0:10 so this is the session in which study we were uh in the session of the neuroanatomy where all the important aspect was covered for the neuron atomy and as much as I was able to complete it but today uh the maximum I will try to cover entire head and neck in this series and all the important topics which is uh actually very important for you to know in the head and X Series so let me start with the session I just want to check with the students I'm so exactly I want everybody to know about the things which will be covered in the headen X Series and which is very very important actually one of the part of the headen X Series that was of cranial for amas few topics are overlapping with the neuroanatomy and headen X Series which we have already done okay so if I talk about the important aspects to be
0:56 covered up it's important that we should be uh so yes the thing is that the all important aspect will be definitely covered so please don't worry about it and the important things to be covered in this topic is we will start with the scalp then we will go with the important structures of the phase then we will go with all the triangles of head and neck so actually what happens why the triangles are very important when I'm talking about the triangles of head and neck it means uh that you have all the structures in the anterior triangle uh the sub triangles of the anterior triangle we have got koted we have got digastric we have got the submental we have got uh the muscular triangle we have got the uh subclavian triangle we have got the occipital triangle we have got the scelo vertebral triangle we have
1:43 got suboccipital triangle actually many many triangles are there and all the important uh aspects of the triangle should be covered because it's entirely very important yes good morning everyone other than that you should have an idea of glands of henite like uh you should be knowing about the pared gland you should be knowing about the submandibular gland you should be knowing about the thyroid gland other than that I will also cover farings laryn okay these are the important aspect to be covered up so exactly many things has deep cervical fascia so actually all these will be covered up along with the mcqs which is very necessary to solve few mcqs because entirely McQ session can be taken afterwards also other than that I will also cover the tongue tongue is a very
2:29 important topic if you are targeting the fmg exam or in the neat PG exam tongue is very very important topic so we will cover up the tongue we will cover up the orbit the extraocular muscles so actually today I have taken too many topics all the vessels important vessels and branches of the arteries will also be covered up so let's start with this so the first topic of today's session is layers of scalp okay so as in the previous session also when I started with the actually my how I start with the topic is like for example if I'm going with the neuron atomy I will open up the skull cap and go inside in the brain and the covering same way when I start with the head and neck I would like to start with the scalp so you have to know the scalp layers as you proceed from uh superficial to deep as you proceed from superficial to deep so
3:15 actually uh here we have got the first layer which I'm talking is the skin so the layers can be spelled by the word scalp the spelling of the word scalp so here s for the skin C for The Connect tissue a for the epon neurotic layer l for the loose connective tissue and P for the pericranium so we have got scalp the five layers and we have got all the all the structures in the same proportion as you proceed from superficial to deep skin the connective tissue layer which is dense the epon neurotic layer which is Theo which is the epon neurotic layer for the two muscle bellies that is the frontal and occipital muscle bellies we have got loose connective tissue and we have got the pericranium so all these structures as you proceed from outside to inside is constituting the scalp
4:02 layer the epicranial epon Neurosis the lose arol tissue the pericranium so all these are the layers so actually when you see the skin if you this is the skin and in the skin what you can see the hair follicles has been shown the glands Associated the the Sous gland and all then we have got the subcutaneous tissue which is adherent to it this layer of the cutaneous tissue the connective tissue layer will be dens this is the Appo con neurotic layer which is containing two muscle valys and we have got the loose connective tissue which is also called as the dangerous layer of the scalp I will tell you the reason why it is called as the dangerous layer of the scalp and the innermost layer will be the P for the pericranium so these are the layers of the scalp as you proceed from Outer aspect to the
4:48 inner aspect now I would also like to show you in another image which will help you to understand this Concepts so we have got the skin we have got the subcutaneous tissue the muscular urtic layer and lose arola tissue and the pericranium all these layers are arranged in the same way and we have to know the important structures residing in this now uh one of the few points which I want you to tell actually you can get confused that there are two connective tissue layer one is the second layer that is the connective tissue layer that is gens and the fourth layer is the loose connective tissue layer the fourth layer that is the loose connective tissue layer if I talk about the fourth layer it is highly important why I will tell you the reason why why it is important is actually uh the reason why it is
5:33 important is because it contains Emissary vein what does it contain Emissary vein the fourth layer is containing Emissary vein and this is forming a connection with the uh veins of the scalp on the outer aspect with the veins lying inside that is Ural Venus cusis what does that means that means the infection from the outer aspect of the skull can be uh transmitted inside and can be leading to uh the infection of the Dural Venus cusis so that is highly important for you to note down so done with this now we'll talk about the epon neurotic layer the third layer is the epon neurotic layer let me slightly enlarge it so when I enlarge it you can see there is a frontalis muscle as you can see here this is the frontalis muscle belly so there is a frontalis muscle belly on the anterior aspect and there is an
6:20 occipitalis muscle belly on the posterior aspect so actually this is very important that you should know about both of these why uh because uh if I talk about the frontalis muscle it is not having any bony attachment so these two bellies here is the frontalis bellies and it is not having a bony attachment it is merging actually what happens if I talk about the frontalis muscle belly it is merging with the skin so exactly it is actually merging so it is inserting uh it is merging with the epicranial epon neurosis and it is merging with the tissues over the eyebrows and the root of the nose and the eyebrows and all structur so actually it is not having a bony attachment but when you now I also want you to se in another muscle belly that is posteriorly that is called as
7:06 occipital muscle belly so when I am talking about the occipital muscle belly what happens it is actually having a bony attachment it is arising from the lateral two3 part of the superior nucle line if you will see in the posterior aspect of the occipital bone there are two lines which is diverging okay in the skull when you sp the skull from the posterior aspect the two lines which is diverging is superior nucle line and occipital muscle belly is attached to that Superior nucle like the two side occipital belly and the frontal belly will fuse with each other leading to the formation of epicranial epuris so the gap which is lying between the frontalis muscle belly and that of occipitalis muscle belly is fused with epicranial epon Neurosis okay so it's it is
