By Hector Davis,2014-12-19 20:26
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Peter’s *Pimp* Head and Neck notes – Gross Anatomy 2004

Frontal Region and Face


    Supplied by Br of CN VII mm of facial expression. O: bones of skull, I: skin


    Orbicularis oculi

     -palpebral (blinks)

     -orbital (close tightly)

     -lacrimal (tears)

    Orbicularis oris


    Levator labii superioris Depressor labii inferioris

    Levator anguli oris (more lat than labii) Depressor anguli oris

    Zygomaticus major and minor (more med than maj)




    Facial N. (? stylomastoid for)

     -pos auricular

     ? parotid gland (5)




     -(marginal) mandibular



    (brs of CN V, cervical plexus, medial brs of dorsal rami of cervical sp nn)

    Trigeminal N.

     Ophthalmic, V1 (5)



     -lacrimal (palpebral br of)


     -ext nasal (br ant ethmoidal n.)

     Maxillary, V2 (3)




     Mandibular, V3 (3)




    Cervical plexus

     -great auricular

     -lesser occipital

     -transverse cervical

    Dorsal rami of cervical sp nn

     -greater occipital


    Facial (? ext carotid)

     -submental (to chin, lower lip)

     -inf labial

     -sup labial

     -lat nasal

    Superficial temporal (?? ext carotid)

     -transverse facial

    Ophthalmic (? int carotid)

     ? optic canal to orbital cavity

     -supratrochlear (? supraorbital margin to face and scalp)

     -supraorbital (? supraorbital for to face and scalp) Other

    Parotid Gland

     -largest salivary gland

     -ant to ear, lat side of face

     parotid duct ? pierce buccintor ? oral vestibule

Cranial Cavity


    Dura mater (two layers: outer cont w/ periosteum, inner w/ coverings of sp cord & CNs)

     -Dural reflections

     a. Falx cerebi (dbl layer of dura btw cereb hemis, contains sup, inf sag sinus)

     b. tentorium cerebelli (covers Cb, supps occ lobes of cerebral Hemis)

     c. falx cerebelli (btw Cb hemis, contains occ sinus posteriorly)

     d. diaphragma sellae (covs pituitary gl)

     -Dural sinuses (drain brain ? int jugular v)

     a. sup sagittal

     b. inf sagittal

     c. straight (? great cerebral v + inf sag sinus)

     d. transverse (? straight)

     e. sigmoid (? transverse, sup petrosal)

     f. occipital

     g. cavernous (? sup petrosal ? sigmoid ? int jugular v)

     (? ophthalmic v, pterygoid venous plexus)

     h. sup petrosal

     i. inf petrosal

     -blood supply

     -ant: ant meningeal (? ethmoidal)

     -mid: middle & accessory meningeal aa (? maxillary)

     -pos: pos meningeal aa (? ascending pharyngeal, occipital, vertebral aa)

     -emissary v: pass directly through skull


     -ant: meningeal brs of ethmoidal (? ophthalmic, CN V)

     -mid: meningeal brs (? maxillary, CN V)

     -pos: Brs of C1-2


     -subarachnoid space filled w/ CSF (? choroids plexi, in ventricles)

    (? arachnoid granulations, near sup sag sinus or lacunae)

    Pia mater



     -div by longitudinal fissure

     -interconnected by corpus callosum (within long fiss)


     -brain stem

     Arterial Supply (int carotid + vertebral aa)


     -pos inferior cerebellar

     Basilar (? R&L vertebral aa)

     -ant inf cerebellar


     -sup cerebellar

     -pos cerebral (term brs)

     Internal carotid

     -ophthalmic (doesn’t supply brain, but ? orbit)

     -ant cerebral (? ant communicating, btw R&L)

     -middle cerebral

     -pos communicating (anas w/ pos cerebral)

     Circle of Willus (imp collateral circ bwt int carotid & vertebral aa)

     -ant communicating

     -ant cerebral

     -int carotid

     -pos communicating

     -pos cerebral (? basilar ? R&L vertebral aa)

    The Orbit


    See below


    Orbicularis oculi

     -closure muscle of eye, CN VII, paralysis CN VII ? inability to close eyelid

     -lacrimal part covers lacrimal sac. Contraction, or blinking, helps remove lac fluid

