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HUMAN
GROSS
ANATOMY
Anthony B. Olinger, PhD
Associate Professor
Department of Anatomy
Kansas City University of Medicine and Biosciences
Kansas City, Missouri
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Printed in China
Library of Congress Cataloging-in-Publication Data
Olinger, Anthony B., author.
Human gross anatomy / Anthony B. Olinger.
p. ; cm.
Includes index.
ISBN 978-1-4511-8740-3
I. Title.
[DNLM: 1. Anatomy—Atlases. QS 17]
QP38
612—dc23
2015007048
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PREFACE
Human Gross Anatomy was written to facilitate the learning process for any student studying anatomy. Having
taught anatomy for many years, I have developed a keen
understanding for what works and what does not when it
comes to learning this subject.
Therefore, this atlas differs from the traditional anatomical atlas in several key ways. Firstly, it is arranged
systemically within each anatomical region rather than following a dissection-style progression. Because institutions
approach dissection differently, progressing systemically
broadens this atlas’s functionality and also provides a consistent framework for the learner. Each chapter begins with
bones (osteology), then progresses in the same sequence
through each system, ending with neurology.Secondly, the
text is presented exclusively in either table or outline/bullet-point format. It has been my experience that students
tend to use an atlas as a reference—a way to quickly look
up a structure or region, rather than to read it in its entirety. The tables and outlines at the beginning of each new
system provide background information on that system’s
associated structures. Outlines are presented consistently
to speed up navigation to specific information.
Thirdly, illustrations are placed side by side with photographs of actual cadaveric dissections. Most anatomical
atlases are either illustrated or photographic, but rarely are
both. Illustrated atlases have the benefit of being able to
depict every anatomical structure, but can be somewhat
misleading because the drawings usually do not look like
what students actually see in the gross anatomy lab. On the
other hand, photographic atlases can show what actual cadaveric dissections look like, but do not always show every
structure that a student may want to see. Moreover, such
atlases can create unrealistic expectations for students,
who typically do not have the time, experience, or technical expertise necessary to replicate the masterfully done
dissections depicted. Having personally performed every
dissection shown in this book, I know that with patience
and proper guidance, most students will be able to recreate them. Also, by having the illustrations adjacent to the
photographs, students get the best of both worlds—they
can use the idealized drawing to deepen their understanding of the anatomy and the photograph to prepare for the
laboratory component of their gross anatomy course. Furthermore, the illustrations feature additional information
to assist with the learning process. For example, muscle
drawings list origin, insertion, action, and innervation;
arterial drawings indicate what each artery supplies; and
nerve illustrations indicate what structures are innervated
by each nerve.
Finally, I realize that most readers will not go on to become anatomists, but will instead likely be headed into the
health care field. As such, each chapter includes Clinical
Notes sections to help students appreciate the relevance
and significance of the anatomy they are studying. This
clinical material is not overwhelming and is intended to
complement clinical training. Helpful Notes sections are
also included, which deliver content in a way students can
readily absorb it. These notes come straight from my lectures and are very popular with my students.
Making this atlas has been a great adventure. I performed each dissection, snapped and processed each
photo, created each drawing, wrote each outline, organized each layout, and labeled each structure. Lucky for
me, I love anatomy so much that I have enjoyed every minute of this huge undertaking. I hope that students in every
field of health care find it a useful tool and guide in their
journey through human gross anatomy.
Anthony B. Olinger
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Introduction
●●
Anatomical methods
Regional anatomy
●● Head
●● Neck
●● Back
●● Upper extremity
●● Thorax
●● Abdomen
●● Pelvis/perineum
●● Lower extremity
■■ Systemic anatomy
●● Osteology: study of skeletal system
●● Chondrology: study of cartilage
●● Arthrology: study of joints and ligaments
●● Myology: study of skeletal muscles
●● Pulmonology: study of lungs and airways
●● Cardiology: study of the heart
●● Dermatology: study of the integumentary system
(skin)
●● Gastroenterology: study of digestive and accessory
digestive systems
●● Urology: study of the urinary system
●● Endocrinology: study of the endocrine system
●● Gynecology: study of the female reproductive and
genital systems
●● Andrology: study of the male reproductive and genital systems
●● Angiology: study of the circulatory system
●● Neurology: study of the nervous system
Positions, planes, and directions:
■■ Anatomical position: standing erect with head and
eyes directed forward (anteriorly), upper extremities
at the side with palmar surface of hands directed forward (anteriorly) and lower extremities together with
toes directed forward (anteriorly)
■■ Planes
●● Sagittal: front to back, parallel to the long axis
●● Coronal (frontal): side to side, parallel to the long
axis
●● Transverse (horizontal): perpendicular to the long
axis
●● Midsagittal: front to back in the midline, parallel to
the long axis
●● Oblique: not in one of the previously mentioned
planes
■■ Directions
●● Dexter: right
●● Sinister: left
●● Anterior: front (ventral)
●● Posterior: back (dorsal)
●● Superior: up (cranial)
●● Inferior: down (caudal)
●● Medial: toward the midline
●● Lateral: away from the midline
●● Median: in the midline
●● Proximal: nearer to a reference point
●● Distal: farther from a reference point
●●
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Superficial: nearer to the surface
Deep: farther away from the surface
●● External: outside
●● Internal: inside
●● Ipsilateral: same side
●● Contralateral: opposite side
●● Supine: lying on back
●● Prone: lying face down
Movements
■■ Flexion: decrease the angle between two structures or
bones, usually in the sagittal plane
●● Dorsiflexion: elevation of the foot at the ankle
●● Plantarflexion: directing the toes inferiorly at the
ankle
●● Lateral flexion: decrease the angle between a midline structure and the lateral surface of the body,
usually in the coronal plane
■■ Extension: increasing the angle between two structures or bones to the point of hyperextension, usually
in the sagittal plane
■■ Abduction: movement away from the midline, usually
in the coronal plane
■■ Adduction: movement toward the midline, usually in
the coronal plane
■■ Medial rotation: rotation toward the midline
■■ Lateral rotation: rotation away from the midline
■■ Circumduction: circular movement through a spheroidal joint
■■ Protrusion (protraction): to push out
■■ Retrusion (retraction): to pull in
■■ Elevation: to lift up
■■ Depression: to pull down
■■ Inversion of the foot: direct the plantar surface medially
■■ Eversion of the foot: direct the plantar surface laterally
■■ Supination of the forearm: direct the palmar surface
anteriorly
■■ Pronation of the forearm: direct the palmar surface
posteriorly
■■ Opposition: touching the thumb to the 5th digit
■■ Reposition: returning from opposed position to anatomical position
Joint classification
■■ Synovial joint (diarthrosis)
●● Planar (flat, arthroidal, uniaxial gliding or sliding
movement, tight joint capsule)
●● Ginglymus (hinge, uniaxial, thin slack joint capsule)
●● Trochoid (pivot, unixial rotation)
●● Condyloid (one or two concave surfaces articulating
with one or two convex surfaces, biaxial)
●● Sellar (saddle, both surfaces are convex and concave, biaxial, allowing false circumduction without
rotation)
●● Spheroidal (ball and socket, multiaxial, allowing circumduction in multiple planes)
■■ Fibrous joint (synarthrosis)
●● Sutures (interlocked bone separated by fibrous connective tissue)
●●
■■
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●●
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Introduction
Serrated suture (interlocking bone with a jagged
edge)
■■ Squamous suture (joined bone with two beveled
surfaces)
■■ Planar suture (two blunt ends joined by fibrous
connective tissue)
●● Schindylesis (tongue-in-groove joined by fibrous
connective tissue)
●● Gomphosis (peg-in-socket joined by fibrous connective tissue)
●● Syndesmosis (two bones separated by a fibrous
membrane)
■■ Cartilaginous joint (amphiarthrosis)
●● Synchondrosis (primary cartilagenous joints, characterized by temporary cartilaginous unions of hyaline cartilage, usually between the diaphysis and
epiphysis of growing bone)
●● Symphysis (secondary cartilaginous joints, characterized by strong slightly moveable joints united by
fibrocartilage)
Shapes of skeletal (striated) muscle
■■ Flat (broad) muscles (thin and expansive)
■■ Pennate muscles (featherlike)
●● Unipennate (tendon on one side, muscle on the
other)
●● Bipennate (muscle on either side of a tendon)
●● Multipennate (multiple feathered muscle groups)
■■ Fusiform muscles (spindle shaped with thick central
region and tapered ends)
●● Bicipital muscles (muscles with two heads)
●● Tricipital muscles (muscles with three heads)
●● Quadracipital muscles (muscles with four heads)
■■ Digastric muscles (muscles with two bellies)
■■ Multiventral muscles (broken up by tendon)
■■ Multicaudal muscles (muscles with multiple tendons)
■■ Serrated muscles (muscles with a serrated edge)
■■ Circular or sphincteral muscles (surrounding an
opening)
■■ Quadrate muscles (equal sided)
Angiology (arteries, veins, capillaries, and lymphatics)
■■ Arteries
●● Convey blood away from the heart
●● Usually carry oxygenated blood (except pulmonary
A.)
●● Types of arteries:
■■ Elastic arteries
■■ Muscular arteries
■■ Arterioles
■■
●●
●●
Veins
Return blood to the heart
●● Usually carry oxygen-depleted blood (except pulmonary V.)
●● Types of veins:
■■ Large veins
■■ Medium-sized veins
■■ Venules
■■ Capillaries
■■ Lymphatics (collect surplus tissue fluid as lymph and
return it to venous circulation)
●● Lymphatic plexuses (lymphatic capillaries in the intercellular space of most tissues)
●● Lymphatic vessels (join the lymphatic plexuses to
the lymph nodes)
●● Lymph nodes (collect lymph for return to venous
circulation)
●● Lymphoid organs (spleen, tonsils, and thymus)
●● Lymphocytes (immunological functional unit)
Divisions of the nervous system
■■ Structural division
●● Central nervous system (CNS) (brain and spinal
cord)
●● Peripheral nervous system (nerve fibers and cell
bodies outside the CNS)
■■ Connect the CNS with peripheral structures
❍❍ Cranial nerves (12 pairs)
–– Spinal nerves (31 pairs)
–– Cervical nerves (8 pairs)
–– Thoracic nerves (12 pairs)
–– Lumbar nerves (5 pairs)
–– Sacral nerves (5 pairs)
–– Coccygeal nerve (1 pair)
■■ Functional division
●● Somatic nervous system (CNS and PNS)
■■ Sensory and motor innervation to all parts of the
body, except for visceral structures, smooth muscle, and glands
■■ Somatic sensation (general and special sensation)
■■ General sensation (touch, pain, temperature,
pressure)
■■ Special sensation (smell, sight, taste, hearing,
position)
■■ Somatic motor innervation (to skeletal muscles)
●● Autonomic nervous system (visceral sensation and
motor innervation via the CNS and PNS)
❍❍ Sympathetic division (thoracolumbar)
❍❍ Parasympathetic division (craniosacral)
■■
●●
●●
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Terminology
General
• Ala: wing (Latin)
• Ampulla: jug
• Apex: superior portion or pointed portion
of a structure
• Aponeurosis: tendinous expansion
• Arch: curved or “bow-like” structure
• Ascending: traveling superiorly
• Base: lowermost part or foundation
• Brevis: denotes a short structure
• Canal: narrow tubular passage
• Condyle: knuckle or rounded projection
• Constrictor: structure designed to close
off a passageway
• Corpus: body
• Cortex: external layer, bark, shell, rind
(Latin)
• Crest: ridge
• Cruciate/cruciform: shaped like a cross
• Crus: leg
• Cutaneous: pertaining to the skin
• Depressor: muscle to depress the
structure into which it inserts
• Descending: traveling inferiorly
• Dilator: structure designed to dilate an
opening
• Extrinsic: coming from or originating
outside
• Fascia: band
• Fissure: cleft or groove
• Foramen: hole
• Fossa: shallow depression
• Fovea: pit or depression
• Fundus: part of hollow organ far from
mouth of that organ
• Hiatus: gap, cleft, or opening
• Hilum: region where vessels and nerves
enter or exit an organ
• Infundibulum: funnel-shaped
• Intrinsic: situated entirely within
• Isthmus: narrow connection between
two larger bodies
• Lamina: thin flat plate or layer
• Levator: muscle to elevate to structure
into which it inserts
• Longus: denotes a long structure
• Magnum: great
• Medulla: innermost part
• Notch: indentation
• Parietal: pertaining to the walls of a
cavity
• Pedicle: little foot
• Piriform: pear-shaped
• Plexus: braid or network
• Process: a prominence or projection
• Pyramidal: shaped like a pyramid
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Ramus: branch
Raphe: seam
Rectus: straight (Latin)
Recurrent: traveling back from the way
it came
Retinaculum: rope or cable
Root: lowermost part
Sheath: tubular structure enclosing or
surrounding other structure
Sigmoid: “S” shaped
Sinus: cavity or channel, hollow (Latin)
Sphincter: structure designed to
constrict an opening
Spine: thorn-like process
Styloid: long and pointed (pencil-like)
Trochlea: pulley
Tubercle: small rounded bump
Tuberosity: roughened region
Ventricle: small cavity
Vestibule: space at the entrance to a
canal
Visceral: pertaining to a large internal
organ
Prefixes
• A-: negative prefix
• Endo-: inside
• Epi-: upon, after, in addition
• Extra-: outside
• Hemi-: half
• Hyper-: above, beyond, more than
normal, excessive
• Hypo-: under, beneath, less than normal,
deficient
• Infra-: beneath
• Inter-: among, between
• Intra-: inside
• Meso-: middle
• Meta-: after, beyond, accompanying
• Para-: beside, beyond
• Peri-: around
• Retro-: backwards
• Semi-: half
• Sub-: under, below
• Supra-: above, beyond, extreme
Head (cranium, cephalic,
capitate)
• Alar: wing-shaped (Latin)
• Alveolar: tooth-socket
• Auricular: external ear (auricle)
• Basicranium: cranial base, cranial floor
• Buccal: fleshy cheek
• Calvaria: skull cap
• Cerebellar: relating to the cerebellum
• Cerebral: relating to the cerebral
hemispheres
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Falx: sickle
Genioid: chin (Greek)
Glossal: tongue (Greek)
Labia: lips
Lacrimal: relating to tears
Lingual: tongue (Latin)
Mandibular: haw, lower teeth
Maxillary: upper teeth
Meatus: passage or pathway
Mental: chin (Latin)
Nasal: nose
Neurocranium: cranial vault
Occipital: near or over the occipital B.
