1. SUBOCCIPITAL TRIANGLE

2. SUBOCCIPITAL TRIANGLE:
These are a pair of muscular triangles situated on each side of the midline in the suboccipital region.
BOUNDARIES:
Supero-medially :
Rectus capitis posterior major
Supero-laterally :
Obliquus capitis superior
Inferiorly :
Obliquus capitis inferior

3. Roof:
Medially : Dense fibrous tissue covered by the semispinalis capitis
Laterally : By the longissimus capitis and occassionally the splenius capitis
Splenius capitis
Semispinalis capitis
Longissimus capitis

4. FLOOR:
Formed by the posterior arch of atlas and posterior atlanto-occipital membrane
Posterior arch of atlas
Posterior atlanto-occipital membrane

5. Contents: - First cervical nerve (suboccipital nerve)
- Third part of vertebral artery
- First cervical nerve (suboccipital nerve)
- Suboccipital plexus of veins
Third part of vertebral artery
First cervical nerve(C1)

6. Clinical importance:
Cisternal puncture is done when lumbar puncture fails to collect the Cerebro spinal fluid. (C.S.F)

7. SIDE OF THE NECK

8. Side of the neck is roughly quadrilateral in outline.
It is bounded:
Anteriorly : By the Anterior midline
Posteriorly : By the anterior border of Trapezius
Superiorly : By the base of the mandible and line joining the angle of the mandible to the mastoid process and superior nuchal line
Inferiorly : By the clavicle.
This quadrilateral space is divided obliquely by the sternocleidomastoid muscle into the Anterior and Posterior traingle

9. The side of neck is covered from outside to inside by 1) Skin
2) Superficial fascia and
3) Deep fascia
Skin:
The skin of neck is supplied by the 2nd, 3rd and 4th cervical nerves.
The anterolateral part of the skin is supplied by --
Anterior primary rami of anterior cutaneous,
Great auricular
Lesser occipital and
Supraclavicular nerves

10. ------ Investing layer ------ Prevertebral layer
DEEP FASCIA:
The deep fascia of neck is condensed to form the following layers:
Investing layer
Prevertebral layer
Pretracheal layer
Carotid sheath

11. Posterior Triangle of Neck

12. Situation: It is Situated just behind the Stenocleidomastoid muscle.
Boundaries:
Infront: Posterior border of Sternocleidomastoid
Behind: Anterior border of Trapezius

13. Inferior/base : Middle 1/3rd of the clavicle.
Apex : Superior nuchal line of occipital bone where sternocleidomastoid and trapezius meets.

14. Roof: It is formed from outside to inside by the 1) Skin
2) Superficial fascia: It contains
MUSCLE
VEIN
ARTERIES
NERVES
Platysma
External jugular vein
Arteries derived from
Occipital
Transverse cervical
Suprascapular
Supraclavicular
Lesser occipital
Great auricular
3) Investing layer of deep cervical fascia

16. Floor: It is formed by the following muscles: Semispinalis capitis
Splenius capitis
Levator scapulae
Scalenus posterior
Scalenus medius
Scalenus anterior (sometimes) and
First digitation of the serratus anterior
All these muscles are covered by prevertebral layer of deep cervical fascia,

17. Divisions of Posterior triangle:
The triangle is subdivided by the inferior belly of the omohyoid into:
The upper larger part called occipital triangle
Lower smaller part called the supraclavicular triangle
Occipital triangle
Inferior belly
of the omohyoid
Supraclavicular triangle

18. Contents of occipital triangle:
Spinal part of accessory nerve:
It appears in the posterior triangle deep to mid point of the posterior border of the sternocleidomastoid and passes between roof and floor of the triangle resting on levator scapulae and disappears under cover of trapezius.
Levator scapulae
Spinal part of Accessory nerve

19. 2) 3rd and 4th cervical nerves:
It provides muscular branches to levator scapulae and trapezius muscle
Accessory nerve
3rd cervical nerve
4th cervical nerve

20. 3) Dorsal scapular nerve:
Arises from the C5 root of brachial plexus and supplies rhomboideus muscles
Dorsal scapualr nerve

21. 4) Transverse cervical artery:
Branch of Thyrocervical trunk of Subclavian artery
Transverse cervical artery
Thyrocervical trunk

22. 5) Four cutaneous branches:
a) Lesser occipital nerve (C2)
b) Great auricular nerve (C2, C3)
c) Transverse cervical nerve (C2, C3)
d) Supraclavicular nerve (C3, C4)
Transverse cervical nerve (C2, C3)
Lesser occipital nerve (C2)
Great auricular nerve (C2, C3)
Supraclavicular nerve (C3, C4)

