The document discusses the anatomy and triangles of the neck, describing boundaries, contents, and clinical significance. It also covers common neck masses including cysts, sinuses, fistulas, ulcers, tumors, and infections. Lymphatic drainage is described for deep cervical nodes along vertical and circular chains.

1. Neck
Swelling

2. Neck triangles .
 Neck tumour.
Cyst .
Sinus .
Fistulas .
Ulcer.
 Thyroglosal cyst.
 Cystic hygroma.
 Lymph nodes of the neck.

3. Anatomic
landmarks
of the neck

4. Mandible Hyoid bone
at the level of C3.
Thyroid cartilage
at the level of C4-C5 Cricoid cartilage
at the level of C6 .
Tracheal rings Sternomastoid muscle.
Suprasternal notch.

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

7. Anterior
Triangle
of the Neck

8. Anterior triangle of the neck
Boundaries :
Anterior border of sternomastoid muscle.
The midline.
The inferior margin of the mandible

10. The anterior triangle is sub divided in to four
triangles by
 Anterior belly of digastric muscles .
 Posterior belly of digastric muscles .
 Superior belly of omohyoid

11. 1. Submentum triangle.
2. Submandibular triangle.
3. Carotid triangle.
4. Muscular triangle.

12. Boundaries of Carotid Triangle

13. The Submental Triangle
Boundaries:
Anterior belly of digastric muscles.
The midline .
The hyoid bone.

14. Triangles of the Neck Anterior Triangle Posterior Triangle
• Anterior Triangle of the Neck

15. Submandibular triangle
Boundaries:
 Body of mandible.
 Antrior belly of digastric muscle.
 postrior belly of digastric muscle .

16. Triangles of the Neck Anterior Triangle Posterior Triangle
• Anterior Triangle of the Neck

17. The Submandibular Triangle

19. Carotid triangle
Boundaries:
 Sternomastoid muscle posteriorly .
 Posterior belly of digastric superiorly.
 Superior belly of omohyoid antero - inferior .

21. Boundaries of Carotid Triangle

24. Carotid triangle
• Vein of the carotid triangle
Vein of the carotid triangle

26. The muscular triangle
Boundaries:
 Mid line of neck .
 Superior belly of omohyoid superiorly .
 Sternomastoid muscle posteriorly .

29. Boundaries of Carotid Triangle

30. Content of anterior triangles:
The thyroid gland.
 The submandibular gland.
 The carotid sheath.
 The deep cervical group of lymph nodes.
 The supra and infrahyoid groups of
muscles.

31. Posterior
triangle

32. Boundaries of Posterior
Triangle
Anterior :- sternomastoid .
Posterior :- trapezius .
Inferior :- middle third of clavicle .

34. The posterior triangle is subdivided by
posterior belly of omohyoid in to :-
 large occipital triangle
 Small supraclavicular triangle

35. Boundaries of Carotid Triangle

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

37. FISTULA
Is an abnormal communication
between two epithelial surface

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

39. ULCER
Is a discontinuity of an epithelial
surface.

40. Tumour
Is a new growth of tissue (mass) which can
refer to an inflammatory or neoplastic growth .
A neoplastic mass is an uncontrolled
proliferation of a clon of cells without useful
function

41. Diagnosis
Depends on :
 Age of patient .
 Clinical course.
 Site.
 Solid or cystic.

42. Midline swelling
 Solid swelling :
 Submental lymph node enlargement.
 Nodule in isthmus.
 Cystic swelling :
 Thyroglossal cyst.
 Dermoid cyst.
 Laryngocoele.
 Cyst of thyroid.
 Cold abscess.

43. Submandibular triangle
swelling
 Enlarged Submandibular lymph node:
Multiple
Rolled over the edge of mandible
Not felt in the floor of mouth
 Enlarged Submandibular salivary gland

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

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

46. Others
Swelling of skin & subcutaneous
tissues:
 As lipoma .
 Sebaceous cyst .
 haemangioma.

47. Carotid 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.

48. Thyroglossal duct cyst

49. The 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 .

50. The 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.

51.  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 .

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

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

54. Thyroglossal 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.

55. Treatment
 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.

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

57. Neck fistula

59. Cystic hygroma
• Also called (cavernous lymphangioma) .
• It occurs due to sequestration of a portion of a
jugular lymph sac from lymphatic systems .
• It occupies the lower third of the neck and as it
enlarges it pass upwards towards the ear.

60. Cystic hygroma
 Usually it manifests itself during early
infancy.
 occasionally it is present at birth .
 Exceptionally it is so larges as to obstruct
labour.

61. Lymphatic drainage

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

63. 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.

64. Vertical chain Deep nodes

65.  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).

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