THE TRIANGLES OF THE NECK

OTPT 102:Take Home Quiz

A Presentation by: Antonio, Taciana Marie Dela Cruz, Ianna Kristine Domingo, Harvey Duata, Paulo Fortea, Michelle Alyssa Go, Lilbert Go, Riezel Pamela Labarete, Rejean Ramel, Jonas Sahagun, Maria Patricia Velasco, Lovely Jane

THE TRIANGLES OF THE NECK

OBJECTIVES

Objectives

To identify the triangles of the neck To identify the borders, subdivisions and contents of each triangle

THE TRIANGLES OF THE NECK

INTRODUCTION

Introduction

The neck is the region of the body below the mandible and above the suprasternal notch and upper border of the clavicle. The neck contains a portion of the respiratory pathways, namely the larynx and trachea, and the digestive pathways, namely the pharynx and esophagus. On its sides, the neck holds the arteries and veins that transport blood to the brain, as well as the vagus nerve and numerous lymph nodes.

Introduction

With many components and structures present, the neck can become difficult to study. To better understand the anatomical components of the neck, its lateral aspect can be divided into portions defined by the following borders: a line from the border of the mandible to the mastoid process above, the upper border of the clavicle below, the middling of the neck in front, and the anterior margin of the trapezius muscle behind.

Introduction

The sternocleidomastoid muscle can be thought of as a line that divides the region defined by the borders above into two imaginary triangles. The contents of these triangles, and other triangles that can be found within, are described in this report.

TRIANGLES OF THE NECK

THE TRIANGLES OF THE NECK

Two Major Triangles:

Anterior Triangle
the area anterior to the sternocleidomastoid and below the inferior border of the mandible

Posterior Triangle
the area posterior to the sternocleidomastoid and above the trapezius

THE STERNOCLEIDOMASTOID

Sternocleidomastoid
paired muscle in the superficial layer of the anterior portion of the neck divides the neck into two triangles, anterior and posterior, to simplify the complicated area Origin:
Sternal head manubrium sterni Clavicular head medial 2/3 of the clavicle

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

Action:
Bilateral: Flexes the neck Single: Flexes the head and laterally rotates to the opposite side

Innervation
Ipsilateral accessory nerve Anterior primary rami of spinal nerves C2 and C3

THE TRIANGLES OF THE NECK

THE ANTERIOR TRIANGLE

Retrieved from http://www.trueknowledge.com/images/thumbs/180/250/1e1803e46a9642ffccf2316a8e3951b2.png

THE ANTERIOR TRIANGLE

Borders:
1. 2. 3. 4. Base: Body of the Mandible Anterior: Midline of the Neck Posterior: Sternocleidomastoid Muscle Apex: Sternum

Contents:
1. Suprahyoid Muscles 2. Infrahyoid Muscles

THE ANTERIOR TRIANGLE

Contents:
1. Suprahyoid Muscles: superior to the hyoid
1. 2. 3. 4. 1. 2. 3. 4. Classifications: Stylohyoid Digastric Mylohyoid Geniohyoid Classifications: Omohyoid Sternohyoid Thyrohyoid Sternothyroid

2. Infrahyoid Muscles: inferior to the hyoid

THE ANTERIOR TRIANGLE

Subdivisions or Subtriangles:
Muscular Triangle Carotid Triangle Submental Triangle Digastric triangle

The Anterior Triangle: Subdivisions

THE MUSCULAR TRIANGLE

MUSCULAR TRIANGLE

THE ANTERIOR TRIANGLE: SUBDIVISIONS

I. Muscular Triangle
also known as the Inferior Carotid Artery Borders
1. Medial: Median line of neck from hyoid bone to the sternum Inferolateral: Anterior border of the Sternocleidomastoid muscle Superolateral: Superior belly of the Omohyoid muscle

2.
3.

