Read In detail about the surgical anatomy and applied anatomy of triangles of neck from department of oral and maxillofacial surgery department , Chennai , india , asian continent , surgical ligations and level of lymph nodes described shortly

1. TRIANGLES OF NECK &
APPLIED ANATOMY
BY
Dr. HARIKRISHNAN K PRASAD
1ST YEAR PG TRAINEE
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

2. Boundaries of side OF NECK
 The side of the neck presents a
somewhat quadrilateral outline.
 It is bounded anteriorly by the anterior
median line
 It is bounded posteriorly by the anterior
border of trapezius
 It is bounded superiorly by the base of
the mandible [ a line joining angle of the
mandible to mastoid process and
superior nuchal line ]
 It is bounded inferiorly by the clavicle

3. Division of quadrilateral space
 The quadrilateral space is divided by the sternocleidomastoid muscle into
 2 main triangles
ANTERIOR TRIANGLE
POSTERIOR TRIANGLE
- The triangle in front of the muscle is called as the ANTERIOR TRIANGLE .
- The triangle behind the muscle is called as the POSTERIOR TRIANGLE.

6. sternocleidomastoid muscle
 Origin:-
1. Sternal head :it is tendinous and arises from the
superolateral part of the front of the manubrium sterni.
2. Clavicular head :- it is musculotendinous and arises
from the medial one third of the superior surface of the
clavicle , it passes deep to the sternal head and the two
heads blend below the middle of neck .
3. Between the two heads there is a small triangular
depression or the lesser supraclavicular fossa,
overlying the internal jugular vein.

7. STERNOCLEIDOMASTOID MUSCLE
1. Nerve supply: - spinal accessory nerve provides the motor supply
– Branches from the ventral rami of c2 and c3 are proprioceptive.
2. Blood supply:- one branch from each superior thyroid artery and suprascapular artery
- two branches from occipital artery

8. Anterior triangle of neck

9. ANTERIOR TRIANGLE OF NECK
 BOUNDARIES: -
 Medially by the anterior median plane of neck
.
 Laterally by the sternocleidomastoid muscle.
 Superiorly by the base of the mandible and a
line joining the angle of mandible to the
mastoid process.

11. FOUR Subdivisions of anterior triangle
 Anterior triangle is subdivided by the digastric muscle and
superior belly of omohyoid into:
1. SUBMENTAL TRIANGLE
2. DIGASTRIC TRIANGLE
3. CAROTID TRIANGLE
4. MUSCULAR TRIANGLE

12. SUBMENTAL TRIANGLE
 This is a median triangle
 Boundaries:
 On each side supported by anterior belly of digastric muscle
 Base formed by the body of the hyoid bone.
 Apex lies chin
 Floor of the triangle is formed by the right and left mylohyoid
muscle and the median raphe uniting them.

13. Contents of submental triangle
 2 to 4 small submental lymph nodes are situated in the super fascia between anterior belly of digastric
muscles:-
 They drain into :
1. Superficial tissues below the chin
2. Central part of lower lip
3. The adjoining gums
4. Anterior part of the floor of the mouth
5. The tip of the tongue.
 Small submental veins join to form anterior jugular veins

14. Digastric OR SUBMANDIBULAR triangle
 Boundaries:-
Antero inferiorly :- anterior belly of digastric
Posteroinferiorly :- posterior belly of digastric
Superiorly or base :- Base of mandible and a line
joining the angle of mandible to the mastoid
process
Roof:-
1. Skin
2. Superficial fascia containing platysma and
cervical branch of facial nerve and ascending
branch of transverse or anterior cutaneous
nerve of the neck
3. Deep fascia splits to enclose the
submandibular salivary gland

15. BOUNDARIES AND CONTENTS OF
DIGASTRIC TRIANGLE

16. Floor of digastric triangle
 Anteriorly formed by the mylohyoid muscle
 Posteriorly formed by the hyoglossus muscle
 A small part of middle constrictor muscle of the pharynx
appears in the floor

17. CONTENTS OF
DIGASTRIC TRIANGLE

18. Contents of digastric triangle
 Contents are further divided into
1. Anterior part
2. Posterior part

19. DIGASTRIC TRIANGLE
 ANTERIOR PART:-
Structures superficial to mylohyoid are
1. Superficial part of the submandibular salivary gland.
2. The facial vein and the submandibular lymph nodes
are superficial to it and the facial artery is deep to it.
3. Submental artery
4. Mylohyoid nerve and vessels
5. Hypoglossal nerve

20. Contents of digastric triangle
 Posterior part of the triangle:-
1. SUPERFICIAL STRUCTURES:-
a. Lower part of the parotid gland
b. External carotid artery before it enters the parotid gland.