7:51 important for you to note down and other than that it's also important that these muscle bellies are getting innervation so they are getting in ation from the branches of facial neres so I just write down here one important point which I want everybody to note down is the front Talis muscle bellies arises from it arises from the tissues over tissue over the
8:41 ibrows and root of nose and it runs backward actually what happens it runs backward and merges with actually it runs backward and merges with that of epicranial the deeper fibers of frontalis so this was one important the deeper fibers of frontalis muscle valy is actually longer and it is actually merging with the muscles it is merging with the muscles like procerus muscle corrugator superciliary and orbicularis OC so it merges with procerus muscle
9:26 corrugator super sly and that of orbicularis O so actually these are the musle so we have got quet superly orbicularis o so actually these are the muscles around here in the nose and also the muscles which is lying at the so we have got these muscles uh here so we have got orbicular so actually these are merging with the muscles here so exactly that is highly highly important for you to note out so in short what I want everybody to understand is that if I'm talking about an important aspect here so if I'm talking about an important aspect here I just want everybody to understand that these is very important why I will tell you because this is how it's uh it is not having any bony
10:12 attachment so this is entirely for the reason that this is not having any bony attachment so uh so if I talk about occipitalis muscle so in between I will check with the mobile if you have got any doubt you can ask in the chat box so Oxalis muscle belly is actually attached to if I talk about occipitalis muscle bellies they arises from the lateral 2/3 of superior nucle line and extend and merges with epicranial epon Neurosis so actually the
10:58 Gap is filled with the Gap that is epicranial osis and this is having a bony attachment now the frontalis muscle belly so I will actually if I talk about the frontalis bellies they are innervated by temporal branch of facial knob and the occipitalis bellies are inner ated by posterior oric branch of facial so in other words you can say both of these are inated by the motor branches of facial what you can say both
11:44 of these muscles are inated by the motor branches of facial now I would also like to explain the nerve Supply actually scalp nerve Supply is very important so the nerve Supply can be understood by seeing this image so let me just U check with the students also are they are able to understand or not if anything which you are not able to understand you can just let me know okay so yes ma'am yes ralis okay thanks for the appreciation uh uh uh so exactly uh so I just want that you should see this image and you can understand the ination which is lying on the scalp so if I enlarge this image you can see there are actually whole of the scalp is having
12:30 eight nerves okay how many nerves the scalp is having the scalp is having eight nerves so just focus on this image so it is having an overall of eight nerves and in that 10 nerves are there eight are the sensory and two are the motor so to two motor already known which is giving inovation to frontalis muscle valy and that of the occipitalis muscle valy but if I talk about the other sensory branches what you can see the sensory branches are giving inovation to the scalp area anterior to that of the Oracle and posterior to that of the Oracle so there are four sensory nerves which is giving innervation to the anterior part of the scalp and there are other four sensory nerves which is giving innervation to the posterior part of the scal so exactly here we can uh uh here we can see this is the supr trar
13:17 nerve so I just want to highlight it so just know the name of these nerves so this is the suat trar and this is the supraorbital ner so actually supr trar supraorbital nerves these are are the branch from the Opthalmic division of trial n and then we have got jagatic temporal jagatic temporal ner is the so if you want I can slightly enlarge it let me just see can you appreciate yeah so we have got the supr trar we have got oric temporal so we have got these nerves we have got these nerves yes you are right actually yes medicine you are right so actually Supra tra Supra orbital are the branch of opthalmic division of trium gigomatic temporal is the branch of maxillary
14:02 division of trium and orico temporal is the branch of mandibular division of trial ner so that means these are the branches of trial nerve okay absolutely right shahil and then we will come to the nerves which is lying posterior to the Oracle if I'm talking of the posterior aspect we have got following nerves we have got great oric nerve I just want everybody to know the name of the nerve and also the root values because in few of the questions being asked in the previous year of examination they have directly asked about the root value of this nerve so great oracular nerve is having the root value of C2 and C3 the leather occipital is having the root value of C2 and that of Greater occipital the great occipital nerve is having C2 and
14:48 third occipital very easy to remember it will be C3 yes so exactly you are right sahil if we talk about great oracular lesser occipital greater occipital and third oxal they are the branches of cervical plexus so shahil is absolutely right so how many so in overall what you can say there are eight sensory nerves there are eight sensory nerves in the scalp and there are two motor nerves two motor nerves so actually motor nerves has already been done and we know that the frontalis muscle belly and occipitalis muscle belly is getting motor ination is it okay is it okay dear so that all are getting inovations and uh so let's talk about
15:36 the next so here also I just want to rub one important yeah so here I want this is an another image where I want everybody to appreciate the arterial Supply and the nerve Supply so let me slightly enlarge this image so actually nerves has already been done so there are 10 nerves and there are five arteries which is giving there are 10 nerves and there are five arteries which is giving uh the arterial Supply onto the scalp so that is important for you to note down so let's talk about the arterial Supply so in that case what you can say the name of that five arteries are Supra trar Supra orbital okay Supra tral sua orbital superficial temporal posterior oracular artery and that of occipital
16:21 artery so these are the five arteries these are exactly the five arteries yeah these are exactly the five arteries which is giving arterial supply to the scalp in this case what I want everybody to understand the Supra can anybody give me the answer Supra trar and supraorbital arteries are the branches of the CH can anybody give me the answer Supra trar supraorbital arteries are the branches of which artery so sahil is telling it's internal cared arteries sahil you are absolutely right wenes is also telling yeah but I got a better answer opthal branch of internal car this was what I was searching for yes so these Supra tra supraorbital are the branch of Opthalmic artery which is
