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SECTION 1: HEAD AND NECK

- - --- - - -

120. Vagus Nerve (X): Schema CEREBRAL VASCULATURE


121. Accessory Nerve (XI): Schema Plates 130- 141
122. Hypoglossal Nerve (XII): Schema 130. Arteries to Brain and Meninges
123. Cervical Plexus: Schema 131. Arteries to Brain: Schema
124. Autonomic Nerves in Neck 132. Arteries of Brain: Inferior Views
125. Autonomic Nerves in Head 133. Cerebral Arterial Circle (Willis)
126. Ciliary Ganglion: Schema 134. Arteries of Brain: Frontal View
12 7. Pterygopalatine and Submandibular and Section
Ganglia: Schema 135. Arteries of Brain: Lateral
128. Otic Ganglion: Schema and Medial Views
129. Taste Pathways: Schema 136. Arteries of Posterior Cranial Fossa
13 7. Veins of Posterior Cranial Fossa
138. Deep Veins of Brain
139. Subependymal Veins of Brain
140. Hypothalamus and Hypophysis
141. Arteries and Veins of Hypothalamus
and Hypophysis

ATLAS OF HUMAN ANATOMY


Skull: Anterior View

Frontal bone

Parietal bone

Sphenoid bone

Lesser wing

Greater wing
Nasal bone

Lacrimal bone

Orbital plate
Zygomatic bone
Perpendicular plate

Temporal process Inferior nasal concha


Zygomaticofacial
foramen - - - - - - "

Maxilla

Zygomatic process

Orbital surface

Frontal process

Alveola1 process

Anterior nasal spin

Right orbit: frontal and slightly lateral view


Posterior and
Orbital surface of frontal bone
Anterior
Orbital surface of lesser ethmoidal foramina
wing of sphenoid bone
Orbital plate of
Superior orbital fissure - - - ---!- -I,:!C_:_l ethmoid bone

Optic canal (foramen) - - - - --f-----,i-----'-----,:1

Orbital surface of greate'_r- - --lf.:ih --c:-1


wing of sphenoid bone

Orbital surface of Orbital process of


zygomatic bon palatine bone

Orbital surface
Infraorbital groove of maxilla

BONES AND LIGAMENTS PLATE 1


Skull: Lateral View

Sphenoid bone Parietal bone Temporal fossa Temporal bone

Greater wing I Supe rior tempora l lin e Squamous part


I
I Inferior te mporal lin e
I

Fossa for
lacrimal sac

Nasal bone
Externa l
Maxilla occipital
protuberance

Ante rior
nasal sp in e
Alveo lar process
Head of condylar process
Zygomatic bone
Zygom aticofacial Co ronoid process
foram e n-----~~:J<,t~:::C, Ramus
Tem pora l process _ _____.,,_,, - - - - - - - - - oblique lin e
~~------------------B ody
: : ; _ - - - - - - - - - - - - Me ntal foram e n

Sphenoid bone

Infratemporal fossa exposed by


Greater wing
removal of zygomatic arch and mandible *- Infratemporal crest
Lateral pl ate of
Pterygom ax ill ary fissure pterygoid process
Pterygo id hamulus
(of medi al pl ate of
pterygo id pro cess)

External aco ustic


meatus
Mandibul ar fossa
Articular tube rcle
Pte rygopalatin e fossa
Stylo id pmcess
Sphenopalatine foramen

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

PLATE 2 HEAD AND NECK


Skull: Midsagittal Section

Sphenoid bone Temporal bone


Parietal bone
Greater wing--~ Squamou s part
Grooves for
Lesse r wing-------. Petrous part
branches of middl e
Anterior clinoid meningeal vessels
process
Groove for superior
Optic ca nal--~ petrosal sinus
External openin g of
vestibu lar aqueduct
Groove for
sigmoid sinus

Lambdoid suture

Occipital bone
Ethmoid bone
Crista galli --------<:~ Groove for
transvers e sinus
Cribriform plate --~~~~~~~~f1~t0
Perp endi cular ....___Exte rn al occipita l
pl ate - - - - ---i'::i
protuberance

Nasal bone

Groove for inferior


Inferior nasal petrosal sinu s
concha---~
Hypoglossal canal
Maxilla

Occipital co ndyle
Palatine bone
Basil ar part

Jii!N
~ .... ~:

Frontal bone
Opening of sphe noidal sinus

Ethmoid bone Sphenopalatine foram en


Cribriform plate

Sphenoid bone
lacrimal bone

Plates of pterygoid process


Latera l }
Maxilla Ptery go id hamulus
N asa l surface
Palatine pro
endicular pl ate }
Palatine bone
Horizontal plate

BONES AND LIGAMENTS PLATE3


Calvaria

Superior view

Co ro nal su ture

Sagittal suture

Lambd a

Occi pital bone

Inferior view
Fro ntal bo ne

Fro ntal cre st

Groove for superio r sagittal sinu s

~~:~
'~~

PLAT4 HEAD AND NECK


Cranial Base: Inferior View

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

Zygomati c bone

Transverse pa latin e sutu re


Sphenoid bone
Pte rygo id process
Ham ul us - - - - , Palatine bone
Medi al plate Ho rizonta l pl ate
Pterygoid fo ssa Greater palatine fo ramen
Lateral plate Pyramidal process
Scaphoid foss a Lesser palati ne for amin a
Greater win g -----...._ Poste rior nasa l spine
Fo ramen ovale

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

Parietal bone

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

BONES AND LIGAMENTS PLATES


Bones of Cranial Base: Superior View

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

Anterior
cranial
fossa

Middle
cranial
fossa

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

Parietal bone
Groove for mi ddle meni ngea l
vessels (parietal bra nches) -------:-.,....-----"
Masto id angle -------------'--..../

Occipital bone
Clivu s - - - - - - - - - - - - - - - _ /
Groove for inferior petrosal sinu s _ _ _ _ _.../
Basil ar par t - - - - - - - - - - - - - - - - "
G roove for poste rior menin geal vessels -----"
Condyle - - - - - - - - - - - - - - "
Groove fo r transverse si nus _ _ _ _ _ _ __.,
G roove fo r occipital sinu s _ _ _ _ _ _ _ __.,
Inte rn al occi pital crest - - - - - - - - - -
Inte rn al occipital protuberance - - - - - - - - -
Groove for superi or sagittal sinu s _ _ _ _ __..-

PLAT6 HEAD AND NECK


Foramina of Cranial Base: Superior View

Foram en cecum------------- Emi ssa ry vein to superior sagittal sinus

N asa l slit--------------- } { Ante rior ethm oidal artery, vein


Anterior ethmoid al foramen and nerve

Fo ramina of cribriform p late- ---- O lfactory nerve bund les

Po ste rior ethm oidal foramen ----Posterior ethmo idal arte ry, ve in
and nerve

. { Optic nerve (II )


Opt1c ca nal--------------- 0 p 11t11a 1m1c artery

Ocu lomotor nerve (Ill)


Troch lear nerve (IV)
s b"t 1 fi . _______ Lacrimal, frontal and nasocili ary
upenor or 1 a ss ul e branches of op hthalmic nerve (V,)
{ Abduce nt nerve (VI )
Superior ophthalmic vein

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

Mandibular nerv e (V3)


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

.
lAccessory menin geal artery
Lesse r petrosal nerve (occasionally)

{ Midd le menin gea l artery and vein


Foramen sp in osum ---------- M eningeal branch of mandibul ar nerve

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

Hiatus for --- - ------------- Greate r petrosal nerve

l
Facial nerve (V II )
Interna l acousti c mea tus------ Vestibu lococh lea r nerve (V III )
Lab yrinthin e artery
Exte rnal opening of
ves tibular aquedu ct---------- Endo lymphatic duct

M as toid foramen (inconstant) --- Emissary vein (a nd occasiona l


branch of occipital artery)

Inferior petrosal sinus


G lo ss opharyn gea l nerve (IX)
Vagus nerve (X)
Ju gular foramen------------
Accessory nerve (X I)
{ Sigmo id sinu s
Posterior menin gea l artery

Cond lar canal (in co nstant) ----{ Emissary vein and meningeal branch
Y of ascend111g p haryngeal arte 1y

H ypoglossal canal ----------- Hypoglossal nerve (X II )

M edulla oblon gata


Meninges
Vertebral arteries
Fo rame n magum ---------- .
Men 1ngeal branches of vertebra l
{ artenes
Spinal roots of accessory nerves

BONES AND LIGAMENTS PLATE 7


Skull of Newborn

lateral view
Anterior fontan ell e Parietal bone

Sphenoid al font a ne ll e
Frontal bone
Squ a mous part---------
Supraorbitalnotch (foramen) Posterior fontanell e

Ethmoid bone Lambdoid suture


Ante rior e thmoidal
foramen --------..
Orb ita l plate
Mastoid fontanelle

Nasal bone

Maxilla--------~

Infraorbital foramen----:-./

Petrosquamous fissur e
Zygomatic bone _ _ _ _ _ _./
Zygo maticofacial foramen-----' Pe trous part
(mastoid process absent)
Greate r win g
Palatine bone Late ral pia te of Tym panic part (bony externa l
Pyra midal process - - - - - - - - ' pte rygo id process aco ustic meatus absent)
Hamulus of medial
plate of pte rygoid I (vestibular) wind ow
process
Round (cochl ear) window

Superior view

Zygomatic process

Frontal bone

Ante rior fontanelle

Corona l suture

Poste rior fon tanelle

PLAT8 HEAD AND NECK


Bony Framework of Head and Neck

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

Coro noid process of mandi


Latera l pterygoid
(b roken line)
H amul us of medi al pterygoid plate
(broken line)
Pterygomandibular raphe
(broken line)

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

Sty lohyoid li game nt

. .
Hyoid bone
Sprn e of sphe nord bon e
l~~sser horn ________,..
G reate r horn----./

Epi glottis
Thyroid cartilage

Sphenopa latin e fora men


Pterygopalatine fossa
Choanae (posteri or nares)

Lateral plate } .
Med ial late of pterygo rd
P process
H amu lus
Infratempo ral fossa
Pyramidal process of pa latin e bone
A lveo lar process of maxi lla

-------------
BONES AND LIGAMENTS PLAT9
Mandible

Coronoid process

Mylohyo id groove
Mandible of infant
Oblique line

Submandibular fos sa
Mylohyoid lin e

Sub lin gual fossa

ln te ralveo lar septa

Ramus

Alveo lar part (crest) - - - - +"':<


Mental fo ra me n
Mental protuberance====t~~-"-___:~~~~~
Me ntal tubercle -----~~'
\.. _________ "
Base of m a ndibl e ---------,..:::::""""..,_.~
, ,.....
Mandible of adult:
Body anterolateral superior view

Condylar process

Mandibular foram e n
Mylohyoid groove

()...R amus
I
I
I
I
I

Mandible of adult: Mandible of aged


left posterior view person (edentulous)

PLATE 10 HEAD AND NECK


Temporomandibular joint

Lateral view

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

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

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

A rti cular disc


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

jaws closed

jaws slightly jaws widely


opened opened
(h in ge actio n (h in ge and glidi ng
predo min ates) ac ti o n co mbin ed)

BONES AND LIGAMENTS PLATE 11


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

nterior articular
Dens facet (for anterior
arch of atlas)

Lateral
T1ansverse
mass Superior articular
process
facet for atlas

\
T1ansvers e
--A~W'--- Vertebral
foramen
foram en

Superi o r ar ticular surface


nsverse
of lateral mass for ..._..--Posterior tub ercle Inferior articu lar
Body process
occipital co ndyl e facet for C3
Groove for ve rtebra l artery

Atlas (Cl ): superior view Axis (C2): anterior view

D ens Posterior articu lar


facet (for transv erse
Superior articular ligament of atlas)
facet for atlas
Vertebral
foram en
Interarticular
part

"""i11-.c~~;::~~;jj;liJ!~=Articular fa cet Inferior


articular
for dens process
Inferior arti cular
surface of lateral Anterior tub ercle
m ass for axis Axis (C2): posterosuperior view
Atlas (Cl ): inferior view

Atlas (Cl)
Superior articular surface
for occipital condyl e

Posterior articular face t


(for transverse li gament
of a t l a s ) - - - - - - _ /

C3

Upper cervical vertebrae,


assembled: posterosuperior view

PLATE 12 HEAD AND NECK


Cervical Vertebrae (continued)
SEE ALSO PLATES 9, 142

Anterior
tubercle
terior tubercle

Posterior
tubercle Posterior tub ercl e

Lamina
Lamina

4th cervical vertebra:


superior view 7th cervical vertebra:
superior view

'/Cervical curvature
C2 \
' Intervertebral foramina for spinal nerves
I
I
I
I
Spinous processes I
I
I
I Interarticular
I
I part
I
I
I
I
I
Zygapophyseal
I joint
I
I
I
I
I Intervertebral
I foramen for
I
Articular pillar------::~~~"" I spinal nerve
I
formed by I
articular I
I
processes and
interarticular
C6: I
3rd, 4th and 5th cervical vertebrae:
parts I anterior view
I

Zygapophyseal joints

Intervertebral joint (symphysis) (disc removed)

2nd cervical to 1st thoracic vertebrae:


II.N
.
right lateral view ~ ' ,",",' ~ ~

BONES AND LIGAMENTS PLATE 13


External Craniocervical Ligaments

Anterior view

Basil ar part of o cc ipital bon e

Phar yngeal tub ercl e

A nteri or atlantooccipitalm emb rane

Capsul e of atlantooccipital joint

Posterior atlanto occipitalm emb rane

Late ral atlantoaxial joint (op ened up )

ior longitu dinal li gam ent

Poste rior atl antooccip ital m embran e


Posterior view
Ax is (C2)

Anterior atlantooccipita lm embrane ansvers e


process
of atlas (C I )

Ligam enta flava

artery Suboccipital nerve (dorsal


ramu s of C l spinal nerve)

Body of axis (C2)


Li ga mentum nu chae
Intervertebral discs (C2- 3 and C3- 4)

~ I t
i
Zyga pophysea l join ts (C4- S and CS- 6)

A nterior tub ercl e of C6 vertebra (ca rotid tubercle)


Sp in ous process
of C7 vertebra Vertebra l ar te ry
(vertebra promin ens)
Tl ve rtebr a

'\"'
JI!!N
=.:..::
Right lateral view

PLATE 14 HEAD AND NECK


Internal Craniocervical Ligaments

Clivus (surface feature)


of bO>iloc pMl of ocdpl "' booj
Upper part of vertebral canal with spinous processes
and parts of vertebral arches removed to expose
ligaments on posterior vertebral bodies: posterior view

Atlas (C l ) Poste rior lon gitudin al li gament

Axis (C2) -------r:::51- Alar li ga ments

Capsul e o f
zy gap oph ysea l
joint
(C2 - 3)

Atl as (Cl )

Superior longitudinal band


Cru ciate
li gam ent Transve rse li ga ment o f atlas
{
Inferior lo ngitudinal band

De eper (accessor-y) part of tectorial membrane

Principal part of tectorial membrane removed


to expose deeper ligaments: posterior view

Api ca l li ga ment of dens


~10:~~~~~- Alar li ga ment
Atla s (C l) - - - - Pos teri o r arti cular face t of dens (for transverse
li ga ment of atlas )

Ax is (C2)

Cruciate ligament removed to show


deepest ligaments: posterior view
Tra nsverse li ga ment
o f atl as

Median atlantoaxial joint: superior view

BONES AND LIGAMENTS PLATE 15


Atlantooccipital junction

Vertebral artery Hypoglossa l ca nal

Te ctorial membran e
Posteri o r margin
of foramen magnum Api ca l li gament of dens

Posterior atl anto- Su pe rior longitudin al band of


occipi ta lm embra ne cru ciate li ga ment of atlas

Ante rior atlanto occipitalm embrane

A nterior arch of atlas (C l)


Ligam entum nu chae
Articu lar cavity

Dens (odontoid process) of axis (C2 )

Tr ansverse li gament of atlas

ln fel-ior lo ngitudinal band of


cruciate li ga ment of atl as

Anteri or lo ngitudin al li gament

Pos terior longitudinal li ga ment

Lowest /
level of
occipital bon e McGregor's line, fro m posterior na sa l sp ine of
hard pa late to lo we st po int of occipi ta l bone.
Average norm al posi tio n of tip o f dens is 1.32 mm
above this lin e w ith standard deviati on of 2.6 mm
as meas ured o n standard latera l radi og1a ph . Tip > 4. 5 mm
above line is co nsid ered to indi ca te basilar impression

Abnormalities of dens, mos t


often associated w ith skeletal
dysplasias such as l<lippei-Feil,
Down' s o r Morquio's syndrom es

Os odontoide um with fibrous uni o n and narrowin g of


Hypopl as tic dens (od o nto id process) vertebral ca nal with head in extension

PLATE 16 HEAD AND NECK


Superficial Arteries and Veins of Face and Scalp
----------------------------------------------------
SEE ALSO PLATES 29, 35, 63, 64, 80, 98

Epicrania l apo neurosis Parietal emi ssa ry vein

l
(galea apo neurotica) Branches of
(cut to revea l sk ull) supe rficial temporal
arte ry and vein
Middle temporal artery and vein

Zygomaticoorbita l

Transve rse facial


artery and vein Anterior
auri c ul ar
Suprao rbital arteries
artery and ve in

Supratrochlear
art ery and vein

Nasofrontal vein

Do rsa l nasa l
artery and ve in

Angular
artery
and vein

Zygomatico-
facial artery Mastoid emi ssa ry
and vein-----' ve in and m enin geal
branch of occipital
arter y (posterior
In fraorbital
menin gea l arte ry)
artery and ve in

Deep fac ial ve in


(from pte rygo id
plex us) _ _ ____/
Posterior auricu lar
artery and vein
Facial artery and ve in
Ex ternal ju gular vein (cut)

Retromandib ular vein

Intern al ju gular vein

Intern al carotid artery

Co mmon ca rotid artery

Lingua l artery and ve in

Sources of arterial supply of face


Black: fro m interna l carotid arte ry (via o phth almic artery) f
Red: from external carotid artery ,.,.~N

SUPERFICIAL FACE PLATE 17


Cutaneous Nerves of Head and Neck
SEEALSOPLAT527, 3 1,40, 4 7, 77 6

From ophthalmic divi sion Auricular branch


of trigeminal nerve (V1 ) of vag us nerve (X)

Supraorb ita l ne rve - - - - - - ,


Supratrochlear ne rve ---------..
M edial branch es
Palpeb ral branch of of dorsal rami
lac ri mal nerve - - - - - - - - - - . . of cervical spinal
nerves
lnfratrochlear nerve - - - - - ,
Greater occipital
External nasal branch of
nerve (C2)
an te ri or ethmo idal nerve
3rd occipital
nerve (C3)

From maxillary division From 4th, 5th,


of trigeminal nerve (V2 ) 6th and 7th
ne rves in
success ion
be low

Branches from
cervical plexus
Lesser occip ital
From mandibular divi si on nerve (C2 , 3)
of tri geminal nerve (V3 )
Great auri cular
ne rve (C2, 3)
Transverse cervical
ne rve (C2 , 3)
Supraclavicula r
nerves (C3 , 4)

/
1

I
Ophthalmic nerve (V1 ) - -----!--
f

~t --,, ____
___.r- Dorsal rami of
cervical spin al
nerves

Trigemin al
) .r]h)' \

_
Note: Auricul ar branch
of vagus ne rve to
extern al aco ustic
nerve (V) meatus and small
area o n poste rom edial
surface of auticl e

Branche s from
cervical plexus

PLATE 18 HEAD AN D NECK


Facial Nerve Branches and Parotid Gland
SEE ALSO PLATE 117

Temporal branches

Parotid
gland

Zygomatic branches

Posterior
auricular
nerve - - - - ----L---.:
Parotid duct

Main trunk of
facial nerve ~--Buccal branches
emerging from
stylomastoid foramen

Marginal mandibular b1anch


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

Horizontal section

Main trunk of facial nerve

Mastoid process

Temporofacial division

Posterior auricular nerve-------:,

Main trunk of facial nerve - -----J;;?..

Nerve to posterior belly


of digastric muscle and
to stylohyoid muscle

Ce1vicofacial division

SUPERFICIAL FACE PLATE 19


Muscles of Facial Expression: Anterior View
SEE ALSO PLATE 48

Fronta l belly (fronta li s) of ep icranius muscle

Procerus muscl e

Corrugator supercilii mu scle

Orbita l part } of orbicu lari s oculi muscle


Palpebral part

Leva tor labii supe ri o ri s alaeq ue nasi muscle

Transvers e part } of nasa li s mu scle


Alar part

Levator lab ii superi o ris muscle

Auricularis anteri or muscle

Zygomaticus minor muscle

Zygomaticus majo r mu scle

Leva tor anguli ori s muscle

Depressor septi nasi muscle

-r------ Orbicularis oris mu scle


- - - - - - Depresso r anguli oris muscle

+ - - - - - - Depressor labii inferioris muscle

7 - - - - - - Menta li s mu scl e

Platysma muscle

Co urse of wrinkle lin es of


skin is transverse to fiber
directio n of facial muscles.
El li ptica l in cisions for removal
of sk in tumo1s conform to
direction of wrinkl e lin es

PLAT20 HEAD AND NECK


Muscles of Facial Expression: Lateral View

Ep icrani al aponeu rosis (ga lea apo neurotica) Auricul ari s anterio r muscle

Auricul ari s supe ri o r muscle


Orb icul ari s ocu li mu scle Auri cul ari s posterior mu scle

Fronta l belly (frontalis) of epicraniu s mu scle

Corru ga tor supercilii mu scle (fro ntali s


and orb iculari s ocu li, partially cut away)

Leva tor labii superi ori s muscl e

Leva tor labi i superioris


alaeque nasi muscle
(partially cut away) ------..

