Imaging of the Neck Submental Triangle

Traditional Neck Triangles Boundaries:

− Used by clinicians to localize H&N lesions • Inferiorly – Hyoid bone.
2 Major subdivisions • Medially – Imaginary sagittal midline of the
− Anterior triangle neck.
− Posterior triangle • Laterally – Anterior belly of the digastric. 
Anterior Triangle *mylohyoid muscle – forms the base of the submental
Boundaries: triangle
• Superiorly – Inferior border of the mandible Main content:
• Laterally – Medial border of the • Submental lymph nodes
sternocleidomastoid
• Medially – Imaginary sagittal line drawn along Posterior Triangle
the midline of the neck Boundaries:
Subdivisions: • Anterior: Posterior border of the
• Carotid Triangle sterncleidomastoid muscle.
• Muscular Triangle • Posterior: Anterior border of the trapezius
• Submental Triangle muscle.
• Submandibular Triangle • Inferior: Middle 1/3 of the clavicle
Carotid Triangle Subdivisions:
Boundaries: • Occipital Triangle
• Superior: Posterior belly of the digastric muscle. • Supraclavicular Triangle
• Lateral: Medial border of the Contents:
sternocleidomastoid muscle. • Muscles
• Inferior: Superior belly of the omohyoid muscle. – Omohyoid muscle (inferior belly)
Contents : – Vertebral muscles
• Common carotid artery • Splenius capitis 
• Internal jugular vein • Levator scapulae
• Hypoglossal and Vagus nerves • Scalene muscles
Muscular Triangle • Vasculature
Boundaries: – External jugular vein
• Superiorly: Hyoid bone – Transverse cervical artery
• Medially: Imaginary midline of the neck – Subclavian artery and vein
• Supero-laterally: Superior belly of the Contents:
omohyoid muscle • Nerves
• Infero-laterally: Inferior portion of the – Accessory nerve (cranial nerve XI)
sternocleidomastoid muscle – Cervical plexus
Contents: – Phrenic nerve- arises from the anterior
• Infrahyoid strap muscles divisions of spinal nerves C3-C5,
• Pharynx innervate the diaphragms
• Thyroid gland – Brachial plexus
• Parathyroid gland Subdivisions
Submandibular Triangle • Occipital triangle- crossed by the accessory
Boundaries:  nerve
• Superiorly: Body of the mandible • Subclavian triangle- contains the distal portion
• Anteriorly: Anterior belly of the digastric muscle of the subclavian artery
• Posteriorly: Posterior belly of the digastric
muscle Traditional Neck Triangles
Contents: • The traditional compartments are important for
• Submandibular gland describing the spread of superficial and
• Submandibular lymph nodes muscosa-based lesions.
• Facial artery and vein • In contrast to this divisions, multiple facial
planes divide the deep head and neck into
spaces that form true compartments.
 • It is important to realize that these deep spaces
are unrelated to the traditional division of the
head and neck and traverse the neck without
regard to the traditional divisions.
• Most radiologist have adapted a spatial
approach to the head and neck, popularized by
Dr. Ric Harnsberger.
Neck Division
− SHN: Deep facial spaces above hyoid bone
including parapharyngeal (PPS), pharyngeal
mucosal space (PMS), masticator (MS), parotid
(PS), carotid (CS), buccal (BS), retropharyngeal
(RS), danger space (DS), perivertebral space
(PVS)

Neck Fasciae − IHN: Spaces predominantly below hyoid bone

• Superficial Cervical Fascia with some continuing into mediastinum or SHN
• Deep Cervical Fascia including visceral space (VS), posterior cervical
– Superficial layer space (PCS), anterior cervical space (ACS), CS,
– Middle layer RPS & PVS.
– Deep layer
SL-DCF NORMAL ANATOMY SHN ANATOMIC SPACES
• SHN: circumscribes MS & PS, contributes to 1. Parapharyngeal space (PPS)
carotid sheath 2. Pharyngeal mucosal space (PMS)
• IHN: “invests” neck by surrounding strap, 3. Carotid space (CS)
Sternomastoid & trapezius muscle; contributes 4. Parotid space (PS)
to carotid sheath 5. Masticator space (MS)
ML-DCF 6. Retropharyngeal space (RPS)
• SHN: Defines PMS deep margin; contributes to 7. Perivertebral space (PVS)
carotid sheath
• IHN: circumbscribes VS; contributes to carotid Posterior Midline
sheath – Retropharyngeal space
DL-DCF • Danger space
• SHN & IHN – surrounds PVS with fascial slip to – Perivertebral space
transverse process dividing PVS into Skull Base Relation
prevertebral and paraspinal components; – Masticator Space
contricutes to carotid sheath. • F. Ovale
• F. Spinosum
Neck Division – Parotid Space
Hyoid Bone/ Cartilage • Stylomastoid foramen
• Suprahyoid Compartment – Carotid Space
• Infrahyoid Compartment • Int Carotid Artery
EXTENT: • Int Jugular Vein
• SHN: neck spaces from skull base to hyoid bone – Pharyngeal Mucosal Space
excluding orbit, sinonasal area and oral cavity • F. Lacerum
(OC) – Parapharyngeal Space
• IHN: Neck spces from hyoid above to – Retropharyngeal Space
cervicothoracic junction below
Hyoid Bone
− U-shape or horse shoe configuration
− Three components
− 2 horns, 1 body
Thyroid Cartilage
− V-shape configuration
− Two components
Cricoid Bone
− Complete cartilagenous ring
− Thicker and taller posteriorlly