HEAD AND NECK REGION

SURFACE ANATOMY
 The Head
• Surface Anatomy
• Nasion – depression in the
midline at the root of the nose
The Head

◼ External occipital
protuberance – bony
prominence in the middle
of the occipital bone
The Head
• Surface Anatomy
• Vertex – highest point on the
skull

Anterior fontanelle –
lies between the
frontal bone and two
parietal bone; closes
by 18 mos.fontanelle
Posterior
– between occipital
bone and parietal
bone; close by the
first year
The Head
• Surface Anatomy
• Superciliary ridges – prominent ridge on
the frontal bone at the upper margin of
the orbit

• Superior nuchal line – lateral line from

the external occipital protruberance to
mastoid process; for attachemnt of
trapezius and SCM
The Head
• Surface Anatomy
• Mastoid process – bony projection
behind ear

• Auricle and external auditory

meatus – in front of mastoid
process; about 1 in. and is long and
forms an S shape
The Head
• Surface Anatomy
• Tympanic membrane – pearly gray
in color and concave toward
meatus; Umbo is the most
depressed part of the membrane
 The Head
• Surface Anatomy
• Pterion – point where the
greater wing of the sphenoid
meets the antero-inferior angle
of parietal bone; where the
anterior branch of middle
meningeal artery lies
The Head
• Surface Anatomy
• Superficial temporal artery – felt as
pulsation across zygomatic arch
The Head
• Surface Anatomy
• Maxillary and frontal air sinuses – situated within the
maxillary bone and frontal bone respectively
 The Head

• Surface Anatomy
• Body of mandible
• Temporomandibular joint –
palpated in front of auricle
The Head
• Surface Anatomy
• Orbital margin – formed by
frontal, zygomatic and
maxillary bones
• Supraorbital notch –
palpated in upper margin of
orbital margin
• Infraorbital foramen – found
in lower border of orbit
about 5 mm.
SURFACE ANATOMY OF
THE NECK
NECK REGION
Surface Anatomy
• Surface anatomy
• Posterior aspect

• occipital protruberance

• spinous process of axis

• spinous process of C7
(vertebral prominence)
 NECK REGION
Surface Anatomy

• Anterior aspect
• Laryngeal prominence
(Adam’s apple) - produced
by thyroid cartilage and is
part of the laryngeal
skeleton
NECK REGION
Surface Anatomy
• Anterior aspect
• Thyroid cartilage - located at the
level of the 4th to 5th cervical
vertebra; vocal fold (cord) lies
about the level with the midpoint of
the anterior border of the thyroid
cartilage

• hyoid bone - lies superior to thyroid

cartilage; U shape; located at the
body of 3rd cervical vertebra
 NECK REGION
Surface Anatomy

• Anterior aspect
• tracheal rings

•jugular notch
(suprasternal notch) -
rounded depression in
the manubrium of the
sternum; palpable
between the medial
ends of the clavicle
 NECK REGION
Surface Anatomy

• Anterior aspect
• sternocleidomastoid muscle (SCM) -
important because it divides the neck
into its different triangle
NECK REGION

• supraclavicular fossa -
important clinically because
it contains pressure point
for the subclavian artery
 NECK REGION

• trapezius muscle
BONES OF THE SKULL
THE SCALP
• Consists of skin (normally hair bearing) and
subcutaneous tissue, covering the calvaria, from
superior nuchal lines on the occipital bone to the
supraorbital margins on the frontal lobe.
• Laterally, extends to the temporal fascia to the
zygomatic arches
SCALP
• Layers
• Consists of 5 layers of tissue:
• Skin – contains:
• sweat and sebaceous
glands
• hair follicles
- has abundant arterial supply
and good venous and
lymphatic drainage

• Connective tissue – thick,

dense, richly vascularized
subcutaneous layer
- well supplied with cutaneous
nerve
SCALP
• Aponeurosis (epicranial
aponeurosis) – a strong
thin, tendinous sheet that
covers the calvaria between
• unites the occipital and
frontal bellies of the
occipitofrontalis muscle
(epicranius muscles)

