Transcript Neck - 山东大学医学院人体解剖学教研室

Neck
山东大学医学院 解剖教研室
李振华
The muscles of neck
Superficial group



Platysma 颈阔肌，a thin sheet-like muscle of facial
expression
Sternocleidomastoid 胸锁乳突肌

Suprahyoid muscles

Digastric 二腹肌

Stylohyoid 茎突舌骨肌
Mylohyoid 下颌舌骨肌
Geniohyoid 颏舌骨肌


Elevate (raise) hyoid bone
and depress mandible.
Infrahyoid muscle


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Sternohyoid 胸骨舌骨肌
Sternothyroid 胸骨甲状肌
Thyrohyoid
Omohyoid
甲状舌骨肌
肩胛舌骨肌
Depress hyoid or larynx
after elevation
Deep group


Lateral
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
Scalenus anterior 前斜角肌
Scalenus medius 中斜角肌
Scalenus posterior 后斜角肌
Medial


longus capitis 头长肌
longus colli 颈长肌
Flex the head, bends the
neck forward
Major muscles of the neck
Sternocleidomastoid

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Origin: manubrium and
sternal end of clavicle
Insertion: mastoid process
of temporal bone
Action: contraction of one
muscle draws head toward
the same side, and turn
face to opposite side; both
muscles act together to
draw head backward
Scalenus anterior

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Origin: transverse processes of
C3-C6.
Insertion: tubercle for scalenus
anterior
Action: unilateral, bends neck
laterally; bilateral, elevate first
rib, an accessory muscle of
inspiration; if rib is fixed, flex
neck anteriorly
Scalene fissure 斜角肌间隙
Above the first rib, there is a
triangular space between
scalenus anterior and midius.
The brachial plexus and the
subclavine a. emerge from this
space.
The arteries of neck
Common carotid artery

颈总动脉
Origin (arises from)
Brachiocephalic trunk
on the right
 Aortic arch on the left
Ascends in neck to upper
border of thyroid cartilage;
bifurcates into internal
and external carotid arteries
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Carotid sinus 颈动脉窦
(baroreceptor), located at a
localizes dilation of terminal
part of common carotid
artery or beginning of
internal carotid artery,
sensitive to blood pressure
changes
Carotid glomus 颈动脉小球
(chemoreceptor), lies
posterior to the point of
bifurcation of common
carotid artery, senses
changes in blood carbon
dioxide (oxygen) levels
Branches of external
carotid a.
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Superior thyroid a.
甲状腺上动脉－descends to
supply upper pole of thyroid
gland and larynx
Lingual a. 舌动脉
Facial a. 面动脉
Occipital a.枕动脉
Posterior auricular a.
耳后动脉


Maxillary a. 上颌动脉
Superficial temporal a.
颞浅动脉
Subclavian artery
锁骨下动脉

Origin (arises from)
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Brachiocephalic trunk on right
Aortic arch on left
Becomes axillary artery at lateral
border of first rib
Branches
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Vertebral a. 椎动脉
Internal thoracic a. 胸廓内动脉
Thyrocervical trunk 甲状颈干


Inferior thyroid artery 甲状腺下动脉
－supplies inferior pole of thyroid
gland
Costocervical trunk 肋颈干
Veins Draining the neck
Internal jugular vein
颈内静脉
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
Begin at jugular foramen,
descending to join the
subclavian vein to form
brachiocephalic vein
Lies lateral first to internal and
then to common carotid a. within
carotid sheath
Chief extracranial tributaries
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Common facial vein 面总静脉
Lingual v. 舌静脉
Pharyngeal v. 咽静脉
Superior thyroid v.甲状腺上静脉
Middle thyroid v. 甲状腺中静脉
Subclavian vein
 It is an continuation of
axillary vein at the lateral
border of first rib
 Joins internal jugular vein
to form the
brachiocephalic vein.
Angle of union is termed
venous angle 静脉角
External jugular vein
颈外静脉
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
Formed behind angle of
mandible by union of posterior
auricular, posterior branch of
retromandibular and occipital
vein
Crossing sternocleidomastoid
to enter subclavian vein
Anterior jugular vein
颈前静脉


Drains submandibular and
anterior neck regions
Descends near midline, runs
posterior to sternal end of
sternocleidomastoid to drain
into external jugular vein or
subclavian vein
Lymph nodes of neck
Anterior cervical
lymph nodes


