ANAKINES

Head and Neck skull and the intracranial

venous sinuses
SCALP Layers o clinically speaking, any
infection in the upper layers
• SCALP refers to the layers of skin can be brought down into the
and subcutaneous tissue that covered scalp (that’s why it’s called
the bones of the cranial vault the dangerous zone)
• Skin, Connective tissue, • Pericranium
Aponeurosis/epicranial, Loose o Periosteal layer, the outer
areolar tissue/danger zone, layer of the skull bones
Pericranium o this is continuous with the inner
• Skin periosteum or endosteum at
o The skin of your scalp is thick, the area of the suture line
it contains numerous hair
follicles and sebaceous
glands
o A common site for sebaceous
cyst
• Connective tissue
o dense, fibrofatty, it connects
the skin to aponeurosis
o highly vascularized (abundant
blood vessels)
o nerves are also found in this
layer
o the blood vessels in this layer
are connected to the
• The scalp consists of five layers, the
connective tissue, so if they
first three layers are tightly bound
are traumatized or cut, it
together, and they would move as
won't be able to contract,
one unit
resulting to profuse bleeding
even if the injury is minor
SCALP arterial supply
• Aponeurosis/epicranial
• External carotid artery
o thin tendon like structure which
connects the muscle that is on • Internal carotid artery
top of the scalp, the
occipitalis and the frontalis SCALP Venous drainage
muscles • The veins of the head and neck
• Loose areolar connective tissue collect deoxygenated blood and return
o a thin connective tissue layer it to the heart
which separates the periosteum • Anatomically, the venous drainage
from the epicranial can be divided into three parts:
aponeurosis o Venous drainage of the
o contains blood vessels, the brain and meninges
important one is the emissary ▪ drained by the dural
vein, which connects the venous sinuses
superficial veins of the scalp to o Venous drainage of the
the deeper darker veins in the scalp and face
ANAKINES

▪drained by the veins • It has four bellies: two bellies for the
synonymous with the front top part, and two bellies for
arteries of the face the occipital part
and scalp, • both innervated by the facial nerve,
▪ these empty into the but they have different branches
internal and external • If the frontal belly is the only one
jugular veins contracting = it raises the skin of the
o Venous drainage of the neck forehead (it looks like you're raising
▪ carried out by the your eyebrows)
anterior jugular veins • If the two bellies contract as one = it
o Dural sinus - spaces which moves the scalp forward and
are located between the backward over the skull
periosteum and meningeal
layers of the dura matter that
are lined by endothelial cells
▪ they collect the venous
blood from the veins
which drain the brain
and bony scalp
▪ clinical note: the
emissary vein that is
found in the layers of
the scalp would
connect it to the dural
venous sinuses,
therefore we have the • Temporalis muscle located just
boost areolar anterior to the ear, above the
connective tissue layer zygomatic arch, also has attachment
which is designated as to the aponeurosis, but they are
the danger zone separate from each other (so if
because of this there's an infection going on in the
established connection lateral side of the head posterior to
the temporalis, it's not going to enter
Occipitofrontalis into the aponeurotic layer and vice
versa)

