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Atlas of
Human Anatomy
Consulting Editors

Jennifer K. Brueckner, PhD Noelle A. Granger, PhD


Assistant Professor Professor
Department of Anatomy and Neurobiology Department of Cell and Developmental Biology
University of Kentucky College of Medicine University of North Carolina School of Medicine
Lexington, Kentucky Chapel Hill, North Carolina

Stephen W. Carmichael, PhD, DSc John T. Hansen, PhD


Professor Professor of Neurobiology and Anatomy
Departments of Anatomy and Orthopedic Surgery Associate Dean for Admissions
Mayo Clinic University of Rochester School of Medicine and Dentistry
Rochester, Minnesota Rochester, New York

Thomas R. Gest, PhD Anil H. Walji, MD, PhD


Associate Professor Professor and Director, Division of Anatomy
Division of Anatomical Sciences and Department Professor of Radiology and Diagnostic Imaging
of Medical Education Professor of Surgery
University of Michigan Medical School Faculty of Medicine and Dentistry
Ann Arbor, Michigan University of Alberta
Edmonton, Alberta, Canada
F o u r t h E d i t i o n
j. *

Frank H. Netter, MD

SAUNDERS
SAUNDERS
ELSEVIER

1600 John F. Kennedy Boulevard


-Suite 1800
Philadelphia, Pennsylvania 19103-2899

Atlas of Human Anatomy Edition with Student Consult Access: ISBN-13: 978-1-4160-3385-1
Fourth Edition ISBN-10: 1 -4160-3385-8
Professional Edition: ISBN-13: 978-1-4160-3699-9
ISBN-10: 1-4160-3699-7
International Edition: ISBN-13: 978-0-8089-2384-8
ISBN-10: 0-8089-2384-6
Enhanced International Edition
with Student Consult Access: ISBN-13: 978-0-8089-2379-4
ISBN-10: 0-8089-2379-X

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

All rights reserved. No part of this book may be produced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage
and retrieval system, without permission in writing from the publishers. Permissions for Netter
Art figures may be sought directly from Elsevier's Health Science Licensing Department in
Philadelphia, Pennsylvania, USA: phone 1-800-523-1649, ext. 3276, or 215-239-3276; email:
H.Licensing@elsevier.com.

NOTICE

Neither the Publisher nor the Editors assume any responsibility for any loss or injury and/or
damage to persons or property arising out of or related to any use of the material contained in
this book. It is the responsibility of the treating practitioner, relying on independent expertise
and knowledge of the patient, to determine the best treatment and method of application for
the patient.

Previous editions copyrighted 2003, 1997, 1989.

Library of Congress Cataloging-in-Publication Data

Netter, Frank H. (Frank Henry), 1906-1991.


Atlas of human anatomy / Frank H. Netter.4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1 -4160-3385-1 ISBN-10: 1 -4160-3385-8
1. Human anatomyAtlases. I. Title.
[DNLM: 1. AnatomyAtlases. QS 17 N474a 2006]
QM25.N46 2006
611.0022'12dc22 2006047497

Acquisitions Editor: Anne Lenehan


Developmental Editor: Marybeth Thiel
Publishing Services Manager: Frank Polizzano
Senior Project Manager: Cecelia B a y r u n s
Design Direction: Louis Forgione
Illustration Manager: Cecilia Nuyianes
Cover Design Concept: M a d e l e n e H y d e
Marketing Manager: Megan Poles

Working together to grow


libraries in developing countries
www.eisevier.com | www.bookaid.org | www.sabre.org
Printed in the United States of America.

Last digit is the print number: 9 8 7 6 5 4 3 ELSEVIER Intern^ional S a b r e Foundation


To my dear wife, Vera
T he Fourth Edition of Atlas of Human Anatomy
Frank H. Netter, MD, has been updated by our
Consulting Editor team of Jennifer K. Brueckner,
Stephen W. Carmichael, Thomas R. Gest, Noelle A. Granger,
John T. Hansen, and Anil H. Walji. We have each reviewed, mod-
by the uncovertebral joints of the cervical vertebrae, the vertebral
veins, and the intricate vasculature of the eye, to mention a few,
with artistic brilliance, anatomical precision, and visual appeal
that is unsurpassed. The section includes a concise treatment of
the central nervous system, including the cranial nerves and im-
ified, and updated a section of the Atlas. Throughout the book, portant central pathways.
new radiographs, c o m p u t e d tomographic (CT) images, CT an- In the Back section, a new plate illustrates the proper
giograms, and magnetic resonance (MR) images have been placement of a lumbar epidural anesthetic agent, as well as the
added, which reflects the importance of diagnostic imaging in location for lumbar puncture or "spinal tap." Autonomics are tra-
clinical anatomy and medicine. In this edition, 45 plates have ditionally the bane of many students, and excellent new draw-
been revised to show corrected anatomical relationships, 290 ings of the autonomic nervous system by Dr. Machado will serve
plates have been relabeled, and there are 17 completely new as a new educational resource for these difficult concepts.
plates. Wonderful new artwork for this edition has been created The Thorax section underwent minor editorial corrections
by Carlos A. G. Machado, MD, w h o has contributed to the of terminology and subtle artwork modifications to more accu-
Netter illustrations for over ten years. Anatomical nomenclature rately reflect the most c o m m o n anatomical patterns. For in-
has been brought up to date, and clinical terms and eponyms in stance, the representation of the azygos venous system pat-
c o m m o n usage have been included parenthetically. The genius tern was altered to reflect the most c o m m o n arrangement of
of Dr. Netter's paintings is that the anatomy is portrayed clearly, these highly variable veins. The inclusion of the thoracic cross-
realistically, and in a clinically relatable fashion while maintaining sectional images at the end of the section, rather than in the
the balance between complexity and oversimplification. We later section, reinforces the importance of knowledge of cross-
have tried to adhere to these principles in the creation of the sectional anatomy in the interpretation of cross-sectional MR
new plates for this edition. Finally, some of the plates were re- and CT images.
arranged as page-pairs, where appropriate, to facilitate side-by- The A b d o m e n section has had the most extensive revision
side comparisons of commonly illustrated elements. This fourth for label changes and positioning of leader lines. By popular re-
edition owes much to the consulting editors of the earlier edi- quest, the plate showing the c o m m o n variations in the branches
tions, Drs. Sharon Colacino (Oberg) (first edition), Arthur F. Dalley of the celiac artery, which appeared in the first edition A b d o m e n
II (second edition), and John T. Hansen (third edition), who shep- section, has been reinstated.
herded their editions with great skill and uncompromising pro- The anatomy of the pelvis is a particularly difficult area to
fessionalism, making our task significantly easier. teach and, because of the depth and tight organization of the in-
The head and neck is a particularly challenging area for stu- ternal structures, difficult to illustrate. The Netter illustrations of
dents, residents and faculty to master, due not only to the sheer pelvic anatomy are outstanding because of the clarity of their
number of structures packed in this relatively small region of the presentation and their scope of coverage. A very small number
human body, but also the complexity of their three-dimensional of plates were eliminated to permit the inclusion of the illustra-
anatomical organization. The age-old aphorism that "there is tion of pelvic fascia, a parasagittal view of the broad ligament,
more anatomy above the hyoid bone than below it" presents a and normal imaging (male and female radiographs, cys-
unique challenge to anyone trying to portray the anatomy of this tourethrograms, and a hysterosalpingogram). Comparative im-
region in a simple, visually appealing, and clinically relevant ages of male and female pelvic anatomy were reorganized to al-
manner. More than ten new plates have been added to this sec- low their side-by-side comparison.
tion. For the first time, spectacular original paintings created by New CT angiograms have been included in the Upper Limb
Carlos Machado illustrate clinically important structures such as and Lower Limb sections. This new technology not only clearly
F@rewrdl

demonstrates blood vessels, but vividly shows bony landmarks help you better understand anatomy and its application to the
to which the blood vessels are related. The ligaments of the practice of clinical medicine. More information about the web-
wrist have been illustrated in more detail to reflect their in- site, including the PIN code for access, can be found on the in-
creased importance in arthroscopic procedures and other appli- side front cover of the Atlas.
cations of new technology to this joint. Jennifer K. Brueckner, PhD
We hope you enjoy this new edition of the Atlas of Human Stephen W. Carmichael, PhD, DSc
Anatomy and that you find it useful for learning and for your ca- Thomas R. Gest, PhD
reer. For the standard edition and enhanced international edition Noelle A. Granger, PhD
of the Atlas, we have included access to the website www. John T. Hansen, PhD
netteranatomy.com. By registering on this website, you will be Anil H. Walji, MD, PhD
able to access supplemental material that has been organized to
Acknowledgments

It has been my pleasure to work with the other members of the I would like to thank Marybeth Thiel, Developmental Editor, our
a
editorial board, Carlos Machado, MD, and the Elsevier staff. superb medical illustrator Dr. Carlos Machado, and the entire
Special thanks go to John Hansen, PhD, for the opportunity to Editorial, Production, Design, Illustration, and Marketing staff at
work on this editorial team. I am indebted to my family for the Elsevier for shepherding this edition to completion. For all our
support and encouragement that they have provided. students, past, present and future, this Atlas is for you. Finally,
to my wife, Paula, thank you for your love and encouragement
Jennifer K. Brueckner, PhD throughout the years.

John T. Hansen, PhD

I would like to thank the specialists at the Mayo Clinic who


helped review the art, especially Richard A. Berger, MD, PhD,
Shawn W. O'Driscoll, MD, PhD, Enrique A. Sabater, MD, and I would like to thank my wife, Parviz, and my daughters, Amreen
Robert J. Spinner, MD. and Farah, for their patience and constant support and encour-
agement during my involvement with this project. My special
Stephen W.: Carmichael, PhD, DSc thanks go to Dr. Carlos Machado, w h o has my utmost admira-
tion for his brilliant artwork and who was an absolute delight to
work with. I would also like to express my sincere appreciation
I must thank my family and especially my daughter, Madison, to all the wonderful staff at Elsevier, in particular Linda Belfus for
and son, Taylor, for their support and understanding of my ef- her exemplary leadership, and Anne Lenehan, Marybeth Thiel,
forts on this editorial task. It was a pleasure to work with my col- and Cecelia Bayruns for all of their hard work, patience, and
leagues on the editorial board and with the staff of Elsevier. It dedication, without which this atlas would not have been possi-
has been my sincere pleasure to work with Dr. Carlos Machado ble. Finally, I would like to thank my fellow coeditors and all of
on the artwork changes for the 4th edition. my colleagues who helped with reviewing the plates, in particu-
lar Pierre Lemelin, PhD, and Daniel Livy, PhD, whose meticulous

Thomas ft Gest, PhD examination of the artwork has helped greatly in ensuring the
accuracy of the head and neck section in this edition.

I am deeply grateful to my colleagues at University of North Anil H. Walji, MD, PhD


Carolina School of Medicine: James Scatliff, MD, former Chair of
the Department of Radiology, for his help with the imaging, and
O.W. Henson, PhD, Professor Emeritus of Anatomy, for his in-
put. I especially thank Carlos Machado, the exceptional artist
whose talent made any change required in the original plates
both seamless and beautiful.

Noelle A. Granger; PhD


Imaging Acknowledgements

Plate 151
Som, P., & Curtin, H. (2003). Head and Neck Imaging (4th ed). St. Louis, MO: Mosby.

Plates 355, 368, and 373

James Scatliff, MD
Former Chair of the Department of Radiology
University of North Carolina

Plates 484 and 547


Enrique A. Sabater, M.D.
Department of Radiology
Mayo Clinic
Preface to the First Edition

I have often said that my career as a medical artist for al-


most 50 years has been a sort of " c o m m a n d performance"
in the sense that it has grown in response to the desires
and requests of the medical profession. Over these many years,
I have produced almost 4,000 illustrations, mostly for The CIBA
and even revision of a number of them in order to make them
more pertinent to today's ever-expanding scope of medical and
surgical practice. In addition, I found that there were gaps in the
portrayal of medical knowledge as pictorialized in the illustra-
tions I had previously done, and this necessitated my making a
(now Netter) Collection of Medical Illustrations b u t also for number of new pictures that are included in this volume.
Clinical Symposia. These pictures have been concerned with the In creating an atlas such as this, it is important to achieve a
varied subdivisions of medical knowledge such as gross happy medium between complexity and simplification. If the
anatomy, histology, embryology, physiology, pathology, diag- pictures are too complex, they may be difficult and confusing to
nostic modalities, surgical and therapeutic techniques and clin- read; if oversimplified, they may not be adequately definitive or
ical manifestations of a multitude of diseases. As the years went may even be misleading. I have therefore striven for a middle
by, however, there were more and more requests from physi- course of realism without the clutter of confusing minutiae. I
cians and students for me to produce an atlas purely of gross hope that the students and members of the medical and allied
anatomy. Thus, this atlas has c o m e about, not through any in- professions will find the illustrations readily understandable, yet
spiration on my part but rather, like most of my previous works, instructive and useful.
as a fulfillment of the desires of the medical profession. At one point, the publisher and I thought it might be nice to
It involved going back over all the illustrations I had made include a foreword by a truly outstanding and renowned
over so many years, selecting those pertinent to gross anatomy, anatomist, but there are so many in that category that we could
classifying them and organizing them by system and region, not make a choice. We did think of men like Vesalius, Leonardo
adapting them to page size and space and arranging them in da Vinci, William Hunter and Henry Gray, who of course are un-
logical sequence. Anatomy of course does not change, but our fortunately unavailable, but I do wonder what their c o m m e n t s
understanding of anatomy and its clinical significance does might have been about this atlas.
change, as do anatomical terminology and nomenclature. This
therefore required much updating of many of the older pictures Frank H. Netter, MD
(1906-1991)
- ' - - -

mm-

mm
Frank H. Netter, MD

F rank H. Netter was born in New York City in 1906. He


studied art at the Art Students League and the
National Academy of Design before entering medical
school at New York University, where he received his Doctor of
Medicine degree in 1931. During his student years, Dr. Netter's
Dr. Netter's works are among the finest examples of the use
of illustration in the teaching of medical concepts. The 13-book
Netter Collection of Medical Illustrations, which includes the
greater part of the more than 20,000 paintings created by Dr.
Netter, became and remains one of the most famous medical
notebook sketches attracted the attention of the medical faculty works ever published. The Netter Atlas of Human Anatomy, first
and other physicians, allowing him to augment his income by il- published in 1989, presents the anatomic paintings from the
lustrating articles and textbooks. He continued illustrating as a Netter Collection. Now translated into 16 languages, it is the
sideline after establishing a surgical practice in 1933, but he ulti- anatomy atlas of choice among medical and health professions
mately opted to give up his practice in favor of a full-time c o m - students the world over.
mitment to art. After service in the United States Army during The Netter illustrations are appreciated not only for their
World War II, Dr. Netter began his long collaboration with the aesthetic qualities, but, more importantly, for their intellectual
CIBA Pharmaceutical Company {now Novartis Pharmaceuticals). content. As Dr. Netter wrote in 1949 "clarification of a subject is
This 45-year partnership resulted in the production of the extra- the aim and goal of illustration. No matter how beautifully
ordinary collection of medical art so familiar to physicians and painted, how delicately and subtly rendered a subject may be, it
other medical professionals worldwide. is of little value as a medical illustration if it does not serve to
Icon Learning Systems acquired the Netter Collection in make clear some medical point." Dr. Netter's planning, concep-
July 2000 and continued to update Dr. Netter's original paintings tion, point of view, and approach are what inform his paintings
and to add newly commissioned paintings by artists trained in and what make them so intellectually valuable.
the style of Dr. Netter. In 2005, Elsevier Inc. purchased the Netter Frank H. Netter, MD, physician and artist, died in 1991.
Collection and all publications from Icon Learning Systems.
There are now over 50 publications featuring the art of Dr. Netter
available through Elsevier Inc.
Contents

Head and Neck


Topographic Anatomy Plate 1

Bones and Ligaments Plates 2-22

Superficial Face Plates 23-26

Neck Plates 27-35

Nasal Region Plates 36-50

Oral Region Plates 51-62

Pharynx Plates 63-73

Thyroid Gland and Larynx Plates 74-80

Orbit and Contents Plates 81-91

Ear Plates 92-98

Meninges and Brain Plates 99-115

Cranial and Cervical Nerves Plates 116-135

Cerebral Vasculature Plates 136-148

Regional Scans Plates 149-151

Back and Spinal Cord


Topographic Anatomy Plate 152

Bones and Ligaments Plates 153--159

Spinal Cord Plates 160--173

Muscles and Nerves Plates 174--180

Thorax
Topographic Anatomy Plate 181

Mammary Gland Plates 182--184

Body Wall Plates 185--195

Lungs Plates 196--210

Heart Plates 211--229

Mediastinum Plates 230--241

Regional Scans Plate 242

Cross-Sectional Anatomy Plates 243--246

Abdomen
Topographic Anatomy Plate 247

Body Wall Plates 248--267

Peritoneal Cavity Plates 268--274

Viscera (Gut) Plates 275--285

Viscera (Accessory Organs) Plates 286--299

Visceral Vasculature Plates 300--317

Innervation Plates 318--328

Kidneys and Suprarenal Glands Plates 329--347

Abdominal Sections Plates 348--349

Regional Scans Plate 350


Section 5 Pelvis and Perineum
Topographic Anatomy Plate 351
Bones and Ligaments Plates 352-355
Pelvic Floor and Contents Plates 356-364
Urinary Bladder ' Plates 365-368
Uterus, Vagina, and Supporting Structures Plates 369-375
Regional Transverse Section Plate 376
Perineum and External Genitalia: Female Plates 377-379
Perineum and External Genitalia: Male Plates 380-387
Homologues of Genitalia Plates 388-389
Testis, Epididymis, and Ductus Deferens Plate 390
Rectum Plates 391-396
Regional Scans Plate 397

Vasculature Plates 398-408

Innervation Plates 409-417

Section 8 Upper Limb


Topographic Anatomy Plate 418
Shoulder and Axilla Plates 419-430
Arm Plates 431-435
Elbow and Forearm Plates 436-451
Wrist and Hand Plates 452-471
Neurovasculature Plates 472-483
Regional Scans Plate 484

Section 7 Lower Limb


Topographic Anatomy Plate 485
Hip and Thigh Plates 486-505
Knee Plates 506-512
Leg Plates 513-522
Ankle and Foot Plates 523-537
Neurovasculature Plates 538-546
Regional Scans Plate 547

Section 8 Cross-Sectional Anatomy


Key Figure for Cross Sections Plate 548

References
Index
Head and Neck
a

Topographic Anatomy
Plate 1

1 Head and Neck

Bones and Ligaments


Plates 2 - 2 2
rnm^^mm^^^mm^mm^mmmmmmmmmmmmmmmmmmmmsm
2 Skull: Anterior View

3 Skull: Anteroposterior Radiograph

4 Skull: Lateral View

5 Skull: Lateral Radiograph

6 Skull: Midsagittal Section

7 Calvaria

8 Cranial Base: Inferior View

9 Bones of Cranial Base: Superior View

10 Foramina of Cranial Base: Inferior View

11 Foramina of Cranial Base: Superior View

12 Skull of Newborn

13 Bony Framework of Head and Neck

14 Cranial Base: Pterygoid Fossae

15 Mandible

16 Temporomandibular Joint

17 Cervical Vertebrae: Atlas and Axis

18 Cervical Vertebrae (continued)

19 Cervical Vertebrae: Uncovertebral Joints

20 Degenerative Changes in the Cervical Vertebrae

21 External Craniocervicai Ligaments

22 Internal Craniocervicai Ligaments


Superficial Face Oral Region
Plates 23-26 Plates 51-62

23 Superficial Arteries and Veins of Face and Scalp 51 Inspection of Oral Cavity

24 Cutaneous Nerves of Head and Neck 52 Roof of Mouth

25 Facial Nerve Branches and Parotid Gland 53 Floor of Mouth

26 Muscles of Facial Expresssion: Lateral View 54 Muscles Involved in Mastication

55 Muscles Involved in Mastication (continued)

Heck 56 Teeth
Plates 27-35
57 Teeth (continued)
27 Muscles of Neck: Lateral View 58 Tongue
28 Muscles of Neck: Anterior View 59 Tongue (continued)
29 Infrahyoid and Suprahyoid Muscles 60 Tongue and Salivary Glands: Sections
30 Scalene and Prevertebral Muscles 61 Salivary Glands
31 Superficial Veins and Cutaneous Nerves of Neck 62 Afferent Innervation of Mouth and Pharynx
32 Cervical Plexus in Situ

33 Subclavian Artery Pharynx


34 Carotid Arteries Plates 63-73

35 Fascial Layers of Neck 63 Pharynx: Median Section

64 Fauces

Nasal Region 65 Muscles of Pharynx: Median (Sagittal) Section


Plates 36-50
66 Pharynx: Opened Posterior View
36 Nose 67 Muscles of Pharynx: Partially Opened Posterior View
37 Lateral Wall of Nasal Cavity 68 Muscles of Pharynx: Lateral View
38 Lateral Wall of Nasal Cavity (continued) 69 Arteries of Oral and Pharyngeal Regions
39 Medial Wall of Nasal Cavity (Nasal Septum) 70 Veins of Oral and Pharyngeal Regions
40 Maxillary Artery 71 Nerves of Oral and Pharyngeal Regions
41 Arteries of Nasal Cavity: Nasal Septum Turned Up 72 Lymph Vessels and Nodes of Head and Neck
42 Nerves of Nasal Cavity: Nasal Septum Turned Up 73 Lymph Vessels and Nodes of Pharynx and Tongue
43 Nerves of Nasal Cavity (continued)

44 Autonomic Innervation of Nasal Cavity

45 Ophthalmic (V,) and Maxillary (V2) Nerves

46 Mandibular Nerve (V3)

47 Nose and Paranasal Sinuses: Cross Section

48 Paranasal Sinuses

49 Paransal Sinsues (continued)

50 Paranasal Sinuses: Changes with Age


Thyroid Gland and Larynx Meninges and Brain
Plates 74-80 Plates 9 9 - 1 1 5

74 Thyroid Gland: Anterior View 99 Meninges and Diploic Veins

75 Thyroid Gland and Pharynx: Posterior View 100 Meningeal Arteries

76 Parathyroid Glands 101 Epidural Hematoma

77 Cartilages of Larynx 102 Meninges and Superficial Cerebral Veins

78 Intrinsic Muscles of Larynx 103 Dural Venous Sinuses

79 Actions of Intrinsic Muslces of Larynx 104 Dural Venous Sinuses (continued)

so Nerves of Larynx 105 Cerebrum: Lateral Views

106 Cerebrum: Medial Views

Orbit and Contents 107 Cerebrum: Inferior View


Plates 81-91
108 Ventricles of Brain
si Eyelids 109 Circulation of Cerebrospinal Fluid
82 Lacrimal Apparatus 110 Basal Nuclei (Ganglia)
83 Fascia of Orbit and Eyeball 111 Thalamus
84 Extrinsic Eye Muscles 112 Hippocampus and Fornix
85 Arteries and Veins of Orbit and Eyelids 113 Cerebellum
86 Nerves of Orbit 114 Brainstem
87 Eyeball 115 Fourth Ventricle and Cerebellum
88 Anterior and Posterior Chambers of Eye

89 Lens and Supporting Structures Cranial and Cervical Nerves


90 Intrinsic Arteries and Veins of Eye Plates 116-135

91 Vascular Supply of Eye 116 Cranial Nerve Nuclei in Brainstem: Schema

117 Cranial Nerve Nuclei in Brainstem: Schema (continued)

Ear 118 Cranial Nerves (Motor and Sensory Distribution): Schema


Plates 92-98
119 Olfactory Nerve (I): Schema
92 Pathway of Sound Reception 120 Optic Nerve (II) (Visual Pathway): Schema
93 External Ear and Tympanic Cavity 121 Oculomotor (III), Trochlear (IV), and Abducent (VI) Nerves:
94 Tympanic Cavity Schema

95 Bony and Membranous Labyrinths 122 Trigeminal Nerve (V): Schema

96 Bony and Membranous Labyrinths (continued) 123 Facial Nerve (VII): Schema

97 Orientation of Labyrinth in Skull 124 Vestibulocochlear Nerve (VIII): Schema

98 Auditory (Pharyngotympanic, Eustachian) Tube 125 Glossopharyngeal Nerve (IX): Schema

126 Vagus Nerve (X): Schema

127 Accessory nerve (XI): Schema

128 Hypoglossal Nerve (XII): Schema

129 Cervical Plexus: Schema

130 Autonomic Nerves in Neck

131 Autonomic Nerves in Head


132 Ciliary Ganglion: Schema 142 Arteries of Brain: Lateral and Medial Views

133 Pterygopalatine and Submandibular Ganglia: Schema 143 Arteries of Posterior Cranial Fossa

134 Otic Ganglion: Schema 144 Veins of Posterior Cranial Fossa

135 Taste Pathways: Schema 145 Deep Veins of Brain

146 Subependymal Veins of Brain

Cerebral Vasculature 147 Hypothalamus and Hypophysis


Plates 136-148 148 Arteries and Veins of Hypothalamus and Hypophysis
136 Arteries to Brain and Meninges

137 Veins of the Vertebral ColumnVertebral Veins Regional Scans


138 Arteries to Brain: Schema Plates 149-151

139 Arteries of Brain: Inferior Views 149 Head Scans: Sagittal MR Images

140 Cerebral Arterial Circle (of Willis) 150 Head Scans: Axial CT Images

141 Arteries of Brain: Frontal View and Section 151 Head Scans: Coronal CT Images
Frontal
bone Infraorbital margin

Supraorbital Zygomatic bone


notch

Superciliary
arch
Helix
Glabella
Tragus

Nasal Antihelix
bone
Antitragus

Ala of nose
Anterior nares
(nostril) Lobule

Commissure of lips
Philtrum

Nasolabial Angle of jaw (mandible)


sulcus
Submandibular gland
Tubercle of
superior lip
External jugular vein
Mental
Inferior belly of omohyoid muscle
protuberance

Brachial plexus
Thyroid cartilage
Trapezius muscle

Clavicle

jugular notch Clavicular head of


sternocleidomastoid muscle

Sternal head of
sternocleidomastoid muscle
Skull: Anterior View
MflnHHHHHMMHBMHHHM

Frontal bone

Glabella
Parietal bone
Supraorbital
notch (foramen) Sphenoid bone

Orbital surface Lesser wing

Nasal bone Greater wing

Temporal bone
Lacrimal bone
Ethmoid bone

Zygomatic bone Orbital plate

Frontal process Perpendicular plate

Orbital surface Middle nasal concha

Temporal process Inferior nasal concha


Zygomaticofacial
foramen Vomer

Maxilla Mandible

Zygomatic process Ramus

Orbital surface Body

Infraorbital foramen Mental foramen

Frontal process Mental tubercle

Alveolar process Mental protuberance

Anterior nasal spine

Right orbit: frontal and slightly lateral view

Orbital surface of frontal Posterior and


Anterior
Orbital surface of lesser ethmoidal foramina
wing of sphenoid bone
Orbital plate of
Superior orbital fissu ethmoid bone

Optic canal (foramen)


Lacrimal bone
Orbital surface of greater
wing of sphenoid bone Fossa for lacrimal sac

Orbital surface of Orbital process of


zygomatic bone palatine bone
Inferior orbital fissure
Orbital surface
Infraorbital groove of maxilla
Skull: Anteroposterior Radiograph
HWBHMBHWBHIwWHBBBB^
See also P l a t e 2

A A n g l e of m a n d i b l e
C Crista galli
E Ethmoid air cells (sinuses)
F Frontal sinus
G Greater w i n g of sphenoid
L Lesser w i n g of s p h e n o i d
M Maxillary sinus
R Ramus of mandible
Skull: Lateral View

Sphenoid bone Parietal bone Temporal fossa Temporal bone

Greater wing Superior temporal line Squamous part

Inferior temporal li Zygomatic process


Frontal bone
Coronal suture
Supraorbital Articular tubercle
notch (foramen) Pterion
Groove for posterior
Glabella deep temporal artery

Ethmoid bone External acoustic


meatus
Orbital plate
Mastoid process
Lacrimal bone

Lambdoid suture
Fossa for
lacrimal sac
Occipital bone

Nasal bone Sutural (wormian)


bone
Maxilla
External
Frontal process occipital
protuberance
Infraorbital
foramen
Anterior
nasal spine
Alveolar process Mandible
Head of condylar process
Zygomatic bone Mandibular notch
Zygomaticofacial Coronoid process
foramen Ramus
Temporal process Oblique line
Body
Mental foramen
Zygomatic arch

Sphenoid bone
Greater wing
Infratemporal fossa exposed by
removal of zygomatic arch and mandible Infratemporal crest

Lateral plate of
Pterygomaxillary fissure pterygoid process

Pterygoid hamulus
Inferior orbital fissure (of medial plate of
pterygoid process)
Infratemporal surface of maxilla
Temporal bone
Alveolar foramina
External acoustic
meatus
Tuberosity of maxilla
Mandibular fossa

Articular tubercle

Styloid process
Sphenopalatine foramen

Superficially, mastoid process forms posterior boundary


Skull: Lateral Radiograph
jffWfflffllMfflHMWBMffl
See also P l a t e 4

A Anterior arch of atlas G Greater wing of


(CI vertebra) sphenoid
C Condyle of mandible H Hypophyseal fossa (sella turcica)
CP Coronoid process of L Lambdoid suture
mandible M Maxillary sinus
CS Coronal suture MS Mastoid air ceils
D Dens of axis (C2 P Palatine process of
vertebra) maxilla
F Frontal sinus S Sphenoid sinus
Skull: Midsagittal Section

Temporal bone
Sphenoid bone Parietal bone
Greater wing Squamous part
Coronal Grooves for
Lesser wing suture Petrous part
branches of middle
Anterior clinoid meningeal vessels Internal acoustic meatus
process
Groove for superior
Optic canal petrosal sinus
Sella turcica External opening of
Sphenoidal sinus vestibular aqueduct
Body Groove for
Medial and lateral sigmoid sinus
plates of
pterygoid
process

Lambdoid suture
Frontal bone
Frontal sinus
Occipital bone
Ethmoid bone
Crista galli Groove for
Cribriform plate transverse sinus
Perpendicular
plate (bony External occipital
nasal septum) protuberance

Jugular foramen
Nasal bone
Groove for inferior
Inferior nasal petrosal sinus
concha
Hypoglossal canal
Maxilla
Foramen magnum
Anterior
nasal spine Occipital condyle
Palatine bone
Nasal surface
Vomer (bony nasal septum) Basilar part
Incisive canal
Palatine process
Alveolar process

Frontal bone
Opening of sphenoidal sinus
Nasal bone

Ethmoid bone Sphenopalatine foramen


Cribriform plate
Superior nasal concha
Middle nasal concha

Sphenoid bone
Lacrimal bone
Body
Inferior nasal concha Medial \
Plates of pterygoid process
Lateral \
Maxilla Pterygoid hamulus
Nasal surfa
Palatine process
Perpendicular plate J
Alveolar process Palatine bone
Horizontal plate j

View of lateral nasal wall with nasal septum removed


Superior view

Frontal bone

Coronal suture

Bregma

Parietal bone

Sagittal suture

Parietal foramen (for emissary vein)

Lambda

Lambdoid suture

Sutural (wormian)
bone

Occipital bone

Inferior view
Frontal bone

Frontal crest

Groove for superior sagittal sinus

Coronal suture

Parietal bone

Granular foveolae
(for arachnoid granulations)

Diploe

Grooves for branches of


middle meningeal vessels

Groove for superior sagittal sinus

Sagittal suture

Lambdoid suture

Occipital bone
Cranial Base: Inferior View

Maxilla
incisive fossa
Palatine process
Intermaxillary suture
Zygomatic process

Zygomatic bone

Frontal bone
Palatomaxillary suture
Sphenoid bone
Pterygoid process
Hamulus Palatine bone
Medial plate Fiorizontal plate
Pterygoid fossa Greater palatine foramen
Lateral plate Pyramidal process
Scaphoid fossa Lesser palatine foramina
Greater wing Posterior nasal spine
Foramen ovale
Foramen spinosum
Spine
Choanae
Temporal bone
Zygomatic process Vomer
Articular tubercle
Mandibular fossa
Styloid process
Groove for auditory
Petrotympanic fissure (pharyngotympanic,
Carotid canal (external opening) Eustachian) tube
Tympanic canaliculus
External acoustic meatus Foramen lacerum
Mastoid canaliculus
Mastoid process
Stylomastoid foramen
Petrous part
Mastoid notch (for
digastric muscle)
Occipital groove
(for occipital artery)
Jugular fossa
(jugular foramen in its depth)
Mastoid foramen

Parietal bone

Occipital bone
Hypoglossal canal
Occipital condyle
Condylar canal and fossa
Basilar part
Pharyngeal tubercle
Foramen magnum
Inferior nuchal line
External occipital crest
Superior nuchal line
External occipital protuberance
Bones of Cranial Base: Superior View
;-> . . . m

Frontal bone
Groove for superior sagittal sinus
Frontal crest
Groove for anterior meningeal vessels
Foramen cecum
Superior surface of orbital part

