Ebook Clinical atlas of head and neck anatomy: Part 1

A Colour Atlas of

FleadandNeck
Anatomy
R.M.H. McMinn

Sir William Collins Professor
of Human and ComparativeAnatomy

R.T. Hutchings

Chief Medical Laboratoff ScientificOfficer

B.M. Logan
v

Prosector

Departmentof Anatomy
Insiitute of BasicMedicil Sciences
Royal Collegeof Surgeonsof England

Wolfe Medical PublicationsLtd


Preface
The receptiongiven to 'A Colour Atlas of Human Anatomy', which
dealt with the whole body, hasencouragedusto producea companion
volume dealingspecfficallywith the head and neck, in order to meet
the anatomicalneedsof thosewho areconcernedparticularlywith this

region of the body. This book is not a reprint of relevantheadandneck
sectionsof the earlier atlas; it is a iompletely new work, with new
specimensand new illustrations.The sameformat hasbeenretained,
namely natural size colour photographswith identification numbers
overlying individual structuresand an adjacentkey, asthis hasproved
andpostgraduates.
to be universallypopularwith both undergraduates
This systemallowsstudentsto testtheir own knowledgeby coveringup
the key. The notes that accompanythe identfficationkeys help to
emphasisecertain important points, but there hasbeenno attemptto
give a complete commentaryon everythingillustrated.The book is
essentiallyan atlasdesignedto complementexistingtexts, dissecting
manualsand other atlases,not to replacethem.
We hope that our contributionwill assistin the understandingof an
intricate but fascinatingpart of the body, and that the quality of
presentation will make even study for examinations a pleasurable
expenence.
R.M.H. McMinn
R.T. Hutchings
B.M. Logan


Contents
The skull page l0
From the front L0
From the front. Muscle attachments1,2
From the left L4
From the left. Muscle attachmentsL6
From behind 18
The cranial vault 20

External surfaceof the base22
External surfaceof the base.Muscle
attachments24
The infratemporalregion. Permanent
dentition 26
Internal surfaceof the base.Anterior,
middle and posteriorcranialfossae28
Median sagittalsectionwith the bony
nasalseptum30
The orbit and nasal cavity 32

Skull bonearticulations54
The facial skeleton.The orbital and
anterior nasal apertures54
The orbit. The roof and lateral wall 56
The orbit. The floor and medial wall58
The nose.The roof, floor and lateral
wall 60
The nose.The maxillaryhiatusand
nasolacrimalcanal62
The baseof the skull. The anterior
cranial fossa64
The baseof the skull. The middle and
posteriorcranialfossae66
The baseof the skull. The external
surface68
The pterygopalatinefossa70
The posteriornasalapertweT2

Bonesof the skull 34

The mandible34
The mandible. Muscle attachments36
The frontal bone 38
The ethmoid bone 40
The sphenoidbone and the vomer42
The occipitalbone 44
The maxilla and the nasaland lacrimal
bones46
The palatine bone and the inferior
concha48
The temporal bone 50
The parietal and zygomaticbones52

The fetal skull T4
Vertebrae 76
The atlas76
The axis 78
Other cervical vertebrae80
Articulated vertebrae, the intervertebral
foramen and the first thoracic
vertebra 82
Other bones 84
The first rib and manubrium of the
sternum and attachments84
The clavicle and scapula86
The clavicle and scapulaand attachments,
and the thoracic inlet 88


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Superfrcialdlrsection II. The len
and related
sternocleidops-stoid
strucrures9-[
SuperficialdissectionIII. The left
anterior triangle96
Superficialdissection[V. The left
posteriortriangle98
and
Deep dissectionI. The greatvessels
nervesof the left side100
and
Deep dissectionII. The greatvessels
102
gland
the thyroid
Deep dissectionIII. The thyroid gland
and the root of the neck 1,04
Deep dissectionIV. The thyroidgland,
root of the neck, thoracicduct, right
lymphaticduct and the thymus106

