ANATOMY RECALL RECALL SERIES EDITOR AND SENIOR EDITOR LORNE H. BLACKBOURNE, M.D. General Surgeon Fayetteville, North Carolina EDITORS JARED ANTEVIL, M.D. United States Marine Corps ‘Camp Pendleton, California CHRISTOPHER MOORE, M.D. Resident in Emergency Medicine Carolinas Medical Center Charlotte, North Carolina Me LIPPINCOTT WILLIAMS & WILKINS ‘A Wolters Kluwer Company Philadelphia » Baltimore + New York + London Buenos Aires + Hong Kong + Sydney + TokyoAcquisitions E ltors Blzabeth A. Nieginski Exlitorial Director: Julie P. Martine Development Editor: Melanie Car Managing Ealvor: Amy Dinkel Marketing Manager: Aimee: Sir Copyright © 2000 by Lippincott Willams & Wilkins. All rights reserved, This book is protected by copyright. No part of t may be nsmitted, in any form or by’ any eans—electronic, mechanical, photocopy, recording, or otherwise—without produced, stored in a retrieval system, oF t the prior written permission of the publisher, exept for brief quot boxed in enitical articles, reviews, and testing and evaluation materials pro- vided by the publisher to schools that have adopted its accompanying textbook Printed in the United States of America, For information, write Lippineote Williams & Wilkins, 530 Walnut Street, Philadelphia, PA 19106, ‘Materials appearing in this book prepared by individuals as part oftheir offical dutiesas U.S. Government emplayees are not covered by the above-mentioned copyright 987654929 Care has been taken to confirm the aconracy ofthe information presented to describe generally accepted practices. However, the authors, editors, publisher are not responsible for errors or omissions or for any consequences from application ofthe information in this book and make no warranty, express ‘or implied, with respect tothe contents ofthe publication “The authors, editors, andl publisher have exerted every effort to ensure that dng selection and dosage set forth inthis text are in accordance with enrent recommendations and practice atthe time of publication. Howeser, in view of ongoing research, changes in government regulations, and the constant flow of formation relating to crag therapy and drug reactions, the reader is urged to chek the package insert for each drug for any change in dications and dosage ‘and for added warnings and precautions. This is particularly important when the recommended agent isa new or infrequently employed drug, ‘Some drugsand medial devices presented inthis publication have Food and Drug Administration (FDA) elearance for limited use in restricted! research settings, Iti the esponsibility of the health care previder to ascertain the FDA, status of each drug or device planned for use in their clinical practice,ASSOCIATE EDITORS James Boyer Fousth-Year Medical Student School Charlottoslle, Virginia “Anikar Chhabra, M.D. Resident in Orthopedic Surgery University of Virginia Charlottesslle, Virginia Hiwot Desta, M.D. in Internal Medicine Ohio State University Columbus, Ohio Kimberly Estler, M.D. in Obstetrics and Gynecology University of Rochester Rochester, New York Barry Hinton, Ph.D. Professor of Anatomy andl Cell Biology University of Virginia School ‘of Medicine Charlotteslle, Virginia Mike Iwanik, Ph.D. Professor of Anatomy and Cell Biology University of Virginia School ‘of Medicine ottesvlle, Virginia Brian Kaplan, M.D. Resident in Otolaryngology University of Virginia Charlottesville, Virginia Clinton Nichols, M.D. Resident in Radiology University of California, San Diego Ravi Rao, M.D. Resident in Nenrost Brigham and Women's Hospital Boston, Massichusetts Jeffrey Rentz, M.D. Resident in General Surgery University of Utah Salt Lake City, Utah Peter Robinson, M.D. Resident in Internal Medicine University of Colorado Boulder, Colorado John Schreiber, M.D. Resident in Radiology Stanford University Stanford, CaliforniaCONTRIBUTORS Wang Cheung, MD. Jamal Hairston, M.D. Meredith LeMasters, M.D. Steven Lin, M.D. Bruce Lo, M.D. Ana Meura, M.D. Suzanne Perks, M.D. Andrew Wang, M.D, Thomas Wang, M.D. Philip Zapata, M.D.Dedication “This book is dedicated to the medical students at the University of Virginia,Contents Preface . = x Acknowledgments mhstwasnaisensinn =) 1 Overview occ coree ve I 2 TheHead occ eececceeserseee Siesrettnssres 2 3 The Central Nervous System — co 6 4 The Cranial Nerves ‘ ae 5 The Neck tot 6 The Back .... Ep : svueene 128) 7. The Upper Extremicy a 3 The Thorax mete 195, 9 The Abdomen .. a 214 10 The Pelvis and Perineum : 253 I The Lower Extremity os 285 Index 2319Preface Anatomy Recall was written by medical students, physicians, and anatomists specifically for use during a fist-year gross anatomy course and as a review for the United States Medical Licensing Examination (USMLE) Step 1. While there are certainly a wealth of gross anatomy texts available, most are better suited for reference than for mastery of the basic anatomy required to be a suc- ‘cessful medical student and physician, Its our intention that Anatomy Recall and an atlas are all you will ned for a comprehonsive study of basic anatomy’ ‘Anatomy Recalls arranged in the extremely successful question-and-answer Format that defines the entiee Recall series—a format that emphasizes active acquisition of knowledge, rather than passive absorption of it. Where appro- priate simple figures have been included to supplement the text material. Fach Chapter concludes with a “power review” that covers the most important and Frequently tested facts in each subject area. These power roviews are ideal for 4 quick review prior to an anatomy examination, a board examination, oF a surgery clerkship, ‘Anatomy is an exciting yet demanding course. It is important to have a text that is comprehensive yet readable and emphasizes (and reemphasizes) key points. A thorough initial study of anatomy wil continue to reward you through ‘outa lifetime of clinial practice. It is our hope that Anatomy Recall will prove to be an invaluable tool for mastering the subject of anatomy. Good luck! ‘The EditorsAcknowledgments. “The editors would like to acknowledge Melanie Cann, Amy Dinkel, Julie Mar- tine, and Elizabeth Nieginski at Lippincott Williams & Wilkins for their help and vision in bringing this