THE HEAD AND THE HEAD AND NECK INECK I

THE HEAD AND THE HEAD AND NECK INECK I

ALEXANDRIA R. BAYAOA, M.D.,DPBODEPARTMENT OF ANATOMY

UERMMMC, Inc.

ALEXANDRIA R. BAYAOA, M.D.,DPBODEPARTMENT OF ANATOMY

UERMMMC, Inc.

OBJECTIVESOBJECTIVESnn Identify the principal parts of the skull & various Identify the principal parts of the skull & various

foramina including important structures passing foramina including important structures passing through them.through them.

nn Identifying the bony and soft tissue structures of the Identifying the bony and soft tissue structures of the head and neck appreciated on different radiograph head and neck appreciated on different radiograph studiesstudies

nn Identifying surface anatomical landmarks in the head Identifying surface anatomical landmarks in the head regionregion

nn Describe the layers of the scalp noting the dangerous Describe the layers of the scalp noting the dangerous layer.layer.

OBJECTIVESOBJECTIVESnn Describing the disposition of the cervical Describing the disposition of the cervical

fascia, noting fascia, noting fascialfascial planes and explaining planes and explaining how infections in the neck may extend how infections in the neck may extend downwards to the downwards to the mediastinummediastinum

nn Describing the course in the neck and contents Describing the course in the neck and contents of the carotid sheath and the of the carotid sheath and the neighboringneighboringcourse of the cervical sympathetic chain.course of the cervical sympathetic chain.

OBJECTIVESOBJECTIVESnn Defining emissary veins and its importance.Defining emissary veins and its importance.nn Identify the Identify the fascialfascial layers of the neck & layers of the neck &

contents.contents.nn Describe the muscles of facial expression as to Describe the muscles of facial expression as to

their origin, insertion, action & their origin, insertion, action & innervationinnervation..nn Name the muscles of mastication, their nerve Name the muscles of mastication, their nerve

supply & action.supply & action.nn Describing the structures of the Describing the structures of the

temporomandibulartemporomandibular joint and classifying itjoint and classifying it

OBJECTIVESOBJECTIVESnn Name the different triangles of the neck Name the different triangles of the neck

(boundaries & contents).(boundaries & contents).nn Describing the gross anatomy of the parotid Describing the gross anatomy of the parotid

gland, noting the structures running through its gland, noting the structures running through its substance and opening of its duct into the oral substance and opening of its duct into the oral cavity.cavity.

nn Name the Name the suprahyoidsuprahyoid and and infrahyoidinfrahyoid muscles muscles including their action and nerve supply.including their action and nerve supply.

nn Identify the muscles of the tongue including Identify the muscles of the tongue including action and action and innervationinnervation..

REFERENCESREFERENCES

nn MOORE, CLINICALLY ORIENTED MOORE, CLINICALLY ORIENTED ANATOMY, 6ANATOMY, 6thth ed.ed.

nn SNELL, CLINICAL ANATOMY FOR SNELL, CLINICAL ANATOMY FOR MEDICAL STUDENTS, 8MEDICAL STUDENTS, 8thth eded

nn LANSANG ET AL, REVIEW NOTESLANSANG ET AL, REVIEW NOTES

SKULLSKULL

FACIAL BONES (14)FACIAL BONES (14)

nn ZYGOMATIC (2)ZYGOMATIC (2)nn MAXILLAE (2)MAXILLAE (2)nn NASAL BONES(2)NASAL BONES(2)nn LACRIMAL (2)LACRIMAL (2)nn VOMER (1)VOMER (1)nn PALATINE (2)PALATINE (2)nn INF. CONCHA(2)INF. CONCHA(2)nn MANDIBLE (1)MANDIBLE (1)

CALVARIA CALVARIA nn TEMPORALTEMPORALnn FRONTALFRONTALnn PARIETAL (2)PARIETAL (2)nn OCCIPITALOCCIPITALnn SPHENOIDSPHENOIDnn ETHMOIDETHMOIDSUTURESUTURE

*CORONAL*CORONAL*SAGITTAL*SAGITTAL*LAMBDOID*LAMBDOID

* * pterionpterion

CRANIUM CRANIUM

BASE OF THE SKULLBASE OF THE SKULL

BASE OF THE SKULLBASE OF THE SKULL

SCALPSCALP

SCALPSCALP

EPICRANIUS/OCCIPITOFRONTALISEPICRANIUS/OCCIPITOFRONTALIS

Emissary VeinsEmissary Veins

nn Traverse cranial apertures and make Traverse cranial apertures and make connections between intracranial venous connections between intracranial venous sinuses and sinuses and extracranialextracranial veinsveins

nn constant:constant:1.Mastoid emissary vein1.Mastoid emissary vein-- connects the connects the sigmoid sinus with the post auricular or sigmoid sinus with the post auricular or occipital veinsoccipital veins