Deep dissectionV. The prevertebral
muscles108
The faceL1O
Surfacemarkings.Surfacemarkingsof
the left side110
Superficialdissection.The right parotid
gland, facial nerveand facial
muscles112
Deep dissectionI. The right temporalis
and massetermusclesand the
joint 114
temporomandibular
Deep dissectionII. The right
infratemporalfossa,pterygoidmuscles
joint 116
and temporomandibular
The orbit 118
The eye, orbicularisoculi and the
nasolacrimalduct LL8
Superficialdissection.The orbital
periosteumand orbital contentsfrom
above120
Deep dissectionI. The ciliary ganglion
and dissectionfrom thefrontl22
Deep dissectionII. Transverseand
sagittalsections,the lacrimalglandand
theeyeI24

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e*rmr-ri,iai >inr.r-The pxarana:aisinu:es.The sphenoidal
and ma-rillan sinu-.es1-11
Transr erseand coronal sectionsand
nen-esof the nasalsePtumlil
The mouth, palateand Pharynx 136
The mouth, palate,pharynxand larynxin
sasittalsection136
Theiongue and the floor of the mouth138
The roof and floor of the mouth and the
salivaryglands140
The insideof the mouth and the hard and
soft palatesL42
The pharynx- externaland internal
surfaces144
The pharynxfrom behind 146
The ear 148
The external,middle and internalear 148

Horizontal sections,and the auditory
ossicles150
The larynx L52
of the
The hyoid bone,and the cartilages
larynxl52
The larynx with the pharynx, hyoid bone
and tracheal,54
The muscles,ligamentsandmembranes
156
The cranial cavity L58
The cranial cavity, brain and meninges
158
The cranialcavity and its coverings160
The brain in situ 162
The falx cerebriand tentoriumcerebelli
I64
The falx, tentorium and cavernoussinus

r66

The cranialfossae168


The brain 170
The brain with the meningesL70
The cerebral hemispheresand cerebellum
172
The externalcerebralveinsL74
The cerebral hemisPherc176

The middle cerebralartery on the lateral
surfaceof the cerebralhemisphere178
A median sagittalsection180
The medial surfaceof the cerebral
hemisphereand the anteriorand
posterlor cerebral arteries1-82
The baseof the brain l'84
The baseof the brain and the arterial
circle 1,86
The brainstem, cranial nervesand
geniculatebodiesL88
The third ventricle and the lateral
ventricles190
The internal capsuleand basalnuclei in
horizontal sectionsof the cerebral
hemispheresl92
The cerebralhemispheresand brainstem
in coronalsection194
The cerebellumand brainstem196

The brain and spinal cord L98
The cerebellum, brainstemand fourth
ventricle, and the sPinalcord 198
The suboccipitaltriangle, vertebral
column and spinal cord, and
intervertebral foramina 200
Radiographsofhead and neck202
The cervical vertebral column 202
The upper part of an arch aortogram204
The head, postero-anteriorand

occipitomental views206
The head. lateral view 208
Carotid arteriograms2|0
Vertebral arteriograms 212
Appendix 2L4
Referenceliststo:
Muscles2L4
Nerves2L6
Lymphatic system2\8
Arteries 219
Yeins222
Skull foraminaZ23
lndex226


The Skull


THE SKULL
From the front
I Frontal bone
2 Glabella
3 Nasion
4 Superciliaryarch
5 Frontal notch
6 Supra-orbitalforamen
7 Lesserwing of sphenoidbone
8 Superiororbital fissure
9 Greater wing of sphenoidbone
l0 Zygomatic bone

11 Inferior orbital fissure
12 Infra-orbital foramen
13 Maxilla
14 Ramus
15 Body
of mandible
16 Mental foramen
17 Mental protuberance
18 Anterior nasalspine
19 Nasal septum
20 Inferior nasalconcha
21 Mastoid process
22 Zy gomaticomaxillarysuture
23 Infra-orbitalmargin
24 Marginal tubercle
25 Frontozygomaticsuture
26 Supra-orbitalmargin
27 Orbital part of frontal bone
28 Optic canal
29 Posteriorlacrimalcrest
30 Fossafor lacrimalsac
31 Anterior lacrimalcrest
32 Frontal processof maxilla
33 Nasalbone
34 Frontonasalsuture
35 Frontomaxillarysuture

O The term skull includes the mandible; the cranium is the
skull without the mandible. but these definitions are not
always strictly observed.

O The calvaria (a term not often used) is the upper part of
the skull that enclosesthe brain (i.e. the cranial cavity) and
has a roof or skull cap, and a floor known as the base of the
skull.
O

The anterior part ofthe skull forms the facial skeleton.