Superficial anterior
cervical lymph nodes
Deep anterior cervical
lymph nodes
Lateral cervical
lymph node

Superficial lateral
cervical lymph nodes
－lie along the external
jugular vein
Deep lateral cervical lymph nodes
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
Extend along the internal jugular
vein from the base of skull to the root
of neck, divided into superior deep
lateral cervical lymph nodes and
inferior deep lateral cervical lymph
nodes
Receive lymphatic vessels from
head, neck, tongue, larynx, cervical
parts of esophagus and trachea,
thyroid gland, upper parts of the
thoracic wall and breast
Efferent vessels form the jugular
trunk－the left jugular trunk joins the
thoracic duct and right may joint the
right lymphatic duct
Superior deep lateral cervical
lymph nodes 颈外侧上深淋巴结
 Jugulodigastric lymph node
颈内静脉二腹肌淋巴结: lies at the
junction of posterior belly of
digastric and internal jugular vein
Inferior deep lateral cervical
lymph nodes 颈外侧下深淋巴结
 Juguloomohyoid lymph node
颈内静脉肩胛舌骨肌淋巴结: lies at
the junction of the intermediate
tendon of omohyoid and internal
jugular vein
 Supraclavicular lymph nodes
锁骨上淋巴结: lie along the
subclavian artery
Right lymphatic duct 右淋巴导管
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Formed by union of right jugular,
subclavian, and bronchomediastinal
trunks
Ends by entering the right venous
angle
Receives lymph from right half of head,
neck, thorax and right upper limb
Thoracic duct 胸导管
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At the roof of the neck, it turns laterally
and arches forwards and descends to
enter the left venous angle
Just before termination, it receives the
left jugular, subclavian and
bronchomediastinal trunks
Cervical plexus
Formation: formed by
anterior rami of C1-C4
spinal nerves
Position: lies in front of
the origin of levator
scapulae and scalenus
medius and deep to the
superior part of the
sternocleidomastoid
Branches

Cutaneous branches:
emerge around middle of
posterior border of
sternocleidomastoid, to
supply skin of neck and
scalp between auricle and
external occipital
protuberance
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Lesser occipital n. 枕小神经
Greet auricular n. 耳大神经
Transverse nerve of neck
颈横神经

Supraclavicular n. 锁骨上神经
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Muscular branches: supply
the deep muscles of neck
Phrenic nerve 膈神经
(anterior rami of C3-C5)
Lies on anterior scalene,
deep to fascia
 To diaphragm (motor and
sensory)
Ansa cervicalis 颈袢:
 Hypoglossal nerve gives off
superior root of ansa
(descendens hypoglossi),
composed of fibers picked
up from nerve C1
 Joins inferior root of ansa
(descendens cervicalis,
C2and C3) to form a loop,
the ansa cervicalis, which
supplies infrahyoid muscles
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Vagus nerve (Ⅹ)

Leaves skull via
jugular foramen

Descends in the neck
in carotid sheath
between internal (or
common) carotid
artery and internal
jugular vein

Branches

Superior laryngeal nerve 喉上神经
passes down side of pharynx and given
rise to

Internal branch 内支
which pierces thyrohyoid membrane to
innervates mucous membrane of larynx
above fissure of glottis

External branch 外支
which innervates cricothyroid
Cervical cardiac branches 颈心支 :

descending to terminate in cardiac plexus
Recurrent laryngeal nerves 喉返神经
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Ascend in tracheo-esophageal groove
Enter larynx posterior to cricothyroid joint,
the nerve is now called inferior laryngeal
nerve
Innervations: laryngeal mucosa below
fissure of glottis , all laryngeal laryngeal
muscles except cricothyroid
Accessory n. (Ⅺ ) 副神经
 Deep to posterior belly of
digastric
 Supplies sternoclidomastoid
and trapezius muscle
Hypoglossal n.(Ⅻ) 舌下神经
 Descends between internal
carotid a. and internal jugular
v., hooks around external
carotid a., to lie on the
hyoglossus before entering
tongue
 Supplies muscles of tongue
Cervical part of sympathetic
trunk 颈交感干
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
Formed by superior , middle
and inferior cervical ganglia
and interganglionic branches
Superior cervical ganglion:
largest, situated in front of
transverse processes of
C1~C3 vertebra
Middle cervical ganglion:
smallest, is at level of
transverse processes of C6
vertebra
Inferior cervical ganglion:
situated at level of C7 vertebra,
and may be fused with first
thoracic ganglion to form
cervicothoracic ganglion
颈胸神经节
Regional anatomy of neck
山东大学医学院 解剖教研室
李振华
Parts and regions of the neck
Boundaries
 Superior－inferior border of
mandible, angle of mandible,
tip of mastoid process,
superior nuchal line, external
occipital protuberance
 Inferior－jugular notch,
sternoclavicular joint,
superior border of clavicle,
acromion, spinous processes
of C7
Landmarks
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Hyoid bone
Thyroid cartilage
Cricoid cartilage
Catotid tubercle
Sternocleidomastoid
Suprasternal fossa
Greater supraclaviclar
fossa
Regions
 Neck 颈



