BACK OF NECK

Back Back of neck or nape supply Medial branches of dorsal Rami of C2 greater occipital C3 third occipital Intrinsic muscles of back Ligamentum nuchae Separates muscles of two sides Muscles of nape

4 layers superficial to deep

1. Trapezius and latissimus dorsi 2. Levator scapulae , rhomboids , serratus posterior superior Splenius ( capitis and cervicis 3. Erector spinae or sacrospinalis Iliocostalis Longissimus Spianlis 4. Multifudus , rotatores , interspinales , intertransversii and suboccipital muscles Suboccipital triangle Suboccipital muscles Rectus capitis posterior ( major and minor ) Obliquus capitis ( superior and inferior ) Arteries Occipital artery Deep cervical artery Third part of vertebral artery Exposure Skin Superficial fascia Boundaries Superomedially Superior oblique capitis Superolaterally Superior oblique capitis Inferiorly Inferior oblique capitis Roof Medially Dense fibrous tissue Laterally Longissimus capitis Floor Posterior arch of atlas Posterior atlantooccipital membrane

Contents Third part of vertebral artery Dorsal ramus of C1 ( suboccipital ) Suboccipital plexus of veins

Occipital artery Arises opposite to facial artery from ECA Course Runs backwards and upwards Deep to lower border of belly of digastric Crosses carotid sheath and accessory and hypoglossal nerves

Prevertebral muscles ( anterior vertebral muscles ) Lognus colli ( cervicis ) Longus capitis Rectus capitis anterior Rectus capitis Lateralis

Vertebral artery First part

Origin of artery to transverse process of 6 th cervical vertebra

Course Runs upwards Scalenovertebral triangle

Present at root of neck

Boundaries

Lateral Scalenus anterior

Medial : oblique part of longus colli Apex : transverse process of cervical vertebra Base : first part of subclavian artery Posterior wall : transverse process of C7 , ventral ramus of C8 , neck of first rib

Relations Anterior Carotid sheath with common carotid artery Vertebral vein Inferior thyroid artery Thoracic duct on left side Posterior Transverse process of 7 th cervical vertebra Stellate ganglion Ventral Rami of nerves C7 , C8

Second part Runs through foramina transversria of upper 6 cervical vertebra Finally reaches foramen of atlas

Relations .accompanied by venous plexus and a large branch from stellate ganglion Ventral Rami of second to 6 th cervical nerves

Third part Lies in suboccipital triangle Emerges from atlas Winds medially around posterior aspect of arch of atlas Relations Medial : ventral ramus of first cervical Lateral : rectus capitis Lateralis Posterior : semispinalis capitis Anterior : lateral mass of atlas

Fourth part Atlantooccipital membrane to pons Vertebral canal it pierces duramater At lower border of pons it joins to form basilar artery

Branches Cervical branches

Arise from 4 th part
Anterior spinal artery

Posterior spinal artery Posterior inferior cerebellar artery Meningeal branches