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A to Z Book Head and Neck18E™:A to Z Book 18/02/09 9:52 AM Page A

The
A to Z
of the
Head and Neck

Dr A. L. Neill
BSc MSc MBBS PhD FACBS
medicalamanda@gmail.com

Front
A to Z Book Head and Neck18E™:A to Z Book 18/02/09 9:08 AM Page 1

Introduction
Since the beginning of the A to Zs there has been a demand for a book to deal
with the structures of the Head and Neck - so here it is! As usual I have

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included a feedback page at the end of this book and I hope that from it, if
there are any suggestions or ideas about the publication that this will be used
as a guide to any of you who may have some ideas for this project. However if
you just want to write fax, email or other send your suggestions to me, I am
always pleased to hear them.

Acknowledgement

aN
Thankyou Apsenpharmacare Australia particularly the CEO Greg Lan, and the
head of sales and marketing Robert Koster. Thank you to those doctors,
students and others who made suggestions gave feedback and have supported
this project.

Dedication
This book is dedicated to solitude.
nd
How to use this book
The format of this book is similar to others in the A to Z series, with a few
minor adjustments. As far as possible alphabetical listing of the structures is
incorporated in the book. This continues the style, as with other A to Z books,
of making the book its own index. References at the bottom of the page
ma

redirect the reader to where that structure is listed. As well as the brief Table
of Contents in the beginning of the book, there is an expanded version at the
beginning of each of the main sections, which also acts as a specialized index
to that section. Basic concepts necessary for the understanding of Anatomy
are placed as usual in the beginning of the book.
The muscles and layers of the face and neck and the muscles of the specialist
structures present are discussed in a summary overview form and then listed
rA

individually in alphabetical order in the usual muscle format: Origin (O),


Insertion (I), Action (A), nerve supply (NS) & blood supply (BS) and Testing (T)
where appropriate. This book is extensively cross referenced against the other
A to Z books, and expands on them. While the nerves of the head and neck
are not discussed here, the nerves of the cervical / neck region are discussed
in detail in the A to Z of Peripheral Nerves and the Cranial Nerves will be
©D

discussed in the A to Z of the Brain and Cranial Nerves.

Thank you
Amanda Neill
BSc MSc MBBS PhD FACBS

ISBN 1 74138 167 5


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The A to Z of the Head & Neck

Abbreviations
A = actions /movements of LL = lower limb
a joint lig = ligament

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aa = anastomosis or anastomoses LP = lumbar plexus
adj. = adjective Lt. = Latin
aka = also known as MC = metacarpal / metacarpo-
ALL = anterior longitudinal ligament (hand)
alt. = alternative MCP = metacarpo-phalangeal
ant. = anterior med = medial

aN
art. = articulation (joint w/o the MT = metatarsal / metatarso (foot)
additional support structures) N = nerve
AS = Alternative Spelling, generally NR = nerve root origin
referring to the diff. b/n NS = Nerve supply / nervous
British & American spelling system
ASIS = anterior superior iliac spine NT = nervous tissue
(of hip bone) O = origin
b/n = between P = phalangeal / phalanges /
nd
BP = brachial plexus phalango-
BS = Blood Supply pl. = plural
C = cervical PLL = posterior longitudinal
c.f. = compared to ligament
CN = cranial nerve PN = peripheral nerve
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CNS = central nervous system post. = posterior


Co = coccygeal R = right / resistance
CP = cervical plexus ROM = range of motion
collat. = collateral S = sacral
CSF = Cerebrospinal fluid sing. = singular
CT = connective tissue SC = spinal cord
e.g. = example SN = spinal nerve
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EC = extracellular (outside the cell) SP = spinous process / sacral


ES = Erector Spinae group of plexus
muscles SS = signs and symptoms
ext. = extensor (as in muscle to T = TEST / thoracic
extend across a joint) TOS = thoracic outlet syndrome
Gk. = Greek TP = transverse process
©D

I = insertion UL = upper limb, arm


IC = intercarpal / intercarpo - (b/n VB = vertebral body
wrist) VC = vertebral column
IMC = intermetacarpal w/n = within
IP = interphalangeal (b/n fingers / w/o = without
toes)
IT = intertarsal / intertarso
jt(s) = joints = articulations
L = lumbar / left

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The A to Z of the Head & Neck

Table of contents
Introduction 1

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Acknowledgement 1
Dedication 1
How to use this book 1

aN
Abbreviations 2
Table of contents 3
Common terms used in the study & examination
of Bones, Joints, Muscles and other structures
of the Head & Neck 4
nd
Anatomical position and Anatomical planes 10
Anatomical movements of the Head & Neck 12
Sites of referred pain and Examination
of the Head & Neck 16
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The Skull & Neck 18


The Bones, Joints & Ligaments of the Head & Neck 60
The Muscles of the Head & Neck 122
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OVERVIEWS of the Head & Neck 258


Arteries & Anastomoses of the Head & Neck 258
Nerves of the Head & Neck 262
268
©D

Venous & Lymphatic drainage (extracranial)


Transverse section & fascial planes of the neck 272
Topography / surface anatomy 274
A to Z Pocket reference medical medical books 276
Feedback form 276

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The A to Z of the Head & Neck

Common terms in the Study and Examination of


Bones, Joints, Muscles and other Structures of
the Head and Neck.

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Ablation the removal of part of the body, generally a boney part,
most commonly the teeth
Acoustic pertaining to hearing
Acromegaly a continuation of growth of the ends of cartilage covered
bone (after fusion of the long bones) hence a gross change
in the features (most noticeable in the jaw and digits)

aN
without growth in height, due mainly to the over activity of
the pituitary gland
Additus opening /entrance
Adenoid gland
Ala a wing, hence a wing-like process as in the Ethmoid bone
pl. - alae.
Alveolus air filled bone - tooth socket adj - alveolar (as in air filled
bone in the maxilla)
nd
Annulus fibrosis the peripheral fibrous ring around the intervertebral disc
Ansa - a loop like structure
Aperture an opening or space between bones or within a bone.
Areola small, open spaces as in the areolar part of the Maxilla
may lead or develop into sinuses.
Arytenoid ladle or pitcher (arytenoids cartilages move in and out like
ma

ladle with changing sounds)


Atlas after Atlas the Greek Demigod who held up the world on
his shoulders
Attrition tooth wear and tear
Auditory pertaining to hearing, hence, pertaining to the ear.
(Auditory exostosis = a bony growth on the walls of the
External Auditory Meatus)
rA

Axial refers to the head and trunk (vertebrae, ribs and sternum)
of the body
Basiocranium bones of the base of the skull
Boss a smooth round broad eminence - mainly in the frontal
bone female > male
Bregma refers to a junction of more than 2 bones in a joint as in
the Bregma of the skull, junction between the coronal and
©D

sagittal sutures which in the infant is not closed and can


be felt pulsating – site of the anterior fontanelle
Buccal pertaining to the cheek
Calotte consists of the calvaria from which the base has been removed
Calvaria refers to the cranium without the facial bones attached.
Canal tunnel / extended foramen as in the carotid canal at the
base of the skull adj canular (canicular - small canal)
Caput / Kaput the head or of a head, adj.- capitate = having a head (c.f.
decapitate)

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Carotid to put to sleep; compression of the common or internal


carotid artery causes coma - the term came from referral
to bony points related to the Carotid vessels
Cavity an open area or sinus within a bone or formed by two or

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more bones (adj. cavernous), may be used interchangeably
with fossa. Cavity tends to be more enclosed fossa a
shallower bowl like space (Orbital fossa-Orbital cavity).
Cephalic pertaining to the head
Cervico- pertaining to the neck
Clinoid like a bed-post, part of a four poster bed so that clinoid
process looks like a bed post (generally with other posts)

aN
as in the Sphenoid bone.
Cleido key or bar (as in the bar of the Clavicle in Sternocleidomastoid)
Clivus slope hence in the anterior cranial fossa referring to a
slope on the base of the cavity.
Cochlea a snail hence snail-like shape relating to the Organ of Corti
in the ear.
Compact bone bone found in the shafts and on external bone surfaces highly
Cortical bone structured in concentric circles or Haversian systems constantly
nd
Dense bone changing and remodeling depending upon the lines of
force, often enclosing the lighter trabecula bone.
Concha a shell shaped bone as in the ear or nose (pl. conchae adj.
chonchoid) old term for this turbinate.
Condyle a rounded enlargement or process possessing an
articulating surface.
ma

Constrictor to squeeze
Cornu a horn (as in the Hyoid)
Corona a crown. adj.- coronary, coronoid or coronal; hence a
coronal plane is parallel to the main arch of a crown which
passes from ear to ear (c.f. coronal suture).
Cranium the cranium of the skull comprises all of the bones of the
skull except for the mandible.
rA

Crest prominent sharp thin ridge of bone formed by the attachment


of muscles particularly powerful ones eg Temporalis/Sagittal crest
Cribiform/Ethmoid a sieve or bone with small sieve-like holes.
Cricoid a ring
Cutus skin - hence cutaneous branches refer to the nerves
supplying the skin and adnexae
Dens A tooth hence dentine and dental relating to teeth, denticulate
©D

having tooth-like projections adj dentate See odontoid


Depression a concavity on a surface
Diaphysis the shaft or body of a long bone. In the young this is the
region between the growth plates and is composed of
compact bone. pl.= diaphyses adj.= diaphyseal
Diploë the cancellous bone between the inner and outer tables of
the skull, adj.- diploic.
Distal further away from the axial skeleton (opposite of Proximal)
Dorsi back

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The A to Z of the Head & Neck

Edentulous without teeth


Eminence a smooth projection or elevation on a bone as in iliopubic eminence
Endocranium refers to the interior of the “braincase” adj. endocranial
divided into the 3 major fossae anterior (for the Frontal

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lobes) middle (containing Temporal lobes) and posterior (for
the containment of the Cerebellum).
Endostium a mesodermal CT which lines the inner surface of all bones
and is the conduit for the NS and BS of the bone - lifting of
the endostium causes cancellous bone to be laid down to
fill the gap b/n the bone and the cellular layer and this
device may be used to encourage bone growth/repair.

aN
Ethmoid sieve
Exostosis a bony outgrowth from a bony surface, often due to
irritation (as in Swimmers ear) and may involve ossification
of surrounding tissues such as muscles or ligaments.
External Auditory Meatus ear hole
Facet a face, a small bony surface (occlusal facet on the chewing
surfaces of the teeth) seen in planar joints.
Fascia face
nd
Fasciule small bundle
Fauces jaws or throat
Fissure a narrow slit or gap from cleft.
Fontanelle a fountain, associated with the palpable pulsation of the
brain as in the anterior fontanelle of an infant. These soft
spots on the skull are cartilagenous connective tissue
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coverings “joints” which allow for skull cranial expansion


and then become the mould for the bone development and
shape joining long the sutural lines, later becoming the Bregma
Foramen a natural hole in a bone usually for the transmission of
blood vessels and/or nerves.(pl. foramina).
Fossa a pit, depression, or concavity, on a bone, or formed from
several bones as in temporomandibular fossa - shallower
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and more like a “bowl” than a cavity


Fovea a small pit (usually smaller than a fossa)- as in the fovea of
the occlusal surface of the molar tooth.
Frankfurt plane the correct anatomical position to view the skull – the EAM
is at the same level as the inferior orbital margin
(equivalent to the eyes looking straight ahead).
Gallus / Galli a cock, hence, crista galli, the cock's comb (i.e. possessive
©D

form of gallus).
Gastric belly (as in the belly of a muscle)
Glottis pertaining to the vocal cords and structures involved in the
production of the voice pl. glottedis
Gomphosis joint b/n the roots of the teeth and the jaw bones pl - gomphoses
Groove long pit or furrow
Hamus a hook hence the term used for bones which “hook around
other bones or where other structures are able to attach by
hooking - hamulus = a small hook.
Hyoid U-shaped
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Incisura a notch.
Incus anvil
Inferior under
Inter between

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Intra within
Introitus an orifice or point of entry to a cavity or space
Joint = Articulation + supporting structures bone X bone
Jugum a bridge between 2 halves of a bone pl.( juga) as in Sphenoid
Labial pertaining to the lips
Lacerum something lacerated, mangled or torn eg foramen lacerum
small sharp hole at the base of the skull often ripping

aN
tissue in trauma.
Lacrimal related to tears and tear drops. (noun lacrima)
Lambda from the Greek letter a capital 'L' and written as an inverted
V.(adj. lambdoid) and used to name the point of connection
between the 3 skull bones Occiput and the 2 Temporal bones
Lamina a plate as in the lamina of the vertebra a plate of bone
connecting the vertical and transverse spines (pl. laminae)
Levator to raise
nd
Ligament a band of tissue which connects bones (articular ligaments)
or viscera - organs (visceral ligaments). A Ligament is a tie
or a connection sing. ligamentum pl ligamenta from ligate
or to tie up, generally composed of collagen fibres
Linea a line as in the Nuchal lines of the Occitipum
Lingual pertaining to the tongue
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Malar cheek
Malleus hammer (as in the ear ossicle)
Mandible from the verb to chew, hence, the movable lower jaw;
adj.- mandibular.
Masseter to chew
Mastoid a breast or teat shape - mastoid process of the Temporal bone
Maxilla the jaw-bone; now used only for the upper jaw; adj.- maxillary
rA

Meatus a short passage; adj.- meatal as in external acoustic


meatus connecting the outer ear with the middle ear.
Mental relating to the chin (mentum = chin not mens = mind).
Modiolus hub or cental core used in the face to indicate that fibrous
hub at the edge of the mouth for the insertion of a number
of muscles / used in the ear to indicate the centre of the
spongy bone of the cochlea tubes
©D

Naris nostrils pl. Nares


Notch an indentation in the margin of a structure.
Nucha the nape or back of the neck adj.- nuchal.
Occiput the prominent convexity of the back of the head Occipitum =
Occipital bone adj. occipital
Occulus an eye
Odontoid relating to teeth, toothlike see Dens
Omo shoulder
Orbit a circle; the name given to the bony socket in which the
eyeball rotates; adj - orbital.
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The A to Z of the Head & Neck

Orifice an opening.
Ossicle a small bone as in the ear ossicles: stapes(stirrup), incus
(anvil) and malleus (hammer).
Otic pertaining to the ear

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Oto pertaining to the ear
Palate a roof adj.- palatal or platatine.
Palpebral pertaining to the eyelid
Parietal pertaining to the outer wall of a cavity from paries, a wall.
Parotid pertaining to a region beside or near the ear
Pars a part of
Pecten a comb.

aN
Perikymata transverse ridges and the grooves on the surfaces of teeth
Periosteum layer of fascial tissue connective tissue on the outside of compact
bone not present on articular (joint) surfaces see endostium
Petrous pertaining to a rock / rocky / stoney adj. petrosal
Pinna feather or fin as in “pinna of the ear”
Process a general term describing any marked projection or
prominence as in the mandibular process.
Proximal closer to the axial skeleton (opposite of distal)
nd
Pterion a wing; the region where the tip of the greater wing of the
sphenoid meets or is close to the parietal, separating the
frontal from the squamous region of the temporal bone. (TERY-on)
alternatively the region where these 4 bones meet.
Pterygoid wing shaped
Raphe line of joint b/n 2 halves, generally of bone or muscles
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for example a fibrous raphe in the tongue allowing for


muscle insertion
Recess a secluded area or pocket; a small cavity set apart from a
main cavity.
Rectus straight - erect
Rhinus/rhino- pertaining to the nose
Ridge elevated bony growth often roughened.
rA

Rima Glottidis space b/n the vocal cords


Rostral towards the anterior/front (of the brain)
Rotundum round
Sagittal an arrow, the sagittal suture is notched posteriorly, making
it look like an arrow by the lambdoid sutures.
Scalene uneven
Sclersosis hard
©D

Sella a saddle; adj. - sellar, sella turcica = Turkish saddle.


Septum a division
Sinus a space usually within a bone lined with mucous membrane,
such as the frontal and maxillary sinuses in the head, (also,
a modified BV usually vein with an enlarged lumen for blood
storage and containing no or little muscle in its wall). Sinuses
may contain air, venous or arterial blood, lymph or serous fluid
depending upon location and health of the subject adj.- sinusoid
Skull the skull refers to all of the bones that comprise the head.
Spheno- a wedge i.e. the Sphenoid is the bone which wedges in the
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base of the skull between the unpaired frontal and occipital


bones adj. - sphenoid .
Spine a thorn adj. - spinous descriptive of a sharp, slender
process/protrusion.

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Splanchocranium the splanchocranium refers to the facial bones of the skull.
Stapes stirrup
Sternum chest
Sulcus long wide groove often due to a BV indentation
Suture the saw-like edge of a cranial bone that serves as joint
between bones of the skull.
Stylos an instrument for writing hence adj. - styloid a

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pencil-like structure.
Sulcus furrow
Superior above
Symphysis a cartilagenous joint or a growth with bone-cartilage-bone
Syn- means together ie the close proximity of or fusion of 2 structures
Syndesmosis tight inflexible joints b/n 2 bones little to no movement
many axial joints
Synostosis fusion of any joints
nd
Temporal refers to time and the fact that grey hair (marking the
passage of time) often appears first at the site of the
temporal bone from the consideration of wisdom in the temple
Tensor to stretch
Tentorium a tent.
Thyroid door
ma

Tonsil little pole


Trachea rough
Transverse to go across
Trochlea a pulley that part of the bone or ligamantous attachment that
pulls the bone in another direction as in the elbow or the ankle
Tubercle a small process or bump, an eminence..
Tuberosity a large rounded process or eminence, a swelling or large
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rough prominence often associated with a tendon or


ligament attachment.
Turbinate a child’s spinning top, hence shaped like a top. An old
term for the nasal conchae.
Tympanum a drum pl. tympani
Uncus a hook adj. - uncinate.
Uvula little grape
©D

Vagina a sheath; hence, invagination is the acquisition of a sheath


by pushing inwards into a structure, and evagination is
similar but produced by pushing outwards adj. - vaginal.
Vertebra turning point
Vomer plough
Wormian bone extrasutural bone in the skull
Zygal H-shaped
Zygoma a yoke , hence, the bone joining the maxillary, frontal,
temporal & sphenoid bones adj zygomatic.

