- Attachment of the Internal or Prevertebral Layer

HEAD AND NECK - Superior - base of the skull

- Inferior - anterior longitudinal ligament of the vertebral column.
W7 - A CERVICAL FASCIA - Posterior - ligamentum nuchae

FASCIAL SPACES AND LAYERS OF THE NECK Other Components of the Deep Cervical Fascia

1. SKIN A condensation of the deep cervical fascia which encloses the following structures:
FASCIAL LAYERS 2. SUPERFICIAL FASCIA I. Common and internal carotid artery,
3. DEEP CERVICAL FASCIA Carotid Sheath II. Internal jugular vein
III. Vagus nerve
SKIN - Outer most covering of the neck IV. Deep cervical lymph nodes

- Lies immediately next to the skin Visceral Fascia - Encloses the pharynx, esophagus, larynx and trachea
SUPERFICIAL - Consist of fats and connective tissue
FASCIA - Contains cutaneous nerves, superficial veins, superficial lymph nodes and Fascial Spaces of the Neck
platysma
- Loose areolar tissue and connective tissue fills the spaces between the various
- CONSIST OF 3 LAYERS layers of the deep cervical fascia
DEEP CERVICAL 1. Superficial layer of Deep cervical fascia Fascial spaces 1. Face
FASCIA 2. Pre-tracheal layer - Buccal, Parotid, Masseter
3. prevetebral 2. Suprahyoid
- Sublingual, Submental, Submandibular
SUPERFICIAL LAYER OF DEEP CERVICAL FASCIA 3. Infrahyoid
- Pretracheal
- Completely encircles and encloses the neck, including the sternocleido-mastoid 4. Spaces of total neck
and trapezius muscles - Retropharyngeal, Space of carotid sheath, Danger space, Prevertebral
- Attachments of the External Layer: space
○ Superior - inion, superior nuchal line, mastoid process, zygomatic arch
and lower border of the mandible. FACE
○ Inferior - acromion process and spine of the scapula, clavicle and
BOUNDED BY:
manubrium sterni.
- The angle of the mouth anteriorly
○ Anterior - it meets the corresponding opposite side at the middle
Buccal space - The masseter muscle posteriorly
○ Posterior - Ligamentum nuchae
- The zygomatic process of the maxilla and the zygomaticus muscles superiorly
- The depressor anguli oris muscle and the attachment of the deep fascia to the
PRE-TRACHEAL LAYER
mandible inferiorly
- The buccinator muscle medially (the buccal space is superficial to the
- Lies deep to the deep investing fascia
Buccinator)
- Attachment of the Middle or Pretracheal layer:
- Platysma muscle, subcutaneous tissue and skin laterally (the space is deep to
- Superior - thyrocricoid cartilage
platysma)
- Inferior - extends into the thorax and blends with the pericardium in the
mediatinium
CONTENTS
- Two Divisions of the Middle or Pre-tracheal Layer
A. The buccal fat pad
1. Muscular Portion
B. The parotid duct (stension’s duct)
- Located in front of the thyroid gland
C. The anterior facial artery and vein
- Encloses the infrahyoid muscles
D. The transverse facial artery and vein
2. Visceral Portion
- Encloses the thyroid and parathyroid glands
BOUNDARIES:
- Superiorly: zygomatic arch
PREVETEBRAL
Masseteric Space - Inferiorly: inferior border of mandible
- Laterally: masseter muscle
- Arises from the investing layer opposite the trapezius. It is much thicker than
- Medially: ramus of mandible
the pre-tracheal layer.
- Posteriorly: parotid gland & its fascia
- Covers the prevertebral muscles - longus, colli, longus capitis, scalenius
- Anteriorly: buccal space & buccopharyngeal fascia
anterior, scalenius medius, and scalenius posterior.
 - Anterior bellies of the digastric muscles laterally.
CONTENTS
- Masseteric Artery & Vein. INFRAHYOID

- This space lies between the superficial and deep capsules of parotid gland - Space infront of the trachea
- Formed by superficial layer of deep fascia and dense septa from capsule into Pretracheal Space - Not related directly to the esophagus
gland. - Defined by the collar of pretracheal fascia
Parotid Space - In addition to the parotid gland, this space contains the parotid gland, this space
contains the parotid lymph nodes, the facial nerve and posterior facial vein. ENTIRE NECK SPACES