Ethmoid bone
Crista gaili
Cribriform plate
Anterior
Sphenoid bone cranial
Lesser wing fossa
Anterior clinoid process
Greater wing
Groove for middle meningeal
vessels (frontal branches)
Body
J u gum
Prechiasmatic groove Middle
( Tuberculum sellae- cranial
Sella ) Hypophyseal fossa
fossa
turcica j Dorsum sellae
V Posterior clinoid process
Carotid groove (for int. carotid a.)
Clivus

Temporal bone
Squamous part
Petrous part
Groove for lesser petrosal n e r v e -
Groove for greater petrosal nerve
Arcuate eminence
Trigeminal impression Posterior
Groove for superior petrosal sinus crania]
Groove for sigmoid sinus
fossa

Parietal bone
Groove for middle meningeal
vessels (parietal branches)
Mastoid angle

Occipital bone
Clivus
Groove for inferior petrosal sinus
Basilar part
Groove for posterior meningeal vessels
Condyle
Groove for transverse sinus
Groove for occipital sinus
Internal occipital crest
Internal occipital protuberance
Groove for superior sagittal sinus
Foramina of Cranial Base: Inferior View

Nasopalatine nerve) .. ,
Sphenopalatine vessels! Incisive tossa

Greater palatine nerve and vessels Greater palatine foramen


Lesser palatine nerve and vessels Lesser palatine foramen
Greater petrosal nerve Foramen lacerum
Lesser petrosal nerve)
Mandibular nerve (V3) > Foramen ovale
Accessory meningeal artery)

Middle meningeal vessels)


Foramen spinosum
Meningeal branch of mandibular nerve (V$) j

Internal carotid artery)


Carotid autonomic plexus) Carotid canal

Chorda tympani of facial nerve (VII) Petrotympanic fissure


Tympanic branch of glossopharyngeal nerve (IX) Tympanic canaliculus
Auricular branch of vagus nerve (X) Mastoid canaliculus

Facial nerve (VII) Stylomastoid foramen

Glossopharyngeal nerve (IX) \


Vagus nerve (X) /
Spinal roots of accessory nerves (XI) \ Jugular fossa
Internal jugular vein (
Inferior petrosal sinus)
Mastoid emissary vein)
Posterior meningeal artery) - M a s t o i d foramen

Hypoglossal nerve (XII)- - Hypoglossal canal

Medulla oblongata )
Vertebral arteries and venous plexus ? Foramen magnum
Spinal roots of accessory nerves (XI))
Foramen cecum Emissary vein to superior sagittal sinus

Nasal slit I \ Anterior ethmoidal artery, vein,


Anterior ethmoidal foramen ) I and nerve

Foramina of cribriform plate Olfactory nerve bundles

Posterior ethmoidal foramen Posterior ethmoidal artery vein,


and nerve

Optic nerve (II)


Ophthalmic artery

Oculomotor nerve
Trochlear nerve (IV)
c . , .. , - ) Lacrimal, frontal, and nasociliary
Superior orbital fissure < b r a n c h e s 0 f ophthalmic nerve (Vi)

Abducent nerve (VI)


Superior ophthalmic vein

Foramen rotundum Maxillary nerve (V2)

( Mandibular nerve (Vj)


Foramen ovale 1 Accessory meningeal artery
( Lesser petrosal nerve (occasionally)

r ( Middle meningeal artery and vein


Foramen sp.nosum j M e n j n g e a , b r a 8 n c h o f mandibular nerve

Sphenoid emissary foramen (of Vesalius) (inconstant)

Foramen lacerum
Internal carotid artery
Carotid canal for
Internal carotid nerve plexus

Hiatus for Lesser petrosal nerve

Hiatus for Greater petrosal nerve

Facial nerve (VII)


Vestibulocochlear nerve (VIII)
! Labyrinthine artery
External opening of
vestibular aqueduct Endolymphatic duct

Mastoid foramen (inconstant) Emissary vein (and occasional


branch of occipital artery)

Inferior petrosal sinus


Glossopharyngeal nerve (IX)
. , ) Vagus nerve (X)
jugular foramen \ Accessory nerve (XI)
Sigmoid sinus
Posterior meningeal artery

Condylar canal (inconstant) - j E m i f a r > ' ve,in ancJ


meningeal branch
( ot ascending pharyngeal artery

Hypoglossal canal Hypoglossal nerve (XII)

Medulla oblongata
Meninges
F. . , Vertebral arteries
c ^ ) Meningeal branches of vertebral
arteries
Spinal roots of accessory nerves
Lateral view Anterior fontanelle Parietal bone
Coronal suture fuber (eminence)
Sphenoidal fontanelle

Frontal bone Squamous suture


Squamous part
/ Posterior fontanelle
Supraorbital notch (foramen) . 'J&.V

Lambdoid suture
Ethmoid bone
Anterior ethmoidal
foramen Occipital bone

Orbital plate
Mastoid fontanelle

Lacrimal bone

Nasal bone

Temporal bone
Maxilla
Infraorbital foramen Squamous part

Petrosquamous fissure
Zygomatic bone Sphenoid
Zygomaticofacial foramen bone Petrous part
(mastoid process absent)
Greater wing \ \
Palatine bone Lateral plate of ^ Tympanic part (bony external
Pyramidal process pterygoid process acoustic meatus absent)
Hamulus of medial
Oval (vestibular) window
plate of pterygoid
process
Round (cochlear) w i n d o w

Styloid process
Superior view
Mandibular fossa

Zygomatic process

Frontal bone

Anterior fontanelle

Coronal suture

Sagittal suture

Posterior fontanelle

Occipital bone Lambdoid suture


Bony Framework of Head and Neck
IJM1MJ

Temporal bone
Sphenoid bone
Temporal fossa
Zygomatic arch
Condylar process of mandible
Mandibular notch
Coronoid process of mandible

Lateral pterygoid plate ( . b r o k e n line)

Hamulus of medial pterygoid plate ( b r o k e n line)


Mastoid
Pterygomandibular raphe {broken line) process
External
acoustic meatus
Ramus
Mandible ^ Angle Atlas (C1)
Body Styloid process
Stylohyoid ligament Axis (C2)
Stylomandibular
Body ligament
Hyoid bone { Lesser horn
Greater horn C3 vertebra
Epiglottis C7 vertebra
Thyroid cartilage
Cricoid cartilage
Trachea -T'l vertebra

1st rib

2nd cervical to 1st thoracic vertebrae:


right lateral view

Dens

Superior articular facet


Foramen
transversarium
Spinous
processes Intervertebral
foramina for
spinal nerves

Articular pillar formed by Groove for spinal


articular processes and nerve in transverse
interarticular parts process
(pars interarticularis)
Zygapophyseal Cervical vertebrae (spine): lateral radiograph
(facet) joints
S Spinous process (axis)
T Transverse process
Spinous process of C VP Spinous process of C /
(vertebra prominens) (vertebra prominens)
Costal facets Z Zygapophyseal (facet) joint
17 Bodies of cervical vertebrae
(for I st rib)
--- Cervical curvature
i i Vertebral canal
Posterior view

External occipital protuberance Superior nuchal line

External occipital crest


Nasal septum
Inferior nuchal line Choana (posterior nasal
aperture)
Foramen magnum
Inferior orbital fissure Mastoid foramen

Occipitomastoid
suture
Occipital condyle
Mastoid process
Styloid process Lateral pterygoid plate
Medial pterygoid plate
Pterygoid fossa
Zygomatic arch Scaphoid fossa
Pyramidal process of
Horizontal plate of palatine bone
palatine bone
Inferior concha
Pterygoid hamulus
Tuberosity of maxilla

Palatine process of maxilla Alveolar process of maxilla


Incisive fossa

* Af-7>.
Inferolateral view

Spine of sphenoid bone


Foramen spinosum
c
Foramen ovale

Sphenopalatine foramen
Pterygopalatine fossa
Choanae (posterior nares)

Lateral plate
of pterygoid
Medial plate
process
Hamulus

Pyramidal process of palatine bone


Alveolar process of maxilla
Mandible
SWi

Head

Attachments for major Condylar process Lateral pterygoid


muscles of mastication
Coronoid process
-Neck
Attachments for Temporalis Mandibular notch
accessory muscles of Lingula
mastication Mylohyoid groove
Mandibular / T e m p o r a l i s
Oblique line foramen
Buccinator
Submandibular fossa
Mylohyoid line

Sublingual fossa

Interalveolar
septa Masseter
Ramus

Alveolar part (crest)


Mental foramen ' . v ::

Mental protuberance-
nfv^jjp.Y.V V - V., ,

Mental tubercle (sssi


Base of mandible
^ v M a n d i b l e of adult:
Body anterolateral superior view
Lateral pterygoid
Coronoid process
Head Condylar process
Neck
/ - Lingula
Mandibular notch
Mandibular foramen
Pterygoid f o v e a s

Temporalis
Mylohyoid line / / Ramus

ligament

\ NAngle

\Medial pterygoid
Pterygomandibular raphe
Mylohyloid
V Submandibular fossa
'Sublingual fossa
Digastric fossa
Digastric, anterior belly
Mental spines (genial tubercles)

Mandible of adult: Mandible of aged


left posterior view person (edentulous)
Temporomandibular Joint
HHHaRBmMH

Lateral view

joint capsule
Lateral (temporomandibular) ligament
Sphenomanclibular ligament
Sphenomandibular ligament (phantom)
Styloid process
Stylomandibular ligament

Mandibular nerve
and otic ganglion

W/;/ Joint capsule _ _ ^ I l l l "'


||# Middle meningeal
W artery %
Auriculotemporal n e r v e j | l
Maxillary artery-""-"""""""^ >11
Inferior alveolar n e r v e j & C %s
tfff Lingual n e r v e ^ N&C \
m , /vjk <
Sphenomandibular l i g a m e n t '
^Mlifr Stylomandibular ligament-""-""""""^ >
W Mandibular fossa
Articular disc
r
I ^ ^ ^ A r t i c u l a r tubercle
Mylohyoid branch o f /
joint capsule inferior alveolar artery Medial view
and mylohyoid nerve

Jaws closed

Jaws slightly Jaws widely


opened opened
(hinge action (hinge and gliding
predominates) action combined)
Cervical Vertebrae: Atlas and Axis
See also P l a t e s 1 3 , 1 5 3

A n t e r i o r tubercle
terior articular
Articular facet Dens facet (for anterior
Anterior arch
for dens arch of atlas)
Lateral
Transverse Pedicle
mass
process Superior articular
facet for atlas Interarticular
part
Tubercle for
transverse
ligament of
Transverse atlas
Vertebral
foramen
foramen
Posterior arch
Superior articular surface
of lateral mass for Posterior tubercle ran s verse
Inferior articular
occipital c o n d y l e process
G r o o v e for vertebral artery facet for C3

Atlas (C1): superior view

Posterior arch
Posterior tubercle Dens Posterior articular
facet (for transverse
Vertebral Superior articular ligament of atlas)
Transverse foramen facet for atlas
process
Interarticular Transverse
part process

Transverse
foramen Articular facet
for dens Inferic
Inferior articular articular
Spinous process
surface of lateral A n t e r i o r tubercle process
mass for axis
Atlas ( C I ) : inferior view

Dens
Superior
articular
surface
for occipital
condyle

Posterior
articular facet Axis (C2)
(for transverse
ligament
of atlas)
C3

Upper cervical
vertebrae, assembled:
posterosuperior view Radiograph of atlantoaxial joint
(open mouth odontoid view)
A Lateral masses of atlas (C1 vertebra)
D Dens of axis (C2 vertebra)
Cervical Vertebrae (continued)
See also P l a t e s 1 3 , 1 5 3

Inferior aspect of C3 and superior aspect of C4 showing


the sites ot the facet and uncovertebral articulations

C3 Bifid spinous process


Inferior aspect Lamina

Inferior articular process and facet Vertebral foramen


Pedicle
Foramen transversarium
Posterior tubercle
Costal lamella Transverse process
Anterior tubercle

Area for articulation of left uncinate process of C4

Vertebral body

Left uncinate process Articular surface of right uncinate process

Superior articular process and facet


Groove for spinal nerve (C4)
C4
Inferior articular process
Superior aspect

4th cervical vertebra: anterior view 7th cervical vertebra: anterior view
Superior articular process Superior articular process
Spinous process Reduplicated foramen transversarium
Uncinate process Costa| |ame]|a Uncinate process

lar surface Articular surface


Inferior
articular Bony spicule
facet dividing foramen
transversarium
Posterior
tubercle . T
Posterior tubercle /
Anterior (Transverse process (Transverse
Foramen transversarium Anterior tubercle (process
tubercle ) Inferior articular facet for T1
(inconspicuous) )
7th cervical vertebra (vertebra prominens): superior view

Body^ / Articular surface of uncinate process


Uncinate process
Costal lamella " V / Foramen transversarium (reduplicated)

Foramen transversarium*
Groove for C7 spinal nerve
Inconspicuous anterior tubercle
(transverse process)
Transverse process (posterior tubercle)
Superior articular process and facet
Pedicle
Inferior articular process
Lamina
Vertebral foramen

Spinous process

*The foramina transversaria of C7 transmit vertebral CMc^/ta^


* A/.7>,
veins, but not the vertebral artery; and are asymmetrical in this specimen
Cervical Vertebrae: Uncovertebral Joints

Cervical vertebrae: anterior view


Dens of axis
Anterior tubercle of atlas
A n t e r i o r arch of atlas

Atlas ( C I ) Foramen transversarium

Intervertebral f o r a m e n (for C3 spinal nerve)

Intervertebral disc

Axis (C2) Vertebral b o d y


Inferior articular process (C3)

Superior articular process (C4)

G r o o v e for spinal nerve

Site of uncovertebral j o i n t (cleft) of Luschka

A n t e r i o r tubercle ) ^
n
Pnct^rmr . ti, i h
i p i r l ,p (> Transverse 'process
Posterior tubercle j
Articular cartilage o n dens for m e d i a n
Carotid tubercle atlantoaxial j o i n t c o m p l e x
Lateral atlantoaxial j o i n t
U n c i n a t e processes Facet (zygapophyseal)
j o i n t b e t w e e n C2 and C3

Atlas (C1)

Vertebra p r o m i n e n s

First thoracic vertebra ( T I ) Axis (C2)

Foramen transversarium

Uncinate processes

Anulus fibrosus

U n c o v e r t e b r a l joints (clefts) of Luschka

Nucleus pulposus

Transverse process

Intervertebral f o r a m e n (for C7 spinal nerve)

Vertebral b o d y (C7)

The u n c o v e r t e b r a l j o i n t s of t h e c e r v i c a l spine: a n t e r i o r v i e w
(C3 t o C7 have been s e c t i o n e d c o r o n a l l y t o expose t h e j o i n t s )

/ /y-A
A/.7).
Degenerative Changes in the Cervical Vertebrae

Degenerative changes in the cervical spine


(ankylosing spondylitis)

C3 vertebral b o d y
(sectioned in coronal plane)

C o m p l e t e transverse cleft Uncovertebral j o i n t


w i t h cleft f o r m a t i o n

f'fsmm
in intervertebral disc

Spread of cleft f o r m a t i o n into BHHfi


XShbiSSSSJS-

central p o r t i o n of intervertebral
disc w i t h age leading t o progressive
degenerative changes in the disc

Spondylophytes (osteophytes)
D e f o r m e d vertebral bodies o n uncinate processes
and lipping of vertebral' margins

N a r r o w i n g of intervertebral foramen

C7 vertebra

Superior articular process


Advanced ankylosing spondylitis w i t h
uncovertebral arthrosis in C4 and C5 Facet j o i n t ossified
due to advanced
osteoarthritic change

A d v a n c e d s p o n d y l o p h y t e (osteophyte) Markedly narrowed


f o r m a t i o n on uncinate processes intervertebral f o r a m e n
may lead to c o m p r e s s i o n
of spinal nerve

Inferior articular
process w i t h facet
Vertebral b o d y

U n c o v e r t e b r a l j o i n t fused d u e to extensive s p o n d y l o p h y t e G r o o v e for spinal nerve


f o r m a t i o n and ossification o n transverse process

Potential for compression of vertebral artery w i t h i n f o r a m e n transversarium Spinous process


External Craniocervicai Ligaments : .

xeMitfiffiTViWitwMr^iC- ;4fC4)aMi
tz&mGmemu
mmmmmmmm

Anterior view

Basilar part of occipital bone

Pharyngeal tubercle

Anterior atlantooccipital membrane

Capsule of atlantooccipital joint

Atlas (C1) Posterior atlantooccipital membrane

Lateral atlantoaxial joint (opened up)

Capsule of lateral Anterior longitudinal ligament


atlantoaxial joint

Posterior atlantooccipital membrane


Posterior view
Axis (C2)

Capsule of
zygapophyseal
joint (C3-4)
Capsule of
atlantooccipital

Anterior atlantooccipital membrane nsverse


process
of atlas ( C I )

Capsule of Capsule of lateral


atlantooccipital atlantoaxial joint
joint
Axis (C2)

Ligamenta flava
Posterior
Atlas ( C D Vertebral
atlantooccipital
artery Suboccipital nerve (dorsal
membrane
ramus of C I spinal nerve)

Ligamenta flava
Body of axis (C2)
Ligamentum nuchae
Intervertebral discs (C2-3 and C3-4)

Zygapophyseal joints (C4-5 and C 5 - 6 )

Anterior tubercle of C6 vertebra (carotid tubercle)


Spinous process
of C7 vertebra Vertebral artery
(vertebra prominens)
T1 vertebra

Right lateral view


Internal Craniooervical Ligaments
BHMBMMMMMMBBBBBWWMBW^

Clivus (surface feature)


of basilar part of occipital b o n e
Upper part of vertebral canal w i t h spinous processes
M&MM and parts of vertebral arches removed to expose
ligaments on posterior vertebral bodies: posterior view

Tectorial m e m b r a n e
Capsule of
atlantooccipitaLj^v^ Deeper (accessory) part of tectorial m e m b r a n e
joint .
Atlas (C'l) Posterior longitudinal ligament

Capsule of lateral .
atlantoaxial j o i n t
Axis (C2) gg Alar ligaments

Capsule of
zygapophyseal
joint ^ ^ ^ ^ ^ (J|
(C2-3)

Atlas (C1)

Superior longitudinal b a n d -
Cruciate
ligament Transverse ligament of atlas

Inferior longitudinal band- Axis (C2)

Deeper (accessory) part of tectorial m e m b r a n e

Principal part of tectorial membrane removed


to expose deeper ligaments: posterior view

Apical ligament of dens


Alar ligament
Atlas ( C D
Posterior articular facet of dens (for transverse
ligament of atlas) ^ ^ A n t e r i o r tubercle of atlas
Alar l i g a m e n t , , ^ S y n o v i a l cavities
Axis (C2)

Cruciate ligament removed to show


deepest ligaments: posterior view
Transverse ligament
of atlas

Median atlantoaxial joint: superior view


Superficial Arteries and Veins of Face and Scalp
See also Plates 34, 40, 69, 70, 85, 104

Skin and
subcutaneous tissue .
Scalp Epicranial aponeurosis Parietal emissary vein
(galea aponeurotica) Frontal Branches of
(cut to reveal skull) superficial temporal
Parietal arterv and vein
Middle temporal artery and vein

Zygomaticoorbital artery

Transverse facial
artery and vein Anterior
auricular
Supraorbital arteries
artery and vein

Supratrochlear
artery and vein

Nasofrontal vein

Dorsal nasal
artery and vein

Zygomaticotemporal
artery and vein

Angular
artery
and vein

Zygomatico-
facial artery Mastoid emissary
and vein vein and meningeal
branch of occipital
Infraorbital artery (posterior
artery and vein meningeal artery)

Deep facial vein Occipital artery


(from pterygoid and vein (cut)
plexus)
Posterior auricular
artery and vein
Facial artery and vein

External jugular vein (cut.)

Retromandibular vein
Common facial vein
Internal jugular vein

Internal carotid artery

External carotid artery

Common carotid artery

Lingual artery and vein

Sources of arterial supply of face


Black: from internal carotid artery (via ophthalmic artery)
Red: from external carotid artery
Cutaneous Nerves of Head and Neck
See also Plates 32, 36, 45, 46, 122

From ophthalmic division Auricular branch


of vagus nerve(X)
of trigeminal nerve (V-,)

Supraorbital nerve

Supratrochlear nerve
Medial branches
Palpebral branch of of dorsal rami
lacrimal nerve of cervical spinal
nerves
Infratrochlear nerve
Greater occipital
External nasal branch of
nerve (C2)
anterior ethmoidal nerve
3rd occipital
nerve (C3)

From maxillary division From 4th, 5th,


of trigeminal nerve (V 2 ) 6th, and 7th
nerves in
Infraorbital nerve succession
below
Zygomaticofacial nerve

Zygomaticotemporal nerve
Branches f r o m
cervical plexus
Lesser occipital
From mandibular division nerve (C2)
of trigeminal nerve (V 3 ) Great auricular
nerve (C2, 3)
Mental nerve
Transverse cervical
Buccal nerve nerve (C2, 3)

Auriculotemporal nerve Supraclavicular


nerves (C3, 4)

Dorsal rami of
O p h t h a l m i c nerve (V,> cervical spinal
nerves

Note: Auricular branch


of vagus nerve to
Trigeminal external acoustic
nerve (V) Maxillary nerve (V 2 )
meatus and small
area on posteromedial
surface of auricle

Branches f r o m
Mandibular nerve (V 3 ) cervical plexus
Facial Nerve Branches and Parotid Gland
w
rn^mm
mssm
See also Plate 123

Temporal branches

Parotid
gland

Zygomatic branches

Posterior
auricular
nerve
Parotid duct

Main trunk of
facial nerve Buccal branches
emerging from
stylomastoid

Marginal mandibular branch


Nerve to posterior
belly of digastric
muscle and to
stylohyoid muscle
Cervical branch

Medial pterygoid muscle


Horizontal section
Ramus of mandible

Main trunk of facial


Masseter muscle

Mastoid process
Parotid gland

Temporofacial division Temporal branch

Posterior auricular nerve -


Zygomatic branches
Main trunk of facial nerve

Nerve to posterior belly


of digastric muscle and Buccal branches
to stylohyoid muscle

Cervicofacial division
Marginal mandibular branch

Cervical branch
Muscles of Facial Expression: Lateral View

Skin and
Scalp subcutaneous tissue
Epicranial aponeurosis (galea aponeurotica) Auricularis anterior muscle

Auricularis superior muscle


Orbital part
Orbicularis oculi muscle Auricularis posterior muscle
Palpebral part
Occipital belly
(occipitalis) of
epicranius muscle

Corrugator supercilii muscle (frontalis


and orbicularis oculi, partially cut away) / /

\ i
Procerus muscle

Levator labii superioris


alaeque nasi muscle
(partially cut away)

Nasalis ) Transverse part


muscle ) Alar part Parotid
fascia

Depressor septi
nasi muscle Masseteric fascia
- '

Orbicularis oris muscle.

Zygomaticus minor muscle Investing layer of


mm
mm (deep) cervical fascia
Zygomaticus major muscle

Orbicularis oris muscle

Mentalis muscle

Deltoid
Depressor labii inferioris muscle
fascia

Depressor anguli oris muscle

Buccinator muscle

Risorius muscle

Platysma muscle

m
Sternum

Clavicle

Pectoralis major fascia


Muscles of Neck: Lateral View
:/..:,/:.' : .

Parotid gland [cut) Masseter muscle

Ramus of mandible Submandibular gland

Hyoglossus muscle
Styloglossus muscle
Mylohyoid muscle

Mastoid process

Styloid process

Stylohyoid muscle

Body of
Digastric muscle mandible
(posterior belly)

Middle pharyngeal
constrictor muscle
Digastric
muscle
Longus capitis muscle (anterior
belly)
Splenius muscle

Sternocleidomastoid muscle Hyoid bone

Levator scapulae muscle Thyrohyoid muscle

I Posterior O m o h y o i d muscle
Scalene muscles \ Middle (superior belly)
Anterior
Sternohyoid muscle
Brachial plexus
Inferior pharyngeal
Trapezius muscle constrictor muscle

Acromion Sternothyroid
muscle
Deltoid muscle

mm

mm

O m o h y o i d muscle (inferior belly) Manubrium of sternum

Clavicle Sternal head


Sternocleidomastoid muscle
Clavicular head
Muscles of Neck: Anterior View

Digastric muscle (anterior belly)


Masseter muscle
Mylohyoid muscle
Parotid gland
Submandibular gland

Platysma muscle Fibrous loop for


{cut away) intermediate
digastric tendon

Mastoid process Stylohyoid muscle

Digastric muscle
Hyoid bone (posterior belly)

External carotid artery


Carotid sheath
Internal jugular vein
Fascia of infrahyoid
muscles and cut edge Thyrohyoid muscle

O m o h y o i d muscle
Thyroid cartilage (superior belly)

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

Scalene muscles
Cricoid
cartilage Trapezius muscle

Deltoid muscle

Clavicle

O m o h y o i d muscle
(inferior belly)

Pretracheal layer of
(deep) cervical fascia over Pectoralis major muscle
thyroid gland and trachea
Clavicular head ( Sternocleidomastoid
Sternal head ( muscle
Suprasternal space (of Burns)

Manubrium of sternum jugular notch


Infrahyoid and Suprahyoid Muscles
See also Plate 53

Hyoid bone Digastric muscle (anterior belly)

Mylohyoid muscle
Thyrohyoid membrane
Hyoglossus muscle
External carotid artery
Stylohyoid muscle
Internal jugular vein
Digastric muscle
Thyrohyoid muscle (posterior belly)

Fibrous loop for


Thyroid cartilage
intermediate
digastric tendon
Omohyoid muscle
(superior belly) Sternohyoid and omohyoid
muscles (cut)
Sternohyoid muscle
Thyrohyoid muscle
Median cricothyroid
ligament Oblique line of
thyroid cartilage
Cricoid cartilage
Cricothyroid muscle
Scalene
Sternothyroid muscle
muscles
Omohyoid
muscle
(superior
Trapezius belly) (cut)
muscle
Thyroid gland
Omohyoid muscle
(inferior belly) Sternohyoid muscle (cut)
Trachea Clavicle

Styloid process
Mastoid process

Stylohyoid muscle
Mylohyoid muscle
Digastric muscle (posterior belly)

Digastric muscle (anterior belly) Thyrohyoid muscle

Geniohyoid muscle Oblique line of thyroid cartilage

Sternohyoid muscle
Omohyoid muscle (inferior belly)
Omohyoid muscle
(superior belly)

Sternothyroid
B , , . . . muscle
Infrahyoid and
suprahyoid muscles and Sternum Scapula
their action: schema
Scalene and Prevertebral Muscles

Basilar part of
Longus capitis muscle (cut)
occipital bone

Occipital condyle

Jugular process of <<.'0


Rectus capitis
occipital bone ' -
anterior muscle
*<K4 &J
Rectus capitis
Mastoid process lateralis muscle

Styloid process
Transverse process of atlas ( C I )

Longus capitis muscle


Antei ior i Tubercles of transverse
Posterior j P r o c e s s of C3 vertebra
Posterior tubercle of
transverse process of axis (C2)

Slips of origin of anterior


Longus colli muscle
scalene muscle {cut)

Slips of origin of posterior


scalene muscle

Anterior
Scalene Middle
Middle Scalene
muscles
muscles
Posterior
Posterior

Anterior scalene
muscle (cut)
Phrenic nerve

Brachial plexus
ijvJS

1st rib
Subclavian artery

Right common carotid artery


Subclavian vein Posterior tubercle of transverse
process of C7 vertebra
Internal jugular vein
^ n n n n i
"vjV

Vi l l i
mmm
Superficial Veins and Cutaneous Nerves of Neck lllftl I^M
V ^ i x - . v

For deep veins of neck see Plate 70

Platysma muscle (cut)


Facial artery and vein
Digastric muscle
(anterior belly)
Marginal mandibular
branch of facial nerve Submandibular gland

Mylohyoid muscle
Hyoid bone
Parotid gland
Retromandibular vein
Omohyoid muscle (cut)

Internal jugular vein External carotid artery

Thyrohyoid muscle
External jugular vein
Sternocleidomastoid muscle (cut)
Anterior jugular vein
Superior thyroid artery and vein

Communicating vein Internal jugular vein

Common carotid artery


Great auricular nerve
Sternohyoid muscle
Thyroid cartilage
Sternothvroid muscle
/

Transverse cervical nerves Ansa cervicalis

Omohyoid muscle
Thyroid gland
(superior belly) (cut)

Omohvoid
I muscle

(inferior belly)
Trapezius muscle

Brachial plexus
Platysma muscle (cut)

Pectoralis major muscle


Supraclavicular nerves

Clavicle
Sternocleidomastoid muscle
Sternocleidomastoid muscle (cut)

Sternothyroid muscle
Cervical Plexus in Situ
See also Plates 127-129, 193

Parotid gland Great auricular


nerve
Facial artery and vein
Lesser occipital
Submandibular gland nerve

Mylohyoid muscle Sternocleidomastoid


muscle [cut, turned up)
Hypoglossal nerve (XII)
Stylohyoid muscle
Digastric muscle Digastric muscle
(anterior belly) (posterior belly)
Lingual artery C2 spinal nerve
(ventral ramus)
External carotid artery
Accessory nerve (XI)
Internal carotid arte
C3 spinal nerve
Thyrohyoid muscle (ventral ramus)
Superior thyroid artery Levator scapulae muscle
Omohyoid muscle (superior belly) ( Middle scalene muscle
Anterior scalene muscle
Ansa cervicalis \ SuPerior root
C5 spinal nerve
( Interior root (ventral ramus)
Sternohyoid muscle Superficial cervical
artery
Sternothyroid muscle
Phrenic nerve
Internal jugular vein
Omohyoid
Common carotid artery muscle
(inferior
Inferior thyroid arte
belly) (cut)
Vagus nerve (X) Brachial plexus
Vertebral artery Dorsal scapular artery
Thyrocervical trunk Suprascapular artery

Subclavian artery and vei..


