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AIIAS OI
Fourth Edition

FrankH.Netter,
MD

Atlasof

Human Anatomy

Gonsulting Editors

JenniferK. Brueckner,PhD
AssistantProfessor
Department
of Anatomyand Neurobiology
University
of KentuckyCollegeof Medicine
Lexington,
Kentucky

NoelleA. Granger,PhD
Professor
Biology
Department
of Celland Developmental
of NorthCarolinaSchoolof Medicine
University
ChapelHill,NorthCarolina

StephenW. Garmichael,PhD, DSc


Professor
Surgery
of Anatomyand Orthopedic
Departments
MayoClinic
Minnesota
Rochester,

John T. Hansen,PhD
and Anatomy
Professorof Neurobiology
AssociateDeanfor Admissions
Schoolof Medicineand Dentistry
of Rochester
University
NewYork
Rochester,

ThomasR. Gest,PhD
AssociateProfessor
Divisionof Anatomical
Sciencesand Department
of MedicalEducation
of MichiganMedicalSchool
University
AnnArbor,Michigan

AnilH. Walji,MD,PhD
Professorand Director,Divisionof Anatomy
lmaging
and Diagnostic
of Radiology
Professor
Professorof Surgery
Facultyof Medicineand Dentistry
Universityof Alberta
Edmonton,Alberta,Canada

SAUNDERS
ELSEVIER

1600John F. KennedyBoulevard
Suite1800
Philadelphia,Pennsylvania19103-2899

Atlas of Human Anatomy


FourthEdition

Editionwith StudentConsultAccess:
Professional
Edition:
International
Edition:
EnhancedInternationalEdition
with StudentConsultAccess:

ISBN-13:978-1-4160-3385-1
ISBN-1O:
1-4160-3385-8
ISBN-13:978-1-4160-3699-9
ISBN-10: 1-4160-3699-7
ISBN-13:978-0-8089-2384-8
ISBN-10: 0-8089-2384-6
ISBN-13: 978-0-8089-2379-4
ISBN-10: 0-8089-2379-X

Copyright @ 2006, 2003, 1997, 1989 by Saunders, an imprint of Elsevier lnc.


All rights reserved. No part of this book may be producedor transmittedin any form or by any
means,electronicor mechanical,includingphotocopying,recording,or any informationstorage
and retrievalsystem,without permissionin writingfrom the publishers.Permissionsfor Netter
Art figuresmay be sought directlyfrom Elsevier'sHealthScienceLicensingDepartmentin
Philadelphia,
Pennsylvania,
USA:phone1-800-523-1649,
ext.3276,or215-239-3276;
email:
H.Licensing@elsevier.com.

NOTICE
Neitherthe Publishernor the Editorsassume any responsibility
for any loss or injuryand/or
damage to persons or property arisingout of or relatedto any use of the materialcontained in
this book. lt is the responsibility
of the treatingpractitioner,
relyingon independentexpertise
and knowledge of the patient, to determinethe best treatment and method of applicationfor
the oatient.
Previouseditionscopyrighted2003, 1997, 1989.

AcquisitionsEditor: Anne Lenehan


DevelopmentalEditor: Marybeth Thiel
Publishing Services Manager: Frank Polizzano
Senior Project Manager: Cecelia Bayruns
Design Direction: Louis Forgione
lllustrationManager: Cecilia Nuyianes
Cover Design Concept: Madelene Hyde
Marketing Manager: Megan Poles

'Working

togetherto grow
librariesin developingcountries
www.elsevier.com I wwwbookaid.org

Printedin the UnitedStatesof America.


L a s t d i g i t i s t h e p r i n t n u m b e r 9:

7 6

3 2

I wwwsabre.org

To my dear wife, Vera

Head and Neck


Superficial Face

Oral Region

Plates 23-26

Plates 5l-62

2s SuperficialArteries
andVeins
ofFace
andScalp

5r

24 Cutaneous
Nerves
of Head
andNeck

52 Roofof Mouth

2s Facial
Nerve
Branches
andParotid
Gland

of Mouth
53 Floor

26 Muscles
of Facial
Expresssion:
LateralView

Involved
s4 Muscles
inMastication
(continued)
Involved
inMastication
55 Muscles

Neck

56 Teeth
(continued)
s7 Teeth

Plates 27-35

27 Muscles
of NeckLateralView

Inspection
of OralCavity

Muscles
of Neck:Anterior
View

58 Tongue
(continued)
s9 Tongue

x,

Infrahyoid
andSuprahyoid
Muscles

60 Tongue
andSalivary
Glands:Sections

30 Scalene
andPrevertebral
Muscles

6r

3r

Innervation
of MouthandPharynx
62 Afferent

Superficial
Veins
andCutaneous
Nerves
of Neck

Glands
Salivary

32 Cervical
Plexus
inSitu
33 Subclavian
Artery

Pharynx

s4 Carotid
Arteries

Plates 6$73

3s Fascial
Layers
of Neck

Median
63 Pharynx:
Section
64 Fauces

Nasal Region

(Sagittal)
65 Muscles
of Pharynr
Median
Section

Plates

0pened
View
66 Pharynx:
Posterior

36*5O

36 Nose

Posterior
View
of Pharynx
Partially
0pened
67 Muscles

s7 LateralWall
of Nasal
Cavity

68 Muscles
of Pharynx:
LateralView

3a LateralWall
ofNasal
Cavig(continued)
(Nasal
3e MedialWall
ofNasal
Cavity
Septum)

of OralandPharyngeal
Regions
69 Arteries

40 Maxillary
Artery

7r

4r

72 Lymph
Vessels
of Head
andNeck
andNodes

Arteries
of Nasal
Cavity:
Nasal
Septum
Turned
Up

42 Nerves
of Nasal
Cavity:
Nasal
Septum
Turned
Up
(continued)
4s Nerves
of Nasal
Cavity
44 Autonomic
Innervation
ofNasal
Cavity
(V,)andMaxillary
(Vr)Nerves
4s 0phthalmic
(V,)
46 Mandibular
Nerve
4z Nose
andParanasal
Sinuses:
Cross
Section
4g Paranasal
Sinuses
(continued)
4s Paransal
Sinsues
so Paranasal
Sinuses:
Changes
withAge

Atlas of l{uman Anatomy

7o Veins
of 0ralandPharyngeal
Regions
Regions
Nerves
of 0ralandPharyngeal

Vessels
73 Lymph
of Pharynx
andTongue
andNodes

1 Head and Neck


Section
Topographic Anatomy
Plate I

HeadandNeck

Bones and Ligaments


Plales 2-22

Anterior
View
Skull:

Skull:AnteroposteriorRadiograph

LateralView
Skull:

Skull:LateralRadiograph
Midsagittal
Section
Skull:

e
z
e
g
to

Calvaria
View
Base:
Inferior
Cranial
SuperiorView
Base:
Bones
ofCranial
View
Base:
Inferior
Foramina
ofCranial

View
Base:
Superior
ofCranial
Foramina
12 SkullofNewborn
andNeck
of Head
13 BonyFramework
rI

Fossae
Base:Pterygoid
14 Cranial
r5

Mandible

r6 TemporomandibularJoint
r7
r8

CervicalVertebrae:AtlasandAxis
(continued)
Vertebrae
Cervical

Joints
Uncovertebral
Vertebrae:
Cervical
Vertebrae
intheCervical
20 Degenerative
Changes
Ligaments
2r External
Craniocervical
i9

Ligaments
Craniocervical
22 Internal

Atlas of Human Anatomy

Frank H. Netter, MD

rank H. Netterwas born in New York City in 1906. He

Dr.Netter'sworks are among the finest examplesof the use

studied ad at the Art Students League and the of illustrationin the teachingof medicalconcepts.The 13-book
NationalAcademy of Design before enteringmedical Netter Collection of Medical lllustrations, which includes the
school at New York University,where he receivedhis Doctor of greater part of the more than 20,000 paintings created by Dr.
Medicinedegree in 1931. During his student years, Dr. Netter's Netter.became and remainsone of the most famous medical
notebook sketches attracted the attention of the medical faculty works ever published. The Netter Atlas of Human Anatomy, first
and other physicians,allowinghim to augmenthis income by il- publishedin 1989, presentsthe anatomicpaintingsfrom the
lustratingadicles and textbooks. He continued illustratingas a

Netter Collection.Now translated into 16 languages,it is the

sidelineafter establishinga surgicalpracticein 1933,but he ulti- anatomyatlas of choice among medicaland health professions
mately opted to give up his practicein favor of a full-timecom- studentsthe world over.
mitment to art. After service in the United States Army during

The Netter illustrationsare appreciatednot only for their

World War ll, Dr. Netter began his long collaborationwith the aesthetic qualities,but, more importantly,for their intellectual
CIBA Pharmaceutical
Company(now NovartisPharmaceuticals).content.As Dr. Netterwrote in l949 "clarificationof a subject is
This 45-yearpartnershipresultedin the productionof the extra- the aim and goal of illustration.No matter how beautifully
ordinarycollectionof medical art so familiarto physiciansand painted,how delicatelyand subtly rendereda subject may be, it
other medicalprofessionalsworldwide.
is of little value as a medical illustration if it does not serve to
lcon Learning Systems acquired the Netter Collection in make clear some medicalpoint." Dr. Netter'splanning,concepJuly 2000 and continuedto update Dr.Netter'soriginalpaintings tion, point of view, and approachare what inform his paintings
and to add newly commissionedpaintingsby artiststrained in and what make them so intellectuallyvaluable.
the styleof Dr.Netter.In 2005, ElsevierInc. purchasedthe Netter
Collection and all publications from lcon Learning Systems.
Thereare now over 50 publicationsfeaturingthe art of Dr.Netter
availablethrough ElsevierInc.

Frank H. Netter,MD, physicianand artist, died in 1991.

Preface to the First Edition

have often said that my career as a medical artist for al- and even revisionof a number of them in order to make them
most 50 years has been a sort of "command performance" more pertinentto today's ever-expandingscope of medicaland
in the sense that it has grown in responseto the desires surgicalpractice.In addition,I found that there were gaps in the
and requestsof the medicalprofession.Over these many years, portrayalof medical knowledgeas pictorializedin the illustraI have producedalmost 4,000 illustrations,mostly for The CIBA tions I had previouslydone, and this necessitatedmy making a
(now Netfer) Collection of Medical lllustrations but also for numberof new picturesthat are includedin this volume.
ClinicalSymposla.These pictures have been concerned with the

In creatingan atlas such as this, it is importantto achievea

varied subdivisionsof medical knowledge such as gross happy medium between complexity and simplification.lf the
anatomy, histology,embryology,physiology,pathology, diag- picturesare too complex,they may be difficultand confusingto
nostic modalities,surgicaland therapeutictechniquesand clin- read; if oversimplified,they may not be adequatelydefinitiveor
ical manifestationsof a multitudeof diseases.As the yearswent may even be misleading.I have thereforestriven for a middle
by, however,there were more and more requestsfrom physi- course of realism without the clutter of confusing minutiae. I
cians and students for me to produce an atlas purely of gross hope that the studentsand membersof the medicaland allied
anatomy.Thus, this atlas has come about, not through any in- professionswill find the illustrationsreadilyunderstandable,yet
spirationon my part but rather,like most of my previousworks, instructiveand useful.
as a fulfillmentof the desiresof the medicalorofession.

At one point,the publisherand I thoughtit might be niceto

It involvedgoing back over all the illustrationsI had made include a foreword by a truly outstanding and renowned
over so many years,selectingthose pertinentto gross anatomy, anatomist,but there are so many in that categorythat we could
classifyingthem and organizingthem by system and region, not make a choice. We did think of men like Vesalius.Leonardo
adapting them to page size and space and arrangingthem in da Vinci,WilliamHunterand HenryGray,who of course are unlogicalsequence.Anatomy of course does not change,but our fortunatelyunavailable,but I do wonder what their comments
understandingof anatomy and its clinical significancedoes might have been about this atlas.
change,as do anatomicalterminologyand nomenclature.
This
thereforerequiredmuch updatingof many of the older pictures

Frank H. Netter.MD
(1906-1991)

Gontents

Section 1
Anatomy
Topographic
Bones
andLigamenb
SuperficialFace
Neck
Nasal
Region
OralRegion
Pharynx
Thyroid
Gland
andLarynx
0rbitandGontenb
Ear
Meninges
andBrain
Nerves
Cranial
andCervical
Vasculature
Cerebral
Regional
Scans

1
Plate
2
Plates
Plates 23-26
Plates 2 5
Plates 36-50
Plates 51-62
Plates 63-73
Plates 74{;0
Plates 81-91
Plates 92-98
Plates 9S-115
Plates 11ts135
Plates 136-148
Plates 14S-151

Anatomy
Topographic
Bones
andLigamenb
SpinalCord
Muscles
andNerves

152
Plate
plates 1S3_159

Anatomy
Topographic
Mammary
Gland
Wall
Body
Lungs
Heart
Mediastinum
Regional
Scans
Anatomy
Cross-Sectional

181
Plate
Pfates 182-184
Plates 18ts195
Plates 196-210
Plates 211-229
Plates 23F241
242
Pfate
Pfates 24T246

Anatomy
Topographic
Body
Wall
Peritoneal
Cavity
(Gut)
Viscera
(Accesory
Viscera
Organs)

247
Pfate
Plates 24V267
Plates 26F274
Pfates 27Y285
Plates 28F299
Plates 300-317
Plates 318-328
Pfates 32Y347
Plates 34f349
350
Plate

Section2
Plates 160-173
Pfates 171180

Section3

Section4

Vasculature
Visceral
lnnervation
Glands
Kidneys
andSuprarenal
Abdominal
Sections
Regional
Scans

Section 5
Topographic
Anabmy
Bones
andLigamenb
PelvicFloorandContenb
Bladder
Urinary
Vagina,
Uterus,
andSupporting
Sfrncfures
Regional
Transverce
Section
Perineum
andExternal
Genihlia:
Female
Perineum
andExtemal
Male
Geniblia:
Homologues
of Geniblia
Epididymis,
Testis,
andDuctus
Deferens

Restum
Regional
Scans
Vasculafure
Innervation

Plab
Plates
Platm
Plates
Plah
Hate
Platc
Phtes
Plates
Plate
Hatos
Plate
platc

351
3
55
35F364
36S368
3f375
376
377-379
3flH87
388-389
390
391-396
397
399_409
Pfates 10/J-4.17

Section6
Topographic
Anabmy
Shoulder
andAxilla
Arm
ElbowandForearm
WristandHand
Neurcvasculature
Regional
Scans

Plato
Haho
Plabs
Phbs
Habs
Pfatas
Hah

Topognaphic
ftrabmy
HipandThigh
Knee
Leg
AnkleandFoot
Neurovasculature
Regional
Scans

i Plate
Platc
Plabs
Plabe
Plabs
Plabs
Plate

418
419-430
431-435
136-151
452471
17243
4U

Section 7

ion I
KeyFigure
forCross
Sections
References
lndex

48s
48H05
5(H12
51 22
52 37
5$tl6
il7

Head and Neck


Thyroid Gland and Larynx

Meninges and Brain

Plates 74-80

Plates 99-l 15

74 Thyroid
View
Gland:Anterior

99

7i

Arteries
too Meningeal

Thyroid
Gland
Posterior
View
andPharynx:

Veins
andDiploic
Meninges

?6 Parathyroid
Glands

lol

Hematoma
Epidural

7z Cartilages
of Larynx

to2

Veins
Cerebral
Meninges
andSuperficial

zs Intrinsic
Muscles
ofLarynx

t03

7s Actions
ofIntrinsic
Muslces
ofLarynx

Venous
Sinuses
Dural
(continued)
Venous
Sinuses
t 0 4 Dural

Bo Nerves
of Larynx

t05

Lateral
Views
Cerebrum:

MedialViews
Cerebrum:
View
Inferior
t 0 7 Cerebrum:
t06

Orbit and Gontents


Plates 8l-9t

t08

Br Eyelids

r09

Ventricles
of Brain

s2 LacrimalApparatus

Fluid
ofCerebrospinal
Circulation
(Ganglia)
Nuclei
t t o Basal

so Fascia
ofOrbit
andEyeball

tll

Thalamus

EyeMuscles
a4 Extrinsic

112

andFornix
Hippocampus

andVeins
85 Arteries
ofOrbit
andEyelids

r'rs Cerebellum

86 Nerves
of 0rbit

r re Brainstem

s7 Eyeball

Ventricle
andCerebellum
r rs Fourth

andPosterior
80 Anterior
Chambers
of Eye
8e LensandSupporting
Structures

Granial and Gervical Nerves

Arteries
90 Intrinsic
andVeins
of Eye

Plates ttFl35

er

Ir6

Vascular
Supply
ofEye

Ear
Plates 92'8

92

Pathway
ofSound
Reception

93

EarandTympanic
External
Cavity

94

Tympanic
Cavity

95

Bony
andMembranous
Labyrinths
(continued)
BonyandMembranous
Labyrinths

96
g7
98

Orientation
ofLabyrinth
inSkull
(Pharyngotympanic,
Auditory
Tube
Eustachian)

inBrainstem:
Schema
Nerve
Nuclei
Cranial
(continued)
Schema
Nuclei
inBrainstem:
Nerve
117 Cranial
(Motor
Distribution):
Schema
andSensory
Nerves
t t 8 Cranial
(l):Schema
Nerve
0lfactory
(ll)(Visual
Pathway):
Schema
12|' 0pticNerve
(Vl)Nerves:
(lV),andAbducent
(lll),Trochlear
121 Oculomotor
Schema
(V):Schema
Nerve
122 Trigeminal

tt9

(Vll):
Schema
Facial
Nerve
(Vlll):
Nerve
Schema
124 Vestibulocochlear
(lX):
Nerve
Schema
125 Glossopharyngeal
123

(X):Schema
Nerve
Vagus
nerve(Xl):Schema
127 Accessory
(Xll):
Nerve
Schema
l 4 Hypoglossal
126

Plexus:
Schema
Cervical
inNeck
Nerves
r 3 0 Autonomic
14,

t 3'l

Nerves
inHead
Autonomic

Atlas of l{uman Anatomy

Head and Neck


roz Ciliary
Ganglion:
Schema
rse Pterygopalatine
andSubmandibular
Ganglia:
Schema

rlz Arteries
ofBrain:
Lateral
andMedialViews

r34 0ticGanglion:
Schema
rss Taste
Pathways;
Schema

rs

reo Arteries
of Posterior
Cranial
Fossa
Veins
of Posterior
Cranial
Fossa

rru Deep
Veins
ofBrain
rrc SubependymalVeins
ofBrain

Gerebral Vasculature

rlz Hypothalamus
andHypophysis

Plates 136-148

rre Arteries
andVeinsof Hypothalamus
andHypophysis

r se Arteries
to Brain
andMeninges
rsz Veins
oftheVertebral
Column-Vertebral
Veins
rse Arteries
to Brain:
Schema

Regional Scans
Plates l4$-l5l

rss Arteries
ofBrain:
Inferior
Views
(ofWillis)
reo CerebralArterial
Circle

res Head
Scans:
Sagittal
MRlmages

rer Arteries
ofBrain:
Frontal
ViewandSection

rsr Head
Scans:
Coronal
CTlmages

Atlas of Human Anatomy

r50 Head
Scans:Axial
CTlmages

Foreword

he Fourth Edition of Atlas of Human Anatomy by the uncovertebraljoints of the cervicalvertebrae,the vertebral
Frank H. Netter, MD, has been updated by our veins, and the intricate vasculatureof the eye, to mention a few,
Consulting Editor team of Jennifer K. Brueckner, with artistic brilliance,anatomicalprecision,and visual appeal
Stephen W. Carmichael,Thomas R. Gest, Noelle A. Granger, that is unsuroassed.The sectionincludesa concisetreatmentof
John T. Hansen,and Anil H. Walji.We haveeach reviewed,mod- the centralnervoussystem,includingthe cranialnervesand imified, and updated a section of the Atlas. Throughoutthe book, portant central pathways.
new radiographs,computed tomographic(CT) images,CT an-

In the Back section, a new plate illustrates the proper

giograms, and magnetic resonance (MR) images have been placementof a lumbar epiduralanestheticagent,as well as the
added, which reflectsthe importanceof diagnostic imaging in locationfor lumbarpunctureor "spinaltap." Autonomicsare traclinicalanatomyand medicine.In this edition,45 plates have ditionallythe bane of many students,and excellentnew drawbeen revised to show corrected anatomicalrelationships,290 ings of the autonomicnervoussystem by Dr.Machadowill serve
plates have been relabeled,and there are 17 completelynew as a new educationalresourcefor these difficultconcepts.
plates.Wonderfulnew artworkfor this edition has been created
The Thorax section underwent minor editorial corrections
by Carlos A. G. Machado, MD, who has contributed to the of terminologyand subtle artwork modificationsto more accuNetter illustrationsfor over ten years.Anatomicalnomenclature rately reflect the most common anatomical patterns. For inhas been broughtup to date, and clinicalterms and eponymsin stance, the representationof the azygos venous system patcommon usage have been included parenthetically.
The genius tern was altered to reflect the most common arrangementof
of Dr. Netter'spaintingsis that the anatomyis portrayedclearly, thesehighlyvariableveins.The inclusionof the thoraciccrossrealistically,
and in a clinicallyrelatablefashionwhile maintaining sectional images at the end of the section, rather than in the
the balance between complexity and oversimplification.We later section, reinforcesthe importanceof knowledgeof crosshave tried to adhere to these principlesin the creation of the sectional anatomy in the interpretationof cross-sectionalMR
new plates for this edition. Finally,some of the plates were re- and CT images.
arrangedas page-pairs,whereappropriate,to facilitateside-byThe Abdomen section has had the most extensiverevision
side comparisonsof commonly illustratedelements.This fourth for labelchangesand positioningof leaderlines.By popularreedition owes much to the consultingeditors of the earlieredi- quest,the plateshowingthe common variationsin the branches
tions, Drs.SharonColacino(Oberg)(firstedition),ArthurF.Dalley of the celiac artery which appearedin the first editionAbdomen
ll (secondedition),and John T. Hansen(thirdedition),who shep- section,has been reinstated.
herded their editions with great skill and uncompromisingprofessionalism,making our task significantlyeasier.

The anatomy of the pelvis is a particularlydifficult area to


teach and, becauseof the depth and tight organizationof the in-

The head and neck is a particularlychallengingareafor stu- ternal structures,difficultto illustrate.The Netter illustrationsof
dents, residentsand facultyto master,due not only to the sheer pelvic anatomy are outstandingbecause of the clarity of their
numberof structurespacked in this relativelysmall regionof the presentationand their scope of coverage.A very small number
human body, but also the complexityof their three-dimensional of plates were eliminatedto permit the inclusionof the illustraanatomical organization.The age-old aphorism that "there is tion of pelvic fascia, a parasagittalview of the broad ligament,
more anatomy above the hyoid bone than below it" presentsa and normal imaging (male and female radiographs,cysuniquechallengeto anyonetrying to portraythe anatomyof this tourethrograms,and a hysterosalpingogram).
Comparativeimregion in a simple, visually appealing, and clinically relevant ages of male and female pelvicanatomywere reorganizedto almanner.More than ten new plateshave been added to this sec- low their side-by-sidecomparison.
tion. For the first time, spectacularoriginalpaintingscreatedby

New CT angiogramshave been includedin the Upper Limb

CarlosMachadoillustrateclinicallyimportantstructuressuch as and Lower Limb sections.This new technologynot only clearly

Foreword

demonstratesblood vessels,but vividlyshows bony landmarks help you better understandanatomy and its applicationto the
to which the blood vessels are related.The ligamentsof the practice of clinical medicine.More informationabout the webwrist have been illustrated in more detail to reflect their in- site, includingthe PIN code for access,can be found on the increasedimportancein arthroscopicproceduresand other appli- side front cover of the Aflas.
cations of new technologyto this joint.
We hope you enjoy this new edition of the Aflas of Human

JenniferK. Brueckner,PhD
StephenW. Carmichael,PhD, DSc

Anatomy and that you find it usefulfor learningand for your ca-

Thomas R. Gest, PhD

reer.For the standardeditionand enhancedinternationaledition

NoelleA. Granger,PhD

of the Aflas, we have included access to the website www.

John T. Hansen,PhD

netteranatomy.com.By registeringon this website, you will be

Anil H. Walji,MD, PhD

able to accesssupplementalmaterialthat has been organizedto

Acknowledgments

Editor,our
It has been my pleasureto work with the other membersof the I would liketo thank MarybethThiel,Developmental
editorial board, Carlos Machado, MD, and the Elsevierstaff. superb medical illustratorDr. Carlos Machado, and the entire
Specialthanks go to John Hansen,PhD, for the opportunityto

Editorial,Production,Design,lllustration,and Marketingstaff at

work on this editorialteam. I am indebtedto my family for the Elsevierfor shepherdingthis edition to completion.For all our
support and encouragementthat they have provided.

students,past, presentand future,this Aflas is for you. Finally,

to my wife, Paula,thank you for your love and encouragement


-Jennifer K. Brueckner PhD throughoutthe years.
-John T Hansen, PhD
I would like to thank the specialistsat the Mayo Clinic who
helped review the art, especiallyRichardA. Berger,MD, PhD,
Shawn W. O'Driscoll,MD, PhD, EnriqueA. Sabater,MD, and I would like to thank my wife, Parviz,and my daughters,Amreen
and Farah,for their patienceand constant support and encour-

RobertJ. Spinner,MD.

agement during my involvementwith this project. My special


-Stephen W. Carmichael,PhD, DSc thanks go to Dr. Carlos Machado,who has my utmost admiration for his brilliantartwork and who was an absolutedelight to
work with. I would also like to expressmy sincereappreciation
I must thank my family and especiallymy daughter,Madison, to all the wonderfulstaff at Elsevier,in particularLinda Belfusfor
and son, Taylor,for their support and understandingof my ef- her exemplaryleadership,and Anne Lenehan,MarybethThiel,
fofts on this editorialtask. lt was a pleasureto work with my col- and Cecelia Bayruns for all of their hard work, patience,and
leagueson the editorial board and with the staff of Elsevier.lt dedication,without which this atlas would not have been possihas been my sincerepleasureto work with Dr. Carlos Machado ble. Finally,I would like to thank my fellow coeditorsand all of
on the artwork changesfor the 4th edition.

my colleagueswho helpedwith reviewingthe plates,in particular PierreLemelin,PhD,and DanielLivy,PhD,whosemeticulous

-Thomas R. Gest, PhD examinationof the artwork has helped greatly in ensuringthe
accuracyof the head and neck sectionin this edition.
I am deeply grateful to my colleaguesat Universityof North
CarolinaSchoolof Medicine:JamesScatliff,MD, formerChairof
the Departmentof Radiology,
for his help with the imaging,and
O.W Henson, PhD, ProfessorEmeritusof Anatomy,for his input. I especiallythank Carlos Machado, the exceptionalartist
whose talent made any change requiredin the originalplates
both seamlessand beautiful.
-Noelle A. Granger,PhD

-AnilH.

Walji, MD, PhD

Head and Neck

Frontal
bone
Zygomatic bone

Supraorbital
notch
Superciliary
arcn

Helix
Tragus
Antihelix

Nasal
oone

Antitragus
Ala of nose

A n t e r i o rn a r e s
(nostril)

Lobule
C o m m i s s u roef l i p s

Philtrum

A n g l eo f j a w ( m a n d i b l e )

Nasolabial

s ut c u s

S u b m a n d i b u lgalra n d

T u b e r c loef
s u p e r i olri p

E x t e r n aj lu g u l a rv e i n

Mental

l n f e r i o rb e l l vo f o m o h v o i d m u s c l e

protuberance

Brachialplexus
T h y r o i dc a r t i l a g e
Trapeziusmuscle

-"*r

. l u g u l anr o t c h

C l a v i c u l a hr e a d o f
s t e r n o c l e i d o m a s t o im
du s c l e

S t e r n ah
l e a do f
s t e r n o c l e i d o m a s t o im
du s c l e

C/Fd4g/*

Topographic Anatomy

Plate I

Skull: Anterior View

C o r o n a ls u t u r e

Frontal bone
Clabell.r

Parietalbone

Supraorbital
notch(foranren)

S p h e n o i db o n e

O r b i t a ls u r f a c e

e s s e rw r n g
C r e a t e rw l n g

Nasal bone

Temporalbone
L a c r i m a lb o n e
E t h m o i db o n e
O r b i t a lp l a t e

Zygomatic bone

P e r p e n d i c u l aprl a t e

Frontap
l rocess

M i d d l e n a s a lc o n c h a

O r b i t a ls u r f a c e
Tenrporal process

Inferior nasal concha

Zygom at icofac iaI


toramen

Vomer
*;o

Maxilla
Z y g o m a t i cp r o c e s s

rl

Mandible

'\

Ramus

O r b i t a ls u r f a c e
I n f r a o r b i t aflo r a m e n
Frontap
l rocess

4{r

Body

^.,,
{
\,,

M e n t a lf o r a m e n
M e n t a lt u b e r c l e

A l v e o l a rp r o c e s s

M e n t a lp r o t u b e r a n c e

A n t e r i o rr r a s asl p i n e

R i g h t o r b i t : f r o n t a l a n d s l i g h t l yl a t e r a lv i e w
O r b i t a l s u r f a c eo f f r o n t a lb o n e
O r b i t a ls u r f a c eo f l e s s e r
w i n g o f s p h e n o i db o n e
S u p e r i o ro r b i t a lf i s s u r e
( ) p t i c c a n a l( f o r a m e r . r )

P o s t e r i oar n d
Anterior
e t h m o i d a lf o r a m i n a
O r b i t a lp l a t eo f
e t h m o i db o n e
L a c r i m a bl o n e

O r b i t a ls u r f a c eo f g r e a t e r
w i n g o f s p h e n o i db o n e

F o s s af o r l a c r i m a sl a c

O r b i t a ls u r f a c eo f
z y g o n r a t i cb o n e

O r b i t a l p r o c e s so f
p a l a t i n eb o n e

I n f e r i o ro r b i t a lf i s s u r e
Infraorbital!lroove

Plate 2

O r b i t a ls u r f a c e
of maxilla

Bones and Ligaments

Skull: Anteroposterior Radiograph

A
C
E
F
G
L
M
R

Bones and Ligaments

Angleof mandible
Cristagalli
Ethmoidair cells(sinuses)
Frontalsinus
Createrwingof sphenoid
Lesser
wing of sphenoid
Maxillarysinus
R a m u so f m a n d i b l e

Plate 3

Skull: Lateral View

S p h e n o i db o n e

Parietalbone

Iemporal bone

Temporalfossa

C r e a t e rw i n
Frontal bone
Supraorbital
notch(foramen)

S q u a n r o u sp a r t
Z y g o m a t i cp r o c e s s
C o r o n a ls u t u r e
A r t i c u l a rt u b e r c l e
Pterion
Croovefor posterior
d e e p t e m p o r a la r t e r y

Clabella

E x t e r n aal c o u s t i c
meatus

E t h m o i db o n e
O r b i t a lp l a t

M a s t o i dp r o c e s s
L a c r i m a lb o n e
L a m b d o i ds u t u r e

F o s s at o r
l a c r i m a sl a c

Occipital bone
Nasal bone

L')

Sutural (wormian)
bone

Maxilla
External
occipital
protuberance

----)aFrontalprocess
I n fr a o r b i t a l
foramen
Anterior
Mandible

H e a d o f c o n d y l a rp r o c e s s
M a n d i b u l a rn o t c h
C o r o n o i dp r o c e s s
Ramus
O b l i q u el i n e
Body
M e n t a lf o r a m e n

Zygomatic bone
Zygom aticofacial
foramen
T e m p o r a lp r o c e s s
Z y g o m a t i ca r c h

S p h e n o i db o n e
C r e a t e rw i n g

lnfratemporalfossaexposedby
removalof zygomaticarchand mandible*-

I n f r a t e m p o r acl r e s t

P t e r y g o m a x i l l a rfyi s s u r e

L a t e r a pl l a t eo f
p t e r y g o i dp r o c e s s

I n f e r i o ro r b i t a lf i s s u r e

P t e r y g o i dh a m u l u s
( o f m e d i a lp l a t eo f
p t e r y g o i dp r o c e s s )

I n f r a t e m p o r asl u r f a c eo f m a x i l l a
Temporal bone
A l v e o l a rf o r a m i n a

Forame
ovale

T u b e r o s i t yo f m a x i l l a

./.1
n

'.

.-*F
_a*-

E x t e r n aal c o u s t i c
meatus
M a n d i b u l a rf o s s a
A r t i c u l a rt u b e r c l e

'";*-"t

P t e r y g o p a l a t i nfeo s s a

S t y l o i dp r o c e s s

S p h e n o p a l a t i nfeo r a m e n
* S u p e r f i c i a l l ym, a s t o i dp r o c e s sf o r m s p o s t e r i o r
bourrcrary

Plate 4

Bones and Ligaments

Skull: Lateral RadiograPh

Anterior arch of atlas


(Cl vertebra)

Creater wing of
sphenoid

C o n d y l eo f m a n d i b l e

Hypophysealfossa(sellaturcica)

C P Coronoid processof
mandible

cs Coronal suture
D

Bones and Ligaments

L a m b d o i ds u t u r e

M a x i l l a r ys i n u s

D e n s o f a x i s( C 2
vertebra)

MS Mastoid air cells


P Palatineprocessof
maxilla

F r o n t a ls i n u s

S p h e n o i ds i n u s

Plate 5

Skull: Midsagittal Section

Sphenoidbone

Temporalbone

Parietalbone

Creater wing

Coronal
sutur

Lesser
wing
Anteriorclinoid
process
Optic canal
Sellaturcica
S o h e n o i d sa il n u s
Body
Medialand lateral
platesof
pterygoid
process

part
Petrouspart

Croovesfor
branches
of middle
meningeal
vessels
tr.M,I:ltg

lnternalacousticmeatus
'?t'zt*

Groovefor superior
petrosalsinus
External
openingof
vestibular
aqueduct
Croove for
s i g m o i ds i n u s

Lambdoidsuture

Frontalbone
Frontalsinus

Occipital bone

Ethmoidbone
Cristagalli
Cribriformplate
Perpendicular
plate(bony
nasalseptum)

for
sinus
transverse
;'---

Externaloccipital
protuberance
foramen
Jugular

Nasalbone
Croove for inferior
petrosalsinus

Inferior nasal
concha

Hypoglossal
canal
Maxilla
Anterior
nasalspine
Nasalsu

Foramenmagnum

Occipitalcondyle

Palatinebone
Vomer(bonynasalseptum)

Incisivecanal

part

Palatine
Alveolar process

Frontalbone
Nasalbone

sinus
Openingof sphenoidal

1l':

Ethmoidbone
Cribriformplate

foramen
Sphenopalatine

Superior nasalconcha
Middle nasalconcha

Lacrimalbone

Sphenoidbone
Body

Inferior nasalconcha
Maxilla
Nasalsurf
Palatineprocess
Alveolar process

Medial I -.
Platesof PterYgoidProcess
1;il
i
Pterygoidhamulus
plate
Perpendicular
Horizontalplate
I

View of lateral nasalwall with nasalseptum removed

Plate 6

euluttn"
non"

*{r

Bones and Ligaments

Galvaria

Superiorview
Frontalbone

Coronalsuture
Bregma
Parietalbone
Sagittal
suture
Parietalforamen (for emissaryvein)

Lambdoidsuture
Sutural(wormian)
bone
Occipital

Inferior view
Frontalbone
Frontalcrest
Croovefor superiorsagittalsinus
Coronalsuture
Parietal
bone
Cranularfoveolae
(forarachnoidgranulations)
Diplod
of
Croovesfor branches
m i d d l em e n i n g e av le s s e l s
Croovefor superiorsagittal
sinus
suture
Sagittal
ambdoidsuture
ipitalbone

Bones and Ligaments

4{tr
Plate 7

Granial Base: Inferior View

Maxilla
I n c i s i v ef o s s a
Palatineprocess

Intermaxillary
suture
Zygomaticprocess
Zygomatic bone
Frontal bone

Palatomaxillary
suture

Sphenoidbone
Pterygoidprocess
Hamulus
M e d i ap
l late
Pterygoidfossa

Lateralplate
Scaphoidfossa
C r e a t e rw i n g
Foramenovale
F o r a m e ns p i n o s u m
Spine

.b

Uit

Palatinebone
Horizontal plate

ir

C r e a t epr a l a t i n feo r a m e n
process
Pyramidal
L e s s epr a l a t i n feo r a m i n a
Posterior
nasalspine

Choanae
Temporalbone
Zygomaticprocess
A r t i c u l atru b e r c l e
Mandibularfossa
Styloidprocess
Petrotvmoanic
fissure
C a r o t i dc a n a l( e x t e r n aol p e n i n g
Tympaniccanaliculus
Externalacousticmeatus

Vomer
Ala
for auditory
(pharyngotympanic,
Eustachian)tube
Foramenlacerum

M a s t o i dc a n a l i c u l u s
Mastoid process
Stylomastoidforamen

Petrous
part
Mastoid notch (for
d i g a s t r i cm u s c l e )
Occipital groove
(for occipital artery)
J u g u l a fr o s s a
(jugularforamen in its depth
Mastoid foramen

Parietalbone
Occipitalbone
Hypoglossal
canal
O c c i p i t acl o n d y l e
Condylar canal and fossa
Basilarparl

Pharyngeal
tubercle
F o r a m e nm a g n u m
I n f e r i o rn u c h a ll i n
Externaloccipital crest
S u p e r i o rn u c h a ll i n e
Externaloccipital protuberance

Plate 8

Nr
Bones and Ligaments

Bones of Granial Base: Superior View

Frontalbone
C r o o v e f o r s u p e r i o rs a g i t t asl i n u s
Frontalcrest
C r o o v e f o r a n t e r i o rm e n i n e e a l
F o r a m e nc e c u m
Superiorsurfaceof orbital part

Ethmoidbone
C r i s t ag a l l i
Cribriform plate

tr

Anterior

Sphenoidbone
L e s s ew
r ing
A n t e r i o rc l i n o i dp r o c e s s
C r e a t e rw i n g
C r o o v e f o r m i d d l em e n i n s e a l
v e s s e l s( f r o n t a lb r a n c h e s )

,rr t
,{

fossa
*

Body
Jugum

Prechiasmaticgroove

tl

Middle
cranial
fossa

I
Carotid g r o o v e ( f o r i n t . c a r o l i da . t

Clivus
Temporal bone
S q u a m o upsa r t
part
Petrous
Croove for lesseroetrosalnerve
Croove for greaterpetrosalnerve
A r c u a t ee m i n e n c e
T r i g e m i n ailm p r e s s i o n
C r o o v e f o r s u p e r i o rp e t r o s a sl i n u s
C r o o v e f o r s i g m o i ds i n u s

Posterior
cranial
fossa

Parietalbone
C r o o v e f o r m i d d l em e n i n g e a l
v e s s e l s( p a r i e t ahl r a n c h e s r
M a s t o i da n g l e

Occipitalbone
Clivus
Croove for inferior oetrosal
Basilap
r art
Croove for posterior m e n i n g e a vl e s s e l s
Condyle
sinus
Croove f o r t r a n s v e r s e
Croove f o r o c c i p i t a ls i n u s
I nternal occipital crest
l n t e r n a loccipital protuberance
C r o o v e f o r s u p e r i o rs a g i t t asl i n u s

Bones and Ligaments

Nr
Plate 9

Foramina of Granial Base: lnferiot View

Nasopalatine
nerve)
sph";;pi;il;"
""tldtil
-----Greaterpalatinenerveandvessels
-----Lesserpalatinenerveandvessels
Createrpetrosalnerve-----Lesserpetrosalnerve)
Mandibularnerve(Vr)t----Accessorymeningealartery)
Middle menineealvessels
I ----Meningealur"n.h o?-minii"di;?;r;;u;j
I

Incisivefossa
Greaterpalatineforamen
Lesserpalatineforamen
Foramenlacerum
Foramen
ovale

Foramenspinosum

Internalcarotidarteryl------Larotlo
canal
Carotidautonomicplexusf
Chordatympaniof facialnerve(Vll)------

Petrotympanic

Tympanicbranchof glossopharyngeal
nerve(lX)------Tympanic canaliculus
Auricularbranchof vagusnerve(X)------ Mastoidcanaliculus
Facialnerve(Vll)------

Glossopharyngeal
nerve(lX)\
Vagusnerve(X)/
Spinalrootsofaccessorynerves(Xl))----InternaliugularveinI
Inferiorp6trosalsinus)

Stylomastoid
for

Jugular

Mastoidemissary
vein) -- - -Mastold
roramen
Posterior
meningeal
irtery|-Hypoglossal
nerve(Xll)-------

Plate I O

Hypoglossal
canal

Bones and Ligaments

Foramina of Granial Base: Superior View

Foramencecum----Nasalslit
Anteriorethmoidalforamen

Emissary
vein to superiorsagittalsinus
I J Anteriorethmoidalartery,vein,
t I and nerve

Foramina
of cribriformplate-----Olfactory nervebundles
Posterior
ethmoidalforamen----

opric
canar

ljl".,
I 3Bilt.n:i#:

Maxillarynerve(Vz)

Foramenrotundum--amenovale--

vein,
Posterior
ethmoidalartery,
and nerve

( Mandibularnerve(Vr)
- { Accessorymeningealartery
( Lesserpetrosalnerve(occasionally)

Foramen
spinosum

I M:11i"rg:tffi?13?'fl1"Tfl,j3',".",

(inconstant)
foramen(of Vesalius)
Sphenoidemissary

Carotidcanalfor

- { Internalcarotidartery
I Internalcarotidnerveplexus

Hiatusfor

Lesserpetrosalnerve

Hiatusfor

Createrpetrosalnerve

Internalacousticmeatus------{
Externalopeningof
----vestibular'aqueduct

{ Facialnerve(Vll)
Vestibulocochlear
nerve(Vlll)
( Labyrinthineartery
Endolymphatic
duct

--- Emissary
Mastoidforamen(inconstant)
vein(andoccasional
branchof occipitalartery)

meningeal
''(' - - - - I tl:1:t::.:and pharyngeal branch
condylarcanal(inconstant)
artery
I of ascending
Hypoglossal
canal------

nerve(Xll)
Hypoglossal

4{F
Bones and Ligaments

Plate I t

Skull of Newborn

Lateralview

Anteriorfontanelle

Sphenoidal
fontanelle

Parietal bone
Tuber(eminence)
suture
Squamous

Frontalbone
part
Squamous
Supraorbital
notch(foramen)

Posteriorfontanelle
Lambdoidsuture

Ethmoidbone
Anteriorethmoidal
foramen
Orbitalplate

bone
Mastoidfontanelle

Temporalbone

Maxilla
Infraorbital
foramen
Zygomaticbone
Zygomaticofacial
foramen
Palatinebone
Pyramidal

part
fissure
Petrosquamous
Sphenoid
bone
Greaterwing
Lateralplateof
pterygoidprocess
Hamulusof medial
plateof pterygoid
process

Petrouspart
(mastoidprocessabsent)
Tympanicpart (bony external
acousticmeatusabsent)
al (vestibular)
window
Round(cochlear)window
Styloidprocess
Mandibularfossa
Zygomaticprocess

Frontalbone
Anteriorfontanelle

Coronalsuture
Parietalbone
Sagittal
suture

Posteriorfontanelle

Occipital bone

Lambdoidsuture

*{r
Plate 12

Bones and Ligaments

Bony Framework of Head and Neck


Temporalbone
S p h e n o i db o n e
Temporalfossa
Zygomatic arch
C o n d y l a rp r o c e s so f m a n d i b l e
M a n d i b u l a rn o t c h
Coronoid orocessof mandible
Lateralpterygoid plate (broken line)

Hamulusof medialpterygoidplate(broken/ine)

Mastoid
process
External
a c o u s t im
c eatus
A t l a s( C 1 )
Styloidprocess
A x i s( C 2 )

raphe(brokenli ne)
Pterygomandibular
( Ramus
M a n d i b l e{ A n g l e
( BodyS t y l o h y o i dl i g a m e n t

Stylomandibular
ligament

( Bodv
H v o i db o n e{ L e s s bhro r n( C r e a t ehr o r n

C3 vertebra

Epiglottis
Thyroid cartilage
C r i c o i dc a r t i l a g e
Trachea

C7 vertebra

Tl vertebra
1st rib

2nd cervicalto 1stthoracicvertebrae:


right lateralview
a.

Dens*
Suoeriorarticularfacet
Foramen
um
transverSafl
Spinous

processes

Articularpillarformed by
articularprocessesand
interarticularparts
(parsinterarticularis)

Spinousprocessof C7
(vertebraprominens)

Bones and Ligaments

Intervertebral
f o r a m i n af o r
spinalnerves

for spinal
nerve In transverse
process
Zygapophyseal Cervical vertebrae (spine): lateral radiograph
(facet)joints
SpinousProcess(axis)
S
Transverseprocess
T
V P S p i n o u sp r o c e s so f C Z
( v e r t e b r aP r o m i n e n s )
Zygapophyseal(facet)joint
Z
Costalfacets
Bodieso{ cervicalvertebrae
1-7
(for l st rib)
... Cervicalcurvature
r-r Vertebral canal

Plate t 3

Granial Base: Pterygoid Fossae

Posteriorview

External
occipitalprotuberance

S u p e r i onr u c h alli n e

External
occipitalcrest

Nasalseptum
Choana(posteriornasal
aperture)

lnferior nuchal line


F o r a m e nm a g n u m
lnferior orbital fissure

astoid foramen
Occipitomastoid
suIUre
al condyle

Mastoid proCss-

Lateralpterygoidplate
Medialpterygoidplate

Styloidprocess
Pterygoidfossa
Zygomaticarch

Scaphoidfossa
Pyramidalprocessof
oalatinebone

Horizontal plate of palatinebone


Inferior concha

Pterygoidhamulus

Tuberosity
of maxilla
processof maxilla
Palatine

Alveolar orocessof maxilla

lncisivefossa

Cfd4/*
Inferolateral view
S p i n eo f s p h e n o i db o n e
F o r a m e ns p i n o s u m
Foramenovale

\ _,

Sphenopalatineforamen
Pterygopalatinefossa
Choanae (posteriornares)

Tuberosityof maxilla
Infratemporalfossa
Alveolar processof maxilla

Plate 14

Pyramidalprocessof palatinebone

*{r

Bones and Ligaments

Mandible

Head

Attachmentsfor major
musclesof mastication

Lateralpterygoid
Pterygoidfovea
Neck

Condylar process
Coronoid process

M a n d i b u l a rn o t c h
Lingula

Temporalis

Attachmentsfor
accessorvmusclesof
mastication

Mylohyoid groove

Mandibular,,TemPoralis

O b l i q u el i n e
Buccinator
S u b m a n d i b u lfaors s a
Mylohyoid line

S u b l i n g u faol s s a
Interalveolar
sepra

Masseter

Alveolar part (crest)


Mental foramen
Mental protuberance

M e n t atl u b e r c l e
B a s eo f m a n d i b l e

Mandibleof adult:
anterolateralsuperiorview
Body
l-ateralpterygoid

Coronoid process
Head
Neck

C o n d y l apr r o c e s s
L i n g ul a

M a n d i b u l a rn o t c h

M a n d i b u l a rf o r a m e n
groove

Pterygoidfovea

Temporalis

4{F

M y l o h y o i dl i n e

\Angle
Medialpterygoid
S u b m a n d i b u lfaors s a
Digastric
fossa
Digastric,anteriorbelly
M e n t asl p i n e s( g e n i atlu b e r c l e s )

Mandibleof adult:
left posteriorview

Bones and Ligaments

Mandibleof aged
person(edentulous)

Plate 15

Temporomandibular Joint

Lateralview
Jointcapsule
Lateral(temporomandibular)
ligament
S p h e n o m a n d i b ulliagra m e n t
Sphenomandibular
ligamen
t (phantom\
Styloidprocess
Stylomandibular
ligament
Mandibularnerve

Jointcapsule
M i d d l em e n i n g e a l
artery
Auriculotemporal
nerve
Maxillaryartery
Inferioralveolar
Lingualnerve

S p h e n o m a n d i b ulliagra m e n t
S t y l o m a n d i b ul iagra m e n t
Mandibularfossa
Articulardisc
Articulartubercle
l o i n tc a p s u l e

Medialview
and mylohyoidnerve

faws closed

faws widely
openeo
( h i n g ea n dg l i d i n g
actioncombined)

Plate 16

4{tr
Bones and Ligaments

Gervical Vertebrae: Atlas and Axis

t e r i o ra r t i c u l a r
facet (for anterior
arch of atlas)

Articularfacet
for dens

Pedicle

Transverse
process

S u p e r i o ra r t i c u l a r
facet for atlas

Transverse
foramen

Interarticular
parr

Vertebral
foramen

Suoeriorarticularsurface
of lateralmassfor
o c c i p i t a lc o n d y l e

Posteriorarch

Posterior
tubercle

lnferior articular
facet for C3

Croove for vertebralartery

Axis(C2):anteriorview

Atlas(C1):superiorview

Posterior
tubercle

Posteriorarch

Dens
Superiorarticular
facet for atlas

Vertebral
foramen

Transverse

P o s t e r i oarr t i c u l a r
facet(fortransverse
ligamentof atlas)

process

Transverse

lnterarticular
parl

Transverse
foramen
l n f e r i o ra r t i c u l a r
surfaceof lateral
massfor axis

Articularfacet
for dens
Anteriorarch

lnferior
articular

process

Anteriortubercle

A x i s ( C 2 ) : p o s t e r o s u P e r i o vr l e w

Atlas(Cl): inferiorview

Superior
a r t i c ul a r
surface
for occipital
condyle

Spinousprocess

A t l a s( C 1 )

Posterior
articularfacet
(fortransverse
ligament
of atlas)

n{r
Bones and Ligaments

Radiosraphof atlantoaxialioint
(openlnduth odontoidview)
of atlas(C1vertebra)
masses
A Lateral
D Dens of axis (C2 vertebra)

Plate 17

Gervical Vertebrae (continuedl

Inferioraspectof C3 and superioraspectof C4 showine


the sitesof the facetand uniovertebialarticulations "

c3

Bifidspinousprocess

lnferior aspect

Lamina

Inferiorarticularprocessandfacet

Vertebral
foramen
Pedicle

Foramentransversarium
Costallamella
Area for articulationof left uncinate processof C4

Vertebralbody

.{
Left uncinate process

Articularsurfaceof rightuncinateprocess

Superiorarticularprocessand facet

Groove for spinal nerve (C4)

c4

Inferiorarticularprocess

Superioraspect

7th cervicalvertebra:anteriorview

lamella

Reduplicated
foramentransversarium
ncrnateprocess

Articularsurface

Inferior
articular
facet

Articularsurface

B o n ys p i c u l e
dividingforamen

Body
Foramentransversarium

Posterior
tubercle) ( | ransverse
Anteriortubercle( process
( r n c o n s p r c u o u s) )
7th cervicalvertebra(vertebraprominens):superiorview
Body

Articularsurfaceof uncinateorocess

Uncinate orocess

Costallamella
Foramen
t
transversarium
I n c o n s p i c u oa
un
s t e r i otru b e r c l e
(transverse
process)
Pedicle

(reduplicated)
Foramen
transversarium
Croovefor C7
process(posteriortubercle)
Transverse
Superiorarticularprocessandfacet
Inferiorarticularprocess

Lamina

Vertebral
foramen
Spinousprocess

*The foramina
transversariaof C7 transmit vertebral
veins,but notthe vertebral artery,and areasymmetricalin this specimen

Plate | 8

eh4s/*

Bones and Ligaments

Gervical Vertebrae: Uncovertebral Joints

Cervicalvertebrae:antenorvrew
Densof axis
Anteriortubercleof atlas
Anterior arch of atlas

m
transversariu
Foramen
(forC3 spinalnerve)
foramen
Intervertebral
disc
lntervertebral
Vertebralbody
lnferiorarticularprocess(C3)

A x i s( C 2 )

S u p e r i oar r t i c u l aprr o c e s (sC 4 )


Groovefor spinalnerve
joint (cleft)of Luschka
Siteof uncovertebral
Transverseprocess

Carotidtubercle

Articularcartilageon dens for median


atlantoaxialjoint complex

Lateralatlantoaxial
ioint
Uncinate processes

Facet(zygapophyseal)
joint between C2 and C3

Vertebra prominens
Axis (C2)

Firstthoracic vertebra (T1)

Foramentransversarium
Uncinate processes
A n u l u sf i b r o s u s

joints(clefts)of Luschka
Uncovertebral
N u c l e u sp u l p o s u s
process
lransverse
lntervertebral
foramen(forC7 spinalnerve)
Vertebralbody (C7)
joints of the cervicalspine:anteriorview
The uncovertebral
(C3 to C7 havebeensectionedcoronallyto exposethe loints)

|\

C(d4/*

Bones and Ligaments

Plate 19

Degenerative Ghanges in the Gervical vertebrae

A t l a s( C 1 )

Degenerativechangesin the cervical spine


(ankylosingspondylitis)

A x i s( C 2 )
C3 vertebralbody
(sectioned
in coronalplane)

Complete transversecleft
i n i n t e r v e r t e b r adli s c

Uncovertebraljoint
with cleft formation

Spreadof cleft formation into


centralportion of intervertebral
disc with age leadingto progressive
degenerativechangesin the disc

Deformed vertebralbodies
a n d l i p p i n go f v e r t e b r a m
l argins

Spondylophytes(osteophytes)
on uncinateprocesses

6/Fd4*/*
Narrowine of intervertebralforamen

C7 vertebra

S u p e r i oar r t i c u l aprr o c e s s
Advancedankylosingspondylitiswith
uncovertebral
arthrosisin C4 and C5

Advanced spondylophyte(osteophyte)
formation on uncinateprocesses

Vertebralbody
joint fused due to extensivespondylophytei
Uncovertebra.l
formation and ossification
Potentialfor compressionof vertebralartery within foramen transversarium

Plate 2O

Facetjoint ossified
due to advanced
osteoarthriticchange
Markedly narrowed
intervertebralforamen
may lead to compression
of spinal nerve

Inferiorarticular
processwith facet
Croove for spinal nerve
on transverseprocess

S p i n o u ps r o c e s s

Bones and Ligaments

External Graniocervical Ligaments

Anteriorview
partof occipitalbone
Basilar
Pharyngeal
tubercle
membrane
Anterioratlantooccipital
Capsuleof atlantooccipital
.ioint
membrane
Posterior
atlantooccipital

A t l a s( C 1 )

joint (openedup)
Lateralatlantoaxial
l ament
A n t e r i o lro n g i t u d i n lai g

Caosuleof lateral
atlantoaxialjoint

Posteriorview

A x i s( C 2 )

Posterioratlantooccipitalmembrane

Capsuleof
zygapophyseal
joint (C3-4)

Capsuleof
atlan tooccipital

Transverse
process
o f a t l a s( C 1 )

Anterior atlantooccipitalmembrane

Capsuleof lateral
joint
atlantoaxial

Capsuleof
atlantooccipital
joint

A x i s( C 2 )

Posterior
atlantooccipital
memDrane

artery

Suboccipitalnerve (dorsal
r a m u so f C l s p i n a ln e r v e )

Ligamentaflava
o f a x i s( C 2 )
L i g a m e n t u mn u c h a e -

discs(C2-3 and C3-4)


Intervertebral

Zygapophysealjoints (C4-5 and cs-6)


Anterior tubercle of C6 vertebra (carotidtubercle)

S p i n o ups r o c e s s
of C7 vertebra
( v e r t e b rpar o m i n e n s )

Vertebralartery
T1 vertebra

4{tr
Rightlateralview

Bones and Ligaments

Plate 21

lnternal Graniocervical Ligaments

Clivus(surface
feature)
of basilarpartof occipitalbone

Upper part of vertebralcanalwith spinousprocesses


and partsof vertebralarchesremovedto expose
ligamentson posteriorvertebralbodies:posteriorview

Tectorialmembrane
Capsuleof

partof tectorialmembrane
Deeper(accessory)

joint

ligament
Posterior
longitudinal

A t l a s( C 1 )

Capsuleof lateral
atlantoaxialjoint

Alarligaments

Axis(C2)
Capsuleof
zygapophyseal
joint

(c2-3\

A t l a s( C 1 )
Superiorlongitudinal
band
Cruciate
ligament

Transverse
ligamentof atlas
Inferiorlongitudinal
band

partof tectorialmembrane
Deeper(accessory)
Principal part of tectorial membrane removed
to expose deeper ligaments: posterior view

Apicalligamentof dens
Alarligament
A t l a s( C 1 )

Posteriorarticularfacetof dens(for transverse


ligamentof atlas)

Alarligament

Anteriortubercleof atlas
Svnovialcavities

Axis(C2)

Cruciateligamentremovedto show
deepestligaments:posteriorview

*{r
Plate 22

ligament
Transverse
of atlas

Median atlantoaxialjoint: superiorview

Bones and Ligaments

Superficial Arteries and Veins of Face and Scalp


S k i na n d
Scalp

t is s u e
subcutaneou
E p i c r a n iaapl o n e u r o s i s
(galea poneurotica)
(cut to revea/skull)

Parietalemissaryvein

Middle temporal artery and


Zygomaticoorbitalartery
Transversefacial
artery and vein

Supraorbital
arteryand vein
Supratrochlear
a r t e r ya n dv e i n
Nasofrontalvein
Dorsal nasal
artery and vein
Zygomaticotemporal
a r t e r ya n d v e i n

Angular
arrery
a n dv e i n
Zygomaticofacialartery
and vein

Mastoidemissary
v e i na n dm e n i n g e a l
branchof occipital
artery(posterior
artery)
meningeal

Infraorbital
a r t e r ya n d

ipitalartery

Deep facialvein
(from pterygoid
plexus)

and vein (cut)

Posterior
auricular
arteryand vein

Facialartery and

jugularvein(cut)
External
vein
Retromandibular
Common facial vein

I n t e r n aj ul g u l avr e i n
lnternalcarotidartery
Externalcarotid artery
Common carotid arterY
Lingualartery and vein

Sourcesof arterialsupplyof face


Black: from internalcarotid artery (via ophthalmic artery)
Red: from externalcarotid artery

Superficial Face

Nr
Plate 23

Gutaneous Nerves of Head and Neck


SeealsoPlates 32, 36, 45,46,122

A u r i c u l a rb r a n c h
o f v a g u sn e r v e ( X )

Fromophthalmicdivision
of trigeminalnerve(V,)
S u p r a o r b i tnael r v e
Supratrochlearnerve

Medial branches
of dorsalrami
of cervicalspinal
nerves

Palpebralbranch of
lacriman
l erve
I n f r a t r o c h l e anr e r v e

Creater occipital
n e r v e( C 2 )

External
nasalbranchof
a n t e r i oer t h m o i d anl e r v e

3rd occipital
n e r v e( C 3 )

Frommaxillarydivision
of trigeminalnerve(Vr)

F r o m4 t h , 5 t h ,
6th, and 7th
nervesIn
successton
below

I n f r a o r b i tn
ae
l rve
Zygomaticofacialnerve
Zygomaticotemporalnerve

Branchesfrom
cervicalplexus
Lesseroccipital
n e r v e( C 2 )

Frommandibulardivision
of trigeminalnerve(Vr)

Creatauricular
n e r v e( C 2 ,3 )

Mentalnerve
Buccalnerve

Transversecervical
n e r v e( C 2 ,3 )

Auriculotemporal
nerve

Supraclavicular
n e r v e s( C 3 , 4 )

i
Ophthalmicnerve(V,)-

Dorsalrami of
cervicalspinal
nerves

;'1

*\:"
Trigeminal
nerve(V)

Maxillarynerve(Vr)

N o t e : A u r i c u l a rb r a n c h
of vagus nerve to
externaa
l coustic
m e a t u sa n d s m a l l
a r e ao n p o s t e r o m e d i a l
s u r f a c eo f a u r i c l e

Mandibularnerve(Vr)

Branchesfrom
cervicalplexus

4{tr
Plale 24

Superficial Face

Facial Nerve Branches and Parotid Gland

Temporalbranches

Zygomatic branches

Parotidduct

M a i n t r u n ko f
facial nerve
emerging from
stylomastoidforamen

Buccalbranches

M a r g i n a lm a n d i b u l a rb r a n c h
Nerve to posterior
belly of digastric
m u s c l ea n d t o
stylohyoid muscle
Cervical branch

Medial pterygoid muscle

Horizontalsection
Main trunk of facial ner

R a m u so f m a n d i b l e
Massetermuscle

Mastoid process
Parotidgland

Temoorofacialdivision

Temporalbranch

Posteriorauricularnerve
Zygomatic branches
Main trunk of facial nerve
Nerve to posterior belly
o f d i g a s t r i cm u s c l ea n d
t o s t y l o h y o i dm u s c l e -

Buccalbranches

Cervicofacialdivision
M a r g i n a lm a n d i b u l a rb r a n c h

*{r
Superficial Face

Cervicalbranch

Plate 25

Muscles of Facial Expression: Lateral View


S k i na n d

s."re subcutaneous
tissue
(galeaaponeurotica)
aponeurosis
{ Epicranial
Temporalfascia
orbicularisoculimuscle{ o'0""' o"u
Palpebral
pa
I
Frontalbelly(frontalis)
of epicranius
muscle

Auricularis
anteriormuscle
Auricularis
superiormuscle
posteriormuscle
Auricularis
Occipitalbelly
(occipitalis)of
epicranius
muscle

Corrugatorsupercilii
muscle(frontalis
and orbicularisoculi,partiallycut awa'
Procerus
muscle
Levatorlabiisuperioris
muscle
Levatorlabiisuperioris
alaequenasimuscle
(partiallycut away)

NasalisJ Trrnru"rr"p.rt
muscle( Alarnarty

Parotid
fascia

Depressorsepti
nasimuscle

Massetericfascia

Orbicularis
orismuscle
Zygomaticus
minormuscle

Investing
layerof
(deep)cervicalfascia

Zygomaticus
majormuscle
Orbicularis
orismuscle
Mentalismuscle
Depressor
labiiinferiorismuscle

Deltoid
fascia

Depressor
anguliorismuscle
Buccinator
Risorius

4{F

Platvsma
muscle
Sternum
Clavicle

Pectoralismajorfascia

Plate 26

Superficial Face

Muscles of Neck Lateral View

Parotidgland (cut)
Ramusof mandible

Massetermuscle

S u b m a n d i b u lgalra n d
muscle
Hyoglossus

muscle
Styloglossus

Mylohyoidmuscle
Mastoidprocess
Styloidprocess
muscle
Stylohyoid
Body of
mandible

D i g a s t r im
c uscle
(posterior
belly)
Middlepharyngeal
muscle
constrictor

Digastric
muscle
(anterior
belly)

Longuscapitismuscle
S p l e n i um
s uscle
muscl
Sternocleidomastoid

Hyoid bone

Levatorscapulaemuscle

Thyrohyoidmuscle

/
\ Posterior

Omohyoidmuscle
(superiorbelly)

Scalenemuscles{ Middle ( Anterior

muscte

Brachialplexus
Inferiorpharyngeal
muscle
constrictor

muscle
Trapezius
Acromion

Sternothyroid
muscle

Deltoidmuscle

Omohvoidmuscle(inferiorbelly)
Clavicle

*{r
Neck

maiormusclei
Pectoralis

Manubrium
of sternum
Sternalhead

)
muscle
) Sternocleidomastoid

head
Clavicular
)

Plate 27

Muscles of Neck Anterior View

gastricmuscle(anteriorbelly)

Masseter
muscle

Mylohyoidmuscle
Parotidgland
S u b m a n d i b u lgalra n d
Platysma
muscle
(cutaway)

Fibrousloopfor
intermediate
digastrictendon

Mastoidprocess

Stylohyoid
muscle
Digastricmuscle
(posterior
belly)

Hyoid bone

External
carotidarterv

Carotid sheath

Internaljugularvein
Fasciaof infrahyoid
musclesand cut edge

Thyrohyoidmuscle
muscle
(superiorbelly)

Thyroidcartilage

Sternohyoid
muscle

Investing
layerof (deep)
cervicalfasciaand cut edge

Sternothyroid
muscle
Scalenemuscles

Cricoid
cartilage

Trapezius
muscle
Deltoidmuscle

icle

Omohvoidmuscle
(inferiorbelly)
Pretracheal
layerof
Pectoralismajor muscle

(deep) cervicalfasciaover

thyroidglandand trachea
Clavicular
head
Sternalhead

Suprasternal
space(of Burns)
Manubriumof sternurh

Sternocleidomastoid
muscle

Jugularnotch

4{r
Plate 28

Neck

lnfrahyoid and Suprahyoid Muscles

Digastricmuscle(anteriorbelly)
Mylohyoidmuscle

Thyrohyoidmembrane

muscle
Hyoglossus
External
carotidartery

muscle
Stylohyoid

Internal.iugular
vein

Digastricmuscle
(posteriorbelly)

Thyrohyoidmuscle

Fibrousloopfor
intermediate
tendon
digastric

Thyroidcartilage
O m o h y o i dm u s c l e
(superiorbelly)

andomohyoid
Sternohyoid
muscles(cut)

muscle
Sternohyoid

Thyrohyoidmuscle
Median cricothyroid
ligament

thyroidcartilage
Cricoid cartilage

muscle
Cricothvroid

Scalene
muscles

muscle
Sternothyroid
mohyoid
muscle
(superior
belly)(cut)

Trapezius
muscle

Thyroidgland

Omohyoidmuscle
(inferiorbelly)

muscle(cut)
Sternohyoid
Clavicle

Nr
Styloidprocess
Mastoid process

muscle
Stylohyoid

Mylohyoidmuscle

Digastricmuscle(posteriorbelly)

Digastricmuscle(anteriorbelly)
Ceniohvoid muscle

Thyrohyoidmuscle
ue lineof thyroidcartilage

muscle
Sternohyoid
Omohyoidmuscle
(superiorbelly)

Infrahyoidand
suprahyoidmusclesand
their action:schema

Omohyoidmuscle(inferiorbelly)

Sternothyroid
muscle
Sternum

Plate 29

Scalene and Prevertebral Muscles

Basilarpartof
occipitalbone

Longuscapitismuscle(cut)

condyle

process
of
Jugular
occipital bone

Rectuscapitis
anteriormuscle

Mastoidprocess

Rectuscapitis
lateralis
muscle

Styloidprocess

processof atlas(C1)
Transverse

L o n g u sc a p i t i sm u s c l e

Posteriortubercle of

processof axis(C
transverse
Slipsof originof anterior
scalenemuscle(cut)

Longuscollimuscle

Slipsof originof posterior


scalenemuscle
Anterior
Scalene
muscles

Middle

I S."t"n"
PosteriorI muscles

Middle

Posterior

Phrenic

plexus
Brachial

4{tr
+
f:i'

Subclavian
artery
Subclavianveiri

Rightcommoncarotidartery

Posterior
tubercleof transverse
processof C7 vertebra

I n t e r n aj ul g u l avr e i n

Plate 3O

Neck

Superficial Veins and Gutaneous Nerves of Neck

muscle(cut)
Platysma
Facialarteryand vein

muscle
Digastric
(anterior
belly)

Marginalmandibular
branch offacial nerve

gland
Submandibular
Mylohyoidmuscle

Hyoid bone
Parotid gland
Retromandibularvein

Omohyoidmuscle(cut)
Externalcarotid artery

I n t e r n a l j u g u l avre i n

muscle
Thyrohyoid

Externaljugularvein

muscle(cut)
Sternocleidomastoid

Anteriorjugularvein

thyroidarteryandvein
Superior
lnternaljugularvein

Communicatingvein

Common carotid artery


Great auricularnerve

muscle
Sternohyoid

Thyroidcartilage

id muscle
Ansa cervicalis

cervicalnerves
Transverse

Omohyoidmuscle
(superior
belly)(cut)

Thyroid gland

Omohyoidmuscle
(inferiorbelly)
muscle
Trapezius

plexus
Brachial

muscle(cut)
Platysma

Pectoralismajor muscle

nerves
Supraclavicular
muscle
Sternocleidomastoid

Clavicle
muscle(cut)
Sternocleidomastoid
Sternothyroidmuscle

4{tr
Neck

Plate 31

Gervical Plexus in Situ


SeealsoPlates 127-129.199

Parotidgland

Creatauricular
nerve

Facialarterv and vein

Lesseroccipital
nerve

S u b m a n d i b u lgalra n d
Mylohyoidmuscle

Sternocleidomastoid
muscfe (cut, turned up)

Hypoglossalnerve (Xll)

Stylohyoid
muscle

Digastricmuscle

Digastricmuscle
(posterior
belly)

( a n t e r i obr e l l y )

Lingualartery

C2 spinalnerve
(ventralramus)

Externalcarotid art

Accessory nerve (Xl)

Internalcarotid artery

C 3 s p i n anl e r v e
(ventralramus)

Thyrohyoidmuscle
Superiorthyroidartery

Levatorscapulae
muscle

O m o h y o i d m u s c l e( s u p e r i o rb e l l y )

M i d d l e s c a l e n em u s c l e
Anterior scalenemuscle

C 5 s p i n anl e r v e
(ventralramus)

Sternohyoidmuscle

ialcervical

Sternothyroidmuscle

artery

I n t e r n ajlu g u l a rv e i n

Phrenicnerve

Common carotid artery

Omohyoid
muscle
(inferior
belly)(cut)

Inferiorthvroid arterv
Vagusnerve (X)

plexus
Brachial
Dorsalscapular
artery
Suprascapular
artery

Vertebral artery

Thyrocervical
trunk

Nr

Subclavianartery and vei


Accessory

Cervicalplexus:schema
(S= grayramus
fromsuperior

Hypoglossal
nerve

Creat auricularnerve
Lesseroccioital nerve

cervicalsympatheticganglion)

Torectuscapitislateralis,
longuscapitis,
andrectus
caoitisanteriormuscles

To geniohyoid muscle
To thyrohyoid muscle
C o m m u n i c a t i o nt o v a g u sn e
Transversecervical nerves

To omohyoid muscle
To longuscapitisand
l o n g u sc o l l i m u s c l e s

Ansa cervicalis
To sternothyroidmuscle
To sternohyoidmuscle
To omohyoid muscle (inferior bellv)

To scaleneand levator
s c a p u l a em u s c l e s

Supraclavicularnerves
P h r e n i cn e r v e

Plate 32

Neck

Subclavian Artery

Rightanteriordissection

Thyroidgland(reflected)

l n t e r n a jl u g u l a rv e i
Common carotid artery

ganglion
Middlecervicalsympathetic

Ascendingcervicalartery

Vagusnerve(X)

P h r e n i cn e r v e
A n t e r i o rs c a l e n em u s c l e

Vertebralartery

Inferior thvroid arterv

Commoncarotidartery

Superficialcervical artery

laryngeal
nerve
Recurrent

S u p r a s c a p ual ar rt e r y
Dorsalscapularartery

trunk
Brachiocephalic

Costocervical

jugularvein(cut)
Internal

Thyrocervical
trunk
Subclavianartery and vei

cervicalartery(-30%)
Commonorigin of superficialcervicaland dorsalscapulararteriesfrom transverse
Superficialbranch of transversecervical artery (superficialcervical
Inferiorthyroid artery
Deep branch of transversecervical artery (dorsalscapularartery)
Transversecervicalartery

Thyrocervical
trunk
artery
Suprascapular

Rightobliqueschematicview
Vertebralartery
Deep cervical artery (ascending
to anastomosewith descending
branch of occipital artery)

Rightexternalcarotidartery
Rightinternalcarotidartery
Ascending cervicalartery

Suoerficialcervical arte
Inferiorthyroid artery

Costocervical
trunk

Superficialcervicalartery

S u p r e m (es u p e r i o r )
intercostal
artery

Right common carotid artery

Dorsalscapularartery
S u p e r i o ra n d i n f e r i o r
transversescapularligaments
Acromion

trunk
Thyrocervical

Right subclavianartery (1st part medial to, 2nd part


posterior to, 3rd part lateralto anterior scalenemuscle)

Dorsalscapularartery

B r a c h i o c e p h atlriuc n k
artery
Suprascapular

S u p r a s c a p u l aar

Aorticarch

Axillaryartery

artery
Internalthoracic(mammary)

1 s ta n d2 n d p o s t e r i o r
intercostal
arteries

1 s t , 2 n da,n d3 r d a n t e r i oirn t e r c o s t a rl t e r i e s
Circumflex
scapularartery

Neck

4{tr
C/Fd4/^

S u b s c a p u laarrt e r y
horacodorsalartery

Plate 33

Garotid Arteries

Parotidspace
(bed):right lateral
dissection

Superficialtemporal artery

Transverse
facialarterv
Maxillaryartery

Mastoid process

External
carotidarterv

Styloidprocess

Posterior
auriculararterV

Facialnerve (Vll) (cut

Clossopharyngealnerve (lX)

Sternocleidomastoid
muscle(cut)

Stylohyoid
muscle

Digastricmuscle(posterior
belly)(cut)

Hypoglossalnerve (Xll)

Occipital artery and


sternocleidomastoidbrancn

Facialartery
Lingualartery

Accessory nerve (Xl)

Mylohyoidmuscle
H y o g l o s s umsu s c l e
Vagus nerve (X)

Digastricmuscle
(anteriorbelly)

Ascending
pharyngeal
artery

Hyoid bone

Carotidbranchof glossopharyngeal
nerve (lX) and carotid body

Branchto
thyrohyoidmuscle
(fromansacervicalis)

Internalcarotid
Internaljugular vein

Superiorlaryngeal
artery
Superiorthyroidartery
External
carotidartery

Superficialtemporal artery
Transversefacial artery

Disastricmuscle
(phantom)

Commoncarotidarterv

Maxillaryartery

Posterior
auricularartery
Occipitalartery
Descending
branch/
Sternocleidomastoid
branch
Internalcarotid artery
Externalcarotid

Facialartery

Lingualartery
Ascendingpharyngealartery

Superiorthyroidarteryand
superiorlaryngeal
branch
Omohyoid muscle (phantom)

Common carotid arter

Externalcarotidbranches:
schema
Thyrocervicaltrunk

4{tr
Plate 34

Neck

Fascial Layers of Neck


seePlates 69-71
sheath
ofcarotid
Forcontents
layer of deep ce.rvicalfascia

Superficial

P l a t v s m am u s c l e
S t e r n o h y o i dm u s c l e
Trachea

Infrahyoidfa

Sternothyroidmuscle
T h y r o i dg l a n d

Pretracheal(visceral)fascia

Esophagus
Omohyoid muscle
'Sternocleidomastoid
muscle

Buccopharyngeal
( v i s c e r a lf)a s c i a
Carotid sheath

Recurrentlaryngeal
nerve

S u b c u t a n e o tui s s u e
\ -----'-\

Common carotid artery


I n t e r n a l u g u l a rv e i n
Vagus nerve (X)

Superficial
(investing
l a)y e r
of deep cervical
fasciaroofing
p o s t e r i o rt r i a n g l e

P h r e n i cn e r v e
Anterior scalenemuscle
S y m p a t h e t i ct r u n k

Fatin
posterior
triangle

S p i n a ln e r v e
Middleand posterior
s c a l e n em u s c l e s
L o n g u sc o l l i m u s c l e

PrevertebralIayer
of (deep)
cervicalfascia

Levatorscapulaemuscle
Trapeziusmuscle
Deeo cervical muscles

Alar fascia
Retropharyngeal
space

Crosssection

Subcutaneous
tissue

Cervicalvertebra (CZ)

Sagittal section

Mandible
Pharynx

C e n i o h y o i dm u s c l e

Buccopharyngeal(visceral)
fascia

Ceniohyoid fascia
lnvestinglayer of (deep)
cervicalfascia

Retropharyngeal
space

F a s c i ao f i n f r a h y o i dm u s c l e s
Alar fascia
Pretracheal(visceral) fascia
Prevertebralfascia

Thyroid gland

Trachea

S u b c u t a n e o u tsi s s u e

Esophagus

asternalspace (of Burns)

:w'-'-

'

M a n u b r i u mo f s t e r n u m
Aorta
Pericardium

Neck

4{F
Plate 35

Nose

Anterolateralview

Inferiorview
Major alar cartilage

Frontalbone
N a s a lb o n e s

Lateral

Frontalprocessof maxilla

Medial
crus

Lateralprocessof
septal nasalcartilages
Septalcartilage
M i n o r a l a rc a r t i l a g e
Accessory nasalcartilage

Alar
fibrofatty
trssue

Nasalseptalcartilage
A n t e r i o rn a s a ls p i n eo f m

Nasalseptal
cartilage

Alarfibrofattytis
Infraorbitalforamen

Anterior
n a s asl p i n e
of maxilla
Intermaxillary
suture

F r o n t a l i sm u s c l e

Supraorbital
arteryand ner
Supratrochleararterv and

P r o c e r um
s uscle
C o r r u g a t osru p e r c i lm
ii uscle
Dorsal nasalarl
Infratrochlearnerve
Angular artery
Externalnasalartery and nerve
Nasalismuscle (transversepart
Infraorbitalartery and nerve
Lateralnasalartery
Transversefacial artery
N a s a l i sm u s c l e( a l a rp a r t )
Depressorsepti nasi muscte

O r b i c u l a ro
i sr i sm u s c l e
Facialartery

Nry
Plate 36

Nasal Region

Lateral Wall of Nasal Gavity

Sohenoethmoidal recess

F r o n t asl i n u s

of
s il n u s
sphenoida

S u p e r i o rn a s a lc o n c h a
Superior nasalmeatus

Hypophysis
( p i t u i t a rgyl a n d )
i n s e l l at u r c i c a

M i d d l e n a s a lc o n c h a
Agger nasi

S p h e n o i d sa il n u s

Atrium of middle nasalmeatus

Pharyngeal
tonsil
(adenoidif enlarged)
Basilarpartof
occipitalbone
Pharyngeal
raphe

M i d d l e n a s a lm e a t u s
Inferior nasalconcha
(turbinate)
L i m e nn a s i

Nasalvestibule
Torustubarius

lnferior nasalme

O p e n i n go f a u d i t o r y
(pharyngotympanic,
E u s t a c h i atnu)b e
recess
Pharyngeal

Palatineprocessof maxilla
I n c i s i v ec a n a l
Tongue

Horizontalplateof
palatinb
eone
Softpalate
M i d d l e n a s a lc o n c h a
M i d d l e n a s a lm e a t u s

Bulging
septum
rway to nasopharynx

*{ry

Inferior nasalconcha
Inferior nasalmeatus
Floor of nasalcavity

F r o n t a sl i n u

Cribriform plate of ethmoid bone


P r o b e i n o p e n i n go f s p h e n o i d asl i n u s

P r o b e p a s s i n gf r o m s e m i l u n a r
h i a t u si n t o f r o n t a ls i n u sv i a
frontonasalduct

S p h e n o i d sa il n u s
Suoeriornasalmeatus
w i t h o p e n i n go f p o s t e r i o r

Middle nasalconcha (cut surface)

e t h m o i d acle l l s

E t h m o i d ablu l l a

part
Basilar
of occipitalbone

O p e n i n g so f m i d d l ee t h m o i d a lc e l l s
S e m i l u n ah
r i a t u s( o s t e o m e a t aul n i t )
w i t h o p e n i n go f a n t e r i o r
e t h m o i d a la i r c e l l s
U n c i n a t ep r o c e s s

Torustubarius
ingof auditory

(pharyngotympanic,
E u s t a c h i atnu)b e

l n f e r i o rn a s a lc o n c h a
(cut surface)

Anterior arch

of atlas(C1vertebra)

O p e n i n go f n a s o l a c r i m a l
lnferior nasalmeatus

Nasal Region

O p e n i n go f
m a x i l l a r ys i n u s

Densof axis
(C2vertebra)

Plate 37

Lateral Wall of Nasal Gavity (continuedf

Lacrimalbone

Middlenasalconcha
Uncinate process

Cribriformplate

Ethmoid bone

S u p e r i o rn a s a lc o n c h a
Highest nasalconcha

recess
Sohenoethmoidal

Nasalbone

Sphenopalatine
foramen

Agger nasi

partof
Basilar
occipitalbone

Lateralprocessof
nasalseptalcartilage
Major alar cartilage

Alarfibrofattytissue

Sphenoidal
sinus
Medial
and
Lateral
S p h e n o i db o n e
platesof
pterygoid
process
Pterygoid
hamulus

Frontalprocess

Anteriornasalspin
Maxilla

Incisivecanal
Palatineprocess
Alveolar process

Inferior
nasalconcha

E t h m o i d ablu l l a
Frontalsi
Opening of frontonasalcanal

O p e n i n go f m i d d l ee t h m o i d a lc e l l s

periornasalconcha(cutaway)
gs of posteriorethmoidal cells

Middle nasalconcha (cutaway)

ingof sphenoidal
sinus
I n f u n d i b u l u ml e a d i n gt o
frontonasalcanal

Semilunar
hiatus(osteomeatal
unit)

O p e n i n g si n t o m a x i l l a r ys i n u s

foramen
Sphenopalatine

with opening of anterior


e t h m o i d a la i r c e l l s
Uncinate process
lnferior nasalconcha (cut away)

processof
Ethmoidal
inferiornasalconcha
Lesserpalatineforamen

O p e n i n go f n a s o l a c r i m a l
Creater palatineforamen

Plate 38

4{tr

Nasal Region

Medial Wall of Nasal Gavity (Nasal Septum|

Falxcerebri
Frontal

m plateof ethmoidbone
Dura mater

Sphenoidal
sin

Sellaturcica
Nasal
Choanae(posteriornasalapertures
)
Lateralprocessof nasalseptalcartilage

alarcartilage
Torustubarius
Nasalvestibule
Anteriornasalspi
Incisivecanal
Oral cavity
Tongue
Soft

4{tr

Cristagalli
Cribriformplate

Ethmoidbone

Nasal
Vomer
Vomerine groove
(for nasopalatine nerve

andvessels)
Septalcartila
Majoralar
cartilage(medialcrus)

Anteriornasal
NasalcrestIncisivecanal,
Palatine
oroce

Nasal Region

Createrpalatineforamen

Plate 39

Maxillary Artery

A n t e r i o r Deeptemporalarteriesand nerves
Posterior
Masseteric
arteryand nerve

Lateralpterygoid artery and muscle

Supraorbital
artery

Lateralligament of

Supratrochlear
artery

joint
temporomandibular

Ophthalmicartery

Middle meningealartery

Auriculotemporal
nerve

Dorsalnasalartery

Maxillaryartery

Angularartery
Infraorbital
arterv

Superficial
temporalartery
Posterior
auricular
artery
Facialnerve
Inferioralveolar
artery and nerve

Buccalarteryand nerve

S p h e n o m a n d i b ulliagra m e n t

Medial pterygoid
artery and muscle

Mylohyoid nerve and branch


of inferior alveolarartery

P t e r y g o m a n d i b urlaapr h e

Digastricmuscle(posteriorbelly)

Lingualnerve

muscle
Stylohyoid

Facialartery

External
carotidarterv

Mentalbranchof
inferioralveolararl
S u b m e n t a lr t e r y

Sphenopalatine
artery
Posterior
lateralnasalbranch

Facialartery
Lingualartery

Arteryof pterygoidcanal
Pharyngealartery
Sphenopalatineforamen

Infraorbital
artery

Anterior I Oeeptemporalarteries
I and nerves
Posterior
Accessory
meningeal
artery
M i d d l e m e n i n g e a al r t e r y

Anteriortympanicartery
Deepauricularartery
Auriculotemporal
nerve

Posterior
suoerior
alveolarartery
Sphenopalatine
artery
Posterior
septalbranches
Creater (descending)
palatineartery

Buccalartery
Superficial
temporalartery
pharyngeal
Ascending
artery

Anastomosis
in
incisivecanal
Left and right

Ascendingpalatineartery

greaterpalatinearteries

Tonsillarbranches

Leftand right
lesserpalatinearteries
Pterygoidarteries

4{tr
Plate 40

Masseteric
artery
Inferior alveolarartery

Tonsillar
artery
External
carotidartery
Facialartery
muscle
Superiorpharyngeal
constrictor
muscle
Styloglossus

Nasal Region

Arteries of Nasal Gavity: Nasal Septum Turned Up

Nasalseptalbranchof superiorlabialbranch
(of facialartery)

Nasalseptum(turnedup

Schematichinge.

betweenposterior
Anastomosis
septalbranchof sphenopalatine
arteryand greaterpalatineartery
i n i n c i s i v cea n a l
Septaland lateralnasal
of posterior
branches
ethmoidalartery

Anterior septal branch,


Anterior lateralnasalbr
Externalnasalbranch
of anterior
ethmoidal
artery

ti.

N,

Posteriorseptal
branchof
sphenopalatine
artery
Sphenopalatine
artery
Sphenopalatine
foramen

Alarbranches
of
lateralnasal
branch
(of facialartery)

Posterior
lateralnasal
b r a n c h eosf
sphenopalatine
artery
Maxillary
artery
Anastomosisbetween
posterior septal branch

External
carotid
artery

of sphenopalatine
artery
and greaterpalatine ,/
artery in incisive

Lesserpalatineforamenand artery
Creater palatineartery

Createrpalatineforamenandartery

Lateralwall of nasalcavity

Nr
Nasal Region

Plate 41

Nerves of Nasal Gavity: Nasal Septum TUrned Up


SeealsoPlates 44,45,119

Olfactory

Nasafseptum(turned up)
Schematic hinge

I n c i s i v ec a n a l

Nasopalatine
n e r v e( V z )

M e d i a l i n t e r n a ln a s a l ,
L a t e r a il n t e r n a ln a s a l ,
E x t e r n anl a s a l
b r a n c h e so f
a nteflor
ethmoidal
n e r v e( V 1 )

S p h e n o p a l a t i nfeo r a m e n
(dlssectedaway)
I n t e r n a ln a s a l
b r a n c h e so f
i n fr a o r b i t a l
n e r v e( V 2 )

Pterygopalatine
ganglion
Nerve(Vidian)
o f p t e r y g o i dc a n a l

P o s t e r i o sr u p e r i o rl a t e r a ln a s a l
b r a n c ho f m a x i l l a r yn e r v e ( V 2 )
I

.I
N a s a lb r a n c ho f
a n t e r i o rs u p e r i o r
a l v e o l a rn e r v e ( V 2 )

C r e a t e ra n d l e s s e rp a l a t i n en e r v e s

P o s t e r i o irn f e r i o rl a t e r a ln a s a l
b r a n c ho f g r e a t e rp a l a t i n en e r v e ( V 2 )
L e s s e rp a l a t i n en e r v e s
C o m m u n i c a t i o nb e t w e e n
g r e a t e rp a l a t i n ea n d n a s o p a l a t i n e
n e r v e sa t i n c i s i v ec a n a l

C r e a t e rp a l a t i n en e r v e

Lateral wall of nasal cavitv

4{tr
Nasal Region

Nerves of Nasal Gavity (continuedf

Distribution of olfactory
mucosa(shadedblue)
Nasal
septum

lateral wall
of nasal cavitv

External
nasalbranchof anteriorethmoidalnerve(Vr)
Lateralinternalnasalbranchof anteriorethmoidalnerve(Vr)
Olfactorybulb
m Dlateof ethmoid bone

Olfactorytract

superiorlateralnasalbranches
Posterior
from maxillarynerve(Vz)
Maxillarynerve(V2)(sphenopalatine
foramendissectedaway)
Pterygopalatineganglion

Createrpetrosalnerve
Deep petrosalnerve
Nerve(Vidian)of pterygoidcanal
Pharyngeal
branchof maxillarynerve(V2)
nerve(Vz)passingto septum(cut)
Nasopalatine
inferiorlateralnasalbranch
Posterior
from greaterpalatinenerve(V2)

Lateral
wall of
nasal
cavity

bulb
Cribriformplate

Olfactorynerves(l)
Createi

Palatinenerves(Vz)
{

Nr

Medialinternalnasalbranch
of anteriorethmoidalnerve(Vr
Olfactorvnerves(
Nasopalatinenerve (V2
Incisivecanal

Nasalseptum

Nasal Region

Plate 43

Autonomic lnnervation of Nasal Gavity

Superiorsalivatorynucleus(parasympathetic)
Facialnerve(Vll)
ganglion)of facialnerve
Geniculum(geniculate
Createrpetrosalnerve(parasympathetic)
Deep petrosalnerve(sympathetic)
Nerve(Vidian)of pterygoidcanal
Maxillarynerve(Vz)enteringforamenrotundum
ganglionin
Pterygopalatine
Lateraland medialposteriorsuperior
nasalbranchesin pterygopalatine
fossa
nerve
lnfraorbital
Posteriorsuperior
and inferiorlateral
nasalnerves
(cut ends)

Tympaniccavity
ternalcarotid
n e r v ea n d p l e x u s

Posterior
supenor
alveolar
nerves

Maxillary
sinus

cervicalganglion
Postsynaptic
fibersto
vessels(sympathetic)
and
glands(parasympathetic)
of nasalcaviry maxillary
sinus,and palate
Preganglionicparasympatheticfi bers
Postganglionicparasympatheticfi bers
Preganglionicsympatheticfi bers
Presynaptic
sympatheticcell
bodiesin intermediolateral
nucleus
(lateralhorn)of graymatter(T1-T5)

Plate 44

Postganglionicsympatheticfi berc

*{r
]laoal Region

Ophthalmic (Vrl and Maxillarv (V"l Nerves

C o m m u n i c a t i n gb r a n c h
Posteriorethmoidal nerve

Anterior ethmoidal nerve

nerve
Supraorbital
Supratrochlearnerve

Long and short ciliary nerves


Lacrimalgland
C i l i a r yg a n g l i o n
Lacrimalnerve
N a s o c i l i a r yn e r v e
Frontalnerve
Tentorialbranch

Infratrochlearnerve
(from nasociliarynerve)

branchof
Cutaneous
lacrimalnerve
Zygomaticotemporal
nerve
Zygomaticofacial
nerve

O p h t h a l m i cn e r v e ( V r )

External
nasal
branchof
anterior
ethmoidal
nerve

Trigeminal
( s e m i l u n a rg) a n g l
Trigeminal

Meningeal

branch
Foramen
rotundum

lnfraorbital
nerve

Foramen
ovare

Anteriorsuperior
alveolarnerve

M a n d i b u l a rn e r v e ( V 3 )

Nasal
branch

Maxillary nerve (V2)


Zygomatic nerve
Nerve (Vidian)of pterygoid canal
Pterygopalatineganglion

Createrand lesserpalatinenerves
Canglionic branchesto pterygopalatineganglion

Mucousmembrane
of maxillarysinus
Dental and gingivalbranches

S u p e r i odr e n t apl l e x u s
Infraorbitalnerve entering
infraorbitalcanal

Middlesuperioralveolarnerve
Posterior
superioralveolarnerve

4{tr
Nasal Region

Plate 45

Mandibular Nerve (V"l


SeeafsoPlates 71,122,
A n t e r i o rd i v i s i o n

Lateral view

Posteriordivision

Temporalfascia
t e m p o r a l i sm u s c l e

Posterior
Anterior

o""o temporal
nerves
I

Foramenovale

Massetericnerve

M e n i n g e a lb r a n c h
ateral pterygoid
nerve and muscle

F o r a m e ns p i n o s u m
Middle
meningealartery

Auriculotemporal
nerve

Posterior
a u r i c u l anre r v e
F a c i an
l e r v e( V l l )
C h o r d at y m p a n i
nerve

Buccalnerve
and buccinator
muscle(cut)

L i n g u a ln e r v e

Submandibular
ganglion

Inferioralveolarnerve (cut)
Nerve to mylohyoid

Sublingual
gland

Medialpterygoidmuscle(cut)
Digastricmuscle (posteriorbelly)

*{r

Mylohyoid
muscle(cut)

muscle
Stylohyoid

Mentalnerve

Hypoglossalnerve
S u b m a n d i b u l aer l a n d

Sublingua
n le r v e
Trigeminal
ganglion
O p h t h a l m i cn e r v e ( V r)
Maxillary nerve (V2
M a n d i b u l a rn e r v e ( V t )

Inferior alveolarnerve (cut)


D i g a s t r i cm u s c l e( a n t e r i o rb e l l y )

r$'
rl,

(geniculate
Ceniculum
ganglion)
of facialnerve
Tympaniccavity
Chordatympaninerve
F a c i anl e r v e( V l l )

Anterior division
Tensorveli palatini
nerve and muscle
Otic ganglio
Chorda tympani nerve
Medial pterygoid
nerve and muscle (cut)

l e n s o rt y m p a n i
m u s c l ea n d n e r v e

Lesseroetrosalnerve
nerve
Auriculotemooral
Maxillaryartery
Mylohyoidnerve

P t e r y g o ihda m u l u s
L i n g u anl e r v e

Plate 46

Inferior alveolarnerve enterinq


m a n d i b u l a rf o r a m e n

Nasal Region

Nose and Paranasal Sinuses: Gross Section

Major alar
cartilage
Nasalvestibule
lnferior nasalconcha

Nasalseptalcartilage

Facialartery
Facialvein

M a x i l l a rby o n e
M a x i l l a rsyi n u s
S p h e n o i bd o n e
Massetermuscle
Coronoid
processof
mandible

Medialpterygoid
muscle

{
Lateral
pterygoid
m u s c l e\

Lateralpterygoid
plate

J.