BOUNDARIES: - Posterior to pharynx and esophagus

- Superior: external auditory meatus and temporomandibular joint. - Anterior to alar layer of deep fascia
- Inferior: it overflows the posterior belly of digastric. - Extends from skull base to T1-T2 (superior mediastinum)
- Anterior: it overflows the mandible with the overlying masseter.
- Medial: lies the styloid process - Anterior border is alar layer of deep fascia
- Posterior border is prevertebral layer
- The fascial envelope is deficient on the supero-medial surface of the gland, - Extends from skull base to diaphragm
facilitating direct communication between this space and the parapharyngeal - It is so named because it contains loose areolar tissue and offers little
space. resistance to the spread of infection
- It comes to an end at the level of the diaphragm
SUPRAHYOID
- These fascial spaces are filled with loose connective tissue, it readily breaks
BOUNDARIES: Clinical Significance down when invaded by infection, blood, air or tumor, making possible for spread
- Superiorly: mylohyoid muscle, inferior border of mandible from one region to the next
- Inferior: anterior & posterior belly of digastric
Submandibular - Laterally: deep cervical fascia, platysma, superficial fascia & skin - Anterior border is prevertebral fascia
Space - Medially: hyoglossus, styloglossus, mylohyoid muscle. - Posterior border is vertebral bodies, Ant. Long. Lig. and deep neck muscles
- Posteriorly: to hyoid bone
Carotid sheath
- Anteriorly: submental space
Visceral Vascular - It is termed the "Lincolin's highway" of the neck
Space Prevertebral sheath
CONTENTS:
- It extends from the base of skull into the mediastinum
- Submandibular salivary gland
- Proximal portion of Wharton’s duct
W7 - TRIANGLES OF THE NECK
- Lingual & hypoglossal nerves
- Branches of facial artery palatine, tonsillar, glandular, submental. ANTERIOR ANGLE
- Consist of SUBLINGUAL AND SUBMYLOHYOID SPACE Bounded
- SUPERIORLY: body of the mandible
- Superiorly: mucosa of floor of mouth. - ANTERIORLY: midline
- Inferior: mylohyoid muscle. - POSTERIORLY: sternocleidomastoid muscle
- Posteriorly: body of hyoid bone. Anterior
- Anteriorly & laterally: inner aspect of mandibular body. CONTENTS:
Sublingual space - Medially: geniohyoid, styloglossus, genioglossus muscle. - muscles, nerves, arteries, veins and lymph nodes.
CONTENTS: - Hyoid bone divides the anterior triangle into 2 areas: suprahyoid and infrahyoid
- Areolar tissue MUSCLES
- Hypoglossal and lingual nerves
- sublingual gland DIVISIONS - Inferior border of mandible
- Wharton's duct - Sternocleidomastoid muscle
- The hyoid bone, suprahyoid and infrahyoid muscles are used to further
- Mylohyoid muscle superiorly subdivide the anterior triangle into four triangles
- Investing layer of deep cervical fascia (and this in turn is covered by the 1. Muscular triangle
Submental space platysma muscle) inferiorly 2. Carotid triangle
- Inferior border of the mandible anteriorly 3. Submandibular triangle
- Hyoid bone posteriorly 4. Submental triangle
 Anterior subdivisions BOUNDARIES
- Posterior: Trapezius muscle
Muscular triangle Boundaries Occipital triangle - Anterior: Sternocleidomastoid muscle
Muscular triangle - Superiorly: hyoid bone - Inferior: Omohyoid muscle
- Medially: Imaginary midline of the neck - Floor: Splenius Capitus m, Levator Scapulae m,Scalenus Medius, and a portion
- Supero-laterally: Superior belly of the omohyoid muscle of Scalenus Anterior
- Infero-laterally: Inferior portion of the sternocleidomastoid muscle - Roof: Superficial layer of Deep Investing Fascia