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Anterior region of neck
Lateral region of neck
Sternocleidomastoid
region
Nape 项部
Anterior region of neck
 Suprahyoid region
舌骨上区
 Submental triangle
颏下三角

Submandibular triangle
下颌下三角

Infrahyoid region
舌骨下区
 Carotid triangle
颈动脉三角

Muscular triangle
肌三角
Lateral region of neck
 Occipital triangle 枕三角
 supraclavicular triangle 锁骨上三角
(greatsupraclavicular fossa) 锁骨上大窝
Skin
 The natural line of cleavage of the skin are constant
and run almost horizontally around the neck
Superficial fascia
 Consists of fat and
connective tissue
 Contents
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Platysma
Superficial veins
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Cutaneous nerves
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Anterior jugular v.
External jugular v.
Lesser occipital n.
Greet auricular n.
Transverse nerve of neck
Supraclavicular n.
Cervical branch of facial n.
Cervical fascia 颈筋膜－three layers
Superficial layer (investing fascia 封套筋膜)

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Encloses trapezius, sternocleidomastoid, posterior belly of digastric
and parotid and submandibular glands
Attached to bony landmarks of upper and lower boundaries of neck
and zygomatic arch of face
Prevertebral layer 气管前层
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Encloses viscera of neck: pharynx, larynx, trachea, esophagus, thyroid
gland and parathyroid glands
Completely surrounds thyroid gland, forming a sheet for it, and bind the
gland to larynx
Extends from hyoid bone to fibrous pericardium of superior mediastinum
Prevertebral layer 椎前层
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Lies anterior to bodies of cervical vertebrae and prevertebral
muscles; extends from base of skull downward into the superior
mediastinum, continuous with anterior longitudinal lig. and
endothoracic fascia
Covers subclavian vessels and roots of brachial plexus
Extends into upper limb as axillary sheath
颈动脉鞘
Formed by components of all three layers of deep cervical fascia
Contains common and internal carotid arteries, internal jugular vein,
and vagus nerve
Ansa cervicalis located on its anterior surface
Carotid sheath
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Suprasternal space
胸骨上间隙
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Over the lower part of the
anterior triangle, the
inversting fascia splits into
two layers, which are
attached to the anterior and
posterior margins of the
upper border of the
manubrium, between these
two layers is a slitlike space,
called the suprasternal
space
Contains connective tissue,
and sometimes a lymph
node
Pretracheal space 气管前间隙
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
Lies between pretracheal layer and cervical part of trachea
Contains arteria thyroidea ima, inferior thyroid v., unpaired
thyroid venous plexus, brachiocephalic trunk and left
brachiocephalic v.
Retropharyngeal space 咽后间隙

Lies between prevertebral layer and buccopharyngeal fascia
Prevertebral space 椎前间隙

