Access to the lingual artery in Pirogov's triangle. Submandibular region, Pirogov's triangle
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 sternocleidomastial 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 hyoid bone 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.
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 margin alveolar process lower jaw. 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 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 innervating 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 structures: 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 fundus area oral cavity, easily penetrate the space around the gland.
Important! Therefore, upon detection inflammatory process in any of the cellular spaces of the face and neck, the doctor examines not only the causal area, but also those bordering it.
The capsule does not completely cover the gland. 2 processes extend beyond it. 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. The end point is the 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 salivary gland entirely during surgical interventions 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 more precisely 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
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.
Medical encyclopedia - Pirogov's triangle
Related dictionaries
Pirogov triangle
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.
Pirogov's triangle (trigonum linguale) - a triangular space in the lateral part of the suprahyoid region of the neck (Fig.), formed from below (behind) by the tendon of the digastric muscle (m. digastricus), from above - by the hypoglossal nerve (n. 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 P. t. 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 the P. t. 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. 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. 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 P. t. artificially by pulling the tendon of the digastric muscle down.
Info-Farm.RU
Pharmaceuticals, medicine, biology
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 projected, to which surgical access can be performed during neck dissection.
Pirogov triangle borders
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 when deep cut tongue, it is necessary to cut 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.
Submandibular region, Pirogov's triangle. Ligation of the lingual artery, indications, technique
Submandibular region (trigonum submandibulare) - the submandibular triangle, bounded above by the edge of the lower jaw, in front, below and behind - by the anterior and posterior bellies of the digastric muscle. The bottom of this triangle is the mylohyoid and mylohyoid muscles.
Within the submandibular region lie: the submandibular salivary gland, the facial artery and vein, the submental artery and vein, the sublingual and maxillary-hyoid nerves, lymph nodes and the tissue surrounding these formations. The latter communicates with the fiber of the sublingual region, pterygomaxillary, peripharyngeal spaces, and the lateral region of the face and neck. Submandibular lymph nodes are regional nodes maxillofacial area, oral cavity.
A triangular space in the lateral part of the suprahyoid region of the neck, formed from below (behind) by the tendon of the digastric muscle, from above by the hypoglossal nerve, passing obliquely along with the lingual vein, and from the inside (in front) by the outer (posterior) edge of the mylohyoid muscle. The bottom of the triangle is occupied by the hypoglossus muscle.
Ligation of the lingual artery
Indications: the need to stop bleeding from wounds in case of mechanical damage to both the arteries and veins themselves and their large branches, or a purulent inflammatory process resulting from arrosion of the vessel wall by a tumor.
Technique: The operation is performed through a 6 cm long incision running parallel to the edge of the lower jaw in the middle of the distance between the edge of the jaw and the greater horn of the hyoid bone, starting from the angle of the jaw. The skin, tissue, superficial fascia, m. platysma. Using a grooved probe, the vagina of the submandibular gland is opened, preserving the passing facial vein. After dislocation of the gland upwards and inwards, in order to avoid damage to the duct, the Pirogov triangle, composed of m. mylohyoideus, tendon of the posterior abdomen of m. digastricus and n. hypoglossus. Within the triangle, m is stupidly moved apart. hyoglossus. The lingual artery is found immediately below the muscle and is ligated. If you act carelessly, you can destroy the wall of the pharynx.
Conicotomy. Indications, technique, complications, their prevention.
It is performed in case of sudden asphyxia, when there is no time to perform a typical tracheostomy or intubation.
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-nervous 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.
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 sternocleidomastial 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 innervating 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 it. 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. The end point is the 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 more precisely 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
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.
Info-Farm.RU
Pharmaceuticals, medicine, biology
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 projected, to which surgical access can be performed during neck dissection.
PIROGOV TRIANGLE
Big medical encyclopedia. 1970 .
See what “PIROGOV TRIANGLE” is in other dictionaries:
Pirogov's triangle - (trigonum linguale; N.I. Pirogov) a section of the upper lateral part of the neck, bounded below and behind by the tendon of the digastric muscle, above by the hypoglossal nerve and lingual vein, in front by the outer (posterior) edge of the maxillohyoid muscle; place of choice for... ... Big medical dictionary
Neck - I Neck (collum) Part of the body, the upper border of which is a line passing along the lower edge of the lower jaw, the lower edge of the external auditory canal, the apex of the mastoid process, the superior nuchal line and the external occipital protrusion; lower... ...Medical encyclopedia
PLASTEINS - PLASTEINS, the name given by Zavyalov to sediments obtained in a thermostat by the action of chymosin on concentrated solutions. products of peptic protein digestion. The phenomenon itself was first described by A. Danilevsky. P.’s education takes place ... Big Medical Encyclopedia
List of streets in Taganrog - This article is proposed for deletion. An explanation of the reasons and the corresponding discussion can be found on the Wikipedia page: To be deleted/October 27, 2012. While the process is being discussed... Wikipedia
CAROTIS ARTERIA - CAROTIS ARTERIA. Contents: Anatomy and embryology. 382 Pathological anatomy. 4J9 Clinic. 410 Anatomy. Common carotid artery (a. ca rotis communis) (Fig. 1 and 2) with its external and internal branches... ... Big Medical Encyclopedia
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-nervous 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.
The submandibular triangle is bounded by the edge of the lower jaw and the bellies of the digastric muscle.
The skin is thin, connected to the superficial fascia of the neck and to the platysma. In the subcutaneous tissue there are small veins, branches of the transverse nerve of the neck, arteries and the subcutaneous muscle of the neck, enclosed in the superficial fascia of the neck, into which r penetrates from the inside. colli n. facialis and innervates it.
