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Basic Head & Neck Instructions

Thirteen laboratory sessions are dedicated to dissection of the head and neck. There are probably as
many structures in the head and neck as in thorax and abdomen combined and they are all located
within a space about the same size as the pelvic girdle! As a dissection team you will want to plan your
work carefully and dissect the structures thoroughly. You can maximize your learning in the lab by taking turns
dissecting (usually only one or two people can work on the cadaver at the same time). Study the skull every
day and use pipe cleaners or thin wire to trace the routes of nerves and vessels through the foramina and across
the regions of the skull. Talk to each other (about head and neck!!) and draw charts and paths on the
blackboard.
In the first or second laboratory session (check your schedule) the ER residents from LIJ will demonstrate
the cricothyrotomy procedure. Please read the relevant case and related handouts prior to this lab and make
sure your cadaver is in the supine position at the beginning of lab. If the procedure will be on the second lab
day you must not dissect the skin away from the midline of the neck during lab 1. Follow the directions
carefully for the dissection of the posterior triangle of the neck (Neck 1, Step 3).
The anterior, lateral and posterior aspects of the neck will be dissected during the first three laboratory
sessions. You will begin on the posterior aspect with dissection of the suboccipital region. The cadaver must
be in the prone position. This dissection should be fairly fast because you have already dissected the deep
muscles of the neck (splenius and semispinalis). The suboccipital muscles and triangle lie just deep to the
semispinalis capitis muscles.
After dissecting the suboccipital triangles, turn the cadaver to the supine position for dissection of the posterior
triangle of the neck, also called the lateral cervical region. This region lies between the anterior margin of the
trapezius muscle and the posterior border of the sternocleidomastoid (SCM) muscle. The inferior boundary is
the clavicle. The posterior triangle/lateral cervical region contains many cutaneous nerves and portions of some
of the important fascias of the neck, including the investing fascia and prevertebral fascia. Deep to the
prevertebral fascia lie the scalene muscles and the roots of the brachial plexus.
The anterior triangle of the neck (between the SCM and the midline of the neck) contains several sets of
muscles involved in moving the hyoid bone and anterior cartilages of the neck during speaking and
swallowing. It also contains some essential neurovascular structures including the phrenic and vagus nerves
and the sympathetic chain and ganglia, the common carotid artery and its branches, and the internal jugular
vein and its tributaries.
Following dissection of the neck, one entire lab session is dedicated to study of the skull. This is a dry lab
held in the Belfer building. Two dissection teams will work with one instructor to identify and discuss the
details of the skull. You must bring your bone boxes and a text and atlas to this session. Advanced
preparation on your part will significantly enhance the value of the session.
Dissection of the head begins with the face. The muscles of facial expression and the motor and sensory
nerves of the face will be revealed. The pathways of the facial artery and vein will be traced and the superficial
structures of the orbit and eye will be explored.
Two lab sessions are devoted to dissection of the parotid region on each side of the face. The parotid glands
are important salivary glands and running right through the middle of each gland are the facial branches of CN
VII, the external carotid artery and the retromandibular vein! Deep to these structures you will dissect the
temporal region including the temporomandibular joint. These dissections take you deep into the sides of the

face and reveal the maxillary artery (a major artery of the face) and the mandibular division of CN V.
The study of the scalp begins the preparation for removal of the calvarium (the top of the skull) and
subsequent removal of the brain from the cranium. The scalp is a very clinically important structure and each
one of you will undoubtedly have to suture a scalp wound during your training, so make the most of your
dissection of the scalp.
Special care must be taken when removing the brain because the brains from these cadavers will be stored
and used in your Nervous System course. During the process of removing the brain the structures of the cranial
dura will also be studied. This very important tissue does more that provide protection for the brain. It forms
venous channels that drain blood and CSF from the head into the jugular system, and pathways for nerve
distribution. You will observe and learn the surface anatomy of the brain, the cranial nerves and the major
vascular structures (circle of Willis) of the brain.
Once the brain is removed, you will conduct a thorough dissection of the orbit and eye using the superior
approach through the anterior cranial fossa. This approach gives the best understanding of the eye and related
musculature, nerves, vessels and glands. A deep dissection of the eye from the anterior approach will complete
the study of the orbit and eye.
Toward the end of the work in head and neck, dissection teams will be asked to use one of two different
approaches to dissection of the deeper structures of the head. It will be important for you to read the directions
for both of these dissections and consult with your instructors to determine which dissection your team will
prepare. Realize that you need to be able to identify structures revealed in both dissections.
The pharynx dissection and the oral/nasal cavity dissection are the two approaches that we will use to
explore the deeper structures of the head and neck. Be sure to follow the progress of your colleagues who
are conducting the dissection that you are not!
During the pharynx dissection the head will be separated from C1 and mobilized anteriorly to expose the
posterior aspect of the muscular pharynx. This dissection also reveals a number of cranial nerves and the
superior portions of the external and internal carotid arteries and the internal jugular vein. Following the study
and removal of the buccopharyngeal fascia the pharynx will be opened posteriorly and the posterior aspects of
the nasopharynx, oropharynx and laryngopharynx will be dissected. This unit ends with dissection of the larynx
including dissection of the vocal cords and the intrinsic muscles that move them, the epiglottis and regions of
the laryngeal airway (vestibule, ventricle, and infraglottis).
Those who do the dissection of the oral and nasal cavities will begin by bisecting the head along the
midsagittal plane. This procedure reveals the tripartite nasal septum, delicate curved conchae, and the intricate
collection of sinuses in the nasal cavities (frontal, maxillary, ethmoid, and sphenoid sinuses). The nasopharynx
houses the auditory tube and muscles that act on the soft palate. The oral cavity contains the teeth, tongue, and
the sublingual and submandibular salivary glands and is subdivided into regions the vestibule, floor and roof
which will be examined and dissected. The oropharynx contains the palatine tonsils and some of the many
muscles that attach to and move the tongue and pharynx. This dissection also permits exploration of the larynx
through an anterior midline opening.
Finally, the middle and inner ear cavities will be dissected. This involves popping off the roof of the petrous
ridge with a chisel and hammer. The results are not 100% predictable but, if you follow the instructions
carefully, you will see many of the structures of the middle and inner ear including the tympanic membrane, the
ossicles, the semicircular canals, the cochlea, and the distribution of CNs VII and VIII.

Read carefully, plan well, and work steadily and you will have a great dissection of the head and neck!

Neck 1
General Overview
The neck is a major conduit between the head, trunk and upper limbs. It contains muscles, glands, major
arteries and veins (common, internal and external carotid arteries and various jugular veins), nerves,
lymphatics, the trachea, larynx, esophagus and vertebrae. As in other regions of the body, understanding the
bony and cartilaginous framework of the neck provides important reference points and landmarks for learning
other structures and for palpation and dissection.
The structures in the neck are organized by the investing, prevertebral and pretracheal fasciae that form
compartments and restrict or direct the flow of fluids, e.g. infectious material. One of these compartments can
transmit infectious material inferiorly into the thoracic cavity!! You must have a good understanding of the
fasciae of the neck.
The neck is subdivided (by anatomists) into the suboccipital region and the anterior and posterior (lateral
cervical) triangles of the neck. The suboccipital region lies on the posterior side of the neck between the
inferior aspect of the occipital bone (specifically the inferior nuchal lines) and C2 vertically, and as far lateral
as the mastoid processes and transverse processes of C1. Dissection of the suboccipital region is often done
with the back unit. Therefore, in your texts you will find suboccipital information and review questions.
The anterior and posterior triangles of the neck are both accessible with the cadaver in the supine position.
(Therefore the posterior triangle of the neck is NOT on the posterior side of the body!) The posterior triangle
of the neck, also called the lateral cervical region, is the region posterior to the sternocleidomastoid muscle and
anterior to the anterior border of the upper trapezius muscle, extending from the mastoid process to the
clavicle. Structures in the posterior triangle include the platysma muscle, cutaneous nerves of the neck, the
external jugular vein, the splenius, levator scapulae and scalene muscles, roots and trunks of the brachial plexus
and some of the vasculature of the shoulder.
The anterior triangle is defined by the anterior border of the sternocleidomastoid muscle, the midline of the
neck and the mandible. The two anterior triangles share a common border at the midline of the neck. When
considered together they demarcate a large diamond shaped region across the anterior neck. The hyoid bone,
thyroid, cricoid and tracheal cartilages form the osteocartilagenous support for the muscles of the anterior
triangle. The structures of the anterior triangle of the neck include the platysma muscle, infra- and suprahyoid
muscles, the thyroid, parathyroid and submandibular glands, the carotid arteries and jugular veins, and several
important nerves including the phrenic and vagus nerves, the cervical sympathetic chain and ganglia, the ansa
cervicalis and CNs XI and XII.
The larynx, formed by the internal aspects of the tracheal and cricoid cartilages, will be studied later in the
head and neck unit in conjunction with the nasal and oral pharyngeal spaces.
Cricothyrotomy
This procedure will be demonstrated during the dissection of the neck by the Emergency Medicine residents
from LIJ Hospital. Do not dissect the skin over the midline of the neck until after the cricothyrotomy
demonstration!
The simplest and most rapid access to the airway inferior to the vocal cords may be created by making an
incision through the cricothyroid membrane and inserting a hollow tube. This technique, known as

cricothyrotomy (or cricothyroidotomy), is an important lifesaving procedure that is often used prior to
tracheotomy (opening made in the trachea) in emergency situations. It is usually used when facial deformities
and profuse bleeding from the nose and mouth prevent oral endotracheal intubation.
1. Expose the neck region of the cadaver with the skin in place.
2. Palpate the thyroid cartilage and, inferior to it, the cricoid cartilage. Your fingers will move over the
cricothyroid membrane (ligament) as you move your hand inferiorly.
3. After locating the cricothyroid membrane, incise it transversely. Your blade will cut through just two
layers, the skin and superficial fascia, before hitting the membrane.
4. Once this membrane is penetrated, an emergency airway can be maintained with a hollow tube that is
inserted into the infraglottic cavity of the larynx.

Neck 1
Step 1
Surface Anatomy, Osteology and Fasciae of the Neck
Instructions
Before beginning dissection, study and palpate the surface anatomy of the neck. Pay close attention to
important clinical landmarks such as the external occipital protuberance, mastoid processes and spinous
processes of the vertebrae posteriorly and the laryngeal prominence, jugular notch and clavicles anteriorly
(refer to your atlas for an image). With deep palpation of the lateral side of the neck you can feel the solidness
of the tips of the transverse processes of the vertebrae even though you can't feel a lot of detail. What is their
A/P position relative to the tip of the mastoid process? What is their A/P position relative to the vertebral
spinous processes and the anterior border of the neck? Be sure to practice these palpations on yourself or a
classmate. The neck is a region that is frequently palpated during the physical exam.

Surface anatomy of the anterolateral neck

Embedded in the subcutaneous tissue (hypodermis) of the anterolateral neck is the platysma muscle (refer to
your atlas for an image). This thin muscle tightens the skin over the neck and may be observed clearly when a
person makes an exaggerated grimace.
The sternocleidomastoid muscle (SCM) is a key landmark on the anterolateral neck (refer to your atlas for an
image). It separates the anterior and posterior triangles from each other. The SCM can be palpated as it passes
superolaterally from the manubrium (sternal head) and medial clavicle (clavicular head) to the mastoid process
of the skull. Watch the action of this muscle as you turn your head to the right or left. Put your hand against the
right side of your face and give resistance as you turn your head to the right. Which SCM muscle stands out
with this resistance? What does that mean?
The jugular notch of the manubrium is located between the sternal heads of the SCM. Above this notch, in the
suprasternal space, you can palpate several of the proximal tracheal rings. The jugular venous arch lies

anterior to the trachea in this region but is not normally palpable. Between the sternal and clavicular heads of
the SCM, just superior and lateral to the sternal extremity of the clavicle, there is a depression that contains the
inferior end of the internal jugular vein (IJV) (refer to your atlas for an image). This site is often used to
access the IJV during central line placement or catheterization of the heart.
Palpate the soft tissues anterior to the SCM and just inferior to the angle of the mandible . You should be
able to feel the carotid pulse there and, if you have a cold or sore throat, you may be able to palpate some of
the numerous superficial lymph nodes of the neck. Continue palpating anteriorly, inferior to the mandible, and
identify the midline laryngeal prominence (Adams apple). It is a protrusion of the thyroid cartilage (refer to
your atlas for an image) and is generally larger and more prominent in men. The hyoid bone lies superior to the
thyroid cartilage and the cricoid cartilage lies inferior to it. You can access the airway by puncturing the
cricothyroid membrane (ligament) that stretches between the thyroid and cricoid cartilages. The ER residents
will demonstrate this procedure during one of your lab session.
Osteology of the Neck
The skeleton of the neck includes the cervical vertebrae as well as the hyoid bone and several cartilages that lie
anterior to the vertebral column (refer to your atlas for an image). Specifically there are:
seven cervical vertebrae
a U-shaped hyoid bone
several midline cartilaginous structures
thyroid and cricoid cartilages that, with associated smaller cartilages, constitute the larynx
6-8 tracheal rings
The manubrium of the sternum and the clavicles define the inferolateral aspect of the anterior neck. They
provide landmarks for palpation and identification of deeper structures, as well as attachment sites for muscles
associated with the neck. The manubrium was discussed in detail in the thorax unit. The clavicles are discussed
in detail in the upper limb unit.
Cervical Vertebrae
Of the seven cervical vertebrae, the atlas and the axis are unique while C3-C7 share many common
characteristics. Refer to an atlas and to the skeleton to review the detailed structure of the cervical vertebrae.
C1 and C2 are atypical vertebrae. Learn their unique characteristics and be able to identify these individual
vertebrae.

Atlas (C1) a unique cervical vertebrae

Axis (C2) a unique cervical vertebrae

Atlas (C1):
ring-like bone
lacks both spinous process and vertebral body
consists of two lateral masses connected by anterior and posterior arches
anterior and posterior tubercles are located centrally on each arch
the posterior arch has groove for vertebral artery on its superior surface
the large horizontal superior articular facets lie directly medial to the transverse processes and
articulate with the occipital condyles of the skull
inferiorly C1 articulates with C2 via the dens and two lateral inferior articular facets
Axis (C2):
has a body with the dens (odontoid process) projecting superiorly from it
the dens articulates with the anterior arch of C1 (synovial pivot joint)
has a spinous process that is, usually bifid
the superior articular facets lie anteromedial to the transverse processes and articulate with the C1
inferior articular facets v ia gliding synovial joints

Typical cervical vertebrae (C3-C7):

Typical cervical vertebrae

7th cervical vertebrae (vertebra prominens)

large triangular vertebral foramen

vertebral body wider from side to side than anteroposteriorly with a concave superior surface and
convex inferior surface
transverse processes with a foramen (transverse foramen) to accommodate the vertebral artery and
vein
anterior and posterior tubercles lateral to each transverse foramen
obliquely oriented articular facets that lie posterior to the transverse processes
short bifid spinous process (except for C7)
Notice that the bodies of the cervical vertebrae have superolateral ridges called uncinate processes. Also, each
articular process of a typical cervical vertebra forms a bulge posterior to the transverse process. On C6 the
large anterior tubercle of the transverse process is called the carotid tubercle because the common carotid
artery can be compressed against it and the vertebral body to control bleeding. Finally, C7, the vertebra
prominens, has a very long spinous process that is not bifid.
Hyoid Bone
The U-shaped hyoid bone lies in the anterior part of the neck at the level of the C3 vertebra (refer to your atla for an
image). It is suspended by horizontally-oriented muscles attached to the mandible and styloid processes
and vertically oriented muscles attached to the thyroid cartilage, manubrium and scapulae inferiorly. The hyoid
bone consists of a body and right and left greater and lesser horns.

Hyoid bone

Hyoid bone and cartilages of the neck

Cartilages of the Anterior Neck

Two large and distinct cartilages, the thyroid and cricoid cartilages, are suspended from the hyoid bone in the
central portion of the anterior neck (refer to your atlas for an image). The thyroid cartilage is the largest and
most superior of the two. It is a shield-shaped structure formed from two relatively flat plates of cartilage
(lamina) that fuse in the midline and create the laryngeal prominence. The thyroid cartilages are open
posteriorly. Superior and inferior horns project from the posterior aspect of each lamina and provide
attachment sites for the thyrohyoid membrane superiorly and the cricothyroid joint inferiorly.
The cricoid cartilage is shaped like a signet ring with its broad lamina facing posteriorly and its narrow arch
(band) facing anteriorly (refer to your atlas for an image). The cricoid cartilage is the only complete ring of
cartilage to encircle the airway! It is very strong. It is attached to the thyroid cartilage by the median
cricothyroid membrane (ligament) which is easily incised to access the airway in an emergency. Inferiorly,
the cricoid cartilage attaches to the first tracheal ring by the cricotracheal ligament.
More details of this region will be covered in the study of the larynx.

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Fasciae of the Neck

The fascial layers of the neck

Superficial and deep cervical fasciae subdivide the neck into compartments that separate structures and direct
the flow of fluid (e.g. infectious materials) in the neck. It is very important to know the distribution of these
fasciae and the structures within the compartments they define (refer to your atlas for an image).
Superficial Cervical Fascia:
The superficial cervical fascia is a loose fatty layer of subcutaneous tissue that lies between the dermis of the
skin and the investing layer of the deep cervical fascia. The thickness of the superficial cervical fascia varies
among people. It contains cutaneous nerves, blood vessels and lymphatics as well as the platysma muscle - a
thin broad muscle that tightens the skin of the anterolateral neck.
Deep Cervical Fascia (three layers):
The deep cervical fascia of the neck consists of three layers of membranous fascia that form compartments
and separate muscle layers and neurovascular structures. The investing layer (red) is the most superficial of
the deep cervical fascias. It surrounds the entire neck just deep to the superficial cervical fascia. Posteriorly it
attaches to the superior nuchal line, ligamentum nuchae and spinous processes of the cervical vertebrae.
Anterolaterally it attaches to the mastoid processes, the zygomatic arches (of the face), and the mandible and
hyoid bones. It encloses the SCM and trapezius muscles by splitting into superficial and deep layers around
these muscles. It also encloses the submandibular and parotid glands.
The pretracheal layer (purple and blue) is found in the anterior neck. The muscular portion of pretracheal
fascia (purple) is a thin layer that encloses the infrahyoid muscles. The visceral portion (blue) is more distinct
and encloses the thyroid gland, trachea and esophagus. Superiorly, it attaches to the hyoid bone and forms a
pulley that anchors the intertendon of the digastric muscle. Inferiorly it is continuous with the fibrous
pericardium. Laterally it blends with the carotid sheath. Posteriorly it is continuous with the
buccopharyngeal fascia of the pharynx.
The prevertebral layer (orange) ensheaths the vertebral column and its many associated muscles:
anteriorly the longus colli and capitis; posteriorly the deep (intrinsic) muscles of the back (splenius,
longissimus, semispinalis etc.); and laterally the scalene muscles. Superiorly it is attached to the cranial base.
Inferiorly it blends with the anterior longitudinal and supraspinous ligaments. At the base of the neck (near
the midpoint of the clavicles) the prevertebral fascia is drawn out laterally as the axillary sheath by the nerve
roots of C5-T1 that form the brachial plexus. Posteriorly, the prevertebral fascia attaches to the spinous

11

processes of cervical vertebrae. Anteriorly, some authors describe an additional layer, the alar fascia, that lies
between the pretracheal and prevertebral fasciae subdividing the retropharyngeal space. The alar fascia attaches
to the carotid sheaths on each side.
The carotid sheath is a condensation of fascia that encloses the common and internal carotid arteries, the
internal jugular vein, the vagus nerve and some deep cervical lymph nodes (refer to your atlas for an
image). It extends from the base of the skull to the root of the neck and receives fascial contributions from all
three layers of deep cervical fascia.
Cricothyrotomy
This procedure will be demonstrated during one of the first lab sessions for dissection of the neck. The cadaver
must be in the supine position. Do not dissect the skin over the midline of the neck until after the
cricothyrotomy demonstration!

12

Neck 1
Step 2
Suboccipital Triangle of the Neck
Dissection Instructions
Position of cadaver = prone

With the cadaver in the prone position, review your previous dissection of the posterior cervical region.
Identify the semispinalis capitis muscles and the greater occipital nerve (dorsal ramus of C2) (refer to your
atlas for an image). This nerve, which pierces the superior aspect of the semispinalis capitis, is quite thick and
contains only cutaneous axons to the posterior scalp. If you don't see it right away, you can continue your work
and look for it as you go.
Palpate the external occipital protuberance, spinous process of C2, mastoid processes and the transverse
processes of C1 and C2 on your cadaver. Also, find these bony landmarks on the skeleton. Note the
relationship of the mastoid process and the C1 transverse process. Also note the difference in length between
the C1 and C2 transverse processes.

Semispinalis capitis

Semispinalis capitis reflected

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The left and right suboccipital triangles lie deep to the semispinalis capitis muscles (refer to your atlas for an
image). The borders of each triangle are defined by three small muscles: the rectus capitis posterior major
and the superior and inferior oblique muscles of the head (obliquus capitis superior and inferior). A
fourth muscle, the rectus capitis posterior minor, lies medial and deep to the rectus capitis major muscle and
does not form a border of the triangle.
Carefully cut the superior attachment of semispinalis capitis close to the skull. Semispinalis capitis is a very
thick muscle (about 1cm) and the suboccipital muscles lie just deep to it so take care when cutting!! Look for
the intermuscular fascial plane. As you are cutting look again for the greater occipital nerve. Take care not to
damage it as you reflect semispinalis capitis. Free the right and left semispinalis capitis muscles from the skull
and reflect them inferolaterally.

Suboccipital triangle with suboccipital nerve and greater occipital nerve

(RCPM - rectus capitis major muscle; SO - superior oblique muscle; IO - inferior oblique muscle)

Gently clean away the fat and areolar tissue deep to semispinalis and expose the rectus capitis posterior
major and minor muscles. The rectus major is a relatively large fan-shaped muscle. It attaches inferiorly to
the C2 spinous process and forms the medial border of the suboccipital triangle. Rectus major is usually
very distinct, but you can make it stand out more by rotating the head to the opposite side of the muscle you are
working on. With the head in this position, clean and define the borders of rectus major. Look for the inferior

14

oblique muscle that also attaches to the C2 spinous process. What is its orientation? What does it attach to
laterally?.
Medial and deep to rectus major is the rectus capitis posterior minor. This small fan-shaped muscle attaches
to the medial aspect of the inferior nuchal line superiorly and the posterior tubercle of C1 inferiorly. It lies
immediately adjacent to the midline of the neck and does not form a border of the suboccipital triangle.
The inferior oblique muscle is oriented horizontally with attachments to the tips of the C2 spinous process
and the C1 transverse process. It defines the inferior boundary of the suboccipital triangle. Clean the
muscle all the way to its lateral attachment. Based on its fiber direction, what is its action?
At the transverse process of C1 find the inferior attachment of the superior oblique muscle. Its superior
attachment is to the lateral aspect of the occipital bone between the superior and inferior nuchal lines. The
superior oblique muscle forms the lateral border of the suboccipital triangle. Clean this muscle and now you
should clearly see the suboccipital triangle.
Emerging from the center of the suboccipital triangle are branches of the suboccipital nerve (dorsal ramus of
C1) that innervate the 4 suboccipital muscles (refer to your atlas for an image). Gently clean the fascia out of
the center of the triangular space and find the suboccipital nerve and its branches. Demonstrate the motor
points (point where the nerve enters the muscle) of the branches.
On one side only (the side with the least beautiful suboccipital muscles), reflect the suboccipital muscles and
identify the posterior arch and transverse process of C1 and the transverse and spinous processes of C2. Look
for the vertebral artery passing vertically through the transverse foramina of C1 and C2 (refer to your atlas for
an image). Follow it as it ascends and turns medially to travel in a groove on the superior surface of the C1
posterior arch just posterior to the superior articular process. Follow it as it passes through the atlantooccipital
membrane stretched between the posterior arch of the atlas and the posterior margin of the foramen magnum.

15

Neck 1
Step 3
Posterior Triangle of the Neck - Suprficial Dissection
Dissection Instructions
Position of the cadaver = supine.

The anterolateral neck is subdivided by the sternocleidomastoid muscle (SCM) into anterior and posterior
triangles (refer to your atlas for an image). The posterior triangle, also called the lateral cervical region, is
further subdivided into occipital and supraclavicular (subclavian, omoclavicular) triangles by the inferior
belly of the omohyoid muscle. In addition to the omohyoid muscle, the posterior triangle of the neck contains
many cutaneous nerves, a motor nerve, the (spinal) accessory nerve (CN XI), the inferior portion of the
external jugular vein and the transverse cervical and suprascapular arteries and veins. Study the drawings
of the cervical triangles in your altas and note the borders and subdivisions of the posterior triangle of the
neck. The floor of the posterior triangle contains portions of the splenius capitis, levator scapulae and the
scalene muscles.

Boundaries of the anterior and posterior triangles Subdivisions of the anterior and posterior triangles
of the neck
of the neck

Borders of the Posterior Triangle of the Neck:

Anterior: posterior border of sternocleidomastoid muscle (SCM)
Posterior: anterior border of trapezius muscle
Inferior: middle third of the clavicle
The posterior triangle has a fascial roof composed of the investing layer of deep cervical fascia and a fascial

16

floor formed from prevertebral fascia (refer to your atlas for an image). The investing fascia splits to envelop
the adjacent trapezius and sternocleidomastoid muscles and is pierced by the external jugular vein and
cutaneous nerves of the neck. The prevertebral fascia which forms the floor of the triangle, covers the splenius
capitis, levator scapulae and scalene muscles and the roots of the brachial plexus.
In its inferior aspect, the posterior triangle of the neck is divided by the inferior belly of the omohyoid muscle
into a large occipital triangle superior to the omohyoid and a small supraclavicular (subclavian,
omoclavicular) triangle inferior to it. The occipital triangle contains the occipital artery at its apex and several
nerves including the accessory nerve (CN XI). The supraclavicular triangle contains the external jugular
vein and the suprascapular artery and vein (refer to your atlas for an image).

Anterior neck skin incisions

Platysma

YOU MUST DISSECT BOTH RIGHT AND LEFT POSTERIOR TRIANGLES OF THE NECK!!
Because you have already dissected the thorax, an incision has been made along the clavicle from its medial
end to a point beyond the acromion process. Beginning at the inferolateral border of the cut skin, near the
acromion process, use a forceps and small scissors to lift and separate the skin along its fascial plane. The skin
is very thin over the neck. The platysma muscle, cutaneous cervical nerves and the external jugular vein
lie just deep to it. Take great care in reflecting the skin!
TIP: The skin in this area is extremely thin. Cut carefully!
Continue to reflect and remove the skin over the posterior triangle of the neck from the inferolateral
border of the clavicle to the anterior border of the SCM. Clean as far superiorly as the auricle of the ear.
Identify the platysma muscle (refer to your atlas for an image). Its fibers arise in the fascia overlying the

17

clavicle and pectoralis major muscle and sweep superomedially over the mandible to interdigitate with the
muscles of the lower face. (You will see much more of platysma after removing the skin from the anterior
triangle of the neck in the next unit.) The platysma is innervated by CN VII, the facial nerve. This nerve
innervates all of the muscles of facial expression and, even though platysma is located on the neck, it is
activated during some of the facial expressions that we make (e.g. grimace). The cervical branch of CN VII
will be dissected with the face.
Carefully reflect platysma superomedially. Keep it intact so you can see the entire muscle after removing the
skin from the anterior triangle. Look for the external jugular vein (EJV) as it crosses the midpoint of the SCM
(refer to your atlas for an image). It descends superficial (external) to the SCM draining venous blood from the
scalp and face. Near the clavicle the EJV pierces the investing layer of deep cervical fascia and terminates in
the subclavian vein just posterior to the clavicle.
TIP: If the EJV is severed its lumen is held open by the tough investing fasica and, due to
negative intrathoracic pressure, air will be sucked into the vein creating an air embolism. The
best way to prevent this is to apply firm pressure to the severed jugular vein until it is sutured to
stop the bleeding and entry of air.
In the same plane as the EJV, at the point where it crosses the posterior border of the SCM, look for the
cutaneous nerves of the neck (cervical plexus) and the accessory nerve, a motor nerve (refer to your atlas
for an image). This area is often called the nerve point of the neck (punctum nervosa) because of the large
number of nerves that pass through the small region.