    Levator palpebrae superioris

     -elevator muscle of upper eyelid

     -striated (CN III) and smooth (superior tarsal m, symNS) m fibers eye movements (anterior view):

    [abducts] inferior oblique superior rectus [adducts]

     lateral rectus [eye] medial rectus

     superior oblique inferior rectus * 4 rectus mm arise medially


    Sup salivatory nucleus (CN VII, pregang) ? greater petrosal n ? n of pterygoid canal ? pterygopalatine ganglion ? (postgang) maxillary div, CN V ? communicating br ? lacrimal n

Ophthalmic division of CN V (see below)

Occulomotor n

     superior division

     -sups SR, levator palpebrae superioris mm

     inferior division

     -IR, MR, IO mm

     -Edinger Westphal nucleus (pregang fibs) ? inf div of CN III ? ciliary gang ? ciliary nn (postgang)

    ? sphincter pupillae m and m of accommodation (imp in light reflex, below)

     -important in convergence, via MR, crossing eyes to focus into something

    Ciliary ganglion (parasym gang, connects to eyeball via short ciliary nn)

    a. motor root

    -synapses here, fr. Inf div of CN III

    b. sensory root

    -br of nasociliary n, carries sensation fr eyeball ? CNS (fr short ciliary nn)

    c. sympathetic root

    -fr deep petrosal n, carries postgang fibs fr sup cervical gang along carotid plexus

    -dilation of pupil, via dilator pupillae m


    Tarsal Glands

     -embedded in tarsal plates, secrete along edges of eyelid lacrimal gland

     -secretes into orbit at superior conjunctival fornix

     -moisture for eye, bactericidal capacity, tears

     -drainage: ? lacrimal puncta ? lacrimal canaliculi ? lacrimal sac ? nasolacrimal duct ? inf meatus

     -lacrimal a, lacrimal v ? ophthalmic vv ? cavernous sinus, lacrimal n (V1)


    Bulbar sheath (Tenon’s capsule)

     -sheath around eyeball & continuous w/ sheath around extraocular mm 7 bones make up orbit: maxilla, frontal (lat part has fossa for lac gl, med trochlea of sup oblique m),

    zygomatic, ethmoid, palatine, sphenoid, lacrimal (fossa for sac)

     -inferior orbital fissure = btw maxilla and grtr wing of sph

    annulus tendineus

     -med side of back of orbit, surrounds optic canal and part of sup orb fissure

     -overlap w/ sup orb fissure: sup and inf div of CN III, nasociliary n, CN VI

     -outside annulus tendineus: CN IV, lacrimal n, frontal n, ophthalmic div (CN V)

    accommodation (three part response of eye and orbit to close vision)

    1. parasym-ciliary gang sys rounds the lens to focus on close images

    2. parasym sphincter action on the pupil

    3. convergence of eyeball via adduction of MR

Posterior and Anterior Triangles of the Neck

    Anterior Cervical Triangle (mandible, styloid process, mastoid; SCM m; midline of neck)

    a. muscular triangle

    -sup belly of omohyoid m; SCM, midline of neck

    -infrahyoid ‘strap’ mm

    +lat to med on hyoid (That’s Obvious Stupid): Thyrohyoid (deep to?), omohyoid,


     +sternothyroid (deep to thyrohyoid and omohyoid mm)

    b. carotid triangle

    -sup belly of omohyoid m; pos belly of digastric m, ant border SCM

    -carotid sheath (common carotid, int jugular, CN X) and lymph nodes

    -carotid sinus (baroreceptor, dilation of int carotid a) and carotid body (chemorecepter, blood O 2


    -ansa cervicalis, CN X, hypoglossal nn traverses through

    c. submandibular triangle

    -mandible, styloid process; pos belly of digastric; ant belly of digastric

    -submandibular gland: submandibular duct (of Wharton) is superfic to hyoglossus m and exits

    anteriorly fr gland to oral cavity. Duct is wrapped around by lingual n (ant, superfic; pos,

    deep to lingual n)

    d. submental triangle

    -ant belly of RnL digastric m; hyoid bone. Floor = mylohyoid m

    -only tri that is not paired and crosses midline

    Posterior Cervical Triangle (SCM, trapezius, clavicle)

    a. occipital triangle

    -SCM, inf belly omohyoid, trapezius

    -nn: lesser occipital, great auricular, transverse cervical, supraclavicular, CN XI

