HUMAN ANATOMY

Is easy to study

Head
Summary (2014-2015)

Dr. Mohamel9ha6 r.f-lin Mosfafa

[Dr. 9ha61lnafon1j}
ProfeJ'J'orof 1lnafon1j
Cairo 1Jniversit:J
I~~Idr_ihab_anatomy70@yahoo.com Mohamed Ihab EI-din

cp Dr. Ihab Anatomy Cairo Univ fD Mohamedihab70

(e learning)

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 Index
Bones Page
- Mandible ! 1
- Important points related to the skull & Skull of the newly born , 2
- Foramina and structures passing through " 4
- Hyoid bone 8

Scalp, face & parotid

- The scalp l 1
- Face 2
- Parotid gland ..1.
, 5

Infratemporal fossa
- Muscles of mastication ! 8
- Teporomandibular joint 9
- Mandibular nerve 10
- Otic ganglion [ 11
- Submandibular ganglion & Maxillary nerve .12
_ Sphenopalatine ganglion 13
- Maxillary artery ' 14
- Pterygoid venous plexus 15
Cranial cavity I
- Dural folds 16
- Dural sinuses ..1. 17
- Cavernous sinus 17
- Emissary veins 18

Orbit
- Extra-ocular muscles 19
- Ophthalmic artery ..19
- Nerves of the orbit 20
- Ciliary ganglion L 21

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Chapter 1:Skull Summary

The Mandible
1
•
Structures related to mandible
A) Three glands related: 1. Sublingual salivary gland: is related to sublingual fossa.
2. Submandibular salivary gland: is related to submandibular fossa.
3. Parotid salivary gland: is related to the posterior border of the ramus.
B) Four liaaments attached' ,
Ligament Mandibular attachment Other attachment
1. Stylomandibular Angle of the mandible Styloid process
2. Sphenomandibular Lingula Sphenoid spine
3. Temporomandibular Posterolateral surface of neck Root of the zygomatic arch
4. Pterygomandibular Posterior end of myelohyoid line Pterygoid hammulus

c~ Five muscles are inserted:

Muscle Attachment
1. Masseter Outer surface of ramus & coronoid process.
2. Temporalis Tip, anterior border & inner surface of coronoid process.
3. Medial pterygoid Rough area on the inner surface of the angle.
4. Lateral pterygoid Anteromedial surface of the neck (pterevqold fovea).
5. Platysma Lower part of the outer surface.
D)S·IX muse Ies ta k e or/am:
Muscle Attachment
1. Myelohoid Mylohoid line (whole lenqth),
2. Superior constrictor of pharynx Mvlohoid line (posterior end).
3. Anterior belly of digastric Diqastric fossa.
4. Genioglossus Upper qenial tubercle.
5. Geniohyoid Lower genial tubercle.
6. Buccinator Outer surface of sockets of molars.
E) Six nerves are related:

.';-.1,.- ",,-Submandibular
fossa fur fue gland
Sup. cOli\s~rictor of pharynx (0)
MyelQhyoid (0)
i\nt. beUy of digastric (0)

____________ ..J
 Chapter 1:Skull Summary 2

E) Six nerves are related:

- 2 nerves are related to the neck:
1. Masseteric nerve: passes laterally in the mandibular notch.
2. Auriculo-temporal nerve: passes backwards medial the neck of the mandible.
- 2 nerves are related to foramina:
1. Inferior alveolar nerve: enters the mandibular foramen.
2. Mental nerve : emerges from the mental foramen.
- 2 nerves are related to grooves:
1. Lingual nerve: passes in the groove below the last molar.
2. Myelohyoid nerve: in myelohyoid groove.
F) Six arteries are related:
1. Facial artery: winds around the lower border of the body of the mandible, 1 inch in front of
the angle. It is related also to the submandibular fossa.
2. External carotid artery: ends deep to the neck of the mandible, dividing into:
a) Maxillary artery. b) Superficial temporal artery.
3. Inferior alveolar artery: enters the mandibular foramen.
4. Mental artery: emerges from the mental foramen.
5. Masseteric artery: passes laterally through the mandibular notch.
6. Myelohyoid artery: runs in the myelohyoid groove.

Important points related to the skull

1. Nasion: Point at the root of the nose.
2. Glabella: Above nasion between 2 superciliary arches.
3. Bregma: Junction of coronal & sagittal sutures.
4. Vertex: Highest point of skull.
5. Lambda: Junction of sagittal & lambdoid suture.
6. Inion: Center of external occipital protuberance.
7. Pterion: Lies 3.5 cm behind and 1.5 cm above the fronto-zygomatic suture, it marks the
anterior branch of middle meningeal artery.
8. Asterion: Lies at the junction of parietal, occipital and mastoid part of temporal-bone, it marks
the highest point of transverse sinus. -

Skull of the newly born

1. The face Icranium ratio is 1/8 as compared to Y2 in the adult.
This is due to small maxillary bones, maxillary sinuses, nasal cavity and non-eruption of teeth.
2. The frontal and parietal eminences are well apparent.
3. The glabella, superciliary arches and mastoid processes are not well developed.
4. There is a frontal metopic suture: Closes at 2-8 years. It exists in skull of (black races) Negroes.
5. Orbital cavities are relatively large.
6. Internal & middle ears and mastoid antrum are almost adult in size.
7. Mandible at birth has 2 halves, mental foramen near upper border & angle was obtuse.

-----~---- -- -- ----
Chapter 1:Skull

6. Ossification of skull bones is not complete as a result of presence of six fontanelles:

a) Anterior fontanelle, the largest, It is diamond-shaped measuring 4 cm in its anteroposterior
diameter and 2.S cm in
the transverse diameter.
It closes at 18 months at
bregma.
b) Posterior fontanelle, is
triangular in shape and
is situated at junction of
sagittal and lambdoid
sutures. It closes at
(birth-3 months) at the
lambda.
c) 2 sphenoid fontanelles,
close at 3 months at the
pterion.
d) 2 mastoid fontanelles,
close at end of the 1st
year at the asterion.
Importance of the
fontanelles:
1. Determination of position
during delivery.
2. Delayed closure of
fontanelles (in rickets).
A- Anterior V. B- LateralV. C- Posterior V. 0- UpperV.
3. Bulging fontanelles occur
1-Anterior fontanelle. 2- Posterior fontanelle.
if the intracranial pressure
3- Sphenoidfontanelle. 4- Mastoidfontanelle.
increases.
5- etopic suture. 6- Frontal bone 7- Parietalbo e
4. Depressed fontanelles 8- Occipital bone. 9- Sagittal suture 10- Coronal suture
occur in dehydration. 11- Lambdoidsuture
S. Anterior fontanelle may
be used for injection of fluids or blood in SSS.

Sex differences of the skull

Till
puberty, there are little differences between the skulls of the two sexes, but female skull is:
1)Smaller (small paranasal sinuses).
2)Lighter in weight.
3)More smooth with less prominent bony ridges (e.g. superciliary arches, glabella, nuchal
lines & ext. occipital protuberance).
4) The mastoid processes and occipital condyles are smaller.
Applied anatomy of the skull
- Fracture of the skull base at the anterior cranial fossa ~ leakage of CSF & blood from the nose.
- Fracture of the skull base at the middle cranial fossa ~ leakage of CSF & blood from external
auditory meatus & 7th and 8th cranial nerves injury.
- Fracture of the skull base at the posterior cranial fossa ~ leakage of blood from back of the
neck due to injury of sigmoid sinus.
Chapter 1: Skull Summary 4

Foramina and Structures Passing Through in Skull

I &II-Norma Verticalis & Occipitalis
FORAMEN STRUCTURES PASSING

1 Parietal emissary F. Parietal emissary V.(between SSS & occipital venous plexus)
2 Mastoid emissary F. - Mastoid emissary V.(between sigmoid sinus & occipital venous
plexus)
- Mastoid branch of occipital artery.

III & IV-Norma Frontalis & Lateralis

FORAMEN STRUCTURES PASSING

1 Supratrochlear notch or F. Supratrochlear nerve and vessels.

2 Supraorbital notch or F. Supraorbital nerve and vessels.
3 Zygomaticofacial F. Zygomaticofacial nerve and vessels.
4 Zygomaticotemporal f. Zygomaticotemporal nerve and vessels.
5 Inferior orbital fissure 1- Infraorbital (maxillary) N. & V. 2- Zygomatic N. &v.
3- Orbital nerves to sphenopalatine ganglion.
4- Communicating veins between ophthalmic veins &
pterygoid venous plexus.
6 Pterygo-maxillarv fissure. Maxillary N. & V.
7 Post. sup. alveolar foramen Posterior superior alveolar N. & V.