Cutaneous nerves and superficial vessels of the

right neck

Posterior triangle of the left neck

18

Carefully pick away the investing fascia (roof) over the posterior triangle and identify and clean the following
nerves (refer to your atlas for an image):
great auricular nerve (C2, C3): travels parallel to the EJV from the punctum nervosa to the auricle of
the ear which it innervates, also provides sensory innervation to the parotid gland (source of pain with
mumps)
transverse cervical nerve (C2, C3): runs transversely across the middle of the sternocleidomastoid
muscle to supply the skin of the anterior triangle of the neck
lesser occipital nerve (C2): a small diameter nerve that runs superoposteriorly, parallel to the posterior
border of the SCM, to supply the scalp over the occipital bone posterior to the auricle of the ear
supraclavicular nerves (C3, C4): pierce the investing fascia in the inferior part of the neck and supply
the skin covering the clavicle. There are three branches (groups): medial, intermediate and lateral
supraclavicular nerves
accessory nerve (CN XI): exits the jugular foramen (not visible on the cadaver at this time but find it
on the skeleton) and travels deep to the SCM (which it innervates) until it emerges in the superior part of
the punctum nervosa. CN XI runs inferolaterally across the posterior triangle of the neck and enters the
deep surface of the trapezius muscle about 5 cm superior to the clavicle. CN XI is a somatic motor
nerve!!
In the inferior portion of the posterior triangle find the inferior belly of the omohyoid muscle (refer to your
atlas for an image). This muscle originates on the scapula (superior border just medial to the suprascapular
notch), passes through a sling of fascia on the deep surface of the SCM and turns superiorly to insert on the
hyoid bone. It is one of the infrahyoid muscles and will be studied with the anterior triangle of the neck. Clean
and preserve it in situ.
Look for the occipital artery in the apex of the posterior triangle of the neck at the point where the SCM
meets the trapezius muscle superiorly (refer to your atlas for an image). It is a branch of the external carotid
artery and supplies the scalp over the occipital bone.

19

Neck 1
Step 4
Posterior Triangle of the Neck Deep Dissection
Dissection Instructions
Carefully remove the prevertebral fascia (floor of the posterior triangle of the neck) (refer to your atlas for an
image). Do not to destroy the nerves, muscles and vessels you have already found. As you remove the
prevertebral fascia identify the splenius capitis, levator scapulae and scalene muscles lying deep to it.
Splenius and levator lie in the superior part of the occipital triangle deep to the prevertebral fascia. Verify that
you have correctly identified these muscles by checking your earlier dissection of these muscles in the back
unit.

Deep posterior triangle

(EJV - external jugular vein)

TIP: It is a good idea to review a cross-sectional drawing of the fascias of the neck and get a
clear idea of where the prevertebral fascia that you are removing lies!
The three scalene muscles form the inferior muscular mass deep to the floor of the posterior triangle (refer to
your atlas for an image). Between the anterior and middle scalenes lie the roots and trunks of the brachial
plexus. In the anterior inferior part of the posterior triangle, identify and clean the omohyoid muscle. Only the

20

inferior belly of omohyoid is visible at this time. It subdivides the posterior triangle into the large occipital and
small supraclavicular (subclavian) triangles (refer to your atlas for an image). The superior belly of omohyoid
will be seen later.
On one side of the body, free the distal ends of the supraclavicular nerves and move them laterally in
preparation for reflecting the clavicular head of the SCM. Clean the area around the inferior aspect of the
SCM and place the handle of a scalpel just deep to the muscle to protect the underlying structures. Cut the
clavicular head close to the bone (what bone?) and reflect it medially.

Left interscalene triangle

(IJV - internal jugular vein)

Left interscalene triangle

In order to have better access to the deep posterior triangle, resect a small part of the clavicle on the same side
of the body that you reflected the clavicular head of SCM. Use a small hand saw to cut the clavicle just medial
to the attachment of the trapezius muscle. Take care - do not cut the accessory nerve! Now cut through the
clavicle at the attachment site of the now reflected clavicular head of the SCM.
Roll the cut portion of the clavicle forward and sever the attachment of the subclavius muscle from its inferior
surface (refer to your atlas for an image). Remove the now free section of clavicle. Examine the medial attachment of the
subclavius muscle to the first rib and costal cartilage. Subclavius retracts and depresses the clavicle and resists
forces that pull the clavicle forward. The clavicle will be studied with upper extremity.
Examine the anterior scalene muscle and clean away any loose fascia from the region. The anterior scalene
muscle attaches superiorly to the transverse processes of C4-C6 and inferiorly to the first rib (refer to your atlas
for an image). With the section of clavicle removed you should be able to palpate its attachment on rib 1. On its
anterior surface the anterior scalene muscle is crossed transversely by the transverse cervical and
suprascapular arteries (and veins) and vertically by the phrenic nerve. Verify your identification of the
phrenic nerve by tugging on its intrathoracic segment. The cervical segment should move.

21

The middle scalene muscle lies posterior to the anterior scalene and attaches to the cervical transverse
processes of C1-C6 and the first rib posterior to the anterior scalene. The anterior and middle scalene
muscles, and the related segment of the first rib, define the interscalene triangle which transmits the
subclavian artery and vertically by the and roots of the brachial plexus (refer to your atlas for an image).
The posterior scalene muscle is rather difficult to see with the cadaver supine because it lies posterior to the
large middle scalene muscle. It attaches to C4-C6 transverse processes and the second rib. Make a note to look
for it next time you turn the cadaver to the prone position.
Clean the newly visible part of the omohyoid muscle (refer to your atlas for an image). What is the origin of
omohyoid?
TIP: "Omo-" refers to the scapula
Trace the external jugular vein to the subclavian vein (refer to your atlas for an image). Clean the loose
fascia and lymph nodes from the region posterior to the clavicle and verify that the subclavian vein lies anterior
to the anterior scalene muscle. Find the following blood vessels:
Suprascapular artery and vein (refer to your atlas for an image): run parallel and posterior to the clavicle,
superficial to the floor of the posterior triangle but deep to the inferior belly of the omohyoid. Ultimately they
pass through the suprascapular notch of the scapula to supply the supra- and infraspinatus muscles. If the upper
trapezius muscle is reflected you will be able to follow the suprascapular vessels over to the scapula. The artery
is a branch of the thyrocervical trunk. The vein empties into either the external jugular or subclavian vein.
Transverse cervical artery and vein (refer to your atlas for an image): branch of the thyrocervical trunk that runs
posteriorly across the shoulder superficial to the floor of the posterior triangle but deep to the inferior belly of
the omohyoid. It supplies the trapezius, levator scapulae, and rhomboid muscles.
Trace the transverse cervical and suprascapular arteries back to their origins from the thyrocervical trunk
(variations occur in the origins of these vessels) (refer to your atlas for an image). If doing this dissection in
your cadaver is very difficult right now, wait until you reflect the rest of the SCM and then find the
thyrocervical trunk.

22

Neck 2
General Overview
The anterior triangle of the neck is a fairly large region and contains many significant structures including the
carotid artery and its branches, the internal jugular vein and its tributaries, cranial nerves X, XI and XII, the
infrahyoid and suprahyoid muscles involved in swallowing, the thyroid, parathyroid and submandibular glands,
and the midline hyoid bone and thyroid, cricoid and tracheal cartilages. The boundaries of the anterior triangle
are:
Superior border (base): inferior border of the mandible
Posterior border: anterior border of the sternocleidomastoid muscle
Anterior border: midline of the neck
Roof: investing layer of deep cervical fascia covered by superficial (subcutaneous) fascia with the
platysma muscle
Floor: pharynx, larynx and thyroid gland
Apex: jugular notch of the manubrium

Boundaries of the anterior and posterior triangles

of the neck

Subdivisions of the of the anterior and posterior

triangles of the neck

The anterior triangle of the neck is divided into suprahyoid and infrahyoid regions and each of these is
subdivided into two smaller triangles the muscular and carotid triangles and the submandibular and
submental triangles respectively. The first dissections will be of the muscular and carotid triangles in the
infrahyoid region.
The muscular triangle contains the infrahyoid (strap) muscles. These four small muscles attach to the hyoid
bone or thyroid cartilage and mediate movements of the larynx during swallowing and speaking. Reflection of
the infrahyoid muscles will reveal the cartilages of the neck and the thyroid gland.

23

In the carotid triangle the common carotid artery divides into the internal and external carotids. You will
clean and follow branches of the external carotid to their various destinations in the neck. The large
hypoglossal nerve (CN XII) traverses the superior aspect of the carotid triangle and carries with it the C1 root
of the ansa cervicalis.
In the suprahyoid region the submandibular triangle contains the submandibular gland, the facial vessels
and CN XII.
The submental triangle is a midline region bounded by the left and right anterior bellies of the digastric
muscles. It contains the mylohyoid muscle.
The root of the neck is the region adjacent to the superior thoracic aperture. It lies posterior to the manubrium
and medial extremity of the clavicle, between the right and left first ribs, and anterior to the body of T1. The
root of the neck contains the structures that pass through the superior aperture of the thorax. You have seen
some of these structures in earlier dissections.

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Neck 2
Step 1
Review Bones, Cartilages, Fascias and Structures of the Anterior Triangle
of the Neck
Instructions
Study a diagram of a cross-sectional view of the neck (refer to your atlas for an image). Note the relative
positions of vessels, nerves, muscles, viscera and the bony and cartilaginous structures of the anterior region
of the neck. Identify the related fascial layers including the investing fascia that envelops the SCM muscles,
both the muscular and visceral portions of the pretracheal fascia, and the anterior part of the prevertebral
fascia. Review the carotid sheath. What structures do you expect to find enclosed by the carotid sheath? What
fascial layers contribute to the carotid sheath?
The viscera of the anterior cervical region include the superior portions of the digestive and respiratory
systems (pharynx, esophagus, larynx and trachea) as well as the thyroid, parathyroid and submandibular
glands.
Bony and cartilaginous structures of the anterior triangle of the neck (refer to your atlas for an image:

Hyoid bone and cartilages of the anterior neck

Hyoid bone: lies at the angle between the floor of the mouth and superior end of the neck. Identify the
body, greater horn and lesser horn of the hyoid in a bony specimen and understand the orientation of the
bone in the neck. The hyoid bone is the only bone in the body with no bony articulations.

25

Thyroid cartilage: largest cartilage of the larynx, formed of two flat plates that meet in the midline and
form the laryngeal prominence (Adam's apple) anterosuperiorly. Posteriorly the thyroid cartilage is open.
Thyrohyoid membrane: joins the thyroid cartilage and hyoid bone.
Cricoid cartilage: lies at the level of C6, inferior to the thyroid cartilage, superior to the 1st tracheal
ring. It is a strong, complete ring of cartilage.
Cricothyroid membrane (ligament): joins the cricoid and thyroid cartilages. It is incised during the
cricothyrotomy procedure.
Fasciae related to the anterior triangles of the neck:

Fasciae of the neck in cross section

Prevertebral layer of deep cervical fascia (orange): is cylindrical and encloses the vertebral column
and associated muscles. The part related to the anterior cervical region covers the longus colli and longus
capitis muscles and the anterior scalenes. Prevertebral fascia contributes to the carotid sheath.
Pretracheal layer of deep cervical fascia (blue and purple): invests the infrahyoid muscles and the
larynx, trachea and thyroid glands. It contributes to the carotid sheath.
Investing layer of deep cervical fascia (red): surrounds all of the structures of the neck deep to the
subcutaneous (superficial) fascia. It divides to enclose the sternocleidomastoid and trapezius muscles.
Viscera of the anterior triangle of the neck (refer to your atlas for an image):
Thyroid and parathyroid glands - lie in the inferior part of the infrahyoid region against the trachea
and larynx, these endocrine organs have a rich blood supply
Submandibular gland - a suprahyoid salivary gland
Pharynx and esophagus - proximal part of the digestive system (will be dissected later)
Larynx and trachea - proximal part of the respiratory system (will be dissected later)

26

Neck 2
Step 2
Muscular Triangle of the Neck
Dissection Instructions
The skin, superficial fascia and platysma muscle must be reflected from the anterior cervical region (refer
to your atlas for an image). Reflect (or remove) the skin beginning at its clavicular edge and carry it over the
superior border of the mandible. Remember that the skin is very thin and the platysma lies just deep to it. If you
preserved the portion of the platysma that extends into the posterior triangle, you can use it as a guide for how
deep to cut when removing the skin and superficial fascia over the anterior triangle.
After removing the skin, scrape away the fatty layer of superficial fascia covering platysma until you can
see the entire muscle (refer to your atlas for an image). Note that it extends over the superior margin of the
mandible and interdigitates with some of the muscles of facial expression. Clean the anterior surface of the
platysma as far superior as the superior border of the mandible. Then reflect platysma superiorly starting
at its inferior margin. It is ok to leave a thin layer of superficial fascia on the deep surface of platysma to help
hold it together. At the angle of the neck, where the mandible and floor of the mouth meet the vertical part of
the neck, reflecting the platysma can become a little difficult because the contours of the deep structures are not
smooth and predictable like the vertical neck. Just use the muscle fibers as your guide and continue to
expose the deep surface of platysma until you can reflect the muscle all the way over the margin of the
mandible. Look along the margin of the mandible for the facial artery and vein (refer to your atlas for an
image). They lie in a shallow depression on the inferior border of the mandible about 1/3 of its length from the
angle. Preserve the facial vessels.

27

Muscular triangle
(SCM - sternocleidomastoid muscle)

Platysma

TIP: The facial artery is easy to palpate along the mandible of a living person and has a very
discernible pulse. It crosses the inferior margin of the mandible about 4 cm anterior to the
angle. Remember do not use your thumb when feeling for a pulse!!
Look for the transverse cervical nerve crossing the SCM at its midpoint, and look for tributaries of the jugular
venous system (refer to your atlas for an image). The anterior jugular vein runs parallel to the midline of the
neck. This vertical vein may be paired or singular. Communicating jugular veins may run obliquely parallel
to the anterior border of the SCM and unite the facial or retromandibular veins with the anterior jugular veins
inferiorly (refer to your atlas for an image).
The muscular triangle is a subdivision of the anterior triangle of the neck. It is a part of the infrahyoid
region and is bounded by the superior belly of the omohyoid muscle, the anterior border of the SCM
muscle and the midline of the neck (refer to your atlas for an image). The hyoid bone defines its superior
extent and the jugular notch defines its inferior extent. The muscular triangle contains the four infrahyoid
muscles and the thyroid and parathyroid glands.
The infrahyoid muscles attach to the hyoid bone or thyroid cartilage superiorly and the manubrium or scapula
inferiorly (refer to your atlas for an image). They are involved in stabilizing or moving the hyoid bone and
thyroid cartilage during swallowing and vocalization. The muscles are arranged in two layers with two
muscles superficial and two deep. Three of the four infrahyoid muscles are innervated by branches from C1-C3
that travel in a special plexus - the ansa cervicalis (refer to your atlas for an image). One muscle, the
thyrohyoid, is innervated by a branch of C1 that takes a different path. These nerves will be dissected with the
carotid triangle because of their pathway in the neck.

28

Clean the anterior surface of the infrahyoid muscles and identify the omohyoid (superior belly) and
sternohyoid muscle. Which is the most lateral? Both of these muscles attach to the hyoid bone superiorly.
The sternohyoid is most medial at the hyoid and attaches to the deep surface of the manubrium inferiorly. With
contraction of this muscle, what direction will the hyoid bone move?
The omohyoid attaches to the hyoid bone lateral to sternohyoid. It descends inferolaterally but before reaching
the manubrium it angles sharply laterally and makes its way to the superior border of the scapula. There it
attaches just medial to the suprascapular notch (refer to your atlas for an image). At the midpoint of the muscle,
where its angulation is greatest (at the level of the cricoid cartilage), muscle tissue is replaced by an
intermediate tendon. A fascial sling, originating from the clavicle, wraps around the tendon and anchors it
in place. The intermediate tendon provides both the inferior attachment of the superior belly of omohyoid and
the superior attachment of the inferior belly of omohyoid. The inferior belly continues from the tendon
across the posterior triangle of the neck (subdividing it), to the scapula.

Deep infrahyoid muscles

(OH - omohyoid muscle)

Superficial infrahyoid muscles

In order to see the full extent of the omohyoid muscles and for better access to the carotid triangle, reflect
both SCMs by cutting their inferior attachments from the manubrium and clavicle. Do this with great care as
there are many important structures that lie deep to the SCM. You may want to put the handle of a scalpel
posterior to the muscle while you cut. Cut close to the bones. Carefully reflect SCM and clean the loose fascia
away until you can see the full extent of omohyoid. Look for the fascial sling. Keep track of the cutaneous
nerves that are related to the SCM at the punctum nervosa. You dissected them with the posterior triangle.
On one side of the body, reflect sternohyoid and omohyoid from their superior attachments in order to see the
deep infrahyoid muscles. Cut both muscles about 1 cm inferior to the hyoid bone and reflect them inferiorly.
Clean and identify the short broad thyrohyoid muscle (refer to your atlas for an image). Note its inferior
attachment to the oblique line of the thyroid cartilage. Thyrohyoid receives innervation from C1 via the
hypoglossal nerve. What are the possible actions of the thyrohyoid muscle?
The sternothyroid muscle attaches to the thyroid cartilage just inferior to the thyrohyoid muscle. From the
inferior attachment of the thyrohyoid follow the sternothyroid inferiorly to the deep surface of the manubrium.
This muscle widens inferiorly. It receives innervation from the ansa cervicalis. When it contracts it depresses
the thyroid cartilage.
Now, cut the sternothyroid muscle close to its attachment on the thyroid cartilage and reflect it inferiorly to

29

expose the thyroid gland (refer to your atlas for an image). Find the very distinct superior thyroid artery
going to the superior pole of the gland. Palpate the isthmus of the thyroid gland - the part that connects right
and left lobes across the midline of the neck (refer to your atlas for an image). A more detailed dissection of the
thyroid and parathyroid glands will be conducted later. Preserve the neurovascular structures in this region.

Thyroid gland

Inspect the midline of the neck between the infrahyoid muscles. With one sternohyoid muscle reflected you
should be able to identify and palpate the laryngeal prominence of the thyroid cartilage, the cricoid
cartilage and the first few tracheal rings (refer to your atlas for an image).

30

Neck 2
Step 3
Carotid Triangle of the Neck
Dissection Instructions
The carotid triangle is a subdivision of the infrahyoid region of the anterior triangle of the neck (refer to
your atlas for an image). It is bounded by the:
superior belly of the omohyoid muscle (anteroinferior)
posterior belly of the digastric muscle (anterosuperior)
anterior border of the sternocleidomastoid muscle (posterior)

Subdivisions of the anterior and posterior triangles

of the neck

Carotid triangle

The pulse of the common carotid artery can be palpated in this region. The common carotid artery divides
into the internal and external carotid arteries at the level of the superior border of the thyroid cartilage. Near
this bifurcation the carotid body a chemoreceptor that monitors O2 levels in the blood, lies wedged between
the internal and external carotid arteries, and the carotid sinus, a baroreceptor that responds to changes in
blood pressure, lies embedded in the muscular wall of the common/internal carotid artery. Reposition the
infrahyoid and SCM muscles and visualize the carotid triangle.
TIP: The external carotid artery gives many branches in the neck. The internal carotid artery
gives no branches in the neck.

31

Deep to the SCM muscle the internal jugular vein, common carotid artery and vagus nerve lie within the
carotid sheath (refer to your atlas for an image). In an earlier step you severed the inferior attachment of SCM
and reflected the muscle far enough to see the omohyoid muscle. Now you need to fully reflect SCM, all the
way up to its attachment on the mastoid process. Pull SCM superiorly and use the small scissors to help clear
fascia from the deep surface of the muscle. Be careful not to damage the nerves of the punctum nervosa.

(Spinal) accessory nerve (CN XI)

On the deep surface of the SCM, about 5 cm inferior to the mastoid process, the accessory nerve enters the
muscle (refer to your atlas for an image). The nerve is very thick at this point. Find it and clean it as far
superiorly as you can. It enters the neck by passing through the jugular foramen on the base of the skull. (Find
this opening on a model skull.) Find the branch of CN XI that descends across the posterior triangle of the neck
to innervate trapezius. You should be able to tug on that branch and wiggle the main trunk of the nerve.

Ansa cervicalis
(CC - common cartoid artery; IJV - internal jugular
vein)

Hypoglossal nerve (CN XII)

The internal jugular vein (IJV) should be visible once you have reflected the SCM. It is the most superficial
structure in the carotid sheath. It lies lateral to the common carotid artery but because it is larger in diameter

32

than the artery, the vein conceals the artery (from this view). Cut the connection between the IJV and the facial
vein so you have better access to the deep structures (refer to your atlas for an image). Gently explore the
fascia of the anterior carotid sheath surrounding the IJV and common carotid artery and locate the ansa
cervicalis. This is a plexus of motor nerves from the ventral rami of C1-C3. The ansa cervicalis innervates the
infrahyoid muscles (refer to your atlas for an image). Follow the ansa branches to the omohyoid and
sternothyroid muscles to verify the relationship between the ansa cervicalis and the infrahyoid muscles. Then
follow the nerves superiorly and note that some pass lateral to the IJV (sometimes between the IJV and
common carotid artery). These branches are from C2, 3 and are called the inferior root of the ansa cervicalis.
The branch running parallel to the carotid artery comes from C1 and is called the superior root (refer to your
atlas for an image).
Follow the C1 superior root superiorly, past the point where the common carotid artery branches into internal
and external carotid arteries. Soon you will see it connected to a thick nerve that loops down into the carotid
triangle and, at the angle of the mandible, turns medially and crosses the external carotid artery and some of its
branches. This thick loop of nerve is the hypoglossal nerve (CN XII). It exits the skull through the
hypoglossal foramen (canal) (find this on a model skull, refer to your atlas for an image) and enters the floor
of the mouth superior to the mylohyoid muscle (suprahyoid region). There it provides motor innervation to the
muscles of the tongue.
Just inferior to the hypoglossal nerve lies the greater horn of the hyoid bone. Palpate this important
landmark then follow the hypoglossal nerve antereomedially cleaning away fascia as you go. Trace a very
slender nerve that appears to be a brnch of hypoglossal. It innervates the thyrohyoid muscle. This nerve is a
branch of C1 not hypoglossal!!
TIP: The hyoid bone has no bony articulations. Therefore it is very mobile. Palpate your own
hyoid bone using your index finger and thumb and move it from side to side. To find the hyoid
bone on yourself or a colleague, first find the superior border of the thyroid cartilage using the
laryngeal prominence as a landmark. Rest your thumb and index finger on the superior border of the
thyroid cartilage lateral to the laryngeal prominence. Now swallow. At the end of the swallow your
thumb and finger should feel a space above the thyroid cartilage and, superior to that, you should
feel the greater horns of the hyoid bone. Move your thumb and finger to the greater horns and glide
the hyoid bone medial-laterally between your fingers. This can be a little uncomfortable so be gentle
if you are palpating someone else.
Just superior to the hypoglossal nerve lies the posterior belly of the digastric muscle, the third border of the
carotid triangle (refer to your atlas for an image). This muscle will become clearer after the dissection of the
suprahyoid muscles.
As you clear away the fascia in the carotid triangle the common carotid artery and its branches will become
more visible. Clean and identify two branches of the external carotid, the superior thyroid artery and lingual
artery (refer to your atlas for an image). The superior thyroid artery descends anterior to the common carotid
artery to supply the thyroid gland. The lingual artery ascends from its origin and follows the hypoglossal nerve
to the tongue.
Using a small scissors, push the IJV and common carotid artery apart and look for the vagus nerve. It lies
within the carotid sheath posterior to the IJV and carotid artery (refer to your atlas for an image). Clean the
full extent of the vagus inferiorly and verify its identity by finding vagus in the ipsilateral thorax and tugging
on it. The vagus in the neck should wiggle.

33

Common carotid artery

Now clean vagus as far superiorly as you can and look for the superior laryngeal nerve, a branch of the vagus
that innervates parts of the larynx. The easiest way to find superior laryngeal nerve is to find its largest branch,
the internal laryngeal nerve, and follow it back to the superior laryngeal. The internal laryngeal nerve pierces
the thyrohyoid membrane just deep to the posterior border of the thyrohyoid muscle (refer to your atlas for an
image). Push away the posterior border of the thyrohyoid muscle and feel the thyrohyoid membrane in the
space between the thyroid cartilage and the hyoid bone. Look for the internal laryngeal nerve piercing the
membrane about 1-1.5 cm lateral to midline. It is quite a large nerve and is accompanied into the larynx by the
small superior laryngeal artery usually a branch of the superior thyroid artery (refer to your atlas for an
image). You will see these structures again during dissection of the larynx. The internal laryngeal nerve
provides sensory innervation to the larynx above the level of the vocal cords. Once you have found the internal
laryngeal nerve, follow it superiorly, gently pushing structures aside as you go, and find the superior laryngeal
and vagus nerves.
TIP: You may want to tilt the cadavers head back and turn it to one side in order to have better
access to the deep parts of the carotid triangle. You can do this by putting a low block under the
shoulder of the cadaver on the side you want to work on. Then reposition the head.
The superior laryngeal nerve typically arises from the vagus nerve superior to the origin of the facial artery
from the external carotid artery. It descends a short distance then divides into internal and external laryngeal
nerves at the point where it crosses the internal carotid artery. Follow the superior laryngeal nerve back down
the neck and look for its other branch the very thin external laryngeal nerve. External laryngeal descends on
the external surface of the larynx to innervate the cricothyroid muscle postioned between the cricoid and
thyroid cartilages (refer to your atlas for an image). If you havent previously reflected the sternothyroid
muscle from its superior attachment, do so now and verify the path of the external laryngeal nerve to the
cricothyroid muscle. Preserve this relationship for study again during dissection of the larynx.
Now that you have cleaned and loosened the superior region of carotid triangle, re-examine the common
carotid artery. Just at its branch point identify a dilation - the carotid sinus (refer to your atlas for an image).
In this region the smooth muscle of the artery contains baroreceptors that transmit information about blood
pressure to the brain via CN IX, the glossopharyngeal nerve. (You can't see the baroreceptors. They are
embedded in the arterial wall.) Straddling the bifurcation of the common carotid artery into internal and
external carotid arteries is another special structure - the carotid body. This small dark brown mass is
connected to the arteries by many capillary-sized vessels from which it samples blood. It sends information

34

about the chemistry of the blood to the brain via CN IX. You will look for CN IX at a later time and from a
different vantage point. Then you can follow it back to the carotid structures.

Branches of the external carotid artery

Now look for several more branches of the external carotid artery (refer to your atlas for an image). You
have already found the superior thyroid, internal laryngeal and lingual branches. Near the point where the
posterior belly of the digastric muscle crosses the external carotid artery look for the facial artery traveling
medially and the occipital artery traveling posteriorly. The facial artery will dive under the submandibular
gland and loop back to cross the inferior border of the mandible (refer to your atlas for an image). It might be
easier to follow the facial artery from the mandible back to the carotid. Do not remove the submandibular
gland, just loosen it and push it aside to follow the artery.
The occipital artery gives a branch to the SCM then dives deep to the muscles attached to the mastoid process
before ascending on the base of the occipital bone. It is visible in the apex of the posterior triangle of the neck.
Look for the small ascending pharyngeal artery just superior to the bifurcation of the common carotid artery.
More superior branches of the external carotid will be dissected in a later step.
TIP: Expect to find variations in the branches of the external carotid artery and the tributaries
of the internal jugular vein!
Veins accompanying these arteries empty into the IJV. Identify the common facial, lingual and superior
thyroid veins, then carefully remove them from the dissection field.

35

Neck 2
Step 4
Submandibular and Submental Triangles
Dissection Instructions
The borders of the submandibular (digastric) triangle are:
Anterior: anterior belly of the digastric muscle
Posterior: posterior belly of the digastric muscle
Superior: inferior border of the mandible

Subdivisions of the anterior and posterior triangles

of the neck

Skull

In order to appreciate the structures that you will dissect in this step, begin by looking at the inferior and lateral
aspects of the temporal bone of the skull and the internal aspect of a mandible. Identify two projections
from the temporal bone - the large mastoid process located posterior and inferior to the external acoustic
meatus; and the styloid process a long narrow projection about 0.5 cm anterior and medial to the mastoid
process (refer to your atlas for an image). In many of the real skulls in your bone boxes the styloid process has
broken off. The plastic skulls in the lab are usually intact.

36

Digastric and submandibular fossae

Mylohyoid line and groove

On the internal aspect of the mandible identify three depressions and one raised element (refer to your atlas
for an image). The digastric fossa(e) lies on the internal surface of the anterior inferior region of the mandible
on each side of the midline mandibular symphysis. These fossae are the attachments sites for the anterior
belly of the left and right digastric muscles. The mylohyoid line is a somewhat obliquely oriented ridge
about 3 cm long located along the middle third of the body of the mandible (refer to your atlas for an image).
It is the attachment site for the mylohyoid muscle - a transversely oriented muscle with a midline raphe. The
mylohyoid muscle supports the floor of the mouth.
Inferior and parallel to the mylohyoid line is the submandibular fossa. This depression houses the
submandibular gland. The mylohyoid groove is located on the internal surface of the angle of the mandible. It
descends for about 1.5 cm from the mandibular foramen and carries the nerves and vessels that supply the
mylohyoid muscle and the anterior belly of the digastric. The mandibular foramen and its contents will be
studied in a later lab.

Submandibular triangle

Hypoglossal nerve (CN XII)

Now return to the cadaver and continue your dissection of the anterior triangle of the neck. Identify the borders
of the submandibular triangle and the submandibular gland that lies within the triangle (refer to your atlas
for an image). Clean the anterior and posterior bellies of the digastric muscle. Deep to the anterior belly of
the digastric, identify the mylohyoid muscle distinctive for its transversely oriented fibers.