    -splenius cervices and levator scapulae mm form floor

    b. supraclavicular triangle

    -SCM; clavicle; inf belly omohyoid, ant edge of trepezius

    -brachial plexus (C5-T1) ? dorsal scapular, suprascapular, long thoracic nn; phrenic (C3-5)

    -dorsal scapular a, transverse cervical, suprascapular aa; subclavian v


    Ansa cervicalis (C1-C3)

     -brs target infrahyoid mm, entering muscular triangle

     -EXCEPTION: C1 runs with CN XII, independently, to innv thyrohyoid m

     -sup (ant) and inf (pos) roots

    Hyoglossal n

     ? hyoglossal canal ? exits carotid tri deep to pos belly of digastric

     innvs intrinsic mm of tongue: hyoglossus, styloglossus, genioglossus

C2-C3 (cervical plexus)

     -lesser occipital, great auricular, transverse cervical

     -cutaneous innervation of scalp behind ear, runs up and ant to ear, ant neck resp (above)

    supraclavicular n (emerges pos to SCM, inf to C2-C3 root)

     -lat, int, and medial brs. Cutaneous innv to resp. regions Spinal Accessory (CN XI)

     -emerges fr SCM runs on levator scapulae m, pierces trapezius to supply eff innv


    Infrahyoid mm

    - all take origin BELOW hyoid bone and DEPRESS, RAISE, STABILIZE larynx and hyoid b during

    swallowing and phonation. Innv by ansa cervicalis motor brs

    1. Thyrohyoid

    2. omohyoid

    3. sternohyoid

    4. sternothyroid

    Suprahyoid mm

    1. stylohyoid (CN VII, elevates retracts hyoid b)

    2. mylohyoid (I: midline raphae and pos in hyoid b, mylohyoid br of inf alveolar n)

    3. pos and ant bellies of digastric

    Intrinsic mm of tongue

    1. hyoglossus

    2. styloglossus

    3. genioglossus

Root of the Neck stBoundaries: manubrium of sternum, first rib, body of 1 thoracic vertebra


    Anterior scalene

     -o: cervical vertebrae (3-6); i: first rib

     -anteriorly: subclv v, suprascapular a, transverse cervical a, ascending cervical a, phrenic n

     -posteriorly: subclv a, ventral rami of brachial plexus (btw ant & mid scalene mm)

    Longus colli

     -o: ant tubercle of C1; i: body of vertebra T3


    Vertebral a

     -in a triangle formed by: subclv a (base), ant scalene and longis colli mm common carotid

     -ascends to pass anteriorly to origin of ant scalene m Neurology

    Sympathetic trunk (runs along ant aspect of longus colli m)

    1. middle cervical ganglion

    -near inf thyroid a

    2. inferior cervical ganglion

    -near vertebral a br off sbclv a

    -sometimes fused with first thoracic ganglion forming stellate ganglion

     -middle and inf gang connected via ansa subclavia, which loops around subclavian Phrenic (C3-5)

     -courses ant to ant scalene m

    CN X

     Left and Right recurrent (inferior) laryngeal brs btw esophagus and trachea

     Superior laryngeal n

     -int (accompanies sup laryngeal a to pierce thyrohyoid membrane) and ext br Brachial plexus

    Other structures

    Thyroid gland

     -extends around trachea and esophagus th -sup limited by ins of sternothyroid m, extends inf to 5 tracheal ring, RnL lobes connect via isthmus

     -regulates metabolism, enlargement = goiter

     -sup by inf/sup thyroid a; inf/mid/sup thyroid vv

    Parathyroid glands (4)

     -pos surface f thyroid gland, secret PTH, regs Ca metab

    Thoracic duct

     -lymphatics fr cisterna chyli, drains at junction of L subclavian v and left int jugular v

Infratemporal Fossa

    Temporomandibular Joint (TMJ)