Emissary veinEmissary vein

2. 2. Parietal emissary veinParietal emissary vein-- connects the connects the superior superior sagittalsagittal sinus with the veins of the sinus with the veins of the scalpscalp3. 3. Venous plexus of the hypoglossal canalVenous plexus of the hypoglossal canal--connects the sigmoid sinus and IJVconnects the sigmoid sinus and IJV4. 4. CondylarCondylar emissary veinemissary vein-- connects the connects the sigmoid sinus and veins in the sigmoid sinus and veins in the suboccipitalsuboccipitaltriangle via the triangle via the condylarcondylar canal canal

Emissary veins:Emissary veins:

5. 5. Venous plexus of foramen Venous plexus of foramen ovaleovale--connects the cavernous sinus to the connects the cavernous sinus to the pterygoidpterygoid plexusplexus via foramen via foramen ovaleovale6. 6. occipital emissary veinoccipital emissary vein-- connects connects confluence of sinuses with the occipital confluence of sinuses with the occipital vein through the occipital protuberance and vein through the occipital protuberance and also receives the occipital also receives the occipital diploicdiploic veinvein

nn SuperficialSuperficialFasciaFascia

nn Deep Deep CervicalCervicalFascia:Fascia:* Investing* Investing

layerlayer*Pretracheal*Pretracheal

fasciafascia*Prevertebral*Prevertebral

fasciafascia

nn SupraSupra--sternal spacesternal spaceof Burnsof Burns

nn RetrophaRetropha--ryngeal ryngeal spacespace

CAROTIDCAROTIDSHEATHSHEATH

ARE YOU STILL AWAKE?ARE YOU STILL AWAKE?

TRIANGLES OF THE NECKTRIANGLES OF THE NECK

TRIANGLES OF THE NECKTRIANGLES OF THE NECKTRIANGLES OF THE NECKTRIANGLES OF THE NECK

nn ANTERIOR ANTERIOR TRIANGLETRIANGLE

nn POSTERIOR POSTERIOR TRIANGLE TRIANGLE

ANTERIOR TRIANGLEANTERIOR TRIANGLEANTERIOR TRIANGLEANTERIOR TRIANGLE

nn SUBMENTAL SUBMENTAL TRIANGLETRIANGLE

nn DIGASTRIC DIGASTRIC TRIANGLETRIANGLE

nn CAROTID CAROTID TRIANGLETRIANGLE

nn MUSCULAR MUSCULAR TRIANGLETRIANGLE

LATERAL CERVICAL REGION/ LATERAL CERVICAL REGION/ POSTERIOR TRIANGLEPOSTERIOR TRIANGLELATERAL CERVICAL REGION/ LATERAL CERVICAL REGION/ POSTERIOR TRIANGLEPOSTERIOR TRIANGLE

nn OCCIPITAL OCCIPITAL TRIANGLETRIANGLE

nn OMOCLAVICULAR/OMOCLAVICULAR/SUBCLAVIAN/ SUBCLAVIAN/ SUPRACLAVICULARSUPRACLAVICULAR

nn OCCIPITAL OCCIPITAL TRIANGLETRIANGLE

nn OMOCLAVICULAR/OMOCLAVICULAR/SUBCLAVIAN/ SUBCLAVIAN/ SUPRACLAVICULARSUPRACLAVICULAR

CONTENTS: ANTERIOR TRIANGLECONTENTS: ANTERIOR TRIANGLEnn SubmentalSubmental: : submentalsubmental lymph lymph

nodesnodesnn DigastricDigastric: : submandibularsubmandibular

glandgland, facial a. & v., , facial a. & v., hypoglossal nhypoglossal n., ., mylohyoidmylohyoid n.n., , submandibularsubmandibular lymph nodes lymph nodes

nn CarotidCarotid: : carotid sheath carotid sheath (ICA/CCA, IVJ, CN X)(ICA/CCA, IVJ, CN X), , external carotid arteryexternal carotid artery, CN XI , CN XI & XII, sup. root of & XII, sup. root of ansaansacervicaliscervicalis, branches of cervical , branches of cervical plexus, part of thyroid, larynx plexus, part of thyroid, larynx and pharynx, deep cervical and pharynx, deep cervical lymph nodeslymph nodes

nn MuscularMuscular((omotrachealomotracheal): ): infrahyoidinfrahyoid ms ms & viscera & viscera ((thyroidthyroid & & parathyroid glandsparathyroid glands))

