Posterior Triangle of Neck

Dr.Juned P. Labbai
MBBS, MD, DNB (Anatomy)
Associate Professor
Department of Anatomy
D Y Patil University - School of Medicine
Competencies
• Describe & and demonstrate attachments, nerve supply, relations,
and actions of sternocleidomastoid
• Explain the anatomical basis of wry neck

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Topics to be covered?
• Surface landmarks in neck region
• Sternocleidomastoid muscle
• Posterior triangle of Neck
• Boundaries
• Contents
• Applied Anatomy

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SIDE OF NECK
SURFACE LANDMARKS
 SURFACE LANDMARKS
Lesser supraclavicular fossa
• Small triangular depression above medial
end of clavicle between sternal and clavicular
heads of sternocleidomastoid muscle
• Internal jugular vein lies deep to this fossa

Greater supraclavicular fossa

• Depression above middle one-third of
clavicle
• Cervical part of brachial plexus and third part
of subclavian artery – situated deep to this
fossa
 STERNOCLEIDOMASTOID MUSCLE
Write short note on
sternocleidomastoid
Write short note on torticollis
• Also called sternomastoid
• Long flat strap of muscle
extends obliquely across side of
neck
• Enclosed within investing layer
of deep cervical fascia
 STERNOCLEIDOMASTOID MUSCLE

• Origin
• Insertion
 STERNOCLEIDOMASTOID MUSCLE
Innervation
• Spinal accessory nerve
• Branches of the ventral
primary rami of C2 and C3
Note
• Fibers of spinal accessory are
motor
• Fibers from C2 and C3 carry
proprioception
STERNOCLEIDOMASTOID MUSCLE
 STERNOCLEIDOMASTOID MUSCLE
Actions
• Unilateral contraction
• Turn chin to opposite side
• Tilts head toward shoulder of same side

• Bilateral contraction
• Flex cervical part of vertebral column
• Extends heads at atlantooccipital joint
• Draws head forward for eating or in lifting head from pillow
• Helps in forced inspiration
 Clinical Integration
• Wry neck or torticollis
Deformity of neck due to
spasm of sternocleidomastoid
muscle

• Presents with bending of head

to one side and chin point to
opposite side
 Clinical Integration
Wry neck or torticollis
• Torticollis may be spasmodic, reflex,
or congenital
• Spasmodic torticollis – repeated
painful contractions of
sternocleidomastoid and trapezius
muscle
• Occurs due to exposure of cold,
psychological stress or
maladjustment of pillow during
sleep
 Clinical Integration
Wry neck or torticollis
• Reflex torticollis occurs due to
irritation of spinal accessory
nerve by pus or inflamed
lymph nodes
• Congenital torticollis occurs due
to birth injury
 POSTERIOR TRIANGLE OF NECK
• Describe posterior triangle of
neck under following headings:
boundaries, roof, floor, contents,
and applied aspects
• On side of neck situated
behind sternocleidomastoid
muscle

Fig. 9.5: Practice figure: Boundaries of the posterior

triangle
of neck (right, lateral view)
 POSTERIOR TRIANGLE OF NECK
Boundaries
Has following boundaries
• Anterior: Posterior border of
sternocleidomastoid muscle
• Posterior: Anterior border of trapezius
muscle
• Inferior or base: Middle 1/3rd of clavicle
• Apex: Lies superiorly on superior
nuchal line at meeting point of Fig. 9.5: Practice figure: Boundaries of the
posterior triangle
sternocleidomastoid and trapezius of neck (right, lateral view)

muscles
 Roof
• Formed by
• Skin
• Superficial fascia containing
• Platysma
• External and posterior jugular veins
• Parts of 4 cutaneous nerves: Great
auricular, transverse cervical,
supraclavicular, and lesser occipital
nerves
• Cutaneous vessels
• Superficial cervical lymph nodes
• Investing layer of deep cervical fascia
SIDE OF THE NECK
CUTANEOUS NERVES
FLOOR OF POSTERIOR TRIANGLE
 Floor
List muscles forming floor of posterior
triangle of neck
• Formed by
• Prevertebral layer of deep cervical
fascia and
• Muscle under cover (above
downward)
• Semispinalis capitis
• Splenius capitis
• Levator scapulae
• Scalenus medius
SUBDIVISIONS AND CONTENTS
 Omohyoid muscle

• Omohyoid muscle consists of two bellies: Superior and

inferior and intermediate tendon
• Inferior belly originates from superior border of scapula
near suprascapular notch
• Passes deep to trapezius and investing layer of deep
cervical fascia of posterior triangle
 Omohyoid muscle
• Passes deep to sternocleidomastoid and inserts on
intermediate tendon which gives origin to superior
belly
• Superior belly traverses upward and forward to insert at
lower border of body of hyoid bone
• Crossing of inferior belly of omohyoid divides
posterior triangle into occipital and supraclavicular
triangle
DISSECTION – POSTERIOR TRIANGLE OF NECK
DISSECTION – CONTENTS OF POSTERIOR TRIANGLE
 Cervical part of brachial plexus
• Derived from ventral primary
rami of C5–C8 and T1 spinal
nerves
• These roots join to form upper
(C5, C6), middle (C7), and lower
(C8, T1) trunks
• These trunks emerge between
scalenus anterior and medius in
lower part of posterior triangle
• They lie deep to prevertebral
fascia
Applied Anatomy

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 Clinical Integration
• Supraclavicular lymphadenopathy: Most common swelling
in posterior triangle
• Causes: Tuberculosis, Hodgkin’s disease, and
malignancy of breast infection of arm
• Left supraclavicular lymph nodes are also called Virchow’s
lymph nodes
• Are commonly involved in metastasis from tumors of
stomach, testes, and other abdominal viscera
 Clinical Integration
• Biopsy of supraclavicular nodes may reveal cause of
their enlargement
• Block dissection of the neck: Removal of cervical lymph
nodes performed in treatment of malignancies
 Clinical Integration
• Abnormal subclavian artery may compress esophagus and
causes dysphagia lusoria (difficulty in swallowing)
Compression of subclavian artery: Can occur due to
• Occasional cervical rib
• Occasional short scalenus anterior muscle
• Surgeries of neck may damage spinal accessory nerve
• Spinal accessory nerve divides posterior triangle into upper
surgically safe area and lower surgically unsafe area as
contains many import nerves and vessels
 Clinical Integration
Brachial plexus block
• Can be blocked by injecting local
anesthetic between first rib and
skin above clavicle
• May be required for upper limb
surgeries
• Pulsations of subclavian artery can
be felt at rest of neck by pressing
artery behind clavicle at lower
end of posterior border of
sternocleidomastoid muscle
 Summary
• Surface landmarks in neck region
• Sternocleidomastoid muscle
• Posterior triangle of Neck
• Boundaries
• Contents
• Applied Anatomy

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