Accessory nerve (XI)
Hypoglossal nerve (XII)
Cervical plexus: schema Great auricular nerve
(S = gray ramus from superior Lesser occipital nerve
cervical sympathetic ganglion)
To rectus capitis lateralis,
longus capitis, and rectus
To geniohyoid muscle capitis anterior muscles
To thyrohyoid muscle
Communication to vagus nerve

Transverse cervical nerves

To omohyoid muscle (superior belly)


longus capitis and
Superior root longus colli muscles
Ansa cervicalis
Inferior root

To sternothyroid muscle
To sternohyoid muscle
To omohyoid muscle (inferior belly)
To scalene and levator
Supraclavicular nerves scapulae muscles
1BBKUKXBBBKBX&BBUKW
See also Plate 427

Right anterior dissection


Thyroid gland ( r e f l e c t e d )
Internal jugular vei
*

Common carotid artery Middle cervical sympathetic ganglion


Ascending cervical artery
Phrenic nerve Vagus nerve (X)
Anterior scalene muscle Vertebral artery
Inferior thyroid artery
Common carotid artery
Superficial cervical artery
Recurrent laryngeal nerve
Suprascapular artery
Dorsal scapular artery
Brachiocephalic trunk
Costocervical trunk
Internal jugular vein (cut)
Thyrocervical trunk
Subclavian artery and vein

C o m m o n origin of superficial cervical and dorsal scapular arteries f r o m transverse cervical artery ( - 3 0 % )

Superficial branch of transverse cervical artery (superficial cervical artery)


Inferior thyroid artery
Deep branch of transverse cervical artery (dorsal scapular artery)
Transverse cervical artery
Thyrocervical trunk

Suprascapular artery

Right oblique schematic view

Vertebral artery
Right external carotid artery
Deep cervical artery (ascending
to anastomose with descending Right internal carotid artery
branch of occipital artery)
Ascending cervical artery

Inferior thyroid artery


Costocervical trunk
Supreme (superior) Superficial cervical artery
intercostal artery Right common carotid artery
Dorsal scapular artery
Thyrocervical trunk
Superior and inferior
transverse scapular ligamen 1 Right subclavian artery (1st part medial to, 2nd part
posterior to, 3rd part lateral to anterior scalene muscle)
Acromion Brachiocephalic trunk
Dorsal scapular artery Suprascapular artery
Suprascapular artery Aortic arch
Axillary artery
Internal thoracic (mammary) artery
1 st and 2nd posterior
intercostal arteries

1 st, 2nd, and 3rd anterior intercostal arteries

Subscapular artery
Circumflex scapular artery Thoracodorsal artery
See also Plates 136, 138

Superficial temporal artery


Parotid space
(bed): right lateral Transverse facial artery
dissection
Maxillary artery

Mastoid process External carotid artery

Styloid process Posterior auricular artery


Facial nerve (VII) (cut) Glossopharyngeal nerve (IX)
Sternocleidomastoid muscle (cut) Stylohyoid muscle
Digastric muscle (posterior belly) Hypoglossal nerve (XII)
Occipital artery and Facial artery
sternocleidomastoid branch
Lingual artery
Accessory nerve (XI
Mylohyoid muscle
Superior root
Ansa cervicalis
Inferior root Hyoglossus muscle

Vagus nerve (X) Digastric muscle


(anterior belly)
Ascending pharyngeal artery
Hyoid bone
Carotid branch of glossopharyngeal
nerve (IX) and carotid body
Branch to
thyrohyoid muscle
Internal carotid artery
(from ansa cervicalis)
Internal jugular vein
Superior laryngeal artery

Superior thyroid artery

External carotid artery


Superficial temporal artery
Transverse facial artery Common carotid artery

Digastric muscle Maxillary artery


(phantom)
Posterior auricular artery
Occipital artery Facial artery
Descending branch
Sternocleidomastoid branch Lingual artery

Ascending pharyngeal artery


Internal carotid a
Superior thyroid artery and
superior laryngeal branch
External carotid artery
Omohyoid muscle ( p h a n t o m )
Common carotid

External carotid branches:


schema
Thyrocervical trunk
Fascial Layers of Neck
For contents of carotid sheath see Plates 69-71

Superficial (investing) layer of deep cervical fascia Platysma muscle


Sternohyoid muscle
Infrahyoid fascia Trachea
Sternothyroid muscle
T h y r o i d gland
Pretracheal (visceral) fascia
Esophagus
Buccopharyngeal Omohyoid muscle
(visceral) fascia Sternocleidomastoid
muscle
Carotid sheath Recurrent laryngeal
nerve
Subcutaneous tissue
Common carotid artery
Superficial Internal jugular vein
(investing) layer
of deep cervical Vagus nerve (X)
fascia roofing Phrenic nerve
posterior triangle
Anterior scalene muscle
Fat in Sympathetic trunk
posterior Spinal nerve
triangle
Middle and posterior
scalene muscles
Prevertebral layer -ongus colli muscle
of (deep)
cervical fascia Levator scapulae muscle
Trapezius muscle
Alar fascia Deep cervical muscles
Cross section Retropharyngeal Subcutaneous Cervical vertebra (C7)
space tissue

Sagittal section

Mandible
Pharynx
Geniohyoid muscle
Buccopharyngeal (visccral)
fascia Geniohyoid fascia

Retropharyngeal Investing layer of (deep)


space cervical fascia
Fascia of infrahyoid muscles
Alar fascia
Pretracheal (visceral) fascia
Prevertebral fascia
Thyroid gland
Trachea
Subcutaneous tissue
Esophagus
Suprasternal space (of Burns)

Manubrium of sternum

Aorta

Pericardium
Anterolateral view Inferior view
Major alar cartilage
Frontal bone

Nasal bo
Lateral Medial
Frontal process of maxilla crus

Lateral process of
septal nasal cartilages

Septal cartilage

Minor alar cartilage

Accessory nasal cartil

. Lateral crus
Major alar cartilage
Medial crus Alar Anterior
fibrofatty nasal spine
Nasal septal cartil
tissue of maxilla
Anterior nasal spine of maxil
Nasal septal
Alar fibrofatty tissue cartilage Intermaxillary
suture
Infraorbital foramen

Frontalis muscle

Supraorbital artery and

Supratrochlear artery and n

Procerus muscle

Corrugator supercilii muscle

Dorsal nasal a

Infratrochlear nerve

Angular artery

External nasal artery and nerve

Nasalis muscle (transverse part)

Infraorbital artery and nerve

Lateral nasal artery

Transverse facial artery

Nasalis muscle (alar part)

Depressor septi nasi muscle

Orbicularis oris muscle

Facial arterv

4
Lateral Wall of Nasal Cavity
HHBwBBnMHHHHRHHRBBH^HHH

Sphenoethmoidal recess
Frontal sinus
ing of
Superior nasal concha dal sinus
Superior nasal meatus Hypophysis
(pituitary gland)
Middle nasal concha
\ in sella turcica
Agger nasi Sphenoidal sinus
Atrium of middle nasal meatus Pharyngeal tonsil
Middle nasal meatus (adenoid if enlarged)
Basilar part of
Inferior nasal concha occipital bone
(turbinate)
Pharyngeal
Limen nasi raphe
Choana
Nasal vestibule
Torus tubarius
Inferior nasal meatus
Opening of auditory
Palatine process of maxilla (pharyngotympanic,
Incisive canal Eustachian) tube
Pharyngeal recess
Tongue
Horizontal plate of
palatine bone
Soft palate

Middle nasal concha


Middle nasal meatus
Bulging septum
rvvay to nasopharynx
Inferior nasal concha
Inferior nasal meatus
Floor of nasal cavity

Speculum view

Frontal sinus Cribriform plate of ethmoid bone

Probe passing from semilunar Probe in opening of sphenoidal sinus


hiatus into frontal sinus via
Sphenoidal sinus
frontonasal duct
Superior nasal meatus
Middle nasal concha {cut surface)
with opening of posterior
ethmoidal cells
Ethmoidal bulla
Basilar part
Openings of middle ethmoidal cells of occipital bone
Semilunar hiatus (osteomeatal unit)
Torus tubarius
with opening of anterior
ethmoidal air cells Opening of auditory
Uncinate process (pharyngotympanic,
Eustachian) tube
Inferior nasal concha
{cut surface)
Anterior arch
of atlas (CI vertebra)
Opening of nasolacrimal duct Dens of axis
(C2 vertebra)
Inferior nasal meatus Opening of
maxillary sinus
Lateral Wall of Masai Cavity (continued)
See also Plate 6

Lacrimal bone
Middle nasal concha
Squamous part Uncinate process Ethmoid bone
Frontal bone Sinus Cribriform plate
Nasal spine perior nasal concha
Highest nasal concha

Nasal bone Sphenoethmoidal recess

Sphenopalatine foramen
Agger nasi

Basilar part of
Lateral process of occipital bone
nasal septal cartilage

Major alar carti

Alar fibrofatty tissue Sphenoidal


sinus
Medial
Frontal process and
Lateral Sphenoid bone
plates of
Anterior nasal spine
pterygoid
process
Maxilla Incisive canal
Pterygoid
Palatine process hamulus
Sphenoidal process
Alveolar process Orbital process
Posterior nasal s p i n e / p a , a t j n e bong

Perpendicular plate
Horizontal plate

Ethmoidal bulla

Frontal sinus ening of middle ethmoidal cells

uperior nasal concha (cutaway)


Opening of frontonasal canal
ings of posterior ethmoidal cells
Middle nasal concha (cui awa
Opening of sphenoidal sinus

Infundibulum leading to
Openings into maxillary sinus
frontonasal cana

Semilunar hiatus (osteomeatal unit) Sphenopalatine foramen


with opening of anterior
ethmoidal air cells

Uncinate

Ethmoidal process of
Inferior nasal concha (cut inferior nasal concha

Lesser palatine foramen


Opening of nasolacrimal can
Greater palatine foramen
medial Wall t Masai Cavity Nasal Septum!

Falx cerebri

Frontal sinus Cribriform plate of ethmoid bone

Dura mater
Sphenoidal sinus
Sella turcica
Nasal septum

Choanae (posterior nasal apertures )

Lateral process of nasal septal cartilage

Major mmi
mm
alar cartilage SKI Torus tubarius

Nasal vestibule
Anterior nasal spine

Incisive canal

Oral cavity

Tongue

Soft palate

Squamous part Crista galli


Frontal bone Sinus Cribriform plate /> Ethmoid bone
Nasal spine Perpendicular plate
Crest
Nasal bone Body
Sphenoidal sinus
Vomer Sphenoid
Medial,
bone
Lateral
plates of
Vomerine groove pterygoid
(for nasopalatine nerve
process
and vessels)
Septal cartilage
Basilar part of
Major alar
occipital bone
cartilage (medial crus)
Pharyngeal
tubercle

Perpendicular plate
Anterior nasal spine Nasal crest-
Posterior nasal spine Palatine
Nasal crest Horizontal plate bone
Maxilla Lesser palatine
Incisive canal foramen
Palatine process Greater palatine foramen
Anterior
Deep temporal arteries and nerves
Lateral pterygoid artery and muscle Posterior
Masseteric artery and nerve
Supraorbital artery
Lateral ligament of
Supratrochlear artery temporomandibular joint
Ophthalmic artery Middle meningeal artery
Dorsal nasal artery Auriculotemporal nerve

Angular artery Maxillary artery

Infraorbital artery Superficial temporal artery


Posterior auricular artery
Superior ( Posterior
alveolar < M i d d l e - Facial nerve
arteries ( Anterior
Inferior alveolar
Buccal artery and nerve artery and nerve
Sphenomandibular ligament
Medial pterygoid
artery and muscle Mylohyoid nerve and branch
Pterygomandibular raphe of inferior alveolar artery
Digastric muscle (posterior belly)
Lingual nerve
Stylohyoid muscle
Facial artery
External carotid artery
Mental branch of
inferior alveolar Facial artery

Submental artery Lingual artery

Anterior ) Deep temporal arteries


Sphenopalatine artery. Artery of pterygoid canal Posterior ) and nerves
Pharyngeal artery Accessory meningeal artery
Posterior lateral nasal branch
enopalatine foramen Middle meningeal artery
Infraorbital artery Anterior tympanic artery
Deep auricular artery
Posterior superior
alveolar artery Auriculo-
temporal
Sphenopalatine artery nerve

Posterior septal branches

Greater (descending)
palatine artery

Buccal artery

Superficial
Anastomosis in
temporal artery
incisive canal
Ascending pharyngeal
Left and right arterv/

greater palatine arteries Ascending palatine artery


Tonsillar branches
Left and right
lesser palatine arteries Tonsillar artery
External carotid artery
Pterygoid arteries
Facial artery
Masseteric artery
Superior pharyngeal constrictor muscle
Inferior alveolar artery
Styloglossus muscle
Arteries of Nasal Cavity: Nasal Septum Turned Up

Nasal septal branch of superior labial branch


(of facial artery)

Nasal septum ( turned up


Anastomosis between posterior
septal branch of sphenopalatine
artery and greater palatine artery
in incisive canal
Schematic hinge

Septal and lateral nasal


branches of posterior
ethmoidal artery
Anterior septal branch,
Anterior lateral nasal branch,
External nasal branch Posterior septal
of anterior branch of
ethmoidal sphenopalatine
artery artery

Sphenopalatine
artery

Sphenopalatine
foramen

Alar branches of
lateral nasal
branch
(of facial artery)

Vii

Posterior
lateral nasal
branches of
sphenopalatine
artery

Maxillary
artery

Anastomosis between
posterior septal branch External carotid
of sphenopalatine artery artery
and greater palatine
artery in incisive canal
Lesser palatine foramen and artery

Greater palatine artery


Greater palatine foramen and artery

Lateral wall of nasal cavity


1 Nerves of Nasal Cavity: Nasal Septum Turned Up
HHHMIMH
See also Plates 44, 45, 119

Olfactory nerves (I)


Nasal septum ( t u r n e d up)

v/.l
Incisive canal
Schematic hinge

Medial internal nasal, Nasopalatine nerve (V 2 )


Lateral internal nasal,
External nasal
branches of
anterior sWs

ethmoidal
nerve (V-j)

Sphenopalatine foramen
[dissected away)

Internal nasal Pterygopalatine


branches of -
ganglion
infraorbital
nerve (V 9 ) Nerve (Vidian)
of pterygoid canal

Posterior superior lateral nasal


branch of maxillary nerve (V 2 )

Nasal branch of Greater and lesser palatine nerves (V 2 )


anterior superior
alveolar nerve (V 2 )
Posterior inferior lateral nasal
branch of greater palatine nerve (V 2 )

Lesser palatine nerves (V 2 )

Communication between
greater palatine and nasopalatine Greater palatine nerve (V 2 )
nerves at incisive canal
Nerves of Nasal Cavity (continued)
Y^ff'y^ji^*flBUfii
See also Plate 119

Distribution of olfactory
mucosa ( shaded blue)
Nasal
septum
Lateral wall
of nasal cavity

External nasal branch of anterior ethmoidal nerve (V-j)


Lateral internal nasal branch of anterior ethmoidal nerve (V q )
Olfactory bulb
Cribriform plate of ethmoid bone
Olfactory tract
Posterior superior lateral nasal branches
from maxillary nerve (V 2 )
Maxillary nerve (V 2 ) (sphenopalatine
foramen dissected away)
Pterygopalatine ganglion
Greater petrosal nerve
Deep petrosal nerve
Nerve (Vidian) of pterygoid canal
Pharyngeal branch of maxillary nerve (V 2 )
Nasopalatine nerve (V 2 ) passing to septum (cut)
Posterior inferior lateral nasal branch
from greater palatine nerve (V 2 )
Lateral
wall of
nasal /Olfactory bulb
cavity
f$M'h*m / /Cribriform plate
Wmki / /
/ / O l f a c t o r y tract

Olfactory nerves (I)

( G
Palatine nerves (V 2 ) <
( Lesser

Medial internal nasal branch


of anterior ethmoidal nerve (V

Olfactory nerves (I)

Nasopalatine nerve (V 2 )

Incisive canal

Nasal septum
Autonomic Innervation of Nasal Cavity
See also Plates 122, 131, 133

Superior salivatory nucleus (parasympathetic)

Facial nerve (VII)

Geniculum (geniculate ganglion) of facial nerve

Greater petrosal nerve (parasympathetic)

Deep petrosal nerve (sympathetic)

Nerve (Vidian) of pterygoid canal

Maxillary nerve (V 2 ) entering foramen rotundum

Pterygopalatine ganglion in
Dterygopalatine fossa

Lateral and medial posterior superior


nasal branches in pterygopalatine fossa
Infraorbital nerve

Posterior superior
and inferior lateral
nasal nerves
(cut ends)

Tympanic cavity

w s s s mm
Internal carotid
MM
nerve and plexus mm
Medulla wm
oblongata
Greater
Internal
and lesser
carotid
palatine Posterior Nasopalatine
artery Maxillary
nerves superior nerve
alveolar sinus
Superior nerves
cervical ganglion
Sympathetic
trunk
Postsynaptic fibers to
vessels (sympathetic) and
glands (parasympathetic)
of nasal cavity, maxillary
sinus, and palate

Preganglionic parasympathetic fibers

Postganglionic parasympathetic fiber

Preganglionic sympathetic fibers

Plate 44 Nasal Region


Ophthalmic (V.,) and Maxillary (V2) Nerves
fm '. ... . v . . ' . v 7 / W M K m W B 9 M H W JJSSwS

See also P l a t e 122

Communicating branch Anterior ethmoidal nerve

Posterior ethmoidal nerve Supraorbital nerve

Supratrochlear nerve
Long and short ciliary nerves
Lacrimal gland
Ciliary ganglion
Infratrochlear nerve
(from nasociliary nerve)
Lacrimal nerve
Cutaneous branch of
Nasociliary nerve lacrimal nerve

Zygomaticotemporal
Frontal nerve
nerve

Tentorial branch Zygomaticofacial


nerve
Ophthalmic nerve (V 1 )
External
nasal
Trigeminal branch of
(semilunar) ganglion anterior
ethmoidal
Trigeminal nerve
nerve (V)

Meningeal
branch

Foramen
rotund urn Infraorbital
nerve
Foramen
ovale Anterior superior
alveolar nerve
Mandibular nerve (V 3 )
Nasal
branch
Maxillary nerve (V 2 )

Mucous membrane
Zygomatic nerve of maxillary sinus

Nerve (Vidian) of pterygoid canal Dental and gingival branches

Pterygopalatine ganglion Superior dental plexus

Greater and lesser palatine nerves Infraorbital nerve entering


infraorbital canal
Ganglionic branches to pterygopalatine ganglion
Middle superior alveolar nerve

Posterior superior alveolar nerve

Plate 45
Mandibular Nerve |W3f
See also Plates 71,122

Anterior division Temporal fascia


md temporalis muscle Posterior
Lateral view Posterior division Deep temporal nerves
Anterior
Foramen ovale
Masseteric nerve
Meningeal branch
Lateral pterygoid
Foramen spinosum
nerve and muscle
Middle
meningeal artery

Auriculotemporal
nerve

Posterior
auricular nerve
"mm
Facial nerve (VII)

Chorda tympani
nerve Buccal nerve
and buccinator
Lingual nerve muscle (cut)

Inferior alveolar nerve (cut) Submandibular


ganglion
iNerve to mylohyoid
o- <
Sublingual
Medial pterygoid muscle (cut)

Digastric muscle (posterior belly) Mylohyoid


muscle (cut)
Stylohyoid muscle
Hypoglossal nerve Mental nerve

Submandibular gland
Inferior alveolar nerve (cut)
Sublingual nerve Digastric muscle (anterior belly)
Medial view

Trigeminal (semilunar)
ganglion Sensory root Geniculum (geniculate
ganglion) of facial nerve
Ophthalmic nerve (V-j)
Tympanic cavity
Maxillary nerve (V 2 )
Chorda tympani nerve
Mandibular nerve (V 3 )
Facial nerve (VII)
Anterior division
Tensor tympani
Tensor veli palatini
muscle and nerve
nerve and muscle
Lesser petrosal nerve
Otic ganglion

Chorda tympani nerve Auriculotemporal nerve

Medial pterygoid Maxillary artery


nerve and muscle (cut)
Mylohyoid nerve
Pterygoid hamulus
Inferior alveolar nerve entering
Lingual nerve
mandibular foramen

Nasal Region
Nose and Paranasal Sinuses: Cross Section
vCIfB
l ftl&HMMMBIMBMtMHBI&fB
li QQti

Major alar
cartilage
Nasal vestibule
Vomer

Nasal septal cartilage Inferior nasal concha

Facial artery
Facial vein
Maxillary bone
Maxillary sinus
Sphenoid bone
Masseter muscle

Coronoid
process of Medial pterygoid
mandible muscle

Lateral Lateral pterygoid


pterygoid plate
muscle
Levator veli
Cartilage palatini muscle
of
auditory
Pharyngeal recess
tube

Neck of Longus capitis


mandible muscle

Parotid
gland Rectus capitis
anterior
muscle
Retroman
dibular
Superficial
vein
temporal
artery
Glosso-
pharyngeal
Sympathetic
nerve
trunk

Styloid
process Styloglossus
muscle
Stylohyoid
muscle

Auricular
cartilage
Medulla oblongata

Mastoid air cells

Vagus nerve
Facial nerve
Hypoglossal nerve

Accessory
nerve

Nasal Region Plate 47


Paranasal Sinuses

Coronal section

Olfactory bulbs
Falx cerebri

Brain
Frontal sinus

Nasal cavities
Orbital fat

Nasal septum
Ethmoidal cells

Middle
nasal concha
Opening of
maxillary sinus

Middle
nasal meatus
Infraorbital
Recesses of
Zygomatic maxillary
Maxillary sinus sinus
Alveolar

Inferior
nasal meatus Buccinator muscle

Alveolar process of maxilla


Inferior nasal concha

Body of tongue
Hard palate

Sublingual gland
m Jit
V \ t, -

Oral cavity-

Mandible (body)

Nasal cavities

Nasal septum
Ethmoidal cells

- M e d i a l wall
of orbit
Orbital fat and muscles

Optic nerve (II)


Sphenoidal sinuses

Brain
Optic chiasm
V

Horizontal section

Plate 48 Nasal Region


Paranasal Sinuses (continued) 8S

Sagittal section
Ethmoidal air cells
(sinuses)

Frontal sinus
Opening of
sphenoidal sinus

Opening of frontonasal duct

Sphenoidal sinus
Semilunar hiatus
(osteomeatal unit)

Uncinate process Middle nasal


concha {cutaway)

Opening of
maxillary sinus

Inferior nasal concha

Frontal sinus

Opening into middle nasal meatus

Orbit Pterygopalatine fossa

Lateral dissection
Roots of teeth

Nasal Region Plate 49


mmmmmmmmmmmmmmmssm

Bones of nasal cavity Sinus represents one or more anterior ethmoidal cells
and paranasal sinuses opening into semilunar hiatus of middle nasal meatus
at birth

Sinus represents one or more middle ethmoidal cells


opening into middle nasal meatus

Part of nasolacrimal duct Sinuses represent two or more posterior ethmoidal cells
that formed in depths of opening into superior nasal meatus
nasooptic furrow
Sphenoidal sinus within bony shell (sphenoidal concha)
located anterior and lateral to body of sphenoid bone
Nasal bone (broken line indicates sinus lateral to sphenoid body)

of sphenoid bone
Lacrimal bone
Hypophyseal fossa
Nasolacrimal
foramen (becomes Vestigial remnant
bony canal) of Rathke's pouch

Medial plate of
pterygoid process
Part of nasolacrimal
duct within nasal
cavity with slit-like Lower border of highest nasal concha
opening in inferior
nasal meatus Lower border of superior nasal concha

Superior nasal meatus


Maxilla

Middle nasal concha (cut edge) (inferior


Uncinate process of ethmoid bone nasal concha completely removed)

Semilunar hi Maxillary sinus with opening into semilunar hiatus (striped


area represents membrane forming most of medial wall of sinus)

Growth of frontal and maxillary


sinuses throughout life

Frontal sinus
within frontal bone

Birth Left orbit


Middle nasal concha
1 year

4 years Nasal septum


Maxillary sinus
7 years within maxilla
Nasal cavity
12 years

Adult Inferior nasal concha


Molar tooth
Old age

Plate 50 Nasal Region


Inspection of Oral Cavity

Philtrum of lip
Soft palate
Palatopharyngeal arch
Uvula
Palatoglossal arch
-Palatine tonsil
Posterior wall of pharynx

Frenulum of upper li
Lingual minor salivary gland
Deep lingual artery and veins
and lingual nerve
Fimbriated fold
Submandibular duct
Sublingual gland
Frenulum of tongue
Sublingual fold with openings
of sublingual ducts
Sublingual caruncle
of submandibular du
Frenulum of lower lip

Parotid papilla with


opening of parotid duct

Plate 51
Roof of Mouth
ramawe

Incisive papilla
Incisive fossa

Transverse palatine
folds Greater palatine artery and nerve

Palatine raphe Greater palatine foramen

Lesser palatine foramen


Palatine process
of maxilla
.esser palatine artery and nerves
Palatine glands
Tendon of tensor veli
palatini muscle
Horizontal plate
of palatine bone
Pterygoid hamulus

Palatine
Interdigitating fibers of
aponeurosis
levator veli palatini muscle
(from tensor
veli palatini
muscle) Buccinator muscle

Uvular muscle Pterygomandibular raphe

Molar minor Superior pharyngeal


salivary glands constrictor muscle

Palatopharyngeus Palatoglossus muscle


muscle

Palatine tonsil

Basilar part of
Anterior view occipital bone

Cartilaginous part
of auditory
(pharyngotympanic,
Eustachian) tube
Levator veli palatini muscle (cut) Pharyngobasilar
fascia
Tensor veli palatini muscle
Levator veli palatini muscle
Medial pterygoid muscle (cut)
Choanae
Medial pterygoid plate
Pterygoid hamulus
Pterygoid hamulus-

Tendon of tensor veli palatini muscle Superior pharyngeal


constrictor muscle (cut)
Levator veli palatini muscle (cut)
Palatopharyngeus muscle
Palatopharyngeus muscle (cut)'

Uvular muscle

Posterior view

Oral Region
Floor of Mouth
mmmwsM
See also P l a t e 29

Lateral, slightly inferior view

Hyoglossus muscle

Mylohyoid muscle

Fibrous loop for intermediate digastric tendon

Digastric muscle (anterior belly)

Median raphe between mylohyoid muscles Mastoid


process
Styloid process
Digastric muscle
Anteroinferior (posterior belly)
view
Stylohyoid muscle
Greater horn \
Lesser horn j Hyoid bone
Body '
Thyrohyoid muscle
Omohyoid muscle
Sternohyoid muscle

Digastric muscle (anterior belly)


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

Posterosuperior view

Inferior alveolar nerve and artery

Mylohyoid nerve and artery

Submandibular gland and duct

Mylohyoid muscle

Geniohyoid muscle
Superior mental spine (genial tubercle)
Lesser horn for origin of genioglossus muscle
Hyoid bone Body-
0
V - Hyoglossus
Greater horn
muscle (cut)

Oral Region Plate 53


Muscles Involved in Mastication
':: : ; .

For facial muscles see Plate 26

...

Temporalis muscle

Temporal fascia
Superficial layer
Deep layer
Levator labii
superioris
alaeque nasi
Zygomatic arch
muscle

Levator labii Articular disc of


superioris temporomandibular joint
muscle

Zygomaticus Deep part \ Masseter


minor muscle Superficial part j muscle

Zygomaticus
major muscle

Levator
anguli
oris
muscle

Orbicularis
oris muscle

Mentalis
muscle

Depressor labii
inferioris muscle

Insertion of temporalis muscle to


coronoid process of mandible

Parotid duct

Buccinator muscle

Orbicularis oris muscle

Masseteric nerve
and artery

Maxillary artery

Insertion of
masseter muscle

Plate 54 Oral Region


Muscles Involved in Mastication (continued)

Articular disc of
temporomandibular joint

Articular tubercle

Lateral pterygoid muscle

Sphenomanclibular ligament

Medial pterygoid muscle

Parotid duct

Buccinator muscle

Pte ry go m an d i b u I a r rap h e

Superior pharyngeal constrictor muscle

Lateral view

Choanae
Sphenomandibular ligament Otic ganglion Cartilaginous part of auditory
(pharyngotympanic, Eustachian) tube

Masseteric nerve
Lateral pterygoid plate
Middle meningeal artery Ai \

am
Auriculotemporal nerve

Lateral pterygoid muscle


Masseteric artery

Medial pterygoid muscle


Maxillary artery

Inferior alveolar nerve

Lingual nerve

Medial pterygoid muscle

Medial pterygoid plate Tensor veli palatini muscle (cut)

Pterygoid hamulus Levator veli palatini muscle (cut)

Nerve to mylohyoid Pterygoid hamulus

Posterior view

Oral Region Plate 55


Teeth

Deciduous Permanent
(primary) (colored blue)
Usual age of Usual age of
.eruption^. eruption

Central incisor (7th year)


Central incisor
(8-10 m o n t h s ) " Lateral incisor (8th year)
Lateral incisor Canine (cuspid) (11 th12th year)
(8-10 months)-
"I st premolar (9th year)
Canine (cuspid)
(16-20 months) 2nd premolar (1 Oth year)

1 st molar 1st molar (6th year)


( 15-2 I months)
2nd molar (12th- 13 th year)
2nd molar
(20-24 months)
3rd molars (1 7th25th year)

2nd molar
(20-24 months)
2nd molar (12th13th year)
I st molar
(15-21 months) I st molar (6th year)
Canine (cuspid) 2nd premolar (10th year)
(16-20 months)
1st premolar (9th year)
Lateral incisor
Canine (cuspid) (11 th12th year)
(15-21 months)
Lateral incisor (8th year)
Central incisor
(6-9 months)""" Central incisor (7th year)

Central incisors

Incisive fossa Lateral incisors

Canines
Palatine process
of maxilla
1st premolars

Horizontal 2nd premolars


plate of
palatine 1 st molars
bone
2nd molars

3rd mola

Greater and lesser


palatine foramina
Upper permanent teeth Lower permanent teeth

Plate 56 Oral Region


Enamel

Dentine and dentinal tubules

Crown < Interglobular spaces


Odontoblast layer
Interproximal spaces
Dental pulp containing vessels
and nerves

Neck Gingival (gum) epithelium (stratified)


Gingival groove

Lamina propria of gingiva (gum)


(mandibular or maxillary periosteum)
Periodontium
(alveolar periosteum)
Papilla
Cement
Root <
Root (central) canals
containing vessels and nerves
Bone
Apical foramina

|\
Left upper
permanent
teeth:
it
labiobuccal

Left lower
ft. m
permanent
teeth:
labiobuccal
view

Lateral

Incisors Canines Premolars Molars


(cuspids)

Oral Region Plate 57


Tongue

m&s.
iglottis
Median glossoepiglottic fold
Lateral glossoepiglottic fold
Vallecula
Palatopharyngeal arch and muscle (cut)
Palatine tonsil {cut)
Lingual tonsil (lingual nodules)
Root
Palatoglossal arch and muscle {cut)
- F o r a m e n cecum
Terminal sulcus
Vallate papillae

- Foliate papillae

Filiform papillae

Body/ s

Fungiform papilla
Midline groove (median sulcus)

Dorsum of tongue

Apex
Lingual tonsil

Filiform papillae

Fungiform papilla

Keratinized tip
of papilla

Intrinsic muscle

Duct of gland
Crypt
Lymph follicles
Stratified squamous Mucous glands
epithelium Vallate papilla
Sustentacular cell
Taste buds
Sensory cell
Furrow
Taste pore
Lamina propria Lingual glands (serous glands of von Ebner)
y

Section of Schematic stereogram: area indicated above


taste bud

Plate 58 Oral Region


See also Plates 34, 46, 53, 128

Palatoglossus muscle
longitudinal muscle of tongue

Mastoid process
' ^W Digastric muscle (posteric
^ W t i i K \ " belly) (cut)
\ Styloid process
\ Pharyngobasilar fascia
m m m \ Superior pharyngeal constrictor mus
^ / J ^ R ^ v Stylohyoid ligament
w f ^ ^ B ^ ^ Styloglossus muscle
Glossopharyngeal part of superior
/ / ' I 3 ' 1 3 r y n g e a l constrictor
| - ; : l \ x S t y l o p h a r y n g e u s muscle
Stylohyoid muscle
Middle pharyngeal constrictor muse
Digastric muscle (posterior belly) [ a
Hyoglossus muscle
ossus muscle ^ I n t e r m e d i a t e tendon of digastric muscle (cut)
Fibrous loop for intermediate digastric tendon

Lateral v i e w

Lingual nerve "uperior pharyngeal


constrictor muscle
Submandibular ganglion Styloglossus muscle
Palatoglossus muscle (cut)
Deep lingual artery
and venae comitantes Stylohyoid ligament
Stylopharyngeus muscle

Hyoglossus muscle (cut)


Lingual artery

External carotid artery


Artery to frenulum
nternal jugular vein
Retromandibular vein
Submandibular duct
Facial vein
Common trunk for facial,
retromandibular and
ingual veins (common
facial vein)
r .i Lingual vein
Sublingual artery and vein Suprahyoid artery

Geniohyoid mu Dorsal lingual artery and vein

Hypoglossal nerve Vena comitans of hypoglossal nerve

Oral Region Plate 59


Tongue and Salivary Glands: Sections

Horizontal section Orbicularis oris muscle


below lingula of
m a n d i b l e (superior v i e w ) Buccinator muscle
demonstrating bed Buccopharyngeal fascia
of parotid gland Fada| artery and vein

Pterygomandibular raphe
Lingual nerve and superior pharyngeal constrictor muscle
Masseter muscle
Palatoglossus muscle in palatoglossal arch
Palatine tonsil
Palatopharyngeus muscle in palatopharyngeal arch
Ramus of mandible
Inferior alveolar artery vein, and nerve
Medial pterygoid muscle
Styloglossus muscle
Facial nerve
Retromandibular vein
External carotid arterv <

Parotid gland
Stylopharyngeus muscle
Stylohyoid muscle
Sternocleidomastoid muscle
Digastric muscle (posterior belly)

Internal jugular vein, internal carotid artery Longus capitis muscle


and nerves IX, X, and XII in carotid sheath
Prevertebral fascia
Superior cervical sympathetic ganglion
Buccopharyngeal fascia
and retropharyngeal space

Superior longitudinal muscle


Vertical and transverse muscles of tongue
Inferior longitudinal muscle
Styloglossus muscle
Buccinator muscle
Muscles of facial expression
Hyoglossus muscle
Genioglossus muscle
Sublingual salivary gland
Submandibular duct
Mandibular canal, inferior alveolar artery, vein, and nerve
Lingual nerve
Nerve to mylohyoid
Vena comitans of hypoglossal nerve (to lingual vein)
Lingual artery
Facial arterv
Hypoglossal nerve (XII)
Submandibular salivary gland
Submandibular lymph node
Frontal section
Mylohyoid muscle
behind 1st molar tooth
Facial vein
(anterior view)
Intermediate digastric tendon
Platysma muscle
demonstrating
beds of sublingual and
Hyoid bone submandibular glands

Plate 60 Oral Region


Salivary Glands
See also Plates 25, 53, 133, 134, 167, 168

Superficial temporal artery and vein


and auriculotemporal nerve

Branches of facial nerve

Transverse facial artery

Accessory parotid gland

Parotid duct

Buccinator muscle (cut)

Masseter muscle

Lingual nerve

Submandibular ganglion

Tongue

Frenulum of tongue

Sublingual fold with openings


of sublingual ducts
Parotid gland
Sublingual caruncle with opening Retromandibular
of submandibular duct vein (anterior and
posterior branches)
Sublingual gland
Digastric muscle
Submandibular duct (posterior belly)
Stylohyoid muscle
Sublingual artery and vein External jugular vein

