Download Carotid Triangle

Parts and regions of the neck
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Boundaries
Superior－ a line joining inferior
border of mandible, angle of
mandible, tip of mastoid process,
superior nuchal line and external
occipital protuberance
Inferior－ a line joining jugular notch,
sternoclavicular joint, superior
border of clavicle, acromion and
spinous processes of C7
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Regions of neck
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Neck
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Anterior region of neck
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Sternocleidomastoid region
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Lateral region of neck
Nape
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Triangles of anterior region of neck
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Suprahyoid region
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Submental triangle
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Submandibular triangle
Infrahyoid region
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Carotid triangle
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Muscular triangle
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Triangles of lateral region of neck
Omohyoid muscle
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Occipital triangle
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supraclavicular triangle
(greater supraclavicular fossa)
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Skin of the neck
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The natural line of
cleavage of the skin are
constant and run almost
horizontally around the
neck
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SKIN INCISIONS
1. Make a skin incision from the mastoid process (E) to the medial end of the clavicle (F).
2. Reflect the skin to the anterior border of the trapezius muscle.
3. Reflect the skin to the midline.
STRUCTURES IN THE POSTERIOR TRIANGLE
1. The platysma muscle is in the superficial fascia. It covers the lower part of the posterior
triangle. It is innervated by the facial nerve.
2. Raise the posterior border of the platysma muscle and reflect it superiorly.
3. The external jugular vein crosses the superficial surface of the sternocleidomastoid muscle.
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4. The skin of the neck is innervated by cutaneous nerves. They are branches of the cervical
plexus. They enter the superficial fascia at the midpoint of the posterior border of the
sternocleidomastoid muscle. Identify: • Lesser occipital nerve • Great auricular nerve •
Transverse cervical nerve • Supraclavicular nerves
5. The accessory nerve (XI) courses from superior to the midpoint of the posterior border of the
sternocleidomastoid muscle to the anterior border of the trapezius muscle. It innervates the
sternocleidomastoid muscle and the trapezius muscle.
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Anterior Triangle of the Neck
Dissection Instructions
SUPERFICIAL FASCIA
1. Follow the external jugular vein superiorly and observe that it is formed by the joining of the
retromandibular vein and the posterior auricular vein.
2. In the superficial fascia near the anterior midline, note the anterior jugular vein. It join the
externaljugular vein in the root of the neck.
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Superficial fascia
Contents
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Platysma
Superficial veins
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Cutaneous nerves
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Anterior jugular v.
External jugular v.
Lesser occipital n.
Greet auricular n.
Transverse nerve of neck
Supraclavicular n.
Cervical branch of facial n.
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★Cervical fascia
Superficial layer of cervical fascia (investing fascia)
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Encloses trapezius, sternocleidomastoid, posterior belly of digastric and parotid and
submandibular glands.
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★Cervical fascia
Pretracheal layer
 Lies deep to the infrahyoid muscle
 Encloses viscera of neck: pharynx, larynx, trachea, esophagus, thyroid gland
and parathyroid glands
 Completely surrounds thyroid gland, forming a sheath, and bind the gland to
larynx to form suspensory ligament of thyroid gland
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★ Cervical fascia
Prevertebral layer
 Lies anterior to bodies of cervical vertebrae and prevertebral muscles;
extends from base of skull downward into the superior mediastinum,
continuous with anterior longitudinal lig. and endothoracic fascia
 Covers subclavian vessels and roots of brachial plexus
 Extends into upper limb as axillary sheath
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Carotid sheath
 Formed by components of all three layers of deep cervical fascia
 Contains common and internal carotid arteries, internal jugular vein, and
vagus nerve
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Fascia spaces
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Between the two
layer of deep
cervical fascia
exist the
interspace such as :
Suprasternal
Pretracheal
Retropharyngeal
Prevertebral
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Anterior region of neck
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Carotid Triangle

