2021/7021MSC Oral Biology Semester 1 2013

Laboratory Manual Anatomy of the Head and Neck Region Laboratory 3 Triangles of the Neck

Laboratory 3: Anterior and Posterior Triangles of the Neck, Review Muscles of mastication and their actions; Review Muscles of facial expression. Learning objectives. At the end of the laboratory students should be able to:
1. Be able to identify the boundaries and contents of the anterior triangle of the neck 2. Be able to identify the boundaries and contents of the posterior triangle of the neck 3. Identify the muscles of facial expression and describe their role. 4. Revise the osteology of the skull. 5. Revise the osteology and arthrology of the TMJ. 6. Revise the anatomy of the mandible. 7. Revise the muscles of mastication and describe their functions in relation to mastication.

Station 1 Muscles of facial expression: label the muscles and indicate their nerve supply

* * * * * * *

* * * * What nerve supplies motor innervation to the Buccinator muscle? What is the embryological origin of these muscles?

Surface anatomy of the neck

Before you work on the triangles of the neck, check out the surface anatomy in your study partner so you can identify landmark features such as the two heads of sternocleidomastoid muscle and the jugular notch, inferior border of the mandible and trapezius.

Note that the labels on the right side of the diagram have been cut, so they should read submandibular gland, mental protuberance and supraorbital margin.

Station 2 Neck fascia and triangles

See pages 272-283 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Note the submental and submandibular triangles Carotid triangle

What is the region labeled 1?___________________________________________ What is the structure labeled 2? ___________________________________________ What is the region that is labeled 3? __________________________________ What forms the boundary between the anterior and posterior triangles of the neck? __________________________________________________________________

Describe the boundaries of the anterior triangle of the neck: Anterior border is an imaginary line travelling from inferior point of the symphysis menti of the mandible, then connecting to the centre of the jugular notch of the manubrium (that is, the midline of the anterior surface of the neck). Posterior border is: __________________________________________________________________________ Superior border is: __________________________________________________________________________

Note the fascial sheath that wraps the sternocleidomastoid and the one that underlies it in front of the trachea. The veins are very superficial and are often removed when deeper dissections are performed. Make sure you check out superficial and deeper dissections of the triangles of the neck
Figure 12.23 page 280 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Which of the following are readily visible in the superficial dissections of the neck o Common carotid artery o External jugular vein o Thyroid gland o Submandibular gland o Parotid gland o Transverse cervical nerve (often lost if you cant see the investing layer of deep cervical fascia. Remember, superficial cervical fascia has to be removed so you can see the fibres of platysma).

Identify the following muscles in the dissections you are observing, they are helpful landmarks when you are trying to identify other co-located structures. o Trapezius o Sternocleidomastoid o Digastric (posterior and anterior bellies) o Omohyoid

Fig12.29 pg 282 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

List the key neurovascular and muscular structures you can identify in this lateral view of the anterior triangle? (Dont worry, you will see these again in later labs!)

Revisit the suprahyoid and infrahyoid muscles and see if you can identify cricothryoid muscle, deep to sternothryoid. Note position of the internal jugular vein, adjacent to right common carotid artery. Common carotid has superior thyroid branch and superior laryngeal branching here.
Fig12.23 pg 280 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Remember that the carotid artery , vagus nerve and the internal jugular vein are located within the carotid sheath so look for it in the prosections. The diagram on the next page is from Associate Professor Forrests lecture notes and it illustrates the relationships between the key structures within the different layers of fascia in the neck. You will explore these further in lectures and future labs on blood vessels, lymphatics and nerves, but it is handy to look at them as you look at the topography of the anterior and posterior triangles of the neck and their contents. Note that the Platysma muscle is very superficial and thus is covered in the superficial fascia associated with the skin. You can also review this material on page 110 of Chapter 7 Textbook of Head & Neck Anatomy 4th Edn Hiat JL and Gartner LP Wolters Kluwer Lippincott Williams and Wilkins Philadelphia PA

 Fascial layers in the neck: 1: Investing (superficial layer) 2: Pretracheal muscular layer 3: Pretracheal visceral layer 4: Prevertebral layer 5: Carotid sheath

Fig12.16 pg 275 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Posterior Triangle The omohyoid muscle is a characteristic landmark that passes through the posterior triangle (dividing it into an inferior subclavian or supraclavicular or omoclavicular triangle and a superior occipital triangle). The posterior belly of omohyoid enters the posterior triangle at the inferoposterior apex and then travels across to disappear under sternocleidomastoid. These subdivisions of the posterior triangle can be seen on the first illustration Figure 12.12. The superior belly of omohyoid is locatedwithin the anterior triangle where it inserts into the hyoid bone.

