Triangles of neck

Lymph nodes level (neck)

Oral cavity

Pharynx

By: Ismah Haron

TRIANGLES OF NECK

Submandibular:

Facial vein

Cervical branch of facial

nerve

Submandibular salivary

gland

Facial artery

Lingual nerve &

submandibular ganglion

Lingual artery

Hypoglossal nerve

Submental: Submental lymph nodes

CAROTID

(Root)Veins – common facial v., retromandibular v.,

post. Auricular v., facial v., external jugular v. and

anterior jugular v.

(Within) Nerves – XII n., root of C1, C2, C3

Arteries – common carotid artery, external carotid

artery, thyroid artery, occipital artery, lingual, facial

and internal carotid arteries.

Floor – superior laryngeal nerve, internal and

external laryngeal n.

MUSCULAR/VISCERAL

Thyroid gland and its arteries

Thyroid cartilage

Cricoid cartilage

Tracheal rings

Occipital:

Spinal accessory n. (XI)

Superficial cervical cutaneous branches of cervical

plexus (C2-C4)

Supraclavicular:

Brachial plexus (superior C5 C6, middle C7, lower trunk

C8)

Subclavian artery

External jugular vein

VERTEBRAL ARTERY TRIANGLE

Extending from the root of neck

Borders: scalenous anterior muscle, longus colli

muscle & superior aspect of subclavian a.

Contents: vertebral a., sympathetic trunk, common

carotid a., right recurrent laryngeal n. and phrenic

n.

LYMPH NODES LEVELSubmental & submandibular group

Upper jugular group

Middle jugular group

Lower jugular group

Posterior triangle group – include supraclavicular LN

Anterior compartment:

Submental LN

Upper jugular group

Posterior triangle group – include supraclavicular LN

Submandibular LN

Submandibular group: Metastases ca arising from oral cavity, ant. nasal cavity, soft tissues structure of midface and submandibular gland

Upper jugular group: Metastases ca arising from oral cavity, nasal cavity,

pharynx, larynx and parotid gland

Middle jugular group: Metastases ca arising from oral cavity, nasal cavity,

pharynx and larynx

Lower jugular group: Metastases ca arising from hypopharynx, cervical

esophagus and larynx

Post. Triangle group: Metastases ca arising from naso & oropharynx (VA)

and thyroid gland (VB)

Ant. Compartment group: Metastases ca arising from thyroid gland, glottic,

subglottic larynx, pyriform sinus and cervical esophagus

ORAL CAVITY

Oral tongue is divided into:› Tip› Lateral

borders› Dorsum› Undersurface

LYMPHATIC DRAINAGE

Medial portion lower lip (LL) submental. Lateral

portion LL submandibular nodes

Upper lip preauricular, infraparotid &

submandibular nodes

Buccal mucosa submental & submandibular

Upper & lower alveolar ridges submental,

submandibular, upper deep cervical, lateral

retropharyngeal nodes.

Hard palate upper deep cervical, lateral

retropharyngeal node, submandibular nodes

Floor of mouth submandibular node, upper deep

cervical nodes

Tongue submental, jugulo-omohyoid, deep

cervical nodes

PHARYNX

Conical fibromuscular tube

12 to 14 cm long, width is 3.5 cm (become 1.5 cm

at pharyngo-esophageal junction)

Extending from base of skull lower border of

cricoid cartilage

Become continuous with esophagus

Ciliated columnar in nasopharynx. Elsewhere; squamous

PHARYNGEAL WALL

2 layers (ext & internal); 3 muscles in each layer

Killian’s dehiscence

› Ext layer-inf constrictor muscle-2 parts (potential gap)

› Perforation during esophagoscopy & herniation of pharyngeal mucosa

= nasopharyngeal tonsil

Waldeyer’s Ring- Lymphoid tissue

Enlarged Eustachian tube occlusion

PHARYNGEAL SPACES

Potential space – abscess can form

Retropharyngeal space and;

Parapharyngeal space

1

2

3

DIVISION OF PHARYNX

THANK YOU

Infected cause persistent postnasal discharge

Craniopharyngioma may arise from it

Increase in size up to 6 years old then gradually atrophy

Sinus of morgani – space between base of skull and

upper free border of superior constrictor muscle

through it enters Eustachian tube, levator veli

palatini, tensor veli palatini, ascending palatine

artery & branch of facial artery

Lymphatic drainage of nasopharynx: upper deep

cervical node, spinal accessory chain

FUNCTION OF NASOPHARYNX

Conduit for air

Eustachian tube – ventilate middle ear, equalizes

air pressure

Cuff of nasopharynx from oropharynx (soft palate

& Passavant’s ridge)

Help in voice production

Drainage mucus from nasal & nasopharyngeal

glands

OROPHARYNX

Tonsillar fossa?

Posterior, anterior & lateral walls

FUNCTION OF OROPHARYNX

Conduit passage for air and food

Pharyngeal phase deglutition

Forms part of vocal tract

Appreciation in taste

Provide local defense and immunity

LARYNGOPHARYNX (HYPOPHARYNX)

Pyriform sinus – internal laryngeal n. runs near it,

pain is referred to the ear in ca of pyriform

sinus

Post cricoid region