     -articulation of condyle of mandible with mandibular fossa of temporal b

     -articular tubercle of temporal b (ant and critical for wide opening of jaw), spine of sphenoid

     -stabilized by fibrous joint capsule AND 3 ligs

     1. temporomandibular lig (lateral lig)

     -lateral strength, next to joint capsule

     2. stylomandibular lig

     -thickening of fib capsule of parotid gland, adds little strength

     3. sphenomandibular lig

     -spine of sphen to lingual on medial mandible, swinging hinge

     -ins site is where mylohyoid br of inf alveolar a and mylohyoid n are found Infratemporal fossa

    -behind maxilla b, below sphenoid and temporal bb, medial to zygomatic arch; btw ramus of

    mandible and pharynx.

    -delineated by lateral pterygoid plate of sphenoid, squamos of temporal; ramus of mandible,

    zygomatic arch; pos surface of maxilla; styloid process, ext acoustic meatus; inf surface of grtr wing

    of sphenoid; sup border of mandible

    Parotid gland

     -parotid duct dives medially at edge of masseter m, piercing buccinator m

     -secretion controlled by parasym innv from CN IX


    Muscles of Mastication (all in infratemporal fossa, EXCEPT masseter)

    1. Temporalis

    -O: inf temporal line, i: coronoid process

    -ant and mid portions elevate, pos retracts

    2. masseter

    -o: zygomatic arch, i: coronoid process, lat surf of ramus, ang mandible

    -strong elevator, assists protraction and retraction

    3. later pterygoid

    -2 heads. Sup head, o: grt wing of sph; i: articular disc of TMJ. Inf head, o: later pterygoid plate

    of sph; i: condylar process of mandible

    -both work together to open or protract, singly to grind (move to opposite side of m)

    4. medial pterygoid

    -deep head, o: med surf of lateral pterygoid plate; superfic head, o: tubercle of maxilla. Both i:

    angle of mand. Acts to elevate (close)


    Parotid Gland

     Parasym innv (motor secretion)

     -Inf Salivatory nucleus ? CN IX ? tympanic br ? lesser (superficial) petrosal n ? Otic ganglion

    (post syn) ? auriculotemporal n ? parotid gl

    Symp (regulates fluid content)

    -sym neurons T1/T2 ? sp n ? white rami ? sym trunk ? ascends SCG ? gray rami ? ext carotid

Submandibular gland

     Parasym (motor sec)

     -sup. Salivatory nucleus ? CN VII (nervus intermedius) ? chorda tympani ? runs w/ lingual n (CN

    V) ? submandibular gang (post syn) ?

    Sym (regulates fluid content)

    -sym neurons of T1/T2 ? sp n ? white rami ? sym trnk ? ascends SCG ? gray rami ? ext carotid CN VII brs overly TMJ, auricular brs of auricultemporal n enter pos part of joint

    All 4 mm of mastication innv by mandibular div, CN V

    Geniculate gang ? chorda tympani ? runs w/ lingual n ? taste to ant 2/3 tongue


    Boundaries: base of occipital b; esophagus & larynx (~C6); retropharyngeal space; choanae, pos 1/3 of

    tongue, pos surface of larynx



    Hamulus of medial pterygoid plate

     -tensor veli palatine m (N48) hooks around this Styloid process of temporal b

    -3 attachments: stylohyoid, styloglossus, stylopharyngeus mm Hyoid bone w/ greater/lesser horns (cornu)

    Epiglottic, thyroid, cricoid cartilages

    Regions continuation of both respiratory and digestive systems



     Auditory tube, torus tubarius

     Salpingopharyngeal fold

     Pharyngeal recess

     Pharyngeal tonsil


     Palatoglossal and palatopharyngeal folds (arches), surrounds:

     Palatine tonsils

     Median and lateral glossoepiglottic folds

     Laryngopharynx (inf to epiglottic cartilage, sup to cricoid cart/C6)

     Piriform recess


    Constrictors all attach to median raphe, therefore to pharyngeal tubercle (base of occipital b)