Carotid triangle Boundaries CONTENTS

Carotid triangle - Superior: Posterior belly of the digastric muscle. - It contains mainly lymph nodes, and nerves of the triangle which include
- Lateral: Medial border of the sternocleidomastoid muscle. - Accessory nerve
- Inferior: Superior belly of the omohyoid muscle. - Dorsal scapular nerve and other branches of the brachial plexus
- Supraclavicular nerves
Submandibular triangle Boundaries - External jugular vein
- Superiorly: Body of the mandible - Parts and branches of cervical plexus
Submandibular - Anteriorly: Anterior belly of the digastric muscle
triangle - Posteriorly: Posterior belly of the digastric muscle BOUNDARIES
- Inferiorly: Hyoid bone - Inferior: Clavicle
- Medially: Imaginary sagittal midline of the neck Subclavian triangle - Superior: Inferior belly of Omohyoid muscle
- Laterally: Anterior belly of the digastric - - Anterior: Sternocleidomastoid muscle
- - Floor: Splenius Capitus m, Levator Scapulae m, Scalenus Medius, and a
POSTERIOR TRIANGLE portion ofScalenusAnterior
- - Roof: Superficial layer of Deep Investing Fascia
- The posterior triangle of the neck (also known as the lateral cervical region)
- It is covered by the investing layer of fascia, and the floor is formed by the
CONTENTS
prevertebral fascia
- Third part of subclavian artery
- It contains key vessels; the external jugular vein, transverse cervical artery,
- Part of subclavian vein
Posterior Triangle subclavian artery and subclavian vein
- Supra-scapular artery
- It is further subdivided by the inferior belly of the omohyoid
- Supraclavicular lymph nodes
BOUNDARIES VISCERAL CONTENTS OF THE NECK
- INFERIORLY: clavicle
- ANTERIORLY: sternocleidomastoid muscle - Highly vascular organ located on the anterior and lateral surfaces of the neck
- POSTERIORLY: trapezius muscle - Formed by a right and a left lobe connected in the midline by an isthmus
- FLOOR: THYROID GLAND - Lies roughly at a level between the 5th cervical and the 1st thoracic vertebrae
- Splenius captitis - The isthmus crosses at the 2nd and 3rd tracheal rings
- Levator scapulae - Arterial supply arises from the superior and inferior thyroid arteries, with the
- Anterior, Middle and Posterior scalene major portion from the inferior thyroid artery
- ROOF OF THE POSTERIOR TRIANGLE:
- Platysma and superficial layer of the deep cervical fascia - Parathyroid glands normally are 4 glands located on the posterior surface of the
PARATHYROID thyroid lobes
CONTENTS GLANDS - The superior parathyroids are supplied by the superior thyroid artery and the
- Accessory nerve XI inferior parathyroids are supplied by the inferior thyroid artery
- Cutaneous nerve branches from the cervical plexus
- Phrenic nerve - Connection between the pharynx and the trachea
- Roots of the brachial plexus LARYNX - Prevents foreign bodies from entering the airways
- The third part of the subclavian artery - Designed for the production of sound (phonation)
- Lymph nodes

DIVISIONS
- Posterior subdivisions
- Occipital triangle
- Subclavian triangle

MUSCLES IN THE NECK

INFRAHYOID AND
SUPRAHYOID
MUSCLES ARTERIAL, VENOUS BLOOD SUPPLY OF THE NECK

Common Carotid - The right arises from the brachiocephalic artery behind the right sternoclavicular
Artery joint
- The left artery arises from the arch of the aorta in the superior mediastinum
- It runs upward through the neck under cover of the anterior border of the
sternocleidomastoid muscle, from the sternoclavicular joint to the upper border
of the thyroid cartilage.

Anterolaterally:
- Skin
Common Carotid - Fascia
Artery (RELATIONS) - Sternocleidomastoid
- Sternohyoid
- Sternothyroid
- Superior belly of the omohyoid

Posteriorly:
- Transverse Processes Of The Lower FourCervical Vertebrae
- Prevertebral Muscles
- Sympathetic Trunk
PREVERTEBRAL
- Vertebral Vessels.

Medially:
- Larynx And Pharynx
- Trachea And Esophagus
- Lobe Of The Thyroid Gland

Laterally:
- Internal Jugular Vein
- Vagus Nerve

It has 2 terminal branches

- External carotid
- Internal carotid

External carotid - It supplies structures in the neck, face, scalp and tongue
artery - It begins at the level of the upper border of the thyroid cartilage and terminates
 in the substance of the parotid gland behind the neck of the mandible Occipital Artery - The artery supplies the back of the scalp
- At the level of the ascending ramus it divides into superficial temporal and
maxillary arteries Posterior Auricular - Supplies the auricle and the scalp
- It emerges from undercover of the sternocleidomastoid muscle, where its Artery
pulsations can be felt
- It lies medial to the internal carotid artery Superficial Temporal - Ascends over the zygomatic where it may be palpated just in front of the auricle
- It is crossed by the posterior belly of the digastric and the stylohyoid Artery - It is accompanied by the auriculotemporal nerve, and it supplies the scalp