book to fruition, xOverview Itis important to adhere toa certain formalism when describing the location or jovement of one body part relative to another, therefore, a significant portion 1 course (like many introductory courses in medicine) is devoted -ating with other healtheare pro ofthe toteac fessionals. language necessary for comm ANATOMIC POSITION What standard position is That of a human standing facing forward, assumed when deseribing feet pointing forward " the human body? outward (the “anatoraie position”) ANATOMIC PLANES. Deseribe the three basic 1. Transverse (horizontal): \ anatomic planes. horizontal plane aeross the body anatomic position; the most commo ‘cut used in computed tomography (CT) and magnetic resonance imaging (MRI) 2. Sagittal A plane formed by a vertical midline cut that divides the body into aeutacross the body in anatomic position from side to side and top to bottom ANATOMIC DESCRIPTORS Define the following terms: Ventral “Tawar the anterior (oF front) ofthe body Dorsal “Toward the posterior (or back of the bry Medial Closer to the midline Lateral Fusther from the miWith the palms facing up, the thumbs are lateral tothe other fingers, Tateral to the forefinger? What is the position of the The great toc is medal ‘great toe (first toe) relative ta the other toes? Define the following terms: Proximal Closcr to the center ofthe body (often ‘considered the heart) Distal Further from the center ofthe body Where is the radial artery The radial arteny (inthe forearm) i distal in relation to the subelavian tothe subclavian artery (under the artery? asic Which is more distal, the The tibia femur or tibia? ANATOMIC MOVEMENTS. What are the three major Simoth, cardia, and skoletal (striated) types of musele? Describe the innervation _ Skeletal musele is gonerally innervated by and characteristics of somatic nerves (i.e,, movement is skeletal muscle. voluntary, and is located etween two stable points (ie, bones). Contraction results in movement of a structure. What four parameters are Origin: Usually the more proximal, more used to describe skeletal medial, and more stable structure that muscles? the muscle is attached to Insertion: Usually the more distal, more Tateral structure that the muscle is attached fo, and the one that is moved by contraction Tnnervation: The nerve that eases the nsele to contract Action: The result ofthe muscle ‘contracting Define the following muscle actions: Flexion Decreasing the bending the joint ng ofa joint, oFChapter | Overview 3 Extension Inereasing the angle ofthe joint, oF straightening the joint Abduction Moving one structure away from another Taterally (ie, away from anatomic position) Adduetion Moving one structure toward another medially (.c. toward the anatomie position)—think add = together Deseribe the action that ‘occurs with each of the following movements: Kicking a soccer ball Extension ofthe leg atthe knee Spreading the fingers Abduction ofthe fingers at the metacarpephalangeal joints Bringing an arm that is Adiduction ofthe arm at the shoulder ‘extended straight out and to the side laterally, toward the body What is the difference ‘Tendons attach the muscle tothe bone, between ligaments and while ligaments attach bone to bone tendons? What isa strain? partial or incomplete tear of a muscle orligament What isa sprain? A partial or incomplete tear ofa tendon2 THE SKULL The Head ‘What is the skull? What are the two regions ‘of the skull? What is the ealvaria? What is diploe? Identify the structures on the following lateral view of the skull: xo7mo 0 1 skeleton of the head, incl mandible ngthe ‘The neuroeranium (i, the portion of the skull that encloses the brain) and the facial cranium “The skull cap (i.e. the vault of the neuro cranium, oF the portion of the skull that is Teft when the facial bones are removed) “The spongy bone layer between the dense ‘outer and inner bone layers of the calvaviaChapter 2/ The Head 5 A= Inferior and superior temporal lines B= Parictal hone C= Lambdoid suture D= Sphenoid bone, greater wing E = Temporal bone F = Zygomatic arch G= Occipital bone H= External occipital protuberance T= Mastoid process J. = Ramus of the mandible K= Angle of the mandible = Mental foramen M= Frontal bone coronal suture *erion (the “p” is silent) acrimal bone sternal auditory (acoustic) meatus terior nasl spine tyloid process Iveolar process What are the superior and ‘The attachment points for the temporal, inferior temporal lines? What region lies below the The temporal fossa superior and inferior temporal lines? What is the clinical signifi- Severe mide ear infections may spread ‘cance of the proximity of the tothe mastoid process ofthe temporal external auditory meatus and bon the mastoid process? NEUROCRANIUM Bones and sutures Which eight bones make ‘The frontal bone, the two parietal boues, up the neurocraniam? the two temporal hones, the ocipital bone, the sphenotd bone, and the ethinokd bone What are the immobile Sutures junetions between the hones of the neuroeranium called?6 Anatomy Recall Which hones articulate at the: Coronal suture? Sagittal suture? Lambdoid suture? sutures called! What is the intersection of the sagittal and coronal sutures called? What is a metopie suture? What is erantorynastosis? What is Scaphocephaly? Acrocephaly? Plagiocephaly? Identify the labeled points fon the neuroeraninm on the following posterior and superior views: “The frontal and patietal bones ‘The parictal hones of ether side The parietal and oceipital bones The lamba The bagi A persistent frontal suture, present in approximately 24 of the population Premature closure of the sutures ure closure ofthe sagittal suture ure closure ofthe coronal suture ure closure ofthe coronal and lambdoid sutures on one side onlyWhat are fontanelles? What are the largest fontanelles, and where are they located? Which sutures form the borders of the posterior fontanelle? How can the anterior and posterior fontanelles be ‘identified on an infant? In adults, what is the name of the remnant of th Posterior fontanelle? What isthe location of the anterolateral (sphenoidal) fontanelle called in adults? Why is the pterion Chepeor 2/ The Head 7 agit suture Lamba hoi