Triangles of the Neck: Difference between revisions
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'''Original Editor '''- [[User:Carina Therese Magtibay|Carina Therese Magtibay]] | |||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | |||
</div> | |||
[[Category:Anatomy]] [[Category:Muscles]] | |||
== Description == | == Description == | ||
{{#ev:youtube|CUvmlf3Wxng}} <ref>5MinuteSchool. TRIANGLES OF THE NECK ANATOMY MADE EASY - EXPLAINED in 3 MINUTES!! CERVICAL TRIANGLES. Available from: https://www.youtube.com/watch?v=CUvmlf3Wxng [last accessed 05/11/2020]</ref> | The neck is the anatomical region that supports the head and serves as a conduit for vital structures passing to and from the torso. As a geometric region, it can be clinically divided using anatomical triangles.{{#ev:youtube|CUvmlf3Wxng}} <ref>5MinuteSchool. TRIANGLES OF THE NECK ANATOMY MADE EASY - EXPLAINED in 3 MINUTES!! CERVICAL TRIANGLES. Available from: https://www.youtube.com/watch?v=CUvmlf3Wxng [last accessed 05/11/2020]</ref> | ||
The [[Sternocleidomastoid|sternocleidomastoid muscle]] obliquely crosses the neck to form the division between the two major neck triangles: anterior triangle and posterior triangle. Both triangles are further divided into sub-triangles. <ref name=":0">Kikuta S, Iwanaga J, Kusukawa J, Tubbs RS. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624334/#:~:text=The%20three%20paired%20triangles%20are,triangle%20is%20the%20submental%20triangle. Triangles of the neck: a review with clinical/surgical applications. Anatomy & Cell Biology.] 2019 Jun 1;52(2):120-7.</ref><ref>Kohan EJ, Wirth GA. [https://www.plasticsurgery.theclinics.com/article/S0094-1298(13)00103-X/fulltext Anatomy of the neck.] Clinics in plastic surgery. 2014 Jan 1;41(1):1-6.</ref> | |||
# Anterior Triangle | # Anterior Triangle | ||
Line 20: | Line 23: | ||
The neck is limited<ref name=":0" />: | The neck is limited<ref name=":0" />: | ||
* superiorly by the inferior border of the mandible | * superiorly by the inferior border of the [[mandible]] | ||
* anteriorly by midline of the neck | * anteriorly by the midline of the neck | ||
* inferiorly by the superior border of the clavicle | * inferiorly by the superior border of the [[clavicle]] | ||
* posteriorly by the anterior margin of the trapezius muscle. | * posteriorly by the anterior margin of the [[trapezius]] muscle. | ||
== Anterior Triangle == | == Anterior Triangle == | ||
{{#ev:youtube|YOgE2pmXfZg}} <ref>Anatomy Knowledge. The Anterior Triangle of the Neck - Boundaries x Subdivisions | Anatomy Tutorial. Available from: https://www.youtube.com/watch?v=YOgE2pmXfZg [last accessed 10/06/2020]</ref> | |||
Borders:<ref name=":0" /><ref name=":1">Stathakios J, Carron MA. [https://www.ncbi.nlm.nih.gov/books/NBK554398/#:~:text=Anterior%20Triangle,border%20of%20the%20sternocleidomastoid%20muscle. Anatomy, Head and Neck, Neck Triangle]. InStatPearls [Internet] 2021 Jul 31. StatPearls Publishing.</ref> | |||
The Anterior Triangle has an apex | * Superior border - inferior border of the mandible | ||
* Medial border- midline of the neck | |||
* Lateral border- anterior border of the sternocleidomastoid muscle | |||
'''The Anterior Triangle has an apex extending to the sternum's manubrium. It is made up of three paired triangles: submandibular (digastric), carotid, and muscular (omotracheal/infrahyoid) triangles, and one unpaired triangle: submental triangle.''' | |||
=== Submandibular/Digastric Triangle === | === Submandibular/Digastric Triangle === | ||
