Surg Radiol Anat (2011) 33:53–57
DOI 10.1007/s00276-010-0697-2
ORIGINAL ARTICLE
Three nearly forgotten anatomical triangles of the neck: triangles
of Beclard, Lesser and Pirogoff and their potential applications
in surgical dissection of the neck
R. Shane Tubbs • Mark Rasmussen •
Marios Loukas • Mohammadali M. Shoja •
Aaron A. Cohen-Gadol
Received: 28 September 2009 / Accepted: 29 June 2010 / Published online: 10 July 2010
 Springer-Verlag 2010
Abstract The neck is an area that lends itself to ana-
tomical geometry, such as triangles. Many triangles of the
neck have been described, and some are well known;
however, some have been nearly forgotten. The purposes of
this study were to review prior literature on the forgotten
triangles of the neck, to measure and document the
occurrence of these triangles and the structures found
within them, and to discuss their surgical significance and
relationships to the standard triangles of the neck. This
study was carried out on 17 (34 sides) formaldehyde-fixed
adult human cadavers (5 males and 12 females), the mean
age being 78 years. All triangles were found within the
submandibular triangle of the anterior cervical triangle.
Beclard’s triangle was present on 28 sides and absent on 6
sides because the posterior belly of the digastric muscle did
not touch the hyoid bone and because the posterior belly of
the digastric muscle was directly over the greater cornu of
the hyoid bone. Lesser’s triangle was present on 30 sides
and absent on 4 sides because the hypoglossal nerve
remained inferior to the digastric muscle. Pirogoff’s tri-
angle was also present on 30 sides and absent on 4 sides,
again because the hypoglossal nerve remained inferior to
the digastric muscle. No statistically significant differences
R. S. Tubbs (&)
M. Rasmussen
Department of Pediatric Neurosurgery, Children’s Hospital,
1600 7th Avenue South ACC 400, Birmingham, AL 35233, USA
e-mail: rstubbs@uab.edu
M. Loukas
Department of Anatomical Sciences, St. George’s University,
Grenada, West Indies
M. M. Shoja
A. A. Cohen-Gadol
Indianapolis Neurosurgical Group, Department of Neurosurgery,
Clarian Neuroscience Institute, Indiana University, Indianapolis,
IN, USA
were found between the measurements of each leg of any
of the three triangles and gender, or between the mea-
surement of each leg of any of the three triangles and right
versus left sides. Beclard’s triangle, when present, was
found to contain both the hypoglossal nerve and the lingual
artery. Pirogoff’s triangle always contained the lingual
artery, and Lesser’s triangle contained no major structures,
but the lingual artery was deep to its floor. Knowledge of
these triangles, their contents, and relationships to other
structures of the neck could be important for cranio-facial,
oral, general, and neurosurgeons who operate within the
neck.
Keywords Neck
Anatomy
Surgery
Landmarks
Introduction
Many anatomical triangles of the neck have been descri-
bed, and some are well known; however, some have been
nearly forgotten [16, 17]. The purposes of this study were
to review prior literature on three nearly forgotten triangles
of the neck, to measure and document the occurrence of
these triangles and the structures found within them, and to
discuss their surgical significance.
On either side of the neck, the sternocleidomastoid
muscle can be used as a guide to divide the neck into an
anterior and a posterior triangle. The anterior border of
the anterior triangle is the midline; the posterior border is
the anterior margin of the sternocleidomastoid, and the
base is directed superiorly and is formed by the mandible
[12]. The anterior cervical triangle can be subdivided into
three paired (bilateral) and one unpaired triangle. The three
paired triangles include the carotid (superior carotid), the
muscular (inferior carotid), and the submandibular
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(submaxillary or digastric) triangles [9, 16]. The single
unpaired triangle is found immediately inferior to the chin
and is the submental triangle.
