Side of the neck
Landmarks1. Sternoclediomastoid
muscle
2. External jugular vein
3. Greater supraclavicular
fossa
4. Lesser supraclavicular
fossa
5. Mastoid process
6. Transverse process of
atlas
7. Anterior border of
trapezius
Side of the neck
Side of the neck
SkinNerve supply- 2nd , 3rd &
4th cervical nerve
Anterolateral part- ant
prim rami through the
cutaneous, greater
auricular, lesser
occiptial &
supraclavicular nerves
Posterior part- dorsal
posterior primary rami
Side of the neck
Deep fascia1. Investing fascia
2. Pretracheal fascia
3. Prevertebral
fascia
4. Carotid sheath
5. Buccopharyngeal
fascia
6. Pharyngobasilar
fascia
Side of the neck
Investing fascia
Attachment
Superiorly-i)external occipital protuberance,ii) superior nuchal line,iii)mastoid
process & base of mandible. The fascia splits to enclose the parotid gland.
It has superficial lamina- parotid fascia thick & dense and attached to the
zygomatic arch
Deep lamina- thin & attached to the styloid process, mandible and the tympanic
bone. Between the styloid process and the mandible the lamina is thickened
to form stylomandibular lig which separates the parotid gland from the
submandibular gland & is pierced by ECA.
Inferiorly-i) spine of scapula, ii)acromion process, iii) clavicle & iv) manubrium.
The fascia splits to enclose the suprasternal and supraclavicular spaces
Posteriorly- i) ligamentum nuchae &ii) spine of 7th cerivcal vertebra
Anteriorly-i) symphysis menti, ii) hyoid bone. It is attached both above and
below to hyoid bone.
Side of the neck
Side of the neck
Pretracheal fascia
AttachmentSuperiorly-i) hyoid bone in the median plane, ii)
oblique line of thyroid cartilage &iv) cricoid
cartilage
Inferiorly-below the thyroid gland it encloses the
inferior thyroid veins and passes behind the
brachiocephalic veins and blends with the arch of
the aorta
On each sides- fuses with the front of the carotid
sheath deep to the sternoclediomastoid muscle.
Side of the neck
Side of the neck
Prevertebral fasciaAttachment
Superiorly- base of the mandible
Inferiorly- extends to the superior mediastinum
and attached to the anterior longitudinal
ligament and to the body of the 4th T vertebra
Anteriorly-separated from the pharynx &
buccopharyngeal fascia by the retropharyngeal
space which contains loose aerolar tissue
Laterally- it lost deep to the trapezius
Side of the neck
Side of the neck
Carotid sheath
Condensation of fibroaerolar tissue
around the main vessels of the
neck. These are CCA, ICA, IJV
and vagus nerve.
Relations
Ansa cervicalis lies embedded in the
anterior wall of the carotid sheath
Cervical sympathetic chain lies behind
the sheath, plastered to the
prevertebral fascia
Sheath is overlapped by the anterior
border of the sternoclediomastoid
and is fused to first three layers of
the deep cervical fascia
Side of the neck
Buccopharyngeal
fasciaIt encloses the superior
constrictor muscle
externally & extends
on the superficial
aspect of the
buccinator muscle
Pharyngobasilar fasciaThickened between the
upper border of the
superior constrictor
muscle and the base
of the skull & lying
deep to the
pharyngeal muscles.
Side of the neck
Side of the neck
Clinical anatomy1. Parotid swellings are very painful
2. While excising submandibular gland, ECA should be secured before
dividing otherwise retract through the submandibular lig and cause serious
bleeding
3. Thyroid gland and all the thyroid swelling moves with deglutition because
the thyroid is attached to larynx by the suspensory lig of the berry.
