TRIANGLES OF NECK

OUTLINE

I. TRIANGLES OF
NECK

II. DEEP
STRUCTURES OF
NECK
STERNOCLEIDO-
MASTOID

TO LOCATE STRUCTURES IN NECK ON PATIENT OR

IN PRACTICAL EXAM MOST USEFUL LANDMARK
IS STERNOCLEIDOMASTOID MUSCLE
 I. TRIANGLES OF NECK

Sternocleidomastoid
Muscle Triangles of Neck –
for description neck
is divided into
anterior & posterior
triangles by
Sternocleidomastoid
Posterior
muscle
triangle
Anterior
triangle
 A. POSTERIOR TRIANGLE
Anterior -
Sternocleidomastoid 1. Boundaries
Muscle

Superficial cover
- superficial
Posterior fascia, platysma
Trapezius and Investing
Layer
Deep - (floor)
Prevertebral
layer of fascia
Clavicle
 B. CONTENTS OF POSTERIOR TRIANGLE

Occipital
artery
Superficial -
Great branches of
Auricular n. cervical
Lesser plexus
occipital n. Trans Cerv. n.
Accessory n.
(XI)
External
Jugular Vein
Supra-
clavicular
nerves
 POSTERIOR TRIANGLE - deeper, saw through
clavicle Nose
Note:
Accessory n. -
divides post.
triangle into
'Carefree' -
superior
'Careful' -
inferior
Phrenic
nerve
Brachial
plexus
roots &
trunks
 POSTERIOR TRIANGLE - deeper
Brachial
plexus roots &
Phrenic n.
trunks
Transverse
Nose
(superf.)
Cervical A.
Suprascapular
A.
Subclavian
Subclavian a. vein

note: Subclavian vein is not in post triangle

 B. ANTERIOR TRIANGLE OF NECK

Sternocleidomastoid
Muscle
1. Boundaries-
ant. - midline of neck
post. - sternocleido-
mastoid
superior - mandible
(lower margin).
Midline Subdivided to
of neck smaller triangles (not
required)
2. CONTENTS OF ANTERIOR TRIANGLE OF NECK

In Carotid
sheath:
- cut through
Int. and
sternocleido-
Common
mastoid 2”
Carotid A.,
above
Int. Jug. V.,
sternum
Vagus N.
Follow
dissection Hypoglossal
to all n. XII & ansa
branches of cervicalis
Ext. carotid
 II. DEEP STRUCTURES OF NECK

A. THYROID GLAND

Two Lateral
Lobes - below
& on sides
thyroid
cartilage

Lateral Lobe Lateral Lobe

 THYROID GLAND

Right Left Pyramidal lobe-

lateral when present often
lateral
lobe attached to hyoid
lobe bone by fibrous
strand

Isthmus
- located
below
cricoid
cartilage
 THYROID GLAND - ARTERIAL SUPPLY

a) Sup.
very Thyroid
vascular- artery &
arteries Sup.
accompanied Laryngeal n.
by nerves
b) Inf.
Thyroid
artery &
Recurrent
laryngeal n.
Note: In thyroid surgery care taken not to damage
Recurrent Laryngeal Nerve
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)
Superior located
parathyroid posterior
gland to or
Inferior within
parathyroid Thyroid
gland gland
 SYMPATHETIC CHAIN

Ant to
vertebrae Sympathetic
Not trunk- deep to
confuse (not in)
with Carotid Sheath
Vagus X
Note: sympathetics
to most of head
are from Superior
Cervical Ganglion
 THORACIC DUCT

INT. JUGULAR V.
THORACIC DUCT
SUBCLAVIAN V.

DRAINS TO LEFT
BRACHIOCEPHALIC
FOLLOWS LEFT
V.
MARGIN OF
ESOPHAGUS AT JUNCTION OF
SUBCLAVIAN AND
INT. JUGULAR VEINS
GUIDE TO DISSECTION

1) Completely Skin Neck

2) Skip p. 175 see:
Prosection Cutaneous
nerves
Do Post. Triangle
3) Cut through clavicle if
not already done
4) Cut through
sternocleidomastoid 2”
(5cm) above sternum p.
178
 FASCIA OF NECK

Superficial fascia:
- connective
tissue below
dermis
- completely
surrounds neck -
thin and hard to
demonstrate
- contains
Platysma &
Superficial veins
 POSTERIOR TRIANGLE - CONTENTS

Occipital
artery
Superficial -
Great branches of
Auricular n. cervical
Lesser plexus
occipital n. Trans Cerv. n.
Accessory n.
(XI)
External
Jugular Vein
Supra-
clavicular
nerves
 POSTERIOR TRIANGLE - deeper, saw through
clavicle Nose

Accessory n.-
divides post.
triangle into
Carefree-
superior
Careful-
inferior Phrenic
nerve
Brachial
plexus
roots &
trunks
 POSTERIOR TRIANGLE - deeper
Brachial
plexus roots &
Phrenic n.
trunks
Transverse
Nose
(superf.)
Cervical A.
Suprascapular
A.
Subclavian
Subclavian a. vein

note: Subclavian vein is not in post triangle

ANTERIOR TRIANGLE OF NECK - CONTENTS

-cut through
Carotid sheath
sternocleido
contents
mastoid 2”
Int. and
above
Common
sternum
Carotid A.,
Int. Jug. V.,
Vagus N. Hypoglossal
n. XII & ansa
Follow cervicalis
dissection to all
branches of ext.
carotid
 EXTERNAL CAROTID ARTERY
Superficial temporal- Maxillary
scalp & temporalis

Post auricular- post. ear &

scalp
Facial

Occipital- post.
scalp
Ascending pharyngeal-
pharynx
Lingual- tongue

Superior thyroid- br. is Sup

laryngeal
PROSECTION
OF
ANTERIOR
NECK
 INFRAHYOID MUSCLES - all depress hyoid

NOSE
deeper

2) STERNOHYOID 4) THYROHYOID - O -
O- Manubrium & thyroid cartilage; also
clavicle elevates larynx
1) OMOHYOID 3) STERNOTHYROID --
intermediate O - manubrium I -
tendon to thyroid cartilage; also
clavicle, rib 1; depresses larynx
Sup. belly to
hyoid
 THYROID GLAND - ARTERIAL SUPPLY

Sup. Thyroid
very artery &
vascular- Sup.
arteries Laryngeal n.
accompanied
by nerves Inf. Thyroid
artery &
Recurrent
laryngeal n.

Note: in thyroid surgery care taken not to damage

Recurrent Laryngeal Nerve
PROSECTION:
DEEP
DISSECTION OF
NECK