suture stemal occipital protuber astoid process Decipital condyle = Bregia ‘ronal sutre agital suture Lambda aambdod suture Large fibrous areas where several sutures ‘meet; often called “soft spots” on an infant's head ‘The anterior and posterior fontanelles, on the superior surface of the neuroe ‘The sagital and lambdoid sutures ‘The anterior fontanelle is diamond. shaped and palpable in children younger than approximately 18 months. The posterior fontanelle is triangular and is not palpable past I year of age. The bregm ‘The asterion ‘The ptevion (brain surgery using an anterolateral incision is ealled a “pterional spproach") ‘The thinnest part of the lateral skull, the plerion is vulnerable to fractures that ean damage the middle meningeal artery, ‘which lies on the internal ska inthis region surface8 Anatomy Recal Internal surface features Label the following view of the floor of the neure- 90 o> superior orbital sure B= Foramen rotundum ramen ovale ypoglossal canal ‘raion magn ‘ramon lacerum nternal auditory meatus = Jugular fora Anterior cranial fossa In addition to the ethmoid The frontal bone bone, which bone eo utes to the floor of the anterior fossa? What is the name of the The enbriform plate flat part of the ethmoid bone that lies anteriorly in the midline? Cranial nerve (CN) I (the olfactory nerve) through the eribriform plate?What is the name of the sharp upward projection of the ethmoid bone in the midline? What is the function of the crista gall? Which structures pass through the anterior and posterior ethmoidal Foran Middle cranial fossa Which part of the brain ‘occupies the middle ‘cranial fossa? What are the borders of the middle cranial fossa: Anteriorly? Posteriorly? Laterally? Ventrally? Which three structures pass from the middle ‘cranial fossa into the orbit, via the optic canal? Which opening between the greater and lesser ‘wings of the sphenoid one conneets the middle ‘eranial fossa with the orbit? (Chapear 21 Tae Head The crista gal It provides the anterior site for the fal cerebri Ge Fold that Hes i the longitud between the two cerebral h spheres) ‘The anterior and posterior ethmoidal nerves and vessels, respectively ‘The temporal lobes of the cerebral The lesser wings of the sphenoid bones ‘The petrous part of the temporal hone 9 ‘The squamous part of the temporal bone, the greater wings of the sphenoid bones, and the parietal bones The temporal bones and the greater wings ofthe sphenoid bones 1. EN IH (the optic nerve) 2 The ophthalmic artery (a branch of tho internal earotid artery) 3, The central vein ofthe retina ‘The superior orbital fissure10 Anatomy Reel Which six structures pass from the middle eranial fossa to the orbit through the superior orbital fissure? The foramen rotundum transmits structures between which two spaces? Which structure passes through the foramen rotundum? ‘The foramen ovale trans- mits structures hetween which two spaces? Which two structures pass through the foramen ovale? ‘The foramen spinosum connects the middle ers fossa with whieh space? Which structure passes through the foramen spinosum? ‘The foramen lacerum lies at the junction of which ‘cranial bones? Grooves on the anterior part of the petrous tem- poral bone transmit which structures? What is the name of the thin plate of bone located at the junction of the petrous and squamous parts of the temporal bon L 3 4 6 (the oculomotor nerve) IV (the trochlear nerve) CNV; (the ophthalinie division of the a c The superior ophthalmie vein The inferior opthalmie vein ‘The middle cranial fossa and the perygopalatine fossa V5 (the mavilary division of the trigeminal nerve) ‘The middle eranial fossa and the infratemporal fossa EX Y; (the mandibular division of the tal nerve) andl the accessory meningeal atery “The infratemporal fossa (ike the foramen ovale) ‘The middle meningeal artery ‘The sphencid bone and the petrous part ‘of the temporal bone "The greater and lesser petrosal nerves “The tegmen tympani‘What is the clinical signi ficance of this thin bone? What is the name of the elevation of the sphenoid bone between the two optic canals? What is the name of the depression posterior to the tuberculum sellae? What is the name of the bony ridge that defines the posterior limit of the sella turelea? What are the boundaries of the sella turciea: Anteriorly? Posteriorly? Which structure lies in the hypophyseal fossa of the sella tureica? Which space is located directly inferior to the sella tureica? Which structure forms the roof of the sella tureiea? Which processes project from the lateral aspects of the dorsum sellac? ‘What structures attach to, the posterior clinoid processes? Posterior cranial fossa Which part of the brain lies in the posterior eranial fossa? Chapter 2/ The Head 11 This bone, which soparates the tympanic cavity from the middle cranial fossa, isso thin that infections ofthe middle ear can spread to the meninges and brain, The tubercubam sellae ‘The sella tureiea (“Turkish sad") The dorsum selle ‘The tuberculum sellae The dorsum sellae ‘The pity ary el The sphenoid sinus (surgery on the pituitary gland uses a “trans-sphenoidal” approich) ‘The diaphragma sellae(1¢., one of the dural folds) “The posterior elinold processes ‘The tentorinm cerebelli (Le, the dural {old between the occipital lobes and the cerebellum) ‘The corebelliun and brain stem12 Anacomy Recall What are the borders of the posterior cranial Fossa Anteriorly? Posteriorly? Ventrally (Le, the floor)? Dorsally (i.e. the roo)? Which three structures pass through the internal audi- tory meatus (ie. the open- 1g in the posterior aspect of the petrous part of the temporal bone)? Which cranial foramen lies the junetion of the pe- trous part of the temporal bone and the occipital bone? Which six structures pass through the jugular foramen? Where is the hypoglossal © relation to the {jugular foramen? Which nerve passes through the hypoglossal canal? Which large opening lies in the posterior midline floor of the posterior fossa? “The petrons part ofthe temporal bone The occipital bone "The occipital bone and the mastoid processes ofthe temporal b The tentorium corebell LGN VI (the abducens nerve) 2 CN VIII (the vestihulocachlear