Lecture 54,55 - Triangles of Neck

8/13/2019 Lecture 54,55 - Triangles of Neck

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Every semester students ask me (Dr Hage) if I will post all my lecture slides on Sakai or if I will give a printed handout of all the slides I show. possession.

You are here at SGU working on becoming a lifelong learner. For that you have a required text book and atlas in your possession while theinternet is available and free. What I want you to develop are the skills to ASSOCIATE and COMMUNICATE. And what do I mean by that? Iwill give you an example:Doc, I cannot hear!That is what you will hear as a physician. No multiple choices, no objectives, no clinical tutor to rely on. What do you do? Stay calm and apply

basic science principles. The following may apply in this case:

Well, tell me since when? Oh do c , abou t f our day s now (and you begin to think how can he answer me when he cannot hear). In both ears? Nodo c , t h e righ t on e i s wor s e (confirmation that it is not bilateral to the same degree and you have a t ime line). So you have always had goodhearing up to four days ago? W e ll t o b e hon e st do c , I c an hardly h e ar any t hing in t h e l e ft e ar s in ce I wa s s m al l . (By asking, you find outimportant information that otherwise would have led you astray; concentrate for the time being on the right ear). Did anything special happenfour days ago? (Let the patient tell you more to learn about cause and effect). t hi s t i m e I wa s r e ally s u ff e ring f ro m a c old and on d e s ce nding I e xp e ri e n ce d t hi s t e rribl e pain in m y e ar s and t ha t wa s i t do c , t h e h e aring wa s down . I t now f ee l s a bi t b e tt e r bu t h e avy a s i f t h e r e i s wa t e r in t h e e ar . (You have to know the anatomy of the ear, the Eustachian tube

tube toequalizing pressure which is especially important when flying or diving to his ear problem. There are many more associations and the moreyou learn the more you will be able to make.)Different scenario: Your patient tells you he has a nagging earache (otalgia) and examination of the ears shows no abnormality what so ever.What next? Hopefully not an antibiotic which most physicians seem to prescribe for earache automatically. You are going to use basic scienceknowledge to solve this problem and show you are a good physician. Pain in the ear but no abnormality in the ear means you have to think

ear? Do theyhave other distribution areas? Examine those areas and look for pathology that could explain the earache in this patient.Printed lecture slides do not help you to develop individual thinking. Open your textbook and atlas along with the course objectives. Read onthe topic that the lecture is about. Look at pictures in the atlas. Browse the internet. Think, associate. What questions could you ask your patientto find out more?

And please, for your own sake, learn the bones of the skull before you start the head and neck series. You need a skeleton to drape muscles onand have nerves travel from one location to the next. That needs a three dimensional picture of the head and neck to facilitate your learning.Do not forget that the head and neck seem complicated but are in fact quite simple. To illustrate this, just realize how many cranial nerves youalready know. Out of 12 pairs, you have learned CN XI (spinal accessory) before midterm (yes, that one innervating the trapezius and SCM)and CN X (the vagus). And you know that CN I is for the nose (olphactory) and CN II is optic and for vision. The face has facial muscles andis supplied by CN VII, the facial nerve. Words for tongue are lingual or glossus and when you hear that there is a nerve going to most of thetongue muscles and it travels below the tongue and is called the hypoglossal nerve, you know it for life. And why it travels below the tongue isfor you to think about! There is a nerve that innervates part of the tongue sensory and most of the pharynx sensory. It is CN IX and is

-study and I wouldlike you to begin to associate for yourself.Have fun with the head and neck series.


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St e rnoc le idomas toid

Trape zius

Omohyoid (infe rior be lly)

Sple nius c apitis

Le vator s c apulae

Pos te rior s c ale ne

Middle s c ale ne

Ante rior s c ale ne


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Plate 32 and 34


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inve s ting fas c ia

pre trac he alfas c ia

SC M

c arotids he athpre ve rte bralfas c ia

trape zius

phre nic n .

s ympathe tic c hainc om . c arotid a.

vagus n .

int. jugular v.ThT

E ?

infr ahyoid fas c ia

?

Plate 35

platysmaCN 7

Posteriortriangle


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C1

C2

C3

C4

phre nic

C1

C1

de s ce nde ndshypogloss i

ans ace rvic alis

de s ce

nds

ce rvic alis

trans ve rs e ce rvic al

s upra c lavic ular

le ss e rocc ipital

gre at aur ic ularC E RV I C A L P L E X US

Hypogloss al(CNXII)

Plate 32


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Supra c lavic ular

Trans ve rs e ce rvic al

G re at aur ic ularLe ss e r occ ipital

CUTANEOUS BRANCHES

Plate 24


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CN XII

de s ce nde ns

hypogloss

ide s ce nde nsce rvic alis

ans ace rvic alis

?

?

s pinal acce ss ory

gre at aur ic ular

le ss e r

occ ipital

Plate 32


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Ante rior s c ale ne

Supra s c apular a.

Subc lavian a.

Plate 33


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A RT E R I E S

CommonCarotid

Subclavian

Thyrocervical trunk

Vertebral

Costocervical trunk Internal thoracic


14/14Plate 75 and 76

Lecture 54,55 - Triangles of Neck

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