• Subaponeurotic space – below the

epicranial aponeurosis; limited in
the front and behind by origins of
the occipitofrontalis muscle;
attached laterally as far as temporal
fascia
SCALP
• Loose areolar connective
tissue – occupies the
subaponeurotic space
that may distend with fluid
resulting from injury or
infection
• allows movement of the
scalp proper over the
underlying calvaria
• contains emissary veins
connecting superfical veins
of scalp with diploic veins
SCALP
• Pericranium –
dense layer of
connective tissue
that forms the
external periosteum
of the calvaria;
• is attached but can
be stripped fairly
easily from calvaria
Muscle of the Scalp
• Occipitofrontalis muscle
• Origin : 4 bellies- 2 occipital and
2 frontal
• Occipital belly – from nuchal lline
• Frontal belly – from skin and
superficial fascia of eyebrows
• Nerve supply
• Facial nerve (cranial nerve 7)
• Action
• Raise eyebrows in expression of
surprise or horror
Sensory nerve supply of scalp
from anterior to the auricle – trigeminal nerve

posterior to the auricle – from spinal cutaneous

nerve (C2-3)
 Vascular supply of scalp
Arterial supply
Comes from external carotid artery
through the occipital, posterior
auricular and superficial temporal
arteries; and from internal carotid
artery through the supratrochlear and
supraorbital arteries

Venous supply
drainage of superficial parts is through
the accompanying veins of scalp arteries
the supraorbital and supratrochlear veins
Clinical Notes
• Scalp infection
• Loose connective tissue layer is the danger area of
scalp because pus or blood spreads easily in it
• Infection in the areas may pass through the emissary
veins and enter the cranial cavity

• Laceration
• Most common type of head injury
• Because of the strength of the aponeurosis,
superficial laceration in the skin do not gape because
margins are held tightly in this layer
SKULL
THE SKULL
• The skeleton of head; consists of
series of bones forming two parts:
A. Neurocranium (brain box
or cranial vault) provides
protection for the brain and
meninges

B. Facial skeleton
(viscerocranium or
splanchnocranium) is the anterior
part of skull
The Skull
• Neurocranium/ cranium
consists of 8 bones
frontal bone 1
parietal bone 2
occipital bone 1
temporal bone 2
sphenoid bone 1
ethmoid bone 1
The Skull
• Neurocranium
consists of 8 bones
frontal bone 1
parietal bone 2
occipital bone 1
temporal bone 2
sphenoid bone 1
ethmoid bone 1
 The Skull
• Facial bone
consists of 14 irregular bones
zygomatic bones 2
maxillae 2
nasal bone 2
lacrimal bone 2
vomer 1
palatine bone 2
inferior chonchae 2
mandible 1
 The Skull
• Anterior Aspect of Skull
Frontal bone – forms the forehead
- articulates with nasal and
zygomatic bones
- Glabella is the slightly
depressed area between the
superciliary arch
 The Skull
• Anterior Aspect of Skull
Frontal bone
- nasion – intersection of frontal
and nasal bone; related to the
depressed area (bridge of the
nose)
- also articulates with the
lacrimal, ethmoid and sphenoid
bones
- forms roof of orbit and floor of
cranial cavity
 The Skull – Anterior aspect

• Frontal bone
- Supraorbital
margin contains the
supraorbital notch or
foramen for the passage
of suprorbital nerve and
vessel
 The Skull – Anterior aspect

• Frontal bone
orbital margin –
bounded by frontal
bone, zygomatic
bone and maxilla
The Skull – Anterior aspect
• Zygomatic bone
- also known as
cheek bone, zygoma,
malar bone
- zygomaticofacial
foramen pierces on
lateral side for passage
of zygomaticofascial and
zygomaticotemporal
nerve
 The Skull – Anterior aspect

• Nasal bone
- form the bridge of
nose
- nasal cavity is
divided into 2 by nasal
septum largely formed by
vomer
- nasal conchae
(superior and middle) are
found on the lateral wall
of each nasal cavity
 The Skull – Anterior aspect
• Maxilla
- form the upper jaw
- alveolar processes
include sockets and
constitute the supporting
bone for maxillary teeth
 The Skull – Anterior Aspect

• - infraorbital foramen
– for passage of
infraorbital nerve and
vessel
The Skull – Anterior Aspect
• Mandible
- lower jaw
- consists of horizontal body and 2 vertical
rami joined at the angle of the mandible
- contains the mental foramen for passage
of mental nerve and vessel
- alveolar process house the mandibular
teeth
- symphysis menti – region where the
halves of the fetal mandible fuse
STUDENT ACTIVITY
How many of the
numbered structures
could you identify?
 1
8

5
9
6

10

11
7
The Skull – Lateral Aspect
• Parietal bone
- form the sides and
roof of the cranium and
articulate each other
through the sagittal suture
- articulates with
occipital bone at the
lambdoid suture and frontal
bone at the coronal suture
 Lateral aspect of the Skull
• Temporal fossa
- bounded by the temporal
line and zygomatic arch
- pterion – found 3 to 4 cm
superior to the midpoint of
zygomatic arch; H shape
formation of sutures that unite
the frontal, parietal, temporal
and sphenoid bones;
clinically important because it
is the thinnest part in the
lateral wall of skull
The Skull – Lateral Aspect
• External acoustic opening
- entrance to external acoustic
meatus which leads to
tympanic membrane

