Pirogov's lingual triangle. The meaning of the Pirogov triangle in medical terms
The structure of the neck of each person implies the presence of four areas: posterior, anterior, lateral, sternocleidomastoid. The triangles of the neck are located within these areas, and during surgery they are the main guides.
Every person's neck has a midline that starts at the chin and ends at the jugular notch. Thus, this line divides the neck into two equal parts - the right side and the left side, which, in turn, are divided into two triangles:
- front;
- rear.
The anterior cervical triangle is located in the anterior part. It has certain restrictions - the lower jaw, the anterior edge and the midline. The upper abdomen divides this triangle into several smaller ones:
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- sleepy;
- scapular-tracheal;
- submandibular;
- Pirogov triangle;
- scapuloclavicular;
- extramandibular fossa.
Classification
Sleepy. This section contains the internal and external carotid arteries, the vagus nerve, and the internal jugular vein. During surgery on the carotid artery, it is ligated to prevent bleeding.
Scapular-tracheal. In this area there are organs that are especially important for humans, such as the trachea, larynx, carotid artery, and thyroid gland. The following surgical interventions are performed in this area:
- strumectomy;
- tracheotomy;
- ligation of the carotid artery;
- laryngectomy.
Submandibular. In this area there are two nerves, the hypoglossal and lingual, and an artery. On given triangle surgical interventions are performed for the following diseases:
- in case of a malignant tumor of the lip or tongue, complete removal of the lymph nodes is performed;
- when tumors appear, the submandibular salivary glands are removed;
- An incision is made in the floor of the mouth in the presence of phlegmon.
Pirogov's triangle. This area is located in the submandibular triangle. In order for the doctor to get to the lingual artery during surgery, he first needs to cut the fibers of the hyoid-lingual muscle, which is located obliquely - longitudinally.
The posterior cervical triangle is located in the middle of the collarbone and between the trapezius muscle. It, in turn, is divided into smaller triangles of the neck.
Scapuloclavicular. The jugular and suprascapular vein and artery pass through this area. During surgical intervention in this area, the subclavian vein and artery are ligated, and on the upper extremities, brachial plexus anesthesia is performed.
Scapular-trapezoidal. In this area under the collarbone there passes an artery, a vein, an accessory nerve, and two cervical arteries: the transverse and superficial.
Extramandibular fossa. This area has the auriculotemporal nerve, the maxillary vein, the external carotid artery, and the facial nerve. Also between the scalene muscles there are two spaces in the form of a triangular shape: prescalene and interscalene.
Classification of cervical fascia
The fascia of the neck is located in the cervical region and reflects the topography of the organs. Each fascia of the neck is a kind of connective tissue framework, which is located throughout its entire area and unites them. Each fascia of the neck has a different origin, some were formed as a result of reduced muscles, and others as a result of compaction of the tissue that surrounds all the cervical organs. As a result, they have a variety of thickness, density and length. Each author classifies them differently, so below are the fascia of the neck according to V. M. Shevkunenko.
Superficial. By its nature it is thin and loose. It spreads from the cervical area to the face, as well as the human chest.
Own. It is strengthened in several places, one part of it to the collarbone and sternum, and the second to the lower jaw. In the posterior part of the fascia of the neck, they are attached to the processes of the cervical vertebrae.
Deep and superficial layers of the cervical fascia. It resembles the shape of a trapezoid and forms a special space for the muscles, and in front the fascial sheet covers the larynx, trachea, and thyroid gland. The second and third fascial layers merge into one along the midline, thus forming the linea alba.
The superficial leaf forms a kind of collar on the neck, which completely envelops the nerves and blood vessels of a person. These two layers of neck fascia form a slit-like space. This space contains veins, as well as loose tissue; damage to them is very dangerous for human health.
Intracervical. Surrounds such important organs as the trachea, pharynx, larynx, thyroid gland, esophagus.
Prevertebral. It is located on the human spine, enveloping the long muscles of the head. It starts from the back of the skull and goes down through the entire throat.
All of the neck fascia provided are varied, some are reduced muscles, other neck fascia are a product of fiber compaction, and the third are of natural origin.
Thus, each triangle and fascia in human anatomy plays a specific and very important role. All of them are of different sizes and have their own specific, responsible function in human anatomy, and during surgical intervention they are landmarks. All fascia of the neck have strong connection with the walls of veins, which perfectly promotes venous outflow.