17:07 subsequently the branch of internal kotd artery same way here superficial temporal is the terminal branch of external koted artery posterior ular and occipital are the posterior branch of external koted artery so you are absolutely right so if you want you can write this also so I just want to enlarge this image and I just want we have already done the nerves part so I just want everybody to concentrate on the arterial Supply so you can just write it yes sahil you are absolutely right I just want everybody to not down here Supra trar Supra orbital are the branch of Opthalmic artery and Opthalmic artery is
17:53 subsequently the branch of AA internal kotd AR superficial temporal is the branch of superficial temporal is a terminal branch of ECA external koted Ary posterior oracular is the posterior branch of EA that is external koted artery occipital artery is posterior branch of ECA that is external carot so you can see these are the branches and you have to know the name of these arteries now I would also like to talk about the Venus drainage which is very important for you to understand actually this is a image where which will help you to understand about the scalp and the facial weight uh
18:39 drainage on the face why it is very important because already in the st's session we have completed cavernous sinus and uh I just want everybody to pay attention to this because cavernous sinus infection is quite common leading to cavernous sinus thrombos so there are certain Roots which is draining the infection from the dangerous triangular area of the face to that of cavna so that roote will be also known to you but important veins which is draining the face and the scalp so I just want to enlarge this Im so when I'm enlarging it here I want you to show okay so you can see this is the Supra trar and supraorbital veins these
19:24 are actually draining angular veins and they are subsequent ly draining angular winds and they are subsequently forming the facial wind so what is this this is the facial wind form that is clear to you now I just want U you to explain about the formation of retromandibular ve so please focus on which ve retromandibular way so all of you pay attention to retromandibular way so this is the retr mandibular vein so when I'm talking about retro let me slightly enlarge it yeah when I'm talking about retro mandibular vein in this diagram itself you can
20:09 appreciate this is the retromandibular vein this is formed by what is the formation so you can see it is formed by the joining of Max ve so it is formed by the joining of Max we and that of the superficial temporal w so this is superficial temporal vein and this is the maxillary vein so these two veins superficial temporal and maxillary vein will join and lead to the formation of retromandibular vein in short we talk about retr Mand if we talk about the retromandibular vein RMV the word we use and this is how it form now after the
20:57 formation of retromandibular ve if you want slightly yeah after the formation of retromandibular vein what happens it divides into anterior and posterior division so you can see this is the anterior division of retromandibular ve which will join with the facial vein and lead to the formation of common facial vein this will lead to the formation of common facial vein and common facial vein is draining into which wind it is draining into internal jugular vein it is draining into internal jugular ve clear now now we will uh see that there is a posterior division of retromandibular vein which will join with the posterior oracular vein so this is the posterior
21:42 oricle vein which joins with the posterior division of the retromandibular vein and leads to the formation of external jugular vein so this is posterior division of retromandibular vein okay so where were we I will just come to that point yes so we were here so let me slightly enlarge it okay so we were here and in this case you can see this is the posterior division of retromandibular vein and as I told you the posterior division of retromandibular vein this is the posterior division of retromandibular vein which is joining the posterior oricle vein so this is posterior oricle vein and this is the retroband ve both of these will join and lead to the formation of both of these will join and lead to the formation of
22:29 external jugular vein external jugular vein is draining into which vein it drains into subclavian ve it drains into subclavian wi so is it clear to you everyone other important point which I want everybody to concentrate if you have got any doubt you can ask me the facial vein will communicate with the Deep facial vein as shown in the diagram and the Deep facial vein will communicate with teroid venous flexus and will drain infection to Via Emery vein it will drain infection to C sinus it will drain infection to cavernous sinus so this root is also important for you facial wind as we have seen the facial Wind forms communication with deep facial wind deep facial wind form communication with teroid Venus flexus teroid Venus flexus why ve Rin infection
23:15 into the cavernous signs so these are the important veins formed if you want a quick um important points can be uh also done so if you wait a minute okay now see here so I just want that everybody if you want I can read I can just write important aspects of it so quickly we can write it if you want because few must can get confused so one of the root of infection please write down root of infection root of infection of cavernous sinus thrombosis so one of the root of infection of cavernous sinus
24:00 thrombosis has been shown here and in that case that root of infection is V facial vein communicate with the facial vein the facial vein communicate with teroid venous plexus teroid vinous plexus communicate via Emissary vein and the infection is reaching to which structure the infection is reaching to cavernous sinus and leading to the condition of cavernous sinus thrombosis and leading
24:46 to the condition of cavernous sinus thrombosis uh which vessel lead to the infection in brain in inferior nose and upper border of the superior Li actually inferior aspect of the nose and the upper area of the face that is called firstly an earlier time it was called so Vates in earlier time we were telling this area into the dangerous area of the face now we take a whole triangular area of the phas which is the dangerous area and why there are two three rule there are two roots of infection one is bya superior Opthalmic vein other is facial vein communicating with the deep facial vein so it is by Deep facial vein and facial vein the infection reaches to the
25:32 teroid venous flexus ultimately bysty vein it is transmitted to the cavernous sinus leading to cavernous sinus thrombosis is it okay venkatesh so this is the root which has to be explained now I also want everybody to understand surgical layer of the scalp so that whole pathway I have written you can go through it okay W it is the other communication is also via Superior Opthalmic vein the infection can drain into the interior of cavernous sinus thrombosis in the st's class I already have explained it if you have missed out you can see that neuroanatomy session okay surgical I have explained that in the cavernous sinus thrombosis cavernous sinus session so you can just see that now talking about the surgical layer of the scalp so actually three
26:18 layers of the scalp there are three layers of the scalp we have got the skin so we have got the skin we have got the connective tissue layer connective tissue layer so actually this connective if I talk about this connective tissue layer this is actually dense so this is the first layer this is the second layer and we have got a third layer that is EP cranial epon Neurosis which is connecting two muscle valys frontalis and that of the oxy and these three layers these three layers together these three layers together is
