ANTERIOR TRIANGLE

OF THE NECK

James Taclin C. Banez, MD, FPSGS, FPCS

 Boundaries
Anterior - midline of the neck
Posterior - sternocleidomastoid
Superiorly – lower border of
mandible
Covered by:
1. Skin
2. Superficial fascia
3. Platysma
4. Investing layer of deep fascia
 Boundaries
Subdivision:
A. Suprahyoid triangles:
1. Submental
2. Digastric (Submandibular)

B. Infrahyoid triangles:
1. Carotid
2. muscular
 Suprahyoid Triangle
1. Submental triangle:
 Boundaries:
Middle - midline of neck
Posterior – body of hyoid
Laterally – anterior belly
of digastric
Floor: - MYLOHYOID
 Suprahyoid Triangle

MYLOHYOID
O = mylohyoid line of
mandible
I = body of hyoid & mid-
fibrous raphe
NS = Mylohyoid branch of
inferior alveolar nerve
 Suprahyoid Triangle
MYLOHYOID
Action:
a. Supports the tongue &
floor of the mouth
b. Mandible if fixed –
elevates the floor of the
mouth & hyoid during
swallowing
c. Hyoid is fixed –
depresses the mandible
& opens the mouth
 Suprahyoid Triangle
2. Digastric triangle
(Submandibular):
Boundaries:
Ant. – anterior belly digastric
Post. – post. Belly digastric
Sup. – body of mandible

Floor:
a. Mylohyoid
b. Hyoglossus
 Suprahyoid Triangle
Hyoglossus:
O – body & greater cornu
of hyoid
I - side of the tongue
NS – hypoglossal nerve
A – depresses the
tongue
 Suprahyoid Triangle

2. Digastric triangle
(Submandibular):
Contents:
A. Anterior:
1. Submandibular
gland
 Wharton’s duct
 Suprahyoid Triangle
2. Digastric triangle:
Contents:
A. Anterior:
2. Facial artery:
 Branches
1. Ascending palatine a.
2. Tonsillar a.
3. Glandular a.
4. Submental a.
 Suprahyoid Triangle
2. Digastric triangle:
Contents:
A. Anterior:
3. Facial Vein
 Joined by anterior
division of
retromandibular vein
and drains into the
internal jugular vein
 Suprahyoid Triangle
2. Digastric triangle:
Contents: Anterior:
4. Hypoglossal nerve
5. Submandibular LN
 Suprahyoid Triangle
2. Digastric triangle:
Contents: Posterior
a. Carotid sheath & it’s
content
b. Stylopharyngeus m.
c. Lower part of parotid
gland
d. Glossopharygeal nerve
Infrahyoid Triangle of
The neck
Carotid Triangle
1. Carotid triangle
 vascular triangle
Boundaries:
Sup. – post belly of
digastric
Inf. – Sup. Belly of
omohyoid
post - SCM
Carotid Triangle
1. Carotid triangle
 vascular triangle
Floor:
a. Thyrohyoid
b. Hyoglossus
c. Middle pharygeal constrictors
d. Inferior pharyngeal constrictors
Carotid Triangle
1. Carotid triangle
THYROHYOID Muscle:
O – oblique line of thyroid
cartilage
I - Body of hyoid bone
NS – C1
A – Depress hyoid or
elevates larynx
Carotid Triangle
1. Carotid triangle
Middle Pharygeal
Constrictor muscle:
O – lesser & greater
cornua of hyoid
- stylohyoid lig.
I – median fibrous raphe
on post. pharyngeal
wall
NS – pharyngeal plexus
A – pulls posterior
pharyngeal wall
forward
Carotid Triangle
1. Carotid triangle
Inferior Pharyngeal
Constrictor:
O – oblique line thyroid
cartilage & cricoid
I – median fibrous lig.
NS – pharyngeal plexus
A – same as middle PC
Contents: Carotid Triangle
1. Common carotid artery
2. External & internal carotid
artery
3. Branches of the external
carotid artery
1. Superior thyroid artery
2. Lingual artery
3. Facial artery
4. Ascending pharyngeal
artery
5. Occipital artery
6. Posterior auricular artery
7. Superficial temporal artery
8. Maxillary artery
 Carotid body (chemoreceptor)
 Carotid sinus (pressure
receptor) – afferent fibers reach
glossopharyngeal nerve through
the nerve of Hering
Carotid Sheath:
1. Common, Internal and External carotid artery
2. Internal jugular vein
 Largest vein in the neck
 Continuation of sigmoid sinus exits the cranial cavity thru
jugular foramen. Unites subclavian vein to form
brachiocephalic vein
 Tributaries:
a. Inferior petrosal sinus
b. Common Facial v.
c. Lingual v.
d. Occipital v.
e. Pharyngeal v.
f. Middle thyroid v.
g. Superior thyroid v.
 Carotid Sheath:
3. Deep cervical LN
a. Jugulo-digastric
node (above the
digastric muscle)
– superior group
b. Jugulo-omohyoid
node – inferior
group
 Carotid Sheath:
4. Vagus nerve:
 Mixed nerve from medulla oblongata,
leaves the cranium through the jugular
foramen
 Has 2 sensory ganglia:
a. Superior ganglion (w/in jugular
foramen)
b. Inferior ganglion (below the foramen)
 Carotid Sheath:
4. Vagus nerve:
 Branches in the neck the supplies visceral
organs are:
a. Meningeal branch – supplies dura mater in post
fossa (superior ganglion)
b. Auricular branch – medial surface of auricle, ext.
auditory canal and lateral side of tympanic
membrane (superior ganglion)
c. Pharyngeal nerve – joins branches of
glossopharyngeal nerve and sympathetic trunk to
form PHARYNGEAL PLEXUS:
 Supplies all muscles of pharynx except
stylopharyngeus, all muscles of soft palate except
tensor veli palatine
Carotid Sheath:
4. Vagus nerve:
 Branches in the neck
the supplies visceral
organs are:
d. Superior laryngeal
nerve:
1. Internal laryngeal
nerve – sensory for
mucous membrane
of the larynx;
pierce thyrohyoid
membrane
2. External laryngeal
nerve – motor for
cricothyroid muscle
Carotid Sheath:
4. Vagus nerve:
 Branches in the
neck the supplies
visceral organs are:
d. Inferior laryngeal
nerve (recurrent
laryngeal nerve):
 Supplies other
intrinsic muscles
of the larynx and
mucosa below the
vocal cord & upper
trachea
 Pierce cricothyroid
membrane
 Muscular Triangle
Boundaries:
Ant. – midline of the neck
Sup – sup. belly omohyoid
Inf - SCM
Contents:
1. Infrahyoid muscles
2. Visceral:
a. Thyroid gland
b. Parathyroid gland
c. Larynx
d. Pharynx
Muscular Triangle

