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Omohyoid muscle

The omohyoid muscle is a long, thin infrahyoid muscle in the anterior neck, characterized by two distinct bellies—an inferior belly and a superior belly—connected by an intermediate tendon that is restrained by a fascial sling to the clavicle, allowing it to run obliquely across the lateral cervical region.^[1]^[2]

Anatomy

The inferior belly originates from the superior border of the scapula near the suprascapular notch, specifically from the transverse scapular ligament and the medial aspect of the suprascapular notch, and extends superiorly and medially to join the intermediate tendon.^[1]^[2] The superior belly arises from this tendon and inserts into the lower border of the hyoid bone, lying superficial to the sternohyoid muscle in the anterior neck.^[1] It is innervated by the deep branch of the ansa cervicalis (spinal nerve roots C1–C3 from the cervical plexus) and receives its blood supply primarily from muscular branches of the inferior thyroid artery, which arises from the thyrocervical trunk of the subclavian artery.^[1]

Function

The omohyoid muscle primarily depresses the hyoid bone, working in concert with other infrahyoid muscles like the sternohyoid and thyrohyoid to facilitate swallowing and speech by stabilizing or lowering the hyoid and larynx.^[1] Additionally, its contraction tenses the carotid sheath, aiding venous return in the internal jugular vein by maintaining low intraluminal pressure, and it serves as an important anatomical landmark in neck surgeries, such as for identifying level III and IV cervical lymph nodes during dissections for metastases.^[1]^[2]

Clinical Significance

Variations in the omohyoid muscle's morphology, such as unusual origins from the cervical vertebrae or absences of one belly, have been documented, which can impact surgical approaches in the neck region, including thyroidectomies and lymph node excisions.^[2] Its position overlying the internal jugular vein also makes it relevant in procedures involving vascular access or compression risks.^[2]

Anatomy

Structure and Attachments

The omohyoid muscle is a slender, digastric infrahyoid muscle composed of two distinct bellies—an inferior belly and a superior belly—joined by an intermediate tendon, giving it a narrow, flat morphology similar to the digastric muscle of the floor of the mouth.^[3]^[4] The inferior belly originates from the superior border of the scapula, medial to the suprascapular notch, with some fibers occasionally arising from the transverse scapular ligament; it then courses superiorly and medially across the posterior cervical triangle to insert into the intermediate tendon at approximately the level of the cricoid cartilage.^[5]^[3] The superior belly arises from the intermediate tendon and extends superiorly to attach at the inferior border of the hyoid bone's body, positioned lateral to the insertion of the sternohyoid muscle; its course runs inferiorly and laterally from the hyoid.^[4]^[5]^[3] The intermediate tendon is a flat, fibrous structure that connects the two bellies, ensheathed by the deep cervical fascia and anchored to the clavicle via a fascial pulley, which provides stability.^[3]^[4] Overall, the muscle exhibits an oblique orientation, extending from the scapular region toward the hyoid bone, with the inferior belly attaching to the scapula via its tendinous origin.^[5]^[3]

Innervation and Vascular Supply

The omohyoid muscle receives its motor innervation from the ansa cervicalis, a neural loop derived from the anterior rami of spinal nerves C1–C3 via the cervical plexus.^[1] The superior belly is innervated by the superior root of the ansa cervicalis, which consists primarily of fibers from C1 and travels inferiorly alongside the hypoglossal nerve (cranial nerve XII) before branching off to the muscle.^[3] In contrast, the inferior belly is supplied by the inferior root, incorporating fibers from C2–C3 (with occasional contributions from C1) that arise directly from the cervical plexus loops.^[3] This dual innervation pattern reflects the muscle's digastric-like morphology, ensuring coordinated control across its two bellies and intermediate tendon.^[5] Arterial blood supply to the omohyoid muscle varies by belly, with the superior portion primarily vascularized by branches of the superior thyroid artery, a direct branch of the external carotid artery.^[4] The inferior belly draws its arterial supply from muscular branches of the inferior thyroid artery, which originates from the thyrocervical trunk off the subclavian artery.^[4] Venous drainage parallels the arterial pattern, with blood from the superior belly draining via the superior thyroid vein and from the inferior belly via the inferior thyroid vein, ultimately converging into the internal jugular vein; the muscle's attachment to the carotid sheath further facilitates low-pressure venous return in this system.^[6]^[1] Lymphatic vessels from the omohyoid muscle drain to the deep cervical lymph nodes, which form chains along the internal jugular vein and receive efferents from infrahyoid structures in the neck.^[7] This drainage pathway integrates with the broader jugular trunk, supporting clearance from the anterior cervical region.^[7]