O

T h e c a v i t i e so f t h e s k u l l :
Cranial cavity, containing the brain and its membranes.
Nasal cavity, divided by the midline nasal septum into right
and left halves.
Orbits or orbital cavities. rieht and left. in which the
eyeballs are lodged.

O

Thebonesoftheskull:
Unpaired
Frontal
Ethmoid
Sphenoid
Vomer
Occipital
Mandible

O

Paired
Maxilla
Nasal
Lacrimal
Inferior nasal concha
Palatine
Zygomatic
Temporal
Parietal

Importantlandmarkson the outsideof the skull include:
the orbits
the anterior nasalaperture(piriform aperture)
the zygomaticarch
ptenon
the externalacousticmeatus
the hard palate
the posteriornasalapertures(choanae)
the foramenmagnum
the mastoidprocess
the styloidprocess

11



isp sxulr,
'From the front. Muscle attachments
I Corrugator supercilii
2 Orbicularis oculi

3 Medial palpebralligament
4 Procerus
5 Levator labii superiorisalaequenasi
6 Levator labii superioris
7 Zygomaticusminor
8 Zygomaticusmajor
9 Levator anguli oris
10 Nasalis(transversepart)
ll Nasalis(alar part)
12 Depressorsepti
13 Buccinator
14 Depressorlabii inferioris
l5 Depressoranguli oris
l6 Platysma
17 Mentalis
18 Masseter
19 Temporalis

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O The supra-orbital, infra-orbital and mental foramina lie
approximately in the same vertical plane.
O The infra-orbital foramen is 0J cm below the infra-orbital

margin, immediately below the pupil (with the eye looking
forwards) and in the long axis ofthe second premolar tooth.
O The attachment of levator labii superioris is above the
infra-orbital foramen, and the attachment of levator anguli
oris below the foramen.
a
The mental foramen lies below and between the apicesof
the two premolar teeth.
O The attachment of depressor labii inferioris lies in Jront of
the mental fbramen and the attachment of depressor anguli
oris below the foramen.

13



THE SKULL
From the left
I
2
3
4
5
6
7
8
9
10
11
12

13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42

43

Frontal bone
Coronal suture
Parietalbone
SuPerior
line
) temporal
lnrenor )
Squamosalsuture
Lambdoid suture
Occipital bone
External occipitalprotuberance
Occipitomastoidsuture
Parietomastoidsuture
Asterion
Mastoid process
Tympanic part of temporalbone
Suprameataltriangle
External acousticmeatus
Sheathof styloid process
Styloid process
Zygomatic arch
Squamouspart of temporalbone
Pterion
suture
Sphenosquamosal
Greater wing of sphenoidbone
Sphenofrontalsuture
Frontozygomaticsuture

Zygomatic bone
Zy gomaticofacialforamen
Coronoid process
Condylar process
Ramus
of mandible
Body
Mental foramen
Mental protuberance
Maxilla
Anterior nasalspine
Frontal processof maxilla
Nasal bone
Anterior lacrimalcrest
Fossafor lacrimalsac
Posteriorlacrimalcrest
Lacrimal bone
Orbital part of ethmoid bone
Nasion

O

Someanatomicalpoints of the skull:

Nasion: the point of articulation betweenthe two nasalbones
and the frontal bone.
Inion: the central point of the externaloccipitalprotuberance
(which is nol the most posterior part of the occipitalbone).
Bregma:at the junctionof the sagittalandcoronalsutures(i.e.
betweenthe frontal and the two parietal bones).In the

newborn skull the anterior fontanelleis in this region.
Lambda: at the junction of the sagittaland lambdoidsutures
(i.e. betweenthe occipitaland the two parietalbones).In the
newborn skull the posterior fontanelleis in this region.
Fterion: an H-shapedarea (not a singlepoint) where the
frontal, parietal,squamouspart of the temporaland greater
wing of the sphenoidbonesarticulate.It is an important
landmark on the sideof the skull asit overliesthe anterior
branchof the middlemeningealartery.In the newbornskull
the sphenoidalfontanelleis in this region.
and
Asterion:at the junction of the lambdoid,parietomastoid
occipitomastoidsutures(i.e. betweenthe occipital,parietal
and temporalbones).In the newbornskullthe mastoid
fontanelleis in this region.