Levatorveli
p a l a t i nm
i uscle

Cartilage
of
auditory

recess
Pharyngeal

tube

Longuscapitis
muscle

Neck of
mandible
Parotid
gland

Rectuscapitis
anterior
muscte

Retromandibular
vetn

! /_\

Superficial
temporal
arrery

.\'i

\.\
Clossopharyngeal

Sympathetic
trunk

nerve

Styloid
proceSs

Styloglossus
muscle
Stylohyoid
muscre

lnternalcarotid

artery

M a s t o i da i r c e l l s

Facialnerve

Medullaoblongata

Internal
j u g u l a rv e i n

Vagusnerve
Hypoglossalnerve

c4#

Nasal Region

Plale 47

Paranasal Sinuses

Olfactorybulbs

Falx

Brain

F r o n t asl i n u s

Nasalcavities

Orbitalfat
N a s a ls e p t u m

E t h m o i d ac le l l s
Middle
nasalconcha

O p e n i n go f
m a x i l l a rsyi n u s

Middle
nasalmeatus

Infraorbital Recesses
of
Zygomatic maxillary
s tn u s
Alveolar

M a x i l l a rsyi n u s
Inferior

Buccinatormuscle

nasalmeatus

ar processof maxilla

Inferior nasalconcha

of tongue
Hard palate

Sublingug
aland
Oral cavit
M a n d i b l e( b o d y )

*^--J

Nasalcavities

Nasal septum
E t h m o i d acl e l l s

Orbitalfat and muscles

M e d i a lw a l l
of orbit

O p t i c n e r v e( l l )
S p h e n o i d asl i n u s e s

4{r

Brain
Optic chiasm

Horizontalsection

Plate 48

Nasal Region

Paranasal Sinuses (continuedl

Sagittalsection
air cells
Ethmoidal
( sni u s e s )
F r o n t asl i n u s

O p e n i n go f
s il n u s
sphenoida

O p e n i n g o f f r o n t o n a s adl u c

S p h e n o i d sa il n u s
S e m i l u n ah
r iatus
(osteomeatalunit)

M i d d l en a s a l
concha(cutaway)

U n c i n a t ep r o c

O p e n i n go f

m a x i l l a rsyi n u s

lnferior nasalconcha

F r o n t a sl i n u s

n i n g i n t o m i d d l e n a s a lm e a t u s

Pterygopalatinefossa

M a x i l l a r ys i n u s

Lateraldissection
Roots of teeth

*{r
Nasal Region

Plate 49

Paranasal Sinuses: Ghanges with Age

Bonesof nasalcavity
and paranasalsinus6s
at birth

Sinrs.r"p.resents
one or moreanteriorethmoidalcells
openinginto semilunar
hiatusof middlenasalmeatus

I
I

!
Partof nasolacrimal
duct
that formedin depthsof
nasoopticfurrow

Sinw represents
one or moremiddleethmoidalcells
1 openinginto middlenasalmeatus
I

Sinur",represent
two or moreposteriorethmoidalcells
openinginto superiornasalmeatus
!
1
\

Nasal

Spfr"noidal
sinuswithinbonyshell(sphenoidal
concha)
locatedanteriorand lateralto body of sphenoidbone
(brokenlineindicates
sinuslateralto sphenoidbody)
Bodyof sphenoidbone

Lacrimalbone
Nasolacrimal
foramen(becomes
bonycanal)

Vestigialremnant
of Rathke'spouch
Medialplateof
pterygoidprocess

Partof nasolacrimal
ductwithinnasal
cavitywith slit-like
openingin inferior
nasalmeatus

Lowerborderof highestnasalconcha
Lowerborderof superiornasalconcha
Palati
bone

Uncinateprocessof ethmoidbond

Pterygoid

Semilunar

Superiornasalmeatus
Middle nasalconcha(cut edge)(inferior
nasalconchacompletelyremoved)

Maxillarysinuswith openinginto semilunar


hiatus(striped
arearepresentsmembraneformingmostof medialwall of sinus)

Grorythof frontal and maxillary


sinu"ses
throughout life
Frontalsinus
withinfrontal

Birth
1 year
4 years

I 7 years
ffi 12years
I Adult
I Old age

Middlenasalconcha

Leftorbit

Nasal
Nasalcavity

Maxillarvsinus
withinmaxilla

Inferiornasalconcha
Molar tooth

Nr
Plate 50

Nasal Region

lnspection of Oral Gavity

F r e n u l u mo f u p p e r
L i n g u am
l i n o r s a l i v a r yg l a n d
D e e p l i n g u a la r t e r ya n d v e r n s
a n d l i n g u a ln e r v e
F i m b r i a t e df o l d
S u b m a n d i b u l ad ru c t

lff--

S u b l i n g u agll a n d
F r e n u l u mo f t o n g u e
S u b l i n g u aflo l d w i t h o p e n i n g s
o f s u b l i n g u adl u c t s

L#

S u b l i n g u acla r u n c l ew i t h o p e n i
o f s u b m a n d i b u l adru c t

Nr
Oral Region

Plate 51

Roof of llouth

I n c i s i vpea p i l l a
Incisivefossa
palatine
Transverse
folds

Createrpalatinearteryand nerve
Createrpalatineforamen

Palatineraphe

Lesserpalatineforamen

Palatineprocess
of maxi

Lesserpalatinearteryand nerves
Palatine
glands

'endon
of tensorveli
palatinimuscle

Horizontalplate
of palatinebone

Pterygoidhamulus
Palatine
aponeurosis
(fromtensor
velipalatini
muscle)

Interdigitating
fibersof
levatorveli palatinimuscle
Buccinator
muscle

Uvularmuscle

Pterygomandibular
raphe

M o l a rm i n o r
salivaryglands

Superiorpharyngeal
constrictor
muscle

Palatopharyngeus
muscle

Palatoglossus
muscle

Palatine
tonsil
partof
Basilar
occipitalbone

Anterior view

part
Cartilaginous
of auditorv
(pharyngotympanic,
Eustachian)
tube
Levatorvelipalatinimuscle(cut)

Pharyngobasilar
lascta

Tensorvelipalatinimuscle

Levatorveli palatinimuscle

Medialpterygoidmuscle(
Medialpterygoidplate

Pterygoidhamulus

Pterygoid

Superiorpharyngeal
muscle(cut)
constrictor

Tendonof tensorvelipalatini
Levatorveli palatinimuscle(cut

Palatopharyngeus
muscle

Palatopharyngeus
muscle(

*{r
Plate 52

Posteriorview

Oral Region

Floor of Mouth

Lateral, slightly inferior view


Hyoglossus
muscle
Mylohyoidmuscle
Fibrousloop for intermediate
digastrictendon
Digastricmuscle(anteriorbelly)
Medianraphebetweenmylohyoidmuscles

Anteroinferior
view

Digastricmuscle(anteriorbelly)
Mylohyoidmuscle
muscle
Stylohyoid
muscle(posterior
belly)
Digastric

Hyoglossus
muscle

digastrictendon
Fibrousloopfor intermediate

Posterosuperior
view
Inferioralveolarnerveand arterv
Mylohyoidnerveand artery
glandandduct
Submandibular

Ceniohyoid muscle

*{r
Oral Region

Superiormentalspine(genialtubercle)
muscle
for originof genioglossus
Createrhorn

Hyoglossus
muscle(cut)

Plate 53

Muscles Involved in Mastication


Forfacial
muscles
seePlate26

muscle
Temporalis
Temporalfascia

Superficial
layer
Deeplayer

Levatorlabii
supenons
alaequenasi
muscre

Tygomatic arch

Levatorlabii
supenons
muscte

Articulardisc of
t e m p o r o m a n d i b u l aj ro i n t

Deeppart
I
S u p e r f i c ipaal r t
I

Zygomaticus
minormuscle
Zygomaticus
major muscle

Masseter
muscle

Parotidduct

Levator
anguli
ons
muscle

B u c c i n a t o rm u s c l e

Orbicularis
o r i sm u s c l e
Mentalis

muscle
D e p r e s s ol ar b i i
inferiorismuscle

D e p r e s s oarn g u l i
o r i sm u s c l e

T e m p o r a l i sm u s c l e
I n s e r t i o no f t e m o o r a l i sm u s c l et o
coronoid orocessof mandible
Parotidduct
B u c c i n a t o rm u s c l e

Orbicularo
i sr i sm u s c l

Lateralpterygoid
muscte
Massetericnerve
and artery

*{r
Plate 54

Maxillary artery
I n s e r t i o no f
massetermuscle

Oral Region

Muscles Involved in Mastication (continuedl

,,ti;ij

Articulardiscof

j*i

t e m p o r o m a n d i b u l aj ro i n t
A r t i c u l a rt u b e r c l e
Lateralpterygoid muscle

S p h e n o m a n d i b ulliagra m e n t
Medial pterygoid muscle
Parotidduct
B u c c i n a t o rm u s c l e

Pterygomandibularraph

l n s t r i c t omr u s c
co
S u p e r i opr h a r y n g e a

Lateralview

Choanae
S p h e n o m a n d i b u l al irg a m e n

Otic ganglion

C a r t i l a g i n o ups a r t o f a u d i t o r y
'(pharyngotympanic,
Eustachian)tube

M a s s e t e n cn e r v e

2q

Middle meningealartery

Lateralpterygoidplate
T e m p o r o m a n d i b u l aj or i n t

A u r i c u l o t e m p o r anl e r v e

teralpterygoidmuscle
Massetericartery

Medialpterygoidmuscle

Maxillaryartery
lnferior alveolarnerve
L i n g u a ln e r v e
M e d i a l p t e r y g o i dm u s c l e

Tensorveli palatini muscle (cut)

Medial pterygoid

Levatorveli palatini muscle (cut)

P t e r y g o ihda m u l u s

Pterygoidhamulus

Nerve to mylohyoid

4{tr
Oral Region

Posteriorview

Plate 55

Teeth

Permanent
(coloredblue)
Usualageof
eruption

Centralincisor(7thyear)

Centralincisor
( B - 1 0m o n t h s )
Lateralincisor
( B - 1 0m o n t h s
C a n i n e( c u s p i d )
(16-20months)

Lateralincisor(Bthyear)
C a n i n e( c u s p i d()11 t h - 1 2 t hy e a r )
st premolar(9thyear)
2 n d p r e m o l a r( 1 O t hy e a r )

1 s tm o l a r
( 1 5 - 2 1m o n t h s )

1 s tm o l a r( 6 t h y e a r )

2 n dm o l a r( 1 2 t h - 1 3 t yhe a r )

2 n dm o l a r
(20-24 months)

l---3rd
2 n dm o l a r
( 2 0 - 2 4m o n t h s )

molars(.17th-25thyear)

2 n d m o l a r( 1 2 t h - 1 3 t yhe a r )
1 s tm o l a r( 6 t hy e a r )

1 s tm o l a r
( 1 5 - 2 1m o n t h s )
C a n i n e( c u s p i d )
(16-20months)

year)
2 n dp r e m o l a(r1 O t h
1 s tp r e m o l a(r9 t hy e a r )

Lateralincisor
( 1 5 - 2 1m o n t h s )

e ( c u s p i d()11t h - 1 2 t hy e a r )
Lateralincisor (Bth year)

Centralincisor
(6-9 months)

Central incisor(7th year)

Central incisors
Lateralincisors
Canines

Palatineprocess
of maxilla

l st premolars

Horizontal
plate of
palatine
oone\

2 n dp r e m o l a r s
1 s tm o l a r
2nd molars

3 r dm o l a r s

Greater and lesser


palatineforamina

4{r
Plate 56

Upperpermanentteeth

Lowerpermanentteeth

Oral Region

Teeth (continuedl

Enamel
Dentineand dentinaltubules
sPaces
Interglobular
Odontoblastlayer
InterproximalsPaces
Dentalpulp containingvessels
and nerves
ival (gum)epithelium(stratified)
Cingivalgroove
Laminapropriaof gingiva(gum)
periosteum)
(mandibular
or maxillary
Periodontium
(alveolarperiosteum)

Root (central)canals
containingvesselsand nerves
Bone
Apicalforamina

Leftupper
permanent
teeth:
labiobuccal

Leftlower
permanent
teeth:
labiobuccal
vtew
Central

4{tr
Oral Region

Lateral

lncisors

12
Canines
(cuspids)

Premolars

Plate 57

Tongue

Epiglottis
Medianglossoepiglottic
fold
teralglossoepiglottic
fold
Vallecula
topharyngeal
archand muscle(cut)
(cut)
Palatinetonsil
Lingualtonsil(lingualnodules)
Palatoglossal
archand muscle(cut)
Foramen
cecum
Terminal
sulcus
Vallatepapillae
'Foliatepapillae

Filiformpapillae

papilla
Fungiform
Midlinegroove(mediansulcus)

Dorsumof tongue

Lingualtonsil

4{tr
Filiformpapillae
Fungiform
papilla
Keratinized
tip
of papilla

I n t r i n s im
c uscle

Stratified
squamous
epithelium
Sustentacular
cell
Sensorycell
Tastepore
Laminapropria
Section of
taste bud

Plate 58

Duct of gland
Crypt
Lymphfollicles
Mucousglands
Vallatepapilla
Tastebuds
Lingualglands(serousglandsofvon Ebner)
Schematic stereogram: area indicated above

Oral Region

Tongue (continued|

Palatopharyngeus
muscle
Palatoglossus
I n f e r i o rl o n g i t u d i n am
l u s c l eo f

Mastoid process

Digastricmuscle(posterior
belly)(cut)
process
fascra
Pharyngobasilar
pharyngeal
constrictormuscle
Superior
ligament
Stylohyoid
S t y l o g l o s sm
u su s c l e
partof superior
Clossopharyngeal
pharyngealconstrictor
muscle
Stylopharyngeus
muscle
Stylohyoid
Middle pharyngealconstrictormuscle

gastricmuscle(posteriorbelly)(cut)
H y o g l o s s umsu s c l e
msu s c l e !
Cenioglossu

lntermediatetendon of digastricmuscle (cut)


loop for intermediatedigastrictendon

Mylohyoidmuscle(cut)
C e n i o h y o i dm u s c l e

Lateralview
L i n g u a ln e r v e
S u b m a n d i b u l agr a n g l i o n

Superiorpharyngeal
c o n s t r i c t omr u s c l e
muscle
Styloglossus
muscle(cut)
Palatoglossus

D e e pl i n g u aal r t e r y
andvenaecomitantes

ligament
Stylohyoid
muscle
Stylopharyngeus
Hyoglossus
muscle(cut)
ngual artery
Externalcarotid artery

Arteryto fren

jugularvein
R e t r o m a n d i b u l avre i n

S u b m a n d i b u l adr u c t

Facialvein

artery
Suprahyoid

S u b l i n g u aal r t e r ya n d
Ceniohyoid muscki

Oral Region

C o m m o n t r u n kf o r f a c i a l ,
r e t r o m a n d i b u l aar n d
l i n g u a lv e i n s( c o m m o n
facial vein)
I vein

Hyoid bone

Dorsal lingual artery and vein

Hypoglossalnerve

Vena comitans of hypoglossalnerve

4{tr
Plate 59

Tongue and Salivary Glands: Sections

Horizontalsection
below lingulaof
mandible(superiorview)
demonstratingbed
of parotid gland

Orbicularo
i sr i sm u s c l e
Buccinatormuscle
Buccopharyngeal fascia
Facialartery and vein
P t e r y g o m a n d i b u l ar ra p h e

Linguan
l e r v e a n d s u p e r i o rp h a r y n g e acl o n s t r i c t o rm u s c l e

Masseter
muscle
Palatoglossus
muscle in palatoglossalarch
Palatinetonsil
Palatopharyngeus
muscle in palatopharyngealarc
R a m u so f m a n d i b l
Inferior alveolarartery,vein, and nerve
Medial pterygoid muscle

Styloglossus
muscle
Facialnerve
R e t r o m a n d i b u l avre i n

4{r

Externalcarotid artery

Parotidgland
Stylopharyngeus
muscle
Stylohyoid
muscle
Sternocleidomastoid
muscre
Digastricmuscle(posteriorbelly)
Internaljugular vein, internalcarotid artery
a n d n e r v e sl X , X , a n d X l l i n c a r o t i d

L o n g u cs a p i t i sm u s c l e
Prevertebralfascia

Superiorcervical sympatheticganglion

Buccopharyngeal fascia
and retropharyngealspace

S u p e r i o rl o n g i t u d i n am
l uscle
Verticaland transversemusctes
I n f e r i o rl o n g i t u d i n am
l uscle

Styloglossus
muscle
B u c c i n a t omr u s c l e

ortonsu"

Musclesof facialexpression

Hyoglossus
muscle
Cenioglossu
msu s c l e
S u b l i n g u saal l i v a rgyl a n d
S u b m a n d i b u ldaur c t
andibularcanal,inferior alveolarartery,vein, and nerve
Lingualnerve
Nerve to mylohyoid
V e n a c o m i t a n so f h y p o g l o s s anl e r v e ( t o l i n g u a lv e i n )
Linguaa
l rtery
. F a c i aal r t e r y
Hypoglossalnerve (Xll)
Submandibularsalivarygland

S u b m a n d i b u llay rm p hn o d e
Mylohyoidmuscle
F a c i avl e i n
I n t e r m e d i a t ed i e a s t r i ct e n o o n
Platysmamuscle
Hyoid bone

Plate 60

Frontalsection
behindl st molartooth
(anteriorview)
demonstrating
bedsof sublingualand
submandibularglands

Oral Region

Salivary Glands

Superficialtemporal artery and vein


and auriculotemporalnerve
Branchesof facial nerve
facial artery
Transverse
Accessoryparotid gland
Parotidduct
B u c c i n a t o rm u s c l e( c u t )
Massetermuscle
L i n g u a ln e r
S u b m a n d i b u l agr a n g l i o n
Tongue
F r e n u l u mo f t o n g u e
S u b l i n g u aflo l d w i t h o p e n i n g s

d lu c t s
of sublingua

Parotid gland

S u b l i n g u acl a r u n c l ew i t h o p e n i n g
o f s u b m a n d i b u l adr u c t

Retromandibular
vein (anteriorand
posterior branches)

gland
Sublingua

Digastricmuscle
(posteriorbelly)

S u b m a n d i b u ldaur c t

muscle
Sublingualartery and vein

Externaljugular vein
Sternocleidomastoidmuscle

Mylohyoidmuscle(cui)
Digastricmuscle (anteriorbelly)

S u b m a n d i b u lgalra n d

4{F

Hyoid bone

Facialartery and vein

Parotidgland:
totally serous

Oral Region

S u b m a n d i b u lgalra n d :
mostlyserous,partiallymucous

Common trunk receivingfacial,


anterior branch of retromandibular,
a n d l i n g u a lv e i n s( c o m m o n f a c i a lv e i n )

I n t e r n aj ul g u l avr e i n
Externalcarotid artery

S u b l i n g ug
al a n d :
almostcompletelymucous

Plate 61

Afferent Innervation of Mouth and pharynx


SeealsoPlates45, 52, Sg,64, 1n,1?fg,,l25, ig3, lgs

Trigeminalnerve(V) :

Trigeminal(V) (maxillaryV2)

V i a s u p e r i o ra l v e o l a r
Glossopharyngeal
nerve 0n {,fffi
nerves
Vagus
nerve (Xl ;-/"7.//.'r
Via pterygopalatine
g a n g l i o na n d n a s o p a l a t i n e
Facialnerve(Vll)
and greaterand lesser
palatinenerves

Facial(Vll) (intermediate
nerve)
Via greater petrosalnerve, pterygopalatine
g a n g l i o na
, n d g r e a t e ra n d l e s s e rp a l a t i n en e r v e s

(lX)
Glossopharyngeal
Via pharyngealplexus
V i a t o n s i l l a rb r a n c h e s
Tasteplus generalsensation
v i a l i n g u a lb r a n c h e s

Trigeminal(V) (maxillaryV2)
a pharyngealbranch of
pterygopalatineganglion

tr

Vagus(X)
Via internalbranchof
s u p e r i olra r y ng e a ln e r v e

Facial(Vll) (intermediate
nerve)
Via greaterpetrosalnerve and
pterygopalatineganglion

(lX)
Glossopharyngeal
plexus
Via pharyngeal
V i a t o n s i l l a rb r a n c h e s
Tasteplus general
s e n s a t i o nv i a
l i n g u a lb r a n c h e s

Vagus(X) and
glossopharyngeal(lX)
Via pharyngeal
prexus
Vagus(X)
V i ai n t e r n a l
branchof
supenor
laryngeal

Trigeminal (V)
(maxillary V2)
Via pterygopalatine
g a n g l i o na n d
nasopalatineand
g r e a t e ra n d l e s s e r
p a l a t i n en e r v e s

V i as u p e r i o r
alveolarnerves

Trigeminal(V)
(mandibularV3)
Via buccal nerve
Via inferior
a l v e o l a rn e r v e

nerve

Trigeminal(V)
(mandibularV3)
ia lingual
nerve
Facial(Vll) (intermediate nerve)
Tastevia chorda tympani and lingual nervt:

*{r
Oral Region

Pharynx: Median Section

Sellaturcica
Frontalsinus

S p h e n o o c c i p i t asly n c h o n d r o s i s

S p h e n o i d asl i n u s

tonsil
Pharyngeal

Nasalseptum

Pharyngealtubercle of occipital bone


aryngealraphe

Nasopharynx

A n t e r i o rl o n g i t u d i n allig a m e n t

Soft palate

terior atlantooccipitalmembrane

Palatineglands
Hard palate.-

Pharyngealopening of auditory
(pharyngotympanic,Eustachian)
tube

A p i c a ll i g a m e n to f d e n s
!

Anterior
arch of
atlas(C1
vertebra)

Oral cavity
I n c i s i v ec a n a l
Palatinetonsil-..-

Dens of
axis (C2
vertebra)

Body of tongue

Oropharynx

Pharyngeal
constrictor
muscles

Foramencecum
L i n g u a tl o n s i l

Buccopharyngeal
fascia

Cenioglossus
muscle
Root of tongue

Retropharyngeal
space

Epiglottis
Mandible

i i!:rj"r,

Ceniohyoid muscle
Hyoid bone
Hyoepiglottic ligament

Prevertebral
fasciaand
anterior
longitudinal
ligament

Vertebral
bodies

Thvrohvoid membrane

Laryngopharynx
Laryngealinlet (aditus)
Thyroid cartilage

Vocalfold
Transversearytenoid
Cricoid cartilage
Trachea
Esophagus

muscles
Esophageal
Thyroidgla
Superficial(investing)layer of deep cervicalfascia
Pretrachealfascia

space(of Burns
Suprasternal
of sternum
Manubrium

Pharynx

4{tr
Plate 63

Medialview
Median (sagittal)section
S o h e n o i d sa il n u s
Pharyngeal
tonsil
Torustubarius
Pharyngeal
tubercle(basilarpartof occipitalbone)
Pharyngeal
raphe
Pharyngealopening of auditory
(pharyngotympanic,Eustachian)tube
Hard palate
Pharyngealrecess
Salpingopharyngealfold
Soft oalate
Palatineglands

Uvula
S e m i l u n a fro l d
Supratonsillarfossa
Palatinetonsil
Palatopharyngeal
arch
Palatoglossal
arch
Oropharynx
Triangularfold
Tongue (drawn forward and downward)
L i n g u a tl o n s i l

Epiglottis
Vallecula

Pharyngealmucosaremoved
C a r t i l a g i n o ups a r t o f a u d i t o r y( p h a r y n g o t y m p a n i cE,u s t a c h i a nt )u b e
Medial pterygoid plate
Tensorveli palatini muscle and tendon
L e v a t o rv e l i p a l a t i n im u s c l e
Ascendingpalatineartery
Pharyngealbranch of ascendingpharyngealartery
Lesserpalatineartery
S a l p i n g o p h a r y n g e umsu s c l e
Pterygoid hamulus
Pterygomandibularraphe
Tonsillarbranch of lesserpalatineartery
Superiorpharyngealconstrictor muscle
Tonsillarbranch of ascendingpharyngealartery
Palatoglossus
muscle
Palatopharyngeus
muscle
Tonsillarbranch of ascendingpalatineartery
Tonsillarbranch of facial
Tonsillarbranch of dorsal lingualartery
Glossopharyngealnerve (lX) and tonsillarbranch
S t y l o h y o i dl i g a m e n t
Hyoglossusmuscle
Middle pharyngealconstrictor muscle
S t y l o p h a r y n g e um
s uscle

4{tr
Plate 64

Pharynx

Muscles of Pharynx: Median (Sagittall Section

Medial pterygoid plate


Cartilaginouspart of auditory (pharyngotympanic,Eustachian)tube
Tensorveli palatinimuscle
Pharyngobasilarfascia
Levatorveli oalatinimuscle
P a l a t i n ea o o n e u r o s i sa n d t e n d o n o f
t e n s o rv e l i o a l a t i n im u s c l e

P h a r y n g etaul b e r c l e( b a s i l apra r to f o c c i p i t abl o n e )


P h a r y n g e arla p h e
A n t e r i o rl o n g i t u d i n alli g a m e n t
Anterior atlantooccipitalmembrane
A p i c a l l i g a m e n to f d e n s

e u sm u s c l e
lpingopharg
yn
Musclesof soft palate
ridge)
Palatopharyngealsphincter(Passavant's
P t e r y g o i dh a m u l u s
Superiorpharyngealconstrictormuscle
Pterygomandibularraphe
muscle
Palatopharyngeus
B u c c i n a t o rm u s c l e
Clossopharyngealpart ol
superior pharyngealconstrictor
Stylopharyngeusmuscle
Stylohyoidligament
Styloglossusmuscle
Middle pharyngealconstrictormuscle
ibers to pharyngoepiglotticfold
B u c c o p h a r y n g e af al s c i aa n d
retropharyngealspace
Prevertebralfasciaand anlenor
l o n g i t u d i n alli g a m e n t

Hyoglossus
muscle

I n t e r n abl r a n c ho f s u p e r i olra r y n g e anle r v e

Ceniohyoid
muscte

L o n g i t u d i n apl h a r y ng e a lm u s c l e s

Mylohyoid
muscte
Hyoid bone

I n f e r i o rp h a r y n g e acl o n s t r i c t o rm u s c l e
P h a r y n g e aal p o n e u r o s i s

Thyrohyoid
memDrane

C r i c o p h a r y n g e um
s uscle
(part of inferior pharyngealconstrictor)

T h y r o i dc a r t i l a g e

r i c o i d a t t a c h m e n to f l o n g i t u d i n a l
e s o p h a g e am
l uscle

Median
cricothyroid ligament

l uscle
C i r c u l a re s o p h a g e am

C o r n i c u l a t ea n d
arytenoid cartilages
Cricoid cartilage
Trachea

l s o p h a g e am
l uscle
o ng i t u d i n ae

#r
. . . M a r g i n so f m i d d l ep h a r y n g e a l
c o n s t r i c t o rm u s c l e
- Margins and attachmentsof inferior
pharyngeal constrictormuscle

Plate 65

Pharynx: Opened Posterior View

r a r t o f o c c i p i t a lb o n e )
B a s eo f s k u l l( b a s i l a p
Pharyngealtonsil

Nasalseptum
Torustubarius

Pharyngeal
opening
of auditory(pharyngotympanic,
Eustachian)
tube
recess

Nasopharynx

Parotidgland

(fold
Toruslevatorius
causedby levator
velipalatinimuscle)
Salpingopharyngeal
fold
Soft palate
A n g l eo f m a n d i b l e

bulargland
Uvula
Palatinetonsil

Oropharynx

Root of tongue

Palatopharyngeal
arch
Prominencecaused by greaterhorn

of hyoidbone
Epiglottis
Laryngealinlet (aditus)

P r o m i n e n ccea u s e db y s u p e r i ohr o r n
of thyroid cartilage

Laryngopharynx

ielotticfold
Piriformfossa(recess)

Cuneiformtubercle
Foldover internalbranch
of superiorlaryngealnerve
Corniculatetubercle
Interarytenoidnotch
overlamina
of cricoid cartilage

Esophagus

4{tr
Trachea

Plate 66

Pharynx

Muscles of Pharynx: Partially Opened Posterior View

Basilarpart of occipital bone

't\

}i,ilri:l,

P h a r y n g e atlu b e r c l e

*-

Pharyngeal
tonsil

*
\:

Cartilaginouspart
of auditory
( p h a r y n g o t y m p ainc ,
Eustachian)tube

Styloid
process

Digastric
muscle
(Posterlor
belly)

Pharyngobasilar
fascia
Choana

Stylohyoid
muscte

Levatorveli
p a l a t i n im u s c l e

Stylopharyngeus
muscre

Superiorpharyngeal
constrictormuscle

muscle
Accessory
b u n d l ef r o m

Salpingopharyngeus
muscte

Petrouspart of
t e m p o r a lb o n e

Uvula

Medial
p t e r y g o i dm u s c l e

Palatopharyngeus muscle
Middlepharyngeal
constrictor muscle

Pharyngobasilar
fascia

muscle
Stylopharyngeus

Pharyngealraphe

goepiglotticfold
Pharyn

Superiorpharyngeal
c o n s t r i c t o rm u s c l e

fold
Aryepiglottic

Hyoid bone (tip of greater

lnferiorpharyngeal
constrictor muscle (cut edgeJ

Middle pharyngealconstrictormusc

l uscles
L o n g i t u d i n apl h a r y n g e am

Epiglottis

S u p e r i ohr o r no f
thyroidcartilage

Inferior pharyngealconstrictormuscle

Cuneiformtubercle

Thyrohyoid membrane

C o r n i c u l a t eu b e r c l e

lnternal branch of
superior laryngealnerve

(Transverse
and oblique)
a r y t e n o i dm u s c l e s

P h a r y n g e aal p o n e u r o s i s

Posteriorcricoarytenoidmuscle
C r i c o p h a r y n g e aml u s c l e( p a r to f
inferior pharyngealconstrictor)
l s o p h a g e am
L o ng i t u d i n a e
l uscle

C r i c o p h a r y n g e um
s u s c l e( p a r to f
inferior pharyngealconstrictor)
Posteriorborder of thyroid cartilagelamina
id attachment of longitudinal
esophagealmuscle

muscle
ularesophageal

4{tr
Pharynx

Plate 67

Muscles of Pharynxl Lateral View

Pharyngobasilar
fascia
T e n s o rv e l i p a l a t i n im u s c l e
Levatorveli palatini muscte
Lateralpterygoid plate

P t e r y g o i dh a m u l u s
B u c c i n a t o rm u s c l e( c u t )

P t e r y g o m a n d i b u l ar ra p h e
igastricmuscle

(posterior
belly)(cut)
Buccinatorcrest
of mandible

yloidprocess
Superiorpharyngealconstrictor muscle
Styloglossusmuscle

Obliqueline
of mandible

Stylohyoidligament
Stylopharyngeusmuscle
M i d d l e p h a r y n g e acl o n s t r i c t o rm u s c l e
H y o g l o s s u sm u s c l e
reater horn of hyoid bone

Digastricmuscle (anteriorbelly

r i o r h o r n o f t h y r o i dc a r t i l a g e

M y l o h y o i dm u s c l e

T h v r o h v o i dm e m b r a n e

Inferiorpharyngeal
constrictormuscle

Hyoid bone
Stylohyoidmuscle (cut)
Thyroid cartilage

T e n d i n o uasr c h
Zone of sparsemusclefibers
C r i c o p h a r y n g em
u su s c l e
(partof inferiorpharyngeal
constrictor)

M e d i a n c r i c o t h y r o i dl i

C r i c o t h y r o im
duscle
C r i c o i dc a r t i l a g e

sopnaSus

Trachea

4{r
Plate 68

Pharynx

Arteries of Oral and Pharyngeal Regions

5i"'{i',..',",.
{ S u p r a t r o c h l eaarr
Supraorbitala

M i d d l e m e n i n g e a al r t e r y
Deep temporal arteries
Dorsal nasala
Massetericartery
A n g u l a ra r t e r y
Infraorbitalartery
S p h e n o p a l a t i naer t e r y
D e s c e n d i n gp a l a t i n e

Transverse
facial
artery(cut)

P o s t e r i o sr u p e r i o r
alveolarartery

Superficial
temporal artery

S u p e r i o rl a b i a la r t
Buccalartery

Maxillaryartery

B u c c i n a t o rm u s c l e
and parotid duct (cut)

Posteriorauricularartery
Ascendingpharyngealartery

I n f e r i o rl a b i a la r t

Occipital artery and


s t e r n o c l e i d o m a s t o ibdr a n c h

S u p e r i o rp h a r y n g e a l
c o n s t r i c t o rm u s c l e

C l o s s o p h a r y n g e anle r v e ( l X )
Ascendingpalatineartely

Mental branch of
i n f e r i o ra l v e o l a ra r t

Tonsillar
artery

Inferior alveolarartery
a n d l i n g u a lb r a n c h

Facialartery
Linguaa
l rtery

Facialartery
S u b m e n t a al r t e r y
M y l o h y o i db r a n c ho f
i n f e r i o ra l v e o l a ra r t e r y
S u b m a n d i b u l agr l a n d
H y p o g l o s s anl e r v e ( X l l )
Suprahyoidarter

External
carotidartery
S u p e r i o rl a r y n g e aal r t

S u p e r i otrh y r o i da
C r i c o t h y r o i da r
Common carotid
Vertebralartery
Subclavianartery

A s c e n d i n gp h a r y n g e aal r t e r y
Internalcarotid artery
Vagus nerve (X)
Superiorcervical
cardiac nerve

trunk
Sympathetic
A n t e r i o rs c a l e n em u s c l e
P h r e n i cn e r v e
M i d d l e s c a l e n em u s c l e
Ascending cervicalartery

Inferiorthyroidartery
cervical artery
Suprascapularartery
Costocervicaltrunk
Thyrocervicaltrunk

4{tr
Pharynx

Plate 69

Veins of Oral and Pharyngeal Regions


SeealsoPlates 23,31,'lO4

S u p r a t r o c h l e avre i n
S u p r a o r b i t avl e i n
Nasofrontalvein
S u p e r i o ro p h t h a l m i cv e i n
A n g u l a rv e i n
Externalnasalvein
Emissaryvein (of Vesalius)
c o m m u n i c a t i n gw i t h
c a v e r n o u ss t n u s
lnfraorbitalvein
O c c i p i t a lv e i n
and artery

Posterior
superior 5;

alveolarveins

Superficialtemporal
vein and artery

Palatinevein

Pterygoidplexus

Transversefacial vein (cut)

S u p e r i ol ra b i avl e i

Posteriorauricularvein

Deep facial vein

R e t r o m a n d i b u l avre i n
(anteriorand

M a x i l l a r yv e i n s

posteriorbranches)
jugularvein(cut)
External

I n f e r i o rl a b i a lv e i n
Mental vein

Inferior alveolarvein and artery


ipital vein and artery

Facialvein and a

H y p o g l o s s anl e r v e ( X l l )

Externalpalatinevei
S u b m e n t a vl e i n
S u b m a n d i b u l agr l a n d
Vena comitans of
hypoglossalnerve
D o r s a ll i n g u a lv e i n c o u r s i n g
medial to hyoglossusmuscle
L i n g u a vl e i n
C o m m u n i c a t i o nt o a n t e r i o rj u g u l a rv e i n
S u p e r i o rl a r y n g e avl e i n
S u p e r i o rt h y r o i dv e i n
Thyroid gland
M i d d l e t h y r o i dv e i n
Inferiorthyroid vei
Termination
o f a n t e r i o rj u g u l a rv e i n ( c u t )
Left brachiocephalicvein

Common trunkreceiving
facial,anterior branch of
retromandibular,and
l i n g u a lv e i n s( c o m m o n f a c i a lv e i n )
Externalcarotid artery
I n t e r n ajlu g u l a rv e i n
Common carotid artery
Vagus nerve (X) and
sympathetictrunk
iddle scalenemuscle

A n t e r i osr c a l e n m
e uscle
j ul g u l avr e i n( c u t )
Externa
Transversecervical
vein (cut)
Suprascapularvein (cut)
Subclavianartery
S u b c l a v i a nv e i n

4{v
Plate 70

Pharynx

Nerves of Oral and Pharyngeal Regions

Zygomaticotemporalnerve (V2)
Deep temporal nerves(V3
Massetericnerve (V3)
M a n d i b u l a rn e r v e ( V 3 )
Nerve to medial pterygoid and
tensor veli palatinimuscles(V:) (cut)
Zygomaticofacialnerve (V2

M a x i l l a rny e r v e( V z )
I n f r a o r b i tn
ae
l r v e( V z )
Pterygopalatineganglion
Creater and lesser
p a l a t i n en e r v e s( V 2 )

AuriculotemporaI
nerve(V:)

A n t e r i o r ,m i d d l e ,a n d p o s t e r i o r
s u p e r i o ra l v e o l a rn e r v e s( V 2 )

meningealartery

Nerve to lateralpterygoid
m u s c l e( V 3 )( c u t )

Superficial
temporal
artery(cut)
Facialnerve(Vll)(cut)
Maxillaryartery

B u c c a ln e r v e ( V : ) C h o r d at y m p a n i n e r v e ( V l l )
Linguan
l e r v e( V 3 )

Accessorynerve (Xl) (cut)

Medialpterygoidmuscle(cut)

C 1 s p i n anl e r v e
(ventralramus)(cut)

(lateralpterygoid removed)

2 spinalnerve

l n f e r i o ra l v e o l a r
nerve (V:)

(ventralramus)(cut)

Mental nerve (Vr)


Nerve to mylohyoid (V3)
S u b m a n d i b u l agr a n g l i o n
Clossopharyngealnerve (lX)
a n d t o n s i l l a rb r a n c h
H y p o g l o s s anl e r v e ( X I l )
C a r o t i dn e r v e ( l X )a n d c a r o t i d
N e r v e t o t h y r o h y o i dm u s c l e( C 1 , 2 v i a X l l )
Internaland externalbranches
o f s u p e r i o rl a r y n g e a nl e r v e( X

slPerior oot
A n s ac e r v i c a l i(sC l , 2 , r , I(
lnferiorroot,
Nerves to superior and inferior belliesof omohyoid,
sternohyoid,and sternothyroidmuscles(ansacervicalis)
Recurrentlaryngealnerve (X)

plexuscomposedof
Pharyngeal
geal
branches
from glossopharyn
(lX),vagus(X),and sympathetic
nerves
Internalcarotidartery
External
carotidartery
Vagusnerve(X)and superior
cervicalcardiacbranch
C 4 s p i n anl e r v e
(ventralramus)(cut)
Phrenin
c e r v e( C 3 ,4 , 5 )
cervicalartery
M i d d l e s c a l e n em u s c l e

r scalenemuscle
Brachialplexus(cut)

Sympathetictrunk and middle cervical


Common carotid artery

Thyrocervicaltrunk

Vertebralartery
artery
Subclavian

*{r
Pharynx

Plate 7l

Lymph Vessels and Nodes of Head and Neck

parotidnodes
Superficial
(deepparotidnodes
d e e pt o a n dw i t h i n
parotid gland)

Subparotid
node
Facialnodes
Nasolabial
Buccinator

nodes
Mastoid nodes

Mandibular

Sternocleidomastoid
nodes

nodes

Superiorlateral
superficialcervical
jugular)
(external
node

Submandibular
nodes

Jugulodigastricnode

Submental
nodes

Suprahyoid
node
Superiordeeplateralcervical
(internal
jugular)nodesSuperiorthyroidnodes

superficial
cervical
(spinalaccessory)
nodes

Intercalatednode

Inferiordeep
lateralcervical
(scalene)
node

node
Juguloomohyoid
Thoracicduct
Anteriordeepcervical
(pretracheal
and thyroid)nodes
(deepto infrahyoidmuscles)
Anteriorsuperficial
cervical
nodes(anteriorjugularnodes

Transverse
cervical
chain of
nodes

J u g u l atr u n k
Supraclavicular
nodes*
Subclaviantrunk and nooe

*Thesupraclavicular
groupof nodes(also
knownasthe lowerdeepcervicalgroup),
especially
on the left,arealsosometimes
referredto asthe signalor sentinellymph
nodesof Virchowor Troisier,
especially
when
sufficiently
enlargedand palpable.
These
nodes(or a singlenode)areso termedbecause
theymaybe the firstrecognizedpresumptive
evidenceof malignant
diseasein the viscera.

Plale 72

4{tr
Pharynx

Lymph Vessels and Nodes of Pharynx and Tongue

gobasilar
fascia
Pharyn
nodes
Retropharyngeal
I n t e r n aj ul g u l avr e i n
belly)
Digastricmuscle(posterior
muscle
Sternocleidomastoid
node
lntercalated
node
f ugulodigastric

Deep lateral cervical


(internaljugular) nodes

J u g u l o o m o h y oni o
dde

entralcollectingvessels
Marginalcollectingvessels
g vessels
Basalcollectin
to
Communication

Lymphaticdrainageof pharynx:
posteriorview

Lymphaticdrainageof tongue

node
Submental
S u b m a n d i b u lnaor d e
node
Jugulodigastric
Deeo lateralcervical
(internaljugular) nodes

node
fuguloomohyoid

Pharynx

Plate 73

Thyroid Gland: Anterior View

Externalcarotid

Hyoid bone

Internalcarotidarterv

Superiorlaryngeal
nerve
Internalbranch
Externalbranch

Superiorthyroidarteryand
Superiorlaryngeal
artery

Thyroidcartilage(lamina)

Thyrohyoidmembrane
Ansa
t
cervicalis{

Mediancricothyroid
ligament

Superior
root
Inferior
root-

muscles
Cricothyroid
Cricoidcartilage

Commoncarotid
Internaljugularvein
Middlethyroidvein
Inferiorthyroidveins
Ascendingcervicalartery

Pretracheal
lymphnodes

lnferiorthyroidartery

'Phrenicnerve

Superficial
cervicalartery

Anteriorscalenemuscle

Suprascapular
artery

Vagusnerve(X)
Thyrocervical
trunk

jugularvein
External

Subclavian
arteryand

Anteriorjugularvein
1strib (cut)

Vagus nerve (X)

Leftrecurrentlaryngeal
nerve

Rightrecurrent
laryngeal
nerve
Brachiocephalic
trunk
Brachiocephalicveins
Supenor vena cava
Aortic arch

Thyroid cartilage

Cricothyroid
ligament
Commoncarotidartery
Medialmarginof
sternocleidomastoidmuscle

Cricothyroid
muscle
Cricoid cartilage

*{ry
Plate 74

Thyroidgland
Cupula(dome)of pleura

Thyroid Gland and La;ynx

Thyroid Gland and Pharynx: Posterior View

Superiorpharyngeal
constrictormuscle
Middlepharyngeal
muscle
constrictor

ExternalcarotidarterY
lnternalcarotidarterY
Facialartery

Tip of greaterhorn
of hyoid[ens-

Lingualartery

Inferiorpharyngeal
muscle'
constrictor

nerve
Superiorlaryngeal
-lnternal branch
Externalbranch

raphe
Pharyngeal

SuperiorthyroidarterY

Zoneof sparse
musclefibers
Cricopharyngeus
muscle(partof inferior
pharyngealconstrictor)
Circularesophageal
musclein V-shaped
areaof sparse
muscle
longitudinal
fibers (areaof Laimer)

SuperiorlaryngealarterY
CommoncarotidarterY
Vagusnerve(X)
Internaljugularvein
Thyroidgland
(rightlobe)
Superiorparathyroidgland

Longitudinal

esophagealmuscle
lnferiorthvroidvein
Trachea

lnferiorbulbof
i n t e r n aj ul g u l avr e i n
Vertebralarterv

cervicalartery
gland
Inferiorparathyroid
lnferiorthyroidartery
nerve
Rightrecurrentlaryngeal
cervicalartery
artery

Leftsubclavian
artervandvein

Thyrocervicaltrunk
Rightsubclavian
arteryandvein

Internalthoracic
arteryandvein
Left brachiocephalicvein
Left recurrent laryngeal

Arch of aorta
Leftvagusnerve

Thyroid Gland and Larynx

vein
Rightbrachiocephalic
trunk
Brachiocephalic
Rightvagusnerve(X)
Superiorvenacava

Plate 75

Parathyroid Glands
SeealsoPlate 80

Posterior view

h y r o h y o i dm e m b r a n e
Hyoid bon

S u p e r i ol ra r y n g e a l
Internalbranch
External
branch

External
carotidartery
Internalcarotidartery
Superiorthyroidartery
Superiorlaryngeal
artery

Vagusnerve(
Epiglottis

Inferiorpharyngeal
constrictor
muscle(cut)
Common carotid artery

Superiorthyroid

Fibrouscapsuleof
thyroidgland(cut)

Common carotid artery

F i b r o ucsa p s u l e
of
t h y r o i dg l a n d( c u t )

Cricopharyngeus
muscle(partof
inferiorpharyngeal
constrictor)
gland
Superiorparathyroid

Superiorparathyroid
gland
Rightlobeof thyroidglano
Leftlobeof thyroidgland
Ascendingcervicalarter

glano
Inferiorparathyroid
(maybe morecaudallylocated,
e v e nw i t h i nm e d i a s t i n u m )
lnferiorthyroidartery

Inferiorparathyroid
gland
recurrentlaryngealnerve
Left recurrentlaryngealnerve

Esophagus

Superficialcervical artery
Suprascapularartery

Thyrocervical
trunk
Subclavianartery

Vertebral
artery

Trachea

Subclavianartery

B r a c h i o c e p h atlriuc n k

Rightlateralview
Externalcarotio

Superiorlaryngeal
arte
S u p e r i otrh y r o i da r t e r y( c
Inferior pharyngealconstrictor muscle

lnternalbranchof
nerve
superiorlaryngeal
External
branchof
superiorlaryngeal
nerve
gland
Superiorparathyroid

C o m m o n c a r o t i da

I n t e r n aj ul g u l a r
Inferiorthyroidartery

T h y r o i dg l a n d( r i g h lto b e )
(retractedanteriorly)
Inferior parathyroidgland

Rightrecurrentlaryngeal
nerve
Esophagus

Plate 76

*{r
Thyroid Gland and Larynx

Gartilages of Larynx

Hyoidbone
Thyrohyoidmembr
Superiorhorn of thyroidcartil
cartilage
Corniculate
Arytenoidcartilage
Superiorthyroidnotch
Thyroidcartilagelami
Vocalligament
ligament
Mediancricothyroid
Inferiorhornof thyroid
Cricoid cartilage

Trachea

Posterior view

Anteriorview

Corniculatecartilage
MuscularprocessI Arytenoid
Vocalprocess
f cartilage

Cricoid
cartilage

Hyoepiglottic
ligament
Hyoidbone
Thvrohvoidmembrane
Thyroidcartilagelamina
O b l i q u el i n e
arynSealpromrnence

cart
Corniculate
Arytenoid
Muscularprocess

*{r
joint
Cricothyroid

Right lateralview

Thyroid Gland and Larynx

Medial view, median


(sagittal)section

Plale 77

lntrinsic Muscles of Larynx

piglottis

Foramen
for superior
laryngeal
vessels
and
internalbranchof
nerve
superiorlaryngeal

yepiglottic

fold
Cuneiform
tubercle

andtransverse
arytenoidmuscles

Corniculate
tubercle
Aryepiglottic
muscle

Posterior
cricoarytenoid
muscle

Oblique
arytenoidmuscle

I
t

Transverse
arytenoidmuscle

Straight
part
Oblique
part

Posterior
cricoarytenoid
muscle

Cricothyroid
muscte

ricoidcartilage

Rightlateralview

Posterior
view
Epiglottis
Aryepiglottic

muscle
O b l i q u ea n d
transverse
arytenoidmuscles
Posterior
cricoarytenoid
muscle

Thyroepiglottic
muscte
Arytenoid
cartilage

Thyroarytenoid
muscte

Laminaof

Lateral
cricoarytenoid
muscte
C o n u se l a s t i c u s

Cricothyroid
muscle (cut away)

Lateraldissection
Posteriorcricoarytenoidmuscre
Lateralcricoarytenoid
T

Transverse
and obliquearytenoidmuscles
Cricothyroid muscle

Conus
elasticus

Thyroarytenoid
muscle

Nr
Plate 78

Vocalismuscle
Vocal ligament

Lamina
of
thyroid
cartilage

Thyroid Gland and Larynx

Actions of Intrinsic Muscles of Larynx

Nr
Cricothyroidjoint
(pivotpoint)

Action of posterior cricoarytenoidmuscles


of vocalligaments
Abduction

Action of cricothyroid muscles


(increasing
tension)
Lengthening
of vocalligaments

Action of lateral cricoarytenoidmuscles

++

Action of transverseand oblique arytenoidmuscles


Adduction of vocal ligaments

Thyroid Gland and Larynx

Action of vocalisand thyroarytenoidmuscles


Shortening(relaxation)of vocal ligaments

Plate 79

Nerves of Larynx

Superior

Internalbranchof
superiorlaryngeal
nerve

laryngealnerve

Internalbranch
External
branch

Sensorybranches
to larynx
of Calen
Aryepiglottic
muscle
Thyroepi
glotticmuscle
Transverse
and oblique
arytenoidmuscles
Thvroarvtenoid
muscle
Vocalismuscle

Cricothvroid
muscle
Cricopharyngeus
muscle
(partof inferior
pharyngealconstrictor)
Rightrecurrent
laryngeal
nerve

Lateralcricoarvtenoid
muscle
Posterior
cricoarvtenoid
muscle
Thyroidarticularsurface
Anteriorand posteriorbranches
of
inferiorlaryngeal
nerve
Rightrecurrentlaryngeal
nerve

Rightlateralview:
thyroid cartilagelamina removed
Rightlateralview

Leftvagusnerve(X)
Rightvagusnerve(
Leftcommoncarotidartery
Anomalous right inferior
laryngealnerve (not recu

Leftinferiorlaryngealnerve

recurrentlaryngeal
nerve
Anomalous (retroesophageal)
right subclavianartery

Leftsubclavian
artery
Right common carotid

Anomalous(retroesophageal)
rightsubclavian
arteryoriginating
from leftsideof aorticarch

Archof aorta
Leftrecurrentlaryngeal
nerve

Anteriorview:
anomalousright
inferior laryngeal
nerve,not recurrent,
associatedwith
anomalousright
subclavianarterv

Plate 80

Nr
Thyroid Gland and Larynx

Eyelids

S u p e r i o rp a l p e b r a cl o n j u n c t i v a
t a r s a (l m e i b o m i a n )g l a n d s
s h i n i n gt h r o u g h

l a p i l l aa n d p u n c t u m
S u p e r i o rl a c r i m a p
P I i c as e m i l u n a r i s
L a c r i m acl a r u n c l ei n
l a c r i m a l a k e( l a c u sl a c r i m a l i s )

C o r n e o s c l e r aj ul n c t i o n
(cornealimbus)

l a p i l l aa n d p u n c t u m
I n f e r i o rl a c r i m a p
B u l b a rc o n j u n c t i v a
over sctera
In f e r i o rc o n j u n c t i v aflo r n i x

L e v a t o rp a l p e b r a es u p e r i o r i sm u s c l e

O r b i t asl e p t u m
Sclera

S u p e r i o rt a r s a l( M i . i l l e r ' sm) u s c l e( s m o o t h )

B u l b a rc o n j u n c t i v a

S u p e r i o rc o n j u n c t i v aflo r n r x
O r b i c u l a r i so c u l i m u s c l e( p a l p e b r apl a r t )

Palpebralconjunctiva

S u p e r i otra r s u s
T a r s a(lm e i b o m i a n )g l a n d s

Cornea
-Lens

S e b a c e o u sg l a n

A n t e r i ocr h a m b e r

( csi l i a )
Eyelashe

*{r

lris

O p e n i n g so f t a r s a lg l a n d s

P o s t e r i ocrh a m b e r

l n f e r i otra r s u s
O r b i c u l a r i so c u l i m u s c l e( p a l p e b r apl a r t )
In f e r i o rc o n j u n c t i v aflo r n i x
O r b i t a ls e p t u m

F r o n t a lb o n e
l n s e r t i o no f l e v a t o rp a l p e b r a e

s u p e r i o r im
suscle
O r b i t a ls e p t u m

S u p e r i otra r s u s
L a t e r ap
l alpebraligament
a n d o v e r l y i n gr a p h e
I n f e r i o rt a r s u s

Supraorbitalartery and nerve


S u p r a t r o c h l e aarr t e r ya n d n e r v e
D o r s a ln a s a la r t e r y
a n d i n f r a t r o c h l e anr e r v e
Lacrimalsac
M e d i a lp a l p e b r a l i g a m e n t

O r b i t a ls e p t u m
M a x i l l a( f r o n t a lp r o c e s s )
Z y g o m a t i cb o n e - - F

Orbit and Gontents

Infraorbitalartery and nerve

Plate 81

Lacrimal Apparatus
6sjtif'a:+

SeealsoPlates 45, 133

l a p i l l aa n d p u n c t u m
S u p e r i o rl a c r i m a p
O r b i t a lp a r t o f
I a c r i m a gl l a n d
L a c r i m acl a n a l i c u l i

Palpebral
partof
l a c r i m agl l a n d-

Excretoryducts of
l a c r i m ag
l land

Lacrimalsac

N a s o l a c r i m adl u c t

P l i c as e m i l u n a r i s
O p e n i n go f
n a s o l a c r i m adl u c t
L a c r i m a cl a r u n c l e

4{tr

I n f e r i o rl a c r i m a lp a p i l l aa n d p u n c t

S u p e r i o rl a c r i m a p
l a p i l l aa n d p u n c t u m
Frontalbone (cut away)

O r b i t a lp a r t o f
lacrimag
l land

L a c r i m acl a n a l i c u l i

L a c r i m a sl a c
Palpebralpart of
l a c r i m ag
l l a n da s o l a c r i m adl u c t
Excretoryducts of
l a c r i m ag
l land

P l i c as e m i l u n a r i s
and lacrimal

Middle nasal
concna

Nasalcavity
L a c r i m acl a r u n c l e

I n f e r i o rl a c r i m a lp a p i l l aa n d p u n c t u m

O p e n i n g o f n a s o l a c r i m adl u c t

Plate 82

I n f e r i o rn a s a l
c o n c h a( c u t )

I n f e r i o rn a s a lm e a t u s

Orbit and Contents

Fascia of Orbit and Eyeball

Horizontalsection

Tarsusof eyelid

4{r

Palpebralconjunctiva
M e d i a lp a l p e b r a l i g a m e n t

B u l b acr o n j u n c t i v a
Nasalcavity

Cornea

C h e c kl i g a m e not f
medialrectusmuscle

Lateralpalpebralligament
r , - C h e c k l i g a m e n to f
lateralrectus muscle

E t h m o i d ac le l l s

Periorbita

Periorbita

Sclera

M e d i a rl e c t u sm u s c l e
andfascialsheath

sheathof eyeball
Fascial
(Tenon's
capsule)

Fascialsheathof eyeball
(Tenon'scapsule)

Episcleral
space
Lateralrectusmuscle
andfascialsheath

Sclera

fat
Retrobulbar
(orbitalfat body)
C o m m o nt e n d i n o ursi n g
S p h e n o i d sa il n u s
Levatorpalpebraesuperiorismuscle and fascialsheath

Frontal section

-{*y*

Superioroblique muscle and fascialsheath


Medial rectus muscle and fascialsheath

S u o e r i o rr e c t u sm u s c l e
and fascialsheath

Periorbita

Lacrimalgland

Ethmoidalcell

Lateralrectusmuscleand
fascialsheath
ascialsheathof eyeball

Periorbita

(Tenon's
capsule)

Scler

lnferiorrectusmuscle
andfascialsheath

Fascialsheathof eyeball
(Tenon'scapsule)

I n f e r i o ro b l i q u e m u s c l e
and fascialsheath

Episcleral
space

Infraorbitalnerve (V2)

R e t r o b u l b a fra t ( o r b i t a lf a t

Muscleattachmentsand nervesand vesselsenteringorbit


S u p e r i oor r b i t a l

muscle
superioris
Levatorpalpebrae

L a c r i m an
l e r v e( V t )

S u p e r i o ro b l i q u em u s c l e

F r o n t a ln e r v e ( V t )

Suoeriorrectus muscle

Trochlearnerve (lV)

Medialrectusmuscle

S u p e r i o ro p h t h a l m i cv e i n
Lateralrectus
S u p e r i o rb r a n c ho f o c u l o m o t o rn e r v e( l l l )

Inferiororbitalfissure
A b d u c e n tn e r v e ( V l )

Orbit and Contents

lnferior rectus muscle


l n f e r i o rb r a n c ho f o c u l o m o t o rn e r v e ( l l l )
N a s o c i l i a r yn e r v e ( V 1 )

Plate 83

Extrinsic Eye Muscles

Rightlateralview

S u p e r i oor b l i q u em u s c l e
Levatorpalpebrae
superioris
muscle

,Trochlea
(pulley)

Suoeriorrectusmuscle
O p t i c n e r v e( l l )

Medialrectusmuscle

al rectusmuscle(cut)
C o m m o n t e n d i n o u sr i n g

Lateralrectusmuscle(cut)

lnferiorobliquemuscle

Inferiorrectusmuscle

periortarsus

Superiorview
Levatorpalpebrae
muscle(cut)
superioris
S u p e r i oor b l i q u em u s c l e
Medialrectusmuscle
Inferiorrectus
C o m m o n t e n d i n o u sr i n g

cF

Superiorrectusmuscle(cut)
Lateralrectusmuscle
Optic nerve(ll)
Superiorrectusmuscle(cut)

muscle(cut)
Levatorpalpebrae
superioris

Innervationof extrinsiceve muscles:


anteriorview

Trochtear

S u p e r i oor b l i q u em u s c l et nerve(lV)
(

Levatorpalpebrae
superioris
muscle
Oculomotor
n e r v e( l l l )

Superiorrectus
Medialrectusmuscle
Inferiorrectus

4{tr
Plate 84

I n f e r i oor b l i q u e

Orbit and Gontents

Arteries and Veins of Orbit and Eyelids

Medialpalpebralartery

Superiorview

ateralpalpebralartery

Supratrochlear
a
Dorsalnasalarterv

artery
Supraorbital
A n t e r i om
r eningeal
Zygomaticbranches
Anteriorethmoidal

Posterior
ciliaryarteries

Posterior
ethmoidal

M u s c u l abr r a n c h
Lacrimal
artery

Continuation of ophthalmic arter

Centralretinalartery

M u s c u l abr r a n c h
Ophthalmic
Internalcarotidartery

Supraorbital
artery
Supratrochlear
artery
nasalartery

Anteriorview
Superiormedial
palpebralartery

Frontalbranchof
superficial
temporal

Angular artery
lnferior medial
palpebral artery

Superiorlateralpalpebral
Inferiorlateralpalpebral
arter

S u p e r i oar n di n f e r i o r
palpebralarterialarches

Zygomaticofacial artery

Facialartery
Transversefacial

Infraorbital
artery

(X = anastomosisof vesselsfrom
externaland internalcarotid arteries)

Supratrochlear
vein
Lateral view

Supraorbitalvein
S u p e r i o ro p h t h a l m i cv e i n

C a v e r n o ussi n u s

Nasofrontalvein

A n g u l avr e i n
Vorticoseveins
Facialvein

I n f e r i o ro p h t h a l m i cv e i n
Pterygoid
Maxillaryvein
R e t r o m a n d i b u l avre i

Orbit and Gontents

Deep facialvein

4{F
Plate 85

Nerves of Orbit

Superiorview

-&lLrJ

Levatorpalpebrae
superioris
muscle

Supratrochlear
nerve

S u p e r i orre c t u sm u s c l e

Medialrectusmuscle

Lacrimalgland

S u p e r i oor b l i q u em u s c l e

Lacrimalnerve

Infratrochlear
nerve

Lateralrectusmuscle
Nasociliarynerve
Frontalnerve
Trochlearnerve (lV)

Maxillarynerve(Vz)

C o m m o n t e n d i n o u sr i n g

Meningealbranch
of maxillarynerve

O p h t h a l m i cn e r v e ( V 1

M a n d i b u l anre r v e( V : )

O p t i c n e r v e( l l )

Lesserpetrosalnerve
Internalcarotid artery
and nerve plexus

Meningeal branch
of mandibularnerve

O c u l o m o t o r n e r v e( l l l )

Createrpetrosalnerve

Trochlearnerve (lV) ,

T r i g e m i n a(l s e m i l u n a rg) a n g l i o n

Abducent nerve (Vl)


Tentorium cerebelli

i:!;1
i
il-

Tentorial(meningeal)
branch of ophthalmic nerve

Long ciliary nerves

Superior view:
levatorpalpebraesuperioris,
superiorrectus,and superior
obliquemusclespartially
cut away
Supratrochlear
nerve(cut)
Supraorbital
nervebranches(cut)
Infratrochlear
n
Anteriorethmoidal
O p t i c n e r v e( l l )
Posteriorethmoidal nerve
S u p e r i o rb r a n c ho f
o c u l o m o t o rn e r v e ( l l l ) ( c u t
Nasociliarynerve
Internalcarotid plexus
Trochlearnerve (lV) (cut)
O c u l o m o t o r n e r v e( l l l )
A b d u c e n tn e r v e ( V l )

Plate 86

Short ciliary nerves


Lacrimalnerve

C i l i a r yg a n g l i o n
root of ciliary
Parasympathetic
ganglion(frominferiorbranch
of oculomotornerve)
theticroot of ciliary
ganglion (from internal
carotid olexus)
Sensoryroot of ciliary ganglion

(fromnasociliary
nerve)
Branches
to inferior
and medialrectusmuscles
A b d u c e n tn e r v e ( V l )
Inferior branch of
oculomotor nerve (lll)
Lacrimalnerve
Frontalnerve (cut)
O p h t h a l m i cn e r v e ( V 1 )

*{r

Orbit and Contents

Eyeball

Cornea

Horizontal section
Z o r r u l afri b e r s
( s u s p e n s o rl yi g a m e n ot f l e n s )

C a p s u l eo f l e n s

A n t e r i o rc h am b e r

Posle r i o r c h a

S c l e r avl e n o u ss i n u s
( c a n a ol f S c h l e m m )

Iridoco

S c l e r asl p ur
tl

C i l i a r yb o d y a n d c i l i a r yn r u s c l e

I angle
'ocesses
B u l b a rc o n j u n c t i v a

C i l i a r yp a r t o f r e t i n . r
I

T e n d o no 1
l a t e r a lr e c t u s
muscle

Ora serrata
Tendon
medial
muscte

,
I

I
t

I
\
\

\
\.

V i t r e o u sb o d y
H y a l o i dc a n a l

I space/
Sclera

L a m i n ac r i b r o s ao f s c l e r a

s h e a t ho f
's
c a p s ul e

O p t i c n e r v e( l l )
C e n t r a lr e t i n a l
a r t e r ya n d v e i n

4{tr"
Orbit and Gontents

Subarachnoid
spac'e

Plate 87

Anterior and Posterior Ghambers of Eye

Schwalbe'sline
Trabecularmeshworkand spaces
of iridocornealangle(of Fontana)

Posteriorlimitinglamina
(Descemet'smembrane)
Endotheliumof anteriorchamber

Scleralvenoussinus(canalof Schlemm)

Cornea

lridocorneal
angle
Pectinateligament
Major arterial
circleof iris
Anteriorciliaryvein
Bulbar
conjunctiva

Anterior chamber

Sclera
Minor arterial
circleof iris

Ciliary
part of

Meridional Circular
fibers
fibers
Ciliarymuscle

Dilatorpupillae
muscle

Ciliarybody
Perichoroidal
space

Note:For clarity,only singleplaneof zonularfibersshown;


actually,
fiberssurroundentirecircumference
of lens.

Plate 88

Pigment
epithelium
(iridialpartof
retina)

Nucleusof lens
Capsuleof lens

Sphincterpupillaemuscle

4{tr
Olbit and Contents

Lens and Supporting Structures

Optic part of retina

Ora serrata
O r b i c u l ucsi l i a r i os f
ciliarybodycovered
by ciliarypartof retina
Ciliaryprocesses

Cortex
Equator

Z o n u l a fri b e r s

Eveballsectionedin frontal plane:


airteriorsegmentviewedfrom behind
Zonularfibers

4{r

Orbiculusciliarisof ciliarvbody

Horizontalsection

Ora serrata
Optic part
of retina

O r b i c u l ucsi l i a r ios f
ciliarvbodvcovered
by ciliarypartof retina

Zonularfibersfanningout
and blendinginto lenscapsule

Enlargement
of segmentoutlinedin top illustration(semischematic)

Orbit and Gontents

Plate 89

Intrinsic Arteries and Veins of Eye


SeealsoPlate 85

Minor arterialcircle of iris


Anterior chamber
M a j o r a r t e r i a cl i r c l eo f i r i s
S c l e r avl e n o u ss i n u s
( c a n a lo f S c h l e m m )

Blood vesselsof ciliary body


coniunctivaand
conjunctivalvessels
Anterior ciliaryartery and vein

Ciliary
body

IL e n s

lridocorneal

angre

Ora serrata

P o s t e r i ocrh a m b e i

M u s c u l aar r t e r ya n dv e i n

Z o n u l a fri b e r s
Extrinsic
eye muscle
Vitreouschamber
Long posterior ciliary artery

Vorticosevein

Episcleralartery and vein


Retinalartery and vein

Long posteriorciliary artery


posteriorciliary arteries
Central retinalartery and vein

S u p e r i otre m p o r a l
r e t i n aal r t e r i o l e

O p t i c n e r v e( l l )

Inferiortemporal
retinalarteriole
and venule

Right retinal vessels:ophthalmoscopic view

Plate 90

S u p e r i onr a s a l
retinalarteriole
a n dv e n u l e

ano

Macula
Foveacentralis

*{r

S u p e r i o rm a c u l a r
arterioleand venule

Optic disc

Inferiornasal
retinalarteriole
a n dv e n u l e
Inferior macular
arterioleand venule

Orbit and Gontents

Vascular Supply of Eye

Vasculararrangements
within the choroid (vasculartunic) of the eyeball
Anterior tributariesof a vorticosevein
Anterior ciliary arteries
Tendonof superiorrectus muscle

J u n c t i o nosf s u p r a c h o r o i d a l
formingvorticosevein
tributaries

Sclera

S u p e r i oor p h t h a l m ivce i n

Posteriorconjunctival
artery and vein

Bulb of vorticose(choroid)vein
Vorticose(choroid)vein

A n t e r i o rc i l i a r yv e i n s

ciliaryartery
Longposterior
Malor arterialcircle of iris

Shortposterior
ciliaryarteries

Minor arterial
c i r c l eo f i r i s

External
sheathof
opticnerve(duramater)

Conjunctiva
ano cornea

lnternalsheath
of optic nerve
(pia-arachnoidmater)

Shortposterior
ciliaryarteries

Centralretinal
arteryand vein

Arteriesand
v e i n so f i r i s
S c l e r avl e n o u ss i n u s
( c a n a lo f S c h l e m m )

Vessels
of internal
sheathof optic nerve

Veinsdrainingscleralvenous
sinus(into anteriorciliaryveins)

ciliaryarteries
Shortposterior

A n t e r i o rc i l i a r yv e i n s
N o n p ig m e n t e da n d p i g m e n t e d
regionsof the retina
Recurrentbranch of anterior ciliarvarterv

Segmentof episcleralvein*

Muscular
artery

lnferiorophthalmicvein
Posteriortributariesof a vorticose vein

*The episcleralveinsare shown here anastomosin1with the vorticose veins,


which they do; however they also drain into thi anterior ciliary veins.

Orbit and Gontents

Cryd4s/*

Plate 91

Pathway of Sound Reception

Frontalsection

Facialnerve (Vll) (cut)


Limbs of stapes

Prominenceof lateralsemicircularcanal

Baseof stapesin oval (vestibular)window

Vestibule
Semicircularducts, ampullae,utricle,and saccule

Tegmen tympani
Facialnerve (Vll) (cut)

M a l l e u s( h e a d )

Vestibular
nerve

Epitympanic

Cochlear nerve
Internalacoustic
meatus

Vestibulocochlear
n e r v e( V l l l )

External
acousticmeatus

Nasopharynx

Tympanicmembrane'
Tympaniccavity

Cochlea

Promontory
Round (cochlear)window
,

Auditory(pharyngotympanic,Eustachian)tube

4Ntr
Plate 92

Scalatvmpi
Note: Arrows indicatecourse of sound waves.

External Ear and fVmpanic GavitY

Otoscopicview of right tympanicmembrane

Rightauricle(pinna)
Triangular
fossa

C r u xo f h e l i x
meatus
acoustic
External

Y a r Sf l a c C l O a

Scaphoidfossa

Lateralprocessof malleus

Posteriormallearfold

Anteriormallear
fold

Cruraof antihelix

L o n gl i m bo f i n c u s

Auriculartubercle(of Darwin)
Antihelix
Concha of auricle

Lobuleof auricle

H a n d l eo f m a l l e u s

Tragus

Umbo

Intertragicnotch

tttragus
Coneof light

fympanic

Parstensa
Coronaloblique sectionof externalacousticmeatusand middle ear (tympaniccavity)

S u p e r i o rl i g a m e n to f m a l l e u s

of malleus
Long limb of incus

S h o r lt i m bo f i n c u s

Tendonof stapediusmuscle
Footplateof stapes

},
Chorda tympani nerve (cut)

Handleof malleus
Promontory
with tympanicplexus

Anterior ligment of malleus(cut)

Tensortympanimuscle

Tympanicmembrane
Tensorveli palatinimuscle
Tympaniccavity

Eustachian)
tube
Auditory(pharyngotympanic,
(lateral
view)
Righttympaniccavity after removalof tympanicmembrane
process
malleus
of
Lateral
Chorda tympani nerve
Tendon of tensor tympani muscle
L o n gl i m b o f i n c u s

Ossiclesarticulated:medial view
Prominenceof facial canar

Pyramidaleminence and tendon


of stapediusmuscle

Stapes

Handle of malleus

Tympanic

Fossaof round window

Lesserpetrosalnerve
Tympanic nerve

Ear

plexuson promontory
Tympanic

process
Lenticular
of incus

C/Fd4g/*

4{tr
Plate 93

lVmpanic Gavity

tateral wall of tympaniccavity:medial(internal)view


Superiorligament of malleus

Head of malleus

S u p e r i ol ri g a m e not f i n c u s

Epitympanic
recess

S h o r tl i m bo f i n c u s

Anteriororocessof m

Posterior
mallearfold

Chordatympaninerve

Posteriorligament of incus

Anteriormallearfold

Long limb of incus

Tensortympanimuscle

tympani nerve

H a n d l eo f m a l l e u s

Lenticular
processof incus

Tympanic
membrane
(parsten

Facialnerve(Vll)

Auditory
(pharyngotympanic,
Eustachian)
tube/
lnternalcarotid artery

Medial wall of tympaniccavity:lateralview

Prominenceof lateralsemicircularcanal
Prominenceof facial canal

Mastoid antrum

G e n i c u l u m( g e n i c u l a t eg a n g l i o n )o f f a c i a ln e r v e
Baseof stapesin
fossaof oval (vestibular)

Creater petrosalnerve

Limbsof s

-/

Pyramidaleminence

Tensortympanimuscle
(tendoncut)

Auditory
(pharyngotympanic,
Eustachian)
tube

Chorda tympani nerve (cut)

Levatorveli palatini
muscle

Mastoid cel

Tendonof stapedius
muscle
Fossa
of round
(cochlear)
window

Promontory with tympanic


n e r v e ( o f J a c o b s o n a) n d p l e x u s
unoer mucosa

fossi
Jugular
Internalcarotid artery

Facialnerve (Vll)

in stylomastoid
foramei

Plate 94

Tympaniccells

4{F

Bony and ltlembranous Labyrinths

Rightbony labyrinth(oticcapsule),anterolateralview:
suiroundihgcincellousbone removed

Dissectedrieht bonv labvrinth(otic capsule):


membranoui labyriirth rbmoved

Ellipticalrecess
Cochlearrecess

Vestibule
(note
perforations
for nerve
fibers)
Helicotrema

Internalopeningof
aqueduct
vestibular

Scalavestibuli
Osseousspiral
lamina
Scalatympani

Rightmembranouslabyrinthwith nerves:posteromedialview
duct
Anteriorsemicircular
ner
Superiorpartof vestibular
(fromutricleandanteriorand
lateralmembranous
ampullae)

ampulla
Anteriormembranous
ampulla
Lateralmembranous

Cochlearduct (basalturn)
Common
membranous
limb
Cochlearnerve
Lateral
semicircular
duct
Posterior
semicircular
duct

Vestibulocochlear
nerve
Vestibular

membranous
Posterior
ampulla

ganglion
Vestibular

4{F
Ear

lnferiorpartof vestibular
nerve(from
sacculeand posteriormembranous
ampulla)

duct
Endolymphatic

Plate 95

Bony and Memblanous Labyrinths (continuedl

Bonyand membranouslabyrinths:schema
A n t e r i o rs e m i c i r c u l acr a n a la n d d u c t
Dura mater

Posteriorsemicircular
c a n a la n d d u c t

Endolymphaticsac

Common bony and

Endolymphaticduct
i n v e s t i b u l aa
r queduct

m e m b r a n o ul is
Lateralsemicircular
canal and duct

f,\,

Utricle

Otic capsule

Saccule

Stapesin oval
(vestibular)window

Helicotrema of cochlea

D u c t u sr e u n i e n s

In c u s

Scalavestibuli

Malleus

C o c h l e a rd u c t

Tympanic cavity

Scalatympani

Externalacoustic meatus

Umbo
Tympa n rc memor ane------7
) indow
R o u n d ( c o c h l e a rw
(closedby secondary
t y m p a n i cm e m b r a n e )

ochlear aoueduct

Otic capsule
Vestibule
Pharyngotympanic(auditory) tube

Sectionthroughturn of cochlea
Scalavestibuli
Osseous
s p i r alla m i n a

Nervefibers

(Reissner's)
Vestibular
memDrane
Cochlearduct
Spiral igament

M o d i o l u so f

Tectorialmembrane

Spiralorgan(of Corti)
S p i r a lg a n g l i o n
Basilam
r embrane
Scalatympani

Osseouscochlea

Outerhaircells
Cochlear nerve

4{tr
Plate 96

P i l l a(rr o d )c e l l s
I n n e rh a i r c e l l

Orientation of Labyfinth in Skull

Superiorprojectionof
right bony labyrinth
on floor of skull

Croovefor greaterpetrosalnerve
ganglion)of facialnerve
Geniculum(geniculate

Cochlea

zPlaneof anterior
canal
,/ semicircular
Cochlear nerve

Facialnerve(Vl
lnternalacoustic
openrnS

Vestibulocochlear
nerve(Vlll

Lateralsemicircular
canal

Vestibular
nerve
Petrouspart
of temporalbone
External
openingof
vestibular
aqueduct
(forendolymphatic
duct)

\. Planeof posterior
canal
semicircular

lateral projection of right membranouslabyrinth


Cochlearduct

Ceniculum(geniculate
of facialnerve

Cochlearnerve
Trigeminal nerve (V)

part of
vestibular
nerve

Vestibulocochlear
n e r v e( V l l l )

lnternaljugularvein
Inferiorpart of
vestibularnerve
duct
al semicircular
duct
Posterior
semicircular

Superior
petrosalsinus
Sigmoid
sinus
Confluence
of sinuses
Transverse
sinus

Ear

4{tr
Plate 97

Auditory (Pharyngotympanic, Eustachian| Ti,rbe


SeealsoPlates 52, 55, 65
C a r t i l a g i n o u sp a r t o f a u d i t o r y
( p h a r y n g o t y m p a n i c ,E u s t a c h i a n )
t u b e a t b a s eo f s k u l l : i n f e r i o r v i e w
Palatineprocessof maxilla
P t e r y g o i dh a m u l u sa n d
medial pterygoid plate.

Horizontal plate of palatinebone

Lateralpterygoid plate

Choana
.

Scaphoidfossa

) of cartilaginouspart of

f?l"l,il11ti"1t auditorylpharynsotympanic,
M e d t a ll a m t n a )
E u s t a c f r i a nt u) b e "

Foramenovale
Foramenlacerum

F O r a m e nS p r n o s u m

Petrouspart of temporal bone

S p i n eo f s p h e n o i db o n e
Internalcarotid artery
entering carotid

Occipital condyle

Mastoidprocess
Foramenmagnum

Sectionthrough cartilaginouspart of auditory


(pharyngotympanic,
Eustachian)
tube,
with tube closed

Sectionthrough cartilaginouspart of auditory


(pharyngotympanic,
Eustachian)
tube,
with tube open
Trigeminalganglion

T r i g e m i n agl a n g l i o n
Internalcarotid artery
in carotid canal
Duramater

Internalcarotid artery in carotid cana

Duramater
Laterallamina

of cartilage

Laterallamina
of cartilage
M e d i a ll a m i n a
of cartilage

A u d i t o r yt u b el u m e n
Tensorveli palatini
muscte
Levatorveli palatini
muscle
Salpingopharyngeu
s
muscte

M e d i a ll a m i n a
of cartil

Auditorytubelumen
Tensorvelipalatini
muscte
Levatorveli palatini

muscle
S a l pni g o p h a r y n g e u s
muScre

Nasopharynx

4{tr

Auditory(pharyngotympanic,
Eustachian)
tubeclosedby
elasticrecoilof cartilage,
tissueturgidity,
and tensionof
salpingopharyngeus
muscles

Plate 98

Nasopharynx
Lumen opened chiefly when attachment
of tensor veli palatinimuscle pulls wall
of tube laterallyduring swallowing

Eat

Meninges and Diploic Veins


. : j ' , '

SeealsoPlate

D i p l o i cv e i n

Coronal
dissection

S u p e r i o rs a g i t t aSl I NU
E m i s s a r vy e i n

Frontaa
l n d p a r i e t a lt r i b u t a r i e s
o f s u p e r f i c i atle m p o r a lv e i n
l ranches
Frontaa
l nd parietab
o f s u p e r f i c i atle m p o r a la r t e r y
C r a n u l a rf o v e o l a
( i n d e n t a t i o no f s k u l lb y
a r a c h n o i dg r a n u l a t i o n )

A r a c h n o i dg r a n u l a t i o n
C e r e b r a vl e i n ( b r i d g i n gv e i n ) p e n e t r a t e s u b d u r a sl p a c et o e n t e r s i n u s
D u r a m a t e r( p e r i o s t e aal n d m e n i n g e a l a y e r s )
D u r a - s k u l li n t e r f a c e( s i t eo f e p i d u r a lh e m a t o m a )
Arachnoid
space
Subarachnoid
P i am a t e r
Middlemeningeal
a r t e r ya n d v e i n
Deep,
m i d d l e ,a n d
superficial
temporal
artefles
and veins

L a t e r a (l v e n o u s )I a c u n a
B r i d g i n gv e i n
Inferior
sagittal
SINUS

/t

l{1,
'l
ir,

S u p e r i o rt h a l a m o s t r i a t ae n d
c h o r o i d a lv e i n s ,i n t e r n a lc e r e b r a l
v e i n s ,a n d c h o r o i d p l e x u so f
l a t e r a vl e n t r i c l e

Diploicand emissary
v e i n so f s k u l l

Frontad
l i p l o i cv e i n

A n t e r i o rt e n r p o r a l
d i p l o i cv e i n

l iddle
D e e p a n d s u p e r f i c i am
c e r e b r a vl e i n s

P a r i e t ael m i s s a r yv e i n
P o s t e r i o tre m p o r a l
d i p l o i cv e i n
O c c i p i t a le m i s s a r yv e i n
d i p l o i cv e i n
M a s t o i de m i s s a r yv e i n

Nr
Meninges and Brain

Plate 99

Meningeal Arteries

Frontal(anterior)and parietal
(posterior)branchesof
m i d d l e m e n i n g e a al r t e r y
Middle
meningealartery

Anterior
meningeal
branch of
anterior
ethmoidal

Arachnoid sranulations

O p e n i n go f s u p e r i ocr e r e b r avle i n
Lateral(venous)lacuna

Superiorsagittalsinus
Dura mater

artery

Mastoid branch of
occipital artery

M e n i n e e a lb r a n c h e so f
ascendingpharyngealartery
Mastoid branch of
occipital artery
Middle meningealartery
Recurrentmeningealbranch of

c )r t e r y
l a c r i m a( lo p h t h a l m i a
Accessory meningealartery
Anterior meningealbranch of

anteriorethmoidalartery
Posteriorethmoidal artery
Internalcarotid artery and its
meningohypophysealtrunk* (phantom
M i d d l e m e n i n g e a al r t e r y

4{tr

Accessorymeningeal

Superficial
temporalartery
Maxillaryartery
Posterior
auricularartery
Occipitalartery
External
carotidarter

Anterior and posterior


meningealbranchesof
vertebralartery
Tentorial,cavernoussinus,and meningeal
branchesof meningohypophysealtrunk*

*Variant;most commonly,
these branchesarisedirectly from internalcarotid artery.

Plate l OO

Meninges and Brain

Epidural Hematoma
Temporalfossahematoma
Medial displacementof
middle cerebralvessels

Shiftof normal
midlinestructures

Skullfracture
middle
crossing
meningeal
a.

Compressionof
posteriorcerebrala.

Herniationof
temporallobe
undertentorium
cerebelli

6ii

Herniationof
cerebellartonsil
Compressionof oculomotor(lll) n.
pupil dilatation
leadingto ipsilateral
and 3rd cranialn. musclepalsv

Shiftof brainstemto
opposite side may
reverselateralization
of signsby tentorial
pressureon contralateralpathways.

hemiparesis,
deeptendonhypersign
reflexia,
and Babinski's

"Questionmark" skin incision(black);


outlineof free bone flap and burr holes(red)

Skinflap reflected(Raneyclipscontrolbleeding).Freebone
flap removed and dura opened. Clot evacuatedby irrigation,

suction,andforceos.

Sectionshowingacutesubduralhematomaon rightsideand
'subduralhematoma associatedwith temooral lobe intracerebral
hematoma ("burst" temporal lobe) on left

Meninges and Brain

Nr
Plate I Ol

Meninges and Superficial Gerebral Veins

Calvaria
Pericranium

Cranularfoveola

Galeaaponeurotica
Arachnoidgranulation

Superiorsagittalsinus
Emissarv
vein
Tributary
of superficial
temporalvein

(siteof epiduralhematoma)
Duramater
Arachnoid-durainterface
(siteof subduralhematoma)
Arachnoid

Bridgingvein

Subarachnoid
space
Piamater
erebralartery
Superiorcerebralvein
Falxcerebri
al hemisphere
Branches
of middlemeningeal
artery
Superiorsagittal

Superiorcerebralveins
(bridgingveins)(penetrating
arachnoidand dura materto
entersuperiorsagittalsinus)

Duramater

Superiorcerebralveins
(beneatharachnoid)

ior anastomotic
vein (of Trolard)

Inferioranastomotic
vein (of Labb6)

middle
Superficial
cerebralvein

4{r

Middlemeningeal
arterVandveins/
Inferiorcerebralveins
(beneatharachnoid)

Plate I 02

Meninges and Brain

Dural Venous Sinuses

S u p e r i osra g i t t asli n u s
si
Straight

Sagittalsection

Creatcerebralvein(of Calen)
cerebelli
Tentorium
S u p e r i osra g i t t asli n u s

Inferiorsagittalsi

S p h e n o p a r i e t asli n u s

Anterior and oosterior


intercavernoussinuses

Superior
petrosalsinus
Basilar
v e n o u sp l e

Inferior
petrosalsin
Tojugular
foramen

Sigmoid
sinus
Transversesinus

O c c i p i t asl i n u i
Falxcerebelli

*{r
Meninges and Brain

of sinuses
Confluence

Plate 1O3

Dural Venous Sinuses (continuedl


Skullsectionedhorizontally:
superiorview

yland)
H y p o p h y s (i p
s i t u i t a rg
,

S u p e r i o rs a g i t t asl i n u s( c u t )
Falxcerebri (cut)

T O p t i c n e r v e( l l )
Internalcarotid artery

S u p e r i o ro p h t h a l m i cv e i n

O c u l o m o t o r n e r v e( l l l )

A n t e r i o ra n d p o s t e r i o r
i ntercavernous
s tn u s e s

S p h e n o p a r i est ai nl u s
Trochlearnerve (lV)
O p h t h a l m i cn e r v e ( V 1 )

S u p e r f i c i am
l iddle
cerebralvein (cut)

Maxillary nerve (V2)

C a v e r n o u ss i n u s

T r i g e m i n agl a n g l i o n

Basilar
v e n o u sp t e

M a n d i b u l a rn e r v e ( V : )

Superior
p e t r o s a sl i n u s

M i d d l e m e n i n g e a al r t e r y
Abducent nerve (Vl)

Inferior
p e t r o s a sl i n u s

Petrosalvein

Tentorial

F a c i a nl e r v e ( V l l ) ,
i n t e r m e d i a t en e r v e ,a n d
v e s t i b u l o c o c h l e anre r v e ( V ll l )

artery
Tentorium
cerebelli

C l o s s o p h a r y n B(el X
a l)
andvagus(X)nerves

Inferior
cerebralvein
(cut

J u g u l a fro r a m e n

Transverse
sinus
I n f e r i osr a g i t t a l
s i n u s( c u t )

Transverse
sinus

S t r a i g h st i n u s

Accessory nerve (Xl)

Falxcerebri (cut)
C o n f l u e n c eo f s i n u s e s

H y p o g l o s s anl e r v e ( X l l )

'#r"

r e a t c e r e b r a vl e i n ( o f C a l e n )

S u p e r i o rs a g i t t asl i n u s( c u t )

*{r

C a v e r n o u ss i n u s
O c u l o m o t o r n e r v e( l l l )

ic chiasm
Posterior
c o m m u n i c a t i n ga r t e r y

Trochlearnerve (lV)
A b d u c e n tn e r v e ( v l )
O p h t h a l m i cn e r v e

lnternalcarotid
arrery
Hypophysis
( p i t u i t a r yg l a n d )

M a x i l l a r yn e r v e
S p h e n o i d asl i n u s

Coronal section
t h r o u g h c a v e r n o u ss i n u s

Plate 1O4

Nasopharynx

Meninges and Brain

Gerebrum: Lateral Views

Centralsulcus(of Rolando)

gyrus
Postcentral

gyrus
Precentral

sulcus
Postcentral

Precentral
sulcus

Superiorparietallobule

Superiorfrontalgyrus
Intraparietal
sulcus
Suoeriorfrontalsulcus
Inferiorparietallobule
pramarginal
gyrus
gurargyrus

Middlefrontalgyrus
Inferiorfrontalsulcus
Inferiorfrontalgyrus
Opercularpart
part
Triangular
Orbitalpart

tooccipital
sulcus

Frontal
pole

pole
Calcarine
sulcus
Lunatesulcus
(inconstant)

t
t

Lateralsulcus Anteriorramus
ramus
(of Sylvius) Ascending
Posterior
ramus
Temporalpole

Transverse
occipitalsulcus
Superiortemporalgyrui

notch
Preoccioital

Superiortemporalsulcui
Middletemporalgyru

Inferiortemporalgyrus

Inferiortemporalsulcui
Frontallobe
Parietallobe

Temoorallobe
Occipital

Parietal
ooerculum
F r o n t aol p e r c u l u m
Orbitalooerculum

4{r
Meninges and Brain

lnsula
(island
of Reil)

Shortgyri
Centralsulcus
Limen

Longgyrus
C i r c u l asr u l c u s

Temporaloperculum

Plate I 05

Gerebrum: Medial Views


Forhypophysis
seePlate 147
S a g i t t a ls e c t i o n o f
brain in situ

C i n g u l a t eg y r u s
Cingulate
sulcus

M e d i a l f r o n t a lg y r
S u l c u so f c o r p u sc a l l o s u

P a r a c e n t r aslu l c u s
C e n t r a ls u l c u s( o f R o l a n d o )
P a r a c e n t r al ol b u l e
M a r g i n a ls u l c u s
C o r p u sc a l l o s u m

Fornix

;.

S e p t u n 'pr e l l u c i d u m
I n t e r v e nt r i c u l a r
f o r a m e n( o f M o n r o
lnterthalamic
adhesion

'/

T h a l a m ua
snd
3rd ventricle

-,-Precuneus
S u p e r i o rs a g i t t asl i n u s
C h o r o i dp l e x u s
of 3rd ventricle
S t r i am e d u l l a r i s
of thalamus
1
Parietooccipital
S UI C U S

S ub c a l l o s a l
(parolfactory)

C un e u s

Anterior
commtssure

P i n e a lb o d y
Posterior
commtssure
Calcarine
s ur c u s
S t r a i g h st i n u s
in tentorium
cerebelli

Habenular
commrssure

S ub c a l l o s a l

gyrus
Hypothalamic
S UI C US

L.rmina
te

r e a t c e r e b r a vl e i n

S up r a optrc
recess

S u p e r i o cr o l l i c u l u s
I n f e r i o rc o l l i c u l u s
l )l a t e
T e c t a l( q u a d r i g e m i n a p

Optic chi
Tubercinereun'r

erebellum

H y p o p h y s i s( p i t u i t a r yg l a n o l
M a m m i l l . r r yb o d y
C e r e b r a lp e d u n c l e
Cerebraa
l queduct
(ot Sylvius)

S u p e r i o rm e d u l l a r yv e l u m
4 t h v e n t r i c l ea n d c h o r o i d p l e x u s
I n f e r i o rm e d u l l a r yv e l u m
M e d u l l ao b l o n g a t a

M e d i a l s u r f a c eo f c e r e b r a l
h e m i s p h e r e :b r a i n s t e m e x c i s e d
C i n g u l a t eg y r u s
M am m i l l o t h . r l a m i c
fasciculus
M a m m i l l a r yb o d y

l s t h m u so f c i n g u l a l eg y r u s
P a r i e t o o c c i p i t as lu l c u s

C un e u s

uncu5
C a l c a r i n es u l c u s

O p t i c n e r v e( l l

Linguag
l yrus

( ) l i a c t o r yt r a c t
C o l l a t e r asl u l c u s
R h i n asl u l c u s
M e d i a l o c c i p i t o t e m p o r agl y r u s
O c c i p i t o t e m p o r asl u l c u s
L a t e r a ol c c i p i t o t e m p o r agl , y r u s

Plate I 06

orro,ni*
Eifl,""
I
F i m b r i ao f h i p p o c a m p u s
D e n t a t eg y r u s
P a r a h i p p o c a m p agly r u s

*{r

Meninges and Brain

Gerebrum: Inferior View

Frontalpole of cerebrum

Sectionedbrainstem

Straightgyrus
Olfactorvsulcus
Orbitalsulci

Longitudinal
cerebralfissure
Cenu of corpuscallosum
L a m i n at e r m i n a l i s

Olfactorybulb
factory tract

Orbitalgyri

O p t i cc h i a s m

Temporalpole of cerebrum

Optic nerve(ll) (cut)

Lateralsulcus(of Sylvius)

Hypophysis
(pituitarygland)

Inferiortemporalsulcus
Inferiortemporal

Anterior
perforated
substance
Optic tract
u b e rc i n e r e u m
Mammillarybody

Inferior(inferol a t e r a lm
) argin
of cerebrum

Posteriorperforated
(in
substance
interpeduncular
fossa)

R h i n asl u l c u s

ebralcrus
Uncus

Lateralgeniculate
body

Inferior
temporal gyru

nigra
Substantia
Medialgeniculate
body

Occipitotemporal
surcus

ed nucleus
Lateraloccipitotemporal gyrus

i n a ro f t h a l a m u s
Superiorcolliculus(of
corporaquadrigemina)

Collateral

ebralaqueduct
Parahippocampal
gyrus
Splenium
o f c o r p u sc a l l o s u m
Medial occipitotemporalgyrus

Calcarine
sulcu

Apexof cuneus
Occipitalpole of cerebrum
Longitudinal
cerebralfissure

lsthmusof cingulate

4{r
Meninges and Brain

Plate I 07

Ventricles of Brain

Left lateralphantomview

Frontal(anterior)
horn

Rightlateralventricle

Centralpart

Left
lateral
ventricle

Temporal(inferior)horn
Occipital (posterior)horn

Cerebralaqueduct(of Sylvius)
4th ventricle
Leftlateralaperture
(foramenof Luschka)
Leftinterventricular
foramen(of Monro)

Leftlateralrecess
Medianaperture
(foramenof Magendie)

3rd ventricle

Supraoptic
recess
Interthalamicadhesio6

I n f u n d i b u l ar er c e s 6

Centralcanalof soinalcord

Pinealrecess
Suprapineal
Corpus callosum
S e p t u mp e l l u c i d u m
Lateralventricle
Body of caudate nucleus
Choroid plexusof lateralventricle
Striaterminalis
Superiorthalamostriatevein
Body of fornix
Internalcerebralvein
Tela choroidea of 3rd ventricle

id plexusof 3rd ventricle


Thalamus
Putamen
) ,
) Lenurormnucreus
C l o b u s p a l l i d u s)
I n t e r n a cl a p s u l e
3rd ventricleand interthalamicadhesion

Hypothalamus
Tail of caudate nucleus
Optic tract

White arrow in left


interventricular
foramen (of Monro)
-

Ependyma
Pia mater

Coronal section of brain: posterior view

Plate I 08

Choroid plexusof lateralventricle


Temporal (inferior)horn of lateralventricle
F i m b r i ao f h i p p o c a m p u s

Hippocampus
Dentategyrus
gyrus
Parahippocampal

4{F

Meninges and Brain

Girculation of Gerebrospinal Fluid

Choroid plexusof lateralventricle(phantom)

Superiorsagittalsinus
achnoid space

C i s t e r no f c o r p u sc a l l o s u m

f, rachnoid granulations

Duramater
Arachnoid

lnterventricular
foramen (of Monro)
Chiasmaticcistern

Choroidplexusof 3rd vent


lnteroeduncularcistern

Cerebralaqueduct(of Sylvius)

Quadrigeminalcistern
(of great cerebral vein)

Prepontinecistern

Lateralaperture(foramenof Luschka)
Choroidolexusof 4th ven

cistern
cerebellomedullary
Medianaperture
(foramenof Magendie)

Duramater
Arachnoid
Subarachnoid
space
Centralcanalof soinalcoro

Nr
Meninges and Brain

Plate I 09

Basal Nuclei (Gangliaf

Horizontalsections
throughcerebrum
C e n u o f c o r p u sc a l l o s u m

H e a d o f c a u d a t en u c l e u s

L a t e r avl e n t r i c l e
S e p t u mp e l l u c i d u m

C o l u m no f f o r n i x -

&

I n s ul a
( i s l a n do f R e i l )

t4".

3rd ventricle

Interthalamic
adhesion

E x t e r n acl a p s u l e

Thalamus

Claustrum

C r u so f f o r n i x

R e t r o l e n t i c u l apra r t
o f i n t e r n a lc a p s u l e

C h o r o i dp l e x u s
o f l a t e r a vl e n t r i c l e

T a i lo f c a u d a t en u c l e u s

S p l e n i u mo f
c o r p u sc a i l o s u m

H i p p o c a m p u sa n d f i m b r i a
O c c i p i t a l( p o s t e r i o r h) o r n
o f l a t e r a vl e n t r i c l e
Habenula

O r g a n i z a t i o no f
b a s a ln u c l e i ( g a n g l i a )

P i n e a lb o d y

C a u d a t eP u t a m e nC l o b u s
nucleus
pallidus
Cleft for internalcapsule

Striatum

Lentifornt
r-rucleus

Corpus
striatum
B a s anl u c l e i
(ganglia)

Caudate
t Body
n u c l e u Is H e a d
Levelsot
sectrons
{Babove

lA-

Thalamus

B
Pulvinar

L e n t i f o r mn u c l e u s
( g l o b u sp a l l i d u sm e d i a l
to putamen)

*{r
Plate I I O

Amygdaloid body -

M e d i a l g e n i c u l a t eb o d y

\Tail of caudate nur

Interrelationship
of thalamus,lentiformnucleus,caudate
nucleus/and amygdaloidbody (schema):
left lateralview

Meninges and Brain

Thalamus

orpuscallosum(cut)

Interventricular
foramen(of Monro)

Headof caudatenucleus

Tela choroidea (cut edge)


of 3rd ventricle-.

S e p t u mp e l l u c i d u m

3rd ventricle

Columnsof fornix

Choroid

Anteriortubercle

Superiorthalamostriate

Striaterminalis

Peshippoca

Interthalamicadhesion

(inferior)horn
Temporal
of lateral ventricle

Laminaaffixa

Internalcerebralvei

Striamedullaris

Dentategyrus

lartrigone

Collateralemi

Pulvinarketractedl

Hippocampus

Lateralgeniculatebody

F i m b r i ao f h i

I geniculatebody

Posterior
commissure

Brachiumof superiorcolliculus

Habenular
commissure

Brachiumof inferiorcolliculus

Pinealbody
Collateral trigone

Superiorcolliculus

Calcaravi

lnferiorcolliculus

Occipital(posterior)
horn
of lateralventricle

Cerebellum

Calcarine
3rd ventricle

lnternal
medullary
lamina

lnterthalamic
adhesion

Intralaminar
nuclei

Reticular
nucleus

External
medullary
lamina
Mediannuclei

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

Meninges and Brain

4{tr
Pulvinar
body
Lateralgeniculate
I geniculate
body

T h a l a m i cn u c l e i
CM
[D
l-P
M
MD
VA
Vl
V[
VP
VPt
VPM

Centromedian
Lateraldorsal
Lateralposterior
Medial
Medialdorsal
Ventralanterior
Ventralintermedia.
Ventrallateral
Ventralposterior
Ventralposterolateral
Ventralposterornedial

Schematic representation of thalamus


(external
medullarylaminaand
reticularnucleiremoved)
I
I

Lateralnuclei
Medialnuclei
'r ,' ', ; ' Anteriornuclei

Plate | | 1

Hippocampus and Fornix

Superiordissection

Cenu of corpuscallosum(cut)
Septumpellucidum
Headof caudatenucleus
Columnsof fornix
Striaterminalis
Bodyof fornix
Peshippocampus
Thalami
of fornix
Dentategyrus
Fimbriaof hippocampus

Commissureof fornix
Spleniumof corpuscallosum(cut)
ventricle

Occipital(posterior)horn
of lateralventricle

4{F

Tailof caudate

Temporal(inferior)horri

Fornix:schema

Plate I l2

Coronal section:posteriorview

lleninges and Brain

Gerebellum

Superiorsurface
Anterior cerebellarnotc

lobule(H lV-V)
Quadrangular
Primaryfissure

C e n t r a ll o b u l e ( l l & l l l

Horizontalfissure
C u l m e n( l V &

i m p l e l o b u l e( H V l )

Posteriorlobe
P o s t l u n a ft ies s u r e
i o rs e m i l u n a r
(anseriform
l o)b u l e( H V l l A )

F o l i u m( V l l A )

Horizontalfissure
l n f e r i osr e m i l u n a r
( c a u d a l )o b u l e( H V l l B )

Posteriorcerebellarnotch

centrallobule

Superiorvermist
( L i n s u l(al ) S u p e r i om
r e d u l l a rvve l u m
(HX)
ventricle

Inferior

lnferior surface

of centrallobule
S u p e r i o)r
Middle ) Cerebellar
peduncles
Inferior
)
Flocculonodularlobe
(dorsolateral)
Posterolateral
fissure
fissure
Retrotonsillar

velum

N o d u l e( )
Inferior
vermis

Posteriorlobe

U v u l a( l X
l onsil

Pyramid(
Tuber(Vl
Posteriorcerebellarnotch

Decussationof
superiorcerebellar

B i v e n t e rl o b u l e ( H V l l l )

(postpyramidal)
Secondary
fissure
Horizontalfissure
l n f e r i osr e m i l u n a r
( c a u d a l )o b u l e( H V l l B )
Cerebralcrus
M e d i a l l o n g i t u d i n afla s c i c u l u s

4th ventricle
Nuclear layer of
medulla oblongata

S u p e r i om
r e du l l a r y

S u p e r i ocre r e b e l l a r
peduncle

Fastigial

Clobose
L i n g u l a( l )

Dentate
Vermis
LmDOtl

4{tr

Sectionin planeof superiorcerebellarpeduncle

Meninges and Brain

Plate I | 3

Brainstem

Posterolateral
view

Thalamus(cut surtace)
Lateralgeniculate
body

Pulvinars
of thalami

Optic tract

P i n e a lb o d y

Medial geniculatebody

S u p e r i ocro l l i c u l i

Brachiaof superiorand inferior colliculi

Inferiorcolliculi

erebralcrus

Trochlearnerve (lV)

Pons

Superiormedullaryvel

rigeminalnerve (V)

Superiorcerebellar

peduncle
cerebellar

Rhomboid fossaof

Vestibulocochlear
nerve(Vlll)

4th ventric

F a c i a nl e r v e ( V l l )

Clossopharyngeal(lX) and

vagus(X)

ferior cerebellarpeduncle

Cuneatetubercle

Hypoglossalnerve (Xll)

C r a c i l et u b e r c l e

Accessorynerve (Xl)

Dorsalrootsof

Nr

l s t s p i n a ln e r v e ( C 1)

Cuneatefasciculus
Cracile fascicu

factorytract

Anteriorview

Anteriorperforated
substance
I n f u n d i b u l u(mp i t u i t a rsyt a l k )

Optic chiasm

M a m m i l l a rbyo d i e s
Temporallobe (cut surtace)

Optic tract

n e r v e( l l l )

Tubercinereum

Trochlear
nerve(lV)
Cerebralcrus

Trigeminalnerve (V)

Lateralgeniculatebody

ucentnerve(Vl)

Posteriorperforatedsubstance

acial nerve (Vll) and


intermediatenerve
Vestibulocochlearnerve (Vlll)
Flocculusof cerebellum

Middle cerebellarpeduncle
Olive

oid plexusof 4th


ventricle

lossopharyngeal
nerve(lX)
Pyramid

V e n t r arlo o t so f 1 s ts p i n a l
Decussationof pyramids

Plate I 14

nerve(X)
H y p o g l o s snael r v e( X l l )
n e r v e( X l )

Meninges and Brain

Fourth Ventricle and Gerebellum

Posteriorview
3rd ventricle
Dorsalmediansulcus

Pulvinao
r f thalam

peduncle
Superiorcerebellar

Pinealbody

Locusceruleus

S u p e r i ocro l l i c u l u s

emrnence

lnferior

Facialcolliculus

Trochlearnerve (lV)

area
Vestibular

Superiormedullary

Dentate nucleus
of cerebellum

( Superior
C e r e b e l l apre d u n c l e {s M i d d l e( Inferior-

riaemedullares

Lateralrecess

Taenia of 4th ventricle

Superiorfovea

Cuneatetubercle
aciletubercle

S u l c u sl i m i t a n s

Dorsalmediansulcus

lnferior fovea

Lateralfuniculus

T r i g e m i n taul b e r c l e

lus
fascicu

Hypoglossaltrigone
Vagal t

e fasciculus

*{r

terthalamicadhesion

Median sagittalsection
Bodyof forn

Posteriorcommissure

H a b e n u l acro m m i s s u r e

T h a l a m u(si n
3rd ventricle

Pinealbody

of corpuscallosum

Interventricular
foramen (of Monro

Great cerebralvein (of Calen)

Anterior commissure
Laminatermi
H y p o t h a l a m i cs u l c

C e r e b r aple d u n c l e
Cerebralaqueduct(of Sylvius
Superiorco
Tectal(quadrigeminal)plate

l n f e r i ocr o l l i c u l u s
Pons

Superiormedullaryvelum
eriormedullaryvelum

M e d i a l l o n g i t u d i n afla s c i

Choroidplexusof 4th ventric


Medulla oblongata
Median aperture (foramen of Magendie)

of pyrami
Decussation
Central canal of spinalcor

Meninges and Brain

Plate t t 5

Granial Nerve Nuclei in Brainstem: Schema


Posteriorphantomview

O c u l o m o t o rn e r v e( l l l )

S u p e r i ocro l l i c u l u s

ed nucleus
nucreus
Accessorvoculomotor
( Edi n ger-Westphal) nucleus

Lateralgeniculate
Mesencephalin
c ucleus
of trigeminal

Trochlearnucleus
Trochlear
nerve(lV)

Principal

sensorynucleusof

Motor nucleusof
trigeminal
nerve

trigeminal
Trigeminalnerve
(V) and ganglion

Trigeminal
nerve(V)
and ganglion

Facialnerve (Vll)
and geniculate
ganglion-

nucreus

Vestibulocochlear

Facialnucleus

n e r v e( V l l l )

Ceniculum
(geniculateganglion)
of facial nerve
Superior
and inferior
salivatory
nuclei

Anterior.

C o c h l e a rJ
nuclei
Posterior

Vestibular
nuclei
pharyngeal
nerve(lX)

Glossopharyngeal
n e r v e( l X )

Vagusnerve(X)
Vagus nerve (X)

A c c e s s o r yn e r v e ( X l ) *

Spinaltract and spinal


nucleusof trigeminalnerve

Nucleua
s mbiguus
(dorsal)nucleus

Solitarytract

Dorsalvagalnucleu

Efferentfibers
I

Afferentfibers

Mixed fibers

o f v a g u s n e r v e( X )

H y p o g l o s snaul c l e u s
S p i n anl u c l e u s
of accessory
nerve

4{tr

*Recent evidence

s_uggests
that the accessorynerve lacksa cranialroot and has no connection to the vagus nerve.
Verificationof this finding awaits further investigation.

