3.

HEAD AND NECK

Contents

Preface to the Eighth Edition vii

Preface to the First Edition (Excerpts) viii
Index of Competencies xix

1. Introduction and Osteology 3 Maxilla 36

Side Determination 36
Introduction 3 Features 36
Functions of Head and Neck 3 Articulations of Maxilla 39
Skull 4 Ossification 39
Bones of the Skull 4 Age Changes 39
Anatomical Position of Skull 5 Parietal Bone 40
Peculiarities of Skull Bones 5 Side Determination 40
Exterior of the Skull 6 Features 40
Norma Verticalis 6 Occipital Bone 40
Clinical Anatomy 6 Anatomical Position 40
Norma Occipitalis 7 Features 40
Norma Frontalis 8 Frontal Bone 41
Clinical Anatomy 10 Anatomical Position 41
Norma Lateralis 10 Temporal Bone 42
Clinical Anatomy 13 Side Determination 42
Norma Basalis 13 Features 42
Interior of the Skull 21 Sphenoid Bone 45
Internal Surface of Cranial Vault 22 Body of Sphenoid 45
Internal Surface of the Base of Skull 22 Greater Wings 45
Clinical Anatomy 23 Lesser Wings 46
Clinical Anatomy 25 Pterygoid Processes 47
Clinical Anatomy 26 Ethmoid Bone 47
Attachments and Relations: Interior of the Skull 26 Cribriform Plate 47
Principles Governing Fractures of the Skull 27 Perpendicular Plate 47
The Orbit 28 Labyrinths 47
Foetal Skull/Neonatal Skull 30 Vomer 48
Dimensions 30 Inferior Nasal Conchae 48
Structure of Bones 30 Zygomatic Bones 48
Ossification 30 Nasal Bones 49
Postnatal Growth of Skull 31 Lacrimal Bones 49
Clinical Anatomy 31 Palatine Bones 50
Sex Differences in the Skull 31 Hyoid Bone 50
Craniometry 31 Attachments on the Hyoid Bone 51
Mandible 32 Development 51
Body 33 Clinical Anatomy 51
Ramus 33 Cervical Vertebrae 51
Attachments and Relations of the Mandible 34 Identification 51
Foramina and Relations to Nerves and Vessels 34 Typical Cervical Vertebrae 51
Ossification 35 Ossification 52
Age Changes in the Mandible 35 First Cervical Vertebra 53
Structures Related to Mandible 35 Ossification 54
Clinical Anatomy 36 Second Cervical Vertebra 54
xii HUMAN ANATOMY—HEAD AND NECK