THE SKULL
From the left. Muscle attachments
1 Corrugator supercilii
2 Orbicularisoculi (orbital and palpebralparts)
3 Orbicularisoculi (lacrimalpart)
4 Medial palpebralligament
5 Procerus
6 Levator labii superiorisalaequenasi
7 Levator labii superioris
8 Nasalis(transversepart)
9 Nasalis(alar part)
10 Depressorsepti

11 Levator anguli oris
12 Buccinator
13 Mentalis
l4 Depressorlabii inferioris
15 Depressorangulioris
16 Platysma
17 Masseter
l8 Temporalis
19 Zygomaticusmajor
20 Zygomaticusminor
2l Sternocleidomastoid
22 Occipital belly of occipitofrontalis
O The buccinator has a bony attachment to the upper and
lower jaws opposite the three molar teeth.
O The medial palpebral ligament and the orbital and
palpebral parts of orbicularis oculi are attached to the znterior
lacrimal crest; the lacrimal part of orbicularis oculi is attached
to Lheposterior lacrimal crest.

17



THE SKULL
A From behind
B From behind, with sutural bones
I
)
3
4

Sagittalsuture
Parietalforamen
Lambda
Lambdoid suture
5 Parietalbone
6 Parietaltuberosity
7 Temporal bone
8 Mastoid process
9 Squamouspart of occipitalbone
10 External occipitalprotuberance(inion)
1 l Supremel
t2 Superior I nuchalline
13 Inferior J
t4 Body 1
l5 Angle I of mandible
1 6 Ramus
t 7 Occipitomastoid
suture
r8 Parietomastoiflsuture
l9 Suturalbones

O Suturalbonesarisefrom separatecentresofossification
that may occurwithin cranialsutures.They arecommonestin
the lambdoidsutureand haveno significance.
a In this skull therehasbeenbonyfusionin somesutural
areas.
O The vertexof the skull is the highestpoint; it is on the
sagittalsuturea few centimetresbehindbregma(seepage20)
O The occiputis the mostposteriorpart of the skull;it is on

abovethe
the midline of the occipitalbonea few centimetres
externaloccipitalprotuberance.

19


./
18


THE SKULL
The cranial vault
A External surface (left half)
B Internal surface (left half)
1 Occipital bone
2 Lambda
3 Lambdoid suture
4 Parietal foramen
5 Sagittalsuture
6 Parietal bone
7 Parietal tuberosity
8 Coronal suture
9 Frontal bone
10 Bregma
11 Out'ertable I
12 Diplod
I of parietalbone
13 Inner table )
14 Groove for superiorsagittalsinus

15 Grooves for middle meningealvessels
16 Frontal crest
17 Frontal sinus
18 Depressionsfor arachnoidgranulations


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THE SKULL
The external surfaceof the base
A From below*
B From belorfarfd betrind

I Incisivefossa
, Palatineprocessof maxilla
3 Median palatinesuture
4 Palatinegroovesand spines
r Transversepalatinesuture
6 Horizontal plate of palatinebone
7 Greater oalatineforamen
8 Lesserpalatineforamina
9 Tuberosityof maxilla
l0 Pvramidalprocessof palatinebone
t l Pterygoidhamulus

t2 Medial pterygoidplate
. .-i*:,.'.'4)'s,.,n1;*413 Scaphoidfoisa
l4 Lateralpterygoidplate
15 Infratemporalcrest
t6 Zygomatic arch
t7 Articular tubercle
18 Mandibular fossa
t9 External acousticmeatus
20 Tympanicpart of temporalbone
2 l Styloidprocess
,) Stylomastoidforamen
23 Mastoid Drocess
24 Mastoid notch
)< Occipital groove
26 Mastoid foramen(doubleon left)
27 Superiornuchalline
28 External occipitalprotuberance
29 Inferior nuchalline
30 External occipitalcrest

31 Foramenmagnum
32 Condylarcanal
33 Occipitalcondyle

O 1
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I

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37 Sheathof styloidprocess

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fissure
38 petrotympanic
fissure
39 Squamotympanic
40
41
42
lir.il,'r-i 43
44
45
46
47