Anterolaterally: Runs forward medial to the neck of the mandible and enters the pterygopalatine
- Skin and fascia fossa of the skull
External carotid - Anterior border of the sternocleidomastoid Maxillary Artery - Its branches supplies
artery (RELATIONS) - Hypoglossal nerve - the upper and the lower jaws
- Posterior belly of the digastric muscle - the muscles of mastication
- Stylohyoid muscles - the nose
- Within the parotid gland, it is crossed by the facial nerve - the palate
- the meninges inside the skull
Medially:
- Wall of the pharynx ARTERIAL SUPPLY OF THE NECK
- Internal carotid artery
Middle Meningeal - Enters the skull through the foramen spinosum and runs laterally within the skull
- Stylopharyngeus muscle
Artery
- Glossopharyngeal nerve
- Pharyngeal branch of vagus nerve
- Begins at the bifurcation of the common carotid artery at the level of the upper
border of the thyroid cartilage
External carotid artery (BRANCHES)
Internal - It supplies the brain, the eye, the forehead, and part of the nose
MNEMONICS AND BRANCHES carotid artery - The artery ascends in the neck embedded in the carotid sheath with the internal
jugular vein and vagus nerve
Mnemonics Branches - It then passes upward and forward in the cavernous venous sinus
- It then inclines backward, lateral to the optic chiasma, and terminates by
- Some Attendings Like Freaking 1. Superior thyroid dividing into the anterior and the middle cerebral arteries.
Out Potential Medical Students 2. Ascending Pharyngeal
- Some Anatomists Like 3. Lingual Anterolaterally:
Forcinating, Others Prefer S & M 4. Facial - Below the digastric lie
- Some Angry Lady Figured Out 5. Occipital - The skin, the fascia, the anterior border of the sternocleidomastoid, and the
PMS 6. Posterior auricular hypoglossal nerve
7. Maxillary - Above the digastric lie
8. Superficial temporal Internal carotid artery - The stylohyoid muscle, the stylopharyngeus muscle, the glossopharyngeal
(RELATIONS) nerve, the pharyngeal branch of the vagus, the parotid gland, and the external
carotid artery
Superior Thyroid - Curves downward to the upper pole of the thyroid gland
Artery - Accompanied by the external laryngeal nerve, which supplies the cricothyroid Posteriorly:
muscle. - - The sympathetic trunk, the longus capitis muscle, and the transverse
processes of the upper three cervical vertebrae
Ascending - The ascending pharyngeal artery ascends along and supplies thepharyngeal
Pharyngeal Artery wall Medially:
- The pharyngeal wall and the superior laryngeal nerve
Lingual Artery - The lingual artery loops upward and forward and supplies the tongue
Laterally:
- It lies deep to the submandibular salivary gland and emerges and bends around - - The internal jugular vein and the vagus nerve
the lower border of the mandible.
Facial Artery - It ascends over the face close to the anterior border of the masseter muscle, Internal carotid artery Ophthalmic Artery
around the lateral margin of the mouth and terminates at the medial angle of the (BRANCHES) - Passes forward into the orbital cavity through the optic canal
eye - it gives off the central artery of the retina, which enters the optic nerve and runs
- Branches of the facial artery supply the tonsil, the submandibular salivary gland, forward to enter the eyeball
and the muscles and the skin of the face.
 Posterior Communicating Artery - formed by the union of the superficial temporal and the maxillary veins
- runs backward to join the posterior cerebral artery Retromandibular - Upon leaving the parotid salivary gland, it divides into an
Vein - Anterior branch: which joins the facial vein
Anterior Cerebral Artery - Posterior branch: which joins the posterior auricular vein to form the
- Passes forward between the cerebral hemispheres external jugular
- It winds around the corpus callosum of the brain to supply the medial and the
superolateral surfaces of the cerebral hemisphere - Formed behind the angle of the jaw by the union of the posterior auricular vein
External with the posterior division of the retromandibular vein
Middle Cerebral Artery Jugular Vein - It descends across the sternocleidomastoid muscle and beneath the platysma
- Runs laterally in the lateral cerebral sulcus of the brain muscle
- Supplies the entire lateral surface of the cerebral hemisphere - Drains into the subclavian vein behind the middle of the clavicle
- Gives off central branches that supply central masses of gray matter and the
internal capsule of the brain - Posterior external jugular vein
External Jugular Vein - Transverse cervical vein
- The lies in the subarachnoid space at the base of the brain (Tributaries) - Suprascapular vein
Circle of Willis - Formed by the anastomosis between the branches of the two internal carotid - Anterior jugular vein
arteries and the two vertebral arteries
- Cortical and central branches arise from the circle and supply the brain. Anterior - Descends in the front of the neck close to the midline
Jugular Vein - Above the sternum, it is joined to the opposite vein by the jugular arch
Right Subclavian Artery - Joins the external jugular vein deep to the sternocleidomastoid muscle
Subclavian Arteries - Arises from the brachiocephalic artery, behind the right sternoclavicular
- It arches upward and laterally over the pleura and between the scalenus - Starts as a continuation of the sigmoid sinus and leaves the skull through the
anterior and medius muscles Internal jugular foramen
Jugular Vein - It then descends through the neck in the carotid sheath lateral to the vagus
Left Subclavian - Arises from the arch of the aorta in the thorax nerve and the internal and common carotid arteries
Artery - It ascends to the root of the neck and then arches laterally in a manner similar - It ends by joining the subclavian vein behind the medial end of the clavicle to
to that of the right subclavian artery form the brachiocephalic vein