21. DIGASTRIC TRIANGLE
2. DEEP STRUCTURES:-
Passing between the external and internal carotid arteries
a. Stlyoglossus
b. Stlyopharngeus
c. Glossopharngeal nerve
d. Pharnyngeal branch of the vagus nerve
e. Styloid process
f. Part of parotid gland

22. DIGASTRIC TRIANGLE
DEEPEST
STRUCTURES :
a. Internal carotid artery
b. Internal jugular veins
c. Vagus nerve

23. DIGASTRIC OR SUBMANDIBULAR TRIANGLE
 Three small triangles are included inside the submandibular triangle are:
 1. LESSER’S TRIANGLE
 2. PIROGOV’S TRIANGLE
 3. BECLARD’S TRIANGLE

25. LESSERS TRIANGLE
 Lessers triangle is named after LADISLAUS LEON
LESSER, a German surgeon .
 It is bounded by the anterior and posterior bellies of
the digastric muscle and the hypoglossal nerve.
 This triangle is also called as lingual triangle.
 The most important structure in it is the lingual artery.
 The floor of lesser triangle is the hyoglossus muscle
and the lingual artery is found beneath it.
 Tubbs et al reported that lesser’s triangle was present
in 30 out of 34 sides and absent on four.
 When it was absent , the hypoglossal nerve coursed
inferior to the digastric muscle.
 Lesser triangle , it is an ideal location for accessing
the lingual artery, especially to control severe
hemorrhage in the oral floor when it is injured .
 The lingual foramen is where the sublingual artery or
submental artery enters the mandible.

26. PIROGOVS TRIANGLE
 Pirogov's triangle, named after Russian surgeon
and scientist Nikolai I. Pirogov (1810–1881) who
first described it,.
 It is bounded by the hypoglossal nerve superiorly,
the intermediate tendon of the digastric muscle
inferoposteriorly, and the posterior border of the
mylohyoid muscle anteriorly .
 This triangle is simply the posterior part of Lesser's
triangle. Previous literature has referred to
Pirogov's triangle as Pinaud's triangle or the
hypoglossohyoid triangle .
 Pirogov's triangle is also an attractive location for
performing a microvascular anastomosis using the
artery.
 This triangle constantly included the lingual artery
deep to the hyoglossus muscle.
 This study concluded that the lingual artery and
hypoglossal nerve were located more inferiorly than
classically reported.

27. Béclard's triangle
 The boundaries of Béclard's triangle, named after the
French anatomist Pierre A. Béclard (1785–1825), are
the posterior belly of the digastric muscle, the posterior
border of the hyoglossus muscle, and the greater horn
of the hyoid bone .
 Tubbs et al. examined Beclard's triangle and found it in
82.4% (28/34 sides). With absent, the reasons were
that the posterior belly of the digastric muscle did not
attach to the hyoid bone, or directly located just above
the greater horn of the hyoid bone.
 Béclard's triangle constantly included both the lingual
artery and hypoglossal nerve.
 Based on this result, Béclard's triangle could be a
convenient landmark for identifying both anatomical
structures.

28. Carotid triangle
 Boundaries:-
ANTEROSUPERIORLY:- posterior belly of the digastric muscle and the stylohyoid.
ANTEROINFERIORLY:- Superior belly of the omohyoid.
POSTERIORLY: - Anterior border of the sternocleidomastoid muscle.
ROOF:-
1. SKIN
2. SUPERFICIAL FASCIA containing
a. The platysma
b. The cervical branch of the facial nerve
c. The transverse cutaneous nerve of the neck
3. Investing layer of deep cervical fascia.

31. FARABEUF’S TRIANGLE
 Farabeuf's triangle, named for the French
surgeon Louis-Hubert Farabeuf (1841–
1910), is a small triangle included within
the carotid triangle.
 The boundaries of this triangle are the
IJV, the common facial vein, and the
hypoglossal nerve and direct its base
superiorly . Tubbs et al. reported that
Farabeuf's triangle was present in 75%
(15/20 sides).
 This triangle was constantly located within
the carotid triangle and included at least
one of the branches of the common
carotid artery on 14 out of 15 sides.