Tegmentympani
fissure
Petrosquamous
Spineof sphenoidbone

Foramenspinosum
Foramenovale
Apex of petrouspart of temporalbone
Foramenlacerum
Pharyngealtubercle

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13V:il:l"vaginal

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53 Infratemporalsurface
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54 Zygomatlc process
suture
55 Zy gomaticomaxillary

56 Zygomaticotemporalforamen
57
58

59
60

Inferior orbital hss,rre
Inferior I
Middle l nasalconcha
Superior

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THE SKULL
The external surfaceof the base.
Muscle attachments

O Principal skull foramina and their contents:
(for more precisedetails seepages223-225)

I Musculus uvulae
2 Palatopharyngeus
3 Superior constrictor of pharynx
4 Medial pterygoid(deephead)
5 Medial pterygoid (superficialhead)
6 Lateral pterygoid (upper head)

7 Masseter
8 Styloglossus
9 Stylohyoid
l0 Stylopharyngeus
11 Pharyngealraphe
12 Longus capitus
13 Rectuscapitisanterior
14 Rectus capitis lateralis
15 Posteriorbelly of digastric
16 Longissimuscapitis
17 Spleniuscapitis
18 Sternocleidomastoid
19 Occipital belly of occipitofrontalis
20 Trapezius
21 Semispinaliscapitis
22 Superioroblique
23 Rectuscapitisposteriorminor
24 Rectuscapitisposteriormajor

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Supra-orbitalforamen
Supra-orbital nerye and vessels
Infra-orbital foramen
Infra-orbital nerve and vessels
Mental foramen
Mental nerve and vessels

Mandibular foramen
Inferior alveolar nerve and vessels
Optic canal
Optic nerve
Ophthalmicartery
Superior orbital fissure
Ophthalmicnerveand veins
Oculomotor, trochlear and abducentnerves
I nfer io r or bit al fu sur e
Maxillary nerve
Sp henop alatinefo ramen
Sphenopalatineartery
ganglion
Nasalbranchesof pterygopalatine
Foramen rotundum
Maxillary nerve
Foramen ovale
Mandibularand lesserpetrosalnerves
Foramenspinosum
Middle meningealvessels
Foramen lacerum
Internalcarotidartery (enteringfrom behindand emerging
abovt)
Greater petrosalnerve (enteringfrom behindand leaving
anteriorlyas the nerveof the pterygoidcanal)
Carotid canal
Internal carotidartgry and nerve
Jugular foramen
Inferior petrosalsinus
nerves

vagusand accessory
Glossopharyngeal,
Internal jugular vein (emergingbelow)
Internal acowtic meatus
nerves
Facialand vestibulocochlear

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Vertebral and anteriorand

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spinalarteries

25


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26

THE SKULL
{ The right infratemporal region, obliquely from
below
I Zygomatic arch
2 Lateral pterygoid plate
3 Sphenopalatineforamen
{ Pterygomaxillaryfissure
5 Infratemporalsurfaceof maxilla
6 Tuberosityof maxilla
7 Pyramidalprocessof palatinebone
8 Pterygoidhamulus
9 Medial pterygoidplate
10 Pharyngealtubercle
ll Foramenovale
12 Spineofsphenoidbone
13 Articular tubercle
14 Mandibular fossa
15 Squamotympanicfissure
16 Tympanic part of temporalbone
17 External acousticmeatus
18 Sheathof styloid process
19 Styloid process
20 Occipital condyle
2l Mastoid process
22 T ympanomastoidfissure

B Permanentdentition. The teethof the upper and
lower jaws in the adult, from the right and

in front
I
2
3
4
5
6
7
8

Central
incisor
Lateral )
Canine
First
premolar
Second
First
molar
Second
Third

O The corresponding teeth of the upper and lower jaws have
corresponding names. In clinical dentistry the teeth are often
identified by the numbers 1 to 8 as listed here, rather than by
'right
upper 6' refers to the right upper first molar
name. Thus,
tooth.
a

The third molar tooth is sometimes called the wisdom
tooth.
O In the deciduous dentition of the child ('milk teeth'),
there are central and lateral incisors and canines in
corresponding positions to the permanent teeth of the same
name, and first and second deciduous molars in the positions
of the permanentpremolars.

27


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37