Atlas de Anatomia Anthony B. Olinger

HUMAN
GROSS
ANATOMY
Anthony B. Olinger, PhD
Associate Professor
Department of Anatomy
Kansas City University of Medicine and Biosciences
Kansas City, Missouri
Olinger9781451187403-fm.indd 1 19/03/15 7:13 pm

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Olinger, Anthony B., author.
Human gross anatomy / Anthony B. Olinger.
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PREFACE
Human Gross Anatomy was written to facilitate the learn- dissections depicted. Having personally performed every
ing process for any student studying anatomy. Having dissection shown in this book, I know that with patience
taught anatomy for many years, I have developed a keen and proper guidance, most students will be able to recre-
understanding for what works and what does not when it ate them. Also, by having the illustrations adjacent to the
comes to learning this subject. photographs, students get the best of both worlds—they
Therefore, this atlas differs from the traditional ana- can use the idealized drawing to deepen their understand-
tomical atlas in several key ways. Firstly, it is arranged ing of the anatomy and the photograph to prepare for the
systemically within each anatomical region rather than fol- laboratory component of their gross anatomy course. Fur-
lowing a dissection-style progression. Because institutions thermore, the illustrations feature additional information
approach dissection differently, progressing systemically to assist with the learning process. For example, muscle
broadens this atlas’s functionality and also provides a con- drawings list origin, insertion, action, and innervation;
sistent framework for the learner. Each chapter begins with arterial drawings indicate what each artery supplies; and
bones (osteology), then progresses in the same sequence nerve illustrations indicate what structures are innervated
through each system, ending with neurology.Secondly, the by each nerve.
text is presented exclusively in either table or outline/bul- Finally, I realize that most readers will not go on to be-
let-point format. It has been my experience that students come anatomists, but will instead likely be headed into the
tend to use an atlas as a reference—a way to quickly look health care field. As such, each chapter includes Clinical
up a structure or region, rather than to read it in its en- Notes sections to help students appreciate the relevance
tirety. The tables and outlines at the beginning of each new and significance of the anatomy they are studying. This
system provide background information on that system’s clinical material is not overwhelming and is intended to
associated structures. Outlines are presented consistently complement clinical training. Helpful Notes sections are
to speed up navigation to specific information. also included, which deliver content in a way students can
Thirdly, illustrations are placed side by side with pho- readily absorb it. These notes come straight from my lec-
tographs of actual cadaveric dissections. Most anatomical tures and are very popular with my students.
atlases are either illustrated or photographic, but rarely are Making this atlas has been a great adventure. I per-
both. Illustrated atlases have the benefit of being able to formed each dissection, snapped and processed each
depict every anatomical structure, but can be somewhat photo, created each drawing, wrote each outline, orga-
misleading because the drawings usually do not look like nized each layout, and labeled each structure. Lucky for
what students actually see in the gross anatomy lab. On the me, I love anatomy so much that I have enjoyed every min-
other hand, photographic atlases can show what actual ca- ute of this huge undertaking. I hope that students in every
daveric dissections look like, but do not always show every field of health care find it a useful tool and guide in their
structure that a student may want to see. Moreover, such journey through human gross anatomy.
atlases can create unrealistic expectations for students,
who typically do not have the time, experience, or techni- Anthony B. Olinger
cal expertise necessary to replicate the masterfully done
iii

Introduction
●● Anatomical methods ●● Superficial: nearer to the surface

■■ Regional anatomy ●● Deep: farther away from the surface
●● Head ●● External: outside
●● Neck ●● Internal: inside
●● Back ●● Ipsilateral: same side
●● Upper extremity ●● Contralateral: opposite side
●● Thorax ●● Supine: lying on back
●● Abdomen ●● Prone: lying face down
●● Pelvis/perineum ●● Movements
●● Lower extremity ■■ Flexion: decrease the angle between two structures or
■■ Systemic anatomy bones, usually in the sagittal plane
●● Osteology: study of skeletal system ●● Dorsiflexion: elevation of the foot at the ankle
●● Chondrology: study of cartilage ●● Plantarflexion: directing the toes inferiorly at the
●● Arthrology: study of joints and ligaments ankle
●● Myology: study of skeletal muscles ●● Lateral flexion: decrease the angle between a mid-
●● Pulmonology: study of lungs and airways line structure and the lateral surface of the body,
●● Cardiology: study of the heart usually in the coronal plane
●● Dermatology: study of the integumentary system ■■ Extension: increasing the angle between two struc-
(skin) tures or bones to the point of hyperextension, usually

●● Gastroenterology: study of digestive and accessory in the sagittal plane
digestive systems ■■ Abduction: movement away from the midline, usually
●● Urology: study of the urinary system in the coronal plane
●● Endocrinology: study of the endocrine system ■■ Adduction: movement toward the midline, usually in
●● Gynecology: study of the female reproductive and the coronal plane
genital systems ■■ Medial rotation: rotation toward the midline
●● Andrology: study of the male reproductive and gen- ■■ Lateral rotation: rotation away from the midline
ital systems ■■ Circumduction: circular movement through a spheroi-

●● Angiology: study of the circulatory system dal joint
●● Neurology: study of the nervous system ■■ Protrusion (protraction): to push out
●● Positions, planes, and directions: ■■ Retrusion (retraction): to pull in
■■ Anatomical position: standing erect with head and ■■ Elevation: to lift up
eyes directed forward (anteriorly), upper extremities ■■ Depression: to pull down
at the side with palmar surface of hands directed for- ■■ Inversion of the foot: direct the plantar surface medially
ward (anteriorly) and lower extremities together with ■■ Eversion of the foot: direct the plantar surface laterally
toes directed forward (anteriorly) ■■ Supination of the forearm: direct the palmar surface
■■ Planes anteriorly
●● Sagittal: front to back, parallel to the long axis ■■ Pronation of the forearm: direct the palmar surface
●● Coronal (frontal): side to side, parallel to the long posteriorly
axis ■■ Opposition: touching the thumb to the 5th digit
●● Transverse (horizontal): perpendicular to the long ■■ Reposition: returning from opposed position to ana-
axis tomical position

●● Midsagittal: front to back in the midline, parallel to ●● Joint classification
the long axis ■■ Synovial joint (diarthrosis)
●● Oblique: not in one of the previously mentioned ●● Planar (flat, arthroidal, uniaxial gliding or sliding
planes movement, tight joint capsule)

■■ Directions ●● Ginglymus (hinge, uniaxial, thin slack joint capsule)
●● Dexter: right ●● Trochoid (pivot, unixial rotation)
●● Sinister: left ●● Condyloid (one or two concave surfaces articulating
●● Anterior: front (ventral) with one or two convex surfaces, biaxial)
●● Posterior: back (dorsal) ●● Sellar (saddle, both surfaces are convex and con-
●● Superior: up (cranial) cave, biaxial, allowing false circumduction without
●● Inferior: down (caudal) rotation)
●● Medial: toward the midline ●● Spheroidal (ball and socket, multiaxial, allowing cir-
●● Lateral: away from the midline cumduction in multiple planes)
●● Median: in the midline ■■ Fibrous joint (synarthrosis)
●● Proximal: nearer to a reference point ●● Sutures (interlocked bone separated by fibrous con-
●● Distal: farther from a reference point nective tissue)
iv

Introduction
■■ Serrated suture (interlocking bone with a jagged ■■ Veins
edge) Return blood to the heart
●●
■■ Squamous suture (joined bone with two beveled ●● Usually carry oxygen-depleted blood (except pul-
surfaces) monary V.)

■■ Planar suture (two blunt ends joined by fibrous ●● Types of veins:
connective tissue) ■■ Large veins

●● Schindylesis (tongue-in-groove joined by fibrous ■■ Medium-sized veins
connective tissue) ■■ Venules

●● Gomphosis (peg-in-socket joined by fibrous con- ■■ Capillaries
nective tissue) ■■ Lymphatics (collect surplus tissue fluid as lymph and

●● Syndesmosis (two bones separated by a fibrous return it to venous circulation)
membrane) ●● Lymphatic plexuses (lymphatic capillaries in the in-
■■ Cartilaginous joint (amphiarthrosis) tercellular space of most tissues)
●● Synchondrosis (primary cartilagenous joints, char- ●● Lymphatic vessels (join the lymphatic plexuses to
acterized by temporary cartilaginous unions of hy- the lymph nodes)

aline cartilage, usually between the diaphysis and ●● Lymph nodes (collect lymph for return to venous
epiphysis of growing bone) circulation)

●● Symphysis (secondary cartilaginous joints, charac- ●● Lymphoid organs (spleen, tonsils, and thymus)
terized by strong slightly moveable joints united by ●● Lymphocytes (immunological functional unit)
fibrocartilage) ●● Divisions of the nervous system

●● Shapes of skeletal (striated) muscle ■■ Structural division
■■ Flat (broad) muscles (thin and expansive) ●● Central nervous system (CNS) (brain and spinal
■■ Pennate muscles (featherlike) cord)
●● Unipennate (tendon on one side, muscle on the ●● Peripheral nervous system (nerve fibers and cell
other) bodies outside the CNS)

●● Bipennate (muscle on either side of a tendon) ■■ Connect the CNS with peripheral structures
●● Multipennate (multiple feathered muscle groups) ❍❍ Cranial nerves (12 pairs)
■■ Fusiform muscles (spindle shaped with thick central –– Spinal nerves (31 pairs)
region and tapered ends) –– Cervical nerves (8 pairs)
●● Bicipital muscles (muscles with two heads) –– Thoracic nerves (12 pairs)
●● Tricipital muscles (muscles with three heads) –– Lumbar nerves (5 pairs)
●● Quadracipital muscles (muscles with four heads) –– Sacral nerves (5 pairs)
■■ Digastric muscles (muscles with two bellies) –– Coccygeal nerve (1 pair)
■■ Multiventral muscles (broken up by tendon) ■■ Functional division
■■ Multicaudal muscles (muscles with multiple tendons) ●● Somatic nervous system (CNS and PNS)
■■ Serrated muscles (muscles with a serrated edge) ■■ Sensory and motor innervation to all parts of the
■■ Circular or sphincteral muscles (surrounding an body, except for visceral structures, smooth mus-
opening) cle, and glands
■■ Quadrate muscles (equal sided) ■■ Somatic sensation (general and special sensation)
●● Angiology (arteries, veins, capillaries, and lymphatics) ■■ General sensation (touch, pain, temperature,
■■ Arteries pressure)
●● Convey blood away from the heart ■■ Special sensation (smell, sight, taste, hearing,
●● Usually carry oxygenated blood (except pulmonary position)
A.) ■■ Somatic motor innervation (to skeletal muscles)
●● Types of arteries: ●● Autonomic nervous system (visceral sensation and
■■ Elastic arteries motor innervation via the CNS and PNS)
■■ Muscular arteries ❍❍ Sympathetic division (thoracolumbar)
■■ Arterioles ❍❍ Parasympathetic division (craniosacral)

Terminology
General • Ramus: branch • Falx: sickle

• Ala: wing (Latin) • Raphe: seam • Genioid: chin (Greek)
• Ampulla: jug • Rectus: straight (Latin) • Glossal: tongue (Greek)
• Apex: superior portion or pointed portion • Recurrent: traveling back from the way • Labia: lips
of a structure it came • Lacrimal: relating to tears
• Aponeurosis: tendinous expansion • Retinaculum: rope or cable • Lingual: tongue (Latin)
• Arch: curved or “bow-like” structure • Root: lowermost part • Mandibular: haw, lower teeth
• Ascending: traveling superiorly • Sheath: tubular structure enclosing or • Maxillary: upper teeth
• Base: lowermost part or foundation surrounding other structure • Meatus: passage or pathway
• Brevis: denotes a short structure • Sigmoid: “S” shaped • Mental: chin (Latin)
• Canal: narrow tubular passage • Sinus: cavity or channel, hollow (Latin) • Nasal: nose
• Condyle: knuckle or rounded projection • Sphincter: structure designed to • Neurocranium: cranial vault
• Constrictor: structure designed to close constrict an opening • Occipital: near or over the occipital B.
off a passageway • Spine: thorn-like process • Occular/optic: eye
• Corpus: body • Styloid: long and pointed (pencil-like) • Oral: mouth
• Cortex: external layer, bark, shell, rind • Trochlea: pulley • Orbit: eye socket
(Latin) • Tubercle: small rounded bump • Palatine: hard palate
• Crest: ridge • Tuberosity: roughened region • Palpebral: eyelid
• Cruciate/cruciform: shaped like a cross • Ventricle: small cavity • Petrous: resembling a rock
• Crus: leg • Vestibule: space at the entrance to a • Pterygoid: wing-shaped (Greek)
• Cutaneous: pertaining to the skin canal • Squamous: plate-like
• Depressor: muscle to depress the • Visceral: pertaining to a large internal • Superciliary: eyebrow
structure into which it inserts organ • Tectorial: roof/covering
• Descending: traveling inferiorly • Temporal: lateral surface of the head
Prefixes
• Dilator: structure designed to dilate an • Tentorium: tent or covering
• A-: negative prefix
opening • Veli: veil (veli palatini: soft palate)
• Endo-: inside
• Extrinsic: coming from or originating • Zygomatic: bony cheek
• Epi-: upon, after, in addition
outside
• Extra-: outside Neck (cervix/collum)
• Fascia: band
• Hemi-: half • Ansa: loop (handle)
• Fissure: cleft or groove
• Hyper-: above, beyond, more than • Cleido: referring to the clavicle
• Foramen: hole
normal, excessive • Deglutination: swallowing
• Fossa: shallow depression
• Hypo-: under, beneath, less than normal, • Digastric: two bellies
• Fovea: pit or depression
deficient • Hyoid: shaped like the Greek letter
• Fundus: part of hollow organ far from
• Infra-: beneath upsilon
mouth of that organ
• Inter-: among, between • Nuchal: posterior neck
• Hiatus: gap, cleft, or opening
• Intra-: inside • Omos: shoulder
• Hilum: region where vessels and nerves
• Meso-: middle • Phrenic: referring to the thoracic
enter or exit an organ
• Meta-: after, beyond, accompanying diaphragm
• Infundibulum: funnel-shaped
• Para-: beside, beyond • Platysma: flat plate
• Intrinsic: situated entirely within
• Peri-: around
• Isthmus: narrow connection between Back
• Retro-: backwards
two larger bodies • Erector: structure that erects
• Semi-: half
• Lamina: thin flat plate or layer • Equine: horse
• Sub-: under, below
• Levator: muscle to elevate to structure • Latissimus dorsi: widest of the back
• Supra-: above, beyond, extreme
into which it inserts • Multifidus: cleft into many parts
• Longus: denotes a long structure Head (cranium, cephalic, • Rhomboid: shaped like a rhombus
• Magnum: great capitate) • Rotatores: rotator
• Medulla: innermost part • Alar: wing-shaped (Latin) • Splenion: bandage
• Notch: indentation • Alveolar: tooth-socket • Trapezium: four irregular shaped sides
• Parietal: pertaining to the walls of a • Auricular: external ear (auricle)
cavity • Basicranium: cranial base, cranial floor Upper extremity
• Pedicle: little foot • Buccal: fleshy cheek • Acromion: (acro- top/extreme; omos-
• Piriform: pear-shaped • Calvaria: skull cap shoulder)
• Plexus: braid or network • Cerebellar: relating to the cerebellum • Antebrachium: forearm
• Process: a prominence or projection • Cerebral: relating to the cerebral • Axilla: armpit
• Pyramidal: shaped like a pyramid hemispheres • Biceps: two-heads
vi