© A. L. Neill 9
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Anatomical position and Anatomical planes


This is the anatomical position.

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A = Anterior aspect from the front, Posterior Aspect from the back,
used interchangeably with ventral and dorsal respectively.
B= Lateral Aspect from either side
C = Transverse / Horizontal plane
D= Midsagittal plane = Median plane; trunk moving away from this
plane = lateral flexion or lateral movement moving into this plane

aN
medial movement; limbs moving away from this direction =
abduction; limbs moving closer to this plane = adduction
E = Coronal plane
F = Median
nd
ma
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©D

10 © A. L. Neill
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aN
nd
ma
rA
©D

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Anatomical movements of the Head and Neck

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neck flexion

aN
nd
neck extension/hyper-extension
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lateral flexion
rA

lateral rotation
©D

note: extension of the neck is in


the normal anatomical position

12 © A. L. Neill
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lateral flexion - testing for
mobility and spinal tenderness

aN
nd
cervical flexion - testing for lateral rotation - testing for
mobility and spinal tenderness mobility and spinal tenderness
ma
rA
©D

© A. L. Neill 13
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aN
neck flexion - testing for
nd strength against R
ma
rA

lateral flexion - testing for


strength against R
©D

14 © A. L. Neill
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extension / hyperextension -

aN
testing for strength against R

nd
ma

lateral rotation - testing for


strength against R
rA
©D

cervical traction - testing


for R and N irritation

© A. L. Neill 15
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1 2

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sites of referred pain in
the cervical spine
3

aN
scalp (1) to SP of C2
ear (2) to body of C2
face (3) to C3
jaw and teeth (4) to C3/4 4
thyroid, cricoid cartilages (5) to C5
nd
5
ma
rA

testing for mobility of


C7/T1 and the first rib
©D

16 © A. L. Neill
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aN
examination for tenderness of
nd the cervical spinous process
ma
rA

examination for tenderness


of the cervical
©D

transverse processes

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The A to Z of the Head & Neck

The Skull & Neck 19-59


Table of Articulations of the Skull
External Skull Anterior (norma frontalis)

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radiology - occipitofrontal (complete)
radiology - occipitofrontal (upper aspect)
radiology - occipitomental (lower aspect)
External Skull Inferior (Base of Skull) (norma basilaris)
radiology - submentovertical view (view from below)
External Skull Lateral (norma lateralis)

aN
radiology - lateral
External Skull Posterior (norma occipitalis)
External Skull Superior (norma verticularis)
Internal Skull Inferior - Skull Cap
Internal Skull Para-Sagittal/Lateral
Internal Skull Superior - Internal Base - cranial fossae
nd
Cavities of the Skull 44-51
Maxillary Sinus
Orbital cavity (Orbital fossa) Anterior
radiology orbital cavity anterior
Sinuses Overview Coronal
ma

Cervical Spine Radiological Overview 52-59


Anterior-Posterior AP
Anterior-Oblique AO
Lateral
Open Mouth - Dens process
rA
©D

18 © A. L. Neill
© A. L. Neill
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rA
ma
nd
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19
The A to Z of the Head & Neck

Red spots indicate when there is an articulation or joint between the bones. Please note the hyoid does not articulate with any bones and the mandible
articulates at the only synovial joint in the skull- the TMJ -temporomandibular joint. All other joints are secondary cartilagenous bone-fibrocartilage-bone.
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The A to Z of the Head & Neck

Skull External Views

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anterior
THE SKULL

1 Frontal bone
2 Fronto-Nasal suture
3 Inter-Nasal suture

aN
4 Nasal bone, Lacrimal bone
5 Supra-Orbital foramen
6 Spheno-Parietal suture
7 Spheno-Frontal suture
8 Spheno-Squamosal suture
9 Zygoma
nd
10 Zygomatico-Maxillary suture
11 Infra-orbital foramen
12 Middle Nasal concha – turbinate (from Ethmoid bone)
13 Inferior nasal concha – turbinate (from Ethmoid bone)
ma

14 Vomer
15 Mandible
16 Mental foramen
17 Inter-Maxllary suture
18 Maxilla
rA

19 Ethmoid bone (Orbital plate)


20 Inferior Orbital fissure
21 Temporo-Zygomatic suture
22 Superior Orbital suture
23 Fronto-Zygomatic suture
©D

24 Greater wing of the Sphenoid


25 Coronal suture - Fronto-Parietal suture
26 Lesser wing of the Sphenoid
27 Optic foramen

20 © A. L. Neill
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1

THE SKULL
27 2

26 3
4

aN
25
24 5

6
23
nd
7
22
8
21
ma

20 10

19 11
rA

18
12
17
©D

16 14 13
15

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External Skull Anterior

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radiology occipitofrontal
THE SKULL

1 Sagittal suture
2 Lamboid suture (view to the posterior) meeting at
the Bregma

aN
3 Frontal sinus
4 Lesser wing of the Sphenoid
5 Supraorbital fissure
6 Greater wing of the Sphenoid
7 Fronto-Zygomatic suture
8 Petrous ridge
nd
9 Anterior clinoid process
10 Floor of the hypophyseal fossa + upper apex of
nasal cavity adjacent to nasal sinuses
11 Lateral pterygoid plate
ma

12 Base of the skull - floor of posterior cranial cavity


13 Foramen rotundum
14 Mastoid process
15 Upper central incisor tooth
16 Mandible
rA
©D

22 © A. L. Neill
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The A to Z of the Head & Neck

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THE SKULL
aN
nd
ma
rA
©D

© A. L. Neill 23
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The A to Z of the Head & Neck

External Skull Anterior

eill
upper and lower views in detail
THE SKULL

radiology occipitofrontal (upper)

1 Frontal sinus

aN
2 Ethmoid sinus
3 Maxillary sinus
4 Foramen rotundum
5 Supraorbital fissure
6 Anterior clinoid process
7 Posterior clinoid process
nd
8 Petrous ridge
9 Floor of the hypophyseal fossa + upper apex of
nasal cavity adjacent to nasal sinuses
10 Crista galli
11 Frontal process of zygoma
ma

12 Middle concha - turbinate


13 Inferior concha - turbinate
14 Lateral border of Greater wing of sphenoid
15 Greater wing of sphenoid
16 Lesser wing of sphenoid
rA

17 Hard palate
18 Infraorbital foramen
19 Zygomaticofacial foramen
20 Coronoid process of the mandible
21 Soft tissue of lower lid
©D

22 Pterygoid plates of the sphenoid

24 © A. L. Neill
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The A to Z of the Head & Neck

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THE SKULL
aN
nd
ma
rA
©D

© A. L. Neill 25
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The A to Z of the Head & Neck

External Skull Anterior

eill
upper and lower views in detail
THE SKULL

radiology occipitomental (lower)

1 Frontal sinus

aN
2 Ethmoid sinus
3 Maxillary sinus
4 Foramen rotundum
5 Supraorbital fissure
6 Anterior clinoid process
7 Posterior clinoid process
nd
8 Petrous ridge
9 Floor of the hypophyseal fossa + upper apex of
nasal cavity adjacent to nasal sinuses
10 Crista galli
11 Frontal process of zygoma
ma

12 Middle concha - turbinate


13 Inferior concha - turbinate
14 Lateral border of Greater wing of sphenoid
15 Greater wing of sphenoid
16 Lesser wing of sphenoid
rA

17 Hard palate
18 Infraorbital foramen
19 Zygomaticofacial foramen
20 Coronoid process of the mandible
21 Soft tissue of lower lid
©D

22 Pterygoid plates of the sphenoid

26 © A. L. Neill
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THE SKULL
aN
nd
ma
rA
©D

© A. L. Neill 27
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The A to Z of the Head & Neck

Skull External Views

eill
inferior base of skull
THE SKULL

1 Incisive fossa - Alveolare


2 Medial Pterygoid plate and Hamulus (Ethmoid)
3 Posterior Nasal aperture

aN
4 Pterygoid plate (ethmoid)
5 Lateral Pterygoid plate (Ethmoid)
6 Zygomatic arch
7 Mandibular fossa
8 External Auditory meatus
nd
9 Styloid process
10 Mastoid process
11 Parieto-Mastoid suture
12 Occipito-Mastoid suture
ma

13 Foramen magnum
14 External Occipital proturberance
15 Sagittal suture - Parieto-Parieto suture
16 Lambda
17 Lambda suture
rA

18 Superior nuchal line (Occipital)


19 Inferior nuchal line (Occipital)
20 Occipital condyle
21 Jugular foramen (fossa)
©D

22 Stylo-Mastoid foramen
23 Carotid foramen - Carotid canal
24 Foramen spinosum
25 Foramen lacerum - Basilar suture
26 Greater Palatine foramen
27 Horizontal plate of Palatine
28 Palatine process of the Maxilla
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The A to Z of the Head & Neck

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THE SKULL
1

aN
28
2

27 3

26 4
nd
5
25
6
24
7
ma

23 8
22 9
21 10
11
rA

20
19 12

18 13
©D

17 14
15
16

© A. L. Neill 29
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The A to Z of the Head & Neck

External Skull Inferior

eill
radiology submentovertical view
THE SKULL

1 Nasal septum (vomer and perpendicular plate of


the ethmoid)
2 Posterior border of vomer

aN
3 Maxillary sinus
4 Ethmoid sinus
5 Greater palatine foramen
6 Lesser palatine foramen
7 Sphenoid sinus
8 Posterior orbital margin - greater wing of the
nd
sphenoid
9 Posterior boundary of the maxillary sinus
10 Zygomatic arch
11 Lesser wing of the sphenoid
ma

12 Head of mandible condyloid process


13 Foramen ovalae
14 Foramen spinosum
15 Spine of the sphenoid
16 Foramen lacerum
17 Clivus - base of the occipital and sphenoid bones
rA

18 Eustachian tube - (pharyngotympanic tube)


19 Carotid canal
20 Jugular foramen
21 Stylomastoid foramen
22 Anterior arch of the atlas (C1)
©D

23 Odontoid process of axis (C2)


24 Occipital condyles
25 Foramen magnum
26 Canaliculus for tympanic nerve
27 Inner and outer tables of the skull - Diploe

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The A to Z of the Head & Neck

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THE SKULL
aN
nd
ma
rA
©D

© A. L. Neill 31
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The A to Z of the Head & Neck

Skull External Views

eill
lateral
1 Frontal bone - Temporal ridges for attachment
THE SKULL

of Temporalis
2 Parietal bone
3 Occipital bone

aN
4 Mastoid process
5 Temporal bone
6 Zygomatic arch
7 Mandible
nd
8 Body of Mandible
9 Maxilla
10 Zygoma
11 Nasal bone
ma

12 Lacrimal bone
13 Frontal bone
14 Greater Wing of the Sphenoid
rA
©D

32 © A. L. Neill
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The A to Z of the Head & Neck

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THE SKULL
aN
1
2
14

13
nd
12
ma

11

10
3
rA

9 4
5
6
8
©D

© A. L. Neill 33
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The A to Z of the Head & Neck

External Skull Lateral / oblique

eill
radiology
THE SKULL

1 Coronal suture
2 Impression for Middle meningeal artery
3 Lambdoid suture

aN
4 Wormian bone - Extrasutural bone
5 Styloid process
6 Posterior wall of Nasopharynx
7 Clivus - (base of Sphenoid and Occiptal bones)
8 Hypophyseal fossa
9 Sphenoid sinus
nd
10 Greater wing of the Sphenoid
11 Posterior Air cells in the Ethmoid - Ethmoid sinus
12 Anterior Air cells in the Ethmoid - Ethmoid sinus
13 Frontal sinus
14 Zygoma - frontal process
ma

15 Maxilla - malar process


16 Zygoma - Arch
17 Posterior border of the Maxillary sinus
18 Hard palate - Palatine bone
19 Alveolar bone in Maxilla
rA

20 Pterygoid plates
21 Soft tissue of Soft Palate and Uvula
22 Mandibular canal
23 Head of Mandible
24 Coronoid process of Mandible
©D

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THE SKULL
aN
nd
ma
rA
©D

© A. L. Neill 35
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The A to Z of the Head & Neck

Skull External Views


posterior

eill
THE SKULL

1 Sagittal sinus
2 Parietal foramen
3 Lambda Pareito-Occipital suture

aN
4 Occipital bone
5 Lambdoid suture -
6 Inferior nuchal groove
7 External Occitipal protruberance
nd
8 Occitipal bone
9 Superior nuchal groove
10 Sutural bones - Inca
ma

11 Parietal bone

Skull External Views


superior

1 Occipital bone
rA

2 Lambdoid suture - Occipito-Parieto suture


3 Parietal eminence - Euryon
4 Frontal bone
©D

5 Bregma
6 Coronal suture
7 Parietal bone
8 Sagittal suture
9 Lambda

36 © A. L. Neill
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The A to Z of the Head & Neck

11 1

eill
2

THE SKULL
3

aN
4

5
10
nd
9 6
8 7
ma

1
9
2
rA

8
3
©D

6
5 4
© A. L. Neill 37
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The A to Z of the Head & Neck

Skull Internal Views

eill
inferior Skull cap
1 Lambda
THE SKULL

2 Lambdoid suture
3 Parietal foramen

aN
4 Diploe
5 Bregma
6 Coronal suture
7 Frontal crest
nd
8 Frontal bone
9 Depressions for arachnoid granulations
10 Grooves for middle meningeal vessels
ma

11 Parietal bone
12 Sagittal suture
13 Groove for superior sagittal sinus
14 Occipital bone
rA
©D

38 © A. L. Neill
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The A to Z of the Head & Neck

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THE SKULL
14 1

aN
13
3
12
4
11
nd
ma

10
rA

9
8
©D

© A. L. Neill 39
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The A to Z of the Head & Neck

Skull Internal Views

eill
Lateral -looking out to the sides of the skull from the inside
1 groove for the middle meningeal artery
THE SKULL

2 Frontal sinus
3 superior nasal concha

aN
4 middle nasal concha
5 inferior nasal concha
6 hard palate
7 mandible
nd
8 lateral pterygoid plate
9 medial pterygoid plate
10 styloid process
ma

11 mastoid process
12 sphenoid sinus
rA
©D

40 © A. L. Neill
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The A to Z of the Head & Neck

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THE SKULL
1

2
aN
nd
3
ma

4
5

12
rA

11
6
10
9
©D

© A. L. Neill 41
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The A to Z of the Head & Neck

Skull Internal Views


superior internal base - cranial fossae

eill
1 Cribiform plate
THE SKULL

2 Frontal sinus
3 Crista Galli
4 Orbital plate of Frontal bone

aN
5 Jugum of Sphenoid
6 Optic canal
7 Lesser wing of the Sphenoid bone
8 Anterior Clinoid process
nd
9 Foramen rotundum
10 Foramen lacerum
11 Foramen ovale
ma

12 Foramen spinosum
13 Dorsum sellae
14 Internal acoustic meatus
15 Jugular foramen
rA

16 Foramen magnum

A POSTERIOR FOSSA
©D

B MIDDLE FOSSA
C ANTERIOR FOSSA

42 © A. L. Neill
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The A to Z of the Head & Neck

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THE SKULL
2 3
1
4

aN
5
6
C
7

8
nd
9
10
ma

11
12
B
13

14
rA

15

16
©D

© A. L. Neill 43
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The A to Z of the Head & Neck

Maxillary Sinus (Left)

eill
Sagittal
1 Frontal sinus
2 Anterior Ethmoidal foramen
3 Orbital plate of Ethmoid

aN
4 Posterior Ethmoidal foramen
5 Lesser wing of the Sphenoid
6 Pterygo-Maxillary fissure
7 Perpendicular plate of the Palatine
8 Alveolar processes of the Maxilla
9 Maxillary Sinus - opened
nd
10 Inferior concha, Maxillary process
11 Anterior Nnasal spine
12 Uncinate process of the Ethmoid
13 Nasal bone
ma

14 Lacrimo-Maxillary suture
15 Supra-Orbital foramen
16 Frontal bone
rA
CAVITIES OF THE SKULL

©D

Description: Maxilla - sinuses within this bone -particularly


around the teeth may cause toothache, complicate
endodontic (root canal) treatment; or act as a conduit for
tooth/nasal/other infection to enter the blood stream.

44 © A. L. Neill
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The A to Z of the Head & Neck

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aN
nd
ma
rA

CAVITIES OF THE SKULL


©D

© A. L. Neill 45
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The A to Z of the Head & Neck

Orbital Cavity / Fossa (Left)

eill
Anterior view from the front
1 Lesser wing of the Sphenoid
2 Optic foramen
3 Anterior and Posterior Ethmoidal foramina

aN
4 Lacrimal bone
5 Nasal bone
6 Orbital plate of the Ethmoid bone
7 Orbital plate of the Maxilla
8 Infraorbital foramen
9 Infraorbital groove
nd
10 Zygoma
11 Inferior Orbital fissure
12 Foramina for Zygomatic branch of the Facial nerve
13 Orbital surface of the Zygoma
ma

14 Greater wing of the Sphenoid


15 Superior Orbital fissure
16 Orbital plate of the Frontal bone
17 Supra-Orbital margin
18 Supra-Orbital foramen
rA
CAVITIES OF THE SKULL

©D

Eyeball and muscles all sit in this cavity with the Optic
nerve entering from the posterior part of the cavity through
the Orbital foramen.