The second cervical fascia, splitting into outer and inner layers, forms a vagina for the submandibular salivary gland, digastric and stylohyoid muscles and fatty tissue located anterior to the submandibular salivary gland.
Under the outer leaf: submandibular gland, vessels, nerves, lymph nodes and fiber.
The most superficial in the tissue of the case is the facial vein, which here receives the submental vein and sometimes merges with the retromandibular vein. Medial to the vein is the facial artery, which gives off the submental artery.
The facial artery penetrates here from the deep parts of the region, pierces the inner layer of the vaginal gland and is directed laterally. At the anterior edge of the attachment of the masticatory muscle, the facial artery with the vein located behind it bends around the lower edge of the lower jaw and goes to the face. In the submandibular triangle, the marginal branch of the facial nerve sometimes passes along the outer surface of the facial artery and vein.
Outer surface The salivary gland contains the middle and posterior submandibular lymph nodes.
Anterior to the submandibular gland on the lower surface of the maxillary-hyoid muscle in the tissue pass the submental vein and artery and the maxillary-hyoid nerve (a branch of the lower alveolar nerve), which crosses the artery from above from outside to inside and innervates the anterior belly of the digastric and mylohyoid muscles.
The submandibular gland is located between the bellies of the digastric muscle and the lower jaw in a capsule formed by the second layer of the cervical fascia. The gland has processes, from which the anterior one, together with the excretory duct, penetrates into the gap between the maxillary-hyoid and mylohyoid muscles, sometimes reaches the sublingual gland and, connecting the fiber of the floor of the mouth with the fiber of the submandibular gland bed, can serve as a conductor of pus. From the inside, the gland is limited by a looser and thinner inner layer of the second cervical fascia, through which the facial artery, anterior process and excretory duct of the gland pass. Directly under the inner leaf are the hypoglossal nerve, the lingual vein and each subsequent one, located deeper than the previous one, the mylohyoid, mylohyoid and styloglossus muscles, forming the bottom of the submandibular triangle.
The triangle described by N.I. Pirogov and proposed by him as a guideline for ligation of the lingual artery is limited by the posterior edge of the mylohyoid muscle, above by the hypoglossal nerve, below and behind by the tendon and posterior belly of the digastric muscle.. The bottom of the triangle is the hyoid muscle , directly inward from which, within the triangle, the lingual artery passes, lying on the middle pharyngeal constrictor.
Topographic anatomy carotid triangle of the neck. Layers, features of the location of fascia, composition and topography of the neurovascular bundle.
1.Limited: lateral anterior edge of the sternocleidomastoid muscle; superior-posterior belly of the digastric muscle; from the inside - the upper belly of the omohyoid muscle.
The skin is thin, mobile, innervated by the transverse nerve of the neck;
Superficial fascia.
Between the 1st and 2nd fascia is the superficial nerve of the neck from the cervical plexus.
The superficial layer of the own fascia of the neck under the sternocleidomastoid muscle fuses with the sheath of the SNP, formed by the parietal layer of the 4th fascia.
In the vagina SNP: internal jugular vein(lateral); common carotid artery(medially); vagus nerve(behind, between artery and vein).
The common vein flows into the vein from above and medially facial vein, a large lymph node may be located at the site of their confluence.
On the surface of the common carotid artery, the upper root of the cervical loop descends from top to bottom and medially.
At the level of the upper edge of the thyroid cartilage, the common carotid artery is divided into external (located more superficially and medially, gives off branches) and internal (laterally and deeper, does not give off branches). In the area of bifurcation there is an expansion that continues onto the internal carotid artery and carotid sinus.
On the posterior surface of the internal carotid artery there is a carotid tangle, located nearby in the tissue nerve plexus: glossopharyngeal nerve, vagus and borderline sympathetic trunk. This reflexogenic zone contains baro- and chemoreceptors, which regulate blood circulation and breathing through the Hering nerve together with the Ludwig-Zion nerve.
The external carotid artery is located in the angle formed by the trunk of the facial vein from the inside, the internal jugular vein laterally, by the hypoglossal nerve from above (Farabeuf's triangle).
From the external carotid depart: the superior thyroid artery, lingual, facial, sternocleidomastoid artery.
Under the posterior belly of the digastric muscle is the hypoglossal nerve (12 pair of h.n.)
On the prevertebral fascia, the superior laryngeal nerve is divided into 2 branches: internal and external.
Cervical region borderline sympathetic trunk is located under the 5th fascia, lies on long muscles head and neck.
There is no fascia 3 in the carotid triangle.
Table of contents of the topic "Neck triangles. Topography of neck triangles.":Lingual nerve. Topography of the lingual nerve. Pirogov's triangle. Topography of the Pirogov triangle. Walls of a Pirogov triangle. Submandibular lymph nodes.
In the same space, but upward from the duct of the submandibular gland, between m. hyoglossus and m. mylohyoideus, located 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.
Pirogov triangle used as an internal reference when accessing a. lingualis. He is limited hypoglossal nerve above, the tendon of the digastric muscle below and behind, and the free posterior edge of the m. mylohyoideus - in front.
Bottom of the Pirogov triangle forms 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.
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 into the submandibular lymph nodes flows 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.
Connection of 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.
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-nervous 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.
Borders: 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, and the vagus nerve is located between the vein and artery and posteriorly.
Projection onto the skin of the carotid artery (a. carotiscommunis)
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.