AnTeRIoR TRIAnGLe of neck

DR (BRIG) SUSHIL KUMAR

PROFESSOR & HEAD
DEPT OF ANATOMY
AMRITA SCHOOL OF MEDICINE
FARIDABAD –121002
anatomist91@gmail.com
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 FRONT OF NECK

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 TRIANGLES OF NECK

2
1
AT 3
AT
PT
4 PT

Ant Triangle
Post Triangle
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 TRIANGLES: BOUNDARIES & DIVISIONS

SCM
AT
PT

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 TRIANGLES OF NECK

Digastric triangle Mastoid process

Mandible
Digastric (Ant belly)
Hyoid
Post Triangle
Omohyoid (Sup belly) Omohyoid (Inf belly)
Trapezius
Sternocleidomastoid

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 TRIANGLES OF NECK

Submental (Suprahyoid) triangle

Digastric (Submaxillary) triangle
Carotid triangle SCM
Occipital triangle
Muscular (Inf Carotid) triangle

Supraclavicular triangle
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 ANTERIOR TRIANGLE OF NECK

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 ANTERIOR TRIANGLE OF NECK

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 MIDLINE STRUCTURES IN NECK
Midline structures: Divided into Suprahyoid &
Infrahyoid structures
Suprahyoid Structures
In Submental triangle:
 Submental LNs
 Mylohyoid raphe
Infrahyoid Structure
 Hyoid bone (C-3)
 Thyrohyoid membrane
 Notch of thyroid cartilage (C-4)
 Cricoid cartilage (C-6)
 Tracheal rings
 Isthmus of thyroid gland (2nd, 3rd tracheal rings)
 Suprasternal notch (disc between T-1 & T-2)
Sternocleidomastoid divides side of neck into:
Anterior & Posterior triangles
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 SUPRA & INFRAHYOID MUSCLES
DG Stylohyoid
DG
ELEVATORS GH MH
 Geniohyoid
Hyoid
 Mylohyoid
 Digastric (both bellies)
 Stylohyoid
DEPRESSORS Thyroid
cartilage
 Sternohyoid
 Sternothyroid
Cricoid
 Omohyoid (two bellies)

Sternohyoid Sternothyroid
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 ANTERIOR MIDLINE STRUCTURES
C-3
HYOID
Thyrohyoid Anatomical events at lower border of
membrane Cricoid cartilage: C-6 Vertebra
1. Jn of Larynx with Trachea
C-4
Thyroid 2. Jn of Pharynx with Esophagus
cartilage 3. Inf Thyroid Artery enters gland
4. Middle Thyroid Vein emerges
Cricothyroid
5. Vertebral artery enters FT of C-6
membrane
C-6 6. Sup belly OH crosses C Sheath
Cricotracheal
7. Middle Cervical Ganglion
ligament THYROID GLAND 8. CCA compressed against
Tracheal ring Tr Pr of C-6 (carotid tubercle)
Trachea
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 ANTERIOR TRIANGLE:
BOUNDARIES & SUBDIVISIONS
Boundaries
 In front: Midline neck structures
 Above: Base of mandible
 Behind: Anterior border of SCM

Subdivided into:
 Muscular triangle
 Carotid triangle
 Digastric triangle
 Submental triangle
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 ANTERIOR TRIANGLE: SUBDIVISIONS
D I
N B
A L
M E
1 2

3
Omohyoid
4
1. Digastric
(sup belly)
Sternohyoid 2. Submental
3. Carotid
4. Muscular

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 ANTERIOR TRIANGLE:
SUBDIVISIONS & BOUNDARIES

Digastric
Digastric 1 (Ant belly)
(Post belly) Hyoid
2 Omohyoid
(Sup belly)
3
1. Digastric triangle
2. Carotid triangle
Omohyoid 3. Muscular triangle
(Inf belly)
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 ANTERIOR TRIANGLE

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 SUBMENTAL TRIANGLE
Boundaries
Unpaired; Anterior bellies of both digastric muscles
 Apex: At chin
 Base: Body of hyoid
 Floor: Mylohyoid muscles
Contents
 Small veins uniting to form Ant Jugular Vein
 LNs
Facial artery Digastric (Ant belly)