Occular/optic: eye
Oral: mouth
Orbit: eye socket
Palatine: hard palate
Palpebral: eyelid
Petrous: resembling a rock
Pterygoid: wing-shaped (Greek)
Squamous: plate-like
Superciliary: eyebrow
Tectorial: roof/covering
Temporal: lateral surface of the head
Tentorium: tent or covering
Veli: veil (veli palatini: soft palate)
Zygomatic: bony cheek
Neck (cervix/collum)
• Ansa: loop (handle)
• Cleido: referring to the clavicle
• Deglutination: swallowing
• Digastric: two bellies
• Hyoid: shaped like the Greek letter
upsilon
• Nuchal: posterior neck
• Omos: shoulder
• Phrenic: referring to the thoracic
diaphragm
• Platysma: flat plate
Back
• Erector: structure that erects
• Equine: horse
• Latissimus dorsi: widest of the back
• Multifidus: cleft into many parts
• Rhomboid: shaped like a rhombus
• Rotatores: rotator
• Splenion: bandage
• Trapezium: four irregular shaped sides
Upper extremity
• Acromion: (acro- top/extreme; omosshoulder)
• Antebrachium: forearm
• Axilla: armpit
• Biceps: two-heads
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Terminology
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Brachium: arm
Capitulum: little head
Carpus: wrist
Conoid: cone-shaped
Coracoid: like a crow’s beak
Coronoid: hooked/curved
Cubitus: elbow
Deltoid: shaped like the Greek letter
delta
Digitus indicis: index finger
Digitus minimus manus: pinky finger
Glenoid: socket
Lumbrical: earthworm-like
Lunate: Mmon-shaped
Manos: hand
Pisiform: pea-shaped
Pollux: thumb
Quadratus: square-shaped
Radialis: radial side of forearm
Scaphoid: boat-shaped
Serratus: saw-like
Teres: long and round
Triceps: three-heads
Triquetrum: three-cornered
Ulnaris: ulnar side of forearm
Thorax (chest)
• Alveolus: small-hollow space
• Areola: small area
• Azygous: unpaired
• Cardiac: heart
• Coronary: term applied to the arterial
supply of the heart
• Costal: ribs
• Manubrium: handle (Latin)
• Pectoral: pertaining to the chest wall
• Pleura: rib-side
• Pulmonary: lungs
• Splanchnic: pertaining to viscera
• Sternum: chest
• Trabeculum: supporting or anchoring
strand
Abdomen
• Cecum: blind gut
• Celiac: belly (Greek)
• Colic: referring to the colon
• Cystic: bladder (Greek)
• Duodenum: 12 at a time (12 finger
breadths in length)
• Epiploic: omentum (Greek)
• Falciform: sickle shaped (Latin)
• Gastric: stomach
• Haustrum: drawer
• Hepatic: liver
• Hypochondriac: abdominal region deep
to costal cartilage
• Inguinal: groin
• Jejunum: empty (2nd part of small
intestine)
• Linea alba: white line
• Mesentery: double layer of peritoneum
• Omentum: fat skin (Latin)
• Peritoneum: stretch around (Greek)
lining of abdominal wall
• Portal: entrance or gateway
• Psoas: muscle of the loin
• Pylorus: gate guard (distal portion of
stomach)
• Renal: kidney
• Rugae: wrinkles or folds
• Vermiform: worm-like
Pelvis (basin) and perineum
(space between anus and
scrotum)
• Ano-, ani-: anal region or anal canal
• Epididymis: epi + double (Greek) also epi
+ testis
• Fimbria: fringe
• Fornix: arch (Latin)
• Lumborum: lumbar region
• Metra: (metrium) uterus
• Obturator: something that closes an
opening
• Pubic: referring to the pubic bone
• Pudendal: to be ashamed (external
human genitalia)
• Rete: net
• Salpinx: tube
• Sciatic: derived from ischial
• Tunica: covering or coat
• Vesical: urinary bladder
Lower extremity
• Acetabulum: shallow vinegar cup
• Calx (calcanean): heel
• Coxa: hip
• Cribriform: seive-shaped
• Cuneiform: wedge-shaped
• Digitus minimus pedis: pinky toe
• Fascia lata: broad fascia
• Fibular (peroneal): lateral side of leg
• Gastrocnemius: stomach-legged
• Gemella: twin
• Genu: knee
• Gluteus (natis, clunis): buttock
• Gracilis: slender
• Hallux: 1st toe
• Linea aspera: rough line
• Meniscus: crescent
• Navicular: little ship
• Pes: foot
• Piriformis: pear-shaped
• Plantar: sole of the foot
• Popliteal: region behind knee
• Quadriceps: four-headed
• Saphenous: visceral structures of the leg
• Sartorius: patched or repaired
• Soleus: resembles a flat fish
• Sural: region on posterior leg
• Tarsus: ankle
• Tibial: medial side of leg
• Trochanter: process on the femur
• Vastus: vast
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ACKNOWLEDGMENTS
First and foremost, my anatomical mentor, the man who
inspired me to become an anatomist, Barclay Bakkum, DC,
PhD. He said on the first day of class that there is no perfect
atlas, because he hadn’t written it yet; until there was an
­atlas with drawings and photos side-by-side, there would
be no perfect atlas. I hope this atlas does your notion justice. Thank you for your mentorship!
I thank all of the anatomy fellows who have offered
their advice and suggestions over the years: Phil Homier,
Julie Easterday, Todd Brittain, Ashley Telisky, Eric Shurtleff, Dustin Woyski, Kelly Dahlstrom, Kara Hessel, Greg
Rice, Erich Wessel, Travis Kauffman, Racquel Skold, Devon
Boydstun, Jacob Pfeiffer, Clive Persaud, Ashley Olsen, Kyle
Busch, Kristen Colyer, and Kenna Schnarr. Your input has
been invaluable. A special shout out to Racquel Skold, who
spent an afternoon converting image files for me simply
because she was bored! Thank you.
I thank all of the students, who were not anatomy fellows, for whom I have had the privilege of being their research mentor: Anwuli Anyah, Mahaletwork Assefa, Ian
Bowers, Pennie Burkias, Stephan Cooper, Gabrielle Farkas,
Brandon Goesling, Greg Grenier, Aaron Heller, Mandalyn
Kautz, Amanda Osterloh, Justin Oveyssi, Brandon Roe,
Julia Ronecker, Jennifer Sharp, Chelsea Sheeler, Danielle
Solomon, and Ricki Tavangari.
I thank all of my colleagues who have offered advice
on the atlas or with whom I’ve done research: Mark Pfefer, Steve Larson, Betsy Mitchell, Bryan Bond, Brion Benninger, Kara Burnham, William Borman, Jim Carollo, Barth
Wright, and Robert Stephens.
Wolters Kluwer and I thank all of the reviewers who
provided invaluable feedback during the development
process:
Olena Bolgova, MD, PhD
Associate Professor
St. Matthew’s University
Anjanette Clifford, MS, DC, CCSP
Assistant Professor, Basic Science
Logan University
Rebecca Scopa Kelso, PhD
Assistant Professor of Anatomy
Department of Biomedical Sciences
West Virginia School of Osteopathic Medicine
Melburn R. Park, PhD, AB
Associate Professor
Anatomy and Neurobiology and Medical Education
The University of Tennessee Health Science Center
William J. Swartz, PhD
Marilyn L. Zimny Professor of Anatomy
Louisiana State University School of Medicine in New
Orleans
Amber van den Raadt, DO
A. T. Still University-SOMA
(DO 2014)
Monika Wimmer, PhD
Instructor, Scientist
Institute of Anatomy and Cell Biology
Justus-Liebig-University Giessen
Giessen, Germany
Steven Xian
Tulane University School of Medicine
(MD 2015)
I thank all of the folks at Wolters Kluwer for seeing the
benefits of this book, in what could be argued is an antiquated and overcrowded market, and for enduring my
stubbornness and rigidity throughout this process. I especially thank Crystal Taylor for being there from the very
beginning and for all of her patience and nurturing of my
vision. I also thank Amy Weintraub who deserves a medal
for all of her work and putting up with me.
I thank my children Emma and Liam, for always offering
me their love and support and never being “grossed out”
by the gross lab.
Finally, I thank the love of my life, for being the wonderful person that you are. I love you.