Scalp sensory innervation

• The scalp drives its innervation from
the three divisions of the trigeminal
nerve:
• The 5TH cranial nerve, ophthalmic,
maxillary, and mandibular divisions
• Ophthalmic division
o specific nerves that are
responsible for innervating
the scalp, the skin of the scalp
starting from the supraorbital
area
ANAKINES
o supratrochlear nerve
o supraorbital nerve
• Maxillary division - area on the side
of the forehead, above the ear
o Zygomaticotemporal nerve
• Mandibular division - area above
the ear which derives its innervation
from the mandibular division
o Auriculotemporal nerve
• The rest of the scalp would be from
the lesser/greater occipital nerve
(C2), like a superior and posterior to
the ear and the skin over the angle
of the mandible and parotid would
be by the cervical spinal nerves, the
second one specifically
• The skin of the face possesses
numerous sweat and sebaceous
glands
• It's connected to the underlying bones
by loose connective tissue, in which are
embedded the muscles of facial
expression
• No deep fascia presents in the face
• Wrinkle lines - repeated folding of
the skin that are perpendicular to the
long axis of the underlying
contracting muscles, loss of youthful
skin elasticity
o Surgical scars on the face are
less noticeable if they follow
the wrinkle lines
Face sensory innervation
• The skin of the face derives its
innervation and proprioception from
the three branches of the trigeminal
nerve/CN5
• Proprioception - means the individual
can feel their muscles move and are
aware that they're doing those facial
expressions
• It’s also responsible for providing
sensory innervation to the mouth,
teeth, nasal cavities, paranasal
sinuses
• Except for that small area covering
the parotid gland or the angle of the
mandible that is by the 2ND & 3RD
cervical spinal nerve roots
• Ophthalmic nerve
o The first division of the
trigeminal nerve
o Some books you can see it as
ophthalmic branch/
ophthalmic division
o This area as the name implies,
provides the skin surrounding
the eye or the orbit
o It also includes the skin of the
forehead (skin covering the
forehead growing posteriorly
up until the vertex of your
skull), upper eyelid, upper
part of the conjunctiva, side
of the nose to the tip
• Maxillary nerve
o Supplies the skin over
posterior part of side of nose,
lower eyelid, cheek, upper lip
and temple (anteroposterior
to the auricle)
• Mandibular nerve
o This applies the skin covering
the lower half of the face,
lower lip, temporal region,
and part of the auricle
ANAKINES
• On the photo above you can see the
three branches of the trigeminal
nerve and also the cervical branches
that also supply the area of the neck
and the posterior surface of the skull
Facial arterial supply
• The arterial supply for the face is
provided by the Facial artery
o Highest branch of external
carotid artery
• Superficial temporal artery
Face venous drainage
• The venous drainage of the face is
by the facial vein, the blood
collected through the facial vein goes
to the cavernous sinus within the
skull via the superior ophthalmic
veins
• This is a clear pathway for the
spread of infection from the face to
the cavernous sinus
Muscles of the Face
• Facial muscles are striated muscles
which attach to the bones of the skull
to perform important functions for
daily life
o When affected, they
intervene in the speech and
strongly affect the social
relationship through facial
expression
o Deficits in these muscles can
lead to significant impairment
of daily function
• The muscles of facial expression are
within the superficial fascia or
subcutaneous tissue
• Originate from the bone, and insert
onto the skin (only group of muscles
that insert on the skin) so when they
contract, they move the skin and give
us our expressions
• These facial muscles have a single
origin, the 2nd pharyngeal arch
• We can group these muscles
according to the location where they
are found:
o orbital, nasal, and oral
group
o you could see that the muscles
are concentrated in areas
that are needed the most
▪ for the orbital, they
contract and protect
ANAKINES
our eyes from dust
when it’s windy
▪ for the naris/nasal
area, they dilate when
we have difficulty of
breathing
▪ for the oral area, it
helps us in speech and
eating
• Frontalis
o muscle on the forehead,
frontal belly of the
occipitofrontalis
o when it contracts it raises the
skin of the forehead
o with the occipital belly, it will
move the skull backward and
forward
o it would also help us to raise
eyebrows
• Corrugator supercilii
o underneath the eyebrows
o when it contracts, it gives us a
downward movement of our
eyebrows
• Procerus
o located in the center of the
corrugator supercilii
o it wrinkles the base of the
nose (when we smell
something bad, expression of
distaste)
• Orbicularis oculi
o the flat part around the orbit
o it makes our eyes full of
wrinkles (when we're
squinting, when we look up in
the sky and it's very sunny)
o it also has the orbital part
which is flat across the eyelid,
and this shuts our eyes close
• Nasalis
o muscle of the nose
o consist of the allar &
depressor septi, these muscles
help to widen the nasalis or to
make the opening smaller on
either side
• Levator labii superioris alaeque
nasi
o runs along the side of the nose
to the medial angle of the eye,
where it anastomoses with the
terminal branches of the
ophthalmic artery
o it elevates the upper lip, dilates
the nostril, and pulls the upper
lip superiorly like in a curl
o this action was noted by Elvis
Presley, because he was
always doing that, so it
ended up being coined to him
• Zygomaticus major/minor
o turns the corner of the lip
upwards, as if you're smiling
• Risorius
o it pulls the corners of the
mouth laterally
o this is a sardonic smile or a
fake smile because it doesn't
reach your eyes
• Depressor labii anguli oris
o draws the angle of the mouth
down
• Depressor labi inferiores
o moving medially
• Mentalis
o in the center, draws the lower
lip forward like when you're
pouting
• Orbicularis oris
ANAKINES
o It closes the mouth
• Buccinator
o lies deep to the levator labii
superioris
o it actually draws the cheeks
against the teeth, when you're
eating it prevents you from
biting your cheek, and when
you're playing the trumpet
• Platysma
o from the lower lip over the
mandible going down onto
the chest wall
Facial muscles ORBITAL group
• Orbicularis Oculi
o Palpebral part
▪ Gentle closure of
eyelid
o Orbital portion
▪ Forceful closure of
eyelid
• Corrugator Supercilii
o draws the eyebrows together
o vertical wrinkles on the
bridge of the nose
• If are unable to close your eyes
because of a facial nerve trauma,
the inability to blink will prevent the
eyes from becoming lubricated, the
cornea will dry out and you'll end up
with a condition called exposure
keratitis
Facial muscles NASAL group
• Nasalis
o the largest and has the
transverse part
o it compresses the nostrils, and
the alar part opens up the
nares
o this muscle is working if you're
very angry (huffing and
puffing) so you can see the
flaring of the alae nasi
o if you have difficulty
breathing, you would have
dilating action of the muscle
• Procerus
o the most superior and it's
located at the bridge of the
nose, in between the
corrugator supercilii
o when you contract this muscle,
it produces transverse ridges
at the base of the nose
• Depressor septi nasi
o not all books would mention
this, but there is a depressor,
and it opens up the nostrils
Face muscles ORAL group
• Orbicularis oris
o the main oral muscle of
expression
o it encloses the opening to the
oral cavity
ANAKINES

o Actions: it narrows the orifice

of mouth, purses lips and
pucker lip edges

Memorize & Practice:

• The facial muscles of

Face muscles for EXPRESSION
expression are innervated by
the facial nerve, so the motor
function is by the facial nerve
and proprioception
• The facial nerve arises from
within the skull, and it travels
at different areas
• It passes through the foramen
that is shared with the
vestibulocochlear nerve in
the middle ear, it exits out at
the stylomastoid foramen, to
enter into the parotid gland,
as it exits from the parotid
gland, it will now be dividing
into its five branches
o vestibulocochlear
nerve > stylomastoid
foramen > parotid
gland > five branches
• Exiting out from the parotid
gland would be the temporal,
then zygomatic, then below
the duct of the parotid gland
but going forward onto the
skin of the face is the buccal,
passing down onto the
mandible is the mandibular,
and finally on the neck which
is your cervical
o Temporal >
Zygomatic > Buccal >
ANAKINES

Mandibular > o Within parotid gland

Cervical
Face muscles for expression
INNERVATION
• Innervates all the muscles of facial
expression but it does not supply the
skin of the face
• Branches before entering the parotid
gland:
o Muscular branch - posterior
belly of digastric and
stylohyoid
o Posterior auricular nerve -
posterior and superior
auricular muscles and the
occipital belly of the
occipitofrontalis
• Temporal branch
o Frontal belly
o Anterior & Superior auricular
o Orbicularis oculi
o Corrugator supercilii
• Zygomatic branch
o Orbicularis oculi
• Buccal branch
o Buccinator, muscles of upper
lip
• Mandibular
o Muscles of lower lip
• Cervical
o Platysma or depressor anguli
oris
Facial nerve Paralysis: Bell’s Palsy
Upper Motor Neuron lesion
• Etiology: involves the pyramidal
tracts
• Normal appearance of the upper
half of the face because there is still
nerve supply, since the upper part of
the face still receives its own
innervations by connection to
corticobulbar tract
Signs and symptoms of Ipsilateral
involvement of facial nerve
• Rapid onset
• Mild weakness to total paralysis on
one side of face (always on one side
of face)
• Hours to days in duration (can be
resolved or can return)
• Facial droop
• Facial expressions affected: closing
your eyes or smiling
• Drooling
• Jaw pain, behind the ear on the
affected side
• Increased sensitivity to sound on the
affected side
• Headache
• Loss of taste
• Tears and saliva affected

• Facial nerve palsy or Bell's paralysis

is involvement of the ipsilateral side
of the facial nerve, and it's classified
as a lower motor neuron lesion so
there's damage of the facial nerve as
it courses from its origin onto the face
• Damage to the:
o Internal acoustic meatus
o In the middle ear
o Facial nerve canal at the
area of the stylomastoid
foramen
ANAKINES

o keep our mouth moist

o when we're eating the food
gets soft and it actually
initiates digestion because of
the presence of amylase in the
saliva
o it also protects our teeth from
decaying

Parotid gland

• Largest salivary gland

• Two other glands are the
submandibular and the sublingual
glands
• Consists of serous type of cells
• Located in a deep hollow, below the
external auditory meatus, behind the
ramus of the mandible, anterior to
the sternocleidomastoid (part of the
sternocleidomastoid is covered by the
parotid gland)
• The facial nerve as it passes through
the parotid gland will divide it into
superficial and deep parts, parotid • If we want to find out exactly where
duct would emerge from its anterior the parotid duct pierces the mucosa,
border to pierce the buccinator and we can easily just draw a line from
enter into the mucosa of the mouth, below the tragus, to the corner of the
opposite the upper 2nd molar tooth mouth, divided into three and then the
• Structures within: Facial nerve, 2/3 starting from the auricle is
Retromandibular vein, External approximately where the parotid
carotid artery gland will pierce the buccinator
• Importance of saliva: • The buccinator itself would actually
o keeps mouth clean because it prevent backflow of saliva, because
washes away the germs when we use our buccinator it enters
ANAKINES

at an oblique angle, so there isn't o Assists in elevating mandible

going to be any back flow of saliva
up to the parotid gland

Other Salivary glands

• Submandibular gland
o Serous and mucous acini
o Located under the lower
border of the body of the
mandible
o it is provided by the
parasympathetic secretomotor
supply of the facial nerve
• Sublingual gland
o Serous and mucous acini
o Located beneath the mucous
membrane, in the sublingual
floor of the mouth and it is
near the frenulum of the
tongue (part where your
tongue is attached by a
fleshy part
o it is provided by the
parasympathetic secretomotor
supply of the facial nerve • Let's take a closer look at the
origin & insertion of these two
Muscles of Mastication muscles
• Masseter originates from the
• All the muscles of mastication are zygomatic arch to insert
innervated by the mandibular downward and laterally to the
division of the trigeminal nerve surface of the ramus of the
mandible, so that it elevates the
• Temporalis
mandible to close the mouth
o Anterior & Superior fibers
▪ Elevate mandible • Temporalis muscle originates
o Posterior fibers from the floor of the
▪ Retract mandible infratemporal fossa, and inserts to
the coronoid process of mandible,
▪ Drags the mandible
which has three groups of fibers:
backward and
upward • Anterior, superior, and posterior.
• Lateral Pterygoid • Posterior group of fibers retract
o Pulls neck and articular disc the mandible and the anterior
forward (part of TMJ) and superior elevate the
o Rotates jaw with Medial mandible
pterygoid o so, all of them elevate the
o While one is contracting, the mandible but with
other is relaxing regards to temporalis, the
• Medial Pterygoid
ANAKINES