Plate I 16

Granial and Gervical Nerves

Granial Nerve Nuclei in Brainstem: Schema (continuedl

Medialdissection

A c c e s s o r yo c u l o m o t o r
(Edinger-Westphal)
nucleus

R e dn u c l e u s

O c u l o m o t onr u c l e u s

O c u l o m o t o r n e r v e( l l l

Trochlear
nucleus

Mesencephalin
c ucleus
of trigeminalnerve

Trochlearnerve (lV)

A b d u c e nnt u c l e u s
Trigeminal
nerve (V)
and ganglion

lnternalgenu
of facial nerve

Principal
F a c i a nl u c l e u s

sensorynucleusof
t r i g e m i n anle r v e -

V e s t i b u l a nr u c l e i
Motor nucleusof
t r i g e m i n a nl e r v e

Anteriorand posterior
c o c h l e anr u c l e i

F a c i a nl e r v e ( V l l )

S u p e r i oar n d
inferiorsalivatory
nuclei

V e s t i b u l o c o c h l e anre r v e ( V l l

A b d u c e n tn e r v e ( V l )

Solitarytractnucleus

C l o s s o p h a r y n g e anle r v e ( l X )

(dorsal)nucleus
Posterior
o f v a g u sn e r v e( X )

Hypoglossalnerve (Xll)

nucleus
Hypoglossal
Vagusnerve(X)
Nucleua
s mbiguus
Accessorynerve (Xl)*
Spinalnucleusof accessorynerve

Olivei
S p i n a lt r a c t a n d s p i n a l
t
nucleusof trigeminalnerve

Efferentfibers

.{nelenr rroers

Mixed fibers

*{Y

C(d4/^

*Recent evidence suggeststhat the accessorynerve lacksa cranialroot and has no connection to the vagus nerve.
Verificationof this finding awaits further investigation.

Granial and Gervical Nerves

Plate I l7

Granial Nerves (Motor and Sensory Distributionf: Schema


Spinalnervefibers
Efferent(motor) fibers
Afferent (sensory)fibers

ill

Oculomotor
I
Olfactory
Nasalcavity

C i l i a r ym u s c l es,p h i n c t e r
pupillae,and all externaleye
musclesexceptthosebelow

tl
Optic
Eye

IV
Trochlear
S u p e r i o ro b l i q u e

vl
Abduc

V
Trigeminal
Sensory-face
sinuses,teeth

Lateralrectus
muscte

Intermediate nerve
Motor-submandibular,
sublingual,lacrimalglands
Taste-anterior% of
tongue, sensorysoft palate

vtl
Facial
Musclesof face

vill
Vestibulocochlear
Cochlear Vestibular

IX
Glossopharyngeal

Taste-posterior1Aof tongue
Sensory-tonsil,pharynx, middle ear
Motor-stylopharyn geus,
parotid gland

Vagus
XI
Accessory
Sternoclei

trapezius
muscles

Motor-heart, lungs,palate,pharynx,
larynx,trachea,bronchi, Cl tract
Sensory-heart,lungs,trachea,

bronchi,larynx,pharynx,
Gl tract,externalear

4{r

?
Strap
muscles
(c1,2,3
fibers)

Plate I l8

Granial and Gervical Nerves

Olfactory Nerve (ll: Schema

S u b c a l l o s a( lp a r o l f a c t o r ya) r e a
S e p t a la r e aa n d n u c l e i

Olfactorybulb cells:schema
F i b e r sf r o m I C o n t r a l a t e r a l

yulb
F i b e r tso I o l f a c t o r b

Efferentfibers to
o l f a c t o r yb u l b

A n t e r i o rc o m m i s s u r e

Afferentfibersfrom bulb
t o c e n t r acl o n n e c t i o n s
a n dc o n t r a l a t e rbaul l b

Medial
olfactory stria

a n u l ec e l l ( e x c i t e db y
a n d i n h i b i t i n gt o m i t r a l
a n d t u f t e dc e l l s )
M i t r a lc e l l
R e c u r r e n pt r o c e s s
l u ft e d c e l l
Periglomerular
cell
Clomerulus

tory
fi b e r s

.k

-T/

ta

t
\:;

fftfnflt
Olfactory trac
( ) l l a c ' t o tv t l

Olfactory trigone
a n d o l f a c t o r yt u b e r c l e
L a t e r aol l f a c t o r ys t r i a
L a t e r aol l f a c t o r yt r a c t n u c l e u s
A n t e r i o rp e r f o r a t e ds u b s t a n c e
A m y g d a l o i db o d y ( p h a n t o m )

4{tr
Granial and Cervical Nerves

UNCUS

Hippocampal
fimbria
Dentate gyrus
P a r a h i p p o c a m p agly r u s

Plate 119

Optic Nerve (lll (Visual Pathwayl: Schema

C e n t r a ld a r k e r
c i r c l er e p r e s e n t s
m a c u t a rz o n e
L i g h t e rs h a d e s
represent
n ' r o n o c u l afri e l d s
E a c hc l u a d r a n t
a d i f f e r e n tc o l o r

P r o j e c t i o no r r
r i g h tr e t i n a

\i":,':

)Y_

Structure of retina: schema


A
B
C
C
H
P
R

nerves
ur)*

A n r a c r i n ec e l l s
[ 3 i p o l acr e l l s
Cones
C a n g l i o nc e l l s
H o r i z o n t a lc e l l s
P i g m e n tc e l l s
Rods

P r o j e c t i o ro. rn r i g h t
d o r s a ll a t e r ; r l
g e n i c u l a t en u c l e u s

Opticradiation

Optic radiation

1
)
i

C.rlcarine

1
{

I
"\
.-<

I
P r o j e c t i o no n l e f t
occipital obe

Plate 12O

A
P r o j e c t i o no n r i g h t
occipital obe

Granial and Cervical Nerves

Oculomotor(llll, Tlochlear(lVl, and AbducentlVIl Nerves:Schema

L o n g c i l i a r yn e r v e
Short ciliary nerves

C i l i a r yg a n g l i o n
Posteriorethmoidal nerve

A n t e r i o re t h m o i d a ln e r v e

Abducentnucleus

S e n s o r yr o o t o f c i l i a r yg a n g l i o n

S u p e r i oor b l i q u em u s c l e

nucleus
Trochlear

Sympatheticroot of ciliary ganglion

Levatorpalpebrae
s u p e r i o r i sm u s c l e

O c u l o m o t onr u c l e u s

S u p e r i o rd i v i s i o no f
oculomotor nerve

Superior
rectusmuscle

oculomotor
Accessory
(Edinger-Westphal)
nucleus(parasympathetic)

Frontalnerve (cut)
Lacrimalnerve (cut)

tugr:l
I
t

Nasociliarynerve

l.\

l'r**
tY-l.'

Trochlearnerve (lV)

Oculomotornerve(lll)
O p h t h a l m i cn e r v e( V r )

Abducent
nerve(Vl)

lnfraorbitalnerve
Zygomalic nerve (cut)

Pterygopalatine
ganglion

I n f e r i oor b l i o u em u s c l e

l n f e r i o rd i v i s i o no f
oculomotor nerve

C i l i a r ym u s c l e
e uscle
D i l a t o rp u p i l l a m

Medialrectusmuscle

S p h i n c t epru p i l l a e
muscle

I n f e r i o rr e c t u sm u s c l e

Efferentfibers
Afferentfibers
Sympatheticfibers
fibers
Parasympathetic

Parasympatheticroot
o f c i l i a r yg a n g l i o n

Granial and Gervical Nerves

M a n d i b u l anre r v e( V 3 )
Internalcarotidartery
a n dn e r v ep l e x u s
Maxillary nerve (Vz)
Lateralrectus muscle and
abducent nerve (turned back)

plexus
Cavernous
C o m m o n t e n d i n o u sr i n g

4ftr
Plate 121

Trigeminal Nerve (Vl: Schema


SeealsoPlates 24,42,43,45,46, 167, 168

' --'-*" Efferent fibers


'^** Afferent fibers
' " . " P r o p r i o c e p t i v ef i b e r s
Parasympatheticfibers
- -.* Sympatheticfibers

Ophthalmic nerve
T e n t o r i a(l n r e n r n g e a bl )r a n c h
N a s o c i l i a r yn e r v e

T r i g e m i n a ln e r v e ( V ) g a n g l i o na n d n u c l e i
M o t o r n u rl e u s
M t ' s t ' n 1e ' p h . r l i nc u c l e u s
P r i r - r c . i psaeln s o r yn u r . l c u s
S p i r r atlr a c t ; r r r r nl u c ' l t ' u s

L a c r i m a nl e r v e

S e n s o r yr o o t o f
c i l i a r yg a n g l i o n
Frontan
l erve
C i l i a r yg a n g l i o n

P o s t e r i o er t h m o i d a ln e r v
L o n g c i l i a r yn e r v
S h o r tc i l i a r yn e r v e s
A n t e r i o re t h n r o i d a nl e r v
S u p r a o r b i t anl
S u p r a t r o c h l e anre r v e
I n f r a t r o c h l e anr e
Internan
l a s a lb r a n c h e s
an0
E x t e r n anl a s a lb r a n c h e s
o f a n t e r i o re t h m o i d a ln e r v e
Maxillary nerve (\
M e n i n g e a lb r a n c h
Zygomaticotemporal
nerve
Zygomaticofacialnerve
Zygomatic r-rerve
l n f r a o r b i t anl e r v e
Pterygopalatine
ganglion
Superior
alveolar
b r a n c h e so f
i n f r a o r b i t anl e r v e

SWJ

N a s a lb r a n c h e s
( p o s t e r i o rs u p e r i o r
l a t e r a l n, a s o p a l a t i n e ,
and posterior
s u p e r i om
r edial)

F a c i a nl e r v e ( V l l )
Chorda
t y m p a n in e r v e

N e r v e ( V i d i a n )o f
l r t e r y g o i dc a n a l
( f r o n rf a c i a ln e r v e l V l l l
. r n dc a r o t i dp l e x r - r s )

n{r

P h a r y n g e abl r a n c h
( , r e a t e ra n d l e s s e r
p a l a t i n en e r v e s

Superficial
t e n r p o r ab
l ranches

D e e p t e m p o r a ln e r v e s
( t o t e m p o r a l i sm u s c l e )
L a t e r a pl t e r y g o i d
a n d m a s s e t e r i cn e r v e s

A r t i c u l a rb r a n c h
and anterior
a u f l c u l a rn e r v e s

T e n s o rv e l i p a l a t i n a
i nd
m e d i a lp t e r y g o i d

A u r i c u l o t e m p o r ani e r v e

B u c c a ln e r v e

Submandibulal
ganglion

M e n t a ln e r v e
I n f e r i o rd e n t a lp l e x u s
Linguan
l erve

Plate 122

M y l o h y o i dn e r v e

lnferior
a l v e o l a rn e r v e
Otic ganglion

Mandibular nerve (Vr) T e n s o rt y m p a n in e r v e

P a r o t i db r a n c h e s
M e n i n g e a lb r a n c h
Lesserpetrosalnerve (fron'r
g , l o s s o p h a r y n g enael r v e I l X l )

Granial and Gervical Nerves

Facial Nerve (Vlll: Schema


Seeals0

Creater petrosalnerve
Deep petrosalnerve (from internalcarotid plexus)
Lesserpetrosalnerve
N e r v e ( V i d i a n )o f p t e r y g o i dc a n a l

Facial nerve (Vll)

c eatus
In t e r n aal c o u s t i m
l n t e r m e d i a t en e r v e

C e n i c u l a t eg a n g l i o n

M o t o r n u c l e u so f f a c i a ln e r v e

Internalcarotid Plexus
(on internalcarotid arterY)

S u p e r i o rs a l i v a t o r yn u c l e u s

Solitarytractnucleus

Otic ganglion
P t e r y g o p a l a t i ngea ng l i o n

Facialmuscles
Frontalbellv(frontalis)
of occipitofrontalis
Orbicularisoculi
Corrugatorsupercilii
Zygomaticusmajor
Zygomaticusminor
Procerus
Levator labii
supeflofls

Levatorlabii
supenons
alaequenasi
Levator
angulioris
Nasalis

Depressor
septinasi

belly

Orbicularis
ons

(occipitalis)of
occipitofrontalis
muscle

ipital

Depressor
angulioris
aurl
nerve

labii
Depressor
inferior

anchesto auricularmuscles

Mentalis

a u r i c u l a rn e r v e

(Risorius)
(notshown)

Nerve to staDediusmuscle
Stylomastoidforamen

Buccinator

T y m p a n i cp l e x u s

S u b l i n g ug
al a n d
Submandibular
Efferentfibers
S u b m a n d i b u l agr a
Afferentfibers
Linguan
l e r v e ( f r o m t r i g e m i n a nl e r v e )
fibers
Parasympathetic
C h o r d at y m p a n in e r v e
fibers
Sympathetic

Granial and Gervical Nerves

),'i'

Tvmpanic nerve (of Jacobson)


(from glossopharyngealnerve)
C l o s s o p h a r y n g e anle r v e ( l X )

s t r i cm u s c l e( p o s t e r i obre l l Y )
Stylohyoidmuscle

4{tr

aroticotympanicnerve (from internalcarotid plexus)

Plate 123

Vestibulocochlear Nerve (Vlll|: Schema


,I

i.il

Afferentfibers

nit.i,:.i:r1-e;Y+:fi9:::+-rr+1*+li++9!sr:::E!j+t!:+i:B!4$G[14fi!jeh]ii",8ddt:$riij.hr

F a c i acl a n a l
Tympaniccavity
C e n i c u l u m( g e n i c u l a t e
g a n g l i o n )o f f a c i a ln e r v e

C h o r d a t y m p a n in e r v e

l erve
C r e a t e rp e t r o s a n

Headof malleus

) anglion
C o c h l e a r( s p i r a l g
V e s t i b u l an
r erve
C o c h l e a rn e r v e
Motor root of facial nerve
a n d i n t e r m e d i a t en e r v e
Vestibulocochlear
nerve(Vlll)
M e d u l l ao b l o n g a t a
( c r o s ss e c t i o r \

A m p u l l ao f l a t e r a l
s e m i c i r c u l adr u c t
Medial

Internal
acoustic
meatus

A m p u l l ao f s u p e r i o r
s e m i c i r c u l adr u c t

Superior
Inferior
A m p u l l ao f p o s t e r i o r
s e m i c i r c u l adr u c t

Lateral

*{r

Plate 124

I n f e r i o rc e r e b e l l a r
p e d u n c l e( t o c e r e b e l l u m )

V e s t i b u l agr a n g l i o n

Saccule
S u p e r i o rd i v i s i o n )
)
- I n f e r i o rd i v i s i o n
)

o l v e s l i b u l a rn e r v e

Granial and Gervical Nerves

Glossopharyngeal Nerve (lXl: Schema


SeealsoPlates167,168

Efferentfibers
Afferentfibers
Parasympathetic
fibers

S p i n a lt r a c t a n d s p i n a ln u c l e u so f t r i g e m i n a nl e r v e
S o l i t a r yt r a c t n u c l e u s
T y m p a n i cn e r v e( o f J a c o b s o n )
T y m p a n i cc a v i t ya n d p l e x u s

N u c l e u sa m b i g u u s
I n f e r i o rs a l i v a t o r yn u c l e u s

S t y l o m a s t o i fdo r a m e n
Caroticotympanin
c e r v e ( f r o m i n t e r n a lc a r o t i dp l e x u s )
Creater petrosalnerve
Deep petrosan
l erve
N e r v e ( V i d i a n )o f p t e r y g o i dc a n a l
L e s s ep
r e t r o s a ln e r v e
P t e r y g o p a l a t i ngea ng l i o n
M a n d i b u l a nr e r v e( V t )
Otic ganglion
A u r i c u l o t e m p o r anl e r v e
l ' , r r oiIrI , l l , r r rI r- * * I r r l r . rllr r , r r rhr ( ) t l ) n t l ) , 1 | ] i1( , 1 , . ' . , , t - - . - - - - - - - - A u d i t o r yrp h a r y n g o t y m p a n i c ,
E u s t a c h i a nt )u b e a n d p h a r y n g e aol p e n i n g
Clossopharyngeal
nerve(lX)

S t y l o p h a r y n g e um
s u s c l e( a n d b r a n c h
irom glossopharyngea
n le r v e )

l u g u l a rf o r a m e n
C o m m u n i c a t i o nt o a u r i c u l a r
b r a n c ho f v a g u s n e r v e

Tasteand
somaltc
sensatlon:
posreflor
Z of tongue

V a g u sn e r v e ( X )
S u p e r i o rc e r v i c a l
s y m p a t h e t i cg a n g l i o n
S y m p a t h e t i ct r u n k
C a r o t i db r a n c ho f
glossopharyngen
ae
l rve

,{

,t
lt

I n t e r n a cl a r o t i da r t e r y

P h a r y n g e apl l e x u s
C a r o t i ds i n u s
P h a r y n g e a tl ,o n s i l l a ra, n d l i n g u a l
ae
l rve
b r a n c h e so f g l o s s o p h a r y n g e n
P h a r y n g e abl r a n c ho f v a g u sn e r v e

Carotid body
C o m m o n c a r o t i da r t e r y
E x t e r n acl a r o t i da r t e r y

Granial and Gervical Nerves

4{tr

Plate 125

Vagus Nerve (Xl: Schema


Posterior
nucleusof vagus
nerve(parasympathetic
andvisceralafferent)

Glossopharyngealnerve (lX)

Solitarytractnucleus(visceral
includingtaste)
afferents

Meningeal branch of vagus nerve

Auricularbranchof vagusnerve

S p i n atlr a c ta n ds p i n a l
n u c l e uo
s f t r i g e m i n anle r v e

Auditory(pharyngotympanic,
Eustachian)
tube

(somaticafferent)

Levatorveli
palatinimuscle

Nucleua
s mbiguus
(motorto pharyngeal
and laryngeal
muscles)

Salpingopharyngeus
muscle

Cranialroot of
accessory
nerve*
(seenextplate)

Palatoglossus
muscle
Palatopharyngeus

Vagusnerve (X)

muscle

foramen
Jugular

Superiorpharyngeal
constrictormuscle-

Superiorganglion of vagus nerve

Stylopharyngeus
muscle
Middle pharyngealconstrictormuscle
Inferiorpharyngealconstrictormuscle

Cricothyroid
musc
Trachea
Esopha

R i g h st u b c l a v i aanr
Right recurrentlaryngealnerve
Heart
Hepatic branch of anterior
vagal trunk (in lesseromentum)
Celiac branchesfrom anterior
and posteriorvagal trunks

to celiacplexus
C e l i a ca n d s u p e r i o rm e s e n t e r i c
gangliaand celiac plexusl -e
Hepatic plex
Callbladder
and bileducts
Liver

Pyloricbranch
from hepaticplexus
Pancreas

Duodenum
A s c e n d i n gc o l o
Cecum

Appendix

Plate 126

Inferior ganglion of vagus nerve


Pharyngealbranch of vagus nerve (motor to musclesof
palate and pharynx;sensoryto lower pharynx)
C o m m u n i c a t i n gb r a n c ho f v a g u sn e r v et o
carotid branch of glossopharyngealnerve

Pharyngeal
plexus
Superiorlaryngealnerve:

Internalbranch(sensory
andparasympathetic)
External
branch(motorto cricothvroidmuscle)
Superiorcervicalcardiac branch of vagus nerve
Inferiorcervicalcardiac branch of vagus nerve
Thoraciccardiac branch ofvagus nerve
Left recurrentlaryngealnerve (motor to musclesof larynx
except cricothyroid;sensoryand parasympatheticto
larynx below vocal folds; parasympathetic,efferent,and
afferentto upper esophagusand trachea)

P u l m o n a rpyl e x u s

Nr

Cardiacplexus
plexus
Esophageal
Anterior vagal trunk

Castric branchesof anterior vaeal trunk


(branchesfrom posterior trunkbehind stomach)

Vagalfibers(parasympathetic
motor,
secretomotor,
and afferentfibers)accompany
superiormesentericartery and its branches
usuallyas far as left colic (splenic)flexure
S m a l li n t e s t i n e

Efferentfibers
Afferentfibers
Parasympathetic
fibers

Granial and Cervical Nerves

Accessory Nerve (XIl: Schema


Nucleua
s mbiguus
Vagus nerve (X)

nerve(joinsvagusnerve
Cranialroot of accessory
nervesuppliesmusclesof
andvia recurrentlaryngeal
larynx,exceptcricothyroid)*
Spinalroot of
nerve
accessory
Foramen
magnum

Jugularforamen
Superiorganglion
of vagus nerve
Accessory nerve (Xl)*

Inferior ganglion
of vagus nerve

C.l spinalnerve

C2 spinalnerve
Accessorv nerve
(to sternocleidomastoid
and trapeziusmuscles)

muscle(cut)
Sternocleidomastoid
3 spinal nerve
C4 soinalnerve

Trapezius
muscle

*{r
Efferentfibers
Proprioceptivefibers
*Recent evidence suggeststhat the accessorynerve lacksa cranialroot and has no connection to the vagus nerve'
Verificationof this finding awaits further investigation.

Granial and Cervical Nerves

Plale 127

Hypoglossal Nerve (XIII: Schema

Hypoglossal
nerve(Xll)
(in hypoglossal
canal)
Superior
longitudinal

Intrinsic
muscres
of tongue

Meningeal branch

H y p o g l o s snaul c l e u s

Transverse
andvertical
Inferior
longitudinal

'." 1t:lr/. rt-::-

Occipitalcondyle
Inferiorganglionof
vagusnerve
Ventralramiof
C 1 , 2 , 3f o r m
ansacervicalis
of cervicalplexus
Superiorcervical
sympathetic
ganglion
Superiorrootof
ansacervicalis

Cenioglossus
muscre

Internalcarotid artery

C e n i o h y o i dm u s c l e
( v i aC 1 )

Hyoglossus
muscle
Thvrohvoidmusclei
( v i aC 1 )
Omohyoid muscle

( s u p e r i obre l l y )
Sternohyoidmuscle

Inferior root of ansacervicalis

Ansa cervicalis

I n t e r n ajlu g u l a rv e i n

Common carotid artery

Sternothyroid
muscle
Omohvoidmuscle(inferiorbel

Efi'erentfibers

4{tr

Plate 128

Granial and Cervical Nerves

Afferentfibers

Gervical Plexus: Schema


SeealsoPlate32
Sternocleidomastoidmuscle (cut)
Accessory nerve (Xl)

Creat auricularnerve
Lesseroccipital nerve

H y p o g l o s s anl e r v e ( X l l )
muscte

Creater occipital nerve


(from dorsal ramus of C2)

Nerves to anterior and lateral


rectus capitisand longus
c a o i t i sa n d c o l l i m u s c l e s

N e r v e st o l o n g u sc a p i t i sa n d
muscles
colliand levatorscapulae
Thyrohyoidmuscle
S u p e r i orro o t
of ansa cervicalis
lnferior root
of ansa cervicalis
Transversecervical nerve

Traoezius
muscle
N e r v e st o l o n g u sc a p i t i sa n d
colli, levator scapulae,and
m i d d l e s c a l e n em u s c l e s
C o m m u n i c a t i o nt o
brachialplexus
Phrenicnerve

Omohyoidmuscle

(superior
muscle
Sternothyroid

Sternohyoid
muscle

Supraclavicularnerves(medial,
intermediate,and lateral)

A n s ac e r v i c a l i s

muscle(cut)
Sternocleidomastoid
Efferentfibers

Nr

Omohyoid muscle (inferior belly)

Granial and Cervical Nerves

Afferentfibers
Proprioceptivefibers

Plate 129

Autonomic Nerves in Neck

Internal
carotidnerve
Clossopharyngeal
n e r v e( l X )

Laryngopharyngeal
sympatheticbranch

Vagusnerve(X)(cut)
Superiorcervical
sympatheticganglion

Pharyngeal
plexus

Pharyngeal
branch
or vaSusnerve
External
carotidarteryand plexus
Superiorlaryngeal
nerve
Internalcarotid artery and carotid
branch of glossopharyngealnerve

Carotidbody
arotidsinus
Superiorcervical cardiac branch
of vagus nerve
Superiorcervical sympathetic
cardiac nerve
Phrenicnerve (cut)
Middle cervicalsympatheticganglion

*{r

Commoncarotidarteryand plexus
Middlecervicalsympathetic
cardiacnerve
Vertebralganglion
Vertebralarteryand plexus
Recurrent
laryngeal
nerve
Cervicothoracic(stellate)ganglion
Ansa subclavia
Vagus nerve (X) (cut)
lnferior cervical sympathetic
cardiac nerve

Thoracicsympathetic
and
vagalcardiacnerves
Subclavianarterv

Plate 13O

Granial and Cervical Nerves

Autonomic Nerves in Head


SeeafsoPlates 4446,86, 121,132-134r,ffi, 106
Creater oetrosalnerve

Deep petrosalnerve

N a s o c i l i a r yn e r v e

Nerve (Vidian)of pterygoid canal


O c u l o m o t o r n e r v e( l l l )

Trigeminalnerve (V)

M a x i l l a r yn e r v e ( V z )

Sensory

Roots of
ciliary
Sympathetic
ganglion
Parasympathetic

O p h t h a l m inc e r v e( V r )

Internalcarotid artery and plexus

Frontaa
l nd
lacrimal
nerves (cut)

C e n i c u l u m( g e n i c u l a t eg a n g l i o n )
of facial nerve

C i l i a r yg a n g l i o n

ciliary nerve

F a c i a nl e r v e ( V l l )
Short ciliary nerves
Vestibulocochlear

Posterior,
superior,
and inferiorlateral
nasatnerves

Clossopharyngeal
n e r v e( l X )
Vagus nerve (
Mandibular
nerve (V:)
Otic
ganglion
lnternal
carotid nerve
C h o r d at y m p a n i

Pterygopalatine
ganglion

S u p e r i ol ra r y n g e a l

eater
and lesser
palatinenerves

nerve (cut)
S u p e r i o rc e r v i c a l
sympatheticganglion

L i n g u a ln e r v e
l n t e r n a lc a r o t i d
artery and plexus'

lnferior
alveolarnerve

Carotid branch of
glossopharyngeal

Submandibular
ganglion

Pharyngeal
plexus

C a r o t i ds i n u s
Maxillaryartery
and plexus

Cervical
s y m p a t h e t i ct r u n k
S u p e r i o rc e r v i c a l
c a r d i a cb r a n c ho f
v a S u sn e r v e

External
carotid
arteryand plexus

M i d d l e m e n i n g e a al r t e r ya n d p l e x u s
Facialartery and plexus

Common carotid artery and plexus


S u p e r i o rc e r v i c a ls y m p a t h e t i cc a r d i a cn e r v e

Granial and Gervical Nerves

*{r
Plate 131

Giliary Ganglion: Schema

e uscle
S p h i n c t epru p i l l a m
Short ciliary nerves

e uscle
D i l a t o rp u p i l l a m

Accessory
oculomotor
(Edinger-Westphal)
nucleus(parasympathetic)

Oculomotor
(parasympathetic)
root of ciliaryganglion

Ciliary
ganglion

Ciliarymuscle

S u p e r i ocro l l i c u l u s
Lateral
geniculatebody

Optic nerve (ll)


Ophthalmic
n e r v e( V t )

Nasociliarynerve
L o n g c i l i a r yn e r v e

Trigeminal
ganglion

Nasociliary(sensory)
root of ciliary ganglion

Internal
carotid plexui

Sympatheticroot of ciliary ganglio

.r-Tectosoinal

I
!

-Th^,^-i-

<-

O p h t h a l m iacr t e r y

tract

^-.,

part
---fhoracic
of spinalcord

Internal
carotid artery
Superiorcervical sympatheticganglion
1st thoracic sympathetictrunk ganglio
C r a y r a m u sc o m m u n i c a

Preganglionic| _
PostganglionicfParasytpatheticfibers

T 1 s p i n a ln e r v e

Preganglionic
sympathetic
cellbodies
in intermediolateral
nucleus
(lateral
horn)of gray
matter

Afferentfibers
Visualpathway
Descending
pathway

Plate | 32

Nr
Granial and Cervical Nerves

Pterygopalatine and Submandibular Ganglia: Schema

Ophthalmicnerve(Vr)

Trigeminalganglion

Deep petrosalnerve
eaterpetrosalnerve

Mandibularnerve(V:)
Otic ganglion

tympaninerve
Trigeminal
nerve(V)
Facialnerve(Vll)
nerve)

Lingualnerve
Maxillarynerve(Vz)
Nerve(Vidian)of pterygoidcanal
ganglion
Pterygopalatine

Superiorsalivatory
nucleus

Lacrimalgland

palatinenerves
Descending

Pharyngealnerve

Posteriornasalner

nerve(lX)
-

I^

Superiorcervicalsympatheticganglion

.l

Palatinen"ru"r I ureater
( Lesser-

Sympathetictrunk
T1 and T2 spinalnerves
Thoracic
spinal
cord

ganglion

Dorsal
root
gland
Sublingual
Submandibular

White

Cray

\-+v-./

Facialartery

Lingualartery

Rami communicantes

carotidarterv

Externalcarotidartervand

Ventral
root

presynapticcell
bodiesin
intermediolateral
nucleus(lateral
horn)of gray
matter

Commoncarotidarteri

Nr
Granial and Cervical Nerves

r
r

Sympatheticpreganglionicfibers
Sympatheticpostganglionicfibers
preganglionicfibers
Parasympathetic
Parasympatheticpostganglionicfibers

Plate 133

Otic Ganglion: Schema

Mandibularnerve(V3)

ganglion
Trigeminal
Lesserpetrosalnerve

Otic ganglion

Chordatympaninerve
Ophthalmicnerve(Vr)

Trigeminal
nerve(V)

Maxillarynerve(Vz)

Facialnerve(Vll)
Clossopharyngeal
nerve(lX)

Auriculotemporalnerve

Inferiorsalivatorynucleus

Superficialtemporalartery

Pons
Parotidgland
Maxillary
artery
Medulla
oblongata
Tympanic
plexus
Inferior
alveolar

Tympanic
nerve
(of Jacobson)
Inferiorganglion(lX)
cervicalsympatheticganglion
Sympathetictrunk
T1 and T2 spinalnerves

Externalcarotidarterv

Thoracic
spinalcord

Internalcarotid

Commoncarotidar
White

Cray

\*^\r-l

Ramicommunicantes

rr r
r r

r
r

Sympatheticpreganglionicfibers
Sympatheticpostganglionicfibers
Parasympatheticpreganglionicfibers
postganglionicfibers
Parasympathetic

Sympathetic
preganglionic
cell bodiesin
intermediolateral
nucleus(lateral
horn)of gray
matter

4{r
Plate 134

Granial and Gervical J{erves

Taste Pathways: Schema

-Usual

pathway
- - - - - -' Accessorypathway

Ventralposteromedial(VPM)
nucleusof thalamus
y cortex(justbelow facearea)
Lateralhypothalamic
area
Amygdaloid
body
Pontinetastearea
Trigeminal
nerve(V)
(semilunar)
ganglion
Trigeminal

Mesencephalic
nucleus
and
Motor nucleus

h a l m i cn e r v e( V r )

of trigeminalnerve

Maxillarynerve(Vz)
Mandibularnerve(Vr)

Createrpetrosalnerve

Nr

Ceniculate

Nerve(Vidian)
of pterygoidcanal
Otic
ganglion

Facialnerve(Vll)
and

Lingualnerve

Intermediatenerve

Nucleusof solitarytract
(rostralpart)

Fungiform
papillae

Clossopharyngeal
nerve(lX)

Foliate
papillae
Medullaoblongata
(lowerpart)
Vallate
papillae
Inferior(petrosal)
ganglion
gealnerve
of glossopharyn
Inferior(nodose)ganglionof vagus
Vagusnerve(X)

Granial and Gervical Nerves

nerve
Superiorlaryngeal

Plate 135

Arteries to Brain and Meninges

Left middle meningealartery

Posterior
cerebralartery
Superiorcerebellar
artery
Basilar
artery

Middlecerebralartery
Anteriorcerebralartery
Anterior communicatingartery

Ophthalmicartery

Leftlabyrinthine
(internalacoustic)
arterv

Posterior
communicating
artery

Mastoidbranchof
leftoccipitalartery

Cavernous
sinus
Anteriorinferior
cerebellar
artery

Middle
meningeal
artery

Posterior
meningeal
branchof leftascendin
pharyngeal
Posterior
inferior
cerebellar
artery
Leftand right
vertebralarteries
(intracranial

Maxillary
artery
Superficial
temporal
artery

Posterior
meningeal
branchof vertebral
arter

External
carotid
atrcry

Anteriormeningeal
branchof vertebralartery
Posterior
auricular
artery

Facialartery

Occipital

Internalcarotidartery
Carotid

Lingualartery
pharyngeal
Ascending
artery
Superiorlaryngeal
artery

Carotid body

Superiorthyroidartery
Vertebral artery
(cervicalpart)
Transverseprocess of C6
Deep cervicalartery

Supremeintercostal
artery
Costocervical
trunk
Subclavianartery

Plate | 36

Common carotid arterv


Ascendingcervicalartery (cut)
Inferior thyroid artery
Thyrocervicaltrunk

Brachiocephalic
trunk
thoracicartery

Nr

Gerebral Vasculature

Veins of the Vertebral Golumn: Vertebral Veins

Variation:right vertebralvein crossing


anterior to right subclavianartery

Left vertebral artery


Leftvertebralvein

Anterior vertebralveins

Left subclavianartery

Right deep cervicalvei

Left brachiocephalicvein

A c c e s s o r yv e r t e b r a l v e i n
Right vertebralartery
Vertebral veins: detail showing
v e n o u sc o m m u n i c a t i o n s

Rightsubclavianarteryand vein

Anterior arch of atlas(C1) (cut)

R i g h ti n t e r n a jl u g u l a rv e i n
( i n f e r i o rb u l b )
R ig h t b r a c h i o c e p h a l ivce i n

Right vertebralvein

D u r am a t e r

R i g h tc l a v i c l e
R i g h tc o m m o n c a r o t i da r t e r y

Rightvertebralartery

A n t e r i o ri n t e r n a l( e p i d u r a l )
vertebralvenous plexus
Dens (C2) (cut)
Venous plexusof vertebralartery
Anterior externalvertebralvenous plexus

Epiduralfat and anterior internalvertebral(epidural)venous plexus


C o m m u n i c a t i n gv e i n
vein
Basivertebral
lntervertebralveins
Veinsof the vertebral
Vertebralartery with venous plexus

column:vertebralveins

S u p e r i obr u l bo f r i g h ti n t e r n aj ul g u l a rv e i n
C o n d v l a re m m i s s a r vv e i n

ii.!-i,
lar-r

Deep cervicalvein

Vertebralarteries
Dura mater

Anteriorvertebral
velns
venouscommunlcauons

M a s t o i de m m i s s a r yv e i n

A n t e r i o ri n t e r n a l( e p i d u r a l v) e r t e b r a vl e n o u sp l e x u s

Venousplexusof vertebralartery
Anterior externalvertebralvenous plexus
C o m m u n i c a t i n gv e i n s

Anterior vertebralveins
Left deep cervicalvein

R i g h td e e p c e r v i c a vl e i n
Left vertebralvein
Formingvertebralvein
Accessoryvertebralvei
Rightvertebralartery and vein

Left vertebralartery
Left thyrocervicaltrunk
L e f t i n t e r n a jl u g u l a rv e i n ( i n f e r i o rb u l b )

Dorsalscapularartery

Left subclavianartery

Costocervicaltrunk
Left subclavianvein

Right thyrocervical ;
trunk

Left brachiocephalicvein
R i g h ts u b c l a v i a nv e i n

Left common carotid arterv

R i g h ti n t e r n a jl u g u l a rv e i n
( i n f e r i o rb u l b )
R i g h tb r a c h i o c e p h a l ivce i n
Right subclavianartery

Gerebral Vasculature

C(d4s/*

R i g h tc o m m o n c a r o t i da r t e r y

Plate | 37

Arteries to Brain: Schema

Anteriorcerebralartery

communicatingartery

Ophthalmicartery

Middle cerebral

Suoraorbital
arterv

Posteriorcommunicatingart

Supratrochlear
artery
Caroticotympanic branch
of internalcarotid artery

Lacrimal
artery
Dorsalnasalartery

Posterior
cerebral

Middle meningealartery

Superiorcerebellar
artery

Angular artery

Anteriortympanicarter
Superficial
temporalartery
Middle meningealar

Posterior
auricular
artery

Maxillaryarter

Facialartery

Occipitalartery

B a s i l aa
r

artery

Anteriorinferior
cerebellar
artery

pharyngealartery
Ascending

Posterior
inferior
cerebellar
ar

Anteriorspinalartery
Spinalsegmental
medullary branches

External
carotidarterf

Vertebral artery

InternalcarotidarterV

ommon carotid artery

Superiorthyroidartery

Deep cervicalartery

ial cervicalartery

Common carotid artery

Suprascapularartery

Vertebralartery

Supremeintercostal
artery
Ascendingcervicalarterir
Costocervicaltrunk
Inferiorthvroid arterv
Thyrocervicaltrunk/

ii

Subclavian
artery
S u b c l a v i a na

Internalthoracic arterv

B r a c h i o c e p h atlriuc n k

Arch
Descending

*{r
Plate | 38

Ascending

Anastomoses
1
2
3
4
5

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

Gerebral Vasculature

Arteries of Brain: lnferior Views

(orbitofrontal)
arter
Medialfrontobasal
A n t e r i o rc o m m u n i c a t i n Ba r t e r y

Anterior cerebralarterv
Distal medial striateartery
(recurrentartery ot
Internalcarotid artery

Anterolateral
arteries
central(lenticulostriate)
Middle cerebralarterv
Lateralfrontobasal(orbitofrontal)

arter
Prefrontal
Anterior choroidal arter
P o s t e r i o cr o m m u n i c a t i n ga r t e r y

Posteriorcerebrala
Superiorcerebellar

artery
Basilar
Pontinearteries

(internalacoustic)
Labyrinthine
arter
Anterior inferior cerebellararterv (AlC

Vertebralar
Anteriorspinalarte
Posterior
inferiorcerebellar
artery(PICA)
Posteriorspinal

Distalmedialstriateartery
(recurrent
arteryof Heubner)

Cerebralarterial
circle(of Willis)
(brokenline)

A n t e r i o rc o m m u n i c a t i n ga r t e r y

Anterior cerebralarterv
Middle cerebralarterv
Posteriorcommunicatingartery
Anterior choroidal artery

1,.

fu

Optic tract
Posteriorcerebralartery
Cerebralcrus
Lateralgeniculatebody
Posteriormedial choroidal artery
Posteriorlateralchoroidal artery
Choroid plexusof lateralventricle

M e d i ag
l e n i c u l a tbeo d y
P u l v i n aorf t h a l a m u s
Lateralventricle

Gerebral Vasculature

Nr
Plate | 39

Gerebral Arterial Gircle (of Willisl

Vesselsdissectedout: inferiorview
Anterior cerebralartery
(A2 segment)

Distal medial striatearterv


(recurrentartery of Heubner)
Anteromedialcentral (perforating)
arteries

A n t e r i o rc o m m u n i c a t i n ga r t e r y
Anterior cerebralartery
(A1 segment)

Hypothalamic
artery
Anterolateral
central
(lenticulostriate)
arteries

Ophthalmicartery
Internalcarotid
Middle cerebralartery

Superiorhypophyseal
artery
Posteriorcommunicatingartery

Inferior hypophysealartery

Anteriorchoroidalarterv
Posterior
cerebralartery
(P2segment)
(P1segment)

Thalamotuberal
(premammillary)artery

S u p e r i o rc e r e b e l l a a
r

Basilar
Pontinearteries
Anterior inferior cerebellarartery (AICA)

Posteromedialcentral
(perforating) arteries

g artery
Thalamoperforatin
Posteromedialcentral
(paramedian)arteries
Labyrinthine(internalacoustic)artery

Vertebralartery

Vesselsin situ: inferiorvrew


Anteriorcerebralartery
Hypothalamicarter

Anterior communicating,artery
ic chiasm

sinus
Cavernous
Internalcarotid arter

Superiorhypophyseal
Middle cerebrala

Inferiorhypophyseal
artery
Posteriorcommunicatingartery

I n f u n d i b u l u(mp i t u i t a rsyt a l k )
portalveins
and longhypophyseal
(anterior
Adenohypophysis
lobeof pituitarygland)
(posterior
Neurohypophysis
lobeof pituitarygland)
ial central
(perforating) arteries

Efferent
hypophyseal
veins
Superiorcerebellarartery

Posterior
cerebral

Plate 14O

Basilarartery

Nr

Gerebral Vasculature

Arteries of Brain: Frontal View and Section

C o r p u sc a l l o s u m

Paracentralartery
M e d i a l f r o n t a lb r a n c h e s

Anterolateral
central
(lenticulostriate
a )r

Pericallosal
artery

Lateralfrontobasal
(orbitofrontal)arter

Callosomarginalartery

Polarfrontalartery
Prefrontal
Anterior cerebral
arteries

Precentral(pre-Rolandic)
a n d c e n t r a l( R o l a n d i c )
sulcalarteries

Medial frontobasal
(orbitofrontal)artery

Anterior parietal
( p o s t c e n t r asl u l c a l )

medial striate
artery (recurrent
artery of Heubner)

artery
Posterior
parietal

lnternalcarotid
artery

artery

Branchto
a n g u l agr y r u s

Anterior choroidal
artery

Temporal
branches

Posteriorcerebral
arterv

( a n t e r i o rm
, iddle,
and posterior

artery
cerebellar
Middle cerebralarterv

Basilarand pontine arteries

and branches
(deep in lateralcerebral
l S y l v i a n sl u l c u s )

Labyrinthine(internal
acoustic)artery

A n t e r i o rc o m m u n i c a t i n g

Vertebralartery

Posteriorcommunicatingartery
Anterior inferior cerebellarartery (AICA)

\Posterior

inferior cerebellarartery (PICA)

artery
Anterior
spinal

I {ffi

4.t'/

Posteriorspinalar
Falxcerebri

C o r p u ss t r i a t u m
(caudateand lentiform nuclei
Anterolateralcentral
(lenticulostriate)arteri
I n s u l a( i s l a n do f R e i l
L i m e no f i n s u l a
Precentral(pre-Rolandic),
c e n t r a l( R o l a n d i c s) u l c a l ,
and parietalarter

Callosomarginalarteries
ano
Pericallosal
arteries
(branchesof anterior
cerebralarteries)
T r u n ko f c o r p u sc a l l o s u m
I n t e r n a cl a p s u l e
S e p t u mp e l l u c i d u m
Rostrumof corpus callosum

Lateralcerebral(Sylvian)
Temooralbranchesof
middle cerebralartery
Temporallobe

Anterior cerebral arteries


Distal medial striateartery
(recurrentartery of Heubner)
A n t e r i o rc o m m u n i c a t i n ga r t e r y

Middle cerebralarterv
Internalcarotid

Gerebral Vasculature

Optic chiasm

Plate 141

Arteries of Brain: Lateral and Medial Views


Anterior parietal(postcentralsulcal)artery{

parietalartery
Posterior

C e n t r a(lR o l a n d i cs )u l c aal r t e r y

Branchto angulargyrus

Precentral(pre-Rolandic)sulcalartery

Terminalbranches
of posteriorcerebral
artery

Prefrontal
sulcal
artery
Terminalbranchesof
anterior cerebral
artery
Lateralfrontobasal
(orbitofrontal)

left middle
cerebralartery
Left anterior
cerebralartery
Occipitotemporal
branches

Anterior communicatingartery

Posteriortemporal branch

Rightanteriorcerebralarteri

M i d d l et e m p o r abl r a n c h
Left internalcarotid artery

Polartemooralarterv

Posterior

Pericallosal
artery

Intermediate

Anterior

Suoeriorand inferior terminal branches(trunks)


Anterior temporal branch

4
4.

Paracentralartery

{r

Cingularbranches
Rightposteriorcerebralartery
Precunealartery

al

Polarfrontalartery

Dorsal branch
to corpus callosum

Parietoocci
oitalbranch
Calcarinebranch

Rightanterior
cerebralartery
Medialfrontobasal(orbitofrontal)artery
Anterior
communicatingartery (cut)
Medial occipital artery
Distal medial striateartery
( r e c u r r e na
t r t e r yo f H e u b n e r

Posteriortemporal brancn
Anterior temooral branch

Right internalcarotid artery

Posteriorcommunicatingartery

*Note: Anterior parietal(postcentral


sulcal)artery also occurs as separateanterior parietaland postcentralsulcalarteries.

Plate 142

Gerebral Vasculature

Arteries of Posterior Granial Fossa

T h a l a m o e e n i c u l a taer t e r i e s

L a t e r a al n d m e d i a lg e n i c u l a t eb o d i e so f l e f t t h a l a m u s

A n t e r i o rc h o r o i d a la r t e r y

C h o r o i d p l e x u s e so f l a t e r a vl e n t r i c l e s

P u l v i n a rosf l e f ta n dr i g h t h a l a m i

C r u r ao f f o r n i x

o f c o r p u sc a l l o s u m
Splenium

Anterolateralcentral
(lenticulostriate
a )r t e r i e s

O c c i p i t a l( p o s t e r i o r h) o r n o f r i g h t l a t e r a vl e n t r i c l e

R i g hd
t o r s abl r a n c ht o c o r p u sc a l l o s u m
(posterior
pericallosal
artery)

H e a d so f c a u d a t en u c l e i

S e p t u mp e l l u c i d u m

P a r i e t o o c c i p i )t aB
l r a n c h eosf
|
) rightposterior
Calcarine) cerebralartery

C o r p u sc a l l o s u m
Anterior
cerebralarteries

,}

Longitudinal
cerebral

fissure

Superior
colliculi
Superior
vermtan
branch

O p t i c n e r v e( l l )
Ophthalmic artery

Posteriormedial
choroidal artery
to choroid plexus
of 3rd ventricle

Anterior

cerebralartery
Middle

Posteriorlateral
choroidal artery

cerebralartery
Posterior
c o m m u n i c a t i n ga r t e r y

L a t e r a (l m a r g i n a l b) r a n c h

T h a l a m o p e r f o r a t i nagr t e r i e s

iiI.:

Inferiorvermian artery
(phantom)

L e f t i n t e r n a lc a r o t i da r t e r v

Choroidal branch to 4th ventricle


(phantom)and

Basilarartery
Pontinearteries

e r e b e l l at ro n s i l l abrr a n c h
of posterior inferior cerebellarartery

L a b y r i n t h i n e( i n t e r n aal c o u s t i c )a r t e r y

Posterior
cerebralarterV
S u p e r i o rc e r e b e l l a a
r rtery
Anterior inferior cerebellarartery (AICA)
A n t e r i o rm e n i n g e a bl r a n c ho f v e r t e b r a a
l rtery

Temporalbranches
of posteriorcerebralarteri,
A n t e r i o rs p i n a la r t e r y

Gerebral Vasculature

Outline of 4th ventricle(broken line)


Posteriormeningealbranch of vertebralartery

inferiorcerebellar
arterv(PICA)
Posterior
Leftposteriorspinalartery
Leftvertebralartery

*{r
Plate 143

Veins of Posterior Granial Fossa

Leftsuperiorand inferiorco
Basalvein (of Rosenthal)
Posteriormesencephalicvein
Medial geniculatebody

Lateral
mesencephalicvein

Lateralgeniculate
body
Leftthalamus
(cut surface)
Optic tracl

Confluence
of sinuses

Inferiorthalamostriatevei

Lefttransverse
sinus(cut)

Deepmiddle
cerebral

Superior
sagittal
Srnus

vetn

Anterior
cerebral
vetn

Optic
nerve(ll)

Superior
vermtan
veln
nferior

vermlanvern
Falxcerebelli(cut)
and occipitalsinus

Anteriorpontomesencephalic
veiri

inferiorcerebellar
h e m i s p h e rvi ce i n s

Trigeminalnerve (V
Transversepontine veiri

ntraculminatevein

ior cerebellar
vein (inconstant)

Petrosalvein (draining

to superiorpetrosalsinui)

vetn

Lateralpontine vein

Precentral
cerebellar
vein
Superiorretrotonsillar
vein

Anteromedian
medullarv
veiri
Vein of lateralrecessof 4th ventricle

4{tr
Plate 744

Superior,
middleand
I
inferiorcerebellar
pedunclei
Anterior soinalvein

(Inferiorretrotonsillar)
veinof cerebellomedullarv
Posteriorsoinalvein
4th ventricle

Partsof cerebellum

Lingula
TU Tuber
cL CentrallobuleP Pvramid
c Culmen
U Uvula
D Declive
N Nodule
F Folium
T Tonsil

Gerebral Vasculature

Deep Veins of Brain


veins
of brainseePlate 102
Forsuperficial

L o n g i t u d i n acl e r e b r a fl i s s u r e
A n t e r i o rc e r e b r a vl e i n s
R o s t r u mo f c o r p u sc a l l o s u m
S e p t u mp e l l u c i d u m
A n t e r i o rv e i n o f s e p t u mp e l l u c i d u m
H e a d o f c a u d a t en u c l e u s
A n t e r i o rv e i n o f c a u d a t en u c l e u s
T r a n s v e r svee i n so f c a u d a t en u c l e u s
I n t e r v e n t r i c u l af or r a m e n( o f M o n r o )
C o l u m n so f f o r n i x
S u p e r i o rt h a l a m o s t r i a tvee t n
S u p e r i o rc h o r o i dv e i n a n d
c h o r o i d p l e x u so f l a t e r a vl e n t r i c l e
lnalamus

T e l ac h o r o i d e ao f 3 r d v e n t r i c l e
L a t e r a dl i r e c tv e i n
P o s t e r i ovr e i n o f c a u d a t en u c l e u s
l n t e r n a lc e r e b r a vl e i n s
B a s a vl e i n ( o f R o s e n t h a l )
C r e a t c e r e b r a vl e i n ( o f C a l e n )
I n f e r i o rs a g i t t asl i n u s
S t r a i g h st i n u s
T e n t o r i u mc e r e b e l l i
T r a n s v e r ssei n u s
C o n f l u e n c eo f s i n u s e s
S u p e r i o rs a g i t t asl i n u s

4ttr
Dissection:
superiorview
U n c a lv e i n
A n t e r i o rc e r e b r a lv e i n
S u p e r f i c i am
l i d d l ec e r e b r a lv e i n
( d r a i n i n gt o s p h e n o p a r i e t asli n u s

Optic chiasm

D e e p m i d d l e c e r e b r a vl e r n

C e r e b r aclr u s
B a s a vl e i n ( o f R o s e n t h a l )
L a t e r a gl e n i c u l a t eb
M e d i a l g e n i c u l a t eb o d y

Inferior
cerebral
VEI NS

P u l v i n aor f t h a l a m u s
S p l e n i u mo f c o r p u sc a l l o s u m
C r e a t c e r e b r a lv e i n ( o f C a l e n )

Inferio r
anastomotrc
vein (of Labb6)

Dissection:
inferiorview

Gerebral Vasculature

Plate 145

Subependymal Veins of Brain

P o s t e r i ovre i n so f s e p t u mp e l l u c i d u m
S u p e r i otrh a l a m i vc e i n
S u p e r i ocrh o r o i dv e i n

Lateraldirect vein
Posteriorterminalvein of caudate nucleus
(posteriorpart of thalamostriatevein)

Internalcerebralveins(rightand left)

Transverse
veinsof caudatenucleus

Medial(atrial)veinof lateralventricle

Superiorthalamostriatevein

Lateral(atrial)vein of lateralventricle

Lateralventricle

Splenium
o f c o r p u sc a l l o s u m

Anterior vein of
caudate nucleus

Creatcerebralvein

Anterior vein of

s e p t u mp e l l u c i d u m

sal vein of corous

callosum

C e n uo f
corpus
callosum

nferior sagittal

srnus
lnternal
occipital vein
Straightsinus

Occipital
(posterior)
hornof
lateral
ventricle

Interventricular
foramen (of Monro)
Anterior commissure
Interthalamica
Anterior cerebralvein
Optic chiasm

Cerebellum

3rd ventricle
Deep middle cerebralvein

Inferiorthalamostriate
Basalvein (of Rosenthal)
Temporal(inferior)hornof lateralventricl6
Posteriormesencephalicvein

) u o e f l o r v e r m t a nv e t n

H i p p o c a m p a la n d i n f e r i o rv e n t r i c u l a vr e i n 6

Cerebralaqueduct

4{tr
Plate 146

4th
Lateraland medianapertures
of 4th

Veinson lateralwall of ventricle


Veinson medialwall and floor of ventricle
All otherveins

Gerebral Vasculature

Hypothalamus and Hypophysis

Septumpellucidum
Thalamus
Fornix
Hypothalamic
sulcus
Anteriorcommissure

Paraventricular
Posterior

Principal
nucleIof
hypothalamus

Dorsomedial
Supraoptic
Ventromedial
Arcuate
(infundibular)
Mammillarybody
tract
Mammillothalamic
Optic chiasm
(pituitarystalk)
Infundibulum

4{tr

Dorsallongitudinal
fasciculus
andother
descendingpathways/ I

(pituitary
Hypophysis

Hypothalamic

sulcus
Paraventricular
hypothalamic
nucleus
hypothalamic
Supraoptic
Supraopticohypophyseal
tract
Tuberohypophyseal
tract

Mammillary
body

Hypothalamohypophyseal
tract
(pituitarystalk)
Infundibulum

Parstuberalis

Adenohypophysis
(anteriorlobe of
pituitarygland)

Fibroustr
Parsintermedia

Parsdistalis

Gerebral Vasculature

nucleus
Arcuate(infundibular)

Medianeminence
of tubercinereum
lnfundibular
stem

Neurohypophysis
(posteriorlobe
of pituitarygland)

Plale 147

Arteries and Veins of Hypothalamus and Hypophysis

portalsystem
Superior
hypophyseal
artery

hypophysealportalveins

Arteryof trabecula
portalveins
hypophyseal
(fibroustissue)
Trabecula
Efferent
hypophyseal
vein
to cavernous
sinus

Secondary
plexus
of hypophyseal
portalsysteml

Efferent
hypophyseal
vein
to cavernous
sinus

Neurohypophysis
(posterior
lobeof
pituitarygland)

Capillaryplexusof
process
infundibular

Efferent
hypophyseal
vein
to cavernous
sinus

Efferenthypophyseal

Inferiorhypophyseal
artery

vernsto cavernous

4{r
Plate 148

Gerebral Vasculature

Head Scans: Sagittal MR lmages

Median(A) and paramedian(8, C) sagittalMR images

c
cc

Corpus
callosum

N P Nasopharynx

Extraocular
muscles

Frontalpole

FV

Fourth
ventricle

PG Pituitarygland

Lateral
ventricle
Medulla
oblongata

Regional Scans

Inferiornasal
concha

Cerebellum

Occipitalpole

O N Opticnerve

Pons
sinus
Sphenoid

SC Spinalcord
T

Thalamus

M B Midbrain

TC Tentorium
cerebelli

sinus
M S Maxillary

TO Tongue

Plate 149

Head Scans: Axial GT lmages

Axial CT imagesof the head from inferior (A) to superior(C)

Basilarartery

Cerebellum

M A M a s t o i da i rc e l l s

CH Cerebral
hemisphere

MB Midbrain
muscle
MM Masseter

cs

C o n f l u e n c eo f
stnuses

MR Medialrectus
muscle

Eye

MS Maxillarysinus

EA Externalacoustic
meatus

E S E t h m o i ds i n u s
F

Fat in orbit

FV Fourthventricle
t

Lens

TP Lateralpterygoid

t-R

Plate 15O

Medullaoblongata

Nasalconcha

NS Nasalseptum
P

Pons

S p h e n o isdi n u s

SC Semicircular
canats

muscte

SS Superiorsagittal
srnus

Lateral rectus
muscle

Temporalis
muscle

Tt

Temporallobe

Regional Scans

Head Scans: Goronal GT Images

CoronalCT imagesof the headfrom anterior (A) to posterior(C)

c
E

A n t e r i ocr l i n o i d
process

Lateralrectus
muscle

C r i s t ag a l l i
Eye(vitreous
chamber)

Levatorpalpebrae
and
superioris
superiorrectus
musctes

sinus
ES E t h m o i d
G

rc
IR

Regional Scans

Createrwing of
the sphenoid
lnferiornasal
concha
lncisivecanal
lnferiorrectus
muscle

Maxillarysinus

M R Medialrectus

muscle
N

Nasalseptum

oc

Oral cavity

S p h e n o isdi n u s

Zygomaticarch

Plate 151

2 Back and Spinal Gord


Section
Topographic Anatomy
Plate 152

rs2 Back

Bones and Ligaments


Plates 153-159

Column
rss Vertebral
Vertebrae
r se Thoracic
Vertebrae
rss Lumbar
RadiograPhs
Vertebrae:
r se Lumbar
andCoccyx
rsz Sacrum
Lumbar
Region
Ligaments:
rss Vertebral
Region
Lumbosacral
Ligaments:
rss Vertebral

Spinal Gord
Plates l6(F173
160
161

inSitu
Rami
andVentral
Cord
Soinal
Nerve
toVertebrae
Roots
ofSpinal
Relation

163

Manifestations
DiscHerniation:
Clinical
Lumbar
Anesthesia
andEpidural
Puncture
Lumbar

t64

Dermatomes

165

Topography
General
Nervous
System:
Sympathetic
pathetrc
Topography
: General
Nervous
System
Parasym

162

166
167
t68

Schema
Nervous
System:
Sympathetic
Schema
Nervous
System:
Parasympathetic

17l,

Roots
andNerve
Membranes
Spinal
Cross
Origin:
Sections
Nerve
Spinal

171

Cord:
Schema
ofSpinal
Arteries

169

Atlas of Human Anatomy

Back and Spinal Gord


rzz Arteries
ofSpinal
Cord:
Intrinsic
Distribution
rzs Veins
ofSpinal
Cord
andVertebral
Column

Muscles and Nerves


Plates 174-l80

rze Muscles
ofBack:
Superficial
Layers
rzs Muscles
ofBack:
Intermediate
Layers
tze Muscles
ofBackDeep
Layers
rzz Nerves
ofBack
rze Suboccipital
Triangle
'rzs Lumbar
Region
ofBack:
Cross
Section
reo TypicalThoracic
Spinal
Nerve

Atlas of Human Anatomy

Back

occipitalprotuberance
External

muscle
Trapezius

L i g a m e n t u mn u c h a e

S p i n eo f s c a p u l a

Spinousprocessof
C7 vertebra

Deltoid muscle
Infraspinatus

muscle
Tricepsbrachii
muscle
Long head
Lateralhead
Tendon

D e l t o i dm u s c l e

S p i n eo f s c a p u l a
Triangleof auscultation
Medialborderof
scapula
lnferiorangleof
scapula
major muscle

Latissimus
L u m b a r( t r i a n g l e d o r s i m u s c l e
of Petit)

Spinousprocessof
T 1 2v e r t e b r a

C l u t e u sm e d i u s
muscle

lliac crest
Erectorspinae
muscle

Posteriorsuperior
iliacspine

Intergluteal(natal)

Sacrum

C l u t e u sm a x i m u s
muscle
Greatertrochanter
of femur

cleft
Clutealfold

e/fd4g/^

Topographic Anatomy

Plate 152

Vertebral Golumn

Anteriorview

left lateralview

Posteriorview
A t l a s( C l )
A x i s( C 2 )
Cervical
curvature

C7

C7
C7
T1

T1

Thoracic
vertebrae

Thoracic
curvature

Lumbar
vertebrae

Lumbar
curvature

(S1-5)
Sacrum
S a c r u m( S 1 - 5 )

*{w
Plate | 53

Bones and Ligaments

Thoracic Vertebrae

articular
processand facet

Superior
costalfacet

Vertebralforamen

Pedicle

Body
Transverse
costalfacet

Superior

Superior
costalfacet

vertebral notch
(forms lower
margin of
intervertebral
foramen)

Transverse
process

Pedicle

lnferior
articular
process

Superior
articularfacet

T6 vertebra:
lateralview
T6 vertebra:
superiorview
Superiorarticular
processand facet
Superiorarticular
processandfacet
7th rib

Costal facet

S p i n o ups r o c e sos f
T7 vertebra

T12vertebra:
lateralview

processof
Transverse
T9 vertebra
Inferiorarticularprocess(T9)

4{tr

Spinousprocess(T9)

T7,Tgand T9 vertebrae:
posteriorview

Bones and Ligaments

Plate 154

Lumbar Vertebrae

A n u l u sf i b r o s u s

Vertebralbody

Nucleus
purposus

Vertebral foramen

process
Transverse

lntervertebraldisc

Superiorarticularprocess

Accessorvorocess

M a m m i l l a r yp r o c e s s
Lamind

Spinousprocess
Mammillary process

[2 vertebra:
superiorview

Transverseprocess

Spinousprocess
Vertebralbody

Vertebralcanal
Superior

Intervertebral
disc

articularprocess
M a m m i l l a r yp r o c e s s
Transverse
process

Vertebralbody

Inferior
articular
process
Inferior
vertebralnotch

Intervertebral
(neural)foramen
Superior
vertebral
notch

Parsinterarticularis
Accessory

process
S p i n o ups r o c e s s
of L3 vertebra

facet
for sacrum

Inferior
articularprocess

[3 and L4 vertebrae:
posterior view

Plate 155

l-umbarvertebrae,assembled:
left lateralview

Bones and Ligaments

Lumbar Vertebrae: RadiograPhs


Lateralradiograph

Anteroposteriorradiograph

B
IA
t
P

Body of L3 vertebra

Intervertebraldisc space

Inferiorarticularprocessof L1 vertebra
L a m i n ao f L 4 v e r t e b r a

I
lA

lntervertebralforamen
Inferiorarticularprocessof L3 vertebra

Pedicleof L3 vertebra

lN

lnferior vertebralnotch of L2 vertebra

S p i n o u sp r o c e s so f L 4 v e r t e b r a

Pedicleof L3 vertebra

SA Superiorarticularprocessof L1 vertebra
S F Sacralforamen
T
Transverseprocessof L3 vertebra

Bones and Ligaments

Spinousprocessof L3 vertebra
SA Superiorarticularprocessof L4 vertebra
SN Superiorvertebralnotch of L3 vertebra
Note: The vertebralbodies are numbered

Plate 156

Sacrum and Goccyx


SeealsoPlates 153, 159, 248,352-gS4
Superior
articular
process

Baseof sacrum
Lumbosacral
articularsurface

Superior
articularprocess
Ala (wing)

Promontory

r a lp a r t
o f p e l v i cb r i m
( l i n e at e r m i n a l i s )

Sacralhiatus
Transverse
ridges

Mediansagittalsection

Apexof sacrum
Transverseprocess
of coccyx
Facetsof
superiorarticular

Anteriorinferior
view

Pelvic surface

A u r i c u l asru r f a c e

Nr

Sacraltuberosity
Lateralsacralcrest
M e d i a n s a c r a lc r e s t
Intermediatesacralcresl
Posterior
sacralforamen

Posterior
sacral
foramina
Sacralcornu
(horn)
Coccygealcornu
(horn)

Anterior (pelvic)
sacralforamen

Coronalsection
through52 foramina

Transverseprocess
of coccyx

Posteriorsuperiorview

Plate 157

Bones and Ligaments

Vertebral Ligaments: Lumbar Region

left lateralview
(partially sectioned
in median plane)

Inferiorarticularprocess
joint
Capsuleof zygapophyseal
(partiallyopened)
S u p e r i oar r t i c u l aprr o c e s s
process
Transverse

Lumbarvertebral

S p i n o ups r o c e s s
L i g a m e n t ufm
lavum

lntervertebraldisc

I n t e r s p i n o ul i sg a m e n t
,i

i\srprarpinous

Anterior
l o n g i t u d i n lai g
l ament

ligament

l
tl

Intervertebralforamen

Posterior
l o n g i t u d i n lai g
l ament

Posteriorvertebralsegments:
anteriorview
Anteriorvertebralsegments:
posteriorview

Pedicle(cut surface)

(pedicles sectioned)

Pedicle (cut surface)

Ligamentumflavum

S u p e r i o ra r t i c u l a r

process
Intervertebraldisc

process
Transverse

l n f e r i o ra r t i c u l a r

Bones and Ligaments

Plate 158

Vertebral Ligaments: Lumbosacral Region

Superiorarticularprocess

Anterior
longitudinal
ligament

I ransverseprocess

Lamina
Pedicle(cut)

Inferiorarticularprocess

Bodyof
L1 vertebra

longitudinal
ligament

Pedicle

lntervertebral
foramen

Intervertebral
discs

Spinousprocess
lnterspinous
ligament
Supraspinous
ligament

Superiorarticularprocesses;
facettropism(difference
in
facetaxis)on rightside
Spinousprocess

process
Transverse
Bodyof
L5 vertebra

Inferiorarticularprocess
Ligamentum
flavum

L5 spinalnerve

lliolumbar
lliaccrest

Auricularsurfaceof sacrum
(forarticulation
with ilium)

Posterior
supeflor
i l i a cs p i n e

Posterior
inferior
i l i a cs p i n e

left lateralview

Posteriorsacroiliacligamenl

Creatersciaticforamen
S p i n eo f i s c h i u m

4{tr

Lateral,

Sacrospinous
sacrococcySeal
ligaments

Lesser
sciaticforamen
Sacrotuberous
ligament

Posteriorview

Plate | 59

Bones and Ligaments

Spinal Gord and Ventral Rami in Situ

B a s eo f s k u l l
C 1 s p i n anl e r v e
C2 vertebra (axis)
C B s p i n a ln e r v e
T.l spinalnerve

C 1 v e r t e b r a( a t l a s )

C e r v i c apl l e x u s
C7vertebra
T1 vertebra
B r a c h i apll e x u s

.l
st rib

ldura mater

F i l a m e n t so f
s p i n a ln e r v e
roots (T7 and TB)

T't2
vertebra

L1
vertebra
1 2 t hr i b

L 1 s p i n a ln e r v e
C o n u sm e d u l

llioinguinal
nerve

L u m b apr l e x u s
C a u d ae q u i n a

L5 vertebra

L5 spinal nerve
Femoralnerve
S 1 s p i n a ln e r v e
Sacralplexus
S a c r u m( c u t a w
F i l u mt e r m i n a l ei n t e r n u m
Terminationof dural sac
F i l u mt e r m i n a l ee x t e r n u m
t c o c c y g e al i g a m e n t )

S u p e r i o ra n d i n f e r i o r
g l u t e a ln e r v e s
Sciaticnerve
Posteriorfemoral
cutaneousnerve

5 5 s p i n a ln e r v e
' P u d e n d a ln e r v e
Coccygealnerve

f,

Coccyx

Spinal Gord

nrlS
4.12

Plate 16O

Relation of Spinal Nerve Roots to Vertebrae

-.
' l s p i n a ln e r v e e x i t s
'' I1Cabove
C.l vertebra

'-C1

Uur" /

c2'
C3
C3 ' c 4

of skull
Cervical
enlargemenl

---C4
C5

C5

t)

C7
T1
T1

T2

C B s p i n a ln e r v e
exits below
C7 vertebra
(there are B cervical
nervesbut only
7 cervicalvertebrae)

r2

T?

T3

r4

TA

T5

T5

r6

r7

Lumbar disc protrusiondoes not usuallyaffect


nerve exiting above disc. Lateralprotrusion
at disc level L4-5 affectsL5 spinalnerve, not
L4 soinalnerve. Protrusionat disc level L5-S1
affectsS.l spinalnerve, not L5 spinal nerve.

T7

.-TB
-T9
--T1O

'r
Lumbar
e n la rge me n t -----_____a

T10

-zT1l
'

T11

-2r'T12 T 1 2

/Lr

L1

C o n u sm e d u l l a r i s
( t e r m i n a t i o no f
s p i n a lc o r d )

,L2
L5 --'L3
C a u d ae q u i n a

-L4

Filum
terminale
Internum

-L5
-Sacrum
S1

Filum
terminale
externum
(coccygeal
ligament)

S3
S4
S5

Terminationof
d u r a ls a c

Nr
Coccygealnerve

I
I
I
I

Plate | 61

Cervicalnerves
Thoracicnerves
Lumbarnerves
Sacraland coccygealnerves

Medial protrusionat disc level L4-5 rarelyaffects


L4 spinal nerve but may affect L5 spinalnerve
a n d s o m e t i m e sS 1 - 4 s o i n a ln e r v e s .

Spinal Gord

Lumbar Disc Herniation: Glinical Manifestations

Schematiccrosssection
s h o w i n gc o m p r e s s i o no f
nerve rool

,/."
{''"'z;""
'//;.d,

.,,.| \
t

4{tr

Nucleus
purposus
Characteristic
posture in left-sided
l o w e r l u m b a rd i s c
herniation

Nerverool

exposureof
Surgical
r isc
l o w e rl u m b a d
herniation

C l i n i c a fl e a t u r e so f h e r n i a t e dl u m b a r n u c l e u sp u l p o s u s
Level of herniation

Pain

Numbness

Weakness

Atrophy

Reflexes

Minor

Changes
uncommon
i n k n e ea n d
a n k l ej e r k s ,
but internal
hamstring
reflex
diminished
or absent

L3
L4
Over
sacro\Ls
iliac
joint,
hip,
SL5
lateral
\
L4-5 disc; t h i g h
5th lumbar and leg
nerve root

[5-Sl disc;
1st sacral
nerve toot

Spinal Gord

Over
sacroiliac
joint,
hip,
posrerolateral
thigh
and leg
to heel

Dorsiflexion
of great toe
and foot;
difficulty
w a l k i n go n
heels;foot
Lateralleg, o r o p m a y
first 3 toes occur

Plantar
f l e x i o no f
foot and
great toe
may be
affected;
difficulty
Back of
w a l k i n go n
calf, lateral toes
heel,foot
to toe

A n k l ej e r k
diminished
or absent
Castrocnemiusand soleus

Plate 162

Lumbar Puncture and Epidural Anesthesia

Lumbarpuncture
C a u d ae q u i n a

Subarachnoid
space
Needleentering
subarachnoidspace
lliac
crest

Arrows show locationsof


insertionof needles.

Epiduralanesthesia

Dural sac
Epiduralspace
Spinousprocessof L4
Ligamentumflavum

Epiduralanesthesia
and lumbarpunctureare performedby insertinga needleabove or below the L4 vertebralspine,
which liesat the levelof the iliaccrest.Forepiduralanesthesia,
the needlepassesinto the epiduralspace,and anesthetic
agentbathesthe nerve rootsin proximity.Lumbarpuncture,on the other hand,is performedin order to collecta sample
of cerebrospinal
fluid (CSF)or to introducean anestheticagentinto the CSF(spinalanesthesia),
so thereforethe needie
penetratesthe duralsac to enter the subarachnoidspace.

Cryd4/^

Plate 163

Spinal Gord

Dermatones

Schematicdemarcationof dermatomes
(accordingto Keeganand Carrett)
Thereis
shownas distinctsegments.
actuallyconsiderableoverlapbetween
any two adjacentdermatomes.An
alternativedermatomemap is that
providedby Foerster(seeReferences).

S3
S4

ss
15,
Ll,
L2

S1

4{F

L5
L4

Levels of principal dermatomes


C5
C5,5,7
C8,Tl
C6
C6,7,8
C8
T4

Spinal Gord

Clavicles
Lateralpartsof upperlimbs
Medialsidesof upperlimbs
Thumb
Hand
Ringand littlefingers
Levelof nipples

T10
t1
Ll,2,3,4
L4,5, 51
L4
sl, 2, L5
s1
s2,3,4

Levelof umbilicus
Inguinalor groin regions
Anteriorand innersurfacesof lower limbs
Foot
Medialsideof greattoe
Posteriorand outer surfacesof lower limbs
Lateralmarginof foot and little toe
Perineum

Plate 164

Sympathetic Nervous System: General Topography

I n t e r n a cl a r o t i dp l e x u s
I n t e r n a cl a r o t i dn e r v e
S u p e r i o rc e r v i c a lg a ng l i o n

Cray ramicommunicantes

Externalcarotid nerve

C e r v i c a ls y m p a t h e t i ct r u n k
M i d d l e c e r v i c a lg a n g l i o n

C e r v i c a lc a r d i a cn e r v e s

C e r v i c o t h o r a c i (cs t e l l a t eg) a n g l i o n
Thoracic visceralnerves
P u l m o n a r yp l e x u s

C a r d i a cp l e x u s

W h i t e a n d g r a yr a m i c o m m u n i c a n t e s

E s o p h a g epalle x u s
C r e a t e rt h o r a c i cs p l a n c h n i cn e r v e

L e s s e rt h o r a c i cs p l a n c h n i cn e r v e

Aorticorenalganglion
L u m b a rs p l a n c h n i cn e r v e s

Celiacplexus
C e l i a cg a n g l i o n

S u p e r i o rm e s e n t e r i cg a n g l i o n
S u p e r i o rm e s e n t e r i cp l e x u s

In f e r i o rm e s e n t e r i cg a n g l i o n
In f e r i o rm e s e n t e r i cp l e x u s
S u p e r i o rh y p o g a s t r i cp l e x u s

Hypogastricnerve
S a c r a sl p l a n c h n i cn e r v e s

Inferiorhypogastricplexus

C/Fd4ae

Plate 165

Spinal Gord

Parasympathetic Nervous System: General Topography

O c u l o m o t o r n e r v e( C N l l l )
F a c i a nl e r v e ( C N V l l )

C l o s s o p h a r y n g e anle r v e ( C N l X )
Vagus nerve (CN X)

L a c r i m agl l a n d
C i l i a r yg a n g l i o n

P t e r y g o p a l a t ignaen g l i o n
Parotidgland
S u b m a n d i b u lgaar n g l i o n
S u b l i n g ua n
l ds u b m a n d i b u lgalra n d s
Cervical
cardiacbranch

C a r d i a cp l e x u s
P u l m o n a r yp l e x u s

Esophagealplexus

Anterior and posteriorvagal


tru nks

C e l i a cp l e x u s

plexus
mesenteric
Superior

P e l v i cs p l a n c h n i cn e r v e s( f r o m 5 2 - 4 )

Inferior hypogastricplexus

Cavernousnerves

Cryd4s4*

Spinal Gord

Plate 166

Sympathetic Nervous System: Schema

Superiorcervicalganglion

Internalcarotid nerve and olexus


Externalcarotid nerve and olexus

$flacrimalgland
C r a y r a m ic o m m u n i c a n t e s
Firstthoracicgan

.\

lnnervationto arrectorpili muscles,..,'


vascularsmooth muscle,and sweat i'}
g l a n d so f s k i n

diac branches
Createrthoracic
s p l a n c h n i cn e r v e
Celiacganglion
tl:

Lesserthoracic
splanchnicnerve

1 . t . . . - - 1 . . -

\.-.-'r'

Aorticorenal
ganglion

Liver

Whiteramus
communtcans

Callbladder
Bileducts
Pancreas

Cray ramus
communtcans

Leastthoracic
splanchnicnerve
Kidneys

mesenteflc
ganglion

Intestines
F i r s tl u m b a r

Lumbar
splanchnic
nerves

Descending lnferior
mesenteric
colon

ganglion

Firstsacralganglion

Sigmoidcolon

Urinary
bladder

lnferior
hypogastric
plexus

Prostate
Preganglionicfibers
Postganglionic fibers

Plate | 67

Externalgenitalia

CryW
Spinal Gord

Parasympathetic Nervous System: Schema

ganglion
Pterygopalatine

C i l i a r yg a n g l i o n
B r a n c ho f o c u l o m o t o rn e r v e( l l l )
Branchof facialnerve (Vll)
Medulla oblongata
Branchof glossopharyngeal
n e r v e( l X )
Otic ganglion
S u b m a n d i b u l agra n g l i o n

fr
/t,

(f

plexus
Pulmonary

Liver

Callbladder

n
g

K' ."

B i l ed u c t s
Pancreas

lntestines
Descendingcolon
Inferiorhypogastric

prexus

s2

Sigmoidcolon
Rectum

53j

Urinarb
y ladder

S4

P e l v i cs p l a n c h n i cn e r v e s
Preganglionic fibers
Postganglionic fibers

Spinal Gord

Externalgenitalia

Prostate
6ry4c/*

Plate 168

Spinal Membranes and Nerve Roots

Posteriorview

V e n t r a lr o o t o f s p i n a ln e r v e
Dorsal root of soinalnerve
) anglion
D o r s a lr o o t ( s p i n a l g
W h i t e a n d g r a yr a m i c o m m u n i c a n t e s
to and from sympathetictrunk
V e n t r a lr a m u so f s o i n a ln e r
Dorsal ramus of soinalnerve

D u r am a t e r

M e s o t h e l i sa el o t u mi n d o r s am
l e d i a ns u l c u s

P i a m a t e ro v e r l y i n gs p i n a lc o r d
Filamentsof dorsal root
D e n t i c u l a t el i g a m e n t

Dorsalhorn
Membranes removed: anterior view

(greatly magnified)
Lateral
horn
Craymatter
White matter

Ventralhorn

F i l a m e no
t sf d o r s arl o o t
Dorsal root of spinalnerve
Filamentsof ventral root
Dorsal root (spinal)ganglion
Dorsal ramus of spinal nerve
Ventral ramus of spinalnerve
Ventral root of soinal nerve

Cray and white


rami communicantes

Plate | 69

4{tr

Spinal Gord

Spinal Nerve Origin: Gross Sections


SeealsoPfates 169, 172,173
Sectionthroughthoracicvertebra
Body of vertebra
Dura mater

F a ti n e p i d u r a ls p a c e

Arachnoid mater*

Sympatheticganglion
D e n t i c u l a t el i g a m e n t
Ventral root

S u b a r a c h n osi d
pace
Pia mater*

White and gray rami


communrcantes

Recurrent
meningeal
b r a n c h e so f s p i n a l
nerve

S p i n a ln e r v e
Ventral ramus
(intercostalnerve)

Pleura
LUnS

Dorsalramus

Dorsalroot
(spinag
l )a n g l i o n
Dorsal root
Lateralhorn of
g r a y m a t t e ro f s p i n a lc o r d

of dorsal
ramus
of spinal
nerve

M e d i a lb r a n c h

Sectionthrough lumbarvertebra

Lateralbranch

lnternalvertebral
(epidural)venous plexus(of Batson)

Dura mater
Arachnoid mater
Ventral root
S p i n a ln e r v e

to lumbarplexus)
Ventralramus(contributes
D o r s arl a m u s

Dorsal and ventral


r o o t s o f l u m b a ra n d
s a c r a ls p i n a ln e r v e s
f o r m r n gc a u o ae q u r n a

Spinal Gord

Dorsalroot
Dorsal root

Nr

ganglion
*Leptomeninges

C o n u sm e d u l l a r i s

Plate | 7O

Arteries of Spinal Gord: Schema


SeealsoPlate 138
Posterior view
Posteriorinferior cerebellarartery

Posterior
cerebralar
Superiorcerebellarartery

Posteriorsoinalarteries
Basilarartery
Anterior inferior
cerebellarartery (Al

Vertebralartery

Posteriorinferior
c e r e b e l l aa
r r t e r y( P I C A )

Posteriorsegmental
m e d u l l a r ya r t e r i e s

_o

A n t e r i o rs p i n a l

Deep cervicalartery

ao

Vertebral
artery
A n t e r i o rs e g m e n t a l
medullary arteries

Ascendingcervicalartery

A s c e n d i n gc e r v i c a l

arrery
Subclavianartery

Deep cervicala
S u b c l a v i a na r t e r

(t:,

t,.l

Anterior segmental

m e d u l l a ray r t e r y

/;:,

Posteriorsegmental
medullary arteries

,:.i\

ifi

Posteriorintercostalartery
i)

Pialplexus

Thoracic
vertebrae

Liki
\UI
/n

Posterior
intercostalarteries

ifj
,t

Major anterior segmental


m e d u l l a r ya r t e r y( g r e a t
r a d i c u l a ra r t e r yo t
Adamkiewicz)

'9,

4{tr

Posteriorintercostalarter
l"-l

, T i I'

A n t e r i o rs e g m e n t a l
m e d u l l a r ya r t e r y

Posteriorsegmental
medullary arteries
omotic loops to

anteriorspinalartery
Lumbar artery
Lumbar arteries

Lumbar
vertebrae
Anastomoticloops to
posterior spinalarteri

fi,

Lateral(or medial)
sacralarteries

C a u d ae q u i n aa r t e r
Lateral(or medial)
sacralarteries

'u

(s
rb

Plate 171

Sacrum

N o t e : A l l s p i n a ln e r v e r o o t s h a v e
associated radicular or segmental
medullary arleries Most roots have
radicular arteries (see Plate 172) Both
types of arteries run along roots, but
r a d i c u l a ra r t e r i e se n d b e f o r e r e a c h i n g
a n t e r i o ro r p o s t e r i o rs p i n a la r t e r i e s ;
l a r g e rs e g m e n t a lm e d u l l a r ya r t e r i e s
c o n t i n u e o n t o s u p p l y a s e g m e n to f
t h e s ea r t e r i e s

Spinal Gord

Arteries of Spinal Gord: Intrinsic Distribution


Posteriorspinalarteries

Anteriorspinalartery
Anterior segmental
medullary artery

artery
Anteriorradicular
radicular
artery
Branchto vertebralbody
and dura mater

nalbranch
Dorsalbranchof posterior
intercostal
artery
intercostal
artery
Posterior
Paravertebral
anastomoses
Prevertebralanastomoses
Thoracic (descending)aorta

*{r
Sectionthroughthoraciclevel:
anterosuperiorview

Sulcal(central)branchesto

rightsideof spinalcord
Posterior
radicular
artery
Anterior segmental

Rightposteriorspinalartery
from pialplexus
Peripheral
branches
to leftside
Sulcal(central)branches
of spinalcord
Leftposteriorspinalartery

medullaryartery
Pial arterialolexus
Anterior and posterior

radicular
arteries
A n t e r i o rs p i n a l

artery
Posterior
radicular

Arterialdistribution:schema

Note: All spinal nerve roots have associated radicular or


segmental medullary arteries Most roots have radicular arteries.
B o t h t y p e s o f a r t e r i e sr u n a l o n g r o o t s , b u t r a d i c u l a ra r t e r i e se n d
before reaching anterior or posterior spinal arteries;larger segmental
medullary arteries continue on to supply a segment of these arteries

Spinal Gord

Anterior segmental
m e d u l l a r ya r t e r y

Pialarterialplexus

Plate 172

Veins of Spinal Gord and Vertebral Golumn

I n t e r n a vl e r t e b r a (l e p i d u r a lv) e n o u sp l e x u s
External
vertebralvenous

plexus
l n t e r v e r t e b r avle i n

I n t e r n a vl e r t e b r a l
( e p i d u r a l v) e n o u s
p l e x u s( B a t s o n ' s
veins)

Externalvertebralvenous olexus

B a s i v e r t e b r av le i n

t e r n a lv e r t e b r a vl e n o u sp l e x u s
Basivertebralvein
I n t e r n a vl e r t e b r a l
( e p i d u r a l v) e n o u sp l e x u s
S e g m e n t am
l edullary/
r a d i c u l a rv e i n s

A n t e r i o rs p i n a lv e i n
A n t e r i o rs u l c a l
( c e n t r a l v) e i n

B a s i v e r t e b r av le i n

Intervertebral
vetn

n t e r n a lv e r t e b r a l

( e p i d u r avl )e n o u sp l e x u s

Internalvertebral
( e p i d u r a l v) e n o u sp l e x u s
Externalvertebral
v e n o u sp r e x u s

l n t e r v e r t e b r avl e i n
A n t e r i o rs e g m e n t am
l e d u l l a r y / r a d i c u l av re i n
P o s t e r i o sr e g m e n t am
l e d u l l a r y / r a d i c u l av re i n
P i a lv e n o u sp l e x u s
P o s t e r i osr u l c a l( c e n t r a l v) e i n
P o s t e r i o sr p i n a lv e i n
I n t e r n a vl e r t e b r a (l e p i d u r a l v) e n o u sp l e x u s

Plate 173

*{ry
Spinal Gord

Muscles of Back Superficial Layers

S u p e r i onr u c h alli n eo f
Spinousprocessof C2 ver
Sternocleidomastoidmuscl

Posterior
trianeleof neck
Trapeziusmuscle
S p i n eo f

S e m i s p i n a l icsa p i t i sm u s c l e
l e n i u sc a o i t i sm u s c l e
Spinousprocessof C7 vertebra
Spleniuscervicismuscle
L e v a t o rs c a p u l a em u s c l e
R h o m b o i dm i n o r m u s c l e( c u t )

D e l t o i dm u s c

Supraspinatus
muscle

natus
Infraspi
fascia

tus
posterior

s u p e r i om
r uscle

major muscle
(cut)

Teresmajor
muscte

Infraspinatus
fascia(over
infraspinatus
muscle)

Latissimus
dorsimuscle

Teresminor
and major
musctes

Spinousprocess
of T12 vertebra

dorsimuscle(cut)
Latissimus

fascia
Thoracolumbar
Serratusanterior muscle
External
o b l i q u em u s c l e

I n t e r n aol b l i q u e
m u s c l ei n l u m b a tr r i a n g l e
(of Petit)

Serratusposteriorinferior

muscre
1 2 t hr i b
rector spinaemuscle

lliac crest

Cluteal aponeurosis
( o v e r g l u t e u sm e d i u sm u s c l e

Muscles and Nerves

External
o b l i q u em u s c l e
nternal
o b l i q u em u s c l e

4{tr

Plale 174

Muscles of Back: Intermediate Layers

S u p e r i onr u c h alli n eo f s k u l l
Posterior
tubercleof atlas(C.l
L o n g i s s i m ucsa p i t i s

Rectuscapitisposteriorminormuscle
Obliquuscapitissuperiormuscle
Rectuscapitisposteriormajormuscle
r uscle
O b l i q u u sc a p i t i si n f e r i om

S e m i s p i n a l icsa p i t i s

L o n g i s s i m cuas p i t i sm u s c l e
S p l e n i ucsa p i t i sa n d
s p l e n i u sc e r v i c i s

posteriorsuperior
Serratus

S e m i s p i n acl iasp i t i sm u s c l e( c u t )
Spinalis
cervicismuscle
Spinousprocessof C7 vertebra

l l i o c o s t a l im
s uscle
o n q t s s t m ucse r v t c t sm u s c t e
Erector
sprnae
muscle

lliocostaliscervicismuscle

Longissimm
u su s c l e
lliocostalis
thoracismuscle
S p i n a l im
s uscle

Hook
Spinalisthoracismuscle
L o n g i s s i m utsh o r a c i sm u s c l e
lliocostalislumborum muscre
SpinousprocessofT12 vertebra

Tendon of origin of
transversusabdominis muscle

Transversus
abdominis
muscle and tendon
of origin

Internao
l blique

muscle

Thoracolumbarfascia
(posteriorlayer)(cut)

E x t e r n aol b l i q u e
muscle (cut)

lliac crest

4ttr
Plate | 75

Muscles and Nerves

Muscles of Back: Deep Layers

S u p e r i onr u c h alli n eo f
Mastoid Drocess

Posterior
tubercleof atlas
(Cl vertebra)
Spinousprocessof axis
(C2vertebra
S e m i s p i n a l icsa p i t i s

Spinousprocess
of C7 vertebra

Rectuscapitisposteriorminormuscle
Obliquuscapitissuperiormuscle
Rectuscapitisposteriormajormuscle
processof atlas(C1)
Transverse
Obliquuscapitisinferiormuscle
Loneus
)
"
) Rotatores
cervicismuscles
Brevis )
Interspinaliscervicismuscle

Levatorcostaemuscle
External
intercostal
muscles

Semispinalis
thoracismuscles

Multifidusmuscles

Thoracolumbarfascia
(anteriorlayer)

Thoracolumbar
fascia
(posteriorlayer)(

Transversus
abdominismuscle

lumborummuscle
lntersoinalis

muscle
Intertransversarius

atuslumborummuscle

and tendon of origin

liaccrest
Multifidusmuscles
Erectorspinaemuscle(cut)

Multifidusmuscles(cut)

4{tr
Muscles and Nerves

PIate 176

Nerves of Back

Accessorynerve (Xl)

Trapeziusmuscle(refI ected)

o c c i p i t a ln e r v e ( d o r s a lr a m u so f
C 2 s p i n a ln e r v e )

3rd occipitalnerve(dorsalramusof

Levatorscapulae
muscle
Cervicalplexus
(ventralramiof
C2, 3 spinalnerves)

Transversecervical artery
and vein

plexus
Subtrapezial

Posterior
cutaneous
branches(frommedial
branches
of dorsalramiof C4-T6soinal
t C 7 , B a r em i n i m a l )

Deltoidmuscle
S up r a s p i n a t u s
muscle

Infrasoinatus
fascia

S p i n eo f

Teresminorand
majormuscles

scapula

Superiorlateralbrachial
cutaneous
nerve(from
axillarynerveC5, 6)

Infraspinatus
fascia

Posterior
cutaneous
branches(fromlateral
branches
of dorsalrami
o I f T - 1 2 s p i n anl e r v e s )

Rhomboid
m i n o rm u s c l e
Rhomboid
m a l o rm u s c l e

Lateralcutaneous
branches
of
ventralrami(intercostal
nerves)

L a t i s s i m ud so r s im u s c l e
E x t e r n aolb l i q u em u s c l e
Spinousprocessof
T12vertebra
Thoracolumbarfascia

lliaccrest
lliohypogastric
nerve
( v e n t r arla m u so f L l s p i n a l
nerve)
Superior
clunialnerves
( d o r s ar la m io f L l , 2 , 3 s p i n a l
nerves)

C l u t e u sm a x i m u s
muscle

4{tr
Plate 177

Medialclunialnerves
( d o r s ar la m io f 5 1 , 2 , 3s p i n a l
nerves)
lnferiorclunialnervesfrom
posteriorfemoralcutaneous
n e r v e( s a c r apl l e x u sS 1 ,2 , 3 )

Muscles and Nerves

Suboccipital TFiangle

Rectuscapitisposteriorminormuscle
Rectuscapitis posterior major muscle

E p i c r a n iaapl o n e u r o s i s
(galeaaponeurotica
Occipital belly (occipitalis)of
occioitofrontalis

a l i sc a p i t i sm u s c l e
(cutand reflected\
Vertebralartery
(atlanticpart)
Obliquuscapitis
suoeriormuscle

Greater occioital nerve


(dorsalramus of C2
s p i n a ln e r v e )

nerve
Suboccipital
(dorsalramusof C1
spinalnerve)

Occipitalartery

Posteriorarchof
atlas(C1vertebra)
Third occipital nerve
( d o r s a lr a m u so f C 3
spinal nerve)

italartery
O b l i q u u sc a p i t i s
inferiormuscle

S e m i s p i n a l icsa p i t i s
a n d s p l e n i u sc a p i t i s

musclesin posterior
triangleof neck

Creater occioital
nerve (dorsalramus

of C2 spinalnerve)
Posterior
auricularartery

C r e a ta u r i c u l anre r v e
(cervicalplexusC2,3

capitismuscle
Splenius
(cut and reflected)
occipital nerve

(dorsalramusof C3
spinalnerve)

Longissimus
capitismuscle
Lesseroccipital nerve
(cervicalplexusC2)

cervicismuscle
Splenius
cervicismuscle
Semispinalis

Sternocleidomastoidmuscle

Traoezius
muscle

Posterior
cutaneous
branches
of dorsalramiof C4, 5 , 6
spinalnerves

and Nerves

liscapitismuscle(cut)
capitismuscle(cut)
Splenius

4{tr
Plate | 78

Lumbar Region of Back: Gross Section

lnferiorvena cava
Descending(2nd) part of duodenum
Kidney
Renal(Cerota's)fascia
(anterior and posterior layers)

Pancreas
Anterior longitudinalligament

Perirenalfat
Cruraof diaphragm

Superior
mesenteric
artervandvein
Extraperitoneal
(subserous)
fascia
(areolar
tissue)

Mesentery
Abdominal aorta

Transversalis
fascia

Duodenojejunal
junction
Bodyof
L2 vertebra
Psoasmajor
muscte
and fascia
Lumbar
spinalnerve
Transverse
process

External
oblique
muscle

Spinal
duramater
Cauda
equina

Internal
o b l i q u em u s c l e

Transversus
abdominis
muscle

Tendonof originof
transversus
abdominis
and
internalobliquemuscles
posterior
Serratus
inferiormuscle
Latissimus
dorsi muscle

lumborummuscle
Quadratus

process
Spinous
of L1vertebra
ligament
Supraspinous
Erector
spinaemuscle
Thoracolumbarfascia(posteriorlayer)
Thoracolumbarfascia(middlelayer)
Thoracolumbarfascia(anteriorlayerquadratuslumborum fascia)

Plate 179

*{r

Muscles and Nerves

fiTpical Thoracic Spinal Nerve

Anterior cutaneousbranch
Lateralbranch

External
I
intercostal
membrane

Transversus
thoracis
muscle

muscle
External
intercostal
lnternalintercostal
muscle
muscle
lnnermostintercostal

Ventralroot
Dorsal root
Anterior branch

lntervertebral
foramen

Dorsalroot (spinal)
ganglion

lateral cutaneousbranch
Posteriorbranch

Spinalnerve
Sympatheticganglion
ray and white rami communicantes

Ventralramus(intercostalnerve

Serratusanterior muscle

atissimusdorsi muscle

Subscapularis
muscle
Teresmaiormuscle

Dorsalramu6
M e d i a lb r a n c h

Lateralbranch
Posteriorcutaneousbranch

Traoezius
muscle
Rhomboidmaiormuscle
Erectorspinaemuscle
lnternalintercostalmembrane

Note: In lower thoracic


region, lateralbranch of
dorsal ramus is longer,
motor, and cutaneous;
medial branch is shorter
and motor onlv.

Muscles and Nerves

muscle
Infrasoinatus

*{r
Plate l8O

3 Thorax
Section
Topographic Anatomy
Plates l8t

181 Thorax

Mammary Gland
Plates 142-144

Gland
182 Mammary
Gland
ofMammary
183 Arteries
Gland
of Mammary
andNodes
Vessels
184 Lymph

Body Wall
Plates 185-195

ofThorax
185 BonyFramework
Joints
186 RibsandSternocostal
Joints
187 Costovertebral
Wall
Thoracic
188 Anterior
Wall(continued)
Thoracic
189 Anterior
Placement
Tube
Drainage
190 Chest
InternalView
Wall:
Thoracic
191 Anterior
Nerves
andArteries
192 Intercostal
Nerve
193 Phrenic
Surface
Thoracic
194 Diaphragm:
Abdominal
Surface
195 Diaphragm:

Lungs
Plates t9G2lO

AnteriorView
ofLungs:
196 Topography
PosteriorView
of Lungs:
197 Topography
View
inSitu:
Anterior
198 Lungs

Atlas of Human Anatomy

Thorax
199 Lungs:
Medial
Views

226 Nerves
of Heaft

200 Bronchopulmonary
Segments

227 lnnervation
of HeartSchema

201 Bronchopulmonary
(continued)
Segments

228 lnnervation
ofBlood
Vessels:
Schema

202 Tracheaand
MajorBronchi

229 Prenatal
andPostnatal
Circulation

203 Nomenclature
ofBronchi:
Schema
204 Intrapulmonary
Airuvays:
Schema

Mediastinum

205 Intrapulmonary
Blood
Circulation:
Schema

Pfates 23O-24l

206 Great
Vessels
ofSuperior
Mediastinum

230 Mediastinum:
Right
Lateral
View

207 BronchialArteries
andVeins

231 Mediastinum:
LeftLateralView

208 Lymph
Vessels
andNodes
ofLung

232 Esophagus
inSitu

209 Autonomic
Nerves
inThorax

233 Topography
andConstrictions
of Esophagus

210 Innervation
ofTracheobronchial
Tree:
Schema

234 Musculature
of Esophagus
235 Pharyngoesophageal
Junction

Heart

236 EsophagogastricJunction

Plates 211-2X,

237 Arteries
of Esophagus

211 Heart
inSitu

238 Veins
ofEsophagus

212 Heart:
Anterior
Exposure

239 Lymph
Vessels
andNodes
of Esophagus

213 Radiograph
ofChest

240 Nerves
of Esophagus

214 HearL
BaseandDiaphragmatic
Surfaces

241 Mediastinum:
Cross
Section

215 Pericardial
Sac
216 Coronary
Arteries
andCardiac
Veins

Regional Scans

2'17 Coronary
Arteries
andCardiac
Veins:Variations

Plale 242

218 Coronary
Arteries:
Arteriographic
Views

242 Chest
Scans:
AxialCTlmages

219 Coronary
Arteries:
(continued)
Arteriographic
Views
220 Right
Atrium
andVentricle

Gross-Sectional Anatomy

221 LeftAtrium
andVentricle

Plates 243-246

222 Yalves
andFibrous
Skeleton
of Heart

243 Cross
Section
ofThorax
atT3Level

(continued)
223 Valves
andFibrous
Skeleton
ofHeart

244 Cross
Section
ofThorax
atT3-4DiscLevel

224 Alria,
Ventricles,
andInterventricu
larSeptu
m
225 Conducting
System
ofHeart

245 Cross
Section
ofThorax
atT't-5DiscLevel

Atlas of Human Anatomy

246 Cross
Section
ofThorax
atTTLevel

Thorax

Biceps
brachii
muscle
muscle
Sternocleidomastoid
Sternalhead
head
Clavicular

Triceps
brachii
muscle
Axilla

Anterior
axillaryfold

Jugular
notch

Posterior
axillaryfold

Deltoid
muscle

Pectoralismajor
muscle
head
Clavicular
Sternalhead

Bodyof
sternum

dorsi
Latissimus
muscle
Cephalic

Xiphoidprocess
of sternum

vetn

Serratus
anteriormuscle
Lineaalba
Rectusabdominis
muscle
Tendinous
intersection
External
oblique
muscle
Serratus
anteriormuscle

Topographic Anatomy

64a4#

Plate l8l

Mammany Gland

Anterolateral
dissection

Suspensory
ligaments
of
breast(Cooper's)
ar
glands

Pectoralis
m a j o rm u s c l e
(deepto
pectoral
fascia)
A x i l l a r yt a i l ( o f S p e n c e )

Serratus
anteriormuscle
External
o b l i q u em u s c l e

2nd ri
Pectoralis
maJor

muscle
Pectoral
fascia
Intercostal
muscles

ligaments
Suspensory
of breast(Cooper's)
Lactiferousduct
actiferoussinus

C l a n dl o b u l e s

Fat (subcutaneous
tissuelayer)

Sagittalsection

Plate 182

4{tr
Mammary Gland

Arteries of Mammary Gland

Subclavianarter
I n t e r n a tl h o r a c i c
artery and its
perforatingbranches
M e d i a l m a m m a r yb r a n c h e s

Axillara
y rter
Brachialplexu
Brachial

Lateralthoracic art
ano
Lateralmammary
branches
A x i l l a r yt a i l ( o f S p e n c e )
Lateralmammary
branchesof
lateralcutaneous
branchesof posterior
intercostalarteries

*fr
Mammary Gland

Plate 183

Lymph Vessels and Nodes of Mammary Gland

Parasternalnodes
Apical axillary

(Rotter's)
Interpectoral
nodes ( s u b c l a v i a nn) o d e s
C e n t r a la x i l l a r yn o d e s

Lateral
axillary
(humeral)
nodes
Posterior
axillary

(subscapular)
nodes

Anterior
axillary
(pectoral)
nodes

Pathwayto anterior
mediastinalnodes

Pathwaysto opposite breast


Pathwaysto inferior phrenic (subdiaphragmatic)nodes and livei

Plate 184

4{tr
Mammary Gland

Bony Framework of Thorax


Jugularnotch

Anteriorview

Manubrium
Angle

Sternum

Coracoid

process

Body

Glenoid
cavity

Xiphoid
process

Neck
Scapular

Subscapular
fossa
Clavicle

Trueribs(l-7)
Costal cartilages

Falseribs(B-.12
loatingribs(.11-12)

Head

Posteriorview
Neck

Tubercle
Angle

Body

Acromion
Supraspinous
fossa
Spine
lnfraspinous
fossa

T r u er i b s( 1 - Z )

4{r

F a l s rei b s( B - 1 2 )

Floatingribs
fi1-12)

Body Wall

Plate t 85

Ribs and Sternocostal Joints

Subclavius
muscle

1st left rib:


superiorview

Muscleattachments
Origins

Croovesfor
subclavian

Insertions

Anterior
scalene
muscle

Middle rib:
posterior view

Head
Neck

Serratus
anterior
muscle

Tubercle

Middle
scalene
muscle

l st digitation)

Posterior
scalene
muscle
Articular
for transverse
processof
vertebra

2nd left rib:


superiorview
Serratus
anterior
(2nddigitation)

\-V^r-l

Articularfacets
for vertebralbodv

lnterclavicula
i gra m e n t
Manubrium
Costalgroove
Costoclavicular
ligament
Articularcavity
lntraarticular
sternocostal
ligament

Costalcartilages

ndraljoints

Radiatesternocostal
ligaments

Note:The headof a typicalrib


articulates
with the superior
costalfacetof the thoracic
vertebraof the samenumber(by
its inferiorarticularfacet),the
inferiorcostalfacetof the
vertebraabove(by its superior
articularfacet),and the
intervertebral
disc betweenthe
two vertebrae.The costal
tuberclearticulateswith the
processof the
transverse
vertebraof the samenumber.

