A n atom y of th e N eck

BOUNDARIES OF NECK
Superiorly: Lower border of mandible Inferiorly: Cla i!le "o#$eriorly: %rape&iu# An$eriorly: An$erior midline of ne!'

TH E N EC K

TR I A N G LES O F TH E N EC K

SC H EM ATI C R EP R ESEN TATI ON

An$erior $rian(le Di(a#$ri! Caro$id )u#!ular "o#$erior $rian(le

Supra!la i!ular O!!ipi$al

H yoi d M u c! e
Supra*yoid

mu#!le# Di(a#$ri! + an$ , po#$ )ylo*yoid S$ylo*yoid -enio*yoid

H yoi d M u c! e
Infra*yoid

)u#!le# Deep (roup %*yro*yoid S$erno$*yroid Superfi!ial (roup Omo*yoid S$erno*yoid

Su"# ahyoi d m u c! e
Ne#$e u""!y Ne#$e to my!ohyoid Facia! Action
%e"#e mandi(!e o# e!e$ate hyoid %e"#e mandi(!e o# e!e$ate hyoid

%i&a tic ' ante#io# (e!!y %i&a t#ic ' "o te#io# Sty!ohyoid My!ohyoid

Facia! Ne#$e to

E!e$ate hyoid (one

%e"#e

I nf # ahyoi d m u c! e
Ne#$e u""!y An a ce#$ica!i C*+ C, and CAn a ce#$ica!i An a ce#$ica!i Fi# t ce#$ica! Action %e"#e e hyoid

Omohyoid ' u"e#io# ) infe#io# Ste#nohyoid Ste#nothy#o id Thy#ohyoid

%e"#e e hyoid %e"#e e !a#yn. %e"#e e hyoid

A nte#i o# T#i an&! e

Boundaries

Ant. Midline anteriorly Mandible superiorly SCM - posteriorly

C om "onent t#i an&! e of neck

Submental triangle Submandibular or

Digastric triangle
Muscular Carotid

Su(m enta! t#i an&! e

Boundarie# Ant. Belly of digastric m. Hyoid bone Floor mylohyoid Con$en$# o Submental lymph nodes o eins that unite !"ant.#ugular $ein

Su(m andi (u! a# t#i an&! e

Boundarie# Ant. and %ost. Bellies of Digastric m. &nferior border of mandible Con$en$# Submandibular gland Submandibular duct C' (&& ) ner$e to mylohyoid Submental artery Submental lymph nodes Suprahyoid muscles

Su(m andi (u! a# t # i an&! e

Hypoglossal ner$e 'er$e to mylohyoid Submental artery branch of facial a. submental lymph nodes

C a#oti d t#i an&! e

Boundarie# Superior belly of omohyoid

%osterior belly of digastric Ant. border of SCM

C a#oti d t#i an&! e

Con$en$# Carotid body -baroreceptor Carotid sinus -chemoreceptor Carotid sheath common carotid a.) $agus) internal #ugular $ein Ansa cer$icalis

M u cu! a# t # i an&! e

Boundarie# Superior belly of omohyoid %ost. belly of digastric Ant. Border of SCM Con$en$# Sternohyoid) sternothyroid) thyrohyoid isceral organs thyroid) parathyroids) laryn*

N e#$e i n the A nte#i o# t#i an&! e

Hypoglossal agus +lossopharyngeal ,rans$erse cer$ical

supplying the s-in o$er the ant. triangle

S/ 0 % I 1I SI O N S O F P O STER I OR TR I A N G LE

O CCI PI TA L TR I A N G LE
Ape. !on$ain# por$ion of o!!ipi$al bone O!!ipi$al ar$ery i# found in #uperior par$ A!!e##ory ner e !ro##e# $*e $rian(le

S/ PR A CLA1 I C/ LA R TR I A N G LE
A/K/A/ Sub!la ian %rian(le Superfi!ial landmar' i# #upra!la i!ular fo##a Cro##ed by e.$ernal 0u(ular ein and #ub!la ian ar$ery