V-Norma Basalis Externa

FORAMEN STRUCTURES PASSING

1 Greater palatine F. Greater palatine nerve and vessels

2 Lesser palatine F. Lesser palatine nerves and vessels
3 Incisive fossa has:
a) 2 lat. foramina: Greater palatine vessels.
b) 2 median formina: Right and left nasopalatine nerves.
4 Foramen ovale. 1- Main trunk of mandibular N. 2- Motor toot of trigeminal nerve.
3- Middle meningeal vein. 4- Accessory meningeal artery.
5- Lesser superficial petrosal N. 6- Emissary vein.
5 Foramen spinosum. 1- Nervus spinosus. 2- Middle meningeal artery.
6 Foramen lacerum. 1- Meningeal br. of ascending pharyngeal- A. 2- Emissary vein.
7 Carotid canal. 1- I.C.A. & sympathetic plexus. 2- Deep petrosal N.
3- Emissary vein.

- -- -- --- - -----
 Parietal bone

Nasal
bone

Temporal bone
Sphenoid bone
Zygomatic bone
Maxillary bone
Mandi Ie
Fig. 5: Norma Lateralis (bones forming it)

1- Superior temporal line. 2- Inferior temporal line.

3- Squamous part of the teporal bone.
5- Temporal process of zygomatic
7- Supramastoid crest
9- Tangent line of ext. aud. meatus
11- Squamous part of temporal bone
13- Asterion
15- Styloid process of temporal bone
4- Greater wing of sphenoid
6- Zygomatic process of temporal
8- External auditory meatus
10- Posterior border of ext. aud. meatus
12- Pterion
14- Mastoid process temporal bone
16- Tympanic part of the temporal bone

Fig.6: Norma lateralis (features)

~------------------------------------------------------ ---
Chapter 1: Skull
8- Jugular foramen:
a) Ant.med. com part:
b) Middle com part. :
c) Postero.lat. com part:
9 Stylomastoid foramen.
10 Hypoglossal canal.
11 Foramen magnum.
12 Vomerovaginal canal
13 Palatovaginal canal
14 Pterygoid canal
15 Tympanic canaliculus
16 Mastoid canaliculus
VI- Norma Basalis Interna
FORAMEN
1 Foramen caecum.
2 Cribriform plate of the
ethmoid.
3 Optic canal.
4 Superior orbital fissure.
5 Foramen rotundum.
6 Internal auditory
meatus.
Summary 5
-* Inferior petrosal venous sinus.
* IX, X, XI cranial nerves.
* End of sigmoid sinus and beginning of I.JV.
1- Facial (VII) N.
2- Stylomastoid branch of occipital or post. auricular A.
1- Hypoglossal (XII) nerve. 2- Emissary vein.
Nervous structures: 1. Medulla oblongata.
2. Spinal accessory nerves. 3. Tonsils of cerebellum
4. Sympathetic plexus around arteries
Vessels: 1. Anterior and posterior spinal arteries.
2. Vertebral plexus of vein.
Ligaments: Apical & vertical limb of cruciate ligaments
Membrana tectoria.
Meninaes: pia, arachnoid & dura maters.
Is blind or for: pharyngeal branch of maxillary A.
1. Pharyngeal nerves to sphenopalatine ganglion.
2. Pharyngeal branch of maxillary A. in most cases.
Vidian N. & A.
Tympanic branch of glossopharyngeal N.
-,I
l
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Auricular branch of vagus N.
STRUCTURES PASSING
Emissarv vein connecting SSS with nasal veins.
1- Olfactory (I) nerve.
2-Anterior ethmoidal nerve and vessels.
t-Ootle (II) nerve. 2- Ophthalmic artery.
Nerves: 1. Lacrimal N. 2. Frontal N. 3. Troch!ear N.
4. Superior division of-oculomotor N. 5.Nasociliary N.
6. Inferior divisions of oculomotor N. 7. Abducent N.
Two Ophthalmic veins Recurrent branch of lacrimal A.
I
Maxillary branch of the trigeminal nerve.
1- Facial (VII) and auditory (VIII) nerves.
2- Internal auditory br. of basilar artery.
 _ Maxillary bone Vomer bone _ Occipital bone

'-- __ -II Palatine bone _sphenoid bone_ Temporal bone

_ Zygomatic bone
Groove for gr. palatine N. & V.
Posterior nasal opening & spine
Pterygoid hamulus
Pterygoid fossa
Lat. pterygoid plate Maxillary tuberosity
Infratemporal surface & crest
of gr. wing of sphenoid

vaginal process of
med. pterygoid plate

Sphenoid spin Petrosquamous sulcus

Articular _
Petrotympanic sulcus
eminence quamotympanic sulcus
Mandibular fos

Rough quadrate area

Styloid
process

Inferior nuchal line

FIg.7: onna ma(featu188)

----~.~~
Chapter 1: Skull Summa-ry 6

Important Attachments in Skull

I & II -Normae Verticalis & Occipitalis
AREA STRUCTURES ATTACHED
1 External occipital crest Base of ligamentum nuchae
2 External occipital 1. Origin of trapezius. 2. Ligamentum nuchae.
protuberance 3. Epicranial aponeurosis. 4. Investing fascia of the neck.
3 Highest nuchal line 1. Epicranial aponeurosis. 2. Occipital bellies of occipitofrontalis.
4 Superior nuchal line 1. Origin of trapezius. 2. Insertion of sternomastoid.
- -
3. Insertion of splenius capitis 4. Investing fascia of the neck.
5. Structures attached to highest nuchal line, if absent.

In &IV - Normae Lateralis & Frontalis

AREA STRUCTURES ATTACHED
1 Floor of the temporal fossa. Origin of the temporalis muscle
--
2 Superior temporal line. 1. Epicranial aponeurosis. 2. Temporal fascia.
Inferior temporal line Origin of temporal is.
3 Zygomatic arch. - Upper border: attachment of the temporal fascia.
- Lower border & deep surface: origin of masseter.
---
4 Infratemporal surface and crest of Origin of the upper head of lateral pterygoid muscle.
greater wing of sphenoid bone.
-~-- _. ---- - --
S Outer surface of lat. pterygoid plate. Origin of the lower head of lateralptervgoid muscle.
6 Inner surface of tat. pterygoid plate. Origin of the deep head of medial ptervqoid muscle. I

7 Maxillary tuberosity. O. of superficial head of medial pterygoid muscle.

8 Outer surfaces of the sockets for Origin of the upper fibers of the buccinator muscle.
the 3 molar teeth of the maxilla.
9 Mastoid process. 1- Insertion of: sternomastoid, splenius capitis &
- --
longissimus capitis muscles.
2- Origin of: posterior belly of the diqastric muscle.
10 Styloid process. 1- Ligaments: stylomandibular and stylohyoid.
2- Muscles: styloglossus, stylohyoid &
stvlopharvnqeus. ,
11 Supramastoid crest Epicranial aponeurosis. I
 21 1 234
Norma Basalis Interna
- 1- Tuberculum sellae & hypophyseal fossa.
3- Anterior clinoid process.
5- Groove for middle meningeal A.
- 7- Crista galli.
9- Free margin of the lesser wing of sphenoid.
- 11- Foramen lacerum.
13- Fossa for trigeminal ganglion, arcuate eminence & tegmen tympani.
14-lnternal auditory meatus.
_ 16- Petrous temporal bone.
18- Jugular foramen.
20- Skull clivus & inferior petrosal sulcus.
5 20
19
.16
17
18
2- Optic groove & optic canal
4- Dorsum sellae & posterior clinoid process.
6- Orbital plate of frontal bone.
8- Cribriform plate of ethmoid & jagum
sphenoidale.
10- Superior orbital fissure.
12- Foramen rotandum.
15- Anterior condylar (hypoglossal) canal.
17- Sigmoid sulcus.
19- Supereior petrosal sulcus.
21- Frontal crest.
 - --

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Norma Basalis Interna

Chapter 1:Skull Summary 7

v - In Norma Basalis externa

AREA
1 Pterygoid hamulus.
2 Scaphoid fossa.
3 Rough quadrate area on under
surface of petrous bone.
4 Spine of sphenoid.
5 Articular eminence.
6 Pharyngeal tubercle.
7 Sulcus tubi.
STRUCTURESATTACHED&REL.
1. Origin of superior constrictor of pharynx.
2. Attachment of pterygomandibular raphe.
Origin of the tensor palate muscle.
Origin of the levator palate muscle.
1. Origin of the tensor palati muscle.
2. Attachment of the sphenomandibular ligament.
Attachment of the temporomandibular liqament.
Attachment of the median raphe of pharynx.
Auditory (Eustachian) tube.