Mylohyoid muscle (cut) Sternocleidomastoid muscle


Common trunk receiving facial,
Digastric muscle (anterior belly) anterior branch of retromandibular,
Hyoid bone and lingual veins (common facial vein)
Submandibular gland
Internal jugular vein
Facial artery and vein
External carotid arterv

m m ffct' v -
-ir- < \ i>

& mm Mm feiB

& / ' * St.,

v'AJfft?x.
Sublingual gland:
almost completely mucous

Oral Region Plate 61


Afferent Innervation of Mouth and Pharynx
BgaSHffigB&RMMm mmmmsmsmsmm
See also Plates 45, 52, 59, 64, 122, 123, 125, 133, 135

Trigeminal (V) (maxillary V 2 ) Trigeminal nerve (V)


Via superior alveolar Glossopharyngeal nerve (IX)
nerves
Via pterygopalatine Vaus nerve W
ganglion and nasopalatine
Facial nerve (VII)
and greater and lesser
palatine nerves

Facial (VII) (intermediate nerve)


Via greater petrosal nerve, pterygopalatine
ganglion, and greater and lesser palatine nerves

B B B B t B a g M a a a M B g g ': Glossopharyngeal (IX)


j&BZSCse&sxaxsa&z&Bi
Via pharyngeal plexus
Via tonsillar branches
Taste plus general sensation
via lingual branches
Trigeminal (V) (maxillary V 2 )
a pharyngeal branch of
pterygopalatine ganglion

Facial (VII) (intermediate nerve)


Via greater petrosal nerve and
L-gggg
pterygopalatine ganglion

Trigeminal (V)
Vagus(X)
Glossopharyngeal (IX) (maxillary V 2 )
Via internal branch of
Via pharyngeal plexus Via pterygopalatine
superior laryngeal nerve
Via tonsillar branches ganglion and
Taste plus general nasopalatine and
sensation via greater and lesser
ingual branches palatine nerves
Via superior
Vagus(X)and alveolar nerves
glosso-
pharyngeal (IX)
Via pharyngeal Trigeminal (V)
plexus (mandibular V 3 )
Via buccal nerve
Vagus(X) Via inferior
Via internal alveolar nerve
branch of
superior
laryngeal
nerve

Trigeminal (V)
(mandibular
Via lingual
nerve

Facial (VII) (intermediate nerve)


Taste via chorda tympani and lingual nerve

Plate 62 Oral Region


Pharynx: Median Section

Sella turcica Pharyngeal opening of auditory


(pharyngotympanic, Eustachian) tube
Frontal sinus
Sphenooccipital synchondrosis
Sphenoidal sinus
Pharyngeal tonsil
Nasal septum
Pharyngeal tubercle of occipital bone
Nasopharynx Pharyngeal raphe
Soft palate 'Anterior longitudinal ligament

Palatine glands -Anterior atlantooccipilal membrane


Apical ligament of dens
Hard palate
Oral cavity Anterior
arch of
Incisive canal
atlas (CI
Palatine tonsil vertebra)

Body of tongue mm Dens of


axis (C2
Oropharynx vertebra)
Foramen cecum Pharyngeal
constrictor
Lingual tonsil muscles
Genioglossus Bucco-
muscle pharyngeal
fascia
Root of tongue
Retro-
Epiglottis
pharyngeal
Mandible space

Geniohyoid muscle Prevertebral


fascia and
Hyoid bone anterior
longitudinal
Hyoepiglottic ligament
< ; . .s ligament
Thyrohyoid membrane Vertebral
bodies
Laryngopharynx
Laryngeal inlet (aditus)
Thyroid cartilage
Vocal fold
Transverse arytenoid muscle
Cricoid cartilage
Trachea
Esophagus
Esophageal muscles^
Thyroid gland
Superficial (investing) layer of deep cervical fascia

Pretracheal fascia
Suprasternal space (of Burns)
Manubrium of sternum

Pharynx
Medial view
Median (sagittal) section
Sphenoidal sinus
Pharyngeal tonsil
Torus Iubarius
Pharyngeal tubercle (basilar part of occipital bone)
Pharyngeal raphe
Pharyngeal opening of auditory
(pharyngotympanic, Eustachian) tube
Hard palate
Pharyngeal recess
Salpingopharyngeal fold
Soft palate
Palatine glands
Uvula
Semilunar fold
Supratonsillar fossa
Palatine tonsil
Palatopharyngeal arch
Palatoglossal arch
Oropharynx
Triangular fold
Tongue (drawn forward and downward)
Lingual tonsil
Epiglottis
Vallecula

Pharyngeal mucosa removed

Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube


Medial pterygoid plate
Tensor veli palatini muscle and tendon
Levator veli palatini muscle
Ascending palatine artery
Pharyngeal branch of ascending pharyngeal artery
Lesser palatine a r t e r y -
Salpingopharyngeus muscle
Pterygoid hamulus
Pterygomandibular raphe
Tonsillar branch of lesser palatine artery
Superior pharyngeal constrictor muscle
Tonsillar branch of ascending pharyngeal artery
Palatoglossus muscle
Palatopharyngeus muscle
Tonsillar branch of ascending palatine artery
Tonsillar branch of facial artery
Tonsillar branch of dorsal lingual artery
Glossopharyngeal nerve (IX) and tonsillar branch
Stylohyoid ligament
Hyoglossus muscle
Middle pharyngeal constrictor muscle
Stylopharyngeus muscle
* /

Plate 64 Pharynx
Muscles of Pharynx: Median (Sagittal) Section
mgiftiMTiiTKiwiOTiifrifl

Medial pterygoid plate


Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube
T BSKhI
Tensor veli palatini muscle
Pharyngobasilar fascia
Levator veli palatini muscle
Palatine aponeurosis and tendon of
tensor veli palatini muscle
Pharyngeal tubercle (basilar part of occipital bone)
Pharyngeal raphe
Anterior longitudinal ligament
Anterior atlantooccipital membrane
Apical ligament of dens
Salpingopharyngeus muscle
'Muscles of soft palate
Palatopharyngeal sphincter (Passavant's ridge)
Pterygoid hamulus
Superior pharyngeal constrictor muscle
P tery g o m andibularra p h e
Palatopharyngeus muscle
Buccinator muscle
Aj
FT} Glossopharyngeal part of
superior pharyngeal constrictor
Stylopharyngeus muscle
Stylohyoid ligament
Styloglossus muscle
Middle pharyngeal constrictor muscle
Fibers to pharyngoepiglottic fold
Buccopharyngeal fascia and
retropharyngeal space

Hyoglossus Prevertebral fascia and anterior


muscle longitudinal ligament
Geniohyoid Internal branch of superior laryngeal nerve
muscle
Longitudinal pharyngeal muscles
Mylohyoid
muscle Inferior pharyngeal constrictor muscle
Hyoid bone Pharyngeal aponeurosis
Thyrohyoid Cricopharyngeus muscle
membrane \ (part of inferior pharyngeal constrictor)
Thyroid cartilage
Cricoid attachment of longitudinal
Median esophageal muscle
cricothyroid ligament
Circular esophageal muscle
Corniculate and
arytenoid cartilages inal esophageal muscle
Cricoid cartilage
Trachea
Margins of middle pharyngeal
constrictor muscle
Margins and attachments of inferior
pharyngeal constrictor muscle

Plate 65
Pharynx: Opened Posterior View

Styloid process
Nasal septum
Torus tubarius
Pharyngeal opening
of auditory (pharyngotympanic,
Eustachian) tube
Nasopharynx
Pharyngeal recess
Parotid gland
Torus levatorius (fold
caused by levator
veli palatini muscle)
Salpingopharyngeal fold
Soft palate
Angle of mandible
Submandibular gland
Uvula

Oropharynx < Palatine tonsil


Root of tongue
Palatopharyngeal arch
Prominence caused by greater horn
of hyoid bone
Epiglottis
Laryngeal inlet (aditus)
Prominence caused by superior horn
of thyroid cartilage
Laryngopharynx ^ iglottic fold
Piriform fossa (recess)
Cuneiform tubercle
Fold over internal branch
of superior laryngeal nerve
Corniculate tubercle
Interarytenoid notch
Prominence over lamina
of cricoid cartilage
Esophagus

Trachea

Plate 66 Pharynx
Muscles of Pharynx: Partially Opened Posterior View
jflBMIIflgjgBIMBWfi^^
See also Plate 235

Basilar part of occipital bone Pharyngeal tubercle

Pharyngeal
tonsil

Cartilaginous part
Styloid of auditory
process
/

(pharyngotympanic,
Eustachian) tube
Digastric
muscle Pharyngobasilar
(posterior fascia
belly)
Choana
Stylohyoid
muscle Levator veli
palatini muscle
Stylopharyngeus
muscle Superior pharyngeal
constrictor muscle
Accessory muscle
bundle from Salpingopharyngeus
petrous part of muscle
temporal bone
Uvula
Medial Palatopharyngeus muscle
pterygoid muscle
Middle pharyngeal
Pharyngobasilar fascia constrictor muscle
Pharyngeal raphe Stylopharyngeus muscle
toyvw-
Superior pharyngeal
constrictor muscle - Pharyngoepiglottic fold

Aryepiglottic fold
Hyoicl bone (tip of greater horn)
Inferior pharyngeal
Middle pharyngeal constrictor muscle constrictor muscle (cut edge)

Longitudinal pharyngeal muscles


Epiglottis
Superior horn of
Inferior pharyngeal constrictor muscle thyroid cartilage

Cuneiform tubercle Thyrohyoid membrane

Corniculafe tubercle Internal branch of


superior laryngeal nerve
(Transverse and oblique)
arytenoid muscles Pharyngeal aponeurosis

Posterior cricoarytenoid muscle Cricopharyngeus muscle (part of


inferior pharyngeal constrictor)
Cricopharyngeal muscle (part of
Posterior border of thyroid cartilage lamina
inferior pharyngeal constrictor)
Cricoid attachment of longitudinal
Longitudinal esophageal muscle esophageal muscle

Circular esophageal muscle

Pharynx Plate 67
Eg Muscles of Pharynx: Lateral View

Pharyngobasiiar fascia

Tensor veli palatini muscle N9HMI


Levator veli palatini muscle

Lateral pterygoid plate

Pterygoid hamulus

Buccinator muscle (cut)

Pterygomandibularraphe
Digastric muscle
(posterior belly) (cut)
Buccinator crest Styloid process
of mandible
Superior pharyngeal constrictor muscle
Styloglossus muscle
Oblique line
of mandible Stylohyoid ligament
Stylopharyngeus muscle
Middle pharyngeal constrictor muscle
Hyoglossus muscle
Greater horn of hyoid bone
Digastric muscle (anterior belly) Superior horn of thyroid cartilage
Mylohyoid muscle Thyrohyoid membrane

Hyoid bone Inferior pharyngeal constrictor muscle

Stylohyoid muscle (cut) Tendinous arch


Zone of sparse muscle fibers
Thyroid cartilage
C ri co p h a ryn ge u s muscle
Median cricothyroid ligament (part of inferior pharyngeal constrictor)

Cricothyroid muscle

Cricoid cartilage Esophagus

Trachea

Plate 68 Pharynx
Arteries of Oral and Pharyngeal Regions mm
asm

See also Plates 34, 40

From f Supraorbital artery /IV. . _

ophthalmic < ml
artery ( Supratrochlear artery

Middle meningeal artery S'/iiiV B

Deep temporal arteries

Dorsal nasal artery

Masseteric artery

Angular artery

Infraorbital artery

Sphenopalatine artery

Descending palatine artery Transverse


Posterior superior facial
alveolar artery artery (cut)

Superior labial artery Superficial


temporal artery
Buccal artery
Maxillary artery
Buccinator muscle Posterior auricular artery
and parotid duct (cut)
Ascending pharyngeal artery
Inferior labial artery
Occipital artery and
Superior pharyngeal sternocleidomastoid branch
constrictor muscle Glossopharyngeal nerve (IX)
Mental branch of Ascending palatine artery
inferior alveolar artery
Tonsillar artery
Inferior alveolar artery
Facial artery
and lingual branch
Lingual artery
Facial artery
Ascending pharyngeal artery
Submental artery
Internal carotid artery
Mylohyoid branch of
Vagus nerve (X)
inferior alveolar artery
Superior cervical
Submandibular gland cardiac nerve
Hypoglossal nerve (XII) Sympathetic trunk
Suprahyoid artery Anterior scalene muscle

External carotid artery Phrenic nerve


Middle scalene muscle
Superior laryngeal artery
Ascending cervical artery
Superior thyroid artery
Inferior thyroid artery
Cricothyroid artery
Superficial cervical artery
Common carotid artery
Suprascapular artery
Vertebral artery Costocervical trunk
Subclavian artery Thyrocervical trunk

Pharynx Plate 69
Veins of Oral and Pharyngeal Regions
........ -....,,.....,..,......... .: x; ; '..,.".:/ ""."": .... . .. ....... .. ...--- - :;;;..; :. r":: " :.''.:;/:v.::v;".;' 'r:::;
See also Plates 23, 31, 104

Supratrochlear vein

Supraorbital vein
Nasofrontal vein
Superior ophthalmic vein
Angular vein
External nasal vein
Emissary vein (of Vesalius)
communicating with
cavernous sinus

Infraorbital vein
Occipital vein
Posterior superior and artery
alveolar veins
Superficial temporal
Palatine vein vein and artery
Pterygoid plexus Transverse facial vein (cut)
Superior labial vein Posterior auricular vein
Deep facial vein Retromandibular vein
(anterior and
Maxillary veins posterior branches)
Inferior labial vein External jugular vein (cut)

Mental vein Inferior alveolar vein and artery

Facial vein and artery Occipital vein and artery

External palatine vein Hypoglossal nerve (XII)


Common trunk receiving
Submental vein
facial, anterior branch of
Submandibular gland r e t r o m a n d i b u I a r, a n d
lingual veins (common facial vein)
Vena co mi tans of
hypoglossal nerve External carotid artery

Dorsal lingual vein coursing Internal jugular vein


medial to hyoglossus muscle Common carotid artery-
Lingual vein Vagus nerve (X) and
Communication to anterior jugular vein (cut) sympathetic trunk
Middle scalene muscle
Superior laryngeal vein
Anterior scalene muscle
Superior thyroid vein
External jugular vein (cut)
Thyroid gland
Transverse cervical
Middle thyroid vein vein (cut)
Inferior thyroid veins Suprascapular vein (cut)
Termination of anterior jugular vein (cut) Subclavian artery
Left brachiocephalic vein Subclavian vein

POat 7 Pharynx
Nerves of Oral and Pharyngeal Regions
mammm
See also Plates 25, 45, 46, 122, 125, 126

Zygomaticotemporal nerve (V 2 >


Deep temporal nerves (V 3 ) mmm
'i
Masseteric nerve (V 3 )
Mandibular nerve (V 3 )
Nerve to medial pterygoid and
tensor veli palatini muscles (V 3 ) (cut)
Zygomaticofacial nerve (V 2 )
Maxillary nerve (V 2 ) M M
-'fflmmOt-t
Infraorbital nerve (V 2 )
P t e r y g o p a latinegangl i o 1i
Greater and lesser
palatine nerves (V 2 )
Auriculotemporal
Anterior, middle, and posterior ^ nerve (V 3 )
superior alveolar nerves (V 2 )
Middle meningeal artery
Nerve to lateral pterygoid
Superficial temporal
muscle (V 3 ) (cut)
artery (cut)
Buccal nerve (V:$) Facial nerve (VII) (cut)
Chorda tympani nerve (VII) Maxillary artery
Lingual nerve (V 3 ) Accessory nerve (XI) (cut)
Medial pterygoid muscle (cut) C I spinal nerve
(lateral pterygoid removed) (ventral ramus) (cut)
Inferior alveolar C2 spinal nerve
nerve (V 3 ) (ventral ramus) (cut)
Mental nerve ( V 3 ) ^ \ , Pharyngeal plexus composed of
branches from glossopharyngeal
Nerve to mylohyoid (V 3 ) (IX), vagus (X), and sympathetic
Submandibular ganglion nerves
Glossopharyngeal nerve (IX) Internal carotid artery
and tonsillar branch External carotid artery
Hypoglossal nerve (XII) Vagus nerve (X) and superior
cervical cardiac branch
Carotid nerve (IX) and carotid body
C4 spinal nerve
Nerve to thyrohyoid muscle (CI, 2 via XII) (ventral ramus) (cut)
Internal and external branches Phrenic nerve (C3, 4, 5)
of superior laryngeal nerve (X)-
Ascending cervical artery
. - i- ^ nx ( Superior root Middle scalene muscle
Ansa cervicalis (CI,2, 3) )
' Inferior root
-Anterior scalene muscle
Nerves to superior and inferior bellies of omohyoid,
sternohyoid, and sternothyroid muscles (ansa cervicalis)
Brachial plexus (cut)
Recurrent laryngeal nerve (X)
Sympathetic trunk and middle cervical ganglion
Common carotid artery Thyrocervical trunk
Vertebral artery

f>- Subclavian artery


)

Plate 71
Lymph Vessels and Nodes of Head and Neck
jJJjjiJfj vi/jy./lv BwnagR krhssk
See also Plate 208

Superficial parotid nodes


(deep parotid nodes
deep to and within
parotic! gland)

mm
Subparotid node

Facial nodes
Nasolabial
Buccinator Occipital nodes

Mastoid nodes
Mandibular Sternocleidomastoid
nodes nodes

Superior lateral
Submandibular superficial cervical
nodes (external jugular)
node

Jugulodigastric node
Submental
nodes Posterior lateral
superficial cervical
(spinal accessory)
Suprahyoid node nodes

Superior deep lateral cervical


(internal jugular) nodes Intercalated node

Superior thyroid nodes Inferior deep


lateral cervical
(scalene) node
Juguloomohyoid node

Thoracic duct
Anterior deep cervical
(pretracheal and thyroid) nodes
(deep to infrahyoid muscles) Transverse
cervical
chain of
Anterior superficial cervical nodes
nodes (anterior jugular nodes)

Jugular trunk

S upraclavi cuI ar nodes"

Subclavian trunk and node

*The supraclavicular group of nodes (also


known as the lower deep cervical group),
especially on the left, are also sometimes
referred to as the signal or sentinel lymph
nodes of Virchow or Troisier, especially when
sufficiently enlarged and palpable. These
nodes (or a single node) are so termed because
they may be the first recognized presumptive
evidence of malignant disease in the viscera.

Plate 72 Pharynx
Lymph Vessels and Nodes of Pharynx and Tongue
H H

Rectus capitis anterior muscle (cut)


Pharyngobasilar fascia

. -..A Retropharyngeal nodes


- * \ V
Internal jugular vein
;.v. M. \ ft'* ^

Digastric muscle (posterior belly)

Sternocleidomastoid muscle

Intercalated node

Jugulodigastric node

Deep lateral cervical


(internal jugular) nodes

Juguloomohyoid node

Apical collecting vessels

Central collecting vessels

Marginal collecting vessels

Basal collecting vessels

Communication to
opposite side

Lymphatic drainage of pharynx:


posterior view

Lymphatic drainage of tongue

Submental node

Submandibular node

Jugulodigastric node

Deep lateral cervical


(internal jugular) nodes

Juguloomohyoid node

Pharynx Plate 73
Thyroid Gland: Anterior View

External carotid artery Hyoicl bone

Internal carotid Superior laryngeal nerve


Internal branch
Superior thyroid artery and vein External branch

Superior laryngeal artery Thyroid cartilage (lamina)

Thyrohyoid membrane Median cricothyroid


ligament
Ansa S Superior root
cervicalis ( Inferior root Cricothyroid muscles

Common carotid artery Cricoid cartilage

Internal jugular vein Pyramidal lobe \


(often absent /
Middle thyroid vein or small) ( Thyroid
Right lobe / gland
Inferior thyroid veins Left lobe \
Isthmus /
Ascending cervical artery
Pretracheal lymph nodes
Inferior thyroid artery-
Phrenic nerve
Superficial cervical artery
Anterior scalene muscle
Suprascapular a r t e r y
Vagus nerve (X)
Thyrocervical trunk
External jugular vein
Subclavian
artervi and vein Anterior jugular vein

Vagus nerve (X) 1 st rib {cut)

Right recurrent Left recurrent laryngeal nerve


laryngeal nerve

B rach i oce p h a I i c I r u n k

Brachiocephalic veins

Superior vena cava

Aortic arch

Thyroid cartilage

Cricothyroid ligament

Common carotid artery

Medial margin of
sternocleidomastoid muscle

Cricothyroid muscle

Cricoid cartilage

Thyroid gland

Cupula (dome) of pleura

Trachea

Plate 74 Thyroid Gland and Larynx


Thyroid Gland and Pharynx: Posterior View

Superior pharyngeal External carotid artery


constrictor muscle

Internal carotid artery


Middle pharyngeal
constrictor muscle
Facial artery

Tip of greater horn


Lingual artery
of hyoid bone

Inferior pharyngeal Superior laryngeal nerve


constrictor muscle Internal branch
External branch

Pharyngeal raphe
Superior thyroid artery

Zone of sparse
Superior laryngeal artery
muscle fibers

Cricopharyngeus C o m m o n carotid artery


muscle (part of inferior
pharyngeal constrictor) Vagus nerve (X)

Circular esophageal Internal jugular vein


muscle in V-shaped
area of sparse Thyroid gland
longitudinal muscle (right lobe)
fibers (area of Laimer)

Superior parathyroid gland


Longitudinal
esophageal muscle
Ascending cervical artery
Inferior thyroid vein
Inferior parathyroid gland
Trachea
Inferior thyroid artery
Inferior bulb of
internal jugular vein Right recurrent laryngeal nerve

Vertebral artery Superficial cervical artery

Left subclavian Suprascapular artery


artery and vein
Thyrocervical trunk

Internal thoracic Right subclavian


artery and vein artery and vein

Left brachiocephalic vein Right brachiocephalic vein

Left recurrent laryngeal nerve Brachiocephalic trunk

Arch of aorta Right vagus


o nerve (X)

Left vagus nerve (X) Superior vena cava

Thyroid Gland and Larynx Plate 75


Parathyroid Glands
See also Plate 80

Thyrohyoid membrane External carotid artery


Posterior view
/ H y o i d bonev Internal carotid artery
Superior laryngeal nerve
Internal branch Superior thyroid artery
Externa) branch
Superior laryngeal artery
Vagus nerve (X)
Inferior pharyngeal
constrictor muscle (cut)
Epiglottis
Common carotid artery
Superior thyroid artery
Fibrous capsule of
(cut)
Common carotid artery
Cricopharyngeus muscle (part of
inferior pharyngeal constrictor)
Fibrous capsule of
thyroid gland (cut)
Superior parathyroid gland
Superior parathyroid gland
Right lobe of thyroid gland

Left lobe of thyroid gland


Inferior parathyroid gland
(may be more caudally located,
Ascending cervical artery even within mediastinum)

Inferior thyroid artery


Inferior parathyroid gland
Right recurrent laryngeal nerve

Left recurrent laryngeal nerve Superficial cervical artery


r-

Suprascapular artery
Esophagus
Thyrocervical trunk

Subclavian artery Vertebral artery

Subclavian artery
Trachea
Brachiocephalic trunk

Right lateral view


Internal branch of
External carotid superior laryngeal nerve
Superior laryngeal artery
External branch of
Superior thyroid artery superior laryngeal nerve

Inferior pharyngeal constrictor muscle


Superior parathyroid gland
Common carotid arte
Thyroid gland (right lobe)
Internal jugular vein (retracted anteriorly)

Inferior thyroid artery


Inferior parathyroid gland
Right recurrent laryngeal nerve

Esophagus

Plate 76
Cartilages of Larynx

-Epiglottis _
Hyoid
:
ff| ^^^-Thyrohyoid membrane-^^
Superior horn of thyroid cartilage
Corniculate c a r t i l a g e - ^ ^
y| | Arytenoid cartilage

t
i Superior thyroid notch
-Thyroid cartilage lamina_

Vocal ligament-
Median cricothyroid ligament
J ^ ^ - I n f e r i o r -Cricoid
horn of thyroid
cartilagecartilage-
Trachea^_
KV-V >>..A<V: ,,

Anterior view Posterior view

Corniculate cartilage
Arytenoid
articular surface
Cricoid Muscular process Arytenoid
cartilage Lamina Vocal process cartilage

Anterosuperior view

___Epiglottis
Hyoepiglottic ligament-
b - Hyoid bone
-Thyrohyoid membrane-
-Thyroid cartilage lamina
^ ^ Oblique line
--Laryngeal prominence
Corniculate cartilage I

Arytenoid cartilage-
Muscular p r o c e s s

Median Vocal process-


Lateral Vocal ligament-"""""^
Thyroepiglottic ligament
Cricothyroid ligament-
" ^ C r i c o i d cartilage
^ " C r i c o t h y r o i d joint
^ ^ ^ ^ T r a ch e a ^ ^ ^
Right lateral view Medial view, median
(sagittal) section

Thyroid Gland and Larynx Plate 77


Intrinsic Muscles of Larynx
mm mexmrnm vw&mSBS :'

Epiglottis Foramen for superior


Aryepiglottic laryngeal vessels and
internal branch of
superior laryngeal nerve
Cuneiform
tubercle

Corniculate Oblique and transverse


tubercle arytenoid muscles

Aryepiglottic
muscle Posterior cricoarytenoid
muscle
Oblique
arytenoid muscle

Transverse Straight ]
arytenoid muscle part ( Cricothyroid
Posterior Oblique ( muscle
cricoarytenoid part )
muscle

Cricoid cartilage

Right lateral view


Posterior
view

Epiglottis

Aryepiglottic
muscle piglottic
muscle
Oblique and
transverse
Thyroarytenoid Arytenoid I Muscular
arytenoid m
muscle cartilage, ) V o c a l

Posterior
cricoarytenoid Lateral Lamina of
muscle cricoarytenoid cricoid cartila
muscle

Thyroid articular
surface Conus elasticus

Cricothyroid
muscle (cutaway)

Lateral dissection

Posterior cricoarytenoid muscle

Lateral cricoarytenoid muscle

Transverse and oblique arytenoid m

Cricothyroid muscle Conus


elasticus
Thyroarytenoid muscle

Vocalis muscle Lamina of


thyroid
Vocal ligament cartilage

Superior view

Plate 78 Thyroid Gland and Larynx


Action of cricothyroid muscles
Cricothyroid joint
(pivot point) Lengthening (increasing tension)
of vocal ligaments

Action of posterior cricoarytenoid muscles Action of lateral cricoarytenoid muscles


Abduction of vocal ligaments Adduction of vocal ligaments

Action of transverse and oblique arytenoid muscles Action of vocalis and thyroarytenoid muscles
Adduction of vocal ligaments Shortening (relaxation) of vocal ligaments

Thyroid Gland and Larynx Plate 79


See also Plates 74-76, 235

Internal branch of
Superior superior laryngeal nerve
laryngeal nerve
Sensory branches to larynx
Internal branch
External branch of Galen

Aryepiglottic muscle

Thyroepiglottic muscle
Inferior pharyngeal
Transverse and oblique
constrictor muscle
arytenoid muscles

Thyroarytenoid muscle

Vocalis muscle

Cricothyroid muscle Lateral cricoarytenoid muscle

Posterior cricoarytenoid muscle


Cricopharyngeus muscle
(part of inferior d articular surface
pharyngeal constrictor)
nterior and posterior branches of
inferior laryngeal nerve
Right recurrent
laryngeal nerve
Right recurrent laryngeal nerve

Right lateral view:


thyroid cartilage lamina removed
Right lateral view

Left vagus nerve (X)


r >f

Right vagus nerve (X)


Left common carotid artery

Anomalous right inferior Left inferior laryngeal nerve


laryngeal nerve (not recurrent)

Left recurrent laryngeal nerve

Anomalous (retroesophageal)
right subclavian artery
Left subclavian artery

Right common carotid artery


malous (retroesophageal)
right subclavian artery originating
from left side of aortic arch

Arch of aorta
Left recurrent laryngeal nerve

Anterior view:
anomalous right
inferior laryngeal
nerve, not recurrent,
associated w i t h
anomalous right
subclavian artery

Plate 80
Superior palpebral conjunctiva:
tarsal (meibomian) glands Superior lacrimal papilla and punctum
shining through

Plica semilunaris
Seen through \ Pupil
cornea
Lacrimal caruncle in
lacrimal lake (lacus lacrimalis)
Corneoscleral junction
(corneal limbus)
Inferior lacrimal papilla and punctum
Bulbar conjunctiva
over sclera

Inferior conjunctival fornix

Inferior palpebral conjunctiva:


tarsal glands shining throu^,.

Levator palpebrae superioris muscle


Orbital septum
Superior tarsal (Muller's) muscle (smooth) Sclera

Superior conjunctival fornix Bulbar conjunctiva

Orbicularis oculi muscle (palpebral part) Palpebral conjunctiva


Superior tarsus Cornea
Tarsal (meibomian) glands
Lens
Sebaceous glands
Anterior chamber
Eyelashes (cilia)
Openings of tarsal gla Iris
Posterior chamber
Inferior tarsus
Orbicularis oculi muscle (palpebral part)
Inferior conjunctival fornix
Orbital septum

Frontal bone

Insertion of levator palpebrae


superioris muscle

Orbital septum
Supraorbital artery and nerve
Superior tarsus Supratrochlear artery and nerve

Lateral palpebral ligament Dorsal nasal artery


and overlying raphe and infratrochlear nerve

Inferior tarsus Lacrimal sac

Medial palpebral ligament


Orbital septum
Maxilla (frontal process)
Zygomatic bone
Infraorbital artery and nerve

Orbit and Contents Plate 81


.Mh
BrasB R
'

i i i
pilf lir
ftftit
Lacrimal Apparatus
gSRSfS^Jy ^iSKfBMSfiBRRW-' ^^CyMfrfry'^^^ vft^oi'xiwSwc^JiWy.v^ji atiK^'wNwKvi.*!!KJ5 .', IM-Wei

See also Plates 45, 133

Superior lacrimal papilla and punctum

Orbital part of
lacrimal gland
Lacrimal canaliculi

Palpebral part of
lacrimal gland Lacrimal sac

Excretory ducts of
lacrimal gland Nasolacrimal duct

Plica semilu
Opening of
nasolacrimal duct
Lacrimal caruncle

Inferior lacrimal papilla and punctu

Superior lacrimal papilla and punctum


Frontal bone (cut

Lacrimal canaliculi
Orbital part of
lacrimal gland

Lacrimal sac
Palpebral part of
lacrimal gland

Nasolacrimal duct
Excretory ducts of
lacrimal gland

Middle nasal
concha
Plica semilunaris
and lacrimal lake

Nasal cavity
Lacrimal caruncle

Inferior nasal
Inferior lacrimal papilla and punctum concha (cut)

Opening of nasolacrimal duct Inferior nasal meatus

Plate 82
Horizontal section Tarsus of eyelid

I conjunctiva
Medial palpebral ligament
Bulbar conjunctiva
Nasal cavity
Cornea
Check ligament of
Lateral palpebral ligament
medial rectus muscle
Check ligament of
Ethmoidal cells lateral rectus muscle

Periorbita Periorbita

Sclera
Medial rectus muscle
and fascial sheath Fascial sheath of eyeball
(Tenon's capsule)
Fascial sheath of eyeba I
(Tenon's capsule) Episcleral space

Lateral rectus muscle


Sclera and fascial sheath

Episcleral space Retrobulbar fat


(orbital fat body)
O p t i c nerve (II) and
outer sheath' C o m m o n tendinous ring

Sphenoidal sinus

Levator palpebrae superioris muscle and fascial sheath


Frontal section Superior o b l i q u e muscle and fascial sheath

Superior rectus muscle Medial rectus muscle and fascial sheath


and fascial sheath
Periorbita
Lacrimal gland
Ethmoidal cell
Lateral rectus muscle and
fascial shealh Sclera

Periorbita Fascial sheath of eyeball


(Tenon's capsule)
Scl
Inferior rectus muscle
Fascial sheath of eyeba and fascial sheath
(Tenon's capsule)
Inferior oblique muscle
Episcleral space and fascial sheath

Retrobulbar fat (orbital fat body) Infraorbital nerve (V 2 )

Muscle attachments and nerves and vessels entering o r b i t

Superior orbital f i s s u r e L e v a t o r palpebrae superioris muscle

Lacrimal nerve - S u p e r i o r oblique muscle


Frontal nerve ( V , ) - Superior rectus muscle
Trochlear nerve ( I V ) ^ ^ ^ ^ Medial rectus muscle

Superior ophthalmic vein nerve (ll)


in optic canal
Lateral rectus muscle -^^^ffi artery
Superior branch of o c u l o m o t o r nerve ( I I I ) ^ ^ j \ \ ^ - I n f e r i o r rectus muscle
Inferior orbital f i s s u r e ^ ^ / \ ^ I n f e r i o r branch of o c u l o m o t o r nerve (III)

Abducent nerve (VI) Nasociliary nerve (Vj)

Orbit and Contents Plate 83


Right lateral view Superior oblique muscle

Levator palpebrae superioris muscle

Superior rectus muscle

Optic nerve (II)


Medial rectus muscle

Lateral rectus muscle (cut)

C o m m o n tendinous ring

Lateral rectus muscle (cut) Inferior oblique muscle

Inferior rectus muscle

Superior tarsus
Superior view
Levator palpebrae
superioris muscle (cut)

Superior oblique muscle


Superior rectus muscle (cut)

Medial rectus muscle


Lateral rectus muscle
*

Optic nerve (II)

Common tendinous ring


Superior rectus muscle (cut)

Levator palpebrae superioris muscle (cut)

Innervation of extrinsic eye muscles: Trochlear


anterior view Superior oblique muscle
nerve (IV)

Levator palpebrae
superioris muscle

Superior rectus muscle Abducent


Oculomotor Lateral rectus muscle
nerve (VI)
nerve (III) Medial rectus muscle

Inferior rectus muscle

Inferior oblique muscle

Plate 84 Orbit and Contents


liilpfil:
mMmrn

See also Plates 23,104

Superior view Medial palpebral artery

Lateral palpebral artery


Supratrochlear artery

Lacrimal gland
Dorsal nasal artery
Supraorbital artery
Anterior meningeal artery
Zygomatic branches
Anterior ethmoidal artery
Posterior ciliarv arteries

Posterior ethmoidal artery


Muscular branch

Continuation of ophthalmic artery- Lacrimal artery

Muscular branch Central retinal artery

Ophthalmic artery

Internal carotid artery


Supraorbital artery

Supratrochlear artery

Dorsal nasal artery


Anterior view
Superior medial
palpebral artery
Frontal branch of
superficial temporal artery Angular artery

Superior lateral palpebral artery- Inferior medial


palpebral artery
Inferior lateral palpebral artery
Superior and inferior
palpebral arterial arches
Zygomaticofacial artery
Facial artery
Transverse facial arterv

Infraorbital artery (X = anastomosis of vessels from


external and internal carotid arteries)

Supratrochlear vein

Lateral view
Supraorbital vein Nasofrontal vein

Superior ophthalmic vein Angular vein

Cavernous sinus Vorticose veins

Facial vein

Inferior ophthalmic vein-'

Pterygoid plexus

Maxillary vein-.