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The A to Z of the Head & Neck

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aN
nd
ma
rA

CAVITIES OF THE SKULL


©D

© A. L. Neill 47
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The A to Z of the Head & Neck

Orbital cavity Inferoanterior

eill
radiology (also Orbital fossa Optic cavity Optic foramen)

1 Frontal sinus
2 Foramen ovale
3 Infraorbital foramen

aN
4 Foramen rotundum
5 Hard palate –floor of nasal cavity
6 Maxillary antrum
7 Lateral wall of maxillary antrum
8 Zygomatic arch
9 Sphenoid sinus
nd
10 Soft tissue of nose and lower lid
ma
rA
CAVITIES OF THE SKULL

©D

48 © A. L. Neill
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The A to Z of the Head & Neck

eill
aN
nd
ma
rA

CAVITIES OF THE SKULL


©D

© A. L. Neill 49
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The A to Z of the Head & Neck

Sinus Overviews

eill
Coronal

1 Cranial Vault
2 ethmoid air cells of Frontal bone and Maxilla
3 Maxillary sinus

aN
4 nasal cavity
5 boney palate
6 inferior meatus 6A inferior concha
7 middle meatus 7A middle concha
nd
8 superior meatus 8A superior concha
9 orbit
ma
rA
CAVITIES OF THE SKULL

©D

50 © A. L. Neill
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The A to Z of the Head & Neck

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aN
1
9
2
nd
8
8A 2
2
ma

7
3
7A
4
6
6A
5
rA

CAVITIES OF THE SKULL


©D

© A. L. Neill 51
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The A to Z of the Head & Neck

Neck Anterior-Posterior

eill
radiology

1 body of C3
2 Transverse processes - C5, C6, C7

aN
3 first rib
4 Transverse process - T1
5 Spinous processes - C4, C5, C6
nd
ma
rA
©D

52 © A. L. Neill
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The A to Z of the Head & Neck

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aN
5 2

4
3
nd
ma
rA
©D

© A. L. Neill 53
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The A to Z of the Head & Neck

Neck Anterior-Oblique

eill
radiology

1 Dens
2 body of C2

aN
3 body of C3
4 body of C4
5 body of C5
6 body of C6
nd
7 body of C7
8 first rib
9 inferior articulating processes
10 intervertebral foraminae C2/3, C3/4
ma

11 Pedicles
12 superior articulating processes
13 Spinous processes C5, C6
rA

14 second rib
©D

54 © A. L. Neill
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The A to Z of the Head & Neck

eill
1

aN
2
11

12 3
10
nd
4
13
5
ma

6
9
7

8
rA

14
©D

© A. L. Neill 55
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The A to Z of the Head & Neck

Neck Lateral

eill
radiology

1 occipital condyles
2 anterior arch of C1

aN
3 Dens process (C2)
4 body of C2
5 zygapophyseal joints = facet joints
6 intervertebral space - intervertebral discs
(radiologically lucent)
nd
7 inferior articulating surfaces
8 vertebral bodies C6, C7, T1
9 Pedicles
ma

10 Spinous processes
11 Lamina
12 superior articulating processes
13 posterior arch of C1
rA

14 Occiput
©D

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The A to Z of the Head & Neck

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1
14

2
3

aN
13
4

12 5
nd
11
6

10
ma

7
rA

8
9
©D

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The A to Z of the Head & Neck

Neck Open Mouth - Dens process

eill
radiology

1 occipital condyles
2 lateral mass of C1

aN
3 Dens process (C2)
4 body of C2
5 Spinous processes C2, C3
6 Occiput
nd
ma
rA
©D

58 © A. L. Neill
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The A to Z of the Head & Neck

6 1

eill
2 2
3

5
aN
nd
ma
rA
©D

© A. L. Neill 59
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The A to Z of the Head & Neck

Bones, Cartilages, Joints & Ligaments,


Overviews

eill
Arytenoid cartilages (see Larynx overview)
Atlas (C1 ) - (Vertebra - cervical)
Atlanto-Axial joints
Atlanto-Occipital joint (see Craniovertebral joint)
Auditory Ossicles: Malleus, Incus and Stapes enclosed within the

aN
Temporal bone
Axial-Occipital joint (see Craniovertebral joint)
Axis (C2) - (Vertebra - cervical)
CHEEK BONES (see Zygoma )
CHIN (see Mandible)
Cranial Fossae (see Skull internal views)
Craniovertebral joints (HEAD/SPINE joints aka Atlanto-Occipital joints &
nd
Axial-Occipital joints)
Cricoid cartilage (see Larynx overview)
Ear Bones – see also Auditory Ossicles
Ethmoid bone
Frontal bone
ma

HANGING joint (see Atlanto-Axial median joint)


HEAD/SPINE JOINTS (see Craniovertebral joints
Hyoid
Incus – see Auditory Ossicles
Inferior Nasal Concha (see Nasal bones and cavity)
JAW (see Mandible)
rA

Lacrimal
Laryngeal cartilages - overview
Malleus – see Auditory Ossicles
Mandible (aka JAW aka CHIN)
Mandibular joint (see Temporomandibular joint)
©D

Maxilla (aka UPPER JAW)


Nasal bones and cavity = NOSE
NOSE see Nasal bones and cavity
Occipital bone (aka Occiput)
Odontoid Joint (see Atlanto-Axial median joint)
Palate
Palatine bones
Parietal bone

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The A to Z of the Head & Neck

eill
Skull – see separate listing
Sphenoid
Stapes – see Auditory Ossicles
Temporal bone
Teeth - overview

aN
Temporomandibular joint
Thyroid cartilage (see Larynx overview)
Vertebrae cervical (typical)
Vomer
Zygoma (aka CHEEK BONES )
nd
ma
rA
©D

© A. L. Neill 61
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The A to Z of the Head & Neck

A
Atlas = C1 = First Cervical Vertebra
anterior / superior

eill
(Atlas - Gk demigod who held up the world on his shoulders)

Articulations: Atlanto-Axial jts (3) C1-C2


Atlanto-Occipital jts (2) C1-Occiput
(Base of the skull)
Special no vertebral body special anterior

aN
features no spinous process facet for dens
no articular discs (odontoid process)

1 facet for odontoid / dens process


2 ant. tubercle
nd
3 superior articular facet
4 inferior articular facet
5 posterior tubercle
ma

6 posterior arch
7 groove for vertebral BVs & suboccipital N
8 Foramen Transversarium = transverse foramen
9 TP
rA

10 lat. mass
11 vertebral foramen
12 ant. arch
©D

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The A to Z of the Head & Neck

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4
aN
nd
9
2
12
1 3
ma

11

10
4
rA

9 6
7
©D

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The A to Z of the Head & Neck

A
Atlanto - Axial joint - median =
ODONTOID JOINT AKA hanging joint

eill
BS spinal branches of vertebral art.
NS spinal Ns dorsal rami (C1-2)
A rotation, circumduction

aN
Atlanto-Axial joints - lateral =
zygapophyseal joints of C1/C2
BS spinal branches of vertebral art.
NS spinal Ns dorsal rami (C1-2)
nd
A flexion, extension, lateral flexion, rotation

1 Dens - Odontoid process (C2)


ma

2 transverse lig of Axis (C2)


3 transverse foramen of Axis (C2)
4 medial tubercle of Atlas (C1)
5 tranverse foramen of Axis (C2)
6 post arch and tubercle of Atlas (C1)
rA

7 lamina and spine of Axis (C2)


8 body of Axis (C2)
9 superior articular facet of atlanto-occipital jt
10 ant arch of Atlas (C1)
©D

11 facet for Dens (C2)


12 ant tubercle of Atlas (C1)

Atlanto-Occipital joint (see Craniovertebral joint)

64 © A. L. Neill
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The A to Z of the Head & Neck

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aN
12
1 2
11

10
3
nd
9
4
ma

8
5
6
7
rA
©D

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The A to Z of the Head & Neck

A
Auditory ossicles = Ear bones - middle
ear (in the Temporal bone)

eill
Overview - In situ -individual bones
Description - 3 bones incus = anvil, malleus = hammer, stapes = stirrup
in the Temporal bone middle ear cavity Malleus abuts the Tympanic
membrane of the middle ear (eardrum) articulates with the Incus and
then the Stapes which abuts to the round window

aN
Articulations: Malleo-Incus Hammer with the eardrum
Incus-Stapes inter ear ossicle articulation
Stapo - Temporal stirrup with the Temporal
bone round membrane
Special small bones with articulate with membrane
features delicate balance to stretched across bone
nd
transmit sound at both ends

1 External Auditory Meatus = Earhole


2 External ear
ma

3 Tympanic membrane = Lateral border for the middle ear


4 Inner ear
5 Auditory tube
6 Cochlea
7 Cochlea N
8 Facial N
rA

9 Vestibular N
10 Oval Window with Stapes
11 Vestibular canals
12 Incus
13 Malleus
©D

14 Promontory
15 Round Window
View of individual bones actual size
Right and Left sides respectively
from above down
Stapes Incus Malleus

66 © A. L. Neill
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The A to Z of the Head & Neck

eill
aN
12 11
10 9
8

13
nd
1
7
ma

3 6

15
5
14
rA
©D

© A. L. Neill 67
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The A to Z of the Head & Neck

A
Axis = C2 = Second Cervical Vertebra
anterior / superior

eill
(Axis - pivot for movement of the head all movements but nodding)

Articulations: Atlanto-Axial jts (3) C1-C2


vertebro-axial Axial jts (2) C1-Occiput
(Base of the skull)
Special no vertebral body Dens acts as an

aN
features dens / odontoid process AXIS for rotation
no articular discs at C1

1 Dens = Odontoid process (tooth)


2 attachment of Alar ligament
nd
3 groove for Transverse ligament
4 pedicle
5 body
6 vertebral foramen
ma

7 spinous process
8 lamina
9 inferior articular process
10 transverse process
rA

11 transverse notch / foramen (if closed)


12 superior articular facet
13 facet for odontoid / dens process
©D

CHEEK BONES (see Zygoma)


CHIN (see Mandible)

68 © A. L. Neill
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eill
12

aN
nd
10
9
1
13
2
ma

12 3

4
rA

5
11
6
7
©D

10 8

© A. L. Neill 69
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The A to Z of the Head & Neck

Craniovertebral joints = HEAD/SPINE joints


anterior
C

eill
(made up of median and lateral Atlanto-Occipital (C1/head) and Axial-
Occipital joints (C2/head) joints)

BS vertebral arteries
NS medial branches of dorsal rami, recurrent laryngeal
spinal branches of ventral rami (C1-3)

aN
A flexion/extension, lateral flexion, rotation

1 basilar of Occiput
2 jugular foramen (transverse foramen in the base of
nd
the skull)
3 mastoid process
4 transverse process of C1
ma

5 ALL = anterior longitudinal lig, attached to tubercle


of Atlas
6 intervertebral disc C2, C3
7 ALL
rA

8 C2/C3 zygapophyseal joint L


9 capsule of the lateral atlanto-occiptal joint
10 capsule of the lateral atlanto-axial joint
11 ant atlanto-occipital membrane
©D

70 © A. L. Neill
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The A to Z of the Head & Neck

eill
11
1

aN
2

3
nd
4
9
ma

5
10

6
rA

8
7
©D

© A. L. Neill 71
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The A to Z of the Head & Neck

Craniovertebral joints = HEAD/SPINE joints


lateral
C

eill
(made up of median and lateral Atlanto-Occipital (C1/head) and Axial-
Occipital joints (C2/head) joints)

BS vertebral arteries
NS smedial branches of dorsal rami, recurrent laryngeal
spinal branches of ventral rami (C1-3)

aN
A flexion/extension, lateral flexion, rotation

1 basilar of Occiput
2 tectorial membrane
nd
3 ant atlanto-occipital membrane leads to the (3A)
4 apical lig of Dens
5 ant arch of Atlas C1
6 Dens of C2
ma

7 longitudinal band of cruciform lig superior (becomes 7A)


7A longitudinal band of cruciform lig inferior
8 C2/C3 intervertebral disc
9 body of C3
rA

10 post. longitudinal lig =PLL


11 lamina of C2
12 transverse lig of atlas (C1)
13 post atlanto-axial lig
©D

14 post arch of C1
15 vertebral artery
16 post atlanto-occipital lig
17 space which leads to foramen magnum and then …
17A vertebral foramen

72 © A. L. Neill
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The A to Z of the Head & Neck

eill
17 1

aN
2
17A

4
16
nd
5
15 6
7
ma

14
3A
13
7A
rA

12
8
11

10 9
©D

© A. L. Neill 73
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The A to Z of the Head & Neck

Craniovertebral joints = HEAD/SPINE joints


posterior
C

eill
(made up of median and lateral Atlanto-Occipital (C1/head) and
Axial-Occipital joints (C2/head) joints)

BS vertebral arteries
NS medial branches of dorsal rami, recurrent laryngeal
spinal branches of ventral rami (C1-3)

aN
A flexion/extension, lateral flexion, rotation

1 jugular foramen
2 transverse process of Atlas
nd
3 tectoral membrane
3A PLL
4 capsule of zygapophyseal joints
ma

5 C2/C3 intervertebral disc


6 longitudinal band of cruciform lig inferior
7 capsule of lat joint of C1 C2
8 transverse band of cruciform lig over the deeper
rA

stronger transverse lig of the Atlas (C1)


9 alar lig*
10 capsule of lat atlanto-occipital jt
11 longitudinal band of cruciform lig superior
©D

*broken in hanging

74 © A. L. Neill
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The A to Z of the Head & Neck

eill
11

aN
1

10
2
9
nd
8
3

7
ma

4
6
rA

3A
5
©D

© A. L. Neill 75
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The A to Z of the Head & Neck

EAR BONES = Auditory Ossicles


in situ

eill
middle ear / INCUS, MALLEUS & STAPES
1 head of Malleus
2 body of Incus
E 3 short process of Incus
4 ant malleolar process

aN
5 post crus of stapes
6 base of Stapes
7 ant crus of Stapes
8 long process of Stapes
9 lenticular process of Incus
10 handle of Malleus
nd
11 ant process of Malleus
12 neck of Malleus
13 lateral malleolar process
ma

cochlea / labyrinth
21 ant semicircular canal
22 ant bony ampulla
23 elliptical recess
24 spherical recess
rA

25 cochlea
26 cupola of cochlea
27 base of cochlea
28 oval window - fenestra vestibuli
29 post bony ampulla
©D

30 round window - fenestra cochlea


31 lat semicircular canal
32 post semicircular canal
33 lat bony ampulla

76 © A. L. Neill
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The A to Z of the Head & Neck

1
2

eill
3 E

aN
4 5
13
12

6
11
nd
7
8
10 9
ma

21
22
23
24
rA

33 25

32 26
©D

31

30 29 28
27

© A. L. Neill 77
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The A to Z of the Head & Neck

Ethmoid bones
anterior / lateral / medial / superior

eill
(Ethmoid = sieve light spongy cubic bone sitting b/n the 2 orbital cavities).

1 Ethmoidal labyrinth containing air cells (part of the


E
Ethmoid sinus) continuous with the Sphenoid sinus

aN
2 Crista Galli
3 Orbital plate of Ethmoid bone (part of the Orbital cavity)
4 Middle Nasal concha
5 Jugum of Sphenoid - Jugum Sphenoidale
(Bridge connecting the 2 wings of the Sphenoid bone)
nd
6 Perpendicular plate of the Palatine bone
7 Uncinate process
8 Ala (of Crista Galli)
ma

9 Anterior groove (on the Ethmoid)


10 Posterior groove (on the Ethmoid)
11 Cribiform plate (entrance for the Olfactory nerve)
12 Vomer
rA
©D

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The A to Z of the Head & Neck

1 2

eill
3
lateral E
7
4 2
8

aN
6 5
1
3
4
nd
6
7
medial
3
ma

10
1
9
11
1
rA

2 6 8
superior
©D

12

© A. L. Neill 79
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The A to Z of the Head & Neck

Frontal bones
anterior / lateral / inferior

eill
Description - Unpaired largest and very robust anterior bone forming the
forehead - horizontal section forming the roof of the orbit.

1 Frontal tuberosity -Frontal bossing


F 2 Superciliary arch

aN
3 Supraorbital margin and notch
4 Nasal spine
5 Superior and inferior temporal lines
6 Superior Orbital plate - pars orbitalis
nd
7 Frontal and Ethmoid air cells - Frontal sinus
8 Posterior Ethmoidal foramen
9 Anterior Ethmoidal foramen
ma

10 Zygomatic process
11 Supra-Orbital notch or foramen
12 Lacrimal fossa
13 Metopic suture - frontal suture, Glabella
rA

14 Frontal squama
15 Ethmoidal notch
©D

80 © A. L. Neill
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The A to Z of the Head & Neck

14

eill
1

13 F

aN
3

5
nd
1

2
ma

3
rA

4
12 4
11
6
10
©D

9 7

8 15

© A. L. Neill 81
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The A to Z of the Head & Neck

Hyoid
Description - Small U-shaped bone. Attached to the styloid processes

eill
via ligaments. This bone has no articulations -the only bone in the body
- and is not normally broken in trauma, protected by the mandible /
CHIN. It may be broken in hanging and strangulation.

Articulations: nil
Special of interest in Forensic investigation rarely

aN
features broken unless specific pressure on this bone
H because of its site, acts to shape the jawline
by supporting and bending the strap muscles
1 body of hyoid
2 greater horn (cornu)
nd
3 lesser horn (cornu)
MUSCLE ATTACHMENTS
4 Genioglossus
ma

5 Geniohyoid
6 Middle Phayngeal Constrictor
7 Hypoglossus
8 Stylohyoid
rA

9 Thyrohyoid
10 Omohyoid
11 Sternohyoid
©D

12 Mylohyoid

Incus – see Auditory Ossicles


Inferior Nasal Concha (see Nasal bones and cavity)

82 © A. L. Neill
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The A to Z of the Head & Neck

eill
2

3
1

aN
H

1
nd
2

3
ma

6
rA

4 7
©D

8
9

12 10
11 5

© A. L. Neill 83
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The A to Z of the Head & Neck

Lacrimal

eill
Description - Small cone shaped bone.

