Ebook Clinical atlas of head and neck anatomy: Part 1

(BQ) Part 1 book Clinical atlas of head and neck anatomy presents the following contents: The skull, bones of the skull, skull bone articulations, the fetal skull, other bones, the face, the orbit, the mouth, palate and pharynx.

A Colour Atlas of

FleadandNeck Anatomy

R.M.H McMinn

Sir William Collins Professor

of Human and Comparative Anatomy

Insiitute of Basic Medicil Sciences

Royal College of Surgeons of England

Wolfe Medical Publications Ltd

The reception given to 'A Colour Atlas of Human Anatomy', which dealt with the whole body, has encouraged us to produce a companion volume dealing specffically with the head and neck, in order to meet the anatomical needs of those who are concerned particularly with this region of the body This book is not a reprint of relevant head and neck sections of the earlier atlas; it is a iompletely new work, with new specimens and new illustrations The same format has been retained, namely natural size colour photographs with identification numbers overlying individual structures and an adjacent key, as this has proved

to be universally popular with both undergraduates and postgraduates This system allows students to test their own knowledge by covering up the key The notes that accompany the identffication keys help to emphasise certain important points, but there has been no attempt to give a complete commentary on everything illustrated The book is essentially an atlas designed to complement existing texts, dissecting manuals and other atlases, not to replace them.

We hope that our contribution will assist in the understanding of an intricate but fascinating part

presentation will make even

The skull page l0

From the front L0

From the front Muscle attachments 1,2

From the left L4

From the left Muscle attachments L6

From behind 18

The cranial vault 20

External surface of the base 22

External surface of the base Muscle

attachments 24

The infratemporal region Permanent

dentition 26

Internal surface of the base Anterior,

middle and posterior cranial fossae 28

Median sagittal section with the bony

nasal septum 30

The orbit and nasal cavity 32

Bones of the skull 34

The mandible 34

The mandible Muscle attachments 36

The frontal bone 38

The ethmoid bone 40

The sphenoid bone and the vomer 42

The occipital bone 44

The maxilla and the nasal and lacrimal

bones 46

The palatine bone and the inferior

concha 48

The temporal bone 50

The parietal and zygomatic bones 52

Skull bone articulations 54 The facial skeleton The orbital and anterior nasal apertures 54 The orbit The roof and lateral wall 56 The orbit The floor and medial wall58 The nose The roof, floor and lateral wall 60

The nose The maxillary hiatus and nasolacrimal canal62

The base of the skull The anterior cranial fossa 64

The base of the skull The middle and posterior cranial fossae 66

The base of the skull The external surface 68

The pterygopalatine fossa 70 The posterior nasal apertweT2 The fetal skull T4

Vertebrae 76 The atlas 76 The axis 78 Other cervical vertebrae 80 Articulated vertebrae, the intervertebral foramen and the first thoracic

vertebra 82 Other bones 84 The first rib and manubrium of the sternum and attachments 84 The clavicle and scapula 86 The clavicle and scapula and attachments, and the thoracic inlet 88

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Superfrcial dlrsection II The len

sternocleidops-stoid and related

Deep dissection I The great vessels and

nerves of the left side 100

Deep dissection II The great vessels and

the thyroid gland 102

Deep dissection III The thyroid gland

and the root of the neck 1,04

Deep dissection IV The thyroid gland,

root of the neck, thoracic duct, right

lymphatic duct and the thymus 106

Deep dissection V The prevertebral

muscles 108

The face L1O

Surface markings Surface markings of

the left side 110

Superficial dissection The right parotid

gland, facial nerve and facial

muscles 112

Deep dissection I The right temporalis

and masseter muscles and the

temporomandibular joint 114

Deep dissection II The right

infratemporal fossa, pterygoid muscles

and temporomandibular joint 116

The orbit 118

The eye, orbicularis oculi and the

nasolacrimal duct LL8

Superficial dissection The orbital

periosteum and orbital contents from

above 120

Deep dissection I The ciliary ganglion

and dissection from thefrontl22

Deep dissection II Transverse and

sagittal sections, the lacrimal gland and

the eyeI24

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The pxarana:ai sinu:es The sphenoidal and ma-rillan sinu-.es 1-11

Transr erse and coronal sections and nen-es of the nasal sePtum lil

The mouth, palate and Pharynx 136 The mouth, palate, pharynx and larynx in sasittal section 136