32. FARABEUFS TRIANGLE
 The carotid bifurcation was contained within this
triangle on two sides, meanwhile, the bifurcation
was located inferior to this triangle on 13 sides.
 Moreover, these authors revealed that the
common facial vein was located 1.5 cm inferior
to the carotid bifurcation at the least, up to 2 cm
superior.
 A jugulodigastric node was observed on eight
sides. Earlier publications discussed the
importance of Farabeuf's triangle during neck
dissection .
 Campbell also mentioned that “this triangle is a
helpful landmark in extensive dissections of the
neck, especially in locating the IJV, the safety of
which is best conserved by promptly exposing
it.”

33. CONTENTS OF CAROTID TRIANGLE

34. Contents of carotid triangle
 ARTERIES:
1. COMMON CAROTID ARTERY WITH CAROTID SINUS AND
CAROTID BODY AT ITS TERMINATION.
2. INTERNAL CAROTID ARTERY
3. EXTERNAL CAROTID ARTERY
SUPERIOR THYROID ARTERY
LINGUAL ARTERY
FACIAL ARTERY
ASCENDING PHARYNGEAL ARTERY
OCCIPITAL ARTERY

35. CONTENTS OF carotid TRIANGLE
 VEINS:-
1. INTERNAL JUGULAR VEIN
2. COMMON FACIAL VEIN
3. PHARYNGEAL VEIN
4. LINGUAL VEIN
2,3,4 respectively drains or end with internal jugular
vein
NERVES:-
1.VAGUS NERVE
2. SUPERIOR LARYNGEAL BRANCH OF VAGUS
3. SPINAL ACCESSORY NERVE backward over the
INTERNAL JUGULAR VEIN
4. HYPOGLOSSAL NERVE
5. CAROTID SHEATH & ITS CONTENTS

36.  Lymph nodes:
1. Deep cervical nodes situated along the internal jugular vein
2. Jugulodigastric node below the posterior belly of the digastric
3. Jugulo-omohyoid node above the inferior belly of omohyoid

37. MUSCULAR TRIANGLE
 BOUNDARIES :
ANTERIORLY:-
Anterior median line of the neck
from hyoid bone to the sternum.
POSTEROSUPERIORLY:-
Superior belly of the omohyoid
muscle
POSTEROINFERIORLY:-
Lower part of anterior border of the
sternocleidomastoid muscle.

39. contents of muscular triangle
1. Infra hyoid muscles:
a. sternohyoid
b. sternothyroid
c. thyrohyoid
2 ANSA CERVICALIS
3 COMMON CAROTID ARTERY

40. CLINICAL CONSIDERATIONS
 Torticollis
 is a condition in which the head is held at an angle, with the ear
drawn toward the shoulder of one side.
 This condition may be either congenital or spasmodic.
 It is believed that congenital torticollis is caused by trauma during
birth, in which one of the sternocleidomastoids is stretched
excessively, causing hemorrhage in the muscle, resulting in
fibrous invasion and subsequent shortening of the muscle.
 Further complications may arise, such as wedge-shaped cervical
vertebrae and muscle atrophy.
 Spasmodic torticollis usually involves the trapezius,
sternocleidomastoid, and perhaps other muscles, all of which
undergo spasmodic contractions.
 The position of the head in this condition mimics congenital
torticollis.
 The defect is not in the muscles but is probably related to
neurogenic involvement.

41. CLINICAL CONSIDERATIONS
 Paralysis of the trapezius may occur if deep wounds in the region of the
posterior triangle involve the spinal accessory nerve.
 Such injury limits the movement of the upper limb to the horizontal position
during lifting of the arm. In addition, it causes depression of the shoulder on
the affected side.
 Referred pain in the region of the shoulder may have its origin in pleurisy that
is causing irritation of the phrenic nerve.
 This situation occurs because the phrenic nerve has the same cervical spinal
nerve components as the supraclavicular nerves, and signals transmitted via
the phrenic nerve may be interpreted as originating in the area of the
shoulder served by the supraclaviculars.

42. POSTERIOR
TRIANGLE

43. POSTERIOR TRIANGLE
 BOUNDARIES:
ANTERIORLY:
Posterior border of
sternocleidomastoid muscle
POSTERIORLY:
Anterior border of trapezius
INFERIOR OR BASE:-
Middle one – third of clavicle
APEX:-
Lies on the superior nuchal line where
the trapezius and sternocleidomastoid
muscle meet.

