ANTERIOR TRIANGLE

OF THE NECK
Introduction to the Neck
• Neck is a cylindrical region connecting the H/N to trunk,with lateral borders concave
• (Skin Incisions,D.Fascia-compts/spaces/planes,cutan nerves,vessels under Platysma,Veins-state of health

• Upper limit : lower border of the mandible

imaginary horizontal line conn angle to M process
superior nuchal line
external occipital protuberance
Lower limit : upper border manubrium
clavicle , Acromion Process,,Horizontal line to 7th C.Sp
There is no visible neck in the new born , no mastoid process
Applied : Torticollis (Wry neck)-spasmodic,reflex,cong,rheumatic ; Sterno Mastoid Tumor
Importance : site for various pathologies:lymphadenopathies,cysts,tumors
: performing various clinical procedures:biopsy,Venous Pr asst, Nerve block
• Posterior limit : ligamentum nuchae in the vertical midline
• Anterior limit : anterior median line(Symp menti to SS notch)
Structures covering superficial to deeper
Skin , Superficial fascia (with Platysma muscle & NV underneath)
followed by Fascia Colli (D F neck)in three layers
C 6 plane : Junction: Larynx – Trachea ; Pharynx – Oesophagus, &
b/w 1& 2 parts of Vert art ,carotid tubercle , apex
of scaleno vert triangle , Sup PT Gland , Ansa cervicalis ,
widest part of cervical enlargement of the Sp.Cord
• SIDE OF THE NECK : Somewhat quadrilateral ,gently concave
• BOUNDARIES : Infront , Behind , Above , Below
Skin of the front & sides of neck supplied by 4 cut nerves
namely Lesser Occ , Great Auricular , Transverse Cervical cut nerve & Supra.Clavicular
PLATYSMA MUSCLE : present in the supf fascia in Loose areolar tissue
Sub cutaneous quadrilateral sheet ,2nd rib level org from DF/SKIN ,to insert in the face
being part of panniculus carnosus , derv 2nd Br Arch
Org ,Ins ,N supply (Cerv br Fn ) – post fibres continuous with Risorius
( through B br Fn) , Actions :Anti Sphincteric ( veins not compressed),Depress the jaw,horror
Peculiarities – cross 2 bones supf which ossify in membrane
Applied –Surgeons need to suture it separately to avoid adhesion-ugly skin scar due to adh skin deeper T
• Applied Anatomy Neck :

- an inch above clavicle EJV pierces deep fascia (Supra C T),where a

cut can cause failure of retraction of the walls leading to
venous air embolism & instant death ( AIR SUCKED IN)
- used for central venous cannulation (EJV=Right)Still not conv
- In lesser supra clavicular fossa – IJV Through needle or catheter
- rt ext jugular -monitor venous pressure,right atrial pressure
recumbent position fills lower third , sitting up the column disapp
• MUSCLES : SCM , Digastric , Omohyoid & Trapezius
• Sternocleidimastoid muscles runs obliquely up the side
of the neck dividing the region into two large triangles
Anterior triangle in front & posterior triangle behind
Ant Triangle infront SCM – 3 & ½ triangles each side
TRIANGLES OF NECK :
Post Triangle behind SCM- Occ & Supra Clav triangles
Rectus cervicis : Infrahyoid muscles = SH,OH,ST,TH ---Segm C1 2 3
through hypoglossal nerve(Sup belly) & ansa cervicalis-SH,ST,Inf belly
• ANTERIOR TRIANGLE OF NECK :
Boundaries : Ant B , Post B , Apex directed down , Base up
Divisions : Each anterior triangle on either side of the mid
line in front is further sub divided into three &
half triangles for convenient of description , &
two muscles – Digastric & Omohyoid forming the
part of boundaries
MUSCULAR , CAROTID , DIGASTRIC & SUB MENTAL TRIANGLES
Submental triangles under the chin are halves on each side
• MUSCULAR TRIANGLE:

Boundaries : Ant , Post , Floor ( Infra hyoid mucles SH,OH,ST,TH)

sup belly & th by C1 , rest by ansa hypoglossi
Contenrs : No significant structures ( under musc=L,T,Oeso,Thy Gl )j
Functions : Depress larynx ,stabilize Hyoid bone during deoression
(IHM) & enables to determine position of hyoid bone
Applied : a cut of EJV at this level can suck air in with dangerous
consequences – ie instant death due to air embolism
: while excising Sub Mand Gl,ECA to be secured before
dividing,otherwise retract causing severe bleeding
• CAROTID TRIANGLE :
• Boundaries : Front & above ,Front & below , Behind , Floor-
TH, HG,INF Constrictor,,Middle Constrictor of Phyx,HG-D,MH-S,Inf C
Pharygeal constrictors covered by BP fascia,on
which Ph plexus ramify overlying middle constr
Contents : Arteries : CCA , ICA , ECA ( b/w them above are
P.Glds , Styloid Pr with attachments, GPn , Pharyngeal br of Vn
no brs in neck from CCA & ICA,whereas ECA 8 brs
Special features : Carotid sinus & body R BR(SV tachy massage)
Veins: IJV & tributaries C S syd-sudden turn
Nerves : Spinal part Acc n ,Loop Hn,Vn(RtRLn,S/I c brs Vn)Ansa &CSyT)
Others : P Gland apex , Deep Cervical Gr of LN chain
• DIGASTRIC TRIANGLE (Sub Mandibular)

Boundaries : Above , Below & behind Post B-Dig(Fn),Below & front Ant B(MyeH Br,Inf Alv) ,
Floor-Myelo H,HyoG & Part of Middle Constrictor before back ,deeper plane
Stylo mandibular divides this triangle into ant & post parts(cont parotid reg)
Contents :
Ant part: Supf part of Sub M.Sal Gld,Fv,SubMand Ln,F art,MH v/n,Part Hypog N
Post part: lower part of P Gld, overlapping P belly Digastric,C.Sh,ECA
Applied : common site for swelling,involving
submental LN ,ant 2/3 tongue,floor mouth,F,E,Max A Sinuses
Sub mandibular salivary glands
• SUBMENTAL TRIANGLE :
Boundaries : Apex , Base ,Sides, Floor-MH=Median fibrous raphe
Contents : Sub Mental LN (3-4),Sub mental veins
& commencement of the anterior jugular vein
Applied : floor of mouth,tip of tongue,incisor teeth-painful due
to enlarged Sub mental LN
APPLIED FOR ANTERIOR TRIANGLE :
- Common ant midline swellings
- enlarged Sub mental LN ,Sub lingual Dermoid
- Thyroglossal cyst & inflamed sub hyoid bursa
- Goitre , Carcinoma larynx , Enlarged LN Supra S notch
• -Tracheostomy : retro thyroid after retracting isthmus
Supra Hyoid(stricture) & Infra Hyoid(deep,Vas) tracheostomy
- Cut throat wounds :S/I Hyoid.Main ves escape inj as they
are pushed back to deeper plane during Vol extension neck
-Skin incisions in neck should be parallel to Langer’s lines
-Ludwig’s angina : cellulitis floor of the mouth.Inf spreads
above MH forcing tongue up & Myelo hyoid muscle down
Swelling seen within mouth & below the chin as well
-Dysphagia lusoria : dysphagia caused by compression abn SCA
• THANK YOU