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Anterior & Posterior Triangles of the Neck
 Dr Mark Lam · Anatomy of the Head and Neck · March 16, 2022 · Last updated: November 6, 2023

Anterior & Posterior Triangles of the Neck

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Table Article
of Contents

Introduction
The neck is a complex region containing numerous important anatomical and neurovasculature
structures. Assessing neck lumps and understanding the surgical approaches for pathological
lesions requires a sound understanding of neck anatomy.
This article will review the surface anatomy that represents the boundaries of the neck, its
divisions into the anterior triangle and posterior triangle and their subdivisions. Relevant clinical
and surgical applications will be discussed in relation to these regions.

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Surface anatomy
The limits of the neck are:

Medial: midline of the neck

Lateral: anterior margin of trapezius
Superior: inferior border of the mandible
Inferior: superior border of the clavicle

The neck can further be divided into the anterior triangle and the posterior triangle. The muscle
which delineates these two regions is the sternocleidomastoid (SCM).

Figure 1. Anterior and posterior triangles of the neck

Anterior triangle
The anterior triangle is bound by the midline of the neck, anterior border of SCM and the inferior
border of the mandible.

This triangle is further subdivided into four sub-triangles by the hyoid bone, suprahyoid and
infrahyoid muscles. These sub-triangles are the submandibular, submental, carotid and
muscular triangles.
 Figure 2. Anterior triangle midline view Figure 3. Anterior triangle boundaries

Submental triangle

Boundaries of the submental triangle include:

Medial: midline
Lateral: anterior belly of digastric
Inferior: body of hyoid bone
Floor: mylohyoid muscle
Roof: investing layer of deep cervical fascia

Contents of the submental triangle include submental lymph nodes that receive lymphatic
drainage from the chin, the tip of the tongue, lower lip, lower incisor teeth and oor of the
mouth and the anterior jugular vein.

Figure 4. Submental triangle boundaries

Clinical relevance: lymph nodes

Odontogenic infection from the lower central and lateral incisor teeth can spread into the
submental space contained within the submental triangle. This may require external
incision and drainage.
 For head and neck cancer staging, the neck is divided into six anatomic lymph node levels.
The submental nodes are classed as level Ia.

Figure 5. Cervical lymph nodes and levels

Submandibular triangle

Boundaries of the submandibular triangle include:

Anterior: anterior belly of digastric

Posterior: the posterior belly of digastric and stylohyoid
Superior: inferior border of the mandible
Floor: mylohyoid muscle

A number of important structures are contained within the submandibular triangle including the
marginal mandibular branch of the facial nerve, the lingual nerve, the hypoglossal nerve, the
facial and lingual arteries (with their corresponding veins), the submandibular gland, and lymph
nodes.

Figure 6. Submandibular triangle boundaries

Clinical relevance: sialadenitis

 Sialadenitis (in ammation of the salivary gland) is a common pathology of the
submandibular gland. This is commonly due to a blocked salivary stone (sialolithiasis).

Common symptoms include post-prandial pain, foul taste in the mouth, submandibular
swelling and overlying skin erythema.

Treatment is usually conservative with encouraging hydration, good oral hygiene and
sialagogues. Occasionally antibiotics are required.

Should surgery to remove the gland be required due to recurrent episodes, there is a
potential risk for marginal mandibular nerve damage (a branch of the facial nerve) that can
lead to weakness of the ipsilateral lower lip.

Figure 7. Right-sided submandibular swelling

secondary to a salivary gland stone.

Carotid triangle

Boundaries of the carotid triangle include:

Superior: the posterior belly of the digastric muscle

Anteroinferior: the superior belly of the omohyoid muscle
Lateral: medial border of SCM
Floor: hyoglossus, thyrohyoid, inferior and middle constrictors

Important contents include the common carotid artery and its bifurcation into the internal and
external carotid arteries, the internal jugular vein, the vagus (CNX), hypoglossal (CNXII) and
accessory nerves (CNXI).
 Figure 8. Carotid triangle boundaries

Clinical relevance: carotid triangle

The carotid sinus, identi able as a visible swelling at the start of the ICA, and the carotid
body are located within this neck triangle.

The carotid sinus contains baroreceptors innervated by a branch of the glossopharyngeal

nerve (CNIX) that detect changes in blood pressure and transmit these to the
cardiovascular regions of the medulla. If the carotid sinus is oversensitive to manual
stimulation, individuals can develop carotid sinus hypersensitivity, leading to hypotension,
bradycardia and syncope.

The carotid body contains chemoreceptor cells that are stimulated by changes in arterial
pO2, pCO2 and H+ ion concentration, leading to activation of cardiorespiratory centres.

Paragangliomas are a rare form tumour that can involve the carotid body. When located in the
adrenal glands they are called a phaeochromocytoma.

Muscular triangle

Boundaries of the muscular triangle include:

Medial: midline of neck from hyoid to the sternum

Superolateral: the superior belly of omohyoid
Inferolateral: anterior border of SCM
Superior: hyoid bone

Important contents include the infrahyoid muscles, superior and inferior thyroid arteries,
anterior jugular vein, larynx, trachea, oesophagus, thyroid and parathyroid glands.
 Figure 9. Muscular triangle boundaries

Clinical relevance: muscular triangle

Common indications for surgical access to this area of the neck include thyroid surgery and
tracheostomies.