Covering
Integument, superficial fascia, platysma, and deep cervical fascia

THE ANTERIOR TRIANGLE: SUBDIVISIONS

I. Muscular Triangle
Contents:
1. (muscle) The Infrahyoid musclesSternohyoid, Sternothyroid 2. (vessel) Common carotid artery, Internal Jugular vein, 3. (nerve) Vagus nerve 4. (glands) Thyroid, Parathyroid

The Anterior Triangle: Subdivisions

THE CAROTID TRIANGLE

Retrieved from http://home.comcast.net/~wnor/necktriangle.jpg

THE ANTERIOR TRIANGLE: SUBDIVISIONS

II. Carotid Triangle
Borders
1. Posterior belly of the Digastric 2. Superior belly of the Omohyoid 3. Anterior border of the sternocleidomastoid muscle

contains the bifurcation of the common carotid artery

THE ANTERIOR TRIANGLE: SUBDIVISIONS

II. Carotid Triangle
Platysma
First layer,under the skin and superficial fascia Forms the roof of the carotid triangle

Common Facial Vein

Second Layer, seen with the Platysma removed

Middle and Lower Pharyngeal Constrictors

Third layer, Lies on the floor of the Carotid Triangle

THE ANTERIOR TRIANGLE: SUBDIVISIONS

II. Carotid Triangle
Contents:
Common Carotid Artery
arises in the base of the neck from the brachiocephalic artery on the right side and directly from the arch of the aorta on the left side in the superior mediastinum of the thorax passes into the base of the neck through the thoracic inlet bounded by T1 vertebral body, the sternum and first rib and ascends into the carotid triangle

II. Carotid Triangle

Contents:

THE ANTERIOR TRIANGLE: SUBDIVISIONS

collects blood from the brain, face and neck begins after exiting the jugular foramen then passes inferiorly through the carotid triangle receiving many tributaries from surrounding structures

Internal Jugular Vein

Vagus Nerve
conveys voluntary motor and sensory nerve fibers to structures in the neck, and viscero-motor fibers to thorax and abdomen enters the neck by exiting the skull through the jugular foramen lies behind and between the carotid and jugular vessels in the carotid triangle

The Anterior Triangle: Subdivisions

THE SUBMENTAL TRIANGLE

Retrieved from http://www.trueknowledge.com/images/thumbs/180/250/1e1803e46a9642ffccf2316a8e3951b2.png

THE ANTERIOR TRIANGLE: SUBDIVISIONS

III. Submental Triangle
also called the Suprahyoid Triangle Borders
Lateral: Two Anterior Bellies of the Digastric Posterior: Body of the Hyoid bone Floor: Mylohyoid muscle (Mylohyoideus)

III. Submental Triangle

Contents:
1.

THE ANTERIOR TRIANGLE: SUBDIVISIONS

Gland/s:
Submental Lymph Glands drain the floor of the oral cavity, tip of the tongue and middle lower lip and central incisors

2.

Veins
Anterior Jugular veins lie in the midline, running from the submental triangle pierce the deep fascia above manubrium pass between the posterior border of the sternocleidomastoid muscle and the upper border of the clavicle drain into the external jugular veins in the posterior triangle of the neck

THE ANTERIOR TRIANGLE: SUBDIVISIONS

III. Submental Triangle
Submental vein supplies the submandibular gland and the mylohyoid muscle in addition to the skin and superficial fascia

4. Artery

The Anterior Triangle: Subdivisions

THE DIGASTRIC TRIANGLE

THE ANTERIOR TRIANGLE: SUBDIVISIONS

IV. Digastric Triangle

also known as Submandibular Triangle the most superior of the infrahyoid triangles continuous with the fossa for the parotid gland floor is formed by the mylohyoid, hyoglossus and middle constrictor muscles

THE ANTERIOR TRIANGLE: SUBDIVISIONS

IV. Digastric Triangle

1. 2. 3.

Borders
Anterior: Anterior belly of Digastric Posterior: Posterior belly of Digastric supported by Stylohyoid muscle Superior: Lower border of Mandible

Floor
formed by the Mylohyoid, Hyoglossus and Superior Constrictor muscles of the Pharynx

THE ANTERIOR TRIANGLE: SUBDIVISIONS

IV. Digastric Triangle

1.

Contents
Glands
Submandibular and Parotid gland

2.

Veins
Anterior Facial and Internal Jugular vein

3.

Arteries
Facial, Submental, Internal and External Carotid, Posterior Auricular, Superficial Temporal and Lingual artery

4.