nerve) 3. The labyrinthine artery Tho jugular forasnon 1. GN IX (the glossopharyngeal nerve) 2 CNX the vagus nerve) 3. CN XE (the accessory ner 4. The intemal jugular vein (superior bulb) 5. The sigmoid sinus 6. The inferior petrosal sinus ‘The hypoglossal canal lies just medial to ‘he jugular foramen, CN XII (the hypoglossal nerve) ‘The foramen magnumWhich structures pass through the foramen smmagnum? What is the name of the bony “ramp” just anterior to the foramen magnum? ‘Which small opening may be present lateral to the foramen magnum? Which structure passes through the condyloid foramen? Which structures pass through the mastoid foramen? ‘What is the name of the midline crest on the in- side of the occipital bone? Which structure attaches to this crest? ‘What is the posterior term- ination of the internal ‘occipital crest? ‘Which structures are trans- ‘mitted in the grooves that project laterally from the internal occipital protuber- ance along the occipital bone? Chapter 2/The Head 13 1. The medulla oblongata (1, the lower aspect ofthe brain stem) 2 CN XI (the spinal accessory nerve 3. The vertebral arteries 4, ‘The venous plesus ofthe vertebral canal 5. ‘The anterior aud posterior spinal esters The clivus ‘The condyloid foran “The condyloid emissary vein ‘The mastoid emissary vein and a branch ‘of the ocepital artery The internal occipital rest ‘The fals cercbeli (Ke, the dural fold that separates the cerebellar hemispheres) “The internal occipital protuberance The transverse sinuses14 Aratomy Recall FACIAL CRANIUM, Label the structures sh on the following anterior view of the skull ken Eo Supraorbita noteh Superior orbital fissure C= Inferior orbital sure D= Inferior nasal concha E = Infraorbital foramen Alveolar process G= Ghabella Optie canal Midale nasal concha ‘Zygomaticofacial foramen K = Nasal septum = Angle ofthe manchible AM= Mental foramen What is the smooth median The glabella prominence of the frontal hone called? Which bone located be- The tween the orbits contains the eribriform plate and a perpendicular plate?Which structures pass through th Infraorbital foramen? ‘Zygomaticofacial foramen? Mental foramen? Orbie Which bones form the margins of the orbit: Superiorly! Laterally? Which twa fissures form a communication between the the orbit? Which structures pass into the orbit from the infratem- poral fossa via the inferior orbital fissure? Which structures pass through the supraorbital notch? Paranasal (air) sinuses What are paranasal sinuses? Chapter 2/The Head 15 ‘The infraorbital nerve (a contimation of EN Vp) the infraorbital artery, and the infraorital vein ‘The zygomaticofacial nerve The frontal bone (orbital plate) ‘The zygomatic bone and zyyomatic process of the frontal bone The maxilla and 7ygomatic hones The ethmoid, lacrimal, sphenoid, and frontal bones "The superior orbital fissure (comnicates with the middle cranial fxs) and the inferior orbital fissure (o ‘municates with the infratemporal fossa ‘The rygomatic branch of C nally division ofthe trig and the infiaorbital artery Va the vninal nerve) ENV; (the opthaliie division ofthe trigeminal nerve, or the supraosbital nerve) and the supraorbital vessels ‘The paranssal shnises are ai spaces within the bones ofthe ski that communicate with the nasal cavity. Don't confuse the pparanasal sinuses with the venous (éural) sinuses, which convey venous blood in the16 Anatomy Recall List the four skull bones that have paranasal sinuses. What is the funet these sinuses? Which sinus, because of its location, ean often lead to the spread of infection into the orbit? Which sinus is susceptible to the spread of infeetion from a tooth? ‘Which sinuses may be present at birth? Nasal caviey Which four bones form the roof of the nasal cavity? Which bones form the floor of the nasal eavity (and the hard palate, or the anterior portion of the roof of the mouth) Which eight bones form the lateral wall of the nasal cavity? Which opening forms a communication between the nasal cavity and the nasopharynx? Which structure divides the nasal cavity into left and right parts? 1. Frontal bone 2 Masia 3 I 4. Sphenoid home wid bone Ther fetion stash alone are thought to lighten the skull and aid in resontion of the voice ‘The maxillary sinus—roots ofthe posterior maxillary teeth often project up into this sinus, ‘The masilary and sphenoid sinuses The nasal bone, the frontal bone, the cribriform plate ofthe ethinoid bone, and the body of the spend bone The palatine process ofthe masilla and the liorizontal plate of the palatine bone “The ethmoid bone ‘The medial pterygoid plate ‘The perpendicular plate ofthe palatine hone ‘The masila “The nasal bone “The frontal bone ‘The herimal bone “The inferior concha The choanae, a large opening at the back of the nasal cavity The nasal septumWhich two bones contribute to the nasal septum? What are the three bony projections from the lateral ‘nasal wall called? What are the spaces below each of the nasal conchae called? ‘The inferior meatus con- tains the opening to which space above the super ‘concha? ‘What is the rounded prom- inence on the wall of the middle meatus? ‘What is the hiatus semi- Iumaris? ‘What isthe infundibulum? Deseribe the drainage of each of the following para- nasal sinuses: ‘The anterior ethmoid "The midalle ethmoid sinus ‘The posterior ethmoid sinus ‘The frontal sinus ‘The sphenoid sinus (Chapter 21 The Head 17 The vomer ancl the perpendicular plate of the ethmoid bone “The nasal conchae—the superior and middle conchae are part ofthe ethimotd bone, while the inferior nasal concha isan independent bone Meatus (eg, the superior meatus isthe space between the superior and middle conchae: the mide bets eatus isthe space 1 the aide and inferior conchae inferior meatus is the space below the inferior conch) an th “The nasolacrimal chct “The sphenoethmoid recess The ethmoid bulla The enrved eleft below the ethmoid bulla atthe: The chs wats semilomaris terior aspect of the "The biatus seminars (ia the infiand bulum), located inthe middle nasal meatus “The ethimoid bulla, located in the middle nasal meats The superior nasal meatus ‘The middle nasal meatus (via the Front nasal duet, which opens into the