HEAD and NECK

SURFACE ANATOMY
• Surface Landmarks of the Head
• Surface Landmarks of the Neck
HEAD
 NASION
• Depression in the midline of the root of the
nose
 EXTERNAL OCCIPITAL
PROTRUBERANCE
• Bony prominence in the middle of the
squamous part of the occipital bone
 VERTEX
• Highest point of the skull in the sagittal plane
 ANTERIOR FONTANELLE
• Lies between the two halves of the frontal
bone and two parietal bone
 POSTERIOR FONTANELLE
• Lies between the squamous part of the
occipital bone and the posterior borders of
the parietal bones
 SUPERCILIARY RIDGES
• Two prominent ridges on the frontal bones
above the upper margin of the orbit
 SUPERIOR NUCHAL LINE
• Curved ridge that runs laterally from the EOP
to the mastoid process of the temporal bone
• Gives attachment to trapezius and SCM
muscles
MASTOID PROCESS OF THE TEMPORAL
BONE
• Projects downward and forward from behind
the ear
 AURICLE AND EXTERNAL AUDITORY
MEATUS
• Lies in front of the mastoid process (EAM-1
inch long forming an S-shaped curve)
 TYMPANIC MEMBRANE
• Pearly gray and is concave toward the meatus
• UMBO – the most depressed part of the
concavity
 ZYGOMATIC ARCH
• Extend in front of the ear and ends in front of
the zygomatic bone
 SUPERFICIAL TEMPORAL ARTERY
• Pulsations can be felt as it crosses the zygomatic
arch, immediately infront of the auricle
 PTERION
• Point where the greater wing of the sphenoid
meets the anteroinferior angle of the parietal
bone
 TEMPOROMANDIBULAR JOINT
• Easily palpated in front of the auricle
ANTERIOR and POSTERIOR BORDER OF
THE RAMUS OF THE MANDIBLE
• Ant - Can be felt deep to the masseter muscle
• Post – overlapped above by the parotid gland
 BODY OF MANDIBLE
• Best examined by having one finger inside the
mouth and another on the outside
 FACIAL ARTERY
• Pulsations can
be felt as it
crosses the
lower margin
of the body of
the mandible,
at the anterior
border of the
masseter
muscle
ANTERIOR BORDER OF THE MASSETER
• Can be felt by clenching the teeth
 PAROTID DUCT
• Runs forward
from the
parotid gland
one
fingerbreadt
h below the
zygomatic
arch
 ORBITAL MARGIN
• Formed by the frontal, zygomatic and
maxillary bones
 SUPRAORBITAL NOTCH
• Can be felt at the junction of the medial and
intermediate thirds of the upper margin of the
orbit
 INFRAORBITAL FORAMEN
• Lies below the lower margin of the orbit
 INFRAORBITAL NERVE
• Emerges from infraorbital foramen and
supplies the skin of the face
 MAXILLARY AIR SINUS
• Situated within the maxillary bone and lies
below the infraorbital foramen on each side
 FRONTAL AIR SINUS
• Situated within the frontal bone and lies deep
to the superciliary ridge on each side
 SURFACE LANDMARKS OF THE NECK
• ANTERIORLY
• POSTERIORLY
• LATERALLY
ANTERIOR ASPECT
 SUBMENTAL TRIANGLE
• BOUNDARIES:
– Anteriorly: midline of the neck
– Laterally: anterior belly of the digastric muscle
– Inferiorly: body of the hyoid bone
– Floor: mylohyoid muscle
– Contents: submental lymph nodes
POSTERIOR ASPECT
EXTERNAL OCCIPITAL PROTRUBERANCE
NUCHAL GROOVE & CERVICAL SPINES
• Can be palpated using the index finger placed
of the skin in the midline
• LIGAMENTUM NUCHAE: covers C1-C6 spines
• C7: vertebra prominens
LATERAL ASPECT
STERNOCLEIDOMASTOID MUSCLE
TRAPEZIUS MUSCLE
PLATYSMA MUSCLE
 LATERAL ASPECT
