Anatomy of Nerves of the Neck in a Nutshell

Anatomy of Nerves of the Neck

Primarily deals with cervical plexus

• C1-C4 cervical nerve ventral rami
• cutaneous branches (4) that emerge from the Nerve point of the neck (found about half way between origin and insertion of SCM). All from upper cervical plexus.
  • Great auricular nerve

1. 1. • Crosses sternocleidomastoid
      • Supplies skin around ear (auricle = external part of ear)

1. • Lesser occipital nerve

1. 1. • Right along posterior border of sternocleidomastoid
      • Supplies part of scalp- posterior / superior to the ear

1. • Transverse cervical nerve

1. 1. • Heads transversely across the SCM into the anterior triangle
      • Supplies the anterior triangle

1. • Supraclavicular nerves (3)

1. 1. • Head inferiorly over the clavicle
      • Supply skin over clavicle and the upper pectoral region

• Ansa cervicalis “goose neck”
  • Have superior root (C1) which joins with inferior root (C 2-3)
  • These form a loop like structure which is found on the carotid sheath (not inside)
  • Supplies ¾ of strap muscles (infrahyoid muscles)

1. 1. • Supplies ‘SOS’ muscles
      • Sternothyroid, Omohyoid, Sternohyoid

• Phrenic nerve (C3-5)
  • C5 from brachial plexus, C3-4 from cervical plexus
  • Found on the anterior surface of the anterior scalene muscle
• Hitchhiking
  • Fibers from C1 will travel along cranial nerve XII (hypoglossal nerve)
  • Supplies thyrohyoid muscle (4^th strap muscle)
• Accessory nerve CN XI
  • Supplies trapezius and sternocleidomastoid
  • Origin from C1-C5 in spinal cord
  • Goes into head and then back out to the neck (does not have cell bodies of origin in the head)
  • Is a motor nerve from the spinal cord that is only called a cranial nerve because it has a pathway through the head
  • Gets contribution from cervical plexus from C2-4

1. 1. • Act as proprioreceptive fibers
      • Tells position of body in space for SCM and trapezius

Vagus nerves:

• Found in the carotid sheath posteriorly
• Left vagus
  • Loops around aortic arch
  • Gives off left recurrent laryngeal nerve
• Right vagus
  • Loops under subclavian artery
  • Gives off right recurrent laryngeal nerve that goes into neck
• Both recurrent laryngeal nerves (R/L) are found within the tracheoesophageal groove
  • Important clinically
  • Esophageal cancer may impinge on these
• Emerges from a hole in the skull = Jugular foramen
  • An opening in base of the skull
  • Also allows internal jugular vein to pass
  • Swelling within the foramen = superior vagal ganglion
• Inferior vagal ganglion: at level C2
• Path:
  • Gives off branches to vessles in the neck
  • Gives off recurrent laryngeal nerve found in the tracheoesophageal groove

• • • Supplies inferior portion of larynx
    • Superior portion of larynx has innervation from branch off inferior vagal ganglion = superior laryngeal nerve.
      1. branches into internal laryngeal which innervates larynx
      2. external laryngeal nerve remains outside the larynx

Cervical sympathetics:

• Continuation of sympathetic chain
• Has 3 ganglia
  • Superior cervical ganglion

1. 1. • Is the largest
      • Found at C1-C2

• • • All sympathetics to the skull (not brain) will synapse here

1. • Middle cervical ganglion

1. 1. • Smaller
      • Found at C6

1. • Inferior cervical ganglion

1. 1. 1. Found at about C7
      2. In many cases, this fuses with the T1 ganglion (first thoracic ganglion) and form the cervicothoracic ganglion aka Stellate Ganglion (C7-T1)

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