2 Objectives Describe the anatomy of posterior triangles of neck List the fascial layers of neck, and the major structures that they encloseIdentify major neurovascular structures in the neck, including external / internal jugular and subclavian veins, common / external / internal carotid and subclavian arteries, proximal brachial plexus, cervical plexus, and lymphatics
3 Cervical Fascia Consists of: 1- superficial fascia 2- deep cervical fasciaa. superficial (investing) layerb. pretracheal layerc. prevertebral layer
4 Superficial Cervical Fascia - immediately deep to the skin of the neck- encloses the platysma muscle- is continuous with that of the head and thorax- It containsA. cutaneous nerves,B. superficial Lymph nodes,C. superficial vessels,D. fat
5 1- investing fascia Deep cervical fascia -surrounds all structures in the neck- between superficial fascia and the muscles-splits to enclose the trapezius and Sternocleidomastoid muscles-splits superiorly to enclose the parotid and submandibular glands
6 *Suprasternal Spacespace between the 2 layers of deep fascia just above the manubrium which enclosessternal head of SternomastoidInf. end of the anterior jugular veinsjugular venous archfatfew lymph nodes
10 2-pretracheal fascia - limited to the anterior part of the neck - completely surrounds the thyroid gland- forming a sheath for the thyroid gland- binds the gland to the larynx
11 pretracheal fasciaencloses the parathyroid glands, trachea, pharynx, esophagus and Infrahyoid musclesinferiorly blends with the fibrous pericardiumlaterally with the carotid sheathsuperiorly attaches to the thyroid cartilage and hyoid bone
13 3-Prevertebral fasciatubular sheath for the vertebral column and its related musclefrom base of the skull to T3, where it fuses with the anterior longitudinal ligament of the thoracic vertebraeextends laterally as the axillary sheath
14 Retropharyngeal Space -the largest and most important interfascial space in the neck-It is a potential space consisting of loose connective tissue-it is between1-prevertebral fascia, and2-Bucchopharyngeal fascia ( covers the pharynxsuperficially and the buccinator muscle)-Closed superiorly by the base of the skull-Opens inferiorly into the superior mediastinum-Permits the movements of the pharynx, larynx, esophagus,and trachea during the swallowingInfection in the retropharyngeal space mayextend inferiorly into the Superior mediastinum
16 SCMdivides the neck Into2 triangles1-anterior2-posterior
17 Posterior Triangle of the Neck Boundaries:Anterior borderposterior border ofthe SCMPosterior borderanterior border of thetrapezius muscleBaseintermediate 1/3 of the clavicleApexmeeting of the anteriorand posterior border
18 Roof 1-skin 2-the superficial fascia which contains a) platysma b) external jugular veinc) cutaneous branchesof the cervical plexus3-the deep fascia
19 Floor 2- levator scapula 3- scalenus posterior 4- scalenus medius 1- splenius capitis2- levator scapula3- scalenus posterior4- scalenus medius5- scalenus anteriorAll covered bythe prevertebral fasciaSmall part of the semispinalis muscle may appear at the apex of the triangle
20 2- subclavian triangle (supraclavicular) *subdivided by the inferior belly of the omohyoid muscleInto : 1-occipital triangle2- subclavian triangle (supraclavicular)
21 OccipitaltriangleInferior belly of omohyoidSupraclaviculartriangle
22 Occipital triangle Bounded by – Anterior border of trapezius muscle – Posterior border of sternocleidomastoid muscle– inferior belly of omohyoid
29 Platysma muscle Origin deep fascia that covers the pec major and deltoid msInsertioninto the lower border ofthe mandiblesome fibers to the Facewhich blend with the muscleat the angle of the mouthNerve supplycervical branchof facial nerveAction-depresses the mandible-draws down the lower lip
30 Omohyoid muscle: Origin Inferior belly upper margin of the scapula medialto suprascapular lig.Superior bellylower border of body of hyoid boneInsertionintermediate tendon ( clavicle and 1st rib by facial sling)Nerve supplyAnsa Cervicalis (C1,2 and 3)Actiondepresses hyoid bone
31 Sternocliedomastoid(SCM) Originmanubrium and medial 1/3 of the clavicle(sternal head and Clavicular head))Insertionmastoid processes of temporal boneand occipital boneNerve supply1-spinal part of theaccessory nerve (motor)2-C2 and C3 (sensory)Action-two muscles acting togetherextend the head and flexthe neck-one muscle rotateshead to opposite side
32 What is torticollis?Torticollis (wry neck) is a congenital or acquired condition of limited neck motion in which the child will hold the head to one side with the chin pointing to the opposite side.It is the result of the shortening of the sternocleidomastoid (neck) muscle.In early infancy, a firm, non-tender mass may be felt in the midportion of the muscle. The mass will go away and be replaced with fibrous tissue.If untreated, there can be permanent limitation of neck movement. There may be flattening of the head and face on the affected side.
34 The veins: -External jugular vein: begins just behind the angle of the mandible-it is deep to the platysma muscle-is formed by union of1-Posterior Auricular vein2-Post. Division of the Retromandibular v.- drain into the subclavian vein.
35 Retromandibular veinIs formed by the superficial temporal and maxillary veinsDivides intoan anterior branch, which joins the facial vein to form the common facial vein, anda posterior branch, which joins the posterior auricular vein to form the external jugular vein
36 Tributaries of EJV . Posterior auricular vein . Post.division of the Retromandibular vein. transverse cervical vein,. suprascapular vein. anterior jug.vein
37 *Superficial cervical LN -lie along the external jugular vein in the posterior triangle, and along the anterior jugular vein in the anterior triangle-superficial to the SCM-Drains into deep cervical LN-Receives Lymph vessels from theoccipital and mastoid LNs
38 a rudimentary cervical rib a tight fibrous band first thoracic rib The brachial plexus and subclavian artery may be compressed in the neck bya rudimentary cervical riba tight fibrous bandfirst thoracic riba tight scalenus anterior musclegiving rise to sensory,motorvascular symptomsin one or both upper extremities.
39 cervical ribPressure in the region of a cervical rib will give rise to local pain as well as pain referred to the hand and arm particularly in the ulnar portion of the hand and forearm since it is the lower trunk of the brachial plexus which is involved (C8,T1). There is muscular weakness of the small hand muscles.
40 Nerves: B-The branches of the Cervical Plexus A-The Accessory nerveB-The branches of the Cervical PlexusC-The Roots and the Trunksof the Brachial Plexus
42 What structures are contained within the posterior triangle of the neck? Posterior triangle of neckMuscles ( SCM, Trapezius, Omohyoid & floor muscles)Accessory nerve3 trunks of brachial plexusCervical plexusExternal jugular veinSubclavian arteryDeep cervical lymph nodes (what is Virchow’s node? )