27:03 called as surgical layer of scalp now the doubt which must be arising to you why these two layers are these three layers are called as surgical layer of the scalp the reason is that the uh three layers of this is very difficult to separate okay it's very difficult to separate these three layers and together they are called as surgical layer of the scalp or called as scalp proper in earlier times in case of in earlier times uh also there was a procedure of giving uh punishment to the uh to the to the accused person and in that case they have removed they for punishing the punishment they removed the three layers of the scalp that is scalp proper in
27:49 case of punishment for the rape cases now the next is black eye so actually Whenever there is a direct blow or hit if there is a direct blow or hit on the face what happens there is actually accumulation of fluid and blood in the area around the eye this condition is called as black eye and if you remember I told you yes you are absolutely right raccoon eyes yes you absolutely right actually the reason I want you to explain the reason is that the frontalis belly is not having any bony attachment it's not having any bony attachment it is just merging with the um muscles like corrugator super cular proas and orbicularis O so exactly the blood can penetrate it cannot it will be letting accumulated
28:37 inside and around the ey so this is the reason and the reason is that the frontalis muscle belly is having no bony attachment frontal bellies has no bony attachment now other condition which I want everybody so firstly I want you to give few differentiating feature of the two condition which is called as captive suum and the other is called as seal hematoma so I just want to enlarge it there is one condition that is called as cap captive suum and the the other condition is called as seal hemat so it's important to differentiate both of it actually the most serious one is Seal
29:25 hematoma the most serious one will be seal hematoma actually seal hematoma in case of seal hematoma there is sub perial bleeding which bleeding the reason of formation of seal hematoma is sub parosteal bleeding but the reason of formation of cap suum is just the pressure which is actually this is very superficial accumulation of soft tissue being compressed when the baby's head during vaginal delivery there is compression of the head part of the baby by the Bony cervical canal and all so exactly it's the fetal head is compressed against the cervix during the labor and in that case there can be compression of superficial veins and it
30:10 will be corrected in about 7 to 10 days so it sometimes in few hours only that that swelling is gone and it does not increases in size but the seal hematoma increases in size and the other important point is the swelling crosses the suture line so the swelling is a generalized swelling if I talk about the condition of captured suum there is a generalized swelling but if you will see the seal hematoma condition there is a correct outline of the swelling and so swelling does not crosses the suture line in the case of seal hematoma the swelling for example most commonly the parital reason and it will accumulate the parital r will not be seen in the occipital reason so the marking and the swelling is demarcated by the suture
30:56 line but in case of captur it can cross the sutal the complication is associated with seal hematoma because it is caused due to sub peral hemorrhages and it takes much more days and months to get resolved and it can be complicated also so I just want everybody to see the two condition one is captive suum so you can see the baby is born can everybody appreciate the baby is born and in this condition of captive suum what you can appreciate what you can appreciate there is a generalized swelling there is a generalized swelling but why I am showing you this images because it can come as image based question but when you are seeing seal hematoma you can see the swelling has got a definite size the swelling is having a defined
31:41 border the swelling is having a defined border now I would also like to show you an image here you can appreciate about the accumulations so you can see the condition of caped suum the accumulation of fluid is just in the second layer that is the connective tissue layer beneath the skin seal hematoma you can see the blood collection is there and exactly it is just in between the epicranial and the partium layer this is the epidural and the subal hematoma is the accumulation beneath the epon neurotic layer so actually these all layers has been demarcated in the scalp and also shown you the accumulation of fluid and the so
32:29 basically the difference which you have to know is the difference between captive suum and seal hematoma which has already been enumerated now let's come to a very very important topic that is triangles of the neck triangles of neck is a very important topic and many many triangles are there and I will cover entire triangles and many of the structures residing there okay so can we start with the session everyone so we have got posterior triangle and we have got an anterior triangle okay dear so I just want everybody to firstly understand what is posterior triangle and what are the structures lying inside how is the roof of posterior triangle
33:16 formed what is the structure which is forming the floor of posterior triangle what are the structures residing in the posterior triangle so I just want everybody to understand all these important features so if you will see this image I'm just enlarging it you can app appreciate the posterior triangle so the outline of posterior triangle is this so I just want this is the whole outline of the posterior triangle okay so here what happens the posterior triangle is defined by so we have got a muscle which is lying anteriorly we have got a muscle which is lying posteriorly so I would like to use a brown color for it and you can see this muscle is stno cleoid muscle which muscle is this this is the stern nooid
34:09 muscle so you can just write down this muscle is stoco myroid muscle which is lying in the anterior so this is forming anterior border of the posterior triangle and the muscle which is Ling posteriorly is the trapesius muscle musle this muscle is the T for trapezius muscle we will mention t for the trapezius muscle so here this is the T for the trapesius muscle so exactly uh if I have to define the boundaries of the posterior triangle how I'm am going to Define it the stoc mustri muscle is forming the anterior border of posterior triangle the trapesius muscle is forming the posterior border of the posterior triangle and this is the Apex so Apex is
34:56 the area where the stoco mus and trous muscle is meeting actually that is the area of superior nucle line of the oxital bone and the base is formed by this what is this this structure is forming the base and this is the middle 1/3 of the clavicle so this is formed by the 1/3 this is formed by 1/3 middle part of clavicle middle 1/3 middle part of clavicle this is formed by 1 of the middle part of Clavin so done so you can clearly see this okay now here I uh so we can see
35:42 the boundary of the entire posterior triangle and also I want you to define the belly so here in this diagram you can see this is the omo hard muscle belly so actually there is inferior Belly of omad the Triangular space which is lying above the inferior belly of HOH that triangular space is the occipital triangle and the Triangular space which is lying below the inferior belly of HOH that is called as the subclavian triangle so it is important that you should Define the boundaries of occipital triangle you should be knowing where is the subclavian triangle and you have to know the contents the roof and the floor so everybody are you clear with the boundaries are you clear with the boundaries of posterior triangle should I move further okay done okay
