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Anterior Cervical Triangle the Anterior Triangle of the Neck Is Bounded By

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Anterior Cervical Triangle the Anterior Triangle of the Neck Is Bounded By Anterior Cervical Triangle The anterior triangle of the neck is bounded by 1. the anterior border of the SCM 2. the anterior midline of the neck. 3. the mandible. 1 Anterior Cervical Triangle The anterior triangle is subdivided into four smaller triangles for descriptive purposes 1. Submental triangle 2. Submandibular (digastric) triangle 3. Carotid triangle 4. Muscular (omotracheal) triangle 2 The submental triangle inferior to the chin is an unpaired suprahyoid area bounded by : 1. the body of the hyoid bone inferiorly 2. the right and left anterior bellies of the digastric muscles laterally. 3 The submental triangle The floor of the submental triangle is formed by the two mylohyoid muscles, which meet in a median fibrous raphe. The apex of the submental triangle is at the mandibular symphysis The base is formed by the hyoid bone. 4 The submental triangle This triangle contains: 1. several small submental lymph nodes. 2. small veins that unite to form ' the anterior jugular vein. 5 6 7 The submandibular triangle It is a glandular area between the inferior border of the mandible and the anterior and posterior bellies of the digastric and the stylohyoid muscle Above by the lower border of the mandible Some people refer to it as the "digastric triangle." The floor of the submandibular triangle is formed by the mylohyoid muscle, hyoglossus muscle, and middle constrictor of the pharynx. 8 Anterior of the triangle contains the submandibular salivary gland the facial deep to the gland The vein and the submandibular LN superficial to the gland The hypoglossal nerve runs on the hypoglossal muscle deep to the gland Maylohyiod nerve and vessel runs inferior surface of this muscle 9 10 Posterior par of the triangle lies the carotid sheath, with the carotid arteries, internal jugular vein, vagus nerve The lower part of the parotid gland projects into the triangle. 11 Submandibular Gland The submandibular gland consists of a mixture of serous and mucous acini. It lies beneath the lower border of the body of the mandible and is divided into superficial and deep parts by the mylohyoid muscle.posterior border of the muscle 12 Superficial surface fills the same space of the between the mandible and the investing layer of fascia It has three surface lateral, medial and inferior.the lateral lies against the submandibular fossa of the mandible overlaping the front of the medial ptrygoid insertion Being deeply grooved posteriorly by the facial artery which hook under the mandible to reach the face 13 the inferior or superficial surface is covered by skin,platysma,and investing fascia and is crossed by the facial vein and the cervical branch of the facial nerve and also by the marginal mandibular branch of the facial nerve. Sumandibular lymph node lie not only in contact with surface of the gland but also within its substance. 14 The medial surface lie against the myelohyoid and its vessels but at the back it overlap the hyoglossus and lingual nerve and the submandibular ganglia nad hypoglossal nerve and the deep lingual vein 15 The deep part of the gland extend forward for a variable distance Sometimes few milimeters between mylohyoid and hyoglossus muscle with lingual nerve above it the submandibular duct and the hyopoglossal nerve below it 16 Submandibular Gland The deep part of the gland lies beneath the mucous membrane of the mouth on the side of the tongue. The submandibular duct emerges from the anterior end of the deep part of the gland and runs forward beneath the mucous membrane of the mouth. It opens into the mouth on a small papilla, which is situated at the side of the frenulum of the tongue 17 submandibular duct ,approximately 5 cm long, arises from the portion of the gland that lies between the mylohyoid and the hyoglossus muscles. Passing from lateral to medial, the lingual nerve loops under the duct that runs anteriorly, opening by one to three orifices on a small sublingual papilla beside the base of the lingual frenulum. The orifices of the submandibular ducts are visible, and saliva can often be seen trickling from them (or spraying from them during yawning .) 18 19 The submandibular gland 1. nearly fills this triangle. 2. Approximately half the size of the parotid gland. 3. the submandibular gland is usually palpable as a soft mass between the body of the mandible and the mylohyoid muscle. 20 The submandibular gland 4. Submandibular lymph nodes lie on each side of the submandibular gland and along the inferior border of the mandible. 5. The submandibular duct approximately 5 cm in length, passes from the deep process of the 21 Nerve Supply Parasympathetic secretomotor supply is from the facial nerve via the chorda tympani, and the submandibular ganglion. The postganglionic fibers pass directly to the gland. 