Borders:<ref name=":0" /><ref>Casale J, Varacallo M. [https://www.ncbi.nlm.nih.gov/books/NBK534833/#:~:text=The%20submandibular%20triangle%20is%20bounded,formed%20by%20the%20mylohyoid%20muscle. Anatomy, Head and Neck, Submandibular Triangle]. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022. PMID: 30521254.</ref> | Borders:<ref name=":0" /><ref name=":2">Casale J, Varacallo M. [https://www.ncbi.nlm.nih.gov/books/NBK534833/#:~:text=The%20submandibular%20triangle%20is%20bounded,formed%20by%20the%20mylohyoid%20muscle. Anatomy, Head and Neck, Submandibular Triangle]. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022. PMID: 30521254.</ref> | ||
* Superior - inferior border of mandible | * Superior - inferior border of the mandible | ||
* Anterior - anterior belly of digastric muscle | * Anterior - anterior belly of [[Digastric Muscle|digastric]] muscle | ||
* Posterior - posterior belly of digastric muscle | * Posterior - the posterior belly of the digastric muscle | ||
* Inferior - hyoid bone | * Inferior - [[Hyoid Bone|hyoid]] bone | ||
Floor: mylohyoid muscle | Floor: [[Mylohyoid Muscle|mylohyoid]] muscle | ||
Contents:<ref name=":0" /> | Contents:<ref name=":0" /> | ||
Line 48: | Line 55: | ||
* Glands and lymphatics: submandibular gland and lymph nodes, lower pole of the parotid gland. | * Glands and lymphatics: submandibular gland and lymph nodes, lower pole of the parotid gland. | ||
* Blood vessels: facial, lingual and submental arteries and veins | * Blood vessels: facial, lingual and submental arteries and veins | ||
* Nerves: marginal mandibular branch of the facial nerve, nerve to the mylohyoid, hypoglossal nerve (CN XII), and the | * Nerves: marginal mandibular branch of the facial nerve, nerve to the mylohyoid, [[Hypoglossal Nerve|hypoglossal nerve]] (CN XII) | ||
'''Clinical Significance:'''<ref name=":2" /> | |||
* Neoplasms, infectious and immunologic pathologies can arise from the submandibular triangle. | |||
* Sialadenitis- inflammation of the submandibular salivary gland. The most common pathology seen in the submandibular triangle. | |||
* Pleomorphic adenoma- the most common benign neoplasm arising in the submandibular triangle followed by adenolymphoma, also known as Warthin’s tumour | |||
* Adenoid cystic carcinoma- the most common malignant neoplasm in the submandibular triangle, followed by mucoepidermoid carcinoma. | |||
=== Carotid Triangle === | === Carotid Triangle === | ||
Borders:<ref name=":0" /> | Borders:<ref name=":0" /> | ||
* Superior - stylohyoid and posterior belly of digastric muscles | * Superior - [[stylohyoid]] and posterior belly of digastric muscles | ||
* Anterior - superior belly of omohyoid muscle | * Anterior - the superior belly of the omohyoid muscle | ||
* Posterior - anterior border of sternocleidomastoid muscle | * Posterior - anterior border of the sternocleidomastoid muscle | ||
Floor: hyoglossus, thyrohyoid, and inferior and middle pharyngeal constrictor muscles | Floor: hyoglossus, thyrohyoid, and inferior and middle pharyngeal constrictor muscles | ||
Line 64: | Line 79: | ||
* Arteries: common carotid and its bifurcation into internal and external carotid arteries, superior thyroid, lingual, facial, occipital, and ascending pharyngeal arteries | * Arteries: common carotid and its bifurcation into internal and external carotid arteries, superior thyroid, lingual, facial, occipital, and ascending pharyngeal arteries | ||
* Veins: internal jugular, superior thyroid, lingual, facial, ascending pharyngeal, and occipital veins | * Veins: internal jugular, superior thyroid, lingual, facial, ascending pharyngeal, and occipital veins | ||
* Nerves: external and internal branches of the superior laryngeal nerve arising from the vagus nerve (CN X), hypoglossal nerve (CN XII). | * Nerves: external and internal branches of the superior laryngeal nerve arising from the [[Vagus Nerve|vagus]] nerve (CN X), hypoglossal nerve (CN XII). | ||
'''Clinical Significance:'''<ref name=":1" /> | |||