infuncibuluen) The sphenocthmoidal recess1 Anatomy Recall iMlary sinus Which three arteries supply branches to the nasal cavity? What are the two primary branches of the ophthalmic artery that supply the nasal cavity? ‘What are the two branches of the masillary artery that supply the nasal cavity? Which branch of the facial artery supplies the nasal cavity? Mandible Where does the body of the ible meet each of the rami? Name the two processes on top of each of the ram What is the name of the notch located between the coronoid and eondyloid processes? What is the name of the ‘opening on the medial surface of the mandible? What structure does the ar foramen lead What structures lie in the sand ilar canal? “The hiatus semi The masilary and facial arteries (branches of the extemal carotid artery) and the ophthalnie artery (a branch ofthe intemal ‘carotid artery) ‘The anterior and posterior ethrnoidal arteries, which supply the lateral wall and rasal septum ‘The sphenopalatine artery (which meatus, and nasal supplies the conchae, septum) and the descending palatine artery (which also supplies the nasal septum) ‘The superior labial artery ‘The coronoid process (anterior) and the condyloid process (posterior) ‘The mandibular noteh The mandibular foramen The mandibular canal ‘The inferior aleolar nerves and vessels,Infratemporal fossa Which structures pass though the: Petrotympanie fissure? ‘The stylomastoid foramen? ‘The greater palatine foramen? ‘The lesser palatine foramen? Chapter 2 The Hed 19 ‘The chorda tympani (a branch of the facial nerve within the temporal bone) ‘The facial nerwe ‘The greater palatine nerve and vessels ‘The lessor palatine nerve and vessels ‘THE SCALP AND SUPERFICIAL AND DEEP FACE SCALP What is the sealp: What are the five layers of the sealp? Branches of which artery constitute the major blood ‘supply of the sealp? What are these branches of the external caro that supply the sealp? Which branches of the internal carotid artery supply the sealp? What is unique about the veins of the seulp? “The skin and faseia that covers the Aponeuresis (gale aponeurotiea) Loose connective tis Pericraninm ‘The external carotid artery ‘The superficial temporal, posterior ‘auricular, and oceipital arteries “The supratrochlear and supraorbital arteries (vla the ophthalnic artery) ‘They have no valves.20. Anatomy Recal What connects the veins of Ennissury wins the scalp with the veins of the skull bones and the ‘veins within the cranium? NOSE What isthe medical term Nares for nostrils? What is the name of the The ala nasi (*wing of the nose cartilaginous part of the external nose that sur rounds each naris? What i the dilated part of The vestibule the nostel called? What three effects does the Warmin nose have on inspired ait? sing, and filtering MUSCLES OF FACIAL EXPRESSION Label the masse of Gc ° eune soz esChapeer 2/ The Hesd 24 A= Orbiculars ocul B= Nasalis C= Lesutor anguli ori D= Buccinstor B= Masseter F = Depressor angull oris G= Depressorlabitinferioris mporalis aerugator (supercili) = Levator lai superions = Zygomaticus major and minor ‘The mesodern ofthe second pharyngeal arch (ic. e hyoid arch) Dysfunction of whi muscle results in difficulty with blinking? ‘The orbicularis ocul (closes eyes) Which musele is primarily The froutalis muscle responsible for raising the eyebrows? Which nerve innervates the museles of facial GN VHT (the facial nerve) expression? ‘TEMPOROMANDIBULAR JOINT (TM) AND MUSCLES OF MASTICATION ‘Temporomandibular joint (TMJ) What type of joint isthe synovial joint TM? Jhtwo types of move. Hinge movement and sliding movement ments are provided by the Tp What are the articular sur- The articular tubercle and mandibular faces of the TMJ? fossa ofthe temporal bone andthe condsloid process of the mandible22 Anatomy Recall Name the three liga of the TMJ. Which ligament reinforces the TMJ by stretehing from the tubercle on the zygoma to the neck of the mandible? Which ligament reinforces the TM] by stretching from the spine of the sphenoid bone to the kingula of the ‘mandible? Dislocation of the TMJ ‘usually occurs in which Describe the origin and insertion for each of the following: Masseter muscle ‘Temporalis muscle (superior head) Lateral pterygoi (inferior head) 1. The lateral temporomandibular Figament 2, The sphenomandibular ligament 3, The stylomandibubar ligament “Tho lateral temporomandibular ligament ‘The sphenomanudbular ligament Anteriorly 1. The masseter nse 2, The temporalis muscle 3. The medial pterygoid muscle 4. The lateral plenyyoid muscle Origins The lower border and medial surface ofthe zygomatic arch Ansertion: The lateral surface of the ‘conoid process, rans, al angle of the mandible Origin: The Hoor ofthe temporal fossa Insertion: The coronoid process ancl ramus of the mandible Origin: The infratemporal surface of the spheroid bon Insertion: The neck ofthe mandible Origin The lateral surface ofthe lateral id pheChapeor2/The Head 23 Insertion: The articular disk and capsule of the TMJ he tuber of the maxi, the dial surface of the lateral pterygoid plate, and the pyramidal process of the palatine bone Inyertion: The medial surface of the angle and the ramus ofthe mandible Medial pterygoid muscle ‘Which muscle is responsible for: Closing the jaw and pro- The medial pterygoid! muscle tending the mandible? ‘Opening the jaw and pro- ‘The lateral pterygoid muscle truding the mandible? Which musele is the primary actor in: Depressing the mandible The lateral pterygoid muscle sat the TMJ? Ketracting the mandible? The temporals musele Which three muscles act to ‘The temporals, masseter, and mesial clevate the mandible at the pterygoid muscles TM? Which two muscles uct to The masseter muscle and the temporalis close the jaw and retract snusele the mandible? Which arteries supply the muscles of mastication? (sometimes called the pterygoid branches) PAROTID GLAND What is the name of the ‘The parotid gland largest of the three sets of salivary glands? What are the boundaries Of the space containing the parotid gland: Anteriorly? es of mastication24 Anatomy Recal Posteriorly? Medi ly? Superiorly? Which structure divides the parotid gland into super and deep parts? Which part