Costalcartilages

joints
Interchondral

4{tr

Xiphoid
process
Costoxiphoid
ligament

Plate 186

Sternocostalarticulations:
anteriorview

Body Wall

Gostovertebral Joints

Transverse
costalfacet(fortubercleof rib of samenumberasvertebra)

Anteriorlongitudinal
ligament

Lateralcostotransverseligament

Inferior costal
facet (for head o{
rib one number

greater)

Intertransverseligament

Interarticular
ligamentof
head of ri

ligament
Superiorcostotransverse

Superiorcostal
facet (for head of
rib of same

Superiorarticular
facetof rib head

number
Radiate
ligament of

ligament
Intraarticular

headof

Radiate
ligament
of head
Synovial
cavities

of rib

Left lateral view

ligament(cut)
Superiorcostotransverse
Superiorcostal
facet(for headof rib
of samenumber)
Transverseprocess

(cutoff
ligament
Costotransverse
Lateralcostotransverseligament

Transverse
section:superiorview
Radiateligamentof head of rib

ostotransverseligament

Lateralcostotransverseligament

uperior costotransverseligament

ansverseligament

Right posterolateralview

Body Wall

Nr
Plate 187

Anterior Thoracic Wall

Sternothyroidmuscle
tnu"st"d
by
Sternohyoidmuscle I
cervicalfascia
Omohyoid muscleJ

Sternocleidomastom
i du
Posteriortriangleof
Trapeziusmuscle

Clavicle

Perforating
branches
of internal
thoracicarteryand anteriorcutaneous
branches
of intercostal
nerves

Subclavius
muscleinvestedby
fascia
clavipectoral
Thoracoacromial
artery(pectoral
branch)and lateralpectoralnerve

Pectoralismajor muscle
C e p h a l i cv e i n

Costocoracoidligament
Coracoid process

Acromion

D e l t o i dm u s c l e

Medial
pectoral
nerve

Long thoracic nerve


and lateralthoracic artery

minor
Pectoralis
muscleinvestedby
Clavipectoral
fascia

Latissimu
d so r s im u s c l e

Digitations
of serratus
a n t e r i om
r uscle

D i g i t a t i o n so f
serratusanterior muscle

xternal intercostal
membranesanterior to
internalintercostal
muscles

Lateralcutaneous
branches
of
intercostalnervesand
posterior intercostalarteries

External
intercostal
muscles
E x t e r n aolb l i q u e
musc

Bodyandxiphoidprocess
of sternum

Anteriorlayerof rectussheath

4{tr
Cryd4*/*
Plate 188

I n t e r n aol b l i q u em u s c l e

Sternalismuscle (inconstant)
L i n e aa l b a

R e c t u sa b d o m i n i sm u s c l e
Cutaneousbranchesof thoracoabdominal
(abdominalportions of intercostal)nerves
and superiorepigastricartery

Body Wall

Anterior Thoracic Wall (continuedl

Omohyoid, sternothyroidand sternohyoidmuscles


Clavicle

S u b c l a v i umsu s c l e
Trapezius
muscle

I n t e r n a jl u g u l a rv e i n
Levatorscaoulaemuscle
Anterior

/ ruiddl" ! s.rl"n" muscles


/ eotturio,)

Thoracoacromialartery

Phrenicnerve
Coracoid process

prexus
C e p h a l i cv e i n
Thoracicduct
Pectoralismajor
muscle (cut)

Subclavian
artery and vein

Deltoid
muscle

artery and vein

Intercostobrachialnerve

Superiorthoracic artery

Long thoracic nerve


andlateral thoracic artery

lnternalthoracic
artery and veins

Pectoralisminor muscle

xternal intercostalmuscle

Digitationsof
serratusanterior muscle
Lateralcutaneous
branchesof intercostal
nervesand posterior
intercostalarteries

intercostal
muscle (cut)
Transversusthoracis
muscle
Anterior intercostal
branchesof internal
thoracic artery

Externalintercostalmuscles
lntercostalnerve

External
intercostal
membranes
anterior to internal intercostalmuscli-'s

l n t e r n a lo b l i o u e m u s c l e
R e c t u sa b d o m i n i sm u s c l ea n d s h e a t h( c u t )

Body Wall

Musculophrenicartery
and vein

abdominismuscre
Transversus
S u p e r i o re p i g a s t r i ca r t e r i e sa n d v e i n s

*{r
Plate | 89

Ghest Drainage Ti,rbe Placement

Preferredsites
(2ndor 3rd
1.Forpneumothorax
interspace
at midclavicular
line)
(5thinterspace
2. Forhemothorax
at midaxillarv
line)

B.Trocarwithdrawn;
tubepassed
into
chestthroughcannula

C.Cannulawithdrawn;
tube connected to
underwater seal(with
suctionif indicated)

D, Intercostal_+
spacers
pierced above
rib to avoid
damageto
neurovascutar
b u n d l el y i n gi n
costal groove

Thoracocentesis
and tube drainage
with underwatersealdrainage
usuallysuffices.

Plate | 9O

Nr
Body Wall

Anterior Thoracic Wall: lnternal View

S t e r n o t h y r om
i du s c l e
S t e r n o h y o im
du s c l e
I n t e r n a jl u g u l a rv e i n

Manubrium
of sternum
C o m m o n c a r o t i da r t e r y
lnferior thyroid artery

Vertebralartery

Anterior scalenemu
S u b c l a v i a na r t e r ya n d v e i n

trunk
Brachiocephalic
Subclavianartery and vein

C l a v i c l e( c u t ) - - *

B r a c h i o c e p h a l ivce i n

Brachiocephalicvein --'

Internalthoracic
artery and vein

P h r e n i cn e r v e a n d
pericardiacophrenic
artery and vei

Anterior intercostal
arteriesand veins
and intercostalnerve

Internalthoracic
artery and vein

intercostal

Anterior intercostal
a r t e r i e sa n d v e i n s
and intercostalnerve

muscles

Perforatingbranches
of internalthoracic
artery and vein and
anterior cutaneous
branch of
intercostalnerve

Innermost
intercostal
muscles

Transversus
thoracis
muscte

Collateral
branchesof
intercostalartery
and vein

Bodyof ster
Sternocostal
triangle

4{tr

Diaphragm
S l i p so f
c o s t a lo r i g i n
of diaphragm

Musculophrenic
arteryandvein

Transversus
abdominis
muscle

Transversus
abdominis
muscle
Sternalpart of diaphragrh
X i p h o i dp r o c e s S

Body Wall

Internalthoracic artery and veins


S u p e r i o re p i g a s t r i ca r t e r ya n d v e i n s

Plate | 91

Intercostal Nerves and Arteries

Ventralroot
Dorsalroot
(spinal)ganglion

Spinal(radicular,
or segmental
medullary)
branchof posteriorintercostalartery
Trapeziusmuscle

Erectorspinae
Medialbranch
Lateralbr

Dorsalramusof thoracicner

Dorsalbranchof posteriorintercostalartery
Rhomboidmajormuscle
Erectorspinaemuscle

Costotransverse
ligamen

Posteriorintercostalarterv

Intercostal
nerve(ventral
ramusof thoracicspinal

Internalintercostalmembrane

Internalintercostalmembrane
deep to externalintercostal
muscle

muscle

Serratusanterior

is muscle
Serratus
anterior
muscle

Lateral
cutaneous
branchof
intercostal
nerve
Anteriorbranch
of lateralcutaneous
branchof
intercostalnerve
External
muscle

*{r

Pectoralismajormuscle
Anteriorcutaneousbranchof intercostalnervb

Plate 192

External
oblique
muscle
Perforating
branch
Superior
epigastricartery
Rectusabdominis

Lateralcutaneous
branchof posterior
intercostalartery
al intercostalmembrane
Anteriorintercostalarteries

Body Wall

Phrenic Nerve

!1 u"",'",*',
|

Ventralrami

{:;
Anterior scalenemuscle

Anterior scalenemuscle

Right common carotid a

plexus
Brachial

Brachial

Left phrenic nerve

Rightphrenicnerve

artery
Leftsubclavian

R i g h st u b c l a v i aanr t

Leftvagusnerve(X)

R i g h tv a g u sn e r v e (

Left common carotid arterv

Right internal

Leftinternal
thoracicartery(cut)

thoracicartery(cut)
Brachioceohalic
trunk

Thoracic cardiac nerves

Right pericardiaco-

Left pericardiacophrenic artery (cut)

phrenicartery(cut
5upeflor vena cava

Leftrecurrent
nerve
laryngeal

Rootof rightlung

Rootof leftlung

Pericardialbranch
of phrenic nerve

partof
Mediastinal
parietalpleura

Mediastinalpart of
parietalpleura,

Costalpart of
parietalpleura

Diaphragmatic
part of parietal

pleura(cut)
P h r e n i c o a b d o m ibnraal n c h e s
of ohrenicnervesto inferior
surfaceof diaphragm

Phrenic
(efferentand
afferentfibers)

Lower intercostalnerves

(afferentonlyfrom peripheral
partof diaphragm)

Body Wall

4ttr
Plate 193

Diaphragm: Thoracic Surface


SeealsoPlates23O,231
T h o r a c i c( d e s c e n d i n ga) o r t a

Neck of rib
Left sympathetictrunk

TB-9 intervertebral
disc

Left greaterthoracic
s p l a n c h n i cn e r v e

R i g h st y m p a t h e ttircu n k

Hemiazygosvein

Right greaterthoracic
s p l a n c h n i cD r V 1

M e d i a s t i n apl l e u r a
Costal part of
parietalpleura

Esophagus

Azygos
VlD-

Thoracic
duct
R i g h tl e a f l e to f
central

Diaphragmatic
part of

parietalpleura
(cutaway)

Diaphragmatic
part of parietal
pleura (cut away)

Left leaflet of
central tendon

R i g h tp h r e n i cn e r v ea n d
pericardiacophrenic
artery and vein

Mediastinalpart of
parietalpleura and
pericardium(cut)

Mediastinalpart of parietal
p l e u r aa n d p e r i c a r d i u m( c u t )

Left phrenic nerve and


pericardiacophrenic
artery and vein

R i g h tc o s t o d i a p h r a g m a t i c
recessof pleuralcavity

Pericardium

lnferior vena cava (receivinghepatic vein!)

Left costomediastinal
recessof pleuralcavity

Right internalthoracic artery and veins


R i g h tc o s t o m e d i a s t i n a l
recessof pleuralcavity

n{r
Plate 194

A n t e r i o rm e d i a s t i n u m
Sternum

Transversus
thoracismuscle
Left internalthoracic artery and veins
5th costal cartilage
Middle leafletof central tendon covered bv oericardium

Body Wall

Diaphragm: Abdominal Surface


SeealsoPlates253,263,
Sternocostaltriangle
Sternalpart of diaphragm
A n t e r i o rb r a n c ho f r i g h t p h r e n i cn e r v e

Anterior branch of left phrenic nerve


Costal part of diaphragm
Centraltendon of diaphragm

R i g h ti n f e r i o rp h r e n i ca r t e r y

hiatus
Esophageal

C a v a lo p e n i n g

F i b e r fsr o mr i g h tc r u sp a s s i n g
hiatus
to leftof esophageal

R i g h ct r u so f d i a p h r a g m

Left inferior phrenic artery

Creater thoracic solanchnicnerve

Recurrentbranch to esophagus

L e s s e rt h o r a c i cs p l a n c h n i cn e r v e

Anterior branch
Lateralbranch

Leftsuperior
artery
suprarenal

Leastthoracic
s p l a n c h n i cn e r v e .

Left phrenic nerve


Costal part
of diaphragm

Leftcrusof
diaphragm

Transversus
abdominis
m

triangle
Lumbocostal
1 2 t hr i b
Lateralarcuateligament

Lumbarpartof diaphragm
Quadratus

M e d i a la r c u a t el i g a m e n t

l u m b o r u mm u s c l e
P s o a sm a j o r m u s c l e
S y m p a t h e t i ctru nk

Aortichiatus

C e l i a ct r u n k

Body Wall

Plate t 95

Topography of Lungs: Anterior View

Thyroid cartilage
Thyroid gland
Cervical(cupula,or dome, of)
parietalpleura

Cricoid cartilage
Trachea

J ug u l a r( s u p r a s t e r nnaol )t c h
A p e xo f l u n g

j or i n t
Sternoclavicula

Arch of aorta

Clavicle

Cardiacnotchof leftlune

I st rib and costalcartila

Left border of heart

R i g h tb o r d e ro f h e a r t

Horizontal
fissure
of right
lung
(often
incomplete)

Right
nipple

Left
nipple

Costomediastinal
recessof pleural
cavtty

fissure
O b l i q u ef i s s u r e
of leftlung

Costodiaphragmatic
recessof pleural
cavity

Costodiaphragmatic
recessof pleuralcavity

Spleen
I n f e r i o rb o r d e r o f r i g h t l u n g

Inferiorborderof leftlung
Left dome of diaphragm

Pleuralreflection

Pleuralreflection
Callbladdei
Stomach
R i g h td o m e o f d i a p h r a g m

Bare area of pericardium


Xiphoid process

Plate 196

*{r
Lungs

Topography of Lungs: Posterior View

Spinousprocessof T1 vertebra

A p e xo f l e f tl u n g
1s t r i b
Obliquefissureof leftlung

Cervical(cupula,or dome, of) parietalpleura

1 s tr i b
e f r i g h tl u n g
O b l i q u ef i s s u r o
Clavicle

H o r i z o n t af ils s u r e
of rightlung(often
incomplete)

S p i n eo f s c a p u l a
Left border of costal
parietap
l leura

R i g hb
t order
of costal
parietalpleura

Costodiaphragmatic
recessof pleural
cavity

Costodiaphragmatic
recessof pleural
cavity

Spleen

Liver

Pleuralreflection

Pleuralreflection

Inferiorborderof leftlung

*{r
Lungs

Inferiorborderof rightlung

Left kidney

R i g h tk i d n e y

Left dome of diaphragm

R i g h td o m e o f d i a p h r a g m

Left suprarenalgland

R i g h ts u p r a r e n agl l a n d

Plate | 97

Lungs in Situ: Anterior View

Thyroidgland
Omohyoid, sternothyroidand sternohyoidmuscles

Manubrium
of sternum

Tracheaand inferior thyroid veins


Common carotid artery
I n t e r n ajlu g u l a rv e i n
Phrenicnerve

Sternocleidomastoidmuscle

j ul g u l avr e i n
Externa

Anteriorscalenemuscle
Thoracicduct

Costal part of parietalpleura (cut away)

a c h i apl l e x u s

Clavicle

Subclavianartery and vein

Pectoralismaior muscle

Pectoralis
m i n o rm u s c l e

Internalthoracic artery
and vein
Axillaryartery and vein

Intercostal
musctes

notch

of leftlung

Superiorlobe,
M i d d l el o b e ,
I n f e r i olro b e
o f r i g h tl u n g

Superiorlobe,
Inferiorlobe
of leftlung
Costomediastinal
space

O b l i q u ef i s s u r e
Horizontal fissure
o f r i g h tl u n g

Oblique fissure

Costodiaphragmaticrecess
Diaphragmatic
part of parietalpleura

M u s c u l o p h r e nai cr t e r y
L i n g u lo
a f s u p e r i olro b eo f l e f tl u n g

Diaphragm

*{r
Plate | 98

7th costal cartilage


Xiphoid process
Pleuralreflectioni

Internalthoracic artery
Mediastinalpart of parietalpleura
F i b r o u sp e r i c a r d i u m

Lungs

Lungs: Medial Views

Rightlung
Areafor trachea
Groovefor subclavian
a

Areafor esophagus

Croovefor brachiocephalic
vein

Croovefor azygosvein

Croovefor 1stri

Obliquefissure
Pleura(cutedge)

Croove for superiorvena cava

Rightsuperiorlobar
(eparterial)
bronchus

Superiorlobe
Areafor.thymus
and fatty.
tissueof anteriormediasti

Rightpulmonaryarteries
Rightbronchialartery

Anteriorborder

Rightintermediate
bronchus

Hilum

R i g h st u p e r i opr u l m o n a rvye i n s
Horizontalfissure

(hilar)
Bronchopulmonary
lymphnodes

C a r d i a ci m p r e s s i o n

Rightinferiorpulmonaryveins

Obliquefissure

lnferior lobe

Middle lobe

for esophagus

Groove for inferior vena cava

ligament
Pulmonary
Diaphragmaticsurface

Inferiorborder

4{ffi

Left lung

4t-/

Apex
arterv
Croovefor subclavian

Areafor tracheaand esophagus


Oblique

Croovefor left
vein
brachiocephalic
roovefor l st rib

Croove for arch of aor

Anteriorborder
Pleura (cut edge)

Leftpulmonary
Leftbronchialarteries
Leftmainbronchus
L e f ts u p e r i o rp u l m o n a r yv e i n s

Areafor_thymus
and fatty.
tissueof anteriormediastinum
Superiorlobe
Hilum
Cardiacimpression
P u l m o n a rl yi g a m e n t

B r o n c h o p u l m o n a r (yh i l a r )

lymphnodes

Cardiacnotch
Inferior

Leftinferiorpulmonaryvei
Croovefor descending
aorta
Inferiorborder

Lungs

Obliquefissure
tor esophagus
surface
Diaphragmatic
ingula

Plate 199

Bronchopulmonary Segments

Rightlung

Anteriorview

Superiorlobe

Superiorlobe

Apical(S1
Anterior(S3
Posterior(S

Middle lobe

l i n g u l a(rS a )
l,lnferior

I
l/

Lateral(Sa

t.

'

, ^q '

(5")
\ lrngutar
I
I

rl
l1

Medial(Ss)

I
I

,
\

ii

Inferiorlobe
Anterior

Inferior lobe
Anteromedial
basal(S7*8)

basal(SB)
Medial

basal(S7

Posterior
basal(S1o)

Lateral
basal(Se)

Posterior
basal(S1o)

'..,

Lateral
basal(Se)

---f-'EE

Posteriorview

Left lung

--+--'
T

-.i;--1:,

Superiorlobe
Apical(Sr)
(S2)
Posterior
Anterior(S3)

-'iir'Middle lobe

isl
Inferior lobe

tl
7'

Lateral(Sa)
Inferior lobe

Superior(56)

Superior(56)

Lateral
basal(Se)

Lateral
basal(Se)

'-lZ.tr.-

Posterior
b a s a1l S t o l

rr!

Posterior
basal(Sro)

lt
tt
t,
ll,
\t,

',
,I

Plate 2OO

r/-\

t--t

iri

4{F
Lungs

Bronchopulmonary Segments (continuedl

Lateralviews
Rightlung
Superiorlobe

Superiorlobe

Apical(S1)
Posterior(52)
A n t e r i o r( S 3 )

Middle lobe
Lateral(Sa)
M e d i a (l S s )
lnferiorlobe
S u p e r i o r( 5 6 )

lnferiorlobe

Anteromedial
basal(S7*8)

Superior(56)
Anterior
basal(58)

Lateral
basal(Se)

Lateral
basal(Se)

Medialviews

Superiorlobe

4{tr
Superiorlobe

A p i c a l( S l )
Posterior(S2)
A n t e r i o r( 5 3 )

Middle lobe
(Ss)
tr4edial

Inferiorlobe
S u p e r i o(r5 6 )
Medial

lnferiorlobe

basal(Si

Superior(56)

Anterior
basal(S

Anteromedial
basal(S7*8)

Lateral

Lateral
basal(Se)

basal(Se)
Posteriorbasal(S1o)

Lungs

Posteriorbasal(Slo)

Plate 2Oi

l|achea and Major Bronchi

Connective
tissuesheath
(visceral
layerof pretracheal
fascia)

Thyroid cartilage
Median cricothyroid
ligament...-

Trachealcartilage(ring)

Elastic
fibers
Cland
Smallartery
Lymphvessels

Cricoid cartilage

Connective tissue
sheath(viscerallaver
of pretracheal fascia)

Nerve

(cutaway)

A n n u l a (r i n t e r c a r t i l a g i n o u s )
ligaments
Trachealcart

Mucosaof oosteriortracheal
wallshowslongitudinal
folds
formedby densecollections
of elasticfibers

Superiorlobar
(eparterial)
bronchus
Gland
Elastic
fibers
Superiorlobar
bronchus

To
supenor
lobe

(smooth)
Trachealis
muscle
muscle
Esophageal
Epithelium
Lymphvessels

Suoeriordivisionbronchus
Lingularbronchus
Middle
lobar bron

{r

To
middle
lobe

Rightand left
m a i nb r o n c h i
Intermediate
bronchus
Inferiorlobar
bronchus

Inferiorlobar
bronchus

Pfate 2O2

g6
87+8

To
inferior
lobe

To
inferior
lobe

Intrapulmonary

To
superior
lobe

Extrapulmonary

*{r

Intrapulmonary

Lungs

Nomenclature of Bronchi: Schema

g 1 + 2 b i ci

Trachea

glbic

BlbiP

B 1 + 2 bci

glbiic

p
B1+2bii
B 1 + 2 a i0i

9 1 + 2 b iB

glbiiP

p
91+2aii

lbi

glai

B1 b

g1+2aii

B1a
g 2 a iP

92aii

1+2a

g 1+ 2 b i

S u p e r i o rl o b a r
(eparterial)I
oroncnus

B2b

g3ai

B2(posterior)

g 3 a iP

Superior
lobar

B1(apical)

92bii
g 3 a ie

81+2ci
+2cii
B1

g2ai c

92ai

81+2b

Superior
division

B1+2(apicoposterior)
g:c7p

bronch

9 3 a i ia
g 3 a i iP

g3bii

g3bi

and left
main bronchi

B3 (anterior)

ir3b

g6a -

B6bi
Middle lobar bronchus

a6!

86 lsuperior, I
lower lobe)---_

B6 (superior,tower lobe)

ga (lateral)
g4ai

Brb
$.3:bii
Lingular
bronchus

---

Intermediate
bronchus

B6c
..
;p Socrt

4a

g4aii

84 (superiorlingutar)

gabi

B6c

94ai
g4aii

B5
(inferior
lingular)

r B4bi

b4b

Bsb
I n f e r i o rl o b a r
bronchus

(medial)

g4bii

84a

b6b

g6ci

gs
B

33ai

B3 (anterior)

g6ai
B6aii

g:a

gabii

I n f e r i o rl o b a r

bronchus

B7*8(anteromedialbasal)

Bz (medialbasal)

g7+8a -97+8ai

B8 (anteriorbasal)
89 (lateralbasat)

gSai
g o a i iv

87b
gab
gTbi

gsbi
89 (lateralbasal
g9ai o

g7+8aii

Blo (posteriorbasal)

B7+8b
7+8bi

g10a
g7+8bii

ETbii

Bel

B9a

B9ai

Blo (posteriorbasal)

geaiP

gl Oaii

g10b

g 9 a i io
g e a i iP

g10c
[e"ii
g9bii

g1Oci

g9bii

gsbiiP

g10aii
[10ai
d

glObi

glObii

4{tr

Nomenclature in common usagefor bronchopulmonary


segments(Plates200 and 201) is that of .lacksonand
Huber, and segmentalbronchi are named accordingly.
lkeda proposed nomenclature(as demonstratedhere) for
bronchialsubdivisionsas far as 6th generation.For simplification on this illustration.onlv some bronchial subdivisions
are labeled as far as 5th or 6th generation.Segmental
b r o n c h i( B ) a r e n u m b e r e df r o m 1 t o 1 0 i n e a c h l u n g ,
correspondingto pulmonary segments.ln left lung,

Lungs

g 9 b ic
'B1Obi
gl0cii

gebiP

globii

Bt and 82 are combined as are 87 and 88. Subsegmental,


or 4th order, bronchi are indicated by addition of lowercase lettersa,b,or cwhen an additional branch is present.
Fifth order bronchi are desisnatedbv Roman numeralsi
(anterior)or ii (posterior)a;d 6th oriler bronchi by Greek
lettersa or p. Severaltexts use alternatenumbers (as
proposed
bv Bovden)for segmentalbronchi.
'
Variationsof'standardbronchial pattern shown here
are common, especiallyin peripheralairways.

Plate 2O3

lntrapulmon ary Airways: Schema

*{Y

9
@!

Cartilages

92

^:

Respiratory
bronchioles
(alveoli
appearat
thislevel)

tro
N@

$n
oc
N6'
J

Cartilages
Decomesparser
(mostlyat
pointsof
branching)

! . =

ii

m-

Alveolarducts
Alveolarsac
Alveoli

No further
cartilages

Acinus
(part
of lung
supplieb
dy
terminal
bronchiole)

lermtnat
bronchiole

OJ

Respiratory
bronchioles
(3-B orders)

Acinus
Alveolar
s a c sa n d
alveoli
Poresof Kohn

Subdivisions
of intrapulmonaryairways
Structureof intrapulmonaryairways

Plale

2O4

Lungs

lntrapulmonaty Blood Girculation: Schema

Terminalbronchiole
Bronchialartery (from left heart
via thoracic aorta)
-.>

P u l m o n a rvye i n
(to leftheart)

Pulmonary
artery (from

r i g h th e a r t

Pulmonary
vein (to
left heart)

4{tr

V i s c e r a pl l e u r aa n d s u b p l e u r acl a p i l l a r i e s

C a p i l l a rbye dw i t h i na l v e o l awr a l l
(cutawayin places)

Pulmonaryarteriesand their branchesdistributesegmentallywith the bronchi.


Pulmonaryveinsand their tributariesdrain intersegmentally.

Lungs

Plate 2O5

Great Vessels of Superior Mediastinum

C r i c o i dc a r t i l a g e
T h y r o i dg l a n d
R i g h tc o m m o n c a r o t i da r t e r y
R i g h tv a g u sn e r v e( X )

Thyroid cartilage
I racnea

Left common carotid artery


Leftvagus nerve (X)

A n t e r i o rs c a l e n em u s c l e

A n t e r i o rs c a l e n em u s c l e

P h r e n i cn e r v e

Phrenicnerve (cut)

R i g h ti n t e r n a jl u g u l a rv e i n
Thoracic duct

E x t e r n aj lu g u l a rv e i n

B r a c h i apll e x u s

B r a c h i a pl l e x u s

Left subclavianartery and vein

Right subclavianartery and vein

Left brachioceohalicvein

B r a c h i o c e p h a l itcr u n k

Internalthoracic artery

R i g h tb r a c h i o c e p h a l ivce i n

Arch of aorta

Phrenicnerve and
pericardiacophrenic
artery and vein (cut

Vagus nerve (X)

S u p e r i o rv e n a c a v a

Left recurrent
laryngealnerve

R i g h ts u p e r i o rl o b a r
(eparterial)

Ligamentum
arteriosum

bronchus
R i g h tp u l m o n a r y

Left
purmonary
artery

P u l m o n a r yt r u n k
Right
purmonary
verns

Left

g:lilo"u"

Mediastinal
part of
parietalpleura
(cut edge)

Mediastinal
part of
parietap
l leura
(cut edge)

Costal part of
parietalpleura
(cut edge)

Costal part of
parietalpleura
(cut edge)

Diaphragmatic
part of
parietap
l leura

P h r e n i cn e r v e
(cut)

Rightcostodiaphragmatic
recessof
pleuralcavity

Diaphragmatic
part of
parietap
l leura
and cut edge

R i e h ti n t e r m e d i a t eb r o n c n u s
P h r e n i cn e r v e( c u t )
Azygos vein
T h o r a c i cd u c t
I n f e r i o rv e n a c a v a

Plate 2O6

Left main bronchus


Pericardium(cut edge)
Diaphragm
E s o p h a g uas n d e s o p h a g e apl l e x u s

*{r
Lungs

Bronchial Arteries and Veins

Esophagus

Nr

Trachea(pulledto left by hook

3 r d r i g h tp o s t e r i o r
intercostalartery-

Superiorleft
b r o n c h i aalr t e r y
R i g h tb r o n c h i a a
l rtery

Aorta(pulledaside
by hook\

R i g h tm a i n b r o n c h u s

Left main bronchus


(pulled to right by hook)

lnferior left
bronchialartery

Esophagealartery

Esophageal
branch
of bronchialartery

Variationsin bronchialarteries

Bronchialveins

Azygos

Right
b r o n c h i a vl e i n

Left main

bronchus(turned
up by hook)
Leftbronchialvein
Accessory
hemiazygos
vein

R i g h ta n d l e f t b r o n c h i a l
a r t e r i e so r ig i n a t i n gf r o m
aorta by singlestem

Lungs

O n l y s i n g l eb r o n c h i a la r t e r y
t o e a c h b r o n c h u s( n o r m a l l y ,
two to left bronchus)

Plate 2O7

Lymph Vessels and Nodes of Lung


SeealsoPlates 72, 184.,239
R i g h tp a r a t r a c h e anl o d e s

Left paratrachealnodes

R i g h ts u p e r i o rt r a c h e o b r o n c h i anl o d e s

B r o n c h o m e d i a s t i n layl m p h a t i ct r u n k

B r o n c h o r r r e d i a s t i nl vam
l p h a t i ct r u n k

Brachiocephalicvein
I n f e r i o rd e e p c e r v i c a l
(scalene)node

B r a c h i o c e p h a l ivce i n
l n f e r i o rd e e p c e r v i c a l
( s c a l e n en) o d e

V i r c h o w ' sn o d e
Thoracicduct

I n t e r n a jl u g u l a rv e i n
a n d j u g u l a rl y m p h a t i ct r u n k

Left superior
t r a c h e o b r o n c h i anl o d e s

R i g h tl y m p h a t i cd u c t
Subclavian
vein
and subclavian
l y m p h a t i ct r u n k

Bronchopulmonary
( h i l a r )n o d e s
P u l m o n a r y( i n t r a p u l m o n a r y )n o d e s

Bronchopulmonary
( h i l a r )n o d e s

Subpleural
lymphatic
prexus

P u l m o n a r y( i n t r a p u l m o n a r y )n o d e s

Subpleural
Iymphatic
prexus

Interlobular
lymph
vessets

Interlobular
lymph
vessel
Drainage
follows
bronchi,
arterres
and
v e tn s

lnferior
t r a c h e o b r o n c iha l
( c a r i n a ln
) odes

Drainage
follows
bronchi,
arteries
and veins

Pulmonary
ligaments
Routesto
mediastinum

4{tr
Drainageroutes
R i g h t l u n g : A l l l o b e sd r a i n t o p u l m o n a r ya n d b r o n c n o p u l m o n a r y( h i l a r )n o d e s ,t h e n t o i n f e r i o rt r a c h e o b r o n c h i a l
( c a r i n a ln
) o d e s ,r i g h t s u p e r i o rt r a c h e o b r o n c h i anl o c r e s ,
and right paratrachealnodes on way to brachiocephalic
v e i n v i a b r o n c h o m e d i a s t i n al yl m p h a t i ct r u n k a n d / o r
i n f e r i o rd e e p c e r v i c a l( s c a l e n e n) o d e .

Plate 2O8

L e f t l u n g : S u p e r i o rl o b e d r a i n st o p u l m o n a r ya n d b r o n c h o p u l m o n a r y( h i l a r )n o d e s ,i n f e r i o rt r a c h e o b r o n c h i a( lc a r i n a l )
nodes,left superiortracheobronchialnodes,left paratracheal
nodes and/or (aortic arch) node of ligamentumarteriosum,
t h e n t o b r a c h i o c e o h a l ivce i n v i a l e f t b r o n c h o m e d i a s t i n at rlu n k
a n d t h o r a c i cd u c t . L e f t i n f e r i o rl o b e d r a i n sa l s ot o o u l m o n a r v
a n d b r o n c h o p u l m o n a r y( h i l a r )n o d e sa n d t o i n f e r i o rt r a c h e o ) o d e s ,b u t t h e n m o s t l yt o r i g h ts u p e r i o r
b r o n c h i a l( c a r i n a l n
t r a c h e o b r o n c h i anl o d e s ,w h e r e i t f o l l o w ss a m e r o u t e a s l y m p h
f r o m r i g h tl u n g .

Lungs

Autonomic Nerves in Thorax


SeealsoPlates 130, 131, 165, 166, 318

Cervicothoracic
( s t e l l a t eg) a n g l i o n
A n s as u b c l a v i a
Cervicalcardiac nerves
(sympathetia
c nd vagal)
T h o r a c i c( s y m p a t h e t i c )
c a r d i a cb r a n c h e s

Left recurrentlaryngealnerve
Cervicalcardiac nerves
(sympatheticand vagal)
Vagus nerve (X) (cut)
Thoracic(sympathetic)
c a r d i a cb r a n c h e s
Left recurrentlaryngealnerve

S y m p a t h e t i ct r u n k
Vagus nerve (X) (cut)
a n d b r a n c h e st o c a r d i a c
a n d p u l m o n a r yp l e x u s e s
T h o r a c i c( s y m p a t h e t i c )
c a r d i a cb r a n c h e s
A n t e r i o rp u l m o n a r yp l e x u s

T h o r a c i cc a r d i a cb r a n c h
ofvagusnerve
C a r d i a cp l e x u s

A n t e r i opr u l m o n a rpy l e x u s
P o s t e r i opru l m o n a rpyl e x u s
( p r o t r u d i nfgr o mb e h i n d
leftbronchus)

P o s t e r i opru l m o n a rpyl e x u s
( p r o t r u d i n gf r o m b e h i n d
r i g h tb r o n c h u 5 ) 6th intercostalnerve
Cray and white
ramicommunicantes

Sympathetictrunk
Thoracicaortic olexus

E s o p h a g epal le x u s
Bth intercostalnerve

6th thoracic
s y m p a t h e t i cg a n g l i o n
Creater thoracic
s p l a n c h n i cn e r v e
S y m p a t h e t i cb r a n c h
t o e s o p h a g e apl l e x u s

ay andwhite
ramicommunicantes
Creater thoracic
s p l a n c h n i cn e r v e
L e s s e tr h o r a c i c
s p l a n c h n i cn e r v e

T h o r a c i cd u c t
A n t e r i o rv a g a lt r u n k
L e s s e tr h o r a c i c
s p l a n c h n i cn e r v e

Diaphragm
(pulled down)

Leastthoracic
s p l a n c h n i cn e r v e
Azygosvein (cut)
I n f e r i o rv e n a c a v a ( c u t )

Lungs

Nr
Plate 2O9

Innervation of Tlacheobronchial Tlee: Schema


SeealsoPlates 167,168

C l o s s o p h a r y n g e anle r v e( l X )

D e s c e n d i n gt r a c t s
i n s p i n a lc o r d

Vagus nerve (X)


(cholinergic;efferent to smooth
muscle and glands;afferent
f r o m a o r t a ,t r a c h e o b r o n c h i a l
m u c o s aa n d a l v e o l i )
S u p e r i o rc e r v i c a l
s y m p a t h e t i cg a n g l i o n
Sympathetic nerves

Afferent nervesfrom
n o s e a n d s i n u s e s( v i a
t r i g e m i n a [l V ] a n d
glossopharyngealflXl
nerves)may also initiate
reflexesin airways

Superior
laryngeal
nerve

Larynx

(adrenergic)

T3
Cough
receptors

T4

T5

S y m p a t h e t i ct r u n k

n{r

P u l m o n a rpyl e x u s

ough receptors

Parasympathetic
fibers
Sympathetic
fibers
Afferentfibers
lrritant receptors

Stretchreceptors(Hering-Breuerreflex)

Plate 21O

Lungs

Heart in Situ

Inferiorthyroid veins

Thymus

Trachea
Left common carotid artery
Left brachiocephalicvein

B r a c h i o c e o h a l itcr u n k

I n t e r n ajlu g u l a rv e i n

R i g h tb r a c h i o c e p h a l ivce i n

Vagus nerve (X)

P h r e n i cn e r v e

Arch of aorta

A n t e r i o rs c a l e n em u s c l e

T h o r a c idc u c t

B r a c h i apl l e x u s

Left recurrentlaryngealnerve

E x t e r n aj lu g u l a rv e i n

Internalthoracic artery

Subclavianartery and vein

Phrenicnerve and
ic
pericardiacophren
artery and vein

Superiorvena cava

1s t r i b

Mediastinalpart
of parietalpleura

P h r e n i cn e r v ea n d
pericardiacophrenic
artery and vei
R i g h tl u n g

Leftlung

Pericardium
Diaphragm

Mediastinal

*{r
Heart

Diaphragmatic
Costal

Partsof
parietal
pleura

L i n eo f f u s i o n
of fibrous
pericardium
to diaphragm

lnternal
thoracic
artery

Superior
epigastric
artery

Musculophrenic
arrery

Plate 211

Heart: Anterior Exposure

Pericardium(cut edge) at site


of reflectionfrom great vessels

Brachiocephalic

Right vagus nerve

Left brachiocephalicvein

R i g h itn t e r n al u
l g u l avr e i n
Arch of aorta

Right recurrentlaryngealnerve
R i g h tb r a c h i o c e p h a l ivce i n

Left common carotid artery

Phrenicnerve
Left internaljugular vein

S u b c l a v i a na r t e r ya n d v e i n
Internalthoracic
artery and vein

Left vagus nerve

Ligamentum
arteriosum

P h r e n i cn e r v ea n d
pericardiacophrenic
artery and vei

Left recurrentlaryngealnerve

P u l m o n a rtyr u n k

Superiorvena cava

Leftpulmonary
artery

Right
p u l m o n a r ya r t e r
Transverse
pericardial

Transverse
p e r i c a r d i sailn u s

R i g h st u p e r i o r
p u l m o n a rvye i n

Left
supenor
pulmonary
vetn

Hilumof
r i g h tl u n g
Mediastinal
pleura
(cut edge)

Hilum
of left
lung

Pericardium
(cut edge)

Mediastinal
part of
parietal
preura
(cut edge)
Pericardium
(cut edge)

Right
ventricle

4{tr

Conusarteriosus
R i g h ta u r i c l e
( a t r i a la p p e n d a g e )

R i g ha
t trium

Plate 212

C o r o n a r ys u l c u s
right coronary artery

A n t e r i o ri n t e r v e n t r i c u l a i

s u l c u sa n da n t e r i o r
i n t e r v e n t r i c u bl ar ra n c h
of leftcoronaryartery

Left
auricle
(atrial
appendage)

Inferior
border
(acute
margin)
of heart

Apex
of heart
Left
ventricle

Leftborder
( o b t u s em a r g i n )
of heart

Heart

Radiograph of Chest

Precordialareasof auscultation
A

Apex of heart

AA

Aortic arch

Clavicle

CP

C o r a c o i d p r o c e s so f s c a p u l a
D o m e o f d i a p h r a g m( r i g h t )

D
lV

l n f e r i o rv e n a c a v a

PA

P u l m o n a r ya r t e r y ( l e f t )

RA

R i g h ta t r i u m

Spineof scapula

SV

S u p e r i o rv e n a c a v a

T r a c h e a( a i r )

Left ventricle

Aortic area

Valves
valve
Pulmonic

P u l m o n i ca r e a

Tricuspidarea

Aortic valve
Mitral

M i t r a la r e a

Tricuspidarea

eUd4/*
Heart

Plate 213

Heart: Base and Diaphragmatic Surfaces

R i g h tp u l m o n a r ya r t e

Arch of aorta

Left pulmonary artery

Right auricle (atrialappendage)

Left auricle
( a t r i a la p p e n d a g e )

Superiorvena cava

Left superior
p u l m o n a r yv e i n

R i g h ts u p e r i o r
p u l m o n a r yv e i n

Left atrium

Rightatrium

Left inferior
p u l m o n a r yv e i n

S u l c u tse r m i n a l i s

Pericardialreflection
Right inferior
p u l m o n a r yv e i n

O b l i q u ev e i n
of left atrium
(of Marshail)

C o r o n a r sy u l c u s

C o r o n a r ys i n u s

Inferiorvena cava

Left ventricle

R i g h tv e n t r i c l e

Apex

Baseof heart:posteriorview

Left subclavianartery
L e f tc o m m o n c a r o t i da r t e r y

Leftpulmonaryartery
L e f ts u p e r i o rp u l m o n a r yv e i n

B r a c h i o c e p h atlriucn k
S u p e r i o rv e n a c a v a
Arch of aorta
Right pulmonary artery
R i g h ts u p e r i o rp u l m o n a r yv e i n

Left auricle (atrialappendage)

R i g h ti n f e r i o rp u l m o n a r yv e i n

Left inferior pulmonary vein

terminalis

O b l i q u e v e i n o f l e f ta t r i u m

R i g h at t r i u m
Left atrium
Pericardialreflection

C o r o n a r sy i n u s
Leftventricle

*{r
Plate 214

Inferiorvena cava
Coronary sulcusand
right coronary artery
Posteriorinterventricularsulcus
and posterior interventricular
branch of right coronary artery
(posteriordescendingartery)
R i g h tv e n t r i c l e

Baseand dia.phragmatic
surfaces:
posrerornreflor
vtew

Heart

Pericardial Sac

Suoeriorvena cava

Archof aorta

Pericardium(cut edge)

P u l m o n a rtyr u n k
Ascendingaorta
Left auricle (atrialappendage)

pericardial
sinus
Transverse

Left ventricle

eft pulmonary veins

Coronary sinus

Oblioue vein of left atrium


(Marshall's)

Posterior
i n t e r v e n t r i c usl aurl c u s

O b l i q u ep e r i c a r d i sa iln u s

R i g h tv e n t r i c l e

Leftatrium

Diaphragmaticpart
of pericardium

R i g h tp u l m o n a r yv e i n
Esophagealprominence

Sternocostaloart of
pericardium(cut edge)

Heart drawn out of opened


pericardialsac:left lateralview

R i g h at t r i u m
{r.";.1"h

!,

lnferior vena cava

Arch of aorta
Ascendingaorta
R i g h tp h r e n i cn e r v ea n d
pericardiacophren
ic
5 U p e n o rv e n a c a v a

Mediastinalpart of
parietalpleura (cut edge)
phrenic nerve and
pericardiacophrenicvessels

pericardial
Transverse
sinus
P u l m o n a rtyr u n k( b i f u r c a t i o n )
Superiorvena cava

Leftlung
R i g h tp u l m o n a r yv e i n s
Mediastinalpart of
parietalpleura (cut edge)
Pericardium(cut edge)

eft pulmonary veins


Pericardium(cut edge)

sinus
Obliquepericardial
Esophagealprominence

Inferiorvena cava
Line of fusion

Diaphragmaticpart
of oericardium

o f f i b r o u sp e r i c a r d i u m
to diaphragm

',
Pericardialsacwith
heart removed:anteriorview

Heart

4{tr
Plate 215

Goronary Arteries and Gardiac Veins

(SA)
Sinuatrial
nodal branch

Leftauricle(cut)
Leftcoronaryartery

Atrialbranchof right
coronaryartery

Circumflexbranchof
left coronaryartery
Rightcoronaryartery
Creatcardiacvein
Left (obtuse)marginalartery
Anteriorinterventricular
branch(leftanterior
descending)
of left
coronaryartery

Anteriorcardiacveins

Smallcardiacvei

Right(acute)marginalbranch
of rightcoronaryiltery -

Diagonalbranch
of anterior
interventricu
lar
artery

Interventricular
septalbranches

Sternocostalsurface

(SA)nodalbranch
Sinuatrial

Obliqueveinof leftatrium
(of Marshall)

(SA)node
Sinuatrial

Creat cardiacvein

Circumflex
branchof
" leftcoronaryartery
Smallcardiacvein

Leftmarginalbranch
Coronarysinus
Posterior
left
ventricular
branch
Posterior
veinof
left ventricle

Middle cardiac vein


Interventricular

septalbranches

Plate 216

Rightcoronaryartery
Posteriorinterventricular
branch(posteriordescendin
g)
of right coronaty artery

Right marginalbranch

Diaphragmaticsurface

4{tr
Heart

Coronary Arteries and Gardiac Veins: Variations

(leftanteriordescending)
Anteriorinterventricular
branchof left coronaryarteryis very short.Apicalpart
surfacesuppliedby branches
of anterior(sternocostal)
(posterior
descending)
from posteriorinterventricular
branchof rightcoronaryarterycurvingaroundapex.

(posteriordescending)
Posteriorinterventricular
branchis derivedfrom circumflexbranchof
left coronaryarteryinsteadof from right
coronaryartery.

(posteriordescending)
Posteriorinterventricular
branchis absent.Areasuppliedchieflyby small
branchesfrom circumflexbranchof left
coronaryarteryand from rightcoronaryartery.

g)
(posterior
descendin
interventricular
Posterior
branchis absent.Areasuppliedchieflyby elongated
(leftanteriordescending)
anteriorinterventricular
branchcurvingaroundapex.

Heart

Plate 217

Goronary Arteries: Arteriographic Views

Rightcoronaryartery:left anteriorobliqueview
(SA)
Sinuatrial
nodalbranch

Right
coronaryartery

Branches to back of left ven

Right(acute)marginalbranch
Posterior
interventricular
branch(posterior
descending
artery)

Rightcoronaryartery:right anteriorobtiqueview
(SA)nodalbranch
Sinuatrial
Conus(arteriosus)
brancn
coronaryartery
R i g h (t a c u t e )
marginalbranch

Atrioventricular(AV)nodalbranch
Rightposterolateral
branches(to back
of left ventricle)
Posteriorinterventricular
branch
(posterior
descending
artery)

Plate 218

4{r
Heart

Goronary Arteries: Arteriographic Views (continued|

Left coronaryartery:left anteriorobliqueview

coronary artery
C i r c u m f l e xb r a n c h

A n t e r i o ri n t e r v e n t r i c u l abrr a n c h( l e f ta n t e r i o rd e s c e n d i n g )
Diagonal branchesof anterior interventricularbranch
Atrioventricularbranch of circumflexbranch
Le{t (obtuse)marginalbranch

rolateralbranches
(Perforating)interventricularseptal branches

Left coronaryartery:right anteriorobliqueview

coronary artery
Anterior interventricular
branch (left anterior
descending)
Circumflex
branch
Perforating)
Interventricular
septalbranches

Arteriogram

Left (obtuse)marginalbranch

branches
erolateral

4{F

D i a g o n a lb r a n c h

of
A n t e r i o irn t e r v e n t r i c u bl ar ra n c h
Atrioventricularbranch of circumflexbranch

Heart

Plate 2l9

Right Atrium and Ventricle

A s c e n d i n ga o r t a

P u l m o n a r yt r u n k
Right auricle (atrialappendage)

Superiorvena cava

C o n u sa r t e r i o s u s

R i g h tp u l m o n a r ya r t

Cristaterminalis

Pericardialreflection

Atrioventricular
part
of membranous
septum

R i g h st u p e r i o r
p u l m o n a rvye i n

a lc u s p

Left atri

of tricuspidvalve
R i g h ti n f e r i o r
p u l m o n a r yv e i n

Pectinatemuscles
ingof

Interatrialseptum

c o r o n a r sy r n u s

Limbusof fossaovalis

alve

(Thebesian)
of coronary
s r nu 5

Fossaovalis
Valve(Eustachian)
of inferiorvena cava
Inferiorvena cav

Openedright atrium: right lateralview

Pericardialreflection
Aorta

Transverse
p e r i c a r d i sa il n u s
Superiorvena cava
R i g h ta u r i c l e( a t r i a la p p e n d a g e )
Right atrium
P a r i e t alli m b
M e m b r a n o u sp a r t o f
interventricularseptum

Pulmonary
trunk
Transversepericardialsinus

A n t e r i osr e m i l u n acru s p
Pulmonary

Rightsemilunar
cusp

VAIVC

L e f ts e m i l u n a cr u s p

C o n u sa r t e r i o s u s
Supraven
tricular
crest
Septal

p a p i l l a rm
y uscle
lnterventricularseptum
(musculap
r art)

Tricuspid
valve
S e p t o m a r g i n at rl a b e c u l a
(moderator band)
Chordae tendineae

P o s t e r i opra p i l l a rm
y uscle

4{tr

A n t e r i o pr a p i l l a rm
y uscle
Trabeculaecarneae

Plate 22O

Openedright ventricle:anteriorview

Heart

Left Atrium and Ventricle

Arch of aorta

s il n u s
T r a n s v e r spee r i c a r d i a
F o l do f l e f ts u p e r i o r
v e n ac a v a( l i g a m e n t
of Marshall)

Ligamentum
arteflosum
L e f tp u l m o n a r y
artery

l ppendage)
L e f ta u r i c l e( a t r i a a
O b l i q u ev e i n o f
left atrium (of Marshall)

R i g h tp u l m o n a r y
artery
f t p u l m o n a r yv e i n s

Leftatrium
A n t e r i o rp a p i l l a r y

R i g hp
t ulmonary
vetns

C h o r d a et e n d i n e a e

Coronary
srnus

Posteriorpapillarymuscle

lnferior
venacava

4{F

Flap opened in posterolateral


wall of left ventricle

L e f ta u r i c l e( a t r i a la p p e n d a g e )

Archof aorta
eftpulmonary
artery

L e f t s e m i l u n a cr u s p
Aortic
VAIVE

R i g h ts e m i l u n a cr u s p
P o s t e r i o sr e m i l u n a cr u s p

Membranous
septum

R i g h tp u l m o n a r y
artery
Left superior
p u l m o n a r yv e i n
Valve of

foramenovale
R i g hp
t ulmonary
vetns

M u s c u l a rp a r t o f
i n t e r v e n t r i clua r

seprum

Leftatrium
C o r o n a r ys i n u s

Mltral valve
kut away

lnferior vena cava

Sectionthrough left atrium and ventricle


with mitral valvecut away

Heart

Plale

221

Valves of Fibrous Skeleton of Heart

A n t e r i o rs e m i l u n a rc u s p
Pulmonary
VAIVE

R i g h ts e m i l u n a cr u s p

C o n u sa r t e r i o s u s
Left fibrous trigone

L e f ts e m i l u n a rc u s p
Right coronary artery

Right (coronary)
s e m i l u n a cr u s p

Aortic
valve

Atrioventricular
partof
membranous

Left (coronary)
semilunar
Posterior
(noncoronary)
s e m i l u n a rc u s p

C i r c u m f l e xb r a n c h l

Mitral

Commissural

VAIVE

cusps
Posterior

\Right

fibrou

-Atrioventricul;
nodalbrancht

Left fibrous ring


(of mitral valve

Posteriorinterventricularbrancht

Heart in diastole:
viewedfrom basewith atria removed

A n t e r i o rs e m i l u n a cr u s o
Pulmonary
valve

R i g h ts e m i l u n a rc u s p

L e f ts e m i l u n acru s p

*{r

Conusarteriosus
eft fibrous trigone

Rightcoronaryartery

Right (coronary)
semilunar

l n t e r v e n t r i clua r
part

Left (coronary)
s e m i l u n a rc u s p

Atrioventricular
part

Posterior
(noncoronary)
semilunar

Membranous
septum

Anterior
cusp

C i r c u m f l e xb r a n c h l

Septal
cusp

Tricuspid
VAIVC

Rightfibrousring
(of tricuspidvalve)

Left fibrous ring


(of mitral valve)

Rightfibroustrigone

Posteriorinterventricularbrancht

Heart in svstole:
viewedfrom basewith atria removed

Atrioventricular(AV) nodal brancht

.Of left coronary


artery
tOf right coronary artery

Pfate 222

Heart

Valves and Fibrous Skeleton of Heart (continued|

C o m m i s s u r eo f s e m i l u n a vr a l v ec u s p s
Opening of left coronary artery

Ascendingaorta

N o d u l e o f s e m i l u n a vr a l v e
(body of Arantius)

Aortic sinuses(of Valsalva)


O p e n i n go f
right coronary artery

Membranous
septum

B r o k e nl i n e i n d i c a t i n gl e v e l
of origin of tricuspidvalve
o n o p p o s i t es i d eo f s e p t u m - '

y uscle
A n t e r i opr a p i l l a rm
Anteriorcusp
of mitralvalve

Muscularpartof
interventricularseptum

Atrioven
tricular
part

O p e n i n go f
inferiorvena cava

Membranous
septum

- lnterventricular
part (behind valve)

R i g h ta t r i u m
O p e n i n go f
c o r o n a r ys r n u s

Posterior
cusp
Anteriorcusp

C h o r d a et e n d i n e a e

Septalcusp

Septal
p a p i l l a rm
y uscle

Tricuspid
VAIVE

Posteriorpapillary
muscle (sectioned)

Posterior
p a p i l l a r ym u s c l e
(sectioned)

A n t e r i o pr a p i l l a r y
muscle

Tricuspid(right atrioventricular)valve
Anteriorcusp

Left atrium

Mitral

cusp
Posterior

VAIVE

C h o r d a et e n d i n e a e

Commissural
cusps
Anterior

p a p i l l a rm
y uscle
(sectioned)

Anterior papillary
muscle (sectioned)

Mitral (left atrioventricular) valve

Heart

*{r
Plale 223

Atria, Ventricles, and Interventricular Septum

P u l m o n a r yt r u n k

R i g h ts u p e r i o rp u l m o n a r yv e i n
Aortic sinus(of Valsalva)

Anteriorcuspof
mitralvalve
Left atrium

Openings of coronary arteries


Ascendingaorta
R i g h ta u r i c l e( a t r i a la p p e n d a g e )

Left auricle
( a t r i a la p p e n d a g e )

Left semil u n a rc u s p

Ascendingaorta
L e f ts e m i l u n a cr u s p

Aortic
valve

Aortic
valve

Left
pulmonary
vetns

R i g h ts e m i
r u n a rc u s p

Posterior
s e m i l u n a r( n o n coronary) cusp

Superior
venacava
Atrioventric
ut a r
part
\
Interventric
ular

Outflow
to
putmonary
trunk

pdrr\\

onus
arteriosus
Right
anteflor
papillary
muscle (cut)
Right
ventricle

Rightatriurir
S e p t o m a r g i n at rl a b e c u l a
(moderator band)

Anterior
cusp
(retracted)

S e p t a l( m e d i a l )p a p i l l a r ym u s c l e

Septal

cusp
Posterior
cusgi
R i g h tv e n t r i c l e

Left
ventricle

4{tr

Leftposterior
p a p i l l a rm
y uscle

R i g h ta n t e r i o r

papillarymuscle(cut)

Left anterior

p a p i l l a rm
y uscle
Right posterior papillarymuscle
Left ventricle
M u s c u l a rp a r t o f i n t e r v e n t r i c u l asre p t u m

Plale 224

Planeof section

Heart

Gonducting System of Heart

Ascendingaorta
A t r i o v e n t r i c u l apr a r t

S u p e r i o rv e n a c a v a

I n t e r v e n t r i c u l apra r t
S i n u a t r i a(lS A )
nodal artery

septum
v"ru,.rnous
I

P u l m o n a r yv a l v e
Atrioventricular(AV) node

Sinuatrial
( S A )n o d e

(AV)
Atrioventricular
b u n d l e( o f H i s )

C r i s t at e r m i n a l i s

R i g hb
t undle

Note: Specific
i n t e r n o d a cl o n d u c t i o n
pathwaysin the atria
may exist based on
s t r o n gp h y s i o l o g i c a l
and someanatomical
evidence

Purkinjefibers
L,

Septomarginal
trabecula
( m o d e r a t o rb a n d )

terior
p a p i l l a rm
y uscle

R i g h ft i b r o u sr i n g
( o ft r i c u s p i vda l v e

Subendocardial
branches

Inferior vena cava ----{

( P u r k i n jfei b e r s )

Rightside

P o s t e r i o sr e m i l u n a rc u s o

Aortic
valve

L e f ts e m i l u n a rc u s p

Arch of aorta

R i g h st e m i l u n acru s p

Membranous
septum

P u l m o n a r yt r u n k

I n t e r v e n t r i c u l apra r t

S u p e r i o rv e n a c a v a

Atrioventricularpart

Left auricle

Leftbundle
Right
p u l m o n a r yv e i n s

Anterior
p a p i l l a r ym u s c l e

Mitral valve
(cut awaY)

Subendocardial
branches
( P u r k i n j ef i b e r s )

M u s c u l apr a r to f
i n t e r v e n t r i c usl aerp t u m

/\_
Left side

Plale 225

Nerves of Heart
$@So Pmts13O, 15,ltr, ffi

S u p e r i o rc e r v i c a l
sympatheticganglio
Rightvagus nerve (X)
( C o n j o i n e ds y m p a t h e t i ca n d
vagal)superiorcervicalcardiac nerves
Middle cervical
sympathetic
Middle cervical
(sympathetic)cardiac nerve
Phrenicnerve
Inferior cervical
(vagal)cardiac branch
Vertebralganglion

I n f e r i otrh y r o i da r t e r y
Vertebralartery
Cervicothoracic
( s t e l l a t eg) a n g l i o n
Ansa subclavia

S u p e r i o rc e r v i c a l
sympatheticganglion
Leftvagus nerve (X)
Superiorcervical
(sympathetic)cardiac nerve
Superiorcervical
(vagal)cardiac branch
Middle cervical
s y m p a t h e t i cg a n g l i o n
Phrenicnerve
Middle cervical
(sympathetic)cardiac nerve
Inferiorcervical
(vagal)cardiac branch

ertebralganglion
Cervicothoracic
( s t e l l a t eg) a n g l i o n
Inferiorcervical
sympathetic
cardiac nerves

Right recurrent
laryngealnerve

Inferior cervical
( s y m p a t h e t i cc)a r d i a cn e r v e s
Thoracic cardiac brancn
of vagus nerve
4th thoracic
sympatheticganglion
Thoracic (sympathetic)
c a r d i a cI p 1 n 6 h s 5 Cardiac plexus

3rd thoracic
s y m p a t h e t i cg a n g l i o n
Thoracic (sympathetic)
cardiac branches
'Thoraciccardiac
branch of
vaSusnerve
Left recurrent
laryngealnerve

Phrenic nerve (cut)

Plale

226

Heart

lnnervation of Heart: Schema


Posterior
nucleus
Superiorcervical
s y m p a t h e t i cg a n g l i o n

ofvagusnerve

Nucleusof
solitarytract

Superiorcervical
(sympathetic)cardiac nerve

Middle cervical
sympatheticga
S u p e r i o rc e r v i c a l
(vagal)cardiac br

Middle cervical
(sympathetic)cardiac nerve

lnferior cervical
(vagal)cardiac branches

I
I
I

Vertebralganglion (variation)

t
I
I

Ascending
connections

A n s as u b c l a v i a

Cervicothoracic

(stellate)

I
I
I
I
I

lst intercostal
nerve

lnferior cervical
(sympathetic)cardiac nerve

Thoracic cardiac
branch ofvagus nerve

2nd thoracic
sympatheticganglion

W h i t e r a m u sc o m m u n i c a

C r a y r a m u sc o m m u n i c a n s
Thoracic (sympathetic)
cardiac branches-

gangliori
4th thoracicsympathetic
Cardiac
prexus

Sympatheticpreganglionic
postganglionic
Sympathetic
preganglionic
Parasympathetic
postganglionic
Parasympathetic
Visceralafferentaccompanying
sympatheticfibers
Visceralafferentaccompanying
parasympathetic
fibers

Heart

*{r
Plale 227

lnnervation of Blood Vessels: Schema

Cervicalsympathetic
trunkganglia

Internalcarotidnerve
------r-r-----r

,a---

White ramuscommunicans
Cervicalcardiacnerves
Brachial
plexus

Cardiopulmonarysplanchnic
\ aand
: : _ aortic
_ _ : _nerves

lntercostal
nerves

Spinalnerves

Upperlumbar
sympathetic
trunkgangli

Spinalnerves
Grayramuscommunicans

*{r

Lowerlumbar
sympathetic
trunkganglia

Sympatheticfibers

Postganglionic
sympathetic
fibersto lumbarand
sacralplexuses
and
to nervesof lowerlimb

Preganglionic
Postganglionic

Plate 22a

Heart

Prenatal and Postnatal Girculation

Prenatalcirculation

Pulmonarv
trunk
Superiorvena
Rightpulmonary

Ductusarteriosus
Leftpulmonaryartery
eft pulmonaryvein

Rightpulmonaryvein
Foramen ovale

Inferiorvenacava
Hepaticvein
Ductusvenosus
Celiactrunk
artery
Superiormesenteric
Ligamentur
arteriosum

Umbilicalarteries

*{r

Fossaovalis
(obliterated
foramenovale
Ligamentum
venosum
(obliterated
ductusvenosus)
Ligamentum
teres
(roundligament)of liver
(obliteratedumbilicalvei
Medialumbilicalligaments
(occludedpartof umbilicalarteries)
Postnatal circulation

Heart

Plate 229

Mediastinum: Right Lateral View


Cervical(cupula,or dome, of) parietalpleura
and suprapleuralmembrane (Sibson'sfascia)

Anterior scalenemuscle and phrenic nerve

B r a c h i apll e x u s
1s t r i b
R i g h ts u b c l a v i a na r t e r ya n d v e i n
Trachea
Clavicle
Rightvagus nerve (X)

S u b c l a v i umsu s c l e
1s t r i b

Sympathetictrunk

Right and left


b r a c h i o c e p h a l ivce i n s

Right superior intercostalvei


4th thoracic vertebral
Arch of azygosvein
R i g h tm a i n b r o n c h u s
a n d b r o n c h i a la r t e r y

Right internalthoracic
artery

Thymus(seenthrough
m e d i a s t i npalle u r a )
S u p e r i o rv e n a c a v a

Azygos vein
Posteriorintercostal
v e i n a n d a r t e r ya n d
intercostalnerve
Internalintercostal
muscte
Internalintercostal
m e m b r a n ed e e p t o
externalintercostal

muscle
Cray and white
r a m tc o m m u n r c a n t e s
Costal part of
parietap
l leura
(cut edge)
Creater thoracic
s p l a n c h n i cn e r v e

E s o p h a g uasn d
plexus
esophageal
B r o n c h o pl m
u onary
(hilar)lymph
P u l m o n a r yl i g a m e n t
(cut)

* N e r v e a n d v e s s e l sc o m m o n l y r u n i n d e p e n d e n t l y

Plate 23O

P h r e n i cn e r v ea n d
pericardiacophrenic
artery and vein"
R i g h tp u l m o n a r y
artery

M e d i a s t i np
aa
l rt
of parietalpleura
(cutedge)
F i b r o u ps e r i c a r d i u m
overrightatrium
Righp
t ulmonary
vetns
lnferior vena cava
(covered by
m e d i a s t i n apl a r t
of parietalpleura)
Diaphragm (covered by
diaphragmaticpart
of parietalpleura)

Costalpartof
parietalpleura(cutedge)
Costodiaphragmaticrecess
of pleuralcavity

Nr
Mediastinum

Mediastinum: Left Lateral View

A n t e r i o rs c a l e n em u s c l ea n d o h r e n i cn e r v e

Cervical(cupula,or dome, of) parietalpleura and


s u p r a p l e u r am
l e m b r a n e( S i b s o n ' sf a s c i a )

B r a c h i apll e x u s
1s t r i b
Left subclavianvein and artery

S u b c l a v i umsu s c l e

Esophagus
Thoracicduct

Clavicle

v a g u sn e r v e( X )

Left brachiocephalicvein

Leftsuperior
vein
intercostal

Left internalthoracic arterv

Archof aorta
T h y m u s( s e e nt h r o u g h
Leftrecurrent
nerve
laryngeal

m e d i a s t i n apl l e u r a )
L i g a m e n t u ma r t e r i o s u m

Bronchopulmonary
( h i l a rl)y m p hn o d e s

Left pulmonary artery

Accessory
hemiazygosvein

Left phrenic nerve and


pericardiacophrenic
artery and veinl

Posteriorintercostal
vein and artery and
intercostalnerve

Mediastinalpart o{
parietalpleura
(cut edge)

Internalintercostal
muscle

F i b r o u sp e r i c a r d i u m

Internalintercostal
m e m b r a n ed e e p t o
externalintercostal
muscre

L e f tp u l m o n a r y
vetns

Crayand white
ramicommunicantes

P u l m o n a r yl i g a m e n t
(cut)

Costalpleura
(cut edge;
E s o p h a g uasn d
plexus
esophageal
(coveredby mediastinal

thetic trunk

part of parietalpleura)

reater thoracic
splanchnicnerve

Diaphragm (covered
b y d i a p h r a g m a t i cp a r t

Thoracic
(descending)aorta

of parietalpleura)

Leftmainbronchus
andbronchialartery

C o s t o di a p h r a g m a t i c
recessof pleuralcavity

Costalpartof
parietalpleura(cutedge)
*Nerve and vesselscommonly run independently

Mediastinum

4{F
Plate 231

Esophagus in Situ

C o m m o n c a r o t i da r t e r y
A n t e r i o rs c a l e n em u s c l e
P h r e n i cn e r v e
P o s t e r i o sr c a l e n em u s c l e
B r a c h i apl l e x u s
S u b c l a v i a na r t e r y
T h y r o c e r v i c at lr u n k

I p a r to f e s o p h a g u s
Recurrentlaryngealnerves
Thoracicduct
I n t e r n ajlu g u l a rv e i n ( c u t )
S u b c l a v i a nv e i n ( c u t )
L e f tb r a c h i o c e p h a l ivce i n ( c u t )
Internalthoracic artery (cut)

V a g u sn e r v e( X

Phrenicnerve (cut)

1 s tr i b( c u t )

Common carotid artery

t
Brachiocephalic

trunk-'

L o n g u sc o l l i m u s c l e

S u b c l a v i a na r t e r y

Vagus nerve (X)

Trachea

Left recurrent
l a r y n g e anl e r v e

Arch of
aorta

Bifurcation
of trachea

Arch of
a z y S o sv e t n
R i g h tm a i n

pleura
(cut edge)

bronchus
S u p e r i ol ro b a r

eft main
bronchus

(eparterial)

bronchus

Thoracic
(descending)
aorta

Thoracicpart
of esophagus
Esophageal
plexus

M e d i a s t i n apl a r t o f
parietalpleura
(cut edge)

Mediastinal
part ot
parietap
l leura
Gut eagel-

Pericardium
(cut edge)
Diaphragm
Diaphragmatic
part of
parietap
l leura

Inferior
vena cava

Anterior
v a g a lt r u n k

(cur)
Hepatic
v e i n s( c u t )
Inferior
v e n ac a v a
R i g h ta n d
l e f t c r u r ao f
diaphragm
In f e r i o rp h r e n i ca r t e r i e s

4{tr

C e l i a ct r u n k
A b d o m i n a la o r t a

Plale 232

Stomach
Abdominal
part of
esopnagus

Mediastinum

Topography and Gonstrictions of Esophagus

lnferiorpharyngeal
muscle
constrictor
Thyroidcartilage
Piriformfossa(recess)
Pharyngoesophageal
constriction

Thyroidcartilage
Cricoidcartilage

16
q
O

Thoracic
(aortobronchial)
constriction

E
o

Cricoidcartila

(muscle)
Cricopharyngeus
partof inferiorpharyngeal
constrictor

Cricopharyngeus
(muscle)partof
inferior
Archof aorta
pharyngeal
constrictor
Sternum
Trachea

.E
Arch of aorta

oo

s
DO
GI
q,

Leftmain
bronchus

Lateralview

38
40

Diaphragmatic
constriction
(inferior
esophageal
"sphincter";+
Abdominalpart
of

Fundusof stomach

Cardiacparl
of

4{tr
Mediastinum

Plate 233

Musculature of Esophagus

nferior pharyngealconstrictor muscle

Zone of sparsemusclefibers
(muscle)
Cricopharyngeus
partof inferiorpharyngeal
constrictor

Cricoid
cartilage

Mainlongitudinal
musclebundle
passingupwardandventrallyto
attachto middleof posterior
surfaceof cricoidcartilage
Accessory
musclebundlefrom posterolateralsurfaceof cricoidcartilageAdditionalfibersfrom contralateral
(muscle)
sideof cricopharyngeus
partof inferiorpharyngeal
constrictor

Trachea

Circularmusclelaverwith
sparselongitudinal
fibers
in V-shaped
area(of Laimer)
Bareareaon ventralsurfaceof
Lateralmassof longitudinal
muscle
Fibroelastic
membranes
with sparsemusclefibers

Windowcut in longitudinal
musclelayer
Circularmusclelayer

Leftmain
bronchus

4{r
Plate 234

Mediastinum

Pharyngoesophageal Junction

muscle
constrictor
Superiorpharyngeal
Rootof tongue
Epiglottis
Middle pharyngealconstrictormuscle
Palatopharyngeusmuscle
I Longitudinal

Stylopharyngeusmuscle
t lil"r'J:g*'
fold
inlet(aditus)
Laryngeal
Thyroidcartilage(superiorhorn)
Thyrohyoidmembrane
branchof superiorlaryngeal
artery
nerveandsuperiorlaryngeal
andvein
arvtenoidmuscle
Transverse
arvtenoidmuscle
Thyroidcartilage
Posteriorcricoarytenoidmuscle
muscle
constrictor
Inferiorpharyngeal
Pharyngeal
aponeurosis(cut away\
Zoneof sparsemusclefibers
(muscle)partof inferior
Cricopharyngeus
pharyngeal
constrictor
Cricoidcartilage(lamina)
Cricoesophagealtendon
(attachmentof longitudinalesophagealmuscle)

Posteriorview with
pharynxopenedand
mucosaremoveo

muscle
Circularesophageal
mucosaand submucosa
Esophageal
area(of Laimer)
Circularmusclein V-shaped
Rightrecurrentlaryngealnerve

muscle
esophageal
Longitudinal

muscle
Windowcut in longitudinal
exposescircularmusclelayer

4{F
Mediastinum

Plate 235

Esophagogastric Junction

Esophagus

gitudinalesophagealmuscle
Esophageal
m

Circularesophagealmuscle

Submucosa
Cradualslightmuscularthickening
Phrenoesophageal
ligament
(ascendingor upper limb)
Supradiaphragmatic
fascia
Diaphragm
nfradiaphragmatic
(transversalis)
fascia
Phrenoesophageal
Iigament
(descendinglimb)
Peritoneum

Subhiatal
fat ring
Zigzag (Z) line:
junctureof
esophagealand
gastnc

Cardiacnotch

Cardiacpart
(cardia)
of stomach

Longitudinalesophagealmuscle(cut)
Circularesophagealmuscle
(shown hereas spiral)
Cardiacnotch

Castricfolds
(rugae)

Fundus
of
stomach
Collarof Helvetius

Window cut in middlecircularmusclelayerof stomach

Innermostobliquemusclelayerof stomach
(formssling)

Outer longitudinalmusclelayerof stomach(cut)

4{F
Plate 236

Mediastinum

Arteries of Esophagus

branchof
Esophageal
Inferiorthyroidartery
Common
carotidartery
Subclavian

Esophageal
branchof
Inferiorthyroidartery
Cervicalpartof esophagus
trunk
Thvrocervical
artery
Subclavian
Vertebralartery
lnternalthoracicartery
Commoncarotidartery
trunk
Trachea
Arch of aorta
artery
3rd rightposteriorintercostal
t bronchialarterv
Superiorleftbronchialartery
branchof rightbronchialartery
Esophageal
branch
Inferiorleftbronchialarteryand esophageal
aorta
Thoracic(descending)
of thoracicaorta
branches
Esophageal

Thoracicpart
of esophagus

inalpart
of esophagus
Diaphragm
Stomach

Inferior phrenic
Common hepatic artery

Mediastinum

Esophageal
branchof left
gastricartery
Leftgastricartery
Celiactrunk
artery(cut)

EsoPhageal
Commonvariations:
branchesmayoriginatefrom left
inferiorphrenicarteryand/or
directlvfrom celiactrunk.
to abdominalesophagus
Branches
mayalsocomefrom splenicor
shortgastricarteries.

Plale 237

Veins of Esophagus
SeealsoPlate 312
I n f e r i o rt h y r o i dv e i n
I n t e r n ajlu g u l a rv e i n

I n f e r i o rt h y r o i dv e i n

I n t e r n aj ul g u l a r
vetn

E x t e r n aj lu g u l a rv e i n
S u b c l a v i a nv e i n
\ Subclavian
vetn

Vertebralvein

Thoracic
duct

Right
b r a c h i o c e p h a l ivce i n

Left brachioc e p h a l i cv e i n

S u p e r i o rv e n a c a v a

Left superior
i n t e r c o s t avl e i n

R i g h ts u p e r i o r
i n t e r c o s t avl e i n

E s o p h a g e avle i n s

(plexus)

Esophagus

Accessory
h e m i a z y g ovse i n

6 t h r i g h tp o s t e r i o r
i n t e r c o s t avl e i n
Azygos vein
Junctionof accessory
nemrazygos
a n d a z y g o sv e i n s
Hemiazygos
Submucous
venousplexus
vetn
inferior phrenic vein
TLeft

Inferiorvena cava (
Diaphragml

,il

S h o r tg a s t r i cv e i n s

Liver

H e p at i c
verns

Hepatic
portal
vetn

R i g h tr e n a lv e i n
Left gastricvein

Omental
(epiploic)
verns
Left gastro-omental
( g a s t r o e p i p l o i cv)e i n

Right gastricvei
Esophagealbranchesof left gastricveiri

Plate 238

I n f e r i o rm e s e n t e r i cv e i n
S u p e r i o rm e s e n t e r i cv e i n
R ig h t g a s t r o - o m e n t a( g
l a s t r o e p i p l o i cv)e i n

Nr

Mediastinum

Lymph Vessels and Nodes of Esophagus


SeealsoPlates 2O8,266

Inferior deep cervical


( i n t e r n ajlu g u l a r )n o d e s
V i r c h o w ' sn o d e
T h o r a c i cd u c t

Paratracheal
nooes
Posterior
mediastinal
nodes
S u p e r i o ra n d i n f e r i o r
t r a c h e o b r o n c iha l
nooes

Posterior
parietalnodes

Intercostal
nooes

S u p e r i o rp h r e n i cn o d e s

Left eastricnodes
(cardiacnodes of stomach)

Juxtaesophageal
and superior
phrenic

C e l i a cn o d e s

*{r
Mediastinum

Plate 239

Nerves of Esophagus

Anterior
view

Superiorganglionof vagusnerve

*{r

ganglion
Superiorcervicalsympathetic
nferior ganglionof vagus nerve

Esophagus

Pharyngealbranch of vagus nerve

Vagusnerve(X)
Recurrent
laryngeal
nerves
Rightrecurrent
laryngeal
nerve

nerve
Superiorlaryngeal
Cervicalsympathetic
trunk
ganglion
Middlecervicalsympathetic
Cervical(sympathetic
andvagal)cardiacnerves
ganglionof cervicalsympathetic
Vertebral
trunk

Ansasubclavia

Ansasubclavia
Branchto esophagus
and recurrent
nervefrom stellateganglion

3rd
intercostal

(stellate)
Cervicothoracic
ganglion
Leftrecurrentlaryngeal
nerve

Crayand
white rami
communicantes

Thoracic(vagal
and sympathetic)
cardiacbranches

Posterior
view

Cardiacolexus
3rd thoracic
sympathetic
ganglion
Thoracic

sympathetic
trunk_
Rightgreater
thoracic
splanchnic
nerve
Sympathetic
fibers along
left inferior
phrenic artery

Branchof
posteriorvagal
trunkto celiac
plexus

plexuses
Pulmonary
plexus
Esophageal
(anteriorportion)
Branchesto esophageal
plexusfrom sympathetic
trunk,greaterthoracic
splanchnic
nerve,and
thoracicaorticplexus
Leftgreaterthoracic
nerve
solanchnic
Anteriorvagaltrunk
Vagalbranchto hepaticplexus
via lesseromentum

Esophageal
prexus
(posterior
portion)

Principal
anteriorvagalbranch
to lessercurvatureof stomach
Vagalbranchto fundus
and bodyof stomach

Posterior
vagaltrunk

Greater
thoracic
splanchnic
nerves

Vagalbranch
to celiacplexus

Sympathetic
fibers along
esophageal
branch of left

gastricartery
Celiacplexus
and ganglia

Plate 24O

Vagal branch
to fundus and
cardiac part
of stomach

Posterior
vagal
branchto
lesser
curvature

Mediastinum

Mediastinum: Gross Section

5th left costal cartilage

Rightventricle

Internalthoracicarteryand vein

thoracismuscle
Transversus
ma.jormuscle
Pectoralis
Pleuralcavity

part,
Interventricular
part
Atrioventricular
of membranous
septum

Muscularpartof
interventricular
septum
Leftventricle

Suoeriorvena cava

Papillarymuscle

Rightatrium

Phrenicnerveand
pericardiacophrenic
artery and vein

Pericardialcavity

partof
Mediastinal
parietalpleura
R i g hltu n g
(middlelobe)
Leftatrium

Phrenicnerveand
pericardiacophrenic
arteryand vein

Coronarysinus

Branchesof right

Leftlung
(superior
lobe)

mainbronchus

of
Branches
leftmainbronchus

Rightinferior
pulmonaryvein

Leftinferior
pulmonary
vein

Oblique
pericardialsinus

Thoracic
(descending)aorta

Esophagusand
esophagealplexus

8th rib
Azygosvein
Hemiazygos vein
Thoracicduct

trunk
Leftsympathetic
TBvertebra

Mediastinum

Leftgreaterthoracicsplanchnicnerve

*{r
Plale

241

Ghest Scans: Axial GT lmages


Seriesof chestaxialCT imagesfrom superior(A) to inferior(C)

A
B
C

ery#
A,
A,
AZ
B
IV
t
TB

tst_
LV
PA

Ascendingaorta
D e s c e n d i n ga o r t a
Azygos vein
Body of vertebra
Inferiorvena cava
Liver
Left (main stem) bronchus
L e f t s u p e r i o rl o b e o f l u n g
Left ventricle
Pulmonaryartery

Plate 242

R
Rib
R B R i g h (t m a i ns t e m )b r o n c h u s
RSI- Rightsuperiorlobeof lung
RV Rightventricle
S
Sternum
SC Spinalcord
SP Spinousprocessof vertebra
SV Superiorvenacava
T
Trachea(bifurcation)

Regional Scans

o
t
o
o
o

f oint
TransverseSection:LowerLevelof T3, Sternoclavicular
Plate243

M e d i a s t i n allv m p h n o d e

Manubrium

o
o
o
t
o

Sternoclavicularioint (articulardisc)
Clavicle

Brachiocephalictrunk
Trachea

II

R i g h tb r a c h i o c e p h a l ivce i n

Left brachiocephalicvein

C o s t a lc a r t i l a s eo f 1 s t r i b

Left common carotid arterY

Pectoralismajor muscle

3
!f
t

Left vagus nerve (X)

R i g h tl u n g

Pectoralisminor muscle

Axillaryfossa
Left subclavian
artery

Tendon of long
head of biceps
brachii muscle

Shaft of left
humerus

S u r g i c anl e c k
of right

Long
headof
triceps
brachii
muscle

humerus
Delroid
muscte

Teres
mrnor
muscle

lntercostal
muscles

Scapula

o
t
o
rl
ql

Left recurrent laryngealnerve

R h o m b o i dm a i o r m u s c l e

Thoracic duct

5
G)

Serratusanterior muscle

Esophagus

o
o
t

ll

Right vagus nerve (X

I n f r a s p i n a tm
u su s c l e

Phrenicnerve

o
o

Leftlung

muscle
Subscapularis

II

Teres
mtnor
muscle

qt

o
-

q)

Costotransverseioint

muscle
Trapezius
Body ofT3 vertebra

S p i n acl o r d

Erectorspinae muscle
Rhomboid maior muscle
muscle
Transversospinalis

C./Td4s/*

o
o

ql

o
-

Transverse
Section:T3-4 Intervertebral
Disc,Manubrium

Plate 244

S u p e r i o rt r a c h e o b r o n c h i al yl m p h n o d e

D
D

o
o

Trachea

Superiorvena cava

o
o
o
t

Right phrenic nerve


Arch of azygosvein

IT

R i g h tl u n g

Internalthoracic artery and vein

Intercostalmuscl

Left lung

Serratusanterior muscle

Ribs

P e c t o r a l i sm i n o r m u s c l e

Tendon of long head of


b i c e p sb r a c h i im u s c l e

C o m b i n e ds h o r t h e a d
o f b i c e p sb r a c h i ia n d
coracobrachialismuscles

Shaft o{

T e n d o no f l o n g
head of biceps
brachii muscle

numerus
Deltoid
muscte

Shaft of
numerus

LOnS
head of
tnceps
brachii

Lateral
head of
tnceps
brachii
muscle

muscte
rl

o
o
I

o
o
o
=,
o
5

Teres
maJor
muscte

Long head of
triceps brachii
muscle

Teresminor muscle

Left latissimusdorsi tendon


( i n s e r t i n go n t o h u m e r u s )

Scapula
Esophagus

Teresmajor muscle

Thoracic duct

T3-4 intervertebraldisc

5
ql

S p i n a lc o r d

R h o m b o i dm u s c l e

o
l

S u b s c a p u l am
r i su s c l e

Left recurrent
laryngealnerve
Left vagus nerve (X)
Trapeziusmuscle

Obliquefissure(of leftlung)

o
rh
{

Axillaryfossa

L a t i s s i m udso r s i
tendon

Pectoralismaior muscle

T e r e sm i n o rm u s c l e
Scapula
I n f r a s p i n a t um
s uscle

CUd4*/*

o
r|
!l

x
!,
t

g)
I

o
o
F

o
g

TransverseSection: T4-5 Intervertebral Disc, Sternal Angle

rt

o
o
o

I n f e r i o rt r a c h e o b r o n c h i al yl m p h n o d e s

o
o
o

M a n u b r i o s t e r n aj ul n c t i o n

A s c e n d i n ga o r t a
Internalthoracic arterYand vein
R i g h tp u l m o n a r ya r t e r y

=.

2nd costal cartilage

Superiorvena cava

Pectoralismajor muscle

R i g h tl u n g

=
ql

P u l m o n a rtyr u n k
Left pulmonary artery

rt

P e c t o r a l im
s inor muscle

Axillaryfossa

Left lung

lntercostalmuscles

Tendon of long
head of biceps
b r a c h i im u s c l e

L o n gh e a d
of biceps
b r a c h i im u s c l e

Deltoid
muscle

Shaftof
numerus

Lateral
head of
triceps
brachii
muscle

Latissimus
dorsi
tendon

Teresmajor muscle

|,|

ll

anterior
Serratus
muscle

D e s c e n d i n ga o r t a

Trapeziusmuscle

R i g h tm a i n b r o n c h u s
Azygos vein

Esophagus

Thoracic duct
T4-5 intervertebraldisc

$
I
(tl

o
F
o

Accessoryhemiazygosvein

Rhomboid maior muscle!

9.
o

Left main bronchus

I n f r a s p i n a t um
s uscl

o
rt

Teres major
muScle

S u b s c a p u l am
r i su s c l e

Scapula

{
,

Long head of triceps


b r a c h i im u s c l e

!l

o
o
=.
o
a
o
t
ll

Latissimus
dorsi
tendon

!-

Ribs

Coracobrachialis
muscre

o
o

Cfd4*/*

!f
t

Transverse
Section:Levelof T7,3rd InterchondratSpace

rt

o
o

Orifice of tricuspidvalve

Coronarysulcus
Internalthoracic artery and vein

S t e r n u m( b o d y )

o
o
t

R i g h tv e n t r i c l e

IT

Anterior interventricularsulcus
R i g h ta t r i u m

o
rt

Pectoralismajor muscle

Interatrialseptum
Apex of heart

Superiorvena cava
l n t e r v e n t r i c u l asre p t u m
R i g h ti n f e r i o r
p u l m o n a r yv e i n

ry muscte
Left ventricle

Azygos vein

Leafletof mitralvalve
Serratus
a n t e r i o rm u s c l e

Coronarysulcus

L a t i s smi u s
dorsi muscle

o
rt

Coronarysinus
Oblique

Inferior
a n g l eo f s c a p u l a

pericardialsinus

o
o

Descendingaorta

o
o
o
-t
o

Thoracic duct
L a t i s s i m uds o r s i m u s c l e

-a

g
D

=
ql
t

Triangleof auscultation

Triangleof auscultation

Neckof 7th rib


Zygapophyseal(facet)joint

Head of 7th rib


Body offT vertebra
Trapezius muscle

CUd4/^

o
rl
!t

x
qf
t
{
{

o
o

4 Abdomen
Section
Topographic Anatomy
Plale 217

z+z Abdomen

Body Wall
Plates 24&167

ofAbdomen
zca Bony
Framework
Dissection
Wall:
Superficial
Abdominal
zlg Anterior
Dissection
Abdominal
Wdl:Intermediate
zso Anterior
Deep
Dissection
Abdominal
Wall:
zsr Anterior
Cross
Sections
zsz Rectus
Sheath:
Internal
View
AbdominalWall:
zsg Anterior
Wall
Abdominal
zsl Posterolateral
Abdominal
Wall
zss Arteries
ofAnterior
Abdominal
Wall
zse Veins
ofAnterior
Wall
Abdominal
z5z Nerves
ofAnterior
Nerves
zss Thoracoabdominal
Dissections
Region:
zss Inguinal
Spermatic
Cord
zeo Inguinal
Canaland
Inguinal
Hernta
zer Indrrect
Canal
Sheath
andInguinal
zez Femoral
Wdl:Internal
View
Abdominal
zee Posterior
Abdominal
Wall
ofPosterior
zec Arteries
Wall
Abdominal
zes Veins
ofPosterior
Abdominal
Wall
of Posterior
Vessels
andNodes
zee Lymph
Abdominal
Wall
ofPosterror
zsz Nerves

Atlas of Human Anatomy

Abdomen
Peritoneal Gavity

Visceral Vasculature

Plates 26,&174

Plates 3OO-317

zea Regions
andPlanes
ofAbdomen

Arteries
ofStomach,
Liver,
andSpleen
301 Arteries
ofLiver,
Pancreas,
Duodenum,
andSpleen

zeg Greater
Omentum
andAbdominalVrscera
zzo Mesenteric
Relations
ofIntestines
zzr Mesenteric
Relations
(continued)
ofIntestines
zzz Omental
Bursa:
Stomach
Reflected
zzg 0mental
Bursa:
Cross
Section
zzc Peritoneum
ofPosterior
Abdominal
Wall

300

3o2

Variations
inCeliac
Trunk

303

Arteriogram
Celiac

Arteries
of Duodenum
andHead
ofPancreas
305 ArterialVariations
andCollateral
Supply
ofLiver
andGallbladder
304

306

Arteries
ofSmall
Intestine

Viscera (Gutl

307

Arteries
ofLarge
Intestine

Pfates 275-285

308

Variations
inColic
Arteries

zzs Stomach
inSitu
zzs Mucosa
ofStomach

309

zzz Musculature
ofStomach
zza Duodenum
inSitu

3tt

Veins
ofLarge
lntestine

312

Hepatic
Portal
VeinTributaries:
Portacaval
Anastomoses

zzs Mucosa
andMusculature
of Duodenum
zso Mucosa
andMusculature
ofSmall
Intestine
zar lleocecal
Region

313

zsz lleocecal
(continued)
Region
zss Vermiform
Appendix
zac Mucosa
andMusculature
ofLarge
Intestine
position
zas Sigmoid
Colon:Variations
in

Veins
ofStomach,
Duodenum,
Pancreas,
andSpleen
3 t o Veins
ofSmall
Intestine

Variations
Portal
ofHepatic
Vein
314 Lymph
Vessels
andNodes
ofStomach

315

Lymph
Vessels
andNodes
ofPancreas

3t6

Lymph
Vessels
andNodes
Intestine
ofSmall

317

Lymph
Vessels
andNodes
Intestine
ofLarge

Innervation
Plates 318-328

Viscera (Accessory Organsf


Plates 286-299

zae Topography
ofLiver

Autonomic
Nerves
andGanglia
ofAbdomen
3 t 9 Nerves
ofStomach
andDuodenum
318

Nerves
(continued)
ofStomach
andDuodenum
321 Innervation
ofStomach
andDuodenum:
Schema
3.20

zez Surfaces
andBedofLiver
zaa LiverinSituandVariations
inForm

322

Nerves
ofSmall
Intestine

zag Liver
Segments
andLobes:Vessel
andDuctDistribution

323

Nerves
ofLarge
Intestine

zso Intrahepatic
Vascular
andDuctSystems
zsr Liver
Structure:
Schema
zsz Intrahepatic
Biliary
Systems:
Schema

Innervation
ofSmall
andLarge
Intestines:
Schema
325 Autonomic
Reflex
Pathways:
Schema

zse Schematic
Cross
Section
ofAbdomen
atT10
zse Gallbladder
andExtrahepatic
BileDucts
(Common)
zss Junction
of
BileDuct
andDuodenum

324

Intrinsic
Autonomic
Plexuses
ofIntestine:
Schema
327 Innervation
andBiliary
ofLiver
Tract:
Schema
326

328

lnnervation
ofPancreas:
Schema

zge Variations
inCystic
andHepatic
Ducts

Kidneys and Suprarenal Glands

zsz Schematic
Cross
Section
ofAbdomen
atT'12
zgs Pancreas
inSitu
zss Spleen

Plates

Atlas of Human Anatomy

SZC}-347

szs Kidneys
inSitu:
Anterior
Views
inSitu:Posterior
seo Kidneys
Views

Abdomen
ofAbdomen
atT12
Cross
Section
33r Schematic
andVeininSitu
sez RenalArtery
inRenalArtery
andVein
eos Variations
ggr Gross
Structure
ofKidney
andRenal
Segments
sos IntrarenalArteries
Tubule:
Schema
andCollecting
sse Nephron
gsz Blood
ofKidney:
Schema
Vessels
inParenchyma
atT12-11
Section
ofAbdomen
Cross
esa Schematic
atLl-2
Cross
Section
ofAbdomen
esg Schematic
geo Ureters
Bladder
andUrinary
ofUreters
ser Arteries

Bladder
andUrinary
Ureters,
ofKidneys,
sce Nerves
ges Innervation
Schema
Ureters:
andUpper
ofKidneys
andSchema
Dissection
Glands:
ofSuprarenal
oee Nerves
gcz Arteries
inSitu
Glands
ofSuprarenal
andVeins

Abdominal Sections
Plates 348-349

(Sagittal)
gcg AbdominalWall
Section
Paramedian
andViscera:
at 13,4
ofAbdomen
CrossSection
srs Schematic

Regional Scans

Fascia
sez Renal

Plate 35O

Bladder
andUrinary
Vessels
andNodes
of Kidneys
a+s Lymph

CTlmages
Scans:Axial
eso Abdominal

Atlas of Human AnatomY

Abdomen

muscle
Sternocleidomastoid
Deltopectoral

triangle

Sternalhead
Clavicularhead

muscle
Trapezius
Sternum
Body

Deltoidmuscle

Xiphoid
process

Pectoralis
major muscle

Serratus
anterior
muscle

Tendinous
intersection
External
oblique
muscle
Lineaalba
S e m i l u n al irn e
Umbilicus

Anteriorsuperior
i l i a cs p i n e

lliaccrest

Superficial
circumflexiliac vein
Superficial
epigastricveins

lnguinal
ligament

Pubicsymphysis

Pubictubercle

c(d4#

Topographic Anatomy

Plale 247

Bony Framework of Abdomen

4{tr
Transverseorocessesof lumbar vertebrae
I n n e rl i p
lliactuberosity

Intermediate
zone

lliaccrest

Outerlip
Wing (ala)of ilium

Tuberculum

Creater
sciatic
notch
Arcuateline

Anteriorsuperior

lschialspine

iliacspine

Lesser
sciaticnotch

Anteriorinferior

iliacspine
Iliopubic
emtnence

ter trochanter
of femur

Superior
pubicramus

Pectenpubis
(pectinealline)

Obturator

Pubicsymphysis

foramen

lschial
tuberosity

Pubictubercle
Inferior
pubicramus
Inferiorpubic ligament

Plate 248

Pubicarch

Lessertrochanter
of femur

Body Wall

Anterior Abdominal Wall: Superficial Dissection

*{r
major
Pectoralis
muscle
Xiphoidprocess
Rectussheath
L i n e aa l b a
Serratus
anterior

External
oblique
muscle

tissue
Subcutaneous
(superficialfascia)
of abdomen

Muscular
part
Aponeurotic

pan

Anteriorsuperior
i l i a cs p i n e

I n g u i n al il g a m e n t
(Poupart's)
lntercrural
fibers

Thoracoepigastric
vein
Camper's(fatty)layer,
(membranous)
Scarpa's
layerof subcutaneous
tissueof abdomen
(turned back)
of
layerto
Scarpa's
fascialata
Superficial
circumflex
iliacvessels

Superficial
i n g u i n arli n g
External
spermatic
fasciaon
spermatic
cord
Cribriformfascia
in saphenous
openrnS
Fascialata

Creat
s a p h e n o uvse i n
Superficial
dorsalveinof penis

Body Wall

Superficial
vessels
epigastric
external
pudendalvessels
ligament
Fundiform
fasciaof
Superficial
penisand scrotum
(dartosfascia)(cut)
Deep(Buck's)
fasciaof peniswith
deepdorsalveinof
penisshowingthrough

Plate 249

Anterior Abdominal wall: Intermediate Dissection

Nr
Pectoralismajor
muscles
'Anteriorlayerof
rectussheath
(cutedges)
Latissimus
d o r s im u s c l e

L i n e aa l b a

Serratus
anteriormuscle

Rectusabdominis
muscle

External
o b l i q u em u s c l e

External
o b l i q u em u s c l e
lcut away)

\cut away)

Tendinous
intersection
External
intercostal
muscles
External
oblique
aponeurosts
(cut edge

Rectussheath
Internal
o b l i q u em u s c l e
Anteriorsuperior
i l i a cs p i n e - I n g u i n al i g a m e n t

(Poupart's)
Cremaster
muscle
(lateralorigin
Inguinalfalx
(conjointtendon
Reflected
i n g u i n al il g a m e n t

Internaloblique
muscle
Pyramidalis
muscle
Inguinalfalx
(conjointtendon)
l n g u i n al il g a m e n t
(Poupart's)
Anteriorsuperior
i l i a cs p i n e
External
oblique
(cutand
aponeurosis
turneddown)
Pectineal
ligament
(Cooper's)
Lacunarligament
(Cimbernat's)
Reflected
inguinal
ligament
Pubictubercle

Femoralvein
(in femoral sheath)

ligament
Suspensory
of penis

Saphenous
openrnS

muscles
Cremaster
and cremasteric
fascia

Cremaster
muscle
( m e d i a lo r i

Deep(Buck's)
fasciaof penis

Fascialata

External
spermatic
fascia(cut)

Great saphenousvein

Plate 25O

Superficial
fascia
of penisand
scrotum(cut)

Body Wall

Anterior Abdominal Wall: Deep Dissection

Superior
vessels
epigastric

4{tr

External
o b l i q u em u s c l e
\cut away)

Anteriorlayerof
rectussheath(cut)
L i n e aa l b a

R e c t u sa b d o m i n i s
muscte

Anteriorlayerof
rectussheath

E x t e r n aol b l i q u e
aponeurosis(cut)

abdominis
Transversus
muscle(cut)

I n t e r n ao
l blique
a p o n e u r o s i s( c u t )

fascia
Transversalis
(opened on left)

Transversus
a b d o m i n i sm u s c l e

Extraperitoneal
fascia(areolartissue)

Internal

o b l i q u em u s c l e( c u t )

M e d i a lu m b i l i c a l
l i g a m e n t( o c c l u d e dp a r t
o f u m b i l i c a la r t e r y )

Posteriorlayer
of rectus sheath
A r c u a t el i n e
Inferior
epigastricvessels

I n f e r i o re p i g a s t r i c
artery and vein (cut)

A n t e r i osr u p e r i o r
i l i a cs p i n e

S i t eo f d e e p i n g u i n a l
r i n g ( o r i g i no f i n t e r n a l
spermaticfascia)

lnguinal ligament

(Poupart's)

C r e m a s t e r i ca n d p u b i c
branchesof inferior
epigastricartery

Superficial
circumflexiliac,
S u p e r f i c i ael p i g a s t r i
Superficial
externalpudendal
arteries(cut)

Femoralsheath
(containsfemoral
a r t e r ya n d v e i n )

I n g u i n a fl a l x
(conioint tendon)

I n g u i n al i g a m e n t
(Poupart's)

P e c t i n e alli g a m e n t

L a c u n a rl i g a m e n t
(Cimbernat's)

(Cooper's)

P e c t i n e alli g a m e n t
(Cooper's)

L a c u n a rl i g a m e n l
(Cimbernat's)

Fat in retropubic space


(of Retzius)

Reflected
inguinaligament

Pectinealfascia

P u b i ct u b e r

nternal spermaticfascia

C r e m a s t e rm u s c l ea n d f a s c i a
E x t e r n asl p e r m a t i cf a s c i a

Body Wall

Deep(Buck's)
fasciaof penis

Superficialfascia
o f p e n i sa n d
scrotum (cut)

muscleandfascia(cut)
Cremaster
xternal spermaticfascia(cut)

Plate 251

Rectus Sheath: Gross Sections

Sectionabovearcuateline
Aponeurosis
of
externalobliquemuscle

Rectusabdominis muscle

Aponeurosis
of

External
oblique

Anteriorlayerof rectussheath

i n t e r n a lo b l i q u e m u s c l e

Skin

lnternal
o b l i q u em u s c l e

L i n e aa l b a

Transversus
a b d o m i n im
s uscle

Aponeurosis
of transversus
a b d o m i n im
s uscle

Posterior
layer
of rectussheath

Peritoneum
Extraperitoneal fascia

Falciform
ligament

Subcutaneous
tissue(fattylayer)

Transversalis
fascia

Aponeurosis
of internalobliquemusclesplitsto formanteriorandposterior
layersof rectussheath.
Aponeurosis
of external
obliquemusclejoinsanteriorlayerof sheath;
aponeuiosis
of transversus
abdominis
musclejoinsposterior
layer.Anteriorandposterior
layeisof rectussheathunitemedially
to formlineaalba.