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CONTENTS
Chapter 1: Thorax 1
Thorax 2
Thoracic Apertures 2
Thoracic Cavity Divisions (3) 2
Osteology 4
Sternum 4
Clavicle 4
Ribs 4
Thoracic Vertebrae (12) 4
Chondrology 9
Costal cartilages 9
Arthrology 9
Sternal Joints 9
Sternocostal Joints 9
Costochondral Joints 9
Interchondral Joints 9
Costovertebral Joints 9
Costotransverse Joints 9
Myology 12
Pulmonology 16
Lungs 16
Trachea 16
Bronchopulmonary Segments 17
Cardiology 27
Heart 27
Dermatology 38
Breasts 38
Gynecology 39
Mammary Gland 39
Gastroenterology 40
Esophagus 40
Angiology 40
Aorta 40
Pulmonary Trunk 42
Pulmonary Veins 42
Cardiac Venous Circulation 42
Superior Vena Cava 43
Inferior Vena Cava 43
Lymphatics 43
Neurology 60
Cranial Nerves in the Thorax 60
Cervical Spinal Nerves 60
Thoracic Spinal Nerves 60
Autonomic Nervous System 60
Chapter 2: ABDOMEN 71
Abdomen 72
Osteology 73
Lumbar Vertebrae 73
Arthrology 73
Lumbar Vertebral Joints 73
Peritoneum 73
Myology 79
Gastroenterology 89
Esophagus 89
Large Intestine 89
Urology 103
Kidneys 103
Endocrinology 106
Suprarenal (Adrenal) Glands 106
Andrology 107
Spermatic Cord and Scrotum 107
Angiology 107
Aortic Arch 107
Descending (Thoracic) Aorta 107
Descending (Abdominal) Aorta 107
Neurology 130
Abdominal Wall Nn. 131
Chapter 3: Pelvis
and Perineum 143
Definition 144
Pelvis 144
Osteology 145
Os Coxae 145
Sacrum 145
Coccyx 145
Chondrology 149
Interpubic Disc 149
Arthrology 149
L5 Vertebral Segment and Sacrum 149
Pelvic Girdle 149
Os Coxae and Sacrum 149
Sacrum and Coccyx 149
Peritoneum 149
Pelvic Fascia and Spaces 150
Perineal Fascia and Spaces 150
Myology 160
Gastroenterology 172
Pelvis 172
Perineum 172
Urology 173
Ureters:urinary Bladder
Gynecology 176
Pelvis 176
Perineum 176
Andrology 183
Perineum 183
Angiology 191
Abdominal Aorta 191
Veins 192
Lymphatics 192
Neurology 202
Pelvic Components of the Lumbar Plexus 202
Sacral Plexus 202
Coccygeal Plexus 202
Autonomic Nervous System Components 202
Chapter 4: Thorax 213
Lower Extremity 214
Osteology 214
Os Coxae 214
Femur 214
Patella 214
Tibia 214
Fibula 215
Tarsal 215
Metatarsal Bb. (1–5) 216
Sesamoid Bones of the Foot 216
Proximal Phalanges (1–5) 216
Middle Phalanges (1-4) 216
Distal Phalanges (1–5) 216
Chondrology 225
Menisci of the Knee Joint 225
Arthrology 225
Pelvic Girdle: See Pelvis and Perineum 225
Sacroiliac Joint: See Pelvis and
Perineum 225
Sacrococcygeal Joint 225
Acetabulofemoral Joint 225
Knee Joint 225
Tibiofibular Joint 226
Talocrural Joint 226
Talocalcaneal (Subtalar) Joint 226
Transverse Tarsal Joint 226
Cuneonavicular Joint 227
Intercuneiform Joint 227
Cuneocuboid Joint 227
Cuboideonavicular Joint 227
Tarsometatarsal Joint 227
Intermetatarsal Joint 227
1St Interphalangeal Joint 227
Proximal Interphalangeal Joint 227
Distal Interphalangeal Joint 227
Fascia of the Lower Extremity 228
Myology 252
Angiology 279
Common Iliac A. 279
Veins 280
Lymphatics 280
Neurology 291
Subcostal N. 291
Lumbar Plexus 291
Posterior Rami Of Lumbar Spinal Nerves 291
Sacral Plexus 291
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Posterior Rami Of Sacral Spinal Nerves 292
Dermatomes 292
Chapter 5: Back 305
Back 306
Osteology 306
Cervical Vertebrae (7) 306
Thoracic Vertebrae (12) 306
Typical Ribs 306
Lumbar Vertebrae (5) 306
Sacrum 306
Coccyx 307
Arthrology 313
Atlantooccipital Joint 313
Median Atlantoaxial Joint 313
Lateral Atlantoaxial Joint 313
Zygapophysial Joints 313
Vertebral Syndesmoses 313
Intervertebral Joint 313
Lumbosacral Joint 313
Sacrococcygeal Joint 313
Myology 320
Angiology 339
Arch Of The Aorta 339
Thoracic (Descending) Aorta 340
Abdominal (Descending) Aorta 341
Summary Of Paraspinal Aa 342
Spinal Veins 342
Neurology 350
Spinal Cord 350
Chapter 6: Upper
Extremity 359
Upper Extremity 360
Osteology 360
Shoulder Girdle 360
Upper Extremity 360
Chondrology 370
Sternoclavicular Joint 370
Acromioclavicular Joint 370
Glenoid Labrum 370
Articular Disc of Distal Radioulnar Joint Triangular-Shaped Fibrocartilaginous
Disc 370
Arthrology 371
Shoulder Girdle: Clavicle, Scapula 371
Elbow (Ginglymus Synovial Joint) 371
Radioulnar Joints 371
Radiocarpal 372
Intercarpal Joints 372
Midcarpal Joint 372
Carpometacarpal Joints 372
Intermetacarpal Joints (4) 372
Metacarpophalangeal Joints (5) 372
1St Interphalangeal Joint 372
Proximal Interphalangeal Joints (4) 373
Distal Interphalangeal Joints (4) 373
Fascia 373
Myology 388
Angiology 410
Subclavian A. 410
Axillary A. 410
Brachial A. 410
Veins 411
Lymphatics 412
Neurology 421
Cervical Plexus 421
Brachial Plexus 421
Thoracic Spinal Nerves 422
Dermatomes 422
Chapter 7: NECK 441
Neck 442
Osteology 442
Hyoid B. 442
Chondrology 442
Thyroid Cartilage 442
Cricoid Cartilage 442
Arytenoid Cartilages 442
Corniculate Cartilage 442
Cuneiform Cartilage 442
Triticeal Cartilage 442
Epiglottic Cartilage 442
Arthrology 445
Pharyngeal Ligaments 445
Laryngeal Joints 445
Fascia of the Neck 445
Myology 449
Endocrinology 465
Thyroid Gland 465
Parathyroid Glands (4) 465
Pulmonology 466
Pharynx 466
Larynx 466
Trachea 466
Gastroenterology 468
Pharynx 468
Esophagus 468
Angiology 469
Common Carotid A. 469
Subclavian A. 469
Superior Vena Cava 469
Lymphatics 469
Neurology 475
Cranial Nerves in Cervical Region 475
Cervical Spinal Nerves 475
Autonomic Nervous System 475
Chapter 8: Head and
Brain 483
Head 484
Osteology 484
Skull 484
Chondrology 505
Nose 505
Ear 505
Arthrology 507
Skull Sutures 507
Skull Landmarks 507
Temporal and Mandible Bb. 507
Dentoalveolar Joint 507
Vomer B. and Perpendicular Plate of
Ethmoid B. With Nasal Crest of
Maxilla and Palatine Bb. 507
Atlantooccipital Joint 507
Myology 510
Endocrinology 528
Pituitary Gland 528
Pineal Gland 528
Pulmonology 529
Nasal Cavity 529
Paranasal Sinuses 529
Nasolacrimal Duct 529
External Nose 529
Gastroenterology 533
External Oral Region 533
Oral Cavity 533
Special Neurology 539
Eye 539
Ear 539
Angiology 544
External Carotid A. 544
Internal Carotid A. 544
Vertebral A. 545
Basilar A. 545
Cerebral Arterial Circle 545
Venous Sinuses of Dura Mater: 545
Neurology 562
Cranial Nerves 562
Brain 562
INDEX 597
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7
NECK
Neck
Osteology
Hyoid b.
Chondrology
Thyroid Cartilage
Cricoid Cartilage
Arytenoid Cartilages
Corniculate Cartilage
Cuneiform Cartilage
Triticeal Cartilage
Epiglottic Cartilage
Arthrology
Pharyngeal Ligaments
Laryngeal Joints
Fascia of the Neck
Endocrinology
Thyroid Gland
Parathyroid Glands
Pulmonology
Pharynx
Larynx
Trachea
Gastroenterology
Pharynx
Esophagus
Angiology
Common Carotid a.
Subclavian a.
Superior Vena Cava
Lymphatics
Neurology
Cranial Nerves in Cervical Region
Cervical Spinal Nerves
Autonomic Nervous System
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 vertebrae, 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.
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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
(anterior aspect)
Lesser horn
Body
Greater horn
Lesser horn
FIG. 7.1d ▲ Bony landmarks of the hyoid bone
(oblique aspect)
Body
FIG. 7.1b ▲ Bony landmarks of the hyoid bone
(posterior aspect)
Greater horn
Lesser horn
Body
Greater horn
FIG. 7.1c ▲ Bony landmarks of the hyoid bone
(lateral aspect)
Lesser horn
Body
FIG. 7.1e ▲ Bony landmarks of the hyoid bone
(superior aspect)
III.Chondrology
b.
Thyroid articular surfaces: articulate with inferior horns of thyroid cartilage
A.
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
cartilage
a.
Superior thyroid tubercle: at base of superior
horn and superior aspect of oblique line
1.Apex: projects superiorly; articulates with corniculate cartilage
b.
Inferior thyroid tubercle: at base of inferior
horn and inferior aspect of oblique line
2.Base: inferior aspect possesses 2 large processes
and an articular surface
c.
Laryngeal prominence: projects anteriorly
from midline at union of 2 laminar plates
a.
Muscular process: projects posteriolaterally,
insertion for posterior and lateral cricoaryted.
Oblique line: travels obliquely from superior
noid and thyroarytenoid mm.
thyroid tubercle to inferior thyroid tubercle;
insertion for sternothyroid m.; origin for thyrob.
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 crito 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
cartilage
2.Superior horn: projects superiorly; joined to
greater horn of hyoid via lateral thyrohyoid l.
E.
Cuneiform cartilage: paired, small pieces of cartilage; embedded in quadrangular membrane
3.Inferior horn: projects inferiorly; articulates with
lamina of cricoid cartilage
F.
Triticeal cartilage: paired, small beads of cartilage;
embedded in lateral thyrohyoid l.
B.
Cricoid cartilage: cartilaginous ring inferior to thyroid cartilage
G.
Epiglottic cartilage: broad superiorly, tapers
inferiorly, to stalk of epiglottis; made of elastic
1.Arch: narrower; anterior aspect of the ring
cartilage
2.Lamina: wider; posterior aspect of the ring
a.
Arytenoid articular surfaces: articulate with
1.Stalk of epiglottis: tapered
inferior
aspect;
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articulates
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Chondrology
Laryngeal Cartilages
Hyoid bone
NECK 443
Triticeal cartilage
Lateral thyrohyoid L.
Lateral thyrohyoid L.
Triticeal cartilage
Hyoid bone
Epiglottic cartilage
Epiglottic cartilage
Stalk of the epiglottis
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
notch
Superior thyroid
tubercle
Superior thyroid
notch
Superior thyroid
tubercle
Lamina
Lamina
Oblique line
Oblique line
Laryngeal prominence
Laryngeal prominence
Inferior thyroid
tubercle
Inferior horn
Inferior thyroid tubercle
Cricoid cartilage:
Cricoid cartilage:
Arch
FIG. 7.3a ▲ Features of the laryngeal cartilages (anterior aspect)
Arch
FIG. 7.3b ▲ Features of the laryngeal cartilages (anterior aspect)
Thyroid cartilage:
Thyroid cartilage:
Superior horn
Superior horn
Lamina
Superior thyroid
tubercle
Oblique line
Lamina
Laryngeal prominence
Superior thyroid
tubercle
Laryngeal prominence
Oblique line
Inferior thyroid tubercle
Inferior thyroid
tubercle
Inferior horn
Cricoid cartilage:
Inferior horn
Cricoid cartilage:
Lamina
Arch
Arch
FIG. 7.4a ▲ Features of the laryngeal cartilages (lateral aspect)
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Lamina
FIG. 7.4b ▲ Features of the laryngeal cartilages (lateral aspect)
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Chondrology
Laryngeal Cartilages
Thyroid cartilage:
Thyroid cartilage:
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
Articular surface
Corniculate cartilage
Lamina
FIG. 7.5a ▲ Features of the laryngeal cartilages (superior aspect)
Lamina
FIG. 7.5b ▲ Features of the laryngeal cartilages (superior aspect)
Thyroid cartilage:
Thyroid cartilage:
Superior horn
Superior horn
Superior thyroid
notch
Superior
thyroid notch
Corniculate
cartilage
Corniculate
cartilage
Arytenoid
cartilage:
Arytenoid cartilage:
Apex
Apex
Muscular
process
Articular surface
Muscular process
Articular surface
Cricoid cartilage:
Cricoid cartilage:
Arytenoid
articular
surface
Arytenoid
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
Thyroid cartilage:
Thyroid cartilage:
Inferior horn
Inferior horn
Superior horn
Superior horn
FIG. 7.7a ▲ Features of the laryngeal cartilages (inferior aspect)
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FIG. 7.7b ▲ Features of the laryngeal cartilages (inferior aspect)
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Laryngeal Cartilages
Epiglottic cartilage
Epiglottic cartilage
Stalk of the epiglottis
Stalk of the epiglottis
FIG. 7.8a ▲ Epiglottic cartilage (posterior aspect)
2 IV.Arthrology
A.
Pharyngeal ligaments
1.Stylohyoid l.: extends from styloid process of
temporal b. to hyoid b.
2.Pterygomandibular raphe
B.
Laryngeal joints
1.Thyrohyoid joint: hyoid b. and thyroid cartilage
a.
Median thyrohyoid l.: extends from body of
hyoid b. to laryngeal prominence
b.
Lateral thyrohyoid l.: extends from greater
horn of hyoid b. to superior horn of thyroid
cartilage
i.
Triticeal cartilage: embedded in lateral
thyrohyoid l.
c.
Thyrohyoid membrane: extends from
hyoid b. to superior edge of thyroid
lamina
2.Cricothyroid joint: thyroid cartilage and cricoid
cartilage
a.
Median cricothyroid l.: extends from inferior
edge of thyroid lamina to superior edge of
cricoid arch
b.