vii
Terminology
• Brachium: arm Abdomen • Pubic: referring to the pubic bone
• Capitulum: little head • Cecum: blind gut • Pudendal: to be ashamed (external
• Carpus: wrist • Celiac: belly (Greek) human genitalia)
• Conoid: cone-shaped • Colic: referring to the colon • Rete: net
• Coracoid: like a crow’s beak • Cystic: bladder (Greek) • Salpinx: tube
• Coronoid: hooked/curved • Duodenum: 12 at a time (12 finger • Sciatic: derived from ischial
• Cubitus: elbow breadths in length) • Tunica: covering or coat
• Deltoid: shaped like the Greek letter • Epiploic: omentum (Greek) • Vesical: urinary bladder
delta • Falciform: sickle shaped (Latin)
Lower extremity
• Digitus indicis: index finger • Gastric: stomach
• Acetabulum: shallow vinegar cup
• Digitus minimus manus: pinky finger • Haustrum: drawer
• Calx (calcanean): heel
• Glenoid: socket • Hepatic: liver
• Coxa: hip
• Lumbrical: earthworm-like • Hypochondriac: abdominal region deep
• Cribriform: seive-shaped
• Lunate: Mmon-shaped to costal cartilage
• Cuneiform: wedge-shaped
• Manos: hand • Inguinal: groin
• Digitus minimus pedis: pinky toe
• Pisiform: pea-shaped • Jejunum: empty (2nd part of small
• Fascia lata: broad fascia
• Pollux: thumb intestine)
• Fibular (peroneal): lateral side of leg
• Quadratus: square-shaped • Linea alba: white line
• Gastrocnemius: stomach-legged
• Radialis: radial side of forearm • Mesentery: double layer of peritoneum
• Gemella: twin
• Scaphoid: boat-shaped • Omentum: fat skin (Latin)
• Genu: knee
• Serratus: saw-like • Peritoneum: stretch around (Greek)
• Gluteus (natis, clunis): buttock
• Teres: long and round lining of abdominal wall
• Gracilis: slender
• Triceps: three-heads • Portal: entrance or gateway
• Hallux: 1st toe
• Triquetrum: three-cornered • Psoas: muscle of the loin
• Linea aspera: rough line
• Ulnaris: ulnar side of forearm • Pylorus: gate guard (distal portion of
• Meniscus: crescent
stomach)
Thorax (chest) • Navicular: little ship
• Renal: kidney
• Alveolus: small-hollow space • Pes: foot
• Rugae: wrinkles or folds
• Areola: small area • Piriformis: pear-shaped
• Vermiform: worm-like
• Azygous: unpaired • Plantar: sole of the foot
• Cardiac: heart Pelvis (basin) and perineum • Popliteal: region behind knee
• Coronary: term applied to the arterial (space between anus and • Quadriceps: four-headed
supply of the heart scrotum) • Saphenous: visceral structures
• Costal: ribs • Ano-, ani-: anal region or anal canal of the leg
• Manubrium: handle (Latin) • Epididymis: epi + double (Greek) also epi • Sartorius: patched or repaired
• Pectoral: pertaining to the chest wall + testis • Soleus: resembles a flat fish
• Pleura: rib-side • Fimbria: fringe • Sural: region on posterior leg
• Pulmonary: lungs • Fornix: arch (Latin) • Tarsus: ankle
• Splanchnic: pertaining to viscera • Lumborum: lumbar region • Tibial: medial side of leg
• Sternum: chest • Metra: (metrium) uterus • Trochanter: process on the
• Trabeculum: supporting or anchoring • Obturator: something that closes an femur
strand opening • Vastus: vast
vii

ACKNOWLEDGMENTS
First and foremost, my anatomical mentor, the man who Rebecca Scopa Kelso, PhD
inspired me to become an anatomist, Barclay Bakkum, DC, Assistant Professor of Anatomy
PhD. He said on the first day of class that there is no perfect Department of Biomedical Sciences
atlas, because he hadn’t written it yet; until there was an West Virginia School of Osteopathic Medicine
atlas with drawings and photos side-by-side, there would
be no perfect atlas. I hope this atlas does your notion jus- Melburn R. Park, PhD, AB
tice. Thank you for your mentorship! Associate Professor
I thank all of the anatomy fellows who have offered Anatomy and Neurobiology and Medical Education
their advice and suggestions over the years: Phil Homier, The University of Tennessee Health Science Center
Julie Easterday, Todd Brittain, Ashley Telisky, Eric Shur-
tleff, Dustin Woyski, Kelly Dahlstrom, Kara Hessel, Greg William J. Swartz, PhD
Rice, Erich Wessel, Travis Kauffman, Racquel Skold, Devon Marilyn L. Zimny Professor of Anatomy
Boydstun, Jacob Pfeiffer, Clive Persaud, Ashley Olsen, Kyle Louisiana State University School of Medicine in New
Busch, Kristen Colyer, and Kenna Schnarr. Your input has Orleans
been invaluable. A special shout out to Racquel Skold, who
spent an afternoon converting image files for me simply Amber van den Raadt, DO
because she was bored! Thank you. A. T. Still University-SOMA
I thank all of the students, who were not anatomy fel- (DO 2014)
lows, for whom I have had the privilege of being their re-
search mentor: Anwuli Anyah, Mahaletwork Assefa, Ian Monika Wimmer, PhD
Bowers, Pennie Burkias, Stephan Cooper, Gabrielle Farkas, Instructor, Scientist
Brandon Goesling, Greg Grenier, Aaron Heller, Mandalyn Institute of Anatomy and Cell Biology
Kautz, Amanda Osterloh, Justin Oveyssi, Brandon Roe, Justus-Liebig-University Giessen
Julia Ronecker, Jennifer Sharp, Chelsea Sheeler, Danielle Giessen, Germany
Solomon, and Ricki Tavangari.
Steven Xian
I thank all of my colleagues who have offered advice
Tulane University School of Medicine
on the atlas or with whom I’ve done research: Mark Pfe-
(MD 2015)
fer, Steve Larson, Betsy Mitchell, Bryan Bond, Brion Ben-
ninger, Kara Burnham, William Borman, Jim Carollo, Barth
I thank all of the folks at Wolters Kluwer for seeing the
Wright, and Robert Stephens.
benefits of this book, in what could be argued is an an-
Wolters Kluwer and I thank all of the reviewers who
tiquated and overcrowded market, and for enduring my
provided invaluable feedback during the development
stubbornness and rigidity throughout this process. I es-
process:
pecially thank Crystal Taylor for being there from the very
beginning and for all of her patience and nurturing of my
Olena Bolgova, MD, PhD
vision. I also thank Amy Weintraub who deserves a medal
Associate Professor
for all of her work and putting up with me.
St. Matthew’s University
I thank my children Emma and Liam, for always offering
me their love and support and never being “grossed out”
Anjanette Clifford, MS, DC, CCSP
by the gross lab.
Assistant Professor, Basic Science
Finally, I thank the love of my life, for being the wonder-
Logan University
ful person that you are. I love you.
viii

CONTENTS
Chapter 1: Thorax 1 Gastroenterology 89 Coccygeal Plexus 202

Esophagus 89 Autonomic Nervous System
Thorax 2
Large Intestine 89 Components 202
Thoracic Apertures 2
Urology 103
Thoracic Cavity Divisions (3) 2
Kidneys 103 Chapter 4: Thorax 213
Osteology 4
Endocrinology 106
Sternum 4 Lower Extremity 214
Suprarenal (Adrenal) Glands 106
Clavicle 4 Osteology 214
Andrology 107
Ribs 4 Os Coxae 214
Spermatic Cord and Scrotum 107
Thoracic Vertebrae (12) 4 Femur 214
Angiology 107
Chondrology 9 Patella 214
Aortic Arch 107
Costal cartilages 9 Tibia 214
Descending (Thoracic) Aorta 107
Arthrology 9 Fibula 215
Descending (Abdominal) Aorta 107
Sternal Joints 9 Tarsal 215
Neurology 130
Sternocostal Joints 9 Metatarsal Bb. (1–5) 216
Abdominal Wall Nn. 131
Costochondral Joints 9 Sesamoid Bones of the Foot 216
Interchondral Joints 9 Proximal Phalanges (1–5) 216
Costovertebral Joints 9 Chapter 3: Pelvis Middle Phalanges (1-4) 216
Costotransverse Joints 9 and Perineum 143 Distal Phalanges (1–5) 216
Myology 12 Chondrology 225
Definition 144
Pulmonology 16 Menisci of the Knee Joint 225
Pelvis 144
Lungs 16 Arthrology 225
Osteology 145
Trachea 16 Pelvic Girdle: See Pelvis and
Os Coxae 145
Bronchopulmonary Segments 17 Perineum 225
Sacrum 145
Cardiology 27 Sacroiliac Joint: See Pelvis and
Coccyx 145
Heart 27 Perineum 225
Chondrology 149
Dermatology 38 Sacrococcygeal Joint 225
Interpubic Disc 149
Breasts 38 Acetabulofemoral Joint 225
Arthrology 149
Gynecology 39 Knee Joint 225
L5 Vertebral Segment and Sacrum 149
Mammary Gland 39 Tibiofibular Joint 226
Pelvic Girdle 149
Gastroenterology 40 Talocrural Joint 226
Os Coxae and Sacrum 149
Esophagus 40 Talocalcaneal (Subtalar) Joint 226
Sacrum and Coccyx 149
Angiology 40 Transverse Tarsal Joint 226
Peritoneum 149
Aorta 40 Cuneonavicular Joint 227
Pelvic Fascia and Spaces 150
Pulmonary Trunk 42 Intercuneiform Joint 227
Perineal Fascia and Spaces 150
Pulmonary Veins 42 Cuneocuboid Joint 227
Myology 160
Cardiac Venous Circulation 42 Cuboideonavicular Joint 227
Gastroenterology 172
Superior Vena Cava 43 Tarsometatarsal Joint 227
Pelvis 172
Inferior Vena Cava 43 Intermetatarsal Joint 227
Perineum 172
Lymphatics 43 1St Interphalangeal Joint 227
Urology 173
Neurology 60 Proximal Interphalangeal Joint 227
Ureters:urinary Bladder
Cranial Nerves in the Thorax 60 Distal Interphalangeal Joint 227
Gynecology 176
Cervical Spinal Nerves 60 Fascia of the Lower Extremity 228
Pelvis 176
Thoracic Spinal Nerves 60 Myology 252
Perineum 176
Autonomic Nervous System 60 Angiology 279
Andrology 183
Perineum 183 Common Iliac A. 279
Chapter 2: ABDOMEN 71 Angiology 191 Veins 280
Abdominal Aorta 191 Lymphatics 280
Abdomen 72
Veins 192 Neurology 291
Osteology 73
Lymphatics 192 Subcostal N. 291
Lumbar Vertebrae 73
Neurology 202 Lumbar Plexus 291
Arthrology 73
Pelvic Components of the Lumbar Posterior Rami Of Lumbar
Lumbar Vertebral Joints 73
Plexus 202 Spinal Nerves 291
Peritoneum 73
Sacral Plexus 202 Sacral Plexus 291
Myology 79
ix

contents
Posterior Rami Of Sacral Midcarpal Joint 372 Superior Vena Cava 469
Spinal Nerves 292 Carpometacarpal Joints 372 Lymphatics 469
Dermatomes 292 Intermetacarpal Joints (4) 372 Neurology 475
Metacarpophalangeal Joints (5) 372 Cranial Nerves in Cervical
Chapter 5: Back 305 1St Interphalangeal Joint 372 Region 475
Proximal Interphalangeal Joints Cervical Spinal Nerves 475
Back 306 (4) 373 Autonomic Nervous System 475
Osteology 306 Distal Interphalangeal Joints (4) 373
Cervical Vertebrae (7) 306 Fascia 373
Thoracic Vertebrae (12) 306 Chapter 8: Head and
Myology 388
Typical Ribs 306 Angiology 410 Brain 483
Lumbar Vertebrae (5) 306 Subclavian A. 410 Head 484
Sacrum 306 Axillary A. 410 Osteology 484
Coccyx 307 Brachial A. 410 Skull 484
Arthrology 313 Veins 411 Chondrology 505
Atlantooccipital Joint 313 Lymphatics 412 Nose 505
Median Atlantoaxial Joint 313 Neurology 421 Ear 505
Lateral Atlantoaxial Joint 313 Cervical Plexus 421 Arthrology 507
Zygapophysial Joints 313 Brachial Plexus 421 Skull Sutures 507
Vertebral Syndesmoses 313 Thoracic Spinal Nerves 422 Skull Landmarks 507
Intervertebral Joint 313 Dermatomes 422 Temporal and Mandible Bb. 507
Lumbosacral Joint 313 Dentoalveolar Joint 507
Sacrococcygeal Joint 313 Vomer B. and Perpendicular Plate of
Myology 320 Chapter 7: NECK 441 Ethmoid B. With Nasal Crest of
Angiology 339 Neck 442 Maxilla and Palatine Bb. 507
Arch Of The Aorta 339 Osteology 442 Atlantooccipital Joint 507
Thoracic (Descending) Aorta 340 Hyoid B. 442 Myology 510
Abdominal (Descending) Aorta 341 Chondrology 442 Endocrinology 528
Summary Of Paraspinal Aa 342 Thyroid Cartilage 442 Pituitary Gland 528
Spinal Veins 342 Cricoid Cartilage 442 Pineal Gland 528
Neurology 350 Arytenoid Cartilages 442 Pulmonology 529
Spinal Cord 350 Corniculate Cartilage 442 Nasal Cavity 529
Cuneiform Cartilage 442 Paranasal Sinuses 529
Chapter 6: Upper Triticeal Cartilage 442 Nasolacrimal Duct 529
Epiglottic Cartilage 442 External Nose 529
Extremity 359 Arthrology 445 Gastroenterology 533
Upper Extremity 360 Pharyngeal Ligaments 445 External Oral Region 533
Osteology 360 Laryngeal Joints 445 Oral Cavity 533
Shoulder Girdle 360 Fascia of the Neck 445 Special Neurology 539
Upper Extremity 360 Myology 449 Eye 539
Chondrology 370 Endocrinology 465 Ear 539
Sternoclavicular Joint 370 Thyroid Gland 465 Angiology 544
Acromioclavicular Joint 370 Parathyroid Glands (4) 465 External Carotid A. 544
Glenoid Labrum 370 Pulmonology 466 Internal Carotid A. 544
Articular Disc of Distal Radioulnar Joint Pharynx 466 Vertebral A. 545
Triangular-Shaped Fibrocartilaginous Larynx 466 Basilar A. 545
Disc 370 Trachea 466 Cerebral Arterial Circle 545
Arthrology 371 Gastroenterology 468 Venous Sinuses of Dura Mater: 545
Shoulder Girdle: Clavicle, Scapula 371 Pharynx 468 Neurology 562
Elbow (Ginglymus Synovial Joint) 371 Esophagus 468 Cranial Nerves 562
Radioulnar Joints 371 Angiology 469 Brain 562
Radiocarpal 372 Common Carotid A. 469
Intercarpal Joints 372 Subclavian A. 469 INDEX 597