The final paired triangle, the submandibular triangle, is
bound superiorly by the inferior border of the body of the
mandible and lies between the anterior and posterior bellies
of the digastric muscle. The submandibular gland almost
completely fills this triangle [14]. Three smaller triangles
of the neck, rarely found in the literature, are housed within
the submandibular triangle; they are Beclard’s, Lesser’s,
and Pirogoff’s triangles (Fig. 1). The inferior leg of
Beclard’s triangle, named after the French anatomist Pierre
A. Beclard (1785–1825) [2, 3, 12], is formed by the greater
cornu of the hyoid bone, the superior leg by the posterior
belly of the digastric; the posterior border of the hyoglossus
muscle serves as the posterior leg and base of the triangle.
Beclard’s triangle is also known as the posterior triangle of
the lingual artery, and contains the lingual artery and the
hypoglossal nerve. This triangle has also been used to aid
in ligating the external carotid artery. The superior border
of Lesser’s triangle (Fig. 1), named after the Polish born,
German surgeon Ladislaus Leo Lesser (1846–1925) [12], is
created by the hypoglossal nerve as it courses deep to the
mylohyoid, the anterior and posterior bellies of the digas-
tric, and more specifically, the anterior belly and interme-
diate tendon of the digastric create the inferior leg. The
posterior leg of Lesser’s triangle is the posterior margin of
the mylohyoid muscle at the intermediate tendon of the
digastric muscle. The hypoglossal nerve also forms the
superior border of Pirogoff’s triangle (Fig. 1), named after
the Russian surgeon Nikolai I. Pirogoff (1810–1881) [6, 14];
Fig. 1 Schematic drawing of
left side Beclard’s, Lesser’s, and
Pirogoff’s triangles
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the other two sides are composed of the intermediate tendon
of the digastric muscle (inferior border), and the posterior
border of the mylohyoid muscle serving as the anterior
border. Pirogoff’s triangle is actually the posterior continu-
ation of Lesser’s triangle. One source has referred to
Pirogoff’s triangle as both Pinaud’s and the hypoglossohy-
oid triangle [6].
Materials and methods
This study was carried out on 17 (34 sides) formaldehyde-
fixed adult human cadavers (5 males and 12 females), the
mean age being 78 years. The presence or absence, size,
anatomical relationships, and accompanying structures
contained within Beclard’s, Lesser’s, and Pirogoff’s trian-
gles were measured with a centimeter ruler and docu-
mented. All measurements were made twice and the mean
taken. No specimen was found to have scars or evidence of
prior surgical procedures to the areas dissected. Statistical
analysis was performed using a Student’s T test (Microsoft
Excel, Redmond, WA, USA), and statistical significance
was observed when P \ 0.05.
Results
Beclard’s triangle was present on 28 sides and absent on 6
sides because the posterior belly of the digastric muscle did
not touch the hyoid bone and because the posterior belly of
the digastric muscle was directly over the greater cornu of
Surg Radiol Anat (2011) 33:53–57 55

Fig. 3 Adult male cadaver noting the submandibular region (area of

Pirogoff’s and Lesser’s triangles). Note the following: digastrics
Fig. 2 Infrahyoid view of the left neck (region of Beclard’s triangle) muscle (D), mandible (M), mylohyoid (MY), facial artery and vein
noting the hypoglossal nerve (XII), omoyhoid muscle, hyoid bone (F), and hypoglossal nerve (XII)
(H), and facial vein (F)

the hyoid bone (Fig. 2). Beclard’s triangle tended to be the

largest of the four triangles studied, ranging from
0.5 9 2.0 9 2.0 cm to 2.0 9 4.0 9 4.0 cm (for the pos-
terior, inferior, and superior legs, respectively). Beclard’s
triangle was found to contain both the hypoglossal nerve
and the lingual artery when it was present (24 of 24 sides).