     Superior pharyngeal constrictor

     -o: pterygoid hamulus, and elsewhere

     middle pharyngeal constrictor

     -o: stylohyoid lig, grtr & lesser horns of hyoid b

     inferior pharyngeal constrictor

     -o: oblique line of thyroid cartilage and lat surface of cricoid cartilage

    Longitudinal mm all blend to ins on pos-sup border of thyroid cart


     -o: hard palate


     -o: cartilaginous part of auditory tube


     -o: outside pharynx on styloid process

Overlapping of constrictor mm (deep to super = sup, mid, inf pharyngeal constricts) and gaps

     Superior-sup constricter

     -closed by pharyngobasilar fascia, levator veli palatini m and auditory tube passes

     sup-mid constricts

     -stylopharyngeus m and its n, CN IX


     -internal laryngeal n (? sup laryngeal ? CN X)

     -sup laryngeal a (? sup thyroid a)


     -recurrent laryngeal n


    from the pharyngeal plexus


     All by CN X, EXCEPT stylopharyneus m (CN IX) and tensor palatini (mandibular, CN V)


     Sup aspect of nasopharynx (pharyngeal br of CN V2), else CN IX Angiology

    Ascending pharyngeal Br (? ext carotid)

    Facial a, small tonsillar and palatine brs

    Descending palatine br and pharyngeal br (? maxillary)

    Sup and inf thyroid aa



     Connects oropharynx w/ trachea for resp

     Valve to protect airway during swallowing



    Hyoid bone (greater & lesser horns)

    Thyrohyoid membrane

    Epiglottic cartilage (attached to hyoid and thyroid cart via ligs) Thyroid cartilage (sup & inf horns, two thyroid laminae fused ant at midline, lat has oblique line for mm)

    Cricothyroid membrane (contribs to conus elasticus)

    Cricoid cartilage (complete cart ring, sup facets for artic w/ arytenoid carts, lat facets w/ inf horns thyroid cart)

    Arytenoids cartilage (paired, apical (sup), muscular (lat), vocal (ant) processes, rest on sup facets of cricoid)

    Vocal ligament (thickened band elastic tissue, forms true vocal cords, space btw is rima glottis, attchs ant

    int surf of thyr cart to vocal process of arytenoid) Quadrangular (Vestibular) membrane

    Vestibular fold (paired, fr thyr to arytenoids carts above true vocal folds and blends w/ aryepiglottic folds. Aka

    false vocal folds

    Ventricle (depression btw true and false vocal folds) Conus elasticus (layer of elastic tissue ext inf from vocal ligs to inner lamina of cricoid cart)

    Laryngeal prominence of the thyroid cartilage (aka adam’s apple)


    Cricothyroid (only extrinsic m of larynx)

     O: ext surf of ea cricoid cart

     I: inf cornu and lamina of thyroid cart

     A: incr tension of vocal ligs via lengthening Posterior cricoarytenoid

     O: pos surf of cricoid lamina

     I: musc process of arytenoids cart

     A: opens rima glottis

    Lateral cricoarytenoid

     O: arch of cricoid cart

     I: musc prc arytenoids

     A: closes rima glottis

    Arytenoideus (oblique and transverse components)

     O: pos border of arytenoids cart

     I: pos border of opposite aryt cart

     A: closes rima glottis


     o: arytenoids

     I: epiglottis

     A: tenses aryepiglottic folds


     O: thyroid cart

     I: arytenoids cart

     A: decr tension of vocal ligs

    Vocalis (most medial fibs of thyroarytenoid)

     O: thyroid and arytenoids carts

     I: vocal ligs

     A: modulates tension

    Thyroepiglotticus (sup ext of thyroarytenoid)

     O: thyroid cart

     I: epiglottis

     A: aids epiglottis in protecting laryngeal opening during swallowing



     -recurrent laryngeal of CN X for all intrinisic laryngeal mm

     -external laryngeal fr sup laryngeal fr CN X innvs cricothyroid Sensory

     -internal laryngeal n (? sup laryngeal ? CN X; sup to true vocal cords)

     -recurrent laryngeal n (? CN X; true vocal cords and inf) Angiology

    Superior laryngeal (? sup thyroid) above true vocals

    Inferior laryngeal (? inf thyroid) to true vocals and below

Nasal Cavity and Paranasal Sinuses


    Posterior and anterior ethmoid aa (? ophthalmic a)