Now describe the boundaries of the posterior triangle of the neck: Anterior border is: __________________________________________________________________________ Posterior border is: __________________________________________________________________________ Inferior border is: __________________________________________________________________________
Figs12.21-12.22C pg 278-9 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Use the following diagrams to help you identify the major structures observed as you examine prosections from superficial to deeper dissections. The layers of fascia have been identified so that you will be familiar with them when you explore them for their clinical relevance in the spread of infection, later in the course.

What is the most superficial large vein in this diagram? Locate it on a specimen and trace its path through the neck. Fig. 12.21

Are the nerves travelling through the posterior triangle in this view all sensory?? Fig. 12.22A - Removed: Investing layer of deep cervical fascia.

In this view, the Pretracheal layer of deep cervical fascia has been removed this has revealed: Omohyoid, omoclavicular (subclavian) triangle at the inferior aspect of the image. Fig. 12.22B

Removing the prevertebral fascia reveals the phrenic nerve from the cervical plexus that runs to innervate the diaphragm (C345 keep the diaphragm alive!) You can also see the brachial plexus between the anterior and middle scalene muscles Fig. 12.22C

Station 3
Using the specimens available revise your knowledge of the osteology of the skull, mandible and cervical region. Label the diagrams on the next page below and complete the boxed questions.

Fig 2.24 pg 38 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Which muscles originate on the mandible? Identify them on this image

For the insertions visible on the mandible, which ones are for muscles that elevate the mandible? Which muscles help to protrude the the mandible? Identify their insertions on this image
Figs 9.23F pg 190 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Identify the medial and lateral pterygoid plates. What muscles originate here? Do any muscles insert here? What actions do the muscles associated with the pterygoid plate perform? Be specific

What is the name of this foramen and what passes through it?

Identify a palpable landmark to help you identify this location clinically? What is the name of these structures and what connects to them? What action do the muscles connected here perform?

Fig1.4B, pg 22 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Figure 7.19, Human Anatomy and Physiology by Marieb, E.N. and Hoehn, K. (Pearson Education, Glenview, IL, USA

Identify which bones are C1 and C2 and indicate their characteristic structural features. What structure passes through the transverse foramina?

Station 4

Fig 9.30 pg 195 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Point of clarification: Note that the articular eminence now generally replaces the term articular tubercle when discussing temporomandibular articulation. The articular eminence is the strongly convex bony elevation on the root of the zygomatic process (anterior most boundary of mandibular fossa). The tubercle is the bony knob on the lateral aspect of the articular eminence where the fibrous capsule and temporomandibular ligament attach. The temporomandibular joint is reinforced by collateral ligaments on the medial and lateral aspects. The tempormandibular ligament is the large obliquely orientated lateral ligament (or lateral ligament) reinforcing the joint. The specific functions of the two accessory ligaments the sphenomandibular and the stylomandibular ligament remain unclear, however they may limit lateral and anterior movement, respectively. See Chapter 13 pages 208-215 Textbook of Head & Neck Anatomy 4th Edn Hiat JL and Gartner LP Wolters Kluwer Lippincott Williams and Wilkins Philadelphia PA for more detail regarding movement of the TMJ. What does the Bennett angle measure? What mandibular movement is occurring? (see page 196 Head
& Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA)

Station 5
Using the specimens available revise your knowledge of the muscles of mastication

What action does the temporalis muscle perform? Which nerve innervates the temporalis muscle?

Fig 9.56A pg 214 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

This diagram includes some additional muscles posterior to the thyroid and larynx. These pharyngeal muscles joint to those of the other side of the neck at a midline raphe. What do you think the function of the pharyngeal muscles may be?
Fig 9.56C pg 215 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Extra challenge: See how many branches of the external carotid artery you can identify on the prosected specimens. Be assured you will explore these in the next lab but you may like to take the opportunity to explore them now, if you have completed the rest of the lab.

Fig3.4 pg 42 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Review your recollection of the arrangement of the fascial sheaths that you explored in the anterior and posterior triangles of the neck.

Label as many structures and fascial layers as possible in the above diagram