01 Head and Neck JM
01 Head and Neck JM
01 Head and Neck JM
SKIN
Thin epidermal layers and a thick dermis (thickest a occipital area)
With hair follicles and sebaceous glands
Arterial Supply
1. Supratrochlear artery Branch of the ophthalmic artery
2. Supraorbital artery Ascend over forehead in the median plane
Smaller terminal branch of the external carotid artery
3. Superficial temporal
Divides into anterior and posterior branches
artery
Supplies over frontal and temporal regions
4. Posterior auricular Branches of the external carotid artery
artery Supplies skin behind the auricle and back of the scalp
5. Occipital artery
*Branches of the ECA Superficial temporal artery, Posterior auricular artery, occipital artery
Venous Drainage
1. Supratrochlear vein Unites at medial orbit margin
2. Supraorbital vein Forms facial vein
Unites with maxillary vein in parotid gland substance
3. Superficial temporal
forms retromandibular vein
vein
4. Posterior auricular Unites with posterior division of the retromandibular vein
*Supratrochlear + Supraorbital forms facial vein
vein - forms external jugular vein
*Superficial temporal + maxillary vein forms RMV
5. Occipital vein
Drains into suboccipital venous plexus into the internal jugular
vein
*Posterior auricular + RMV forms external jugular
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
SKULL
BASE OF THE SKULL
Cranium components Facial bone components Anterior Cranial Fossa Middle Cranial Fossa Posterior Cranial Fossa
(Neurocranium) (viscerocranium) Lodges frontal loves of Lodges temporal lobe of the Lodges cerebellum, pons,
8 bones: 14 bones: cerebral hemispheres cerebrum, auditory cortex, and medulla oblongata
Frontal: 1 Vomer: 1 and vestibular pathways
Occipital: 1 Mandible: 1 Anterior: inner surface of frontal Anterior: petrous part of the
Sphenoid: 1 Zygomatic bones: 2 bone (with crest in midline for falx Anterior: lesser wing of sphenoid temporal bone
Ethmoid: 1 Maxillae: 2 cerebri) Posterior: petrous parts of Posterior: squamous part of
Temporal: 2 Nasal: 2 Posterior: lesser wing of sphenoid temporal bone occipital bone
Parietal: 2 Lacrimal: 2 Floor: orbital plates of the frontal Lateral: squamous parts of Floor: basilar, condylar, and
Palatine: 2 bone temporal bone squamous parts of the occipital
Inferior conchae: 2 Medial: Cribiform plate of the Floor: greater wing of the sphenoid bone; mastoid part of temporal
ethmoid and parietal bones
THE FACE
Skin of the face
Distinguishing features of the skin of the face:
1. Numerous sweat and sebaceous glands
2. Connected to bones by loose connective tissue
3. NO DEEP FASCIA IN THE FACE
Wrinkles
Due to repeated folding of skin perpendicular to the
long axis of underlying muscles
Loss of skin elasticity
1. Lacrimal nerve skin and conjunctiva of lateral 1. Infraorbital nerve direct continuation 1. Mental nerve skin of lower lip and chin
part of the upper eyelid of maxillary nerve; skin of lower eyelid, 2. Buccal nerve skin over the small area of the
2. Supraorbital nerve skin and conjunctiva on cheek, side of the nose, upper lip cheek
central part of upper eyelid, forehead skin (around infraorbital area) 3. Auricotemporal nerve skin of the auricle,
3. Infratrochlear nerve skin and conjunctiva on 2. Zygomaticofacial nerve skin over external auditory meatus, outer surface of the
medial part of the upper eyelid, lower part of prominence of the cheek tympanic membrane, and the scalp above the
forehead 3. Zygomaticotemporal nerve skin over auricle
4. External nasal nerve skin on side of the nose to the temple (around the zygomatic arch)
the tip
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Course: Tributaries
1. Starts from ECA at the level of the hyoid bone Opposite with the branches of facial artery
2. Arch upward and over the submandibular salivary glands
