THE HEAD AND NECK 



BACK OF THE SCALP AND NECK 



Landmarks. — ^The external occipital protuberance can, as a rule, 

 readily be made out, and the superior curved line, if well developed, 

 may be felt extending outwards from it. The mastoid process of 

 the temporal bone can be distinguished without difficulty behind 

 the auricle. The occipital artery, with the great occipital nerve 

 on its inner side, lies a little internal to the centre of a line connect- 

 ing the external occipital protuberance and the tip of the mastoid 

 process. The occipital lymphatic gland, or glands, may be felt, when 

 enlarged, over the upper part of the trapezius or complexus muscle. 

 The spine of the seventh cervical vertebra, or vertebra prominens, 

 can easily be felt, and that of the sixth may also be made out. 

 Extending from the external occipital protuberance to the seventh 

 cervical spine there is an elongated depression, called the nuchal 

 furrow, which indicates the position of the ligamentum nuchas. 

 It is possible to feel the strong bifid spine of the axis by sinking 

 the finger deeply into the upper part of the nuchal furrow, near 

 the occipital bone, but the spines of the third, fourth, and fifth 

 cervical vertebrae lie too deeply for detection. The lymphatic 

 glands, known as the gland ulae concatenatae, may be felt, when en- 

 larged, along the posterior border of the sterno-cleido-mastoid 

 muscle. 



Back of the Neck — Fasciae. — ^The superficial fascia presents 

 nothing worthy of note. The deep fascia closely invests the 

 cervical portion of the trapezius, and is then prolonged over the 

 posterior triangle of the neck to the posterior border of the sterno- 

 cleido-mastoid, where it divides to ensheathe that muscle. It 

 will be described in connection with the deep cervical fascia. 



Nerves. — ^The nerves of this region are as follows : the great 

 occipital ; the least or third occipital ; the internal branches of 

 the posterior primary divisions of the third, fourth, and fifth cervical 

 spinal nerves ; the small occipital ; the great auricular ; the super- 

 ficial cervical ; the spinal accessory ; and the descending superficial 

 branches of the cervical plexus, namely, the suprasternal, supra- 

 clavicular, and supra-acromial. 



1058 



