Triangles of the neck

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Triangles of the neck

  1. 1. Triangles ofTriangles of the Neckthe Neck By: Aljeirou D. Alcachupas
  2. 2. Muscles of the NeckMuscles of the Neck
  3. 3. Anterior TriangleAnterior Triangle BoundariesBoundaries:: front,front, by the middle line of the neckby the middle line of the neck behind,behind, by the anterior margin of the Sternocleidomastoid;by the anterior margin of the Sternocleidomastoid; base,base, directed upward, formed by the lower border of the body of thedirected upward, formed by the lower border of the body of the mandiblemandible apexapex is below, at the sternum.is below, at the sternum.
  4. 4.  This space is subdividedThis space is subdivided into four smaller trianglesinto four smaller triangles by the Digastricus above,by the Digastricus above, and the superior belly of theand the superior belly of the Omohyoideus below. TheseOmohyoideus below. These smaller triangles are namedsmaller triangles are named thethe carotid,carotid, thethe submandibular,submandibular, thethe submental,submental, and theand the muscular.muscular.
  5. 5.  Muscular TriangleMuscular Triangle Boundaries:Boundaries:  Front,Front, by the median line of theby the median line of the neck from the hyoid bone to theneck from the hyoid bone to the sternum;sternum;  Behind,Behind, by the anterior margin ofby the anterior margin of the Sternocleidomastoid;the Sternocleidomastoid;  AboveAbove, by the superior belly of the, by the superior belly of the Omohyoid. It is covered by theOmohyoid. It is covered by the integument, superficial fascia,integument, superficial fascia, Platysma, and deep fasciaPlatysma, and deep fascia
  6. 6.  The muscles forming and withinThe muscles forming and within the triangle are seen in imagethe triangle are seen in image labeled:labeled:  superficial layersuperficial layer  sternohyoid (sh)sternohyoid (sh)  superior belly of omohyoidsuperior belly of omohyoid (oh)(oh)  deep layerdeep layer  thyroid (th)thyroid (th)  sternothyroid (st)sternothyroid (st)
  7. 7.  Contents: common carotid artery, internalContents: common carotid artery, internal jugular vein and vagus nerve, inferior thyroidjugular vein and vagus nerve, inferior thyroid artery, the recurrent nerve, and the sympatheticartery, the recurrent nerve, and the sympathetic trunk , esophagus, the trachea, the thyroid gland,trunk , esophagus, the trachea, the thyroid gland, and the lower part of the larynxand the lower part of the larynx
  8. 8. Thyroid gland andThyroid gland and its arterial supplyits arterial supply  When the strap musclesWhen the strap muscles are reflected, you can seeare reflected, you can see the thyroid gland (tg)the thyroid gland (tg) with its arteries (superiorwith its arteries (superior thyroid artery from thethyroid artery from the external carotid (sta) andexternal carotid (sta) and the inferior thyroid arterythe inferior thyroid artery from the thyrohyoidfrom the thyrohyoid trunk from thetrunk from the subclavian (ita).subclavian (ita).
  9. 9.  If the thyroid gland isIf the thyroid gland is reflected laterally, thereflected laterally, the structures making up thestructures making up the larynx and trachea are seen:larynx and trachea are seen:  thyrohyoid membrane (thm)thyrohyoid membrane (thm)  thyroid cartilage (Adam'sthyroid cartilage (Adam's apple)(tc)apple)(tc)  cricothyroid membrane andcricothyroid membrane and ligament (ctm)ligament (ctm)  cricoid cartilage (cc)cricoid cartilage (cc)  tracheal rings (tr)tracheal rings (tr) Cartilages and membranes
  10. 10. Anterior View of Thyroid GlandAnterior View of Thyroid Gland  The thyroid gland is hiddenThe thyroid gland is hidden under the sternohyoid andunder the sternohyoid and sternothyroid muscles andsternothyroid muscles and consists of two lobes and anconsists of two lobes and an isthmus.isthmus.  An occasional pyramidal lobeAn occasional pyramidal lobe extends upward near the midextends upward near the mid line.line.  The inferior thyroid artery isThe inferior thyroid artery is closely associated with theclosely associated with the recurrent laryngeal nerverecurrent laryngeal nerve (rln).(rln).