Theiongue and the floor of the mouth 138 The roof and floor of the mouth and the salivary glands 140

The inside of the mouth and soft palates L42

The pharynx- external and surfaces 144

The pharynx from behind 146

The ear 148 The external, middle and internal ear 148 Horizontal sections, and the auditory ossicles 150

The larynx L52 The hyoid bone, and the cartilages of the larynxl52

The larynx with the and tracheal,54

pharynx, hyoid bone

The muscles, ligaments and membranes 156

The cranial cavity L58 The cranial cavity, brain and meninges

1 5 8 The cranial cavity and its coverings 160 The brain in situ 162

The falx cerebri and tentorium cerebelli I64

The falx, tentorium and cavernous sinus

r66

The cranial fossae 168

the hard andinternal

The brain 170

The brain with the meninges L70

The cerebral hemispheres and cerebellum

172

The external cerebral veins L74

The cerebral hemisPherc 17 6

The middle cerebral artery on the lateral

surface of the cerebral hemisphere 178

A median sagittal section 180

The medial surface of the cerebral

hemisphere and the anterior and

posterlor cerebral arteries 1-82

The base of the brain l'84

The base of the brain and the arterial

The internal capsule and basal nuclei in

horizontal sections of the cerebral

hemispheresl92

The cerebral hemispheres and brainstem

in coronal section 194

The cerebellum and brainstem 196

The brain and spinal cord L98 The cerebellum, brainstem and fourth ventricle, and the sPinal cord 198 The suboccipital triangle, vertebral column and spinal cord, and intervertebral foramina 200 Radiographs ofhead and neck 202 The cervical vertebral column 202 The upper part of an arch aortogram 204 The head, postero-anterior and

occipitomental views 206 The head lateral view 208 Carotid arteriograms 2|0 Vertebral arteriogra ms 212 Appendix 2L4

Reference lists to:

Muscles 2L4 Nerves2L6 Lymphatic system 2\8 Arteries 219

Yeins222 Skull foraminaZ23 lndex226

The Skull

7 Lesser wing of sphenoid bone

8 Superior orbital fissure

9 Greater wing of sphenoid bone

O The calvaria (a term not often used) is the upper part of the skull that encloses the brain (i.e the cranial cavity) and has a roof or skull cap, and a floor known as the base of the

s k u l l

O The anterior part ofthe skull forms the facial skeleton.

O T h e c a v i t i e s o f t h e s k u l l : Cranial cavity, containing the brain and its membranes Nasal cavity, divided by the midline nasal septum into right and left halves.

Orbits or orbital cavities rieht and left in which the eyeballs are lodged.

of mandible O T h e b o n e s o f t h e s k u l l :Unpaired

Frontal Ethmoid Sphenoid Vomer Occipital Mandible

Paired

M a x i l l a Nasal Lacrimal Inferior nasal concha Palatine

Zygomatic Temporal Parietal

20 Inferior nasal concha

29 Posterior lacrimal crest

30 Fossa for lacrimal sac

31 Anterior lacrimal crest

32 Frontal process of maxilla

the posterior nasal apertures (choanae) the foramen magnum

the mastoid process the styloid process

1 1

5 Levator labii superioris alaeque nasi

6 Levator labii superioris

7 Zygomaticus minor

8 Zygomaticus major

9 Levator anguli oris

10 Nasalis (transverse part)

ll Nasalis (alar part)

12 Depressor septi

13 Buccinator

14 Depressor labii inferioris

l5 Depressor anguli oris

l6 Platysma

17 Mentalis

18 Masseter

19 Temporalis

O The supra-orbital, infra-orbital and mental foramina lie

approximately in the same vertical plane.

O The infra-orbital foramen is 0J cm below the infra-orbital

margin, immediately below the pupil (with the eye looking

forwards) and in the long axis ofthe second premolar tooth.

O The attachment of levator labii superioris is above the

infra-orbital foramen, and the attachment of levator anguli

oris below the foramen.

a The mental foramen lies below and between the apices of

the two premolar teeth.

O The attachment of depressor labii inferioris lies in Jront of

the mental fbramen and the attachment of depressor anguli

oris below the foramen.

