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Triangles of Neck
Dr.R.Arulmoli
Learning objectives
Name the triangles of neck.
Describe the boundaries, contents & clinical importance of posterior triangle of neck.
Describe the boundaries, divisions, contents & clinical importance of anterior triangle of neck.(submental,digastric and carotid)
Neck-boundaries
Anterior- anterior median line.
Posterior-anterior border of trapezius.
Superior-base of the mandible to the mastoid process.
Inferior-clavicle.
Bony Structures
mandible
skull base
sella
C1
C2
C3
C4
C5
C6
C7
hyoid
Deep cervical fascia(fascia colli)
Deep fascia of neck – 4 modifications:
1. Investing layer- encloses 2 muscles (trapezius & sternocleidomastoid), 2 salivary glands (parotid & submandibular).
2. Pretracheal fascia - in front of the trachea & encloses thyroid gland.
3. Carotid sheath- encloses common carotid artery, internal carotid artery, internal jugular vein & vagus nerve.
4. Prevertebral fascia- forms the floor of posterior triangle encloses prevertebral muscles.
Deep cervical fascia
Investing layer
Pretracheal layer
Carotid sheath
Prevertebral layer
Triangles of neck
The sternocleidomastoid muscle divides the side of the neck into anterior and posterior triangles.
Triangles of neck
Posterior triangle of neck
Posterior triangle- boundaries
Anterior – Posterior border of sternocleidomastoid
muscle.
Posterior – Anterior border of trapezius muscle.
Inferior – Middle 1/3 of clavicle.
Posterior triangle- boundaries
Posterior triangle- Divisions
The inferior belly of omohyoid muscle divides the posterior triangle into 2 triangles.
1. Occipital triangle- larger upper one.
2. Supraclavicular triangle- smaller lower one.
Posterior triangle - Roof
Skin.
Superficial fascia containing :
- Platysma
- External jugular vein
- Cutaneous nerves arising from cervical plexus
- Lymph vessels
Investing layer of deep cervical fascia.
Platysma
Platysma
Origin: Arise from the pectoral fascia (deep fascia).Insertion:Ascends up and inserted into the base of the mandible and skin of the face. Nerve supply: Facial nerve (cervical branch) Action:Depresses the mandible and pulls down the angle of mouth in horror or surprise.
External jugular vein
Ext. Jugular Vein
Formation:Formed by the union of posterior auricular vein and the posterior branch of retromandibular vein.Course :Descends in the superficial fascia across the sternocleidomastoid.Termination: Pierces the deep fascia,descends behind the clavicle and drains into the subclavian vein.
External jugular vein - termination
EXT.JUGULAR VEIN
SUBCLAVIAN VEIN
External jugular vein-clinical significance
External jugular vein is distended in cardiac failure.
Injury to the vein in the region where it pierces the deep fascia, may lead to air embolism.
Cutaneous nerves - cervical plexus
Formation: Ventral rami of C1-C4.
Branches:
Cutaneous -
1.Lesser occipital (C2)
2.Great auricular (C2,3)
3.Anterior or transverse cutaneous nerve of neck (C2,3)
4.Supraclavicular nerve(C3,4)
Cervical plexus- Cutaneous Nerves
Cervical plexus- Cutaneous Nerves
Posterior Triangle - Floor
Prevertebral layer of deep cervical fascia.
Prevertebral muscles –
Semispinalis capitis-inconstant
Splenius capitis
Levator scapulae
Scalenus posterior
Scalenus medius
Scalenus anterior
Posterior triangle - Floor
Scalene muscles
Scalenus anterior
Scalenus medius
Scalenus posterior
Posterior triangle - Contents
1.Spinal Accessory Nerve – XI cranial nerve
2.Cutaneous nerves of cervical plexus – -Lesser occipital nerve - Great auricular nerve - Transverse cutaneous nerve of neck - Supra clavicular nerves.
3. Muscular branches to - - Levator scapulae - Rhomboides - Serratus anterior - Subclavius
4. Trunks of brachial plexus
5. Third part of subclavian artery and vein.
6. Transverse cervical artery and vein
7. Lymph nodes- occipital & supraclavicular nodes.
Posterior triangle - Contents
Accessory nerve
Accessory nerve
Posterior triangle - Contents
Trunks of brachial plexus
Sternocleidomastoid
Origin- Sternal head from front of manubrium sterni & Clavicular head from medial 1/3 of clavicle. Insertion- Mastoid process & lateral half of superior nuchal line.