of the parotid gland extends upward behind the TMJ? Which part of the parotid sland extends anteriorly superficial to the masseter muscle? What is the name of the extension of the parotid gland between the medial pterygoid muscle and the ‘mandible? What is the name of the ‘major duct of the parotid land? Where does the parotid duct begin? ‘The parotid duct pierces which muscle on its course Which three major structures traverse the parotid gland? The extemal auditory meatus and mastoid proves The styloid process The zygomatic arch CN VII (the facial nemve ‘The glenoid process ‘The facial process The pterygoid process ‘The parotid duct (Stensen's duct At the facial process ofthe parotid gland The buceinator Opposite the second upper molar tooth 1, EN VI (the facial nerve) 2. The retromandibular vein 3, The extemal carotid arteryFrom which ganglion do the parasympathetic fibers that supply the parotid land originate? What is the source of para: sympathetic fibers to the otie ganglion? Which nerve transmits post ganglionic parasympathetic fibers to the parotid gland? Sympathetic innervation to narotid gland! Folloss which structure? SUBMANDIBULAR REGION Name the two sets of sali- vary glands that lie in the submandibular region OF the three sets of salivary glands, which is the smallest? Where do the ducts of the sublingual salivary glands ‘open into the mouth? Which structure separates the parotid gland and the submandibular glands? Which duct drains the sub- ‘manlibular gland? Wharton's duct lies between which two structures? Where does Wharton's duct, Which major blood vessels ‘run in the submandibular region? CChapeer2/The Hed 25 ‘The otic ganglion Parasymmpathetic fibers originate in the Inferior salivary nucleus of CN IX (th elossopharyn tympani branch, and then travel to the ‘otic ganglion via the lesser petrosal nerve passing through the otic ganglion, e postganglionic parasyn are transmitted to the parotid gland via the auriculotemporal nerve ‘The external carotid artory ibaa gh 2. Sublingual glands ds ‘The sublingual glands Wharton's duet ‘The sublingual glands and the genioglossus suscle Alongside the frenulum of the tongue “The facial branches ud Kinga arteries (bo ofthe external carotid artery)26 Anatomy Recall What is the source of para- CN VII (the ficial nerve), via the chorda sympathetic innervation to tympani and lingual nerve the submandibular and sublingual salivary glands? INNERVATION OF THE FACE Which cranial nerve pro- VI (the facial nerve) vides motor innervation to the face? Identify the five terminal branches of CN VII on the following figure: A= Temporal branch B = Zygomatie branch (© = Buccal branch D= Mandibular branch E = Cervical branch thin which structure does The parotid gland CN VII divide i branches? Which eranial nerve pro. CNV the triger vides sensory innervation to the face?Identify the nerves that provide sensory innervation to the face on the following figure: (Chapeer2/The Head 27 ‘The supraorbital and supra trochlear nerves are branches of which nerve? What structures are inner- vated by the supraorbital and supratrochlear nerves? Which nerve provides sen- sory innervation to the eye and the septum, lateral walls, and tip of the nose? ster occipital nerve Auriculotemporal nerve = Lesser occipital nerve D= Zygomaticotemporal nerve ‘Zygomaticofacial nerve fraorbital nerve worbital nerve Supratrochlear nerve 1 = Lacrimal nerve J. = Infratrochlear nerve External nasal nerve L = Buccal nerve Mental nerve ‘The frontal nerve28 Anatomy Recall Deseribe the branches termination of the nasociliary nerve. Which branch of the naso- ciliary nerve provides sen- sory innervation to the sept tip of the nose? fateral walls, and Which branches of CN V, (the maxillary division of the trigeminal nerve) pro- vide sensory innervation to the nasal cavity? Which cranial nerve pro vides special sensory inner- vation to the nose? Describe the sensory innervation of the: Roof of the mouth Floor of the mouth, Cheek VASCULATURE OF THE FACE Arteries What is the source of arterial blood to the face? After giving off the posterior ethmoidal nerve the ciliary nerves to the irs, and a ‘communicating branch to the ciliary zzglion, the nasoeiiary nowve endl in the anterior ethmoidal nerve ancl the infaorbital nerve. ‘The anterior ethmoidal 1. Posterior inferior lateral nasal nerve 2 Posterior superior lateral nasal nerve 3. Nasopalatine nerve 4. Anterior superior alveolar nore EN 1 the olfactory nerve) —CN I passes ‘Hough the opening of the eribriform plate ofthe ethmoid bone on the way to the olfactory bulbs “The greater palatine and nasopalatine nienves (branches of CN V,, the msllary division of the trigeminal ner “The lingual nerve (a branch of CN Vy, the mandibular division ofthe trigeminal The bneeal nerve (also a branch af cNY) The external carotid arteryName the eight branches of the external carotid artery, from proximal to distal. Facial artery Describe the course of the facial artery in the sub- mandibular region. Where can the pulse of the facial artery be easily palpated? Name three branches of the facial artery. Maxillary arcery Where does the ‘maxillary artery branch from the external earotid artery? ‘The maxillary artery is divided into three parts by which muscle? Where does the pterygo- palatine part of the ‘maxillary artery run in rela- tion to the lateral pterygoid muscle? Chapter 2/ The Head 29 1. Superior thyroid artery 2 Ascending pharyngeal artery 3. Lingual artery 4. Facial art 5. Occipital artery 6. Posterior auricular artery 7. Superficial temporal artery 8. Masillary artery ‘The facial artery arses from the external carotid artery above the hyoid bone ascends deep to the digastric and stylohyoid muscles and then behind the submandibular gland, hooks around the inferior border ofthe mandibular body and then enters the anterior margin of the masseter muscle. 