Lateral cricothyroid l.: see Conus elasticus
c.
Cricothyroid articular capsule: extends from
inferior horn of thyroid cartilage to lamina of
cricoid cartilage
3.Cricoarytenoid joint: cricoid cartilage and arytenoid cartilage
a.
Cricoarytenoid l.: from arytenoid cartilage to
lamina of cricoid cartilage
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FIG. 7.8b ▲ Epiglottic cartilage (posterior aspect)
4.Epiglottic joint
a.
Thyroepiglottic l.: from thyroid cartilage to
epiglottis
b.
Hyoepiglottic l.: from hyoid b. to epiglottis
5.Cricotracheal joint: inferior to cricoid cartilage
a.
Cricotracheal l.
6.Fibroelastic laryngeal membrane
a.
Quadrangular membrane: between epiglottis
and arytenoid cartilage
b.
Conus elasticus: cricovocal membrane;
comprises lateral cricothyroid and vocal ll.
i.
Lateral cricothyroid l.: extends from medial
edges of cricoid cartilage to vocal l. and
then to posterior aspect of lamina of thyroid cartilage
ii.
Vocal l.: extends from vocal process of
arytenoid cartilage
C.
Fascia of the neck
1.Superficial cervical fascia: thin subcutaneous
connective tissue
2.Deep cervical fascia
a.
Investing layer: superficial layer of deep cervical fascia
b.
Pretracheal layer: continuous inferiorly with
fibrous pericardium; continuous posteriorly
with buccopharyngeal fascia encloses infrahyoid muscles, thyroid gland, trachea, and
esophagus
c.Prevertebral layer: surrounds vertebral column
and musculature
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Arthrology
Pharyngeal
Ligaments
Stylohyoid L.
Pterygomandubular
raphe
Middle pharyngeal
constrictor M.
Greater horn
of the hyoid B.
Stylohyoid L.
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.
Laryngeal
Joints
Triticeal cartilage
Lateral thyrohyoid L.
Thyrohyoid membrane
Triticeal cartilage
Thyrohyoid membrane
Median thyrohyoid L.
Median thyrohyoid L.
Median cricothyroid L.
Median cricothyroid L.
Cricothyroid articular
capsule
Cricothyroid articular
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
Median cricothyroid L.
Median cricothyroid L.
Cricothyroid articular
capsule
Cricothyroid articular capsule
Cricotracheal L.
FIG. 7.11a ▲ Ligaments of the larynx (lateral aspect)
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FIG. 7.11b ▲ Ligaments of the larynx (lateral aspect)
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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
capsule
Cricothyroid articular
capsule
FIG. 7.12a ▲ Ligaments of the larynx (posterior aspect)
Lateral thyrohyoid L.
FIG. 7.12b ▲ Ligaments of the larynx (posterior aspect)
Hyoepiglottic L.
Conus elasticus
Triticeal cartilage
Lateral
cricothyroid L. Vocal L.
Thyrohyoid membrane
Median cricothyroid L.
Thyroepiglottic L.
Cricoarytenoid L.
Cricothyroid articular
capsule
Vocal L.
Conus
Lateral
cricothyroid L. elasticus
Median
cricothyroid L.
Cricoarytenoid L. Cricothyroid articular
capsule
FIG. 7.13b ▲ Ligaments of the larynx
(superior aspect)
FIG. 7.13a ▲ Ligaments of the larynx with the thyroid cartilage sagittally
sected (sagittal section)
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Arthrology
Fascia of the Neck
Superficial cervical
fascia
Deep cervical fascia:
Investing layer
Prevertebral layer
Superficial cervical
fascia
Level of transverse
section below
Deep cervical fascia:
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.
Longissimus capitis M.
Superficial cervical
fascia
Middle scalene M.
Longus capitis M.
Deep cervical fascia:
Anterior scalene M.
Investing layer
Inferior pharyngeal
constrictor M.
Prevertebral layer
Carotid sheath
Transverse and oblique
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)
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V. Myology
TABLE 7.1 Myology
Muscle
3
Origin
1. Trapezius M.
2
Insertion
Action
Innervation
A.Posterior Triangle (bound by trapezius m., sternocleidomastoid m., and clavicle)
• Medial 1/3 of superior
nuchal line
• External occipital
protuberance
• Nuchal l.
• Spinous processes C7–T12
• Lateral 1/3 of clavicle
• Acromion
• Scapular spine
Actions associated with neck:
• Extends neck (bilaterally)
• Laterally flexes neck (unilaterally)
• Rotates face away (unilaterally)
• Spinal accessory N.
2.Sternocleidomastoid • Sternal head: superoanterior • Mastoid process
M.
surface of manubrium
temporal b.
• Clavicular head: superior
• Lateral aspect
edge of middle 1/3 of
superior nuchal line
clavicle
• Extends neck at atlantooccipital
joint (bilaterally)
• Flexes remaining neck (bilaterally)
• Laterally flexes neck (unilaterally)
• Rotates face away (unilaterally)
3.Levator Scapulae M. • Posterior tubercles of
• Medial border of
transverse processes C1–C4
scapula (superior to
scapular spine)
sActions associated with neck:
• Dorsal scapular N.
• Extends neck (bilaterally)
• 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
transverse processes C3–C6
1st rib
• Flexes neck (bilaterally)
• Anterior rami C4–C6
• Laterally flexes neck (unilaterally)
• Elevates 1st rib
6.Middle Scalene M.
• Posterior tubercles of
• Superior surface 1st
transverse processes C2–C7
rib
• Flexes neck (bilaterally)
• Anterior rami C3–C8
• Laterally flexes neck (unilaterally)
• Elevates 1st rib
7.Posterior Scalene M. • Posterior tubercles of
• Lateral edge 2nd rib
transverse processes C5–C7
• Laterally flexes neck (unilaterally) • Anterior rami C6–C8
• 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.
• Elevates floor of mouth and
tongue
• N. to mylohyoid
b.Geniohyoid M.
• Inferior mental spine
mandible
• Body of hyoid b.
• Elevates hyoid b.
• Shortens floor of mouth
• Widens pharynx
• C1 via hypoglossal
N.
c.Digastric M.
• Anterior belly: digastric
fossa mandible
• Posterior belly: mastoid
notch temporal b.
• Intermediate tendon
on body and greater
horn of hyoid b.
• Elevates hyoid b.
• Steadies hyoid b.
• Depresses mandible
• Anterior belly: N. to
mylohyoid
• Posterior belly: facial
N.
c.Stylohyoid M.
• Styloid process temporal b.
• Body of hyoid b.
• Elevates hyoid b.
• Retracts hyoid b.
• Elongates floor of mouth
• Facial N.
2. Infrahyoid muscles
a.Sternohyoid M.
• Posterior surface
• Body of hyoid b.
manubrium
• Posterior surface sternal end
clavicle
• Depresses hyoid b.
• Ansa cervicalis
(C1–C3)
b.Sternothyroid M.
• Posterior surface
manubrium
• 1st costal cartilage
• Oblique line thyroid
cartilage
• Depresses thyroid cartilage
• Ansa cervicalis
(C2–C3)
c.Thyrohyoid M.
• Oblique line thyroid
cartilage
• Inferior edge body of • Depresses hyoid b.
hyoid b.
• Elevates thyroid cartilage
• Greater horn hyoid b.
• C1 via hypoglossal
N.
d.Omohyoid M.
• Internal surface superior
border scapula posterior to
suprascapular notch
• Body of hyoid b.
• Ansa cervicalis
(C1–C3)
• Depresses hyoid b.
• Retracts hyoid b.
(table continues on page 454)
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TABLE 7.1 Myology (continued )
Muscle
Origin
C.Platysma M.
• Fascia over pectoralis major • Inferior border body
M. and deltoid M.
of mandible
• Skin/subcutaneous
tissue face
Insertion
Action
Innervation
• Draws corner of mouth inferiorly
• Draws skin of neck superiorly
• Cervical branch
facial N.
D.Suboccipital Region
1.Rectus Capitis
Posterior Major M.
• Spinous process axis (C2)
• Lateral aspect inferior • Extends head
nuchal line
• Rotates face toward
2.Rectus Capitis
Posterior Minor M.
• Posterior tubercle atlas (C1)
• Inferior to inferior
nuchal line
3.Obliquus Capitis
Superior M.
• Transverse process atlas
(C1)
• Between superior and • Extends head
inferior nuchal lines
• Laterally flexes head
4.Obliquus Capitis
Inferior M.
• Spinous process axis (C2)
• Transverse process
atlas (C1)
• Extends head
• Suboccipital N.
(posterior ramus 1st
cervical spinal N.)
• Rotates face toward
E.Pharyngeal Muscles
1.Superior Pharyngeal • Pterygoid hamulus
Constrictor M.
• Pterygomandibular raphe
• Posterior aspect mylohyoid
line
• Lateral aspect of tongue
2.Middle Pharyngeal
Constrictor M.
• Stylohyoid l.
• Greater/lesser horn hyoid b.
3.Inferior Pharyngeal
Constrictor M.
• Oblique line
• Thyroid cartilage
• Cricoid cartilage
4.Palatopharyngeus
M.
• Hard palate
• Palatine aponeurosis
5.Salpingopharyngeus • Cartilaginous part
M.
pharyngotympanic tube
6.Stylopharyngeus M. • Styloid process temporal b.
• Pharyngeal tubercle
• Pharyngeal raphe
• Pharyngeal branch
of vagus N.
• Constricts pharyngeal wall
• Pharyngeal raphe
• Lamina thyroid
cartilage
• Lateral pharynx and
esophagus
• Elevates pharynx
• Elevates larynx
• Pharyngeal branch
of vagus N.
• Branches of
recurrent Laryngeal
N.
• Pharyngeal branch
of vagus N.
• Glossopharyngeal N.
F. Laryngeal Muscles
1. Cricothyroid M.
• Anterolateral part of arch of
cricoid cartilage
2.Posterior
Cricoarytenoid M.
• Lamina cricoid cartilage
3.Lateral
Cricoarytenoid M.
• Superolateral edge of arch
cricoid cartilage
4.Transverse and
Oblique Arytenoid
M.
• Inferior edge lamina
thyroid cartilage
• Inferior horn thyroid
cartilage
• Stretches vocal l.
• Tenses vocal l.
• External laryngeal N.
• Abducts vocal fold
• Muscular process
arytenoid cartilage
• Adducts vocal fold
• Posterior aspect arytenoid
cartilage
• Posterior aspect
contralateral
arytenoid cartilage
• Adducts arytenoid cartilage
• Closes intercartilaginous part of
rima glottidis
5.Thyroarytenoid M.
• Posterior part thyroid
cartilage
• Anterolateral aspect
arytenoid cartilage
• Relaxes vocal l.
6.Vocalis M.
• Vocal process arytenoid
cartilage
• Vocal l.
• Relaxes posterior part of vocal l.
• Tenses anterior part of vocal l.
• Recurrent laryngeal
N.
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
transverse processes C3–C6
b.
3.Rectus Capitis
Anterior M.
• Transverse process atlas
4.Rectus Capitis
Lateralis M.
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• Flexes neck (bilaterally)
• Anterior rami C1–C3
• Laterally flexes neck (unilaterally)
• Anterior to occipital
condyle
• Flexes atlanooccipital joint
• Jugular process
occipital b.
• Laterally flexes atlanooccipital
joint
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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
neck (lateral aspect)
FIG. 7.16b ▲ Subtriangles of the posterior triangle of
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.
Anterior scalene M.
Intermediate
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
supraclavicular N.
Posterior scalene M.
Anterior scalene M.
Intermediate
supraclavicular N.
Inferior belly
omohyoid M.
Medial
supraclavicular N.
FIG. 7.17b ▲ Contents of the posterior triangle of the neck
(anterolateral aspect)
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FIG. 7.17c ▲ Contents of the posterior triangle of the neck
(lateral aspect)
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Posterior Triangle (Boundary Muscles)
Sternocleidomastoid M.
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 atlantooccipital joint (bilaterally)
-Flex remaining neck
(bilaterally)
-Laterally flex neck
(unilaterally)
-Rotate face away
(unilaterally)
FIG. 7.18a ▲ Boundary muscles of the posterior triangle
of the neck: sternocleidomastoid muscle (posterior aspect)
FIG. 7.18b ▲ 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)
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NECK 453
Posterior Triangle (Scalene Muscles)
FIG. 7.20a Scalene muscles
(anterolateral aspect)
FIG. 7.21 Anterior scalene muscle (lateral aspect) showing
the origin, insertion, action, and innervation
▲
▲
Anterior tubercles
of transverse processes
C3–6 (Origin)
Anterior rami C4–6
(Innervation)
Anterior scalene M.