Nerves
Vagus, Glossopharyngeal, Facial and Hypoglossal nerve

THE TRIANGLES OF THE NECK

THE POSTERIOR TRIANGLE

Posterior Triangle of the Neck: Please refer to the pink-colored area in the illustration
Retrived from http://upload.wikimedia.org/wikipedia/commons/e/e9/Posterior_triangle_of_the_neck.PNG

THE POSTERIOR TRIANGLE

Subdivisions or Subtriangles:
Occipital Triangle Subclavian Triangle

Borders
1. Anterior: Posterior margin of the Sternocleidomastoid muscle 2. Posterior: Anterior margin of the Trapezius muscle 3. Inferior: Middle one-third of the clavicle

THE POSTERIOR TRIANGLE

4. The base of the posterior triangle:
formed by the clavicle formed in the superior nuchal line of the occipital bone wherein the sternocleidomastoid and the trapezius meet

5.The apex of the posterior triangle:

Roof (Posterior Triangle of the Neck)

covered by the skin, the superficial and deep fasci, and by the Platysma below

Floor (Posterior Triangle of the Neck)

composed of the Splenius capitis, Levator Scapulae, Scalene muscles, and Omohyoid

THE POSTERIOR TRIANGLE

Structures exterior to sternocleidomastoid:
External jugular vein it serves as a drainage to the scalp and face and unfills into the subclavian. Superficial cervical lymph nodes Lesser occipital nerve passes along the latter margin of the sternocleidomastoid and supplies the skin of the face and scalp posterior to the auricle. Great auricular nerve it rises towards the parotid gland through the upper border of the sternocleidomastoid and supplies the skin inferior to the auricle. Transverse cervical nerve it transversely passes across the middle part of the posterior border of the sternocleidomastoid and supplies the skin with its branches located over the anterior triangle of the neck. Supraclavicular nerves a single trunk divided into medial, lateral and intermediate branches which supplies the skin of the anterior part of the chest and shoulders.

THE POSTERIOR TRIANGLE

Structures exterior to sternocleidomastoid: Spinal accessory nerve it innervates the sternocleidomastoid and trapezius Structures close to the root of the neck: Brachial plexus Subclavian artery Subclavian vein Other structures found in the posterior triangle of the neck: Transverse cervical artery Suprascapular artery

The Posterior Triangle: Subdivisions

THE OCCIPITAL TRIANGLE

Retrieved from http://commons/archive/9 /93/20090520062314!Musculi_coli_ base,_my_edits_for_tringles,_Occipital_triangles.svg

THE POSTERIOR TRIANGLE: SUBDIVISIONS

I. Occipital Triangle
the larger division of the posterior triangle, lying above the inferior belly of the omohyoid covered by the skin, the superficial and deep fasci, and by the Platysma below Borders
1. 2. 3. 4. 5. Posterior: Trapezius Muscle Anterior: Sternocleidomastoid Muscle Inferior: Omohyoid Muscle Floor: Splenius Capitus, Levator Scapulae muscle, Scalenus Medius, and a portion of Scalenus Anterior Roof: Superficial layer of Deep Investing Fascia.

THE POSTERIOR TRIANGLE: SUBDIVISIONS

I. Occipital Triangle
Contents:
Spinal Accessory nerve (XI)
crosses the upper half of the triangle diagonally and, passing from the deep surface of sternocleidomastoid inferiorly on levator scapulae to reach the deep surface of trapezius, innervates sternocleidomastoid and trapezius

Superficial cervical cutaneous branches of Cervical plexus

formed from ventral primary rami of spinal nerves C2-C4, which emerge from posterior border of sternocleidomastoid

THE POSTERIOR TRIANGLE: SUBDIVISIONS

I. Occipital Triangle

Contents:
Lesser Occipital (C2)
follows posterior border of SCM to innervate the scalp behind and above the ear.

Great Auricular Nerve (C2,3)

crosses superficial to SCM and innervates the skin over the parotid gland, angle of the jaw and the posterior ear

Transverse Cervical Cutaneous Nerve of the neck (C2,3)

crosses SCM superficially and, is cutaneous for the skin of the front and side of the neck (anterior triangle)

THE POSTERIOR TRIANGLE: SUBDIVISIONS

I. Occipital Triangle

Contents:
Supraclavicular Nerves (C3,4)
divides into medial, intermediate, and lateral branches, which supply sensation over the shoulder(from the sternoclavicular joint to the acromion process), lateral neck and anterior upper thoracic wall

Part of the occipital and parts of the transverse cervical and suprascapular arteries are also found in the occipital triangle.