• Anterior Triangle of the Neck
• Carotid Sheath
• Posterior Triangle of the Neck
• Roots and Trunk of the Brachial Plexus
• Third Part of the Subclavian Artery
• External Jugular Veins
• Salivary Glands (parotid, submandibular,
sublingual)
 THE SCALP
LAYERS:
1. Skin – thick and hair bearing and contains
numerous sebaceous glands
2. Connective tissue – fibro-fatty tissue located
beneath the skin; fibrous septa uniting the
skin to the underlying aponeurosis; arteries
and veins
 THE SCALP
LAYERS:
3. APONEUROSIS (EPICRANIAL) – thin,
tendinous sheet that unites the occipital and
frontal bellies of the occipitofrontalis muscle
4. LOOSE AREOLAR TISSUE – occupies the
subaponeurotic space and loosely connects
the epicranial aponeurosis to the
periosteum of the skull (the pericranium)
 THE SCALP
5. PERICRANIUM – periosteum covering the
outer surface of the skull bones

Muscle of the Scalp: OCCIPITOFRONTALIS

 BONES
• The Skull
 Cranium (8)
 Face (14)
 THE SKULL
• SUTURES – immobile joints uniting the several
separate joints
• SUTURAL LIGAMENT – connective tissue
between the bones
• DIVISIONS:
– CRANIUM
• Vault (upper part)
• Base (lowest part)
– FACE
 THE SKULL
CRANIUM FACE
• FRONTAL BONE • ZYGOMATIC BONES
• PARIETAL BONES • MAXILLAE
• OCCIPITAL BONE • NASAL BONES
• TEMPORAL BONES • LACRIMAL BONES
• SPHENOID BONE • VOMER
• ETHMOID BONE • PALATINE BONES
• INFERIOR CONCHAE
• MANDIBLE
THE CRANIUM
FRONTAL BONE
PARIETAL BONES
OCCIPITAL BONE
TEMPORAL BONES
SPHENOID BONE
SPHENOID BONE
ETHMOID BONE
ETHMOID BONE
ETHMOID BONE
 SUTURES
• SAGITTAL
• CORONAL
• LAMBDOID
• SQUAMOUS
THE FACE
ZYGOMATIC BONES
MAXILLAE
MAXILLAE
NASAL BONES
LACRIMAL BONES
VOMER
PALATINE BONES
PALATINE BONES
INFERIOR CONCHAE
MANDIBLE
MANDIBLE
TEMPOROMANDIBULAR JOINT
 TEMPOROMANDIBULAR JOINT
• Synovial type of joint
• Articulation occurs between the articular
tubercle and the anterior portion of the
mandibular fossa of the temporal bone above
and the head (condyloid process) of the
mandible below.
• Movements: depression-elevation
protrusion-retraction
rotation
 MUSCLES OF THE SUBMANDIBULAR
REGION
• Digastric
• Mylohyoid
• Hyoglossus
• Geniohyoid
• Genioglossus
• Styloglossus
 MUSCLES
• MUSCLES OF THE FACE
• MUSCLES OF MASTICATION
MUSCLES OF THE FACE
MUSCLES OF THE MASTICATION
 MUSCLES OF THE TONGUE
MUSCLE ACTION INNERVATION
PALATOGLOSSUS ELEVATES PHARYNGEAL
PLEXUS
GENIOGLOSSUS PROTRUDES CN XII
HYPOGLOSSUS DEPRESSES CN XII
STYLOGLOSSUS CURLS CN XII
 LATERAL MUSCLES OF THE NECK
SCALENES MUSCLE SCM
C3-C6 INNERVATION CN XI, C3, C4
POSTERIOR LOCATION/ ANTERIOR
TRIANGLE CONCENTRATION TRIANGLE
NECK BILATERAL NECK FLEXION
FLEXION
I/L SIDE UNILATERAL I/L SIDE
FLEXION FLEXION
I/L ROTATION C/L ROTATION
ANTERIOR MUSCLES OF THE NECK
SUPRAHYOID DIGASTRIC
GENIOHYOID
STYLOHYOID
MYOHYOID
HYOID BONE
INFRAHYOID THYROHYOID
OMOHYOID
STERNOHYOID
STERNOTHYROID
 MAJOR PARTS OF THE BRAIN
PARTS OF THE SUBDIVISIONS CAVITIES OF THE
BRAIN BRAIN
FOREBRAIN CEREBRUM RIGHT AND LEFT
DIENCEPHALON LATERAL
VENTRICLES
THIRD VENTRICLE
MIDBRAIN CEREBRAL
AQUEDUCT
HINDBRAIN PONS FOURTH VENTRICLE
MEDULLA AND CENTRAL
OBLONGATA CANAL
CEREBELLUM
 CEREBRUM
• Largest part of the brain and consists of two
cerebral hemispheres connected by a mass of
white matter called the corpus callusom.