3. Curves around inferior margin of the mandible Deep facial vein - joins it to the pterygoid venous plexus
4. Runs upward toward the angle of the mouth Superior ophthalmic vein joins it to the cavernous sinus
5. Ascends into zygomaticus muscles and levator labii superioris muscle Transverse facial vein joins the superficial temporal vein with the
6. Runs alongside of the nose terminating at medial angle of the eye parotid gland
2. Inferior labial Near the angle of the mouth pharyngeal arch and supplied by facial
artery Supplies lower and upper lip nerve
Inferior: anastomoses with ILA at other side Orifices of the face: orbit, nose, mouth
3. Superior labial Superior: gives branches to septum and ala of the guarded by eyelids, nostrils, lips
artery nose
Function:
4. Lateral nasal 1. Serve as sphincters and dilators
Supplies skin on the side and dorsum of the nose
artery for the orifices
2. Modify facial expression
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
THE NECK
Neck boundaries SUPERFICIAL FASCIA OF THE NECK
1. Cutaneous Nerves
Superior: lower margin of the mandible
Lesser Occipital Nerve Supplies skin over lateral part of occipital region
Inferior : upper border of the clavicle and the suprasternal notch
(C2) and behind
Anterior: Median line of the neck
Great auricular nerve Supplies skin over angle of the mandible, parotid
Posterior: Sternocleidomastoid muscle
(C2,3) gland, and auricle surfaces
Transverse cutaneous Supplies skin on the anterior and lateral surfaces
Skin of the neck
nerve (C2, 3) of the neck body of the mandible to the sternum
Natural lines of cleavage run horizontally around the neck
Medial supplies skin as far as the median
*Important clinically incision along cleavage will heal as a narrow scar
plane
Skin over trapezius muscles and back on the scalp supplied by posterior
Supraclavicular nerve Intermediate supplies skin of the chest wall
rami of cervical nerves 2-5 (greater occipital nerve)
(C3, 4) Lateral supplies skin over the shoulder and
Skin in front and sides of the neck supplied by anterior rami of cervical
upper half of the deltoid, posterior aspect of
nerves 2-4 through the cervical plexus
the shoulder up to scapula spine
*Branches emerge from beneath the posterior border of the
sternocleidomastoid muscle 2. Platysma
3. Superficial Veins
Commencement: behind the angle of the
mandible
Union: Posterior auricular vein + posterior division
External Jugular Vein
of the RMV
Termination: behind middle portion of the clavicle
Drainage: Subclavian vein
Commencement: below the chin
Jugular arch: union of 2 anterior jugular veins
Anterior Jugular Vein
above the suprasternal notch; drains into the EJV
(AJVJugular arch EJV)
4. Superficial Lymph Nodes
Lie along external jugular vein superficial to SCM
Receive lymph vessels from occipital and mastoid lymph nodes
Drainage: deep cervical lymph nodes
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Subdivided into smaller triangles by the anterior and posterior bellies of the digastric and the
superior belly of the omohyoid
1. Digastric triangle (Submandibular triangle)
With submandibular gland
(opens at the floor of the mouth via Whartons duct)
Superior: lower border of the mandible
Inferior: posterior belly of the digastric and stylohyoid
Floor: Mylohyoid
2. Submental triangle
Bounded by anterior bellies of the digastric, floor: mylohoid
Contains lymph nodes, fats, and small veins POSTERIOR triangle of the neck
(Commencement of AJV)
3. Carotid triangle Anterior: posterior border of the sternocleidomastoid muscle
Contains CCA, IJV, and Vagus Nerve Posterior: anterior border of the trapezius
Superior: Bellies of posterior digastric and stylohyoid Inferior: clavicle
Posterior: Anterior border of the SCM
Anterior: Anterior belly of the omohyoid
