Humerus Arm Anatomical Neck Arm

Structure

Region

System

Innervation (what it innervates)

Blood Supply

Origin / Insertion

Action

Clinical Correlation

Netter Plate #'s

humerus arm anatomical neck

Skeletal

humerus - capitulum

arm

Skeletal

Lateral side of distal humerus and articulation point for the head of the radius.

420, 421

humerus coronoid fossa

arm

Skeletal

Anterior fossa just above the trochlea for coronoid process of ulna to articulate with during full flexion of the elbow

420, 421

humerus deltoid tuberosity

arm

Skeletal

Lateral tuberosity where deltoid inserts, approximately at the midpoint of the humerus.

420, 421

humerus arm greater tubercle

Skeletal

3 of 4 rotator cuff muscle tendons insert here— supraspinatus, infraspinatus, and teres minor

420, 421

humerus - head arm

Skeletal

Articulate with glenoid fossa. Directed upward, medially, and posteriorly

420, 421

humerus – intertubercular arm (bicipital) sulcus

Skeletal

420, 421

arm

Skeletal

Point of origin for extensors (including supinator), often called the common extensor origin

The common extensor origin is the site of pain in individuals lateral epicondylitis (commonly called “tennis elbow”). It is thought to primarily be a chronic overuse 420, 421 injury with any motions causing repetitive wrist extension and/or forearm supination. Pain is often worst 1-2 cm distal to the lateral epicondyle.

humerus - lesser arm tubercle

Skeletal

Projects anteriorly from humerus, insertion site for the subscapularis muscle of the rotator cuff

humerus medial epicondyle

Skeletal

Point of origin for flexors and pronator teres. Ulnar nerve runs in a groove behind this structure

Medial epicondylitis (commonly called “little league elbow” or “golfer’s elbow”) is 420, 421 due to repetitive motions causing wrist flexion and/or forearm pronation.

humerus arm olecranon fossa

Skeletal

Posterior fossa on back side distal humerus for olecranon process of ulna to articulate with during full extension of the elbow

420, 421

humerus - radial arm groove

Skeletal

humerus surgical neck

Skeletal

humerus lateral epicondyle

arm

arm

420, 421

420, 421

420, 421 between the tubercles and shaft

common site of fracture

420, 421

humerus trochlea

arm

Skeletal

basilic vein

arm

Vascular

Spool-shaped or pulley-like; articulates with proximal end (trochlear notch) of ulna

420, 421

429, 479, 480

brachial artery

arm

Vascular

used to take blood pressure readings. It is palpated and traced to the cubital fossa, and the bell of the stethoscope is placed over this spot

cephalic vein

arm

Vascular

PICC lines (peripherally inserted central catheters) are one way of administering 429, 479, 480 chemotherapy, iv nutrition (TPN), and longterm antibiotics.

profunda brachii (deep brachial) arm Vascular artery triceps brachii arm - extension Muscular m. - lateral head

429, 433, 473

429 Radial (C7)

branch of profunda brachii a.

upper humerus (longitudinal) / chief extensor of forearm olecranon of ulna

arm - extension Muscular

Radial (C7)

branch of profunda brachii a.

lateral border (superior) humerus / olecranon of ulna

chief extensor of forearm; resists dislocation of humerus (especially important during abduction)

431-433

triceps brachii arm - extension Muscular m. - medial head

Radial (C7)

branch of profunda brachii a.

lower half & upper medial humerus / olecranon of ulna

chief extensor of forearm

431-433

biceps brachii m. - long head

arm - flexion

Muscular

Musculocutaneo branches of us (C5,C6) brachial a.

supraglenoid tubercle (neck of supinates forearm and, when scapula / radial tuberosity supine, flexes forearm

431-433

biceps brachii m. - short head

arm - flexion

Muscular

Musculocutaneo branches of us (C5,C6) brachial a.

coracoid process / radial tuberosity

(see long head); also resists dislocation of shoulder

431-433

brachialis m.

arm - flexion

Muscular

radial recurrent Musculocutaneo a., branches of us (C6) brachial a.

distal half of humerus / ulnar tuberosity and coronoid process

flexes forearm in all positions (strongest flexor of the elbow joint)

431-433

coracobrachialis arm - flexion m.

Muscular

coracoid process / medial, middle of humerus

helps flex shoulder and adduct arm; resists dislocation of shoulder

431-433

triceps brachii m. - long head

intercostobrachi axilla / shoulder Innervation al nerve

muscular Musculocutaneo branches of us (C6) brachial a. supplies skin of the upper medial and posterior aspects of the arm anterior and posterior posterior circmflex, deltoid branches of branch of axillary (C5-C6) thoracoacromial

431-433

429, 430

anterior – humeral flexor, medial rotator; middle – humeral abductor; posterior – humeral extensor, lateral rotator

423-429

posterior surface of inferior adducts and medially rotates angle of scapula / medial lip of arm intertubercular groove

174-177

lateral third of clavicle, spine and acromion of scapula / deltoid tuberosity of humerus

deltoid m.

axilla / shoulder Muscular

teres major m.

axilla / shoulder Muscular

clavicle

axilla / shoulder Skeletal

419-423

coracoacromial ligament

axilla / shoulder Skeletal

419-423

Inferior Subscapular (C6-C7)

circumflex scapular

coracoclavicular axilla / shoulder Skeletal ligament

419-423

glenoid labrum

420-421

axilla / shoulder Skeletal

scapula acromion axilla / shoulder Skeletal process scapula axilla / shoulder Skeletal coracoid process scapula glenoid cavity scapula infraspinous fossa

420-421 420-421

axilla / shoulder Skeletal

420-421

axilla / shoulder Skeletal

420-421

scapula - spine

axilla / shoulder Skeletal

420-421

scapula suprascapular notch scapula -

axilla / shoulder Skeletal

420-421

axilla / shoulder Skeletal supraspinous fossa superior transverse axilla / shoulder Skeletal scapular ligament anterior humeral circumflex axilla / shoulder Vascular artery

420-421 over the suprascapular notch of the scapula. Nerve runs under, vessels over

423, 425, 427

from lateral border of the 1st rib as continuation of subclavian a., ending at inferior border of the teres major

427, 429, 433, 434

axillary artery

axilla / shoulder Vascular

axillary vein

axilla / shoulder Vascular

429

lateral thoracic artery posterior

axilla / shoulder Vascular

427, 429, 434

axilla / shoulder Vascular

427, 429, 432, 434

axilla / shoulder Vascular

427, 429, 434

subclavian vein

axilla / shoulder Vascular

429

subscapular artery

axilla / shoulder Vascular

427, 429, 434

suprascapular artery

axilla / shoulder Vascular

427, 429

humeral circumflex artery subclavian artery

thoracoacromial axilla / shoulder Vascular artery thoracodorsal axilla / shoulder Vascular artery Quadrangular Space

427-429, 434 427, 429, 434 Space between the vertically running long and lateral heads Traversed by posterior circumflex humeral of the triceps brachii and the artery and axillary n horizontally running teres minor and major.

axilla / shoulder

accessory nerve back (CN XI)

Innervation

trapezius, stemocleidomas toid m.

erector spinae

bilaterally: extend vertebral (from medial-->lateral) - semispinalis, column and head; unilaterally: longissimus, iliocostalis laterally flex vertebral column

174-177

extends, adducts, medially rotates humerus; raises body toward arms during climbing; scapular depression

174-177

back

Muscular

latissimus dorsi back m.

Muscular

Thoracodorsal (C6-C8)

levator scapulae back m.