Sectionbelow arcuateline
Aponeurosis
of
e x t e r n aol b l i q u em u s c l e
A p o n e u r o s i so f
internaloblique muscle

R e c t u sa b d o m i n i sm u s c l e

Aponeurosis
of transversus
a b d o m i n im
s uscle

Extraperitonealfascia

Internal
oblique muscle

Transversus
a b d o m i n im
s uscle

Transversalis
fascia
Peritoneum

External
o b l i q u em u s c l e

Anteriorlayerof rectussheath

Median umbilical
ligament(obliterated
u r a c h u s i)n m e d i a n
u m b i l i c aflo l d

M e d i a lu m b i l i c a l
ligamentand fold
aneouS

tissue(fattyand
membranous
layers)

A p o n e u r o soi sf i n t e r n aol b l i q u em u s c l ed o e sn o t s p l i ta t t h i sl e v e b
l u t p a s s ecso m p l e t e layn t e r i otro
rectusabdominismuscleand is fusedtherewith both aponeurosis
of externalobliquemuscleund thut
of transversus
abdominismuscle.Thus,posteriorwalloi rectussheathis absentbelbwarcuateiine,
and rectusabdominismusclelieson transversalis
fascia.

Plale 252

*{r

Body Wall

Anterior Abdominal Wall: Internal View


seePlate229
Forumbilicalvessels
Parietal
pleura

Diaphragm
Diaphragmatic
fascia

Round
ligament
(ligamentum
teres)of liver
ano
paraumbilical
vetns

Falciform
ligament
Peritoneum
(cut edges)

tcus

Transversalis
fasciaand
its cut edge

Peritoneum

A r c u a t el i n e

ransversalis
fascia

Rectus
abdominis
muscle

Externaland
lnternal
oblique
musctes

Inferior
epigastric

Transversus
abdominis
muscle

VCSSCIS

Inguinal
triangle
(Hesselbach's)

Left medial
umbilical
ligament
(obliterated
leftumbilical
artery)

Transversalis
fascia(cut)
lnterfoveolar
ligament

R i g h tm e d i a l
u m b i l i c a fl o l d

Deep
circumflex
i l i a cv e s s e l s

Median
umbilical
ligament
(obliterated
urachusa
) nd
paraumbilical
v e i n si n m e d i a n
u m b i l i c a fl o l d

Deep
i n g u i n arl i n g
Cremasteric
and pubic
branchesof
inferior
epigastricartery

U m b i l i c a lp r e v e s i c a l
fascia

Testicularvessels

L a t e r a ul m b i l i c a fl o l d
(containsinferior
epigastricvessels)

E x t e r n aill i a cv e s s e l s
Spermaticcord

oral nerve
Femoralsheath
Lacunarligament (Cimbernat's)

muscle
lliopsoas

Pectinealligament (Cooper's)

xternal iliac vessels


Supravesicalfossa

I n g u i n afl a l x ( c o n j o i n t e n d o n )

Transversevesicalfold

U m b i l i c a la r t e r y
(occluded part distalto this point)

Obturator internusmuscle

Obturator nerve and vessel6

Ureter(cut)
Anterior recessof ischioanalfossa
Superiorvesicalartery
Ductus (vas)deferens

Body Wall

L e v a t o ra n i m u s c l e

"**r --Brlbourethral (Cowper,s)


gland embedded
perinealmuscle
inalvesicle in deeptransverse
Prostateand sphincterurethraemuscle

U r i n a r yb l a d d e r
P e r i n e am
l embrane

Plate 253

Posterolateral Abdominal Wall

Serratus
anteriormuscle
lnfraspinousfascia

Rhomboim
d a j o rm u s c l e
Auscultatory
triangle
Lateralcutaneous
branchof dorsalramusof TZ soinal
Medialcutaneous
branchof dorsalramusof TZ spinal
Trapezius
muscle
Latissimu
d so r s im u s c l e
E x t e r n aolb l i q u em u s c l e
Thoracolumbar
fascia(posterior
layer)
Lateralcutaneous
branchof
subcostal
nerve(ventralramusof T12)
Lumbartriangle(of Petit)
lliaccrest
Lateralcutaneous
branchof iliohypogastric
nerve(11)
Superiorclunialnerves(lateralcutaneous
branches
of dorsalramiof L1-13spinalnerves)
Glutealaponeurosis
overqluteusmediusmuscle
Cluteusmaximusmuscle

Latissimus
dorsimuscle
Latissimus
dorsimuscle(cutand turnedback)
Serratus
oosteriorinferiormuscle
Digitations
of costaloriginof latissimus
dorsimuscle
Digitations
of costaloriginof externalobliquemuscle
Externalobfique muscle(cutand turnedback)
Tendon of origin of transversusabdominis muscle
Internaloblioue muscle

Lateralcutaneous
branchof subcostal
nerve(ventralramusofTl 2)
Lateralcutaneous
branchof iliohypogastric
nerve(Ll )
l l i a cc r e s t

Superiorclunialnerves(lateralcutaneous
branches
of dorsalramiof L1-13soinalnerves)
Cluteusmaximusmuscle

Plate 254

4{tr
Body Wall

Arteries of Anterior Abdominal Wall

arterv
Subclavian
Lateralthoracic
artery
Subscapular

Internalthoracicarteries
Pericardiacophrenic
arterywith
phrenicnerve

*{r
arterv
Thoracodorsal

ransversus
thoracis
muscle
anch to falciform

ligamentof liver
Anterior
intercostal
arteries

Musculophrenic
arteries
Superiorepigastric
arteries
Diaphragm
Transversus
abdominis
muscleand aponeurosis

with lower
Anastomoses
intercostal,
subcostal,
a n dl u m b a r
Ex
Internal
oblique
muscres
Transversus
abdominismuscre
Ascendingbranch of
deep circumflexiliac artery

Superficial
circumflexiliac
Superficial
epigastric
artery

Rectusabdominis
muscles
Internal
o b l i q u em u s c l e
External
o b l i q u em u s c l e
Posteriorlaverof
rectussheath
ate line

Inferiorepigastric
artery
Superficialepigastric
arterv

Femoralartery
Femoralartery

Superficial
external
pudendalartery
Deepexternal
pudendalartery

Cremasteric
andtesticular
arteriesand artervto ductus
deferensin spermatic

Body Wall

arteriesof
penis (deep to
Buck's fascia)

Plate 255

Veins of Anterior Abdominal Wall

Subclavian
vein
Axillaryvein

External
Internal
Anterior

Cephalicvein

Intercostal
tributaries
to axillary
vern

Lateralthoracicvein

C e p h a l i cv e i n

Anterior
intercostalveins

Axillaryvein

Internalthoracic vein

al thoracicvein

Musculophrenic
vei

venousplexus

Superiorepigastric
veins
Thoracoepigastric
vein

Perforatin
g tributaries
to internalthoracic
vetn

Paraumbilical
veinsin
roundligamentof liver

gastricvein
Thoracoepi

Inferiorepigastric
veins

tariesof
paraumbilicalveins

Tributaries
to deep
circumflexiliacveins

Thoracoepigastric
vein

Thoracoepi
gastricvein
Superficial
epigastric
vein
Superficial
circumflexiliacvein

al circumflex
iliacvein

Superficialepigastricvein

External
pudendalvein

Externalpudendalvein

S a p h e n o u so p e n i n g

fascia over

s a p h e n o uosp e n i n g
Femoralvein

Creatsaphenous
vein
(venous)plexus
Pampiniform
Deep dorsal vein of penis
(deep to Buck'sfascia)Superficialdorsalvein of penis

Plate 256

saphenousvein

Anteriorscrotalveins

Nr
Body Wall

Nerves of Anterior Abdominal Wall

Medial brachial
cutaneous nerve

Intercostobrachial
n e r v e( T 1 , 2 )
Long thoracic nerve

Latissimus
dorsimuscle

Serratus
anteriormuscle
External
obliquemuscle(cut)
Posteriorlayerof
rectussheath
Anteriorlayerof
rectussheath(cut)

Lateralcutaneous
branches
of intercostalnerve(T2-11
Anteriorcutaneous
branches
of intercostal
nerve(T1-11
Lateralcutaneous
branch
of subcostal
nerve(T12)
Lateralcutaneous
branch
of iliohypogastric
nerve(11)
Anteriorcutaneous
branch
of subcostal
nerve(T12
Lateralfemoralcutaneous
nerve(12,3)
Anterior cutaneousbranch
of iliohypogastricnerve (11
Femoralbranchesof
genitofemoralnerve (11,2)

Anteriorscrotalbranch
o f i l i o i n g u i nn
ae
l r v e( 1 1 )

Rectusabdominismuscle
Transversus
abdominis
muscle
Internalobliquemuscle
(cut)
and aponeurosis
Anteriorand lateral
branches
cutaneous
of subcostal
nerve(T12)
Anteriorbranchof
iliohypogastric
nerve(11)
i o i n g u i n anle r v e( 1 1 )
External
oblique
aponeurosis(cut)
Anteriorcutaneous
branch
nerve(11)
of iliohypogastric
llioinguinn
ae
l r v e( 1 1)
muscle
Cremasteric
cord
of soermatic
External
spermatic
fascia
of spermatic
cord

Cenitalbranchof
genitofemoralnerve (11, 2)

Body Wall

4{tr
Plate 257

Thoracoabdominal Nerves

Spinalnervetrunk
Meningealbranch
Spinalsensory
(dorsalroot)ganglion
Dorsalroot
Ventral rool

Erectorspinaemuscle
Medialbranch,
Lateralbranchof
Dorsal(posterior)
r

Ventral(anterior)
ramusof spinalnerve(intercostal
nerve)
Collateral
branch
External
intercostal
muscle
Internalintercostal
muscle
Innermostintercostal
muscle
Latissimus
dorsi
muscle

Subcostal
muscles

Serratus
anterior
muscle

Windowcut
in innermosl
intercostal
muscl6

Lateral
cutaneous
branch

Communicating
branch

Creater and lesser


thoracic s p l a n c h n i c

nerves
Sympathetictru
Cray and white rami communicante!

R e c t ua
s b d o m i n im
s uscle

Internal
intercostal
Internalintercostal
muscle
membranes
anteriorto
externalintercostal
muscles
Collateral
branch
rejoiningintercostal
Transversus
abdominismuscle

lnnermost
intercostal
muScle
Internal
intercostal
muscle
External
intercostal
muscte

Lineaalba

External
intercostal
membrane
External
o b l i q u em u s c l e
Anteriorcutaneous
branch

*{r
Plate 258

Body Wall

lnguinal Region: Dissections

L i n e aa l b a

E x t e r n aol b l i q u e
m u s c l ea n d
aponeurosrs

Rectussheath
(anteriorlayer)

A n t e r i o rs u p e r i o ri l i a cs p i n e

Transversalis
fasciawithin
inguinaltriangle
(site of direct
i n g u i n a lh e r n i a )

Internao
l b l i q u em u s c l e
kut and reflected\

Transversus
abdominismuscle
D e e pi n g u i n arli n g

l n g u i n a fl a l x
(conjoint
tendon)

(in transversalis
fascia)
Cremastermuscle
(lateralorigin)

Reflected
inguinal
ligament

InferiorepiBastricvessels
(deep to transversalis
fascia)
I ng u i n a ll i g a m e n t( P o u p a r t ' s )

fibers

L a c u n a rl i g a m e n t( C i m b e r n a t ' s )

External
spermaticfascia
on spermatic
cord exiting

Cremaster
muscle
( m e d i a lo r i g i n )
S u p e r f i c i ai ln g u i n a lr i n g
L a t e r a cl r u s -

Superficial
i n g u i n a lr i n g
Fundiform
l i g a m e n to f p e n i s

M e d i a cl r u s
Pubiccrest

Posterior(internal)view

4{tr
Rectussheath(posteriorlayer)
Arcuateline
M e d i au
l m b i l i c al il g a m e n t
Anteriorsuperioriliacspine
Transversalis
fascia(cutaway)
Rectusabdominismuscle
l l i o p u b i tcr a c t
vessels
Inferiorepigastric
i n a l ( H e s s e l b a c h ' st r)i a n g l e
Femoralnerve
enital branch of genitofemoralnerve
and testicularvessels
D e e p i n g u i n a lr i n g
lliopsoasmuscle
Externaliliac vessels
al ring (dilated)(broken line)
L a c u n a rl i g a m e n t( C i m b e r n a t ' s )
Rectinealligament (Cooper's)
Ductus (vas)deferens

anastomosis
Obturator-pubic
Obturatorvessels
vessels
Pubicbranches
of inferiorepigastric
M e d i a nu m b i l i c al il g a m e n t
Pubicsymphysis
Hesselbach'striangle by Carlos Machado after Frank Netter

Body Wall

Cryd4/*

Plate 259

lnguinal Ganal and Spermatic Gord

Testicularvesselscovered by peritoneum

External
obliquemuscle

Testicularvesselsand genital branch of genitofemorai

Internao
l b l i q u em u s c l e

Ductus (vas)deferens

Transversus
abdominis muscle

Cremastericvessels

Transversalis
fasc

Externaliliac vesselscovered by peritoneum

Extraperitoneal
fascia(loose
connectivetissue)

Ductus (vas)deferenscovered by peritoneum


I n f e r i o re p i g a s t r i cv e s s e l s

Peritoneum

Medialumbilicaligament
( o c c l u d e dp a r t o f u m b i l i c a la r t e r y )
U m b i l i c a lp r e v e s i c afla s c i a

Urinarybladder
R e c t u sa b d o m i n i sm u s c l e
P y r a m i d a l im
s uscle
Medianumbilical
ligament (urachus)
Superficial
i n g u i n a lr i n g s

Anterior
supeflor
i l i a cs p i n e
gin of internal
spermaticfascia
from transversalis
fasciaat deep
i n g u i n a lr i n g
llioinguinalnerve

Pubic
symphysis

S p e r m au c
cord

(covered by
intermingling
fibers of
external
oblique
aponeurosts)

Femoral
vessets

P u b i ct u b e r c l e

Cremastermuscle
and cremasteric
fasciaon
spermaticcord

Externalspermaticfascia
e n v e l o p i n gs p e r m a t i c

In g u i n a l i g a m e n t(P o u p a r t ' s )
Inguinalfalx (conjoint tendon)
Intercruralfibers

Plate 260

Body Wall

Indirect Inguinal Hernia

Loop of bowel
e n t e r i n gh e r n i a ls a c

vessels,
testicular
Ductus(vas)deferens,
nerve
and genitalbranchof genitofemoral
forming spermaticcord

Neck of hernialsac
Inferiorepigastric
vessels
Origin of

internalspermatic
fasciafrom
fasciaat
transversalis
d e e p i n g u i n a lr i n g

Peritoneum
Extraperitoneal
fascia
fascia
Transversalis

*;';,
D e e p i n g u i n a lr i n g

"?,:',

External
spermatic
fascia

Cremaster
muscleand
fascia

Superficial
i n g u i n arli n g

Internalspermatic
fascia

H e r n i a ls a c

Ductus(vas)deferensand
cord
vessels
of spermatic

Body Wall

*{r
Plate 261

Femoral Sheath and Inguinal Ganal

Transversalis
fascia(cutedge)
Extraperitoneal
fascia
peritoneum
Parietal
Medianumbilicalligament(urachus)
Medialumbilicalligament(occludedpart
of umbilicalarterv)
Inferiorepigastricvessels
Deepcircumflexiliacvessels
Testicular
vessels
teric artery
Ductus(vas)deferens
External
iliacvessels
Pubic(obturatoranastomotic)
vessels
(cut)
External
obliqueaponeurosis
Internalspermatic
fasciaon spermatic
cord
Femoralnerve(deepto iliopsoas
fascia)
Femoralvessels
in femoralsheath
Falciform
marginof saphenous
opening
(cutand reflected)
Ureter
Cenitofemoral nerve
Urinary
bladder
Pectineal
ligament
(Cooper's)

Lacunar
ligament
(Gimbernat's)
Inguinal
ligament
(Poupart's

Transversalis
fasciaforms
anteriorwall of
femoralsheath
(posterior
wall
formedby
iliopsoas
fascia)
Lateralfemoralcutaneous
lliac fascia
Cenital branch of genitofemoralnerve
Femoralbranch of genitofemoral

Testicular
vessels
Externaliliac
Inferior epigastric

Ductus(vas)deferensandcremasteric
a
Pectinealligament (Cooper's

*{r
Plate 26.2

Femoralring
Transversalis
fasciaforms
anterior wall of femoral sheath
L a c u n a rl i g a m e n t( C i m b e r n a t '

I n g u i n al il g a m e n(tP o u p a r t ' s
Lymphnode(Cloquet's)
in femoral
Femoralsheath(cutopen)
Pectineal
fascia

Body Wall

Posterior Abdominal Wall: Internal View

Cavalopening
Diaphragm
tendonof diaphragm
andvagaltrunks
crusof diaphragm
Leftcrusof diaphragm
Medianarcuateligament
Aortaandthoracicduct
and least
; lesser,
nerves
thoracicsplanchnic
Medialarcuateligament
Lateralarcuateligament
trunk
Sympathetic

Quadratuslumborum
muscle
minormuscle
majormuscle
abdominis
Transversus
muscle
Internal
obliquemuscle
obliquemuscle
External
lliacusmuscle

iliacspine
superior
muscle
Piriformis
(ischiococcygeus)
muscle
ligament(Poupart's)
internusmuscle
muscle
Rectococcygeus
Tendinous
archof
levatorani muscle
Openingfor femoralvessels
ligament(Cooper's)
Pectineal
Lacunarligament(Cimbernat's)
Pubicsymphysis
Lesser
trochanterof femur
membrane
Urethra
Pubictubercle

Body Wall

*{r
Plate 263

Arteries of Posterior Abdominal Wall

Inferior phrenic

Recurrent
branch
esophagus

Celiactrunkwith commonhepatic,
leftgastric,
and splenicarteriel

Superiorsuprarenal
arteries
artery
$iddle suprarenal
Superiormesenteric
artery

Superiorsuprarenal
arteries

Inferiorsuprarenal
artery

Middlesuprarenal
artery
lnferior
suprarenal
artery

Leftrenalartery

Right
renalartery

(ovarian)
Testicular
arteries

Psoasmajor
muscle(cut)

Abdominalaorta
mesenteric
artery

Quadratus
lumborum
muscle

Leftcolic artery
arteries

Subcostal
artery

Superiorrectal
artery

1stto 4th right


lumbararteries
Common
iliacarteries

Mediansacral
artery

lliolumbar
artery

Internaliliac
artery
Superiorgluteal
artery

Lateral
sacralarteries
External
iliac artery

Umbilical(patent
part)arterygiving
riseto superior
vesicalarteries

Testicular

(ovarian)
artery
Ascending
branch of-

Obturatorarterv

qeep
circumflex
iliacartery

Inferiorvesical
arteryand arteryto
ductusdeferens

Superficial
circumflex
iliacartery

Middlerectal
artery

lnferior
epigastric

Internalpudendal
artery

artery

Inferiorgluteal
artery

Pubic,
Cremasteric
branches
of inferior
epigastric
artery
Superficial
epigastric
artery(cua)

Transversalis
fascia(cut)

Femoralartery
Ductusdeferensand testicular
artery(cut)
Superficial
externalpudendalarteri
Deepexternalpudendalartery

Plate 264

abdominalwall
(turned down)

Medialumbilicalligament
(occludedpartof umbilical
artery)

4{F

Body Wall

Veins of Posterior Abdominal Wall

lnferiorphrenic

Diaphragm

Hepatic veins

Esophagus

lnferior vena cava

veinsand
Leftsuprarenal
with inferior
anastomosis
phrenicvein

Right inferior
s u p r a r e n avl e i n
Right renal vein

Leftrenalvein

Psoasmajor
muscle (cut)

Ovarian(testicular)
verns

Quadratus

Ascending
l u m b a rv e i n s

l u m b o r u mm u s c l e
vein
Subcostal

iliac

vetn
l st to 4th right
lumbar vei

Internaliliac
vetn

l l i o l u m b a rv e i n

Superiorgluteal
vetn

Common
i l i a cv e i n

nferiorgluteal
veln

Ovarian

(testicular)
v e i n sa n d
ureter(cut)

lnternal
pudendal vein

Internal

iliac
External
vetn

i l i a cv e i n

Middlerectal
veln

Median
sacralvein

Uterinevein

Lateral
sacralvei

Superiorvesical
vern

Deepcircumflex
i l i a cv e i n

Deep circumflex
iliacvein

Superficial
circumflex
i l i a cv e i n

Obturatorvein
of uterus

lnferior
epigastricvein
(cut)

Inferiorepigastric
vetn
Superficialepigastricvein (cut)

tal venous

plexus

Pubic (obturator anastomotic)vein

Uterovaginalvenous
plexus

Femoralvein

4{tr
Body Wall

vein
Creatsaohenous
pudendalvein
External

Vesicalvenousplexus
Anteriorabdominal
wall fturned down)

Plate 265

Lymph vessels and Nodes of posterior Abdominal wall

R i g h st u b c l a v i at n
runk

Thoracicduct

Tracheobronchialnodes

Inferiorphrenicnodes
Thoracicduct
Cisternachyli
R i g h ltu m b a trr u n k
Intestinal
trunk

Celiac
nooes
Superior
mesenteric
nodes

Visceral
(preaortic)
lymph
nodes

lnferior
mesenteric
node

Leftlumbartrunk

Lumbarnodes
(lateralaorticnodes)

Common iliac nodes

Common iliac nodes

Middle sacralnodes

Internaliliacnodes
External
iliacnodes

Lateralsacralnodes

Inferior
epigastric
OOO-

Node of Cloquet,
or Rosenmi.iller
(highestdeep
i n g u i n anl o d e )

Superficial
inguinal
nooes
(superior,
horizontal,
and
inferior
lverticall
groups)

Deep
inguinal
nooes

Plate 266

n{r
Body Wall

Nerves of Posterior Abdominal Wall

and least
Creater,lesser,
nerves
thoracicsplanchnic
trunks
Sympathetic
nerve(T12)
Subcostal
lliohypogastricnerve
(L 1 )

Celiac,superiormesenteric,
and aorticorenalganglia

lliohypogastric
nerve(11)
llioinguinalnerve (Ll)

Muscularbranches
from lumbarplexus
nerve(T12)
Subcostal

llioinguinal
n e r v e( L l

Psoasmajor
muscle(cut)

Cenitofemoral
n e r v e( L 1 , 2 )

Quadratus
lumborum
muscle

Transversus
abdominis
muscle(cut)

lliohypogastric
nerve(11)

Subcostal
nerve (T1
and its
lateral

cutaneous
branch
Intermesenteric
(paraaortic)

plexus
Crayand
white rami
communicantes

llioinguinal
n e r v e( 1 1 )
Cenitofemoral
n e r v e( L 1 , 2 )
Lateralfemoral
cutaneous
nerve(L2,3)
Femoralbranch,
Cenitalbranch
of genitofemoral
n e r v e( L 1 , 2 )
Lumbosacral
trunks(14,5)
Obturatornerves
Accessorvobturator
nerve(13,4) (occasional)

Lateral
femoral
cutaneous
nerve
(L2,3\
Femoral
nerve

Femoralnerve
plexus(14-54)

Pudendal
nerve(S2,3, 4)

(L2-L4)

Obturatornerve(12,3, 4)

*{r
Body Wall

nerve(11)
Anteriorcutaneous
branchof iliohypogastric
'Anterior
nerve(L.l)
of ilioinguinal
scrotal(labial)branches

Plate 267

Regions and Planes of Abdomen

Right
lateralrectusplane
( s e m i l u n al irn e )

Righthypochondrium
(hypochondriac
region

Umbilical region

Rightflank(lumbarregion)

Left
lateralrectusplane
( s e m i l u n al irn e )

Left
hypochondr

Leftflank(lumbar
region)

.Et9$g!9tc!elplaE
nous Dlane

Rightgroin(inguinalregion

eft groin(inguinal
region)

Pubic(hypogastric
region)

Plate 268

Peritoneal Gavity

Greater Omentum and Abdominal Viscera

Falciformligament

Left lobe of liver

Right lobe of liver

Stomach

Callbladder

Creater omentum overlYing


colon and small
transverse
i n t e s t i n e( j e j u n u ma n d i l e u m )

Createromentum(turnedup)
Transverse
colon(turnedup)
Transverse
mesocolon

Left colic (splenic)fle

R i g h tc o l i c ( h e p a t i c )f l e x u r

S m a l li n t e s t i n e( l e j u n u ma n d i l e u m )

A s c e n d i n gc o l o n

Cecum
S m a liln t e s t i n(ec o v e r i ndge s c e n d i ncgo l o n )
S i g m o i dc

U r i n a r yb l a d d e r

Peritoneal Gavity

4{v
Plate 269

Mesenteric Relations of Intestines

Transverse
colon (e/evated)
Transversemesocolon

S u p e r i odr u o d e n af lo l d
Superiorduodenal fossa
Left colic (splenic)flexure
Paraduodenalfossa
Inferior duodenal fossa
I n f e r i o rd u o d e n a lf o l d
Mesentericoparietalrecess(fossa)

Superiormesenteric
artery
in root of mesentery
ferior mesentericartery and vein
A b d o m i n a la o r t a

Esophagus
R i g h tc r u s o f d i a p h r a g m
( p a r tp a s s i n gt o r i g h t
of esophagealhiatus)
R i g h tc r u s o f d i a p h r a g m
(part passingto left
of esophagealhiatus)
Left crus of diaphragm

Exposureof suspensory
muscleof duodenum
(ligamentof Treitz)

Celiac trunk
Suspensorymuscle of
tf
d u o d e n u m( l i g a m e n o
Treitz)
Superiormesentericartery
Duodenojejunalflexure
e n d i n g( 4 t h ) p a r t
of duodenum
Jejunum

4{tr
Pfate 27O

Inferior (horizontal,or
3rd) partof duodenum
D e s c e n d i n g( 2 n d ) p a r t
of duodenum

Peritoneal Gavity

Mesenteric Relations of Intestines (continuedl

colon
ransverse
(e/evated)

mesocolon

Creater
omentum
(e/evated)

(e/evatedover pancreas\

fejunum(cut)
Freetaenia
(taenialibera)

Mesentery(cutand
smallintestineremoved)

Omental
(epiploic)
append

flexure
eft colic(splenic)

Rightcolic
(hepatic)
flexure
Rightparacolic
gutter

Leftparacolicgutter

Ascending

Sigmoidmesocolon

Terminalpartof
i l e u m(

gmoidcolon

Cecum
Retrocecal

recess
Vermiform
appendix

*{r

Sigmoid colon (reflected)


Sigmoid mesocolon

Intersigmoid
Parietal
peritoneum
Commoniliacvessels

Peritoneal Gavity

Plale 271

Omental Bursa: Stomach Reflected

Inferior vena cava (retroperitoneal)

Castro-omental(gastroepiploic)arterialanastomosis(enclosed
in gastrocolicligament)

Common hepatic artery


(in peritonealfold)
Hepatoduodenalligament
(right margin of lesseromentum)
Probe in omental
(epiploic)foramen

Stomach(posteriorsurface)
Caudatelobeof liver
in superiorrecessof omentalbursa
Left gastricartery (in gastropancreaticfold)

Leftinferiorphrenicartery
(retroperitoneal)

Callbladder

Castrophrenicligament

Diaphragm

Leftsuprarenal
glandand superior
poleof kidney(retroperitoneal)

Liver

stro-

splenic
(gastrolienal)
ligament
Spleen

R i g h tc o l i c
(hepatic)flexure

Left colic (splenic)flexure


ligament

Kidney(retroperitoneal)
(2nd)partofduodenurh
Descending
Rightgastro-omental
(gastroepiploic)
artery(coveredby peritoneum)
A n t e r i osr u p e r i opr a n c r e a t i c o duodenal artery (retroperitoneal)
Head of pancreas(retroperitoneal)

Plate 272

S p l e n o r e n a(ll i e n o r e n a ll)i g a m e n t
Tailof pancreas(intraperitoneal)

I Posteriorlayers | ^,
ligament
Anteriortry"r, iiril I of Sastrocolic
Transverse
mesocolon
Body of pancreas(retroperitoneal)

Nr

Peritoneal Gavity

Omental Bursa: Cross Section

Vertebralbodyof L1

Left kidney

R i g h tk i d n e y

Parietal
perttoneum

C r e a t e ro m e n t u m
Visceralperitoneum (cut edges)
O m e n t a l( e p i p l o i c ) /
foramen (of Winslow)
( C o m m o n )b i l e d u c t
Portal
triad

Stomach

Pancreas
O m e n t a l b u r s a( l e s s e sr a c )

Hepatic portal vein


Proper hepatic artery

Peritoneal Gavity

L e s s eo
r m e n t u m( h e p a t o d u o d e n a l
and hepatogastricligaments)

Nr
Plate 273

Peritoneum of Posterior Abdominal wall

Inferiorvena cava
( C o m m o n )b i l e d u c t a n d
proper hepatic artery
C o r o n a r yl i g a m e n to f l i v e r

R i g h st u p r a r e ngal a n d
O m e n t u m ( e p i p l o i c )f o r a m e n
\
behind right free margin
o f l e s s e ro m e n t u m
R i g h tt r i a n g u l a r
ligament---1
Attachment
of transverse
mesocolon
and right
gastro-omental
(gastroepiploic)
vessels

Abdominal aorta and celiac trunk


F a l c i f o r ml i g a m e n t
Hepatic
VCINS

Superiorrecessof omental bursa (lessersac)


Attachment of lesseromentum and
left gastricartery

Esophagus

Left triangular
ligament
of liver
Castrophrenic
l i g a m e n ta n d
left inferior
phrenic artery
t gastflc

vessels

R i g h tk i d n e y

Splenorenal
(lienorenal)
l i g a m e n ta n d
splenicvessels

Parietal
peritoneum

Phrenicocolic
ligament

Duodenum

Root of
mesentery
Site of
ascending
colon
Common iliac
artery (retroperitoneal)
Externaliliac
artery (retroperitonea

Testicular
v e s s e l(sr e t r o peritoneal)

Ureters(retroperitoneal
Siteof deep
i n g u i n a lr i n g
Median
umbilical
fold
(contains

uracnus)

Nr
Plale 274

Pancreasand
splenicartery
(retroperitoneal)
Attachment of
transverse
meS0colon
Superior
mesenteric
vessels
Siteof
descending
colon
Attachment of
sigmoid
mesocoton
and sigmoid
vessets
Superior
rectal vessels
Sacrogenital
fold (ligament)
Lateral
u m b i l i c a fl o l d
(contains
inferior epigastricvessels)
Medial
u m b i l i c a fl o l d
(contarns
occluded part
of umbilical
artery)

Peritoneal Cavity

Stomach in Situ

Leftlobeof liver
Falciform
ligament

ligament )
Hepatoduodenal
omentum
I Lesser
ligament,
Hepatogastric
Abdominalpart
of esophagus

notch(incisure)
Cardiac

Round
ligament
ofl
(obliterated
umbilical
vein)

Fundusof stomach
Diaphragm

lnferior
border
of
Quadrate
lobeof
liver
Riehtlobe
ofliver.Gallbladder
Omental
(epiploic)
fora

(of Winslow)
Pylorus
Duodenum
Rightkidney
(retroperitoneal)

*{r

Rightcolic
(hepatic)
flexure

createromentum

flexure
Leftcolic(splenic)

Variationsin
positionand
contour of
stomachin
relationto
bodv habitus

Hypertonic stomach

Viscera (Gutl

Orthotonic stomach

Hypotonic stomach

Atonic stomach

Plate 275

Mucosa of Stomach
SeeatsoPhe 236

Z i g z a g( Z ) l i n e
(junction of gastric
and esophagealmucosa)

Cardiacorifice

Gastricfolds(rugae)
Pyloricorifice

Gastriccanal
(magenstrasse)

S u p e r i o(r1 s t )p a r t
of duodenum
( a m p u l l ao,r

Pylorus

d u o d e n a lc a p )

Castric and
fundic zones

4{F
Pyloriczone

Surfaceepith e l i a l

e1
M u c o u sc e l l

Parietal
cell
(betweenmucouscell
a n dc h i e fc e l l )

S o l i t a r yl y m p h f o l l i c l e( n o d u l e )
N e u r o e n d o c r i n eC c e l l

Muscularis
Submucosa

Plate 276

Castric (fundic)glands

Viscera (Gutl

Musculature of Stomach

muscleof esopha
Longitudinal

musclelayerof stomach
Outerlongitudinal
(concentratedchieflyat lesserand Sreater
curvaturesand at pyloric part)

Middlecircularmusclelaverof stomach

4{tr
Collarof Helvetius
(middlecircularand
i n n e r m o sotb l i q u e
fibersblendhere)

Outer longitudinalmuscle

layer(cutaway)

Section
through
pylorus
(composeo
chieflyof
thickened
circular
muscle)

Middlecircular
musclelayer
lnnermost
obliquemuscle
layer

Circularmuscle
of duodenum
Longitudinal
m u s c l eo f d u o d e n u m

Viscera lGutl

Windowscut in
m i d d l ec i r c u l a r
musclelayer

Plale 277

Duodenum in Situ

Head of pancreas

Suprarenal
gland
Kidney

Superiormesentericvessets

Transverse
mesocolon
and itscut edges

Celiactrunk
Rightfreemarginof lesser
omentum(hepatoduodenal
ligament)

Splenicartery

Transverse
colon (cut)
Leftcolic
(splenic)
flexure

Suprarenal
gland

Pylorus
Ki
Transverse
mesocolon
and its
cut edges
Right
colic
(hepatic)

flexure
Transverse
colon(cut)

Ascending
colon

Psoas
maJor
muscle

S u p e r i o(r1 s t )p a r t

Descending
colon

Descending(2nd) part

Duodenum

Inferiorduodenalfold andfossa

Inferior (horizontal,

or 3rd)part
Ascending
(4th)par
Rootof mesentery(cut edgei)

Duodenojejunal
flexureandjejunum(cut)
Inferiormesenteric
artery
Abdominalaorta
Inferiorvena cava

Plate 278

4{r
Viscera (Gutl

Mucosa and Musculature of Duodenum


Hepatic portal vein

Properhepaticartery
artery
troduodenal

( C o m m o nb) i l ed u c t

Rightgastricartery
Rightfreemarginof lesser
omentum(hepatoduodenal
ligament)

Commonhepaticartery

Pyloricorifice

Superiorduodenal

(Common)bileduct

S u p e r i o(r1 s t )p a r t
( a m p u l l ao,r
duodenalcap)
(no circularfolds)

Accessorypancreatic
duct (of Santorini)
(Principal)pancreatic
duct (of Wirsung)

Descending

(2nd)part
Minor duodenal
papilla (inconstant

flexure
Duodenojejunal

Circularfolds
(valves
of

Jejunum

Major duodenal
papilla(of Vater)

(4th)part
Ascending
Head of pancreas

mesentericartery and vein

Inferiorduodenalflexure
Inferior(horizontal,
or 3rd)part

Outer
longitudinal
musclelayer
(with window
cut)

lnner

circular
muscle
layer
(with
window
cut)

Laversof
dubdenalwall

Submucosa
with duodenal
(Brunner's)
glands

*{r
Viscera lGutl

of stomach,
Barium radiograph
-proximal
jejunum
duodenum, and
B Bodyof stomach
D Duodenalcap (1st part)
D 2 D e s c e n d i n(g2 n d )p a r t
of duodenum
F Fundusof stomach
jejunum
Proximal
I
P Pylorus
PA Pyloricantrum

Plate 279

Mucosa and Musculature of small Intestine

fejunum
Mesentery
A n a s t o m o t i cl o o p
( a r c a d e )o f
jejunal arteri
Straightarteries
(arteriaerectae)
Serosa(visceral
pefltoneum)
Longitudinal
m u s c l el a y e r
Circular
m u s c l el a y e r
Barium radiographof jejunum

Submucosa
Mucosa

C i r c u l afro l d s
(valves
of
Kerckring)
Solitary
l y m p h o i dn o d u l e

lleum
Mesentery
Anastomotic loops
(arcades)of
ileal arteries
Straightarteries
(arteriaerectae
Serosa(visceral
pefltoneum)

Longitudinal
musclelayer
Circular
musclelayer

Barium radiographof ileum

Submucosa
Mucosa

Circularfol
S o l i t a r yl y m p h o i dn o d u l e s
Aggregatelymphoid
n o d u l e s( P e y e r ' sp a t c h e s

Plate 28O

4{tr
Viscera (Gutl

lleocecal Region

lleocolicartery
-Colic branch
llealbranch
Superiormesentericartery
Posteriorcecalarterv
artery
Appendicular
Anteriorcecalartery
Vascularfold of cecum
uoeriorileocecalrecess
lleocecalfold (bloodlessfold of Treves)
Terminalpartof ileum
Inferiorileocecalrecess

Appendicular
artery
Vermiformappendix
Freetaenia
(taenialibera)

External
iliacvessels
(retroperitoneal)
Retrocecalrecess
Cecalfolds
Rightparacolicgutter
Omental taenia

*{r

Posteriorcecal
Cecalfolds

Somevariationsin posteriorperitonealattachmentof cecum


nesof

Viscera (Gutl

Plate 281

lleocecal Region (continuedl

Free taenia (taenia libera)

Ileocecallips:labialform of ilealorifice
(asseencommonlypostmortem
and occasionally
in vivo)

Terminalpartof ileum

Orifice of vermiform appendix

Freetaenia
(taenialibera)
Vermiform appendix

Circularmuscleof colon
Mesocolic taenia

Fibersto papilla
Fibersto ileum
Fibersaround ileocecaljunction

C i r c u l am
r u s c l eo f i l e u m

llealpapilla:papillary
formof ilealorifice
(found.mostcommonly
In vtvol

Schemaof musclefibersat ileal orifice

Plate 282

4{F
Viscera (Gutl

Vermiform Appendix

long
of unusually
Bariumradiograph
appendix(A Appendix;C Cecum)

Variationsin position of appendix

Mesoappendix
(visceral
peritoneum)
o n g i t u d i n aml u s c l e
Circularmuscle

4{tr
Viscera lGutl

Plate 283

Mucosa and Musculature of Large Intestine


Forrectum
andanalcanal
seeplates391-396

Creater omentum (cut away)


R i g h tc o l i c
(hepatic)flexure

Transversemesocolon
Transversecolon
Omental taenia

Omental
(epiploic)
appendices
Haustra

(cut away)

Peritoneum
(cutaway)

Omental
taenia
(exposed

Descending
colon

Peritoneum

by hook

Freetaenia
(taenialibera)

Ascending
coton

Mesocolic
taenta
(exposed
by hook)

S e m i l u n af or l d s
R e c t o s i g m o i jdu n c t i o n
(taeniaespreadout and
unite to form longitudinal

Freetaenia
(taenialibera)

musclelayer)
lleal
orifice

Vermiform appendix

Levatorani muscl

Externalanal sphinctermuscle

Plate 284

Nr
Viscera (Gutl

Sigmoid Golon: Variations in Position

Short,straight,
obliquelyinto pelvis

*{r

Looping to right side

Viscera lGutl

Ascendinghigh into abdomen

Plate 285

Topography of Liver

Lateralrectus
( s e m i l u n a rp) l a n e

Transpyloric
plane

Diaphragm

Liver
covered by
diaphragm,
p l e u r aa n d
rung
(percussion
duliness)
Diaphragm
Liver
covered by
diaphragm
and pleura
(percussion
flatness)

Liver
coveredby
diaphragm,
p l e u r aa, n d
rung
(percussion
dullness)

Liver
covered by
diaphragm
(percussion
flatnessor
intestinal
resonance)

Liver
covered by
diaphragm
and pleura
(percussion
flatness)

Nr
Diaphragm

Plate 286

Livercovered
bydiaphragm,
preura,
a n dl u n g
(percussion
d ul l n e s s )

Livercovered
by diaphragm
and pleura
(percussron
flatness)

allbladder
lnferior border of liver

Viscera (Accessory Organsl

Surfaces and Bed of Liver


Coronaryligament

Diaphragm(pulled

ligament
Lefttriangular

Right
triangular

Fibrousappendixof liver

ligament
Leftlobe of liver
Rightlobe
of liver-

ligament
Falciform

teres)of liver
Roundlieament(ligamentum
(obliteraiedumbiliial vein)formingfree
borderof falciformligament

Costal

*{r

Anteriorview

Portahepatis
teres
Fissure
for ligamentum
Hepaticportalvein

C o l i ci m p r e s s i o n

hepaticartery
process
process
Papillary
Caudatelobe
for
Fissure
venosum
ligamentum
sophageal

Roundligamentof liver
Callbladder
Quadratelobe
Duodenal
R e n ailm p r e s s i
Cysticduct

rmpresslon

Castricimpression

Common hepatic duct


( C o m m o n )b i l e d u c t

ligament
Righttriangular
portionof
Hepatorenal
coronary ligament

impr
Suprarenal
Bare area
lnferior vena

Coronary
ligament

Hepatic veins

Visceralsurface

Lefttriangular
ligament

ligament
Coronary
Barearea
lnferior vena cava
Suprarenalgland

Rightkidney

Left
triangular
ligament

R i g ht r i a n g u l a r
ligament

Superiorrecess
of omentalbur

for
Fissure
ligamentum
venosum

Duodenum

Stomach

Croove for (inferior)vena

Posteriorview

Viscera (Accessory Olgansl

Bedof liver

Plale 287

Liver in Situ and Variations in Form

Roundligament(ligamentum
teres)of liver
(obliterated
umbilicalvein)
Quadrate
Callbladder

Leftlobe of liver
Caudatelobeseenthroughlesser
omentum(hepatogastric
ligament)

Rightlobeof liver

cut in lesseromentum
(hepatoduodenal
ligament)

Omental
(epiploic)
foramen
(of Winslow)

Properhepaticartery
(Common)bileduct
portalvein

Kidney
(retroperitoneal)

Lesser
omentum
(hepatogastric
ligament)

Duodenum

Spleen

Leftcolic
(splenic)
flexure
Rightcolic
(hepatic)
flexure

*{r
Variationsin form of liver

Verysmallleft
lobe,deepcostal
impressions

Completeatrophy
of leftlobe
(leftportalvein
compression)

Transverse,
"saddlelikd'liver,
relativelylargeleft lobe

Verydeep renal
impression
and
'torsetconstriction"

Plate 288

Viscera lAccessory Olgansl

Liver Segments and Lobes: Vessel and Duct Distribution


-

6b;;

Functional
surgical
segments

Leftlobe

Rightlobe

Anatomicf

Right(partof) liver
Lateral
division

Medial division

is
Divisioninto segments
basedupon ramificationsof
bile ductsand hepaticvessels.
It doesnot entirelycorresPond
with divisioninto anatomiclobes.

Left(partof) liver
Medial
division

Posterior
lateral
seBment
(vil)
(Posterior
supenor

Lateraldivision

Parietal
surface

area)

Right
anterior
lateral
segment

Rightlobe

(vt)

(Posterior
inferior
area

Visceral
surface

4{F

Distributionof vessels
and ducts
I
2
3
4
D

Phantomdivision
betweenanteriorand
posteriorsuperiorareas

Inferiorvenacavd

Viscera lAccesso;y Organsl

Commonhepaticduct,hepaticportal
vein,and properhepaticarterY

6
7
8
9
10
11
12
13
t4
l5
16

Rightbranch
Left branch
Anteriorsegment
Medialsegment
Posteriorsegment
Lateralsegment
Anteriorinferiorarea
Medialinferiorarea
Anteriorsuperiorarea
Medialsuperiorarea
Posteriorinferiorarea
Lateralinferiorarea
Posteriorsuperiorarea
Lateralsuperiorarea
Caudatelobe
(rightand left)
Caudateprocess

Plate 289

lntrahepatic vascutar and Duct systems

S u b l o b u l avre i n

H e p a t i cv e i n

o b u l a rv e i n s

Portal
triad

Portal triads

Properhepaticartery
Perivascular
fibrous(Clisson,s)
capsuleextendinginto porta
hepatisalongvesielsa'jd bileduct

Hepatic portal vein


C o m m o n h e p a t i cd u c t

Portaltriad

to hepatic vein

Normallobularpatternof liver

Plate 29O

4{tr
Viscera (Accessory Olgansl

Liver Structure: Schema

Lymphvessel

Connective
tissue
Limiting
plate

Centralvein

of portal space

vein (tributary
to hepaticvein)
Sublobular

Periportal
space(of Mall)

Perisinusoidal
spaces(of Disse)

Centralvein
Sinusoids
Centralvein

Periportal
bileductule
(canalof

Branchof
portal vein

Bileduct

Branchof
hepaticartery
Portalarteriole
Intralobular
bileductule(cholangiole)

Periportal
arteriole
Intralobular
arteriole

Central vein

Periportal
bileductule(canalof Hering)
Inletvenule
Distributing
vein

Viscera (Accessory Organsl

4{tr
Plate 291

Intrahepatic Biliary Systems: Schema

l l i l , ' , . rn . r l i tu l i

Si r ru s o i c i

&.1'
$

I n l t , r l , r, tl r l , rIrr r l l r l r r rl L r l r , r ,J r , , l ,rr, r; j , , 1 , . ( ,

N o l r . ; l r r t l t e . t l r o v r ,i l l u s l r . r t i o r r ,
l r i c r . l r . r l r cu l i , r 1 t p r ' , rars
: l t . t rlrr r r l sr r i l l rr r , r l l , , r lt l r r . i r
o , , rn l l o t t e \ ( , r ,i t \ r l t o t t n l r l r t l

, t c lr r , r i l t , ,st l t e ' ri . t l i z , r l r o O
r tl
- t r ' l ' { t s r , r l ' r . , . , - , , t r { 1 , , ri i | r
l i v t ' r p . r r r , n lr t l r n a l r r ' l l s .

(,

ic?

4{tr
.::'

''

i'\

d)

L o w - p o w e rs e c t i o n o f l i v e r

Plate 292

Viscera (Accessory Organsl

o
o
o
rt

TransverseSection: Level of T1 0, Esophagogastricfunction

ql
,-'

D
o
o
o

Diaphragm

o
o

R e c t u sa b d o m i n i sm u s c l e

Xiphoidprocess

Costal cartilages

o
o

ju nction
Esophagogastric

rt

|o
ql
3

-o

3
ql

Castric folds (rugae)

R i g h tc r u s o f d i a p h r a g m
(forming right boundary
of esophagealhiatus)1

t
II

o
F u n d u so f s t o m a c h

Right crus of diaphragm


(forming left boundary of
esophagealhiatus)

Serratus
a n t e r i o rm u s c l e

Thoracic aorta
Azygos vein

Left crus of
diaphragm

o
rh

Spleen

lnferior lobe of left lung in


costodiaphragmaticrecess

I n f e r i o rl o b e o f r i g h t l u n g i n
costodiaphragmaticrecess

Bodyof T10 vertebrS

o
gf

r
c
o
3
o
f

Erectorspinae muscle

!t
rl

!r
rf

o
o
t
IT

Latissimusdorsi muscle

o
o
o
to

Diaphragm

o
rt

lnferior vena cava

.{

Thoracic duct

cryd4#

Gallbladder and Extrahepatic Bile Ducts

Right and left


h e p a t i cd u c t s

Rightand left hepaticarteries


Properhepaticartery

Common
hepatic ducl

Anteriorlayerof
lesseromentum(cutedge)

Cystic
artery

Rightgastricartery
Cystic duct
ommon hepatic artery

Hepatic
p o r t a lv e i n

Gastroduodenal
artery
Liver
Stomach
(Common)
bileduct

Callbladder
Hepaticducts

S u p e r i o(r1 s t )
partof
duodenum

Left

Cysticduct

Transverse
colon (cut)

Spiral Smooth
par!
fold

Head of
pancreas

4{tr

(Hartmann's
pouch)

Common
hepatic
duct
Cland
orifices

Callbladder

(Common)
bileduct

Descending
( 2 n d )p a r t o f
duoden

Hepatopancreatic
ampulla (of Vater)
M a j o r d u o d e n a lp a p i l l a( o f V a t e r

Plate 294

Viscera (Accessory Organsl

Junction of (Gommonl Bile Duct and Duodenum

(Common) bile duct


( d u c t u sc h o l e d o c h u s )
Longitudinalmuscle
of duodenum

Minor
duodenal
Longitudinal
duodenal
muscteseen
through
openrng
in circular

papilla
Circular
folds
Major
duodenal
papilla

ircularmuscle
of duodenum
Pancreaticduct
Sphincterof (common)
bile duct (choledochus)

muscle

o n g i t u d i n ablu n d l e
Reinforcing

of pancreatic
Sphincter
duct (inconstant)

fibers
Longitudinal

fold

Fibersto
longitudinal

Reinforcing
fibers
Duodenalmusclefibersto
longitudinal
bundle

bundle

Interior of descending
(2nd)part of duodenirm

Sphincterof hepatopancreatic
ampulla

D u o d e n am
l ucosa

( C o m m o n )b i l e d u c t

( C o m m o n )b i l e d u c t

Pancreas

Sphincterof
( c o m m o n )b i l e
L o n g i t u d i n aIl D u o d e n a l
L o n e i t u d i nbaul n d l e
Circular
I muscle
Pancreatic
( C o m m o n )b i l e d u c t

D u o d e n am
l uscle

L o n g i t u d i n abl u n d l e

Pancreas

S p h i n c t e ro f ( c o m m o n )
bileduct (choledochus)
Pancreaticduct

Fibersto
longitudinb
au
l ndle
Sphincterof pancreatic
duct (inconstant)

( C o m m o nb) i l ed u c t
of
Sphincter
hepatopancreatic
ampulla

L o n g i t u d i nbaul n d l e
Pancreaticduct

S p h i n c t eorf
hepatopancreatic
ampulla

ion, level B
Sphincterof
hepatopancreatic

Major
d u o d e n a lp a p i l l a

Reconstruction

ampulla
Hepatopancreatic
ampulla
(common
channel)

Variationsin union of bile and pancreaticducts


(Common)
b i l ed u c t

Pancreatic
duct
tncter

of ampulla
Short common
channel

f (Common;
I bileduct

Pancreatic
duct
Duodenal

ncter of

ampulla

watl

No common
channel

Viscera (Accessory Olgansl

L o n gc o m m o n
channel

4{tr
Plate 295

Variations in Gystic and Hepatic Ducts

Variationsin cysticduct
Adherentto
common
hepaticduct

Highunion
with common
hepaticduct

Anteriorspiral
, o r n r n cgo m m o n
hepaticducton
left side

Accessory(aberrant)hepatic ducts

Plate 296

Viscera (Accessory Organsl

TransverseSection: level of T12, Inferior to Xiphoid

o
o
rt
!f
A

D
o
o
o

Pyloric canal

o
o

o
-

Right colic (hepatic)flexure of colon


Transversecolon
(ascendingto left colic flexure)

Gallbladder

rt

to
!l
=

IT

o
rt

D e s c e n d i n gc o l o n
(descendingfrom left
colic flexure)

(Common)
b i l ed u c t

Splenicartery and vein

Proper
hepatic

Left suprarenalgland

anery
Superiorpoleof
leftkidney

Portal
Inferiorvena cav

Thoracic aorta
Pancreas

5
ll

Rightcrusof diaphragm

o
o
!i.
o
5
o
+
r
c
o
3
o

Left crus of diaphragm

Right suprarenalgland

o
o

Spleen

o
N
o

o
ll

of duodenum

Hepatoduodenal
ligament

!ql

Superior(.1st)part

Portaltriad

cr7#

{
-

N
\

Pancreas in Situ

C e l i a ct r u n k

Splenicartery

Stomach (cut)

Portal
triad( Proper
heparrc
I
( ( C o m m o n )b i l e

Right free margin of lesseromen


Suprarenalgla
Duodenum
R i g h tk i d n e y
(retroperitoneal)

Attachment
of transverse
mesocolon

R i g h tc o l i c
(hepatic)
flexure

Transverse
colon (cut)
Transverse
colon (cut

Left kidney (retroperitoneal)


Attachment of
transversemesocolon
Inferior mesentericvein
(retroperitoneal)

Middlecolicarteryandveifi
Superiormesentericartery and veir{

Duodenofejunal
flexure

Uncinate processof panc

Root of mesentery(cut)

4ttr

Low-power
section
of pancreas

Pancreaticnotch
(of Langerhans)

n t e r l o b u l adru c t
Interlobula
r ptum
se

Plate 298

Pancreaticduct
(ofWirsung)

y pancreaticduct (of Santorini)

Viscera (Accessory Organsl

Spleen

Posterior
extremity

ligament
Castrosplenic

Posterior
extremity

Superior

Short
gastric
vessels

Castric
impression

Renal
impression

Hilum

lnferior
border
Splenorenal
(lienorenal)
ligament

Splenicartery
Leftgastro-omental
(gastroepiploic)
vessels
Splenic
Colic
Anteriorextremi

Diaphragmatic
surface

Visceralsurface

Anteriorextremitv

Shortgastricvessels
Stomach(cut)
Serosa(visceral

S p l e n ip
culp
Splenic
trabeculae
Splenicvein

Crosssection

gland
Suprarenal

Splenicarteryand

*{r

(lienorenal)
ligament
Splenorenal
(cut)
mesocolon
Attachmentof transverse

Viscera (Accessory Organsl

Spleenin situ

Plate 299

Arteries of Stomach, Liver, and Spleen

Right and left inferior phrenic arteries


A b d o m i n a la o r t

Left gastricartery
Splenicartery

Celiac trunk

Esophagealbranch of left gastricartery

Lefthepaticartery
Recurrentbranch of left inferior
phrenic artery to esophagus

Right hepatic artery

Short
gastric
arteries

Cystic

artery
Cystic
duct
Proper
hepatic
artery
(Common;

bileduct
Hepatic
portal vein
Right
gastric

artery
Supraduodenal
artery

*{ry
Posterior
superior,
A n t e r i osr u p e r i o r
pancreaticoduodenalarteries

C o m m o n h e p a t i ca r t e r v
Right gastro-omental
( g a s t r o e p i p l o i ca)r t e r y
Castroduodenalartery

Plate 3OO

S p l e n i cb r a n c h e so f
splenicartery
Left gastro-omental
(gastroepiploic)artery
Dorsal pancreaticartery

Visceral Vasculature

Arteries of Liver, Pancreas, Duodenum, and Spleen

Intermediate
hepaticartery
Properhepaticartery
Righthepaticartery

Rightand leftinferiorphrenic
arteries(shownherefrom
commonstem)

Lefthepaticartery
Hepatic portal vein

e l i a ct r u n k

Common hepatic

artery

Abdominalaorta

Cysticartery
Left
gastric
artery

Callbladder

Short
gastric
arteries

Cystohepatic
triangle
(of Calot)
Cystic
Commonhepaticduc
( C o m m o n )b i l e

Rightgastricartery
Leftgastro-omental
(gastroepiploic)
artery

Supraduodenal
a

Arteryto tail of pancreas

Gastroduodenal
artery

eaterpancreaticartery
Splenicartery
I pancreaticartery
pancreatic
artery
Anastomotic
branch
Middlecolicartery(cut)
Posterior
superior
pancreaticoduodenal
attery (phantom

artery
Superiormesenteric
artery
Inferiorpancreaticoduodenal

Anteriorsuperior
pancreaticoduodenalartery
Right gastro-omental

(gastroepiploic)
arteri

Visceral Vasculature

Posterior
inferior
pancreaticoduodenal
artery
Anteriorinferior
pancreaticoduodenal
artery

*{r
Plate 3Ol

Variations in Geliac llunk

Splenicartery
t a k e so r i g i n

C o m m o no r i g i no f
c e l i a ct r u n ka n d
superiormesenteric
arrery

Splenicand hepatic
arteriestakeorigin
rromsupenor
mesenteric

Replacedright hepatic
artery takes origin from
superior mesenteric;
inferior pancreaticod u o d e n a la n d 1s t
jejunal arteriesfrom
replaced right hepatic

Accessory
righthepatic
arterytakesoriginfrom
superiormesenteric;
inferioroancreaticoduodenalarteriesfrom
accessory
righthepatic;
I stjejunalartery
from anteriorinferior
pancreaticoduodenal

Plate 3O2

,/

f r o ms u p e r i o r
m e s e n t e n(cn o t e
replacedleft
hepaticartery
from leftgastric)

Hepatolieno-

mesenteric
trunk

Replacedhepatic
artery takes origin
Tromsupenor
mesenteric(note
inferior pancreaticoduodenalartery
from 1st jejunal)

Lienogastric
trunk

Hepatomesenteric
trunk

te
c e l i a ct r u n k
teflc

Accessory
right hepatic
artery takes
origin from
supeflor
mesenteric

Complete
celiac trunk

Hepatomesenteric
trunk

Rightgastroepiploic
(gastro-omental)
:r

celiac trunk artery takes


origin from
Hepatomesenteric
supenor
mesenteric
(Noteaccessorv (note accessory
left gastricartery left hepatic
from left hepatic) artery from
left gastric)

Visceral Vasculature

Geliac Arteriogram
SeealsoPlates 300, 301

1i

Visceral Vasculature

CH
CT
G
CD
H
RC

C o m m o n h e p a t i ca r t e r y
C e l i a ct r u n k
Left gastricartery

S p l e n i ca r t e r y

C a s t r o d u o d e n aal r t e r y
P r o p e rh e p a t i ca r t e r y
R i g h tg a s t r i ca r t e r y

Plate 3O3

Arteries of Duodenum and Head of Pancreas

Duodenum and head of pancreasreflectedto left


( C o m m o nb) i l ed u c t
Castroduodenal
artery
Posterior
superiorpancreaticoduodenal
Anteriorsuperiorpancreaticoduodenal
artery
(phantom\

Superiormesenteric
artery
Inferior pancreaticoduodenalarterv

Posterior
inferior
pancreaticoduodenalartery

Anteriorinferior
pancreaticoduodenalartery
(partially in phantom)

Inferiorvena cava

Celiactrunk
Splenicartery

oper hepatic artery


Common hepatic artery
Supraduodenalartery

Castroduodenal
artery
(partiallyin phantom\
Posterior
superior
pancreaticoduodenal
artery
( C o m m o nb) i l ed u c t
Rightgastro-omental
(gastroepiploic)
artery
(phantom,cut)
Createrpancreaticartery
Inferior
pancreaticartery
Dorsal
pancreaticartery

Anteriorsuperior
pancreaticoduodenal
artery
(phantom)
ic branch
Posteriorinferior
pancreaticoduodenalartery

Superior
mesentericartery
Inferior

Anterior inferior pancreaticoduodenaf artery (ph antom)

pancreaticoduodenalartery

Posteriorview

Plate 3O4

Visceral Vasculature

ArterialVariationsandGollateralSupplyof Liverand Gallbladder


Umbilicus(turnedup\

Internalthoracicarteries
with arteries
alciformand roundligaments

Right,middle(variable),
and lefthepaticarteries

Shortgastricarteries

Cystic
artery

lntercostal
arteries

Left
gastro-omental
(gastroepiploic)
artery

Inferior
phrenic
artery
Castroduodenal
artery

Leftgastric
artery

Common hepatic

Celiactrunk
Posteriorsuperior

pancreaticoduodenal
artery

Splenicartery

Anteriorsuperior
pancreaticoduodenal
arter

Dorsal
pancreatic
artery

Rightgastricartery

Superior
mesenteric
artery

Rightgastro-omental
(gastroepiploic)

Inferiorpancreatic
artery

Inferior pancreaticoduodenalartery

Omental(epiploic)arteri
Omental(epiploic)arterialarc

*{r
Accessoryor replacedarteries
1. Rightor commonhepatic
2. Lefthepatic
3. Righthepatic
4. Cvstic
Anastomoses
of correspondingarteries
left hepatic
5. Inferiorphrenic/leftgastricH
6. Right<-+ left hepatic

Visceral Vasculature

Cystic

Capsular

Right
gastric
Gastroduodenal
relativesafety
Effectsof hepatic I l" Zonr.of

;[il;;'i''ffiil"I Bi:ffi:1iJ""Ji':;E?i?"",'5:
Plate 3O5

Arteries of Small Intestine

Common hepatic artery

S u p r a d u o d e n aal r t e r v

C e l i a ct r u n k
S p l e n i ca r t e r va n d v e i n

C a s t r o d u o d e n aal r t e r y

Posterior
superior
pancreaticoduodenalartery
Right gastro-omental
( g a s t r o e p i p l o i ca)r
A n t e r i o rs u p e r i o r
pancreaticoduodenalartery

Dorsal
pancreatrcartery
nor

pancreatrc
artery
Superiormesenteric
arteryandvein

Anastomosis
(inferior
pancreattcoduodenal to
1s t j e j u n a l

artery

R i g h tc o l i c
artery
lleocolic
anery

Superior
mesenteflc

artery
Anterior
cecal artery
Posterior
cecal artery

Appendicular
artery

J e j u n aal n d i l e a l( i n t e s t i n a la) r t e r i e b
A n a s t o m o t i cl o o p s ( a r c a d e s )
Straightarteries(arteriaerectae)

Plate 3O6

4{tr
Visceral Vasculature

Arteries of Large Intestine


Forafteries
Superiormesentericartery

Middle colic artery


Transverse
mesocoron

Marginal
dr rEr y

Straightarteries
(arteriaerectae

i u n a la n d i l e a l
(intestinal)arteries

\
Marginal artery

(Common
portion)

lnferior
mesenteric
aruery

Posterior
Anterior

eft colic

artery

Marginal artery

Ascending
branch
Descending
branch
Marginal
arrery

lleocolic
a
Colic
branch
lleal
branch

Sigmoid
arteries
igmoid
mesocolon

Anterior
cecal arter

Posterior
cecalartery
Appendicular

arrery

I n t e r n a li l i a c
aight
artenes
(arteriae
rectae)

Median sacralartery
(from abdominal aorta)

Middlerectalartery
Branchof superior rectalartery

Visceral Vasculature

rior rectalartery

,d,
nferiorrectalartery

4{r

Plate 3O7

Variations in Golic Arteries

Middlecolic

Middle
colic artery

artery

Right
colic
arrery

R i g h tc o l i c

arrery
lleocolic
artery

Commontrunk for
right colic and middle
colic arteries
Largebranch
from left
colic artery

Middlecolic
artery absent

R i g h tc o l i c
artery absent

Right
colic
artery lleocolic
artery -

lleocolic

artery

Absenceof middlecolic
artery replacedby large
branchfrom left colic
artery
of Riolan
Middlecolic

artery

Superior
mesenteric
artery

R i g h tc o l i c

arrery

Inferiormesenteric
artery

lleocolic

Leftcolic
artery

artery

Arc of Riolanbetween
middlecolic and
left colicarteries

Plate 3O8

$r
Visceral Vasculature

Veins of Stomach, Duodenum, Pancreasr and Spleen

H e p a t i cv e
Hepatic portal

lnferior vena cava


Left gastricvein and esophagealtributary

Posterior
supenor
pancreaticoduodenal

Short
gastnc
vetns

vetn

Right
gastricvei
Prepyloric
vetn

Anterior
supenor
pancreatrcoduodenal
vern
Right
gastro-omental
(gastroepiploic)

Leftgastroomental
(gastroepiploic)
vetn

vel

Posterior
inferior
pancreatrcoduodenal
vet

Anterior
inferior
pancreaticod u o d e n a lv e i n
vern
n t cv e t n

S u p e r i o rm e s e n t e r i c

gastric
verns
Hepatic portal vein
R i g h tg a s t r i cv e i n
P o s t e r i o sr u p e r i o r
pancreaticoduodenalvein
S u p e r i o rm e s e n t e r i cv e i n
Right gastro-omenta
( g a s t r o e p i p l o i cv)e i
Anterior superior pancreaticoduodenalvei

Left gastro-omental
(gastroepiploic)vein
(Creat) pancreaticvein

Anterior inferior oancreaticoduodenaJ


vein
Posteriorinferior oancreaticoduodenalvei

Visceral Vasculature

Inferior mesentericvein

*{r
Plate 3O9

Veins of Small Intestine

Hepatic portal vein

Left gastricvein

S p l e n i cv e i n
Right
gastric
vern

S u p e r i o rm e s e n t e r i cv e i n

Middle
colic
vetn
(cut)

J e i u n a al n d i l e a l( i n t e s t i n a lv)e i n s
A n a s t o m o t i cl o o p s

Right
colic
vetn

Straightveins (venae rectae)

Transversecolon
(e/evated)
Transverse
mesocoton

*{r
S u p e r i o rm e s e n t e r i ca r t e r ya n d v e i n

l e j u n a la n d i l e a l( i n t e s t i n a lv)e s s e l

Relations
of superior
mesentericvein and artery
in root of mesenterv

Plate 31O

Visceral Vasculature

Veins of Large lntestine

Left gastric vein

Hepatic
portal vein

S p l e n i cv e i n

Prepyloric
vetn

Superior
mesenteric
Rightgastroomental(gastroepiploic) vei

(Dorsalor superior)
pancreaticvein
lnferior
vein
mesenteric

Anteriorsuperior
pancreaticoduodenalvein

from colon(cut)
Tributary
Posterior
inferior
pancreaticoduodenalvein
Anterior inferior
pancreaticoduodenalvei
Middle colic vein (cut)
Right colic
lleocolic
Anterior cecal vein
Posteriorcecal vein

Appendicular

Jeiunaland ileal
(intestinal)
veins
eft colic vein

Lefttesticular
(ovarian)vessels
mesentertcveln
Sigmoidveins
Median
sacralvein

Superior
rectalvein

Righttesticular
(ovarian)
vessels
iliacvessels
External
lnternaliliac ve

Superiorglutealvein
Obturator

Tributaries
of left
and rightsuperior
rectalveins
rectalvenousplexus
Perimuscular
Leftmiddlerectalvein
Leftinternalpudendalvein
in pudendalcanal(Alcock's)
Externalrectalvenousplexus

Right middle rectalvein


Right inferior rectalvein

(to internalpudendalvein)

Visceral Vasculature

Nr
Plate 3l I

Hepatic Portal Vein Tlibutaries: Portacaval Anastomoses

Falciform
ligamentand
roundligamentof liver
Paraumbilical
veins

Right
gastric
vetn

Esophageal
veins

I
I
I

Bloodfrom superior
mesentericvein
Bloodfrom splenic,gastric,
and inferior mesentericveins
Mixture of above two
Cavaltributaries
Leftgastricvein

Hepatic
portal

Short
gastric
veins

Posterior,
Anterior
superior
pancreaticoduodenal

Left
gastroomental
(gastroepiploic)
vein

vernS

Superiormesenteric
vein
Splenicvein
Posterior,
Anterior
inferior
pancreati
duodenal
verns
Middle
colicvein

Rightgastroomental(gastroepiploic)vein
Inferior
mesenteric
vein
Leftcolic
vein

Right
colicvein

Sigmoidveins

Anterior,
Posterior

Leftand right
superior
rectalveins

cecal
vetns

Appendicular
vetn

Middlerectalveins
Levatorani muscle

1
2

Portacavalanastomoses
Esophageal
3 Rectal
Paraumbilical
4 Retroperitoneal

Pfate 312

lnferiorrectalveins

4{tr
Visceral Vasculature

Variations of Hepatic Portal Vein

Typicalarrangement

Esophagealvein
Cysticvein

Short
gastric
vetn

Leftgastric
veln

Hepatic
portal vein

--t---,
1 . 0 9c m

__t___
Posterior
superior
pancreaticoduodenalvein

Pancreaticveins

Suoeriormesentericvei

Leftgastro-omental
(gastroepiploic)
vein

Rightgastro-omental
(gastroepiploic)
vein

lnferior mesentericvein

Inferiorpancreatico-

Left colic vein

duodenal veins

Middlecolicvein
Right colic

and ileal
Jejunal
(intestinal)
veins

l l e o c o l i cv e i n

lnferior mesenteric
vein mav enter
junctionof splenic
and superior
mesentericveins
Hepatic
portal vein

S p l e n i cv e i n

lnferior mesentericvern
mayentersuperior
mesentericvein
Hepatic
portal
vetn

Superior
mesenteric

Superior
mesenteric

vetn

High intestinalveins

Splenicvein
lnferior
vein
mesenteric

vetn

Leftgastricvein
oftenentersjunction
of splenicandsuperior
mesentericveins

Left gastricvein may


entersplenicvein
(24% of cases)
Right gastricvein
Hepatic

portal
vetn

Hepatic
Left gastric vein

Leftgastric

portal
vetn

Superior
mesenteric
vetn

4{tr
Visceral Vasculature

Plate 313

Lymph Vessels and Nodes of Stomach

Celiac nodes
Nodes around cardia
Left gastricnodes

Right
supeflor
pancreatlc

Suprapyloric
nodes.
Splenic
nodes

Subpyloric
nooes.

Leftgastroomental
(gastroepiploic)
nooe

Right gastro-omental
(gastroepiploic)

Left gastric nodes

Nodesaround
cardia
Leftgastroomental

z'
Z o n e sa n d
pathwaysof
gastriclymph
d r a i n a g e( z o n e s
not sharply
demarcated)

Right gastro-omental(gastroepiploic)n

4{tr
Plate 314

Suprapyloric,
retropyloric,
and
s u b p y l o r inco d e s

Left superior pancreatic


nodes
Celiac nodes

Right superior pancreaticnode

Superiormesentericnodes

Visceral Vasculature

Lymph Vessels and Nodes of Pancreas

Anterior view
gastricnodes

Hepatic nodes

Splenicnodes
nodes
Superiorpancreatic
Celiacnodes
nodes
Superiormesenteric
(centralsuperiorgrouP)

node
(of Calot)

Pancreaticoduodenalnodes
Hepatic

portalvein
Celiacnodes

Posteriorview

nodes
Superiorpancreatic

Hepaticnodes
aroundbileducts
andproperhepatic
artery

S p l e n i vc e i n
lnferior mesentericvein
Superiormesenteric

arteryand vein

nodes
Superiormesenteric
(centralsuperiorgroup)

Visceral Vasculature

Pancreaticoduodenal
nodes

4{tr
Plate 315

Lymph Vessels and Nodes of Small Intestine

R i g h tl y m p h a t i ct r u n k

Thoracic duct

Celiac nodes
Superiormesenteric
nodes (central
s u p e n o rg r o u p )
Thoracic duct

Cisternachyli

Intestinal
lymphatic
tru nk -

R i g ha
t nd
leftlumbar
lymphatic
trun

Plate 316

Superior
mesenteric
nodes
(juxtaintestinal
group)

Visceral Vasculature

Lymph Vessels and Nodes of Large Intestine

E p i c o l i cn o d e s

Middle
c o l i cn o d e s
Superior
mesenleflc
nooes
(central
supenor

lnferior mesentericnodes

group)

Left colic nodes

Right
colicnodes

Preaorticnodes

S i g m o i dn o d e s

P a r a c o l i cn o d e s

Superiorrectal nodes

Left colic
nooeS
Preaortic
nooes

Common iliac
I n t e r n a li l i a cn o d e s

Superior
rectal
nodes
Middle
rectal
nooes

E x t e r n aill i a cn o d
M i d d l e r e c t a ln o d e s

Nr

S u p e r f i c i ai ln g u i n a l
Perineallymph vessels
( d r a i nl a r g e l yt o i n g u i n a l

Visceral Vasculature

Plate 317

Autonomic Nerves and Ganglia of Abdomen


$eealsoPlates lGi, 166

R i g h ts y m p a t h e t i ct r u n k
Thoracic duct

Anterior,
Posterior
vagal trunks

Right greater
a n d l e s s e rt h o r a c i c
s p l a n c hn i c
nerves

Left gastricartery
and plexus

R i g h tp h r e n i cn e r v e

Left greaterthoracic
s p l a n c h n i cn e r v e

Celiac ganglia

I n f e r i o rp h r e n i c
a r t e r i e sa n d p l e x u s e s

Left lesserthoracic
s p l a n c h n i cn e r v e

Right greater
a n d l e s s e rt h o r a c i c
s p l a n c hn i c
nerves

S p l e n i ca r t e r y
and plexus
Common hepatic
artery and plexus

R i g h ts u p r a r e n a l

prexus

Superiormesenteric
g a n g l i o na n d p l e x u s

Right aorticor e n a lg a n g l i o n

Left aorticorenal
ganglion

R i g h tl e a s tt h o r a c i c
s p l a n c h n i cn e r v e/

Left sympathetic
t r un k

R i g h tr e n a l
artery and plexus

Intermesenteric
(aortic)plexus

Right
s y m p a t h e t i ct r u n k

Inferior mesenteric
ganglion

W h i t ea n dg r a y
r a m ic o m m u n i c a n t e s

Left colic artery


and plexus

C i s t e r n ac h y l i

Inferior mesenteric
artery and plexus

C r a y r a m u sc

Left common iliac


artery and plexus

3 r d l u m b a rg a n g l i o n
of sympathetictrunk

Superiorrectal
artery and plexus

2nd and 3rd lumbar


s p l a n c h n i cn e r v e s

Superior hypogastric
prexus

R i g h tu r e t e ra n d p l e x u s
R i g h tt e s t i c u l a (r o v a r i a n )
artery a n d p l e x u s
4 t h l u m b a rs p l a n c h n i cn e r v e
l st sacralganglion
o f s y m p a t h e t i ct r u n k

Internaland external
i l i a ca r t e r i e sa n d
plexuses
Right and left
hypogastricnerves
to inferior hypogastric(pelvic)plexus

Cray ramicommunicantes

4{tr
Plate 318

Innervation

Nerves of Stomach and Duodenum

Right and left inferior phrenic arteriesand plexu


A n t e r i o ra n d p o s t e r i o rl a v e r so f l e s s e ro m e n t u m

H e p a t i cb r a n c ho f a n t e r i o rv a g a lt r u n k
A n t e r i o rv a g a lt r u n k
Celiac branch of posteriorvagal trunk

Right greaterthoracic
s p l a n c h n i cn e r v e

C e l i a cb r a n c ho f a n t e r i ovr a g a tl r u n k
Left gastricartery and plexus

Vagal
branch
from
hepatic
plexus
to
pyloric
part of
stomach
H e p a t i cp l e x u s
R i g h tg a s t r i c

Anterior gastric
branch of anterior
vagal trunk
Left greaterthoracic
s p l a n c h n i cn e r v e

$.'
i?,

Left lesserthoracic
s p l a n c h n i cn e r v e

Splenicarteryand plexus
C e l i a cg a n g l i aa n d p l e x u s
Plexuson gastro-omenta
(gastroepiploic)arteries
Superiormesentericartery and plexus

*{Y
lnnervation

P l e x u so n a n t e r i o rs u p e r i o ra n d a n t e r i o r
inferior pancreaticoduodenalarteries
(posteriorpancreaticoduodenalarteries
a n d p l e x u s e sn o t v i s i b l ei n t h i s v i e w )

Plate 319

Nerves of Stomach and Duodenum (continuedl


SeealsoPlates 16ti, 166
Plexuson gastro-omental
(gastroepiploic)arteries

Posteriorgastricbranch of posteriorvagal trunk


Hepatic branch of anteriorvagal trunk via lesseromentum

H e p a t i cp l e x u s

Branchfrom hepatic plexusto cardia via lesseromentum

Rightgastric
arteryand
prexus

Rightinferiorphrenicarteryand plexus
teriorvagaltrunk
Celiacbranchof posteriorvagaltrunk
Celiac branch of anterior vagal trunk
eft gastricartery and plexus

eft inferiorphrenicarteryand plexus


Celiac gangliaand plexus
Creater, lesser,and least
thoracic splanchnicnerves
Aorticorenalganglia
Splenicartery and plexus

4{tr
Greater,
Lesser,

ganglion
anch from right inferior phrenic

Least

plexusto cardiaof stomach

thoracic
splanchnic
nerveS

Rightand leftinferiorphrenic
arteriesand plexuses
Anteriorvagaltrunk

View
with
stomach
reflected
cephalad

Plexus
on
anteriorsuperior
and anteriorinferior
pancreaticoduodenal arteries
Plexuson gastroduodenalartery

Plexuson posteriorsuperior
and posteriorinferior
pancreaticoduodenal
arterie6
S u p e r i o rm e s e n t e r i cg a n g l i o na n d p l e x u ' s

Right greater,
lesser,and
leastthoracic
s p l a n c h n i cn e r v e s

Left gastric
C e l i a cg a n g l i a
R i g h ta o r t i c o r e n a lg a n g l i o n

S u p e r i o rm e s e n t e r i cg a n g l i o na n d p l e x u s

Plate 32O

Celiac branches
of anterior
and posterior
vagal trunks

arteryand plexus
Leftgreater,lesser,
and leastthoracic
splanchnn
i ce r v e s
Left aorticorenalganglion

Innervation

lnnervation of Stomach and Duodenum: Schema


SeealsoPlates 167, 168
R i g h t6 t h t h o r a c i c
g a n g l i o no f
s y n rp a t he t i c
trunk

-y

\
pl exus
Esophagea

-"-o=

Cray,
White
r a t n lc o m m u n r c a n t e s

e t t g r e a t e rt h o r a c i c
s p l a nc hn i < nerve

s/

S p i n a sl e n s o r v
( c l o r s ar lo o t )
ganglion

ticplexus
L e f t9 t h t h o r a c i c
g a n g l i o no f
s y m p a t h e t i ct r u n k

Anterior
( v o n t r a l r) o o t
of spinan
l erve

P o s t e r i ovr a g a lt r u n k
a n d c e l i a cb r a n c h

R i g h tg r e a t e rt h o r a r . i <
s p l a n c h n i ct ' t e f v - -

\,
\
\

R ig , h tl e s s e rt l r o r . r c - i <
s p l a n c h n i nc e r v e

A n t e r i o rv a g a lt r u n k
a n d c . e l i a cb r a n c ho f
v a g u sn e r r v e( X )
Left gastricartery

C e l i a cg a n g l i . r
t*
t

L e r a st th o r a c i c
s p l a n c h n i nc e r v e

/\s-

e l i a ct r u n k
.rrtery

Cornn'ror.r
h e p a t i ca r t e r l -

t\
I

Short
gastflc
arIefles

Proper
h e p a t i ca r t e r y
Superior
nresenterc
gangJion
Aortir.orenal
g,.r
n glia
R i g h tg a s t r i ca r t e r y ,
R i g , hrte n a la r t e r v
( l a s t r o d u o d e n aal r t u r y
P o s t e r i oar n d a n t e r i o r
s u p e r i o pr a n c r e a t i r . o c l u o c l e n aalr t e r i e s

Superior
r ) r e s et e
n rc

Left,
R i g h tg a s t r o o n r e nt a I
(gastroepiploic)
artenes

ar r e r y
Posterior
. r n da n t e r i o r
ilttenor
p.rnc.reatico
cluocler-ral

Sympatheticfibers
Preganglionic
P o s t g a n g l i o n i .- - * * *
Parasympatheticfibers

.lrteI es

4{tr
lnnervation

Preganglionic
Postganglionic
Afferent fibers

Plate 321

Nerves of Small Intestine


SeealsoPlates 165,166

A n t e r i o rv a g a lt r u n
Posteriorvagal trunk

C e l i a cb r a n c h e so f a n t e r i o r
and posteriorvagal t

Hepatic plexus
Creater thoracic
s p l a n c h n i cn e r v e s
C e l i a cg a n g l i aa n d p l e x u s
Castroduodenalartery and plexus
Lesserthoracic
s p l a n c h n i cn e r v e s
Leastthoracic
s p l a n c h n i cn e r v e s
Aorticorenalganglia
S u p e r i o rm e s e n t e r i cg a n g l i o n
I n t e r m e s e n t e r i(ca o r t i c )p l e x u s
Inferior pancreaticoduodenal
arteriesand plexuses
S u p e r i o rm e s e n t e r i c

arteryand plexus
Middle colic artery and plexus (cut)
R i g h tc o l i c a r t e r ya n d p l e x u s
l l e o c o l i ca r t e r ya n d p l e
S u p e r i o rm e s e n t e r i c
artery and plexus
Peritoneum(cut edge)

M e s e n t e r ibcr a n c h e s
M e s o a p p e n d i x( c o n t a i n s
a p p e n d i c u l a ar r t e r ya n d
nerve ptexus

4{tr
Plate 322

Innervation

Nerves of Large Intestine


of
Fornerves

A n t e r i o rv a g a lt r u n k a n d hepatic branc
Posteriorv a g a lt

Right greaterthoracic
s p l a n c h n i cn e r v e

M a r g i n aal r t e r ya n dp l e x u s
Esophagus

Left greaterthoracic
s p l a n c h n i cn e r v e

C e l i a cg a n g l i aa n d p l e x u s

Leftsuprarenal
plexus
Left lesserand
leastthoracic
s p l a n c h n i cn e r v e s

R i g ha
t orticor e n ag
l anglion

Left aorticorenal
ganglion

Superior
mesenteric
ganglion

Leftrenalartery
a n dp l e x u s

Middlecolic
artery
and plexus

l s t l e f tl u m b a r
nerve
splanchnic
Leftlumbar
sympathetictrunk
lntermesenteric
(aortic)plexus
Left colic artery
and plexus

R i g h tc o l i c
arrery
and plexus

lnferior
mesenteric
ganglion,artery,
and plexus

lleocolic
artery
and plexus

Sigmoid
arteries
and plexuses

C e c a la n d
appendicular
arteries
and plex

Superior
hypogastric
plexus
tor

rectal
arrery
and plexus

Sacralsympathetictru

Rightsacralplexu

ightand left

P e l v i cs o l a n c h n i cn e r v e s

hypogastric
nerves

Middle rectal arterv and plexus


R i g h ti n f e r i o rh y p o g a s t r i c

( p e l v i cp) l e x u s
Vesicalplexus

Nr
lnnervation

Rectalplexus

Nerves from inferior hypogastric(pelvic)


p l e x u s e st o s i g m o i dc o l o n , d e s c e n d i n g
c o l o n , a n d l e f t c o l i c ( s p l e n i c f)l e x u r e

U r i n a r yb l a d d e r

Plate 323

Innervation of Small and Large Intestines: Schema


SeealsoPlates 167, 168

Thalanrus

l{

t
.J

Hypothalamus
( r e d : s y m p a t h e r i cp a r t ,
b l u e = p a r a s y n r p a t h e t pi ca r t )

P o s t e r i o (r d o r s a l )
n u c l e u so f v a g u s

V a g u sn e r v e ( X )
M y e l e n c e pl . r al o n
(medulla
oblongata)
S y n r p a t h e t itcr u n k

I wr'it" I

S p i n a ls e n s o r y
( d o r s a lr o o t ) g a n g l i r > n

I cray/

Creater
Thoracic
{ Lesser
(
splanchnic
L e a st
nerves*

T10

T h o r a c o lu n r b a r
s p i n a lc o r d

T11

Aorticorenal
ganglion

T12

I n t e r m e s e tne r i c
( a o r t i c )p l e x u s

L.l

l n f er i or
mesenteilc
ganglion

L2

=1t--'
[3

Lunrbar
splanchnic
ne r v e s *

L4
t5
Hypogastric
ne r v e s

Sacral
s p i n a lc o r d

rJ

Sacral
s p l a n c h ni c
n e r v e s-

I n f e r io r
hypogastric
( p e l v i c )p l e x u s

{
rY
P e l v i cs p l . r n c h n i nc e r v e s
P u d e n d a ln e r v e
* A b d o m i n o p e l v i cs p l a n c h n i cn e r v c s

Plate 324

lnnervation

Innervation of Small and Large Intestines: Schema

Sympatheticefferents
Parasympathetic
efferents
Somaticefferents
Afferentsand CNSconnections
Indefinitepaths -----

4{tr
S u p e r i o rr e c t a l a r t e r v a n d n e r v e s

Rectalplexus

I n f e r i o r a n a l ( r e c t a l )n e r v e

Innervation

Levator
ani muscle
E x t e r n a la n a l
s p h i n c t e rm u s c l e

C h i e f s e g m e n t a ls o u r c e s
of sympathetic fibers
i n n e r v a t i n gd i f f e r e n t
r e g i o n so f i n t e s t i n a l
tract are indicated.
N u m e r o u s a f f e r e n tf i b e r s
are carriedcentripetally
through approximately
the same sympathetic
s p l a n c h n i cn e r v e s
that transmit
preganglionic fibers.

Plate 324

Autonomic Reflex Pathways: Schema

Sympathetic

Spinal
Dorsal(posterior)
root
sensory
(dorsal
root)
ganglion

Thoracicpart
of spinalcord
lntermediolateral
c e l lc o l u m n

C a n g l i o no f
s y m p a t h e t i ct r u n k

Spinalnerve
to vesselsand

g l a n d so f s k i n

r ror
V e n t r a(la n t eior)

W h i t er a m u sc o m m u n i c a n s
C r a yr a m u sc o m m u n i c a n d
C a n g l i o no f

s y m p a t h e tti rcu n k

Meningeal branch to spinal


m e n i n g e sa n d s p i n a lp e r i v a s c u l a r Stretch
plexuses(usuallyarisesfrom
(distention)
spinalnerve)

Abdominopelvic
(greater,
lesser,
and least)thoracic
splanchnn
i ce r v e s
Vagus
nerve(X)

Enteric
prexuses

C a n g l i o no f
sympathetictrunk

of gut

Superior
mesenteric
ganglion

Sympatheticf Preganglionic
fibers
I eostganglionic-----

Plate 325

Parasympathetic Preganglionic
fibers
P o s t g a n g l i o n -i c- - - -

4{tr
Afferentfibers -

lnnervation

Intrinsic Autonomic Plexuses of Intestine: Schema

Peritoneal
layersof
mesentery

Branchof
straight
artery
(arteriae
rectae)
to intestineand
accompanying
nerves
plexus
Longitudinalintramuscular

(Auerbach's)plexus

plexus
r intramuscular

(Meissner's)plexus

plexus
Periglandular

Visceralperitoneum(serosa)
Subserous
connectivetissue
muscle
Longitudinal
Intermuscular
stroma
Circularmuscle
Submucosa
S u b m u c o sgal a n d s

Nr

Muscularismucosae
glands
Mucosaand intestinal

Note:Intestinal
wall is shown
muchthickerthanin actualitv.

lnnervation

Plate 326

Innervation of Liver and Biliary Tlact: Schema


SeeahoPlateo 167,168

S y m p a t h e ttircu n k
Dorsalroot
(spinag
l )a n g l i o n
Thoracicpartof spinal
cord
R i g h tg r e a t e rt h o r a c i cs p l a n c h n i c

Leftgreaterthoracic
nerve
splanchnic

Posteriorvagal trunk
Right phrenic nerve to diaphragmatic
part of parietal(and visceral?)periton

Anteriorvagaltrunk

*{r
ic branchof
anterior vagal trunk
Diaphragm
P h r e n i cg a n g l i o n
C e l i a cg a n g l i a
Common hepatic artery
Splenicartery
Anterior hepatic plexus
Posteriorhepatic plexus

\Castroduodenal
arteryand plexus
Sympatheticfibers
Preganglionic
P o s t g a n g l i o n i-c- - - - - Parasympathetic
fibers
Preganglionic
P o s t g a n g l i o n i-c- - - - - Afferentfibers

Plate 327

S o h i n c t e ro f
h e p a t o p a n c r e a t iacm p u l l a

Ramificationof
fibersaroundfine
of hepaticartery

lnnervation

Innervation of Pancreas: Schema

Dorsalroot
(spinag
l )a n g l i o n

Right
sympathetic
t r u n k_

trunk
eft sympathetic
Thoracic part of
spinalcord

Rightgreater
thoracic
splanchnic
nerve

Leftgreaterthoracic
splanchnic
nerve
Anteriorvagaltrunk

Posterior
vagaltrunk
Common areasof
p a n c r e a t i cp a i n

Celiac ganglia

n{r

mesenteric
ganglion

Superiormesenteric
arteryand plexus

Sympatheticfibers
Preganglionic
Postganglioni

S c h e m ao f
intrinsic
nerve
supply

Parasympathetic
fibers
Preganglionic
Postganglioni
Afferentfibers

lnnervation

Plate 328

Kidneys in Situ: Anterior Views

Esophagus
Diaphragm
Left suprarenalgland
R i g h ts u p r a r e n a l
gland

C e l i a ct r u n k

R i g h tk i d n e y

Left kidney

R i g h tr e n a l
artery and vein

Left renal artery


and vein

Right subcostalnerve

mesenteric
artery (cut)

Transversus
a b d o m i n i sm u s c l e

tal nerve
Abdominal aorta

Quadratus

Iumborum
muscle

liohypogastricnerve

l l i a cc r e s t

l i o i n g u i n anl e r v e

P s o a sm a j o r m u s c l e
l l i a c u sm u s c l e

Lateral femoral
cutaneousnerve

Right ureter

Cenitofemoral nerve
Left testicular
(ovarian)artery and vein

R i g h tc o m m o n
iliac artery

Inferior mesenteric
artery (cut)

Right external
i l i a ca r t e r

Peritoneum(cut)

R i g h ti n t e r n a l
iliac artery

Sigmoid mesocolon (cut)

U r i n a r yb l a d d e r

Rectum

*{r
Esophagus
Inferiorvena cava
Area for bare
a r e ao f l i v e r

eft suprarenalgland
S p l e n o r e n al li g a m e n t

Right
s u p r a r e n agl l a n d

Area for stomach

Peritoneum

Area for spleen

(cut)
Area for liver

Tailof pancreas

Duodenum

Transversemesocolon

Peritoneum

Area for small intestine

(cut)
Area for colon
Area for
s m a l li n t e s t i n e

Plate 329

A r e a f o r d e s c e n d i n gc o l o n

Anterior relations
of kidneys

Kidneys and Suprarenal Glands

Kidneys in Situ: Posterior Views

Latissimus
dorsi
Serratusposterior
inferiormuscle-

Pleura(costodiaphragmaticrecess)
mbocostalligament
Quadratuslumborum
muscle(cut)

External
obliquemuscle

Diaphragm

Aponeurosis
of
transversus
abdominismuscle

Subcostalnerve

lnternal
obliquemuscle

Ascending
colon

Thoracolumbar
fascia
(posterior
layer)

ightkidney

Transversus
abdominismuscle
nerve
lliohypogastric

lliaccrest
Erectorspinae
Clutealaponeurosis
(overgluteusmedius
muscle)

dratuslumborum
muscle(cut)
Psoasmajor muscle
r ligament

Gluteusmaximus
muscle

Projection
of 11th rib
Areafor
Projectionof 12th

*{r
Posteriorrelations
of kidneys
Areafor diaphragm
o f 1 2 t hr i b

Areafor aponeurosis
ot transversus
abdominismuscle

Areafor aponeurosis
of transversus
abdominismuscle

Areafor quadratus
lumborummuscle

Areafor quadratus
lumborummuscle

Areafor
psoasmajormuscle

Areafor psoas
majormuscle

Kidneyls and Supralenal Glands

Plate 33O

Schematic Cross Section of Abdomen at T12


Lineaalba
Falciformligamenl
Superiorepigastricvessels
Transversalis
fascia
Parietalperitoneum
Visceralperitoneumof liver

Properhepatic
(bifurcation)

Rectusabdominismuscle
Lesseromentum
Leftgastricarteryand vein

7th costalcartilage
External
obliquemuscle
Diaphragm
Stomach

Commonhepaticduct
Cysticduct
Hepatic
portalvein
Costodiaphragmatic
recessof
pleural
cavity

Castrosplenic
ligamentand
short gastric
vessets
Spleen

lntercostal
vessets
and
nerve
Omental
(epiploic)
foramen
(of Winslow)
Common
hepaticartery
(retroperitoneal)
Hepatorenalrecess
(Morison'spouch)
Inferiorvena cava
Omentalbursa(lessersac)

Intercostal
muscles
ligament
Splenorenal
with splenicvessels
Parietalperitoneum
on posteriorwall
of omentalbursa

Rightsympathetic
trunk
Rightcrusof diaphragm
Azygosvein
Thoracicduct
Anteriorlongitudinal
ligament
Celiacganglia
Abdominalaorta
Body of T12 vertebra

Plate 331

Left kidney
Leftsuprarenalgland

musc'e
iH*F;"Trs 4{tr
[fft;f*r,

Kidneys and Supranenal Glands

Renal Artery and Vein in Situ

Inferiorvena cava

Esophagus
Left inferior phrenic vein

Right and left inferior phrenic arteries

Leftsuperiorsuprarenalarteries

Celiac trunk

Leftmiddle
suprarenal
artery

Rightsuperior
suprarenala

vein
Leftsuprarenal
R i g h tm i d d l e
suprarenalartery

Leftinferior
artery
suprarenal

vein
Rightsuprarenal
Rightinferior
suprarenal
arter

Uretericbranchof
left renalartery
Leftrenal
arteryandvein
Uretericbranch

Left testicular (ovarian)


arterv and vein

of right renal artery


Right renal artery and vein

Left2nd lumbarveinand communication


lumbarvein
to ascending

Right testicular (ovarian) artery and vein

Inferiorvenacavi
Abdominalaortd

Kidneys and Suprarenal Glands

arterv
Inferiormesenteric
artery(cut)
Superiormesenteric

*{r
Plate 332

Variations in Renal Artery and Vein

Proximal
subdivision
of renal
artery

A Low accessoryrightrenal
arterymay passanteriorto inferior
venacavainsteadof posteriorto it
B Inferiorphrenicarterywith
superiorsuprarenal
arteriesmayarise
from renalartery(middlesuprarenal
arteryabsent)
Doubleleftrenal
vein mayform
ringaround
abdominalaorta

Multiplerenalveins
Persistent
left
inferiorvenacava
mayjoin leftrenalvein

*{r
Plate 333

Kidneys and Suprarenal Glands

Gross Structure of Kidney

Anteriorsurface
of right kidney

Fibrouscapsule
(cutand peeledback)
Medialborder
Hilum
Renalartery
R e n avl e i n
Renalpelvis
Stellateveins visible

throughcapsule

Medialborder
Ureter

Suprarenalgland
and lobulated
kidney of infant

Fibrouscapsule
Cortex

Medulla(pyramids)

Renalpapilla

Minorcalices
Bloodvessels
enteringrenal
parenchyma
I sinus
Majorcalices

Renalcolumn
(of Bertin)

Renalpelvis
Fatin renalsinus
Minor calices

Baseof pyramid
Ureter

Rightkidneysectionedin
severalplanes,exposing
parenchymaand renal pelvis

Kidneys and Suprarenal Glands

Plate 334

Intrarenal Arteries and Renal Segments

Superior(apical)segmental

Frontalsectionof left kidnev:


anteriorview

Anteriorsuperior
segmental
artery
Capsular
and
perirenalbranches
Inferior
suprarenalartery
Anteriorbranch
of renalartery
Renal

Posteriorbranch
of renalartery
(posterior
segmental
artery)
Pelvicand uretericbranches
Anteriorinferior
segmental
artery
Posterior
segmental
arteries
Inferiorsegmentalartery

Vascularrenalsegments

Nr
Anteriorsurfaceof left kidnev

Plate 335

Posteriorsurfaceof left kidney

Kidneys and Supralenal Glands

Nephron and Gollecting Ti,rbule:Schema

Fibroustuot''".--.-----.=
"

'

convolutedtubule
Proximal

--ciitl-.il-renalcorpuscle
luxtamedullary
renalcorpuscle
Proximal
convoluted
tubule

Distal

I convolutedtubule

convoluted
tubule

H e n l e ' sl o o p
D e s c e n d i n gl i m b
A s c e n d i n gl i m b

C o l l e c t i n gt u b u l e

5
-

Henle's

loop

LCJ

Descending
Renal
medulla
(pyramid)

R e n a l( m a l p gi h i a n )c o r p u s c l e ;
g l o m e r u l a r( B o w m a n ' s )c a p s u l e
with glomerulus

Ascending

li

Afferent and efferent


glomerulaa
r rterioles

C
N

c
c

Openings
of papillary
ducts

Nr

ffi

tubutes
Cottecting

C r i b r i f o r ma r e a o f r e n a lp a p i l l a

Kidneys and Suprarenal Glands

Plate 336

Blood Vessels in Parenchyma of Kidney: Schema

A f f e r e n tg l o m e r u l a ra r t e r i o l e
E f f e r e ngt l o m e r u l a ra r t e r i o l e

J u x t a m e d u l l agrlyo m e r u l u s
( e f f e r e ngtl o m e r u l aarr t e r i o l e
d e s c e n disn t or e n a p
l yramid)

C o r t i c a lg l o m e r u l u s
E f f e r e n gt l o m e r u l a r
a r t e r i o l e( j o i n sc o r t i c a l
c a p i l l a r yp l e x u s

Corticomedullarg
y lomerulus
Cortical
capillary
US

f f e r e n tg l o m e r u l a ra r t e r i o l e
( j o i n sc o r t i c a lc a p i l l a r yp l e x u s
a n d a l s od e s c e n d si n t o r e n a lp y r a m i d )

Stellate
vetn

F i b r o u sc a p s

C a p s u l a ra n d p e r f o r a t i n gv e i n s
Cortical
radiate
(interlobular)
artefles
a n dv e i n s
Subcapsular

,> zone

uate
artery
andvein
Vasa rectae
s p u r i a( f r o m
juxtamedullary
efferent
glomerular
arterioles)

\1 i 1

Vasa rectae
vera (from
a r c u a t ea n d
cortical radiate
artefles)
Venulae
rectae
Medullary
capillary
plexus
Interlobar
arrery
andvein

e,

Renal
cotumn
(of Bertin)
H e n l e ' sl o o p
of nephron
Collecting
tubule

4{tr
Plate 337

lnterlobar
a r t e r ya n d
v e t nI n
perirenal
fat of
r e n a ls i n u s

Kidneys and Suprarenal Glands

TransverseSection: Level of T12-L1 lntervertebral Disc

o
o

o
3
c

o
tr

S u p e r i o rm e s e n t e r i cv e i n ( b e c o m i n gp o r t a lv e i n )

o
5

E!

qt

ll

ql

Transversecolon

II

!r
J

c
o

rt

A s c e n d i n gc o l o n
( r i g h tc o l i c f l e x u r e )
E x t e r n aol b l i o u e m u s c l e
( C o m m o n )b i l e d u c t
D e s c e n d i n gc o l o n

o
o
o

o
o
o

=i.