Mylohyoid
Masseter Mylohyoid raphe

SM gland (outline) Hyoglossus

Digastric (Post belly)
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Hyoid ASM Intermediate tendon 18
 MUSCULAR TRIANGLE
Boundaries
Median line from hyoid to sternum
Inferoposteriorly: Anterior margin of SCM
Posterosuperiorly: Superior belly of omohyoid
Contents:
Mandible
Infrahyoid muscles Midline
 Sternohyoid
 Omohyoid (Sup belly) Omohyoid
 Thyrohyoid Muscular
triangle
 Sternothyroid SCM

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 MUSCULAR TRIANGLE: STRAP MUSCLES

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 INFRAHYOID STRAP MUSCLES OF NECK
Developmentally
• Derivatives of longitudinal rectus sheath; extends from chin to pubic symphysis
• Sheet divided into different parts
• Some parts disappear
Existing parts include:
 Geniohyoid (suprahyoid component)
 Infrahyoid muscles (between hyoid & sternum)
 Sternalis (occasional) in front of sternum
 Rectus abdominis & Pyramidalis
 Omohyoid attachment to scapula is secondary, following migration from medial end of clavicle
Infrahyoid muscles (4) are arranged in two strata:
 Superficial stratum: Sternohyoid & Omohyoid
 Deep stratum: Sternothyroid & Thyrohyoid
 All are supplied by Ansa cervicalis
 Since attached to hyoid & thyroid cartilage, thus, move them
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Boundaries DIGASTRIC (SM) TRIANGLE
 Above: Base of mandible & line joining angle of mandible to mastoid Pr
 Posteroinferiorly: Digastric (posterior belly) & Stylohyoid
 Anteroinferiorly: Digastric (anterior belly)
 Roof: Skin, Superficial fascia with Platysma & Deep fascia (Investing layer)
 Floor: Mylohyoid & Hyoglossus

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 DIGASTRIC TRIANGLE: CONTENTS
In Anterior Region
 Submandibular Gland
 Facial Vessels
 Submental Vessels
 Mylohyoid Vessels & Nerve
 Submandibular LNs
In Posterior Region
 Submandibular land
 Parotid gland (lower part)
 External Carotid Artery
 XII CN
 Stylohyoid muscle
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Boundaries
CAROTID TRIANGLE
 Posteriorly: SCM
 Anteroinferiorly: Omohyoid (superior belly)
 Superiorly: Digastric (posterior belly) & Stylohyoid
 Roof: Skin, Superficial fascia with Platysma & Deep fascia
 Floor: Thyrohyoid, Hyoglossus, Constrictors of Pharynx (Inferior & Middle)

Stylohyoid
Digastric (Post belly)
Hyoid SCM

Omohyoid (Sup belly)

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 CAROTID TRIANGLE: CONTENTS
CCA & divisions (ECA & ICA)
• Branches of ECA
 Superior Thyroid
 Lingual
 Facial
 Occipital
 Ascending Pharyngeal
• IJV & tributaries
• X, XI & XII CNs
• Superior laryngeal nerve
– Internal laryngeal nerve
– External laryngeal nerve
• Sympathetic chain
• Deep Cervical LNs (JD & JO)
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 CARITID TRIANGLE & CAROTIDS
8

7 I
E 6
C ECA: Branches
C A 5
4 A
1. Ascending Pharyngeal
2. Superior Thyroid
3. Lingual
1
4. Facial
3
I 5. Occipital
J 6. Posterior Auricular
2 C V 7. Maxillary
C
8. Superficial Temporal
A

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 STERNOCLEIDOMASTOID

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 STERNOCLEIDOMASTOID
Forms common boundary of neck triangles; Arises by two heads:
Sternal head: Upper part of anterior surface of manubrium sterni
Clavicular head: Superior surface of medial third of clavicle
Insertion: Mastoid process & lateral half of superior nuchal line
XI CN passes deep to SCM, pierces (& supplies) it; reappears just above middle of posterior border

Nerve supply
 Spinal accessory nerve (XI CN)
 Branches from ventral rami of 2nd - 4th cervical nerves

Actions
 Acting alone, SCM tilts head towards same shoulder; simultaneously rotates head so that face turns towards
opposite side (sideways glance)
 Acting together from below, muscles draw head forwards, help longus colli to flex cervical vertebral column
(common in feeding)
 Two muscles used to raise head when body is supine
 When head fixed, help to elevate thorax in forced inspiration
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 TORTICOLLIS
Reflex
 Compression of XI CN in infection of Head & Neck
Congenital
 Bleeding in SCM; causes fibrous shortening of SCM
Psychogenic
 Abnormal use of neck
Spasmodic
 Defective Basal ganglia function, sustained action
of SCM

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 ANSA CERVICALIS

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