Muscular

posterior tubercles of transverse elevates scapula and tilts its Dorsal Scapular transverse processes of C1-C4 cervical a., dorsal glenoid cavity inf by rotating (C3,C4,C5) / med border of scapula scapular a. scapula superior to root of spine

174-177

pectoralis major back m.

Muscular

clavicular head - ant surface of med ½ of clavicle sternocostal pectoral branch of Medial and head: ant surface of sternum, thoracoacromial Lateral Pectoral superior 6 cartilages, a., internal (C5-T1) aponeurosis of external thoracic a. oblique mm / lateral lip of intertubercular groove

adducts and medially rotates humerus; in isolation, clavicular head flexes humerus; in isolation, sternocostal head extends humerus

174-177

pectoralis minor back m.

Muscular

Medial Pectoral (C8-T1)

stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall

174-177

rhomboid major back m.

Muscular

spinous processes of T2-T5 / retract scapula and rotate it to Dorsal Scapular dorsal scapular a. medial border of scapula from depress glenoid cavity; fix (C5) level of spine to inferior angle scapula to thoracic wall

174-177

rhomboid minor back m.

Muscular

nuchal ligament, spinous Dorsal Scapular processes of C7-T1 / smooth dorsal scapular a. (C5) triangular area at medial end of scapular spine

174-177

serratus anterior m.

back

Muscular

Long Thoracic (C5-C7)

back

Muscular

back

Muscular

back

Muscular

serratus posterior inferior m. serratus posterior superior m. splenius m.

trapezius m.

back

Muscular

axillary nerve

brachial plexius Innervation

anterior rami of T9 to T12 spinal nerves 2-5th intercostals n posterior rami of spinal n

thoracodorsal a.

spinous processes of T7-T12, thoracolumbar fascia, iliac crest, and inf 3 ribs / floor of intertubercular groove

R3-5 near costal cartilages / same as pec. maj. med and superior coracoid process

same as major

external surfaces of lateral protracts scapula and holds lateral thoracic a. parts of R1-8; anterior surface against thoracic wall; rotates of medial border scapula scapula upward

174-177

depress ribs

174-177

elevate ribs

174-177

laterally flex neck and rotate head to side of active muscles acting together: extend head and neck

174-177

medial 1/3 of superior nuchal line, external occipital protub, Spinal Root of transverse elevates / ascending: nuchal ligament, spinous Accessory Nerve cervical a., dorsal depresses / middle or all parts processes of C7-T12 / lateral and C3-C4 scapular a. together retracts scapula 1/3 of clavicle; acromion and spine of scapula Innervates the glenohumeral joint, deltoid, teres minor, skin of superolateral arm

174-177

Get stabbed in the quadrangular space and you won’t be able to abduct. You’ll also 429, 430, 432, have loss of sensation over the lateral 477 aspect of the deltoid m.

dorsal scapular nerve

brachial plexius Innervation

lateral cord of brachial plexus

brachial plexius Innervation

lateral pectoral nerve

brachial plexius Innervation

rhomboids and sometimes levator scapulae

429, 430, 477

429, 430 Pectoralis major

429, 430

long thoracic nerve

brachial plexius Innervation

serratus anterior

The serratus anterior m. inserts on the anteromedial aspect of the scapula. It functions to protract the scapula (ie: pull it anteriorly as with a punch) and also to fix the scapula against the thoracic wall. When the long thoracic nerve is cut, winging of 429, 430 the scapula occurs. The manifests as a protrusion of the medial border of the scapula, especially with flexion of the shoulder and with resistance (ie: flex at both shoulders and push against a wall)

lower subscapular nerve

brachial plexius Innervation

Inferior portion of subscapularis and teres major

429, 430

lower trunk of brachial plexus

brachial plexius Innervation

429, 430

medial cord of brachial plexus

brachial plexius Innervation

429, 430

medial cutaneous nerve brachial plexius Innervation of arm

Sensory nerve to posteromedial side of the lower 1/3 of the arm

429, 430, 433, 473,

medial cutaneous nerve brachial plexius Innervation of forearm

Sensory nerve to medial aspect of forearm arm

429, 430, 433, 472, 473,

medial pectoral brachial plexius Innervation nerve

Pectoralis minor and major

429, 430

median nerve

brachial plexius Innervation

middle trunk of brachial plexus

brachial plexius Innervation

musculocutaneo brachial plexius Innervation us nerve posterior cord of brachial plexius Innervation brachial plexus

see --->

Muscles of anterior forearm compartment (except flexor carpi ulnaris and ulnar ½ of flexor digitorum profundus); five intrinsic mm. in thenar half of palm and palmar skin

429, 430, 433, 465, 472, 473, 475

429, 430

see --->

m. of anterior compartment of arm (coracobrachialis, biceps brachii, and brachialis); skin of lateral aspect of forearm

429, 430, 433, 472, 473, 474 429, 430

radial nerve

brachial plexius Innervation

see --->

suprascapular nerve

brachial plexius Innervation

supraspinatus and infraspinatus

thoracodorsal nerve

brachial plexius Innervation

latissimus dorsi

ulnar nerve

upper subscapular nerve upper trunk of brachial plexus

brachial plexius Innervation

see --->

brachial plexius Innervation

superior part of subscapularis

posterior compartments of arm and forearm; skin of posterior and inferolateral arm, posterior forearm, dorsum of hand lateral to middle of the fourth digit

429, 430, 432, 433, 472, 473, 477, 478

travels under the superior transverse scapular ligament.

429, 430, 477 429, 430

flexor carpi ulnaris and ulnar half of flexor digitorum profundus (forearm); most intrinsic muscles of hand; skin of hand medial to midline of 4th (ring) finger

429, 430, 433, 465, 472, 473, 476

429, 430

brachial plexius Innervation

429, 430

sternum - body

chest

Skeletal

Narrower, middle portion

419

sternum manubrium

chest

Skeletal

Superior

419

sternum suprasternal (jugular) notch

chest

Skeletal

Superior to the manubrium and between the medial ends of the clavicles

419

sternum chest xiphoid process

Skeletal

inferior

419

abductor pollicis forearm longus m. extention

Muscular

Posterior interosseous (C7,C8)

abducts and extends thumb

445

forearm extention

Muscular

Radial (C7-T1)

forearm extention

Muscular

Deep branch of radial (C7,C8)

forearm extention

Muscular

Radial (C6,C7)

extensor carpi ulnaris m.

forearm extention

Muscular

extensor digiti minimi m.

forearm extention

Muscular

extensor digitorum m.

forearm extention

Muscular

Posterior interosseous (C7,C8)

posterior interosseous a.

extensor indicis forearm m. extention

Muscular

Posterior interosseous (C7,C8)

posterior interosseous a.

extensor pollicis forearm brevis m. extention

Muscular

Posterior interosseous (C7,C8)

posterior interosseous a.

anconeus m. extensor carpi radialis brevis m. extensor carpi radialis longus m.