44. Posterior triangle of neck
 ROOF: -
 Formed by the investing layer of deep cervical fascia
 Superficial fascia over the posterior triangle contains :-
- The platysma
- The external jugular and posterior external jugular veins
- Parts of the supraclavicular , greater auricular and transverse cutaneous and
lesser occipital nerve
- Lymph vessels which pierce the deep fascia to end in the supraclavicular
nodes.

45. Posterior triangle of neck
FLOOR:-
The floor of the posterior triangle of
neck is formed by the prevertebral
layer of deep cervical fascia covering
following muscles:
1. Splenius capitis.
2. Levator scapulae.
3. Scalaneus medius.
4. Semispinalis capitis.

46. Division of posterior triangle of neck
 it is subdivided by the inferior belly of omohyoid into:-
 2 types
 1. a larger upper part called as occipital triangle
 2. a smaller lower part called as supraclavicular or subclavian triangle

47. Occipital triangle
 BOUNDARIES:-
 Anteriorly by the posterior border
of sternocleidomastoid muscle.
 Posteriorly by the anterior border
of trapezius.
 Inferiorly by the inferior belly of
omohyoid.

48. Subclavian/ supraclavicular triangle
 BOUNDARIES :-
 Anteriorly by the posterior border of
sternocleidomastoid muscle
 Posteriorly by the inferior belly of
omohyoid
 Floor by the first rib, scalaneus
medius and first slip of serratus
anterior
 Roof by the skin , superficial fascia ,
platysma and investing layer of deep
cervical fascia.

49. CONTENTS

50. CONTENTS SL.NO OCCIPITAL TRIANGLE SUBCLAVICULAR TRIANGLE
NERVES 1. SPINAL ACCESSORY NERVE 1. ROOTS AND TRUNKS OF BRACHIAL PLEXUS
2. FOUR CUTANEOUS BRANCHES OF
CERVICAL PLEXUS
2. NERVE TO SERRATUS ANTERIOR
a. LESSER OCCIPITAL (C2) 3.NERVE TO SUBCLAVIUS
b. GREAT AURICULAR (C2, C3) 4. SUPRASCAPULAR NERVE
c. ANTERIOR CUTANEOUS NERVE OF
NECK (C2,C3)
d. SUPRACLAVICULAR NERVES(C3,C4)
3. MUSCULAR BRANCHES:
a. TWO SMALL BRANCHES TO THE
LEVATOR SCAPULAE (C3,C4)
b. TWO SMALL BRANCHES TO TRAPEZIUS
( C3,C4)
c. NERVE TO RHOMBOIDS (
PROPRIOCEPTIVE) C5

51. CONTENTS SL.NO OCCIPITAL TRIANGLE SUBCLAVICULAR TRIANGLE
VESSELS 1. TRANSVERSE CERVICAL ARTERY AND VEIN 1. THIRD PART OF SUBCLAVIAN
ARTERY AND SUBCLAVIAN VEIN
2. OCCIPITAL ARTERY 2. SUPRASCAPULAR ARTERY AND
VEIN
3. COMMENCEMENT OF TRANSVERSE
CERVICAL ARTERY AND TERMINATION
OF THE CORRESPONDING VEIN
4.LOWER PART OF EXTERNAL
JUGULAR VEIN
LYMPH NODES ALONG THE POSTERIOR BORDER OF THE
STERNOCLEIDOMASTOID, MORE IN THE LOWER
PART - THE SUPRACLAVICULAR NODES AND A
FEW AT THE UPPER ANGLE – THE OCCIPITAL
NODES
A FEW MEMBERS OF THE
SUPRACLAVICULAR CHAIN

52. CLINICAL ANATOMY OF POSTERIOR TRIANGLE
 The most common swelling in the posterior triangle is due to enlargement of the supraclavicular lymph nodes.
While doing biopsy of the lymph node, one must be careful in preserving the accessory nerve which may get
entangled amongst enlarged lymph nodes .
 Supraclavicular lymph nodes are commonly enlarged in tuberculosis , hodgkins disease and in malignant
growth of the breast arm or chest.
 Block dissection of the neck for malignant diseases is the removal of cervical lymph nodes along with other
structures involved in the growth. This procedure does not endanger those nerves of the posterior triangle
which lie deep to the prevertebral fascia , i.e., the brachial and cervical plexuses and their muscular branches.
 A cervical rib may compress the second part of subclavian artery. In these cases blood supply reaches via
anastomoses around the scapula.
 Dysphagia caused by compression of the oesophagus by an abnormal subclavian artery is called dysphagia
lusoria.

