997633 Ana Head and Neck

8/14/2019 997633 Ana Head and Neck

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This LCD projector

Is donated by the USA based SWU MHAM MedicalAlumni to the Anatomy Department and received byDr. Allan Librando, Chairman.This project is Initiated by:Dr. Halbert CapuyDr. Lorens AlaanDr. Mel Allego ( President)Other USA based Medical practitioners who attendedthe SWU 60 th Diamond Jubilee anniversary in January11 14, 2007


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Head and neck

The skull


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The Neurocranium

bones Frontal bone Parietal bones ( paired) Temporal bones ( paired) Occipital bone Sphenoid bone Ethmoid bone> Largely flat, curved and united by

fibrous interlocking sutures.


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Facial skeleton

( viscerocranium or splanchnocranium

) Lacrimal bones ( 2 ) Nasal bones ( 2 ) Maxillae ( 2 ) Zygomatic bones ( 2 ) Palatine bones ( 2 ) Inferior nasal conchae ( 2 ) Mandible ( 1 ) Vomer ( 1 )


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Anterior Skull

Glabella the smooth slightly depressedarea between the superciliary arches. Nasion the intersection of the frontal and thenasal bone ( bridge 0f the nose) Supraorbital arch the angular boundary betweenthe squamous and orbital bones. Supraorbital notch or foramen passage for vessels andnerves. Superciliary arch a ridge superior and lateral tothe glabella. Orbital fissures superior and inferior Optic canal for passage of optic nerve


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Anterior Skull

Zygomatic bones ( zygoma, cheekbone, malar bone) Zygomatico facial foramen Piriform apertures pear shaped anterior nasalapertures Nasal septum bony divide of the nasal cavity Nasal conchae curved bony plates on the lateral wall Maxillae the upper jaw (alveolar processes for themaxillary teeth ). Infraorbital foramen passage for the infraorbial nerves Mandible U shaped bone with alveolar process for the

mandibular teeth Mental foramina for the mental nerve and vessels. Mental protuberance prominence of the chin.


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Clinical applications

Injury to Superciliary arches laceration with profusebleeding,

Blackeye bruising and bleeding of tissues around theorbit with hematoma formation.

Malar flush redness of the skin covering the zygomaticprominence.e.g. fever in PTB

Le Fort Fracture - Fractures of the maxillae, alveolarprocess, bony nasal septum, lacrimal, pterygoid plates ofthe sphenoid, bridge of the nose.

Resorption of alveolar bones due to loss of teeth. Mandibular prognathism decrease in vertical facial

dimensions with overclosure due to total loss of teeth.


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Clinical

Fractures of the Calvaria a. Depressed fracture

b. Linear fracture

c. Comminuted fracture

d. Contrecoup fracture(counterblow)


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Lateral aspect of the

skull Pterion the union of frontal, parietal, sphenoidand temporal bones.

Importance - It overlies the anterior branch of themiddle meningeal artery.

Temporal fossa boundaries; superior/posterior by temporal lines, inferiorlyby the zygomatic arch. Zygomatic arch formed by the union of the temporal process ofzygomatic and zygomatic process of temporal bone External acoustic meatus Mastoid process

Infratemporal fossa space inferior and deep to thezygo arch, mandible and posterior maxilla.


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Posterior aspect of the

skull Occiput from occipital,parietal,mastoid part oftemporal

Inion - Occipital protuberance Foramen magnum large opening atthe base

Superior nuchal line Lambda the junction of the sagittal

and lambdoid sutures


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Superior aspect of skull

Parietal eminence Frontal eminence Coronal sutures separates frontal and parietalbone

Sagittal sutures separates parietal bones Lambdoid sutures separates the parietal andtemporal bone from occipital bone Bregma intersection of sagittal and coronalsutures.

Vertex most superior point of the skull Parietal foramen found posteriorly near thesagittal sutures, transmits emissary veins.


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Landmark Shape and location

Pterion G. Wingsphenoid

Lambda Pt. of coronal/sagittalsutures

Bregma(forepart of

head)

Pt. of coronal/sagittal

sutures

Vertex Superior part of skull

Asterion Starshaped,parietomastoid,

occipitomastoid and

lambdoid sutures

Glabella At the root of the nose

Inion ( back of

head)

Prominent at external

occipital protuberance

Meetin of frontonasal


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SCALP

S Skin C Subcutaneous tissue A - Aponeurosis L Loose connective

tissue

P - Periostium


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Muscles of facial

expression Buccinator - this is the muscle of the cheek. It is used in whistlingand sucking and is also involved in mastication.