Posterior interosseous (C7,C8) Posterior interosseous (C7,C8)

posterior surface of ulna, radius, and interosseous memb / base of metacarpal I lat epicondyle of humerus / lat deep brachial surface of olecranon and artery superior part of posterior surface of ulna radial and radial common extensor tendon / recurrent arteries promixal 3rd metacarpal anteriorolateral, distal radial and radial humerus / proximal 2nd recurrent arteries metacarpal common extensor tendon, posterior middle ulna / proximal 5th interosseous a. metacarpal posterior interosseous a.

posterior interosseous a.

common extensor tendon / distal & middle 5th phalange

assists triceps in extending forearm; stabilizes elbow joint; may abduct ulna during pronation extends wrist and abducts hand extends wrist and abducts hand

441

extends wrist and abducts hand

441

extends little finger

441

extends index, middle, ring, common extensor tendon / and little fingers; assists in distal & middle 2-4 phalanges wrist extension medial,distal ulna & interosseous membrane / extends proximal phalanx of middle and distal 2nd index finger phalange distal radius & interosseous / proximal 1st phalange

441

extends proximal phalanx of thumb

441

445

445

extensor pollicis forearm longus m. extention

Muscular

Posterior interosseous (C7,C8)

posterior interosseous a.

middle ulna & interosseous / distal 1st phalange

brachioradialis m.

forearm - flexion Muscular

Radial (C5-C7)

laterodistal humerus / styloid radial recurrent a. process of radius (most laterodistal part)

flexor carpi radialis m.

forearm - flexion Muscular

Median (C6,C7)

radial a.

flexor carpi ulnaris m.

forearm - flexion Muscular

Ulnar (C7-T1)

posterior ulnar recurrent a.

common flexor tendon / proximal 1,2 metacarpals

extends distal phalanx of thumb

445

flexion of elbow joint

446

flexes hand, assists in abduction

446

common flexor tendon & proximal posterior ulna / flexes hand, assists in pisoform, hook of hamate, adduction lateroproximal 5th metacarpal

Ulnar nerve runs along medial aspect of the arm and under the muscle belly of the extensor carpi ulnaris. It can become entrapped at this level in “cubital tunnel syndrome”, which can occur when a person 446 sleeps with their hand near the level of the head and the elbow flexed. The flexion pinches the nerve causing numbness/tingling and paralysis after waking.

flexor digitorum forearm - flexion Muscular profundus m.

anterior medially - Ulnar interosseous a., anteromedial, proximal ulna / (C8,T1); laterally branches of ulnar distal 2-5 phalanges - Median (C8,T1) a.

flexor digitorum forearm - flexion Muscular superficialis m.

Median (C7-T1)

ulnar and radiol arteries

humeroulnar head, common flexes middle and proximal flexor tendon, proximal radius phalanges; assists in hand / middle 2-5 phalanges flexion

446

flexor pollicis longus m.

forearm - flexion Muscular

Anterior interosseous branch of median (C8,T1)

anterior interosseous a.

medial radius & interosseous membrane / distal 1st phalange

flexes phalanges of thum

448

palmaris longus forearm - flexion Muscular m.

Median (C6,C8)

posterior ulnar recurrent a.

common flexor tendon / palmar aponeurosis

flexes hand and tenses palmar fascia

446

pronator quadratus m.

forearm rotators

Muscular

Anterior interosseous branch of median (C8,T1)

anterior interosseous a.

distal ulna / distal radius

pronates forearm

440

pronator teres m.

forearm rotators

Muscular

Median (C6,C7)

anterior ulnar recurrent a.

supinator m.

forearm rotators

Muscular

Deep radial nerve (C5,C6)

anterior interosseous nerve

forearm / hand

Innervation

common digital nerve

forearm / hand

Innervation

lateral cutaneous nerve forearm / hand of the forearm

Innervation

branch of the median nerve

2 branches to thumb, 1 branch each to 2,3,4 digits Sensory nerve to the lateral aspect of the forearm

flexes distal phalanges; assists in hand flexion

superior to medial epicondyle & common flexor tendon / pronates forearm, assists in middle anterior border of flexion radius radial recurrent & lateral epicondyle (humerus) & posterior proximal posterior ulna / supinates forearm interosseous a. proximal anterior radius

flexor pollicis longus, lateral ½ of the flexor digitorum profundus, and the pronator quadratus

448

446

440, 445 Anterior Interosseous Syndrome A nerve entrapment which produces a characteristic deficit with pincer grasp due to weak flexion of the DIP of the thumb and the first two fingers. The AIN has no 475 cutaneous sensory fibers like the median nerve proper, and therefore does not produce numbness and tingling when compressed. 475

472, 474

posterior interosseous nerve

forearm / hand

Innervation

see --->

proper digital nerve

forearm / hand

Innervation

see --->

recurrent branch of the median forearm / hand nerve

Innervation

thenar muscles

superficial branch of the radial nerve

Innervation

see --->

forearm / hand

annular ligament

forearm / hand

Skeletal

capitate b.

forearm / hand

Skeletal

Branch off of the radial nerve, pierces the supinator muscle and innervates most of the extensor muscles in the forearm (except anconeus, brachioradialis, and extensor carpi radialis longus) Sensory nerve branches off of medial and ulnar cutaneous branches. Ulnar to the medial 1 ½ fingers, median n. to the palmar surfaces and dorsal surfaces of the finger tips of the lateral 3 ½ digits

473, 478

472, 473

473 cutaneous sensation to the dorsal parts of the first 3 ½ digits, except distal phalanges Strong band of fibers wrapping prevents radial head around the head (proximal subluxation part) of the radius, attaching to (partial/incomplete the anterior and posterior dislocation) aspects of the ulna

472, 473, 478

If a babysitter lifts a child by the wrist with the arm extended and pronated, the radial head can sublux (partially dislocate from the annular ligament). 453, 445, 456

distal interphalangeal forearm / hand joint (DIP)

Skeletal

In general, osteoarthritis is more likely to affect the DIP and PIP joints, while rheumatoid arthritis more classically affects the MCP and PIP joints. This is easy to remember as osteo- arthritis affects 458 people further along in life (ie: PIP and DIP are the two more distal joints), while rheumatoid arthritis affects people earlier in life (ie: MCP and PIP are the two more proximal joints).

distal phalanx

Skeletal

456

hammate b.

forearm / hand

forearm / hand

The ulnar nerve travels into the hand by passing over the flexor retinaculum and through Guyon’s (or the “ulnar”) canal between the hamate and pisiform bones. Thus fractures of the hamate can cause numbness and weakness of the little and half of the ring fingers.

Skeletal

Fibrous membrane between the radius and ulna.

Because the the radius has a more significant articulation with the carpals at the wrist joint, forces are transmitted from the hand to the radius. The ulna has a more significant articulation than the radius at the elbow joint.

453, 445, 456

The fibers of the interosseous membrane run obliquely and transfer energy from the radius to the ulna, and thus onto the 439 humerus. This more effectively disperses axial forces from the hand to the forearm, and to the humerus.

interosseous membrane

forearm / hand

Skeletal

lunate b.

forearm / hand

Skeletal

453, 445, 456

metacarpal

forearm / hand

Skeletal

456

metacarpophala forearm / hand ngeal joint (MP)

Skeletal

458

middle phalanx

forearm / hand

Skeletal

456

pisiform b.

forearm / hand

Skeletal

453, 445, 456

Skeletal

458

Skeletal

456

proximal interphalangeal forearm / hand joint (PIP) proximal forearm / hand phalanx radius - head

forearm / hand

Skeletal

proximal end, articulates with capitulum of lateral humerus

439, 450, 451

radius - radial tuberosity

forearm / hand

Skeletal

medial aspect of the proximal radius, insertion site for biceps brachii tendon

439, 450, 451

radius - styloid process

forearm / hand

Skeletal

lateral projection on distal end of the radius, insertion point for the brachioradialis

439, 450, 451

scaphoid b.

forearm / hand

Skeletal

60% of carpal bone fractures are scaphoid fractures; failure to diagnose these 453, 455, 456 fractures can lead to avascular necrosis

trapezium b.

forearm / hand

Skeletal

453, 455, 456

trapezoid b.

forearm / hand

Skeletal

453, 455, 456

triquetrum b.

forearm / hand

Skeletal

453, 455, 456

ulna - coronoid process

forearm / hand

Skeletal

439, 450, 451

ulna - olecranon forearm / hand process

Skeletal

439, 450, 451

forearm / hand

Skeletal

439, 450, 451

forearm / hand

Vascular

forearm / hand

Vascular

460

forearm / hand

Vascular

434

forearm / hand

Vascular

465

forearm / hand

Vascular

forearm / hand

Vascular

434

forearm / hand

Vascular

460

radial artery

forearm / hand

Vascular

465

superficial palmar arch

forearm / hand

Vascular

460

ulna - styloid process anterior interosseous artery common digital artery common interosseous artery deep palmar arch median cubital vein posterior interosseous artery proper digital artery

communication between cephalic and basilic v.