37

Identify the submandibular gland. It is larger than what you see on the surface. It wraps around the posterior
border of the mylohyoid muscle. Thus, its superficial portion lies inferior to the mylohyoid muscle while its
deep portion lies superior to the mylohyoid between the mylohyoid and hyoglossus muscles. Its duct passes
anteriorly and medially to open onto the floor of the mouth. The submandibular gland has relations to the facial
artery and vein as well as the lingual and hypoglossal nerves. Detailed dissection of the gland and duct will be
done with dissection of the oral cavity.
Loosen the submandibular gland from its surrounding fascia but do not remove it from its location.
Separate the facial artery and vein from the submandibular gland. Note that branches of the facial artery
supply the gland. Review the origin of the facial artery from the external carotid artery.
Identify the intermediate tendon that joins the anterior and posterior bellies of the digastric muscle (refer to
your atlas for an image). It is anchored to the body and greater horn of the hyoid bone via a fibrous sling of
pretracheal fascia. Examine the posterior belly of the digastric muscle near the intermediate tendon and note
that it is straddled by the stylohyoid muscle (refer to your atlas for an image). Carefully push the fibers of the
stylohyoid away from the digastric and follow it superiorly as far as you can. Stylohyoid originates from the
styloid process of the temporal bone. You can probably feel the tip of the styloid process if you slide your
finger superiorly along the muscle. Follow the posterior belly of the digastric to the mastoid process.
TIP: The anterior and posterior bellies of the digastric muscle have different embryological
origins. This explains the fact that they are innervated by different nerves! The mylohyoid
muscle and anterior belly of digastric receive a branch of CN V3 (nerve to mylohyoid), the
stylohyoid muscle and posterior belly of digastric are innervated by CN VII.
Locate the hypoglossal nerve (CN XII) in the carotid triangle and follow it into the submandibular triangle
(refer to your atlas for an image). Confirm that the nerve travels superior to the mylohyoid muscle. Its pathway
inside the oral cavity will be dissected later.
Pull the anterior belly of the digastric medially and identify the nerve to the mylohyoid (branch of CN V3)
(refer to your atlas for an image). The nerve lies against the mylohyoid muscle which it innervates and sends a
branch anteriorly to innervate the anterior belly of the digastric muscle.

Submental triangle

38

Identify the submental triangle (refer to your atlas for an image). Its borders and floor are the:
Anterior belly of the left and right digastric muscles (left and right lateral)
Body of the hyoid bone (base)
Two mylohyoid muscles (floor)
Find and clean all of the muscles that form the borders and floor of the submental triangle the anterior belly
of the right and left digastric muscles and the two mylohyoid muscles. Identify the raphe that joins the right and
left mylohyoid muscles.Look for the nerve to the mylohyoid muscle. It is a branch of CNV3.

39

Neck 2
Step 5
Thyroid and Parathyroid Glands
Dissection Instructions
Return to the midline of the neck and reexamine the thyroid gland. It lies inferior to the thyroid and cricoid
cartilages (refer to your atlas for an image). Its right and left lobes are united in the midline by an isthmus.
Note that the isthmus lies anterior to the 2nd to 4th tracheal rings. The isthmus may give rise to a pyramidal
lobe that extends superiorly. Determine if this is the case in your cadaver. Approximately 50% of people have a
pyramidal lobe.

Thyroid gland

Identify the superior thyroid artery, a branch of the external carotid artery (refer to your atlas for an image).
To find the inferior thyroid artery, pull one lobe of the thyroid gland anteriorly away from the trachea. Don't
remove it, just pull it forward. The artery should be visible. Trace it to its origin from the thyrocervical trunk.
Some people (10%) have a thyroid ima artery. This unpaired artery usually arises from the brachiocephalic
trunk (refer to your atlas for an image).
Look for superior, middle and inferior thyroid veins draining the thyroid gland (refer to your atlas for an
image). These veins form a venous plexus over the anterior surface of the gland. The superior thyroid veins
parallel the superior thyroid arteries and drain into the internal jugular veins (IJV). The middle thyroid veins
parallel the inferior thyroid artery and also drain into the IJVs. The inferior thyroid veins drain the inferior
aspects of the gland into the brachiocephalic vein.

40

Left recurrent laryngeal nerve relation to thyroid

gland

Thyroid gland reflected

Cut through the isthmus of the thyroid gland and reflect the right and left lobes laterally. You will find a
fascial band that connects the capsule of the gland to the 1st tracheal ring (refer to your atlas for an image).
Clean along the trachea on the left side of the body and find the recurrent laryngeal nerve ascending toward
the larynx. Verify its identity by returning to the thorax and following the left recurrent around the aorta and
into the superior thoracic aperture.
On the right side, find the right recurrent laryngeal nerve by following the vagus nerve toward the superior
thoracic aperture. The right recurrent nerve recurs around the subclavian artery (refer to your atlas for an
image). Clean the region until you can verify this pathway.

41

Parathyroid glands (posterior view)

Reflect one of the thyroid lobes anteriorly and medially so you can inspect its posterior surface. Look for the
parathyroid glands which are small (approximately 0.5 cm in diameter) dark masses located between the
capsule and the sheath. They are often hard and very smooth. There are usually 2 parathyroid glands on each
side, but there may be 1 to 3 (refer to your atlas for an image).

42

Neck 2
Step 6
Root of the Neck
Dissection Instructions
The root of the neck is the junction between the thorax and the neck. It is sometimes called the
thoracocervical region. It contains the superior thoracic aperture through which all of the important
structures running between the thorax and the head pass. The boundaries of the root of the neck are:
Manubrium of sternum (anterior)
1st and their costal cartilages (lateral)
Body of T1 vertebra (posterior)
On the left side only, sever the internal jugular vein 2 cm inferior to the bifurcation of the common carotid
artery and reflect it anteriorly. It is not usually necessary to cut the common carotid artery but check with your
lab instructor if you have any questions about your cadaver. DO NOT CUT THE VAGUS OR PHRENIC
NERVES!! Use a dissecting pin or needle probe to hold the IJV anteriorly so you can explore the root of the
neck.

Subclavian vein

Look for the thoracic duct that arches over the left subclavian artery and terminates in the left venous angle
formed by the joining of the left subclavian and internal jugular veins (refer to your atlas). Return to the
thoracic cavity and find the thoracic duct there. Free it along its path toward the left venous angle until you can
tug on it in the thorax and see it wiggle in the root of the neck. Take great care in dissecting the thoracic duct
because it is easily torn.

43

Vagus and phrenic nerves

Identify and clean the distal cervical parts of the vagus and phrenic nerves. Note that the phrenic nerve is
intimately applied to the anterior surface of the anterior scalene muscle (refer to your atlas for an image). What
is its relation to the prevertebral fascia? Follow both the phrenic and vagus nerves along their full paths through
the neck and into the thorax. Describe their relation to each other at three points: the level of C6, in the root of
the neck, and in the superior thorax.

Thyrocervical trunk

Note that the transverse cervical and suprascapular arteries pass superficial to the phrenic nerve and anterior
scalene muscle (refer to your atlas for an image). Trace these arteries back to their origin from the
thyrocervical trunk (occasionally the subclavian artery). Identify the inferior thyroid artery as it arises from
the thyrocervical trunk. Follow it as it passes posterior to the carotid sheath to supply the thyroid gland.
TIP: Expect to find variations in the branches of the thyrocervical trunk and subclavian artery!
Clean the subclavian artery working medially from the thyrocervical trunk. Find the vertebral artery, the
first and largest branch of the subclavian artery (refer to your atlas for an image). It ascends for a short distance
in a triangular space bounded by the anterior scalene and longus colli muscles before it dives deep to enter the

44

transverse foramen of C6. It will pass through the transverse foramina of C1-C6 before it enters the skull
through the foramen magnum.

Vertebral and internal thoracic arteries, thyrocervical trunk

Find the internal thoracic artery where it arises from the subclavian artery opposite to the thyrocervical trunk
(refer to your atlas for an image). The internal thoracic artery descends into the thorax adjacent to the sternum,
posterior to the first 6 costal cartilages and supplies the anterior thoracic wall.
Now follow the subclavian artery laterally. Where it passes between the anterior and middle scalene muscles it
gives rise to the costocervical trunk which divides into the superior intercostal and deep cervical arteries
(refer to your atlas for an image). They supply the first two intercostal spaces and the deep cervical muscles
respectively.
Finally, clean along the anterior surface of the cervical vertebrae parallel and medial to the vagus nerve.
Identify the cervical sympathetic trunk and ganglia (refer to your atlas for an image).
TIP: The vagus nerve and sympathetic trunk can sometimes look similar. Be sure that you
identify some distinguishing characteristics of each so you can easily tell them apart!
The middle cervical ganglion lies near the upper border of C6. It is not always very distinct but you may see
small nerves descending from it into the thorax. The inferior cervical ganglion lies at the level of C7-T1.
Sometimes it fuses with the T1 ganglion. Then it is called the stellate ganglion. The superior cervical ganglion
will be identified in subsequent dissections.

45

Osteology
General Overview
Cranial Osteology Conference: Skull
Introduction
The following outline provides a guide to the important cranial structures that you need to know in order to
understand and appreciate the clinical anatomy of the head. It is best to become familiar with these structures
on the dry skull prior to beginning dissection of the soft tissue of the head. Refer to your text or atlas to
identify the structures listed below.
The structures that will be the focus of the Cranial Osteology Conference are listed in bold. They are organized
according to visible perspective of the skull (superior view etc.) Many structures can be seen from more than
one perspective. However, in the following list they are bolded only in their most visible perspective of the
skull. Soft tissue structures related to the bony structures are listed in italics. Realize that in most cases, the
appearance of each foramen in the dry skull is quite different from that in the cadaver (or living person!)
because many of the foramina are covered by dura or other soft tissue structures.

46

Exterior of the Adult Skull

I. Superior View (Norma Verticalis) (Childs skull - refer to your atlas for an image).

Child's Skull (superior view)

1. Bones
frontal bone
parietal bones (paired)
occipital bone
sutural bones (variable): wormian bones - most often found in lambdoid suture; a large sutural
bone at lambda is often called in Inca bone; sutural bones are genetic rather than pathological in
nature.
2. Sutures
coronal suture
sagittal suture
lambdoid suture
metopic suture (variable)
3. Landmarks and Foramina
bregma
lambda
zygomatic arch (paired)
superciliary arch (paired)
parietal foramina: when present they transmit emissary veins
parietal eminence (paired)
superior and inferior temporal lines

47

II. Anterior View (Norma Frontalis) (refer to your atlas for an image)

Anterior view of skull

1. Bones
frontal bone
nasal bones (paired)
maxillae (paired) (maxilla, singular)
frontal process
alveolar process
palatine process
zygomatic bones (paired)
sphenoid bone
ethmoid bones
crista galli
orbital plate
perpendicular plate
superior and middle conchae
superior and middle meati
lacrimal bones (paired)
vomer
palatine bones (paired)
inferior nasal conchae (concha, singular)
mandible
2. Landmarks and Foramina
superciliary ridges or arches
glabella
nasion
supraorbital foramen or notch
infraorbital foramen
anterior nasal aperture

48

3.

4.

5.

6.
7.

orbit
anterior nasal spine
zygomaticofacial foramen
zygomaticotemporal foramen
Orbital Cavity
superior orbital fissure
optic canal
inferior orbital fissure
infraorbital groove
anterior ethmoidal foramen
posterior ethmoidal foramen
lacrimal fossa
opening of nasolacrimal canal
Nasal Cavity
superior concha (part of ethmoid bone)
middle concha (part of ethmoid bone)
inferior nasal concha (a separate bone)
sphenoethmoidal recess
opening of sphenoid sinus
openings of cribriform plate
superior meatus
openings of posterior ethmoidal air cells
middle meatus
atrium
ethmoidal bulla
semilunar hiatus
opening of frontonasal canal from frontal sinus
opening of maxillary sinus
openings of anterior & middle ethmoidal air cells
inferior meatus
opening of nasolacrimal canal
posterior nasal apertures (choanae)

49

III. Posterior View (Norma occipitalis) - (refer to your atlas for an image)
1. Bones
occipital bone
parietal bones (paired, already seen from superior and lateral views)
2. Sutures
lambdoid suture
(other sutures named by the bones they join)
3. Landmarks and Foramina
mastoid processes
external occipital protuberance (inion)
superior nuchal line
lambda
IV. Lateral View (Norma Lateralis) (refer to your atlas for an image)

Lateral view of skull

1. Bones
temporal bones (paired)
squamous part
petrous part
mastoid part
tympanic part
sphenoid bone
greater wing
infratemporal crest
lateral pterygoid plate
2. Sutures
squamous suture
(other sutures named by bones they join)
3. Landmarks
temporal fossa
infratemporal fossa
pterygomaxillary fissure
pterygopalatine fossa
external acoustic meatus

50

styloid process
zygomatic arch
pterion
mandibular fossa
articular eminence

51

V. Inferior View (Norma Basalis) (refer to your atlas for an image)

Inferior view of skull base (righ half)

1. Bones
maxillae (paired)
palatine bones (paired)
vomer
sphenoid bone
pterygoid process
medial pterygoid plate
pterygoid hamulus: process around which the tendon of the tensor veli palatini
muscle winds
lateral pterygoid plate
pterygoid fossa (separates medial and lateral pterygoid plates)
zygomatic bones (paired)
temporal bones (paired)
occipital bone
basal part
pharyngeal tubercle - attachment of superior constrictor muscle and median pharyngeal
raphe
occipital condyles

52

2. Landmarks and Foramina

bony palate
incisive fossa containing two incisive foramina (transmit greater palatine artery and
nasopalatine nerve)
greater palatine foramen (transmits greater palatine vein, artery and nerve)
lesser palatine foramen (transmits lesser palatine vein, artery and nerve)
sphenopalatine foramen (transmits sphenopalatine vein, artery and superior nasal nn.)
posterior nasal spine
posterior nasal apertures (choanae)
foramen ovale (transmits mandibular nerve (CN V3))
foramen spinosum (transmits middle meningeal artery)
foramen lacerum
carotid canal
auditory tube
petrotympanic fissure (transmits chorda tympani)
stylomastoid foramen (transmits facial nerve)
foramen magnum
jugular foramen (transmits CNs XI, X, XI)
hypoglossal canal (anterior condylar canal)
condylar canal (posterior condylar canal)
mastoid notch (attachment of posterior belly of digastric muscle)

53

VI. Mandible

Mandible, external surface

Mandible, internal view

1. Ramus
condyle
mandibular notch
coronoid process
angle
mandibular foramen (transmits inferior alveolar vein, artery and nerve)
mandibular canal
mylohyoid groove (contains mylohyoid vein, artery and nerve)
lingula (attachment of sphenomandibular ligament)
2. Body
mental foramen (transmits mental vein, artery and nerve)
mental protuberance or eminence (chin)
alveolar ridge
superior and inferior mental spines (genial spines, attachment of genioglossus and geniohyoid
muscles respectively)
digastric fossa (attachment of anterior belly of digastric muscle)
mandibular symphysis
mylohyoid line
submandibular fossa

54

Interior of the Skull

I. Inner Table of Cranial Vault (Calvarium) (refer to your atlas for an image)
1. Impressions of the middle meningeal artery
anterior and posterior branches
2. Longitudinal groove for superior sagittal sinus
attachment of falx cerebri
extends from the frontal crest to the internal occipital protuberance
3. Shallow depressions for arachnoid granulations
4. Parietal foramina for transmission of emissary veins

55

Anterior, Middle and Posterior Cranial Fossae

I. Anterior Cranial Fossa (refer to your atlas for an image)

Superior view of skull base (right half)

1.
2.
3.
4.

Superior view of skull base 2 (right half)

Orbital plates of frontal bone

Cribriform plate of the ethmoid bone
Lesser wings of sphenoid bone
Landmarks and Foramina
foramen cecum at the base of the crest of the frontal bone, through which passes (infrequently)
an emissary vein from the superior sagittal sinus to nasal cavity
crista galli of ethmoid bone to which attaches falx cerebri
cribriform plate of ethmoid (transmits olfactory nerve fibers from nasal olfactory epithelium to
olfactory bulb of the brain (which overlies the plate)
posterior ethmoidal foramen (paired) (transmits posterior ethmoidal artery, branch of the
ophthalmic artery, and posterior ethmoidal nerve, branch of nasociliary nerve)
anterior ethmoidal foramen (paired) (transmits anterior ethmoidal artery and nerve)

56

II. Middle Cranial Fossa (refer to your atlas for an image)

1.
2.
3.
4.

Body, greater wings and sella turcica of the sphenoid bone

Petrous and squamous parts of temporal bone
Sphenoid angle of parietal bone
Landmarks and Foramina
chiasmatic groove
optic canals (transmits optic nerve and ophthalmic artery)
anterior clinoid processesof the lesser wings of the sphenoid (attachment for the tentorium
cerebelli)
hypophyseal fossa (for pituitary gland)
dorsum sellae
posterior clinoid processes of the dorsum sellae (attachment for the tentorium cerebelli)
carotid groove (for internal carotid artery)
superior orbital fissure (transmits ophthalmic vein and CNs III, IV, ophthalmic branch of CN V,
and CN VI)
foramen rotundum (transmits maxillary branch of CN V)
foramen ovale (transmits mandibular branch of CN V, accessory meningeal artery, lesser
petrosal nerve)
foramen spinosum (transmits middle meningeal artery and meningeal branch of mandibular
nerve)
foramen lacerum (closed by cartilage in life; transmits meningeal branch of ascending
pharyngeal artery)
pterygoid canal (transmits nerve of the pterygoid canal)
canal for greater petrosal nerve
groove for lesser petrosal nerve (not constant)

III. Posterior Cranial Fossa (refer to your atlas for an image)

1.
2.
3.
4.

Dorsum sellae of sphenoid bone

Occipital bone
Petrous and mastoid parts of temporal bones
Landmarks and Foramina
foramen magnum (transmits spinal cord, meninges, CSF, vertebral artery, anterior and
posterior spinal arteries, and spinal roots of CN XI)
hypoglossal canal (transmits CN XII)
condylar canal (transmits emissary vein)
jugular foramen (transmits CNs IX, X, XI and venous blood that enters the internal jugular vein
on the external surface of the jugular foramen)
internal acoustic meatus (transmits CNs VII and VIII)
internal occipital crest (attaches falx cerebri and lodges occipital sinus)
mastoid foramen (transmits emissary vein)
impression of transverse sinus
impression of sigmoid sinus

57

Clinical Correlations
Metopic Suture
The frontal bone of the skull actually develops from two separate bones that are united by a frontal suture. In
most cases, the frontal suture is obliterated by the 8th year of life. However, in about 8 % of people a remnant
of it, the metopic suture, persists. A persistent metopic suture must not be interpreted as a frontal fracture in
an X-ray or other type of medical imaging.
Significance of the Pterion
The pterion is a significant clinical landmark because it overlies the anterior branches of the middle meningeal
vessels, which lie in grooves on the internal aspect of the middle cranial fossae and calvarium. Blunt trauma to
the side of the head may fracture the thin bones forming the pterion, rupture the artery, and cause a hematoma
that exerts pressure on the cerebral cortex. This could lead to death in a matter of hours.

58

Face
General Overview
In this unit you will perform a series of dissections of the soft tissues of the face. Refer to your atlas for an
image of the Surface Anatomy of the face. You need to understand the organization of the bony and soft tissue
structures that you will be dissecting.
The skin of the face is very thin and relatively loosely attached to the deeper layer of fatty subcutaneous
tissue except over the forehead and nose where it is tightly adherent to the deep fascia. The subcutaneous tissue
is variably thick in people and contributes significantly to the contours of the lower face. The muscles of facial
expression are embedded in the superficial (subcutaneous) fascia. They are very thin but usually quite distinct.
Most of them have one attachment to bone and one attachment to dermis! The function of these muscles is to
move the skin of the face when expressing emotion (joy, sadness, fright, anger, etc.) or when speaking, eating,
or blinking. Three of the muscles of facial expression are sphincteric muscles that surround the eyes and mouth
(2 orbicularis oculi and 1 orbicularis oris). All of the muscles of facial expression, including platysma, are
innervated by branches of CN VII (facial nerve) (refer to your atlas for an image).
CN VII exits the skull through the stylomastoid foramen (refer to your atlas for an image) and approaches the
face from the posterior border of the ramus of the mandible. There it enters the parotid gland (external to the
ramus of the mandible) and divides into five main branches that exit the gland and fan out over the face to
reach all of the muscles of facial expression (refer to your atlas for an image). The branches of CN VII are
close to the surface and easy to identify as long as you don't cut them away!
The facial artery provides the major blood source to the lower superficial region of the face (refer to your atlas
for an image). The superficial temporal artery, a terminal branch of the external carotid artery, supplies the
lateral and upper regions of the face. Both of these arteries will be identified and dissected. The facial artery
and vein travel an oblique pathway between the inferior border of the mandible and the medial side of the
orbital region. Superior and inferior labial arteries branch from the facial vessels at the corner of the mouth
and supply the lips. Near the medial corner of the eye the facial artery terminates as the angular artery.
The trigeminal nerve (CN V) is the major sensory nerve of the face (refer to your atlas for an image). It sends
three large terminal branches, the supraorbital, infraorbital and mental nerves (paired), through the
supraorbital, infraorbital and mental foramina. Each of these branches derives from a different division of
the trigeminal nerve. The supraorbital nerve is from CN V1, the infraorbital nerve from CN V2 and the mental
nerve is from CN V3. In a later dissection of the cranial cavity, you will find the trigeminal ganglion and the
proximal parts of CN V1, V2, and V3. In addition to CN V, the great auricular nerve provides sensory
innervation to the angle of the mandible and auricle of the ear.
The anterior aspect of the orbit is formed by the eyelids (palpebrae). The orbicularis oculi muscles lie just
deep to the skin which is particularly thin and fragile on the eyelids. The structure of the eyelids is supported
by tarsal plates (refer to your atlas for an image). Deep dissection of the orbit is described in a later unit.
The external aspect of the nose and the external ear will be examined and dissected to reveal the hyaline and
elastic cartilages that give shape and flexibility to the nose and ear respectively (refer to your atlas for an
image).

59

Face
Step 1
Skin Incisions, Muscles, Vessels and Nerves of the Lower Face
Dissection Instructions
In this dissection the muscles of facial expression will be studied. There is wide variation in the size and
definition of these muscles. DO NOT spend a lot of time looking for every muscle of facial expression.
Between all of the cadavers in each lab you will get to see most of the muscles.
Make bilateral shallow skin incisions as illustrated on the left side of the face in the image below.

Facial incisions

In the midline make a vertical incision from the vertex (top) of the head (not shown) to the inferior
border of the mandible.
Make circular incisions around the external margin of the lips and around each orbital margin.
In the coronal plane make bilateral vertical incisions from the vertex, across the temporal region,
anterior to the ear, to a point just posterior to the angle of the mandible.
Beginning at the inferior border of the mandible, identify the platysma muscle and use it as a guide for the
appropriate depth to incise the skin. Carefully remove the skin only, leaving the underlying subcutaneous
fascia intact. The facial muscles, nerves and vessels run through this fascia. Remember that the skin on the
face is very thin and the muscles of facial expression are attached directly to the skin (dermis). You must take
care to not damage these muscles. DO NOT REMOVE THE SKIN OVER THE NOSE OR FOREHEAD YET
(see Step 2).

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TIP: Begin reflecting the skin of the face at the inferior border of the mandible where the
platysma muscle interdigitates with some of the inferior muscles of facial expression. Use these
muscles as your guide for the depth at which you expect to find the rest of the facial muscles. Save
the forehead and nose for last because they are most difficult to do.
Once the skin is removed from the lower face, (interior to the superior border of the zygomatic arch), use the
small scissors to push apart the fatty superficial fascia and expose the muscles of facial expression
embedded there (refer to your atlas for an image). With the scissors closed, push the tip into the fatty layer then
open the scissors and it will push the fat aside. Once you can see the muscle layer, snip the overlying fat away.
In the lower face the depressor anguli oris is very easy to identify and clean (refer to your atlas for an image).
This muscle is attached to the mandible just lateral to the mental foramen and narrows superiorly to insert near
the corner of the mouth. Contraction of this muscle pulls the corners of the mouth down as when frowning.
Continue to clean around the margin of the upper and lower lips and identify the circular orbicularis oris
muscle.

Superficial facial structures

Lateral to the corner of the mouth look for the facial artery ascending from the inferior border of the mandible
to the medial corner of the eye (refer to your atlas for an image). Like the splenic artery, the facial artery is very
tortuous, so look for loops or u-turns of the artery especially near the corners of the mouth. The flatter,
straighter facial vein runs parallel to the artery, slightly lateral to it. Superiorly the facial vein communicates
with the superior ophthalmic vein which carries blood to the cavernous sinus deep inside the head. The facial
vein provides a route by which bacteria can travel from the face into the brain! Inferiorly it empties into the
jugular venous system, usually via the IJV.
Identify the zygomaticus major muscle running obliquely between the corner of the mouth and the zygomatic
arch (refer to your atlas for an image). Sometimes you can also find the zygomaticus minor muscle running
parallel and just superior to the major. These muscles make you smile! :)
A little bit superior and lateral to the corner of the mouth look for the large flat white-ish parotid duct running
transversely across the cheek external to the masseter muscle (refer to your atlas for an image). The duct
originates from the parotid gland (will be dissected later), which lies along the posterior border of the ramus of
the mandible partially covering the masseter muscle. At the anterior border of masseter, near the inferior part of
zygomaticus major, the parotid duct dives medially and pierces the buccinator muscle to enter the oral cavity.
You may not see the buccinator muscle yet because the buccal fat pad lies superficial to it. On the inside of the
cheek, adjacent to the second upper molar, the parotid papilla contains the opening of the duct. The parotid

61

duct delivers saliva from the parotid gland to the oral cavity.
TIP: You can see the parotid papilla in your own mouth if you look in a mirror and turn your
cheek in-side-out. Look in a friend's mouth and find their parotid papillae.
The masseter muscle is one of the muscles of mastication (refer to your atlas for an image). It is a large
more-or-less vertical muscle that attaches to the angle of the mandible inferiorly and the zygomatic arch
superiorly. You can easily palpate it and (maybe) the parotid duct diving around its anterior border when you
clench your teeth.
Look for the masseter muscle on the cadaver but do not try to clean its entire extent yet! Between the
parotid duct and the zygomatic arch, find the zygomatic branch of the facial nerve and the transverse facial
artery. The artery is small and may be difficult to find but the nerve should be easy to find as it approaches the
zygomaticus major muscle and innervates it.

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Face
Step 2
Muscles, Vessels and Nerves of the Upper Face
Dissection Instructions
Follow the parotid duct from the region near the mouth laterally to the point where it emerges from the
parotid gland. Clean and define the parotid gland taking care to not cut the branches of CN VII that exit its
perimeter (refer to your atlas for an image). You will soon return to the parotid gland and find all five branches
of CN VII.

Facial muscles

Branches of facial nerve

On the superior margin of the parotid gland just anterior to the tragus of the ear, find the superficial
temporal artery and follow it superiorly using it as a guide to remove the skin on the side of the face and over
the forehead (refer to your atlas for an image). The frontal branches of the superficial temporal artery run
superficial to the frontalis muscle so if you can see the artery you can see the muscle!!
The frontalis muscle runs vertically in the subcutaneous tissue of the forehead and has no bony attachments.
Inferiorly it is attached to the skin under the eyebrows and on the forehead. Superiorly it is attached to a large
tendon - the epicranial aponeurosis - that also receives the occipitalis muscle, which is attached to the
occipital bone on the posterior side of the head (refer to your atlas for an image). This entire musculotendinous
unit is called the occipitofrontalis muscle. Frontalis raises the eyebrows and wrinkles the forehead. The
aponeurosis forms a layer of the scalp (studied later).

