Bones of Orbit
Frontal Maxilla Zygoma Ethmoid Sphenoid Lacrimal Palatine
Zygomatic Bone
Part of lateral wall and floor of orbit
Parts of temporal and infratemporal fossa
Articulates w/ maxilla (anteriorly), temporal bone (posteriorly) and frontal bone (superiorly)
Maxilla - Components, boundaries of, and fossae
Has body and four processes - zygomatic, frontal, alveolar and palatine
Boundaries of: roof of mouth (palate), floor and lateral wall of nose, floor of orbit
Two fossae: Infratemporal and pterygopalatine
Infratemporal Boundaries - Anterior, posterior, medial, lateral
Posterior maxilla
Temporal bone (articular tubercle) and spine of sphenoid
Lateral pterygoid plate (sphenoid)
Mandibular ramus
Infratemporal fossa Boundaries - Roof, floor
Greater wing of spehnoid (w/ foramen ovale)
Medial pterygoid muscle
Infratemporal Fossa Contents
Temporalis and pterygoid muscles
Maxillary artery and branches
Pterygoid plexus of veins
Mandibular nerve
Chorda Tympani
Otic ganglion (CN 9)
Pterygopalatine Fossa Boundaries - Anterior, posterior, medial, lateral, roof, floor
Maxilla
Pterygoid plates
Nasal Fossa
Infratemporal fossa
Greater wing of sphenoid (opens into IOF)
Pyramidal process of palatine bone
Pterygopalatine Fossa Contents
Pterygopalatine (3rd part) part of maxillary artery and branches
Maxillary Nerve
Nerve of pterygoid canal
Pterygopalatine ganglion and branches
Pterygopalatine Fossa - Lateral Communication
Passageway
Contents Passing
Space
Pterygomaxillary Fissure
Posterior Superior Alveolar NAV
Infratemporal fossa
Pterygopalatine Fossa - Anterosuperior Communication
Passageway
Contents Passing
Space
Inferior orbital fissure
CN V2
Orbit
Pterygopalatine Fossa - Posterosuperior Communication
Passageway
Contents Passing
Space
Foramen rotundum and pterygoid canal
CN V2; nerve of pterygoid canal (formed by deep and greater petrosal nerves)
Middle cranial fossa
Pterygopalatine Fossa - Medial Communication
Passageway
Contents Passing
Space
Sphenopalatine foramen
Sphenopalatine artery and vein, nasopalatine nerve
Nasal cavity
Pterygopalatine Fossa - Inferior Communication
Passageway
Contents Passing
Space
Palatine canals
Greater and lesser palatine NAVs
Oral cavity
Nasal Septum Bones
Vertical plate of ethmoid
Vomer
Nasal crest of maxilla and palatine bones
Nasal crest of sphenoid bone
Septal cartilage
Kisselbach’s Plexus - 5 arteries anastomosis
Sphenopalatine artery (maxillary a) Greater palatine artery (maxillary a) Superior labial artery (facial a) Anterior ethmoid artery (opthalmic a) Lateral nasal branches from facial a
Nasolacrimal Apparatus Drainage
Inferior meatus
Frontal Sinuses Drainage
Hiatus semilunaris (middle meatus)
Maxillary sinuses Drainage
Middle meatus - ostium (within hiatus semilunaris)
Ethmoid sinuses Drainage
Anterior
Middle
Posterior
Hiatus semilunaris
Ethmoidal bullae
Superior meatus
Sphenoid sinus drainage
Sphenoethmoidal recess of nasal cavity
Epidural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Middle meningeal artery
Bridging vein
Ruptured aneurysm (ex: anterior communicating a)
Falx Cerebri (vertical)
Vertical/midline
Seperates cerebral hemispheres
Forms superior/inferior sagittal sinuses
Falx cerebelli (vertical)
Separates cerebellar hemispheres
Contains occipital sinus
Tentorium Cerebelli (Horizontal)
Separates occipital lobe from cerebellum
Contains straight, transverse and superior petrosal sinuses
Diaphragma sella (Horizontal)
Roof of sella turicica
Small hole = passage for pituitary stalk
Cavernus Sinus Anterior
Connections
Contents
Description
Superior/inferior opthalmic veins, pterygoid plexus of veins.