53. APPLIED ANATOMY OF TRIANGLE OF NECK
 DIGASTRIC TRIANGLE :-
 Submandibular group of lymph nodes are affected in inflammation
and in malignancies
 Preservation of facial artery in surgical procedure
 Preservation of marginal mandibular nerve in fracture of mandible.
CAROTID TRIANGLE:- ( Vagus nerve)
1. Baroreceptors :- carotid sinus , a fusiform dilatation involving the
bifurcation of common carotid and beginning of internal carotid.
2. Supraventricular tachycardia is susceptible to vagal effects and may
be converted to normal sinus rhythm by carotid massage.

54. APPLIED ANATOMY OF TRIANGLE OF NECK
 Sternocleidomastoid muscle:
 Spasm of the muscle is one of the cause of flexion deformity of the neck known as
wry neck or torticollis, in this case ear lies close to the tip of the shoulder, and the
chin is rotated to the opposite side.
INTERNAL JUGULAR VEIN : It is one of the most vital structures in the neck to prevent
damage during surgical dissection of neck tumours.

55. VARIOUS INCISIONS
FOR NECK
DISSECTION

57. CLASSIFICATION OF LEVELS OF NECK DISSECTION

58. LIGATION OF EXTERNAL CAROTID
ARTERY
 The method is broadly divided by 2 approaches
Exposure through carotid triangle
Exposure through Retromandibular fossa

59. PATIENT POSITION
 Supine position with shoulder on roll , neck extended and
turned to opposite side

60. EXPOSURE OF CAROTID ARTERY THROUGH CAROTID
TRIANGLE
 LANDMARKS :-
 1. Upper border of thyroid cartilage.
 2. Carotid sheath
 3. internal jugular vein
 4. Anterior jugular vein
 - lower border of mandible
 - anterior border of sternocleidomastoid
muscle

61. LIGATION IN EXTERNAL CAROTID ARTERY
 KEY POINTS:-
1. Internal carotid artery doesn’t branch in the
neck, except for rare exceptions.
2. External carotid artery is usually anterior
and superficial to internal carotid artery but
not always.
3. Follow the external carotid artery to its
second branch.

62.  Incision of skin at level of
angle, behind anterior border
of sternocleidomastoid
muscle downwards parallel to
the anterior border of the
muscle to the level of cricoid.

63.  Dissection is carried through skin,
platysma, then anterior border of SCM is
identified and retracted posteriorly.
 A clamp is used to dissect anterior to the
muscle parallel to great vessels to identify
carotid sheath.
 The common carotid artery is carefully
separated from other contents of sheath.
 The internal jugular vein, vagus nerve and
hypoglossal nerve are retracted posteriorly.

64.  Usually at this place , a vesicular loop is
placed loosely around common carotid
artery to obtain control.
 Then dissection is carried up along the
common carotid artery to the bifurcation
area.
 At this point hypoglossal nerve is
identified crossing the branches, it
should be preserved.

65.  External carotid artery is usually
anterior and superficial to internal
carotid artery but not always.
 Follow the external carotid artery
to its second branch .
 A 2 -0 silk is placed between the
superior thyroid and lingual
arteries.
 The wound is closed in layers,
after the removal of vesicular loop
from common carotid artery.

66. LIGATION OF EXTERNAL
CAROTIID ARTERY

70. Exposure in the retromandibular fossa
The surgical exposure of the external carotid artery at
the stylomandibular ligament is a simpler and less
dangerous procedure than the exposure of the artery in
the neck.
The skin is incised in a line starting at the tip of the
mastoid process and circling the mandibular angle,
continuing forward below the mandible for about one
inch.
The incision is kept at an equal distance from the
posterior and inferior borders of the mandible.

71. EXPOSURE THROUGH RETROMANDIBULAR FOSSA
After the scalpel has passed through the skin and some
of the posterior fibers of the platysma muscle, the
retromandibular vein or the external jugular vein is
located, tied, and cut.
Branches of the great auricular nerve must also be cut to
permit the mobilization of the cervical lobe of the parotid
gland.
To this end, the attachment of the parotid capsule to the
anterior border of the sternocleidomastoid muscle must
be severed with the scalpel.