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Superficial view of the right eye

Once you have identified and cleaned frontalis, prepare to remove the skin over the upper and lower eyelids
(refer to your atlas for an image). Identify the palpebral commissures (canthi, canthus sing.) the points
medially and laterally where the upper and lower eyelids meet. Open the eyelids and identify the lacrimal
lake, a triangular region deep to the medial canthus with a small mound, the caruncle, in the middle. Each
eyelid has a lacrimal papilla near the medial canthus and on the papilla is the lacrimal punctum. Tears are
secreted from the lacrimal gland located in the superolateral corner of the orbit. They wash across the eye and
collect in the lacrimal lake before entering the lacrimal puncta to drain into the nasolacrimal duct.
Use a very sharp scalpel blade to incise the skin along the margin of each eyelid parallel to the row of
eyelashes. Use only the very tip of the blade and make the cut shallow. Then, beginning around the
periphery of the orbit, carefully remove the skin over the orbit and eyelids. In many cases you can lift the skin
with a forceps and use the small scissors to separate it from the underlying orbicularis oculi muscle rather
than using a scalpel. Orbicularis oculi has two superficial components - the orbital part lying superior and
inferior to the actual eyelids, and the palpebral part lying directly over the eyelids (refer to your atlas for an
image).
With the skin removed, identify the medial palpebral ligament (refer to your atlas for an image). It connects
the upper and lower tarsal plates to the medial margin of the orbit. The orbicularis oculi muscle attaches to the
medial palpebral ligament. On one eye reflect the orbicularis oculi from lateral to medial and examine the
tarsal plates. These dense bands of connective tissue provide support and structure to the eyelid. Look for the
lateral palpebral ligament (check ligament), which is less distinctive than the medial and may be difficult to
identify. You will return to the orbital region later.
Remove the skin over the sides and bridge of the nose and identify the vertically oriented procerus muscle
and transversely oriented nasalis muscle (refer to your atlas for an image). In the nasolabial groove (sulcus)
adjacent to the nose, look for the thin vertical levator labii superioris alaeque nasi (elevator of the superior lip
and wing of the nose) muscle. Continue cleaning adjacent to the nares toward the upper lip and find the very
distinct levator labii superioris muscle (refer to your atlas for an image). This muscle raises the upper lip a la
Elvis Presley.
Now that all of the superficial facial muscles are exposed, return to the parotid gland. Tease apart the
fascia around the margin of the gland and locate the small nerves that branch from the 5 major branches of
the facial nerve (refer to your atlas for an image). The 5 major branches of CN VII formed within the parotid

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gland and then branched again before they exited so you will find one or more nerves from each branch exiting
the gland. Verify the major branch that each small nerve comes from by tracing it out to its target muscle. The
complete dissection of the facial nerve within the parotid gland will be done in the Parotid Region unit.
Temporal branches emerge from the superior border of the parotid gland and innervate the frontalis
and superior part of orbicularis oculi muscles.
Zygomatic branches pass obliquely to the muscles inferior to the eye including the inferior part of the
orbicularis oculi and the zygomatic and levator labii muscles.
Buccal branches travel parallel and inferior to the parotid duct and innervate buccinator and nasalis
muscles as well as the zygomatic and levator labii muscles.
Marginal mandibular branches emerge from the inferior border of the parotid gland and cross the
mandible deep to the platysma to innervate the depressor anguli oris, depressor labii inferioris and
risorius muscles.
Cervical branches pass from the inferior border of the parotid gland and run posterior to the angle of
the mandible to innervate platysma.
MNEMONIC: Tappan Zee Bridge May Close or Two Zebras Bit My Cookies - remind you of
the order of the anterior branches of the facial nerve from superior to inferior - temporal,
zygomatic, buccal, marginal mandibular and cervical.
Anterior to the border of the masseter, deep to the parotid duct, find the buccal fatpad and carefully pick it
away in order to expose the underlying buccinator muscle (refer to your atlas for an image). Verify that the
parotid duct pierces the buccinator muscle.
Two different nerves pierce the buccinator muscle the buccal branch of the facial nerve and the buccal
nerve, a branch of the trigeminal nerve (CN V3) (refer to your atlas for an image). The former nerve supplies
motor innervation to the buccinator muscle, while the latter supplies sensory innervation to the mucosa of the
vestibule of the mouth and a small area of skin on the cheek. Don't look for the buccal branch of CN V yet. You
will find it in a later dissection. These two similarly named nerves are often confused.
TIP: Remember that the facial nerve innervates all the muscles of the facial expression plus
the posterior belly of the digastric muscle and the stylohyoid muscle. The muscles of
mastication or chewing (temporalis, masseter, lateral pterygoid and medial pterygoid) are innervated
by the mandibular nerve (CN V3).

65

Face
Step 3
Facial Artery and Vein, Lower Lip
Dissection Instructions
Return to the facial artery where it crosses the inferior border of the mandible adjacent to the anterior border
of the masseter muscle (refer to your atlas for an image). Clean the artery well along its full extent but leave it
lying in place. Near the corner of the mouth, look for the labial arteries branching from the facial artery and
entering the upper and lower lips. Follow the artery superiorly to the medial canthus of the eye.

Facial artery

Danger triangle

Find the facial vein running parallel but posterior (lateral) to the facial artery. Near the medial canthus of the
eye, the facial vein anastomoses with the superior ophthalmic vein. These veins do not have valves
regulating the direction of venous blood flow. Thus, an infection of the face can spread via the superior
ophthalmic vein to the cavernous sinus and pterygoid venous plexuses which are parts of the intracranial
venous system. Because of this, the triangular area from the corners of the mouth to the glabella is considered
the danger area of the face

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Lip incisions

Mental foramen

On one side of the mouth make two parallel vertical incisions through the entire lower lip - one in the
midline and the other at the angle of the mouth. Continue the incision inferiorly to the gum. Reflect the cut flap
of the lip and look for the inferior labial artery in the cross-section of the lip parallel to the vermillion border.
Follow it transversely dissecting away the mucosa to reveal the length of the artery in its position in the lip.
Dissect the mucosa from the internal surface of the lip as far as the gum. Look for small white labial glands
immediately deep to the mucosa.
Gently peel the cut flap of lip inferiorly pulling the tissues away from the mandible. (Do not pull the lip
off!!!) Clean the bone and identify the mental foramen, an opening in the mandible about 2-3 cm lateral to the
median plane of the chin, and the mental nerve exiting the foramen. Refer to a dry skull or model to verify the
relationships. The mental nerve is a terminal branch of CN V3. It carries sensory information from the chin
and lower lip back to the brain. Clean the nerve and follow its branches as they run superiorly in the lip flap.

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Face
Step 4
Sensory Branches of the Trigeminal Nerve
Dissection Instructions
The sensory nerves of the face are derived primarily from the trigeminal nerve (CN V) (refer to your atlas for
an image). They originate from the brainstem and travel through the middle cranial fossa and facial portions of
the skull to exit via three pairs of foramina - the supraorbital, infraorbital and mental foramina - on the
anterior surface of the skull. Axons from these nerve branches carry sensory innervation for the entire face
except for the angle of the mandible (great auricular nerve). These nerves also supply the lateral and
anterior portions of the scalp (to the vertex).
TIP: Unlike other regions of the integument, cutaneous postganglionic sympathetic axons
enter the face via arteries, primarily branches of the external carotid arteries. These
sympathetic axons ultimately jump off of the arteries and distribute to the glands of the skin via
branches of the trigeminal nerve.

Sensory branches of the trigeminal nerve on the

face

Sensory branches of the trigeminal nerve on the

face

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Refer to a dry skull and find the supraorbital, infraorbital and mental foramina. Compare the skull to
your cadaver and estimate the position of the supraorbital and infraorbital foramina. (The mental foramen and
nerve were located in the previous dissection.) Find the supraorbital foramen and nerve on the same side of the
face that you found the mental foramen and nerve. To do this, cut the superior border of the frontalis muscle
from the epicranial aponeurosis (3-4 cm superior to the supraorbital margin) and carefully reflect it inferiorly
just over the edge of the superior margin of the orbit. Clean the deep surface of the frontalis muscle and look
for branches of the supraorbital nerve and vessels. Follow them to the supraorbital notch or foramen, which
lies about 2 cm from midline on the superior orbital margin. The supraorbital nerve and vessels exit the skull
via this opening and pierce the deep surface of the frontalis muscle to innervate the skin of the forehead and
scalp as far as the vertex of the skull (refer to your atlas for an image). The supraorbital nerve is a terminal
branch of the ophthalmic division of the trigeminal nerve (CN V1).
TIP: Some people have a supraorbital notch rather than a foramen. A notch is an incomplete
foramen. Look on several real skulls and you will see examples of both morphologies. There is
no clinical significance.
The infraorbital nerve is a terminal branch of the maxillary division of the trigeminal nerve (CN V2). It
enters the face via the infraorbital foramen located about 0.5 cm inferior to the inferior orbital margin and 1
cm lateral to the nasolabial fold. It conveys sensation from skin on the lower eyelids, upper lip, and lateral
portion of the nose (refer to your atlas for an image).
The mental nerve was dissected in the previous step. It exits the mental foramen on the body of the mandible
about 2-3 cm lateral to midline. It is a terminal branch of the mandibular division (CN V3) of the
trigeminal nerve. It supplies the chin, mucous membrane and skin of the lower lip and the labial mandibular
gingivae.

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Face
Step 5
External Nose and External Ear
Dissection Instructions
The shape of the mobile external part of the nose is determined by the nasal bones proximally and several
distinct hyaline cartilages and condensations of fibrofatty tissue distally (refer to your atlas for an image).

External nasal cartilages

External nasal cartilages

The nasalis muscle covers the distal position of the nasal bones and the lateral nasal and part of the septal
cartilages. Reflect nasalis and explore the lateral and septal cartilages. They are actually connected to each
other. The lateral cartilages are expansions of the septal cartilage that runs from the surface of the nose
posteriorly into the nasal cavity and divides it into two air passages.
The alar cartilages shape the tip of the nose and the condensations of fibrofatty tissue form the lateral aspects
of the nares that define the nostrils.

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Auricle of the ear

Examine the external parts of the ear, the auricle and the external acoustic meatus (refer to your atlas for an
image). The auricle is shaped by one large elastic cartilage that has several distinct grooves and ridges. The
outer rim of the auricle is the helix. Anterior to the helix is another prominent ridge called the anti-helix. The
tragus is a triangular bump adjacent to the face partially covering the opening of the external meatus. It points
posteriorly and has hairs on its medial surface. The anti-tragus is the bump at the inferior aspect of the
anti-helix that projects toward the tragus. The concha is the rounded depression that leads into the external
auditory meatus. The most inferior part of the external ear is the fat-filled lobule or ear lobe. It is usually
pendulous.
TIP: Dont spend too much time trying to dissect the cartilages of the nose and ear. Do learn
the names of the major cartilages of the nose and the regions of the auricle of the ear.

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Face
Step 6
Eye, Eyelids, Lacrimal Apparatus and Orbital Region
Dissection Instructions
The aim of this step is to continue dissection of the superficial structures of the eye and orbit. Deeper
dissections via the anterior cranial fossa will follow the removal of the brain.

Orbicularis oculi

Deep dissection of the eye (anterior approach)

In your atlas, review the bony structures of the orbit including the lacrimal fossa and the nasolacrimal
duct. Previously you reflected the skin over the eyelids and identified the orbicularis oculi muscle - the
sphincteric muscle that covers the margins of the orbit and the eyelids (refer to your atlas for an image). It has
two visible parts - the palpebral part that covers the eyelids, and the orbital part that overlies the orbital
rim. A third part, the lacrimal part, lies posterior to the lacrimal sac and helps to drain tears. You will not likely
see it. When all three parts contract, the eye closes tightly. The palpebral commissures are the medial and
lateral corners of the eyes where the eyelids meet. The canthi (singular is canthus) are the medial and lateral
angles created at the commisures. The palpebral fissure is the opening defined by the eyelids.

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Superficial eye

Identify the superficial structures of the eye on your lab partner or yourself (in a mirror). Examine your
cadaver and identify them. If the eyeball is sunken, you can inflate it temporarily by injecting water deep to the
sclera. On the eyeball itself, identify the cornea that covers the iris and pupil of the eye (refer to your atlas for
an image). In the living person the cornea is transparent. In the cadaver it will be cloudy. The iris is the colored
adjustable diaphragm of the eye and the pupil is the black central aperture. The sclera is the white dense outer
covering of most of the eyeball.
The internal surface of the eyelids and the visible part of the sclera are covered with a transparent mucous
membrane - the conjunctiva (refer to your atlas for an image). The superior and inferior fornices are the
reflections of the palpebral conjunctiva onto the sclera as the bulbar conjunctiva. The conjunctival sac is the
space between the conjunctiva-covered surfaces of the eyelids and the eyeball.

Ligaments of the eye (right eye)

Each eyelid is supported by a fusiform-shaped band of dense connective tissue called the tarsus or tarsal plate
(refer to your atlas for an image). The palpebral portions of the orbicularis oculi muscles attach to the tarsi.
Also, tarsal glands are embedded in the tarsi. You may see their pinpoint-sized ducts along the margin of the
eyelid posterior to the eyelashes. Eyelashes grow in the connective tissue anterior to the tarsal plate and are
associated with ciliary glands that you won't see.

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Lacrimal apparatus (right eye)

Examine the medial angle of the eye. Between the upper and lower eyelids is the triangular lacrimal lake with
the caruncle in the middle. On the edge of the eyelids near the lacrimal lake are the lacrimal papillae, each
with a lacrimal punctum. This opening permits tears to enter the lacrimal canaliculi which direct them to the
lacrimal sac and ultimately to the nasolacrimal duct.
Identify the medial palpebral ligament, a fibrous band that attaches the superior and inferior tarsal plates to
the anterior crest of the lacrimal fossa at margin of the orbit. It also provides attachment for the orbicularis
oculi muscles along its superior border. A lateral palpebral ligament attaches the tarsi to the lateral orbit but
does not attach the orbicularis muscle.
On one eye, gently lift the lateral margin of the orbicularis oculi (both parts) and reflect it medially. Identify
the orbital septum - a membranous sheet of connective tissue that is attached to the orbital margin and the
tarsal plates (refer to your atlas for an image). Turn the upper lid in-side-out and examine the edge of the
eyelid. If you squeeze the eyelid (A-P) with blunt forceps you may see a lipid-rich sebaceous fluid exiting the
tarsal ducts.
Cut through the superior orbital septum along the lateral border of the supraorbital margin and look for the
lacrimal gland embedded in the loose fat of the orbit (refer to your atlas for an image). Six to ten small
lacrimal ducts connect the gland to the reflection of conjunctiva in the upper lateral quadrant of the eye. Try to
find them.
Return to the medial corner of the eye and push a probe into the lacrimal sac, posterior and inferior to the
medial palpebral ligament. Gently define its opening but don't push too far. Later, in the bisected head, you will
pass a blunt probe all the way through the nasolacrimal duct into the inferior meatus of the nasal cavity.

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Parotid Region
General Overview
The parotid, temporal and infratemporal regions are located on the lateral side of the face. Dissection of
these regions will expose the muscles of mastication (temporalis, masseter, medial and lateral pterygoids)
which attach to both the external and internal surfaces of the ramus and angle of the mandible. This muscule
group is distinct in several ways from the muscles of facial expression. The individual masticatory muscles are
much larger than any of the muscles of facial expression and they are attached on both ends to bones, which
they move. The function of the masticatory muscles is to move the mandible for chewing. The four major
masticatory muscles are innervated by CN V3, the mandibular division of the trigeminal nerve. Only this
division of CN V carries motor axons in addition to sensory axons for the face.
The parotid gland is the first structure that will be dissected. As you already know, it envelops the stem and 5
main branches of CN VII, the facial nerve. In addition it contains the external carotid artery and the
retromandibular vein. The parotid gland will be picked away and its related neurovascular structures
revealed.
The temporal region includes both the temporal fossa superior to the zygomatic arch and the infratemporal
fossa inferior and deep to the zygomatic arch. The temporal fossa contains the large temporalis muscle. The
masseter muscle attaches to the zygomatic arch but is in the infratemporal fossa because it lies inferior to the
zygomatic arch.
The medial and lateral pterygoid muscles, the two other major muscles of mastication, lie in the
infratemporal fossa and attach to the internal surface of the mandible. During dissection of the infratemporal
fossa the temporomandibular joint (TMJ) will be studied and dissected. The TMJ is the most frequently used
joint in the body. Pain free and effective movement of this articulation is critical for maintaining a normal,
healthy diet. Loss of TMJ function due to injury, arthritis or malalignment can have severe consequences for a
person's general health and well being. In addition, normal vocalization and expression of emotion require a
functional TMJ.

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Parotid Region
Step 1
Structures of the Parotid Region
Dissection Instructions
TIP: Before beginning this dissection, refer to a dry skull and identify the bony landmarks of
the parotid, temporal and infratemporal regions. This will help you to get your bearings on the
cadaver. The boundaries of the parotid region include: the mastoid process posteriorly, the ramus of
the mandible anteriorly, the external acoustic meatus superiorly, the styloid process medially, and
the parotid fascia and sheath laterally.
Refer to a dry skull. Identify and palpate the zygomatic arch and the angle and ramus of the mandible
(refer to your atlas for an image).Also identify the mastoid and styloid processes on the temporal bone of the
skull. Find and palpate these structures on your cadaver. Identify the parotid gland and note the relationship of
the parotid gland to the bony landmarks. It lies inferior to the zygomatic arch and extends inferiorly and
posteriorly over the inferior margin of the ramus and angle of the mandible. It lies anterior and lateral to the
mastoid and styloid processes.

Branches of CN VII

Superficial partoid region

The parotid gland is superficial to the infratemporal fossa and the muscles of mastication. It must be dissected
in order to explore these deeper regions. In Step 2 of the Face Unit, the parotid gland was identified and the
muscular branches of CN VII were cleaned between the margin of the gland and their target muscles. Now
return to the parotid gland and branches of CN VII on your cadaver. (refer to your atlas for an image).

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On both sides of the face cut the parotid duct at the anterior aspect of the gland leaving a little knob of
glandular tissue on it (refer to your atlas for an image). Reflect the duct anteriorly and recall that it pierces the
buccinator muscle to enter the oral cavity. Pick away the parenchyma of the parotid gland leaving the
branches of CN VII in tact (refer to your atlas for an image). The best way to do this is to use a small
scissors to push apart the gland as you follow the nerve branches from the margin of the gland into its
center. Poke the closed scissors in to the gland parallel to the nerve branch. Then open the scissors to loosen
the glandular tissue. Use blunt forceps to pick away the loosened tissue and reveal the nerve branches.

CN VII in situ

Close-up CN VII

The nerve is the most superficial neurovascular structure within the gland. As you clean away the gland tissue
superficial to the nerve branches, look for the retromandibular vein running deep to the facial nerve branches
(refer to your atlas for an image). It descends vertically through the gland. Do not disturb the retromandibular
vein. It is described below.
With the glandular tissue cleared from the nerve, identify the superior (temporofacial) and inferior
(cervicofacial) trunks of CN VII near the posterior border of the mandibular ramus (refer to your atlas for an
image). Follow these trunks posteriorly around the posterior margin of the mandibular ramus, pushing (but
not cutting) the SCM, posterior belly of digastric and other tissues away from your path. Both the SCM and
digastric muscles attach to the mastoid process. Note that SCM lies more superficial than digastric. On a dry
skull find the mastoid notch (attachment site of the posterior digastric muscle) on the inferomedial side of the
mastoid process. On the cadaver, palpate the tip of the mastoid process and verify the relative positions of
SCM and digastric muscles. (refer to your atlas for an image).
The superior and inferior nerve trunks branch from the main stem of CN VII near the posterior border of the
mandibular ramus (refer to your atlas for an image). Keep following the main stem of CN VII back to the

77

stylomastoid foramen, using the scissors to push away tissue as you go. Refer to the dry skull to see the
location of the stylomastoid foramen (refer to your image for an image). On the cadaver you won't see the
opening of the foramen because it is filled with the nerve tissue, but you will clearly see the main stem of CN
VII emerging medial to the mastoid process. Palpate the styloid process on the cadaver and note that it is
medial to CN VII. It is easily broken so palpate gently!!
On one side of the face only, cut the branches of the facial nerve near their target muscles as far away from
the main stem as possible, and reflect the whole nerve posteriorly over the auricle of the ear. (You can put it
back in place for study in the future.) On the other side of the face, leave the full dissection of CN VII in tact
as shown in the image above (CN VII in situ). Clean the digastric muscle on this side and the arteries and
nerves that you exposed during dissection of the carotid triangle.

Deep parotid region

On the side where you cut and reflected CN VII, carefully separate the remaining tissue of the parotid gland
with small scissors and trace the course of the retromandibular vein and external carotid artery. These
vessels pass vertically through the parenchyma of the parotid gland deep to the branches of the facial nerve
(refer to your atlas for an image). The retromandibular vein receives venous blood from the superficial
temporal and maxillary veins. In the inferior aspect of the gland it branches into a posterior branch that
contributes to the external jugular vein, and an anterior branch that receives the facial vein and empties into
the internal jugular vein. Deep to the retromandibular vein lies the posterior belly of the digastric muscle.
Push the vein aside and cut the posterior belly of digastric from the mastoid process. Reflect it anteriorly away
from the field you are working in.
The external carotid artery lies deep and parallel to the retromandibular vein (refer to your atlas for an
image). Clean away any residual glandular tissue and follow the artery inferiorly into the carotid triangle.

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Superiorly, find the superficial temporal artery and recall that it is a terminal branch of the external carotid
artery. Clean it and verify its distribution onto the forehead and side of the head. Look for branches of the
auriculotemporal nerve running parallel to the superficial temporal artery near the neck of the mandible,
anterior to the tragus of the ear (refer to your atlas for an image). Auriculotemporal nerve is a branch of CN V3
and carries secretomotor axons to the parotid gland. Where do these axons originate?
Posterior to the neck of the mandible find the origin of the other terminal branch of external carotid - the
maxillary artery (refer to your atlas for an image). It dives medially into the infratemporal fossa. We will open
the fossa and dissect several branches of this artery in Step 3 of this unit.
The sternocleidomastoid, posterior belly of digastric, stylohyoid and masseter muscles are all closely
associated with the parotid gland and are visible during this dissection. Clean these muscles and review their
attachments, actions, innervations and relations.

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Parotid Region
Step 2
Temporal Region, Masseter Muscle and Zygomatic Arch
Dissection Instructions
The temporal region of the head consists of two fossae separated by the zygomatic arch (refer to your atlas for
an image):

Temporal region

temporal fossa:
located superior to the zygomatic arch
floor = four different bones: frontal, parietal, temporal and sphenoid
contains the temporalis muscle, an important muscle of mastication
infratemporal fossa:
located inferior and deep to the zygomatic arch, medial to the mandibular ramus
contains the pterygoid muscles, the mandibular nerve (CN V3), maxillary vessels and the otic
ganglion

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Masseter muscle and temporal fascia

Cut lines for masseter muscle and zygomatic arch

Conduct this dissection on the side WITH CN VII REFLECTED.

Clean the superficial surface of the masseter muscle from its origin on the zygomatic arch to the angle of the
mandible (refer to your atlas for an image). Based on the direction of its muscle fibers, what are the actions of
the masseter muscle? Clean the zygomatic arch and surface of the temporalis muscle. Note that temporalis is
covered by a very tough temporal fascia. Incise the temporal fascia from its superior border on the lateral side
of the skull and from the superior margin of the zygomatic arch. Do Not Cut the Temporalis Muscle Deep to the
Fascia!!!
Cut the anterior part (about 1 cm) of the zygomatic attachment of masseter from the inferior border of
the zygomatic arch.
Prepare to make two cuts through the zygomatic arch as shown above. Compare the image above showing the
cut lines to the dry skull and plan the appropriate cuts on your cadaver. The anterior cut through the zygomatic
arch should be in line with the frontal process of the zygoma. If you push a probe deep to the zygomatic arch as
far anteriorly as possible it will help you find the right place and protect the deeper structures while you cut. If
you cut too close to the orbit the dissection of the orbit (conducted at a later time) will be difficult. If you cut too
far away from the orbit the dissection of the infratemporal fossa will be difficult!!
The posterior cut through the zygomatic arch should be just at the point where the zygomatic process becomes
free from the temporal bone (refer to a dry skull!). If you slide a probe deep to the arch as far posteriorly as
possible it will help you find the right place and protect the deeper structures while you cut. Using a hand saw,
make the anterior and posterior cuts through the zygomatic arch. Leave the cut piece of bone attached to the
masseter muscle.

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Masseter muscle and section of zygomatic arch (reflected)

Carefully reflect the masseter muscle with the piece of zygomatic arch attached. Reflect only a few
centimeters inferiorly, just enough to see the masseteric nerve and vessels, which pass from the deep side of
the mandibular ramus to the masseter muscle through the mandibular notch. If you reflect too far, you will
break these small neurovascular structures. Gently scrape the deep surface of the masseter muscle and identify
the masseteric nerve and vessels as they pass through the mandibular notch to enter the deep surface of the
muscle. What is this nerve a branch of?
TIP: The large muscle of the temporal fossa is called either temporal muscle or temporalis
muscle. Both terms are correct.
Cut the temporal fascia from its attachments around the temporalis muscle (refer to your atlas for an image).
Be aware that some muscle fibers arise from the fascia and, as you reflect the fascia away from the muscle,
you must scrape the attached muscle fibers free and pat them in place on the muscle. Remove the temporalis fascia.
Clean and examine the temporalis muscle. Note its large origin from the temporal fossa and its extensive
insertion on the coronoid process of the mandible. It inserts onto the medial and posterior surfaces of the
process as well as the lateral and anterior surfaces that are visible now. Note the direction of the muscle fibers
of temporalis. What is the primary action of the anterior part of the muscle? ...posterior part of the muscle?
A thick fat pad lies deep to the anterior part of the zygomatic arch adjacent to the temporalis muscle and the
orbit. It is an extension of the buccal fat pad. Remove the fat and examine the buccinator muscle deep to it.
Note that buccinator is a deep muscle with anterior/posterior oriented fibers. The parotid duct pierces it to enter
the oral cavity.

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Parotid Region
Step 3
Infratemporal Fossa and Temporomandibular Joint (TMJ)
Dissection Instructions
TIP: In order to gain access to the infratemporal fossa, you will have to saw through the
mandible. The nerves and vessels of the infratemporal fossa are numerous and some are closely
associated with the mandible. In order to get a good dissection result, prepare for making the saw
cuts by studying the dry skull, drawings and instructions carefully.
The infratemporal fossa: contains the lateral and medial pterygoid muscles, mandibular nerve branches,
maxillary artery and branches, chorda tympani and the otic ganglion (refer to your atlas for an image). The
following bones define the boundaries of the infratemporal fossa:
Styloid process of the temporal bone (posterior)
Posterior surface of maxilla (anterior)
Inferior surface of the greater wing of sphenoid (superior)
Lateral pterygoid plate of sphenoid (medial)
Ramus of mandible (lateral)

Infratemporal Fossa

Mandible cuts

To enter the infratemporal fossa and examine the temporomandibular joint you will need to cut away
part of the mandible. Do this only on the side where you cut the zygomatic arch. The electric bone saw works
best for these cuts because the mandible is rather recessed in the soft tissue. Be warned that important nerves
and vessels lie just deep to the mandible. Prepare carefully and cut very conservatively!! Refer to the
drawing above.

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Temporalis reflected

The first cut will remove the coronoid process and the insertion of the temporalis muscle from the mandible.
Protect the underlying soft structures by first pushing them medially away from the medial surface of the
coronoid process. Then place the flat, wide end of a scalpel handle (without a blade on it!) between the
buccinator muscle and the coronoid process. Angle it a little superiorly for maximum protection. Cut most but not all - of the way through the coronoid process (note that it is very thin!), parallel to the attachment of
the temporalis muscle. Remove the saw and snap off the process by pushing the tip medially. Reflect the
coronoid process superiorly along with the fibers of the temporalis muscle that attach to it. Do not remove
the muscle from the skull!!
Clean the loose fat and fascia from the infratemporal fossa and identify the maxillary artery and the deep
temporal nerves and vessels (refer to the atlas for an image). Look for the pterygoid muscles. The fibers of
the lateral pterygoid run anterior/posterior (horizontally in this view). The fibers of the medial pterygoid
parallel the masseter muscle (about 90 degrees to the lateral pterygoid). The maxillary artery is tortuous and
gives many branches (refer to your atlas for an image). From the current view you should be able to see the
deep temporal arteries and nerves that enter the deep surface of the temporalis muscle and supply it.
TIP: Usually the maxillary artery runs superficial to the lateral pterygoid muscle and is easily
discernible with light cleaning. Occasionally it runs deep to the lateral pterygoid. In this case
ask an instructor for assistance!

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TMJ 1

The next (second) saw cut is the one most likely to damage underlying structures that you want to see. To
prevent that, look along the deep surface of the superior border of the ramus and find the inferior alveolar
artery (refer to your atlas for an image). This branch of the maxillary artery descends with the inferior
alveolar nerve to enter the mandibular foramen (find this on the dry skull) which is centrally located on the
medial surface of the ramus. Find the inferior alveolar vessels and nerves and slide the scalpel handle
between them and the medial surface of the ramus of the mandible. If you do this correctly, the saw will hit
the scalpel handle before it hits the vessels and nerve. However, Do Not Let the Saw Hit the Handle!!!
The second cut through the ramus runs transversely just superior to the mandibular foramen. As before, cut
most but not all of the way through the bone. Remove the saw and push on the cut groove to snap the two
parts of the bone apart. The part of the mandible superior to the cut line will not fall away because it is still
articulated with the temporal bone at the TMJ (temporomandibular joint).