23. 3 2 1 Contents of supraclavicular triangle:
Third part of subclavian artery and vein
Suprascapular artery and vein
Transverse cervical artery and vein
Terminal part of external jugular vein 3 2 1

24. a d b 5) Trunks of brachial plexus : a) Dorsal scapular nerve
b) Long thoracic nerve
c) Nerve to subclavius
d) Suprascapular nerve a d b

25. ANTERIOR TRIANGLE
OF THE NECK

26. Boundaries of triangle:
Anteriorly : Median plane
Posteriorly : By the sternocleidomastoid muscle
Superiorly : By the base of the mandible, and by the line joining the angle of the mandible to the mastoid process
Apex : It lies above the manubrium sterni
Sternocleidomastoid
Median plane

27. The triangle encloses four Suprahyoid and four Infrahyoid muscles
A) Suprahyoid muscles :
Digastric
Stylohyoid
Mylohyoid
Geniohyoid

28. B) Infrahyoid muscles:
3) Thyrohyoid
1) Sternohyoid
2) omohyoid
4) Sternothyroid

29. Subdivisions of the triangle:
The triangle is subdivided by the Digastric muscle and the superior belly of omohyoid into:
1) Submental triangle
2) Digastric triangle
3) Carotid triangle
4) Muscular triangle 2 1 4 3

30. Submental triangle: It is a median triangle
Boundaries of the triangle:
On each side: Anterior belly of corresponding digastric muscle
Base : Body of hyoid bone
Apex : Lies at the chin
Floor : Formed by right and left Mylohyoid muscles and the median raphe uniting them.
Anterior belly of digastric
Mylohyoid
Hyoid bone

31. Contents:
2-4 small submental lymph nodes situated in the superficial fascia between the anterior bellies of the digastric muscles.
Small submental veins join to form the anterior jugular vein.

32. Anterior belly of digastric
2) Digastric triangle:
Boundaries of digastric triangle:
Above: Lower border of the body of the mandible and a line extending fro the angle of mandible to the mastoid process
Below and behind: Posterior belly of digastric and stylohyoid muscles.
Below and Infront: Anterior belly of digastric
Posterior belly of digastric
Anterior belly of digastric
Stylohyoid

33. Cervical branch of facial nerve Transverse cutaneous nerve of neck
Roof:
1) Skin
2) Superficial fascia containing:
The platysma,
Cervical branch of facial nerve,
The ascending branch of the transverse cutaneous nerve of the neck.
Cervical branch of facial nerve
Transverse cutaneous nerve of neck
Platysma

34. Middle constrictor muscle
3) Deep fascia :
It splits to enclose the submandibular salivary gland
Floor:
Anteriorly: It is formed by the Mylohyoid muscle
Posteriorly: By the Hyoglossus muscle
A part of middle constrictor muscle also appears in the floor
Middle constrictor muscle
Mylohyoid muscle
Hyoglossus muscle

35. Submandibular salivary gland Submandibular lymph node
Contents:
1) Anterior part of the triangle:
Superficial part of the submandibular salivary gland.
The facial vein and submandibular lymph nodes, superficial to the gland and facial artery lies deep to gland
Submental artery
Mylohyoid vessels and nerve
And part of hypoglossal nerve.
Submandibular salivary gland
Facial vein
Submandibular lymph node
Facial artery

36. 2) Posterior part of the triangle:
a) Lower part of the parotid gland.
b) External carotid artery before it enters the parotid gland.
c) Carotid sheath containing internal carotid artery, internal jugular vein and vagus nerve.
Internal Carotid Artery
External carotid artery
Internal jugular vein

37. Posterior belly of digastric Superior belly of omohyoid
3) Carotid triangle:
It contains all the large vessels and nerves of the neck
Boundaries:
Superiorly: Posterior belly of digastric and Stylohyoid muscle
Infront and below: Superior belly of omohyoid
Posteriorly: Anterior border of the sternocleidomastoid muscle
Posterior belly of digastric
Carotid triangle
Superior belly of omohyoid
Sternocleidomastoid

38. Cervical branch of facial nerve Transverse cutaneous nerve of neck
Roof:
1) Skin
2) Superficial fascia containing: It contains
a) Platysma
b) Cervical branch of facial nerve
c) The transverse cutaneous nerve of neck
Cervical branch of facial nerve
Transverse cutaneous nerve of neck
Platysma