* Distention of the jugular vein can be palpated and assessed in the carotid triangle | |||
* Internal jugular vein is usually utilized to establish central venous access for parental nutrition, dialysis, and administration of chemotherapy drugs. | |||
* Carotid sinus is a baroreceptor that regulates blood pressure. Carotid sinus massage can be performed to terminate supraventricular tachycardia and other cardiac arrhythmias as. | |||
=== Muscular Triangle === | === Muscular Triangle === | ||
Borders:<ref name=":0" /> | Borders:<ref name=":0" /><ref>Standring S. Gray's anatomy: the anatomical basis of clinical practice. 41st ed. London: Elsevier Health Sciences; 2015.</ref> | ||
* Anterior- midline of neck | * Anterior- midline of the neck | ||
* Inferoposterior- anterior margin of the | * Inferoposterior- anterior margin of the sternocleidomastoid muscle | ||
* Posterosuperior- superior belly of the omohyoid muscle | * Posterosuperior- the superior belly of the omohyoid muscle | ||
Line 80: | Line 102: | ||
* Muscles: thyrohyoid, sternothyroid, sternohyoid, omohyoid muscles | * Muscles: thyrohyoid, sternothyroid, sternohyoid, omohyoid muscles | ||
* Nerves: ansa cervicalis (C1-3) | * Nerves: ansa cervicalis (C1-3) | ||
* Organs: esophagus, trachea, thyroid gland, and the lower part of the larynx | * Organs: esophagus, [[Trachea and Larynx|trachea]], [[Thyroid Gland|thyroid]] gland, and the lower part of the [[Trachea and Larynx|larynx]] | ||
'''Clinical Significance:'''<ref name=":0" /> | |||
* Tracheostomy and thyroidectomy- surgically accessed through the muscular triangle | |||
* Injury of the superior thyroid artery can result in bleeding during surgery. | |||
=== Submental Triangle === | === Submental Triangle === | ||
Borders:<ref name=":0" /> | Borders:<ref name=":0" /> | ||
* Inferior - hyoid bone | * Inferior - hyoid bone | ||
* Lateral - anterior belly of digastric muscle | * Lateral - the anterior belly of the digastric muscle | ||
* Medial - midline of neck | * Medial - midline of the neck | ||
Floor: mylohyoid muscle | Floor: mylohyoid muscle | ||
Line 96: | Line 122: | ||
* submental lymph nodes | * submental lymph nodes | ||
* anterior jugular vein | * anterior jugular vein | ||
'''Clinical Significance:'''<ref>Al-Missri MZ, Al Khalili Y. [https://www.ncbi.nlm.nih.gov/books/NBK545296/ Anatomy, Head and Neck, Submental Triangle]. InStatPearls [Internet] 2022 Jun 4. StatPearls Publishing.</ref> | |||
* Tumors and cysts develop within the submental triangle | |||
* Abscess from odontogenic infections can spread into the submental space | |||
* Swollen submental lymph nodes can be indicative of malignant lesions. However, lesions in this area commonly develop from a local and benign pathology of the head and neck | |||
* The submental lymph nodes are commonly involved in the metastasis of oral cavity cancer<ref>Trivić A, Krejović-Trivić S, Milovanović J, Djukić V, Arsović N, Dimitrijević M, Petrović Z, Mikić A. [https://pubmed.ncbi.nlm.nih.gov/15756792/ Distribution of cervical metastases from carcinoma of the cervicofacial region]. Acta Chirurgica Iugoslavica. 2004 Jan 1;51(1):83-7.</ref> | |||
== Posterior Triangle == | == Posterior Triangle == | ||
{{#ev:youtube|UoVIk4tvX_w}} <ref>Anatomy Knowledge. The Posterior Triangle of the Neck - Boundaries & Content - Head & Neck Anatomy. Available from: https://www.youtube.com/watch?v=UoVIk4tvX_w [last accessed 16/09/2019]</ref> | |||
Borders:<ref name=":0" /> | |||
* Anterior - posterior margin of sternocleidomastoid muscle | |||
* Posterior - anterior margin of trapezius muscle | |||
* Inferior - middle one-third of clavicle | |||
'''<br /> | |||
Two subdivisions are formed within the posterior triangle: Occipital Triangle and the Subclavian/Supraclavicular Triangle''' | |||