Retromandibular vein Deep facial vein

Orbit and Contents Plate 85


Nerves of Orbit
See also Plates 45, 121, 132

Superior view Medial branch ) Supraorbital nerve


Lateral branch )

Supratrochlear nerve Levator palpebrae superioris muscle

Medial rectus muscle Superior rectus muscle

Lacrimal gland
Superior oblique muscle
Lacrimal nerve
Infratrochlear nerve
Lateral rectus muscle
Nasociliary nerve
Frontal nerve
Trochlear nerve (IV)
Maxillary nerve (V 2 )
Common tendinous ring
Meningeal branch
of maxillary nerve
Ophthalmic nerve (V-j)
Mandibular nerve (V 3 )
Optic nerve (II)
Lesser petrosal nerve
Internal carotid artery
and nerve plexus Meningeal branch
of mandibular nerve
Oculomotor nerve (III)
Greater petrosal nerve
Trochlear nerve (IV)
Trigeminal (semilunar) ganglion
Abducent nerve (VI) Tentorial (meningeal)
branch of ophthalmic nerve
Tentorium cerebelli

Long ciliary nerves


Superior view:
levator palpebrae superioris, Short ciliary nerves
superior rectus, and superior
Lacrimal nerve
oblique muscles partially
cut away Ciliary ganglion
Parasympathetic root of ciliary
Supratrochlear nerve (cut) ganglion (from inferior branch
of oculomotor nerve)
Supraorbital nerve branchesfcuO
Sympathetic root of ciliary
Infratrochlear nerve ganglion (from internal
carotid plexus)
Anterior ethmoidal nerve
Sensory root of ciliary ganglion
Optic nerve (II)
(from nasociliary nerve)
Posterior ethmoidal nerve Branches to inferior
Superior branch of and medial rectus muscles
oculomotor nerve (III) Abducent nerve (VI)
Nasociliary nerve Inferior branch of
oculomotor nerve (III)
Internal carotid plexus
Lacrimal nerve
Trochlear nerve (IV) {cut)
Frontal nerve (cut)
Oculomotor nerve (III)
Ophthalmic nerve (V,)
Abducent nerve (VI)

Plate 86 Orbit and Contents


Eyeball

Horizontal section Cornea

Zonular fibers Capsule of lens Anterior chamber


(suspensory ligament of lens)
Posterior chamber
Scleral venous sinus
(canal of Schlemm)
Iridocorneal angle
Scleral spur
Ciliary processes
Ciliary body and ciliary muscle
Bulbar conjunctiva
Ciliary part of retina
Ora serrata
Tendon of
lateral rectus
Tendon of
muscle
medial rectus
muscle

::

fflmm.
V
SfflH

mm -Si.'/'Mi/W:

mrnmmmi

M M

Optic (visual)
part of retina
\ itreous body
Choroid

Perichoroidal space Hyaloid canal

Sclera
Lamina cribrosa of sclera
Fascial sheath of eyeball
(Tenon's capsule) Optic nerve (II)

Episcleral space
Central retinal
Fovea centralis in macula (lutea) artery and vein

Outer sheath of optic nerve

Subarachnoid space

Orbit and Contents Plate 87


Schwalbe's line Posterior limiting lamina
(Descemet's membrane)
Trabecular meshwork and spaces
of iridocorneal angle (of Fontana) Endothelium of anterior chamber

Scleral venous sinus (canal of Schlemm) Cornea

Scleral spur

Iridocorneal angle

Pectinate ligament
Major arterial \
circle of i r i s \ \

onjunctiva Anterior chamber


Sclera \
Minor arterial
circle of iris

Posterior chamber

Ciliary
process
Ciliary Meridional Circular
part of fibers fibers Dilator pupillae
retina muscle

Pigment Nucleus of
Zonular fibers epithelium
(suspensory (iridial part of
ligament retina)
of lens)
Sphincter pupillae muscle

Note: For clarity, only single plane of zonular fibers shown;


actually, fibers surround entire circumference of lens.

Plate 88 Orbit and Contents


Lens and Supporting Structures

Sclera

Choroid

Optic part of retina

Ora serrata

Orbiculus ciliaris of
ciliary body covered Nucleus
by ciliary part of retina Capsule

Ciliary processes Cortex

Zonular fibers
Anterior chamber
Lens
Iris

Posterior chamber

Ciliary body
Eyeball sectioned in frontal plane:
anterior segment viewed f r o m behind Ciliary

Preequatorial
Zonular fibers <( Equatorial
Postequatorial

Orbiculus ciliaris of ciliary body


Horizontal section
Ora serrata

Optic part of retina

Ora serrata
Orbiculus ciliaris of
Optic part ciliary body covered Zonular fibers fanning out
of retina by ciliary part of retina and blending into lens capsule

i xm
Zonular fibers

Enlargement of segment outlined in top illustration (semischematic)

Orbit and Contents Plate 89


of Eye

Cornea Minor arterial circle of iris


Anterior chamber
Major arterial circle of iris
Scleral venous sinus
(canal of Schlemm)
Blood vessels of ciliary body

Bulbar conjunctiva and


conjunctival vessels

Anterior ciliary artery and vein

Iridocorneal
angle

Posterior cham
Muscular artery and vein
Zonular fibers
Extrinsic eye muscle
Retina
Vitreous chamber

Long posterior ciliary artery

Choroid

Sclera
Vorticose vein

Episcleral artery and vein


f

Retinal artery and vein

Long posterior ciliary artery

Short posterior ciliary arteries


Superior macular
Central retinal artery and vein arteriole and venule

Superior nasal
Superior temporal retinal arteriole
retinal arteriole and venule
and venule
Optic nerve (II)

Macula
Fovea centralis

Inferior nasal
Inferior temporal
retinal arteriole
retinal arteriole
and venule
and venule
Inferior macular
Right retinal vessels: ophthalmoscopic view arteriole and venule

Plate 90 Orbit and Contents


Vascular arrangements within the choroid (vascular tunic) of the eyeball

Anterior tributaries of a vorticose vein


Anterior ciliary arteries
Episcleral vein*
Tendon of superior rectus muscle
Junctions of suprachoroidal
Sclera tributaries forming vorticose vein

Posterior conjunctival Superior ophthalmic vein


artery and vein
Bulb of vorticose (choroid) vein

Anterior ciliary veins Vorticose (choroid) vein

Long posterior ciliary artery

Major arterial circle of iris


Short posterior
Minor arterial ciliary arteries
circle of iris

External sheath of
tic nerve (dura mater)
Conjunctiva
and cornea
Internal sheath
of optic nerve
(pia-arachnoid mater)

Short posterior
ciliary arteries

Central retinal
Arteries and artery and vein
veins of iris

Scleral venous sinus


(canal of Schlemm) Vessels of internal
sheath of optic nerve
Veins draining scleral venous
sinus (into anterior ciliary veins)
Short posterior ciliary arteries
Anterior ciliary veins
Segment of episcleral vein*
Nonpigmented and pigmented
regions of the retina Muscular artery Inferior ophthalmic vein
Recurrent branch of anterior ciliary artery
Posterior tributaries of a vorticose vein

*The episcleral veins are shown here anastomosing with the vorticose veins, /
which they do; however they also drain into the anterior ciliary veins.

Orbit and Contents Plate 91


Pathway of Sound Reception

Frontal section Facial nerve (VII) (cut)

Limbs of stapes Base of stapes in oval (vestibular) w i n d o w

Prominence of lateral semicircular canal Vestibule


Incus
Semicircular ducts, ampullae, utricle, and saccule
Tegmen tympani
Facial nerve (VII) (cut)
Malleus (head)
Vestibular nerve
Epitympanic recess
Cochlear nerve
i
Auricle
Internal acoustic
meatus

Vestibulocochlear
nerve (VIII)

External
Helicotrema Nasopharynx
acoustic meatus
Scala vestibuii
Tympanic membrane
Cochlear duct
Tympanic cavity Cochlea
containing
spiral organ
Promontory
(of Corti)
Round (cochlear) w i n d o w
Scala tympani
Auditory (pharyngotympanic, Eustachian) tube
Note: Arrows indicate course of sound waves.

Plate 92
External Ear and Tympanic Cavity

Right auricle (pinna) Otoscopic view of right tympanic membrane


Triangular fossa Crux of helix

Helix External acoustic meatus


Pars flaccida
tiaccida
Lateral process of malleus
Scaphoid fossa Posterior mallear fold

Crura of antihelix Anterior mallear


fold

Auricular tubercle (of Darwin) Long limb of incus

Antihelix Tragus Handle of malleus

Concha of auricle Umbo


Intertragic notch
Antitragus
Lobule of auricle Cone of light
Tympanic
Pars tensa

Coronal oblique section of external acoustic meatus and middle ear (tympanic cavity)

Tegmen tympani
Epitympanic recess
Dura mater
Superior ligament of malleus Head of malleus
Long limb of incus
Short limb of incus Tendon of stapedius muscle

Footplate of stapes

Handle of malleus
Chorda tympani nerve (cut)
Promontory with tympanic plexus
Anterior ligment of malleus {cut)
tympani muscle

Tympanic membrane

Tensor veli palatini muscle


External acoustic meatus

Auditory (pharyngotympanic, Eustachian) tube


Right tympanic cavity after removal of tympanic membrane (lateral view)

Chorda tympani nerve ^ Lateral Proce5S of malleus


Tendon of tensor tympani muscle
Long limb of incus
Ossicles articulated: medial view
Prominence of facial canal
Malleus Incus

Pyramidal eminence and tendon


of stapedius muscle Handle of malleus
Lenticular process
of incus
Stapes Tympanic
Stapes CMc^ML
*
Fossa of round w i n d o w
Lesser petrosal nerve
Tympanic nerve
Tympanic plexus on promontory

Ear Plate 93
Tympanic Cavity
See also Plates 46, 123, 124, 135

Lateral w a l l o f t y m p a n i c c a v i t y : m e d i a l ( i n t e r n a l ) v i e w

Superior ligament of malleus


Head of malleus

Superior ligament of incus


Epilympanic recess

Short limb of incus


Anterior process of malle

Posterior mallear fold


Chorda tympani

Posterior ligament of incus


Anterior mallear fold

Long limb of incus


Tensor tympani muscle
Chorda tympani nerve
Handle of malleus
Lenticular process of incus
Tympanic membrane
(pars tensa)
Facial nerve (VII)
Auditory
(p h a r y n g o ty m p a n i c,
Eustachian) tube

Internal carotid artery

M e d i a l wall of t y m p a n i c cavity: lateral view


Prominence of lateral semicircular canal
V """

Prominence of facial canal


Mastoid antrum

Geniculum (geniculate ganglion) of facial nerve


Base of stapes in
fossa of oval (vestibular) Greater petrosal nerve
window
Tensor tympani muscle
(tendon cut)
Limbs of stapes

Pyramidal eminence Auditory


(pharyngotympanic,
Eustachian) tube
Chorda tympani nerve (cut)
Levator veli palatini
m uscle
Mastoid cells

Tendon of stapedius muscle


Promontory with tympanic
nerve (of Jacobson) and plexus
Fossa of round under mucosa
(cochlear) w i n d o w
Internal carotid artery
Facial nerve (VII) Tympanic, cells
in stylomastoid foramen

Plate 94 Ear
Bony and Membranous Labyrinths
See also Plate 124

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

Posterior D
osterior
Lateral Semicircular canals Lateral Semicircular canals
Anterior Anterior

^ mmon bony limb Elliptical recess


Cochlear recess Vestibule
mpullae Spherical recess (note
perforations
Vestibule for nerve
fibers)
Cochlea

H el i cot re ma

Hamulus
of spiral
lamina
Internal opening of Scala vestibuli
Oval (vestibula vestibular aqueduct
Cochlear
window (for endolymphatic Osseous spira
cupula
duct) lamina
Round (cochlear)
window Round (cochlear) window Scala tympani

Right membranous labyrinth w i t h nerves: posteromedial view


Anterior semicircular duct
Superior part of vestibular nerve
(from utricle and anterior and
lateral membranous ampullae) Anterior membranous ampulla
Utricle

Lateral membranous ampulla


Cochlear duct (basal turn)
Common
membranous limb
Coc hlear nerve

Lateral
semicircular
duct

Posterior
Vestibulocochlear nerve (VIII)
semicircular
duct
Vestibular nerve
Posterior membranous
ampulla
Vestibular ganglion

Endolymphatic duct
Inferior part of vestibular nerve (from
saccule and posterior membranous ampulla)

Ear Plate 95
Bony and Membranous Labyrinths (continued)

Bony and membranous labyrinths: schema

Anterior semicircular canal and duct


Dura mater
Posterior semicircular
canal and cluct
|-r Endolymphatic sac
Common bony and
membranous limbs Endolymphatic duct
in vestibular aqueduct
mm
Lateral semicircular mmm
mmm
canal and duct Utricle

Otic capsule Saccule

Stapes in oval Helicotrema of cochlea


(vestibular) window
Ductus reuniens
Incus
Scala vestibuli
Malleus
Cochlear duct
Tympanic cavity
Scala tympani
External acoustic meatus

Umbo
. . . ' ' : . ' .

Tympanic membrane

Round (cochlear) window Otic capsule


(closed by secondary Vestibule
tympanic membrane)

Pharyngotympanic (auditory) tube

Section through turn of cochlea


Scala vestibuli
Osseous
spiral lamina Vestibular (Reissner's)
membrane

Cochlear duct
Nerve fibers

Spiral ligament

Tectorial membrane

Spiral organ (of Corti)


Spiral ganglion
Basilar membrane

Osseous cochlea
Scala tympani

Outer hair cells

Cochlear nerve Pillar (rod) cells

Inner hair cell

Plate 96
Orientation of Labyrinth in Skull
HBHWMBBHHMBB^SS

Superior projection of
right bony labyrinth Groove for greater petrosal nerve
on floor of skull
Geniculum (geniculate ganglion) of facial nerve
Cochlea
z Plane of anterior
/ semicircular canal
Cochlear nerve

Facial nerve (VII)

Internal acoustic
opening

Vestibulocochlear nerve (VIII) Lateral semicircular


canal

Vestibular nerve

Petrous part
of temporal bone

External opening of
vestibular aqueduct Plane of posterior
(for endolymphatic cluct) semicircular canal

Lateral projection of right membranous labyrinth


Geniculum (geniculate ganglion) Cochlear duct
of facial nerve

Cochlear nerve

Trigeminal nerve (V)


uperior part of
vestibular nerve

Vestibulocochlear
nerve (VIII) Internal jugular vein

Inferior part of
Anterior vestibular nerve
semicircular cluct

Lateral semicircular cluct


Cerebellum
Posterior semicircular duct

Superior
petrosal sinus

Sigmoid sinus
Confluence
of sinuses
Transverse sinus

Ear Plate 97
Auditory (Pharyngotympanic, Eustachian) Tube
See also Plates 5 2 , 5 5 , 6 5

Cartilaginous part of auditory


(pharyngotympanic, Eustachian)
tube at base of skull: inferior view

Palatine process of maxilla

Pterygoid hamulus and


medial pterygoid plate Horizontal plate of palatine bone

Lateral pterygoid plate Choana

) of cartilaginous part of
Scaphoid fossa
Lateral lamina ( auditory (pharyngotympanic,
Medial lamina) Eustachian) tube
Foramen ovale

Foramen I ace rum


Foramen spinosum

Petrous part of temporal bone


Spine of sphenoid bone

Internal carotid artery Occipital condyle


entering carotid canal

Mastoid process
Foramen magnum

Section through cartilaginous part of auditory Section through cartilaginous part of auditory
(pharyngotympanic, Eustachian) tube, (pharyngotympanic, Eustachian) tube,
with tube closed w i t h tube open
Trigeminal ganglion
Trigeminal ganglion
Internal carotid artery in carotid
Internal carotid artery
in carotid canal Dura mater
Dura mater
Lateral lamina
Lateral lamina of cartilage
of cartilage
Medial lamina
Medial lamina of cartilage
of cartilage
Auditory tube lumen
Auditory tube lumen
Tensor veli palatini
Tensor veli palatini muscle
muscle
Levator veli palatini
Levator veli palatini muscle
muscle
Salpingopharyngeus
Salpingopharyngeus
muscle
muscle
Nasopharynx Nasopharynx

Auditory (pharyngotympanic, Eustachian) tube closed by Lumen opened chiefly when attachment
elastic recoil of cartilage, tissue turgidity, and tension of of tensor veli palatini muscle pulls wall
salpingopharyngeus muscles of tube laterally during swallowing

Plate 98
Meninges and Diploic Veins
See also Plate 23

Diploic veins Arachnoid granulation


Coronal
dissection Superior sagittal sinus
Cerebral vein (bridging vein) penetrates subdural space to enter sinus
Dura mater (periosteal and meningeal layers)
Emissary vein
Dura-skull interface (site of epidural hematoma)
Frontal and parietal tributaries Arachnoid
of superficial temporal vein
Subarachnoid space
Frontal and parietal branches Pia mater
of superficial temporal artery
Middle meningeal
Granular foveola artery and vein
(indentation of skull by Deep,
arachnoid granulation) middle, and
superficial
Lateral (venous) lacuna temporal
Bridging vein arteries
Inferior and veins
sagittal
sinus

Superior thalamostriate and


choroidal veins, internal cerebral
veins, and choroid plexus of
lateral ventricle Deep and superficial middle
cerebral veins

Diploic and emissary


veins of skull
Parietal emissary vein

Posterior temporal
Frontal diploic vein diploic vein

Anterior temporal Occipital emissary vein


diploic vein
Occipital diploic vein

Mastoid emissary vein

Meninges and Brain Plate 99


See also Plates 40,136

Frontal (anterior) and parietal Arachnoid granulations


(posterior) branches of
middle meningeal artery Opening of superior cerebral vein

Middle Lateral (venous) lacuna


meningeal artery

Superior sagittal sinus


Anterior
meningeal
branch of Dura mater
anterior
ethmoidal
artery

Mastoid branch of
occipital artery

Meningeal branches of
ascending pharyngeal artery

Mastoid branch of
occipital artery
Middle meningeal artery
Recurrent meningeal branch of
lacrimal (ophthalmic) artery
Accessory meningeal artery
Anterior meningeal branch of
anterior ethmoidal artery
Posterior ethmoidal artery
Internal carotid artery and its
meningohypophyseal trunk* {phantom)
Middle meningeal artery
Accessory meningeal artery
Superficial
temporal artery
Maxillary artery
Anterior and posterior
Posterior auricular artery meningeal branches of
vertebral artery
Occipital artery

tentorial, cavernous sinus, and meningeal


branches of meningohypophyseal trunk*

^'Variant; most commonly, these branches arise directly from internal carotid artery.

Plate 100 Meninges and Brain


mm

Epidural Hematoma
WIBBHMMMIllllHIIMI^^
Temporal fossa hematoma

Medial displacement of Shift of normal


middle cerebral vessels midline structures

Skull fracture Compression of


crossing middle posterior cerebral a.
meningeal a.
Shift of brainstem to
opposite side may
Herniation of reverse lateralization
temporal lobe of signs by tentorial
under tentorium pressure on contra-
cerebelli lateral pathways.

Compression of corticospinal
and associated pathways,
resulting in contralateral
hemiparesis, deep tendon hyper-
Compression of oculomotor (III) n.
reflexia, and Babinski's sign
leading to ipsilateral pupil dilatation
and 3rd cranial n. muscle palsy

mm

''Question mark" skin incision (biack);


outline of free bone flap and burr holes (red)

Brain

Dura

Skin flap reflected (Raney clips control bleeding). Free bone


flap removed and dura opened. Clot evacuated by irrigation,
suction, and forceps.

Burst

Section showing acute subdural hematoma on right side and


subdural hematoma associated with temporal lobe intracerebral
hematoma ("burst" temporal lobe) on left

Meninges and Brain Plate 101


Meninges and Superficial Cerebral Veins
For deep veins of brain see Plate 145

Calvaria

Pericranium Granular foveola


ior sagittal sinus
Galea aponeurotica Emissary vein
Skin Tributary of superficial temporal vein
Diploic vein
Dura-skull interface
(site of epidural hematoma)
Dura mater
Arach noid-dura i nterface
(site of subdural hematoma)
Bridging vein
Arachnoid
Subarachnoid space
Pia mater
Cerebral artery
Superior cerebral vein
Falx cerebri
Ce reb ra I h e m i s p here

Branches of middle meningeal artery


Superior cerebral veins
Superior sagittal sinu (bridging veins) (penetrating
arachnoid and dura mater to
enter superior sagittal sinus)

Dura mater

Superior cerebral veins


(beneath arachnoid)

Superior anastomotic
vein (of Trolard)

Inferior anastomotic
vein (of Labbe)

Superficial middle
cerebral vein

Middle meningeal
artery and veins
Inferior cerebral veins
(beneath arachnoid)

Plate 102 Meninges and Brain


Bora! Venous Sinuses
mmmssstSB^msms^msmemmsmSi

Superior sagittal sinus

Straight sinus
Sagittal section
Great cerebral vein (of Galen)

Tentorium cerebelli

Superior sagittal sinus

Falx cerebri

Inferior sagittal sinus

Sphenoparietal sinus

Anterior and posterior


intercavernous sinuses

Superior
petrosal sinus

Basilar
venous plexus

Inferior
petrosal sinus

To jugular
foramen

Sigmoid sinus

Transverse sinus

Occipital sinus

Falx cerebelli

Confluence of sinuses

Meninges and Brain Plate 103


Dural Venous Sinuses (continued)
See also Plate 85

Skull sectioned horizontally:


superior view -Hypophysis (pituitary gland)

Optic nerve (II)


Superior sagittal sinus (cut)
Falx cerebri (cut) Internal carotid artery
Superior ophthalmic vein Oculomotor nerve (III)
Anterior and posterior , /> Sphenoparietal sinus
intercavernous
sinuses 'Trochlear nerve (IV)

Superficial middle Ophthalmic nerve (V-j)


cerebral vein (cut)
Maxillary nerve (V 2 )
Cavernous sinus
-Trigeminal ganglion
Basilar
venous plexus Mandibular nerve (V 3 )
Superior Middle meningeal artery
petrosal sinus
Abducent nerve (VI)
Inferior
petrosal sinus Petrosal vein
Tentorial
Facial nerve (VII),
artery
intermediate nerve, and
Tentorium vestibulocochlear nerve (VIII)
cerebelli
Glossopharyngeal (IX)
Inferior and vagus (X) nerves
cerebral vein
(cut) Jugular foramen

Transverse sinus Sigmoid sinus (continuation


of transverse sinus)
Inferior sagittal
sinus (cut) Transverse sinus
Straight sinus Accessory nerve (XI)
Falx cerebri (cut) Hypoglossal nerve (XII)
Confluence of sinuses
Great cerebral vein (of Galen)
Superior sagittal sinus (cut)

Cavernous sin Optic chiasm

Oculomotor nerve (III) Posterior


communicating artery
Trochlear nerve (IV)
Internal carotid
Abducent nerve (VI) artery

Ophthalmic nerve (Vq Hypophysis


(pituitary gland)
Maxillary nerve (V 2

Sphenoidal sinus

Nasopharynx
Coronal section
through cavernous sinus

Plate 104 Meninges and Brain


Cerebrum: Lateral Views

Central sulcus (of Rolando)

Precentral gyrus Postcentral sulcus

Precentral sulcus

Superior frontal gyrus

Superior frontal sulcus

Middle frontal gyrus Inferior parietal lobule


Supramarginal gyrus
Inferior frontal sulcus Angular gyrus

Inferior frontal gyrus


Parieto-
Opercular part
occipital
Triangular part
sulcus
Orbital part

Frontal
pole Occipital
pole
Calcarine
sulcus
Lunate sulcus
Lateral sulcus ( Anterior ramus (inconstant)
(of Sylvius) ) Ascending ramus
Transverse
( Posterior ramus
occipital sulcus
Superior temporal gyrus Preoccipital notch
Temporal pole
Superior temporal sulcus Inferior temporal gyrus
Middle temporal gyrus
Inferior temporal sulcus

Frontal lobe

Parietal lobe

Temporal lobe

Occipital lobe Parietal operculum


Frontal operculum
Orbital operculum
Short gyri
Insula Central sulcus
(island Li men
of Reil) Long gyrus
Circular sulcus
Temporal operculum

Meninges and Brain


Cerebrum: Medial Views
...... . . ... - . . . . . . . . . . . - . . .-,;:: v . - . :: :"..: '/. ; : ' ' ; : : '

For hypophysis see Plate 147

Sagittal section of Cingulate gyrus Paracentral sulcus


brain in situ , . , Central sulcus (of Rolando)
Cingulate sulcus Paracentral lobule
Medial frontal gyrus Marginal sulcus
Sulcus of corpus callosum Corpus callosum
Fornix Precu neus
Superior sagittal sinus
Septum pellucidum
Interventricular Choroid plexus
foramen (of Monro) of 3rd ventricle
Interthalamic Stria medullaris
/ / *7
adhesion of thalamus
Thalamus and Parietooccipital
3rd ventricle sulcus
Subcallosal Cuneus
(parolfactory) Habenular
area commissure
Anterior Pineal body
commissure Posterior
commissure
Subcallosal
gyrus Calcarine
sulcus
Hypothalamic
sulcus Straight sinus
in tentorium
Lamina / cerebelli
terminals
Great cerebral vein
Supra- (of Galen)
optic
recess Superior colliculus
Inferior colliculus
Optic chiasm
Tectal (quadrigeminal) plate
Tuber cinereum
Cerebellum
Hypophysis (pituitary gland)
Superior medullary velum
Mammillary body
4th ventricle and choroid plexus
Cerebral peduncle Inferior medullary velum
Pons Cerebral aqueduct . Medulla oblongata
(of Sylvius)

Medial surface of cerebral Genu


hemisphere: brainstem excised Rostrum
Trunk corpus callosum
Splenium
Cingulate gyrus
Islhmus of cingulale gyrus
Mamillothalamic
fasciculus Parietooccipital sulcus
Mammillary body
Cuneus
Uncus
Calcarine sulcus
Optic nerve (II)
Lingual gyrus
Olfactory tract

Collateral sulcus Crus


Body V of fornix
Rhinal sulcus Column
Medial occipitotemporal gyru Fimbria of hippocampus
Occi p i totem po ra (sulcus Dentate gyrus
Lateral occipitotemporal gyrus Parahippocampal gyrus

Plate 108 Meninges and Brain


Cerebrum: inferior View
For hypophysis see Plate 147

Sectioned brainstem Frontal pole of cerebrum

Straight gyrus

Olfactory sulcus Lamina terminalis

Orbital sulci Olfactory bulb

Orbital gyri Olfactory tract

Temporal pole of cerebrum / O p t i c chiasm

Lateral sulcus (of Sylvius) Optic nerve (II) (cut)

Hypophysis
Inferior temporal sulcus (pituitary gland)

Inferior temporal gyrus Anterior

perforated substance

Optic tract

Tuber cinereum
Inferior (infero-
lateral) margin 88 Mammillary body
v'-oS

of cerebrum Posterior perforated


sss substance (in
interpeduncular
Rhinal sulcus

Cerebral cr us
Uncus
Lateral geniculate
body
\
Inferior
temporal gyrus- \ \
Substantia nigra
X
X
Medial geniculate
Occipitotemporal body
sulcus
MS
Red nucleus
Lateral occipito-
temporal gyrus Pulvinar of thalamus

Superior colliculus (of


corpora quadrigemina)
\\
Cerebral aqueduct
Pa ra h i p p o ca m p a I gy r u s
Splenium of corpus callosum
Medial occipitotemporal gyrus"
Apex of cuneus

Calcarine sulcus Occipital pole of cerebrum

Longitudinal cerebral fissure

Meninges and Brain Plate 107


Ventricles of Brain
H6W&aamSBl

Left lateral phantom view Frontal (anterior) horn


v;'
Central part Left
Right lateral ventricle lateral
Temporal (inferior) horn ventricle

Occipital (posterior) horn

Cerebral aqueduct (of Sylvius)

4th ventricle

Left lateral aperture


(foramen of Luschka)

Left interventricular Left lateral recess


foramen (of M o n r o )
3rd ventricle ^yvW/MJfj Median aperture
(foramen of Magendie)
Supraoptic recess
Interthalamic adhesion
Infundibular recess Central canal of spinal cord
Pineal recess
Suprapineal recess
Corpus callosum
Septum pellucidum
Lateral ventricle
Body of caudate nucleus
Choroid plexus of lateral ventricle
Stria terminalis
Superior thalamostriate vein
Body of fornix
Internal cerebral vein
Tela choroidea of 3rd ventricle
Choroid plexus of 3rd ventricle
Thalamus
Putamen / . ,
> Lentiform nucleus
Globus pallidus )
Internal capsule
3rd ventricle and interthalamic adhesion
Hypothalamus
Tail of caudate nucleus
Optic tract
Choroid plexus of lateral ventricle
; White arrow in left Temporal (inferior) horn of lateral ventricle
) interventricular
/ foramen (of M o n r o ) Fimbria of hippocampus
Hippocampus
Ependyma
Pia mater Dentate gyrus
Parahippocampal gyrus

Coronal section of brain: posterior view

Plate 108
Circulation of Cerebrospinal Fluid
wmsmmm mm^mmm

Choroid plexus of lateral ventricle {phantom) Superior sagittal sinus

Cistern of corpus callosum Subarachnoid space

Dura mater Arachnoid granulations

Arachnoid

Interventricular
foramen (of Monro)

Chiasmatic cistern

Interpeduncular cistern

Cerebral aqueduct (of Sylvius)


Quadrigeminal cistern
(of great cerebral vein)
Prepontine cistern

(Posterior)
Lateral aperture (foramen of Luschka) cerebellomedullary cistern

Choroid plexus of 4th ventricle Median aperture


(foramen of Magendie)
Dura mater

Arachnoid

Subarachnoid space

Central canal of spinal cord

Meninges and Brain Plate 109


Horizontal sections
through cerebrum

Genu of corpus callosum


Head of caudate nucleus

Lateral ventricle Anterior limb


~ ( of internal
Septum pellucidum G e n u ( capsule
Posterior limb

Column of fornix
Putamen \ Lentiform

Insula Globus pallidus S nucleus


(island of Reil)
3rd ventricle
Interthalamic
adhesion External capsule

Thalamus Claustrum

Crus of fornix Retrolenticular part


of internal capsule

Choroid plexus
of lateral ventricle Tail of caudate nucleus

Splenium of Hippocampus and fimbria


corpus callosum
Occipital (posterior) horn
of lateral ventricle

Habenula

Organization of
basal nuclei (ganglia) Pineal body

Caudate Putamen Globus


nucleus pallidus
Cleft for internal capsule

Lentiform
Striatum nucleus
Caudate J Body
nucleus ) H e a d Thalamus
Corpus
striatum Levels of ( ^
K sections \
above (
Basal nuclei
(ganglia)
Pulvinar
Lentiform nucleus Medial geniculate body
(globus pallidus medial
to putamen) Lateral geniculate body

Amygdaloid body Tail of caudate nucleus

Interrelationship of thalamus, lentiform nucleus, caudate


nucleus, and amygdaloid body (schema): left lateral view

Plate 110 Meninges and Brain


Thalamus

Corpus callosum [cut)


