Deep Head & Neck Spring 2014 Fredit

Structure Type

Grant

15th Drake Notes Landmarks

Temporal Region

mandibular fossa Temporal 230 921 Articulation point for mandible.

A fossa just anterior to the external acoustic

meatus. Also inferior to the zygomatic process of

temporal bone.

articular tubercle (or eminence) Temporal 230 Forms anterior boundary of the mandibular fossa.

mandibular condyle Mandible 230 Also known as condyloid process.

The posterior articulation of the mandible's ramus

to the TMJ.

mandibular notch Mandible 230 922

The divot, or "U," between the mandible's

coronoid process and condylar process.

coronoid process Mandible 230 815 The anterior articulation of the mandible's ramus.

lingula Mandible 230 922

For attachment of sphenomandibular

ligament.

Intenal surface of ramus of mandible, a little

inferior of the mandibular notch and just superior

to the mandibular foramen.

mandibular foramen Mandible 230 922 For inferior alveolar nn's and vessels. Just inferior to the lingula of mandible.

mylohyoid groove Mandible 230 922

For the nn to mylohyoid mm and for the

mylohyoid vessels.

A groove on the internal surface of the mandible's

ramus, just inferior to the mandibular foramen.

inferior orbital fissure Multiple bones 231 885

Holds the Maxillary nn [V2], its zygomatic

branch, the infra-orbital vessels.

Between the greater wing of sphenoid bone and

the maxilla.

pterygoid process Sphenoid 231 941

From the posterior view, the pterygoid processes

are inferior to the great wings of the sphenoid

bone, inferior to the foramen rotundum.

masseter muscle muscle 231 925

Elevates the mandible inmastication.

Innervated by masseteric nn from

anterior trunk of mandibular nn [V3] .

Suppled by masseteric aa from maxillary

aa .

Originates from zygomatic arch an dmaxillary

process of zygomatic bone, inserts to lateral

surface of ramus of mandible.

styloid process Temporal 231 921

A spine-like projection beginning just inferior to

the external acoustic meatus.

temporalis muscle muscle 232 927

Elevates and retracts mandible.

Inneravted by dep temporal nn from

anterior trunk of mandibular nn [V3] .

Supplied by deep temporal aa's, middle

temporal aa. Large, fan-shaped mm filling the temporal fossa.

infratemporal fossa Multiple bones 232 926

Bounded superiorly by zygomatic arch, anteriorly

by infratemporal surface of maxilla, laterally by

ramus of mandible, medially by lateral plate of

pterygoid process.

mandibular canal Mandible 233 Contains inferior alveolar nn and vessels.

Runs obliquely inferiorly and anteriorly along the

ramus of mandible. A side canal communicates

with the mental foramen.

maxillary artery maxillary aa 233

928,

938

Arises near bifurcation of external carotid aa.

Crosses superficial surface or deep surface of

lateral pterygoid mm.

middle meningeal artery maxillary aa 233 938 Supplies dura mater.

Arises medial to neck of mandible, goes superiorly

and deep to lateral pterygoid mm, going through

split in auriculotemporal nn. Enters skull via

Foramen Spinosum.

inferior alveolar artery maxillary aa 233 938

Supplies all lower teeth, buccal gingivae,

chin, lower lip.

Descends from maxillary aa to enter mandibular

foramen and canal, along with the inferior

alveolar nn.

masseteric artery maxillary aa 233 938 Supplies the masseter mm.

May arise from superior border of maxillary aa

and then course laterally through mandibular

notch to enter deep surface of masseter mm.

deep temporal artery (anterior and

posterior) maxillary aa 233 938 Supplies temporalis mm.

Arise from superior border of maxillary aa and

course superiorly across roof of infratemporal

fossa and enters deep surface of temporalis mm.

buccal artery maxillary aa 233 938 Supplies the cheek. Passes anteriorly onto the buccinator mm.

lateral pterygoid muscle muscle 234 931

Protrusion and side-to-side movements

of mandible. Innervated by nn to lateral

pterygoid directly from anterior trunk of

V3 or from buccal branch. Supplied by

pterygoid branches of maxillary aa .

Upper head originates from roof of infratemporal

fossa, lower head from lateral surface of lateral

plate of pterygoid process. Inserts into capsule of

TMJ near articular disc.

medial pterygoid muscle muscle 234 930

Elevation and side to side movements of

mandible. Innervated by nerve to medial

pterygoid from V3 . Supplied by

pterygoid branches of maxillary aa .

Deep head originates from medial surface of

lateral plate of pterygoid process; SF head from

pyramidal process of maxilla. Inserts to medial

surface of mandible near angle.

inferior alveolar nerve V3 - posterior 234 933

Innervates all lower teeth, mucosa and

skin of lower lip, skin of chin. Motor

branch to mylohyoid mm and anterior

belly of digastric mm.

Passes anteriorly within mandibular canal of

lower jaw.

lingual nerve V3 - posterior 234 933

General sensory of anterior 2/3 of

tongue, oral mucosa on floor of oral

cavity, lingual gingivae of lower teeth.

Joined by chorda tympani [VII].

Enters oral cavity between posterior attachment

of mylohyoid mm to the mylohyoid line and

attachment of superior pharynx constrictor. The

lingual nn enters floor of oral cavity in groove on

medial surface of mandible just inferior to the last

molar.

chorda tympani nerve VII 234 933

Carries taste from the anterior 2/3 of

tongue. Does parasymp to all salivary

glands below the oral fissure.

Originates from CN VII within temporal bone, goes

anteriorly through a small canal, goes through

middle ear, enters infratemporal fossa, descends

medial to spine of sphenoid and then to lateral

pterygoid mm, then joins the Lingual nn.

posterior superior alveolar artery maxillary aa 234 946

Supplies molar, pre-molar teeth, and

maxillary sinus.

Originates from maxillary aa as it goes through

pterygo-maxillary fissure. Accompanies posterior

superior alveolar nn through alveolar foramen on

infratemporal surface of maxilla.

superior cavity of the TMJ TMJ 234 923

Articular disc divides joint into upper and lower

part. Upper part allows head of mandible to

translocate forward (protrusion) onto articular

tubercle and back (retraction).

inferior cavity of the TMJ TMJ 234 923

Lower part of TMJ allows depression and

elevation of mandible.

