The surface anatomies of the face and neck and their supporting structures that can be palpated have been described in Chapter 20. It is now time to move to the structures that lie under the skin but which cannot be identified by touch starting with the neck and moving up on to the face and scalp. The cervical vertebral column comprises the seven cervical vertebrae and the intervening intervertebral discs. These have the same basic structure as the thoracic vertebrae described in Section 10.1.1. Examine the features of the cervical vertebra shown in Figure 23.1 and compare it with the thoracic vertebra shown in Figure 10.3. You will see that cervical vertebrae have a small body and a large vertebral foramen. They also have two distinguishing features, a bifid spinous process and a transverse foramen, piercing each transverse process; the vertebral vessels travel through these foramina. The first and second vertebrae are modified. The first vertebra, the atlas, has no body. Instead, it has two lateral masses connected by anterior and posterior arches. The lateral masses have concave superior facets which articulate with the occipital condyles where nodding movements of the head take place at the atlanto-occipital joints. The second cervical vertebra, the axis, has a strong odontoid process (or dens because of its supposed resemblance to a tooth) projecting upwards from its body. This process is, in fact, the body of the first vertebra which has fused with the body of the axis instead of being incorporated into the atlas. The front of the dens articulates with the back of the anterior arch of the atlas; rotary (shaking) movements of the head occur at this joint. The seventh cervical vertebra has a very long spinous process which is easily palpable. The primary curvature of the vertebral column is concave forwards and this persists in the thoracic and pelvic regions. In contrast, the cervical and lumbar parts of the vertebral column are convexly curved anteriorly. These anterior curvatures are secondary curvatures which appear in late fetal life. The cervical curvature becomes accentuated in early childhood as the child begins to support its own head and the lumbar curve develops as the child begins to sit up.
Idiopathic ovarian vein thrombosis causing pulmonary embolism: case report and literature review