VI - In Norma Basalis Interna

AREA STRUCTURESATTACHED&REL.
1 Frontal crest and crista galli. Attachment of the apex of the falx cerebri
2 Anterior clinoid process. Free border of tentoriumcerebelli & diaphragma sellae.
3 Posterior clinoid process. Attached border of tentorium cerebelli and
diaphragma sellae.
4 Superior petrosal & transverse sulei Attached border of the tentorium cerebelli.
-
5 lnternal-occlpital crest, - 1. Falx cerebelli. 2. Occipital sinus.
6 Internal occipital protuberance. Confluence of sinuses.
7 Side of sphenoid body. ICA inside cavernous sinus.
8 Trigeminal impression. 1. Triqeminal oanqlion. 2. Cavum triqeminale.
9 Superior petrosal sulcus. Superior petrosal sinus.
10 Inferior petrosal sulcus. Inferior petrosal sinus.
11 Clivus. 1. Midbrain. 2. Basilar venous sinus.
1.2 Margin-ooflesser wing of spheno-id. Sphenop-arietal sinus. .
1.3 Superior sagittal sulcus. Superior saqittal sinus.
Parts of Important Bones in Skull
1. Frontal bone. 1. Vertical plate. 2. Orbital plate. 3. Nasal process. 3.Zygomatic pro
2. Maxillary bone. t. Vertical plate. 2. Orbital plate. 3. Nasal process. 3.lygomatic pro
4. Alveolar process. 5.Palatine process.
3. Zygomatic bone. Body and frontal, maxillary and temporal processes.
4. Temporal 1. Squamous ~art. 2. Mastoid process....----3. Petrous part.
bone. 4. Tympanic part. 5. Styloid process.
5. Occipital bone. 1. Squamous part. 2. Occipital condyles. 3. Lateral parts. 4. Basilar part.
 Chapter 2: The Scalp, Face and Parotid gland Summary 1
-
The Scalp
Nerve supply of the Scalp
In front of auricle: A) Sensory (from trigeminal n.): ~--------------------------~
1- Supratrochlear nerve: It supplies medial part of upper
eyelid and related area of the forehead.
2- Supraorbital nerve:lt supplies middle part of upper
eyelid & related area of forehead till lambdoid suture.
3- Zygomaticotemporal n.: Supplies ant. part of temple.
4- Auriculotemporal nerve: It supplies the auricle (upper
% of the lateral surface) & temple (posterior part).
B) Motor:
5- Temporal branch of facial nerve:
- It supplies frontal belly of occipitofrontalis & upper part
of the orbicularis oculi.
Behind the auricle: A) Sensory:
1- Lesser occipital N.: Supplies upper % of med. surface
of the auricle & scalp close to it.
2- Great auricular nerve: It supplies the skin over angle
of the mandible and parotid gland.
3- Greater occipital N: To upper part of back of the scalp (thickest cutaneous nerve in the body).
4- 3rd occipital nerve: It supplies lower part of back of the scalp & upper part of back of the neck.
B) Motor:
5- Posterior auricular branch of facial nerve: to occipital belly of occipitofrontalis.
Arterial supply of the scalp
2 Arteries supply its anterior part: 1. Supratrochlear & ~. Supraorbital arteries:
- Both arise from ophthalmic branch of ICA.
- They supply the anterior part of the scalp.
2 Arteries supply its posterior part:
;!. Posterior auricular & 1:,. Occipital arteries:
- Both arise from back of external carotid A.
- They ascend backwards along the posterior belly of
digastric. They supply back of the scsalp.
1 On side of the scalp: §.. Superficial temporal artery:
- It is the smaller of the 2 terminal branches of ECA
-It comes out from upper pole of the parotid gland.
-It crosses the root of the zygoma for 5 cm.
-Branches:
1- Anterior auricular: To auricle & external auditory
meatus.
2- Middle temporal: To temporalis muscle. 3- Parotid branches: To parotid & TMJ.
4- Transverse facial: To the face. 5- Zygomatico-orbital: To the face.
6- Terminal branches (frontal and parietal).
 Chapter 2: The Scalp, Face and Parotid gland Summary 2

Venous Drainage of the Scalp

1,2- Supratrochlear & Supraorbital veins:
- They drain the anterior part of the scalp.
- Both unite at the medial angle of the eye forming the facial
(anterior facial vein).
3- Superficial temporal vein:
- It drains the lateral part of the scalp.
- It unites with the maxillary vein to form the retromandibular
(posterior facial) vein.
4- Posterior auricular vein:
- It drains back of the scalp.
- It descends behind the auricle, JOinS posterior division of
retromandibular vein to form the EJV.
5- Occipital vein:
- It drains back of the scalp.

The Face
Muscles of the Face
1. Orbicularis oculi muscle three parts: Medial palpebral lig.amen!
Orbicu lari s
Orbital part (thickest part, surrounds the orbital margin). (lctJlimusc.le

Orig~n: 1. ~ed~al palpebral lig('" {!::}2. Bones above & below it.
Insertion: Lower aspect of medial palpebral ligament & eye brow.
Action: Firm & sudden closure of the eye (as in danger).
Palpebral part (Thin, in the eyelids).
Origin: - Medial palpebral ligament.
Insertion: - Fibers interlace at the lateral palpebral raphe.
Action: Gentle closure of the eye (as in sleep).
Lacrimal part
Origin: From posterior lacrimal crest & fascia covering lacrimal sac.
Insertion: Tarsi of both eyelids.
Action: Draws eye lids medially and dilates lacrimal sac, so it helps drainage of tears.
\ Nerve supply] Temporal and zygomatic branches of facial nerve. ,....------------,
2. Buccinator muscle:
Origin (3 parts):
- Upper part: Alveolar process of maxilla opposite
upper 3 molars.
- Lower part: Alveolar process of the mandible
opposite lower 3 molars.
- Middle part: Pterygo mandibular ligament.
Insertion:
- The upper & lower most fibers pass into the corresponding lip.
- The middle fibers decussate at the mouth angle.
 Chapter 2: The Scalp, Face and Parotid gland Summary 3

Nerve supply: Buccal branch of facial nerve.

_ Actions: The muscle is an accessory muscle of mastication, 'f~
1. It prevents accumulation of food in mouth vestibule & dribbling of saliva.
2. Sucking in infants. 3. Whistling & bloyving of mouth. ,....----------,.----,
- Relations: ·t-
* Deeply: Buccal mucosa.
* Superficially: 1- Buccopharyngeal fascia. 2- Facial A. & V.
3- Buccal pad of fat. 4- Buccal branches of facial N.
5- Parotid duct, which pierces it.
* Pierced by: Parotid duct, buccal N. & vessels.
3. Orbicularis Oris: It consists of intrinsic & extrinsic parts:
Nerves of the Face
The sensory nerve supply of the face comes from 2 sources:
1. Trigeminal nerve (main supply). 2. Great auricular N. (to skin over angle of the mandible) (10).
- Supply of trigeminal nerve to scalp and face:
-=:::;:::-;:;--:::::====::-
a) The area supplied by ophthalmic division of trigeminal nr.e-;rv;:::e::: __ ---,
1, 2- Supratrochlear (1) & supraorbital (2) nerves (of
frontal): To the forehead.
3- Palpebral branch of lacrimal nerve (3): To lateral part of
upper eyelid.
4- Infratrochlear nerve (of nasociliary) (4): To upper part of
the dorsum of the nose.
5- External nasal nerve (of nasociliary) (5): To lower part of :~~~~~:IIN'
the dorsum of the nose.
b) Area supplied by maxillary div. of trigeminal nerve:
1- Infraorbital (6): It supplies the lower lid (palpebral), side
(ala) of the nose (nasal) and upper lip (labial).
2- Zygomatico-facial (7): It supplies skin of bony cheek.
c) The area supplied by mandibular div. of trigeminal nerve:
1- Buccal nerve (8): It supplies the skin covering and mucosa lining buccinator.
2- Mental nerve (9): To the chin and lower lip.
The motor nerve supply of the Face
Facial nerve emerges from stylomastoid foramen.
It winds around styloid process, enters posteromedial
surface of parotid.
Branches of facial nerve in scalp & face:
A) Before parotid:
1- Posterior. auricular N.: To occipitalis muscle.
2- Descending branch: To posterior belly of digastric &
stylohyoid.
B) 5 Terminal branches (within parotid):
Temporal br.: To: frontalis & upper part of orbicularis oculi.
Zygomatic branches (2): Platysma
Motor nerve supply of the face
 Chapter 2: The Scalp, Face and Parotid gland Summary 4
-
- Upper zygomatic: To lower part of orbicularis oculi.
- Lower zygomatic: To nasal muscles.
Buccal branch: It supplies: buccinator & orbicularis oris.
Mandibular branch: Emerges from the anterior border of parotid to orbicularis oris. I
I
i
CervicClI branch: Emerges from the anterior border' of parotid to platysma. I .