36:33 everyone so done everyone let's write the boundaries so I just want everybody to uh this is the roof this is the roof this the floor so I just want everybody to First write the boundaries so let's start with the boundaries so all of you please write on the heading boundaries of posterior triangle boundaries of posterior triangle of neck boundaries of posterior triangle of
37:24 neck so the boundaries are please write on what is this boundaries of posterior triangle of neck and the boundaries are so anteriorly it is bounded by posterior border of stoc cleoid muscle posteriorly it is bounded by anterior border of trapesius
38:20 muscle inferiorly or base inferior or base is formed by Superior aspect of middle 1/3 of clavical okay Apex if I talk about Superior aspect or apex apex is formed by meeting point of meeting point of sternomastoid stern croid and trapas
39:07 muscle and trapas muscle at the superior nucal line of oxital bone at the superior nucal line of o ipal Bard okay so done so here we have done with the boundaries so what we have done we have done with the boundaries so everyone is it okay we have done with the boundaries now I want everyone to concentrate for the uh so we have done with the boundaries now let's talk about the floor roof firstly so as I want you to tell about the roof so if we are
39:53 talking about the roof structures the roof is formed by investing layer of Deep Survival field so we know that whole of the neck is surrounded by a fascia the name of that fascia is deep cital fascia so in this categorization the roof of posterior triangle is formed by investing layer of deep cervical fascia and this is stretching between the stern mus and trapas muscle and actually uh the investing layer of deep cervical fascia will be overlapped by The Superficial fascia and the Skin So roof is and also roof here we can see this is the muscle this is the muscle which is is lying in The Superficial fascia of the roof that is platisa muscle which muscle is this platisa muscle so exactly roof roof of posterior triangle is
40:40 formed by roof of posterior triangle is formed by investing layer of deep cervical facia it is formed by investing layer of deep cervical fascia it is formed by investing layer of deep cervical fascia and which is actually overlapped by The Superficial fascia is covering the roof so you just can write this also The Superficial fascia is covering the roof and it will contain few important structures it will have the it will have external it will have a muscle that is platisa muscle external jugular vein and cutaneous nerve so actually I just want everybody so all of you please concentrate on this cadic image so this is a cavic image which I'm
41:27 sharing with you and actually in this cavic image what you have to understand in this cavic image what you have to understand is the structures of the roof and what are the structures which is residing so exactly um I just want to use black color so this is Sterno cleoid muscle which muscle is this this is the stoco myid muscle this is stoco myroid
42:19 muscle okay posteriorly we have got this is the part of the muscle which you are seeing this is the part of the muscle which you are seeing is this so this is the joining of both the muscles okay and the this part which you are seeing is a for the Apex and this is B for the base and this muscle which you are seeing here is the trapezius muscle this is P for the trapezius muscle this is T for trapas so done so in short we have done with the boundaries so I feel that you can understand the boundaries of the posterior triangle of the neck now the next point is to know the roof structures what all the structures are
43:05 residing in the roof so that is important for you have to understand that so for that I just want everybody so I just want everybody to concentrate so exactly here we have got uh important structure so nerves are there so exactly we can uh we are having important nerves so this is the nerve which you are seeing this is the nerve which you are seeing and these are the nerves which you are seeing so actually uh the nve which is shown lower down going towards the clavicle so I just want to use uh yeah so this will be Supra this will be the Supra clavicular nerves this is
43:51 supraclavicular nerves yes these are the this is the cervical point and the nerves are emerging out from these Point yes these are the cervical Point are the posterior border of the stoco and we have got uh so other than that we have got many important nerves residing we have got great oricle nerve we have got transverse cervical nerve so we have got a transverse so this nerve which you are seeing here will be the transverse survive so this is transverse cervical nerve this is the supraclavicular nerve which already written yeah this will be the Great oracular and the Leer occipital now so this is the
44:38 Lear occipital and this will be the great oracular nerve so so these are the nerves which is uh seen in The Superficial fasia of the posterior triangle and what about the vein so the vein is I'm just using blue color for the vein and this vein which you are seeing is the external jugular vein so the vein is also visible and that is external jugular vein which will be seen in the posterior triangle of the neck so exactly these are the structures in the cavic image of the posterior triangle of the neck which we have which have have just seen I would like to write the details of it also so we'll talk about the details of of it also so please write on the heading roof of posterior triangle and the structures residing
45:35 roof of posterior triangle of neck roof of posterior triangle of the neck so if I talk about the roof of posterior triangle of the neck we will uh know the details so the roof of posterior triangle of the neck is having it's formed by investing layer of deep cervical fascia which I have already written and The Roof Is overlapped by so it it is overlapped by superficial fascia and this superficial fascia will contain so if I talk about The Superficial fasia there are certain structures residing in The Superficial fascia and The Superficial fascia will contain a muscle that is platisa muscle so can anybody tell me the muscles which is lying in The Superficial fascia we
46:21 get uh we yes you are absolutely right shahil if I talk about the import certain structures in The Superficial fasia we have got external jugular vein we have got the branches of the cervical plexus we have got the platisa muscle here the platisa muscle is residing in The Superficial fascia and the muscles which is residing in The Superficial fascia a common term is used for these kind of the muscle and what is it called as it is called as a type of panicular gnosis muscle so platis is there we have got a uh external jugular vein we have got branches of cervical plexus and here we have got four
47:08 cutaneous nerves so let's talk about that four nerves the four cutaneous so we have got four cutaneous branches of cervical flexes we have got leer occipital nve which is having the root value C2 we have got the greater oric nerve having the root value C2 and C3 we have got uh the transverse cical now having again the root value C2 and C3 we have got the supraclavicular