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Temporomandibular joint articular disc

Now prepare to remove the superior piece of the mandible (superior part of the ramus and condylar process),
the articular disc and the lateral pterygoid muscle as a single unit (see the image above). First, scrape or
cut the lateral pterygoid muscle from its attachment to the lateral pterygoid plate (refer to your atlas for
an image). The small scissors or the tip of the scalpel will work well for this. Move any vessels or nerves aside
while you free the muscle. Try to keep the muscle intact as you remove it from its attachment. Lift the lateral
pterygoid muscle laterally away from the maxillary artery.
Now go to the TMJ and push the superficial temporal vessels and auriculotemporal nerve posteriorly (refer to
your atlas for an image). Use a small scissors or the tip of the scalpel to cut the posterior wall of the joint
capsule and ligament away from the mandibular fossa. Pry the head of the mandible with the articular
disc and lateral pterygoid muscle out of the mandibular fossa. Pat the muscle into its normal shape and hold
the unit adjacent to the infratemporal fossa as shown in TMJ 1. Review the normal anatomy.
On the isolated piece of mandible, excise the posterior attachment of the articular disc and lift the disc away
from the head of the mandible (refer to your atlas for an image). Leave it attached to the neck via its anterior
attachments. Inspect the inferior joint cavity.

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TMJ 2

On the skull, clean the infratemporal fossa now that the lateral pterygoid is gone and identify the medial
pterygoid muscle (refer to your atlas for an image). What are its actions? You should also be able to see the
most posterior attachment of the buccinator muscle. Review its attachments, action and innervation.
Continue to clean the maxillary artery and identify some of its branches (refer to your atlas for an image).
The inferior alveolar artery is easily identified as it enters the mandibular foramen with the inferior alveolar
nerve. A small nerve that branches from the inferior alveolar nerve posteriorly and runs on the surface of the
mylohyoid muscle is the mylohyoid nerve. Verify that this nerve is the same as the one you found in your
dissection of the suprahyoid region.
Find a branch of the maxillary artery that arises near the inferior alveolar artery, but travels superiorly (refer
to your atlas for an image). This is the middle meningeal artery. This very important vessel leaves the
infratemporal fossa and enters the cranial cavity via the foramen spinosum. What structures does it supply?
The middle meningeal artery will be difficult to find if you haven't cleaned the infratemporal fossa enough. In a
later unit, after removing the calvarium and brain, you can push a pin parallel to the middle meningeal artery
through the foramen spinosum and feel it pierce the dura of the middle cranial fossa!
The auriculotemporal nerve splits to encircle the middle meningeal artery near the point where the artery
ascends to the foramen spinosum (refer to your atlas for an image). Look for this characteristic relationship.
The auriculotemporal nerve supplies sensory innervation to the skin of the tragus and carries postganglionic
parasympathetic axons to the parotid gland from the otic ganglion (refer to your atlas for an image). The otic
ganglion hangs from the posterior side of V3 inferior to the foramen ovale. Follow the auriculotemporal nerve
back to the otic ganglion. The preganglionic parasympathetic axons in this pathway come from CN IX.
Just medial to the foramen spinosum and middle meningeal artery, the mandibular division of CN V3 enters
the infratemporal fossa through the foramen ovale (refer to your atlas for an image). After we remove the
calvarium and brain you can push a probe through the foramen ovale and feel it pierce the dura of the middle
cranial fossa.
The inferior alveolar nerve is a branch of V3 so you can follow it to the main trunk of the mandibular nerve
(refer to your atlas for an image). The lingual nerve, which runs parallel and a little medial to the inferior
alveolar nerve is also a branch of V3. It innervates the tongue. What kind of axons travel in this nerve? Look
for a very small nerve that branches posteriorly away from the lingual nerve, deep to the inferior alveolar
nerve, toward the roof of the infratemporal fossa. This is the chorda tympani nerve. It is a branch of CN VII

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that travels with the lingual nerve in its path through the infratemporal fossa. It carries the sense of taste from
the anterior 2/3 of the tongue.
Identify the buccal nerve, a branch of V3 (refer to your atlas for an image). It pierces the buccinator muscle
and supplies the mucosa of the cheek. What nerve innervates the buccinator muscle with motor axons?
TIP: Remember that while the BUCCAL NERVE (branch of CN V3) provides sensory fibers
to the buccal mucosa, the BUCCAL BRANCH of the facial nerve (CN VII) is responsible for
motor innervation of the buccinator muscle.

Maxillary artery branches

Trace the course of the maxillary artery through the infratemporal fossa (refer to your atlas for an image). Try
to identify the posterior superior alveolar artery, one of the last branches of the maxillary artery, as it runs
inferiorly on the posterior surface of the maxilla on its way to supply the maxillary sinus and the upper molar
and premolar teeth (refer to your atlas for an image). Beyond this artery the maxillary artery passes through the
pterygomaxillary fissure and ultimately through the sphenopalatine foramen as the sphenopalatine artery.
Once it passes through the sphenopalatine foramen it is in the nasal cavity and supplies the mucosa there.

Inferior alveolar vessels and nerve

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Return to the angle and body of the mandible. Using a chisel and hammer, gently chip away the outer
lamina of the ramus, angle and body of the mandible. Inside clean and trace the pathway of the inferior
alveolar nerve and vessels. You should be able to follow them to the mental foramen. Look for branches that
ascend within the mandible to supply the teeth.

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Scalp and Brain

General Overview
The scalp covers the neurocranium (part of the skull that encases the brain) and extends laterally over the
temporal fascia to the zygomatic arches. It is a very distinct structure composed of three tightly associated
layers of tissue overlying a layer of loose areolar fascia just external to the pericranium. It is richly supplied
with vessels and nerves. You must have a good understanding of the structure of the scalp in order to safely and
effectively suture scalp wounds!
To gain access to the brain and cranial cavities, the calvarium (skull cap) must be removed. There is more
than one way to do this. Some instructors prefer to have students saw carefully with a hand saw through the
skull without cutting the dura mater that closely adheres to the internal surface of the skull. The skull cap is
then pried away leaving the dura in place for study (see the photos in Step 1). Other instructors prefer to have
students saw through both the skull and dura simultaneously and remove them together. Regardless of the
approach you use, removal of the calvarium and subsequent study of the meninges and brain is quite a learning
experience!! You can make it a very productive learning experience by reading ahead and understanding the
relation of the dura and its structures to the contours of the cranium and brain. Factors that impact the
success of calvarium and brain removal include preparedness of the student, time available, tools used (hand
saw or bone saw), skills of the student and condition of the cadaver.
Inside of the cranium the dura mater adheres to the bone and provides the tough external covering of the
brain. It is continuous from the cranial cavity to the vertebral canal but there are differences in the dura of these
two regions. In the skull the dura is a double layer. The external layer is attached to the bony surfaces
inside the cranial cavity and it is continuous with the periosteum covering the outside of the skull. This layer of
dura does not extend into the spinal canal. The internal layer of dura (meningeal layer) is tightly fused to the
external layer except in some special places where the inner layer deviates to create: folds of dura that
subdivide the cranial cavity, e.g. the falx cerebri and tentorium cerebelli, and venous sinuses, lined with
endothelium, that receive most of the venous blood from the brain and return it to the internal jugular veins.
The dura mater of the vertebral canal was studied in the Back Unit.
The brain will be removed during this unit and its surface structure and general organization will be studied.
Embryonically, the brain derives from specialized regions of the neural tube, the prosencephalon,
mesencephalon and rhombencephalon, which give rise to forebrain, midbrain and hindbrain respectively.
This classification schema is a very useful way to describe and understand the adult brain even though much
growth, folding and rearrangement of tissue occurred during development into the adult form.
The cranial nerves are related to the brain through their origin or termination. They are also related to the
dura and the cranium via their pathways between structures.
The interior of the cranial cavity with the dura mater intact looks very different than the interior of the
dry skull!! You need to know the contours, openings and contents of the cranium in both dry and dural covered
presentations. LOOK AT YOUR DRY SKULL EVERY DAY AND BUILD A DURAL LAYER FOR IT OUT
OF TISSUE PAPER so you can study these differences at home!
The vascular supply of the brain is derived from both the internal carotid and vertebral arteries. Although
these arteries originate adjacent to each other in the root of the neck, they approach the brain from very
different pathways. The right and left internal carotid arteries enter the cranium via the carotid canals and pass

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through a tortuous conduit to emerge in the cranial cavity on either side of the sella turcica. The internal
carotid arteries terminate as anterior and middle cerebral arteries that supply most of the cerebral
hemispheres of the brain. The vertebral arteries enter the skull via the foramen magnum and ascend along the
clivus of the cranial base. Near the inferior aspect of the pons they fuse to form the midline basilar artery.
Near the superior aspect of the pons the basilar artery ends by dividing into posterior cerebral arteries.
The anterior, middle and posterior cerebral arteries are connected to each other by anterior and posterior
communicating arteries. The three paired cerebral arteries and their communicating branches form an arterial
circle, the circle of Willis, on the ventral surface of the brain. These anastomoses are believed to be protective
by providing redundancy of blood flow in cases of vascular obstruction. In reality, the anastomoses are not
100% effective in maintaining an adequate blood flow to the brain. Variations in the circle of Willis are
common.

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Scalp and Brain

Step 1
Scalp, Calvarium and Dura
Dissection Instructions
The scalp covers the neurocranium and must be removed and studied before removal of the calvarium and
brain. The scalp is formed from three layers of tightly bound tissue overlying a layer of loose areolar fascia
external to the pericranium (periosteum). The deepest of the three bound layers, the epicranial aponeurosis,
attaches to the frontalis muscle anteriorly and the occipitalis muscle posteriorly (see Face Step 2). The scalp
extends laterally over the temporal fascia as far as the zygomatic arches. It is richly supplied with vessels and
nerves.
The layers of the scalp are easy to see in dissection and can be easily memorized using the mnemonic
SCALP:
1. Skin: usually covered with hair, contains sweat and sebaceous glands
2. Connective tissue (dense): thick, dense subcutaneous layer
3. Aponeurosis (epicranial): strong tendinous sheet that covers the cranium between the occipitalis and
frontalis muscles
4. Loose connective tissue: a cobwebby layer that allows movement of the scalp proper (first three layers
of the scalp) over the underlying calvarium. It creates a potential space that may harbor infections or
distend with fluid
5. Pericranium: external periosteum of the calvarium

Scalp

Scalp close-up

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Incise the entire thickness of the scalp along the midsagittal line as far posteriorly as the external occipital
protuberance. Reflect the scalp laterally identifying the Loose connective tissue layer that attaches the
aponeurosis to the pericranium. Cut along the superior and posterior sides of the ear and remove the entire
scalp from the cadaver. Examine the cut midsagittal surface and identify the 3 layers of scalp proper. Scalp
wounds bleed profusely because the vessels in the second layer (dense connective tissue) are attached to the
fibers of this layer via their adventitia. When the scalp is lacerated the vessels can't constrict as they usually do
because the connective tissue holds them open. Identify vessels in this layer. Examine the remnants of the
Loose connective tissue layer on the surface of the skull. Using a small scissor, scrape into the pericranium
on the surface of the calvarium and lift up a small flap of pericranium.
If not already done, incise the temporal fascia along the curvature of the superior temporal lines and reflect it
laterally. Reflect both temporalis muscles inferiorly from the temporal fossa to the level of the zygomatic
arches but DO NOT detach them from the head. Once the skull is free of scalp, put a large rubber band or
string around the circumference of the skull 1 cm superior to the supraorbital margin anteriorly and 0.5 cm
superior to the external occipital protuberance posteriorly. Use the band as a guide to mark cut lines on the
skull with a black pencil or marker. The goal is to cut the skull around its widest diameter and thus facilitate
the subsequent removal of the brain while not compromising the structure of the orbits anteriorly or the
transverse sinus posteriorly.
TIP: Sawing through the skull and removing the calvarium can be done with the cadaver in the
supine position! Begin anteriorly. After sawing through the frontal bone, place two blocks of
wood under the occipital region of the skull and tilt the head forward. This should expose the entire
surface of the occipital bone at the level that you need to saw through it!! Turn the head slightly to
each side as you saw through the pterion and temporal bones. Complete the cuts through the skull
by sawing through the occipital bone.

Skull cut lines

Using a hand saw, cut through the skull along the line that you marked. Be sensitive to the sound and feel of
the saw when you are cutting. The skull is 0.3-0.7 cm thick. It is thinnest along the pterion and thickest
through the occipital bone. It is formed from two layers of compact bone (the inner and outer tables)
separated by a layer of spongy bone (diploe). Anteriorly most people have frontal sinuses between the
compact bone layers. Try to cut all the way through the bone without cutting the dura mater.
Carefully use a broad chisel to pry the calvarium from the dura. DO NOT HAMMER THE CHISEL
TOWARD THE BRAIN!!! IF YOU DO YOU WILL MOST CERTAINLY IMPALE THE BRAIN.

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Dura after removal of the calvarium

It is not necessary to use a hammer at all. Carefully place the chisel blade between the cut surfaces and twist
it prying the calvarium superiorly. Do this in a few places pushing the dura off of the bone with your fingers or
the flat end of a forceps. Soon you should be able to peel the calvarium off of the dura leaving the dura intact
as shown above. If you are having a particularly difficult time, ask your lab instructor for help.
Leave the head propped on the wooden blocks as you inspect the skull and dura. In the cut surface of the
frontal bone, look for the frontal sinuses. These air sinuses are highly variable in size and position. They are
lined with mucosa and drain into the middle meati of the nasal cavity.
Observe the dura mater covering the brain and identify the branches of the right and left middle meningeal
arteries on its surface (refer to your atlas for an image). Note the relation of the anterior meningeal branches
to the pterion. When the pterion is damaged via blunt trauma, the middle meningeal artery and its branches are
frequently torn producing an epidural hematoma.

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Exposure of the brain

Dural sinuses

Refer to an atlas to understand the distribution of the dura mater and the formation of its special
structures: the superior sagittal sinus, falx cerebri and tentorium cerebelli. Using a small scissors, cut
through the dura about 1.5 cm lateral to midline on both sides of the superior sagittal sinus (see the photo
above). Then cut parallel to the cut edge of the skull and remove the two pieces of dura covering the sides of
the brain. Leave the superior sagittal sinus and falx cerebri in place. Much of the brain is now exposed.
Examine the surface of the left and right cerebral hemispheres. The bumps are gyri (sing. gyrus) and the
grooves are sulci (sing. sulcus). The covering of the brain that you are looking at is arachnoid mater (refer to
your atlas for an image). Use a blunt forceps to peel away a small section of arachnoid mater. Note that it is
fairly dense and does not descend into the depths of the sulci. Fine trabeculae attach it to the deeper pia mater
that directly covers the surface of the brain. The arachnoid and pia develop from the same embryonic layer
and effectively form the parietal and visceral components of the leptomeninges. The pia mater is very thin
and indistinct but it gives the surface of the brain a shiny appearance. Do not try to peel the pia off of the brain.
Along the midline, gently pull one of the cerebral hemispheres away from the dura and identify the falx
cerebri (refer to your atlas for an image). This fold of dura mater dips down between the left and right
cerebral hemispheres of the brain. In its superior portion, it forms the triangular superior sagittal sinus
between two sections of internal dura and one section of external dura. The dural venous sinuses are lined with
endothelium and receive most of the venous drainage of the brain. The superior sagittal sinus also receives
cerebral spinal fluid via arachnoid granulations that pierce the sinus wall. With a small scissors, cut into the
sinus along the midline and look for arachnoid granulations. You may also see veins emptying into the sinus.
The falx cerebri descends between the two cerebral hemispheres to the level of the corpus callosum of the
brain (refer to your atlas for an image). There is a small inferior sagittal sinus within its deepest folds. Do not
try to identify it now. Gently separate the two hemispheres of the brain and examine the depth of the falx.
Anteriorly the falx is attached to the frontal crest and crista galli (refer to your atlas for an image). Posteriorly
it is attached to the internal occipital protuberance and is continuous with the tentorium cerebelli. Deep to
the falx identify the corpus callosum, a white region of brain formed from axons that connect the right and left
hemispheres.

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Lift the frontal lobes of the brain and cut the falx from the frontal crest and crista galli. Leave the falx in the
longitudinal cerebral fissure and attend to the posterior part of the brain. Lift the occipital lobes and examine
the tentorium cerebelli (refer to your atlas for an image). It supports the weight of the occipital lobes and
forms the roof of the cerebellar fossa. Posteriorly it contains the transverse sinuses. Anteriorly it attaches to
the anterior clinoid processes.
Note that the brainstem is encircled by the tentorium cerebelli!! If the tentorium is not incised fully in the
proper place, attempts to remove the brain by pulling on the cerebrum will result in ripping the brain in half.
Refer to your atlas to fully appreciate the difficulty of removing the brain intact from the cranial fossa. A
procedure for removing the brain is described in the next step. It is not the only way to do it, but it is a safe way
that nearly always results in successful removal of the intact brain.

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Scalp and Brain

Step 2
Brain
Dissection Instructions
TIP: Be as careful as possible when removing the brain. After we study its superficial structure
it will be stored and used in your Nervous System course. In the Clinical and Developmental
Anatomy course you will be tested on the major regions of the brain and the cranial nerves but will
not be required to know the intricate details of the brain's structure and function.
In order to remove the brain from the skull, it will be necessary to free all of its attachments: the 12 pairs of
cranial nerves, the blood vessels supplying the brain, the spinal cord and the dural folds. To better
anticipate what you are going to see while removing the brain, refer to an atlas illustration of the cranial
cavity with dura, nerves and vessels in situ.
TIP: The brain is generally soft but when well embalmed it is firm and fairly easy to work
with. The most difficult task is to keep the brainstem attached to the cerebrum. When you are
lifting parts of the cerebrum to cut the dural structures or cranial nerves as described below, lift very
carefully and only as far as you absolutely must in order to make the cuts. Always support the brain
with your hand when changing positions of the head of the cadaver (as when turning from supine to
prone).
Two different ways to remove the brain from the skull are described. The easiest way is to remove a wedge
of occipital bone and expose the occipital lobe of the brain and the posterior aspect of the tentorium cerebelli.
This permits easier access to the tentorium cerebelli which you must cut extensively prior to removing the
brain. If the brain is large or soft you will certainly want to use the wedge approach. It is described below under
*WEDGE APPROACH. If the brain is very firm and there has been some shrinkage that permits comfortable
access to the tentorium cerebelli without cutting an occipital wedge, then use the +ALTERNATIVE
PROCEDURE. Confirm with your lab instructor the approach that your should use.

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*WEDGE APPROACH: If access to cut the tentorium cerebelli is difficult because the brain is large or soft,
remove a wedge of occipital bone before cutting the tentorium. To do this, turn the cadaver into the prone
position STABILIZING THE BRAIN IN THE CRANIUM AS YOU TURN. Scrape the suboccipital muscles
from the external surface of the occipital bone and mark lines for cutting through the bone (see the image
below). They should pass just medial to the mastoid processes and through the foramen magnum on both sides.
Carefully saw through the occipital bone along these lines and remove the wedge of bone. The occipital lobes
of the brain, the cerebellum and tentorium cerebelli should all be visible through the open occipital space.

Cut lines wedge

Gently lift the occipital and parietal lobes of the brain on one side and carefully cut the tentorium from its
attachments to the anterior clinoid processes and along the petrous ridges and occipital bone (see the image
below). Take care to not cut the underlying cerebellum.

Exposure of the brain

Cuts tentorium

Make the same cuts on the other side of the head, then use your fingers to gently break any connective tissue
attachments between the tentorium, the falx and the brain. Verify that the falx is cut free from the frontal crest
and crista galli (Step 1). Remove the tentorium cerebelli and falx cerebri from the cadaver as one unit. Set
it aside to be studied in the next Step.

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Cut through the spinal cord by pushing the scalpel blade between the posterior arch of C1 and the spinous
process of C2 and making a transverse cut. It is important that the cord is completely severed so you might
want to repeat this cut a few times.
Turn the cadaver to the supine position, STABILIZING THE BRAIN IN THE CRANIUM AS YOU
TURN. Stack two wooden blocks horizontally under the posterior aspect of the head and proceed with cutting
the cranial nerves and vessels as described next.
Standing behind the cadaver, approach the right side of the head (if you are right handed, otherwise left side),
carefully elevate the frontal lobes and look on either side of the crista galli for the olfactory bulbs and tracts.
Loosen them from the cribriform plate using a blunt probe. Your goal is to keep them with the brain.
TIP: !! The cranial nerves are easily pulled out of the brain so take great care when cutting
them!! Use a fresh sharp scalpel blade and do not pull on the nerves!! Use a sawing motion if
you can't just slice through them with one cut.
Continue carefully lifting the anterior brain away from the anterior cranial fossa and remember to support the
posterior brain by having someone hold their hand over the wedge opening. Identify and sever the optic nerves
and adjacent internal carotid arteries (refer to your atlas for an image). Next cut the infundibulum of the
pituitary gland and the oculomotor nerves (CN III).

Cranial fossae

Brain - lateral view

Continue to elevate the brain just until you can see the brainstem lift away from the dorsum sellae. It is not
possible to identify the remainder of the cranial nerves as you cut them. Slide the sharp scalpel between the
brain stem and the clivus of the skull and cut the cranial nerves on one side by sweeping the scalpel close to
the skull. Remove the scalpel, turn it around, and go back in to cut the other side.
Make sure the temporal lobes and cerebellum are free from the dura by sliding your fingers under and
around these parts of the brain. Since the tentorium has been removed there are no more large attachments to
cut but sometimes little connections are present between the arachnoid on the brain and the dura.
Place your hand on top of the brain to hold it in the cranium while someone removes the two wooden
blocks from under the head. Let the head tilt posteriorly (holding the brain) until it is resting on the table.
Support the posterior part of the brain with your left hand while you slide your right hand around the
frontal lobes and brainstem and gently lift the whole brain from the cranium.

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If you meet any resistance DO NOT PULL! Check for adhesions between the arachnoid and dura. Check your
cuts through the brainstem and vertebral arteries. You may need to try again to sever the spinal cord and
vertebral arteries. If you have trouble please ask an instructor for assistance.
With the brain removed, look in the cranium and identify the anterior, middle and posterior cranial fossae.
In the foramen magnum, identify the cut ends of the spinal cord and the vertebral arteries.
+ALTERNATIVE PROCEDURE: If the brain is very firm and shrunken from the walls of the cranial cavity
you will be able to remove it without cutting a wedge in the occipital bone. Keep the cadaver in the supine
position and stack two wooden blocks horizontally under the posterior aspect of the head.
Gently lift the occipital and parietal lobes of the brain on one side and carefully cut the tentorium from its
attachments to the anterior clinoid processes and along the petrous ridges and occipital bones (see the image
Cuts tentorium above). Take care to not cut the underlying cerebellum.
Make the same cuts on the other side, then use your fingers to gently break any connective tissue attachments
between the tentorium and falx and the brain. Verify that the falx cerebri is cut free from the frontal crest and
crista galli (Setp 1). Remove the tentorium cerebelli and falx cerebri from the cadaver as one unit. Set it
aside to be studied in the next Step.
Standing behind the cadaver, approach the right side of the head (if you are right handed, otherwise left side),
carefully elevate the frontal lobes and look on either side of the crista galli for the olfactory bulbs and tracts.
Loosen them from the cribriform plate using a probe. Your goal is to keep them with the brain.
Continue carefully lifting the anterior brain away from the anterior cranial fossa. Identify and sever the optic
nerves and adjacent internal carotid arteries (refer to your atlas for an image). Next cut the infundibulum of
the pituitary gland and the oculomotor nerves (CN III).
It is not possible to identify the remainder of the cranial nerves as you cut them. Continue to elevate the brain
just until you can see the brainstem lift away from the dorsum sellae. Slide the sharp scalpel between the
brain stem and the clivus of the skull and cut the cranial nerves on one side by sweeping the scalpel close to
the skull. Remove the scalpel, turn it around, and go back in to cut the other side.
You must cut through the spinal cord in order to remove the brain from the skull. To do this, slide your
fingers under the frontal lobes and down to the brainstem pushing it a little posteriorly. Slide the scalpel
along the clivus as far distally as it will go and cut through the spinal cord and vertebral arteries. You will
not be able to see what you are doing but you will feel when the cord is severed.
Slide your fingers around all aspects of the brain to make certain that it is free from the dura. Place your hand
on top of the brain to hold it in the cranium while someone from your team removes the two wooden blocks
from under the head. Let the head tilt posteriorly (holding the brain) until it is resting on the table. Support the
posterior part of the brain with your left hand while you slide your right hand around the frontal lobes
and brainstem. Lift the whole brain from the cranium.
If you meet any resistance DO NOT PULL! Check for adhesions between the arachnoid and dura. Check your
cuts through the brainstem and vertebral arteries. You may need to try again to sever the spinal cord and
vertebral arteries. If you have trouble please ask an instructor for assistance.
With the brain removed, look in the cranium and identify the anterior, middle and posterior cranial fossae.
In the foramen magnum, identify the cut ends of the spinal cord and the vertebral arteries.

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Scalp and Brain

Step 3
Falx Cerebri, Venous Sinuses, Tentorium and Falx Cerebelli
Dissection Instructions
Following removal of the brain, return to the cranium and inspect the dura and its structures. The meningeal
(internal) layer of the dura mater forms three folds that partially divide the cranial cavity: the falx cerebri, the
tentorium cerebelli and the falx cerebelli. In addition, a layer of dura, the diaphragma sella, encloses the
pituitary gland within the hypophyseal fossa. The falx cerebri and tentorium cerebelli were previously
removed. Replace them in the cranial cavity to study their normal relations.

Falx cerebri and tentorium cerebelli

Tentorium cerebelli

The superior sagittal sinus runs in the superior aspect of the falx cerebri (refer to your atlas for an image).
Follow it from anterior to posterior where it empties into the confluence of the sinuses just anterior and
superior to the internal occipital protuberance. The inferior sagittal sinus runs in the inferior border of the falx
cerebri in the same plane and direction as the superior sagittal sinus. Follow it with your probe posteriorly to
the point where it joins the great cerebral vein and forms the straight sinus. The straight sinus travels
posteriorly through the junction between the falx cerebri and the tentorium cerebelli, joining with the
transverse sinuses and the superior sagittal sinus to form the confluence of the sinuses. The transverse sinuses
run in the lateral direction to the petrous portion of the temporal bone where they curve sharply medially to
become the sigmoid sinuses (refer to your atlas for an image). Each S-shaped sigmoid sinus carries venous
blood to the ipsilateral jugular foramen and into the internal jugular vein.
Follow the falx cerebri posteriorly and identify the tentorium cerebelli (cerebellar tentorium). It sits between
the occipital lobes of the cerebrum and the cerebellum. This sheet of dura mater supports the occipital pole of
the cerebrum and covers the cerebellum.

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Locate the small sickle-shaped falx cerebelli (cerebellar falx) between the right and left cerebellar fossae. Note
that it is attached to the posterior and inferior parts of the tentorium cerebelli.

Landmarks in the cranial cavity

Upon completion of the examination of the dural folds, identify the grooves of the venous sinuses on the inner
surface of a dry skull from which the calvarium has been removed. Find the groove of the superior sagittal
sinus running in the superior/inferior direction along the midline of the occipital bone. Find the grooves of the
transverse sinuses running in the lateral directions along the occipital bone, and the grooves of the sigmoid
sinuses leading from the lateral occipital/temporal junction in the posterior cranial fossa to the jugular foramen.
In the cranium of the cadaver, identify the cavernous sinuses on either side of the sella turcica. Compare the
interior of the cranium of your cadaver with a dry skull to appreciate the volume of the cavernous sinuses.
(Refer to your atlas for an image). The ophthalmic veins connect the facial veins with
the cavernous sinuses anteriorly. It is by this pathway that infectious material can be transported from the
danger zone of the face into the cranial venous system. Posteriorly, the petrosal sinuses connect the cavernous
sinuses with the transverse and sigmoid sinuses.

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Scalp and Brain

Step 4
Surface Anatomy of the Brain
Dissection Instructions
Examine the brain (refer to your atlas for an image). It consists of the cerebrum most superiorly, the
cerebellum posteriorly and the diencephalon and brainstem deep and inferiorly. All of these regions, their
landmarks and major subdivisions are visible on the external surfaces of the brain.

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Lobes of the brain (lateral view)

Cerebral hemispheres (superior view)

Anterior view of the brain

Posterior view of the brain

The cerebrum consists of two hemispheres separated by the longitudinal cerebral fissure which
accommodates the falx cerebri. Each hemisphere has four lobes distinguishable on the external surface of the
brain. Some of the lobes are separated from each other by large sulci or fissures. The frontal lobes, positioned
most anteriorly, are separated from the parietal lobes by the central sulcus. The temporal lobes, best seen in
the lateral view, are separated from the frontal and part of the parietal lobes by the lateral sulcus. The occipital
lobes are not distinctly separated from the parietal and temporal lobes on the external surface of the brain, but,
in a midsagittal section the parieto-occipital sulcus is quite clear (refer to your atlas for an image).
The diencephalon, or deep forebrain, includes the epithalamus, thalamus and hypothalamus. These regions

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are mostly covered by the cerebrum but you can see the infundibulum of the pituitary gland which is a
continuation of the hypothalamus. It lies in the midline just posterior to the optic chiasm. Paired bumps, the
mammillary bodies, are also visible parts of the hypothalamus. They lie just posterior to the infundibulum. In a
midsagittal view the thalamus and epithalamus are visible (refer to your atlas for an image). The epithalamus
contains the pineal gland. The thalamus consists of right and left halves separated by the midline 3rd ventricle.
The right and left thalami are connected by the interthalamic commisure which spans the 3rd ventricle. The
thalamus is the major sensory relay center in the brain.