=== Occipital Triangle === | === Occipital Triangle === | ||
Borders:<ref name=":0" /> | |||
* Anterior - posterior margin of sternocleidomastoid muscle | |||
* Posterior - anterior margin of trapezius muscle | |||
* Inferior - the inferior belly of the omohyoid muscle | |||
Floor: [[Levator Scapulae|levator scapulae]], [[Splenius Capitis|splenius capitis]], and middle and posterior [[Scalene|scalene muscles]] | |||
Contents:<ref name=":0" /> | |||
* Artery: transverse cervical artery | |||
* Lymphatics: accessory lymph nodes and inferior deep lateral cervical lymph nodes | |||
* Nerves: accessory nerve (CN XI), cutaneous and muscular branches of the [[Cervical Plexus|cervical plexus]], the uppermost part of [[Brachial Plexus|brachial plexus]], supraclavicular nerves | |||
'''Clinical Significance:''' | |||
* A lot of nerves pass through the occipital triangle. It houses major nerves that innervate muscles vital for head and neck functions | |||
=== Subclavian/Supraclavicular/Omoclavicular Triangle === | |||
Borders: <ref name=":0" /> | |||
* Superior - the inferior belly of the omohyoid muscle | |||
* Anterior-posterior edge of the sternocleidomastoid muscle | |||
* Inferior - clavicle | |||
Contents: <ref name=":0" /> | |||
* Blood vessels: subclavian artery and vein | |||
* Nerves: brachial plexus trunks and nerve to subclavius muscle | |||
* Lymphatics: supraclavicular lymph nodes | |||
'''Clinical Significance:'''<ref>Casale J, Geiger Z. [https://www.statpearls.com/ArticleLibrary/viewarticle/36637 Anatomy, Head and Neck, Posterior Neck Triangle]. InStatPearls [Internet] 2021 Jul 26. StatPearls Publishing.</ref> | |||
* Virchow’s node, the left-sided supraclavicular lymph node, can be used to aid in the discovery and diagnosis of carcinomas originating from the abdomen. Troisier’s sign (an enlarged, firm, non-tender Virchow’s node) can indicate cancer arising from the stomach, ovaries, testicles, and kidneys. | |||
* The right-sided supraclavicular lymph node drains lymphatic fluid from the thorax. A firm, enlarged, non-tender right-sided supraclavicular lymph node can indicate metastasis from lung or oesophagal cancer and Hodgkin’s lymphoma. | |||
== | == References == | ||
<references /> | |||
[[Category:Cervical Spine - Anatomy]] | |||
[[Category:Anatomical Landmarks]] |
Latest revision as of 19:02, 8 March 2024
Original Editor - Carina Therese Magtibay
Top Contributors - Carina Therese Magtibay, Ewa Jaraczewska and Kim Jackson
Description[edit | edit source]
The neck is the anatomical region that supports the head and serves as a conduit for vital structures passing to and from the torso. As a geometric region, it can be clinically divided using anatomical triangles.
The sternocleidomastoid muscle obliquely crosses the neck to form the division between the two major neck triangles: anterior triangle and posterior triangle. Both triangles are further divided into sub-triangles. [2][3]
- Anterior Triangle
- Digastric/Submandibular Triangle
- Carotid Triangle
- Muscular Triangle
- Submental Triangle
- Posterior Triangle
- Occipital Triangle
- Subclavian/Supraclavicular
The neck is limited[2]:
- superiorly by the inferior border of the mandible
- anteriorly by the midline of the neck
- inferiorly by the superior border of the clavicle
- posteriorly by the anterior margin of the trapezius muscle.
Anterior Triangle[edit | edit source]
- Superior border - inferior border of the mandible
- Medial border- midline of the neck
- Lateral border- anterior border of the sternocleidomastoid muscle
The Anterior Triangle has an apex extending to the sternum's manubrium. It is made up of three paired triangles: submandibular (digastric), carotid, and muscular (omotracheal/infrahyoid) triangles, and one unpaired triangle: submental triangle.