Middle scalene M.
Scalene tubercle of
first rib (Insertion)
Posterior scalene M.
Action:
Actions associated
with the neck:
-Extend the neck
(bilaterally)
-Laterally flex the
neck (unilaterally)
Anterior scalene M.
Posterior tubercles of
transverse processes C2–7
(Origin)
Anterior rami C3–8
(Innervation)
Superior surface
first rib (Insertion)
▲
FIG. 7.22 Middle scalene
muscle (lateral aspect)
showing the origin, insertion,
action, and innervation
Action:
Actions associated
with the neck:
-Extend the neck
(bilaterally)
-Laterally flex the
neck (unilaterally)
Middle scalene M.
Posterior tubercles of
transverse processes
C5–7 (Origin)
Anterior rami C6–8
(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)
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FIG. 7.23 ▲ Posterior scalene muscle (lateral aspect) showing
the origin, insertion, action, and innervation
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Anterior Triangle
Anterior Triangle
Divisions:
Submandibular
triangle
Submental
triangle
Body of the mandible
(Superior border)
Anterior triangle
Carotid triangle
Midline of the neck
(Anterior border)
Muscular triangle
Sternocleidomastoid M.
(Posterior border)
FIG. 7.24a ▲ Borders of the anterior triangle
of the neck (lateral aspect)
Anterior Triangle Contents
FIG. 7.24b ▲ Subtriangles of the anterior
triangle of the neck (lateral aspect)
Occipital A.
Vagus N.
Hypoglossal N.
Posterior belly
digastric M.
Facial A.
Anterior belly
digastric M.
External carotid A.
Submental A.
Thyrohyoid M.
Carotid sinus
Sternohyoid M.
Superior root
ansa cervicalis
Superior belly
omohyoid M.
Inferior root
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.
Submandibular
gland
Anterior belly
digastric M.
Hypoglossal N.
Mylohyoid M.
External carotid A.
Carotid sinus
Sternocleidomastoid M.
Superior thyroid A.
Superior belly
omohyoid M.
Internal jugular V.
Superior root
ansa cervicalis
Sternohyoid M.
Inferior root
ansa cervicalis
FIG. 7.25b ▲ Contents of the anterior triangle of the neck
(anterior aspect)
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FIG. 7.25c ▲ Contents of the anterior triangle of the neck
(anterolateral aspect)
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Anterior Triangle
NECK 455
Anterior Triangle
Divisions:
Submandibular
triangle
Body of the mandible
(Superior border)
Submental triangle
Anterior triangle
Carotid triangle
Midline of the neck
(Anterior border)
Muscular triangle
Sternocleidomastoid M.
(Posterior border)
FIG. 7.26a ▲ Subtriangles of the anterior triangle of the neck (anterior aspect)
Submental A.
Facial A.
Anterior belly
digastric M.
Submandibular gland
Mylohyoid M.
Hypoglossal N.
Posterior belly
digastric M.
Superior root
ansa cervicalis
Sternocleidomastoid M.
Superior belly
omohyoid M.
Inferior root
ansa cervicalis
Thyrohyoid M.
Thyroid gland
Superior thyroid A.
Vagus N.
Sternothyroid M.
Common carotid A.
Sternohyoid M.
Internal jugular V.
FIG. 7.26b ▲ Contents of the anterior triangle of the neck (anterior aspect)
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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
sagitally sected) showing the origin, insertion, action, and innervation
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FIG. 7.28b ▲ Mylohyoid muscle
(anteroinferior aspect)
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Geniohyoid M.
C1 via hypoglossal N. (Innervation)
Mylohyoid M. (Reflected)
FIG. 7.29a ▲ Geniohyoid muscle (anteroinferior
aspect with the mylohyoid muscle reflected)
NECK 457
Anterior Triangle
(Suprahyoid muscles)
Action:
Inferior mental spine Body of the hyoid B.
-Elevate the hyoid B.
manduble (Origin)
(Insertion)
-Shorten floor of mouth
-Widen pharynx
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
hyoid B. (Insertion)
Posterior belly:
Mastoid notch
temporal B. (Origin)
Posterior belly:
Facial N. (Innervation)
Anterior belly:
Digastric fossa
mandible (Origin)
Action:
-Elevate the hyoid B.
-Steady the hyoid B.
-Depress the mandible
Anterior belly:
N. to the mylohyoid
(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
hyoid B. (Insertion)
Action:
-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
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Anterior Triangle (Infrahyoid muscles)
Sternohyoid M.
Superior belly
omohyoid M.
Thyrohyoid M.
Inferior belly
omohyoid M.
FIG. 7.32a ▲ Superficial dissection of the infrahyoid
muscles (anterolateral aspect)
Sternothyroid M.
Superior belly
omohyoid M.
Sternohyoid M.
Inferior belly
omohyoid M.
FIG. 7.32b ▲ Infrahyoid muscles (anterior aspect)
Sternohyoid M.
Body of the hyoid B.
(Insertion)
Ansa cervicalis (C1–3)
(Innervation)
Posterior surface
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
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Myology
Anterior Triangle
(Infrahyoid Muscles)
Thyrohyoid M.
Greater horn hyoid B.
(Insertion)
Body of the hyoid B.
(Insertion)
C1 via hypoglossal N.
(Innervation)
FIG. 7.34 Deep dissection of the infrahyoid muscles
(anterior aspect)
▲
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.
Body of the hyoid B.
(Insertion)
Ansa cervicalis (C2–3)
(Innervation)
Posterior surface
manubrium (Origin)
Thyrohyoid M. Sternothyroid M. Sternohyoid M.
(Reflected)
First costal cartilage
(Origin)
Superior belly
omohyoid M.
(Reflected)
Action:
-Depress thyroid
cartilage
FIG. 7.37a Omohyoid muscle (anterior aspect)
showing the origin, insertion, action, and innervation
FIG. 7.36 ▲ Sternothyroid muscle (anterior aspect)
showing the origin, insertion, action, and innervation
▲
Body of the hyoid B.
(Insertion)
Action:
-Depress hyoid B.
-Retract hyoid B.
Superior belly
Pretracheal fascia
Inferior belly
Superior belly
Pretracheal fascia
Inferior belly
Ansa cervicalis (C1–3)
(Innervation)
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Internal surface superior
border scapula posterior
to suprascapular notch (Origin)
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FIG. 7.37b ▲ Omohyoid muscle
(lateral aspect) showing the origin,
insertion, action, and innervation
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Skin and subcutaneous
tissue of the face (Insertion)
Platysma
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
(anterolateral aspect)
Pharyngeal Muscles
FIG. 7.38b ▲ Platysma muscle (lateral aspect) showing the origin,
insertion, action, and innervation
Pharyngeal tubercle
Superior pharyngeal
constrictor M.
Superior pharyngeal
constrictor M.
Pharyngeal raphe
Middle pharyngeal
constrictor M.
Pharyngeal raphe
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
(posterior aspect of the pharynx)
FIG. 7.39a ▲ Pharyngeal constrictor muscles
(posterior aspect of the pharynx)
Superior pharyngeal
constrictor M.
Superior pharyngeal
constrictor M.
Middle pharyngeal
constrictor M.
Middle pharyngeal
constrictor M.
Greater horn hyoid B.
Thyroid cartilage
Greater horn hyoid B.
Inferior pharyngeal
constrictor M.
Inferior pharyngeal
constrictor M.
Cricoid cartilage
Action:
Thyroid cartilage
FIG. 7.40a ▲ Pharyngeal constrictor muscles
(posterolateral aspect of the pharynx)
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- Constrict pharyngeal
wall
FIG. 7.40b ▲ Pharyngeal constrictor muscles (lateral aspect)
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NECK 461
Pharyngeal Muscles
Pharyngeal
tubercle
(Insertion)
Pterygoid
hamulus
(Origin)
Pterygomandibular
raphe (Origin)
Pharyngeal raphe
(Insertion)
Stylohyoid L.
(Origin)
Pharyngeal raphe
(Insertion)
Greater and lesser
horns hyoid B.
(Origin)
Oblique line
thyroid cartilage
(Origin)
Cricoid cartilage
(Origin)
Posterior aspect
mylohyoid line
(Origin)
Lateral aspect
tongue (Origin)
Pharyngeal branch
vagus N. and
recurrent laryngeal
N. (Innervation)
Pharyngeal branch
vagus N.
(Innervation)
FIG. 7.41 ▲ Superior pharyngeal
constrictor muscle (lateral aspect) showing
the origin, insertion, action, and innervation
FIG. 7.42 ▲ Middle pharyngeal constrictor
muscle (lateral aspect) showing the origin,
insertion, action, and innervation
Pharyngeal raphe
(Insertion)
FIG. 7.43 ▲ Inferior pharyngeal constrictor
muscle (lateral aspect) showing the origin,
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.
Salpingopharyngeus M.
Palatopharyngeus M.
FIG. 7.44b ▲ Pharyngeal muscles (Midsagittal Pharynx
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FIG. 7.44c ▲ Pharyngeal muscles
(posterolateral pharyngeal wall)
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Pharyngeal Muscles
Hard palate
(Origin)
Palatine
aponeurosis
(Origin)
Lamina
thyroid
cartilage
(Insertion)
Lateral aspect
pharynx and
esophagus
(Insertion)
Styloid
process
temporal B.
(Origin)
Cartilaginous
part pharynogotympanic tube
(Origin)
Lamina thyroid
cartilage
(Insertion)
Lateral aspect
pharynx and
esophagus
(Insertion)
Pharyngeal branch
vagus N. (Innervation)
FIG. 7.45 ▲ Palatopharyngeus muscle
(lateral aspect) showing the origin, insertion,
action, and innervation
Glossopharyngeal N.
(Innervation)
FIG. 7.46 ▲ Salpingopharyngeus muscle
(lateral aspect) showing the origin, insertion,
action, and innervation
Cricothyroid M.
FIG. 7.47 ▲ Stylopharyngeus muscle
(lateral aspect) showing the origin, insertion,
action, and innervation
▲
FIG. 7.48b Laryngeal
muscles (anterior aspect)
Laryngeal
Muscles
External laryngeal N.
(Innervation)
Inferior edge lamina
thyroid cartilage
(Insertion)
Inferior horn thyroid
cartilage (Insertion)
Anterolateral part of
arch of cricoid cartilage
(Origin)
▲
FIG. 7.48a Laryngeal
muscles (anterior aspect)
Aryepiglottic part
oblique arytenoid M.
Aryepiglottic part
oblique arytenoid M.
Oblique arytenoid M.
Oblique arytenoid M.
Transverse arytenoid M.
Transverse arytenoid M.
Posterior
cricoarytenoid M.
Posterior cricoarytenoid M.
FIG. 7.49b Laryngeal muscles
(posterior aspect)
▲
▲
FIG. 7.49a Laryngeal
muscles (posterior aspect)
Thyroarytenoid M.
Thyroarytenoid M.
Lateral cricoarytenoid M.
Lateral cricoarytenoid M.
FIG. 7.50b Laryngeal muscles
(lateral aspect with the thyroid
cartilage sagittally sected)
▲
▲
FIG. 7.50a Laryngeal muscles
(posterolateral aspect with the
thyroid cartilage reflected)
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Myology
Laryngeal Muscles
NECK 463
Innervation:
Recurrent laryngeal N.
Muscular process
arytenoid cartilage
(Insertion)
Muscular process
arytenoid cartilage
(Insertion)
Superolateral edge
of arch of cricoid
cartilage (Origin)
Lamina cricoid
cartilage (Origin)
FIG. 7.51 ▲ Posterior cricoarytenoid muscle (posterior
aspect) showing the origin, insertion, action, and innervation
FIG. 7.52 ▲ Lateral cricoarytenoid muscle (lateral aspect
with the thyroid cartilage sagittally sected) showing the
origin, insertion, action, and innervation
Posterior aspect
contralateral arytenoid
cartilage (Insertion)
Posterior aspect
contralateral arytenoid
cartilage (Insertion)
Posterior aspect
arytenoid cartilage
(Origin)
FIG. 7.53 ▲ Transverse arytenoid muscle (posterior aspect)
showing the origin, insertion, action, and innervation
Posterior aspect
arytenoid cartilage
(Origin)
FIG. 7.54 ▲ Oblique arytenoid muscle (posterior aspect)
showing the origin, insertion, action, and innervation
Anterolateral aspect
arytenoid cartilage
(Insertion)
Vocal L. (Insertion)
Posterior aspect
thyroid cartilage
(Origin)
FIG. 7.55 ▲ Thyroarytenoid muscle (lateral aspect with
the thyroid cartilage sagittally sected) showing the origin,
insertion, action, and innervation
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Vocal process
arytenoid cartilage
(Origin)
FIG. 7.56 ▲ Vocalis muscle (lateral aspect with the thyroid
cartilage sagittally sected) showing the origin, insertion,
action, and innervation
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464 NECK
Myology
Anterior Vertebral Column Muscles
Rectus capitis
anterior M.