Interior of the Skull

groove for the superior sagittal

sinus (superior sagittal sulcus) Multiple bones 237 822

Shockingly, this groove holds the

superior sagittal sinus.

Superior point of termination of frontal crest sees

beginning of this groove.

grooves for branches of the middle

meningeal artery Multiple bones 237 832

The middle meningeal aa arises from the

maxillary aa.

Can be seen along the inside of the parietal bone

portion of the skullcap (calvaria).

crista galli Ethmoid 238 1017 Anchors the Falx Cerebri.

A large triangular process on superior surface of

cribiform plate.

cribriform plate Ethmoid 238 1017

Perforations enable CN I to communicate

with the outside world.

A perforated sheet of bone seen anteriorly in the

skull anterior.

anterior clinoid process Sphenoid 238

Point of attachment for tentorium

cerebelli.

Postero-Medially projecting spines on the

sphenoid bone.

posterior clinoid process Sphenoid 238 825

Point of attachment for tentorium

cerebelli.

Rouded projections which can be seen at the

superior margin of the posterior border of the

Turkish saddle.

petrous part Temporal 238 Also known as the "pyramid."

Between sphenoid and occipital bones. Near the

center of the posterior part is the internal acoustic

meatus.

internal acoustic meatus Temporal 238 902

The vestibulocochlear nn passes through

this meatus. Canal in petrous part of temporal bone.

jugular foramen Multiple bones 238 820

The anterior portion carries the inferior

petrosal sinus; intermediate portion

carries CN VII, X, and XI; posterior

transmits sigmoid sinus, ascending

pharyngeal nn's.

Postero-lateral to the carotid canal. Just medial to

the styloid process.

hypoglossal canal Occipital 238 826

Allows CN XII to leave posterior cranial

fossa.

Located very medially, almost right on the margin

of the foramen magnum.

foramen magnum Occipital 238 820 The spinal cord descends.

The absolutely massive hole in the base of the

skull.

groove for the sigmoid sinus

(sigmoid sulcus) Temporal 238 826

Carries the sigmoid sinus for drainage of

the brain.

Grooves inferior to the internal acoustic meatus,

going towards the jugular foramen.

groove for the transverse sinus

(transverse sulcus) Occipital 238 826

Carries the TV sinus for drainage of the

brain.

Transverse grooves on posterior cranial fossa on

the lateral side.

Dural Infoldings & Dural Venous

Sinuses

cerebral falx (or falx cerebri) dura mater 239 831 The "sickle" of dura mater.

Lies between the cerebral hemispheres. Attaches

to crista galli anteriorly, to calvaria on both sides

of groove for superior sagittal sinus, and to

cerebellar tentorium posteriorly.

cerebellar tentorium (or tentorium

cerebelli) dura mater 239 831

A tent of dura mater over the

cerebellum.

Attaches to clinoid processes of sphenoid bone,

superior border of petrous part of temporal bone,

and occipital bone on either side of groove for the

TV sinus. A transverse "tent" atop the cerebellum.

cerebellar falx (or falx cerebelli) dura mater 239 831 A falx for the cerbeellum.

Inferior to the cerebellar tentorium in the midline.

Attaches to inner surface of occipital bone.

superior sagittal sinus dural sinus 239 842 Superior draining vv of brain. Along the superior midline of the brain.

confluence of sinuses dural sinus 239 842

Receives the superior sagittal sinus,

straight sinus, TV sinuses.

Near the posterior margin in the posterior cranial

fossa.

inferior sagittal sinus dural sinus 239 842 Inferior draining vein of the brain. Along the inferior margin of the falx cerebri.

straight sinus dural sinus 239 842

Receives the inferior sagittal sinus and

great cerebral vv. Drains into the

Confluence of Sinuses.

In the line of junction of the cerebral falx and the

cerebellar tentorium.

great cerebral vein vein 239 842 Aka "Vein of Galen." A deep cerebral vv.

transverse sinus (right and left) dural sinus 239 842

Venous drainage away from the

confluence of sinuses.

Run along the groove for TV sinus on the occipital

bone.

sigmoid sinus dural sinus 240 842

Venous drainage away from the TV

sinuses. Run inferiorly from the TV sinuses.

cavernous sinus dural sinus 240

842,

844 Receives cerebral and opthalmic vv's. Along the lateral aspect of the body of sphenoid.

inferior petrosal sinus dural sinus 240 842 Drain into the internal jugular vv.

Begins at posterior end of cavernous sinus, pass in

a groove between petrous part of temporal bone

and basal part of occipital bone.

Cranial Fossae

greater wing Sphenoid 242 941

Holds the foramen rotundum, foramen

ovale, and foramen spinosum, moving

from medially to lateral. Wide, lateral wing of the sphenoid bone.

internal occipital protuberance Occipital 243 826

At the posterior point of the occipital bone, near

the conjunction of the grooves for TV sinuses.

anterior cranial fossa bone 243 823

Contains the foramen cecum, olfactory

foramina in cribiform plate, and optic

canal.

Floor is composed of frontal bone, ethmoid bone

(midline), sphenoid body (midline) and lesser

wings (laterally).

middle cranial fossa bone 243 825

Composed of sphenoid and tem poral

bone. Contains: superior orbital fissure,

foramen rotundum, foramen ovale,

foramen spinosum, hiatuses for greater

and lesser petrosal nn's.

Midway between the anterior and posterior cranial

fossae.

middle meningeal artery maxillary aa 243 832

Supply parts of the meninges which rest

in the middle meningeal fossa. Rest in grooves visible on the calvaria.

foramen spinosum Sphenoid 243 820 Carries the middle meningeal aa.

In the middle cranial fossa, posterolateral from the

foramen ovale.

superior petrosal sinus dural sinus 243 842

Drains cavernous sinus, cerebral, and

cerebellar vv's.