The Posterior Triangle: Subdivisions

THE SUBCLAVIAN TRIANGLE

Retrieved from http://commons/0/0b/Musculi_coli_base,_my_edits_for_tringles,_Subclavian.svg

THE POSTERIOR TRIANGLE: SUBDIVISIONS

II. Subclavian Triangle
Borders
1. 2. 3. 4.

Inferior: Clavicle Superior: Inferior Belly of Omohyoid Muscle Anterior: Sternocleidomastoid Muscle Floor:
Splenius Capitus Muscle Levator Scapulae Muscle Scalenus Medius Muscle Scalenus Anterior Muscle (only a small portion)3

5. Roof: Superficial layer of Deep Investing Fascia

THE POSTERIOR TRIANGLE: SUBDIVISIONS

II. Subclavian Triangle
Contents
1. Superior trunk of the brachial plexus
the union of C5 and C6 two nerves come from this trunk

2. Suprascapular
through the suprascapular foramen to innervate supraspinatus and infraspinatus Suprascapular innervates supraspinatus and infraspinatus Nerve to Subclavius innervates subclavius

THE POSTERIOR TRIANGLE: SUBDIVISIONS

II. Subclavian Triangle
Contents
3. Middle trunk of the brachial plexus
continuation of the anterior primary division of the C7 nerve the anterior primary division of the C8 and T1 nerves divided into 3 parts with the scalenus anterior muscle as the landmark First: Medial to Scalenus anterior muscle Second: Posterior to Scalenus anterior muscle Third: lateral to the scalenus anterior muscle

4. Lower trunk of the brachial plexus

5. Subclavian artery

II. Subclavian Triangle

Contents

THE POSTERIOR TRIANGLE: SUBDIVISIONS

6. External Jugular Vein
Retromandibular Vein union of superficial temporal and maxillary vein divides at the angle of mandible into anterior and posterior divisions Internal Jugular Vein into which common facial v. (anterior division and facial vein) drains into External Jugular Vein union of posterior division and posterior auricular vein descends across Sternocleidomastoid muscle to drain into Subclavian vein descends to the anterior angle of the posterior triangle where it enters the subclavian vein Anterior Jugular Vein from small veins below mandible descends to join External Jugular vein above clavicle

THE TRIANGLES OF THE NECK

CONCLUSION/ SUMMARY

CONCLUSION/SUMMARY

The triangles of the neck are described as the anterior and posterior triangles. The anterior triangle is further subdivided into the muscular triangle, carotid triangle, submental triangle and digastric triangle. The posterior triangle is further subdivided into the occipital and subclavian triangles. The anterior triangle is bordered by the body of the mandible, midline of the neck, sternocleidomastoid and sternum, and contains the suprahyoid and infrahyoid muscles.

CONCLUSION/SUMMARY

The muscular triangle is bordered by the median line of the neck, the anterior border of the sternocleidomastoid, and the superior border of the omohyoid muscles, and contains the infrahyoid muscles, common carotid artery, internal jugular vein, vagus nerve, and thyroid and parathyroid glands. The carotid triangle is bordered by the posterior belly of the digastric, superior belly of the omohyoid, and anterior border of the sternocleidomastoid. It contains the platysma, common facial vein, middle and lower pharyngeal constrictors, the vagus nerve, common carotid artery and internal jugular vein. The submental triangle is bordered by the two anterior bellies of the digastric, the body of the hyoid bone, and the mylohyoid muscle. It contains the submental lymph glands, the anterior jugular and submental veins, and arteries.

CONCLUSION/SUMMARY

The digatric triangle is bordered by the anterior belly of the digastric, the posterior belly of the digastric, and the lower border of the mandible. It contains glands, veins, arteries and nerves. The posterior triangle is bordered by the posterior margin of the sternocleidomastoid, the anterior margin of the trapezius, the clavicle and the superior nuchal line. It contains the external jugular vein, the lymph nodes, the lesser occipital, transverse cervical, supraclavicular, spinal accessory and auricular nerves, subclavian artery and vein, transverse cervical and suprascapular arteries.

CONCLUSION/SUMMARY

The subclavian triangle is bordered by the clavicle, inferior belly of omohyoid muscle, sternocleidomastoid muscle, other muscles and fascia. It contains the superior, middle and lower trunk of the brachial plexus, suprascapular, subclavian artery, and external jugular vein. The occipital triangle is bordered by the trapezius muscle, omohyoid muscle, sternocleidomastoid, splenius muscle, and other muscles. It contains the spinal accessory nerves, branches of the cervical plexus, lesser occipital, great auricular, transverse cervical cutaneous nerves, supraclavicular nerve and certain arteries.