This triangle is bound by the
superior belly of the omohyoid,
posterior belly of the digastric, and
anterior border of the
sternocleidomastoid.
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CAROTID TRIANGLE
1. The contents of the carotid triangle are the carotid arteries (common, internal, and external),
the branches of the external carotid artery, the hypoglossal nerve, and branches of the vagus
nerve (X). The boundaries of the carotid triangle are:
• Inferomedial – superior belly of the omohyoid muscle
• Inferolateral – anterior border of the sternocleidomastoid muscle
• Superior – posterior belly of the digastric muscle
2. Transect the sternocleidomastoid muscle. Do not damage the cutaneous branches of the
cervical plexus. Reflect it superiorly.
3. Find the accessory nerve (XI). It crosses the deep surface of the sternocleidomastoid muscle.
Trace it superiorly.
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4. Cut the facial vein. It empties into the internal jugular vein.
5. Find the hypoglossal nerve superior to the tip of the greater horn of the hyoid bone. A
muscular branch of the occipital artery crosses superior to the hypoglossal nerve. The
hypoglossal nerve passes medial to the posterior belly of the digastric muscle.
6. The superior root of the ansa cervicalis travels with the hypoglossal nerve. It is mainly
composed of fibers from C1. The inferior root of the ansa cervicalis (C2, C3) join the superior
root. Thus, a loop is formed.
7. Clean the ansa cervicalis and trace its delicate branches to the lateral borders of the infrahyoid
muscles.
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8. Find the internal branch of the superior laryngeal nerve. It passes through the thyrohyoid
membrane. It supplies the mucosa of the larynx with sensory fibers.
9. Trace the external branch of the superior laryngeal nerve distally. It innervates the
cricothyroid muscle.
10. Open the carotid sheath. It contains the common carotid artery, internal carotid artery,
internal jugular vein, and vagus nerve (X).
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11. Internal jugular vein is located lateral to the common carotid or internal carotid artery. Its
largest tributaries: common facial vein, superior thyroid vein, and middle thyroid vein.
Remove the tributaries of the internal jugular vein.
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12. At the level of the superior horn of the thyroid cartilage, find the origin of the external
carotid artery..
13. The external carotid artery has six branches in the carotid triangle. Identify: • Superior
thyroid artery • Lingual artery • Facial artery • Occipital artery • Posterior auricular artery
14. Observe the carotid sinus and carotid body. They are innervated by the glossopharyngeal
nerve (IX).
15. Identify the internal carotid artery and note that it has no branches in the neck.
16. Identify the vagus nerve (X). It lies between and posterior to the vessels.
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Carotid Triangle
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Clean the carotid bifurcation and
note the dilated proximal portion
of the internal carotid artery. This
is the carotid sinus region.
In the bifurcation, closely
adherent to the internal carotid
artery is the carotid body,
another specialized receptor
(chemoreceptor) which monitors
blood O2 and CO2 levels, and
pH (innervated by a small
branch of CN.Ⅸ).
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Submendibular gland
Digastric
Accessory n.
Hypoglossal n.
Superior thyroid a.
Ansa cervicalis
Sternothyroid
Sternohyoid
Vagus n.
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Cervical plexus
Phrenic n.
Omohyoid
Hypoglossal n.
Vagus n.
Internal branch
Vertebral a.
Superior thyroid a.
External branch
Inferior thyroid a.
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Infrahyoid region
★ Muscular triangle
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Bounded by midline of the neck,
superior belly of the omohyoid and
anterior border of the
sternocleidomastoid.
Covered by skin, superficial fascia,
platysma, anterior jugular v.,
coutaneous n. and investing fascia
Deep－prevertebral fascia
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Infrahyoid region
Muscular triangle
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Contents
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Superior belly of omohyoid
Sternohyoid
Sternothyroid
Thyrohyoid
Thyroid gland
Parathyroid gland
Cervical part of trachea and
esophagus
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MUSCULAR TRIANGLE
1. The contents of the muscular triangle of the neck are the infrahyoid muscles, the thyroid
gland, and the parathyroid glands. The boundaries of the muscular triangle are:
• Superolateral – superior belly of the omohyoid muscle
• Inferolateral – anterior border of the sternocleidomastoid muscle
• Medial – median plane of the neck
2. Identify the sternohyoid muscle. The inferior attachment is the sternum and its superior
attachment is the body of the hyoid bone.
3. Identify the superior belly of the omohyoid muscle.
4. Transect the sternohyoid muscle close to the hyoid bone and reflect it inferiorly.
5. Transect the superior belly of the omohyoid muscle close to the hyoid bone and reflect it
inferiorly.
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6. Identify the sternothyroid muscle and thyrohyoid muscle.
7. The ansa cervicalis innervates the infrahyoid muscles.
8. Retract the right and left sternothyroid muscles to identify:
• Laryngeal prominence • Cricothyroid ligament • Cricoid cartilage • • Isthmus of the
thyroid gland
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★ Thyroid gland
Shape and position
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H-shape
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Left and right lobes: lie on either side of
