GROSS B MYLOHYOID

Anterior Triangle of the Neck O: Mylohyoid line of mandible

Dr Banez I: Body of hyoid mid-fibrous raphe
N: Mylohyoid branch of inferior alveolar
Boundaries of Anterior Neck nerve (branch of mandibular nerve of
Anterior: Midline of the neck the trigeminal nerve)
Posterior: Sternocleidomastoid A: Supports the tongue & floor of the mouth
Superiorly: Lower border of mandible Mandible if fixed:
Elevates the floor of the mouth &
Anteriorly, you have a midline. Make an imaginary line hyoid during swallowing and
from the mental portion of the mandible up to the _?_ drinking
notch. Posteriorly, youll have the SCM and superiorly will Hyoid is fixed:
be the lower border of the mandible. So youll have a Depresses the mandible &
triangle on the left and on the right. opens the mouth

Covered by: DIGASTRIC TRIANGLE

1. Skin
2. Superficial fascia Boundaries:
3. Platysma
skeletal muscle located in the
superficial fascia)
4. Investing layer of deep fascia
represented as pre-tracheal fascia
and carotid sheath)

Subdivision:
A. Suprahyoid triangles (above hyoid bone):
1. Submental
2. Digastric (Submandibular)
Since the lower boundary is formed
by the anterior and posterior belly of
the digastrics muscle, so it is also Anterior: Anterior belly digastric
called the digastrics triangle Posterior: Posterior belly digastric
Superior: Body of mandible
B. Infrahyoid triangles (below hyoid bone): Floor: Mylohyoid
1. Carotid Hyoglossus (moves the tongue;
2. Muscular found underneath)

SUPRAHYOID TRIANGLE

SUBMENTAL TRIANGLE
Boundaries:
HYOGLOSSUS
O: Body & greater cornu of hyoid
I: Side of the tongue
N: Hypoglossal nerve
A: Depresses the tongue

Contents:

Middle: Midline of neck Anterior:

Posterior: Body of hyoid Submandibular gland
Laterally: Anterior belly of digastric o Also a major salivary gland
Floor: Mylohyoid o Mixed secretion but more of SEROUS
o The other name of submandibular duct is
The only structure that you can see in the two submental WHARTONS duct
triangles is a muscle that serves also as one of the floor of
the mouth which called the MYLOHYOID MUSCLE.
1 Bernabe, Maria Katrina (2013)
 Facial artery
o Is a branch of the external carotid artery
and in turn, the external carotid artery is
one of the terminal branches of the
common carotid artery
The common carotid artery only
divides at the superior horn of
the thyroid cartilage
o Is the 2nd, 3rd and 4th branch of the
external carotid artery
o Branches of facial artery found in the
digastrics triangle
Ascending palatine a.
Supplies the soft palate
and hard palate
Tonsillar a.
Supplies tonsils
Glandular a.
Supply submandibular
gland
Submental a.
o Will also supply the face and will also
have several branches (not found in
digastrics triangle)
Superior labial artery
Inferior labial artery CAROTID TRIANGLE
Anastomosis to internal maxillary
artery
Angular artery
Facial Vein
o Joined by anterior division of
retromandibular vein and drains into the
internal jugular vein
The retromandibular vein is also
called the posterior facial vein
The Retromandibular vein will
have two divisions: anterior
division and posterior division.
The posterior division will be
united with the posterior
auricular vein to form the
EXTERNAL JUGULAR VEIN.
The anterior division will be
together with the facial vein to
form the COMMON FACIAL VEIN
The external jugular vein and
common facial vein will
eventually drain to the INTERNAL
JUGULAR VEIN.
The internal jugular vein will join
with the subclavian vein to
become the BRACHIOCEPHALIC
VEIN (right and left).
The two brachiocephalic veins
(right and left) will meet to form
the SUPERIOR VENA CAVA.
2 Bernabe, Maria Katrina (2013)
Hypoglossal nerve (CN12)
o Supplies the intrinsic and extrinsic muscles
of the tongue
o The only muscle that is not innervated by
the hypoglossal nerve is the
PALATOGLOSSUS muscle. This is
innervated by the pharyngeal plexus
which is a part of the vagus nerve.
Submandibular Lymph Node
Posterior
Carotid sheath & its contents
o Contains the internal carotid artery
o Internal jugular vein
o Vagus nerve
Stylopharyngeus Muscle
Lower part of parotid gland
Glossopharygeal nerve (CN9)
INFRAHYOID TRIANGLE
vascular triangle
It is called the carotid triangle because it is where
you can palpate for the carotid pulse
o Carotid artery is a major artery that supplies
the brain
Boundaries:
Superior: Posterior belly of digastric
Inferior: Superior belly of omohyoid
Posterior: SCM
Floor:
Thyrohyoid
Hyoglossus
Middle pharygeal constrictors
o Important for swallowing
Inferior pharyngeal constrictors
NOTE:
The superior pharyngeal constrictors are NOT
included because it is located very high for this
particular triangle. It is in the wall of the pharynx
at the back of the nasal cavity.
 The external carotid artery is found at the level of the
superior horn of the thyroid cartilage
The internal carotid artery has no branch outside the skull.
It will only branch if it is within the cranial cavity