Nasa lis ) Tr ansverse pa rt


mu scle ~ A lar part

Zygomati cus minor muscl e Inves tin g laye r of


(deep) cervica l fas cia
Zygomati cus major muscle

O rbicul ari s oris muscle

M entalis muscle

Deltoid
Depresso r labii in fe ri oris mu scle
fa scia

Depresso r angu li o ris muscl e

Bu ccin ato r mu scle

Pl atysm a muscl e

JIN
....:.: :
~

Pecto rali s majo r fascia

SUPERFICIAL FACE PLATE 21


Muscles of Neck: Lateral View

Parotid gland (cut) Masseter muscle

Ramu s of mandibl e Subm andibular gland

Mastoid proce ss

Digastri c mu scl e Body of


(posterior belly ) mandibl e

M iddle ph aryngeal
constrictor mu scle
Di gas tri c
mu scl e
Longus capit is muscle
(a nterior
b elly)
Sp leniu s mu scl e - - - -

Levator sca pul ae muscl e

Posterior
Omohyoid mu scl e
Scalene mu scl es M iddl e (s uperior bell y)
{ Anterior

Stemohyoid mu scl e
Brachia l plex us
In ferior pharyngeal
constrictor mu scl e

Acromion

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

Pectorali s major muscl e


Stemal head
Clavi cular hea d
l Stemocl eido mas toid mu scl e

PLAT22 HEAD AND NECK


Muscles of Neck: Anterior View

Digastric muscle (anterior belly)


Masseter muscle
Mylohyoid muscle
Parotid gland
Submandibular gland

Fibrous loop fm
intermediate
digastric tendon

Stylohyoid muscle

Hyoid bone

External carotid artery

Internal jugular vein

-----Omohyoid muscle
Thyroid cartilage (superior belly)

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

Cricoid
cartilage - - - Trapezius muscle

Clavicle

Omohyoid muscle
(inferior belly)

Pretracheallayer of Pectoralis major muscle


(deep) cervical fascia over
thyroid gland and trachea
l Sternocleidomastoid
} muscle
Suprasternal space

Manubrium of sternum jugular notch

NECK PLATE23
lnfrahyoid and Suprahyoid Muscles
SEE ALSO PL ATE 47

Hyo id bo ne Di gastri c mu scl e (a nteri or belly)

M ylo hyo id muscl e


Thyrohy o id membran e
Hyogloss us mu scle
Extern al ca rotid artery

Intern al ju gu lar vein

Thyro hyo id mu scle

Th yro id ca rtil age Fibro us loop for


intermediate
di gastri c tend o n
Om ohyoid mu scl e
(s upe rio r be ll y) ------~ Stern o hyo id and o mo hyo id
mu scles (cut )

Th yro hyo id mu scle


M edi an crico th yro id
li gament

Cri coth yroid mu scl e


Scalene
mu scles
Om ohyo id
mu scle
(s upe ri or
bell y) (c u t)

O mohyo id mu scl e
(inferi o r be ll y)

Mylo hyoid mu scle


D igastric mu scle (pos terior belly)

Di gas tric mu scle (a nterior belly) I.- - - - - T hyroh yo id mu scl e

Ge ni ohyoid mu scl e - - - - - o blique lin e of th yroid cartil age

Stern ohyo id mu scl e

O mo hyoid mu scl e O mohyo id muscle (inferi o r belly)


(supe ri o r belly) _ ___.,

Sternoth yroid
mu scl e
lnfrahyoid and
suprahyoid muscles and
their action: schema

PLATE24 HEAD AND NECK


Scalene and Prevertebral Muscles

Basil ar pa rt o f
Lon gus ca piti s mu scl e (cut)
occipital bone

Occipita l cond yle

M as to id process

ransverse process of atlas (CI )

l Tub ercl es of tran sverse


~ process of C3 ve rtebra
Pos teri o r tub ercle of
transverse process of axis (C2 )

Lo ngus ca lli muscle

Sli ps of origin of po sterior


sca lene muscle

Scalene ~ Middl e l Sca lene


mu scl es (
Posterior ~ mu scl es

Anterior sca lene


muscle (c ut )

Brachi al plex us

-~t ~ -

' ~.~~

I st rib

Common ca ro tid artery


Subclavian vein Pos teri o r tubercle of tran sverse
process o f C7 vertebra
In tern al ju gul ar ve in

NECK PLATE25
Superficial Veins and Cutaneous Nerves of Neck
FOR DEEP VEINS OF NECK SEE PLATE 64

Platysma muscle (cut)


Facial artery and ve in

Submand ibul ar gland

Retrom andibu lar vein


O mohyoid muscle (cut)

Internal ju gular vein Externa l ca rotid artery

yrohyo id muscle

Anteri o r ju gular ve in

Co mmunicating vein In terna l jugul ar vei n

Common ca rotid artery

Ansa cerv ical is

Omohyoid mu scl e
Thyroid gland (s uperior belly) (cut)

Omohyoid mu scle
(inferior b elly)

Brachial plexus

Supraclav icu lar nerves

Ste rnocleidomastoid mu scl e


Ste rn ocle idom as to id muscl e (cut)

Stern othyro id muscl e

PLAT26 HEAD AND NECK


Cervical Plexus In Situ
SEE ALSO PLATES 727, 722, 723, 782

Parotid gland Great auri cul ar

Submand ibul ar gland


M yloh yo id muscle Sternocleidoma stoi d
muscle (cut, turned up)
H ypoglossa l nerve (X II)
~'!ill--- Sty loh y oid mu scle
Di gastri c muscle Di gastric mu scle
(a nteri o r bell y) - - ----"'Ole-;; (posterior bell y)
C2 spina l nerve
(ventral ramus )

Internal carotid
C3 sp inal nerve
(vent1al ramus)
Sup erior thyroid artery Levator scapu lae muscl e
Midd le sca len e muscl e
Ante ri or sca lene muscl e
Ansa ce rvica li s { Superior roo t
Inferior roo t CS spinal nerve
(ven tral ramu s)
Sternoh yoid muscl e
a.----Transverse cervica l
artery
Internal ju gul ar vein Phreni c nerv e
-w~~~- Omohyoid
Common carotid artery
muscl e
(inferior
bell y) (cut)

Verteb ral artery


Dorsa l sca pular artery
Th yrocer vica l trunk
Supra sca pul ar artery
Subclavian artery and vein
UN
~ :.. ; :
',
Hypoglossa l nerve (X II )
Great au ri cular nerve

1-t-- - Lesse r occipital nerve

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


longus ca pitis and rectus
cap iti s anterior muscles

Co mmuni ca tion to vagus nerve

T1 ansve rse cervical ne1 ves

To longus capitis and


longus colli muscles

To scalene and leva tor


sca pulae muscles

NECK PLAT27
Subclavian Artery
SEE ALSO PLATE 398

Right anterior dissection


Thyroid gland
(reflected)

Middle cervical
sympatheti c ga ngli on

Vertebral artery

Com mon carotid artery


Tr ansve rse cervical artery

Suprasca pular artery

Dorsa l sca pular artery


Bra chiocephali c trunk
Cos tocervical trunk

Th yroc ervica l trunk Internal jugular vein


(cut)
Subcl av ian artery and vein

Right lateral schematic view /


/
/

Ve rtebral artery
Extern al ca rotid artery

Intern al ca rotid artery

Ascend in g ce rvica l artery

Inferior thyro id artery

Transve rse ce rvi ca l artery


Costoce rvi ca l t1unk

:-""""'"""~"\--------- Subclavia n ar tery


(1st pa rt m edial to,
2nd part behind,
3 rd part lateral to
anterior scalene muscl e)

Intern al thoracic artery

PLAT28 HEAD AND NECK


Carotid Arteries
SEE ALSOPLATES 130, 13 1

Parotid space Superficia l tempor al artery


(bed): right lateral Transverse facial artery
dissection

Externa l carotid artery


Styloid process -------l-'-;-;,,-+~J_ Posterior au ri cul ar artery
Facial nerve (VII ) (cut)----4'

Sternocle idomastoid mu scle (cut)


Stylohyoid muscle
D igastric muscle (posterior be ll y) (cut)
Hypoglossal nerv e (X II )
Occipital artery and
sternocleidomastoid branch
Lin gua l artery

Mylohyo id muscle
Ansa cervica li s {

-::.::.::~-- Di gastri c mu scle


(ante1ior belly)
Asce ndin g pha ryngeal artery - - ---\.-:\-""\t:\\\1" \!

Carotid branch of glossopharyngea l


nerve (IX) and ca rotid body _ _ ___...-
Branch to
thyrohyoid muscl e
In terna l ca rotid artery
(from ansa cervica li s)
In terna l ju gular ve in
Superi or laryngea l ar tery

Superior th yro id artery

External carotid artery


Superfi cial temporal artery
Commo n ca rotid artery

ll"~::l!!toii::.::<~~:::W?
.a---- Facia l artery
~--------- L in g u a l artery

Asce ndin g ph aryngeal artery


In terna l carotid artery
Superior th yro id artery and
supe ri or laryngea l branch
External carotid arte ry
O m ohyo id mu scl e (phantom)
Common carotid artery

External carotid branches:


schema
Th yro cervica l trunk

NECK PLATE 29
Fascial Layers of Neck
FOR CONTENTS OF CAROTID SHEATH SEE PLATES 63, 64, 65

In vestin g layer of (deep) cervica l fasc ia Platysma mu scle


Sternohyo id muscle
Muscul ar portio n of pretracheal laye r of
(deep) cervical fas cia (of infra hyo id muscl es)

Visceral portion of pretrachea l


laye r of (deep) cervica l fas cia

Omo hyo id muscle

Ca rotid sheath 'Jr--.;__-- Recurrent laryngea l


nerve
;;--~--- Common carotid ar tery
Intern al jugul ar ve in
Inves ting layer
of (deep) cervical Vagus nerve (X)
fascia roofin g Phrenic nerve
posterior triangle
Anterio r scalene muscl e
Fat in Sympathetic trunk
posterior Sp in al nerve
triangle
Middle and posterior
sca lene muscl es
Longus coll i muscle
Levator scap ulae muscle
Trapeziu s muscle
Alar fascia - - - f Deep cervical muscles
Cross section Retropha ryngea l Subcuta neous Cervica l ve rtebra (C7)
space tiss ue

Sagittal section

Buccopharyngeal
fasc ia ------------Brr---b~..,._,ii- ~_;;_-----G e ni o h yo id fascia

Retropharyngea l J~---------lncevesting layer of (deep)


rvica l fascia
space
+,~-----Fa sc i a of in fra hyoidmuscles

Pretracheal fasc ia

Suprasterna l space

Ma nubrium of sternum

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

PLAT30 HEAD AND NECK


Nose

Anterolateral view Inferior view


M ajo r alar ca rtil age

Lateral M edi al

Anterior
nasa l spi ne
of maxill a
Anterior nasal spine o f maxilla

Alar fibrofatty ti ssu Intermaxillary


suture

Co rru ga to r supercilii mu scl e

Dorsa l nasa l arte

ln frat rochlear nerve

A ngul ar artery

Exte rn al nasa l artery and nerve

Nasali s muscle (transverse part)

Infraorbita l artery and nerve

Latera l nasal artery

Transverse fac ial artery

Na sa li s mu scl e (alar part)

D epresso r septi nas i muscle

Facial artery

NASAL REGION PLATE31


Lateral Wall of Nasal Cavity

penin g of
sphenoidal sinus
Superior nasa l mea tu s Hypoph ys is
(pituitary gland )
Midd le nasal co ncha in sella turc ica

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


Atrium of middl e nasal meatus Pharyngeal to nsil
(ade noid if enl arged)
Middl e nasa l meatu s
Basilar part of
Inferior nasa l concha occipital bone
(turbinate) ----~:L.
,li:,J' 'fl'~~~r---4+- Pharyn gea I
.,..,,__..,_ __ raphe

Inferi o r nasa l
Open in g of
ph aryngotym pani c
(a uditory) tub e
Ph aryng ea l recess
Horizontal plate of
pa latine bone
Soft pal ate

Middle nasa l conch a


M idd le nasa l mea tu s t7
\ t~.~
~ '< _,..:
~ /

rw ay to nasoph arynx
Inferior nasal co ncha
iA.....Iil--':r - In fe ri o r nasal meatus

Speculum view

Cribriform plate of ethmo id bo ne


Pro be in opening of sphenoidal sinu s

Superi or nasal mea tu s


with ope ning of posteri o r
ethm o id al ce ll s

Open in gs of midd le ethmoida l cell s

Semilun ar hi atus with openin g rus tubariu s


of anterior ethmoidal cell s
Opening of
pharyngotym pa ni c
Un cinate process
(auditory) tub e
Inferi or nasal co ncha
(cut surface) _ _ __....- Anterior arch
o f atlas (Cl vertebra)
Openin g of nasol acrim al du D ens of axis
(C2 ve rteb ra)
Inferior nasa l meatus Open in g of
maxillary sinu s

PLAT32 HEAD AND NECK


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

Lacrimal bone

Squamous part
Frontal bone Sinus - - - - --4--l:-t-
{ Nasal spine

Sphenoethmoidal recess

Sphenoethmoidal foramen

Basilar part of
occipital bone

Major alar ca

Medial
Frontal process and
Lateral Sphenoid bone
plates of
pterygoid
Maxilla process
Pterygoid
hamulus
Inferior Sphenoidal process
Alveolar process nasal concha
Orbital process
Posterior nasal spine
Perpendicular plate
Horizontal plate

Ethmoidal bulla

Frontal sin Opening of middle ethmoidal cells

uperior nasal concha (cut away)


Opening of frontonasal canal
penings of posterior ethmoidal cells
Middle nasal concha (cut away)
Opening of sphenoidal sinus

Openings into maxillaty sinus

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

Ethmoidal process of
Inferior nasal concha (cut away) inferior nasal concha

Lesser palatine foramen


Opening of nasolacrimal canal
Greater palatine foramen

NASAL REGION PLAT33


Medial Wall of Nasal Cavity (Nasal Septum)

Cribri form plate of ethmoid bone

Sphenoidal sin

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

Anterior nasa l sp in e

Fronta l bo ne l , - - - - - - - Cri sta galli


Cribri fo rm plate } Ethmoid hm'<

Nasal b

Sphenoid
bone

Vome rin e groove


(for naso palatine nerve
and vessels) -------......
Septal
Bas il ar part of
Major alar occip ital bon e
ca rtil age (med ial crus)
Pharyngea l
tubercle

l
Anteri or nasa l spin
Posterior nasa l spine Pa latin e

l
Nasal crest---~ H o rizontal plate bon e
Maxil la Lesser pa latine
In cisive cana l fora men
Pa latin e nrr>r P""' Greater pa latin e foramen

PLAT34 HEAD AND NECK


Maxillary Artery
SEE ALSO PLATE 29
Anterior
. } Deep tempo ral arten.es and nerves
Lateral pterygo id artery and mu scle Poste nor
Masseteric artery an d nerve
Supraorbita l artery
Late ral li ga ment of
Sup ratrochl ea r artery temp o ro mandibular j o int

Ophthalmi c artery ---r:~~=--iiiii~~~ Midd le menin geal artery

Dorsa l na sal artery Auricu lotempora l nerve

Ang ular artery

l
In frao rbital a rtery -4?--JI-...-.:Y,~~~~ Superficial tempo ral artery

Superior Posteri o r
alveo lar M iddl e ------''l\--l!~--!i Facial nerve
arte ri es Anter i or ------lll~
--.,---,---In fe ri or alveol ar
artery and nerve
Bucca l artery and nerve
Sphen o mandi bula r li ga ment
M edi al pterygoid
artery and muscle Mylohyoid nerve and branch
of inferi or alveolar ar tery
Pterygom andibul ar raph e
D igas tric mu scle (poste rior belly)
Lin gual nerve
Stylohyoid muscl e
Facial artery --0~:;bdc;~~==-_i\'!
Extern al ca rotid artery
Mental branch of
in fer io r alveo lar artery --J~<z~~~!!)l~~~~~~
Submental artery- Lin gual artery

Anteri or ~ D eep temporal arteries


Sphenopalatine artery A rtery of pter ygo id ca nal
Pos terior j and nerves
Pharyngea l artery Accessory men ingeal artery
Posteri or lateral na sal branch
Middl e meningeal artery
Infraorb ital artery Anterior tympani c artery
Deep auri cular artery
A uriculo-
tempora l
nerve

Pos terior septa l branches

D escendin g palatin e
artery in p te rygo-
p aIatin e fossa ----1'i~---::L--4::_~__j_

Superfi cial
Anastomosis in temporal artery
incisive ca n a l-----+--'->-~~~:dl
Asce ndin g ph aryngea l
artery

Left and ri ght


lesser palatin e arteries
Exte rnal carotid artery
Pterygo id arteries
Masseteri c artery
Superio r pharyngea l co nstri ctor mu scl e
Inferio r alveolar artery
Stylogloss us muscl e
fi!!N
.. : :
~ ...~

NASAL REGION PLAT35


Arteries of Nasal Cavity

Nasal septal branch of superior labial branch


(of facial artery)

Nasal septum (turned up)


Anastomosis between posterior
septa l branch of sphe nopalatine
artery and grea ter palatine artery
in incis ive ca nal
Schematic hinge
Septal and lateral nasal
branches of posterior
ethmoidal artery
Anterior septa l branch,----.,_
Anterior lateral nasal bran ch,
Posterior septa l
External na sa l branch
branch of
of anterior
sphenopa latin e
ethmoid al
artery
artery

Sphenopalatin e
artery

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

Posterior
lateral nasa l
branch es of
sphenop alatin e
artery

Anastomosis between
posterior sep tal branch
of sphenopalatine artery artery
and grea ter palatine
artery in in cisive canal
Lesser pa lati ne foramen and artery

Greater palatin e foramen and artery

Lateral wall of nasal cavity

':"
. .P ~ -~~~:~
r! i"'
mi.N

PLAT36 HEAD AND NECK


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

Nasal septum (turn ed up)

In cisive ca nal
Schematic hinge

Naso palatin e nerve (V2)


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

Sphenopalatine forame n
(dissected away)

Interna l nasa l
b ranches of
infrao rbita l
nerve (V2) Ne rve (V id ian)
of pterygoid cana l

Poste ri or superi or lateral nasa l


b ranch of maxillary nerve (V2)

Nasa l b ranch of G rea ter and lesse r pa latin e ne rves (V2)


anterio r superio r
alveolar nerve (V2)
Pos teri or in fer ior lateral nasal
b1a nch of grea ter palatin e nerv e (V2 )

Lesse r pa latine ne rves (V2)

Co mmuni catio n be tween


greater palatine and nasopa latine
nerves at incis ive ca nal - - - - - '

lateral wall of nasal cavity

ll!iN
'....::
~

NASAL REGION PLAT37


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

Distribution of olfactory
mucosa (shaded blue)

Lateral wall
of nasa l cavity

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

~..,_- Greate r petrosal nerve


~;;;;::;:;:;2~i5S:!\c-- Deep petrosa I nerve
~;..---,...-"""'::;;."'
Nerve (vidian) of pterygo id ca nal
Pharyngeal bra nch of maxill ary nerve (V2l
N aso pa latin e nerve (V 2 ) pass in g to septum (cut)
Posterior inferio r latera l nasa l branch
from greater pala tin e nerve (V2)
Lateral
wall of
nasa l
cavity

Palatin e nerves (V2l {


Lesse r

M edial in ternal nasal bra nch


of anteri or ethmoidal nerve (VI )

O lfacto ry nerves (I)

Incisive ca nal

Nasal septum

-------
PLAT38 HEAD AND NECK
Autonomic Innervation of Nasal Cavity
SEE ALSO PLATES 776, 725, 727

Superior salivatory nucleus (parasympathetic)

Facial nerve (VII)

Geniculum

Greater petrosal nerve (parasympathetic)

Deep petrosal nerve (sympathetic)

Nerve (Vidian) of pterygoid canal

Maxillary nerve (V2 ) entering foramen rotundum

Pterygopalatine ganglion in
pterygopalatine fossa

Lateral and medial posterior superior


nasal branches in pterygopalatine fossa

Posterior superior
and inferior lateral
nasal nerves
(cut ends)

nerve
\
Greater
I
I
Internal
carotid
and lesser
palatine
- -'-Spinal artery nerves superior Maxillary nerve
cord alveolar sinus
nerves

Sympathetic
trunk---+ Postsynaptic fibe1s to
vessels (sympathetic) and
glands (parasympathetic)
of nasal cavity, maxillary
sinus and palate

Presynaptic parasympathetic fibers

---------- Postsynaptic parasympathetic fibers


- - - - - Presynaptic sympathetic fibers

Presynaptic sympathetic cell ---------- Postsynaptic sympathetic fibers


bodies in intermediolateral nucleus
(lateral horn) of gray matter

IIDN
.': ,",' z
~ ~

NASAL REGION PLAT39


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

Com municatin g branch Anterior ethmoidal nerve

Posterior ethmoidal nerve Supraorbital nerve

Supratrochlear nerve
Lon g and short cil iary nerves
Lacrim al gland

lnfratrochlear nerve
(from nasociliary nerve)

Cutaneous bran ch of
lacrimal nerve

Zygomaticotemporal

Tentorial nerve Zygoma ticofa cial

Extern al
nasal
Trigemin al bran ch of
(semilun ar) ga nglion anterior
ethmoidal
Trigemin al nerve
nerve (V)

Meningeal
branch --.....---

Foram en
rotundum

Foramen
ovale Anterio1 superior
alveola r nerv e

Maxillary nerve (V2)


Mucous membrane
of maxillary sinus

Nerve (Vidi an) of pterygoid cana l Dental and gingival branches

Pterygopa latine ganglion Superior dental p lex us

Grea ter and lesser pal atin e nerves Infrao rbital nerve entering
in fraorbita l canal

Gangli onic branches to pterygopalatine ga ngli on

Posterior superior alveolar nerve

.P
t{
fl!!N
~~ :.: : ~

PLAT40 HEAD AND NECK


Mandibular Nerve (\.'1)
SEE ALSO PLATES 65, 11 6

Temporal fasc ia
and temporali s muscle
Lateral view } Deep temporal nerves

Masseteri c nerv e
M eningeal bran ch

Foramen spinosum

Middle
menin gea l arter y

Auricul o temporal
nerv e ------,-7+-':t:--.:::;~

Posterior
auri cul ar nerve

Facial nerve (VII )

Chord a tympani
nerve

Inferior alveo lar nerve (cut) Submandibul ar


ganglion
N erve to mylohyoid

M edi al pterygoid muscl e (cut)

D igastric muscle (posterior belly)

Stylohyoid mu scl e

Hypo glossa l nerve

Subm andibul ar gland

Sublin gua l nerve Di gas tri c mu scle (a nterior belly)


Medial view

Tri ge min al (sem ilunar)


ga nglion -----------:~:-:77::r--K

Ophtha lmic nerve (V 1) - --'rl"lri'


Tympanic cavity

M andibul ar nerve (

A nterior division
Tensor tympa ni
Tenso r ve li palatini muscle and nerve
nerve and muscle

Otic ga ngli on
Auricu lotempo ral nerve
Chorda tympani nerve

M ed ial pterygo id M axillary artery


nerve and muscle (cut)

Pterygo id hamu lus


Inferior alveo lar nerve en terin g
mandibul ar fo rame n

NASAL REGION PLAT41


Paranasal Sinuses

Coronal section

O lfac tory bu lbs

Brain

Middl e

M iddle
nasa l mea tus ---;~r:f-n~::--.;.~~~g
Recesses of
max ill ary
} sinu s
Max ill ary si

Inferi o r
nasa l meatus

Infe ri o r nasa l co nch a

Optic nerve (II )

Bra in

Horizontal section

PLAT42 HEAD AND NECK


Paranasal Sinuses (continued)

Sagittal section
Ethmoidal ce lls

Opening of
sphenoidal sinu s

Opening of fr o ntonasal duct

Sphenoidal sinu s

Middl e nasa l
concha (cut away)

Opening of
maxillary sinu s

Inferior nasa l co ncha

Opening into middle nasa l mea tu s

Pterygopalatine fossa

Maxillary sinus

Lateral dissection

:~o
I
IIN
:..:.::

NASAL REGION PLAT43


Paranasal Sinuses: Changes With Age

Bones of nasal cavity Sinu s 1eprese nts one or more anteri o r ethmoid al ce ll s
and paranasal sinuses openin g into se milun ar hi atus of middl e nasal meatus
at birth

Sinu s represe nts one or mo re middl e ethm o ida l cell s


openin g in to m idd le nasa l meatus

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

Naso lacrima l
foramen (beco mes
bony ca nal)

Med ial plate of


Pa rt of naso- pterygoid process
lacrim al duct w ithin
nasa l cavity wi th slit- Lower border of hi ghest nasal co ncha
like ope nin g in in fe ri or
nasa l mea tu s -------" Lowe r bo rde r of superi o r nasa l co ncha

Supe ri or nasa l meatus


M ax ill a
M idd le nasa l concha (cu t edge) (in fe rior
Uncinate process of ethmo id bone nasal concha co mpletely re moved)

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

Growth of frontal and maxillary


sinuses throughout life I@N
..: ,",'=:
~

Fro nta l sinu s


w ithin fro ntal bo ne

Birth
M idd le nasal co ncha
1 year

4 yea rs Nasal septum

7 yea rs

12 yea rs

Ad ult
Nasal cavity

Infe ri or nasa l concha


- - - Maxillary sinu s
w ithin max ill a

O ld age
Palate

PLAT44 HEAD AND NECK


Inspection of Oral Cavity

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


Soft palate

Palatopharyngeal arch
Uvula

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


!--_:_-----'::,_,.:..;:'ff-- - - Palatine tonsi I
'-"-::-:---..:;;_:.:.J-_ _ _ Posterior wall of pharynx

Frenulum of upper lip


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

Parotid papilla with


opening of pamtid duct

ORAL REGION PLAT45


Roof of Mouth
- ---- -------~~~~--------------------------------------~

G rea ter palatine artery and nerve

G rea ter palatin e fo ramen

Palatin e p rocess Less er palatin e fo ram en


of max ill a -----~O,!jll
Lesser palatin e artery and nerve s

Tendon of tensor veli


pa latini muscl e
Hori zo ntal p late
of pa latine bo ne - --f'-'--*llrtf'lf
Pterygo id hamul us

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

Pterygom andibul ar rap he

Mo lar m in or Superior phary ngea l


sa li vary gla11d s - --+"""""' con stricto r muscl e

Palatoph arynge us Pa lato glossus muscl e


muscl e _ _ _ __.....-

Bas il ar part of
Anterior view
o ccip ital bone

Cartil agin ous part of


pharyngotympani c
(a udito ry) tub e

-........~,.__-- Pharyngobas ilar


fascia

Levato r ve li palatini muscle


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

M edial pterygoid plate


Pterygoid hamulu s
Pte rygo id hamu lu

Tendon of tenso r ve li palatini mu scl e Superi or pharyngea l


co nstric tor mu scl e
Levato r veli palatini mu scl e (cu t )
Palatopharynge us m uscl e
Palatoph aryngeus muscl e