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16 External acoustic meatus

17 Sheath of styloid process

35 Anterior nasal spine

36 Frontal process of maxilla

37 Nasal bone

38 Anterior lacrimal crest

39 Fossa for lacrimal sac

40 Posterior lacrimal crest

41 Lacrimal bone

42 Orbital part of ethmoid bone

43 Nasion

O Some anatomical points of the skull:

Nasion: the point of articulation between the two nasal bones and the frontal bone.

Inion: the central point of the external occipital protuberance (which is nol the most posterior part of the occipital bone) Bregma: at the junction of the sagittal and coronal sutures (i.e between the frontal and the two parietal bones) In the newborn skull the anterior fontanelle is in this region Lambda: at the junction of the sagittal and lambdoid sutures (i.e between the occipital and the two parietal bones) In the newborn skull the posterior fontanelle is in this region Fterion: an H-shaped area (not a single point) where the frontal, parietal, squamous part of the temporal and greater wing of the sphenoid bones articulate It is an important landmark on the side of the skull as it overlies the anterior branch of the middle meningeal artery In the newborn skull the sphenoidal fontanelle is in this region.

Asterion: at the junction of the lambdoid, parietomastoid and occipitomastoid sutures (i.e between the occipital, parietal and temporal bones) In the newborn skull the mastoid fontanelle is in this region.

THE SKULL

From the left Muscle attachments

1 Corrugator supercilii

2 Orbicularis oculi (orbital and palpebral parts)

3 Orbicularis oculi (lacrimal part)

4 Medial palpebral ligament

5 Procerus

6 Levator labii superioris alaeque nasi

7 Levator labii superioris

8 Nasalis (transverse part)

9 Nasalis (alar part)

10 Depressor septi

11 Levator anguli oris

12 Buccinator

13 Mentalis

l4 Depressor labii inferioris

15 Depressor anguli oris

22 Occipital belly of occipitofrontalis

O The buccinator has a bony attachment to the upper and

lower jaws opposite the three molar teeth.

O The medial palpebral ligament and the orbital and

palpebral parts of orbicularis oculi are attached to the znterior

lacrimal crest; the lacrimal part of orbicularis oculi is attached

to Lhe posterior lacrimal crest.

1 7

Squamous part of occipital bone

External occipital protuberance (inion)

O Sutural bones arise from separate centres ofossification that may occur within cranial sutures They are commonest in the lambdoid suture and have no significance.

a In this skull there has been bony fusion in some sutural areas.

O The vertex of the skull is the highest point; it is on the sagittal suture a few centimetres behind bregma (see page20)

O The occiput is the most posterior part of the skull; it is on the midline of the occipital bone a few centimetres above the external occipital protuberance.

1 8

THE SKULL

The cranial vault

A External surface (left half)

B Internal surface (left half)

14 Groove for superior sagittal sinus

15 Grooves for middle meningeal vessels

16 Frontal crest

17 Frontal sinus

18 Depressions for arachnoid granulations

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Palatine process of maxilla

Median palatine suture

Palatine grooves and spines

Transverse palatine suture

Horizontal plate of palatine bone

Greater oalatine foramen

Lesser palatine foramina

Tuberosity of maxilla

Pvramidal process of palatine bone

Pterygoid hamulus

Medial pterygoid plate

Scaphoid foisa -i*: ,.'.'4 )'s,.,

n1;*4-Lateral pterygoid plate

Infratemporal crest

Zygomatic arch

Articular tubercle

Mandibular fossa

External acoustic meatus

Tympanic part of temporal bone

Mastoid foramen (double on left)

Superior nuchal line

External occipital protuberance

Inferior nuchal line

External occipital crest

32 Condylar canal I

33 Occipital condyle I

36 Ca-rotid canal r'f "po-/a/l,rrt lcr'razulu.q

37 Sheath of styloid process

38 petrotympanic fissure fu gfu x lzt*r/

39 Squamotympanic fissure ' pJ"Lr* ,tuiln

48 Palatova;;;;l ;;;;i -+ Pna,atreest btqrrc!^oo SPk

13 V:il:l"vaginal canal : _.-.- +rn*xtlto^1e(ft

3 Superior constrictor of pharynx

4 Medial pterygoid (deep head)

5 Medial pterygoid (superficial head)

6 Lateral pterygoid (upper head)

13 Rectus capitis anterior

14 Rectus capitis lateralis

15 Posterior belly of digastric

23 Rectus capitis posterior minor

24 Rectus capitis posterior major

O Principal skull foramina and their contents:

