Posterior triangle of the neck

and its applied aspect

 Contents
• Boundaries
• Contents
• Muscles
• Nerves
• Vessels
• Lymphatics
• Applied aspect
SCM
divides the
neck Into
2 triangles
1-anterior
2-posterior
 Posterior Triangle of the Neck
Boundaries:

Base

Anterior border

Posterior border

Apex
Roof
1-skin

2-the superficial fascia

which contains
a) platysma
b) external jugular vein
c) cutaneous branches
of the cervical plexus

3-the deep fascia

Floor

1- splenius capitis
2- levator scapulae
3- scalenus posterior
4- scalenus medius
5- scalenus anterior

All covered by
the prevertebral fascia

Small part of the semispinalis muscle may appear at

the apex of the triangle
*subdivided by the inferior belly of the omohyoid muscle
Into : 1-occipital
2- subclavian triangles (supraclavicular)
*Contents
A-Muscles the inferior belly of the omohyoid m
B-nerves
Vessels:
Arteries
-Transverse cervical
vessels
-Suprascapular vessels
-Subclavian artery
crossing the first rib

Veins
External jugular vein
Muscles
Platysma muscle
Origin

Insertion

Blood supply

Nerve supply

Action
-depresses the mandible
-drawers down the lower lip
Omohyoid muscle:
Origin

Insertion

Nerve supply
Ansa Cervicalis (C1,2 and 3)

Action
depresses hyoid bone
Nerves
Nerves:
Spinal Accessory Nerve

Course

Surface marking

Erb’s point

Torticollis
Torticollis
The cervical plexus:
-anterior primary rami of the upper four cervical nerves
-deep to the SCM
-Each nerve except the first divides into upper and lower branches
The cervical plexus:

*4 Cutaneous Branches:
1-lesser occipital nerve
2-great auricular nerve
3-Transverse cutaneous
Nerve of the neck
4-Supraclavicular nerve

•May relay pain referred to the shoulder from the

phrenic nerve
•Distribution Supplies the skin of thorax to the level
of second rib
The cervical plexus:
*4 muscular branches:
a-prevertebral muscles C1-C4

b-levator scapulae m C3,C4

c-Scalenus ant.,med., and posterior

d-infrahyoid and geniohyoid ms. C1,C2,C3

e-phrenic nerve C3,C4,C5

f-SCM C2,C3 + Trapezius C3,C4

ONLY - Afferent (Propriception)
- Sympathetic fibers
Phrenic nerve
-C3,4,and 5, Mainly C4

1- motor innervation
of the diaphragm
2- Sensory
A-pericardium
B- mediastinal pleura
C- pleural and
peritoneal
And coverings of the
central part of the
diaphragm
The Brachial plexus:

*is formed by union of the anterior

primary rami of C5-T1

Surface markings:

Roots

Trunks

Cords
 The brachial plexus and subclavian artery may be compressed in
the neck by

• a rudimentary cervical rib

• a tight fibrous band
• first thoracic rib
• a tight scalenus anterior muscle

• giving rise to sensory,

– motor
– vascular symptoms
– in one or both upper extremities.
Cervical rib

• Pressure in the region of a

cervical rib will give rise to local
pain as well as pain referred to
the hand and arm particularly in
the ulnar portion of the hand and
forearm since
• There is muscular weakness of
the small hand muscles.
 Birth Brachial Plexus Palsy
Pathogenesis
Prevalence
• Total Prevalence:
0.2 - 2.5 / 1,000 births
• Persistent Weakness:
0.4 - 5.0 / 10,000 births

The first recorded mention of it is by William

Smellie in a 1768 publication on midwifery.
Upper Brachial Plexus (Erb's) Palsy

These infants cannot move the shoulder and keep

their arms extended and turned inward, giving the
appearance of the “porter's tip hand."
Lower Brachial Plexus (Klumpke's) Palsy
Vessels
The veins:
A. The subclavian vein
(which lies on the scalenus
anterior muscle)

B. Two veins which end in

the external jugular vein

1- the transverse cervical vein

2- the suprascapular vein
C-External jugular vein:

- begins just behind the angle of the

mandible
- lies on a line joining the angle of
the mandible to the middle
of the clavicle
- deep to the platysma muscle
 Jugular venous pressure

• External Jugular vein catheterization

Subclavian artery

*Grooves the first rib as it passes between

- scalenus anterior
- scalenus medius muscles
*Is divided into 3 parts by the scalenus anterior muscle
Subclavian artery

1-first part
a. vertebral artery
b. thyrocervical trunk
c. internal thoracic artery
2-second part
* costocervical trunk
a. deep cervical artery
b. superior intercostal artery
first 2 post.intercostal artery
3-third part
* dorsal scapular artery
when it is present it replaces
the deep branch of the
transverse cervical artery
*Transverse Cervical a.
-across the scalenus anterior m
Phrenic n and trunks of the Br
plexus
-across the post.Triangle of the
Neck

*Suprascapular artery
-across the scalenus anterior muscle and the Brachial plexus
 Applied aspect
• Palpation and compression of Subclavian
artery in patients with upper limb hemorrhage
• Pleura and lung injuries in the root of the neck
• Cervical rib and Scalenus anticus syndrome
• Dysphagia lusoria
Battle’s sign - Occipital artery
• Periauricular/ mastoid echymosis
Superficial cervical LN
-lie along the external jugular vein in the
posterior triangle, and along the anterior
jugular vein in the anterior triangle
-superficial to the SCM
-Drains into deep cervical LN
-Receives Lymph vessels from the
occipital and mastoid LNs
 Neck Dissection
Level V
Posterior triangle of neck
– Posterior border of SCM
– Clavicle
– Anterior border of
trapezius
– Va Spinal accessory
nodes
– Vb Transverse cervical
artery nodes
Radiologic landmark
– Inferior border of Cricoid
– Supraclavicular nodes
Neck Dissection
Neck Dissection
 Lateral Neck swellings
Differential Diagnosis:
• Supraclavicular lymph nodes
• Cystic Hygroma
• Pharyngeal pouch
• Cervical rib
• Subclavian aneurysm
• Lipoma
 Supraclavicular lymph nodes
• Tuberculosis
• Hodgkin’s disease
• Head and neck Malignancy
• Virchow’s nodes

Virchow’s node
Cystic hygroma
Pharyngeal pouch
Subclavian Aneurysm
 References
• Clinical Anatomy for medical students – Richard Snell, 5th
Ed.
• Sicher and DuBRUL’s Oral anatomy, 8th Ed.
• Student’s Gray’s anatomy
• Grant’s Method of Anatomy, A Clinical problem solving
approach, 11th Ed.
• NMS Clinical anatomy – Ernest April, 3rd Ed.
• Stell & Maran’s Head and Neck surgery, 4th Ed.
• B D Chaurasia’s Human anatomy, Volumes 1 & 3
• A Concise textbook of surgery – S Das, 3rd Ed.
• P J Mehta’s Practical Medicine