Arterial supply of the face

1- Facial artery (in the face):
- It arises from anterior aspect of ECA.
- It enters the face along the antero-inferior angle of masseter muscle, 1 inch in front of the angle
of the mandible.
- It ascends on buccinator, in front of the facial vein in a wavy course (to allow for facial expression).
- It runs 1 cm behind the mouth angle, ala of the nose.
- It ends near medial angle of the eye as angular artery.
- Branches of the facial artery in the face:
1- Inferior labial: To lower lip.
2- Superior labial: To upper lip, gives septal branch to
nasal septum.
3- Nasal: To the nose.
4- Angular: To the medial angle of the eye.
2- Transverse facial artery:
- It arises from superficial temporal artery.
- It passes transversely over masseter, below the
zygomatic arch & above the parotid duct.
- 3- Zygomatico-orbital: (From superficial temporal artery). It
supplies the orbicularis oculi. vein
4- Infra orbital: emerges from infraorbital foramen.
5- Buccal: It supplies the skin of the cheek.
6- Mental: to the chin & lower lip.
7- Supratrochlear & supraorbital branches of ophthalmic A. to upper eye lid.
8- Dorsal nasal branches of ophthalmic A. to dorsum of the nose.
Venous drainage of the face
1- Facial (anterior facial) vein:
It is formed at the medial angle of the eye by the union of
supratrochlear & supraorbital veins.
It descends on the side of the nose and backwards behind the
facial artery. (vclv--oMO(r1Ji b",\~,<)
It ends by joining the anterior division of posterior facial vein to
form the common facial vein.
Tributaries:
1- Supratrochlear & supraorbital veins.
2- Veins from the submandibular gland.
3- Deep facial vein: to pterygoid venous plexus.
 Chapter 2: The Scalp, Face and Parotid gland Summary 5

4- Tonsillar veins: from palatine tonsils.

NB - Dangerous area of the face:
* The area drained by the facial vein (area around the nose & upper lip) is called the dangerous area of
the face, as infection here can reach the brain via the cavernous sinus.
* The facial vein communicates with the cavernous sinus by the superior ophthalmic vein and with
pterygoid venous plexus through the deep facial vein. From the plexus an emissary vein reaches the
cavernous sinus through the foramen ovale.
2. Retromandibular (Posterior facial) vein:
It is formed inside the parotid gland by union of maxillary & superficial temporal veins.
It ends near the lower pole of the parotid by dividing into:
1- The anterior branch: unites with the anterior facial vein to form the common facial vein (largest
tributary of IJV).
2- The posterior branch: unites with the posterior auricular vein to form the external jugular vein.

Parotid G land (The largest salivary gland)

Surface anatomy:
a) Upper pole: Is represented by a concave line along the
external auditory meatus from mandibular head, in front of
the tragus (point 1) to center of mastoid process (point 2).
b) Posterior border: Is represented by a straight line from the
center of mastoid process (point 2) till a point 2 cm below,
behind angle of the mandible (point 3).
c) Anterior border: Is represented by a curved line extending
from the mandibular head (point 1) to the middle of the
masseter muscle (point 4) and then downwards and
backwards to a point 2 cm below and behind the angle of the
mandible (point 3).
d) Parotid duct: Is represented by middle third of a line
extending from the tragus to a point midway between ala of
the nose and the red margin of the upper lip (point 5).
General features and relations: It is formed of:
1- Main part: Wedge-shaped
2- Deep part: Deep to the mandible
3- Accessory part: Along parotid duct, superficial to the masseter.
The superficial part has 3 surfaces, 2 poles (ends) & 2 borders:
1. Lateral (superficial) surface:
It is related to: Skin, superficial fascia with great auricular nerve & superficial parotid LNs in it.
2. Anteromedial surface: It is related to:
1- Ramus of the mandible .
••
2- :4asseter: on outer surface of the ramus.
3-Jtedial pterygoid muscle on inner surface of the angle.
- This surface is pierced by ~xillary vessels.
3. Posteromedial surface: Related to:
- 2 Processes: mastoid & styloid (with structures attached to it).
 Chapter 2: The Scalp, Face and Parotid gland Summary 6
-
- 2 Muscles (attached to mastoid process): sternomastoid & posterior belly of digastric.
- Carotid sheath containing:
- 2 vessels (ICA & IJV). Mastoid Styloid
process
Medial
pterygoid
process

- The last 4 cranial nerves.

This surface is pierced by facial N. & ECA.
4. Upper pole (end) is related to:
a) Superficial temporal V. b) Superficial temporal A.
c) Auriculotemporal n. d) Ext. auditory meatus & TMJ.
5. Lower pole (end) is related to:
a) ECA. b) 2 branches of retromandibular vein.
c) Cervical branch of facial nerve.
d) Posterior belly of digastric.
6. Posterior border is related to mastoid process &
sternomastoid.
7. Anterior border (in order):
a) Temporal branch of facial nerve.
b) Zygomatic branches of facial nerve. Su'rtaces 0
c) Transverse facial artery (above the duct). ?hab
d) Parotid duct (leaves), with the accessory part.
e) Buccal branches of facial nerve (below the duct).
Temporal
f) Mandibular branch of facial nerve (leaves).
Structures within parotid: From superficial to deep:
A) Facial nerve:
- It enters the posteromedial surface of the gland.
- It divides into its 5 terminal branches emerging from behind the
anterior border.
B) Retromandibular vein:
- It descends in the gland then divides near the lower pole into
anterior and posterior branches.
C) External carotid artery:
- It enters the gland through its posteromedial surface.
- It ascends in the gland.
- It divides opposite the neck of the mandible into superficial
temporal and maxillary arteries.
D) Deep parotid LNs: around the vessels.
Parotid duct (Stensen's duct):
- It appears at anterior border of the gland at level of the ear lobule.
- It is about 5 cm in length (thick wall, narrow lumen).
- It is accompanied by: 1. Accessory part.
2. Buccal nerve. 3. Transverse facial artery.
- It pierces: a. Buccal pad of fat.
b. Buccopharyngeal membrane. c. Buccinator muscle.
d. Buccal mucosa (opposite the upper 2nd molar).
-.~~~~~~~~~~~~~~~~~~~~~
Chapter 2: The Scalp, Face and Parotid gland Summary 7

Nerve supply of parotid gland

Sensory: 1- Auriculotemporal nerve to the gland itself. 2 - Great auricular nerve to parotid fascia.
Sympathetic: Plexus around external carotid and middle meningeal arteries.
Parasympathetic:
- Glossopharyngeal nerve receives parasympathetic fibers from inferior salivary nucleus in
medulla oblongata.
- Glossopharyngeal nerve gives tympanic branch (Jacobson's N.) which reaches middle ear via
tympanic canaliculus.
- It forms tympanic plexus which gives lesser superficial petrosal N. which traverses F. ovale.
- - It relays in the otic ganglion, postganglionic fibers join the auriculotemporal nerve to parotid.

In/pl lor .S2:l/iv~!XI c /etv.J

'#---~----:::tn GlossoPj!'!Jf7gea/

TYmpanIc l»:

Hiddle
ear

~l{pe (}i 6 CA \ O\f'~ d-ee P 'f'()\'(of.;

~e~ -b-cJ d--eef ~ Y-J\ c~.

