the anatomy of the triangles of the neck and its possible swellings

1. The Neck
By:
Tamer Rushdy EL-Alfy
Assistant lecturer of general surgery

2. Neck triangles .
 Neck swellings
 Thyroglosal cyst.
 Branchial cyst
 Lymph nodes of the neck.

3. AnatomyAnatomy
Each sides of the neck is divided by
sternomastoid muscle in to two main
triangles :-
1. The anterior triangle.
2. The posterior triangle.

5. CYSTCYST
Means a swelling consisting of a
collection of fluid in a sac which is
lined by epithelium or endothelium

6. FISTULAFISTULA
Is an abnormal communication
between two epithelial surface

7. SINUSSINUS
Is a blind track lined with
granulations leading from an
epithelial surface in to the
surrounding tissues .

8. Swelling in the carotidSwelling in the carotid
triangletriangle
Solid :
 Deep cervical L.Node.
 Enlarge lateral lobe of thyroid gland.
 Carotid body tuomour.
 Cystic:
 Cold abscess.
 Brancheal cyst.

9. Swelling in the posterior triangleSwelling in the posterior triangle
Solid :
L.Node enlargement .
Neurofibroma.
Cervical rib.
 Cystic:
Cystic hygroma.
Cold abscess.
Pneumatocele.

10. OthersOthers
Swelling of skin & subcutaneous
tissues:
 As lipoma .
 Sebaceous cyst .
 haemangioma.

11. Carotid body tuomourCarotid body tuomour
Rare .
 Slow growing malignant tuomour.
 Arise from the chemoreceptor at the bifurcation of
carotid artey.
 Usually occur at middle age .
 Usually smooth but may be lobular.
 Move side to side but not vertically.
 Exhibit transmitted pulsation from underlying
carotid artery.

14. Thyroglossal duct cyst

15. The thyroglossal duct cystThe thyroglossal duct cyst
It is a remnant of the diverticulum formed by
migration of thyroid tissue from foramen cecum at
the base of the tongue through the hyoid bone to
its final position around the tracheal cartilage .

16. The thyroglossal duct cystThe thyroglossal duct cyst
 Failure of subsequent closure and obliteration of this tract
predisposes to thyroglossal cyst formation.
 Is a rare but occasional cause of a benign neck mass.
 Almost always in the midline.

17.  site:
20% are suprahyoid.
15% occur at the hyoid .
65% are infrahyoid.
 Present by the age of 10 in 50% of cases. but
may be found in the older population as well.
 No sex predominance .

18.  size:
It measure about 0.5-5cm in diameter, and
gradually ↑ in size.
 It is painful if increase in size or became
infected

19.  Asymptomatic
 Hot , red & tender if infection present.
 Consistency:
Firm to hard
 Movement:
Upward by deglutition, & protrusion
of the tongue.
 Diagnosis is usually made clinically.

20. Thyroglossal fistulaThyroglossal fistula
Are almost always the result of infection with
spontaneous or surgical drainage.
It can drain internally , externally or both.
Discharge of mucus & recurrent attack of
inflamation is the clinical finding.

21. TreatmentTreatment
 Before thyroglossal duct cysts are excised,
it is important to demonstrate that normally
functioning thyroid tissue is in its usual
location.
Thyroid scans and thyroid function studies
are ordered preoperatively.

22. TreatmentTreatment
Total surgical excision (sistrunk procedure)
including:-
 The cyst and sinus to the base of the tongue.
 Whole fistula.
 Middle third of hyoid bone.

27. Branchial Cyst:Branchial Cyst:
• ETIOLOGY:
2727
Persistent cervical sinus
PATHOLOGY
:
 Lined by stratified squamous epithelium &
most have lymphoid
tissue in the wall.
 Contain straw-coloured fluid rich in
cholesterol crystals.

28. Branchial Cyst:Branchial Cyst: (cont.)(cont.)
• INCIDENCE:
2828
Most frequently seen in young adults
Peak age: third decade
CLINICAL PICTURE:
 Slowly-growing, painless, soft cystic swelling,
characteristically under the ant. border of the upper &
middle 1/3 of the SCM muscle.
 Branchial cysts are not translucent & do not move on
swallowing

29. Branchial Cyst:Branchial Cyst: (cont.)(cont.)
2929
Surgical excision(Band?(
INVESTIGATIONS:
TREATMENT:

33. Lymphatic drainage

34. Lymphatic drainage of head and neck are
particularly important when locating and
working up a "neck mass" or possible
malignancy.

35. Lymphatic drainage:Lymphatic drainage:
 Superficial nodes:
Are few nodes lies superficial to the deep fascia :
1. The anterior cervical node along the anterior jugular vein.
2. The superficial cervical nodes along the external jugular
vein.
 Deep nodes:
1. Vertical chain.
2. Circular chain.

36. Vertical chain Deep nodes

37.  Is closely related to internal jugular vein.
 Types of vertical chains:
1. Superior deep cervical (jugulo-digastric nodes ).
2. Inferior deep cervical (jugulo-omohyoid nodes ).
3. Few nodes in the root of the neck called supraclavicular
nodes (virchow’s nodes ), (Troisier’s sign).

38. Circular chainCircular chain
Submental nodes .
 Submandibular nodes .
 Buccal or facial nodes .
 Preauricular (parotid ) nodes .
 Posterior auricular nodes .
 Occipital nodes .
 Retropharyngeal , pretracheal nodes .

39. 3939
Lymph node levels
• Level I
– Refers submental and submandibular nodes
– Drains the lip, oral cavity and tongue

40. 4040
• Level II
– Forms upper jugular group of nodes
– Drains the oropharynx, larynx, hypopharynx
and parotid
• Level III
– Refers to middle jugular node
– Drains the larynx and pharynx

41. 4141
• Level IV
– Refers to lower jugular group of nodes
– Drains the larynx and hypopharynx

42. • Level V
– Refers to posterior triangle group of nodes
– Drains the other lymphatic regions in the neck
– Level Va:
• Superior to inf belly of omohyoid
• Contains the chain of nodes along the accessory
nerve, which drain the nasopharynx
– Level Vb:
• Inferior to inf belly of omohyoid
• Contains nodes related to the thyrocervical trunk
which drains the thyroid gland

43. 4343
• Level VI:
– Anterior or central group of nodes
– Paratracheal, perithyroidal, Delphian nodes
• Level VII:
– Corresponds to the superior mediastinal
tissues