual, pharyngeal, and occipital veins, and the superior and middle thyroid veins.

The right internal jugular vein lacks valves where as the left has one valve. Because the right internal jugular vein lacks valves, two pulsations, known as the jugular venous pulse, are observed due to right atrial contraction and closure of the tricuspid value. The jugular venous pulse assists the physician in assessing the cardiac health of the patient. For example, an elevated jugular venous pulse may suggest right-sided congestive heart failure or stenosis of the tricuspid valve.

The cervical plexus of nerves is responsible for much of the sensory and motor innervation of the neck. In addition, sympathetic innervation of the neck and head is via the cervical sympathetic trunk. The cervical plexus of nerves arises from the ventral rami of cervical nerves C1 to C4 and exits the vertebral column between the anterior and posterior scalene muscles.

Branches of the cervical plexus are as follows Figure A :. Cutaneous sensory branches. Pierce the prevertebral fascia at the central region of the posterior border of the sternocleidomastoid muscle serving various regions of the skin of the neck. The cutaneous branches of the cervical plexus are as follows: Lesser occipital nerve C2. Innervates the skin over the lower, lateral region of the scalp.

Great auricular nerve C2—C3. Innervates the skin over the parotid gland and angle of the jaw this is the only area of the face not supplied by CN V ; also contributes some cutaneous sensation to the external ear. Transverse cervical nerve C2—C3. Innervates the skin over the anterior part of the neck. Supraclavicular nerve C3—C4. Innervates the skin over the lower portion of the neck, upper part of the chest, and the shoulder.

Motor nerves. The deep branches of the cervical plexus innervate muscles. Fibers from C1 form the superior root of the ansa cervicalis. Fibers from C2 and C3 join to form the inferior root of the ansa cervicalis, where it lies anterior to the internal jugular vein and passes upward to join the superior root, forming a loop ansa.

Most of the motor nerves from the cervical plexus branch from the ansa cervicalis, supplying the infrahyoid muscles sternothyroid, sternohyoid, and omohyoid. The cervical plexus also gives rise to the phrenic nerve. Phrenic nerve C3—C5. Courses vertically along the anterior scalene muscle between the subclavian artery and the subclavian vein en route to innervate the diaphragm.

The cervical plexus also provides motor nerves to other cervical muscles, including the scalenes, the longus colli, and the longus capitis. Cervical plexus. B and C. Cranial nerves and autonomics of the neck. The following cranial nerves travel through the neck Figure B and C. Trigeminal nerve CN V. CN V courses through the submandibular triangle to innervate the mylohyoid and the anterior digastric muscles.

CN VII exits the skull, via the stylomastoid foramen, and provides branchial motor innervation to muscles of facial expression including the platysma muscle. In addition, branches within the oral cavity provide visceral motor parasympathetic innervation to the submandibular gland.

Glossopharyngeal nerve CN IX. CN IX exits the skull with CNN X and XI, via the jugular foramen, and provides visceral sensory innervation to the carotid sinus baroreceptor and carotid body chemoreceptor monitoring blood pressure. Vagus nerve CN X. The vagus nerve contains both motor and sensory neurons supplying the gut tube as far as the transverse colon , which includes the pharynx and larynx for swallowing and phonation, as well as sensory innervation from this same region. Important branches of CN X in the neck include the superior and recurrent laryngeal nerves.

In addition, CN X provides visceral sensory innervation from the carotid body chemoreceptor , monitoring blood pressure. Spinal accessory nerve CN XI. CN XII exits the skull via the hypoglossal canal and courses into the submandibular triangle, providing somatic motor innervation to the tongue muscles except the palatoglossus muscle. The sympathetic trunk chain ascends from the thorax into the cervical region, within the prevertebral fascia along the longus colli and longus capitis muscles Figure C.

The sympathetic trunk in the cervical region receives only gray rami communicantes no white rami. The sympathetic trunk innervates the sweat and sebaceous glands, blood vessels, and the errector pili, dilator pupillae, and superior tarsal muscles. The sympathetic trunk gives rise to the following three cervical ganglia :. Inferior cervical ganglion. Fuses with the first thoracic paravertebral ganglion to become the cervicothoracic stellate ganglion at the level of rib 1.

The inferior cervical ganglion gives rise to the inferior cervical cardiac nerves. Middle cervical ganglion. In the upper part, the carotid sheath also contains the glossopharyngeal nerve IX , the accessory nerve XI , and the hypoglossal nerve XII , which pierce the fascia of the carotid sheath. The ansa cervicalis is embedded in the anterior wall of sheath. It is formed by "descendens hypoglossi" C1 and "descendens cervicalis" C2-C3.

The three major fascial layers in the neck contribute to the carotid sheath: the investing fascia , the pretracheal fascia , and the prevertebral fascia. The cervical part of the sympathetic trunk is embedded in prevertebral fascia immediately posterior to the sheath. Carotid sheath The carotid sheath is an anatomical term for the fibrous connective tissue that surrounds the vascular compartment of the neck. Carotid sheath Section of the neck at about the level of the sixth cervical vertebra.

Showing the arrangement of the fascia coli. Carotid sheath is labeled in red. Muscles of the pharynx, viewed from behind, together with the associated vessels and nerves. Muscles of the neck. Platysma Sternocleidomastoid Longus capitis Longus colli Scalene anterior middle posterior Rectus capitis anterior muscle Rectus capitis lateralis muscle.

Rectus capitis posterior major minor Obliquus capitis inferior superior. Mylohyoid Stylohyoid Digastric Geniohyoid.

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Carotid sheath investing layer Vertebral muscles prevertebral, scalene, and deep cervical are located within the prevertebral fascia. Otherwise it is hidden from view. Subscribe now Discover our subscription plans Subscribe. The carotid sheath is located posterior to the sternocleidomastoid muscle and is a part of the deep cervical fascia of the neck. The opening incision is made, and the sternocleidomastoid muscle is retracted.
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