D e s c e n d i n g( 2 n d )
partof duodenum
Left suprarenalgland

o
J

o
D

I n f e r i o rv e n a c a v a

rh

Spleen

R i g h ts u p r a r e n agl l a n d

c
o
3
o

Liver
S u p e r i o rp o l e o f r i g h t k i d n e y

R i g h tc r u s o f d i a p h r a g m

qf
t

o
G)
g)

f 12-t'l intervertebraldisc

qt

L e f tc r u s o f d i a p h r a g m

{
I

A b d o m i n a la o r t a

c44e/*

I
F
I

!l

o
o

TransverseSection:Levelof L1-2 IntervertebralDisc

:'

G)
g)

Superiormesentericvein

qt
t

Creater omentum
Pancreaswith uncinate process
Transversecolon

J u n c t i o no f 2 n d a n d 3 r d
p a r t so f d u o d e n u m

II

Superiormesentericartery

o
rt

Transversecolon

o
o

lleum

lejunum

o
o
rt

Perirenalfat

IT

A s c e n d i n gc o l o n

o
rh

4
c
5

o
o

D e s c e n d i n gc o l o n

R i g h tr e n a lv e i n
(enteringinferior
vena cava)

Left kidney
Major calyx and renal pelvis

ql
f

c
o
tr

lt
ql
!

o
3

t
o
I

o
3
o
o

c
o
3
o

Renalfascia

Right kidney

Pararenalfat

Inferior vena cav

!t
t
F
I

Right crus of diaphragm


Psoasmajor muscl

Left renal artery

Left renal vein (entering


inferior vena cava)

L1-2 intervertebraldist
Left crus of diaphragm
C o n u sm e d u l l a r i sa n d c a u d a e q u i n

Cfd4/*

Ureters

Uretersin male:
anterior view
Leftkidney
Rightkidney
Leftureter
Duodenum
lnferior
mesenteric
artery

Superior
mesenteric

Leftcolic artery
Rightcolicartery
Sigmoidarteries
R i g hu
t re
lleocolic artery

Superiorrectal
artery(cut)

Testicular
vessel

nerve
Cenitofemoral

C o m m o n i l i a ca r t e r
lnternal iliac arter
Externaliliac arter

Inferiorvesicalarterv

Middle rectal a

Diagonalcourse
of ureter
throughbladder
wall
Bladdermucosa

Ductusdeferens
narybladder

4{tr

Ureter

Urinarybladder
Medialumbilical
ligament(occluded
partof umbilicalartery)
Roundligament
of uterus
Superiorvesicalartery

Broadligament

Uterineartery
Umbilicalartery
Obturatorartery
and nerve
Ureter

Uterosacral
(sacrogenital)
fold

Vaginalarteryand
inferiorvesicalbranch
External
iliacartery

Ureter
(re
Intersigmoid
Sigmoid mesocolon

Uretersin female:
superiorview

Kidneys and Suprarenal Glands

ian vessels

Internaliliacartery
iliacartery
Root of mesenterv

Plate 34O

Arteries of Ureters and Urinary Bladder


a

A b d o n r i n aal o r t a
S u p e r i o nr r e s e n t e r i c
arterv

R e n aa
l r t e r ya n d v e i n
Uretericbrar-rch
from renalartery
Ovarianartery
Ureter

Inferior
mesentencartery(cut)
Uretericbranchfronr aorta
Uretericbranchesfron'r
ovarianand conrmon
r l i a ca r t e r i e s
C o m n r o ni l i a ca r t e r y
M e d i a ns a c r aal r t e r y
I n t e r n aill i a ca r t e r y
l l i o l u n r b aar r t e r y
S u p e r i o gr l u t e aal r t e r y
Lateralsacral:rrtery
Inferiorglute.rland
i n t e r n apl u d e n d aal r t e r i e s
U m b i l i c aal r t e r y
(patentpart)
U t e r i n ea r t e r y

Inferiorvcsicalartery
a n d u r e t e r i cb r a n c - h
S u p e r i ovr e s i c aal r t e r i e s
I n f e r i o cr p i g a s t r iac r t e r y
Uretericbranc-hfronr
s u p e r i o vr e s i c aal r t e r y
M e d i a lu n r b i l i c al il g a n r e n t

Plate 341

Kidneys and Suprarenal Glands

Renal Fascia

Duodenum
Right
Rightcolic (hepatic)flexure
Liver

flexure
Duodenojejunal
Superiormesenteric
vein and artery Abdominal

Left renal vein and artery


Left kidney

lnferior
vena cava

Transversalis
fascia
fat
Pararenal
(retroperitoneal)
Quadratuslumborum muscre

Cruraof diaphragm

Transverse
sectionthrough 2nd
lumbarvertebrademonstrates
horizontaldispositionof fascia

Psoasmaior muscleand fascia

Perirenal
fat
Fibrouscapsuleof kidney
Anterior and posterior
layersof renal (Cerota's) fascia

Diaphragm
Diaphragmaticfascia
( c o n t i n u a t i o no f
transversalis
fascia)

Lung
Liver

Costodiaphragmatic

recess

Bare area of liver

S u p r a r e n agl l a n d

F i b r o u sc a p s u l eo f k i d n e y

Perirenalfat

Peritoneum

1 2 t hr i b

Anterior and posterior


layersof renal (Cerota's)fascia

Pararenalfat
(retroperitoneal)
R i g h tk i d n e y
Transversalis
fa

Right colic (hepatic)flexure

Q u a d r a t ulsu m b o r u mm u s c l
l l i a cc r e s t

*{r
Kidneys and Suprarenal Glands

Sagittalsectionthrough right kidney


and lumbarregiondemonstrates
verticaldispositionof renalfascia

Plate 342

Lymph Vessels and Nodes of Kidneys and Urinary Bladder


SeealsoPlates406,408

Subcapsular
l y m p h a t ipc l e x u s

Cortical lymph vesselsalong cortical


r a d i a t e( i n t e r l o b u l a rat r t e r i e s
Lymph vesselsalong arcuatearteries
Lymph vesselsalong interlobararteries

Medullary
lymphvessels

*{r
Note:Arrows
indicatedirection
of flow.

L u m b alry m p ht r u n k st o
cisternachyliandthoracicduct

Lateralaortic (lumbar),precaval,
and postcavalnodes

C o m m o n i l i a cn o d e s

P r o m o n t o r i a(l m i d d l es a c r a l )n o d e

I n t e r n a li l i a cn o d e s

E x t e r n aill i a cn o d e s

Lymph vesselsfrom dorsal


part and trigone of bladder

Lymphvessels
fromsuperior
andanteriorpartsof bladder

Lateralvesicaland
prevesicalnodes

Plate 343

Kidneys and Supralenal Glands

Nerves of Kidneysr Ureters, and Urinary Bladder

Anteriorvagaltrunk
Posteriorvagaltrunk
nerve
Createrthoracicsplanchnic
Celiac gangliaand plexus

Lesser
nerve
thoracicsplanchnic
ganglion
Superiormesenteric
Leastthoracic splanchnicnerve
Aorticorenal ganglion

Renalplexusand ganglion
2nd lumbarsplanchnic
Renaland upperuretericbranches
fromintermesenteric
(aortic)plexus
Intermesenteric

ganglion
Inferiormesenteric
trunkand ganglion
Sympathetic
Middleuretericbranch
Superiorhypogastric
nerves
Sacralsplanchnic
(branches
from uppersacral
sympatheticgangliato
hypogastricplexus)-

Cravramuscommunicans
Hypogastricnerves

Sacralplexus

Pelvicsplanchnic
(pelvic)plexus
Inferiorhypogastric
loopsand
with periureteric
branches
to lowerureter
Rectalplexus
Vesicalplexus
Prostaticplexu

Kidneys and Suprarenal Glands

4{tr
Plate 344

Innervation of Kidneys and Upper Ureters: Schema

ucleusof solitarvtract
(dorsal)nucleus
Posterior
of vagusnerve
Medullaoblongata
Crayramuscommunicans
Vagusnerve(X)
ng fibers

Ventralramusof T10
(intercostal
nerve)

Ascending
fibers
W h i t er a m u sc o m m u n i c a n s

nalcord segments
T10-11

Cangliaof sympathetic
trunk

Lesser
thoracic
splanchnic
nerve

1 s tl u m b a sr p l a n c h n n
i ce r v e

splanchnic
nerve

thoracic

Celiacgangliaand plexus
Superiormesenteric
ganglion
ganglion
Aorticorenal
plexus
Intermesenteric

4{tr
Sympatheticfibers
Preganglionic
P o s t g a n g l i o n i-c- - - - - - - .
Parasympathetic
f ibers
Preganglionic
Postganglioni

Superiorhypogastric
plexus

Hypogastric
nerve
Sacralplex
Pelvic
splanchnic

nerves

Afferentfibers

Plate 345

Kidneys and Suprarenal Glands

Nerves of Suprarenal Glands: Dissection and Schema

Left phrenic nerve

Right phrenic nerve

vagaltrunk
Posterior
Left inferior phrenic
artery and plexus
Left suprarenalgland
Left greaterthoracic
s p l a n c h n i cn e r v e

R i g h st u p r a r e n g
al a n d
Right greaterthoracic
splanchnichrv:-

C e l i a cp l e x u s
a n dg a n g l i a
Leftlesserthoracic
splanchnn
i ce r v e
Aorticorenal
ganglia

R i g h tr e n a l
g a n g l i o na n d p l e

Left least
thoracic
splanchnic
nerve
Left
renal
ganglion
and
prexus

trunk
Leftsympathetic

R i g h ts y m p a t h e t i c

L e f t 1 s t l u m b a rs p l a n c h n i cn e r v e

Righ1
t s tl u m b a sr p l a n c h n n
i ce r v e

S u p e r i o rm e s e n t e r i cg a n g l i o n
In t e r m e d i o l a t e r acle l l c o l u m n
(lateralhorn of gray matter)

T5

T6
T7

Medulla
Thoracic
splanchnic
nerves
(preganglionic
flbers)

Postganglionic
f i b e r ss u p p l y
bloodvessels

Celiac
ganglion

T8
t
I
I
I

4{tr

Preganglionic
fibers ramify
a r o u n dc e l l s
of medulla
Suprarenalgland

Kidneys and Suprarenal Glands

Plate 346

Artefes and Veins of Suprarenal Glands in Situ

Liver(retractedsuperiorly)

Superiorsuprarenal
arteries
(frominferiorphrenicartery)
lnferior vena cava (retracted mediallvl

Suprarenal
vein
Branches
of middlesuprarenal
arteries(fromabdominalaorta)
(cutedge)
Peritoneum

Pancreasand spleen
(re tr acted sup eri o r Iy)

Leftinferiorphrenicartery
ior suprarenal
arteries
gland
Suprarenal
Renal(Cerota's)
fascia
Left
kidney

Renal
(Cerota's)
fascia
Right kidney

(pulleddown)
gland
Suprarenal
Inferiorsuprarenal
artery
(from renalartery)
Abdominal exposure of right suprarenal gland

Crosssection
through
suprarenal
gland

psule
Cortex
Medulla

Duodenojejunalflexure
Leftcolic(splenic)
flexure(pulled
Middlesuprarenal
artery

*{r

Suprarenalvein

Inferiorsuprarenal
arterir

Leftrenalartery
andvein

Peritoneum
(cut edges)

Abdominalexposureof left suprarenalgland

Plate 347

Kidneys and Supranenal Glands

AbdominalWall and Viscera: Paramedian(Sagittall Section

D i a p h r a g m( c e n t r a tl e n d o n )

C o r o n a r yl i g a m e n t
e n c l o s i n gb a r e a r e a
of liver

-,":ij

Esophagus
P a r i e t apl e r i t o n e u m
Superiorrecessof omental
bursa (lessersac)

Liver
L e s s e ro m e n t u m

H e p a t i cp o r t avl e i na n d
properhepaticartery
i n r i g h tm a r g i no f

O m e n t a l( e p i p l o i c )
foramen (of Winslow)

l e s s e ro m e n t u m
O m e n t a lb u r s a
(lessersac)

e l i a ct r u n k

Stomach

S p l e n i cv e s s e l s

Middle colic artery

Renalvessels

Transversemesocolon

Pancreas

Parietalperitoneum (of
a n t e r i o ra b d o m i n a lw a l l )

Superiormesentericartery
Inferior (horizontal,or 3rd) part
of duodenum

Transversecolon
Creater omentum
S m a l li n t e s t i n e

Abdominal aorta

Rectusabdominis

muscle

Parietaloeritoneum (of
posterior abdominal wall)
Mesenteryof small intestine

Transversalis
fascia

Medianumbilical
l i g a m e n t( u r a c h u s )
Fatty layer of

subcutaneou
t is s u e

Rectovesicaloouch

(Camper'sfascia)

Rectum

M e m b r a n o u sl a y e r
o f s u b c u t a n e o u tsi s s u e
(Scarpa'sfascia)

Rectoprostatic
( D e n o n v i l l i e r sf' a
) scia

U r i n a r yb l a d d e r

Levatorani muscle
Prostate

P u b i cb o n e

Deep
Superficial
Subcutaneous

R e t r o p u b i c( p r e v e s i c a l )
space (cave of Retzius)

Deep and superficial


p e r i n e a lm u s c l e s

D e e p ( B u c k ' s f) a s c i a
of penis

B u l b o s p ogni o s u sm u s c l e

P e r i n e am
l e m b r a n ea n d b u l b o u r e t h r a(lC o w p e r ' s )g l a n d
Tunica vaginalistestis

Abdominal Sections

P u b o r e c t a l im
s u s c l e( t h i c k e n e dm e d i a l
edge of left levator ani muscle)

Plate 348

Schematic Gross Section of Abdomen at L3, 4

Round ligament(ligamentumteres)of liver


Transverse
colon
Branchesof inferiorepigaslricvessels

Rectussheath
Transversus
abdominis
aooneurosis
Externaloblique aponeurosis
Internaloblique aponeurosis

L i n e aa l b a
Rectusabdominismuscle
Omental appendices

Createromentum
Parietalperitoneum
Transversalis
fascia
Transversus
abdominismuscre

Mesenteryof smallintestine

I n t e r n aol b l i q u e
muscte

Superiormesentericvessels

S m a liln t e s t i n(ei l e u m )

External
oblique
muscle

L y m p hn o d e
Ascending
coton

R i g h t1

paracolic
gutter

Smallintestine
(jejunum)
X,

Descending
coron
Left
paracolic
gutter

Left
ureter

Tendon
of origin of
transversus
abdominis
muscle

Quadratus
lumborum
muscle

lliohypogastricnerve

Latissimus
dorsimuscle

l l i o i n g u i n anl e r v e

Testicular(ovarian)vessels

( Combined
Laversof
thoracolumba'
I| ftiddl.
""'' ;
Tascra
( posterior

Psoasminor muscle
Parietalperitoneum

Psoasmajormuscle
Right genitofemoral nerve

Inferiorvena cava

Leftsympathetictrunk

Anterior longitudinalligament
Ligamentumflavum

Erectorspinaemuscle

Abdominal aorta
Spinousprocessof L3 vertebra
Intermesenteric(aortic)plexus

Plate 349

Abdominal Sections

Abdominal Scans: Axial GT lmages

Seriesof abdominalaxial CT imagesfrom superior(A) to inferior (D)

A
AC
B
DC
It
lV
tA
tl
tK
tt

Aorta
Ascending
colon
Bodyofvertebra
Descending
colon
lleum
Inferiorvenacava
Lineaalba
Leftcommoniliacartery
Leftkidney
Leftlobeof liver

Abdominal Sections

M
P
R
RA
RI
Rt

s
ST
TC

Deepbackmuscles
Psoasmuscle
Rib
Rectusabdominismuscle
Rightcommoniliacartery
Rightlobeof liver
Spleen
Stomach
Transverse
colon

Plate 35O

5 Pelvis and Perineum


Section
Topographic AnatomY
Plate 351

andPerineum
ssr Pelvis

Bones and Ligaments


Plates 352-355

of Pelvis
andLigaments
ssz Bones
(continued)
of Pelvis
andLigaments
3s3 Bones
Measurements
of Pelvis:
sse SexDifferences
Pelvis
oftheMaleandFemale
sss Radiographs

Pelvic Floor and Gontents


Plates 35F364

gse Pelvic
Female
Diaphragm:
(continued)
Female
Diaphragm:
ssz Pelvic
Male
Diaphragm:
ssa Pelvic
Male(continued)
Diaphragm:
oss Pelvic
geo Pelvic
Female
Viscera
andPerineum:
Male
Viscera
andPerineum:
ser Pelvic
Female
Contents:
aez Pelvic
Male
Contents:
ses Pelvic
Spaces
Fascia
andPotential
oel Endopelvic

Urinary Bladder
Plates 36$68

andSupports
Bladder:
0rientation
oes Urinary
Female
andMale
Bladder:
eee Urinary
oez Sphincters
Cystourethrograms
368 MaleandFemale

Atlas of Human Anatomy

Pelvis and Perineum

ina, andSupporti
ns
t.r".i3ft,vas
Plates 36975

oes Pelvic
Viscera:
Female

Rectum
Plates 391-396

ssr Rectum
inSitu:Female
andMale

ozo Uterus,
Vagina,
andSupporting
Structures

Fossae
ogz lschioanal
gss Rectum
andAnalCanal

szr Uterus
andAdnexa

Musculature
sgl Anorectal

szz Pelvic
Ligaments

AnalSphincter
Muscle:
Perineal
Views
sss External

3zs Uterus:
AgeChanges
andMuscle
Pattern

andPotential
Perineopelvic
396 Actual
Spaces

szl Uterus:
Position
andProlapse
ozs Ectopic
Pregnancy

Regional Scans
Plate 397

Regional Tlansverse Section

ssz Pelvic
Scans:
Sagittal
MRlmages

Plate 376

Bladder-Prostate
sze MalePelvis:
Junction

Vasculature
Plates 398409

Perineum and External


Genitalia: Female
Plates 377-379

(Pudendum
ezz Female
Perineum
andExternal
Genitalia
orVulva)
(Superficial
Perineum
szs Female
Dissection)
gzs Female
Perineum
andDeep
Perineum

(Male)
ofRectum
andAnalCanal
ese Arteries
(Female)
ess Veins
of Rectum
andAnalCanal
loo Arteries
Female
andVeins
ofPelvic
0rgans:
cor Arteries
andVeins
ofTestis
coz Arteries
andVeins
of Pelvis:
Female
Male
eos Arteries
andVeins
of Pelvis:

Perineum and External


Genitalia: Male

eoe Arteries
andVeins
andUterus
of Perineum

Plates 38G87

me Lymph
Vessels
andNodes
ofPelvis
andGenitalia:
Female

(Superficial
oso Perineum
andExternal
Genitalia
Dissection)

Female
mz Lymph
Vessels
andNodes
ofPerineum:

(Deeper
set Perineum
andExternal
Genitalia
Dissection)
gaz Penis
ges Perineal
Spaces

Vessels
Male
eoe Lymph
andNodes
ofPelvis
andGenitalia:

sal Prostate
andSeminalVesicles

eos Arteries
Male
andVeins
of Perineum:

lnnervation
Plates

4O9-4l7

ses Urethra

409

Nerves
of External
Male
Genitalia:

sse Descent
ofTestis

4lo

Nerves
ofPelvic
Viscera:
Male

sgz Scrotum
andContents

4ll

Nerves
Male
ofPerineum:

412

Nerves
Viscera:
Female
ofPelvic

413

Female
Nerves
ofPerineum
andExternal
Genitalia:

414

Neuropathways
in Parturition

see Homologues
of External
Genitalia

415

Innervation
Reproductive
Organs:
Schema
of Female

ees Homologues
ofInternal
Genitalia

4t6

Innervation
ofMaleReproductive
0rgans:
Schema

417

Innervation
Bladder
of Urinary
andLowerUreter:
Schema

Homologues of Genitalia
Plates 38&389

Testis, Epididymis, and Ductus


Deferens
Plate 39O

Epididymis,
ogo Testis,
andDuctus
Deferens

Atlas of Human Anatomy

Pelvis and Perineum

Sternocleidomastoid
muscle

muscle
Trapezius
Deltoidmuscle
Pectoralis
majormuscle

Serratus
anterior
muscle

Semilunar
line

Tendinous
intersection
External
oblique
muscle
Rectus
abdominis
muscle

Lineaalba

Anteriorsuperior
i l i a cs p i n e

Umbilicus
lliaccrest

Superficial
circumflexiliacvein
Superficial
epigastricveins

Inguinal
ligament

Pubicsymphysis

Pubictubercle
dorsal
Superficial
veinof penis
C l a n so f p e n i s

Body(shaft)of
penis

External
urethral
orifice(meatus)

Scrotum
+*
f"{,

Topographic Anatomy

6(d4/*

PIate 351

Bones and Ligaments of Pelvis

Bodyof L5 vertebra
lliac J Intermediate
zone
c r e s t I n n e rl i p I

Falsepelvis

(15-S1) intervertebral
Lumbosacral
disc

llia.cfossa(wing
OI lllum)--

Sacralpromontory

Anteriorsuperior

Creatersciaticforamen

iliac

'Truepelvis

Arcuateline

ial spine

Anteriorinferior
iliac spine

Sacrospinous
ligament

lliopubiceminence

Lessersciaticforamen

Obturatorcanal

Sacrotuberous
ligament

Superiorpubicramus

Coccyx

Pectenpubis
(pectineal
line)

lschialtuberosity

Pubictu
Symphyseal
surface
Obturatormembrane

lateral view

Bodyof L4 vertebra

Supraspinous
ligament
Posterior,anterior,and
inferiorgluteallines

Posterior
superioriliacspine
Mediansacralcrest
Posterior
inferioriliacspine

rmediateron" )
Outerlip
) lliaccrest
lliactubercle )
Wing (ala)of ilium
(glutealsurface)
Bodyof ilium
Anteriorsuperior
iliacspine
Anteriorinferior
iliacspine

Posteriorsacroiliacligament
labrum

Greatersciaticforamen
Sacrospinous
ligament
Posterior
and lateral
sacrococcygeal
ligaments
Sacrotuberous
ligament
lschialspine
Lessersciaticforamen

*{r
Plate 352

Acetabularmargin
(articular)
surface
notch
Transverse
acetabular
ligament
Superiorpubicramus
Pubictubercle
Obturatorcrest

lschialtuberosity
Obturatormembrane

canal
Inferiorpubicramus

Bones and Ligaments

Bones and Ligaments of Pelvis (continuedl

lliolumbarligament

ligament
Supraspinous
Posterior
superioriliacspine
Posteriorsacroiliacligaments

Posteriorsacralforamina
reatersciaticforamen
Anteriorsuperioriliacspine
ligament
acrospinous
ligament
Sacrotuberous
Lessersciaticforamen
margin
Acetabular
tuberosity
Tendonof longheadof
bicepsfemorismuscle
lliolumbar
ligament

Anterior sacroiliacligament

Sacralpromontory
Creatersciaticforamen
Anteriorsuperioriliacspi
ligament
Sacrotuberous
ligament
Sacrospinous
Anterior inferior iliac spine

lschialspine

/ z-----Arcuateline..sciaticforamen
Lesser
/ ,t
--{
lliopectineal
lliopubic
eminence

Nr
Bones and Ligaments

Anterior
sacrococcygeal

(pectineal
line)
Obturatorforamen
Inferiorpubicr
Anteriorview
Pubictubercle

Plate 353

Sex Differences of Pelvis: Measurements


SFSo'Blrb,2l8
Femalepelvis/femalepelvic
inlet: anteriorview
S a c r o i l i a jco i n t
al promontory
Diagonal conjugate (-12 cm)

Diameters
of
the pelvis

(-13cm)
Transverse
O b l i q u e( - 1 2 . 5c m )
l l i o p u b i ce m i n e n c e

Nr

Pubicsymphysis
lschialtuberosity

Male pelvis/malepelvic
inlet: anteriorview
Allmeasurements
slightly
shorter
in
relationto body sizethanin female
Pelvicinletorientedmoreanteroposteriorly
thanin female,where
it tendsto be transversely
oval
Pubicsymphysis
deeper(taller)
Pubicarch(subpubicangle)narrower
lschialtuberosities
lessfar apart
lliacwingslessflared

Transverse
diameter of pelvic
o u t l e t( - 1 1c m )

Pubic
symphysis

Sacral
oromontorv-

onjugate

schial

diameter
of pelvic inlet
("11cm)

tuberosity
Anteroposterior
diameter of
pelvic outlet
( v a r i e s9 . 5 - l 1 . 5c m
becauseof mobility
of coccyx)

l s c h i a sl p i n e

Tip of coccyx

pelvis/femalepelvicoutlet:
Fema.le
tntenor vtew

Plate 354

Pubic
symphysis

Anteroposterior
diameter of
pelvic outlet
( 9 . 5 - 1 1 . 5c m )

Female:sagittalsection

Bones and Ligaments

Female and Male Pelvis Radiographs

FemalePelvis
A
B
C
D
E
F
G
H
I
I
K
L
M

Sacrum
llium
Pubis
lschium
P u b i ss y m p h y s i s
Obturatorforamen
Headof femur
Creatertrochanter
trochanter
Lesser
Femur
P e l v i cf o r a m i n a
Airincolon
S a c r o i l i aj oci n t
Acetabulum
Pelvicinlet

Male Pelvis
AL5
B
C
D
E
F
C
H
I
I
K
L
M
N
O
P

Bones and Ligaments

Sacrum
Ala of sacrum
llium
Pubis
lschium
P u b i cs y m p h y s i s
Obturatorforamen
lschialtuberosity
l s c h i asl p i n e
Headof femur
Creatertrochanter
trochanter
Lesser
Femur
Airincolon
S a c r o i l i aj oci n t
Acetabulum
S u b p u b iac n g l e

Plate 355

Pelvic Diaphragm: Female


SeealsoPlates 263,366,370,392
) ubic ligament
l n f e r i o r( a r c u a t e p

Superiorview

Deeo dorsal vein of clitoris

P u b i cs y m p h y s i s

perinealligament
Transverse
Inguinaligament
(Poupart's)

Fasciaof deep perinealmuscles


Urethra
Vagina
Obturator canal

Obturatorfascia
( o v e ro b t u r a t o r
i n t e r n um
s uscle)
Pubococcygeus
muscle
(partof levatorani
muscle)
Tendinous
archof
levatorani muscle
Rectum
lliococcygeusmuscle
( p a r to f l e v a t o ra n i m u s c l e )
l s c h i a sl p i n e
Levatorplate (median raphe)
of levatorani muscle
Coccygeus(ischiococcygeus)
muscte
mismuscle

Coccyx
A n t e r i o rs a c r o coccygealligament
Sacralpromontory

Piriformis
muscte

Medialview

l s c hi a l
sprne

A r c u a t el i n e o f i l i u m
o b t u r a t o r i n t e r n u sm u s c l e
and obturator fascia(cut)
T e n d i n o u sa r c h o f l e v a t o ra n i m u s c l e
O b t u r a t o rc a n a l ,
l l i o c o c c y g e u sm u s c l e
( p a r to f l e v a t o ra n i m u s c l e )

Rectum
Urethra
Pubococcygeusmuscle
( p a r to f l e v a t o ra n i m u s c l e )
Vagina
S p h i n c t e ru r e t h r a em u s c l e

4{ffi*
Plate 356

Left puborectalismuscle and


p e r i n e a lm e m b r a n e
C o m p r e s s o ru r e t h r a ea n d u r e t h r o v a g i n a l
s p h i n c t e r( p o r t i o n so f s p h i n c t e ru r e t h r a em u s c l e

Coccygeus
( i s c hi o c o c c y g e u s )
muscre
Left levatorani
muscle (cut)
Externalanal
s p h i n c t e rm u s c l e
Superficialand deep
transverseperinealmuscles

Pelvis Floor and Contents

Pelvic Diaphragm: Female (continuedl

lnferior view
to urethra
Musculofascial
extensions
Pubicsymphysi

to vagina
Musculofascial
extensions

Inferior(arcuate)
pubicligament

fibersof perineum
Interdigitating
muscle
(partof levatorani muscle)

Deepdorsal
vein of c

muscle
Pubococcygeus
(partof levatorani muscle)

Inferiorpubicra

Tendinous
archof levatorani muscle

Urethra

Obturatori nternusmuscle

Vagina

lliococcygeus
muscle
(partof levatorani muscle)

Rectum

lschialtuberositv
l s c h i asl p i n e
Obturatorinternus
tendon
ligament
Sacrospinous
ligament
Sacrotuberous
muscle
Piriformis
Median raphe
of levator ani muscle

lschialspine

Coccygeus
(ischiococcygeus)

Anococcygeal body (ligament)


(attachmentof externalanal sphinctermuscle)

muscle
Piriformis
muscle(

Tip of coccyx

Sacrospinous
ligament
Sacrotuberous
ligament

Piriformis
muscle
sciaticforamen

Lateralview
Mediansacralcrest

l s c h i asl p i n e
lliococcygeusmuscle
(part of levator ani muscle)

Tendinous
archof levatorani muscle
muscle
Pubococcygeus
(partof levatorani muscle)

Sacrotuberous
ligament(cut)

muscle
Puborectalis
(partof levatorani muscle)

4th posterior(dorsal)sacralfor
Coccygeus (ischiococcygeus) muscle

liBament(cut)
Sacrospinous
Coccyx

4{tr
Pelvic Floor and Contents

Pubicbone
(cut surface)
Deepdorsalvein
of clitoris
Urethra

Plate 357

Pelvic Diaphragm: Male


SeealsoPlates 263, 266, 392
) ubicligament
I n f e r i o r( a r c u a t e p

P u b i cs y m p h y s i s

Superiorview
(viscera removedl

H i a t u sf o r d e e p d o r s a lv e i n o f p e n i s
Pubic crest
P u b i ct u b e r c l e

P e c t e np u b i s( p u b i cp a r t
o f i l i o p e c t i n elai nl e )

Transverseperinealligament
( a n t e r i o rt h i c k e n i n go f
r i n e a lm e m b r a n e )
Hiatus for urethra

S u p e r i orra m u so f p u b i s

Muscle fibers from levator anr ro


l u s c l eo f a n a lc a n a l
c o n l o i n e dl o n g i t u d i n am

O b t u r a t ocr a n a l
Obturator fascia

Levatorani
muscle

l l i o p u b i ce m i n e n c e
Tendinousarch of
l e v a t o ra n i m u s c l e

A c e t a b u l a rm a r g i n
A n t e r i o ri n f e r i o r
i l i a cs p i n e

Obturator
i n t e r n um
s uscle

Wing (ala)
of ilium
A r c u a t el i n e
( i l i a cp a r t o f
i l i o p e c t i n e al li n e )

l s c h i a sl p i n e
Coccygeus(ischiococcygeus)
muscle

l s c h i a sl p i n e

P i r i f o r mm
i su s c l e

S a c r o i l i a jco i n t

A n t e r i o rs a c r a l( p e l v i c )f o r a m r n a

Sacrum

Anterior sacrococcygealligament
Sacralcanal

Plate 358

A n o r e c t a lh i a t u s

4{tr

Pelvic Floor and Gontents

Pelvic Diaphragm: Male (continuedl


seePlate 383
Forurogenital
diaphragm
Inferiorview
D e e p d o r s a lv e i n so f p e n i s
Fat in retropubic (prevesical)space
S p h i n c t e ru r e t h r a em u s c l ea s c e n d i n g
a n t e r i o ra s p e c to f p r o s t a t e

P u b i cs y m p h y s i s
I n f e r i o rp u b i c ( a r c u a t e l)i g a m e n t
P e r i n e abl o d y
F i b r o m u s c u l aerx t e n s i o n so f l e v a t o r
ani muscle to orostate
P u b i ct u b e r c l e
R e c t o u r e t h r a l si su p e r i o rm u s c l e

Urethra
) scia
R e c t o p r o s t a t i(cD e n o n v i l l i e r sf' a

Prerectal
musclefibers(of Luschka)
f r o ml e v a t oar n im u s c l e

M e d i a l b o r d e r( p i l l a r )
o f l e v a t o ra n i m u s c l e

Musclefibersfrom levator
longitudinal
a n it o c o n j o i n e d
m u s c l eo f a n a lc a n a l

P e r i n e am
l e m b r a n e( c u t a w a y
lschiopubic
ramus\
-"t*

i'PF"
ti

Obturator
i n t e r nu s
tendon

C l u t e u sm a x i m u s
muscle

l s c h i a tl u b e r o s i t y
S a c r o t u b e r o ulsig a m e n t( c u t )

Obturator internusmuscle

S a c r o s p i n o ulsi g a m e n t( c u t )
O b t u r a t o ri n t e r n u sm u s c l e
( i s c h i o c o c c y g e u sm)u s c l e
S a c r o s p i n o ulsi g a m e n t( c u t )
Sacrotuberousligament (cut)
Tip of coccyi

Pelvic Floor and Gontents

Plate 359

Pelvic Viscera and Perineum: Female

Paramedian(sagittal)dissection
Ureter
Uterine
(fallopian)
tube
Ovary
Ligament
of ovary Round
ligament
of uterus
Broad

pouch
Rectouterine
(of Douglas)
Peritoneum(cutedge)
pouch
Vesicouterine
Rectum
reter
Urinarybladder

ligament(cut)
S u p e r i opr u b i c
ramus(cut)
Inferiorpubic
ramus(cut)

Vagina

Ischiocavernosus
muscle

External
anal
sphinctermuscle

Pelvicdiaphragm
(levatorani muscle)
Deeptransverse
perinealmuscle(cut)

Bodvof clitoris
Labia
minora
Labium

marus

Median (sagittal)section
Sacralpromontory
Ureter
Suspensory
ligamentof ovary
Uterine(fallopian)
tube
Ovary
External
iliacvessels
Ligament
of ovary
Bodyof uterus
R o u n dl i g a m e not f u t e r u s
(ligamentumteres

F u n d u os f u t e r u s
Urinarybladder
Pubicsymphysis
Urethra
Sphincterurethrae
Deep transverse
perinealmuscle

terosacral
ligament
pouch
Vesicouterine
pouch
Rectouterine
(of DouBlas)
Cervixof uterus
part
Posterior
of vaginalfornix
Anteriorpart
of vaginalfornix
-Rectum
Vagina
.Peiineal
memDrane
Levatorani
muscle

Analcanal

Deepdorsalveinof clitoris
Crusof clitoris
External
urethralorifice
perinealmuscle
Superficial
transverse
L a b i u mm i n u s
Labiummajus
Vaginalorifice

Plate 360

Pelvic Floor and Contents

Pelvic Viscera and Perineum: Male

Ductus(vas)deferens

(sagittal)dissection
Paramedian

Urinarvbladderandfascia
Ureter(cut)

iliacvessels
External
Peritoneum

Seminalvesicle

Rectusabdominis

muscte

Rectovesicalpouch

Anterior layer
of rectus sheath

Rectoprostatic
(Denonvilliers')
fascia

Transversalis
fascia
Umbilical

te (covered by fascia)

prevesicalfascia

Sub( fatty{Camper'
c u t a n e o u{sm e m b r a n o u s
tissue
( ts.urpu'rtSuperiorpubicramus(cut

ramus(cut)
lschiopubic
Pelvicdiaphragm
(levatorani muscle)
Deeptransverse
perinealmuscle

Fundiform
l i g a m e not f p e n i s
Suspensory
ligamentof penis
Areolartissueandvesical
venousplexusin retropubic(prevesical)
space
Deepdorsalveinof pen
Corpuscavernosum
Deep(Buck's)

Perineal
body
anal
Deep
) External
Superficial ) sPhincter
Subcutaneous
) muscle
Deep perineal(investingor
Callaudet's)fascia
Superficialperineal(Colles')fascia
(inferiorfasciaof superficial
perinealspace)

fasciaof peni

Corpusspongiosum
(dartos)
fascia
Superficial
of penisand scrotum
Septumof scrotum

Superficial(dartos)fasciaof scrotum
Externalspermatic fascia

Vesical fascia
Rectovesicalpouch

Rectum

Median (sagittal)section

Seminal
vesicle

Prostate
U r i n a r yb l a d d e r
Rectoprostatic
(Denonvilliers')
fascia
Fundiformligamentof

Sphincter
urethrae
muscte

Suspensoryligamentof peni
lnferior (arcuate)pubic ligamen

Bulbourethral
(Cowper's)
gland

Transverseperinealligament (anterior
t h i c k e n i n go f p e r i n e a lm e m b r a n s ) Perinealmembrane

Perinealbody

muscle
Bulbospongiosus

perinealspace
Superficial

Deep perineal(investingor
Callaudet's)fascia

Corpuscavernosum
Corpusspongiosum
Superficial(dartos)fasciaof penis and scrotum
Deep (Buck's)fasciaof penis
Prepuce

Clanspenisandexternalurethralmeatus

Pelvic Floor and Gontents

Superficialperineal(Colles')fascia

Buck'sfascia
Septumof scrotum
fossa
Navicular

Plate 361

Pelvic Gontents: Female

Uterus(fundus)

Superiorview

Ligamentof ovary
Ova
U t e r i n e( f a l l o p i a nt)u b e

R o u n dl i g a m e not f u l
Broad(lateraluterine)ligament

Urinarybladderand transverse
vesicalfold
Rectusabdominismuscle
Medialumbilicalfold and ligament
(occludedpartof umbilicalartery)

Lineaalba

Median
umbilical
fold and
ligament
(urachus)

pouch(of Douglas)
Rectouterine
Inferiorepigastric
vessels
and
lateralumbilicalfold
Uterosacralfold
Uretericfold

Femoralring
Deepinguinalring
lliopubictract
(coveredby peritoneum)
External
iliacvessels

Suspensoryligament
of ovary (contains
ovarian vessels)

lliac fossa
(false pelvis)

Cecum

Cecalfolds

Left
paracolic

Right
paracolic

Butter

gut

4{F
Sigmoidcolori
Quadratus
lumborum
muscle
Descendingcolon

Psoasmajor
a n dm i n o r
muscles

Sympathetic
trunk
Anterior
Abdominal
longitudinalligament
muscles
Bodyof L3 vertebrd

Plate 362

aflan

vessels
Pararectal
fossa
Inferiorvena cava

Sacralpromontory
Abdominalaorta
plexus
Superiorhypogastric

Transversalis
fascia
peritoneum
Parietal
Ascending
colon
ileum
Terminal
Ureter
Root of mesenterv

Pelvic Floor and Gontents

Pelvic Gontents! Male


Superiorview
Rectum
S e m i n a vl e s i c l e( s u b p e r i t o n e a l )

fold)
Ductusdeferens(in peritoneal
Lineaterminalisof pelvis

vesicalfold
Urinarybladderandtransverse

L i n e aa l b a
Median
umbilical
fold and
ligament
(urachus)

M e d i a l u m b i l i c a fl o l d a n d l i g a m e n t
(occluded part of umbilical artery)

s uscle
R e c t ua
s b d o m i n im

Femoralring

Pubicbranchof in{eriorepigastric

Rectovesicalpouch
Inferior epigastricvesselsand
lateralumbilicalfold
Vesicosacral
(sacrogenital)fold

arterv (obturator anastomotic)


D e e p i n g u i n a lr i n g

fossa
Pararectal
Uretericfold

iliacvessels
External
vessels
Testicular
( i n p e r i t o n e af ol l d )

l l i o p u b i ct r a c t,
(extraperitoneal)
Cecum

l l i a cf o s s a( f a l s ep e l v i s )
fascia
Transversalis

Cecal
folds

Parietal
perl
Left
paracolic

guttef

Quadratui

S i g m o i dc o l o n

lumborum
muscle
D e s c e n d i n gc o l o n

Transversus
Abdominal
abdominis
I n t e r n aol b l i q u e m u s c l e s
E x t e r n aol b l i q u e

Psoasminor
and major
muscles
Svmpathetictrunk
Anterior
l o n g i t u d i n alli g a m e n t
Body of L3 vertebra

Pelvic Floor and Contents

Testicular
vessels
Inferior
vena cava

Sacralpromontory
Abdominal aorta

plexus
Superiorhypogastric

Right paracolic
gutter

A s c e n d i ncgo l o n
ileum
Terminal
Ureter

ormesentery
fi{tr
Plate 363

Endopelvic Fascia and Potential Spaces


Female:superiorview (peritoneumand looseareolartissueremoved)
Umbilicalprevesical
fascia
Medialumbilicalligament(occludedpartof umbilicalartery)
Urinary bladder and vesicalfascia

Rectusabdominismuscle
Superiorvesicalarteryin lateralligamentof bladder
Lineaterminalisof pelvis
Femoral ring

Inferiorepigastric
artery
and
Pubic branch

Medianumbilicalligament(urachus)
Pubicsymphysis
Inferior(arcuate)
pubicligament
dorsalveinof clitoris
pubic(prevesical)
space
perinealligament(anterior
Transverse
t h i c k e n i nogf p e r i n e aml e m b r a n e )
Medial pubovesicalligament

Lateralpubovesical
ligament
Vesicocervicalfascialfibers

Superiorfasciaof pelvic
4iaphragm(superior
levatoranifascia)
Obturatorcanaland
obturatorarterv

D e e pi n g u i n arli n g
lliopubic trac
Transversalis
fascia

External
iliac
vessels
Femoral
nerve
(under
fascia)

Deep
circumflex
iliac
vessels
Tendinous
arch
of pelvicfascia
(reflected
laterally)
lliac
fascia
Ovarian
vesselsin
suspensory
ligament
of ovary

lliacusmuscle
urator
internus
fascia

Psoasmaiormuscle
Internaliliacvessels
Inferiorvesical
and vaginalarterie

(neurovascular)
Hypogastric
sheath
Middlerectalarterv
Cervixof uterusand uterinefascia
Superiorrectalartery(leftbranc6)
Rectum and rectal fascia
Rectovaginal(potential)spa

(potential)space(spreadoperi)
Presacral

4{tr
Plate 364

Median sacralarteri

Tendinous
archof
Jevator
ani muscle
Tendinous
archof
pelvicfascia
Uterosacralligament

Cardinal(transverse
cervicalor
Mackenrodt's)
ligamentwith uterineartery
Vaginorectal
fascialfibers
Presacraltascia(pulled away)
Anterior sacrococcygealligament
Vesicocervicaland vesicovaginal(potential)spaces

Pelvic Floor and Gontents

Urinary Bladder: Orientation and Supports


Female:midsagittalsection
Peritoneum
fascia
Transversalis
M e d i a n u m b i l i c a l i g a m e n t( u r a c h u s )
Umbilical prevesicalfascia
U t e r u s( f u n d u s )
Vesicouterinepouch

Fundus
Uretericorifice
Trigone
P u b i cs y m p h y s i s
Retropubic(prevesical)space and
venous plexus
Inferior (arcuate)pubic ligament
Deep dorsal vein of clitoris
Transverseperinealligament
Sphincterurethraeand
S p h i n c t e ru r e t h r o v a B i n a l t s
musctes
Perinealmembrane

Urethra
Vagina
L a b i u mm i n u s
Perinealbody
'Ampulla
External
anal
of rectum
s o h i n c t emr u s c l e

P u b i cs y m p h y s i s
) ubicligament
I n f e r i o r( a r c u a t e p
Deep dorsal vein of cli

Labium ma.jus

Superiorview with
peritoneum
and vesical
fascia
removed

M e d i a l p u b o v e s i c alli g a m e n t
( m e d i a lp u b o p r o s t a t i cl i g a m e n ti n m a l e )
Transverseperinealligament (anterior
t h i c k e n i n go f p e r i n e a lm e m b r a n e ) - Tendinousarch of levatorani muscle
Obturator canal
Lateralpubovesicalligament
(lateralpuboprostaticligament in male)
Tendinousarch of pelvic fascia
S u p e r i o rf a s c i ao f p e l v i cd i a p h r a g m
( c o v e r i n gl e v a t o ra n i m u s c l e )
Obturator fasciaover
obturator internusmusc
Urinary bladder pulled up and back
(vesica/fasciaremoved)

4{tr
e/Fd4/*

M e d i a n u m b i l i c a l i g a m e n t( u r a c h u s () c u t )
I n f e r i o rv e s i c a a
l n d v a g i n a la r t e r i e s

Urinary Bladder

Ureter

Plate 365

Urinary Bladder: Female and Male


StraboPfatsg{q ffi1, St,oGq {S, M,4oo.417
Female:frontal section
Peritoneum
Body of bladder
F u n d u so f b l a d d e r
Interuretericcrest
Left uretericorifice
Trigoneof bladder
Neck of bladder
Paravesicalendopelvicfascia
and vesicalvenous plexus
Vesicalfascia
Tendinousarch of levatorani muscle

O b t u r a t oirn t e r n u m
s uscle
Levatorani muscle
Tendinousarch of pelvic fascia

Urethra
Sphincter
urethraemuscle
Perinealmembrane

I n f e r i opr u b i cr a m u s

Round
ligament
of uterus

C r u so f c l i t o r i sa n d i s c h i o c a v e r n o s umsu s c l e

B u l bo f v e s t i b u laen db u l b o s p o n g i o sm
u su s c l e
Deep perineal(investingor Gallaudet's)fascia
Superficialperineal(Colles')fascia

Peritoneum
Body of bladder
F u n d u so f b l a d d e r
Ductus (vas)deferens
Interuretericcrest
Right uretericorifice
Trigone of bladder
Neckof bladder
Paravesicalendopelvic fascia
a n d v e s i c a vl e n o u so l e x u s
T e n d i n o u sa r c h o f l e v a t o ra n i m u s c l e
Uvula of bladder
O b t u r a t o ri n t e r n u sm u s c l e
L e v a t o ra n i m u s c l e

Capsuleof prostate
Prostateand prostaticurethra

Internal
urethral
sphincter
Tendinous
arch of
pelvic
fascia
Anterior
recessof
ischioanal
fossa
Inferior
pubic
ramus

Seminal

B u l b o u r e t h r(aCl o w p e r ' sg)l a n d


P e r i n e am
l e m b r a n ea n d s p h i n c t e ru r e t h r a em u s c l

tg

Nffi

C r u so f
p e n i sa n d
ischiocavern o s u sm u s c t e

Bulbousportionof spongyurethraC o r p u ss p o n g i o s u a
mn db u l b o s p o n g i o sm
u su s c l e Deepperineal(investing
or callaudet's)
fascia

"Cryr4gl*

Plate 366

Urinary Bladder

Sphincters

Vagina
Urethra
Levatorani muscle
Urogenitah
l iatus

Sphincter
u r e t h r a em u s c l e
Perineal

body

External
sphincter
(voluntary)

U rethrovaginal
muscle
Compressor
urethraemuscle

Urinary Bladder

Plate 367

Male and Female Gystourethrograms

Femaleurethra,
8-year-oldchild

Voiding
cystourethrogram,
2-year-oldmale

Plate 368

Urinary Bladder

Pelvic Viscera: Female

Superiorview with peritoneumintact


Medianumbilicalfold (urachus)
Vesicouterine
pouch

bladder
of uterus
Deepinguinalring

Paravesical

fossa

Roundligamentof uterus
Bodyof uterus
Broad ligament
Ligamentof ovary

lpinx(of broadligament)
Cervixof uterus
pouch(of Douglas)
Rectouterine
fold
Rectouterine
Uterine(fallopian)tube
iliacvessels
External
fossa
ligamentof ovary
Suspensory
(containsovarianvessels)
Uretericfold
bladder
fascia (cut edge)
Obturator fascia
Sigmoidcolon

Sacral
Median sacral

Abdominalaorta
Obturatorcanal
Obturatorartery
Superiorfasciaof pelvicdiaphragm
fascia
Cervixof uterusand uterovaginal
Uterinevessels
Cardinal(transversecervical
or Mackenrodt's)
Rectocervicaland rectovaginal(potential)
Rectal fascia (cut edge)

4{tr

(sacrouterine)
Rectouterine
ligament
Externaliliac vessels
Ureter

Sacralpromon

Superiorview with peritoneum and uterusremoved

Uterus, Vagina, and Supporting Structures

Plate 369

Uterus, Vagina, and Supporting Structures


Mesovarium
Broad ligament
Cut edge of peritoneum
forming floor of
paravesicalpouch

Ovary
Planeof section

Uterine
( f a l l o p i a nt)u b e

+\

A n g l eo f v i e w

R o u n dl i g a m e n t

il

Uterus

(pulled

Ligament
of ovary.

I n t e r n a li l i a c
artery and vein

\q

Lineaterminalis
(pelvic brim)

d !

'

Suspensory
ligamentof ovary

of uterus

',t,

Uterinevessels
Obturator
membrane

Cardinal(transverse
cervicalor
Mackenrodt's)
ligament

Obturator
fascia

Tendinousarch
of levator ani
muscle

Obturator
i n t e r n um
s uscle

Vaginalartery

Levatorani muscle
(iliococcygeusand
puDococcygeus
muscles)

Ureter
Uterovaginalfascia

Anteriorrecess
of ischioanal
fossa

l s c h i o p u b i cr a m u s

Compressor
urethralis
musc

of clitoris
lschi ocavernosus
muscle

Perineal
memorane

Fascialata of thigh

Artery of bulb of ves

Superficialperineal
space

S p h i n c t eurr e t h r o v a g i n aml ius s c l

Perinealartery
Terminalpart of round

perineal
Superficial
(Colles')
fascia

ligamentof uterus
L a b i u mm a

B u l b o s p o n g i o s um
s u s c l ea n d d e e p
perineal(investingor Callaudet's)fascia

L a b i u mm i n u d

Bulbof vestibule

Vestibule

Vaginalwall
H y m e n a lc a r u n c l e

Plate 37O

Uterus, Vagina, and Supporting Structures

Uterus and Adnexa

Suspensoryligamentof ovary

Posteriorview

Mesosalpinx(of broad ligament)

tube
Uterine(fallopian)
Infundibulum
Ampulla

Ligamentof ovary

Vesicular
appendix
(hydatidof
Mor8agni)

Fundus
of
uterus

Abdominal
ostium

Corpusluteum
Ovary

ligament
Suspensory
of ovary
Ovary

Body
of uterus

Mesovarium(of
broad ligament)

Mesometrium(of
broad ligament)

Ligamentof ovary

Ureter
Uterine(fallopian)tube

Uterosacralligament
Rectouterineoouch
(of Douglas)

Fundus
of uterus
Body
of uterus
lnfundibulum
Foldsof
utenne
tube

lsthmus
of
uterus

Ligament
of ovary

Internal

Endometrium

os

Fimbriae

Vesicularappendix
(hydatid of Morgagni)

Myometrium
Mesometrium(of
broad ligament)

Cervix
of
uterus

ligament
Suspensory
of ovary(contains
ovarianvessels)

Epoophoron

Uterine vessels
Cardinal(transverse
cervicalor
Mackenrodt's)
ligament
Cervicalcanal
with palmatefolds
Vaginalfornix
Vagina

Uterus, Vagina, and Supporting Structures

Frontalsection

*{r
Plate 371

Pelvic Ligaments

Anterior

Posterior
Suspensory
ligament
of theovary
(containing
theovarianvessels)

Subdivisions
and
contentsof the
broad ligament

External
iliacvessels

A m p u l l ao f u t e r i n et u b e
R o u n dl i g a m e n t

Rightovary
Rightureter
Laminaeof the mesosalpinx
ObliteratedumbilicalarteryOvarian branches
of uterine vessels
R o u n dl i g a m e n t

Laminaeof the mesovarium


Posterior
laminaof broadligament
Anteriorlaminaof broadligament

Transversevesicalfold
Vesicouterine
(uterovesical)pouch

Uterinearteryandvenousplexus
Vaginalartery

Horizontal portion of

ligament
Uterosacral
Cardinalligament

Pelvicfascia
and ligaments

Horizontal
portionof vagina
Vertical
portion of
vagrna

,ol'INAC{-ro

e4a4/*

Plate 372

Urethra

Arcustendineous
fasciaepelvis
portionof
Distal(vertical)
pubocervical
fasciasupports
urethraand U-Vjunctionand
providesbackstopagainst
which urethrais compressed
duringstraining

Uterus, Vagina, and Supporting Structures

Uterus: Age Ghanges and Muscle Pattern

Adult
(nulliparous)

Adult
(postmenopausal)

Adult
(parous)

C Contrastmediumin abdominalcavity
uterus
H Hysterosalpingogram
R Rightfallopiantube infection

Ligament
of ovary

Round
ligament
of uterus

Uterine
musculature
(schema)

Uterosacral
ligament
Cardinal
(transverse
cervicalor
Mackenrodt's)
ligament

fiberspass
Spiral
deeplyintowall
and interlace
(schema)
Vaginalwall

Uterus, Vagina, and Supporting Structures

Nr
Plate 373

Uterus: Position and Prolapse


Degrees of retroversion
3rd degree 2nd degree l st degree

Variations
in position

Retroflexion

Anteflexion
(normal and severe)

Slightdescent(1st degree)

Cervixat introitus (2nd degree)

Plate 374

*{r
Uterus, Vagina, and Supporting Structures

Ectopic Pregnaney

Sitesof ectopic implantation


Interstitial

Tubal
(isthmic)

Abdominal
Iuoal

(ampullar)

lnfundibular
(ostial)

*{r

Unruptured
tubalpregnancy
Villi invading
tubularwall

Chorion
Amnion

Sectionthrough
tubal pregnancy

Uterus, Vagina, and Supporting Structures

Plate 375

ql

fransverse Section: Pubic Crest, Femoral Heads, Coccyx

!l
I

GI
{

Superiorportionof pubicsymphysis

Spermaticcord
Plate 376

Interior of urinary bladder

A d d u c t o lro n s u sm u s c l e

s.

of pubis

B e g i n n i n go f u r e t h r a

2
tr

s muscte

Prostategland with
prostatic urethra

Femoralvein
P s o a sm u s c l ea n d

qt

Femoralartery
l l i a c u sm u s c l e
Femoralnerve
Headof femur

S a r t o r i um
s uscle

Neckof femur
l l i o p s o a sm u s c l e

Cluteus
medius
muscle

Rectusfemoris
muscle

Tensor
fasciaelatae
muscle

Cluteus
mtntmus
tendon

Cluteus
medius
muscre

Creater

trochanter

o
9.
o

lnferior
gemellus
muscl

Obturator
artery,vein,
and nerve

ql
f

o
rt
o
o
o
o
o
t
o
II

c
c
o
rt

Acetabular
fossa
Cluteus

L u n a t e( a r t i c u l a r )
surfaceof
acetabulum

O b t u r a t o ri n t e r n u sm u s c l e
Sacrotuberousligament

Left sciaticnerve

Ejaculatory
ducts

Internalpudendal artery and vein

Perinealflexure (terminationof
rectum, beginningof anal canal)
Tip of coccyi

Pudendalnerve
Fat bodv of ischioanalfossa
Levatorani muscle (puborectalis)

Cfd4/*

!rl

o
o
t
It
t

o
c
C
5

!L

o
5

FemalePerineumand ExternalGenitalia(Pudendumor Vulva|

M o n sp u b i s
of
Anteriorcommissure
labiamajora
Prepuceof clitoris
Pudendal
cleft(grooveor
spacebetweenthe
labiamajora)
Clansof clitoris
Frenulumof clitoris
urethralorifice
L a b i u mm i n u s
Labiummajus
Openingsof paraurethral
(Skene's)
ducts
of vagina

(cleftor spacesurrounded
by labiaminora)
Openingof greater
(Bartholin's)
gland
vestibular
Hymenalcaruncle
Vestibularfossa
Frenulum
of labiaminora
ol
commrssure
labiamajora
raphe
Perineal
(overperinealbody)
Anus

A n n u l ahr v m e n

Septatehymen

Perineum and External Genitalia: Female

*{r

Parousintroitus

Plate 377

Female Perineum (Superficial Dissection)

S u p e r f i r . i af al t t y ( C a n r p e r ' sl)a y c r

Su b c u t an e o u s
trssue

R e i t u s s h e a t h( a n t e r i o rl a y e r )
A p o n e u r o s i so f e x t e r n a o
i b l i q u en r u s c l e
S u p e r f i ir. r li n g u i n . rrl i n g
A t t l e r i o r s t t l t e r i o ri l i , t t : p i n e

I l o u n c l i g a m e n to f u t e r u sa n d c o v e r i n g s( c u t )
l n g , u i n aI li g a n r e n(t P o u p a r t ' s )
P u b i ct u b e r c l e
P u b i cs y n r p h y s i s
S a p h e n o uosp e n i n g
S u s p e n s o r lyi g a n r e not f c l i t o r i s
F a s c . il.ar t ao f t h i g h
l s c ' h i o p u b ri ca n r u s
S L r p e r i i c ipael r i n e a(l C o l l e s 'f)a s c i a
( c r / ta \ v . r v t)o o p e n s u p e r i i c i a l
p e r i n e asl p a c e
Is r - hio c a v e r no su s n rr - r s c l e
B u l b o s p o n g , i o s runsu s c l e( c o v e r s
br,rllrot vestiltr-rle
)
l ) e r i n e . rnl r e n r b r a n e
D e e l rp e r i n e a{l i n v e s t i nogr C a l l a u c l e t ' s )
iascia(lrartia//),cut a\1,.ry)
S r r rl t ' r t i ri . r ll r . t t r ' re r r e l l e r i t r e a n
l ru\cle

I s c h i a tl r - r b e r o s i t y
S u p e rl i c i a lp e ' r i n e a(lC o l l e s ' i)a s c i a
(c'utc'c/gc,
trrlrcc/c/orvn)
F a tb o c l yo f i s c h i o a n aflo s s a

-:-Rt't

Sulrcutanr:ous
\ f ..xy-------l

ltts

i ii:lt.;;,,,,./

Superficial
perir.rea
(C
l olles')
iascia

rvl.l

tr,t r l

t{ ,U\_

-.,-

R e t l u . r l t e . t t l tt . r r t l e r i o lr , r t t t t /

|f';ilX,l'.-:ili"'
c()vennBS

Tt'atrsve,rs,tIis i.rsc.i.t

P u b i cs y n t p h y s i-s. -

(arcuafe)
tnferior
tiganrcr,r---__
uubir'
T r a n s v e r s e1 l t ' r i t ' t t ' al il g . t r l r t ' l l t

___=-.=N

S u s l ; e n s o r yl i g a n t e n to l t l i l o r i s

Sphi nc:teru rethrae ar-rcl


slth i nc'teru rethrovaginalis ntust lt,s---l-\
l l . r i n t , arl r t ' n r l t r . r r r t ,
Sr-r1re rf ir:ia | 1rc ri nt' a| (( rrIIt's' ) l,\ s( id -------/
S u l t t ' r i o r[ . r s ri a < >p[ r ' l v i r r l i a l t h r a g n r
I r ' v . r l o r. r r r n
i ruscle

Plate 378

Anococcygeal
body
E x t e r n aal n a l
s p h i n c t enr r u s c l e

Perineum and External Genitalia: Female

Female Perineum and DeeP Perineum

B u l b o s p o n g i o smu us s c l e
with deepperineal(investing

S u s p e n s o r yl i g a m e n to f c l i t o r i s

Clitoris

o r C a l l a u d e t ' sf;a s c i a
partiallyremoved

lschiocavernosusmuscle

B u l bo f v e s t i b u l e
S u p e r f i c i apl e r i n e a sl p a c e
( p o u c ho r c o m p a r

membrane
Perineal

l s c h i o p u b irca m u s
w i t h c u t e d g eo f
superficial
p e r i n e a(lC o l l e s ' )
fascia-

Creatervestibular
( B a r t h o l i n 'Bs l)a n d
Bulbospongiosus
muscte
lcut away)

Perineal
membrane
lschial
tuberosity

Superficial
transverse
perineal
muscle

Sacrotuberous
ligament,

Perineal
body

Cluteus
maxrmus
muscte

lschioanalfossa

Coccyx

Obturator
fascia

Urethra
Tendinousarch of
levator ani muscle

Crusof
clitoris-

S p h i n c t e ru r e t h r a e
muscle

lschiopubic
ram

P e r i n e aml e m b r a n e
(cutand reflected)
urethrae
Compressor
muscte

lnferior fasciaof
pelvic diaphragm (cut)
Levatorani muscle
Externalanal sphinctermuscle
Anococcygeal(ligament)body

S p h i n c t e ru r e t h r o v a g i n a l i s

muscle
Vagina
Creater vestibular
( B a r t h o l i n ' sg)l a n d

Deeptransverse
p e r i n e aml u s c l e

4{tr

P e r i n e am
l embrane

Perineum and External Genitalia: Female

Plate 379

Perineum and External Genitalia (Superficial Dissectionf

SLrpcrlia
cl
l.rtt\'{(-.rnl)er's)
in(| (|('('l)('l
n r t ' n rIr T , n
t c lL rs

{ S <a r p a ' sltr v t ' r


( ) l s u l ) cu t . l t e o L t s
trstu('

Anterior
ol
sul)e11
i l i a cs p i n t '
S L r l ; t ' ri lr . i l l ( c l a r t o s )
l a s ci a o 1 p c n i s a n c l
s( rotu|ll

Ingr,rin.rl
lrSainrent
(Poupart's)

S .p
r h c r ro L r s
ol)('nilr{l .lnd

1r'nror.rl
.trt('rv
a r r r lv t , i n

l l r o l < t ' nl i n e
in(li(.lt('s
lint'o1
n t f . r h( n r ( ' n t
ol (.olles'
a n r lS ca r p a ' s
l . r s r . i . rwt ,i t l r
cleep l-.rsc'iir

l s ch i o pulrit
rJnrLrs

I : , r l r o c l yi n i s c h i o a n . r{ lo s s a

P u b i cs y m p h y s i s

U r o g e n i t at lr i a n g l e
l s c hi o p r . r l r irca-n r u s

R e g i o n s( t r i a n g l e s )
ot penneum:
s u r l a c et o p o g r a p h y

\ n ( l lt r i a n g l e

Nr
Plate 38O

Tip of cocc.vr

%tc#

Perineum and External Genitalia: Male

Perineum and External Genitalia (Deeper Dissectionf

Skinof penis
(dartos)
Superficial
fasciaof penis
of
Aponeurosis
externaloblique
muscre
(Scarpa's)
Deepmembranous
layerof subcutaneous
tissue(cutaway)
I n g u i n al il g a m e n t
(Poupart's)
Deep(Buck's)
fasciaof penis
Superficial
i n g u i n arli n g
Externalspermaticfascia
investingspermaticcord
*J,

Fascialata (deep fascia)of thigh

B u l b o s p o n g i o smuus s c l e
muscle
lschiocavernosus
coverscrusof penis
perineal(Colles')fascia(cut
Superficial
perinealspacel
awayto open superficial
Perinealmembrane

or Callaudet's)
Deepperineal(investing
fascia(partiallycut away)covers
perinealspace
musclesof superficial
perinealmuscle
transverse
Superficial
lschialtuberosity
fascia(cutedge)
perineal(Colles')
Superficial
fossa
Levatoranimuscleroofingischioanal
xternalanalsphinctermuscle
s uscle
C l u t e u sm a x i m um

Superficialdorsalvein

Dorsalarteryand nerve
Deep dorsal vein

vein
Lateralsuperficial
Superficial(dartos)fasciaof pe

Corpus cavernosumand its


tunica albuginea

Deep (Buck's)fasciaof penis

Deep artery
Intercavernousseptum of deep fascia

Urethra

and its
Corpusspongiosum
t u n i c aa l b u g i n e a

4{tr

Sectionthrough body of penis

Perineum and External Genitalia: Male

Plate 381

Penis

E x t e r n aul r e t h r a o
l r i f i c e( m e a t u s )

C l a n sp e n i s
oronaof glans
Frenulum

Neckof glans
O p e n i n g o f p r e p u t i a l( T y s o n ' sg) l a n d

Skin

Superficial(dartos)fasciaof penis

D e e p( B u c k ' sf )a s c i ao f p e n i s
Externalspermaticfasciainvestingspermaticcord (cut)
Superficialperineal(Colles')fascia(cut away to open
supe rfi cial per i neal space\
Deep perineal(investingor Gallaudet's)fascia
(cut away) over musclesof superficialperinealspace
lschiocavernosusmuscle (cut away)
Superficialtransverseperinealmuscle

C l a n sp e n i s
oroora cavernosa
of penis

lntercavernous
septumof deep
(Buck's)fascia
C o r p u ss p o n g i o s u m
Pubictubercle
Superior
p u b i cr a m u s
lschial

Perineal
membrane

tuberosity
C l u t e u sm a x i m u m
s uscle
L e v a t o ra n i m u s c l e
and inferior fascia
of pelvic dia.phragm I
rooilng rscnroanatlossa

Perineal
body

B u l bo f p e n i s
Tip of coccyx

C r u so f p e n i s

Externalanal
s p h i n c t e rm u s c l e

Perineal
memorane

4{F

lschial
tuberosity

External
anal
s p h i n c t emr u s c l e

Plate 38.2

Perineum and External Genitalia: Male

Perineal Spaces

Pubic

P u b i cb o n e

Superior
pubic

perinealligament(anterior
Transverse
t h i c k e n i nogf p e r i n e aml e m b r a n e )

ramus\\
\

Dorsalarteryand nerveof penis

Inferior
(arcuate)
pubic
ligament

Deeparteryof penis

D e e pd o r s a l
veinof penis

(Cowper's)
gland
Ductof bulbourethral

Urethralartery

Arteryof bulbof penis


fasciaover
or Callaudet's)
Deepperineal(investing
and
bulbospongiosus,
ischiocavernosus,
perinealmuscles(cutaway)
transverse
superficial

Urethra
Perineal
m e m b r. at l lnt re-

ficial perineal(Colles')fascia(cutaway)

perinealmuscle
transverse
Superficial
kut and reflected)
Perineal
body

Inferior views

tuberosity
External
a n a ls p h i n c t e r
muscte

Dorsal artery and nerve of


Deep artery of penis

Urethral
(Cowper's)
gland
Bulbourethral
Arteryof bulbof penis
membrane(cutedge)
Perineal

Sphincter
urethrae
muscle

Internalpudendalartery
and dorsalnerveof penis
I n t e r n apl u d e n d aal r t e r ya n dp e r i n e abl r a n c h

Urethra
Deeptransverse
perinealmuscle
Levatorani muscle
P e r i n e am
l embrane
Deep transverseperinealmuscle
Deep perineal(investing

fascia
or Callaudet's)
Corpus cavernosum(crus of penis)
and deep (Buck's)fasciaof peni
lschiocavernosusmuscle
S u p e r f i c i apl e r i n e a l( C o l l e s ' f) a s c i a
( c l o s e ss u p e r f i c i apl e r i n e a sl p a c e )

U r i n a r yb l a d d e r
Prostate
uratorinternusmuscle
l s c h i o p u b ri ca m u s
urethraemuscle
Sohincter
(Cowper's)
gland
Bulbourethral
muscle
lschiocavernosus
a )n d
B u l bo f p e n i s( c o r p u s p o n g i o s u m
d e e p( B u c k ' sf )a s c i ao f p e n i s
B u l b o s p o n g i o smuus s c l e

1frffi

"'"erfu#
A

Frontalsection,anteriorview of perineum:schema

Perineum and External Genitalia: Male

aa

Plate 383

Prostate and Seminal Vesicles


SeealsoPlates361,363,366,403,
410
Ureteric
orifice
Trigone
of urinary

bladder
In t e r n a l
urethral
sphincter
Uvula
of bladder

Prostate
S e m i n aclo l l i c u l u s

Urethral
crest

Prostatic
utricle

Openings
of prostatic
d u c t si n
prostatrc

O p e n i n go f
ejaculatoryduct

S I NU S

Sphincter
urethrae
muscle
Bulbourethral
(Cowper's)
gland
i+...j

O p e n i n go f b u l b o u r e t h rdaul c t

Perinealbody

Rectovesicalor rectoprostatic
(Denonvilliers')fascia

Frontalsection,anteriorview
of bulbousportion of sponsy
urethraschematicallv
extendtid

Rectum
and
rectal
fascia

Seminal
vesicle

Sagittalsection

U r i n a r yb l a d d e r
Ductusdeferens
Anteriormuscularbandof skeletalmuscle
(continuationof sphincterurethrae)

Ampulla
of ductus

Prostatic
urethra

deferens

I s t h m u sa n d f i b r o m u s c u l a r
ma (smooth muscle)
atic utricle

Seminal

ian lobe

col
Beginning
of ejaculatory
duct

Inferolateral
lobe

Inferolateral

lobe

Prostate
l s c h i o p u b i cr a m
Deep t
perineam
l uscle
and fascia

Capsuleof
prostate

(Cowper's)
Bulbourethral
glands

Posteriorview

Plate

lnferooosteriorlobe

Crosssectionthrough prostate

Perineum and External Genitalia: Male

Urethra

Trigoneof
urinary bladder

of bladder
Prostate
Urethralcrest
Prostatic
sinuses
Prostatic
u rethra

O p e n i n g os f
prostaticducts

Prostaticutricle

lntermediate
part of
(membranous)
urethra

urethrae

Bulbof oeni
C r u so f p e n i s
Bulbous
portion

Bulbourethral
(Cowper's)
gland

:el

,:,_$s/
Corpus cavern
T u n i c aa l b u g i n e a

Corpusspongiosum
T u n i c aa l b u g i n e a

Deeparteryof peni

lntercavernousseptum
of deep (Buck's)fascia
oo

PendutouS
(penile)

Urethrallacunae(Morgagni)
and urethralglands(Littr6)

portion

LacunamaBna(inconstant)

fossa
Navicular
C l a n sp e n i s
External
urethralorifice(meatus)

Roof of
urethra

Perineum and External Genitalia: Male

Floor of
urethra

Plate 385

Descent of Testis

gland
Suprarenal

gland
Suprarenal

Kidney

Suspensory
(diaphragmatic)
ligament

Suspensory
(diaphragmatic)
ligament
(atrophic)

Mesonephric
(wolffian)duct

Testes
Epididymis

Cubernacul

Cubernaculum

Urinarybla

Deepinguinalring
Urinarybladder

I weeks
(22.5-mmcrown-rump)

(43-mm crown-rump)

Cubernaculum

4 lunar months
(107-mmcrown-rump)

S u p e r f i c iianlg u i n arli n g
Ductusdeferens
Scrotum(cutopen)

*{r
Processus
vaginalis

Cubernaculum

8 lunarmonths
(26-cm crown-rump)

Plate 386

Cavityof
tunica
vaginalis
(cutopen)

Perineum and External Genitalia: Male

Scrotum and Gontents

Skinof penis
Superficialfascia
of penis(Colles'fascia)
Deep(Buck's)
fasciaof penis

Superficial
i n g u i n arli n g

Testicular
artery

External
fascia
spermatic

Ductusdeferens
to ductusdeferens

muscle
Cremaster

italbranchof
genitofemoralnerve

and fascia

(venous)
plexus
Pampiniform

Septumof scrotum
(formedby
dartosfascia)

Appendixof epididymis
Superficial
(dartos)fascia
of scrotum

Appendixof testis
Testis(coveredby visceral
layerof tunicavaginalis)

Skinof scrotum
Parietal
layerof tunicavaginalis

(dartos)
Superficial
fasciaof scrotum
fascia
External
spermatic
Cremastermuscleand fascia
Internalspermatic
fascia
Parietal
layerof tunicavagi
Epididymis
Testis(coveredby viscerallayerof tunicavaginalis)

*{r

Skinof

Perineum and External Genitalia: Male

Plate 387

Homologues of External Genitalia

Undifferentiated
Epithelialtag

fold
Urogenital

Cenitaltubercle

Urogenitalgroove
Lateralpart
of tubercle
Analtubercle
Anal pit

Male

45-50 mm
(-10 weeks)

Female

Epithelial
tag
Coronalsulcus
Siteof futureoriginof prepuce
Urethralfold

45-50 mm
(-10 weeks)

Urogenital groove

Lateraltubercle
(shaftor corpus)
Labioscrotal
swelling
Urethralfoldspartly fused(urethralraphe)
Analtubercle
Anus
External
urethralorifice

Body of

clitoris
Prepuce
Fully developed

Clansof
clitoris
Raphe
of penis

External
urethral
orifice

Labium
mrnus
Labium
maJus

Posterior
commrssure
Perinealraphe

Perianal
tissues
(includingexternal
analsphincter
muscle)

Plate 388

Homologues of Genitalia

Homologues of lnternal Genitalia

--

Diaphragmaticligament

(suspensory
ligamentof ovarY)

(mi.illerian)
duct
Paramesonephric

Mesonephric
tubules

(wolffian)duct
Mesonephric

Cenitalcord

fold1
Inguinal

sinus
Urogenital
i

(d)
(Cowper's)
of bulbourethral
Primordium
(9 ) glands
(Bartholin's)
or of greatervestibular

(d )
Primordium
of prostate
(Skene's)
or of paraurethral
(9) glands

M^r" 2,/

Undifferentiated
1*

4{tr
Femare

Seminalvesicle
deferens

Prostatic
utricle
Prostate
Openingof
ejaculatory
Bulbourethral
(Cowpe/s)
of epididymis
Epididymis
Efferent
ductules
Appendixof testis
Testis
Paradidvmis
Scrotalligamen
(gubernaculum)

Homologues of Genitalia

Plate 389

Testis, Epididymis, and Ductus Deferens

Efferentductules
Aberrantductule(vestigial
mesonephric
tubule)
Ductusdeferens

Areaof rete testis(in mediastinumtestis)

Epididymis

Frontal section
Ductusdeferens
Efferentductules
Epididymalduct
Retetestis(in mediastinum
testis)
Aberrantductule
Seminiferous
tubules
Schema
Skinof scrotum
(dartos)fascia
Superficial
Lobulesof testis

External
spermatic
fascia
muscleandfascia

Scrotalseptum(dartos)

Internalspermatic
fascia
Septa

Parietallayerof tunicavaginalis

Retetestis(in
mediastinum
testis)

Viscerallayerof tunicavaginalis
Tunicaalbuginea
of testis

Ductusdeferens

Sinusof epididymis
Epididymis

Crosssectionthroughscrotumand testis

Plate 39O

Nr

Testis, Epididymis, and Ductus Defenens

Rectum in Situ: Female and Male

Sigmoidcolon
Free taenia
(taenialibera)

Sigmoidmesocolon
Rectosigmoid

Ductus(vas)
deferens(cut)

Peritoneal
reflection

Ureter(cut)

pouch
Rectovesical

Urinary
bladder

Rectumand
rectalfascia

Seminal
vesicle

Levatorani muscle
(pelvicdiaphr

(Denonvilliers')
fascia

Coccyx

Prostate

part of
Puborectalis
levatorani muscle

lschiocavernosus
muscleanddeep
perineal(investing
or Callaudet's)
fascia(partially
cut away)

Deep
External
anal
sphinctermuscle* Superficial
Subcutaneous

Deep transverse
perinealmuscle

Female

Perineal
body
transverse
perinealmuscle
and deep perineal
(investing)
fascia

Sigmoid
mesocolon

Rectosigmoid
lunction

perineal(Colles')
fascia

Peritoneal
reflection

Sigmoidcolon
Freetaenia(taenialibera)

Rectalfascia
and rectum

pouch

Rectouterine
pouch
(of Douglas)

4{y

Ureter(cut)
Vaginaand vaginalfascia

Coccyx

Urinarybladderandvesicalfascia

Levatorani
muscle
(pelvic
diaphragm)

muscleand
lschiocavernosus
or
deepperineal(investing
fascia
Callaudet's)
Deeptransverseperinealmuscle
and perinealmembrane

Puborectalis
part of levator

ani muscle

fascia
perineal(Colles')
Superficial
perinealmuscleand deep
Superficialtransverse
fascia
perineal(investing
or Callaudet's)
bodv
Perineal

*Partsvariableand often indistinct

Rectum

Plate 391

lschioanal Fossae
SaeahoPt$asO' ?, 41o-{t8

lliacus
muscle
andfascia

External
iliac
vessels

Obturator
internus
m u s c l ea n d
fascia

canal

(Alcock's)
contains
internalpudendal
pudendal
vessels,
nerve,and
perinealnerve

lschial
tuberosity

Ureter

Tendinousarch of levator ani muscle

Extraoeritoneal
(supralevator)
space
(fibrofatty
tissue)
Fatbody of ( DeePerPart 1
ischioanal J Superficial I
tossa
( (perianal)
part
Transverse
fibrousseptum
of ischioanal
fossa
S u b m u c o ussp a c e( i n t e r n avle n o u sp l e x u i )
Perianal
space(external
venousplexui)
Intersphinctericgroove (anocutaneouslinb)

Pfate 392

Sacrogenitalfold (uterosacral
in female)
Levatorani muscle and superiorand
inferior fasciaof pelvic diaphragm

(cutedge)formingfloorof pararectal
fossa
Peritoneum
Rectalfascia

External
analsphinctermuscle
l uscle
C o n j o i n e dl o n g i t u d i n am

4{tr

Internalanal sphinctermuscle

Rectum

Rectum and Anal Ganal

Sigmoidcolon

15-17

junction
Rectosigmoid
11-13

folds
Transverse
of rectum(valves
of Houston)

reflection
Peritoneal

8-9

fascia

musclelayer
Longitudinal
musclelayer
mucosae
Muscularis
evator ani muscle

5-6

4-5

2.5-3

0.s-1

Anal verge

Pecten
Anoderrh

*Partsvariableand oftenindistinct

Rectum

Anorectalline
A n a lc o l u m n s( M o r g a g n i ' s )
Analsinus
(dentate)line
InternalrectalvenousPlexus
in submucous
space
Deep part* of external
sphinctermuscle
muscle
Conjoinedlongitudinal
Internalsphinctermuscle
Analvalve
Analcrypt
Superficialpart* of external
sphinctermuscle
Analglands
fibrousseptum
Transverse
mucosaeof analcanal
Muscularis
space
utaneouspart*of externalsphinctermuscle
Corrugator
cutisani muscle
rectalvenousplexusin perianalspace
External
line)
groove(anocutaneous
Intersphincteric

4{F

Plate 393

Anorectal Musculature
Rectosigmoid
junction

Anteriorview

S i g m o i dc o l o n

Freetaenia (taenialibera)

of taeniaspreadout to form longitudinal


musclelayerof rectum
ibersfrom longitudinalmusclejoin circular muscle layer
Window cut in longitudinalmuscle layerto expose underlying

rculam
r u s c l el a y e r

Levatorani muscle

Frontalsection

Deep
Parts"of
externalanal
Superficial
S u b c u t a n e o u s s p h i n c t emr u s c l e

Fibrousseptum
Corrugator
cutis
a n im u s c l e

4{tr

Perianal
skin

Superiorfasciaof pelvic diaphr


Inferiorfasciaof pelvic diaphr

Levatorani muscle
Rectalfascia
L o n g i t u d i nm
a lu s c l eo f r e c t u m
Circularmuscleof rectum
Muscularis
mucosaeof rectum
Deep part* of externalanal sphincterm

Internalrectalvenousplexus
Conjoinedlongitudinal
muscle
part*of externalanalsphincter
Superficial
I n t e r n aa
l n a l s o h i n c t e rm
Muscularismucosaeof anal canal
Transversefibrous septum of ischioanalfossa

part*of externalanalsphincter
Subcutaneous
Corrugatorcutis ani muscle
Externalrectalvenous plexus

Intersphincteric
groove
(anocutaneous
line)

*Partsvariableand
often indistinct

Plate 394

Rectum

External Anal Sphincter Muscle: Perineal Views

scrotal(dartos)fascia
Superficial
tum of scrotum
(Buck's)fasciaof penis
B u l b o s p o n g i o sm
u su s c l ew i t h d e e pp e r i n e a l
(investingor Callaudet's)fasciaremoved
musclewith deep perineal
schiocavernosus
(investingor Gallaudet's)
fasciaremoved
Perinealmembrane
I s c h i o p u b irca m u s
Perinealbody
perinealmusclewith deep
transverse
Superficial
peiineal(investingor Callaudet's)fasciaremoved
subculaneous
) ,uur- of externalanal
5uPerllclal
I sohinctermuscle
ueep
,
Superficialperineal(Colles')fascia(cut edges)
fibrousseptumof ischioanalfossa(cut)
Transverse
lschialtuberosity
t u b e r o u sl i g a m e n t
Pubococcygeus)
Puborectalis I Levatorani muscle
lliococcygeus )
Anococcygealbody (ligament)(posteriorextensions
of superficialexternalanalsphinctermuscle)
C l u t e u sm a x i m u sm u s c l e
Tip of coccyx

Female
Clitoris
Externalurethral
orifice
Superficialperineal(Colles')fascia(cut edge)
lschiocavernosus
musclewith deep perineal
(investingor Callaudet's)fasciaremoved
Bulbospongiosus
musclewith deep perineal
(investingor Callaudet's)fasciaremoved
Fibersfrom superficialexternalanal
sphinctermuscleto ischiopubicramus
P e r i n e aml e m b r a n e
transverseperinealmusclewith
Superficial
deep perineal(investingor Callaudet's)
fasciaremoved
Superficialperineal(Colles')fascia(cut edge)
Perinealbody
Crossedfibersfrom superficialand deep external
sphinctersto superficialtransverseperinealmuscle

iopubic
ramuS
Anus

P a r r so* f e x t e r n a l a n- a Il P e e P r
/
s'o h i n c t e r ' m u s ; i ; - J S u p e r f i c i a l
( Subcutaneous
. ( Puoococcygers
L e v a t o r a nm
i u s c l e{ P u b o r e c t a l i s /
( lliococcygeusC l u t e u sm a x i m u sm u s c l e
Anococcygealbody (ligament)(posteriorextensions
of superficialexternalanalsphinctermuscle)
"Partsvariableand often indistinct

Rectum

Plate 395

Actual and Potential Perineopelvic Spaces


Sagittalsection
Peritoneum
fascia
Rectal
fascia
Rectal
fascia
Presacral
fascia
Retropubic
(prevesical)
space(of Retzius)
Recto-( Retrovesicall
vesicalI P1g1ss16lspace ( Retroprostatic
Sphincter
urethrae

Presacral
space
Rectovesical
or rectoprostatic
(Denonvilliers')
fascia(septum)

DeePand superficialperinealmuscles
transverse

Levatorani muscle
and fasciaof
pelvicdiaphragm
Deep postanalspace
Anococcygeal
body (ligament)

Deep(Buck's)
fasciaof penis
Superficial
perineal(Colles')
fascia

postanalspace(part
Superficial
of perianalspace)
Submucous
space

*Partsvariableand
oftenindistinct

Perianalspace
Bulbospongiosus
muscleanddeepperineal(Gallaudet's)
fascia
perinealcompartment
(spaceor pouch)
Superficial

Perineal
membrane,
perinealmuscleand
Deeptransverse
perinealmuscle
Superficial
transverse
(cutaway)to expose
Anteriorrecessof ischioanal
fossa
-Preanalcommunication
(inconstant)
between
rightand leftischioanal
fossae
Pusin ischioanal
fossa
Posterior
communication
betweenrightand left
ischioanalfossaevia deeppostanalspace
deepto anococcygeal
body(ligament)
Gluteusmaximusmuscleand
ligament
Sacrotuberous
(cut)
Posteriorrecessof ischioanalfossa

Perinealview
Spreadof perinealabscessin perinealspaces

Plate 396

4{ft*
Rectum

Pelvic Scans: Sagittal MR lmages


Median (A) and paramedian(B) sagittalMR imagesof femalepelvis
AB

c
D
P
R

Analcanal
External
os of cervix
sac
Dural(thecal)
Pubicsymphysis
Rectum

muscle
RA Rectusabdominis
s Sacrum
U Uterus
U B Urinarybladder
v Vagina

Median (C) and paramedian(D) sagittalMR imagesof male pelvis

c
cc

Corpusspongiosum
Corpuscavernosum
G Glanspenis
P Pubicsymphysis
PS Prostate

Regional Scans

s
T
U

Rectum
Sacrum
Testis
Urinarybladder

Plate 397

Arteries of Rectum and Anal Ganal (Male|

Posteriorview

Left colic artery


Ascendingbranch

Inferiormesenteric
artery
Abdominal aorta

D e s c e n d i n gb r a n c h

Inferiorvena cava

Sigmoid arteries

Median sacralartery
Common iliac artery

Marginal artery

Externaliliac artery

Rectosigmoidarteries

Internaliliac artery

Superior
rectal
arrery
(bifurcation)

Lateral sacral artery

Superiorgluteal
artery

Middle
rectal
artery

Inferior
gluteal
artery

l s c h i a sl p i n e

Obturatorartery

Obturator

I n t e r n apl u d e n d a l
artery

i n t e r n um
s uscle
lnternal
pudendalartery

ical artery
nferior vesicalartery

Pudendalcanal (Alcock's)
lschialtuberosity
Coccygeus(ischiococcygeus)muscle
Inferior rectal artery
Levatorani muscle

Plate 398

to ductus deferens

Anus

Superiorvesicalartery
External
anal
s p h i n c t emr u s c l e
P u b o r e c t a lm
i su s c l e
(severed)

Middle rectal artery


Inferior rectal artery

Nr

Vasculature

Veins of Rectum and Anal Ganal (Femalel

Anterior view
Inferiormesentericvein (to portalvein
via splenicvein)
lnferior vena cava
S i g m o i dv e i n s
Common iliac veins

Median sacralvein

Superiorrectalvein(bifurcation)
iliacvein
External

Internaliliacvein

Obturatorvein
Superiorvesicaland
uterineveins(from
uterinevenousplexus)
Middle rectalvein
nternalpudendalvein
betweeninternal
Communication
rectalplexuses
and perimuscular
aginalvein (fromvaginal
venousplexus)
vein
lnferiorvesicular
Internalpudendalveinin
pudendalcanal(Alcock's)
lnferiorrectalvein
betweeninternal
and externalvenousplexuses

Internalrectalplexus
Perimuscular
rectalvenousplexus
External
rectalolexus

Vasculature

4{tr
Plate 399

Arteries and Veins of Pelvic Organs: Female

Anteriorview
Renalarteryandvein
Renal
artery
andvein

Ovarianarteryand vein
Abdominalaorta

Kidney

Ureter

Ovarian
artery
andvein

Inferiormesenteric
artery
Psoasmajormuscle

Ureter

Commoniliacartery

Inferior
venacava

Mediansacralvessels
Superiorrectalartery(cut)

Psoasmajor
muscle

ligamentof uterus(cut)
Peritoneum
(cut edge)

artery
nternal iliac artery

Suspensory
ligament
of ovary
contains

Anteriordivision
Externaliliacarterv

ovanan
vessels

Obturatorarteryand nerve

Rectum

Umbilicalartery
(patentpart)

Ovary

Middle rectalartery

Uterine
(fallopian)

Uterinearterv
'aginal
artery

Uterus

Inferiorvesicalartery

Round
ligament
of uterus

Roundligament
of uterus(cut)

Vagina

Superiorvesicalarteries

Urinary
bladder

ior epigastric
arteryandvein

Medial
umbilicalfold

Umbilicalartery
(occludedpart)
Superiorvesicalarteries

*{r

Medialumbilicalligament
Medianumbilicalligament(urachus)

Vasculature

Arteries and Veins of Testis

Anteriorview
*

Renalvessels
lnferior vena cava
Abdominal aorta
Testicularvessels
(part of spermaticcord)
Ureter
Inferior
mesenteflcarterY
o m m o n i l i a cv e s s e l s
l n t e r n a li l i a cv e s s e l s
Externaliliac vessels
Inferiorvesical
artery
Inferior epigastric
vessels
Artery to ductus
deferens
Cremasteric
vessers
Testicularvessels
in spermaticcord

Femoral
vessels
Superficial
external
pudendal
vessels(cut-Pass
superficialto
s p e r m a t i cc o r d )
Deep external
pudendal
vessels
Pampiniform
v e n o u sp l e x u s
Deep dorsal vein
and dorsal
arteriesof
p e n i su n d e r
deep (Buck's)
fasciaof penis

4{r
Vasculature

Plate 4Ol

Arteries and Veins of Pelvis: Female

M e d i a ns a c r a l

A b d o m i n a la o r t a

arrery

n i g h t I C o m m o ni l i a c
Left I arteries

lliolumbar
artery
Lateral
sacral
arteries

I n t e r n a il l i a ca r t e r y
P o s t e r i odr i v i s i o n
Anterior division
Externaliliac artery
Umbilicalartery (patent part)

Superior
gluteal
arter

Obturator artery

Piriformis
muscle

U t e r i n ea r t e r y

M i d d l e r e c t a la r t e r y

Vaginalartery

Inferior
gluteal

Inferiorvesicalartery
Superiorvesicalarteries

artery

M e d i a lu m b i l i c a l i g a m e n t
(occluded part of umbilicalartery)

Internal
pudendal
artery

P u b i cs y m p h y s i s

Coccygeus
(ischiococcygeus
muscle

Right paramedian section:


lateral view

Sacrotuberous
ligament---Obturator fascia
( o f o b t u r a t o ri n t e r n u sm u s c l e

A b d o m i n a la o r t a

Internap
l u d e n d a la r t e r y
i n p u d e n d a lc a n a l( A l c o c ks t

Inferiorvena cava
R i g h tc o m m o n i l i a ca r t e r y

L e v a t o ra n i m u s c l e{ c u t e d g e

Left common iliac artery

Ureters
Externaliliac artery (cut)
S u p e r i o rg l u t e a la r t e r
U m b i l i c a la r t e r y( p a t e n tp a r t )

I n t e r n a il l i a ca r t e r y
P o s t e r i odr i v i s i o n
A n t e r i o rd i v i s i o n

Obturatorartery
Piriformm
isuscle
Internap
l u d e n d a la r
Inferior glutealartery
C o c c y g e u s( i s c h i o c o c c y g e u sm) u s c l e
Middle rectal artery-----j
U t e r i n ea r t e r y
Vaginalartery
I n f e r i o rv e s i c a a
l rt
Internap
l u d e n d a la r t e r

4{tr

Inferior rectal arte


S u p e r i o rv e s i c a a
l rteries
M e d i a lu m b i l i c a l i s a m e n r
( o c c l u d e dd i s t a lp a r t o f u m b i l i c a a
l rtery)

Plate 4O2

turator
canal
Obturator
tnlernus
muscle
Levatorani
muscle

Vasculature

Arteries and Veins of Pelvis: Male


left paramediansection:
lateralview

Abdominalaorta

lnferior vena cava

Rightobturator

Commoniliacvessels

Righu
t m b i l i c aalr t e r
(patentpart)

Mediansacralvessels
(cut)
External
iliacvessels

Superiorvesicalartery

Internaliliacvessels

Umbilicalartery
(occludedpart)

lliolumbararterv

Deep
circumflex
iliac

teralsacralartery
Superiorglutealartery
Obturatorartery

Inferior
epigastric

Umbilicalartery

vessels

Ureter(cut)

Ductus
deferens
and its artery

Inferiorglutealartery
Inferiorvesicalartery

M e d i a lu m b i l i c a l
ligament

Middle rectalartery

M e d i a nu m b i l i c a l
ligament(urachus)

Internalpudendal
artery
Ductusdeferensand
its arterv

Superior
vesicalartery

of
Prostatic
branches
inferiorvesicalartery

Superficial
dorsalvein
of

Inferiorrectalarterv
venousplexus

Deepdorsalvein
a n dd o r s a l
arteryof
Deep(Buck's)
fascia of pen

Testicular
a

urethraemuscle
Sphincter
Perineal
artery
Posterior
scrotal
arteries

lnternalpudendalartery
on superioraspectof perinealmembrane

Pampiniform

(venous)
Arteryto ductusdeferens
Vesical(retropubic)
venousplexu6

Inferior
vesical

Branchto prostate
Urethralbranches
Capsular
branches
Hyperplastic
middlelobe
Hyperplasticlaterallobe
urethraemucle
Sohincter

Arterialsupplyof prostate
(Frontal
section,
anterior
viewof
specimenwith benign hyperplasia)

Vasculature

Plate 4O3

Arteries and Veins of Perineum and Uterus

Posterior
labialartery

Dorsalarteryof clitoris
Deeparteryof clitoris

Ischiocavernosu
s

B u l bo f v e s t i b u l e

muscte

Compressor
urethraemuscle

Bulbospongiosus
muscle

Arteryto bulbof vestibule


(Bartholin's)
gland
Creatervestibular

Superficial
perinealspace

perinealmuscle
Deeptransverse

Perineal

Internalpudendal(clitoral)artery

membrane

Perinealmembrane(cut away)

Perineal
artery

Perinealartery(cut)
perineal(Colles')
Superficial
fascia(cutand reflected)
perinealspace
to opensuperficial
Internalpudendalartery
in pudendalcanal(Alcock's)

Superficial
transverse
perineal

muscle
Perineal
art

Inferiorrectalartery

Internal
pudendal
arteryin
pudendal
canal
(Alcock's)

Roundligament
Tubal

Inferior
rectalartery

Branches
of
uterine
artery

External
analsphinctermuscle
Note:Deepperineal(investing
or
Callaudet's)
fasciaremovedfrom
perinealspace.
musclesof superficial

Ovarianvessels
Tubal branchesof ovarianvessels

Vaginalbranches
of uterine
Vaginalarter

Levatorani
Perineal
membrane
Internalpudendalartery
Perineala

perinealspace
Superficial
perineal(Colles')
f,
Superficial

Plate 4O4

Vasculature

Arteries and Veins of Perineum: Male

(dartos)fasciaof scrotum
Superficial

External
spermatic
fasciaover
testis
ano
spermatic
cord

Septumof scrotum
Posteriorscrotalarteries
fasciaof penis
Deep(Buck's)

Bulbospongiosus
muscle

perineal(Colles')fascia(cutedge)

Ischiocavernosu
s
muscle

perinealspace(opened)
Superficial
Perinealartery and vein

Perineal
membrane

superior
Internalpudendalarterypasses
to perinealmembrane

Perineal
body

perineal
rficialtransverse
perineal
muscleand transverse
arterv(cut and reflected)

Superficial
transverse
perineal
muscle

and
Internalpudendalvessels
pudendalnerve(cut)in pudendal
(openedup)
canal(Alcock's)

Transverse
perineal
arter

lnferiorrectalarterv
Inferiorfasciaof pelvicdiaphragm
(roof of ischioanalfossa)

Superficial
perineal
(Colles')fascia
(cut edge

Pudendal
canal(Alcock'

Note:Deepperineal
(investing
or
Gallaudet's)fascia
removedfrom muscles
of superficialperinealspace

Deep arteryof penis


Deepdorsalveinof peni
Dorsalartervand nerveof

4{tr

Transverseperinealligament (anterior
thickeningof perinealmembrane;-

Deep arteryof penis


Dorsalarteryof penis
Urethralartery
Perineal
membrane(cutedge)
Arteryof bulbof penis
Internalpudendalartery
Perineal
artery(cut)

Internalpudendalvessels
in pudendalcanal(Alcock's)
perineal(Colles')
Superficial
fascia(cutedge)

Vasculature

Plate 4O5

Lymph Vessels and Nodes of Pelvis and Genitalia: Female

L a t e r . ral o r t i c( l u n r b a r )
nodes
P r e a o r t i cl y n r p hn o d e s
P r o n r o n t o r i a(lm i c l d l es a c r a l )n o d e s
iliac r-rodes
Conrnror-r

( L a t e r a ls)a c r anl o d e

l n t e r n aill i a cn o d e

L a t e r a(l s u p e r i o r )
e x t e r n aill i a cn o d e

O b t u r a t o rr r o d e

Su p e r i i c i aI
inguinal
nodes
Hig,hest
deep
i n pl,ui r-ral
no(le
(of Cloquet)
f)een

inguinaI
nodes

t,/

Nr
Plate 406

Vasculature

Lymph Vessels and Nodes of Perineum: Female

Highestdeep
inguinal
node
(of Cloquet)

'ascialata(cutaway\
lnferior nodes
(verticalgroup)

vessels
and nerve

Superolateralnodes

(horizontal
group

Deepinguinalnodes

Suoeromedialnodes

(horizontal
group)

4{tr
Vasculature

Plate 4OZ

Lymph Vessels and Nodes of Pelvis and Genitalia: Male

Preaorticnodes

Pathwaysfrom testesalong
testicularvessels

C o m m o n i l i a cn o d e s

Promontorial

sacral)nodes

Lateral)sacralnode

I n t e r n a il l i a cn o d e s

E x t e r n aill i a cn o d e s

H i g h e s td e e p i n g u i n a l
node (of Cloquet)

D e e p i n g u i n a ln o d e s

S u p e r f i c i ai ln g u i n a ln o d e s
y
: t.