Along superior margin of petrous part of temporal

bone.

optic nerve (CN II) nerve 243 850, Provides vision.

Courses through the optic canal in the anterior

cranial fossa.

superior orbital fissure Multiple bones 243 885

Carries the superior/inferior branches of

CN III, CN IV, CN VI, the opthalmic nn

[V1] branches (lacrimal, frontal,

nasociliary branches), superior opthalmic

vv. Just lateral to the optic canal.

oculomotor nerve (CN III) nerve 243

850,

894

Superior branch goes to superior rectus

and levator palpebrae superioris mm's.

Inferior divides into 3 branches: 1

(medial rectus); 2 (inferior rectus mm); 3

(inferior oblique mm). Lesion: eye moves

down and out.

Leaves anterior brainstem between midbrain and

pons. Divides into superior/inferior just before

entering orbit and pass through superior orbital

fissure within the common tendinous ring.

trochlear nerve (CN IV) nerve 243

850,

895

Innervates superior oblique mm. Lesion:

eye can't look down when eye is adducted

(down and in). See Drake 855 for more

lesions.

Arise from posterior surface of midbrain, passes

around midbrain to enter edge of tentorium

cerebelli, then passes through cavernous sinus just

below CN III. In the orbit, crosses above levator

palpebrae superioris mm to et to superior oblique

mm.

ophthalmic division of trigeminal

nerve (CN V1) nerve 243

850,

895,

944

Sensory from orbit and some branches of

face and scalp.

Smallest and most superior of the trieminal nn

divisions. Leaves trigeminal ganglion, goes

forward and inferior to trochlear and oculomotor

nn's. Divides into Nasociliary, Lacrimal, Frontal

nn's to enter orbit via Superior Orbital Fissure.

Frontal and Lacrimal nn's are outside common

tendinous ring, nasociliary nn is within.

abducens nerve (CN VI) nerve 243 850,

Innervates the lateral rectus mm, allowing

abduction of the eye. Lesion: inability to

abduct the eye.

Arises from brainstem between pons and medulla,

masses forward, crosses superior edge of petrous

temporal bone, crosses cavernous sinus

inferolateral to internalc arotid aa, enters orbit via

superior orbital fissure.

trigeminal nerve (CN V) nerve 244

850,

866

Major sensory nn of the head, also

innervates mm's that move mandible.

V1 (Opthalmic) goes forward, enters orbit through

superior orbital fissure. V2 (Maxillary) courses

just inferior to opthalmic nn, leaves cranial cavity

via foramen rotundum, enters pterygopalatine

fossa. Mandibular (v3) leaves inferior margin of

trigeminal ganglion, leaves skull via foramen

ovale.

trigeminal ganglion nerve 244 932

Trigeminal ganglion sits in the middle cranial

fossa in the Trigeminal Cave.

maxillary division of the trigeminal

nerve (V2) nerve 244

850,

943

Sensory from middle cranial fossa dura

mater, nasopharynx, palate, nasal cavity,

upper teeth, maxillary sinus, skin of side

of nose, lower eyelid, cheek, upper lip.

Courses forward in dura mater of lateral wall of

cavernous sinus, inferior to V1. Leaves cranial

cavity via foramen rotundum, enters

pterygopalatine fossa.

foramen rotundum Sphenoid 244 941 Carries V2. Antero-medial from the foramen ovale.

mandibular division of the

trigeminal nerve (V3) nerve 245

850,

932,

933,

934

V3 is the only trigeminal nn with motor.

Innervates the four mm's of mastication:

temporalis, masseter, medial/lateral

pterygoids. Also innervates tensor

tympani, tensor veli palatini, anterior

digastric, mylohyoid mm's.

Leaves inferior margin of trigeminal ganglion,

leaves skull via foramen ovale. Motor root of

trigeminal nnalso goes through foramen ovale and

unites with sensory component of V3 outside of

the skull.

foramen ovale Sphenoid 245 820

The mnemonic OVALE: (otic ganglion,

V3, accessory meningeal aa, lesser

petrosal nn, emissary vv's).

Between the foramen rotundum and foramen

spinosum.

internal carotid artery artery 245 941

Enters cranial aa via carotid canal, makes an S-

shaped bend in cavernous sinus, emerges near

optic nn.

carotid canal Temporal 245 820 Carries the internal carotid aa.

When the skull is viewed from inferior, the carotid

canal is almost directly posterior from the foramen

spinosum.

hypophyseal fossa Sphenoid 245 825 Holds the hypophysis. Deep central area in the Turkish Saddle.

posterior cranial fossa bone 245 826

Contains the foramen magnum, internal

acoustic meatus, jugular foramen,

hypoglossal canal, condylar canal. Located in the posterior portion of the skull.

facial nerve (CN VII) nerve 245

850,

868 Innervates mm's of facial expression.

Leaves brainstem between pons and medulla.

Motor and sensory roots leave cranial cavity via

internal acoustic meatus, enter facial canal in

petrous part of temporal bone, forming a

geniculate ganglion.

vestibulocochlear nerve (CN VIII) nerve 245

850,

913 Supplies hearing and balance.

Goes from lateral surface of brainstem between

pons and medulla, emerges from internal acoustic

meatus, crosses posterior cranial fossa and course

within petrous part of temporal bone to inner ear.

glossopharyngeal nerve (CN IX) nerve 245 850

GVA (carotid body, sinus), GSA

(posterior third of tongue, other posterior

regions), SA (taste of opsterior third of

tongue), GVE (parasymp for parotid

gland).

Arises as rootlets on anterolateral surface of upper

medulla. Cross posterior cranial fossa, enter

jugular foramen.

vagus nerve (CN X) nerve 245 850

The major parasymp nn of the body.

Some sensory input from throat, aotic

body and arch, as well as body in general.

Innervates palatoglossus mm, mm's of

soft palate (except tensor veli palatini),

pharynx (except stylopharyngeus), and

larynx.

Arises from anterolateral surface of medulla just

inferior to the rootlets for CN IX. Rootlets cross

posterior cranial fossa, enter jugular foramen.

cervical root of accessory nerve

(CN XI) nerve 245 850

Innervates sternocleidomastoid and

trapezius mm.