479, 480

ulnar artery

forearm / hand

Vascular

460 proximal metacarpals / deep palmar arch proximally at proximal phalanges proximal metacarpals / deep palmar arch proximally at proximal phalanges

interosseous m. hand - dorsal I to IV

Muscular

Deep branch of ulnar (C8,T1)

interosseous m. hand - palmar I to III

Muscular

Deep branch of ulnar (C8,T1)

lumbrical m. I and II

hand

Muscular

Median (C8,T1)

superficial and deep palmar arches

lumbrical m. III and IV

hand

Muscular

Deep branch of ulnar (C8,T1)

superficial and deep palmar arches

extensor retinaculum

hand

flexor retinaculum

hand

palmar aponeurosis

hand

abductor digiti minimi (quinti) m. flexor digiti minimi (quinti) m. opponens digiti minimi (quinti) m.

460 439

extends index and middle flexor digit. profundus tendon / fingers at interphalangeal lateral side of phalanges joints; flexes metacarpophalangeal joints 1 and 2 extends ring and little fingers flexor digit. profundus tendon / at interphalageal joints; flexes lateral side of phalanges meta-carpophalangeal joints 3 and 4

463 Fibrous sheath over the dorsal aspect of the forearm, just proximal to the hand. It 468-470 holds the tendons of the extensor muscles in place as the muscles contract.

This is partially cut in surgery for carpal forms the roof over the carpal tunnel syndrome, in order to relieve the tunnel increased pressure in the carpal tunnel.

447, 454

446, 454, 480 pisiform b, tendon of flexor deep palmar carpi ulnaris / medial side of branch of ulnar a. base of proximal phalanx of little finger flexor retinaculum and hook of deep palmar hamate b. / proximal 5th branch of ulnar a. phalanx flexor retinaculum and hood of deep palmar hamate bone / medial border branch of ulnar a. of metacarpal V

hand hypothenar

Muscular

Deep branch of ulnar (C8,T1)

hand hypothenar

Muscular

Deep branch of ulnar (C8,T1)

hand hypothenar

Muscular

Deep branch of ulnar (C8,T1)

Muscular

Recurrent branch of median (C8,T1)

flexor retinaculum, scaphoid, abducts; also assists superficial palmar and trapezium b. / lateral side opposition and extensionof branch of radial a. of proximal phalanx of thumb thumb

Deep branch of ulnar (C8,T1)

oblique head – bases of metacarp’s II and III; capitate deep palmar arch and trapezoid bb / medial side adducts and flexes thumb of base of proximal phalanx of thumb

Recurrent branch of median (C8,T1) Recurrent branch of median (C8,T1)

flexor retinaculum and superficial palmar trapezium b. / lateral proximal branch of radial a. 1st phalanx flexor retinaculum and superficial palmar trapezium b. / lat side of branch of radial a. metacarpal I

abductor pollicis hand - thenar brevis m.

463

adductor pollicis hand - thenar m.

Muscular

flexor pollicis brevis m.

hand - thenar

Muscular

opponens pollicis m.

hand - thenar

Muscular

abducts little finger

465, 476

flexes proximal phalanx of little finger

465, 476

draws metacarpal V forward to face thumb

465, 476

465, 475 Froment’s sign: Have a patient try to hold a piece of paper between their thumb and the side of the index finger with the hand flat. Try to pull the paper away from the patient, and if they resort to flexing the DIP of the thumb to hold the paper, then this is a positive Froment’s sign. (The flexor pollicis longus is innervated by the anterior interosseous nerve, a branch of the median nerve. Therefore, this muscle can compensate by flexing to make of for lost adduction with lost adduction.

flexes proximal phalanx of thumb

465, 475

draws metacarpal I forward and medially

465, 475

Tested by having patient fix elbows at their sides with elbows bent to 90o, and then having patient externally rotate against 423-429 resistance. (Same test is used for teres minor)

infraspinatus m. rotator cuff

Muscular

subscapularis m. rotator cuff

Muscular

Subscapular (C5- subscapular a., subscapular fossa / lesser C7) lateral thoracic a. tubicle (humerus)

medially rotates and adducts arm; helps hold humeral head in glenoid cavity

423-429

supraspinatus m.

rotator cuff

Muscular

Suprascapular (C5-C6)

helps to initiate first 10 degrees of abduction and helps deltoid with abduction

174-177

teres minor m.

rotator cuff

Muscular

Posterior branch circumflex of Axillary (C5scapular C6)

cauda equina

spinal cord

Innervation

conus medullaris

spinal cord

Innervation

dorsal primary ramus

mixed motor and sensory to the deep muscles of the back cell bodies of the afferent nerves

suprascapular a.

suprascapular a.

infraspinous foss / greater tubicle (humerus)

externally rotates humerus; help hold humeral head in glenoid cavity of scapula

Suprascapular (C5-C6)

supraspinous fossa / greater tubicle (humerus)

lateral border, scapular / inf. to laterally rotate arm, help hold greater tubicle humeral head in glenoid cavity

174-177 Lumbar puncture : You want to put the needle in below the level of the conus medullaris, as the nerve roots of the cauda equine are bathed in CSF and move out of the way like wet noodles. The most 160-163, 169, commonly used level is the L3-4 space. 170 The easiest way to find this is by following the tops of the iliac crests posteriorly and the L3-4 space should be approximately at this level. 160-163, 169, 170 160-163, 169, 170

spinal cord

Innervation

dorsal root spinal cord (spinal) ganglion

Innervation

dura mater

spinal cord

Innervation

160-163, 169, 170

filum terminale

spinal cord

Innervation

gray communicating ramus

160-163, 169, 170

spinal cord

Innervation

160-163, 169, 170

spinal cord

spinal cord

Innervation

160-163, 169, 170

spinal nerves

spinal cord

Innervation

160-163, 169, 170

ventral primary ramus

spinal cord

Innervation

160-163, 169, 170

ventral root

spinal cord

Innervation

white communicating ramus

160-163, 169, 170

spinal cord

Innervation

160-163, 169, 170

sacrum

spinal cord

Skeletal

153-159

vertebra - atlas (C1)

spinal cord

Skeletal

153-159

vertebra - axis (C2)

spinal cord

Skeletal

153-159

160-163, 169, 170

vertebra - axis (C2) – Dens / Odontoid process vertebra - body

spinal cord

Skeletal

153-159

spinal cord

Skeletal

153-159

vertebra - C3

spinal cord

Skeletal

153-159

vertebra - C4

spinal cord

Skeletal

153-159

vertebra - C5

spinal cord

Skeletal

153-159

vertebra - C6

spinal cord

Skeletal

153-159

vertebra - C7

spinal cord

Skeletal

153-159

Skeletal

153-159

Skeletal

153-159

vertebra inferior articular spinal cord facet vertebra spinal cord lamina vertebra lumbar

spinal cord

Skeletal

153-159

vertebra pedicle

spinal cord

Skeletal

153-159

vertebra - sacral spinal cord

Skeletal

153-159

spinal cord

Skeletal

153-159

spinal cord

Skeletal

153-159

spinal cord

Skeletal

153-159

spinal cord

Skeletal

153-159

spinal cord

Skeletal

153-159

vertebra spinous process vertebra superior articular facet vertebra thoracic vertebra transverse foramen vertebra transverse process