inferior part of larynx and superior part of
trachea, extend from middle of thyroid
cartilage to level of sixth trachea cartilage
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Isthmus: overlies 2nd to 4th tracheal
cartilage
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Pyramidal lobe: some times arises from
isthmus
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★ Thyroid gland
Coverings of the thyroid gland
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False capsule: a sheath of pretracheal fascia which is attached to arch of cricoid
and thyroid cartilages to form the suspensory ligament of thyroid gland, hence,
the thyroid gland moves with larynx during swallowing and oscillates during
speaking
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True capsule: fibrous capsule
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Space between sheath and capsule of thyroid gland: there are loose connective
tissue, vessels, nerves and parathyroid glands
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★ Thyroid gland
Relations of the thyroid gland
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Anteriorly:
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Posteromedially:
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Skin
superficial fascia
investing fascia
Infrahyoid muscles and pretracheal fascia
Larynx and trachea
Pharynx and esophagus
Recurrent laryngeal nerve
Posterolaterally:
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Carotid sheath with common carotid a.,
internal jugular v., and vagus n.
Cervical sympathetic trunk
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★ Arteries of the thyroid gland
Superior thyroid a.
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Branch of external carotid a.
Runs superficial and parallel to
the external branch of superior
laryngeal n. to reach the upper
pole of thyroid gland
Gives off superior laryngeal a. in
company with internal branch of
superior laryngeal n.
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★ Arteries of the thyroid gland
Inferior thyroid artery
 Branch of thyrocervical trunk of
subclavian a.
 Turns medially and downward,
reaches the posterior border of the
thyroid gland, where it is closely
related to the recurrent laryngeal n.
 Supplies inferior pole of thyroid
gland
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★ Arteries of the thyroid gland
Arteria thyroidea ima
May arise (4%) from the
brachiocephalic a. or aortic arch
lowest thyroid artery
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★ Nerves of the larynx
Superior laryngeal n.
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Internal branch：which pierces
thyrohyoid membrane to innervates
mucous membrane of larynx above
fissure of glottis
External branch：is fine n., which
descends in company with the superior
thyroid a. and supplies cricothyroid
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★ Nerves of the larynx
Recurrent laryngeal nerves
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Ascend in tracheo-esophageal groove
Pass deep to the lobe of the thyroid gland
and come into close relationship with the
inferior thyroid a.
Cross either in front of or behind the
artery of may pass between its branches
Nerves enter larynx posterior to
cricothyroid joint, the nerve is now called
inferior laryngeal nerve
Innervations: laryngeal mucosa below
fissure of glottis , all laryngeal muscles
except cricothyroid
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Venous drainage of the thyroid gland
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Superior thyroid veins drain into
internal jugular vein
Middle thyroid veins drain into internal
jugular vein
Inferior thyroid veins of two sides
anastomose with one another as they
descend in front of the trachea to form
unpaired thyroid venous plexus. They
drain into brachiocephalic veins.
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★ Parathyroid gland
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Yellowish-brown, ovoid bodies
Position
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Two superior parathyroid glands: lie at
junction of superior and middle third of
posterior border of thyroid gland
Two inferior parathyroid glands: lie near
the inferior thyroid artery, close to the
inferior poles of thyroid gland
Function: regulate calcium and
phosphate balance and is therefore
essential for life
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Root of neck
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At thoracic inlet
Formed by
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Anteriorly－manubrium sterni
Posteriorly－body of first thoracic
vertebra
Laterally－first rib and costal cartilage
Central markers－scalenus anterior
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Root of neck
Contents
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Cupula of pleura－extends up into the
neck, over the apex of lung, 2～3cm
above the medial third of clavicle
Subclavian v.
Thoracic duct and right lymphatic duct
Subclavian a.
Vagus n.
Phrenic n.
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Triangle of the vertebral a.
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Boundaries
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Medially－longus colli
Laterally－scalenus anterior
Inferiorly－first part of subclavian a.
Apex－transverse process of C6
Posteriorly－cupula of pleura, transverse
process of C7, anterior rami of C8 spinal
nerves, costal neck of 1st rib
Anteriorly－carotid sheath, phrenic n.
and arch of thoracic duct (left)
Contents
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Vertebral a. and v.
Inferior thyroid a.
Cervical part of sympathetic trunk
Cevicothoracic ganglion
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Base of the Neck
