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The topography of the Neck. Fasciae of the neck, their classification by Shevkunenko

MUSCLES OF THE NECK

The group of cervical muscles includes muscles of different origin.

l. Derivatives of the visceral arches: (a) derivatives of the first visceral
arch: m. mylohyoideus, venter anterior m. digastrici. Innervation: n. trige-
minus; (b) derivatives of the second visceral arch: m. stylohyoideus, venter
posterior m. digastrici, platysma. Innervation: n. facialis; (c) derivatives
of the branchial arches: m. sternocleidomastoideus. Innervation: n. acces-
sorius and plerus cervicalis.

2. Autochthonous muscles of the neck: (a) anterior muscles: m. sterno-
hyoidean, m. sternothyroideus, m. thyrohyoideus, and m. omohyoideus,
as well as m. mylohyoideus; (b) lateral muscles: mm. scaleni anterior,
medius and posterior (c) prevertebral muscles: m. longus colli, m. longus
capitis and m. rectus capitis anterior.

The autochthonous cervical muscles are rudiments of the ventral
musculature on whose distribution two important circumstances had an
effect: reduction of the ribs and reduction of the body cavity. As a result
some of the autochthonous muscles of the neck disappeared in man, and only
the scalene, vertebral, and geniohyoid muscles remained. According to
their development, they are innervated by the anterior branches of the cervi-
cal spinal nerves.

The muscles located below the hyoid bone are connected with the
sublingual apparatus and innervated from the ansa cervicalis.

Topographically, the muscles of the neck are grouped as follows.

1. Superficial muscles (platysma, m. sternocleidomastoideus).

2. Medial muscles, or muscles of the hyoid bone: (a) muscles located
above the hyoid bone (mm. mylohyoideus, digastricus, styloh'yoideus, ge-
niohyoideus); (b) muscles located below the hyoid bone (mm. sternohyoideus,
sternothyroideus, thyrohyoideus, omohyoideus).

3. Deep muscles: (a) lateral, attached to the ribs (mm. scaleni ante-
rior, medius and posterior); (c) prevertebral muscles (m. longus colli, m.
longus capitis, m. rectus capitis anterior and lateralis).

The fist fascia, or the superscial cervical fascia (fascia colli superficial)
is part of the common supeficial (subcutaneous) fascia of the body and is
continuous with the fasciae of the neighbouring areas. It is distinguished
from the superficial fascia of the other parts of the body in that it contains
the platysma muscle for which it is the perimysium.

The second fascia, or the superficial layer of the cervical fascia proper
(lamina superficialis fascia colli propriae) encloses the whole neck like a collar
and covers the suprahyoid and infrahyoid group of muscles, the salivary
glands, the vessels, and the nerves. It is attached above to the mandible and
the mastoid process and is continuous on the face with the parotid and masse-
teric fasciae which cover the parotid gland and the masseter muscle

The third fascia, or the deep layer of tbe cervical fascia proper (laming
pnfunda facial colli propriae) is manifest only in the middle part of the
neck behind the sternocleidomastoid muscle where it is stretched like a tra-
pezium over a triangular space bounded above by the hyoid bone, on both
sides by the omohyoid muscles, and below by the clavicles and the sternum,

The fourth fascia, or the endocervical fascia (fascia endocenncalis)
encloses the organs located in the neck (Iarynx, trachea, thyroid gland,
pharynr, oesophagus, and the large vessels). It consists of two layers, a vis-
ceral layer which invests each of these organs and forms a capsule for them,
and a parietal layer which encloses all the organs in the aggregate and
forms a sheath for the important vessels, the common carotid artery and
the internal jugular vein.

The fifth, prevertebral fascia (fascio prevertcbreLis) covers anteriorly
the prevertebral and scalene muscles stretching on the spine, and by fusing with the transverse processes of the vertebrae forms sheaths for these muscles.

The five fasciae described differ in origin: some are reduced muscles
(the first fascia is the perimysium of platysma muscle, the third fascia is the
reduced cleidohyoideus muscie of which only the aponeurosis remains);
others are the products of thickening of the fatty tissue surrounding the
organs (the parietal and visceral layers of the fourth fascia), and still others
originate in a manner common to fasciae (the second and fifth fasciae).