  11. 11. Boundaries:Boundaries:  Above,Above, by the posteriorby the posterior belly of digastricbelly of digastric muscle and stylohyoidmuscle and stylohyoid  Below,Below, by the superiorby the superior belly of the omohyoidbelly of the omohyoid muscle (so)muscle (so)  BehindBehind, anterior border, anterior border of sternomastoidof sternomastoid musclemuscle Carotid Triangle
  12. 12.  Roof of the carotid:Roof of the carotid: The first layer, under theThe first layer, under the skin and superficial fasciaskin and superficial fascia includes the platysma,includes the platysma, which forms the roof ofwhich forms the roof of the carotid triangle. Notethe carotid triangle. Note the location of thethe location of the carotid triangle in purple.carotid triangle in purple.
  13. 13.  Floor of the carotid:Floor of the carotid: The floor is the the deepestThe floor is the the deepest aspect of the carotid triangle.aspect of the carotid triangle.  The muscles, at this level, areThe muscles, at this level, are the middle and lowerthe middle and lower pharyngeal constrictors (mpcpharyngeal constrictors (mpc and ipc).and ipc).  The structures seen passingThe structures seen passing through this level are:through this level are:  superior laryngeal nerve, asuperior laryngeal nerve, a branch of the vagus its 2branch of the vagus its 2 terminal branchesterminal branches  internal laryngeal (ilb--sensoryinternal laryngeal (ilb--sensory to upper part of the larynx)to upper part of the larynx)  external laryngeal (elb--motorexternal laryngeal (elb--motor to the cricoid muscle)to the cricoid muscle)
  14. 14.  Contents: upper part of the common carotidContents: upper part of the common carotid artery, internal jugular vein, hypoglossal nerve,artery, internal jugular vein, hypoglossal nerve, vagus nerve, accessory nerve, internal branch ofvagus nerve, accessory nerve, internal branch of the superior laryngeal nerve, external branch ofthe superior laryngeal nerve, external branch of the superior laryngeal nervethe superior laryngeal nerve
  15. 15.  Veins within the CarotidVeins within the Carotid With the roof removed, here are theWith the roof removed, here are the boundaries of the carotid triangleboundaries of the carotid triangle and the superficial veins related toand the superficial veins related to it:it:  common facial vein (cf) (common facial vein (cf) (within carotidwithin carotid triangle)triangle)  Other structures near by:Other structures near by:  retromandibular vein (retromandibular vein (rmrm))  posterior auricular vein (posterior auricular vein (pavpav))  facial vein (facial vein (fvfv))  external jugular vein (external jugular vein (ejej))  anterior jugular vein (anterior jugular vein (ajaj))
  16. 16. Nerves within the Carotid TriangleNerves within the Carotid Triangle
  17. 17.  The nerves that enter theThe nerves that enter the carotid triangle and thatcarotid triangle and that lie superficial to thelie superficial to the internal jugular vein,internal jugular vein, internal and externalinternal and external carotid arteries are:carotid arteries are:  hypoglossal (XII)hypoglossal (XII)  C1 root of ansa cervicalisC1 root of ansa cervicalis (C1)(C1)  C1 fibers running withC1 fibers running with hypoglossal nerve (nervehypoglossal nerve (nerve to thyrohyoid muscleto thyrohyoid muscle (nth)(nth)  C2-C3 root of ansaC2-C3 root of ansa cervicaliscervicalis  ansa cervicalis (ac)ansa cervicalis (ac)
  18. 18. Reflection of sternomastoid andReflection of sternomastoid and removal of common facial veinremoval of common facial vein  ccacca-common carotid artery-common carotid artery ecaeca-external carotid artery-external carotid artery  stasta-supterior thyroid artery-supterior thyroid artery  oaoa-occipital artery-occipital artery  lala-lingual artery-lingual artery  fafa-facial artery-facial artery  icaica-internal carotid artery-internal carotid artery
  19. 19. Arteries in the Carotid TriangleArteries in the Carotid Triangle
  20. 20.  corresponds to the region of thecorresponds to the region of the neck immediately beneath theneck immediately beneath the body of the mandible.body of the mandible. Boundaries:Boundaries:  Above,Above, by the lower border of theby the lower border of the body of the mandible and thebody of the mandible and the mastoid processmastoid process  Below,Below, by the posterior belly ofby the posterior belly of the Digastric and the Stylohyoid;the Digastric and the Stylohyoid;  Front,Front, by the anterior belly of theby the anterior belly of the Digastric.Digastric.  Floor,Floor, coverd by mylohiodeuscoverd by mylohiodeus Submandibular Triangle
  21. 21.  The superficial (roof)The superficial (roof) structures of thestructures of the submandibular regionsubmandibular region are:are:     platysmaplatysma  facial vein (fv)facial vein (fv)  cervical branch of facialcervical branch of facial nerve (cbf)nerve (cbf)
  22. 22.  Contents:Contents: Anterior part:Anterior part: submaxillary gland,submaxillary gland, anterior facial vein,anterior facial vein, external maxillaryexternal maxillary artery, submentalartery, submental artery, mylohyoidartery, mylohyoid artery and nerve,artery and nerve, external carotidexternal carotid artery, internalartery, internal carotid artery, facialcarotid artery, facial nervenerve
  23. 23.  Removal of the superficialRemoval of the superficial structures displays thestructures displays the submandibular salivary glandsubmandibular salivary gland itself.itself.