#'s

Structure

Region

System

4

arachnoid granulations brain

Innervation

5

arachnoid mater

Innervation

brain

45

dura mater

Brain

Innervation

153

optic tract

Brain

Innervation

164

pituitary gland

Brain

Innervation

70

falx cerebelli

Brain

Membrane

71

falx cerebri

Brain

Membrane

231

tentorium cerebelli

Brain

Membrane

12

basilar artery

brain

Vascular

46

dural venous sinus – inferior sagittal sinus

Brain

Vascular

47

dural venous sinus – Brain superior sagittal sinus

Vascular

Innervation (what it innervates)

Blood Supply (what it supplies) protrude into venous sinuses

CN V1-V3 - Each contributes a meningeal branch(es)

CN II

Origin / Insertion

Action

Clinical Correlation

Netter Plate Moore Page #'s #'s

meninges

facilitates CF exit from brain into bloodstream

projections from arachnoid mater into venous sinus

102

meninges

insulates brain

located between dura mater and pia mater

102

Outermost layer of meninges (dura, arachnoid, pia) Cranial dura mater has 2 layers: (1) external periosteal layer (2)internal meningeal layer). Spinal dura (internal meningeal only) External periosteal layer 99, 102 adheres to internal surface of cranium. At dural infoldings/reflections, meningeal layer reflects away from external layer. Supports dural venous sinuses (carry blood from brain to heart).

Pg. 865-872

Arteries of dura supply more blood to calvaria than to dura. Largest: Middle Meningeal Artery Veins of dura accompany meningial arteries in pairs.

Optic n. posterior to the optic chiasm

107-8, 112, 114, 144

Vision sensation Release of hormones that control numerous bodily functions (e.g. growth, blood pressure, sex organ function, thyroid gland function, metabolism, temperature regulation, water regulation)

Pituitary tumors may expand the sellar diaphragm, disturbing endocrine 107, 147, 140, function, may lead to visual disturbances 148, 149, 37 due to pressure on the optic chiasm

small, cresent-shaped sagittally-oriented fold of dura mater lying between cerebellar hemispheres; doesn’t pass deeply b/w them cresent-shaped sagittally-oriented fold of dura mater lying between cerebral hemispheres Rostrally: clinoid processes of sphenoid Divides the cranial cavity into b.; Rostrolaterally: petrous part temporal supratentorial & infratentorial b.; Posteriolaterlly: internal surface of compartments occipital b. & part of parietal b. inferior surface arteries of pons posterior part of circle of Willis and anastomoses with blood supplied to the anterior part of the circle of Willis from the carotid Purpose of Dural Venous Sinus: 1. Receive blood from internal and external Smaller than superior sagittal sinus veins of brain in these cavities. 2. Runs in inferior concave free border of Drains into straight sinus Receive cerebrospinal fluid (CSF) from falx cerebri subarachnoid space. 3. Empty most of the blood of the brain into the Internal Jugular Vein (IJV).

Lies in convex attached border of falx cerebri

Receives superior cerebral veins and communicates on each side through slit-like openings with lateral venous lacunae, lateral expansions of the superior sagittal sinus. Drains into IJV through the transverse sinus from the confluence of sinuses.

1061

144

867

843, 868 86, 101, 103, 144, 145

867-8, 1057 140

103, 104

Pg. 867

103, 104

Pg. 867

48

dural venous sinus – transverse sinus

Brain

Vascular

49

dural venous sinus – cavernous sinus

Brain

Vascular

50

dural venous sinus – sigmoid sinus

Brain

Vascular

51

dural venous sinus – straight sinus

Brain

Vascular

94

internal carotid artery Brain

Vascular

95

internal jugular vein

Brain

Vascular

132

middle meningeal artery

Brain

Vascular

Cavernous Sinus Contents: O TOM CAT O TOM = lateral wall components (from superior to inferior) CA = components within sinus (from Passes laterally from confluence of medial to lateral) sinuses. Forms groove in occipital bones *CA ends at the level of T from level of and posteroinferior angles of parietal Blood received from confluence of O TOM.* bones. / Courses along posterolateral sinuses is drained through transverse Occulomotor Nerve (CN III) 103, 104 attached margins of the tentorium sinuses. (Usually left sinus is larger). Trochlea Nerve (CN IV) cerebelli. Ophthalmic Nerve (CN V1) Becomes sigmoid sinus in posterior Maxillary Nerve (CN V2) aspect of petrous temporal bones. Carotid Artery Abducent Nerve (CN V1) “T” when written CA connects to level of T. Receives blood from superior and inferior ophthalmic veins, superficial Inside each cavernous sinus is the Extends from superior orbital fissure middle cerebral vein, and sphenoparietal internal carotid artery, carotid plexus anteriorly to apex of the petrous part of sinus.Drains posteroinferiorly through 103, 104 of sympathetic nerves, and the the temporal bone posteriorly. superior and inferior petrosal sinuses and abducent nerve. emissary veins to the basilar and pterygoid plexuses. Follows S-shaped courses in posterior cranial fossa, forming deep grooves in Two areas beneath brain, allows veins to drain blood from center of head temporal and occipital bones. Each 103, 104 sigmoid sinus turns anteriorly and then downward. Drains blood from transverse sinus into IJV. continues inferiorly as the IJV after traversing the jugular foramen. From transverse sinus, beneath temporal Drains blood from inferior sagittal bone snaking along to internal jugular sinus and great cerebral vein into the vein confluence of sinuses.

103, 104

Partial occlusion of ICA may cause a transient ischemic attack(sudden focal loss of neurological function - dizziness (Part of Clinical Correlation) Stenosis: main blood supply of brain; & disorientation) or a minor stroke. ant’r and middle cerebral aa and with advancing age, artery may anastomoses with vertebral aa Carotid endarterectomy - operation to ophthalmic a (w/supratrochlear and – narrow owing to atherosclerotic in the Circle of Willis (or opening artery at origin, stripping off orbital aa) are terminal branches thickening of intima of arteries. Can cerebral arterial circle). atherosclerotic plaque with the intima, cause brain infarction. and administering drugs to inhibit clot formation until endothelium has regrown. needle & catheter can be inserted into IJV for diagnostic/therapeutic tributaries: pharyngeal, lingual, brain, cranial cavity, skull, purposes.Right is preferable (larger and formed at the base of the skull where the common facial, sternocleidomastoid, face, viscera of the neck; straighter). To perform: palpate common sigmoid sinus ends superior thyroid, middle thyroid veins; largest v of head and neck carotid a., then insert needle lateral to it, into brachiocephalic v 30 degree angle, directed inferolaterally toward ipsilateral nipple