Infrahyoid Muscle
1. Sternohyoid
2. Sternothyroid
3. Thyrohyoid
4. Omohyoid
Muscular Triangle
Neck Viscera:
1. Thyroid gland:
 Blood supply
 Venous drainage
 Lymphatic drainage
 Nerve supply
Muscular Triangle
Neck Viscera:
2. Parathyroid gland:
 Secretion
 Blood supply
 Venous drainage
 Lymphatic drainage
 Nerve supply
Muscular
Triangle
Neck Viscera:
3. Larynx:
 voice box
 sphincter of lower
respiratory tract
Larynx:
 Spaces w/in the larynx: laryngeal inlet (vestibule),
laryngeal ventricle, rima vestibuli, rima glottidis,
subglottic space.
 sphincter of lower respiratory tract
 Muscles of the Larynx
1. Extrinsic:
a. Elevators: b. Depressors:
i. Digastric i. Sternohyoid
ii. Stylohyoid ii. Sternothyroid
iii. Mylohyoid iii. omohyoid
iv. Geniohyoid
v. Stylopharyngeus
vi. Salphingopharyngeus
vii. palatopharyngeus
 Muscles of the
Larynx
2. Intrinsic:
 Innervated by recurrent
laryngeal n except
cricothyroid
a. Cricothyroid
O – side of cricoid
I – lamina & inferior cornu of
thyroid cart.
A – tenses vocal lig.
b. Arytenoid
a) Oblique (aryepiglottic m.)
b) Transverse
 closes laryngeal inlet
Muscles of the Larynx
2. Intrinsic:
c. Thyroarytenoid
O – thyroid cart
I – vocal processs of
arytenoid cart.; some
fibers forms the
vocalis muscle and
thyroepiglottic muscle
A – relaxes the vocal lig.
Muscles of the Larynx
2. Intrinsic:
d. Lateral cricoarytenoid
O – arch of cricoid cart
I – muscular process arytenoid
A – adducts the vocal folds

e. Posterior cricoarytenoid
O – lamina of cricoid cart.
I – same
A – abducts the vocal folds
 Muscular
Triangle
Neck Viscera:
4. Trachea:
 At the angle of Louis
it divides into two;
 Blood supply –
mainly inferior
thyroid artery
 Nerve – vagi,
recurrent laryngeal
nerves
 Sympathetic trunks
 ESOPHAGUS
 10 inches tube at midline of
neck from C6
 Structures adjacent:
 Ant. – trachea (neck)
 Post – pre-vertebral fascia, longus
colli & vert. column
 Lat. – lobes of thyroid gld & carotid
sheath
 Bld supply – Inf. thyroid artery
 Innervated: - recurrent laryngeal
nerve
- sympathetic trunks
THANK
YOU
THANK
YOU