Cerebellum (inferior view)

Pons and medulla oblongata

The brainstem includes the very small midbrain, the pons and the medulla oblongata (refer to your atlas
for an image). Most of the cranial nerves come from these regions of the brain. The midbrain gives rise to CN
III and IV.
The pons lies between the midbrain and the medulla oblongata. It has a characteristic anterior bulge on which
the basilar artery ascends. Note that the lateral portions of the pons are connected to the cerebellum. The pons
gives rise to CNs V-VIII.
The cerebellum is easily seen from the lateral, posterior and inferior views of the brain. It is an outgrowth of
the hindbrain and is connected to the pons by large tracts of axons - the peduncles. The cerebellum consists of
two lateral hemispheres and a central vermis.
The medulla oblongata is the most distal part of the brainstem. It is continuous with the pons superiorly and
the spinal cord inferiorly. It gives rise to CNs IX-XII.
Some instructors may suggest that you hemisect the brain. Refer to your atlas for a description of this view.

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Scalp and Brain

Step 5
Cranial Nerves
Dissection Instructions
On the inferior surface of the brain identify the 12 pairs of cranial nerves.
TIP: You should be able to find most of these nerves on the brain and in the cranial cavity.
However, problems in removing the brain could have compromised some of them. If you
cannot find a particular nerve, consult other tables in your lab.
The neurons that form the cranial nerves are categorized as special sensory, general sensory, somatic motor,
visceral motor or branchial motor. Many cranial nerves carry more than one type of axon. You should know
what type of axons travel in a particular cranial nerve, where the nerve originates (general terms), its pathway
and its destination. Refer to your text for a comprehensive description and for a quick reference chart to the
cranial nerves.

Cranial nerves

CN I

On the inferior surface of the frontal lobes find CN I, the olfactory nerve. It is a special sensory nerve
conducting the sense of smell directly into the temporal lobe of the cerebrum (all other sensation goes to the
thalamus first). It consists of a series of neurosensory cells, some of which lie outside of the cranial cavity in
the olfactory epithelium of the nasal cavity. The sensory cells in the nasal cavity synapse with secondary
sensory cells in the olfactory bulb across the foramina of the cribriform plate.
Posterior to CN I identify the stumps of CN II, the optic nerve. These neurons originate in the retina and pass,
by way of the optic tracts, to the thalamus. They conduct the special sense of vision. CN II enters the cranium
at the optic canal.

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CN II

CN III

Identify the junction of the pons and the midbrain posterior to the optic chiasm. Close to the midline, anterior
to the pons, find CN III, the oculomotor nerve. It carries somatic motor axons to the extraocular muscles and
visceral motor preganglionic parasympathetic axons to the ciliary ganglion in the orbit. The related
postganglionic parasympathetic axons innervate the sphincter of the pupil and the ciliary muscle. CN III exits
the cranium at the superior orbital fissure.
CN IV, the trochlear nerve, is a thread-sized nerve that emerges from the posterior side of the brain stem and
encircles it anteriorly where it enters the cavernous sinus. You will find it piercing the arachnoid mater on
either side of the pons near CN III. It is a somatic motor nerve innervating one extraocular muscle. It passes
through the cavernous sinus and exits the cranium at the superior orbital fissure.

CN IV

CN V

The large CN V, trigeminal nerve, emerges from the lateral aspect of the pons. It is the primary general
sensory nerve of the face, nasal and oral cavities. In addition it carries branchial motor axons to the muscles
of mastication. In the middle cranial fossa it branches into three large nerves that exit the cranium through the
superior orbital fissure, foramen rotundum, and the foramen ovale. These major nerves are the ophthalmic
nerve (V1), maxillary nerve (V2) and the mandibular nerve (V3).
Inferior to the pons, identify the medulla oblongata. CN VI, the abducens nerve, emerges from the pons
close to the midline, just at the margin between the pons and medulla oblongata. It is a somatic motor nerve

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innervating one extraocular muscle. After passing through the cavernous sinus it exits the cranium at the
superior orbital fissure.

CN VI

CN VII

Just lateral to CN VI identify (from superior to inferior) CN VII, the facial nerve, and VIII, the
vestibulocochlear nerve. CN VIII is a little larger in diameter than CN VII. CN VII carries branchial motor
axons innervating the muscles of facial expression, special sensory axons for taste from the anterior 2/3 of the
tongue, and visceral motor preganglionic parasympathetic axons to the pterygopalatine and submandibular
ganglia. The related postganglionic axons innervate the lacrimal gland and glands of the nose and palate, and
the submandibular and sublingual glands respectively. The largest part of CN VII exits the cranium at the
stylomastoid foramen.
Both parts of CN VIII are special sensory nerves: one for hearing, the other head position and movement.
Neither exits the cranium but both pass through the internal acoustic meatus on their way from the inner ear to
the brain stem.

CN VIII

CN IX

CNs IX, X, XI and XII come from the medulla oblongata. CNs IX and X are adjacent to each other. CN IX,
the glossopharyngeal nerve carries branchial motor, visceral motor, visceral sensory, special sensory and
general sensory axons!! It innervates one pharyngeal muscle, sends preganglionic parasympathetic to the otic
ganglion (post to parotid gland), receives visceral sensory information from the parotid gland, carotid body and

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sinus, and the pharynx and middle ear, special sensory of taste from the posterior 1/3 of the tongue, and general
sensation from the posterior 1/3 of the tongue and external ear. It exits the cranium via the jugular foramen.
CN X, the vagus nerve, is similarly complex. It carries branchial motor to the pharyngeal constrictors,
larynx, muscles of the palate and the upper esophagus, visceral motor (preganglionic parasympathetic) to the
thorax and abdomen, visceral sensory from the base of the tongue, pharynx and larynx as well as the airway,
heart, and GI tract (as far as the left colic flexure), special sense of taste from the epiglottis and palate, and
general sensation from the auricle, external acoustic meatus and the dura of the posterior cranial fossa. It exits
the cranium via the jugular foramen.

CN X

CN XI

CN XI, the accessory nerve is a somatic motor nerve that arises primarily from the cervical spinal cord. Its
cranial contribution joins the vagus nerve. Its cervical contribution enters the cranium through the foramen
magnum and exits the cranium via the jugular foramen.

CN XII

CN XII, the hypoglossal nerve, is somatic motor to the tongue. It exits the cranium via the hypoglossal canal.

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Cranial nerves in the cranial fossa

Posterior cranial fossa and nerves

Observe the cranial cavity and review the cranial positions of the twelve pairs of cranial nerves.
Re-familiarize yourself with the relevant bony landmarks on a dry skull including the cribriform plate, the
optic canal, the superior orbital fissure, the foramen rotundum, the foramen ovale, the stylomastoid
foramen, the internal acoustic meatus, the jugular foramen and the hypoglossal canal.

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Scalp and Brain

Step 6
Cerebral Arterial Circle (of Willis)
Dissection Instructions
On the cadaver, find the vertebral arteries as they pass through the foramen magnum to enter the cranial
cavity (refer to your atlas for an image). Also look on the inferior surface of the brain and observe that the
vertebral arteries join near the posterior pons to form the basilar artery.

Arterial Circle of Willis

Circle of Willis

The basilar artery runs superiorly along the midline of the pons. At its inferior end it gives the anterior
inferior cerebellar arteries. At it superior end it gives the posterior cerebral arteries.
In the middle cranial fossa identify the internal carotid arteries that enter near the anterior clinoid processes.
Observe that they are joined to the posterior cerebral arteries by the posterior communicating arteries.
Identify the two terminal branches of the internal carotid artery: the anterior cerebral arteries and the middle
cerebral arteries. Identify the anterior communicating artery that joins the two anterior cerebral arteries.
TIP: The Circle of Willis allows the cerebral arteries to anastomose. However, if any of these
arteries are blocked by a blood clot, the anastomosis may not be sufficient to prevent damage to
brain tissue.

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Orbit and Eye

General Overview
Each orbit is a cone-shaped space in the anterior superior part of the facial region of the skull. The medial
walls of the orbits are parallel to each other but the axial orientation of the orbits relative to each other is about
45 degrees (refer to your atlas for an image). This orientation has implications for the actions of the extraorbital
muscles in controlling the position of the eyeball.
The orbit is formed from contributions of seven bones! The arrangement of these bones creates several
fissures and foramina through which nerves and vessels pass on their way to and from the eye. The anterior
margin of the orbit is relatively strong but the medial and inferior walls are thin and may be fractured by a blow
that does not injure the margin. These fractures impact the ethmoid, sphenoid and maxillary sinuses which
are adjacent to the orbit. Bleeding or swelling that occurs within the orbit puts pressure on the eyeball and can
cause it to protrude from the orbit.
The globe of the eye and its associated optic nerve are surrounded by the extraocular muscles, nerves and
vessels of the orbit as well as a significant amount of fat. The ciliary ganglion, a parasympathetic ganglion, is
also present and identifiable in the orbit.
Six extraocular muscles move the eye in elevation, depression, adduction, abduction and rotation
(torsion). An additional muscle in the orbit elevates the upper eyelid. The movements are complex and will
require some concerted effort on the part of the student to understand and be able to explain them. The
difference between the orientation of the orbit and the orientation of the eyeball within the orbit contribute
to the complexity of muscle/movement relations. You will find it fun and informative to explore an animation,
Simulation and Testing of Eye Movements, that is accessible from the Clinical and Developmental Anatomy
course home page.
Innervation to the structures of the orbit and the eyeball comes from several different sources. The extraocular
muscles receive somatic innervation from three cranial nerves, oculomotor, trochlear and abducens (CNs
III, IV and VI respectively). Sensory innervation to the eyelids, conjunctiva, eyeball and the skin surrounding
the orbit comes from CN V1 & 2 (ophthalmic and maxillary). Axons from V1 pass through the orbit as the
frontal, nasociliary and lacrimal nerves.
Autonomic innervation to structures of the eyeball includes preganglionic parasympathetic axons from CN
III to the ciliary ganglion. Postganglionic axons of this pathway innervate the sphincter pupilae muscle and
ciliary body. Postganglionic sympathetic axons to the eyeball come to the orbit from the superior cervical
ganglion via the internal carotid plexus and innervate the dilator pupilae muscle and ciliary body. These
postganglionic parasympathetic and sympathetic axons, accompanied by sensory axons, travel from the orbit to
the eyeball via the short and long ciliary nerves.
The lacrimal gland lies in the superolateral aspect of the orbit. It produces a watery fluid that bathes the
anterior eyeball protecting it from desiccation and washing away any dust or debris that is present. Lacrimal
fluid drains from the surface of the eye into the nasal cavity by the nasolacrimal duct.
The innervation of the lacrimal gland differs from that of the eye. The preganglionic parasympathetic axons
come from CN VII to the pterygopalatine ganglion. They are accompanied by postganglionic sympathetic
axons from the superior cervical ganglion. From the pterygopalatine ganglion both parasympathetic and

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sympathetic axons travel a complex pathway, riding on two different nerves, to arrive at the lacrimal gland.
The ophthalmic artery, a branch of the internal carotid artery, is the main source of blood supply to the
eyeball and orbit. It gives several branches within the orbit including the central retinal artery and the ciliary
arteries that supply the retina and choroid of the eyeball. Other branches, e.g. anterior ciliary and ethmoidal
arteries, supply the muscles and intraorbital structures before exiting the orbit.
Dissect the muscles and structures of the orbit by the superior approach on the same eye that you
performed the anterior dissection in Face Step 6.

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Orbit and Eye

Step 1
Osteology of the Orbit
Dissection Instructions
Using a dry skull examine the orbit of the eye. It is formed by contributions from seven bones (refer to your
atlas for an image). The arrangement of the bones creates several important openings through which nerves and
vessels pass traveling to and from the eye.

Bones of the orbital cavity

The anterior margin of the orbit is a fairly strong ring of bone formed by the frontal bone superiorly, the
maxilla medially and inferiorly, and the zygomatic bone laterally (refer to your atlas for an image). The frontal
bone also forms most of the roof (superior wall) of the orbit (refer to your atlas for an image). The frontal lobes
of the brain rest on the superior side of the orbital roof. The supraorbital notch or foramen lies in the frontal
bone on the superomedial aspect of the margin. It conducts the supraorbital neurovascular bundle.
The maxilla forms the largest part of the orbital floor (inferior wall). The infraorbital groove and canal
traverse the floor carrying the infraorbital vein, artery and nerve (maxillary nerve, CN V2) toward the
infraorbital foramen. The maxillary sinus lies inferior to the orbital floor.
The medial wall of the orbit is formed by the small lacrimal bone anteriorly and the ethmoid bone
posteriorly. The lacrimal bone contains the lacrimal fossa which holds the lacrimal sac. The ethmoid bone
makes up most of the medial wall. Is it paper thin and prone to fracture from traumatic forces applied to the
orbit or head. The air cells of the ethmoid sinuses lie medial to the medial wall of the orbit. On the superior
margin of the ethmoid bone are the anterior and posterior ethmoidal foramina that transmit like-named
nerves and vessels.
The lateral wall of the orbit is formed by the zygomatic bone anteriorly and the greater wing of the sphenoid
bone posteriorly. The sphenoid bone contains the superior orbital fissure (posterolaterally) and the optic
canal at the apex of the orbit. The superior orbital fissure lies between the lesser and greater wings of the
sphenoid bone and transmits the ophthalmic division of trigeminal nerve (CN V1), the oculomotor (CN III),
trochlear (CN IV), and abducens (CN VI) nerves, as well as the ophthalmic vein. The optic canal is
positioned at the junction of the lesser wing and the body of sphenoid bone. It transmits the optic nerve (CN

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II) and ophthalmic artery. The sphenoid bone is separated from the maxilla by the inferior orbital fissure.
A very tiny part of the palatine bone is juxtaposed between the maxilla and sphenoid bones just inferior to the
optic canal.
The bones of orbit are lined with periorbita which is continuous with the periosteal dura.
The maxillary sinus (inferior), ethmoidal sinuses (medial) and frontal sinuses (superior) surround much of
the orbit.

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Orbit and Eye

Step 2
Superior Approach to the Orbit
Dissection Instructions
Do the first part of this dissection on both orbits. Then, on the same side that you did the anterior
dissection of the eye in Face Step 6, do the full, deep dissection of the orbit. On the other side, clean the
fat away but leave the muscles and superficial nerves and vessels intact.
To access the contents of the orbit chisel away the shelf of frontal bone that forms the orbital roof (refer to
your atlas for an image). This must be done with great control as the bone is relatively thin and some of
the structures you want to see lie just deep to the bone. First remove the dura from the frontal bone on the
floor of the anterior cranial fossa by incising it with a scalpel and then peeling it from the bone. Then mark the
outline of the opening that you want to create in the bone. The finished opening needs to be as wide as possible
without compromising the walls of the orbit. Leave the superior orbital margin (most anterior part of the frontal
bone) intact as you will need to verify the course of the supraorbital nerves and vessels as they leave the orbital
cavity through the supraorbital foramen. Refer to a skull as you create your dissection plan.
Use a wooden hammer and chisel to CAREFULLY break the orbital roof. Pick away the bone fragments
and clean the area for dissection. Observe that the roof of the orbit is variably hollow on its medial and anterior
edges due to the presence of the ethmoidal and frontal sinuses respectively. The frontal sinuses are quite
variable in size and distribution. The ethmoid sinuses (air cells) are like a honeycomb. Identify the mucosal
lining of both the frontal and ethmoid sinuses.

Periorbita after removal of orbital roof

First view of the orbital cavity

After removing the bony roof, identify the dense membranous periorbita enclosing the structures in the orbit

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(refer to your atlas for an image). Periorbita is continuous with the periosteal layer of dura mater at the optic
canal and superior orbital fissure. It is continuous with the periosteum of the facial bones around the anterior
margins of the orbit.
To increase the size of your work space, carefully remove the lesser wing of the sphenoid bone. Place a
probe between the periorbita and the lesser wing and cut through the thin piece of bone with bone shears. This
procedure should expose the contents of the superior orbital fissure and the optic canal and, as long as you
don't break the periorbita, you will not disturb the structures that you want to dissect.

Right orbital cavity

Use small scissors to cut through the medial, anterior and posterior sides of the visible periorbita making
a flap. Reflect it laterally and examine the contents of the superior orbit. The large frontal nerve, a branch of
CN V1, is the most superficial structure. The frontal nerve enters the orbit through the superior orbital fissure.
Within the orbit it lies on a large fat pad. The frontal nerve branches into the supraorbital and supratrochlear
nerves near the anterior margin of the orbit. If you tug on it you should see the supraorbital nerve that you
dissected earlier wiggle on the anterior surface of the orbit.
Use the small scissors to loosen the fatpad deep to the frontal nerve and carefully pick the fat from the orbit
using blunt forceps. Several muscles and vascular structures should become apparent almost immediately.

Superficial structures of the eye

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Examine the most superior (superficial) muscles in the orbit - the levator palpebrae superioris and, just deep
to it, the superior rectus (refer to your atlas for an image). They may look like one muscle. If so, use a blunt
probe to separate them and verify that there are two muscles. The levator palpebrae superioris elevates the
upper eyelid. Tug on the muscle and look at the eyelid to verify its function. The superior rectus inserts onto the
sclera of the eyeball. It elevates, adducts and medially rotates the eye (refer to your atlas for an image). Both
muscles are innervated by CN III.

Nasociliary and trochlear nerves

Along the medial wall of the orbit identify the superior oblique muscle. Trace its course anteriorly and look
for its pulley (trochlea) in the anterior medial corner of the orbit. (You may have to chip away a little more
bone to see it). The tendon of the muscle passes through the pulley and angles posteriorly to insert on the
posterolateral part of the eyeball (refer to your atlas for an image). The action of superior oblique is to depress,
abduct and medially rotate the eyeball. It is innervated by the trochlear nerve (CN IV). Although this nerve is
very thin, it is easy to find lying on the superior surface of the proximal one third of the superior oblique
muscle belly. You can see 2-3 twigs of the nerve entering the muscle. Review its pathway from the brain stem.
Continue the dissection only on the side with the anterior dissection of the eye (Face Step 6).
Cut the levator palpebrae superioris 1 cm from its posterior attachment and reflect it anteriorly in order to
better expose the underlying superior rectus muscle. Examine the anterior attachment of superior rectus to
the sclera of the eyeball and its origin from the common tendinous ring (common anular tendon) posteriorly.
Cut the superior rectus muscle about 1 cm from its posterior attachment and reflect it anteriorly. Examine the
underlying branches of the oculomotor nerve (CN III) that innervate the muscle.
Inferior to the superior oblique muscle along the medial wall of the orbit is the medial rectus muscle. It
adducts the eye. Clean the muscle and find the branch of CN III that enters its lateral (internal) surface.
The nasociliary nerve is visible deep to the levator palpebrae superioris and superior rectus muscles. It crosses
to the medial side of the orbit and splits near the midpoint of the superior oblique muscle into the anterior
ethmoidal and the infratrochlear nerves. These branches pass between the superior oblique and the medial
rectus muscles on the way to their exits from the orbit. The nasociliary nerve originates from CN V1. What is
its function?

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TIP: Clean very gently on the lateral side of the orbit because there are several small structures
that could be broken or unintentionally removed. One is the lacrimal nerve which lies on the
lateral wall of the orbit superior to the lateral rectus. It is very thin. Deeper in the orbit, between the
optic nerve and the lateral rectus muscle, lie the ciliary ganglion and its associated nerves. The
ganglion looks like a knot of nerve tissue (see image Deeper muscles of the eye). The short ciliary
nerves connect the ganglion to the posterior aspect of the eyeball. The other nerves that enter the
sclera nearby are the long ciliary nerves. With gentle cleaning using a blunt forceps you should be
able to see all of these structures.
On the lateral wall of the orbit find the delicate lacrimal nerve as it emerges from the superior orbital fissure
and travels to the lacrimal gland in the superolateral corner of the orbit. What kind of axons travel in the
lacrimal nerve?
Also on the lateral wall of the orbit identify the lateral rectus muscle. It abducts the eye. Trace the abducens
nerve (CN VI) to the medial (internal) surface of the muscle. The lateral rectus has two heads but they can be
hard to distinguish. Wait until more of the orbit is dissected before you look for them.

Inferior oblique muscle

To find the inferior oblique muscle you must approach the orbit from the anterior (face) view. Palpate the
inferior margin of the orbit then slice open the lower orbital septum with the tip of the small scissors. Remove
the fat on the medial side of the inferior orbit and look for the inferior oblique muscle running transversely
across the orbit. It originates on the anterior medial wall of the orbit and passes obliquely, posterolaterally, to
insert on the eyeball. It elevates, abducts and laterally rotates the eye. It is innervated by CN III.

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Common tendinous ring (right orbit)

The four recti muscles originate from a ring of connective tissue called the common tendinous ring or
common anular tendon. It is a stiff circular/oval structure that surrounds the optic canal and part of the
superior orbital fissure (refer to your atlas for an image).
The following structures pass through both the superior orbital fissure and the common tendinous ring to
reach their targets: nasociliary nerve, superior and inferior divisions of the oculomotor nerve and the
abducens nerve.
The optic nerve (CN II) and ophthalmic artery pass through the tendinous ring and the optic canal but not
the superior orbital fissure.
The lacrimal nerve, frontal nerve, trochlear nerve and the superior and inferior divisions of the
ophthalmic vein pass through the superior orbital fissure but not the tendinous ring (refer to your atlas for an
image).

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Orbit and Eye

Step 3
Nerve Pathways, Cavernous Sinus and the Ciliary Ganglion
Dissection Instructions
Prepare to study the pathways of the nerves of the orbit by removing the dura from the floor of the
middle cranial fossa and the lateral wall of the cavernous sinus. Do this on both right and left sides. On
the side with the deep orbital dissection, complete the full dissection described in this step. On the other
side, leave the trigeminal ganglion intact.

Dural space vessels and nerves of the middle cranial fossa

Incise the dura along the lateral margin of the floor of the middle cranial fossa and peel it away medially
revealing the vessels and nerves that traverse the floor. Identify the middle meningeal artery. Through what
foramen is it entering the middle cranial fossa? Near the posteromedial aspect of the middle cranial fossa
identify and define the very large trigeminal ganglion. Clear away any overlying dura and look for the
mandibular nerve (CN V3) passing into the foramen ovale.
On either side of the sella turcica the cavernous sinuses form between layers of the periosteal and meningeal
dura (refer to your atlas for an image). These venous sinuses contain thin-walled veins that communicate from
the superior orbital fissure to the apex of the petrous portion of the temporal bone. They receive blood from
several sources, including the ophthalmic veins (see Danger Area of the face in Face Step 3), and drain
posteriorly into the petrosal sinuses and emissary veins.

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Close-up middle cranial fossa and cavernous sinus

Carefully remove the dura of the lateral wall of the cavernous sinus and identify the other two divisions of
the trigeminal nerve - the maxillary and ophthalmic nerves. Trace the maxillary nerve (V2) from the
trigeminal ganglion to the foramen rotundum and define its path. Find the ophthalmic nerve (V1) from the
ganglion along the lateral aspect of the cavernous sinus, and follow it through the superior orbital fissure into
the orbit (refer to your atlas for an image). In the orbit V1 gives three branches - the nasociliary, lacrimal and
frontal nerves. Find these branches and connect them to their origin from V1 (refer to your atlas for an image).
You should now be able to trace their entire paths.

Deeper nerves and ciliary ganglion in the orbit

Earlier you traced the frontal nerve through the orbit. Now find the nasociliary nerve and trace its complete
route in the orbit (refer to your atlas for an image). It enters the orbit through the superior orbital fissure, within
the common tendinous ring. Initially it gives a few branches that pass laterally and enter the ciliary ganglion.
Then, nasociliary passes over (superior to) the optic nerve and gives several long ciliary nerves to the
posterior part of the eyeball. These provide sensation to the eye. The nasociliary continues obliquely toward the
medial wall of the orbit. Just before it passes between the superior oblique and medial rectus muscles it gives
the anterior ethmoidal nerve. This branch passes through the anterior ethmoidal foramen and supplies the
anterior ethmoidal air cells and walls of the nasal cavity. It emerges at the inferior border of the nasal bones as
the external nasal nerve and supplies the skin of the nose. The infratrochlear nerve continues anteriorly and
ultimately supplies the skin of the eyelid and the lateral side of the nose. The posterior ethmoidal branch leaves

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the orbit via the posterior ethmoid foramen. It is not necessary to look for it.
The lacrimal nerve, also a branch of V1, enters the orbit through the superior orbital fissure superior to the
tendinous ring. It passes superolaterally along the superior border of the lateral rectus muscle, through the
lacrimal gland and orbital septum to innervate the conjunctiva and skin on the lateral side of the eye. The
lacrimal nerve communicates with the zygomatic branch of the maxillary nerve where it picks up
parasympathetic axons from the pterygopalatine ganglion to deliver to the lacrimal gland (refer to your atlas
for an image).
The internal carotid artery is a large presence in the cavernous sinus (refer to your atlas for an image). On
the side with the deep dissection of the orbit, cut the branches of the trigeminal ganglion leaving a stub of nerve
in each foramen (see Close-up middle cranial fossa above). Pick away the bone/cartilage covering the
foramen lacerum and expose the carotid artery in the carotid canal (refer to your atlas for an image). Study
a dry skull to review the path of the internal carotid artery.
Trace the course of the abducens nerve (CN VI) through the cavernous sinus where it lies inferolateral to the
internal carotid artery (refer to your atlas for an image). From here it enters the orbit through the superior
orbital fissure and passes between the two heads of the lateral rectus muscle to get to the medial surface of the
muscle. If possible, make the connection between the orbital and cavernous parts of the nerve that you can see.
Identify the oculomotor nerve (CN III) in the cranial cavity as it pierces the dura between the posterior and
anterior clinoid processes (refer to your atlas for an image). As the nerve enters the superior orbital fissure it
divides into an inferior division supplying the medial rectus, inferior rectus and inferior oblique muscles and
superior division supplying the levator palpebrae superioris and superior rectus muscles (refer to your atlas for
an image). Look for the superior and inferior divisions of CN III. Preganglionic parasympathetic axons
from the inferior division go to the ciliary ganglion located between the optic nerve and the lateral rectus
muscle (refer to your atlas for an image).
Look for the ciliary ganglion in the lateral aspect of the orbit between the lateral rectus and the optic nerve. It
looks like a small knot of nerve tissue. Short ciliary nerves exit the ganglion and enter the posterior aspect of
the eye. Long ciliary nerves from the nasociliary nerve also enter the posterior surface of the eye but they do
not pass through the ganglion.
TIP: The inferior branch of CN III carries presynaptic parasympathetic nerve fibers to the
ciliary ganglion where they synapse. Postsynaptic axons travel via the short ciliary nerves to
enter the back of the eyeball. They distribute to the ciliary muscle and sphincter pupillae muscles in
the anterior part of the eye. Excitation of these fibers causes contraction of the ciliary muscle and
constriction of the pupil, which allows you to focus on nearby objects. Postsynaptic sympathetic
fibers also travel through the ciliary ganglion, but do not synapse there. Upon excitation they cause
relaxation of the ciliary muscle to allow you to see distant objects, and contraction of the dilator
pupillae muscle which opens the pupil.
Once again examine the contents of the superior orbital fissure and identify the superior ophthalmic vein. If
you can, trace it from the point where it anastomoses with the facial vein at the medial angle of the eye to the
point where it drains into the cavernous sinus.

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Orbit and Eye

Step 4
Optic Nerve and Ophthalmic Artery
Dissection Instructions
Find the optic nerve (CN II) exiting the posterior surface of the eyeball. The optic nerve is actually a
continuation of a brain tract. Thus it is surrounded by the three meningeal layers (dura, arachnoid and pia).

Optic nerve

Branches of internal carotid artery

Traveling within the proximal part of the optic nerve (the part emerging from the eyeball) is the central artery
of the retina (refer to your atlas for an image). You can see this vital structure by cutting the optic nerve in
cross section about 0.75 cm from the globe of the eye and examining the cut surface.
Identify the ophthalmic artery at the point that it arises from the internal carotid artery and trace its course
through the orbit (refer to your atlas for an image). At the optic canal, it lies inferior and lateral to the optic
nerve. As it continues anteriorly the artery curves superior to the optic nerve and reaches the medial wall of the
orbital cavity. The ophthalmic artery gives numerous branches within the orbit, most important of which is the
central artery of the retina.
Move the cut optic nerve aside to get a better view of the underlying inferior rectus muscle.

