Netter - Atlas Of Human Anatomy

SECTION 1: HEAD AND NECK

- - -·-·- - - -··

121. Accessory Nerve (XI): Schema

CEREBRAL VASCULATURE Plates 130- 141

122. Hypoglossal Nerve (XII): Schema

130. Arteries to Brain and Meninges

123. Cervical Plexus: Schema

131. Arteries to Brain: Schema

124. Autonomic Nerves in Neck

132. Arteries of Brain: Inferior Views

125. Autonomic Nerves in Head

133. Cerebral Arterial Circle (Willis)

126. Ciliary Ganglion: Schema

134. Arteries of Brain: Frontal View

120. Vagus Nerve (X): Schema

12 7. Pterygopalatine and Submandibular Ganglia: Schema 128. Otic Ganglion: Schema 129. Taste Pathways: Schema

and Section 135. Arteries of Brain: Lateral and Medial Views 136. Arteries of Posterior Cranial Fossa 13 7. Veins of Posterior Cranial Fossa 138. Deep Veins of Brain 139. Subependymal Veins of Brain 140. Hypothalamus and Hypophysis 141. Arteries and Veins of Hypothalamus and Hypophysis

ATLAS OF HUMAN ANATOMY

Skull: Anterior View

Frontal bone Parietal bone Sphenoid bone Lesser wing Greater wing

Nasal bone

Lacrimal bone

Orbital plate

Zygomatic bone

Perpendicular plate

Temporal process

Inferior nasal concha

Zygomaticofacial foramen - - - - - - "

Maxilla Zygomatic process Orbital surface

Frontal process Alveola1· process Anterior nasal spin

Right orbit: frontal and slightly lateral view Posterior and Anterior ethmoidal foramina

Orbital surface of frontal bone Orbital surface of lesser wing of sphenoid bone Superior orbital fissure - - - ---!- -I,:!C_:_l

Orbital plate of ethmoid bone

Optic canal (foramen) - - - - --f-----,i-----'-----,:1 Orbital surface of greate'_r- - --lf.:ih wing of sphenoid bone

--c:-1

Orbital surface of zygomatic bon

Orbital process of palatine bone

Infraorbital groove

Orbital surface of maxilla

BONES AND LIGAMENTS

PLATE 1

Skull: Lateral View

Sphenoid bone

Parietal bone

Greater wing

Temporal bone

Temporal fossa

I I I I

Squamous part

Supe rior tempora l lin e Inferior te mporal lin e

Fossa for lacrimal sac Nasal bone

Externa l occipital protuberance

Maxilla

Ante rior nasal sp in e Alveo lar process Head of condylar process Zygomatic bone

Zygom aticofacial foram e n-----~~:J<,t~:::C,

Tem pora l process _ _____.,,_,,

Co ronoid process Ramus - - - - - - - - - oblique lin e ~~------------------B ody

: : ; _ - - - - - - - - - - - - Me ntal foram e n

Sphenoid bone

Greater wing

Infratemporal fossa exposed by removal of zygomatic arch and mandible *-

Infratemporal crest Lateral pl ate of pterygoid process

Pterygom ax ill ary fissure

Pterygo id hamulus (of medi al pl ate of pterygo id pro cess)

External aco ustic meatus Mandibul ar fossa Articular tube rcle Pte rygopalatin e fossa

Stylo id pmcess

Sphenopalatine foramen *Supe rfi ciall y, mastoid process forms poste ri o r boundary

PLATE 2

HEAD AND NECK

Skull: Midsagittal Section

Sphenoid bone

Temporal bone

Parietal bone

Squamou s part

Greater wing--~ Lesse r wing-------. Anterior clinoid process Optic ca nal--~

Grooves for branches of middl e meningeal vessels

Petrous part

Groove for superior petrosal sinus External openin g of vestibu lar aqueduct Groove for sigmoid sinus

Lambdoid suture

Occipital bone Ethmoid bone Crista galli

Groove for transvers e sinus

--------<:~

Cribriform plate --~~~~~~~~f1~t0 Perp endi cular pl ate - - - - ---i'::i

....___Exte rn al occipita l protuberance

Nasal bone Groove for inferior petrosal sinu s

Inferior nasal concha---~

Hypoglossal canal

Maxilla Occipital co ndyle

Palatine bone

Basil ar part

©Jii!N ~

·.·.·.·.· ~:

Frontal bone Opening of sphe noidal sinus

Ethmoid bone

Sphenopalatine foram en

Cribriform plate

Sphenoid bone

lacrimal bone

Plates of pterygoid process Latera l }

Maxilla

Ptery go id hamulus

N asa l surface Palatine pro endicular pl ate } Horizontal plate

BONES AND LIGAMENTS

Palatine bone

PLATE3

Calvaria

Superior view

Co ro nal su ture

Sagittal suture

Lambd a

Occi pital bone

Inferior view Fro ntal bo ne Fro ntal cre st Groove for superio r sagittal sinu s

~~:~ ©'·~~

PLAT£4

HEAD AND NECK

Cranial Base: Inferior View

Maxilla

In cisive fo ssa --------... Palatin e p r o ces s ---~ Medi an palatine sut ure Zygomatic process Zygomati c bone

Transverse pa latin e sutu re Sphenoid bone

Pte rygo id process Ham ul us - - - - , Medi al plate Pterygoid fo ssa Lateral plate Scaphoid foss a Greater win g -----...._ Fo ramen ovale

Temporal bone

Palatine bone

Ho rizonta l pl ate Greater palatine fo ramen Pyramidal process Lesser palati ne for amin a Poste rior nasa l spine

-------Tu,

Zygom atic process Arti cul ar tube rcl e - - - - - - -t;r;-< Mand ib ul ar fossa - - - - - - - - - ,A&Styloid process - - - - - - - ---+--'lr7:;----..... Petrotympanic fissu re ------irtA~:-:-:;;Y::CN''r' Ca rotid ca nal (extern alI ~o~p~e~n~~=:j~~=d~ Tympanic ca nali culu s Extern al acousti c meatus Masto id canal icul us Masto id process Stylo masto id foram e n Petrou s part - - - - - - - Masto id no tch (for di ga stric muscl e) O ccipital groove (for occip ital arte ry) jugul ar fo ssa (ju gul ar fo rame n in its de pth ) Ma sto id fo 1·ame n - - - - - J _

Groove fo r pharyngoty mpanic (aud itory) tu be Forame n lace ru m

Parietal bone Occipital bone

Hypoglossal canal O ccip ita l co ndyle Condylar canal and fo s Basil ar par t - - - - - - - - - ' Pharyngeal tubercl e - - - - - ' Fo rame n magn um- - - - - - ' Infe rio r nu challi ne ------...1 Exte rn al occipital crest - - - - - - ' Supe rior nuchal li ne - - - - - - - ' Externa l occipital protuberance

BONES AND LIGAMENTS

PLATES

Bones of Cranial Base: Superior View

Frontal bone Groove for sup erio r sagitta l si nu s- - - - - Fro nta l cres t - - - - - - - - - - - - - - - . . _ Groove for ante rior me nin gea l vessels --:---Fo rame n cec u m - - - - - - - - - - - - ' - - Supe ri o r surface of orbital part -----'------.._

Anterior cranial fossa

Middle cranial fossa

Temporal bone Sq uamo us pa rt----------~--' Petro us part Groove fo r lesser petrosal ne rve _ _ _;____~ Groove fo r greater petrosal nerve ---:--~ Arcuate e mine nce - - - - - - - - - , - - - - Tri ge minal impression - - - - - -----;------Groove for supe rio r petrosa l s inu s ----~ Groove for sigmo id si nus - - - - --+-____..-

Posterior cranial fossa

Parietal bone Groove for mi ddle meni ngea l vessels (parietal bra nches) -------:-.,....-----" Masto id angle -------------'--..../ Occipital bone Clivu s - - - - - - - - - - - - - - - _ / Groove for inferior petrosal sinu s _ _ _ _ _.../ Basil ar par t - - - - - - - - - - - - - - - - " G roove for poste rior menin geal vessels -----" Condyle - - - - - - - - - - - - - - " Groove fo r transverse si nus _ _ _ _ _ _ __., G roove fo r occipital sinu s _ _ _ _ _ _ _ __., Inte rn al occi pital crest - - - - - - - - - Inte rn al occipital protuberance - - - - - - - - Groove for superi or sagittal sinu s _ _ _ _ __..-

PLAT£6

HEAD AND NECK

Foramina of Cranial Base: Superior View

Foram en cecum------------- Emi ssa ry vein to superior sagittal sinus N asa l slit--------------- } { Ante rior ethm oidal artery, vein Anterior ethmoid al foramen and nerve Fo ramina of cribriform p late- ---- O lfactory nerve bund les Po ste rior ethm oidal foramen ----Posterior ethmo idal arte ry, ve in and nerve . { Optic nerve (II ) Opt1c ca nal--------------- 0 p 11t11a 1m1·c artery Ocu lomotor nerve (Ill) Troch lear nerve (IV) b"t 1 fi . _______ Lacrimal, frontal and nasocili ary branches of op hthalmic nerve (V,) upenor or 1 a ss ul e { Abduce nt nerve (VI ) Superior ophthalmic vein

s

·

Foramen rotundum ·----------Maxill ary nerve (V2l

Foramen ovale -------------

Mandibular nerv e (V3) Accessory menin geal artery Lesse r petrosal nerve (occasionally)

l

. { Midd le menin gea l artery and vein Foramen sp in osum ---------- M eningeal branch of mandibul ar nerve

Hi atus for -----------------Lesse r petrosal nerve Hiatus for --- - ------------- Greate r petrosal nerve

Interna l acousti c mea tus------

l

Facial nerve (V II ) Vestibu lococh lea r nerve (V III ) Lab yrinthin e artery

Exte rnal opening of ves tibular aquedu ct---------- Endo lymphatic duct M as toid foramen (inconstant) --- Emissary vein (a nd occasiona l branch of occipital artery) Inferior petrosal sinus G lo ss opharyn gea l nerve (IX) Vagus nerve (X) Ju gular foramen-----------Accessory nerve (X I) { Sigmo id sinu s Posterior menin gea l artery Cond lar canal (in co nstant) ----{ Emissary vein and meningeal branch Y of ascend111g p haryngeal arte 1·y H ypoglossal canal ----------- Hypoglossal nerve (X II ) M edulla oblon gata Meninges Vertebral arteries Fo rame n magum ---------. Men 1ngeal branches of vertebra l { artenes Spinal roots of accessory nerves

BONES AND LIGAMENTS

PLATE 7

Skull of Newborn

lateral view

Anterior fontan ell e

Parietal bone

Sphenoid al font a ne ll e

Frontal bone Squ a mous part--------Supraorbitalnotch (foramen)

Posterior fontanell e Lambdoid suture

Ethmoid bone Ante rior e thmoidal foramen --------.. Orb ita l plate

Mastoid fontanelle

Nasal bone Maxilla--------~

Infraorbital foramen----:-./ Petrosquamous fissur e

Zygomatic bone _ _ _ _ _ _./ Zygo maticofacial foramen-----' Greate r win g

Palatine bone Pyra midal process - - - - - - - - '

Pe trous part (mastoid process absent)

Late ral pia te of pte rygo id process

Tym panic part (bony externa l aco ustic meatus absent)

Hamulus of medial plate of pte rygoid process

I (vestibular) wind ow Round (cochl ear) window

Superior view

Zygomatic process

Frontal bone Ante rior fontanelle

Corona l suture

Poste rior fon tanelle

PLAT£8

HEAD AND NECK

Bony Framework of Head and Neck

Temporal bone Sphenoid bone Tem poral fossa Zygomati c ar-ch Co ndylar process of mandible

Coro noid process of mandi Latera l pterygoid

(b roken line) H amul us of medi al pterygoid plate

(broken line) Pterygomandibular raphe

(broken line)

Mandible

l~~~~~s----.wlm:.::J!~~-.;__---'-'"---:;; : : : ; Body --------+~~~-----

Sty lohyoid li game nt

Hyoid bone . . Sprn e of sphe nord bon e

l~~sser

horn ________,.. G reate r horn----./ Epi glottis Thyroid cartilage

Sphenopa latin e fora men Pterygopalatine fossa Choanae (posteri or nares) Lateral plate } . Med ial late of pterygo rd P process H amu lus Infratempo ral fossa A lveo lar process of maxi lla

Pyramidal process of pa latin e bone

----·-·-·------BONES AND LIGAMENTS

PLAT£9

Mandible

Coronoid process

Mylohyo id groove Mandible of infant

Oblique line Submandibular fos sa Mylohyoid lin e Sub lin gual fossa ln te ralveo lar septa Ramus

Alveo lar part (crest) - - - - +"':< Mental fo ra me n Mental protuberance====t~~-"-___:~~~~~ Me ntal tubercle -----~~' Base of m a ndibl e ---------,..:::::""""..,_.~ , \..

_________ "

,.....

Body

Mandible of adult: anterolateral superior view

Condylar process Mandibular foram e n Mylohyoid groove

()...R amus

I I I

I I

Mandible of adult: left posterior view

PLATE 10

Mandible of aged person (edentulous)

HEAD AND NECK

Temporomandibular joint

Lateral view oint capsul e Lateral (tempo roma ndibul ar) ligament Sphenomandibu lar li gamen t Spheno mandibular li ga ment (phantom) Stylo id process Stylomandi bu lar li gament

j oi nt capsu le ------' M iddl e menin gea l arter y

Maxillary artery Inferi o r alveo lar nerve Lin gual nerve Sp henoma ndi bul ar li game nt Styloma ndibul ar li game nt

A rti cular disc A rti cu lar tubercle M ylohyoid branch of inferior alveo lar artery and mylo hyoid nerve

jaws closed

jaws slightly opened

jaws widely opened

(h in ge actio n predo min ates)

(h in ge and glidi ng ac ti o n co mbin ed)

BONES AND LIGAMENTS

PLATE 11

Cervical Vertebrae: Atlas and Axis SEE ALSO PLATES 9, 742

nterior articular facet (for anterior arch of atlas)

Dens Lateral mass

T1·ansverse process

Superior articular facet for atlas

\ T1·ansvers e foramen

--A~W'--- Vertebral

foram en

Superi o r ar ticular surface of lateral mass for occipital co ndyl e

..._..--Posterior tub ercle Groove for ve rtebra l artery

Inferior articu lar facet for C3

Axis (C2): anterior view

Atlas (Cl ): superior view

D ens

Vertebral foram en

"""i11-.c~~;::~~;jj;liJ!~=Articular fa cet for dens Inferior arti cular surface of lateral m ass for axis

nsverse process

Body

Posterior articu lar facet (for transv erse ligament of atlas)

Superior articular facet for atlas Interarticular part

Inferior articular process

Anterior tub ercle

Axis (C2): posterosuperior view Atlas (Cl ): inferior view

Atlas (Cl) Superior articular surface for occipital condyl e

Posterior articular face t (for transverse li gament of a t l a s ) - - - - - - _ / C3

Upper cervical vertebrae, assembled: posterosuperior view

PLATE 12

HEAD AND NECK

Cervical Vertebrae (continued) SEE ALSO PLATES 9, 142

Anterior tubercle terior tubercle Posterior tubercle

Posterior tub ercl e

Lamina Lamina

4th cervical vertebra: superior view

7th cervical vertebra: superior view

'/Cervical curvature C2 \ ' Intervertebral foramina for spinal nerves I I

Spinous processes

I I I I

I I I I I I

Interarticular part

I I I I I

Articular pillar------::~~~"" formed by articular processes and interarticular parts

Zygapophyseal joint

I I I I I I I I I I I

C6: I I

Intervertebral foramen for spinal nerve

3rd, 4th and 5th cervical vertebrae: anterior view

I

Zygapophyseal joints Intervertebral joint (symphysis) (disc removed)

2nd cervical to 1st thoracic vertebrae: right lateral view

BONES AND LIGAMENTS

©II.§N ·.

~ ' ,",",' ~ ~

PLATE 13

External Craniocervical Ligaments

Anterior view Basil ar part of o cc ipital bon e Phar yngeal tub ercl e A nteri or atlantooccipitalm emb rane Capsul e of atlantooccipital joint Posterior atlanto occipitalm emb rane Late ral atlantoaxial joint (op ened up ) ior longitu dinal li gam ent

Poste rior atl antooccip ital m embran e

Posterior view

Ax is (C2)

ansvers e process of atlas (C I )

Anterior atlantooccipita lm embrane

Ligam enta flava artery

Suboccipital nerve (dorsal ramu s of C l spinal nerve)

Body of axis (C2) Li ga mentum nu chae

Intervertebral discs (C2- 3 and C3- 4)

~

I

t

i

Zyga pophysea l join ts (C4- S and CS- 6) A nterior tub ercl e of C6 vertebra (ca rotid tubercle)

Sp in ous process of C7 vertebra (vertebra promin ens)

Vertebra l ar te ry Tl ve rtebr a

•'\"' ©JI!!N =·.·:.·.·::

Right lateral view

PLATE 14

HEAD AND NECK

Internal Craniocervical Ligaments

Clivus (surface feature)

of bO>iloc pMl of ocdpl "' booj

Upper part of vertebral canal with spinous processes and parts of vertebral arches removed to expose ligaments on posterior vertebral bodies: posterior view

Poste rior lon gitudin al li gament

Atlas (C l )

Alar li ga ments

Axis (C2) -------r:::51Capsul e o f zy gap oph ysea l joint (C2 - 3)

Atl as (Cl ) Superior longitudinal band Cru ciate li gam ent

Transve rse li ga ment o f atlas {

Inferior lo ngitudinal band

De eper (accessor-y) part of tectorial membrane

Principal part of tectorial membrane removed to expose deeper ligaments: posterior view

Api ca l li ga ment of dens ~10:~~~~~- Alar li ga ment

Atla s (C l)

- - - - Pos teri o r arti cular face t of dens (for transverse li ga ment of atlas )

Ax is (C2)

Cruciate ligament removed to show deepest ligaments: posterior view Tra nsverse li ga ment o f atl as

Median atlantoaxial joint: superior view

BONES AND LIGAMENTS

PLATE 15

Atlantooccipital junction

Hypoglossa l ca nal

Vertebral artery

Te ctorial membran e

Posteri o r margin of foramen magnum

Api ca l li gament of dens

Posterior atl antooccipi ta lm embra ne

Su pe rior longitudin al band of cru ciate li ga ment of atlas Ante rior atlanto occipitalm embrane A nterior arch of atlas (C l)

Ligam entum nu chae

Articu lar cavity Dens (odontoid process) of axis (C2 ) Tr ansverse li gament of atlas ln fel-ior lo ngitudinal band of cruciate li ga ment of atl as Anteri or lo ngitudin al li gament Pos terior longitudinal li ga ment

Lowest / level of occipital bon e

McGregor's line, fro m posterior na sa l sp ine of hard pa late to lo we st po int of occipi ta l bone. Average norm al posi tio n of tip o f dens is 1.32 mm above this lin e w ith standard deviati on of± 2.6 mm as meas ured o n standard latera l radi og1·a ph . Tip > 4. 5 mm above line is co nsid ered to indi ca te basilar impression

Abnormalities of dens, mos t often associated w ith skeletal dysplasias such as l
Hypopl as tic dens (od o nto id process)

PLATE 16

Os odontoide um with fibrous uni o n and narrowin g of vertebral ca nal with head in extension

HEAD AND NECK

Superficial Arteries and Veins of Face and Scalp -·--·------------------------------------------------SEE ALSO PLATES 29, 35, 63, 64, 80, 98 Epicrania l apo neurosis (galea apo neurotica) (cut to revea l sk ull)

Parietal emi ssa ry vein

l

Middle temporal artery and vein

Branches of supe rficial temporal arte ry and vein

Zygomaticoorbita l Transve rse facial artery and vein

Anterior auri c ul ar arteries

Suprao rbital artery and ve in Supratrochlear art ery and vein Nasofrontal vein Do rsa l nasa l artery and ve in

Angular artery and vein Zygomaticofacial artery and vein-----'

Mastoid emi ssa ry ve in and m enin geal branch of occipital arter y (posterior menin gea l arte ry)

In fraorbital artery and ve in Deep fac ial ve in (from pte rygo id plex us) _ _ ____/

Posterior auricu lar artery and vein

Facial artery and ve in

Ex ternal ju gular vein (cut) Retromandib ular vein Intern al ju gular vein Intern al carotid artery

Co mmon ca rotid artery Lingua l artery and ve in

Sources of arterial supply of face Black: fro m interna l carotid arte ry (via o phth almic artery) Red: from external carotid artery

SUPERFICIAL FACE

f·

,.©,.~N

PLATE 17

Cutaneous Nerves of Head and Neck SEEALSOPLAT£527, 3 1,40, 4 7, 77 6

Auricular branch of vag us nerve (X)

From ophthalmic divi sion of trigeminal nerve (V1 ) Supraorb ita l ne rve - - - - - - , Supratrochlear ne rve ---------..

M edial branch es of dorsal rami of cervical spinal nerves

Palpeb ral branch of lac ri mal nerve - - - - - - - - - - . . lnfratrochlear nerve - - - - - ,

Greater occipital nerve (C2)

External nasal branch of an te ri or ethmo idal nerve

3rd occipital nerve (C3) From 4th, 5th, 6th and 7th ne rves in success ion be low

From maxillary division of trigeminal nerve (V2 )

Branches from cervical plexus Lesser occip ital nerve (C2 , 3)

From mandibular divi si on of tri geminal nerve (V3 )

Great auri cular ne rve (C2, 3) Transverse cervical ne rve (C2 , 3) Supraclavicula r nerves (C3 , 4)

/

I )

Ophthalmic nerve (V1 ) - -----!--

Trigemin al nerve (V)

1

f

___.r- Dorsal rami of

·~t --,, ____ .r]h)' \ · _

cervical spin al nerves Note: Auricul ar branch of vagus ne rve to extern al aco ustic meatus and small area o n poste rom edial surface of aut·icl e Branche s from cervical plexus

PLATE 18

HEAD AN D NECK

Facial Nerve Branches and Parotid Gland SEE ALSO PLATE 117

Temporal branches Parotid gland Zygomatic branches Posterior auricular nerve - - - - ----L---.:

Main trunk of facial nerve emerging from stylomastoid foramen

Nerve to posterior belly of digastric muscle and to stylohyoid muscle

Parotid duct

~--Buccal branches

Marginal mandibular b1·anch

Cervical branch

Horizontal section Main trunk of facial nerve Mastoid process

Temporofacial division Posterior auricular nerve-------:, Main trunk of facial nerve - -----J;;?.. Nerve to posterior belly of digastric muscle and to stylohyoid muscle Ce1·vicofacial division

SUPERFICIAL FACE

PLATE 19

Muscles of Facial Expression: Anterior View SEE ALSO PLATE 48

Fronta l belly (fronta li s) of ep icranius muscle Procerus muscl e Corrugator supercilii mu scle Orbita l part } of orbicu lari s oculi muscle Palpebral part Leva tor labii supe ri o ri s alaeq ue nasi muscle Transvers e part } of nasa li s mu scle Alar part Levator lab ii superi o ris muscle Auricularis anteri or muscle Zygomaticus minor muscle Zygomaticus majo r mu scle Leva tor anguli ori s muscle Depressor septi nasi muscle

-r------ Orbicularis oris mu scle - - - - - - Depresso r anguli oris muscle + - - - - - - Depressor labii inferioris muscle 7 - - - - - - Menta li s mu scl e Platysma muscle Co urse of wrinkle lin es of skin is transverse to fiber directio n of facial muscles. El li ptica l in cisions for removal of sk in tumo1·s conform to direction of wrinkl e lin es

PLAT£20

HEAD AND NECK

Muscles of Facial Expression: Lateral View

Ep icrani al aponeu rosis (ga lea apo neurotica)

Auricul ari s anterio r muscle Auricul ari s supe ri o r muscle

Orb icul ari s ocu li mu scle

Auri cul ari s posterior mu scle

Fronta l belly (frontalis) of epicraniu s mu scle Corru ga tor supercilii mu scle (fro ntali s and orb iculari s ocu li, partially cut away)

Leva tor labii superi ori s muscl e Leva tor labi i superioris alaeque nasi muscle

(partially cut away) ------.. Nasa lis ) Tr ansverse pa rt mu scle ~ A lar part

Zygomati cus minor muscl e

Inves tin g laye r of (deep) cervica l fas cia

Zygomati cus major muscle O rbicul ari s oris muscle M entalis muscle Depresso r labii in fe ri oris mu scle

Deltoid fa scia

Depresso r angu li o ris muscl e Bu ccin ato r mu scle

Pl atysm a muscl e

©JI§N ·....:.·: : ~

Pecto rali s majo r fascia

SUPERFICIAL FACE

PLATE 21

Muscles of Neck: Lateral View

Parotid gland (cut) Ramu s of mandibl e

Masseter muscle Subm andibular gland

Mastoid proce ss

Body of mandibl e

Digastri c mu scl e (posterior belly ) M iddle ph aryngeal constrictor mu scle

Di gas tri c mu scl e (a nterior b elly)

Longus capit is muscle Sp leniu s mu scl e - - - -

Levator sca pul ae muscl e

Scalene mu scl es

Posterior M iddl e { Anterior

Omohyoid mu scl e (s uperior bell y) Stemohyoid mu scl e

Brachia l plex us

In ferior pharyngeal constrictor mu scl e Acromion

Om ohyoid muscl e (in fer io r bell y)

Stemal head Clavi cular hea d

l

Manubrium of stemum

Stemocl eido mas toid mu scl e

Pectorali s major muscl e

PLAT£22

HEAD AND NECK

Muscles of Neck: Anterior View

Digastric muscle (anterior belly)

