2557

Human Gross Anatomy

(. 208) 2557 2555
2556 Grant's Atlas of Anatomy
edition edition 13

2.2 2 2 Grants atlas
2.2 Grants atlas 2.2 Grant's Atlas of
Anatomy. thirteenth edition

2557

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13

14

Superficial back, Pectoral region and Axilla

Shoulder (or Scapular) Region, Arm, and Anterior
Compartment of the Forearm
Palm of the Hand, Posterior Compartment of the Forearm,
Dorsum of the Hand and Joints of the Upper Limb
Bones, Muscles and Joints of the Vertebral Column
Triangles of the Neck
Face, Scalp, Parotid and Temporal Regions
Infratemporal Fossa
Skull and Cranial Fossa
Orbit and Contents
Nose, Mouth and Pharynx
Lower Limb I.
(Bones of the Lower Limb, Anterior and Medial
Compartments of Thigh, Gluteal Region and
Posterior Compartment of the Thigh)
Lower Limb II.
(Leg, Plantar of Foot and Joints of the Lower Limb)

1-2
3-8
9 - 11
12 - 29
30 - 36
37 - 49
50 - 63
64 - 77
78 - 86
87 - 93
94 - 109
110 - 116
117 - 130
131 - 145

146 - 162


1. Agur A.M.R. and Dalley AF. Grant's Atlas of Anatomy. Thirteenth edition. Lippincott Williams &
Wilkins, China. 2013.
2. Moore KL. Clinical Oriented Anatomy. Ilustrations from Grant's Atlas. fourth edition, The
Williams & Wilkins, Baltimore/London, 1999.
3. Morton DA, Peterson KD, Albertine KH. GRAYS Dissection Guide for Human Anatomy. Second
edition. Churchill Livingstone. 2007.
4. Tank PW. Grant's Dissector. Fourteenth edition, Lippincott Williams & Wilkins,
Baltimore/Maryland, U.S.A. 2009.

atlas
,
,
, loose connective tissue veins

1. ridged
gripping surfaces
2.
3.
4.
2 5
1

atlas
surface landmarks

skin incisions structures connective

tissue, fat fascia scissor
technique

structures
structures loose connective tissue structures

A.

B.

superficial fascia

C. Scissor technique

structures

1

landmarks
1.1 ( 1.3 Grants atlas)
- jugular notch (sternum)
- clavicle jugular notch lateral
end lateral acromion scapula
- body of sternum xiphoid process
sternum
- (nipple) areola

1.1 surface anatomy of the anterior chest wall (Grays dissection,2009)

Removal of skin of the pectoral region

skin incisions 1.2 :

1.2 (Grants dissector,2005)

1.
2.
3.
4.
5.
6.

jugular notch clavicle acromion of the scapula (A - B)

acromion (B - E)
skin incision (E - F)
skin incision jugular notch sternum (A-C)
skin incision sternum midaxillary line (C-D)
skin incision sternum nipple incision
(C-E)

(superficial fascia)
superficial fascia block
musculoskeletal system superficial
fascia deep fascia
deep fascia

Removal of skin of the upper limb

1.4
1.3
A, anterior view. B, posterior view
upper limb 1.3 1.4
structures
superficial fascia medial lateral flaps **
** superficial vein
1.5 ( 6.11 Grants atlas)
superficial vein (
)

1.5 Superficial veins of the upper limb

Removal of skin of the lower limb

1.6 :
oblique incision inguinal
ligament
anterior vertical incision lower
limb
(patella knee cap)
tibia dorsum of foot
transverse incision tibial
tuberosity, ,
lower limb

1.6:

superficial fascia

superficial inguinal lymph

nodes ( 1.7
5.16 Grants atlas)

1.7: superficial inguinal lymph nodes

superficial fascia great saphenous vein long

saphenous vein superficial vein
1.8 ( 5.11 Grants atlas)
superficial vein (
)

1.8: Superficial veins of the lower limb

Removal of deep fascia

deep fascia ( 5.15 Grants atlas)
deep fascia
deep fascia iliotibial band (tract)
( 5.26 Grants atlas) iliac tubercle
lateral tibial condyle (Gerdys tubercle) 2
tensor of fascia lata gluteus maximus
deep fascia (leg) (dorsum of foot)
extensor retinaculum ( 5.65 Grants atlas) deep fascia

Clinical Correlation:
superficial veins (valves) valves
valve superficial veins
(varicose veins)
coronary bypass surgery great saphenous vein graft vessel
graft.
------------------------

2

Removal of skin of the superficial back
:
landmarks
2.1 ( 4.28 Grants atlas) : external occipital protuberance
vertebral prominence
spine of the seventh cervical vertebra (C7)
sacrum iliac crest hip bone
anterior superior iliac spine medial
border of scapula inferior angle

2.1 Surface anatomy of the back (Gray dissection,2009)

10

2.2 :
1. skin incision external occipital
protuberance (X) (S)
posterior superior iliac spine
2. skin incision iliac crest S
T
3. skin incision inferior
angle scapula U V
4. skin incision vertebral
prominence (R) tip of
acromion (B) incision

5. skin incision external occipital

protuberance base of
mastoid process (M)

2.2:

skin superficial
fascia of back
3 flaps
deep fascia

2.3
( 4.29 Grants atlas)
**
** **

2.3 Superficial back muscle (Grays Dissection,2009)

11

Removal of skin of the lower limb ()

2.4 :
sacral spines tip of
coccyx
tip of coccyx
thigh
thigh
gluteal fold
tibial tuberosity
malleoli
2

lower limb
superficial fascia

2.4:

deep fascia

common fibular (peroneal)
nerve lateral
(head of fibula) ( 2.5
5.28 B Grants atlas)
deep fascia leg
5.69 B Grants atlas
skin deep fascia
plantar
aponeurosis ( 5.76 B Grants atlas)

2.5 Posterior view of the thigh

12

Superficial Back, Pectoral Region and Axilla

Atlas of Human Anatomy F.H Netter Grants Atlas

of Anatomy Grays Anatomy for Students

?

3.1 Bones of the upper limb

(Grays dissection,2009)

13

(clavicle or collar bone) ( 3.2 6.3 A,B Grants atlas)

3.2 Right clavicle (collar bone)

(scapula or shoulder blade) ( 3.3 6.3 A,B Grants atlas)

3.3 Right scapula A,Posterior view. B,Anterior view. C,Lateral view

14

15

(humerus) ( 3.4 6.3 6.34 Grants atlas)

3.4 Right humerus

(Grays dissection,2009)

16

ulna radius ( 3.5 6.3, 6.61

6.81 Grants atlas)

3.5 Right radius and ulna (Grays dissection,2009)

17

(bones of the hand) ( 3.6 6.91 Grants atlas )

3.6 (Grays dissection,2009)

18

2 Superficial Back, Pectoral Region and Axilla

superficial back muscles

3.7 Superficial back muscles

1. Trapezius muscle
deep fascia () trapezius

1. 3.8 ( 6.32 Grants atlas) trapezius
1 .

2. spinal accessory nerve (CN. XI)

transverse cervical artery

19

3.8 Spinal accessory nerve transverse cervical artery

trapezius

2. Latissimus dorsi muscle

3.9 ( 6.32 Grants atlas) latissimus dorsi

1. latissimus dorsi
thoracolumbar fascia
(
)

2.
thoracodorsal nerve deep
fascia

3.9 latissimus dorsi

20

3. Levator scapulae, Rhomboideus major and minor muscles

1. 3.7 ( 6.32 Grants atlas) trapezius
levator scapulae
2. rhomboideus major minor levator scapulae

pectoral region
(breast)

(mammary glands) 15-20 ( 1.5 A,B Grants

atlas) (lactiferous duct) (nipple)

1. 3.10 ( 1.5 C Grants atlas)

retromammary space
deep fascia
pectoralis major
2.

suspensory ligaments (Coopers
ligaments)
mammogram
3.
deep fascia
3.10 Sagittal section of female breast

21

Pectoralis

3.11 pectoral region

Pectoralis major and minor muscles

3.11 ( 6.14 Grants atlas) deep fascia
pectoralis major
humerus deltoid
1. pectoralis major 1 . (
humerus)

3.12 pectoralis major

22

2. lateral pectoral
( pectoralis major
lateral pectoral nerve) ( 6.20 Grants atlas)

3.13 pectoralis major lateral

lateral pectoral nerve medial pectoral nerve
3. 3.13 ( 6.26 Grants atlas) medial pectoral
pectoralis minor pectoralis major
4. pectoralis minor pectoralis major
medial pectoral nerve

23

Axilla
1. pectoralis minor
2. contents
axilla
3. 3.14 ( 6.26 Grants atlas) 3 contents of axilla
Long head of biceps brachii muscle
Short head of biceps brachii muscle
Coracobrachialis muscle
4. probe axillary sheath contents of axillary sheath
5. tributaries axillary vein cephalic vein

3.14 Walls and contents of axilla

24

axillary artery 3.15 3.16

3.15 Axillary artery

3.16 Axillary artery

25

1. axillary artery 3.15 3.16 ( 6.26 Grants atlas)

axillary artery artery subclavian artery first rib
axilla teres major brachial
artery
2. 3 axillary artery pectoralis minor :
First part lateral border of first rib
medial border pectoralis minor
Second part pectoralis minor
Third part lateral border pectoralis minor
teres major
3. axillary artery 2nd part 3rd part
Thoracoacromial artery second part axillary artery
pectoralis minor
Lateral thoracic artery second part axillary artery
pectoralis minor lateral
Subscapular artery third part of axillary artery
lateral border scapula subscapularis
teres major circumflex scapular artery
structure scapula circumflex branch
subscapular artery latissimus dorsi
thoracodorsal artery
Anterior posterior circumflex humeral arteries
subscapular artery surgical neck of
humerus posterior circumflex humeral artery quadrangular
space axilla axillary nerve

26

brachial plexus axilla 3.17 ( 6.26 Grants atlas)

3.17 Brachial plexus. A,divisions and cords. B, cords in situ

1. terminal branches of brachial plexus M 3.17 ( 6.26 Grants atlas)
2. lateral cord, medial cord posterior cord second part of
axillary artery
3. musculocutaneous nerve lateral root of median nerve terminal
branches of lateral cord
4. ulnar nerve medial root of median nerve terminal branches of medial
cord

27

5. 6.27 Grants atlas axillary nerve radial nerve terminal

branches of posterior cord
6. median nerve ( 6.26 Grants atlas) lateral root of
median nerve medial root of median nerve
7. medial cutaneous nerve of the forearm medial cord
ulnar nerve medial side of third part of axillary
artery

3.18 Brachial plexus: branches medial lateral cords

28

8. 3.19 ( 6.27 Grants atlas) posterior cord of brachial

plexus
thoracodorsal nerve 3 posterior
cord latissimus dorsi
thoracodorsal artery subscapular artery
lower subscapular nerve inferior subscapular nerve posterior
cord of brachial plexus thoracodorsal nerve lower
subscapular nerve subscapularis
teres major
upper subscapular nerve superior subscapular nerve
subscapularis ()