Anatomical Relations

The omohyoid muscle traverses the lateral aspect of the neck, dividing the posterior cervical triangle into the superior occipital triangle and the inferior subclavian triangle.^[8] The inferior belly forms the boundary between these subdivisions, running superficially across the posterior triangle.^[9] In the posterior cervical triangle, the inferior belly of the omohyoid muscle crosses superficially over the brachial plexus, subclavian artery, and external jugular vein as it extends from its origin on the scapula toward the intermediate tendon.^[3] This positioning places it deep to the sternocleidomastoid muscle but anterior to these neurovascular structures.^[5] Within the anterior cervical triangle, the superior belly lies superficial to the sternohyoid muscle and deep to the sternocleidomastoid muscle, converging toward its insertion on the hyoid bone.^[5] It also forms the anteroinferior border of the carotid triangle.^[3] The intermediate tendon is positioned within or adjacent to the carotid sheath, lying anterior to the internal jugular vein and vagus nerve, which often course posterior to or in close approximation with it.^[10] This tendon is anchored by fascial connections to the clavicle and first rib.^[3] Superficially, the omohyoid muscle is covered by the platysma muscle and the investing layer of the deep cervical fascia throughout its course in the neck.^[11] Deeply, the superior belly is adjacent to the thyrohyoid membrane near its hyoid insertion, while the muscle as a whole relates to the pretracheal fascia enclosing adjacent strap muscles.^[5]

Anatomical Variations

The omohyoid muscle exhibits anatomical variations in approximately 5-15% of individuals, based on cadaveric studies, with deviations primarily affecting the origins, insertions, bellies, and intermediate tendon.^[12]^[13] These variations can alter the muscle's morphology from its typical digastric structure, potentially impacting its role as a surgical landmark in the neck.^[12] Common variations include duplication of the muscle bellies, where an extra inferior or superior belly arises, observed in about 2.86% of cases in one bilateral cadaveric analysis of 35 specimens.^[12] For instance, a duplicated omohyoid may feature two inferior bellies originating from the superior border of the scapula, with one connecting via the intermediate tendon to the superior belly and the other fusing directly with the sternohyoid muscle, as reported in a rare cadaveric case.^[14] Another frequent anomaly involves the inferior belly originating from the clavicle rather than the scapula, with prevalence rates ranging from 3% to 8.57% across studies; this shift can occur unilaterally, such as on the left side, 2.2 cm lateral to the sternoclavicular joint.^[15]^[12] Additionally, the superior belly may merge with the sternohyoid muscle, noted in 5.71% of examined cadavers.^[12] Tendon variations are less common but significant, including the absence of the intermediate tendon, which results in a single continuous muscle band; this has been documented bilaterally with clavicular origins of the inferior belly, measuring 3.3-3.6 cm in length without the typical tendinous sling.^[16] In some instances, the superior belly may lack a distinct tendon and fuse directly with adjacent infrahyoid muscles, further blurring the standard digastric configuration.^[17] Multiple intermediate tendons or accessory slips from the sternum have also been reported sporadically, occurring in about 2.86% of cases.^[12] These morphological differences are often unilateral and may show a tendency for left-sided predominance in certain anomalies due to asymmetric vascular and fascial influences, though comprehensive bilateral comparisons remain limited.^[18] Such variations underscore the need for preoperative imaging in neck procedures to avoid inadvertent injury to nearby neurovascular structures.^[12]