4. Neck infection behind the prevertebral fascia-i) a chronic retropharyngeal
abscess: bulging in the posterior wall of the pharynx median plane ,ii)
laterally to the axillary sheath and point in the posterior triangle iii) superior
mediastinum
5. Neck infection in front of the prevertebral fascia-i) acute retropharyngeal
abscess which bulges forwards in the paramedian position due to fusion of
buccopharygneal fascia to the prevertebral fascia in the median plane. ii)
superior mediastinum and to the posterior mediastinum
6. Neck infection in front of the pretracheal fascia- suprasternal area or
extends downwards into the anterior mediastinum
7. EJV- (air embolism and consequent death)
Posterior triangle
BoundariesAnter- post border of sternoclediomastoid
Post- ant border of trapezius
Infer or base- middle 1/3rd of clavicle
Apex- lies on superior nuchal line where the trapezius &
sternoclediomastoid meets
Roof-i) investing layer of deep cervical fascia, ii) platysma, iii) EJV
& posterior external jugular vein, iv)supraclavicular, greater
auricular, transverse cutaneous and lesser occipital nerves v)
unnamed arteries derived from the occipital, transverse cervical
and suprascapular arteries & vi) lymph vessels which pierce the
deep fascia to end, in the supraclavicular nodes
Floor-prevertebral fascia of the deep cervical fascia, i) splenius
capitis, levator scapulae, scalenus medius & scalenus posterior
Posterior triangle
Posterior triangle
Posterior triangle
Posterior triangle
Subdivision of the
triangleInferior belly of
omohyoid muscle
1. Occipital triangle
2. Supraclavicular
triangle or
subclavian
triangle
Posterior triangle
Posterior triangle
Posterior triangle
Sternoclediomastoid muscleOrigin- sternal head arises
from superolateral part of
the front of the manubrium
sterni & clavicular head is
musculotendinous arising
from medial 1/3rd of
superior surface of the
clavicle
Insertion-lateral surface of
the mastoid process, from
its tip to its superior border
& lateral ½ of the superior
nuchal line
Posterior triangle
Nerve supplyspinal accessory nerve is motor, branches from the ventral rami
of C2 which is proprioceptive
Blood supply(1)superior thyroid artery & suprascapular arteries; (2) occipital
artery
Veins are the same name as that of the arteries
Action• When one muscle contracts: a) turns the chin to the
opposite side, b) also tilts the head towards the shoulder
• When both muscles contracts: a) draw the head forwards,
as in eating and in lifting the head from the pillow, b) with the
longus colli they fix the neck against the resistance, c)
reverse action of the forceful inspiration
Posterior triangle
Relations- Sternoclediomastoid is enclosed in the investing layer of the deep
fascia & pierced by the accessory nerve and by 4 sternoclediomastoid
arteries.
Superficial- skin, superficial fascia; superficial lamina of the deep cervical
fascia; platysma; EJV, superficial cervical lymph nodes; greater auricular,
transverse or anterior cutaneous & medial supraclavicular nerves and
parotid gland
Deep1. bones & joints: mastoid process,sternoclavicular jt
2. Carotid sheath
3. Muscles- sternohoid,sternothyroid,omohyoid, 3scalene, levator scapulae,
splenius capitis, longissimus capitis & posterior belly of the digastric
4. Arteries-CCA,ICA,ECA, sternmastoid arteries 2 from the occipital, 1 from
superior thyroid and suprascapular, occipital, subclavian, suprascapular
and transverse cervical
5. Veins- IJV, ant jugular vein, facial and lingual vein
6. Nerves- vagus, accessory,cervical plexus, upper part of the brachial
plexus,phrenic and ansa cervicalis
7. Lymph nodes- deep cervical
Posterior triangle
Clinical anatomy1. Swelling in the posterior triangle is due enlargement of supraclaviular
lymph nodes. Lipoma, cystic hygroma or lymphangioma, pharyngeal
pouch or a cervical rib. Supraclavicular lymph nodes are commonly
enlarged in tuberculosis, Hodgkin’s disease and in malignant growth of
the breast, arm or chest.
2. Left supraclavicular nodes or Virchow’s or Scalene nodes are mostly
involved in malignant growths of distant organs, eg stomach,testis and
other abdominal organs. Because of the drainage to the thoracic duct
3. Torticollis or wry neck- deformity in which the head bent to one side and
the chin points to the other side.
a) Rehumatic torticollis- due to exposure to cold or draught
b) Reflex torticollis- due to inflamed or suppurating cervical lymph nodes
which irritate the spinal accessory nerve
c) Congenital torticollis- due to birth injury
d) Spasmodic torticollis- due to central irritation
4. Block dissection of the neck- (malignant disease) removal of cervical lymph
nodes along with other structures involved in the growth.
Posterior triangle
5. Cervical rib may compress the subclavian artery.
Decrease in the radial pulse or obliterated on
turning the patient head upwards and to the
affected side after a deep breath blood( Adson’s
test)
6. Dysphagia caused by compression of the
oesophagus by an abnormal subsclavian artery is
called dysphagia lusoria
7.Blalock’s operation for fallot’s tetratogy right
subsclavian artery is anastomosed end to side
short circuit the pulmonary stenosis