47:53 now which is called as C3 and C4 four so actually all these are the branches of the cervical plexus done with this all these are the branches from the cervical plexus now so we have done with this now we will talk about the floor of posterior triangle so it's important to know the floor of posterior triangle and actually uh if we see the floor of posterior triangle it is also overlapped by uh the layer so it is overlapped by the other layer yes sahil you are absolutely right that supraclavicular nerve is ultimately having so sahil is giving an extra information that is absolutely correct that supraclavicular nerve is having lateral medial and intermediate branches and can you tell me among these branches
48:40 which is the branch which is piercing the clavical bone and that is the reason clavical bone is an example of atypical long bone can anybody tell me sahil can give me the answer s is absolutely right that there are three branches so he is absolutely right that there are three branches and among this I just want to know which is the branch which is piercing the clavicle and the name of that branch is intermediate branch of supra clavicular n so only the clavicle is regarded as a atypical bow okay floor of posterior triangle is covered by pre vertebral layer of deep cervical fasia it is covered by pre vertebral layer of deep cervical fasia
49:25 and we have to know know the name of the floor muscle we have to also know the important structure which is plastered on the prevertebral layer of deep cervical fasia it's also important that you should know the prevertebral layer of deep cical fascia will continue in the axila and will lead to the formation of axillary fascia so you can just write floor of posterior triangle is formed by PR vertebral fascia that is the part of deep cervical fascia pre vertebral fascia is the part of deep cervical fasia and it's important to know that all the muscles which is forming the floor so we have got many muscle and few important muscles which is very important for you to know is
50:16 semi spinalis capitus we have got splenius capitus we have got lator scapi lator scapi we have got scalenus medius scalenus medius and we have got first digitations of sometimes first digitations of sometimes we have got first digitations of first digitations
51:02 of seratus anterior muscle seratus anterior muscle so all these muscle which I have written is the muscle forming the floor or posterior triangle all these muscles are forming the floor of posterior triangle and the floor of posterior triangle is covered by pre vertebral layer of deep cervical fure now the uh so here we can see the boundaries and we can see the muscles also we can see the Apex base and the anterior posterior boundary of the posterior triangle and here we can see the muscles forming the floor of posterior triangle which I have already written semispinalis capitus has been sown splenial capitus has been swn the latus cap the scelus medus muscle has been swn the next important thing is to know the content of posterior triangle so if I want to pay attention to this point the content of posterior triangle
51:49 can be memorized by knowing the content which is lying in the occipital triangle and by knowing the content which is lying in the sub clavant triangle actually there is a muscle belly which is called as inferior belly of omo hard muscle which is overall dividing the posterior triangle into two parts the area which is lying above the inferior belly of HOH hard is the occipital triangle and the area which is lying below the inferior belly of HOH is the subcl triangle and individually you have to know the contents in each of these triangular spaces in the occipital triangle and in that of the subcl Triangular spaces you have to know the content so examp exctly we will talk about the contents of these individual triangle so firstly I will write the content but I just want everyone to see
52:35 this image actually in this image the occipital triangle has been designated and the contents has been denoted with the red color and actually all important by the name only it is called as the occipital triangle so it will contain occipital lymph node it will contain occipital artery it will contain spinal accessory nerve actually spinal accessory nerve is a very important content of occipital triangle the spinal accessory nerve is sandwiched between the roof and the floor layer and it is giving inovation to stern must and tedious muscle so we have got spinal accessory nve we have also got the other contents like we have got the the four branches of the cervical plexus cutaneous branches is
53:20 the content we have got the C3 C4 nerves we have got we have got the dorsal scapular nerves and we have got the super occipital lymph nose and sometimes superficial transfer cical Lal in the lower triangular space which content has been sewn with green color that is the space which is the subcl triangle which is also called as supraclavicular triangular space and in the supraclavicular Triangular space again you can see the trunk of breel plexus lies the third so actually the third part of subclavian artery and the branches like subclavian vein also the lymph nodes we have Got The Superficial transverse cervical dorsal scapular arteries all these are important structures residing so that is enough to sub clavis and suprascapular nerve that
54:06 is the nerve of upper trunk of Bal plexus so I just want everybody to write the details of contents so please focus on this topic contents of posterior triangle so please write down contents of posterior triangle content of posterior triangle so firstly you can write the contents in occipital triangle content in occipital triangle and in the B part you can write the content in the subclavian triangle content in the subclavian triangle
54:56 which is also called a supraclavicular triangular space so these two contents you have to understand okay so let's start so the contents are if I talk about spinal accessory nerve please write down the important contents the important most important content is spinal accessory nerve actually the spinal accessory nerve is prone to get injured in the posterior triangle why it is more injured in the posterior triangle because of its location it is exactly traversing between the roof and the floor layer it is passing between the investing layer and the pre vertebral layer of deep cervical fascia it is plastered in between these two layers so whenever there is any case of uh drainage has to be done any absis is there in the posterior triangle any lymph node has to be dissected out or
55:41 has been operated in this area there can be a chance of injury of spinal accessory nerve the other nerves are third and fourth third and fourth cervical nerves third and fourth cervical nerves then we have got dorsal scapular nerve then we have got the four cutaneous branch of cervical plexus we have got four cutaneous branches of cervical plexus
56:27 we have got four cutaneous branches of cervical plexes then we have got superficial transverse cervical artery super faal transverse cervical artery other than that we have got uh oxy lymph node and occipital occipital lymph node and occipital artery actually the four cutaneous branch of cervical plexus name I have not written because we already have mentioned that four branches transfer cervical supraclavicular great oric leer
57:14 occipital in the roof part okay now coming to the contents of the subcl triangle so if we talk about the contents of subcl triangle you can just write down the content of subclavian triangle in the subclavian triangle we have got the third part of subclavian artery we have got the subclavian vein we have got the terminal branch of external jugular vein terminal branch of ejv external jug ve we have got the trunks of Briel plexus as the
58:08 content we have got TRS of Briel plexus as the content we have got the lymph node supraclavicular lymph nodes actually the branches of the trunk of braal plexus that is the n to sub cavis Nerf to sub cavis and we have got NF to sub clavis and we have got suprascapular nerve okay and also the arteries sometime so arteries are also there that is the uh suprascapular artery dorsal
