head and neck surface anatomy

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Head and Neck
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Topographical view
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Surface anatomy - neck

1. Hyoid
2. Thyroid cartilage
3. Cricoid cartilage
4. SCM muscle
5. Sternum
6. Chassaignacs tubercles
7. Sternal notch

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Surface anatomy - neck

1. Inion
2. Trapezius
3. Trasversocostal muscle group
4. C7 spinous process
5. T1 spinous process
6. Nuchal ligament
7. Post. facet joint
8. Suboccipital muscle
9. Greator occipital nerve

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Bony Landmark Trails
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Bony Landmark Trails
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Bony Landmark Trails
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Muscles of the Head, Neck and Face
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Sternocleidomastoid

• Action
• Bilateral Extends the head, assists in
  respiratio when the head is fixed
• Unilateral Tilts the head to the same side,
  rotates the head to the opposite side
• Origin
• Sternal head Manubrium
• Clavicular head Medial third of the clavicle
• Insertion
• Mastoid process and superior nuchal line
• Innervation
• Acessory nerve and direct branches from the
  cervical plexus (C1-2)

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Sternocleidomastoid

• Supine
• Locate the matoid process, medial clavicle and
  the top of the sternum
• Ask pt. to raise his head very slightly off the
  table as you palpate SCM

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Sternocleidomastoid

• Palpate along the borders of the SCM
• Follow it behind the earlobe and then down to the
  clavicle and sternum

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Test for SCM
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Test for SCM

• Patient Supine with elbows bent and hands beside
  the head, resting on table
• Fixation If the anterior abdominal muscles are
  weak, the examiner can provide fixation by
  exerting firm, downward pressure on the thorax
• Test Anterolateral neck flexion
• Pressure Against the temporal region of the head
  in an obliquely posterior direction

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Scalene muscles

• Anterior scalene
• Middle scalene
• Posterior scalene
• Actions of scalenes muscles
• Unilaterally Laterally flex the head and neck to
  the same side, rotate head and enck to the
  opposite side
• Bilaterally Elevate the ribs during inhalation,
  flex the head and neck

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Anterior scalene

• Origin
• TP of 3rd through 6th cervical vertebrae (ant.
  tubercle)
• Insertion
• 1st rib
• Innervation
• Cervical and brachial plexus (C3-6)

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Middle scalene

• Origin
• TP of 3rd through 7th cervical vertebrae (post.
  tubercle)
• Insertion
• 1st rib
• Innervation
• Cervical and brachial plexus (C3-6)

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Posterior scalene

• Origin
• TP of 5th through 7th cervical vertebrae (post.
  tubercle)
• Insertion
• 2nd rib
• Innervation
• Cervical and brachial plexus (C3-6)

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Scalenes as a group

• Supine
• Cradle the head to allow for easier palpation
• Place your finger pad along the ant. and lat.
  sides of the neck b/w SCM and trapezius

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Masseter

• Supine
• Locate zygomatic arch and angle of the mandible
• Place your fingers b/w these bony landmarks and
  palpate the surface of the masseter
• Ask pt. to alternately clench and relax her jaw

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Temporalis

• Supine and locate the zygomatic arch
• Place your finger pads 1 inch superior to the
  arch
• Ask pt. to alternately clench and relax her jaw

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Temporalis

• To locate the insertion site of the temporalis
  tendon, ask pt. to open her mouth wide
• Locate and explore the coronoid process

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Occipitofrontralis

• Frontalis fibers
• supine
• place fingers on the forehead
• ask pt. to raise his eyebrows
• Occipitalis fibers
• supine or prone
• locate sup. nuchal line
• slide fingers 1 inch superiorly

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Splenius muscles
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Splenius muslces

• 7. Splenius cervicis
• 8. Splenius capitis

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Splenius muscles

• Action
• Entire muscle bilateral contraction extends the
  cervical spine and head, unilateral contraction
  flexes and rotates the head to the same side
• Origin
• Splenius cervicis Spinous process of T3-T6
  vertebrae
• Splenius capitis Spinous process of C3-T3
  vertebrae
• Insertion
• Splenius cervicis Transverse process of C1-2
• Splenius capitis Lateral superior nuchal line,
  mastoid process
• Innervation
• Lateral branches of dorsal rami of spinal nerves
  C1-6

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Splenius capitis

• Prone, locate the upper fibers of the trapezius
• Isolate the lat. edge of the trapezius by
  extending pts head slightly
• Palpate just lateral to the trapezius and follow
  the oblique fiber up to the mastoid process

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Both splenii muscles

• Supine with head rotated 45 away from the side
  palpating
• Cradle the head with one hand while the other
  hand locates the lamina groove of the upper
  cervical vertebrae

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Suboccipitalis
Rectus capitis post. minor
Rectus capitis posterior major
Oblique capitis superior
Oblique capitis inferior
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Suboccipitalis

1. Rectus capitis posterior major
2. Rectus capitis posterior minor
3. Rectus capitis superior
4. Rectus capitis inferior

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Rectus capitis posterior major

• A Bilateral contraction extends the head.
  Unilateral contraction rotates the head to the
  same side
• O SP of the axis
• I Inferior nuchal line of the occiput
• N Suboccipital

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Rectus capitis posterior minor

• A Bilateral contraction extends the head.
  Unilateral contraction rotates the head to the
  same side
• O Tubercle of the posterior arch of the atlas
• I Inferior nuchal line of the occiput
• N Suboccipital

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Oblique capitis superior

• A Bilateral contraction extends the head.
  Unilateral contraction tilts the head to the same
  side and rotates it to the opposite side
• O TP of Atlas
• I Above the insertion of the rectus capitis
  posterior major
• N Suboccipital

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Oblique capitis inferior

• A Bilateral contraction extends the head.
  Unilateral contraction rotates the head to the
  same side
• O Sp of the axis
• I TP of the atlas
• N Suboccipital

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Suboccipitalis

• Supine position
• Cradle the head in both hands
• Passively extending the neck a bit
• Locate sup. nuchal line and spinous process of
  C2
• ? Suboccipital span the area between these two
  landmarks

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Suboccipitals

• Prone position
• Locate lat. edge of the trapezius upper fiber
• Palpating beside the level of C1, place one
  finger at the lateral edge of the trapezius
• Slowly sink medially into the suboccipitalis

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Test for posterolateral neck extensor
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Test for posterolateral neck extensor

• Splenius capitis/cervicis, semispinalis
  capitis/cervicis, and cervical erector muscles
• Patient Prone with elbows bent and hands
  overhead, resting on the table
• Fixation None necessary
• Test Posterolateral neck extension, with the
  face turned toward the side being tested
• Pressure Against the posterolateral aspect of
  the head in an anterolateral direction