Interventricular foramen (of Monro)

Tela choroiclea (cut edge) Head of caudate nucleus


of 3rd ventricle
Septum pellucidum
3rd ventricle
Columns of fornix
Choroid plexus
Anterior tubercle
Superior thalamostriate vei
Stria terminalis
Pes hippocampi
Interthalamic adhesion
Temporal (inferior) horn
of lateral ventricle Lamina affixa
Internal cerebral vei
Stria medullaris
Dentate gyrus
Habenular trigone
Collateral eminence
Pulvinar (retracted)
Hippocampus
Lateral geniculate body
Fimbria of hippocampus-
Posterior commissure Medial geniculate body

Habenular commissure Brachium of superior colliculus

Pineal-body Brachium of inferior colliculus

Collateral trigon Superior colliculus


Calcar Inferior colliculus
Occipital (posterior) horn
Cerebellum
of lateral ventricle
Calcarine sulcu

Internal 3rd ventricle


medullary Interthalamic
lamina adhesion
Pulvinar

Intralaminar
nuclei

3rd ventricle

Reticular nucleus

Pulvinar
Thalamic nuclei
geniculate body
CM Centromedian
Medial geniculate body
LD Lateral dorsal
LP Lateral posterior
Median nuclei Schematic representation of thalamus
M Medial
MD Medial dorsal (external medullary lamina and
Schematic section VA Ventral anterior reticular nuclei removed)
through thalamus
VI Ventral intermedial
(at level of broken
line shown in figure VL Ventral lateral Lateral nuclei
at right) VP Ventral posterior
Medial nuclei
VPL Ventral posterolateral
VPM Ventral posteromedial Anterior nuclei

Meninges and Brain Plate 11i


mm
imi
W
Hippocampus and Fornix
mm iffii1lTwii*iiiii<iiwwiiiiiiiiiiiiiiiiiiiiiii ipi mm iiwiiiiiiiBiMtiwiimi 'Sm1CSM0ES5:

Superior dissection Genu of corpus callosum (cut)

Septum pellucidum

Head of caudate nucleus

Columns of fornix

Stria terminalis

Body of fornix

Pes hippocampus

Thalami

ra of fornix

Dentate gyrus

Fimbria of hippocampus

Hippocampus

Commissure of fornix

Splenium of corpus callosum (cut)

Lateral ventricle

Calcar avis

Occipital (posterior) horn


of lateral ventricle

Tail of caudate nucleus


Choroid

Body of fornix Fimbria of hippocampus


Columns O p t i c tract
Commissure
of fornix
of fornix

Crura of fornix
Hippocampal
sulcus

Dentate
gyrus

Hippocampus

Alveus of
hippocampus
Fimbria of hippocampus
Temporal (inferior) horn
Hippocampus of lateral ventricle

Fornix: schema Coronal section: posterior view

Plate 112 Meninges and Brain


Cerebellum
mwmmmMmmmm

Anterior cerebellar notch Anterior lobe


Quadrangular lobule (H IV-V)
Central lobule (II & Primary fissure
Horizontal fissure
Culmen (IV & V)
Simple lobule (H VI)
Superior
vermis
Posterior lobe
Declive (VI)
Postlunate fissure
Folium (VII A) Superior semilunar
(anseriform) lobule (H VII A)
Horizontal fissure
Inferior semilunar
Posterior cerebellar notch (caudal) lobule (H VII B)

Anterior lobe
Central lobule Inferior surface
Superior vermis W i n g of central lobule
Lingula (I)
Superior J
Superior medullary velum Middle > Cerebellar peduncles
Inferior \
Flocculus (H X)
Flocculonodular lobe
4th ventricle
Posterolateral (dorsolateral)
Inferior medullary velum fissure

Nodule (X) Retrotonsillar fissure

Inferior Uvula (IX) Posterior lobe


vermis Tonsil
Pyramid (VIII)
Biventer lobule (H VIII)
Tuber (VII B) Secondary (postpyramidal)
fissure
Posterior cerebellar notch
Horizontal fissure
Inferior semilunar
(caudal) lobule (H VII B)

Cerebral c.rus
Decussation of
superior cerebellar peduncles
Medial longitudinal fasciculus
4th ventricle
Nuclear layer of
Superior medullary velum medulla oblongata

Fastigial Superior cerebellar


peduncle
Globose
Cerebellar
Lingula (I)
nuclei
Dentate
Vermis
Emboliform

Section in plane of superior cerebellar peduncle

Meninges and Brain Plate 113


11111r^^S
Brainstem
.v-^"?.'IjWTMHNHMMBH

Posterolateral view alamus (cut surface)

Lateral geniculate body

Pulvinars of thalami Optic tract

Pineal body Medial geniculate body


Superior colliculi Brachia of superior and inferior colliculi
Inferior colliculi Cerebral crus
Trochlear nerve (IV) Pons
Superior medullary velu
Trigeminal nerve (V)
Superior cerebellar peduncle
Middle cerebellar peduncle
Rhomboid fossa of
4th ventricle bulocochlear nerve (VIII)

Glossopharyngeal (IX) and Facial nerve (VII)


vagus(X)
Inferior cerebellar peduncle
Cuneate tubercle
Hypoglossal nerve (XII)
Gracile tubercle
Accessory nerve (XI)
Dorsal roots of
1 st spinal nerve (C1)

Cuneate fasciculu

Gracile fascicul

Olfactory tract

Anterior view Anterior perforated substance


>f
Infundibulum (pituitary stalk)
Optic chiasm
Mammillarv bodies

Optic tract Temporal lobe (cut surface)

Oculomotor nerve (111)


Tuber cinereum
chlear nerve (IV)
Cerebral crus geminal nerve (V)

Lateral geniculate body Abducent nerve (VI)

Facial nerve (VII) and


Posterior perforated su intermediate nerve

Vestibulocochlear nerve (VIII)


Pons
Flocculus of cerebellum
Middle cerebellar pedun
Choroid plexus of 4th
ventricle
Olive
Glossopharyngeal nerve (IX)
Pyramid s nerve (X)

Ventral roots of 1st spinal nerve (C I ypoglossal nerve (XII)

Accessory nerve (XI)


Decussation of pyramids

Plate 114 Meninges and Brain


Fourth Ventricle and Cerebellum

rJm$mm
mam mmmmmmmmwm\wmmmm
Rv i;

Posterior view Habenular trigone

3rd ventricle literal' j Geniculate bodies

Pulvinar of thalamus Dorsal median sulcus


Pineal body Superior cerebellar peduncle
Superior collicul Locus ceruleus

Inferior colliculu Medial eminence

Trochlear nerve (IV) Facial colliculus

Superior medullary velu Vestibular area

Superior Dentate nucleus


Cerebellar peduncles { Middle of cerebellum
Inferior Striae medullares
Lateral recess enia of 4th ventricle
Superior fovea Cuneate tubercle
Sulcus limitans Gracile tubercle
Inferior fovea Dorsal median sulcus
Trigeminal tubercle Lateral funiculus
Hypoglossal trigone uneate fasciculus
Vagal trigone Gracile fasciculus
Obex

Interthalamic adhesion
Median sagittal section
Posterior commissure
Body of fornix
Habenular commissure
Thalamus (in
3rd ventricle) Pineal body
Interventricular Splenium of corpus callosum
foramen (of Monro)
Anterior commissure Great cerebral vein (of Galen)

Lamina terminalis
Lingula (I)
Hypothalamic sulcus
Central lobule (ll-III)
Cerebral peduncle Vermis of
Culm en (IV-V) cerebellum
Cerebral aqueduct (of Sylvius) Declive (VI)
Superior colliculus Folium (VII A)
Tectal (quadrigeminal) plate
Superior medullary velum
Inferior colliculus
Pons -Inferior medullary velum
Medial longitudinal fasciculus
Tuber (VII B)
4th ventricle
Pyramid (VIII) Vermis of
Choroid plexus of 4th ventricle
Uvula (IX) cerebellum
Medulla oblongata
Nodulus (X)
Median aperture (foramen of Magendie)
Decussation of pyramids Choroid plexus of 4th ventricle

Central canal of spinal cord Tonsil of cerebellum

Meninges and Brain FBafe 115


Cranial Nerve Nuclei in Brainstem: Schema
jvA'^v^t^KvXffi'K^;: fit:

Posterior phantom view Oculomotor nerve (III)

Red nucleus
Superior colliculus

Oculomotor nucleus

Accessory oculomotor
Lateral geniculate body (Edinger-Westphal) nucleus

Mesencephalic nucleus Trochlear nucleus


of trigeminal nerve
Trochlear nerve (IV)
Principal
sensory nucleus of Motor nucleus of
trigeminal nerve trigeminal nerve

Trigeminal nerve Trigeminal


(V) and ganglion nerve (V)
and ganglion
Facial nerve (VII)
and geniculate
ganglion Abducent nucleus

Vestibulocochlear Facial nucleus


nerve (VIII)-
Geniculum
(geniculate ganglion)
of facial nerve

Superior
Anterior and inferior
Cochlear salivatory
nuclei Posterior nuclei

Vestibular
nuclei Glosso-
pharyngeal
nerve (IX)
Glossopharyngeal
nerve (IX)
Vagus nerve (X)

Vagus nerve(X)
Accessory nerve (XI)*

Spinal tract and spina Nucleus ambiguus


nucleus of trigeminal nerve

Posterior (dorsal) nucleus


Solitary tract nucleus of vagus nerve (X)

Dorsal vagal nucleus Hypoglossal nucleus

Spinal nucleus
Efferent fibers of accessory nerve

Afferent fibers
Mixed fibers

*Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve.
Verification of this finding awaits further investigation.

Plate 116 Cranial and Cervical Nerves


Cranial Nerve Nuclei in Brainstem: Schema (continued)
WjjBWSKj

Medial dissection
Accessory oculomotor
(Edinger-Westphal) nucleus

Red nucleus
Oculomotor nucleus

Oculomotor nerve nucleus

Mesencephalic nucleus nerve (IV)


of trigeminal nerve

Abducent nucleus
Trigeminal
nerve (V)
and ganglion Internal genu
of facial nerve

Principal
sensory nucleus of Facial nucleus
trigeminal nerve

Vestibular nuclei
Motor nucleus of
trigeminal nerve
Anterior and posterior
cochlear nuclei
Facial nerve (VII)

Superior and
inferior salivatory
Vestibulocochlear nerve (VIII)
nuclei

Abducent nerve (VI)


Solitary tract nucleus

Glossopharyngeal nerve (IX) Posterior (dorsal) nucleus


of vagus nerve (X)

Hypoglossal nerve (XII)


Hypoglossal nucleus

Vagus nerve (X)


Nucleus ambiguus

Accessory nerve (XI)*


Spinal nucleus of accessory nerve

Efferent fibers
Spinal tract and spinal
nucleus of trigeminal nerve Afferent fibers
4P
Mixed fibers

"Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve.
Verification of this finding awaits further investigation.

Plate 117
Cranial Nerves (Motor and Sensory Distribution): Schema
M M H I m^umemmmmm asJefSKSS

Spinal nerve fibers


Efferent ( m o t o r ) fibers
Afferent (sensory) fibers

Oculomotor ^ ^
Ciliary muscle, sphincter
Olfactory pupillae, and all external eye
Nasal cavity muscles except those below

Trochlear
Superior oblique muscl mm Motormuscles of
Trigeminal mastication-^""
VI Sensorvface
I

Abducent___y/^ sinuses, teeth


Lateral r e c t u s ^ / / /
muscle yyx

Intermediate nerve
VII M o t o rs u b m a n d i b u I a r,
Facial sublingual, lacrimal glands
Muscles of face Tasteanterior -/i of
tongue, sensory soft palate

VIII
Vestibulocochlear
j, v-

Cochlear Vestibular

Glossopharyngeal
Tasteposterior of tongue
Sensorytonsil, pharynx, middle ear
Motorstylopharyngeus,
parotid gland

liiiK;

Vagus
Motorheart, lungs, palate, pharynx,
pfe^l'S.f
larynx, trachea, bronchi, Gl tract
XII Sensoryheart, lungs, trachea,
ill Accessory \ bronchi, larynx, pharynx, ^
Hypoglossal Sternocleidomastoid
Tongue tj* Gl tract, external ear IB
trapezius muscles
muscles ^

Strap
muscles
(CI, 2, 3
fibers)

Plate 118 Cranial and Cervical Nerves


Subcallosal (parolfactory) area

Septal area and nuclei


Olfactory bulb cells: schema
Fibers from \ Contralateral
Efferent fibers to Fibers to \ olfactory bulb
olfactory bulb

Afferent fibers from bulb Anterior commissure


to central connections
and contralateral bulb Medial
olfactory stria
Granule cell (excited by
and inhibiting to mitral
and tufted cells)

Mitral cell

/ - 7

Olfactory
nerve fibers

Dura
mater

Olfactory cells Olfactory tract

Olfactory mucosa Olfactory trigone /


and olfactory tubercle
Olfactory nerves (I)
Lateral olfactory stria Uncus
Olfactorv bulb
Lateral olfactory tract nucleus
Hippocampal
Cribriform plate of ethmoid bone
fimbria
Anterior perforated substance
Anterior olfactory nucleus
Amygdaloid body Dentate gyrus

Piriform lobe Parahippocampal gyrus

Cranial and Cervical Nerves Plate 119


Optic Nerve (II) (Visual Pathway): Schema


1 mm*

Central darker
Mttmrn circle represents
macular zone
Overlapping i Lighter shades
visual fields 1 represent
monocular fields
Each quadrant
a different color

Projection on
Projection on right retina
left retina

\ O p t i c nerves ( I I ) j
Choroid Choroid
\ \ Optic chiasm y
s ^ / j
Periphery Macula

Structure of retina: schema Projection on right


Projection on left
dorsal lateral
A Amacrine cells dorsal lateral
geniculate nucleus
B Bipolar cells geniculate nucleus
Optic tracts
C Cones
G Ganglion cells
H Horizontal cells
Lateral
P Pigment cells geniculate
R Rods bodies \

Optic radiation
Optic radiation

Calcarine
sulcusv

Calcarine
sulcus

mm

Projection on left Projection on right


occipital lobe occipital lobe

Plate 120 Cranial and Cervical Nerves


Oculomotor (III), Trochlear (IV), and Abducent (VI) Nerves: Schema
mmmxtm IIIIIIIIMIIlllillllilllWIilWM^
See also Plates 86,132, 167, 168

Long ciliary nerve Ciliary ganglion

Short ciliary nerves Posterior ethmoidal nerve Abducent nucleus


Anterior ethmoidal nerve
Sensory root of ciliary ganglion
Trochlear nucleus
Superior oblique muscle
Sympathetic root of ciliary ganglion
Levator palpebrae
Oculomotor nucleus
superioris muscle Superior division of
oculomotor nerve
Superior Accessory oculomotor
rectus muscle (Edinger-Westphal)
Frontal nerve (cut)
nucleus (parasympathetic)
Lacrimal nerve (cut)

Trochlear nerve (IV)


Nasociliary nerve

O c u l o m o t o r nerve (III)

Ophthalmic nerve (V |)

Abducent
Infraorbital nerve
nerve (VI)
Zygomatic nerve (cut) Pterygopalatine
ganglion Mandibular nerve (V3)
Inferior oblique muscle
Internal carotid artery
Ciliary muscle Inferior division of
and nerve plexus
oculomotor nerve
Dilator pupillae muscle Maxillary nerve (V 2 )
Medial rectus muscle
Sphincter pupillae muscle
Lateral rectus muscle and
Inferior rectus muscle abducent nerve {turned back)
Efferent fibers
Afferent fibers Parasympathetic root Cavernous plexus
of ciliary ganglion
Sympathetic fibers Common tendinous ring
Parasympathetic fibers

Cranial and Cervical Nerves Plate 121


Trigeminal Nerve (V): Schema
mflMMMHBM^^
See also Plates 24, 42, 43, 45, 46, 167, 168

Trigeminal nerve (V) ganglion and nuclei


Ophthalmic nerve (V^) Motor nucleus
Efferent fibers Mesencephalic nucleus
Afferent fibers Tentorial (meningeal) branch Principal sensory nucleus
Proprioceptive fibers Nasociliary nerve Spinal tract and nucleus
Parasympathetic fibers Lacrimal nerve
Sympathetic fibers Sensory root of
ciliary ganglion
Frontal nerve
Ciliary ganglion
Posterior ethmoidal nerve
Long ciliary nerve
Short ciliary nerves
Anterior ethmoidal nerve
Supraorbital nerve
Supratrochlear nerve
Infratrochlear nerve
Internal nasal branches
and
External nasal branches
of anterior ethmoidal nerve

Maxillary nerve (V 2 )
Meningeal branch
Zygomaticotemporal
mk*
nerve
Zygomaticofacial nerve
Zygomatic nerve
Infraorbital nerve
Pterygopalatine
ganglion
Superior
alveolar
branches of
infraorbital nerve
Nasal branches
(posterior superior
lateral, nasopalatine, Facial nerve (VII)
and posterior
superior medial) Chorda
tympani nerve
Nerve (Vidian) of
pterygoid canal
(from facial nerve [Vllj
and carotid plexus)
Pharyngeal branch
Greater and lesser
palatine nerves

Superficial
Deep temporal nerves
temporal branches
(to temporalis muscle)
Lateral pterygoid Articular branch
and masseteric nerves and anterior
auricular nerves
Tensor veli palatini and
medial pterygoid nerves Auriculotemporal nerve
Submandibular Inferior \ \ \
Buccal nerve Parotid branches
ganglion alveolar nerve I \
Mental nerve Meningeal branch
Inferior dental plexu Mylohyoid nerve / Otic ganglion \
Lesser petrosal nerve (from
Lingual nerve Mandibular nerve (V 3 ) Tensor tympani nerve glossopharyngeal nerve IIX])

Plate 122 Cranial and Cervical Nerves


Facial Merwe (VII): Schema
See also Plates 25, 167, 168

Facial nerve (VII) Internal acoustic meatus


Greater petrosal nerve
Deep petrosal nerve (from internal carotid plexus) Geniculate ganglion Intermediate nerve

Lesser petrosal nerve Internal carotid plexus Motor nucleus of facial nerve
(on internal carotid artery)
Nerve (Vidian) of pterygoid ca nal Superior salivatory nucleus

Otic gang lion Solitary tract nucleus

Pterygopalatine ganglion

Facial muscles

Frontal belly (frontalis)


of o c c i p i t o f r o n t a l
Orbicularis oculi
Corrugator supercilii
Zygomaticus major
Zygomaticus minor
Procerus
Levator labii
superiors
Levator labii
superioris
alaeque nasi
Levator
anguli oris
Nasalis

omatic
Depressor
jwOccipital
septi nasi
If belly
Buccal
Orbicularis femches W m I ( c c ' P ' t a ' ' s ) of
oris occipitofrontal
muscle
Depressor Occipital
anguli oris branch of
posterior
Depressor labii auricular
inferioris nerve

Mentalis Branches to auricular muscles


Posterior auricular nerve
(Risorius)
(not shown) Nerve to stapedius muscle
Buccinator Stylomastoid foramen

Platysma tympanic plexus


Tympanic nerve (of Jacobson)
Sublingual gland (from glossopharyngeal nerve)
Submandibular gland Glossopharyngeal nerve (IX)
- Efferent fibers
Submandibular ganglion Digastric muscle (posterior belly)
- Afferent fibers
n .. r-i Lingual nerve (from trigeminal nerve) Stylohyoid muscle
Parasympathetic fibers
- Sympathetic fibers Chorda tympani nerve Caroticotympanic nerve (from internal carotid plexus)

Cranial and Cervical Nerves Plate 123


Afferent fibers Facial canal

Geniculum (geniculate
ganglion) of facial nerve Chorda tympani nerve

Greater petrosal nerve Head of malleus

Cochlear (spiral) ganglion


Incus

Vestibular nerve

Cochlear nerve

Motor root of facial nerve


and intermediate nerve

Vestibulocochlear
nerve (VIII)

Medulla oblongata
(cross section)

mm* \ '
&
V-' vm
; v1- . / V-
ms

Ampulla of lateral
semicircular duct
Internal
Medial acoustic Ampulla of superior
meatus semicircular duct
Vestibular Superior-
nuclei Anterior Utricle
Cochlear
(diagrammatic) Interior
Posterior nuclei
Ampulla of posterior
Lateral semicircular duct
Inferior cerebellar
peduncle (to cerebellum) Saccule

Superior division
Vestibular ganglion of vestibular nerve
Inferior division

Plate 124 Cranial and Cervical Nerves


Glossopharyngeal Nerve (IX): Schema

Efferent fibers Spinal tract and spinal nucleus of trigeminal nerve


Afferent fibers Solitary tract nucleus
Parasympathetic fibers Tympanic nerve (of Jacobson) Nucleus ambiguus
Tympanic cavity and plexus Inferior salivatory nucleus
Stylomastoid foramen Geniculum (geniculate
ganglion) of facial nerve
Caroticotympanic nerve (from internal carotid plexus)
\i
Greater petrosal nerve
Deep petrosal nerve

Nerve (Vidian) of pterygoid canal


Lesser petrosal nerve
Pterygopalatine ganglion
Mandibular nerve (V 3 )
Otic ganglion
Auriculotemporal nerve

Parotid gland

Tubal branch of tympanic plexus

Auditory (pharyngotympanic,
Eustachian) tube and pharyngeal open ng
j* "
Glossopharyngeal
Stylopharyngeus muscle (and branch nerve (IX)
from glossopharyngeal nerve)
Jugular foramen

Communication to auricular
branch of vagus nerve

Superior and
Inferior ganglia of
Glossopharyngeal nerve

Communication to facial nerve (VII)


Taste and
somatic Vagus nerve (X)
sensation:
posterior Superior cervical
V>of tongue sympathetic ganglion

Sympathetic trunk

Carotid branch of
glossopharyngeal nerve

Internal carotid artery


Pharyngeal plexus
Carotid sinus
Pharyngeal, tonsillar, and lingual
branches of glossopharyngeal nerve Carotid body

C o m m o n carotid artery
Pharyngeal branch of vagus nerve

External carotid artery

Cranial and Cervical Nerves Plate 125


Vagus Nerve (X): Schema
I8fififiQfDSffln99BfiK&3fi3BS

See also Plates 167, 168


/I* N v' Xt X/Posterior nucleus of vagus
I \ \ ~ ' / n e r v e (parasympathetic

Glossopharyngeal nerve (IX) v i\ \h, / and visceral afferent)

Solitary tract nucleus (visceral


Meningeal branch of vagus nerv
afferents including taste)
Auricular branch of vagus nerve
Spinal tract and spinal
Auditory (pharyngotympanic, Eustachian) tube nucleus of trigeminal nerve
(somatic afferent)
Levator veli
palatini muscle Nucleus ambiguus
(motor to pharyngeal
Salpingopharyngeus and laryngeal muscles)
muscle Cranial root of
accessory nerve*
Palatoglossus muscle (see next plate)
Palatopharyngeus Vagus nerve (X)
muscle
Jugular foramen
Superior pharyngeal
constrictor muscle Superior ganglion of vagus nerve

Stylopharyngeus muscle Inferior ganglion of vagus nerve

Middle pharyngeal constrictor muscl Pharyngeal branch of vagus nerve (motor to muscles of
palate and pharynx; sensory to lower pharynx)
Inferior pharyngeal constrictor muscle
Communicating branch of vagus nerve to
Cricothyroid muscle carotid branch of glossopharyngeal nerve

Trachea Pharyngeal plexus

Esophagus Superior laryngeal nerve:


Internal branch (sensory and parasympathetic)
Right subclavian a External branch (motor to cricothyroid muscle)

Right recurrent laryngeal nerve Superior cervical cardiac branch of vagus nerve

Heart Inferior cervical cardiac branch of vagus nerve


A

Hepatic branch of anterior Thoracic cardiac branch of vagus nerve


vagal trunk (in lesser omentum)
Left recurrent laryngeal nerve (motor to muscles of larynx
Celiac branches from anterior except cricothyroid; sensory and parasympathetic to
and posterior vagal trunks larynx below vocal folds; parasympathetic, efferent, and
to celiac plexus afferent to upper esophagus and trachea)

Celiac and superior mesenteric Pulmonary plexus


ganglia and celiac plexus
Cardiac plexus
Hepatic plexus
Esophageal plexus
Gallbladder
and bile ducts Anterior vagal trunk

Liver Gaslric branches of anterior vagal trunk


(branches from posterior trunk behind stomach)
Pvloric branch
/

fibers (parasympathetic motor,


from hepatic plexus
secretomotor, and afferent fibers) accompany
superior mesenteric artery and its branches
Pancreas
usually as far as left colic (splenic) flexure
Duodenum
Small intestine
Ascending colon
Efferent fibers
Cecum
Afferent fibers
Appendix Parasympathetic fibers

Plate 126 Cranial and Cervical Nerves


mmrnm

A c c e s s o r y Merwe (XI): S c h e m a p i l i
JHll
See also Plate 32

Nucleus ambiguus
Cranial root of accessory nerve (joins vagus nerve
and via recurrent laryngeal nerve supplies muscles of
Vagus nerve (X) larynx, except cricothyroid)

Jugular foramen

Superior ganglion
of vagus nerve

Accessory nerve (XI)*

Inferior ganglion
of vagus nerve

CI spinal nerve

C2 spinal nerve

Accessory nerve
(to sternocleidomastoid
and trapezius muscles)

Sternocleidomastoid muscle (cut)

C3 spinal nerve

C4 spinal nerve

Trapezius muscle

Efferent fibers
Proprioceptive fibers

*Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve.
Verification of this finding awaits further investigation.

Cranial and Cervical Nerves Plate 127


Hypoglossal Nerve (XII): Schema
K&.vl-j,-:

See also Plate 32

Hypoglossal nerve (XII) Meningeal branch


(in hypoglossal canal)

Hypoglossal nucleus
Superior
longitudinal
Intrinsic
muscles Transverse
of tongue and vertical
Styloglossus
Inferior muscle
longitudinal

Occipital condyle

Inferior ganglion of
vagus nerve

Ventral rami of
C1, 2 , 3 form
ansa cervicalis
of cervical plexus

Superior cervical
sympathetic
ganglion

Superior root of
Genioglossus ansa cervicalis
muscle

Internal carotid artery


Geniohyoid muscle
(via CI)'
Inferior root of ansa cervicalis

Thyrohyoid muscle' Ansa cervicalis


(via C I )

Omohyoid muscle Internal jugular vein


(superior belly)

Common carotid artery

Efferent fibers

Afferent fibers

Plate 128
See also Plate 32

Sternocleidomastoid muscle (cut) Great auricular nerve

Accessory nerve (XI)


Lesser occipital nerve
Hypoglossal nerve (XII)
Greater occipital nerve
Geniohyoid muscle (from dorsal ramus of C2)

Nerves to anterior and lateral


rectus capitis and longus
capitis and colli muscles

Nerves to longus capitis and


colli and levator scapulae muscles
Thyrohyoid muscle rapezius muscle

Superior root Nerves to longus capitis and


of ansa cervicalis colli, levator scapulae, and
middle scalene muscles
Inferior root
of ansa cervicalis Communication to
brachial plexus
Transverse cervical nerve
Phrenic nerve
Omohyoid muscle
(superior belly)

Sternothyroid muscle

Sternohyoid muscle Supraclavicular nerves (medial,


intermediate, and lateral)
Ansa cervicalis

Sternocleidomastoid muscle {cut)


Efferent fibers
Omohyoid muscle (inferior belly)
Afferent fibers

Proprioceptive fibers

Plate 129
B V / Q .

Autonomic Nerves in Neck


QBmUBXSi

See also Plates 71, 125, 126, 165, 166, 209, 226, 240, 318

Internal V"
j .
carotid nerve > *

fi m
4 rV;JT fe
w <

^A
wSKB
.v;

Glossopharyngeal
nerve (IX) 1
V
i
'^Vij
La r y n go p h a r y n gea I
sympathetic branch
0x8:

M
m
Vagus nerve (X) (cut)
m m
m
Superior cervical /- zmm-x& /I;':' I
sympathetic ganglion K
^ J t i
f I
t* J-
are
15 u
:i..>.-' X
C2
/
m ISki
,M
i
Si c.'..'y.'.'/

"^Pharyngeal
X plexus
V / /

Pharyngeal branch
of vagus nerve
m:
111 External carotid artery and plexus
Gray rami Superior laryngeal nerve
communicantes
Internal carotid artery and carotid
branch of glossopharyngeal nerve
Carotid body
Carotid sinus
9
W Superior cervical cardiac branch
/
of vagus nerve
I Superior cervical sympathetic
IC . ,

V'VA
7
cardiac nerve
i Phrenic nerve (cut)
Middle cervical sympathetic ganglion
iflHH

Common carotid artery and plexus


Middle cervical sympathetic cardiac nerve
t
Vertebral ganglion
AT:
''^ig K Vertebral artery and plexus
C8 m
ISw
jB Recurrent laryngeal nerve
W
Cervicothoracic (stellate) ganglion
JfP5B
Ansa subclavia
Vagus nerve (X) (cut)
X; mm Inferior cervical sympathetic
-Ma cardiac nerve
V
M Thoracic sympathetic and
--y'y
vagal cardiac nerves
>VS:

Subclavian artery

Plate 130 Cranial and Cervical Nerves


Autonomic Nerves in Head
See also Plates 44-46, 86, 121, 132-134, 165, 166

Greater petrosal nerve Deep petrosal nerve Nasociliary nerve


Nerve (Vidian) of pterygoid canal
Sensory root Sensory ) Roots of

Trigeminal nerve (V) <{ Motor root Oculomotor nerve (III) Sympathetic > ciliary
Ganglion Maxillary nerve (V 2 ) Parasympathetic )

Ophthalmic nerve (V ,)
Internal carotid artery and plexus
Frontal and Ciliary ganglion
lacrimal
Geniculum (geniculate ganglion)
of facial nerve nerves {cut)
Long ciliary nerve
Facial nerve (VII)
Short ciliary nerves
Vestibulocochlear
nerve (VIII)
Posterior, superior,
Glossopharyngeal and inferior lateral
nerve (IX) nasal nerves

Vagus nerve (X)

Mandibular
nerve (V 3 )

Otic
ganglion

Internal
carotid nerve

Chorda tympani
nerve Pterygopalatine
ganglion

Superior laryngeal
nerve (cat) Greater
and lesser
palatine nerves
Superior cervical
sympathetic ganglion
Lingual nerve
Internal carotid
artery and plexus Inferior
alveolar nerve
Carotid branch of
glossopharyngeal nerve Submandibular
ganglion
Carotid sinus
Maxillary artery Middle meningeal artery and plexus
and plexus
Cervical
sympathetic trunk Facial artery and plexus
External carotid
artery and plexus
Superior cervical
cardiac branch of Common carotid artery and plexus
vagus nerve

Superior cervical sympathetic cardiac nerve

Plate 131
Ciliary Ganglion: Schema
See also Plates 167, 168

Sphincter pupillae muscle Oculomotor Accessory oculomotor


Short ciliary nerves (parasympathetic) (Edinger-Westphal)
root of ciliary ganglion nucleus (parasympathetic)
Ciliary
Ciliarv muscle

Superior colliculus

Lateral
geniculate body

81

Optic nerve (ll) /


Tympanic,
Ophthalmic
Nasociliary nerve' plexus
nerve (V.)