I ,_1

Po sterior view

PLAT46 HEAD AND NECK


Floor of Mouth
SEE ALSO PLATE 24

Lateral, slightly inferior view

Hyoglossus muscle

Mylohyoid muscle

Fibrous loop for intermediate digastric tendon

Digastric muscle (anterior belly)

Median raphe of mylohyoid muscle

Anteroinferior
VIeW

Thyrohyoid muscle

Sternohyoid muscle

Digastric muscle (anterior belly)


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

Posterosuperior view

Inferior alveolar nerve and artery

Mylohyoid nerve and artery

Submandibular gland and duct

Mylohyoid muscle-----'

Geniohyoid muscle----"'

Body--------c
G reater horn Hyoglossus
muscle (cut)

ORAL REGION PLAT47


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

Temp o ral fascia


Sup erficial laye r
Deep layer
Levator labii
superioris
alaeque nasi
mu scle----.. Zygomatic arch

Levator labii Articular disc o f


superioris temporomandibul ar joint
mu scle

~ Masseter
) muscle

Levato r Buccin ato r mu scle


anguli
o ri s
muscl e

M entalis
mu scl e

Dep ressor labii


infer ioris mu scl e D epresso r anguli
oris muscle

Tempo rali s muscl e

Insertion of temporal is muscl e to


co ronoid process of mandibl e

Parotid du ct

Orbi cularis oris muscle

In serti o n of
masseter mu scle

PLAT48 HEAD AND NECK


Muscles Involved in Mastication (continued)

Articular disc of
temporomandibular joint

Articular tubercle

Lateral pterygoid muscle

Sphenomandibular ligament

Parotid duct

Pterygomandibular raphe

Superior pharyngeal constrictor muscle

Lateral view

Choanae

artilaginous part of pharyngotympanic


(auditory) tube
Masseteric nerve

Middle meningeal artery


Temporomandibular joint
Auriculotemporal nerve

Lateral pterygoid muscle


Masseteric

Maxillary artery

Inferior alveolar nerve

Lingual nerve

Medial pterygoid muscle

Medial pterygoid plate

Pterygoid hamulus Levator veli palatini muscle

Pterygoid hamulus

Posterior view

ORAL REGION PLAT49


Teeth

Permanent
(colored blue)
Usual age of
eruption

Ce ntral inci sor


r__:_-:c::_--:-----:-::---==~~=~~~~3:------ Ce1 tra l in ciso r (7th yea r)
(8- 10 month s) c:=---~-'--~~~~::._ _ _r,.~~-- Late ral in ciso r (8th yea r)
Lateral in ciso r nine (c usp id ) (11th- 12 th yea r)
(8- W month s)
1st pre mo la r (9 th yea r)
2nd pre mo lar (10th yea r)
1st mo lar I st mo la r (6th year )
(15-2 1 mo nth s)
2nd mo lar (12th-1 3th yea r)
2 nd mo la r
(20-2 4 months)

2 nd mo la r
(20- 24 mo nth s) - - - - - - - - - - - - - - - - - , .
2nd mo lar (12th- 13 th yea r)
1st mola r
(15- 21 month s) 1st mo lar (6 th year)
-4---- 2 nd pre mo la1 (10th yea r)
-1- - - 1 st pre mo la r (9th yea r)
Late ral in cisor
(15- 21 month s) ~~p=:;";?""-----C a nin e (c usp id ) (11th- 12th yea r)
Central in cisor - - - - - - - - - Late ral inc iso r (8th yea r)
(6- 9 mo nth s) - - - - - - - - - - - - - - Ce ntral in ciso 1 (7th yea 1)

In cisive fossa

Palatin e process
of max ill a

Ho ri zonta l
pl ate of
pa latin e
bon e

G re ater and lesse r


palatine fo ra min a
Upper permanent teeth Lower permanent teeth

PLATE SO HEAD AND NECK


Teeth (continued)

Enamel
(substa nti a adam antina)
D entin e and dentin al tubul es
(substantia eburnea)
Crown - --M- - - - - I n terglob ul ar spaces
_ _1.- t---- - - - Odo ntoblast layer
- . f _ - = - - - - - l n terproximal spaces
D ental p ulp co ntaining vessels
and nerves

Neck G in gival (gum) ep ith elium (stratified)


Ep itheli al attachment
Lamin a prop ri a of gingi va (gum)
(mandibu lar or m ax ill ary perios te um )
Peri odontium
(a lveolar pe ri os teum )
Papill a
Cem ent (ce mentum )
Root
Root (ce ntral ) ca nals
co ntainin g vesse ls and nerves
Bo ne
Ap ica l fo ramina

. \ !,,~
~

JfiiN
:,-.,;::

Left upp er
perm anent
teeth:
labiobuccal
view

nr~i \]
Left lower
permanent
t1
~
tee th: I g
labiobuccal
view
\t
Ce ntral Lateral 1 2
~ ~
In ciso rs Ca nin es Premo lars Mo lars
(c usp ids )

ORAL REGION PLATE 51


Tongue

M edi an glossoepi glottic fold


:;!;-_!!~..------L a t e r a l glossoepiglotti c fold

Palatopharyngea l arch and mu scl e


Pa latine ton sil (c u t)
Lingual ton sil (li ngual nodul es)
Root
Palatoglossal arch and muscl e (cut)
7:iitlr- - - - - F o ramen cecum

J----- Foli ate papi ll ae

>----Filiform papi ll ae

Body

- - - - - Fungifo rm papi lla


- - - - - Mid line groove (m edian sulcus)

Dorsum of tongue

Lin gual to nsil

IIDN
'..,".' : :
~

In trin sic muscl e

Duct of gland
Crypt
Lymph fol licles
Stratifi ed squamous

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


Lamin a propria

Schematic ste reogram: area indicated above


Section of
taste bud

PLAT 52 HEAD AND NECK


Tongue (continued)
SEE ALSO PLATES 29, 47, 47, 722

Pal atopharynge us mu scle


Palatoglossus muscl
Inferi o r lo ngitudin al muscle of

M as toid pro cess


Di gas tri c muscle (posterio r
bell y) (cut)

Supe rior ph aryngea l co nstrictor mu scle


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

M ylohyoid muscle (c ut) brous loop for intermediate di gastri c te nd on


I'
Hyo id bo ne
Geni ohyoid mu scle

II!!N Superior pharyngeal


Lin gual nerve
:.;!
~. ~
constri cto r muscle
Subm andibu lar

Dee p li ngua l artery


and venae co mitantes

Artery to fre nu

Subm andibu lar duct

Common trunk for fac ial,


retromand ibul ar and
lin gual veins

Lin gua l ve in
Sub lin gual artery and ve in Suprahyo id arte ry

Geni o hyo id muscl e rsa llingu al artery and vein

Hypoglossaln Vena comitans of hypoglossal nerve

ORAL REGION PLATE 53


Tongue and Salivary Glands: Sections

Horizontal section Orbicularis oris muscle


below lingula of
Buccinator muscle
mandible (superior view)
demonstrating bed Buccopharyngeal fascia
of parotid gland Facial artery and vein
Pterygomandibular raphe
Lingual nerve and superior pharyngeal constrictor muscle

Palatoglossus muscle in palatoglossal arch

Palatopharyngeus muscle in palatopharyngeal arch


Ramus of mandible
Inferior alveolar artery, vein and nerve
Medial pterygoid muscle
Styloglossus muscl

Retromandibular vein
External carotid artery
Parotid gland
Stylopharyngeus muscle
Stylohyoid muscle
Sternocleidomastoid muscle ---~"'
Digastric muscle (posterior belly) - - --r-T

Internal jugular vein, internal carotid artery


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

Superior longitudinal muscle l


Vertical and transverse muscles
Inferior longitudinal muscle
of tongue

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

PLATE 54 HEAD AND NECK


Salivary Glands
SEE ALSO PLATES 79, 47, 727, 728, 753

Superfi cial temporal artery and vein


and auri culotemporal nerv e

Branches of faci al nerv e

Transve rse facial a

Buccinator mu scle (cut)

M assete r muscl e

Lingual

Subm andibular gangli on

Frenulum of ton gue

Sublin gual fo ld w ith op enin gs


of sublin gual ducts------+.;~~~

Sub lin gual ca runcle w ith opening


of submand ibul ar duct------1'"11/i'f:~~j

Sublingual gland

Submand ibular du ct
Stylohyoid muscle
Sublingual artery and vein

M ylohyo id mu scle (cu Sterno cleidomasto id mu scle


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

Parotid gland: Subm andibular gland:


totally serous mostly serous, partially mu co us

ORAL REGION PLAT 55


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

Trigeminal (V) (maxillary V2)


Via superior alveolar
Trigeminal nerve (V)
Glossopharyngeal nerve (IX) ~/~
=====
nerves
Via pterygopalatine Vagus nerve (X) 'l"'///.r:;:.
ganglion and greater
Facial nerve (VII)
and lesser palatine

Facial (VII) (intermediate nerve)


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

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

Via greater petrosal nerve and


pterygopalatine ganglion

Trigeminal (V)
Vagus(X) (maxillary V2)
Via internal branch of Glossopharyngeal (IX)
Via pharyngeal plexus ~-,--...-7--';;t"-- Vi a pte ry go-
superior laryngeal nerve palatine ganglion
Via tonsillar branches
Taste plus general and greater and
sensation via lesser palatine
lingual branches

Vagus(X)and
glosso-
pharyngeal (IX)
Via pharyngeal
plexus---

Vagus (X)
Via internal
branch of

PLATE 56 HEAD AND NECK


Pharynx: Median Section

Ph aryngea l o penin g o f pharyngo tympani c


(a uditory) tub e
Sphenooccipital syn chondrosis
Ph aryngeal ton sil
Ph aryngeal tub ercle of occipital bo ne
Ph aryngeal raphe
nterior lon gitudinal li ga ment
nterior atl antooccipitalmembrane
Api ca l ligam ent of dens

Anterior
arch of
atl as (C1
ve rtebra)
D ens of
ax is (C2
vertebra)
Ph aryngea l
constrictor
Lingu al mu scle s
~~t.ti-'-'----- Bucco-
ph aryngeal
fascia
Root o f
Retro-
pharyn gea l
space

Ge niohyoid mu scle _ ____.._ :iiia.:- Prevertebral


fascia and
Hyoid bone --__::::--:ii':'~::- anterior
longitudinal
Hyoepi glo tti c ligam ent li ga ment
Thyrohyoid mem brane Vertebral
bodies
Laryngoph arynx
Lar yngea l inlet (aditus)

Transve rse aryteno id muscl e

Esoph agea l muscles


Th yroid gland
Inves ting layer of (deep) cervical fascia

Supraste rnal space


M anubrium of sternum --~11-m

Jfi!N
:..: :
~~

PHARYNX PLATE 57
Fauces
Medial view
Median (sagittal) section

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

.!,.<f.;---l-'1+--- Palatopharyngeal arch

-iT.I~rnT-Ht--- Palatoglossal arch


- -"'-'"-"'"'--ltll-- - 0 ro pharynx
t:"=~::::::Jl!it__ Triangular fold
'lf'-'=~:=;,r-\lli--Tongue (drawn forward and downward)
1"--'------ Lingual tonsil
:___---Epiglottis
Vallecula

Pharyngeal mucosa removed

Cartilaginous part of pharyngotympanic (auditory) tube-~i$::~.~~....,.,:~.


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

PLAT 58 HEAD AND NECK


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

M edial pterygoid plate


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

terior lon gitud inal li gament


terior atl antoocc ipitalmembrane
ica lli ga ment of dens
Salp in go ph arynge us muscl e
Muscles of so ft palate
Palatopharyngea l sphincter (Passavant's rid ge)
Pterygoid hamu lus
~tlttr;;ift~~H~M-- superior ph aryngea l constricto r muscl e
Pterygom andibul ar raph e
Palatopharyn ge us mu scl e
Buccin ator mu scl e
+ == = =4+-- c l ossoph aryn gea l part of
superior ph aryngea l co nstri ctor
Stylopharyngeus mu scl e
Styloh yo id li ga ment
Stylo glossus mu scl e
Midd le phary ngea l co nstri ctor muscle
'\,-;So;"""'P ,..:..-jH---t-i bers to ph aryngoe pi glo ttic fold
:J~:;:~:,~~e.,;"--++---Bu ccoph a ryn gea l fascia and
retroph aryn gea l space
yo glossus Prevertebral fascia and anterior
mu scl e longitudin al li ga ment
G enioh yoid Intern al branch o f superior laryngeal nerve
mu scl e
Lon gitudin al ph aryngea l muscles
M yloh yoid
mu scl e nferior ph aryngea l con strictor muscl e
Hyoid bone Pharyngea l apo neurosis
Th yrohyoid 1.--.'~~~:':------\i\ic--Cri c oph a r y n ge u s mu scle
membrane (part o f inferio r ph aryngeal con stri ctor)
Cricoid attachm ent of lo ngitudin al
M edian esop hagea l mu scl e
cri co thyro id li ga ment
Circul ar eso ph ageal muscle
Com iculate and
arytenoid carti lages Lon gitudin al esophageal muscl e

.................. M argins of middl e pha ry ngeal


,.,
constri cto r mu scl e
'~-, :
- - - - - - - - - M argin s and attachments of in fe rio r
J@N
;. :.. ~ :
ph aryngea l co nstrictor muscl e

PHARYNX PLATE 59
Pharynx: Opened Posterior View

Base of skull (basilar part of occipital bone)


haryngeal tonsil

ru s tu bari us
~~~r--Pharyngeal ope ning
of pharyngotympanic
(auditory) tube
Nasopharynx

orus levatorius (fold


caused by levato r
veli palatini muscle)
Salpingopharyngeal fold

Angle of mandible
Submandibular gland

Oropharynx

Prominence caused by greater horn


of hyoid bone

Laryngeal inlet (aditus)


Prominence caused by superior horn
of thyroid cartilage
Laryngopharynx iglottic fold

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

PLAT60 HEAD AND NECK


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

Phar yngeal
ton sil

Cartilaginou s part
Styloid of pharyngotympani c
p rocess (a udito ry) tube

Stylo hyo id
mu scl e - - - -L:::.--..: .;;.l--tr--Levato r veli
palatini muscl e
Stylopharynge us
muscle - - - - ---.:- ;--.,..___ Superior pharyngea l
co nstri ctor mu scle
Accessory mu scle
bund le from
petrous pa rt of
temporal bone

M ed ial Palatopharyngeu s muscle


pterygo id muscle
f"L---Middle phar-yngeal
Pharyn go basilar fascia co nstri ctor mu scle

Ph aryngeal raph e Stylop haryngeus mu scl e

Superi or- pharyngea l Pharyngoepiglottic fold


constri ctor mu scle
A ryepi glo tti c fold
H yo id bone (tip of grea ter horn)
Inferior- phar yngeal
M idd le pharyngeal co nstri ctor muscle co nstri ctor muscl e (cut edge)

Longitud in al pharyngeal muscl es

Supe ri o r horn of
Infer io r ph aryngeal constri ctor muscl e thyro id ca r-tilage

Cun eiform tubercle Thyrohyo id membrane

Interna l branch of
superi o r laryngea l nerve

Ph aryngeal aponeurosis

Posterior cricoa ryteno id mu scle Cricopharyngeus mu scle (part of


inferior pharyngea l co nstrictor)
Cri cop haryngea lmu scle (part of
Posteri o r bo rder of thyro id ca rtilage lamin a
inferior ph aryn gea l co nstri cto r)
Cricoid attachment of lo ngitudin al
Lon gitudin al esop hageal muscle esophageal mu scle

Circul ar esophagea l muscle

PHARYNX PLAT61
Muscles of Pharynx: Lateral View
-----~-----------------

Ph ary ngobasil ar fasc ia

Te nso r veli palatini muscle

Leva tor ve li pa latini muscle

Late ral pterygoid plate

Ptery go id ha mu lu s

Buccinator muscle (cut)

Pterygomandibu lar raph e

tylo id process
Superio r pharyngea l constri ctor mu scle
Styloglossus mu scle
Ob li qu e line
of mand ible Stylohyo id li gament
Stylopharyngeus muscle
Middl e pharyn gea l co nstri ctor muscl e
Hyoglossus mu scl e
Greater horn of hyo id bon e
Di gastri c mu scle (a nterior belly) Sup eri or horn of thyroid carti lage
M ylohyo id muscl e Th yrohyo id membrane

Hyoid bone Inferior pharyngea l co nstri ctor muscl e

Stylo hyo id mu scle (cut)


Zo ne of spa rse mu scle fibers
Cri coph aryngeus muscle
Med ian crico thyroid li ga men (pa rt of inferior pharyngea l co nstrictor)

Cricoth yroid muscle

Cri co id ca rtila ge

PLAT62 HEAD AND NECK


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

From { Supraorbital arter


ophthalmic
artery Supratrochlear arte

Middle meningeal

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

Glossopharyngeal nerve (IX)


Mental branch of Ascending palatine artery
inferior alveolar a

Inferior alveolar artery


and lingual branch

Ascending pharyngeal artery


Internal carotid at-tery
Mylohyoid branch of
Vagus nerve (X)
inferior alveolar artery
Submandibular gland

Hypoglossal nerve (XII)


terior scalene muscle

Middle scalene muscle


Superior laryngeal
Ascending cet-vical artery
Superior thyroid
Inferior thyroid artery
nsverse cervical artery
Common carotid

Subclavian artery Thyrocervical trunk

PHARYNX PLAT63
Veins of Oral and Pharyngeal Regions
SEE ALSO PLATES 10 26, 98

Supra tr ochl ea r vei n


Sup raorbi ta l ve in ----:ifi---''11
Nasofrontal vein ----J'IH\1'0
Superior ophthalmi c vein
Angul ar vein
Extern al nasal vein ----T-~'ftll

Emissary vein (Vesa liu s) --~~aitt=-::~~::__


commu ni cating w ith
caverno us sinu s

Occipital vein
and artery
Supe rfi cial te mporal
Pterygo id plexus vein and arte ry
Superior labial vein Transverse facial vein (cut)
Dee p facial ve in
Maxillary veins Retrom andibular vein
Inferior labial vein Extern al jugular vei n (cut)

Mental ve in
Facial vein and artery
Exte rn al palatin e vein Hypoglossal nerve (X II )

Subm ental ve in Com mon trunk for


facial, retromandibular
Submandibular gland and lin gua l veins

Ven a com itan s of


hypoglossal nerve
Dorsal lingua l vein coursing
medial to hyoglossus muscle mmon caroti d artery
Lin gual ve in
Communication to anteri or jugular vein (cut)
idd le sca lene muscle
Anteri or sca lene muscle
External ju gular vein (cut)

Middle th yro id vein


Infer io r th yroid vei ns Suprascap ular vein (cut)
Termination of anterior ju gul ar vein (cut) ~ "~- ~ subclav i an artery
Left bra chi ocephali c vein ..;..,11~----ilr-- S u bclav i a n ve in

PLAT64 HEAD AND NECK


Nerves of Oral and Pharyngeal Regions
SEE ALSO PLATES 79, 40, 47, 776, 7 79, 720

Zygomaticotemporal nerve (V2l


Deep temporal nerves (V3)
Masseteric nerve (V3)
Mandibular nerve (V3)
Nerve to medial pterygoid and
tensor veli palatini muscles (V3) (cut)
Zygomaticofacial nerve (V2)
Maxillary nerve (V2)
Infraorbital nerve (V2)
Pterygopalatine ganglion--w.-;::..,...__
Greater and lesser
palatine nerves (V2l - - ---!Jr-<-""717
Auriculotemporal
Anterior, middle and posterior nerve (V3)
superior alveolar nerves (V2)
Middle meningeal artery
Nerve to lateral pterygoid
Superficial temporal
muscle (V3) (cut)----=-<
arte1y (cut)
Buccal nerve (V3) Facial nerve (VII) (cut)
Chorda tympani nerve (VII)
Lingual nerve (V3) Accessory nerve (XI) (cut)
Medial pterygoid muscle (cut) Cl spinal nerve
(lateral pterygoid removed) (ventral ramus) (cut)
2 spinalne1ve
(ventral ramus) (cut)
Mental nerve (V3) Pharyngeal plexus composed of
branches from glossopharyngeal
Nerve to mylohyoid (V3) (IX), vagus (X) and sympathetic
Submandibular ganglion
Glossopharyngeal nerve (IX)
and tonsillar branch _ _ ____/
Hypoglossal nerve (XII) gus nerve (X) and superior
Carotid nerve (IX) and carotid body cervical cardiac branch
C4 spinal nerve
Nerve to thyrohyoid muscle (Cl, 2 via XII)
(ventral ramus) (cut)
Internal and external branches Phrenic nerve (C3, 4, 5)
of superior laryngeal nerve (X)
. 1.IS (Cl , , ) { Superior root
A nsa cerv1ca 2 3
Inferior root
or scalene muscle
Nerves to superior and inferior bellies of omohyoid,
sternohyoid and sternothyroid muscles (ansa cervicalis)
Recurrent laryngeal nerve (X)

Common carotid arrPrv--


Vertebral artery---

Subclavian artery

PHARYNX PLAT65
Lymph Vessels and Nodes of Head and Neck
SEE ALSO PLATE 79 7

(r.~P
IIN
.
~ .~:.: :

Superficial parotid nodes


(deep parotid nodes
deep to and within
parotid gland)

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

Sternocleidomastoid
nodes

Superio1 latera l
Submandibular superfi cial ce rvi ca l
nodes-----~;, (ex tern al ju gular)
node

)ugulodi gastric node


Submental
n o de s ---~~~ Posteri o r latera l
superfi cial ce rvica l
(s pin al accessory)
nodes

Superior deep lateral cervical


(intern al jugul ar) nodes Interca lated nod e

Superior thyroid nodes Inferior deep


lateral cervical
(scalene) node
)u gul oomo hyo id node
Th o racic duct
Anterior deep ce rvical
(pretracheal and thyroid) nodes
Transverse
(deep to infrahyoid mu scles)
ce rvical
chain of
nodes
Anteri or superfi cial ce rvi ca l
nod es (ante rior ju gu lar n

Supraclavicular nodes

Subclavi an trunk and node

PLAT66 HEAD AND NECK


Lymph Vessels and Nodes of Pharynx and Tongue

Ph aryngobas il ar fascia

Retroph aryngea ln odes

Intern al ju gul ar ve in

Di gastri c mu scl e (pos teri o r belly)

Sternocl eido masto id mu scl e

ju gul od igastric nod e

Deep lateral ce rvica l


(intern al ju gular) nodes

ju gul oomoh yoid node

Api ca l coll ectin g vessels

ntral co ll ec tin g vesse ls

M argin al co ll ectin g vessels

Lymphatic drainage of pharynx:


posterior view

Lymphatic drainage of tongue

Submental nod e

Submandi bular node

)ugul odi gastri c nod

Deep late ral ce rvica l


(intern al ju gul ar) nodes - - -

PHARYNX PLAT67
Thyroid Gland: Anterior View

Thyroh yo id membran e

A nsa { Superior ro ot

l
ce rvicali s . Inferi o r root Cricoth yro id muscles

Co mmo n ca rotid arte

Pyramidallobe
(o ften absent
Middle thyroid vein o r small) Th yroid
Right lobe gland
Inferi or th yro id vein s Left lobe
Isthmu s
Asce ndin g ce rvical artery
Pretracheal lymp h nodes

Phrenic nerve

A nteri o r scalene muscle

Vagus nerv e (X)


Th yrocervical trunk

Subclavian
artery and ve in Anterior ju gul ar ve in

1st rib (cut)

Right recurrent
laryn gea l nerve

Brachiocephal ic trunk

Brachiocephalic ve in s

Superior vena cava

Aortic arch

Th yroid ca rtil age

Cricothyro id ligamen t

Com mon ca rotid arte ry

Tra

PLAT68 HEAD AND NECK


Thyroid Gland and Pharynx: Posterior View

Superior pharyngeal
External carotid arte1-y
constrictor muscle

Internal carotid artery


Middle pharyngeal
constrictor muscle - -1-----'-4.!
Facial artery
Tip of greater horn
of hyoid bone---+ --+ Lingual artery

Superior laryngeal nerve


=--- - Internal branch
External branch

Superior thyroid artery

Superior laryngeal artery

Cricopharyngeus Cornrnon carotid artery


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

Circular esophageal Internal jugular vein


muscle in V-shaped
area of sparse
longitudinal muscle
fibers (area of Lairner)

Longitudinal Superior parathyroid gland


esophageal muscle
nding cervical artery

Inferior parathyroid gland

il----lnferior thyroid artery


Inferior bulb of
internal jugular vein Right recurrent laryngeal nerve

Vertebral al-tery

Left subclavian ,-ascapular 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

Right vagus nerve (X)

THYROID GLAND AND LARYNX PLAT69


Parathyroid Glands
SEE ALSO PLATE 74

External ca rotid artery


Posterior view
Intern al ca rotid arte1y
Superi o r laryngeal
Intern al branch Superi or th yroid artery
Extern al branch

Inferi o r pharyn gea l


co nstri ctor mu scle (cut)

Common ca rotid artery


Superior thy roid artery
Fibrou s ca psule of
thyroid gland (cut)

Cricopharynge us mu scl e (part of


inferior ph aryngeal constrictor)
Fibrou s capsul e of
thyroid gland (cut) - ---7-f-!-M I-
Sup erior parathyroid gland
Superior parathyroid gland
Right lobe of th yroid gland

Inferior parath yroid gland


(may be more ca ud ally loca ted,
Ascending ce rvical artery even within mediastinum )

ecu rrent laryngea l nerve

Recurr ent laryngeal nerv e

Th yrocervical trunk

Subclavian Vertebral arter y

Brachi ocep hali c trun k

Right lateral view


Internal bran ch of
Extern al ca rotid a superio r laryngea l nerve
Superior laryngea l
Extern al bran ch of
Superior th yroid artery ( superior laryngea l nerve

Inferi or ph aryngeal co nstrictor muscl e

Th yroid gland (right lobe)


(retracted anteriorly)

Inferior thyroid arte ry


Inferior parathyroid gland

PLAT70 HEAD AND NECK


Cartilages of Larynx

~------Cricoid cartilage------
Trachea

Anterior view Posterior view

~~'~j~~~~:~i~urface
Corniculate cartilage

Cricoid
cartilage

l
Lamina

Arch -------~

Anterosuperior view
Muscular process } Arytenoid
Vocal process cartilage

Med1an } Vocal p1o


Late1 al \ Vocalligamen
~1yroepiglottic liga
Cricothy1 01d ligament

Trachea Medial view, median


Right lateral view
(sagittal) section

THYROID GLAND AND LARYNX PLATE 71


Intrinsic Muscles of Larynx

Foramen for supe rior


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

Ob li que and transverse


arytenoid mu scles

Posterio r cricoarytenoid
mu scle

Posterior
l
)
Cricoth yro id
muscl e
crico'ar ytenoid
muscle
Cricoid cartil age
Right lateral view
Posterior
view

A ryepiglo ttic
muscle Thyroep iglottic
mu scle
Obliqu e and
tra nsverse Aryteno id ) Muscular process
aryteno id muscles Thyroaryten o id
muscle ca rtil age { Vo ca l process

Lateral
cri coa rytenoid
muscle

Thyroid articu lar


s urface ------.Q:!~ Conus elasticus

Cricothyroid
mu scle (cut awa y)

Lateral dissection

Posterior cri coaryteno id muscl

Late ral cri coarytenoid muscle

Transverse and ob liqu e aryteno id muscles

Cri co th yroid mu scle

Th yroarytenoid muscl e

Vocalis mu scle Lam in a of


th yroid
Vocal li game nt ca rtil age

Superior view

PLAT72 HEAD AND NECK


Action of Intrinsic Muscles of Larynx

Action of cricothyroid muscles


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

Action of posterior cricoarytenoid muscles Action of lateral cricoarytenoid muscles


Abduction of voca l li ga ments Adducti o n o f voca l li ga ments

--

Action of transverse arytenoid muscle Action of vocal is and thyroarytenoid muscles


Addu ction of voca l li ga ments Shortening (relaxa ti on) o f vocal ligaments

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

THYROID GLAND AND LARYNX PLATE 73


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

In terna l branch of
~~~-:-::-------Superior sup eri o r laryngea l nerve
laryngeal nerv e
Senso ry branches to larynx
Intern al bran ch
External branch Ansa of Ga len