(for more precise details see pages 223-225) Supra-orbital foramen

Supra-orbital nerye and vessels Infra-orbital foramen

Infra-orbital nerve and vessels Mental foramen

Mental nerve and vessels Mandibular foramen Inferior alveolar nerve and vessels Optic canal

Optic nerve Ophthalmic artery Superior orbital fissure Ophthalmic nerve and veins Oculomotor, trochlear and abducent nerves

I nfe r io r o r b it al fu s ur e Maxillary nerve

S p he no p alatine fo rame n Sphenopalatine artery Nasal branches of pterygopalatine ganglion Foramen rotundum

Maxillary nerve Foramen ovale Mandibular and lesser petrosal nerves Foramen spinosum

Middle meningeal vessels Foramen lacerum

Internal carotid artery (entering from behind and emerging abovt)

Greater petrosal nerve (entering from behind and leaving anteriorly as the nerve of the pterygoid canal)

Carotid canal Internal carotid artgry and nerve Jugular foramen

Inferior petrosal sinus Glossopharyngeal, vagus and accessory nerves Internal jugular vein (emerging below) Internal acowtic meatus

Facial and vestibulocochlear nerves

Vertebral and anterior and posterior spinal arteries

furdl'od furg AccessorY nerves

2 5

l T 1 f i

\

\ 12

26

16 Tympanic part of temporal bone

17 External acoustic meatus

18 Sheath of styloid process

19 Styloid process

20 Occipital condyle

2l Mastoid process

22 T ympanomastoid fi ssure

B Permanent dentition The teeth of the upper and

lower jaws in the adult, from the right and

O The corresponding teeth of the upper and lower jaws have

corresponding names In clinical dentistry the teeth are often

identified by the numbers 1 to 8 as listed here, rather than by

name Thus, 'right upper 6' refers to the right upper first molar

tooth.

a The third molar tooth is sometimes called the wisdom

tooth.

O In the deciduous dentition of the child ('milk teeth'),

there are central and lateral incisors and canines in

corresponding positions to the permanent teeth of the same

name, and first and second deciduous molars in the positions

o f t h e p e r m a n e n t p r e m o l a r s

2 7

/2

22527

THE SKULL

The internal surface ofthe base The anterior,

middle and posterior cranial fossae

-{ From above

B Part of the middle cranial fossa, from above,

right and behind

C Left part of the middle cranial fossa, from

above, showing the occasional foramina

8 Groove for anterior ethmoidal nerve and vessels

9 Cribriform plate of ethmoid bone

l0 Orbital part of frontal bone

ll Jugum of sphenoid bone

20 Lesser wing of sphenoid bone

2l Greater wing of sphenoid bone

22 Hiatus and groove for greater petrosal nerve

23 Hiatus and groove for lesser petrosal nerve

24 Squamous part of temporal bone

25 Petrosquamous fissure

26 Tegmen tyrnpani

27 Arcuate eminence

28 Petrous part of temporal bone

29 Groove for superior petrosal sinus

30 Groove for inferior petrosal sinus and

36 Groove for transverse sinus

37 Groove for superior sagittal sinus

38 Internal occipital protuberance

39 Internal occipital crest

40 Foramen magnum4l Hypoglossal canal

42 Clivus

43 Internal acoustic meatus

44 Apex of petrous part of temporal bone

4 5 T r i g e m i n a l i m p r e s s i o n " , i , ,

46 Grooves for middle meningeal vessels

47 Foramen spinosum-18 Foramen ovale

50 Foramen rotundum

51 Superior orbital fissure

52 Venous (emissary sphenoidal) foramen(of Vesalius)

53 Petrosal (innominate) foramen

O For details of the bones of the cranial fossae see pages 64-67.

a The foramina rotundum, ovale and spinosum are always present within the greater wing of the sphenoid bone; the venous (emissary sphenoidal) foramen (of Vesalius) and the petrosal (innominate) foramen are occasional additions ( a s in C).