Roots arise from motor neurons in upper five

segments of cervical spinal cord, leave lateral

surface of spinal cord, enter cranial cavity via

foramen magnum, exit via jugular foramen.

hypoglossal nerve (CN XII) nerve 245 850

Innergates hyoglossus, styloglossus,

genioglossus mm's and all intrinsic mm's

of tongue.

Arises as rootlets from anterior medulla, passes

laterally across posterior cranial fossa, exits via

hypoglossal canal.

hypoglossal canal Occipital 245 820 Carries the hypoglossal nn. Somewhat anterolateral from the medulla.

Orbit

infraorbital groove Maxilla 246 Carries infraorbital vessels and nn.

A groove coursing medially from the inferior

orbital fissure near the juncture to the superior

orbital fissure.

optic canal Sphenoid 246 885 Carries the optic nn and opthalmic aa. Just medial to the superior orbital fissure.

lesser wing Sphenoid 246 941 Superior to the greater wing.

lacrimal gland gland 248 883 Contains tears.

Supero-lateral to the eyeball, deep to part of the

tendon of levator palpebrae superioris mm.

lacrimal groove Maxilla/Lacrimal 248 878 Assists medial drainage of tears.

Groove on medial aspect of orbit, along lacrimal

and maxilla bones.

nasolacrimal duct soft tissue 248 884

Drains tears from the medial aspect of

the eye and the lacrimal sac into the

nose.

Extends inferiorly from the lacrimal sac and enters

inferior meatus of nasal cavity.

frontal sinus Frontal 249 1019

One frontal sinus on each side, drains

onto the lateral wall of the middle metus

via frontonasal duct. Innervated by

supraorbital nn from opthalmic [V1].

Blood from anterior ethmoidal aa's.

A large hole/sinus in the frontal bone (shocking, I

know) between the two orbits in the forehead.

periorbita CT 249 886 Periosteum of the orbit. Periosteum that lines the orbit.

frontal nerve CN V1, frontal nn 249 895

Also gives off a lacrimal nn and anterior

ethmoidal nn.

Enters the orbit superior to the extraocular mm's.

Courses from apex of orbit towards superior

orbital margin. Divides into Supratrochlear nn and

Supraorbital nn.

supratrochlear nerve CN V1, frontal nn 249 895

Provides skin of eyelid and lower

forehead.

A thin nn that comes off and courses medially

from the frontal nn's division into supraorbital

and supratrochlear nn.

supraorbital nerve CN V1, frontal nn 249 895

Sensory innervation to conjunctiva,

frontal sinus, skin of forehead.

Pterminal branch of V1, passes through

supraorbital foramen and divides into a medial

and lateral branch to supply the scalp.

lacrimal nerve CN V1, frontal nn 249 895 Innervates the lacrimal gland.

Passes through superior orbital fissure lateral to

the frontal nn and innervates the lacrimal gland.

trochlear nerve (CN IV) CN IV 249 895

Innervates the superior rectus mm,

which pulls the eye to look down and

out.

Passes through the superior orbital fissure medial

to the frontal nn to supply the superior oblique

mm by entering its superior surface.

superior oblique muscle (of the

eye) muscle 249 889

Innervated by the trochlear nn (CN IV).

Depression, abduction, medial rotation

of eyeball.

The important note is its wrapping through the

trochlear "sling" before sliding into place. The rule

of the oblique mm's is that both pull the eyeball

outwards (abduction).

levator palprebae superioris

muscle muscle 249 889

Innervated by CN III. Elevates upper

eyelid.

Originates from lesser wing of sphenoid and

inserts to anterior surface of tarsal plate and skin.

superior rectus muscle (of the eye) muscle 249 889

Innervated by CN III. Elevate, adduct,

medial rotation of eyeball.

Originates from common tendinous ring, inserts

to superior aspect of eyeball.

oculomotor nerve (CN III) nerve 249 894

Innervates most intrinsic mm's of the

eye.

Leaves anterior surface of brainstem between

midbrain and pons, divides into superior and

inferior branches, then enter orbit via superior

orbital fissure. Its third branch gives a branch to

ciliary ganglion (parasymp).

lateral rectus muscle (of the eye) muscle 250 889

Innervated by the abducens nn (CN VI).

Abduction of eyeball.

Originates from lateral part of common tendinous

ring, inserts into lateral side of eyeball.

abducens nerve (CN VI) nerve 250 897 Innervates the lateral rectus mm.

Arises from brainstem between pons and

medulla. Enters cavernous sinus, runs lateral to

internal carotid aa. Enters orbit via superior

orbital fissure within common tendinous ring,

then courses laterally to get to lateral rectus mm.

nasociliary nerve

CN V1, nasociliary

nn 250 895

Gives off long ciliary nn, posterior

ethmoidal nn, infratrochlear nn, anterior

ethmoidal nn.

Emerges from V1, often first branch from

opthalmic nn (V1). Enters within common

tendinous ring, enters orbit, crosses superior

surface of optic nn and passes medially, below

superior rectus mm.

long ciliary nerves

CN V1, nasociliary

nn 250 895

Sensory to the eyeball. May contain

sympathetic fibers for pupillary dilation.

Come from the nasociliary nn and head towards

the medial side of the eyeball's posterior midline.

anterior ethmoidal nerve

CN V1, nasociliary

nn 250 895

Supplies anterior cranial fossa, nasal

cavity, skin of lower half of nose.

Courses to the medial aspect of the orbit and

plugs into the ethmoid bone. Exits the orbit

through anterior ethmoidal foramen.

superior division of the oculomotor

nerve CN III 250 894

Innervates superior rectus and levator

palpebrae superioris mm's.

Superiormost nerve in the superior optic fissure

that courses through the common tendinous ring.

Passes up over the lateral side of the optic nn.

inferior division of the oculomotor

nerve CN III 250 894

Branch to the medial rectus; inferior

rectus; and inferior oblique mm.

Inferiormost nn in the superior optic fissure that

courses through the common tendinous ring.