3.19 Brachial plexus: branches posterior cord

29

9. 3.20 ( 6.29 Grants atlas) serratus anterior

10. long thoracic nerve apex of axilla superficial surface

serratus anterior

3.20 serratus anterior long thoracic nerve

serratus anterior
subscapularis serratus anterior
medial border of scapula serratus anterior
protract scapula
-------------------

30

4
Shoulder (or Scapular) Region, Arm, and Anterior
Compartment of the Forearm
Dissection of shoulder region and posterior compartment of the
arm

1. deep fascia deltoid
2. deltoid spine acromion of scapula
clavicle deltoid axillary
nerve posterior circumflex humeral artery deltoid
( 6.42 Grants atlas)

4.1 Right deltoid. A, posterior view. B, anterior view.

C, anterior view subacromial bursa deep surface deltoid

31

3. trapezius

clavicle
4.2 ( 6.42 Grants
atlas) deep fascia

scapula

supraspinatus, infraspinatus,
teres minor, teres major, long
head lateral heads of
triceps brachii.
4. 4.4 ( 6.42 Grants
atlas) quadrangular space
axillary nerve
posterior circumflex humeral
artery

4.2 Posterior view of shoulder and arm

5. axillary nerve

teres
minor
6.
supraspinatus
infraspinatus
4.3
suprascapular nerve
artery

4.3 Suprascapular nerve artery

32

7. radial nerve profunda brachii artery long head lateral heads of

triceps brachii
8. 4.4 A ( 6.41 Grants atlas) probe radial nerve profunda
brachii artery lateral head of triceps brachii muscle spiral groove of
humerus radial nerve
brachioradialis brachialis
9. lateral head of triceps brachii muscle radial nerve profunda brachii
artery spiral (radial ) groove

4.4 lateral head of triceps brachii muscle

radial nerve profunda brachii artery

33

anterior compartment of the arm

4.5 Muscles and nerves anterior compartment of the arm

1. 4.5 4.6 ( 6.37 Grants atlas) 3 anterior
compartment
coracobrachialis
brachialis
biceps brachii
2. 6.39 Grants atlas tendon of long head of biceps brachii muscle
capsule of shoulder joint
3. musculocutaneous nerve coracobrachialis
distal lateral cutaneous nerve of the forearm

 4
34
4. median nerve brachial artery cubital fossa
5. ulnar nerve medial side brachial artery medial
intermuscular septum medial epicondyle

4.6: A. Cubital fossa; B. Muscles of anterior compartment of arm and related structures;
C. Section of biceps brachii musculocutaneous nerve

cubital fossa
1. 4.6 ( 6.49 C Grants atlas) tendon of biceps brachii cubital
fossa
2. bicipital aponeurosis tendon of biceps ( 4.6 A)
3. biceps tendon, brachial artery, median nerve cubital fossa
lateral medial
4. brachial artery distal brachial artery 2 terminal
branches radial artery ulnar artery ( 6.49 D Grants atlas)

35

anterior compartment of the forearm

1.
superficial layer of anterior
forearm muscles
radial side to ulnar side
4.7 ( 6.63
Grants atlas) :
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris

4.7: Superficial layer of anterior

forearm muscles
2. tendon of palmaris
longus
5 ..
tendon
3. 4.8 ( 6.64 Grants
atlas)
flexor
digitorum superficialis
second layer of superficial muscles of
the anterior forearm
4. origin flexor
digitorum superficialis
anterior oblique line of the
radius

4.8: Flexor digitorum superficialis

36

5. 4.9 ( 6.65 Grants

atlas) deep flexor muscles
of the forearm 3 :
flexor digitorum profundus,
flexor pollicis longus
pronator quadratus
6. 4.10 ( 6.65 Grants atlas)
radial artery medial
(anterior)
border

brachioradialis
7. ulnar artery
flexor digitorum superficialis
ulnar
nerve flexor capi ulnaris
8. common interosseous artery
ulnar artery
9. 6.67 Grants atlas
median nerve

flexor digitorum superficialis

tendons
flexor carpi radialis flexor
digitorum superficialis

tendon of palmaris longus

10. 6.65 Grants atlas
anterior interosseous
nerve 3 deep flexor
muscles of the forearm

median nerve

4.9: Deep flexor muscles of the forearm

4.10 Nerves and vessels of the forearm

37

5 Palm of the Hand, Posterior Compartment of

the Forearm, Dorsum of the Hand, and Joints
of the Upper Limb
palm of the hand
1. tendons flexor
digitorum superficialis, flexor digitorum profundus / flexor pollicis longus (
)
2. skin superficial
fascia
palmar aponeurosis deep
fascia ( 6.69
Grants atlas)
3. fascia
lateral palmar
aponeurosis thenar
muscles thenar
eminence
4. palmaris brevis
muscle superficial
muscle origin medial
border of palmar aponeurosis

5.1 Palmar aponeurosis

hypothenar eminence
5. palmaris brevis muscle palmar aponeurosis medial
ulnar nerve and artery
6. palmar aponeurosis distal tendon of palmaris longus
palmar aponeurosis nerves and blood vessels

 5
38
7. 5.2 ( 6.74 A Grants atlas) superficial palmar arch
ulnar artery superficial palmar branch of
radial artery
8. common palmar digital arteries superficial palmar arch
palmar digital nerves
9. 6.74 B Grants atlas) ulnar nerve superficial branch
of ulnar nerve (little or fifth finger) medial half (ring or
fourth finger)
10. deep branch of ulnar nerve hypothenar
muscles deep branch of ulnar nerve

5.3 flexor retinaculum

5.2 Suparficial dissection of the palm
11. flexor retinaculum flexor retinaculum
12. probe carpal tunnel flexor retinaculum forearm

 5
39
13. 5.3 flexor retinaculum probe structures
carpal tunnel
14. flexor retinaculum 2 flaps carpal tunnel ( 6.75
Grants atlas) median nerve, tendons flexor digitorum superficialis, flexor digitorum
profundus flexor pollicis longus synovial sheaths
15. 5.4 ( 6.74 B Grants atlas) median nerve
recurrent branch of median nerve
thenar muscles

5.4 Nerves of the hand: median nerve and ulnar nerve

16. 5.5 ( 6.74 Grants atlas) deep fascia thenar eminence
thenar muscles 3
abductor pollicis brevis flexor pollicis brevis
recurrent branch of median nerve thenar eminence
abductor pollicis brevis distal recurrent branch of median
nerve distal part distal
opponens pollicis
flexor pollicis brevis proximal part recurrent
branch of median nerve

 5
17. hypothenar muscles 3

40

abductor digiti minimi origin pisiform bone

flexor digiti minimi lateral abductor digiti minimi
origin flexor retinaculum ()
opponens digiti minimi abductor digiti minimi
18. 5.5 ( 6.74 B
Grants atlas)

fibrous digital sheaths

19. fibrous digital

sheaths
tendons of flexor digitorum
superficialis
tendons of flexor digitorum
profundus
( 6.78 Grants
atlas)
5.5 : Muscles and tendons of the hand
20. 6.74 B Grants
atlas)

lumbrical
tendons of flexor digitorum
profundus
21. tendons of flexor
digitorum superficialis
flexor digitorum profundus
2 3

adductor
pollicis ( 5.6
6.77 Grants atlas)

5.6 : Deep structures of the hand

41

posterior compartment of forearm and dorsum of hand

5.7: Superficial layer of posterior forearm muscles

1. 5.7 ( 6.84 Grants atlas) deep fascia posterior of
forearm :
Brachioradialis
Extensor carpi radialis longus
2. brachioradialis transverse axis of
elbow joint flexor of elbow joint

 5
42
3. superficial group of extensor muscle of the forearm lateral epicondyle
radial side ulnar side
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti mimini
Extensor carpi ulnaris
4. extensor retinaculum deep fascia
tendons tendons synovial sheaths

5.8 Deep layer of posterior forearm muscles A, posterior view. B,lateral view

 5
43
5. 5.8 ( 6.85 Grants atlas) tendons
anatomical snuff box :
abductor pollicis longus
extensor pollicis brevis
extensor pollicis longus
6. tendons forearm (fleshy
bellies) extensor carpi radialis
brevis extensor digitorum 3
lateral epicondyle
7. 5.9 ( 6.85 Grants atlas) supinator upper third of
radius
8. extensor
indicis tendon
compartment
tendons extensor
digitorum
9. posterior
interosseous nerve
deep branch
of radial nerve
supinator
10. superficial branch of
radial nerve

5.9 Posterior interosseous nerve

 5
11. 5.10 ( 6.84
Grants atlas)

extensor tendon

12. dorsal interossei

muscle

13. redial artery

floor of anatomical
snuffbox

1st dorsal
interosseous muscle

44

5.10 Dorsal surface of the hand

14. 5.11 ( 6.88 Grants atlas) tendon of extensor digitorum

Dorsal hood (Extensor hood) extensor expansion
metacarpophalangeal (MP) joint palmar ligament (volar plate)
anterior capsule of MP joint
Central band median band of extensor digitorum base of middle
phalange
Terminal tendon of extensor expansion lateral band
base of distal phalange

5.11 Extensor expansion

45

Joints of the Upper Limb

1. Sternoclavicular joint ( 5.12) ( 6.44 Grants atlas)

medial end of clavicle superolateral of manubrium of the
sternum synovial joint saddle

Sternoclavicular ligament
Costoclavicular ligament
Articular disc of
sternoclavicular joint

5.12 Sternoclavicular joint

2. Acromioclavicular joint ( 5.13) ( 6.44 6.45 Grants atlas)

lateral end of clavicle medial margin of acromion synovial
joint plane

Acromioclavicular joint
Coracoclavicular ligament
Coracoacromial ligament

5.13 Acromioclavicular and shoulder joints

46

3. Shoulder joint ( 5.14) ( 6.46 Grants atlas)

glenoid fossa head of humerus synovial joint ball
and socket

Anterior joint capsule glenohumeral ligament
Long head of biceps tendon
Glenoid labrum

5.14 Shoulder joint . A, anterior view. B, lateral view of the opened joint capsule

47

4. Elbow joint Proximal radio-ulnar joint ( 5.15 5.16) ( 6.55

6.56 Grants atlas)
Elbow joint synovial joint hinge proximal radio-ulnar joint
synovial joint pivot

Radial (lateral) collateral ligament
Ulnar (medial) collateral ligament
Anular ligament

5.15 Anterior view of elbow joint and proximal radio-ulnar joint

5.16 Elbow joint and proximal radio-ulnar joint : left, lateral view. Right, medial view

48

5. Wrist joint ( 5.17) ( 6.95 Grants atlas)

Wrist joint distal end of radius articular disc of distal radio-ulnar
joint proximal row of carpal bone (scaphoid, lunate, and triquetrum) synovial joint
condyloid

wrist joint
Bony articular surface of wrist joint
Articular disc of distal radio-ulnar joint

