POSTERIOR TRIANGLE OF NECK AND

ITS APPLIED

Presented by Moderator
Snehal kharche Dr. Arati S. Neeli
Contents
Boundaries
Muscles
Nerves
Vessels
Lymphatics
Applied aspect
Boundaries
Roof
Floor
Subdivisions of posterior triangle of neck
Contents
Muscles: inferior belly of omohyoid
Nerves
 Accessory nerve

 Root, trunks of brachial plexus and their branches :

• Nerves to rhomboideus(dorsal scapular n)
• Nerves to serratus anterior(long thoracic n)
• Nerves to subclavius
• Suprascapular nerve

 Cervical nerves
• Greater occipital nerve
• Great auriclular nerve
• Lesser occipital nerve
• Transverse cervical nerve of neck
• Supraclavicular nerve
 3rd and 4th cervical nerves supplying trapezius
Arteries
 Occipital artery
 Third part of subclavian artery & branches of subclavian artery
• Suprascapular
• Transverse cervical
Veins
 External jugular vein & its tributaries
 Subclavian vein is lower down and not in the triangle
Lymph nodes
Supraclavicular lymph nodes are present on posterior
border of sternocleidomastoid
Occipital nodes
Torticollis
Spinal accessory nerve palsy
The brachial plexus and subclavian artery may be
compressed in the neck by

rudimentary cervical rib

tight fibrous band
tight scalenus anterior muscle

giving rise to
◦ sensory symptoms
◦ vascular symptoms
Cervical rib
 Pressure in the cervical rib will give rise to local pain as
well as pain referred to hand and forearm particularly in
the ulnar portion
Brachial plexus palsies
Upper brachial plexus (erb’s) palsy
These infants cannot move the shoulder and keep their
arm extended and turned inward, giving the appearance
of the “porter's tip hand."
Lower brachial plexus (klumpke’s) palsy
External jugular vein
 Itcan be used for assessing jugular venous pressure and
for catheterization.
Subclavian artery
 Palpation and compression of the subclavian artery in
patients with upper limb hemorrhage
 Cervical rib and scalenous anticus syndrome
 Dysphagia lusoria
Neck dissection
Firstconceptual approach- Kocher
Crile introduced RND & was followed by Martin

Staging of Neck Nodes

 NX:
Regional lymph nodes can not be assessed

 N0:
No regional lymph node metastasis

 N1:
Metastasis in a single ipsilateral lymph nodes, 3 cm or less

 N2:
N2a:
 Metastasis in a single ipsilateral lymph nodes, > 3 cm < 6 cm
 N2b:
 Metastasis in multiple ipsilateral lymph nodes, not more than 6
cm
N2c:
 Metastasis in bilateral or contralateral nodes not more than 6
cm in diameter
 N3 :
Metastasis in lymph nodes more than 6 cm in in greatest diameter
Lymph node levels
Level I:
Ia- Submental group
Ib- Submandibular group

Level II:
around upper third of IJV &
adjacent to SAN
IIa- located anteriorly to SAN
IIb- located posteriorly to SAN

Level III:
around middle third of IJV
 Level IV:
around lower third of IJV

 Level V (posterior triangle group):

Va- spinal accessory nodes
Vb- nodes around transverse cervical vessels &
supraclavicular node

 Level VI:

pre & paratracheal, precricoid, perithyroidal & those

around reccurent laryngeal nerves
Classification
Radical neck Dissection:
Removing all lymphatic tissues in regions I - V and
include removal of SAN, SCM and IJV

Modified radical neck dissection:

Excision of all lymph nodes removed with RND with
preservation of one or more non-lymphatic structures,
SAN, SCM and/or IJV
 Subtype I: Preserve SAN
 Subtype II: Preserve SAN & IJV
 Subtype III: preserve SAN, IJV and SCM
Selective Neck dissection:
Any type of cervical lymphadenectomy with preservation of
one or more lymph node groups
Four subtype:
 Supraomohyoid neck dissection- I to III
 Posterolateral neck dissection- II to IV
 Lateral neck dissection- II to V
 Anterior neck dissection- VI

Extended neck dissection:

Any previous dissection and including one or more
additional lymph node groups and/or non-lymphatic tissues
Lateral neck swellings
 Lymph nodes
 Cystic hygroma
 Pharyngeal pouch
 Subclavian aneurysm
Cystic hygroma
 Failure of one of the lymphatics to join major lymph sac
of body
 Infancy and early childhood
 Soft, cystic, fluctuant
Pharyngeal pouch
Subclavian anuerysm
References
Clinical Anatomy for medical students – Richard Snell, 5th Ed.
Student’s Gray’s anatomy
Head and neck anatomy- James L. Hiatt
Grant’s Method of Anatomy, A Clinical problem solving
approach, 11th Ed.
Head and neck surgery otolaryngology- Byron J. Bailey
Otolaryngology head and neck surgery- Cumming’s
Cancer of face and mouth- McGregor
Stell & Maran’s Head and Neck surgery, 4th Ed.
B D Chaurasia’s Human anatomy, Volumes 1 & 3
A Concise textbook of surgery – S Das, 3rd Ed.
P J Mehta’s Practical Medicine