Seventh Cervical Vertebra 55 Skin 84

Ossification 55 Superficial Fascia 85
Clinical Anatomy 55 Dissection 85
Ossification of Cranial Bones 56 Clinical Anatomy 86
Development of Neurocranium 57 Deep Cervical Fascia (Fascia Colli) 86
Foramina of Skull Bones and their Contents 58 Investing Layer 86
Mnemonics 59 Clinical Anatomy 88
Facts to Remember 60 Pretracheal Fascia 89
Clinicoanatomical Problem 60 Clinical Anatomy 89
Further Reading 60 Prevertebral Fascia 89
Frequently Asked Questions 61 Clinical Anatomy 89
Multiple Choice Questions 61 Carotid Sheath 90
Viva Voce 61 Buccopharyrgeal Fascia 90
Pharyngobasilar Fascia 90
2. Scalp, Temple and Face 62 Pharyngeal Spaces 90
Introduction 62 Retropharyngeal Space 90
Surface Landmarks 62 Lateral Pharyngeal Space 90
Scalp and Superficial Temporal Region 63 Sternocleidomastoid Muscle (Sternomastoid) 91
Scalp 63 Clinical Anatomy 92
Dissection 63 Posterior Triangle 93
Superficial Temporal Region 65 Dissection 93
Clinical Anatomy 66 Clinical Anatomy 94
Face 67 Contents of the Posterior Triangle 95
Dissection 68 Clinical Anatomy 96
Skin 68 Mnemonics 97
Superficial Fascia 68 Facts to Remember 97
Facial Muscles 68 Clinicoanatomical Problem 97
Nerve Supply of Face 71 Further Reding 97
Clinical Anatomy 73 Frequently Asked Questions 98
Clinical Anatomy 74 Multiple Choice Questions 98
Arteries of the Face 75 Viva Voce 98
Dissection 75
Facial Artery 75 4. Anterior Triangle of the Neck 99
Veins of the Face 76 Introduction 99
Clinical Anatomy 76 Surface Landmarks 99
Lymphatic Drainage of the Face 77 Structures in the Anterior Median Region
Eyelids or Palpebrae 78 of the Neck 100
Dissection 78 Dissection 101
Clinical Anatomy 79 Clinical Anatomy 102
Lacrimal Apparatus 79 Anterior Triangle 103
Components 79 Boundaries 103
Dissection 79 Subdivisions 103
Clinical Anatomy 80 Submental Triangle 103
Development of Face 81 Digastric Triangle 103
Molecular Regulation 81 Dissection 104
Mnemonics 81 Carotid Triangle 105
Facts to Remember 81 Dissection 105
Clinicoanatomical Problems 81 Muscular Triangle 107
Further Reading 82 Dissection 107
Frequently Asked Questions 83 Ansa Cervicalis or Ansa Hypoglossi 107
Multiple Choice Questions 83 Common Carotiol Artery 109
Viva Voce 83 Clinical Anatomy 109
External Carotid Artery 109
3. Side of the Neck 84 Branches 110
Introduction 84 Potential Tissue Spaces in Head and Neck 112
Landmarks 84 Mnemonics 112
Boundaries 84 Facts to Remember 112
 CONTENTS xiii

Clinicoanatomical Problem 112 7. Submandibular Region 142

Further Reading 113
Introduction 142
Frequently Asked Questions 113
Suprahyoid Muscles 142
Multiple Choice Questions 113
Dissection 144
Viva Voce 113 Submandibular Salivary Gland 146
Dissection 146
5. Parotid Region 114
Submandibular Duct/Wharton’s Duct 147
Introduction 114 Sublingual Salivary Gland 147
Salivary Glands 114 Submandibular Ganglion 148
Parotid Gland 114 Histology 149
Dissection 114 Comparison of the Three Salivary Glands 149
Clinical Anatomy 115 Clinical Anatomy 150
Relations 115 Facts to Remember 151
Parotid Duct/Stenson’s Duct 119 Clinicoanatomical Problem 151
Further Reading 151
Clinical Anatomy 120
Frequently Asked Questions 152
Histology 120
Multiple Choice Questions 152
Development 120 Viva Voce 152
Facts to Remember 120
Clinicoanatomical Problem 120 8. Structures in the Neck 153
Further Reading 121
Introduction 153
Frequently Asked Questions 122 Glands 153
Multiple Choice Questions 122 Thyroid Gland 153
Viva Voce 122 Dissection 153
Clinical Anatomy 157
6. Temporal and Infratemporal Regions 123 Histology 158
Introduction 123 Development 158
Temporal Fossa 123 Parathyroid Glands 159
Infratemporal Fossa 123 Histology 160
Clinical Anatomy 160
Landmarks on the Lateral Side of the Head 124
Thymus 160
Muscles of Mastication 124
Clinical Anatomy 161
Features 124
Histology of Thymus 161
Temporal Fascia 124
Development of Thymus and Parathyroid
Dissection 124
Glands 161
Relations of Lateral Pterygoid 126
Blood Vessels of the Neck 162
Relations of Medial Pterygoid 127
Subclavian Artery 162
Clinical Anatomy 127
Dissection 162
Maxillary Artery 127
Clinical Anatomy 165
Dissection 127 Common Carotid Artery 165
Branches of Maxillary Artery 128 Dissection 165
Clinical Anatomy 130 Clinical Anatomy 166
Pterygoid Venous Plexus 130 Internal Carotid Artery 166
Temporomandibular Joint 130 Subclavian Vein 167
Dissection 130 Internal Jugular Vein 168
Clinical Anatomy 134 Clinical Anatomy 169
Mandibular Nerve 134 Brachiocephalic Vein 169
Dissection 134 Nerves of the Neck 169
Otic Ganglion 137 Glossopharyngeal Nerve—IX Nerve 169
Clinical Anatomy 138 Vagus Nerve—X Nerve 169
Mnemonics 139 Accessory Nerve—XI Nerve 169
Facts to Remember 139 Cervical Part of Sympathetic Trunk 171
Clinicoanatomical Problem 139 Formation 171
Further Reading 140 Dissection 171
Frequently Asked Questions 141 Ganglia 172
Multiple Choice Questions 141 Clinical Anatomy 172
Viva Voce 141 Lymphatic Drainage of Head and Neck 173
xiv HUMAN ANATOMY—HEAD AND NECK