SUBCLAVIAN ARTERY PARTS ANTEROLATERAL:

- Skin, Fascia, Sternocleidomastoid, Parotid Gland
First part Second part Third part
Internal Jugular Vein POSTERIORLY:
- Vertebral artery - Costocervical trunk - Usually has no branches (RELATIONS) - Transverse processes of the cervical vertebrae, Levator scapulae, Scalenus
- Thyrocervical trunk - Deep cervical artery - BUT if: medius, Scalenus anterior, Cervical plexus, Phrenic nerve,Thyrocervical trunk,
- Internal thoracic artery - Superior intercostal artery - Superficial cervical Vertebral Vein, First part of the subclavian artery
arteries
- Suprascapular MEDIALLY:
arteries - The 9th, 10th, 11th, and 12th cranial nerves
- Common carotid artery
- Vagus nerve
VENOUS SUPPLY OF THE NECK - Inferior petrosal sinus
Internal Jugular Vein - Facial vein
- Formed at the medial angle of the eye by the union of the supraorbital and (TRIBUTARIES) - Pharyngeal veins
supratrochlear veins - Lingual vein
Facial Vein - It is connected through the ophthalmic veins with the cavernous sinus - Superior thyroid vein
- It descends down the face with the facial artery and passes around the lateral - Middle thyroid vein
side of the mouth.
- Continuation of the axillary vein at the outer border of the 1st rib
- Formed on the side of the scalp Subclavian Vein - Joins the internal jugular vein to form the brachiocephalic vein and it receives
Superficial Temporal - It follows the superficial temporal artery and the auriculotemporal nerve the external jugular vein
Vein - It enters the parotid salivary gland, where it joins the maxillary vein to form the
retromandibular vein. Subclavian Vein - Anteriorly: Clavicle
(RELATIONS) - Posteriorly: Scalenus anterior muscle andPhrenic nerve
Maxillary Vein - Formed in the infratemporal fossa from the pterygoid venous plexus - Inferiorly: The upper surface of the 1st rib
- It joins the superficial temporal vein to form the retromandibular vein.
 LYMPHATIC DRAINAGE OF HEAD AND NECK D. Hypoglossal
- Also known as cranial nerve XII
- Arises as a series of rootlets from the medulla oblongata and passes through
the hypoglossal canal

- Skin of the neck receives sensory innervation from both dorsal and ventral rami
- Ventral rami provide most of the sensory innervation to the neck through the
sensory branches of the cervical plexus
2. Cervical plexus VENTRAL RAMI
1. Lesser occipital
2. Great auricular
3. Transverse cervical
4. Supraclavicular

- Formed by Cl to C4 ventral rami

- Originates deep to the sternocleidomastoid
DORSAL RAMI
- 1. Greater occipital
- 2. 3rd occipital
- 3. Dorsal ramus of C4
- 4. Dorsal ramus of C5

3. Brachial plexus - Ventral rami of C5 to C8 and T1 form the brachial plexus, which provides motor
and sensory function to the upper limb

4. Phrenic - Arises from the ventral rami of C3 to C5

- Passes inferiorly along the anterior surface of the anterior scalene m.
- Eventually passes through the thorax to innervate the diaphragm

