INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Alam mo gusto ko sanang mag pulis….
…para ikaw ang MOST WANTED KO!

ALAM MO GUSTO KO SANANG MAGING
PULIS,
… PARA IKAW ANG ...
PAG IKAW ANG KASAMA KO …
TINATAMAD AKO …
… KASE ANG SARAP MAGPAHINGA SA
PILING MO.

www.indiandentalacademy.com
SANA ULAN KA AT LUPA NA LANG AKO
… PARA KAHIT GAANO KALAKAS ANG
PATAK MO, SA AKIN PA RIN ANG
BAGSAK MO.

www.indiandentala...
BAGYO KA BA?
KASI THE MOMENT YOU LEFT MY AREA
OF RESPONSIBILITY, YOU LEAVE MY
HEART IN A STATE OF CALAMITY

www.indiandent...
HINDI KA NAMAN KAMERA …
PERO TUWING NAKIKITA KITA,
NAPAPANGITI AKO.

www.indiandentalacademy.com
SURGICAL ANATOMY
OF THE
NECK
ELMO R. LAGO JR. MD FPCS FPSO-HNS
OUR LADY OF LOURDES HOSPITAL
www.indiandentalacademy.com
OBJECTIVES
GENERAL OBJECTIVE
– TO KNOW THE SURGICAL ANATOMY OF THE
NECK
SPECIFIC OBJECTIVES
– TO KNOW THE BASIC TERMINOLOG...
ANATOMICAL TERMINOLOGIES
UNDERSTANDING THE TERMS IS VERY CRITICAL TO
UNDERSTANDING ANATOMY. LANGUAGE USED TO
COMMUNICATE S...
PLANES AND TERMINOLOGIES
MIDSAGITTAL PLANE – VERTICAL PLANE PASSING
THE CENTER OF THE BODY DIVIDING THE BODY
INTO EQUAL LE...
PLANES AND TERMINOLOGIES
TRANSVERSE PLANE – IT IS A HORIZONTAL PLANE
RUNNING PERPENDICULAR TO THE FIRST TWO
PLANES AND DIV...
PLANES AND TERMINOLOGIES
www.indiandentalacademy.com
THE NECK
THE NECK IS THAT REGION OF THE BODY LOCATED
BETWEEN THE MANDIBLE ABOVE AND THE
CLAVICLE BELOW. IT IS ENCLOSED SUP...
THE DEEP CERVICAL FASCIA
3 LAYERS:
1. INVESTING – SURROUNDS THE NECK, ENCLOSES
THE SCM AND TRAPEZIUS MUSCLES
2. PRETRACHEA...
SUPERFICIAL AND DEEP CERVICAL FASCIA

www.indiandentalacademy.com
CLINICAL TRIANGLES
AND MUSCLES OF
THE NECK
• ANTERIOR TRIANGLE
• POSTERIOR TRIANGLE

www.indiandentalacademy.com
www.indiandentalacademy.com
CLINICAL TRIANGLES AND MUSCLES OF
THE NECK
ANTERIOR
SUBMENTAL – ANTERIOR BELLIES OF THE DIGASTRIC, HYOID
SUBMANDIBULAR – M...
www.indiandentalacademy.com
TRIANGLE STRUCTURES
SUBMENTAL
SUBMENTAL LYMPH NODES, SUBMENTAL FAT, GH
SUBMANDIBULAR
SUBMANDIBULAR GLAND, SUBMANDIBULAR LY...
OCCIPITAL
SPINAL ACCESSORY NERVE, FAT, POSTERIOR
GROUP OF NODES
SUPRACLAVICULAR
TIP OF THE LUNG, SUPRACLAVICULAR LYMPH
NOD...
www.indiandentalacademy.com
PALPATING THE CAROTID PULSE

www.indiandentalacademy.com
MUSCLES OF THE NECK
STERNOCLEIDOMASTOID
FROM UPPER PART OF MANUBRIUM STERNI
(STERNAL HEAD) AND MEDIAL THIRD OF THE
CLAVICL...
STERNOCLEIDOMASTOID