Submandibular/Digastric Triangle[edit | edit source]
- Superior - inferior border of the mandible
- Anterior - anterior belly of digastric muscle
- Posterior - the posterior belly of the digastric muscle
- Inferior - hyoid bone
Floor: mylohyoid muscle
Contents:[2]
- Glands and lymphatics: submandibular gland and lymph nodes, lower pole of the parotid gland.
- Blood vessels: facial, lingual and submental arteries and veins
- Nerves: marginal mandibular branch of the facial nerve, nerve to the mylohyoid, hypoglossal nerve (CN XII)
Clinical Significance:[6]
- Neoplasms, infectious and immunologic pathologies can arise from the submandibular triangle.
- Sialadenitis- inflammation of the submandibular salivary gland. The most common pathology seen in the submandibular triangle.
- Pleomorphic adenoma- the most common benign neoplasm arising in the submandibular triangle followed by adenolymphoma, also known as Warthin’s tumour
- Adenoid cystic carcinoma- the most common malignant neoplasm in the submandibular triangle, followed by mucoepidermoid carcinoma.
Carotid Triangle[edit | edit source]
Borders:[2]
- Superior - stylohyoid and posterior belly of digastric muscles
- Anterior - the superior belly of the omohyoid muscle
- Posterior - anterior border of the sternocleidomastoid muscle
Floor: hyoglossus, thyrohyoid, and inferior and middle pharyngeal constrictor muscles
Contents:[2]
- Arteries: common carotid and its bifurcation into internal and external carotid arteries, superior thyroid, lingual, facial, occipital, and ascending pharyngeal arteries
- Veins: internal jugular, superior thyroid, lingual, facial, ascending pharyngeal, and occipital veins
- Nerves: external and internal branches of the superior laryngeal nerve arising from the vagus nerve (CN X), hypoglossal nerve (CN XII).
Clinical Significance:[5]
- Distention of the jugular vein can be palpated and assessed in the carotid triangle
- Internal jugular vein is usually utilized to establish central venous access for parental nutrition, dialysis, and administration of chemotherapy drugs.
- Carotid sinus is a baroreceptor that regulates blood pressure. Carotid sinus massage can be performed to terminate supraventricular tachycardia and other cardiac arrhythmias as.
Muscular Triangle[edit | edit source]
- Anterior- midline of the neck
- Inferoposterior- anterior margin of the sternocleidomastoid muscle
- Posterosuperior- the superior belly of the omohyoid muscle
Contents:[2]
- Blood vessels: superior thyroid artery, anterior jugular and inferior thyroid veins
- Lymphatics: anterior cervical, infrahyoid, prelaryngeal, thyroid, pretracheal, paratracheal lymph nodes
- Muscles: thyrohyoid, sternothyroid, sternohyoid, omohyoid muscles
- Nerves: ansa cervicalis (C1-3)
- Organs: esophagus, trachea, thyroid gland, and the lower part of the larynx
Clinical Significance:[2]
- Tracheostomy and thyroidectomy- surgically accessed through the muscular triangle
- Injury of the superior thyroid artery can result in bleeding during surgery.
