Surgical anatomy of the head and neck /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


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…para ikaw ang MOST WANTED KO!

ALAM MO GUSTO KO SANANG MAGING
PULIS,
… PARA IKAW ANG MOST WANTED KO.


PAG IKAW ANG KASAMA KO …
TINATAMAD AKO …
… KASE ANG SARAP MAGPAHINGA SA
PILING MO.


SANA ULAN KA AT LUPA NA LANG AKO
… PARA KAHIT GAANO KALAKAS ANG
PATAK MO, SA AKIN PA RIN ANG
BAGSAK MO.


BAGYO KA BA?
KASI THE MOMENT YOU LEFT MY AREA
OF RESPONSIBILITY, YOU LEAVE MY
HEART IN A STATE OF CALAMITY


HINDI KA NAMAN KAMERA …
PERO TUWING NAKIKITA KITA,
NAPAPANGITI AKO.


SURGICAL ANATOMY
OF THE
NECK
ELMO R. LAGO JR. MD FPCS FPSO-HNS
OUR LADY OF LOURDES HOSPITAL

OBJECTIVES
GENERAL OBJECTIVE
– TO KNOW THE SURGICAL ANATOMY OF THE
NECK
SPECIFIC OBJECTIVES
– TO KNOW THE BASIC TERMINOLOGIES
USED IN DESCRIBE STRUCTURES OF
THE NECK
– TO KNOW THE FASCIA OF THE NECK
– TO KNOW THE DIFFERENT TRAINGLES OF THE
NECK AND DETERMIINE THEIR SIGNIFICANCE
– TO KNOW THE CERVICAL LYMPHATICS OF THE
NECK AND THEIR SIGNIFICANCE

ANATOMICAL TERMINOLOGIES
UNDERSTANDING THE TERMS IS VERY CRITICAL TO
UNDERSTANDING ANATOMY. LANGUAGE USED TO
COMMUNICATE STRUCTURES.
MAKES USE OF THE “STANDARD ANATOMICAL
POSITION” AS THE BASIS OF TERMS


PLANES AND TERMINOLOGIES
MIDSAGITTAL PLANE – VERTICAL PLANE PASSING
THE CENTER OF THE BODY DIVIDING THE BODY
INTO EQUAL LEFT AND RIGHT HALVES
MEDIAL – NEARER THE MIDSAGITTAL PLANE
LATERAL – AWAY THE MIDSAGITTAL PLANE
CORONAL PLANE – VERTICAL PLANE RUNNING
PERPENDICULAR TO THE MIDSAGITTAL PLANE
AND DIVIDES THE BODY TO A FRONT AND A BACK
ANTERIOR – GOING FRONT
POSTERIOR – GOING BACK

TRANSVERSE PLANE – IT IS A HORIZONTAL PLANE
RUNNING PERPENDICULAR TO THE FIRST TWO
PLANES AND DIVIDES THE BODY INTO A UPPER
AND LOWER PART.
SUPERIOR – GOING CRANIAL
INFERIOR – GOING CAUDAL


THE NECK
THE NECK IS THAT REGION OF THE BODY LOCATED
BETWEEN THE MANDIBLE ABOVE AND THE
CLAVICLE BELOW. IT IS ENCLOSED SUPERFICIALLY
BY THE SKIN AND ITS UNDERLYING FASCIA
THE FASCIA CAN BE GROUPED INTO A SUPERFICIAL
CERVICAL AND A DEEP CERVICAL FASCIA.
SUPERFICIAL CERVICAL FASCIA – ENCLOSES THE
PLATYSMA, CUTANEOUS NERVES, EXTERNAL
JUGULAR VEIN AND ANTERIOR JUGULAR VEIN AND
SUPERFICIAL LYMPH NODES

THE DEEP CERVICAL FASCIA
3 LAYERS:
1. INVESTING – SURROUNDS THE NECK, ENCLOSES
THE SCM AND TRAPEZIUS MUSCLES
2. PRETRACHEAL – SURROUNDS THE STRAP
MUSCLES (INFRAHYOID MUSCLES) AND THE
VISCERA OF THE NECK (LARYNX, THYROID)
3. PREVERTEBRAL – SURROUNDS THE CERVICAL
VERTEBRAE AND THE NECK MUSCLES
THE CAROTID SHEATH IS FORMED BY
CONTRIBUTIONS FROM THE 3 LAYERS OF DEEP
FASCIA.THIS SHEATH ENVELOPS THE IJV, CCA, AND
VAGUS NERVE