Divides into three branches.

ciliary ganglion nerve 250

894,

897

Site of synapse for pre- and post-

ganglionic parasymp nn's to eyeball.

The branch of CN III going to inferior oblique mm

gives off branch to ciliary ganglion.

superior ophthalmic vein vein 250 893

Drains the eye and orbit. Only vein in the

superior orbital fissure.

Vein in the superior orbital fissure, just inferior to

branches of V1 and IV.

ophthalmic artery internal carotid aa 251 892

Branches provide blood to the orbit and

eyeball.

Arises from the internal carotid aa just inferior to

the optic chiasm. Enters the orbit, usually superior

to the optic nn and reaches medial wall of orbit.

medial rectus muscle (of the eye) muscle 251 889

Innervated by CN III. Adduction of

eyeball.

Originates from medial part of common tendinous

ring.

inferior rectus muscle (of the eye) muscle 251 889

Innerated by CN III. Depression,

adduction, lateral rotation of eyeball.

Originates from inferior part of common

tendinous ring.

inferior oblique muscle (of the eye) muscle 251 889

Innervated by CN III. Allows you to look

up and out (elevtion, adduction) and

lateral rotation of eyeball.

Originates from medial floor of orbit, inserts to

outer posterior quadrant of eyeball.

occipital condyle Occipital 252 820 Articulates with the Atlas.

Bump just lateral on either side of the foramen

magnum.

Cervical Vertebrae

sympathetic trunk nerve 254 980 Point for synapsing sympathetic nn's.

Rests on the anterior surface of the cervical

vertebral column.

superior cervical sympathetic

ganglion nerve 254 980

Marks superior extent of sympathetic

trunk. Goes to carotid aa's, cervical spinal

nn's C1 to C4, pharynx, and heart

(superior cardiac nn's). Rests near CV I and CV II.

middle cervical sympathetic

ganglion nerve 254 980

Branches to nerves C5 and C6 and to

heart as middle cardiac nn's. About the level of CV VI.

inferior cervical sympathetic

ganglion nerve 254 980

Nerves to C7 - T1, vertebral aa, and

inferior cardiac nn's to heart. About level of CV VII.

longus colli muscle muscle 254 975

Innervated by branches from anterior

rami of C2-6. Flex neck anteriorly and

laterally, slight rotation to opposite side.

Prevertebral mm, originates from cervical and

upper thoracic vertebrae.

longus capitis muscle muscle 254 975

Flex the head. Innervated by branches

from anterior rami C1-3.

Originates from TV processes of upper cervical

vertebrae, insert to inferior surface of basilar part

of occipital bone.

anterior scalene muscle muscle 254 975

Innervated by upper cervical nn's.

Elevate first rib, flex neck to that side.

Originates from lower cervical vertebrae, insert to

first rib.

Pharynx

inferior pharyngeal constrictor

muscle

pharyngeal

constrictor mm 255 988

Innervated by Vagus nn. Constricts

pharynx.

Posterior attachment to pharyngeal raphe.

Anterior attachment to cricoid, oblique line of

thyroid cartilage.

middle pharyngeal constrictor

muscle

pharyngeal

constrictor mm 255 988

Innervated by Vagus nn. Constricts

pharynx.

Posterior attachment to pharyngeal raphe.

Anterior attachment to upper margin of greater

horn of hyoid bone.

superior pharyngeal constrictor

muscle

pharyngeal

constrictor mm 255 988

Innervated by Vagus nn. Constricts

pharynx.

Posterior attachment to pharyngeal raphe.

Anterior attachment to pterygomandibular raphe,

mandible, pterygoid hamulus.

pterygomandibular raphe CT 255 1034 Ligament.

Attaches to hamulus of medial pterygoid plate

and mylohyoid line of mandible.

stylopharyngeus muscle muscle 255 989 Innervated by CN IV. Elevates pharynx.

Originates to medial side of base of styloid

process. Inserts to pharyngeal wall.

glossopharyngeal nerve (CN IX) nerve 256 996

Sensory of the oropharynx and is the

afferent limb of the gag reflex.

Exits skull through jugular foramen, decends on

posterior surface of stylopharyngeus mm, goes

between superior and middle constrictors to

reach the posterior tongue, just inferior to the

palatine tonsil.

superior laryngeal nerve (internal

and external branches) nerve 256 996

External innervates cricothyroid mm,

pharyngeal plexus. Internal provides

sensory to epiglottis, base of tongue.

Branch of the vagus nn, with an internal and

external branch.

pharyngeal branch of the vagus

nerve nerve 256 996 Major motor nn of the pharynx.

Originates from upper part of the vagus nn's

inferior ganglion, above origin of superior

laryngeal nn.

uvula soft tissue 257 1041

Innervated by pharyngeal branch of

vagus nn.

The "punching bag" like thing dangling in the oral

cavity from the roof.

nasopharynx space 258 Posterior to the nose, superior to the soft palate.

oropharynx space 258

Posterior to the oral cavity, bounded superiorly by

soft palate and extends inferiorly to the epiglottis.

laryngopharynx space 258 Posterior to the larynx.

posterior nasal aperture (choana) space 258 1025

Transition region from nasal cavity to

nasopharynx. Separated by nasal septum. Region between nasal cavity and nasopharynx.

opening of the auditory tube space 258 992

Leads to the auditory tube, eustachian

tube.

Lateral wall of the nasopharynx, almost straight

posteriorly from the inferior choncha.

salpingopharyngeus muscle

(and/or fold) muscle 258 989

Raise pharynx and larynx in swallowing.

Can open the pharyngotympanic tube to

equalize pressure with pharynx and

auditory canal. Innervated by CN X.

Extends posteroinferiorly from the torus tubarius,

courses inferiorly and parallel with the

palatopharyngeus for a time.

pharyngeal recess space 258 992

Posterior to the opening to the pharyngotympanic

tube and torus tubarius.

palatoglossus muscle (and/or fold) muscle 258

992,

1041

Innervated by pharyngeal branch of

Vagus nn. Closes oropharyngeal isthmus,

prevents saliva from spilling into

oropharynx, assists swallowing.