posterior fibers can also attachment of the anterior belly of the

retract the mandible
Mandible
• The mandible is the largest and
strongest bone of the face it
articulates with the skull forming the
temporomandibular joint
Mandible Lateral view
digastric muscle
• The ramus of the mandible is
critically placed, and it has the
anterior coronoid process which
receives the attachment of the
temporalis muscles, so its posterior
fibers will retract the mandible
• Before the head of the mandible or
condylar process, we have the
mandibular notch
o these two processes, coronoid
and condylar, are separated
from each other by the
mandibular notch
• the lateral surface of the ramus is
also rough, it receives the attachment
of the masseter muscle

Mandible Medial Internal surface view

• Horseshoe-shaped
• Consists of a body and a pair of
rami, so this is a vertical part
• The body of the mandible would
meet the vertical part, the ramus,
forming the angle of the mandible,
and the mandible meets the other
side in the center which is called the
symphesis menti
• The upper border of the body of the
mandible lodges at the teeth and
they form alveolar processes for the
teeth, and it has gomphoses joints
• The adult jaw consists of 16 sockets
for the roots of the teeth
• if you palpate the lower border of
the body of the mandible, it's kind of
rough and you call this area the
digastric fossa, it receives the
ANAKINES
• In the medial surface of the body of
the mandible, you can see the mental
spines anteriorly which gives origin
to the genioglossus muscle (tongue
muscle) above and the geniohyoid
muscle below
• On the lateral surface starting from
upwards, going downwards, towards
the mental spine, is your myloyhyoid
line, it's an oblique bridge and it is
the area just below the third molar
tooth, above it you have the
submandibular fossa, and
posteriorly you have the sublingual
fossa
• There is also the presence of the
lingual spine, this is for attachment
of the sphenomandibular ligament
(ligament of TMJ)
• The foramen now would lead into the
mandibular canal, which opens up
opposite the lateral surface of the
body of the mandible at the mental
foramen, the incisive canal is a
continuation forward of the
mandibular canal beyond the mental
form and below the incisor teeth
Temporomandibular joint
• The temporomandibular joint is very
unique, its articulation is between the
condylar head of the mandible and
above the articular tubercle of the
mandibular fossa
• Synovial joint
• The articular surfaces are surrounded
externally by a fibrous capsule which
has the synovial membrane
• Has a cartilage over the articular
surfaces
• Has a biconcave oval plate of
cartilage in the middle of that joint,
horizontally dividing now that joint,
into an upper joint cavity, and a
lower joint cavity
• ENTs, PTs, dentists, specialize in this
joint
• TMJ has two cavities, the synovial
joint capsule is adherent to the
fibrocartilage within, aside from
attaching to the front of the lateral
pterygoid and to the head of the
mandible these connections would
ensure that the disc would move
forward and backward with the
head of the mandible during
retraction and protraction
Sagittal section of TMJ
• The upper surface is actually the
mandibular fossa which is covered
by the hyaline cartilage
• the interior protruding part is the
articular tubercle
• the rounded head of the mandible is
the condylar process also covered
by the hyaline cartilage, in between
is the articular disc, it has
attachments anteriorly to the capsule
and to the tendon of the lateral
pterygoid and posteriorly to the
mandibular fossa and the condylar
head
• When you move your jaw forward,
backward, elevate, and depress your
mandible, that cartilage is going to
be moving with these two surfaces
• Anteriorly it's concave and convex,
inferiorly it's concave to
accommodate the two surfaces on
either side
ANAKINES

