POSTERIOR TRIANGLE OF NECK AND ITS APPLIED

Presented by Snehal kharche

Moderator Dr. Arati S. Neeli

Contents
Boundaries y Muscles y Nerves y Vessels y Lymphatics y Applied aspect
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Boundaries

Roof .

Floor .

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Subdivisions of posterior triangle of neck .

Contents y Muscles: inferior belly of omohyoid .

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 ‡ ‡ ‡ ‡  y 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 .y Nerves   Accessory nerve Root.

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y Arteries  Occipital artery  Third part of subclavian artery & branches of subclavian artery ‡ Suprascapular ‡ Transverse cervical .

y Veins  External jugular vein & its tributaries  Subclavian vein is lower down and not in the triangle .

y Lymph nodes Supraclavicular lymph nodes are present on posterior border of sternocleidomastoid Occipital nodes .

Torticollis .

Spinal accessory nerve palsy .

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The brachial plexus and subclavian artery may be compressed in the neck by y y y rudimentary cervical rib tight fibrous band tight scalenus anterior muscle giving rise to sensory symptoms vascular symptoms y .

Cervical rib y 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 .

" . giving the appearance of the ´porter's tip hand.Brachial plexus palsies Upper brachial plexus (erb·s) palsy These infants cannot move the shoulder and keep their arm extended and turned inward.

Lower brachial plexus (klumpke·s) palsy .

External jugular vein y It can 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 y Cervical rib and scalenous anticus syndrome y Dysphagia lusoria y .

> 3 cm < 6 cm   .Kocher y Crile introduced RND & was followed by Martin y Staging of Neck Nodes  NX: Regional lymph nodes can not be assessed  N 0: No regional lymph node metastasis N 1: Metastasis in a single ipsilateral lymph nodes. 3 cm or less N 2: N2a: x Metastasis in a single ipsilateral lymph nodes.Neck dissection First conceptual approach.

not more than 6 cm N2c: x Metastasis in bilateral or contralateral nodes not more than 6 cm in diameter N 3: Metastasis in lymph nodes more than 6 cm in in greatest diameter . N2b: x Metastasis in multiple ipsilateral lymph nodes.

Submental group Ib.located anteriorly to SAN IIb.Submandibular group y Level II: around upper third of IJV & adjacent to SAN IIa.located posteriorly to SAN y Level III: around middle third of IJV .Lymph node levels y Level I: Ia.

perithyroidal & those around reccurent laryngeal nerves y y .y Level IV: around lower third of IJV Level V (posterior triangle group): Va.nodes around transverse cervical vessels & supraclavicular node Level VI: pre & paratracheal. precricoid.spinal accessory nodes Vb.

V and include removal of SAN. IJV and SCM . SCM and/or IJV x Subtype I: Preserve SAN x Subtype II: Preserve SAN & IJV x Subtype III: preserve SAN. SCM and IJV y Modified radical neck dissection: Excision of all lymph nodes removed with RND with preservation of one or more non-lymphatic structures. SAN.Classification y Radical neck Dissection: Removing all lymphatic tissues in regions I .

II to V x Anterior neck dissection.y Selective Neck dissection: Any type of cervical lymphadenectomy with preservation of one or more lymph node groups Four subtype: x Supraomohyoid neck dissection.II to IV x Lateral neck dissection.I to III x Posterolateral neck dissection.VI y 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 y Cystic hygroma y Pharyngeal pouch y Subclavian aneurysm y .

cystic. fluctuant y .Cystic hygroma Failure of one of the lymphatics to join major lymph sac of body y Infancy and early childhood y Soft.

Pharyngeal pouch .

Subclavian anuerysm .

Head and neck surgery otolaryngology. P J Mehta·s Practical Medicine . B D Chaurasia·s Human anatomy.Cumming·s Cancer of face and mouth. 5th Ed. Bailey Otolaryngology head and neck surgery.References y y y y y y y y y y y Clinical Anatomy for medical students ² Richard Snell.James L. Volumes 1 & 3 A Concise textbook of surgery ² S Das. A Clinical problem solving approach.McGregor Stell & Maran·s Head and Neck surgery. Hiatt Grant·s Method of Anatomy. 11th Ed. 3rd Ed.Byron J. Student·s Gray·s anatomy Head and neck anatomy. 4th Ed.

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