    Medial posterior nasal (? sphenopalatine a)

    Nasopalatine (? spenopalatine, anast w/ brs of greater palatine a thru incisive canal

    Septal br of superior labial (? CN VII)

    Venous drainage is via ophthalmic vv and pterygoid plexus


    Medial nasal br (? ant ethmoid n ? ophthalmic, CN V)

    Nasopalatine n and medial (septal) posterior nasal n (? sphenopalatine ? maxillary, CN V)

    CN I superiorly


    Medial nasal wall (septum)

    Perpendicular plate of ethmoid b, vomer, crest of body of sph, palatine crest of hard palate, septal


    Lateral nasal wall

     Nasal, ethmoid, maxilla, frontal, lacrimal, inf concha


     -palatine canal (w/ desc palatine a, greater & lesser palatine nn)

     -sphenopalatine foramen

    Nasal conchae (aids in warming and moistening inspired air)

     -sup & inf conchae (ethmoid bone) and inf concha (independent) Meati (spaces inf and lat to ea concha)

     -sphenoethmoidal recess (above sup concha)

     -superior, mid, inf meatus

    Openings in lat nasal wall

     -sphenoethmoidal recess ? opening of sph sinus

     -pos ethmoid sinuses ? sup meatus

     -mid ethmoid sinuses on ethmoid bulla ? mid meatus

     -hiatus semilunaris ? all to mid meatus

     ant ethmoid sinus

     frontal sinus via frontonasal duct to ant portion of hiatus

     maxillary sinus through pos portion of hiatus

     -sphenopalatine foramen ? sphenopalatine n & a

Paranasal Sinuses

    Maxillary ? opening in pos hiatus semilunaris ? mid meatus

    Ethmoid (ant, mid, pos all interconnected)

     Pos ? sup meatus

     Mid ? ethmoidal bulla

     Ant ? directly into hiatus semilunaris

    Frontal ? frontonasal duct ? ant aspect hiatus semilunaris in mid meatus Sphenoid ? sphenoethmoidal recess

    Pterygopalatine Fossa rdContents: pterygopalatine gang (+ n brs to and from), 3 part of maxillary a + its brs Leads inferiorly to greater and lesser palatine foramina


     Lateral: pterygomaxillary fissure (btw pterygoid plate and pos sur of maxilla)

     Anterior: inf orbital fissure (groove in maxilla)

     Medial: sphenopalatine foramen (body of sph meets notch in palatine b)

     Posterior: pharyngeal canal (junction of pos and med walls, runs towards nasopharynx)

     Pterygoid canal (runs posteriorly thru base of sph sinus)

     Foramen rotundum (enters pos-superiorly)

Mouth and Tongue

    Oral cavity

     -frenulum (upper and lower lip, under tongue) nd -parotid papilla (opening of parotid duct, opp 2 molor)

     -sublingual caruncles (papillae); openings of submandibular ducts

     -sublingual folds w/ openings of sublingual ducts

     -isthmus of the fauces: trans from mouth to oropharynx

     -palatoglossal (ant) and palatopharyngeus (pos) arch w/ palatine tonsil in btw

     + covers palatoglossus and palatopharyngeus mm resp


     -sup by labial brs of facial

     -innv by infraorbital n (upper lip) and mental (lower)

     -orbicularis oris m (? mandibular br of facial n)

     -submandibular nodes (up/lat low lips) and submental nodes (med low lip) Teeth

     -adult has 32 (2 incisors, canine, 2 premolars, 3 molars); 20 deciduous (baby), 2i,c,2m


    -maxillary div of CN V ? pos sup alveolar (molar) and mid/ant sup alv (rest upper teeth)

     -mandibular div of CN V ? inf alveolar n (all mandibular teeth)

     -sensation in buccal surfaces of gums follow same innerv pathway as teeth

     -sensation in palatine gums of up teeth & palate = grtr palatine and nasopalatine nn

     -lingual surf of mandibular gums via lingual n


     -pos sup alv, mid/ant sup alv brs(? infraorb a?maxillary): upper teeth

     -inf alv (? maxillary): lower teeth

     -submandibular, submental, superior deep cervical nodes

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