Lateral wall: CN 3, 4, V1, V2
Route of infection to brain
Cavernus Sinus Posterior
Connections
Contents
Description
Superior/inferior petrosal sinus, intercavernous sinus
CN 6 and ICA (running through cavernous sinus)
Cavernus sinus thrombosis
Venticles - Nearby Anatomical Structures
Lateral Ventricle
Lateral Ventricle (Inferior Horn)
Third Venticle
Floor of fourth ventricle
Caudate nucleus
Hippocampus
Hypothalamaus
Pons
CSF Circulation Pathway
Lateral Ventricles -> Foramen of Monro -> Third ventricle -> Cerebral aqueduct -> Fourth ventricle -> Foramina of Magendie (Medial) and Luschka (Lateral) -> Bathes subarachnoid space -> Arachnoid granulations of superior sagittal sinus -> Venous circulation
Anterior 2/3rd of tongue Taste
Nerve
Pathway
Brain Stem nucleus
Thalamic Nucleus
CN 7 - Chorda tympani (travels via lingual nerve to geniculate ganglion)
Solitary Tract
Nucleus of solitary tract (gustatory nucleus)
VPM
Posterior 1/3rd of tongue taste
Nerve
Pathway
Brain Stem nucleus
Thalamic Nucleus
CN 9
Solitary Tract
Nucleus of solitary tract (gustatory nucleus)
VPM
Epiglottis taste
Nerve
Pathway
Brain Stem nucleus
Thalamic Nucleus
CN 10
Solitary Tract
Nucleus of Solitary Tract (gustatory nucleus)
VPM
Lymph Drainage of Tongue
Posterior
Lateral
Middle Anterior
Lateral Anterior/Tip
Superior Deep Cervical
Submandibular
Contralateral Inferior Deep Cervical
Ipsilateral Submental/Contralateral Submental
Genioglossus Action and Innervation
Protrudes tongue
CN 12
Hyoglossus Innervation and Action
Depress tongue, pull down sides (retracts)
CN 12
Styloglossus innervation and action
Pull tongue up and back
CN 12
Palatoglossus innervation and action
Pull tongue up and back toward palate
CN 10 (pharyngeal plexus)
Longitudinal Superior/Inferior tongue muscle
Shorten tongue (both)
Make dorsum concave (superior)
Make dorsum convex (inferior)
Transversus tongue muscle
Narrows and elongates tongue
Verticalis tongue muscle
Flattens and broadens the tongue
Medial to Hyoglossus
Lingual Artery
Lateral to hyoglossus
Lingual vein and nerve
Submandibular Duct
Hypoglossal Nerve
Lymph, Sinuses, Crypts:
Pharyngeal Tonsils
Palatine Tonsils
Lingual Tonsils
No lymph, sinuses, crypts
Contain crypts and lymphoid follicles (no sinuses)
Lymphoid follicle each w/ single crypt
Superior Pharyngeal Constrictor
Pterygomandibular raphe - Midline pharyngeal raphe
Contract in waves to propel food
Sensory = CN 10 Motor = CN 11 via 10
Middle Pharyngeal Constrictor
Hyoid bone - Midline pharyngeal raphe
Contract in waves to propel food
Sensory = CN 10 Motor = CN 11 via 10
Inferior Pharyngeal Constictor
Thyroid/cricoid cartilage - Midline pharyngeal raphe
Contract in waves
Sensory = CN 10 Motr = CN 11 via 10
Cricopharyngeus Constrictor
Lower fibers of inferior constrictor - midline raphe
Constant contraction (serves as UES)
Sensory = CN 10 Motor = CN 11 via 10
Palatopharyngeus muscle
Palatal aponeurosis - posterolateral pharync
Raise pharynx and larynx during swalling
CN 11 (via 10, pharyngeal plexus)
Salpingopharyngeus
Catilage of eustachian tube - palatopharyngeus muscle
Elevate nasopharynx, open auditory tube, equalize pressure
CN 11 via 10 (pharyngeal plexus)
Stylopharyngeus
Styloid process - passes between superior/middle constrictors and blends w/ palatopharyngeus
Raise pharynx/larynx during swallowing
CN 9
Lymphatic Drainage of Parotid Gland
Parotid gland -> parotid nodes -> superior deep cervical lymph nodes
Lymphatic drainage of Submandibular/sublingual glands
Submandibular and sublingual glands -> submandibular and deep cervical nodes
Parotid Gland
Secretion
Duct
Innervation
Blood Supply
Serous
Stenson’s duct (at level of Max 2nd molars)
Pregang: Lesser petrosal (CN 9)
Synapse: Otic Ganglion
Postgang: Travels w/ auriculotemporal
Blood Supply: Branches of superficial temporal and transverse facial
Submandibular Gland
Secretion
Duct
Innervation
Blood Supply
Serous and Mucous
Wharton’s duct, crosses lingual nerve (near sublingual gland), empties at sublingual caruncle/papilla
Pregang: Chorda tympani