Preaorticnode

is
Promontorialnode

Presymphysealnode

Common iliac

E x t e r n aill i a cn o d e s

Pathwayalong inferior vesicalvessels


t o i n t e r n a li l i a cn o d e s( p r i n c i p apl a t h w a y )

P a l h w a yo v e r b l a d d e rt o e x t e r n a il l i a cn o d e s

Internal
i l i a cn o d e s
(Middle
and lateral)
sacralnodes

Pathway
alongside
rectum to
( m i d d l ea n d
lateral)sacral
nodes

Prevesicalplexusand pathway (broken line\


to externaliliac nodes

Pathway(broken /ine)from lower


p r o s t a t ea n d m e m b r a n o u su r e t h r a
a l o n g i n t e r n a lp u d e n d a lv e s s e l s( b e n e a t h
p e l v i cd i a p h r a g m )t o i n t e r n a li l i a cn o d e s

Plate 4O8

Vasculature

Nerves of External Genitalia: Male


SeealsoPlates165,166,318

Splanchnic
nerves

Creater
Lesser

C e l i a cg a n g l i a

Least

S u p e r i o rm e s e n t e r i cg a n g l i o n

S u b c o s t anl e r v e ( T 1 2 )

ganglia

lliohypogastricnerve

L u m b a rs p l a n c h n i cn e r v e s

llioinguinalnerve

nferior
mesenteflc
ganglion

5 y m p a t h e t ti cr u n k
and ganglia
Cenitofemoral
nerve

artery
Testicular
a n dp l e x u s

Lateralfemoral
cutaneousnerve

Superior
hypogastric
plexus

Femoralbranch
ano
C e n i t a lb r a n c h
of genitofemoral
nerve

Femoralnerve

lnferior
hypogastric
(pelvic)
prexus

Lateralfemoral
c u t a n e o us
nerve

Ductus
deferens
a n dp l e x u s

Femoral
b r a n c h e so f
genitofemoral
nerve

Anterior
cutaneous
b r a n c h e so f
femoral nerve

A n t e r i o rc u t a n e o u s
branch of iliohypogastric

Cenital branch of senitofemoralnerve

Testicular
artery
and plexus

D o r s a ln e r v e so f p e n i s

4{ry

Anterior scrotalnerve (from ilioinguinalnerve)

lnnervation

Plate 4O9

Nerves of Pelvic Viscera: Male

Anteriorvagaltrunk

T10spinalnerve(ventralramus)

Posterior
vagaltrunk

te and grayramicommunicantes

and
Celiac branch

lnferiorphrenicarteriesand
Leftgastricarteryand gastric

Diaphragm

plexus,andtrunk
Celiacganglia,

Leftrenalartery
and plexus

Left aorticorenalganglion

L 1s p i n anl e r v e
(ventralramus)

Superiormesentericganglion

Superiormesenteric
arteryand
(aortic)plexus
Intermesenteric
Inferiormesenteric
ganglion,
arteryand plexus
Ureterand uretericplexus
Superiorhypogastric
plexus
Superiorrectalarteryand plex
Hypogastricner

1 s t2
, n d ,3 r dl u m b a sr p l a n c h n n
i ce r v e s
Cravramicommunicantes
Sympathetic
trunkand ganglia
5th lumbarsplanchnic
nerve
L5 spinalnerve(ventralramus)
Lumbosacral
trunk

Nerve from inferior


hypogastricplexus
to sigmoid and descending

Crayramicommunicantes

colon(parasympathetic)

S 1 s p i n a ln e r v e
(ventralramus)

Sacralsplanchnic
nerves
(sympathetic)
1_

ic splanchnic
nerves
(parasympathetic)

Inferiorhypogastric
(pelvic)plexus-

al plexus

Obturatornerve
and artery

Piriformis
muscle

Ductusdeferens
and plexus

C l u t e u sm a x i m u s
muscleandsacrotuberousligament

Vesicalplexus
Rectalplexus

(ischiococcygeus)
Coccygeus
muscleand sacrospinous

Prostatic
plexus

ligament

Cavernous
nerves
of penis

Pudendalnerve

atorani muscle
nferior anal (rectal)nerve
Perinealnerve
Dorsal nerve of penis

Posterior
scrotalnerves

Plate 41O

Innervation

Nerves of Perineum: Male

Posteriorscrotal nerves
Perineal
nerves

t
t

Superficial

Deep

Dorsal nerve of penis

P e r i n e aml e m b r a n (ec u t t os h o w
on superior
structures
neurovascular
aspectof perinealmembrane)
Dorsalnerveof oenis
( c o n t i n u a t i oonf
p u d e n d anl e r v es u p p l y i n g
muscleson superioraspect
of oerinealmembrane)

Superficialperineal
(Colles')fascia(cut
to open superficial
perineal space)
Superficialand deep
branchesof
perinealnerve

ffi

nerve of penis

(passes
superiorto
p e r i n e aml e m b r a n e )
Perinealnerve

Obturatorfascia
(of obturator
internusmuscle)
Posteriorfemoral
cutaneousnerve
Pudendalcanal

(Alcock's)
(openedup)
Pudendalnerve

Inferior
c l u n i a ln e r v e s

Piriformm
isuscle

Inferior anal (rectal)


Perforating
curaneousnerve
Anococcygealnerve

Coccygeus(ischiococcygeus)
muscle -------_--.\
l s c h i a sl p i n e
Pudendalnerve
Levatorani muscle

Obturatorinternusmuscle

4{r

Sacrotuberousligament (cut)

lnnervation

C l u t e u sm a x i m u m
s u s c l e( c u t )

l n f e r i o ra n a l( r e c t a l )n e r v e
Perinealnerve

Plate 411

Nerves of Pelvic Viscera: Female


SeealsoPlates165,166,318

S y m p a t h e ttircu n k
and L2 ganglio

Peritoneum

A b d o m i n a la o r t a
Inferiorvena cava
Extraperitoneal

W h i t ea n d
grayraml
communicantes

( s ub s e r o u s )
fascia
Common
i l i a cv e s s e l s

\.

a n dp l e x u s
Lumbar
splanchnic

Ureter

nerves

Intermesenteric
( a o r t i c )p l e x u s

Crayrami
communicantes

Ovarian artery
and plexus

Superior
hypogastric

prexus
Sacral
promontory
Superior
hypogastric
prexus

Right
hypogastric

nerve(cut)

Common
i l i a ca r t e r y
and plexus

R i g h ta n d
left sacral
sympathetic
t r u n k sa n d
ganglia

Ureter
Internal
iliac artery
ano prexus
External
iliac artery
and plexus

Piriformis
muscle

Right and left


hypogastricnerves

Uterus
Sacral
s p l a n cnhi c
nerves
(sympathetic)

R ig h t s y m p a t h e t i ct r u n k
eft hypogastricnerve
Inferior hypogastric(pelvic)plexus

U t e r i n e( f a l l o p i a nt u) b e
Ovary
Pelvic
splanchnic
nerves
(parasympathetic)

Symphyseal
surfaceof pubis
U r i n a r yb l a d d e r
Vesicalplexus

Coccygeus(ischiococcygeus)
muscle

R e c t apl l e x u s

plexus
Uterovaginal
(retracted)

Nr

Rectum (retracted)

Plate 412

Innervation

Nerves of Perineum and External Genitalia: Female

Anteriorlabialnerve
(fromilioinguinal
nerve)
Dorsalnerveof clitoris
labialnerves
Posterior
'suoer[;.;u;
) B'unth"'
,/---) otperineal
nerve
,/ ,zDeep
)
branchof
posteriorfemoral
cutaneousnerve

Dorsalnerveof
clitorispassing
superiorto
perinealmembrane
nerve
nervern
pudendalcanal
(Alcock's)(dissected)
nferiorclunial
nerves
maxtmus

muscle(cut away)
ligament
Sacrotuberous
g cutaneous
nerve
Perforatin
Inferioranal(rectal)nerves
Anococcygeal nerves

lschialtuberosity
sprne

*fr
Innervation

Plate 413

Neuropathways in Parturition

Greater
Splanchnic
Lesser
nerves
Least

Celiac ganglion

T7 spinal
nerve(anterior
ramus)
Sympathetic
trunk
and ganglia

Aorticorenalganglion

Superiormesenteric
ganglion

T 11 s p i n a l
nerve(anterior
ramus)
R a m ic o m m u n i c a n t e s

Intermesenteric

(aortic)plexus
Lumbar
splanchnic
nerves

I n e r v e( T 1 2 )
nferior
mesentericganglion
Intermesenteric
(aortic) plexus

Superiorhypogastric
plexus
Sl spinalnerve
(anteriorramus)
lliohypogastric
nerve (Ll )

Hypogastricnerves

l l i o i n g u i n anl e r v e( 1 1)

Pelvicsplanchnic
nerves

Vesicalplexus
Dorsalnerveof clitoris
Posterior
labial

Inferiorhypogastric
(pelvic)plexus
plexus
Uterovaginal
Pudendalnerve(S2,3, 4)
Inferioranal(rectal)nerve

Sensorv
fibersfrom uterine
Sensoryfibersfrom cervixand upper
Sensoryfibersfrom lower vagina
bodyandfundusaccompanysympathetic
vaginaaccompanypelvicsplanchnic
nerves
and perineumaccompanysomaticfibers
fibersvia hypogastric
plexuses
to T11, 12 (11?) (parasympathetic)
via pudendalnerveto 52,3,4
to 52,3, 4
Motor fibersto uterinebody
Motor fibersto loweruterinesegment,
Motor fibersto lowervaginaand
dus(sympathetic)
cervix,and uppervagina(parasympathetic) perineumvia pudendalnerve(somatic)

Plate 414

Innervation

lnnervation of Female Reproductive Organs: Schema

S y m p a t h e ttircu n k

rT5

and ganglion

Celiac gangliaand plexus


C r a y r a m u sc o m m u n i c a n s

W h i t e r a m u sc o m m u n i c a n s

'+-

ganglia
Aorticorenal

Creater
splanchnn
i ce r v e
Superiormesenteric
ganglion

Lesser
s p l a n c h n i cn e r

T11 '-'

Least
s p l a n c h n i cn e r v e

r12
trunk
Sympathetic

L u m b a rs o l a n c h n i c

L 3 s p i n a ln e r v e

Ovarian artery and plexus

Superiorhypogastric
plexus

U t e r i n e( f a l l o p i a nt)u b e

nerves
Hypogastric
Note: Painfrom
intraperitonealpelvic
viscera(e.g.,uterine
contractions)goesvia
uterovaginaland pelvic
plexuses,hypogastric
nerves/supenor
hypogastricplexus,lower
aortic plexus,lower

- - - - - l n f e r i o re x t e n t
of peritoneum
and inferior
Uterovaginal
(pelvic)plexuses
hypogastric

Ovary

nerves
Pelvicsplanchnic

nerves,
lumbarsplanchnic
sympathetic
trunkfrom
L4to L5to soinalnerves
T11, 12. Painfrom
subperitonealpelvic
viscera(e.g.,cervical
dilationand upper
vagina)goesvia pelvic
splanchnicnervesto 52,

3, 4. Afferentfibersfrom
lowervaginaandperineum
go viapudendalnerves
to 52,3,4.
Sympatheticf Preganglioni6postganglionic
fibers
----I

lnnervation

Sacralplexus

*{r
Pudendalnerve

Parasympathetic{ Preganglionic
fibers
lpostganglionic-----

Afferentfi[s15 -

Plate 415

Innervation of Male Reproductive Organs: Schema


SeealsoPlatos 167, 168

Sympathetictrunk and ganglia

C e l i a cg a n g l i a

Creater splanchnicnerve (T5-9)

T1
Superiormesentericganglion
G r a y r a m u sc o m m u n i c a n s

T11;1
W h i t er a m u sc o m m u n i c a n s

Left aorticorenalganglion

T12

Lessersplanchnicnerve
Leastsplanchnicnerve

R e n a lg a n g l i o n

L1.7
U p p e rl u m b a sr p l a n c h n i c
Intermesenteric
(aortic)plexus

L2:';

nferior mesentericganglion

L3
C r a y r a m u sc o m m u n i c a n s

Testicular
arteryand plexus

plexus
Superiorhypogastric

Testicular
artervand olexus

Hypogastric
nerves

Ductusdeferensand plexus

Inferiorextentof peritoneum

Ductusdeferens
and plexus

P e l v i cs p l a n c h n i cn e r v e s
ic splanchnic
nerves

Sacralplexus
$2sp3lplgxu5-

Pudendalnerve

Pudendan
l erve
Inferior hypogastric(pelvic)plexus

Dorsalnervesof penis

Vesical
plexus

Epididymis

4{F

plexus
Prostatic
Testis
(Createrand lesser)
cavernous
nervesof penis

Sympathetic{ Preganglionicfibers
f postganglionic__-__

Plate 416

Parasympathetic Preganglionic
fibers
Postganglionic-----

Afferentfibers -

Innervation

lnnervation of Urinalv Bladder and Lower Ureter: Schema

root
sal(posterior)
Ventral(anterior)
root

S p i n asl e n s o r y
(dorsalroot)
ganglion

Celiac ganglia

Superiormesentericganglion

white I Rami
lCraY I communicantes

Aorticorenalganglion

arteryand plexus
lntermesenteric
(aortic)plexus

ganglion
Inferiormesenteric
l s t a n d2 n d l u m b a r
nerves
splanchnic

Lumbarpart
of spinalcord

plexus
Superiorhypogastric

L 2s p i n a l
nerve(ventral
ramus)

nerves
Hypogastric

Sacralpart
of spinalcord

Sympathetic
trunk

Descending
fibers

Ascending

fibers

Crayrami
communicantes

Inferiorhypogastric
(pelvic)plexus

nervesfrom
sacral
sympathetic
trunkto
inferior
hypogastric
(pelvic)
plexus

Urinarybladder

f,"--

nerve
Pudendal

Sacralplexus
Pelvicsplanchnicnerves

plexus
Vesical
Prostatic
urethraemuscle
Sphincter
superior to perinealmembrane

Bulbospongiosus

Sympathetic f Preganglionic
fibers
I P o s t g a n g l i o n- i-c- - -

lnnervation

Parasympathetic( Preganglionic
fibers
ipostganglionic-----

Somaticefferentfibers Afferent fibers -

Plate 417

6 Upper Limb
$ection
Topographic AnatomY
Plate 418

Limb
ere Upper

Shoulder and Axilla


Plates 419430

Joint
andSternoclavicular
ers Clavicle
Views
andScapula:Anterior
lzo Humerus
View
Posterior
andScapula:
lzt Humerus
Radiograph
Anteroposterior
ezz Shoulder:
(Glenohumeral
Joint)
cze Shoulder
ofShoulder
lzl Muscles
Cuff
ofRotator
ezs Muscles
Dissection
eze Scapulohumeral
Scapula
around
andAnastomoses
Artery
ezz Axillary
Fasciae
andAxillary
Clavipectoral,
eze Pectoral,
View
(Dissection):
Anterior
lzs Axilla
Schema
Plexus:
mo Brachial

Arm
Plates 43t4il5

Views
ofArm:Anterior
csr Muscles
Views
ofArm:Posterior
esz Muscles
inSitu
ess BrachialArterY
Elbow
around
andAnastomoses
Artery
ege Brachial
Sections
Cross
lss Arm:Serial

Atlas of Human AnatomY

Upper Limb
Elbow and Forearm

Lumbrical
Muscles
andBursae,
Spaces,
andSheaths:
Schema

Plates 436-451

r3e Bones
of Elbow

464

Flexor
andExtensor
Tendons
inFingers

eez Elbow:
Radiographs

465

Intrinsic
Muscles
ofHand

ese Ligaments
of Elbow
lgg Bones
of Forearm

466

Arteries
andNerves
of Hand:
Palmar
Views
Wrist
andHand:
Superficial
Radial
Dissection

clo Individual
Muscles
ofForearm:
Rotators
ofRadius
eer Individual
Muscles
of Forearm:
Extensors
ofWristandDigits
llz Individual
Muscles
of Forearm:
Flexors
ofWrist

468

elg Individual
Muscles
ofForearm:
Flexors
of Digits
lec Muscles
(Superficial
of Forearm
Layer):
Posterior
View

471

ss

Muscles
(Deep
of Forearm
Layer):
Posterior
View

ele Muscles
(Superficial
of Forearm
Layer):Anterior
View
lez Muscles
(lntermediate
ofForearm
Layer):Anterior
View
lle Muscles
(Deep
ofForearm
Layer):Anterior
View
lcg Forearm:
Serial
Cross
Sections
eso Attachments
of Muscles
of Forearm:
Anterior
View

467

469
47|,

Wrist
andHand:
Superficial
Dorsal
Dissection
Wrist
andHand:
Deep
Dorsal
Dissection
Extensor
Tendons
atWrist
Fingers

Neurovasculatune
Plates 472483

ezz Cutaneous
Innervation
ofWristandHand
lzs Arteries
andNerves
ofUpper
Limb
lzl Musculocutaneous
Nerve
czs Median
Nerve

lsr Attachments
of Muscles
of Forearm:
Posterior
View

eze Ulnar
Nerve

Wrist and Hand

lzz Radial
NerveinArmandNerves
of Posterior
Shoulder
rzs RadialNerve
inForearm

Pfates 45471

rsz Carpal
Bones
lss Movements
ofWrist
csl Ligaments
ofWrist
ess Ligaments
ofWrist(continued)
es6 Bones
ofWristandHand
lsz Wrist
andHand:Anteroposterior
Radiograph
ese Metacarpophalangeal
andInterphalangeal
Ligaments
css WristandHand:
Superficial
Palmar
Dissections
eeo WristandHand:
Deeper
Palmar
Dissections
eer Flexor
Tendons,
Arteries,
andNerves
atWrist
lez Bursae,
Spaces,
andTendon
Sheaths
of Hand

Atlas of Human Anatomy

lzg Cutaneous
Nerves
andSuperficial
Veins
ofShoulder
andArm
eso Cutaneous
Nerves
andSuperficial
Veins
ofForearm
lat Cutaneous
lnnervation
ofUpper
Limb
lsz Dermatomes
ofUpper
Limb
ces Lymph
Vessels
andNodes
of Upper
Limb

Regional Scans
Plate 484

eal CTAngiograms
ofArteries
of theUpper
Limb

Anterior view

Trapeziusmuscle
Clavicle

Acromion
Deltoidmuscle
Cephalicvein

Bicepsbrachiimuscle
Pectoralismajor
muscle
Cubitalfossa
Posteriorview
Deltoid
muscle

Cephalicvein

muscle

Mediancubitalvein

Tricepsbrachii
muscle(longhead)
silicvein

Brachioradialis
muscle
Flexorcarpi
radialis
tendon
Thenar

(median)
Intermediate
vein
antebrachial
Triceps
longus
Palmaris
brachiimuscle
tendon
Longhead
Flexordigitorum
Lateralhead
superficialis
tendons
Tendon
Flexorcarpiulnaristendon
\ Hypothenar eminence
Proximal palmar crease

Proximaldigitalcrease

Brachioradialis
and extensor

carpiradialis
longusmuscles

Middle digital crease

Radial
longitudinal
crease

Commonname
of digits
1 Thumb
2 Index
3 Middle
4 Ring
5 Little

Distaldigitalcrease

pollicis
Extensor
longustendon

Extensor
carpi
radialisbrevis
muscte

Olecranonof ulna

Flexorcarpiulnarismuscle
Extensorcarpiulnarismuscle

Extensor
indicis
tendon

Cephalicvein

digitorumtendons
Extensor
Siteof proximal
(PlP)joint
interphalangeal
Siteof distal
(DlP)joint
interphalangeal

Topographic Anatomy

e/fZN*

Plate 4t I

Glavicle and Sternoclavicular Joint

Right clavicle

Superiorsurface

A c r o m i a le n d

Posbrior

S t e r n a el n d

4a

Inferior surface
Anterior -

T r a p e z o i dl i n e

Postertor

Conoid tubercle
S u b c l a v i a ng r o o v e
( f o r s u b c l a v i u sm u s c l e )

I
I
I

T r a p e z i u sm u s c l e

Superiorsurface

Muscleorigins
Muscleinsertions
Iigament attachments

'Dosterior

S t e r n o c l e i d o m a s tm
ou
i ds c l e
D e l t o i dm u s c l e
Deltoid
P e c t o r a l im
s ajormuscle
t o r a l i sm a j o r m u s c l e
C o s t o c l a v i c u l al irg a m e n t

C o r a c o c l a v i c u rl a
ligament

Trapezoid
ligament
Conoidligamen

A n t e r i o rs t e r n o c l a v i c u l al irq a m e n

Postertor
S u b c l a v i u sm u s c l e
S t e r n o h y o i dm u s c l e

Sternoclavicular
foint

A r t l c u l a rd i s c o f
s t e r n o c l a v i c u l aj or i n t

Clavicle

S u b c l a v i umsu s c l
C o s t o c l a v i c u l al irg a m e n t

C o s t o c l a v l c u l al irg a m e n t

''"it'.

\fEr.
S y n c h o n d r o s iosf 1 s t r i b

Costal cartilages

*{ry
Plate 419

Manubrium
Sternocostal
( s y n o v i a lj)o i n t

R a d i a t es t e r n o c o s t al li s a m e n

t e r n a ls y n c h o n d r o s i s

Shoulder and Axilla

Humerus and Scapula: Antelior Views

Acromial angle

Acromion

Coracoid process

Clavicle(cut)
Superiorangle

Supraglenoid
tubercle.-

Superiorborder

Anatomical neck

scapularnotch

Creater tubercle

Neck

Lesser
tubercle

Medialborder

neck
Surgical

fossa
Subscapular

lntertubercular
sulcus

Clenoid
cavity of
scapura

Crestof

Head of
numerus

SreaIer

lnfraglenoid
tubercle
Lateralborder
Inferiorangle

Trapezius
muscle

Crest of

lessertubercle

minormuscle
Pectoralis

Humerus

muscle

Deltoidtuberosity
Medial
ridge.
supracondylar

B i c e p sb r a c h i im u s c l e
( l o n gh e a d )

Lateral

Supraspinatus
muscle
muscle
Subscapularis
Coracobrachialismuscle
and
Bicepsbrachii musc
(short head)

Radial
fossa

Pectoralis
majormuscle

Lateral
epicondyle

Latissimus
dorsimuscle

Capitulum

Teresmajor muscle

Coronoid fossa

Deltoidm
muscle
Coracobrachialis

Trochlei
M e d i a le o i c o n d v l e

B r a c h i a lm
i su s c l e
Brachioradialis
muscle

Triceps
brachii
muscle
( l o n gh e a d )

atus
anterior
muscle

Subscapularid
muscle

Muscleattachments
Origins
I
Insertions
I

longusmuscle
Extensor
carpiradialis
Pronatorteresmuscle(humeralhead)
Common flexor tendon
Common extensortendon
(extensorcarpi radialisbrevis,extensor
digitorum with extensordigiti minimi,
and extensorcarpi ulnarismuscles)
B r a c h i a l im
s uscle

4{tr
Shoulder and Arilla

Supinatormuscle
Bicepsbrachii muscle

(flexorcarpiradialis,
palmarislongus,
flexorcarpiulnarisandflexordigitorum
head]muscles)
superficialis
[humeroulnar
muscle
Flexordigitorumsuperficialis
( h u m e r o u l nh
ae
r ad)
Pronatorteresmuscle(ulnarhead)
Flexorpollicislongusmuscle(ulnarhead)

Plate 42O

Humerus and Scapula: Posterior View

Suprascapular
notch
Superiorborder
S u p e r i o ra n g l e
angle

Supraspinous
fossa

Notchconnecting
supraspinous
and
Inlrasprnous
tossae

Spine
Neck

Greatertubercle

Infraspinousfossa

Headof humerus
Anatomical neck

Medial border

Surgicalneck

Lateralborder

Croovefor
circumflex
scapular
vessels

Inferiorangle
Supraspinatus
muscle

Trapezius
muscle

Scapula

Infraglenoid
tubercle
Deltoidtuberosity
Radialgroove

Humerus

Medial
supracondylarridge

Deltoid muscle
aspinatusmuscle
Rhomboid
mtnor
muscle

Lateral
supracondylarridge

Infraspinatus
muscle
Teresminormuscle

Olecranon fossa
Rhomboid
maJor

Triceosbrachii muscle

Triceps
brachii
muscte
( l o n gh e a d )

muscle

Lateraleoicondvle

(lateralhead)

Trochlea

Infraspinatus

muscle

Croove for ulnarnerve

Teresminor
muscle

Latissimusdorsi
m u s c l e( s m a l l
slip of origi

Teresmajor
muscle

Brachialismuscle

Medial epicondyle

iceps brachii muscle


( m e d i a lh e a d )

Muscleattachments
I
I

Origins
Insertions

Tricepsbrachii

Commonflexortendo

Commonextensortendon

Anconeus muscle

Plale

421

*{r

Shoulder and Axilla

Shoulder: Anteroposterior Radiograph


SeealsoPlate 420

Shoulder and Axilla

r\rronr()n

AN

, \ n . t t o n r i r , r rl l r I ' o l h L t t l t ' t t t s

( l , r ri <l r ,

CP
G

( o r a co i t l l ) r () ( ( ' \ \
( , l t ' r t o i r l( , r \ l \ ( ) l \ ( J l ) l . ,t t

GT

( , t t ' , t 1 t 'l tL t l r t ' tl ir '

I lrllc'rrrs

HH

[ ] t , . r rol L l r r r r r r l l t t

LT

Lt ' : r t , rl u l r c t r l

S c. t l t t t l , rl , r l c r , tl lr o t c l t ' r

SN

S L r r g , i r .nrcl t l . o l i r t r l r t t ' t u s

SS

S p i n t .o l s r , r 1 r r t [ , r

Plate 422

Shoulder (Glenohumeral Joint|


Anteriorview
A c r o m i o c l a v i c u l aj or i n t c a p s u l e

( i n c o r p o r a t i nagc r o m i o c l a v i c ulliagra m e n t )

Clavicle

Acromion
Coracoacromialligament
Supraspinatustendon (cut)
Coracohumeralligament

Superiortransverse
scapularligamentand
suprascapular
notch

Creater tubercle and

Lesser
tubercle
of humerus

process

Transverse
humeralligament

Communication oI
subrtendinous

Intertubercular
tendonsheath

bursaof subscapularis

(communicateswith synovialcavity)

Brokenlineindicates
positionof subtendinous
bursaof subscapularis

Subscapularis
tendon(cut)
Bicepsbrachii tendon (long head)

Capsular
ligaments

Anterior
view

4{r

aspinatus
muscle
Subdeltoid
bursafusedwith
subacromial
bursa

Deltoid
muscle
(reflected)

Subscapularis
muscle
Subdeltoid
bursa
Supraspinatus
tendon
Capsularligament

Capsular
ligament

Svnovialmembrane

Deltoid
muscte
acoacromialligament
Acromion
Coracoid process

Supraspinatus
(fusedto capsule)

o r a c o h u m e r alli g a m e n t

Subdeltoid
bursa

Bicepsbrachiitendon
( l o n gh e a d )

Infraspinatustendon
(fusedto capsule)

S u p e r i ogr l e n o h u m e r a l
ligament

Clenoid cavity (cartilage)

S u b s c a o u l atrei sn d o n
(fusedto capsule)

Teresminor tendon

(fusedto capsule)
Synovialmembrane (cut edge)
O p e n i n go f s u b t e n d i n o u s

b u r s ao f s u b s c a o u l a r i s

M i d d l eg l e n o h u m e r a l
ligament
I n f e r i o rg l e n o h u m e r a l
ligament

loint opened:lateralview

Plate 423

Clenoid

labrum

Clenoid
cavity of
scapula

Axillaryrecess

Coronalsectionthroughjoint

Shoulder and Axilla

Muscles of Shoulder

Posteriorview

capitismuscleI Not .onn".t"d


Semispinalis
to upperlimb
spleniuscapitismuscle
I
Spinousprocessof C7 vertebra
muscle
Levatorscapulae

Trapezius
muscle

Rhomboim
d i n o rm u s c l e
id majormuscle

Deltoid
muscle

muscle
Supraspinatus
S p i n eo f s c a p u l a
muscle
lnfraspinatus
Teresminormuscle
Teresmajormuscle
issimus
dorsimuscle
Longhead

of tricePs

> Dracnll

Lateralhead ! muscle
Spinousprocessof
T12vertebra

Triangle
of auscultation
muscle
Trapezius

Anteriorview
Acromion

Omohyoidmuscleand
investing
layerof
deep cervicalfascia
Sternocleidomastoid
muscle

Deltopectoraltriangle
Deltoid muscle

Deltoidbranchof
thoracoacromial
artery

Pectoralis
maJor
muscte

Cephalicvein

Biceps Longhead,
f
Dracnil1
muscle ( Shorthead
Tricepsbrachiimuscle
(lateralhead)
Latissimus
dorsimuscle
Serratus
anteriormuscle

-Sternum
6th costalcartilage
'Anterior laver of
rectus sheath

External
obliquemuscle

Shoulder and Axilla

Plate 424

Muscles of Rotator Guff

Superiorview

"t

C o r a c o c l a v i c u l a r l i g a m e n{t

Trapezoidligament
Conoidligamenl

Coracoid orocess

ubscapularis
tendon
oracoacromialligament

u l a rj o i n t
Supraspinatus
tendon
Infraspinatus
tendon
Teresminor
tendon

4{r
nfraspinatus
muscle
Superiorborderof sca
Subscapularis
muscle

Spineof scapula

Supraspinatus
muscle

Coracoacromialligament
Coracoid process

Superiortransverse
s c a p u l al irg a m e nat n d
suprascapular
notch

Acromion
Supraspinatus
tendon

Biceps
brachii
tendon

Infraspinatus
muscle

(long
head)

Teres
mtnor
muscle

Subscapulari6

Anteriorview

Plate 425

e&4/*

Axillarynerve

Posteriorview

Shoulder and Axilla

Scapulohumeral Dissection
Lateral view
P h r e n i cn e r v e

L e v a t o rs c a p u l a em u s c l e
A c c e s s o r yn e r v e ( X l )

( Anterior'
S c a l e n em u s c l e s { t r , t i d a t e( Posterior
B r a c h i a lp l e x u s
S u b c l a v i a na r t e r y a n d v e i n
S u p e r i o rt h o r a c i c a r t e r y
l embrane
E x t e r n a il n t e r c o s t a m
l usc
a n t e r i o rt o i n t e r n a li n t e r c o s t a m

Scapula (rettacted\
Subscapularis
muscle

P e r f o r a t i n gb r a n c h o f i n t e r n a
t h o r a c i ca r t e r y a n d a n t e r i o r
c u t a n e o u sb r a n c h o f i n t e r c o s t a ln e r v e

major muscle

l n t e r c o s t o b r a c h i anl e r v e

L o n g t h o r a c i cn e r v e

E x t e r n a il n t e r c o s t a l
L a t e r a lt h o r a c i c a r t e r y
L a t e r a lc u t a n e o u sb r a n c h e s
l e r v e sa n d
of intercostan
p o s t e r i o ri n t e r c o s t a l
S e r r a t u sa n t e r i o r

Anterior view
Acromion
S u p r a s p i n a t utse n d o n
C r e a t e r t u b e r c l eo f h u m e r
S u b s c a p u l a r itse n d o n
l n t e r t u b e r c u l a tre n d o n s h e a t h
A n t e r i o r c i r c u m f l e xh u m e r a la r t e r y
B i c e p sb r a c h i it e n d o n
( l o n g h e a d )( c u
A x i l l a r yn e r v e a n d
p o s t e r i o rc i r c u m f l e x
h u m e r a la r t e r y
Q u a d r a n g u l a rs p a c e
Radial nerve -/-)

C o r a c o a c r o m i al i g a m e n t
coid process
S u p r a s c a p u l aar r t e r Ya n d n e r v e
S u p e r i o rt r a n s v e r s es c a P u l a r
l i g a m e n ta n d s u P r a s c a P u l a r
notch
P e c t o r a l i sm i n o r t e n d o n ( c u t )
B i c e p sb r a c h i i t e n d o n
(short head) (cut) and
c o r a c o b r a c h i a l i tse n d o n
b s c a p u l a r i sm u s c l e

artery
Subscapular
nerve
Lowersubscapular
(to teresmaiormuscle)
Circumflexscapularartery
Thoracodorsal artery and
n e r v e ( t o l a t i s s i m u sd o r s i
muscle)
S u b s c a p u l a r im
s uscle

C o r a c o b r a c h i a l i sm u s c l e

Teres maior muscle

Triangular
L a t i s s i m u sd o r s i m u s c l e
S u p r a s c a p u l aar r t e r ya n d n e r v e
Acromion

Posteriorview
S u p e r i o rt r a n s v e r s es c a p u l a r
l i g a m e n ta n d s u p r a s c a p u l a r
notch

nfraspinatustendon (reflected)
c a p s u l eo f s h o u l d e r
Deltoid muscle (reflected)
T e r e sm i n o r m u s c l e

S u p r a s p i n a t um
s u s c l et c u t )
S p i n eo f s c a p u l a
I n f r a s p i n a t u sm u s c l e( c u t )
T r i a n g u l a rs p a c ew i t h
c i r c u m f l e xs c a p u l a ra r t e r y
deep to space

4{tr

T e r e sm a j o r m u s c l e

Shoulder and Axilla

Q u a d r a n g u l a rs p a c e
t r a n s m i t t i n ga x i l l a r Y
nerve and posterior
c i r c u m f l e xh u m e r a la r t e r Y
S u p e r i o rl a t e r a lb r a c h i a l
cutaneouSnerve
P r o f u n d ab r a c h i i ( d e e P
b r a c h i a l )a r t e r ya n d
R a d i a ln e r v e
shown between
eral head and
Lone head of
trice-psbrachii muscle

Pfate 426

Axillary Artery and Anastomoses around scapula


SeealsoPlates 33, 434
scendingcervicalartery

Anteriorview

Transversecervicalartery

Inferiorthyroidartery
Thvrocervical
trunk

Suprascapular
artery

Subclavian
artery

A c r o m i o na n d
acromial anastomosis

Anterior scalenemuscle
Clavicle(cut)

Dorsalscapular

Superiorthoracic
artery

Coracoidprocess

Thoracoacromialartery

Anteriorcircumflex
humeralartery

cularbranch

Posterior
circumflex
humeralartery

Acromialbranch
Deltoidbranch

Subscapular
art

Pectoral
branch

Circumflex
scapulararl

1,2, 3 indicate1st,
2nd, and 3rd partsof
axillaryartery

Brachial
artery

Nr

Thoracodorsala
Lateralthoracic

Omohyoid muscle (inferiorbelly)

Suprascapular
artery

Levatorscapulaemu

Acromial branch of
thoracoacromialartery
A c r o m i o na n d
acromial plexus

Dorsal scapularart

Infraspinous
branchof
suprascapurar
artery

Supraspinatus
muscle(cut)

Posterior
circumflex
humeral
a r t e r y( i n
quadrangular
space)and
ascending
and
descending
branches

Superiortransverse
s c a p u l al irg a m e n t
and suprascapular
notch

S p i n eo f s c a p u l a

Infraspinatus
muscle(cut)
Circumflex
scapular
artery
Teresminor muscle (cut)

Teresmajormuscle

Lateralhead
L o n gh e a d

c4d4/*
Posteriorview

Plate 427

Shoulder and Axilla

Pectoral, Glavipectoral, and Axillary Fasciae

Thoracoacromial
arter

Trapeziusmuscle
muscleinvestedby
fasciaof infrahyoidmuscles

Coracoidprocess

Clavicle
Fascia
investing
subclavius
muscle*

Cephalicvein

Costocoracoidligament*
Deltoid
muscle

ligament
Costoclavicular
membrane*
Costocoracoid

Pectoralis
maJor
muscle(cut)

Fasciainvesting pectoralis
minormuscle*
ligamentof axilla*
Suspensory
Pectoralismajormuscleand
pectoralfascia(superficial
anddeeplayers)

Biceps
brachii
muscle
Shorthead

Latissimus
dorsifascia

Long head

Serratus
anteriorfascia
Axillaryfascia(anteriorpart)

Brachial fascia
(cut edge) over
coracobrachialis
and biceps brachii
muscles

Nr
Omohyoidmuscle

Oblique parasagittalsectionof axilla


Trapezius
muscle
( Lateralcordplexus
Brachial
cord
J Posterior
( Medialcordmuscle
Supraspinatus

scapura;U;
{
Infraspinatus
muscle
Subscapularis
muscle
Teresminormuscle
Teresmaiormuscle
Latissimus
dorsimuscle

lavicle

muscleandfascia*
Subclavius
ligament*
ostocoracoid
Thoracoacromial artery and cephalic vein

membrane*
ostocoracoid
Lateralpectoralnerve
Axillaryarteryandvein
majormuscleand fascia
Pectoralis
Pectoralisminor muscle and fascia*
Medial pectoral nerve

ligamentof axilla
Suspensory
Axillaryfascia(fenestrated)

*Components
fascia
of clavipectoral

Shoulder and Axilla

Plate 428.

Axilla (Dissection|: Anterior View

Thoracoacromial
artery
Pectoralisminor tendon (cut)

Trapezius
muscte

A c r o m i a lb r a n c h

Deltoidbranch

Coracoid process
Acromion
C e p h a l i cv e i n

Suprascapularartery and nerve

Dorsalscapular
arteryandnerve
Transversecervical artery

Clavicularbranch
Pectoralbranch

Musculocutaneous
nerve

Axillaryartery

Anteriorcircumflexhumeralartery

Clavicleand
subclavius
muscle
(cut)

Axillarynerve and posterior


circumflexhumeralartey
Pectoralismajor muscle (cut)

Anterior scalene
muscle
Sternocleidomastoid
muscte

Coracobrachialis
muscle
Phrenic
nerve

Deltoidmuscle

Omohyoid
muscte

B i c e p sb r a c h i im u s c l e

Musculocutaneousnerve

Brachi
muscle

U l n a rn e r v e
M e d i a lb r a c h i a l
cutaneousnerve

Profunda
brachii
(deep
brachial)
artery

Intercostobrachial
nerve

Circumflex
scapularartery

Radialnerve

Lower sub-

scapular

Triceps
brachii
muscle
B r a c h i avle i n i
Ulnarnervi:

Teresmajor muscle

Latissimus
dorsimuscle

Median nerve

Brachial
arterf

Plate 429

1st rib

Thoracodorsalartery and nerve

M e d i a la n t e b r a c h i a l
c u t a n e o u sn e r v e
B a s i l i cv e i n

*{r

Subclavian
artery and vein

Subscapular
artery

Uppersubscapular
nerve
S e r r a t uasn t e r i om
r uscle

Lateralthoracic artery and long thoracic nerve

Ansapectoralis

B r a c h i apll e x u s
Suoeriorthoracic arterv
Lateralpectoral nerve
Medial pectoral nerve

Pectoralisminor (cut)

Shoulder and Axilla

Brachial Plexus: Schema

shown.
Note:Usualcomposition
PrefixedplexushaslargeC4
contributionbut lacksT1.
PostfixedplexuslacksC5 but
hasT2 contribution.

Contribution
from C4
Dorsal
ramus

Dorsalscapular
nerve(C5)

jt(\$\Ss
Suprascapular
n e r v e( C 5 , 6 )

Tophrenic
nerve

Tosubclavius
n e r v e( C 5 , 6 )

..ts"
aLateralpectoral
n e r v e( C 5 , 6 ,7 )

^"$'"
Musculocutaneou
s
n e r v e( C 5 , 6 ,7

Contribution
from T2
fo longuscolli
and scalene
muscles
(c5,6,7,9)

Axillary
nerve(C5,6)
Radialnerve
( c 5 , 6 , 7 ,8 , T 1 )
Mediannerve
( c 5 , 6 , 7 ,8 , T 1
Ulnarnerve

(c7,8,T"1

1st intercostalnerve
Longthoracic
nerve(C5,6, 7)
Medialpectoralnerve(C8,T1)
Medialbrachialcutaneousnerve(T1)
nerve (C8,Tl)
cutaneous
antebrachial

Inconstant
contribution

nerve(C5,6)
Uppersubscapular
(middlesubscapular)
nerve(C6,Z 8)
acodorsal
nerve(C5,6)
subscapular

Shoulder and Axilla

4{r

Plate 43O

Muscles of Arm: Anterior Views


SeealsoPlate 474

Acromion

C o r a c o a c r o m i al li g a m e n t

Coracoidprocess

S u b d e l t o ibdu r s a

Pectoralis
minortendon(cut)
Creatertubercle,
Lesser
tubercle
of humerus

Subscapularis
muscle

Intertubercular
tendonsheath

C o r a c o b r a c h i aml ius s c l e

Musculocutaneous
nerve(cut)

Circumflex
scapularartery(cut)

D e l t o i dm u s c l e

Teresmajormuscle

(reflected)

Latissimus
dorsimuscle
Pectoralismajor
muscle (reflected)
Anterior circumflex
h u m e r a la r t e r y

B i c e p s L o n gh e i
f
oracnil \
m u s c l e( S h o r n
te
Brachial
artery(cut)

B i c e p sb r a c h i i
tendons (cut)
S h o r th e a d
Long head

Median nerve (cut)


B r a c h i a l im
s uscle

C o r a c o b r a c h i a l im
suscle
Lateralantebrachial
cutaneousnerve

M u s c u l o c u t a n e o uns e r
Branchto biceps brachii (cut)

B i c i p i t aal p o n e u r o s i s

D e l t o i d m u s c l e( c u t )
Bicepsbrachiitendon
B r a c h i o r a d i a lm
i su s c l e
Pronatorteres muscle
Flexorcarpi
r a d i a l i sm u s c l e
B r a c h i a l im
s uscle

Superficiallayer
Lateralintermuscularseptum

Medial
intermuscular
septum

Lateralepicondyleof humerus
Lateralantebrachialcutaneousnerve
Head of radius

Nry

Medial
epicondyle
of humerus

B i c e o sb r a c h i it e n d o n
R a d i a tl u b e r o s i t y

Tuberosity
of ulna

Deep layer

Plate 431

Arm

Muscles of Arm: Posterior Views

Superficiallayer

Acromion

S u p r a s p i n a tm
u su s c l e
atertubercleof humerus
muscle
Infraspinatus
Teresminor muscle
Axillary nerve and posterior
circumflexhumeral artery
Deltoid muscle (cut and reflected)
Superiorlateralbrachialcutaneousnerve
.ateralhead I of Tricepsbrachii muscle
-endon
)
B r a c h i o r a d i a lm
i su s c l e

r int
C a p s u lo
e f s h o u l d ej o
tendon
Supraspinatus
Teresmaiormuscle

and
Infraspinatus
Teresminortendons(cut)

Posteriorbrachial
c u t a n e o u sn e r v e
(from radial nerve

Axillarynerve

Medial interm u s c u l a rs e p t u m

Teres
malor
muscle

Ulnar nerve
M e d i a le p i c o n d y l e

Posterior
circumflex
humeralartery
Superiorlateralbrachial
nerve
cutaneous

of humerus
Profundabrachii(deep
artery
brachial)
Radialnerve

O l e c r a n o no f u l n a
Flexorcarpi
u l n a r i sm u s c l e

artery
Middlecollateral

A n c o n e um
s uscle
Extensor
carpi

Radialcollateral
artery

r a d i a l i sl o n g u sm u s c l e

Inferiorlateralbrachial
nerve
cutaneous

Extensorcaroi ulnarismuscle
Posteriorantebrachial
cutaneousnerve (f
radial nerve)

Long head of
tricepsbrachii muscle

E x t e n s odri g i t o r u m
muscle
Extensorcarpi radialisbrevis muscle

Lateralhead of triceps

b r a c h im
i u s c l e( c u t )
Medialheadof
tricepsbrachiimuscle
Medialepicondyle
of humerus

*{r

Nerve to anconeusand
medial head of
tricepsbrachii muscle
Posteriorantebrachial
cutaneousnerve

U l n a rn e r v e
Olecranon of ulna

Deep layer

Arm

Lateralintermuscular
septum

Lateralepicondyle
of humerus

A n c o n e u sm u s c l e

Plate 432

Brachial Artery in Situ

C o r a c o i dp r o c

Axillaryartery
D e l t o i dm u s c l e
Pectoralisminor muscle (cut)
Anterior circumflex
humeral artery

Lateralcord,
Medialcord
of brachialplexus

Humerus

Musculocutaneous
nerve

Pectoralismajor
m u s c l ea n d t e n d o n (

S u b s c a p u l am
r i su s c l e
B i c e p s ( L o n gh e a d
b r a c h i i{
m u s c l e ( S h o r th e

Anterior and oosterior


circumflexhumeral arteries
Teresmajor muscle

Coracobrachialismuscle

atissimusdorsi muscle
Brachial
Profundabrachii (deeo
brachial)arterv
M u s c u l a rb r a n c h
Medial brachialcutaneousnerve
Median nerve

Ulnar nerve
Medial antebrachialcutaneousnerve

M u s c u l a rb r a n c h

B i c e p sb r a c h i im u s c l e
Superiorulnar collateralartery
B r a c h i a l im
s uscle

i n t e r m u s c u lsaer p t u m
Radialrecurrentartery

B i c e p sb r a c h i it e n d o n

Inferior ulnar collateralartery


M e d i a le p i c o n d y l eo f h u m e r u s
B i c i p i t aal p o n e u r o s i s

Radialartery

Pronator

muscre

nar artery
F l e x o rc a r o i r a d i a l i sm u s c l e
r a c h i o r a d i a l im
s uscle

Plate 433

4{tr
Arm

Brachial Artery and Anastomoses around Elbow

branch
Clavicular

Pectoralbranch

Acromialbranch
Deltoidbranch
Thoracoacromial
arterv

thoracicarterv

Axillary artery

al thoracicartery

Anteriorcircumflexhumeralarter
Posterior
circumflexhumeral

artery
Subscapular
ircumflexscapular
artery

Brachialartery

artery
Thoracodorsal
Profundabrachii(deepbrachial)
artery
of lowermargin
of teresmajormuscle
is landmarkfor name
changefrom axillary
to brachialartery
Radialcollateral

Middlecollateral
artery
Superiorulnarcollateralartery

artery
Inferiorulnarcollateral
Radialrecurrent artery

Recurrent
interosseous
arterv
Anteriorulnarrecurrentartery
ulnarrecurrentarterv
Posterior
Radialartery

artery
common interosseous
artery
Anteriorinterosseous

4{tr

Ulnarartery

Arm

Plate 434

Arm: Serial Gross Sections

neousnerve

Pectoralis
majormuscleandtendon

Mediannerve

Cephalicvein

Medialantebrachial
nerve
cutaneous

(
shorthea
Biceps
brachii
muscleI
(
Long hea,

Brachial
artervandveins
Coracobrachialis
muscle

vern
Profundabrachii(deep
brachial)
artery
Ulnarnerve

Deltoidmuscle

Radialnerve
Medialbrachial
nerve
cutaneous

Bicepsbrachiimuscle

Latissimus
dorsitendon
Musculocutaneous
nerve

Teresmajor muscle

Brachialis
muscle

Brachial
fascia

Cephalicvein

Mediannerve

Radial
Posterior
an
cutaneous
nerve
(fromradialnerve)

Brachial
artervandveins
Medial antebrachial
cutaneousnerve

silicvein

Radialcollateral
artery

Medialbrachialcutaneous
nerve

Middlecollateral
arterv

Neurovascular
compartment
Lateralintermuscular
septum

Ulnarnerve

of Triceps( u"ai"tr'""a
brachii {
muscle
(

Superiorulnarcollateral
artery

Lateralhead
Longhead-

Medialintermuscular
septum
Brachialfascia

Bicepsbrachii

ateralantebrachial
cutaneous
nerve
(frommusculocutaneous
nerve)

Cephalicvein

Brachialis
muscle
Brachioradialis
muscle
Radialnerve
Extensor
carpi
radialislongus
muscte

Medialantebrachial
nerve
cutaneous
Basilicvein
Median nerve

Ulnarnerve
Brachial
artervandveins
Medialintermuscular
septum

Posterior
antebrachial
cutaneous
nerve(from
radialnerve)

Plate 435

Humerus
Tricepsbrachiimuscleand tendon
Lateralintermuscular
septum

*{r

Bones of Elbow

Rightelbow
Humerus

Humerus

*{r

edial
supracondylarridge
Coronoid
fossa

Radialfossa

Olecranon
fossa

Lateralepicondyle
Lateralepicondyle

Medial epicondyle

Capitulum

Olecranon

Trochlea

Head

Head

Coronoid
process

Neck

Tuberosity

Radialnotchof ulna

Tuberosity

Tuberosity
Ulna

In extension: anterior view

In extension:posteriorview

ln extension:medialview
Humerus
Medialepicondyle
Capitulum

Lateralepicondyle

Capitulum
Head

Tuberosity

Radialnotch
Coronoid process
Trochlearnotch
Olecranon

Tuberosity
Coronoid process
of ulna

In 90" flexion: lateral view

Elbow and Forearm

Trochlearnotch
Olecranon
Olecr
In 90'flexion: medialview

Plate 436

Elbow: Radiographs

Lateralradiograph

c
CP
H
HR
t

o
R
T
U

Capitulum
Coronoidprocessof ulna
Humerus
Headof radius
Lateralepicondyle
Olecranon
Radius
Trochlear
notch
Ulna

Anteroposteriorradiograph

c
CP
H
HR
t
M
NR

o
OF
R
T
RT
U

Plate 437

Capitulum
Coronoidprocessof ulna
Humerus
Headof radius
Lateralepicondyle
Medialof epicondyle
Neckof radius
Olecranon
Olecranonfossa
Radius
Trochleaof humerus
Radialtuberosity
Ulna

Elbow and Folearm

Ligaments of Elbow

Rightelbow
Anteriorview

Humerus

Jointcapsule
Medial epicondyle

Lateralepicondyle
Radialcollateralligament

ligament
Ulnarcollateral

A n n u l alri g a m e not f r

Insertionof brachialismuscle

Bicepsbrachiitendon

Obliquecord

Humerus

4{r

Joint
ioint capsule

ligament
Ulnarcollateral

Radialcollateralligament

A n n u l a lri g a m e not f r a d i u s

A n n u l alri g a m e not f r a d i u s
Biceosbrachiitendon

Humerus

Triceps
brachii
tendon

Bicepsbrachiitendon

Obliquecord

Subcutaneous
olecranon

-$=::---:.Ff

DUTSA

ln 90o flexion:medialview

In 90o flexion:lateralview

Jointcapsule(cutedge)

Subcutaneous
olecranon
bursa

Humerus

Fatpads

Openrd joint:
antenor vrew

Synovialmembrane

Openedjoint:
postenorvrew

Articularcartilage

Elbow and Forearm

Plate 438

Bones of Forearm

Olecranon

Rightradiusand ulna
in supination:anteriorview

Trochlearnotch

Rightradiusand
ulna in pronation:
anteriorview

Coronoid process
R a d i a ln o t c h o f u l n a

U l n a rt u b e r o s i t y

Ulnartuberosity

O b l i q u ec o r d

R a d i atlu b e r o s i t y

Anterior surface

Anteriorsurface

Obliquecord

Lateralsurface
Posterior
border

Anterior border

Anteriorborder

Posterior
surface
lnterosseous

membrane
Interosseous
border
Interosseous
border

Interosseous
membrane

Dorsaltubercle
Croove for extensor

p o l l i c i sl o n g u sm u
Croove for extensor
digitorum and extensor

i n d i c i sm u s c l e s
Styloidprocess
of ulna

Croove for extensor


carpi radialislongus
and brevis muscles

Areafor extensor
pollicib
s r e v i sa n d
abductorpollicis
longusmuscles

Styloidprocess

Styloidprocess

U l n a rn o t c h
of radius
Styloid
process

Styloidprocess

Areafor s phoid bone

Area for lunate bone

Carpalarticularsuface

Plate 439

4{F

Coronal sectionof
radiusdemonstrates
how thicknessof
cortical bone of
shaftdiminishes
to thin layerover
cancellousbone
at distalend

Elbow and Forearm

lndividual Muscles of Forearm: Rotators of Radius

Rightforearm:anteriorview
Pronatedposition

Supinatedposition

Medial eoicondvle

Lateralepicondyle

Pronatorteres

*{r

Elbow and Forearm

Plate 44O

Individual Muscles of Forearm:Extensorsof Wrist and Digits

N o t e : A n c o n e u sm u s c l en o t s h o w n
becauseit is extensorof elbow

al epicondyle
Olecranon
Lateralepicondyle

Extensorsof wrist
Olecranon

Extensor
carpi
radialislongus

Lateral
epicondyle

Extensor
carpi
radialisbrevis
Extensor
carpiulnaris

Common
extensor
tendon

Extensors
of digits
(exceptthumb)

Common
extensor
tendon

Extensor
digitorum
and extensor
d i g i t im i n i m i
(cutaway\

Interosseous
memDrane

Extensor
digitorum
Extensor
digiti minimi
Extensorindicis

Extensors
of thumb
Abductorpollicis
pollicisbrevis
Extensor
Extensorpollicislongus

E x t e n s odr i g i t o r u m
and extensordigiti
m i n i m i t e n d o n s( c u t

t!
I

Plale

441

Rightforearm:
posterior
(dorsal)views

4{tr
Elbow and Forearm

Individual Muscles of Forearm: Flexors of Wrist

Note:Brachioradialis
musclenot shown
becauseit is flexorof elbow
Medial epicondyle

Lateralepicondyle
flexortendon

Flexorcarpiradialis
Palmarislongus
Flexorcarpiulnaris

(cut)
almaraponeurosis

Rightforearm:
anterior(palmar)view

Elbow and Forearm

Plate 442

lndividual Muscles of Forearm: Flexors of Digits

Medial epicondyle
Lateralepicondyle

Lateralepicondyle
Common flexor tendon
Coronoid process
Interosseousmembrane

Flexorpollicislongus

Flexordigitorumsuperficialis
tendons (cut away)

4{tr
Plate 443

Rightforearm:
anterior(palmar)views

Elbow and Forearm

Muscles of Forearm (Superficial Layerf: Posterior View

S u p e r i our l n a rc o l l a t e r aalr
( a n a s t o m o sdeiss t a l lw
y itn
posteriorulnarrecurrentartery)

Tricepsbrachiimuscle

B r a c h i o r a d i aml ius s c l e
U l n a rn e r v e
Extensor carpi radialislongus muscle

M e d i ael p i c o n d y loef h u m e r u s
Common extensortendon
O l e c r a n o no f u l n a

Extensorcarpi radialisbrevis muscle


Anconeus muscle

Flexorcarpi ulnarismuscle

Extensorcaroi ulnaris

Extensordigitorum muscle

Extensordigiti minimi muscle

Abductorpollicislongusmuscle

Extensor
oollicisbrevismuscle
xtensorpollicislongustendon
Extensorcarpi radialisbrevistendon

Extensor
retinaculum
(compartments
numbered)

Dorsal branch of ulnar nerve

Extensorcarpi radialislongustendon

Suoerficialbranch of radial nerve

A b d u c t op
r o l l i c i lso n g u st e n d o n
E x t e n s ocr a r p i u l n a r i st e n d o n
E x t e n s o dr i g i t im i n i m i t e n d o n

Extensor
oollicisbrevistendon
E x t e n s opro l l i c i sl o n g u st e n d o n

Extensordigitorum
E x t e n s o irn d i c i st e n d o n
Anatomical snuffbox

Nr

5th metacarpalbone

Elbow and Forearm

Plate 444

Muscles of Forearm (Deep Layerf: Posterior View


SeeafsoPlates 47O,479

Middlecollateral
branchof
deepbrachialartery

Superiorulnarcollateral
Branches
of
{
tnreflorutnar
brachial'arterv
" ! ' / I ( p o s t e r i o r coilareral
branch)1
(
Medialintermuscular
septum

Lateralintermuscular
septum
Brachioradialis
muscle

U l n a rn e r v e

longusmuscle
Extensor
carpiradialis

Posterior
ulnarrecurrenta
M e d i a el p i c o n d y loef h u m e r u s

Lateralepicondyleof humerus
Commonextensortendon(partiallycut)

Tricepsbrachiitendon(cut)
O l e c r a n o no f u l n a

Extensor
carpiradialis
brevismuscle

Anconeus

S u p i n a t omr u s c l e

F l e x ocr a r p iu l n a r i m
s

nerve
interosseous
Posterior

Recurrent
interosseous
artery

onatorteresmuscle(slipof insertion)

Posterior
interosseous
artery

Radius

Ulna

nerve
rnterosseous

pollicislongusm
Extensor

t o r p o l l i c i lso n g u sm u s c l e

Extensor
indicismuscle

pollicisbrevismuscle

Anterior interosseousartery (termination)

xtensorcarpiradialis
brevistendon
xtensorcarpiradialis
longustendon

Extensor
carpiulnaristendon(cut)

adialartery

Extensordigiti minimi tendon (cut)

Extensor
digitorumtendons(cut)

2'"

ir,
'&,

1st metacarpalbone

Nr
Plate 445

Extensor
retinaculum
(compartments
numbered)
5th metacarpal
bone

bone
2nd metacarpal
I st dorsal
muscle
interosseous

Elbow and Folearm

Muscles of Forearm (superficial Layerl: Anterior View


SeeahoPtaH 475,476

Medialantebrachial
cutaneous
nerve

Bicepsbrachii muscle

Ulnarnerve

Brachialartery and median nerve

Tricepsbrachiimuscle
Lateralantebrachialcutaneousnerve
(terminam
l u s c u l o c u t a n e o unse r v e )

septum
Medialintermuscular
B r a c h i a lm
i su s c l e

Ulnarartery
M e d i ael p i c o n d y loef h u m e r u s

B i c e p sb r a c h i it e n d o n

ommon flexor tendon

Radialartery

Pronatorteres muscle
B i c i p i t aal p o n e u r o s i s
Flexorcarpi
radialismuscle
Brachioradialm
isuscle

longus
Palmaris
muscle

Extensor
carpi
r a d i a l ilso n g u sm u s c l e

f
)
f

Superficial
flexor
muscles

Extensorcaroi
radialisbrevis muscle

F l e x opr o l l i c i lso n g u s
muscle and tendon

P a l m a r li o
s n g u st e n d o n
Radialartery

Median nerve

branch of ulnar nerve

artery and nerve

Palmarcarpal ligament
( c o n t i n u o u sw i t h

e x t e n s orre t i n a c u l u m )

T h e n am
r u

P a l m a ra p o n e u r o s i s

Elbow and Forearm

Pisiform

Palmarbranch of median nerve

Hypothenar muscles

4{tr
Pfate 446

Muscles of Forearm (lntermediate Layer|: Anterior View


Sceal$oPbba{ft4 {ru

Bicepsbrachiimuscle

Brachialis
muscle

U l n a rn e r v e

Median nerve

Brachial
artery
Lateralantebrachialcutaneousnerve (cut)

(frommusculocutaneous
nerve)

intermuscular
septum
Pronatorteresmuscle (humeralhead)
(cut and reflected)

Radialnerve
Deepbranch
Superficial
branch

Medial epicondyle
Flexorcarpi radialisand palmaris
longus tendons (cut)

Biceosbrachiitendon

Anteriorulnarrecurrentartery
Radialrecurrentarterv

Flexordigitorumsuperficialis
ae
r ad)
m u s c l e( h u m e r o u l n h
Radialartery
U l n a ra r t e r y
S u p i n a t omr u s c l e

Common interosseousarterv

Pronatorteresmuscle(ulnarhead)(cut)

B r a c h i o r a d i aml ius s c l e

Anteriorinterosseous
artery
Pronatorteresmuscle(cut

lexorcarpiulnarismuscle
or digitorumsuperficialis
muscle

Flexordigitorumsuperficialis
muscle(radialhead)

U l n a ra r t e r y
F l e x o rp o l l i c i sl o n g u sm u s c l e

Ulnarnerveanddorsalbranch
Median nerve

Palmar
of medianand ulnarnerves(cut)
branches
siform
Flexorcarpi radialis
tendon (cut)

Deeppalmarbranchof ulnarartery
anddeepbranchof ulnarnerve
Superficial
branchof ulnarnerve

palmarbranch
Superficial
of radialartery

Plate 447

Flexorretinaculum
(transverse
carpalligament)

Nr

Elbow and Forearm

Muscles of Forearm (Deep Layerf: Anterior View

B r a c h i a lm
i su s c l e

U l n a rn e r v e

M u s c u l o c u t a n e o unSe r v e
(becomes)
Lateralantebrachialcutaneousnerve

M e d i a nn e r v e
Brachialartery

septum
Lateralintermuscular

Medialintermuscular
septum

Radialnerve

Pronatorteresmuscle
(humeralheadcut and reflected)

Lateralepi

ulnarrecurrentartery

Bicepsbrachiitendon (cut)
'Medial

Radialrecurrentartery
Radialartery

epicondyle of humerus

Flexorcarpi radialis,
palmarislongus,
flexor digitorum superficialis
( h u m e r o u l n ahr e a d ) ,a n d
flexor carpi ulnaris
muscles(cut)

S u p i n a t o rm u s c l
Posteriorand anterior
i nterosseousarteries-

Posterior
ulnarrecurrentartery

Flexordigitorumsuperficialis
muscle (radialhead) (cut)

Ulnarartery
Pronatorteres muscle
(cut and reflected)

ommon Interosseousarterv

Radialartery

Flexorpollicislongus
muscleandtendon(cu

r e a d )( c u t )
t o r t e r e sm u s c l e( u l n a h
Median nerve (cut)

Flexordigitorumprofundusmuscle
Pronatorquadratusmuscle
B r a c h i o r a d i a l ti e
s n d o n( c u t )
Radialartery and

Anterior interosseousartery and nerve


U l n a r n e r v e a n d d o r s a lb r a n c h
Palmarcarpal branchesof radialand ulnar arteries

palmarbranch
superficial
Flexorcarpi ulnaristendon (cut)
F l e x o rp o l l i c i sl o n g u st e n d o n
Pisiform
Flexorcarpi radialistendon (cut)

A b d u c t o pr o l l i c i lso n g u s
Extensorpollicis brevistendon
l s t m e t a c a r o abl o n e

Elbow and Forearm

palmar branch of ulnar artery


and deeo branch of ulnar nerve
of hamate
5th metacarpalbone

Nr
Plate 44A

Forearm: Serial Gross Sections

l e x o rd i g i t o r u m
superficialis

M e d i a n a n t e b r a c h i avl e i n

m u s c l e( r a d i a lh e a d )
Pronatorteres muscle

Anterior branch of media


antebrachialcutaneousnerve

Radialarterv and superficialbranch of radial nerve

F l e x o rp o l l i c i sl o n g u sm u s c l e

Radius

Interosseousmembrane

B r a c h i o r a d i a lm
i su

Flexorcarpi radialismuscle

Cephalicvein and lateralantebrachial


cutaneousnerve (from musculocutaneous
nerve)
S u p i n a t o rm u s c l e

Ulnararteryand mediannerve
P a l m a r il so n g u sm u s c l e
Flexordigitorumsuperficialis
ae
r ad)
m u s c l e( h u m e r o u l n h

Deep branch of radial nerve

Commoninterosseous
artery

E x t e n s o cr a r p i r a d i a l i sl o n g u sm u s c l e

U l n a rn e r v e

Extensorcaroi radialisbrevismuscle

F l e x ocr a r o iu l n a r i m
s uscle

Extensordigitorum muscle

B a s i l i cv e i n

E x t e n s odr i e i t i m i n i m i m u s c l e

p r o f u n d um
s uscle
F l e x odr i g i t o r u m

E x t e n s ocra r p iu l n a r i m
s uscle

and antebrachialfascia
A n c o n e u sm u s c l e

F l e x ocr a r p ir a d i a l im
s uscle

Posterior
antebrachial
cutaneous

B r a c h i o r a d i a lm
i su s c l e

nerve (from radial nerve)

Radialartery and superficial


branch of radial nerve

P a l m a r i sl o n g u sm u s c l e

muscle
Flexordigitorumsuperficialis

F l e x o rp o l l i c i sl o n g u sm u s c l e

Median nerve

Extensorcaroi radialis
l o n g u sm u s c l ea n d t e n d o n

Ulnar artery and nerve


'lexorcarpi ulnarismuscle

Radiu

Anterior interosseousartery and nerve


(from median nerve)

E x t e n s ocr a r o i r a d i a l i s
b r e v i sm u s c l ea n d t e n d o n

F l e x o rd i g i t o r u mp r o f u n d u sm u s c l e
U l n a a n d a n t e b r a c h i af la s c i a

A b d u c t o pr o l l i c i lso n g u sm u s c l

In t e r o s s e o u m
s e m b r a n ea n d
e x t e n s o rp o l l i c i sl o n g u sm u s c l e

E x t e n s odri e i t o r u m
muscle
E x t e n s o dr i g i t im i n i m i m u s c l e

Posteriorinterosseousartery and nerve


(continuationof deep branch of radialnerve)

E x t e n s o cr a r p i u l n a r i sm u s c l e

P a l m a r i sl o n g u st e n d o n

F l e x o rc a r p i r a d i a l i st

Median nerve

Radialartery

digitorum superficialismuscle and tendons


Flexorcaroi ulnarismuscle and tendon

B r a c h i o r a d i a lti e
sndon

Ulnar artery and nerve

A b d u c t o pr o l l i c i sl o n g u s
S u p e r f i c i abl r a n c ho f r a d i a l

E x t e n s opro l l i c i sb r e v i st e n d o n
E x t e n s ocra r p ir a d i a l i s
l o n g u st e n d o n

Dorsalbranchof ulnarnerve
lexor digitorum profundus muscle and tendons
Antebrachialfascia

Ulna
t e n s o rc a r p i u l n a r i st e n d o n

Extensorcaroi radialisbrevis tendon

F l e x opr o l l i c i lso n g u sm u s c l e
E x t e n s o pr o l l i c i sl o n g u st e n d o n

*{ry
Plate 449

s embrane
P r o n a t o ro u a d r a t u sm u s c l ea n d i n t e r o s s e o um
E x t e n s o irn d i c i sm u s c l ea n d t e n d o n
E x t e n s o dr i g i t im i n i m i t e n d o n
E x t e n s odr i g i t o r u mt e n d o n s( c o m m o n t e n d o n
t o d i g i t s4 a n d 5 a t t h i s l e v e l )

Elbow and Forearm

Attachments of Muscles of Forearm: Anterior View

a c h i a l i sm u s c l e

B r a c h i o r a d i am
l iu
sscle
Extensor
longusmuscle
carpiradialis

Pronatorteresmuscle(humeralhead)

Supinator
Extensor
carpiradialisbrevis,
extensordigitorum,extensor
d i g i t im i n i m ie, x t e n s ocra r p i
ulnarim
s uscles
Brachialis
muscle
Flexordigitorumsuperficialis
muscle
( h u m e r o u l nh
ae
r ad)
B i c e p sb r a c h i im u s c

r ead)
t e r e sm u s c l e( u l n a h
S u p i n a t o rm u s c l e

Flexordigitorumsuperficialis
m u s c l e( r a d i ahl e a d ) -

Flexordigitorumprofundusmuscle

Pronatorteresmuscl
F l e x o rp o l l i c i sl o n g u sm

Pronatorquadratusmuscle
Pronatorquadratusmuscle

Note:Attachments
of intrinsic
musclesof handnot shown

B r a c h i o r a d i aml ius s c l e
A b d u c t o pr o l l i c i sl o n g u sm u s c l e

F l e x o rc a r o i u l n a r i sm u s c l e

Extensor
caroiulnarismuscle
Flexorcarpi radialis

Flexorpollicis
l o n g u sm u s c l e

Flexordigitorumsuperficialis
muscle

Flexordigitorum profundus muscle

Elbow and Forearm

origins

Insertions

Plate 45O

Attachments of Muscles of Forearm: Posterior View

Tricepsbrachii muscle (medial head)

Note: Attachmentsof intrinsic


musclesof hand not shown

Tricepsbrachii tendon
Supinator

F l e x ocr a r p iu l n a r i m
s u s c l e( h u m e r a l
origin via common flexor tendon

A n c o n e um
s uscle

s brachiimuscle

Flexorcarpi ulnarismuscle

p r o f u n d um
s uscle
F l e x odr i g i t o r u m

S u p i n a t o rm u s c l e

Abductorpollicislongusmuscle
r rigin)
E x t e n s ocra r p iu l n a r i m
s u s c l e( u l n a o
Pronatorteres muscle

Extensor
pollicislongusmuscle
pollicisbrevismuscle
Extensor
Extensorindicis

Extensorcarpi radialislongus muscle


B r a c h i o r a d i a lm
i su s c l e

Extensorcarpi radialisbrevismuscl

A b d u c t o pr o l l i c i sl o n g u sm u s c l e
Extensor
caroiulnarismuscle

Extensordigitorum muscle (centralbands)

E x t e n s o dr i g i t im i n i m i m u s c l e

Extensoroollicis brevis muscle

pollicislongusmuscle
Extensor

Extensor
indicismuscle
Extensordigitorum muscle (lateralbands)

Plate 451

origins

Insertions

4{ry
Elbow and Forearm

Garpal Bones

Anterior(palmar)view

Ulna
Radialstyloidproc

Ulnarstyloidprocess
Lunate

Tubercleof scaphoid

Triquetrum
Pisiform

Tubercleof trapeziu

Hamate
of hamate

pitate

Metacarpalbones

Posterior(dorsal)view

Dorsaltubercleof radius(Lister's)

Ulnarstyloid

Radialstyloidprocess
Trapezium
Trapezoid

Metacarpalbones

Wrist and Hand

4{tr
Plate 452

Movements of Wrist

-Ulna

-Ulna

Radius

: ,zLunare

Scaphoid

Triquetrum
Capitate

Scaphoid.

Trapezoid

Pisiform

Lunate

Capitate

Trapezium

Triquetrum

Trapezoid
Trapezium

Pisiform

Hamate
Metacarpal
Metacarpal
bones

00nes

Sesamoid
DOnes

P o s i t i o no f c a r p a l b o n e s w i t h h a n d i n a b d u c t i o n :
anterior (palmar)view

P o s i t i o no f c a r p a l b o n e s w i t h h a n d i n a d d u c t i o n :
anterior (palmar)view
) int
W r i s t ( r a d i o c a r p a jl o

Radius

M i d c a r p a lj o i n t
C a r p o m e t a c a r p aj ol i n l

Wrisl
(radiocarpal)
lornr
A r t i c u l a rd i s c
o f w r i s tj o i n t
L un a t e
Midcarpal
joint
aprtate
Carpometacarpal
JOrnt

) int
W r i s t ( r a d i o c a r p a jl o

3 r d m e t a c a r p abl o n e

M i d c a r p a jl o i n t
C a r p o m e t a c a r p aj ol i n t

Dorsum-)

f-Palm
Hand in
anatomical
position

Sagittal
sectionsthroughwrist and
middlefinger

Plate 453

Hand in
extension

4{v
Wrist and Hand

Ligaments of Wrist

Carpaltunnel:palmarview

Ulna

Radius

l n t e r o s s e o um
s embrane

P a l m a r i sl o n g u st e n d o n
P a l m a rc a r p a ll i g a m e n t
(thickeningof deep antebrachial
fascia)(cut and reflected)

Ulnar artery and nerve


Flexorcarpi ulnaristendon

Radialartery and
s u p e r f i c i apl a l m a rb r a n c h

F l e x o rd i g i t o r u m
profundustendons

Flexorcarpi radialistendon

Flexordigitorum
superficialistendons

F l e x o rp o l l i c i sl o n g u st e n d o n

Pisiform

M e d i a nn e r v e

Deep palmar branch of ulnar artery


a n d d e e p b r a n c ho f u l n a rn e r v e

P a l m a ra p o n e u r o s i s
Tubercleof scaphoid

Hook of hamate
Tubercleof trapezium
Flexorretinaculum
(transversecarpal ligament)

Flexorretinaculumremoved:
palmarview

S h o r tr a d i o l u n a t el i g a m e n t
P a l m a rr a d i o l u n a t el i g a m e n t
L o n g r a d i o l u n a t el ig a m e n t
U l n o l u n a t el i g a m e n t
R a d i o s c a p h o c a p i t altieg a m e n t
U l n o c a p i t a t el i g a m e n t
Scaphotrapeziotrapezoidligament

Ulnotriquetralligament

Scaphocapitateligment

Lunotriquetralligament

Trapeziotrapezoidligament

Triquetrohamateligament
Triquetrocapitateligament

Capitohamateligament
Trapeziocapitate
ligament

Metacarpalbones

Wrist and Hand

Plate 454

Ligaments of Wrist (continuedl

Posterior(dorsal)view
Dorsal radial metaphysealarcuateligament
Dorsal radiocarpalligament
D o r s a lr a d i o u l n a lri g a m e n t
U l n o t r i q u e t r alli g a m e n t( d o r s a vl i e w )

S c a p h o l u n a t lei g a m e n t

Triquetrohamateligament

Trapeziotrapezoidligament

D o r s a li n t e r c a r p alli g a m e n t
Trapeziocapitateligament

C a p i t o h a m a t el i g a m e n t

Metacarpalbones

Coronal section: dorsal view


Ulna

Radius

D i s t arl a d i o u l n aj or i n t

Lunate

joint
Wrist(radiocarpal)

A r t i c u l adr i s co f w r i s tl o i n t

Scaphoid

Meniscus

M i d c a r p a lj o i n t
Trapezoid

I n t e r o s s e o uisn t e r c a r p alli g a m e n

Trapezium

Triquetrum

Carpometacarpaljoint

Hamate

ntermetacarpaljoints

Capitate

4{tr
6(a4*/*
Metacarpalbones

Plate 455

Wrist and Hand

Bones of Wrist and Hand

saseI

Shafts)
Head J

Metacarpalbones

Righthand:
anterior(palmar)view

gase I

Proximal
Phalanges

nXf f
oaseI
n'jf

Middlephalanges

Lunate

Carpal
bones

\
-.-scaphoid \
Capitate

Carpalbones {

Metacarpalbones (

phalanges{
Proximal
Riehthand:
(dorsal)view
po-sterior
Middle phalanges{

Wrist and Hand

Trapezoid
Trapezium

Triquetrum
Hamate
l.

1' a"r"

Shafts
I Head

Base
Shafts
I Head

f ert"

Shafts
I Head

Plate 456

Wrist and Hand: Anteroposterior Radiograph


Seealso

BM
BP
C
DP

Baseof 5th metacaroal


Baseof 4th proximal phalanx
Capitate
Distal phalanxof thumo

DPR Distal phalanx of ring finger


H
Hamate
HH
Hook of hamate
HM
Head of 5th metacaroal
HP

Plate 457

H e a d o f p r o x i m a lp h a l a n x
Lunate

M
MP

Metacarpalof index finger


Middle phalanxof middle finger

P
PP
PPI
R
S
SH
SP
SPR
T
TP
TZ
U

Pisiform
Proximalphalanxof thumb
Proximalphalanxof indexfinger
Radius
Scaphoid
Shaftof 5th metacarpal
Styloidprocessof ulna
Styloidprocessof radius
Triquetrum
Trapezoid
Trapezium
Ulna

Wrist and Hand

Metacarpophalangeal and lnterphalangeal Ligaments

form

Anterior (palmar)view

of hamate
Trapezium
mar carpometacarpalligaments
Palmarmetacarpalligaments

J o i n tc a p s u l e

Deeptransverse
ligaments
metacarpal

CollateralIigam

Palmarligaments
(plates)

Cut marginsof
digitalfibrousshea

Flexordigitorum
suoerficialistendons (cut)
Flexordigitorum profundustendons

M e t a c a r p o p h a l a n g(eMaPl )i o i n t
collateral proximal interphalangeal(plp) joint
Accesso.ry
7

ligament
Truecollateral
ligament

Metacarpalbone

Distal interphalangeal
( D l P )j o i n t

ln extension:
medialview
Palmarsurface

Proximal

Middle

Palmarligament (volarplate

Accessory
collateral
ligament

In flexion:
medialview

Phalanges

True collateralligament
Palmarligament(volarplate)

4{tr

Note: Ligamentsof metacarpophalangeal


and inteiphalangealjoints are similar

Wrist and Hand

Plate 458

Wrist and Hand: Superficial Palmar Dissections

Palmarislongustendon

Palmarbranch of ulnar nerve

Branchof superficial
radial nerve to skin of
lateralthenar area

Pisiform
Deep palmar branch of ulnar artery and deep
branch of ulnar nerve

P a l m a rc a r p a ll i g a m e n t
( t h i c k e n i n go f d e e p
antebrachialfascia
c o n t i n u o u sw i t h
extensorretinaculum)

Superficial
branchof ulnarnerve
U l n a ra r t e r y
Palmaris
brevismuscle

Palmarbranch of
m e d i a nn e r v e

Hypothenar
muscles

T h e n a rm u s c l e s

Palmar
aponeurosis

Recurrent
(motor)
branch of
median
nerve to
thenar

muscres

Palmarisbrevis
muscle (reflected)

Minute fasciculi
attach palmar
a p o n e u r o s i st o d e r m i s

Anterior (palmar)views

Palmardigital
nervesfrom
superficial
branch of ulnar
nerve to 5th and
medial half of
4th fingers

Palmaraponeurosis

Transversefasciculi

Palmardigital arteriesand nerves

Superficialtransversemetacarpalli

*{ry
Plate 459

Wrist and Hand

Wrist and Hand: Deeper Palmar Dissections


Radialartery and venae comitantes

Ulnar artery with venae comitantesand ulnar nerve

Flexorcarpi radialistendon

Flexorcarpi ulnaristendon

T e n d i n o u ss h e a t ho f
flexor pollicislongus

C o m m o n f l e x o rs h e a t h( u l n a rb u r s a )c o n t a i n i n g
superficialisand profundusflexor tendons

( r a d i abl u r s a )

Pisiform

Median nerve
P a l m a r i sl o n g u st e n d o n a n d
p a l m a rc a r p a ll i g a m e n l
Transversecarpal

Deep palmar branch of ulnar artery and deep


branch of ulnar nerve
Superficialbranch of ulnar nerve
Palmardigital nervesto 5th finger and
medial half of 4th finger

ligament(flexor
retinaculum)

n nerve

T h e n am
r uscles
Properpalmar

Commonflexorsheath(ulnarbursa)

digital nerves
of thumb-

palmararterialandvenousarches
Superficial
2nd.3rd.and4th lumbricalmuscles(in fascialsheaths)

(Synovial)
tendinous

(Synovial)
of fingers
flexortendonsheaths

sheathof flex
p o l l i c i sl o n g u s
(radialbursa)
P r o b ei n I s t
lumbrical

Superficial
palmarbranch
of radialartery
and recurrent
branchof
mediannerve
to thenar
muscles

fascial
Common palmar
digital

Properpalmar
digitalarteries
Septafrom.palmar
a p o n e u r o srrosr m r n g
Palmaraponeurosis
(reflected)

Anterior(palmar)views

Ulnarartery
ano nerve
Common palmar
digital branches
of median nerve (cut)

muscles
Proper palmar digital nervesof
Fasciaover adductor oollicismuscl

l s t d o r s ailn t e r o s s e o m
u su s c l e

s h e a t h( u l n a r
bursa)
5th finger
(synovial)
t e n d i n o ussh e a t h

Probein dorsalextension
of thenar
space deep to adductor pollicis

Probein
midpalmarspace

Thenarspace (deep to flexor tendons

'l
and st lumbricalmuscle

Septum separatingthenar from midpalmarspace


C o m m o n p a l m a rd i g i t a l
Proper palmar digital arteriesand
Annular and cruciform oartsof fibrous sheath
over (synovial)flexor tendon sheaths

Wrist and Hand

M i d p a l m asrp a c e
(deepto flexor
tendonsand
l u m b r i c aml u s c l e s )
Insertionof
flexor digitorum
superficialistendon
lnsertionof flexor digitorum
profundustendon

Plate 460

Flexor Tendons, Arteries, and Nerves at Wrist


Palmar view
Flexordigitorumsuperficialis
t e n d o n sa n d
flexordigitorumprofundus
tendons
Commonflexorsheath
( u l n ab
r ursa)

P a l m a r i sl o n g u st e n d o n
Median nerve
Radialartery
Flexorcarpi radialis
tendon

F l e x opr o l l i c i lso n g u s
t e n d o ni n t e n d o n
sheath(radialbursa)

Ulnarartery
U l n a rn e r v e
F l e x ocr a r p iu l n a r i s
tendon

Palmarcarpal ligament (reflec


(Synovial)tendon sheath

Pisiform

Flexorretinaculum(transverse
carpalligament)
Trapezium

A b d u c t o rd i g i t im i n i m i m u s c l e

1st metacarpalbone
Flexordigiti minimi brevis muscle

s uscle
Opponenp
s ollicim
Abductorpollicis
b r e v i sm u s c l e

O p p o n e n sd i g i t i m i n i m i m u s c l e

(reflec

Superficialpalmar (arterial)arch

u m b r i c am
l uscles

Flexorpollicis
b r e v i sm u s c l e

4{tr

A d d u c t o r o o l l i c i sm u s c r e

(reflected)

Transverse
crosssectionof wrist demonstratingcarpaltunnel
Palmarislongus
tendon

Flexorretinaculum(transverse
carpalligament)

Median nerve*
Ulnar artery
and nerve
Flexorcarpi

u l n a r i tse n d o n
Flexor
digitorum
superficialis
tendons'

Flexorcarpi
radialistendon

Flexor
digitorum
profundus
tendons*

Flexorpollicis
longustendon
in tendonsheath*
Radialartery

Trapezium
S i m p l em e t h o d o f d e m o n s t r a t i n g
arrangementof flexor
di gitorum superficialis
tendonswithin carpaltunnel

Plate 461

Capitate

Trapezoid
*Contentsof carpal tunnel

Wrist and Hand

Bursae, Spaces, and Tendon Sheaths of Hand

muscle
Pronatorquadratus
Flexorcarpiradialis
tendon
Common
flexorsheath
(ulnarbursa)

Tendinous
sheathof flexorpollicislongus(radialbursa
Flexorretinaculum(transverse
carpalligament)(reflectedl
Flexordigitorumprofundus
Tendinous
sheathof flexorpollicis
longus(radialbursa)
Fascia
of adductorpollicismuscle

Flexordigitorum
tendons
superficialis

Thenarspace
(deepto flexortendon
and1stlumbrical
muscle

Commonflexorsheath
(ulnarbursa)(opened)
Lumbricalmusclesin
fascialsheaths

(Synovial)
tendon
sheathof finger

Midpalmar space
(deepto flexortendons
and lumbricalmuscles)

Lumbricalmusclesin fascialsheaths
(cutand

Fibrousand synovial(tendon)
sheathsof finger(opened)

Annularand cruciformparts
(pulleys)
of fibroussheathover
synovialsheath)of finger

4{ffi*

Flexordigitorumsuperficialis
tendon
Flexordigitorumprofundus
tendon

Midpalmarspace

Palmaraponeurosis

Septaformingcanals
flexortendonsto 3rd diSit
and superficialis
Profundus
and thenarspaces
Septumbetweenmidpalmar

Thenarspace
Commonpalmardigital
arteryand nerve\

Flexorpollicislongus
tendonin tendon
sheath(radialbursa)

Lumbricalmuscle
in its fascialsheath

pollicis
Extensor
longustendon

Flexortendonsto 5th
digitin commonflexor
sheath(ulnarbur
Hypothenarmuscles
Dorsalinterosseous
fascia
Dorsalsubaponeurotic
space
Dorsalfasciaof hand
Dorsalsubcutaneous
space

Wrist and Hand

Adductorpollicismuscle
fascia
Palmarinterosseous
muscles
Palmarinterosseous
muscles
Dorsalinterosseous
Extensortendons

Plate 462

Lumbrical Muscles and Bursae,Spaces,and Sheaths:Schema


Usualarrangement

Commonvariation

Tendinoussheathof flexor
p o l l i c i sl o n g u s( r a d i a lb u r s a )
Intermediatebursa
(communication
between common
flexor sheath Iulnar
b u r s a la n d t e n d i n o u s
sheathof flexor pollicis
l o n g u sI r a d i a lb u r s a ] )

Common flexor sheath

( u l n ab
r ursa)

Thenar

L u m b r i c aml u s c l e s
(in fascialsheaths)
J

( S y n o v i a lt)e n d o n
s h e a t h so f f i n g e r s

[umbricalmuscles:
schema

Flexordigitorum
profundustendons

1 s t a n d 2 n d l u m b r i c a lm u s c r e s
(unipennate)

3rd and 4th lumbricalmuscles


(bipennate)

C a m p e rc h i a s m

N o t e : F l e x o rd i g i t o r u ms u p e r f i c i a l iasn d
p r o f u n d u st e n d o n se n c a s e di n s y n o v i a l
s h e a t h sa r e b o u n d t o p h a l a n g e sb y f i b r o u s
digital sheathsmade up of alternating
s t r o n ga n n u l a r( A ) a n d w e a k e rc r u c i f o r m( C )
p a r t s( p u l l e y s ) .
41

Flexordigitorum
s u p e r f i c i a l itse n d o n s( c u t )

Cl

C2

A3

C3

C4

n)

Tendonsof
flexor digitorum
superficiali

a n dp r o f u n d u s /i
muscres
,i

tendon sheath

Plate 463

a l m a rl i g a m e n t s( p l a t e s

4{tr
Wrist and Hand

Flexor and Extensor Tendons in Fingers

Long extensor
Extensor
expansron tendon
(hood)

lnsertionof central band of extensor


tendon to base of middle phalanx

S l i p so f l o n g
extensortendon
to lateral

T r i a n g u l aarp o n e u r o s i s

lnterosseous
muscles

Posterior
(dorsal)
vtew

Metacarpal
bone

Insertionon extensortendon

lnterosseous
t e n d o ns l i p
to lateralband

to baseof distalphalanx
Lateralbands

Lumbricalmuscle

(hood)
Extensor
expansion

Lateralband

Insertionof extensortendon

to baseof middlephalan

tendon
Partof interosseous
passes
to baseof proximal
phalanxandjoint capsule

Long extensortendon

Centralband

-1S

Insertionof extensor
tendon to base

o f d i s t apl h a l a n x

Metacarpalbone

Fingerin
extension:
lateralview
Collateral
ligament

Vinculum
oreve

Flexordigitorum
orofundustendon

Vincula
longa

Flexordigitorum
superficialistendon

Insertionof smalldeepslipof extensor


x n dj o i n tc a p s u l e
t e n d o nt o p r o x i m apl h a l a n a

muscles
lnterosseous
Lumbricalmuscle

.-,

Attachment of interosseousmuscle to
base of proximal phalanxand joint capsule

)>

,4

aa
Insertionof lumbrical

muscleto extensor

/,

Palmarligament(plate)
Flexordigitorum
superficialis
tendon(cut)

muscles
lnterosseous
Lumbrical
muscle

ligaments
Collateral
Flexordigitorum

profundustendon(cut)
Palmarligament(plate)

c44e/^

Wrist and Hand

Note: Blackarrows indicate


pull of long extensortendon;
red arrows indicatepull
of interosseousand
lumbrical muscles;dots
indicate axis of
rotation of ioints

Pfate 464

lntrinsic Muscles of Hand

Radialartery and palmar carpal br

Pronatorouadratusmuscle

U l n a rn e r v e

Radius

ar artery and palmar carpal branch

Superficialpalmar branch of radial

c a r o iu l n a r i st e n d o n

Flexorretinaculum(transverse
carpal ligament)(reflected)

Palmarcaroalarterialarch

Opponenp
s o l l i c i sm u s c l e

l'rsrlorm
Median nerve

Branchesof median nerve


t o t h e n a rm u s c l e sa n d t o 1 s t
a n d 2 n d l u m b r i c a lm u s c l e s

A b d u c t o r d i g i t im i n i m i m u s c l e( c u t )

D e e pp a l m a br r a n c ho f u l n a ra r t e r y
and deeobranchof ulnarnerve

A b d u c t o rp o l l i c i s

brevismuscle(cut

F l e x o rd i g i t im i n i m i b r e v i sm u s c l e( c u t )

F l e x opr o l l i c i s

O p p o n e n sd i g i t i m i n i m i m u s c l e

brevis muscle

Deep palmar (arterial)arch

A d d u c t o rp o l l i c i s

muscle

Palmarmetacarpalarteries
Common palmar digital arteries

lst dorsal

interosseous
muscle

Deep transversemetacarpalligaments

Branches
from deep
branch of ulnar nerve
to 3rd and 4th lumbrical
musclesand to all
interosseousmuscles

Anterior(palmar)view
Lumbrical
muscles(reflec

Palmarinterosseous
m u s c l e(su n i o e n n a t e
Deep transverse
metacarpalligaments

Radialartery

A b d u c t o rd i g i t i
m i n i m im u s c l e

A b d u c t o pr o l l i c i s
brevismuscle
Dorsalinterosseous
m u s c l e(sb i p e n n a t e )

T e n d i n o ussl i p s
to extensor
expansrons
(hoods)

Cryd4*/*
Posterior
(dorsal)view
Note: Arrows indicateaction of muscles.

Plate 465

Wrist and Hand

Arteries and Nerves of Hand: Palmar Views

Radialartery

Ulnar artery and nerve


P a l m a rc a r p a ll i g a m e n t( c o n t i n u o u s
w i t h e x t e n s o rr e t i n a c u l u m )

M e d i a n n e r v ea n d o a l m a rb r a
S u p e r f i c i apl a l m a rb r a n c ho f r a d i a la r t e r

Flexorretinaculum(transverse
c a r p a ll i g a m e n t )

A b d u c t o r p o l l i c i sb r e v i sm u s c l e( c u t )

D e e p p a l m a rb r a n c ho f u l n a ra r t e r y
and deep branch of ulnar nerve

O p p o n e n sp o l l i c i sm u s c l e

Suoerficialbranch of ulnar nerve


F l e x o ro o l l i c i sb r e v i sm u s c r e
Common flexor sheath
( u l n a rb u r s a )

Recurrent(motor) branch of
median nerve to thenar mu

palmar (arterial)arch

Proper digital nerves


a n d a r t e r i e st o t h u m b

o m m o n p a l m a rd i g i t a ln e r v e s
and arteries

A d d u c t o r p o l l i c i sm u s c l e

Communicatingbranch of
median nerve with ulnar nerve
Proper palmar digital nerves
and arteries

Branchesof median nerve to


l s t a n d 2 n d l u m b r i c a lm u s c l e s
Flexortendons,

ovial

and fibrous

Branchesof proper palmar


digital nervesand
arteriesto dorsum of
middle and distal
phalanges

Ulnar artery and nerve


Radial

Palmarcarpal branchesof
radialand ulnar arteries

M e d i a nn e r

Pisiform

Superficialpalmar branch of radialarter


D e e p p a l m a r( a r t e r i a la) r c h a n d
d e e o b r a n c ho f u l n a rn e r v e
P r i n c e p sp o l l i c i sa r t e r y

Deep palmar branch of


u l n a ra r t e r ya n d d e e p
branch of ulnar nerve
Branchesto hypothenar
muSctes
Superficialbranch of
u l n a rn e r v e
Hook of hamate

D i s t a ll i m i t o f
s u p e r f i c i apl a l m a ra r c h
R a d i a l i si n d i c i s
Palmarmetacaroalarteries
Common palnrardigital arteri
Proper palmar digital arter
Proper palmar digital nervesfrom median nerve

Wrist and Hand

Deep palmar branch of


u l n a rn e r v et o 3 r d a n d
4 t h l u m b r i c a l a, l l
interosseous,adductor
p o l l i c i s a, n d d e e p h e a d
of flexor pollicis brevis
muscles
ing branch
of median nerve with
u l n a rn e r v e
Proper palmar digital
nervesfrom ulnar nerve

Plate 466

Wrist and Hand: Superficial Radial Dissection

lateral (radial)view
branch of radial nerve

Extensor
retinaculum

M e d i ab
l ranch
Lateralbranch
Dorsal digital branchesof radial nerve

Dorsal carpal branch

of radialartery

Scaphoid
Radialartery in anatomicalsnuffbox

Extensorcarpi
r a d i a l i sb r e v i s
tendon

Trapezium

Extensor
carpi
r a d i a l ilso n g u s

lnsertionof abductor
p o l l i c i sl o n g u st e n d o n

tendon
l s t m e t a c a r p abl o n e
Radialartery

1 s td o r s ailn t e r o s s e o u
msu s c l

Insertionof extensor
pollicisbrevis tendon

nsertionof extensor
p o l l i c i sl o n g u st e n d o n
Deep fascia(cut

Fractureof middle
third (waist)of
scaphoid(most
common)

4{F
Plate 467

Wrist and Hand

Wrist and Hand: Superficial Dorsal Dissection

Posterior(dorsal)view
cutaneous
Posterior
antebrachial
nerve(from radialnerve)

branchof radialnerve
Superficial
(thickening
retinaculum
Extensor
fascia)
of posteriorantebrachial
of
branches
Communicating
radialand ulnarnerves

Dorsalbranchof ulnar
Dorsalvenous
network of

Dorsalmetacarpalveins

Probein dorsal
space
subaponeurotic
(betweenopened
dorsalfasciaof handand
dorsalinterosseous
fascia)
Intercapitular
veins
Dorsaldigitalnervesand

Dorsalbranches
of
properpalmardigitaln

4{tr
pathwaysshownin black;
Note:Lymphatic
arrowsindicatedirectionof drainage

Wrist and Hand

Plate 468

Wrist and Hand: Deep Dorsal Dissection

M e d i a la n t e b r a c h i a l
cutaneousnerve

Lateralantebrachlalcutaneousnerve
(terminalpart of musculocutaneousnerve)

Posteriorantebrachial
culaneous nerve
(branch of radial nerve

Suoerficialbranch of radial nerve

Extensordigitorum, extensordigiti minimi,


and extensorindicistendons (cut)

Extensor
retinaculum
Radialartery in anatomicalsnuffbox

Dorsalbranchof ulnar
Abductorpollicislongustendon
pollicisbrevistendon
Extensor

Dorsal carpal branch


of ulnar artery

e n s o rp o l l i c i sl o n g u st e n d o n
Extensorcarpi radialislongus
tendon
Extensorcarpi radialisbrevis
tendon

Extensorcarpi ulnaris

Dorsal carpal (arterial)

Dorsaldigitalarteries

Dorsal metacarpalarteries

Dorsal digital branches


of dorsal branch
o f u l n a rn e r v e

Dorsal digital branchesof superficial


'lst,2nd,
branch of radial nerve to
3rd, and radial half of 4th fingers
Dorsal branchesof proper
p a l m a rd i g i t a lb r a n c h e s
of ulnar nerve and of
p r o p e r p a l m a rd i g i t a l
arteriesto dorsum
o f m i d d l ea n d
distal phalangesof
5 t h a n d u l n a rh a l f
of 4th fingers

4ttr
Plate 469

Posterior(dorsal)view
Dorsalbranches
of properpalmardigital
branches
of mediannerveand of
properpalmardigitalarteriesto
d o r s u mo f m i d d l ea n dd i s t apl h a l a n g e s
o f 2 n d , 3 r d a, n dr a d i ahl a l fo f 5 t h
fingers

Wrist and Hand

Extensor Tendons at Wrist

Posterior(dorsal)view
Extensor
carpiulnaris- Compartment6
Extensor
digitiminimi- Compartment5

Extensor
9'qlt:"t I co.partment+
indicis I
Extensor
xtensorpollicislongus- Compartment3
---: --;:-:.-,- Compartment2
longus |)
r carprraoralrs
Abductorpollicislongus)
comPartment1
pollicisbrevis i
Extensor

Planeof crosssection

shownbelow
Extensor
retinaculum

snuffbox
Radialarteryin anatomical
A b d u c t odr i g i t i
m i n i m im u s c l e

l n t e r t e n d i n o u cs o n n e c t i o n s

Transverse
fibersof
(hoods)
extensorexpansions

Crosssectionof most distalportion of forearm


Extensor
retinaculum
ComRartment
+

{ extensorindicis

c o m 'p a r t m e n t s I E l t g l s o . r .
(

pollicislongus- Compartment3
Extensor

E x t e n s odri g i t o r u m
and

olSltl mlnlml

carpi
Extensor
radialisbrevis
carpi
Extensor
r a d i a l ilso n g u s

Compartment2

{ Extensor
Compartment5 J carpi
( ulnaris

Wrist and l{and

Plate 47O

Fingers

Svnovialmembrane
Articularcartilage

Sagittalsection

Eponychium
(cuticle)
Lunule
Flexor
digitorum
superficialis
tendon

Bodyof nail

Distalphalanx

Nerves

Arteries

\--------

Septa
--___--t

v
Distalanteriorclosedspace(pulp)

tendon
sheathof finger
Synovial(flexortendon)
sheathof finger
Flexordigitorumprofundustendon
Palmarligament(plate)
Articularcavity
Bodyof nail

Crosssection
throush distal
phalaix

Subungual
space

Nailbed

Minutearteries

Distalphalanx

Fine nerves

Fibrousseptaand areolar
tissuein anterior
closedspace(pulp)

Dorsaldigitalarteryand nerve

Dorsalbranches
of properpalmar
digitalarteriesand nervesto dorsum
of middleandterminalphalanges

Arteriesand nerves

4{tr
Nutrientbranchto epiphysis
Nutrientbranches
to metaphysis

Plate 471

Properpalmardigitalartery
t o n e i g h b o r i ndgi g i t

Properpalmardigitalarteryand nervti

Wrist and Hand

Gutaneous lnnervation of Wrist and Hand

A n t e r i o r ( p a l m a r )v i e w

nadial S u p e r f i c i a l
nerve J branch
t

Ulnar nerve

Palmar
digital
branches

Median
nerve

Palmar
branch

Posterior(dorsal)view

Palmar
digital
branches

M usculocutaneous
nerye

Medial an

cutaneousnerve
D i v i s i o nb e t w e e n u l n a ra n d r a d i a l
n e r v ei n n e r v a t i o no n d o r s u mo f
handisvariable.