PIROGOV TRIANGLE, trigonum lingua-1e, a small triangular space in the lateral part of the suprahyoid region of the neck, formed from below (behind) by the tendon of the digastric muscle (m. digastricus), the superior hypoglossal nerve (n. hypoglossus), passing obliquely and together with the lingual vein, and the inside (front) is the outside (posterior) edge of the maxillohyoid muscle (m. mylohyoideus). The bottom of the triangle is occupied by the hypoglossus muscle (m. hyo-glossus). This triangle is the surest path to the lingual artery (a. lingualis; Pirogov). In the ability to accurately determine the course of the tongue. arteries and lies the practical significance of P. t. Pirogov's triangle is part of the medial wall of the submandibular region; to reach his opera, -
Pirogov triangle; 1-sh. stylo-hyoideus; 2-posterior bryshko m. digastrici; 3-m. hyoglossus; 4- p. hypoglossus; S - anterior abdomen of t. digastrici; c - t. mylo-hyoideus; 7-a. maxillaris ext.
in a positive way, the patient should be placed with a strongly thrown back and turned in the opposite side head. With an incision starting at the anterior edge of the sternocleidomastial muscle in the middle of the distance between the lower jaw and the hyoid bone, the skin and subcutaneous tissue with superficial fascia, the subcutaneous muscle of the neck (m. platysma myoides) and the first aponeurosis of the neck, which forms here the anterolateral wall of the bed (capsule) of the submandibular salivary gland; to penetrate deep into the gland, it is cut off and tilted upward, the thin fascial medial wall of its bed is exposed, the edges are easily separated by blunt means, after which a small layer of fiber lining the i.t. is exposed. the intermediate tendon of the digastric muscle is visible, attached here to the small horns of the hyoid bone, and both bellies of the muscle, and the posterior belly is partly covered by the stylohyoid muscle (m. stylohyoideus), attached to the large horn of the hyoid bone. It extends obliquely from the large horn of the hyoid bone. upward and inwardly there is a thin hyoid-glossus muscle (m. hyo-glossus), along its lateral surface the hypoglossal nerve passes in the form of a white, shiny, round formation in cross-section and below it the lingual vein (v. lingualis). If you cut across or push bluntly along the fibers of the hyoglossus muscle immediately above the hyoid bone, then in the tissue lying behind the muscle, a strongly pulsating lingual artery is found and isolated and, if necessary, immediately ligated.
The described relationship between the artery and the named formations is so precise that ligating it in this place is relatively easy. But there may be cases of either a significant reduction in the size of the already small triangle or even its complete absence, which makes it very difficult to find the lingual artery. The base of the P. t. faces upward to the hypoglossal nerve, and the apex downwards to the hyoid bone. Dimensions of the triangle? are small, its height—the distance from the hypoglossal nerve to the hyoid bone—is on average about one centimeter. P. t. is very small in the case when the hypoglossal nerve and hyoid bone come close to each other; then the hypoglossal nerve passes too close to the tendon of the digastric muscle. P. t. may be completely absent if the tendon of the named muscle is held at the hyoid bone by a wide and longer tendon loop than usual; as a result of this, the tendon of the digastric muscle rises up, moves away from the hyoid bone by 3-4 cm and passes either over the hypoglossal nerve or above it. When approaching the lingual artery, in this case it is necessary to artificially create a Pirogov’s triangle by pulling the tendon of the BIGASMIC MUSCLE DOWN.
A. Sirotkin.
po krainei mere eto oficialnoe videnie problemi????? what is it?