Synapse: Submandiblar ganglion
Postgang: Leaves ganglion to gland
Glandular branches of facial artery
Sublingual Gland
Secretion
Duct
Innervation
Blood Supply
Mucous
Sublingual (Rivian) ducts at sublingual folds, anterior ducts open medially into submandibular duct (bartholin’s)
Pregang: Chorda tympani
Synapse: Submandibular ganglion
Postgang: to gland
Glandular branches of lingual artery (sublingual A)
Minor Salivary Glands
Labial/Buccal -> mucous only
von Ebner’s glands -> at base of circumvallate, serous only
Glands of Blandin-nuhn/Anterior lingual glands -> mixed serous-mucous
Parotid Space Contents
Parotid Gland
Facial Nerve
External Carotid Artery
Retromandibular Vein
Submandibular Space Contents
Submandibular Gland Lymph Node Hypoglossal Nerve Nerve to mylohyoid Facial Artery
Sublingual Space Contents
Sublingual gland
Deep submandibular gland and duct
Lingual artery
Hypoglossal Nerve
Tonsillar Space Contents
Palatine tonsil
Glossopharyngeal nerve
Tonsillar and ascending palatine branches of facial artery
Masticator Space Contents
Mandibular ramus and TMJ Muscles of mastication Mandibular Nerve Maxillary Artery Pterygoid plexus of veins Chorda tympani nerve
Parapharyngeal Space Contents
Carotid Sheath
Deep Cervical chain of lymph nodes
Masseter
Origin
Insertion
Action
Superficial = Zygomatic process of maxilla and anterior 2/3 zygomatic arch… Deep = zygomatic arch (inner post 1/3)
Superficial = angle of mandible, Deep = lateral ramus
Elevation, retrustion (deep and post fibers), ipsilateral excursion
Temporalis
Origin
Insertion
Action
Origin = lower temporal line, temporal fossa, temporal fascia
Medial coronoid, anterior ramus
Elevation (anterior/superior fibers), retrusion (posterior), ipsilateral excursion
Medial pterygoid
Origin
Insertion
Action
Medial side of lateral pterygoid plate
Medial side of mandibular angle
Elevation, protrusion, contralateral excursion
Lateral Pterygoid
Origin
Insertion
Action
Superior: greater wing of sphenoid, inferior: lateral side of lateral pterygoid plate
Superior: articular capsule and disc, inferior: anterior condylar neck
Protrusion, depression, contralateral excursion
Temperomandibular Ligament (Lateral Ligament) Parts and Functions
Outer oblique portion: prevents posterior and inferior displacement
Inner horizontal portion: prevents lateral or mesial displacement
Main ligament
Sphenomandibular Ligament
Remnant of Meckel’s Cartilage
Connects spine of sphenoid w/ lingula of mandible
Stylomandibular ligament
Connects styloid process to mandibular angle
Superficial Cervical Fascia (Subcutaneous Tissue) Contents
Cutaneous nerves, blood and lymphatic vessels, fat, platysma
Layers of Deep Cervical Fascia (Muscular fascia)
Investing, Pretracheal, Prevertebral
Investing Fascia Contents
Sternocleidomastoid and trapezius muscles and submandibular and parotid glands
Pretracheal Fascia Contents
Thyroid gland, larynx, pharynx and esophagus
Continuous with buccophayngeal fascia
Prevertebral Fascia Contents
Vertebrae and deep cervical muscles
Carotid Sheath Contents
CCA
IJV
CN 10
Associated with: Lymph noedes, carotid sinus nerve, sympathetic nerves
Retropharyngeal Space
Between pharynx (buccopharyngeal fascia) and prevertebral fascia
Communicates w/ mediastinum (infection spread, ludwig’s angina)
Posterior Triangle Boundaries
Anterior Posterior Inferior Floor Roof
SCM (post border)
Trapezius (anter border)
Clavicle (middle 1/3rd)
Splenius Capitus, levator scapulae, scalene muscles
Skin, superficial fascia, platysma, deep investing fascia of neck
Posterior triangle Contents
EJV Cervical plexus Lesser occipital nerve Great auricular nerve CN 11 Phrenic nerve Subclavian vein/artery Brachial Plexus
Anterior Triangle Boundaries
Anterior Posterior Superior Floor Roof
Neck Midline
SCM (Anterior Border)
Inferior border of mandible
Pharynx, larynx, thyroid
Skin, superficial fascia, platysma, deep investing fascia
Anterior Triangle Contents
Infrahyoid/suprahyoid muscles CCA, ICA IJV/EJV Retromandibular vein CN 10, 11, 12, cervical plexus