Function

Muscle Actions

The primary action of the omohyoid muscle is the depression of the hyoid bone and larynx, which facilitates swallowing by lowering the hyoid to allow passage of the bolus and supports respiration by reopening the laryngeal inlet after swallowing.^[19]^[20] This depression occurs through coordinated contraction of its two bellies, with the inferior belly originating from the superior border of the scapula pulling the intermediate tendon downward and medially toward the shoulder girdle, thereby tensioning the tendon and enabling the superior belly—arising from the tendon and inserting on the hyoid—to draw the hyoid inferiorly.^[3] The muscle works in concert with other infrahyoid muscles, such as the sternohyoid and sternothyroid, to achieve this collective depressive force on the hyoid and larynx.^[19] Secondary actions include retraction of the hyoid bone in a posterior direction due to the oblique orientation of the muscle bellies, which draws the hyoid medially and posteriorly during contraction.^[20] Additionally, the omohyoid tensions its intermediate tendon and the surrounding deep cervical fascia, stabilizing the hyoid bone during phonation by counteracting excessive elevation and maintaining laryngeal position for vocal fold vibration.^[21] This tensioning also opposes the elevating actions of the suprahyoid muscles, such as the mylohyoid and geniohyoid, ensuring balanced hyoid mobility.^[22] In terms of broader movement contributions, the omohyoid indirectly assists in lowering the jaw by depressing the hyoid, which provides a stable base for suprahyoid muscles to pull the mandible downward during mouth opening.^[22] Electromyographic studies reveal activity in the superior belly of the omohyoid during deglutition, with bursts coinciding with hyoid depression to coordinate bolus propulsion, and during forced inspiration, where it helps maintain upper airway patency by tensing the cervical fascia and preventing soft tissue collapse.^[23]^[20]

Physiological Role

The omohyoid muscle plays a key role in swallowing by depressing and retracting the hyoid bone after its elevation by suprahyoid muscles, thereby facilitating the coordinated movement of the hyolaryngeal complex and supporting the opening of the upper esophageal sphincter. This action stabilizes the hyoid to enable efficient tongue propulsion of the bolus while coordinating with pharyngeal constrictors to ensure smooth pharyngeal transit and minimize the risk of aspiration by maintaining laryngeal positioning during the swallow sequence.^[22]^[20] In respiration, the omohyoid contributes by depressing the hyoid and larynx post-swallowing to reopen the upper airway, aiding in the restoration of normal breathing patterns after deglutition. It also supports respiratory mechanics indirectly by enhancing venous return from the head and neck via tension on the carotid sheath, which helps maintain low intrajugular pressure during inspiration and prevents vascular compression in the cervical region.^[22]^[1] During phonation, the omohyoid provides supportive stabilization to the hyoid bone, preventing excessive upward displacement of the larynx and allowing for controlled vocal fold adduction and vibration essential to voice production. This stabilizing function integrates with the broader actions of the infrahyoid group to maintain laryngeal height and tension for sustained vocalization.^[22] In upright posture, the omohyoid helps maintain cervical tension by continuously influencing hyoid positioning and carotid sheath dynamics, contributing to overall neck stability and minor assistance in head flexion through its depressor effect on the hyoid. It interacts synergistically with the sternohyoid and thyrohyoid muscles to achieve balanced control of hyoid depression and elevation, ensuring coordinated hyolaryngeal excursion across physiological demands like swallowing and speech.^[1]^[22]

Clinical Significance

Surgical Anatomy

The omohyoid muscle serves as a critical landmark in neck dissection procedures, particularly in radical and selective neck dissections for head and neck cancers. Its inferior belly delineates the posterior border of the posterior triangle of the neck, aiding surgeons in identifying and accessing lymph node levels III and IV, where metastases commonly occur.^[24] This positioning facilitates precise removal of involved nodes while minimizing damage to surrounding structures, and the muscle is typically preserved unless its sacrifice improves exposure of level IV.^[25] In supraclavicular approaches, the inferior belly overlies the trunks of the brachial plexus, requiring careful retraction to avoid nerve injury during explorations for tumors or trauma.^[26] The intermediate tendon of the omohyoid muscle provides a reliable guide for internal jugular vein (IJV) ligation during neck surgeries, as it crosses superficially over the lower third of the vein, often in close association with the sternocleidomastoid muscle.^[27] This relationship necessitates meticulous dissection to prevent inadvertent injury to carotid sheath contents, including the IJV, common carotid artery, and vagus nerve, which lie immediately deep to the muscle. In thyroidectomy, the omohyoid is generally preserved to maintain neck contour and function, serving as an identifiable landmark for locating adjacent vessels and strap muscles.^[28] During tracheostomy, retraction of the sternocleidomastoid often involves mobilizing the omohyoid to expose the trachea safely, reducing the risk of vascular complications.^[29] Anatomical variations of the omohyoid, such as duplication, can complicate surgical navigation by obscuring the IJV or altering expected landmarks, potentially prolonging operative time and increasing the risk of vascular injury.^[30] For instance, a duplicated inferior belly passing deep to the IJV may lead to unexpected bleeding if not anticipated during dissection.^[30]