7
NECK
Neck Endocrinology Angiology

Osteology Thyroid Gland Common Carotid a.
Hyoid b. Parathyroid Glands Subclavian a.
Chondrology Pulmonology Superior Vena Cava
Thyroid Cartilage Pharynx Lymphatics
Cricoid Cartilage Larynx Neurology
Arytenoid Cartilages Trachea Cranial Nerves in Cervical Region
Corniculate Cartilage Gastroenterology Cervical Spinal Nerves
Cuneiform Cartilage Pharynx Autonomic Nervous System
Triticeal Cartilage Esophagus
Epiglottic Cartilage
Arthrology
Pharyngeal Ligaments
Laryngeal Joints
Fascia of the Neck
The neck occupies the body region between the lower

mandible and suprasternal arch of the sternum and the
upper clavicle (below). It is supported by the cervical ver-
tebrae, which are surrounded by muscles that allow
extension, flexion, rotation, and lateral flexion.
The neck houses important structures of both the respiratory
(larynx and trachea) and the digestive (pharynx and esophagus)
systems and, thus, has immediate clinical significance. The carotid
arteries, jugular veins, the vagus nerves, and deep cervical lymph
nodes traverse the neck vertically.
441
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442 NECK Chondrology
1 I. Neck: consists of the junction between the trunk, head, and upper extremity
II. Osteology
A. Hyoid b.: “U”-shaped bone; convex anteriorly, concave posteriorly
1. Body: centrally located
2. Greater horn: projects posteriorly
3. Lesser horn: projects posterosuperiorly
Hyoid Bone
Greater horn
Lesser horn Greater horn
Body
FIG. 7.1a ▲ Bony landmarks of the hyoid bone Lesser horn

(anterior aspect)
Body
Greater horn
FIG. 7.1d ▲ Bony landmarks of the hyoid bone
Lesser horn (oblique aspect)
Body
FIG. 7.1b ▲ Bony landmarks of the hyoid bone

(posterior aspect)
Greater horn
Lesser horn
Body Lesser horn
Greater horn Body
FIG. 7.1c ▲ Bony landmarks of the hyoid bone FIG. 7.1e ▲ Bony landmarks of the hyoid bone
(lateral aspect) (superior aspect)
III. Chondrology b. Thyroid articular surfaces: articulate with infe-

A. Thyroid cartilage rior horns of thyroid cartilage
1. Laminae: 2 plates of cartilage; meet anteriorly in C. Arytenoid cartilages: paired, cartilaginous, 3-sided
midline pyramids; rest superiorly on lamina of cricoid
a. Superior thyroid tubercle: at base of superior cartilage
horn and superior aspect of oblique line 1. Apex: projects superiorly; articulates with cor-
b. Inferior thyroid tubercle: at base of inferior niculate cartilage
horn and inferior aspect of oblique line 2. Base: inferior aspect possesses 2 large processes
c. Laryngeal prominence: projects anteriorly and an articular surface
from midline at union of 2 laminar plates a. Muscular process: projects posteriolaterally,
d. Oblique line: travels obliquely from superior insertion for posterior and lateral cricoaryte-
thyroid tubercle to inferior thyroid tubercle; noid and thyroarytenoid mm.
insertion for sternothyroid m.; origin for thyro- b. Vocal process: projects anteriorly; posterior
hyoid and inferior pharyngeal constrictor mm. attachment for vocal l.
e. Superior thyroid notch: gap in lamina superior c. Articular surface: articulates with lamina of cri-
to laryngeal prominence coid cartilage
f. Inferior thyroid notch: shallow indentation on D. Corniculate cartilage: paired, small pieces of
inferior border of lamina cartilage; rest superiorly on apex of arytenoid
2. Superior horn: projects superiorly; joined to cartilage
greater horn of hyoid via lateral thyrohyoid l. E. Cuneiform cartilage: paired, small pieces of carti-
3. Inferior horn: projects inferiorly; articulates with lage; embedded in quadrangular membrane
lamina of cricoid cartilage F. Triticeal cartilage: paired, small beads of cartilage;
B. Cricoid cartilage: cartilaginous ring inferior to thy- embedded in lateral thyrohyoid l.
roid cartilage G. Epiglottic cartilage: broad superiorly, tapers
1. Arch: narrower; anterior aspect of the ring inferiorly, to stalk of epiglottis; made of elastic
2. Lamina: wider; posterior aspect of the ring cartilage
a. Arytenoid articular surfaces: articulate with 1. Stalk of epiglottis: tapered inferior
DESIGN SERVICESaspect;
OF
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/ K lamina of thyroid cartilage
articular processes of arytenoid cartilages
Title: Human Gross Anatomy 1/e
articulates
Short / Normal / Long
S4CARLISLE
Publishing Services
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Chondrology NECK 443
Laryngeal Cartilages
Hyoid bone
Triticeal cartilage
Lateral thyrohyoid L.
Triticeal cartilage
Hyoid bone
Epiglottic cartilage
Stalk of the epiglottis Epiglottic cartilage
Cuneiform
cartilage
Corniculate
cartilage
Arytenoid cartilage Thyroid cartilage
Thyroid cartilage
Cricoid cartilage
Cricoid cartilage
FIG. 7.2a ▲ Laryngeal cartilages (posterior aspect) FIG. 7.2b ▲ Laryngeal cartilages (lateral aspect)
Thyroid cartilage: Thyroid cartilage:

Superior horn Superior horn
Superior thyroid Superior thyroid

notch notch
Superior thyroid Superior thyroid
tubercle tubercle
Lamina Lamina
Oblique line Oblique line
Laryngeal prominence Laryngeal prominence
Inferior thyroid tubercle Inferior thyroid

tubercle
Cricoid cartilage: Inferior horn
Cricoid cartilage:
Arch
Arch
FIG. 7.3b ▲ Features of the laryngeal cartilages (anterior aspect)

FIG. 7.3a ▲ Features of the laryngeal cartilages (anterior aspect)

Lamina Superior thyroid
tubercle
Laryngeal prominence
Oblique line
Superior thyroid
Lamina
tubercle
Oblique line Laryngeal prominence
Inferior thyroid tubercle

Inferior thyroid
Inferior horn tubercle
Cricoid cartilage: Inferior horn

Cricoid cartilage:
Lamina
Arch
Arch
Lamina
FIG. 7.4a ▲ Features of the laryngeal cartilages (lateral aspect) FIG. 7.4b ▲ Features of the laryngeal cartilages (lateral aspect)

444 NECK Chondrology
Superior thyroid
notch Superior thyroid
Notch
Lamina
Lamina
Cricoid cartilage:
Cricoid cartilage:
Arch Arch
Arytenoid cartilage: Arytenoid cartilage:
Vocal process Vocal process
Muscular process Muscular process
Articular surface Corniculate cartilage Articular surface
Lamina Lamina
FIG. 7.5a ▲ Features of the laryngeal cartilages (superior aspect) FIG. 7.5b ▲ Features of the laryngeal cartilages (superior aspect)
Superior thyroid Superior

notch thyroid notch
Corniculate
Corniculate
cartilage
cartilage
Arytenoid
cartilage: Arytenoid cartilage:
Apex
Apex
Muscular
process Articular surface
Articular surface Muscular process
Cricoid cartilage:
Cricoid cartilage:
Arytenoid
articular Arytenoid
surface articular surface
Lamina
Lamina
FIG. 7.6a ▲ Features of the laryngeal cartilages (posterior aspect) FIG. 7.6b ▲ Features of the laryngeal cartilages (posterior aspect)
Cricoid cartilage: Cricoid cartilage:
Arch
Arch
Lamina
Lamina
Arytenoid cartilage:
Arytenoid cartilage:
Vocal process
Vocal process
Inferior horn Inferior horn

FIG. 7.7a ▲ Features of the laryngeal cartilages (inferior aspect) FIG. 7.7b ▲ Features of the laryngeal cartilages (inferior aspect)

Arthrology NECK 445
Epiglottic cartilage Epiglottic cartilage
Stalk of the epiglottis Stalk of the epiglottis
FIG. 7.8a ▲ Epiglottic cartilage (posterior aspect) FIG. 7.8b ▲ Epiglottic cartilage (posterior aspect)
2 IV. Arthrology 4. Epiglottic joint

A.
Pharyngeal ligaments a. Thyroepiglottic l.: from thyroid cartilage to
1. Stylohyoid l.: extends from styloid process of epiglottis
temporal b. to hyoid b. b. Hyoepiglottic l.: from hyoid b. to epiglottis
2. Pterygomandibular raphe 5. Cricotracheal joint: inferior to cricoid cartilage
B.
Laryngeal joints a. Cricotracheal l.
1. Thyrohyoid joint: hyoid b. and thyroid cartilage 6. Fibroelastic laryngeal membrane
a. Median thyrohyoid l.: extends from body of a. Quadrangular membrane: between epiglottis
hyoid b. to laryngeal prominence and arytenoid cartilage
b. Lateral thyrohyoid l.: extends from greater b. Conus elasticus: cricovocal membrane;
horn of hyoid b. to superior horn of thyroid comprises lateral cricothyroid and vocal ll.
cartilage i. Lateral cricothyroid l.: extends from medial
i. Triticeal cartilage: embedded in lateral edges of cricoid cartilage to vocal l. and
thyrohyoid l. then to posterior aspect of lamina of thy-
c. Thyrohyoid membrane: extends from roid cartilage
hyoid b. to superior edge of thyroid ii. Vocal l.: extends from vocal process of
lamina arytenoid cartilage
2. Cricothyroid joint: thyroid cartilage and cricoid C.
Fascia of the neck
cartilage 1. Superficial cervical fascia: thin subcutaneous
a. Median cricothyroid l.: extends from inferior connective tissue
edge of thyroid lamina to superior edge of 2. Deep cervical fascia
cricoid arch a. Investing layer: superficial layer of deep cervi-
b. Lateral cricothyroid l.: see Conus elasticus cal fascia
c. Cricothyroid articular capsule: extends from b. Pretracheal layer: continuous inferiorly with
inferior horn of thyroid cartilage to lamina of fibrous pericardium; continuous posteriorly
cricoid cartilage with buccopharyngeal fascia encloses infra-
3. Cricoarytenoid joint: cricoid cartilage and aryte- hyoid muscles, thyroid gland, trachea, and
noid cartilage esophagus
a. Cricoarytenoid l.: from arytenoid cartilage to c. Prevertebral layer: surrounds vertebral column
lamina of cricoid cartilage and musculature

446 NECK Arthrology
Pharyngeal
Ligaments
Stylohyoid L.
Pterygomandubular
raphe
Middle pharyngeal
constrictor M.
Greater horn
Stylohyoid L. of the hyoid B.
Inferior pharyngeal
constrictor M.
Lamina of
thyroid cartilage
FIG. 7.9a ▲ Ligaments of the pharynx (lateral aspect) FIG. 7.9b ▲ Ligaments of the pharynx (posterolateral aspect)
Lateral thyrohyoid L. Triticeal cartilage Laryngeal

Joints
Triticeal cartilage Thyrohyoid membrane
Thyrohyoid membrane
Median thyrohyoid L. Median thyrohyoid L.
Median cricothyroid L.
Cricothyroid articular Cricothyroid articular

capsule capsule
Cricotracheal L. Cricotracheal L.
FIG. 7.10a ▲ Ligaments of the larynx (anterior aspect) FIG. 7.10b ▲ Ligaments of the larynx (anterior aspect)
Lateral thyrohyoid L. Lateral thyrohyoid L.
Triticeal cartilage Triticeal cartilage
Thyrohyoid membrane
Median thyrohyoid L.
Median thyrohyoid L.
Thyrohyoid membrane
Cricothyroid articular
capsule
Cricothyroid articular capsule
Cricotracheal L.
FIG. 7.11a ▲ Ligaments of the larynx (lateral aspect) FIG. 7.11b ▲ Ligaments of the larynx (lateral aspect)

Arthrology NECK 447
Laryngeal Joints
Lateral thyrohyoid L. Lateral thyrohyoid L.
Triticeal cartilage Triticeal cartilage
Thyrohyoid membrane Thyrohyoid membrane
Quadrangular membrane Quadrangular

membrane
Cuneiform cartilage Cuneiform cartilage
Corniculate cartilage Corniculate cartilage
Cricoarytenoid L. Cricoarytenoid L.
Cricothyroid articular Cricothyroid articular

capsule capsule
FIG. 7.12a ▲ Ligaments of the larynx (posterior aspect) FIG. 7.12b ▲ Ligaments of the larynx (posterior aspect)
Lateral thyrohyoid L. Hyoepiglottic L.
Triticeal cartilage Conus elasticus

Lateral
Thyrohyoid membrane cricothyroid L. Vocal L. Median cricothyroid L.
Thyroepiglottic L.
Cricoarytenoid L.
Vocal L.
Lateral Conus Cricoarytenoid L. Cricothyroid articular

cricothyroid L. elasticus capsule
Cricothyroid articular
capsule FIG. 7.13b ▲ Ligaments of the larynx
Median
cricothyroid L.
(superior aspect)
FIG. 7.13a ▲ Ligaments of the larynx with the thyroid cartilage sagittally
sected (sagittal section)