Aryep iglottic muscle

Th yroep iglo ttic muscle


Inferior phar yngea l Tr ansve rse and oblique
constri ctor mu scl e aryte no id mu scles

Th yroaryteno id muscl e

Vo ca li s muscle

Cri cothyroid muscl e Latera l cricoa rytenoid muscl e

Posterio r cricoa rytenoid muscl e


Cricop haryngeus mu scl e
(pa rt of inferior Th yroid arti c ular surfa ce
ph aryngea l co nstri ctor)
A nterior and posterior branches of
in fe ri or laryngea l nerve
Recurrent
laryngea l nerve

Right lateral view:


thyroid cartilage lamina removed
Right lateral view

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


Right vagus nerve (X)

Anoma lo us ri ght inferi o r


laryng ea l nerve (not rec urrent)

Anomalo us (re tmesophageal)


ri ght subcl avian artery -----,Q~
Left subclavian artery

Ri ght co mmon carotid arte ry Anoma lo us (retroesophageal )


ri ght subcl avian artery originatin g
from left sid e of ao rtic arch

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

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

PLATE 74 HEAD AND NECK


Inspection of Larynx

Positi on o f
pa tient and
ph ys ician

M irror w armed over alco hol flame


to prevent fogg in g, th en tes ted
on back o f physician's hand

M irro r
elevates
uvula

Roo t o f to ngue
M edian glossa-
(lin gual to nsil )
epi glo ttic fo ld

Vall ec ula- --..


Vestibul ar folds
Vocal folds
(false voca l cords)
(true voca I co rds) --;----:r-~:::._.J:---I
Ves tibu le

A tyep iglo ttic fo ld

Cun eifo rm tub ercle


lnterarytenoid
notch o rni cu late tub ercle

N ormal larynx: in spiration Normal larynx: phonation

THYROID GLAND AND LARYNX PLATE 75


Eyelids

Superior palpebral conjun cti va:


tarsal (me ibom ian) glands Superior lacrimal papil la and punctum
shinin g throu gh

Pli ca semilunaris
Seen th rough { Pupi l
co rn ea Iri s
Lacrima l carnucl e in
lacrim al lake (lacus lacrim alis )
Corneoscleral jun ctio n
(co rn ea l limbus)---------~
Infer io r lacrim al pap ill a and pun ctum
Bulbar co njun ctiva
over sclera _ _ __.-

Inferi o r co njunctiva l forn ix

Inferi or palpebral co njunctiva:


tarsa l glands shinin g through

Levato r palpebrae superioris mu scle


Orb ital septum
Superior tarsa l (Mu ll er's) muscle (smooth )
Superi o r conjunctiva l forni x
O rbicu laris ocu li muscle (palpeb ral part) Palpeb ral conjun ctiva

Tarsa l (me ibomi an) glan ds


Sebaceous glands
Eyelas hes (cili a)
Ope nings o f tarsa l glands

O rbi cu laris oculi muscle (pa lpebral part)


Inferior co njun ctival forni x
Orb ital septum

Fronta l bone ------------

In se rtion of leva tor palpebrae


superiori s muscle

Supraorbital artery and nerve


Supratroch lea!' artery and nerve

Lateral palpebral li gam ent Dorsa l nasal artery


and overlyin g rap he - - - - - - - ';it;,...--; and infratro chl ea r nerve
Lacrimal sac
M edia l palpebral li ga ment
M ax ill a (frontal process)
Zy go matic bon e
-"----!---In frao rbital arte ry and nerve

PLATE 76 HEAD AND NECK


Lacrimal Apparatus
SEE A LSO PL ATES 40, 727

Superior lacrim al pap illa and punc tum

O rbita l part of
lacrimal gland
Lacrimal ca nali culi

Lacrimal sac

Excretor y du cts of
lacrimal gland Nasolacrim al duct

~--- Op e nin g of
naso lacrim al duct
Lacrima l ca runcl e

Inferi o r lacrim al pap ill a and punctum


J~
i

Supe ri or lacrim al pap ill a and pun ctum


Frontal bo ne (cu t away)

Lacrim al ca nali culi

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

Nasolac rim al du ct

Pli ca se milun aris


andl acrim all ake

In fe rior lacrim al papil la and pun ctum

Openin g of nasolacrimal du ct Inferior na sa l meatu s

ORBIT AND CONTENTS PLAT77


Fascia of Orbit and Eyeball

Hori zo ntal section Tarsus of eye lid

Pa lp eb ral conjun ctiva


M edial pa lpebral li gament

Check li ga ment of
Latera l pa lpebra l li gament
medial rectus muscl e ----;i~IU
~~"-...
Check ligament of
Ethmo idal ce ll s- - - - ; lateral rectus muscle

Peri orb ita

Sclera
Med ial rectus muscl e
and fasc ial sheath Fascial sheath of eyeba ll
(Tenon's capsu le)
Fascial shea th of eyeba ll
(Tenon's capsu l e) ---~ Ep iscle ral space

Lateral rectus m uscle


and fascial sheath

Retrobu lbar fat


(orb ital fat body)
Optic nerve (II ) and
o uter shea th _ _ __..--

Spheno idal sinus

Levator palpebra e superi oris muscle and fasci al sheath


Frontal section Superior oblique mu scle and fascial sheath

Superior rectus muscle Medial rectus muscle an d fascial sheath


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

Ethmoidal ce ll
Lateral rec tus muscl e and
fasc ial sheath ------+-~1t':-lh=ili'!J1i Sclera
illJt:IIJ.----Fasc ial sheath of eyeball
(Tenon's caps ule)
r-;;:~~~~-ffir----ln fe ri or rectus muscl e
and fascial sheath
In fer ior obl ique muscle
Episcleral and fascia l shea th
Retrobu lbar fat (orbital fat body In fraorbita l nerve (V2 )

Muscle attachments and nerves and vessels entering orbit

Superior orbital fissure Leva tor palpebrae superio ri s muscle


Lacrim al nerve (V 1 ) Superior obliq ue muscle
~-.,-----Sup er i or rectus muscle
Trochl ear nerve (IV) m - - - - Med ial rectus muscle

Supe ri or ophtha lmic vein Optic nerve (II ) }


in optic canal
Lateral rectu s Ophthalmic artery

Superior branch of ocu lomotor nerve (Ill ) Infe ri or rectus mu scle


In ferior orbital fissure Infe rior branch of ocu lomotor nerve (Ill )
Abduce nt nerve (V I) Nasoci li ary nerve (V 1 )

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

PLAT78 HEAD AND NECK


Extrinsic Eye Muscles

Right lateral view Superior oblique muscle

Levator palpebrae superioris muscle


Trochlea (pulley)
Superior rectus muscle

Medial rectus muscle

Lateral rectus muscle (cut)

Common tendinous ring

Lateral rectus muscle (cut)

Inferior rectus muscle

Superior view
' ~ --Levator palpebrae
superioris muscle (cut)

Inferior rectus muscle

Superior rectus muscle (cut)

Levator palpebrae superioris muscle (cut)

Innervation and action of extrinsic eye muscles:


anterior view

Levator palpebrae
superioris muscle

Abducent
Oculomotor Lateral rectus muscle { nerve (VI)
nerve (Ill) Medial rectus muscle

Inferior rectus muscle


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

ORBIT AND CONTENTS PLAT79


Arteries and Veins of Orbit and Eyelids
SEE ALSO PLATES 70 98

Superior vi ew Med ial palpebral artery

Lateral palp eb ral art ery

Anterior m enin geal artery


Zygoma ti c branches
Ante ri o r ethmoidal artery
Posterio r cili ary arteries

Poste ri o r ethm oidal arte ry

Ce ntral retinal artery

Suprao rbital artery

Supratro chl ea r artery

Dorsa l nasal art ery


Anterior view
Supe ri or medial
pa lpeb ral ar tery
Frontal branch of
superficial temporal artery

Superio r latera l pa lpebral arte =-D;LJ-+--+.---In feri or medial


pa lpeb ral artery

Superior and infe ri or


pa lpeb ral arterial arches

Transverse fac ial

In fraorbita l artery (X= anastomosis of vesse ls from


externa l and internal carotid arteries)

Lateral view
Supraorb ital vein Nasofronta l vein

Superior ophtha lmi c vein Angular ve in

Cavernous sinus

Facia l vein

In fe ri or op hth almi c ve in

Pterygo id p lexus - - --,,f;(F-,

Max ill ary vei

PLAT80 HEAD AND NECK


Nerves of Orbit
SEE ALSO PLATES 40, 775, 726

Superior view Media l bra nch } Suprao rbital nerve


Latera l bra nch

Supratroch lear nerve Leva tor palp ebrae superioris muscle

Medial rectus mu scle Superi or rectus muscl e

Lateral rectus mu scle

Frontal nerve
Trochlear nerv e (IV)
Maxillary nerv e (Vz)
Common tendinous rin g
Men in geal branch
of maxillary nerve
Ophthalmi c nerve (V,)
Mandibu lar nerve (V3)

Lesse r petro sa l nerve


In terna l carotid artery
and nerve plexu s- - - -----llf::=- Men in gea l branch
of mandibular nerve

Greate r petrosal nerve

Trigeminal (se milun ar) gangli on

l J~~r.::::=-~.-2....,.------Tentor i a ln erve (meningeal)


'- bran ch of ophthalmi c nerve
Tentorium cerebel li

Long ciliary nerves


Superior view:
levator palpebrae superiori s, Short cili ary nerves
superior rectus and superior
oblique mu scles partially
cut away Cili ary gangli on
Parasympathetic root of cili ary
Supratrochl ear nerve (cut) ganglion (from inferi o r branch
of ocu lomotor nerve)
Supraorb ita l nerve branch es (cut)
Sympathetic root of ciliary
ln fratrochlear nerve ga ngli on (from intern al
ca rotid plexus)
Anterio r ethm oid al ne rve