Articulations with Ethmoid laterally All 2º


with Frontal superiorly fibrocartilagenous
with Inferior Nasal joints
Concha inferiorly

aN
with Maxilla medially

1 Apex – articulates with Frontal


2 Lacrimal crest and groove
nd
3 Hammulus
L 4 Descending process
5 Inferior edge
ma

6 Medial edge

JAW – see Mandible


rA

Malleus – see Auditory Ossicles


©D

84 © A. L. Neill
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The A to Z of the Head & Neck

eill
1

6
aN 2
nd
L
3
ma

5
4
rA
©D

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The A to Z of the Head & Neck

Larynx
Cartilages articulated and disarticulated

eill
1 Hyoid bone
2 Epiglottis
3 Thyroid membrane

aN
4 Thyroid cartilage
4A/B Thyroid cartilage - superior horn
- inferior horn
5 Medial cricothyroid ligament
nd
6 Cricoid cartilage

L 7 Arytenoid cartilages
8 Tracheal “rings”
9 Corniculate cartilages
ma

10 Attachment for Transverse Arytenoid


11 Muscular process (for arytneoids)
12 Attachment for vocal cords
rA

11 7
©D

86 © A. L. Neill
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The A to Z of the Head & Neck

eill
aN
1

2
nd
4

4B L
3
ma

4
4B
7
6
rA

10
2
12
4A
©D

4B 6

© A. L. Neill 87
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The A to Z of the Head & Neck

Mandible = JAW
lateral / posterior

eill
(Mandible - lower jaw bone joins the skull via the condyles and a
cartilaginous articular plate in the Temporal fossa.
Primary function - mastication, houses all the bottom teeth).

Articulations with the Temporal TMJ =


fossa - this shallow temporomandibular

aN
fossa makes it easy to joint
dislocate this joint

1 mandibular notch
2 pterygoid fovea
3 head of Mandible - condylar process
nd
4 neck of Mandible
5 post. border of ramus of Mandible
6 ramus - vertical ramus
M
7 angle of mandible
ma

8 oblique line
9 inferior border
10 body - horizontal ramus
11 base
12 mental foramen
rA

13 mental tubercle - Gnathion


14 mental protuberance
15 alveolar bone surrounding teeth
16 anterior border of ramus
17 coronoid process - endocoronial ridge
©D

18 mandibular foramen
19 lingula
20 superior and inferior mental spines
21 digastric fossa
22 mylohyoid line
23 mylohyoid groove

88 © A. L. Neill
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The A to Z of the Head & Neck

1 2

eill
3
17
4

16 5
6

aN
15
7
14
8
10
nd
13 11 9
12

M
ma

18
5
21
19
23 22 20
rA
©D

changes in the mandible from child <1yo to adult

© A. L. Neill 89
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The A to Z of the Head & Neck

Mandible Anterior

eill
radiology
orthopantomogram = OPG

Used to show mandibular fractures and an overview of


sinuses and complete dentition

aN
1 Central incisor (21)*
2 Lateral incisor (22)
3 Canine (23)
4 First premolar (24)
5 Second premolar (25)
nd
6 First molar (26)
7 Second molar (27)
8 Pulp chamber of molars (16, 17)
M 9 Coronoid process
10 Head of mandible
ma

11 Zygoma
12 Maxillary sinus
13 Anterior nasal spine of maxilla
14 Vomer (nasal septum)
15 Sites for the third molar (18, 28, 38, 48)
rA

16 Hard palate

* See Teeth overview page108


©D

90 © A. L. Neill
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The A to Z of the Head & Neck

eill
aN
nd
M
ma
rA
©D

© A. L. Neill 91
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The A to Z of the Head & Neck

Mandible Lateral

eill
radiology
Showing relationship to surrounding soft tissue

1 Head of mandible – Condylar process


2 Neck of the Mandible

aN
3 Hard Palate
4 Soft Palate
5 Anterior arch of the Atlas (C1)
6 Odontoid process of the Axis (C2) – Dens
7 Posterior aspect of the tongue
8 Retropharyngeal sac
nd
9 Epiglottis
10 Vallecula - fold anterior to epiglottis
11 Hyoid bone
M
ma
rA
©D

92 © A. L. Neill
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The A to Z of the Head & Neck

eill
aN
nd
M
ma
rA
©D

© A. L. Neill 93
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The A to Z of the Head & Neck

Maxilla / Maxillae Bones


anterior / lateral / medial

eill
(The Maxillae are 2 paired bones which form the dominant portion of
the face and hold the upper teeth. The “overgrowth” of the Maxilla is
often the reason for orthodontic treatment.)

1 frontal process
2 medial orbital surface

aN
3 infra-orbital margin
4 zygomatic process
5 infra-orbital foramen
6 nasal notch
7 nasal crest
nd
8 anterior nasal spine
9 alveolar bone around teeth
10 tuberosity
M 11 infra-temporal surface
ma

12 orbital surface
13 palatine process
14 ethmoid crest
15 middle meatus
16 conchal crest
rA

17 which tooth is this?


18 premaxillary suture is here - fuses with completed jaw growth
Incisive canal supported by the canine jugun
19 Greater Palatine canal - groove
20 articulating surface – with Palatine bones
©D

21 maxillary hiatus continues with the sinus


22 Nasal Lacrimal process
23 alveolus -bone containing tooth root
24 canine jugun
25 inferior meatus

94 © A. L. Neill
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The A to Z of the Head & Neck

1
2

eill
3
4
13 5

aN
6
7
24
8
9
1
12
nd
11
3
4
5 M
ma

6
7 8
24
9 10
rA

1 14
22 15
16
21
25
7
©D

20 8
18
19 9

10 23 24
13
17

© A. L. Neill 95
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The A to Z of the Head & Neck

Nasal Bones and Cavity = NOSE


BONES external / internal / paired - posterior
The NOSE consists of: - 2 small thin rectangular bones below the Glabella, the NASAL

eill
BONES; 2 lateral walls which house the 3 PAIRED TURBINATES or CONCHAE; the
MEDIAL SEPTUM - made up of the VOMER and the ETHMOID bones and the many
cartilages which determine the length and shape of the nose and nasal nares (nostrils).
The cavity is surrounded by sinuses which open into it and superiorly by the Ethmoid
plate allowing the OLFACTORY nerves to drop processes into the cavity.
Articulations with Frontal superiorly All 2º

aN
with Lacrimal laterally fibrocartilagenous joints
with itself medially
with Ethmoid inferiorly
SPECIAL “articulates” with nasal BS in septum does
FEATURES cartilages anteriorly not extend to cartilage
superior & parts of the Ethmoid bone
middle nasal
conchae
nd
inferior nasal 2 small snail like bones lying
conchae on top of Palantine bones

1 frontal sinus
2 Nasal spine of frontal bone
N 2A articulation with frontal bone
ma

3 Nasal bone - external surface


3A Nasal bone internal surface
4 perpendicular plate of Ethmoid
5 ant. nasal spine
6 Maxilla
6A articulation b/n Nasal bones and Maxilla
rA

7 Sphenoid bone - (pterygoid plates)


8 Vomer
9 Sphenoidal sinus
10 Crista Galli
11 foramen for Nasal vein
12 notch for external nasal Nerve
©D

13 articulation with other Nasal bone


14 Lacrimal bone
15 Inferior concha and meatus
16 Palantine bone - perpendicular plate and incisive fossa
17 sphenopalantine meatus
18 superior concha and meatus
19 middle concha and meatus
20 groove for Ethmoidal Ns
21 articulation with lateral nasal cartilages
96 © A. L. Neill
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The A to Z of the Head & Neck


2A

eill
6A
2A
13
11
6A
3A

aN
21
12
3 1
1
10 3
2
3 9
nd
9

4
15
N
ma

8
5
6 7

1 19 19
18 18
rA

3A 9

14
©D

6 7

15
17
16

© A. L. Neill 97
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The A to Z of the Head & Neck

Occipital bone external / internal


Articulations with Sphenoid onteriorly

eill
with Vertebral Column inferiorly
with C1 laterally
with C2
Special large bowl- like bone with a
features hole at the infero-posterior
portion of the skull

aN
1 superior angle
2 highest nuchal line
3 superior nuchal line
4 inferior nuchal line
5 Mastoid margin
nd
6 jugular process
7 condylar fossa
8 Occipital condyle
9 foramen magnum
10 hypoglossal canal
ma

11 condylar canal
O 12 lateral surface
13 lateral angle
14 Occipital crest (external)
15 squamous surface
16 Occipital protuberance (internal)
rA

17 lamboid margin
18 groove for superior sagittal sinus
19 posterior cerebral fossa / Occipital fossa
20 groove for transverse sinus
21 attachment for Tentorium Cerebelli
©D

22 groove for sigmoid sinus


23 jugluar notch
24 jugular tubercle
25 attachments for Falx Cerebri
26 opisthion
27 basion
28 Occipital sulcus - sagittal sinus

98 © A. L. Neill
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The A to Z of the Head & Neck

1
17

eill
2
16

15 3

14

aN
4

13
5

12 6
nd
11
7
10 9 8
25 18
ma

28

17
19 O
20
16
rA

21
14

13 5
12
©D

22

11 23
27 24
26 10
9
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The A to Z of the Head & Neck

Palate
Inferior view - looking up into the Palate - roof of the mouth
Maxilla + Upper Teeth + Palatine bones

eill
1 Nasopalatine Ns emerging from the Incisive
Foramen (Alveolare)

aN
2 Greater Palatine Ns emerging from the Greater
Palatine Foraminae
3 Lesser Palatine Ns emerging from the Lessser
Palatine Foraminae
4 Hard Palate
nd
5 Soft Palate
6 Nasal process
ma

P
rA
©D

100 © A. L. Neill
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The A to Z of the Head & Neck

eill
1

aN
nd
4
2
3
ma

P
6
rA
©D

© A. L. Neill 101
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The A to Z of the Head & Neck

Palatine bones (Left)


sagittal / medial / anterior / posterior

eill
Articulations mainly with the 2o
upper jaw (Maxilla) fibrocartilagenous
and the Sphenoid joints
Special L-shaped bones -
features forms the floor of
the Nasal cavity

aN
1 perpendicular plate - vertical plate
2 Palato-Maxillary suture
3 Maxilla
nd
4 Orbital process
5 Spheno-Papalatine notch
6 Sphenoidal process -
6A Pterygo-Palatine canal
ma

7 horizontal plane

P
rA
©D

102 © A. L. Neill
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The A to Z of the Head & Neck

eill
aN
nd
1
3
2
ma

P
rA

5 4
5
6
1 1 6
©D

6A
8

7 2
7

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The A to Z of the Head & Neck

Parietal bone (Left)


external / internal

eill
Articulations with the Frontal - anterior All 2o
with the Temporal - inferiorly fibro-
with the Occipital - posteriorly cartilagenous
with itself medially joints
Special large square bone - largest of

aN
features the cranial vault - even
thickness all 4 corners made
up the basis of the
fontanelles in the infant
1 superior temporal line
2 parietal eminence
nd
3 articulation with the Occipital bone (Lambdoid suture)
4 articulation with the Temporal bone (Mastoid)
Parieto-Mastoid suture
5 articulation with the Temporal (Squamous)
ma

Temporo-Parietal suture
6 articulation with the Sphenoid (Greater wing)
P Spheno-Parietal suture
7 articulation with the Frontal bone Coronal suture
rA

8 inferior Temporal line


9 articulation between Parietal bones Sagittal suture
10 frontal angle
11 sphenoidal angle
12 groove for frontal branch of Middle Meningeal vessels
©D

13 groove for parietal branch of Middle Meningeal vessels


14 mastoid angle
15 groove for sigmoid sinus
16 occipital angle
17 groove for superior sagittal sinus

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9
8 2

aN
7

3
nd
6
5
4
ma

17
10

P
rA

16
©D

15

11
14
13 12

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The A to Z of the Head & Neck

Sphenoid
anterior / posterior / schema - developement

eill
A single wedge-shaped bone consisting of four parts: the central body;
the lateral greater wings, the medial lesser wings and the lower
ptergoid plates. The bone looks like a bat in flight and is the centre
piece of the skull.

1 articulation with L Temporal bone

aN
2 orbital surface
3 infratemporal crest
4 body of the Sphenoid
5 openings for sphenoidal sinuses
6 lesser wing (come accross and meet to form jugum)
nd
7 squamosal suture - articulation with R Temporal bone
8 superior orbital fissure
9 foramen rotundum
10 pterygoid canal
ma

11 rostrum
12 vaginal process
13 medial pterygoid plate
14 pterygoid hamulus
rA

15 pterygoid notch
S 16 lateral pterygoid plate
17 pterygoid process
18 sphenoid spine
19 greater wing
©D

19A cerebral surface of the greater wing


20 anterior clinoid process
21 posterior clinoid process
22 dorsum sellae
23 articulation with occiput

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1 2 3
6
4 5

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7

8
18
9
17 10

aN
16 11
12
15 13
14

19A
nd
6 20 21
22 23
8
19 9
ma

7
18 10
12
16
11
rA

15
14 13
19A S
6 8
4
19
©D

17
15

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The A to Z of the Head & Neck

Teeth Overview
There are many different methods used to name teeth, define their
positions and dentitions and describe their surfaces. This overview

eill
shows the 1o & 2 o dentitions, describes their positions and tooth types
using some of the better known methods.
Teeth are labeled XY on the Left and Right - X is the quadrant of the
teeth and dentition type - adult or child - Y is the tooth type
(devised by the Federation Dentaire Internationale)

aN
1 Maxillary upper right quadrant - adult
2 Maxillary upper left quadrant - adult
3 Mandibular lower left quadrant - adult
4 Mandibular lower right quarant - adult
5 Maxillary upper right quadrant - child
6 Maxillary upper left quadrant - child
nd
7 Mandibular lower left quadrant - child
8 Mandibular lower right quarant - child
1 Central Incisor
2 Lateral Incisor
ma

3 Canine
4 First Pre-molar
5 Second Pre-molar
6 First Molar
7 Second Molar
8 Third Molar
rA

A Palatal - upper tooth surface facing the inside of the mouth


B Buccal - any tooth surface facing the cheek
T C Mesial - any tooth more anterior than the 1st molar
D Distal - all teeth behind the 1st molar
©D

E Lingual - lower tooth surface facing the tongue


F Occlusal - any tooth surface which abuts with another
tooth-bite surface (shown surface)
G Labial - any tooth surface facing the lips

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aN
nd
ma
rA

T
Teeth are labeled by letters and subscripts on the Right letters
I = incisors 2o dention (adult) i = incisors 1o dentition (child)
©D

C = canine c = canine
M = molar m= molar
P = premolar
Teeth are labeled using roman numerals in the smaller circle to
demonstrate this method - (not commonly used)
Each tooth has several surfaces and lies in different oral regions

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The A to Z of the Head & Neck

Temporal bone (Left)


external / inferior / internal

eill
Temporal = TIME. This bone shows first signs of aging - grey hair. It is
involved in both the wall and the base of the skull. Temporal bones contain
the auditory ossicles/ear bones & form the only joint with the mandible.

1 suprameatal triangle
2 groove for middle Temporal artery
3 parietal notch

aN
4 squamo-Mastoid suture
5 mastoid area
6 mastoid process
7 sheath of styloid process
8 styloid process
9 tympanic part l
10 external acoustic meatus / anterior border (bony ear hole)
11 tympanosquamosal (squamotympanic) fissure
nd
12 mandibular fossa
13 zygomatic process
14 articular tubercle
15 postglenoid tubercle
16 squamous part - Squama
ma

17 stylomastoid foramen
18 mastoid notch - Digastric groove
19 occipital groove
20 jugular surface
21 jugular fossa
22 canaliculus (opening) for Tympanic nerve
23 petrous part
rA

24 carotid canal
25 edge of tegmen tympani
26 groove for the middle meningeal vessels
T 27 groove for the superior Petrosal sinus
28 articulation with the greater wing of the Sphenoid
Spheno-Temporal suture
©D

29 Zygomatic process
30 groove for the middle meningeal vessels
31 internal acoustic meatus
32 articulates with the Occipital bone
33 aqueduct of the vestibule
34 mastoid foramen
35 groove for sigmoid sinus - sigmoid sulcus
36 arcuate eminence
37 articulates with the parietal bone Temporoparietal suture
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1 2
16 3

eill
15
14 4

13
5
12

aN
11 6

10 7 11
25 13
9 8 24 14
nd
12
23
9
22
8
ma

21
17
20
19 6
26
16 18
rA

37 27
28
36
T
29
35
©D

30
34
31
33
8
32

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The A to Z of the Head & Neck

Temporo-Mandibular joint = TMJ


closed - lateral / medial
open - sagittal

eill
(only SYNOVIAL joint in the skull)

BS superficial temporal & maxillary arteries


NS auriculotemporal & masseteric branches of

aN
mandibular branch of Trigeminal N (CN5)
A depression/elevation, protrusion/retraction, lateral
movements

1 fibrous capsule
nd
2 lateral TMJ lig
3 stylomandibular lig
4 Mandible
ma

5 ant Temporal attachment of Meniscus


6 meniscus
7 ant. mandibular attachment
8 condyle of mandible
rA

9 posterior attachment
10 sphenomandibular lig
T 11 posterior temporal attachment
12 lower joint compartment
©D

13 Temporal bone
14 upper compartment
15 ext. auditory meatus

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aN
15 1
2
3
nd
ma

10
rA

6 3 14 4
13 12
T
6
©D

11

12 7
9
8
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The A to Z of the Head & Neck

Temporo-Mandibular joint (TMJ) Lateral


radiology

eill
Open - upper
Shut - lower

1 Head of mandible – Condylar process


2 Neck of the Mandible

aN
3 Coronoid process
4 Zygomatic arch
5 External auditory meatus + Handle of the malleus
6 Articular cubicle
7 Tympanic plate
8 Mastoid process
nd
9 Groove for posterior belly of Digastric muscle
10 Mandibular fossa
11 Greater wing of the sphenoid (basal surface)
12 Lesser wing of the sphenoid
ma
rA

T
©D

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aN
nd
ma
rA

T
©D

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The A to Z of the Head & Neck

Vertebrae
Typical cervical C3-7
superior

eill
Articulations with vertebra above VB -VB joints symphysis
& below -2 unpaired Spinous process joints
joints syndesmosis
2 paired joints paired zygapophyseal

aN
planar synovial
paired TP joints fibrous
sydesmosis
Special transverse foramen
features bifid spinous process
small curved bodies
nd
1 body
2 pedicle
ma

3 superior articular facet


4 vertebral foramen
5 lamina
6 spinous process -bifid*
rA

7 post tubercle of TP
8 transverse foramen*
9 sulcus for peripheral N outlet
10 anterior tuberble of TP
©D

V
* only in cervical vertebrae

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7

6 aN
nd
5

4
ma

9
rA

3 10

2
©D

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Vomer
lateral / posterior / in situ

eill
A single small narrow frail plough-shaped midline bone. It is the
deviation of this bone which may obstruct the nasal airways.