448 NECK Arthrology
Fascia of the Neck
Superficial cervical
fascia
Deep cervical fascia:
Investing layer
Prevertebral layer
Superficial cervical Level of transverse

fascia section below
Investing layer
Pretracheal layer
FIG. 7.14 ▲ Fascial layers of the neck (sagittal section)
Trapezius M.
Rhomboid minor M.
Splenius cervicis M.
Levator scapulae M.
Transversospinalis Ms.
Superficial cervical Longissimus capitis M.

fascia
Middle scalene M.
Longus capitis M.
Anterior scalene M.
Investing layer
Inferior pharyngeal
Prevertebral layer constrictor M.
Transverse and oblique
Carotid sheath arytenoid Ms.
Pretracheal layer Sternocleidomastoid M.
Platysma M.
Omohyoid M.
Left lobe thyroid gland
Sternothyroid M.
Sternohyoid M.
FIG. 7.15 ▲ Fascial layers of the neck (transverse section)

Myology NECK 449
V. Myology
TABLE 7.1 Myology
Muscle Origin Insertion Action Innervation
3 A. Posterior Triangle (bound by trapezius m., sternocleidomastoid m., and clavicle)
1. Trapezius M. • Medial 1/3 of superior • Lateral 1/3 of clavicle Actions associated with neck:
nuchal line • Acromion • Extends neck (bilaterally)
• External occipital • Scapular spine • Laterally flexes neck (unilaterally)
protuberance • Rotates face away (unilaterally)
• Nuchal l.
• Spinous processes C7–T12 • Spinal accessory N.
2. Sternocleidomastoid • Sternal head: superoanterior • Mastoid process • Extends neck at atlantooccipital
M. surface of manubrium temporal b. joint (bilaterally)
• Clavicular head: superior • Lateral aspect • Flexes remaining neck (bilaterally)
edge of middle 1/3 of superior nuchal line • Laterally flexes neck (unilaterally)
2 clavicle • Rotates face away (unilaterally)
3. Levator Scapulae M. • Posterior tubercles of • Medial border of sActions associated with neck: • Dorsal scapular N.
transverse processes C1–C4 scapula (superior to • Extends neck (bilaterally)
scapular spine) • Laterally flexes neck (unilaterally)
4. Splenius Capitus M. • Lower 1/2 nuchal l. • Mastoid process • Extends neck (bilaterally) • Posterior rami C3–C5
• Spinous processes C7–T3/T4 temporal b. • Laterally flexes neck (unilaterally)
• Lateral 1/3 of superior • Rotates face toward (unilaterally)
nuchal line occipital b.
5. Anterior Scalene M. • Anterior tubercles of • Scalene tubercle of • Flexes neck (bilaterally) • Anterior rami C4–C6
transverse processes C3–C6 1st rib • Laterally flexes neck (unilaterally)
• Elevates 1st rib
6. Middle Scalene M. • Posterior tubercles of • Superior surface 1st • Flexes neck (bilaterally) • Anterior rami C3–C8
transverse processes C2–C7 rib • Laterally flexes neck (unilaterally)
• Elevates 1st rib
7. Posterior Scalene M. • Posterior tubercles of • Lateral edge 2nd rib • Laterally flexes neck (unilaterally) • Anterior rami C6–C8
transverse processes C5–C7 • Elevates 2nd rib
B. Anterior Triangle (bound by midline of neck, sternocleidomastoid m., and body of mandible)
1. Suprahyoid Muscles
a. Mylohyoid M. • Mylohoid line mandible • Body of hyoid b. • Elevates hyoid b. • N. to mylohyoid
• Elevates floor of mouth and
tongue
b. Geniohyoid M. • Inferior mental spine • Body of hyoid b. • Elevates hyoid b. • C1 via hypoglossal
mandible • Shortens floor of mouth N.
• Widens pharynx
c. Digastric M. • Anterior belly: digastric • Intermediate tendon • Elevates hyoid b. • Anterior belly: N. to
fossa mandible on body and greater • Steadies hyoid b. mylohyoid
• Posterior belly: mastoid horn of hyoid b. • Depresses mandible • Posterior belly: facial
notch temporal b. N.
c. Stylohyoid M. • Styloid process temporal b. • Body of hyoid b. • Elevates hyoid b. • Facial N.
• Retracts hyoid b.
• Elongates floor of mouth
2. Infrahyoid muscles
a. Sternohyoid M. • Posterior surface • Body of hyoid b. • Depresses hyoid b. • Ansa cervicalis
manubrium (C1–C3)
• Posterior surface sternal end
clavicle
b. Sternothyroid M. • Posterior surface • Oblique line thyroid • Depresses thyroid cartilage • Ansa cervicalis
manubrium cartilage (C2–C3)
• 1st costal cartilage
c. Thyrohyoid M. • Oblique line thyroid • Inferior edge body of • Depresses hyoid b. • C1 via hypoglossal
cartilage hyoid b. • Elevates thyroid cartilage N.
• Greater horn hyoid b.
d. Omohyoid M. • Internal surface superior • Body of hyoid b. • Depresses hyoid b. • Ansa cervicalis
border scapula posterior to • Retracts hyoid b. (C1–C3)
suprascapular notch
(table continues on page 454)

450 NECK Myology
TABLE 7.1 Myology (continued )

Muscle Origin Insertion Action Innervation
C. Platysma M. • Fascia over pectoralis major • Inferior border body • Draws corner of mouth inferiorly • Cervical branch
M. and deltoid M. of mandible • Draws skin of neck superiorly facial N.
• Skin/subcutaneous
tissue face
D. Suboccipital Region
1. Rectus Capitis • Spinous process axis (C2) • Lateral aspect inferior • Extends head
Posterior Major M. nuchal line • Rotates face toward
2. Rectus Capitis • Posterior tubercle atlas (C1) • Inferior to inferior • Extends head
Posterior Minor M. nuchal line • Suboccipital N.
(posterior ramus 1st
3. Obliquus Capitis • Transverse process atlas • Between superior and • Extends head cervical spinal N.)
Superior M. (C1) inferior nuchal lines • Laterally flexes head
4. Obliquus Capitis • Spinous process axis (C2) • Transverse process • Rotates face toward
Inferior M. atlas (C1)
E. Pharyngeal Muscles
1. Superior Pharyngeal • Pterygoid hamulus • Pharyngeal tubercle • Pharyngeal branch
Constrictor M. • Pterygomandibular raphe • Pharyngeal raphe of vagus N.
• Posterior aspect mylohyoid
line
• Lateral aspect of tongue
• Constricts pharyngeal wall
2. Middle Pharyngeal • Stylohyoid l. • Pharyngeal branch
Constrictor M. • Greater/lesser horn hyoid b. of vagus N.
3. Inferior Pharyngeal • Oblique line • Pharyngeal raphe • Branches of
Constrictor M. • Thyroid cartilage recurrent Laryngeal
• Cricoid cartilage N.
4. Palatopharyngeus • Hard palate • Pharyngeal branch

M. • Palatine aponeurosis • Lamina thyroid of vagus N.
cartilage • Elevates pharynx
5. Salpingopharyngeus • Cartilaginous part
• Lateral pharynx and • Elevates larynx
M. pharyngotympanic tube
esophagus
6. Stylopharyngeus M. • Styloid process temporal b. • Glossopharyngeal N.
F. Laryngeal Muscles
1. Cricothyroid M. • Anterolateral part of arch of • Inferior edge lamina • Stretches vocal l. • External laryngeal N.
cricoid cartilage thyroid cartilage • Tenses vocal l.
• Inferior horn thyroid
cartilage
2. Posterior • Lamina cricoid cartilage • Abducts vocal fold
Cricoarytenoid M. • Muscular process
3. Lateral • Superolateral edge of arch arytenoid cartilage • Adducts vocal fold
Cricoarytenoid M. cricoid cartilage
4. Transverse and • Posterior aspect arytenoid • Posterior aspect • Adducts arytenoid cartilage • Recurrent laryngeal
Oblique Arytenoid cartilage contralateral • Closes intercartilaginous part of N.
M. arytenoid cartilage rima glottidis
5. Thyroarytenoid M. • Posterior part thyroid • Anterolateral aspect • Relaxes vocal l.
cartilage arytenoid cartilage
6. Vocalis M. • Vocal process arytenoid • Vocal l. • Relaxes posterior part of vocal l.
cartilage • Tenses anterior part of vocal l.
G. Anterior Vertebral Column
1. Longus Colli M. • Superior oblique: transverse • Superior oblique: • Flexes neck (bilaterally) • Anterior rami C2–C6
processes C3–C5 anterior tubercle atlas • Laterally flexes neck (unilaterally)
• Vertical: vertebral bodies • Vertical: vertebral • Rotates face away
C5–T3 bodies C2–C4
• Inferior oblique: vertebral • Inferior oblique:
bodies T1–T3 transverse processes
C5–C6
2. Longus Capitis M. • Anterior tubercles of • Basilar part occipital • Flexes neck (bilaterally) • Anterior rami C1–C3
transverse processes C3–C6 b. • Laterally flexes neck (unilaterally)
3. Rectus Capitis • Anterior to occipital • Flexes atlanooccipital joint
Anterior M. condyle
• Transverse process atlas • Anterior rami C1–C2
4. Rectus Capitis • Jugular process • Laterally flexes atlanooccipital
Lateralis M. occipital b. joint

Myology NECK 451
Posterior Triangle
Posterior Triangle
Divisions:
Sternocleidomastoid M.
(Anterior border)
Occipital triangle
Trapezius M.
(Posterior border) Inferior belly omohyoid M.
(Division line)
Posterior triangle
Clavicle (Inferior border) Omoclavicular triangle
FIG. 7.16a ▲ Borders of the posterior triangle of the FIG. 7.16b ▲ Subtriangles of the posterior triangle of
neck (lateral aspect) the neck (lateral aspect)
Posterior Triangle
Contents
Great auricular N.
Splenius capitis M.
Lesser occipital N.
External jugular V.
Spinal accessory N.
Levator scapulae M.
Transverse cervical N.
Transverse cervical A. Posterior scalene M.
Medial supraclavicular N. Middle scalene M.
Intermediate Anterior scalene M.

supraclavicular N.
Lateral
supraclavicular N.
FIG. 7.17a ▲ Contents of the posterior triangle of the neck (lateral aspect)
Great auricular N.
Lesser occipital N.
External jugular V.
Spinal accessory N.
Transverse cervical N. Splenius capitis M.
Transverse cervical A. Levator scapulae M.
Middle scalene M.
Lateral
Posterior scalene M.
supraclavicular N.
Anterior scalene M.
Intermediate
supraclavicular N. Inferior belly
omohyoid M.
Medial
supraclavicular N.
FIG. 7.17b ▲ Contents of the posterior triangle of the neck FIG. 7.17c ▲ Contents of the posterior triangle of the neck
(anterolateral aspect) (lateral aspect)

452 NECK Myology
Sternocleidomastoid M. Posterior Triangle (Boundary Muscles)
Lateral aspect superior

nuchal line (Insertion)
Mastoid process
(Insertion)
Spinal accessory N.
(CN XI) (Innervation)
(Deep to muscle)
Sternal head: superoanterior

surface of manubrium (Origin)
Clavicular head: superior

aspect medial 1/3 of
clavicle (Origin)
Action:
-Extend neck at atlanto-
occipital joint (bilaterally)
-Flex remaining neck
(bilaterally)
-Laterally flex neck
(unilaterally)
-Rotate face away
(unilaterally)
FIG. 7.18a ▲ Boundary muscles of the posterior triangle FIG. 7.18b ▲ Sternocleidomastoid muscle (posterior aspect)
of the neck: sternocleidomastoid muscle (posterior aspect) showing the origin, insertion, action, and innervation
Levator scapulae M. (see back)
FIG. 7.19 Muscles of the posterior triangle

▲
of the neck (lateral aspect)

Splenius capitis M. (see back)

Myology NECK 453
Posterior Triangle (Scalene Muscles)
FIG. 7.20a Scalene muscles FIG. 7.21 Anterior scalene muscle (lateral aspect) showing
▲ ▲
(anterolateral aspect) the origin, insertion, action, and innervation
Anterior tubercles
of transverse processes
C3–6 (Origin)
Anterior scalene M. Anterior rami C4–6

(Innervation)
Middle scalene M.
Scalene tubercle of
Posterior scalene M. first rib (Insertion)
Action:
Actions associated
with the neck:
-Extend the neck
(bilaterally)
Anterior scalene M. -Laterally flex the
neck (unilaterally)
Posterior tubercles of
transverse processes C2–7
(Origin)
Anterior rami C3–8

(Innervation)
Superior surface
FIG. 7.22 Middle scalene
▲
first rib (Insertion)

muscle (lateral aspect)
showing the origin, insertion,
action, and innervation Action:
Actions associated
with the neck:
-Extend the neck
(bilaterally)
Middle scalene M. -Laterally flex the
neck (unilaterally)
Posterior tubercles of
transverse processes
C5–7 (Origin)

(Innervation)
Lateral edge second rib

(Insertion)
Posterior scalene M.
Action:
Actions associated
with the neck:
-Extend the neck
(bilaterally)
-Laterally flex the
neck (unilaterally)
FIG. 7.20b ▲ Scalene muscles (lateral aspect) FIG. 7.23 ▲ Posterior scalene muscle (lateral aspect) showing
the origin, insertion, action, and innervation

454 NECK Myology
Anterior Triangle Anterior Triangle

Divisions:
Submandibular
triangle
Submental
Body of the mandible
triangle
(Superior border)
Anterior triangle
Carotid triangle
Midline of the neck
(Anterior border) Muscular triangle
(Posterior border)
FIG. 7.24a ▲ Borders of the anterior triangle FIG. 7.24b ▲ Subtriangles of the anterior
of the neck (lateral aspect) triangle of the neck (lateral aspect)
Anterior Triangle Contents

Occipital A.
Vagus N.
Posterior belly Hypoglossal N.

digastric M.
Facial A.
Anterior belly External carotid A.

digastric M.
Submental A.
Thyrohyoid M.
Carotid sinus
Sternohyoid M. Superior root

ansa cervicalis
Superior belly Inferior root

omohyoid M. ansa cervicalis
Common carotid A.
FIG. 7.25a Contents of the anterior
▲
triangle of the neck (lateral aspect)

Internal jugular V.
Facial A.
Submental A.
Anterior belly Submandibular

digastric M. gland
Hypoglossal N.
Mylohyoid M.
External carotid A.
Sternocleidomastoid M. Carotid sinus
Superior thyroid A.
Superior belly
omohyoid M. Internal jugular V.
Superior root
Sternohyoid M. ansa cervicalis
Inferior root
ansa cervicalis
FIG. 7.25b ▲ Contents of the anterior triangle of the neck FIG. 7.25c ▲ Contents of the anterior triangle of the neck
(anterior aspect) (anterolateral aspect)

Myology NECK 455
Anterior Triangle Anterior Triangle
Divisions:
Submandibular
triangle
Body of the mandible

Submental triangle
(Superior border)
Anterior triangle
Carotid triangle
Midline of the neck
(Anterior border) Muscular triangle
(Posterior border)
FIG. 7.26a ▲ Subtriangles of the anterior triangle of the neck (anterior aspect)
Submental A.
Anterior belly Facial A.

digastric M.
Submandibular gland
Mylohyoid M.
Hypoglossal N.
Posterior belly Superior root
digastric M. ansa cervicalis
Sternocleido- Inferior root

mastoid M. ansa cervicalis
Superior belly
omohyoid M. Superior thyroid A.
Thyrohyoid M. Thyroid gland
Sternothyroid M. Vagus N.
Common carotid A.
Sternohyoid M.
Internal jugular V.
FIG. 7.26b ▲ Contents of the anterior triangle of the neck (anterior aspect)

456 NECK Myology
Anterior Triangle (Suprahyoid muscles)
Stylohyoid M.
Anterior belly
digastric M.
Posterior belly
digastric M.
Mylohyoid M.
FIG. 7.27a ▲ Suprahyoid muscles (anterolateral aspect)
Stylohyoid M.
Posterior belly
digastric M.
Mylohyoid M.
Geniohyoid M.
Anterior belly
digastric M.
FIG. 7.27b ▲ Suprahyoid muscles ( medial aspect of the mandible, sagitally sected)
Mylohyoid M.
Mylohyoid line
mandible B. (Origin)
N. to the mylohyoid
(Innervation)
Body of the hyoid B.