 DIENCEPHALON
• THALAMUS – large mass of gray matter that
lies on either side of the third ventricle; relay
station on the afferent sensory pathway to
cerebral cortex
• HYPOTHALAMUS – lower part of the lateral
wall and floor of the third ventricle
 MIDBRAIN
• Narrow part of the brain that passes through
the tentorial notch and connects the forebrain
to the hindbrain
 HINDBRAIN
• PONS – situated on the anterior surface of the
cerebellum below the midbrain and above the
medulla oblongata
• MEDULLA OBLONGATA – conical in shape;
connects the pons above to the spinal cord
below
• CEREBELLUM – lies within the posterior cranial
fossa beneath the tentorium cerebelli;
situated posterior to the pons and medulla
oblongata
 CRANIAL NERVES
I. OLFACTORY SENSORY
II. OPTIC SENSORY
III. OCULOMOTOR MOTOR
IV. TROCHLEAR MOTOR
V. TRIGEMINAL MIXED
VI. ABDUCENT MOTOR
 CRANIAL NERVES
VII.FACIAL MIXED
VIII. VESTIBULOCOCHLEAR SENSORY
IX. GLOSSOPHARYNGEAL MIXED
X. VAGUS MIXED
XI. ACCESSORY MOTOR
XII. HYPOGLOSSAL MOTOR
 CRANIAL NERVES
NERVE FUNCTION OPENING IN SKULL
I. OLFACTORY SMELL CRIBRIFORM PLATE
OF ETHMOID
II. OPTIC VISION OPTIC CANAL
III. OCULOMOTOR LIFTS UPPER EYELID, SUPERIOR ORBITAL
TURNS EYEBALL FISSURE
UPWARD,
DOWNWARD AND
MEDIALLY;
CONSTRICTS PUPIL;
ACCOMODATES EYE
 CRANIAL NERVES
NERVE FUNCTION OPENING IN SKULL
IV. TROCHLEAR ASSIST IN TURNING THE SUPERIOR ORBITAL
EYEBALL DOWNWARD FISSURE
AND MEDIALLY
V. TRIGEMINAL
OPHTHALMIC CORNEA, SKIN OF SUPERIOR ORBITAL
DIVISION FOREHEAD, SCALP, FISSURE
EYELIDS AND NOSE
MAXILLARY SKIN OF FACE OVER FORAMEN
DIVISION MAXILLA AND UPPER ROTUNDUM
LIP; TEETH OF UPPER
JAW, MAXILLARY AIR
SINUS, PALATE
 CRANIAL NERVES
NERVE FUNCTION OPENING IN SKULL
MANDIBULAR MUSCLES OF FORAMEN OVALE
DIVISION MASTICATION
SKIN OF CHEEK, SKIN
OVER MANDIBLE,
LOWER LIP AND SIDE OF
HEAD; TMJ
VI. ABDUCENT TURNS EYEBALL SUPERIOR ORBITAL
LATERALLY FISSURE
 CRANIAL NERVES
NERVE FUNCTION OPENING IN SKULL
VII. FACIAL MUSCLES OF THE FACE, INTERNAL
CHEEK AND SCALP; ACOUSTIC MEATUS,
STAPEDIUS FACIAL CANAL,
TASTE FROM ANTERIOR STYLOMASTOID
2/3 OF TONGUE FORAMEN
VIII. POSITION AND INTERNAL
VESTIBULO- MOVEMENT OF HEAD ACOUSTIC MEATUS
COCHLEAR HEARING
IX. GLOSSO- ASSISTS IN JUGULAR
PHARYNGEAL SWALLOWING; GENERAL FORAMEN
SENSATION AND TASTE
FROM POSTERIOR THIRD
OF TONGUE AND
PHARYNX
 CRANIAL NERVES
NERVE FUNCTION OPENING IN SKULL
X. VAGUS CONSTRICTOR MS OF JUGULAR
PHARYNX AND FORAMEN
INTRINSIC MS OF
LARYNX, INVOLUNTARY
MS OF TRACHEA AND
BRONCHI, HEART,
ALIMENTARY TRACT;
LIVER AND PANCREAS
TASTE FROM EPIGLOTTIS
AND AFFERENT FIBERS
OF THE STRUCTURES
AFOREMENTIONED
 CRANIAL NERVES
NERVE FUNCTION OPENING IN SKULL
XI. ACCESSORY MUSCLES OF SOFT JUGULAR
PALATE, PHARYNX AND FORAMEN
LARYNX
SCM AND TRAPEZIUS
XII. MUSCLES OF TONGUE HYPOGLOSSAL
HYPOGLOSSAL CONTROLLING ITS CANAL
SHAPE AND
MOVEMENT
AUDITORY OSSICLES
 MUSCLES OF THE MIDDLE EAR
• TENSOR TYMPANI – dampens down vibrations