Masseter muscle

Mylohyoid muscle Parotid gland

Submandibular gland Fibrous loop fm intermediate digastric tendon Stylohyoid muscle

Hyoid bone External carotid artery Internal jugular vein

-----Omohyoid muscle (superior belly)

Thyroid cartilage

Sternohyoid muscle Investing layer of (deep) cervical fascia and cut edge

Cricoid cartilage - - -

Trapezius muscle

Clavicle Omohyoid muscle (inferior belly) Pretracheallayer of (deep) cervical fascia over thyroid gland and trachea

Pectoralis major muscle

l

Sternocleidomastoid } muscle

Suprasternal space Manubrium of sternum

NECK

jugular notch

PLATE23

lnfrahyoid and Suprahyoid Muscles SEE ALSO PL ATE 47 Di gastri c mu scl e (a nteri or belly)

Hyo id bo ne

M ylo hyo id muscl e

Thyrohy o id membran e

Hyogloss us mu scle

Extern al ca rotid artery Intern al ju gu lar vein Thyro hyo id mu scle

Fibro us loop for intermediate di gastri c tend o n

Th yro id ca rtil age Om ohyoid mu scl e (s upe rio r be ll y) ------~

Stern o hyo id and o mo hyo id mu scles (cut ) Th yro hyo id mu scle

M edi an crico th yro id li gament Cri coth yroid mu scl e Scalene mu scles Om ohyo id mu scle (s upe ri or bell y) (c u t) O mohyo id mu scl e (inferi o r be ll y)

Mylo hyoid mu scle D igastric mu scle (pos terior belly)

Di gas tric mu scle (a nterior belly) Ge ni ohyoid mu scl e

I.- - - - - T hyroh yo id mu scl e - - - - - o blique lin e of th yroid cartil age

Stern ohyo id mu scl e O mo hyoid mu scl e (supe ri o r belly) _ ___.,

lnfrahyoid and suprahyoid muscles and their action: schema

PLATE24

O mohyo id muscle (inferi o r belly)

Sternoth yroid mu scl e

HEAD AND NECK

Scalene and Prevertebral Muscles

Basil ar pa rt o f occipital bone

Lon gus ca piti s mu scl e (cut)

Occipita l cond yle

M as to id process

ransverse process of atlas (CI )

l

Tub ercl es of tran sverse

~ process of C3 ve rtebra

Pos teri o r tub ercle of transverse process of axis (C2 )

Lo ngus ca lli muscle

Sli ps of origin of po sterior sca lene muscle

~

Scalene mu scl es (

Middl e Posterior

l

Sca lene

~ mu scl es

Anterior sca lene muscle (c ut )

Brachi al plex us

-~t

~

-

' ©~.~~

I st rib

Subclavian vein

Common ca ro tid artery

Pos teri o r tubercle of tran sverse process o f C7 vertebra

In tern al ju gul ar ve in

NECK

PLATE25

Superficial Veins and Cutaneous Nerves of Neck FOR DEEP VEINS OF NECK SEE PLATE 64 Platysma muscle (cut) Facial artery and ve in

Submand ibul ar gland

Retrom andibu lar vein

O mohyoid muscle (cut)

Internal ju gular vein

Externa l ca rotid artery yrohyo id muscle

Anteri o r ju gular ve in Co mmunicating vein

In terna l jugul ar vei n Common ca rotid artery

Ansa cerv ical is Omohyoid mu scl e (s uperior belly) (cut)

Thyroid gland

Omohyoid mu scle (inferior b elly) Brachial plexus

Supraclav icu lar nerves Ste rnocleidomastoid mu scl e Ste rn ocle idom as to id muscl e (cut) Stern othyro id muscl e

PLAT£26

HEAD AND NECK

Cervical Plexus In Situ SEE ALSO PLATES 727, 722, 723, 782 Great auri cul ar

Parotid gland

Submand ibul ar gland Sternocleidoma stoi d muscle (cut, turned up)

M yloh yo id muscle H ypoglossa l nerve (X II)

~'!ill--- Sty loh y oid

Di gastri c muscle (a nteri o r bell y) - - ----"'Ole-;;

mu scle

Di gastric mu scle (posterior bell y) C2 spina l nerve (ventral ramus )

Internal carotid C3 sp inal nerve (vent1·al ramus) Levator scapu lae muscl e

Sup erior thyroid artery

Midd le sca len e muscl e Ante ri or sca lene muscl e

Ansa ce rvica li s { Superior roo t Inferior roo t

CS spinal nerve (ven tral ramu s)

Sternoh yoid muscl e

a.----Transverse cervica l artery Phreni c nerv e

Internal ju gul ar vein

-w~~~-

Common carotid artery

Verteb ral artery Th yrocer vica l trunk

Omohyoid muscl e (inferior bell y) (cut)

Dorsa l sca pular artery Supra sca pul ar artery

Subclavian artery and vein

©U§N ~

Hypoglossa l nerve (X II )

·:.·.· ; :

',

Great au ri cular nerve 1-t-- - Lesse r

occipital nerve

~--------\--l.;-+!---H--To rec tus capitis laterali s,

longus ca pitis and rectus cap iti s anterior muscles Co mmuni ca tion to vagus nerve T1 ansve rse cervical ne1 ves

To longus capitis and longus colli muscles

To scalene and leva tor sca pulae muscles

NECK

PLAT£27

Subclavian Artery SEE ALSO PLATE 398 Right anterior dissection Thyroid gland (reflected) Middle cervical sympatheti c ga ngli on

Vertebral artery Com mon carotid artery

Tr ansve rse cervical artery Suprasca pular artery Dorsa l sca pular artery

Bra chiocephali c trunk

Cos tocervical trunk Th yroc ervica l trunk

Internal jugular vein (cut)

Subcl av ian artery and vein

/

Right lateral schematic view / /

Ve rtebral artery

Extern al ca rotid artery Intern al ca rotid artery Ascend in g ce rvica l artery Inferior thyro id artery

Costoce rvi ca l t1·unk

Transve rse ce rvi ca l artery

:-""""'"""~"\--------- Subclavia n ar tery (1st pa rt m edial to, 2nd part behind, 3 rd part lateral to anterior scalene muscl e) Intern al thoracic artery

PLAT£28

HEAD AND NECK

Carotid Arteries SEE ALSOPLATES 130, 13 1 Superficia l tempor al artery

Parotid space (bed): right lateral dissection

Transverse facial artery

Externa l carotid artery Styloid process -------l-'-;-;,,-+~J_

Posterior au ri cul ar artery

Facial nerve (VII ) (cut)----4' Sternocle idomastoid mu scle (cut)

Stylohyoid muscle

D igastric muscle (posterior be ll y) (cut)

Hypoglossal nerv e (X II )

Occipital artery and sternocleidomastoid branch Lin gua l artery Mylohyo id muscle Ansa cervica li s { -::.::.::~--

Asce ndin g pha ryngeal artery - - ---\.-:\-""\t:\\\1" \! Carotid branch of glossopharyngea l nerve (IX) and ca rotid body _ _ ___...-

Di gastri c mu scle (ante1·ior belly)

Branch to thyrohyoid muscl e (from ansa cervica li s)

In terna l ca rotid artery In terna l ju gular ve in

Superi or laryngea l ar tery Superior th yro id artery External carotid artery

Superfi cial temporal artery Commo n ca rotid artery

ll"~::l!!toii::.::<~~:::W? .a---- Facia l artery

~--------- L in g u a l artery Asce ndin g ph aryngeal artery In terna l carotid artery External carotid arte ry

Superior th yro id artery and supe ri or laryngea l branch O m ohyo id mu scl e (phantom)

Common carotid artery

External carotid branches: schema Th yro cervica l trunk

NECK

PLATE 29

Fascial Layers of Neck FOR CONTENTS OF CAROTID SHEATH SEE PLATES 63, 64, 65 In vestin g layer of (deep) cervica l fasc ia

Platysma mu scle Sternohyo id muscle

Muscul ar portio n of pretracheal laye r of (deep) cervical fas cia (of infra hyo id muscl es) Visceral portion of pretrachea l laye r of (deep) cervica l fas cia

Omo hyo id muscle

Ca rotid sheath

'Jr--.;__-- Recurrent

laryngea l

nerve ;;--~--- Common

carotid ar tery

Intern al jugul ar ve in

Inves ting layer of (deep) cervical fascia roofin g posterior triangle

Vagus nerve (X) Phrenic nerve Anterio r scalene muscl e Sympathetic trunk

Fat in posterior triangle

Sp in al nerve Middle and posterior sca lene muscl es Longus coll i muscle Levator scap ulae muscle Trapeziu s muscle

Alar fascia - - - f

Cross section

Deep cervical muscles Retropha ryngea l space

Subcuta neous tiss ue

Cervica l ve rtebra (C7)

Sagittal section

Buccopharyngeal fasc ia ------------Brr---b~..,._,iiRetropharyngea l space

~_;;_-----G e ni o h yo id fascia

layer of (deep) J~---------lncevesting rvica l fascia +,~-----Fa sc i a of in fra hyoidmuscles

Pretracheal fasc ia

Suprasterna l space Ma nubrium of sternum

---~,----~---------~-------·

PLAT£30

HEAD AND NECK

Nose Anterolateral view

Inferior view M ajo r alar ca rtil age

Lateral

M edi al

Anterior nasa l spi ne of maxill a Anterior nasal spine o f maxilla Alar fibrofatty ti ssu

Intermaxillary suture

Co rru ga to r supercilii mu scl e Dorsa l nasa l arte ln frat rochlear nerve A ngul ar artery Exte rn al nasa l artery and nerve Nasali s muscle (transverse part) Infraorbita l artery and nerve Latera l nasal artery Transverse fac ial artery Na sa li s mu scl e (alar part) D epresso r septi nas i muscle

Facial artery

NASAL REGION

PLATE31

Lateral Wall of Nasal Cavity

penin g of sphenoidal sinus Superior nasa l mea tu s

Hypoph ys is (pituitary gland ) in sella turc ica

Midd le nasal co ncha

'-----"""~":"- Sphenoidal sinu s

Atrium of middl e nasal meatus

Pharyngeal to nsil (ade noid if enl arged)

Middl e nasa l meatu s

Basilar part of occipital bone

Inferior nasa l concha (turbinate) ----~:L.

,li:,J' 'fl'~~~r---4+- Pharyn gea I

.,..,,__..,_ __

raphe

Inferi o r nasa l

Open in g of ph aryngotym pani c (a uditory) tub e Ph aryng ea l recess Horizontal plate of pa latine bone Soft pal ate Middle nasa l conch a M idd le nasa l mea tu s

t7

\ t~.~

~ '< _,..:

~

/

rw ay to nasoph arynx Inferior nasal co ncha iA.....Iil--':r

-

In fe ri o r nasal meatus

Speculum view Cribriform plate of ethmo id bo ne Pro be in opening of sphenoidal sinu s

Superi or nasal mea tu s with ope ning of posteri o r ethm o id al ce ll s Open in gs of midd le ethmoida l cell s rus tubariu s

Semilun ar hi atus with openin g of anterior ethmoidal cell s

Opening of pharyngotym pa ni c (auditory) tub e

Un cinate process Inferi or nasal co ncha

Anterior arch o f atlas (Cl vertebra)

(cut surface) _ _ __....-

Openin g of nasol acrim al du Inferior nasa l meatus

PLAT£32

Open in g of maxillary sinu s

D ens of axis (C2 ve rteb ra)

HEAD AND NECK

Lateral Wall of Nasal Cavity (continued) SEE ALSO PLATE 3

Lacrimal bone

Frontal bone

Squamous part Sinus - - - - --4--l:-t{ Nasal spine Sphenoethmoidal recess Sphenoethmoidal foramen Basilar part of occipital bone

Major alar ca

Medial and Lateral plates of pterygoid process

Frontal process

Maxilla

Alveolar process

Inferior nasal concha

Sphenoid bone

Pterygoid hamulus Sphenoidal process Orbital process Posterior nasal spine Perpendicular plate Horizontal plate

Ethmoidal bulla Frontal sin

Opening of middle ethmoidal cells uperior nasal concha (cut away)

Opening of frontonasal canal penings of posterior ethmoidal cells Middle nasal concha (cut away) Opening of sphenoidal sinus Openings into maxillat·y sinus

Semilunar hiatus with openings of anterior ethmoidal cells------'~

Inferior nasal concha (cut away)

Sphenopalatine foramen

Ethmoidal process of inferior nasal concha Lesser palatine foramen

Opening of nasolacrimal canal Greater palatine foramen

NASAL REGION

PLAT£33

Medial Wall of Nasal Cavity (Nasal Septum)

Cribri form plate of ethmoid bone Sphenoidal sin

Latera l process of septal nasal ca rtil age Major alar cartila ge

Anterior nasa l sp in e

Fronta l bo ne

l

, - - - - - - - Cri sta galli Cribri fo rm plate } Ethmoid hm'<

Nasal b Sphenoid bone Vome rin e groove (for naso palatine nerve and vessels) -------...... Septal

Bas il ar part of occip ital bon e

Major alar ca rtil age (med ial crus)

Pharyngea l tubercle

Anteri or nasa l spin

l

Nasal

Maxil la

crest---~

In cisive cana l Pa latin e

PLAT£34

nrr>r P""'

Posterior nasa l spine H o rizontal plate Lesser pa latine fora men Greater pa latin e foramen

l

Pa latin e bon e

HEAD AND NECK

Maxillary Artery SEE ALSO PLATE 29 Anterior . } Deep tempo ral arten.es and nerves Poste nor Masseteric artery an d nerve

Lateral pterygo id artery and mu scle Supraorbita l artery

Late ral li ga ment of temp o ro mandibular j o int

Sup ratrochl ea r artery

Midd le menin geal artery

Ophthalmi c artery ---r:~~=--iiiii~~~

Auricu lotempora l nerve

Dorsa l na sal artery Ang ular artery

l

Superficial tempo ral artery

In frao rbital a rtery -4?--JI-...-.:Y,~~~~ Superior alveo lar arte ri es

Posteri o r M iddl e ------''l\--l!~--!i

Facial nerve

Anter i or ------lll~

--.,---,---In fe ri or alveol ar artery and nerve

Bucca l artery and nerve

Sphen o mandi bula r li ga ment

M edi al pterygoid artery and muscle

Mylohyoid nerve and branch of inferi or alveolar ar tery

Pterygom andibul ar raph e

D igas tric mu scle (poste rior belly)

Lin gual nerve Facial artery --0~:;bdc;~~==-_i\'!•

Stylohyoid muscl e Extern al ca rotid artery

Mental branch of in fer io r alveo lar artery --J~
Sphenopalatine artery

A rtery of pter ygo id ca nal Pharyngea l artery

Posteri or lateral na sal branch

Lin gual artery

Anteri or ~ D eep temporal arteries Pos terior j and nerves Accessory men ingeal artery Middl e meningeal artery

Infraorb ital artery

Anterior tympani c artery Deep auri cular artery A uriculotempora l nerve

Pos terior septa l branches D escendin g palatin e artery in p te rygop aIatin e fossa ----1'i~---::L--4::_~__j_

Superfi cial temporal artery

Anastomosis in incisive ca n a l-----+--'->-~~~:dl

Asce ndin g ph aryngea l artery

Left and ri ght lesser palatin e arteries Exte rnal carotid artery Pterygo id arteries Masseteri c artery Inferio r alveolar artery

©fi!!N .. : :

Superio r pharyngea l co nstri ctor mu scl e Stylogloss us muscl e

~ ·.·.·.~

NASAL REGION

PLAT£35

Arteries of Nasal Cavity

Nasal septal branch of superior labial branch (of facial artery)

Nasal septum (turned up)

Schematic hinge

Anastomosis between posterior septa l branch of sphe nopalatine artery and grea ter palatine artery in incis ive ca nal

Septal and lateral nasal branches of posterior ethmoidal artery Anterior septa l branch,----.,_ Anterior lateral nasal bran ch, External na sa l branch of anterior ethmoid al artery

Posterior septa l branch of sphenopa latin e artery

Sphenopalatin e artery

Alar branches of lateral nasa l branch (o f fa cial artery)

Posterior lateral nasa l branch es of sphenop alatin e artery

Anastomosis between posterior sep tal branch of sphenopalatine artery and grea ter palatine artery in in cisive canal

artery Lesser pa lati ne foramen and artery Greater palatin e foramen and artery

Lateral wall of nasal cavity

':"

. .P ~ -~~~:·~

r!

i"'

©mi.N

PLAT£36

HEAD AND NECK

Nerves of Nasal Cavity SEE ALSO PLATES 39, 40, 113

Nasal septum (turn ed up) Schematic hinge

In cisive ca nal

Naso palatin e nerve (V2) Lateral interna l nasal Exte rn al nasa l b ranches of ante ri or ethm o ida l ne rve (V I)

Sphenopalatine forame n

(dissected away) Interna l nasa l b ranches of infrao rbita l nerve (V2)

Ne rve (V id ian) of pterygoid cana l

Poste ri or superi or lateral nasa l b ranch of maxillary nerve (V2)

Nasa l b ranch of anterio r superio r alveolar nerve (V2)

G rea ter and lesse r pa latin e ne rves (V2)

Pos teri or in fer ior lateral nasal b1·a nch of grea ter palatin e nerv e (V2 ) Lesse r pa latine ne rves (V2) Co mmuni catio n be tween greater palatine and nasopa latine nerves at incis ive ca nal - - - - - '

lateral wall of nasal cavity

©ll!iN '.·.·.·.·:: ~

NASAL REGION

PLAT£37

Nerves of Nasal Cavity (continued) ·---------·----· SEE ALSO PLATE 7 73

Distribution of olfactory mucosa (shaded blue) Lateral wall of nasa l cavity

Externa l nasa l bra nch of ante ri m ethmo idal nerve (V 1 )

~..,_- Greate r

petrosal nerve

~;;;;::;:;:;2~i5S:!\c-- Deep petrosa I nerve ~;..---,...-"""'::;;."'

Nerve (vidian) of pterygo id ca nal Pharyngeal bra nch of maxill ary nerve (V2l N aso pa latin e nerve (V 2 ) pass in g to septum (cut) Posterior inferio r latera l nasa l branch from greater pala tin e nerve (V2)

Lateral wall of nasa l cavity

Palatin e nerves (V2l {

Lesse r

M edial in ternal nasal bra nch of anteri or ethmoidal nerve (VI ) O lfacto ry nerves (I)

Incisive ca nal

Nasal septum

------PLAT£38

HEAD AND NECK

Autonomic Innervation of Nasal Cavity SEE ALSO PLATES 776, 725, 727 Superior salivatory nucleus (parasympathetic) Facial nerve (VII) Geniculum Greater petrosal nerve (parasympathetic) Deep petrosal nerve (sympathetic) Nerve (Vidian) of pterygoid canal Maxillary nerve (V2 ) entering foramen rotundum Pterygopalatine ganglion in pterygopalatine fossa Lateral and medial posterior superior nasal branches in pterygopalatine fossa

Posterior superior and inferior lateral nasal nerves (cut ends)

nerve

\

I I

- -'-Spinal cord

Internal carotid artery

Sympathetic trunk---+

Greater and lesser palatine nerves

superior alveolar nerves

Maxillary sinus

nerve

Postsynaptic fibe1·s to vessels (sympathetic) and glands (parasympathetic) of nasal cavity, maxillary sinus and palate

Presynaptic parasympathetic fibers ---------- Postsynaptic parasympathetic fibers - - - - - Presynaptic sympathetic fibers Presynaptic sympathetic cell bodies in intermediolateral nucleus (lateral horn) of gray matter

---------- Postsynaptic sympathetic fibers

©IIDN ·.': ,",' z ~

NASAL REGION

~

PLAT£39

Ophthalmic (\tj) and Maxillary(~) Nerves SEE ALSO PLATE 716

Com municatin g branch Posterior ethmoidal nerve

Anterior ethmoidal nerve Supraorbital nerve Supratrochlear nerve

Lon g and short cil iary nerves Lacrim al gland lnfratrochlear nerve (from nasociliary nerve) Cutaneous bran ch of lacrimal nerve Zygomaticotemporal

Tentorial nerve

Zygoma ticofa cial

Extern al nasal bran ch of anterior ethmoidal nerve

Trigemin al (semilun ar) ga nglion Trigemin al nerve (V) Meningeal branch --.....--Foram en rotundum Foramen ovale

Anterio1· superior alveola r nerv e

Maxillary nerve (V2) Mucous membrane of maxillary sinus Nerve (Vidi an) of pterygoid cana l Pterygopa latine ganglion Grea ter and lesser pal atin e nerves

Dental and gingival branches Superior dental p lex us Infrao rbital nerve entering in fraorbita l canal

Gangli onic branches to pterygopalatine ga ngli on Posterior superior alveolar nerve

.P

t{

©fl!!N

~~ ·:.·: : ~

PLAT£40

HEAD AND NECK

Mandibular Nerve (\.'1) SEE ALSO PLATES 65, 11 6 Temporal fasc ia and temporali s muscle

Lateral view

} Deep temporal nerves

Masseteri c nerv e M eningeal bran ch Foramen spinosum Middle menin gea l arter y Auricul o temporal nerv e ------,-7+-':t:--.:::;~ Posterior auri cul ar nerve Facial nerve (VII ) Chord a tympani nerve

Submandibul ar ganglion

Inferior alveo lar nerve (cut) N erve to mylohyoid M edi al pterygoid muscl e (cut) D igastric muscle (posterior belly) Stylohyoid mu scl e Hypo glossa l nerve Subm andibul ar gland

Medial view

Sublin gua l nerve

Di gas tri c mu scle (a nterior belly)

Tri ge min al (sem ilunar) ga nglion -----------:~:-:77::r--K Ophtha lmic nerve (V 1) - --'rl"lri'

Tympanic cavity

M andibul ar nerve ( A nterior division Tenso r ve li palatini nerve and muscle

Tensor tympa ni muscle and nerve

Otic ga ngli on Chorda tympani nerve M ed ial pterygo id nerve and muscle (cut)

Auricu lotempo ral nerve M axillary artery

Pterygo id hamu lus Inferior alveo lar nerve en terin g mandibul ar fo rame n

NASAL REGION

PLAT£41

Paranasal Sinuses

Coronal section O lfac tory bu lbs

Brain

Middl e

M iddle nasa l mea tus ---;~r:f-n~::--.;.~~~g }

Max ill ary si

Recesses of max ill ary sinu s

Inferi o r nasa l meatus

Infe ri o r nasa l co nch a

Optic nerve (II )

Bra in

Horizontal section

PLAT£42

HEAD AND NECK

Paranasal Sinuses (continued)

Sagittal section Ethmoidal ce lls

Opening of sphenoidal sinu s Opening of fr o ntonasal duct Sphenoidal sinu s

Middl e nasa l concha (cut away) Opening of maxillary sinu s

Inferior nasa l co ncha

Opening into middle nasa l mea tu s

Pterygopalatine fossa

Maxillary sinus

Lateral dissection

:~o

I

NASAL REGION

©II§N :·.·.·:.·::

PLAT£43

Paranasal Sinuses: Changes With Age

Bones of nasal cavity and paranasal sinuses at birth

Sinu s 1·eprese nts one or more anteri o r ethmoid al ce ll s openin g into se milun ar hi atus of middl e nasal meatus

Sinu s represe nts one or mo re middl e ethm o ida l cell s openin g in to m idd le nasa l meatus Part of nasolacrimal duct that fo rm ed in depth s of nasoopti c furrow

Sinu ses represent two o r mo re posteri o r ethm oida l cell s openin g into superio r nasa l mea tu s Sp henoida l sinu s w ith in bony shell (sphe noida l co ncha) loca ted ante rior and latera l to body of sp henoid bo ne (broken line in dicates sinu s lateral to sp heno id body)

Naso lacrima l foramen (beco mes bony ca nal) Med ial plate of pterygoid process

Pa rt of nasolacrim al duct w ithin nasa l cavity wi th slitlike ope nin g in in fe ri or nasa l mea tu s -------"

Lower border of hi ghest nasal co ncha Lowe r bo rde r of superi o r nasa l co ncha Supe ri or nasa l meatus

M ax ill a

M idd le nasa l concha (cu t edge) (in fe rior nasal concha co mpletely re moved)

Uncinate process of ethmo id bone Semilunar hi atus

Maxillary sinu s w ith ope nin g into semilunar hiatus (stri ped are represents membrane formin g most of medial wa ll of sinus)

Growth of frontal and maxillary sinuses throughout life

©I@N ·..: ,",'=: ~

Fro nta l sinu s w ithin fro ntal bo ne Birth M idd le nasal co ncha 1 year

•

4 yea rs

Nasal septum

7 yea rs Nasal cavity

- - - Maxillary sinu s w ithin max ill a

12 yea rs

Ad ult O ld age

PLAT£44

Infe ri or nasa l concha Palate

HEAD AND NECK

Inspection of Oral Cavity

:~Cc.___2:-"--~;--------'~7'-:-i;-f-- Philtrum of lip

Soft palate Palatopharyngeal arch Uvula

t:=_,...._::_-;~'frr--- Pal atogl ossa I arch !--_:_-----'::,_,.:..;:'ff-- - - Palatine tonsi I

'-"-::-:---..:;;_:.:.J-_ _ _ Posterior wall of pharynx

Frenulum of upper lip Lingual minor salivary gland Deep lingual artery and veins and lingual nerve------~"'----Fimbriated fold Submandibular duct Sublingual gland Frenulum of tongue Sublingual fold with openings of sublingual ducts-------,:...--\,Sublingual caruncle with opening of submandibular duct Frenulum of lower lip--"--_'ll,

Parotid papilla with opening of pamtid duct

ORAL REGION

PLAT£45

Roof of Mouth ·- ----

·-------~~~~-------·-----------------·-----·---------~

G rea ter palatine artery and nerve G rea ter palatin e fo ramen Less er palatin e fo ram en

Palatin e p rocess of max ill a -----~O,!jll

Lesser palatin e artery and nerve s

Hori zo ntal p late of pa latine bo ne -

Tendon of tensor veli pa latini muscl e --f'-'--*llrtf'lf

Pterygo id hamul us Palatin e

In terd igita tin g fibers of levator veli pa latini mu scl e

Pterygom andibul ar rap he Superior phary ngea l con stricto r muscl e

Mo lar m in or sa li vary gla11d s - --+"""""' Palatoph arynge us muscl e _ _ _ __.....-

Pa lato glossus muscl e

Bas il ar part of o ccip ital bone

Anterior view

Cartil agin ous part of pharyngotympani c (a udito ry) tub e -........~,.__--

Pharyngobas ilar fascia

Levato r ve li palatini muscle

M edial p te rygo id mus cle (c ut) M edial pterygoid plate

Pterygoid hamulu s

Pte rygo id hamu lu

Superi or pharyngea l co nstric tor mu scl e

Tendon of tenso r ve li palatini mu scl e Levato r veli palatini mu scl e (cu t )

Palatopharynge us m uscl e

Palatoph aryngeus muscl e

I

,_1

Po sterior view

PLAT£46

HEAD AND NECK

Floor of Mouth SEE ALSO PLATE 24

Lateral, slightly inferior view Hyoglossus muscle Mylohyoid muscle Fibrous loop for intermediate digastric tendon Digastric muscle (anterior belly) Median raphe of mylohyoid muscle

Anteroinferior VIeW

Thyrohyoid muscle

Sternohyoid muscle

Digastric muscle (anterior belly) Mylohyoid muscle Stylohyoid muscle Digastric muscle (posterior belly) Fibrous loop for intermediate digastric tendon

Posterosuperior view

Inferior alveolar nerve and artery Mylohyoid nerve and artery Submandibular gland and duct Mylohyoid muscle-----' Geniohyoid muscle----"'

Body--------c G reater horn

ORAL REGION

Hyoglossus muscle (cut)

PLAT£47

Muscles Involved in Mastication FOR FACIAL MUSCLES SEE PLATES 20,21

Temp o ral fascia Sup erficial laye r Deep layer

Levator labii superioris alaeque nasi mu scle----..