Optic nerve (I I)
~~~~::~- Se nsory root of cili ary ganglion
(from nasociliary nerve)
Poste ri or ethm o id al nerve f.of;r-~----- Branches to in fer ior
Sup eri o r b ranch of and medial rectus muscl es
ocu lomotor nerve (Ill ) (cut) Abducent nerve (V I)
Nasocili ary nerve In fer ior branch of
ocu lomoto r nerve (Ill )
Interna l ca rotid plexus---!....:-~~=-r

Tr och lea r nerve (IV) (cut)


Fronta l nerve (cut)
Oculomotor nerve (Ill) _ ___,.;:::,..,...__,-;:.:::
Ophthalmi c nerve (V,)

ORBIT AND CONTENTS PLAT81


Eyeball

Horizontal section Cornea

Zonular fibers Capsule of lens Anterior chamber


(suspensory ligament of lens)
Lens Posterior chamber
Scleral venous sinus
(Sch lemm's cana l) Iris lridocorneal angle

Ciliary processes
Ciliary body and ciliary muscl
Bulbar conjunctiva

Ora senata
Tendon of
lateral rectus
Tendon of
muscl
medial rectus
muscle

Vitreous body

Perichoroidal space Hyaloid canal

Lamina cribrosa of sclera


Fascial sheath of eyeball
(Tenon's capsule)

U-- - - - - Central retinal


Fovea centralis in macula artery and vein

Outer sheath of optic nerve

Subarachnoid space

PLAT82 HEAD AND NECK


Anterior and Posterior Chambers of Eye

Schwalbe's I Posterior limitin g lamin a


(Descemet's membran e)
Trabecular meshwo rk and spaces
of iridoco rn eal angle (Fo ntana) Endo th elium of anteri o r chamber
Scle ral ve nous sinu s (Schl emm's ca t

Pectin ate li ga ment

Bulbar
conjun cti va

process
M eri diona l Circul ar
fib ers fib ers

Cili ary mu scle


Pigm ent
onul ar fibers epith elium
Cili ary body (s uspenso ry (iridi al part of
li gament retin a)
of lens)
Peri cho roid al space Sphin cter mu scl e o f pupil

N o te: For cl arity, o nly single pl ane o f zonul ar fi bers shown;


actu ally, fib ers surround entire circumference of lens

ORBIT AND CONTENTS PLATE 83


lridocorneal Angle of Anterior Chamber of Eye

Mirror

Contact lens

Goldmann gonioscopic mirror

Open (normal)
iridocorneal angle:
gonioscopic view

Scl e ral venous sinus


(Schlemm's canal-
visible if it contains blooc/)

:-----Line of scleral spur


Trabeculae

;-----Pupil

Closed angle:
gonioscopic view

PLAT84 HEAD AND NECK


Lens and Supporting Structures

Optic part of retin a

Orbiculus ciliaris of
ci li ary body cove red
by ciliary part of retina

Ciliary processes

Zonular fibers

Posterio r chamber

Eyeball sectioned in frontal plane:


anterior segment viewed from behind

Zonular fibe1 s l
Horizontal section

Ora se rrata

I
Orbiculus ciliaris of
Optic part ciliary body cove red Zonular fibers fanning out
and blending 111to lens capsule

of"""\
by cili ary part of retina

Ciliary processes onula1 fibe1 s


Iri s Lens

~~-

Enlargement of segment outlined in top illustration (semischematic)

ORBIT AND CONTENTS PLAT85


Intrinsic Arteries and Veins of Eye
SEE ALSO PLATE 80

Cornea Minor arterial circle of iris


Anterior chamber
Major arterial circle of iris

Blood vessels of ciliary body

Anterior ciliary artery and vein

Iridocorneal Iris Lens


angle----'

Posterior chamber
Muscular artery and vein
Zonular fibers
'i:-- - Extrinsic eye muscle

Vitreous chamber

Vorticose 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
Optic nerve (II) and venule --~t~Jr-=::~;:S~.;:::~(>

Macula and
fovea centralis---~-,-1-,---------

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

PLAT86 HEAD AND NECK


Pathway of Sound Reception

Frontal section Facial nerve (V II ) (cut)

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

Prominence of late ral se mi circul ar canal

Sem icircul ar du cts, ampu ll ae, utricl e and saccul e

Faci al nerve (V II ) (cut)

Ves tibular nerve

Cochl ear nerve


Aur icle
In te rn al acousti c

Exte rn al
Nasop harynx

Tympanic membran e Sca la vestibu li

Tympanic cavity Coch lear du ct


Coc hl ea
con tainin g
Pro monto sp iral organ
(Co rti)
Rou nd (cochlea r) w in dow
Sca la tympani
Pharyngotympanic (a uditory) tu
p
.... Note: Ar rows indi cate co urse o f so und waves
j'

'~N

EAR PLATE87
External Ear and Tympanic Cavity

Tri angul ar fossa Lon g li mb of in cus

Crura of
antih elix
Anterior mall ear fold
Auricular
tubercle -""~!*---Later al process
(Darwi n) of malleus

Antih elix

Concha { Cy mba Umbo


of auricle Cavity

Lobule
of auricle
Right tympanic membrane (eardrum)
Right auricle viewed through speculum

Ep itympa nic Ma lleus Chorda tympani nerve


ng lim b of incu s
Stapes in oval
(vestibular) w in dow
Lateral process
of malleu s
Tend on of tensor
tympan i
muscle
Handle
of malleus
Promontory
endo n of stapedius
Cartil agin o us muscle
~ sa of round (coch lear) window
Extern al aco ustic mea tu s
Tympanic membrane Levator veli palatini muscl e
View into tympanic cavity after
Coronal oblique section of external acoustic meatus and middle ear removal of tympanic membrane

Auditory ossicles

Ar ti cular
surface
for malleus

Long
limb

Incus:
lateral view

Malleus:
lateral view Stapes: superolateral view O ssicles articulated: medial view

PLAT88 HEAD AND NECK


Tympanic Cavity
SEEALSOPLATES47, 777,77 8, 729

Lateral wall of tympanic cavity: medial (internal) view

rior ligament of malleus

Superior li ga ment of in cus


Epitympan ic recess

Shor t limb of incus


Anterior p rocess of ma l

Posterio r mal lear fold


Chorda tympani

Posterior ligament of in cus


A nterior mall ea r fold
Lo ng limb of in cus
Te nso r tymp ani mu scl e
Chord a tympani nerve

Tympani c memb rane


(pars tensa) --------<

Ph aryngotympa nic
(auditory) tube _ ___...-

'
p~
<
~.~~

Medial wall of tympanic cavity: lateral view Promin ence of late ral sem icircu lar canal

Mastoid an trum

win
Tenso r tympani muscle
(tendo n cut)

Pharyngotympan ic
(auditory) tub e

Chorda tympan i nerve (cut)


Leva tor veli p alatini
mu scl e
Mastoid ce ll s

Tendon of staped ius mu scle


Prom o ntory w ith tympa ni c
nerve (J acobso n) and plexus
Fossa of ro und under mucosa
(cochl ear) w ind
Intern al ca ro tid artery
Facial nerve (V II ) Tymp ani c ce lls
in stylomastoid foramen

------------------------ -------------
EAR PLAT89
Bony and Membranous Labyrinths
SEE ALSO PLATE 118

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

terior
Lateral
Anterior
l Semicircular canals
Anterior

Common bony limb Elliptical recess


Cochlear recess l~ Vestibule
(note
Spherical recess
perforations
for nerve
fibers)

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

Right membranous labyrinth with nerves: posteromedial view


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

Lateral membranous ampulla


Cochlear duct (basal turn)
Common
membranous limb
Cochlear nerve

Posterior
Vestibulocochlear nerve (VIII)
semicircular
duct

Saccule Posterior membranous


ampulla
Vestibular ganglion

Endolymphatic duct
Inferior part of vestibular nerve (fro
saccule and posterior memb1anous ampulla)

PLAT90 HEAD AND NECK


Bony and Membranous Labyrinths (continued)

Bony and membranous labyrinths: schema

Anterior semicircular ca nal and du ct

Pos teri o r se micircular


ca nal and duct

Endolymphati c du ct
in ves tibul ar aquedu ct

Sta pes in o val Helicotrema of cochl ea


(ves tibul ar) window

Scal a ves ti buli

Ro und (cochl ear) window


(closed by secondary
tymp ani c membrane )

Section through turn of cochlea

I Sca la ves tibuli

~/
Osseo us
spiral lamina

Cochlear du ct
N erve fib ers

M odio lu s o f cochleus

Spiral ga nglion

Pill ar (rod ) cell s

Inn er hair ce ll

EAR PLAT91
Orientation of Labyrinth in Skull

Superior projection of
right bony labyrinth G roove for greate r petrosal nerve
on floor of skull
Ge ni culum of fa cial nerv e
Cochl ea

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

Facial nerv e (VII)

f--__,:.,.,-----'J-f.-t- Lateral se mi circ ular


canal

Petrous part
o f temporal bon e

Extern al openin g of ' 'Plane of posteri o r


ves tibular aquedu ct
(fo r endolymphati c du ct) , ___ / se micircul ar ca nal

lateral projection of right membranous labyrinth


/Auricl e (retracted Cochl ea r duct

Geniculum o f fac ial / -- '""' anterio rly)


Cochlea r nerve

Trigemin al nerve (V)

~~:==-,._:_:__ _:___ __:__ _ _ _ lnferi or part of


Anterior vestibu lar nerve
semi circul ar duct

Lateral semicircul ar duct


Cerebe llum
Posteri or semicitcul ar duct

Superior
petrosa l sinus

Si gmoid si nus
Conflu ence
of sinuses
Transverse sinu s

PLAT92 HEAD AND NECK


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

Pterygoid hamulus and


med ial pterygoid plate H orizonta l p late of palatine bone

Lateral pterygoid plate Choana

of cartil agin ous part of


Late rall amin a pharyngotympani c
Media l lam in a } (a udito ry) tub e

Foramen lace rum

Spine of sp henoid bon e

In tern al carotid artery Occipi ta l co ndyle


enterin g caro tid cana l

Foramen ma gnum

Section through cartilaginous part of Section through cartilaginous part of


pharyngotympanic (auditory) tube, pharyngotympanic (auditory) tube,
with tube closed with tube open
Tri gemin al ga ngli o n
Tri ge min al ga ngli o n
In terna l ca rotid artery in ca rotid ca nal

Dura mater - - - ---=;;o;;;;:::::-..::;;;;;.."'

Leva tor ve li palatini


mu scl e - - - - - -
Sa lpin gop haryngeus
Salpingop harynge us
muscle - - - - - -"1'fl
muscle - - - - - - - -
Nasopharynx

Ph ary ngotymp ani c (auditory) tub e closed by Lum en opened chiefly w hen attachment
elastic recoil of ca rtilage, tiss ue turgidity and of tensor veli pa latini muscle pull s wa ll
tension of salp in gop haryn ge us mu scles of tube late rall y durin g swallowi ng

------------------
EAR PLATE93
Meninges and Diploic Veins
SEE ALSO PLATE 77

Coronal Dipl o ic ve ins Arachno id granulation


dissection Cerebral vein penetrates subdural space to enter sinus
Superi or sagittal sinu
Dura mater (periostea l and meningea l laye rs)
Dura-skul l interface (site of epidural hematom a)
Frontal and parietal tributari es
of superfic ial temporal vein
Subarachnoid space
Frontal and pari etal branches
of superficial tempora l artery

Gran ular foveo la


(indentation of sku ll by D eep,
arachno id granu lation) middl e and
superficial
Lateral (venous) lacu temporal
Mteries
Inferior and veins
sagitta l
sinus

Superio r th alamostriate and


choroida l veins, internal ce reb ral
veins and cho roid plexus of
latera l ventricle _ _ _ _ _ _.../ Deep and supe rficial middl e
cerebral veins

Diploic and emissary


veins of skull
Pari etal emissary vein

Frontal diploic vein

Occipital diploic vein

Mastoid emi ssa ry ve in

PLAT94 HEAD AND NECK


Meningeal Arteries
SEE ALSO PLATES 35, 730

Frontal (anterior) and parietal Arachnoid granulations


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

Middle
'----Lateral (venous) lacuna
meningeal arte

Superior sagittal sinus


Anterior
meningeal
branch of

artery

Mastoid branch of
occipital artery

Meningeal branches of
ascending pharyngeal artery

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

Accessory meningeal
Superficial
temporal artery--...,.:u
Maxillary
Anterior and posterior
meningeal branches of
Occipital a r t e r y - - - - - - vertebral artery

External carotid artery-----.:;


Tentorial, cavernous sinus and meningeal
branches of meningohypophyseal trunk *

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

MENINGES AND BRAIN PLAT95


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

Calvaria

Pericranium Granu lar fov eo la

Galea apo neurotica Emissary ve in


Skin Tributary of superficial temporal vein

Dura-skull interface (site of epidural hematom a)

Arachnoid-du1a in terface
(site of subdural hematoma )
chnoid

Cerebra l artery
Superior cerebra l vein
Falx cerebri
- - - - - - - Cerebral hemi sp here

Branches of middle meningeal arte


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

UN
~ . :.. ::

Superficial middle
cereb ral vein

Inferior cerebral ve in s
(beneath arachno id )

PLAT96 HEAD AND NECK


Dural Venous Sinuses

Superior sagittal sinus

Straight sinus
Sagittal section
Great cerebral vein (Galen)

Tentorium cerebelli

Superior sagittal sinus

Falx cerebri

Sphenoparietal sinus

Anterior and posterior


intercavemous sinuses -;f.~~~iiili!iiiiif!i~1

Basilar
venous pi

Inferior
petrosal sinus

To jugular
foramen

Occipital sinus

Falx cerebelli

Confluence of sinuses

MENINGES AND BRAIN PLAT97


Dural Venous Sinuses (continued)
SEE ALSO PL ATE 80

Skull sectioned horizontally:


superior view ypophysis (p ituitary gla nd )

Superior sagittal sinus (cutl---:-=


Fal x ce rebri (cut) Intern al carotid artery

Superior ophthalmic vein Oculomotor nerve (Ill)


Anterior and posterior
intercave rn ous
sinuses------ Trochlea r nerve (IV)

Superfi cial middle Ophthalmi c nerve ((VJ)


cerebral vein (cut)

Trigeminal ga ngli o n
Basil ar
venous 1-l'"' "L' ~ --._;
Superior iddl e meningeal artery
petrosal sin
du cent nerve (V I)
Inferi o r
petrosal sinus
Tento rial
--'-~~-:tnr-r-- Facial nerve (VII),
artery---+m
interm ed iate nerv e and
Tento rium ves tibul ocochl ea r nerve (V III )
cerebelli --=.~.
G lossop haryngea l (IX)
Inferio r an d vagus (X) nerves
cerebral vein
(c ut)

Sigmo id sinus (conti nuati on


of transverse sinus)
Tran sve rse sinus

Accessory nerve (XI)

Hypoglossal nerve (XII)

re at ce rebral ve in (Ga len)


Superior sagittal sinus (cut)

Cavernous sin Optic chiasm

Oculom oto r nerve (Ill ) .-;El!!!!:o--Posterior


co mmunica tin g artery
Trochl ea r nerve (IV)
Internal caro tid
Abducent nerve (V I) artery

Op hthalmic nerve (V,) H ypop hys is


(pituitary glan d)
Maxillary nerve (V2l

Coronal section through


cavernous sinus

PLAT98 HEAD AND NECK


Cerebrum: Lateral Views

Central su lcus (Rolando ) Postcentral gy1us

Intrapari eta l su lcus

Inferior parietal lobu le


Supramargin al gyru s
In ferior fronta l sulcus Angu lar gyrus

Inferior frontal gyrus Pari eto-


Op ercul ar pa rt occipita l
Trian gul ar part su lcus
Orbital part
'

/
..
..(

f
Frontal
po le - - - ---t /~ ~Occipital
\ po le
Calcarin e
sulcus

Lateral sulcus
(Sylv1u s)
l Antenor 1a mus
Ascend 1n g ram u / < : s
Posten or 1am us
<~~~"'

Lunate su lcus
(inconstant)
Transverse
occipita l su lcus
Superior tempo ral gyrus
Tempora l pole
Superior tempo ral sulcus Inferio r temporal gyrus
Middl e temporal gyru s
Inferior temporal sul cus

Frontal lobe

Occipita l lobe Parietal opercu lum


Frontal operculum
Orbital ope rculum
Short gyri
Insul a Ce ntral su lcus
(island Limen----"
of Rei I) { Lo ng gyrus
Circu lar sulcu s
lfiiN Temporal operculum
;.: ::: :

MENINGES AND BRAIN PLAT99


Cerebrum: Medial Views
FOR HYPOPHYSIS SEE PLATE 140

Sagittal section of Paracentral sulcus


brain in situ Central sulcu s (Ro lando )

Precun eus
Septum pellu cidum Superi or sagitta l si nu s
In te rventri cular Choroid plex us
fo ramen (Mo nro) of 3rd ventricle

Tha lam us and Pari etooccipital


3 rd ventricl e sul cus
Subca ll osal _ ...J:-- -\11l\l-'it:T:'IT- Cuneus
(parolfacto ry) Habenular
~L-.:_...1.L---o:7ilre\:l commiss ure
area-,;~~~~.
Ant~~~?_r_ ..
-~--::::r~~~r----::-1111-~!rr- Pi nea l body
il"~"i"'--"'"~~;s.'f/1~~\.__ Pos terior
Subca llosal co mmi ssure
Ca lca rine
su lcus
Straight sinu s
in tentorium
cerebell i

Supra-
optic
recess
Optic chiasm
Tuber cin ereum
Hypop hysis (pitu itary gland)
erior medu llary ve lum
4th ventricl e and choro id pl ex us
In ferio r medu ll ary velu m
Cerebra l aqueduct Medu ll a ob lo ngata
(Sylviu s)

Medial surface of cerebral


hemisphere: brain stem excised ~~~~~LIIll
Trunk
}
of
corpus call osum
Sp leniu m

Isthmus of cin gul ate gyru s

Parietooccipital sul cus

Calcarine sulcus

Crus
Body
~ of forni x
Co lumn
Med ial occipitote mpora l Fimbria of hi ppocampus

Latera l occipitotemporal gyru s - - -


Para hi ppoca mpal gyrus

PLATE 100 HEAD AND NECK


Cerebrum: Inferior View
FOR HYPOPHYSIS SEE PLATE /40

Sectioned brainstem Frontal pole of cerebrum Longitudinal cerebral fissure

of corpus callosum

Orbital sulci

Temporal
Optic nerve (II) (cut)

Inferior temporal gyrus

Inferior (infero-
lateral) margin
of cerebrum----~,:.~ --..,.-"r--:f-'---+---::-~H,;-- Posterior perforated
substance (in
interpeduncular
Rhinal sulcus fossa)

Cerebral crus

Lateral geniculate
body
Inferior
temporal gyrus Substantia nigra

Occipitotemporal
sulcus _ _ _ ____.,

Lateral occipita-
temporal gyrus nar of thalamus

Collateral sulc

Cerebral aqueduct
Parahippocampal gyrus
Splenium of corpus callosum
Medial occipitotemporal gyrus

Calcarine sulcus Occipital pole of cerebrum

Longitudinal cerebral fissure


Isthmus of cingulate gy1us

MENINGES AND BRAIN PLATE 101


Ventricles of Brain

Left lateral phantom view Frontal (a nterior ) horn

l
Central part Left
Right late ral ventricl e lateral
Temporal (inferi or) horn ventri cle
Occipita l (poste ri or) horn

Cereb ral aqu ed uct (Sy lvius)

4th ve ntri cle

Left latera l ape rture


(fora men of Luschka)

Left lateral recess

Med ian ape rture


(fo ramen of Magendi e)

Central ca nal of sp in al cord

Co rpu s ca ll osum
Septum pe llucidu m
Lateral ventricl e
Body of ca udate nucl eus
Choroid plexus of lateral ventricl e
Stri a terminal is
Jt~~::::::::::::-:--_.,..-~-- Superior thalamo striate vein
~==---,~...::.---:---- Bo dy of forn ix
~=--.:_:::..:;;,..:::....::'-:---.,=---,,...-:";"-:~--::--~--1 ntern al ce rebra I vein

~7~~;:ff'-"'--'--7~--;"';-----r--,-..,...:.:....._+:------ T,ela cho ro idea of 3 rd ventricl e


tll~-;::;:v-;-~:_ __ -1,;:-..:_-~~-____:o._ _ Cho roid plexus of 3 rd ventri cle
~:r-------7_.::~:_----Thalamus
Putamen } .
Lent1form nucleus
::==~C=-"T--:---;Cb_-=-= G lob us pa llidus
Intern al caps ule
3rd ventricle and in terthalami c adhesion
:;-T----7~=-====------- Hypothalam us
;:--,----Tail of caudate nucl eus

Cho roid plex us of lateral ve ntricle


White arrow in left Temporal (inferio r) horn of latera l ve ntricle
interventricul ar
Fimbria of hippocamp us
foram en (Monro)
Ependyma
Den tate gy rus
- Pia mater
Parahippocampal gyrus

Coronal section of brain: posterior view

PLATE 102 HEAD AND NECK


Circulation of Cerebrospinal Fluid

Choroid plexus of late ral ve ntricl e (phantom) Superior sagittal sinu s

Cistern of corpus cal losum Subarachnoid space

Dura mater chnoid granulations

Arachnoid

Interve ntricular
foramen (Monro)

Chiasmati c cistern

Choroid plex us of 3rd ve ntricle

Interped un cul ar ciste rn

Cerebral aq ueduct (Sylvius)


Quadrigeniinal cistern
(of great cerebral vein)
Prepontine cistern
(Posterior)
Lateral apertu re (foramen of Luschka) ce rebel lomed ull ary cistern

Choro id plexus of 4th ven tricl e Median aperture


(forame n of Magendie)

Subarachnoid space

Ce ntral cana l of spinal co rd

IIDN
~ . :.. : ;

MENINGES AND BRAIN PLATE 103


Basal Nuclei (Ganglia)

Horizontal sections
through cerebrum A . 1 _

\
' . ~ . .'
/('c~- /'
I
Genu of corpus cal losum
' . of ca udate nucleus
\ \
Lateral ventricle
~~::~~ior limb } of i ntemal
Septum pellu cidum capsule
Postettot ltrnb

Column of forn ix
Putam en } Lentiform
In su la Globu s pal lidu s nucleus
(island of Rei I)

lnterthal ami c
ad hes i o n----,f"--'----lll{---"'"'""

austrum

Retrolenticu lar part


of internal capsule

Choroid ple xus


of Ia tera l ventricle Tail of ca udate nucl eus

Splenium of Hippocamp us and fimbria


corpus callo sum
Occipital (pos terior ) hom
of lateral ventricle

Ha benu la
Organization of
basal nuclei (ganglia) Pineal body

Cau date Putamen G lob us

~
Cleft for intemal caps ule

Lentiform
Striatum nucleus
Caudate { Body
~ nucleu s Head
Corpus
striatum Le vels of { A _ ----A
~ secttons
above
B
- ---- B
Basal nuclei
(ga nglia )
Pu lvinar
Lentiform nucleu s Medial genicu late body
(globu s pa llidu s med ial
to putame n) Latera l ge ni cul ate body

Tail of caudate nucleu s

Interrelationship of thalamus, lentifo rm nucleus, caudate


nucleus and amygdaloid body (schema): left lateral view

PLATE 104 HEAD AND NECK


Thalamus

Corpus callosum (cut)


Interventricular foramen (Monro)
Head of caudate nucleus

Septum pellucidum

Columns of fornix

Anterior tubercle

Temporal (inferior) horn lnterthalamic adhesion


of lateral ventricle

Habenular trigone
Collateral eminence

Lateral geniculate body


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

Posterior commissure Medial geniculate body

Habenular commissure

Brachium of inferior colliculus

Occipital (posterior) horn


of lateral ventricle---~
Calcarine sui

3rd ventricle
lnterthalamic
adhesion-"21~--~L~

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


nuclei

-. -Reticular nucleus

Thalamic nuclei Pulvinar


teral geniculate body
CM Centro median
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 Vl Ventral lateral 1111111!!111111!111111 lateral nuclei
line shown in figure VP Ventral posterior
at right) liiiiii 14 Medial nuclei
VPL Ventral posterolateral
VPM Ventral posteromedial Anterior nuclei

MENINGES AND BRAIN PLATE 105


Hippocampus and Fornix

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

Head of ca ud ate nucleu s

Columns of forni x

rura of forni x

Den tate gy ru s

Fim bria of hi ppoca mpus

Occipital (posterior) ho rn
of lateral ventricle

Tail of ca ud ate nucl eus

Body of forni x Fimbria of hippocam


Co lum ns Opti c t
of fo rnix

Hi ppocampa l
su lcus

Alveu s of
hippocamp us
Fim bria of hippoca mpu s
Temporal (inferi or) horn
Amygda lo id bodi es Hippoca mpus of lateral ventricl e

Fornix: schema Coronal section: posterior view

PLATE 106 HEAD AND NECK


Cerebellum

Superior surface

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

mple lobule (H VI)


Superior
vermis
Posterior ldbe

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

Central lobule Inferior surface


Superior vermis of central lobule
{ Lingula (I)

Flocculonodular lobe
Posterolateral (dorsolateral)
Inferior medullary velum fissure

Nodule (X) Retrotonsillar fissure

Uvula (IX) Posterior lobe


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

Decussation of
superior cerebellar peduncles

Superior medullary velum

Cerebellar
nuclei

is

Section in plane of superior cerebellar peduncle

MENINGES AND BRAIN PLATE 107


Brainstem

Posterolateral view

Pineal body -----'~5 .,....;;::.~:::.:...--"--- M e d i a l ge ni culate bod y

Superior co lli culi ----""""""''+--.!~ r - - - - - - srach ia of superior and infe ri or co lli culi
Inferior coll iculi - - - --<.:- - - - - - - - cerebral cru s
Trochl ear nerv e ( I V) ----~~~~
Superi o r medu ll ary ve l um ----,.c...~
-+- - -Tri geminal nerve (V)
Superior ce rebellar peduncle - - _,
tj--- - - -Midd le ce rebellar peduncl e
Rhomboid fo ssa of
4th ventri cl e - - - -+-7'"' Vestibulococh lea r nerve (V III )

G lossoph aryngeal (IX) and


vagus (X) n e rves -------_J~AJ..!~ Inferi or ce rebe ll ar peduncle
Cuneate tub ercl e
Graci le tub ercle - - - -.ll!-..L
Dorsa l roots of
1st sp inal nerve (Cl )- - - -H - +<"!M
Cuneate fas ciculus- - - --tfr-t--t-

Graci le fa scicu

Anteri or view Anterior perforated su bstan ce

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


~:S~~l~~~,~---:::--\--= Mammi ll ary bod ies
- =---- - Tempo ral lobe (cut surface)

~-'~,.-;;-t...;~~--;1-~-lr----- Ocul omotor nerve (Ill )


Tuber cinereum