--------------------------------------------------

5.17 Wrist joint. A, osteology. B, ligament

49

6. Joints of the hand ( 5.18) ( 6.97 Grants atlas)

1st carpometacarpal joint
metacarpophalangeal (MP) joint
interphalangeal (IP) joint
Lateral collateral ligament of metacarpophalangeal (MP) joint
Palmar ligament (Volar plate) of metacarpophalangeal (MP) joint

5.18 Joints of the hand

-------------------------------

50

Bones, Muscles and Joints of the Vertebral

Column

Bones of the Vertebral Column

vertebra
vertebra vertebra

6.1 vertebra A,typical vertebra. B, intervertebral foramen

51

6.2 A, atlas and axis. B, typical thoracic vertebra. C, lumbar vertebra

6.3 A, sacrum. B, coccyx

52

2 Muscles of the Vertebral Column

()

6.5 rhomboid

6.4 latissimus dorsi

Intermediate muscles of the back

1. latissimus dorsi

2. serratus posterior
inferior
3. trapezius, levator
scapulae rhomboid
spines

4. serratus posterior
superior ( 4.30
Grants atlas)
6.6 Intermediate muscles of the back

53

Deep muscles of the back

6.7 Deep muscles of the back. A, superficial view. B, deep view

1. 6.7 ( 4.31 Grants atlas) erector spinae sacrospinalis

sacrum, spines
2. 3 erector spinae medial lateral
spinalis
longissimus
iliocostalis

54

3. erector spinae sacrum lumbar

transverso-spinalis ( 4.34 Grants atlas)

6.8 erector spinae

4. 3
multifidus,
rotatores,
semispinalis

multifidus lumbar

6.9 transverso-spinalis

55

5. quadratus lumborum anterior layer thoracolumbar

fascia lateral transverse processes iliac crest quadratus
lumborum lateral bending of the trunk

6.10: quadratus lumborum

56

Extensor muscles of the neck ()

1. trapazius
spine
()

2. 6.12 ( 4.31 Grants

atlas) splenius
capitis cervicis
upward and laterally

6.11 trapazius

6.12 Posterior muscles of the neck

3. splenius capitis cervicis spine

4. semispinalis capitis cervicis

transversospinalis ( 4.32 Grants atlas)
5. longissimus capitis cervicis lateral semispinalis
2

57

Suboccipital Region
skull bony landmarks
6.13
Superior nuchal line
Inferior nuchal line
External occipital protuberance
Foramen magnum
Occipital condyle
Occipital condyle articulate
superior articular facets of atlas
atlanto-occipital joints
Dens of axis articulate facet for
dens of anterior arch of atlas
atlanto-axial joint

6.13 : Occipital portion of skull

6.14: Posterior view of bony skeleton of the suboccipital region

58

suboccipital triangle ()
6.15 ( 4.37 Grants atlas) semispinalis capitis occipital
bone greater occipital nerve
semispinalis capitis (Greater occipital nerve dorsal ramus of C2
spinal nerve sensory nerve fibers vertebral canal intervertebral
foramen C1 C2 scalp occipital region)
semispinalis cervicis spinous process of axis
suboccipital triangle ( 4.38
Grants atlas)
obliquus capitis inferior (inferior oblique)
spinous process of axis (C2) transverse process of
atlas (C1)
rectus capitis posterior
major medial border
spinous process of axis (C2)
superolaterally inferior nuchal
line medial side
rectus capitis posterior
minor origin posterior tubercle
of atlas
obliquus capitis superior
(superior oblique) lateral border

transverse process of atlas (C1)
occipital bone
( suboccipital regions
suboccipital nerve
dorsal ramus of C1 spinal nerve
vertebral canal
occipital bone atlas)

6.15 : Suboccipital region

59

suboccipital nerve 6.15 ( 4.38 Grants atlas)

vertebral artery () content suboccipital triangle
vertebral artery suboccipital
triangle vertebral artery transverse foramen axis
atlas posterior arch of atlas ( 4.39 A Grants
atlas)
posterior atlanto-occipital membrane
posterior arch of atlas posterior margin of foramen magnum of occipital bone
vertebral artery posterior atlanto-occipital membrane
foramen magnum cranial cavity
Clinical Correlation:
cervical vertebrae ( 4.11 Grants atlas)
fractured dens spinal cord cervical region

60

joints of the vertebral column

( )
1. anterior posterior intervertebral joints

6.16 Intervertebral joints

Anterior intervertebral joint fibrous joint symphysis bodies

vertebrae intervertebral disc ( 4.17 4.18 Grants atlas)
Nucleus pulposus

Anulus fibrosus

Anterior longitudinal ligament

Posterior longitudinal ligament

6.17 intervertebral disc ligaments anterior intervertebral joint

61

Posterior intervertebral joint facet joint zygapophyseal joint

synovial joint gliding 6.18 6.19 (4.19 Grants atlas)
Ligamentum flavum
Interspinous ligament
Supraspinous ligament

6.18 Ligamentum flavum

6.19 Ligaments vertebrae

62

2. atlanto-axial atlanto-occipital joints

Atlanto-axial joint C1 C2 atlanto-occipital joint
occipital condyle skull C1

6.20 Atlanto-axial Atlanto-occipital joints

63

6.21 (4.13 4.14 Grants atlas) ligaments

Anterior longitudinal ligament anterior atlanto-occipital membrane

Posterior longitudinal ligament membrana tectoria
Transverse ligament of atlas
Alar ligament

A.

Transverse ligament
of atlas

B.

 6
64
6.21 Ligaments axis, atlas skull A, lateral view. B, posterior view.

64

Triangles of the Neck

Fascial planes of the Neck

fascial planes of the neck
7.1 ( 8.2 Grants atlas)

7.1 Overview of the fascial planes of the neck

Skin
Superficial cervical fascia platysma
Deep cervical fascia
Investing fascia
Pretracheal fascia
Prevertebral fascia
Carotid fascia
Retropharyngeal space potential space pretracheal prevertebral fascias

65

7.2
(A)
suprasternal notch (B)
A mandible
base of mastoid process (D)
7.2: Skin incision
B clavicle
lateral end (D) ()

platysma superficial muscle of
neck 7.3 ( 8.1 Grants atlas)
posteroinferior part platysma
basal part of posterior triangle of neck
7.3 Platysma

platysma muscle supraclavicular nerves ( 8.8 A Grants atlas)

fascial roof of posterior triangle of neck clavicle (
)
7.4 ( 8.8 Grants atlas) external jugular vein superficial
vein angle of mandible sternocleidomastois
fascial roof just superior to clavicle posterior triangle of the
neck

7.4 Contents of the superficial layer of the posterior triangle of the neck

 7
7.5
sternocleidomastoid flexor
muscles of the neck
spinal accessory nerve

sternocleidomastoid
7.4 ( 8.8 Grants atlas)

sternocleidomastoid posterior
triangle trapezius

66

7.5 Anterior muscles of the neck

sternocleidomastoid cutaneous nerves

7.4 ( 8.8 A Grants atlas) cutaneous nerves
7.6 ( 8.8 D Grants atlas) deep fascia floor of posterior
triangle of the neck scalenus anterior, scalenus medius levator
scapulae
7.7 ( 8.8 E Grants atlas) brachial plexus supraclavicular part
scalenus anterior scalenus medius
phrenic nerve scalenus anterior

7.6 Contents of the Intermediate layer

7.7 Contents of the deep layer

 7
Resection of Middle Portion of Clavicle

67

7.8 ( 8.8 E Grants atlas) clavicle 2 :

1. lateral trapezius deltoid clavicle
2. medial sternocleidomastoid clavicle

7.8 Resection of middle portion of clavicle

clavicular head sternocleidomastoid clavicle
middle portion of clavicle subclavius inferior
surface clavicle subclavius clavicle
7.6 ( 8.8 E Grants atlas) inferior belly omohyoid
base of posterior triangle medial end of clavicle fibrous expansion
omohyoid fascia
omohyoid fascia blood vessels and nerves base of posterior triangle
7.8 ( 8.8 F Grants atlas) subclavian vein
clavicle medially scalenus anterior sternocleidomastoid
3rd part of subclavian artery subclavian vein
subclavian artery scalenus anterior scalenus medius
trunk of brachial plexus
phrenic nerve scalenus anterior

68

Anterior Triangle of the neck

7.9 ( 8.6 Grants atlas) anterior triangle of neck :
median line of neck

sternocleidomastoid

mandible
Anterior triangle
triangles :
Carotid triangle
Muscular triangle
Submental triangle
Submandibular triangle

Muscular Triangle

7.9 Anterior triangle of the neck

7.10 ( 8.9 8.10 Grants

atlas) infrahyoid muscles 4
Sternohyoid muscle superficial
medial
Omohyoid muscle superficial
lateral
sternohyoid hyoid bone
sternothyroid
muscle ( 8.18 Grants atlas)
deep sternum
7.10 Infrahyoid muscles
oblique line of thyroid cartilage
thyrohyoid muscle deep oblique line of thyroid cartilage
hyoid bone

69

infrahyoid muscles gap

7.11 ( 8.18 A Grants
atlas)

superficial
structures of the neck midline

Hyoid bone
Thyroid cartilage largest
cartilage larynx
laminae
laryngeal prominence
7.11 Superficial structures in the anterior triangle
Adams apple

Cricoid cartilage thyroid cartilage cricoid cartilage

first tracheal ring sixth cervical vertebra
Thyroid gland trachea 2 lobes
isthmus
Trachea tracheal cartilaginous rings thyroid cartilage
thyrohyoid membrane thyroid cartilage hyoid bone
cricothyroid membrane thyroid cartilage cricoid cartilage
cricothyroid ligament
cricothyroid anterolateral cricothyroid ligament
Clinical Correlation:
Tracheotomy (tracheostomy) trachea

(vocal cords)
Superior (high) tracheotomy trachea isthmus of thyroid gland.
Inferior (low) tracheotomy trachea isthmus of thyroid gland.