Muscle arises from anterior surface of soft palate.

Divides oral cavity from oropharynx, just posterior-

inferior from the soft palate and posterior from

the base of tongue.

palatine tonsil soft tissue 258 989 Provides immunological surveillance. Seen in the superior pharyngeal constrictor mm.

palatopharyngeus muscle (and/or

fold) muscle 258 989

Innervated by pharyngeal branch of

Vagus nn. Pulls pharynx and larynx

upward over an incoming bolus of food

to prevent the food from going to the

nasopharynx.

Originates from palatine aponeurosis, inserts to

upper border of thyroid cartilage.

epiglottis larynx 259 999

Lies within larynx in breathing. During

swallowing, is part of anterior of

pharynx.

Leaf-shaped cartilage attached to posterior aspect

of thyroid cartilage.

Nose and Nasal Cavity

middle nasal concha Ethmoid 259 1017 Makes inspired air turbulent. Curved shelf of bone in the nasal cavity.

sphenoidal sinus Sphenoid 259 844

Paired paranasal sinuses inferior to the pituitary

gland.

perpendicular plate of palatine

bone Palatine 259 1022

Superiorly projecting portion of palatine bone just

lateral to the inferior and middle choncae.

sphenopalatine foramen Multiple bones 259 940

Transmits sphenopalatine aa, vv,

nasopalatine nn. Connects nasal cavity to pterygopalatine fossa.

perpendicular plate of the ethmoid Ethmoid 260 1017

Perpendicular flat sheet of ethmoid bone going

straight down from the cribiform plate, crista galli.

vomer bone 260

820,

1020

Bone that projects anterior-inferiorly from the

sphenoidal sinus, ending a little above the hard

palate on the medial wall of the nasal cavity,

connecting to the septal cartilage.

septal cartilage CT 260 1020 Thin cartilage that bisects the nasal cavity.

nasopalatine nerve nerve 260 1028

Supplies oral mucosa covering hard

palate.

Pass diagonally down the nasal septum (henc eon

the medial wall of the nasal septum) from

sphenopalatine foramen to the incisive canal.

sphenopalatine artery artery 260 1026

Supplies oral mucosa covering hard

palate.

Terminal branch of the maxillary aa in the

pterygopalatine fossa, enters nasal cavity by

passing medially through sphenopalatine foramen

and onto the lateral wall of the nasal cavity.

superior nasal concha Ethmoid 261 1017 Assists in making inspired air turbulent. Bony projection which sits high in the nasal cavity.

inferior nasal concha bone 261 1019 Assists in making inspired air turbulent. Bony projection which sits low in the nasal cavity.

nasolacrimal duct space 261 884 Drains the lacrimal sac.

Leads from the lacrimal sac inferiorly into the

bone.

semilunar hiatus space 261 1023

The floor of the hiatus has the opening of

maxillary sinus.

A crescent shaped groove covered by the middle

choncha.

opening of maxillary sinus space 262 1023 Opens to the maxillary sinus. Along the floor of the semilunar hiatus.

maxillary sinus Maxilla 263 1017

Roof is the floor of the orbit, with

mucosa innervated by infraorbital nn.

Floor is the alveolar process of maxilla.

Infero-lateral of the ethmoid bone, in the maxilla

bone, superior-lateral to the teeth.

Hard and Soft Palate

hard palate Multiple bones 263 820 Forms most of the roof of the oral cavity.

Composed of parts from the maxilla and palatine

bone.

incisive fossa (mislabelled as

foramen) Maxilla 263 820

Carries nasopalatine nn's,

sphenopalatine aa to supply the hard

palate mucosa.

A hole in the maxilla part of the hard palate,

located anteriorly and in the midline.

palatine process Maxilla 263 1032 Holds the incisive fossa.

Smooth ridge/plateau on either side of the

midline of the hard palate, along the anterior 2/3

of the hard palate.

horizontal plate of palatine bone Palatine 263 1032

Plate in the posterior third of the hard palate.

Holds the greater and lesser palatine foramina,

and eventually projects back the posterior nasal

spine.

lesser palatine foramen Palatine 263 820 Carries lesser palatine nn.

Posterolateral of the greater palatine foramen,

perforating the pyramidal process of the palatine

bone.

posterior nasal spine Palatine 263 820

Serves as attachment for musculus

uvulae.

A posteriorly projecting bump on the horizontal

plate of palatine bone.

pterygoid canal Sphenoid 263 941

Carries nn, aa, vv of the pterygoid canal.

The nn is formed from combination of

greater petrosal nn (facial nn, parasymp

pregang) and deep petrosal nn (symp

nn's). The parasymp's synapse in the

pterygopalatine ganglion, the symp's do

not.

Bony canal opening onto posterior surface of

pterygoid process, opens into middle cranial fossa

just antero-inferior to the internal carotid aa's

passage through the carotid canal.

medial pterygoid plate Sphenoid 264 820

Has a hamulus for the tensor veli palatini

mm. Comes off of the body of the sphenoid bone.

lateral pterygoid plate Sphenoid 264 921

Gives attachment for lateral pterygoid

mm.

Comes laterally off of the body of the sphenoid.

Do not confuse this with the greater wing of

sphenoid.

soft palate CT 264 810

Can be depressed to close orophayngeal

isthmus or elevated to separate

nasopharynx from oropharynx. Formed

by 5 mm's: tensor veli palatini, levator

veli palatini, palatoglossus,

palatopharyngeus, and musculus uvulae,

which are innervated by Vagus nn via

pharyngeal branch to pharyngeal plexus

(except tensor veli palatini, which is

mandibular nn V3).

Soft tissue that projects posteriorly from the hard

palate.

palatoglossus muscle mm - soft palate 264 1041

Innervated by Vagus nn, pharyngeal

branch to pharyngeal plexus. Depress

palate, moves palatoglossal arch towards

midline, elevates back of tongue.

Originates from inferior surface of palatine

aponeurosis, inserts to lateral margin of tongue.

palatopharyngeus muscle mm - soft palate 264 989

Vagus nn. Depress soft palate, move

palatopharyngeal arch towards midline,

elevates pharynx.