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Orbit and Eye

Step 5
Deep Anterior Dissection of the Eye
Dissection Instructions
Return to the anterior margin of the orbit. Reflect the orbital part of the orbicularis oculi muscle and incise
the orbital septum so you can examine the various structures within the orbital cavity (refer to your atlas for an
image). Identify the lacrimal gland in the superolateral corner of the orbit and the trochlea (the pulley for the
superior oblique muscle) in the superomedial corner of the orbit. Incise the inferior orbital septum and find the
lacrimal sac and the origin of the inferior oblique muscle in the inferomedial corner of the orbit. Follow the
inferior oblique laterally and define its position in the inferior aspect of the orbit.
Clean the orbit thoroughly and study the relations of the muscles, nerves and vessels.

Anterior view of the orbit and eye

Option:
If the eyeball is well preserved you may remove it from the orbit by cutting the muscle attachments close to the
sclera. Once removed,use a very sharp blade to make a sagittal plane cut through the cornea and the entire
eyeball. The eyeball has three major layers:
1. an external fibrous layer represented by the sclera and cornea
2. a middle vascular layer consisting of the choroid, ciliary body and iris
3. the internal nervous layer, the retina
Inside of the globe of the eye look for the optic disc - the area where the optic nerve and retinal vessels enter
(refer to your atlas for an image).

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Pharynx
General Overview
Consult with your lab leader regarding the next several dissections as the assignment and sequence may
be different for each dissecting team!!!
TIP: This lab describes the process of separating the head and cervical viscera from the
vertebral column in order to access the posterior wall of the pharynx. The following unit, Oral
and Nasal Cavities, describes the bisection of the head in order to access the nasal and oral cavities.
Both of these procedures are not performed on the same cadaver. Consult your lab leader to
find out which procedure your team should perform. It is imperative that you view both dissections
since many structures will be visible in only one of these dissection.
In this dissection the head and cervical viscera will be separated from the vertebral column. This approach
permits study of the pharynx, particularly the pharyngeal constrictors, from a posterior perspective. The
local cranial nerves (CNs IX, X, XI and XII) will be traced from their cranial exits to their target organs, and
the carotid and internal jugular vessels followed along their pathways in the neck. In addition, on the anterior
aspect of the cervical vertebrae those muscles enclosed by the prevertebral fascia (e.g. longus colli and
capitis muscles) are visible.
In Step 1 the craniovertebral joints will be exposed and prepared for dislocation. The cruciform and alar
ligaments stabilize the articulations between the occipital bone, C1 and C2, and hold the dens against the
anterior arch of C1. The ligaments between the occipital bone and C1 will be cut in order to separate the head
from the vertebral column. Those uniting C1 and C2 will be left in tact.
Following separation, the muscles (e.g. longus colli and capitis, scalene muscles) and nerves of the anterior
cervical region, and the structures deep in the root of the neck (such as the vertebral artery and thoracic duct)
will be fully exposed.
Cranial nerves IX, X, XI and XII are all visible from the posterior view of the pharynx and will be cleaned
and traced along their full pathways to better understand their relationship to the musculoskeletal and vascular
components of the neck including the muscles of the anterior triangle of the neck and the pharyngeal
constrictors, as well as the common, internal and external carotid arteries, and internal jugular vein and
tributaries.
In Step 4 the muscles of the pharynx, the pharyngeal constrictors, will be cleaned and dissected. A vertical
incision in the pharyngeal muscular tube will reveal their relationship to the nasal and oral cavities, the larynx
and the esophagus.
In the last step, the larynx will be dissected and the major muscles, nerves and vessels identified. All of the
intrinsic muscles of the larynx are innervated by the recurrent laryngeal nerve except for the cricothyroid
muscle which receives the external laryngeal branch of the superior laryngeal nerve. The false and true
vocal folds are evident on the lateral walls of the laryngeal cavity. The true vocal folds are responsible for
producing sound by vibrating as air passes between them. The many cartilages of the larynx that change the
position and tension of the vocal folds thus impacting on the quality and pitch of vocalizations, will be seen.

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Pharynx
Step 1
Head and Cervical Vertebrae Separation, Prevertebral and Lateral
Vertebral Regions
Dissection Instructions
Position of the cadaver = prone

The occipital bone will be separated from C1 by cutting through the atlanto-occipital membranes and
joints. Review the articulations and supporting ligaments of the craniovertebral joints (between the occipital
bone, C1 and C2; refer to your atlas for an image).

Cut lines through occipital bone

Wedge cut (superior view)

If you have already cut an occipital wedge, proceed to the next paragraph. If you need to cut an occipital
wedge now, turn the cadaver in the prone position and remove all of the skin, fascia and muscles from the
posterior occipital and suboccipital regions. Identify the spinous process of C2 and the posterior arch of C1.
Using a saw (both electric and hand saws are equally effective), make two obliquely vertical cuts (wedge
cuts) through the posterior of the cranium just medial to the mastoid processes (as illustrated above). Continue
the cuts inferiorly through the rim of the foramen magnum only. Remove the wedge of occipital bone.

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Craniovertebral region

Dura incised

With the cadaver in the prone position, palpate the anterior margin of the foramen magnum (refer to your
atlas for an image). Just inferior to its rim you can feel the 'bump' of the dens resting against the anterior
arch of C1. Have a classmate rotate the head while you palpate the dens and you will feel the pivot motion that
occurs at the atlantoaxial joint. Expose the cruciate (cruciform) and alar ligaments of this joint by cutting a
flap first through the dura mater, and then through the tectorial membrane (continuation of the posterior
longitudinal ligament). To do this, make a 2 cm wide transverse cut and two 3 cm long vertical cuts through the
dura over the lower clivus and across the atlanto-occipital and atlanto-axial joints (refer to your atlas for an
image). Make the longitudinal cuts just medial to each vertebral artery as it pierces the dura to enter the
cranium. Peel away the dura. Clean, then cut the tectorial membrane from the rim of the foramen magnum
and reflect it inferiorly.

Tectorial membrane

Transverse band of the cruciform ligament

Identify and clean the thick transverse band of the cruciate ligament (refer to your atlas for an image).

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Palpate the dens and demonstrate that the transverse band attaches to the anterior arch of C1 on either side of
the dens. The transverse band prevents the posterior displacement of C2 relative to C1. Look for the slender
superior and inferior bands that, together with the transverse band, form the cross-shaped cruciate
(cruciform) ligament. The superior band attaches to the anterior margin of the foramen magnum. It may have
been removed when you removed the tectorial membrane. If not, remove it at this time. The inferior band
attaches to the body of C2. Do not cut it. Also, DO NOT CUT the transverse band.

Alar ligament and dens

Find the alar ligaments (refer to your atlas for an image). These very thick ligaments attach from the
anterolateral margins of the foramen magnum to the dens. The alar ligaments limit the amount of rotation
between the C1 and C2 vertebrae to 45 degrees on either side (90 degrees total range of motion). Rest your
finger on one of the alar ligaments and rotate the head to each side. Does the ligament become taut when the
head rotates to the same side or the contralateral side?
Carefully cut the alar ligaments close to the dens (refer to your atlas for an image). Do not cut deeper than
the alar ligaments as you might sever some of the structures that you want to see in the next few steps. Rotate
the head again and note the increased range of motion.
Now cut through the dura along the margin of the foramen magnum taking care to not cut the hypoglossal
nerves. Use a scalpel to cut the posterior aspect of the capsules of the atlanto-occipital joints. Tilt the head
laterally to the opposite side in order to see what you are cutting. Do not cut anything except the posterior joint
capsules and posterior atlanto-occipital membrane. Do this on both sides then rotate the head with some force
to loosen the C1-occipital attachments.
Now turn the cadaver to the supine position.

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Fascial layers of the neck

Retropharyngeal space

Define the retropharyngeal space (refer to your atlas for an image) on both sides of the neck by pushing your
hands posterior to the structures enclosed by the carotid sheath and posterior to the sympathetic chain and
structures enclosed by the pretracheal fascia. Your hands should meet in the middle of the retropharyngeal
space. Use them to separate the structures along the fascial plane all the way up to the base of the skull and all
the way down into the thorax. Discuss the clinical implications of infections in the retropharyngeal space!!
Carefully pull the vessels and nerves (internal jugular, internal carotid, CN IX, X, XI, XII and the sympathetic
chain and superior cervical ganglion) anteriorly away from the vertebrae and make sure they are well separated
from the prevertebral fascia.

Separation of head

Prevertebral muscles

With one hand protecting the left side nerves and vessels anteriorly, rotate the head to the right as far as you can
and sever the left side ligaments and muscles (longus capitis) that attach the head to C1. Cut through the
anterior capsule of the atlanto-occipital joint. Repeat on the other side. Then return to the neutral position and
tilt the head forward. Cut around the inside of the foramen magnum always protecting the neurovascular

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structures!!! Apply force to flex the head anteriorly and separate it from C1. This may take several rounds of
pushing then cutting before the head is free. Once it is free, move the head forward to expose the posterior
surface of the pharynx (with the head) and the anterior surface of the cervical vertebrae (lying on the table).
Examine the anterior surface of the cervical vertebrae and identify the longus colli, longus capitis and
anterior scalene muscles (refer to your atlas for an image). Observe the fascia that covers these muscles - the
prevertebral fascia (refer to your atlas for an image). Some anatomists describe two layers of prevertebral
fascia. The anterior one is the alar fascia. When present it spans the distance between the carotid sheaths from
the base of the skull to C7. The potential space between the posterior aspect of the pretracheal fascia
(buccopharyngeal fascia) and the prevertebral fascia is called the danger space since infections may travel in
this space to the posterior mediastinum.
Find the anterior scalene muscles and the phrenic nerves. Examine the superior attachments of the anterior
scalene. It attaches to the transverse processes of C4-6. Identify the middle scalene muscles and note that their
superior attachments are more extensive and superior than the anterior scalene. The middle scalene extends as
far superiorly as C1. Reexamine the scalene triangle and its contents.
Now look medially at the muscles on the anterior surface of the cervical vertebral bodies (refer to your atlas
for an image). These are the longus colli and longus capitis muscles. They are postural muscles that flex the
neck and head and assist in lateral bending.
Follow the longus colli superiorly (refer to your atlas for an image). They end on the anterior tubercle of C1.
Look for a laterally placed pair of muscles - the longus capitis muscles. They originate on the anterior
tubercles of C3-C6 and insert into the occipital part of the skull (you cut through them). They flex the head.
Deep to the longus capitis are the small rectus capitis anterior muscles. Lateral to them are the rectus capitis
lateralis both of which act only on the atlanto-occipital joints.
The sympathetic trunk is located anterior to the prevertebral fascia (refer to your atlas for an image). If the
procedure that you did to separate the head and C1 went according to the plan outlined above, you will not see
the sympathetic chains on the anterior surface of the cervical vertebrae. They will be on the posterior side of
the pharynx with the other nerves and vessels. Find the sympathetic chains and identify the large superior
cervical ganglion. All of the sympathetic innervation to the head comes from these ganglia!! Look for the
middle (near C6) and inferior (near T1) cervical ganglia. They are not very distinct. Review the origin of the
preganglionic axons that supply the 3 cervical ganglia.

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Pharynx
Step 2
Exterior of Base of the Skull and Structural Components of the Anterior
Cervical Viscera
Instructions
In preparation for the rest of this dissection, examine a skull from your bone box and identify the following
structures on the external surface of the skull base (refer to your atlas for an image):

Exterior base of skull

Foramen magnum: largest foramen in the skull located in the posterior cranial fossa (specifically occipital
bone). The vertebral artery and spinal part of the accessory nerve (CN XI) are transmitted through the
foramen magnum on their way up to the brain. Of course the spinal cord and associated meninges also pass
through the foramen magnum.
Jugular foramen: lies just lateral to the occipital condyles at the anterior margin of the foramen magnum. It is
divided into three compartments:

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anterior receives the inferior petrosal sinus

intermediate transmits CNs IX, X, XI
posterior receives the sigmoid dural sinus; the internal jugular vein originates on the external surface of
the posterior compartment of the jugular foramen
Carotid canal: lies immediately anterior to the jugular foramen and receives the internal carotid artery.
Styloid process: long (1-2 cm) spike of bone just lateral to the jugular foramen. It is an attachment site for
muscles including stylohyoid, styloglossus and stylopharyngeus, as well as the stylomandibular ligament.
Mastoid process: bulbous bony projection posterior and lateral to the styloid process. It is an attachment site
for several muscles including SCM.
Stylomastoid foramen: small foramen between the styloid and mastoid processes. It transmits the largest
component of CN VII.
Hypoglossal canal: located along the anterolateral margin of the foramen magnum adjacent to the jugular
foramen. It is the passageway for CN XII.
Occipital condyles: large articular surfaces located on the anterolateral margin of the foramen magnum. They
articulate with the atlas and permit flexion/extension of the head on C1.
Pharyngeal tubercle: small raised bump on the basilar part of the occipital bone about 1 cm anterior to the
foramen magnum. It is the attachment site of the superior pharyngeal constrictor muscle.

Hyoid bone and cartilages of larynx

Hyoid bone: on an articulated skeleton identify the hyoid bone. It is a horseshoe-shaped bone that lies anterior
to the body of C3. It is the most superior structural component related to the airway. It has posteriorly directed

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greater and lesser horns for attachment of the middle constrictor muscle and stylohyoid ligament
respectively.
Thyroid and cricoid cartilages: In the photo above (or refer to your atlas for an image) review the landmarks
and relations of the thyroid and cricoid cartilages. The inferior constrictor muscle attaches to the oblique line
of the thyroid cartilage and side of the cricoid cartilage.

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Pharynx
Step 3
Nerves and Vessels at the Base of the Skull Related to the Pharynx
Instructions
During this step, keep the cadaver in the supine position with the head laying forward into the thorax or
supported by a wooden block. You may lay the head back into anatomical position occasionally to verify
identification of a structure and to review its full pathway in the neck.

Posterior pharynx on first exposure

Examine the nerves and vessels related to the posterolateral pharynx including the sympathetic trunk and
superior cervical ganglion, CNs IX, X, XI and XII and the internal jugular and carotid vessels (refer to your
atlas for an image). You have identified many of these structures and seen their inferior portions and pathways
during dissection of the carotid triangle. After cleaning the posterior pharyngeal region you will be able to
demonstrate their superior pathways and relations to the skull and posterior pharynx.

Posterior aspect of pharynx

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Carefully remove the fascia (buccopharyngeal fascia and carotid sheath) from the posterior surface of the
pharyngeal constrictors and adjacent neurovascular structures. Gentle separating with the tip of the scissors will
raise the fascia from the pharynx. Then you might be able to peel it off or cut it off with the scissors. The
pharyngeal constrictors are very thin muscles - similar to the facial muscles - so take care. Use blunt forceps
or scissors to clean the vessels and nerves on each side of the pharynx. You should be able to make it look like
the photos above (dissections by students in the class of 08!).

Dissection of the posterior aspect of the pharynx

Find and clean the common carotid artery and internal jugular vein (refer to your atlas for an image).
Confirm that the artery lies medial to the vein. Find the sympathetic trunk (chain) and superior cervical
ganglion posterior and medial to the artery and vein. In terms of appearance, the sympathetic trunk looks like a
long nerve with 3 dilations. The dilations are the ganglia - 1 large and 2 small. The smaller ganglia are often
diamond or triangular in shape. The large superior cervical ganglion is located superior to the level of the hyoid
bone at about C2. The middle cervical ganglion is at the level of the cricoid cartilage (C5-6) near the
inferior thyroid artery. The inferior cervical ganglion is found at the level of the first rib, often anterior to
the vertebral artery. When this ganglion fuses with the first thoracic ganglion, it is called the stellate
ganglion.
Next, find the vagus nerve (CN X) between the internal jugular vein and the carotid arteries, anterior and
lateral to the sympathetic trunk (refer to your atlas for an image). Verify that you have found the correct nerve
by tugging on the portion of the vagus that you identified in the neck. Review the full pathway of vagus and
find some of its branches. First, find the swelling on the superior part of the vagus nerve at the base of the
jugular foramen. This is the inferior (nodose) ganglion. This ganglion may not be visible if the soft tissue at
the base of the skull has not been thoroughly cleared. Look for a thin posteromedially directed branch of the
vagus nerve that leaves this ganglion and goes to the pharyngeal constrictor muscles. This is the pharyngeal
branch of vagus.
Inferior to the inferior vagal ganglion identify the superior laryngeal nerve (refer to your atlas for an image).
The best way to identify this nerve is to find its branches, the internal and external laryngeal nerves, and
follow them back to the point before they branched. You probably found the internal laryngeal nerve in an

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earlier dissection. It pierces the thyrohyoid membrane and supplies sensation to the area of the larynx above the
vocal cords. The thin external laryngeal nerve innervates the cricothyroid muscle (the only laryngeal muscle
not innervated by the recurrent laryngeal branch of the vagus). Trace the internal and external laryngeal
nerves to their common origin from the superior laryngeal nerve. Trace the superior laryngeal nerve to its
branchpoint from the vagus.
You found CN XII (hypoglossal nerve) in an earlier dissection of the neck. Return the head and neck to
anatomical position and find CN XII again. Now follow it back to the base of the skull cleaning as you go.
Verify that it lies posterior and medial to vagus. Study its descent from the hypoglossal canal inferiorly then
curving anteriorly a little superior to the hyoid bone (C2-C3) to disappear deep to the mylohyoid muscle.
TIP: Remember CN XII innervates all muscles that end in glossusexcept palatoglossus.
When CN XII nerve is injured, the tongue deviates to the injured side.
Find the spinal accessory nerve (CN XI) immediately lateral to the vagus nerve (refer to your atlas for an
image). Both of these nerves pass through the jugular foramen. Trace CN XI to the sternocleidomastoid
muscle and trapezius muscles in order to verify its identity. Remember that the extracranial part of CN XI
originates from the cervical spinal cord.
TIP: Part of the accessory nerve originates in the spinal cord (spinal portion) and part of it
originates in the brain (cranial portion). The spinal portion comes from nerve roots of C1-C5
that ascend in the vertebral canal and enter the base of the skull through the foramen
magnum. These axons then join the cranial part of CN XI for a very short distance. Both spinal and
cranial contributions pass through the jugular foramen on their way out of the skull. However, the
cranial portion joins the vagus nerve at inferior vagal ganglion (nodose ganglion) immediately
external to the jugular foramen. The nerves from this ganglion go on to form the pharyngeal plexus
that innervates the constrictor muscles of the pharynx (to be dissected in the next step) and the
motor components of the external and recurrent laryngeal nerves. The spinal portion of the
accessory nerve is purely motor and innervates the sternocleidomastoid and trapezius muscles.

Glossopharyngeal nerve

CN IX, the glossopharyngeal nerve, is smaller than the previously dissected cranial nerves. It is easiest to
find in its path posterior and parallel to the stylopharyngeus muscle (derived from the 3rd pharyngeal arch)
which originates from the styloid process and descends obliquely toward the posterolateral pharynx. There it

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inserts between the superior and middle pharyngeal constrictors forming a portion of the internal
longitudinal layer of the pharynx. A good approach to finding this nerve and muscle is to look along the lateral
border of the pharynx between the superior and middle constrictor muscles. The vertical fibers of
stylopharyngeus are fairly easy to find there. Follow them superiorly and look for CN IX which is in contact
with the posteroinferior surface of the muscle along much of its length. The superior part of stylopharyngeus is
always deeper and more lateral than you expect. Use blunt dissection to follow it back to the styloid process
anterior to the common carotid artery and internal jugular vein. Then, trace the nerve inferiorly along the path
of the stylopharyngeus muscle to positively identify it as CN IX. A large branch of CN IX goes to the posterior
1/3 of the tongue and so travels anteriorly, passing between the internal and external carotid arteries. Look for
this branch but don't worry if you don't find it immediately. Your colleagues who are doing the bisection of the
head will find it in the oral cavity and you can look at it there.
TIP: CN IX is responsible for both general sensation, such as pain and temperature, and taste
sensation of the posterior 1/3 of the tongue. The anterior 2/3 of the tongue is innervated by
lingual nerve (CN V3) for general sensation and chorda tympani (CN VII) for taste. The
circumvallate papillae and sulcus terminalis divide the tongue into the anterior 2/3 and posterior 1/3
with respect to innervation. All motor innervation of the tongue is by CN XII.

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Pharynx
Step 4
Pharynx
Dissection Instructions
The pharynx extends from the base of the skull (pharyngeal tubercle) to the superior end of the esophagus
and larynx (refer to your atlas for an image). It is bounded posteriorly and laterally by a semicircular 'tube' of
muscles called the pharyngeal constrictors. Each of the three pairs of constrictors meets in the posterior
midline forming a raphe. The constrictors overlap each other posteriorly but have gaps between them laterally
for the passage of nerves and vessels. Pairs of longitudinal muscles, present superiorly, elevate the pharynx
during swallowing.

Muscles of the pharynx

The pharyngeal wall is composed of layers of tissue. From posterior to anterior they are the buccopharyngeal
fascia, pharyngeal muscles, pharyngobasilar fascia, and submucosa with mucous membrane. The pharyngeal
muscles are covered by buccopharyngeal fascia posteriorly. Most of this fascia has already been removed in
order to see the muscle fibers and nerves. The buccopharyngeal fascia permits movement of the pharynx
against the prevertebral fascia and contains the pharyngeal plexus of nerves and veins. Anterior to the
constrictor muscles is a strong fibrous pharyngobasilar fascia. Anterior to this is the submucosa, and anterior
to the submucosa is the mucous membrane that you see when you look into someone's 'throat.' The mucous
membrane will be removed during this dissection.

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Pharyngeal constrictors

Continue to clean the buccopharyngeal fascia from the constrictor muscles and identify the large diamondshaped pair of inferior constrictor muscles (refer to your atlas for an image). Verify that they originate from
the thyroid and cricoid cartilages. Their superior edges overlap with the middle constrictor muscles, i.e.the superior edge of the inferior constrictor is superior and posterior (superficial from this view) to the inferior
edge of the middle constrictor. The middle constrictors originate from the hyoid bone and stylohyoid
ligament. Define the borders of these muscles.
In the lateral space between the middle and inferior constrictors identify the internal laryngeal nerve (branch
of superior laryngeal nerve) and the superior laryngeal artery (branch of the superior thyroid artery) where
they pierce the thyrohyoid membrane (refer to your atlas for an image). You may want to return the head to
anatomical position and find these structures, then follow them posteriorly again.
The superior edge of the middle constrictor lies superior and posterior to the inferior edge of the superior
constrictor muscle (refer to your atlas for an image). The superior constrictor originates from the
pterygomandibular ligament and the bones that the ligament connects (the pterygoid plates and mandible).
Observe that the stylopharyngeus muscle and CN IX enter the space between the superior and middle
constrictors.
Along the inferior edge of the inferior constrictor, find the recurrent laryngeal nerves entering the pharyngeal
wall deep to the inferior constrictor muscle (refer to your atlas for an image). Trace the recurrent nerves
inferiorly to verify their identification and observe their position between the esophagus and trachea.

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Cut line through pharynx

In order to study the internal surface of the pharynx the constrictor muscles must be cut. Make a vertical
incision in the midline of the constrictor muscles from the base of the skull to the esophagus. Open the two
flaps of pharynx and examine the internal structures. Identify the soft palate and uvula superiorly. Identify the
epiglottis - a large curved flap of elastic cartilage located in the mid region of the pharynx and the larynx.
Find the thyroid and cricoid cartilages that form the larynx. Note that the larynx is a tubular 'box'. The
soft palate and uvula, epiglottis, and laryngx define the boundaries of the nasopharynx, oropharynx and
laryngopharynx.

Internal pharynx

Tonsil

The nasopharynx lies superior to the soft palate and extends to the base of the skull. Anteriorly it
communicates with the nasal cavities. Identify the choanae - the posterior openings into the nasal cavities. The
nasal septum between them is formed from vomer (posteriorly) and the perpendicular plate of the ethmoid
bone (refer to your atlas for an image). Note that all of the surfaces in the pharynx of the cadaver are covered
by mucous membrane. Compare what you are seeing in the cadaver with the appearance of the choanae and
vomer in a dry skull. Other structures in the nasopharynx, include the opening of the pharyngotympanic
(auditory) tube, the pharyngeal tonsil and recess, and the salpingopharyngeal fold. These are better seen in the

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bisected head. A photograph is included above (refer to your atlas for an image).
Lift up the soft palate and inspect the space between it and the epiglottis. This is the oropharynx. From this
view you can see the root of the tongue (posterior 1/3 of the tongue) covered with the bumpy lingual tonsil.
The circumvallate papillae are visible along the anterior border of the sulcus terminalis. Between the root of
the tongue and the anterior surface of the epiglottis are two 'little valleys' separated by a frenulum. These are
the valleculae (sing. vallecula) separated by the median glossoepiglottic fold. Food can get caught in the
valleculae and push the epiglottis posteriorly over the opening of the larynx, thus closing the airway.
You want to identify three other structures in the oropharynx, all of which will be easier to see on a cadaver
with a bisected head. They are the palatoglossal and palato-pharyngeal arches and the palatine tonsil (refer
to your atlas for an image). They are shown in a photo above. The palatoglossal arch consists of muscle
covered by mucous membrane that extends from the soft palate to the junction of the anterior 2/3 and posterior
1/3 of the tongue. The palatoglossus muscle elevates the tongue.
Posterior to the palatoglossal arch is the palatopharyngeal arch that runs from the soft palate to the pharynx at
the level of the thyroid cartilage. The muscle of this arch, palatopharyngeus, elevates the pharynx. The
palatine tonsils lie between the 2 arches on each side of the oropharynx. Many people have had their tonsils
removed so you may not find them in your cadaver. Again, all of these structures are best seen on a bisected
head.
The lowermost portion of the pharynx is the laryngopharynx. It is bound anteriorly by the cartilaginous
structure of the larynx, posteriorly by the inferior constrictor muscles and superiorly by the epiglottis. Identify
the inlet or aditus of the larynx bounded in part by the epiglottis. Palpate the circular cricoid cartilage in the
inferior aspect of the larynx, and the thyroid cartilages anterolaterally. Note that the thyroid cartilages do not
enclose the posterior aspect of the larynx. Feel their superior and inferior horns and study their relation to
this region in your atlas (refer to your atlas for an image).
Identify the right and left piriform recesses (pear-shaped fossae)lateral to the laryngeal inlet. Each is bounded
medially by the aryepiglottic fold and laterally by the medial surfaces of the thyroid cartilage and thyrohyoid
membrane. Posteriorly each is enclosed by the inferior constrictor muscles. The piriform recess contains
branches of the internal and recurrent laryngeal nerves deep to the mucosa. This pear-shaped fossa is a
common place for food (e.g. bones or seeds) to get caught. Most students agree that you will "know it when
you see it."
TIP: Food often gets stuck in the piriform recess. This stimulates the internal laryngeal and
recurrent laryngeal nerves to initiate a cough reflex. Piercing the mucosa in this area by
swallowing a sharp object or during a procedure performed by a physician can lead to infection in
the retropharyngeal space.
You have identified the internal laryngeal nerve already. Find it now and tug on it while looking at the
piriform recess. You should see movement of the soft tissues. The internal laryngeal nerve supplies sensory
innervation to the region above the level of the vocal folds.

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Pharynx
Step 5
Larynx
Dissection Instructions
Strip the mucosa from the pharyngeal aspect of the larynx to expose the intrinsic laryngeal muscles attached
to the external surface of the laryngeal cartilages (refer to your atlas for an image). The covering mucosa is thin
and should easily peel away from the muscles. Make a small opening with the small scissors then grasp the
edge of the mucosa with a blunt forceps and strip it off of the muscle layer over the larynx and the adjacent
pharyngeal walls.
The posterior cricoarytenoid muscles will be the easiest to find and clean (refer to your atlas for an image).
They are attached to the posterior lamina of the cricoid cartilage and the muscular processes of the arytenoid
cartilages. Use a probe to define the borders of each muscle. The posterior cricoarytenoid muscles are
innervated by the recurrent laryngeal nerve (CN X), which is located posterior to the cricothyroid joint.
Return to the site in the root of the neck where you found the recurrent laryngeal nerve earlier. Follow the
nerve into the larynx cleaning as you go.
The transverse and oblique fibers of the arytenoid muscle join the two arytenoid cartilages superior to the
cricoid cartilage (refer to your atlas for an image). The oblique fibers cross the midline and attach to the
opposite rim of the epiglottis. These fibers are also called the aryepiglottic muscles (aryepiglotticus).
Disarticulate the cricothyroid joint (refer to your atlas for an image) taking care not to damage the recurrent
laryngeal nerve located just posterior to the joint. Use a small scissors to cut through the ligaments of the joint
in order to disarticulate it. Bend the thyroid cartilage laterally until it snaps. This will expose the lateral and
anterior aspects of the larynx. The thyroid cartilage is connected to the cricoid cartilage anteriorly by the
cricothyroid muscle (refer to your atlas for an image).

Posterior view of laryngeal structures

The lateral cricoarytenoid muscle will be visible now (refer to your atlas for an image). Verify its attachments
to the superior border of the cricoid cartilage (and the cricothyroid ligament) and the muscular process of the

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arytenoid cartilage (refer to your atlas for an image).

