ﻢﻴﺣﺮﻟﺍ ﻦﻤﺣﺮﻟﺍ
¼ ﺍ ﻢﺴﺑ
Anterior triangle of
the neck
Mohamed Osman Mohamed Idres
MBBS, Msc, MRCS
Out
lines
subtriangles
borders
main contents
suprahyoid and infrahyoid
muscles
branches of the external carotid
artery
Objective
s
Describe the anterior triangle of the neck
(position and borders).
Describe the contents of the anterior triangle of
the
neck .
Torticollis
• Abnormal
sustained
contraction of the
neck musculature
causing the head
to be pulled to
one side.
Case study
•
• During a brawl, a 24 year old male was stabbed in the neck, the knife
penetrating the right sternocleidomastoid muscle just posterior to
the angle of the mandible. Following hospitalization and treatment,
he complained of the following:
• His head tilted to the left
• Numbness over the part of the right auricle and
adjacent parts of the scalp, and
• Some difficulty in tongue movement.
• Describe the subdivision of the
anterior triangle
• List the contents of each triangle
• What nerve was injured and what
muscle was affected
Anterior Triangle of the
Neck
Subtriangl
es digastric
(submandibul
subment
ar)
al
Hyoid caroti
bone d
muscul
ar
S ubdivisions of the A nterior
Triangle:
A nterior belly of
digastric
• Submental triangle
• Submandibular
triangle Digastric
• Carotid triangle
• Muscular triangle triangle
Submental
triangle
Posterior belly
of digastric
Carotid
triangle
Sternomasto
Superior belly of id
omohyoid
Inferior
belly of
Muscular omohyoid
triangle
Submental triangle
• Lymph nodes
• Small veins form
the anterior
jugular vein
Submental triangle
• Lymph nodes
Contents of submental
triangle • Small veins form
the anterior
jugular vein
Contents of submental
triangle
Anterior jugular
vein
Submental triangle
• Lymph nodes
• Small veins form
the anterior
jugular vein
Submental
Triangle
Boundari Floor: Content
• Right: Anterior belly of
es • M ylohoid s:• S ubmental
digastric m. •S
• Inf: LNubmental
Left:Hyoid
A nterior belly of
digastric
bone veins
S ubmental
LN
Ant. Jug.
V
S ubmental
veins
Ext. Jug. V
M ylohyoi S uprastern
d Posterior al
belly of space
digastric Jug. Subclavian
Hyoglossus arch V.
Anterior
belly of
digastric
Boundaries of digastric
triangle
Digastric
triangle
• Submandibula
r gland and
lymph nodse
Contents of digastric
triangle
Digastric (S ubmandibular) Posterior
triangle belly of B ase of
digastric Hyogloss the
us mandible
Boundari Floor
• Ant. Belly of • A nt: M ylohoid m.
es
digastric • Post: Hyoglossus
• Post. Belly of m.
digastric
• Base of the M ylohyoi
mandible d
S ternomasto
id
Anterior
belly of
digastric
M ylohyoi
d Posterior
belly of
digastric
Anterior Hyoglossus
belly of
digastric
Contents of the digastric
triangle
Glands:
• Submandibular Gland. (and submandibular LN)
• Parotid Gland.
Parotid
gland
Submandibular
LN
Submandibular gland
Nerves:
• X, XI and XII cranial
nerves
Vessels:
• ECA, ICA, IJV
• Facial artery (a branch from )
ECA
• Facial vein
S ternomasto
id (cut)
IJV
EC
A
Post.
Belly of
digastric
Facial
XI, X & XII
a. M ylohyoi
ICA
d
Vagus Ant. Belly of
digastric
H ypoglossal
n.
Mylohyoid muscle
O: mylohoid line of the
mandible I : mylohyoid
raphe
hyoid bone
N: mylohyoid n. (from the inferior alveolar branch of the
mandibular n.) A : -elevation of hyoid bone and floor of the
mouth
-depression of the mandible
Anterior
M ylohyoid
belly of
raphe digastric
M S tylohyoi
d yloh d
yo
i
Posterior
Hyogloss belly
us of digastric
H yoid
bone
Digastric muscle
O: arises by two bellies:
-ant belly: digastric fossa of mandible
-post belly: mastoid notch
I : Intermediate tendon is attached by a fibrous loop to the
hyoid bone N: -ant belly: mylohyoid nerve (madibular division
of trigeminal N)
-post belly: facial nerve
A: -elevation of hyoid bone during swallowing
-depression of mandible
Stylohyoid muscle
O: styloid
process I:
hyoid bone.
N facial nerve
A elevation
and retraction
of hyoid bone
Posterior
M ylohyoi belly of
d digastric
Anterior Stylohyoid
belly of
digastric
Hyogloss
us
Hyoid
bone
Boundaries of carotid
triangle
Caroti
d
triangl
e
Contents of carotid
triangle
Carotid triangle
• carotid
sheath
post.
digastri superfici
c al
temporal
Posterior auricul maxillar
y facial
Occipital lingual
intrnal ascendin
carotid g
pharyng
ea
ex
superio
ternal
r
carotid
thyroid
com
mon omohyoi
carotid d (sup.