TRAPEZIUS

www.indiandentalacademy.com
TRAPEZIUS

STERNOCLEIDOMASTOID

www.indiandentalacademy.com
SUPRAHYOID MUSCLES
DIGASTRIC, POSTERIOR BELLY
FROM MASTOID TO LESSER HORN OF THE HYOID
DIGASTRIC, ANTERIOR BELLY
INNER SUR...
INFRAHYOID MUSCLES
STERNOHYOID
FROM STERNUM TO HYOID
STERNOTHYROID
FROM STERNUM TO THE OBLIQUE LINE, THYROID
CARTILAGE
THY...
NECK MUSCLES
www.indiandentalacademy.com
SUPRAHYOID GROUP OF MUSCLES

INFRAHYOID GROUP OF MUSCLES

www.indiandentalacademy.com
CERVICAL LYMPHATICS

www.indiandentalacademy.com
• LEVEL 1 – Submental / Submandibular
Lymph Nodes
• LEVEL 2 – Upper Jugular Lymph Nodes
• LEVEL 3 – Middle Jugular Lymph N...
6 LEVELS FOR DESCRIBING THE LOCATION OF LYMPH NODES IN THE
NECK
www.indiandentalacademy.com
SUBLEVEL DIVISION OF NECK LEVELS
2001 Report of the American Head and Neck Society’s Neck
www.indiandentalacademy.com
Diss...
Per structure/region
• Neck
– Integrated as “filtering stations”
– Receive almost all parts of head and neck region
– Left...
Per structure/region
• Esophagus
– Posterior mediastinum and pulmonary hilum

• Face and external nose
– Mainly submandibu...
Per structure/region
• Larynx
– Subdivided anatomically into supraglottic, glottic,
and subglottic
– More numerous above t...
Per structure/region
• Lips
– Submandibular and submental lymph nodes

• Tongue and oral floor
– Ipsilateral and contralat...
Per structure/region
• Submandibular gland
– Lymph nodes in the lateral and posteroinferior
portion of the gland

• Pharyn...
Lymphatic Drainage of External Areas of the Head and Neck
www.indiandentalacademy.com
Lymphatic Drainage from Internal Areas of the Head and Neck
www.indiandentalacademy.com
DRAINAGE PATTERNS
1.

SUBMENTAL – floor of the mouth, anterior oral
tongue, anterior mandibular ridge and lower lip

2.

S...
DRAINAGE PATTERNS
6. POSTERIOR TRIANGLE GROUP – nasopharynx,
oropharynx, cutaneous structures of the posterior scalp
and n...
WORK-UP OF ASYMMETRIC, UNILATERAL NODAL
NECK MASS
1.