~----J,___ ___.,..__.---'--- Troch Iea r ne rve (IV)
Cerebral crus Trigem inal ne rve (V)

bdu cen t nerve (V I)


Lateral ge ni cu late body
Facial nerve (V II ) and
Poste rio r perfo rated substance interm edi ate nerve

Vestibul ocochl ea r nerve (V II I)

Flocculu s of cerebell um

-'-o;..--"tt~~- Cho r oid pl ex us of 4th


ventricl e

Glossop haryngea l nerve (IX)


Pyram i Vagus nerv e (X)

Hypoglossa l nerve (X II )

Acce ssory nerve (X I)


Decussation of pyram ids

PLATE 108 HEAD AND NECK


Fourth Ventricle and Cerebellum

Posterior view abenular trigone

Medial } G en1cu
. Iate b o d.1es
3rd ventricle Lat era I
Pulvinar of thalamus

Pineal body Superior cerebellar peduncle

Superior colliculu
Inferior colliculus

Trochlear nerve (IV)

Superior medullary velum

l
Superior
Cerebellar peduncles Middle
Inferior--'-:::---< Striae medullares

Tenia of 4th ventricle

Cuneate tubercle
Sulcus limitans Gracile tubercle

Trigeminal tubercle
Hypoglossal trigone neate fasciculus
Vagal trigone Gracile fasciculus
Obex

lnterthalamic adhesion
Median sagittal section

Habenular commissure

Splenium of corpus callosum

Hypothalamic ~u,Lu:>
Midbrain tegmentum
Cerebral aqueduct (Sylvius)
Great cerebral vein (Galen)

Lingula (I)
Central lobule (II-III)
Culmen (IV-V)
Declive (VI)
lVermis of
cerebellum

Superior colliculus Folium (VII A)

Tectal (quadrigeminal) plate


Superior medullary velum

Inferior medullary velum


Medial longitudinal fasciculu
Tuber (VII B) }
Pyramid (VIII) Vermis of
Choroid plexus of 4th ventricle cerebellum
Uvula (IX)
Medulla oblongata
-----Nodulus (X)
Median aperture (foramen of Magendie)
Decussation of pyrami Choroid plexus of 4th ventricle

Central canal of spinal cord of cerebellum

MENINGES AND BRAIN PLATE 109


Cranial Nerve Nuclei in Brainstem: Schema

Posterior phantom view cu lom otor nerve (Ill)

ed nucleus

Oculomotor nucleus

Accessory oculomotor
Lateral gen icul ate b (Ed in ge r-Westpha l) nucleus

Mesencephalic nucl eus Trochlear nucleus


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

Tri ge min al
nerve (V)
and gangl io n

nerve

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

Vestibula
nucl ei lasso-
pharyngeal
nerve (IX)
Glossopharyngeal
nerve (IX)---_J
Vagus nerve (X)

Vagus nerve (X)


Accessory nerve (XI)

Sp inal tract and sp inal


nucleus of trigeminal nerve

o-n<;rPnnr (dorsal) nucleus


of vagus nerve (X)

Spinal nucleu s
of accessory nerve
Efferent fibers
Afferent fibers
1"1111'111111111111#1111 Mixed fibers
4~~
'~N

PLATE 110 HEAD AND NECK


Cranial Nerve Nuclei in Brainstem: Schema (continued)

Medial dissection
Accessory oculomotor
(Edinger-Westphal) nucl eus

Red nucl eus


Oculomotor nucleus

Oculomo tor nerve (II Trochl ea r nucl eus

bducent nucl eus


Tri ge minal
nerve (V)
and ga ngli o n Intern al genu
of fa cial nerve

Principa l
sensory nu cleus of Facial nucleus
tri geminal nerve

Vestibular nu clei
Moto r nucl eus of
trigeminal nerve

i\t-+illllllf-_,_--f,---- Supe ri o r and


Vestibu locochl ea r nerve (V III ) infe ri or salivator y
nuclei

So litary tract nucleus

Glossopharyngea l nerve (IX) Posterior (dorsal) nucl eus


of vagus nerv e (X)

Hypo glossa l nerve (X II )


Hypoglossa l nucl eus

Vagus nerve (X)


Nucleus ambiguus

Accessory nerve (X I)
Sp in al nucl eus of accessory nerve

O li ve

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

CRANIAL AND CERVICAL NERVES PLATE 111


Cranial Nerves (Motor and Sensory Distribution): Schema

- - - - - - Spinal nerve fibers


- - - - Efferent (motor) fibers
- - - - Afferent (sensory) fibers

II
Olfactory

VII Motor-sub man d ib u Ia r,


Facial subl in gual, lacrimal gland s
Muscles of face Taste-anterior YJ of
ton gue, sensory soft palate

VIII
Vestibulocochlear
Cochlear Vestibular

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

X
Vagus
Motor-h ea rt, lun gs, palate, pharynx, ~:w

lary nx, trachea, bronchi, Gl tract ~;,v:~~


Senso ry-heart, lun gs, trachea, v
bro nchi, larynx, ph arynx, JfiiN
;.:.,': ;
Gl tract, external ear

Strap
muscles
(C l, 2
fibers)

PLATE 112 HEAD AND NECK


Olfactory Nerve (1): Schema

Subcallosal (parolfactory) area

Septal area and nuclei


Olfactory bulb cells: schema
Contralateral
l Efferent fibers to } olfactory bulb
~--- i olfactory bulb

Afferent fibers from bulb


---+.....~r----
.--~ l to central connections
and contralateral bulb Medial
olfactory stria
Granule cell (excited by
and inhibiting to mitral
and tufted cells)

Mitral cell

Recurrent process

Tufted cell

Peri glomerular
cell

Glomerulus

Olfactory
nerve fibers
_,.~4.

~-)l-

Olfactmy cells

Olfactmy trigone
and olfactory tubercle
Olfactory nerves (I)
Lateral olfactory stria
Olfactory bulb
Lateral olfactory tract nucleus
Cribriform plate of ethmoid bone
Anterior perforated substance
Anterior olfactory nucleus
Amygdaloid body (phantom) Dentate gyrus

Pirifmm lobe Parahippocampal gyrus

CRANIAL AND CERVICAL NERVES PLATE 113


Optic Nerve (II) (Visual Pathway): Schema

Ce ntral da rke r
circl e represe nts
macu lar zone
Ove rlappin g Lighter shades
visual fi elds rep rese nt
monocular field s
Each qu ad rant
a different co lor

Projectio n on
ri ght retina

II!IIIIIIDCb -'11111
Choroid :~, --~Choi-Q[d~,
~~
Periph ery M ac ula

Structure of retina: schema Projection on ri ght


Projection on left
A Ama crin e cell s do rsal latera l dorsa l late ral
B Bipolar ce lls ge nicul ate nucleus geni cul ate nucl eus
C Cones
C Ganglion ce lls
H Hori zo nta l cell s
P Pigm ent cells
R Rods

I
I
I
I
I
I
I'
I
Ca lcarin e I
sui I
I
I
I
I
I Ca lca rin e
I sul cus
I
/
/
I
/
I
I
)
Proj ection on left
Proj ection o n right
occipital lobe
occipital lobe

-------------
PLATE 114 HEAD AND NECK
Oculomotor (Ill), Trochlear (IV) and Abducent (VI) Nerves: Schema
SEE ALSO PLATES 87, 726, 753

Long ciliary nerve Ciliary ganglion

Short ciliary nerves Posterior ethmoidal nerve 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
Accessory oculomotor
Frontal nerve (cut) (Edinger-Westphal)
nucleus (parasympatheti
Lacrimal nerve (cut)

Trochlear nerve (IV)


Nasociliary nerve

Oculomotor nerve (Ill)

Zygomatic nerve (

Inferior oblique muscle


Internal carotid artery
Inferior division of
and nerve plexus
oculomotor nerve

Medial rectus muscle


Sphincter muscle of pupil
Lateral rectus muscle and
Inferior rectus muscle abducent nerve (turned back)
- - - Efferent fibers
- - - Afferent fibers Parasympathetic root
of ciliary ganglion
- - - - Sympathetic fibers
Parasympathetic fibers
Common tendinous ring
;f
JIN
..:.: :
~

CRANIAL AND CERVICAL NERVES PLATE 115


Trigeminal Nerve (V): Schema
SEE ALSO PLATES 78, 37, 38, 40, 47, 153 Tri ge minal nerve (V) ganglion and nuclei
Ophthalmic nerve (V1 ) Mo tor nucl eus
-- Efferent fibers Mese nceph alic nucleus
-- Afferent fibers Tentorial (menin gea l) branch Prin cipal senso ry nu cleus
.. Proprioceptive fib ers Nasocili ary nerve Sp inal tr act and nucleus
.... .. .. Parasympathetic fibers Lacrimal nerv e
---- Sympathetic fibers Se nso ry root of
ciliary ga ngli on
Frontal nerve

Posterior ethmoidal nerve

Short ciliar y nerves


Anterior ethmo idal nerve
Supraorbital nerv e
Supratrochl ea r nerve

Meningeal branch

lnfraorbit~~l;n;:~~=2:J~J~~~~~~~::==i
Pterygopalatin e
ganglion
Superior
alveolar
branches of
infraorbital nerve
Nasal branches
(posterior superior
lateral, nasopa latine
and posterior
supe rior m ed ial)
N erve (vidian) of
pterygoid ca nal
(from faci al nerve [VII]
and carotid plex us)
Pharyngeal branch
Greater and lesser
palatine nerves

Deep tempora l nerves


(to temporali s muscle)
Lateral pterygoid
and masseteric nerves
Tenso r veli palatini and
medi al pterygoid nerves Au ri culotempora l nerve
Subm andibul ar Inferior
ganglion alveo lar nerve
Mental nerve
Mylohyoid nerve
Inferior dental plexus
Lesser petrosal nerve (from
Lin gual nerve Mandibular nerve (V 3 ) Tensor tympani nerve glossopharyngea l nerve [IX])

-----------
PLATE 116 HEAD AND NECK
Facial Nerve (VII): Schema
SEE ALSO PLATES 79, 753
Facial nerve (VII) Internal acoustic meatus
Greater petrosal nerve
Deep petrosal nerve (from internal carotid pie Geniculate ganglion Nervus intermedius

Lesser petrosal nerve Internal carotid plexus Motor nucleus of facial nerve
(on internal carotid artery)
Nerve (Vidian) of pterygoid canal Superior saliva tory nucleus

Pterygopalatine ganglio

Facial muscles

Orbicularis oculi

Zygomaticus major

Procerus
Levator labii
superioris
Levator labii
superioris
alaeque nasi

Levator
anguli oris

Nasalis

Dewessor
Occipital
septi nasi
belly
Orbicularis (occipitalis) of
oris---:::_ occipitofrontalis
muscle
Depressor
anguli oris----'""""'
pos teri or
Depressor labii auri c ul ar
inferioris------; nerve

Mentalis----;-

(Risorius)
(not shown)

Tympanic nerve (Jacobson)


Sublingual gland (from glossopharyngeal nerve)
Submandibula1- gland Glossopharyngeal nerve (IX)
- - Efferent fibers
Submandibular gan Digastric muscle (posterior belly)
- - Afferent fibers
... ... .. .. Parasympathetic fibers Lingual nerve (from trigeminal nerve Stylohyoid muscle
- - -- Sympathetic fibers Chorda tympani nerve Caroticotympanic nerve (from internal carotid plexus)

CRANIAL AND CERVICAL NERVES PLATE 117


Vestibulocochlear Nerve (VIII): Schema

- - - Afferent fibers Facial canal


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

Greater petrosal nerve

Cochlear (spiral) ganglion

Vestibular nerve

Cochlear ner

Motor root of facial nerve


and intermediate nerve

Vestibulocochlear
nerve (VIII)

Ampulla of lateral
semicircular duct

acoustic Ampulla of superior


meatus semicircular duct

Vestibular
nuclei
(diagrammatic)
~ Cochlear
Inferior } nuclei
Ampulla of posterior
semicircular duct
Later 1------'
Inferior cerebellar
peduncle (to cerebellum) Saccule

Vestibular ganglion
Superior division
Inferior division
l of vestibular nerve

PLATE 118 HEAD AND NECK


Glossopharyngeal Nerve (IX): Schema
SEE ALSO PLATE 153

Efferent fibers Spinal tract and spinal nucleus of trigeminal nerve


Afferent fibers
Parasympathetic fibers Tympanic nerve (Jacobson) Nucleus ambiguus
Tympanic cavity and plexus Inferior salivatory nucleus
Stylomastoid foramen Geniculate ganglion
of facial nerve
Caroticotympanic nerve (from internal carotid plexus)
/
Greater petrosal nerve
Deep petrosal nerve

Nerve (Vidian) of pterygoid canal


Lesser petrosal nerve

Pterygopalatine ganglion
Mandibular nerve (V 3 )

Otic ganglion

Auriculotemporal nerve

Tubal branch of tympanic plexus


Pharyngotympanic (auditory)
tube and pharyngeal opening
Stylopharyngeus muscle (and branch Glossopharyngeal
from glossopharyngeal nerve) nerve (IX)

Communication to auricular
branch of vagus nerve

Superior and
Inferior ganglia of
Glossopharyngeal nerve

Superior cervical
sympathetic ganglion

Carotid branch of
glossopharyngeal nerve

Internal carotid artery


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

Common carotid artery


Pharyngeal branch of vagus nerve

External carotid artery

CRANIAL AND CERVICAL NERVES PLATE 119


Vagus Nerve (X): Schema
Pos terior nucleus of vagus
SEE ALSO PLATE 153 nerve (parasympath eti c
G lossopharyngea l nerve (IX)
So li tary tract nucl eus (v iscera l
Meninge al branch of vagus nerve
affe rents includin g taste)

' "'""'...,'''-S pinal tract and spin al


nucl eus of trigemin al nerv e
(somatic afferent)

Nucleus ambiguus
(motor to pharyngea l
Sa lp in gop haryngeus and laryngea l mu scl es)
mu scle -----~
ni al root of
Palatoglossus mu scl e accessor y nerve

Palatopharyngeus Vagus nerve (X)


111 uscl e - - - - - - - -
Ju gul ar foramen
Superior pharyngeal
constri cto r mu scle Superior ga ngli o n o f vagus nerve

Stylop haryngeus muscl e In fer ior ga ngli o n of vagus nerve

Middle pharyngea l con stri c to r muscle Pharyngea l branch o f vagus nerve (motor to mu scles of
palate and lower pharynx; senso ry to lower ph arynx)
Inferi o r pharyngeal constrictor mu scle
Commun icating branch of vagus nerve to
Cricothyro id muscle caro tid branch of glossop haryngea l nerve

aryngeal plexu s

Esophagus Superior laryngea l nerve :


Internal branch (se nso ry and parasympath etic)
External branch (moto r to crico th yroid muscl e)

Right recuiTent laryngea l nerve Superior cervica l ca rdi ac branch o f vagus nerve

Inferior cervica l ca rdi ac branch of vagus nerve

H epatic branch of anterior Thoracic cardiac branch of vagus nerve


vaga l trunk (in lesser omentum)
Left recurrent laryn gea l nerve (mo tor to mu scle s of larynx
Ce li ac branches from ante1"ior except cricothyroid; se nso ry and parasympath eti c to
and posterior vagal trunks larynx below vo ca l fo lds; pa rasy mpathetic, efferent and
to ce li ac plex us------.._ afferent to upp er esop hag us and trachea)

~:'"

"------Cardi ac plex us rh ~-~rt::


H epati c plexus /"
Esoph ageal p lex us lfiiN
Ga ll bladder ~. :..-:: ~

and bi le ducts Anterior vaga l trunk

Gastri c branches of anterior vaga l trunk


(b ranches from posterio r trunk behind sto mach)
Pyl o ri c branch
fro m hepa ti c plexus Va ga l branches (parasympathetic motor,
secretomotor and affe rent fibers) accompany
superior mesenteric artery and its branches
usu all y as far as left co li c (s plenic) flexure

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

PLATE 120 HEAD AND NECK


Accessory Nerve (XI): Schema
SEE ALSO PLATE 27

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

Spinal root of
accessory nerve jugular foramen

Accessory nerve (XI)

Internal branch of accessory nerve

C1 spinal nerve

'.I...J--"'"....:r---External branch of accesso1-y nerve


(to sternocleidomastoid
and trapezius muscles)

----Sternocleidomastoid muscle (cut)

C3 spinal nerve

C4 spinal nerve

Trapezius muscle

Efferent fibers
Proprioceptive fibers

CRANIAL AND CERVICAL NERVES PLATE 121


Hypoglossal Nerve (XII): Schema
SEE ALSO PLATE 27

Hypoglossal nerve (XII) Me ni ngea l branch


(in hypoglossa l can al)

Hyp oglossa l nucl eus


Supe ri o r
lo ngitudin al
Intrinsic
mu scl es Transverse
of ton gue and verti ca l
Styloglossus
mu scle

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


vag us nerve

73J....,~-- ve ntra l ram i of


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

Superior cervica l
sympath eti c
ga nglion

Ge niogloss us
muscl e _ _ __J

Intern al ca roti d artery

Hyoglossus mu scl e Infe ri or root of ansa cervical is

A nsa ce rvica li s

In ternal ju gular vei n

Commo n ca ro tid arte ry

Stern othyroid muscl e

O mo hyo id mu scle (infe rior belly) - - - - Efferent fibers

- - - - Afferent fibers

--------------,--~-------
' ~----------' -----
PLATE 122 HEAD AND NECK
Cervical Plexus: Schema
SEE ALSO PLATE 27

Sternocleidomastoid muscle (cut) Great auri cular nerve

Hyp oglossal nerve (XI


Greater occipital nerve
Geniohyoid muscle (from dorsal ramu s of C2)

--'--Nerves to ante rior and lateral


'11L---'--r;7lJ,. rectus capitis and longus
capitis and co lli muscles

N erves to longus capitis an d


co lli and levator scapulae muscles

Trapezius muscle

Superior root Nerves to longus capitis and


of ansa cervical is co lli, levator scapulae and
middle scalene muscles
Inferior root
of ansa cervica l is Communication to
brachial plexus

Supraclavicular nerves (medial,


intermed iate and lateral)

Sternocleidomastoid muscle (cut)


- - - - Efferent fibers
Omohyoid muscle (inferior belly)
- - - - Afferent fibers

.. ... Proprioceptive fibers

CRANIAL AND CERVICAL NERVES PLATE 123


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

In te rn al
ca ro ti d nerve

Laryngopharyngea l
sympathetic branch

Vagus ne rve (X) (c u t)

Supe ri o r ce rv ical
sy mpathetic ga nglion

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

r. tt M id dle cervica l sy mpa th eti c ca rdiac nerve


t '~.~/ Ve rte bral ga ngli o n
UN
;.: ,.': :
Ve rteb ral arte ry and pl ex us
Rec urrent laryngeal nerve
Ce rvicothoracic (s tellate) ga ngli on
-'tt-- - A nsa subclavia
Vagus nerve (X) (c ut )
~,..-..:---In fe ri o r ce rvica l sympa th etic
ca rdi ac nerve
~':-- T h o rac i c sympath eti c and
vaga l ca rdiac nerves

Subclavian artery

PLATE 124 HEAD AND NECK


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

Greater petrosal nerve Deep petrosal nerve

Nerve (Vidian) of pterygoid canal


Sensory root
Trigeminal nerve (V) Motor root Oculomotor nerve (Ill)
{
Ganglion Maxillary nerve (V 2 )

Ophthalmic nerve (V 1)
Internal carotid artery and plexus
Frontal and Ciliary ganglion
lauimal
Geniculate ganglion nerves (cut)
Long ciliary nerve

Vestibulocochlear
nerve (VIII)

Glossopharyngeal
nerve (IX)

Mandibular
nerve (V3)---~'l.!iii

Otic
ganglion

Internal
carotid nerve

Chorda tympani
Pterygopalatine
nerve-------
ganglion

Superior laryngeal
nerve (cut)---~-

Superior cervical
sympathetic ganglion
Lingual nerve

Internal carotid
artery and plexus

Carotid branch of
glossopharyngeal nerve Submandibular
ganglion

Facial artery and plexus

Superior cervical
cardiac branch of Common carotid artery and plexus
vagus nerve - - - - - - - lrttl
Superior cervical sympathetic cardiac nerve

CRANIAL AND CERVICAL NERVES PLATE 125


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

SEE ALSO PLATE 153

Sphincter mu scl e of pup il Oculomoto r Accesso ry oculo moto r


Short cili ary nerve s (parasy mpathetic) (Edin ge r-Wes tph al)
Di lator muscl e of pup il ro ot of cili ary ga nglion nucl eus (parasympath etic)
Ci li ary
ga ngli o n

! - - - - T ecto sp in al trac t
Nasocili ary (sensory)
root of cili ary gangli o n
Inte rna l
Sympatheti c root of cili ary gan gli o n carotid plexus

O phth almic artery

Superi o r cervical sympath eti c gangli o n

1st th o racic sy mpath etic trunk gan gli o n ___..--r--


Presyn aptic
sympath etic
Gray ramu s communi ca ns ce ll bodi es
Presynaptic in inter-
----- Postsynaptic } Sympathetic fibers
White ramu s communi cans
medi olateral
nucleus
(lateral

-----
Presynaptic
Postsynaptic } Parasympathetic fibers
ho rn) o f gray
matte r

Afferent fibers

- - - - - V isual pathway

- - - - Descending pathway

119N
....-..:
~ ~

------------
PLATE 126 HEAD AND NECK
Pterygopalatine and Submandibular Ganglia: Schema
---------------------
SEE ALSO PLATE 753

Tri gemin al ga ngli on


Ophthalmic nerve (V 1)
D ee p petro sa l nerve

Cho rd a tymp ani nerve


Lin gual nerve
Tri ge min al nerve (V)
M axill ary nerve (V2 )
Facial nerve (VII)
N erve (Vidian) of pterygo id ca nal (intermediate nerve)
Pterygopalatine ganglio n Superior sali va tory
nucleus
Lacrim al gland

\ G loss opharyngeal nerv e (IX)


Sup erior ce rvica l sympatheti c gan gli o n
Sympath eti c trunk
Tl and T2 spinal nerves

Dorsal
root

Subm andibul ar gland


Sympath eti c
Facial artery Rami communicantes
roo t presynaptic cell
bodies in
Internal carotid artery interm edio lateral
nucleus (lateral
Extern al ca rotid artery and plexus horn) of gray
matter
Co mmon carotid artery

Sympathetic presynaptic fibers


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

CRANIAL AND CERVICAL NERVES PLATE 127


Otic Ganglion: Schema
SEE ALSO PLATE 753

Ma ndi bular nerve (V3 ) Tri gem in al ga nglion

Lesse r petrosal nerve

Ophthalmi c nerve (V 1 )

Max ill ary nerve (V 2 )

Aur iculo tempo ral nerve


Infer ior sa livatory nucleu s
Superficial tem po ral artery

Maxi ll ary
artery

Med ulla
ob longata

~ri-f--f~~:----;-;----:.'--- Tympani c
p lex us

In fer io r Tympa ni c
alveolar nerve nerve
(Jacobso n)

In fer ior ga ngli on (IX)

Superi o r ce rvica l sympath etic gangli on


Sympatheti c trun k

Extern al ca rotid artery

Dorsa l root

Intern al carotid

Common ca ro tid artery

W hi te G ray Ve ntral roo t Sympath etic


~
presynaptic
Rami co mmuni ca ntes ce ll bod ies in
i ntermed i olateral
nucleus (lateral
horn ) of gray
Sympathetic presynaptic fibers
matter
- - - Sympathetic postsynaptic fibers
Parasympathetic presynaptic fibers
- - - Parasympathetic po stsynaptic fibers

PLATE 128 HEAD AND NECK


Taste Pathways: Schema
SEEA LSO PLAT541, 89, 117,119, 120

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

Ve ntral posteromed ial (VP M)


nucl eus of th alamu s

Sensory co rtex (ju st be low face area)

Lateral hypo th alam ic area

Amygdaloid body

Tri gem in al nerve (V)

Tri geminal (semilunar) ganglion


M ese nceph ali c nucleu s
and
Motor nucl eus Ophth almi c nerve (V 1 )
of tri ge min al nerve ----:-;r.!~-,!~
// M ax illary nerve (V2)

Mandibular nerve (V3)

Geniculate ga ngli on

'..ru....n .....
N. Faci al nerve (V II )
and
Interm edi ate nerve

Nucleus of so litary tr act


(rostral part)------

/--- ~~
......:....-+- Foli ate

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

Vall ate
papilla e

In fe ri o r (petrosal ) ga ngli on Epi glottis


of glossopha ryngeal nerve

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


.I

---- ---------------
CRANIAL AND CERVICAL NERVES PLATE 129
Arteries to Brain and Meninges
SEE ALSO PLATES 28, 29

Left middle meningea l artery Midd le cerebral artery

Posterior cerebra l arte ry Anterior cerebra l artery

Superior cerebell ar artery Anterior communicating artery

Left labyrin thine


(interna l acoustic) artery

Mastoid branch of
left occipita l artery
Cavernou s sinus
Anterior inferior
cerebellar artery

Posterior inferior
cerebellar artery

Left and ri ght


vertebra l arteries
(intracrani al part)

Posterior menin geal


branch of vertebral
artery - - - - - _ /

Anterior meningeal
branch of vertebral artery

Posterior auricular arte

Occip ital artery Lingual artery

Internal caro tid artery


Ascending pharyngea l artery

Superior laryngea l artery

Superior thyroid artery

Common carotid artery

As ce nding cervic al artery (cut)

Deep cervical Inferior thyroid artery

Suprem e intercostal
Thyro cervical trunk
artery

Brachiocepha li c trunk

Subclavian artery Interna l thma cic artery

PLATE 130 HEAD AND NECK


Arteries to Brain: Schema

Anterior cerebral artery Anterior communicating artery

Middle cerebral Ophthalmic artery

Posterior communicating artery


pratrochlear artery
Caroticulympanic branch
of internal carotid artery

Middle meningeal artery

Anterior tympanic arte


perficial temporal artery
Middle meningeal Posterior auricular artery

Facial artery

Basilar artery

cending pharyngeal artery

Posterior inferior Anterior spinal artery


cerebellar arte
~-----f.;J--*--\\--E:-t-1-1!---- Spinal segmental
medullary branches

ommon carotid artery

Supreme intercostal artery


Ascending cervical artery
Costocervical trunk
Inferior thyroid

Thyrocervical

Subclavian arter Internal thoracic artery

Anastomoses
Right-Left
Descending ---r---,-;,.~'"1ii~Z:::::.~~~: 2 Carotid--Vertebral
3 Internal carotid-External carotid
Ascending-----+~-
4 Subclavian-Carotid
5 Subclavian-Vertebral

CEREBRAL VASCULATURE PLATE 131


Arteries of Brain: Inferior Views

M edi al frontobasal (orbitofrontal) artery

Ante rior communi ca ting artery

Anterior cerebral artery


Media l stri ate artery
(recurrent artery of H eubn er)

In terna l carotid artery

Anterolatera l ce ntral (lenti culo stri ate) arteri es

Middle cerebral artery


Lateral frontobasal (o rbitofrontal) arte ry- --il.,;r:...-S;h
