6.0 Anatomy of the Neck

Surgically, it is useful to consider the neck anatomy in terms of compartments or levels and to consider fascial layers. The neck is covered by a layer of superficial fascia, and the deep cervical fascia can be divided into superficial, middle, and deep layers ( Fig. 6.1 ). This is relevant in terms of spread of infection and lymphatic spread of cancer. The neck can be grossly divided into the anterior and posterior neck. Posteriorly, of course, are the cervical spine and paraspinal muscles. Anterolaterally, the neck contents are considered in terms of nodal levels I though VI ( Fig. 6.2 ).

Each level contains a compartment of fibrofatty lymph node–bearing tissue that is addressed for removal during neck dissection procedures for cancer. Level I consists of the submental region and the submandibular area containing the submandibular gland. Level II is the upper jugular chain lymph node region, level III is the middle jugular chain, and level IV is the inferior jugular chain region. Level V is the posterior triangle from the anterior border of the trapezius to the posterior border of the sternocleidomastoid muscle. Level VI is the node-bearing tissue of the central compartment. The visceral structures of the neck are included in the central compartment and include the laryngotracheal complex, the thyroid and parathyroids, and the cervical esophagus.

Blood Supply

The common carotid artery ascends into the neck and bifurcates into the internal and external carotid artery approximately at the level of the hyoid bone. The internal carotid has no branches in the neck and delivers important blood supply to the brain, along with the vertebral arteries. The external carotid supplies the head and neck structures via multiple branches (in order, starting inferiorly): the superior thyroid, ascending pharyngeal, lingual, facial, occipital, posterior auricular, superficial temporal, and maxillary arteries ( Fig. 6.3 ). Venous drainage tends to parallel major arteries, with variable anterior and external jugular branches superficially, and large common facial veins joining into the internal jugular vein, which feeds the subclavian veins. The carotid sheath, formed by all three layers of the deep cervical fascia, contains the carotid artery, jugular vein, and vagus nerve. Important delicate lymphatics from the thoracic duct carry chyle into the jugular vein near its junction with the subclavian in the left neck; however, accessory thoracic ducts commonly occur on the right.

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