70

cricothyrotomy cricothyroid membrane

medial part of cricoid cartilage thyroid cartilage
tracheotomy

Carotid triangle
7.12 ( 8.11 Grants atlas)
carotid triangle:
Posterior belly of digastric muscle

Superior belly of omohyoid muscle

Anterior border of sternocleidomastoid

muscle

7.12 Carotid triangle

sternocleidomastoid sternum clavicle

spinal accessory nerve spinal accessory nerve
internal jugular vein skull jugular foramen
( deeper structures common facial vein internal
jugular vein)
ansa cervicalis 7.13 ( 8.14 Grants atlas)
Ansa cervicalis inferior root C2-3 superior root C1
hypoglossal nerve carotid sheath

infrahyoid muscles

7.13 Carotid sheath contents

71

probe blunt dissect carotid sheath identify vessels carotid sheath

internal jugular vein lateral artery deep cervical lymph

nodes internal jugular vein
common carotid artery medial internal
external carotid arteries
Internal carotid artery neck
External carotid artery anteromedial internal carotid artery

7.14 carotid sinus bifurcation of common carotid artery

superior end of common carotid internal carotid artery
muscle fibers elastic fibers carotid
sinus pressoreceptors respond blood pressure
carotid body small mass of tissue
medial of carotid bifurcation carotid body respond chemical
composition
external carotid artery 7.15 ( 8.15 Grants atlas)

7.14 Carotid body and sinus

7.15 external carotid artery

72

superior thyroid artery ( 8.18 A Grants atlas)

external carotid artery just inferior and posterior to tip of greater horn of
hyoid bone superior pole of thyroid gland
superior laryngeal artery ( 8.20 Grants atlas) internal
laryngeal nerve thyrohyoid membrane larynx
7.16 ( 8.14 Grants
atlas) internal jugular vein
lateral
carotid arteries ( internal and
external carotid) medial
vagus nerve
posterior part of carotid sheath
internal carotid
artery internal jugular vein

7.16 : common carotid artery,

internal jugular vein vagus nerve

omohyoid
sternohyoid hyoid (
) hyoid
bone thyrohyoid
thyrohyoid hyoid bone 1
thyrohyoid membrane

7.17 ( 8.20 Grants atlas)
internal laryngeal nerve
thyrohyoid membrane just
inferior to greater horn of hyoid bone
superior part of larynx (
vocal cord)

7.17 Laryngeal branches of vagus nerve

73

internal laryngeal nerves terminal branch

superior laryngeal nerve
external laryngeal nerve superior laryngeal nerve
lateral and inferior internal laryngeal nerve
sternothyroid oblique line of thyroid cartilage
external laryngeal nerve cricothyroid

Submental Triangle ( 2 )
7.18 ( 8.11 Grants atlas)
submental triangle
:
Body of hyoid bone
Right and left anterior bellies of
digastric muscles

mylohyoid floor
submental triangle

7.18 Submental triangle

Submandibular Triangle
7.19
submandibular triangle:
Inferior border of the mandible
Anterior belly of the digastrics m.
Posterior belly of the digastrics m.

7.19 Submandibular triangle

8.13 Grants atlas submandibular gland submandibular lymph nodes

submandibular triangle submandibular lymph nodes

74

fascia superficial part of submandibular salivary gland

deep part mylohyoid
superficial part of submandibular salivary gland mylohyoid
superficial part of submandibular salivary gland
7.20 ( 8.14 Grants
atlas) stylohyoid
posterior belly of
digastrics muscle
tip of greater horn of hyoid
bone carotid artery
just inferior to posterior belly of
digastric muscle
7.21
hypoglossal nerve tip of
greater horn of hyoid bone
posterior belly of digastric
muscle
hypoglossal
nerve
hypoglossal nerve
posterior belly of digastric
stylohyoid muscles
submandibular triangle
hypoglossal nerve

mylohyoid

7.20 Contents of submandibular triangle

remove submandibular gland

7.21 Hypoglossal nerve

facial artery submandibular triangle

Thyroid Gland
7.22 ( 8.18 Grants atlas)
right and left lobes of thyroid
gland

isthmus tracheal
rings 2-4
pyramidal lobe ()
thyroid gland endocrine gland
arteries veins drain
7.23 ( 8.18
Grants atlas)
superior thyroid artery
external carotid artery
7.22 Thyroid gland and its relation
superior thyroid vein drain
internal jugular vein
Middle thyroid vein
vein drain internal
jugular vein
Inferior thyroid vein
inferior poles

lobes

brachiocephalic vein
manubrium
lateral lobe of thyroid gland

Inferior thyroid artery (

8.21 Grants atlas)
thyrocervical trunk
7.23 thyroid gland

75

76

7.24 ( 8.20 Grants atlas)

parathyroid glands
lateral lobes
thyroid gland

7.24 parathyroid gland

Clinical Correlation:
thyroid gland, parathyroid glands, recurrent
laryngeal nerve thyroidectomy
Parathyroid glands calcium phosphorus metabolism
parathyroid gland

Root of the Neck

root of neck thoracic inlet superior thoracic aperture :
manubrium of sternum
lateral first rib
body of first thoracic vertebra

left side of root of neck

7.25 ( 8.22 Grants
atlas) thyroid gland, trachea
esophagus
middle thyroid vein left
common carotid artery, internal
jugular vein, vagus nerve
content of carotid sheath

7.25 Left root of the neck

77

thoracic duct 7.26 ( 8.22

C Grants atlas)
thoracic duct mediastinum
esophagus
left carotid sheath
vein left
subclavian vein left internal jugular
vein.
7.26 ( 8.22 A Grants atlas)
thyrocervical trunk
1st part of subclavian artery
inferior thyroid artery

7.26 Thoracic duct in root of neck

suprascapular transverse cervical arteries

thyrocervical trunk phrenic nerve
internal thoracic artery inferior surface of subclavian artery
thoracic inlet thorax.
vertebral artery ( 8.22 B Grants atlas) 1st
part of subclavian artery
7.27 ( 8.23 B
Grants atlas) vertebral
artery

foramen transversarium of C6
vertebra apex
triangle of vertebral artery

scalenus anterior longus

colli
7.27 Triangle of vertebral artery

78

Face, Scalp, Parotid and Temporal Regions

8.1
A
C
(chin)

B nasion
8.1: Skin incisions
orbital margins
nasion
A tragus angle of
mandible C

subcutaneous fat (facial muscles)
subcutaneous muscles

8.2

79

8.2
orbicularis oris ( 7.16 Grants atlas) muscle
fibers
orbicularis occuli ( 7.12 Grants atlas) muscle
fibers 2 :
Orbital part
Palpebral part ( )
frontalis fibers orbicularis oculi
buccal fatpad ( 7.16 Grants atlas)
masseter
buccal fatpad buccinator
buccinator fibers
orbicularis oris
2.3 ( 7.16 Grants atlas)

inferior orbital margin

probe infraorbital nerve
and vessels infraorbital
foramen

inferior eyelid, side

of nose, upper lip

vertical plane
infraorbital nerve
mental nerve mental
foramen of mandible

8.3 Infraorbital and mental nerves

80

8.4 ( 7.16 Grants

atlas) supraorbital
nerve and vessels
superior orbital margin
supraorbital notch or foramen

8.4 Supraorbital nerves

Facial Nerves, Vessels, and Related Structures

8.5 ( 7.13 Grants
atlas) platysma
mandible

masseter
zygomatic arch
ramus of mandible
zygomatic arch
2 .. parotid
duct zygomatic arch

masseter
muscle

buccinators

8.5 Parotid gland and duct

81

parotid gland
masseteric fascia
masseter
5 facial nerve
parotid gland

Temporal branch
Zygomatic branch
Buccal branch
Mandibular branch
Cervical branch

8.6 Facial nerve and its branches

facial artery masseter

mandible medial angle of eye mandible, buccinator
muscle, maxilla
facial vein facial artery medial angle of eye

Parotid Region
bony skull bony landmarks
( 7.48 Grants atlas)
temporal bone : styloid
process, mastoid process, external
acoustic meatus, mandibular fossa
for head of mandible
mandible : head, neck,
posterior border of ramus
base of skull :
8.7 Bony landmark parotid region
stylomastoid foramen
base of styloid process base of mastoid
process facial nerve

82

Parotid region
Parotid sheath ( 7.47 A Grants atlas) deep fascia parotid gland
stem of facial nerve stylomastoid foramen :

sternocleidomastoid mastoid process

parotid sheath parotid gland mastoid process
mastoid styloid processes
facial nerve stylomastoid foramen ( 7.47 B Grants atlas)

external carotid artery carotid

triangle parotid
gland bifurcate
neck of mandible maxillary artery
superficial temporal artery (
7.47 C Grants atlas)

parotid
region auriculotempral
nerve mandibular
division of trigeminal nerve
superficial temporal vessels

8.8 Terminal branches of external carotid artery

Scalp
Scalp ( 7.20 Grants atlas) 5

8.9 scalp

83

1. (S) Skin
2. (C) Superficial connective tissue (fascia) dense connective tissue
vessels and nerves scalp
3. (A) Aponeurosis aponeurosis 2 frontalis muscle
occipitalis muscle epicranial
aponeurosis galea aponeurotica
4. (L) Loose connective tissue tissue 3
scalp frontalis occipitalis
5. (P) Pericranium periosteum

Scalp
8.10
nasion (A) vertex
(B) external occipital protuberance
(C)
coronal plane vertex (B)
(D)

8.10 Skin incisions

4 flaps of scalp superficial 3 layers of scalp pericranium loose

areolar space flaps of scalp sensory nerves vessels scalp
scalp temporalis fascia temporalis

84

Temporal Region
Bony Landmarks
skull bony landmarks 8.11 ( 7.3 Grants atlas)

8.11 Lateral view of the skull

Superior and inferior temporal lines zygomatic bone
temporal fossa posterior end of zygomatic arch
floor of temporal fossa:
Frontal bone
Parietal bone
Squamous part of temporal bone
Greater wing of sphenoid bone
Pterion suture H 4 floor of temporal
fossa

85

mandible bony landmarks 8.12 ( 7.48 Grants atlas)

Ramus angle of mandible
Mandibular notch ramus of mandible head
condyle of mandible coronoid process
mandible :
Lingula mandibular foramen
Mylohyoid groove
Mylohyoid line

8.12 Mandible

Structures of Temporal Region

parotid gland parotid duct
temporalis masseter ( 7.49 A Grants atlas)
muscles of mastication
masseteric fascia masseter

86

8.14 zygomatic arch

8.13 masseter
8.13 masseter zygomatic arch zygoma
angle of mandible messeteric nerve and vessels
mandibular notch
zygomatic arch zygoma 8.14 zygomatic arch
temporal fascia temporalis
temporal fascia temporalis
temporalis insertion coronoid process of mandible ( 7.49
Grants atlas) temporalis vertical
mandible (closure of the jaw) temporalis
retract mandible
------------------------

87

9 Infratemporal Fossa
Bony Landmarks
bony skull mandible
infratemporal fossa
9.1 ( 7.48 D Grants atlas) :
Medial wall - Lateral pterygoid plate
sphenoid
Anterior wall - Posterior surface of
maxilla
Lateral wall deep surface of ramus of
mandible
Posterior Temporomandibular joint (TMJ)
:

9.1 Infratemporal fossa

Inferior orbital fissure maxilla greater wing
of sphenoid
Pterygomaxillary fissure medial border of posterior surface of maxilla
lateral pterygoid plate maxillary vessels pterygopalatine
fossa
Greater wing of sphenoid roof infratemporal fossa roof
2 foramen ovale foramen spinosum
foramen ovale mandibular division of
trigeminal nerve
foramen spinosum spine cranial cavity
middle meningeal vessels
spine foramen spinosum
sphenomandibular ligament lingula of mandible

88

Infratemporal fossa ()
mandible 9.2
1 coronoid process

forcep

structures coronoid
9.2 mandible
process
coronoid process temporalis
temporal fossa deep temporal vessels and nerve