1 Ala (Alae)
2 Articulation with Maxillae and Palatine

aN
Maxillovomer suture / Palatinovomer suture
3 Groove for the nasopalantine nerves and vessels
4 articulation with nasal cartilages
5 articulation with Sphenoid bone
nd
6 articulation with the Ethmoid plate
7 Perpendicular plate of the Ethmoid
8 Body of Vomer
ma

9 Maxillae areolar bone


10 Medial pterygoid plate
11 Frontal bone
12 Sphenoid sinus
rA

13 anterior of nasal bones


14 Frontal sinus
©D

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4
5

3
8 1

aN
2
1

3
7
nd
8
11
ma

14
7 6 12

13
rA

4 5

8
©D

V
9 2 10

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The A to Z of the Head & Neck

Zygoma = CHEEK BONES


antero-lateral / postero-medial

eill
These bones form the prominent corners of the face under the
orbital rim.

1 frontal process
2 Zygomatico-Facial formina

aN
3 articulation with the Frontal bone
4 articulation with the Sphenoid
5 Zygomatico-Orbital foramina
6 articulation with Maxilla
nd
7 Zyomatico-Temporal foramina
8 temporal process
9 maxillary process
ma

10 orbital surface
rA
©D

Z
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3

aN
4

5
nd
8

1 6
7
ma

10 2

4
rA

9
©D

Z
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The A to Z of the Head & Neck

The Muscles of the Head & Neck


Classification, Naming and Examination of Muscles 126

eill
Summaries of Skeletal muscles of the Head & Neck 128-143
Muscles and muscle layers of the Back & Neck
Muscles of the Eye
Muscles of the Face - expression
- mastication

aN
- speech (articulation)
Muscles of the Hyoid & Thyroid
Muscles of the Larynx and Pharynx

MUSCLES OF THE HEAD & NECK - regional and functional guide


nd
Muscles of caput/basocranium & cervical spine
Muscles of expression
Muscles of the eye & ear
Muscles of mastication
Muscles of the hyoid & thyroid
ma

Muscles of pharynx & larynx


Muscles of the tongue
rA
©D

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The A to Z of the Head & Neck

Index of Muscles
A 144

eill
Aryepiglotticus
Arytenoids Oblique, Transverse (Crico-)
Auricularis = Extrinsic Auricular Muscles
B 148
Buccinator
C 150

aN
Ciliary muscle (Ciliaris)
Constrictors - see Pharyngeal Constrictors
Corrugator Supercilii
Cricothyroid
D 156
Depressor - Anguli Oris
Depressor Labii Inferioris
nd
Digastric
Dilator Pupillae - see Pupillary muscles
E 160
Epicranius = Frontalis + Occipitus = Occipitofrontalis
Erector Spinae - Capitus and Cervicis regions -
see Summaries of the intrinsic Back muscles
ma

Extrinsic Auricular Muscles see Auricularis


Extrinsic Ocular Muscles see Summaries of the muscles of the Eye
F 160
Frontalis - see Epicranius
G 162
Genioglossus
rA

Geniohyoid
H 162
Hypoglossus
I 164
Incisivus Labii Inferioris
Incisivus Labii Superioris
©D

Inferior Lingualis see Linguali muscles / Intrinsic muscles of the Tongue


Inferior Oblique
Inferior Pharyngeal Constrictor see Pharyngeal Constrictors
Inferior Rectus
Interspinalis Cervicus
Intertransversarii Cervicus
Intrinsic muscles of Tongue see Linguali muscles

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The A to Z of the Head and Neck

L 172
Lateral Cricoarytenoid
Lateral Pterygoid - see Pterygoids
Lateral Rectus

eill
Levator Anguli Oris (Caninus)
Levator Labii Superioris
Levator Labii Superioris Alaeque Nasi
Levator Palpebrae Superioris
Levator Veli Palatini
Linguali muscles = Intrinsic muscles of the Tongue
Longissimus Capitus

aN
Longissimus Cervicis
Longus Capitus
Longus Colli
M 186
Masseter
Medial Pterygoid see Pterygoids
Medial Rectus
nd
Mentalis
Multifidus Capitus
Multifidus Cervicis
Muscularis Uvulae
Mylohyoid
N
ma

196
Nasalis
O 198
Oblique Arytenoid - see Arytenoids
Obliquus Capitis Inferior
Obliquus Capitis Superior
Occipitalis see Epicranius
rA

Occipitofrontalis see Epicranius


Omohyoid
Orbicularis Oculi
Orbicularis Oris
P 206
Palatoglossus
©D

Palatopharyngeus
Pharyngeal Constrictors - inferior
Pharyngeal Constrictors - middle
Pharyngeal Constrictors - superior
Platysma
Posterior Cricoarytenoid
Procerus
Pterygoids -Lateral, Medial

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R 220
Rectus Capitus Anterior
Rectus Capitus Lateralis

eill
Rectus Capitus Posterior Major
Rectus Capitus Posterior Minor
Risorius
Rotatores Longus and Brevis (Cervical region)
S 228
Salpingopharyngeus
Scalenus Anterior

aN
Scalenus Medius
Scalenus Minimus
Scalenus Posterior
Semispinalis Capitus, Cervicis
Sphincter Pupillae (see Pupillary mucles)
Spinalis Capitus, Cervicis
Splenius Capitus
nd
Splenius Cervicus
Stapedius
Sternocleidomastoid
Sternohyoid
Sternothyroid
Styloglossus
ma

Stylohyoid
Stylopharyngeus
Superior Lingualis see Linguali muscles /Intrinsic muscles of the Tongue
Superior Oblique
Superior Rectus
T 248
Temporalis
rA

Temporoparietalis
Tensor Tympani
Tensor Veli Palatini
Thyroarytenoid
Thyroepiglotticus
Thyrohyoid
Transverse Arytenoid see Arytenoids
©D

Transverse Lingualis see Linguali muscles / Intrinsic muscles of the Tongue


UV 252
Vertical Lingualis see Linguali muscles / Intrinsic muscles of the Tongue
Vocalis see Thyroarytenoid
WXYZ 256
Zygomaticus Major
Zygomaticus Minor

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The A to Z of the Head & Neck

Classification, Naming and Examination of Muscles


There are 3 types of muscle tissue and this book discusses only one of them
SKELETAL MUSCLE. The other 2 are smooth muscle (for the gut and other

eill
areas of involuntary movement) and cardiac muscle (for the heart).

SKELETAL muscle is defined as muscle which is “striated” or striped, indicating


and ordered cell structure, of myosin and actin filaments, and is generally under
voluntary control, which has an action on the skeleton or bones in the body.
In its relaxed form it is at its maximum length and this is generally how the

aN
tissue is found. Stimulation generally causes contraction and a shortening and
thickening of the tissue. As it is attached to a minimum of 2 points, the Origin
(O) and the insertion (I) - although these may be arbitrarily named – this
“contraction” brings these 2 points closer together. To reverse this, another
muscle must be attached to 2 different points which when they move together
cause a reversal of the position of the 2 or more affected bones, hence for
each muscle there is an antagonist (opposing muscle) and in many situations a
synergist (a muscle which enhances the original movement).
nd
There are a few exceptions to this, for example SPHINCTERS are circular
groups of muscle fibres which upon contraction close the circle they have
formed and may not be attached to bones at all. Their function is to prevent
leakage or passage of material from one area to another. Modified Sphincters
ma

are observed in the Head and Neck as the ORBICULARIS muscles - they are
circular but not true sphincters as they can modify their circular shape which
allows for the pronunciation of sounds (muscles of Articulation or Speech) and
different degrees of closure. As a secondary function they also prevent the
passage of material from one area to another.

Many of the MUSCLES OF FACIAL EXPRESSION are inserted into the deep
rA

fascia of the skin and hence change the soft tissues of the face but do not
affect the bones underneath. We as humans have a great deal of these
muscles, and they may be shifted or injured in many cosmetic procedures
because of this structure.

Muscle are shaped to allow their contraction to occur in the most efficient
©D

manner, for example sheets of muscles cover expanses of tissue to contain


them, as in the OBLIQUES to contain and move bulky abdominal contents, or
DIAPHRAGMS to separate as well as move large anatomical regions around,
while TERES muscles are small, cordlike, focused groups of fibres for very
specific movements.
Generally the smaller the muscles, the deeper they are placed, so larger and
more powerful muscles ones can cover them, for example ZYGOMATICUS
MAJOR covers ZYGOMATICUS MINOR. Smaller muscles generally have more

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The A to Z of the Head & Neck

specific actions, are more resilient but weaker, they contract and relax
repeatedly for example, to maintain position of the face, as in the small

eill
muscles around the nose and upper lips of the face. They are essential for a
“balanced” even facial expression and lip movement and can be affected
greatly in cosmetic surgery and increasingly injected procedures. Larger, longer
muscles by definition cannot be as precise but have larger ranges of motion
and more power and are placed more superficially – closer to the surface, as
in ERECTOR SPINAE.

aN
Fibrous tissue inserts give the muscle more strength but less ability to move,
as in EPICRANIUS.

Muscles are named using many different criteria singly or in combination: for
example they may be named according to their action – Pharyngeal Constrictor
and size – Zygomaticus Major and Minor; their shape and location- Orbicularis
Oris, or Orbicularis Oculi, Longus Colli, the direction of their muscle fibres and
nd
anatomical layer – Anterior, Posterior or Superior Auricularis but there does not
seem to be a consistent pattern in this naming - only that from the name it is
often possible to determine their site, action &/or shape and this helps when
memorizing these muscles.
ma

Between each muscle group is a fascial layer to transport in the BVs and the
Nerves. This is particularly important in the Head and Neck because of the great
mobility in this region and its many, often similtaneously occurring actions.

Testing of a muscle is often impossible to do singly and they must be tested


as an anatomical and functional group. The tests are generally graded 1-5,
with 5 being the strongest and 3 being the point where when appropriate the
rA

muscle can overcome. Gravity often a natural form of resistance to the muscle
action. This level of testing muscles is not dealt with in this book but will be
discussed in the A to Z of Muscle and Sensory testing to follow - it is also
examined in some detail in the A to Z of Peripheral Nerves and the updated
version of the A to Z of Skeletal Muscles - however testing of the primary
action of most muscles is listed on each page as a guide to the practitioner for
©D

basic testing and grouping of muscles. Please use this testing section as a
guide only.

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The A to Z of the Head & Neck

Muscles and muscle layers of the Back and Neck

NECK - has 2 major groups of muscles

eill
1 those concerned with the neck movement
i.e. movement of the cervical spine and head;
2 those concerned with the anterior neck structures.
These muscles are dealt with in the laryngeal, pharyngeal and other
related structures.

aN
Other muscles are concerned with the anterior regions of the head and
are mentioned here.

deep posterior - suboccipital muscles - extensors (see the next


page included with the back muscles) / hyperextensors / rotators
and stabilizers
Rectus Capitus Posterior - Major and Minor
Obliquuis Capitus muscles
nd
Cervical and Cephalic / Capitus regions of the muscles of the
VC

NS segmental - dorsal rami of the related SNs


BS dorsal branches of the carotids
ma

deep anterior - prevertebral A


flexors, rotators and stabilizers
Rectus Capitus Anterior and Lateral
Longus Colli and Capitus

NS segmental - ventral rami of related SNs


rA

BS branches of carotids and other local vessels

anterior - flexors, rotators B


Scalenii muscles
NS segmental anterior branches of the ventral rami
BS superficial cervical
©D

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aN
nd
ma

B
rA
©D

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The A to Z of the Head & Neck

BACK - has 2 major groups of muscles

1 those which are intrinsic to the VC basically segmental muscles concerned

eill
with movements and stability of the VC particularly the deepest layers –
connected with the movement of the neck etc.
2 those which use the VC as an immoveable post and move structures
around the back extrinsic concerned with the anterior neck structures.
The Extrinsic muscles do not affect the Head and Neck but are discussed in
detail in the A to Z of Skeletal Muscles.

aN
EXTRINSIC
muscles which move the shoulder and arm
Trapezius, Latissimus Dorsi, Rhomboids
Levator Scapulae
muscles which move the rib cage
Serratus Posterior inferior and superior
nd
NS segmental - ventral rami of related SNs
BS branches of carotids and other local vessels

INTRINSIC
most superficial
ma

Erector Spinae (ES) - Iliocostalis, Longissimus, Spinalis. - ES divided into a


number of muscle groups with regional distinctions. (Part of the Intrinsic
muscles of the back)
medial lateral
Spinalis Iliocostalis Longissimus
Iliocostalis - Lumborum, Thoracis, Cervicus
Longissimus - Thoracis, Cervicus, Capitus
rA

Spinalis - Thoracis, Cervicus, Capitus

O & I listed individually in the text as a group


as a group
O along the VC + Ribs
I into the VC + Ribs
©D

A listed individually
A as a group the ES in these regions extend and rotate the head & neck.
NS segmental spinal roots generally the dorsal rami but may also have innervation
from the dorsal branches of the ventral rami branches (C1-T1).
BS segmental dorsal branches of the carotids.
T to extend and hyper-extend the neck and head and maintain a correct
carriage of the head.

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aN
nd
ma
rA
©D

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The A to Z of the Head & Neck

Muscles of the Eye - note all 6 of these muscles act “in concert” in eye
movement and depend upon the fixation and focus of the eye included is the
muscle which moves the eyelid to follow the eye gaze, hence 6+1.

eill
Extrinsic
Muscles responsible for movement of the upper eyelid
1 Levator Palpebrae Superioris
NS Occulomotor N (CN III)
BS supraorbital, branches of ophthalmic N (from CN V1)

aN
Muscles responsible for movement of the eyeball
2 Recti muscles - Inferior /Superior, Medial/Lateral.
These muscles are straight and are responsible for one movement
up/down, in/out
3 Oblique muscles - Inferior, Superior
These muscles are attached via a trochlea or pulley and movements
nd
therefore vary on eye position and are diagonal up and out / down and in

All are attached to the scleral surface, the Recti via the optic canal on the
common annular tendon, and the Obliques via bones in the optic cavity

NS oculomotor N (CN III) - except Lateral Rectus - abducent N (CN VI) and
ma

Superior Oblique - trochlea N (CN IV)


BS ophthalmic and branches of internal carotid

Intrinsic
These muscles are responsible for moving structures within the eyeball
and are not shown.
rA

NS oculomotor N (CN III) parasympathetic outflow


BS ophthalmic and branches of internal carotid

Ciliaris, Dilator Pupillae, Sphincter Pupillae


©D

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2

aN
nd
2
3
ma
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©D

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The A to Z of the Head & Neck

Eye structures
in situ
removal of superficial tissue / coronal section/enucleation with

eill
muscle bed intact

1 Levator Palpabrae Superioris


2 4 x Recti muscles (superior, inferior, lateral, medial)

aN
3 2 x Oblique Muscles (superior, inferior)
4 Trochlear N (CN IV)
5 ciliary ganglion (CN III)
6 Abducens N (CN VI)
nd
7 Oculomotor N + branches (CN III)
8 Trochlea
9 superior orbital notch
10 superior orbital fissure
ma

11 Optic N (CN II)


12 Lacrimal gland
see orbital cavity for bony orbit p48
rA
©D

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1
8

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12 4

aN
1 3

2
2
nd
11
ma

9
2 7
1
rA

8
10
3
4
2
©D

2
11

6
7
5 2
3

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The A to Z of the Head & Neck

Muscles of the Face

Expression

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1 Buccinator
2 Corrugator Supercili
3 Depressor Anguli Oris -
4 Depressor Labii Inferioris, (overlying Incisivus inf.)
5 Depressor Septi
6 Frontalis (of Occipitofrontalis)
(4) Incisivus Labii Inferioris

aN
(8) Incisivus Labii Superioris
7 Levator Anguli Oris (Caninus),
8 Levator Labii Superioris (overlying Incisivus sup.)
9 Levator Labii Superioris alaeque nasi
10 Mentalis
11 Nasalis (compressor & dilator)
12 Orbicularis Oculi
nd
13 Orbicularis Oris
14 Platysma
15 Procerus
16 Risorius
17 Zygomaticus Major
ma

18 & Minor

NS facial N (CN VII)


BS facial
These muscles are often involved in cosmetic surgery and their function may
be compromised by incisions at the level of the deep fascia.
rA
©D

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2 6
12
15

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aN
9
5

18 16
nd
3
8
4
17 13
ma

12
2
rA

15
11
5
17, 18
13
©D

8
5

3 10
10
14

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The A to Z of the Head & Neck

Muscles of the Face and Neck

Mastication

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19 Masseter,
20 Pterygoids Lateral (deep to Masseter)
21 Pterygoids Medial (deep to Buccinator)
22 Temporalis + Temporoparietalis

All are attached to the Mandible – Jaw bone and part of the Splanchnocranium

aN
NS trigeminal N –mandibular branch (CN V3)
BS trigeminal and facial branches

Speech - Articulation
31 Genioglossus
32 Geniohyoid
33 Styloglossus
nd
34 Hypoglossus
35 Stylohyoid
36 Thyrohyoid
37 Sternothyroid

NS hypoglossal (CN XII) and C1-3 of ansa cervicalis


ma

BS facial branches
These muscles are often involved in stroke and overlap with the muscles used
for swallowing, and the muscles of the Hyoid and Thyroid and Tongue
rA
©D

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The A to Z of the Head & Neck

22
9,11

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8

13

aN
3

1 19 nd 10

35

31
ma

33
rA

32

34

36
©D

37

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The A to Z of the Head & Neck

Muscles of the Thyroid & Hyoid


- superficial anterior neck muscles
- muscles of the Anterior Triangle

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- strap muscles

1 Digastricus
2 Geniohyoid
3 Mylohyoid
3A Mylohyoid central raphe

aN
These muscles elevate and position the Hyoid and the floor of the mouth to
facilitate swallowing and occlusion of the Larynx
NS hypoglossal (CN XII) and C1 of ansa cervicalis
BS facial branches