Originates from superior surface of palatine

aponeurosis, inserts to pharyngeal wall.

salpingopharyngeus muscle muscle 264 989 Vagus nn. Elevates pharynx.

Originates from inferior aspect of pharyngeal end

of pharyngotympanic tube, inserts to pharyngeal

wall.

stylopharyngeus muscle muscle 265 989 CN IX. Elevates pharynx.

Originates from medial side of base of styloid

process. Inserts to pharyngeal wall.

levator veli palatini muscle mm - soft palate 265 989

Vagus nn. Only mm that elevates the soft

palate proper above the neutral position.

Originates from petrous part of temporal bone,

anterior to opening for carotid canal. Inserts to

superior surface of palatine aponeurosis. Runs

parallel to and posterior to the tensor veli palatini

mm.

tensor veli palatini muscle mm - soft palate 265 989

Mandibular nn (V3) via branch to medial

pterygoid mm. Tenses soft palate, opens

pharyngotympanic tube.

Originates from scaphoid fossa of sphenoid bone,

inserts to palatine aponeurosis. Runs parallel to

and anterior to the levator veli palatini mm.

scaphoid fossa Multiple bones 265 820

Origin attachment point for tensor veli

palatini.

A depression between the medial and lateral

pterygoid plates.

hamulus of the medial pterygoid

plate Sphenoid 265 921

Tensor veli palatini mm's tendon slides

along the hamulus.

A small hook on the medial plate of pterygoid

process of sphenoid bone.

greater palatine nerve CN V2 265 1052

Gives general sensory and parasyp

innervation.

Branch of pterygopalatine ganglion, emerges

through greater palatine foramen and continues

onto inferior surface of hard palate.

greater palatine artery maxillary aa 265 1052 Supplies the mucosa of the hard palate.

Originates from maxillary aa in pterygopalatine

fossa, descends into palatine canal (giving rise to

lesser palatine branch), continues through greater

palatine foramen onto inferior surface of hard

palate.

greater palatine foramen Palatine 265 820 Transmits the greater palatine aa and nn.

Foramen on the horizontal plate of the palatine

bone.

lesser palatine nerve CN V2 266 1052

Gives general sensory and parasyp

innervation.

Follows the same course as the greater palatine

nn, though branches go back to the lesser palatine

foramen and project back to cover the soft palate.

descending palatine artery maxillary aa 266 946

Gives rise to greater and lesser palatine

aa's.

The maxillary aa gives off the descending palatine

aa which eventually branches into the greater and

lesser palatine aa's.

lesser palatine artery maxillary aa 267 1052 Supplies soft palate.

Projects posteriorly to the soft palate afte

rbranching off of the descending palatine aa,

going through the lesser palatine foramen.

pterygopalatine ganglion nerve 267 943

The largest parasymp ganglion in the

head, formed by cell bodies of the post-

ganglionic nn's associated with

preganglionic parasymp fibers of facial

nn carried by greater petrosal nn and nn

of pterygoid canal. Post-ganglionic symp

fibers pass through the ganglion, too, to

join the Maxillary nn (V2) on their way

out.

Ganglion that sits in the pterygopalatine fossa,

that divot just posterior to the superior lateral

corner of the maxilla bone.

nerve of the pterygoid canal nerve 267 944

Mainly carries preganglionic parasymp

and post-ganglionic symp fibers.

Formed in middle cranial fossa by greater petrosal

nn (CN VII) and deep petrosal nn (internal carotid

plexus). Passes into pterygopalatine fossa and

joins pterygopalatine ganglion.

infraorbital artery maxillary aa 267 946

Supplies parts of the face below the

orbit.

The maxillary aa continues forward, giving off the

descending palatine aa and posterior superior

alveolar aa's (inferiorly), the aa of pterygoid canal

and sphenopalatine aa's (superiorly), and

continues with the infra-orbital aa through the

inferior orbital fissure and emerges through infra-

orbital foramen.

Oral Region

epiglottic vallecula larynx 269 992

The recess serves as a "spit trap" to hold

saliva and prevent initiation of the

swallow reflex.

A recess/fold below the epiglottis, just behind the

root of the tongue.

geniohyoid muscle muscle 269 1040

Innervated by C1 (carried along with CN

XII). If mandible is fixed, pulls hyoid bone

forward. If hyoid bone is fixed, pulls

mandible down and in.

Deep to the mylohyoid mm. Originates from

inferior mental spine on inner mandible, inserts to

anterior surface of hyoid bone.

genioglossus muscle

mm - extrinsic

tongue 270

1038,

1040

Innervated by CN XII. Protrudes tongue,

depress center of tongue.

Originates from superior mental spine. Inserts to

body of hyoid and entire length of tongue. Deep

to the geniohyoid mm.

sublingual gland gland 270 1045 Mucus salivary gland. Mucosal gland just inferior to the tongue.

submandibular duct gland 270 1043

Drains saliva from the submandibular

and sublingual ducts.

Duct leading from submandibular and sublingual

ducts.

lingual nerve CN V3 270 1045

General sensation from oral part of

tongue, mucosa of floor of oral cavity,

gingiva of lower teeth. Carries parasymp

and taste fibers from oral part of tongue

that are part of facial nn CN VII.

Originates in infratemporal fossa, passes

anteriorly into floor of oral cavity through the gap

between mylohyoid, superior pharyngeal

constrictor, and middle pharyngeal constrictor

mm's. Loops under submandibular duct, ascends

into tongue on external and superior surface of

the hyloglossus mm.

submandibular ganglion nerve 270 1047

One of the four major parasymp ganglia

(along with otic, pterygopalatine, ciliary).

Post-ganglionic fibers leave ganglion and

go directly to the submandibular and

sublingual glands while others hop back

onto Lingual nn to target glands.

Just superior to the deep part of the

submandibular gland (which itself wraps around

the mylohyoid mm). Sits on the hyoglossus mm.

hypoglossal nerve (CN XII) CN XII 270 1043

All mm's of the tongue innervated by CN

XII except for the palatoglossus mm (CN

X).