Zygomatic arch

Levator labii superioris mu scle

Articular disc o f temporomandibul ar joint

~ )

Levato r anguli o ri s muscl e

Masseter muscle

Buccin ato r mu scle

M entalis mu scl e Dep ressor labii infer ioris mu scl e

D epresso r anguli oris muscle

Tempo rali s muscl e Insertion of temporal is muscl e to co ronoid process of mandibl e Parotid du ct

Orbi cularis oris muscle

In serti o n of masseter mu scle

PLAT£48

HEAD AND NECK

Muscles Involved in Mastication (continued)

Articular disc of temporomandibular joint Articular tubercle Lateral pterygoid muscle Sphenomandibular ligament

Parotid duct

Pterygomandibular raphe Superior pharyngeal constrictor muscle

Lateral view

Choanae artilaginous part of pharyngotympanic (auditory) tube Masseteric nerve Middle meningeal artery Temporomandibular joint Auriculotemporal nerve Lateral pterygoid muscle

Masseteric Maxillary artery Inferior alveolar nerve Lingual nerve Medial pterygoid muscle Medial pterygoid plate Pterygoid hamulus

Levator veli palatini muscle Pterygoid hamulus

Posterior view

ORAL REGION

PLAT£49

Teeth

Permanent (colored blue) Usual age of eruption

Ce ntral inci sor (8- 10 month s) Lateral in ciso r (8- W month s)

r__:_-:c::_--:-----:-::---==~~=~~~~3:------ Ce1 tra l in ciso r (7th yea r) c:=---~-'--~~~~::._

_ _r,.~~-- Late ral in ciso r (8th yea r)

nine (c usp id ) (11th- 12 th yea r) 1st pre mo la r (9 th yea r) 2nd pre mo lar (10th yea r)

·1st mo lar (15-2 1 mo nth s)

I st mo la r (6th year ) 2nd mo lar (12th-1 3th yea r)

2 nd mo la r (20-2 4 months) 2 nd mo la r (20- 24 mo nth s) - - - - - - - - - - - - - - - - - , . 2nd mo lar (12th- 13 th yea r)

1st mola r (15- 21 month s)

1st mo lar (6 th year) -4---- 2 nd pre mo la1· (10th yea r) -1- - - 1 st pre mo la r (9th yea r)

Late ral in cisor (15- 21 month s)

~~p=:;";?""-----C a nin e

(c usp id ) (11th- 12th yea r)

- - - - - - - - - Late ral inc iso r (8th yea r) - - - - - - - - - - - - - - Ce ntral in ciso 1· (7th yea 1·)

Central in cisor (6- 9 mo nth s)

In cisive fossa Palatin e process of max ill a Ho ri zonta l pl ate of pa latin e bon e

G re ater and lesse r palatine fo ra min a Upper permanent teeth

PLATE SO

Lower permanent teeth

HEAD AND NECK

Teeth (continued)

Enamel (substa nti a adam antina) D entin e and dentin al tubul es (substantia eburnea) Crown

- --M- - - - - I n terglob ul ar spaces

_ _1.- t---- - - - Odo ntoblast layer - . f _ - = - - - - - l n terproximal spaces D ental p ulp co ntaining vessels and nerves G in gival (gum) ep ith elium (stratified)

Neck

Ep itheli al attachment Lamin a prop ri a of gingi va (gum) (mandibu lar or m ax ill ary perios te um ) Peri odontium (a lveolar pe ri os teum ) Papill a Cem ent (ce mentum )

Root

Root (ce ntral ) ca nals co ntainin g vesse ls and nerves Bo ne Ap ica l fo ramina

. \ !,,~ ~

©JfiiN :·,-.·,·;::

Left upp er perm anent teeth: labiobuccal view

Left lower permanent tee th: labiobuccal view

nr~···i I

g

\t Ce ntral

\]

t1 ~

Lateral

~ In ciso rs

ORAL REGION

Ca nin es (c usp ids )

1 2 ~ Premo lars

Mo lars

PLATE 51

Tongue

M edi an glossoepi glottic fold :;!;-_!!~..------L a t e r a l

glossoepiglotti c fold

Palatopharyngea l arch and mu scl e Pa latine ton sil (c u t) Lingual ton sil (li ngual nodul es)

Root

Palatoglossal arch and muscl e (cut) 7:iitlr- - - - - F o ramen cecum

J-----

Foli ate papi ll ae

>----Filiform papi ll ae Body - - - - - Fungifo rm papi lla - - - - - Mid line groove (m edian sulcus)

Dorsum of tongue

Lin gual to nsil

©IIDN '.·.·,".' : : ~

In trin sic muscl e

Duct of gland

Stratifi ed squamous

Lamin a propria

Crypt Lymph fol licles

Lingual gland s (serous gland s of von Ebn er)

Schematic ste reogram: area indicated above Section of taste bud

PLAT£ 52

HEAD AND NECK

Tongue (continued) SEE ALSO PLATES 29, 47, 47, 722 Pal atopharynge us mu scle Palatoglossus muscl Inferi o r lo ngitudin al muscle of

M as toid pro cess Di gas tri c muscle (posterio r bell y) (cut)

Supe rior ph aryngea l co nstrictor mu scle Stylo hyoid li gam ent Styloglossus mu scle G lossophar yngea l pa rt of superio r pha ryngeal constrictor Sty lop haryn ge us muscle Sty lohyoid mu scle Middl e pharyngea l co nstrictor mu scle D igastric muscl e (poste rior belly) (cut) Hyoglossus muscl e Geni ogloss us mu scle

Interm ed iate tendo n of di gastri c muscle (cut)

M ylohyoid muscle (c ut)

I'

brous loop for intermediate di gastri c te nd on Hyo id bo ne

Geni ohyoid mu scle

©II!!N ·:.·;! ~·.

Lin gual nerve

~

Superior pharyngeal constri cto r muscle

Subm andibu lar Dee p li ngua l artery and venae co mitantes

Artery to fre nu

Subm andibu lar duct Common trunk for fac ial, retromand ibul ar and lin gual veins Sub lin gual artery and ve in

Suprahyo id arte ry

Geni o hyo id muscl e

rsa llingu al artery and vein Hypoglossaln

ORAL REGION

Lin gua l ve in

Vena comitans of hypoglossal nerve

PLATE 53

Tongue and Salivary Glands: Sections

Horizontal section below lingula of mandible (superior view) demonstrating bed of parotid gland

Orbicularis oris muscle Buccinator muscle Buccopharyngeal fascia Facial artery and vein Pterygomandibular raphe

Lingual nerve and superior pharyngeal constrictor muscle

Palatoglossus muscle in palatoglossal arch

Palatopharyngeus muscle in palatopharyngeal arch Ramus of mandible Inferior alveolar artery, vein and nerve Medial pterygoid muscle Styloglossus muscl

Retromandibular vein External carotid artery Parotid gland Stylopharyngeus muscle Stylohyoid muscle Sternocleidomastoid muscle ---~"' Digastric muscle (posterior belly) - - --r-T Internal jugular vein, internal carotid artery and nerves IX, X and XII in carotid sheath Superior cervical sympathetic ganglion

Buccopharyngeal fascia and retropharyngeal space

l

Superior longitudinal muscle Vertical and transverse muscles of tongue Inferior longitudinal muscle Styloglossus muscle Buccinator muscle Muscles of facial expression Hyoglossus muscle Genioglossus muscle Sublingual salivary gland Submandibular duct Mandibular canal, inferior alveolar artery, vein and nerve Lingual nerve :.Ji.l:..---'--- Nerve to mylohyoid ..J..----Vena comitans of hypoglossal nerve (to lingual vein) 4~~--Lingual artery !/lit-,-,,----Facial artery ~§ii~~£=~ Hypoglossal nerve (XII) Submandibular salivary gland Submandibular lymph node Frontal section Mylohyoid muscle behind 1st molar tooth Facial vein (anterior view) Intermediate digastric tendon demonstrating Platysma muscle Hyoid bone

PLATE 54

beds of sublingual and submandibular glands

HEAD AND NECK

Salivary Glands SEE ALSO PLATES 79, 47, 727, 728, 753 Superfi cial temporal artery and vein and auri culotemporal nerv e Branches of faci al nerv e Transve rse facial a

Buccinator mu scle (cut) M assete r muscl e Lingual Subm andibular gangli on

Frenulum of ton gue Sublin gual fo ld w ith op enin gs of sublin gual ducts------+.;~~~ Sub lin gual ca runcle w ith opening of submand ibul ar duct------1'"11/i'f:~~j Sublingual gland Submand ibular du ct Stylohyoid muscle Sublingual artery and vein Sterno cleidomasto id mu scle

M ylohyo id mu scle (cu

Common trunk recei vin g facial, retrom and ibular and lin gual vei ns Submandib~d a r gland

Parotid gland: totally serous

ORAL REGION

Hyo id bone

Subm andibular gland: mostly serous, partially mu co us

PLAT£ 55

Afferent Innervation of Mouth and Pharynx SEEALSOPLATES4t46,53,58, 776,777,779,727,729

=====

Trigeminal nerve (V) Trigeminal (V) (maxillary V2) Via superior alveolar Glossopharyngeal nerve (IX) ~/~ nerves Vagus nerve (X) Via pterygopalatine ganglion and greater Facial nerve (VII) and lesser palatine

'l"'///.r:;:.

Facial (VII) (intermediate nerve) Via greater petrosal nerve, pterygopalatine ganglion and greater and lesser palatine nerves

Glossopharyngeal (IX) pharyngeal plexus tonsillar branches ste plus general sensation via lingual branches Trigeminal (V) (maxillary V2) a pharyngeal branch of pterygopalatine ganglion

Via greater petrosal nerve and pterygopalatine ganglion

Vagus(X) Via internal branch of superior laryngeal nerve

Glossopharyngeal (IX) Via pharyngeal plexus Via tonsillar branches Taste plus general sensation via lingual branches

Trigeminal (V) (maxillary V2) ~-,--...-7--';;t"--

Vi a pte ry gopalatine ganglion and greater and lesser palatine

Vagus(X)and glossopharyngeal (IX) Via pharyngeal plexus--Vagus (X) Via internal branch of

PLATE 56

HEAD AND NECK

Pharynx: Median Section

Ph aryngea l o penin g o f pharyngo tympani c (a uditory) tub e Sphenooccipital syn chondrosis Ph aryngeal ton sil Ph aryngeal tub ercle of occipital bo ne Ph aryngeal raphe nterior lon gitudinal li ga ment nterior atl antooccipitalmembrane Api ca l ligam ent of dens Anterior arch of atl as (C1 ve rtebra) D ens of ax is (C2 vertebra) Ph aryngea l constrictor mu scle s

Lingu al ~~t.ti-'-'-----

Root o f

Buccoph aryngeal fascia Retropharyn gea l space Prevertebral fascia and anterior longitudinal li ga ment

Ge niohyoid mu scle _ ____.._ :iiia.:Hyoid bone --__::::--:ii':'~::-­ Hyoepi glo tti c ligam ent Thyrohyoid mem brane

Vertebral bodies

Laryngoph arynx Lar yngea l inlet (aditus)

Transve rse aryteno id muscl e

Esoph agea l muscles Th yroid gland Inves ting layer of (deep) cervical fascia

Supraste rnal space M anubrium of sternum --~11-m

©Jfi!N ·:.·.·: : ~~

PHARYNX

PLATE 57

Fauces Medial view Median (sagittal) section

Torus tubarius Pharyngeal tubercle (basilar part of occipital bone) Pharyngeal raphe Pharyngeal opening of pharyngotympanic (auditory) tube Hard palate Pharyngeal recess Salpingopharyngeal fold Soft palate Palatine glands Uvula Semilunar fold J..I-:;,J-1.-~,P.,..-tff,ft--Supratonsillar fossa = ---!f-1r;--- Palatine tonsil .!,.
__

'lf'-'=~:=;,r-\lli--Tongue (drawn forward and downward) 1€"--'------ Lingual tonsil :___---Epiglottis Vallecula

Pharyngeal mucosa removed Cartilaginous part of pharyngotympanic (auditory) tube-~i$::~.~~....,.,:~. Medial pterygoid plate Tensor veli palatini muscle and tendon Levator veli palatini muscle Ascending palatine artery Pharyngeal branch of ascending pharyngeal artery Lesser palatine artery Salpingopharyngeus muscle - -f-...-..;....,.;.....,.__ Pterygoid hamulus _ .J-..:......;II;.=:;:---,Pterygomandibular raph e -~----­ Tonsillar branch of lesser palatine artery Superior pharyngeal constrictor muscle Tonsillar branch of ascending pharyngeal artery Palatoglossus muscle Palatopharyngeus muscle Tonsillar branch of ascending palatine artery Tonsillar branch of facial artery Tonsillar branch of dorsal lingual artery Glossopharyngeal nerve (IX) and tonsillar branch Stylohyoid ligament Hyoglossus muscle Middle pharyngeal constrictor muscle Stylopharyngeus muscle

PLAT£ 58

HEAD AND NECK

Muscles of Pharynx: Median (Sagittal) Section ------ --· -· ---~----·---

M edial pterygoid plate Ca rtila gin o us part of ph aryn gotympani c (aud itory) tub e Tensor ve li palatini mu scl e Pharyngobas il ar fa sc ia Levator ve li palatini mu scl e Palatine apo neurosis and tend o n of tenso r vel i pa latini muscl e ~- -J:.,i-:-->t"'\--Ph ar y ngeal

tubercl e (basil ar part of occipital bon e)

terior lon gitud inal li gament terior atl antoocc ipitalmembrane ica lli ga ment of dens Salp in go ph arynge us muscl e Muscles of so ft palate Palatopharyngea l sphincter (Passavant's rid ge) Pterygoid hamu lus

~tlttr;;ift~~H~M-- superior ph aryngea l constricto r muscl e Pterygom andibul ar raph e Palatopharyn ge us mu scl e Buccin ator mu scl e + == = =4+-- c l ossoph aryn gea l part of superior ph aryngea l co nstri ctor Stylopharyngeus mu scl e Styloh yo id li ga ment Stylo glossus mu scl e Midd le phary ngea l co nstri ctor muscle '\,-;So;"""'P ,..:..-jH---t-i bers to ph aryngoe pi glo ttic fold :J~:;:~:,~~e.,;"--++---Bu ccoph a ryn gea l

fascia and retroph aryn gea l space

yo glossus mu scl e G enioh yoid mu scl e M yloh yoid mu scl e Hyoid bone Th yrohyoid membrane M edian cri co thyro id li ga ment Com iculate and arytenoid carti lages

Prevertebral fascia and anterior longitudin al li ga ment Intern al branch o f superior laryngeal nerve Lon gitudin al ph aryngea l muscles nferior ph aryngea l con strictor muscl e Pharyngea l apo neurosis 1.--.'~~~:':------\i\ic--Cri c oph a r y n ge u s mu scle

(part o f inferio r ph aryngeal con stri ctor) Cricoid attachm ent of lo ngitudin al esop hagea l mu scl e Circul ar eso ph ageal muscle Lon gitudin al esophageal muscl e

.................. M argins of middl e pha ry ngeal constri cto r mu scl e

,.,

'~-, :· ©J@N ;•. ·:.·.· ~ :

PHARYNX

- - - - - - - - - M argin s and attachments of in fe rio r ph aryngea l co nstrictor muscl e

PLATE 59

Pharynx: Opened Posterior View

Base of skull (basilar part of occipital bone) haryngeal tonsil

ru s tu bari us ~~~r--Pharyngeal ope ning

Nasopharynx

of pharyngotympanic (auditory) tube

orus levatorius (fold caused by levato r veli palatini muscle) Salpingopharyngeal fold Angle of mandible Submandibular gland

Oropharynx

Prominence caused by greater horn of hyoid bone Laryngeal inlet (aditus) Prominence caused by superior horn of thyroid cartilage Laryngopharynx

iglottic fold Cuneiform tubercle Fold over internal branch of superior laryngeal nerve Corniculate tubercle lnterarytenoid notch Prominence over lamina of cricoid cartilage

Esophagus

PLAT£60

HEAD AND NECK

Muscles of Pharynx: Partially Opened Posterior View SEE ALSO PLATE 223

Phar yngeal ton sil Cartilaginou s part of pharyngotympani c (a udito ry) tube

Styloid p rocess

Stylo hyo id mu scl e - - - -L:::.--..: Stylopharynge us muscle - - - - ---.:-

.;;.l--tr--Levato r veli palatini muscl e ;--.,..___ Superior pharyngea l co nstri ctor mu scle

Accessory mu scle bund le from petrous pa rt of temporal bone M ed ial pterygo id muscle Pharyn go basilar fascia Ph aryngeal raph e Superi or- pharyngea l constri ctor mu scle

Palatopharyngeu s muscle f"L---Middle phar-yngeal co nstri ctor mu scle Stylop haryngeus mu scl e Pharyngoepiglottic fold A ryepi glo tti c fold

H yo id bone (tip of grea ter horn) M idd le pharyngeal co nstri ctor muscle

Inferior- phar yngeal co nstri ctor muscl e (cut edge) Longitud in al pharyngeal muscl es

Infer io r ph aryngeal constri ctor muscl e Cun eiform tubercle

Supe ri o r horn of thyro id ca r-tilage Thyrohyo id membrane Interna l branch of superi o r laryngea l nerve Ph aryngeal aponeurosis

Posterior cricoa ryteno id mu scle Cri cop haryngea lmu scle (part of inferior ph aryn gea l co nstri cto r) Lon gitudin al esop hageal muscle

Cricopharyngeus mu scle (part of inferior pharyngea l co nstrictor) Posteri o r bo rder of thyro id ca rtilage lamin a Cricoid attachment of lo ngitudin al esophageal mu scle Circul ar esophagea l muscle

PHARYNX

PLAT£61

Muscles of Pharynx: Lateral View ·----·-~-----------------·

Ph ary ngobasil ar fasc ia Te nso r veli palatini muscle Leva tor ve li pa latini muscle Late ral pterygoid plate

Ptery go id ha mu lu s Buccinator muscle (cut)

Pterygomandibu lar raph e

tylo id process Superio r pharyngea l constri ctor mu scle Styloglossus mu scle

Ob li qu e line of mand ible

Stylohyo id li gament Stylopharyngeus muscle Middl e pharyn gea l co nstri ctor muscl e Hyoglossus mu scl e Greater horn of hyo id bon e

Di gastri c mu scle (a nterior belly) M ylohyo id muscl e Hyoid bone

Sup eri or horn of thyroid carti lage Th yrohyo id membrane Inferior pharyngea l co nstri ctor muscl e

Stylo hyo id mu scle (cut) Zo ne of spa rse mu scle fibers Med ian crico thyroid li ga men

Cri coph aryngeus muscle (pa rt of inferior pharyngea l co nstrictor)

Cricoth yroid muscle Cri co id ca rtila ge

PLAT£62

HEAD AND NECK

Arteries of Oral and Pharyngeal Regions SEE ALSO PLATES 29, 35

From { Supraorbital arter ophthalmic artery Supratrochlear arte Middle meningeal

Superficial temporal artery Maxillary at-tery Posterior auricular artery Ascending pharyngeal artery

Glossopharyngeal nerve (IX) Mental branch of inferior alveolar a

Ascending palatine artery

Inferior alveolar artery and lingual branch Ascending pharyngeal artery Internal carotid at-tery Mylohyoid branch of inferior alveolar artery

Vagus nerve (X)

Submandibular gland Hypoglossal nerve (XII) terior scalene muscle

Superior laryngeal Superior thyroid

Middle scalene muscle Ascending cet-vical artery Inferior thyroid artery nsverse cervical artery

Common carotid

Subclavian artery

PHARYNX

Thyrocervical trunk

PLAT£63

Veins of Oral and Pharyngeal Regions SEE ALSO PLATES 10 26, 98

Supra tr ochl ea r vei n Sup raorbi ta l ve in ----:ifi---''11 Nasofrontal vein ----J'IH\1'0 Superior ophthalmi c vein Angul ar vein Extern al nasal vein ----T-~'ftll Emissary vein (Vesa liu s) --~~aitt=-::~~::__ commu ni cating w ith caverno us sinu s

Occipital vein and artery Supe rfi cial te mporal vein and arte ry

Pterygo id plexus Superior labial vein

Transverse facial vein (cut)

Dee p facial ve in Retrom andibular vein

Maxillary veins

Extern al jugular vei n (cut)

Inferior labial vein Mental ve in Facial vein and artery

Hypoglossal nerve (X II )

Exte rn al palatin e vein Subm ental ve in Submandibular gland

Com mon trunk for facial, retromandibular and lin gua l veins

Ven a com itan s of hypoglossal nerve Dorsal lingua l vein coursing medial to hyoglossus muscle

mmon caroti d artery

Lin gual ve in Communication to anteri or jugular vein (cut) idd le sca lene muscle Anteri or sca lene muscle External ju gular vein (cut) Middle th yro id vein Infer io r th yroid vei ns Termination of anterior ju gul ar vein (cut) Left bra chi ocephali c vein

PLAT£64

Suprascap ular vein (cut) ~ "··~- ~ subclav i an

artery

..;..,11~----ilr-- S u bclav i a n

ve in

HEAD AND NECK

Nerves of Oral and Pharyngeal Regions SEE ALSO PLATES 79, 40, 47, 776, 7 79, 720 Zygomaticotemporal nerve (V2l Deep temporal nerves (V3) Masseteric nerve (V3) Mandibular nerve (V3) Nerve to medial pterygoid and tensor veli palatini muscles (V3) (cut) Zygomaticofacial nerve (V2) Maxillary nerve (V2) Infraorbital nerve (V2) Pterygopalatine ganglion--w.-;::..,...__ Greater and lesser palatine nerves (V2l - - ---!Jr-<-""717 Auriculotemporal nerve (V3)

Anterior, middle and posterior superior alveolar nerves (V2)

Middle meningeal artery

Nerve to lateral pterygoid muscle (V3) (cut)----=-<

Superficial temporal arte1·y (cut)

Buccal nerve (V3)

Facial nerve (VII) (cut)

Chorda tympani nerve (VII) Lingual nerve (V3)

Accessory nerve (XI) (cut)

Medial pterygoid muscle (cut) (lateral pterygoid removed)

Cl spinal nerve (ventral ramus) (cut) 2 spinalne1·ve (ventral ramus) (cut)

Pharyngeal plexus composed of branches from glossopharyngeal (IX), vagus (X) and sympathetic

Mental nerve (V3) Nerve to mylohyoid (V3) Submandibular ganglion Glossopharyngeal nerve (IX) and tonsillar branch _ _ ____/ Hypoglossal nerve (XII) Carotid nerve (IX) and carotid body Nerve to thyrohyoid muscle (Cl, 2 via XII) Internal and external branches of superior laryngeal nerve (X) . 1.IS (Cl , , ) { Superior root A nsa cerv1ca 2 3 Inferior root

gus nerve (X) and superior cervical cardiac branch C4 spinal nerve (ventral ramus) (cut) Phrenic nerve (C3, 4, 5)

or scalene muscle

Nerves to superior and inferior bellies of omohyoid, sternohyoid and sternothyroid muscles (ansa cervicalis) Recurrent laryngeal nerve (X)

Common carotid arrPrv-Vertebral artery---

Subclavian artery

PHARYNX

PLAT£65

Lymph Vessels and Nodes of Head and Neck SEE ALSO PLATE 79 7

(r.~P ©II§N •. ~ ·.~:.·: :

Superficial parotid nodes (deep parotid nodes deep to and within parotid gland)

Facial nod es Nasolabial - - - - - - ::-'1

Sternocleidomastoid nodes Submandibular nodes-----~;,

Superio1· latera l superfi cial ce rvi ca l (ex tern al ju gular) node )ugulodi gastric node

Submental n o de s ---~~~

Superior deep lateral cervical (intern al jugul ar) nodes Superior thyroid nodes

Posteri o r latera l superfi cial ce rvica l (s pin al accessory) nodes

Interca lated nod e Inferior deep lateral cervical (scalene) node

)u gul oomo hyo id node Th o racic duct Anterior deep ce rvical (pretracheal and thyroid) nodes (deep to infrahyoid mu scles)

Anteri or superfi cial ce rvi ca l nod es (ante rior ju gu lar n

Transverse ce rvical chain of nodes

Supraclavicular nodes Subclavi an trunk and node

PLAT£66

HEAD AND NECK

Lymph Vessels and Nodes of Pharynx and Tongue

Ph aryngobas il ar fascia Retroph aryngea ln odes Intern al ju gul ar ve in Di gastri c mu scl e (pos teri o r belly) Sternocl eido masto id mu scl e

ju gul od igastric nod e

Deep lateral ce rvica l (intern al ju gular) nodes ju gul oomoh yoid node

Api ca l coll ectin g vessels ntral co ll ec tin g vesse ls M argin al co ll ectin g vessels

Lymphatic drainage of pharynx: posterior view

Lymphatic drainage of tongue

Submental nod e Submandi bular node )ugul odi gastri c nod Deep late ral ce rvica l (intern al ju gul ar) nodes - - -

PHARYNX

PLAT£67

Thyroid Gland: Anterior View

Thyroh yo id membran e { Superior ro ot A nsa ce rvicali s . Inferi o r root

l

Cricoth yro id muscles

Co mmo n ca rotid arte Pyramidallobe (o ften absent o r small) Right lobe Left lobe Isthmu s

Middle thyroid vein Inferi or th yro id vein s

Th yroid gland

Asce ndin g ce rvical artery Pretracheal lymp h nodes Phrenic nerve A nteri o r scalene muscle Vagus nerv e (X) Th yrocervical trunk Subclavian artery and ve in

Anterior ju gul ar ve in 1st rib (cut)

Right recurrent laryn gea l nerve Brachiocephal ic trunk Brachiocephalic ve in s Superior vena cava Aortic arch

Th yroid ca rtil age Cricothyro id ligamen t Com mon ca rotid arte ry

Tra

PLAT£68

HEAD AND NECK

Thyroid Gland and Pharynx: Posterior View

Superior pharyngeal constrictor muscle Middle pharyngeal constrictor muscle -

External carotid arte1-y Internal carotid artery -1-----'-4.!