O The openings in the anterior cranial fossa are:

the foramen caecum the foramina of the cribriform plate of the ethmoid bone

O The openings in the middle cranial fossa are:

the ootic canal the superior orbital fissure the foramen rotundum the foramen ovale the foramen spinosum the venous (emissary sphenoidal) foramen (of Vesalius) (occasional)

the petrosal (innominate) foramen (occasional) the foramen lacerum

the hiatus for the greater and lesser petrosal nerves

a The openings in the posterior cranial fossa are:

the foramen magnum the jugular foramen the internal acoustic meatus the hypoglossal canal the aqueduct of the

5 External occipital protuberance

6 Groove for transverse sinus

7 Groove for sigmoid sinus

14 Internal acoustic meatus

15 Groove for inferior petrosal sinus

33 Anterior nasal spine

34 Nasal crest of maxilla

35 Nasal crest of palatine bone

r t

, = s {

THE SKULL

The orbit and the nasal cavity

A The left orbit, from the front, slightly left and

above

1 Frontal notch

2 Supra-orbital foramen

3 Supra-orbital margin

4 Orbital part of frontal bone

5 Lesser wing of sphenoid bone

18 Orbital process of palatine bone

The right half of the nasal cavity, lateral wall After removal of the inferior concha

After removal of the middle concha Oblique view, from the front and the right, of the left side of a midline sagittal section of the skull (with the nasal septum removed) Cribriform plate of ethmoid bone Superior nasal concha

Spheno-ethmoidal recess Sphenoidal sinus

Superior meatus Middle nasal concha Sphenopalatine foramen Perpendicular plate of palatine bone Medial pterygoid plate

Horizontal plate of palatine bone Palatine process of maxilla Incisive canal

Inferior meatus Inferior nasal concha Maxillary hiatus Uncinate process of ethmoid bone Middle meatus

Crista galli Frontal sinus Nasal bone Conchal crest of perpendicular plate of

BCDE

) forming roof

forming lateral wall

forming floor forming medial wall

3 132333435363738394041424344454647484950

2l Orbital plate of ethmoid bone

22 Body of sphenoid bone

23 Anterior lacrimal crest

24 Lacrimal groove

25 Fossa for lacrimal sac

26 Posterior lacrimal crest

?3 fJr:,""'.fi ) ethmoidal roramen

58 Lacrimal piocess I or lnrerlor nasal concna

59 Descending process of lacrimal bone

Bones of the Skull

THE MANDIBLE

A From the front

B From the left and aboye

C From the left and trelow

25 Superior and inferior mental spines

O I n t h i s m a n d i b l e t h e t h i r d m o l a r teeth are unerupted.

THE MANDIBLE

Muscle attachments

(The dotted line indicates the limit of attachment of

the oral mucous membrane)

A From the front

B From the left and above

C From the left and below

I Capsule of temporomandibular joint

2 Temporalis

3 Masseter

4 Lateralpterygoid

5 Buccinator

6 Depressor labii inferioris

7 Depressor anguli oris

O Compare with the normal adult bone, as in B and C and

note that the angle between the ramus and body has become

more obtuse and that alveolar bone has become resorbed so

that the mental foramen lies near the upper surface of the

e d e n t u l o u s b o d y

External surface, from the left

Internal surface, from above and

External surface, from the front,

the frontal suture

showing l 9 Roof of ethmoidal air cells;r

20 Superior temporal line

21 Inferior temporal line

13 Fossa f& lacrimal sland

l4 Trochlear fovea (tibercle in C)

O T h e l i o n t a l ( m e t o p i c ) s u t u r e is n o r m a l l y obliterated by the

a g e o f 8 y e a r s b u t o c c a s i o n a l l y p e r s i s t s i n t o a d u l t l i f e , a s in F

O I n C t h e o r b i t a l p a r t s h a v e b e c o m e jo i n e d p o s t e r i o r l y

25

E From the left

F From the left, below and behind

I Ethmoidal labyrinth and air cells

2 Cribriform plate

3 Crista galli

4 Ala of crista galli

5 Slit for anterior ethmoidal nerve and vessels

6 Groove for anterior ethmoidal nerve andvessels

7 Groove for posterior ethmoidal nerve and

O The main features of the ethmoid bone are:

the perpendicular plate with the crista galli at the upper end the cribrifbrm plates

THE SPHENOID BONE

From the front

\ledial pterygoid plate

Groove of pterygoid hamulus

-{nterior clinoid process

Posterior clinoid process