CLINICAL CORRELATION

TORTICOLLIS - Also known as "wryneck," is a disorder in which the muscles of the neck are
flexed, extended, or twisted in an abnormal position
- The sternocleidomastoid is the most commonly affected muscle
NERVE SUPPLY OF THE NECK
The nerve supply to the neck is extensive: - The pituitary gland regulates the thyroid's
- normal production of the hormones thyroxine and triiodothyronine
A. Glossopharyngeal HYPOTHYROIDISM - A condition characterized by hypermetabolism and elevated levels of thyroid
- Also known as cranial nerve IX hormones
- Branches from the medulla oblongata and passes through the jugular foramen - Can lead to thyrotoxicosis, a toxic condition caused by excess thyroid hormones
with the vagus and spinal accessory nn. Immediately after passing through the regardless of the cause
1. Cranial nerves jugular foramen
SCALP AND MUSCLES OF FACIAL EXPRESSION
B. Vagus
- Also known as cranial nerve X - Consist of a multilayered structure with layers
- Branches from the medulla oblongata and passes through the jugular foramen S-skin
with the glossopharyngeal and spinal accessory nn. SCALP C-connective tissue (dense)
A-aponeurotic layer (galea aponeurotica)
C. Spinal accessory L-loose connective tissue
- Also known as cranial nerve XI P-pericranium
- Described as being formed from 2 parts: cranial and spinal - The first three layers are tightly held together, forming a single unit
- Exits through the jugular foramen
Skin - is thick, hair bearing and contains numerous sebaceous glands.
 - Fibrofatty - ZYGOMATICOTEMPORAL NERVE
- The fibrous septa uniting the skin to the underlying aponeurosis of the - AURICULOTEMPORAL NERVE
Connective tissue occipito-frontalis muscle - LESSER OCCIPITAL NERVE
- Numerous arteries and veins are found in this layer - GREATER OCCIPITAL NERVE
- Arteries are branches
- External and Internal carotid arteries Lymphatic Drainage - Posterior half of the scalp drain to occipital and posterior auricular nodes
- Anterior half drain to the parotid nodes
Aponeurosis - is a thin, tendinous sheet that unites the occipital and frontal bellies of the
(epicranial) occipitofrontalis muscle MUSCLES OF FACIAL EXPRESSION
- The lateral margins of the aponeurosis are attached to the temporal fascia.
- The muscles of the face develop from the 2nd pharyngeal arch and are
- Occupies the subaponeurotic space and loosely connects the epicranial innervated by branches of the facial nerve CN 7
aponeurosis to the periosteum of the skull (the pericranium) - They are in the superficial fascia, with origins from either bone or fascia, and
- The areolar tissue contains a few small arteries, but it also contains some insertions into the skin
Loose important emissary veins - They act as sphincters and dilators of the orifices of the face (i.e. the orbits,
areolar tissue - The emissary veins are valveless and connect the superficial veins of the skall nose, and mouth)
bones and with the intra cranial venous sinuses
- Called dangerous layer of scalp
- emissary veins open here and carry any infections inside the brain (venous
sinus)

Pericranium - which is the periosteum covering the outer surface of the skull bones.

- Five pairs of arteries

- 3 from External carotid and 2 from Internal carotid

External carotid
- superficial temporal artery gives off frontal and parietal branches to supply
much of the scalp
Blood Supply - occipital artery which runs posteriorly to supply much of the posterior aspect of
(Artery) the scalp
- posterior auricular artery a branch of the external carotid artery, ascends
behind the auricle to supply the scalp above and behind the auricle