Facial artery Tip of greater horn of hyoid bone---+ --+

Lingual artery

=--- -

Superior laryngeal nerve Internal branch External branch Superior thyroid artery Superior laryngeal artery

Cricopharyngeus muscle (part of inferior pharyngeal constrictor) Circular esophageal muscle in V-shaped area of sparse longitudinal muscle fibers (area of Lairner) Longitudinal esophageal muscle

Cornrnon carotid artery Vagus nerve (X) Internal jugular vein

Superior parathyroid gland nding cervical artery Inferior parathyroid gland il----lnferior thyroid artery

Inferior bulb of internal jugular vein

Right recurrent laryngeal nerve

Vertebral al-tery Left subclavian artery and vein

,-ascapular artery Thyrocervical trunk

Internal thoracic artery and vein Left brachiocephalic vein Left recurrent laryngeal nerve

Right subclavian artery and vein Right brachiocephalic vein Brachiocephalic trunk Right vagus nerve (X)

THYROID GLAND AND LARYNX

PLAT£69

Parathyroid Glands SEE ALSO PLATE 74

Posterior view

External ca rotid artery Intern al ca rotid arte1·y

Superi o r laryngeal Intern al branch Extern al branch

Superi or th yroid artery

Inferi o r pharyn gea l co nstri ctor mu scle (cut) Common ca rotid artery Superior thy roid artery

Fibrou s capsul e of thyroid gland (cut) - ---7-f-!-M I-

Fibrou s ca psule of thyroid gland (cut) Cricopharynge us mu scl e (part of inferior ph aryngeal constrictor) Sup erior parathyroid gland

Superior parathyroid gland Right lobe of th yroid gland

Ascending ce rvical artery

Inferior parath yroid gland (may be more ca ud ally loca ted, even within mediastinum )

ecu rrent laryngea l nerve Recurr ent laryngeal nerv e

Th yrocervical trunk Subclavian

Vertebral arter y

Brachi ocep hali c trun k

Right lateral view Extern al ca rotid a Superior laryngea l Superior th yroid artery (

Internal bran ch of superio r laryngea l nerve Extern al bran ch of superior laryngea l nerve

Inferi or ph aryngeal co nstrictor muscl e Th yroid gland (right lobe) (retracted anteriorly) Inferior thyroid arte ry

PLAT£70

Inferior parathyroid gland

HEAD AND NECK

Cartilages of Larynx

~------Cricoid

cartilage------

Trachea

Anterior view

Cricoid cartilage

Posterior view

~~'~j~~~~:~i~urface

Corniculate cartilage

l

Muscular process } Arytenoid Vocal process cartilage

Lamina

Arch -------~ Anterosuperior view

Med1an }

Vocal p1o

Late1 al

Vocalligamen

\

~1yroepiglottic liga

Cricothy1 01d ligament

Right lateral view

THYROID GLAND AND LARYNX

Trachea

Medial view, median (sagittal) section

PLATE 71

Intrinsic Muscles of Larynx

Foramen for supe rior laryn gea l vesse ls and in te rn al bran ch of supe rior laryngea l nerve

Ob li que and transverse arytenoid mu scles Posterio r cricoarytenoid mu scle

l )

Posterior crico'ar ytenoid muscle

Cricoth yro id muscl e

Cricoid cartil age

Right lateral view

Posterior view

A ryepiglo ttic muscle Obliqu e and tra nsverse aryteno id muscles

Thyroep iglottic mu scle Thyroaryten o id muscle

Aryteno id ) Muscular process ca rtil age

{ Vo ca l process

Lateral cri coa rytenoid muscle Thyroid articu lar s urface ------.Q:!~

Conus elasticus

Cricothyroid mu scle (cut awa y)

Lateral dissection Posterior cri coaryteno id muscl Late ral cri coarytenoid muscle Transverse and ob liqu e aryteno id muscles Cri co th yroid mu scle Th yroarytenoid muscl e Vocalis mu scle

Lam in a of th yroid ca rtil age

Vocal li game nt

Superior view

PLAT£72

HEAD AND NECK

Action of Intrinsic Muscles of Larynx

Action of cricothyroid muscles Length enin g (in creasing ten sio n) of voca l ligaments

Action of posterior cricoarytenoid muscles

Action of lateral cricoarytenoid muscles

Abduction of voca l li ga ments

Adducti o n o f voca l li ga ments

--

Action of transverse arytenoid muscle

Action of vocal is and thyroarytenoid muscles

Addu ction of voca l li ga ments

Shortening (relaxa ti on) o f vocal ligaments

------~-~---------

THYROID GLAND AND LARYNX

PLATE 73

Nerves of Larynx SEE ALSO PLATES 68, 69, 70, 223

~~~-:-::-------Superior laryngeal nerv e

Intern al bran ch External branch

In terna l branch of sup eri o r laryngea l nerve Senso ry branches to larynx Ansa of Ga len Aryep iglottic muscle Th yroep iglo ttic muscle

Inferior phar yngea l constri ctor mu scl e

Tr ansve rse and oblique aryte no id mu scles Th yroaryteno id muscl e Vo ca li s muscle

Cri cothyroid muscl e Cricop haryngeus mu scl e (pa rt of inferior ph aryngea l co nstri ctor) Recurrent laryngea l nerve

Latera l cricoa rytenoid muscl e Posterio r cricoa rytenoid muscl e Th yroid arti c ular surfa ce A nterior and posterior branches of in fe ri or laryngea l nerve

Right lateral view: thyroid cartilage lamina removed

Right lateral view

;;;-- - - Left vagus nerve (X) Right vagus nerve (X)

Anoma lo us ri ght inferi o r laryng ea l nerve (not rec urrent)

Anomalo us (re tmesophageal) ri ght subcl avian artery -----,Q~ Left subclavian artery Ri ght co mmon carotid arte ry

Anoma lo us (retroesophageal ) ri ght subcl avian artery originatin g from left sid e of ao rtic arch

.p,_- - - - Left recurrent laryngea l nerve

Anterior view: anomalous right inferior laryngeal nerve, not recurrent, associated with anomalous right subclavian artery

PLATE 74

HEAD AND NECK

Inspection of Larynx

Positi on o f pa tient and ph ys ician

M irror w armed over alco hol flame to prevent fogg in g, th en tes ted on back o f physician's hand

M irro r elevates uvula

Roo t o f to ngue (lin gual to nsil )

M edian glossaepi glo ttic fo ld Vall ec ula- --.. Vocal folds (true voca I co rds) --;----:r-~:::._.J:---I

Vestibul ar folds (false voca l cords) Ves tibu le A t·yep iglo ttic fo ld

Cun eifo rm tub ercle

lnterarytenoid notch

o rni cu late tub ercle

N ormal larynx: in spiration

THYROID GLAND AND LARYNX

Normal larynx: phonation

PLATE 75

Eyelids Superior palpebral conjun cti va: tarsal (me ibom ian) glands shinin g throu gh

Superior lacrimal papil la and punctum Pli ca semilunaris

Seen th rough { Pupi l co rn ea Iri s

Lacrima l carnucl e in lacrim al lake (lacus lacrim alis )

Corneoscleral jun ctio n (co rn ea l limbus)---------~

Infer io r lacrim al pap ill a and pun ctum Bulbar co njun ctiva over sclera _ _ __.Inferi o r co njunctiva l forn ix Inferi or palpebral co njunctiva: tarsa l glands shinin g through

Levato r palpebrae superioris mu scle Orb ital septum Superior tarsa l (Mu ll er's) muscle (smooth ) Superi o r conjunctiva l forni x O rbicu laris ocu li muscle (palpeb ral part)

Palpeb ral conjun ctiva

Tarsa l (me ibomi an) glan ds Sebaceous glands Eyelas hes (cili a) Ope nings o f tarsa l glands

O rbi cu laris oculi muscle (pa lpebral part) Inferior co njun ctival forni x Orb ital septum

Fronta l bone -----------In se rtion of leva tor palpebrae superiori s muscle Supraorbital artery and nerve Supratroch lea!' artery and nerve Lateral palpebral li gam ent and overlyin g rap he - - - - - - - ';it;,...--;

Dorsa l nasal artery and infratro chl ea r nerve Lacrimal sac M edia l palpebral li ga ment M ax ill a (frontal process)

Zy go matic bon e

PLATE 76

-"----!---In frao rbital arte ry and nerve

HEAD AND NECK

Lacrimal Apparatus SEE A LSO PL ATES 40, 727

Superior lacrim al pap illa and punc tum O rbita l part of lacrimal gland Lacrimal ca nali culi

Lacrimal sac

Excretor y du cts of lacrimal gland

Nasolacrim al duct

~--- Op e nin g

of naso lacrim al duct

Lacrima l ca runcl e

Inferi o r lacrim al pap ill a and punctum J~

i

Supe ri or lacrim al pap ill a and pun ctum Frontal bo ne (cu t away) Lacrim al ca nali culi

Lacrim al sac Palp eb ral pa rt of lacrima l gland - - - - - ---tiTI-)(1:": Nasolac rim al du ct

Pli ca se milun aris andl acrim all ake

In fe rior lacrim al papil la and pun ctum

Openin g of nasolacrimal du ct

ORBIT AND CONTENTS

Inferior na sa l meatu s

PLAT£77

Fascia of Orbit and Eyeball

Hori zo ntal section

Tarsus of eye lid Pa lp eb ral conjun ctiva

M edial pa lpebral li gament

Check li ga ment of medial rectus muscl e ----;§i~IU

Latera l pa lpebra l li gament

~~"-...

Check ligament of lateral rectus muscle

Ethmo idal ce ll s- - - - ;

Peri orb ita Sclera

Med ial rectus muscl e and fasc ial sheath

Fascial sheath of eyeba ll (Tenon's capsu le)

Fascial shea th of eyeba ll (Tenon's capsu l e) ---~

Ep iscle ral space Lateral rectus m uscle and fascial sheath Retrobu lbar fat (orb ital fat body)

Optic nerve (II ) and o uter shea th _ _ __..-Spheno idal sinus Levator palpebra e superi oris muscle and fasci al sheath

Frontal section

Superior oblique mu scle and fascial sheath

Superior rectus muscle and fascial s h eath------'14j~tf~/~~~~~l

Medial rectus muscle an d fascial sheath

Ethmoidal ce ll Lateral rec tus muscl e and fasc ial sheath ------+-~1t':-lh=ili'!J1i

Sclera illJt:IIJ.----Fasc ial sheath of eyeball (Tenon's caps ule) r-;;:~~~~-ffir----ln fe ri or rectus muscl e

and fascial sheath In fer ior obl ique muscle and fascia l shea th

Episcleral Retrobu lbar fat (orbital fat body

In fraorbita l nerve (V2 )

Muscle attachments and nerves and vessels entering orbit Superior orbital fissure Lacrim al nerve (V 1 )

Leva tor palpebrae superio ri s muscle Superior obliq ue muscle ~-.,-----Sup er i or

Trochl ear nerve (IV) Supe ri or ophtha lmic vein

rectus muscle

m - - - - Med ial rectus muscle Optic nerve (II )

}

Ophthalmic artery

Lateral rectu s Superior branch of ocu lomotor nerve (Ill ) In ferior orbital fissure Abduce nt nerve (V I)

in optic canal

Infe ri or rectus mu scle Infe rior branch of ocu lomotor nerve (Ill ) Nasoci li ary nerve (V 1 )

-----,~-,~------------

PLAT£78

HEAD AND NECK

Extrinsic Eye Muscles

Right lateral view

Superior oblique muscle Levator palpebrae superioris muscle

Trochlea (pulley)

Superior rectus muscle Medial rectus muscle Lateral rectus muscle (cut) Common tendinous ring

Lateral rectus muscle (cut)

Inferior rectus muscle

Superior view ' ~··· --Levator

palpebrae superioris muscle (cut)

Inferior rectus muscle

Superior rectus muscle (cut)

Levator palpebrae superioris muscle (cut)

Innervation and action of extrinsic eye muscles: anterior view Levator palpebrae superioris muscle

Oculomotor nerve (Ill)

Abducent Lateral rectus muscle { nerve (VI) Medial rectus muscle Inferior rectus muscle Inferior oblique muscle

ORBIT AND CONTENTS

Note: Arrows indicate direction of eye movement produced by each muscle

PLAT£79

Arteries and Veins of Orbit and Eyelids SEE ALSO PLATES 70 98 Med ial palpebral artery

Superior vi ew

Lateral palp eb ral art ery

Anterior m enin geal artery Zygoma ti c branches Ante ri o r ethmoidal artery Posterio r cili ary arteries Poste ri o r ethm oidal arte ry

Ce ntral retinal artery

Suprao rbital artery Supratro chl ea r artery Dorsa l nasal art ery

Anterior view Supe ri or medial pa lpeb ral ar tery Frontal branch of superficial temporal artery Superio r latera l pa lpebral arte

=-D;LJ-+--+.---In feri or medial pa lpeb ral artery Superior and infe ri or pa lpeb ral arterial arches

Transverse fac ial In fraorbita l artery

Lateral view

Supraorb ital vein Superior ophtha lmi c vein

(X= anastomosis of vesse ls from externa l and internal carotid arteries)

Nasofronta l vein Angular ve in

Cavernous sinus Facia l vein In fe ri or op hth almi c ve in Pterygo id p lexus - - --,,f;(F-, Max ill ary vei

PLAT£80

HEAD AND NECK

Nerves of Orbit SEE ALSO PLATES 40, 775, 726

Superior view

Media l bra nch } Suprao rbital nerve Latera l bra nch Leva tor palp ebrae superioris muscle

Supratroch lear nerve

Superi or rectus muscl e

Medial rectus mu scle

Lateral rectus mu scle Frontal nerve Trochlear nerv e (IV)

Maxillary nerv e (Vz)

Common tendinous rin g

Men in geal branch of maxillary nerve

Ophthalmi c nerve (V,)

Mandibu lar nerve (V3) Lesse r petro sa l nerve In terna l carotid artery and nerve plexu s- - - -----llf::=-

Men in gea l branch of mandibular nerve Greate r petrosal nerve Trigeminal (se milun ar) gangli on l· J~~r.::::=-~.-2....,.------Tentor i a ln erve

'-

(meningeal) bran ch of ophthalmi c nerve

Tentorium cerebel li

Long ciliary nerves

Superior view: levator palpebrae superiori s, superior rectus and superior oblique mu scles partially cut away Supratrochl ear nerve (cut) Supraorb ita l nerve branch es (cut) ln fratrochlear nerve Anterio r ethm oid al ne rve Optic nerve (I I) Poste ri or ethm o id al nerve Sup eri o r b ranch of ocu lomotor nerve (Ill ) (cut) Nasocili ary nerve Interna l ca rotid plexus---!....:-~~=-r

Short cili ary nerves

Cili ary gangli on Parasympathetic root of cili ary ganglion (from inferi o r branch of ocu lomotor nerve) Sympathetic root of ciliary ga ngli on (from intern al ca rotid plexus)

~~~~::~- Se nsory root of cili ary ganglion (from nasociliary nerve)

f.of;r-~----- Branches to in fer ior and medial rectus muscl es Abducent nerve (V I) In fer ior branch of ocu lomoto r nerve (Ill )

Tr och lea r nerve (IV) (cut) Oculomotor nerve (Ill) _ ___,.;:::,..,...__,-;:.:::

Fronta l nerve (cut) Ophthalmi c nerve (V,)

ORBIT AND CONTENTS

PLAT£81

Eyeball Cornea

Horizontal section Zonular fibers (suspensory ligament of lens) Scleral venous sinus (Sch lemm's cana l)

Capsule of lens Lens Iris

Anterior chamber Posterior chamber lridocorneal angle Ciliary processes

Ciliary body and ciliary muscl Bulbar conjunctiva Ora sen·ata

Tendon of lateral rectus muscl

Tendon of medial rectus muscle

Vitreous body Hyaloid canal

Perichoroidal space

Lamina cribrosa of sclera Fascial sheath of eyeball (Tenon's capsule)

U-- - - - - Central Fovea centralis in macula

retinal artery and vein

Outer sheath of optic nerve Subarachnoid space

PLAT£82

HEAD AND NECK

Anterior and Posterior Chambers of Eye

Schwalbe's I Trabecular meshwo rk and spaces of iridoco rn eal angle (Fo ntana)

Posterior limitin g lamin a (Descemet's membran e) Endo th elium of anteri o r chamber

Scle ral ve nous sinu s (Schl emm's ca t

Pectin ate li ga ment

Bulbar conjun cti va

process M eri diona l fib ers

Circul ar fib ers

Cili ary mu scle

Cili ary body

onul ar fibers (s uspenso ry li gament of lens)

Peri cho roid al space

Pigm ent epith elium (iridi al part of retin a) Sphin cter mu scl e o f pupil

N o te: For cl arity, o nly single pl ane o f zonul ar fi bers shown; actu ally, fib ers surround entire circumference of lens

ORBIT AND CONTENTS

PLATE 83

lridocorneal Angle of Anterior Chamber of Eye

Mirror

Contact lens

Goldmann gonioscopic mirror

Open (normal) iridocorneal angle: gonioscopic view

Scl e ral venous sinus (Schlemm's canalvisible if it contains blooc/)

:-----Line of scleral spur Trabeculae

;-----Pupil

Closed angle: gonioscopic view

PLAT£84

HEAD AND NECK

Lens and Supporting Structures

Optic part of retin a

Orbiculus ciliaris of ci li ary body cove red by ciliary part of retina Ciliary processes Zonular fibers

Posterio r chamber

Eyeball sectioned in frontal plane: anterior segment viewed from behind

Zonular fibe1 s

l Horizontal section

Ora se rrata Optic part

of"""\

Orbiculus ciliaris of ciliary body cove red by cili ary part of retina

I

Zonular fibers fanning out and blending 111to lens capsule Ciliary processes

onula1 fibe1 s Iri s

Lens

~~·-·

Enlargement of segment outlined in top illustration (semischematic)

ORBIT AND CONTENTS

PLAT£85

Intrinsic Arteries and Veins of Eye SEE ALSO PLATE 80 Cornea

Minor arterial circle of iris

Anterior chamber

Major arterial circle of iris Blood vessels of ciliary body

Anterior ciliary artery and vein

Iridocorneal angle----'

Iris

Lens

Posterior chamber

Muscular artery and vein

Zonular fibers 'i:-- - Extrinsic eye muscle

Vitreous chamber

Vorticose vein

Long posterior ciliary artery Short posterior ciliary arteries Central retinal artery and vein

Superior temporal retinal arteriole Optic nerve (II)

Superior macular arteriole and venule Superior nasal retinal arteriole and venule

and venule --~t~Jr-=::~;:S~.;:::~(> Macula and fovea centralis---~-,-1-,---------

Inferior temporal retinal arteriole and venule

Right retinal vessels: ophthalmoscopic view

PLAT£86

Inferior nasal retinal arteriole and venule Inferior macular arteriole and venule

HEAD AND NECK

Pathway of Sound Reception

Frontal section

Facial nerve (V II ) (cut) Limbs of stapes

Base of stapes in ova l (vestibu lar) wi ndow

Prominence of late ral se mi circul ar canal Sem icircul ar du cts, ampu ll ae, utricl e and saccul e Faci al nerve (V II ) (cut) Ves tibular nerve Cochl ear nerve Aur icle In te rn al acousti c

Exte rn al Nasop harynx Tympanic membran e

Sca la vestibu li

Tympanic cavity Pro monto Rou nd (cochlea r) w in dow Pharyngotympanic (a uditory) tu

p

Coch lear du ct con tainin g sp iral organ (Co rti)

Coc hl ea

Sca la tympani Note: Ar rows indi cate co urse o f so und waves

....

j'

©'·~N

EAR

PLATE87

External Ear and Tympanic Cavity

Lon g li mb of in cus

Tri angul ar fossa Crura of antih elix

Anterior mall ear fold

Auricular tubercle (Darwi n)

-""~!*---Later al

process of malleus

Antih elix Umbo

Concha { Cy mba of auricle Cavity Lobule of auricle

Right tympanic membrane (eardrum) viewed through speculum

Right auricle

Ep itympa nic

Chorda tympani nerve

Ma lleus

ng lim b of incu s Stapes in oval (vestibular) w in dow Lateral process of malleu s Tend on of tensor tympan i muscle Handle of malleus Promontory endo n of stapedius muscle

Cartil agin o us ~

sa of round (coch lear) window

Extern al aco ustic mea tu s Tympanic membrane

Levator veli palatini muscl e View into tympanic cavity after removal of tympanic membrane

Coronal oblique section of external acoustic meatus and middle ear

Auditory ossicles Ar ti cular surface for malleus

Long limb

Incus: lateral view

Malleus: lateral view

PLAT£88

Stapes: superolateral view

O ssicles articulated: medial view

HEAD AND NECK

Tympanic Cavity SEEALSOPLATES47, 777,77 8, 729 Lateral wall of tympanic cavity: medial (internal) view rior ligament of malleus Superior li ga ment of in cus

Epitympan ic recess

Shor t limb of incus

Anterior p rocess of ma l

Posterio r mal lear fold

Chorda tympani

Posterior ligament of in cus

A nterior mall ea r fold

Lo ng limb of in cus Te nso r tymp ani mu scl e Chord a tympani nerve

Tympani c memb rane (pars tensa) --------< Ph aryngotympa nic (auditory) tube _ ___...-

'

p~

<

©~.~~

Medial wall of tympanic cavity: lateral view

Promin ence of late ral sem icircu lar canal

Mastoid an trum

win Tenso r tympani muscle (tendo n cut)

Pharyngotympan ic (auditory) tub e Chorda tympan i nerve (cut)

Leva tor veli p alatini mu scl e

Mastoid ce ll s

Tendon of staped ius mu scle Prom o ntory w ith tympa ni c nerve (J acobso n) and plexus under mucosa

Fossa of ro und (cochl ear) w ind

Intern al ca ro tid artery Facial nerve (V II ) in stylomastoid foramen

Tymp ani c ce lls

---·-·-·-------------------

EAR

·----·------·---·· PLAT£89

Bony and Membranous Labyrinths SEE ALSO PLATE 118 Dissected right bony labyrinth (otic capsule): membranous labyrinth removed

Right bony labyrinth (otic capsule), anterolateral view: surrounding cancellous bone removed

terior Lateral Anterior

l

Semicircular canals Anterior Elliptical recess

Common bony limb

Cochlear recess Spherical recess

l~

Vestibule (note perforations for nerve fibers)

Hamulus of spiral lamina Oval (vesti window

Internal opening of vestibular aqueduct (for endolymphatic duct)

Cochlear cupula

Osseous spiral lamina

Round (cochlear) window

Scala tympani

Right membranous labyrinth with nerves: posteromedial view Anterior semicircular duct Superior part of vestibular nerv (from utricle and anterior and lateral membranous ampullae)

Anterior membranous ampulla

Utricle

Lateral membranous ampulla Cochlear duct (basal turn) Common membranous limb Cochlear nerve

Posterior semicircular duct

Vestibulocochlear nerve (VIII)

Posterior membranous ampulla

Saccule Vestibular ganglion

Inferior part of vestibular nerve (fro saccule and posterior memb1·anous ampulla)

PLAT£90

Endolymphatic duct

HEAD AND NECK

Bony and Membranous Labyrinths (continued)

Bony and membranous labyrinths: schema Anterior semicircular ca nal and du ct Pos teri o r se micircular ca nal and duct Endolymphati c du ct in ves tibul ar aquedu ct

Helicotrema of cochl ea

Sta pes in o val (ves tibul ar) window

Scal a ves ti buli

Ro und (cochl ear) window (closed by secondary tymp ani c membrane )

Section through turn of cochlea

I

Osseo us spiral lamina

N erve fib ers

Sca la ves tibuli

~/

Cochlear du ct

M odio lu s o f cochleus

Spiral ga nglion

Pill ar (rod ) cell s Inn er hair ce ll

EAR

PLAT£91

Orientation of Labyrinth in Skull

Superior projection of right bony labyrinth on floor of skull

G roove for greate r petrosal nerve Ge ni culum of fa cial nerv e

Cochl ea

/Plane of anteri o r se mi circul ar ca nal

Cochlear nerve Facial nerv e (VII)

f--__,:.,.,-----'J-f.-t-

Lateral se mi circ ular canal

Petrous part o f temporal bon e

Extern al openin g of ves tibular aquedu ct (fo r endolymphati c du ct)

' 'Plane of posteri o r se micircul ar ca nal

, ___ /

lateral projection of right membranous labyrinth /Auricl e (retracted Geniculum o f fac ial

/

--

Cochl ea r duct

'""' anterio rly)

Cochlea r nerve Trigemin al nerve (V)

~~:==-,._:_:__ _:___ __:__ _ _ _ lnferi or part of Anterior semi circul ar duct

vestibu lar nerve

Lateral semicircul ar duct Cerebe llum Posteri or semicit·cul ar duct Superior petrosa l sinus Si gmoid si nus Conflu ence of sinuses Transverse sinu s

PLAT£92

HEAD AND NECK

Pharyngotympanic (Auditory) Tube SEE ALSO PLATES 46, 49, 59 Cartilaginous part of pharyngotympanic (auditory) tube at base of skull: inferior view Palatin e process of maxilla Pterygoid hamulus and med ial pterygoid plate

H orizonta l p late of palatine bone

Lateral pterygoid plate

Choana of cartil agin ous part of Late rall amin a pharyngotympani c } Media l lam in a (a udito ry) tub e

Foramen lace rum

Spine of sp henoid bon e Occipi ta l co ndyle

In tern al carotid artery enterin g caro tid cana l

Foramen ma gnum

Section through cartilaginous part of pharyngotympanic (auditory) tube, with tube closed

Section through cartilaginous part of pharyngotympanic (auditory) tube, with tube open Tri gemin al ga ngli o n

Tri ge min al ga ngli o n

In terna l ca rotid artery in ca rotid ca nal Dura mater - - - ---=;;o;;;;:::::-..::;;;;;.."'