22 Submandibular Ganglion The submandibular ganglion is a parasympathetic ganglion that lies deep to the submandibular salivary gland and is attached to the lingual nerve by small nerves( and .)66-11 Preganglionic parasympathetic fibers reach the ganglion from the facial nerve via the chorda tympani and the lingual nerves. Postganglionic secretomotor fibers pass to the submandibular and the sublingual salivary glands 23 24 The arterial supply of the submandibular glands is from the submental arteries. The veins accompany the arteries. The lymphatic vessels of the glands end in the deep cervical lymph nodes ,particularly the jugulo- omohyoid node. Developmentally the gland is almost certainly of ectodermal origin from the floor of the mouth 25 Clinical Notes Submandibular Salivary Gland : Calculus Formation The submandibular salivary gland is a common site of calculus formation. This condition is rare in the other salivary glands. The presence of a tense swelling below the body of the mandible, which is greatest before or during a meal and is reduced in size or absent between meals, is diagnostic of the condition. Examination of the floor of the mouth will reveal absence of ejection of saliva from the orifice of the duct of the affected gland. Frequently, the stone can be palpated in the duct, which lies below the mucous membrane of the floor of the mouth. 26 Clinical Notes Enlargement of the Submandibular Lymph Nodes and Swelling of the Submandibular Salivary Gland The submandibular lymph nodes are commonly enlarged as a result of a pathologic condition of the scalp, face, maxillary sinus, or mouth cavity. One of the most common causes of painful enlargement of these nodes is acute infection of the teeth. Enlargement of these nodes should not be confused with pathologic swelling of the submandibular salivary gland. 27 The end 28 Carotid Triangle The carotid triangle lies behind the hyoid bone. It is bounded sjjperiorly by the posterior belly of the digastric, in-feriorly by tfie superior belly~oTthe omohyoid, ancTposteri-orly by the anterior_Dorder oLttie_sIernocTej?omastoid mus­cle (Fig. 11-7). Its floor is formed by portions of the" thyrohyoid, hyoglossus, and middle andjnferior constrictor muscles ^f j^hj^pfiarynx.. The triangle contains the carotid sheath,:with the conv. mon carotid artery dividing within the triangle into internal and external carotid arteries; numerous branches of the_ex-terria]_carotid_artery; the internal jugularjein jind its trlbu-taries; the hypoglossal nerve wTfrTTfs'clescending branch; the internal and external laryngeal nervesjlRe accessory and va- gus nerves; and part of the chain of deep cervical lymph ;. 11-10). •" ~~———————- "riq_ The internal jugular vein tends to be overlapped by the anterior border of the sternocleidomastoid muscle and is therefore hidden 29 The carotid triangle It is a vascular area behind the hyoid bone bounded by: 1. the superior belly of the omohyoid,inferiorly 2. the posterior belly of the digastric, superiorly 3. the anterior border of the SCM .posteriorly 4. Floor is formed by portion of thyrohyoid, hyoglossal,and middle and inferior constrictor muscle of the pharynx 30 The carotid triangle It is an important area because the common carotid artery ascends into and is where its pulse can be auscultated or palpated by compressing it lightly against the transverse processes of the cervical vertebrae. 31 At the level of the superior border of the thyroid cartilage, the common carotid artery divides into the internal And external carotid arteries. Found at this site are: 1. The carotid sinus 2. The carotid body 32 The carotid triangle 1. The carotid sinus, a slight dilation of the proximal part of the internal carotid artery; and may involve the common carotid. It is principally innervated by the glossopharyngeal nerve (CN IX) through the carotid sinus nerve, as well as by the vagus nerve, It is a baroreceptor (pressoreceptor) that reacts to changes in arterial blood pressure. 33 The carotid triangle 2.The carotid body, a small, reddish-brown ovoid mass of tissue, lies on the medial (deep) side of the bifurcation of the common carotid artery in close relation to the carotid sinus. Supplied mainly by the carotid sinus nerve (CN IX) and by CN X, It is a chemoreceptor that monitors the level of oxygen in the blood. It is stimulated by low levels of oxygen and initiates a reflex, which increases the rate and depth of respiration, heart rate, and blood pressure. 34 35 The carotid sheath a tubular, thickly matted fascial condensation on each side of the neck, extends from the base of the skull to the root of the neck. 36 The inferior part of the carotid sheath, contains the following clinically important structures: 1. The common carotid artery medially 2. The internal jugular vein laterally 3. The vagus nerve posteriorly. ** Superiorly, the common carotid is replaced by the internal carotid artery. 37 The carotid sheath The ansa cervicalis usually lies on (or is embedded in) the anterolateral aspect of the sheath.
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