(Insertion)
Action:
-Elevate hyoid B.
-Elevate floor of mouth
and tongue
FIG. 7.28a ▲ Mylohyoid muscle (medial aspect of the mandible FIG. 7.28b ▲ Mylohyoid muscle
sagitally sected) showing the origin, insertion, action, and innervation (anteroinferior aspect)

Myology NECK 457
Anterior Triangle
Geniohyoid M. (Suprahyoid muscles)
C1 via hypoglossal N. (Innervation)
Mylohyoid M. (Reflected) Inferior mental spine Body of the hyoid B. Action:

manduble (Origin) (Insertion) -Elevate the hyoid B.
-Shorten floor of mouth
-Widen pharynx
FIG. 7.29a ▲ Geniohyoid muscle (anteroinferior
aspect with the mylohyoid muscle reflected)
FIG. 7.29a ▲ Geniohyoid muscle (lateral aspect with the mandible
sagitally sected) showing the origin, insertion, action, and innervation
Intermediate tendon
on the body and
greater horn of the Posterior belly:
hyoid B. (Insertion) Mastoid notch
temporal B. (Origin)
Anterior belly: Posterior belly:

Digastric fossa Facial N. (Innervation)
mandible (Origin)
Action:
-Elevate the hyoid B.
Anterior belly:
-Steady the hyoid B.
N. to the mylohyoid
-Depress the mandible
(Innervation)
FIG. 7.30 ▲ Digastric muscle (lateral aspect with the mandible sagitally sected) showing the origin, insertion, action, and innervation
Stylohyoid M.
Styloid process
temporal B. (Origin)
Facial N. (Innervation)
Body of the Action:

hyoid B. (Insertion) -Elevate the hyoid B.
-Retract the hyoid B.
-Elongate floor of mouth
FIG. 7.31 ▲ Digastric muscle (lateral aspect with the mandible sagitally sected) showing the origin, insertion, action, and innervation

458 NECK Myology
Anterior Triangle (Infrahyoid muscles)

Thyrohyoid M. Sternothyroid M. Sternohyoid M.
Sternohyoid M. Superior belly Inferior belly

Superior belly Inferior belly
omohyoid M. omohyoid M.
omohyoid M. omohyoid M.
FIG. 7.32a ▲ Superficial dissection of the infrahyoid FIG. 7.32b ▲ Infrahyoid muscles (anterior aspect)
muscles (anterolateral aspect)
Sternohyoid M.

(Insertion)
Ansa cervicalis (C1–3) Posterior surface

(Innervation) manubrium (Origin)
Posterior surface
sternal end clavicle
(Origin)
Action:
-Depress hyoid B.
FIG. 7.33 ▲ Sternohyoid muscle (anterior aspect) showing the origin, insertion, action, and innervation

Myology NECK 459
Anterior Triangle Thyrohyoid M.
(Infrahyoid Muscles) Greater horn hyoid B. Body of the hyoid B.
(Insertion) (Insertion)
FIG. 7.34 Deep dissection of the infrahyoid muscles

▲ C1 via hypoglossal N.
(anterior aspect) (Innervation)
Oblique line thyroid

cartilage (Origin)
Action:
-Depress hyoid B.
-Elevate thyroid cartilage
FIG. 7.35 ▲ Thyrohyoid muscle (anterior aspect)

showing the origin, insertion, action, and innervation
Sternothyroid M.
(Insertion)
Ansa cervicalis (C2–3)

(Innervation)
Posterior surface
manubrium (Origin)
First costal cartilage

Thyrohyoid M. Sternothyroid M. Sternohyoid M. Superior belly (Origin)
(Reflected) omohyoid M.
(Reflected) Action:
-Depress thyroid
cartilage
FIG. 7.36 ▲ Sternothyroid muscle (anterior aspect)

FIG. 7.37a Omohyoid muscle (anterior aspect)
▲ showing the origin, insertion, action, and innervation
Action:
(Insertion) -Depress hyoid B.
-Retract hyoid B.
Superior belly
Pretracheal fascia
Inferior belly
Superior belly
Pretracheal fascia
Inferior belly
Ansa cervicalis (C1–3) Internal surface superior FIG. 7.37b ▲ Omohyoid muscle
(Innervation) border scapula posterior (lateral aspect) showing the origin,
to suprascapular notch (Origin) insertion, action, and innervation

460 NECK Myology
Skin and subcutaneous

Platysma tissue of the face (Insertion)
Inferior border body

of mandible (Insertion)
Cervical branch
facial N. (Innervation)
Fascia over the pectoralis

major M. and deltoid M.
(Origin)
Action:
-Draw corner of the mouth
inferiorly
-Draw the skin of the neck
superiorly
FIG. 7.38a ▲ Platysma muscle FIG. 7.38b ▲ Platysma muscle (lateral aspect) showing the origin,
(anterolateral aspect) insertion, action, and innervation
Pharyngeal Muscles Pharyngeal tubercle
Superior pharyngeal
constrictor M.
Superior pharyngeal
constrictor M.
Pharyngeal raphe
Pharyngeal raphe Middle pharyngeal

constrictor M.
Middle pharyngeal
constrictor M.
Greater horn hyoid B.
Greater horn
hyoid B.
Inferior pharyngeal
constrictor M.
Inferior pharyngeal
constrictor M.
FIG. 7.39a ▲ Pharyngeal constrictor muscles FIG. 7.39a ▲ Pharyngeal constrictor muscles
(posterior aspect of the pharynx) (posterior aspect of the pharynx)
Superior pharyngeal
Superior pharyngeal constrictor M.
constrictor M.
Middle pharyngeal
constrictor M.
Middle pharyngeal
constrictor M.
Greater horn hyoid B.
Greater horn hyoid B. Thyroid cartilage
Inferior pharyngeal
constrictor M.
Inferior pharyngeal
constrictor M.
Cricoid cartilage
Thyroid cartilage Action:

- Constrict pharyngeal
wall
FIG. 7.40a ▲ Pharyngeal constrictor muscles FIG. 7.40b ▲ Pharyngeal constrictor muscles (lateral aspect)
(posterolateral aspect of the pharynx)

Myology NECK 461
Pharyngeal Muscles
Pharyngeal
tubercle
(Insertion)
Pterygoid
hamulus Stylohyoid L.
(Origin) (Origin)
Pterygo- Pharyngeal raphe
mandibular (Insertion)
raphe (Origin)
Greater and lesser
Pharyngeal raphe horns hyoid B.
(Insertion) (Origin)
Oblique line
Posterior aspect thyroid cartilage
mylohyoid line (Origin)
(Origin) Cricoid cartilage
Lateral aspect (Origin)
tongue (Origin)
Pharyngeal branch
Pharyngeal branch vagus N. and
vagus N. recurrent laryngeal Pharyngeal raphe
(Innervation) N. (Innervation) (Insertion)
FIG. 7.41 ▲ Superior pharyngeal FIG. 7.42 ▲ Middle pharyngeal constrictor FIG. 7.43 ▲ Inferior pharyngeal constrictor
constrictor muscle (lateral aspect) showing muscle (lateral aspect) showing the origin, muscle (lateral aspect) showing the origin,
the origin, insertion, action, and innervation insertion, action, and innervation insertion, action, and innervation
Salpingopharyngeus M.
Stylopharyngeus M.
Palatopharyngeus M.
FIG. 7.44a Pharyngeal muscles (lateral aspect)

▲
Stylopharyngeus M.
Styloglossus M.
Stylohyoid M.
Superior pharyngeal
constrictor M.
Palatopharyngeus M.
FIG. 7.44b ▲ Pharyngeal muscles (Midsagittal Pharynx FIG. 7.44c ▲ Pharyngeal muscles
(posterolateral pharyngeal wall)

462 NECK Myology
Pharyngeal Muscles
Hard palate Styloid
(Origin) process
temporal B.
Palatine (Origin)
aponeurosis
Cartilaginous
(Origin)
part pharynogo-
Lamina tympanic tube
thyroid (Origin)
cartilage Lamina thyroid
(Insertion) cartilage
(Insertion)
Lateral aspect
pharynx and Lateral aspect
esophagus pharynx and
(Insertion) esophagus
(Insertion)
Pharyngeal branch Glossopharyngeal N.

vagus N. (Innervation) (Innervation)
FIG. 7.45 ▲ Palatopharyngeus muscle FIG. 7.46 ▲ Salpingopharyngeus muscle FIG. 7.47 ▲ Stylopharyngeus muscle
(lateral aspect) showing the origin, insertion, (lateral aspect) showing the origin, insertion, (lateral aspect) showing the origin, insertion,
action, and innervation action, and innervation action, and innervation
Cricothyroid M. Laryngeal
FIG. 7.48b Laryngeal
▲
Muscles
muscles (anterior aspect)
External laryngeal N.
(Innervation)
Inferior edge lamina

thyroid cartilage
(Insertion)
Inferior horn thyroid

cartilage (Insertion)
Anterolateral part of
FIG. 7.48a Laryngeal arch of cricoid cartilage
▲
muscles (anterior aspect) (Origin)
Aryepiglottic part
Aryepiglottic part oblique arytenoid M.
oblique arytenoid M.
Oblique arytenoid M.
Transverse arytenoid M.
Posterior
Posterior cricoarytenoid M. cricoarytenoid M.
FIG. 7.49a Laryngeal FIG. 7.49b Laryngeal muscles

▲
muscles (posterior aspect) (posterior aspect)
Thyroarytenoid M. Thyroarytenoid M.
Lateral cricoarytenoid M. Lateral cricoarytenoid M.
FIG. 7.50a Laryngeal muscles FIG. 7.50b Laryngeal muscles

▲
(posterolateral aspect with the (lateral aspect with the thyroid

thyroid cartilage reflected) cartilage sagittally sected)

Myology NECK 463
Laryngeal Muscles Innervation:
Recurrent laryngeal N.
Muscular process
arytenoid cartilage
(Insertion)
Muscular process
arytenoid cartilage
(Insertion)
Superolateral edge
Lamina cricoid of arch of cricoid
cartilage (Origin) cartilage (Origin)
FIG. 7.51 ▲ Posterior cricoarytenoid muscle (posterior FIG. 7.52 ▲ Lateral cricoarytenoid muscle (lateral aspect
aspect) showing the origin, insertion, action, and innervation with the thyroid cartilage sagittally sected) showing the
origin, insertion, action, and innervation
Posterior aspect Posterior aspect

contralateral arytenoid contralateral arytenoid
cartilage (Insertion) cartilage (Insertion)
Posterior aspect Posterior aspect

arytenoid cartilage arytenoid cartilage
(Origin) (Origin)
FIG. 7.53 ▲ Transverse arytenoid muscle (posterior aspect) FIG. 7.54 ▲ Oblique arytenoid muscle (posterior aspect)
showing the origin, insertion, action, and innervation showing the origin, insertion, action, and innervation
Anterolateral aspect
arytenoid cartilage
(Insertion)
Vocal L. (Insertion)
Posterior aspect
Vocal process
thyroid cartilage
arytenoid cartilage
(Origin)
(Origin)
FIG. 7.55 ▲ Thyroarytenoid muscle (lateral aspect with FIG. 7.56 ▲ Vocalis muscle (lateral aspect with the thyroid
the thyroid cartilage sagittally sected) showing the origin, cartilage sagittally sected) showing the origin, insertion,
insertion, action, and innervation action, and innervation

464 NECK Myology
Anterior Vertebral Column Muscles
Rectus capitis Rectus capitis
anterior M. anterior M.
Rectus capitis Rectus capitis

lateralis M. lateralis M.
Longus capitis M. Longus capitis M.
Superior oblique Superior oblique

longus colli M. longus colli M.
Vertical longus Vertical longus

colli M. colli M.
Inferior oblique Inferior oblique

longus colli M. longus colli M.
FIG. 7.57a ▲ Muscles of the anterior vertebral column FIG. 7.57b ▲ Muscles of the anterior vertebral column
(anterior aspect of the vertebral column) (anterior aspect of the vertebral column)
Anterior tubercle
atlas (Insertion) Vertebral bodies Basilar part
C2–4 (Insertion) occipital B.
Superior oblique (Insertion)
longus colli M.
Vertical longus Longus capitis M.
Transverse processes
C3–5 (Origin) colli M.
Anterior tubercles of
Transverse processes transverse processes
C5–6 (Insertion) C3–6 (Origin)
Vertebral bodies
Inferior oblique C5–T3 (Origin)
longus colli M.
Vertebral bodies Anterior rami
(Innervation)
T1–3 (Origin) C2–6 (Innervation)
FIG. 7.58 ▲ Parts of the longus colli muscle (anterior aspect of FIG. 7.59 ▲ Longus capitis muscle (anterior aspect of the vertebral
the vertebral column) showing the origin, insertion, action, and column) showing the origin, insertion, action, and innervation
innervation
FIG. 7.61 Rectus capitis anterior muscle (anterior aspect)
▲
Anterior to occipital
condyle (Insertion)
Rectus capitis
anterior M.
Transverse process
atlas (Origin)
(Innervation)
Jugular process
occipital B.
(Insertion)
Rectus capitis
lateralis M.
Transverse process
atlas (Origin)
FIG. 7.60 ▲ Rectus capitis anterior and lateralis muscles on the FIG. 7.62 ▲ Rectus capitis lateralis muscle (anterior aspect)
anterior vertebral column (anterolateral aspect of the vertebral column) showing the origin, insertion, action, and innervation