According to the Paris Nomina Anatomica, all fasciae of the neck are
embraced under the term fascia cervicalis, which is divided into three layers
as follows.

1. The superficiol layer (fascia) (lamina superficiolis) corresponding
to the first fascia, fascia colli superficialis.

2. The pretracheal layer (fascia) (4mina pretruchcolQ) covering the
salivary glands, muscles, and other structures located in front of the trachea,
hence its name. It corresponds to the second and third fasciae (after Shevku-
nenko), i.e. the superficial aud deep layers of fascia colli propriae.

3. The prevertebral layer (fascia) (lamino prevertebralis) corresponding
to the fifth fascia, i. e. fascia prevertebralis (after Shevkunenko).

The fourth fascia (fascie endocervicalis) is omitted in PNA.

The cervical fasciae are firmly connected with the walls of the veins
by means of connective-tissue strands which prevent them from collapsing
in injuries. Damage to even the small cervical veins is therefore fraught with
danger because due to the closeness of the right atrium and the suction action
of the chest air can enter the blood flow, i.e. air embolism can occur.

46. Muscles & fasciae of the chest, their structure, function, topography, blood & nerve supply. Topography of intercostal spaces. Diaphragm: structure, function, topography, blood & nerve supply, lymphatic drainage.

The musculature of the chest is divided into the muscles that originate from the surface of the thoracic cage and stretch from it to the shoulder girdle and upper limb and the muscles proper (autochthonous) of the chest, which are components of the thoracic wall.

1. Chest muscles related to the upper limb: m. pectoralis major, m. pectoralis minor, m. subclavius, m. serratus anterior. Innervation is from the branches of the brachial plexus.

2. Autochthonous muscles of the chest: mm. intercostales extend, mm. intercostales interni, mm. subcostales and m. transversus thoracis. Innervation is from the intercostal nerves. We shall also describe here the diaphragm, which delimits and separates the thoracic cavity from the abdominal cavity. The diaphragm is related to the neck in origin and is therefore innervated mainly from the cervical plexus (phrenic nerve, C3-5).

CHEST MUSCLES RELATED TO THE UPPER LIMB

1. The pectoralis major muscle (m. pectoralis major) originates from the medial half of the clavicle (pars clavicularis), the anterior surface of the sternum and cartilages of the second to seventh ribs (pars sternocostalis) and, from the anterior wall of the sheath of the rectus abdominis muscle (pars abdominalis).

Innervation: C5-8. Medial and lateral pectoral nerves.

2. The pectoralis minor muscle (m. pectoralis minor) is under the greater pets al muscle, It originates from 2^nd to 5^th ribs by means of four slips and is inserted into the coracoid process of the scapula. Innervation: C7-8. Medial and lateral pectoral nerves.

3. The subclavius muscle (m. subclavius) is very small and stretches from the clavicle to the first rib. Innervation: C5-6.. Subclavius nerve

4. The serratus anterior muscle (in. serratus anterior) is on the surface of the lateral chest wall. Contraction of the whole anterior serratus muscle simultaneously with the muscles of the back (the rhomboid and trapezius muscles) immobilizes the scapula by pulling it forward. The lower end of the muscle rotates anteriorly and laterally the inferior angle of the scapula, as occurs in lifting the limb above the shoulder. The superior slips move the scapula together with the clavicle forward and act as antago-nists of therve. middle fibres of the trapezius muscle. Innervation: C5-7. long thoracic nerve

AUTOCHTHONOUS MUSCLES OF THE CHEST

I. The external intercostal muscles (mm. intercostales externi) fill the intercostal spaces from the smile to the costal cartilages. They Originate from the inferior border of each rib, descend posteroanteriorly, and attach to the superior border of the contiguous rib above. Between the costal cartilages the muscles are replaced by a fibrous band with fibres lying in the same direction (membrana irztercostalis externs). Innervation: Th1-11. Intercostal nerves.