Leva tor ve li palatini mu scl e - - - - - Salpingop harynge us muscle - - - - - - - -

Sa lpin gop haryngeus muscle - - - - - -"1'fl

Nasopharynx Ph ary ngotymp ani c (auditory) tub e closed by elastic recoil of ca rtilage, tiss ue turgidity and tension of salp in gop haryn ge us mu scles

Lum en opened chiefly w hen attachment of tensor veli pa latini muscle pull s wa ll of tube late rall y durin g swallowi ng

-----------------EAR

PLATE93

Meninges and Diploic Veins SEE ALSO PLATE 77 Coronal dissection

Dipl o ic ve ins Superi or sagittal sinu

Arachno id granulation Cerebral vein penetrates subdural space to enter sinus Dura mater (periostea l and meningea l laye rs) Dura-skul l interface (site of epidural hematom a)

Frontal and parietal tributari es of superfic ial temporal vein

Subarachnoid space

Frontal and pari etal branches of superficial tempora l artery Gran ular foveo la (indentation of sku ll by arachno id granu lation)

D eep, middl e and superficial temporal Mteries and veins

Lateral (venous) lacu Inferior sagitta l sinus

Superio r th alamostriate and choroida l veins, internal ce reb ral veins and cho roid plexus of latera l ventricle _ _ _ _ _ _.../

Diploic and emissary veins of skull

Deep and supe rficial middl e cerebral veins

Pari etal emissary vein

Frontal diploic vein

Occipital diploic vein Mastoid emi ssa ry ve in

PLAT£94

HEAD AND NECK

Meningeal Arteries SEE ALSO PLATES 35, 730

Frontal (anterior) and parietal (posterior) branches of middle meningeal artery

Middle meningeal arte

Anterior meningeal branch of

Arachnoid granulations Opening of superior cerebral vein '----Lateral (venous) lacuna

Superior sagittal sinus

artery

Mastoid branch of occipital artery

Meningeal branches of ascending pharyngeal artery

Mastoid branch of occipital artery Middle meningeal a r t e r y - - - - Recurrent meningeal branch of lacrimal (ophthalmic) artery----._ Accessory meningeal arte

Accessory meningeal Superficial temporal artery--...,.:u Maxillary Occipital a r t e r y - - - - - External carotid artery-----.:;

Anterior and posterior meningeal branches of vertebral artery Tentorial, cavernous sinus and meningeal branches of meningohypophyseal trunk *

*Variant; most commonly, these branches arise directly from internal carotid artery

MENINGES AND BRAIN

PLAT£95

Meninges and Superficial Cerebral Veins FOR DEEP VEINS OF BRAIN SEE PLATE 738 Calvaria Pericranium

Granu lar fov eo la

Galea apo neurotica Skin

Emissary ve in Tributary of superficial temporal vein

Dura-skull interface (site of epidural hematom a)

Arachnoid-du1·a in terface (site of subdural hematoma ) chnoid

Cerebra l artery Superior cerebra l vein Falx cerebri - - - - - - - Cerebral hemi sp here Branches of middle meningeal arte Superior sagittal

Superior ce rebral veins (penetratin g arachnoid and dura mater to enter superior sagittal sinu s)

©U§N ~ ·. ·:.·.· ::

Superficial middle cereb ral vein

Inferior cerebral ve in s (beneath arachno id )

PLAT£96

HEAD AND NECK

Dural Venous Sinuses

Superior sagittal sinus Straight sinus

Sagittal section

Great cerebral vein (Galen) Tentorium cerebelli Superior sagittal sinus

Falx cerebri

Sphenoparietal sinus

Anterior and posterior intercavemous sinuses -;f.~~~iiili!iiiiif!i~1£

Basilar venous pi

Inferior petrosal sinus To jugular foramen

Occipital sinus Falx cerebelli Confluence of sinuses

MENINGES AND BRAIN

PLAT£97

Dural Venous Sinuses (continued) SEE ALSO PL ATE 80 Skull sectioned horizontally: superior view

ypophysis (p ituitary gla nd )

Superior sagittal sinus (cutl---:-= Fal x ce rebri (cut) Superior ophthalmic vein Anterior and posterior intercave rn ous sinuses------

Intern al carotid artery Oculomotor nerve (Ill)

Trochlea r nerve (IV) Ophthalmi c nerve ((VJ)

Superfi cial middle cerebral vein (cut)

Trigeminal ga ngli o n

Basil ar venous 1-l'"' "L' ~ --._; Superior petrosal sin

iddl e meningeal artery du cent nerve (V I)

Inferi o r petrosal sinus Tento rial artery---+m

--'-~~-:tnr-r-- Facial nerve (VII),

interm ed iate nerv e and ves tibul ocochl ea r nerve (V III )

Tento rium cerebelli --=.~.

G lossop haryngea l (IX) an d vagus (X) nerves

Inferio r cerebral vein (c ut)

Sigmo id sinus (conti nuati on of transverse sinus) Tran sve rse sinus Accessory nerve (XI) Hypoglossal nerve (XII) re at ce rebral ve in (Ga len) Superior sagittal sinus (cut)

Cavernous sin Oculom oto r nerve (Ill )

Optic chiasm .-;El!!!!:o--Posterior co mmunica tin g artery

Trochl ea r nerve (IV) Abducent nerve (V I) Op hthalmic nerve (V,)

Internal caro tid artery H ypop hys is (pituitary glan d)

Maxillary nerve (V2l

Coronal section through cavernous sinus

PLAT£98

HEAD AND NECK

Cerebrum: Lateral Views

Central su lcus (Rolando )

Postcentral gy1·us

Intrapari eta l su lcus Inferior parietal lobu le Supramargin al gyru s Angu lar gyrus

In ferior fronta l sulcus Inferior frontal gyrus Op ercul ar pa rt Trian gul ar part Orbital part

Pari etooccipita l su lcus '

/ ·..

/~ ~Occipital

f

Frontal po le - - - ---t

Lateral sulcus (Sylv1u s)

..(

l

Antenor 1·a mus Ascend 1n g ram u / < : s Posten or 1am us

\

po le Calcarin e sulcus

Lunate su lcus (inconstant)

<~~~"'

Transverse occipita l su lcus

·

Superior tempo ral gyrus

Tempora l pole

Superior tempo ral sulcus

Inferio r temporal gyrus

Middl e temporal gyru s Inferior temporal sul cus Frontal lobe

Occipita l lobe

Parietal opercu lum Frontal operculum Orbital ope rculum

©lfiiN ;•.·: ::: :

MENINGES AND BRAIN

Short gyri Insul a Ce ntral su lcus Limen----" (island of Rei I) { Lo ng gyrus Circu lar sulcu s

Temporal operculum

PLAT£99

Cerebrum: Medial Views FOR HYPOPHYSIS SEE PLATE 140 Sagittal section of brain in situ

Paracentral sulcus Central sulcu s (Ro lando )

Precun eus Superi or sagitta l si nu s Choroid plex us of 3rd ventricle

Septum pellu cidum In te rventri cular fo ramen (Mo nro)

Pari etooccipital sul cus

Tha lam us and 3 rd ventricl e

_ ...J:-- -\11l\l-'it:T:'IT- Cuneus

Subca ll osal (parolfacto ry)

Habenular

area-,;~~~~. Ant~~~?_r_ ..

~L-.:_...1.L---o:7ilre\:l commiss ure -~--::::r~~~r----::-1111-~!rr-

Pi nea l body

il"~"i"'--"'"~~;s.'f/1~~\.__ Pos terior co mmi ssure Ca lca rine su lcus Straight sinu s in tentorium cerebell i

Subca llosal

Supraoptic recess Optic chiasm Tuber cin ereum Hypop hysis (pitu itary gland)

Cerebra l aqueduct (Sylviu s)

Medial surface of cerebral hemisphere: brain stem excised

erior medu llary ve lum 4th ventricl e and choro id pl ex us In ferio r medu ll ary velu m Medu ll a ob lo ngata

~~~~~LIIll

Trunk Sp leniu m

}

of corpus call osum

Isthmus of cin gul ate gyru s Parietooccipital sul cus

Calcarine sulcus

Crus Body Co lumn Med ial occipitote mpora l

Latera l occipitotemporal gyru s - - -

PLATE 100

~

of forni x

Fimbria of hi ppocampus

Para hi ppoca mpal gyrus

HEAD AND NECK

Cerebrum: Inferior View FOR HYPOPHYSIS SEE PLATE /40 Sectioned brainstem

Frontal pole of cerebrum

Longitudinal cerebral fissure of corpus callosum

Orbital sulci

Temporal Optic nerve (II) (cut)

Inferior temporal gyrus

Inferior (inferolateral) margin of cerebrum----~,:.~

--..,.-"r--:f-'---+---::-~H,;-- Posterior

perforated substance (in interpeduncular fossa)

Rhinal sulcus

Cerebral crus Lateral geniculate body Inferior temporal gyrus

Substantia nigra

Occipitotemporal sulcus _ _ _ ____.,

Lateral occipitatemporal gyrus

nar of thalamus

Collateral sulc Cerebral aqueduct Parahippocampal gyrus Splenium of corpus callosum Medial occipitotemporal gyrus

Calcarine sulcus

Occipital pole of cerebrum Longitudinal cerebral fissure

Isthmus of cingulate gy1·us

MENINGES AND BRAIN

PLATE 101

Ventricles of Brain

Left lateral phantom view

Frontal (a nterior ) horn Central part

Right late ral ventricl e

Temporal (inferi or) horn Occipita l (poste ri or) horn

l

Left lateral ventri cle

Cereb ral aqu ed uct (Sy lvius) 4th ve ntri cle Left latera l ape rture (fora men of Luschka) Left lateral recess Med ian ape rture (fo ramen of Magendi e)

Central ca nal of sp in al cord

Co rpu s ca ll osum Septum pe llucidu m Lateral ventricl e Body of ca udate nucl eus Choroid plexus of lateral ventricl e Stri a terminal is

Jt~~::::::::::::-:--_.,..-~-- Superior thalamo striate vein ~==---,~...::.---:---- Bo dy of forn ix ~=--.:_:::..:;;,..:::....::'-:---.,=---,,...-:";"-:~--::--~--1 ntern al ce rebra I vein ~7~~;:ff'-"'--'--7~--;"';-----r--,-..,...:.:....._+:------ T,ela cho ro idea of 3 rd ventricl e tll~-;::;:v-;-~:_ -1,;:-..:_-~~-____:o._ _ Cho roid plexus of 3 rd ventri cle

__

~:r-------7_.::~:_----Thalamus

Putamen

::==~C=-"T--:---;Cb_-=-= G lob us pa llidus

}

. Lent1form nucleus

Intern al caps ule

3rd ventricle and in terthalami c adhesion :;-T----7~=-====------- Hypothalam us ;:--,----Tail of caudate nucl eus Cho roid plex us of lateral ve ntricle White arrow in left interventricul ar foram en (Monro) Ependyma -

Pia mater

Temporal (inferio r) horn of latera l ve ntricle Fimbria of hippocamp us Den tate gy rus Parahippocampal gyrus

Coronal section of brain: posterior view

PLATE 102

HEAD AND NECK

Circulation of Cerebrospinal Fluid

Choroid plexus of late ral ve ntricl e (phantom)

Superior sagittal sinu s Subarachnoid space

Cistern of corpus cal losum

chnoid granulations

Dura mater Arachnoid

Interve ntricular foramen (Monro) Chiasmati c cistern Choroid plex us of 3rd ve ntricle Interped un cul ar ciste rn Cerebral aq ueduct (Sylvius) Quadrigeniinal cistern (of great cerebral vein)

Prepontine cistern Lateral apertu re (foramen of Luschka) Choro id plexus of 4th ven tricl e

(Posterior) ce rebel lomed ull ary cistern Median aperture (forame n of Magendie)

Subarachnoid space Ce ntral cana l of spinal co rd

©IIDN ~ ·. ·:.·.· : ;

MENINGES AND BRAIN

PLATE 103

Basal Nuclei (Ganglia) Horizontal sections through cerebrum

A .

\

' /('c~·-

Genu of corpus cal losum Lateral ventricle

' \ \

1

_

. ~ . .' ·/'

.

I

of ca udate nucleus

~~::~~ior limb

}

Septum pellu cidum

of i ntemal capsule

Postettot ltrnb Column of forn ix Putam en

} Lentiform

Globu s pal lidu s

In su la (island of Rei I)

nucleus

lnterthal ami c ad hes i o n----,f"--'----lll{---"'"'"" austrum Retrolenticu lar part of internal capsule Choroid ple xus of Ia tera l ventricle

Tail of ca udate nucl eus Hippocamp us and fimbria

Splenium of corpus callo sum

Occipital (pos terior ) hom of lateral ventricle Ha benu la

Organization of basal nuclei (ganglia)

Pineal body

Cau date Putamen G lob us

~ Striatum

Cleft for intemal caps ule

Lentiform nucleus

~ Corpus striatum

~ Basal nuclei (ga nglia )

Caudate { Body nucleu s Head Le vels of { A _ B secttons above -

----A ---- B Pu lvinar

Lentiform nucleu s (globu s pa llidu s med ial to putame n)

Medial genicu late body Latera l ge ni cul ate body Tail of caudate nucleu s

Interrelationship of thalamus, lentifo rm nucleus, caudate nucleus and amygdaloid body (schema): left lateral view

PLATE 104

HEAD AND NECK

Thalamus

Corpus callosum (cut)

Interventricular foramen (Monro)

Head of caudate nucleus Septum pellucidum Columns of fornix Anterior tubercle

lnterthalamic adhesion

Temporal (inferior) horn of lateral ventricle

Habenular trigone Collateral eminence Lateral geniculate body

Fimbria of hippocampus----&:::=-----1~

Medial geniculate body

Posterior commissure Habenular commissure

Brachium of inferior colliculus

Occipital (posterior) horn of lateral ventricle---~ Calcarine sui

3rd ventricle lnterthalamic

adhesion-"21~--~L~·

> - - - - 'H ;,---- Intra Iami n a r

nuclei

-. -Reticular nucleus

Pulvinar

Thalamic nuclei

teral geniculate body

CM

Centro median Lateral dorsal Lateral posterior LP M Medial MD Medial dorsal VA Ventral anterior VI Ventral intermedial Vl Ventral lateral VP Ventral posterior VPL Ventral posterolateral VPM Ventral posteromedial

LD

Median nuclei

Schematic section through thalamus (at level of broken line shown in figure at right)

MENINGES AND BRAIN

Medial geniculate body

Schematic representation of thalamus (external medullary lamina and reticular nuclei removed)

1111111!!111111!111111 lateral nuclei 14 Medial nuclei Anterior nuclei

liiiiii

PLATE 105

Hippocampus and Fornix

Superior dissection

Genu of co rpu s ca ll os um (cut)

Head of ca ud ate nucleu s Columns of forni x

rura of forni x Den tate gy ru s Fim bria of hi ppoca mpus

Occipital (posterior) ho rn of lateral ventricle

Tail of ca ud ate nucl eus

Body of forni x

Fimbria of hippocam

Co lum ns of fo rnix

Opti c t

Hi ppocampa l su lcus

Alveu s of hippocamp us Fim bria of hippoca mpu s Amygda lo id bodi es

Fornix: schema

PLATE 106

Hippoca mpus

Temporal (inferi or) horn of lateral ventricl e

Coronal section: posterior view

HEAD AND NECK

Cerebellum Superior surface Anterior lobe Quadrangular lobule (H IV-V) Central lobule (II & Ill)

·mple lobule (H VI)

Superior vermis

Posterior ldbe

Superior semilunar (anseriform) lobule (H VII A) ;___---Horizontal fissure -----Inferior semilunar (caudal) lobule (H VII B)

Central lobule Superior vermis

{

Inferior surface of central lobule

Lingula (I)

Flocculonodular lobe Posterolateral (dorsolateral) fissure

Inferior medullary velum

Retrotonsillar fissure

Nodule (X) Inferior vermis

Posterior lobe

Uvula (IX) Tonsil

Biventer lobule (H VIII) Secondary (postpyramidal) fissure

Posterior cerebellar notch - - - - - - - - -

Horizontal fissure Inferior semilunar (caudal) lobule (H VII B)

Decussation of superior cerebellar peduncles

Superior medullary velum

Cerebellar nuclei is

Section in plane of superior cerebellar peduncle

MENINGES AND BRAIN

PLATE 107

Brainstem

Posterolateral view

Pineal

body -----'~5

.,....;;::.~:::.:...--"--- M e d i a l ge ni culate bod y

Superior co lli culi ----""""""''+--.!~ Inferior coll iculi - - - --<.:-

r - - - - - - srach ia of superior and infe ri or co lli culi - - - - - - - cerebral cru s

Trochl ear nerv e ( I V) ----~~~~ Superi o r medu ll ary ve l um ----,.c...~ Superior ce rebellar peduncle - - _,

-+- - -Tri geminal nerve (V) tj--- - - -Midd le ce rebellar peduncl e

Rhomboid fo ssa of 4th ventri cl e - - - -+-7'"'

Vestibulococh lea r nerve (V III )

G lossoph aryngeal (IX) and vagus (X) n e rves -------_J~AJ..!£~

Inferi or ce rebe ll ar peduncle

Cuneate tub ercl e Graci le tub ercle - - - -.ll!-..L Dorsa l roots of 1st sp inal nerve (Cl )- - - -H - +<"!M Cuneate fas ciculus- - - --tfr-t--tGraci le fa scicu

Anterior perforated su bstan ce

Anteri or view _

_::~~P~:~~~~:~~~~~~~::£~--,--:--- Infundibulum (pituitary sta lk)

~:S~~l~~~,~---:::--\--= Mammi ll ary bod ies - =---- - Tempo ral lobe (cut surface) ~-'~,.-;;-t...;~~--;1-~-lr----- Ocul omotor nerve (Ill )

Tuber cinereum ~----J,___

Cerebral crus

___.,..__.---'--- Troch Iea r ne rve (IV) Trigem inal ne rve (V) bdu cen t nerve (V I)

Lateral ge ni cu late body

Facial nerve (V II ) and interm edi ate nerve

Poste rio r perfo rated substance

Vestibul ocochl ea r nerve (V II I) Flocculu s of cerebell um -'-o;..--"tt~~- Cho r oid pl ex us of 4th

ventricl e Glossop haryngea l nerve (IX) Pyram i

Vagus nerv e (X) Hypoglossa l nerve (X II ) Acce ssory nerve (X I)

Decussation of pyram ids

PLATE 108

HEAD AND NECK

Fourth Ventricle and Cerebellum

abenular trigone

Posterior view

Medial } G en1cu . Iate b o d.1es Lat era I

3rd ventricle Pulvinar of thalamus

Superior cerebellar peduncle

Pineal body Superior colliculu Inferior colliculus Trochlear nerve (IV) Superior medullary velum Cerebellar peduncles

l

Superior Middle Inferior--'-:::---<

Striae medullares Tenia of 4th ventricle Cuneate tubercle

Sulcus limitans

Gracile tubercle

Trigeminal tubercle Hypoglossal trigone Vagal trigone

neate fasciculus Gracile fasciculus

Obex

lnterthalamic adhesion

Median sagittal section Habenular commissure

Splenium of corpus callosum Great cerebral vein (Galen)

Lingula (I) Central lobule (II-III)

Hypothalamic ~u,Lu:>­ Midbrain tegmentum

Culmen (IV-V)

l

Vermis of cerebellum

Declive (VI)

Cerebral aqueduct (Sylvius)

Folium (VII A)

Superior colliculus Tectal (quadrigeminal) plate

Superior medullary velum Inferior medullary velum Medial longitudinal fasciculu Tuber (VII B) } Pyramid (VIII) Choroid plexus of 4th ventricle

Uvula (IX)

Medulla oblongata

Vermis of cerebellum

-----Nodulus (X)

Median aperture (foramen of Magendie) Decussation of pyrami Central canal of spinal cord

MENINGES AND BRAIN

Choroid plexus of 4th ventricle of cerebellum

PLATE 109

Cranial Nerve Nuclei in Brainstem: Schema

Posterior phantom view

cu lom otor nerve (Ill) ed nucleus Oculomotor nucleus

Lateral gen icul ate b

Accessory oculomotor (Ed in ge r-Westpha l) nucleus

Mesencephalic nucl eus of trigeminal nerve

Trochlear nucleus Trochlear nerve (IV)

Principal sensory nucl eus of trigeminal nerve

Motor nucleus of trigeminal nerve Tri ge min al nerve (V) and gangl io n

nerve ~b~~!:j;r''-----------Superi or and inferior sa livatory nuclei

Cochl ea r nuclei

Vestibula nucl ei

lassopharyngeal nerve (IX)

Glossopharyngeal nerve (IX)---_J

Vagus nerve (X) Vagus nerve (X)

Accessory nerve (XI)

Sp inal tract and sp inal nucleus of trigeminal nerve o-n<;rPnnr (dorsal) nucleus of vagus nerve (X)

Efferent fibers Afferent fibers 1"1111'111111111111#1111 Mixed fibers

PLATE 110

Spinal nucleu s of accessory nerve

4~~ ©'·~N

HEAD AND NECK

Cranial Nerve Nuclei in Brainstem: Schema (continued)

Medial dissection

Accessory oculomotor (Edinger-Westphal) nucl eus

Red nucl eus

Oculomotor nucleus

Oculomo tor nerve (II

Trochl ea r nucl eus

bducent nucl eus

Tri ge minal nerve (V) and ga ngli o n

Intern al genu of fa cial nerve

Principa l sensory nu cleus of tri geminal nerve

Facial nucleus

Vestibular nu clei Moto r nucl eus of trigeminal nerve

i\t-+illllllf¥-_,_--f,---- Supe ri o r and infe ri or salivator y nuclei

Vestibu locochl ea r nerve (V III )

So litary tract nucleus Glossopharyngea l nerve (IX)

Posterior (dorsal) nucl eus of vagus nerv e (X)

Hypo glossa l nerve (X II ) Hypoglossa l nucl eus Vagus nerve (X) Nucleus ambiguus Accessory nerve (X I) Sp in al nucl eus of accessory nerve O li ve

Efferent fibers Spinal tract and sp in al nucl eus of trigem in al nerve

• • • Afferent fibers • • • Mixed fibers

CRANIAL AND CERVICAL NERVES

PLATE 111

Cranial Nerves (Motor and Sensory Distribution): Schema - - - - - - Spinal nerve fibers - - - - Efferent (motor) fibers - - - - Afferent (sensory) fibers

II Olfactory

VII Facial Muscles of face

Motor-sub man d ib u Ia r, subl in gual, lacrimal gland s Taste-anterior YJ of ton gue, sensory soft palate

VIII Vestibulocochlear Cochlear Vestibular

IX Glossopharyngeal Taste-posterior Y, of tongue Sensory-tonsil, pharynx, middle ear Motor-stylopharyngeus, upper ph aryngea l muscles, parotid gland

X Vagus Motor-h ea rt, lun gs, palate, pharynx, lary nx, trachea, bronchi, Gl tract Senso ry-heart, lun gs, trachea, bro nchi, larynx, ph arynx, Gl tract, external ear

~:w

~;,v:~~

v

©JfiiN ;•.·:.·,': ;

Strap muscles (C l, 2

fibers)

PLATE 112

HEAD AND NECK

Olfactory Nerve (1): Schema

Subcallosal (parolfactory) area Septal area and nuclei

Olfactory bulb cells: schema

l

~---

---+.....~r---.--~

Contralateral } olfactory bulb

i

Efferent fibers to olfactory bulb

l

Afferent fibers from bulb to central connections and contralateral bulb

Medial olfactory stria

Granule cell (excited by and inhibiting to mitral and tufted cells) Mitral cell Recurrent process Tufted cell Peri glomerular cell Glomerulus Olfactory nerve fibers

_,.~4.

~-)l-

Olfactmy cells Olfactmy trigone and olfactory tubercle Olfactory nerves (I)

Lateral olfactory stria Olfactory bulb Lateral olfactory tract nucleus Cribriform plate of ethmoid bone Anterior perforated substance Anterior olfactory nucleus Amygdaloid body (phantom) Pirifmm lobe

CRANIAL AND CERVICAL NERVES

Dentate gyrus Parahippocampal gyrus

PLATE 113

Optic Nerve (II) (Visual Pathway): Schema

Ce ntral da rke r circl e represe nts macu lar zone Ove rlappin g visual fi elds

Lighter shades rep rese nt monocular field s Each qu ad rant a different co lor

Projectio n on ri ght retina

II!IIIIIIDCb

Choroid

-'11111

:~, --~Choi-Q[d~,

~~

Periph ery

M ac ula

Structure of retina: schema A B C

C H

P R

Ama crin e cell s Bipolar ce lls Cones Ganglion ce lls Hori zo nta l cell s Pigm ent cells Rods

Projection on ri ght dorsa l late ral geni cul ate nucl eus

Projection on left do rsal latera l ge nicul ate nucleus

I I I

I I

I I'

I

Ca lcarin e sui

I I I I I

I

I

I

I

Ca lca rin e sul cus

/ / /

I

I

I

) Proj ection on left occipital lobe

Proj ection o n right occipital lobe

---·---------PLATE 114

HEAD AND NECK

Oculomotor (Ill), Trochlear (IV) and Abducent (VI) Nerves: Schema SEE ALSO PLATES 87, 726, 753 Long ciliary nerve

Ciliary ganglion

Short ciliary nerves

Posterior ethmoidal nerve

Anterior ethmoidal nerve

Abducent nucleus

Sensory root of ciliary ganglion Trochlear nucleus

Superior oblique muscle

Sympathetic root of ciliary ganglion

Levator palpebrae superioris muscle

Oculomotor nucleus

Superior division of oculomotor nerve

Accessory oculomotor (Edinger-Westphal) nucleus (parasympatheti

Frontal nerve (cut) Lacrimal nerve (cut) Nasociliary nerve

Trochlear nerve (IV)

Oculomotor nerve (Ill)

Zygomatic nerve ( Inferior oblique muscle Inferior division of oculomotor nerve

Internal carotid artery and nerve plexus

Medial rectus muscle

Sphincter muscle of pupil

Inferior rectus muscle

Lateral rectus muscle and abducent nerve (turned back)

- - - Efferent fibers - - - Afferent fibers · - - - - Sympathetic fibers

Parasympathetic root of ciliary ganglion

··········· ·· Parasympathetic fibers

Common tendinous ring

;f

©JI§N ·.·.·:.·: : ~

CRANIAL AND CERVICAL NERVES

PLATE 115

Trigeminal Nerve (V): Schema SEE ALSO PLATES 78, 37, 38, 40, 47, 153 Ophthalmic nerve (V1 ) --· · · .. ·· · .... .. .. ----

Efferent fibers Afferent fibers Proprioceptive fib ers Parasympathetic fibers Sympathetic fibers

Tentorial (menin gea l) branch Nasocili ary nerve

Tri ge minal nerve (V) ganglion and nuclei Mo tor nucl eus Mese nceph alic nucleus Prin cipal senso ry nu cleus Sp inal tr act and nucleus

Lacrimal nerv e Se nso ry root of ciliary ga ngli on

Frontal nerve Posterior ethmoidal nerve Short ciliar y nerves Anterior ethmo idal nerve Supraorbital nerv e Supratrochl ea r nerve

Meningeal branch

lnfraorbit~~l;n;:~~=2:J~J~~~~~~~::==i

Pterygopalatin e ganglion

Superior alveolar branches of infraorbital nerve Nasal branches (posterior superior lateral, nasopa latine and posterior supe rior m ed ial) N erve (vidian) of pterygoid ca nal (from faci al nerve [VII] and carotid plex us) Pharyngeal branch Greater and lesser palatine nerves Deep tempora l nerves (to temporali s muscle) Lateral pterygoid and masseteric nerves Tenso r veli palatini and medi al pterygoid nerves

Au ri culotempora l nerve Subm andibul ar ganglion

Mental nerve Inferior dental plexus Lin gual nerve

Inferior alveo lar nerve

Mylohyoid nerve Mandibular nerve (V 3 ) Tensor tympani nerve

Lesser petrosal nerve (from glossopharyngea l nerve [IX])

-----------· PLATE 116

HEAD AND NECK

Facial Nerve (VII): Schema SEE ALSO PLATES 79, 753 Facial nerve (VII)

Greater petrosal nerve

Internal acoustic meatus

Geniculate ganglion

Deep petrosal nerve (from internal carotid pie

Nervus intermedius Motor nucleus of facial nerve

Internal carotid plexus (on internal carotid artery)

Lesser petrosal nerve Nerve (Vidian) of pterygoid canal

Superior saliva tory nucleus

Pterygopalatine ganglio

Facial muscles

Orbicularis oculi

Zygomaticus major

Procerus Levator labii superioris Levator labii superioris alaeque nasi Levator anguli oris Nasalis

Dewessor septi nasi

Occipital belly (occipitalis) of occipitofrontalis muscle

Orbicularis oris---:::_ Depressor anguli oris----'""""'

pos teri or auri c ul ar nerve

Depressor labii inferioris------; Mentalis----;(Risorius) (not shown)

Tympanic nerve (Jacobson) (from glossopharyngeal nerve)

Sublingual gland Submandibula1- gland

- - Efferent fibers - - Afferent fibers ... ... .. .. Parasympathetic fibers

Submandibular gan Lingual nerve (from trigeminal nerve

- - -- Sympathetic fibers

CRANIAL AND CERVICAL NERVES

Chorda tympani nerve

Glossopharyngeal nerve (IX) Digastric muscle (posterior belly) Stylohyoid muscle Caroticotympanic nerve (from internal carotid plexus)

PLATE 117

Vestibulocochlear Nerve (VIII): Schema

Facial canal

- - - Afferent fibers

Tympanic cavity Geniculum of facial nerve (site of geniculate ganglion)

Chorda tympani nerve

Greater petrosal nerve Cochlear (spiral) ganglion Vestibular nerve Cochlear ner Motor root of facial nerve and intermediate nerve

Vestibulocochlear nerve (VIII)

Ampulla of lateral semicircular duct acoustic meatus Vestibular nuclei (diagrammatic)

Inferior

Ampulla of superior semicircular duct

~

Cochlear } nuclei

Ampulla of posterior semicircular duct

Later 1------' Inferior cerebellar peduncle (to cerebellum)

Vestibular ganglion

Saccule Superior division

l

of vestibular nerve

Inferior division

PLATE 118

HEAD AND NECK

Glossopharyngeal Nerve (IX): Schema SEE ALSO PLATE 153

Spinal tract and spinal nucleus of trigeminal nerve

Efferent fibers Afferent fibers Parasympathetic fibers

Tympanic nerve (Jacobson) Tympanic cavity and plexus Stylomastoid foramen

Nucleus ambiguus Inferior salivatory nucleus Geniculate ganglion of facial nerve

Caroticotympanic nerve (from internal carotid plexus) /

Greater petrosal nerve Deep petrosal nerve Nerve (Vidian) of pterygoid canal Lesser petrosal nerve Pterygopalatine ganglion Mandibular nerve (V 3 ) Otic ganglion Auriculotemporal nerve

Tubal branch of tympanic plexus Pharyngotympanic (auditory) tube and pharyngeal opening

Glossopharyngeal nerve (IX)

Stylopharyngeus muscle (and branch from glossopharyngeal nerve)

Communication to auricular branch of vagus nerve Superior and Inferior ganglia of Glossopharyngeal nerve

Superior cervical sympathetic ganglion

Carotid branch of glossopharyngeal nerve Internal carotid artery Pharyngeal plexus Carotid sinus Pharyngeal, tonsillar and lingual branches of glossopharyngeal nerve

Carotid body Common carotid artery

Pharyngeal branch of vagus nerve External carotid artery

CRANIAL AND CERVICAL NERVES

PLATE 119

Vagus Nerve (X): Schema SEE ALSO PLATE 153

Pos terior nucleus of vagus nerve (parasympath eti c G lossopharyngea l nerve (IX) So li tary tract nucl eus (v iscera l affe rents includin g taste)

Meninge al branch of vagus nerve

' "'""'·...,'''-S pinal tract and spin al nucl eus of trigemin al nerv e (somatic afferent) Nucleus ambiguus (motor to pharyngea l and laryngea l mu scl es)

Sa lp in gop haryngeus mu scle -----~

ni al root of accessor y nerve

Palatoglossus mu scl e

Vagus nerve (X)

Palatopharyngeus 111 uscl e - - - - - - - -

Ju gul ar foramen

Superior pharyngeal constri cto r mu scle

Superior ga ngli o n o f vagus nerve

Stylop haryngeus muscl e Middle pharyngea l con stri c to r muscle

In fer ior ga ngli o n of vagus nerve Pharyngea l branch o f vagus nerve (motor to mu scles of palate and lower pharynx; senso ry to lower ph arynx)

Inferi o r pharyngeal constrictor mu scle Cricothyro id muscle

Commun icating branch of vagus nerve to caro tid branch of glossop haryngea l nerve aryngeal plexu s

Esophagus

Right recuiTent laryngea l nerve

Superior laryngea l nerve : Internal branch (se nso ry and parasympath etic) External branch (moto r to crico th yroid muscl e) Superior cervica l ca rdi ac branch o f vagus nerve Inferior cervica l ca rdi ac branch of vagus nerve

H epatic branch of anterior vaga l trunk (in lesser omentum) Ce li ac branches from ante1"ior and posterior vagal trunks to ce li ac plex us------.._

Thoracic cardiac branch of vagus nerve Left recurrent laryn gea l nerve (mo tor to mu scle s of larynx except cricothyroid; se nso ry and parasympath eti c to larynx below vo ca l fo lds; pa rasy mpathetic, efferent and afferent to upp er esop hag us and trachea)

~:'"

rh· ~-~rt·::

"------Cardi ac plex us H epati c plexus

/"

Esoph ageal p lex us Ga ll bladder and bi le ducts

©lfiiN

~·. ·:.·.-:: ~

Anterior vaga l trunk Gastri c branches of anterior vaga l trunk (b ranches from posterio r trunk behind sto mach)

Pyl o ri c branch fro m hepa ti c plexus

Va ga l branches (parasympathetic motor, secretomotor and affe rent fibers) accompany superior mesenteric artery and its branches usu all y as far as left co li c (s plenic) flexure

- - - - Efferent fibers - - - - Afferent fibers ............... Parasympathetic fibers

PLATE 120

HEAD AND NECK

Accessory Nerve (XI): Schema SEE ALSO PLATE 27 Nucleus ambiguus Vagus nerve (X)

Cranial root of accessory nerve (joins vagus nerve and via recurrent laryngeal nerve supplies muscles of lal-ynx, except cricothyroid) Spinal root of accessory nerve

jugular foramen

Accessory nerve (XI)

Internal branch of accessory nerve

C1 spinal nerve

'.I...J--"'"....:r---External branch of accesso1-y nerve (to sternocleidomastoid and trapezius muscles) ----Sternocleidomastoid muscle (cut) C3 spinal nerve C4 spinal nerve Trapezius muscle

Efferent fibers Proprioceptive fibers

CRANIAL AND CERVICAL NERVES

PLATE 121

Hypoglossal Nerve (XII): Schema SEE ALSO PLATE 27

Hypoglossal nerve (XII) (in hypoglossa l can al)

Hyp oglossa l nucl eus

Supe ri o r lo ngitudin al Intrinsic mu scl es of ton gue

Transverse and verti ca l

Me ni ngea l branch

Styloglossus mu scle