Rectus capitis
anterior M.
Rectus capitis
lateralis M.
Rectus capitis
lateralis M.
Longus capitis M.
Longus capitis M.
Superior oblique
longus colli M.
Superior oblique
longus colli M.
Vertical longus
colli M.
Vertical longus
colli M.
Inferior oblique
longus colli M.
Inferior oblique
longus colli M.
FIG. 7.57a ▲ Muscles of the anterior vertebral column
(anterior aspect of the vertebral column)
Superior oblique
longus colli M.
Transverse processes
C3–5 (Origin)
Transverse processes
C5–6 (Insertion)
Inferior oblique
longus colli M.
Vertebral bodies
T1–3 (Origin)
Vertebral bodies
C2–4 (Insertion)
Basilar part
occipital B.
(Insertion)
Vertical longus
colli M.
Longus capitis M.
Anterior tubercles of
transverse processes
C3–6 (Origin)
Vertebral bodies
C5–T3 (Origin)
Anterior rami C1–3
(Innervation)
Anterior rami
C2–6 (Innervation)
FIG. 7.58 ▲ Parts of the longus colli muscle (anterior aspect of
the vertebral column) showing the origin, insertion, action, and
innervation
FIG. 7.59 ▲ Longus capitis muscle (anterior aspect of the vertebral
column) showing the origin, insertion, action, and innervation
FIG. 7.61 Rectus capitis anterior muscle (anterior aspect)
showing the origin, insertion, action, and innervation
▲
Anterior tubercle
atlas (Insertion)
FIG. 7.57b ▲ Muscles of the anterior vertebral column
(anterior aspect of the vertebral column)
Anterior to occipital
condyle (Insertion)
Rectus capitis
anterior M.
Transverse process
atlas (Origin)
Anterior rami C1–2
(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
anterior vertebral column (anterolateral aspect of the vertebral column)
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FIG. 7.62 ▲ Rectus capitis lateralis muscle (anterior aspect)
showing the origin, insertion, action, and innervation
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Endocrinology
VI.Endocrinology
A.
Thyroid gland: largest endocrine gland; produces
thyroid hormone
1.Right lobe
2.Left lobe
3 3.Isthmus: joins 2 lobes, anterior to trachea
NECK 465
B.
Parathyroid glands (4): on posterior surface of thyroid gland
1.Superior parathyroid glands: 2
2.Inferior parathyroid glands: 2
Lamina thyroid
cartilage
Lamina thyroid
cartilage
Right lobe
thyroid gland
Arch cricoid
cartilage
Right lobe
thyroid gland
Arch cricoid
cartilage
Isthmus
thyroid gland
Left lobe
thyroid gland
Left lobe
thyroid gland
Isthmus
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
parathyroid gland
Right superior
parathyroid gland
Right superior
parathyroid gland
Left inferior
parathyroid gland
Left inferior
parathyroid gland
Right inferior
parathyroid gland
Right inferior
parathyroid gland
Esophagus
FIG. 7.63e ▲ Thyroid and parathyroid glands (posterior aspect)
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FIG. 7.63f ▲ Thyroid and parathyroid glands (posterior aspect)
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466 NECK
Pulmonology
VII.Pulmonology
a.
Laryngeal inlet
A.
Pharynx: extends from base of skull to inferior bori.
Aryepiglottic folds: between epiglottis and
der of cricoid cartilage
arytenoid cc.
1.Nasopharynx: superior to soft palate; respiratory
ii.
Corniculate tubercles: mucosa over corfunction
niculate cc.
a.
Choanae: passages from nasal cavities to
iii.
Cuneiform tubercles: mucosa over cuneinasopharynx
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 salpingopharyni.
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 orophariii.
Rima glottidis: region between vocal folds
ynx to trachea
e.
Infraglottic cavity: between vocal folds and
inferior border of cricoid cartilage
1.Laryngeal cartilages: see Chondrology
2.Laryngeal musculature: see Myology
Trachea: extends from larynx to its bifurcation in
5
4 C.
thorax
3.Laryngeal cavity
Choanae
Pharyngeal
recess
Torus tubarius
Pharyngeal
opening of the
pharyngotympanic tube
Salpingopharyngeal
fold
FIG. 7.64a ▲ Parts of the pharynx (posterior aspect) with the
pharyngeal constrictor muscles reflected laterally from a midline incision
FIG. 7.65a ▲ Parts of the pharynx (sagittal section)
Torus tubarius
Pharyngeal
opening of the
pharyngotympanic tube
Choana
Nasopharynx
Oropharynx
Choanae
Pharyngeal
recess
Laryngopharynx
Salpingopharyngeal
fold
Laryngeal inlet
Aryepiglottic
fold
Aryepiglottic fold
Laryngeal
inlet
FIG. 7.64b ▲ Parts of the pharynx (posterior aspect) with the
pharyngeal constrictor muscles reflected laterally from a midline incision
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Trachea
Esophagus
FIG. 7.65b ▲ Parts of the pharynx (sagittal section)
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Pulmonology
Larynx
Epiglottis
Epiglottis
Laryngeal vestibule
Laryngeal vestibule
Vestibular fold
Vestibular fold
Laryngeal ventricle
Laryngeal ventricle
Vocal fold
Vocal fold
Conus elasticus
Vocal L.
Vocal L.
Vocalis M.
Vocalis M.
Infraglottic cavity
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
propped open posteriorly after a midline incision through the lamina
of the cricoid cartilage
FIG. 7.67b ▲ Parts of the larynx (posterior aspect)
with the larynx propped open posteriorly after a midline
incision through the lamina of the cricoid cartilage
Glottis
Epiglottis
Epiglottis
Rima
glottidis
Vocal
fold
Glottis
Rima
glottidis
Vocal
fold
Vestibular fold
Vestibular
fold
Aryepiglottic
fold
Aryepiglottic
fold
Cuneiform
tubercle
Cuneiform
tubercle
Corniculate
tubercle
FIG. 7.68a ▲ Parts of the larynx (superior aspect)
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Corniculate
tubercle
FIG. 7.68b ▲ Parts of the larynx (superior aspect)
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Gastroenterology
VIII. Gastroenterology
A.
Pharynx: extends from base of skull to inferior border of cricoid cartilage
1.Nasopharynx: see Pulmonology
2.Oropharynx: between soft palate and base of
tongue; digestive function
a.
Fauces: passage from oral cavity to
oropharynx
i.
Isthmus of the fauces: passage from oral
cavity to oropharynx, between epiglottis
and uvula
ii.
Soft palate: musculomembranous mass
extending posteriorly from hard palate;
ends inferiorly as uvula
(a)
Uvula: musculomembranous conical
extension from soft palate
(b)
Palatoglossal arch: anterior pillar of fauces; mucosa covering palatoglossus m.
(c)
Palatopharyngeal arch: posterior pillar
of fauces; mucosa covering palatopharyngeus m.
b.
Epiglottic valleculae: between anterior surface
of epiglottis and root of tongue
2.Laryngopharynx: posterior to larynx; from epiglottis to esophagus
3.Piriform recess: depression on either side of
laryngeal inlet
6
B.
Esophagus: extends from laryngopharynx to stomach
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
pharyngeal constrictor muscles reflected laterally from a midline incision
FIG. 7.70a ▲ Parts of the oropharynx (sagittal section)
Soft palate
Uvula
Palatopharyngeal
arch
Nasopharynx
Nasopharynx
Palatoglossal arch
Fauces
Isthmus of the
fauces
Oropharynx
Oropharynx
Epiglottis
Aryepiglottic fold
Laryngopharynx
Laryngopharynx
Epiglottic vallecula
Piriform recess
Laryngeal inlet
FIG. 7.69b ▲ Parts of the oropharynx (posterior aspect) with the
pharyngeal constrictor muscles reflected laterally from a midline incision
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Trachea
Esophagus
FIG. 7.70b ▲ Parts of the oropharynx (sagittal section)
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Angiology
IX.Angiology
A.
Common carotid a.: originates from brachiocephalic
5
trunk on right side and from aortic arch on left side
7 1.Carotid sinus: slight dilation in diameter of common carotid a.; branch point into internal and
external carotid aa.
2.Internal carotid a.: no cervical branches
3.External carotid a.: travels superiorly between
mandible and external ear; embedded in parotid
gland and terminates as maxillary a. and superficial temporal a.
a.
Superior thyroid a.: travels inferiorly to thyroid
gland deep to infrahyoid mm.
i.
Superior laryngeal a.: to larynx (accompanies internal laryngeal n.)
b.
Ascending pharyngeal a.: travels superiorly
deep to internal carotid a. giving branches to
pharynx, anterior vertebral mm., middle ear,
and cranial meninges
c.
Lingual a.: travels superiorly deep to hypoglossal n., stylohyoid m., posterior belly of
digastric m. and hyoglossus m.; becomes dorsal lingual a., deep lingual a., and sublingual a.
d.
Facial a.: travels superiorly deep to digastric and
stylohyoid mm.; gives off ascending palatine,
tonsilar, and submental branches, hooks under
inferior border of mandible, and enters face
i.
Ascending palatine a.: to palate; anastomoses with lesser palatine a. from descending
palatine a. of maxillary a.
ii.
Tonsillar branch: to palatine tonsils
iii.
Submental a.: anteriorly to submandibular
gland
e.
Occipital a.: travels posteriorly to posterior
aspect of scalp superficial to internal carotid a.
f.
Posterior auricular a.: travels posteriorly
between external auditory meatus and mastoid
process, supplying nearby musculature, parotid
gland, facial n., temporal b., auricle, and scalp
g.
Maxillary a.: terminal branch; see Head
h.
Superficial temporal a.: terminal branch; see Head
B.
Subclavian a.
1.Region 1: proximal to anterior scalene m.
a.
Vertebral a.: travels superiorly in transverse
foramina of cervical vertebrae (C6–C1);
crosses over posterior arch of atlas, enters
posterior cranial fossa through foramen magnum, meets with contralateral vertebral a., and
forms basilar a.
b.
Internal thoracic a.: travels inferiorly to posterior aspect of anterior chest wall; produces
anterior intercostal aa.
c.Thyrocervical trunk
i.
Inferior thyroid a.: supplies thyroid gland
(a)
Ascending cervical a.: supplies lateral
muscles of superior neck
ii.
Suprascapular a.: travels posteriorly across
phrenic n., anterior scalene m., and over transverse scapular l. to posterior aspect of scapula
iii.
Transverse cervical a.: travels posteriorly
across phrenic n., anterior scalene m., and
brachial plexus to deep surface of trapezius m.
(a)
Superficial branch: travels with spinal
accessory n. along deep surface of trapezius m.
(b)
Deep branch: if present, replaces dorsal
scapular a. traveling along medial border of scapula supplying levator scapulae and rhomboid mm.
2.Region 2: deep to anterior scalene m.
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a.
Costocervical trunk
i.
Supreme intercostal a.: to 1st and 2nd posterior intercostal spaces
ii.
Deep cervical a.: to posterior deep cervical
muscles; anastomoses with descending
branch of occipital a.
3.Region 3: distal to anterior scalene; proximal to
inferior border of 1st rib
a.
Dorsal scapular a.: variably arises from 3rd part
of subclavian a., travels superior to scapula
then along medial border of scapula supplying
levator scapulae and rhomboid mm.; if this vessel arises from transverse cervical a. it is known
as deep branch of the transverse cervical a.
C.
Superior vena cava: formed by union of right and
left brachiocephalic vv.
1.Brachiocephalic vv.: formed by union of subclavian and internal jugular vv.
a.
Subclavian v.: drains upper extremity; receives
external jugular v.; forms brachiocephalic v. with
internal jugular v.; possesses bulb and valve to
resist pressure produced by atrial contraction
i.
External jugular v.: formed by union of retromandibular and posterior auricular vv.;
drains scalp and lateral face; travels inferiorly across sternocleidomastoid m.; receives
suprascapular, transverse cervical, and anterior jugular vv.; then empties into subclavian
v.; smaller than internal jugular v.
