Neck Facia + Post. Triangle+Anterior Tirangle Flashcards
بسم الله الرحمن الرحيم
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مالك يوم الدين
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Mention layers of deep fascia of neck
Investing Facia
Pretracheal
prevertebral
Carotid sheath
Investing fascia surrounds the neck as collar and when meeting The Sternomastoid o Trapeizus it splits to enclose the muscle then after trapezius attach to ?
Ligamentum Nuchae
layers of Neck ?
Skin
superficial fascia contaitnig platysma
Deep fascia :
investing
pretireaheal Visceral
prevertebral Vertebral
Carotid sheath Vascular
Carotid sheath enclosing ?
1-Carotid artery
2-Internal Jugular
3-Vagus
The roof of anterior and posterio triangles of neck formed by?
Investing deep Fascia
Investing Fascia
Surroundung neck as …….deep to …….is ?
collar
platysma
Investing deep fascia is ? لفافة الثنائيات ليه ؟
Investing 2 muscles : Sternomastoid - trapezius
investing 2 glands : submandiublar + parotid
Froming 2 spaces :
Suprasternal + supraClavicular
Froming 2 pullyes for digastric + omohyoid muscle
The investing fascia enclose 2 glands but separates them how?
Parotid + submandiublar glands
Separating them by thickening to form StyloMandibular ligament !
mention attachments of The investing Facia of NEck
Behind ligamentum nuchae + C7
ABOVE: external occipital protuberance superior nuchal line , mastoid process , base of mandible
anterior : symphisis menti thyroid ciricoid Maniburum
below : Maniburm + clavicle + scapule + then to Ligamnrtum nuchae
Continuous with that of opposite side aboce and below hyoid bone
Describe preTracehal fascia
enclosing Thyroid gland attaching it to Trachea
Lying in front of trachea deep to infrahyoid muscles
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above : with Hyoid and oblique line of thyroid and Ciricoid cartilage.
below with Fibrous pericaridum or Adventia of Aortic Arch
imp of Pretracheal fascia ?
Provide slippery surface for free movment of trachea during swallowing
describe carotid sheath
attachments :
above: base of skull
below: adventia of aortic arch
anterior : pretracehal fascia
posterior :prevertebral fascia
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contents divided to 2 division according to level of thyroid cartilage c34
Lower: CCA +IJV+Vagus
Upper : ICA + IJV+Last 4 cranial nerves
Embeded anteriorly loop like ansa cervicalis from c123 veentral rami
Emeded posteriorly
cervical sympathic chain
___________________
why internal and external carotid named like this ?
According to their conituity in carotid sheath
the internal continue so it is interna
the external exit so it is ,,,
Main supply of infrahyoid muscles ?
Ansa cervicalis c123 venetral rami
Fascia coveirng the mucsles of floor of posterio triangle ?
PREVERTEBRAL
pREvertebral Fascia coveing ?
Prevetebral muscles middle scalene
Cevical + Brachial pleuxes
Subclavian artery
nereve roots of cervical and bracical plexus lie …….subcalvian artery ?
Behind
Axillary sheath covers?
Subclavian artery & Brachial plexus
Attachments of Prevertebral Fascia
________________
Relations of it ?
Anterio carotid sheath
posterior : investing fascia + ligamentum nuchae
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amterior to it lying:
Pharynx +osepohagus
Larynx + trachaea
=Subclavian Vein =
Extent of Prevetrebral fascia
From base of skull extending to superior mediastium
t3.4 joinig anterior longitudinal ligament
Buccopharyngeal fascia covering?
Buccinator +
superior constiructo of pharynx
the space behind is retrophatyngeal space
Retropharyngeal between ?
buccopharyngeal + Prevertebral fascia
exteneding from base of skull down to superior mediatstium bounded from each side by carotid sheath
TB in cervical vertebra casuing ?