73. If this is done, the flap of soft tissues, consisting of skin and parotid gland, is
retracted anteriorly and upward.
Immediately underneath the parotid gland, the posterior belly of the digastric
muscle, and, slightly above it, the thin round flesh of the stylohyoid muscle
become visible.
Above these muscles the styloid process and the upper border of the
stylomandibular ligament can be palpated, especially if at this moment the
lower jaw of the patient is pulled forward.
This movement of the mandible not only widens the entrance into the
retromandibular fossa, but also tenses the stylomandibular ligament.
At the stylomandibular ligament the pulse of the external carotid artery can be
felt, and it is easy to isolate the artery and to tie it, even if it is accompanied by
a larger vein.

74. Ligation of the facial artery
 The facial artery can be easily exposed at the point
where it crosses the lower border of the mandible to pass
from the submandibular region into the face.
 This point is situated anterior to the attachment of the
masseter muscle to the mandible.
 Here the pulse of the artery can be felt, especially if the
contracted masseter muscle is used as a landmark.
 The artery is accompanied by facial vein, which lies
posterior to the artery.
 The artery and vein are crossed superficially by the
marginal mandibular branch of the facial nerve.

75. LIGATION OF FACIAL ARTERY
The nerves and vessels are covered by the platysma muscle , the
subcutaneous tissue and the skin.
Since the mandibular branch of the facial nerve supplies the
muscles of the lower lip, it is necessary to plan the operation in
such a way that the nerve is not being cut.
To achieve this end, the incision is made at least half inch below
the border of the mandible and parallel to it.
The skin , the platysma and deep fascia are cut and then the soft
tissues are bluntly retracted upward until the palpating finger can
feel the pulse of the facial artery.
The artery can then be isolated , tied and cut.

76. LIGATION OF
FACIAL ARTERY

77. Ligation of the lingual artery
 The exposure of the triangle is done in the submandibular ( Digastric
triangle).
 This region is bounded by the lower border of the mandible and the two
bellies of the digastric muscle.
 Surgically the procedure of exposing the lingual artery is as follows;
1. The submandibular gland is palpated through the skin , and an incision
is made that circles the lower pole of the gland .
2. The posterior part of the incision should point toward the tip of the
mastoid process ; the anterior part of the incision should point toward
the chin.
3. If the skin, platysma and deep fascia are incised, the lower pole of the
submandibular gland is exposed .
4. If the gland is lifted from its bed by blunt dissection and the entire flap
is retracted upward, the tendon of the digastric muscle becomes
visible.
5. This muscle is divided bluntly, and in the gap between its vertical fibres
, the lingual artery is found.

78. LIGATION OF LINGUAL ARTERY
1. Following the tendon anteriorly, the free border of
the mylohyoid muscle is easily ascertained where it
is crossed by the tendon not far above the hyoid
bone.
2. If one follows the free border of the mylohyoid
muscle upward and backward, the hypoglossal
nerve can be identified by the accompanying vein
and the fact is that the vein and the nerve disappear
at the posterior border of the mylohyoid muscle.
3. The lingual triangle between the digastric tendon,
the posterior mylohyoid border and the hypoglossal
nerve has been circumscribed.
4. Pulling the digastric tendon downwards helps to
enlarge this triangle, at floor of which finely bundled
hyoglossus muscle with its vertical fibers becomes
visible.

79. LIGATION OF
LINGUAL
ARTERY

80. REFERENCES
 1. B D CHAURASIA’S HUMAN ANATOMY – HEAD AND NECK – 9TH EDITION
 2. TEXT BOOK OF HEAD AND NECK ANATOMY BY JAMES L HIATT AND LESLIE P GARTNER – 4TH
EDITION
 3. Triangles of the neck: a review with clinical/surgical applications, Shogo Kikuta,1,2 Joe
Iwanaga,corresponding
 author1,2,3 Jingo Kusukawa,2 and R. Shane Tubbs1,4.
 4. ORAL AND MAXILLOFACIAL INFECTION BY TOPAZIAN
 5. STELL AN MARAN’S TEXTBOOK OF HEAD AND NECK ONCOLOGY
 6. Sicher and Debruls oral anatomy by E. LLOYD DuBRUL – 8TH EDITION.
 7. Text book of Anatomy by VISHRAM SINGH – SECOND EDITION.