• Mastoid process of temporal

bone

• Styloid process
The Skull – Posterior Aspect
• Occipital bone
- external occipital protruberance (inion) is a palpable
elevation in median plane; serves as attachment of
muscles and ligamentum nuchae
- superior nuchal line – extension of external occipital
proturberance laterally toward temporal bone
- lambdoid suture

• Foramen Magnum
- large opening in the base of occipital bone
The Skull – Superior Aspect
- Oval shape
- Broadens posterolaterally at parietal eminences
- Coronal suture (frontal and parietal bones)
- Sagittal suture (between parietal bones)
- Bregma – landmark formed by intersection of
sagittal and coronal sutures
- Vertex – most superior point of skull
- Parietal foramen – located posteriorly in parietal
bone near sagittal suture for transmission of
emissary veins
The Skull – Superior Aspect
- Oval shape
- Broadens posterolaterally at parietal eminences
- Coronal suture (frontal and parietal bones)
- Sagittal suture (between parietal bones)
- Bregma – landmark formed by intersection of
sagittal and coronal sutures
- Vertex – most superior point of skull
- Parietal foramen – located posteriorly
bregma
in parietal
bone near sagittal suture for transmission of
emissary veins
The Skull – Base of Skull
• Hard palate – formed by palatine process of maxillae and
horizontal plates of palatine bone posteriorly
• Sphenoid bone – irregular unpaired bone consisting of
body, greater and lesser wings and pterygoid process
• Foramen magnum for passage of spinal cord and its
covering, the vertebral arteries, anterior and posterior
spinal arteries, the accessory nerve
The Skull – Base of Skull
• Occipital condyle by which skull articulates with vertebral
column
• Jugular foramen – passage of internal jugular vein and
CN IX through CN XI
• Internal acoustic meatus – for passage of CN VII and VIII
• Carotid canal for passage of internal carotid artery
• Stylomastoid foramen for transmitting the facial nerve and
stylomastoid artery
 The Skull – Base of Skull
• Hard palate – formed
by palatine process of
maxillae and
horizontal plates of
palatine bone
posteriorly
• Sphenoid bone –
irregular unpaired
bone consisting of
body, greater and
lesser wings and
pterygoid process
The Skull – Base of Skull
• Foramen magnum for
passage of spinal cord
and its covering, the
vertebral arteries,
anterior and posterior
spinal arteries, the
accessory nerve
 The Skull – Base of Skull
• Occipital condyle by
which skull articulates
with vertebral column
• Jugular foramen –
passage of internal
jugular vein and CN IX
through CN XI
• Carotid canal for
passage of internal
carotid artery
The Skull – Base of Skull

• Stylomastoid
foramen for
transmitting the facial
nerve and
stylomastoid artery
• Internal acoustic
meatus – for
passage of CN VII
and VIII
INTERNAL ASPECT OF
THE SKULL
Interior aspect of Skull
 Internal Aspect of the Skull
• Anterior Cranial Fossa
- lodges the frontal lobes
of the cerebral
hemisphere
- Formed by the frontal
bone (anteriorly),
ethmoid bone
(medially) and lesser
wings of sphenoid
(posteriorly)
 Internal Aspect of the Skull
- Foramen cecum –
passage of vessels
during development
- Crista galli (cock’s
comb)- median ridge
of bone posterior to f.
cecum
- Cribriform plate of
ethmoid – olfactory
nerve pass through
the foramina to reach
olfactory bulbs of
brain
Internal Aspect of Skull
• Middle Cranial Fossa
- butterfly shape formed
by the greater wings of
sphenoid, squamous
part of temporal bone,
petrous part of temoral
bone; Supports the
temporal lobe of brain
Internal Aspect of Skull
• Middle Cranial Fossa
- Sella turcica (Trukish saddle) – centrally on the body of
sphenoid bone; surrounded by the anterior and
posteiror clinoid processes
has 3 parts:
1. Tuberculum sellae (saddle horn) – olive shaped swelling
anterior to hypophysial fossa
2. Hypophyseal fossa (pituitary fossa) – depression for
pituitary gland
3. Dorsum sellae (back of saddle) – square part of bone of
sphenoid posterior to sella turcica
Sphenoid bone
 Internal Aspect of Skull
• Lesser wings of sphenoid –
ends into the anterior clinoid
process
• Four foramina at the root of
the greater wing of sphenoid
Internal Aspect of Skull
1. Superior orbital fissure – between greater and lesser
wings; provides communication with orbit; transmits
ophthalmic veins and nerves, CN 3, 4, 5, 6 and
sympathetic fibers
Internal Aspect of Skull