Moment iz lichnogo opita kogda ychilsia - akademik Vagner proizvodil rezikciy iazika, to nachali s pereviazki dannoi arterii i kak raz v oblasti etogo treygolnika
A bandage was proposed by Pirogov as an option
1) common carotid artery
2) lingual artery and vein
3) hypoglossal nerve
4) vagus nerve
17. The vagus nerve is located in the neck
1) in front of the common carotid artery
2) medial to the common carotid artery
3) outside the internal jugular vein
4) between the common carotid artery and the internal jugular vein
The internal jugular vein is located
1) medial to the common carotid artery
2) lateral to the common carotid artery
3) in front of the common carotid artery
4) behind the common carotid artery
The common carotid artery is located
1) medial to the internal jugular vein
2) lateral to the internal jugular vein
3) in front of the internal jugular vein
4) behind the internal jugular vein
In the carotid triangle, posterior and medial to the fascicular ganglion of the vagus nerve, lies
1) superior laryngeal nerve
2) inferior laryngeal nerve
3) superior node of the sympathetic trunk
4) hypoglossal nerve
The sino-carotid reflexogenic zone is located
1) on the external carotid artery
2) at the bifurcation of the common carotid artery
3) on the internal carotid artery
4) on the common carotid artery
The superior thyroid artery arises in the neck
1) from the external carotid artery
2) from the internal carotid artery
3) from the common carotid artery
4) from all of the listed arteries
The sheath for the common carotid artery, vagus nerve and internal jugular vein forms
1) 3 fascia of the neck
2) parietal layer 4 fascia of the neck
3) visceral layer 4 fascia of the neck
4) 5 fascia of the neck
The superior ganglion of the cervical sympathetic trunk is located
1) at the level of 1-2 cervical vertebrae
2) at the level of 2-3 cervical vertebrae
3) at the level of 3-4 cervical vertebrae
4) at the level of the 4th cervical vertebra
The deep lymph nodes of the neck are located
1) along the common carotid artery
2) along the internal carotid artery
3) along the vagus nerve
4) along the internal jugular vein
The sympathetic trunk is located on the neck
1) under the 3rd fascia of the neck
2) under the parietal layer of the 4th fascia of the neck
3) under the visceral layer of the 4th fascia of the neck
4) under the 5th fascia of the neck
For the sternocleidomastoid and trapezius muscles of the neck, the motor nerve is
1) hypoglossal nerve
2) accessory nerve
3) vagus nerve
4) facial nerve
The neck loop is located
1) outside the external carotid artery
2) outside the superior thyroid artery
3) outside the internal carotid artery
4) outside the common carotid artery
29. The bed for the submandibular salivary gland forms
1) 1 neck fascia
2) 2 fascia of the neck
3) 3 fascia of the neck
4) 4 fascia of the neck
In the submandibular triangle of the neck there are
1) superior laryngeal vein and artery
2) facial vein and artery
3) superior thyroid artery and vein
4) all of the above
31. In the submandibular triangle of the neck there is
1) hypoglossal nerve
2) accessory nerve
3) vagus nerve
4) facial nerve
The phrenic nerve in the neck is located
1) on the sternocleidomastoid muscle
2) on the trapezius muscle
3) on the anterior scalene muscle
4) on the omohyoid muscle
The base of the scalene-vertebral triangle of the neck forms
2) anterior scalene muscle
3) dome of the pleura
4) longus colli muscle
The apex of the scalene-vertebral triangle of the neck is formed by
1) transverse process of the 6th cervical vertebra
2) anterior scalene muscle
3) dome of the pleura
4) longus colli muscle
The outer border of the scalene-vertebral triangle of the neck is formed by
1) transverse process of the 6th cervical vertebra
2) anterior scalene muscle
3) dome of the pleura
4) longus colli muscle
36. The thoracic lymphatic duct passes through the neck
1) between the common carotid artery and the internal jugular vein
2) between the internal jugular vein and the vertebral veins
3) between the internal jugular and facial veins
4) between the internal jugular and external jugular veins
37.Where does the thoracic lymphatic duct flow into the neck?
1) right venous angle of Pirogov
2) left venous angle of Pirogov
3) subclavian artery
4) vertebral artery
38. The subclavian artery in the neck is projected
1) to the middle of the upper edge of the clavicle
2) to the middle of the lower edge of the clavicle
3) on the medial third of the upper edge of the clavicle
4) on the medial third of the lower edge of the clavicle
In the scapular-trapezoid triangle of the neck is located
1) hypoglossal nerve
2) accessory nerve
3) vagus nerve
4) glossopharyngeal nerve
hypoglossus), passing obliquely along with the lingual vein, and inside (in front) - with the outer (posterior) edge of the mylohyoid muscle (m. mylohyoideus). The bottom of the triangle is occupied by the hyoglossus muscle (m. hyoglossus). The Pirogov triangle is the site of choice for ligation of the lingual artery. For surgery on Pirogov's triangle, the patient is placed with his head thrown back and turned in the opposite direction. The incision is made from the anterior edge of the sternocleidomastoid muscle in the middle between the lower jaw and the hyoid bone. Having reached the submandibular salivary gland, it is separated and tilted upward, the thin medial wall of its bed is bluntly divided, after which the tissue lining Pirogov's triangle is exposed, and under it is the hyoglossus muscle. The hypoglossal nerve (n. hypoglossus) runs along its lateral surface and below it - the lingual vein (v. lingualis). If you cut across or bluntly push apart the fibers of the muscle above the hyoid bone, then a strongly pulsating lingual artery is found in the underlying tissue. The described relationship of the artery with the named formations is so precise that ligating it in this place is relatively easy.