The mean length and standard deviation for the posterior,
inferior, and superior legs were 1.23 ± 0.43, 3.05 ± 0.40,
and 3.22 ± 0.50 cm, respectively. No statistically signifi-
cant differences were found between the measurements of
each leg of Beclard’s triangle and gender, or between the
measurement of each leg of Beclard’s triangle and right
versus left sides.
Lesser’s triangle was present on 30 sides and absent on 4
sides because the hypoglossal nerve remained inferior to
the digastric muscle. Lesser’s triangle was found within the Fig. 4 Adult male cadaver noting the submandibular region (area of
Pirogoff’s and Lesser’s triangles) following the removal of the
submandibular triangle of the anterior cervical triangle on
mylohyoid in order to illustrate the continued course of the
all sides (Figs. 3, 4). The posterior border of Lesser’s tri- hypoglossal nerve (XII). Also note digastrics muscle (D), mandible
angle was also the anterior border of Pirogoff’s triangle and (M), mylohyoid (MY), facial artery and vein (F), and hypoglossal
was the smallest of the three legs, measuring from 0.5 to nerve (XII)
2.0 cm. The superior leg, the most difficult to measure due
to its course deep to the mylohyoid muscle, was between anterior cervical triangle, directly posterior to Lesser’s
1.0 and 3.0 cm. The inferior leg ranged from 1.0 to 3.5 cm. triangle. By strict definition, no structures were found
The mean length and standard deviation for the posterior, within the triangle, but Pirogoff’s triangle always contained
superior, and inferior legs were 0.73 ± 0.38, 2.08 ± 0.46, the lingual artery, found deep to the hyoglossus muscle, the
and 2.35 ± 0.51 cm, respectively. No statistically signifi- floor of the triangle. Pirogoff’s triangle was the smallest of
cant differences were found between the measurements of the three triangles, with measurements ranging from 0.5 to
each leg of Lesser’s triangle and gender, or between the 2.0 cm for the anterior border (also the posterior border of
measurement of each leg of Lesser’s triangle and right Lesser’s triangle), 0.5–2.0 cm for the superior border, and
versus left sides. 0.5–2.5 cm for the inferior border. The mean length and
Pirogoff’s triangle was also present on 30 sides and standard deviation for the anterior, superior, and inferior
absent on 4 sides, again because the hypoglossal nerve legs were 0.73 ± 0.38, 1.18 ± 0.38, and 1.29 ± 0.48 cm,
remained inferior to the digastric muscle. Pirogoff’s tri- respectively. No statistically significant differences were
angle was found within the submandibular triangle of the found between the measurements of each leg of Pirogoff’s

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triangle and gender, or between the measurement of each
leg of Pirogoff’s triangle and right versus left sides.
Discussion
While reference to the three forgotten cervical triangles
described herein can be found in medical dictionaries and
eponym books [7, 8, 13], most, if not all, recently published
anatomy books fail to mention of any of these triangles.
For example, Deaver [6] is one of the few older books to
describe Lesser’s triangle, which is also referred to as the
lingual triangle. The roof of the triangle is the sub-
mandibular gland, while the floor is formed by the hyo-
glossus and middle pharyngeal constrictor muscle. The
most important structure found within this triangle is the
lingual artery. Deaver [6] stated that ligation of the lingual
artery is easily performed via access through Lesser’s tri-
angle. van Es and Thuau [18] mentioned that Pirogoff’s
triangle is the ideal location for ligation of the lingual
artery. The borders of Lesser’s triangle as described by
Deaver [6] were: superiorly, the hypoglossal nerve, pos-
teriorly by the posterior belly of the digastric muscle, and
anteriorly by the anterior belly of the digastric and the
mylohyoid muscles. As previously mentioned, Pirogoff’s
triangle is simply a continuation of Lesser’s triangle pos-
teriorly, past the posterior border of the mylohyoid muscle.