4 Omohyoid , (4A tendinous sling)


5 Sternohyoid
nd
6 Sternothyoid

facilitate swallowing and occlusion of the Larynx


NS ansa cervicalis C1-3
BS thyroid vessels
ma

7 Stylohyoid
8 Thyrohyoid

These muscles are involved in support of swallowing - Thyrohyoid both lowers


and elevates the Hyoid
NS ansa cervicalis C1-3
rA

BS facial and thyroid vessels

As a group, these muscles define the neck line and shape, are involved in
swallowing and sound production may be tightened in cosmetic surgery – they
may attach to the Hyoid, Sternum and other bones in the region as a “through”
bones – i.e. they have fascial slings to support them and separate them into 2
©D

muscle bellies

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2

3 1

aN
4

4A 6
nd
ma

7
rA

3
©D

8 1
3

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The A to Z of the Head & Neck

Muscles of the Larynx and Pharynx

1 Salpingopharyngeus - attaches to the inferior of the auditory tube (1A)

eill
and blends with Palatopharyngeus to raise the pharyngeal wall, close off
the auditory tube for swallowing
2 Palatopharyngeus - attaches to the Thyroid cartilages and the Palate
to bring the pharynx forward allowing food to leave the mouth and enter
the pharynx
3 Stylopharyngeaus - attaches to the styloid process and the constrictors

aN
to elevate and dilate the pharynx in the early stages of swallowing*
4 Pharygneal Constrictors - superior (4A), middle (4B), inferior (4C) -
attach to the Medial Pterygoid plate, Hyoid bone and Thyroid cartilages
and blend in with each other and the posterior root of the tongue in order
to commence swallowing and the resultant peristaltic movement at the
beginning of the oesophagus (5). They also have ligament support - the
Stylohyoid ligament (5A).
nd
NS vagus (CN X) and branches of ansa cervicalis (C1-3)
BS maxillary, facial
Note in CVAs - strokes these muscles under voluntary control and are involved
in the early stages of swallowing - so may be affected greatly limiting the
person’s capacity to swallow
ma

6 Cricothyroid - attached to the cricoid cartilage (6A)


7 Arytenoids muscles - attached to the arytenoids cartilages (7A) at the
back of the vocal cords responsible for altering the shape and angle of
these cartilages - cricoid and thryroid cartilages (7B),
Cricoarytenoids - posterior and lateral, Thyroarytenoid, Transverse
rA

arytenoids,
8 Vocalis - also attached to the arytenoids cartilages for voice regulation.
NS for most of these muscles comes from the vagus (CN X)
BS from the thyroid vessels and branches of the carotids
9 Middle concha
10 Hard palate
©D

11 L Upper M2 tooth (27)


12 Thyroid memebrane (connecting Thyroid and Cricoid cartilages)
13 Arytenoid cartilages
14 Cricothyroid fibres Note surface anatomy guides
15 Sternohyoid
16 Disc b/n C4/5 opp. Thyroid cartilage
17 Body of C3 opposite Hyoid bone

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The A to Z of the Head & Neck


1A

1
9

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4A 10
2
11
3

aN
12

13
7 7A 6A
nd
5 14
ma

6
8
5A 7B
rA

4A

17
©D

16 4B
15
4C
5

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The A to Z of the Head & Neck

A
Aryepiglotticus
part of the muscles of the Larynx

eill
O apex of the arytenoid cartilage
I lateral border of epiglottus
A aids in the closure of the opening of the larynx (additis)
moves the arytenoids to the epiglottic tubercle
NS recurrent laryngeal N (branch of vagus CN X)

aN
BS laryngeal and thyroid vessels

Arytenoids
Crico - Oblique, Transverse
part of the muscles of the Larynx
nd
Oblique
O/I b/n the muscular processes of the arytentoid cartilages
A adduction of the aryepiglottic fold and the vocal cords
to cause closure with Aryepiglotticus forms a sphincter
of the laryngeal outlet
ma

NS recurrent laryngeal N (branch of vagus CN X)


BS laryngeal and thyroid vessels
Transverse
O/I b/n the muscular processes of the arytenoid cartilages
- medial on one to the posterior surface of the other
rA

A adduction of the arytenoid cartilages and attached


vocal cords - closure with of the rima glottis
NS recurrent laryngeal N (branch of vagus CN X)
BS laryngeal and thyroid vessels
©D

note the larynx is normally closed – antagonistic muscular


contraction forces the structure open, hence in paralysis the
larynx will close and prevent the passage of air
note the CRICOARYTENOID muscle below attaching to the
base of the arytenoids and important in pitch and tone

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The A to Z of the Head & Neck

A
Auricularis
anterior, posterior, superior

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Extrinsic muscles of the Ear (present in 30%)
O ant. Epicranial Aponeurosis
post. Mastoid process of Temporalis
sup. Epicranial Aponeurosis
I ant. root of Auricle

aN
post. root of Auricle
sup. root of Auricle
A moves ear Pinna
NS facial N (CN VII)
BS facial / temporal
nd
T present if there is movement of the ear
ma
rA
©D

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The A to Z of the Head & Neck

Buccinator
B part of the muscles of the mastication

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O lateral – outer surface of alveolar process of Maxilla
lateral surface (Mandible)
I deep part of the Orbicularis Oris deep fascia of the face
A compresses cheeks against the teeth - draws the
angle of the mouth down and laterally

aN
NS facial N (CN VII)
BS facial and maxillary
T ability to blow a saxophone or shape lips in this way
nd
ma
rA
©D

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The A to Z of the Head & Neck

Ciliaris
part of the muscles of the Eye
C O scleral spur

eill
I stroma of the choroid
A modify the shape of the lens for distant (thinning of the
lens – less convexity) or close focus (thickening of the
lens – increased convexity)

aN
NS oculomotor (CNIII) parasympathetic fibres - for near focus
- superior cervical ganglion - long ciliary Ns -
for far vision
BS lacrimal and ophthalmic branches of internal carotid
T ability to focus (note other factors are relevant but the
nd
loss of elasticity of the lens and the muscle to contract
effectively contribute to changes in vision)
ma
rA
©D

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The A to Z of the Head & Neck

Corrugator Supercili
part of the muscles of facial expression
C O medial suprorbital margin (Frontal bone)

eill
I deep fascia of the skin in the midpart of the orbital arch -
glabella
A pulls brows down and medially, frowning
NS facial N, supraorbital supratrochlear branches (CN VII)

aN
BS facial, ophthalmic
T ability to wrinkle brow as in frowning
nd
ma
rA
©D

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Cricothyroid
part of the muscles of the Larynx
C O anterolateral aspect of the cricoid cartilage

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I inferior cornu and lower lamina of the thyroid cartilage
A tilts thyroid cartilage forwards, lengthening and
tightening the vocal cords
NS superior laryngeal N (branch of the vagus N = CN X)

aN
BS cricothyroid branches of superior and inferior
thyroid arteries
T ability to change voice pitch and tone
nd
ma
rA
©D

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The A to Z of the Head & Neck

Depressors
part of the muscles of facial expression

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Depressor Anguli Oris
D O oblique lines (Mandible) below and lateral to Labii Inferioris
I deep fascia - at the corner of the lips -
interdigitating other facial muscles
A turns the corners of the lips down as in frowning

aN
NS facial N, maxillary branch (CN VII)
BS facial -mandibular + inferior labial branches
T ability to turn the corners of the mouth down as in frowning
Depressor Labii Inferioris
nd
O anterior-medial surfaces of Mandible
I deep fascia medial to the corners of the lips
A pulls lips down and back (with Platysma)
NS facial N, superior buccal & mandibular branches (CN VII)
ma

BS facial – inferior labial branches + inferior alveolar


T ability to draw back lips and tighten neck
(continuous with Platysma)
Depressor Septi
rA

O anterior-medial surfaces of Maxilla (incisive fossa)


I deep fascia at the base of the nose
A pulls nostrils inwards and lips up
NS facial N, maxillary branch (CN VII)
BS facial -maxillary, superior buccal branches
©D

T ability to constrict nostrils (difficult to detect)

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D

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©D

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The A to Z of the Head & Neck

Digastricus
Digastric muscle

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part of the muscles of the Hyoid (anterior neck)
D 2 muscular bellies anterior / posterior passing through a
fibrous loop
O anterior - inner side (lingular) of jaw (Mandible)
posterior - mastoid notch (Temporal bone)

aN
I slides through the Hyoid tendon/ligamentous loop
A elevates, retracts and protracts Hyoid
depresses Mandible
NS anterior - trigeminal N (CN V) - mylohyoid branch
posterior - facial N (CN VII)
nd
BS facial mandibular branch
superior cervical
T open jaw against R
note movement of Hyoid on swallowing
ma
rA
©D

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The A to Z of the Head & Neck

Epicranius
Frontalis + Occipitalis = Occipito-Frontalis
Galea Aponeurosis = fibrous connection b/n the 2

eill
muscle « bellies »
2 heads anterior = Frontalis
E posterior = Occipitalis
Frontalis

aN
O skull aponeurosis
I superficial fascia superior to brow
A raises eyebrows / wrinkles forehead
NS facial N temporal branches (CN VII)
BS supraorbital supratrochlear branches of ophthalmic artery
nd
Occipitalis
O Occipital bone - mastoid process (Temporalis)
I skull aponeurosis
ma

A draws scalp back


NS facial N postauricular branch
BS facial
T ability to raise one and both eyebrows
rA
©D

Erector Spinae (ES) - Iliocostalis, Longissimus, Spinalis


Part of the Intrinsic muscles of the back - see the summary of the Muscles
of the Back and Neck and individual listings of Iliocostalis - Lumborum,
Thoracis, Cervicus Longissimus - Thoracis, Cervicus, Capitus Spinalis -
Thoracis, Cervicus, Capitus Frontalis see Epicranius

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The A to Z of the Head & Neck

Genioglossus
O superior mental spine of Symphysis Menti
(Mandibular symphysis)

eill
I ventral surface of the central mass of tongue and its mucous
membrane interdigitating with intrinsic muscles of the tongue
hypoglossal membrane and the upper anterior surface of the
Hyoid interdigitates with the Superior Pharyngeal Constrictor
A protracts tongue / pokes out tongue

aN
G depression of the centre of the tongue to form a tunnel
H NS C1 travelling + Hypoglossal N (CN XII)
BS facial – lingual branches
T ability to poke out tongue
ability to curl up tongue into a tube/tunnel
nd
Geniohyoid
O inferior mental spine posterior of Symphysis Menti
(Mandibular symphysis)
I anterior surface of Hyoid
ma

A elevation and protrusion of Hyoid


depression of Mandible (fixed Hyoid)
NS C1 travelling with Hypoglossal N (CN XII)
BS facial – mandibular branch
T observe swallowing
rA

open jaw against R


Hypoglossus
O superior border + anterior surface of the Hyoid bone
and greater cornu
©D

I sides of the tongue, interdigitating with the intrinsic


muscles of the tongue
A depresses the tongue
NS Hypoglossal N (CNXII)
BS facial – lingual branches
T observe swallowing in early stages

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H
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The A to Z of the Head & Neck

Iliocostalis Cervicus
part of ES

eill
O angles of ribs 3-6
I TPs of cervical VBs 4-6
A bilateral action - extension of the cervical spine unilateral
action - lateral flexion of the neck / cervical spine
NS segmental dorsal branches of SNs

aN
BS segmental dorsal branches of the carotids
T extend neck against R and laterally flex against R
I
nd
ma
rA
©D

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The A to Z of the Head & Neck

Incisivus Labii
Inferior, Superior
upper and lower parts of the one muscle helping Orbicularis

eill
Oris to protrude lips from above and below
Inferior
O inferior border of Mandible, lateral to Mentalis, near
eminence of the lateral incisor (tooth)

aN
I into Orbicularis Oris + fascia at the corner of the mouth
A protrudes lower lip
I NS facial N (CN VII) inferior buccal branches
BS facial – labial branches
T ability to protrude lips
nd
Superior
O incisive fossa of Maxilla superior to the lateral
incisor (tooth)
ma

I into Orbicularis Oris + Levator Anguli Oris fascia at the


corner of the mouth
A protrudes upper lip
NS facial N (CN VII) superior buccal branches
BS facial – labial branches
rA

T ability to protrude lips


note these muscles are often missed as they lie deep to other facial
muscles, and may cause imbalance or crookedness if neglected in surgery /
injection procedures performed in this region
©D

Inferior Lingualis see Linguali muscles

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The A to Z of the Head & Neck

Inferior Oblique
part of the extrinsic muscles of the eye

eill
O orbital surface (Maxilla) lateral to nasolacrimal groove
I sclera in the back lower outer quadrant behind the
equator of the eyeball b/n Inf. and Lat. Recti
A with eye adducted - moves eyeball up
with eyeball abducted - moves eyeball laterally ie UP & OUT

aN
NS oculomotor N (CN III)
BS infraorbital
I T test eye movements (note works in conjunction with
other eye muscles)
nd
Inferior Pharyngeal Constrictor see Pharyngeal
Constrictors
Inferior Rectus
part of the extrinsic muscles of the eye
ma

O inferior surface of common annular ring


I anteroinferior surface of sclera in front of the equator
of the eyeball
A with eye adducted - moves eyeball laterally
rA

with eyeball to the front - moves eyeball downwards


ie DOWN & OUT
NS oculomotor N (CN III)
BS infraorbital, ophthalmic
T test eye movements (note works in conjunction with
©D

other eye muscles)

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The A to Z of the Head & Neck

Interspinalis Cervicus
(note thoracic and lumbar regions not discussed)

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O cervical SP of C3-7
I SP of the immediate VB above
A draws adjacent VBs together extending the cervical VC
NS segmental – dorsal branches of relative SNs (C1-T1)
BS cervical –branches of the internal carotid

aN
T ability to extend neck / maintain upright neck position

I
nd
ma

Intertransversarii Cervicus
(note thoracic and lumbar regions not discussed)
O cervical TP of C1-T1 on the anterior & posterior surfaces
rA

I TP of the immediate VB above on the same surface


A draws adjacent VBs together extending the cervical VC
NS segmental – ventral branches of relative SNs
BS cervical –branches of the internal carotid
©D

T ability to extend and rotate neck / maintain upright


neck position

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Lateral Cricoarytenoid
O lateral aspect of cricoid arch

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I muscular process of arytenoid cartilage
A adductor of vocal cords -closes rima glottidis/vocal
cord opening
NS recurrent laryngeal branch of vagus N (CN X)
BS branches of inferior and superior thyroids

aN
T ability to open vocal cords - note this may be
compromised in stroke victims
nd
L
ma
rA
©D

Lateral Pterygoid –see Pterygoids

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The A to Z of the Head & Neck

Lateral Rectus
part of the intrinsic muscles of the eye

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O inferior surface of common annular ring
I anteroinferior surface of sclera in front of the equator
of the eyeball
A with eye adducted - moves eyeball laterally
with eyeball to the front - moves eyeball downwards

aN
ie DOWN & OUT
NS abducens N (CN VI)
BS infraorbital, ophthalmic
T test eye movements (note works in conjunction with
other eye muscles)
nd
L
ma
rA
©D

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Levator Anguli Oris (Caninus)


O below the infraorbital foramen / canine fossa (Maxilla)

eill
I outer edge upper lip & modiolus interdigitating with
other facial muscles and nasolabial fold
A elevates the angle of the mouth / smiling muscle
NS facial N (CN VII) buccal branches
BS facial, infraorbital

aN
T ability to smile
Levator Labii Superioris
O infraorbital margin (Maxilla and Zygoma)
I upper lip interdigitating with other facial muscles
nd
A elevates and everts the upper lip / “curling the lip”
L NS facial N (CN VII) buccal branches
BS facial, infraorbital
T ability to smile
ma

Levator Labii Superioris Alaeque Nasi


O frontal process of Maxilla
I upper lip interdigitating with other facial muscles
rA

greater alar cartilages and skin of the nose


A elevates and everts the upper lip / “curling the lip”
dilates nares and moves edge of nose out and up
NS facial N (CN VII) buccal branches
BS facial, infraorbital
©D

T ability to sneer (often works unilaterally)

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Levator Palpabrae Superioris


O inferior aspect of the lesser wing of Sphenoid, superior

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to the optic canal
I superior tarsal plate and skin of upper eyelid
A elevates eyelid
NS oculomotor N (CN III) superior division
BS ophthalmic , supraorbital

aN
T ability to raise eyelids /”open eyes”

Levator Veli Palatini


O inferior surface of Temporal bone - petrous part
nd
rim of auditory tube
L upper part of carotid sheath
I palatine aponeurosis
ma

soft palate
interdigitates with its opposite and Palatopharnygeus muscle
A elevates soft palate, closing off nasopharynx from oropharynx
NS vagus N (CN X) pharyngeal branch
accessory N (CN XI)
rA

BS facial, maxillary ± ascending pharyngeal


T snoring indicates poor muscle function
often affected in stroke where fluids are directed out of the nose
note this is the muscle responsible for
©D

“popping ears” by yawning –it opens


the auditory tube and equalizes
pressure in the middle ear

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Linguali Muscles
Intrinsic muscles of the Tongue – Inferior, Superior,
Transverse & Vertical

eill
Inferior Linguali
O lingual root / root of the tongue
body of the Hyoid
I apex of the tongue

aN
A depresses apex and shortens tongue
Superior Linguali
O submucosa of the epiglottus
median fibrous septum
nd
I apex and margins of the tongue
L A raises apex and shortens tongue
Transverse Linguali
O median fibrous septum
ma

I margins of the tongue


palatoglossus and palatoglossal arch
A narrows and elongates tongue
Vertical Linguali
rA

O/I top to bottom of tongue at the sides (runs


dorsoventrally)
A flattens and widens tongue
©D

NS hypoglossal N (CN XII)


BS lingual and branches
T as a group test the mobility of tongue and speech clarity
ability to swallow and masticate effectively

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Longissimus Capitus
part of ES