P O STER I OR TR I A N G LE
Spleniu# !api$i#
O + li(/ Nu!*ae1 #pine# of C23%4 I + la$eral #uperior nu!*al line and ma#$oid A + draw# *ead ba!' and la$eral ro$a$e *ead $o #ame #ide $o(e$*er1 e.$end# *ead and ne!' NS + lower !er i!al ner e#

Le a$or #!apula
O + $ran# er#e pro!e## C53C6 I + medial border of #!apula abo e #pine A + ele a$e# #!apula NS + dor#al #!apular ner e

P O STER I OR TR I A N G LE
S!alene po#$erior
O + $ran# er#e pro!e## C63C7 I + 8nd rib A + ele a$e# 8nd rib1 fle. !er i!al er$ebra NS + C73C9

S!alene mediu#
O + $ran# er#e pro!e## C53C2 I + 5#$ rib A + ele a$e 5#$ rib: fle. and ro$a$e !er i!al !olumn $o oppo#i$e #ide NS + lower !er i!al ner e#

P O STER I OR TR I A N G LE
S!alene an$erior
O + $ran# er#e pro!e## C43C7 I + #!alene $uber!le of 5#$ rib A + rai#e 5#$ rib: #li(*$ ro$a$ion of ne!' NS + lower !er i!al ner e#

C! i ni ca! co##e! ati on

I nfecti on of the N ecK

&nfection of s-in)

./,&) etc. infection that occurs bet!een the in$esting and pretracheal layers of fascia) it can spread into the thoracic ca$ity anterior to the pericardium. Retropharyngeal abscess

C on&eni ta! To#ti co! ! i

%or$i!olli# is a fle*ion deformity of the nec,he most common cause of torticollis ;wry ne!'< results from a fibrous tissue tumor (fibromatois colli) that de$elops in the sternocleidomastoid before birth. SCM might be in#ured !hen an infant0s head is pulled too much during a difficult birth) tearing its fibers (muscular

C e#$i ca! 1ei n of C ! i ni ca! I m "o#tance

'ec- $eins used for ,%' and C % monitoring 5/ Sub!la ian =ein:

C e#$i ca! 1ei n of C ! i ni ca! I m "o#tance

'ec- $eins used for ,%' and C % monitoring 8/ In$ernal >u(ular =ein:

Caro$id O!!lu#ion and Endar$ere!$omy

Due to atherosclerosis

C! i ni ca! C o##e! ati on of C a#oti d A #te#y

%artial occlusion leads to ,&A 1transient ischemic attac-2) a sudden loss of neurological function that disappears !ithin 34 hrs Minor stro-e loss of neurological function 1!ea-ness or sensory loss2 on one side of the body that e*ceeds 34 hrs but disappears !ithin 5 !ee-s

C! i ni ca! C o##e! ati on of C a#oti d A #te#y

Caro$id O!!lu#ion and Endar$ere!$omy

Detected !ith use of Doppler color study Carotid endarterectomy stripping off the atherosclerotic pla6ue !ith the intima
%ossible ner$es in#ured !" abo$e procedure7
C' &( C' ( C' (& C' (&&

Le i on of the C e#$i ca! Sym "atheti c t#unk

/esults to ?orner Syndrome
Contraction of the pupil ;mio#i#<1 due to paralysis of the dilator pupillae Drooling of the superior eyelid ;p$o#i#<1 resulting from paralysis of the smooth 1tarsal2 muscle intermingled !ith the striated muscle of the le$ator palpebrae superioris. Sin-ing in the eye ;enop$*almo#2) possibly caused by paralysis of the smooth 1orbitalis2 muscle in the floor of the orbit asodilation and absence of s!eating on the face and nec- ;an*ydro#i#<1 caused by lac- of a sympathetic 1$asoconstricti$e2 ner$e supply to the blood $essels and s!eat glands.