(a)
Retromandibular v.: receives superficial
temporal and maxillary vv.; posterior division contributes to external jugular v., anterior division contributes to common facial v.
(b)
Posterior auricular v.: drains posterior scalp
(c)
Transverse cervical v.: follows companion a.
(d)
Suprascapular v.: follows companion a.
(e)
Anterior jugular v.: drains submental region
b.
Internal jugular v.: extracranial continuation of
sigmoid sinus; receives inferior petrosal sinus
and occipital, pharyngeal, common facial,
lingual, and superior and middle thyroid vv.;
joins with subclavian v. to form brachiocephalic v.; possesses bulb and valve to resist
pressure produced by atrial contraction
i.
Inferior petrosal sinus: exits skull through
jugular foramen
ii.
Occipital v.: follows companion a.
iii.
Pharyngeal v.: arises from pharyngeal
venous plexus
iv.
Common facial v.: union of facial v. and
anterior division of retomandibular v.; sends
communicating branch to anterior jugular v.;
can receive lingual and superior thyroid vv.
(a)
Facial v.: follows companion a.
(b)
Retromandibular v.: receives superficial
temporal and maxillary vv.; sends anterior division into common facial v.
(c)
Communicating branch: communication
between common facial and anterior
jugular vv.
v.
Lingual v.: follows companion artery
vi.
Superior thyroid v.: drains thyroid gland
vii.
Middle thyroid v.: drains thyroid gland
2.Inferior thyroid vv.: drain thyroid gland; empty
into left brachiocephalic vein
D.
Lymphatics
1.Lypmh nodes
a.
Superficial nodes
i.
Occipital nodes: drain occipital region
ii.
Mastoid nodes: drain posterior neck
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Angiology
iii.
Superficial parotid nodes: drain parotid region
iv.
Anterior superficial nodes: drain anterior neck
along communicating and anterior jugular v.
v.
Lateral superficial nodes: drain lateral neck
along external jugular v.
b.
Deep nodes
i.
Deep parotid nodes: drain parotid region
ii.
Submental nodes: drain face
iii.
Submandibular nodes: drain face
iv.
Anterior deep nodes
(a)
Infrahyoid nodes: drain infrahyoid region
(b)
Thyroid nodes: drain tissue around thyroid gland
(c)
Pretracheal nodes: drains tissue around
trachea
(d)
Paratracheal nodes: drains tissue
around trachea
Superficial
temporal A.
Maxillary A.
see head
(e)
Retropharyngeal nodes: drains pharynx
v.
Lateral deep nodes
(a)
Superior deep nodes: drain tissue along
internal jugular v.
(b)
Inferior deep nodes: drain tissue along
internal jugular v.
vi.
Supraclavicular nodes
2.Lymphoid organs
a.
Oropharynx
i.
Lingual tonsil: on root of tongue
8 ii.Palatine tonsils: lymphoid tissue on either
side of oropharynx (between palatoglossal
and palatopharyngeal arches)
b.
Nasopharynx
9 i.Pharyngeal tonsil (adenoids): lymphoid tissue on either side of nasopharynx
Posterior
auricular A.
External Carotid A.
see head
Soft
palate
Ascending
palatine A.
Palatine
Tonsils
Face
Submental A.
Tonsillar branch
Posterior
scalp
Submandibular
gland
Tongue
Facial A.
Occipital A.
FIG. 7.71b Branches of the external carotid artery
(lateral aspect of the neck)
▲
Parotid gland
facial N.
temporal B.
auricle scalp
Lingual A.
External carotid A.
Pharynx
anterior vertebral
muscles middle ear
cranial meninges
Posterior External
Occipital A. auricular A. carotid A. Facial A. Submental A.
Ascending
pharyngeal A.
Larynx
Thyroid
gland
Internal Carotid Common Superior
Superior
carotid A. sinus carotid A. thyroid A. laryngeal A.
FIG. 7.71a ▲ Schematic of
the external carotid artery
showing the branches,
distribution, and supply
Occipital A.
Ascending
pharyngeal A.
Lingual A.
Internal
carotid A.
Superior
thyroid A.
Carotid sinus
▲
FIG. 7.71c Branches of the
external carotid artery (lateral
aspect of the neck immediately
inferior to the mandible)
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Superior
laryngeal A.
Common
carotid A.
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NECK 471
Subclavian A.
Deep
cervical A.
Brain
Lateral and posterior
neck musculature/
spinal branches
Ascending
cervical A.
Transverse
cervical A.
Transverse
cervical A.
(superficial
branch)
Transverse
cervical A.
(deep branch)
Anterior
scalene M.
Vertebral A.
Inferior
thyroid A.
Trapezius M.
Thyrocervical
trunk
Dorsal
scapular A.
Rhomboid major M.
Rhomboid minor M.
Levator scapulae M.
Thyroid gland
Suprascapular A.
Costocervical
trunk
Supraspinatus M.
Infraspinatus M.
II
Part
Brachiocephalic
trunk
Part III
Supreme
intercostal A.
Pa
rt
I
Left common
carotid A.
1st intercostal space
Axillary A.
Internal
thoracic A.
Anterior thoracic wall
Aortic arch
Upper extremity
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.
Suprascapular N.
Vertebral A.
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)
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Angiology
Middle
scalene M.
Spinal
accessory N.
Ascending
cervical A.
Trapezius M.
Anterior
scalene
M. (Bisected)
Transverse
cervical A.
Inferior
thyroid A.
Dorsal
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.
(Bisected)
Subclavian A.
(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.
Dorsal
scapular N.
Common
carotid A.
Suprascapular A.
Ascending
cervical A.
Suprascapular N.
Inferior
thyroid A.
Deep
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
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Angiology
Superior Vena Cava
NECK 473
Inferior petrosal sinus
Posterior
scalp
Occipital V.
Superficial temporal Vs.
see head
Maxillary Vs.
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.
Anterior jugular V.
Suprascapular V.
Internal jugular V.
FIG. 7.73b ▲ Distribution of the internal and external jugular veins (lateral neck)
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Angiology
Lymph Nodes
Deep parotid
nodes
Occipital
nodes
Superior
deep
nodes
Submandibular
nodes
Superficial
parotid
nodes
Mastoid
nodes
Infrahyoid
nodes
Submental
nodes
Retropharyngeal
nodes
Anterior
superficial
nodes
Lateral
superficial
nodes
Pretracheal
nodes
Thyroid
nodes
Paratracheal
nodes
FIG. 7.74a ▲ Superficial lymph nodes of the neck (lateral aspect)
Inferior
deep
nodes
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
(posterior aspect) with the pharyngeal constrictor
muscles reflected laterally from a midline incision
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FIG. 7.75b ▲ Lymphoid organs of the neck: tonsils (sagittal section)
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Neurology
X.Neurology
A.
Cranial nerves in cervical region: for full description
see Head Neurology
1.Vagus n.: exits posterior cranial fossa through
jugular foramen, travels in carotid sheath; while
in neck, produces pharyngeal branch, superior
laryngeal n., right recurrent laryngeal n., and
superior and inferior cardiac branches; enters
thorax through superior thoracic aperture and
produces left recurrent laryngeal n.
a.
Pharyngeal branch: carrying fibers that traveled briefly with spinal accessory n., contributes to pharyngeal plexus and innervates 5
pharyngeal muscles
b.
Superior laryngeal n.: from inferior vagal
ganglion, divides in carotid sheath to become
internal and external laryngeal nn.
i.
Internal laryngeal n.: to larynx above vocal
folds
ii.
External laryngeal n.: innervates cricothyroid m.
c.
Recurrent laryngeal n.: on right side, originates from vagus n. in neck, travels under
right subclavian a. and returns to larynx; on
left side, originates from vagus n. in thorax,
travels under aortic arch, and returns to larynx
i.
Inferior laryngeal n.: continuation of recurrent laryngeal n., innervates all other laryngeal muscles
d.
Superior cardiac branch: to heart
e.
Middle cardiac branch: to heart
2.Spinal accessory n.: passes through posterior
triangle then travels deep to trapezius m.; innervates sternocleidomastoid and trapezius mm.
3.Hypoglossal n.: exits hypoglossal canal, passes
between external carotid a. and internal jugular v.;
receives branches from anterior ramus of C1 which
produces superior root of ansa cervicalis; sends
branches carrying C1 fibers to geniohyoid and thyrohyoid mm., then turns superiorly toward tongue to
innervate 7 intrinsic and extrinsic tongue muscles
B.
Cervical spinal nerves: C1–C8
1.Anterior rami
a.
Cervical plexus of nerves: anterior rami C1–C4
i.
Lesser occipital n. (C2): travels posterosuperiorly from nerve point of neck; cutaneous innervation to skin of neck and scalp
posteriosuperior to auricle
ii.
Great auricular n. (C2–C3): travels superiorly from nerve point of neck; cutaneous
innervation to skin over parotid gland,
posterior aspect of auricle, and skin from
mandible to mastoid process
iii.
Transverse cervical n. (C2–C3): travels anteriorly across sternocleidomastoid m. from
nerve point of neck; cutaneous innervation
to skin over anterior triangle
iv.
Supraclavicular n. (C3–C4): travels inferiorly
from nerve point of neck; cutaneous innervation to skin over neck and shoulder
(a)
Lateral supraclavicular n.
(b)
intermediate supraclavicular n.
(c)
Medial supraclavicular n.
v.
Ansa cervicalis (C1–­C3): loops down over
carotid sheath; innervates 3 infrahyoid mm.
(a)
Superior root (C1): travels briefly with
hypoglossal n.
(b)
Inferior roots: C2–C3
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vi.
Muscular branches
(a)
Rectus capitis anterior m.
(b)
Rectus capitis lateralis m.
(c)
Longus capitis m.
(d)
Longus colli m.
b.
Phrenic n. (C3–C5): travels anterior to anterior
scalene m. deep to internal jugular v., passes
between subclavian a. and v., and enters thorax; innervates thoracic diaphragm
6 c.Brachial plexus of nerves: anterior rami C5–T1;
at level of trunks, travel between anterior and
middle scalene mm.; for full description, see
Upper Extremity
2.Posterior rami
a.
Suboccipital n.: dorsal ramus of C1; innervates
musculature of suboccipital region; exists in
suboccipital triangle
b.
Greater occipital n.: posterior ramus of C2;
cutaneous to posterior scalp, appears below
suboccipital triangle traveling superiorly
c.
Least occipital n.: posterior ramus of C3; cutaneous and muscular innervation
d.
C4–C8: cutaneous and muscular innervation
C.
Autonomic nervous system
1.Sympathetic presence in cervical region
a.
Cervical sympathetic trunk: presynaptic fibers
from thoracic spinal levels ascending to cervical sympathetic ganglia
i.
Superior cervical ganglion (C1–C2): largest
cervical ganglion; sends internal and external carotid branches forming periarterial
plexus; produces superior cervical cardiac
branch; also sends gray rami communicans
to anterior rami of C1–C4 spinal nerves
(a)
Internal carotid n.: contributes to carotid
periarterial plexus; supplies viscera of
head and neck
(b)
External carotid n.: contributes to
carotid periarterial plexus; supplies viscera of head and neck
(c)
Superior cervical cardiac branch: feeds
into cardiac plexus and supplies heart
ii.
Middle cervical ganglion: smallest cervical
ganglion; often absent; sends branches to
carotid periarterial plexus, produces middle
cervical cardiac branch, and sends gray
rami communicans to anterior rami of C5–
C6 spinal nerves
(a)
Middle cervical cardiac branch: feeds
into cardiac plexus and supplies heart
iii.
Inferior cervical ganglion: often fuses with
1st thoracic sympathetic ganglion to form
large cervicothoracic (stellate) ganglion;
sends branches to carotid and vertebral
periarterial plexuses, produces inferior cervical cardiac branch, and sends gray rami
communicans to anterior rami of C7–C8
spinal nerves
(a)
Inferior cervical cardiac branch: feeds
into cardiac plexus and supplies heart
(b)
Vertebral n.: feeds into vertebral periarterial plexus and supplies viscera of
head and neck
2.Parsympathetic presence in cervical region
a.
Vagus n.: parasympathetic innervation to larynx, pharynx, and carotid bodies
i.
Pharyngeal branch: parasympathetic to
pharynx
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ii.
Superior laryngeal n.: parasympathetic to
larynx above vocal folds
iii.
Recurrent laryngeal n.: parasympathetic to
larynx below vocal folds
iv.
N. to carotid body
v.
Superior cardiac branch: to heart
vi.
