The Muscles and Triangles of the Neck

Regions of the Neck 

To facilitate the seemingly complicated area, the neck is divided into two major areas, or triangles, by the sternocleidomastoid muscle. muscle. These are: 1. anterior triangle - the area anterior to the SCM and below the inferior border of the mandible. 2. posterior triangle - the area posterior to the SCM and is limited posteriorly by the trapezius muscle.

Sternocleidomastoid Muscle
Muscle
Sternocleido mastoid muscle

Origin
Two heads: Sternal head manubrium sterni Clavicular head - Medial 2/3 of the clavicle

Insertion
Mastoid process of the of the temporal bone and lateral half of the superior nuchal line.

Action
Bilateral: Flex the neck Single: Flex the head and laterally rotate to the opposite side

Nerve Supply
1. Spinal accesory nerve 2. Anterior primary rami of spinal nerves C2 and C3.

Trapezius Muscle
Muscle
Trapezius muscle

Origin
External occipital protruberance , the medial half of the superior nuchal line, the ligamentum nuchae, and the lower cervical and all the thoracic spines

Insertion
Fibers originating from the head insert into the lateral third of the clavicle, and the remaining fibers insert into the acromion process and spine of the scapula

Action
Contract to rotate and elevate the scapule. Its cervical portion, acting bilaterally, can extend the head and singly, it can rotate the head and face to the opposite side

Nerve Supply
1. Spinal accessory nerve 2. Anterior primary rami of the spinal nerves C3 and C4.

The Anterior Triangle of the Neck

Boundaries of the Anterior Triangle 

Anterior - median line of the neck Posterior anterior border of the sternocleidomastoid muscle Superior - inferior border of the mandible Roof - skin, superficial fascia, platysma, and investing layer of deep cervical fascia   

Muscles of the Anterior Triangle of the Neck

I. Infrahyoid Muscles
Muscle
Omohyoid

Origin
Inferior belly: Superior border of the scapula Superior belly: Intermediate tendon

Insertion

Action

Nerve Supply
Ansa cervicalis (APR of C1, C2, C3)

Inferior belly: Depresses the hyoid bone Intermediate and larynx tendon Superior belly: Lower border of the body of the hyoid bone Lower border Depresses the of the body of hyoid bone the hyoid and larynx bone

Sternohyoid

Manubrium of the sternum, posterior aspect

Ansa cervicalis (APR of C1, C2, C3)

Infrahyoid Muscles
Muscle
Sternothyroid

Origin
Manubrium of the sternum, posterior aspect

Insertion

Action

Nerve Supply

Oblique line of Depresses the Ansa thyroid larynx cervicalis cartilage (APR of C1, C2, C3) Thyrohyoid branch of the hypoglossal nerve

Thyrohyoid

Oblique line of Body and Depresses the thyroid greater horn hyoid bone cartilage of hyoid bone, lower border

II. Suprahyoid Muscles
Muscle Origin Insertion Action Nerve Supply Facial nerve Stylohyoid Styloid process Greater horn Elevates hyoid bone of hyoid bone
Intermediate tendon Raises the hyoid bone

Digastric (Posterior belly)

Digastric notch of the temporal bone at the base of the skull Intermediate tendon

Facial nerve

Digastric (anterior belly)

Digastric fossa of the mandible

Elevates the hyoid bone

Nerve to the mylohyoid muscle

Suprahyoid Muscles
Muscle
Mylohyoid

Origin

Insertion

Action
Elevates the hyoid bone, base of the tongue, and floor of the mouth

Nerve Supply
Nerve to mylohyoid muscle

Mylohyoid line Median raphe on the medial and body of aspect of hyoid mandibular body

Geniohyoid muscle

Inferior border genial tubercle of the mandible

Body of hyoid bone

Elevates hyoid APR of C1 bone, protracts hyoid bone

Boundaries of the Anterior Triangle 

Anterior - median line of the neck Posterior anterior border of the sternocleidomastoid muscle Superior - inferior border of the mandible Roof - skin, superficial fascia, platysma, and investing layer of deep cervical fascia   

Subdivisions of the Anterior Triangle
1. 2. 3.

4.

Digastric Triangle Carotid triangle Muscular or inferior carotid triangle Submental triangle

1. Digastric Triangle 

1.

Boundaries:
SuperiorSuperiorlower border of the mandible Anterior anterior belly of the digastric Posterior posterior belly of the digastric Floor mylohoid and hyoglossus muscles and superior contrictor muscle of the pharynx

2.

3.

4.

