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Nafeeya
1st yr pg
Anatomy Of Neck And Its
Medicolegal Importance
Overview
 Anatomy and its relations
 Glands of neck and its functions
 Hyoid bone
 Neck dissection
 Injuries of neck
 Medicolegal importance
Compartments
 Content of neck is grouped into neck
spaces called the compartments
 Vertebral compartments-cervical
vertebrae and postural muscles.
 Visceral compartments-glands[thyroid
,parathyroid and thymus],larynx ,pharynx
and trachea.
 Vascular compartments-common
carotid artery ,jugular vein ,and vagus
nerve on either side.
 Each compartments is enclosed by
musculofacial collar.
Vertebral Compartment
 Long flexible part
 It consist of 7 bones
 C1-C7
 Intervertebral disc
Muscles Of The Neck
Triangles Of Neck
Posterior Triangle Of Neck
Vasculature Of Neck
Nerve Supply Of Neck
 The
Cranial Nerves mainly
supplying neck are
 The Facial [VII],
 Glossopharyngeal [IX],
 Vagus [X],
 Accessory [XI], And
 Hypoglossal [XII] Nerves.
 Transverse Cervical Nerve
 Supraclavicular Nerve
Anatomy Of Thyroid Gland
 15-25gm
 Butterfly
 2 Lobes
 2 Capsule
 Isthmus Extends Across Midline
In Front Of 2 ,3
4th Tracheal Ring.
 Located Deep To Sternothyroid
and Sternohyoid
 Functions-metabolism
Growth,development.
 Regulates Body Function
Hyoid Bone
 U- shaped structure
 Located in the anterior neck.
 It lies at the base of the mandible (approximately c3)
 It acts as a site of attachment for the anterior neck muscles.
 The hyoid is ossified from 6 centers: two for the body, and one for
each cornu.
 The cartilage of the third pharyngeal arch forms the greater cornu
of the hyoid and the lower portion of the body of the hyoid.
 Ossification commences in the greater cornua toward the end of
fetal development. [3rd trimester]
 In the lesser cornua during the first or second year after birth.
 Elderly -calcified
Tension
Required
 TO OCCLUDE
VARIOUS
STRUCTURES IN THE
NECK:
 JUGULAR VEIN -2 KG
 CAROTID ARTERIES -5
KG
 TRACHEA -15 KG
 VERTEBRAL
ARTERIES -20 KG
Autopsy Neck Dissection
V-Shaped neck incision
Platysma and subcutaneous
tissue dissection.
Deep cervical fascia is
incised and reflected
Sternocleidomastoid
dissected & reflected
on each side
Omohyoid
,sternohyoid,thyrohy
oid reflected on
each side
Thyroid and carotid
sheath are freed from
investing layer
Larynx ,trachea,pharynx and
oesophagus are pulled away
from prevertebral tissue.
Larynx And Trachea
 Cartilagenous , ligamentous
 Below - hyoid
 Above -trachea .
 3-6 cervical vertebrae
 4-6 brachial arches
 Facilitates breathing and sound
 MC-triticeal cartilage [30%]
Injuries Of Neck
Injuries Of Thyroid Gland
 Complicated thyroidectomy surgery
 Recurrent laryngeal injury
 Branch of vagus nerve
 Unilateral injury-vocal cord motion
-Less-voice weak and motionless
 Bilateral injury-incomplete and complete
 Leads to adduction of cord and suffocation
 Complete-leads to aphonia
 Tetany
Zones Of Neck
Injuries Over The Region Of
Neck
1.Homicidal
o Strangulation- ligature or manual
o Throttling or manual strangulation
o Bansdola
o Garrotting
o Mugging
2.Penetrating Injuries-knife Or Gunshot
3.Cut Throat Injury
4.Injuries above level of C4- rapid death
o Atlanto occipital injury-fatal
o C1-C2-injury-neurogenic shock ,Odontoin#
o C2-C3-Hangman #
2.Suicidal
• Hanging[mc]
3.Judicial hanging
4.Accidental
 Hanging ?
