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triangles of neck
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TRIANGLES OF NECK
TO LOCATE STRUCTURES IN NECK ON PATIENT OR IN PRACTICAL EXAM MOST USEFUL LANDMARKIS STERNOCLEIDOMASTOID MUSCLE
OUTLINE
I. TRIANGLES OFNECK
II. DEEPSTRUCTURES OFNECK
STERNOCLEIDO-MASTOID
Triangles of Neck –for description neck is divided into anterior & posterior triangles bySternocleidomastoidmusclePosterior
triangleAnterior triangle
SternocleidomastoidMuscle
I. TRIANGLES OF NECK
1. Boundaries
Superficial cover - superficial fascia, platysmaand Investing Layer
Deep - (floor) Prevertebrallayer of fascia
Clavicle
A. POSTERIOR TRIANGLE
PosteriorTrapezius
Anterior -SternocleidomastoidMuscle
Superficial -branches of cervical plexus
Trans Cerv. n.
External Jugular VeinSupra-
clavicular nerves
Occipital artery
Great Auricular n.
Lesser occipital n.
Accessory n. (XI)
B. CONTENTS OF POSTERIOR TRIANGLE
Note: Accessory n. -divides post. triangle into 'Carefree' -superior 'Careful' -inferior Phrenic
nerveBrachial plexus roots & trunks
POSTERIOR TRIANGLE - deeper, saw throughclavicle Nose
note: Subclavian vein is not in post triangle
Nose
Phrenic n.Brachial plexus roots & trunks
Transverse (superf.) Cervical A.
Suprascapular A.
Subclavian a.Subclavian vein
POSTERIOR TRIANGLE - deeper
1. Boundaries-ant. - midline of neckpost. - sternocleido-mastoid superior - mandible (lower margin).
Subdivided to smaller triangles (not required)
Midline of neck
SternocleidomastoidMuscle
B. ANTERIOR TRIANGLE OF NECK
In Carotid sheath:Int. and Common Carotid A., Int. Jug. V., Vagus N.
Follow dissection to all branches of Ext. carotid
- cut through sternocleido-mastoid 2” above sternum
Hypoglossal n. XII & ansa cervicalis
2. CONTENTS OF ANTERIOR TRIANGLE OF NECK
Two Lateral Lobes - below & on sides thyroid cartilage
Lateral Lobe
A. THYROID GLAND
Lateral Lobe
II. DEEP STRUCTURES OF NECK
THYROID GLAND
Right lateral lobe
Left lateral lobe
Isthmus- located below cricoid cartilage
Pyramidal lobe-when present often attached to hyoid bone by fibrous strand
very vascular-arteries accompanied by nerves
a) Sup. Thyroid artery &Sup. Laryngeal n.
b) Inf. Thyroid artery & Recurrent laryngeal n.
Note: In thyroid surgery care taken not to damage Recurrent Laryngeal Nerve
THYROID GLAND - ARTERIAL SUPPLY
THYROID GLAND - LOTS OF VEINS
1) Sup. Thyroid vein follows Sup. Thyroid artery
2) Middle Thyroid vein - to Int Jugular
3) Inf. Thyroid vein -Both sides join at midline -> L. Brachiocephalic Vein
PARATHYROID GLANDS
- 4 small bodies (2 on each side) located posterior to or within Thyroid gland
Superior parathyroid gland
Inferior parathyroid gland
Sympathetic trunk- deep to (not in) Carotid Sheath
Ant to vertebrae
Not confuse with Vagus X
SYMPATHETIC CHAIN
Note: sympatheticsto most of headare from SuperiorCervical Ganglion
FOLLOWS LEFT MARGIN OF ESOPHAGUS
DRAINS TO LEFT BRACHIOCEPHALIC V.
AT JUNCTION OF SUBCLAVIAN AND INT. JUGULAR VEINS
THORACIC DUCT
SUBCLAVIAN V.
INT. JUGULAR V.
THORACIC DUCT
1) Completely Skin Neck
2) Skip p. 175 see: Prosection Cutaneousnerves
Do Post. Triangle
3) Cut through clavicle if not already done
4) Cut through sternocleidomastoid 2” (5cm) above sternum p. 178
GUIDE TO DISSECTION
Superficial fascia:
- connective tissue below dermis - completely surrounds neck -thin and hard to demonstrate - contains Platysma & Superficial veins
FASCIA OF NECK
Superficial -branches of cervical plexus
Trans Cerv. n.
External Jugular VeinSupra-
clavicular nerves
Occipital artery
Great Auricular n.
Lesser occipital n.
Accessory n. (XI)
POSTERIOR TRIANGLE - CONTENTS
Accessory n.-divides post. triangle into Carefree-superior Careful-inferior Phrenic
nerveBrachial plexus roots & trunks
POSTERIOR TRIANGLE - deeper, saw throughclavicle Nose
note: Subclavian vein is not in post triangle
Nose
Phrenic n.Brachial plexus roots & trunks
Transverse (superf.) Cervical A.
Suprascapular A.
Subclavian a.Subclavian vein
POSTERIOR TRIANGLE - deeper
Carotid sheath contents Int. and Common Carotid A., Int. Jug. V., Vagus N.
Follow dissection to all branches of ext. carotid
-cut through sternocleidomastoid 2” above sternum
Hypoglossal n. XII & ansa cervicalis
ANTERIOR TRIANGLE OF NECK - CONTENTS
Superficial temporal-scalp & temporalis
Post auricular- post. ear & scalp
Occipital- post. scalp
Ascending pharyngeal-pharynx
Lingual- tongue
Superior thyroid- br. is Sup laryngeal
Maxillary
EXTERNAL CAROTID ARTERY
Facial
PROSECTION OFANTERIORNECK
2) STERNOHYOID O- Manubrium & clavicle
1) OMOHYOID intermediate tendon to clavicle, rib 1; Sup. belly to hyoid
4) THYROHYOID - O -thyroid cartilage; also elevates larynx
3) STERNOTHYROID --O - manubrium I -thyroid cartilage; also depresses larynx
INFRAHYOID MUSCLES - all depress hyoid
deeperNOSE
very vascular-arteries accompanied by nerves
Sup. Thyroid artery &Sup. Laryngeal n.
Inf. Thyroid artery & Recurrent laryngeal n.
Note: in thyroid surgery care taken not to damage Recurrent Laryngeal Nerve
THYROID GLAND - ARTERIAL SUPPLY
PROSECTION: DEEPDISSECTION OFNECK