Endocrinology NECK 465
VI. Endocrinology Parathyroid glands (4): on posterior surface of thy-

B.
A. Thyroid gland: largest endocrine gland; produces roid gland
thyroid hormone 1. Superior parathyroid glands: 2
1. Right lobe 2. Inferior parathyroid glands: 2
2. Left lobe
3 3. Isthmus: joins 2 lobes, anterior to trachea
Lamina thyroid Lamina thyroid

cartilage cartilage
Arch cricoid Right lobe

cartilage thyroid gland
Right lobe Arch cricoid

thyroid gland cartilage
Isthmus Left lobe

thyroid gland thyroid gland
Left lobe Isthmus

thyroid gland thyroid gland
FIG. 7.63a ▲ Thyroid gland (anterior aspect) FIG. 7.63b ▲ Thyroid gland (anterior aspect)
Cricothyroid M.
Right lobe
thyroid gland Right lobe
thyroid gland
Isthmus
thyroid gland
FIG. 7.63c ▲ Thyroid gland (lateral aspect) FIG. 7.63d ▲ Thyroid gland (lateral aspect)
Inferior pharyngeal
constrictor M.
Left lobe
thyroid gland Left lobe
thyroid gland
Right lobe
thyroid gland Right lobe
thyroid gland
Left superior
parathyroid gland Left superior
Right superior parathyroid gland
parathyroid gland Right superior
Left inferior parathyroid gland
parathyroid gland Left inferior
Right inferior parathyroid gland
parathyroid gland Right inferior
Esophagus parathyroid gland
FIG. 7.63e ▲ Thyroid and parathyroid glands (posterior aspect) FIG. 7.63f ▲ Thyroid and parathyroid glands (posterior aspect)

466 NECK Pulmonology
VII. Pulmonology a. Laryngeal inlet

A. Pharynx: extends from base of skull to inferior bor- i. Aryepiglottic folds: between epiglottis and
der of cricoid cartilage arytenoid cc.
1. Nasopharynx: superior to soft palate; respiratory ii. Corniculate tubercles: mucosa over cor-
function niculate cc.
a. Choanae: passages from nasal cavities to iii. Cuneiform tubercles: mucosa over cunei-
nasopharynx form cc.
b. Torus tubarius: elevation of pharyngotympanic iv. Interarytenoid notch
tube b. Laryngeal vestibule: superior to vestibular folds
i. Salpingopharyngeal fold: mucosal layer i. Vestibular folds: false vocal cords, mucosa
covering salpingopharyngeus m. covering vestibular ll.; protective function
c. Pharyngeal opening for pharyngotympanic c. Laryngeal ventricle: laryngeal sinus; between
tube: communication between nasopharynx vestibular and vocal folds
and middle ear d. Glottis
d. Pharyngeal recess: between salpingopharyn- i. Vocal folds: true vocal cords
geal fold and posterior wall of pharynx (a) Vocal l.: see Arthrology
2. Oropharynx: posterior to oral cavity (b) Vocalis m.: see Myology
3. Laryngopharynx: see Gastroenterology ii. Vocal process: of arytenoid cartilage
B. Larynx: designed for vocalization; connects orophar- iii. Rima glottidis: region between vocal folds
ynx to trachea e. Infraglottic cavity: between vocal folds and
1. Laryngeal cartilages: see Chondrology inferior border of cricoid cartilage
2. Laryngeal musculature: see Myology Trachea: extends from larynx to its bifurcation in
4 C.
5
3. Laryngeal cavity thorax
Choanae
Pharyngeal
recess
Torus tubarius
Pharyngeal
opening of the
pharyngo-
tympanic tube
Salpingo-
pharyngeal
fold
FIG. 7.64a ▲ Parts of the pharynx (posterior aspect) with the FIG. 7.65a ▲ Parts of the pharynx (sagittal section)
pharyngeal constrictor muscles reflected laterally from a midline incision
Torus tubarius
Pharyngeal
opening of the Choana
pharyngo-
tympanic tube
Nasopharynx
Oropharynx
Choanae
Pharyngeal
recess Laryngopharynx Salpingopharyngeal
fold
Aryepiglottic Laryngeal inlet
fold
Aryepiglottic fold
Laryngeal Trachea
inlet
Esophagus
FIG. 7.64b ▲ Parts of the pharynx (posterior aspect) with the
pharyngeal constrictor muscles reflected laterally from a midline incision FIG. 7.65b ▲ Parts of the pharynx (sagittal section)

Pulmonology NECK 467
Larynx
Epiglottis
Epiglottis
Laryngeal vestibule
Laryngeal vestibule
Vestibular fold
Vestibular fold
Laryngeal ventricle
Laryngeal ventricle
Vocal fold
Vocal fold
Vocal L. Conus elasticus
Vocalis M. Vocal L.
Infraglottic cavity Vocalis M.
Infraglottic cavity
FIG. 7.66a ▲ Parts of the larynx (coronal section) FIG. 7.66b ▲ Parts of the larynx (coronal section)
Epiglottis Epiglottis
Aryepiglottic fold Aryepiglottic fold
Laryngeal vestibule Laryngeal vestibule
Vestibular fold Vestibular fold
Laryngeal ventricle Laryngeal ventricle
Vocal fold Vocal fold
Infraglottic cavity Infraglottic cavity
FIG. 7.67a ▲ Parts of the larynx (posterior aspect) with the larynx FIG. 7.67b ▲ Parts of the larynx (posterior aspect)
propped open posteriorly after a midline incision through the lamina with the larynx propped open posteriorly after a midline
of the cricoid cartilage incision through the lamina of the cricoid cartilage
Glottis
Epiglottis Epiglottis Glottis
Rima Rima
glottidis glottidis
Vocal
Vocal
fold
fold
Vestibular fold
Vestibular
fold
Aryepiglottic
fold Aryepiglottic
fold
Cuneiform
tubercle Cuneiform
tubercle
Corniculate
tubercle Corniculate
tubercle
FIG. 7.68a ▲ Parts of the larynx (superior aspect)
FIG. 7.68b ▲ Parts of the larynx (superior aspect)

468 NECK Gastroenterology
VIII. Gastroenterology (a) Uvula: musculomembranous conical

A. Pharynx: extends from base of skull to inferior bor- extension from soft palate
der of cricoid cartilage (b) Palatoglossal arch: anterior pillar of fau-
1. Nasopharynx: see Pulmonology ces; mucosa covering palatoglossus m.
2. Oropharynx: between soft palate and base of (c) Palatopharyngeal arch: posterior pillar
tongue; digestive function of fauces; mucosa covering palatopha-
a. Fauces: passage from oral cavity to ryngeus m.
oropharynx b. Epiglottic valleculae: between anterior surface
i. Isthmus of the fauces: passage from oral of epiglottis and root of tongue
cavity to oropharynx, between epiglottis 2. Laryngopharynx: posterior to larynx; from epi-
and uvula glottis to esophagus
ii. Soft palate: musculomembranous mass 3. Piriform recess: depression on either side of
extending posteriorly from hard palate; laryngeal inlet
ends inferiorly as uvula 6 Esophagus: extends from laryngopharynx to stomach
B.
Soft palate
Uvula
Palatopharyngeal
arch
Fauces
(Dotted line)
Isthmus of the
Fauces
Epiglottic
vallecula
Epiglottis
Laryngeal inlet
Aryepiglottic
fold
Cuneiform
tubercle
Corniculate
tubercle
Piriform recess
FIG. 7.69a ▲ Parts of the oropharynx (posterior aspect) with the FIG. 7.70a ▲ Parts of the oropharynx (sagittal section)
Soft palate
Uvula
Palatopharyngeal
arch Nasopharynx
Nasopharynx
Palatoglossal arch
Fauces
Isthmus of the
Oropharynx fauces
Oropharynx
Epiglottis
Aryepiglottic fold
Laryngo-
pharynx Laryngo-
Epiglottic vallecula pharynx
Piriform recess
Laryngeal inlet Trachea

Esophagus
FIG. 7.69b ▲ Parts of the oropharynx (posterior aspect) with the FIG. 7.70b ▲ Parts of the oropharynx (sagittal section)

Angiology NECK 469
IX. Angiology a. Costocervical trunk
A.
5 Common carotid a.: originates from brachiocephalic i. Supreme intercostal a.: to 1st and 2nd pos-
trunk on right side and from aortic arch on left side terior intercostal spaces
7 1. Carotid sinus: slight dilation in diameter of com- ii. Deep cervical a.: to posterior deep cervical
mon carotid a.; branch point into internal and muscles; anastomoses with descending
external carotid aa. branch of occipital a.
2. Internal carotid a.: no cervical branches 3. Region 3: distal to anterior scalene; proximal to
3. External carotid a.: travels superiorly between inferior border of 1st rib
mandible and external ear; embedded in parotid a. Dorsal scapular a.: variably arises from 3rd part
gland and terminates as maxillary a. and superfi- of subclavian a., travels superior to scapula
cial temporal a. then along medial border of scapula supplying
a. Superior thyroid a.: travels inferiorly to thyroid levator scapulae and rhomboid mm.; if this ves-
gland deep to infrahyoid mm. sel arises from transverse cervical a. it is known
i. Superior laryngeal a.: to larynx (accompa- as deep branch of the transverse cervical a.
nies internal laryngeal n.) Superior vena cava: formed by union of right and
C.
b. Ascending pharyngeal a.: travels superiorly left brachiocephalic vv.
deep to internal carotid a. giving branches to 1. Brachiocephalic vv.: formed by union of subcla-
pharynx, anterior vertebral mm., middle ear, vian and internal jugular vv.
and cranial meninges a. Subclavian v.: drains upper extremity; receives
c. Lingual a.: travels superiorly deep to hypo- external jugular v.; forms brachiocephalic v. with
glossal n., stylohyoid m., posterior belly of internal jugular v.; possesses bulb and valve to
digastric m. and hyoglossus m.; becomes dor- resist pressure produced by atrial contraction
sal lingual a., deep lingual a., and sublingual a. i. External jugular v.: formed by union of ret-
d. Facial a.: travels superiorly deep to digastric and romandibular and posterior auricular vv.;
stylohyoid mm.; gives off ascending palatine, drains scalp and lateral face; travels inferi-
tonsilar, and submental branches, hooks under orly across sternocleidomastoid m.; receives
inferior border of mandible, and enters face suprascapular, transverse cervical, and ante-
i. Ascending palatine a.: to palate; anastomo- rior jugular vv.; then empties into subclavian
ses with lesser palatine a. from descending v.; smaller than internal jugular v.
palatine a. of maxillary a. (a) Retromandibular v.: receives superficial
ii. Tonsillar branch: to palatine tonsils temporal and maxillary vv.; posterior divi-
iii. Submental a.: anteriorly to submandibular sion contributes to external jugular v., ante-
gland rior division contributes to common facial v.
e. Occipital a.: travels posteriorly to posterior (b) Posterior auricular v.: drains posterior scalp
aspect of scalp superficial to internal carotid a. (c) Transverse cervical v.: follows companion a.
f. Posterior auricular a.: travels posteriorly (d) Suprascapular v.: follows companion a.
between external auditory meatus and mastoid (e) Anterior jugular v.: drains submental region
process, supplying nearby musculature, parotid b. Internal jugular v.: extracranial continuation of
gland, facial n., temporal b., auricle, and scalp sigmoid sinus; receives inferior petrosal sinus
g. Maxillary a.: terminal branch; see Head and occipital, pharyngeal, common facial,
h. Superficial temporal a.: terminal branch; see Head lingual, and superior and middle thyroid vv.;
B. Subclavian a. joins with subclavian v. to form brachioce-
1. Region 1: proximal to anterior scalene m. phalic v.; possesses bulb and valve to resist
a. Vertebral a.: travels superiorly in transverse pressure produced by atrial contraction
foramina of cervical vertebrae (C6–C1); i. Inferior petrosal sinus: exits skull through
crosses over posterior arch of atlas, enters jugular foramen
posterior cranial fossa through foramen mag- ii. Occipital v.: follows companion a.
num, meets with contralateral vertebral a., and iii. Pharyngeal v.: arises from pharyngeal
forms basilar a. venous plexus
b. Internal thoracic a.: travels inferiorly to pos- iv. Common facial v.: union of facial v. and
terior aspect of anterior chest wall; produces anterior division of retomandibular v.; sends
anterior intercostal aa. communicating branch to anterior jugular v.;
c. Thyrocervical trunk can receive lingual and superior thyroid vv.
i. Inferior thyroid a.: supplies thyroid gland (a) Facial v.: follows companion a.
(a) Ascending cervical a.: supplies lateral (b) Retromandibular v.: receives superficial
muscles of superior neck temporal and maxillary vv.; sends ante-
ii. Suprascapular a.: travels posteriorly across rior division into common facial v.
phrenic n., anterior scalene m., and over trans- (c) Communicating branch: communication
verse scapular l. to posterior aspect of scapula between common facial and anterior
iii. Transverse cervical a.: travels posteriorly jugular vv.
across phrenic n., anterior scalene m., and v. Lingual v.: follows companion artery
brachial plexus to deep surface of trapezius m. vi. Superior thyroid v.: drains thyroid gland
(a) Superficial branch: travels with spinal vii. Middle thyroid v.: drains thyroid gland
accessory n. along deep surface of tra- 2. Inferior thyroid vv.: drain thyroid gland; empty
pezius m. into left brachiocephalic vein
(b) Deep branch: if present, replaces dorsal D.
Lymphatics
scapular a. traveling along medial bor- 1. Lypmh nodes
der of scapula supplying levator scapu- a. Superficial nodes
lae and rhomboid mm. i. Occipital nodes: drain occipital region
2. Region 2: deep to anterior scalene m. ii. Mastoid nodes: drain posterior neck