Submandibular Triangle (Subset of Anterior Triangle) Boundaries
Inferior
Superior
Floor
Roof
Bellies of digastric
Inferior border of mandible
Mylohyoid, Hyoglossus
Skin, superficial fascia, platysma, deep fascia
Submandibular Triangle Contents (2 glands/nodes, 2 nerves, 2 arteries, 2 veins)
Submandibular gland Submandibular lymph nodes Hypoglossal nerve Mylohyoid nerve Lingual and facial arteries and veins
Infrahyoid muscle innervation
Ansa cervicalis = sternohyoid, sternothyroid, omohyoid
C1 via CN 12 = Thyrohyoid (also geniohyoid)
Muscular Triangle Boundaries and Contents
Superior Belly of omohyoid, SCM, midline of neck
Infrahyoid strap muscles
Carotid Triangle Boundaries and Contents
Superior belly of omohyoid, posterior belly of digastric, SCM
CCA, IJV, CN 10, 11, 12, cervical plexus
Submental Triangle Boundaries and Contents
Right and left anterior bellies of digastric, body of hyoid
Mylohyoid muscle (midline raphe)
SCM Action and Innervation
Bilateral = Flexes neck
Unilateral = pulls head to shoulder, turns head to opposite side
CN 11
Trapezius Action and Innervation
Bilateral = Extends head
Unilateral = Chin up to opposite side,, elevate acromion (rotates, elevates scapula and clavicle)
CN 11
Digastric Anterior
Origin
Insertion
Innervation
Intermediate tendon
Anterior mandible (digastric fossa)
CN V3 - Nerve to mylohyoid
Digastric Posterior
Origin
Insertion
Innervation
Temporal bone (digastric notch)
Intermediate tendon
CN 7
Mylohyoid
Origin
Insertion
Innervation
Medial mandible (mylohyoid line)
Median raphe/body of hyoid
CN V3 - Nerve to mylohyoid
Geniohyoid
Origin
Insertion
Innervation
Genial tubercles (mandible)
Body of hyoid
C1 Fibers via CN 12
Stylohyoid
Origin
Insertion
Innervation
Styloid Process
Hyoid (greater horn)
CN 7
Omohyoid
Origin
Insertion
Innervation
Superior Belly: Intermediate tendon, Inferior Belly: Superior Scapula
Superior belly: Hyoid (body), Inferior Belly: Intermediate tendon
Ansa Cervicalis
Sternohyoid
Origin
Insertion
Innervation
Manubrium of sternum
Hyoid (lower surface)
Ansa cervicalis
Sternothyroid
Origin
Insertion
Innervation
Manubrium of Sternum
Thyroid Cartilage (oblique line)
Ansa cervicalis
Thyrohyoid
Thyroid Cartilage (Oblique line)
Hyoid (body and greater horn)
C1 fibers Via CN 12
Branches of ECA
Some anatomist like football, others prefer soccer matches
Superior Thyroid Ascending Palatine Lingual Facial Occipital Posterior Auricular Sperficial temporal Maxillary
Cervical Branches of Facial Artery
Tonsillar
Ascending Palatine
Glandular
Submental
Facial Branches of Facial Artery
Inferior Labial
Superior Labial
Lateral Nasal
Angular
Mandibular Portion of Maxillary Artery
Deep Auricular Anterior Tympanic Middle Meningeal Accessory Meningeal Inferior Alveolar
Pterygoid Portion of Maxillary Artery
Anterior and posterior deep temporal
Pterygoid
Masseteric
Buccal
Pterygopalatine Portion of Maxillary Artery
Posteriosuperior Alveolar Infraorbital - becomes ASA Descending Palatine Artery of Pterygoid Canal Pharyngeal Sphenopalatine
External Jugular Vein Receives what veins
Posterior auricular and Posterior retromandibular formEJV
Superficial temporal Vein receives what, merges with what and splits into what?
Receives = Pterygoid Plexus of veins, retromandibular vein
Merges w/ = Maxillary vein = retromandibular vein
Splits into: Anterior/posterior retromandibular vein
IJV receives what and what does this vein receive?
IJV receives = Common facial vein
Common Facial Vein Receives = Anterior facial vein and anterior retromandibular vein (from superficial temporal vein)
Superficial Ring of Nodes
Occipital Mastoid Parotid Submanibular Submental
Deep nodes
Retropharyngeal
Deep cervical Lymph nodes
Jugulodigastric node
Juguloomohyoid node
Lymph Drainage sequence
Occipital and mastoid -> Retropharyngeal -> Jugulodigastric
Parotid, submandibular to jugulodigastric
Jugulodigastric to jugulo-omohoyoid
Submental Lymph Node caveat
Submental drains to submandibular (which then goes to jugulodigastric then to jugulo-ommohyoid) or it drains directly to jugulo-omohyoid