A potential risk of both is damage to the recurrent laryngeal nerve. Other than the
cricothyroid muscle, it supplies all the intrinsic muscles of the larynx, including the posterior
cricoarytenoid; the only muscle that abducts the vocal cords. Injury can cause
hoarseness, aphonia and dyspnoea.

Figure 10. Cadaveric anatomical dissection of neck

midline structures. Note the close relationship of the
recurrent laryngeal nerves to the thyroid gland and
trachea.

Posterior triangle
The posterior triangle is bound by the posterior edge of SCM anteriorly, the anterior border of the
trapezius posteriorly and the middle 1/3 of the clavicle inferiorly.
The omohyoid is the important structure that subdivides the triangle into the occipital triangle
above and the subclavian triangle below.

Figure 11. Posterior triangle of the neck

Occipital triangle

Boundaries of the occipital triangle include:

Anterior: posterior border of SCM

Posterior: anterior border of trapezius
Inferior: inferior belly of omohyoid
Floor: levator scapulae, splenius capitis, middle and posterior scalene muscles

Important contents include accessory nerve (CNXI), cutaneous and muscular branches of the
cervical plexus, upper part of the brachial plexus, supraclavicular nerves and the transverse
cervical artery.

Figure 12. Occipital triangle boundaries

Clinical relevance: occipital triangle

Lymph node biopsy in this area can cause damage to the accessory nerve and
subsequently trapezius innervation, leading to inability of the patient to shrug their shoulder.
Subclavian/supraclavicular triangle

Boundaries of the subclavian/supraclavicular triangle include:

Anterior: posterior border of SCM

Superior: the inferior belly of omohyoid
Inferior: middle 1/3 of the clavicle
Floor: rst digitation of serratus anterior, middle scalene and the rst rib

Contents include the third part of the subclavian artery, the inferior aspect of the external
jugular vein, trunks of the brachial plexus, nerve to subclavius and lymph nodes.

Figure 13. Subclavian triangle boundaries

Clinical relevance: Virchow’s node

The left supraclavicular lymph node or Virchow’s node is near the junction of the thoracic
duct and the left subclavian vein. It receives lymphatic drainage from most of the body
except the right arm, chest, head and neck.

Enlargement of this lymph node can indicate metastasis of gastrointestinal malignancy,

though can also arise from ovarian, renal or testicular origin. The term Troisier’s sign is used
to describe this presentation.
 Figure 14. CT scan demonstrating an enlarged Virchow
node

Editor

Dr Chris Je eries

References

Reference texts

Ellis, H and Mahadevan, V. Clinical Anatomy: Applied Anatomy for Students and Junior Doctors.
Published in 2013.
Brennan, P., Mahadevan, V and Evans, BT. Clinical Head and Neck Anatomy for Surgeons.
Published in 2016.
Kikuta, S., Iwanaga, J., Kusukawa, J and Tubbs, RS. Triangles of the neck: a review with
clinical/surgical applications. Published in 2019. Available from: [LINK]
Radiopaedia Triangles of the neck. Published in 2020. Available from: [LINK]

Image references

Figure 1. Wikimedia Commons [image modi ed by Mark Lam]. Anterior and posterior triangles of
the neck. Licence: [CC BY-3.0]
Figure 2. Geeky Medics. Anterior triangle of the neck midline view.
 Figure 3. Geeky Medics. Anterior triangle of the neck boundaries.
Figure 4. Wikimedia Commons. Submental triangle boundaries. Licence: [CC BY-3.0]
Figure 5. Wikimedia Commons. Cervical lymph nodes and levels. Licence: [CC BY-3.0]
Figure 6. Wikimedia Commons. Submandibular triangle boundaries. Licence: [CC BY-3.0]
Figure 7. Wikimedia Commons. Right-sided submandibular swelling secondary to salivary gland
stone. Licence: [CC BY-3.0]
Figure 8. Wikimedia Commons. Carotid triangle boundaries. Licence: [CC BY-3.0]
Figure 9. Wikimedia Commons. Muscular triangle boundaries. Licence: [CC BY-3.0]
Figure 10. Wikimedia Commons. Cadaveric anatomical dissection of neck midline structures.
Licence: [CC BY-3.0]
Figure 11. Geeky Medics. Posterior triangle of the neck.
Figure 12. Wikimedia Commons. Occipital triangle boundaries. Licence: [CC BY-3.0]
Figure 13. Wikimedia Commons. Subclavian triangle boundaries. Licence: [CC BY-3.0]
Figure 14. Wikimedia Commons. CT scan demonstrating an enlarged Virchow node. Licence:
[CC BY-4.0]

TAGS #ENT NOTES #HEAD AND NECK ANATOMY NOTES #UKMLA | EAR NOSE AND THROAT

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 Dr Mark Lam
Junior Doctor and previous Dental Graduate with a special interest in Head and Neck
Anatomy.

Related

 
The Hypoglossal Nerve (CN XII)
Acute Sinusitis
Suprahyoid and Infrahyoid Muscles
 Bones of the Skull

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M E D I C -T O - M E D I C

TA B L E O F C O N T E N T S

1. Introduction
2. Surface anatomy
3. Anterior triangle
4. Posterior triangle
5. References
     

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