146 The Cervical Nerves 



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level than the lesser occipital behind the sterno-mastoid, and, winding 

 up over that muscle, reaches the parotid gland, giving branches to the 

 skin of the masseteric and the mastoid regions, to the back of the pinna, 

 and to the lobule. 



The superficial cervical winds across the middle of the sterno- 

 mastoid, under the external jugular vein and the deep fascia, and, 

 piercing the fascia at the front of the neck, divides beneath the pla- 

 tysma into an ascending branch, which supplies the skin over the sub- 

 maxillary region, joining there with the infra-maxillary branch of the 

 facial, and a descending branch, which supplies the skin along the front 

 and lower part of the neck. 



The supra-clavicular are the lowest and last of the superficial 

 branches ; they come from the third and fourth trunks, and emerge 

 from behind the sterno-mastoid. They descend in sternal, median, 

 and acromial branches to supply the skin of the pectoral and deltoid 

 regions. Sometimes one of the median set courses through the sub- 

 stance of the clavicle. In the case of fracture of the collar-bone 

 branches of these nerves may be bruised between the fragments, great 

 pain resulting. 



The supra-clavicular nerves take the place of lateral cutaneous 

 branches of the first and second dorsal nerves. 



When, as the result of caries, for instance, there is pressure upon 

 the posterior roots of the third and fourth nerves, peripheral pain 

 usually occurs in the area of distribution of these nerves : symmetrical 

 pains about the shoulders of a child should always direct attention to 

 the neck. 



Peripheral neuralgias of the scalp, neck, pectoral region, or 

 sJioulder, are often caused by inflammatory pressure upon the 

 sensory roots of the nerve-trunks, and are often met with in disease 

 of the occipito-atloid joint, and in caries of the upper cervical verte- 

 bras. These pains are generally, but not always, in symmetrical 

 areas, whilst neuralgia which is due to pressure of a tumour outside the 

 spinal canal would be confined to one side, unless, indeed, it reached 

 across the middle line. A little girl who was brought to me with 

 mid-cervical caries suffered from darting pains across the front of the 

 neck, which she quaintly called ' belly-ache in the neck.' When 

 there is pressure upon the second nerve the pains in the area of the 

 lesser and greater occipitals are often called ' head-ache,' and when 

 those filaments of the second and third nerves which belong to the 

 great auricular are in distress the neuralgia may be called * ear-ache,' 

 or 'face-ache.' It is, then, of the greatest importance to know the 

 exact distribution of these nerves (see PINNA, p. 94). 



Of the deep branches, some communicate with the sympathetic, 

 vagus, and hypoglossal; the second and third send down also com- 

 nninicantes hypoglossi (or noni) over the internal jugular vein to join 

 the descendens noni. Other branches pass to neighbouring muscles, 



