posterior triangle of neck and its applied
TRANSCRIPT
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POSTERIOR TRIANGLE OF NECK AND ITS APPLIED
Presented by Moderator
Snehal kharche Dr. Arati S. Neeli
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ContentsBoundariesMusclesNervesVesselsLymphaticsApplied aspect
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Boundaries
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Roof
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Floor
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Subdivisions of posterior triangle of neck
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ContentsMuscles: inferior belly of
omohyoid
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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
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ArteriesOccipital arteryThird part of subclavian artery & branches of
subclavian artery• Suprascapular• Transverse cervical
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VeinsExternal jugular vein & its tributariesSubclavian vein is lower down and not in the
triangle
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Lymph nodesSupraclavicular lymph nodes are present
on posterior border of sternocleidomastoidOccipital nodes
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Torticollis
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Spinal accessory nerve palsy
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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
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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
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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."
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Lower brachial plexus (klumpke’s) palsy
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External jugular vein It can be used for assessing jugular venous
pressure and for catheterization.
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Subclavian arteryPalpation and compression of the subclavian
artery in patients with upper limb hemorrhage
Cervical rib and scalenous anticus syndromeDysphagia lusoria
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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
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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
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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
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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
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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
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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
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Lateral neck swellingsLymph nodesCystic hygromaPharyngeal pouchSubclavian aneurysm
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Cystic hygromaFailure of one of the lymphatics to join major
lymph sac of body Infancy and early childhoodSoft, cystic, fluctuant
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Pharyngeal pouch
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Subclavian anuerysm
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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