470 NECK Angiology
Superficial parotid nodes: drain parotid region

iii. (e) Retropharyngeal nodes: drains pharynx
iv. Anterior superficial nodes: drain anterior neck v. Lateral deep nodes
along communicating and anterior jugular v. (a) Superior deep nodes: drain tissue along
v. Lateral superficial nodes: drain lateral neck internal jugular v.
along external jugular v. (b) Inferior deep nodes: drain tissue along
b.
Deep nodes internal jugular v.
i. Deep parotid nodes: drain parotid region vi. Supraclavicular nodes
ii. Submental nodes: drain face 2. Lymphoid organs
Submandibular nodes: drain face
iii. a. Oropharynx
iv. Anterior deep nodes i. Lingual tonsil: on root of tongue
(a) Infrahyoid nodes: drain infrahyoid region 8 ii. Palatine tonsils: lymphoid tissue on either
(b) Thyroid nodes: drain tissue around thy- side of oropharynx (between palatoglossal
roid gland and palatopharyngeal arches)
(c) Pretracheal nodes: drains tissue around b. Nasopharynx
trachea 9 i. Pharyngeal tonsil (adenoids): lymphoid tis-
(d) Paratracheal nodes: drains tissue sue on either side of nasopharynx
around trachea
Superficial Posterior
temporal A. Maxillary A. auricular A.
see head see head External Carotid A.
Soft Palatine
palate Tonsils Face
Parotid gland
Ascending
facial N.
temporal B.
palatine A. Submental A.
Submandibular
auricle scalp Tonsillar branch gland Facial A.
Posterior
scalp
Tongue
Occipital A. FIG. 7.71b Branches of the external carotid artery
▲
Lingual A. (lateral aspect of the neck)
External carotid A. Posterior External
Pharynx
anterior vertebral Ascending Occipital A. auricular A. carotid A. Facial A. Submental A.
muscles middle ear pharyngeal A.
cranial meninges
Larynx
Thyroid
gland
Internal Carotid Common Superior Superior

carotid A. sinus carotid A. thyroid A. laryngeal A. Occipital A.
FIG. 7.71a ▲ Schematic of
the external carotid artery Ascending
showing the branches, pharyngeal A.
distribution, and supply
Lingual A.
Internal
carotid A.
Superior
thyroid A.
Carotid sinus
FIG. 7.71c Branches of the Superior

▲
laryngeal A.
external carotid artery (lateral
aspect of the neck immediately Common
inferior to the mandible) carotid A.

Angiology NECK 471
Subclavian A.
Brain Deep
Lateral and posterior
cervical A.
neck musculature/
Ascending spinal branches Transverse
cervical A. cervical A.
Anterior Transverse
scalene M. cervical A.
(superficial
Vertebral A. branch)
Transverse
cervical A.
Inferior Trapezius M.
(deep branch)
thyroid A.
Rhomboid major M. Dorsal
Rhomboid minor M.
Thyrocervical Thyroid gland Levator scapulae M.
scapular A.
trunk
Suprascapular A.
Costocervical Supraspinatus M.
Infraspinatus M.
trunk
II Part III
Left common Part
carotid A.
Supreme
intercostal A.
I
Brachiocephalic
rt
Pa
trunk 1st intercostal space

Axillary A.
Internal
thoracic A.
Upper extremity
Anterior thoracic wall
Aortic arch
FIG. 7.72a ▲ Schematic of the subclavian artery showing the branches, distribution, and supply
Middle scalene M.
Spinal accessory N.
Brachial plexus of
nerves (Trunks) Trapezius M.
Anterior scalene M.
Transverse cervical A.
Phrenic N.
Dorsal Scapular N.
Ascending cervical A.
Suprascapular A.
Inferior thyroid A.
Vertebral A. Suprascapular N.
Thyrocervical trunk Dorsal scapular A.
Left subclavian A.
Axillary A.
Internal thoracic A.
1st Rib
FIG. 7.72b ▲ Branches of the subclavian artery (anterolateral aspect of the neck)

472 NECK Angiology
Middle
scalene M. Spinal
accessory N.
Ascending Trapezius M.
cervical A.
Anterior Transverse
scalene cervical A.
M. (Bisected)
Inferior Dorsal
thyroid A. scapular N.
Vertebral A.
Dorsal
scapular A.
Thyrocervical
trunk
Suprascapular A.
Subclavian A.
(Part 2)
Suprascapular N.
Subclavian A.
(Part 1) Dorsal
scapular A.
Anterior
scalene M. Subclavian A.
(Bisected) (Part 3)
Internal
thoracic A. Axillary A.
Phrenic N. 1st Rib
FIG. 7.72c ▲ Branches of the subclavian artery (anterolateral aspect of the neck) with the anterior scalene muscle reflected
Spinal
accessory N.
Transverse
cervical A.
Common Dorsal
carotid A. scapular N.
Suprascapular A.
Ascending
cervical A.
Suprascapular N.
Inferior Deep
thyroid A. cervical A.
Supreme
intercostal A.
Vagus N.
Costocervical
trunk
Internal
thoracic A. Dorsal
scapular A.
1st Rib
Phrenic N.
FIG. 7.72d ▲ Branches of the subclavian artery (lateral aspect of the neck) with the anterior scalene muscle reflected

Angiology NECK 473
Superior Vena Cava Inferior petrosal sinus
Posterior see head Superficial temporal Vs.

scalp
Maxillary Vs.
Occipital V.
see head
Retromandibular V.
Pharyngeal venous plexus
Face
Pharyngeal V.
Facial V.
to anterior jugular V.
Communicating branch
Tongue
Internal jugular V.
Lingual V.
Superior thyroid V.
Middle thyroid V. Thyroid

gland
External jugular V.
Right brachiocephalic V.
Left brachiocephalic V.
Subclavian V.
Inferior thyroid V.
Superior vena cava
FIG. 7.73a ▲ Schematic of internal and external jugular veins showing the branches, distribution, and drainage
Superficial temporal Vs.

Posterior auricular V.
Retromandibular V.
Facial V.
External jugular V.
Communicating branch
Transverse cervical V.
Suprascapular V. Anterior jugular V.
Internal jugular V.
FIG. 7.73b ▲ Distribution of the internal and external jugular veins (lateral neck)

474 NECK Angiology
Lymph Nodes
Deep parotid
nodes
Occipital
nodes Superior
deep
nodes
Submandibular
nodes
Superficial
parotid Mastoid Infrahyoid
nodes nodes nodes
Submental
nodes
Retropharyngeal
nodes
Anterior
superficial Pretracheal
nodes nodes
Lateral
superficial Thyroid
nodes nodes
Paratracheal
nodes
Inferior
deep
nodes
FIG. 7.74a ▲ Superficial lymph nodes of the neck (lateral aspect)
FIG. 7.74b ▲ Deep lymph nodes of the neck (lateral aspect)
Lymph Organs
Pharyngeal tonsil
Palatine tonsil
Lingual tonsil
Lingual tonsil
FIG. 7.75a ▲ Lymphoid organs of the neck: tonsils FIG. 7.75b ▲ Lymphoid organs of the neck: tonsils (sagittal section)
(posterior aspect) with the pharyngeal constrictor
muscles reflected laterally from a midline incision

Neurology NECK 475
X. Neurology vi. Muscular branches

A. Cranial nerves in cervical region: for full description (a) Rectus capitis anterior m.
see Head Neurology (b) Rectus capitis lateralis m.
1. Vagus n.: exits posterior cranial fossa through (c) Longus capitis m.
jugular foramen, travels in carotid sheath; while (d) Longus colli m.
in neck, produces pharyngeal branch, superior b. Phrenic n. (C3–C5): travels anterior to anterior
laryngeal n., right recurrent laryngeal n., and scalene m. deep to internal jugular v., passes
superior and inferior cardiac branches; enters between subclavian a. and v., and enters tho-
thorax through superior thoracic aperture and rax; innervates thoracic diaphragm
produces left recurrent laryngeal n. 6 c. Brachial plexus of nerves: anterior rami C5–T1;
a. Pharyngeal branch: carrying fibers that trav- at level of trunks, travel between anterior and
eled briefly with spinal accessory n., contrib- middle scalene mm.; for full description, see
utes to pharyngeal plexus and innervates 5 Upper Extremity
pharyngeal muscles 2. Posterior rami
b. Superior laryngeal n.: from inferior vagal a. Suboccipital n.: dorsal ramus of C1; innervates
ganglion, divides in carotid sheath to become musculature of suboccipital region; exists in
internal and external laryngeal nn. suboccipital triangle
i. Internal laryngeal n.: to larynx above vocal b. Greater occipital n.: posterior ramus of C2;
folds cutaneous to posterior scalp, appears below
ii. External laryngeal n.: innervates cricothy- suboccipital triangle traveling superiorly
roid m. c. Least occipital n.: posterior ramus of C3; cuta-
c. Recurrent laryngeal n.: on right side, origi- neous and muscular innervation
nates from vagus n. in neck, travels under d. C4–C8: cutaneous and muscular innervation
right subclavian a. and returns to larynx; on C. Autonomic nervous system
left side, originates from vagus n. in thorax, 1. Sympathetic presence in cervical region
travels under aortic arch, and returns to larynx a. Cervical sympathetic trunk: presynaptic fibers
i. Inferior laryngeal n.: continuation of recur- from thoracic spinal levels ascending to cervi-
rent laryngeal n., innervates all other laryn- cal sympathetic ganglia
geal muscles i. Superior cervical ganglion (C1–C2): largest
d. Superior cardiac branch: to heart cervical ganglion; sends internal and exter-
e. Middle cardiac branch: to heart nal carotid branches forming periarterial
2. Spinal accessory n.: passes through posterior plexus; produces superior cervical cardiac
triangle then travels deep to trapezius m.; inner- branch; also sends gray rami communicans
vates sternocleidomastoid and trapezius mm. to anterior rami of C1–C4 spinal nerves
3. Hypoglossal n.: exits hypoglossal canal, passes (a) Internal carotid n.: contributes to carotid
between external carotid a. and internal jugular v.; periarterial plexus; supplies viscera of
receives branches from anterior ramus of C1 which head and neck
produces superior root of ansa cervicalis; sends (b) External carotid n.: contributes to
branches carrying C1 fibers to geniohyoid and thyro- carotid periarterial plexus; supplies vis-
hyoid mm., then turns superiorly toward tongue to cera of head and neck
innervate 7 intrinsic and extrinsic tongue muscles (c) Superior cervical cardiac branch: feeds
B. Cervical spinal nerves: C1–C8 into cardiac plexus and supplies heart
1. Anterior rami ii. Middle cervical ganglion: smallest cervical
a. Cervical plexus of nerves: anterior rami C1–C4 ganglion; often absent; sends branches to
i. Lesser occipital n. (C2): travels posterosu- carotid periarterial plexus, produces middle
periorly from nerve point of neck; cutane- cervical cardiac branch, and sends gray
ous innervation to skin of neck and scalp rami communicans to anterior rami of C5–
posteriosuperior to auricle C6 spinal nerves
ii. Great auricular n. (C2–C3): travels superi- (a) Middle cervical cardiac branch: feeds
orly from nerve point of neck; cutaneous into cardiac plexus and supplies heart
innervation to skin over parotid gland, iii. Inferior cervical ganglion: often fuses with
posterior aspect of auricle, and skin from 1st thoracic sympathetic ganglion to form
mandible to mastoid process large cervicothoracic (stellate) ganglion;
iii. Transverse cervical n. (C2–C3): travels ante- sends branches to carotid and vertebral
riorly across sternocleidomastoid m. from periarterial plexuses, produces inferior cer-
nerve point of neck; cutaneous innervation vical cardiac branch, and sends gray rami
to skin over anterior triangle communicans to anterior rami of C7–C8
iv. Supraclavicular n. (C3–C4): travels inferiorly spinal nerves
from nerve point of neck; cutaneous inner- (a) Inferior cervical cardiac branch: feeds
vation to skin over neck and shoulder into cardiac plexus and supplies heart
(a) Lateral supraclavicular n. (b) Vertebral n.: feeds into vertebral peri-
(b) intermediate supraclavicular n. arterial plexus and supplies viscera of
(c) Medial supraclavicular n. head and neck
v. Ansa cervicalis (C1–C3): loops down over 2. Parsympathetic presence in cervical region
carotid sheath; innervates 3 infrahyoid mm. a. Vagus n.: parasympathetic innervation to lar-
(a) Superior root (C1): travels briefly with ynx, pharynx, and carotid bodies
hypoglossal n. i. Pharyngeal branch: parasympathetic to
(b) Inferior roots: C2–C3 pharynx

476 NECK Neurology
ii. Superior laryngeal n.: parasympathetic to iv.

N. to carotid body
larynx above vocal folds v. Superior cardiac branch: to heart
Recurrent laryngeal n.: parasympathetic to
iii. Middle cardiac branch: to heart
vi.
larynx below vocal folds
Cranial Nerves in Cervical Region

Superior vagal
ganglion
Hypoglossal N.
Inferior vagal
ganglion
Right
Pharyngeal vagus N.
branch Superior
laryngeal N.
Pharyngeal
plexus
Superior pharyngeal constrictor M.
Middle pharyngeal constrictor M.
Internal
Inferior pharyngeal constrictor M. laryngeal N.
Palatopharyngeus M.
External
laryngeal N.
Superior
laryngeal N.
Left vagus N.
Right vagus N.
Internal
laryngeal N.
Laryngeal mucosa
superior to vocal folds
External
laryngeal N. FIG. 7.76b ▲ Branches of the right vagus nerve (lateral aspect)
Cricothyroid M.
Right vagus N.
Superior Left vagus N.

cardiac branch
Right recurrent
laryngeal N.
Posterior cricoarytenoid M. Middle
Lateral cricoarytenoid M.
cardiac branch
Thyroarytenoid M.
Middle cardiac
Vocalis M. branch
Arch of
the aorta
Left recurrent
Inferior laryngeal N.
laryngeal N.
Trachea
Heart
Inferior
cardiac branch
Left recurrent
laryngeal N.
Arch of
FIG. 7.76a ▲ Schematic of the left vagus nerve the aorta
showing the branches, distribution, and innervation
FIG. 7.76c ▲ Branches of the right and left vagus nerves
(anterior aspect of the deep neck and superior mediastinum)