Subdivided by the inferior belly of the omohyoid into
4. Muscular triangle
occipital triangle and supraclavicular triangle
Pretracheal of infrahyoid muscles (Strap muscles) ensheathed by
pretracheal layer
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Retromandibular vein
Nerves
Facial Nerve Vagus nerve Hypoglossal nerve
Fibers Motor and sensory Motor
Course 1. Emerges on anterior surface of hindbrain between pons 1. Emerges from anterior surface of medulla 1. Emerges from anterior
and medulla oblongata oblongata surface of medulla
2. Pass laterally in posterior cranial fossa 2. Passes laterally through posterior cranial fossa oblongata
3. Enter internal acoustic meatus in petrous part of 3. Leaves skull through jugular foramen 2. Crosses posterior cranial
temporal bone 4. Gives off to superior (meningeal and auricular fossa
4. Enters facial canal (lateral through inner ear) branches) and inferior (Pharyngeal) sensory 3. Leaves skull via hypoglossal
5. Forms geniculate ganglion ganglia canal
6. Nerve descends behind pyramid and emerges from 5. Descends through the neck within the carotid 4. Passes downward and
temporal bone via stylomastoid foramen sheath forward in the neck
7. Passes forward though parotid gland 6. Passes through the mediastinum of the thorax 5. Crosses ICA and ECA
8. Terminates to its distributions for facial expression 7. Passes behind root of lungs 6. Terminates in the tongue
8. Enters abdomen via esophageal opening in
diaphragm
Branches Greater petrosal nerve - from geniculate ganglion; Meningeal and auricular branches Meningeal branch
and contains parasympathetic fibers Pharyngeal branch supplies pharynx muscles Descending branch (C1
Innervatio Secretomotor to lacrimal gland, with taste fibers and soft muscles fibers passes downwards
n Nerve to stapedius stapedius muscle in middle ear Superior laryngeal nerve joining descending cervical
Chorda tympani leaves middle ear through Internal laryngeal nerve larger branch; nerve (C2 and 3) forms
petrotympanic fissure; with parasympathetic sensory to mucous membrane of piriform ansa cervicalis
secretomotor fibers to submandibular and sublingual fossa and larynx up to vocal cords Nerve to thyrohyoid muscle
salivary glands External laryngeal nerve motor; supplies (C1)
With taste fibers cricothyroid cartilage Muscular branches to all
Posterior auricular from stylomastoid foramen; Recurrent laryngeal nerve supplies larynx tongue muscles (except
posterior belly of digastric and stylohyoid nerves muscles (except cricothyroid), mucous palatoglossus)
membrane below vocal cords and upper part of Nerve to geniohyoid muscle
Facial expression branches : trachea (C1)
1. Temporal auricular muscles, occipitofrontalis, Right recurrent hooks to subclavian
corrugator supercilii artery; Innervates tongue muscles
2. Zygomatic orbicularis oris Left recurrent hooks to arch of aorta; (controls shape and movement)
3. Buccal- buccinators, upper lip muscles, nostril Cardiac Branches arise in the neck, descend
4. Mandibular- lower lip muscles into the thorax, end in cardiac plexus Ansa cervicalis sternothyroid,
5. Cervical - lower border of gland, platysma, omohyoid, sternohyoid (SOS)
depressor anguli oris Innervates heart, great vessels in the thorax,
larynx, trachea, bronchi, lungs
Innervates facial expression, salivation, lacrimation
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Cranial Nerves (Oh Oh Oh To Touch And Feel Virgin Girls Vagina And Hymen)
Nerve Components Function Opening in the Skull
1. Olfactory Sensory Smell Opening in cribiform plate
2. Optic Sensory Vision Optic Canal
Lifts upper eyelid, turns eyeball upward, downward and medially; constricts
3. Oculomotor Motor
pupil; accommodates eye
4. Trochlear Motor Assists in turning eyeball downward and laterally
Superior orbital fissure
5. Trigeminal