Infection spread behind prevertebral fascia may spread :
1-forward to posterio pharyngeal wall
2-lateral : posterior tiragnel
3-inferior : superior mediastiunm
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Infection in retrpharyngeal space
infont of preveterbral fascia
due to infection in retopharyngeal LN then RetroPharyngeal Abscess extending to parameidan palne anteiroly pusing pharynx
or infrerioly Till posterior mediastium
Infection in front of pretracheal fascia leads to ?
Bulging of infection to suprastrenal area
Anterior Mediastium
neck is between ?
Lower border of mandible and
upper border of clavical and suprasternal notch
the …..divding neck into l……&<,,,,,,
Sternocleidomastoid
Anterior + posterior Triangle
Mention boundaries of Posterior Triangle
Post of sternomastoid
ant of trapizus
apex joining of 2 muscles at superior nucal line
base middle 1/3 of clavicle
Mention muscles of floor of post triangle
Scalenus anterior
SLS
Scalenus medius
Levator scapulae
Splenis capits
semispinalis capitis
____________
covered by prevertebral fascia
mention components of Roof of posterior triagnle
Skin
superficial fascia conating platysma
Cutanuous branches of Cervical pleux
External Jugular vein
Deep investing Fascia
__________________s[fojsfd
brachial pleux between ?
Scalenus anterior & Scalenus medius
spinal acessory pass above …. muscle in post triangle ?
Levator scapular
Muscles in posterior tiangle ?
inferior belly of omohyoid muscle
dividing it into
Occipital + Supraclavicular Triangles
LN In posterior triangle
Occipital
SupraClaviclular LN
Nerves in posteiror triangle
Spinal Acessory
Cervical Pleux
Brahcial Plexus
Describe spinal accessory nerve
Descend obliquley deep to sternomstoid to appear in posterior triagnel at mid point of post sternomastoid then descends obliqule to be deep to trapezius
during passing through post tirangle it is above levator scpaulae
Cervical pleux formed of
Ventral Rami of c1234
describe cut branch of cervical pleux
at mid point of post vorfer of sternomastid
giving :
Great auricular superior anteirorly
Lesser occipital in post border of sternomastoid superiorly
tranvere cerivcal : transverse
supreclavicular inferiorly
local anastheis to midpont of post of sternomastoid casuing ?
Anasthesia in all cut branhes of cervical pleux
Greater auricualr
lesser occipital
transverse cervical
supraclvicular
Called Cutanuous Nerve Block
Root and trunck of brachial pleux between ?
Scalenus ant & medius
upper and middle trunk pass,,…….sublclaian artery but lower trunk …….
Above
below
covered by prevertebral fasica
…part of subclavian artery between ant scalene and middle scalene ?
third
Subclavian artert contiue as axillary artery at
oute boder of firs rib
Subclavian atery and vein separated by ?
Scalenus anterior
65% THIRD Subclavian gives ?
deep branch of transverse cervical artery
mention arteries of the post triangle ?
Third part of subclavian
________________
Thyrocervical trunk of first part subclavian branches :
1-suprascapular
2-transverse cervical
__________________
Occipital Of ECA
EJV Tributaries and drainage
Tri:
sta
Suprascapular vein
transverse cervical vein
anterior jugular vein
posterior external juglar
_______________
drains into Subclavian vein
EJV ?
one of the superificla compnent of posterio triangle
superifical to investing layer crossing the sternomastoid descneding vertically to a finger breadth above clavicle to pirece deep fascia to drain into subclavian vein as the only tribuitary for it
subclavian vein is ?
Cotiuation of axillary vein at oute border of first rib receing its olnly triubray the EJV Lying anterior to scalnes anteiror
Clinical imp of EJV
indicate venous pressure
apply canula:
Rough measue of venous pressure
Fluid infusion
External jugular veins sereves as Internal barometer ?
