1. Back Of neck & Sub occipital TRIANGLE Dr. Jitendra Patel M.S. (ENT) OM ENT Hospital, Everest complex,1 st Floor, Near Limda chowk, RAJKOT Mobile: 9726538428

2. The back of the neck is limited above by EXTERNAL OCCIPITAL PROTUBERANCE & SUPERIOR NUCHAL LINES and below by SPINE OF C7 VERTEBRA. The important structures on the back of the neck include : »Ligamentum Nuchae »Extensor Muscles of Neck »Sub occipital Triangle »Arterial Anastomosis around Semispinalis Capitis

3. The skin on the back of the neck is supplied by the medial branches of dorsal rami of C2, C3 & C4 spinal nerves.

4. The superficial fascia of he back is thick and in spite of its fat content, it is very tough. It contains cutaneous nerves and vessels.

5. The deep fascia of the back is called Nuchal fascia. It is attached in the median plane to the spines, supraspinous ligaments and Ligamentum Nuchae.

6. LIGAMENTUM NUCHAE It is triangular sheet of fibro elastic tissue that forms the median fibrous septum between the muscles of the two sides of the back of the neck to which it is attached under deep fascia.

7. The muscles of the back of the neck on either side are arranged into Superficial and Deep Group of Muscles.

8. SUPERFICIAL GROUP  First layer consisting of TRAPEZIUS  Second layer consisting of LEVATOR SCAPULAE.

9. It is a large, flat and triangular muscle which is placed superficially on the back of the neck and thorax. ORIGIN : Arises from the med. third of superior nuchal line, external occipital protuberance, ligamentum nuchae & spine of C7. INSERTION : Upper surface of lat. third of clavicle. Med. Border of Acromion Tubercle of Spine of Scapula

10. NERVE SUPPLY : »Spinal Accessory Nerve »Ventral Rami of C3 & C4 ACTION : » Helps in the elevation and shrugging of shoulders. » Also helps in retracting and steadying the scapula.

11. ORIGIN : Arise from post. Tubercles of the transverse processes of the first four cervical vert. INSERTION : Into the med. border of the scapula NERVE SUPPLY : Branches from ant. Rami of C3 & C4 ACTION : Elevates the Scapula

12. DEEP GROUP Muscles of this group form the intrinsic musculature. The muscles are arranged in 4 layers : External : Consisting of SPLENIUS CAPITIS Intermediate : Consisting of LONGISSIMUS CAPITIS Deep : Consisting of SEMISPINALIS CAPITIS Deepest layer : Formed by the SUBOCCIPITAL MUSCLES.

14. This is a triangular muscular space situated deep in the sub occipital region of the neck one on each side of the midline and bounded by the three muscles of the sub occipital group of muscles.

15. In order to expose the triangle, the following layers are reflected: The skin is very thick The superficial fascia is fibrous and dense The fibres of trapezius run downwards and laterally over the triangle and sternocleidomastoid overlaps the region laterally. The splenius capitis runs upwards & laterally for insertion into mastoid process. The semispinalis capitis runs vertically upwards for insertion into medial part of the area between the sup. And inf. Nuchal lines. {Reflection of semispinalis capitis exposes the sub occipital triangle }

18. ROOF MEDIALLY MEDIALLY- Dense fibrous tissue covered by the semispinalis capitis LATERALLY LATERALLY- Longissimus Capitis

19. FLOOR Post. Arch of atlas

21. The neck rigidity occurs in meningitis due to spasm of extensor muscles on the back of the neck. The posterior cranial fossa is approached by neurosurgeons to remove the brain tumour by clearing the sub occipital muscles and removing the exposed bone. The connections between the sub occipital venous plexus and internal vertebral venous plexus serves as a path of intra cranial infection in carbuncles of the neck.

22. Origin of Suboccipital Muscles

23. Insertion of Suboccipital Muscles

24. Revision - Video

25. Ready for Quiz? Take Pen & Paper to write answers. Ready for Quiz? Take Pen & Paper to write answers.

26. A: C: B: D: Ligamentum Nuchae Flexor Muscles of Neck Sub occipital Triangle Arterial Anastomosis Select the correct answer Q 1: Which of the following structure is not present on the back of the neck? 1 / 10

27. A: C: B: D: C1,C2,C3C1,C2 C2,C3C2,C3,C4 Select the correct answer Q 2: The skin on the back of the neck is supplied by… 1 / 10

28. A: C: B: D: superior nuchal line external occipital protuberance ligamentum nuchae spine of C6. Select the correct answer Q 3: Which structure does not give origine to Trapezius muscle? 1 / 10

29. A: C: B: D: Middle third of clavicle lateral third of clavicle Lateral third of Acromion Lateral Border of Acromion Select the correct answer Q 4: Trapezius is inserted on… 1 / 10

30. A: C: B: D: transverse processes of the C1 vert. transverse processes of the C1 to C2 vert. transverse processes of the C1 to C4 vert. transverse processes of the C1 & C4 vert. Select the correct answer Q 5: Levator Scapulae originates from… 1 / 10

31. A: C: B: D: Rectus Capitis Posterior Major Levetor Scapule Superior ObliqueInferior Oblique Select the correct answer Q 6: Which muscle forms superomedial boundary of Sub occipital Triangle? 1 / 10

32. A: C: B: D: Longisimus Capitis Semispinalis Capitis Splenius CapitisPost Arch of Atlas Select the correct answer Q 7: Which structure forms the floor of the Sub occipital Triangle? 1 / 10

33. A: C: B: D: First part of Vertebral Artery Third part of Vertebral Artery First Cervical Nerve Suboccipital Venous Plexus Select the correct answer Q 8: Which is not the content of Suboccipital Triangle? 1 / 10

34. A: C: B: D: Flexor muscles on the back of the neck Extensor muscles on the back of the neck Medial muscles on the back of the neck Lateral muscles on the back of the neck Select the correct answer Q 9: Neck rigidity occurs in meningitis due to spasm of … 1 / 10

35. A: C: B: D: Lat part between Nuchal lines Medial part between Nuchal lines Spine of Axis Posterior Tubercle of Atlas Select the correct answer Q 10: Oblique capitis inferior originates from… 1 / 10

36. Correct answers : Q. 1: B Q. 2: D Q. 3: D Q. 4: B Q. 5: C Q. 6: A Q. 7: D Q. 8: A Q. 9: B Q. 10: C