Triangles of neck Lymph nodes level (neck) Oral cavity Pharynx

By: Siti Nurulismah

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

V E R T E B R A L A R T E RY T R I A N G L E
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 LEVEL

Submental & submandibular group Upper jugular group Middle jugular group Anterior compartment: Posterior triangle group include supraclavicular LN

Lower jugular group

Submandibular LN

Upper jugular group

Submental LN

Posterior triangle group include supraclavicular 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 pharyngoesophageal junction) Extending from base of skull lower border of cricoid cartilage Become continuous with esophagus

PHARYNGEAL WALL

Ciliated columnar in nasopharynx. Elsewhere; squamous 2 layers (ext & internal); 3 muscles in each layer Ext layer-inf constrictor muscle-2 parts (potential gap)

Perforation during esophagoscopy & herniation of Killians dehiscence pharyngeal mucosa

= nasopharyngeal tonsil

Enlarged Eustachian tube occlusion

Waldeyers Ring - Lymphoid tissue

PHARYNGEAL SPACES
Potential space abscess can form Retropharyngeal space and; Parapharyngeal space

DIVISION OF PHARYNX

2
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Craniopharyngioma may arise from it

Infected cause persistent postnasal discharge
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

F U N C T I O N O F N A S O P H A RY N X
Conduit for air Eustachian tube ventilate middle ear, equalizes air pressure Cuff of nasopharynx from oropharynx (soft palate & Passavants ridge) Help in voice production Drainage mucus from nasal & nasopharyngeal glands

OROPHARYNX
Posterior, anterior & lateral walls
Tonsillar fossa?

F U N C T I O N O F O RO P H A RY N X
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