1. Inferior labial artery 2. Superior labial artery 3. Lateral nasal artery At the posterior border of the ramus of the mandible, within the parotid gland “The lateral pterygoid Between the two heads30 Anatomy Recall Identify the branches of the ‘maxillary artery on the following figure: Supartca enpera arery Mastin arery Name the five branches of the masillary artery within the infratemporal fossa. Which branch of the max- illary artery supplies the: External auditory meatus? ‘Tympanic membrane? B = Middle meningeal artery Anterior tympanic artery D= Deep auricular artery E = Masseter artery F = Sphenopalatine artery orbital artery Posterior superior alveolar artery Descending palatine artery Buccal artery Inferior alveolar artery 1, Deep auricular artery 2. Anterior tyimpanie artery 3. Middle meningeal artery 44 Accessory meningeal artery 5 Inferior alveolar artery ‘The deep auricular artery “The anterior tympanic arteryDamage to which artery resulls in an epidural hematoma? How does the middle men- ingeal artery enter the skull? wi maxillary artery supplies the chin and lower teeth? h branch of the Name the six major artery in the pterygo- palatine foss Describe the course of the sphenopalatine artery and the structures it supplies. Superficial emporal artery Where can the superficial temporal arterial pulse be nerve accompanies the superficial temporal artery? ‘The superficial temporal artery gives rise to the transverse facial artery. Between which two structures does the trans- verse facial artery pass? Veins Deseribe three pathways for venous drainage in the face and sealp. (Chapter 2/ The Head 31 “The middle meningeal artery (most often damaged in fractunes ofthe temporal bone) "Through the foramen spinostan The inferior alveolar artery 1. Posterior superior alwolar artery 2. Infraorbital artery 3, Descending palatine artery 4. Artery of the pterygoid canal 5. Pharyngeal artery 6. Sphenopala ‘The sphenop perygopalatine fossa, passes through the latine artery leaves the plerygopalatine foramen, and enters the nasal cavity, where it supplies the sal sept, interior to the auricle ofthe external The aurieulotemporal nerve ‘The zygomatic arch above and the parotid duct below 1, Facial vein to the retromandibular vein tothe external jugular vein 2, Plesnses within the face tothe external jugar vein 8. Vennns (dural) sinuses to the internal jugular vein32 Anscomy Recall Describe the origin of the The retrom retromandibular vein. the superficial temporal and masilary veins unite, The supraorbital al supratrochlear veins facial vein. join to form the angular vein, whieh becomes the facial vein at the lower margin ofthe orbit The retromandibular vein which structure to form the internal jugular vein? What are the (wo major The masilary vein and the pterygoid avenues of venous drainage venous plesis from the infratemporal fossa? How does the ptorygotd Via the deep facial vein “Tho wsterior, lateral, and occipital 2 Where does the anterior To the subnanulibular and submental Iymphatie chain drain? nodes, then tothe deep cervical nodes Where does the lateral To the superficial parotid andl deep Iymphatie chain drain? parotid nodes, and then to the deep ‘cervical nodes Where does the occipital To the occipital and retroaucicular nodes Iymphatic chain drain? sau then to the deep cervied! nodes ‘THE ORAL CAVITY PALATE What roof of the ‘The hard palate (anteriorly) ‘mout palate (posteriorly) Which bones comprise the The palatine processes of the masila ancl hard palate? the horizontal plates ofthe palatine bones ‘Where is the incisive Posterior to the central incisor teeth foramen located?Which structures pass through the incisive foramen? ‘TEETH What is the normal number ‘of adult tooth? Which nerves provide inner vation to the maxillary teeth? ve innervates the Which. mandibular tect What mechanism is respons- ible when a patient ‘experiences: Ear pain as a result of « ower jaw infection? Symptoms of sinusitis as a result of a tooth infection? TONGUE the midline undersurface of the tongue? What is ankyloglossia? What nerve provides for taste sensation on the anterior two thirds of the tongue, in addition to pro- viding parasympathetic innervation to the subman- dibular and sublingual salivary glands and the lacrimal glands? Which nerve provides for taste sensation on the pos: terior third of the tongue? Chapter 2/ The Head 33 The gre lorael tor and lesser pal of the sphiewopalatin ssopalatine nerve ine arteries 3218 12 molars) isos, 4 can 8 premolars, and “The anterior, middle, ancl posterior superior alwcolar branches of CN V5 (the rnulary division of the trigeminal nerve ‘The inferior alveolar branch ofthe Irritation of the mandibular nerve Irritation ofthe masilary nerve The fren An abnormally short frenulumy (can lead tospeech impediment) “The chorda tympani, a branch of CN VIL (the facial nerve) EN 1X (the glossopharyngeal nerve)34 Anatomy Recall Which nerve provides sensory innervation to the tongue? Musculature of the tongue What is the function of the vinsie tongue museles? Which four museles com Hyoglossus muscle? Styloglossus muscle? Palatoglossus muscle? Which one of the extrinsic muscles of the tongue is not innervated by ON XII (the hypoglossal nerve)? Lesions of CN XII cause the tongue to deviate toward which side? EN Y, the mandiblar division of the ‘They help the tongue maintain its shape © 1. Gonioglossus 2. Hyoalossus 3. Styloglossus 4. Palatoglossus Origin: The gonial tubercle ofthe snancible Insertion: The inferior aspect of the tongue and the body of the hyoid bone Action: Protrudes and depresses the ton Origin: The body of the greater hom of the hyoid bone Insertion: The side ‘and inferior aspect ofthe tongue Aetion: Depresses and retracts the tongue Origin: The styloid process Insertion: The side and inferior aspect of the tong Action: Retracts and elevates tongue Origin: Aponcuroses of the soft palate Insertion: The dorsolateral sie ofthe tongue Action: evates the tongue “The palatoglossus [this muscle is innewvated by CN X (the vagus nerve) via the pharyngeal plevus] ‘Toward the side ofthe lesion (this i own asthe “wheelbarrow effet.” think of what happens when you push a ‘wheelbarrow with one hand—to which side does it tend to deviate?)Vasculature of the tongue What is the arterial supply to the tongue? What is the lymphatic drainage from the: Anterior third (tip) of the tongue? Posterior two thirds of the tongue? ‘What are the lymph nodules located under the posterior tongue called? ‘THE PHARYNX Chapter 