Neck Triangles GT

Which fascia will invest and protect important vasculature and the Vagus N

Carotid Sheath
Common Carotid A
Internal Jugular V

Which structure (nerve) lies on top of (anteriorly) and outside of the  carotid sheath?

Ansa cervicalis— from roots C1-3; sensory and motor (primarily infrahyoid)

Which structure lies under and outside of the carotid sheath

Sympathetic ganglia (trunk)

The bilateral function of the sternocleidomastoid is

Extension

The unilateral function(s) of the sternocleidomastoid

Lateral flexion same side

Lateral rotation opposite side

What is the nerve and artery for:

Sternocleidomastoid

CN XI     Transverse cervical A from thyrocervical trunk

What is the nerve and artery for:

Trapezius

CN XI     Transverse cervical A from thyrocervical trunk

What is the nerve and artery for:

Scalenes

Cervical ventral rami  - Vertebral A/Ascending cervical (~C3-8)

Which artery runs UNDER the Scalenes

Subclavian A

Which nerve runs OVER the anterior scalene?

Phrenic N

Which nerve runs just medial to the anterior scalene

Vagus N

How will you tell the difference between the stylohyoid muscle and the posterior digastric

Stylohyoid will be just superior and minimally superficial (at the tendon) to the posterior digastric

How do you tell the difference between Mylohyoid and Geniohyoid (location)

Both are bilateral but Mylohyoid can be seen externally and internally but the Geniohyoid is only internal

Which suprahyoid muscle is innervated by the CN V3

Mylohyoid (via a mylohyoid branch FYI); think anterior compartment  GOOD JOB DAN 😊

Anterior digastric (via mylohyoid branch FYI);think anterior compartment

Which suprahyoid muscle is innervated by C1 via hypoglossal N

Geniohyoid

Which suprahyoid muscles are innervated by the facial nerve

Stylohyoid

Posterior digastric

Think posterior compartment

Suprahyoid muscles are primarily perfused by what artery (via branches)

Facial Artery (branch of the External Carotid A)

Which muscle group will depress the hyoid and can you list the muscles?

Infrahyoid

OOOOOOOOOOOOmohyoid

Sternohyoid

Sternothyroid

Thyrohyoid

With the exception of one infrahyoid muscle, what are they innervated by; and what is the exception of this rule

Ansa Cervicalis C1-C3

 Thyrohyoid is the exception

The thyrohyoid is innervated by

C1 via Hypoglossal N

What is the artery serving the infrahyoid muscles and complete its story

Superior Thyroid A is a direct branch of the External Carotid A (Sally)

What is the general innervation for the prevertebral muscles

Longus capitis, Longus Colli

Ventral Rami of the cervical segments C2, 3, 4; pre vertebral muscles

Which of the branches of the common carotid artery will have branches in the neck region

External carotid

What are the branches of the external carotid artery that serve the areas they are named for…

Sally- Superior Thyroid    to thyroid

Likes- Lingual                     to tongue region

Flirting – Facial                  to face

On- Occipital                      to occipital region

A – Ascending Pharyngeal    to pharynx region

Portland- Posterior Auricular  to posterior ear region

Main- Maxillary to maxillary region

Street- Superficial (Superior) Temporal to temporal region

The Cervical Plexus is derived from what roots

C1-C4(5)

Motor and Sensory

The ansa cervicalis loop is derived from which roots

C1-C3; most infra hyoid muscles

The geniohyoid and thyrohyoid will be innervated by

C1 via hypoglossal N; the superior belly of the omohyoid is innervated by C1 which contributes to the superior root of ansa

Which roots will comprise the phrenic nerve and what does it innervate

C3,4,5  (over anterior scalene)

Innervates diaphragm

Can you name the cutaneous nerves derived from the cervical plexus

Transverse cervical nerve C2-C3

Supraclavicular nerve C3-C4

The ansa cervicalis will innervate

Infrahyoid muscles EXCEPT thyrohyoid

What nerve will serve the sensory aspects of the face

Trigeminal V1, 2, 3

V1: Opthalmic region

V2: Maxillary region

V3: Mandibular region

Can you name the facial nerve branches that are named for the region they serve

Temporal

Zygomatic

Buccal

Mandibular

Cervical

What is the muscle that stands to divide the neck into anterior and posterior

Sternocleidomastoid (SCM)

What are the boundaries of the Posterior Triangle

Anterior   Sternocleidomastoid

Posterior  Trapezius

Inferior    Clavicle

Which muscle provides a division line to divide the posterior triangle into 2 subtriangles (and name the two subtriangles)

OOOOOOOOOOmohyoid!!