2 ramus of mandible lingula of mandible :

forceps neck of mandible
sphenomandibular ligament ramus of mandible lingula
sphenomandibular ligament
ramus of mandible blade of forceps structures
ramus of mandible
3 neck of mandible just inferior to temporomandibular joint
ramus of mandible lingula of mandible contents of
infratemporal fossa

89

9.3 ( 7.50 A Grants atlas) structures :

9.3 Lateral view of infratemporal fossa

inferior head of lateral pterygoid muscle lateral surface of lateral
pterygoid plate neck of mandible articular disc and capsule of
temporomandibular joint
lateral pterygoid 2
lateral pterygoid medial pterygoid inferior alveolar nerve lingual
nerve
inferior alveolar nerve lateral lingual nerve inferior alveolar
artery maxillary artery mandibular foramen
lingual nerve medial inferior alveolar nerve lingual nerve
superficial surface of medial pterygoid muscle medial side of last molar
mylohyoid nerve nerve to mylohyoid muscle
inferior alveolar nerve mandibular foramen

90

maxillary artery external carotid artery

neck of mandible infratemporal fossa superficial
deep inferior head of lateral pterygoid muscle (1/3 )
superior head of lateral pterygoid muscle inferior surface of greater
wing of sphenoid bone roof of infratemporal fossa
lateral pterygoid medial pterygoid
lingual nerve inferior alveolar nerve inferior head of
lateral pterygoid muscle superficial surface of lateral pterygoid plate
lateral pterygoid insertion neck of mandible articular disc
and capsule of temporomandibular joint
lateral pterygoid nerve vessels
lateral pterygoid

9.4 Nerves in infratemporal fossa

9.4 ( 7.50 B Grants atlas) lingual nerve superficial surface
of medial pterygoid muscle medial pterygoid
chorda tympani nerve facial nerve lingual
nerve

91

inferior alveolar nerve superficial surface of medial pterygoid muscle

lingual nerve mandibular nerve
foramen ovale roof of infratemporal fossa
probe foramen ovale mandibular nerve trigeminal
ganglion foramen ovale
buccal nerve mandibular nerve lingual nerve
buccinator muscle mucosa skin
sensory nerve
auriculotemporal nerve mandibular nerve inferior alveolar
nerve neck of mandible
temporal region superficial temporal artery

9.5 Arteries in infratemporal fossa

9.5 ( 7.51 Grants atlas) maxillary artery :
Inferior alveolar artery inferior surface of maxillary artery mandibular
foramen inferior alveolar nerve
Middle meningeal artery superior surface of maxillary artery
inferior alveolar artery middle meningeal artery foramen spinosum
middle cranial fossa
maxillary artery pterygomaxillary fissure pterygopalatine
fossa

92

Temporomandibular Joint
bony skull :
Mandibular fossa articular tubercle temporal bone
Neck and head with articular condyle mandible

9.6 A temporomandibulae joint

9.6 B temporomandibulae joint

9.6A capsule of temporomandibular joint head of

mandible
articular disc cavity of temporomandibular joint superior inferior
compartments ( 7.56 A Grants atlas)
lateral pterygoid insert neck of mandible
articular disc lateral pterygoid head of
mandible articular disc mandibular fossa articular
tubercle
skull cap
:
skull cap region
anterior half of scalp superior orbital margin (supraorbital
margin)
posterior half of scalp superior nuchal line

93

temporalis :
temporal fascia superior temporal line superior
posterior margins temporalis
temporalis
zygomatic arch

Remove skull cap (calvaria) and laminae ()
(elastic rubber string) skull supraorbital margin 2 ..
external occipital protuberance 2 ..
magic outer lamina
skull red bone marrow diploe
inner lamina dura mater brain cranial cavity
laminectomy C2
1-2 vertebrae
posterior arch of atlas lateral ends
posterior arch
occipital bone A (
lambdoid suture skull
calvaria ) B
lateral margin foramen magnum
9.7

9.7 occipital bone

---------------------------

 10

10

94

Skull and Cranial Fossa

: (skull)
medial wall

Skull on Anterior View

10.1 Anterior view of the skull

skull anterior aspect of skull 10.1 ( 7.2 Grants atlas) bony
landmarks :
Frontal bone
Maxilla frontal process frontal bone
medial aspect orbital margin

 10

95

Zygomatic bone
Mandible
Anterior nasal aperture piriform aperture
Nasion depression root of the nose
Superciliary arch (ridge)
Glabella smooth eminence superior to nasion superciliary arches
Entrance of the orbit 3 :frontal, maxillary,
zygomatic bone 1/3 orbital margin
Lacrimal bone anterior part of medial orbital wall frontal
process of maxilla lacrimal fossa nasolacrimal canal
nasal cavity
Teeth adult 32 16 alveolar processes
upper jaw maxilla 16 alveolar processes lower
jaw mandible. 2 (temporal or decidual teeth) 20
10

skull on lateral and posterior views

skull lateral posterior aspect of skull 10.2 ( 7.3 Grants atlas)
bony landmarks :
Frontal bone
Parietal bones
Coronal suture fibrous joint frontal bone parietal bones
Sagittal suture fibrous joint parietal bones
Bregma coronal sagittal sutures
Occipital bone
Lambdoid suture fibrous joint occipital bone parietal bones
Lambda lambdoid sagittal sutures

 10

96

Pterion 4 frontal, parietal, temporal, sphenoid

middle meningeal artery

Zygomatic arch 2 bony processes zygoma of temporal bone
temporal process of zygomatic bone suture line anterior third arch

10.2 Lateral and posterior views of the skull

Interior of Skull
Removal of Skull Cap (Calvaria)
(chisel) inner lamina
calvaria skull cap dura mater

remove occipital bone 10.3

 10

97

10.3 removed calvaria and occipital bone

skull cap calvaria removed ( 7.22 A Grants atlas)
3 :
Outer lamina compact bone
Inner lamina compact bone
Diploe spongy bone (sandwiched) outer inner laminae
diploe diploic veins. diploe temporal region
bones temporalis
dura mater 10.4 ( 7.23 Grants atlas) 2 layers:
Endosteal layer periosteum inner lamina of skull
Meningeal layer
dural venous sinuses

 10

98

10.4 Meninges of the brain

dura mater cerebral cerebellar hemispheres
outer layer of dura mater middle meningeal artery dura
mater cranial bones grooves for
branches of middle meningeal artery calvaria
Clinical Correlation:
Middle meningeal artery head injury. Arterial blood
bony skull dura mater epidural
hematoma. hematoma
fatal pressure course of middle meningeal artery projection on surface
of cranium

grooves for anterior

branches of middle meningeal
artery calvaria
area of the
pterion

10.5 calvaria

 10

99

10.6 ( 7.23 Grants atlas)

superior sagittal sinus right
and left transverse sinuses
superior sagittal sinus

arachnoid granulations

(cauliflower-like masses)
superior sagittal sinus lacunae
laterales

10.6 Dural venous sinuses

Clinical Correlation: Arachnoid granulations subarachnoid space filled with cerebrospinal

fluid (CSF) dural venous sinus CSF venous sinuses diffusion.
Arachnoid granulations calvaria
Reflect the dura mater
dura mater 10.7 arachnoid
dural flaps cerebral hemispheres

10.7 Insicion of dural mater

 10
dural folds 10.8 (
7.24 Grants atlas) inner
layer of dura mater 3 dural
folds :
Falx cerebri dural fold

cerebral hemispheres
median plane
Tentorium cerebella dural
fold
occipital pole of
cerebral hemisphere
cerebellum
petrous part of temporal bone
Falx cerebelli dural fold

cerebellar hemispheres
median plane

100

10.8 Dural Folds

10.9 dura mater

skull
A B
10.9 Insicion of dural mater

Cranial dural venous sinuses

superior sagittal sinus superior border of falx cerebri
superior sagittal sinus cerebral veins superior sagittal
sinus cerebral veins superior sagittal sinus

 10

101

falx cerebri falx cerebri

cerebral hemispheres free inferior border of falx cerebri
superior surface of corpus callosum cerebral hemispheres
dura mater transverse sinus 2
lambdoid suture
10.10 occipital lobe
tentorium
cerebelli transverse sinus
lambdoid suture
posterolateral curve tentorial
notch 2 falx cerebri
tentorium cerebelli
10.10 Incision tentorium cerebelli
10.11 ( 7.25 C Grants atlas) inferior sagittal sinus inferior
concave border of falx cerebri sinus great cerebral vein of
Galen straight sinus posterior end of falx cerebri superior
surface of tentorium cerebelli

10.11 Dural venous sinous

 10

102

straight sinus posterior confluens of the sinuses sinuses

internal occipital protuberance:
Superior sagittal sinus
Right and left transverse sinuses
Straight sinus
Occipital sinus
dura mater arachnoid dura mater archnoid
potential space subdural space
Clinical Correlation: Head injuries superior cerebral veins subdural space
subdural hematoma cerebral hemisphere
arachnoid thin nonvascular membrane cerebral hemispheres
sulci
arachnoid arachnoid
. 305

Removal of Brain

10.12 remove brain
:
falx cerebri
longitudinal cerebral fissure
frontal poles of cerebral
hemispheres
floor of anterior cranial fossa
probe olfactory
bulb cribriform
plate of ethmoid bone
10.12 Removal of the brain

 10

103

brain infundibulum hypothalamus of brain

optic chiasm
infundibulum
optic nerves anterolateral to optic chiasm optic nerves
internal carotid arteries lateral optic chiasm internal carotid
arteries

oculomotor nerves
tentorium cerebelli superior margin of petrous bone groove of
transverse sinuses
abducens nerves
cranial nerves (IV, V, VII through XII)
foramen magnum spinal cord
cranial cavity

10.13 cranial fossae

anterior, middle, posterior
cranial
cavity :
Frontal lobe anterior cranial fossa
Temporal lobe middle cranial
fossa
Occipital lobe posterior cranial
fossa tentorium cerebelli
( grooves for transverse sinuses)
Cerebellum posterior cranial
fossa tentorium cerebelli (
grooves for transverse sinuses)

10.13 Brain and its relation to 3 cranial fossae

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removed
. 305

Cranial Fossa
10.14
( 7.6 Grants atlas)
anterior cranial fossa
3 floor :
sphenoid bone
crista galli and cribriform plate of
ethmoid bone
orbital plates of frontal bone
middle cranial fossa
2 sphenoid bone
temporal bone greater wing
of sphenoid foramina

10.14 Cranial fossae

bony landmarks middle

cranial fossa
Superior orbital fissure :
Oculomotor nerve (III),
Trochlear nerve (IV),
Ophthalmic division of trigeminal nerve
(V1),
Abducens nerve (VI),
Sympathetic nerve fibers
Superior ophthalmic vein

10.15 Middle cranial fossa

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Foramen rotundun maxillary division of trigeminal nerve (V2)