COMPLETE REPEATED P.E. OF:
ORAL CAVITY, NASOPHARYNX, HYPOPHARYNX, LA...
NECK DISSECTION

www.indiandentalacademy.com
THE END

www.indiandentalacademy.com
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Surgical anatomy of the head and neck /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Surgical anatomy of the head and neck /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Alam mo gusto ko sanang mag pulis…. …para ikaw ang MOST WANTED KO! ALAM MO GUSTO KO SANANG MAGING PULIS, … PARA IKAW ANG MOST WANTED KO. www.indiandentalacademy.com
  3. 3. PAG IKAW ANG KASAMA KO … TINATAMAD AKO … … KASE ANG SARAP MAGPAHINGA SA PILING MO. www.indiandentalacademy.com
  4. 4. SANA ULAN KA AT LUPA NA LANG AKO … PARA KAHIT GAANO KALAKAS ANG PATAK MO, SA AKIN PA RIN ANG BAGSAK MO. www.indiandentalacademy.com
  5. 5. BAGYO KA BA? KASI THE MOMENT YOU LEFT MY AREA OF RESPONSIBILITY, YOU LEAVE MY HEART IN A STATE OF CALAMITY www.indiandentalacademy.com
  6. 6. HINDI KA NAMAN KAMERA … PERO TUWING NAKIKITA KITA, NAPAPANGITI AKO. www.indiandentalacademy.com
  7. 7. SURGICAL ANATOMY OF THE NECK ELMO R. LAGO JR. MD FPCS FPSO-HNS OUR LADY OF LOURDES HOSPITAL www.indiandentalacademy.com
  8. 8. OBJECTIVES GENERAL OBJECTIVE – TO KNOW THE SURGICAL ANATOMY OF THE NECK SPECIFIC OBJECTIVES – TO KNOW THE BASIC TERMINOLOGIES USED IN DESCRIBE STRUCTURES OF THE NECK – TO KNOW THE FASCIA OF THE NECK – TO KNOW THE DIFFERENT TRAINGLES OF THE NECK AND DETERMIINE THEIR SIGNIFICANCE – TO KNOW THE CERVICAL LYMPHATICS OF THE NECK AND THEIR SIGNIFICANCE www.indiandentalacademy.com
  9. 9. ANATOMICAL TERMINOLOGIES UNDERSTANDING THE TERMS IS VERY CRITICAL TO UNDERSTANDING ANATOMY. LANGUAGE USED TO COMMUNICATE STRUCTURES. MAKES USE OF THE “STANDARD ANATOMICAL POSITION” AS THE BASIS OF TERMS www.indiandentalacademy.com
  10. 10. PLANES AND TERMINOLOGIES MIDSAGITTAL PLANE – VERTICAL PLANE PASSING THE CENTER OF THE BODY DIVIDING THE BODY INTO EQUAL LEFT AND RIGHT HALVES MEDIAL – NEARER THE MIDSAGITTAL PLANE LATERAL – AWAY THE MIDSAGITTAL PLANE CORONAL PLANE – VERTICAL PLANE RUNNING PERPENDICULAR TO THE MIDSAGITTAL PLANE AND DIVIDES THE BODY TO A FRONT AND A BACK ANTERIOR – GOING FRONT POSTERIOR – GOING BACK www.indiandentalacademy.com
  11. 11. PLANES AND TERMINOLOGIES TRANSVERSE PLANE – IT IS A HORIZONTAL PLANE RUNNING PERPENDICULAR TO THE FIRST TWO PLANES AND DIVIDES THE BODY INTO A UPPER AND LOWER PART. SUPERIOR – GOING CRANIAL INFERIOR – GOING CAUDAL www.indiandentalacademy.com
  12. 12. PLANES AND TERMINOLOGIES www.indiandentalacademy.com
  13. 13. THE NECK THE NECK IS THAT REGION OF THE BODY LOCATED BETWEEN THE MANDIBLE ABOVE AND THE CLAVICLE BELOW. IT IS ENCLOSED SUPERFICIALLY BY THE SKIN AND ITS UNDERLYING FASCIA THE FASCIA CAN BE GROUPED INTO A SUPERFICIAL CERVICAL AND A DEEP CERVICAL FASCIA. SUPERFICIAL CERVICAL FASCIA – ENCLOSES THE PLATYSMA, CUTANEOUS NERVES, EXTERNAL JUGULAR VEIN AND ANTERIOR JUGULAR VEIN AND SUPERFICIAL LYMPH NODES www.indiandentalacademy.com
  14. 14. THE DEEP CERVICAL FASCIA 3 LAYERS: 1. INVESTING – SURROUNDS THE NECK, ENCLOSES THE SCM AND TRAPEZIUS MUSCLES 2. PRETRACHEAL – SURROUNDS THE STRAP MUSCLES (INFRAHYOID MUSCLES) AND THE VISCERA OF THE NECK (LARYNX, THYROID) 3. PREVERTEBRAL – SURROUNDS THE CERVICAL VERTEBRAE AND THE NECK MUSCLES THE CAROTID SHEATH IS FORMED BY CONTRIBUTIONS FROM THE 3 LAYERS OF DEEP FASCIA.THIS SHEATH ENVELOPS THE IJV, CCA, AND VAGUS NERVE www.indiandentalacademy.com
