Anterior triangle of the neck

The borders of the ant. triangle: 1234The base: The whole inferior border of the mandible, the base of this triangle located superiorly. The apex: located where the medial border will mix the lateral border in the mid line in the jugular notch (suprasternal notch)-the upper part of the sternum, the apex located inferiorly. The anterior border: formed by Imaginary Midline crossing the middle. Of the body (mid-sagittal line). The pos.border: will be the anterior border of SCM (sternocleidomastoid muscle in ant. Aspect of the neck).

So many structures find in this triangle<blood vessels, nerves, muscles and even structures like thyroid gland and parathyroid gland> so in order to

simplifying its study we divide this triangle into further four triangles => so we use mainly two important muscles in this area: Digastric muscle (one of the suprahyoid muscle. (ant and pos.bellies) along with the sup. Belly of omohyoid muscle, those three bellies of muscles are used to divide the anterior triangle into four subtriangles: Submental Submandibular (Digastric) CarotidMuscular.

1- Submental triangle:
It is bellow the mental area (bellow the chean?) , smallest one, some anatomist considered this triangle as one submental triangle, other texts as two triangles one to the right and one to the left based on the mid-imaginary line, Borders of this triangle: The lateral part is the ant.belly of digastric, the medial boundary is mid.sagittal line, the base by the body of the hyoid bone.

The contents:............................
a small group of submental veins that unit to form larger vein in the superfacial fascia these vein is the ant. jugular vein then it descends all the way down out of the triangle through the neck to go and drain into external jugular vein at the root of the neck bellow,,, another thing we can find a group of lymph nodes that responsible for draining of the lymph from the chean (submental lymph nodes).

2- Submandibular triangle(digastric triangle):

digastric because all the digastric muscle contributing in this triangle, submandibular because its bellow the mandible, one in each side, its containing a large part of the submandibular salivary glands. Remember; we have three salivary glands, one sublingual located beneath the tongue, and the other two glands are parotid and submandibular (we can find it in this triangle) so we classified the submandibular triangle as glandular triangle. The Boundaries: the lateral is the inferior border of the mandible, the medial is the anterior belly of digastric, posteriorly: post. belly of digastric, the floor: is bond by two important muscles the flat sheet that extends from the mandible to the mid-line which is mylohyoid muscle which represented the floor of the mouth, anything above it will be in oral cavity and anything bellow it will be in the neck- the other muscle behind it, is-hyoglossus muscle. P.S.: hyoglossus muscle: its one of the muscles responsible for moving of the tongue, its located at the base of the tongue, -hyo- from hyoid bone and glossus is part of the tongue).

-The contents:..............................

submandibular gland
the submandibular gland which is the second in size from the major salivary glands after the sublingual gland, its sleeping in the pos.border of mylohyoid muscle, part of this gland is located in the cervical region-superficially- and the other smaller part of the gland is deep within the oral cavity-above mylohyoid-so the superficial part of submandibular gland located in the

submandibular triangle, in addition to the gland there are blood vessels, the vein and artery located in the submandibular triangle are the fascial ones(fascial artery and fascial vein)- facial artery which providing blood supply to the face and the facial veins draining the blood from the face, however; IF we look to their relation to submandibular gland we can see the artery loops deep to superficial part of that gland and the vein go to superfacial aspect of it.

Blood vessels :
In the head and neck region the main blood supply comes from the common carotid artery which divide into and internal go to the brain and external. the external carotid gives many branches one of them is the fascial artery; the facial artery arise from the ant. aspect of external carotid, when it arising there it passes deep to pos.belly of digastric and stylohyoid muscle (from the styloid process to hyoid bone). As The fascial artery crossing the pos.belly of digastric it will inter to submandibular triangle, once the artery enter it will go between the submandibular and the floor of the triangle then the artery loops at the inferior border of the mandible and ascends up into the face, at the looping area its become very superficial so its very easily to feel the pulse of these artery and this region we refer to it as facial pulse. -Three major areas to measure the pulse in the head and neck region one of contents of the them is The lower border of the mandible.
submandibular triangle:

- However; when the vein comes back it doesnt do all this looping and deep, it pass directly all the way superficially to the gland and descends down to drain into internal jugular. so its a superficial vein.

facial veins facial arteries 2 nerves : hypoglossal n. & n. to mylohyoid. organs : the facial part of submandibular salivary gland. group of lymph nodes. 4

the nerves
2 important nerves in the submandibular triangle

1- hypoglossal nerve CN (XII) from the brain through the hypoglossal canal "in the posterior cranial fossa" then it descends down until it appears at the carotid triangle then it loops and go deep to the post. belly of digastric muscle (which is the border between the carotid triangle and submandibular triangle) there it will find one of its favorite muscles "hyoglossus muscle" going above mylohyoid to reach the tongue in the oral cavity. fxn : motor innervations of the tongue muscles
in the posterior cranial fossa there are 4 main openings: 1- jugular foramena 2- foramen magnum 3- hypoglossal canal 4- internal auditory meatus

So hypoglossal nerve located into two triangles :

carotid triangle , submandibular triangle 2- nerve to mylohyoid : branch from the inf. alveolar nerve (inf. dental n.) just before it inters the mandibular foramen gives a branch which goes medially crossing over the floor of the oral cavity near the inf. aspect of mylohyoid muscle and innervate it , it's name is "nerve to mylohyoid". after that it goes to innervate the anterior belly of digastric by passing between mylohyoid superiorly and anterior digastric inferiorly.
Q: the posterior belly of digastric forming border of which triangle ? Both the carotid and the submandibular triangle

submandibular L.N.
located on the lateral and medial border of the sub mandibular glands.