Dissection 173 Frequently Asked Questions 205

Superficial Group 173 Multiple Choice Questions 205
Deep Group 174 Viva Voce 205
Deepest Group 175
Main Lymph Trunks at the Root of the Neck 175 11. Contents of Vertebral Canal 206
Clinical Anatomy 176 Introduction 206
Styloid Apparatus 176 Contents 206
Development of the Arteries 177 Dissection 206
Mnemonics 177 Clinical Anatomy 208
Facts to Remember 178 Spinal Nerves 209
Clinicoanatomical Problem 178 Clinical Anatomy 209
Further Reading 178 Vertebral System of Veins 209
Frequently Asked Questions 178 Facts to Remember 210
Multiple Choice Questions 179 Clinicoanatomical Problem 210
Viva Voce 179 Further Reading 210
Frequently Asked Question 211
9. Prevertebral and Paravertebral Regions 180 Multiple Choice Questions 211
Introduction 180 Viva Voce 211
Prevertebral Muscles 180
Vertebral Artery 180 12. Cranial Cavity 212
Dissection 180 Introduction 212
Scalenovertebral Triangle 181 Conterts of Cranial Cavity 212
Development of Vertebral Artery 183 Dissection 212
Trachea 183 Cerebral Dura Mater 213
Clinical Anatomy 184 Clinical Anatomy 216
Oesophagus 184 Venous Sinuses of Dura Mater 216
Clinical Anatomy 184 Cavernous Sinus 216
Joints of the Neck 184 Dissection 216
Clinical Anatomy 187 Clinical Anatomy 218
Paravertebral Region 188 Superior Sagittal Sinus 219
Scalene Muscles 188 Clinical Anatomy 220
Dissection 188 Straight Sinus 220
Cervical Pleura 190 Transverse Sinuses 220
Cervical Plexus 190 Sigmoid Sinuses 220
Phrenic Nerve 192 Clinical Anatomy 220
Clinical Anatomy 193 Hypophysis Cerebri (Pituitary Gland) 221
Facts to Remember 193 Dissection 221
Clinicoanatomical Problems 193 Subdivisions/Parts and Development 222
Further Reading 194 Molecular Regulation 222
Frequently Asked Questions 194 Histology 222
Multiple Choice Questions 194 Clinical Anatomy 223
Viva Voce 195 Trigeminal Ganglion 224
Dissection 224
10. Back of the Neck 196
Clinical Anatomy 225
Introduction 196 Middle Meningeal Artery 225
Dissection 196 Dissection 226
Nerve Supply of Skin 197 Clinical Anatomy 226
Muscles of the Back 197 Other Structures Seen in Cranial Fossae after
Suboccipital Region 201 Removal of Brain 226
Dissection 201 Dissection 226
Suboccipital Muscles 201 Internal Carotid Artery 226
Eeposure of Suboccipital Triangle 202 Cranial Nerves 226
Clinical Anatomy 203 Petrosal Nerves 227
Mnemonics 203 Mnemonics 228
Facts to Remember 204 Facts to Remember 228
Clinicoanatomical Problem 204 Clinicoanatomical Problem 229
Further Reading 204 Further Reading 229
 CONTENTS xv