Internal carotid
- supratrochlear artery to the midline forehead, a branch of the ophthalmic
branch of the internal carotid artery PALPEBRAL PART
- supraorbital artery to the lateral forehead and scalp as far up as the vertex, - ORIGIN: MEDIAL PALPEBRAL LIGAMENT
branch of the ophthalmic branch of the internal carotid - INSERTION: LATERAL PALPEBRAL RAPHE
- ACTION: CLOSES THE EYELIDS AND DILATES THE LACRIMAL SAC
- supratrochlear vein begins on the forehead in a venous plexus which ORBICULARIS - BLOOD SUPPLY: FACIAL ARTERY, SUPERFICIAL TEMPORAL ARTERY
communicates with the frontal branches of the superficial temporal vein OCULI AND OPHTHALMIC
- supraorbital vein begins on the forehead where it communicates with the
frontal branch of the superficial temporal vein ORBITAL PART
Blood Supply - superficial temporal vein side of the skull - ORIGIN: MEDIAL PALPEBRAL LIGAMENT
(Veins) - communicates with the frontal vein and supraorbital vein, with the - INSERTION: LOOPS RETURN TO ORIGIN
corresponding vein of the opposite side, and with the posterior auricular - ACTION: THROWS SKIN AROUND ORBITINTO FOLDS TO PROTECT
vein and occipital vein EYEBALL
- posterior auricular vein side of the head, in a plexus which communicates with - BLOOD SUPPLY: FACIAL ARTERY, SUPERFICIAL TEMPORAL ARTERY
the tributaries of the occipital vein and superficial temporal veins AND OPHTHALMIC
- occipital vein posterior aspect of the scalp from the external occipital
protuberance and superior nuchal line to the back part of the vertex of the - ORIGIN: SUPERCILIARY ARCH
CORRUGATOR - INSERTION: SKIN OF EYEBROW
Scalp Nerve Supply - SUPRATROCHLEAR NERVE SUPERCILLI - ACTION: FORMS VERTICAL WRINKLES OF FOREHEAD, FROWNING
- SUPRAORBITAL NERVE - BLOOD SUPPLY: OPHTHALMIC ARTER
 - ORIGIN: FRONTAL PROCESS OF MAXILLA the gland, superficial to the masseter muscle
COMPRESSOR - INSERTION: APONEUROSIS OF THE BRIDGE OF NOSE - The duct pierces the buccinator muscle, then opens into the oral cavity on the
NASI - ACTION: COMPRESSES MOBILE NASALCARTILAGE inner surface of the cheek, usually opposite the maxillary second molar
- BLOOD SUPPLY: FACIAL ARTERY
Relation to other structures
- ORIGIN: MAXILLA
DILATOR - INSERTION: ALA OF THE NOSE Superficial or lateral - The gland is situated deep to the skin, superficial fascia, superficial lamina of
NARIS - ACTION: WIDENS NASAL APERTURE relations: investing layer of deep cervical fascia and great auricular nerve
- BLOOD SUPPLY: FACIAL ARTERY
Anteromedial - situated posterolaterally to the mandibular ramus, masseter and medial
- ORIGIN: NASAL BONE relations: pterygoid muscles.
- INSERTION: SKIN BETWEENEYEBROWS
PROCERUS - ACTION: WRINKLES SKIN OF NOSE AND PROCERUS PULLS - situated anterolaterally to mastoid process of temporal bone with its attached
EYEBROWSDOWNWARDS Posteromedial sternocleidomastoid and digastric muscles, styloid process of temporal bone
- BLOOD SUPPLY: SUPRAORBITALBRANCH OF OPHTHALMIC ARTERY relations: with its three attached muscles (stylohyoid, stylopharyngeus, and styloglossus)
and carotid sheath with its contained neurovasculature (internal carotid artery,
- ORIGIN: MAXILLA, MANDIBLE AND SKIN internal jugular vein, and 9th, 10th, 11th, and 12th cranial nerves).
ORBICULARIS - INSERTION: ENCIRCLES ORAL ORIFICE
ORIS - ACTION: COMPRESSES LIP TOGETHER - The parotid gland comes into contact with the superior pharyngyeal constrictor
- BLOOD SUPPLY: SUPERIOR AND INFERIORLABIAL BRANCHES OF THE muscle at the medial border
FACIALARTERY Medial relations: - Structures that pass through the gland
- These are from lateral to medial:
- All motor nerves are from the facial nerve and supply the muscles of facial - Facial nerve
NERVE SUPPLY expression - Retromandibular vein
OF THE FACE - Sensory nerves of the face are derived mainly from the 3 divisions of the - External carotid artery
trigeminal nerve (V1, V2, V3) - Superficial temporal artery
- Branches of the great auricular nerve
CLINICAL CORRELATION - Maxillary artery

- Also called tic douloureux Clinical Correlations

- Usually affects the maxillary (V2) or mandibular (V3) division of the trigeminal
TRIGEMINAL nerve;rarely affects the ophthalmic division (V1) SITES OF LESION
NEURALGIA - Cause is unknown a. Intracranial and/or internal auditory meatus.
- Periods of intense (lasting 1 to 2 minutes), paroxysmal pain along one of the BELL'S PALSY b. Geniculate ganglion.
divisions of the trigeminal nerve c. Facial canal.
d. Below stylomastoid
- Pathologic condition involving the cavernous sinus that is often caused by a e. Foramen (parotid gland tumor, trauma)
thrombosis, tumor, aneurysm, fistula, or trauma
- It affects the contents of the cavernous sinus, including: - Caused by regeneration of the auriculotemporal autonomic fibers in an
CAVERNOUS - Internal carotid artery with sympathetics abnormal fashion, innervating the sweat glands near the parotid gland after a
SINUS SYNDROME - Cranial nerve III FREY'S parotidectomy
- Cranial nerve IV SYNDROME - Symptoms include sweating and redness in the distribution of the
- Cranial nerve V1 auriculotemporal nerve during eating
- Cranial nerve V2 - Diagnosis is via Minor's starch iodine test creates a dark spot over the
- Cranial nerve VI gustatory sweating area

