THE NECK. 65 



The Submaxillary Triangle. The submaxillary triangle, which is reached by following the 

 course of the hypoglossal nerve and the facial artery, is bounded by the lower margin of the jaw 

 and by the two bellies of the digastric muscle. After the removal of the skin, platysma, and deep 

 fascia we find that the largest structure in this region is the submaxillary gland (see Figs. 24 and 

 25), which may even be visible through the skin in markedly emaciated individuals. The fascia 

 covering the gland is rather firm and offers a certain resistance to the spontaneous external rupture 

 of glandular abscesses. The submaxillary lymphatic glands are situated along the lower margin 

 of the jaw and the upper margin of the submaxillary salivary gland, some of them being partly 

 imbedded in the latter structure. Since these glands, like those situated nearer the median line 

 (the submental lymphatic glands), receive the lymphatics from the face, they may easily be 

 affected in diseases of the face (such as labial carcinoma) and require extirpation. The sub- 

 maxillary gland receives numerous branches from the facial artery, which runs from behind for- 

 ward in this triangle. This vessel is imbedded in the substance of the submaxillary gland and 

 leaves the cervical region at the anterior border of the masseter muscle, where it lies directly upon 

 the margin of the jaw. The chief branch of the facial artery in this region is the submental, which 

 is covered by the gland and runs toward the chin upon the mylohyoid muscle ; it is accompanied 

 by the small mylohyoid branch of the inferior maxillary nerve (motor). At the angle of the jaw 

 the facial vein is joined by the anterior division of the temporo-maxillary vein (see Fig. 24). [This 

 union, according to Cunningham, usually takes place a little below the angle of the jaw. ED.] 

 If the submaxillary gland is lifted up, the submaxillary duct may be seen anteriorly in the depths 

 of the triangle as it disappears beneath the mylohyoid muscle ; still deeper and at a higher level 

 the lingual nerve is in relation with the submaxillary gland and the small submaxillary ganglion. 

 The comparatively small glossopharyngeal nerve is found near the pharynx, deeply situated 

 between the styloglossus and stylopharyngeus muscles; it passes beneath the tonsil to end in the 

 circumvallate papillas of the lingual mucous membrane. 



The median cervical region is situated beneath the hyoid bone and extends to the upper 

 margin of the sternum. It is bounded above and to the outer side by the inner margins of the sterno- 

 hyoid muscles, and below and to the outer side by the sternothyroid muscles, presenting a narrow 

 triangular surface in this situation (see Fig. 24). The greatest breadth of this narrow region is 

 about two centimeters and it is situated approximately midway between the hyoid bone and the 

 sternum. In this important region the trachea is covered only by skin and fascia. Incised 

 wounds of the trachea are consequently common in this region, particularly in cases of suicide, and 

 the physician, under certain circumstances, must rapidly perform tracheotomy in this situation in 

 order to save the life of his patient. The structures which may be palpated through the skin at 

 this place (see page 62) are responsible for the subdivision into the following regions: the hyoid 

 region (hyoid bone), the subhyoid region (the thyrohyoid membrane or ligament), the laryngeal 

 region (the larynx), the thyroid region (the thyroid gland), and the suprasternal region (just above 

 the sternum). 



In the subhyoid region the respiratory tract cannot be entered by simply dividing the mid 

 thyrohyoid ligament (see Figs. 24 and 26). Behind the ligament there is a relatively thick mass of 

 fat, which extends for about one centimeter in the sagittal plane and is limited posteriorly by the 

 hyoepiglottic ligament, passing from the epiglottis to the hyoid bone, and by the attach 

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