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O TP of C1-5
I mastoid process (Temporalis)
A extension and rotation of the head
NS segmental spinal roots generally the dorsal branches
(C1-2)

aN
BS segmental dorsal branches of the ascending cervical BVs
T ability to extend head and laterally flex head

Longissimus Cervicis
nd
part of ES
L O TP of C1-5
I TP of C2-6
A extension and rotation of the neck
ma

NS segmental spinal roots generally the dorsal branches


(C1-T1)
BS segmental dorsal branches of the ascending cervical BVs,
T to rotate head and neck and laterally flex
rA
©D

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Longus Capitus
O TP of C3-7

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I anterior surface of Occiput
A flexion neck (bilaterally action)
rotation of neck (unilateral action)
NS N to Longus Capitus (C1-C3)

aN
BS vertebral – maybe damaged in Whiplash accidents
T flexion of Neck against R
rotation of neck against R

Longus Colli
nd
O TP and anterior surface of C1-T3
L
I anterior arch of Atlas (C1)
A flexion neck (bilaterally action)
ma

rotation of neck (unilateral action)


NS N to Longus Colli (C1-C3)
BS vertebral – maybe damaged in Whiplash accidents
T flexion of Neck against R
rotation of neck against R
rA
©D

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Masseter
part of the muscles of mastication

eill
O zygomatic arch (Maxilla)
I angle and lower ramus of the Mandible, interdigitates
with Medial Pterygoid
coronoid process of Mandible
A closes jaw

aN
clenches teeth
protraction and retraction of jaw
assists in side to side movement of jaw
NS trigeminal N- mandibular branch (CN V3)
nd
BS maxillary, facial, transverse facial
T to clench teeth and move jaw in and out

M
ma
rA
©D

Medial Pterygoid see Pterygoids

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The A to Z of the Head & Neck

Medial Rectus
part of the extrinisic muscles of the eye

eill
O medial surface of common annular ring
I medial surface of sclera in front of the equator of
the eyeball
A moves eyeball medially - adduction ie CROSS EYED IF
BOTH CONTRACT AT ONCE

aN
NS oculomotor N (CNIII) inf. division
BS infraorbital, ophthalmic
T test eye movements (note works in conjunction with
other eye muscles)
ability to “cross eyes”
nd
M
ma
rA
©D

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Mentalis
part of the muscles of facial expression

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O Mandible - incisive fossa
I deep fascia of the skin of the chin
A protrudes lips
raises bottom lip
NS facial N - mandibular branch (CN VII)

aN
BS facial - mandibular branch, inferior alveolar
T to lift up and protrude bottom lip
nd
M
ma
rA
©D

Middle Pharyngeal Constrictor see Pharyngeal


Constrictors
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Multifidus Capitus
Multifidus Cervicis

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part of deep spinal muscle layer
O articular processes (zygapophyseal) of C1-T4
I SP of 2-3 VB above
A extension and rotation of the VC
stability of the VC

aN
NS segmental spinal roots generally the dorsal branches
(C1-T4)
BS segmental dorsal branches of the ascending cervical BVs,
T to maintain an erect and correctly postured head
and neck
nd
mobilization of this region is facilitated by these
deep muscles
M
ma
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©D

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Muscularis Uvulae
O posterior border of hard palate

eill
palatine aponeurosis
I uvular mucosa
A elevation and retraction of the Uvula
NS pharyngeal branch of vagus N (CN X) and accessory
N (CN XI)

aN
BS maxillary - greater palatine branch
T say AHHH and watch uvula

Mylohyoid
nd
O mylohyoid line (Mandible)
I posterior fibres - anterior surface of Hyoid
ant & middle fibres - decussate along median fibrous
M
raphe from mandibular symphysis to the Hyoid
ma

A elevation of Hyoid
elevation of the floor of the mouth
depression of Mandible
NS inferior alveolar branch of Trigeminal N (CN V3 division)
rA

BS facial - submental branch, lingual - sublingual branch,


T observe swallowing - elevation of the floor of the mouth
©D

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Nasalis
Compressor Naris

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Dilator Naris
complex pair of muscles which pull the nostrils down and
flatten them opening and closing them
O frontal process of Maxilla interdigitating with Procerus
and Depressor Septi

aN
I nasal aponeurosis (which connects it to its opposite side)
cartilaginous ala nasi
A dilation and compression of nostrils in forced respiration
NS superior buccal branches of facial N (CN VII)
BS facial and infraorbital branches
nd
T no real test observation in situations of respiratory stress

N
ma
rA
©D

Oblique Arytenoid see Arytenoids and Aryepiglotticus

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Obliquuis Capitus Inferior


O SP of C2 Axis

eill
I TP of C1 Atlas
A rotates head at the Atlanto-axial joint
NS suboccipital N (C2) and dorsal rami of C1-2
BS vertebral

aN
T ability to rotate head ±R
Obliquuis Capitus Superior
O TP of C1 Atlas
I base of skull (Occiput) lateral _ of inferior nuchal line
A extends head (bilateral)
nd
lateral flexion of head (unilateral)
NS suboccipital N (C2) and dorsal rami of C1-2
BS ascending cervical
ma

T ability to flex head ± R


O Occipitalis see Occipito-Frontalis = Epicranius
rA
©D

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Omohyoid
part of the muscles of the Hyoid (anterior neck)
2 muscular bellies inferior / superior

eill
O inferior – upper border of Scapula inner side (lingular)
of jaw (Mandible)
superior – intermediate tendon (attached to 1st rib
and Clavicle)

aN
I the inferior belly slides through a sling of deep fascia
intermediate tendon to become the superior belly and
attach to the lower border of Hyoid
A lower the raised Hyoid (for e.g. after swallowing)
lower the Larynx
nd
NS ansa cervicalis (C1-3)
BS subscapular
thyroid
T observe movement of Hyoid after swallowing
ma

O
rA
©D

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Orbicularis Oculi
part of the muscles of facial expression

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O Frontalis, medial margin of Maxilla, Lacrimal bone
I inserts into deep fascia of the orbit on all sides
lateral palpebral raphe
A tight closure of closure of eyelids and closure of eyebrows =
“screwing up eyes”

aN
blinking
drainage of tear ducts
NS facial N (CN VII) temporal and zygomatic branches
BS zygomatico-orbital, palpebral branches of ophthalmic
and lacrimal
nd
T ability to “screw up eyes and eyebrows” on command
against R
ma

O
rA
©D

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Orbicularis Oris
part of the muscles of facial expression

eill
O Maxilla, Mandible and Modiolus at the angle of the mouth
I deep fascia of skin and muscles around the mouth
interdigitating with surrounding muscles decussation
with opposite side at the modiolus of the lips
A tight closure (deep fibres), pursing and protrusion of

aN
lips (superficial fibres)
assists in the actions of other muscles here
NS facial N (CN VII)
BS facial, inferior alveolar branches
T ability to protrude lips and close mouth against R
nd
note other muscles act in synergy in a lot of these actions
ma

O
rA
©D

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Palatoglossus
part of the Palatine Arch - palatoglossal = anterior pillar

eill
O palatine aponeurosis
I posterolateral surface of the tongue / interdigitates
with its opposite and lateral lingualis
A raises the posterior of the tongue closes
oropharyngeal isthmus

aN
initiates swallowing
NS vagus N (CN X)
BS maxillary, greater palatine branch
T ability to swallow
nd
Palatopharyngeus
part of the Palatine Arch - palatopharyngeal = posterior pillar
O palatine aponeurosis
ma

posterior margin of the hard palate


interdigitates with its opposite,
Levator Veli Palatini, Salpingopharyngeus
P
and Stylopharyngeus
I upper posterior border of Thyroid cartilage
rA

interdigitates with other side and with


Pharyngeal constrictors
A continues swallowing, raises and protracts Pharynx
and closes nasopharyngeal isthmus
NS vagus N (CN X) pharyngeal branch
©D

BS facial, maxillary, pharyngeal, palatine branches


T ability to swallow

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Pharyngeal Constrictors
These are circular skeletal muscles which act to coordinate
swallowing before it becomes completely reflexive.

eill
Inferior Pharyngeal Constrictor
O/I Cricopharyngeal part - lateral aspect of Cricoid cartilage
Thyropharyngeus part - oblique line of Thyroid cartilage
connecting fibrous tissue b/n the 2 cartilages - fibrous

aN
cricothyroid arch
A Cricopharyngeal part acts as an upper sphincter in
the oesophagus
BS thyroid arteries

Middle Pharyngeal Constrictor


nd
O/I Anterior - lower 1/3 of the Stylohyoid ligament
lesser and greater cornu of the Hyoid
Posterior - posterior median pharyngeal raphe
interdigitates with the other constrictors
ma

A commencement of peristaltic swallowing contractions


BS thyroid arteries, lingual
P
Superior Pharyngeal Constrictor
O/I Anterior - lower 2/3 of Medial Pterygoid Plate
rA

Pterygomandibular raphe
Mandible - mylohyoid line
I Posterior - upper part of posterior pharyngeal raphe
aponeurosis to the clivus of Occiput
interdigitates with Middle Pharyngeal Constrictor
©D

A commencement of swallowing
BS facial maxillary lingual and pharyngeal branches

NS pharyngeal plexus with fibres from: glosso pharyngeal


(CN IX) vagus N (CN X), hypoglossal N (CN XI) and
sympathetic fibres
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Platysma
part of the muscles of facial expression
muscle completely in the superficial fascia of the face

eill
O superficial fascia of the upper chest
I superficial fascia of the chin and jaw up to the lower lips
interdigitates with the muscles at the modiolus of the
corners of the mouth

aN
A moves the skin from lower jaw to chest
depresses the lower lip
assists in depression of the Mandible
NS facial N cervical branch (CN VII)
BS facial, inferior alveolar, laryngeal
nd
T ability to tighten neck and jaw muscles and skin
ma

P
rA
©D

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Posterior Cricoarytenoid
part of the muscles of the Larynx

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O posterior aspect of the cricoid cartilage
I muscular process of the arytenoid cartilage
A abducts the arytenoid cartilages opening the
rima glottidis
NS recurrent laryngeal N (branch of the vagus N = CN X)

aN
BS cricothyroid branches of superior and inferior
thyroid arteries
T ability to breathe

This is the only muscle which opens the normally closed rima
nd
glottidis and allows for the passage of air into the lungs -note
if the recurrent laryngeal nerve is damaged it may be
impossible for air to enter the trachea.
Note the direct antagonist the CRICOARYTENOID has similar
attachments but different placement causing reverse
ma

swivelling of the cartilages and closing the vocal cords.

P
rA
©D

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Procerus
part of the muscles of facial expression

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O facial aponeurosis covering the lower part of the nose
and lateral nasal cartilages
I superficial fascia b/n eyebrows continuous with
Frontalis (Epicranius)
A depresses medial end of the eyebows - frowning muscle

aN
NS facial N (CN VII) temporal branch
BS ophthalmic - supraorbital, supratrochlear branches
T ability to wrinkle forehead
nd
ma

P
rA
©D

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Pterygoid Lateral, Medial


part of the muscles of mastication

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Lateral Pterygoid
O superior head - infratemporal crest of Sphenoid
inferior head - lateral surface of lateral pterygoid plate
of Sphenoid
I intra-articular cartilage of temporomandibular joint

aN
pterygoid fovea inferior to the condyloid process of
the Mandible
A opens jaw via depressing and protracting Mandible
pulls the intra-articular cartilage of the TMJ forward
moves Mandible from side to side
nd
NS N to Lateral Pterygoid from trigeminal N mandibular
division (CN V3)
BS maxillary and its branches
T open jaw against R
Medial Pterygoid
ma

O medial surface of lateral pterygoid plate of Sphenoid


Palatine bones, Maxilla
P I medial surface of the angle of the Mandible
A closes jaw / Mandible
rA

moves Mandible back and clenches teeth


assists in side to side action of the Mandible
NS trigeminal N mandibular division (CN V3)
BS maxillary and its branches
T abililty to clench teeth and pull jaw back
©D

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Pupillary muscles = Dilator Pupillae +


Sphincter Pupillae

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part of the intrinsic muscles of the eye
Dilator Pupillae
O mesodermal stroma in the periphery of the iris
I the iris interdigitates with the outer parts of the
Sphincter Pupillae

aN
A constriction of pupil aperature for light and focus
NS oculomotor N (CN III) - parasympathetic fibres
BS internal carotid and ophthalmic and lacrimal branches
to the eye
T ability to adjust to light and focus
nd
Sphincter Pupillae
O/I collagenous connective tissue at the pupillary end of
the dilator pupillae
ma

circumferentially around the pupil


A constriction of pupil aperature for light and focus
NS oculomotor N (CN III) - parasympathetic fibres
P
BS internal carotid and ophthalmic branches to the eye
T ability to adjust to light and focus
rA
©D

Recti muscles part of muscles of the Eye see Inferior


Rectus, Lateral Rectus, Medial Rectus, and Superior
Rectus - medial/lateral - superior/inferior

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Rectus Capitus
Anterior / Lateralis / Posterior

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Rectus Capitus Anterior
O TP of Atlas (C1)
I Occiput - inferior surface of basilar part
A flexion (head) at the Atlanto-Occipital joint
NS N to Rectus Capitus part of CP (C2-3), suboccipital N (C1)

aN
BS vertebral
T flex head against R
Rectus Capitus Lateralis
O TP of Atlas (C1)
nd
I Occiput - jugular process
A lateral flexion (head) unilateral action
NS N to Rectus Lateralis (C1-3) part of CP
BS vertebral
ma

T laterally flex head against R


rA

R
©D

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Rectus Capitus
Posterior - Major

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O SP of Axis (C2)
I Occiput - lateral to the inferior nuchal line
A bilateral extension (head)
unilateral ipsi-rotation - (to the same side)
NS suboccipital N (C1)

aN
BS vertebral, occipital
T extend head against R / turn head against R
Rectus Capitus
Posterior - Minor
nd
O posterior arch of Atlas (C1)
I Occiput - medial to the inferior nuchal line
A extension (head)
NS suboccipital N (C1)
ma

BS vertebral, occipital
T extend head against R
rA

R
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Risorius
O deep fascia of the face superficial to Masseter

eill
I skin at the angle of the mouth
A grinning (variable) - retracting the angle of the mouth
NS facial N inferior buccal branch (CN VII)
BS facial - transverse facial branch

aN
nd
ma
rA

R
©D

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The A to Z of the Head & Neck

Rotatores - Longus, Brevis


part of the deepest layer of muscles of the Spine - VC
series of small muscles extending from Atlas to Sacrum

eill
Longus completely overlays Brevis.
Has slips in the Neck - Cervicis region although not
individually named
O&I Longus - SP to lamina of the VB 2 above

aN
Brevis - SP to lamina of the VB 1 above
A bilateral - extension of the VC -neck region
unilateral - rotation of the VC at the level of individual VBs
NS segmental dorsal rami of the SNs
BS vertebral
nd
carotid, posterior branches of
ma
rA

R
©D

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Salpingopharyngeus
part of the muscles of the anterior triangle in the neck

eill
O inferior surface of auditory tube
I blends with Palatopharyngeus
A elevation of upper pharyngeal wall
opens auditory tube in swallowing
NS vagus N (CN X)

aN
accessory N (CN XI)
BS facial, maxillary pharyngeal branches
T ability to swallow – early stages
note this is the muscle which helps to equalize the pressure
nd
in the ears and why there is relief when yawning or opening
the mouth in a plane
ma
rA

S
©D

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The A to Z of the Head & Neck

Scalenus
Anterior, Medial & Posterior (Minimus)

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Dilator Pupillae
O anterior TP of C3-7
medial TP of C3-7
posterior TP of C5-7

aN
I anterior anteromedial surface of rib 1
medial lateral to the anterior muscle rib 1
posterior rib 2 inferior to the Clavicle
A with fixed neck and Clavicle
elevation of the ribs in forced inspiration
nd
accessory muscle of inspiration
bilateral - flexion (neck)
unilateral - rotation & lateral flexion of the neck
NS segmental - SNs anterior branches
ma

(C4-7 anterior & lateral C6-8 posterior)


supraclavicular branches of the BP Ns (C4-8)
N to Longus Colli and N to Scaleni muscles
BS superficial cervical
rA

T flex neck against R


S laterally flex neck against R
note on Scalenus Minimus - variable slip pf muscle which
attaches to the Suprapleural membrane (Sibson’s fascia) and
©D

TP of C7 maintains the elevation of this pleura above the


Clavicle often considered part of Scalenus Anterior

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The A to Z of the Head & Neck

Semispinalis - Capitus, Cervicis


part of the deep muscles of the spine / neck
more lateral than Spinalis

eill
Capitus
O TP of C4-7
I superior & inferior nuchal lines (Occiput)
A bilateral extension (head)

aN
unilateral rotation (head)
NS suboccipital N - dorsal rami (C1)
Cervicis
O TP of T1-6
nd
I SP of C1-5
A bilateral extension (neck)
unilateral rotation (head)
NS dorsal rami of the segmental SNs (C2-T5)
ma

BS segmental branches from local BVs


T ability to extend and rotate neck

Soft Palate Muscles – Musculus Uvulae, Palatoglossus,


rA

Levator & Tensor Veli Palatini


S see the muscles of the Larynx, Pharynx and individual
listings

Sphincter pupillae see Pupillary muscles


©D

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Splenius - Capitus, Cervicis


superficial to Spinalis

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Capitus
O SP and supraspinous ligaments of T1-3
I lateral superior nuchal lines (Occiput)
mastoid process (Temporal bone)
A bilateral hyperextension, extension (head and neck)

aN
stabilization (head)
unilateral rotation (head and neck)
NS dorsal branches of SN - dorsal rami (C1-4)
suboccipital N, greater occipital N (C1-4)
Cervicis
O ligamentum nuchae and TP of C1-3
nd
I SP and interspinous ligaments of T1-4
A bilateral extension, hyperextension (neck and upper VC)
unilateral stabilization (neck)
NS dorsal rami of the segmental SNs (C3-8)
ma

BS branches of the internal carotids


T neck movements
rA

S
©D

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The A to Z of the Head & Neck