The superior border of each triangle is the hypoglossal
nerve. At some point in history, Lesser’s triangle must have
been divided into a new smaller, anterior Lesser’s triangle,
with the posterior border being the posterior margin of the
mylohyoid muscle, and the posterior portion renamed
Pirogoff’s triangle. Deaver [4] also mentioned the fact that
‘‘if the attachment of the digastric central tendon is long,
the hypoglossal nerve may be below the muscle, so that in
reality no lingual triangle is present, the artery being found
closer to the hyoid bone than the central tendon’’.
Campbell [5] also mentioned Lesser’s triangle and its
importance for in locating the lingual artery. The floor of
the triangle is the hyoglossus muscle, beneath which is
found the lingual artery. Heisler [10] also made reference
to the triangle of Lesser and its favorable location as a site
for ligating the lingual artery, but incorrectly gives its
borders as Pirogoff’s triangle. ‘‘… this is the hypoglossal
nerve, this portion of which should now be cleaned, and
which forms the base of the triangle of Lesser, while the
posterior belly of the digastric and the free border of the
mylohyoid form its sides’’.
In an article by Burke and Masch [4], a case study was
presented where lingual artery ligation, using Pirogoff’s
triangle, was performed in order to control severe intraoral
hemorrhage. In 2000, van Es and Thuau [18] presented a
technical note examining Pirogoff’s triangle as an
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Surg Radiol Anat (2011) 33:53–57
alternative site for microvascular anastomosis to the lingual
artery during free vascularised tissue transfer in recon-
structive head and neck surgery, especially in the maxil-
lofacial area. In their opinion, Pirogoff’s triangle is an ideal
location to gain access to the lingual artery because of the
ease of access. The authors summarized that not only is
Pirogoff’s triangle the ideal site for ligation of the lingual
artery in the case of severe hemorrhage, it is also an
attractive option for the performance of a microvascular
anastomosis to the lingual artery [16]. The results for
Pirogoff’s triangle are somewhat in disagreement with
Homze et al. [11]. In their study, Pirogoff’s triangle was
only present in 58.2% of their dissections, while in the
present study it is was found in 88% [10]. The authors
concluded that the lingual artery and hypoglossal artery
are located more inferiorly than has been classically
described [11].
Homze et al. [11] described variations in the lingual
artery position to review the anatomy of some of the
smaller/forgotten cervical triangles, with emphasis given to
Pirogoff’s triangle, and to discuss management of intraoral
hemorrhage emanating from the lingual artery. The authors
performed 91 extraoral dissections of the submandibular
region in 54 adult cadavers [11]. For each, the presence or
absence of Pirogoff’s triangle and the positions of the
hypoglossal nerve and lingual artery relative to the digas-
tric tendon and hyoid bone were recorded. The lingual
artery was found inferior to the superior border of the
digastric tendon (within Pirogoff’s triangle) in 67% and
superior to the superior border of the digastric tendon in
33%. This study demonstrated that the lingual artery and
hypoglossal nerve were found to be located more inferiorly
than is classically portrayed.
Bademci and Yaşargil [1] investigated the microsurgical
anatomy, including the course and the relationship to
important landmarks of the hypoglossal nerve. In addition,
the authors also described a new ‘hypoglossal’ triangle,
bordered posteriorly by the descending portion of the
hypoglossal nerve, inferiorly by the transverse portion of
the hypoglossal nerve, and superiorly by the inferior border
of the stylohyoid muscle [1]. Important structures found
within the hypoglossal triangle were the occipital, and the
external and internal carotid arteries.
Conclusion
Additional anatomical landmarks during surgery of the
neck may be useful to the surgeon. Isolation of the hypo-
glossal nerve for neurotization procedures and identifica-
tion of the lingual artery for ligation are just two examples
of uses of the triangles described herein. These geometric
regions lie within the internationally accepted zones I and II
Surg Radiol Anat (2011) 33:53–57
of the neck [15]. Our hopes are that these data will help
minimize surgical morbidity and aid in the efficiency of
surgical dissections.
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