Middle cardiac branch: to heart
Cranial Nerves in Cervical Region
Superior vagal
ganglion
Inferior vagal
ganglion
Pharyngeal
branch
Pharyngeal
plexus
Superior pharyngeal constrictor M.
Middle pharyngeal constrictor M.
Inferior pharyngeal constrictor M.
Salpingopharyngeus M.
Palatopharyngeus M.
Hypoglossal N.
Right
vagus N.
Superior
laryngeal N.
Internal
laryngeal N.
External
laryngeal N.
Superior
laryngeal N.
Left vagus N.
Right vagus N.
Internal
laryngeal N.
Laryngeal mucosa
superior to vocal folds
External
laryngeal N.
Cricothyroid M.
FIG. 7.76b ▲ Branches of the right vagus nerve (lateral aspect)
Right vagus N.
Superior
cardiac branch
Middle
cardiac branch
Posterior cricoarytenoid M.
Lateral cricoarytenoid M.
Transverse arytenoid M.
Oblique arytenoid M.
Thyroarytenoid M.
Vocalis M.
Arch of
the aorta
Inferior
laryngeal N.
Left vagus N.
Right recurrent
laryngeal N.
Middle cardiac
branch
Left recurrent
laryngeal N.
Trachea
Heart
Inferior
cardiac branch
Left recurrent
laryngeal N.
FIG. 7.76a ▲ Schematic of the left vagus nerve
showing the branches, distribution, and innervation
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Arch of
the aorta
FIG. 7.76c ▲ Branches of the right and left vagus nerves
(anterior aspect of the deep neck and superior mediastinum)
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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
branch
Pharyngeal
branch
Superior
laryngeal N.
Superior
laryngeal N.
Internal
laryngeal N.
Internal
laryngeal N.
External
laryngeal N.
External
laryngeal N.
Inferior
laryngeal N.
Inferior
laryngeal N.
Left vagus N.
Right
vagus N.
Left recurrent
laryngeal N.
Right recurrent
laryngeal N.
Right
subclavian A.
Arch of
the aorta
FIG. 7.77b ▲ Branches of the left vagus nerve (lateral aspect)
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FIG. 7.77c ▲ Branches of the right vagus nerve (lateral aspect)
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Neurology
Cranial Nerves in Cervical Region
Sternocleidomastoid M.
Spinal accessory N.
(CN XI)
Trapezius M.
FIG. 7.78a ▲ Schematic of the spinal accessory nerve in
the neck showing the branches, distribution, and innervation
(posterior aspect)
FIG. 7.78b ▲ Spinal accessory nerve in the neck
(anterolateral aspect)
Hypoglossal N.
(CN XII)
Superior root
ansa cervicalis
(C1)
FIG. 7.79a ▲ Hypoglossal nerve in the neck showing
its relationship to the ansa cervicalis (lateral aspect)
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FIG. 7.79b ▲ Hypoglossal nerve in the neck showing
its relationship to the ansa cervicalis (lateral aspect)
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NECK 479
Cervical Plexus
Great
auricular N. (C2,3)
Skin neck and
scalp behind auricle
Lesser
occipital N. (C2)
Hy
po
glo
ss
al N
.
Skin over parotid gland,
posterior auricle,
mandible to mastoid
Tongue
musculature
Anterior
ramus
Hypoglossal N.
(CN XII)
Geniohyoid
branch (C1)
Geniohyoid M.
C1
Thyrohyoid M.
Anterior
ramus
C2
Thyrohyoid
branch (C1)
Superior root ansa
cervicalis (C1)
Anterior
ramus
C3
Inferior root ansa
cervicalis (C2,3)
Anterior
ramus
C4
Anterior
ramus
Transverse
cervical N. (C2,3)
Skin over anterior
triangle
C5
Sternothyroid M.
Medial
supraclavicular N.
(C3,4)
Omohyoid M.
Sternohyoid M.
Intermediate
supraclavicular N.
(C3,4)
Skin neck
and shoulder
Phrenic N. (C3,4,5)
Thoracic diaphragm
Skin neck
and shoulder
Skin neck
and shoulder
Lateral
supraclavicular N.
(C3,4)
FIG. 7.80a ▲ Schematic of the cervical plexus showing the branches, distribution, and innervation
Hypoglossal N.
(CN XII)
Anterior ramus 2nd
cervical spinal N.
Great
auricular N. (C2,3)
Lesser
occipital N. (C2)
Anterior ramus 3rd
cervical spinal N.
Superior root ansa
cervicalis (C1)
Transverse
cervical N. (C2,3)
(Reflected laterally)
Inferior root
ansa cervicalis (C2,3)
Lateral
supraclavicular N.
(C3,4)
Anterior ramus 4th
cervical spinal N.
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)
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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)
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NECK 481
Sympathetic Nervous System
Head and neck
viscera
Carotid periarterial
plexus
Anterior ramus
1st cervical spinal N.
Internal carotid N.
Superior cervical
ganglion
External carotid N.
Grey rami
communicans
Superior cervical
cardiac N.
External carotid A.
Interganglionic
branch
Internal carotid A.
Branches to the carotid
periarterial plexus
Middle cervical
ganglion
Middle cervical
cardiac N.
Grey ramus
communicans
Branches to the carotid
periarterial plexus
Vertebral N.
Inferior cervical
ganglion
Vertebral A.
Grey ramus
communicans
Inferior cervical
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:
A.
Superficial cervical fascia: thin subcutaneous connective tissue
B.
Deep cervical fascia
i.
Investing layer: superficial layer of deep cervical fascia
ii.
Pretracheal layer
•Continuous inferiorly with fibrous pericardium
•Continuous posteriorly with buccopharyngeal fascia
•Encloses infrahyoid muscles, thyroid gland,
trachea, and esophagus
iii.
Prevertebral layer: surrounds vertebral column and
musculature
2.
1. The 3 types of joints are synovial joints (diarthrosis; united
by an articular capsule), fibrous joints (synarthrosis; united
by fibrous tissue), and cartilaginous joints (amphiarthrosis;
united by hyaline cartilage or fibrous cartilage). The following are further classifications of the 3 main joint types:
•Synovial joints: diarthrosis, freely moveable, characterized by a fibrous capsule lined with a synovial membrane, a joint space, hyaline cartilage lining the articular
surfaces, and synovium
•Planar: flat, arthroidal, non-axial gliding movement
(e.g., acromioclavicular joint)
•Ginglymus: hinge, uniaxial (e.g., humeroulnar joint)
(continues on page 482)
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•Trochoid: pivot, unixial, rotation (e.g., median atlantoaxial joint)
•Condylar: 1–2 concave surfaces articulating with 1–2 convex surfaces, biaxial (e.g., metacarpophalangeal joint)
•Sellar: saddle, both surfaces are convex and concave,
biaxial, allowing circumduction without rotation (e.g.,
carpometacarpal joint)
•Spheroidal: ball and socket, triaxial, allowing rotation along all 3 axes (e.g., femoroacetabular joint)
•Compound: any combination of the above joints
•Fibrous joints: synarthrosis, characterized by bone,
fibrous connective tissue, and bone
•Sutures: interlocked bone (e.g., skull sutures)
•Schindylesis: tongue-in-groove (e.g., vomer b./perpendicular plate of the ethmoid b. into the nasal crest)
•Gomphosis: peg-in-socket (e.g., dentoalveolar joint)
•Syndesmosis: bone-ligament-bone (e.g., middle radioulnar joint by the interosseous membrane)
•Cartilagenous joints: amphiarthrosis, characterized by
bone, cartilage, bone
•Synchondrosis: primary cartilagenous joints, characterized by temporary cartilagenous unions of hyaline cartilage, usually between the diaphysis and epiphysis of
growing bone
•Symphysis: secondary cartilagenous joints, characterized by strong, slightly moveable joints united by
fibrocartilage
3. The posterior triangle is bound by the sternocleidomastoid
m., trapezius m., and the clavicle. The contents of the posterior triangle include the levator scapulae m.; the anterior,
middle, and posterior scalene mm.; the inferior belly of
the omohyoid m.; and the splenius capitus m. The inferior
belly of the omohyoid m. further subdivides the posterior
triangle into the occipital triangle (superior to the inferior
belly of the omohyoid m.) and the supraclavicular triangle
(inferior to the inferior belly of the omohyoid m.). The contents of the occipital triangle include the external jugular
v., the posterior branches of the cervical plexus, and the
transverse cervical a. The contents of the supraclavicular
triangle include the 3rd part of the subclavian a. and the
suprascapular a.
4. The anterior triangle is bordered by the median line of
the neck, the sternocleidomastoid m., and the mandible.
The muscular contents of the anterior triangle include the
mylohyoid, geniohyoid, digastric, stylohyoid, sternohyoid,
sternothyroid, and thyrohyoid mm. and the superior belly
of the omohyoid m.
•The anterior triangle is further subdivided into 2 suprahyoid triangles by the hyoid b., the posterior belly of the
digastric m., and 2 infrahyoid triangles. The 2 suprahyoid
triangles, the submental triangle (anterior) and the submandibular triangle (posterior), are separated by the anterior belly of the digastric m. The contents of the submental
triangle include the submental a., submental lymph nodes,
and small veins. The contents of the submandibular triangle include the submandibular gland, hypoglossal n.,
nerve to the mylohyoid m., and parts of the facial a. and v.
•The two infrahyoid triangles, the muscular triangle (anterior) and the carotid triangle (posterior), are separated
by the superior belly of the omohyoid m. The contents
of the muscular triangle include the thyroid gland and
parathyroid glands. The contents of the carotid triangle
include the common carotid a, internal jugular v., vagus
n., hypoglossal n., spinal accessory n., the superior root
of the ansa cervicalis, thyroid gland, larynx, pharynx,
and branches of the cervical plexus.
5. The carotid sheath houses the common carotid a., the
internal jugular v., and the vagus n.
6. The suboccipital triangle is made up of the rectus capitus
posterior major, obliquus capitus inferior, and the obliquus
capitus superior mm. The suboccipital n. exits the suboccipital triangle, the greater occipital n. travels superficial to
the suboccipital triangle, and the vertebral a. can be seen
deep in the suboccipital triangle.
Clinical Notes
1. The anterior longitudinal l. is important due to its possible
splinting action that should be used whenever fracture
of the vertebral column is suspected (except with cervical fractures due to hyperextension). When a fracture of
the vertebral column occurs, the patient should be kept in
hyperextension at all times. The pull of the anterior longitudinal l. will help realign fragments of bone and keep
further injury to the spinal cord from occurring.
2. Congenital torticollis is a disorder results in a fibrous tissue tumor, which forms in the sternocleidomastoid m.,
causing the head to tilt towards the affected side and the
face to look away from the affected side. A hematoma can
arise and impinge on the spinal accessory n., which denervates the sternocleidomastoid m.
3. Enlargement of the thyroid gland is called goiter. One type
of goiter, exophthalmic goiter, is produced by an overproduction of thyroid hormone and can result in bulging of
the eyeballs.
4. Fractures of the laryngeal skeleton occur often in sports
and can produce respiratory obstruction, hoarseness, and
an inability to speak.
5. Cancer of the larynx is common among individuals who
smoke. Laryngectomy and tracheostomy are performed
in cases of laryngeal malignancy. Vocalization can be
achieved by an electrolarynx, tracheoesophageal prosthesis, or esophageal speech.
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6. Tracheoesophageal fistula is a congenital anomaly of
the esophagus in which, in its most common form, the
esophagus ends in a blind-ended pouch, and the stomach
communicates with the trachea. Other forms include a
blind-ended pouch with no tracheal communication and a
complete esophagus with tracheal communication distal
to the epiglottis.
7. Carotid bodies (chemoreceptors) exist at the carotid sinus
and monitor the oxygen content of blood before it reaches
the brain. Adjustments to heart rate, respiratory rate, and
blood pressure can be made accordingly based on the
oxygen content in the carotid sinus via the glossopharyngeal n. The carotid sinus is also hypersensitive to pressure (baroreceptors); therefore, excessive pressure to the
carotid sinus can produce slow heart rate, a drop in blood
pressure, and fainting.
8. Tonsillectomy is a removal of the palatine tonsils due
to their inflammation obstructing the communication
between the oral cavity and the oropharynx. Due to the
presence of the tonsilar a., glossopharyngeal n., and
internal carotid a., tonsillectomy makes these vessels and
nerves vulnerable to injury.
9. Adenoiditis is an inflammation of the pharyngeal tonsils
obstructing the nasal passageways and opening of the
auditory tube. This can cause hearing impairment and lead
to otitis media.
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