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Presentation on theme: "Necks."— Presentation transcript:

1 Necks

2 Triangles of the Neck Anterior Triangle Mandible Posterior Triangle
Median Plane Triangles Posterior Triangle borders (review) Posterior: Trapezius Anterior: Sternocleidomastoid Inferior: Clavicle Anterior Triangle Borders: Lateral: Superior: Medial: Sternocleidomastoid

3 Omohyoid (superior belly)
Muscular Triangle Contents: Infrahyoid mm Cricothryoid m Thyroid gland Parathyroid gland Omohyoid (superior belly) Median plane Muscular Triangle Borders: Superolateral: Inferolateral: Medial: Contents: Muscles Glands Sternocleidomastoid

4 Hyoid Bone Hyoid bone “Hyoid” Boney articulations?
Vertebral position of hyoid: Greater horns Lesser horns Strangling

5 Cartilages Thyroid Cartilage Cricoid Cartilage Thyrohyoid membrane
Cricothyroid ligament Cricothyroid ligament Cartilages Thyroid cartilage “Thyroid” Laryngeal prominence Oblique line Thyrohyoid membrane Superior horns Inferior horn Cricoid cartilage “Cricoid” Arch Cricothyroid Membrane (or Ligament) Superior Horn Laryngeal Prominence Inferior Horn Oblique line Cricoid Cartilage Thyroid Cartilage

6 Infrahyoid “Strap” Muscles Superficial Layer
Omohyoid Superior Belly Inferior Belly Sternohyoid Omohyoid Sternohyoid Infrahyoid Muscles (Superficial) Omohyoid O: Scapula- just medial to scapular notch I: Lower border of hyoid Intermediate tendon Fascial sling attached to: Sternohyoid O: Deep side of manubrium and SC joint I: Lower border of hyoid bone Fascial sling of omohyoid

7 Infrahyoid “Strap” Muscles Deep Layer
Sternothyroid Thyrohyoid Thyrohyoid Sternohyoid Sternothyroid Omohyoid Infrahyoid Muscles (deep) Sternothyroid O: Deep side of manubrium I: Oblique line of thyroid cartilage Thyrohyoid O: Oblique line of thyroid cartilage I: Lower border of hyoid bone Collective Function (of all 4): Exception: Common Innervation:

8 Cricothyroid Muscle External Laryngeal N. Cricothyroid Cricothyroid
O: Arch of cricoid cartilage I: Lamina of thyroid cartilage Fxn: Inn: Cricothyroid

9 Thyroid Gland Variation Vasculature Pyramidal lobe Superior Thyroid A
Inferior Thyroid A Thyroid Ima (occassionally) Inferior Thyroid A Thyroid Gland Lobes Isthmus Location Pyramidal Lobe Blood Supply Superior thyroid A Branch of: Inferior thyroid A Thyroid ima

10 Thyroid: Clinical Considerations
Recurrent Laryngeal N Parathyroid Glands Considerations Thyroid Ima A Recurrent Laryngeal NN Thyroid (cont) Thyroid ima A “Ima” Branch of: Relevance Recurrent laryngeal NN Location: Supply: Thyroid Ima A

11 Parathyroid Glands Recurrent Recurrent
Most common number: Range: Pharyngeal (Brancheal) Arch of superior parathyroid glands: Same arch as: Theoretical Location of superior parathyroid glands: Pharyngeal (Brancheal) Arch of inferior parathyroid glands: Theoretical Location of inferior parathyroid glands: Common anomalous locations: Parathyroid function Recurrent Recurrent The Center for Advanced Head and Neck Surgery.