Lies between prevertebral muscles, cervical part of vertebral column and
prevertebral layer
Suprahyoid region
Submental triangle 颏下三角
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Lies below the chin and is
bounded laterally by anterior
bellies of digastric, and
inferiorly by the body of hyoid
bone
Covered by skin, superficial
fascia and investing fascia
Floor－mylohyoid muscles
Contents－submental lymph
nodes
Submandibular triangle 下颌下三角
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Bounded by anterior and posterior bellies of digastric and lower border
of the body of the mandible
Covered by skin, superficial fascia, platysma and investing fascia
Floor－ mylohyoid, hyoglossus and middle constrictor of pharynx
Contents－submandibular gland, facial a., v., hypoglossal n. and v.,
lingual n., submandibular ganglion and submandibular lymph nodes
Infrahyoid region
Carotid triangle 颈动脉三角
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Bounded by anterior border of
sternocleidomastoid, superior
belly of omohyoid and posterior
belly of digastic muscles
Covered by skin, superficial
fascia, platysma and investing
fascia
Floor－prevertebral fascia and
lateral wall of pharynx
Contents－common carotid a.
and its branches, internal
jugular v. and its tributaries,
hypoglossal n. with its
descending branches, the
accessory and vagus nerves,
and part of the chain of deep
cervical lymph nodes
Posterior belly of digastic
muscle
 Superficial－great auricular
n., retromandibular v.,
cervical branch of facial n.
 Deep－internal and external
carotid a., internal jugular v.,
Ⅹ～Ⅻ cranial n. and
cervical part of sympathetic
trunk
 Superior－posterior
auricular a., facial a. and
glossopharyngeal n.
 Infeior－occipital a. and
hypoglossal n.
Muscular triangle 肌三角
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Bounded by midline of the neck,
superior belly of the omohyoid
and anterior border of the
sternocleidomastoid.
Covered by skin, superficial
fascia, platysma, anterior jugular
v., coutaneous n. and investing
fascia
Floor－prevertebral fascia
Contents－sternohyoid, superior
belly of omohyoid, sternothyroid,
thyrohyoid, thyroid gland,
parathyroid gland, cervical part of
trachea and esophagus
Thyroid gland 甲状腺
Shape and position
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H-shape
Left and right lobes: lie on either
side of inferior part of larynx and
superior part of trachea, extend
from middle of thyroid cartilage to
level of sixth trachea cartilage
Isthmus: overlies 2nd to 4th
tracheal cartilage
Pyramidal lobe: some times arises
from isthmus
Fibrous capsule:
A sheath of pretracheal fascia which is
attached to arch of cricoid and thyroid
cartilages, hence, the thyroid gland
moves with larynx during swallowing and
oscillates during speaking
Relations

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Anteriorlly－skin , superficial fascia,
investing fascia, infrahyoid muscles
and pretracheal layer
Posteromedialy－ larynx and trachea,
pharynx and esophagus, recurrent
laryngeal n.
Posterolateraly－carotid sheath and
cervical part of sympathetic trunk
Arteries of thyroid gland and nerves of larynx
Superior thyroid a.
 Branch of external carotid a.
 Runs superficial and parallel to
the external branch of superior
laryngeal n. to reach the upper
pole of thyroid gland
 Gives off superior laryngeal a.
in company with internal
branch of superior laryngeal n.
Superior laryngeal nerve
 Internal branch which
pierces thyrohyoid
membrane to innervates
mucous membrane of larynx
above fissure of glottis
 External branch is fine n.,
which descends in company
with the superior thyroid a.
and supplies cricothyroid
Inferior thyroid artery 甲状腺下动脉
 Branch of thyrocervical trunk off
subclavian a.
 Turns medially and downward, reaches
the posterior border of the thyroid gland
and is closely related to the recurrent
laryngeal n.
 Supplies inferior pole of thyroid gland
Recurrent laryngeal nerves 喉返神经
 Ascend in tracheo-esophageal groove
 Pass deep to the lobe of the thyroid
gland and come into close relationship
with the inferior thyroid a.
 Cross either in front of or behind the
artery of may pass between its
branches
 Nerves enter larynx posterior to
cricothyroid joint, the nerve is now
called inferior laryngeal nerve
 Innervations: laryngeal mucosa below
fissure of glottis , all laryngeal laryngeal
muscles except cricothyroid
Arteria thyroid ima 甲状腺最下动脉
 May arise (4%) from the brachiocephalic a. or aortic arch
Venous drainage
 Superior and middle thyroid veins into internal jugular vein
 Inferior thyroid veins to left brachiocephalic vein
Parathyroid gland 甲状旁腺
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Yellowish-brown, ovoid bodies
Position
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Two superior parathyroid
glands: lie at junction of
superior and middle third of
posterior border of thyroid
gland
Two inferior parathyroid
glands: lie near the inferior
thyroid artery, close to the
inferior poles of thyroid gland
Function: regulate calcium and
phosphate balance and is
therefore essential for life
Cervical part of trachea 气管颈部
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
Begins at lower end of larynx－level of
C6 vertebra
Consists of a series of incomplete
cartilage rings
Extends into thorax
Relations in the neck