Lateral Temporomandibular Ligament o Posterior movement of

mandible
• These ligaments are responsible for o Posterior fibers of temporalis
protecting the joint
• Lateral temporomandibular
ligament
o Strengthens lateral aspect of Tongue
capsule
o Limits posterior movement of • Striated skeletal muscle covered by
mandible mucous membrane
o Protects external auditory • Anterior 2/3rds of the tongue is in
meatus the mouth
• Sphenomandibular ligament • Posterior 1/3rd of the tongue is in
o Remains of the 1st the pharynx
pharyngeal arch • Attached above to styloid process &
• Stylomandibular ligament soft palate
o Band of thickened deep • Attached below to the mandible &
fascia hyoid bones
• Fibrous septum - divides tongue into
Movements at TMJ right & left halves
• Tongue mucous membrane:
• Depression & elevation o Sulcus terminalis
o Occurs in the lower cavity of ▪ V-shaped
TMJ ▪ divides the tongue into
• Depression (mouth opening) anterior 2/3rd oral
o Digastrics part & posterior
o Geniohyoid 1/3rd pharyngeal
o Mylohyoid part
o Lateral pterygoid (pulls • Types of Tongue Papillae
mandible forward) o Filiform
• Elevation (mouth closing) ▪ Numerous and
o Temporalis scattered on the
o Masseter anterior 2/3rds of
o Medial pterygoids - also tongue
assists in rotating when ▪ Conical, whitish
chewing projections
o Posterior fibers of temporalis o Fungiform
– pulls head of mandible ▪ Less numerous,
posteriorly scattered on sides
• Protrusion ▪ Mushroom – shaped,
o Forward, backward, gliding reddish
movements only o Vallate
o Occurs in upper cavity ▪ Few, 10-12 only,
o Lateral pterygoids assisted located in front of
by medial pterygoids sulcus terminalis
• Retraction o Lingual tonsils – posterior
1/3rd, nodular irregular
surface
ANAKINES
• Depressed in the center, different
papillae scattered around
Tongue Inferior surface
• Inferior surface is smooth
• Frenulum of tongue
o connects the undersurface of
tongue to the floor of the
mouth
• Deep lingual vein
o runs on either side of the
frenulum
• Plica fimbriata
o side of the tongue has a
fringed fold of mucous
membrane
Tongue muscles
• Intrinsic
o longitudinal fibers
o transverse fibers
o vertical fibers
o Innervation: CN XII
(Hypoglossal n.)
o Action: alters shape of tongue
• Extrinsic
o Arise from structures outside
the tongue, such as in the
hyoid bone, soft palate,
styloid process, they will now
merge with the intrinsic
muscles on tongue
o Genioglossus
▪ attached to the
geniospine
o Hyoglossus
▪ attached to the hyoid
bone
o Styloglossus
▪ attached to the styloid
process
o Palatoglossus
▪ attached to the palate
o Innervation: CN XII
(Hypoglossal n.)
Tongue movements
• Protrusion: genioglossus
• Retraction: styloglossus & hyoglossus
• Depression: hyoglossus &
genioglossus
• Retraction & Elevation: styloglossus &
palatoglossus
Tongue Sensory Innervation
rd
• Anterior 2/3
• For general sensation
o Trigeminal nerve
o When you bit your
tongue and you know
where it hurts
• For taste, excluding vallate
papillae
o Facial nerve
• Posterior 1/3rd
• For general sensation and
taste, including vallate papillae
o Glossopharyngeal
nerve
Extraocular muscles
• The eye sockets are bony orbit,
bilateral, and symmetrical cavities in
the head
ANAKINES
• Enclosed the eyeball and its
associated structures
Orbit walls and its Openings
• Formed by several bones
• Roof/superior wall - formed
superiorly by the frontal bone, the
lesser wing of the sphenoid
• Frontal bone - separates the orbit
from the anterior cranial fossa above
• Floor/Inferior wall - formed by the
maxilla, palatine, and zygomatic
bones
• Maxilla - separates the orbit from
the underlying maxillary sinus
• Medial wall - formed by the
ethmoid, maxilla, lacrimal, and
sphenoid bones
• Ethmoid bone -separates the orbit
from the ethmoid sinus
• Lateral wall - formed by the
zygomatic bone in greater wing of
the sphenoid
• Apex - located at the opening to the
optic canal and the optic forming is
facing inward
• Base - the one that opens out into the
face and is bounded by the eyelids;
it's also known as the orbital rim, the
bony orbit contains the eyeballs and
their associated structures
Orbit muscles
• Levator palpebrae superioris
o Contains both skeletal
and smooth muscle fibers
o Thin, triangular-shaped
muscle
o Located within the upper
eyelids
o Has involuntary control
that allows you to
unconsciously keep your
eyes open when you're
awake
o Elevates upper eyelid CN
lll (Oculomotor)
o Its superior tarsal muscle is
innervated by
postganglionic
sympathetic axons from
the sympathetic n. (S.
Cervical ganglion)
Extraocular muscles
• Extraocular muscles are also located
surrounding the eyeball, they come
from a common tendinous ring of
fibrous ring that surrounds the optic
nerve which runs posterior to the
eyeball
• Common origin
o Superior rectus CN lll
(Oculomotor)
▪ Raise & rotate
medially
o Inferior rectus CN lll
(Oculomotor)
ANAKINES

▪ Depress & rotate

medially
o Medial rectus CN lll
(Oculomotor)
▪ Medially
o Lateral rectus CN Vl
(Abducens)
▪ Laterally
▪ Different innervation
o Superior oblique CN
lV (Trochlear cranial)
▪ Downward & laterally
o Inferior oblique CN III
(Oculomotor) Cranial Nerves
▪ Upward & laterally

• The cranial nerves serve functions

such as smell, sight, eye movement,
feeling in the face, balance, hearing
and swallowing
• Emerge directly from the brain,
including the brain stem
• Relay information between the brain
and parts of the body, to and from
regions
• Cranial nerve is paired, and it is
present on both sides
• There are 12 pairs of cranial nerves,
and their numbered from anterior to
posterior on the ventral surface of
the brain
• As they exit the brain, they will be
transmitted through different skull
ANAKINES

foramina depending on the cranial

fossa they are located in

1. Olfactory nerve
o these nerves are very short, and they
exit out from the cribriform plate of
the ethmoid bone to enter into the
nasal cavity
o Responsible for the sense of smell
2. Optic nerve
o posteriorly in anterior cranial fossa to
the slip like opening, the optic chiasm
where it passes into the optic canal
o responsible for vision
o as we leave the anterior
cranial fossa will go past
now between the lesser
wing of the sphenoid
bone and the greater
wing of the sphenoid
bone located here in the
middle cranial fossa that
is the superior orbital
fissure, group of cranial
nerves (very easy to
remember because they
are in succession cranial
nerves 3,4,5,6)
3. Ocular motor
4. Trochlear
5. Trigeminal
o Opthalmic nerve
ANAKINES