 Chapter 3: The Infratemporal Fossa Summary 8 ~~-!i}<il.:.i
- .» (YV~yi{cte U'af+--; tevY'(,u'(rAti<; dU elev~~ e-KC€r~
rliJt?«
TU'JJfI,J
Muscles of Mastication L- ;5 L (llJ&-I~n't1!J)
1. Masseter muscle
Origin: Lower border & inner surface of zygomatic arch.
Insertion: In the outer surface of the ramus of the mandible.
Nerve supply: N. to masseter (from anterior division of
mandibular nerve).
Actions: 1- Elevation of the mandible. 2- Antigravity muscle.
3- Protraction (superficial head).
2. Temporalis muscle
Origin: 1- Inferior temporal line. 2- Floor of temporal fossa.
3- Temporal fascia. Temporalis
& Masseter
_ Insertion: Tip, anterior border & medial surface of coronoid
process of mandible.
N. supply: ant. division of mandibular N.
Actions: 1- Elevation of mandible. 2- Antigravity muscle.
3- Retraction of the protruded mandible.
3. Medial pterygoid muscle
Origin: Superficial head (smaller): From maxillary tuberosity.
Deep head (main part): Medial surface of lateral pterygoid plate Spteryqoid fossa.
Insertion: Inner surface of the angle, ramus of the mandible.
Nerve supply: Main trunk of mandibular nerve.
Actions: 1-Acting alone: Protraction to opposite side.
2- Alternative manner with its fellow: Side to
side movement.
3- Both muscles: Protraction and elevation.
4. Lateral pterygoid muscle
Origin: Upper head: Infra temporal surface and crest of
greater wing of sphenoid.
1:ower head (larger): !:ateral surface of lateral ~~~h~;::rictor
pterygoid plate.
Insertion: 1- Front of neck of mandible (fovea). 2-
Capsule and intra-articular disc of TMJ.
N. supply: From anterior division of mandibular N.
Actions: 1- Acting alone: Protraction of mandible to opposite side.
2- Acting in an alternate manner with the other muscle: Side to side movement.
3- Both lateral pterygoids: Protraction and depression of the mandible.
 Chapter 3: The Infratemporal Fossa Summary 9

Relations:
- Upper border: Temporal, masseteric branches of mandibular nerve.
- Lower border: Lingual, info alveolar nerves.
- Between both heads: 1- Buccal nerve comes out.
2- Maxillary artery enters.
- Superficial relations:
1- Mandibular ramus. 2- Buccal N.
3- Maxillary A., pterygoid venous plexus.
4- Superficial head of medial pterygoid, temporalis &
masseter.
- Deep relations: 1- Middle & accessory meningeal Relations of the lateral pterygoid
arteries. 2- Mandibular & chorda tympani nerves.

Temporomandibular Joint
- Type: Synovial, biaxial condylar variety, it lies between head of mandible (below) and mandibular
fossa and articular eminence of the temporal bone (above).
Capsule: It is attached: Above: to margins of articular fossa and eminence,

Below: neck of mandible, circumference of the articular disc.

Ligaments:
1. Temporomandibular ligament (the main ligament):
It is triangular in shape. Its base is attached to the root of the zygomatic arch.
Its apex is attached to the
Temporomandibular
posterolateral aspect of the neck ligament
of mandible.
2. Stylomandibular ligament:
Between styloid process & angle
of the mandible.
3. Sphenomandibular ligament:
Between spine of sphenoid &
lingula.
4. Pterygomandibular ligament:
Between pterygoid hamulus & posterior end of myelohyoid line.
Movements at the joint:
Movements Muscles responsible
1. Depression. - Lateral pterygoid (mainly). Assisted by gravity.
- Opening against resistence occurs by:
1- Platysma. 2- Mylohyoid. 3- Geniohyoid. 4- Anterior belly of digastric
2. Elevation 1- Masseter. 2- Medial pterygoid. 3- Temporalis.
3. Protraction. 1- Pterygoid muscles. 2- Superficial fibers of masseter.
4. Retraction. - Posterior fibers of temporalis.
5. Side to side movement. - Pterygoid muscles
Nerve supply: 1- Auriculotemporal N. (to posterior aspect). 2- N. to masseter (to anterior aspect).
 Chapter 3: The Infratemporal Fossa Summary 10
-
Mandibular Nerve
This mixed nerve has two roots: A- Motor root (smaller). B- Sensory root (larger).
Course: ~----~~~---------------------,
Motor root
\
Sensory root

Both roots descend in foramen ovale.

They join each other, to form a mixed trunk one cm
long, in the infra temporal fossa. ~ __ To tensor tympani

It ends by dividing into smaller anterior & larger N. to medial pterygoid

posterior divisions.
Branches:
I) Trunk of mandibular nerve: 2 deep lemporal n.n.
N. to masseter
1. Nerve to medial pterygoid (Motor): Auriculo- -.......•••• " •••. ..-oT,ateral
N. to
temporal N. pterygoid
It supplies medial pterygoid. Buccal N.

It gives a branch which traverses otic ganglion without

relay to supply tensor palati & tensor tympani.
2. Nervous spinosus (Sensory):
It re-enters F. spinsoum.
Branches of the
It supplies dura of the middle cranial fossa. mandibular nerve
II) Anterior division: (3 motor, 1 sensory)
1. 2 deep temporal nerves: To temporalis.
2. Nerve to masseter: To masseter.
3. Nerve to lateral pterygoid.
4. Buccal nerve (Sensory): It appears between 2 heads of lat. pterygoid.
It supplies the skin over and mucosa lining the buccinator.
III) Posterior division: (3 sensory, 1 motor)
1. Auriculotemporal nerve:
It arises by two roots which surround the middle meningeal artery.
It supplies: - Upper ~ of outer surface of auricle. - Skin of the post. Yz of the temple.
- External auditory meatus. - Outer surface of ear drum.
- Temporo-mandibular joint (capsule). - Sensory & parasympathetic fibers to parotid.
2. Lingual nerve:
- It is one of the 2 terminal branches of the posterior Genioglossus
division of the mandibular nerve. .
- It appears deep to lateral pterygoid where it is joined -.
by chorda tympani (branch of facial nerve).
- It descends on the lower border of lateral pterygoid.
- It runs on medial pterygoid.
- It appears in the groove below the lower last molar
(common site for its injury).
At the side of the tongue:
It runs forwards crossing styloglossus. Rt. lingual nerve (Iat. view)
 Chapter 3: The Infratemporal Fossa Summary 11
-
It runs along hyoglossus, suspending submand. ganglion.
It crosses the submandibular duct twice (triple relation: lateral, below then medial) at anterior border
of hyoglossus.
It lies on genioglossus, deep to sublingual gland to end in tongue.
Branches:
1- General sensation to: a) Anterior ~ of the tongue. b) Mouth floor & gum.
2- Chorda tympani carries:
a) Taste from anterior ~ of tongue. b) Secretomotor to sublingual & submandibular glands.
3. Inferior alveolar nerve:
- It is the largest branch from the posterior division.
- It appears at the lower border of lateral pterygoid, runs
on medial pterygoid.
- It enters the mandibular foramen, traverses the
mandibular canal.
- Branches:
1- Dental branches to lower teeth, gums.
2- Incisor branches to lower incisors and canine teeth.
3- Mental: Comes out from mental foramen to supply
mucosa of lower lip & skin of the chin.
4- Mylohyoid nerve (Motor):
It arises from inferior alveolar nerve. It pierces the sphenomandibular ligament.
It runs in mylohyoid groove.
It supplies: 1- Anterior belly of digastric muscle. 2- Mylohyoid muscle.

Otic Ganglion
Site: In the infratemporal fossa deep to the
Sen~ory root Lesser superficial petrosal N.
trunk of the mandibular N. below the (parasympathetic)

foramen ovale.
Roots:
Sensory root: Mandibular nerve (the
ganglion is suspended to its main trunk).
- Parasympathetic root: Lesser superficial To
parotid
petrosal nerve.
- Sympathetic root: Plexus around middle
meningeal artery.
- Motor root: Motor fibers from the nerve to
the medial pterygoid, traverses the otic
ganglion without relay to supply tensor palati
& tensor tympani.
Branches: to parotid gland.
Otic Ganglion
 - Chapter 3: The Infratemporal Fossa Summary 12

Submandibular Ganglion
- Site: In submandibular region, suspended from the
r-------------~==~I
lingual nerve on the outer surface of hyoglossus.
- Roots: - Sensory root: Lingual nerve.
- Parasympathetic root: Chorda tympani N.
- Sympathetic root: Plexus around facial A.
- Branches: Parasympathetic, sympathetic & sensory to:
submandibular & sublingual glands.