  15. 15. SUPERFICIAL AND DEEP CERVICAL FASCIA www.indiandentalacademy.com
  16. 16. CLINICAL TRIANGLES AND MUSCLES OF THE NECK • ANTERIOR TRIANGLE • POSTERIOR TRIANGLE www.indiandentalacademy.com
  17. 17. www.indiandentalacademy.com
  18. 18. CLINICAL TRIANGLES AND MUSCLES OF THE NECK ANTERIOR SUBMENTAL – ANTERIOR BELLIES OF THE DIGASTRIC, HYOID SUBMANDIBULAR – MANDIBLE, POSTERIOR BELLY, ANTERIOR BELLY OF THE DIGASTRIC CAROTID – SCM, OMOHYOID, POSTERIOR BELLY MUSCULAR – OMOHYOID, SCM, MIDLINE POSTERIOR OCCIPITAL – TRAPEZIUS, SCM, OMOHYOID SUPRACLAVICULAR – OMOHYOID, SCM, CLAVICLE www.indiandentalacademy.com
  19. 19. www.indiandentalacademy.com
  20. 20. TRIANGLE STRUCTURES SUBMENTAL SUBMENTAL LYMPH NODES, SUBMENTAL FAT, GH SUBMANDIBULAR SUBMANDIBULAR GLAND, SUBMANDIBULAR LYMPH NODES, FACIAL ARTERY, WHARTON’S DUCT, MH CAROTID COMMON CAROTID ARTERY, INTERNAL JUGULAR VEIN, VAGUS NERVE, JUGULAR NODES MUSCULAR HYOID, THYROID CARTILAGE, CRICOID CARILAGE, TRACHEA, THYROID GLAND, OMOHYOID, STERNOHYOID, STERNOTHYROID, THYROHOID www.indiandentalacademy.com
  21. 21. OCCIPITAL SPINAL ACCESSORY NERVE, FAT, POSTERIOR GROUP OF NODES SUPRACLAVICULAR TIP OF THE LUNG, SUPRACLAVICULAR LYMPH NODES www.indiandentalacademy.com
  22. 22. www.indiandentalacademy.com
  23. 23. PALPATING THE CAROTID PULSE www.indiandentalacademy.com
  24. 24. MUSCLES OF THE NECK STERNOCLEIDOMASTOID FROM UPPER PART OF MANUBRIUM STERNI (STERNAL HEAD) AND MEDIAL THIRD OF THE CLAVICLE (CLAVICULAR HEAD) TO MASTOID PROCESS TILTING HEAD AND FACE UPWARDS AND TO THE OPPOSITE SIDE ACCESSORY NERVE (XII) TRAPEZIUS FROM EOP AND SNL TO LATERAL 1/3 OF CLAVICLE, ACROMION SHOULDER SHRUG ACCESSORY NERVE (XII) www.indiandentalacademy.com
  25. 25. STERNOCLEIDOMASTOID TRAPEZIUS www.indiandentalacademy.com
  26. 26. TRAPEZIUS STERNOCLEIDOMASTOID www.indiandentalacademy.com
  27. 27. SUPRAHYOID MUSCLES DIGASTRIC, POSTERIOR BELLY FROM MASTOID TO LESSER HORN OF THE HYOID DIGASTRIC, ANTERIOR BELLY INNER SURFACE OF MANDIBLE TO LESSER HORN OF THE HYOID MYLOHYOID FROM MYLOHYOID LINE TO ANTERIOR SURFACE OF THE HYOID GENIOHYOID FROM INFERIOR MENTAL SPINE TO BODY OF HYOID SUPRAHYOID MUSCLES ALL ELEVATE THE HYOID www.indiandentalacademy.com
  28. 28. INFRAHYOID MUSCLES STERNOHYOID FROM STERNUM TO HYOID STERNOTHYROID FROM STERNUM TO THE OBLIQUE LINE, THYROID CARTILAGE THYROHYOID FROM OBLIQUE LINE, THYROID CARTILAGE TO THE HYOID BONE OMOHYOID FROM SCAPULA TO THE HYOID BONE ALL INFRAHYOID MUSCLES DEPRESS THE HYOID www.indiandentalacademy.com
  29. 29. NECK MUSCLES www.indiandentalacademy.com
  30. 30. SUPRAHYOID GROUP OF MUSCLES INFRAHYOID GROUP OF MUSCLES www.indiandentalacademy.com
  31. 31. CERVICAL LYMPHATICS www.indiandentalacademy.com
  32. 32. • LEVEL 1 – Submental / Submandibular Lymph Nodes • LEVEL 2 – Upper Jugular Lymph Nodes • LEVEL 3 – Middle Jugular Lymph Nodes • LEVEL 4 – Lower Jugular Lymph Nodes • LEVEL 5 – Posterior Triangle Lymph Nodes • LEVEL 6 – Anterior Compartment Lymph Nodes www.indiandentalacademy.com
  33. 33. 6 LEVELS FOR DESCRIBING THE LOCATION OF LYMPH NODES IN THE NECK www.indiandentalacademy.com
  34. 34. SUBLEVEL DIVISION OF NECK LEVELS 2001 Report of the American Head and Neck Society’s Neck www.indiandentalacademy.com Dissection Committee