2/ The Head 38 ‘The lingual branch of the externa carotid artery, the ascending pharyngeal artery and branches ofthe fail artery submental nodes The submental nodes andl the submandibular nodes (to the deep ‘cervical lymphatic chain) “The lingual tonsils ‘What is the pharynx? What are the superior and inferior borders of the pharynx? PHARYNGEAL MUSCLES ‘What two groups of muscles ‘comprise the pharynx? Pharyngeal constrictor (external) muscles Name the three constrictor muscles, from interior to exterior. What is the action of the constrictors? ‘A museulr tube through which food and ‘water pass tothe esophagus and air passes to the laryns, trachea, andl hangs The pharyns extends from the base ofthe skull to vertebra C 1. Estemal circular layer the constrictors) Internal longitudinal ayer Superior constletor Middle constrictor Inferior constrictor By constricting in a coortinated fashion, these muscles push food into the esophagus. Constriction is under autonomie control36 Anatomy Reel Overlapping of the pharyngeal constrictors creates four gaps that allow: structures to acess the pharynx. Where are these aps located? What is the origin of the: Superior constrictor? Middle constrictor? Inferior constrictor? Longitudinal (internal) muscles Name the three longitudinal internal) museles of the pharynx. What is the action of the Jongitudinal museles? What is the origin ofthe: Palatopharyngeus musele? Salpingopharyngeus muscle? Stylopharyngeus muscle? What is the common in- sertion of the longitudinal muscles? 1. Superior ta the superior constrictor 2. Between the superior snd middle constrictors 3. Betwcen the middle and inferior 4. Inferior tothe inferior constrictor ‘The pterygoid hamulus, pterygo mandibular raphe, and posterior imloivoid line of the nade The stylohyoid ligament anel hyoid bone The thyroid and ericoid cartilages of the The median raphe ofthe pharyis (ie, the smline in the posterior ofthe pharyns The pharyngeal and superior laryngeal branches of CN X (the vagus nerve), via the pharyngeal plexus 1. Palatopharyngens muse 2, Salpingopharyngens muscle 3, Stylopharyngeus muscle These niscles ras the phanyn and nis curing swallowing snd spea ‘The hard palate (palaro-) The eartilaginons enstachian tube (saipine means tube" in Latin) The styoidl process (stylon "The posterior and superior border of the Uyroid cartilageWhat is the innervation of the longitudinal muscles? PHARYNGEAL REGIONS What are the three divisions of the pharyns? Hdentify the labeled. structures on the following posterior view of the pharyngeal region: ronmoo oo (Chapeer2/The Head 37 “The palatopharyngens muscle and the salpingopharyngens muse re innervation from CN X (the vagus nerve) via the pharyngeal plesus. The ilopharyngens muscle is innervated by IN IX (the glossopharyngeal nerve! “The nasopharyns, oropharyns, and laryngopharynx Nasal septum Nasal eavity Eustachian (auditory) tube Uvula38 Acstomy Recall Nasopharynx What structure forms the boundary between the nasal cavity and the nasopharyns? Which Iymphoid tissue collection protrudes from the posterior roof of the nasopharynx? Which structure connects) the tympanic cavity with the nasopharynx? Where in the nasopharynx is the opening of the ‘eustachian tube? Which muscle attaches to the eustachi Oropharynx What forms the border between the oral eavity and the oropharynx? What are the superior and inferior borders of the oropharynx? Which two folds bound the orophirymy katerally? What lies between these two folds? What is the name of the inferior projection from the ‘midline of the soft palate? F = Toye G= Middle constrictor musele piglotis 1 = Arytenoid musele Piriform recess K= Inferior constrictor nmasele The choanac, a hinge pent posterior extent of the nasal eaity The pharyngeal tonsils ‘The cuastachian tube Inthe later all The Ipingopharyngeus wnsce The palatoglossl arch (Formed by underlying muscle of the same name The soft palate (superiorly) and the superior border of the epiglttis The palatoglossal arches 1 palatophanyngeal ‘The palatine tonsils (within the tonsil The vata (als kono as “that litle thing atthe back of your throat‘What is the sensory inner- vation of the oropharynx? List the five muscles of the soft palate. Which musele is responsible for elevating and retracting the soft palat Laryngopharynx What isthe laryngopharyne Posteriorly, the laryngo- ppharyns is related to which vertebra What are the superior and inferior margins of the laryngopharyns? ‘THE EYE AND ADNEXA CChopter2/TheHesd 39 ENIX (the glossopharyngeal nerve 1. Tensor vli palatni muscle 2. Levator vel palatin’ usc 3, Palatoglexsus muscle 4. Palatopharyngeus muscle 5. Muscuhis wwulae anisele The levator vel palatin The portion of the pharynx that lies posterior tothe lays Vertebrae C106 Superior: The upper border ofthe ‘pilots Inferior: The lower border ofthe ericoid cartilage (Le, the beginning ofthe trachea) EYEBALL Identify the structures on the following figure of the vom»40 Aratomy Recall Chambers of the eye ‘The lens lies between which two structures? “The irs divides the space hetween the Tens and cornea into which chambers? What fills these chambers? ‘Trace the flow of aqueous humor. Obstruction of the canal of Schlemm can lead to which clinical condition? What are the con of glaucoma? equences ‘Ocular tunics What are the three ocular tunis? Fibrous tunic What two structures form the fibrous tunie of the eyeball? A= Comea B= Ins C= Ciliary body D> Lateral rectus mu E=Sclera acuta (a part ofthe retina) Aqueous humor = Ciliary processes Suspensory ligament (zonular fibers) reas bevy hood Dptic dise ON IL (the eptic nerve) “The irs (anteriorly) and the vitreous body (posteriorly) “The anterior and posterior chambers Aqueous humor Made by the ciliary processes, the acjueons humor enters the posterior chamber lows into the anterior chamber (via the pupil), and is drained from the: anterior chamber via the canal of Seblemm, Glaucoma The resultant increase in intraocular pressure can ease retinal damage and blindness The fibrons tunic, the vasenlar tun, and the retina The sclera (covers the posterior five sisths of the eyeball) and the comea (covers the anterior one sith of the eyeball)