Maxillary Nerve
It is 2nd division of trigeminal N. (purely sensory).
Course:
- It arises from the trigeminal ganglion at the apex of petrous temporal bone.
- It runs forwards in the middle cranial fossa, along the side of sphenoid.
- It traverses the lower part of the lateral wall of the cavernous sinus.
- It enters the foramen rotundum to reach the pterygopalatine fossa.
- It traverses the pterygomaxillary fissure to reach the infratemporal fossa.
- It runs in the inferior orbital fissure, to become the infra-orbital nerve which passes in infra-orbital
groove, infra-orbital canal to come out from infra-orbital foramen.

- -.------~
caveracao
SIl'7tJt)

Nasal

Anterior sup.
Middle sup.
Maxillary Nerve alveolar N.
alveolar N.

Branches of maxillary nerve:

a) In middle cranial fossa: 1- 2 meningeal branches: Supply dura mater of the middle cranial fossa.
b) In pterygopalatine fossa: 2- 2 ganglionic branches: Suspend the sphenopalatine ganglion.

~ ~---- ----
 ..•
-Chapter 3~The Infratemporal Fossa Summary

c) In infratemporal fossa:
3. Zygomatic nerve: Enters the orbit through the inferior orbital fissure and divides into:
a) Zygomatico-temporal N: Runs in corresponding foramen to supply skin of anterior part of temple.
b) Zygomatico-facial N: Runs through the corresponding foramen to supply skin of the bony cheek.
4. Posterior superior alveolar: Passes through the posterior superior dental foramen.
It supplies the upper 3 molar teeth, gums and maxitlbry air sinus.

d) In infra orbital groove:

5. Middle superior alveolar: Runs downwards and fortvards in the lateral wall of maxillary sinus to
supply the upper premolar teeth, gums and maxillary 1ir sinus.

e) In infra orbital canal:

6. Anterior superior alveolar: Runs in the roof then the anterior wall of the maxillary sinus.
I
It supplies the upper canine, incisors, gums and maxillary air sinus.

f) In the face:
7. Palpebral: To the lower eyelid. 8. Nasal: To ala of the nose. 9. Labial: To upper lip.

Sphenopalatine Ganglion
Site: In the pterygopalatine fossa, suspended from the maxillary nerve by 2 sensory roots.
Roots:
A. Sensory: Maxillary nerve. It carries sensations from Ithe orbit, nose, palate & nasopharynx.
B. Parasympathetic: Greater superficial petrosal nerve relays in the ganglion.. -
- It contains preganglionic fibers from superior salivary nucleus in pons.
- It arises from the geniculate ganglion of the facial nere in petrous part of temporal bone.
- It emerges from greater superficial petrosal hiatus then groove to reach the foramen lacerum.
- It joins the deep petrosal N. to form N. of pterygoid canal (Vidian N.).
- It traverses the pterygoid canal to reach the sphenopalatine ganglion and relays.
- The postganglionic fibers supply lacrimal gland, mucrus gl~m:js of nose, palate & nasopharynx.

C. Sympathetic: Deep petrosal nerve.. o0-'h V ~o..{\~\~d~l

-It arises from internal carotid plexus from SCSG(5 e .c.
- It traverses the ganglion without
J (I'clY ce1';:C~ 5lj {YIP

relay to supply tHe lacrimal gland, blood vessels of the nOSE:-,

palate & nasopharynx.
Branches: I
1. Orbital (sensory): Traverses the inferior orbital fissJre to orbital periosteum.
2. Pharyngeal (sensory, sympathetic & parasympathetic): Traverses the palatovaginal canal to
supply the nasopharynx & auditory tube ..
3. Greater palatine (sensory, sympathetic & parasympathetic): Traverses the greater palatine canal
to hard palate then pass in lateral incisive foramina to supply the nose also.
 Parasympathetic
Sensory ., Sympathetic
I r __
~
Sup. salivary nucleus ~
~
~ geniculate
ganglion Pterygo-palatine ~.
Pterygo maxillary (\~
Facial N. fossa fissure .
F. rotandum

Orbit

Greater superficial
petrosal N.