لانه لو الضغط عادي بيبقي باين شوية مش واضح قوي
لكن لو الضغط الوريدي عالي هيبقي باين جدا في مساره كله
5 GROUPS OF CONTENTS
1-1MUSCLE
2-2LN
3-3N
4-4A
5-5V
5 GROUPS OF CONTENTS
1-1MUSCLE
2-2LN
3-3N
4-4A
5-5V
قل الحمدلله وسلام علي عباده الذين اصطفي آلله خير أما يشركون
أمن خلق السماوات والأرض وأنزل من السماء ماءا فأنبتنا به حدائق ذات بهجة ما كان لكم أن تنبتوا شجرها ءإله مع الله بل هم قوم يعدلون
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“يا أبتِ إني إخاف أن يمسك عذاب من الرحمن فتكون للشيطان وليا “
Sternomastoid muscle has 2 heads mention
Sternal head from anterior surface of manibrum sterni
Clavicualr head from upper surface of medial 1/3 of clavcile
to be inserted into Mastoid process & Lateral 1/3 of superior Nucehal line
_________________
nerve supply to sternomastioid mention it
Motor : spinal accessory nerve
Sensroy propriceptive : Ventral Rami of C2,3
Show superifical relations of sternomastoid
Superficial:
Skin
superficial fascia :Platysma + EJV + bRANCHES Of cervical pleux Greater auricular +Transverse cervical + supraclavicular
______________
deep fascia
Parotid gland
Mention lower deep relations of Sternomastoid
SCI : SternoClavicualr joint
Subclavian 1st
Carotid sheath
InfraHyoid Muscle
Mention middle deep relations of sternomastoid
Structures Muscles nerves vessels LNs
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Structures: Thyroid + Carotid Sheath
Muscles:prevertebral +Scalene
Nerves :-
Ansa Cervicalis + Brachial+Cervical Pleux + phrenic nerve
Vessels : External carotid and its branches
LNs:Deep cervical LNs
Upper deep relations of sternomasotid mention
Bone :mastoid process muscles attached to it
Arteries : Occipital
Nerves : Spinal acessory will supply trapeizus
Show actions of sternoMastoid
From one side : Tilting neck at that side and Face turning to opposite side
Form both sides: flexion of head to anterior
Can pull the thoracic cage upward during Inspiration
Superficial structures in the median region of neck
Symphysis menti
Mylohyoid ligament
Hyoid bone
Thyrohyoid ligmant median
Thyroid cartilage
ciricothyroid ligament
Circioid cartilage
CiricoTracheal lig
First Tracheal Ring
Levator Glandulae thyroidae
Isthmus of Thyroid
Superficial structures in the median region of neck
Symphysis menti
Mylohyoid ligament
Hyoid bone
Thyrohyoid ligmant median
Thyroid cartilage
ciricothyroid ligament
Circioid cartilage
CiricoTracheal lig
First Tracheal Ring
Levator Glandulae thyroidae
Isthmus of Thyroid
Suprasternal notch structures Mention
TIBJ
-Trachea
-Inferior Thyroid veins
-Part of Brachiocephalic artery
Jugular ach connecting to anterior Juglar veins
Boundaries of Anterior Triangle mention
Anteriorly : anterior midline of neck
Posteriorly: anterior border of Sternomastoid
Superiorly : inferior border of Mandible + line from mastoid to angle of Mandilbe
How is the anterior triangle divided and to what?