 Chocking
 Café coranary
 Traumatic asphyxia
 Postural asphyxia
Hanging Ligature Strangulation
Ligature mark –oblique
Does not encircle the neck completely
Below chin and above thyroid cartilage
Base-pale ,hard and parchment like
Ligature mark-transverse
Encircle the neck completely
At or below thyroid cartilage
Base-soft and reddish
Brushing of neck muscles not common Brushing of neck muscles common
Neck streched and elongated Not so
Hyoid bone fracture may occur Uncommon –[manual-common]
Thyroid cartilage fracture –less
common
Thyroid cartilage fracture- more
common
Carotid intimal tear seen rare
Salivary dribbling present absent
Bleeding -uncommon common
Subconjuctival hemorrhage- absent present
PM Findings Of Hanging In The
Neck
 Petechiae-Tardieu spot
 Le facies sympathique
 Salivary dribbling
 Ligature mark
 Tissue under ligature mark are
dry ,pale,and glistening
 Thyroid cartilage fracture
 Hyoid bone fracture
Blunt Force Impact
 Blunt force impact to the side of neck-excessive rotation or
hyperextension
1. Shearing of neck muscle
2. Tearing of vertebral artery
3. Carotids get dissected
4. Veins damaged
5. Sub arachnoid hemorrhage.
 Blunt force impact on anterior neck
1. Crush injury larynx and trachea
2. Compression of esophagus against
spinal column
3. Sudden increased in intratracheal
pressure against closed glottis
4. Crush bruise
5. Rapid acceleration/deceleration-
tracheal injury
Sections
 Sec299-culpable homicide not amounting to
murder
 Sec 304-[life imprisonment with fine]
 Sec300-culpable homicide amounting to murder
 Sec 302-[capital punishment or life imprisonment
with fine]
 Sec305-abetment of suicide of child or insane
 Sec 306-abetment of suicide[1-10yrs +fine]
 Sec 307-attempt to murder[1-10yrs with fine]
 Sec 308-attempt to commit culpable homicide[1-
3yrs+fine]
Referrences
 Bd chaurasias human anatomy vol-3
 Richard and snells textbook of anatomy
 Guyton and hall text book of physiology
 Narayana reddy essential of forensic medicine
 Anil agarwal textbook of forensic medicine
 Rajesh bardalae textbook of forensic medicine
 Colour atlas of charles castanese
 Brendan c stalk neck dissection
 Essential of anatomy and physiology valarie c
scanlon

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anatomy of neck and its medicolegal importance

  • 1. Nafeeya 1st yr pg Anatomy Of Neck And Its Medicolegal Importance
  • 2. Overview  Anatomy and its relations  Glands of neck and its functions  Hyoid bone  Neck dissection  Injuries of neck  Medicolegal importance
  • 3. Compartments  Content of neck is grouped into neck spaces called the compartments  Vertebral compartments-cervical vertebrae and postural muscles.  Visceral compartments-glands[thyroid ,parathyroid and thymus],larynx ,pharynx and trachea.  Vascular compartments-common carotid artery ,jugular vein ,and vagus nerve on either side.  Each compartments is enclosed by musculofacial collar.
  • 4. Vertebral Compartment  Long flexible part  It consist of 7 bones  C1-C7  Intervertebral disc
  • 9. Nerve Supply Of Neck  The Cranial Nerves mainly supplying neck are  The Facial [VII],  Glossopharyngeal [IX],  Vagus [X],  Accessory [XI], And  Hypoglossal [XII] Nerves.  Transverse Cervical Nerve  Supraclavicular Nerve
  • 10. Anatomy Of Thyroid Gland  15-25gm  Butterfly  2 Lobes  2 Capsule  Isthmus Extends Across Midline In Front Of 2 ,3 4th Tracheal Ring.  Located Deep To Sternothyroid and Sternohyoid  Functions-metabolism Growth,development.  Regulates Body Function
  • 11. Hyoid Bone  U- shaped structure  Located in the anterior neck.  It lies at the base of the mandible (approximately c3)  It acts as a site of attachment for the anterior neck muscles.  The hyoid is ossified from 6 centers: two for the body, and one for each cornu.  The cartilage of the third pharyngeal arch forms the greater cornu of the hyoid and the lower portion of the body of the hyoid.  Ossification commences in the greater cornua toward the end of fetal development. [3rd trimester]  In the lesser cornua during the first or second year after birth.  Elderly -calcified
  • 12. Tension Required  TO OCCLUDE VARIOUS STRUCTURES IN THE NECK:  JUGULAR VEIN -2 KG  CAROTID ARTERIES -5 KG  TRACHEA -15 KG  VERTEBRAL ARTERIES -20 KG
  • 14. V-Shaped neck incision Platysma and subcutaneous tissue dissection. Deep cervical fascia is incised and reflected
  • 15. Sternocleidomastoid dissected & reflected on each side Omohyoid ,sternohyoid,thyrohy oid reflected on each side Thyroid and carotid sheath are freed from investing layer Larynx ,trachea,pharynx and oesophagus are pulled away from prevertebral tissue.