CONTENTS: POSTERIOR TRIANGLECONTENTS: POSTERIOR TRIANGLE

nn OmoclavicularOmoclavicular::subclaviansubclavian a a (3(3rdrd part), part), part of part of subclaviansubclavian v. v. suprascapularsuprascapular a., a., supraclavicularsupraclavicular lnln

nn Occipital: Occipital: External External jugular vein, parts of jugular vein, parts of cervical & brachial cervical & brachial plexus, plexus, CN XICN XI, cervical , cervical lymph nodes, splenius lymph nodes, splenius capitiscapitis, , levatorlevator scapulae scapulae & scalene ms& scalene ms

LATERAL CERVICAL REGIONLATERAL CERVICAL REGION

MUSCLES OF FACIAL MUSCLES OF FACIAL EXPRESSIONEXPRESSION

nn Embedded in superficial Embedded in superficial fascia fascia

nn Most arise from the Most arise from the bones of the skull & are bones of the skull & are inserted into the skin.inserted into the skin.

nn Serve as sphincters or Serve as sphincters or dilators of the eyelids, dilators of the eyelids, nostrils and lipsnostrils and lips

MUSCLES OF MUSCLES OF THE EYELIDS:THE EYELIDS:

nn Sphincters: Sphincters: ORBICULARIS ORBICULARIS OCULIOCULI**PalpebralPalpebral*Orbital*Orbital

nn Dilators:Dilators:1. LEVATOR 1. LEVATOR

PALPEBRAE PALPEBRAE SUPERIORISSUPERIORIS

2. OCCIPITO2. OCCIPITO--FRONTALISFRONTALIS

MUSCLES OF MUSCLES OF FACIAL FACIAL EXPRESSIONEXPRESSION

nn Corrugator Corrugator superciliisupercilii

nn Orbicularis orisOrbicularis orisnn Dilator muscles of Dilator muscles of

lips lips

MUSCLES MUSCLES OF THEOF THECHEEKS:CHEEKS:

nn BuccinatorBuccinator

MUSCLES MUSCLES OF THEOF THECHEEKS:CHEEKS:

nn BuccinatorBuccinator

MUSCLES OF FACIAL EXPRESSIONMUSCLES OF FACIAL EXPRESSION

MUSCLES OF MASTICATIONMUSCLES OF MASTICATION

nn IInternal/medial nternal/medial pterygoidpterygoid –– elevator of the mandibleelevator of the mandiblenn TTemporalisemporalis –– elevator of the mandibleelevator of the mandiblenn EExternal/lateral xternal/lateral pterygoidpterygoid –– protractor of the jaw & protractor of the jaw &

depressor of mandibledepressor of mandiblenn MMasseterasseter –– elevator of mandibleelevator of mandiblenn SSuprahyoiduprahyoid muscles (DGMS)muscles (DGMS)Nerve supplyNerve supply: : mandibularmandibular division of CN Vdivision of CN VExcept the posterior belly of Except the posterior belly of digastricdigastric & & stylohyoidstylohyoid

innervated by CN VII, innervated by CN VII, geniohyoidgeniohyoid by C1by C1

nn MASSETERMASSETER

nn TEMPORALISTEMPORALIS

nn MASSETERMASSETER

nn TEMPORALISTEMPORALIS

SUPRAHYOID & INFRAHYOID MSSUPRAHYOID & INFRAHYOID MS

nn SUPRASUPRAHYOID:HYOID:*Mylohyoid*Mylohyoid*Geniohyoid*Geniohyoid*Stylohyoid*Stylohyoid*Digastric*Digastric~Ant. belly~Ant. belly~Post. belly~Post. belly

nn INFRAINFRA--HYOID:HYOID:**SternohyoidSternohyoid**SternothyroidSternothyroid**ThyrohyoidThyrohyoid**OmohyoidOmohyoid~Inf. belly~Inf. belly~Sup. Belly~Sup. Belly

nn NERVE SUPPLY: NERVE SUPPLY: AnsaAnsa cervicaliscervicalisC1C1--C3C3

nn INFRAINFRA--HYOID:HYOID:**SternohyoidSternohyoid**SternothyroidSternothyroid**ThyrohyoidThyrohyoid**OmohyoidOmohyoid~Inf. belly~Inf. belly~Sup. Belly~Sup. Belly

nn NERVE SUPPLY: NERVE SUPPLY: AnsaAnsa cervicaliscervicalisC1C1--C3C3

PAROTID GLANDPAROTID GLAND

nn INTRINSICINTRINSICMUSCLES MUSCLES (longitudinal, (longitudinal, transverse & transverse & vertical)vertical)

nn EXTRINSICEXTRINSICMUSCLES:MUSCLES:

**GenioglossusGenioglossus**HyoglossusHyoglossus**StyloglossusStyloglossus**PalatoglossusPalatoglossus

THANK YOU!!!THANK YOU!!!