Long ciliary nerve


Trigeminal
ganglion- Tectospinal tract
Nasociliary (sensory)
root of ciliary ganglion
Internal i
Sympathetic root of ciliary ganglion carotid plexus Thoracic part
of spinal cord
Ophthalmic artery
Internal .
carotid artery

Superior cervical sympathetic ganglion

1 st thoracic sympathetic trunk ganglion-


Preganglionic
sympathetic
Gray ramus communicans cell bodies
Preganglionic I in inter-
n * * r - ( Sympathetic fibers .. mediolateral
nucleus
Postganglionic) White ramus communicans (lateral
horn) of gray
T1 spinal nerve
Preganglionic \ matter

Postganglionic) Parasympathetic fibers


Visual pathway
Afferent fibers
Descending pathway

Plate 132 Cranial and Cervical Nerves


Pterygopalatine and Submandibular Ganglia: Schema
See also Plates 167, 168

Trigeminal ganglion
Ophthalmic nerve (V-j)
Deep petrosal nerve
Mandibular nerve (V 3 )
Greater petrosal nerve
Otic ganglion
Chorda tympani nerve
Lingual nerve
Trigeminal nerve (V)
Maxillary nerve (V 2 )
Facial nerve (VII)
Nerve (Vidian) of pterygoid canal (intermediate nerve)
Pterygopalatine ganglion Superior salivatory
nucleus
Lacrimal gland

Descending palatine nerves


Posterior nasal nerves

Glossopharyngeal nerve (IX)


Superior cervical sympathetic ganglion
Palatine nerves
Sympathetic trunk
T1 and T2 spinal nerves

Submandibular ganglion Thoracic


spinal
cord

Dorsal
root

Sublingual gland

Submandibular gland
Ventral Sympathetic
Facial artery-
'OOt preganglionic cell
bodies in
Lingual artery intermediolateral
nternal carotid artery
nucleus (lateral
External carotid artery and plexus horn) of gray
matter
Common carotid artery

if Sympathetic preganglionic fibers


Sympathetic postganglionic fibers
Parasympathetic preganglionic fibers
Parasympathetic postganglionicfibers

Cranial and Cervical Nerves Plate 133


Otic Gangliem Schema
See also Plates 167, 168

Mandibular nerve (V 3 ) Trigeminal ganglion

Lesser petrosal nerve


Otic ganglion
Chorda tympani nerve
Ophthalmic nerve (V-j)
Trigeminal nerve (V)

Maxillary nerve (V 2 ) Facial nerve (VII)

Glossopharyngeal nerve (IX)


AuricuIotemporal nerve
Inferior salivatory nucleus
Superficial temporal artery
Pons
Parotid gland

Maxillary
artery

Medulla
oblongata

Tympanic
plexus

Inferior Tympanic
alveolar nerve nerve
(of Jacobson)

Inferior ganglion (IX)


Lingual nerve
Superior cervical sympathetic ganglion
Sympathetic trunk
Thoracic
spinal cord
External carotid artery

Dorsal root

Internal carotid artery

Common carotid artery

White Gray
Sympathetic
preganglionic
Rami communicantes cell bodies in
intermediolateral
nucleus (lateral
i i Sympathetic preganglionic fibers horn) of gray
matter
^ ^ ^ Sympathetic postganglionic fibers
M^vttw^wi Parasympathetic preganglionic fibers
m ess] Parasympathetic postganglionic fibers

Plate 134 Cranial and Cervical Nerves


Taste Pathways: Schema
See also Plates 46, 94,123, 125, 126

f n Usual pathway
\ .J ~ Accessory pathway

Ventral posteromedial (VPM)


nucleus of thalamus

Sensory cortex (just below face area)

-ateral hypothalamic area

Amygdaloid body

Pontine taste area

Trigeminal nerve (V)

Trigeminal (semilunar) ganglion


Mesencephalic nucleus
and
Motor nucleus Ophthalmic nerve (V j)
of trigeminal nerve
Maxillary nerve (V 2 )

Mandibular nerve (V 3 )

Pterygopalatine
\ ganglion

Im

Fungiform
papillae
Glossopharyngeal nerve (IX)

Foliate
papillae
Medulla oblongata
(lower part)

Vallate
papillae

Inferior (petrosal) ganglion


Epiglottis
of glossopharyngeal nerve

Inferior (nodose) ganglion of vagus nerve


Larynx

7
Vagus nerve (X)
..;; K
Superior laryngeal nerve

Cranial and Cervical Nerves Plate 135


Arteries to Brain and Meninges
See also Plates 33, 34

Left middle meningeal artery Middle cerebral artery

Posterior cerebral artery Anterior cerebral artery

Superior cerebellar artery Anterior communicating artery

Basilar artery hthalmic artery


Left labyrinthine
(internal acoustic) artery Posterior
communicating
Mastoid branch of artery
left occipital artery
Cavernous sinus
Anterior inferior
cerebellar artery Middle
meningeal
Posterior meningeal artery
branch of left ascending
pharyngeal artery

Posterior inferior
cerebellar artery

Left and right Maxillary


vertebral arteries artery
(intracranial part)
Superficial
Posterior meningeal temporal
branch of vertebral artery
artery
External
Anterior meningeal carotid
branch of vertebral artery artery

Posterior auricular artery Facial artery

Occipital artery Lingual artery

Internal carotid artery Ascending pharyngeal artery

Carotid sinus
Superior laryngeal artery

Carotid body
Superior thyroid artery
Vertebral artery
(cervical part) Common carotid artery

Transverse process of C6 Ascending cervical artery (cut)

Deep cervical artery Inferior thyroid artery

Supreme intercostal
Thyrocervical trunk
artery

Costocervical trunk Brachiocephalic trunk

Subclavian artery Internal thoracic artery

Plate 136 Cerebral Vasculature


Veins of the Vertebral Column: Vertebral Veins

Variation: right vertebral vein crossing


anterior to right subclavian artery Left vertebral artery ,
Left vertebral vein
Anterior vertebral veins
Left subclavian artery
Right deep cervical vein Left brachiocephalic vein
Accessory vertebral vein
Right vertebral artery
rib Vertebral veins: detail showing
Right subclavian artery and vein venous communications

Right internal jugular vein Anterior arch of atlas (CI) (cut)


(inferior bulb)
Right brachiocephalic vein Dura mater

Right vertebral vein


Right clavicle Right vertebral artery
Right c o m m o n carotid artery
Anterior internal (epidural)
vertebral venous plexus
Dens (C2) (cut)
Venous plexus of vertebral artery
Anterior external vertebral venous plexus
Epidural fat and anterior internal vertebral (epidural) venous plexus
Communicating vein
Basivertebral vein
Intervertebral veins
Veins of the vertebral
c o l u m n : vertebral veins Vertebral artery with venous plexus

Superior bulb of right internal jugular vein Deep cervical vei


Vertebral arteries
Anterior vertebral
Condylar emmissary vein Dura mater veins
Body of C3 cut away to show
venous communications

Mastoid emmissary vein Anterior internal (epidural) vertebral venous plexus


Venous plexus of vertebral artery
Anterior external vertebral venous plexus

Communicating veins Anterior vertebral veins

Left deep cervical vein


Right deep cervical vein
Left vertebral vein
Forming vertebral vein Left vertebral artery

Accessory vertebral vein Left thyrocervical trunk


Right vertebral artery and vein Left internal jugular vein (inferior bulb)
Dorsal scapular artery
Left subclavian artery
Costocervical trunk
Right thyrocervical Left subclavian vein
trunk
Left brachiocephalic vein
Right subclavian vein
Left c o m m o n carotid artery C'/Ytf^cwb-
Right internal jugular vein
(inferior bulb)
Right brachiocephalic vein
Right subclavian artery Right c o m m o n carotid artery

C e r e b r a l W a s e u l a t y r e P l a t e 1 3 7
Arteries to Brain: Schema
BBgBggBBSBSSag^^ Illllllll

Anterior cerebral artery Anterior communicating artery

Middle cerebral artery Ophthalmic artery

Supraorbital artery
Posterior communicating artery
Supratrochlear artery
Caroticotympanicbranch
of internal carotid artery -acrimal artery

Dorsal nasal artery


Posterior cerebral artery
Middle meningeal artery
Superior cerebellar artery
Angular artery
Anterior tympanic artery
Superficial temporal artery

Middle meningeal artery Posterior auricular artery

Maxillary artery Facial artery

Basilar artery Occipital artery

Lingual artery
Anterior inferior
cerebellar artery Ascending pharyngeal artery

Posterior inferior Anterior spinal artery


cerebellar artery
Spinal segmental
medullary branches
External carotid artery
Vertebral artery
Internal carotid artery
Common carotid arterv
Superior thyroid artery Deep cervical artery

Common carotid arte ry Superficial cervical artery

Suprascapular artery
Vertebral artery
Supreme intercostal artery
Ascending cervical artery
Costocervical trunk

Inferior thyroid artery

Thyrocervical trunk
Subclavian artery
Subclavian arterv Internal thoracic artery

Brachiocephalic trunk

Anastomoses
1 Right-Left
Aorta Descending 2 CaroticJ-Vertebral
3 Internal carotid-External carotid
Ascending-
4 Subclavian-Carotid
5 Subclavian-Vertebral

Plate 138 Cerebral Vasculature


Arteries of Brain: Inferior Views
....... y,-.*.
SwEB^iMvyMi

Medial frontobasal (orbitofrontal) arter

Anterior communicating artery

Anterior cerebral artery

Distal medial striate artery


(recurrent artery of Heubner)

Internal carotid artery

Anterolateral central (lenticulostriate) arteries

M i d d l e cerebral artery

Lateral frontobasal (orbitofrontal)

Prefrontal artery

Anterior choroidal artery

Posterior communicating artery

Posterior cerebral artery

Superior cerebellar

Basilar artery

Pontine arteries

Labyrinthine (internal acoustic) arter

Anterior inferior cerebellar artery (AICA)

- Vertebral artery

Anterior spinal

Posterior inferior cerebellar artery (PICA) (cut)

Posterior spinal artery

Cerebral arterial
circle (of Willis)
Distal medial striate artery {broken line)
(recurrent artery of Heubner)
Anterior communicating artery
Anterior cerebral artery
Middle cerebral artery
Posterior communicating artery
Anterior choroidal artery
Optic tract
Posterior cerebral artery
Cerebral crus
Lateral geniculate body
Posterior medial choroidal artery
Posterior lateral choroidal artery
Choroid plexus of lateral ventricle
Medial geniculate body
Pulvinar of thalamus
Lateral ventricle

Cerebral Vasculature Plate 139


Cerebral Arterial Circle (of Willis)
For hypophyseal arteries see Plate 148

Distal medial striate artery


Vessels dissected out: inferior view (recurrent artery of Heubner)

Anterior cerebral artery


Anteromedial central (perforating)
(A 2 segment)
arteries
Anterior communicating artery
Hypothalamic artery
Anterior cerebral artery
(A] segment)
Anterolateral central
Ophthalmic artery (lenticulostriate) arteries

Internal carotid artery

Middle cerebral
Superior hypophyseal artery

Posterior communicating artery Inferior hypophyseal artery

Anterior choroidal artery


Posterior c e r e b r i artpr
(P2 segment) fhalamotuberal
(P] segment) (premammillary) artery

Posteromedial central
Superior cerebellar artery (perforating) arteries

Basilar artery Thalamoperforating artery

Pontine arteries Posteromedial central


(paramedian) arteries

Anterior inferior cerebellar artery (AICA) Labyrinthine (internal acoustic) artery

Vertebral artery

Vessels in situ: inferior view

Anterior cerebral artery Anterior communicating artery

Optic chiasm
I lypothalamic artery
Cavernous sinus
Internal carotid arte
Infundibulum (pituitary stalk)
and long hypophyseal portal veins
Superior hypophyseal artery
Adenohypophysis (anterior
Middle cerebral artery lobe of pituitary gland)

I n f e r i o r h y p o p h y seal Neurohypophysis (posterior


lobe of pituitary gland)
Posterior communicating artery Posteromedial central
(perforating) arteries
Efferent hypophyseal veins
Superior cerebellar artery
Posterior cerebral artery
Basilar arterv

Cerebral Vasculature
MW&
Arteries of Brain: Frontal View and Section
llllliliiM |iilMIIHIHi|l|i'Mlll

Corpus callosum Paracentral artery

Medial frontal branches


Anterolateral central
(lenticulostriate) Pericallosal artery

Lateral frontobasal Callosomarginal artery


(orbitofrontal) artery
Polar frontal artery
Prefrontal
Anterior cerebral
Precentral (pre-Rolandic) arteries
and central (Rolandic)
sulcal arteries Medial frontobasal
(orbitofrontal) artery
Anterior parietal
(postcentral sulcal) Distal medial striate
artery artery (recurrent
artery of Heubner)
Posterior parietal
Internal carotid
artery
artery
Branch to Anterior choroidal
angular gyrus artery

Temporal branches Posterior cerebral


(anterior, middle artery
and posteri
Superior cerebellar artery
M i d d l e cerebral artery
and branches Basilar and pontine arteries
(deep in lateral cerebral
[Sylvian] sulcus) Labyrinthine (internal
acoustic) artery
Anterior communicating artery
Vertebral artery
Posterior communicating artery
Posterior inferior cerebellar artery (PICA)
Anterior inferior cerebellar artery (AICA) Anterior spinal artery

Posterior spinal a ,
Falx cerebri

Callosomarginal arteries
Corpus striatum and
(caudate and lentiform nuclei Pericallosal arteries
(branches of anterior
Anterolateral central cerebral arteries)
(lenticulostriate) a

Insula (island of Reil) Trunk of corpus callosum

Limen of insula Internal capsule


Precentral (pre-Rolandic),
central (Rolandic) sulcal, Septum pellucidum
and parietal arteries
Rostrum of corpus callosum

Anterior cerebral arteries


Temporal branches of
middle cerebral artery
Distal medial striate artery
(recurrent artery of Heubner)
Temporal lobe
Anterior communicating artery
Middle cerebral artery
Optic chiasm
Internal carotid artery

Cerebral Vasculature
Arteries of Brain: Lateral and Medial Views

Anterior parietal (postcentral sulcal) artery Posterior parietal artery

Central (Rolandic) sulcal artery

Precentral (pre-Rolandic) sulcal artery


Terminal branches
of posterior cerebral
Prefrontal sulcal artery
artery

Terminal branches of
anterior cerebral
artery

Lateral frontobasal
(orbitofrontal) artery

Left middle
cerebral artery

Left anterior
cerebral artery
Occipitotemporal
Anterior communicating artery branches

Posterior temporal branch


Right anterior cerebral artery
Middle temporal branch
Left internal carotid artery
Superior and inferior terminal branches (trunks)

Polar temporal artery Anterior temporal branch

Paracentral artery
Pericaliceal artery
Medial * Posterior
Cingular branches
frontal < Intermediate
branches Right posterior cerebral artery
Anterior
Precuneal artery
Callosomarginal
Dorsal branch
arterv
to corpus callosum

Parietooccipital branch
Polar frontal artery
Calcarine branch
Right anterior
cerebral artery

Medial fronto-
basal (orbito-
frontal) artery

Anterior
communicating artery (cut)
Medial occipital artery
Distal medial striate artery Posterior temporal branch
(recurrent artery of Heubner)
Anterior temporal branch
Right internal carotid artery Posterior communicating artery

*Note: Anterior parietal (postcentral sulcal) artery also occurs as separate anterior parietal and postcentral sulcal arteries.

Plate 142 Cerebral Vasculature


Arteries of Posterior Cranial Fossa
H H H B H H M H H n M H M M B H H B B B n H I M R M W n n B H B H
'WglfiigM
M H H i

Thalamogeniculate arteries Lateral and medial geniculate bodies of left thalamus

Anterior choroidal artery Choroid plexuses of lateral ventricles

Crura of fornix Pulvinars of left and right thalami


Splenium of corpus callosum
Anterolateral central
(lenticulostriate) arteries Occipital (posterior) horn of right lateral ventricle

Heads of caudate nuclei Right dorsal branch to corpus callosum


(posterior pericallosal artery)
Septum pellucidum
Parietooccipital ) Branches of
Corpus callosum > right posterior
Calcarine ) cerebral artery
Anterior
cerebral arteries

Longitudinal
cerebral
fissure

Superior
colliculi

Superior
vermian
Optic nerve (II) branch
Ophthalmic artery Posterior medial
choroidal artery
Anterior
to choroid plexus
cerebral artery
of 3rd ventricle
Middle
Posterior lateral
cerebral artery choroidal artery
Posterior
Lateral (marginal) branch
communicating artery
Inferior vermian artery
Thalamoperforating arteries (phantom)
Left internal carotid artery
Choroidal branch to 4th ventricle
Basilar artery (phantom) and
Cerebellar tonsillar branch
Pontine arteries of posterior inferior cerebellar artery
Labyrinthine (internal acoustic) artery
Outline of 4th ventricle (broken line)
Posterior cerebral artery
Posterior meningeal branch of vertebral artery
Superior cerebellar artery
Posterior inferior cerebellar artery (PICA)
Anterior inferior cerebellar artery (AICA)
Anterior meningeal branch of vertebral artery Left posterior spinal artery
Temporal branches of posterior cerebral artery
Left vertebral artery
Anterior spinal artery

Cerebral Vasculature P0ate 143


Left superior and inferior colliculi Left pulvinar

Basal vein (of Rosenthal) Right pulvinar

Posterior mesencephalic vein Internal cerebral veins

Medial geniculate body Splenium of corpus callosum

Lateral Great cerebral vein (of Galen)


mesencephalic vein
Dorsal vein of corpus callosum
Lateral geniculate body Inferior sagittal sinus
Left thalamus Straight sinus
(cut surface)
Falx cerebri
Optic tract Confluence of sinuses
Tentorium
Inferior thalamo- cerebelli (cut) Left transverse
striate veins sinus {cut)
Deep middle
cerebral Superior
vein {cut) sagittal
sinus
Anterior
cerebral
vein

Optic
nerve (II)

Superior
vermian
* >> * * yf "f ) vein

Inferior
vermian vein

Anterior ponto- Falx cerebelli (cut)


mesencephalic vein and occipital sinus

Inferior cerebellar
Trigeminal nerve (V)
hemispheric veins
Transverse pontine vein Intraculminate vein

Petrosal vein (draining Superior cerebellar vein (inconstant)


to superior petrosal sinus)
Preculminate vein
Lateral pontine vein Precentral cerebellar vein

Anteromedian medullary vein Superior retrotonsillar vein

(Inferior retrotonsillar) Parts of cerebellum


Vein of lateral recess of 4th ventricle
vein of cerebellomedullary
L Lingula TU Tuber
cistern
Superior, middle and CL Central lobule P Pyramid
inferior cerebellar peduncle's Posterior spinal vein C Culmen U Uvula
D Declive N Nodule
Anterior spinal vein 4th ventricle F Folium T Tonsil

Plate 144 Cerebral Vasculature


For superficial veins of brain see Plate 102

Longitudinal cerebral fissure


Anterior cerebral veins
Rostrum of corpus callosum
Septum pellucidum
Anterior vein of septum pellucidum
Head of caudate nucleus
Anterior vein of caudate nucleus
Transverse veins of caudate nucleus
Interventricular foramen (of Monro)
Columns of fornix
Superior thalamostriate vein
Superior choroid vein and
choroid plexus of lateral ventricle
Thalamus
a choroidea of 3rd ventricle
Lateral direct vein
Posterior vein of caudate nucleus
Internal cerebral veins
Basal vein (of Rosenthal)
Great cerebral vein (of Galen)
Inferior sagittal sinus
traight sinus
um cerebelli
nsverse sinus
Confluence of sinuses
Superior sagittal sinus

Dissection: superior view

Anterior cerebral vein

Superficial middle cerebral vein


(draining to sphenoparietal sinus Optic chiasm

Deep middle cerebral vei

Cerebral crus

Basal vein (of Rosenthal)


Inferior
Lateral geniculate body cerebral
veins
Medial geniculate body

Pulvinar of thalamus

Splenium of corpus callosum

Great cerebral vein (of Galen) Inferior


anastomotic
vein (of Labbe)

Dissection: inferior view

Plate 145
Subependymal Veins of Brain

Posterior veins of septum pellucidum Lateral direct vein

Superior thalamic veins Posterior terminal vein of caudate nucleus


(posterior part of thalamostriate vein)
Superior choroid vein
Internal cerebral veins (right and left)
Transverse veins of caudate nucleus
Medial (atrial) vein of lateral ventricle
Superior thalamostriate vein
Lateral (atrial) vein of lateral ventricle
Lateral ventricle
Splenium of corpus callosum
Anterior vein of
caudate nucleus Great cerebral vein
(of Galen)
Anterior vein of
septum pellucidum Dorsal vein of corpus
callosum
Genu of
corpus Inferior sagittal
callosum sinus

Internal
occipital vein

Straight sinus

Occipital
(posterior)
horn of
lateral
ventricle

Interventricular
foramen (of Monro)

Anterior commissure

nterthalamic adhesion

Anterior cerebral vein

Optic chiasm
Cerebellum
3rd ventricle

Deep middle cerebral vein

Inferior thalamostriate veins

Basal vein (of Rosenthal)


Temporal (inferior) horn of lateral ventricle

Posterior mesencephalic vein Superior vermian vein

Hippocampal and inferior ventricular veins

Cerebral aqueduct
Veins on lateral wall of ventricle
4th ventricle
Veins on medial wall and floor of ventricle
Lateral and median apertures of 4th ventricle All other veins

Plate 146 Cerebral Vasculature


Hypothalamus and Hypophysis
MMHnHHHRHHHHnnnn^
See also Plates 106, 107

Septum pellucidum

Thalamus

Fornix

Hypothalamic sulcus

Anterior commissure

Paraventricular
Posterior

Principal Dorsomedial
nuclei of Supraoptic
hypothalamus
Ventromedial
Arcuate
(infundibular)
Mammillary body
V
Optic chiasm

Infundibulum (pituitary stalk)

Hypophysis (pituitary gland)

Lamina terminalis Hypothalamic


sulcus
Paraventricular hypothalamic nucleus

Supraoptic hypothalamic nu

Supraopticohypophyseal tract

Tuberohypophyseal tract
Mammillary
/
body
Hypothalamohypophyseal tract

Infundibulum (pituitary stalk) Arcuate (infundibular) nucleus

Pars tuberalis
Median eminence
of tuber cinereum
Adenohypophysis Fibrous trabecu
(anterior lobe of Neurohypophysis
Pars intermedia Infundibular
pituitary gland) stem (posterior lobe
of pituitary gland)
Pars distalis
Infundibular
process

Plate 147
Arteries and Veins of Hypothalamus and Hypophysis
See also Plate 140

v. ,

1{ v

Primary plexus of
hypophyseal portal system

Superior
hypophyseal
artery Long hypophyseal portal veins

Short hypophyseal portal veins


Trabecula (fibrous tissue)

Efferent hypophyseal vein Efferent hypophyseal vein


to cavernous sinus to cavernous sinus

Secondary plexus Neurohypophysis


of hypophyseal (posterior lobe of
portal system pituitary gland)

Capillary plexus of
infundibular process
Adenohypophvsis
(anterior lobe of
pituitary gland)

Efferent hypophyseal vein


to cavernous sinus

Inferior hypophyseal artery


Efferent hypophyseal
veins to cavernous sinus

Plate 148 Cerebral Vasculature


Head Scans: Sagittal MR Images

Median (A) and paramedian (B, C) sagittal MR images

c Cerebellum N Inferior nasal


cc Corpus concha
callosum NP Nasopharynx
E Extraocular O Occipital pole
muscles O N Optic nerve
F Frontal pole P Pons
FV Fourth PG Pituitary gland
ventricle
S Sphenoid sinus
L Lateral
ventricle SC Spinal cord

M Medulla T Thalamus
oblongata TC Tentorium
MB Midbrain cerebelli

MS Maxillary sinus TO Tongue

mm

Regional Scans Plate 149


SSoB8S8BS$zS3

Axial CT images of the head f r o m inferior (A) to superior (C)

A
B Basilar artery M Medulla oblongata
C Cerebellum MA Mastoid air cells
CH Cerebral MB Midbrain
hemisphere
M M Masseter muscle
CS Confluence of MR Medial rectus
sinuses muscle
E Eye MS Maxillary sinus
EA External acoustic N Nasal concha
meatus
NS Nasal septum
ES Ethmoid sinus
P Pons
F Fat in orbit
S Sphenoid sinus
FV Fourth ventricle
SC Semicircular
L Lens canals
LP Lateral pterygoid SS Superior sagittal
muscle sinus
LR Lateral rectus T Temporalis muscle
muscle
TL Temporal lobe

Plate 150 Regional Scans


Head Scans: Coronal CT Images
See also Plates 48, 83

Coronal CT images of the head from anterior (A) to posterior (C)

A Anterior clinoid L Lateral rectus


process muscle
C Crista gaili LS Levator palpebrae
superioris and
E Eye (vitreous
superior rectus
chamber)
muscles
ES Ethmoid sinus
M Maxillary sinus
G Greater wing of
the sphenoid MR Medial rectus
muscle
I ' Inferior nasal
concha N Nasal septum

IC Incisive canal OC Oral cavity


S Sphenoid sinus
IR Inferior rectus
muscle Z Zygomatic arch

Regional Scans
Back and Spinal Cord

Topographic Anatomy
Plate 152

152 Back

Bones and Ligaments


Plates 153-159

153 Vertebral Column

154 Thoracic Vertebrae

155 Lumbar Vertebrae


efflgp 156 Lumbar Vertebrae: Radiographs

157 Sacrum and Coccyx

158 Vertebral Ligaments: Lumbar Region

159 Vertebral Ligaments: Lumbosacral Region

Spinal Cord
Plates 160-173

160 Spinal Cord and Ventral Rami in Situ

161 Relation of Spinal Nerve Roots to Vertebrae

162 Lumbar Disc Herniation: Clinical Manifestations

163 Lumbar Puncture and Epidural Anesthesia

164 Dermatomes

165 Sympathetic Nervous System: General Topography

166 Parasympathetic Nervous System: General Topography

167 Sympathetic Nervous System: Schema

168 Parasympathetic Nervous System: Schema

169 Spinal Membranes and Nerve Roots

170 Spinal Nerve Origin: Cross Sections

171 Arteries of Spinal Cord: Schema

Atlas of Human Anatomy


Back and Spinal Cord

172 Arteries of Spinal Cord: Intrinsic Distribution

173 Veins of Spinal Cord and Vertebral Column


ESS

Muscles and Nerves


Plates 174-180

174 Muscles of Back: Superficial Layers

175 Muscles of Back: Intermediate Layers

176 Muscles of Back: Deep Layers

177 Nerves of Back

178 Suboccipital Triangle

179 Lumbar Region of Back: Cross Section

180 Typical Thoracic Spinal Nerve

Atlas of Human Anatomy


Back

Trapezius muscle External occipital protuberance

Ligamentum nuchae
Spine of scapula
Spinous process of
Deltoid muscle C7 vertebra

Infraspinatus
muscle

Triceps brachii
muscle
Long head
Lateral head
Tendon

Deltoid muscle

Spine of scapula
Triangle of auscultation

Medial border of
scapula

Inferior angle of
scapula

Spinous process of
T12 vertebra

Latissimus
Lumbar (triangle dorsi muscle Gluteus medius
of Petit) muscle
Iliac crest

Erector spinae Sacrum


muscle

Gluteus maximus
Posterior superior muscle
iliac spine

Greater trochanter
of femur
Intergluteal (natal)
cleft
Gluteal fold

* .

Topographic Anatomy Plate 152


Vertebral Column
See also P l a t e s 1 3 , 1 7 , 1 8 , 1 5 4 , 1 5 5 , 1 5 7 , 1 8 5 , 2 4 8

Anterior view Left lateral view Posterior view


Atlas (C1)
-Atlas (C1)
Axis (C2)
Axis (C2)
Cervical
>
vertebrae

Thoracic
vertebrae

Lumbar
> vertebrae

Sacrum ( S I - 5 )

Sacrum (SI 5)

Coccyx
Coccyx

Plate 153 Bones and Ligaments


See also Plate 187

Superior articular
Superior process and facet
Vertebral foramen costal facet
Pedicle

Transverse
costal facet
Superior
vertebral notch Superior
nsverse
(forms lower costal facet
process
margin of
Pedicle
intervertebral
Inferior
foramen)
articular
process
sverse
costal facet Interior
costal

Inferior
vertebral notch spinous
Superior process
articular facet
Spinous process T6 vertebra:
lateral view
T6 vertebra:
superior view
Superior articular
process and facet
Vertebral cana
Superior articular
process and facet sverse
7th rib process

Costal facet

Inferior articular
process and
Spinous process of
T7 vertebra T12 vertebra:
lateral view
Transverse process of
T9 vertebra

Inferior articular process (T9)


Lamina

Spinous process (T9)

T7, T8 and 19 vertebrae:


posterior view

Bones and Ligaments PDafte 1S4


Vertebral body Anulus fibrosus

Nucleus
Vertebral foramen pulposus

Pedicle
me?.

Transverse process
Intervertebral disc

Superior articular process

Mammillary process

Lamina
Superior articular process
Spinous process
Pedicle Mammillary process

L2 vertebra: Transverse process


superior view
Spinous process

Vertebral canal Vertebral body


Inferior
Superior articular
Intervertebral disc
articular process process

Mammillary process \ Inferior


Vertebral body vertebral notch
Transverse \ \
process \ Intervertebral
(neural) foramen

Superior
vertebral
Pars interarticularis notch

Accessory
process
Lamina

Spinous process
of L3 vertebra - -

Lamina

Articular facet
Inferior for sacrum
articular process

L3 and L4 vertebrae Lumbar vertebrae, assembled


posterior view left lateral view

PQate USS H o w e s a m d L i g a m e n t s
LyoirafeaB* W e r S e f e r a e ^ f ^ a d o e g r a p B i s

Anteroposterior radiograph Lateral radiograph

B Body of L3 vertebra D Intervertebral disc space


IA Inferior articular process of L1 vertebra I Intervertebral foramen
L Lamina of L4 vertebra IA Inferior articular process of L3 vertebra
P Pedicle of L3 vertebra IN Inferior vertebral notch of L2 vertebra
S Spinous process of L4 vertebra P Pedicle of L3 vertebra
SA Superior articular process of L1 vertebra S Spinous process of L3 vertebra
SF Sacral foramen SA Superior articular process of L4 vertebra
T Transverse process of L3 vertebra SN Superior vertebral notch of L3 vertebra
Note: The vertebral bodies are numbered

Biraes and] Ugameinr&s P l a t 1S


Sacrum and Coccyx
See also Plates 153, 159, 248, 352-354

Superior
Base of sacrum articular
process

Lumbosacral
articular surface Sacral
canal
Superior
articular process

Ala (wing)

Promontory
mm.
Sacral part
of pelvic brim
(linea terminalis)
BK5

Anterior (pelvic)
sacral foramina Sacral hiatus

Transverse
ridges Median sagittal section

- A p e x of sacrum

Transverse process
of coccyx
Coccyx
Facets of
superior articular
Anterior inferior processes^
view Pelvic surface

Auricular surface

Sacral tuberosity

Lateral sacral crest

Median sacral crest


Median sacral crest
Intermediate sacral crest
Sacral canal

Intervertebral Posterior
foramen sacral foramen Posterior
sacral
foramina

Mi
W y . -Sacral cornu
r (horn)
Sacral hiatus Coccygeal cornu
Anterior (pelvic) ^ (horn)
sacral foramen Dorsal surface
Transverse process
Coronal section of coccyx
through S2 foramina

Posterior superior view

PiaSe 1 5 7 B@ps a n d L i g a m e n t s
Vertebral Ligaments: Lumbar Region 2
Left lateral view Inferior articular process
(partially sectioned
in median plane) Capsule of zygapophyseal joint
(partially opened)

Anterior
Superior articular process
longitudinal ligament

Transverse process

Lumbar vertebral body


Spinous process

Ligamentum flavum
Intervertebral disc

:
Interspinous ligament

Anterior a l l Supraspinous ligament


^
longitudinal ligament-
^ ' . r - ' S v . ;

Intervertebral foramen

Posterior
longitudinal ligament TV

\ f
" .' : . -

Posterior vertebral segments:


anterior view

Anterior vertebral segments:


Pedicle (cut surface)
posterior view
(pedicles sectioned)

Ligamentum flavum
Pedicle (cut surface)

Posterior surface
of vertebral bod'

Lamina

Posterior
longitudinal ligament Superior articular
process

Intervertebral disc

Bones and Ligaments Plate 158


Anterior Superior articular process
longitudinal
ligament Transverse process

Lamina
Pedicle [cut) Posterior
Body of Inferior articular process
longitudinal
LI vertebra
Pedicle ligament

Intervertebral foramen
Intervertebral
discs Spinous process

Interspinous ligament
L2 spinal Supraspinous ligament
nerve

Superior articular processes;


facet tropism (difference in
facet axis) on right side

Spinous process

Lamina

Transverse process
Body of
Inferior articular process
L5 vertebra
Ligamentum flavum

L5 spinal nerve Iliolumbar ligament

Iliac crest

Auricular surface of sacrum


Posterior
(for articulation with ilium)
superior
iliac spine

Sacrum

Posterior
Coccyx inferior
iliac spine

Left lateral view

Posterior sacroiliac ligaments

Greater sciatic foramen

Spine of ischium
Lateral,
Sacrospinous ligament Posterior
sacro-
Lesser sciatic foramen coccygeal
ligaments
Sacrotuberous ligament
Posterior view

Plate 159 Bones and Ligaments


Spinal Cord and Ventral Rami in Situ

C I vertebra (atlas)

C1 spinal nerve Cervical plexus

C2 vertebra (axis) C7 vertebra

C8 spinal nerve T1 vertebra

Brachial plexus
T1 spinal nerve

1 st rib Spinal dura mater

Filaments of
spinal nerve
roots (T7 and T8)
Intercostal
nerves
T12
vertebra
T12 spinal mat
nerve
LI
vertebra
12th rib

Iliohypogastric
nerve

Subcostal
nerve

L1 spinal nerve
Ilioinguinal
Conus medullaris nerve

Lumbar plexus
Cauda equina
L5 vertebra
L5 spinal nerve
Femoral nerve
S1 spinal nerve
Sacral plexus
Sacrum (cut away)
ist
Superior and inferior
Filum terminale internum gluteal nerves

Termination of dural sac Sciatic nerve

Filum terminale externum


Posterior femoral
(coccygeal ligament) cutaneous nerve
S3 spinal nerve
Pudendal nerve
Coccygeal nerve
Coccyx

SporaaQ PGafe <3 6


Relation of Spinal Nerve Roots to Vertebrae

C1 spinal nerve exits


Base above C1 vertebra
of skull
Cervical
enlargement

C8 spinal nerve
exits below
C7 vertebra
(there are 8 cervical
nerves but only
7 cervical vertebrae)

Lumbar disc protrusion does not usually affect


nerve exiting above disc. Lateral protrusion
at disc level L4-5 affects L5 spinal nerve, not
L4 spinal nerve. Protrusion at disc level L5-S1
affects SI spinal nerve, not L5 spinal nerve.

