Deep structures

of neck
 SCALENUS ANTERIOR

 Origin
 Ant tubercles of transverse processes of
C3-6
 Action
 Accessory to inspiration. Lat flexion of neck
when 1st rib fixed
 Insertion
 Scalene tubercle on sup aspect of 1st rib
 Nerve
 Ant primary rami of C5, 6
 SCALENUS MEDIUS

 Origin
 Post tubercles of transverse processes of
C2-7
 Action
 Accessory to inspiration
 Insertion
 Sup aspect of neck of 1st rib
 Nerve
 Ant primary rami of C3-8
 SCALENUS MINIMUS

 Origin
 Ant tubercle of transverse process of C7
 Action
 Supports suprapleural membrane
 Insertion
 Suprapleural membrane (Sibson's fascia)
 Nerve
 Ant primary rami of C7
Thyroid gland

Endocrine gland
 The thyroid gland is located in
the neck, in close approximation
to the first part of the trachea
 has a "butterfly" shape, with two
lateral lobes that are connected by a
narrow section called the isthmus.
 Sometimes a third lobe ,pyramidal
lobe may project from the isthmus
 Situation and extent
 Liesagainst C 5,6,7 and T1
 Each lobe extends from mid of
thyroid cart to 4-5 tracheal ring
 Isthmus lies against 2-3 ring
 Lobes of thyroid
 conical in shape,
 the apex of each being directed
upward and lateralward
 about 5 cm. long; its greatest width
is about 3 cm., and its thickness
about 2 cm.
 lateral or superficial
surface
 isconvex,
 covered by the skin, the superficial and
deep fasciæ, the Sternocleidomastoideus,
the superior belly of the Omohyoideus, the
Sternohyoideus and Sternothyreoideus
 the pretracheal layer of the deep fascia,
which forms a capsule for the gland
 deep or medial surface
 moulded over the underlying structures,
viz., the thyroid and cricoid cartilages,
the trachea, the Constrictor pharyngis
inferior and posterior part of the
Cricothyreoideus, the esophagus
(particularly on the left side of the neck),
the superior and inferior thyroid arteries,
and the recurrent nerves.
 anterior border is thin, and inclines
obliquely from above downward
toward the middle line of the neck,
 the posterior border is thick and
overlaps the common carotid artery,
and, as a rule, the parathyroids.
 isthmus
 connects together the lower thirds of the lobes
 it measures about 1.25 cm. in breadth, and the
same in depth
 usually covers the second and third rings of the
trachea.
 In the middle line of the neck it is covered by the
skin and fascia, and close to the middle line, on
either side, by the Sternothyreoideus.
 Across its upper border runs an anastomotic
branch uniting the two superior thyroid arteries;
at its lower border are the inferior thyroid veins.
 pyramidal lobe
 conical shape, frequently arises from the upper
part of the isthmus, or from the adjacent
portion of either lobe, but most commonly the
left,
 ascends as far as the hyoid bone.
 A fibrous or muscular band is sometimes found
attached, above, to the body of the hyoid
bone, and below to the isthmus of the gland, or
its pyramidal lobe. When muscular, it is termed
the Levator glandulæ thyreoideæ.
 Capsule of thyroid
 True capsule:
 Formed by peripheral condensation
of the conn tissue
 False capsule
 Pretracheal layer of deep cervical
fascia
 The capillary plexus lies deep to true
capsule
 Development.
 The thyroid gland is developed from a median
diverticulum which appears about the fourth week
 It grows downward and backward as a tubular duct,
which bifurcates and subsequently subdivides into a
series of cellular cords, from which the isthmus and
lateral lobes of the thyroid gland are developed.
 The connection of the diverticulum with the pharynx
is termed the thyroglossal duct; it undergoes
degeneration, its upper end being represented by the
foramen cecum of the tongue, and its lower by the
pyramidal lobe of the thyroid gland.
 Blood supply
Arterial
Superior thyroid artery (branch of external
carotid)
Inferior thyroid artery (branch of thyrocervical
trunk)
Thyroid "ima" artery (variable)

Venous
Superior thyroid vein
Middle thyroid vein
Inferior thyroid vein
 Lymphatic drainage and nerve
supply
 Lymphatic drainage
 Deep cervical nodes
 Nerve supply
 Middle cervical ganglion (mainly)
 Superior and inferior cervical
ganglion partly
 Applied anatomy
 Goitre
 Thyroidectomy
 Hypo and hyperthyroidism
Parathyroid glands
 Parathyroid Glands
 Four glands: two on each side
 Derived from branchial pouches III and IV:
 Superior parathyroid glands from pouch
IV
 Inferior parathyroid gland from pouch III.
 Position
 Superior parathyroid:
 More consstant
 Usually lies at the middle of the
posterior border
 It is usually dorsal to recurrent
laryngeal nerve
 Inferior parathyroid
 It may lie
 1) within thy cap below the inf thy art
 2).behind and outside thy cap
 3).within substance of lobe near post
border
 Blood and nerve supply
 Inf thyroid artery and
 Anastomosis between superior and
inferior thyroid art
 Nerve from middle and superior
cervical ganglia