SUPERFICIAL AND DEEP CERVICAL FASCIA


CLINICAL TRIANGLES
AND MUSCLES OF
THE NECK
• ANTERIOR TRIANGLE
• POSTERIOR TRIANGLE


CLINICAL TRIANGLES AND MUSCLES OF
THE NECK
ANTERIOR
SUBMENTAL – ANTERIOR BELLIES OF THE DIGASTRIC, HYOID
SUBMANDIBULAR – MANDIBLE, POSTERIOR BELLY, ANTERIOR
BELLY OF THE DIGASTRIC
CAROTID – SCM, OMOHYOID, POSTERIOR BELLY
MUSCULAR – OMOHYOID, SCM, MIDLINE

POSTERIOR
OCCIPITAL – TRAPEZIUS, SCM, OMOHYOID
SUPRACLAVICULAR – OMOHYOID, SCM, CLAVICLE

TRIANGLE STRUCTURES
SUBMENTAL
SUBMENTAL LYMPH NODES, SUBMENTAL FAT, GH
SUBMANDIBULAR
SUBMANDIBULAR GLAND, SUBMANDIBULAR LYMPH
NODES, FACIAL ARTERY, WHARTON’S DUCT, MH
CAROTID
COMMON CAROTID ARTERY, INTERNAL JUGULAR
VEIN, VAGUS NERVE, JUGULAR NODES
MUSCULAR
HYOID, THYROID CARTILAGE, CRICOID CARILAGE,
TRACHEA, THYROID GLAND, OMOHYOID,
STERNOHYOID, STERNOTHYROID, THYROHOID

OCCIPITAL
SPINAL ACCESSORY NERVE, FAT, POSTERIOR
GROUP OF NODES
SUPRACLAVICULAR
TIP OF THE LUNG, SUPRACLAVICULAR LYMPH
NODES


PALPATING THE CAROTID PULSE


MUSCLES OF THE NECK
STERNOCLEIDOMASTOID
FROM UPPER PART OF MANUBRIUM STERNI
(STERNAL HEAD) AND MEDIAL THIRD OF THE
CLAVICLE (CLAVICULAR HEAD) TO MASTOID
PROCESS
TILTING HEAD AND FACE UPWARDS AND TO THE
OPPOSITE SIDE
ACCESSORY NERVE (XII)
TRAPEZIUS
FROM EOP AND SNL TO LATERAL 1/3 OF CLAVICLE,
ACROMION
SHOULDER SHRUG
ACCESSORY NERVE (XII)

STERNOCLEIDOMASTOID

TRAPEZIUS


TRAPEZIUS

STERNOCLEIDOMASTOID


SUPRAHYOID MUSCLES
DIGASTRIC, POSTERIOR BELLY
FROM MASTOID TO LESSER HORN OF THE HYOID
DIGASTRIC, ANTERIOR BELLY
INNER SURFACE OF MANDIBLE TO LESSER HORN
OF THE HYOID
MYLOHYOID
FROM MYLOHYOID LINE TO ANTERIOR SURFACE
OF THE HYOID
GENIOHYOID
FROM INFERIOR MENTAL SPINE TO BODY OF
HYOID
SUPRAHYOID MUSCLES ALL ELEVATE THE HYOID

INFRAHYOID MUSCLES
STERNOHYOID
FROM STERNUM TO HYOID
STERNOTHYROID
FROM STERNUM TO THE OBLIQUE LINE, THYROID
CARTILAGE
THYROHYOID
FROM OBLIQUE LINE, THYROID CARTILAGE TO THE
HYOID BONE
OMOHYOID
FROM SCAPULA TO THE HYOID BONE
ALL INFRAHYOID MUSCLES DEPRESS THE HYOID

