Posterior Triangle

Posterior Triangle Muscle Platysma Innervation Cervical branch of facial nerve (CN VII) Accessory nerve (CN XI) Accessory nerve (CN XI) and C3, C4 nerves Dorsal scapular nerve (C5) and C3, C4 nerves C1-C3 by a branch of ansa cervicalis C4-C6 C3-C8 C4-C6 Function Draws corners of mouth inferiorly and widens it in expressions of sadness and fright. Draws skin of neck superiorly when teeth are clenched. Laterally flex head and neck, rotates head and neck to the opposite side. Together: flex head and neck Superior fibers elevate scapula, middle fibers retract scapula, inferior fibers depress scapula, superior and inferior together rotate scapula superiorly Elevates and inferiorly rotates scapula. Depress, retract, and steady hyoid Lateral flexion of neck, rotation of head and neck to the opposite side, elevation of first rib. Together: flex neck Laterally flex neck, elevation of first rib. Laterally flex neck, elevation of second rib.

Sternocleidomastoid

Trapezius

Levator scapulae Omohyoid Anterior scalene Middle scalene Posterior scalene

Fascia Investing layer of deep cervical fascia Prevertebral layer of deep cervical fascia

Most superficial layer, surrounds entire neck deep to skin/subcutaneous tissue Tubular sheath for vertebral column and muscles associated with it (longus colli and longus capitis anteriorly, scalenes laterally, deep cervical muscles posteriorly)

Posterior Triangle Clinical Correlates Affected structure muscles Clinical correlate torticollis: contraction of cervical mucles that produces twisting of neck and slanting of head (wry neck). Due fibrous tissue tumor in SCM, pulling infant's head at birth. Spasmodic torticollis: cervical dystonia. Begins in adulthood, involves bilateral combination of lateral neck muscles (SCM, trapezius). penetrating trauma/surgery/tumors/fractures. Weakness in turning head to one side against resistance, weakness/atrophy of trapezius. Drooping of shoulder, unilateral paralysis of the trapezius (pt cannot elevate and retract shoulde or elevate arm superior to horizontal) paralysis of half of diaphragm. Used in lung operation. Anesthesia injected on anterior surface of anterior scalene. inject anesthesia along posterior border of SCM at nerve point of the neck. central line placement "internal barometer," becomes prominent when venous pressure rises (heart failure, obstruction of superior vena cava, enlarged supraclavicular lymph nodes, incr intrathoracic pressure) can be seen deep to SCM superior to medial end of clavicle. reflects ECG recordings and right atrium pressure. usually right internal jugular vein because it is straighter and larger ligation to control bleeding from a branch. Occipital artery provides main collateral circulation surgical approach to carotid arteries, IJV, vagus, hypoglossal, cervical sympathetic trunk palpate artery between trachea and infrahyoid muscles atherosclerotic thickeningtransient ischemic attack: loss of neurological function. carotid endarterectomy: open artery at origin, strip of atherosclerotic plaque with intima.

SCM

nerves veins arteries

spinal accessory nerve (CN XI) phrenic nerve block cervical plexus subclavian vein external jugular vein internal jugular pulse internal jugular vein puncture external carotid artery carotid triangle carotid pulse carotid occlusion