Stapedius S
O posterior wall of the inner ear

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I neck of Stapes
A dampens down the ossicle chain to reduce vibrations
NS facial N (CN VII) inner ear branch
BS internal carotid, maxillary, facial, middle
meningeal branches

aN
Tensor Tympani T
O cartilaginous and boney margins of the auditory tube
greater wing of the Sphenoid
I handle of the Malleus
nd
A pulls the Malleus medially and tenses the “ear drum”
NS N to Medial Pterygoid (from mandibular division of
trigeminal N (CN V3)
BS middle meningeal of mandibular
ma

pharyngeal, internal carotid branches


T involved in control of hearing adjustment to
sound levels
rA

S
T
©D

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S
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T S
T
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The A to Z of the Head & Neck

Sternocleidomastoid
O Manubrium (breastbone)

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anterior surface of medial 1/3 of the Clavicle
I mastoid process (Temporal bone)
anterior 1/3 of superior nuchal line
A bilateral flexion (head and neck)

aN
unilateral rotation (head and neck)
NS accessory N (CN XI)
N to Sternocleidomastoid (ventral rami of SNs C1-2)
BS superficial cervical
T turn head against R
nd
flex head against R
ma
rA

S
©D

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The A to Z of the Head & Neck

Sternohyoid
part of the muscles of the Hyoid (anterior neck)

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O posterior surface of Clavicle and Manubrium
I inferior border of Hyoid
A depress the Hyoid (for swallowing)
NS ansa cervicalis (C1-3)
BS thyroid

aN
T observe movement of Hyoid with swallowing
Sternothyoid
part of the muscles of the anterior triangle in the neck
O posterior surface of Manubrium and 1st costal cartilage
nd
I oblique lines of the laminae of the Thyroid cartilage
A depress the Hyoid and Larynx (for swallowing)
NS ansa cervicalis (C1-3)
BS thyroid
ma

T observe movement of Hyoid with swallowing


rA

S
©D

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The A to Z of the Head & Neck

Styloglossus
O apex of styloid process (Sphenoid)

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stylomandibular ligament
I superolateral sides of the tongue
decussating with Hypoglossus
A retracts and elevates tongue

aN
NS hypoglossal N (CN XII)
BS facial, lingual
T ability to initiate swallowing
nd
ma
rA

S
©D

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The A to Z of the Head & Neck

Stylohyoid
part of the muscles of the anterior triangle in the neck

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O base of styloid process (Sphenoid)
I posterior surface of the Hyoid to the greater cornu
A elevate and retract the Hyoid and larynx (for swallowing)
NS facial N (CN VII)
BS posterior auricular, occipital

aN
T ability to swallow
Stylopharyngeus
part of the muscles of the Pharynx
O medial aspect of styloid process (Sphenoid)
nd
I posteriolateral border of the laminae of the
Thyroid cartilage
A elevates the Hyoid and Larynx (for swallowing)
NS glossopharyngeal N (CN XII)
ma

BS thyroids, tonsillar, lingual


T ability to swallow
rA

S
©D

Superior Lingualis see Linguali muscles/Intrinsic muscles


of the Tongue

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The A to Z of the Head & Neck

Superior Oblique
O lesser wing of Sphenoid superomedial to tendinous ring

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I through the trochlea/fibrocartilagneous loop to the
sclera behind the equator
A depresses eye in adduction
medially rotates eye in abduction
NS trochlear N (CN IV)

aN
BS ophthalmic
T test eye movements (note works in conjunction with
other eye muscles)

Superior Pharyngeal Constrictor see Pharyngeal


nd
Constrictors
Superior Rectus
O superior tendinous ring
I superior scleral equator
ma

A elevates eye
medially rotates eye in adduction
NS oculomotor N (CN III)
BS ophthalmic
rA

T test eye movements


S (note works in conjunction with other eye muscles)
©D

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The A to Z of the Head & Neck

Temporalis
O temporal fossa of the Frontal, Parietal and

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Temporal bones
I coronoid process and ramus (Mandible)
A closes jaw
retracts Mandible
clenches teeth

aN
NS mandibular division of trigeminal N (CNV)
BS maxillary
middle & superior temporals
T test strength of closed jaw or close against R (with care)
nd
Temporparietalis
O deep to Temporalis, aponeurosis above Auricularis
I galeal aponeurosis (b/n Frontalis and Occipitals)
A fixes galeal aponeurosis
ma

NSfacial N (CN VII)


BSmaxillary
middle & superior temporals
T test strength of closed jaw or close against R (with care)
rA

Tensor Tympani see Stapedius


T
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The A to Z of the Head & Neck

Tensor Veli Palatini


O scaphoid fossa (Sphenoid)

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rim of auditory tube
spine of Sphenoid
I palatine aponeurosis, crest and osseous surface via a
pulley through the pterygoid hamulus
soft palate

aN
A elevates soft palate, closing off nasopharynx
from oropharynx
NS N to Medial Pterygoid from mandibular division of
trigeminal N (CN V3)
BS facial, maxillary ± ascending pharyngeal
nd
T poorly function in snoring
often affected in stroke where fluids are directed out
of the nose
ma
rA

T
©D

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The A to Z of the Head & Neck

Thyroarytenoid + Vocalis
O inferior surface of thyroid cartilage

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cricothyroid ligament
I vocal processes of the arytenoid cartilages
A relaxes the vocal folds by protracting the
arytenoid cartilages
NS vagus N (CN X) recurrent laryngeal branch

aN
BS hyroids pharyngeal branches
T ability to change voice tone

Thyroepiglotticus (not shown)


nd
O lower posterior surface of thyroid cartilage
I epiglottic fold and margin
A closes additus to the Larynx
NS vagus N (CN X) recurrent laryngeal branch
ma

BS thyroids pharyngeal branches


T ability to change voice tone

these small muscles interdigitate, work together in a


rA

coordinated manner and are responsible for the tone and


special qualities of the voice

T
©D

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Thyrohyoid
part of the muscles of the anterior triangle in the neck

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O oblique lines of the laminae of the Thyroid cartilage
I Hyoid - cornu and body
A depresses & elevates the Larynx
NS C1 with hypoglossal N (CN XII)
BS thyroid

aN
T observe movement of Hyoid with swallowing

Transverse Arytenoid see Arytenoids

Transverse Lingualis see Linguali muscles/Intrinsic


nd
muscles of the Tongue

Vertical Lingualis see Linguali muscles/Intrinsic


muscles of the Tongue
ma

Vocalis see Thyroarytenoid


rA

T
©D

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The A to Z of the Head & Neck

Zygomaticus – Major, Minor


part of muscles of facial expression

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Zygomaticus Major
O Zygoma - cheekbone
I deep fascia at the angle of the mouth (modiolus)
A draws mouth back smiling/laughing

aN
NS facial N (CN VII)
BS facial
T smile
Zygomaticus Minor
O Zygoma - cheekbone
nd
deep fascia of the upper lip
A maintains nasolabial furrow - philtum
everts upper lip
NS facial N (CN VII) buccal branch
ma

BS facial
often lost in cosmetic surgery i.e. no skin crease from
nose to lips
rA
©D

Z
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The A to Z of the Head & Neck

Overviews of Structures and features of the


Head and Neck

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Arteries and Anastomoses (AA)
of the Head and Neck
The arterial supply of the Head and Neck and face is
particularly rich and overlapping (anastomotic). This is most

aN
important due to the poor definition of the fascial layers, the
extensive mobility of the region, the concentration of Ns and
special sensory structures.
The major supply of the extracranial BVs are from the external
carotid. Supply also comes from the internal carotid and the
vertebral arteries, and communication exists b/n all 3 sources.
nd
Major Arteries of the Head and Neck
1 supraorbital
2 supratrochlear
ma

3 frontal
4 parietal
5 zygomatico-orbital
6 infraorbital
rA

7 transverse facial
8 anterior & posterior auricular
9 external carotid from the common carotid
10 facial
11 mandibular - sublingual + submental branches
©D

12 maxillary - superior +inferior alveolar branches


13 superfical temporal
14 middle temporal
15 labial vessels

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1 2 1
3

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4

aN
6
10
nd
9

15
13
ma

3
14

4 1
2
rA

7
©D

12
8
11
9 10

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The A to Z of the Head & Neck

Major Anastomoses of the Head and Neck


1 AA b/n the supratrochlear / supraorbital / superficial

eill
temporal arteries from both the internal and external
carotid arteries
2 AA b/n the anterior ethmoidal / maxillary branches and
deep facial arteries in the nasal septum - (Little’s area)
3 AA b/n the R & L and the upper & lower labial arteries

aN
4 AA b/n the sublingual / submental /inferior alveolar
arteries - all from the external carotid artery
5 AA b/n the superior and inferior thyroid arteries - from
the external and common carotid arteries
6 AA b/n the ascending & deep cervical / vertebral
nd
arteries - from the aortic arch and common carotid
artery
7 AA b/n the occipital and deep cervical arteries
8 AA b/n the posterior auricular / occipital / superficial
ma

temporal arteries - from the external carotid


9 AA b/n the superficial temporal arteries -
communicating b/n different sides of the scalp
10 AA b/n the deep temporal and the middle meningeal
arteries -communicating b/n the extra-cranial and
rA

intra-cranial BSs
11 AA b/n the superficial and deep arteries of the face -
communicating b/n the fascial and muscle layers
which are poorly defined in the face
©D

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10

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9 1

aN 2
nd
ma

3
7

6
11
rA

5
©D

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The A to Z of the Head & Neck

Nerves of the Head


and Neck -

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Cervical Ns, Cranial Ns and
Cutaneous Ns CN
I
The Cervical Ns are from the PNS.
II
They are the 8 paired Spinal Ns
which come from the SC and exit III

aN
from the intervertebral foraminae of
the Cervical Vertebrae - (discussed
in the A to Z of Peripheral Ns). The
Dorsal rami of these Ns innervate IV
most of the posterior muscles of the V
neck and the overlying skin and the
nd
Ventral rami form the Cervical VI
Plexus (CP) and innervate,
VII
combining with the CNs: the neck
structures, including the muscles
ma

and skin, anterior to the VC.


The Cranial Nerves are defined as
those Ns which exit directly from VIII
the Cranium/ Skull. There are 12 IX
pairs and their functions are
rA

summarized in the table below.


They are numbered according to the
order at which they exit the cranium
and they are named to reflect their X
function. Their pathways are
©D

discussed in detail in the A to Z of


the Brain and Cranial Ns but an
overview showing their origin is XI
demonstrated in the diagram
XII
showing the Head & Neck in the
sagittal plane.

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The A to Z of the Head & Neck

Cranial Ns
1 Olfactory tract and bulb (CN I)

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2 Optic chiasma and N (CN II)
3 Occulomotor (CN III)
4 Trochlear (CN IV)
5 Trigeminal (CN V)

aN
6 Abducens (CN VI)
7 Facial N and Nervus Intermedius (CN VII)
8 Vestibulococchlear (CN VIII)
9 Glossophayngeal N (CN IX)
10 Vagus (CN X)
nd
11 Accessory spinal and cranial component (CN XI)
12 Hypoglossal (CN XII)
ma
rA
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4
3
2

aN
nd 1
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7, 8
rA

10, 11
©D

12 6

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The A to Z of the Head & Neck

The Cutaneous Ns
The Cutaneous Ns are those PNs which innervate the skin

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of the Head & Neck. They are derived from: the Cervical
Plexus = CP - (Ventral rami of the Cervical Spinal Ns),
Dorsal rami of the Cervical SNs = dr, and branches of the
Trigeminal N in all divisions (CN V1, V2, V3).
There is extensive overlap of the innervation of this region

aN
and supply of Ns is considerable. Nerves are found to supply
the muscles, skin and special structures with a fair degree of
variation. The commonest distribution and emergence of the
cutaneous Ns is demonstrated in this diagram.
Cutaneous Ns
nd
1 Supratrochlear (CN V1)
2 Supraorbital (CN V1)
3 Palpebral branch of the Lacrimal N (CN V1)
4 Zygomaticotemporal + Zygomaticofacial (CN V2)
ma

5 Auriculotemporal (CN V3)


6 Greater Occipital N (C2 dr)
7 Occipital Ns - (C3-C8 dr)
8 Lesser Occipital N (C2-3 dr)
rA

9 Greater Auricular N (C2-3 CP)


10 Supraclavicular Ns (C3-4 CP)
11 Transverse Cutaneous N of the neck
= Tansverse Cervical N (C2-3 CP)
©D

12 Mental N (CN V3)


13 Buccal N (CN V2)
14 Infraorbital (CN V2)
15 External Nasal Br of the Anterior Ethmoidal N (CN V1)
16 Infratrochlear (CN V2)

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4 3
2
5 1

aN
16

15
nd
6
ma

7 14
rA

13
12
©D

8 11
9
10

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The A to Z of the Head & Neck

Extra-cranial Venous and Lymphatic


drainage of the Head & Neck

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Major Veins + Lymphatic vessels
1 Superficial Temporal V (drains the scalp)
2 Supraorbital V (drains the scalp)
3 Supratrochlear and communicating branches (drains

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the scalp)
4 Pterygoid plexus (drains the deep facial layers)
5 Maxillary V
6 Facial V (drains most of the face superficial and deep)
7 Mandibular V
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8 Lingual V
9 Common facial Vs
10 Anterior Jugular Vs (drains chin and superficial tissues
of the neck - drains to the External Jugular V)
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11 R Thoracic Lymphatic Duct


12 R Subclavian
13 Superior Vena Cava
14 L Brachiocephalic V
15 venous arch - communicating Vs
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16 L Subclavian
17 Thoracic duct
18 Internal Jugular (commences at the end of the
sigmoid sinus)
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19 External Jugular (superfical to the deep fascial layer of


the neck)
20 External Jugular posterior branch
21 Retromandibular V
22 Posterior Auricular V
23 Occipital V (draining into the Vertebral V)

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The A to Z of the Head & Neck

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The A to Z of the Head & Neck

Extra-cranial Venous and Lymphatic


drainage of the Head and Neck

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The venous and lymphatic drainage is subject to great
variation, extensive anastomoses and communication.
However the major vessels demonstrated here tend to be
consistent. Many of the veins in this region do not have
the same name as the arteries, and do not run with them.

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In the face there is no separation b/n the deep and superficial
fascial layers, but in the neck, veins are either superficial to
the deep fascia or deep to it traveling in these cases with the
respective arteries, as in other areas of the body.
Except for the cornea and CNS, all the structures of the
Head and Neck have extensive lymphatic drainage.
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Major groups are :
MASTOID - behind the ear, draining the ear & side of the head
OCCIPITAL - at the base of the skull, draining the posterior scalp
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PAROTID - superficial to the parotid salivary gland,


draining the side of face and scalp
SUBMANDIBULAR - near the submandibular salivary gland,
draining the side of the face and scalp
SUBMENTAL - under the chin, draining the chin, bottom
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teeth, lower face and anterior of the tongue


also the PRE-AND POST-AURICULAR AND
SUPRACLAVICULAR NODES are of significance clinically.
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The A to Z of the Head & Neck

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The major groups of Lymph nodes drain to the:

UPPER DEEP LOWER DEEP


CERVICAL NODES CERVICAL NODES
or

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around the internal at the root of
jugular vein the neck

Deep lymphatic drainage from the orbit,


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nose and pharynx drains to the:
LINGUAL TONSIL PALATINE TONSIL
around the internal or at the root of
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jugular vein the neck


children < 7 drains to
RETROPHARYNGEAL
TISSUE = ADENOIDS
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THEN ALL DRAIN to the major lymphatic ducts:


RIGHT LEFT
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THORACIC DUCT THORACIC DUCT

at the venous
or at the venous
junction b/n R subclavian junction b/n the L
& R internal jugular veins subclavian & L internal
subclavian veins

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The A to Z of the Head & Neck

Transverse section and fascial planes


of the Neck

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The neck unlike the face has well defined fascial planes
which allow for gross movements, and all the muscles lie
as usual deep to the investing fascial layer. These defined
planes are well demonstrated in the transverse section of
the neck opposite. Only one muscle is an extension from

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the face and lies outside these deep layers - Platysma.
1 skin, subcutaneous tissue, superficial fascia
2 SP of cervical vertebra
3 deep fascia and investing layers
4 Trapezius
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5 Splenius
6 Spinalis
7 loose CT / with LNs + vessels / autonomic ganglion / BVs
8 Transverse foramen + Vertebral artery
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9 Platysma
10 Sternocleidomastoid muscle
11 External Jugular V
12 anterior neck muscles / strap muscles
13 Anterior Jugular V
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14 Trachea + cartilagenous ring and surrounding fascia


15 Thyroid = 2 lobes + connecting Isthmus
16 Oesophagus
17 Carotid sheath and contents = carotid artery + internal
jugular vein + Vagus N
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18 Pretracheal fascia to allow for movement as a whole of


the trachea + thyroid and cricoid cartilages + glands
in swallowing
19 deep muscles of the neck and back = Rotatores,
Multifius, Intertransversarii
20 SC - Nervous tissue + coverings

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The A to Z of the Head & Neck

Head & Neck Topography Surface Anatomy


These regions do not reflect the Dermatomes or Langerhans

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lines, but act as a sensible regional guide to the skin areas of
the Head and Neck.
1 supraorbital
2 orbital
3 Nasal

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4 Infraorbital
5 Zygomatic
6 Oral / labial
7 Buccal / cheek
8 Parotid / masseteric
9 Mental / chin
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10 Submental
11 Submandibular
12 Hyoid
13 Carotid
14 Infrahyoid
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15 laryngeal
16/25 sternocleidomastoid
17 thyroid
18 suprasternal/jugular notch
19 Infraclavicular
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20 Acromial
21 Clavicular
22 Supraclavicular
23 Nuchal/posterior neck
24 Lateral cervical
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26 Occipital
27 Mastoid
28 Auricular
29 Temporal
30 Parietal
31 Frontal
32 Glabella (b/n the eyes)

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aN
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A to Z Book Head and Neck18E™:A to Z Book 18/02/09 9:33 AM Page 280

Dr. A. L. NEILL
BSc MSc MBBS PhD FACBS
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