Anteriorly
The skin , superficial fascia, investing
fascia, suprasternal space and jugular
arch, infrahyoid muscles and pretracheal
fascia, isthmus of thyroid gland ( in front
of the 2nd to 4th tracheal cartilage),
inferior thyroid v. and unpaired thyroid
venous plexus, arteria thyroid ima ( if
present), and left brachiocephalic v. in
child


Laterally
The lobes of the thyroid gland ( down as far as the sixth ring) and
the carotid sheath
Posteriorly
The right and left recurrent laryngeal nerves, the esophagus
Cervical part of esophagus 食管颈部



Connecting the pharynx at level of
C6 vertebra
Consists of smooth muscle tube
Relations of the neck
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

Anteriorly
Trachea , recurrent laryngeal nerves
ascend, one on each side, in the
groove between the trachea and
esophagus
Posteriorly
Prevertebral layer of cervicl fascia,
longus colli, and vertebral column
Laterally
Lobe of the thyroid gland and
carotid sheath
Sternocleidomastoid region
胸锁乳突肌区
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
Covered by
sternocleidomastoid
Contents
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Ansa cervicalis
Carotid sheath
Cervical plexus
Cervical part of
synpathetic trunk
Root of neck 颈根部

Formed at thoracic inlet by



Anteriorly－manubrium
sterni
Posteriorly－body of first
thoracic vertebra
Laterally－first rib and costal
cartilage

Contents
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Cupula of pleura－
extends up into the neck,
over the apex of lung,
2～3cm above the medial
third of clavicle
Subclavian v.
Subclavian a.
Thoracic duct
Right lymphatic duct
Vagus n.
Phrenic n.
Lateral region of neck 颈外侧区


Bounded by posterior
border of
sternocleidomastoid,
anterior border of
trapezius and middle
third of clavicle
Divided by inferior belly
of omohyoid into
occipital and
supraclavicular
triangles
Triangle of the vertebral a.

椎动脉三角
Boundaries
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Medially－longus colli
Laterally－scalenus anterior
Inferiorly－first part of subclavian a.
Apex－transvese procss of C6
Posteriorly－cupula of pleura,
transvese procss of C7, anterior rami
of C8 spinal nerves, costal neck of
1st rib
Anteriorly－carotid sheath, phrenic n.
and arch of thoracic duct (left)
Contents
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Vertebral a.
Inferior thyroid a.
Cervical part of sympathetic trunk
Cevicothoracic ganglion
Occipital triangle 枕三角
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
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Bounded by posterior border of
sternocleidomastoid, anterior
border of trapezius and
superior border of inferior belly
of omohyoid
Covered by skin, superficial
fascia, and investing fascia
Floor－prevertebral fascia and
scalenus anterior, scalenus
medius, scalenus posterior,
splenius capitis and levator
scapulae
Conents


Accessory n.－emerges above
the middle of the posterior
border of sternocleidomastoid
and crosses the occipital
triangle to trapezius
Cervical and brachial plexuses
Supraclavicular triangle 锁骨

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上三角
Bounded by posterior border of
sternocleidomastoid, inferior
belly of omohyoid and middle
third of clavicle
Covered by skin, superficial
fascia, and investing fascia
Floor－prevertebral fascia and
inferior parts of scalenus
Conents


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Subclavian v. and venous
angle
Subclavian a.
Brachial plexus
Dissection
Platysma
Cutaneous nerves and superficial veins
Lesser occipital n.
External jugular vein
Greet auricular n.
Transverse nerve of neck
Anterior jugular vein
Supraclavicular n.
Submendibular gland
Digastric
Accessory n.
Hypoglossal n.
Superior thyroid a.
Ansa cervicalis
Sternothyroid
Sternohyoid
Vagus n.
Cervical plexus
Phrenic n.
Omohyoid
Hypoglossal n.
Vagus n.
Internal branch
Superior thyroid a.
Vertebral a.
External branch
Inferior thyroid a.
Inferior thyroid a.
Recurrent laryngeal n.
Vagus n.
Thoracic duct
Vertebral a.
Transvers cervical a.
Costocervical
trunk
Inferior thyroid a.
Thyrocervical trunk
Suprascapular a.
Internal thoratic a.