Pathologies and Disorders

The omohyoid muscle is susceptible to laceration in penetrating neck injuries, where breach of the platysma often involves transection of this infrahyoid structure, potentially contributing to hematoma formation from associated vascular damage or airway compromise due to proximity to the trachea and larynx.^[31]^[32]^[33] Surgical repair typically involves approximation of the muscle with absorbable sutures to restore integrity and prevent complications such as fistula formation when interposed between repaired esophageal or arterial sites.^[32]^[34] Iatrogenic injury to the omohyoid muscle can arise during neck procedures, including central venous catheter insertion into the internal jugular vein—where anatomical variations increase risk of inadvertent transection—or lymph node biopsy, leading to denervation and subsequent muscle palsy.^[35]^[36] Such damage disrupts the muscle's role in stabilizing the hyoid bone, potentially exacerbating postoperative neck swelling or functional deficits.^[37] Rare disorders affecting the omohyoid muscle include hypertrophy or fibrosis, which can manifest as acquired torticollis with hyperactivity resembling spasmodic features, alongside functional dysphagia from impaired hyoid depression during swallowing.^[38] Duplicate or anomalous variants may also cause progressive dysphagia and even dyspnea by mechanically obstructing the pharyngeal space.^[39] These conditions often present with lateral neck bulging or discomfort, distinguishing them from more common cervical dystonias.^[40] In oncologic contexts, the omohyoid muscle serves as a landmark for metastatic neck lymphadenopathy affecting levels III and IV from head and neck cancers; resection or sacrifice during selective neck dissection is common to ensure complete nodal clearance, though it may lead to minor functional alterations in hyoid mobility.^[41]^[42] This approach is standard in supraomohyoid dissections for oral cavity squamous cell carcinoma, balancing oncologic efficacy with preservation of non-lymphatic structures.^[43]^[44] Post-denervation weakness of the omohyoid muscle, often resulting from ansa cervicalis injury during trauma or surgery, can impair hyoid depression and stabilization, contributing to deglutition difficulties such as delayed bolus clearance or aspiration risk in affected patients.^[45] This deficit is particularly notable in coordinated swallowing phases, where the muscle's depressive action supports laryngeal closure.^[46] Diagnostic imaging plays a key role in identifying omohyoid pathologies; high-frequency ultrasound reveals muscle thickening or abnormal contraction in syndromes like omohyoid muscle syndrome, while also detecting variation-related compression of adjacent vessels such as the internal jugular vein.^[47]^[48] MRI is effective for assessing inflammation, fibrosis, or hypertrophy, showing signal changes indicative of edema or mass effect in cases of torticollis or myositis ossificans.^[49]^[50] These modalities help differentiate benign variants from malignant involvement without invasive biopsy.^[51]