Foramen ovale mandibular division of trigeminal nerve (V3)
Foramen spinosum middle meningeal vessels groove for middle
meningeal artery foramen spinosum
Sella Turcica pituitary gland hypophyseal fossa
Optic canal optic nerve ophthalmic artery
Foramen lacerum hypophyseal fossa apex of petrous bone
posterior cranial fossa fossa middle cranial
fossa dorsum sellae superior margins of right and left petrous bones
posterior cranial fossa foramen magnum medulla oblongata
of brain stem superior end of spinal cord
clivus inclining bony surface foramen magnum clivus pons and
medulla oblongata of brain stem
openings posterior cranial fossa :
Hypoglossal canal hypoglossal nerve (XII)
Jugular foramen glossopharyngeal nerve (IX), vagus nerve (X), accessory nerve
(XI)
Internal acoustic meatus facial nerve (VII) vestibulocochlear nerve (VIII)

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Posterior Cranial Fossa

10.16 Internal view of posterior cranial fossa

10.16 ( 7.26 Grants atlas) posterior cranial fossa
transverse sinus lateral end tentorium
sigmoid sinus
sigmoid sinus floor of posterior cranial fossa cranial
cavity jugular foramen
superior petrosal sinus attachment of tentorium cerebelli superior
margin of petrous bone superior petrosal sinus small venous sinus
cavernous sinus transverse sinus
trigeminal nerve (V) dura mater
medial part of superior margin of petrous bone
tentorium cerebelli trigeminal cave middle cranial fossa
stump of abducent nerve (VI) dura mater posterior cranial
fossa medial stump trigeminal nerve (V)
stump of facial nerve (VII), Vestibulocochlear nerve (VIII), Glossopharyngeal nerve
(IX), Vagus nerve (X), Accessory nerve (XI), Hypoglossal nerve (XII).

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Middle Cranial Fossa

10.17 Internal view of middle cranial fossa

10.17 ( 7.26 Grants atlas) optic nerve optic canal
hypophysis cerebri pituitary gland pituitary stalk remove
brain hypophysis cerebri pituitary gland diaphragma sellae circular
dural fold roof of hypophyseal fossa probe diaphragma sellae
pituitary stalk
superior petrosal sinus cavernous sinus anteromedial

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10.18 Cavernous sinuses. A, Internal view. B, Coronal section through the sphenoid bone
cavernous sinus 10.18 ( 7.30 Grants atlas) artery cranial
nerves :
Internal carotid artery
Oculomotor nerve
Trochlear nerve
Abducens nerve
Ophthalmic division of trigeminal nerve
Maxillary division of trigeminal nerve
Clinical Correlation: internal carotid artery cavernous sinus fractures of
base of skull internal carotid artery arteriovenous fistula (shunt)
internal carotid artery cavernous sinus ophthalmic vein drain contents of orbital

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cavity protruded, engorged, pulsating synchrony radial pulse
pulsating exophthalmos. injuries or infections of cavernous sinus
cranial nerves
10.17 ( 7.30 Grants atlas) abducens nerve dura mater
posterior cranial fossa dura mater abducens nerve cavernous sinus
oculomotor nerve dura mater roof of cavernous sinus
trigeminal nerve superior margin of petrous bone
trigeminal cave dural cave 1 ..
arachnoid.
dura mater roof of trigeminal cave ( superior petrosal sinus )
dura mater greater wing of sphenoid trigeminal ganglion
trigeminal divisions 3.
mandibular division of trigeminal nerve foramen ovale
maxillary division of trigeminal nerve foramen rotundum
ophthalmic division of trigeminal nerve superior orbital fissure
cavernous part internal carotid artery S close
relations oculomotor, trochlear, abducens nerves
middle cranial fossa middle meningeal artery
foramen spinosum

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Orbit and Contents

Bony Landmarks of orbit

bony skull
orbital cavity
11.1 ( 7.36 A Grants atlas)

Maxilla
Zygomatic bone
Frontal bone
Lacrimal bone
Ethmoid bone
Sphenoid bone

11.1 Right orbit

structures :
Optic canal junction lesser wing body of sphenoid bone
Superior orbital fissure greater lesser wings sphenoid
Inferior orbital fissure maxilla greater wing of sphenoid
Infraorbital groove floor orbital cavity inferior orbital fissure
infraorbital canal maxilla infraorbital foramen
Lateral wall of orbit

Orbit ()
dura mater posterior sharp margin of lesser wing of sphenoid lateral margin of
cribriform plate
dura mater anterior cranial fossa roof of orbital cavity

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11.2 center of roof of orbit bone forceps roof of orbit

:
11.3a periorbita
periosteum
walls of orbital cavity
probe bony
roof periorbita
superior orbital fissure
bone forceps lesser
wing of sphenoid
superior orbital fissure
superior orbital fissure

bone forceps probe

roof lateral wall of optic
canal
bone forceps anterior
11.2 removal of orbital plate
clinoid process dura
periorbita anterior margin of orbit
second incision anteroposterior remove periorbita roof of orbit
superior part of orbital contents 11.3b

11.3a Periorbita

11.3b Periorbita remove

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11.3b ( 7.38 A Grants atlas) intracranial stump of trochlear nerve

lateral wall of cavernous sinus lateral to internal carotid artery
orbital cavity superior orbital fissure trochlear nerve medial side of
frontal nerve
trochlear nerve medial wall of orbit trochlear nerve
superior oblique
frontal nerve ophthalmic division of trigeminal nerve superior
orbital fissure orbit small supratrochlear nerve larger
supraorbital nerve
supraorbital nerve supraorbital notch superior orbital margin
superior orbital fissure lateral to frontal nerve lacrimal nerve
lacrimal nerve lateral border of roof of orbit lacrimal gland
fine lobules of loose fatty tissue orbital cavity
levator palpebrae superiorlis superficial
levator palpebrae superiorlis
superior rectus
superior rectus insertion eyeball inserts superior
surface of eyeball equatorial plane eyeball

11.3a Intermediate view. (superficial)

11.3b Intermediate view. (deep)

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superior rectus insertion

superior branch of oculomotor nerve superior rectus
levator palpebrae superiorlis deep surface
superior oblique medial border pulley
tendon superior oblique eyeball
posterolaterally equatorial plane of eyeball insert posterolateral quadrant of superior
surface of eyeball

Nasociliary Nerve
11.4 ( 7.38 C Grants atlas) nasociliary nerve
ophthalmic division of trigeminal nerve

11.4 Deep view.

11.4 ( 7.38 C Grants atlas) nasociliary
nerve optic nerve lateral to medial long ciliary nerves 2 3
posterior part of eyeball medial wall of orbit anterior ethmoidal
nerve nasociliary nerve superior oblique medial
rectus anterior ethmoidal foramen anterior cranial fossa lateral to cribriform plate
nasal cavity external nasal nerve.

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Abducens Nerve
stump of abducens nerve posterior cranial fossa cavernous sinus
lateral internal carotid artery orbit superior orbital fissure
11.4 abducens nerve orbital cavity abducens nerve anulus
tendineus medial surface lateral rectus

Oculomotor Nerve
oculomotor nerve cavernous sinus dura mater
anterior posterior clinoid processes orbit superior orbital fissure
superior orbital fissure superior inferior divisions ( 7.39 Grants atlas)
superior division of oculomotor nerve optic nerve levator
palpebrae superioris superior rectus
inferior division of oculomotor nerve optic nerve
medial rectus, inferior rectus, inferior oblique
11.4 ( 7.38 A Grants atlas) ciliary ganglion optic
nerve lateral rectus. Ciliary gnaglion 1 2 ..
lateral side of optic nerve apex of orbit 1 ..
Ciliary ganglion preganglionic parasympathetic fibers inferior division of oculomotor nerve.
Postganglionic parasympathetic fibers ciliary ganglion eyeball short ciliary
nerves

Optic Nerve Ophthalmic Artery

roof of optic canal optic nerve brain tract 3
meningeal layers: dura mater, arachnoid mater, pia mater ( 7.38 C Grants atlas)

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11.5 ( 7.44 A Grants atlas) ophthalmic artery

internal carotid artery

11.5 Superior view of ophthalmic artery

11.5 optic canal ophthalmic artery inferior and
lateral to optic nerve
ophthalmic artery orbital cavity ophthalmic artery optic
nerve optic nerve medial wall of orbit
7.38 C Grants atlas optic nerve posterior pole of eye ball
inferior rectus
inferior oblique inferior rectus insert
posterolateral quadrant of inferior surface of eyeball equator of eyeball (
7.39 A Grants atlas)
medial rectus ( 7.38 C Grants atlas) superior oblique
7.41 B Grants atlas insertion of extraocular muscles recti
muscles 4 equator line of eyeball insert scleral coat thin, wide
tendons cornea; oblique muscles 2 equator line of eyeball
insert scleral coat thin, wide tendons equator line of
eyeball

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Orbit ()

11.6 Surgical approach to the right orbit

both eyelids orbital septum orbital margin
11.6 ( 7.37 A Grants atlas) structures :
superolateral corner lacrimal gland
superomedial corner trochlea for superior oblique muscle
inferomedial corner origin of inferior oblique muscle lacrimal sac
insertion of 4 recti muscles 2 oblique muscles oblique
muscles corresponding recti

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Nose, Mouth and Pharynx

Craniovertebral Joints

12.1 Craniovertebral joints

suboccipital region
posterior arch of atlas lamina C2-3
12.1 ( 4.14 Grants atlas) dura mater dorsum sellae
3 ..
transverse incision dura mater vertebral arteries
dura mater cranial cavity just medial to points of exit of
hypoglossal nerves

dura mater inferior axis tectorial

membrane
tectorial membrane just superior to anterior border of foramen
magnum tectorial membrane ligaments of craniovertebral region
ligaments craniovertebral region
Transverse ligament of C1 (Atlas)
Cruciform ligament
Alar ligament

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Removal of Head
12.2 ligaments
capsules C1
occipital condyle (atlanto-occipital joint)
CN. IX-XII

superior facets of atlas

occipital condyles
sternocleidomastoid
mastoid process
12.3 retropharyngeal
space cervical
viscera contents in carotid sheath
prevertebral fascia
cervical viscera superior cervical ganglion
sympathetic trunk
retropharyngeal space
vertebrae
base of skull ( 8.23 B Grants atlas)

transverse processes of atlas
occipital bone :
Rectus capitis lateralis lateral

12.2 ligaments capsules

12.3 retropharyngeal space

Rectus capitis anterior longus

capitis medial
anterior atlanto-occipital membrane
( 4.13 A Grants atlas) anterior
arch of atlas anterior margin of foramen
12.4 Reflection of the head and neck
magnum
head cervical viscera vertebral column

