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Triangles of neck By Dr. Adel Sahib Al-Mayaly FICMS, FACS The side of the neck • It is quadrilateral outline • Boundaries:• Above:- lower border of mandible and an imaginary line extending from the angle of the mandible to the mastoid process . • Below:- by the upper border of the clavicle. • In front:- the mid-line of the neck. • Behind:- the anterior margin of the Trapezius • Posterior Triangle and Its Subdivisions • Boundaries: • Anteriorly: posterior border of the SCM muscle. Posteriorly: anterior border of the trapezius muscle • Inferiorly: intermediate one-third of the clavicle • • Is subdivided into occipital and Subclavian triangles by inferior belly of omohyoid m. Subdivisions • Subclavian (Omoclavicular) triangle. • Ooccipital1-1-ccipital triangle. Anterior triangle Subdivisions of anterior triangle 1-Submandibular triangle. 2- Submental triangle. 3-Carotid triangle. 4-Muscular triangle. Carotid triangle • Boundaries: • Anteriorly: superior belly of the omohyoid muscle • Posteriorly: sternocleidomastoid muscle • Superiorly: posterior belly of the digastric and the stylohyoid muscles • Floor: thyrohyoid, sternothyroid, and inferior constrictor muscles Contents • the carotid arterial system, the internal jugular vein with tributaries • , the hypoglossal nerve, vagus nerve, the superior laryngeal nerve, and the sympathetic trunk. Muscular triangle • • • • • • • • Superior belly of omohyoid above. Anterior border of SCM muscle behind. Midline of neck infront. Floor: strap muscles:1- sternohyoid m. 2- sternothyroid m. 3- thyrohyoid m. 4- superior belly of omohyoid m. Submandibular triangle • • • • Lower border of mandible above Posterior belly digastric & stylohyoid behind . Anterior belly of digastric infront Floor:- the Mylohyoid, Hyoglossus, and superior constrictor of pharynx. • Contents :- submandibular g.& duct, submandibular L.Ns. Submental (suprahyoid) triangle • • • • Anterior belly of digastric on both sides. Body of hyoid bone below. Floor:- mylohyoid muscle. Contents;- Submental lymph nodes Muscles of anterior triangle • 1- superficial muscles:- platysma, SCM & trapezius. • 2- Infrahyoid muscles. • 3- Suprahyoid muscles. • 4- lateral vertebral muscles (scalenae muscles). Blood vessels of anterior triangle. • • • • • Carotid arterial system Common carotid artery:Origin :Right side:- brachiocephalic trunk behind sternoclavicular j. Left side:- arch of aorta in the superior mediastinum Carotid arterial system Common carotid artery • On either side; it ascends upward within the carotid sheath. • At the level of upper border of thyroid cartilage; • It bifurcates into • 1- Internal carotid artery. • 2- External carotid artery. Internal carotid artery • It ascends upward within carotid sheath from its origin. • First; it is SF to ECA but then it becomes behind & deep to ECA. • At base of skull; it enters carotid canal to gain access to cranial cavity. • It gives no branches in the neck. External carotid artery • At first, it lies medial to the internal carotid artery, • As it ascends in the neck; it passes backward and lateral to it. • It is crossed by the posterior belly of the digastric and the stylohyoid. Branches of ECA • • • • • • • • Superior thyroid artery Ascending pharyngeal artery Lingual artery Facial artery Occipital artery Posterior auricular artery Superficial temporal artery Maxillary artery Internal jugular vein • It emerges from jugular foramen at the base of skull. • It lies behind ICA at first ( at the base of skull). • Here it receives the inferior petrosal sinus • It descends in the carotid sheath lateral to the ICA then CCA. • At root of neck; it joins the subclavian vein to form the brachiocephalic v. Surface anatomy of IJV Tributaries of IJV Carotid sheath • It extends from the base of skull (carotid canal) to the arch of aorta. • It encloses the carotid art., IJV & vagus nerve in between. • The sympathetic trunk is lying behind the sheath. • The ansa cervicalis (C!,2,3) is embedded in its ant. Wall.