surgical anatomy of neck


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1 : ANATOMY OF NECK BY DR.Sunil Kumar
2 : SURGICAL ANATOMY OF NECK Surgeons should master the anatomy of the Neck before embarking on any Neck dissection. The upper border of the neck is the floor of the mouth anteriorily and the skull base posteriorily. The lower border is the upper border of the first rib and the body of first thoracic vertebrae.
3 : Surface anatomy of neck
4 : SURFACE ANATOMY Mandible- this represents the upper border of the neck . Mastoid- when examining the neck this is a good place to start as it represents the origin of the sternocleidomastoid muscle. Hyoid bone- The body and the greater cornu of the hyoid bone are the important bony landmarks in the neck. The body is in the midline and the greatrer cornu is just inferior to the angle of mandible. Thyroid cartilage- ust inferior to the body of hyoid is the thyroid cartilage. Cricoid cartilage- this cartilage can be palpated inferior to the thyroid cartilage in midline. Between thyroid and cricoid is the cricothyroid membrane. The cricoid is at the level of the sixth cervical vertebrae and represents the boundary between the larynx and trachea, and the pharynx and the esophagus. Thyroid gland– the isthmus can be palpated overlying trachea between second and fourth rings. Sternocleidomastoid muscle—this muscle arises from the mastoid process and divides into a tendinous sternal head and a fan shaped clavicular head. It divides the neck into anterior and posterior triangles. On its deep surface is the carotid sheath.
5 : Triangles of Neck Neck is divided by the sternocleidomastoid muscle into anterior and posterior triangles. Anterior triangle ? Boundary -? Anterior border of the SCM ? -Midline of the neck ? -Mandible. Posterior triangle ? Boundary ? -Posterior border of the SCM ? -Trapezius muscle ? -Clavicle ?
6 : Subdivisions of anterior triangle Submental triangle-- boundaries ? Anterior belly of the digastric ? Hyoid Bone ? Midline of neck ?Submandibular triangle ? Mandible, posterior belly of the digastric ? Anterior belly of the digastric. Muscular triangle ? the midline ? superior belly of the omohyoid ? SCM ? Carotid triangle- ? Superior belly of the omohyoid ? SCM ? Posterior belly of the digastric
7 : Subdivisions of posterior triangle Supraclavicular triangle ? Inferior belly of the omohyoid ? Clavicle ? SCM ? Occipital triangle ? Inferior belly of the omohyoid ? Trapezius ? SCM
8 : Vasculature of neck Vasculature ? Arterial supply of the head and neck ? derived from the common carotid, vertebral and subclavian arteries.? The right common carotid arises from the brachiocephalic trunk . ? The left common carotid arises from the aortic arch. ? The common carotid divides into external and internal carotid arteries at upper border of the thyroid cartilage. ?
9 : Venous drainage There are two sets of jugular veins: external and internal. The internal jugular vein is formed by the anastomosis of blood from the sigmoid sinus of the dura mater and the common facial vein. The internal jugular runs with the common carotid artery and vagus nerve inside the carotid sheath. It provides venous drainage for the contents of the skull. The external jugular runs superficially to sternocleidomastoid. The left and right external jugular veins drain into the subclavian veins. The internal jugular veins join with the subclavian veins more medially to form the brachiocephalic veins. Finally, the left and right brachiocephalic veins join to form the superior vena cava, which delivers deoxygenated blood to the right atrium of the heart.[1]
10 : Lymphatic nodes distribution in neck Node Distribution: Nodal Groups For practical reasons, the neck may be artificially divided into different lymph node regions. This does not mean that there is a true anatomical or physiological separation within the lymphatic system of the neck. Not only is there no physical separation within the lymphatic system of the neck, but a widespread interconnection exists between the different nodal chains, as already described. Thus, the regional lymph node classification should be regarded only as a schematic representation of the lymphatic system of the neck, and not as an anatomical transcription of the reality.
11 : Lymph node levels Lymphatic system is? divided into six levels within the defined anatomic triangles. it is? important when locating and working up a "neck mass" or possible malignancy. Lymphatic system ? I--Submental and submandibular nodes ? II--Upper jugulodigastric group ? III--Middle jugular nodes draining the naso- and oropharynx, oral cavity, hypopharynx, larynx. ? IV--Inferior jugular nodes draining the hypopharynx, subglottic larynx, thyroid, and esophagus. ? V-- Posterior triangle group ? VI--Anterior compartment group
12 :
13 : Subdivisions of lymph node levels Division of nodal groups by subzones. IA, submental nodes IB, submandibular nodes; IIA, upper jugular nodes anterior to the eleventh nerve; IIB, upper jugular nodes posterior to the eleventh nerve; VA, lymph nodes in the posterior triangle located above the level of the inferior border of the cricoid cartilage; VB, lymph nodes in the posterior triangle located below the level of the inferior border of the cricoid cartilage.
14 : Cross section of neck Horizontal cross section of the neck at the level of the sixth cervical vertebra showing the superficial layer of the deep cervical fascia
15 : Cross sections of neck Horizontal cross section of the neck at the level of the sixth cervical vertebra showing the prevertebral layer of the deep cervical fasci
16 : Cross sections of neck Horizontal cross section of the neck at the level of the sixth cervical vertebra showing the carotid sheath.
17 : Suprahyoid neck coronal section Suprahyoid region of the neck—line diagram (coronal view). Note the muscular sling, primarily provided by the mylohyoid muscles, forming the floor of the mouth. The submandibular and submental triangles lie below this sling, and contents of the oral cavity lie above it.
18 : Infrahyoid region of neck Infrahyoid region of neck (thyroid gland level)—line diagram (axial view). Superior belly of omohyoid muscle often can be seen as separate structure on deep surface of sternocleidomastoid muscle. Recurrent laryngeal nerves lie in tracheoesophageal grooves. Posterior aspect of thyroid gland is in intimate contact with common carotid artery. Note locations of vagus and phrenic nerves.

 

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