posterior triangle of neck and its applied
TRANSCRIPT
POSTERIOR TRIANGLE OF NECK AND ITS APPLIED
Presented by Moderator
Snehal kharche Dr. Arati S. Neeli
ContentsBoundariesMusclesNervesVesselsLymphaticsApplied aspect
Boundaries
Roof
Floor
Subdivisions of posterior triangle of neck
ContentsMuscles: inferior belly of
omohyoid
Nerves Accessory nerve
Root, trunks of brachial plexus and their branches :• Nerves to rhomboideus(dorsal scapular n)• Nerves to serratus anterior(long thoracic n)• Nerves to subclavius• Suprascapular nerve
Cervical nerves• Greater occipital nerve • Great auriclular nerve• Lesser occipital nerve• Transverse cervical nerve of neck• Supraclavicular nerve
3rd and 4th cervical nerves supplying trapezius
ArteriesOccipital arteryThird part of subclavian artery & branches of
subclavian artery• Suprascapular• Transverse cervical
VeinsExternal jugular vein & its tributariesSubclavian vein is lower down and not in the
triangle
Lymph nodesSupraclavicular lymph nodes are present
on posterior border of sternocleidomastoidOccipital nodes
Torticollis
Spinal accessory nerve palsy
The brachial plexus and subclavian artery may be compressed in the neck by
rudimentary cervical rib tight fibrous bandtight scalenus anterior muscle
giving rise to◦ sensory symptoms◦ vascular symptoms
Cervical ribPressure in the cervical rib will give rise to
local pain as well as pain referred to hand and forearm particularly in the ulnar portion
Brachial plexus palsies Upper brachial plexus (erb’s) palsy
These infants cannot move the shoulder and keep their arm extended and turned inward, giving the appearance of the “porter's tip hand."
Lower brachial plexus (klumpke’s) palsy
External jugular vein It can be used for assessing jugular venous
pressure and for catheterization.
Subclavian arteryPalpation and compression of the subclavian
artery in patients with upper limb hemorrhage
Cervical rib and scalenous anticus syndromeDysphagia lusoria
Neck dissectionFirst conceptual approach- KocherCrile introduced RND & was followed by Martin
Staging of Neck Nodes NX:
Regional lymph nodes can not be assessed
N0:No regional lymph node metastasis
N1:Metastasis in a single ipsilateral lymph nodes, 3 cm or less
N2:N2a:
Metastasis in a single ipsilateral lymph nodes, > 3 cm < 6 cm
N2b: Metastasis in multiple ipsilateral lymph nodes, not
more than 6 cm
N2c: Metastasis in bilateral or contralateral nodes not
more than 6 cm in diameter N3:
Metastasis in lymph nodes more than 6 cm in in greatest diameter
Lymph node levelsLevel I:
Ia- Submental group
Ib- Submandibular group
Level II:around upper third of IJV &
adjacent to SANIIa- located anteriorly to SANIIb- located posteriorly to SAN
Level III:around middle third of IJV
Level IV:around lower third of IJV
Level V (posterior triangle group):Va- spinal accessory nodesVb- nodes around transverse cervical vessels & supraclavicular node
Level VI:pre & paratracheal, precricoid, perithyroidal & those around reccurent laryngeal nerves
ClassificationRadical neck Dissection:
Removing all lymphatic tissues in regions I - V and include removal of SAN, SCM and IJV
Modified radical neck dissection:Excision of all lymph nodes removed with RND with preservation of one or more non-lymphatic structures, SAN, SCM and/or IJV Subtype I: Preserve SAN Subtype II: Preserve SAN & IJV Subtype III: preserve SAN, IJV and SCM
Selective Neck dissection:Any type of cervical lymphadenectomy with preservation of one or more lymph node groupsFour subtype: Supraomohyoid neck dissection- I to III Posterolateral neck dissection- II to IV Lateral neck dissection- II to V Anterior neck dissection- VI
Extended neck dissection:Any previous dissection and including one or more additional lymph node groups and/or non-lymphatic tissues
Lateral neck swellingsLymph nodesCystic hygromaPharyngeal pouchSubclavian aneurysm
Cystic hygromaFailure of one of the lymphatics to join major
lymph sac of body Infancy and early childhoodSoft, cystic, fluctuant
Pharyngeal pouch
Subclavian anuerysm
References Clinical Anatomy for medical students – Richard
Snell, 5th Ed. Student’s Gray’s anatomy Head and neck anatomy- James L. Hiatt Grant’s Method of Anatomy, A Clinical problem
solving approach, 11th Ed. Head and neck surgery otolaryngology- Byron J.
Bailey Otolaryngology head and neck surgery- Cumming’s Cancer of face and mouth- McGregor Stell & Maran’s Head and Neck surgery, 4th Ed. B D Chaurasia’s Human anatomy, Volumes 1 & 3 A Concise textbook of surgery – S Das, 3rd Ed. P J Mehta’s Practical Medicine