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

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