  • 16. Larynx And Trachea  Cartilagenous , ligamentous  Below - hyoid  Above -trachea .  3-6 cervical vertebrae  4-6 brachial arches  Facilitates breathing and sound  MC-triticeal cartilage [30%]
  • 18. Injuries Of Thyroid Gland  Complicated thyroidectomy surgery  Recurrent laryngeal injury  Branch of vagus nerve  Unilateral injury-vocal cord motion -Less-voice weak and motionless  Bilateral injury-incomplete and complete  Leads to adduction of cord and suffocation  Complete-leads to aphonia  Tetany
  • 20. Injuries Over The Region Of Neck 1.Homicidal o Strangulation- ligature or manual o Throttling or manual strangulation o Bansdola o Garrotting o Mugging 2.Penetrating Injuries-knife Or Gunshot 3.Cut Throat Injury 4.Injuries above level of C4- rapid death o Atlanto occipital injury-fatal o C1-C2-injury-neurogenic shock ,Odontoin# o C2-C3-Hangman # 2.Suicidal • Hanging[mc] 3.Judicial hanging 4.Accidental  Hanging ?  Chocking  Café coranary  Traumatic asphyxia  Postural asphyxia
  • 21. Hanging Ligature Strangulation Ligature mark –oblique Does not encircle the neck completely Below chin and above thyroid cartilage Base-pale ,hard and parchment like Ligature mark-transverse Encircle the neck completely At or below thyroid cartilage Base-soft and reddish Brushing of neck muscles not common Brushing of neck muscles common Neck streched and elongated Not so Hyoid bone fracture may occur Uncommon –[manual-common] Thyroid cartilage fracture –less common Thyroid cartilage fracture- more common Carotid intimal tear seen rare Salivary dribbling present absent Bleeding -uncommon common Subconjuctival hemorrhage- absent present
  • 22. PM Findings Of Hanging In The Neck  Petechiae-Tardieu spot  Le facies sympathique  Salivary dribbling  Ligature mark  Tissue under ligature mark are dry ,pale,and glistening  Thyroid cartilage fracture  Hyoid bone fracture
  • 23. Blunt Force Impact  Blunt force impact to the side of neck-excessive rotation or hyperextension 1. Shearing of neck muscle 2. Tearing of vertebral artery 3. Carotids get dissected 4. Veins damaged 5. Sub arachnoid hemorrhage.  Blunt force impact on anterior neck 1. Crush injury larynx and trachea 2. Compression of esophagus against spinal column 3. Sudden increased in intratracheal pressure against closed glottis 4. Crush bruise 5. Rapid acceleration/deceleration- tracheal injury
  • 24. Sections  Sec299-culpable homicide not amounting to murder  Sec 304-[life imprisonment with fine]  Sec300-culpable homicide amounting to murder  Sec 302-[capital punishment or life imprisonment with fine]  Sec305-abetment of suicide of child or insane  Sec 306-abetment of suicide[1-10yrs +fine]  Sec 307-attempt to murder[1-10yrs with fine]  Sec 308-attempt to commit culpable homicide[1- 3yrs+fine]
  • 25. Referrences  Bd chaurasias human anatomy vol-3  Richard and snells textbook of anatomy  Guyton and hall text book of physiology  Narayana reddy essential of forensic medicine  Anil agarwal textbook of forensic medicine  Rajesh bardalae textbook of forensic medicine  Colour atlas of charles castanese  Brendan c stalk neck dissection  Essential of anatomy and physiology valarie c scanlon