Frequently Asked Questions 229 Pharynx 257

Multiple Choice Questions 230 Dissection 258
Viva Voce 230 Parts of the Pharynx 258
Waldeyer’s Lymphatic Ring 258
13. Contents of the Orbit 231 Clinical Anatomy 258
Introduction 231 Palatine Tonsil (The Tonsil) 259
Orbits 231 Clinical Anatomy 261
Dissection 231 Histology 261
Orbital fascia or Periorbita 231 Development 261
Facial Sheath of Eyeball or Bulpar Fascia 232 Laryngeal Part of Pharynx (Laryngopharynx) 261
Extraocular Muscles 232 Structure of Pharynx 262
Dissection 232 Muscles of the Pharynx 263
Involuntary Muscles 233 Structures in between Pharyngeal Muscles 264
Clinical Anatomy 236 Dissection 265
Vessels of the Orbit 237 Killians’ Dehiscence 265
Ophthalmic Artery 237 Clinical Anatomy 265
Dissection 237 Nerve Supply of Pharynx 265
Clinical Anatomy 239 Blood Supply of Pharynx 266
Ophthalmic Veins 239 Lymphatic Drainage of Pharynx 266
Nerves of the Orbit 239 Deglutition (Swallowing) 266
Optic Nerve 239 Development 266
Clinical Anatomy 240 Pharyngo Tympanic Tube 267
Ciliary Ganglion 240 Clinical Anatomy 268
Oculomotor Nerve 240 Mnemonics 268
Trochlear Nerve 241 Facts to Remember 268
Abducent Nerve 241 Clinicoanatomical Problem 268
Branches of Ophthalmic Division of Trigeminal Further Reading 268
Nerve 241 Frequently Asked Questions 269
Some Branches of Maxillary Division of Trigeminal Multiple Choice Questions 269
Nerve 243 Viva Voce 270
Sympathetic Nerves of the Orbit 244
Mnemonics 244 15. Nose, Paranasal Sinuses and Pterygopalatine
Facts to Remember 244 Fossa 271
Clinicoanatomical Problem 244 Introduction 271
Further Reading 244 Nose 271
Frequently Asked Questions 245 External Nose 271
Multiple Choice Questions 245 Nasal Cavity 271
Viva Voce 245 Clinical Anatomy 272
Nasal Septum 273
14. Mouth and Pharynx 246 Dissection 273
Oral Cavity 246 Clinical Anatomy 274
Vestibule 246 Lateral Wall of Nose 274
Clinical Anatomy 246 Dissection 275
Oral Cavity Proper 247 Conchae and Meatuses 275
Nerve Supply of Gums 248 Dissection 276
Clinical Anatomy 248 Clinical Anatomy 277
Teeth 248 Olfactory Nerve—1st Nerve 277
Clinical Anatomy 249 Clinical Anatomy 277
Stages of Development of Deciduous Teeth 250 Paranasal Sinuses 277
Molecular Regulation of Teeth Develop- Dissection 277
ment 251 Clinical Anatomy 279
Hard Palate 252 Pterygopalatine Fossa 280
Dissection 252 Maxillary Nerve 280
Soft Palate 252 Pterygopalatine Ganglion/Spheno-palatine
Muscles of the Soft Palate 254 Ganglion/Ganglion of Hay Fever/Meckel’s
Clinical Anatomy 257 Ganglion 281
Development of Palate 257 Dissection 282
xvi HUMAN ANATOMY—HEAD AND NECK