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Look for the thoracic duct, Which
enters the angle between the left
internal jugular vein and left
subclavian vein .
Next find the vertebral artery, the first
and largest branch of the subclavian.
This artery usually passes through the
transverse foramen of C6.
Finally, identify the sympathetic trunk
and its chain ganglia posterior to the
carotid sheath.
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Sympathetic trunk
Inferior thyroid a.
Recurrent laryngeal n.
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Vagus n.
Thoracic duct
Vertebral a.
Transvers cervical a.
Costocervical
trunk
Inferior thyroid a.
Thyrocervical trunk
Suprascapular a.
Internal thoratic a.
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Lateral region of neck 颈外侧区
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Bounded by posterior border of
sternocleidomastoid, anterior
border of trapezius and middle
third of clavicle
Divided by inferior belly of
omohyoid into occipital triangle
and supraclavicular triangle
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Occipital triangle 枕三角
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Bounded by posterior border of
sternocleidomastoid, anterior border
of trapezius and superior border of
inferior belly of omohyoid
Covered by skin, superficial fascia,
and investing fascia
Deep－prevertebral fascia and
scalenus anterior, scalenus medius,
scalenus posterior, splenius capitis
and levator scapulae
Conents
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Accessory n.－emerges above the
middle of the posterior border of
sternocleidomastoid and crosses the
occipital triangle to trapezius
Cervical and brachial plexuses
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Supraclavicular triangle 锁骨上三角
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Bounded by posterior border of
sternocleidomastoid, inferior belly of
omohyoid and middle third of clavicle
Covered by skin, superficial fascia,
and investing fascia
Deep－prevertebral fascia and
inferior parts of scalenus
Conents
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Subclavian v. and venous angle
Subclavian a.
Brachial plexus
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Muscular Triangle
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This triangle includes the “strap”
muscles that lie anterior to the
trachea. The superficial layer of
strap muscles consists of the
superior belly of the omohyoid and
sternohyoid.
Deep to these are the sternothyroid
and short thyrohyoid muscles.
Spread the infrahyoid muscles apart
and identify the cricothyroid
membrane stretching between the
thyroid and cricoid cartilages.
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Thyroid Gland
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Expose the thyroid gland and verify that it
consists of right and left lobes and an
intervening isthmus. Sometimes, a
pyramidal lobe is found ascending from the
isthmus.
Examine the gland’s blood supply:
superior and inferior thyroid arteries,
and three veins (superior, middle and
inferior). The inferior thyroid artery often is
looped and is a branch of the thyrocervical
trunk of the subclavian artery.
Cut the isthmus of the gland to turn the
lobes laterally and probe for the recurrent
laryngeal nerves that ascend on each
side posterior to the gland and often lie in
the groove between the trachea and
esophagus .
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SUBMANDIBULAR TRIANGLE
1. The contents of the submandibular triangle are the submandibular gland, facial artery, facial
vein, stylohyoid muscle, hypoglossal nerve (XII), and lymph nodes.
The boundaries of the submandibular triangle are:
• Superior – inferior border of the mandible
• Anteroinferior – anterior belly of the digastric muscle
• Posteroinferior – posterior belly of the digastric muscle
2. Identify the submandibular gland. It extends deep to the mylohyoid muscle.
3. Separate the facial artery and vein from the submandibular gland. Facial vein passes superficial
to the submandibular gland and the facial artery courses deep to the gland.
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4. Remove the superficial part of the submandibular gland. Do not disturb the deep part of the
gland.
5. Identify the anterior and posterior bellies of the digastric muscle.
6. Identify the tendon of the stylohyoid muscle. It attaches to the body of the hyoid bone.
7. Follow the hypoglossal nerve (XII) into the submandibular triangle. It passes deep to the
mylohyoid muscle.
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SUBMENTAL TRIANGLE
1. The contents of the submental triangle are the submental lymph nodes. The submental
triangle is an unpaired triangle. The boundaries are:
• Right and left – anterior bellies of the right and left digastric muscles
• Inferior – hyoid bone
• Floor – mylohyoid muscle
2. Clean the superficial fascia from the surface of the right and left mylohyoid muscles.
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Thyroid and Parathyroid Glands
Dissection Instructions
1. Loosen the sternothyroid muscle from deeper structures and transect it near the sternum and
reflect it superiorly.
2. Observe the thyroid gland. It is located at vertebral levels C5-T1. Laterally, it is in contact
with the carotid sheath.
3. Identify the right lobe and left lobe of the thyroid gland. The two lobes are connected by the
isthmus. It crosses the anterior surface of tracheal rings 2 and 3.
4. The thyroid gland has a pyramidal lobe. It extends superiorly from the isthmus. The
pyramidal lobe is a remnant of development.
5. Identify the superior thyroid artery. It is a branch of the external carotid artery.
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6. The superior and middle thyroid veins are tributary to the internal jugular vein. The right