W9 PAROTID BED & GLAND - An inflammation of the parotid glands that typically is caused by a bacterial or
viral infection
- They are the largest of the salivary glands - Pain through mandibular movement is the result of the compression of the deep
The parotid gland lies inferior to the zygomatic arch, anteroinferior to the PAROTITIS/MUMPS lobe of the gland by the mandibular ramus
external acoustic meatus, anterior to the mastoid process, and posterior to the - BACTERIAL PAROTITIS
Parotid gland ramus of the mandible - Less common since the introduction of antibiotics, proper hydration, and
- is shaped roughly like an inverted pyramid, with three (or tour) sides better oral hygiene
- It has a base, apex, lateral (ant & post) surface - VIRAL PAROTITIS
- The parotid duct, has a long excretory duct, emerges from the anterior border of - Known as mumps
 - Causative virus is a paramyxovirus that infects different body parts,
notably the parotid glands
- Usually is spread through saliva, coughing, and sneezing

- Both parotid fistulas and sialoceles often occur as the result of trauma
- May also be caused by:
- Removal of parotid tumors, especially those of the accessory lobe
FISTULAS AND - Primary or secondary malignant tumors that ulcerate the skin
SIALOCELES - Incision and drainage for acute bacterial parotitis
- Ulceration and infection associated with large salivary calculi
- Congenital
- Infection

W10 B Temporomandibular Joint

Articulation - Occurs between the articular tubercle and the anterior portion of the mandibular
fossa of the temporal bone above and the head (condyloid process)
- Covered with fibrocartilage

LIGAMENTS - Lateral: runs downward and backward from the tubercle on the root of the
zygoma to the lateral surface of the neck of the mandible
- strengthens the lateral aspect of the capsule
- Sphenomandibular ligament: lies medial on the side of the joint, attached above
to the spine of the sphenoid bone and below to the ingula of the mandibular
foramen
- Represent the remains of the first pharyngeal arch in this region
- Stylomandibular ligament: lies behind and medial to the joint
- It is a mere band of thickened deep cervical fascia that extends from the
apex of the styloid process to the angle of the mandible

Articular disk - Divides the joint into upper and lover cavities
- An oval plate of fibrocartilage that is attached circumferentially to the capsule

W11-Pterygopaline fossa

Pterygopalatine - Pyramid-shaped fossa on the lateral aspect of the skull between the maxilla's
fossa infratemporal surface and the pterygoid process of the sphenoid
- Contains major nerves and blood vessels
- 7 foramina/fissures allow passage of nerves and vessels

Contents of the Pterygopalatine Fossa

NERVE 1. Maxillary division of the trigeminal
2. Posterior superior alveolar
3. Zygomati
4. Ganglionic branches
 Characterized by diminished pupillary light reflexes
5. Infraorbital
- These nerves of the maxillary division travel through the
● Trigeminal neuralgia
pterygopalatine ● Cavernous sinus syndrome
● Periorbital edema
PTERYGOPALATIN 1. Nasopalatine n ● Option 5
E GANGLION 2. Posterior superior nasal
● Ophthalmoplegia
3. Greater palatine
4. Lesser palatine
Postero-superior boundary of the parotid gland
5. Pharyngeal
● Sternocleidomastoid
● External acoustic meatus
● Mastoid process
QUIZ NAKARAAN ● Masseter muscle
A thin connective tissue layer of the scalp that separates the periosteum of the skull from the epicranial Travels posteriorly to enter the parotid gland and join the supercial temporal vein
aponeurosis.
● Transverse facial vein
● Skin ● Superficial temporal vein
● Periosteum ● Retromandibular vein
● Loose areolar connective tissue ● Maxillary vein
● Dense connective tissue
A condition that is caused by injury to the auriculotemporal nerve which includes sweating while eating and facial
Blood supply of the scalp that travels superiorly as a continuation of external carotid artery and supplies the frontal flushing
and temporal regions
● Frey's syndrome
● Superficial temporal artery ● Option 5
● Supraorbital artery ● Bell's palsy
● Posterior auricular artery ● Parotitis
● Supratrochlear artery ● Sialolithiasis
Small pyramidal muscle occupying the region of the glabella, found between the eyebrows Anterior wall of the infratemporal fossa
● Procerus ● Ramus and condylar process of mandible
● Corrugator supercili ● Greater wing of sphenoid
● Orbicularis oculi ● Tympanic plate, mastoid and styloid process of the temporal bone
● Occipitofrontalis ● Posterior and infratemporal surface of the maxilla
A branch of facial nerve that emerges from the anterior border of the lower part of the parotid gland into the neck Forms the muscular basis of the cheek, filling the interval between the maxilla and mandible
where it lies deep to the platysma and the investing layer of deep fascia
● Zygomaticus major
● Mandibular branch ● Levator labi superioris muscle
● Cervical branch ● Risorius
● Buccal branch ● Buccinator
● Marginal mandibular branch