Nerve supply- Motor- Spinal part of accessory nerve. Sensory- Ventral ramus of C2.
Action - Turns the face to opposite side & tilt the head towards the shoulder(one muscle).
Draw the head forwards (both muscles).
Sternocleidomastoid: Torticollis or Wry Neck
Deformity where head is bent to one side and chin points to opposite side.
Due to spasm of muscles supplied by accessory nerve- (sternocleidomastoid & trapezius).
Posterior triangle - Clinical Importance
Common swellings in the posterior triangle:
- Enlarged supraclavicular lymph nodes.
- Lipoma.
- Cystic hygroma.
Enlarged left supraclavicular node (Virchow’s node)- occurs in cancer of stomach & testis.
Anterior triangle of Neck
Anterior triangle of Neck
Boundaries:
Superior - Inferior margin of Mandible
Anterior - Midline of Neck
Posterior - Sternocleidomastoid muscle
Anterior triangle of Neck
Anterior triangle - subdivision
1. Submental triangle
2. Digastric triangle
3. Carotid triangle
4. Muscular triangle
Anterior triangle- subdivision
Submental triangle
Submental triangle
Boundaries:
Side - Anterior belly of digastric muscle.
Base - Body of hyoid bone.
Apex- Chin.
Roof :
Skin,superficial fascia,
deep fascia.
Floor: Mylohyoid muscles.
Contents:
• Submental lymph nodes.
• Submental vein.
Submental triangle - floor
Digastric triangle
Digastric triangle (submandibular triangle)
Boundaries :
Antero inferior- Anterior belly of digastric.
Postero inferior- Posterio belly of digastric.
Superior (Base) - Base of the mandible.
Roof :
Skin,
Superficial fascia with platysma,
Cervical branch of facial nerve,
Transverse cut. nerve of neck.
Floor :
Mylohyoid & hyoglossus muscle.
Digastric triangle
Digastric triangle
Digastric triangle - contents
Submandibular salivary gland
Facial vein
Facial artery
Submandibular lymph nodes
Mylohyoid nerve & vessels
Hypoglossal nerve
External carotid artery
Glossopharyngeal nerve.
PROFESSOR: Who talks in someone else's sleep.
Carotid triangle
Carotid triangle
Boundaries:
Superior- Posterior belly of digastric & stylohyoid.
Anteroinferior- Superior belly of omohyoid.
Posterior- Anterior border of sternocleidomastoid.
Carotid triangle
Boundaries:
Superior- posterior belly of digastric & stylohyoid.
Anteroinferior- superior belly of omohyoid.
Posterior- anterior border of sternocleidomastoid
Carotid triangle
Roof :
Skin, superficial fascia with platysma & investing layer of deep cervical fascia.
Floor :
Thyrohyoid muscle
Hyoglossus muscle
Middle constrictor muscle
Inferior constrictor muscle.
Carotid triangle
Contents:
Arteries – common carotid artery, internal carotid artery & external carotid artery with its branches, superior thyroid, lingual, facial, ascending pharyngeal,occipital
Veins - Internal jugular vein, common facial vein, lingual vein.
Nerves - Vagus nerve, superior laryngeal nerve, spinal accessory nerve, hypoglossal nerve, ansa cervicalis, sympathetic chain.
Lymph nodes- Deep cervical nodes:jugulo-digastric & jugulo-omohyoid.
Carotid triangle- contents
Carotid triangle- contents - Ansa cervicalis
Thin nerve loop embedded in the anterior wall of carotid sheath.
Formation:
- Superior root – C1 fibres pass along hypoglossal nerve.
- Inferior root – C2 & C3.
Carotid triangle- contents - Ansa cervicalis
Ansa cervicalis
Carotid triangle- contents
Muscular triangle
Muscular triangle
Boundaries:
Anterior- Midline of neck from hyoid bone to sternum.
Posterosuperior-Superior belly of omohyoid.
Posteroinferior-Anterior border of sternocleidomastoid.
Contents :• Infrahyoid muscles - Sternohyoid - Omohyoid - Sternothyroid - Thyrohyoid
Muscular triangle - contents
Infra hyoid muscles
Sterno hyoid
Summary
Hodgkin’s lymphoma Submandibular abscess
Thyroid nodule
Any questions ?
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