There are cases when the Pirogov triangle is very small or absent, which makes it very difficult to find the lingual artery. Pirogov's triangle is very small when the hypoglossal nerve and hyoid bone come close to each other; then the hypoglossal nerve passes too close to the tendon of the digastric muscle. The Pirogov triangle is absent if the tendon of the named muscle is held at the hyoid bone by a wide and longer than usual tendon loop; as a result of this, the tendon of the digastric muscle will rise up, move away from the hyoid bone by 3-4 cm and pass either over the hypoglossal nerve or above it. When approaching the lingual artery, in this case it is necessary to create a Pirogov triangle artificially by pulling the tendon of the digastric muscle down.
Pirogov triangle: 1 - a. facialis; 2 - m. mylohyoideus; 3 - anterior abdomen m. digastricus; 4 - n. hypoglossus; 5 - m. hyoglossus; 6 - posterior abdomen m. digastricus; 7- m. stylohyoideus; 6 - platysma.
Submandibular triangle: its topography and significance
The submandibular triangle is an anatomical region bounded by the anterior and posterior belly of the biceps muscle and the edge of the alveolar process of the mandible. The structure and significance of this area will be discussed in detail in the article.
Boundaries of the submandibular triangle
The boundaries of the submandibular triangle include the following anatomical formations:
- lower edge of the alveolar process of the lower jaw;
- anterior belly of the digastric muscle;
- posterior belly of the digastric muscle.
Externally it can be found by landmarks:
- lower edge of the lower jaw;
- mastoid process of the temporal bone;
- chin.
Layers and fascia of the submandibular triangle
The submandibular triangle consists of 4 layers:
- leather;
- subcutaneous fatty tissue;
- first fascia of the neck;
- second fascia of the neck.
- pectoral fascia;
- facial muscles of the corner of the mouth;
- parotid masticatory fascia.
The nerve that innervates this muscle arises from the facial nerve and is called its cervical branch.
This layer also contains superficial lymph nodes, branches of the transverse nerve of the neck and the cervical plexus.
- The second fascia of the neck is involved in the formation of the capsule of the submandibular salivary gland. The fascia itself consists of 2 sheets:
- The first, or superficial, covers the outer side of the salivary gland. Its point of attachment is the lower edge of the mandible.
- The second and deeper one, which forms a septum separating the two salivary glands: the parotid and submandibular.
- Also, the second fascia of the neck forms capsules for the anterior belly of the digastric muscle and the mylohyoid muscle.
- The lowest point of attachment of this layer is the hyoid bone.
The submandibular triangle contains a large number of important anatomical formations: the submandibular salivary gland, lymph nodes, muscles, blood vessels and nerves.
Topographic anatomy of the submandibular salivary gland
Anatomical formations located near the gland:
- lower jaw;
- from the inside there are the mylohyoid and mylohyoid muscles, which are separated by fascia;
- the hyoid bone is located below;
- digastric.
As mentioned above, the capsule of the gland is formed by the second fascia of the neck. The leaf freely frames the gland and does not grow together with it. There are no additional processes going deeper.
Between the capsule and the body of the gland there is fatty tissue. Its peculiarity is that it communicates with other spaces of the face and neck along the salivary duct. All inflammatory processes occurring in the area of the bottom of the oral cavity easily penetrate to the space around the gland.
Important! Therefore, when an inflammatory process is detected in any of the cellular spaces of the face and neck, the doctor examines not only the causative area, but also those bordering it.
The capsule does not completely cover the gland. 2 processes extend beyond its limits. The posterior one is located under the lower edge of the jaw and ends in the area of the internal pterygoid muscle. The anterior process departs along with the excretory duct and reaches the muscles of the floor of the oral cavity.
Excretory duct
It originates from the inner edge of the gland, goes forward and upward, passing between the mylohyoid and mylohyoid muscles. End point– mucous membrane of the floor of the oral cavity.
A number of important nerves and vessels pass along the duct:
Lymph nodes
The lymph nodes are located in the area of the upper and posterior edges of the gland, since this is where the facial vein passes. They can also be found under the capsule and between its leaves.
It is this location that leads to the need to remove the entire salivary gland during surgery for cancerous tumors.
Muscles of the submandibular triangle
The submandibular triangle consists of the following muscles:
The digastric and stylohyoid muscles are the boundaries of the triangle, and the mylohyoid and mylohyoid are involved in the formation of its bottom.