12 Suprahyoid Muscles Digastric Stylohyoid Mylohyoid Geniohyoid
Anterior Belly Posterior Belly Stylohyoid Mylohyoid Geniohyoid Digastric (post) Digastric (ant) Suprahyoid Digastic O: Digastric fossa of mandible I: Mastoid notch Intermediate tendon Fascial sling attached to: Innervation of anterior belly: Innervation of posterior belly: Additional Fxn (general fxn listed below): Stylohyoid O: Styloid process I: Hyoid bone Splits to go around: Inn: Mylohyoid O: Mylohyoid line on mandible Geniohyoid Deep to: O: Mental spines (aka genial tubercles) of mandible General function of all: Elevate/Stabilize hyoid Digastric (post) Mylohyoid Geniohyoid Stylothyoid Digastric (ant)

13 Carotid Triangle Contents: Digastric (posterior belly)
Common Carotid A. Internal Carotid A. External Carotid A. Branches Internal Jugular V. Hypoglossal N. Vagus N. (branches) Parts of Cervical Plexus Carotid triangle Borders: Lateral Medial Superior Contents (see slide) Omohyoid (superior belly) Sternocleidomastoid

14 External Carotid Bifurcation Branches Superior Thyroid A. Lingual A.
Superior Laryngeal A. Lingual A. Facial A. Ascending Pharyngeal A. Occipital A. Others: Maxillary A. Superficial Temporal A. Posterior Auricular A. Subclavian A. Common Carotid A. Superior Thyroid A. Lingual A. Occipital A. Ascending Pharyngeal A. Facial A. Carotid arteries Common Carotid origin: ‘Carotid’ Approximate location of common carotid bifurcation: Internal Carotid A Branches before entering skull? External Carotid Branches Superior Thyroid A Superior Laryngeal A Pierces: Lingual A Deep to: Facial A Common anomaly: Ascending pharyngeal A Occipital A Off external carotid but not seen in neck: Maxillary A Superficial Temporal A Posterior Auricular A

15 Sternocleidomastoid (cut)
Carotid Sheath Carotid Sheath Carotid Sheath Internal Jugular V. Vagus N. Common Carotid A. Then, Internal Carotid A Investing Fascia Pretracheal Fascia Prevertebral Fascia Carotid Sheath Carotid Sheath Carotid sheath Inferior endpoint Superior endpoint Contents: (1) (2) (3) Sternocleidomastoid (cut)

16 Cervical Plexus VPR C1-C4 Phrenic nerve Cutaneous branches
* already seen in the posterior triangle Muscular branches Cervical Plexus Anterior or posterior primary rami? Spinal cord levels: Phrenic nerve Cord levels: Location (in cervical region): Cutaneous Branches discussed last time: Lesser Occipital N (C2) Great Auricular N (C2,3) Transverse Cervical N (C2,3) Supraclavicular NN (C3,4) Muscular branches (Ansa Cervicalis) Fig 8.11 Clinically Oriented Anatomy 5th Ed. Moore & Dalley

17 Cervical Plexus: Muscular Branches
Hypoglossal N (CN XII) VPR C1 Nerve to Thyrohyoid Superior root of Ansa Cervicalis Inferior root of Ansa Cervicalis Phrenic N C2 C3 . Ansa cervicalis Superior root (C1) Inferior root (C2,3) N. to thyrohyoid Cervical Plexus (Muscular) Ansa cervicalis Supplies: Superior root: Inferior root: ‘Ansa’ Hypoglossal nerve Superior root of ansa cervicalis Nerve to thyrohyoid

18 Cervical Plexus: Muscular Branches
Phrenic N Unnamed nerves prevertebral mm. N. to thyrohyoid Ansa cervicalis Superior root Inferior root Spatial context of ansa cervicalis Relation of superior root to carotid sheath: Relation of inferior root to carotid sheath: Contents of carotid sheath: Fig 7.8, Grant’s Dissector 14th Ed.

19 Submandibular Triangle
Mandible Contents: Submandibular gland Facial A. & V. Stylohyoid M. Lymph Nodes Hypoglossal N (portion) Digastric (Post. Belly) Submandibular triangle Borders: Superior Posteroinferior Anteroinferior Contents (see slide) Digastric (Ant. Belly)

20 Hypoglossal Nerve (CNXII)
Hypoglossal N (CN XII) Hypoglossal nerve Origin: medulla oblongata Exits skull: VPR C1 Supplies: Exception: Functional component(s) of Hypoglossal:

21 Digastric (Ant. Bellies)
Submental Triangle Digastric (Ant. Bellies) Contents: Submental Lymph Nodes Hyoid Submental triangle “Mental” Borders: Inferior Superolateral (both sides) Contents:

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