and left inferior thyroid veins drain into the right and left brachiocephalic veins, respectively.
7. Cut the isthmus of the thyroid gland. Detach the capsule of the thyroid gland from the 1st
tracheal ring. Spread the lobes widely apart.
8. Display the recurrent laryngeal nerve. It ascends immediately posterior to the thyroid gland
in the groove between the trachea and esophagus.
9. Examine the posterior aspect of the left lobe of the thyroid gland and attempt to identify the
parathyroid glands. Usually, there are two parathyroid glands on each side.
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Root of the Neck
Dissection Instructions
1. The clavicle has been cut at its midlength during dissection of the thorax.
2. Reflect the sternohyoid muscle and sternothyroid muscle.
3. Cut the internal thoracic artery close to the subclavian artery. Remove the anterior thoracic
wall.
4. Clean the omohyoid muscle.
5. Identify the subclavian vein. Loosen it from structures that lie deep to it. Remove the
tributaries of the subclavian vein.
6. Follow the subclavian vein proximally. It is joined by the internal jugular vein to form the
brachiocephalic vein.
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7. Identify the subclavian artery. The right subclavian artery is a branch of the brachiocephalic
trunk and the left subclavian artery is a branch of the aortic arch.
8. The subclavian artery has three parts. They are defined by the presence of the anterior scalene
muscle:
• First part – from its origin to the medial border of the anterior scalene muscle
• Second part – posterior to the anterior scalene muscle
• Third part – between the lateral border of the anterior scalene muscle and the lateral border of
the first rib
9. The first part of the subclavian artery has three branches:
• Vertebral artery • Internal thoracic artery • Thyrocervical trunk.
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The thyrocervical trunk has three branches: Transverse cervical artery; Suprascapular artery;
Inferior thyroid artery.
Trace the inferior thyroid artery toward the thyroid gland and it passes posterior to the cervical
sympathetic trunk. The ascending cervical artery is a branch of the inferior thyroid artery.
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10. The second part of the subclavian artery has one branch, the costocervical trunk. It
divides into the deep cervical artery and the supreme intercostal artery. The supreme
intercostal artery gives rise to posterior intercostal arteries 1 and 2.
11. The third part of the subclavian artery has one branch, the dorsal scapular artery. It
passes between the superior and middle trunks of the brachial plexus to supply the muscles of the
scapular region.
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12. Find the thoracic duct. It ascends from the thorax into the neck. It is posterior to the
esophagus at the level of the superior thoracic aperture, then arches anteriorly and to the left to
join the venous system near the junction of the left subclavian vein and the left internal jugular
13. On the right side of the neck, right lymphatic duct drains into the junction of the right
subclavian and right internal jugular veins.
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14. Find the vagus nerve in the carotid sheath and follow it into the thorax. It passes posterior to
the root of the lung.
15. The right vagus nerve passes anterior to the subclavian artery. It gives off the right recurrent
laryngeal nerve. The left recurrent laryngeal nerve is given off as the left vagus nerve passes
the aortic arch.
16. Follow the right and left recurrent laryngeal nerves superiorly along the lateral surface of the
trachea and esophagus. Trace them as far as the first tracheal ring.
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17. Verify that the phrenic nerve crosses the anterior surface of the anterior scalene muscle.
Follow the phrenic nerve into the thorax and confirm that it passes anterior to the root of the lung.
SDU.
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温州医学院人体解剖学教研室
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18. Identify the cervical portion of the sympathetic trunk. Inferior cervical sympathetic ganglion
is located in the root of the neck. Verify that the cervical sympathetic trunk is continuous with the
thoracic sympathetic trunk.
SDU.
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19. Identify the anterior, middle, and posterior scalene muscles.
20. Define the borders of the anterior scalene and middle scalene muscles. They attach to the
first rib. The first rib and the adjacent borders of the anterior and middle scalene muscles form
the boundaries of the interscalene triangle. The subclavian artery and the roots of the
brachial plexus pass through the interscalene triangle.
• The subclavian vein cross the anterior surface of the anterior scalene muscle. • The phrenic
nerve descends vertically across the anterior surface of the anterior scalene muscle.
21. Clean the roots of the brachial plexus at the level of the interscalene triangle. Identify the
parts of the supraclavicular portion of the brachial plexus: roots, trunks, and divisions.
SDU.
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温州医学院人体解剖学教研室
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TEMPORAL FOSSA
1. The superficial temporal vessels and the auriculotemporal nerve are located in the scalp,
superficial to the temporal fascia.
2. The temporal fascia is attached to the superior temporal line and was cut. Cut the temporal
fascia along the superior border of the zygomatic arch and remove the fascia completely.
3. Identify the temporalis (temporal) muscle.
• Inferior attachment of the temporalis muscle is the coronoid process of the mandible.
• Fibers of the anterior portion of the temporalis muscle have a vertical direction (important for