of tympanic membrane
• STAPEDIUS – dampens down vibrations of
stapes
 TEETH
• DECIDUOUS TEETH – 20
– 4 incisors
– 2 canines
– 4 molars
• PERMANENT TEETH – 32
– 4 incisors
– 2 canines
– 4 premolars
– 6 molars
 APPROXIMATE TIMES OF ERUPTION
• DECIDUOUS TEETH
– Central incisors: 6-8 mos
– Lateral incisors: 8-10 mos
– First molar: 1 year
– Canines: 18 mos
– Second molars: 2 years
 APPROXIMATE TIMES OF ERUPTION
• PERMANENT TEETH
– First molars: 6 years
– Central incisors: 7 years
– Lateral incisors: 8 years
– First premolars: 9 years
– Second premolars: 10 years
– Canines: 11 years
– Second molars: 12 years
– Third molars (wisdom teeth): 17-30 years
 THE NOSE
• ROOT OR BRIDGE OF THE NOSE – attaches the
nose to the forehead
• NOSTRILS OR NARES – external orifices of the
nose
• ALA – bound the nostril laterally
• NASAL SEPTUM - bounds the nostril medially
 TRIANGLES OF THE NECK
• ANTERIOR TRIANGLE OF THE NECK
• POSTERIOR TRIANGLE OF THE NECK
 CONTENTS
ANTERIOR CONTENTS POSTERIOR
TRIANGLE TRIANGLE
INTERNAL VEIN EXTERNAL
JUGULAR JUGULAR
CAROTID ARTERY SUBCLAVIAN
CN 9-10-11-12 NERVES BRACHIAL
PLEXUS, CN XI
ANTERIOR TRIANGLE OF THE NECK
BOUNDARIES:
ANTERIOR – midline of the neck
POSTERIOR – anterior border of the SCM
SUPERIOR – lower margin of the body of
the mandible
ANTERIOR TRIANGLE OF THE NECK
SUBDIVISIONS:
• SUBMENTAL TRIANGLE
• DIGASTRIC/SUBMANDIBULAR TRIANGLE
• CAROTID TRIANGLE
• MUSCULAR TRIANGLE
 SUBMENTAL TRIANGLE
• BOUNDARIES:
– Anteriorly: midline of the neck
– Laterally: anterior belly of the digastric muscle
– Inferiorly: body of the hyoid bone
– Floor: mylohyoid muscle
– Contents: submental lymph nodes
 DIGASTRIC TRIANGLE
BOUNDARIES:
ANTERIOR – anterior belly of the digastric
POSTERIOR – posterior belly of the
digastric and the stylohyoid
SUPERIOR – lower border of the body of
the mandible
FLOOR – mylohyoid and hyoglossus muscle
 CAROTID TRIANGLE
BOUNDARIES:
SUPERIOR – posterior belly of digastric
INFERIOR – superior belly of the omohyoid
POSTERIOR – anterior border of the SCM
FLOOR – thyrohyoid, hyoglossus, and
middle and inferior constrictor
muscles of the pharynx
 MUSCULAR TRIANGLE
BOUNDARIES:
ANTERIOR – midline of the neck
SUPERIORLY – superiorly belly of the
omohyoid
INFERIORLY – anterior border of the SCM
FLOOR – sternohyoid and strenothyroid
muscles
 POSTERIOR TRIANGLE OF THE NECK
BOUNDARIES:
ANTERIOR – posterior border of the SCM
POSTERIOR – anterior border of the
trapezius
INFERIOR – middle third of the clavicle
 POSTERIOR TRIANGLE OF THE NECK
Contents:
Arteries – subclavian artery (third part),
superficial cervical artery,
suprascapular artery, occipital artery
Veins – external jugular vein, subclavian
vein (occasionally)
Nerves – brachial plexus, spinal part of the
accessory nerve, branches of the
cervical plexus
 POSTERIOR TRIANGLE OF THE NECK
SUBDIVISIONS:
• OCCIPITAL TRIANGLE
• SUPRACLAVICULAR TRIANGLE