Neurology NECK 477
Cranial
Nerves in
Cervical
Region
Pharyngeal
branch Superior pharyngeal
constrictor M.
Pharyngeal
plexus
Middle pharyngeal
constrictor M.
Left vagus N.
Inferior pharyngeal
constrictor M.
FIG. 7.77a ▲ Schematic of the pharyngeal branches of the vagus nerve (posterior aspect)
Pharyngeal Pharyngeal
branch branch
Superior Superior
laryngeal N. laryngeal N.
Internal Internal
External External
Inferior Inferior
Left vagus N. Right

vagus N.
Left recurrent Right recurrent

Arch of Right
the aorta subclavian A.
FIG. 7.77b ▲ Branches of the left vagus nerve (lateral aspect) FIG. 7.77c ▲ Branches of the right vagus nerve (lateral aspect)

478 NECK Neurology
Cranial Nerves in Cervical Region
Spinal accessory N.
(CN XI)
Trapezius M.
FIG. 7.78a ▲ Schematic of the spinal accessory nerve in FIG. 7.78b ▲ Spinal accessory nerve in the neck
the neck showing the branches, distribution, and innervation (anterolateral aspect)
(posterior aspect)
Hypoglossal N.
(CN XII)
Superior root
ansa cervicalis
(C1)
FIG. 7.79a ▲ Hypoglossal nerve in the neck showing FIG. 7.79b ▲ Hypoglossal nerve in the neck showing
its relationship to the ansa cervicalis (lateral aspect) its relationship to the ansa cervicalis (lateral aspect)

Neurology NECK 479
Cervical Plexus
Skin over parotid gland,

Skin neck and Great
scalp behind auricle
posterior auricle, auricular N. (C2,3)
mandible to mastoid
.
al N
Lesser
ss
occipital N. (C2)
glo
po
Tongue
Geniohyoid
Hy
musculature
branch (C1)
Anterior
Hypoglossal N. ramus
Geniohyoid M.
(CN XII) C1
Thyrohyoid
branch (C1)
Thyrohyoid M.
Anterior
ramus
C2 Superior root ansa
cervicalis (C1)
Anterior
ramus
C3
Inferior root ansa
Anterior cervicalis (C2,3)
ramus
C4
Skin over anterior

Transverse
Anterior
ramus
triangle cervical N. (C2,3)
C5
Sternothyroid M.
Medial
supraclavicular N.
(C3,4) Omohyoid M.
Sternohyoid M.
Intermediate
supraclavicular N.
(C3,4) Lateral
Skin neck supraclavicular N.
Phrenic N. (C3,4,5) and shoulder
Skin neck Skin neck (C3,4)
and shoulder and shoulder
Thoracic diaphragm
FIG. 7.80a ▲ Schematic of the cervical plexus showing the branches, distribution, and innervation
Hypoglossal N.
(CN XII)
Anterior ramus 2nd Great

cervical spinal N. auricular N. (C2,3)
Lesser
Anterior ramus 3rd
occipital N. (C2)
cervical spinal N.
Superior root ansa

cervicalis (C1)
Transverse
cervical N. (C2,3)
(Reflected laterally)
Inferior root
ansa cervicalis (C2,3)
Lateral
Anterior ramus 4th supraclavicular N.
cervical spinal N. (C3,4)
Intermediate
supraclavicular N.
(C3,4)
Medial
supraclavicular N.
(C3,4)
FIG. 7.80b ▲ Branches of the cervical plexus of nerves in the neck (anterolateral aspect)

480 NECK Neurology
Cervical Plexus
Great
auricular N. (C2,3)
Lesser
occipital N. (C2)
Nerve point
of the neck
Transverse
cervical N. (C2,3)
Lateral
supraclavicular N.
(C3,4)
Intermediate
supraclavicular N.
(C3,4)
Medial
supraclavicular N.
(C3,4)
FIG. 7.81a ▲ Schematic of the cutaneous branches of the cervical plexus of nerves
Great
auricular N. (C2,3)
Lesser
occipital N. (C2)
Nerve point
of the neck
Transverse
cervical N. (C2,3)
Lateral
supraclavicular N.
(C3,4)
Intermediate
supraclavicular N.
(C3,4)
Medial
supraclavicular N.
(C3,4)
FIG. 7.81b ▲ Cutaneous branches of the cervical plexus of nerves (anterolateral aspect)

Neurology NECK 481
Sympathetic Nervous System
Head and neck

viscera
Carotid periarterial Anterior ramus

plexus 1st cervical spinal N.
Internal carotid N. Superior cervical
External carotid N. ganglion
Grey rami
Superior cervical
communicans
cardiac N.
External carotid A.
Interganglionic
Internal carotid A. branch
Branches to the carotid
periarterial plexus
Middle cervical
Middle cervical ganglion
cardiac N.
Grey ramus
Branches to the carotid communicans
periarterial plexus
Vertebral N. Inferior cervical

ganglion
Vertebral A. Grey ramus
Inferior cervical communicans
cardiac N. Anterior ramus 8th
cervical spinal N.
Common carotid A.
Interganglionic
branch
FIG. 7.82 Schematic of the cervical
▲
sympathetic trunk showing the branches,

distribution, and innervation
(anterior aspect of the vertebral column)
Heart
Helpful Notes
1. Fascia of the neck: 2.
1. The 3 types of joints are synovial joints (diarthrosis; united
A. Superficial cervical fascia: thin subcutaneous connec- by an articular capsule), fibrous joints (synarthrosis; united
tive tissue by fibrous tissue), and cartilaginous joints (amphiarthrosis;
B. Deep cervical fascia united by hyaline cartilage or fibrous cartilage). The follow-
i. Investing layer: superficial layer of deep cervical fascia ing are further classifications of the 3 main joint types:
ii. Pretracheal layer • Synovial joints: diarthrosis, freely moveable, character-
• Continuous inferiorly with fibrous pericardium ized by a fibrous capsule lined with a synovial mem-
• Continuous posteriorly with buccopharyngeal fascia brane, a joint space, hyaline cartilage lining the articular
• Encloses infrahyoid muscles, thyroid gland, surfaces, and synovium
trachea, and esophagus • Planar: flat, arthroidal, non-axial gliding movement
iii. Prevertebral layer: surrounds vertebral column and (e.g., acromioclavicular joint)
musculature • Ginglymus: hinge, uniaxial (e.g., humeroulnar joint)
(continues on page 482)

482 NECK Neurology
• Trochoid: pivot, unixial, rotation (e.g., median atlanto- transverse cervical a. The contents of the supraclavicular
axial joint) triangle include the 3rd part of the subclavian a. and the
• Condylar: 1–2 concave surfaces articulating with 1–2 con- suprascapular a.
vex surfaces, biaxial (e.g., metacarpophalangeal joint) 4. The anterior triangle is bordered by the median line of
• Sellar: saddle, both surfaces are convex and concave, the neck, the sternocleidomastoid m., and the mandible.
biaxial, allowing circumduction without rotation (e.g., The muscular contents of the anterior triangle include the
carpometacarpal joint) mylohyoid, geniohyoid, digastric, stylohyoid, sternohyoid,
• Spheroidal: ball and socket, triaxial, allowing rotation sternothyroid, and thyrohyoid mm. and the superior belly
along all 3 axes (e.g., femoroacetabular joint) of the omohyoid m.
• Compound: any combination of the above joints • The anterior triangle is further subdivided into 2 supra-
• Fibrous joints: synarthrosis, characterized by bone, hyoid triangles by the hyoid b., the posterior belly of the
fibrous connective tissue, and bone digastric m., and 2 infrahyoid triangles. The 2 suprahyoid
• Sutures: interlocked bone (e.g., skull sutures) triangles, the submental triangle (anterior) and the sub-
• Schindylesis: tongue-in-groove (e.g., vomer b./perpen- mandibular triangle (posterior), are separated by the ante-
dicular plate of the ethmoid b. into the nasal crest) rior belly of the digastric m. The contents of the submental
• Gomphosis: peg-in-socket (e.g., dentoalveolar joint) triangle include the submental a., submental lymph nodes,
• Syndesmosis: bone-ligament-bone (e.g., middle radio- and small veins. The contents of the submandibular tri-
ulnar joint by the interosseous membrane) angle include the submandibular gland, hypoglossal n.,
• Cartilagenous joints: amphiarthrosis, characterized by nerve to the mylohyoid m., and parts of the facial a. and v.
bone, cartilage, bone • The two infrahyoid triangles, the muscular triangle (ante-
• Synchondrosis: primary cartilagenous joints, character- rior) and the carotid triangle (posterior), are separated
ized by temporary cartilagenous unions of hyaline car- by the superior belly of the omohyoid m. The contents
tilage, usually between the diaphysis and epiphysis of of the muscular triangle include the thyroid gland and
growing bone parathyroid glands. The contents of the carotid triangle
• Symphysis: secondary cartilagenous joints, charac- include the common carotid a, internal jugular v., vagus
terized by strong, slightly moveable joints united by n., hypoglossal n., spinal accessory n., the superior root
fibrocartilage of the ansa cervicalis, thyroid gland, larynx, pharynx,
3. The posterior triangle is bound by the sternocleidomastoid and branches of the cervical plexus.
m., trapezius m., and the clavicle. The contents of the pos- 5. The carotid sheath houses the common carotid a., the
terior triangle include the levator scapulae m.; the anterior, internal jugular v., and the vagus n.
middle, and posterior scalene mm.; the inferior belly of
the omohyoid m.; and the splenius capitus m. The inferior 6. The suboccipital triangle is made up of the rectus capitus
belly of the omohyoid m. further subdivides the posterior posterior major, obliquus capitus inferior, and the obliquus
triangle into the occipital triangle (superior to the inferior capitus superior mm. The suboccipital n. exits the suboc-
belly of the omohyoid m.) and the supraclavicular triangle cipital triangle, the greater occipital n. travels superficial to
(inferior to the inferior belly of the omohyoid m.). The con- the suboccipital triangle, and the vertebral a. can be seen
tents of the occipital triangle include the external jugular deep in the suboccipital triangle.
v., the posterior branches of the cervical plexus, and the
Clinical Notes
1. The anterior longitudinal l. is important due to its possible 6. Tracheoesophageal fistula is a congenital anomaly of
splinting action that should be used whenever fracture the esophagus in which, in its most common form, the
of the vertebral column is suspected (except with cervi- esophagus ends in a blind-ended pouch, and the stomach
cal fractures due to hyperextension). When a fracture of communicates with the trachea. Other forms include a
the vertebral column occurs, the patient should be kept in blind-ended pouch with no tracheal communication and a
hyperextension at all times. The pull of the anterior lon- complete esophagus with tracheal communication distal
gitudinal l. will help realign fragments of bone and keep to the epiglottis.
further injury to the spinal cord from occurring. 7. Carotid bodies (chemoreceptors) exist at the carotid sinus
2. Congenital torticollis is a disorder results in a fibrous tis- and monitor the oxygen content of blood before it reaches
sue tumor, which forms in the sternocleidomastoid m., the brain. Adjustments to heart rate, respiratory rate, and
causing the head to tilt towards the affected side and the blood pressure can be made accordingly based on the
face to look away from the affected side. A hematoma can oxygen content in the carotid sinus via the glossopharyn-
arise and impinge on the spinal accessory n., which dener- geal n. The carotid sinus is also hypersensitive to pres-
vates the sternocleidomastoid m. sure (baroreceptors); therefore, excessive pressure to the
3. Enlargement of the thyroid gland is called goiter. One type carotid sinus can produce slow heart rate, a drop in blood
of goiter, exophthalmic goiter, is produced by an overpro- pressure, and fainting.
duction of thyroid hormone and can result in bulging of 8. Tonsillectomy is a removal of the palatine tonsils due
the eyeballs. to their inflammation obstructing the communication
4. Fractures of the laryngeal skeleton occur often in sports between the oral cavity and the oropharynx. Due to the
and can produce respiratory obstruction, hoarseness, and presence of the tonsilar a., glossopharyngeal n., and
an inability to speak. internal carotid a., tonsillectomy makes these vessels and
nerves vulnerable to injury.
5. Cancer of the larynx is common among individuals who
9. Adenoiditis is an inflammation of the pharyngeal tonsils
smoke. Laryngectomy and tracheostomy are performed
in cases of laryngeal malignancy. Vocalization can be obstructing the nasal passageways and opening of the
achieved by an electrolarynx, tracheoesophageal prosthe- auditory tube. This can cause hearing impairment and lead
sis, or esophageal speech. to otitis media.


Atlas de Anatomia Anthony B. Olinger

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Atlas de Anatomia Anthony B. Olinger

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Copyright © 2016 Wolters Kluwer.

Library of Congress Cataloging-in-Publication Data

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●● Anatomical methods ●● Superficial: nearer to the surface

(skin) tures or bones to the point of hyperextension, usually

ital systems ■■ Circumduction: circular movement through a spheroi-

eyes directed forward (anteriorly), upper extremities ■■ Depression: to pull down

axis tomical position

planes movement, tight joint capsule)

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surfaces) monary V.)

connective tissue) ■■ Large veins

connective tissue) ■■ Venules

nective tissue) ■■ Lymphatics (collect surplus tissue fluid as lymph and

acterized by temporary cartilaginous unions of hy- the lymph nodes)

epiphysis of growing bone) circulation)

fibrocartilage) ●● Divisions of the nervous system

other) bodies outside the CNS)

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General • Ramus: branch • Falx: sickle

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Chapter 1: Thorax 1 Gastroenterology 89 Coccygeal Plexus 202

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Neck Endocrinology Angiology

The neck occupies the body region between the lower

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Lesser horn Greater horn

FIG. 7.1a ▲ Bony landmarks of the hyoid bone Lesser horn

FIG. 7.1b ▲ Bony landmarks of the hyoid bone

Body Lesser horn

Greater horn Body

III. Chondrology b. Thyroid articular surfaces: articulate with infe-

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Stalk of the epiglottis Epiglottic cartilage

Arytenoid cartilage Thyroid cartilage

Thyroid cartilage: Thyroid cartilage:

Superior thyroid Superior thyroid

Oblique line Oblique line

Laryngeal prominence Laryngeal prominence

Inferior thyroid tubercle Inferior thyroid

FIG. 7.3b ▲ Features of the laryngeal cartilages (anterior aspect)

Thyroid cartilage: Thyroid cartilage:

Inferior thyroid tubercle

Cricoid cartilage: Inferior horn

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Arytenoid cartilage: Arytenoid cartilage:

Vocal process Vocal process

Muscular process Muscular process

Articular surface Corniculate cartilage Articular surface

Thyroid cartilage: Thyroid cartilage:

Superior horn Superior horn

Superior thyroid Superior

Articular surface Muscular process

Cricoid cartilage: Cricoid cartilage:

Thyroid cartilage: Thyroid cartilage:

Inferior horn Inferior horn

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Epiglottic cartilage Epiglottic cartilage