Carotid body (chemoreceptor)

Detects acidity
Carotid sinus (pressure receptor)
afferent fibers reach glossopharyngeal nerve
through the nerve of Hering
recognizes increase and decrease in pressure

NOTE:
The carotid body and sinus are always are
always normally inhibited.

However, when you have a problem with regards

to pressure (e.g. increase in BP) or acidity, the
inhibition is released which will cause the nerve
THYROHYOID MUSCLE
there to send an impulse to the hypothalamus
O: Oblique line of thyroid cartilage
through the Nerve of Hering which will
I: Body of hyoid bone
accompany CN9 (Glossopharyngeal Nerve).
N: C1 (Ansa cervicalis)
A: Depress hyoid
The inhibition is released when there is a problem
Elevates larynx (or thyroid cartilage)
with internal homeostasis.
NOTE:
Carotid Sheath:
Ansa Cervicalis is a group of nerves of the
1. Common, Internal and External carotid artery
anterior rami of the cervical plexus.
2. Internal Jugular Vein
3. Deep Cervical Lymph Node
MIDDLE PHARYGEAL CONSTRICTOR MUSCLE
4. Vagus Nerve
O: Lesser & greater horn of hyoid
Stylohyoid ligament INTERNAL JUGULAR VEIN
I: Median fibrous raphe on posterior Also seen in the carotid triangle because it is
pharyngeal wall located beside the carotid artery
N: Pharyngeal plexus Largest vein in the neck
A: Pulls posterior pharyngeal wall forward Continuation of sigmoid sinus exits the cranial
cavity thru jugular foramen. Unites subclavian
INFERIOR PHARYNGEAL CONSTRICTOR vein to form brachiocephalic vein
O: Oblique line thyroid cartilage & cricoid Tributaries (text NOT in bold letters are NOT found
I: Median fibrous ligament in the carotid triangle):
N: Pharyngeal plexus o Inferior petrosal sinus
A: Same as middle PC o Facial vein
. o Lingual vein
PHARYNGEAL CONSTRICTOR LOCATION o Occipital vein
Superior Back of nose o Pharyngeal vein
Middle Back of oral cavity o Middle thyroid vein
Inferior Back of larynx o Superior thyroid vein

Contents: DEEP CERVICAL LYMPH NODE

Common carotid artery -Found below SCM
External & internal carotid artery JUGULO-DIGASTRIC NODE
Branches of the external carotid artery o above the upper half of the digastric
o Superior thyroid artery muscle
o Lingual artery o superior group
o Facial artery JUGULO-OMOHYOID NODE
o Ascending pharyngeal artery o inferior group
o Occipital artery
o Posterior auricular artery
o Superficial temporal artery
o Maxillary artery