~~~r----lnfe rior ga ngli o n of

vag us nerve

73J....,~-- ve ntra l

ram i of C 1, 2, 3 fo rm ansa cervicali s of ce rvi ca l plex us

Superior cervica l sympath eti c ga nglion

Ge niogloss us muscl e _ _ __J Intern al ca roti d artery

Infe ri or root of ansa cervical is

Hyoglossus mu scl e

A nsa ce rvica li s

In ternal ju gular vei n

Commo n ca ro tid arte ry

Stern othyroid muscl e O mo hyo id mu scle (infe rior belly)

- - - - Efferent fibers - - - - Afferent fibers

--------------,--~----·--' ~----------'

PLATE 122

-----

HEAD AND NECK

Cervical Plexus: Schema SEE ALSO PLATE 27 Sternocleidomastoid muscle (cut)

Great auri cular nerve

Hyp oglossal nerve (XI Greater occipital nerve (from dorsal ramu s of C2)

Geniohyoid muscle

'11L---'--r;7lJ,.

--'--Nerves to ante rior and lateral rectus capitis and longus capitis and co lli muscles N erves to longus capitis an d co lli and levator scapulae muscles Trapezius muscle

Superior root of ansa cervical is Inferior root of ansa cervica l is

Nerves to longus capitis and co lli, levator scapulae and middle scalene muscles Communication to brachial plexus

Supraclavicular nerves (medial, intermed iate and lateral)

Sternocleidomastoid muscle (cut) - - - - Efferent fibers Omohyoid muscle (inferior belly)

- - - - Afferent fibers ·· .. · ·· ... ·· Proprioceptive fibers

CRANIAL AND CERVICAL NERVES

PLATE 123

Autonomic Nerves in Neck -----------

In te rn al ca ro ti d nerve

Laryngopharyngea l sympathetic branch

Vagus ne rve (X) (c u t)

Supe ri o r ce rv ical sy mpathetic ga nglion

Ph ary ngea l pl ex us Ph aryngeal branch of vagus nerve Ex tern al ca ro tid artery and plex us G ray ra mi co mmunica ntes

Superi or laryngeal nerve Intern al ca ro tid artery and ca ro tid branch of glosso ph aryngeal nerve Ca rotid body Ca rotid sinus Supe ri o r ce rvica l cardi ac branch of vagus nerve Su peri o r ce rvica l sympath etic ca rdi ac nerve Phreni c nerve (c u t) M idd le cervica l sympath eti c ga nglio n Co mmo n carotid artery and pl ex us

r. tt

t •'·~.~/ ©U§N ;•.·: ,·.': :

M id dle cervica l sy mpa th eti c ca rdiac nerve Ve rte bral ga ngli o n Ve rteb ral arte ry and pl ex us Rec urrent laryngeal nerve Ce rvicothoracic (s tellate) ga ngli on -'tt-- - A nsa subclavia Vagus nerve (X) (c ut ) ~,..-..:---In fe ri o r

ce rvica l sympa th etic ca rdi ac nerve

~':-- T h o rac i c sympath eti c and

vaga l ca rdiac nerves Subclavian artery

PLATE 124

HEAD AND NECK

Autonomic Nerves in Head SEE ALSO PLATES 39, 40, 47, 87, 7 75, 726, 727, 728, 752 Greater petrosal nerve

Nerve (Vidian) of pterygoid canal

Sensory root Motor root

Trigeminal nerve (V) {

Deep petrosal nerve

Oculomotor nerve (Ill)

Ganglion

Maxillary nerve (V 2 ) Ophthalmic nerve (V 1)

Internal carotid artery and plexus Frontal and lauimal nerves (cut)

Geniculate ganglion

Ciliary ganglion

Long ciliary nerve

Vestibulocochlear nerve (VIII) Glossopharyngeal nerve (IX)

Mandibular nerve (V3)---~'l.!iii Otic ganglion Internal carotid nerve Chorda tympani nerve-------

Pterygopalatine ganglion

Superior laryngeal nerve (cut)---~Superior cervical sympathetic ganglion Lingual nerve Internal carotid artery and plexus Carotid branch of glossopharyngeal nerve

Submandibular ganglion

Facial artery and plexus Superior cervical cardiac branch of vagus nerve - - - - - - - lrttl

Common carotid artery and plexus Superior cervical sympathetic cardiac nerve

CRANIAL AND CERVICAL NERVES

PLATE 125

Ciliary Ganglion: Schema ----------~--------· ---·

SEE ALSO PLATE 153 Sphincter mu scl e of pup il

Oculomoto r (parasy mpathetic) ro ot of cili ary ga nglion

Short cili ary nerve s Di lator muscl e of pup il

Accesso ry oculo moto r (Edin ge r-Wes tph al) nucl eus (parasympath etic)

Ci li ary ga ngli o n

! - - - - T ecto sp in al trac t

Nasocili ary (sensory) root of cili ary gangli o n Inte rna l carotid plexus

Sympatheti c root of cili ary gan gli o n O phth almic artery

Superi o r cervical sympath eti c gangli o n 1st th o racic sy mpath etic trunk gan gli o n ___..--r-Gray ramu s communi ca ns

-----

Presynaptic Postsynaptic

}

Sympathetic fibers

-----

Presynaptic Postsynaptic

}

Parasympathetic fibers

White ramu s communi cans

Presyn aptic sympath etic ce ll bodi es in intermedi olateral nucleus (lateral ho rn) o f gray matte r

Afferent fibers - - - - - V isual pathway - · - · - · - Descending pathway

©119N ·...·.-.·.: ~

~

-----------PLATE 126

HEAD AND NECK

Pterygopalatine and Submandibular Ganglia: Schema ----------------·----SEE ALSO PLATE 753 Ophthalmic nerve (V 1)

Tri gemin al ga ngli on D ee p petro sa l nerve

Cho rd a tymp ani nerve Lin gual nerve

Tri ge min al nerve (V)

M axill ary nerve (V2 )

Facial nerve (VII) (intermediate nerve)

N erve (Vidian) of pterygo id ca nal Pterygopalatine ganglio n

Superior sali va tory nucleus

Lacrim al gland

\

G loss opharyngeal nerv e (IX)

Sup erior ce rvica l sympatheti c gan gli o n Sympath eti c trunk

Tl and T2 spinal nerves

Dorsal root

Subm andibul ar gland Facial artery

Rami communicantes Internal carotid artery

Extern al ca rotid artery and plexus

roo t

Sympath eti c presynaptic cell bodies in interm edio lateral nucleus (lateral horn) of gray matter

Co mmon carotid artery

CRANIAL AND CERVICAL NERVES

-

-

-

-

-

-

Sympathetic presynaptic fibers Sympathetic postsynaptic fibers Parasympathetic presynaptic fibers Parasympathetic postsynaptic fibers

PLATE 127

Otic Ganglion: Schema SEE ALSO PLATE 753 Tri gem in al ga nglion

Ma ndi bular nerve (V3 )

Lesse r petrosal nerve

Ophthalmi c nerve (V 1 ) Max ill ary nerve (V 2 ) Aur iculo tempo ral nerve Infer ior sa livatory nucleu s Superficial tem po ral artery

Maxi ll ary artery Med ulla ob longata ~ri-f--f~~:----;-;----:.'--- Tympani c

p lex us In fer io r alveolar nerve

Tympa ni c nerve (Jacobso n) In fer ior ga ngli on (IX) Superi o r ce rvica l sympath etic gangli on Sympatheti c trun k

Extern al ca rotid artery

Dorsa l root Intern al carotid

Common ca ro tid artery W hi te

G ray

~

Rami co mmuni ca ntes

Sympathetic presynaptic fibers

Ve ntral roo t

Sympath etic presynaptic ce ll bod ies in i ntermed i olateral nucleus (lateral horn ) of gray matter

- - - Sympathetic postsynaptic fibers Parasympathetic presynaptic fibers -

-

-

PLATE 128

Parasympathetic po stsynaptic fibers

HEAD AND NECK

Taste Pathways: Schema SEEA LSO PLAT£541, 89, 117,119, 120

- - - - Usual pathway ------- Accessory pathway

Ve ntral posteromed ial (VP M) nucl eus of th alamu s Sensory co rtex (ju st be low face area) Lateral hypo th alam ic area Amygdaloid body

Tri gem in al nerve (V) Tri geminal (semilunar) ganglion

M ese nceph ali c nucleu s and Motor nucl eus of tri ge min al nerve ----:-;r.!~-,!~

Ophth almi c nerve (V 1 )

//

M ax illary nerve (V2) Mandibular nerve (V3)

Geniculate ga ngli on

©'··..ru....n ..... N.

Faci al nerve (V II ) and Interm edi ate nerve Nucleus of so litary tr act (rostral part)------

/--- ~~

~

M ed ull a ob longata (lowe r p a rt)-----~

......:....-+- Foli ate papill ae ·--.Vall ate papilla e

In fe ri o r (petrosal ) ga ngli on of glossopha ryngeal nerve

Epi glottis

Inferior (nodo se) ga ngli o n of vagus nerve

Larynx

.I ---CRANIAL AND CERVICAL NERVES

--------------PLATE 129

Arteries to Brain and Meninges SEE ALSO PLATES 28, 29 Left middle meningea l artery Posterior cerebra l arte ry Superior cerebell ar artery

Midd le cerebral artery Anterior cerebra l artery Anterior communicating artery

Left labyrin thine (interna l acoustic) artery Mastoid branch of left occipita l artery Cavernou s sinus Anterior inferior cerebellar artery

Posterior inferior cerebellar artery Left and ri ght vertebra l arteries (intracrani al part) Posterior menin geal branch of vertebral artery - - - - - _ / Anterior meningeal branch of vertebral artery Posterior auricular arte Occip ital artery Internal caro tid artery

Lingual artery Ascending pharyngea l artery Superior laryngea l artery Superior thyroid artery Common carotid artery As ce nding cervic al artery (cut)

Deep cervical Suprem e intercostal artery

Inferior thyroid artery Thyro cervical trunk Brachiocepha li c trunk

Subclavian artery

PLATE 130

Interna l thma cic artery

HEAD AND NECK

Arteries to Brain: Schema

Anterior cerebral artery

Anterior communicating artery Ophthalmic artery

Middle cerebral Posterior communicating artery

pratrochlear artery Caroticulympanic branch of internal carotid artery

Middle meningeal artery

Anterior tympanic arte perficial temporal artery Middle meningeal

Posterior auricular artery Facial artery

Basilar artery

cending pharyngeal artery Posterior inferior cerebellar arte

Anterior spinal artery ~-----f.;J--*--\\--E:-t-1-1!---- Spinal segmental medullary branches

ommon carotid artery

Supreme intercostal artery Ascending cervical artery

Costocervical trunk

Inferior thyroid Thyrocervical Subclavian arter

Internal thoracic artery

Anastomoses Descending ---r---,-;,.~'"1ii~Z:::::.~~~: Ascending-----+~-

CEREBRAL VASCULATURE

2 3

4 5

Right-Left Carotid--Vertebral Internal carotid-External carotid Subclavian-Carotid Subclavian-Vertebral

PLATE 131

Arteries of Brain: Inferior Views

M edi al frontobasal (orbitofrontal) artery Ante rior communi ca ting artery

Anterior cerebral artery Media l stri ate artery (recurrent artery of H eubn er) In terna l carotid artery Anterolatera l ce ntral (lenti culo stri ate) arteri es

Middle cerebral artery Lateral frontobasal (o rbitofrontal) arte ry- --il.,;r:...-S;h Prefro ntal artery _ ___,,,. Anterior choroidal arte r y------;~~~~~-r.:.:__ ___::~~

Superior ce rebe ll ar

Lab yrinth in e (internal aco ustic)

Posterior in fer ior cerebellar artery (P ICA) (cut) Posterior sp in al artery

Cerebral arterial circle (Willis) (broken lin e)

M ed ial striate artery (rec urrent artery of Heubner)

~I!~(:I.-~(---1-~~-F~~~~:-=Ante rior comm u n ica ti ng artery 1 '

Middle cerebral ::~lti~~~!=~~~~~~~=A~nterior cerebral artery artery Posterior commun ica ting artery ~~,-------~""-~---:;:t--- Ante rior cho roida l artery

~----71'1\\::;:;::~~-- 0ptic tra ct

¥'::-- -++-----Posterior cerebral artery

tt~=::1t~~~tt== Ce reb ral crus

Lateral gen icul ate body Posterior medi al choroidal artery Posterior lateral choroidal artery

Choro id pl ex us of late ral ventricle M edial genicu late body Pul vin ar of ~ h.:1 l a mus Lateral ve •m icle

PLATE 132

(,'

I,,,

©'WN

HEAD AND NECK

Cerebral Arterial Circle (Willis) -------

_______________ ,

FOR HYPOPHYSEAL ARTERIES SEE PLATE J4 1 Vessels dissected out: inferior view Anteri o r ce reb ral artery (A 2 segment) - - - - - -- t

Anterom edi al ce ntral (pe rforating) arteries

Anterior communicatin g arte ry H ypo th alami c art ery Anterior cereb ral artery (A 1 segment) - - - - - - - ---="' Ophthalmi c artery

Posterio r co mmunicatin g artery

Anterolate ral central (lenti culostriate) arterie s

Inferior hypoph ysea l al"tery Anterior cho ro idal artery Th alamo tub eral (premammillary) artery

Superior ce rebell ar artery

Po ste ro med ial ce ntral (perforating) arteri es Th alamoperforatin g artery Posterom edi al ce ntral (paramedian) art eri es

A nterior inferio r ce rebell ar artery Ve rtebral an ery

Vessels in situ: inferior view Anterio r ce reb ral artery

Anterio r comm uni cating artery

H ypothalami c Cavernous sinus Internal carotid arter In fundibulum (pituitary sta lk) and long_hypophyse al po1·tal vein s ~="f-- Adenohypophys is (anterior

Middle cerebra l ane Inferi o r hypophyseal Pos terior co mmunicatin g artery

lobe of p itu itary gland) ~-- Neurohypophysis

(posterior lo be of p ituitary gland)

,$---,~---""""7"~~_:>------- Posteromed ial central

(perforatin g) arteri es Efferent hypoph ysea l ve in s Superi or cerebellar artery Posterior ce reb ral arte

CEREBRAL VASCULATURE

PLATE 133

Arteries of Brain: Frontal View and Section

Corpus callosum Medial frontal branches

Anterolateral central (lenticulostriate) arteri Lateral frontobasal (orbitofrontal) artery

Callosomarginal artery

Anterior cerebral arteries

Precentral (pre-rolandic) and central (rolandic) sulcal arteries----.