2. The internal intercostal muscles (mm. intercostales interni) are under the external muscles, and the direction of their fibres is opposite to that of thee thereof the latter, which they intersect at an angle. Innervation: Th1-11 Intercostal nerves

3. The subcostal muscles (rnm. subcostales) are thin muscular bundles found on the inner surface of the lower part of the thoracic cage in the costal angles. Innervation: Th8-11 intercostal nerves

4. The transversus thoracis muscle. Innervation: Th3-6. intercostal nerves

FASCIAE OF THE CHEST The anterior surface of the pectoralis major muscle is covered by the superficial sheet of the pectoral fascia (fascia pectoralis), which is continuous medially with the sternal periosteum, superiorly with the clavicular periosteum, and laterally with the deltoid fascia (fascia deltoidea). In females this sheet separates the muscle from the rnammary gland. Under the pectoralis major muscle is the more conspicuous deep sheet of the pectoral fascia; it is thickest in the region of the clavipectoral triangle and is known here as the clavipectoral fascia (fascia clavipectoratis).

The diaphragm is the dome-shaped sheet of muscle that separates the chest from the abdomen. It is also referred to the thoracic diaphragm because it’s located in the thoracic cavity, or chest. It is attached to the spine, ribs and sternum and is the main muscle of respiration, playing a very important role in the breathing process. The lungs are enclosed in a kind of cage in which the ribs form the sides and the diaphragm, an upwardly arching sheet of muscle, forms the floor. When we breathe, the diaphragm is drawn downward until it is flat. At the same time, the muscles around the ribs pull them up like a hoop skirt. The chest, or thoracic, cavity becomes deeper and larger, making more air space.

47. Muscles of the abdomen: structure, function, topography, blood & nerve supply. The inguinal canal, its walls, superficial and deep rings and content.

The muscles of the abdomen occupy the space between the inferior
circumference of the thoracic cage and the superior border of the pelvis.
They surround the abdominal cavity and form its walls

i. The lateral muscles: the external oblique muscle (m. obliquus ezter-
nus abdominis), the internal oblique muscle (m. obliquus internus abdominis),
the transversus abdominis muscle (m. transversus abdominis).

2. The anterior muscles: the rectus abdominis muscle (m. rectus abdo-
minis) and the pyramidalis muscie (m. pyramidalis).

3. The posterior muscies: the quadratus lumborum muscle (m. quadra-
tus lumborum).

The abdominal muscles are exclusively related to the autochthonous
ventral musculature of this region and are innervated by the intercostal
nerves (5th to 12th) and the superior branches of the lumbar plexus.

48. Muscles & fasciae of the back: structure, function, topography, blood & nerve supply.

1.Superficial muscles: a) trapezius. Function- upper fibers of muscles lift up the shoulder girdle, the scapula rotates its lower angle in the lateral direction, as it happens, for example, picked up arms above the horizontal line.

b) the latissimus dorsi. Function - Pulling the hand backwards and downwards with turning it inwards, as, for example, is done by removing the conductor handkerchief from his back pocket of his coat.

a) m. levator scapulae(function-. Muscles that attach to the ribs lie in the third layer of the surface of the back muscles in the form of two thin plates) and m. rhomboideus(function- With the reduction of the rhomboid muscle pulls the shoulder blade and the spine upwards)

2.Muscles that attach to the ribs: mm. serratus posterior superior(function-Raises ribs (Inn. ThI-IV, Nn. Intercostales)). Inferior(function- Lowers the lower ribs (Inn. ThIX-XII, Nn. Intercostales

3.Deep muscles Autochthonous back muscles

- M. splenius capitis etcervicis. Function. With the reduction of one muscle head turns towards reduction, while bilateral contraction of the muscle to bend over backwards head and neck.

Lateral tract.

1. M. erector spinae

a) to the ribs - m. iliocostalis, ilio- costal muscle (lateral part of m. erector spinae);

b) to the transverse processes - m. longissimus, muscle length (middle part m. erector spinae) and processus mastoideus (department head);

c) to the spinous processes - m. spinalis, bearded muscle (medial m. erector spinae).

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