CONCLUSION/SUMMARY

References:
Carotid Triangle. (2004). In The Free Dictionary by Farlex. Retrieved from http://medical-dictionary.thefreedictionary.com/carotid+triangle Carotid Triangle. (n.d.). In The Anterior Triangle of the Neck. Retrieved from http://iris3.med.tufts.edu/ headneck/Triangles/Anterior%20Triangle%20of%20the%20Neck.htm Edmison, J., et al. (n.d.). Structures in Triangles of Neck. A Summary of the Curriculum of the First Two Years at the School of Medicine of Case Western Reserve University. Retrieved from http://d3jonline.tripod.com/28Head_and_Neck_Anatomy/Structures_in_Triangles_of_the_Neck.htm Gray, H. 1918. The Triangles of the Neck. In Gray's Anatomy of the Human Body (VI. Arteries). Retrieved from http://education.yahoo.com/reference/gray/subjects/subject/145

References:
Gray, H. (1918). Gray's Anatomy of the Human Body. Lea and Febiger, Philadelphia, USA Gray, H. (1918). The triangles of the neck. Retrieved from http://iris3.med..tufts.edu/ headneck/Triangles/Posterior%20Triangle %20of%20the%20Neck.htm#OccipiOcc.

The Muscles and Triangles of the Neck [PPT format]. (n.d.). Retrieved from http://www.scribd.com/doc/42017062/The-Muscles-and-Triangles-of-theNeck
Norman, W. (1999). Anterior triangle of the neck in detail. Retrieved from http://home.comcast.net/~wnor/lesson5.htm on June 23, 2011. Norman, W. (1999). The Carotid Triangle. In Anatomy of the Head and Neck. Retrieved from http://home.comcast.net/~wnor/lesson5.htm

References:
Norman, W. (1999). Sternomastoid Region and Posterior Triangle of Neck. The Anatomy Lesson. Retrieved from http://home.comcast.net/~wnor/lesson6.htm Photius Coutsoukis. (n.d.). The triangles of the neck. Retrieved from http://www.theodora.com/anatomy/the_triangles_of_the_neck.html on June 23, 2011. Rafique, M. Anterior Triangle of Neck, Supra-hyoid & Infra-hyoid muscles [PowerPoint slides]. Retrieved from http://www.docstoc.com/docs/57150790/Anterior-Triangle-of-NeckSupra-hyoid-and-Infra-hyoid-muscles Snell, R. S. (2008). Clinical Anatomy by Regions. Lippincott Williams & Wilkins, Philadelphia, USA Tank, P. (2005). Carotid, Submandibular and Submental Triangles of the Neck. Retrieved from http://anatomy.uams.edu/anatomyhtml/anteriortriangle.html on June 23, 2011.

References:
Tank, P. W. (2005). Grant's Dissector 13th ed. Lippincott Williams & Wilkins, Philadelphia, USA Tufts University Department of Anatomy and Cellular Biology Medical and Dental Gross Anatomy.(n.d). The Anterior Triangle of the Neck. Retrieved from http://iris3.med. tufts.edu/headneck/Triangles/Anterior%20Triangle%20of%20the%20Neck.htm Tufts University Department of Anatomy and Cellular Biology Medical and Dental Gross Anatomy. (n.d.). Retrieved from http://iris3.med.tufts.edu/headneck/Triangles/Posterior%20Triangle%20of%20the%20 Neck.htm

Tufts University Department of Anatomy and Cellular Biology Medical and Dental Gross Anatomy. (n.d). The Anterior Triangle of the Neck. Reyrieved from http://iris3.med.tufts.edu/headneck/Triangles/Anterior%20Triangle%20of%20the%20 Neck.htm#Submental on June 23, 2011.

References:
Tufts University Department of Anatomy and Cellular Biology Medical and Dental Gross Anatomy. (n.d).The posterior triangle of the neck. Retrieved from http://iris3.med.tufts.edu/ headneck/Triangles/Posterior%20Triangle%20of%2 0the%20Neck.htm#Occipital. Willson, R., n.d, The Anterior Triangle of the Neck. Retrieved from http://iris3.med.tufts.edu/headneck/Triangles/Ante rior%20Triangle%20of%20the%20Neck.htm