2. Foramen rotundum
(round) – posterior to
superior orbital fissure,
transmits maxillary n. (cn rotundum
5)
Internal Aspect of Skull
3. Foramen ovale (oval)
– posterolateral aspect
of f. rotundum; opens to
infratemporal fossa and
transmits mandibular n.
(cn 5) and small ovale
accessory meningeal
artery
Internal Aspect of Skull

4. Foramen spinosum
(spinous) –
posterolateral to
foramen ovale;
transmits middle
meningeal vessels and lacerum
meningeal branch of
mandibular nerve spinosum

* foramen lacerum –
posterolateral to
hypophyseal fossa
Internal Aspect of Skull
• Posterior Cranial Fossa
- largest and deepest of three cranial fossa
- Lodges cerebellum (little brain); pons, medulla
oblongata
- Formed largely by occipital bone
- Contains the following foramen:
foramen magnum, jugular foramen, internal acoustic
meatus, hypoglossal canal
Posterior cranial fossa
CRANIAL NERVES
 Cranial Nerves: I - XII

• 12 Pairs
• Numbered Anterior to Posterior
• Attach to Ventral surface of brain
• Exit brain through foramina in skull
• I + II attach to Forebrain (cerebrum + diencephalon)
• III-XII attach to Brainstem (midbrain, pons, medulla)
• Only X goes beyond the head-neck
 How to Remember CN I-XII

On Old Olympus
Tower Top A Finn
And German Viewed
A Hop.
• OLd • Oh Oh
OPie • One Oh
OCCasionally • Once Oh
TRIes • Took
TRIGonometry To
And • The Touch
Feels • Anatomy And
VEry • Final Feel
GLOomy • Very
VAGue A
And • Good Girl’s
HYPOactive • Vacations Vagina
• Are Ah
• Heavenly. Heaven
I Olfactory (On )
II Optic (Old)
III Oculomotor (Olympus)
IV Trochlear (tower)
V Trigeminal (1-3) (top)
VI Abducens (a)
VII Facial (Finn)
VIII Auditory/Vestibulocochlear (and)
IX Glossopharyngeal (German)
X Vagus (view)
XI Accessory (a)
XII Hypoglossal (hop)
Foramina serving Cranial Nerves

• You must know what

foramina each CN leaves
the skull through
Cranial Nerves and Exit
Cranial nerve Exit in the Skull

1 Olfactory Cribriform plate

II Optic Optic canal

III Oculomotor Superior orbital fissure

IV Trochlear Superior orbital fissure

V Trigeminal
V-1 Ophthalmic Superior orbital fissure
V-2 Maxillary Foramen rotundum

V-3 Mandibular Foramen ovale

VI Abducent Superior orbital fissure
Cranial Nerves and Exit
Cranial nerve Exit in the Skull

VII Facial Internal acoustic meatus, facial canal,

stylomastoid foramen
VIII Auditory internal acoustic meatus

/vestibulocochlear
IX Glossopharyngeal Jugular foramen

X Vagus Jugular foramen

XI Accessory Jugular foramen

XII Hypoglossal Hypoglossal canal

 Motor vs. Sensory Nerves

• Sensory = Afferent
• Send nervous impulse from sensory receptors to brain to bring in
information
• e.g. pressure, temperature, pain
• Motor = Efferent
• Send nervous impulses from brain to body to accomplish an
action
• e.g. movement of a muscle, activation of a gland
 Sensory Nerves

• Sensory = Afferent
• Visceral Sensory (sensory innervation of viscera)
• stretch, pain, temp., chemical changes, irritation in viscera
• Special: taste
• Somatic Sensory (sensory innervation of outer part body)
• touch, pain, pressure, vibration, temp. in skin, body wall, limbs
• Special: hearing, equilibrium, vision, smell
Motor Nerves
• Motor Nerves
(motor innervation muscle of the
• Visceral Motor
viscera + glands)
• innervation smooth + cardiac muscle, glands
(motor innervation of
• Branchial Motor
pharyngeal arch m.)
• facial expression, pharyngeal constrictors, suprahyoid,
sternocleidomastoid, trapezius
• Somatic Motor (motor innervation of skeletal
muscle)
• innervation of skeletal muscles (except pharyngeal arch
m.)
 Mnemonic for CN Function
• Some (CN I)
• Say (CN II)
• Marry (CN III)
• Money (CN IV)
• But (CN V)
• My (CN VI)
• Brother (CN VII)
• Says (CN VIII)
• Big (CN IX)
• Brains (CN X)
• Matter (CN XI)
• Most! (CN XII)