Medial frontobasal (orbitofrontal) artery

Anterior parietal (postcentral sulcal) artery _ _ _ _ _ __J

Medial striate artery (recurrent artery of Heubner)

Posterior parietal artery-----"

Internal carotid artery

Branch to angular gyrus

Anterior choroidal

Temporal branches (anterior, middle and posterior Superior cerebellar artery

Middle cerebral artery and branches _ _ _ ___, (deep in lateral cerebral [sylvian] sulcus)

Basilar and pontine arteries Labyrinthine (internal acoustic) artery

Anterior communicating a

Vertebral artery

Posterior communicating artery Anterior inferior cerebellar artery

Posterior inferior cerebellar artery Anterior spinal artery

Posterior spinal Falx cerebri

Corpus striatum (caudate and lentiform nuclei)

Callosomarginal arteries and Pericallosal arteries (branches of anterior cerebral arteries)

Insula (island of

Precentral (pre-rolandic), central (rolandic) sulcal and parietal arteries----~~

Rostrum of corpus callosum

Lateral cerebral (sylvian) sulcus Temporal branches of middle cerebral artery

Anterior cerebral arteries Medial striate artery (recurrent a1·tery of Heubner) Anterior communicating artery

Internal carotid a

PLATE 134

Optic chiasm

HEAD AND NECK

Arteries of Brain: Lateral and Medial Views

An terior pari etal (pos tcentral su lca l) arte

Posteri or parietal artery

Centra l (rolandi c) su lca l artery Precentral (pre-ro landi c) su lca l artery

Termin al branches of poste ri or cerebral artery

Prefrontal su lca l artery-----.... Termin al branches of anterior ce rebral artery Lateral fronto basal (o rbitofronta l) ar Left middle cerebral artery---;,........&-,...*",.-'-"'"" Left anterior cerebral artery

Occipitotempora l branches

A nteri o r communicating artery ·1-' rlc: t•~ '· "''

Right anterior cerebral artery

temporal branch

Middle tem po ral branch Left internal ca rotid arte ry Polar tempo ral arter y

Med ial { Posteri or fran tal Interm ediate branches A t . n eno1

Peri ca llosa l artery

Superi o r and inferior terminal branches (trunks) Ante rior temporal branch Parace ntra l art ery

©IIJ!N ·.·.-.·.·: ~

~

Precun ea l artery Dorsa l branch to co rpu s callosum Pari etooccip ita l b ranch Calcarin e branch Right anterior cerebral artery

Medial fro ntobasal (orbitofrontal) arte ry

'~~~~

A nterior co mmuni catin g artery M ed ial striate artery (recurrent artery of H eubner)

Posteri o r te mporal branch A nterior temporal bra nch

Right intern al ca ro tid artery

Posterior communi ca tin g artery

Note: Anteri o r parietal (po stce nt ral sulcal) artery also o cc urs as se parate anterio r parietal and postce ntral sul ca l arteries

CEREBRAL VASCULATURE

PLATE 135

Arteries of Posterior Cranial Fossa

Thal amoge ni cul ate ar teri es

Latera l and medial gen icul ate bodies of left thalamus

Anterior cho roid al arte ry

Cho ro id plexuses of late ral ventricl es Pulvinars of left and right th alam i

Crura of forn ix

Splenium of co rpus ca ll osum

Antero lateral central (lenticulostriate) arteries

Occipital (posterior) horn of ri ght late ral ve ntricle Ri ght dorsal branch to co rpu s ca ll osum (posterior perica llosa l arter y)

Heads of ca udate nu clei Septum pellucidum

Pari etoo ccipital ~ Branch es of right posterior Ca lca rine cereb ral artery

Co rpu s ca llosum Anterior ce rebral arteries Lon gitud in al ce reb ral fissure\ ,J

-

- ...n•uv

~:-:__,~-:-----::0:"""---~!- Superior co lli culi

Optic nerve (II ) Poste rior med ial choroi da l artery to cho ro id plex us of 3 rd ve ntri cle Middl e ce rebral artery

Posterior lateral choroid al arte ry

Posterior co mmuni ca ting artery

Late ral (ma rgin al) branch

Th alamoperforating arteries

Inferior ve rmi an artery (p hantom)

Choroida l branch to 4th ventricle (phantom) and

Cerebe ll ar tonsillar branch of poste ri or inferior ce r·ebe ll ar artery

Labyrinthine (intern al acoustic) artery

utlin e of 4th ve ntricl e (broken lin e)

Poste ri o r ce rebral artery Superior ce rebe ll ar artery A nterior inferi o r cerebell ar artery

Posterior men in gea l branch of ve rteb ral artery Posterior in fer io r cerebell ar arte ry (PI CA)

Anterior menin gea l branch of ve rtebral artery Tempo ral bran ches of posteri or cerebral artery A nterior spina l artery

PLATE 136

Left posterior sp in al artery Left ve rteb ral arter y

HEAD AND NECK

Veins of Posterior Cranial Fossa

Left superior and inferi o r co lli culi

Left pulvin ar

Basal vein (Rose nthal)

Ri ght pulvinar In te rnal cereb ral ve ins Splenium o f co rpu s callos um

M edial geniculate

Grea t ce rebral vein (Ga len) Do rsa l vein of co rpu s callosum Lateral ge ni cul ate b

Inferior sa gittal sinus Strai ght sinu s Falx ce rebri

Co nfluen ce o f sinu se s

Tento rium li (cut)

Left tr ansve rse sinus (cut)

ve in

vein Inferi or vermi an ve in Fal x ce rebelli (cu t) and occipital sinus

A nterior po ntomesen ceph ali c ve in

nferior cerebell ar hemispheric ve in s

Trigemin al nerve (V

lntraculmin ate vein uperior ce rebell ar vein (in co nstant)

Petros al ve in (draining to superi o r petrosal sinus)

reculmin ate vein

A nteromedian medullary vein Vein of lateral recess of 4th ventricl e Superi o r, middle and inferi o r cereb ellar ped uncl es Anteri o r spinal vein

CEREBRAL VASCULATURE

(Inferi o r retrotonsill ar) vein of ce rebellom edull ary cistern Posteri o r spin al ve in 4th ve ntricle

Parts of cerebellum

l

Lin gul a

TU Tub er

Cl Central lobule P Pyramid C Culm en D D eclive F Fo lium

U Uvul a N N odule T Ton sil

PLATE 137

Deep Veins of Brain FOR SUPERFICIAL VEINS OF BRA IN SEE PLATE 96

Dissection: superior view

Anterior ce rebral ve in Supe rfi cial middle ce rebral ve in (dra inin g to sphenoparietal si Deep middle cereb ral vein

Basal vein (Rosenthal) Late ral gen icu late body M ed ial ge niculate body

Infer ior ce reb ral ve in s

Pu lvina r of thalamus Sple nium of co rp us ca ll os um

anastomotic ve in (Labbe)

Dissection: inferior view

PLATE 138

HEAD AND NECK

Subependymal Veins of Brain

Posterior veins of septum pellucidum Superior thalamic veins Superior cho roid vein

Latera l direct vein Posterior terminal vein of caudate nucleu s (posterior part of thalamostriate vein) Internal cerebral vein s (right and left)

Transverse veins of cauda te nucleus Medial (atrial) vei n of latera l ventricl e Superior thalamostriate vein Lateral (atria l) vein of latera l ventricle Splenium of corpus ca ll os um Anterior ve in of caudate nucl eus An terior ve in of septum pellucidum Genu of co rpus ca llosum

Straight sinus

/

Occipi ta l (posterior) horn of lateral ventricle

j,

Interventricu lar foramen (Mo nro) Anterior com missure lnterthal am ic adhesion Anterior cerebra l vein Optic chiasm Cerebellum

3rd ventricle Deep middle ce rebra l vein Inferior th alamostri ate veins

/ )../ _,,i

Tempo ral (inferior) horn of lateral ventricle Posterior mesencephalic vein

\

~'"

Superior vermian vein

Hippocampal and inferior ventricu lar veins

Lateral and median apertures of 4th ventricle

CEREBRAL VASCULATURE

Veins on lateral wall of ventricle Veins on medial wall and floor of ventricle All other veins

PLATE 139

Hypothalamus and Hypophysis SEE ALSO PLATES 700, 707 Septum pellucidum Thalamus Fornix Hypothalamic sulcus Anterior commissure

Posterior ----2"""""'---'~~!!!!!f~:---4---!-__: Do rsom edi al----~--,--_,.ll:,...,-'--'-4-h---

Principal nuclei of hypothalamus

Supraoptic ----"',::::;;;l~~.-c-i------;-""';;; Ventromedial-~-.:_----~--;;l

Arcuate (infundibularr J)-~==~~~;:=-~~,c:_-~t:~ MammillaryMammillothalamic tract

Infundibulum (pituitary stalk)

Dorsal longitudinal fasciculus and other descending pathways

Paraventricular hypothalamic nucleus Supraoptic hypothalamic

Tuberohypophyseal tract Hypothalamohypophyseal tract

--+--Mammillary body

Infundibulum (pituitary stalk) Arcuate (infundibular) nucleus

Adenohypophysis (anterior lobe of pituitary gland)

PLATE 140

Fibrous trabecula

Neurohypophysis (posterior lobe of pituitary gland)

HEAD AND NECK

Arteries and Veins of Hypothalamus and Hypophysis SEE ALSO PLATE 133

'12~~---- Pr i mary plex us of

hypophyseal po rtal system Superio r hypophyseal artery

Long hypop hysea l portal ve ins

A rte ry of trabecul ort hypophysea l porta l vein s Trabecu la (fibrous tissue) Effere nt hypop hyseal vein to cavernous sinu s

Efferent hypophysea l vein to cavern o us sinus

Secondary plexus of hypophyseal porta l system

Capi ll ary plex us of infundibul ar process

Inferior hypophyseal artery Effere nt hypophyseal veins to caverno us sinu s

CEREBRAL VASCULATURE

PLATE 141

;cl,

{ '

Section II

BACK AND SPINAL CORD

BONES AND LIGAMENTS Plates 142 - 147

142. Vertebral Column 143. Thoracic Vertebrae 144. Lumbar Vertebrae 145. Sacrum and Coccyx 146. Vertebral Ligam ents: Lumbar Region 147. Vertebral Ligam ents: Lumbosacral Region

152. Autonomic Nervous System: General Topography 15 3. Autonomi c Nervous System: Schema 154. Cholinergic and Adrenergic Synapses: Schema 155. Spinal Membranes and Nerve Roots 156. Spinal Nerve Origin: Cross Sections 157. Arteries of Spinal Cord: Schema 158. Arteries of Spinal Cord: Intrinsic Distribution

SPINAL CORD Plates 148 - 159

159. Veins of Spinal Cord and Vertebral Column

148. Spinal Cord and Ventral Rami In Situ 149. Relation of Spinal Nerve Roots to Vertebrae

MUSCLES AND NERVES Plates 160- 166

150. Dermatomes

160. Muscles of Back: Superficial Layers

151. Spinal Cord Cross Sections:

161. Muscles of Back: Intermediate Layers

Fiber Tracts

162. Muscles of Back: Deep Layers

ATLAS OF HUMAN ANATOMY

SECTION II: BACK AND SPINAL CORD

163. Nerves of Back 164. Subocc ipital Trian gle 165. Lumbar Re gion of Back: Cross Section (Superior View) 166. Typical Thoracic Spinal Nerve

ATLAS OF HUMAN ANATOMY

Vertebral Column SEE ALSO PLATES 9, 72, 73, 743, 744, 745, 770, 23 7 Anterior view

Left lateral view

Posterior view

Cervical vertebrae

Thoracic vertebrae

Lumbar ve1·tebrae

Sacrum (51-5)

©JiliN : ~·.·.·.': :

BONES AND LIGAMENTS

PLATE 142

Thoracic Vertebrae SEE ALSO PLATE 172 Body

uperior articul ar process and facet

Superi o r costa l face t

Transve rve costal facet

Superior ve rte bral notch (fo rm s lower margin of interverteb ral fo ramen ) - - ----'11

Sup eri o r costal facet - - - I n ferior articular process Transve rse costal face t

T6 vertebra: lateral view T6 vertebra: superior view Superior arti cular process and facet uperi o r articu lar process and face t

Tr ansve rse process

Costa l face t Inferior arti cul ar process and fac

T12 vertebra: lateral view Transv erse process of T9 vertebra Inferi or articular process (T9)

La min

'·fl)

/~

I

.... '

©J@N •........:: : ~

T7, T8 and T9 vertebrae: posterior view

PLATE 143

BACK AND SPINAL CORD

Lumbar Vertebrae

Ve rtebral body N ucle us pu lposus --H~*"'---,-...,...,...~

Verteb ral foramen

Transverse process

Intervertebral disc

Ma mmill ary process

Superi o r articular process Sp ino us process Ma mmill ary process

L2 vertebra: superior view

Transve rse process Spin ous process

Vertebral bo

Vertebral ca nal ----... Supe ri o r arti cul ar process

In te rverteb ral disc

t--~-.r-- ln fe ri o r

articul ar process

Ma mmill ary proces ~,---Jill- Int e r ve rt e bra l

foramen - - - - - - S u peri o r ve rteb ral notch

Inferi o r articul ar process

L3 and L4 vertebrae: posterior view

BONES AND LIGAMENTS

Lumbar vertebrae, assembled: left lateral view

PLATE 144

Sacrum and Coccyx SEE ALSO PLATES 742, 74 7, 23 7, 330, 33 7, 332 Superior articul ar proces s

Base of sacrum

acral canal

Ala (late ral part) Superio r arti cul ar process Ala (win g) Promonto

Sacral pa rt of pe lvic brim (l in ea te rmin alis )

Anterior (pelvic) sacral foram in a Tran svers e

Median sagittal section

rid ges ----~'\':

,,....._.._ 11>..

Coccyx

Anterior inferior view

Pelvic surface

4,,~ t1·

Sacral tube

©II§N :•.·:::: : M edian sacral crest Interm ed iate sacral crest

Posterior sacral foramina -..r---sacral co rnu (horn) Sacra l hi atu s A nterior (pelvic) sacral fo1·am en

Coronal section through S1 foramina

Dorsal surface

Transve rse process of coccyx

Posterior superior view

PLATE 145

BACK AND SPINAL CORD

Vertebral Ligaments: Lumbar Region

Left lateral view

Inferi o r arti cular process

(partially sectioned in median plane)

Caps ul e of zyga pophyseal joint (partially opened)

Anterior longitudina l li gament

Superi o r articular process Transve rse process

Li ga mentum flavum Intervert eb ral disc In te rsp in o us li gament Ante ri or lo ngitudin alli "'" '""PnT'

rasp in ous ligament Interverteb ral foram en

Posteri or longitudin al li ga ment - -4--'

Posterior vertebral segments: anterior view Anterior vertebral segments: posterior view

(pedicles sectioned)

Pedicle (cut surface)

Posterior surface of ver teb ral bod ·

Poste ri or longitudinal li ga ment

Superi or articular process

Interverteb ral disc

Transverse process

In fer io r arti cular facet

BONES AND LIGAMENTS

PLATE 146

Vertebral Ligaments: Lumbosacral Region

Superior articular process

Anterior lo ngitudin al li ga men t - - - ---!111.'

Transverse process

Pedicle (c ut)

Inferi or arti cular process

Body of L1 vertebra

Posteri o r longitudina l li gam ent

Interverteb ral foramen In tervertebra l discs - - - -1!r"!7'Intersp in ous li ga ment Supraspinous li ga ment

nerv e

Superior arti cular processes; facet tropism (d ifference in facet axis) on right s id e --~..!!!:._"' Sp in ous process

Body o f LS vertebra

Ili olum ba r li ga men

LS sp ina l nerve

iliac cres t

Au ri cul ar surface of sa crum (fo r articulation with ilium )

Posterior supe ri or ili ac sp in e - --:'i-.,..-:'-;,-1---

Left lateral view

Posteri o r sacroiliac ligaments Greater sciatic foramen

Sacrospinous li ga ment sacrococcygea l li ga ments

Lesse r sciati c foram en

©ll!.iN :·.·.·::: :

PLATE 147

Sacrotuberou s ligament

Posterior view

BACK AND SPINAL CORD

Spinal Cord and Ventral Rami In Situ

C l ve rteb 1·a (atlas) Cervi ca l plexus C2 vertebra (axis) Tl ve rtebra Brachi al plex us

vertebra

Ll vertebra

Iliohypogastri c nerve

Ilioin guin al nerve

Cauda equina

Sacrum (cut away) Intern al term in al filum (p ial part)

: - - - ; - - - Sup eri o r and inferior glutea l nerves

Termin ation of dural Externa l termin al fi lum (d ural part)

Pudend al nerve

©IWN ·.·:.·.·! : ~

SPINAL CORD

PLATE 148

Relation of Spinal Nerve Roots to Vertebrae

it.-A;....--- c 1 { C1 spin al nerve exits above C 1 vert ebra

rr~~-- c2

ni"~~-- c3

Ce rvical enlargement - - - - - - - t t "

51

Lumbar eli se pro tru sion does not usu ally affec t nerve exitin g above eli se. Lateral protrusio n at eli se leve l L4-5 affects LS spinal nerve, no t L4 spin al nerve. Pro tru sion at elise leve l LS- 51 affects 51 spin al nerve, no t LS spinal nerve

Lum ba r enl arge ment Conu s meclull ari s (termin atio n of spinal co rd)

lntem al terminal filum (pi al pMt)----~.._H IIII M ,~.....,.....,....:....-- L4

Exte m al termin al filum (dural pa rt) - - - - - - - '':11

-

PLATE 149

Cervical nerves Thoracic nerves lumbar nerves Sacral and coccygeal nerves

Medial pro tru sion at disc level L4-5 rar ely affects L4 spin al nerve but may affect LS spinal nerve and som etim es 51-4 spin al nerves

BACK AND SPINAL CORD

Derma tomes SEE ALSO PL ATES 457, 507; FOR MAPS OF CUTANEOUS NERVES SEE PLATES 78, 447, 443, 444, 445, 447, 450, 502 - 506

Schematic demarcation of derm ato mes shown as distin ct segments. Th ere is actu ally consid erabl e ove rla p between any two adj acent derm ato mes

Levels of principal dermatomes CS

CS, 6, 7 C8, T1 C6

C6, 7, 8 C8 T4

SPINAL CORD

Clavicles Lateral pa rts of upper limbs Medial sides of upper limbs Thum b Hand Ring and littl e fin ge rs Leve l of nippl es

T10 T12

Ll, 2, 3, 4 L4, 5, 51 L4 51, 2, l5 51

52, 3, 4

Level of umbili cus In guin al or groin regi o ns Anteri or and inn er surfaces of lower limbs Foot Med ial side of grea t to e Pos teri o r and o uter surfaces of lowe r limbs Lateral margin of foot and littl e toe Perin eum

PLATE 150

Spinal Cord Cross Sections: Fiber Tracts Sections through spinal cord at various levels Dorsal medi an sul cus

Lateral ho m of gray matter (intermed iolate ral nucleu s)

Gray matter

T8

L1

Principal fiber tracts of spinal cord

52

L2

-

Ascending pathways

-

Descending pathways

-

Fibers passing in both directions Septomarginal fasciculu s (ova l bundle)

Dorsa l { Gracil e fasciculu s column system Cun eate fao'-'. '-L"u"' Dorso late1·al fasciculus (trac t o f Lissa uer) --------.,~ Posterior (dorsa l) sp in oce rebe llar tract - - --rf:-

Interfascicul ar (sem ilun ar) fasciculus Late ral co rtico spinal (pyramid al) tract Rubrospinal tra ct Med ullary (late ral ) reti culospinal tract

A nteri o r (ventral ) sp inoce rebe llar tract

Pontoreticul osp in al (media l reticulo spinal) tract

Antero late ral system (ALS) includ es sp in othalam ic, sp in o reticul ar, sp i no m ese ncephalic (sp in otectal ) and sp in ohyp othalami c fi

,z;..,.=-- --::::i<---Anterior (ventral ) cor ti cospinal tract

Spinooliva ry tract Fascicul i proprii

PLATE 151

Medial lo ngitudin al (sulcomargin al) fasc iculi

BACK AND SPINAL CORD

Autonomic Nervous System: General Topography

Cili ary gangli on Pterygop alatin e ga nglion G lossopha ryngea l nerve (I Chorda tympani nerve In te rnal carotid nerve and pl ex us Sup erior ce rvical sympathetic gan gli o n C4 spinal nerve Middl e ce rvical sympathetic ga ngli on

Lingual nerve Submandibul ar ga ngli on Ph aryngea l and superi o r laryngea l bra nches of vagus nerve Recurrent laryngea l b ranch of vag us nerve

Cer vicothoracic (s tell ate) ga ngli o n Sy mp ath etic trun k Cervical (sympatheti c) card iac nerves

l

Supe rior . dl M1d e In fe ri or

Thoraci c (sympathetic) cardiac 6th interco sta l nerve (ve ntral ramus of T6 spinal nerve) -----"

Superi or cervical } Cardiac branches lnfenor cerv1cal of vagus nerve Th o racic Ca rdiac pl exus Ap ntterior } Pu lm onary p lexuses os eno r Esop hageal plexus Thora cic ao rti c p lex us

Posterior vaga l trunk 6th thoracic sympatheti c ga ngli o n Gray and wh ite rami communi ca ntes G reater sp lanchni c nerve Lesse r spl anchni c nerve Lea st sp lanchni c nerve

Superi or mesente ri c ga ngli o n Superi o r mese nteric arte 1·y and pl ex us lnterm esen teric (a bdomin al ao rti c) pl ex us Inferi or mese nteric ga nglion

G ray rami com muni Sacra l sp lanchnic nerves (sympathetic Pelvic splanchnic nerves (sacra l parasympathetic outflow) - - - - - - -- f,_,.!L

Inferi o r mese nteri c artery and p lex us Superi o r hypogas tri c pl exus Para sympatheti c branch from inferior hypogastric pl exus to descending co lo n H ypogastri c nerves

Vesical pl exus

- - - - Sympathetic fibers - - - - Parasympathetic fibers

SPINAL CORD

Prostatic plexus

PLATE 152

Autonomic Nervous System: Schema

Oculomotor nerve (111)---;?'----~S....--. Facial nerve (VII) Glossopharyngeal nerve (IX) Medulla oblongata

Pulmonary plexus

~ ~

Sweat ..

gland

\ T \

\

---------Superior mesenteric ganglion Arrector (smooth) muscle of hair follicle Note: Above three structures are shown at only one level but occur at all levels

-:;-;--------Inferior mesenteric ganglion

~~::-;~~,i~

r:;;:::----~·J--~~~~:__~::::~-------- Superior

hypogastric plexus

Note: Blue-shaded areas indicate zones of parasympathetic outflow from CNS

- --=::::--------Inferior hypogastric plexus Sacral splanchnic nerves

Pelvic splanchnic nerves

Sympathetic { Presynaptic

Parasympathetic { Presynaptic

fibers

fibers

PLATE 153

Postsynaptic

Postsynaptic

Antidromic conduction

BACK AND SPINAL CORD

Cholinergic and Adrenergic Synapses: Schema

Parotid gland

Internal carotid nerve Medulla oblongata Vagus nerve (X)

..,,,' -----------,,, ,-

______ ....

I

~

I I I I

I

Hair follicles Thoracic part of spinal cord

Visceral arteries Upper lumbar part of spinal cord (L 1-2 [3])

Sacral part of spinal cord

Gastrointestinal tract

Pelvic splanchnic nerves Urinary bladder

Cholinergic synapses

Urethra Prostate

Adrenergic synapses

Sympathetic { Presynaptic fibers Postsynaptic

SPINAL CORD

Parasympathetic { Presynaptic fibers Postsynaptic

Somatic fibers Antidromic conduction - - -

PLATE 154

Spinal Membranes and Nerve Roots

Posterior view

Ven tral root of spina l nerve Do rsa l root of sp in al nerve Sp inal sensory (dorsal root) ga ngli on W hite and gray rami co mmun ica ntes to an d from sympathetic trunk

Dorsal ramu s of sp in al nerve

Dura mater

A ra chnoid - - - - - -41--_::._mater

Meso th eli al septum in dorsa l m ed ian su lcus

Fil aments of do rsal root D enticu late li gament

Membranes removed: anterior view (greatly magnified) Gray m atter----z White matter - --r::-::JO Dorsa l root of sp in al nerv e Filam ents o f ve ntral root

Dorsal ramus of sp inal nerve Ventral ramu s of spinal nerve al root of spina l nerve

Gray and w hi te rami commun ica ntes n

(·

~.