The thyroarytenoid muscle lies superior to the lateral cricoarytenoid muscle. It is attached to the anterior
portion of the thyroid cartilage near the thyroepiglottic ligament and to the arytenoid cartilages on each side
(refer to your atlas for an image).
Look for the vocalis muscle along the superior margin of thyroarytenoid muscle. It is hard to distinguish it
from the thyroarytenoid. The vocalis is comprised of the superior and most medial fibers of the
thyroarytenoid muscle. It is lateral and inferior to the vocal ligament.
Look for the thyroepiglotticus muscle which is superior to the thyroarytenoid muscle and is attached to the
thyroid cartilage and the epiglottis.
TIP: It is key to understand that each of these muscles has a special role in movement of the
larynx. The posterior cricoarytenoid is the only muscle with the ability to abduct the vocal
folds (open the rima glottidis interval between the true vocal cords). The vocalis manipulates the
vocal fold during phonation, and the cricothyroid stretches and tenses the vocal cords, which alters
pitch. The lateral cricoarytenoid adducts the vocal fold (closes the rima glottidis). The transverse
and oblique arytenoids close the laryngeal aditus by bringing the arytenoid cartilages together.

Intrinsic muscles of the larynx

TIP: Choking is most often caused by aspirated foods that get lodged in the rima glottidis.
Often this obstruction can be removed by performing the Heimlich maneuver where
compression of the abdomen causes air to be expelled from the lungs upwardly through the larynx
thus propelling the obstruction out of the rima.

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Compartments of the larynx

TIP: The recurrent laryngeal nerve innervates all the muscles of the larynx except the
cricothyroid muscles which are supplied by the external laryngeal nerves.

Arytenoid cartilage

The internal aspect of the larynx contains three compartments (refer to your atlas for an image):
The vestibule is the region superior to the vestibular folds or false vocal folds.
The ventricle is the very small region between the vestibular folds and the true vocal folds.
The infraglottic cavity is the region between the true vocal folds and the trachea.
In order to study the interior of the larynx it is necessary to make an incision in the cricoid cartilage in the
posterior median plane using a scissors. This will split the lamina of the cricoid and the soft tissues between
the arytenoid cartilages (refer to your atlas for an image).
Examine the walls of the internal larynx. Observe the false (vestibular) vocal folds and the true vocal folds

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(refer to your atlas for an image). On each side a ventricle (lateral extension of the laryngeal space) lies
between the vestibular (false vocal) fold and the true vocal fold. Insert a blunt probe between the false
and true vocal folds and explore the ventricle. In some people there is an additional recess within the
ventricle called the saccule (refer to your atlas for an image).
The internal laryngeal nerve pierces the thyrohyoid membrane to enter the interior of the larynx. Return to
the anterior triangle of the neck and find the internal laryngeal nerve and accompanying superior laryngeal
artery. Wiggle the nerve and verify its path into the larynx. The internal laryngeal nerve supplies sensory
innervation to the area of the larynx superior to the vocal folds (cords).
TIP: The recurrent laryngeal nerve supplies the sensory innervation below the vocal cords via
the inferior laryngeal nerve, a terminal branch of the recurrent laryngeal nerve. The internal
laryngeal nerve supplies sensory innervation above the vocal cords including the taste buds on the
epiglottis.
Remove the mucous membrane from one-half of the internal larynx to expose the cricothyroid ligament
(refer to your atlas for an image). This ligament is attached to the superior border of the arch of the cricoid
cartilage and to the thyroid cartilage and vocal processes of the arytenoid cartilage. The free edge of the
ligament forms a thickened portion known as the vocal ligament.
Finally, the quadrangular membrane extends between the lateral border of the epiglottic cartilage and the
arytenoid cartilage (refer to your atlas for an image). Its free inferior border forms the vestibular ligament
(refer to your atlas for an image).
TIP: A cricothyrotomy is a surgical procedure used to rapidly open an airway due to
obstruction of the airway superior to the vocal folds. An opening is created by piercing through
the cricothyroid membrane (refer to your atlas for an image).

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Oral and Nasal Cavities

General Overview
Consult with your lab leader regarding the next several labs as each lab may sequence the following
dissections a little differently!!!!!
In order to access the nasal and oral cavities and nasal and oral pharynges the head must be bisected. The
bisection occurs in two phases. The first phase involves bisecting the upper face, cranial base and the hard
palate. These parts of the head are then separated laterally to provide a view of the dorsal surface of the intact
tongue.
After inspection of the tongue, phase two involves bisecting the tongue and soft tissues of the oral cavity
and the mandible. At this point the entire head can be separated into right and left halves.
A detailed dissection of the nasal cavities reveals the three components of the nasal septum, the conchae of
the lateral nasal wall, the maxillary, frontal and sphenoid sinuses and the pterygopalatine fossa with the palatine
nerves and pterygopalatine ganglion - a parasympathetic ganglion that receives preganglionic axons from CN
VII.
The nasal pharynx contains the opening to the auditory tube, two distinctive muscles that act on the soft
palate, the pharyngeal tonsil and the anterior surface of the superior pharyngeal constrictor muscle.
The oropharynx is defined anteriorly by the palatoglossal and palatopharyngeal arches. Between these two
mucosa-covered muscle masses lie the palatine tonsils and the entry point for the glossopharyngeal nerve into
the oral cavity.
Dissection of the oral cavity, the final one in this unit, includes an introduction to surface anatomy of the oral
cavity and directions to expose the sublingual and submandibular glands, their ducts, nerves and vessels and
pathways through the floor of the mouth. Some of the deeper muscles like hyoglossus and styloglossus will be
revealed.

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Oral and Nasal Cavities

Step 1
Bisection of the Head, Examination of the Tongue
Dissection Instructions
Position of the cadaver = supine

Begin the bisection of the head by determining on which side of the nasal septum you should cut. The nasal
septum usually deviates to one side making the nasal cavities unequal in size. The cut should be in the larger,
more open side. Make a vertical cut through the external nose just lateral to the nasal septum. Make all the rest
of the vertical cuts on the face in the midline. Use a scalpel to cut through the soft tissues of the external nose
and the upper and lower lips.

Anterior cut lines for bisection

Superior cut lines for bisection

Using a hand saw, make a parasagittal cut through the frontal bone. Align the cut so that it passes adjacent to
the crista galli and along the nasal septum on the same side as the cut through the nares. After cutting through
the ethmoid bone gradually move the saw cut to the midline and continue cutting through the rest of the skull
base.
Saw through the body of the sphenoid bone, the dorsum sellae, the midline of the clivus and finally through
the rim of the foramen magnum. If you have previously made an occipital wedge, cutting the through the
face to the hard palate will be very easy. If you have not made an occipital wedge, cut through the occipital
bone along its midline before trying to cut the hard palate. Cut through the rim of the foramen magnum.

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Now saw though the hard palate (floor of the nasal cavity) parallel to the nasal septum close to the midline.
Do this carefully until you reach the soft palate. Use a scalpel to divide the uvula and the soft palate in the
midline.
DO NOT CUT THROUGH THE TONGUE AND MANDIBLE.

Dorsal surface of tongue, circumvallate papillae

Separate the two superior halves of the head laterally and inspect the dorsal surface of the tongue (refer
to your atlas for an image). Locate the circumvallate papillae, which are quite pronounced in the shape of a V
with the apex pointing backward. The anterior two thirds of the tongue (oral part) are separated from the
posterior one-third of the tongue (pharyngeal part) by the sulcus terminalis. The sulcus terminalis is also in
the shape of a V pointing towards the epiglottis. It is a small groove (sometimes not obvious) that runs just
posterior to the circumvallate papillae. The foramen cecum is a small pit at the apex of the V in the midline
of the tongue.
TIP: The foramen cecum is the remnant of the embryological site of the thyroglossal duct.
Endodermal tissue of the foregut forms the thyroid diverticulum that connects the tongue to the
thyroid gland during its caudal migration. A thyroglossal duct cyst can form if the thyroglossal duct
persists.
In addition to the circumvallate papillae identify the fungiform, filiform and foliate papillae on the dorsal
surface of the tongue (refer to your atlas for an image). Filiform papillae cover most of the tongue and have a
"grass-like" appearance. The fungiform papillae are little reddish islands of tissue that look like mushrooms
(fungiform = fungi) in the grass. They are concentrated near the tip and lateral margins of the tongue. The
foliate papillae are located on the lateral sides of the tongue just anterior to the pharyngeal part of the tongue.
They look like slits and are very prominent in herbivores (foliate = foliage). They are not always obvious in
humans.
TIP: The oral and pharyngeal parts of the tongue differ in their innervation and development.
The oral part is innervated by the lingual nerve (CN V3 - general sensory) and the chorda
tympani (CN VII - taste), whereas the pharyngeal part receives innervation from the
glossopharyngeal nerve (CN IX- both taste and general sensation).

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On the pharyngeal part of the tongue identify the lingual tonsil (refer to your atlas for an image). Posterior to
the tongue find the epiglottis. Between the epiglottis and the tongue identify the median glossoepiglottic fold
and two 'little valleys', the valleculae, on each side of this fold. The valleculae are sites where food can get
caught causing choking.

Submental triangle

In order to complete the bisection of the head, the mandible, hyoid bone and floor of the mouth must be cut.
Before cutting, return to the submental triangle and locate the anterior bellies of the digastric muscles and
the underlying mylohyoid muscle (refer to your atlas for an image). Using a sharp scalpel, divide the
mylohyoid along its raphe. Push the two muscles apart and identify the underlying geniohyoid muscles. Clean
them and define their origin on the mental spine of the mandible.
Return to the anterior view of the face and use a scalpel to bisect the lower lip and soft tissues covering the
chin if it hasn't been done already. Then use a hand saw to cut vertically through the mandible between the two
geniohyoid muscles in the midsagittal plane.
Bisection of the tongue is the last step. Use a sharp scalpel to make an incision in the midsagittal plane from
the anterior tip of the tongue to its attachment to the hyoid bone. Push the soft tissues apart a little then
continue the incision through the midline of the epiglottis if you can. You will run into the cartilages of the
larynx and the hyoid bone.

Bisected head

Hyoid bone and mandible, epiglottis

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Use a small hand saw to cut through the hyoid bone. Push it apart a little and cut the nearby soft tissues of the
neck in the midsagittal plane with a scalpel. Then finish bisecting the head by sawing (in the midsagittal plane)
through the larynx and cervical vertebrae with a larger hand saw. Separate the two halves of the head and
inspect the tongue and associated muscles in the floor of the mouth (refer to your atlas for an image). Identify
the large fan-shaped genioglossus muscle. Running in the sagittal plane, parallel to its inferior fibers is the
geniohyoid muscle. The thin and distinctly transverse mylohyoid muscle is inferior to the geniohyoid. What
are the innervations of these three muscles? Genioglossus is attached to the superior mental spine (superior
genial spine) of the mandible. The geniohyoid attaches to the inferior mental spine (inferior genial spine)
anteriorly and the hyoid bone posteriorly. On one side only, make a transverse cut on the bisected tongue to
expose the intrinsic musculature of the tongue.
TIP: In its embryological origin the genioglossus forms from two muscle masses that fuse at
the midline. Each mass is separately innervated by the ipsilateral CN XII. If the hypoglossal
nerve is damaged unilaterally, the tongue will not be able to protrude straight out. The side without
the lesion/damage will protrude more making the tongue deviate to the side of the lesion.

Sagittal section tongue, floor of mouth

Schematic of muscles of tongue

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Oral and Nasal Cavities

Step 2
Nasal Cavities
Dissection Instructions
Start with the medial nasal wall - the nasal septum.

Nasal septum

Examine the nasal septum and identify the choana (pl. choanae) the posterior opening into the nasal cavity
(refer to your atlas for an image). Carefully peel the mucous membrane off of the nasal septum. The individual
bony and cartilaginous components of the septum are now exposed. Identify the three components of the
septum, the septal cartilage anteriorly, the vomer posteroinferiorly and the perpendicular plate of the
ethmoid bone posterosuperiorly.
The nerves and vessels of the nasal septum are located in the septal mucosa which you just removed (refer
to your atlas for an image). The contralateral nerves and vessels are usually visible through the very thin
vomer and perpendicular plate of the ethmoid bone. In order to expose them in situ, use small scissors to cut
through the vomer and cartilage parallel to the floor of the nasal cavity and carefully lift the bony septum
up to view the deep surface of the contralateral mucosa. You can leave the bony septum as a flap or remove it
entirely.

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Nasopalatine nerve

Septal nerves

Identify the nasopalatine nerve, a branch of CN V2 that passes through the pterygopalatine ganglion, enters
the nasal cavity through the sphenopalatine foramen and terminates by traversing the hard palate through the
incisive foramen (refer to your atlas for an image). Look for the anterior ethmoidal nerve (branch of CN V1)
which enters the superior nasal cavity through the anterior ethmoidal foramen and parallels the contour of the
external nose.
Also located in the superior part of the nasal cavity are the hair cells of the olfactory nerves radiating
downward from the cribriform plate (refer to your atlas for an image). They are normally connected to the
olfactory bulbs, which by this time have been removed or destroyed.
Now examine the lateral wall of the nasal cavity. At this point both lateral nasal walls may be exposed
depending on whether or not the nasal septum was completely removed. Perform the dissection of the lateral
nasal wall on one side only - the side that has the best exposure. Preserve the other lateral nasal wall to study
the conchae.

Inferior and middle concha

Middle meatus, ethmoid bulla

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Identify the inferior, middle and superior conchae (refer to your atlas for an image). Anterior to the middle
and inferior concha identify the nasal crest, atrium and vestibule (refer to your atlas for an image). The
vestibule is the space just superior to the nostril. It contains numerous long hairs. The atrium is the region
superior to the vestibule, anterior to the middle and inferior conchae. The nasal crest is a raised area directly
anterior to the middle concha.
Explore the meati (sing. meatus) of the lateral nasal wall (refer to your atlas for an image). The meati are the
spaces deep to the conchae. The lateral walls of the meati contain openings related to the nasolacrimal
apparatus and air sinuses of the face. They are not visible when the conchae are in tact.
The nasolacrimal duct opens into the inferior meatus. Locate it by passing a wire (an unfolded large paper clip
works well) through the nasolacrimal duct starting from its origin in the orbit of the eye. Lift the inferior
concha (or remove it using scissors) to observe the wire.
Cut the middle concha away and explore the middle meatus (refer to your atlas for an image). The distinct
curved slit is the semilunar hiatus. Superior to it is the bulging ethmoidal bulla. Anterosuperior to the
semilunar hiatus (still under the middle concha) is the infundibulum, a part of a passageway from the frontal
sinus into the nasal cavity. Pass a wire from the frontal sinus, through the frontonasal duct into the
infundibulum. The large, lateral maxillary sinus drains into the middle meatus via one or more openings
related to the semilunar hiatus (refer to your atlas for an image).
The sphenoid sinus opens into the sphenoethmoidal recess just posterior to the superior concha (refer to your
atlas for an image). After finding this recess, remove the superior concha and identify the ethmoid air cells
deep to it. Remove the mucosa covering the wall if you need to clarify the region. Review the relation of the
ethmoid air cells to the orbit. Refer to your atlas for detailed images (refer to your atlas for an image).

Maxillary sinus

Infraorbital nerve

Remove the mucous membrane from the lateral nasal wall and open the maxillary sinus by picking away
the bone deep to the inferior and middle meati (refer to your atlas for an image). Remove the mucous
membrane within the sinus. On the roof of the sinus identify the infraorbital canal that contains the
infraorbital nerve and accompanying vessels (refer to your atlas for an image). You can see the nerve through
bone because the bone is so thin. Pick away the bone and tug on the nerve to verify its exit through the
infraorbital foramen.
In the nasopharynx, posterior to the conchae, identify the opening of the auditory tube (known by many
names, e.g. eustachian tube, pharyngotympanic tube) (refer to your atlas for an image). It connects to the

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middle ear. Surrounding the opening is a mucosa covered semicircular cartilage called the torus tubarius.
Hanging from the posterior tip of the torus is the salpingopharyngeus muscle. When still covered with
mucosa its contour creates the salpingopharyngeal fold.
Posterior to the torus is the pharyngeal recess. The thin sheet of tissue forming the posterior wall of the recess
is the pharyngobasilar fascia and superior pharyngeal constrictor. Consult with one of the tables in the lab
that is doing the pharynx dissection and compare views of this region.
Superior to the torus tubarius, attached to the base of the skull is the pharyngeal tonsil (adenoids) (refer to
your atlas for an image). It may not be very distinct but when you push against the region it should feel spongy
if the tonsil is still present.
TIP: When pharyngeal tonsils become enlarged, they may impede nasal breathing by
preventing air from passing through the nasal pharynx. They may also interfere with air
movement in the auditory canal to the middle ear, thus affecting middle ear air pressure and even
affecting the senses of balance or hearing in the related inner ear.

Palatini muscles

The bulge of mucosa covered muscle visible directly inferior to the torus tubarius is the levator veli palatini
muscle (refer to your atlas for an image). Scrape the mucosa off of the muscle and verify that this fat short
muscle terminates in the soft palate. When you pull on it, it elevates the soft palate. Anterior to the levator
muscle and deeper in the shelter of the auditory cartilage is the tensor veli palatini muscle. Remove the rest of
the mucosa covering the nasopharynx and probe anterior to the levator for the tensor veli palatini. Palpate
along the posterolateral aspect of the hard palate for the hamulus of the medial pterygoid plate. Refer to a dry
skull to get your bearings and verify that you have found the hamulus. The tendinous part of the tensor veli
palatini muscle passes around the hamulus. Pull on the tensor muscle and observe the tension in the soft palate.

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Oral and Nasal Cavities

Step 3
Sphenopalatine Foramen and Pterygopalatine Fossa
Dissection Instructions
Refer to the bony skull and identify the greater and lesser palatine foramina (refer to your atlas for an
image). Push a thin wire (unfolded small paper clip) superiorly into the greater palatine foramen. Notice that it
ends up in the pterygopalatine fossa. If you look from the medial wall of the pterygopalatine fossa on the dry
skull you should be able to see the wire through the thin bone. The opening at the superior end of that bit of
bone is the sphenopalatine foramen. The following dissection takes you through the medial wall of the
pterygopalatine fossa to find the sphenopalatine foramen, palatine nerves and the pterygopalatine ganglion.
TIP: Refer to a dry skull frequently during this dissection!!!
Reflect the posterior half of the middle concha (if not already done) and remove the mucosa from the wall of
the nasopharynx just posterior to the conchae (refer to your atlas for an image). Through the thin bony wall
you might be able to see the vertical pathway of the palatine nerves. Use this as a guide to locate the greater
palatine foramen, the passageway of the greater palatine nerve onto the inferior surface of the hard palate. The
foramen is generally medial to the third molar tooth.

Greater palatine nerve

Greater palatine foramen

In order to expose the greater palatine foramen, carefully pry the mucoperiosteum from the inferior surface
of the hard palate (refer to your atlas for an image). Excise the soft tissue in the midline of the palate and
reflect laterally toward the palatine foramen. The greater palatine nerve exits this foramen. Once the foramen
is located insert a very small wire or needle through the greater palatine foramen into the greater palatine
canal, which leads to the sphenopalatine foramen. The tip of the needle should stop just inferior to the
sphenoid sinus and may be hidden by the middle concha if it hasnt been removed.

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Pterygopalatine ganglion

Vidian nerve, pterygopalatine ganglion

Use small scissors to remove the bony medial wall of the palatine canal covering the inserted needle or wire
(refer to your atlas for an image). This will expose the greater palatine nerve and the greater palatine artery.
Follow the greater palatine nerve superiorly to the pterygopalatine ganglion just lateral to the
sphenopalatine foramen. The pterygopalatine ganglion hangs from the maxillary nerve by sensory axons.
Remove more of the roof of the maxillary sinus to expose the infraorbital nerve (a branch of the maxillary
nerve) and confirm the relationship of the nerve and ganglion.
The nerve of the pterygoid canal (vidian nerve) reaches the pterygopalatine ganglion via the pterygoid canal
(refer to your atlas for an image). Find this in your dry skull (it must be a real skull not a model). The vidian
nerve is composed of preganglionic parasympathetic fibers from the greater petrosal nerve and postganglionic
sympathetic fibers from the deep petrosal nerve.

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Oral and Nasal Cavities

Step 4
Palate, Palatine Tonsil and Pharyngeal Wall
Dissection Instructions
The palate is composed of two regions the anterior hard palate (anterior two-thirds) and the posterior soft
palate (posterior one-third) (refer to your atlas for an image). It is covered with palatine glands that secrete
mucous and whose pinpoint orifices should be visible. Scattered isolated taste buds are also present.

Palatine tonsil

Previously, the greater palatine foramen was located. If you havent done so already, expose and trace the
greater palatine nerve, which runs anteriorly from the foramen, and the lesser palatine nerve, which runs
posteriorly.

Tonsillar bed

In the oropharynx locate the palatine tonsil between the palatoglossal arch (from the palate to the tongue) and
the palatopharyngeal arch (from the palate to the pharynx) (refer to your atlas for an image). These arches are

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formed by the mucosa-covered palatoglossus and palatopharyngeus muscles. If the tonsils have been
surgically removed you will see only a fossa between the arches.
If the tonsils have not been removed, make an incision in the mucous membrane along the palatoglossal arch
(refer to your atlas for an image). Use blunt dissection to remove the tonsil by freeing the anterior edge, then
the posterior edge, and finally the inferior edge where it is most adherent due to its attachment lingual tonsil.
Removing the tonsil will expose a fibrous layer, the pahryngobasilar fascia, covering the bed of the tonsil.
Remove the fibrous layer to expose the palatopharyngeus and superior constrictor muscles (refer to your
atlas for an image). Use a probe to locate the free inferior border of the superior constrictor. Keep the probe
beneath the superior constrictor and use it to push the constrictor out of the way in order to observe the
styloglossus muscle and the glossopharyngeal nerve (CN IX). The styloglossus muscle has attachments to
the styloid process and the lateral aspect of the tongue. The glossopharyngeal nerve can be found as it passes
between the superior and middle constrictors supplying sensation to the area of the palatine tonsil. It may be
necessary to carefully remove a small part of the superior constrictor just anterior to the palatopharyngeus to
make these observations. If so, use the probe beneath the superior constrictor as a protective guide when
making any incision.
At this point remove any remaining mucous membrane from the soft palate, lateral pharyngeal wall and the
nasopharynx. Doing so will expose the palatoglossus and palatopharyngeus muscles that give substance to
the arches. Please note as an academic point the palatopharyngeus is divided into three parts; tubal
(salpingopharyngeus muscle) attaches to the auditory tube, palatine posterior portion of soft palate and
the tonsillar spreads toward bed of palatine tonsil (refer to your atlas for an image).
At the superior border of the superior constrictor muscle there is a gap between it and the base of the skull.
Look for the auditory tube, levator veli palatini and ascending pharyngeal artery as they pass through this
gap (refer to your atlas for an image).

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Oral and Nasal Cavities

Step 5
Oral Cavity
Dissection Instructions
The boundaries of the oral cavity are:
Teeth and gums (laterally and anteriorly)
Hard palate (superiorly)
Tongue (inferiorly)
Palatoglossal arch (posteriorly and laterally)
Inspection of the oral cavity to identify surface landmarks is best done on one of your colleagues or on
yourself in front of a mirror in addition to inspecting the cadaver. The vestibule is the space between the lips
and the teeth. There you can identify the gingiva, alveolar processes, labial frenula and labial mucosa.

Oral cavity

Geniohyoid and mylohyoid

Within the oral cavity proper, inspect the roof of the mouth formed by the hard and soft palates (refer to
your atlas for an image). The palatine raphe is visible in the midline of the hard palate, and the uvula is the
distinct posterior elongation of the soft palate. It is quite variable in size and shape.
On the floor of the mouth, identify the mylohyoid, geniohyoid and the genioglossus muscles (refer to your
atlas for an image). In the floor of the mouth locate the sublingual region of the oral cavity inferior to the

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mobile portion of the tongue. Within this region look for the lingual frenulum. Your bisection cut may have
passed right through the middle of it so it may not be visible. Locate the deep lingual veins on the deep
surface of the tongue on either side of the lingual frenulum. Also located to either side close to the root of
the lingual frenulum, find the openings of the submandibular ducts. There are several smaller ducts
superior to the sublingual ducts along the sublingual folds. The sublingual folds (plica sublingualis) are more
lateral on the floor of the mouth running parallel to the mandibular bone.
TIP: There are many important structures medial to the sublingual gland, but not lateral to
the gland. Thus the directions are to cut lateral to the gland.
The sublingual salivary gland is located on the floor of the mouth encased in areolar tissue (refer to your
atlas for an image). Move the tongue medially and expose the sublingual gland by making a shallow incision
through the oral mucosa starting at the frenulum of the tongue. Stay close to the teeth. Take the incision
posteriorly stopping at the 2nd molar tooth. Keep the incision superficial and use a probe to isolate the
sublingual gland and displace it medially. Carefully probe the superior border of the sublingual gland and
look for several small ducts (12 or so) that open on the summit of the sublingual fold. The sublingual gland
rests on the mylohyoid muscle. Demonstrate that to your lab partners.

Sublingual ducts

Submandibular gland

Now locate the submandibular duct on the medial aspect of the sublingual gland. Trace it anteriorly to its
papilla lateral to the lingual frenulum (refer to your atlas for an image). Then trace it posteriorly to the
submandibular gland.
Find the lingual nerve posterior to the third molar tooth (refer to your atlas for an image). Follow it
anteriorly and note that it winds around the submandibular duct en route to the anterior two-thirds of the
tongue. Initially, in the posterior part of the mouth, you will find the nerve lateral and superior to the duct.
Clean along its length and follow it as it twists around the duct. Also notice that it gives several branches to
the tongue.
TIP: The relationship of the lingual nerve and the submandibular duct changes along the
floor of the mouth. At first the nerve is lateral and superior to the duct. Then it dives under
the duct and crosses medial to it. Then it ascends to a position superior (and still medial) to the
duct just as it enters the tongue.

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The submandibular ganglion hangs from the lingual nerve in the posterior part of the mouth (refer to your
atlas for an image). Look for the ganglion by following the lingual nerve posteriorly to the area of the third
molar tooth. The ganglion and can be picked away so clean carefully!! Where do the preganglionic axons that
synapse in the submandibular ganglion come from?

Lingual and hypoglossal nerves

Lingual artery

Next, locate the hypoglossal nerve (refer to your atlas for an image). It lies lateral to the hyoglossus muscle
and inferior to the lingual nerve. Go back to the carotid region of the neck where you first found hypoglossal
nerve. Find it now and tug on it while you look in the oral cavity. Define the attachments of the mylohyoid
muscle to the hyoid bone then carefully cut that connection and reflect the mylohyoid superiorly to expose
the hyoglossus muscle. Both the lingual nerve and the hypoglossal nerve traverse the lateral side of
hyoglossus. Clean CN XII along its path verifying it by tugging as you go.
The hyoglossus muscle separates the lingual nerve (lateral) and the lingual artery (medial) from each othe
(refer to your atlas for an image). Go back to the external carotid artery in the neck and find the lingual artery
branching from it. Clean and wiggle it to verify its path medial to the hyoglossus muscle. To fully expose the
lingual artery cut the hyoglossus muscle from the hyoid bone and reflect it.
Now trace the styloglossus muscle from its attachment on the styloid process to the lateral aspect of the
tongue where the fibers interdigitate with the hyoglossus muscle. Styloglossus has a very horizontal
orientation and so is very distinct and easy to identify.

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Middle and Inner Ear

General Overview
This unit constitutes the final dissection in the head and neck regions, the dissection of the middle and inner
ear. This dissection always yields an interesting view of the contents of the petrous portion of the temporal
bone, but exactly what will come into view is not very predictable!!
The tympanic membrane and associated malleus and incus are commonly exposed, and one or more of the
semicircular canals is usually visible. Occasionally you will get a good view of the cochlea or the pathway of
CN VII through the middle ear. It is not a difficult dissection and it is very much worth the effort.

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Middle and Inner Ear

Step 1
Middle and Inner Ear
Dissection Instructions
Dissection of the middle and inner ear, while unpredictable, is not very difficult and often gives spectacular
results.

Cut lines in petrous ridge of the temporal bone

Use an electric saw to make two parallel cuts through the petrous ridge of the temporal bone. Make the cuts
in the sagittal plane. The more medial one should be just lateral to the internal acoustic meatus. The lateral
one should be as far lateral as possible on the ridge. The depth of the cut should be to an oblique line that
connects the floor of the middle and posterior cranial fossae.
Then take a sharp chisel and align it between the saw cuts parallel to the floor of the middle cranial fossa about
0.5 cm inferior to the edge of the ridge (about the level of the internal acoustic meatus). Have someone hold
onto the head to stabalize it then strike the chisel with a hammer once or twice fairly hard to pop off the top of
the ridge. Depending on how it opens you will see some, and maybe all, of the structures listed below (refer to
your atlas for an image).

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Overview of ear

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