Zygomaticus minor - it elevates the upper lip in order to showcontempt and deepens the nasolabial sulcus to express sadness.

Levator anguli oris - this raises the corner of the mouth. Depressor labii inferioris - it depresses the lip and is used in theexpression of impatience. Levator labii superioris - this elevates and everts the upper lip and

aids the zygomaticus minor muscle in the expression of sadness.

Risorius - this is involved in grinning. Procerus - this small muscle runs from the bridge of the nose to theforehead and is useful in frowning and in reducing the glare of brightlights.

Platysma - this is a sheet-like muscle which covers the neck andlower face. It has an embryological role related to the facial nerve.


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Facial muscles Facial expression

1. Orbicularis oris Oral sphincter, pucker,whistle

2. Dilator musclesOpen mouth wide

3. Levator labii

superioris alaquenasi

Elevate upper lip and wing

of nose

4. Mentalis Expression of doubt

5. Buccinator Aids in mastication,blowing

6. Depressor angulioris7. Procerus

Frowning,depress anglemouth

Draws eyebrow inferior,

frown

8. Levator anguli

oris

Elevates corner of mouth

Smile, laughing


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Muscles of the Nose

Procerus small slip from frontalis, draws eyebrowinferiorly as in frowning or from glare.

Depressor septi, from maxilla into mobile part ofnasal septum. Helps in deep inspiration

Nasalis main muscle, composed of the a.compressor naris transverse, compress the piriformaperture ( nostril)

b. dilator naris alar (wing) part, from maxilla to alarcartilage

* All innervated by buccal branch of facial nerve


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Branches of Facial

nerve Temporal - cross the parotid, to auriclaris, occipitofrontalis & orbicularis oculi.

Zygomatic inferior orbicularis occuli, inferior ofeye. Buccal buccinators, orbicularis oris, lev. labii sup. Mandibular risorius & muscles of lower lip/chin. Cervical platysma and superficial neck muscles.


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Facial nerve injury

Injury results to paralysis of the affected muscles.

1. Inflammation at the stylomastoid foramen produces edemaand swelling and compression of the nerve.

2. Loss of tonus of orbicularis oculi > eversion of lower lid

3. Cornea cannot be lubricated, becomes dry, ulcerations orkeratitis

4. Patient cannot blow, whistle or chew effectively. Weakensthe buccinator, orbicularis oris, cheek and lip muscle.Results to displacement and drooping of mouth cornersdue to contraction of unopposed contralateral facialmuscles cause saliva and food dribbling at the sides of themouth.


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Nerves of the face

Trigeminal nerve (C.n.V)sensorynerve of the face, and motor nerve formastication

Branches of the Trigeminal ganglion:a. Ophthalmic nerve*****

1. nasociliary nerve

2. Frontal nerve

3. Lacrimal nerve

b. Maxillary nerve

c. Mandibular nerve , sensory part


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Ophthalmic nerve

Cutaneous branches:

a. external nasal nerve

b. infratrochlear nervec. supratrochlear nerve

d. supraorbital nerve

e. lacrimal nerve


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Maxillary nerve

Cutaneous branches1. Infraorbital nerve to the upper cheek,

mucosa of maxillary sinus, incisors,canine, premolar, upper gingiva,

inferior eyelids, nose, skin and mucosa

of upper lip.

2. Zygomaticotemporal nerve to the

temple

3. Zygomaticofacial nerve to the face at

the zygoma


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Mandibular nerve

Cutaneous Branches

Auriculotemporal nerve to theauricle, external acoustic meatus,tympanic membrane.

Buccal nerve to the buccinator,mucosa of cheek and gingiva

Mental nerve to the chin mucousmembrane of lower lip and inferiorlabial fold.


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Facial Vasculature

Mostly from the External carotid artery1. Facial artery cervical branches; ascending palatine, tonsillar,

glandularSMG,submental, muscular.

facial br.;inferior/sup. Labial, Lateral nasal,muscular & angular

2. Superficial temporal artery transverse facial, medial temporal,anterior auricular, frontal & parietal.

3. Maxillary artery , composed of 3 parts1st part(bet. Mandibular/sphinopalatine) = ant. Tympanic, deep auricular,

middle meningeal(cranial via for.ovale), accessory meningeal, inferior

alveolar to mandible, gingiva, teeth.


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Maxillary artery,

continue 1st part branches thru foramen and canals, ant. Tympanic, deepauricular, middle meningeal (cranial via for.ovale), accessorymeningeal, inferior alveolar to mandible, gingiva, teeth.

