4. Mandible Hyoid bone
at the level of C3.
Thyroid cartilage
at the level of C4-C5 Cricoid cartilage
at the level of C6 .
Tracheal rings Sternomastoid muscle.
Suprasternal notch.
5. Anatomy
Each sides of the neck is divided by
sternomastoid muscle in to two main
triangles :-
1. The anterior triangle.
2. The posterior triangle.
8. Anterior triangle of the neck
Boundaries :
Anterior border of sternomastoid muscle.
The midline.
The inferior margin of the mandible
9.
10. The anterior triangle is sub divided in to four
triangles by
Anterior belly of digastric muscles .
Posterior belly of digastric muscles .
Superior belly of omohyoid
30. Content of anterior triangles:
The thyroid gland.
The submandibular gland.
The carotid sheath.
The deep cervical group of lymph nodes.
The supra and infrahyoid groups of
muscles.
40. Tumour
Is a new growth of tissue (mass) which can
refer to an inflammatory or neoplastic growth .
A neoplastic mass is an uncontrolled
proliferation of a clon of cells without useful
function
43. Submandibular triangle
swelling
Enlarged Submandibular lymph node:
Multiple
Rolled over the edge of mandible
Not felt in the floor of mouth
Enlarged Submandibular salivary gland
44. Swelling in the carotid
triangle
Solid :
Deep cervical L.Node.
Enlarge lateral lobe of thyroid gland.
Carotid body tuomour.
Cystic:
Cold abscess.
Brancheal cyst.
46. Others
Swelling of skin & subcutaneous
tissues:
As lipoma .
Sebaceous cyst .
haemangioma.
47. Carotid body tuomour
Rare .
Slow growing malignant tuomour.
Arise from the chemoreceptor at the bifurcation of
carotid artey.
Usually occur at middle age .
Usually smooth but may be lobular.
Move side to side but not vertically.
Exhibit transmitted pulsation from underlying
carotid artery.
49. The thyroglossal duct cyst
It is a remnant of the diverticulum formed by
migration of thyroid tissue from foramen cecum at
the base of the tongue through the hyoid bone to
its final position around the tracheal cartilage .
50. The thyroglossal duct cyst
Failure of subsequent closure and obliteration of this tract
predisposes to thyroglossal cyst formation.
Is a rare but occasional cause of a benign neck mass.
Almost always in the midline.
51. site:
20% are suprahyoid.
15% occur at the hyoid .
65% are infrahyoid.
Present by the age of 10 in 50% of cases. but
may be found in the older population as well.
No sex predominance .
52. Racial predominance in whites.
size:
It measure about 0.5-5cm in diameter, and
gradually ↑ in size.
It is painful if increase in size or became
infected
53. Asymptomatic
Hot , red & tender if infection present.
Consistency:
Firm to hard
Movement:
Upward by deglutition, & protrusion
of the tongue.
Diagnosis is usually made clinically.
54. Thyroglossal fistula
Are almost always the result of infection with
spontaneous or surgical drainage.
It can drain internally , externally or both.
Discharge of mucus & recurrent attack of
inflamation is the clinical finding.
55. Treatment
Before thyroglossal duct cysts are excised,
it is important to demonstrate that normally
functioning thyroid tissue is in its usual
location.
Thyroid scans and thyroid function studies
are ordered preoperatively.
56. Treatment
Total surgical excision (sistrunk procedure)
including:-
The cyst and sinus to the base of the tongue.
Whole fistula.
Middle third of hyoid bone.
59. Cystic hygroma
• Also called (cavernous lymphangioma) .
• It occurs due to sequestration of a portion of a
jugular lymph sac from lymphatic systems .
• It occupies the lower third of the neck and as it
enlarges it pass upwards towards the ear.
60. Cystic hygroma
Usually it manifests itself during early
infancy.
occasionally it is present at birth .
Exceptionally it is so larges as to obstruct
labour.
62. Lymphatic drainage of head and neck are
particularly important when locating and
working up a "neck mass" or possible
malignancy.
63. Lymphatic drainage:
Superficial nodes:
Are few nodes lies superficial to the deep fascia :
1. The anterior cervical node along the anterior jugular vein.
2. The superficial cervical nodes along the external jugular
vein.
Deep nodes:
1. Vertical chain.
2. Circular chain.
65. Is closely related to internal jugular vein.
Types of vertical chains:
1. Superior deep cervical (jugulo-digastric nodes ).
2. Inferior deep cervical (jugulo-omohyoid nodes ).
3. Few nodes in the root of the neck called supraclavicular
nodes (virchow’s nodes ), (Troisier’s sign).