NECK MUSCLES

SUPRAHYOID GROUP OF MUSCLES

INFRAHYOID GROUP OF MUSCLES


CERVICAL LYMPHATICS


• LEVEL 1 – Submental / Submandibular
Lymph Nodes
• LEVEL 2 – Upper Jugular Lymph Nodes
• LEVEL 3 – Middle Jugular Lymph Nodes
• LEVEL 4 – Lower Jugular Lymph Nodes
• LEVEL 5 – Posterior Triangle Lymph
Nodes
• LEVEL 6 – Anterior Compartment Lymph
Nodes

6 LEVELS FOR DESCRIBING THE LOCATION OF LYMPH NODES IN THE
NECK

SUBLEVEL DIVISION OF NECK LEVELS
2001 Report of the American Head and Neck Society’s Neck
Dissection Committee

Per structure/region
• Neck
– Integrated as “filtering stations”
– Receive almost all parts of head and neck region
– Left side, drains into junction of left subclavian and
internal jugular veins at the left thoracic duct
– Right side, drains into junction of the right
subclavian and internal jugular veins at right
thoracic duct
– Includes lymphatic organs of nasopharynx and
oropharynx
– Normal nodes are neither visible nor palpable

• Esophagus
– Posterior mediastinum and pulmonary hilum

• Face and external nose
– Mainly submandibular lymph nodes

• Nasal cavity
– Retropharyngeal and deep cervical


• Larynx
– Subdivided anatomically into supraglottic, glottic,
and subglottic
– More numerous above the glottis
• Supraglottic- deep cervical lymph nodes
» Ipsilateral drainage complemented by
contralateral drainage
• Glottic – sparse
• Subglottic –deep cervical lymph nodes
» With connections to peritracheal and mediastinal
nodes
» Ipsilateral and contralateral drainage

• Lips
– Submandibular and submental lymph nodes

• Tongue and oral floor
– Ipsilateral and contralateral submandibular and
submental nodes which drain to lymph nodes at
junction of the facial and internal jugular veins

• Parotid gland
– Intraglandular and periglandular nodes to
submandibular and deep jugular nodal chains


• Submandibular gland
– Lymph nodes in the lateral and posteroinferior
portion of the gland

• Pharynx
– Upper portion: retropharyngeal nodes
– Lower portion: parapharyngeal or deep cervical
nodes


Lymphatic Drainage of External Areas of the Head and Neck

Lymphatic Drainage from Internal Areas of the Head and Neck

DRAINAGE PATTERNS
1.

SUBMENTAL – floor of the mouth, anterior oral
tongue, anterior mandibular ridge and lower lip

2.

SUBMANDIBULAR – oral cavity, anterior nasal cavity,
soft-tissue structures of the midface, submandibular
gland

3.

UPPER JUGULAR – oral cavity, nasal cavity,
nasopharynx, hypopharynx, larynx, parotid gland

4.

MIDDLE JUGULAR – oral cavity, nasopharynx,
hypopharynx, oropharynx and larynx, cervical
esophagus

DRAINAGE PATTERNS
6. POSTERIOR TRIANGLE GROUP – nasopharynx,
oropharynx, cutaneous structures of the posterior scalp
and neck
7. ANTERIOR COMPARTMENT – thyroid gland, glottic and
subglottic larynx, apex of the pyriform sinus and cervical
esophagus


WORK-UP OF ASYMMETRIC, UNILATERAL NODAL
NECK MASS
1.

COMPLETE REPEATED P.E. OF:
ORAL CAVITY, NASOPHARYNX, HYPOPHARYNX, LARYNX,
THYROID, SALIVARY GLANDS, SKIN OF THE NECK

2.
3.

NEEDLE BIOPSY
IMAGING – CHEST, UPPER AERODIGESTIVE TRACT (+)

4.

PANENDOSCOPY WITH GUIDED BIOPSY BASED ON
LOCATION OF THE NODAL MASS –NASOPHARYNX, BASE
OF THE TONGUE

5.

OPEN BIOPSY OF THE CERVICAL MASS

NECK DISSECTION


THE END


Surgical anatomy of the head and neck /certified fixed orthodontic courses by Indian dental academy

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