▪ going posterolateral of nerves travel with each

the foramen other 9,10, 11
rotundum is now 9. Glossopharyngeal
transmitting the 10. Vagus
second division of the 11. Accessory
trigeminal nerve: o then finally, near the
o Maxillary nerve opening of the foreman
▪ going inferior to that magnum, just above it, is
foramen, you have the the hypoglossal canal
foramen ovale which which transmits the:
transmits the last 12. Hypoglossal nerve
division of the
trigeminal nerve the:
o Mandibular nerve
▪ then we move on into
the posterior cranial
fossa, on the top of
that ridge you have
the internal acoustic
meatus where CN 7
& 8 travels together
6. Abducens
o The abducens nerve is a
purely somatic motor
nerve, It has no sensory
function. It innervates the
lateral rectus muscle, an
extraocular muscles of
the eye, which is
responsible for the
abduction of the eyes on
the same (ipsilateral)
side
7. Facial nerve
o carries nerve fibers
that control facial
movement and
expression. The facial
nerve also carries nerves
that are involved in taste
to the anterior 2/3 of
the tongue and
producing tears
8. Vestibulocochlear nerve
o you go down inferiorly,
and you'll come across an
opening there at the
base, that is your jugular
foramen, another group
ANAKINES

▪ vestibular nerve is for

transmitting
information about
balance
• Motor cranial nerve
o Oculomotor CN lll
▪ responsible for
controlling most eye
movements and for
constriction of the
pupil
▪ also maintains the
eyelid open
o Trochlear CN lV
▪ innervates the superior
oblique muscle of the
eye and controls
rotational movement
▪ contains the smallest
number of axons
▪ has the greatest
• Sensory cranial nerve intracranial length,
o Olfactory CN l most slender
▪ one of the very few o Abducent Vl
nerves that are ▪ innervates lateral
capable of rectus muscle of the
regeneration eye which controls
o Optic CN ll lateral movement
▪ largest nerve in the o Accessory CN Xl
orbit, receives visual ▪ responsible for
information from innervating the
photoreceptors sternocleidomastoid
located in layer of the and trapezius
retina and it's ▪ begins from the
transmitted to the outside of the skull
brain (only cranial nerve
▪ the eye's blind spot is that enters and exits
a result of the the skull)
absence of these o Hypoglossal CN Xll
photoreceptors in the ▪ responsible for
area where the retina controlling the tongue
meets the optic nerve movements, it will
as it leaves the eye affect speech food
o Vestibulocochlear CN manipulation and
Vlll swallowing
▪ has two components • Mixed cranial nerve
▪ cochlear nerve is for o Trigeminal CN V
transmitting hearing ▪ largest cranial nerves
information
ANAKINES

▪ responsible for ▪ responsible for heart

sensation of the face rate, gastrointestinal
and mouth, provides movement, sweating,
tactile motion, muscle movements of
position, and pain the mouth, including
sensations for the face that for speech and
and mouth keeping the larynx
▪ it's motor function open for breathing
activates the muscles ▪ responsible for many
of the jaw, muscles of parasympathetic
mastication, and some output to the heart
muscles in the inner and visceral organs
ear
o Facial Vll Neck boundaries
▪ controls the muscles of • Located below the lower margin of
facial expression and the mandible and superior nuchal line
functions that are • Below the neck you will find the
conveyed from the suprasternal notch and clavicle, and
taste sensations of the skin lines of cleavage constant;
anterior 2/3 of the horizontal (during surgery these lines
tongue and oral should be followed)
cavity
o Glossopharyngeal CN lX Neck Cutaneous Nerves
▪ receives sensory
information from the • After the skin that is overlaying the
tonsils, pharynx, trapezius on the back of the neck up
middle ear and to the to vertex, there are cutaneous nerves
posterior 1/3 of the present directly beneath them
tongue • These nerves are responsible for
▪ has special sensory providing sensory innervation to the
fibers of case from posterior aspect of your neck,
the posterior third of specifically at the nape
the tongue • Posterior rami of cervical nerves 2-5
▪ also responsible for • Greater occipital n ( branch of C2)
swallowing and gag • C1 has no cutaneous n.
reflex • The following group of nerves are
▪ receives an abundant responsible for innervating the skin on
amount of visceral the anterolateral surface of the neck
sensory fibers from • These nerves exit out from the
the carotid bodies posterior border of the SCM, they
and carotid sinus of are formed by the:
the carotid artery • Anterior rami cervical n. 2-4
▪ motor to the o Lesser occipital n. (C2)
stylopharyngeus ▪ ends from behind the
muscle SCM to innervate the
o Vagus CN X area on the posterior
▪ most extensive surface of the ear and
distribution lateral surface surface
of the scalp and skin,
ANAKINES