Le i on of C e#$i ca! N e#$e

Le#ion# of Spinal A!!e##ory: not common7 but the most common iatrogenic ner$e in#ury in the necCau#e#:
8. 3. 5.

penetrating trauma 1bullet or -nife2 Surgical procedure 1iatrogenic2 ,umors at the cranial base or cancerous cer$ical 9' 4. Fracture of the #ugular foramen !here C' (& lea$es the cranium ;ea-ness and atrophy of SCM and trape<ius) impairing nec- mo$ement. =. Difficulty in ele$ating the upper limb >. Drooping of the shoulder
:.

)anife#$a$ion:

Le i on of C e#$i ca! N e#$e

In0ury of "*reni! Ner e:

/esult to paralysis of the corresponding half of the diaphragm Temporary paralysis of the ner$e anesthetic in#ection 1lung surgery2 Prolonged paralysis iatrogenic in#ury during nec- dissection %aralysis of diaphragm detected a parado*ical mo$ement seen in *-ray

Le i on of C e#$i ca! N e#$e

In0ury $o $*e Supra#!apular Ner e: Happen in fracture of middle 8"5 of the cla$icle %aralysis of the S&,s muscles 9oss of lateral rotation and initial abduction of the upper limb Waiters tip position rela*ed limb rotates medially.

Le i on of C e#$i ca! N e#$e

In0ury $o Laryn(eal ner e: 1. Inferior laryngeal nerve

Due to thyroidectomy %aralysis of $ocal fold) leading to hoarseness of $oice. Bilateral paralysis resulting to stridor 1high pitch) noisy respiration2.

Le i on of C e#$i ca! N e#$e

In0ury $o Laryn(eal ner e:
8/ Superior

laryn(eal ner e:

%aralysis of the cricothyroid muscle

Le i on of Thy#oi d G ! and %*yro(lo##al Du!$

Cy#$:

,hyroid gland begins in the floor of the tongue 1foramen cecum2) then descends passing anterior to the hyoid and thyroid cartilage to reach it0s final position.

%*yro(lo##al Du!$ Cy#$: During this descent) the

Le i on of Thy#oi d G! and

thyroid gland is attached to the foramen cecum by the thyroglossal duct that normally disappears. /emnant of it0s epithelium forms thyroglossal duct cyst forming a soft mass at the anterior part of the nec-.

Le i on of Thy#oi d G! and
%*yroid Enlar(emen$:
-ra e@# di#ea#e:
8. Diffuse thyroid

enlargement 3. Hyperthyroidism 5. ?*opthalmos

Le i on of Thy#oi d G! and Neopla#m:

Beni(n:
"apillary adenoma 8/ Folli!ular adenoma 4/ *ur$le !ell adenoma#
5/

)ali(nan$:
6/ A/ 7/ 2/ 9/

"apillary !ar!inoma Folli!ular !ar!inoma ?ur$le !ell !ar!inoma )edullary !ar!inoma Anapla#$i! !ar!inoma

Le i on of Thy#oi d and Neopla#m: G !

%*yroide!$omy:

Indi!a$ion:

%*yroid !ar!inoma -ra e#@# di#ea#e -oi$er wi$* pre##ure #ymp$om# and for !o#me$i! rea#on#

%ype#:

%o$al or near $o$al $*yroide!$omy Sub$o$al $*yroide!$omy Lobe!$omy w, or w,o i#$*me!$omy

Compli!a$ion:

Re!urren$ laryn(eal ner e ?ypopara$*yroidi#m Bleedin(

Le i on of Pa#athy#oi d G! and
5/ ?yperpara$*yroidi#m

Due parathyroid adenoma Due to iatrogenic remo$al of gland during thyroidectomy /esults to tetany ---@ death

8/ ?ypopara$*yroidi#m

LA R2N 3
5/ Fra!$ure of $*e

laryn.
Due to accidents 1automobile2 Subcutaneous edema /esp. obs.) hoarseness of $oice