By Hyoid bone + Digastic + Supeiror belly of Omohyoid muscle
__________________
to 3 1/2 Triangles
Digastric
Submental
carotid
Musclar
Describe submental Triangle
It is Median Triangle by connection of the anterior 2 triangle the between chin and hyoid bone
______________
Base= hyoid bone
apex = sympheis menti
each side = anterior belly of diagastric
floor : 2 mylohyoid + meidan raphae
______________
Half of the triangle bounded
apex sympheis menti
base hyoid
side anterior b diagatric
Mention Contents of Submental Triangle
1-submental LNs
2-Submental Vein +artery
3-Small veins forming anterior juglar veins
4-Mylohyoid Nerve and vessels
Mention boundaries of digastric tirangle
Base: inferior border of Mandible + line between angle of Mandilbe + Mastoid process
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anteiror : anterior belly of digastirc
posteiror : posterior posterior belly of digastric + stylohyoid muscles
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superifical : skin superficial fascial + deep fascia splitting enclosing the submandibular slaivary gland
Floor : Mylohyoid + Hyoglossus
List contents in the anterior part of digastric Triangle
3S
1Submandiublar salivary glands + submandiublar LNs
Facial veins seuprficial to gland and facial artery deep to it
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2Superficial to myolyoid muscle :
Mylohyoid nerve +vessels
submental vessels
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3Superficial to hyoglossus
Lingual nerve suspending submandiublar gnaglion
Submandibular gland + duct
Hyoglossal nerve
Mention contents of Posterior part of The digastric tirandle
Lower parotid
ECA
Caroid sheath:
ICA
IJV
Vagus
Mention Boundaries of Carotid Triangle
Ant : supeiror belly of omohyoid
post: anterior sternomastoid
superiorly: post belly of digastric
______________
roof skin Superifical fascia +investing deep fascia
Floor : 2 anterior +2post
ant : hyoglossus + thyrohyoid
Post: middle + inferior constrictors
Mention contents of Carotid Tirangle
Caroootid ?! arteires1
Common carotid
ICA
ECA with 5 SALFO branches
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
________________
Veins : IJV + Tributaries
Superior thyroid
Pharyngeal
Lingual
common facial
__________
Nerves : last 3 cranail nerves : Vagus + Spinal accessory + Hypoglossal
_________________
Ansa cervicalis :anterior
Sympathatic chain: post
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Carotid Sheath : ICA +IJV +Vagus
Deep Cervical LNs
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Metion borders and contents of Musclar Triagnle of anterior neck Triangle
ANterior : Median line of neck
posterior :
posterosuperiolry: superior omohyoid
posteroinferior ant sternomastoid
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roof: skin superifical facia and deep investing fascia
Floor : preTracheal Fascia
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contents infrahyoids
List Infrahyoid muscles
Sternohyoid
sternothyroid
thyrohyoid
Omohyoid
Sternohyoid and sternothyroid compare origin and insertion
Origin :
sternohyoid from back of maniburum and medial calvical
Sternothyorid from back of maniburum and medial first costal cartialge
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insertion :
Sternohyoid in lower border of hyoid
Sternothroid Oblique line of thyorid cartilage
Sternothyroid and thyorid hyoid compaer origin and insertion
Sternothyroid : from back of manicbum and medial first costal cartigle to oblique line of thyroid cartilage
ThyroHyoid from oblique line of thyroid cartilage to lower boeder of hyoid and its greate cornu
Describe omohyoid
Superiro belly from lower border of hyoid
and Inferior belly from superior scapula + supreaScapular ligament to the intermediate tendon that is attached to clavical via Fascial Sling
All infrahyoid muscles supplied by Ansa Cervicalis from c123 except ?
Thyrohyoid by C1 fibers accompanying hypoglossal Nerve
Illustarte the structure of Ansa cervicalis
Descending Hypoglossi + Descnding Cerivalis
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superior limb descending hypoglossi from c1 fibers some of them accompany hypoglossal nerve and the others decends as superor limb of Ansa
lower limb descedning cervicalis from c2,3 fibers
infront of IJV
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Supply infrahyoids except thyrohyoid muscle
Show Actions of Infrahyoid
SternoHyoid : depress hyoid bone
Omohyoid : depress hyoid
Thyrohyoid: derpess hyoid + elevate larynx
Sternothyorid :
depress larynx
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so 3 depress hyoid : Sternohyoid + Thyrohyoid + omohyoid
2 antagoistics:
Sterothyroid VS Thyrohyoid
” يا أبت إني أخاف أن يمسك عذاب من الرحمن فتكون للشيطان وليا “ !