Submental Triangle[edit | edit source]
Borders:[2]
- Inferior - hyoid bone
- Lateral - the anterior belly of the digastric muscle
- Medial - midline of the neck
Floor: mylohyoid muscle
Contents:[2]
- submental lymph nodes
- anterior jugular vein
Clinical Significance:[8]
- Tumors and cysts develop within the submental triangle
- Abscess from odontogenic infections can spread into the submental space
- Swollen submental lymph nodes can be indicative of malignant lesions. However, lesions in this area commonly develop from a local and benign pathology of the head and neck
- The submental lymph nodes are commonly involved in the metastasis of oral cavity cancer[9]
Posterior Triangle[edit | edit source]
Borders:[2]
- Anterior - posterior margin of sternocleidomastoid muscle
- Posterior - anterior margin of trapezius muscle
- Inferior - middle one-third of clavicle
Two subdivisions are formed within the posterior triangle: Occipital Triangle and the Subclavian/Supraclavicular Triangle
Occipital Triangle[edit | edit source]
Borders:[2]
- Anterior - posterior margin of sternocleidomastoid muscle
- Posterior - anterior margin of trapezius muscle
- Inferior - the inferior belly of the omohyoid muscle
Floor: levator scapulae, splenius capitis, and middle and posterior scalene muscles
Contents:[2]
- Artery: transverse cervical artery
- Lymphatics: accessory lymph nodes and inferior deep lateral cervical lymph nodes
- Nerves: accessory nerve (CN XI), cutaneous and muscular branches of the cervical plexus, the uppermost part of brachial plexus, supraclavicular nerves
Clinical Significance:
- A lot of nerves pass through the occipital triangle. It houses major nerves that innervate muscles vital for head and neck functions
Subclavian/Supraclavicular/Omoclavicular Triangle[edit | edit source]
Borders: [2]
- Superior - the inferior belly of the omohyoid muscle
- Anterior-posterior edge of the sternocleidomastoid muscle
- Inferior - clavicle
Contents: [2]
- Blood vessels: subclavian artery and vein
- Nerves: brachial plexus trunks and nerve to subclavius muscle
- Lymphatics: supraclavicular lymph nodes
Clinical Significance:[11]
- Virchow’s node, the left-sided supraclavicular lymph node, can be used to aid in the discovery and diagnosis of carcinomas originating from the abdomen. Troisier’s sign (an enlarged, firm, non-tender Virchow’s node) can indicate cancer arising from the stomach, ovaries, testicles, and kidneys.
- The right-sided supraclavicular lymph node drains lymphatic fluid from the thorax. A firm, enlarged, non-tender right-sided supraclavicular lymph node can indicate metastasis from lung or oesophagal cancer and Hodgkin’s lymphoma.
References[edit | edit source]
- ↑ 5MinuteSchool. TRIANGLES OF THE NECK ANATOMY MADE EASY - EXPLAINED in 3 MINUTES!! CERVICAL TRIANGLES. Available from: https://www.youtube.com/watch?v=CUvmlf3Wxng [last accessed 05/11/2020]
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 Kikuta S, Iwanaga J, Kusukawa J, Tubbs RS. Triangles of the neck: a review with clinical/surgical applications. Anatomy & Cell Biology. 2019 Jun 1;52(2):120-7.
- ↑ Kohan EJ, Wirth GA. Anatomy of the neck. Clinics in plastic surgery. 2014 Jan 1;41(1):1-6.
- ↑ Anatomy Knowledge. The Anterior Triangle of the Neck - Boundaries x Subdivisions | Anatomy Tutorial. Available from: https://www.youtube.com/watch?v=YOgE2pmXfZg [last accessed 10/06/2020]
- ↑ 5.0 5.1 Stathakios J, Carron MA. Anatomy, Head and Neck, Neck Triangle. InStatPearls [Internet] 2021 Jul 31. StatPearls Publishing.
- ↑ 6.0 6.1 Casale J, Varacallo M. Anatomy, Head and Neck, Submandibular Triangle. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022. PMID: 30521254.
- ↑ Standring S. Gray's anatomy: the anatomical basis of clinical practice. 41st ed. London: Elsevier Health Sciences; 2015.
- ↑ Al-Missri MZ, Al Khalili Y. Anatomy, Head and Neck, Submental Triangle. InStatPearls [Internet] 2022 Jun 4. StatPearls Publishing.
- ↑ Trivić A, Krejović-Trivić S, Milovanović J, Djukić V, Arsović N, Dimitrijević M, Petrović Z, Mikić A. Distribution of cervical metastases from carcinoma of the cervicofacial region. Acta Chirurgica Iugoslavica. 2004 Jan 1;51(1):83-7.
- ↑ Anatomy Knowledge. The Posterior Triangle of the Neck - Boundaries & Content - Head & Neck Anatomy. Available from: https://www.youtube.com/watch?v=UoVIk4tvX_w [last accessed 16/09/2019]
- ↑ Casale J, Geiger Z. Anatomy, Head and Neck, Posterior Neck Triangle. InStatPearls [Internet] 2021 Jul 26. StatPearls Publishing.