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Prevertebral and Lateral Vertebral region

prevertebral fascia
12.5 ( 8.23 B Grants
atlas) longus colli
longus capitis
vertebral column
retropharyngeal space
scalenus anterior
scalenus medius

scalenus
anterior scalenus medius
roots of brachial plexus

12.5 Prevertebral muscles

Structures at base of skull

12.6 Nerves and vessels pharyngeal wall

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12.6 ( 8.31 B Grants atlas) superior cervical ganglion

sympathetic trunk carotid sheath
superior end posterior wall of pharynx pharyngeal tubercle posterior wall of
pharynx foramen magnum
common carotid artery bifurcation internal carotid artery
common carotid external carotid
internal carotid carotid canal jugular foramen
structures Internal jugular vein posterior compartment of jugular
foramen sigmoid dural venous sinus inferior petrosal
sinus
vagus nerve internal jugular vein carotid artery vagus
nerve jugular foramen just inferior to jugular foramen vagus
inferior ganglion of vagus (nodose ganglion)
glossopharyngeal nerve (CN IX)
stylopharyngeus lumbrical muscle pharyngeal wall
superior and middle pharyngeal constrictors

Pharynx
12.7 ( 8.31 B Grants
atlas) fascia
pharynx

pharynx
Superior pharyngeal constrictor
Middle pharyngeal constrictor
Inferior pharyngeal constrictor
Stylophryngeus

superior middle
pharyngeus constrictor

12.7 Posterior view of pharynx

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12.8 ( 8.32 B Grants

atlas) Internal laryngeal nerve
superior laryngeal vessels
thyrohyoid membrane
larynx
inferior constrictor
recurrent laryngeal nerve
12.8 Laryngeal nerves
pharyngeal wall
8.33 A Grants atlas posterior wall of pharynx
cricoid cartilage pharyngeal tubercle base of skull

Bisection of the head and neck

12.9

midsagittal plane
epiglottis

12.9 Bisection of the face

Nasopharynx
12.10 ( 8.36 A Grants
atlas) nasopharynx
soft palate
choanae
nasal cavities
nasopharynx
pharyngeal orifice of the auditory tube
pharyngeal recess
torus of auditory tube

12.10 Medial view of pharynx

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Oropharynx
oropharynx :
superior soft palate
inferior epiglottis
oral cavity
lingual tonsil (follicles) lymphoid tissue mucous membrane posterior 1/3

Laryngopharynx
12.10 12.11 (
8.33 A Grants atlas)
laryngopharynx
epiglottis
cricoid cartilage
inlet (aditus) larynx
piriform recess :
medial larynx
lateral thyroid
cartilage thyrohyoid
membrane

inferior constrictor

12.11 Posterior view of pharynx and larynx

Clinical Correlation: piriform recess

irritate mucosa innervated recurrent laryngeal internal laryngeal nerves
subconjunctival hemorrhage
piriform fossa

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Nasal cavity and pterygopalatine fossa

bisect skull (
) identify structures on
lateral wall of nasal cavity
12.12 ( 7.70 A
Grants atlas) :
Nasal bone
Superior concha
Middle concha
Inferior concha
Sphenopalatine foramen
pterygopalatine fossa
12.13 ( 7.70 B
Grants atlas)
bony nasal septum :
Vomer bone unpaired
bone of skull
Perpendicular plate of ethmoid

12.12 Lateral nasal wall

12.13 Medial nasal wall

6.5
structures lateral wall of
nasal cavity
12.14 ( 7.73 Grants atlas)

12.14 View of lateral nasal wall

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Inferior concha 1.5 .. inferior concha

pharyngeal orifice of auditory tube
Inferior meatus space lateral to and inferior to inferior concha
Middle concha anterior free edge superior
Middle meatus space lateral to and inferior to middle concha
Superior concha roof of nasal cavity body of
sphenoid bone
Superior meatus space lateral to and inferior to superior concha
Sphenoethmoidal recess posterosuperior to superior concha
Nasal crest agger anterior free edge of middle concha
ethmoidal crest of maxilla
Vestibule mobile part of nasal cavity (nostril)
inferior meatus mobile part vibrissae (nasal hairs)
Atrium nasal cavity vestibule middle meatus

pterygopalatine fossa

12.15 Pterygopalatine fossa

12.16 Inferior view of the palate

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12.15 12.16 ( 7.78 A Grants atlas) pterygopalatine

fossa
Pterygomaxillary fissure maxilla lateral
pterygoid plate of sphenoid maxillary artery pterygopalatine fossa
Sphenopalatine foramen medial wall pteryopalatine fossa

Greater palatine foramen horizontal plate of palatine bone

medial third molar teeth palatine
canal pteryopalatine fossa
Pterygoid canal ( 7.5 B Grants atlas) medial
pterygoid plate nerve of pterygoid canal autonomic fibers
greater petrosal nerve (parasympaticis fibers) deep petrosal nerve
(sympathetic fibers) pteryopalatine ganglion
maxillary nerve pterygopalatine ganglion
pterygopalatine fossa 12.17 ( 7.79 C,D,E Grants atlas)

12.17 Maxillary nerve pterygopalatine fossa

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Hard Palate and Soft Palate

sagittal section
palate 12.18 ( 7.73 Grants
atlas)
Hard palate anterior 2/3
Soft palate posterior 1/3
mobile part

12.18 Sagittal section of palate

12.19 ( 7.63 B Grants atlas)

mucoperiosteum
palate alveolar processes of
upper teeth greater palatine
nerve and vessels greater
palatine foramen medial to third molar
tooth
sagittal section of soft palate
soft palate glandular tissue of
palatine glands soft
palate aponeurosis
anterior 1/3 of soft palate

12.19 Nerves and vessels of the palate

12.20 12.21 ( 8.36 A Grants atlas) pharyngeal orifice of auditory

tube
torus tuberius torus of auditory tube cartilage
auditory tube

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8.36 B Grants atlas levator elevation soft

palate pharyngeal opening of auditory tube
mucosa cartilage of auditory tube levator veli
palatini
tensor veli palatini levator palatini fibers
aponeurosis of soft palate palatine aponeurosis

12.20 Pharynx with the

mucous membrane intact

12.21 Pharynx with the

mucous membrane removed

Bed of Palatine Tonsils Pharyngeal wall

12.21 ( 8.36 Grants atlas) tonsillar bed palatoglossal
arch palatopharyngeal arch
fascia tonsilar bed palatopharyngeus
superior constrictor of pharynx muscular coat pharynx
palatopharyngeus stylopharyngeus
superior middle constrictors of pharynx longitudinal musculature
of the pharynx

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Mouth and Tongue

Bony Landmarks
bony mandible bony
landmarks 12.22
( 7.48 E Grants atlas)
Mylohyoid line
mylohyoid
Sublingual fossa
mylohyoid line
Submandibular fossa
mylohyoid line

12.22 Inner surface of the mandible

12.23 ( 7.57 Grants atlas)

Anterior 2/3 of tongue oral part of tongue
Posterior 1/3 of tongue
pharyngeal part of tongue

Sulcus terminalis
V oral part pharyngeal part
of tongue
foramen cecum
Vallate papillae papillae

sulcus terminalis
Glossoepiglottic fold fold of
mucous membrane dorsum of
tongue epiglottis
Valleculae medial
12.23 Dorsum of the tongue
glossoepiglottic fold
Lingual tonsil lymphoid follicles posterior 1/3 of tongue

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muscles of floor of mouth and tongue

12.24 ( 7.58 Grants atlas) bisected head mylohyoid,
geniohyoid, genioglossus

12.24 Extrinsic muscles of the tongue

(medial view)

12.25 Extrinsic muscles of the tongue

(lateral view)

() 12.26 A (
7.61 Grants atlas) mucous membrane
mandible
frenulum of tongue second
molar
sublingual salivary
gland medial

mylohyoid
mylohyoid line of mandible
genioglossus
mental spine

sublingual salivary gland
sheath of areolar tissue
fixes gland floor of mouth
12.26 Oral cavity. A, Incisions. B, Nerves and
vessels of the tongue, salivary glands.

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submandibular duct posteroanteriorly medial aspect of sublingual

salivary gland sublingual caruncle lateral to root of frenulum of tongue
submandibular duct posterior deep part of
submandibular salivary gland
lingual nerve last molar ramus of mandible
medial pterygoid
lingual nerve anterior lingual nerve submandibular duct lingual
nerve lateral and superior to submandibular duct
medial superior and medial to submandibular duct
hypoglossal nerve (XII) deep part of submandibular salivary gland
hyoglossus inferior lingual nerve
hyoglossus hypoglossal nerve lingual nerve
lingual artery hyoglossus
Clinical Correlation: genioglossus paired muscle midline

intact side deviated damaged side lesion side
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13 Lower Limb I.
(Bones of the Lower Limb, Anterior and Medial Compartments of
Thigh, Gluteal region and Posterior Compartment of the Thigh)

13.1 Bones of the lower limb

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13.2 Hip bone: A, medial view. B, lateral view.

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13.3 Femur: A, anterior view. B, posterior view. C, cross-section.

133

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13.4 Patella. A, anterior and posterior views. B, cross-section

Tibia & Fibula: C,anterior view. D, posterior view. E, cross-section.

134

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135

13.5 Bones of the foot. A, dorsal view. B, lateral view

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136

deep fascia deep

fascia
iliotibial tract (band) ( 5.26 B Grants atlas)

13.6: anterior compartment of the thigh

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137

anterior compartment of the thigh

1.
2.
3.
4.

13.6 ( 5.21 Grants atlas)

iliotibial tract
tensor fascia latae tensor fascia latae
iliotibial tract
sartorius
4 quadriceps femoris
Rectus femoris
Vastus lateralis
Vastus medialis

Vastus intermedius
5. patella sesamoid bone quadriceps tendon insert
tuberosity of tibia

femoral triangle contents

13.7 Femoral triangle and its contents

1. 13.7 ( 5.18 Grants atlas) femoral triangle :
superior inguinal ligament
lateral medial border of sartorius muscle
medial medial border of adductor longus muscle

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2. femoral artery and vein femoral triangle

3. profunda femorais artery deep femoral artery
femoral artery femoral triangle
4. femoral vein () veins
5. fat fascia floor femoral triangle iliopsoas
lateral pectineus medial
6. femoral nerve lateral femoral artery

medial compartment of the thigh

13.8 medial compartmrnt of the thigh.