Lumbar
enlargement

Conus medullaris
(termination of
spinal cord)

Cauda equina
Filum
terminale
internum

Sacrum

Filum
terminale
externum Termination of
(coccygeal S4 clural sac
ligament)
S5

Coccygeal nerve

Coccyx Coccygeal nerve

Cervical nerves
Thoracic nerves Medial protrusion at disc level L4-5 rarely affects
Lumbar nerves L4 spinal nerve but may affect L5 spinal nerve
Sacral and coccygeal nerves and sometimes S I - 4 spinal nerves.

Plate 161 Spinal Cord


Lumbar Disc Herniation: Clinical Manifestations

Schematic cross section


showing compression of
nerve root

Nucleus
pulposus
Characteristic
posture in left-sided Nerve root
lower lumbar disc
herniation
Dura
Surgical exposure of
lower lumbar disc
herniation

Clinical features of herniated lumbar nucleus pulposus

Level of herniation Pain Numbness Weakness Atrophy Reflexes

Changes
uncommon
in knee and
Over ankle jerks,
Dorsiflexion Minor but internal
sacro-
of great toe hamstring
iliac
and foot; reflex
joint,
difficulty diminished
hip,
walking on or absent
lateral
heels; foot
L45 disc; thigh Lateral leg, drop may
5th lumbar and leg first 3 toes occur
nerve root

Over Plantar
sacro- flexion of
iliac foot and
joint, great toe
hip, may be
postero- affected;
lateral difficulty
Back of Ankle jerk
thigh walking on
calf, lateral diminished
and leg toes
L 5 - S 1 disc; heel, foot or absent
to heel Gastrocnemi-
1st sacral to toe
nerve root us and soleus

SpinaS @rdl Pflate 162


Lumbar Puncture and Epidural Anesthesia

Lumbar puncture
Cauda equina

Subarachnoid
space

Needle entering
subarachnoid space

Iliac
crest

Arrows show locations of


insertion of needles.

Epidural anesthesia

Dural sac
Epidural space
Spinous process of L4
Ligamentum flavum

Needle entering epidural space

Epidural anesthesia and lumbar puncture are performed by inserting a needle above or below the L4 vertebral spine,
which lies at the level of the iliac crest. For epidural anesthesia, the needle passes into the epidural space, and anesthetic
agent bathes the nerve roots in proximity. Lumbar puncture, on the other hand, is performed in order to collect a sample
of cerebrospinal fluid (CSF) or to introduce an anesthetic agent into the CSF (spinal anesthesia), so therefore the needle
penetrates the dural sac to enter the subarachnoid space. ^ , ,

Plate 163 Spinal Cord


Dermatomes
, _

See also Plates 483, 543; for maps of cutaneous nerves see Plates 24, 472, 474-476, 478, 481, 538-542

Schematic demarcation of dermatomes


(according to Keegan and Garrett)
shown as distinct segments. There is
actually considerable overlap between
any two adjacent dermatomes. An
alternative dermatome map is that
provided by Foerster (see References).

Levels of principal dermatomes


T10 Level of umbilicus
C5 Clavicles L1 Inguinal or groin regions
C5, 6, 7 Lateral parts of upper limbs LI/ 2, 3, 4 Anterior and inner surfaces of lower limbs
C8, T1 Medial sides of upper limbs L4, 5, SI Foot
C6 Thumb L4 Medial side of great toe
C6, 7, 8 Hand 51, 2, L5 Posterior and outer surfaces of lower limbs
C8 Ring and little fingers SI Lateral margin of foot and little toe
T4 Level of nipples 52, 3, 4 Perineum

Spinal Cord Plate 164


Sympathetic Nervous System: General Topography

Internal carotid plexus


Internal carotid nerve
Superior cervical gan

Gray rami communicantes External carotid nerve

Cervical sympathetic trunk

Middle cervical ganglion


Cervical cardiac nerves

Cervicothoracic (stellate) ganglion

Thoracic visceral nerves

Pulmonary plexus Cardiac plexus

White and gray rami communicantes

Esophageal plexus

Greater thoracic splanchnic nerve

Lesser thoracic splanchnic nerve Celiac plexus

Aorticorenal ganglion Celiac ganglion

Lumbar splanchnic nerves Superior mesenteric ganglion


Superior mesenteric plexus

Inferior mesenteric ganglion


Inferior mesenteric plexus

Superior hypogastric plexus

Hypogastric nerve
Sacral splanchnic nerves

Inferior hypogastric plexus

C/YczdwL
/

Plate 165 Spinal Cord


Lacrimal gland
Oculomotor nerve (CN III)
Facial nerve (CN VII) Ciliary ganglion

Pterygopalatine ganglion
Glossopharyngeal nerve (CN IX)
Parotic! gland
Vagus nerve (CN X)
Submandibular ganglion

Sublingual and submandibular glands

Cervical cardiac branch

Cardiac plexus
Pulmonary plexus

Esophageal plexus

Anterior and posterior vagal


trunks

Celiac plexus

Superior mesenteric plexus

Pelvic splanchnic nerves (from S2-4)

Inferior hypogastric plexus


Cavernous nerves

C/Yc^avk-
/

Spinal Cord Plate 166


Superior cervical ganglion Internal carotid nerve and plexus

External carotid nerve and plexus

Grav rami communicantes

First thoracic ganglion


Parotid gland
Innervation to arrector pili muscles,
vascular smooth muscle, and sweat-
glands of skin
Submandibular gland
Larynx
Trachea
Bronchi
Lungs

Cardiac branches

^ - G r e a t e r thoracic
' splanchnic nerve
Heart
Celiac ganglion
{W' \
-"Lesser thoracic
splanchnic nerve
Stomach
Aorticorenal
0 Liver ganglion
White r a m u s '
Gallbladder
communicans
... Bile ducts
Pancreas
Gray ramus ^ ^^ Least thoracic
communicans
i \

\ splanchnic nerve

Superior
mesenteric
ganglion
Intestines Lumbar
First lumbar ganglion splanchnic
nerves
Sacral
f Descending Inferior
splanchnic
/ colon mesenteric
nerves
ganglion
First sacral ganglion Sigmoid colon

Rectum
Inferior
Urinary hypogastric
bladder plexus

Prostate
Preganglionic fibers
External genitalia
Postganglionic fibers

Plate Spinal Cord


Parasympathetic Nervous System: Schema

Ciliary ganglion Pterygopalatine ganglion

Branch of oculomotor nerve (III) , , Lacrimal glands


Branch of facial nerve (VII)

Medulla oblongata

Branch of glossopharyngeal
nerve (IX) Parotid glands

Otic ganglion
Sublingual glands
A
jRg^L
Submandibular ganglion
""--III! Submandibular glands
4.-, Larynx
3 Trachea
Bronchi
Vagus nerve (X) Lungs

^ } ... Pulmonary plexus

Heart
Celiac ganglion

x Stomach

Liver
Superior
* Gallbladder
mesenteric
ganglion x
Bile ducts

V.;: Pancreas

Kidnevs

Intestines
Descending colon

Interior hypogastric
plexus
Sigmoid colon

Rectum

Urinary bladder
Pelvic splanchnic nerves
Prostate
Preganglionic fibers C/ictf/tatik-
External genitalia //y.P.
Postganglionic fibers

Spinal Cord Plate 168


Posterior view Ventral root of spinal nerve

Dorsal root of spinal nerve

Dorsal root (spinal) ganglion

White and gray rami communicantes


to and from sympathetic trunk

Ventral ramus of spinal

Dorsal ramus of spinal nerve

Dura mater

Arachnoid
mater

Mesothelial septum in dorsal median sulcu

Pia mater overlying spinal cord

Filaments of dorsal root

Denticulate ligament

Dorsal horn
Membranes removed: anterior view
(greatly magnified)
Ventral horn
Lateral horn
Gray matter
Filaments of dorsal root
White matter
Dorsal root of spinal nerve
Filaments of ventral root

Dorsal root (spinal) ganglion

Dorsal ramus of spinal nerve

Ventral ramus of spinal nerve

root of spinal nerve

Spinal nerve

ray and white


rami communicantes

Plate 169 Spinal Cord


H M M W M M _ _ _
Spinal Nerve Origin: Cross Sections


HMMMMHMMMMBMBMi
2
See also Plates 169,172,173

Section through thoracic vertebra

Body of vertebra

Dura mater Fat in epidural space


Arachnoid mater*
Sympathetic ganglion
Subarachnoid space Denticulate ligament
Ventral root
Pia mater*
White and gray rami
Recurrent communicantes
meningeal
branches of spinal
nerve Spinal nerve
Ventral ramus
(intercostal nerve)

Dorsal ramus

Dorsal root
(spinal) ganglion

Dorsal root

Lateral horn of
gray matter of spinal cord

of dorsal Internal vertebral


Medial branch ramus (epidural) venous plexus (of Batson)
Section through lumbar vertebra of spinal
Lateral branch
nerve

Sympathetic
ganglion Dura mater

Gray ramus Arachnoid mater


communicans
Ventral root
Fat in
epidural Spinal nerve
space
Ventral ramus (contributes to lumbar plexus)

Dorsal ramus

4
Dorsal and ventral Dorsal root (spinal) ganglion
roots of lumbar and Dorsal root
sacral spinal nerves
forming cauda equina Conus medullaris
*
Leptomeninges

SpimaS G^d] Plate 170


Arteries of Spinal Cord: Schema
See also Plate 138
Anterior view Posterior view

Posterior cerebral artery

Superior cerebellar artery


Posterior spinal arteries
Basilar artery

Anterior inferior Vertebral artery


cerebellar artery (AICA)

Posterior inferior
Posterior segmental
cerebellar artery (PICA)
medullary arteries
Anterior spinal artery
Deep cervical artery
Vertebral artery

Anterior segmental Ascending cervical artery


medullary arteries

Ascending cervical
artery

Deep cervical artery Subclavian artery

Subclavian artery
Posterior segmental
Anterior segmental medullary arteries
medullary artery

Posterior intercostal artery

Pial plexus Thoracic


Posterior
vertebrae
intercostal arteries

Major anterior segmental


medullary artery (great
radicular artery of
Adamkiewicz)

Anterior segmental Posterior segmental


medullary artery medullary arteries

Anastomotic loops to
anterior spinal artery

Lumbar artery

Lumbar Lumbar arteries


W > vertebrae <
i W

Anastomotic loops to
posterior spinal arteries- Lateral (or medial)
sacral arteries

Note: All spinal nerve roots have


associated r a d i c u l a r or s e g m e n t a l
m e d u l l a r y a r t e r i e s . M o s t roots have
Lateral (or medial)
radicular arteries {see Plate 172). Both
sacral arteries types of arteries run along roots, but
Sacrum radicular arteries end before reaching
anterior or posterior spinal arteries;
larger segmental medullary arteries
continue o n to supply a segment of
these arteries.

Plate 171 Spinal Cord


Posterior spinal arteries

Anterior spinal artery

Anterior segmental
medullary artery

Anterior radicular artery

Posterior radicular artery

Branch to vertebral body


and dura mater

Spinal branch

Dorsal branch of posterior


intercostal artery

Posterior intercostal artery

Paravertebral anastomoses

Prevertebral anastomoses

Thoracic (descending) aorta

Section through thoracic level:


anterosuperior view

Right posterior spinal artery


Sulcal (central) branches to
right side of spinal cord Peripheral branches from pial plexus

Posterior radicular artery Sulcal (central) branches to left side


of spinal cord

Anterior segmental Left posterior spinal artery


medullary artery

Pial arterial plexus

Anterior and posterior


radicular arteries

Anterior spinal artery


Posterior radicular artery
Arterial distribution: schema
Anterior segmental
medullary artery

Note: All spinal nerve roots have associated r a d i c u l a r or


Pial arterial plexus
s e g m e n t a l m e d u l l a r y a r t e r i e s . Most roots have radicular arteries.
Both types of arteries run along roots, but radicular arteries end
before reaching anterior or posterior spinal arteries; larger segmental
medullary arteries continue on to supply a segment of these arteries.

Spinal Cord Plate 172


Internal vertebral (epidural) venous plexus

External
vertebral venous
plexus
Intervertebral vein
j " (. V

Internal vertebral
(epidural) venous
External vertebral venous plexus
plexus (Batson's
veins)

Basivertebral vein External vertebral venous plexus

Basivertebral vein

Internal vertebral
dural) venous plexus

wm Segmental medullary/

mem / ft
radicular veins

Basivertebral vein Intervertebral


Anterior spinal vein
vein
Internal vertebral
Anterior sulcal
(epidural) venous plexus
(central) vein
(Batson's veins)

Internal vertebral
(epidural) venous plexus

External vertebral
venous plexus

Intervertebral vein

Anterior segmental medullary/radicular vein

Posterior segmental medullary/radicular vein

Pial venous plexus

Posterior sulcal (central) vein

Posterior spinal vein

Internal vertebral (epidural) venous plexus

Plate 173 Spinal Cord


Muscles of Back: Superficial Layers 2

Superior nuchal line of skull S e m i s p i n a l capitis muscle

Spinous process of C2 vertebra Splenius capitis muscle

Sternocleidomastoid muscle Spinous process of C7 vertebra

Posterior triangle of neck Splenius cervicis muscle

Trapezius muscle Levator scapulae muscle

Rhomboid minor muscle (cut)

Supraspinatus
muscle
Infraspinatus
fascia Serratus
posterior
superior muscle
Teres minor
muscle
Rhomboid
major muscle
Teres major (cut)
muscle

Infraspinatus
fascia (over
infraspinatus
Latissimus muscle)
dorsi muscle

Teres minor
and major
muscles
Spinous process
of T12 vertebra
Latissimus dorsi muscle (cut)
Thoracolumbar fascia
Serratus anterior muscle

External
oblique muscle Serratus posterior inferior
muscle

Internal oblique 12th rib


muscle in lumbar triangle
(of Petit)
Erector spinae muscle

Iliac crest External


oblique muscle

Gluteal aponeurosis
Internal
(over gluteus medius muscle)
oblique muscle

Gluteus maximus muscle

Muscles and Nerves Plate 174


Superior nuchal line of skull Rectus capitis posterior minor muscle

Obliquus capitis superior muscle

Rectus capitis posterior major muscle


Longissimus capitis muscle

Obliquus capitis inferior muscle

Longissimus capitis muscle


Splenius capitis and
splenius cervicis muscles S e m i s p i n a l capitis muscle (cut)

Spinalis cervicis muscle

Spinous process of C7 vertebra

I l i o c o s t a l muscle
Longissimus cervicis muscle

Erector lliocostalis cervicis muscle


spinae <
muscle
lliocostalis thoracis muscle

Hook
Spinalis muscle

Spinalis thoracis muscle

Longissimus thoracis muscle


Serratus posterior
inferior muscle lliocostalis lumborum muscle

Spinous process of T12 vertebra


Tendon of origin of
transversus abdominis muscle
Transversus abdominis
muscle and tendon
of origin
Internal oblique
muscle
Thoracolumbar fascia
(posterior layer) (cut)

External oblique
muscle (cut)

Iliac crest

Plate 175 Muscles and Nerves


Superior nuchal line of skull Rectus capitis posterior minor muscle

Mastoid process Obliquus capitis superior muscle

Posterior tubercle of atlas Rectus capitis posterior major muscle


(CI vertebra)-
Transverse process of atlas ( C I )
Spinous process of axis
(C2 vertebra) Obliquus capitis inferior muscle

Semispinalis capitis muscle Longus


Rotatores cervicis muscles
Brevis
Spinous process
of C7 vertebra

Levator costae muscle


External intercostal muscles

Longus ) Rotatores
Brevis \ thoracis muscles

Semispinalis thoracis muscles


Brevis \ Levatores
Longus \ costarum muscles

iMultifidus muscles

Thoracolumbar fascia
Interspinals lumborum muscle
(anterior layer)

Thoracolumbar fascia Intertransversarius muscle


(posterior layer) (cut)

Quadratus lumborum muscle


Transversus abdominis muscle
and tendon of origin

Iliac crest
iMultifidus muscles

iMultifidus muscles (cut)


Erector spinae muscle (cut) S,\V . . . .

GlyseOes a n d i l e r w e s P l a t e 1 7
2 Nerves of Back
See also Plates 180, 192, 254, 258

Accessory nerve (XI) Greater occipital nerve (dorsal ramus of


C2 spinal nerve)
Trapezius muscle ( r e f l e c t e d ) 3rd occipital nerve (dorsal ramus of
C3 spinal nerve)
Levator scapulae muscle
Lesser occipital nerve / Cervical plexus
_ . . ( (ventral rami of
Transverse cervical artery Great auricular nerve ) C2, 3 spinal nerves)
and vein
Trapezius muscle
Subtrapezial plexus
Posterior cutaneous branches (from medial
branches of dorsal rami of C4-T6 spinal
nerves; C7, 8 are minimal)
.. / Deltoid muscle
Supraspinatus
muscle Infraspinatus fascia

Spine of Teres minor and


scapula major muscles

Infraspinatus Superior lateral brachial


fascia cutaneous nerve (from
axillary nerve C5, 6)

Posterior cutaneous
branches (from lateral
branches of dorsal rami
of T7-12 spinal nerves)
Rhomboid
minor muscle
Lateral cutaneous branches of
Rhomboid ventral rami (intercostal nerves)
major muscle

Latissimus dorsi muscle

External oblique muscle


Spinous process of
T12 vertebra Iliac crest

Iliohypogastric nerve
Thoracolumbar fascia (ventral ramus of LI spinal
nerve)

Superior clunial nerves


(dorsal rami of L1, 2, 3 spinal
nerves)

Medial clunial nerves


(dorsal rami of S1, 2, 3 spinal
Gluteus maximus nerves)
muscle
Inferior clunial nerves from
posterior femoral cutaneous
nerve (sacral plexus S1, 2, 3)

Plate 177 Muscles and Nerves


Suboccipital Triangle

Epicranial aponeurosis Semispinalis capitis muscle


(galea aponeurotica) (cut and reflected)

Occipital belly (occipitalis) of


occipitofrontalis muscle Vertebral artery
(atlantic part)

Obliquus capitis
Greater occipital nerve SEfe ' superior muscle
(dorsal ramus of C2
spinal nerve)
Suboccipital nerve
(dorsal ramus of C1
Occipital artery spinal nerve)

mm
Posterior arch of
atlas (CI vertebra)
Third occipital nerve
(dorsal ramus of C3
spinal nerve) Occipital artery

Obliquus capitis
Semispinalis capitis inferior muscle
and splenius capitis
muscles in posterior
triangle of neck Greater occipital
nerve (dorsal ramus
of C2 spinal nerve)

Posterior auricular artery Splenius capitis muscle


(cut and reflected)

Third occipital nerve


Great auricular nerve (dorsal ramus of C3
(cervical plexus C2, 3) spinal nerve)

Longissimus capitis muscle


Lesser occipital nerve
(cervical plexus C2) Splenius cervicis muscle

Semispinalis cervicis muscle


Sternocleidomastoid muscle

Trapezius muscle Semispinalis capitis muscle (cut)

Splenius capitis muscle (cut)


Posterior cutaneous branches
of dorsal rami of C4, 5, 6
spinal nerves

ilyseles and Nerwes Plate 178


Inferior vena cava
Descending (2nd) part of duodenum

Kidney Pancreas
Renal (Gerota's) fascia
(anterior and posterior layers) Anterior longitudinal ligament
Perirenal fat
Crura of diaphragm
Pararenal fat

Peritoneum Superior mesenteric artery and vein

Extraperitoneal Mesentery
(subserous) fascia
(areolar tissue)
Abdominal aorta
Transversalis
fascia
Duodenojejunal
junction

Body of
L2 vertebra

Psoas major
muscle
and fascia

Lumbar
spinal nerve

Transverse
process

External
Spinal
oblique
dura mater
muscle

Internal Cauda
oblique muscle equina

Transversus abdominis
muscle
Spinous process
Tendon of origin of of L1 vertebra
transversus abdominis and
internal oblique muscles
Supraspinous ligament

Serratus posterior inferior muscle Erector spinae muscle

Latissimus dorsi muscle Thoracolumbar fascia (posterior layer)

Quadratus lumborum muscle Thoracolumbar fascia (middle layer)

Thoracolumbar fascia (anterior layer-


quadratus lumborum fascia)

Plate 179 Muscles and Nerves


*' v

2
*

Typical Thoracic Spinal Nerve


See also Plates 192, 258

Anterior cutaneous branch


Medial branch Lateral branch

Sternum

External intercostal muscle

Internal intercostal muscle

Innermost intercostal muscle

-Anterior branch
Intervertebral Lateral cutaneous branch
foramen Posterior branch

Serratus anterior muscle

Latissimus dorsi muscle

Subscapularis muscle

Teres major muscle

Scapula

Dorsal ramus Infraspinatus muscle


Medial branch
Rhomboid major muscle
Lateral branch
Posterior cutaneous branch
Erector spinae muscle

nternal intercostal membrane

Note: In lower thoracic 4


region, lateral branch of
dorsal ramus is longer,
motor, and cutaneous;
medial branch is shorter
and motor only.

Muscles and Nerves Plate 180


ion 3 Thorax

Topographic A n a t o m y
Plates 181
MeMMJXMMMMMl

181 Thorax

Mammary Gland
Plates 182-184

182 Mammary Gland

183 Arteries of Mammary Gland

184 Lymph Vessels and Nodes of Mammary Gland

B o d y Wall
Plates 185-195

185 Bony Framework of Thorax

186 Ribs and Sternocostal Joints

187 Costovertebral Joints

188 Anterior Thoracic Wall

189 Anterior Thoracic Wall (continued)

190 Chest Drainage Tube Placement

191 Anterior Thoracic Wall: Internal View

192 Intercostal Nerves and Arteries

193 Phrenic Nerve

194 Diaphragm: Thoracic Surface

195 Diaphragm: Abdominal Surface

L y ^ g s
Plates 196-210

196 Topography of Lungs: Anterior View

197 Topography of Lungs: Posterior View

198 Lungs in Situ: Anterior View

Atlas of Human Anatomy


Thorax

199 Lungs: Medial Views 226 Nerves of Heart

200 Bronchopulmonary Segments 227 Innervation of Heart: Schema

201 Bronchopulmonary Segments (continued) 228 Innervation of Blood Vessels: Schema

202 Trachea and Major Bronchi 229 Prenatal and Postnatal Circulation

203 Nomenclature of Bronchi: Schema

204 Intrapulmonary Airways: Schema Mediastinum


Plates 230-241
205 Intrapulmonary Blood Circulation: Schema

206 Great Vessels of Superior Mediastinum 230 Mediastinum: Right Lateral View

207 Bronchial Arteries and Veins 231 Mediastinum: Left Lateral View

208 Lymph Vessels and Nodes of Lung 232 Esophagus in Situ

209 Autonomic Nerves in Thorax 233 Topography and Constrictions of Esophagus

210 Innervation of Tracheobronchial Tree: Schema 234 Musculature of Esophagus

235 Pharyngoesophageal Junction

Heart 236 Esophagogastric Junction


Plates 211-229 237 Arteries of Esophagus

211 Heart in Situ 238 Veins of Esophagus

212 Heart: Anterior Exposure 239 Lymph Vessels and Nodes of Esophagus

213 Radiograph of Chest 240 Nerves of Esophagus

214 Heart: Base and Diaphragmatic Surfaces 241 Mediastinum: Cross Section #

215 Pericardial Sac

216 Coronary Arteries and Cardiac Veins Regional S c a n s


Plate 242
217 Coronary Arteries and Cardiac Veins: Variations

218 Coronary Arteries: Arteriographic Views 242 Chest Scans: Axial CT Images

219 Coronary Arteries: Arteriographic Views (continued)

220 Right Atrium and Ventricle Cross-Sectional Anatomy


Plates 243-246
221 Left Atrium and Ventricle

222 Valves and Fibrous Skeleton of Heart 243 Cross Section of Thorax at T3 Level

223 Valves and Fibrous Skeleton of Heart (continued) 244 Cross Section of Thorax at T3-4 Disc Level

224 Atria, Ventricles, and Interventricular Septum 245 Cross Section of Thorax at T4-5 Disc Level

225 Conducting System of Heart 246 Cross Section of Thorax at T7 Level

Atlas of Human Anatomy


H6M H H mwHESNKn! 36 .
Thorax 3

Biceps
brachii
muscle

Sternocleidomastoid muscle
Sternal head Triceps
brachii
Clavicular head muscle

Axilla

Clavicle

Anterior
Jugular
axillary fold
notch
Posterior
axillary fold
Deltoid
muscle Pectoralis major
muscle
Body of Clavicular head
sternum Sternal head

Nipple
Latissimus dorsi
muscle
Cephalic
vein Xiphoid process
of sternum

Serratus
anterior muscle

Linea alba

Rectus abdominis
muscle

fmm-:.. Tendinous
intersection

External oblique
muscle
Serratus
anterior muscle C/farfatk-
/ Af.7>.

T@p@gsraptilc Anatomy Plate 181


3 M a m m a r y G l a n d

Anterolateral Suspensory
dissection ligaments of
breast (Cooper's)

-Areolar
(y glands
v I
Pectoralis M
major muscle Wmmt : Is? sjviy A

(deep to
pectoral
Wfam W*
' f| f A

fascia) / fel m*
Axillary tail (of Spence)
Serratus anterior muscle
m
External
oblique muscle
m m n
.

i m
' v gSeM
Clavicle

JB5 di
Im
s*. Lv^"-"
M. *
m
1
> .i

S3 SOr.
7>fr v X m.
X V v w .- ^ <
1 jJKfc'

1
M

major
muscle
v <. . - v V < ,. -i . v;-" . V .
Areola
Pectoral
Nipple
ft

fascia- IC': ( Fat


iM
Lactiferous ducts
Intercostal it Gland lobules
muscles Lactiferous sinus
^ Ik I ^ L '
s f t l ! is 1
yi

mm if - y ^ Z ^ h . ,
Suspensory ligaments of breast (Cooper's)
Intercostal AH
M ...

vessels
and nerve Lactiferous duct
>
- )

v V;

Lactiferous sinus
Lung-
I
AM Gland lobules
r / ; ' .|
v i l l i v

Fat (subcutaneous
M tissue layer)
. V- V V,

\\ W J;
6th rib m

;. -./m
;< ' ^ :' - ' v . y - N v ; ' ; , : ?

Sagittal section

Plate 182 Mammary Gland


Arteries of Mammary Gland

Subclavian artery

Internal thoracic
artery and its
perforating branches

Medial mammary branches

Axillary artery

Brachial plexus

Brachial artery

imm

Lateral thoracic artery


and
Lateral mammary
branches

Axillary tail (of Spence)


Lateral mammary
branches of
lateral cutaneous
branches of posterior
intercostal arteries

Mmmmar^ Darsdj Plate 183


Lymph Vessels and Nodes of Mammary Gland

Parasternal nodes

Apical axillary
Interpectoral (Rotter's) nodes (subclavian) nodes

Central axillary nodes

WK

Lateral
axillary
(humeral)
nodes
is

Posterior
axillary
(subscapular)
nodes

Anterior
axillary
(pectoral)
nodes

Pathway to anterior
mediastinal nodes

P l a t e 1 8 4 M a m m a r y l a n d
Bony Framework of Thorax
3
See also Plate 248

Anterior view

Acromion

Coracoicl Sternum
process

Glenoid
cavity Xiphoid
Scapula process
Neck

Scapular
notch
Subscapular
fossa

True ribs (1-7)

Costal cartilages

False ribs (8-12)

Floating ribs (11-12)

Clavicle

Posterior view

Acromion

Supraspinous
fossa
Scapula
Spine

Infraspinous
fossa

True ribs (1-7)

False ribs (8-12)

Floating ribs
(11-12)

Body Wall Plate 185


Ribs and Sternocostal Joints

Subclavius muscle Muscle attachments


Head Origins
1st left rib: Grooves for
superior view \ subclavian Neck Insertions
vein and artery
Tubercle
(no angle)
Anterior' 1
scalene Middle rib:
Head
muscle^"" posterior view
Head
Neck
Tubercle Neck
Serratus
Middle
anterior
scalene
muscle
muscle
(1 st digitation)
Posterior
scalene
muscle

%U
2nd left rib: N for transverse
superior view process of Articular facets
vertebra for vertebral body
Serratus anterior m u s c l e ^
Interclavicular ligament
(2nd digitation)
^^^Clavicle Articular disc
. Manubrium
Costal groove

Costoclavicular
ligament

Articular cavity
Manubriosternal joint
Intraarticular
sternocostal Note: The head of a typical rib
ligament articulates with the superior
costal facet of the thoracic
Articular cavities vertebra of the same number (by
Costal cartilages its inferior articular facet), the
inferior costal facet of the
vertebra above (by its superior
articular facet), and the
Costochondral joints intervertebral disc between the
two vertebrae. The costal
Vst^V A
tubercle articulates with the
transverse process of the
vertebra of the same number.

Radiate sternocostal Costal cartilages


ligaments

Interchondral joints

/ Xiphoid i y f x .
/ process
Costoxiphoid Sternocostal articulations:
ligament anterior view

Plate 186 Body Wall


Costovertebral Joints
See also Plate 154

Anterior longitudinal Transverse costal facet (for tubercle of rib of same number as vertebra)
ligament

Inferior costal Lateral costotransverse ligament


facet (for head of
rib one number
greater) Intertransverse ligament
Interarticular
ligament of
head of rib

Superior costal Superior costotransverse ligament


facet (for head of
rib of same
number) Superior articular
facet of rib head
Radiate
ligament of
Intraarticular ligament
head of rib Radiate
ligament
of head
of rib Synovial
cavities

Left lateral view

Superior costotransverse ligament (cut)

Superior costal
facet (for head of rib
' jijjjitiVlf"

of same number)

Transverse process
[cut

Costotransverse ligament

Lateral costotransverse ligament

Transverse section: superior view


Radiate ligament of head of rib

Costotransverse ligament

Lateral costotransverse ligament

Superior costotransverse ligament

Intertransverse ligament

Right posterolateral view

Plate 187
3 Anterior Thoracic Wall

Sternocleidomastoid muscle Sternothyroid muscle


' Sternohyoid muscle [ l n v e ? t e f ' b V .
. . . . \ cervical fascia
Posterior triangle of neck Omohyoid muscle

Trapezius muscle Clavicle

Perforating branches of internal Subclavius muscle invested by


thoracic artery and anterior cutaneous clavipectoral fascia
branches of intercostal nerves
Thoracoacromial artery (pectoral
Pectoralis major muscle branch) and lateral pectoral nerve

Cephalic vein Costocoracoid ligament

Acromion Coracoid process

Deltoid muscle Medial


pectoral
nerve
>..>'y

Long thoracic nerve


and lateral thoracic artery
Pectoralis minor
muscle invested by
Clavipectoral fascia
Latissimus dorsi muscle

Digitations of serratus
Digitations of anterior muscle
serratus anterior muscle
External intercostal
membranes anterior to
Lateral cutaneous branches of internal intercostal
intercostal nerves and muscles
posterior intercostal arteries
External intercostal muscles
External oblique
muscle- Body and xiphoid process
of sternum
Anterior layer of rectus sheath
Internal oblique muscle

Sternalis muscle (inconstant) Rectus abdominis muscle

Cutaneous branches of thoracoabdominal


//y.p. (abdominal portions of intercostal) nerves
and superior epigastric artery

Plate 188 Body Wall


iHMHMi CWC5C
Anterior Thoracic Wali (continued)
a
l Wg
jB
i IMyMM
li ^ I HIinlHHilil PWWr . .' ... .
3
Omohyoid, sternothyroid and sternohyoid muscles nternal jugular vein

Clavicle Levator scapulae muscle

Subclavius muscle
Anterior
Middle > Scalene muscles
Posterior
Thoracoacromial artery
Phrenic nerve
Coracoid process
Brachial plexus
Cephalic vein
Thoracic duct
Pectoralis major
muscle (cut)
Subclavian
artery and vein
Deltoid
muscle
Axillary
artery and vein

Intercostobrachial nerve Superior thoracic artery

Long thoracic nerve Internal thoracic


and lateral thoracic artery artery and veins

Pectoralis minor muscle External intercostal muscle

Internal intercostal
Digitations of
muscle (cut)
serratus anterior muscle

Transversus thoracis
Lateral cutaneous muscle
branches of intercostal
nerves and posterior
intercostal arteries Anterior intercostal
branches of internal
thoracic artery
External intercostal muscles
Intercostal nerve

External intercostal membranes Musculophrenic artery


anterior to internal intercostal muscles and vein

Transversus abdominis muscle

Superior epigastric arteries and veins


Rectus abdominis muscle and sheath (cat)

Body Wall