CN XII passes between deep part of

submandibular gland and hyoglossus mm. Both

hypoglossal nn and lingual nn pass between

hyoglossus and mylohyoid mm to enter sublingual

region. The hypoglossal nn is inferior to the

lingual nn and goes lateral to the hyoglossus mm.

hyoglossus muscle

mm - extrinsic

tongue 270 1040 Innervated by CN XII. Depress tongue.

Originates from greater horn and body of hyoid

bone. Inserts to lateral surface of tongue.

styloglossus muscle

mm - extrinsic

tongue 270 1040

Innervated by CN XII. Elevate and retract

tongue.

Originates from styloid process. Inserts to lateral

surface of tongue.

Larynx

epiglottic cartilage cartilage 271 999

thyroid cartilage cartilage 271 998

superior cornu (horn) of the

thyroid cartilage thyroid cartilage 271 998

inferior cornu (horn) of the thyroid

cartilage thyroid cartilage 271 998

The inferior horn has a facet to articulate

with the cricoid cartilage.

Horns that are projecting inferiorly from the

thyroid cartilage. They also seem to curve a little

bit anteriorly.

cricoid cartilage cartilage 271 998

Articulates to the inferior horn of the

thyroid cartilage. Its superolateral facet

articulates with the base of arytenoid

cartilages.

A bulgous ring-like cartilage at the top of the

trachaea. Shaped like a signet ring.

arytenoid cartilage cartilage 271 1000

The anterolateral surface has a superior

attachment point for the vetstibular

ligament and an inferior attachment

point for the vocalis mm.

Small triangularly-shaped cartilages which

articulate at the superolateral facets of the cricoid

cartilage.

cricothyroid muscle

mm - intrinsic

larynx 272 1005

Innervated by external branch of

superior laryngeal nn (from Vagus).

Forward and forward rotation of thyroid

cartilage at cricothyroid joint.

Straight and oblique parts run between the

cricoid cartilage and inferior aspect of the thyroid

cartilage.

piriform recess larynx 272 1004

internal branch of the superior

laryngeal nerve nerve 272 1012

inferior laryngeal nerve (recurrent

laryngeal nerve) nerve 272 1012

posterior cricoarytenoid muscle

mm - intrinsic

larynx 272 1006

Recurrent laryngeal branch of Vagus nn.

Abduct and external rotation of

arytenoid cartilage.

Originates from oval depression on oval

depression on posterior surface of lamina of

cricoid cartilage. Inserts to posterior surface of

muscular process of arytenoid crtilage. The two

mm's form a sort of "U" which can be seen on the

posterior aspect of the cricoid cartilage and

arytenoid cartilage.

transverse arytenoid muscle

mm - intrinsic

larynx 272 1006

Recurrent laryngeal branch of Vagus nn.

Adduction of arytenoid cartilage.

Originates from lateral border of posterior surface

of arytenoid cartilage. Inserts to lateral border of

posterior surface of opposite arytenoid cartilage.

Forms a sort of transverse "wrapping" about the

posterior face of the arytenoid cartilages.

oblique arytenoid muscle

mm - intrinsic

larynx 272 1006

Recurrent laryngeal branch of Vagus nn.

Sphincter of laryngeal inlet.

Originates from posterior surface of mm proces of

arytenoid cartilage, inserts to posterior surface of

apex of adjacent arytenoid cartilage. The two

mm's form an "X" when the cricoid cartilage and

arytenoid crtilages are viewed from behind.

lateral cricoarytenoid muscle

mm - intrinsic

larynx 273 1006

Recurrent laryngeal branch of Vagus nn.

Internal rotation of arytenoid cartilage,

adduction of vocal folds.

Originates from superior surface of arch of cricoid

cartilage. Inserts to anterior surface of mm

process of arytenoid cartilage. Somewhat

resemble slender "wings" falling away and

forward along the lateral edge of the cricoid

cartilage.

thyroarytenoid muscle

mm - intrinsic

larynx 273 1007

Recurrent laryngeal branch of Vagus nn.

Sphincter of vestibule and laryngeal inlet.

Originate from thyroid angle and adjacent

cricothyroid ligament. Insert to anterolateral

surface of arytenoid cartilage. Forms a broad

band of mm running parallel to the ground.

rima glottidis larynx 273 1006

Not to be confused by the Rima Vestibuli,

which is defined by the Vestibular Folds

(the "false" vocal cords).

A narrow triangular opening between the vocal

cords.

vestibule of larynx larynx 274 1004

Portion of the laryngeal cavity which is superior to

the vestibular folds.

ventricle of larynx larynx 274 1004

A depression between the vestibular fold and the

vocal fold. Kinda "flaps" or folds out to either side.

Just superior to the Rima Glottis.

infraglottic cavity larynx 274 1004

Space inferior to the vocal folds and continuous

with the trachaea.

vestibular folds larynx 274 1004

The "false" vocal cords, define the ridge

of the Rima Vestibuli and are superior to

the Rima Glottidis/Vocal Folds. Mucosa that overlies the vestibular ligament.

vocal folds larynx 274 1004

The "true" vocal cords, define the Rima

Glottidis. Mucosa that overlies the vocal ligament.

Ear

groove for the greater petrosal

nerve Temporal 275 825 Carries the greater petrosal nn.

A groove a bit posterior to the triad of foramen

rotundum/ovale/spinosum, running somewhat

parallel to it.

internal acoustic meatus Temporal 275 826

Carries CN VII and VIII towards inner and

middle ear.

In the anterior portion of the internal acoustic

meatus, just anterior and a little superior to the

jugular foramen.

stylomastoid foramen Temporal 275 820

Carries CN VII and the stylomastoid aa.

Bell's Palsy may result from inflammation

or impingement of the facial nn here.

When looking at the inferior skull, a foramen on

the temporal bone just posterior to the base of

the styloid process.

jugular fossa Temporal 275 820 Lodges the bulb of the internal jugular vv.

When viewing the inferior skull, just medial to the

base of the styloid process, posterior to the

carotid canal.