on the posterior
surface of the ear
o Greater auricular n. (C2, C3)
▪ provides sensory to
the skin covering the
angle of the mandible
and parotid gland
o Transverse cutaneous n. (C2,
C3)
▪ pass anterior to the
SCM to provide
innervation to the
anterior lateral aspect
of the neck all the
way up to the midline
of the chest
o Supraclavicular n. (C3, C4)
▪ there are three
groups medial,
• Platysma
intermediate, and
o beneath the skin, within the
lateral
loose areolar tissue
▪ supplies the skin on
o depresses mandible draws
the clavicle, to the
down the lower lip and angle
upper part of the
of mouth down (when guys
chest, to the midline of
shave their beard)
the chest, and
• Deep cervical fascia
laterally on the
o Surrounds and encircles the
shoulder and the skin
entire neck, thicker in some
covering the upper
certain areas to protect
half of the deltoid
structures
muscle
o Axillary sheath - brachial
plexus, axillary artery
Neck o Carotid sheath - houses that
carotid artery and its
branches, vagus nerve, deep
cervical lymph nodes

Neck superficial veins

ANAKINES
• The superficial veins of the neck can
be grouped into superficial or deep,
the superficial drainage would refer
to the venous drainage of the
subcutaneous tissues that are drained
by the:
• External jugular vein
o popping out on the side of
the neck, easily seen on
singers
• Jugular arch
o located in the super sternal
notch, which is a union of the
anterior jugular veins
Neck triangles
• Formed because of the important
surface landmark there, the
sternocleidomastoid
• It divides the neck now into:
• Anterior triangle
o Laterally, anterior to
sternocleidomastoid
o Superiorly, beneath the lower
border of the mandible
o Medially, sagittal line on the
anterior neck
• Posterior triangle
o Posterior to
sternocleidomastoid
o Anterior to SCM
o Posteriorly, anterior border
of the trapezius
o Inferiorly, the medial of
clavicle
o covered by investing layer of
fascia and the floor is formed
by prevertebral fascia
Sternocleidomastoid
• Straplike muscle
• Upon bilateral contraction it extends
neck at atlanto-occipital joint and
flexes the cervical part of vertebral
column
• Ipsilaterally, it produces lateral
flexion, and rotates head so face
looks upward to opposite side
• Origin of the SCM is from the
anterior and superior part of the
manubrium and the superior medial
third of the clavicle, so that means
there are two heads to the origin of
the SCM
• The two bellies will now unite and
insert on the lateral aspect of the
mastoid process and the lateral half
of the superior nuchal line
Neck posterior triangle
ANAKINES
• Boundaries
• Supraclavicular nerves muscles:
o Semispinalis capitis
o Splenius capitis
o Levator scapulae
o Scalenus medius
o Scalenus anterior
• Occipital triangle - bigger
• Supraclavicular triangle/ Omohyoid
- smaller
• Contents:
• Arteries: Subclavian 3rd part
• Veins: External jugular v.
(superficial), Subclavian v. (deep)
• Nerves: Roots of brachial plexus,
Accessory C.N., Cervical plexus
• Subclavian artery
o divided into 3 parts by
Scalenus anterior
o Posterior to subclavian
artery
▪ Lower trunk of
brachial plexus
o Superior to the subclavian
artery
▪ Upper & middle trunks
of brachial plexus
o Inferior to subclavian artery
▪ Upper surface of 1st
rib
• Subclavian vein
o proximal continuation of the
axillary vein, which is coming
from the upper extremity,
drains and brings blood up
by subclavian artery, blood
passes through the subclavian
vein
o Outer border of 1st rib
▪ Where the axillary
vein continues as the
Subclavian vein in the
neck.
• Brachial Plexus Roots (Anterior rami
C5,6,7,8 & T1)
o located exiting between
Scalenus anterior & Scalenus
medius
o Trunks: Upper, Middle &
Lower
o Divisions: Anterior & Posterior
o Cords: Lateral, Posterior,
Medial
o Descends behinds clavicle &
enters axilla
• Branches of brachial plexus at roots
o Dorsal scapular n. (C5)
▪ Innervates the Levator
scapulae and
Rhomboid muscles
o Long thoracic n. ( C5,6,7)
▪ Union of C5,6,7 unite
to form long thoracic
nerve
▪ Innervates serratus
anterior
• Branches of brachial plexus at
trunks
o Suprascapular n. (upper
trunk)
▪ Innervates
supraspinatus &
Infraspinatus muscles
o Nerve to subclavius (upper
trunk)
▪ Innervates subclavius
muscle
▪ Contains accessory
phrenic fibers
• Accessory nerve / CN Xl
o Innervates Trapezius
• Branches of cervical plexus ( ant.
rami C3,4)
o Provides proprioception to
trapezius
Neck posterior triangle to the Floor
ANAKINES
• A number of vertebral muscles on the
floor of the posterior triangle are
covered by prevertebral fascia
• Trapezius is posterior border
• Some persons may have the scalenus
posterior, so there are three scalenus
posterior; the medius and interior that
attached to the first rib, but the
scalene posterior attaches to the
second rib, not everyone has this
muscle
Neck anterior triangle
• Comprises the interior surface of the
neck
• Deep to the superficial cervical
fascia and the platysma
• Laterally it's bounded by the interior
border of the SCM, and its superior
border is the inferior margin of the
mandible
• Medially the boundary of the interior
triangle is the midline of the neck
• The anterior triangle can be
subdivided into four smaller triangles:
Submental, Digastric, Carotid,
Muscular
• Submental
ANAKINES
o Immediately beneath the chin
o Boundaries
o Floor & Contents:
▪ Mylohyoid muscle -
raise the roof of
mouth, elevates hyoid
bone, swallowing
▪ Beginning of anterior
Jugular veins
▪ Submental Lymph
nodes
• Digastric
o Beneath the border of body
of the mandible
o Boundaries - two digastric
bellies and stylohyoid muscle
o Floor is formed by Mylohyoid
& hyoglossus
o Contents
▪ Submandibular &
parotid gland
(salivary glands)
▪ Facial vein & artery
▪ Hypoglossal n.
▪ Mylohyoid nerve and
vessels
▪ Carotid sheath w/
contents
• Carotid
o Bounded by the anterior
aspect of SCM, superior belly
of the omohyoid, posterior
belly of the digastric, and
stylohyoid muscle
o Floor is formed by
Thyrohyoid & hyoglossus
o Pulsations of carotid artery
can be felt here
o Carotid sheath:
▪ Carotid arteries
▪ External carotid
artery
▪ Internal jugular vein &
tributaries
▪ Hypoglossal n.
▪ Laryngeal nerves, CN
X and CN Xl
▪ Deep cervical lymph
nodes
• Muscular
o Consists of the infrahyoid
group of muscles
ANAKINES
• The muscles in the anterior part of the
neck are divided as to where they lie
in relation to the hyoid bone
• Suprahyoid muscles - located
superiorly to the hyoid bone, found in
between the lower border of the
mandible and the hyoid bone
o They all act to elevate the
hyoid bone action involved in
swallowing
o most of these muscles are
attached to the mandible,
when they contract, they
depress the mandible
o they also attached to the
hyoid bone, so it would
elevate the hyoid bone
• Infrahyoid muscles - located
inferiorly to the hyoid bone
o Stabilize hyoid bone
o Provides for a base for
movements of the tongue
o Participate in movements of
the larynx in swallowing
Neck scalene muscles
• Paired muscles
• Located on the floor of the Posterior
triangle
• Act as accessory muscles of
respiration, assist especially in times
of difficulty in breathing
o Ipsilateral Flexion at the neck
o Bilateral Flexion
• Act to elevate the first and second
ribs,
• Increases the intrathoracic volume
• Scalenus anterior
o Deeply placed muscles
o Key muscle
o Root of the neck
o Attached to 1st rib
• Scalenus Medius - attached to 1st rib
• Scalenus posterior - attached to 2nd
rib
• Brachial plexus roots are transmitted
between Scalenus medius & anterior
Neck Main arteries
• Common Carotid Artery
o Right common carotid which
originates from Right
brachiocephalic artery
o Left common carotid which
originates form arch of the
aorta
• Carotid sinus
o At the beginning of common
carotid artery
o Dilatation at bifurcation of
common carotid artery -
o The lining is Tunica
adventitia, which is very thick
o Contains numerous
glossopharyngeal nerve
endings
o Serves as a reflex
Pressoreceptor
o Pressoreceptor mechanism:
▪ Elevation of BP causes
a reflex
▪ Slowing of HR, with
vasodilatation of
arterioles
• Carotid body
o small structure that lies
posterior to the point of
bifurcation of the common
carotid artery
o innervated by the
glossopharyngeal nerve
ANAKINES