Pg. 867

Pg. 869 (text) Reference figure: 7.31 for most help

Pg. 869 (text) Reference figure: 7.31 for most help Pg. 867 (text) Reference figure 7.31 for most help

864-869, 873, 882-888, 919, 23, 69, 75, 85, 953, 959, 971, 100, 125, 131, 1001-1019, 136-143 1035-1036, 1057, 10691077

23, 29-34, 59, 1004, 1011, 75 1039

supplies dura mater

pg.839

21

CNaI / olfactory bulb

Brain - Cranial Innervation Nerves

neuron cell bodies in olfactory epitheliumspecial sensory - smell

22

CNbI / olfactory tract

Brain - Cranial Innervation Nerves

neuron cell bodies in olfactory epitheliumspecial sensory - smell

23

CNcII / optic nerve

Brain - Cranial Innervation Nerves

neuron cell bodies in retina

special sensory - vision

injury causes anosmia (loss of sense of smell), possibly caused by fracture of cribriform plate injury causes anosmia (loss of sense of smell), possibly caused by fracture of cribriform plate injury causes anopsias (visual field defects), possibly caused by eyeball trauma

116,118

1054-1061

116,118

1054-1061

116,118,132,

1058-1062

24

CNdIII / oculomotor nerve

Brain - Cranial Innervation Nerves

somatic motor: neuron cell bodies located in upper midbrain (oculomotor nucleus) visceral motor: preganglionic cell bodies located in upper midbrain (Edinger-Westphal nucleus); postganglionic neuron cell bodies located in cliliary ganglion (attached to V1)

25

CNeIV / trochlear nerve

Brain - Cranial Innervation Nerves

neuron cell bodies located in lower midbrain - trochlear nucleus

26

CNf V / trigeminal nerve

Brain - Cranial Innervation Nerves

27

CNgV1 / ophthalmic division

Brain - Cranial Innervation Nerves

neuron cell bodies located in trigeminal (semilunar) ganglion

28

CNhV2 / maxillary division

Brain - Cranial Innervation Nerves

neuron cell bodies located in trigeminal (semilunar) ganglion

29

CNi V3 / mandibular division

Brain - Cranial Innervation Nerves

30

CNj VI / abducent nerve

Brain - Cranial Innervation Nerves

somatic motor: causes eye movement, innvervates levator palpebrae m., superior rectus m., inferior rectus m., medial rectus m., and inferior oblique m. visceral motor: innervates sphincter pupillae m to cause pupil constriction and innervates ciliary m to cause lens accommodation for near vision

somatic motor function causes eye movement, innvervates superior oblique m.

somatic motor: injury can cause ptosis (eyelid droops due to paralysis of levator palpebrae m.), lateral strabismus (eye turns down and laterally due to unopposed action of superior oblique and lateral rectus m.'s), and diplopia (double vision due to lateral strabismus), injury can be caused by cavernous sinus injury 101,116,118,1 or aneurysms of posterior cerebral or 1058-1064 31 superior cerebellar a.'s visceral motor: injury causes mydriasis (pupil dilation) due to paralysis of sphincter pupillae m. and unopposed action of dilator pupillae m., also loss of accommodation due to paralysis of ciliary m. injury causes inability to look down when eye is adducted (diplopia), possibly 116,118 1058-1065 caused by cavernous sinus injury 116,118,131,1 1058-1067 33,134,45,

sensory and motor

motor

somatic sensory function - sensory injury causes anesthesia (loss of pain and 116,118,131,1 from skin of forehead, scalp, mucous touch senstaion to innervated areas) and 1058-1067 33,134,45, membranes (nasal) posslble cause of injury is inflammation

injury causes anesthesia (loss of pain and touch senstaion to innervated areas) and trigeminal neuralgia/Tic douloureux (intermittent excruciating pain); posslble cause of injury is inflammation Sensory: injury causes anesthesia (loss of Somatic sensory -- skin of the lower pain and touch sensation to innervated jaw, mucosa of anterior 2/3 of the Sensory -- trigeminal (semilunal) areas) and trigeminal neuralgia/Tic tongue Branchial motor -- temporalis ganglion, largest division, exits through douloureux (intermittent excruciating m, lateral and medial pterygoid mm, foramen ovale. Motor -- pons (motor pain); possible cause of injury is masseter m, tensor veli palatini m, nucleus V), exits through foramen ovale inflammation. tensor veli tympani, mylohyoid m, Motor -- injury results in difficulty anterior belly of digastric m. chewing. somatic sensory function - sensory from skin of upper lip, skin over prominence of cheek, palate, maxillary sinus

Pons abducent nucleus, emerges near median plane at the junction of pons and medulla, passes through cavernous sinus innervates lateral rectus m. of the eye. and superior orbital fissure, then through common tendinous ring of rectus mm.

Injury to cavernous sinus or fracture of the base of the skull may injure the nerve. This results in medial strabismus and diplopia.

116,118,131,1 1058-1067 33,134,45,

116,118,131,1 849-853, 1058, 33,134,45, 1065-1067

1058, 1068

31

CNkVII / facial nerve

Brain - Cranial Innervation Nerves

Somatic sensory, Special sensory, Motor, Parasympathetic

32

CNl VIII / vestibulocochlear nerve

Brain - Cranial Innervation Nerves

special sensory

33

CNnIX / Brain - Cranial Innervation glossopharyngeal nerve Nerves

Somatic sensory, Special sensory, Visceral sensory, Motor, Parasympathetic

Somatic sensory -- Geniculate ganglion, enters internal acoustic meatus and exits via stylomastoid foramen. Special sensory -- Geniculate ganglion, enters internal acoustic meatus and exits via petrotympanic fissure. Motor somatic -Pons motor nucleus VII, enters internal acoustic meatus and exits via stylomastoid foramen, forms parotid plexus, gives 5 branches: temporal, zygomatic, buccal, mandibula and cervical. Parasympathetic -- to lacrimal gland (Pons superior salivary nucleus, through nervous intermedius and geniculate ganglion, via grater petrosal n, pterigopalatine ganglion with attached V2, via zygomaticotemporal n. (V2) and lacrimal n. (V1).) to salivary gland except parotid (Pons superior salivatory nucleus, through nervous intermedius and geniculate ganglion, via chorda tympani, joins lingual n. (V3), sabmandibular ganglion) Spiral ganglion (cochlea) and vestubular ganglion, enter internal acoustic meatus, cochlea and vestibules of the inner ear. Somatic sensory-- Superior ganglion of IX, exit via jugular foramen. Special sensory-- Superior ganglion of IX, exit via jugular foramen. Visceral sensory-Superior ganglion of IX, exit via jugular foramen, forms carotid body and sinus. Motor -- medulla nucleus ambiguus, exit via jugular foramen Parasympathetic --medulla inferior salivatory nucleus, exit brain w/CN IX, pass via tympanic n. and lesser petrosal n., enters otic ganglion (attached to V3), continuous via auriculotemporal n. to parotid gland.

Somatic sensory --skin behind ear, external acoustic meatus, external surface of tympanic membrane. Special sensory -- taste from anterior 2/3 of the tongue and palate. Motor somatic -- muscles of facial expression (platisma, buccinator, frontalis, occipitalis, orbicularis occuli and oris, etc), stapedius, stylohyoid, posterior belly of digastric m. Parasympathetic-- lacrimal, submandibular and sublingual glands.