Prefro ntal artery _ ___,,,.

Anterior choroidal arte r y------;~~~~~-r.:.:__ ___::~~

Superior ce rebe ll ar

Lab yrinth in e (internal aco ustic)

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

Posterior sp in al artery

Cerebral arterial
circle (Willis)
M ed ial striate artery (rec urrent (broken lin e)
artery of Heubner)

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

::~lti~~~!=~~~~~~~=A~nterior
1

' Middle cerebral


cerebral artery
artery
Posterior commun ica ting artery
~~,-------~""-~---:;:t--- Ante rior cho roida l artery
~----71'1\\::;:;::~~-- 0ptic tra ct
'::-- -++-----Posterior cerebral artery
tt~=::1t~~~tt== Ce reb ral crus
Lateral gen icul ate body
Posterior medi al choroidal artery
Posterior lateral choroidal artery
Choro id pl ex us of late ral ventricle
M edial genicu late body
(,'
Pul vin ar of ~ h.:1 l a mus I,,,
Lateral ve m icle
'WN

PLATE 132 HEAD AND NECK


Cerebral Arterial Circle (Willis)
------- _______________ ,

FOR HYPOPHYSEAL ARTERIES SEE PLATE J4 1

Vessels dissected out: inferior view

Anteri o r ce reb ral artery Anterom edi al ce ntral (pe rforating)


(A 2 segment) - - - - - -- t arteries
Anterior communicatin g arte ry
H ypo th alami c art ery
Anterior cereb ral artery
(A 1 segment) - - - - - - - ---="'
Anterolate ral central
Ophthalmi c artery (lenti culostriate) arterie s

Posterio r co mmunicatin g artery Inferior hypoph ysea l al"tery

Anterior cho ro idal artery

Th alamo tub eral


(premammillary) artery

Po ste ro med ial ce ntral


Superior ce rebell ar artery (perforating) arteri es

Th alamoperforatin g artery

Posterom edi al ce ntral


(paramedian) art eri es

A nterior inferio r ce rebell ar artery

Ve rtebral an ery

Vessels in situ: inferior view

Anterio r ce reb ral artery Anterio r comm uni cating artery

H ypothalami c
Cavernous sinus
Internal carotid arter
In fundibulum (pituitary sta lk)
and long_hypophyse al po1tal vein s

~="f-- Adenohypophys is (anterior


Middle cerebra l ane lobe of p itu itary gland)

Inferi o r hypophyseal ~-- Neurohypophysis (posterior


lo be of p ituitary gland)

Pos terior co mmunicatin g artery ,$---,~---""""7"~~_:>------- Posteromed ial central


(perforatin g) arteri es
Efferent hypoph ysea l ve in s
Superi or cerebellar artery
Posterior ce reb ral arte

CEREBRAL VASCULATURE PLATE 133


Arteries of Brain: Frontal View and Section

Corpus callosum
Medial frontal branches
Anterolateral central
(lenticulostriate) arteri

Lateral frontobasal Callosomarginal artery


(orbitofrontal) artery

Anterior cerebral
Precentral (pre-rolandic) arteries
and central (rolandic)
sulcal arteries----. Medial frontobasal
(orbitofrontal) artery
Anterior parietal
(postcentral sulcal) Medial striate
artery _ _ _ _ _ __J artery (recurrent
artery of Heubner)
Posterior parietal Internal carotid
artery-----"
artery
Branch to Anterior choroidal
angular gyrus

Temporal branches
(anterior, middle
and posterior
Superior cerebellar artery
Middle cerebral artery
and branches _ _ _ ___, Basilar and pontine arteries
(deep in lateral cerebral
[sylvian] sulcus) Labyrinthine (internal
acoustic) artery
Anterior communicating a
Vertebral artery
Posterior communicating artery
Posterior inferior cerebellar artery
Anterior inferior cerebellar artery Anterior spinal artery

Posterior spinal
Falx cerebri

Callosomarginal arteries
Corpus striatum and
(caudate and lentiform nuclei) Pericallosal arteries
(branches of anterior
cerebral arteries)

Insula (island of

Precentral (pre-rolandic),
central (rolandic) sulcal
and parietal arteries----~~
Rostrum of corpus callosum
Lateral cerebral (sylvian) sulcus
Anterior cerebral arteries
Temporal branches of
middle cerebral artery
Medial striate artery
(recurrent a1tery of Heubner)

Anterior communicating artery

Optic chiasm
Internal carotid a

PLATE 134 HEAD AND NECK


Arteries of Brain: Lateral and Medial Views

An terior pari etal (pos tcentral su lca l) arte Posteri or parietal artery

Centra l (rolandi c) su lca l artery

Precentral (pre-ro landi c) su lca l artery


Termin al branches
of poste ri or
Prefrontal su lca l cerebral artery
artery-----....

Termin al branches of
anterior ce rebral
artery

Lateral fronto basal


(o rbitofronta l) ar

Left middle
cerebral artery---;,........&-,...*",.-'-"'""

Left anterior
cerebral artery

Occipitotempora l
A nteri o r communicating artery branches

1-' rlc: t~ ' "'' temporal branch


Right anterior cerebral artery
Middle tem po ral branch
Left internal ca rotid arte ry
Superi o r and inferior terminal branches (trunks)

Polar tempo ral arter y Ante rior temporal branch

Parace ntra l art ery


Peri ca llosa l artery
Med ial { Posteri or IIJ!N
..-..:
~ ~

fran tal Interm ediate


branches A t .
n eno1
Precun ea l artery

Dorsa l branch
to co rpu s callosum

Pari etooccip ita l b ranch

Calcarin e branch
Right anterior
cerebral artery

Medial fro nto-


basal (orbito-
frontal) arte ry

'~~~~
A nterior
co mmuni catin g artery

M ed ial striate artery Posteri o r te mporal branch


(recurrent artery of H eubner)
A nterior temporal bra nch
Right intern al ca ro tid artery Posterior communi ca tin g artery

Note: Anteri o r parietal (po stce nt ral sulcal) artery also o cc urs as se parate anterio r parietal and postce ntral sul ca l arteries

CEREBRAL VASCULATURE PLATE 135


Arteries of Posterior Cranial Fossa

Thal amoge ni cul ate ar teri es Latera l and medial gen icul ate bodies of left thalamus

Anterior cho roid al arte ry Cho ro id plexuses of late ral ventricl es

Crura of forn ix Pulvinars of left and right th alam i


Splenium of co rpus ca ll osum
Antero lateral central
(lenticulostriate) arteries Occipital (posterior) horn of ri ght late ral ve ntricle
Heads of ca udate nu clei Ri ght dorsal branch to co rpu s ca ll osum
(posterior perica llosa l arter y)
Septum pellucidum
Pari etoo ccipital ~ Branch es of
Co rpu s ca llosum right posterior
Ca lca rine cereb ral artery
Anterior
ce rebral arteries

Lon gitud in al
ce reb ral
fissure\

,J
- - ...nuv

~:-:__,~-:-----::0:"""---~!- Superior
co lli culi

Optic nerve (II )

Poste rior med ial


choroi da l artery
to cho ro id plex us
of 3 rd ve ntri cle
Middl e
ce rebral artery Posterior lateral
choroid al arte ry
Posterior
co mmuni ca ting artery Late ral (ma rgin al) branch
Th alamoperforating arteries
Inferior ve rmi an artery
(p hantom)

Choroida l branch to 4th ventricle


(phantom) and
Cerebe ll ar tonsillar branch
Labyrinthine (intern al acoustic) artery of poste ri or inferior ce rebe ll ar artery

Poste ri o r ce rebral artery utlin e of 4th ve ntricl e (broken lin e)

Superior ce rebe ll ar artery Posterior men in gea l branch of ve rteb ral artery
A nterior inferi o r cerebell ar artery
Posterior in fer io r cerebell ar arte ry (PI CA)
Anterior menin gea l branch of ve rtebral artery
Left posterior sp in al artery
Tempo ral bran ches of posteri or cerebral artery
Left ve rteb ral arter y
A nterior spina l artery

PLATE 136 HEAD AND NECK


Veins of Posterior Cranial Fossa

Left superior and inferi o r co lli culi Left pulvin ar

Basal vein (Rose nthal) Ri ght pulvinar


In te rnal cereb ral ve ins

M edial geniculate Splenium o f co rpu s callos um


Grea t ce rebral vein (Ga len)
Do rsa l vein of co rpu s callosum
Lateral ge ni cul ate b Inferior sa gittal sinus
Strai ght sinu s
Falx ce rebri
Co nfluen ce o f sinu se s
Tento rium
li (cut) Left tr ansve rse
sinus (cut)

ve in

vein
Inferi or
vermi an ve in

A nterior po nto- Fal x ce rebelli (cu t)


mesen ceph ali c ve in and occipital sinus
nferior cerebell ar
Trigemin al nerve (V
hemispheric ve in s
lntraculmin ate vein

Petros al ve in (draining uperior ce rebell ar vein (in co nstant)


to superi o r petrosal sinus)
reculmin ate vein

A nteromedian medullary vein


(Inferi o r retrotonsill ar) Parts of cerebellum
Vein of lateral recess of 4th ventricl e
vein of ce rebellom edull ary
l Lin gul a TU Tub er
cistern
Superi o r, middle and Cl Central lobule P Pyramid
inferi o r cereb ellar ped uncl es Posteri o r spin al ve in C Culm en U Uvul a
D D eclive N N odule
Anteri o r spinal vein 4th ve ntricle F Fo lium T Ton sil

CEREBRAL VASCULATURE PLATE 137


Deep Veins of Brain
FOR SUPERFICIAL VEINS OF BRA IN SEE PLATE 96

Dissection: superior view

Anterior ce rebral ve in

Supe rfi cial middle ce rebral ve in


(dra inin g to sphenoparietal si

Deep middle cereb ral vein

Basal vein (Rosenthal)


Infer ior
Late ral gen icu late body
ce reb ral
M ed ial ge niculate body ve in s

Pu lvina r of thalamus

Sple nium of co rp us ca ll os um

anastomotic
ve in (Labbe)

Dissection: inferior view

PLATE 138 HEAD AND NECK


Subependymal Veins of Brain

Posterior veins of septum pellucidum Latera l direct vein

Superior thalamic veins Posterior terminal vein of caudate nucleu s


(posterior part of thalamostriate vein)
Superior cho roid vein
Internal cerebral vein s (right and left)
Transverse veins of cauda te nucleus
Medial (atrial) vei n of latera l ventricl e
Superior thalamostriate vein
Lateral (atria l) vein of latera l ventricle

Splenium of corpus ca ll os um
Anterior ve in of
caudate nucl eus

An terior ve in of
septum pellucidum

Genu of
co rpus
ca llosum

Straight sinus
/
Occipi ta l
(posterior)
horn of
lateral
ventricle

j,

Interventricu lar
foramen (Mo nro)

Anterior com missure

lnterthal am ic adhesion

Anterior cerebra l vein

Optic chiasm
Cerebellum
3rd ventricle

Deep middle ce rebra l vein

Inferior th alamostri ate veins


/
)../
_,,i
~'"
Tempo ral (inferior) horn of lateral ventricle \
Posterior mesencephalic vein Superior vermian vein

Hippocampal and inferior ventricu lar veins

Veins on lateral wall of ventricle


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

CEREBRAL VASCULATURE PLATE 139


Hypothalamus and Hypophysis
SEE ALSO PLATES 700, 707

Septum pellucidum

Thalamus

Fornix

Hypothalamic sulcus

Anterior commissure

Posterior ----2"""""'---'~~!!!!!f~:---4---!-__:

Principal Do rsom edi al----~--,--_,.ll:,...,-'--'-4-h---


nuclei of Supraoptic ----"',::::;;;l~~.-c-i------;-""';;;
hypothalamus
Ventromedial-~-.:_----~--;;l
Arcuate
(infundibularr J)-~==~~~;:=-~~,c:_-~t:~
Mammillary-

Mammillothalamic tract

Dorsal longitudinal
Infundibulum (pituitary stalk) fasciculus and other
descending pathways

Paraventricular hypothalamic nucleus

Supraoptic hypothalamic

Tuberohypophyseal tract
--+--Mammillary
body
Hypothalamohypophyseal tract

Infundibulum (pituitary stalk)


Arcuate (infundibular) nucleus

Adenohypophysis Fibrous trabecula


(anterior lobe of Neurohypophysis
pituitary gland) (posterior lobe
of pituitary gland)

PLATE 140 HEAD AND NECK


Arteries and Veins of Hypothalamus and Hypophysis
SEE ALSO PLATE 133

'12~~---- Pr i mary plex us of


hypophyseal po rtal system

Superio r
hypophyseal
artery Long hypop hysea l portal ve ins

A rte ry of trabecul
ort hypophysea l porta l vein s
Trabecu la (fibrous tissue)

Effere nt hypop hyseal vein Efferent hypophysea l vein


to cavernous sinu s to cavern o us sinus

Secondary plexus
of hypophyseal
porta l system

Capi ll ary plex us of


infundibul ar process

Inferior hypophyseal artery


Effere nt hypophyseal
veins to caverno us sinu s

CEREBRAL VASCULATURE PLATE 141


;cl,
{ '

Section II
BACK AND
SPINAL CORD

BONES AND LIGAMENTS 152. Autonomic Nervous System:


Plates 142 - 147 General Topography
142. Vertebral Column 15 3. Autonomi c Nervous System:
143. Thoracic Vertebrae Schema
144. Lumbar Vertebrae 154. Cholinergic and Adrenergic Synapses:
145. Sacrum and Coccyx Schema
146. Vertebral Ligam ents: 155. Spinal Membranes and Nerve Roots
Lumbar Region 156. Spinal Nerve Origin: Cross Sections
147. Vertebral Ligam ents: 157. Arteries of Spinal Cord: Schema
Lumbosacral Region 158. Arteries of Spinal Cord: Intrinsic
Distribution
SPINAL CORD 159. Veins of Spinal Cord and
Plates 148 - 159
Vertebral Column
148. Spinal Cord and Ventral Rami In Situ
149. Relation of Spinal Nerve Roots MUSCLES AND NERVES
to Vertebrae Plates 160- 166
150. Dermatomes 160. Muscles of Back: Superficial Layers
151. Spinal Cord Cross Sections: 161. Muscles of Back: Intermediate Layers
Fiber Tracts 162. Muscles of Back: Deep Layers

ATLAS OF HUMAN ANATOMY


SECTION II: BACK AND SPINAL CORD

163. Nerves of Back


164. Subocc ipital Trian gle
165. Lumbar Re gion of Back: Cross
Section (Superior View)
166. Typical Thoracic Spinal Nerve

ATLAS OF HUMAN ANATOMY


Vertebral Column
SEE ALSO PLATES 9, 72, 73, 743, 744, 745, 770, 23 7

Anterior view Left lateral view Posterior view

Cervical
vertebrae

Thoracic
vertebrae

Lumbar
ve1tebrae

Sacrum (51-5)

JiliN
: ~...': :

BONES AND LIGAMENTS PLATE 142


Thoracic Vertebrae
SEE ALSO PLATE 172

Body uperior articul ar


Superi o r process and facet
costa l face t

Transve rve
costal facet
Superior
ve rte bral notch Sup eri o r
(fo rm s lower costal facet
margin of
interverteb ral
fo ramen ) - - ----'11 - - - I n ferior
articular
process
Transve rse
costal face t

T6 vertebra:
lateral view
T6 vertebra:
superior view
Superior arti cular
process and facet

uperi o r articu lar


process and face t Tr ansve rse
process

Costa l face t

Inferior arti cul ar


process and fac

T12 vertebra:
lateral view
Transv erse process of
T9 vertebra

Inferi or articular process (T9) 'fl)


/~
La min I
.... '
J@N
........:: :
~

T7, T8 and T9 vertebrae:


posterior view

PLATE 143 BACK AND SPINAL CORD


Lumbar Vertebrae

Ve rtebral body

N ucle us
Verteb ral foramen pu lposus --H~*"'---,-...,...,...~

Transverse process Intervertebral disc

Ma mmill ary process

Superi o r articular process


Sp ino us process
Ma mmill ary process

L2 vertebra: Transve rse process


superior view
Spin ous process

Vertebral ca nal ----... Vertebral bo


t--~-.r-- ln fe ri o r
articul ar
Supe ri o r In te rverteb ral disc
process
arti cul ar process
Ma mmill ary proces

~,---Jill- Int e r ve rt e bra l


foramen

- - - - - - S u peri o r
ve rteb ral
notch

Inferi o r
articul ar process

L3 and L4 vertebrae: Lumbar vertebrae, assembled:


posterior view left lateral view

BONES AND LIGAMENTS PLATE 144


Sacrum and Coccyx
SEE ALSO PLATES 742, 74 7, 23 7, 330, 33 7, 332

Superior
Base of sacrum articul ar
proces s

Ala (late ral acral


part) canal
Superio r
arti cul ar process

Ala (win g)

Promonto

Sacral pa rt
of pe lvic brim
(l in ea te rmin alis )

Anterior (pelvic)
sacral foram in a

Tran svers e Median sagittal section


rid ges ----~'\':
,,....._.._ 11>..

Coccyx

Anterior inferior
view Pelvic surface

4,,~ Sacral tube


t1
IIN
:.:::: :

M edian sacral crest


Interm ed iate sacral crest

Posterior
sacral
foramina

-..r---sacral co rnu
(horn)
Sacra l hi atu s
A nterior (pelvic)
sacral fo1am en Dorsal surface
Transve rse process
Coronal section of coccyx
through S1 foramina
Posterior superior view

PLATE 145 BACK AND SPINAL CORD


Vertebral Ligaments: Lumbar Region

Left lateral view Inferi o r arti cular process


(partially sectioned
in median plane) Caps ul e of zyga pophyseal joint
(partially opened)

Anterior
longitudina l li gament Superi o r articular process

Transve rse process

Li ga mentum flavum
Intervert eb ral disc

In te rsp in o us li gament

Ante ri or rasp in ous ligament


lo ngitudin alli "'" '""PnT'

Interverteb ral foram en

Posteri or
longitudin al li ga ment - -4--'

Posterior vertebral segments:


anterior view

Anterior vertebral segments:


posterior view
(pedicles sectioned)

Pedicle (cut surface)

Posterior surface
of ver teb ral bod

Poste ri or
longitudinal li ga ment Superi or articular
process

Interverteb ral disc

Transverse process

In fer io r arti cular facet

BONES AND LIGAMENTS PLATE 146


Vertebral Ligaments: Lumbosacral Region

Anterior Superior articular process


lo ngitudin al
Transverse process
li ga men t - - - ---!111.'

Pedicle (c ut) Posteri o r


Body of Inferi or arti cular process
longitudina l
L1 vertebra
li gam ent

Interverteb ral foramen


In tervertebra l
discs - - - -1!r"!7'-

Intersp in ous li ga ment

Supraspinous li ga ment
nerv e

Superior arti cular processes;


facet tropism (d ifference in
facet axis) on right s id e --~..!!!:._"'

Sp in ous process

Body o f
LS vertebra

LS sp ina l nerve Ili olum ba r li ga men

iliac cres t

Au ri cul ar surface of sa crum


Posterior
(fo r articulation with ilium )
supe ri or
ili ac sp in e - --:'i-.,..-:'-;,-1---

Left lateral view

Posteri o r sacroiliac ligaments

Greater sciatic foramen

Sacrospinous li ga ment
sacro-
Lesse r sciati c foram en coccygea l
li ga ments
ll!.iN Sacrotuberou s ligament
:..::: :
Posterior view

PLATE 147 BACK AND SPINAL CORD


Spinal Cord and Ventral Rami In Situ

C l ve rteb 1a (atlas)

Cervi ca l plexus

C2 vertebra (axis)

Tl ve rtebra

Brachi al plex us

vertebra

Ll
vertebra

Iliohypogastri c
nerve

Ilioin guin al
nerve

Cauda equina

Sacrum (cut away)


: - - - ; - - - Sup eri o r and inferior
Intern al term in al filum (p ial part) glutea l nerves

Termin ation of dural

Externa l termin al fi lum (d ural part)

Pudend al nerve

IWN
.:..! :
~

SPINAL CORD PLATE 148


Relation of Spinal Nerve Roots to Vertebrae

it.-A;....--- c 1 { C1 spin al nerve exits


above C 1 vert ebra
rr~~-- c2
ni"~~-- c3
Ce rvical
enlargement - - - - - - - t t "

51

Lumbar eli se pro tru sion does not usu ally affec t
nerve exitin g above eli se. Lateral protrusio n
at eli se leve l L4-5 affects LS spinal nerve, no t
L4 spin al nerve. Pro tru sion at elise leve l LS- 51
affects 51 spin al nerve, no t LS spinal nerve

Lum ba r
enl arge ment

Conu s meclull ari s


(termin atio n of
spinal co rd)

lntem al terminal
filum (pi al pMt)----~.._H IIII M ,~.....,.....,....:....-- L4

Exte m al
termin al filum
(dural pa rt) - - - - - - - '':11

- Cervical nerves
- Thoracic nerves Medial pro tru sion at disc level L4-5 rar ely affects
- lumbar nerves L4 spin al nerve but may affect LS spinal nerve
- Sacral and coccygeal nerves and som etim es 51-4 spin al nerves

PLATE 149 BACK AND SPINAL CORD


Derma tomes
SEE ALSO PL ATES 457, 507; FOR MAPS OF CUTANEOUS NERVES SEE PLATES 78, 447, 443, 444, 445, 447, 450, 502 - 506

Schematic demarcation of derm ato mes


shown as distin ct segments. Th ere
is actu ally consid erabl e ove rla p
between any two adj acent derm ato mes

Levels of principal dermatomes


T10 Level of umbili cus
CS Clavicles T12 In guin al or groin regi o ns
CS, 6, 7 Lateral pa rts of upper limbs Ll, 2, 3, 4 Anteri or and inn er surfaces of lower limbs
C8, T1 Medial sides of upper limbs L4, 5, 51 Foot
C6 Thum b L4 Med ial side of grea t to e
C6, 7, 8 Hand 51, 2, l5 Pos teri o r and o uter surfaces of lowe r limbs
C8 Ring and littl e fin ge rs 51 Lateral margin of foot and littl e toe
T4 Leve l of nippl es 52, 3, 4 Perin eum

SPINAL CORD PLATE 150


Spinal Cord Cross Sections: Fiber Tracts

Sections through spinal cord at various levels

Dorsal medi an sul cus

Lateral ho m of gray matter


(intermed iolate ral nucleu s)

Gray
matter

T8

L1 L2 52

- Ascending pathways
Principal fiber tracts
of spinal cord - Descending pathways
- Fibers passing in both directions

Septomarginal fasciculu s (ova l bundle)


Dorsa l { Gracil e fasciculu s
column
system Cun eate fao'-'. '-L"u"' Interfascicul ar (sem ilun ar) fasciculus

Dorso late1al fasciculus Late ral co rtico spinal


(trac t o f Lissa uer) --------.,~ (pyramid al) tract

Rubrospinal tra ct
Posterior (dorsa l)
sp in oce rebe llar tract - - --rf:-
Med ullary (late ral )
reti culospinal tract
A nteri o r (ventral )
sp inoce rebe llar tract
Pontoreticul osp in al
(media l reticulo spinal)
Antero late ral system (ALS) tract
includ es
sp in othalam ic,
sp in o reticul ar,
sp i no m ese ncephalic
(sp in otectal ) and ,z;..,.=-- --::::i<---Anterior (ventral )
sp in ohyp othalami c fi
cor ti cospinal tract

Spinooliva ry tract

Fascicul i proprii Medial lo ngitudin al (sulcomargin al) fasc iculi

PLATE 151 BACK AND SPINAL CORD


Autonomic Nervous System: General Topography

Cili ary gangli on

Pterygop alatin e ga nglion

G lossopha ryngea l nerve (I

Chorda tympani nerve


In te rnal carotid nerve and pl ex us Lingual nerve
Sup erior ce rvical sympathetic gan gli o n
Submandibul ar ga ngli on
C4 spinal nerve
Ph aryngea l and superi o r laryngea l bra nches
of vagus nerve
Middl e ce rvical sympathetic ga ngli on
Recurrent laryngea l b ranch of vag us nerve

Cer vicothoracic (s tell ate) ga ngli o n Superi or cervical } Cardiac branches


lnfenor cerv1cal of vagus nerve
Th o racic
Sy mp ath etic trun k

Supe rior Ca rdiac pl exus


Cervical (sympatheti c)
card iac nerves
l
Thoraci c (sympathetic) cardiac
. dl
M1d e
In fe ri or Ap ntterior } Pu lm onary p lexuses
os eno r

Esop hageal plexus


6th interco sta l nerve Thora cic ao rti c p lex us
(ve ntral ramus of T6
spinal nerve) -----"

Posterior vaga l trunk


6th thoracic sympatheti c ga ngli o n

Gray and wh ite rami communi ca ntes

G reater sp lanchni c nerve


Superi or mesente ri c ga ngli o n
Lesse r spl anchni c nerve
Superi o r mese nteric arte 1y
Lea st sp lanchni c nerve and pl ex us

lnterm esen teric


(a bdomin al ao rti c) pl ex us

Inferi or mese nteric ga nglion


G ray rami com muni
Inferi o r mese nteri c artery
Sacra l sp lanchnic nerves (sympathetic and p lex us

Pelvic splanchnic nerves Superi o r hypogas tri c pl exus


(sacra l parasympathetic
outflow) - - - - - - -- f,_,.!L Para sympatheti c branch from
inferior hypogastric pl exus to
descending co lo n

H ypogastri c nerves

Vesical pl exus
- - - - Sympathetic fibers
Prostatic plexus
- - - - Parasympathetic fibers

SPINAL CORD PLATE 152


Autonomic Nervous System: Schema

Oculomotor nerve (111)---;?'----~S....--.


Facial nerve (VII)
Glossopharyngeal nerve (IX)
Medulla oblongata

Pulmonary plexus
Sweat ..
gland
~
~

\ T
\
\

---------Superior
mesenteric
ganglion
Arrector
(smooth)
muscle of -:;-;--------Inferior
hair follicle ~~::-;~~,i~ mesenteric
Note: Above three ganglion
structures are
shown at only
one level but r:;;:::----~J--~~~~:__~::::~-------- Superior
occur at all levels hypogastric
plexus

Note: Blue-shaded
areas indicate
zones of
parasympathetic - --=::::--------Inferior
outflow from hypogastric
CNS plexus

Sacral Pelvic
splanchnic
splanchnic
nerves nerves

Sympathetic { Presynaptic Parasympathetic { Presynaptic Antidromic


fibers Postsynaptic fibers Postsynaptic conduction

PLATE 153 BACK AND SPINAL CORD


Cholinergic and Adrenergic Synapses: Schema

Parotid
gland

Internal carotid nerve


Medulla
oblongata
Vagus nerve (X)

..,,,'
______ .... I

------------
,,, ,-
~
I
I
I
I
I

Hair follicles
Thoracic
part of
spinal cord

Visceral
arteries
Upper
lumbar
part of Gastrointestinal
spinal cord tract
(L 1-2 [3])

Sacral Pelvic splanchnic nerves


part of Urinary bladder
spinal cord

Urethra
Cholinergic synapses Prostate
Adrenergic synapses

Sympathetic { Presynaptic Parasympathetic { Presynaptic Somatic fibers


fibers Postsynaptic fibers Postsynaptic Antidromic conduction - - -

SPINAL CORD PLATE 154


Spinal Membranes and Nerve Roots

Posterior view Ven tral root of spina l nerve

Do rsa l root of sp in al nerve

Sp inal sensory (dorsal root) ga ngli on