Cornea, forehead skin, scalp, eyelids, nose; mucous membrane of paranasal
Ophthalmic division Sensory
sinuses and nasal cavity
Face skin over maxilla and upper lip; upper jaw teeth, nsoe mucous
Maxillary division Sensory Foramen rotundum
membrane, maxillary air sinus, palate
Mandibular division Motor Muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani
Foramen ovale
Sensory Skin of cheek, mandible, lower lip, side of head; teeth of lower jaw
6. Abducent Motor Lateral rectus muscle, turns eyeball laterally Superior orbital fissure
Face muscles, stapedius muscle of middle ear, stylohyoid, posterior belly of
Motor
digastric
Internal acoustic meatus, facial
7. Facial Sensory Taste from anterior 2/3 of the tongue, floor of mouth, palate
canal, stylomastoid foramen
Secretomotor Submandibular and sublingual salivary glands, lacrimal gland, and glands of
parasympathetic nose and palate
8. Vestibulocochlear
Vestibular Sensory Position and head movement
Internal acoustic meatus
Cochlear Sensory Hearing
Motor Stylopharyngeaus muscle; assists in swallowing
Secretomotor Parotid salivary gland
9. Glossopharyngeal
parasympathetic
rd
Sensory General sensation and taste from posterior 3 of tongue, carotid sinus/body
Constrictor muscle of pharynx and intrinsic larynx muscles; involuntary
Motor Jugular foramen
10.Vagus muscle of trachea and bronchii, heart, alimentary tract; liver pancreas
Sensory Taste from epiglottis and vallecular and afferent fibers
11.Accessory
Cranial root Motor Soft palate muscle, pharynx, larynx
Spinal root Motor Sternocleidomastoid and trapezius muscles
12.Hypoglossal Motor Tongue muscles controlling shape and movement Hypoglossus canal
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Glands
Characteristics Blood Supply / Venous drainage Nerve supply
Largest salivary gland Glossopharyngeal nerve
Composed of serous acini (Secretomotor
Parotid Gland Deep hollow below external auditory meatus behind ramus parasympathetic supply)
*Parotid duct mandible Transverse Facial artery Otic ganglion
(Stensens duct) Divided into superficial and deep lobes by the facial nerve (branch of the superficial temporal artery) Lesser petrosal
Transverse by the Facial nerve, RMV, and ECA nerve
*Parotid Duct drains in the vestibule of the mouth (buccal Auriculo-temporal
nd
mucosa) at the level of the upper 2 molar tooth nerve
Mixture of serous and mucous acini Facial nerve
Beneath lower border of body of the mandible (Parasympathetic
Submandibular gland Divided into superficial and deep part by the mylohyoid secretomotor supply via
Opens into the mouth on a small papilla at the side of chorda tympani and
tongue frenulum submandibular ganglion)
With right and left lobes connected by a narrow isthmus Blood Supply: Superior, middle, and
Surrounded by sheath from pretracheal layer of deep 1. Superior thyroid artery inferior cervical sympathetic
fascia (Ligament of Berry) attaches glad to larynx and Branch of ECA ganglia
trachea Accompanied by external
Pear/H-/Butterfly shaped gland laryngeal nerve
Apex directed upward up to oblique line on lamina of 2. Inferior thyroid artery
thyroid cartilage Branch of thyrocervical trunk
Isthmus located in front of 3nd tracheal cartilage; base Ascends at level of cricoid
th
4 tracheal cartilage cartilage
Levator glandulae thyroideae muscular band connecting Crossed by the recurrent
pyramidal love to hyoid bone laryngeal nerve
Thyroid gland
3. Thyroidea ima arise from
Function: for thyroid hormones, thyroxine and brachiocephalic artery or arch of the
triiodothyronine increases metabolic activity of cells in the aorta
body
Venous drainage
1. Superior thyroid vein drains into
IJV
2. Middle thyroid vein drains into IJV
3. Inferior thyroid vein drain into left
brachiocephalic vein
Anatomy 1C Joshua Montelibano 1st shift 2015-2016