58:54 scapular artery super FAL transverse cervical artery so all these are also the contents so basically important contents you have to know so we have done with this now I would like to talk about anterior triangle so everyone can we go to the next that is anterior triangle okay third and fourth okay third and fourth is giving Branch two so a question has arised Yes dear third and fourth so yes third and fourth cutaneous cervical no you want to know third and fourth cervical nerve is giving innervation to lator scapi muscle and trapas muscle so is it okay shahil no it's what is a question asked by wenes wenes third
59:41 and fourth nerve is giving Innovation to the skell uh muscle and also giv giving inovation so exactly it is also giving Innovation to the muscle of the trapesius muscle so it is giving latus caply it is giving innervation to to live it a capap and trapezius muscle okay now anterior triangle so let's focus on to the next topic that is anterior triangle so anterior triangle is another very important triangle which you have to know so individually you have to know about the four triangles which is lying inside but before starting the individual triangle I would like to show you this image so just enlarge this image so when I enlarging this image you can see uh the dotted line which has been shown to you the black dotted line which is showing you
1:00:26 the whole boundary for the anterior triangle so anterior triangle is bounded so you can see here the anterior boundary is by the anterior median neckline so it is bounded anteriorly by the anterior mid neckline it is bounded by the anterior mid neckline it is bounded by the anterior mid neckline anteriorly and it is bounded posteriorly by stoc croid muscle the base is lying above which is formed by the lower border of mandul and an imaginary line drawn to the mustri process so an imaginary line going
1:01:13 towards the must was this hole is forming the base this hole is forming the base the Apex so if I talk about the Apex the Apex is lower down the Apex is lower down which is at the level of Supras sternal notch so this is is at the level of Supras sternal notch this is at the level of supra's teral not so this is the overall boundary of anterior triangle so you can just write on the boundaries write on the heading boundaries so anteriorly it is bounded by anterior mid
1:02:03 neckline posteriorly it is bounded by the stern croid muscle Apex is formed by the Supras sternal notch base is lying in the up above Direction and is formed by the lower border of mandible base is formed by the lower border of mandible and an imaginary line extending to the mid process of tempo extending
1:02:49 to to the must process of temporal Bond extending to the must process of which bone of the temporal bone so done now I just want everybody actually the main uh thing which everybody has to understand is the subdivision of anterior triangle because individually you have to understand the Triangular spaces and individually I will talk about the Triangular spaces and the details so that is very important for you okay so uh actually there are uh there is a muscle that is the poster belly of digastric so there is digastric muscle that is there is superior belly of homide so Superior belly of homide digastric muscles are dividing the whole
1:03:35 triangular area of anterior triangle into four subt triangular area into how many subt triangular area into for subt triangular area so I first want to Define so this is stoc croid muscle so let me just so exactly this this is stoc cloid muscle this is the anterior neck line and this is actually the mandible lower border going towards the must so black outline which you are seeing the black outline which you are seeing which I have marked here is the whole of the boundary for the anterior triangle so you can see whole of the anterior triangle I have marked out so no worries about this let me just check with the students so
1:04:22 exactly uh everybody if you have got any doubt yes you are right sah so exactly if I talk about the overall boundary of anterior triangle has been so now I want you to know about the sub triangular spaces for example pink color area which you are seeing actually this is one half of a triangular space that is submental triangle which triangle is this this is the submental triangle so wait a minute so I'm talking about this triangular space this is the submental triangle area okay this one half of the sub so actually below the symphisis M what is
1:05:07 this this is symphisis M on both the side here there will be a complete subt triangular area and this is lying below the symphisis M but it is lying above to this bone which bone is this this is the hyoid bone so this is H for hyid bone so this is lying above the hyid bone so it is lying above h bone so this is L above hyoid bone okay this bone I will use gray color for it this is the hyoid B done now there is a green color triangular area so exactly this triangular area we are talking about this triangular area this green color triangular area which has been shown here this is the next triangular area
1:05:53 that is sub Mand triangular area actually subm triangular area is also called as digastric triangular area and it is bounded by the anterior so actually in between the two anterior bellies of the digastric muscle the small triangular space which is lying above hyid bone and Below symphisis M that is submental triangle area yeah so exactly uh the base of the mandible and the line going towards the musite process below it here we have got a triangular area here this area this is called as digastric triangular area or the sub mular triangular area so exactly lower to it you can see the the bellies of the muscle so this is the digastric muscle belly and Stylo head so this muscle bellies are forming the
1:06:38 boundaries and this is the anterior belly of digastric muscle so you can see here the two digastric muscle is there and the yellow color triangular area which you are seeing here is the muscular triangle area actually this muscle belly is the superior muscle Belly of the omo hard muscle which is uh which is uh participating in the division of the anterior triangle now and the blue color triangular area which you are seeing is the koted Triangular area which is like anterior to sternal PLO must muscle and in between the superior Bell of mohide and the digastric muscle so don't worry I individually also I'm going to tell you about the boundaries so this was just a uh just a overall subdivision of the Triangular areas of
1:07:23 the anterior triangle but overall I will give you the individual definitions of the boundaries of the Triangular area so four triangular areas are there let's start with the first triangular area which is called as submental triangular area which triangular area I'm talking about submental so let me just enlarge it can everybody appreciate the submental Triangular area okay so exactly you can see this small triangular so this is the mandible
1:08:11 bone and this is the hyoid bone so what you can see that exactly exactly below the mandible so exactly this is the area this is the mandible bone and this is the high bone exactly below the mandible in between the two side anterior belly of digastric muscle we are talking about the anterior belly of digastric muscle so this is exactly this green muscles which you are seeing here are the anterior belly of d