LA R2N 3
8/ A#pira$ion of

Forei(n Bodie#: . Abstruct $estibule of laryns ---@ death !"in : 8B mins

!eimlich "aneuver &nsertion of large bore needle to cricothyroid membranes or cricothyrotomy

TR A C H EA
5/ %ra!*eo#$omy

,o established an air!ay .se of tracheostomy tube

ES O P H A G / S
5/ In0urie# 8/ %ra!*eoe#op*a(eal fi#$ula:

Most common congenital anomaly of the esophagus

ES O P H A G / S
4/ E#op*a(eal

Car!inoma

4 one of the N eck

Bone I:
?*tends from the

cla$icle and manubrium to the le$el of the inferior border of cricoid cartilageC

Cer$ical pleura Apices of the lungs ,hyroid and parathyroid gland ,rachea ?sophagus Common carotid arteries Dugular $eins Cer$ical region of the $ertebral column

4 one of the N eck

Bone II:
?*tends from the

cricoid cartilage to the le$el of the angles of the mandibleC Superior pole of the thyroid gland 9aryn* 9aryngopharyn* Carotid arteries Dugular $eins ?sophagus Cer$ical region of the $ertebral column

4 one of the N eck

Bone III:
Angle of the

mandible up to the base of the s-ull

Sali$ary glands Aropharyn* 'asopharyn* Aral and nasal

ca$ities

F#actu#e of Ce#$i ca!1e#te(#a!Co! um n

5 u e ti on

*6I nt hy# oi dect om y+t he ne# $e t hat m ay(e i n7 u# ed du# i n& ! i &at i on of u"e# i o# t hy# oi d a# t e# y8
A/ In$ernal laryn(eal B/ #uperior laryngeal C/ E.$ernal laryn(eal D/ Inferior laryn(eal

1a&u N e# $e
Superior LN

5/ In$ernal LN + #en#ory abo e o!al !ord area 8/ E.$ernal LN + #upplie# Cri!o$*yroid Inferior LN , Re!urren$ LN + mo$or $o mu#!le# of p*ona$ion e.!ep$ Cri!o$*yroid : #en#ory below o!al !ord area

Thy# oi d G! and
Blood #upply:

Superior $*yroid + e.$ernal !aro$id Inferior $*yroid + $*yro!er i!al $run' =enou# draina(e: Superior $*yroid + I>= )iddle $*yroid + I>= Inferior $*yroid + Bra!*io!ep*ali!

,6Fo# m t he ! a# yn&ea! "# om i nence i nt he neck8

A/ Cri!oid !ar$ila(e B/ Thyroid cartilage C/ Epi(lo$$i# D/ Ary$enoid !ar$ila(e

 Unpaired

Car$ila(e# Epi(lo$$i# %*yroid Cri!oid "aired Car$ila(e# Ary$enoid Corni!ula$e Cuneiform

-61e# t e(# a "# om i nence i t he ot he# nam e of 8

A/ Cer i!al 5 B/ Cer i!al 8 C/ Cer i!al A D/ $ervical %

Ce# $i ca!1e# t e(# a

%ypi!al Cer i!al + C4

$o C7 S*or$1 bifid #pinou# pro!e## A$ypi!al Cer i!al + C5: C8 and C2 =er$ebra "rominen!e C C2 + lon( #pinou# pro!e## and no$ bifid
%ran# er#e foramen +

for

er$ebral ar$ery

 Cer i!al 5 C

A$la#

Cer i!al 8 C A.i#

pre#en!e of Odon$oid pro!e## , Den#

96The Ri &ht com m on ca# ot i d a# t e# y o# i &i nat e f # om t he8

A/ &rachiocephalic trun' B/ Ri(*$ Sub!la ian C/ Ar!* of Aor$a D/ A#!endin( Aor$a

 Bra!*io!ep*ali!