©'·~N

PLATE 155

BACK AND SPINAL CORD

Spinal Nerve Origin: Cross Sections SEE ALSO PLATES 154, 155, 158, 159 Section through thoracic vertebra Body of vertebra

Fat in ep idural space

D ura mater

Sympath etic ga ngli on

Arachn oid mater* Ventral

Recurrent m enin gea l branches of spin al nerve

Sp in al nerve -------.. Ventral ramus (intercos tal nerve) Do rsa l ramu s

Spinal sensory (do rsa l root) ga ngli o n D o rsal root Late ral horn of gray matter of sp in al co rd

Section through lumbar vertebra

D ura mater G ray ra mus co mmu nica ns

Arachn o id mater

l

of do rsa l ram us o f spinal Medial branch } nerve Late ral branch

Intern al ve rtebral (epidura l) ve no us p lexus

Ve ntral roo t

Dorsa l and ventral roots of lumbar and sacral sp in al nerves fo rming ca uda equin a

Spina l senso ry (do rsal roo t) ganglion

* Leptome nin ges

SPINAL CORD

PLATE 156

Arteries of Spinal Cord: Schema SEE ALSO PLATE 131

Anterior view

Posterior view Pos terio r inferior cerebel lar artery

Posterior cerebral artery Superior cerebe llar artery

Vertebra l artery

cervical artery

Asce nding cervic al arte ry Ascend in g cerv ical artery - - - - - - - - - " D ee p cervical a Subclavian artery 1------Posterior segmental medu ll ary arteries

Posteri o r intercostal a1·tery

Thoracic ve rtebrae

:--.«..-=-- - + - - Posterior intercostal arteri es

Major anterior segmental medullary artery (artery or~f-----~~'I!J.d~~~ Adam ki ewicz)

::rt;~--

Posterior segmental medu ll ary arteries

'!~ \ \~---- A n as to motic

loop s to anterior spinal artery

Lumb ar vertebrae

Lumbar arteri es

A nas tomotic loops to poste rior sp in al arteri Ca uda equina arte · Late ral (o r m ed ial) sacral arterie s- - - - -fl Sacrum

Note: A ll spinal nerve roots have associated radicular or segmental medullary arteries. Mos t roots have rad icular arteri es (see Plate 158). Both ty pes of arteries run along roots, but radi cular arteri es end before reaching anle ri o r or posterior sp in al arte ri es;

large r segmental medull ary arte ri es conti nu e on to supply a segment of these arte ri es

PLATE 157

BACK AND SPINAL CORD

Arteries of Spinal Cord: Intrinsic Distribution

Anterior spin al artery Anterior segme ntal medull ary artery Anterior radi cular artery Poste rior radi cular artery Bran ch to verteb ral bod y and dura mater

Dorsal branch of posterior intercostal arte ry Posterior intercostal artery

Preve rtebral anas tomoses Thorac ic (d esce ndin g) aorta

Section through thoracic level: anterosuperior view

Sulcal (central) branch es to right side of spinal co rd Posterior radicul ar arte ry

Sulcal (centt·a l) branches to left si de of sp in al cord Left posterior sp inal artery

Pial ar terial plexus

Zone suppli ed by penetrating branches from pial plexus Zo ne suppli ed by central branch es

Anterior and posterior rad icular arteries----~-,.Q;.

Zo ne supplied by both ce ntral branches and branch es from pi al plexus Posterior radicul ar artery

Arterial distribution: schema

No te: All sp inal nerve roo ts have asso ciated radicular or segmental medullary arteries . Most roo ts have rad icul ar arteri es. Both types of arteries run along roots, but rad icular arteri es end

Ante rior segmental medullary artery Pial arterial plexus

be(or e reachin g anterior or posterior sp in al art eries; large r segmental

m edull ary arteri es continue on to supp ly a segment o f th ese arteries

SPINAL CORD

PLATE 158

Veins of Spinal Cord and Vertebral Column

Posterior in ternal vertebral (ep idural) venous plexus Ante ri or extern al vertebral ve nous plexus- - - - - '

In tervertebra l vein

Basivertebra l ve in

Anteri o r extern al ve rtebral veno us p lexus Basivertebra l vei n Anterio r intern al vertebra l ( pidural) venous p lex us A nterior and posterior segmental med ull ary/ rad icu lar ve in s

Ante ri or spinal ve i Anterior sulca l (cen tral ) vein

Basiverteb ral ve in Anterior intern al ve rtebral (ep idural) venous pl ex us

Posterior intern al vert ebral (ep idural) ve nous p lex us Posteri o r ex ternal ve rteb ral venous plexus

Posteri or segmental m ed ullary/ radi cul ar vein Pi al venous plexus Poste rior su lca l (centra l) vein

Posterior intern al ve rtebral (ep idural) ve nou s p lexus

____________ ______-----------------------------------,

PLATE 159

BACK AND SPINAL CORD

Muscles of Back: Superficial Layers ---·-----

Superior nu chal lin e of skull Spinous process o f C2 ve rteb ra Sternocleidom as toid mu scle

Trapeziu s mu Spin e of scapul a

Semi spin ali s ca pitis muscle Ieniu s capi tis muscle Spino us process of C7 vertebra

Levato r scap ul ae mu scle Rh o mboid minor muscle (c ut)

Delto id muscl e

Te res majo r

m usci e - - ----11

Lati ssimus do rsi muscl e Ter es min o r and maj o r mu scl es Lati ssimus dorsi muscle (c u t)

Exte rnal o bliqu e m

Intern al o blique mu scl e in lumbar tri angle (Petit)- - - - - - - - --#},

G lutea l apo neurosis (over glu teus mediu s 1

MUSCLES AND NERVES

Erecto r spin ae muscl e

In te rn al ob liqu e mu scl e

PLATE 160

Muscles of Back: Intermediate Layers

Superio r nu chal li ne of sku ll Poste ri or tubercle of atl as (Cl)

Rectus ca pitis posterior minor mu scl e Ob li quus ca pitis superior mu scle

Obl iquu s ca pitis inferi o r muscl e Longiss imu s cap iti s muscle Splenius capitis and sp len iu s ce rvicis muscles - - - -

Semi spin ali s ca pitis mu scle (cut)

Se rratus posterior superi or mu scl e Sp inous proces s of C7 ve rtebra Ili ocosta li s mu scle

Lon gissimu s cervicis mu scle ili ocosta li s cerv icis muscl e

Erector sp in ae muscl e

Ili ocostali s tho racis mu scle Hook Sp in ali s thoraci s muscle Lon giss imus thora cis mu scle Ili ocosta li s lumborum muscl e Sp in ous process of Tl2 ve rteb ra

Tendon of o ri gin of transve rsus abdom ini s muscl e

In ternal ob liqu e mu scle - - - - - - - -

Tra nsversus abdominis mu scl e and tendon of origin _ _ _ Th o raco lum bar fasc ia (cu t edge)

Ilia c cres t

PLATE 161

BACK AND SPINAL CORD

Muscles of Back: Deep Layers

Rectus ca pitis posterior minor mu scle

Superior nuch al lin e of sk ull

Obliquus ca pitis superior muscl e Posterior tub ercl e of atla s (C l vertebra) Spinou s process of axis (C2 verteb ra) - - - - - - - - Semispinalis cap iti s muscl e

liquus capiti s inferior muscle Longu s

~

Rotato res ce rvici s muscl es

Brevis Spinous process of C7 verteb ra ----------:

Interspin alis cervi cis muscle

Levato r cos tae muscle Extern al intercosta l mu scl es Rotatores } thoracis muscl es Semispinalis thoracis mu scle - --IfLevatores } cos tarum muscles

Multifidi mu scles

In tersp in alis lumborum mu scl e

Thoracolumbar fasci a (posterior layer) (cut) - - - -

Latera l intertransversarius muscl e

Transversus abdominis mu scle and tendon of origin-------"'-Ili ac crest

MUSCLES AND NERVES

PLATE 162

Nerves of Back SEEALSOPLATES 766, 779,237,24 7 reater occip ita l nerve (do rsal ramu s of C2 spinal nerv e) 3rd occipital nerve (dorsal ramus of C3 sp in al nerv e) Leva tor sca pulae mu scle Su perfi cia l cervical artery (descendin g branch) and vein Subtrapezial plexus

Lesser occip ital ne rve 1/A~--+----urea t auricu lar nerve

J

Cervical plexus (ventral ram i of C2, 3 spi nal nerves)

Poste ri or cutaneous branches (from medial b1·anches of do rsa l ram i of C4- T6 sp in al nerves; C7, 8 are minimal) De lto id muscle Infraspinatus fa scia

Spine of scapula

Teres minor and major muscl es

Infraspin atus fascia---"

Superi o r lateral bra chi al cutaneous nerve (from axillary nerve CS , 6) '·'""- - Poste rior cutaneo us branches (from lateral branches of dorsal ram i of T7-12 spinal nerves)

Rhombo id min o r muscle

Rhombo id major muscl e

Late ral cutaneo us branches of ve ntral rami (intercos tal nerves)

Lati ssimus dorsi mu scle Exte rn al ob liqu e muscl e Sp in ous process of T12 ve l· tebra---~

Th oracolum bM fascia

Ili ohypogastri c nerve (ve ntral ramus of L1 sp in al nerv e) Superi o r cluneal nerves (dorsa l ra mi of L1, 2, 3 spinal nerves)

G lu te us max imus muscl e - - - - - - -

M ed ial cluneal nerves (dorsa l rami o f S1, 2, 3 spinal nerves) Inferior clun ea l nerves from posterior fe mo ral cutaneous nerve (sacral plexus S1, 2, 3)

PLATE 163

BACK AND SPINAL CORD

Suboccipital Triangle

tu s cap itis posteri o r mi no r muscle Rectus ca pitis posteri o r majo r muscl e Epi cranial apo neurosi s (ga lea apo neurotica O ccipital b elly (occipitali s) of occipitofro ntalis muscl e-------.

Semisp in alis capitis mu scle (c u t and reflected)

Vertebral artery (atl antic part)

G rea ter occipital nerve (do rsal ram us of C2 spin al ne

Su boccipital nerve (do rsa l ramu s of C l spinal nerve)

Occipital arter y

Po sterio r arc h of atl as (C l verteb ra)

3rd (least) occipital nerve (do rsa l ramu s of C3 spina l nerve)

Semispin ali s capitis and spleniu s ca piti s mu scl es in pos terio r tri angle o f neck

G rea ter occipital nerve (do rsal1·amu s o f C2 spin al nerve) Spleniu s capiti s mu scl e (cut and reflected ) """- ----~ 3i·d (least) occip ital nerve

G reat auricul ar nerve (cervica l plex us C2, 3

(do rsa l ramu s of C3 sp in al nerve ) Lo ngissim us ca pi ti s m uscl e

Lesser occip ita l nerve (ce rvical plex us C2, 3) Semi spin ali s cervicis m uscle Sternocle idom as to id muscl e

Trapeziu s mu scl

Poste ri o r cutaneou s branch es of do rsal rami o f C4, 5, 6 sp inal nerves - - - - - - - '

Se mi spin ali s capiti s muscl e (cut) pleni us ca pitis muscl e (c u t )

~-©fiDN

:·.·:.·:: :

MUSCLES AND NERVES

PLATE 164

Lumbar Region of Back: Cross Section (Superior View)

Inferior vena cava Pancreas Anterior longitudinal ligament

Descending (2nd) part of duodenum Kidney Renal fascia (anterior and posterior layers) Perirenal fat

Crura of diaphragm Superior mesenteric artery and vein

neum

Abdominal a

Body of L2 vertebra

Lumbar spinal nerve

rna I oblique muscle Cauda equina

Internal oblique muscle Transversus abdominis muscle Spinous process of L1 vertebra

on of origin of transversus abdominis and internal oblique muscles

Erector spinae muscle Thoracolumbar fascia (posterior layer Thoracolumbar fascia (middle layer)

Serratus posterior inferior muscle Latissimus dorsi muscle Quadratus lumborum muscle

Thoracolumbar fascia (anterior layerquadratus lumborum fascia)

PLATE 165

BACK AND SPINAL CORD

Typical Thoracic Spinal Nerve SEE ALSO PLATES 779, 24 7

Anterior cutaneous branch

Medial bran ch

Intern al intercos tal muscle

Innerm ost intercostal mu scle Ventral root Dorsal root

Anterio r branch Intervertebra l foramen

Sp in al se nso ry (do rsa l ro ot) ga ngli o n

tr'LU--J-.---lateral cutaneous branch

Poste ri or branch

Spinal nerve

Sympath etic ganglion Gray and w hite rami commu ni ca ntes Se rratu s anterio r mu scle

Latissimus dorsi mu scle

Teres major muscle

Scapu la

Dorsal ramus

Medial branch

Erecto r spinae mu scle Intern al intercostal membrane No te: In lower thoracic region, later al branch of dorsal ramu s is longe r, motor and cutaneo us; med ial branch is shorter and motor o nly

MUSCLES AND NERVES

PLATE 166

Section Ill

THORAX

MAMMARY GLAND

181. Diaphragm: Abdominal Surface

Plates 167- 169

182. Phrenic Nerve

167. Mammary Gland

183. Muscles of Respiration

168. Arteries of Mammary Gland 169. Lymph Vessels and Nodes of Mammary Gland

LUNGS Plates 184 - 199 184. Topography of Lungs: Anterior View

BODY WALL Plates 170- 183

185. Topography of Lungs: Posterior View

170. Bony Framework of Thorax

186. Lungs In Situ: Anterior View

171. Ribs and Sternocostal Joints

187. Lungs: Medial Views

172. Costovertebral Joints

188. Bronchopulmonary Segments

173. Cervical Ribs and Related Anomalies

189. Bronchopulmonary Segments

174. Anterior Thoracic Wall

(continued)

175. Anterior Thoracic Wall (continued)

190. Trachea and Major Bronchi

176. Anterior Thoracic Wall: Internal View

191. Nomenclature of Bronchi: Schema

177. Posterior and Lateral Thoracic Walls

192. Intrapulmonary Airways: Schema

178. Posterior Thoracic Wall

193. Intrapulmonary Blood Circulation:

179. Intercostal Nerves and Arteries 180. Diaphragm: Thoracic Surface

Schema 194. Pulmonary Arteries and Veins

- - - - -· - - - - ----------..---· ATLAS OF HUMAN ANATOMY

SECTION Ill: THORAX

195. Great Vessels of Superior Mediastinum

212. Atria, Ventricles and Interventricular Septum

196. Bronchial Arteries and Veins

213. Conducting System of Heart

197. Lymph Vessels and Nodes of Lung

214. Nerves of Heart

198. Autonomic Nerves in Thorax

215. Innervation of Heart: Schema

199. Innervation of Tracheobronchial Tree:

216. Innervation of Blood Vessels: Schema

Schema

217. Prenatal and Postnatal Circulation

HEART

MEDIASTINUM

Plates 200- 217

Plates 218-230

200. Heart In Situ

218. Mediastinum: Right Lateral View

201. Heart: Anterior Exposure

219. Mediastinum: Left Lateral View

202. Heart: Base and Diaphragmatic

220. Esophagus In Situ

Surfaces 203. Pericardia! Sac

221. Topography and Constrictions of Esophagus

204. Coronary Arteries and Cardiac Veins

222. Musculature of Esophagus

205. Coronary Arteries and Cardiac Veins:

223. Pharyngoesophageal Junction

Variations 206 . Coronary Arteries: Arteriographic Views 207. Coronary Arteries: Arteriographic

224. Esophagogastric Junction 225. Arteries of Esophagus 226. Veins of Esophagus 227. Lymph Vessels and Nodes

Views (continued)

of Esophagus

208. Right Atrium and Ventricle

228. Nerves of Esophagus

209. Left Atrium and Ventricle

229. Intrinsic N erves and Variations

210. Valves and Fibrous Skeleton of Heart 211. Valves and Fibrous Skeleton of Heart (continued)

ATLAS OF HUMAN ANATOMY

in Nerves of Esophagus 230. Mediastinum: Cross Section (Superior View)

Mammary Gland

Suspenso ry li game nts (Cooper)

Anterolateral dissection

reo la r gland s Pectorali s major mu scle - - - -.,..-:h! (deep to pectoral fascia) Serra tus a nterior mu scle Exte rn al ob liqu e mu scl e -----..

Pectoralis major muscle-----' Areo la Pectoral fasc ia-----,...,.

ippl e

Inte rco sta l muscle s ------.:;;:;~

Suspenso ry li gaments (Coo per)

Inte rcosta l vesse ls a nd ne rve - - - - - - : ;""""!

Gland lobu les

Sagittal section

MAMMARY GLAND

PLATE 167

Arteries of Mammary Gland

Subclavian artery Intern al th o racic artery and its perfo ratin g branch es M edial mammary branches Ax ill ary arte ry

Lateral tho racic arte and Lateral m amm ary br a n c h es ----~

Late ral ma mmary branches of lateral cuta neous branches of posterio r intercos tal arterie s

PLATE 168

THORAX

Lymph Vessels and Nodes of Mammary Gland

lnterpectoral (Rotter's) n

Apical (subclavian) axillary nodes

Subscapular (posterior) axillary nodes Pectoral (anterior) axillary nOU!~S---'

Pathway to anterior mediastinal nodes

Pathways to opposite breast Pathways to inferior phrenic (subdiaphragmatic) nodes and liver

MAMMARY GLAND

PLATE 169

Bony Framework of Thorax SEE A LSO PLATE 23 1 Anterior view

Sternum

Xiph o id pro cess

Scapula

Subscapul ar fossa - - - - ' Clavicle

Fl oatin g ribs (11 - 12)

Posterior view

Scap ul a In fra spino us fossa

> - - -True ribs (1-7)

©JI!!N '....: .·: : ~

~--F a l se

ribs (8- 12)

Floatin g ri bs --""-..)o"'l'• (11-12)

PLATE 170

THORAX

Ribs and Sternocostal joints

Muscle attachments Origins

1st left rib: superior view

Neck

Insertions

Tub ercl e (no angle)

Middle rib: posterior view

ngle

An gle

superior view

Articular face ts for vertebral body

Cos tal groove

Note: Th e head of a typi ca l rib articul ates w ith th e superi o r co stal face t o f the thoracic vertebra o f the same number (by its inferi o r arti cular fa ce t), th e inferi o r costa l facet of th e vertebra numbered on e num ber lower (by its superior fa ce t) and th e intervertebral di sc between the two ve rtebrae. Th e costa l tubercl e arti culates with th e transv erse pro cess of th e vertebra o f th e same number Costal ca rtil ages

lntercho ndral joints

process Cos to xiph oid li ga ment

BODY WALL

Sternocostal articulations: anterior view

PLATE 171

Costovertebral joints SEE ALSO PLATE 743 Anterio r longitud inal li ga men t Inferior costa l facet (fo r head of rib one number higher) - - - - - -

Tr ansverse cos tal facet (for tub ercl e of rib of sa me number as ve rtebra)

Lateral costotransve rse li ga ment

Radi ate li ga m ent of head of ri

lntraa rti cular li gam ent Radi ate li ga m ent of head of rib

Synov ial cav iti es

Left lateral view

Superio r costal facet (for head of rib of sa m e number) Tran sve rse process (c ut

Costotransverse li ga ment Lateral costo transv erse li ga m ent

Transverse section: superior view Rad iate li gament of head of rib

Cos totransv erse li gament

Lateral cos totransve rse li ga ment

Sup eri or costotransverse li ga ment

lntertran sve rse li gament

Right posterolateral view

PLATE 172

THORAX

Cervical Ribs and Related Anomalies SEE ALSO PLATES 28, 400, 401

Scalene muscles Ante rio Mid

Cervical rib co mpresses subclavian artery: poststenotic dilation

Cervical rib adheres to 1st thorac ic rib by den se fibrous band

Lowest cord of brachial plexus eleva ted by cervical rib

Rudimentary 1st tho racic rib w ith postfixed brachial plexus

Norm al morphology

Note: Cervical rib also often asymptomatic

BODY WALL

PLATE 173

Anterior Thoracic Wall

Sternocl eidomastoid muscle Posteri o r triangle o f 1

Perforating branches o f intern al thoracic artery and anterior cutaneo us branches qf intercos tal

Sternothyroid muscl e ~ Invested by Sternohyoid mu scle ce rvical fascia Omohyoid mu scle

Subcl avius mu scle invested by cl avipectoral fasc ia Thot·acoacrom ial artery (p ecto ral branch) and lateral pecto ral nerve

Pecto rali s major muscl

Costocoracoid li gament Coraco id process Deltoid muscle

Med ial p ectoral nerve

Lo ng thoracic nerve and late ral thoracic

Pectoralis minor muscle invested by Clavipectoral fasc ia

Latiss imus dors i muscle

Digitation s of se rratus anterior muscle

D igitations of se rratus anterior muscle

External intercos tal membranes anterior to interna l intercostal muscles

Late ral cuta neo us branch es of intercos ta l nerves and posteri or in te rcostal arteri es

Exte rnal intercosta l mu scles External obliqu e muscle

Body and xiphoid process of ste rnum

A nterior laye r of rectus shea

Intern al obliqu e mu scle Rec tu s abdomini s mu scle

., Nr~.~,. . .

t l

••. j .' ' .,.A•

{- .l./ ©II!!N \'.·:.·.· : :

PLATE 174

Lin ea alba

Cutaneous branches o f thoracoabdom in al (a bdominal portions of intercosta l) nerves and superior epigastric artery

THORAX

Anterior Thoracic Wall (continued)

Omohyoid, stern othyroid and stern ohyoid muscl Clavicl

nal ju gular vein to r sca pu lae mu scl e

Subclaviu s muscl e

Thoracoa cromi al a

Pectora li s major mu scle (cut) De lto id muscl e

Intercostobra chi al

Superio r thor acic artery

Long thoracic nerve and lateral thorac ic arter y

Internal thoracic artery and vein s

Pectorali s minor muscl e

Exte rn al intercosta l muscle

Digitatio ns of serratu s anteri or muscl Lateral cutaneo us branch es of intercostal nerves and posterior intercosta l arteri es - - - - ¥

Transversus th o racis muscle Ante ri or intercosta l branches of intern al thoracic ar tery

Extern al intercostal muscl es In tercostal nerve Extern al in tercos tal membranes anteri o r to interna l in tercosta l mu scl es

Musculophreni c artery and vein Transversus abdom ini s muscl e

Rectus abdo mini s muscle and shea th (cut)

BODY WALL

Supe ri o r epi gastri c arteri es and vein s

PLATE 175

Anterior Thoracic Wall: Internal View

Sternothyroid muscl e

M anubrium of sternum

nferior thyroid arte ry Ante ri or scalene muscl Subclavian artery and vein

Vertebra l artery Brachiocephalic trunk Subclav ian artery and vein Brachiocephali c ve in

Brach iocepha li c ve in Phren ic nerve and perica l-diacophrenic arte ry an d vein - - - - - -:!>

A nterior in tercosta l arteries and ve in s and intercostal nerve

Intern al thoracic artery and ve in---li~~i-'...:...,~ Anterior in tercostal arteries and veins and intercostal nerve Perforating branches of in terna l thoracic artery and ve in and anterio r cutaneous branch of intercosta l Co llateral branches of intercosta l artery and vein - - - - - ', Body of sternum Sternocosta l triangle ----~

Slips of costa l origin of diap hragm Musculophreni c artery and vein

Transve rsus abdom ini s mu scle

Xiphoid process

PLATE 176

Superior epigastric artery and veins

THORAX

Posterior and Lateral Thoracic Walls SEE ALSO PLATES 760, 76 7, 762

Spl en iu s ca pitis and ce rvi cis muscles Posteri or scalene mu scle

Extern al intercos tal mu scl es Th oracolu mbar fascia over erecto r sp in ae muscl e

Ex ternal intercostal muscles

Erector sp in ae muscl e cut away to revea l levato res cos tarum and transversospin ales muscles Serratus posteri or inferi o r mu scle Digitatio ns of externa l ob lique muscl e Intern al obliqu e mu scle Tend on o f origin of transve rsus abdominis m uscle

Trans ve rsus abdomini s muscle---+

Sca lene muscl es

l

Subcl av ian artery and ve in Superior tho racic artery Extern al intercostal membrane anteri or to in te rn al in te rcos tal mu scl e Perforatin g b ranch of in te rn al thoraci c artery and anterio r cutaneous b ranch of in tercostal nerve

Scapul a (retracted) scapu lari s muscle

In tercos tobrach ial nerve Ex ternal in tercosta l muscl e

Long thoracic ne1·ve

Lateral thoracic ae rtery Late ral cutaneo us branch es of intercosta l nerves and posterior inte rcos tal arteri es Serratus anteri o r mu scl e

-·----·--

------

BODY WALL

PLATE 177

Posterior Thoracic Wall

plenius capitis muscle External occipital protuberance

ator scapulae muscle

Sternocleidomastoid muscl

Trapezius muscle

omboid major muscle Supraspinatus muscle

Infraspinous fascia

Deltoid muscle

Teres major muscle----Spinous processes of thoracic vertebrae

Latissimus dorsi muscle (cut)

Latissimus dorsi muscle

External oblique muscle----<:_

Lower digitations of serratus anterior muscle

Digitations of external oblique muscle

Lumbar t1·iangle (Petit) with internal oblique muscle in its floor Serratus posterior inferior muscle Iliac cres

Thoracolumbar fas c ia over deep muscles of back (erector spinae) Posterior cutaneous branches (from Medial Lateral } medial and lateral branches of dorsal rami of thoracic spinal nerves)

PLATE 178

THORAX