Somatic sensory -- anesthesia of the innervated area. Special sensory -- injury to chorda tympani leads to loss of taste from innervated area. Motor somatic -- Bell's palsy. Summary: distal to stylomastoid foramen>>>facial m. paralysis (1). proximal to branching off of chorda tympani>>>>(1) , loss of taste from anterior 2/3 of the tongue (2), loss of salivation from sublingual and submandibular glands (3). distal to geniculate ganglion>>>>> (1)-(3), hyperacusis (4). grater petrosal nerve>>>> (1)-(4), loss of taste from palate (5) and loss of lacrimation (6).

853-855, 1058, 1068-1070

Hearing and balance

Loss of hearing, vertigo, tinnitus. Possible injury is by tumor.

1059, 10711072

Somatic sensory-- mucosa of posterior 1/3 of the tongue, soft palate, pharynx, middle ear, auditory tube, mastoid air cells Special sensory-- taste from posterior 1/3 of the tongue. Visceral sensory-- chemoreceptors in carotid body monitor O2, Baroreceptors in carotid sinus monitor arterial BP. Motor --stylopharengius m. (elevates pharynx in speech and swallowing. Parasympathetic --salivation from parotid.

Somatic sensory-- neck lacerations may lead to dysphasia, dysarthria. Special sensory-- neck laceration may lead to loss of taste from innervated area. Visceral sensory-neck laceration may lead to blood pressure changes. Motor -- dysphasia and dysarthria Parasympathetic -- loss of salivation from parotid.

1059, 1072

Injury to motor portion result in sagging soft palate, difficulty speaking, coughing, clearing throat, swallowing (recurrent laryngeal n.), dysphasia.

1059, 10731075

neck lacerations may lead to weakness in turning head to opposite side and shrugging shoulders.

1059, 1075

34

CNoX / vagus nerve

Brain - Cranial Innervation Nerves

Somatic sensory, Visceral sensory, Special sensory, Motor, Parasympathetic

Somatic sensory-- pharynx, larynx, external ear, external auditory canal, external surface of tympanic membrane, meningies in posterior cranial fossa. Visceral sensory-- muscles and mucous Somatic sensory -- superior ganglion of membranes in the pharynx, larynx, X, temporal bone and occipital bone, exit thoracic and abdominal viscera, via jugular foramen. Visceral sensory chemoreceptors in aortic body, stretch and Special sensory -- Inferior ganglion receptors in walls of the aortic arch. of X, temporal bone and occipital bone, Special sensory-- taste from epiglottis. exit via jugular foramen. Motor Motor-- skeletal ms of the soft -- Medulla nucleus ambiguus, exit via palate except stylopharengius (IX) and jugular foramen. Parasympathetic -tensor veli palatini (V3), pharyngeal Medulla dorsal motor nucleus X, exit via constrictor ms, levator veli palatini, jugular foramen, autonomic ganglia near salpingopharyngeus, or within the walls of target organs. palatopharyngeus, palatoglossus, cricothyroid (external laryngeal n.), ms of the larynx (recurrent laryngeal n.) Parasympathetic -- smooth ms and glands of gastrointestinal, pulmonary & cardiovascular systems.

35

CNpXI / spinal accessory nerve

Brain - Cranial Innervation Nerves

Motor

spinal cord anterior horn of cervical Head and neck movement: region, entry via foramen magnum, then sternocleidomastoid and trapezius exit via jugular foramen. mm.

36

CNqXII / hypoglossal Brain - Cranial Innervation nerve Nerves

60

external ear – antihelix Ear

Auditory

61

external ear – antitragus

Ear

Auditory

62

external ear – concha

Ear

Auditory

63

external ear – helix

Ear

Auditory

64

external ear – lobule

Ear

Auditory

65

external ear – tragus

Ear

Auditory

Motor

11

auriculotemporal n.

Ear

Innervation

Supplies the auricle, external acoustic meatus, outer side of the tympanic membrane and the skin in the temporal region (superficial temporal branches)

19

chorda tympani

Ear

Innervation

CN VII

10

auditory / eustachian tube

ear

161

parotid duct

Face

Gland

Medulla hypoglossal nucleus, emerges from sides of medulla anterior to olives, exit via hypoglossal canal, curves forward near angle of the mandible superior to ansa cervicalis to enter tongue. elevated portion of ext’l ear on other side of scaphoid fossa (or scapha) from the helix roughly opposite tragus and slightly inferior deepest depression, which leads into ext’l acoustic meatus elevated margin of auricle non-cartilaginous (“earlobe”), fibrous tissue, fat, and blood vessels; easily pierced for taking small blood samples and inserting earrings tragus: “goat” alluding to goat’s beard since hair often grow on; tongue-like projection overlapping opening of ext’l acoustic meatus

V3 branch

Swallowing, sucking, chewing, tongue Neck lacerations may lead to: Peripheral protrusion: All intrinsic tongue m, all lesion >>>protruded tongue deviates extrinsic m (except palatoglossus CN toward side of injury. X)

emerges posterior and inferior to the TMJ and scends posterior to the superficial temporal vessels carries preganglionic parasympathetic axons to submandibular ganglion

frequently injured in TMJ surgery;

1059, 10751078

1, 93

967

1, 93

967

93

966-7

1, 93

966-7

1, 93

967

1, 93

966-7

16; 24

71,93-94,122921,941,971 124

Mucus drainage - upper airway infections/allergies can cause tube to Pressure equalization - will open to become swollen, trapping bacteria and (Also called pharynogotympanic tube) - allow a small amount of air through to 95, 93, 96, causing ear infections. Earaches more 966, 970-973 links the pharynx to the middle ear equalize pressure between middle ear 125, 126 common in children (tube more & atmosphere. horizontal, smaller, movement of fluid more difficult) Sialography - injection of radiopaque fluid into the duct and followed by radiography of the parotid gland, demonstrates parts of parotid duct system that may be dilated or displaced by Runs from the parotid gland, through disease - duct can be blocked by the buccinator muscle, into the oral calcified deposit (sialolith or calculus), cavity opposite of the 2nd maxillary pain associated with parotid gland is 25, 54, 55, 61, molar, responsible for the delivery of worsened by eating, sucking a lemon 69 saliva from the parotid gland to the slice is painful ( buildup of saliva in mouth proximal part of the blocked duct) -Mumps virus may cause inflammation of the duct, producing redness of the parotid papilla (small projection at the opening of the duct into the mouth)

CN V3 branch (auriculotemporal nerve)

80% of salivary gland tumors occur in the parotid glands (most are benign). Parotidectomy - removal of cancerous parotid gland (danger of damage to CN VII plexus and branches during procedure) - Parotid gland may become infected by blood-borne Largest of three paired salivary glands pathogens (parotiditis) and results in severe pain because parotid sheath limits swelling, usually causes an abscess (abscesses can be of dental origin) -Parotid gland disease - can lead to pain in the auricle, external acoustic meatus, temporal region and TMJ because of stimulation of the auriclotemporal nerve

External carotid artery and branches (maxillary artery, superficial temporal artery)

25, 26, 27, 28, 31, 32, 55, 125, 134, 166, 167

162

parotid gland

Face

Gland

202

submandibular gland – Face duct

Gland

17

buccal n.

Face

Innervation

branch of V3, branches of VII

75

frontal nerve

Face

Innervation

skin of the forehead and the medial part of the upper eyelid & mucous membrane of the frontal sinus

ophthalmic division of the trigeminal the most superior linear structure within n. (V1); branches into supraorbital n., the orbit supratrochlear n.