* 2nd part - supplies muscles, 2 deep temporals, pterygoids,masseteric, buccal arteries

3rd part - accompanied by maxillary nerve thru bony canal, lie at[pterygopalatine fossa lateral to the ganglion.

branches; posterior superior alveolar, infraorbital, descendingpalatine, artery of pterygoid canal, pharyngeal, sphenopalatine.

* Features: there are 5 branches from each part, first 5 reachdestination by entering foramina, middle 5 supply soft tissue & useno foramina, last 5 use foramina. The infraorbital the 6th branch is

really the termination of the maxillary artery.


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Other clinical facts of the facial

vasculatures

Compression of facial artery on one side cannot stop anybleeding due to anastomoses of its branches and otherfacial vessels. Facial wounds bleed freely and healquickly. Pulses of the Facial arteries;a. temporal pulse, just anterior to auricleb. facial pulse, at inferior border of mandible Transverse facial artery from the superfacial temporalartery supply the parotid gland and duct, masseter andskin of face anastomose with facial artery. There are anastomoses in the head between the branchesof the internal and external carotid artery. Branches of the Post. Sup. Alveolar supply the gum, molar,premolars and maxillary sinus.


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Other clinical features

Branches of the infraorbital artery supply theorbital structures, maxillary sinus, via the

anterior superior alveolar branch of canine and

incisor teeth. Descending palatine artery divides into greaterand lesser palatine arteries.

The pharyngeal branch via the pharyngeal canalsupplies the pharynx posterior to the auditory

tube. The sphenopalatine artery passes thru thesphenopalatine foramen and supplies the lateral

wall and septum of nasal cavity.


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Facial venous drainage

Supratrochlear vein Supraorbital vein Facial vein Superfacial temporal vein Retromandibular vein


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Infratemporal fossa and its

contents

An irregular shaped space lying behind the maxilla,deep to the ramus of the mandible and inferior tothe temporal bone. Boundaries:

Lateral = ramus of mandibleMedial = lateral pterygoid plate

Anterior = infratemporal surface of maxilla

Posterior = anterior surface of condylar process ofmandible, styloid process of temporal bone.

Roof = inferior surface of greater sphenoid wing.

Inferior = insertion of medial pterygoid to themandible near the angle


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Infratemporal fossa ,

continue

Contents:

Lower part of temporalis muscle Medial and lateral pterygoid muscles Maxillary artery and branches Pterygoid plexus of veins Mandibular division of Trigeminal nerve ** Chorda tympanni (cn.Vll) Otic ganglion


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Mandibular division of Trigeminal

nerve and its branches

1. Inferior alveolar nerve

2. Nerve to mylohyoid muscles

3. Lingual nerve

4. Buccal nerve

5. Auriculotemporal nerve

6. Nerves to muscles of mastication

Mandibular nerve block = local anesthesia thru 2 routes:extraoral = via the mandibular notch, anesthesia to the auriculotemporal, inferior alveolar, lingual, buccal nerve, skin.Intraoral = thru the buccal mucosa & buccinator muscle medial to

mandibular ramus, near foramen. Affects the inferior alveolar andlingual nerve to mandibular body, ramus, mandibular teeth andgingiva, mucosa of anterior 2/3 of tongue.


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Triangles of the Neck

Cervical Triangles

Anterior


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Anterior triangle:

Ventrally by midline, SCM lateral,

cephalic by body of mandibleSubdivisions:

1. Digastric (submandibular) = sup. by mandible, anterior and

below by digastric ant. belly, post below by digastric and

stylohyoid muscles

2. Carotid = sup. by post belly digastric & stylohyoid, inf. bysup.belly omohyoid, post. by SCM

3. Submental (suprahyoid) = lat. by ant. belly digastric, inferiorly

by hyoid, medially by midline of neck.

4. Muscular = post. & inferior by SCM, post. & superior by

sup.belly omohyoid, medially by midline from hyoid to sternum.


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Posterior triangle:

anterior by SCM, posterior by

trapezius,

inferior by clavicle

Subdivisions:

1. Occipital triangle = posterior by

trapezius, anterior by SCM, caudallyby inferior belly omohyoid.