• S = Sensory function M = Motor function

• B = BOTH (Sensory and Motor function)
Cranial Nerves
• OLFACTORY
• from olfactory receptor nerve cell in the olfactory mucous
membrane at the upper of nasal cavity (above superior nasal
concha)
• Function: smell
• Lesion in the olfactory nerve: anosmia
Cranial Nerve
• OPTIC NERVE
• Comes from back of eyeball
and leaves orbital canal
through optic canal
• For vision
• Lesion: blindness
Cranial Nerves
• Oculomotor
• Motor: supplies:
• levator palpebrae superioris
(elevates the eyelids)
• Superior, middle and inferior
rectus and inferior oblique
(extraocular muscle of eye
movement)
• Constrictor pupillae of iris and
cillary muscle (cillary constriction)

• Lesions:
• Ptosis
• diplopia
Cranial Nerve
• Oculomotor
• Superior,
inferior, medial
recti and inferior
oblique

• Trochlear
• Superior oblique

• Abducent
• Lateral rectus
Cranial nerve
• Trigeminal
• Largest cranial nerve
• Motor and sensory function
• 3 divisions:
• Ophthalmic (V-1)
• Maxillary (V-2) and
• Mandibular (V-3)
• Only Motor branch is the
mandibular division supplying
muscles of mastication
Cranial Nerve
• Facial Nerve
• Motor : muscles of facial
expression, stapedius
muscle of middle ear,
stylohyoid, posterior
digastric
• Sensory: taste from anterior
2/3 of tongue, floor of
mouth and palate
• Parasympathetic: salivary
glands (submandibular and
sublingual), lacrimal and
glands of nose and palate

• Lesion: Bell’s Palsy

Cranial nerve
• Auditory (Vestibulocochlear
nerve)
• Vestibular – position and
movement of head
• Cochlear – hearing

Glossopharyngeal
Motor: stylopharyngeus
muscle (swallowing)
parasympathetic : parotid
gland
sensory: sensation and taste
of posterior 1/3 of tongue, pharynx,
carotid sinus and carotid body
Cranial Nerve
• Vagus nerve
• Constrictor muscle of pharynx
• Instrinsic muscle of larynx
• Muscle of trachea, bronchi, heart,
alimentary tract
• Sensory: taste from epiglottis,
vallecula

• Spinal accessory n.
• Cranial root: muscle of soft palate,
pharynx and larynx
• Spinal root: sternocleidomastoid and
trapezius

• Hypoglossal nerve
• Muscle of tongue
 Cranial Nerve Function

I Olfactory--------Sensory--smell
II Optic-------------Sensory--vision
III Oculomotor----Motor----extrinsic eye muscles
IV Trochlear-------Motor----extrinsic eye muscles
V Trigeminal
V1 Opthalmic-----Sensory-cornea, nasal mucosa, face skin
V2 Maxillary------Sensory-skin of face, oral cavity, teeth
V3 Mandibular---Motor-muscles of mastication
---Sensory-face skin, teeth, tongue (general)
Distribution of sensory innervation to skin
of face from CN V

CN V = Trigeminal
V1 = Opthalmic
V2 = Maxillary
V3 = Mandibular
 Cranial Nerves (continued)

VI Abducens--------------Motor-----eye abduction muscles

VII Facial-------------------Sensory---part of tongue (taste)
-------------------Motor------muscles of facial expression
VIII Vestibulocochlear---Sensory----hearing, equilibrium
IX Glossopharyngeal----Motor------stylopharyngeus muscle
----Sensory----tongue (gen & taste), pharynx
X Vagus------------------Motor-------pharynx, larynx
-------------------Sensory----pharynx, larynx, abd. organs
XI Accessory-------------Motor------trapezius, sternocleidomastoid
XII Hypoglossal----------Motor-------tongue muscles
 Summary of Functional Groups

• Purely Sensory = I, II, VIII

• Primarily Motor = III, IV, VI, XI, XII
• Mixed = V, VII, IX, X

• Parasympathetic Fibers = III, VII, IX, X (Division of

Autonomic NS = Visceral Motor)
STUDENT ACTIVITY
LET US RECALL
CRANIAL NERVES
STUDENT ACTIVITY