elevation of the mandible).
• Fibers of the posterior portion of the temporalis muscle have a more horizontal direction
(important for retrusion of the mandible).
SDU.
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温州医学院人体解剖学教研室
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INFRATEMPORAL FOSSA
1. The ramus of the mandible must be removed to view the contents of the infratemporal fossa.
2. Insert a probe through the mandibular notch and push it anteroinferiorly (arrow 1). Keep the
probe in close contact with the deep surface of the mandible. Use a saw to cut through the
coronoid process to the probe.
3. Reflect the coronoid process together with the temporalis muscle in the superior direction.
Release the temporalis muscle from the skull and the temporal nerves enter the muscle from its
deep surface. The temporal nerves are accompanied by deep temporal arteries.
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温州医学院人体解剖学教研室
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4. Insert a probe medial to the neck of the mandible (arrow 2). Use a saw to cut through the neck
of the mandible to the probe.
5. Insert the handle of a probe medial to the neck of the mandible and slide it inferiorly until it
catches on the lingula (arrow 3). Use a saw to cut down to the probe and remove the superior part
of the ramus of the mandible.
SDU.
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温州医学院人体解剖学教研室
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6. Deep to the mandible, identify the lateral pterygoid muscle. It has two heads.
The anterior attachment of the superior head is the infratemporal surface of the greater wing of
the sphenoid bone. The anterior attachment of the inferior head is the lateral surface of the lateral
plate of the pterygoid process. The posterior attachments are the neck of the mandible and the
articular disc within the capsule of the temporomandibular joint. The lateral pterygoid muscle
depresses the mandible (opens the jaw).
SDU.
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温州医学院人体解剖学教研室
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7. Identify the medial pterygoid muscle. The proximal attachments are the maxilla and the
medial surface of the lateral plate of the pterygoid process. The distal attachment is the inner
surface of the ramus of the mandible. It elevates the mandible (closes the jaw).
SDU.
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温州医学院人体解剖学教研室
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8. On the superficial surface of the medial pterygoid muscle, identify the inferior alveolar nerve
and vessels. Clean the inferior alveolar nerve and follow it to the mandibular foramen.
SDU.
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温州医学院人体解剖学教研室
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9. The inferior alveolar nerve and vessels enter the mandibular foramen and pass distally in the
mandibular canal. The mental nerve is a branch of the inferior alveolar nerve. It passes
through the mental foramen to innervate the chin and lower lip.
SDU.
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10. Identify the lingual nerve. It emerges between the lateral and medial pterygoid muscles just
anterior to the inferior alveolar nerve. It passes medial to the third mandibular molar tooth and it
innervates the mucosa of the anterior 2/3 of the tongue and floor of the oral cavity.
SDU.
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温州医学院人体解剖学教研室
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11. Identify the maxillary artery. It arises from the bifurcation of the external carotid artery. It
crosses either the superficial surface (2/3) or the deep surface (1/3) of the lateral pterygoid muscle.
SDU.
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12. Trace the maxillary artery through the infratemporal fossa. Identify:
• Middle meningeal artery –passes through the foramen spinosum to supply the dura mater.
• Deep temporal arteries (anterior and posterior)– pass across the infratemporal fossa and
enter the deep surface of the temporalis muscle.
• Inferior alveolar artery – enters the mandibular foramen with the inferior alveolar nerve.
• Buccal artery – passes anteriorly to supply the cheek.
SDU.
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温州医学院人体解剖学教研室
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13. Cut the lateral pterygoid muscle close to its posterior attachments to the neck of the mandible
and the articular disc. Remove the muscle.
14. Follow the inferior alveolar nerve and the lingual nerve to the foramen ovale in the roof of
the infratemporal fossa. Identify the chorda tympani. It joins the posterior side of the lingual
nerve.
SDU.
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温州医学院人体解剖学教研室
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15. Follow the maxillary artery toward the pterygopalatine fossa. Within the pterygopalatine
fossa, identify only the posterior superior alveolar artery. It enters the infratemporal surface of
the maxilla.
SDU.
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温州医学院人体解剖学教研室
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TEMPOROMANDIBULAR JOINT
1. Identify the capsule of the temporomandibular joint. The joint capsule is loose and its lateral
surface is reinforced by the temporomandibular ligament.
2. Insert scalpel into the temporomandibular joint close to the mandibular fossa and open the
superior synovial cavity of the joint. Remove the head of the mandible along with the articular
disc.
3. Cut the articular capsule to open the inferior synovial cavity and observe the shape and
variable thickness of the articular disc.
SDU.
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温州医学院人体解剖学教研室
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Suprahyoid region
Submental triangle 颏下三角