Occipital

Supraclavicular

In general, what is the characteristic of the structures in the posterior triangle

IN GENERAL they are the structures leaving the neck region and entering the upper extremity

What may help you locate the spinal accessory nerve in posterior triangle

Locate the posterior border of your SCM, it will come out from under the SCM here and then continue across the posterior triangle (occipital portion)

What structures of the brachial plexus are located in the posterior triangle

Trunks

Superior trunk will also include Suprascapular N

The more superficial multiple nerve branches in the posterior triangle (moving over the SCM,etc) are …

The Cervical Plexus Cutaneous nerves

Which primary artery will branch to the posterior triangle

Thyrocervical Trunk

Transverse cervical

Suprascapular

Dorsal Scapular

If someone stabs you with a pencil posterior to your sternocleidomastoid, which arterial structures should you worry about?

Occipital A from external carotid A

Transverse Cervical A from thyrocervical trunk

Suprascapular A from thryocervical trunk

Dorsal Scapular A  from either subclavian or thyrocervical trunk br

Subclavian A from brachiocephalic trunk or aorta (left side)

What venous structures are you worried about

External jugular vein from subclavian and superficial to sternocleid…

Subclavian V

What nerves (and what muscles may be affected)

Spinal Accessory (trap and SCM)

Sensory branches of cervical plexus

Suprascapular N (infra and supraspinatus)

Trunks of BP

Dorsal Scapular (Rhomboid, Lev Scap)

What are the boundaries of the entire anterior triangle

Sternocleidomastoid

Mandible

Midline of Neck

What are the other triangles of the anterior triangle

Submandibular (think gland)

Submental  (think lymph nodes)

Carotid (think sheath and other critical neurovasculature)

Muscular (think muscles)

The anterior and posterior digastric muscles and the mandible serve as boundaries for which anterior triangle component

Submandibular Triangle of anterior triangle

What are the boundaries of the carotid triangle

Posterior digastric

Sternocleidomastoid

Omohyoid

Which is perhaps the most critical of the anterior triangles due to the vital structures within it

Carotid triangle

If someone stabbed you in the carotid triangle—what are you thinking about (beside “911”, etc)

Artery: Common Carotid Internal/External Carotid and then the branches of the External Carotid (Sally ….)

Vein: Internal Jugular Vein;

Nerve: Hypoglossal N (superior aspect of the triangle)

             Spinal Accessory (making its way to posterior tri)

             Vagus N (in between the IJV and Common Carotid)

            Ansa cervicalis(sits on top of carotid and jugular)

What adds specific, additional protection to the IJV, Vagus N, and Common C A within the carotid triangle

Carotid sheath

What lies just anterior to the carotid sheath

Ansa Cervicalis

By luck, they stab you in the submental triangle with the eraser end of the pencil –what may be sore and/or swollen later

Mylohyoid

Geniohyoid (deep)

Submental Lymph nodes

What are the muscles in the muscular triangle of the anterior triangle and can you provide the nerve and artery supply?

Thyrohyoid – C1 via hypoglossal N, Superior Thyroid A (INFRAHYOID)

Sternohyoid- Ansa Cervicalis (C1-3), Superior Thyroid A (INFRAHYOID)

Sternothyroid- Ansa Cervicalis (C1-3)l Superior Thyroid A (INFRAHYOID)

What are the primary Arteries of the Root of the Neck

Brachiocephalic trunk (right side only)

Common Carotid

Subclavian (R and L)

   Vertebral

   Thyrocervical Trunk

Internal Thoracic

What veins?

Subclavian

Beginning of Internal and External Jugular V

Brachiocephalic Vein

Nerves from lateral to medial (root of neck and anterior triangle)

Phrenic—Vagus—Recurrent Laryngeal

Branches of Thyrocervical Trunk

Inferior Thyroid A

Ascending Cervical A

Transverse Cervical A

Suprascapular A

Sometimes Dorsal Scapular A