Carotid Triangle
the borders : sup. --> post. belly of digastric inf. --> sup. belly of omohyoid post. --> SCM the contents : in the contents we have to find 5 different structures

carotid sheath
the most important structure it is part of the deep cervical facia that contain 4 structures :internal jugular vein (IJV) the most lateral ,common --> internal carotid artery (ICA) the most medial , vagus nerve the most posterior and the internal group of cervical lymph nodes following the IJV.

nerves:
1- ansa cervicalis : ansa (loop) cervicalis (in the neck), it is usually attached to the anterior part of the carotid sheath , it's made by the anterior ramie of C1(ant.root) ,C2&C3(pot.root) it innervate all the infrahyoid muscles except thyrohyoid muscle. cervical part of sympathetic chain: it is responsible for the autonomic innervations (sympathetic) while vagus n.(ant. to it) is the parasympathetic , it has 3 parts cervical thoracic & abdominal, it is attached to the posterior part of the carotid sheath .

" ansa cervicalis & sympathetic chain are NOT within the carotid sheath but they are attached to it from ant. and post. " 2- Hypoglossal nerve : 1stly appears at the carotid triangle then crossthe border deeply (post. belly of digastric) to get into submandibular triangle then meet the hyoglossus m. then within it to the tongue.

External carotid artery (ECA):

the carotid a. is a branch from the brachiocephalic a. (Right) behind the sterno clavicular joint & arch of aorta (Left) then ascend up and inter the neck region. in the neck at the level of adam's apple (upper border of thyroid cartilage, disc C3C4 ) the common carotid a. cleaves into internal and external carotid arteries (ICA, ECA) the ICA continuo through the carotid sheath but the ECA leave the carotid sheath. so u can see the ECA within the carotid triangle but it's out the carotid sheath. Branches: common carotid a. : has no branches ICA : has no branches out the skull . ECA: gives 8 branches after it leaves the carotid sheath P.S. plz follow the pic while studying its useful :) ---> nxt page

ECA starts at the level of C3-C4 & terminates behind neck of the mandible we classify them based on ascending aspect of the artery : 1- ascending pharyngeal a. : the first branch from the medial aspect of the ECA to the wall of the pharynx then ascend up to the wall of the pharynx providing blood supply to the muscles forming the wall of the pharynx . then we will have the next three important anterior branches:

2-superior thyroid a. : the first one of the ant. branches it goes inferiorly to the thyroid gland , sup. cuz it reaches thyroid from above. the inf. one come from the subclavian a. 3- lingual a. :the second one of the ant. it goes to supply the tongue. 4- facial a. : the third and the most superior ant. branch , goes ant. deep to the digastric m. inter the sub mandibular triangle deep to the sub mandibular gland then make looping on the lower border of the mandible and goes into the face to supply it. then we will have the next two posterior branches: 5- posterior auricular a. : a smaller post. branch that goes behind the auricle between the external meatus & the mastoid process, supplying the skin behind the auricle. 6- occipital a.the larger post. branch that ascend all the way behind the mastoid process to provide blood supply to the posterior half of the head and scalp ( ")we've seen it in the apex of the post. triangle", then the artery ascends until the neck of the mandible we will have the final two large branches: 7- superficial temporal a. : it's a super facial a. over the temporal bone it has two branches anterior and posterior superficial temporal arteries ,U will feel the puls ant. to the tragus of the ear which is "the temporal puls" 8- maxillary a. : it's considered the largest branch , it goes deep to the ramous of the mandible anteriorly into the infratemporal fossa to provide blood supply to the maxillary teeth , then it gives a branchout from the maxilla infraorbital a. , JUST to know :D in this small passage of the maxillary a. it gives 15 branches. "elle bdo y3rfhom 2lo t7ea 5a9a mny ..! :p"
till now we know 2 of three regions of the puls in the head and neck: the lower border of the mandible "facial puls" , anterior to auricle "the temporal puls". and the third one isanterios to the SCM "the carotid puls"

there are two very important structures in the carotid triangleat the bifurcation area "division area" :

Carotid Sinus
a localized dilatation at the terminal rat of common carotid a. or the beginning part of internal carotid a. the wall of those arteries become very thin cuz the tunica media becomes ver thin (the smooth muscles layer) so it becomes weak and dilate in addition to that the glussopharyngeal n. (IX) gives many nerve endings and terminate in this sinus. the net --> ( decrease the wall thickness and increase the innervations) .... why? to monitor blood pressure physiology of carotid sinus :it is a mechanoreceptor (pressoreceptor) when the bld pressure increase "increase flowing rate" this will result a stretching in the wall pressing the receptors and activating them those sends impulse all the way back into the brain across the IX , The closest nerve to it is the vagus (X) which is a parasympatetic that will send signal to viscera "lungs & heart" to reduce heart beating (heart rate) then this will reduce bld pressure.
Remember: Arteries made of three layers : tunica intima, tunica media & tunica adventitia. the nervous nervosum located in the tunica adventitia.

Carotid Body
oval mass of connective tissue usually behind (post. to ICA) or at the bifurcation area (between ICA &ECA) and there are also many nerve endings that sense the O2 rate in the bld.

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physiology of carotid body : it is a chemoreceptoe it sense the lower rate of O2 by the high rate of the CO2 in the bld by the glussopharengyal n. (IX) to the brain sending signals to sympathetic chain which will increase the respiratory rate so more O2 coming in.

The last thing is the muscular triangle in the next lec. :)

THE HAPPY END

Done by : Asmaa Al-Mawas Baraa'h Al-Salamat

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