Lies below the chin
Boundaries





Laterally by anterior bellies of
digastric
Inferiorly by the body of hyoid
bone
Covered by skin, superficial fascia
and investing fascia
Floor－mylohyoid muscles
Contents－submental lymph
nodes
SDU.
LIZHENHUA
Suprahyoid region
Submandibular triangle

Boundaries





Anterior and posterior bellies of
digastric
Lower border of the body of the
mandible
Covered by skin, superficial fascia,
platysma and investing fascia
Floor－ mylohyoid, hyoglossus and
middle constrictor of pharynx
Contents－submandibular gland,
facial a., v., hypoglossal n. lingual a.
v. and n., submandibular ganglion
and submandibular lymph nodes
SDU.
LIZHENHUA
Infrahyoid region
★

Carotid triangle
Boundaries






Anterior border of
sternocleidomastoid
Superior belly of omohyoid
Posterior belly of digastic
Covered by skin, superficial
fascia, platysma and investing
fascia
Deep－prevertebral fascia
Medial － lateral wall of
pharynx
SDU.
LIZHENHUA
Infrahyoid region
★ Carotid triangle
 Contents

Common carotid a. and its branches
Internal jugular v. and its tributaries

Hypoglossal n. with its descending

branches



Vagus nerve
Accessory nerve
Deep cervical lymph nodes
SDU.
LIZHENHUA
Infrahyoid region
Relations of posterior belly of digastic

Superficial




Deep





internal and external carotid a.
internal jugular v.
Ⅹ～Ⅻ cranial n.
cervical part of sympathetic trunk
Superiorly




great auricular n.
retromandibular v.
cervical branch of facial n.
posterior auricular a.
facial a.
glossopharyngeal n.
Infeiorly


SDU.
occipital a.
hypoglossal n.
LIZHENHUA
Skin incisions


Make the skin incisions
shown in figure
Reflect the skin
posteriorly to well
behind the ear.
SDU.
LIZHENHUA
Dissection of Superficial Structures

Note the underlying platysma
muscle, a muscle of facial
expression, which has migrated onto
the neck. Beneath the platysma lie
the supraclavicular cutaneous nerves
(C3-4) (medial，intermediate and
lateral). Slightly superior to the
middle of the posterior border of the
sternocleidomastoid muscle, locate
the spinal accessory nerve coursing
downward toward the trapezius
muscle.
SDU.
LIZHENHUA
Platysma
Dissection of Superficial Structures