Dorsal
branch
ano
dorsal
digital

Superficial
branch
ano
dorsal
digital
branches

Dranc

Nr
Neurovasculature

Proper
palmar
digital
branches

Proper
palmar
digital
branches

Median
nerve

Plate 472

Arteries and Nerves of Upper Limb

Anteriorview
D e l t o i dm u s c l e
C o r a c o b r a c h i a l im
s uscle
Intercostobrachial nerve
M e d i a lb r a c h i a l
cutaneousnerve

M u s c u l o c u t a n e o uns
B r a c h i a l im
s uscle

Radialnerve

B i c e p sb r a c h i im u s c l e( c u t )a n d t e n d o n

U l n a rn e r v e

Lateralantebrachialcutaneousnerve
(from musculocutaneousner

Radialnerve

Medial antebrachial
cutaneousnerve

oeeobranch-1
J
branch
I Superficial

Median nerve
Brachialartery

S u p i n a t o rm u s c l e

Bicipitalaponeurosis

B r a c h i o r a d i a lm
i su s c l
Radialartery
Pronator teres muscle (partially cut
Median nerve

Flexorcarpi radialismuscle (cut)

F l e x o rp o l l i c i sl o n g u s
Flexorcarpi radialis
tendon (cut)
F l e x o rr e t i n a c u l u m
(transversecarpal
ligament)
S u p e r f i c i abl r a n c h
of radial nerve
R e c u r r e n (t m o t o r )
branch of
median nerve to

Flexordigitorum profundus muscle


F l e x o rc a r p i u l n a r i sm u s c l e
U l n a r a r t e r ya n d n e r v e
D o r s a lb r a n c ho f u l n a rn e r v e
F l e x o rd i g i t o r u ms u p e r f i c i a l itse n d o n s( c u t )

t h e n am
r uscles
D e e p p a l m a rb r a n c ho f u l n a ra r t e r ya n d d e e p b r a n c ho f u l n a rn e r v e
S u p e r f i c i abl r a n c ho f u l n a rn e r v e
S u p e r f i c i apl a l m a ra r c h ( c u t )
Common palmar
digital branches
of median nerve

P r o p e rp a l m a r
digitialbranches
of median nerve

Plate 473

C o m m o n p a l m a rd i g i t a lb r a n c ho f u l n a rn e r v e
C o m m u n i c a t i n gb r a n c ho f m e d i a nn e r v ew i t h u l n a rn e r v e
P r o p e rp a l m a rd i g i t a lb r a n c h e so f u l n a rn e r v e

4{tr

Neurovasculature

Musculocutaneous Nerve

Anteriorview
Note: Only musclesinnervated
by musculocutaneous
nerve snown

Musculocutaneous
nerve(C5,6,7)
1 i e d i a l ) Cordsof
. Posterior) brachial
Lateral ) p r e x u s
Coracobrachialismuscle

Medialbrachial
nerve
cutaneous
Bicepsbrachiimuscle
(retracted\

Medial antebrachial
cutaneousnerve

Ulnarnerve

Nr

Median nerve
Radialnerve

Brachialis
muscle

Axillarynerve

Articularbr

Anterior branch

Posterior
bra

Cutaneous
innervation
(via lateral
antebrachial
cutaneous
nerve)
Anterior (palmar)view

Neurovasculatune

Posterior(dorsal)view

Plate 474

Median Nerve
Anterior view

Note:Onlv musclesinnervated
by mediannerveshown

Musculocutaneous
nerve
Mediannerve(C5,6,7, 8,T1
Medial
Posterior

lnconstantcontribution

Lateral

Cordsof
brachial
prexus

Pronatorteresmuscle(humeral
Medialbrachial
cutaneous
nerve
Articularbranch
Medialantebrachial
nerve
cutaneous
Flexorcaroi radialismuscre
Axillarynerve

Palmaris
longusmuscle

Radial nerve

Pronatorteresmuscle(ulnarhead)

Nr

Ulnarnerve

Flexordigitorumsuperficialis
muscle
(turnedupl
Flexordigitorumprofundusmuscle
(lateralpartsuppliedby median
nerve;
[anteriorinterosseous]
medialpartsuppliedby ulnarnerve)
Anterior interosseousnerve

Flexorpollicislongusmuscle
Pronatorquadratus
muscle
Palmarbranchof mediannerve

Thenar
muscles

Abductoroollicisbrevis
Opponenp
s ollicis
Superficial
headof
flexorpollicisbrevis
(deephead
suppliedby
u l n a rn e r v e )

1st and 2nd


lumbricalmuscles

Palmar view
C o m m u n i c a t i nbgr a n c h
of mediannervewith
ulnarnerve
Commonoalmar
digitalnerves

Dorsalbranches
to
dorsumof middleand
distalphalanges

Properpalmar
digitalnerves

Posterior(dorsal)view

Plate 475

Neurovasculature

Ulnar Nerve

Anterior view

Note:Only musclesinnervated
bv ulnarnerveshown
Ulnar nerve(C7,8,T11
(no branchesaboveelbow)
tnconstantcontribution

Medialepicondyle
branch
(behindcondyle)
digitorumprofundus
muscle(medialpart only;
lateralpart suppliedby
anteriorinterosseous
branchof mediannerve)

Palmarview

Flexorcarpiulnarismuscle
(drawn aside)

I branchof ulnarnerve

Palmarbranch
Flexorpollicisbrevismusclel
(deepheadonly;superficial\
headand otherthenarmuscles
suppliedby mediannerve)

Adductorpollicis

Abductordigitiminimi
Flexordigitiminimibrevis
Opponensdigitiminimi

Hypothenar
muscles

Commonpalmardigitalnerve
branchof mediannervewith
Communicating
ulnarnerve
muscles
Palmarand dorsalinterosseous
3rd and 4th lumbricalmuscles(turneddownl

4{r
Neurovasculatule

Properpalmardigitalnerves
(doisaldigitalnervesarefrom dorsalbranch)
to dorsumof middleanddistalphalanges
branches

Plate 476l

Radial Nerve in Arm and Nerves of Posterior Shoulder

scapularnerve(C5)
S u p r a s p i n a tm
u su s c l e
pular nerve(C5,6)
Levatorscapulae
muscle(supplied
alsobv branches
from C3 and C4

Deltoidmuscle
Teresminormuscle
Axillary nerve(C5, 6)
Superiorlateralbrachial
nerve
cutaneous

Rhomboid
m i n o rm u s c l e

Radialnerve
( c 5 ,6 , 7 , 8 , T 1 )
lnconstantcontribution

Rhomboid
majormuscle

lnferiorlateralbrachial
nerve
cutaneous

Posteriorantebrachial
nerve
cutaneous
Infraspinatus
muscld
Teresmajormuscld
Lowersubscapularnerve(C5, 6)
Posteriorbrachialcutaneousnerve
(branchof radial nerve in axilla)

Long head

Tricepsbrachiimuscle

Lateralintermuscular
septum

Brachialis
muscle(lateral
part;remainder
of muscle
suppliedby musculonerve)
cutaneous

Lateral
Medial
Brachioradialis
muscle

Tricepsbrachii
Medial epicondyle

Extensor
carpiradialis
longusmuscle

Olecr
Anconeus
Extensor
digitorum
Extensor
carpiulnaris

Pfate 477

Neurovasculature

Radial Nerve in Foreatm

Radialnerve(C5,6, Z8,T1l

I nconstantcontribution

(terminal)
Superficial
branch
Deep (terminal)branch

Posteriorview

Lateralepicondyle

A n c o n e um
s uscle
B r a c h i o r a d i aml ius s c l e
Extensorcarpi radialislongus muscle
S u p i n a t o rm u s c l e

xtensorcarpiradialisbrevismuscle
Extensor
caroiulnarismuscle

Extensor-supinator
groupof muscles

Extensor
digitorummuscleand
extensordigitiminimimuscle
Extensor
indicismuscle
pollicislongusmuscle
Extensor
Abductorpollicislongusmuscle
Extensorpollicis brevis muscle

4{tr

Posterior
i nterosseous
nerve
(continuation
of deepbranchof
radialnervedistalto supinatormuscle)
Suoerficial
branchof radialnerve

Fromaxillarynerve

Superiorlateral
brachialcutaneous
nerve

lnferiorlateral
brachialcutaneous
nerve

Posterior
brachial
cutaneousnel
From radial nerve

Posterior
antebrachial

cutaneousnerve
Superficialbranch of
radialnerve and dorsal
digital branches

Dorsaldigitalnerves
Cutaneousinnervationfrom
radialand axillarynerves

Neurovasculature

Plate 478

GutaneousNervesand SuperficialVeinsof Shoulderand Arm

Posteriorview

Anterior view

Supraclavicular
nerves
(fromcervicalplexus)

Lateralsupraclavicular
nerve

Medial

lntermediate
Lateral

branchof

Acromialbranches
of
thoracoacromial
vein

Superficial
branches
of
posterior
circumflex
humeralvein
Intercosto
brachialnerve
Medialbrachial
cutaneous
nerve

Superiorlateral
brachialcutaneous
nerve(from

Superiorlateral
brachial
cutaneous
nerve
(fromaxillary
nerve)

axillarynerve)

Cephalic

Posterior
brachial
nerve
cutaneous
(from radialnerve)

Inferiorlateral
brachialcutaneous
nerve(from
radialnerve)

Inferiorlateral
brachialcutaneous
nerve(from
radialnerve)

Posterior
antebrachial
cutaneous
nerve(from
radialnerve)
Accessory

Posterior
antebrachial
cutaneous
nerve
(fromradial
nerve)

Branches
of medial
antebrachial
cutaneousnerve
Basilicvein
Lateralantebrachial
cutaneousnerve
(terminaloart of
m u s c u l o c u t a n e o unse r v e )

Branches
of medial
antebrachial
cutaneous

nerve

Median cubital vein


Intermediate(median)
antebrachialvein
tcvetn
Perforatingveins
Cephalicvein

Branches
of
lateralantebrachial
nerve
cutaneous
(terminalpartof
nerve
musculocutaneous

4{tr
Plate 479

Neurovasculatule

Gutaneous Nerves and Superficial Veins of Forearm

Posterior(dorsal)view

Anterior(palmar)view

C e p h a l i cv e i n
Posteriorantebrachial
cutaneousnerve
(from radial nerve)

B a s i l i cv e i n

(frommusculoc u t a n e o unse r v e )

terior branch
and
Posteriorbranch
of medial
antebrachial
cutaneous
nerve
Posterior

Accessory
cephalicvein

Median
b a s i l i cv e i n

Lateralantebrachial
cutaneousnerve

branch
of medial
antebrachial
cutaneous
nerve

Median
c e p h a l i cv e i

Bicipital
aponeurosrs

C e p h a l i cv e i

B a s i l i cv e i n
Perforating
vetns

Median
antebrachialvein
Note: ln 7O"/"o( cases,
a median cubital
vein (tributaryto
basilicvein) replaces
m e d i a nc e p h a l i c
a n d m e d i a nb a s i l i c
veins (see PlaLe479\.
Superficialbranch
of radial nerve
Palmarbranch
of median
lntercaoitularveins

Posterior
antebrachial
cutaneous
nerve (from
radial nerve)

Accessory
cephalic
vetn
Posterior
branchof
lateral
antebrachial
cutaneous
nerve(from
musculocutaneousnerve)
Cephalicvein

B a s i l i cv e i n

Extensor
retinaculum
r branch
o f u l n a rn e r v e
Dorsal branch
of ulnar nerve
Palmarcarpal
ligament
(continuous
with extensor
retinaculum)
Palmar
aponeuroSrs

Dorsalbranch
of ulnarnerve
Dorsal
metacarpal
v e tn s

Suoerficialbranch
of radial nerve

Dorsal
venous
network

lntercapitular
vetns

transverse
metacarpal
ligament

Proper palmar digital nerves


a n d p a l m a rd i g i t a lv e i n s

Neurovasculature

Dorsal digital nervesand veins

Plate 48O

Gutaneous Innervation of Upper Limb

Anterior (palmar)view

Posterior(dorsal)view
aclavicularnerves
(from cervical
plexus-C3,4)

Supraclavicular
nerves
(from cervical
plexus-C3,4)

Axillarynerve
Superiorlateral
brachialcutaneous
nerve (C5,6)

Axillarynerve
lateralbrachial
cutaneousnerve
(c5,6)

Radialnerve
Inferiorlateral
brachialcutaneous
n e r v e( C 5 , 6 )
Intercosto'
brachial
nerve (T2)
and medial
brachial
cutaneous
nerye
(c8,T1,2)

Lateralantebrachial
cutaneousnerve

(cs,5171)

(terminalpart of
musculocutaneous
nerve)

Radialnerve
Superficialbranch
(c6-8)
\

Plate 481

(clsl,6-8)

Medial
antebrachial
cutaneous
nerve
( c 8 ,T 1 )

Lateralantebrachialcutaneous
nerve
(c5,6 [7])
(terminalpart of
musculocutaneous
nerve)

Ulnarnerve(C8,T1)

digital
branches

Mediannerve
Palmarbranch
and
Palmar
digitalbranches
(c6-8)

Radialnerve
Posteriorbrachialcutaneous
nerve(C5-8)
Inferiorlateralcutaneous
nerye
Posteriorantebrachial
cutaneousnerve

Nr

Dorsalbranch
and dorsal
digital
Properpalmar
digital
branches

Radialnerve
Superficialbranch
and dorsaldigital
branches(C6-8)

Mediannerve
Properpalmar
digitalbranches

Note: Divisionvariablebetweenulnarand radial


innervationon dorsumof handand often alignswith
middleof 3rd digit insteadof 4th digit as shown

teurovasGulatur

Dermatomes of Upper Limb

Note: Schematicdemarcationof dermatomes


(accordingto Keeganand Carrett) shown as
distinct segments.There is actuallyconsiderable
overlap between adjacent dermatomes.An
alternativedermatome map is provided by
Foerster(seereferences).

Anteriorview

*:.

ki

$'r
s

$
ii

Neurovasculature

*{r
Plate 482

Lymph Vessels and Nodes of Upper Limb


SeealsoPlates 184, 468

D e l t o p e c t o r anl o d e

Lateralaxillarynodes
( a l o n ga x i l l a r yv e i n )

C e p h a l i cv e i n

B a s i l i cv e i n

C u b i t anl o d e s

M e d i a n c u b i t a lv e i n

Vessels
passing
to
d o r s u mo f h a n d

C e p h a l i cv e i n

Vesselspassingto
d o r s u mo f h a n d

V e s s e l sp a s s i n ga r o u n d
web to dorsum of hand
Vesselspassingto
dorsum of fingers

Note: Arrows indicate


d i r e c t i o no f d r a i n a g e

Plate 483

Neurovasculature

GT Angiograms of Arteries of the Upper Limb

Regional Scans

PIate 484

7 Lower Limb
Section
Topographic Anatomy
Plate 485

las Lower
Limb

Hip and Thigh


Plates

486-505

486

Bone
Hip(Coxal)

487
488

HipJoint
Anteroposterior
Radiograph
HipJoint:

489

Femur

View
of Muscles
of HipandThigh:Anterior
BonyAttachments
Posterior
of HipandThigh:
of Muscles
49t Bony
Attachments
View
View
Views
Anterior
492 Muscles
ofThigh:
(continued)
Views
493 Muscles
ofThigh:Anterior

490

Lateral
View
Muscles
ofHipandThigh:
Views
Posterior
495 Muscles
ofHipandThigh:
Muscles
496 Psoas
andlliacus
494

497

Plexuses
andCoccygeal
Lumbosacral

498

Lumbar
Plexus

Plexuses
andCoccygeal
Sacral
Views
ofThigh:Anterior
500 Arteries
andNerves
(continued)
Views
ofThigh:Anterior
501 Arteries
andNerves
499

502

View
Posterior
ofThigh:
Arteries
andNerves

Nerves
of HipandButtock
Head
andNeck
of Femoral
504 Arteries
Cross
Sections
505 Thigh:
Serial
503

Atlas of ]luman Anatomy

Lower Limb
Knee

szz Ligaments
andTendons
ofAnkle

Platec 506-512

sza Ligaments
andTendons
Plantar
ofFoot:
View

soe Knee:
Lateral
andMedialViews

Sheaths
szg Tendon
ofAnkle

soz Knee:
AnteriorViews

sso Muscles
of Dorsum
ofFoot:Superficial
Dissection

sos Knee:
lnterior

ssr Dorsum
ofFoot:
Deep
Dissection

Ligaments
sog Knee:
andCollateral
Cruciate

ssz SoleofFoot:
Superficial
Dissection

Radiograph
sro Knee:
Anteroposterior

ses Muscles
ofSoleofFoot:
FirstLayer

st r Knee:
Posterior
Views
andSagittal

sse Muscles
ofSoleof FootSecond
Layer

andKnee:
Schema
sr z Arteries
ofThigh

sss Muscles
ofSoleofFoot:Third
Layer
sse Interosseous
Muscles
Arteries
andDeep
of Foot

Leg

ssz Interosseous
Muscles
of Foot

Pfates 513-622

srs Tibia
andFibula
(continued)
srr TibiaandFibula

Neurovasculature
Plates 538-546

srs Attachments
ofLeg
ofMuscles
View
Dissection):
Posterior
sre Muscles
of Leg(Superficial

sse Femoral
Nerve
andLateral
Femoral
Cutaneous
Nerve

View
Dissection):
Posterior
sr z Muscles
ofLeg(lntermediate
Dissection):
Posterior
View
sre Muscles
ofLeg(Deep

Nerve
slo Sciatic
andPosterior
Femoral
Cutaneous
Nerve

View
Dissection):Anterior
srg Muscles
ofLeg(Superficial
Dissection):Anterior
szo Muscles
View
ofLeg(Deep

(Peroneal)
Fibular
sez Common
Nerve

szr Muscles
ofLeg:LateralView

Nerves
ss Superficial
andVeins
ofLower
Limb:Anterior
View

szz Leg:Cross
andFascial
Compartments
Sections

ses Superficial
Nerves
andVeins
of Lower
Limb:
Posterior
View

Nerve
sos 0bturator
Nerve
ser Tibial
ses Dermatomes
ofLower
Limb

*e

Vessels
Lymph
andNodes
of Lower
Limb

Ankle and Foot


Plates 523-537

Regional Scans

szs Bones
of Foot
szl Bones
of Foot(continued)

Plate 547

szs Calcaneus
szs Ankle:
Radiographs

Atlas of Human Anatomy

scz CTAngiograms
ofArteries
of theLowerLimb

Lower Limb
Posteriorview

Anterior view

l l i a cc r e s t
Cluteus
medius

l l i a cc r e s t
Anterior
s u p e r i o ri l i a

MUSCIE

spn
re

Inguinal
ligament

T e n s o rf a s c i a e
l a t a em u s c l e

S a r t o r i u sm u s c l e

muscle

Creater
trochanter
of femur

Cluteal
fold

Vastus
l a t e r a l i sm u s c l e
R e c t u sf e m o r i s

Cluteus
maxrmus
muscle

Creat
s a p h e n o us
vetn

Semitendinosus

muscle
Adductor
maSnus

muscre
Vastus
medialis
MUSCIE

C racilis
tenoon
l l i o t i b i a tl r a c t

F i b ul ar i s
(peroneus)
l o n g u sm u s c l e

R e c t u sf e m o r i s
t e n d o n( b e c o m i n g
p a r to f q u a d r i c e p s
Creat
f e m o r i st e n d o n )
saphenous
vern
Patella

B i c e p sf e m o r i s
muscle
L o n gh e a d
Short head

Popliteal
fossa

P a t e l l a lri g a m e n t
T i b i a lt u b e r o s i t y
Creatsaphenous
vetn

Castrocnemius
muscte
M e d i a lh e a d
Lateralhead

Tibialis
a n t e r i om
r uscle
A n t e r i o rb o r d e r
of tibia

Small
sapnenous
vetn

Calcaneal
tendon

L a t e r aml a l l e o l u s

Fibularis
( p e r o n e u s l)o n g u s
a n d b r e v i st e n d o n s

Medial
malleolus
M e d i a lm a l l e o l u s

E x t e n s o dr i g i t o r u m
l o n g u st e n d o n s

P l a n t a rs u r f a c e
of foot

L a t e r am
l alleolus
Calcaneal
tuberosity

6ryd4/*

Topographic Anatomy

Plate 485

Hip lGoxalf Bone


Lateralview

Intermediate
ron" )
-Tuberculum
) lliaccrest
--Outerlip
)

Posterior

(ala)of ilium
(glutealsurface)

Posterior
superior
iliacspine

superioriliacspine
Anteriorinferioriliacspine

Posterior
inferior
iliac
lum
Lunatesurface
Margin(limbus)of acetabulum
Acetabularnotch

Creatersciaticnotch

pubicramus

Bodyof ilium
lschialspine

*{r

tubercle

Lesser
sciatic
Bodyof ischium

Obturatorcrest
ior pubicramus

lschialtuberosity

Ramusof ischium

Anteriorsuperioriliacspine
Wing (ala)of ilium
(iliacfossa)
Anteriorinferioriliacspine

surface
(for sacrum)

Arcuateline
l l i o p u b i ce m i n e n c e
Superiorpubicramus
Pectenpubis
(pectinealline)
Pubictubercle

inferior
iliacspine
Creatersciaticnotch
sprne
of ilium
Lessersciaticnotch

Symphyseal
surface

llium

lschium

eutis

Plate 486

of ischium
Obturatorgroove
Inferiorpubicr

lschialtuberosity
Ramusof ischium

Hip and Thigh

Hip Joint

Anteriorview
l l i o f e m o r a l i g a m e n t( Y l i g a m e n to f B i S e l o w )
lliopectinealbursa (over gap in ligaments)

Anterior

\\

supenor
i l i a cs p i n s -

P u b o f e m o r alli g a m e n t

Obturatorcrest

A n t e r i o ri n f e r i o r
i l i a cs p i n e

S u p e r i opr u b i cr a m u s

Creater
trochanter

Posteriorview
l l i o f e m o r al i a g m e n t
l s c h i o f e m o r al li g a m e n t
Zonaorbicularis

Creater
trochanter
Lessertrochanter
lschial
tuberosity

Protrusion
of synovial
memDrane

l n t e r t r o c h a n t e r ilci n e

\
n te rtrochan teric
crest

HlJ"iliJ;o'
b

Lessertrochanter

A n t e r i o rs u p e r i o ri l i a cs p i n e
L u n a t e( a r t i c u l a r )
surfaceof
acetabulum

A n t e r i o ri n f e r i o ri l i a cs p i n e
l l i o p u b i ce m i n e n c e
A c e t a b u l a rl a b r u m( f i b r o c a r t i l a g i n o u s )

A r t i c u l a rc a r t i l a g e

Fatin acetabularfossa (covered by


s y n o v i am
l embrane)

Creater
trochanter

Obturatorartery
A n t e r i o rb r a n c h
Posteriorbranch
Acetabularbranch

Headof
Neckof femur

O b t u r a t o rm e m b r a n e

lntertrochanteric
line
L i g a m e n to f
h e a do f f e m u r

(cut)

Hip and Thigh

Transverseacetabularligament
l s c h i a tl u b e r o s i t y

4{ry

Lessertrochanter

Plate 487

Hip Joint: Anteroposterior Radiograph

A
F
G
H
I
lC
It
lT
L
N
O
P

Plate 488

Acetabulum
Femur
Greatertrochanter
Headof femur
lschium
Intertrochanteric
crest
llium
lschialtuberosity
Lessertrochanter
Neck
Obturatorforamen
P u b i s( s u p e r i orra m u s )

Hip and Thigh

Femur

Anteriorview
Creater
trochanter

Neck

Intertrochanteric
crest

trochanter
Lesser
Pectinealline
Cluteal tuberosity

Shaft(body)
Lineof attachment
of borderof
synovialmembrane
Lineof reflection
of synovialmembrane
Lineof attachment
of fibrouscapsule
Lineof reflectionof fibrous
capsule(unattached)
Poplitealsurface

4{F
Adductortubercle

Lateralepicondyle

Lateralcondyle

Hip and Thigh

Lateralepicondyle

Patellar
surface

fossa
Intercondvlar

Plate 489

Bony Attachments of Muscles of Hip and Thigh: Anterior View

lliacum
s uscle

Origin of psoasmajor muscle


from sidesof vertebralbodies,
intervertebraldiscs,and
transverseprocesses (J'l 2-L4)

#: ",,

Sartorius
Piriformm
isuscle

Rectusfemorismuscl

Pectineus
muscle

Obturatori
and superiorand inferior
g e m e l l u sm u s c l e s

Adductorlongusmuscle

Piriformis
muscle

Adductorbrevismuscle

C l u t e u sm i n i m u s

racilismuscle

Vastuslateralis
mu

Obturatorexternusmuscle

l l i o p s o a sm u s c l e
Vastusmedialismu

A d d u c t om
r a g n u sm u s c l e
femorismuscle
Quadratus

Vastusintermedius
muscle

I
I

Origins
Insertions

Articularis
genusmuscle
u c t o r m a g n u sm u s c l e

lliotibialtract

Bicepsfemorismuscle
Quadricepsfemoris muscle
(rectus femoris,
vastuslateralis,
vastusintermedius/
and vastusmedialis
via patellarligament)

Plate 49O

Pesanserinus

4{tr
Hip and Thigh

Bony Attachments of Muscles of Hip and Thigh: Posterior View

C l u t e u sm e d i u sm u s c l e
C l u t e u sm i n i m u sm u s c l e
Tensor fasciaelatae muscte
C l u t e u sm a x i m u sm u s c l e

S a r t o r i u sm u s c l e
R e c t u sf e m o r i sm u s c l e

s uscle
S u p e r i ogr e m e l l um

Obturatorexternusmuscle

s uscle
I n f e r i ogr e m e l l um

C l u t e u sm e d i u sm u s c l e

' Q u a d r a t ufse m o r i sm u s c l e

Q u a d r a t ufse m o r i sm u s c l e

l l i o p s o am
s uscle

O b t u r a t o ri n t e r n u sm u s c l e
A d d u c t o r m a g n u sm u s c l e
B i c e p sf e m o r i s( l o n g h e a d )
a n d s e m i t e n d i n o s um
s uscles

s uscle
C l u t e u sm a x i m u m
a s t u sl a t e r a l i sm u s c l e
A d d u c t o r m a g n u sm u s c l e

S e m i m e m b r a n o s um
s uscle
uctor brevis muscle

Pectineusmuscle

I
I

V a s t u sm e d i a l i sm u s c l e

V a s t u si n t e r m e d i u sm u s c l e
B i c e o sf e m o r i sm u s c l e( s h o r th e a d )

Origins
lnserlions

A d d u c t o r l o n g u sm u s c l e

d u c t o r m a g n u sm u s c l e
V a s t u sl a t e r a l i sm u s c l e

Plantarim
s uscle
A d d u c t o r m a g n u sm u s c l e
C a s t r o c n e m i u sm u s c l e( l a t e r a hl e a d )
C a s t r o c n e m i u sm u s c l e( m e d i a lh e a d )

muscte

S e m i m e m b r a n o s um
s uscle

P o p l i t e u sm u s c l e

Note: Width of zone of attachmentsto posterioraspect


o f f e m u r ( l i n e aa s p e r a )i s g r e a t l ye x a g g e r a t e d .

Hip and Thigh

4{tr
Plate 491

Muscles of Thigh: Anterior Views

A n t e r i osr u p e r i oirl i a cs p i n e
A n t e r i o rs u p e r i o ri l i a cs p i n e

l i a c u sm u s c l e

S a r t o r i um
s u s c l e( o r i g i n )

majormuscle

Anteriorinferior
i l i a cs p i n e

C l u t e u sm e d i u sm u s c l e
I n g u i n al i g a m e n t

ments
of hip joint

Pubictubercle

Pectineus
muscte

Tensorfasciaelatae muscle
Pectineusmuscle
Tensorfasciaelatae muscle (origin
R e c t u sf e m o r i sm u s c l e( o r i g i n )
Creater trochanter
l l i o p s o a sm u s c l e( c u t )

A d d u c t o lro n g u sm u s c l e
racilim
s uscle
Sartorius
muscle
Rectusfemorismuscle*
Vastuslateralis
muscle*
Vastusintermedius
muscle*
'astus
medialismuscle"
lliotibialtract
Rectusfemoris tendon (becoming part
of quadricepsfemoris tendon)
Lateralpatellarretinaculum
Patella
M e d i a l p a t e l l a rr e t i n a c u l u m

Anteromedial
intermuscular

septum

Patellarligament
Sartoriustendon
C r a c i l i st e n d o n
S e m i t e n d i n o s utse n d o n
Tibial tuberosity

P e sa n s e r i n u s
l l i o t i b i a tl r a c t ( c
Rectusfemoris tendon
Quadricepsfemoris I
Lateralpatellarretinaculum
Medial patellarretinaculum

4{tr

Head of fibula
P a t e l l a lri g a m e n t
Tibial tuberosity

Sartorius
tendon

* M u s c l e so f q u a d r i c e p sf e m o r i s

Plate 492

Hip and Thigh

Muscles of Thigh: Anterior Views (continuedl

Deepdissection
Pectineusmuscle (cut and reflected\
A n t e r i o rs u p e r i o ri l i a c

S u p e r i orra m u so f p u b i s

A n t e r i o ri n f e r i o ri l i a cs o i

tor longusmuscle(cutand reflected)


L i g a m e n t so f h i p j o i n t
Creater trochanterof femur

l l i o p s o am
s u s c l e( c u t )
P e c t i n e ums u s c l e

ctor brevismuscle(cut)

P u b i ct u b e r c l e

C r a c i l im
s u s c l e( c u t )

(cut and reflected)

Adductorbrevismuscle
(cut and reflected)
V a s t u si n t e r m e d i u sm u s c l e

Obturatorexternusmuscle

Q u a d r a t ufse m o r i sm u s c l e

A d d u c t o lro n g u sm u s c l e
(cut and reflected)

A d d u c t om
r i n i m u sp a r to t
A d d u c t om
r a g n u sm u s c l e

Femoralarteryandvein
p a s s i ntgh r o u g hh i a t u s
of adductormagnusmuscle

ingsfor perforating
branchesof profunda femoris
(deep femoral) artery

V a s t u sm e d i a l i sm u s c l e( c u t )
Rectusfemoris tendon (cut as it
becomes part of quadriceps tendon)

Vastuslateralis
muscle(

Tendon of adductor magnus muscle


insertineon adductor tubercle
on medial eoicondvle of femur

Cracilismuscle(cut)

Lateraleoicondvle of femur
Tibialcollateralligament

Lateralpatellar
F i b u l a rc o l l a t e r alli g a m e n t
Head of fibula

P e sa n s e r i n u s

Patellarligament
Tibial tuberosity

Hip and Thigh

4{r
Plate 493

Muscles of Hip and Thigh: Lateral View

l l i a cc r e s t

Clutealaponeurosis
s e d i u sm u s c l e
o v e rg l u t e u m

External
oblique
muscle

Anteriorsuperior
i l i a cs p i n e

Sartorius
muscle
G l u t e u sm a x i m u m
s uscle
Tensorfasciaelatae muscle

Rectusfemoris muscle

Vastuslateralis
muscle

l l i o t i b i at rl a c t

Lateralcondvle of tibia
and Cerdv's tubercle
S e m i m e m b r a n o s um
s uscle

Lateralpatellarretinaculum
Fibularcollateralligament

Plantaris
muscle
tensordigitorumlongusmuscle
Gastrocnemius
muscle(lateralhead)

Head of fibula

F i b u l a r i s( p e r o n e u s l)o n g u sm u s c l e

Plate 494

Patellar
ligament

T i b i a l ias n t e r i om
r uscle

*{r

Hip and Thigh

Muscles of Hip and Thigh: Posterior Views


Forpiriformis
andobturator
internus
seealsoPlates356,357;For

seePlate

Superficialdissection

C l u t e a la p o n e u r o s i so v e r

C l u t e u sm e d i u sm u s c l e
C l u t e u sm i n i m u sm u s c l e
s uscle
C l u t e u sm a x i m u m
Piriformis
muscle
Sciaticnerve
S a c r o s p i n o ulsi g a m e n t
S u p e r i o rg e m e l l u sm u s c l e
O b t u r a t o ri n t e r n u sm u s c l e
l n f e r i o rg e m e l l u sm u s c l e
Sacrotuberousligament

femorismuscle
Quadratus
lschialtuberosity
Semitendinosusmuscle
Creater trochanter
B i c e p sf e m o r i sm u s c l e{ l o n g h e a d )
Adductor minimus part of
Adductor magnus muscle

S e m i m e m b r a n o smuuss c l e
l l i o t i b i a tl r a c t
C r a c i l i sm u s c l e

B i c e p fse m o r i sm u s c l e
S h o r th e a d
Long head
S e m i m e m b r a n o s um
s uscle
S e m i t e n d i n o s um
s uscle
Poplitealvesselsand tibial nerve
) erve
C o m m o n f i b u l a r( p e r o n e a l n

tarismuscle
C a s t r o c n e m i u sm u s c l e
M e d i a lh e a d
Lateralhead
Sartoriusmuscle
Popliteusmuscle
T e n d i n o u sa r c h o

Soleum
s uscle
Plantaris
tendon(cut

Hip and Thigh

Plate 495

Psoas and lliacus Muscles


SeealsoPlate 263

Q u a d r a t ulsu m b o r u m
muscle

1 2 t hr i b

'l

l l i o i n g u i n anl e r v e

Origin of psoas major


musclefrom vertebral
bodies,transverse
procesSes/
ano
intervertebraldiscs
$12-L4) and origin
of psoas minor muscle
from vertebralbodies
( T 1 2 ,L 1 )

P s o a sm i n o r
muscte

L u m b a rp l e x u s

T 1 2\

Transversus
abdominis
muscle (cut)

[1
lliohypogastricnerve

Psoasmajor
muscte

umbosacral
trunk
Cenitofemoral nerve
lliac crest

Lateralfemoral
cutaneousnerve

Anteriorsuperior
i l i a cs p i n e

l l i a c u sm u s c l e
Femoralnerve

lliopectinealbursa

S u p e r i opr u b i cr a m u s
Creatertrochanter

lliofemoral
l i g a m e n to f
hipjoint
(Y ligament
of Bigelow)

of femur

lliopsoasmuscle
passesbackward
to insertionon
lessertrochanter

Shaft(bodv)of femur

Abductors
( g l u t e um
s edius
and
m r n t m ums u s c l e s )

Note: Arrows indicate


direction of action
of ilioosoasmuscle.

Adductors

Plate 496

4{r
Hip and Thigh

Lumbosaeral and Goccygeal Plexuses

.l
Intercostalnerve (T1 )

-1:::

Anteriordivision
Posteriordivision

Subcostal
nerve(T12
lliohypogastricnerve
( T 1 2 ,L 1 )

Sympathetictrunk

l l i o i n g u i n anl e r v e ( L l )

To psoasmajorand
osoasminormuscles
,)
C e n i t o f e m o r a nl e r v e( 1 1 2
Lateralfemoral cutaneous

n e r v e( 1 2 ,3 )
G e n i t a lb r a n c ha n d
Femorab
l ranch
of genitofemoralnerve

Lumbarplexus

To
ro psoasmalor
major and
i l i a c u sm u s c l e s
Anterior branches.
and\l

Lateralbranches
and
of subcostal
iliohypogastricnerves

L u m b o s a c rtar u
l nk

*{r

Nerve to quadratus
femoris (and inferior
g e m e l l u s () 1 4 ,5 , S 1 )
Nerve to obturator

Sacralplexus

i n t e r n u(sa n ds u p e r i o r
g e m e l l u s( 1
) 5 ,S 1 ,2
S u p e r i ogr l u t e a l
n e r v e( 1 4 ,5 , S 1)
N e r v e t o p i r i f o r m i s( S 1 ,2
O b t u r a t o r n e r v e( L 2 , 3 , 4 l
Accessoryobturator nerve
( 1 3 ,4 ) ( i n c o n s t a

I n f e r i ogr l u t e anl e r v e( L 5 ,5 1, 2

ao""r*"at plexus

Femoralnerve (12, 3, 4

P e l v i cs p l a n c h n i c
nerves

Sciaticnerve

Perforatingcutaneous
nerve (S2,3)

Posteriorfemoral
c u t a n e o u sn e r v e( S 1 , 2 ,
Pudendalnerve (S2,3, 4)

Nerve to levator ani


and coccygeus(53, 4)
Perinealbranch of
4th sacralnerve
Anococcygealnerves
Obturator nerve
lnferior anal
(rectal)nerve
Dorsal nerve of penis/clitoris

branches
scrotal/labial
Perineal
nerveand Posterior

Hip and Thigh

Plate 497

Lumbar Plexus

Schema

Subcostal
nerve

T12

White and gray rami communicantes

lliohypogastric
nerve
l l i o i n g u i n anl e r v e

Ventral
ramiof
spinal
nerves

Genitofemoralnerve

Lateralfemoral
cutaneous
nerve
Cray rami

M u s c u l abr r a n c h e s
to psoasand iliacusmusctes

t5

Femoralnerve
Accessoryobturator nerve (often a

Obluratornerve
Lumbosacral
trunk

I
ffi

Anteriordivision
Posteriordivision

(cut)
Diaphragm

White and gray


ramicommunicantes

Subcostal
nerve(T12)

Subcostalnerve (T12)

Sympathetic
trunk

lliohypogastricnerve
l l i o i n g u i n anl e r v e

l l i o h y p o g a s t rniec r v e
llioinguina
n le r v e
Genitofemoralnerve (cut)
Lateralfemoral
cutaneous

Transversus
abdominis

muscre
Quadratuslumborummuscle
Psoasmajormuscle
Cray ramicommunicantes
Cenitofemoral nerve

Femoralnerve
obturator nerve

Psoasmajormuscle(
Lumbosacraltrunks
I n g u i n a l i g a m e n t( P o u p a r t ' s )

l l i a c u sm u s c l e
Lateralfemoral
cutaneousnerve
Femoralnerve
Cenital branch and
Femoralbranch of
genitofemoralnerve

Obturatornerve

Nr
Plate 498

Hip and Thigh

Sacral and Goccygeal Plexuses

Schema
I

Anterior division

Posteriordivision

trunk
Lumbosacral

Gray rami communicantes

sl
Superiorglutealner
lnferiorgluteal

S2

nerves
Pelvicsplanchnic
(parasympathetic
to
inferiorhypogastric
lpelviclplexus)

Nerveto oiriformis

Tibial nerve
Coccygeal nerve

Commonfibular

Anococcygealnerve
branchof 4th sacralnerve
Perineal

(peroneal)

to levator ani and

(ischiococcygeus)
muscles
coccygeus
nerve
Pudendal
g cutaneousnerve
Perforatin
Nerveto obturatorinternus(andsuperiorgemellu's)

nerve
femoralcutaneous
Posterior

4{F

trunk
Sympathetic
trunk
Lumbosacral

Gravramicommunicantes

Psoasmaiormuscle
Superiorglutealarteryand nerve
Obturatornerve
lliacusmuscle

splanchnic
nerves(cut)
(parasympathetic
to inferior
hypogastric
lpelviclplexus)

Inferiorglutealartery
Nerveto ouadratus

Nerveto obturatorinternus
Pudendalnerve

Obturatorinternusmuscle,
Superiorpubicramus
Piriformis
muscle
(ischiococcygeus)
muscle
Coccygeus
Nerve to levatorani muscle

Levatorani

Topography:medialand slightlyanteriorview
of hemisectedpelvis

Hip and Thigh

I
splanchnic
nerves(cut)
(sympathetic
to inferior
hypogastric
lpelviclplexus)

Plate 499

Arteries and Nerves of Thigh: Anterior Views


SeealsoPlate 538

A n t e r i o rs u p e r i o ri l i a cs p i n e
Lateralfemoral cutaneousnerve
I n g u i n al i g a m e n t
l l i o p s o a sm u s c l e

Superficial
dissections
Lateralfemoral cutaneousnerve (cut)
Tensorfasciaelatae
muscle (retracted)

Cluteus
mtntmus

Superficialcircumflex
i l i a cv e s s e l s

Sartorius
muscle(cut)
lliopsoasmuscle

and medius

Superficial
epigastric
vessels

muscres

Superficialand
Deep external
p u d e n d a lv e s s e l s

Pectineus
muscre

Lateral
circumflex
femoral
artery
Rectus
femoris

Vastus
lateralis
muscle
Vastus
medialis
muscle
Femoral
sheath

Pectineus
muscle
ofunda femoris
(deep femoral)
artery

Adductor
longus
muscle
Sartorius
muscle

Vastusmedialis
muscle

Saphenous
n e r v ea n o
sapnenous
branch of
descending
genicula

artery
Articularbra
of descending
genicularartery
(emergesfrom
v a s t u sm e d i a l i s
muscle)

Fascialata (cut)
Rectusfemoris muscle
Vastuslateralismuscle
Tensorfasciaelatae muscle

Plate 5OO

*{r

u n d af e m o r i s
(deep femoral)
artery
Adductor
l o n g u sm u s c l e
Adductor canal
( o p e n e db y
removal of
sartorius
muscle)
Saphenous
nerve

Femoralnerve,
artery,and vein

Cracilis
muscle

Femoralnerve,
artery,and
vetn

Patellar
anastomos
Infrapatellar
branch of
S a p h e n o u sn e r v e

Nerve to
vastusmedialis
muscte
Adductor
magnus muscle

Anteromedial
intermuscular
septum
covers
entranceof
femoralvessels
to poplitealfossa
(adductorhiatus)
Sartorius
muscle (cut)
S u p e r i o rm e d i a l
genicular
artery (from
popliteal artery)
I n f e r i o rm e d i a l
genicular
artery (from
popliteal artery)

Hip and Thigh

Arteries and Nerves of Thigh: Anterior Views (continuedf

Deepdissection
Externaliliac artery and vein

Deep circumflex iliac artery

Inguinalligament (Poupart's)

Lateralfemoral
c u t a n e o u sn e r v e

Femoralartery and vein (cut)

Sartorius
muscle(cut)

Pectineus
muscle(cut)

l l i o p s o a sm u s c

Obturatorcanal
Tensorfasciaelatae
muscle (retracted)

Obturatorexternusmuscle

C l u t e u sm e d i u sa n d

Adductorlongusmuscle(cut)

m i n i m u sm u s c l

Anterior branch and


ior branch of

Femoral

obturatornerve
Rectusfemoris muscle

femorismuscle
Quadratus

Ascending,transverseand
d e s c e n d i n gb r a n c h e so f

Adductorbrevismuscle

Lateralcircumflex
femoralar

of posteriorbranch
Branches
of obturatornerve

Medial circumflexfemoral artery


Pectineusmuscle (cut

r magnusmuscle

Profundafemoris(deepfemoral)artery

C r a c i l im
s uscle

Perforatingbranches

utaneousbranch of obturator nerve

A d d u c t o lro n g u sm u s c l e( c u t )

Femoralartery and vein (cut)

V a s t u sl a t e r a l im
s uscle
Descendinggenicularartery

Articularbranch
S a p h e n o ubsr a n c h

Vastusintermediusmuscle

Rectusfemorismuscle(cut)

A d d u c t o hr i a t u s

S a p h e n o u sn e r v

muscle(cut)
Sartorius

Anteromedialintermuscular
septum (opened)

magnustendon
Adductor tubercle on
medial eoicondvle of femur

Vastusmedialismuscle
Quadricepsfemoris tendon

Superiormedial genicularartery
(from poplitealartery)

Patellaand patellar
anastomosis

Nr

Infrapatellarbranch of
Saphenousnerve

Medialpatellarretinaculu
l------

Hip and Thigh

Inferior medial genicularartery


(from popliteal artery)

Plate 5Ol

Arteries and Nerves of Thigh: Posterior Views


Seealm Pfatc 310

l l i a cc r e s t
S u p e r i o rc l u n i a ln e r v e s
Gluteus maximus muscle (cut)
M e d i a l c l u n i a ln e r v e s
Inferior glutealartery and nerve

C l u t e a la o o n e u r o s i sa n d
gluteusmedius muscle (cut)
Superiorglutealartery and nerve
t e u sm i n i m u sm u s c l e
Tensorfasciaelatae muscre

Pudendan
l erve

Piriformm
isuscle
Nerve to obturator internus

( a n ds u p e r i ogr e m e l l u s )

C l u t e u sm e d i u sm u s c l e( c u t )
s uscle
S u p e r i ogr e m e l l um

Posteriorfemoral
culaneous nerve

Greatertrochanter
of femur
Sacrotuberouslieament

lschialtuberosity
Inferiorclunialnerves(cut)
A d d u c t o r m a q n u sm u s c l e
C r a c i l i sm u s c
Sciaticnerve
Muscular branchesof sciaticnerve
Semitendinosusmuscle (retracted)
S e m i m e m b r a n o s um
s

Sciaticnerve
A r t i c u l abr r a n c h

Obturatorinternusmuscle
lnferiorgemellusmuscle
uteus maximus muscle (cut)
Quadratusfemoris muscle
Medial circumflexfemorar
artery
Vastuslateralismuscle
and iliotibialtract
A d d u c t o r m i n i m u sp a r t o f
adductor magnus muscle
.l
st perforating artery (from
profunda femoris artery)
A d d u c t o r m a g n u sm u s c l e
2nd and 3rd perforatingarteries
(from profunda femoris artery)

Adductorhiatus
P o p l i t e avl e i n a n d a r
S u p e r i o rm e d i a lg e n i c u l a ra r t e r y
Medial epicondyle of femur
T i b i a ln e r v e
Castrocnemiusmuscle (medial head)
Medial suralcutaneousnerve

*{ry
Plate 5O2

S m a l ls a o h e n o u sv e i n

4th perforatingartery (from


profunda femoris artery)
Long head (retractecl)| ,,."0, femoris
muscle
Short head
J
S u p e r i o rl a t e r a lg e n i c u l a ra r t e r y
Common fibular (peroneal)nerve
Plantarim
s uscle
Castrocnemiusmuscle (lateralhead)
Lateralsuralcutaneousnerve

Hip and Thigh

Nerves of Hip and Buttock

lliac crest

Cluteusmaximusmuscle(cut)
C l u t e u sm e d i u sm u s c l e( c u t )
Superiorglutealnerve
C l u t e u sm i n i m u sm u s c l e
Sciaticnerve

formismuscle
Inferior gluteal nerve

s uscle
S u p e r i ogr e m e l l um
Posteriorfemoral
culaneous nerve
Tensorfasciaelatae
muscle

Nerve to obturator internus


( a n d s u p e r i o rg e m e l l u s )

C l u t e u sm e d i u s
muscle(cut)

Pudendalnerve
l s c h i a sl p i n e

Sacrospinous

e to quadratus

ligament

femoris (and
inferior
gemellus)
supplying
articularbranch to
hipjoint

Perforating
cutaneousnerve

Sacrotuberous
ligamentGreater trochanter
of femur

I n f e r i o ra n a l
(rectal)nerve

Intertrochanteric
crest

Dorsal nerve
of penis

Inferiorgemellus
muscle

Perineal
nerve

femoris
Quadratus
muscle

Posterior
scrotal

C l u t e u sm a x i m u s
muscle(cut)

P e r i n e abl r a n c h e s
of posteriorfemoral
cutaneous

Sciaticnerve
l s c h i a tl u b e r o s i t y

S e m i t e n d i n o sm
uu
s scle
B i c e p fse m o r i sm u s c l e( l o n gh e a d )
(coverssemimembranosus
muscle)

Hip and Thigh

Posteriorfemoral cutaneousnerve

I n f e r i ocr l u n i anl e r v e s

4{tr
Plate 5O3

Arteries of Femoral Head and Neck


SeealsoPlate 512
Posteriorview

Anteriorview
AcetabuJar
branchof
obturator artery
(often minute)

Retinacular Superior
I
artefles
I Anterior
(subsynoviall
( lnferior

Superior
Posterior
lnferior

Anastomosis
betweenmedial
and lateral
circumflex
femoral
arteries

Retinacular
arteries
(subsynovial)
nastomosrs

lschiofemoral
ligamentand
joint capsule

lliofemoral(Y)
ligamentand
joint capsule

Medial
circumflex
femoral artery

tendon
Medial circumflex
femoral artery

Ascending,
Transverse,
Descending
branchesof
Lateralcircumflex

Profunda
femoris
(deepfemoral)
artery

Lateral
circumflex
femoral artery'

Nutrientartery
of femur

femoralartery
Nutrientartery
of femur

Coronal section

Medial circumflex
femoral artery

Acetabular
labrum
Ligamentsand
joint capsule1

Retinacular

muscre

Anastomosis

Femoral
artery

Lateralcircumflex
femoral artery
Ascending,
Transverse,
Descending
branches

Pectineus
muscte

Acetabular
branch
Obturator
artery

Medial
circumflex
femoral
artery
Profundafemoris
(deepfemoral)
artery
Medial circumflexfemoralartery
lliopsoastendon
Lateralcircumflexfemoral artery

4{N

Femur of child: anterior view

Plate 5O4

Hip and Thigh

Thigh: Serial Gross Sections

S a r t o r i um
suscle
Profundafemoris (deep femoral) artery and vein
Pectineus

lliopsoas

Fascialata
Branchesof femoral nerve
Femoralartery and vein

Adductorlongusmuscle
Creat saphenousvein

Rectusfemorismuscle

Obturatornerve(anteriorbranch)

V a s t u sm e d i a l i s

Adductorbrevismuscle

Lateralfemoralcutaneous

Obturatornerve
(posteriorbranch)

V a s t u si n t e r m e d i u s

C r a c i l im
s uscle
Vastuslateralis

A d d u c t om
r a g n u sm u s c l e

Tensorfasciaelatae muscre

Sciaticnerve

l l i o t i b i a tl r a c t

femoral
Posterior
nerve
cutaneous

C l u t e u sm a x i m u sm u s c l e

S e m i m e m b r a n o smuuss c l e
S e m i t e n d i n o sm
u su s c l e
Bicepsfemoris muscle (long head)

Vastusmedialism
Rectusfemoris muscle
V a s t u si n t e r m e d i u sm u s c l e

i n t e r m u s c u lsaer p t u mo f t h i g h
muscle
Sartorius

Vastuslateralis
muscle
in adductor
canal

lliotibialtract
Lateralintermuscular

septumof thigh
Biceps
{ S h o r th e a d
temons I
muscle ( Long head

Creat saphenousvein

Adductorlongusmuscle
Cracilismuscle

S e m i t e n d i n o s um
s uscle
S e m i m e m b r a n o s um
s uscle

Adductorbrevismuscle
femoris (deep femoral) artery

A d d u c t om
r a q n u sm u s c l e
Rectusfemoris tendon
V a s t u si n t e r m e d i u sm u s c l e
l l i o t i b i a tl r a c

septumof thigh
intermuscular
Posterior
Sciaticnerve
V a s t u sm e d i a l i sm u s c l e

Vastuslateralis

muscle
Sartorius

A r t i c u l a rg
i se n u sm u s c l e

genicular
artery
aphenousnerveand descending

Lateralintermuscular
septumof thigh
Fem
Bicepsfemoris muscle
Common fibular
(peronealn
) erve
Tibial nerve

Hip and Thigh

Creat saphenousvein

C r a c i l im
s uscle
AdductormaBnustendon
Poplitealvein and artery

Nr

S e m i m e m b r a n o s um
s uscre
Semitendinosusmuscle

Plate 5O5

Knee: Lateral and Medial Views

Lateral view

Vastuslateralis
muscle

lliotibialtract
femoristendon
Quadriceps

Bicepsfemoris { Lone head

muscle

I Snoitneao

Bursadeep to iliotibialtr

Patella

F i b u l a rc o l l a t e r alli g a m e n t
and bursa deep to it---

Plantaris
muscle

Lateralpatellarretinaculum

Bicepsfemoris tendon and its

inferiorsubtendinous
bursa

Jointcapsuleof knee

C o m m o nf i b u l a r
(peroneal)
nerve
P a t e l l a lri g a m e n t
Head of fibula

Castrocnemius
muscle

Tibialtuberosity

Soleum
s uscle
F i b u l a r (i sp e r o n e u s )
l o n g u sm u s c l e

Tibialisanterior muscle

Medialview
Sartorius
muscle

Vastus
medialis
muscle
Quadricepsfemoris tendon

Cracilim
s uscle
Tendon of semitendinosusmuscle
anosusmuscle and tendon

Medialepicondyle
of femur

A d d u c t om
r a g n u tse n d o n
Parallel
- . . - fibers
--) Tibial
) collateral
Obliquefibers ligament
)

Medialpatellarretinaculum

Nr

Patellarli

Semimembranosus
DUrSa
Anserinebursa
deep to
Semitendinosus, l
Pes
C r a c i l i s a, n d
) anseflnus
Sartoriustendons )

Castrocnemim
u su s c l e
T i b i atlu b e r o s i
Soleusmuscle

Plate 506

Knee

Knee: Anterior Views


Rightknee in extension
Femur
muscle
Vastusintermedius

genusmuscle
Articularis

Vastuslateralis
muscle
Vastusmedialismuscle

lliotibialtract
Lateralpatellarretinacul

Rectusfemoristendon(becoming
femoristendon)
quadriceps

Lateralepicondyleof femur

Patella

Fibularcollateralligament and

Medialepicondyleof femur

Bicepsfemoris tendon and its

Medialpatellarretinaculum

inferiorsubtendinous

ligament
Tibialcollateral

Broken line indicates


bursa deep to iliotibialtract

Pes
ansennus

Insertionof iliotibialtract to Cerdy's


t u b e r c l ea n d o b l i o u el i n e o f t i b i a
) erveC o m m o n f i b u l a r( p e r o n e a l n

A n s e r i n be u r s a

Head of finut.-=}

Medialcondyleof tibia

(peroneus)
longusmuscle
Fibularis

ligament
Patellar

digitorumlongus
Extensor

Tibialtuberosity

T i b i a l ias n t e r i om
r uscle

muscle
Castrocnemius

foint opened,
kneeslightlyin flexion
(synovial)
bursa
Suprapatellar
genusmuscle
Articularis
Synovialmembrane (cut edge

Cruciate ligaments(covered by synovialmembrane)

Medial condyle of femur

Lateralcondyle of
Infrapatellarsynovialfold
Origin of popliteustendon
(covered by synovialmembrane

M e d i a lm e n i s c u s

recess
Subpopliteal
Alar folds (cut)
Lateralmeniscus
Fibularcollateralligament
Head of fibula

Infrapatellarfat pads (lined by synovialmembrane)

Suprapatellar(synovial)bu rsa (roof re flected)

(articular
surface
Patella
on posterioraspect)

Vastuslateralis
muscle
(reflected i nferiorly\

Knee

Vastus medialis muscle (reflected inferiorly)

4{r
Plate 5O7

Knee: Interior

lnferior view
P a t e l l a lri g a m e n t

l l i o t i b i a tl r a c t b l e n d e di n t o l a t e r a l
p a t e l l a rr e t i n a c u l u ma n d c a p s u l e

patellarrelinaculum
Yedial
b l e n d e di n t o j o i n t c a p s u l e

, --------

Bursa

S u p r a p a t e l l asry n o v i a b
l ursa

Subpopliteal

S y n o v i am
l e m b r a n e( c u t e d g e )
P o p l i t e u st e n d o

I n f r a p a t e l l asry n o v i a fl o l d
'---

ri

Posterior cruciaIe ligamenl

p-Iibi
al col la.tera| |igament
(superlicia
d ln d d e e p p a r l s )
l'
L . r t e r acl o n d y l eo f f e m u r

M e d i a l c o n d y l eo f f e m u r

A n t e r i o rc r u c i a t el i g a m e n t

Obliquepopliteal igament

A r c u a t ep o p l i t e a l i g a m e n t

S e m i m e m b r a n o s ut se n d o n
Posterior aspect
Superior view
--- .-

P o s t e r i om
r e n i s c o f e m o r al lig a m e n t

semimembranosustendon
Obliquepopliteal igament

A r c u a t ep o p l i t e a l i g a m e n t

Posteriorcruciate ligament
T i b i a lc o l l a t e r alli g a m e n t
( d e e pp a r t b o u n d t o
m e d i a lm e n i s c u s )

P o p l i t e u st e n d o n

M e d i a lm e n i s c u s

S u b p o p l i t e arle c e s s

S y n o v i am
l embrane

L a t e r am
l eniscus

S u p e r i o ra r t i c u l a rs u r f a c e

S u p e r i o ra r t i c u l a sr u r f a c e
o f t i b i a ( l a t e r afl a c e t )

\.:l'l:;Jffdia'|fa'ce,

l l i o t i b i a tl r a c t
b l e n d e di n t o c a p s u l e

A n t e r i o rc r u c i a l el i g a m e n t

I n f r a p a t e l l af ra t p a d

P a t e l l a lri g a m e n t

ani".io, aspectI
S u p e r i o r v i e w : l i g a m e n t sa n d c a r t i l a g er e m o v e d
A t t a c h m e n to f p o s t e r i o rc r u c i a t el i g a m e n t

A l t a rh m e n t o f s y n o v i a m
l embrane---r-_

S u p e r i o ra r t i c u l a rs u r f a c e
o f t i b i a( l a t e r afl a c e t )

A t t a c h m e n t so f h o r n s
o f l a t e r a lm e n i s c u s

In t e r c o n d y l aer m i n e n c e
A t l a c h m e nol I s y n o v i am
l embrane
S u p e r i o ra r t i c u l a sr u r f a c e
o f t i b i a ( m e d i a lf a c e t )
A t t a c h m e n to f a n t e r i o r
c r u c i a t el i g a m e n t

A t t a c h m e n t so f h o r n so f m e d i a lm e n i s

T i b i atl u b e r o s i t y

Plate 5O8

Nr
Knee

Knee: Gruciate and Gollateral Ligaments

Right knee in flexion: anterior view


Posterior
cruciateligament

Anteriorcruciate
Lateralcondvleof
femur(articular

surface)
Medialcondyleof femur(articular

surf
Medialmeniscus

Popliteus
tendon
Fibularcollateral
ligament

ligament
collateral

Medialcondyleof tibia

Lateralmeni
Transverse
ligamentof

'Tibialtuberosity

Headof fibu

Right knee.inextension:
posteflor vlew

Cerdv'stubercle

Posteriorcruciateligament
Anteriorcruciateligament
Posteriormeniscofemoral
ligament

Adductortubercleon
medialepicondyleof

Lateralcondyleof
femur (articular
surface)

Medialcondyleof femur(articular
surface)

Popliteustendon
Medialmeniscus
Fibularcollateral
ligament
ligament
Tibialcollateral
Lateralmeniscus
Medialcondyleof ti

of fibula

4{tr
Knee

Plate 5O9

Knee: Anteroposterior Radiograph

F
FE
HF
ICE
L
l-CF

Fibula
Femur
Head of fibula
Intercondylareminence
L a t e r ael p i c o n d y l e

Lateralcondyle of femur
tCT Lateralcondyle of tibia
M
M e d i a le p i c o n d y l e
M C F M e d i a lc o n d y l eo f f e m u r
M C T M e d i a l c o n d y l eo f t i b i a
P
Patella
T

Plate 5l O

Tibia

Knee

Knee: Posterior and Sagittal Views

Rightknee:
Femur(poplitealsurface)
A d d u c t o r m a g n u st e n d o n

Attachment of joint capsule

Medial head of gastrocnemrus


m u s c l ea n d s u b t e n d i n o u sb u r s a

Plantarismuscle
Lateralhead of gastrocnemiusmuscle
a n d s u b t e n d i n o u sb u r s a

T i b i a lc o l l a t e r alli g a m e n t
S e m i m e m b r a n o s ut se n d o n

F i b u l a rc o l l a t e r alli g a m e n t
and its inferior
S u b t e n d i n o u sb u r s a

Obliquepopliteal igament
( t e n d i n o u se x p a n s i o no f
s e m i m e m b r a n o s um
s uscle)

Biceosfemoris tendon
and bursa beneath it

S e m i m e m b r a n o s ubsu r s a
deep to tendon (broken line

Arcuate popliteal ligament


(edge of capsulethat arches
o v e r p o p l i t e u sm u s c l e )

Popliteusmuscle

Headof fibula
Posteriorligament of
f i b u l a rh e a d
Attachment of joint capsule

Femur

Articularis
S e n u sm u s c l e

Interosseousmembrane
Tibia

Quadriceps
femoristendon

Lateral
subtendinous
bursaof

S u p r a p a t e l l(asry n o v i abl )u r s a
Patella

gastrocnemius
muscte

S u b c u t a n e o up
s r e p a t e l l abr u r s a
Articularcavity
S y n o v i am
l embrane
P a t e l l a lri g a m e n t
Synovial
memDrane

Infrapatellarfat pad

infrapatellar
bursa
Subcutaneous
D e e p( s u b t e n d i n o ui ns f) r a p a t e l lbaur r s a
Lateralmeniscus

A r t i c u l acra r t i l a g e s

Tibia

Knee

Tibialtuberosity

*{r

Sagittalsection
(lateralto midlineof knee)

Plate 511

Arteries of Thigh and Knee: Schema

Superficial
circumflex iliac artery

Superficialepigastricartery
Superficialexternalpudendal artery

Femoralartery

Obturator artery
Deep externalpudendal artery
Medial circumflexfemoral artery

A s c e n d i n gb r a n c h ,
Transversebranch,
Descendingbranch of
Lateralcircumflex
femoral artery

Profundafemoris
(deep femoral)

Femoralartery

Muscularbranches

artery

Perforatingbranches

Femoralartery passing
through adductor hiatus
Descendinggenicularartery
.zArticular branch

S a p h e n o ubsr a n c h
S u p e r i om
r e d i agl e n i c u l aarr t e r y
S u p e r i o rl a t e r a lg e n i c u l a ra r t e r y

Popliteal
artery(phantom)
Patellaranastomosis
Inferior lateralseniculararter
(partiallyin phintom)
Posteriortibial recurrentartery
(phantom\

C i r c u m f l efxi b u l a b
rr
Anterior tibial a

Nr

Plate 512

I n t e r o s s e om
u se m b r a n e

Middlegeniculararrery(phantom)
lnferiormedialgenicularartery
(partiallyin phantom)

Anteriortibialrecurrentartery
Posterior
tibialartery(phantom)
Fibular(peroneal)
artery(phantom)

Knee

Tibia and Fibula

B o n e so f
right leg

Anterior
i n t e r c o n d y l aar r e a

view
Posterior

Anterior view

-lntercondylar eminencel
Lateral
Medial
intercondylar intercondylar

/-lntercondylar eminencel
Lateral
Medial
intercondylar intercondylar
tubercle
tubercle

tubercle
Posterior
intercondylar
\
area

L a t e r a cl o n d y ' " \ ,

tubercle
/___-

Medial
condyle

Lateralcondyle

C e r d y ' st u b e r c l e
( i n s e r t i oonf
iliotibialtract)

Neck
of
fibula

Apex,
Head,
Neck
of
fibula
Croove for
insertionof
semimembranosus
tendon

Tibial
Solealine
Lateral

Superior
articularsurfaces
( m e d i a la n d
lateralfacets)

Lateralsurface
Nutrient
foramen
A n t e r i o rb o r d e r

Anterior
border..............._

Interosseous

border

Interosseous
border

Posterior
surface

It

Medial surface

Posterior
surface

Medial crest

Medial surface
M e d i a lb o r d e r

M e d i a lb o r d e r - .
Lateralsurface

Tibia

Posterior
border

4ftr

Croove for
t i b i a l i sp o s t e r i o r
a n d f l e x o rd i g i t o r u m
l o n g u st e n d o n s
F i b u l a rn o t c h

Lateral
malleolus

Medial
malleolus

Lateral
malleolus

malleolus-

{
Y

Articularfacet
of lateral
malleolus

Leg

lnferior
articular
surface

r t i c u l a rf a c e to f
m e d i a lm a l l e o l u s

Articularfacet
of medial
malleolus

lnferior
articular
surface

M a l l e o l a rf o s s a
of lateral
malleolus

Plate 513

Tibia and Fibula (continuedl

Anteriorview with ligamentattachments


lliotibialtract

Superiorview

osterior I Cruciate
Anterior J ligaments

Fibular
collateral
ligament

Posteriorligament
of fibular head

intercondylararea
(origin of posterior
cruciate ligament)

Tibial
collateral
ligament

Biceps
femoris

Fibula

te

Intercondylar
emtnence

Posterior

Tibia

Anterior ligament
of fibular head

Head of

Medial condvle

fibula

Lateral
condyle

Anterior
ligament
of fibular

Superior
articularsurface
(medialfacet)

Superior
articularsurface
(lateralfacet)

head

Tibial
tuberosity

Cerdy's
tubercle

\tuuai"t
I

Anterior

Lateralt

Anterior

intercondylar
area
(originof anterior

Intercondylar
tubercles

cruciate ligament

Anterior
border

Anterior
border

Crosssection

Interosseous
border

Interosseous
border

Interosseousborder

Lateralsurface

nterosseous
membrane

Lateral
surface

Lateral
surface
Tibia

4{ry

Posteriorsurface

Inferior view
Anterior
Anterior
tibiofibular
ligament

Articularfacet

Anterior

of lateral

Fibula

Lateral
malleolus

Calcaneofibular
ligament

Pfate 514

Medial
malleolus

Anterior
talofibular
ligament

Medial
(deltoid)
ligament
of ankle

Malleolar
fossaof
lateralmalleol
Posterior
tibiofibularligament

Articular
facet of
medial
malleolus
Medial
malleolus

Tibia
Posterior
Inferiorarticular
surfaceof tibia

Leg

Attachments of Muscles of Leg

Anteriorview

Posteriorview

Plantaris
muscle

muscle
Castrocnemius
( m e d i a lh e a d )

(lateralhead)

l l i o t i b i a tl r a c t

muscle
Popliteus

Bicepsfemoris muscle

Fibularis
(peroneus)
l o n g u sm u s c l e

Extensor
digitorum
l o n g u sm u s c l e

Quadricepsfemoris
m u s c l ev i a
p a t e l l a rl i g a m e n t

Soleus

Tibialisposterior
muscle

musc

T i b i a l i sa n t e r i o r
muscle

Flexor
digitorum
l o n g u sm u s c l e

Extensor
hallucis
l o n g u sm u s c l e

Fibularis
(peroneus)
brevismuscle

Fibularis
(peroneus)
t e r t i u sm u s c l e

Origins

Insertions

Note:Attachments
of intrinsicmuscles
of foot not shown

Tibialis
posteriormuscle

Flexorhallucis
l o n g u sm u s c l e

F i b u l a r i(sp e r o n e u s )
brevismuscle
Plantaris
muscle
S o l e ua
snd
gastrocnemius
via
muscles
(Achilles)
calcaneal
tendon

Fibularis
(peroneus)
b r e v i sm u s c l e
Fibularis
(peroneus)
tertiusmuscle
Extensor
digitorum
l o n g u sm u s c l e

4fF
Leg

Flexorhallucis
Extensor
longusmuscle
hallucis
l o n g u sm u s c l e

Fibularis
(peroneus)
rongus
muscre
Flexor
digitorum
longus
muscle

Plate 515

Muscles of Leg (superficial Dissection|: Posterior view


Seealm Plate 540

l l i o t i b i at rl a c t

S e m i t e n d i n o s um
s uscre

B i c e p fse m o r i sm u s c l e

S e m i m e m b r a n o s um
s uscre

Tibialnerve

Cracilim
s uscle

) erve
C o m m o n f i b u l a r( p e r o n e a l n

P o p l i t e aal r t e r ya n d v e i

S u p e r i o rl a t e r a lg e n i c u l a ra r t e r y

S a r t o r i u sm u s c l e

t a r i sm u s c l e

S u p e r i o rm e d i a lg e n i c u l a ra r t e r y

Castrocnemim
u su s c l e( l a t e r ahl e a d )

C a s t r o c n e m i u sm u s c l e( m e d i a lh e a d

Lateralsuralcutaneous
nerve(cut)

N e r v et o s o l e u sm u s c l e

Medialsuralcutaneous
nerve(cut)
S m a l ls a p h e n o u sv e i n

C a s t r o c n e m i u sm u s c l e

S o l e u sm u s c l e

S o l e u sm u s c l e

P l a n t a r ti e
s ndon

Flexordigitorum longus tendon --__*


Tibialis posterior t"naon __________
Posteriortibial artery and vei
T i b i a ln e r v e

-"---j
Medialmalleolus
Flexorhallucislongus tendon
F l e x o rr e t i n a c u l u

*{r
Plate 516

Calcanealbranch of
posterior tibial artery

F i b u l a r i s( p e r o n e u s l)o n g u st e n d o n
i
Fibularis(peroneus)brevis tendon
a l c a n e a (l A c h i l l e st)e n d o n
L a t e r am
l alleolus
S u p e r i o rf i b u l a r( p e r o n e a l r) e t i n a c u l u m

i b u l a r( p e r o n e aal )r t e r y
Calcanealbranchesof fibular (peroneal)artery
alcanealtuberosity

Leg

Muscles of Leg (lntermediate Dissection): Posterior View


SeealsoPlate 541

Tibial nerve

Adductor magnustendon

Common fibular (peroneal)nerve (cut)


P o p l i t e aal r t e r ya n d v e i n
Superiorlateralgenicularartery
S u p e r i o rm e d i a lg e n i c u l a ra r t e r y
C a s t r o c n e m i u sm u s c l e
( m e d i a lh e a d )( c u t )
T i b i a fc o l l a t ear l | g a m e n t /

Lateraland medial suralcutaneousnerves(cut)


C a s t r o c n e m i u sm u s c l e( l a t e r ahl e a d )( c u t )
F i b u l a rc o l l a t e r alli g a m e n t
Bicepsfemoris tendon (cut)

S e m i m e m b r a n o s ut se n d o n (
taris muscle
I n f e r i o rm e d i a lg e n i c u l a ra r t e r y
lnferior lateralgenicularartery

Popliteus
muscle
T e n d i n o uasr c ho f
Soleum
s uscle

Head of fibula
) e r v e( c u t )
m m o n f i b u l a r( p e r o n e a l n
N e r v e t o s o l e u sm u s c l e

P l a n t a r i tse n d o n
F i b u l a r i (sp e r o n e u s l)o n g u sm u s c l e
C a s t r o c n e m i u sm u s c l e( c u t )
muscle

S o l e u sm u s c l ei n s e r t i n gi n t o
c a l c a n e a(l A c h i l l e st)e n d o n

F l e x o rd i g i t o r u ml o n g u st e n d o n
T i b i a l i sp o s t e r i o rt e n d o n
Posteriortibial artery and vein
Tibial
Medial
F l e x o rh a l l u c i sl o n g u st e n d o n
Flexorretinaculum
Calcaneal(Achilles)tenoon
Calcanealbranch of
posteriort i b i a la r

Leg

F i b u l a r i s( p e r o n e u s l)o n g u st e n d o n
F i b u l a r i s( p e r o n e u s b) r e v i st e n d o n
L a t e r am
l alleolus
S u p e r i o rf i b u l a r( p e r o n e a l r) e t i n a c u l u m
Fibular(peroneal)artery
Calcanealbranches
of fibular (peroneal)artery
Calcanealtuberosity

4{tr
Plate 517

Muscles of Leg (Deep Dissectionf: Posterior View

Superiormedialgenicular
artery
Castrocnemius
muscle(medialhead)(cut)
S u r a(l m u s c u l abr )r a n c h e s
Popliteal
arteryand tibialnerve
Tibial collateralligament

Semimembranosus
tendon(cut

Superiorlateralgenicular
artery
Plantaris
muscle(cut)
Castrocnemius
muscle(lateralhead)(cut)
Fibularcollateral
ligament
Bicepsfemoristendon(cut)
Inferiorlateralgenicular
artery
of fibula

Inferiormedialgenicular
artery
Commonfibular(peroneal)
nerve
Popliteus
muscle
Posterior
tibialrecurrentartery
Tendinous
archof soleusmuscre

Posterior
tibialartery

Flexordigitorumlongusmuscle

muscle(cutand reflected)
Anteriortibialartery

Fibular(peroneal)
artery

Tibial nerve

Flexorhallucislongusmuscle(retracted)
Tibialisposterior muscle

Fibular(peroneal)
artery

(Achilles)
Calcaneal
tendon

Interosseous
membrane

Flexordigitorumlonguste
Tibialisposteriortendon
Medial malleolusand posterior medial
malleolarbranch of posteriortibial art<

Flexorretinaculum

(peroneus)
Fibularis
longustendon
(peroneus)
Fibularis
brevistendon
Lateralmalleolus
and posteriorlateral
malleolar
branchof fibular(peroneal)
artery
Superiorfibular(peroneal)
retinaculum

Medial calcanealbranchesof
posteriortibial artery and tibial

Lateralcalcaneal
branch
of fibular(peroneal)
artery

Tibialisposteriortendon

Lateralcalcaneal
branchof suralnerve

Medialplantararteryand nerve

Inferiorfibular(peroneal)
retinaculum

Lateralplantararteryand nerve

*{r
Plate 518

Flexorhallucislongustendon
l st metatarsalbone

(peroneus)
Fibularis
brevistendon
(peroneus)
Fibularis
longustendon
Flexordigitorumlongustendon
5th metatarsal
bone

Leg

Muscles of Leg (superficial Dissection|: Anterior View

muscle
Vastuslateralis

Vastusmedialismuscle
Patella

Rectusfemoris tendon
q u a d r i c e p sf e m o r i st e n d o n )

Superiormedialgenicularartery

lliotibialt

artery
Superiorlateralgenicular

ligament
Tibialcollateral
M e d i a pl a t e l l arre t i n a c u l u m

Lateralpatellarretinaculum
Bicepsfemoristendon
Inferiorlateralgenicular
) erve
C o m m o n f i b u l a r( p e r o n e a l n

Headof fibula

artery
nferiormedialgenicular
lnfrapatellar
branch(cut)of
nerve(cut)
Saphenous
J o i n tc a p s u l e
ligament
Patellar
muscle
Insertion
of sartorius

(peroneus)
Fibularis
longusmuscle

Tibialtuberosity
Tibia

T i b i a l ias n t e r i om
r uscle
muscle
Gastrocnemius
Superficial
fibular
(peroneal)nerve

Soleum
s uscle

Extensor
digitorumlongusmuscle

Extensor
hallucislongusmuscle

Fibula
Superiorextensorretinaculum

Medialmalleolus

Lateralmalleolus
Inferiorextensorretinaculum

lis anterior tendon

Extensor
digitorumlongustendons

Medial branch of deep fibular (peroneal)nerve

F i b u l a r (i sp e r o n e u st e) r t i u st e n d o n

E x t e n s o hr a l l u c i sl o n g u st e n d o n

Extensor
digitorumbrevistendons
Extensorhallucisbrevistenoon
Dorsaldigital branches
of deep fibular (peroneal)nerve

Dorsaldigitalnerves

Leg

4{tr
Plate 519

Muscles of Leg (Deep Dissection): Anterior view


SeeafsoPlate &2

S u p e r i o rm e d i a lg e n i c u l a ra r t e r y

S u p e r i o rl a t e r a lg e n i c u l a ra r t e r y

Q u a d r i c e p sf e m o r i st e n d o n

Fibular collateralliBament---_____-_
L a t e r a pl a t e l l a r e t i n a c u l u m

T i b i a lc o l l a t e r alli g a m e n t

l l i o t i b i a tl r a c t ( c u r
Bicepsfemoris tendon (cut)
I n f e r i o rl a t e r a lg e n i c u l a ra r t e r y
C o m m o n f i b u l a r( p e r o n e a rnJ e r v e
Headof fibula
F i b u l a r i s( p e r o n e u s l)o n g u sm u s c l e( c u t

M e d i a l p a t e l l a rr e t i n a c u l u m
nfrapatellarbranch of saphenousnerve (cuf)
I n f e r i o rm e d i a lg e n i c u l a ra r t e r y
Saphenousnerve (cut)
P a t e l l a lri g a m e n t
Insertionof sartoriustenoon

A n t e r i o rt i b i a la r t e r y

E x t e n s odri g i t o r u m
l o n g u sm u s c l e( c u t
) erve
S u p e r f i c i af li b u l a r( p e r o n e a t n
D e e p f i b u l a r( p e r o n e a rnl e r v e
F i b u l a r i s( p e r o n e u s l)o n g u sm u s c l e

A n t e r i o rt i b i a lr e c u r r e n ta r t e r ya n d
r e c u r r e n tb r a n c ho f d e e p p e r o n e a ln e r v e
I n t e r o s s e o um
s embrane
T i b i a l i sa n t e r i o rm u s c l e( c u t )
C a s t r o c n e m i u sm u s c l e

E x t e n s o dr i g i t o r u ml o n g u sm u s c l e
F i b u l a r i s( p e r o n e u s )
b r e v i sm u s c l ea n d t e n d o n

Soleum
s uscle
Tibia
) e r v e( c u t )
S u p e r f i c i af li b u l a r( p e r o n e a l n

F i b u l a r i s( p e r o n e u s l)o n g u st e n d o n
Perforatingbranch of
) rtery
f i b u l a r( p e r o n e a l a
Anterior lateralmalleolarar
L a t e r am
l a l l e o l u sa n d a r t e r i a n
l etwork
Lateraltarsalartery and lateral
b r a n c ho f d e e p f i b u l a r( p e r o n e a rn. ,e r v
E x t e n s o dr i g i t o r u mb r e v i sa n d
e x t e n s o rh a l l u c i sb r e v i sm u s c l e s( c u t

E x t e n s oh
r a l l u c i sl o n g u sm u s c l ea n d t e n d o n ( c u t )
l n t e r o s s e o um
s embrane
A n t e r i o rm e d i a lm a l l e o l a ra r t e r y
ial malleolusand arterialnetwork
D o r s a l i sp e d i sa r t e r y
T i b i a l i sa n t e r i o rt e n d o n
M e d i a lt a r s a la r t e r y
M e d i a l b r a n c ho f d e e p f i b u l a r( p e r o n e a l n
) erve

) r e v i st e n d o n
F i b u l a r i s( p e r o n e u s b
Arcuate artery
Posteriop
r e r f o r a t i n gb r a n c h e s
from deep plantar aich

Deep plantar artery

E x t e n s odr i g i t o r u ml o n g u st e n d o n s( c u t )

Dorsal metatarsalarteries

Extensordigitorum brevis tendons (cut

Extensorhallucislongus tendon (cut)

D o r s a ld i g i t a la r t e r i e s

4{tr
Pfate 52O

Branc.hes
of proper plantar
d i g i t a la r t e r i e sa n d

E x t e n s o hr a l l u c i sb r e v i st e n d o n ( c u t )
digital branchesof
d e e p f i b u l a r( p e r o n e a l )n e r v e

Leg

Muscles of Leg: Lateral View

muscle
Vastuslateralis
Biceps
femoris
muscle

Long

lliotibialtract

Short head

femoristendon
Quadriceps

Tendon

artery
Superiorlateralgenicular
Patella

F i b u l a rc o l l a t e r a l i g a m e n t

Lateralpatellarretinaculum
C o m m o nf i b u l a r
( p e r o n e anl )e r v e

Lateralcondyle of tibia
Patellarligament

lnferior lateral
genicularartery

Tibialtuberosity

Headof fibula
Tibialisanteriormuscle
C a s t r o c n e m i u sm u s c l e

digitorumlongusmuscle
Extensor

F i b u l a r (i sp e r o n e u sl o) n g u s

fibular
Superficial
(peroneal)
nerve(cut)

muscle and tendon

Extensordigitorum longus tendon


Extensorhallucislongus muscle and tendon

F i b u l a r (i sp e r o n e u sb)r e v i s

S u p e r i oer x t e n s orre t i n a c u l u m

m u s c l ea n d t e n d o n

Inferiorextensorretinaculum

Fibula

nsor digitorum brevis muscle

Lateralmalleolus

xtensor hallucislongus tendon

(Achilles)
tendon
Calcaneal
\\
(Subtendinous)
bursa
of tendocalcaneus\
Superiorfibular
( p e r o n e arl e
) tinaculum
l n f e r i ofri b u l a r
( p e r o n e arl e
) tinaculum
(peroneus)
longus
Fibularis
to soleof foot
tendonpassing

Leg

l o n g u st e n d o n s
E x t e n s odri g i t o r u m
\

-l'

(peroneus)
brevistendon
(peroneus)
tertiustendon
Fibularis
5th metatarsal
oone

*{r
Plate 521

Leg: Gross Sections and Fascial Gompartments

Deepfasciaof
(cruralfascia)

Interosseous
membrane

Anteriorcompartmenl
Extensor
muscles
T i b i a l ias n t e r i o r
E x t e n s odri g i t o r u m
longus
E x t e n s ohra l l u c ilso n g u s
F i b u l a r i(sp e r o n e u st e) r t i u s
A n l e r i o tri b i a a
l r t e r ya n dv e i n s
D e e pf i b u l a (r p e r o n e anl )e r v e

ilDra

Deepposteriorcompartment
Deepflexormuscles
F l e x odr i g i t o r u m
longus
T i b i a l ios o s t e r i o r
F l e x ohr a l l u c ilso n g u s
Popliteus
Posteriortibial artery and veins
T i b i a ln e r v e
) r t e r ya n d v e i n s
F i b u l a r( p e r o n e a l a

Anteriorintermuscular
septum
Lateral compartment
F i b u l a r i s( p e r o n e u s l)o n g u sm u s c l e
F i b u l a r i s( p e r o n e u s b) r e v i sm u s c l e
Superficialfibular (peroneal)nerve

Transverseintermuscular septum

Superficialposteriorcompartmenl
flexormuscles
Superficial
Soleus
Gastrocnemius
P l a n t a r (i st e n d o n )

Posteriorintermuscular
septum
FIDUIA

Deep fascia of leg (crural fascia)

Crosssectionjust abovemiddle of leg


T i b i a l i sa n t e r i o rm u s c l e
E x t e n s ohr a l l u c i sl o n q u sm u s c r e
E x t e n s odr i g i t o r u ml o n g u sm u s c l e

A n t e r i o rt i b i a la r t e r ya n d v e i n sa n d
d e e p f i b u l a r( p e r o n e a l )n e r v e
ilDta

l n t e r o s s e o um
s embrane

S u p e r f i c i af li b u l a r( p e r o n e a l )

Creat saphenousvein
a n d s a p h e n o u sn e r v e

A n t e r i o ri n t e r m u s c u l asr e p l

r uscle
T i b i a l ipso s t e r i om

Deep fasciaof leg


(cruralfascia)

Flexordigitorum longus
muscre

F i b u l a r i(sp e r o n e u s )
l o n g u sm u s c l e
F i b u l a r i s( p e r o n e u s )
b r e v i sm u s c l e

) rtery
F i b u l a r( p e r o n e a l a
and veins

P o s t e r i o irn t e r m u s c u l asre D r u m

Posteriortibial artery
a n d v e i n sa n d t i b i a ln e r v e

Flexorhallucislongus
muscte

Lateralsuralcutaneousnerve

Deep fasciaof leg (cruralfascia)

TransverseintermuscularseDtum

P l a n t a r i tse n d o n

Soleum
s uscle
C a s t r o c n e m i u sm u s c l e( l a t e r ahl e a d )

4{tr
Pfate 522

S u r a lc o m m u n i c a t i n gb r a n c h
o f l a t e r a sl u r a lc u t a n e o u sn e r v e

C a s t r o c n e m i u sm u s c l e( m e d i a lh e a d )
M e d i a l s u r a lc u t a n e o u sn e r v e
S m a l ls a p h e n o u sv e t n

Leg

Bones of Foot

Dorsalview

Lateral tubercle

tubercle

Calcaneus
BodyFibular

Posterior
process

Croove for
tendon of
flexor hallucis
longus
Trochlea
Neck
ao

(peroneal)
trochlea

Navicular
Tuberosity

Tuberosity
of 5th
metatarsal
DOne

.q

r"rroretatarsaljoint
Base

Plantarview

Calcaneus
Tuberosity
Medial process

Shaft(body)

Lateral
tubercle

ateralprocess
tali
Sustentaculum

Medial
tubercle

Croove for
tendono{ flexor
h a l l u c ilso n g u s
Fibular(peroneal)
trochlea

Posterior
process
Head

Transverse
tarsaliointl,

Cuboid
Tuberosity
roove for

Tuberosity

Navicular
Tuberosity

fibularis
(peroneus,
longustendon
Tuberosity
of 5th
metatarsal
bone

al iointj
Tarsometatars

Base
Shaft(body)

Metatarsalbones

r ''-dirl
Sesamoid
Uones{ i"lYj
Lareral
t

Head
Base
Shaft(body)
Head
Base
Head
Tuberosity

*{r
Ankle and Foot

Phalanges

Plate 523

Bones of Foot (continued|

lateral view
ransversetarsaljoint
Navicular

l"T;1J;: cun"iro,.
tron",
I
joint
Tarsometatarsal
Metatarsalbones

Body
t.

Fibular
(peroneal)

trochlea
Tuberosity
Croovefor
f i b ul a r i s
(peroneus)

Cuboid
Tuberosity

Tuberosity
of
5th metatarsal
bone

l o n g u st e n d o n
Croove for fibularis

( p e r o n e u sl o) n g u st e n d o n

M e d i a l vew
i
Transversetarsaljo i n t

Navicular
Tuberosity
cuneiform"uon",
" -" {
I

Intermediate
\
Mediat-f

Tarsometatarsal
ioint--a
Metatarsalbones

Tuberosityof
l st metatarsal
bone
Sesamoidbone

Tuberosity
Croove for tendon of
flexor hallucisloneus

Calcaneus

Sustentaculum
tali

Plate 524

Ankle and Foot

Galcaneus
Rightfoot
Posteriortalar
articularsurface

Articularsurface
for cuboidbone

Anteriortalar
a r t i c u l asru r f

Middletalar
articularsurface
Anteriortalar
articularsurface

Middletalar
articularsurface

Posterior
talar
articular
surface

Articularsurface
f o r c u b o i db o n e

Fibular
(peroneal)
trochlea

Tuberosity
Lateralprocess

Sustentaculumtali

Croovefor fibularis

of tuberosity

Body

( p e r o n e u s l)o n g u st e n d o n

Lateralview
Anterior talar
articularsurface

ibular
(peroneal)
trochlea

C a l c a n e asl u l c u s

Middle talar articularsurface

Tuberosity

Posterior
talar
articularsurface

Superiorview
Middletalararticularsurtace

Articular
surface
for cuboid

rior talar
articularsurface

Tuberosity

bone

tali
Sustentaculum
Sustentaculumtali

Groovefor tendon
o f f l e x o rh a l l u c ilso n g u s

Medial
processof
tuberosity

Medialview

I n t e r o s s e om
u se m b r a n e

Medial
(deltoid)
ligament
of ankle

Posterior
talocalcaneal
ligament

*{r
Ankle and Foot

Fibular
(peroneal)
trochlea

h a l l u c ilso n g u s
Medial

Fibula

Talus

Croove for
tendon of flexor

Posterior
tibiofibular
ligament

processof
tuberosity

teral
processof
tuberosity

Tuberosity

Posteriorview

Posterior
talofibular
ligament
Calcaneofibular
ligament
F i b u l a r( p e r o n e a l )
t e n d o n si n i n f e r i o r
f i b u l a r( p e r o n e a l )
retinaculum

Posteriorview
with ligaments

Functionalrelationsof calcaneus

Plate 525

Ankle: Radiographs

Lateralview
C
CB
F
HT
tC
N
PT
ST
T
TC
TM
TT

Calcaneus
Cuboid
Fibula
Headof talus
Lateralcuneiform
Navicular
processof talus
Posterior
Sustentaculum
taliof calcaneus
Tibia
Tuberosity
of calcaneus
Tuberosity
of 5th metatarsal
Trochleaof talus

Anterior view
F

t-M
MM
T
TA

Plate 526

Fibula
Lateralmalleolus
M e d i am
l alleolus
Tibia
Talus

Ankle and Foot

Ligaments and Tendons of Ankle

Rightfoot: lateralview

Tibia

of lateral
Components
(collateral)
ligament
of ankle

Fibula--------

lnterosseoustalocalcanealligament
Dorsal talonavicularligament

A n t e r i o ra n d

Posterior
tibiofibular
ligaments

C a l c a n e o n a v i c u l a r l i g a m e| n t^ . .
a,:-----.-a
BlturcatellEament
/ c.l.rn"o.uboid lig--amentI
cu boideonavicularligament

Superiorfibular(peroneal)
retinaculum-

ligaments
Dorsalcuneonavicular
ligaments
Dorsalintercuneiform
ligaments
Dorsaltarsometatarsal

Calcaneal(Achilles)
tendon (cut

lnferior
fibular
(peroneal)
retinaculum

Dorsal metatarsalligaments

Lateraltalocalcanealligament

Dorsalcuneocuboidligament

Long plantar ligament

Cuboidbone

F i b u l a r (i sp e r o n e u sl o) n g u st e n d o n

Dorsal calcaneocuboidliqament

(peroneus)
Fibularis
brevistendon

Rightfoot: medialview
ligament
Medialtalocalcaneal

Medial(deltoid)
l i g a m e n to f a n k l e

processof talus
Posterior
Dorsal talonavicularligament

Posterior
talocalcaneal

Navicularbone

ligament

Dorsal cuneonavicularli
Medial cuneiform bone

Calcaneal
(Achilles)
tendon
(cut)

Dorsal intercuneiformligament

Dorsaltarsometatarsal
ligaments
I st metatarsal

Tuberosity

Nr

T i b i a l i sa n t e r i o r

Ankle and Foot

Tibialisoosteriortendon

Shortplantar
ligament
Plantarcalcaneon a v i c u l a r( s p r i n g )l i g a m e n t

ong plantarligament

Plale 527

Ligaments and Tendons of Foot: Plantar View

F l e x o rd i g i t o r u ml o n g u st e n d o n t o 2 n d t o e ( c u t

Distalphalanxof greattoe

Flexordigitorum brevis tendon to 2nd toe (cut

I n t e r p h a l a n g e( laPl )j o i n t

4 t h d i s t apl h a l a n x

F l e x ohr a l l u c ilso n g u st e n d o n( c u t )

4 t h m i d d l ep h a l a n x
Proximalphalanxof great toe
Deep transversemetatarsalIigaments
Metatarsophalangeal(MP) joint

5 t h p r o x i m a lp h a l a n

S e s a m o i db o n e s

4 t h l u m b r i c a lt e n d o n ( c u t )

A b d u c t oh
r a l l u c iasn dm e d i ahl e a d
of flexorhallucisbrevistendons(cut)

A b d u c t o rd i g i t i m i n i m i
a n d f l e x o rd i g i t im i n i m i
brevistendons (cut)

Adductor hallucisand lateralhead


of flexor hallucisbrevis tendons (cut)

Plantarligaments(plates)

Interosseous
muscles(cut)

l st metatarsal
bone

5th metatarsalbone

Plantartarsometatarsalligaments

Plantarmetatarsalligaments

M e d i a lc u n e i f o r mb o n e

Tuberosity
of 5th metatarsal
bone
Tibialisanterior tendon (cut)

F i b u l a r (i sp e r o n e u s )
brevistendon

P l a n t a rc u n e o n a v i c u l alri g a m e n t

Cuboidbone

P l a n t a rc u b o i d e o n a v i c u l al ri g a m e n t

F i b u l a r i s( p e r o n e u s )
longus tendon

T u b e r o s i toyf n a v i c u l abro n e
P l a n t a rc a l c a n e o n a v i c u l a( sr p r i n g )l i g a m e n t

T u b e r o s i t yo f c u b o i d b o n e
L o n g p l a n t a rl i g a m e n t

Tibialisoosteriortendon

Plantarcalcaneocuboid
(short plantar)ligament,

Flexordigitorum longustendon (cut)

S u s t e n t a c u l ut aml i

Calcaneus

F l e x o rh a l l u c i sl o n g u st e n d o n ( c u t )

Medial process
and
Lateralprocess
of

Posteriororocessof talus
( m e d i a la n d l a t e r a tl u b e r c l e s )

Tuberosity
of calcaneus

*{r
P h a l a ng e s

J o i n ct a p s u l e
Proximal

Metatarsalbone

Capsulesand ligaments of
metatarsophalangealand
i n t e r p h a l a n g e a jl o i n t s :
lateral view
Collateralligaments

Plate 528

P l a n t a rl i g a m e n t

Ankle and Foot

Tendon Sheaths of Ankle

Lateralview

S o l e u sm u s c l e

Extensordigitorum longus muscle

F i b u l a r (i sp e r o n e u s )
l o n g u sm u s c l e

Suoeriorextensorretinaculum
snterior
T e n d i n o ussh e a t ho f t i b i a l i a

F i b u l a r (i sp e r o n e u s )
b r e v i sm u s c l e

b su r s a
L a t e r aml a l l e o l uasn ds u b c u t a n e o u

C a l c a n e a(l A c h i l l e st)e n d o n

Inferiorextensorretinaculum

C o m m o n t e n d i n o u ss h e a t h

sheathof extensordigitorum
Tendinous
tertius
longusandfibularis(peroneal)

o f f i b u l a r i(sp e r o n e u s )
l o n g u sa n d b r e v i

Tendinous
sheathof
extensorhallucislongus

Subcutaneouscalcanealoursa

( S u b t e n d i n o ubsu)r s a
of calcanealtendon
S u p e r i o ra n d
l n f e r i o r-

f i b u l a (r p e r o n e a l )
r e t i n a clua
Calcaneus
Extensordigitorum brevis

Fibularis
(peroneus)
ronSus
tendon

Abductordigiti

Medialview
T i b i a l i sa n t e r i o rt e n d o n a n d s h e a t h

4{tr

Tibia
S h e a t ho f t i b i a l i so o s t e r i o rt endo

Superiorextensor
Medialmalleolus
and subcutaneous
bursa
lnferior extensorretinaculum
Tibialisoosteriortendon and sheat

Fibularis
(peroneus)
brevis
tendon

(peroneus)
tertiustendon
Fibularis
bone
Tuberositv
of 5th metatarsal

Calcaneal(Achilles)
tendon
T e n d i n o u ss h e a t ho f
flexor digitorum longus

tibialartery
Posterior
and tibialnerve
sheathof
Tendinous
f l e x o rh a l l u c ilso n g u s
Subcutaneous
bursa
calcaneal

Tibialisanterior tendon and sheath


T e n d i n o u ss h e a t h
o f e x t e n s o rh a l l u c i sl o n e u

( S u b t e n d i n o ubsu)r s a
tendon
of calcaneal
F l e x or e t i n a c u l u m
Calcaneus

Lateralplantarnerve
M e d i a lp l a n t a r
1st metatarsal
Tendinoussheathof flexor hallucislongui

Ankle and Foot

Tendinoussheathof
flexor digitorum

Abductorhallucismuscle(cut)
Plantaraponeurosis(cut)

Flexordigitorumbrevismuscle(cut)

Pfate 529

Muscles of Dorsum of Foot: Superficial Dissection

Superficialfibular (peroneal)nerve (cut)


F i b u l a r i s( p e r o n e u s b) r e v i sm u s c l e

Tibialisanterior tendon
A n t e r l o rt i b i a la r t e r ya n d
) erve
d e e p f i b u l a r( p e r o n e a l n

Fibularis(peroneus)longus tendon---]
Tibia
Extensordigitorum
l o n g u sm u s c l ea n d t e n d o n
S u p e r i o re x t e n s o r e t i n a c u r u m

F i b ul a
Perforatingbranch of
fibular (peroneal)artery
L a t e r am
l a l l e o l u sa n d a n t e n o r
lateralmalleolarartery
I n f e r i o re x t e n s o rr e t i n a c u r u m
Lateraltarsalartery and lateral
b r a n c ho f d e e p p e r o n e a ln e r v e
(to musclesof dorsum of foot)

E x t e n s o hr a l l u c i sl o n g u st e n d o n
T e n d i n o u ss h e a t ho f
extensordigitorum longus
M e d i a lm a l l e o l u s
T e n d i n o u ss h e a t ho f
t i b i a l i sa n t e r i o r
T e n d i n o u ss h e a t ho f
e x t e n s o rh a l l u c i sl o n g u s
ior medial malleolarartery
Dorsalispedis arterv and medial branch
o f d e e p f i b u l a r( p e r o n e a l )n e r v e
Medial tarsalartery

) r e v i st e n d o n
F i b u l a r i s( p e r o n e u s b
Arcuate artery

Tuberosity
of 5th metatarsal
bone
F i b u l a r i s( p e r o n e u s t)e r t i u st e n d o n
E x t e n s odr i g i t o r u mb r e v i sa n d
e x t e n s o rh a l l u c i sb r e v i sm u s c l e s

Deepplantar
.l arterypassingbetween
headsof st dorsalinterosseous
m u s c l et o j o i n d e e pp l a n t aar r c h
E x t e n s oh
r a l l u c i sl o n e u st e n d o n
Extensorexpansions

E x t e n s odri s i t o r u m
rongus
Lateraldorsal cutaneous
n e r v e( c o n t i n u a t i o no f
sural nerve) (cut)
Dorsal metatarsalarteries

Dorsaldigitalarteries
D o r s abl r a n c h eosf
properplantardigital
arteriesand nerves

Plate 53O

Dorsaldieitalbranches
of
deepfibular(peroneal)
nerve

Dorsal digital branches


o f s u p e r f i c i af li b u l a r
( p e r o n e a l )n e r v e

4ffffi

4.t'/

Ankle and Foot

Dorsum of Foot: Deep Dissection

Soleum
s uscle

Superficialfibular (peroneal)nerve (cut)

r u s c l ea n dt e n d o n
T i b i a l ias n t e r i om

F i b u l a r i s( p e r o n e u s l)o n g u st e n d e n F i b u l a r i s( p e r o n e u s b) r e v i s
m u s c l ea n d t e n d o n

Tibia
Anterior tibial artery and

d e e pf i b u l a (r p e r o n e anl )e r v e

E x t e n s o dr i g i t o r u ml o n g u s
m u s c l ea n d t e n d o n-

E x t e n s ohra l l u c ilso n g u s
m u s c l ea n dt e n d o n

hrbula

Perforatingbranch of
fibular (peroneal)artery

A n t e r i o rm e d i a lm a l l e o l a a
r rtery
M e d i a lm a l l e o l u s

Anterior lateralmalleolarartery

Dorsalispedis artery

Lateral

M e d i a l b r a n c ho f d e e p f i b u l a r
(peronealn
) erve

Lateralbranch of deep peroneal


n e r v e( t o m u s c l e so f d o r s u m
of foot) and lateraltarsalartery

Medial tarsalarteries

Fibularis(peroneus)longustendon (cut)---_.Extensordigitorum brevis and extensor


hallucis breiris muscles (cut)-----------<

l'

F i b u l a r i(sp e r o n e u sb)r e v i st e n d o n( c u 0 - 1
F i b u l a r (i sp e r o n e u s )
tertiustendon (cut)

Tuberosityof navicularbone
Arcuate artery
Posteriorperforatingbranches
from deep plantar arch

f ,.
Deep plantar artery
to deep plantar arch

A b d u c t o dr i g i t i m i n i m i m u s c l e
A b d u c t o hr a l l u c im
s uscle
Dorsalmetatarsalarteries
E x t e n s o hr a l l u c i sl o n q u st e n d o n
Metatarsalbones
D o r s a li n t e r o s s e o um
s uscles
Lateraldorsal cutaneous
n e r v e( c o n t i n u a t i o no f
sural nerve) (cut)
Anterior perforating branches
from plantar metatarsalarteries

E x t e n s o hr a l l u c i sb r e v i st e n d o n
(cut)
Extensordigitorum brevis
t e n d o n s( c u t )
E x t e n s o dr i g i t o r u m
l o n g u st e n d o n s( c u t )
E x t e n s oer x p a n s i o n s

Dorsal digital arteries


D o r s a lb r a n c h e so f
p r o p e r p l a n t a rd i g i t a l
arteriesand nerves

Dorsal digital branchesof


) erve
d e e p f i b u l a r( p e r o n e a l n
Dorsal digital branches
of superficialfibular
( p e r o n e a l )n e r v e

Nr
Ankle and Foot

Plate 531

Sole of Foot: Superficial Dissection

Superficial
transverse
metatarsal
ligaments

Properplantardigital
arteriesand nerves

Superficial
branchof
medialplantarartery

Transversefasciculi

Digitalslipsof
plantaraponeurosis

Lateralolantarfascia

Medial olantarfascia

Cutaneous
branches
of lateralplantar
artery and nerve

Cutaneous
branchesof medial
plantararteryand nerve

Lateralbandof plantaraponeurosis
(calcaneometatarsal
ligament)

Plantaraponeurosis

Medial calcanealbranchesof tibial


nerve and posteriortibial artery

Tuberosity
of calcaneus
with overlyingfat
pad (partially cut awa

4{F
Plate 532

Ankle and Foot

Muscles of Sole of Foot: First Layer

Proper plantar digital branches


o f m e d i a lo l a n t a rn e r v e

Properplantardigitalbranches
of lateralolantarnerve
plantar digital arteries

plantar digital arteries


from plantar metatarsalarteries

L u m b r i c am
l uscles

F i b r o ussh e a t h s
of flexortendons

Flexordigitorum brevis
overlying
F l e x o rd i g i t o r u ml o n g u st e n d o n s

Superficialbranch o{
medial plantarartery

Lateralhead
and
Medial head
of flexor hallucis
brevis muscle

F l e x o rh a l l u c i sl o n g u st e n d o n

Plantarmetatarsal
branchof
lateralplantarartery
Abductorhallucismuscle
andtendon
F l e x o rd i e i t im i n i m i b r e v i sm u s c l e

Flexordigitorumbrevismuscle

Abductordigiti minimi muscle


(deepto lateralplantarfascia)
Plantaraponeurosis(cut)
Medial process
ano
Lateralprocess
of

Medial calcanealbranchesof tibial


nerve and posteriortibial artery

Tuberosity
of calcaneus

4{tr
Ankle and Foot

Plate 533

Muscles of Sole of Foot: Second Layer

Proper plantar digital branches


of medial plantar ner

Flexordigitorumlongustendons
Properplantardigitalbranches
of lateralplantarnerve

Flexordigitorum brevis tendons

Fibroussheaths(opened)
S e s a m o i db o n e s
C o m m o n p l a n t a rd i g i t a l
nervesand arteries
Lumbrical muscles
Lateralhead
ano
Medial head of
F l e x o rd i g i t i m i n i m i
brevis muscle

flexorhallucisbrevismuscre
Flexorhallucislongustendon

Superficialbranch
and

Deepbranch
of lateral
plantarnerve

Lateralplantar nerve and a

Abductorhallucistendon
and muscle(cut)
Flexordigitorumlongustendon
and deep branches
of medial plantar artery
Medial plantarartery and nerve

Quadratusplantaemuscle
T i b i a l i so o s t e r i o rt e n d o n

A b d u c t o dr i g i t im i n i m m
i u s c l e( c u r )

N e r v e t o a b d u c t o rd i g i t i m i n i m i m u s c l e
(from lateralplantar nerve)

F l e x ohr a l l u c ilso n g u st e n d o n
Posterior
tibialarteryand
tibialnerve(dividing)
Flexorretinaculum

Flexordigitorum brevis muscle


and plantar aponeurosis(cut)

Lateralcalcanealnerve and arterv (from


sural nerve and fibular [peroneal]artery

Abductorhallucismuscle(cut)
Medial calcanealartery and nerve
Tuberosityof calcaneus

Plate 534

Nr

Ankle and Foot

Muscles of Sole of Foot: Third Layer

of medialplantarnerve
Properplantardigitalbranches

P r o p e rp l a n t a rd i g i t a lb r a n c h e s
of lateralplantar nerve
Proper plantar digital branch
of superficialbranch
of medial plantar artery
Anterior perforating arteries
to dorsal metatarsalarteries

Tendonsof lumbricalmuscles(cut)
S e s a m o i db o n e s
Flexordigitorum
l o n g u st e n d o n s
Flexordigitorum
brevistendons (cut

Flexordigiti minimi
brevismuscle
Plantarmetatarsal
arteries
Plantarinterosseous
muscles

Transversehead
and
Obliqueheadof
adductorhallucismuscle
head
and
Lateral head of
flexor hallucis brevis muscle
Superficialbranchesof medial
plantar artery and nerve
Flexorhallucislongustendon (cut)

Superficialbranch of
lateralplantar nerv
Deep plantar arterialarch and
deep branchesof lateralplantar nerve
Tuberosityof