  35. 35. Per structure/region • Neck – Integrated as “filtering stations” – Receive almost all parts of head and neck region – Left side, drains into junction of left subclavian and internal jugular veins at the left thoracic duct – Right side, drains into junction of the right subclavian and internal jugular veins at right thoracic duct – Includes lymphatic organs of nasopharynx and oropharynx – Normal nodes are neither visible nor palpable www.indiandentalacademy.com
  36. 36. Per structure/region • Esophagus – Posterior mediastinum and pulmonary hilum • Face and external nose – Mainly submandibular lymph nodes • Nasal cavity – Retropharyngeal and deep cervical www.indiandentalacademy.com
  37. 37. Per structure/region • Larynx – Subdivided anatomically into supraglottic, glottic, and subglottic – More numerous above the glottis • Supraglottic- deep cervical lymph nodes » Ipsilateral drainage complemented by contralateral drainage • Glottic – sparse • Subglottic –deep cervical lymph nodes » With connections to peritracheal and mediastinal nodes » Ipsilateral and contralateral drainage www.indiandentalacademy.com
  38. 38. Per structure/region • Lips – Submandibular and submental lymph nodes • Tongue and oral floor – Ipsilateral and contralateral submandibular and submental nodes which drain to lymph nodes at junction of the facial and internal jugular veins • Parotid gland – Intraglandular and periglandular nodes to submandibular and deep jugular nodal chains www.indiandentalacademy.com
  39. 39. Per structure/region • Submandibular gland – Lymph nodes in the lateral and posteroinferior portion of the gland • Pharynx – Upper portion: retropharyngeal nodes – Lower portion: parapharyngeal or deep cervical nodes www.indiandentalacademy.com
  40. 40. Lymphatic Drainage of External Areas of the Head and Neck www.indiandentalacademy.com
  41. 41. Lymphatic Drainage from Internal Areas of the Head and Neck www.indiandentalacademy.com
  42. 42. DRAINAGE PATTERNS 1. SUBMENTAL – floor of the mouth, anterior oral tongue, anterior mandibular ridge and lower lip 2. SUBMANDIBULAR – oral cavity, anterior nasal cavity, soft-tissue structures of the midface, submandibular gland 3. UPPER JUGULAR – oral cavity, nasal cavity, nasopharynx, hypopharynx, larynx, parotid gland 4. MIDDLE JUGULAR – oral cavity, nasopharynx, hypopharynx, oropharynx and larynx, cervical esophagus www.indiandentalacademy.com
  43. 43. DRAINAGE PATTERNS 6. POSTERIOR TRIANGLE GROUP – nasopharynx, oropharynx, cutaneous structures of the posterior scalp and neck 7. ANTERIOR COMPARTMENT – thyroid gland, glottic and subglottic larynx, apex of the pyriform sinus and cervical esophagus www.indiandentalacademy.com
  44. 44. WORK-UP OF ASYMMETRIC, UNILATERAL NODAL NECK MASS 1. COMPLETE REPEATED P.E. OF: ORAL CAVITY, NASOPHARYNX, HYPOPHARYNX, LARYNX, THYROID, SALIVARY GLANDS, SKIN OF THE NECK 2. 3. NEEDLE BIOPSY IMAGING – CHEST, UPPER AERODIGESTIVE TRACT (+) 4. PANENDOSCOPY WITH GUIDED BIOPSY BASED ON LOCATION OF THE NODAL MASS –NASOPHARYNX, BASE OF THE TONGUE 5. OPEN BIOPSY OF THE CERVICAL MASS www.indiandentalacademy.com
  45. 45. NECK DISSECTION www.indiandentalacademy.com
  46. 46. THE END www.indiandentalacademy.com

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