2. Subclavian ( omoclavicular) =

anterior by SCM, Superior by inferior

belly omohyoid, inferiorly by clavicle


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Cervical fascia

Superficial = covers the ant. and post. Triangle,splits to enclose SCM and trapezius. Attaches to ext.occipital protuberance. Lig. Nuchae, C7 spine, sup.Nuchal line, mastoid process, mandible, clavicle,manubrium, acromion, scapular spine. Fascia of Infrahyoid muscle = Superficialenclose the sternohyoid and omohyoid, DEEP investsthe sternohyoid and thyrohyoid muscles. Visceral fascia = enclosesthe pharynx, larynx,trachea, esophagus, thyroid. Parts pretracheal encloseslarynx and trachea, Buccopharyngeal covers thebuccinator and posterior esophagus. Prevertebral fascia = encloses the vertebralcolumn and its muscles. Covers the prevertebralmuscles and forms the floor of posrterior triangle. Sibsons fascia ( suprapleural membrane deep to thescalene muscle) covers the cervical pleura.


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Carotid sheath

An investment (cover) of the:1. internal carotid

2. common carotid arteries

3. Internal jugular veins

4. Vagus nerve. It is adherent to the thyroid sheathand fascia under the SCM. Attachment, cepahlically bone at

jugular foramen and carotid canal,caudally continues to the thorax.


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Veins of the neck

Internal jugular vein, start in jugular fossa as continuation ofSigmoid sinus.Tributaries : 1. inferior petrosal sinus & meningeal veins 2.pharyngeal plexus veins 3. common facial veins 4. lingual veins, 5.superior thyroid veins thyroid veins 6. middle thyroid veins 7. rightlymphatic ducts or the left thoracic duct.

External jugular vein = formed by the posteriorretromandibular and posterior auricular veins. Tributaries: 1.posterior auricular, occipital, retromandibular and anterior jugularvein2. posterior external jugular from cephalic part of back of neck.3. Transverse scapular from scapular region 4. Transverse cervical

Subclavian vein = from axillary veins. Tributaries: 1. externaljugular 2. transverse cervical 3. thoracoacromial from shoulder andupper pectoral region.


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Arteries of the Head and Neck

1. Common carotids

2. Vertebral arteries

3. Basilar arteries

4. Posterior cerebral arteries

5. Subclavian artery branches

6. External carotid artery and its

branches


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Common carotid artery

Left arise from the arch independently In the carotid sheath with internal jugualr vein and vagus

nerve.

Division:1. Internal carotid, S shaped curved artery, divides into

middle and anterior cerebral artery with branches to the:

A. middle ear ( caroticotympanic)

B. cavernous sinus nerves, trigeminal ganglion,hypophysis and choroid plexus

C. Ophthalmic artery to the orbit

2. Middle cerebral artery to the frontal and temporal lobe tothe cerebrum

3. Anterior cerebral artery to the corpus callosum. Bothcerebrals are terminal and have no collateral circulationsand occludes easily.


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Vertebral artery

A branch of the subclavian. Runs superiorlyto the verterbral column and enters the

transverse process C6

Vertebral supplies: muscles, vertebralcolumn, spinal column meninges, medulla,

pons, cerebellum and cerebrum.

Spinal branches enters intervertebralforamina to supply the cord. Last branch of the vertebral is thePosterior Inferior Cerebellar artery.


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Basilar artery,

terminates in the interpeduncular cistern anddivides into right and left cerbral.

1. Pontine = to pons, ventrolateral cerebellar cortex,

inferior midbrain2. Internal auditory = to dura of canal, cochlea,

labyrinth, facial nerves

3. Anterior inferior cerebellar = to brain stem,

superior and middle cerebellar peduncle, anterior

cerebellar hemisphere4. Superior cerebellar = to the inferior colliculi,

superior cerebellar peduncle and dentate nerve

5. Posterior Cerebral artery


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Posterior cerebellar artery

Branches:

a. posteromedial ganglion to hypothalamus,

thalamus, choroid plexus and 3rd

ventricle.b. posterior choroidal branch, thalamus,

subthalamus, internal capsule, choroid plexus, 3rd

ventricle, lateral ventricle

c. cortical branch = to inferior surface of temporal

and occipital lobes


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External carotid artery, branches:

1. Superior thyroid = infrahyoid region, larynx, thyroid gland

2. Ascending pharyngeal = pharynx, prevertebral muscles,

meninges, soft palate

3. Lingual = tongue, suprahyoid, sublingual gland, palatine

tonsils.4. Facial = submandibular gland, lips, nose, facial muscles,

angle of eye

5. Occipital = to SCM, meningeal branches, scalp

6. Posterior auricular = tympanic membrane, external ear,

posterior scalp.

7. Superficial temporal = parotids, ear, face, zygomatic and

temporal regions.

8. Maxillary artery = to masticatory muscles


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997633 Ana Head and Neck

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