1:08:58 muscle these are anterior anterior belly of digastric muscle so these are anterior belly of digastric muscle and above the high bone we have got which triangle we have got the submental triangle and what is important for your examination is to know the contents of submental triangle and the boundaries is it okay so let's talk about the submental triangle so I just want to enlarge this and I want everybody to write uh the details of submental triangle you have
1:09:43 to know about the boundaries and the content so on each side it is bounded by [Music] anterior bellies of digastric muscle anterior bellies of d gastric
1:10:36 muscle anterior belly of digastric muscle base body of hyid bone if Apex symphisis Mente so done so these are all about the boundaries so these are all about the boundaries of submental track so these are all about the boundaries of submental triangle and the next is to know the content of submental
1:11:22 triangle and next is to know the content of submental triangle so the content of submental triangle is so the roof is formed by if I talk about the roof so if I talk about the roof the roof is formed by investing layer of deep cervical fascia roof is formed by investing layer of deep cervical fascia so roof is formed by investing
1:12:09 layer of deep cervical fascia and the content is the content is some mental lymph node and that of submental lymph node and also the vein which is commenced and for here is anterior jugular ve so it contains some mental lymph node it contains some mental lymph node it contains commencement of anterior jugular ve
1:12:56 so the submental lymph node the anterior jugular vein all these are the contents for the submental triangle now I just want also that you should know the floor of submental triangle so it's also important so this this is about the roof this is about the content and what about the floor so can you please note down the floor so if I talk about the floor the floor of submental triangle is formed by uh uh just one muscle that is the mohide muscle and which is meeting in the midline to form miloy rapid so the floor is formed by mohide muscle miloy muscle and it is meeting in
1:13:44 midline to form Milo hyoid rapid done done everyone so the next thing is to know the next triangular space which I want everybody to understand is the digastric triangle or the submental triangle okay dear if anybody uh so is the pace okay is the pace okay should I go more faster or is it okay are you able to understand now the next triangular space is the digastric triangle which is also called as submandibular triangular area digastric okay so very good D so stud
1:14:32 everyone was telling me to go slow today they are telling okay so here wenes is telling okay you can go at a faster rate very good yesterday everyone was telling please go slow soly I started slow so okay the other name of digastric triangle is can anybody tell me median ra okay you are not under so Hassan is tell Hassan is asking what is median ra actually if two muscles meet in the midline the fibers which is interdigitating so the fibers of interdigitating muscles is called as median RAF Hass I will show you an image for it so if you will see this image this is about the submental triangle so Hass can you appreciate here see here H so you can see these
1:15:20 fibers are meeting in the midline so if you will see the F mus muscle fibers of the muscle fibers of the two side mohide muscle is meeting in the midline so if you will see the muscle fibers are meeting in the midline I should use black color so that you can understand see here so you can see the fibers are meeting in the midline and these meeting of the mohide fibers together is called as uh Medan RAF so Hass is it okay have you understood okay now let's talk about the digastric triangle the other name of digastric triangle is some mandibular triangle so I will go slight faster because everybody is okay for it so you can see this is the mandible bone lower border this is
1:16:09 the so this is the anterior belly of digastric this is the posterior belly of digastric along with the styo hard muscle and this is the hyoid bone so this triangular area which you are seeing is the is the submandibular Triangular area or the digastric Triangular area so I just want everybody to quickly write it because yes we have to finish many topics so I want to be slightly faster so let's uh write the boundaries of digastric triangle boundaries of digastric triangle so the boundaries are ano inferiorly Antero inferiorly it is bounded by anterior belly of digastric muscle
1:17:04 okay postero inferiorly and if I talk about postero inferiorly postero inferiorly it is bounded by posterior belly of digastric it is bounded by posterior belly of digastric muscle and this is supplemented by one more muscle and the name of that muscle is stoh highed muscle the name of that muscle is stylohyoid muscle now coming to the base the base is formed by the base of mandible base of mandible and the imaginary line which is extending till the level of must process so I think
1:17:52 plus the must process imaginary so I think it is uh it is known to you this is an imaginary line extending till the level of mastoid process Apex if I talk about Apex the Apex is formed by intermediate tendon of Apex is formed by intermediate tendon of digastric muscle so done so here we have done with the boundaries of digastric triangle and now I want everybody to note down the floor so floor muscles you can see these are the floor muscles so you have to know about the floor muscles and the floor
1:18:38 muscle of digastric triangle are so then we will come up with the content so the floor muscles are please write down the floor of digastric triangle floor of digastric triangle is formed by Milo hyid muscle hyoglossus muscle and that of middle constrictor muscle mle constrictor muscle posteriorly now what about the contents so if I talk about the contents as the name only suggest the digastric triangle will have some mandibular Tri so the digastric triangle is having some mandibular gland it is having actually the content of content of the digestive triangle or the sub man triangle can be
1:19:23 categorized as the content lying in the anterior part and the content lying in the posterior part if I talk about the content in the anterior part it contains some Mand gland it contains some Mand lymph node it contains hypoglossal ner it contains facial vein facial artery the submental artery Milo hard nerves and the vessel when we will proceed more posteriorly it will have the external koted artery the part of the koted sheath also and the structures which is passing in between the external and internal carotin artery so we will write the important content so I just want you to the cadic image in this cavic image you can see the outline of the submandibular gland which is an important content for the digastric triangle you can also appreciate the facial artery as the content you can also appreciate the
1:20:11 facial vein as the content you can also appreciate the Milo hard muscles and you can see other important contents also has been shown so see here the important so you can important content which I want want everybody to note down here is the nerve so we have got hypoglossal nerve so you can see this is the hypoglossal nerve which is an important content we have got mohide nerves and the vessel NF to mohide is there these are all important so we can see here important contents of the digastric triangle is been shown so we have we are seeing the hypogen L we are seeing the miloy nerve to miloy nerves and we can also see the other contents here as the SU ular gland the facial
1:20:57 vein facial artery you can see the facial vein and facial arteries okay so all the important contents of the digastric triangle is done so let me just write quickly everyone is it okay can we write quickly
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