i6o 



APPLIED ANATOMY. 



second and third vertebrae. Working still higher, the transverse process of the 

 atlas or first cervical vertebra will be felt and seen below and to the inner side of the 

 mastoid process. The connective tissue adherent to the nodes is attached to this 

 transverse process and may have to be cut loose or scraped away. In doing so 

 keep to the outer edge because the jugular vein and internal carotid artery lie on its 

 anterior surface. 



Beneath the sternomastoid runs the anterior scalene muscle and on it, coming 

 from the third, fourth, and fifth cervical nerves, is the phrenic nerve; so that it is 

 not permitted to dig into and disturb the muscular mass to the outer side of the 

 common carotid artery on which these nodes frequently lie. 



In operating in the submental region there is nothing to fear. The space 

 between the two anterior bellies of the digastric muscles on the sides, the hyoid 

 bone below, and down to the anterior surface of the mylohyoid muscle beneath, can 

 be cleared out with impunity. 







Occipitalis major nerve 

 Occipital artery 

 Occipitalis minor nerve 



Splenius muscle 



Auricularis magnus nerve 



Superficial cervical nerve 



Levator scapulae muscle 



Spinal accessory nerve 



Trapezius 



Middle scalene muscle 



Sternomastoid muscle 



Anterior scalene muscle 



Phrenic nerve 



Internal jugular vein 



Omohyoid muscle 



Transverse cervical 



artery 



Brachial plexus 



- Posterior scalene muscle 

 External jugular vein 



Omohyoid muscle 



Subclavian vein 



Subclavian artery 



FIG. 182. The posterior cervical triangle. 



In the submaxillary region remember that the fascia covering the submaxillary 

 gland is thin, so that the gland will probably be exposed as soon as the superficial 

 structures are raised. As the facial artery and vein cross the mandible just in front 

 of the masseter muscle, the vein is posterior. The artery goes under the gland and 

 is adherent to it, so that as the gland is raised the artery is brought up also. The 

 facial and lingual veins usually empty into the internal jugular, but, as shown in Fig. 

 1 68, they may receive a communicating branch from the external jugular and the 

 anterior jugular and continue down as the anterior jugular to empty into the 

 external jugular low down in the neck, beneath the sternomastoid muscle. The 

 hypoglossal nerve will be seen lying on the hyoglossus muscle, but it is readily 

 avoided. The lingual artery is beneath the hyoglossus muscle anteriorly but both it 

 and the facial must be looked for as one nears the posterior belly of the digastric. 



In the lower cervical region, opposite the cricoid cartilage, the omohyoid muscle 

 will be met. It will sometimes be necessary to divide it. The sternohyoid and sterno- 

 thyroid muscles and the thyroid gland are to be drawn inward and the sternomastoid 

 outward. One should always keep away from the thyroid gland, as the recurrent 