39. 3) Investing layer of deep cervical fascia
Floor : It is formed by
a) Thyrohyoid muscle
b) Hyoglossus
c) Middle and inferior
constrictors of the pharynx
Hyoglossus
Middle constrictor
Inferior constrictor
Thyrohyoid muscle

40. Contents: A) Arteries: 1) Common carotid artery and its divisions.
2) External carotid artery and its branches.
Internal carotid artery
External carotid artery
Common carotid artery

41. B) Veins: 1) Internal jugular vein 2) Common facial vein
3) Pharyngeal vein
4) Lingual vein
Internal jugular vein
Common facial / Internal jugular vein
Common facial vein
Lingual vein
Internal jugular vein

42. s v H C) Nerves: 1) Vagus running vertically downwards
2) Superior laryngeal
Internal and
External laryngeal nerve
3) Spinal accessory
4) Hypoglossal nerve
5) Sympathetic chain H s v

43. Internal & External laryngeal branches of Superior laryngeal
Vagus

44. D) Carotid sheath with its contents
E) Lymph nodes: Jugulo-digastric and Jugulo-omohyoid lymph nodes
Jugulo-digastric
Jugulo-omohyoid

45. D) Muscular triangle: Boundaries:
Infront: Anterior median line of the neck from the hyoid bone to sternum.
Behind and above: Superior belly of omohyoid muscle
Behind and below: Anterior border of sternocleidomastoid.
Superior belly of omohyoid
Sternocleidomastoid
Muscular triangle

46. Supplied by Ventral rami of spinal nerves C1, C2, C3.
Contents:
Infrahyoid muscles are chief contents of the triangle
Sternohyoid
Sternothyroid
Thyrohyoid
Omohyoid
Supplied by Ventral rami of spinal nerves C1, C2, C3.

47. FACE

48. Extent of the face: Superiorly : It extends upto hair line
Inferiorly : To the chin and the base of the mandible
On each side: To the auricle

49. Skin: Superficial fascia: It is very vascular
It is rich in sebaceous and sweat glands . Sebaceous glands keeps the face oily and sweat glands regulates the body temparature.
It is very elastic and thick because facial muscles are inserted into it.
Superficial fascia:
It contains:
1) Facial muscles, all of which are inserted into the skin
2) The vessels and nerves
3) Variable amount of fat

50. Deep fascia:
It is absent , except over parotid gland where it forms the parotid fascia, and over the buccinator where it forms the Buccopharyngeal fascia.

51. Facial muscles:
The Facial muscles are the subcutaneous muscles and bring about differential facial expression.

52. Topographically, the muscles are grouped as follows:
A) Muscles of scalp: Occipofrontalis
Occipofrontalis

53. B) Muscles of auricle: Around the ear
AURICULARIS SUPERIOR
AURICULARIS
ANTERIOR
AURICULARIS POSTERIOR

54. C) Muscles of the eyelids:
Orbicularis oculi
Corrugator supercilli
Levator palpebrae superioris 1 3 2

55. 1 2 3 4 D) Muscles of nose: Procerus Compressor naris Dilator naris
Depressor septi 1 2 3 4

56. 4 1 E) Muscles around the mouth: Orbicularis oris
Levator labii superioris alaequae nasi
Levator labii superioris
Levator anguli oris
Zygomaticus minor
Zygomaticus major 4 1

57. 11 10 7 8 9 E) Muscles around the mouth: 7) Depressor anguli oris
8) Depressor labii inferioris
9) Mentalis
10) Risorius
11) Buccinator 11 10 7 8 9

58. F) Muscles of neck:
Platysma
Platysma

59. Name of the Muscle Expression
Muscles producing facial expression :
Name of the Muscle
Expression
Zygomatics Major
Smiling & Laughing
Levator Labii Superioris &
Levator Anguli Oris
Sadness
Depressor Anguli Oris
Grief
Dilator Naris & Depressor Septi
Anger
Corrugator Supercilli & Procerus
Frowning
Frontalis
Surprise
Mentalis
Doubt
Risorius
Grinning
Zymaticus Minor
Contempt

60. Blood supply: Arterial supply: Venous drianage:
It is supplied by Facial artery and Transverse facial artery.
Venous drianage:
The veins accompany the arteries and drains into common facial and retromadibular vein.

61. Motor nerve supply of face comes from
‘terminal branches of facial nerve’
Sensory Nerve Supply:
Sensory nerve supply of face comes from
‘trigeminal nerve’

62. THANK YOU