Triangles of the Neck Flashcards by Jacob Thorn

Fascia of the neck

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Contents of superficial fascia

Platysma m.

Cutaneous nn.

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Contents of the superficial cervical (investing) fascia

Sternocleidomastoid m.

Trapezius m.

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Contents of the infrahydoid fascia

The strap muscles:

Sternohyoid m.
Omohyoid m.
Sternothyroid m.
Thyrohyoid m.

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Contents of the pretracheal fascia

Thyroid and parathyroid glands

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Contents of the carotid sheath

Internal jugular vein

CN X (vagus)

Common carotid aa

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Contents of the prevertebral fascia

Deep neck muscles

Roots of brachial/cervical plexuses

Phrenic n.

Sympathetic trunk

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Triangles of the neck

Surface anatomy

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The nerve point

2/3 of the way up the sternocleidomastoid muscle

Supraclavicular nerve
Transverse cervical nerve
Great auricular nerve
Lesser occipital nerve
CN XI

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Carefree zone

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Careful zone

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External jugular vein

Surface anatomy

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Subclavian triangle

Subdivision of careful zone

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Submental triangle

Anterior belly of digastric m. (CN V-3)

Mylohyoid (CN V-3)

Sumental lymphnode (lymph from tongue)

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Submandibular triangle

Posterior belly of digastric (CN VII)

Mylohyoid/stylohyoid muscles (CN VII)

CN XII
Mylohyoid n.
Genioglossus (C1)

Facial artery and vein

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Carotid triangle

Lots of nerves

CN IX
CN XII
Ansa cervicalis (C1-3)
Thyrohyoid n
Laryngeal n.

Deep cervical nodes
Jugulodigastric nodes
Jugulo-omohyoid nodes

Thyroid artery

Superior belly of omohyoid m. (ansa cervicalis innervates)

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Muscular triangles

Sternohyoid+omohyoid+sternothyroid (ansa cervicalis innervates these) and thyrohyoid (innervated by C1)

Prelaryngeal nodes
Pretracheal nodes

Anterior jugular and communicating veins

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Posterior triangle

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Anterior triangle

CN XII is just anterior to the superior aspect of external jugular (image on left - lateral view)

CN XII pierces the carotid sheath

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Submental triangle (center of image)

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Branches of the external carotid artery

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Anastomoses between the internal and external carotid arteries

The facial a./lingual a./ and ascending pharyngeal artery also anastomose at the palantine tonsil bed

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Major branches off of the right subclavian

Transverse cervical a.
Inferior thyroid a.
Suprascapular a.
Dorsal scapular a. (sometimes off transverse cervical)

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Branches of the external carotid a.

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Branches of the right subclavian a.

Superior laryngeal nerve

Superior laryngeal nerve (CN X) branches to form the external superior laryngeal nerve Innervates the cricothyroid muscle

The nerve point Contains part of the C2-3 loop (common place to anesthetize) Contains: Lesser occipital n. Greater auricular n. Transverse cervical n.

The ansa cervicalis

The descending hypoglossi

The descending cervicalis

The phrenic nerve (C3-5)

Nerve to the thyrohyoid muscle

The cervical plexus

C1-2 loop C2-3 loop C4

C1-2 loop of the cervical plexus

Contains the nerve to the thyrohyoid muscle (tongue) and the descending hypoglossi nerve

C2-3 loop of the cervical plexus

Contains the descending cervicalis nerve, lesser occipital nerve, greater auricular nerve, transverse cervical nerve (also contains fibers from C4), supraclavicular nerve (also contains fibers from C4), and the phrenic nerve

Anterior carotid triangle

Cartilage/Bone landmarks

What innervates the sternocleido mastoid muscle?

CN XI (spinal acessory nerve) - delineates the carefree and careful zone

Anterior digastric innervation

CN V-3 (the mandibular branch) ## Footnote Specifically by the nerve to the mylohyoid muscle

Posterior digastric innervation

CN VII

Vertebral level of bifurcation of the common carotid

CV4

Ansa cervicalis

Loop from the cervical plexus carrying fibers from the descending hypoglossi n C1-3 Motor to the muscles in the muscular triangle ## Footnote Ansa - means loop

Motor innervation of the muscle that tenses the vocal cords

Cricothyroid muscle is innervated by the external laryngeal nerve ## Footnote Travels right with the superior thyroid artery (commonly damaged during thyroid surgery)

Muscle innervation and action of the sternohyoid

Ansa cervicalis innervates the sternohyoid muscle which pulls down on the hyoid when contracted (during swallowing)

What is superficial to the thyroid gland (and location)

The thyroid is deep to the sternothroid and sternohyoid muscles 2nd and 3rd tracheal rings of the larynx

The lateral region

Forms the posterior triangle (Home of the careful and carefree zones) Borders: Posterior - trapezius m Inferior - clavicle Anterior - sternocleidomastoid

The anterior cervical region

Borders: Posterior - sternocleidomastoid Inferior - manubrium superior - mandible ## Footnote Four sub divisions (triangles) - submental, submandibular, carotid, and muscular

Congenital torticollis

Sternocleidomastoid m. is damaged due to a tumor or tearing

Zones of cutaneous innervation

Virchow's node

swelling indicative of infection or cancer in head, neck or chest | Deep to investing fascia

Where is an emergency cricothyrotomy incision made?