Development and Terminology

Embryology

The omohyoid muscle originates from the mesoderm of the cervical myotomes, setting it apart from many other neck muscles that derive from the mesenchyme associated with the branchial arches. This somitic origin is shared with the other infrahyoid muscles, but the omohyoid exhibits a unique developmental pattern involving a common primordium in the anterior cervical region that divides into superficial and deep layers. The superficial layer contributes to the splenius muscles, with an external extension migrating to form the omohyoid, while the deep layer gives rise to the sternohyoid.^[52]^[53] The digastric structure of the omohyoid arises from distinct embryological contributions to its superior and inferior bellies. The superior belly develops as a true infrahyoid muscle from the deep cervical mesoderm, whereas the inferior belly shares an origin with the primordium of the subclavius muscle, reflecting a more lateral migration pattern. This dual origin explains the muscle's characteristic morphology and its functional role in hyoid depression. During early fetal development, the omohyoid muscle appears as a single long, undifferentiated belly around 7 weeks of gestation, oriented in a straight supero-inferior direction, and remains so until approximately 15 weeks. At 15 weeks, the intermediate tendon forms as a short plate-like condensation of connective tissue along the medial margin, influenced by mechanical stress from the bending muscle, the expanding clavicle, and shoulder girdle development. Differentiation into distinct superior and inferior bellies occurs after 15 weeks, with the tendon maturing through transition of muscle fibers to collagenous tissue by around 20 weeks. Innervation via the ansa cervicalis is established by the 10th to 12th week, coinciding with the maturation of cervical spinal nerve branches.^[54]^[55]^[56] Embryological variations in the omohyoid often stem from incomplete migration of its primordia, leading to duplications, ectopic attachments, or absence of one belly, frequently linked to persistent elements of the splenius muscle primordia. For instance, failure of the external splenius extension to fully separate can result in accessory bellies or altered tendon positions. In comparative embryology, the omohyoid parallels other infrahyoid muscles in its somitic derivation but stands out due to this dual primordium involvement, contributing to its higher incidence of anatomical variability compared to strap muscles like the sternohyoid.^[54]^[21]

Etymology

The name "omohyoid" derives from the Ancient Greek word ōmos (ὦμος), meaning "shoulder," which refers to the muscle's origin at the superior border of the scapula, combined with "hyoid," from the Greek hyoeidēs (ὑοειδής), meaning "U-shaped" or "hyoid-shaped," alluding to its insertion on the hyoid bone.^[5]^[22] This composite term highlights the muscle's distinctive bimanual attachments spanning from the shoulder girdle to the hyoid apparatus.^[57] In modern anatomical nomenclature, the muscle is designated as musculus omohyoideus in Latin, following the standardized Terminologia Anatomica established by the Federative International Programme on Anatomical Terminologies.^[58] This Latin form preserves the Greek roots while adapting them to binomial naming conventions for muscles, emphasizing precision in scientific description.^[59] As part of the infrahyoid muscle group, the omohyoid is distinguished by its digastric structure—comprising superior and inferior bellies linked by an intermediate tendon—unlike the single-bellied muscles in the group, such as the sternohyoid; its name specifically underscores these dual attachments rather than action or location alone.^[60] This naming reflects a broader convention where terms denote morphological features to differentiate structures within functional groups.^[61] The etymology of the omohyoid muscle exemplifies the classical Greek and Latin traditions in anatomical nomenclature, rooted in the works of ancient physicians like Galen (c. 129–c. 216 CE), who drew from everyday objects and body landmarks to describe structures, a practice continued by Renaissance anatomists to create a universal lexicon for medical science.^[59]^[62]

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[58]
Omohyoid Muscle | Function, Origin & Innervation - Study.com
The omohyoid muscle originates from the top of the scapula and then extends up the neck and attaches to the bottom part of the hyoid bone, which is a horseshoe ...
[59]
Omohyoid - Anatomy.app
The omohyoid depresses the hyoid bone. This muscle is composed of two bellies - inferior and superior - connected by an intermediate tendon.
[60]
Musculoskeletal etymology: What's in a name? - PMC
This paper reviews the musculoskeletal etymology as pertaining to orthopaedics, highlighting the resemblance of bones and muscles to day-to-day objects.
[61]
Omohyoid Muscle - Earth's Lab
In the inferior belly of the omohyoid muscle, the muscle fibers originate via shoulder; therefore, its name originates from the Greek word for shoulder “omos”.<|control11|><|separator|>
[62]
Omohyoid | Interactive Biology, with Leslie Samuel
Syn: musculus omohyoideus, omohyoid muscle. Word origin: From Greek omos meaning shoulder, giving one of its attachments, and hyoid, giving the other ...Missing: etymology | Show results with:etymology
[63]
Historical evolution of anatomical terminology from ancient to modern
The evolution has five stages: Galen's limited terms, Vesalius's ordinal system, new terms by Sylvius/Bauhin, Latin textbooks, and international terminology.