$run'
Lef$ Common

Caro$id
Lef$ Sub!la ian Ar!* of Aor$a

C O M M O N C A R O TI %
E.$ernal Caro$id

- Superior thyroid - Asc. %haryngeal - 9ingual - Facial - Accipital - %ost. Auricular - Superficial ,emporal - Ma*illary

In$ernal Caro$id

S/ 0 C LA1 I AN

Di$isible into 4 par$# by S!alenou# an$erior

Fir#$ "ar$ ertebral ,hyrocer$icaltrans$erse"superficial cer$ical) suprascapular) inferior thyroid &nternal ,horacic

Se!ond par$ Costocer$ical-deep cer$ical) highest"superior intercostal

%*ird par$3 occasionally suprascapular or superficial cer$ical

I nte#na! : u&u! a#
Continuation of

Sigmoid sinus %ribu$arie#: &nf petrosal sinus Facial %haryngeal 9ingual Sup thyroid Middle thyroid

0R A CH I O C EP H A LI C 1 EI N
In$ernal 0u(ular E #ub!la ian ein# At the le$el of the inf border of the 5#$ R !o#$al !ar$ila(e) / " 9 unite to form S=C %ribu$arie#: &nternal thoracic ertebral &nferior thyroid Superior intercostal

;6A! !oft he f o! ! o< i n& a# e Su"# ahyoi d m u c! e E3CEPT8

A/ Di(a#$ri! B/ -enio*yoid C/ (mohyoid D/ )ylo*yoid

H yoi d M u c! e
Supra*yoid

mu#!le# Di(a#$ri! + an$ , po#$ )ylo*yoid S$ylo*oid -enio*yoid

H yoi d M u c! e
Infra*yoid

)u#!le# Deep (roup %*yro*yoid S$erno$*yroid Superfi!ial (roup Omo*yoid S$erno*yoid

Su"# ahyoi d m u c! e
Ne#$e u""!y Ne#$e to my!ohyoid Facia! Action
%e"#e mandi(!e o# e!e$ate hyoid %e"#e mandi(!e o# e!e$ate hyoid

%i&a tic ' ante#io# (e!!y %i&a t#ic ' "o te#io# Sty!ohyoid My!ohyoid

Facia! Ne#$e to

E!e$ate hyoid (one

%e"#e

I nf # ahyoi d m u c! e
Ne#$e u""!y An a ce#$ica!i C*+ C, and CAn a ce#$ica!i An a ce#$ica!i Fi# t ce#$ica! Action %e"#e e hyoid

Omohyoid ' u"e#io# ) infe#io# Ste#nohyoid Ste#nothy#o id Thy#ohyoid

%e"#e e hyoid %e"#e e !a#yn. %e"#e e hyoid

=6The m u c! et hat di $i de t he "o t e# i o# t # i an&! e oft he neck i nt o O cci "i t a!and Su"# ac! a$i cu! a# t # i an&! e >
A/ Superior belly of Omo*yoid B/ Inferior belly of (mohyoid C/ An$erior belly of Di(a#$ri! D/ "o#$erior belly of Di(a#$ri!

 An$erior $rian(le

Di(a#$ri! Caro$id )u#!ular "o#$erior $rian(le Supra!la i!ular O!!ipi$al

?6Su t ai ned t en i on oft he $oca! co# d i (e t achi e$ed t h# ut he act i on of< hat i nt # i n i c m u c! e oft he ! a# yn.>
A/ "o#$erior Cri!oary$enoid B/ La$eral Cri!oary$enoid $. $ricothyroid D/ %*yroary$enoid

 Cri!o$*yroid + %en#or "o#$/ Cri!oary$enoid +

Abdu!$or La$eral Cri!oary$enoid + Addu!$or %*yroary$enoid + Rela.or Supplied by Re!urren$ , Inferior LN e.!ep$ Cri!o$*yroid ; E.$ernal LN <