A, superficial layer. B. intermediate layer

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13.8 ( 5.21 A Grants atlas) muscles in medial region of thigh

1.
Pectineus
Gracilis
2.
3.
4.
5.
6.

Adductor longus
13.9 ( 5.25 Grants atlas) deep femoral vessels (profunda femoris
vessels) pectineus adductor longus
adductor longus deep femoral vessels
adductor longus
adductor brevis adductor longus
obturator nerve anterior posterior branches
adductor brevis
adductor magnus deep layer of medial thigh muscle

13.9 Nerves and vessels of anterior and medial region of the thigh

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gluteal region

13.10 Muscles of the gluteal region. A, superficial layer. B, deep layer.

1. 13.10 ( 5.28 Grants atlas) gluteus maximus
2. gluteus medius gluteus maximus

3. gluteus maximus 13.10 A

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4. 13.11 ( 5.31 A Grants atlas) gluteus maximus
lateral inferior gluteal vessels and nerve
vessels and nerve
5. gluteus maximus insertion iliotibial tract
sacrotuberous ligament
6. trochanteric bursa synovial bursa
gluteus maximus greater trochanter of femur friction
7. gluteus medius fibers
8. gluteus medius ilium gluteus minimus
( 5.32 Grants atlas)
9. piriformis
10.
piriformis
superior gluteal
nerve and vessels
11.
piriformis
inferior gluteal
nerve and vessels
posterior
cutaneous nerve
of thigh
sciatic nerve

13.11 Deep dissection of gluteal region

12. sciatic nerve

Superior gemellus muscle
Tendon of obturator internus
Inferior gemelli muscles
Quadratus femoris

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posterior compartment of the thigh

1. 13.12 ( 5.28 C
Grants atlas)

hamstring muscles :
Long head of biceps femoris
Semitendinosus
Semimembranosus

13.12 Hamstring muscles of the thigh

2. long head of biceps femoris superior 1/3
sciatic nerve posterior of thigh
3. long head of biceps femoris short head of biceps femoris
4. hamstring part of adductor magnus

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5. 13.13 ( 5.32 Grants atlas) sciatic nerve tibial

division ( medial ) common peroneal division ( lateral )
6. perforating branches profunda femoris artery adductor
magnus posterior compartment of thigh

13.13 Sciatic nerve posterior of the thigh

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144

popliteal fossa
1. 13.14 ( 5.43
Grants atlas)
popliteal fossa

superolateral angle
biceps femoris
superomedial angle
tendon of semitendinosus
muscle
semimembranosus muscle

inferolateral angle
lateral head
gastrocnemius
inferomedial angle
medial head
gastrocnemius

13.14 Popliteal fossa A, Boundaries. B,

gastrocnemius
2. popliteal fossa
gastrocnemius
3. deep fascia gastrocnemius ()
4. heads gastrocnemius 13.14 B ( 5.44
Grants atlas)

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13.15 Popliteal fossa and its contents

5. superior angle of popliteal fossa tibial common peroneal nerves
6. tibial nerve popliteal fossa
soleus
7. common peroneal nerve superolateral border of popliteal fossa
neck of fibula
8. 13.15 ( 5.45 Grants atlas) tibial nerve popliteal fossa
deep fascia popliteal artery popliteal
vein ( vein )
9. probe adductor hiatus adductor
magnus femoral artery adductor hiatus popliteal artery
popliteal vein adductor hiatus femoral vein

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146

14 Lower Limb II.

(Leg, Plantar of Foot and Joints of the Lower Limb)
posterior compartment of leg

14.1 Superficial layer of posterior compartment of leg.

A,gastronemius. B, soleus
1. 14.1 ( 5.69 Grants atlas) calcaneus tendon common tendon
gastrocnemius and soleus
2. head gastronemius 1
soleus
3. soleus
4. plantaris lateral head of gastrocnemius.

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147
5. soleus tibial
fibula ( 14.2)
6. soleus lateral intermuscular septum

14.2 Deep layer of

posterior compartment of leg

14.3 Posterior tibial vessels tibial nerve

7. intermuscular septum posterior tibial vessels tibial

nerve
8. 14.2 ( 5.70 A Grants atlas) flexor hallucis longus
flexor digitorum longus
9. flexor hallucis longus flexor digitorum longus
tibialis posterior
10. popliteus floor of popliteal fossa
11. 14.3 ( 5.70 C Grants atlas) popliteal vessels tibial nerve
superficial surface popliteus
12. popliteus anterior tibial artery
popliteal artery interosseous membrane anterior crural
compartment

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148
13. posterior tibial artery popliteal artery
posterior compartment of leg tibial nerve
14. fibular (peroneal) artery proximal part of posterior tibial artery
lateral compartment of leg

medial side of ankle

14.4 Structures medial side of ankle

15. 14.4 ( 5.71 Grants
atlas) deep fascia
medial side of ankle
flexor retinaculum
16. tendon tibialis
posterior
flexor retinaculum
medial malleolus
14.5 Structures medial side of ankle

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149
17. tendon flexor digitorum longus
tibialis posterior tendon
18. tendon flexor hallucis longus flexor retinaculum
sustentaculum tali calcaneus
19. posterior tibial vessels tibial nerve flexor retinaculum
tendon flexor digitorum longus tendon
flexor hallucis longus

lateral compartment of the leg lateral side of the Ankle

14.6 Muscles of the lateral compartment of the leg

and lateral side of the ankle
1. 14.6 ( 5.65 Grants atlas) lateral compartment of the leg
peroneus (fibularis) longus superficial
peroneus (fibularis) brevis deep
2. tendons peroneus (fibularis) longus and brevis
plantar flexion evert foot
3. common peroneal nerve neck of fibula crural
fascia lateral compartment of the leg

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4. probe common peroneal nerve peroneus longus
superficial peroneal nerve peroneus longus probe
common peroneal nerve superficial and deep peroneal nerves ( 5.65
Grants atlas)
5. superficial peroneal nerve peroneus longus
peroneus brevis

anterior compartment of leg dorsum of foot

14.7 Muscles of the anterior compartment of the leg and dorsum of the foot
1. 14.7 ( 5.60 Grants atlas) superior inferior extensor
retinacula tendons
2. deep fascia leg muscles superior inferior extensor retinacula
3. anterior compartment of the leg
ankle medial to lateral side :
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus

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4. 14.8 ( 5.62 B Grants atlas) deep fibular (peroneal) nerve
anterior tibial vessels tendon tibialis anterior extensor
hallucis longus
5. deep fibular (peroneal) nerve
anterior tibial artery

6. deep fibular (peroneal) nerve

anterior tibial artery

lateral extensor hallucis longus
tendon anterior tibial artery
dorsalis pedis
artery ( 5.62 C Grants atlas)

14.8 nerves and vessels of

anterior compartment of the leg
7. tendon extensor
digitorum longus
extensor digitorum brevis
extensor hallucis brevis (
14.9 5.63 B Grants atlas)

14.9 Dorsum of the foot

8. metatarsal 1
2 1st dorsal
interosseous

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plantar of foot

14.10 Plantar aponeurosis

1. 14.10 ( 5.76 B
Grants atlas) plantar
aponeurosis
2. plantar aponeurosis


( 14.11)
3. medial lateral flaps of
plantar aponeurosis

14.11: Incisions in plantar aponeurosis

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14.12 First layer of plantar muscles

1. 14.12 ( 5.77 Grants atlas) deep fascia

abductor hallucis medial to plantar aponeurosis origin medial side of
calcaneus plantar digital nerve and artery medial side of
great toe
abductor digiti minimi lateral side plantar aponeurosis
flexor digitorum brevis abductor muscles
central part of plantar aponeurosis tendons 4
lateral 4 toes
2. flexor digitorum brevis calcaneus

3. posterior tibial artery tibial nerve medial side of ankle

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14.13 Second layer of plantar muscles

4. 14.13 ( 5.79 Grants atlas) medial and lateral plantar
arteries and nerves
5. 5.78 Grants atlas quadratus plantae flexor
accessorius origin calcaneus
insert tendon flexor digitorum longus
anterolaterally
6. distal portion of flexor digitorum longus tendon 4 slips
lateral 4 toes
7. lumbrical muscles 4 origin flexor digitorum longus
tendon medial side
8. tendon of flexor digitorum longus tendon flexor
digitorum brevis
9. tendon of flexor hallucis longus sesamoid bones head of first
metatarsal bone base of distal phalanx of great toe

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14.14 Third layer of plantar muscles

10. flexor digitorum longus tendon quadratus plantae
11. distal part of flexor digitorum longus tendon lumbricals
lumbricals
12. 14.14 ( 5.79 Grants atlas) deep fascia anterior
half of foot :
flexor hallucis brevis plantar surface of first metatarsal
distal end medial lateral tendons sesamoid bone
tendon.
adductor hallucis 2 heads transverse head oblique
head maintain transverse arch of foot
flexor digit minimi plantar surface of fifth metatarsal
bone

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14.15 Fourth layer of plantar muscles

13. 14.15 4 interossei muscles
4 dorsal interossei abductors of the toes
3 plantar interossei adductors of the toes
abduction adduction 2nd toe
14. dorsal interossei
15. fibularis (peroneus) longus tendon lateral border of cuboid bone
insert base of first metatarsal medial
cuneiform
16. tibialis posterior tendon medial border of foot insertions
navicular, cuneiform, cuboid, bases of second, third, and fourth metatarsals
17. quadratus plantae

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long plantar ligament calcaneus

cuboid base metatarsal 2-4 inferior binder
lateral longitudinal arch of foot
short plantar ligament (plantar calcaneocuboid ligament)
medial long plantar ligament inferior binder lateral longitudinal arch of foot

spring ligament (plantar calcaneonavicular ligament) inferior binder medial

longitudinal arch of foot
18. 14.16 ( 5.71 Grants atlas) medial side of ankle
medial malleolus tendons of tibialis posterior, flexor digitorum longus,
flexor hallucis longus
medial malleolus tendons of tibialis anterior

14.16 Structures flexor retinaculum of the leg

19. 5.66 Grants atlas lateral side of ankle
lateral malleolus tendons of fibularis (peroneus) brevis and longus

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Joints of the Lower Limb

1. Hip joint

( 5.36 5.37 Grants atlas)

Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament

14.17 Hip joint. A, anterior view. B, posterior view

fibrous capsule
head of femur
acetabulum 14.18
Ligament of the head of femur
(ligamentum teres)
Acetabular labrum
14.18 Hip joint: open capsule

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2. Knee joint
( 5.49, 5.50, 5.51, 5.52 5.53 Grants atlas)
: Extra-articular ligaments
: Intra-articular ligaments
Ligamentum patellae (patellar
ligament)

Anterior cruciate ligament

Tibial (medial) collateral ligament

Posterior cruciate ligament

Fibular (lateral) collateral ligament

Medial meniscus
Lateral meniscus

14.19 Knee joint: A, anterior view (flexed). B, posterior view (extended).

C, superior view of tibia

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3. Ankle joint

( 5.83, 5.85 5.87 Grants atlas)
Deltoid ligament
Anterior talofibular ligament
Calcaneofibular ligament
Posterior talofibular ligament

14.20 Ankle joint. A, medial view. B, lateral view

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4. Joints of the foot ( 5.97 Grants atlas)

ligaments tendons support arch of the foot
Tibialis posterior tendon
Peroneus (fibularis) longus tendon
Spring ligament plantar calcaneonavicular ligament
Long plantar ligament
Short plantar ligament plantar calcaneocuboid ligament

14.21 Joints of the foot

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5. sacroiliac joints ( 3.8 Grants atlas)

sacroiliac joint articular surface sacrum iliac synovial
joint gliding ligaments
- Posterior sacroiliac ligament
- Sacrotuberous ligament
- Sacrospinous ligament

14.22 Sacroiliac joint

B.
A

14.23 Sacroiliac joint (A) transverse section

(B)