The first muscle consists of 2 parts: the anterior and posterior abdomen. The posterior abdomen begins from the temporal bone, or rather from its mastoid notch. The anterior one originates on the body of the lower jaw. They have a common second attachment point - the hyoid bone.
The stylohyoid muscle is located near the posterior abdomen, tightly adjacent to it. Its beginning is located at the styloid process, and its end is also at the hyoid bone.
The mylohyoid muscle is located deeper than the digastric muscle. Its attachment points are the mylohyoid line on the lower jaw and the hyoid bone. The right and left muscles form the suture of the bottom of the lower jaw and participate in the formation of the diaphragm of the mouth.
The mylohyoid muscle seems to continue the mylohyoid muscle. Having the same starting point, it ends on the lateral surface of the tongue.
Important anatomical structures pass through this muscle:
Arteries and veins
The main vessel in this area is the facial artery. It is the main supply line of the face. In the submandibular triangle, the vessel bends and passes along the upper and posterior surfaces of the gland, located next to the pharyngeal wall.
The facial vein is located in the thickness of the superficial layer of the second fascia. In the region of the posterior border of the triangle, it connects with the retromandibular vein and forms the common facial vein.
Pirogov triangle
This is a small portion of the triangle where the lingual artery can be found. The boundaries of the Pirogov triangle will be:
- hypoglossal nerve;
- digastric tendon;
- mylohyoid muscle.
The hyoglossus muscle acts as the bottom of the triangle. The Pirogov triangle can only be detected when the head is strongly thrown back and tilted in the opposite direction.
Important! The instructions that the doctor must follow when working with this area are extremely important, since the cost of an error is very high. Bleeding from the lingual artery can be fatal.
Lymph nodes
The lymph nodes in this area are located above, in the thickness or under the second fascia. They collect lymph from:
As a result, with inflammation in any of the presented areas, the submandibular nodes increase in size. The photos and videos in this article clearly show the anatomy of the submandibular triangle.
Pirogov triangle border
In the same space, but upward from the duct of the submandibular gland, between m. hyoglossus and m. mylohyoideus, is the lingual nerve, n. lingualis, giving off branches to the submandibular salivary gland (Fig. 6.6).
Thus, in the gap between m. hyoglossus and m. mylohyoideus pass starting from the bottom, n. hypoglossus, v. lingualis, ductus submandibularis, n. lingualis.
Pirogov's triangle. Topography of the Pirogov triangle. Walls of a Pirogov triangle.
The Pirogov triangle is used as an internal reference point when accessing a. lingualis. It is bounded by the hypoglossal nerve above, the tendon of the digastric muscle below and behind, and the free posterior edge of m. mylohyoideus - in front.
The bottom of the Pirogov triangle is formed by m. hyoglossus, along the upper (deep) surface of which there is a lingual artery, and along the lower surface there is a vein. To access the lingual artery for the purpose of ligating it, for example, with a deep cut of the tongue, it is necessary to dissect the deep layer of the 2nd fascia and separate the fibers of the hyoglossus muscle.
Submandibular lymph nodes.
The submandibular lymph nodes, nodi submandibulares, are located under the superficial plate of the 2nd fascia of the neck or above it. They are also present in the thickness of the gland, which makes it necessary to remove not only the lymph nodes, but also the salivary gland during metastases of cancerous tumors (for example, the lower lip).
Lymph flows into the submandibular lymph nodes from the medial part of the eyelids, external nose, mucous membrane of the cheek, gums, lips through chains of nodes running along the facial artery. Lymph from the floor of the mouth and the middle part of the tongue also flows into the submandibular nodes.
The connection of the fiber of the submandibular triangle with the oral cavity along the gland duct, as well as the outflow of lymph from the superficial parts of the face, explain the fairly frequent development of submandibular phlegmon. There is practically no further spread of the purulent-inflammatory process due to the isolation of the cellular space of this triangle.
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Pirogov triangle
Pirogov's triangle or lingual triangle of the neck (lat. Trigonum linguale) is an anatomical area located in the submandibular triangle within the inferior socket fossa and under the hyoglossus muscle (m. Hyoglossus). The triangle was first described by the Ukrainian surgeon and anatomist Nikolai Pirogov.
Borders
Below and behind is the tendon of the posterior belly of the digastric muscle (m. Digastricus). In front is the posterior edge of the mylohyoid muscle (m. Mylohyoideus). Above is the hypoglossal nerve.
Clinical significance
Within the triangle, the lingual artery and vein are designed, which can be surgically accessed during neck dissection.