Using your scissors incise and spread the
tough fascial covering of the posterior
triangle and locate the lesser occipital
nerve (C2-3) emerging close to CN.Ⅺ,
note the direction that each nerve takes as
it traverses the posterior triangle.
Next locate the great auricular nerve
(C2-3) which ascends posterior and
parallel with the external jugular vein on
the sternoclidomastoid.
Try to identify the small transverse
cervical nerve (C2-3) supplying skin over
the anterior neck.
Look for the facial vein, retromandibular
vein and, if present, the small anterior
jugular vein, and review the external
jugular system.
SDU.
LIZHENHUA
Cutaneous nerves and superficial veins
Lesser occipital n.
External jugular vein
Greet auricular n.
Transverse nerve of neck
Anterior jugular vein
SDU.
LIZHENHUA
Supraclavicular n.
Cervical part of trachea



Begins at lower end of
larynx－level of C6 vertebra
Consists of a series of
incomplete cartilage rings
Extends into thorax
SDU.
LIZHENHUA
Relations of cervical part of trachea
★ Anteriorly









Skin
Superficial fascia
Investing fascia
Suprasternal space and jugular arch
Infrahyoid muscles and pretracheal fascia
Isthmus of thyroid gland ( in front of the
2nd to 4th tracheal cartilage)
Inferior thyroid v. and unpaired thyroid
venous plexus
Arteria thyroid ima ( if present)
Thymus, left brachiocephalic v. and aortic
arch in child
SDU.
LIZHENHUA
Relations of cervical part of trachea



Superolaterally
 lobes of the thyroid gland ( down
as far as the sixth ring)
Posteriorly
 Esophagus
 R. & L. recurrent laryngeal nerves
Posterlaterally
 Cervical sympathetic trunk
 Carotid sheath
SDU.
LIZHENHUA
Cervical part of esophagus



Extending from pharynx at level of C6 vertebra
Descends through the neck, it inclines to the left
side
Relations of the cervical part of esophagus

Anteriorly



Posteriorly




Prevertebral layer of cervicl fascia
Longus colli
Vertebral column
Laterally


SDU.
Trachea
Recurrent laryngeal nerves
Lobe of the thyroid gland
Carotid sheath with common carotid a.,
internal jugular v., and vagus n.
LIZHENHUA
Sternocleidomastoid region
胸锁乳突肌区


Covered by sternocleidomastoid
Contents




SDU.
Ansa cervicalis
Carotid sheath
Cervical plexus
Cervical part of sympathetic
trunk
LIZHENHUA
Carotid Triangle


Palpate and locate the tip of the greater
horn of the hyoid bone. Just superior to
the tip, find the hypoglossal nerve where
it crosses the carotid sheath anteriorly
and lataerally.
Now try to find the superior root of the
ansa cervicalis which is composed
mainly of fibers from C1 that run with
the CN. Ⅻ. The inferior root (C2-3)
descends from the more posterior
superior neck region to join the superior
root, together forming a loop overlying
the carotid sheath. The ansa innervates
the infrahyoid muscles and often is
enmeshed in the carotid sheath.
SDU.
LIZHENHUA
Carotid Triangle


Find the vagus nerve by carefully
opening the carotid sheath. It lies
within the carotid sheath between
the common carotid artery and
internal jugular vein.
Relax the neck, and then sever the
omohyoid, sternohyoid, and
thyrohyoid muscles close to the
hyoid bone. This exposes the
thyrohyoid membrane and the
internal laryngeal nerve can be
seen piercing this membrane. The
other portion of the superior
laryngeal nerve is its very small
external laryngeal nerve.
SDU.
LIZHENHUA
Carotid Triangle


Identify the common carotid artery,
internal carotid artery and the closely
applied internal jugular vein.
Identify the external carotid artery and
its first five branches.





SDU.
Superior thyroid a.: Supplies the upper
part of the thyroid gland and gives off
the superior laryngeal artery, which
pierces the thyrohyoid membrane with
the internal laryngeal nerve.
Lingual a.
Facial a.
Occipital a.
Ascending pharyngeal a.
LIZHENHUA