Carotid
triangle
Boundari Floor
• Anterior border of
es : • A nt: Hyoglossus and
• Posterior belly of
sternomastoid • Post: pharyngeal
thyrohoid ms.
digastric wall
• Superior belly of
omohyoid
Post. Belly of
dig as tric Hmy.
oglossus m.
M iddle
constrictor
of pharynx
Inferior Thyrohoid
of
constrictor m.
pharynx S up. belly
of
omohyoid
m.
S ternomastoid m.
Contents of the carotid
triangle
Vessel Nerve
s•:CCA, ECA, ICA, s•:Cranial nerves X,
• Beginning
IJV of some branches XI, XIIcervicalis (on the outer surface of
• Ansa
of ECA carotid sh
• Sympathetic trunk (lies behind the carotid
sheath)
• CCA, ICA, IJV and vagus nerve are all ensheathed in a tubular
sheath of deep fascia called carotid sheath
• The IJV is lateral in position, and the vagus lies between the artery
A nsa
cervicalis
Muscular triangle
• strap muscles-
infrahyoid
muscles
M uscular
triangle
Main
contents
Submental triangle Digastric triangle
• Lymph nodes • Submandibula
• Small veins form r gland and
lymph nodse
the anterior
jugular vein • Facial vessels
Carotid triangle
Muscular triangle
• carotid sheath
• Strap muscles-
infrahyoid
muscles
M uscular
triangle
Boundari Floor &
• Anterior border of
es Contents :
• sternomastoid
Superior belly ofm. • Infrahyoid
•M iddle linem.
omohyoid of the front of the muscles
neck • Sternohyoid
• Sternothyroid
• Thyrohyoid
• Omohyoid
Thyrohyoi
d
Omohyoid
Sternothyro
n o h
m.
S t e r
d
id
y o i
Infrahyoid
muscles
Sternohyoid
• Origin: back of manubrium
sterni
• Insertion: hyoid bone
• Action: depression of hyoid
Sternothyroid
bone
• Origin: back of manubrium Thyrohyoi
sterni d
• Insertion: thyroid cartilage
Omohyoid
Sternothyro
• Action: depression of larynx m.
n o h
Thyrohyoid
• Origin: thyroid cartilage
• Insertion: hyoid bone
• Action:
S t e r
depression of hyoid bone
id
y o i
Omohyoid
• Origin: by two bellies
- Inferior belly; from the upper border of scapula
- Superior belly; from the hyoid bone
• Insertion: intermediate tendon
The tendon is attached to the clavicle and 1st rib by a
loop of fascia.
• Action: depression of hyoid bone
• All infrahyoid muscles (except thyrohyoid) are supplied by the ansa cervicalis
• The superior belly of omohyoid is supplied by a branch from the superior limb of
ansa cervicalis
• The infrahyoid muscles fix the hyoid bone during movements of the tongue
Main
contents
Submental triangle Digastric triangle
• Lymph nodes • Submandibula
• Small veins form r gland and
lymph nodse
the anterior
jugular vein • Facial vessels
Carotid triangle
• carotid sheath Muscular triangle
• strap muscles-
infrahyoid
muscles
Suprahyoid
Muscles
- geniohyoid
(C1)
- mylohyoid
(V3)
- anterior
digastric (V3)
- posterior
digastric (VII)
- stylohyoid
(VII)
Infrahyoid
Muscles (strap
(V3)
Mylohyoid
Stylohyoid(V
(V3)
int. jugular II)
v. Posterior
H Digastric
(VII)
omohyoi
d T thyrohyoid
(C1)
C (ansa
? cervicalis)
sternohyoid
sternothyroid
omohyo
id
Suprahyoid and Infrahyoid
Muscles
Hyoid Muscles
• Suprahyoid
muscles
D igastric – ant /
post Mylohyoid
Stylohyoid
Geniohyoid
Hyoid Muscles
• Infrahyoid
M uscles Deep
group
Thyrohyoid
Sternothyro
id
Superficial
group
Omohyoid
Sternohyoid
Suprahyoid muscles
Nerve supply
Digastic – V3
anterior belly
Digastric VII
–
posterio
r
Stylohyoid VII
Mylohyoid V3
Infrahyoid muscles
Nerve supply Action
Omohyoid – Ansa Depresses
superior cervicalis hyoid
/ C1, C2 and
inferior C3
Sternohyoid Ansa cervicalis Depress
es
hyoid
Sternothyroid Ansa cervicalis Depress
es
larynx
Thyrohyoid C1 Depresses
Case study
•
• During a brawl, a 24 year old male was stabbed in the neck, the knife
penetrating the right sternocleidomastoid muscle just posterior to
the angle of the mandible. Following hospitalization and treatment,
he complained of the following:
• His head tilted to the left
• Numbness over the part of the right auricle and
adjacent parts of the scalp, and
• Some difficulty in tongue movement.
• Describe the subdivision of the
anterior triangle
• List the contents of each triangle
• What nerve was injured and what
muscle was affected