1. Digastric Triangle
Structures: 1. Glands parotid and submandibular 

2. Arteries - Internal and external carotid, facial, submental, posterior auricular, superficial temporal and lingual. 3. Veins - anterior facial and internal jugular. 4. Nerves vagus, glossopharyngeal, facial, and hypoglossal.

2. Carotid Triangle 
1.

Boundaries: Superior posterior belly of the digastric Inferior superior belly of omohyoid

2.

3. Posterior anterior border of the SCM
4.

Floor - thyrohyoid muscle, hyoglossus muscle, and the middle and inferior constrictor muscles of the pharynx.

2. Carotid Triangle 
1.

2.

3.

4.

Structures: Organs larynx and pharynx (lower part) Arteries - CCA, facial, occipital, acending pharyngeal, superior thyroid, and lingual. Veins - internal jugular, superior thyroid, lingual, facial, occipital and ascending pharyngeal. Nerves - vagus, accessory, hypoglossal, ansa hypoglossi, external and internal laryngeal.

3. Muscular or Inferior Carotid Triangle 
1.

2.

3.

4.

Boundaries: SuperoSupero-posterior - superior belly of omohyoid inferoinfero-posterior - anterior border of SCM Anterior - median line of the neck Floor - sternohyoid and sternothyroid

3. Muscular or Inferior Carotid Triangle 
1.

2. 3. 4.

Structures: Organs thyroid and parathyroid glands, trachea Arteries - inferior thyroid Veins - internal jugular Nerves - vagus, recurrent laryngeal, sympathetic n.

4. Submental Triangle 
1.

2.

Boundaries: Lateral - two anterior bellies of the digastric Posterior - body of the hyoid bone Structures: Submental lymph glands Beginning of the anterior jugular vein

1. 2.

The Posterior Triangle of the Neck

The Posterior Triangle of the Neck 
1.

Boundaries: Anterior - posterior border of the SCM. Posterior - anterior border of the trapezius muscle. Inferior - superior border of the intermediate 1/3 of trhe clavicle. Superior - meeting of the trapezius and SCM at the superior nuchal line. Roof - formed by the skin, superficial fascia, platysma and investing layer of the deep cervical fascia. Floor - formed by several muscles semispinalis capitis, aplenius capitis, levator scapulae, and scalenius medius

2.

3.

4.

5.

6.

Muscles of the Posterior Triangle of the Neck

Muscle
Platysma

Origin
Superficial fascia of the deltoid and pectoral regions

Insertion
Inferior border of the mandible, some fibers sweep upward and blend with risorius Mastoid process and the superior nuchal line

Action

Nerve

Stretches Facial nerve tight the skin of the neck, depresses the mandible

Splenius capitis

Lower part of the ligamentum nuchae, lower cervical spines

Bilateral: Extends the head Individual: Flexes the head laterally

Cervical spinal nerves

Muscle
Levator scapulae

Origin

Insertion

Action

Nerve

Transverse Superior Elevates and Dorsal processes of portion of rotates the scapular C1 to C4 the vertebral scapula nerves border of the scapula Flexes the Transverse Superior processes of aspect of the neck C5 and C6 second rib Transverse Superior Flexes the processes of aspect of the neck C2 to C7 first rib Transverse Scalene processes of tubercle of C3 to C6 the first rib Participates in forced inspiration by elevating the ribs and sternum APR of C5 to C8 APR of C3 and C4 APR of C5 to C8

Scalenius posterior Scalenius Medius Scalenius anterior

Subdivisions of the Posterior Triangle
1. 2.

Occipital Triangle Supraclavicular Triangle

1. Occipital Triangle 
1.

Boundaries: Anterior - posterior border of SCM Posterior - anterior border of the Trapezius M. Superior - meeting between the trapezius and SCM Inferior - superior border of the inferior belly of omohyoid

2.

3.

4.

2. Supraclavicular or Subcalvian or Omoclavicular Triangle 
1.

Boundaries: Anterior - posterior border of SCM Superior - inferior border of the inferior belly of omohyoid Inferior - superior border of the intermediate 1/3 of the clavicle

2.

3.

Contents of the Posterior Triangle
1.

Arteries - subclavian artery, transverse cervical artery, occipital artery and suprascapular artery. Veins - external jugular vein, anterior jugular vein, transverse cervical vein, suprascapular and subclavian veins. Nerves - spinal accessory nerve, cutaneous and muscular branches of the cervical plexus, ansa cervicalis and root, trunk and divisions of the brachial plelxus. Lymph glands - supraclavicular lymph glands, and the lateral superior deep cervical lymph glands.

2.

3.

4.

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