Between the thyroid and cricoid cartilages

A - great auricular n. C - lessor occipital n. D - spinal accessory n. (CN XI) Zone A - carefree zone Zone B - careful zone

Careful zone contents

Muscles - Levator scapulae, anterior/middle/posterior scalene muscles Nerves - Roots and trunks of cervical and brachial plexuses, phrenic nerve, dorsal scapular nerve Blood vessels - subclavian artery and vein, transverse cervical artery, dorsoscapular artery, and suprascapular arteries, and the internal jugular vein

What separates the border between the careful and carefree zones of the posterior triangle (lateral region)

CN XI (spinal acessory nerve) - pierces the sternocleidomastoid m. on its way to the trapezius, picks up branches of C2-3 en route.

Thoracic outlet syndrome cause

Suffieicient muscle tension can build up in the scalenes to compress the C5-6 roots giving rise to nuerogenic symptoms

A - mylohyoid B - anterior belly of the digastric C - hyoid bone

A - Posterior belly of the digastric B - Common facial v. C - Hypoglossal n. (CN XII) D - Submandibular gland E - Anterior belly of digastric muscle

A - Superior belly of the omohyoid m. B - Ansa cervicalis C - Facial artery D - Carotid sheath

A - CN XII (hypoglossal n.) B - Omohyoid m. C - CN X (vagus) D - Internal carotid artery E - External carotid artery F - Common carotid a. G - Phrenic nerve (anterior to the anterior scalene)

A - Internal jugular B - superior belly of omohyoid muscle C - subclavian triangle D - CN XI (spinal accessory n.) E - transverse cervical a F - prevertebral fascia

A - sternohyoid muscle (innervated by ansa cervicalis) B - Sternothyroid (also innervated by ansa cervicalis) C - Superior belly of omohyoid m. D - Thyrohyoid muscle

A - Great auricular n.m (C2-3) B - Lesser occipital n. () C - Transverse cervical (C2-3) D - CN XI (spinal accessory n.) E - Superficial cervical lymph node (deep are at the level of internal jugular vein) F - Supraclavicular n. (C3-4)

A - Sympathetic trunk (posterior to common carotid artery) B - Anterior scalene m. C - Phrenic n. D - Vagus n.

A - CN XI (spinal accessory n.) B - CN X (vagus n.) C - Cervical sympathetic trunk

A - CN XII B - C1 - nerve to the thyrohyoid C - Interal laryngeal n. D - External laryngeal n. E - Ansa cervicalis

Cricothyroid m.

A - Maxillary atery B - Facial artery C - Lingual artery D - Superior thyroid artery E - Superificial temporal artery F - Posterior auricular artery G - CN XI (spinal accessory nerve - under occipital artery) H - Internal carotid a. I - Carotid sinus

A - Occipital artery B - CN XI C - CN IX (nerve to the carotid sinus) D - CN X (vagus between common carotid a. and internal jugular vein)

Nerves that emerge from the jugular foramen

CN IX, X, and XI

A - External carotid a. B - Superior thyroid a. C - Inferior thyroid a. D - Transverse cervical a.

A - Transverse cervical (superior to suprascapular, both run over anterior scalene m.) B - Dorsal scapular a. C - Suprascapular a. (inferior to transverse cervical, both run over the anterior scalene m.) D - Anterior scalene (phrenic nerve runs over it) E - Vertebral a.

Boundaries of the submental triangle

Anterior bellies of the digastric muscle and anterior aspect of the hyoid bone

Functions of the hypoglossal nerve

Somatic motor innervation of the intrinsic and some extrinisic muscles of the tongue

Which muscles are not innervated by the ansa cervicalis? A. Omohyoid muscles. B. Sternohyoid muscle. C. Sternothyroid muscle. D. Thyrohyoid muscle.

The thyrohyoid muscle is innervated by a branch of the ansa cervicalis (C1) called the nerve to the thyrohyoid muscle

A 59-year-old man complains of numbness in the anterior cervical triangle. Therefore, damage has occurred to which of the following nerves? A. Greater auricular nerve B. Lesser occipital nerve C. Phrenic nerve D. Supraclavicular nerve E. Transverse cervical nerve

E. Transverse cervical nerve

.During surgery on a 56-year-old man for a squamous cell carcinoma of the neck, the surgeon notices profuse bleeding from the deep cervical artery. Which of the following arteries must be ligated immediately to stop bleeding? A. Ascending cervical artery B. Costocervical trunk C. Inferior thyroid artery D. Thyrocervical trunk E. Transverse cervical artery

B. Costocervical trunk

8.Any irritation of the diaphragm (e.g. infection, tumor) may create referred pain that seems (to the patient) to originate in the area atop the shoulder. This is due to the fact that the phrenic nerve shares spinal segments with what cutaneous nerve in the shoulder region? A. Dorsal scapular B. Lesser occipital nerve C. Long thoracic nerve D. Supraclavicular nerve E. Suprascapular nerve

D. Supraclavicular Nerve

At the superior orbital fissure compressing the oculomotor nerve