3 Bernabe, Maria Katrina (2013)

What are the 4 important structures that you can palpate When a solid structure touches
in the carotid triangle? the larynx, it will open up
1. Carotid artery and its branches o sensory for mucous membrane of the
2. Internal jugular vein and its tributaries larynx
3. Deep cervical lymph nodes o pierce thyrohyoid membrane
4. Vagus Nerve EXTERNAL LARYNGEAL NERVE
All of these structures are surrounded by the carotid o motor for cricothyroid muscle
sheath which is one of the deep fascias of the neck. cricothyroid muscle is one of the
intrinsic muscles of the larynx
VAGUS NERVE
Mixed nerve from medulla oblongata Inferior Laryngeal Nerve (Recurrent Laryngeal Nerve)
leaves the cranium through the jugular foramen Supplies other intrinsic muscles of the larynx and
along with the internal jugular vein mucosa below the vocal cord & upper trachea
Longest cranial nerve Pierce cricothyroid membrane
o it reaches up to the abdomen Longer because it loops in the arch of aorta
o can stimulate up to the splenic portion of Found in the tracheo-esophageal groove
the colon Motor
Has 2 sensory ganglia: Supplies the intrinsic muscles of the larynx except
o Superior ganglion CRICOTHYROID
w/in jugular foramen
within cranial cavity
o Inferior ganglion MUSCULAR TRIANGLE
below the foramen
outside cranial cavity

Branches of the Vagus Nerve in the neck that supplies

visceral organs are:
Meningeal branch SENSORY
Auricular branch SENSORY
Pharyngeal nerve MOTOR
Superior laryngeal nerve MIXED
Inferior laryngeal nerve (Recurrent Laryngeal
Nerve) MOTOR

If your boyfriend licks the auricle of your ear, what is the

Boundaries:
cranial nerve being stimulated?
Anterior: Midline of the neck
VAGUS NERVE (Auricular Branch)
Superior: Superior belly omohyoid
Inferior: SCM
Meningeal Branch
supplies dura mater in post fossa (superior
Contents:
ganglion)
1. Infrahyoid muscles
2. Visceral:
Auricular Branch
a. Thyroid gland
medial surface of auricle, ext. auditory canal and
b. Parathyroid gland
lateral side of tympanic membrane (superior
c. Larynx
ganglion)
d. Pharynx
Pharyngeal Nerve
joins branches of glossopharyngeal nerve and
sympathetic trunk to form PHARYNGEAL PLEXUS:
o Supplies:
all muscles of pharynx except
stylopharyngeus
all muscles of soft palate except
tensor veli palatine

Superior Laryngeal Nerve:

Will accompany the superior thyroid artery
MIXED nerve
INTERNAL LARYNGEAL NERVE
o Purely sensory
o SENSORY larynx
4 Bernabe, Maria Katrina (2013)
INFRAHYOID MUSCLE (STRAP MUSCLES OF THE NECK) PARATHYROID GLAND
Sternohyoid found medially Located behind the thyroid gland
Sternothyroid located behind sternohyoid Increases calcium levels in the blood
Thyrohyoid Should not be cut during surgery because the
Omohyoid located laterally patient can have hypoparathyroidism
All of these muscles are innervated by the Ansa Superior pair:
Cervicalis nerve which is a branch of the cervical o Not located at the superior pole
plexus. o located at the level of the isthmus
o more constant in location
Neck Viscera Inferior pair:
o Located at the inferior pole
THYROID GLAND o Varies in location
Found posterior to the strap muscles of the neck o Its farthest location is the mediastinum
Has a right and left lobe which are connected Blood supply
via the isthmus o Primarily supplied by the Inferior thyroid
o Another thyroid parenchyma might be Artery
present which is the ISTHMUS. This is not Because these structures are
always present. Only 50-60% have closer to the inferior thyroid
isthmus. artery
Arises from the tongue
Produces T3 and T4 that is for metabolism LARYNX
o Produced by the follicular cells of the Voice box
thyroid gland Where the air should enter in order to reach up to
Produces Calcitonin to lower the Ca in the blood the trachea bronchia lungs
o Produced by parafollicular cells Sphincter of lower respiratory tract
o Independent from TSH (from the anterior Cartilages
pituitary) (3 unpaired)
Blood supply: o Thyroid cartilage
o Superior Thyroid Artery (1st branch of Found in front
external carotid artery) Serves as a shield
PAIRED o Cricoid cartilage
o Inferior Thyroid Artery (from thyrocervical o Epiglottis
trunk which is a branch of the subclavian (Paired)
artery) o Arytenoid
PAIRED most important in speech
The thyrocervical trunk has 3 where muscles to move the
branches namely: vocal cord are attached
Inferior Thyroid A, o Corniculate
Transverse Cervical A, o Cuneiform
Suprascapular A. Spaces w/in the larynx:
o Laryngeal inlet (vestibule)
NOTE: o Laryngeal ventricle
There is NO such thing as MIDDLE Thyroid Artery. Space from false vocal cord to
true vocal cord
o Thyroideia Ima o Rima vestibule
60% incidence Space in between the false
UNPAIRED vocal cord
Branch of brachiocephalic artery o Rima glottidis
Space in between the true
Q: How many arteries does the Thyroid have? vocal cord
A: 5. 2 are paired. 1 is unpaired o Subglottic space
From true vocal cord to trachea
Venous drainage Sphincter of lower respiratory tract
o Superior Thyroid Vein
o Middle Thyroid Vein
o Inferior Thyroid Vein
Lymphatic drainage
o Superior and middle thyroid vein will
drain to Internal Jugular Vein
o Inferior thyroid vein will drain to the
Inominate Vein
Nerve supply: Autonomic Nervous System
5 Bernabe, Maria Katrina (2013)
Muscles of the Larynx Thyroarytenoid
O: Thyroid cartilage
1. EXTRINSIC (origin is NOT larynx; insertion is I: Vocal processs of arytenoid cartilage
larynx/hyoid bone)) Some fibers forms the vocalis muscle and
a. Elevators: thyroepiglottic muscle
i. Digastric A: Relaxes the vocal ligament
ii. Stylohyoid
iii. Mylohyoid *Vocalis Muscle: inward fiber of thyroarytenoid
iv. Geniohyoid
v. Stylopharyngeus Lateral Cricoarytenoid
vi. Salphingopharyngeus O: Arch of cricoid cart
vii. palatopharyngeus I: Muscular process arytenoid
b. Depressors: A: Adducts the vocal folds
i. Sternohyoid
ii. Sternothyroid Posterior Cricoarytenoid
iii. omohyoid O: Lamina of cricoid cart.
2. INTRINSIC I: Same
o Cricothyroid A: ABDUCTS the vocal folds
Only muscle located outside
and anteriorly TRACHEA
o Arytenoid serves as passageway of air
o Thyroarytenoid horseshoe-shaped
o Lateral cricoarytenoid At the angle of Louis it divides into two;
o Posterior cricoarytenoid Blood supply: Mainly inferior thyroid artery
Nerve: Vagi
o Innervated by recurrent laryngeal n Recurrent laryngeal nerves
except cricothyroid Sympathetic trunks

ESOPHAGUS
Passageway
No digestion and absorption of food in this area
Continuation of the laryngopharynx
Portions:
o Cervical portion
o Thoracic portion
o Abdominal portion
10 inches tube at midline of neck from C6
Structures adjacent:
Anterior: Trachea (neck)
Posterior: Pre-vertebral fascia
Longus colli
Vertebral column
Cricothyroid Lateral: Lobes of thyroid gland
O: Side of cricoid Carotid sheath
I: Lamina & inferior cornu of thyroid cart. Blood Supply: Inferior thyroid artery
A: Tenses vocal ligament Innervated: Recurrent laryngeal nerve
Sympathetic trunks
**Sign if with lesion: bedroom voice due to no
tense in the vocal cord, therefore, NO VOLUME.

Arytenoid
Oblique fiber (Aryepiglottic M.)
o Attached to the arytenoids and
epiglottis
o N: Recurrent Laryngeal nerve
o A: Pulls larynx downward (closes
vestibule)
Transverse
o closes laryngeal inlet

6 Bernabe, Maria Katrina (2013)