W hite and gray rami co mmun ica ntes


to an d from sympathetic trunk

Dorsal ramu s of sp in al nerve

Dura mater

A ra chnoid - - - - - -41--_::._-
mater

Meso th eli al septum in dorsa l m ed ian su lcus

Fil aments of do rsal root

D enticu late li gament

Membranes removed: anterior view


(greatly magnified)

Gray m atter----z

White matter - --r::-::JO


Dorsa l root of sp in al nerv e
Filam ents o f ve ntral root

Dorsal ramus of sp inal nerve

Ventral ramu s of spinal nerve

al root of spina l nerve

Gray and w hi te
rami commun ica ntes
n
( ~.

'~N

PLATE 155 BACK AND SPINAL CORD


Spinal Nerve Origin: Cross Sections
SEE ALSO PLATES 154, 155, 158, 159

Section through thoracic vertebra

Body of vertebra
Fat in ep idural space
D ura mater
Sympath etic ga ngli on
Arachn oid mater*
Ventral

Recurrent
Sp in al nerve -------.. m enin gea l
Ventral ramus branches of
(intercos tal nerve) spin al nerve

Do rsa l ramu s

Spinal sensory
(do rsa l root) ga ngli o n

D o rsal root

Late ral horn of


gray matter of sp in al co rd

Section through lumbar vertebra

Late ral branch l


of do rsa l
ram us
o f spinal
D ura mater Medial branch }
nerve

Arachn o id mater Intern al ve rtebral


G ray ra mus
(epidura l) ve no us p lexus
co mmu nica ns
Ve ntral roo t

Dorsa l and ventral Spina l senso ry (do rsal roo t) ganglion


roots of lumbar and
sacral sp in al nerves
fo rming ca uda equin a
* Leptome nin ges

SPINAL CORD PLATE 156


Arteries of Spinal Cord: Schema
SEE ALSO PLATE 131 Anterior view Posterior view

Posterior cerebral artery Pos terio r inferior cerebel lar artery

Superior cerebe llar artery

Vertebra l artery

cervical artery

Asce nding cervic al arte ry

Ascend in g cerv ical


artery - - - - - - - - - "

D ee p cervical a

Subclavian artery
1------Posterior segmental
medu ll ary arteries

Posteri o r intercostal a1tery

Thoracic
:--...-=-- - + - - Posterior
ve rtebrae
intercostal arteri es
Major anterior
segmental medullary
artery (artery or~f-----~~'I!J.d~~~
Adam ki ewicz)

::rt;~-- Posterior segmental


medu ll ary arteries

'!~ \ \~---- A n as to motic loop s to


anterior spinal artery

Lumb ar Lumbar arteri es


vertebrae

A nas tomotic loops to


poste rior sp in al arteri

Ca uda equina arte


Note: A ll spinal nerve roots have
associated radicular or segmental
medullary arteries. Mos t roots have
Late ral (o r m ed ial) rad icular arteri es (see Plate 158). Both
sacral arterie s- - - - -fl ty pes of arteries run along roots, but
radi cular arteri es end before reaching
Sacrum anle ri o r or posterior sp in al arte ri es;
large r segmental medull ary arte ri es
conti nu e on to supply a segment of
these arte ri es

PLATE 157 BACK AND SPINAL CORD


Arteries of Spinal Cord: Intrinsic Distribution

Anterior spin al artery

Anterior segme ntal


medull ary artery

Anterior radi cular artery

Poste rior radi cular artery

Bran ch to verteb ral bod y


and dura mater

Dorsal branch of posterior


intercostal arte ry

Posterior intercostal artery

Preve rtebral anas tomoses

Thorac ic (d esce ndin g) aorta

Section through thoracic level:


anterosuperior view

Sulcal (central) branch es to


right side of spinal co rd

Posterior radicul ar arte ry Sulcal (centta l) branches to left si de


of sp in al cord

Left posterior sp inal artery

Zone suppli ed by penetrating


branches from pial plexus
Pial ar terial plexus
Zo ne suppli ed by central branch es
Anterior and posterior
rad icular arteries----~-,.Q;. Zo ne supplied by both
ce ntral branches and branch es
from pi al plexus

Posterior radicul ar artery


Arterial distribution: schema
Ante rior segmental
medullary artery

No te: All sp inal nerve roo ts have asso ciated radicular or Pial arterial plexus
segmental medullary arteries . Most roo ts have rad icul ar arteri es.
Both types of arteries run along roots, but rad icular arteri es end
be(or e reachin g anterior or posterior sp in al art eries; large r segmental
m edull ary arteri es continue on to supp ly a segment o f th ese arteries

SPINAL CORD PLATE 158


Veins of Spinal Cord and Vertebral Column

Posterior in ternal vertebral (ep idural) venous plexus

Ante ri or extern al
vertebral ve nous
plexus- - - - - '
In tervertebra l vein

Basivertebra l ve in Anteri o r extern al ve rtebral veno us p lexus

Basivertebra l vei n

Anterio r intern al vertebra l


( pidural) venous p lex us

A nterior and posterior


segmental med ull ary/
rad icu lar ve in s

Basiverteb ral ve in
Ante ri or spinal ve i

Anterior sulca l Anterior intern al ve rtebral


(ep idural) venous pl ex us
(cen tral ) vein

Posterior intern al vert ebral


(ep idural) ve nous p lex us

Posteri o r ex ternal ve rteb ral


venous plexus

Posteri or segmental m ed ullary/ radi cul ar vein

Pi al venous plexus

Poste rior su lca l (centra l) vein

Posterior intern al ve rtebral (ep idural) ve nou s p lexus

____________ ______------------------------------------
,

PLATE 159 BACK AND SPINAL CORD


Muscles of Back: Superficial Layers
--------

Superior nu chal lin e of skull Semi spin ali s ca pitis muscle

Spinous process o f C2 ve rteb ra Ieniu s capi tis muscle

Sternocleidom as toid mu scle Spino us process of C7 vertebra

Trapeziu s mu Levato r scap ul ae mu scle

Spin e of scapul a Rh o mboid minor muscle (c ut)

Delto id muscl e

Te res majo r
m usci e - - ----11

Lati ssimus
do rsi muscl e

Ter es min o r
and maj o r
mu scl es

Lati ssimus dorsi muscle (c u t)

Exte rnal
o bliqu e m

Intern al o blique
mu scl e in lumbar tri angle
(Petit)- - - - - - - - --#},
Erecto r spin ae muscl e

G lutea l apo neurosis


(over glu teus mediu s 1 In te rn al
ob liqu e mu scl e

MUSCLES AND NERVES PLATE 160


Muscles of Back: Intermediate Layers

Superio r nu chal li ne of sku ll Rectus ca pitis posterior minor mu scl e

Ob li quus ca pitis superior mu scle


Poste ri or tubercle of atl as (Cl)

Obl iquu s ca pitis inferi o r muscl e

Longiss imu s cap iti s muscle


Splenius capitis and
sp len iu s ce rvicis muscles - - - - Semi spin ali s ca pitis mu scle (cut)

Se rratus posterior superi or mu scl e

Sp inous proces s of C7 ve rtebra

Ili ocosta li s mu scle


Lon gissimu s cervicis mu scle

Erector ili ocosta li s cerv icis muscl e


sp in ae
muscl e
Ili ocostali s tho racis mu scle

Hook

Sp in ali s thoraci s muscle

Lon giss imus thora cis mu scle

Ili ocosta li s lumborum muscl e

Sp in ous process of Tl2 ve rteb ra


Tendon of o ri gin of
transve rsus abdom ini s muscl e
Tra nsversus abdominis
mu scl e and tendon
of origin
In ternal ob liqu e
mu scle - - - - - - - -
_ _ _ Th o raco lum bar fasc ia
(cu t edge)

Ilia c cres t

PLATE 161 BACK AND SPINAL CORD


Muscles of Back: Deep Layers

Superior nuch al lin e of sk ull Rectus ca pitis posterior minor mu scle

Obliquus ca pitis superior muscl e

Posterior tub ercl e of atla s


(C l vertebra)

Spinou s process of axis


(C2 verteb ra) - - - - - - - - - liquus capiti s inferior muscle

Semispinalis cap iti s muscl e Longu s ~ Rotato res ce rvici s muscl es


Brevis
Spinous process
of C7 verteb ra ----------:
Interspin alis cervi cis muscle

Levato r cos tae muscle


Extern al intercosta l mu scl es

Rotatores
} thoracis muscl es

Semispinalis thoracis mu scle - --If-


Levatores
} cos tarum muscles

Multifidi mu scles

In tersp in alis lumborum mu scl e

Thoracolumbar fasci a Latera l intertransversarius muscl e


(posterior layer) (cut) - - - -

Transversus abdominis mu scle


and tendon of origin-------"'--

Ili ac crest

MUSCLES AND NERVES PLATE 162


Nerves of Back
SEEALSOPLATES 766, 779,237,24 7

reater occip ita l nerve (do rsal ramu s of


C2 spinal nerv e)

3rd occipital nerve (dorsal ramus of


C3 sp in al nerv e)
Leva tor sca pulae mu scle
Lesser occip ital ne rve J Cervical plexus
(ventral ram i of
Su perfi cia l cervical artery 1/A~--+----urea t auricu lar nerve C2, 3 spi nal nerves)
(descendin g branch) and vein

Subtrapezial plexus
Poste ri or cutaneous branches (from medial
b1anches of do rsa l ram i of C4- T6 sp in al
nerves; C7, 8 are minimal)
De lto id muscle

Infraspinatus fa scia

Spine of Teres minor and


scapula major muscl es

Infraspin atus Superi o r lateral bra chi al


fascia---" cutaneous nerve (from
axillary nerve CS , 6)

''""- - Poste rior cutaneo us


branches (from lateral
branches of dorsal ram i
of T7-12 spinal nerves)
Rhombo id
min o r muscle
Late ral cutaneo us branches of
ve ntral rami (intercos tal nerves)
Rhombo id
major muscl e

Lati ssimus dorsi mu scle

Exte rn al ob liqu e muscl e


Sp in ous process of
T12 ve l tebra---~

Ili ohypogastri c nerve


Th oracolum bM fascia (ve ntral ramus of L1 sp in al
nerv e)

Superi o r cluneal nerves


(dorsa l ra mi of L1, 2, 3 spinal
nerves)

M ed ial cluneal nerves


(dorsa l rami o f S1, 2, 3 spinal
G lu te us max imus nerves)
muscl e - - - - - - -
Inferior clun ea l nerves from
posterior fe mo ral cutaneous
nerve (sacral plexus S1, 2, 3)

PLATE 163 BACK AND SPINAL CORD


Suboccipital Triangle

tu s cap itis posteri o r mi no r muscle

Rectus ca pitis posteri o r majo r muscl e

Epi cranial apo neurosi s Semisp in alis capitis mu scle


(ga lea apo neurotica (c u t and reflected)

O ccipital b elly (occipitali s) of


occipitofro ntalis muscl e-------. Vertebral artery
(atl antic part)

G rea ter occipital nerve


(do rsal ram us of C2
spin al ne
Su boccipital nerve
(do rsa l ramu s of C l
Occipital arter y spinal nerve)

Po sterio r arc h of
atl as (C l verteb ra)
3rd (least) occipital nerve
(do rsa l ramu s of C3
spina l nerve)

Semispin ali s capitis


and spleniu s ca piti s
mu scl es in pos terio r
tri angle o f neck G rea ter occipital
nerve (do rsal1amu s
o f C2 spin al nerve)

Spleniu s capiti s mu scl e


(cut and reflected )

"""- ----~ 3id (least) occip ital nerve


G reat auricul ar nerve (do rsa l ramu s of C3
(cervica l plex us C2, 3 sp in al nerve )

Lo ngissim us ca pi ti s m uscl e
Lesser occip ita l nerve
(ce rvical plex us C2, 3)

Semi spin ali s cervicis m uscle


Sternocle idom as to id muscl e

Trapeziu s mu scl Se mi spin ali s capiti s muscl e (cut)

pleni us ca pitis muscl e (c u t )


Poste ri o r cutaneou s branch es
of do rsal rami o f C4, 5, 6
sp inal nerves - - - - - - - ' ~-fiDN
:.:.:: :

MUSCLES AND NERVES PLATE 164


Lumbar Region of Back: Cross Section (Superior View)

Inferior vena cava


Descending (2nd) part of duodenum

Pancreas Kidney

Renal fascia (anterior and posterior layers)


Anterior longitudinal ligament
Perirenal fat
Crura of diaphragm

Superior mesenteric artery and vein


neum

Abdominal a

Body of
L2 vertebra

Lumbar
spinal nerve

rna I
oblique
muscle

Cauda
equina Internal
oblique muscle

Transversus abdominis
muscle
Spinous process
of L1 vertebra on of origin of
transversus abdominis and
internal oblique muscles

Erector spinae muscle Serratus posterior inferior muscle

Thoracolumbar fascia (posterior layer Latissimus dorsi muscle

Thoracolumbar fascia (middle layer) Quadratus lumborum muscle

Thoracolumbar fascia (anterior layer-


quadratus lumborum fascia)

PLATE 165 BACK AND SPINAL CORD


Typical Thoracic Spinal Nerve
SEE ALSO PLATES 779, 24 7

Anterior cutaneous branch


Medial bran ch

Intern al intercos tal muscle

Innerm ost intercostal mu scle

Ventral root

Dorsal root
Anterio r branch
Intervertebra l Sp in al se nso ry (do rsa l tr'LU--J-.---lateral cutaneous branch
foramen ro ot) ga ngli o n
Poste ri or branch
Spinal nerve

Sympath etic ganglion

Gray and w hite rami commu ni ca ntes

Se rratu s anterio r mu scle

Latissimus dorsi mu scle

Teres major muscle

Scapu la

Dorsal ramus
Medial branch

Erecto r spinae mu scle

Intern al intercostal membrane

No te: In lower thoracic


region, later al branch of
dorsal ramu s is longe r,
motor and cutaneo us;
med ial branch is shorter
and motor o nly

MUSCLES AND NERVES PLATE 166


Section Ill
THORAX

MAMMARY GLAND 181. Diaphragm: Abdominal Surface


Plates 167- 169 182. Phrenic Nerve
167. Mammary Gland 183. Muscles of Respiration
168. Arteries of Mammary Gland
169. Lymph Vessels and Nodes of LUNGS
Mammary Gland Plates 184 - 199
184. Topography of Lungs: Anterior View
BODY WALL 185. Topography of Lungs:
Plates 170- 183 Posterior View
170. Bony Framework of Thorax 186. Lungs In Situ: Anterior View
171. Ribs and Sternocostal Joints 187. Lungs: Medial Views
172. Costovertebral Joints 188. Bronchopulmonary Segments
173. Cervical Ribs and Related Anomalies 189. Bronchopulmonary Segments
174. Anterior Thoracic Wall (continued)
175. Anterior Thoracic Wall (continued) 190. Trachea and Major Bronchi
176. Anterior Thoracic Wall: Internal View 191. Nomenclature of Bronchi: Schema
177. Posterior and Lateral Thoracic Walls 192. Intrapulmonary Airways: Schema
178. Posterior Thoracic Wall 193. Intrapulmonary Blood Circulation:
179. Intercostal Nerves and Arteries Schema
180. Diaphragm: Thoracic Surface 194. Pulmonary Arteries and Veins

- - - - - - - - - ----------..---
ATLAS OF HUMAN ANATOMY
SECTION Ill: THORAX

195. Great Vessels of Superior 212. Atria, Ventricles and


Mediastinum Interventricular Septum
196. Bronchial Arteries and Veins 213. Conducting System of Heart
197. Lymph Vessels and Nodes of Lung 214. Nerves of Heart
198. Autonomic Nerves in Thorax 215. Innervation of Heart: Schema
199. Innervation of Tracheobronchial Tree: 216. Innervation of Blood Vessels: Schema
Schema 217. Prenatal and Postnatal Circulation

HEART MEDIASTINUM
Plates 200- 217 Plates 218-230
200. Heart In Situ 218. Mediastinum: Right Lateral View
201. Heart: Anterior Exposure 219. Mediastinum: Left Lateral View
202. Heart: Base and Diaphragmatic 220. Esophagus In Situ
Surfaces 221. Topography and Constrictions
203. Pericardia! Sac of Esophagus
204. Coronary Arteries and Cardiac Veins 222. Musculature of Esophagus
205. Coronary Arteries and Cardiac Veins: 223. Pharyngoesophageal Junction
Variations 224. Esophagogastric Junction
206 . Coronary Arteries: Arteriographic 225. Arteries of Esophagus
Views 226. Veins of Esophagus
207. Coronary Arteries: Arteriographic 227. Lymph Vessels and Nodes
Views (continued) of Esophagus
208. Right Atrium and Ventricle 228. Nerves of Esophagus
209. Left Atrium and Ventricle 229. Intrinsic N erves and Variations
210. Valves and Fibrous Skeleton of Heart in Nerves of Esophagus
211. Valves and Fibrous Skeleton of Heart 230. Mediastinum: Cross Section
(continued) (Superior View)

ATLAS OF HUMAN ANATOMY


Mammary Gland

Anterolateral Suspenso ry
dissection li game nts
(Cooper)
reo la r
gland s
Pectorali s
major mu scle - - - -.,..-:h!
(deep to
pectoral
fascia)

Serra tus a nterior mu scle

Exte rn al
ob liqu e mu scl e -----..

Pectoralis
major
muscle-----'
Areo la
Pectoral ippl e
fasc ia-----,...,.

Inte rco sta l


muscle s ------.:;;:;~

Suspenso ry li gaments (Coo per)


Inte rcosta l
vesse ls
a nd ne rve - - - - - - : ;""""!

Gland lobu les

Sagittal section

MAMMARY GLAND PLATE 167


Arteries of Mammary Gland

Subclavian artery

Intern al th o racic artery


and its
perfo ratin g branch es

M edial mammary branches

Ax ill ary arte ry

Lateral tho racic arte


and
Lateral m amm ary
br a n c h es ----~

Late ral ma mmary


branches of
lateral cuta neous
branches of posterio r
intercos tal arterie s

PLATE 168 THORAX


Lymph Vessels and Nodes of Mammary Gland

Apical (subclavian)
lnterpectoral (Rotter's) n axillary nodes

Subscapular
(posterior)
axillary
nodes

Pectoral
(anterior)
axillary
nOU!~S---'

Pathway to anterior
mediastinal nodes

Pathways to opposite breast

Pathways to inferior phrenic (subdiaphragmatic) nodes and liver

MAMMARY GLAND PLATE 169


Bony Framework of Thorax
SEE A LSO PLATE 23 1

Anterior view

Sternum

Xiph o id
Scapula pro cess

Subscapul ar
fossa - - - - '

Clavicle

Fl oatin g ribs (11 - 12)

Posterior view

Scap ul a

In fra spino us
fossa

> - - -True ribs (1-7)

JI!!N
'....: .: :
~ ~--F a l se ribs (8- 12)

Floatin g ri bs --""-..)o"'l'
(11-12)

PLATE 170 THORAX


Ribs and Sternocostal joints

Muscle attachments

Origins
1st left rib:
superior view Neck Insertions
Tub ercl e
(no angle)

Middle rib:
posterior view

ngle An gle

superior view Articular face ts


for vertebral body

Cos tal groove

Note: Th e head of a typi ca l rib


articul ates w ith th e superi o r
co stal face t o f the thoracic
vertebra o f the same number (by
its inferi o r arti cular fa ce t), th e
inferi o r costa l facet of th e
vertebra numbered on e num ber
lower (by its superior fa ce t) and
th e intervertebral di sc between
the two ve rtebrae. Th e costa l
tubercl e arti culates with th e
transv erse pro cess of th e
vertebra o f th e same number

Costal ca rtil ages

lntercho ndral joints

process
Cos to xiph oid Sternocostal articulations:
li ga ment anterior view

BODY WALL PLATE 171


Costovertebral joints
SEE ALSO PLATE 743

Anterio r longitud inal Tr ansverse cos tal facet (for tub ercl e of rib of sa me number as ve rtebra)
li ga men t

Inferior costa l Lateral costotransve rse li ga ment


facet (fo r head of
rib one number
higher) - - - - - -

Radi ate
li ga m ent of
lntraa rti cular li gam ent
head of ri Radi ate
li ga m ent
of head
of rib Synov ial
cav iti es

Left lateral view

Superio r costal
facet (for head of rib
of sa m e number)

Tran sve rse process


(c ut

Costotransverse li ga ment

Lateral costo transv erse li ga m ent

Transverse section: superior view


Rad iate li gament of head of rib

Cos totransv erse li gament

Lateral cos totransve rse li ga ment

Sup eri or costotransverse li ga ment

lntertran sve rse li gament

Right posterolateral view

PLATE 172 THORAX


Cervical Ribs and Related Anomalies
SEE ALSO PLATES 28, 400, 401

Scalene muscles
Ante rio
Mid

Cervical rib Cervical rib adheres to


co mpresses 1st thorac ic rib by
subclavian den se fibrous band
artery:
poststenotic
dilation

Lowest cord of
brachial plexus
eleva ted by
cervical rib

Rudimentary
1st tho racic rib
w ith postfixed
brachial plexus

Norm al morphology

Note: Cervical rib also


often asymptomatic

BODY WALL PLATE 173


Anterior Thoracic Wall

Sternocl eidomastoid muscle Sternothyroid muscl e ~


Invested by
Sternohyoid mu scle
ce rvical fascia
Posteri o r triangle o f 1 Omohyoid mu scle

Perforating branches o f intern al Subcl avius mu scle invested by


thoracic artery and anterior cutaneo us cl avipectoral fasc ia
branches qf intercos tal
Thotacoacrom ial artery (p ecto ral
Pecto rali s major muscl branch) and lateral pecto ral nerve

Costocoracoid li gament

Coraco id process

Deltoid muscle Med ial


p ectoral
nerve

Lo ng thoracic nerve
and late ral thoracic
Pectoralis minor
muscle invested by
Clavipectoral fasc ia
Latiss imus dors i muscle

Digitation s of se rratus
D igitations of anterior muscle
se rratus anterior muscle
External intercos tal
membranes anterior to
Late ral cuta neo us branch es of interna l intercostal
intercos ta l nerves and muscles
posteri or in te rcostal arteri es
Exte rnal intercosta l mu scles
External obliqu e
muscle Body and xiphoid process
of ste rnum
A nterior laye r of rectus shea
Intern al obliqu e mu scle

Rec tu s abdomini s mu scle


., Nr~.~,. . .
t
l j .' ' .,.A
.
Cutaneous branches o f thoracoabdom in al
{- .l./ Lin ea alba (a bdominal portions of intercosta l) nerves
II!!N
\'.:.. : : and superior epigastric artery

PLATE 174 THORAX


Anterior Thoracic Wall (continued)

Omohyoid, stern othyroid and stern ohyoid muscl nal ju gular vein

Clavicl to r sca pu lae mu scl e

Subclaviu s muscl e

Thoracoa cromi al a

Pectora li s major
mu scle (cut)

De lto id
muscl e

Intercostobra chi al Superio r thor acic artery

Long thoracic nerve Internal thoracic


and lateral thorac ic arter y artery and vein s

Pectorali s minor muscl e Exte rn al intercosta l muscle

Digitatio ns of
serratu s anteri or muscl

Transversus th o racis
Lateral cutaneo us muscle
branch es of intercostal
nerves and posterior
intercosta l arteri es - - - - Ante ri or intercosta l
branches of intern al
thoracic ar tery
Extern al intercostal muscl es

In tercostal nerve

Extern al in tercos tal membranes Musculophreni c artery


anteri o r to interna l in tercosta l mu scl es and vein

Transversus abdom ini s muscl e

Supe ri o r epi gastri c arteri es and vein s


Rectus abdo mini s muscle and shea th (cut)

BODY WALL PLATE 175


Anterior Thoracic Wall: Internal View

Sternothyroid muscl e M anubrium of sternum

nferior thyroid arte ry

Ante ri or scalene muscl Vertebra l artery

Subclavian artery and vein Brachiocephalic trunk

Subclav ian artery and vein

Brach iocepha li c ve in Brachiocephali c ve in

Phren ic nerve and


perica l-diacophrenic
arte ry an d vein - - - - - -:!>
A nterior in tercosta l
Intern al thoracic arteries and ve in s
artery and ve in---li~~i-'...:...,~ and intercostal nerve

Anterior in tercostal
arteries and veins
and intercostal nerve

Perforating branches
of in terna l thoracic
artery and ve in and
anterio r cutaneous
branch of
intercosta l

Co llateral
branches of
intercosta l artery
and vein - - - - - ',

Body of sternum

Sternocosta l
triangle ----~

Slips of
costa l origin
of diap hragm
Musculophreni c
artery and vein

Transve rsus
abdom ini s
mu scle

Xiphoid process Superior epigastric artery and veins

PLATE 176 THORAX


Posterior and Lateral Thoracic Walls
SEE ALSO PLATES 760, 76 7, 762

Spl en iu s ca pitis and ce rvi cis muscles

Posteri or scalene mu scle

Extern al intercos tal mu scl es

Th oracolu mbar fascia over


Ex ternal erecto r sp in ae muscl e
intercostal
muscles Erector sp in ae muscl e cut away to revea l
levato res cos tarum and transversospin ales muscles

Serratus posteri or inferi o r mu scle

Digitatio ns of externa l ob lique muscl e

Intern al obliqu e mu scle

Trans ve rsus Tend on o f origin of transve rsus abdominis m uscle


abdomini s
muscle---+

Sca lene muscl es l


Subcl av ian artery and ve in

Superior tho racic artery

Extern al intercostal membrane Scapul a (retracted)


anteri or to in te rn al in te rcos tal mu scl e

Perforatin g b ranch of in te rn al scapu lari s


thoraci c artery and anterio r muscle
cutaneous b ranch of in tercostal nerve

In tercos tobrach ial nerve


Long thoracic ne1ve
Ex ternal in tercosta l muscl e

Lateral thoracic ae rtery

Late ral cutaneo us branch es


of intercosta l nerves and
posterior inte rcos tal arteri es

Serratus anteri o r mu scl e

------- ------
BODY WALL PLATE 177
Posterior Thoracic Wall

plenius capitis muscle

External occipital protuberance

ator scapulae muscle

Sternocleidomastoid muscl

Trapezius muscle omboid major muscle

Supraspinatus muscle

Infraspinous fascia

Deltoid muscle

Teres major
muscle-----
Spinous
processes of
thoracic
vertebrae

Latissimus dorsi
muscle (cut)

Lower digitations of
serratus anterior muscle
Latissimus dorsi muscle

Digitations of external
oblique muscle
External
oblique muscle----<:_

Lumbar t1iangle (Petit) with


internal oblique
muscle in its floor
Serratus posterior inferior muscle

Iliac cres Thoracolumbar fas c ia over deep


muscles of back (erector spinae)

Medial Posterior cutaneous branches (from


Lateral } medial and lateral branches of dorsal
rami of thoracic spinal nerves)

PLATE 178 THORAX