= ! Naso-
=- ~~ : t ;;pharynx
Deep petrosal N.
<, Pterygoid canal
--..-;;;:)
Nose
~~~~~~~-

Sup. cervical
sympathetic
ganglion
 Chapter 3: The Infratemporal Fossa Summary 14

4. Lesser palatine (sensory, sympathetic & parasympathetic): Traverses lesser palatine canal to
soft palate.
5. Nasal (Sphenopalatinet (sensory, sympathetic & parasympathetic): They are long & short.
- The short sphenopalatine (nasal) nerves supply the postero-superior part of lat. wall of the nose.
- The long sphenopalatine (nasopal-atine) nerves supply the nasal septum & floor of the nose. It
traverses the median incisive foramina to supply the palate as well.

Maxillary Artery
Origin: It arises behind the neck of the mandible, inside the parotid gland, as the larger of the 2
terminal branches of the external carotid artery. It has 3 parts.

Course & Relations:

t" part (mandibular part):
It runs forwards & downwards between neck of the mandible and sphenomandibular ligament.
It reaches the lower border of lower head of lateral pterygoid.
~d part (pterygoid part):
It ascends obliquely forwards, either superficial or deep to the lower head of lateral pterygoid.
It dips between the 2 heads of lateral pterygoid (if superficial).
3rd part (pterygopalatine part):
It enters pterygomaxillary fissure to reach pterygopalatine fossa ant. to sphenopalatine ganglion.
It traverses the inferior orbital fissure (as the infra orbital artery).
It runs in the infraorbital groove, canal & foramen to face.

Branches: of first part of maxillary artery (MIADA)

1. Middle meningeal artery
It arises from the upper aspect of the first part of maxillary
.-----~-.-------------------,
A. deep to the lateral pterygoid. --
It ascends between the 2 roots of auriculotemporal nerve,
behind the mandibular N.
It passes in foramen spinosum to enter the cranial cavity.
It runs extradurally in a groove on the floor of the middle
cranial fossa, divides into anterior & posterior branches.
Surface anatomy:
Main stem is represented by a vertical line upwards 2 cm
from the middle of zygomatic arch.
The anterior branch is represented by a line drawn
towards pterion, then upwards, backwards to the vertex Surface anatomy
(midway between nasion &inion).
The posterior branch: represented by a horizontal line to the lambda (2 inches above inion).
Branches: 1- The inner table of skull and dura mater. 2- Trigeminal ganglion.
 Chapter 3: The Infratemporal Fossa Summary 15 I~." .,.
-
3- Superior tympanic to middle ear. 4- Anastomotic branch anastomoses with lacrimal artery.
2. Inferior alveolar artery
It enter the mandibular foramen, traverses the mandibular canal (with its nerve).
It ends near the first premolar by dividing into mental and incisive arteries.
Branches:
1. Lingual branch: Accompanies lingual nerve. 2. Mylohyoid artery .
. 3. To lower teeth. 4. Incisor branch: to lower incisor and canine teeth.
5. Mental branch: Comes out from the mental foramen to supply the chin and lower lip.
3. Accessory meningeal artery
It enters foramen ovale to supply: 1- trigeminal ganglion. 2- dura of the middle cranial fossa.
4. Deep auricular
It supplies: 1- External auditory meatus. 2- Outer surface of ear drum. 3- TMJ.
5. Anterior tympanic supplies the middle ear.
Branches: of second part of maxillary artery
- 4 muscular branches: to muscles of mastication. - Buccal artery: to buccinator.
Branches: of third part of maxillary artery (Similar to branches of sphenopalatine ganglion)
1. Pharyngeal: It enters palatino-vaginal canal to the nasopharynx.
2. Posterior superior alveolar (dental):
It enters the posterior superior dental foramen.
It supplies the upper molars and premolars and the maxillary air sinus.
3. Greater palatine: It enters greater palatine canal, foramen to supply the hard palate.
4. Lesser palatine arteries: Enters lesser palatine foramina to soft palate and tonsil.
5. Artery of pterygoid canal: Traverses pterygoid canal to the nasopharynx and auditory tube.
6. Sphenopalatine artery: It enters the sphenopalatine foramen to reach the nose.
7. Infra orbital: It enters inferior orbital fissure then infra orbital groove, canal & foramen.
It gives: 1. Middle superior alveolar. 2. Anterior superior alveolar. 3. Zygomatic.
4. Orbital branches. 5. Terminal: palpebral, nasal & labial.

Pterygoid Venous Plexus

It is a network of small veins superficial, deep and ...----------------..., \
between the 2 heads of the lateral pferygoid.
It is formed by union of veins corresponding to branches
of maxillary artery.
It ends posteriorly as one or two maxillary veins which
join the superficial temporal vein within the parotid
gland to form the retromandibular vein.
Connections of pterygoid venous plexus:
1- With cavernous sinus by emissary vein in F. ovale.
2- With facial vein by deep facial vein.
3- With inferior ophthalmic vein.
Clinical significance: Via pterygoid venous plexus,
infection from any area drained by its tributaries can
reach cavernous sinus.

"-------
 Chapter 4: Cranial ccvity Summary 16

1- Dural Folds
They are double sheet of inner layer of dura, separate different parts of the brain supporting them.

1- Falx cerebri:
It is double sheet of inner layer of dura, separates the right and left cerebral hemispheres.
It has:
Apex: Attached to crista galli and frontal crest.
Base: Attached to peak of tentorium cerebelli,
contains the straight sinus.
Upper (attached) border: is convex,
attached to superior sagittcl groove,
contains superior sagittal sinus.
Lower (free) border: Is concave. It rests on
corpus callosum. It contains inferior sagittal
sinus in its posterior %.

2- Tentorium cerebelli:
It is a horizontal double sheet of dura mater separating the cerebellum from the cerebrum.
It is tent like having:
Summit (peak): is elevated by attachment of flax cerebri to it, contains the straight sinus.
Inner (free) border: It is attached to anterior clinoid processes. It is U-shaped.
It encloses the tentorial notch which surrounds the midbrain.
Outer (attached) border:
It is attached to posterior clinoid processes, lips of superior petrosal sucli and transverse sulci.
The attached border is crossed by the free border (at the apex of petrous bone).
Three cranial nerves pierce the dura mater in relation to this point of decussation:
- Oculomotor nerve III (in front of the decussation).
- Trochlear nerve IV (at the point of decussation).
- Trigeminal nerve V (behind the point of decussation).

*Sinuses related to tentorium cerebelli:

- Straight sinus: in the middle at the attachment of the falx cerebri.
- Superior petrosal & transverse sinuses at the attached border.
3- Falx.cerebelli:
It is a small sickle-shaped fold between the two cerebellar hemispheres. It has:
Apex: is attached to the foramen magnum (below).
Base: Is attached to posterior part of inferior surface of the tentorium cerebelli (above).
Anterior border: Is related to back of cerebellum.
Posterior border: Attached to internal occipital crest. It contains the occipital sinus.
4- Diaphragma sellae: Covers the pituitary gland. It is attached to the 4 clinoid processes.
 1 rJiU:
~
rfj :.

Chapfer 4: Cranial cavity 5tlmmary 17 Ii ,~~,.,.

5- Cavum trigeminale: Surrounds the trigeminal ganglion at the apex of petrous bone.

11-Dural Venous Sinuses

Single Sinuses: 1. Superior sagittal sinus
- It begins at the foramen coecum.
- It runs upwards & backwards along upper border of falx cerebri.
- It ends at the internal occipital protuberance as the right transverse sinus.
- Sometimes, it ends as left transverse sinus, so rare it communicates with straight sinus forming the
confluence of sinuses.
2. Inferior sagittal sinus
- It lies in posterior % of inferior (free) border of falx cerebri.
- It ends by uniting with great cerebral vein (of Gallen) to form the straight sinus.
3. Straight sinus
- It lies along the summit (peak) of the tentorium cerebelli.
- It is formed by union of great cerebral vein (of Gallen) and inferior sagittal sinus.
- It ends as left transverse sinus (in most cases).
4. Basilar plexus
- Lies on the clivus connecting both inferior petrosal sinuses.
5. Occipital sinus (the smailestofthe sinuses)
- Lies along the posterior border of the falx cerebelli.
Paired Sinuses: 1) Transverse sinus
Begins: In most cases: The right is from superior sagittal sinus. The left is from straight sinus.
Or the reverse or both arise from confluence of sinuses.
It ends as sigmoid sinus or unites with superior petrosal sinus forming the sigmoid sinus.
2) Sigmoid sinus
The continuation of transverse sinus runs forwards & medially (S- shaped course) grooving mastoid.
It ends at the jugular foramen by becoming the internal jugular vein.
3) Superior petrosal sinus
It arises from back of cavernous sinus. It ends in the transverse sinus.
4) Inferior petrosal sinus
It arises from back of the cavernous sinus. It ends in the internal jugular vein just outside the skull.
5) Spheno parietal sinus
It passes along the posterior border of lesser wing of sphenoid to end in the cavernous sinus.

6) Cavernous sinus
A) Site: - On either side of the body of the sphenoid between the 2 layers of dura mater.
- It measures 2 cm long, 1- cm in wide & 1 cm in height.
8) Relations:
Anteriorly: 1- Apex of the orbit. 2- Superior orbital fissure.
Posteriorly: 1- Apex of petrous. 2- Cerebral peduncle of midbrain.
Superiorly: 1- ICA. 2- Uncus.
Inferiorly: - Greater wing of sphenoid.
Laterally: 1- Temporal lobe of brain. 2- Trigeminal ganglion (Posterolaterally).
Medially: 1- Body of sphenoid. 2- Pituitary fossa & gland. 3- Sphenoid air sinus.
 Chapter 4: Cranial cavity Summary 18
-
C) Structures related to its walls: Pituitary stalk
Diaphragma sellae

- In the lateral wall 4 nerves are embedded

(from above downwards):
1- Oculomotor. 2- Trochlear.
3- Ophthalmic & 4- Maxillary divisions of
trigeminal nerve.
- In floor & medial wall lie leA & abducent N.
D) Communications (tributaries):
It receives pituitary veins.
Its anterior wall receives: 1- Sphenoparietal sinus. 2- Superior and inferior ophthalmic veins.

Its posterior wall receives: 1. Superior petrosal sinus. 2. Inferior petrosal sinus.

Its roof receives: Superficial middle cerebral vein.

Its floor receives: - Emissary vein traverses the foramen ovale to pterygoid venous plexus.
- Emissary vein traverses the carotid canal to pharyngeal venous plexus or IJV.
- 2-3 Emissary veins traverse foramen lacerum to pterygoid & pharyngeal venous plexuses.