  24. 24.  contents of thecontents of the submandibular triangle aresubmandibular triangle are structures passing through:structures passing through:  facial artery (fa)facial artery (fa)  lingual nerve andlingual nerve and submandibular ganglionsubmandibular ganglion (ln)(ln)  submandibular duct (smd)submandibular duct (smd)  lingual artery (la)lingual artery (la)  hypoglossal nerve (XII)hypoglossal nerve (XII)  the lingual nerve andthe lingual nerve and submandibular duct passsubmandibular duct pass through a gap between thethrough a gap between the hypoglossal (hg) andhypoglossal (hg) and mylohyoid (mh) musclesmylohyoid (mh) muscles  the lingual artery passes deepthe lingual artery passes deep to the hyoglossus muscle.to the hyoglossus muscle.
  25. 25. Submental TriangleSubmental Triangle BoundariesBoundaries BBehind,ehind, by the anterior bellyby the anterior belly of the Digastricusof the Digastricus Front,Front, by the middle line ofby the middle line of the neck between the mandiblethe neck between the mandible and the hyoid boneand the hyoid bone Below,Below, by the body of theby the body of the hyoid bone;hyoid bone; FloorFloor is formed by theis formed by the Mylohyoideus which aids inMylohyoideus which aids in swallowing and in depressingswallowing and in depressing the mandible.the mandible.  StructuresStructures  submental lymph node(s) (ln) -submental lymph node(s) (ln) - drain the floor of the mouth.drain the floor of the mouth.  some small veins; the lattersome small veins; the latter unite to form the anteriorunite to form the anterior jugular vein.jugular vein.
  26. 26. Posterior TrianglePosterior Triangle BoundariesBoundaries:: Front,Front, by the Sternocleidomastoid;by the Sternocleidomastoid; Behind,Behind, by the anterior margin of the Trapezius;by the anterior margin of the Trapezius; BaseBase, by the middle third of the clavicle, by the middle third of the clavicle Apex,Apex, by the occipital bone. The space is crossed, above the clavicle, byby the occipital bone. The space is crossed, above the clavicle, by the inferior belly of the Omohyoid, which divides it into, anthe inferior belly of the Omohyoid, which divides it into, an upperupper oror occipital,occipital, and aand a lowerlower oror supraclavicular.supraclavicular.
  27. 27. Occipital TriangleOccipital Triangle Boundaries:Boundaries: Front,Front, by theby the SternocleidomastoidSternocleidomastoid Behind,Behind, by the Trapeziusby the Trapezius Below,Below, by the Omohyoid.by the Omohyoid. FloorFloor is formed from aboveis formed from above downward by the Spleniusdownward by the Splenius capitis, Levator scapulæ, andcapitis, Levator scapulæ, and the Scaleni medius andthe Scaleni medius and posterior.posterior.
  28. 28.  It is covered byIt is covered by the skin, thethe skin, the superficial andsuperficial and deep fasciæ, anddeep fasciæ, and by the Platysmaby the Platysma below.below.
  29. 29.  Contents: accessoryContents: accessory nerve, supraclavicularnerve, supraclavicular nerves and thenerves and the transverse cervicaltransverse cervical vessels, lymph nodes,vessels, lymph nodes, brachial plexusbrachial plexus
  30. 30. Supraclavicular TriangleSupraclavicular Triangle Boundaries:Boundaries: Above,Above, by the inferiorby the inferior belly of the Omohyoid;belly of the Omohyoid; Below,Below, by the clavicle;by the clavicle; BaseBase is formed by theis formed by the posterior border of theposterior border of the Sternocleidomastoid.Sternocleidomastoid. floorfloor is formed by theis formed by the first rib with the firstfirst rib with the first digitation of the Serratusdigitation of the Serratus anterior.anterior.
  31. 31.  Contents:Contents:  third portion of thethird portion of the subclavian artery,subclavian artery,  subclavian vein,subclavian vein,  cervical artery,cervical artery,  external jugular veinexternal jugular vein  lymph nodes.lymph nodes.

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