o It has a Chemoreceptor
mechanism
▪ Sensitive to excess
CO2 and reduced
Oxygen tension in
blood
▪ Reflexely produces an
increase in blood
pressure, heart rate,
respiratory rate
• External Carotid artery
o supplies neck, face, scalp,
tongue & maxilla
• Internal Carotid artery
o supplies brain, eye, forehead, • Viscera
part of nose • Thyroid gland
o does not give off any o right & left lobes
branches in the neck o isthmus, which attaches the
• Internal jugular vein 2nd, 3rd & 4th tracheal rings
o receives blood from brain, • Pyramidal lobe
face & neck o Levator glandulae thyroidea
o begins at jugular foramen, it • Parathyroid glands
is actually a continuation of
the sigmoid sinus
o will unite with subclavian vein
to form the brachiocephalic
vein
• Cervical plexus
o Formed by the anterior rami
C1-4
o Forms a loop anterior to
levator scapulae & scalenus
anterior
o Cutaneous
o Muscular o yellowish brown, ovoid bodies
o Phrenic nerve #4
▪ only motor innervation • Trachea
to diaphragm • Mobile membranous, cartilaginous
tube
Other structures of the Neck • Begins from the level of the cricoid
cartilage to the larynx then it
branches into Right & left mainstem
bronchi at T4-T5 level
• Arterial supply
o Inferior thyroid arteries
• Innervation
o Vagi & recurrent laryngeal
nerve
o sympathetic trunks
ANAKINES

• Esophagus

o Muscular 10in length tube

o Located posteriorly to the
trachea