Medially it receives: Inter-cavernous sinuses (ant. & posterior) connect both cavernous sinuses.
E) Cavernous sinus thrombosis:
Infection from the dangerous area of the face may extend to the cavernous sinus.
Infection of cavernous sinus may spread to the brain through the superficial middle cerebral vein.

Emissary Veins
Definition: Are valveless veins connecting veins in scalp or face (extra cranial) with venous dural
sinuses (intracranial) and they pass through emissary foramina in the skull.
Significance: 1- They equalize the pressure outside and inside the skull.
2- Infection in scalp or face may extend through these veins to the inside of the skull
leading to septic thrombosis of the sinuses (e.g. cavernous sinus thrombosis).
Sites and distribution of the emissary veins:
A) Emissary veins connected to superior sagittal sinus:
1) Emissary vein from the nose, passing in foramen coecum.
2) Parietal emissary veins from occipital veins of the scalp via parietal emissary foramen.
B) Emissary veins connected to sigmoid sinus:
3) Mastoid emissary veins from posterior auricular or occipital veins.
4) Anterior condylar emissary veins from internal jugular vein.
5) Posterior condylar emissary veins from suboccipital venous plexus.
C) Emissary veins connected to cavernous sinus:
6) From pterygoid venous plexus through foramen ovale.
7) From pharyngeal venous plexus or IJV through carotid canal.
8) From pterygoid & pharyngeal venous plexuses 2-3 emissary veins traverse foramen lacerum.
9) The ophthalmic veins to the supraorbital and supratrochlear veins.
10) Inferior petrosal sinus to internal jugular vein.
NB 9 & 10 may be considered as emissary veins.
 Pituita
Sphenoid b

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peduncle

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canal to pharyngeal
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: Communication. of CIlwm
 Chapter 5: Orbit Summary 19
-
1-Ocular Muscles
There are 7 extra ocular muscles:
Muscle Origin Insertion N. supply Action
1. Levator Roof of the orbit - Skin, tarsus of the upper Sup. Div. of Elevation of
palpebrae in front of the eye lid. (III) . & the upper eye
superioris. optic canal. - Upper conjunctival fornix. Svrnp. nerves. lid.
Recti 2. Medial Common In sclera Inf. div. of Adduction.
rectus. tendinous ring of 5.5 mm From oculomotor
around the optic corneoscleral nerve (III).
3. Lateral foramen and the 7 mm junction Abducent' Abduction.
rectus. medial end of the nerve (VI).
4. superior orbital 6.5 mm Inf. div. of Depression,
Inferior fissure. oculomotor adduction &
rectus. nerve (III) extorsion.
5. 7.5 mm Sup. div. of Elevation,
Superior oculomotor adduction &
rectus. nerve (III). intorsion.
Obliques 6. Roof of the orbit, - Its tendon traverses Trochlear Depression,
Superior just above and trochlea then curves nerve (IV). abduction &
oblique. medial to optic backwards, downwards & intorsion.
foramen & origin laterally.
of superior rectus. - Is inserted in superolateral
quadrant of back of sclera.
7. Floor of orbit, just - It runs below the eye ball Inf. div. of Elevation,
Inferior lateral to backwards, upwards & oculomotor abduction &
oblique. nasolacrimal laterally. nerve (III). extorsion.
groove. - Is inserted in superolateral
quadrant of back of sclera
below the superior oblique.

NB: - All extraocular muscles are supplied by oculomotor (III) nerve except S04 & LR6.

11-Ophthalmic Artery
Origin: It arises from ICA, enters the orbit through the optic canal inferolateral to the optic nerve.
Course: - It crosses above the optic nerve from lateral to medial with the nasociliary nerve.
- It runs forwards along medial wall of the orbit.
End: It ends by dividing into supratrochlear and dorsal nasal arteries.
Branches:
1. Central artery of the retina: It is the most important branch.
- It runs below then within the optic nerve (vasa nervosa) 1 cm from the eye ball.
- It supplies the retina, and as it is an end artery, its occlusion leads to blindness.
2. Lacrimal artery: It is the largest branch.
- It supplies the lacrimal gland, gives lateral palpebral arteries to eyelids.
3. Posterior ciliary arteries (short and long): Pierce the back of the sclera to supply the ciliary
body, iris and choroid coat.
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1- Superior rectus 2- Inferior rectus

3- Medial rectus 4- Lateral rectus
5- Superior oblique 6- Levator palpebrae superioris
7- Inferior oblique
-- Chapter 5: Orbit Summary 20

4. Muscular arteries supply the orbital muscles and give off anterior ciliary arteries to the iris.
- 5. Posterior ethmoid artery: Passes through the posterior ethmoid foramen to supply the posterior
ethmoid air sinus.
_ 6. Anterior ethmoid artery
- It passes through anterior ethmoid foramen to enter the anterior cranial fossa supplying its dura &
anterior and middle ethmoid air cells.
- It traverses the cribriform plate of ethmoid to be internal nasal (in nose).
- It emerges between nasal bone & cartilage to be external nasal artery.
7. Supraorbital artery
- It arises from the ophthalmic artery as it crosses the optic nerve.
- It passes through the supraorbital foramen to supply the upper eyelid and skin of forehead.
8. Supratrochlear artery: It is one of the 2 terminal branches, gives medial palpebral arteries.
- It supplies the upper eyelid and skin of forehead.
9. Dorsal nasal artery: It is the other terminal branch.
- It accompanies the infratochlear nerve to supply the dorsum of the nose.

111-Nerves of the Orbit

A- Sensory Nerves: Optic nerve (II)
- It consists ofaxons of ganglionic cells of the retina (carries visual fibers from the retina to the brain).
~ - It leaves the orbit by passing through the optic canal with ophthalmic artery.
- It joins the optic nerve of the opposite eye to form optic chiasma (here the nasal fibers decussate).
Ophthalmic nerve (V1)
- The first division of trigeminal nerve (purely sensory), arises from the trigeminal ganglion.
- It enters the lateral wall of cavernous sinus (below trochlear nerve and above the maxillary nerve).
- It divides just before it passes in the superior orbital fissure into three branches.
1- Lacrimal nerve:
- It runs forwards on the lateral rectus muscle to end in lacrimal gland (the smallest branch).
- It gives palpebral branch to lateral 1/3 of upper eye lid.
2- Frontal: The largest branch.
- It runs above the levator palpabrae in contact with the periosteum of roof of orbit.
- It divides into supratrochlear and supraorbital nerves to upper eye lid & scalp.
3- Nasociliary:
- It enters the orbit via the superior orbital fissure between the 2 heads of the lateral rectus.
- It crosses the optic nerve from lateral to medial to reach the medial wall of the orbit.
- Branches:
1. Sensory roots: to carry ciliary ganglion on lateral side.
2. Two long ciliary nerves: - They carry sympathetic fibers (from plexus around leA).
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 Chapter 5: Orbit Summary 21

- They supply the dilator pupillae, iris, ciliary body & cornea.
3. Posterior ethmoid N.: It passes in the posterior ethmoidal F. to supply the ethmoid air sinuses.
4. Anterior ethmoid nerve:
- It passes through the anterior ethmoidal foramen to reach the anterior cranial fossa.
- It supplies the anterior ethmoid air cells and dura mater of anterior cranial fossa.
- It enters the nose (as internal nasal N.) then it comes out of the nose as external nasal nerve.
5. Infratrochlear nerve: It runs below the trochlea, supplies medial part of the lower eyelid and
root of the nose.
8- Motor Nerves: Oculomotor nerve (III)
- It passes between posterior cerebral and superior cerebellar arteries.
- It pierces dura mater just in front of decussation of tentorium cerebelli.
- It pierces roof then lateral wall of cavernous sinus (where is joined by sympathetic fibers).
- It divides into superior & inferior divisions carry sympathetic & parasympathetic fibers respectively.
- Both divisions enter the superior orbital fissure to enter the orbit.
Branches:
A) Superior division: Supplies superior rectus and levator palpebrae superioris. Its sympathetic
fibers supply the Muller's muscle.
B) Inferior division: Supplies medial rectus, inferior rectus & inferior oblique. Its parasympathetic
fibers supply the ciliary muscle and constrictor pupillae muscle.
Oculomotor nerve injury leads to:
1- Ptosis (levator palpebrae is paralyzed). 2- Lateral squint (medial rectus is paralyzed).
3- Mydriasis (constrictor pupillae is paralyzed). 4- Diplopia. 5- Exophthalmos.
I 6- Loss of accommodation (ciliary muscle is paralyzed).
Trochlear nerve (IV)
- It passes between posterior cerebral and superior cerebellar arteries.
- It pierces dura mater at point of decussation of tentorium cerebelli.
- It runs in lateral wall of cavernous sinus to enter the orbit through the superior orbital fissure.
- It supplies the upper (orbital) surface of superior oblique muscle.
Abducent nerve (VI)
- It pierces the dura mater of posterior cranial fossa (covering clivus)
- It winds around posterior clinoid process & apex of petrous.
- It pierces back of cavernous sinus (lateral to internal carotid artery).
- It enters the orbit through the superior orbital fissure.
Branches: To lateral rectus muscle only.

Ciliary Ganglion(Thesmallest parasympathetic ganglion)

- Site: Near the apex of the orbit between the optic nerve & lateral rectus muscle.
- Roots: - Sensory: Nasociliary nerve, from which the ganglion is suspended.
- Sympathetic: Plexus around internal carotid artery.
- Parasympathetic: Oculomotor N. through the N. to inferior oblique.
- Branches: 12-15 short ciliary nerves, they carry:
- Parasympathetic fibers to ciliary & constrictor pupillae muscles.
- Sensory fibers to iris, cornea & choroid (eye coats).
- Sympathetic fibers to blood vessels of the orbit (vasoconstrictor).

"'-- ----
 Edinger Westphal
nucleus (parasympathetic) Levator palpebrae
Inta rpeduncular
fossa euperlcrte

Oculomotor Nerve Ciliary

muacla

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Superficial attach' ent of oculomotor, Abducent Nerve

trochlear & abducent nerves
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Long ciliary N. To blood vessels

of the orbit
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pupillae muscle
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Ophthalmic A""

Nasociliary N.

Lacrimal N.

Ciliary
Ganglion
Ophthalmic N.
Maxillary N.

Mandibular N.