Clinical Anatomy 283 External Acoustic Meatus 310

Summary of Pterygopalatine Fossa 283 Dissection 311
Facts to Remember 283 Tympanic Membrane 311
Clinicoanatomical Problem 284 Clinical Anatomy 312
Further Reading 284 Middle Ear 314
Frequently Asked Questions 285 Dissection 314
Multiple Choice Questions 285 Functions of Middle Ear 318
Viva Voce 285 Tympanic or Mastoid Antrum 318
Dissection 318
16. Larynx 286 Clinical Anatomy 319
Introduction 286 Internal Ear 320
Constitution of Larynx 286 Bony Labyrinth 320
Dissection 286 Membranous Labyrinth 321
Cartilages of Larynx 287 Vestibulocochlear Nerve 323
Laryngeal Joints 289 Clinical Anatomy 324
Laryngeal Ligaments and Membranes 289 Development 324
Cavity of Larynx 290 Molecular Regulation 324
Mucous Membrane of Larynx 290 Reasons of Earache 324
Clinical Anatomy 291 Mnemonics 324
Intrinsic Muscles of Larynx 291 Facts to Remember 324
Clinical Anatomy 294 Clinicoanatomical Problem 325
Movements of Vocal Folds 295 Noise Pollution 325
Infant’s Larynx 295 Further Reading 325
Mechanism of Speech 296 Frequently Asked Questions 326
Facts to Remember 296 Multiple Choice Questions 326
Clinicoanatomical Problem 296
Viva Voce 326
Further Reading 297
Frequently Asked Questions 298 19. Eyeball 327
Multiple Choice Questions 298
Viva Voce 298 Introduction 327
Outer Coat 327
17. Tongue 299 Sclera 327
Dissection 328
Introduction 299
Cornea 329
Dissection 299
Dissection 329
Parts of Tongue 299 Clinical Anatomy 329
Clinical Anatomy 300 Middle Coat 330
Papillae of the Tongue 300 Choroid 330
Muscles of the Tongue 301 Ciliary Body 330
Hypoglossal Nerve—XII Nerve 303 Iris 330
Clinical Anatomy 303 Clinical Anatomy 331
Histology 304 Inner Coat/Retina 331
Development of Tongue 305 Clinical Anatomy 332
Taste Pathway 306 Aqueous Humour 333
Clinical Anatomy 306 Clinical Anatomy 333
Facts to Remember 306 Lens 333
Clinicoanatomical Problem 307 Dissection 334
Clinical Anatomy 334
Further Reading 307
Vitreous Body 334
Frequently Asked Questions 308
Development 335
Multiple Choice Questions 308
Molecular Regulation 335
Viva Voce 308 Facts to Remember 335
Clinicoanatomical Problem 335
18. Ear 309
Further Reading 335
Introduction 309 Frequently Asked Questions 336
External Ear 309 Multiple Choice Questions 336
Auricle/Pinna 309 Viva Voce 336
 CONTENTS xvii

20. Surface Marking and Radiological Anatomy 337 Appendix: Parasympathetic Ganglia, Arteries,
Introduction 337 Pharyngeal Arches and Clinical Terms 350
Surface Landmarks 337 Introduction 350
Landmarks on the Face 337 Cervical Plexus 350
Phrenic Nerve 350
Landmarks of the Lateral Side of the Head 338
Sympathetic Trunk 350
Landmarks on the Side of the Neck 339 Parasympathetic Ganglia 350
Landmarks on the Anterior Aspect of the Submandibular Ganglion 350
Neck 340 Pterygopalatine Ganglion 351
Other Important Landmarks 341 Otic Ganglion 352
Surface Marking of Various Structures 342 Ciliary Ganglion 353
Arteries 342 Arteries of Head and Neck 354
Pharyngeal Apparatus 356
Veins/Sinuses 343
Structures Derived from Components of
Nerves 344 Pharyngeal Arches 356
Glands 345 Derivatives of Endodermal Pouches 356
Paranasal Sinuses 346 Derivatives of Ectodermal Clefts 356
Radiological Anatomy 347 Clinical Terms 357
Lateral View of Skull (Plain Skiagram) 347 Molecular Regulation of Pharyngeal Arches 357
Spots 359
Special PA View of Skull for Paranasal Sinuses 348
Answers of Spots 360
Carotid Angiogram 349
Further Reading 349 Index 361