PIROGOV TRIANGLE
Big medical encyclopedia. 1970 .
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5. Pirogov's triangle.
Pirogov's triangle is used as an internal landmark when accessing the lingual artery (a. lingualis). It is bounded by the hypoglossal nerve above, the tendon of the digastric muscle below and behind, and the free posterior edge of m. mylohyoideus - in front. The bottom of the Pirogov triangle is formed by m. hyoglossus, along the upper (deep) surface of which there is a lingual artery, and along the lower surface there is a vein. To access the lingual artery for the purpose of ligating it, for example, with a deep cut of the tongue, it is necessary to dissect the deep layer of the 2nd fascia and separate the fibers of the hyoglossus muscle. Lingual artery, a. lingualis arises from the external carotid artery at the level of the hyoid bone, 1-1.5 cm above the superior thyroid artery.
Rice. 2. Schematic representation of the areas and triangles of the neck: 1 - scapuloclavicular triangle; 2 - scapular-trapezoidal triangle; 3 - sleepy triangle; 4 - scapular-tracheal triangle; 5 - submandibular triangle; 6 - retromandibular fossa; 7 - sternocleidomastoid muscle; 8 - omohyoid muscle; 9 - digastric muscle; 10 - trapezius muscle.
Ticket 70
1. Sterno-clavicular-mastoid region: boundaries, external landmarks, layers, fascia and cellular spaces, vessels and nerves. 2. Topography of the main vascular-nervous bundle of the neck (course, depth, relative position of vascular- nerve elements, projection onto the skin of the carotid artery). 3. Rapid access to the carotid artery.
1. Sterno-clavicular-mastoid region: boundaries, external landmarks, layers, fascia and cellular spaces, vessels and nerves.
Boundaries: The sternocleidomastoid region corresponds to the position of the muscle of the same name and reaches the mastoid process at the top, and the clavicle and manubrium of the sternum at the bottom.
External landmarks: The main external landmark is the sternocleidomastoid muscle itself, which covers the medial neurovascular bundle of the neck (common carotid artery, internal jugular vein and vagus nerve).
Layers: The skin of this area is thin and easily folded together with the subcutaneous tissue and superficial fascia. Near the mastoid process it is dense, the subcutaneous one is moderately developed. Between the superficial fascia (1st) and the superficial plate of the fascia of the sternocleidomastoid region of the neck (2nd) are the external jugular vein, superficial cervical lymph nodes and cutaneous branches of the cervical plexus of spinal nerves.
Vessels and nerves: Common carotid artery, internal jugular vein, vagus nerve.
At the middle of the posterior edge of the sternocleidomastoid muscle, the exit site of the sensory branches of the cervical plexus is projected. The Pirogov venous angle, as well as the vagus (medially) and phrenic (lateral) nerves are projected between the legs of this muscle.
2. Topography of the main vascular-nervous bundle of the neck (course, depth, relative position of vascular-nervous elements, projection onto the skin of the carotid artery).
There are two large vascular-nerve bundles in the neck: the main and subclavian.
The main neurovascular bundle of the neck consists of the common carotid artery, internal jugular vein, and vagus nerve. It is located in the neck in the area of the sternocleidomastoid (sternocleidomastoid) muscle and the carotid triangle. Thus, the main vascular-nerve bundle along the carotid artery has two sections: the 1st section in the area of the sternocleidomastoid muscle, the 2nd section in the carotid triangle. In the area of the sternocleidomastoid muscle, the neurovascular bundle lies quite deep, covered by the muscle, the 2nd and 3rd fascia. The sheath of the bundle is formed by the parietal leaf of the 4th fascia and, in accordance with Pirogov’s laws, has a prismatic shape, with spurs the sheath is fixed to the transverse processes of the cervical vertebrae.
Higher up, the main neurovascular bundle is located in the carotid triangle. The depth of the neurovascular bundle differs in that it is not covered by muscle and third fascia. With the head thrown back, the pulsation of the carotid artery is clearly visible on the neck, and with palpation the pulse here can be determined even with a significant decrease in blood pressure.
The relative position of the neurovascular elements: A vein lies in front and outward of the artery, the vagus nerve lies between the vein and artery and posteriorly.
The head is turned in the opposite direction and pulled up:
Left common carotid artery is projected from the middle of the distance between the apex of the mastoid process and the angle of the lower jaw to the middle of the distance between the legs of the sternocleidomastoid muscle.
Right common carotid artery is projected from the middle of the distance between the apex of the mastoid process and the angle of the lower jaw to the sternocleidomastoid joint.