849, 850, 852, 902-903, 1066

79

greater auricular nerve Face

Innervation

skin of the ear and skin below the ear

the great auricular n. crosses the superficial surface of the sternocleidomastoid m.

cervical plexus (contributions from the ventral primary rami of spinal nerves C2&C3); mastoid n, auricular n.

851-954, 915, 916, 966, 968, 993, 996, 997

80

greater palatine artery Face and/or nerve

Innervation

greater palatine n. passes through the greater palatine canal and foramen

maxillary division of the trigeminal n. (V2); posterior, inferior, lateral nasal branches

850, 934, 937, 939, 960, 1066

85

inferior alveolar nerve Face

Innervation

sensory: mucous membrane of the inferior part of the lateral nasal wall; mucosa of the hard palate sensory: teeth of mandible and skin of chin motor: mylohyoid m and anterior belly of digastric m

Arises from portion of gland between the mylohyoid and hypolglossus muscles branch of V3 : sensory to skin of cheek and buccal mucosa branches of VII: motor to buccinator m, zygomatic maj and min mm, orbicularis oris m, levator anguli oris, levator labii superioris and alaque nasi mm, risorius, procerus, and nasalis mm.

Can be demonstrated through a sialogram (special type of radiograph)

51, 53, 59

use buccal nerve block to anesthetize the 85024,40,46,71,12 skin and mucous membrane of the cheek 852,925,931,1 2 (blue box p. 862) 066,862

forms inferior dental plexus, innervating mandibular teeth, and branches to mental nerve

46, 53, 60, 131

850, 921, 931, 962, 1069

93

infraorbital nerve, artery and/or vein

Face

Innervation

mucous memb of maxillary sinus, upper premolar, canine, and incisor teeth; maxillary gingiva; skin of lateral nose, lower eyelid, upper lip, and zygomatic region

130

mental nerve

Face

Innervation

skin of chin and skin; oral mucosa of inferior lip

emerges from mandibular canal via injection of anesthetic agent into mental terminal branch of inferior alveolar nerve mental foramen in anterolateral aspect foramen blocks mental nerve (often done 24, 46, 71, 122 862, (CN V3) of body of mandible to suture lip/skin lacerations)

138

nasociliary nerve

Face

Innervation

supplies several branches to the orbit

branches from ophthalmic nerve

139

nerve of pterygoid canal

Face

Innervation

pterygoid canal

Innervation

Lacrimal gland, paranasal sinuses, glands of the mucosa of the nasal cavity and pharynx, gingiva, mucus membrane and glands of the hard palate

169

pterygopalatine ganglion

Face

passes thru infraorbital groove, canal, and foramen

maxillary branch of V (V3); branches to middle alveolar and anterior superior alveolar nn

Nerve block: treating wounds of upper lip and cheek, or repairing maxillary incisor teeth. Injection made at site of infraorbital foramen

862, 850, 851, 23, 24, 40, 44, 853, 862892, 85 952, 953, 962

pg.950 122, 123, 125, 131, 133, 135, 166, 168

189

stellate ganglion

Face

Innervation

(see 'clinical correlation') -->

below middle cervical ganglion

219

supratrochlear nerve

face

Innervation

skin of upper eyelid and skin and pericranium of anteromedial forehead

from opthalamic division of trigeminal nerve

41

deep temporal artery

Face

Vascular

67

facial artery

Face

Vascular

68

facial vein

Face

Vascular

80

greater palatine artery and/or nerve

Face

Vascular

93

infraorbital nerve, artery and/or vein

Face

Vascular

126

maxillary artery

face

Vascular

141

occipital artery

Face

Vascular

Temporalis m.

stellate ganglion is formed by the fusion of the inferior cervical sympathetic ganglion and the T1 ganglion of the sympathetic trunk

gray rami communicans to spinal nerves C8 and T1 (postganglionic sympathetic); thoracic visceral br.; vascular smooth muscle, arrector pili muscle, sweat glands of the C8 & T1 cutaneous distribution on chest & upper limb (C8 and T1 dermatomes); vascular smooth muscle of the lungs; pain from lungs (sensory); 122

Second (pterygoid) part of maxillary artery, which is part of external carotid. Adjacent (superficial or deep) to lateral pterygoid muscle; ascends obliquely anterosuperiorly, medial to temporalis muscle. Anterior and posterior arteries ascend between temporalis muscle and bone of temporal fossa, supplying mainly muscle

923-925

Compression of Facial a.: Facial a. can be occluded by applying pressure to mandiblewhere vessel crosses. B/c of 31, 32, 34, 36, numerous anastomoses btwn. It and other 40, 60, 75, 85, arteries of face, occlusion on one side 131, 133, 136, does not stop all bleeding resulting from 138 laceration of facial artery. For lacer. of lip, need to compress both sides of cut (Moore 863). Thrombophlebitis of Facial v.: Because facial v. makes important connections deep: off of facial v; drains into with cavernous sinus, infection of face pterygoid venous plexus; drains face; may spread to cavernous sinus and valveless Drains anterior scalp and forehead, pterygoid plexus. Thrombophlebitis of common: formed by union of facial v 23, 30, 32, 59, eyelids, external nose, anterior cheek, facial v.--inflammation of facial v. with and ant’r division of retromandibular v; 60, 85 lips, chin, and submandibular gland secondary thrombus (clot) formation-drains into internal jugular v; drains face can lead to thrombophlebitis of the and ant’r scalp; lingual v may drain into cavernous sinus if pieces of an infected clot extend into intracranial venous system (Moore 875). off of external carotid a; ascending palatine a., tonsilar br., submental a., superior labial a., inferior labial a., lateral nasal a., angular a.; lower part of the Supplies muscles of facial expression palatine tonsil, submandibular gland, and face facial muscles and fascia; the angular branch of the facial a. anastomoses with the ophthalmic a.

supplies hard palate, palatine glands, palatine mucosa supplies IO and rectus mm of eye, lacrimal sac, maxillary canines and incisors teeth, mucous memb of maxillary sinus, and skin of infra-orbital region of face supplies deep structures of the face scalp of the back of the head, as far as the vertex

endangered by anesthetic injections for dental procedures

branch of descending palatine a off of third part of maxillary a; thru infraorbital fissure, infraorbital groove, canal, and foramen

3 parts of maxillary, with a ton of branches (Moore, 923)

external carotid artery

posterior auricular artery

Face

Vascular

scalp posterior to auricle and origin: external carotid artery auricle

171

retromandibular vein

Face

Vascular

drains parotid gland and masseter muscle

formed anterior to ear by union of superficial temporal and maxillary veins/unites with posterior auricular vein to form external jugular vein

854, 857, 857t, 858, 858t, 868, 870, 875-6, 919, 995, 998, 1004, 1005

925, 937, 959

23, 24, 40, 44, 905, 906, 923, 85 925, 953, 962

terminal branch of external carotid artery

166

854-5, 855t, 863, 919, 943, 999, 1003, 1034

40, 19

supplies adjacent muscles, parotid gland, facial nerve and structures in the temporal bone, auricle, and scalp

23, 34, 40, 100, 136, 138, 178 23, 51, 59, 85, 61, 70

921, 963, 1003

188

sphenopalatine artery

face

Vascular

203

superficial temporal artery

Face

Vascular

walls and septum of nasal cavity; frontal, ethmoidal, sphenoid, and maxillary sinuses; and anterior-most palate Facial muscles and skin of frontal and temporal regions muscles and skin of forehead and scalp

218

supratrochlear artery

face

Vascular

18

buccinator m.

Face - facial expression

Muscular

buccal branch of CN VII

42

depressor anguli oris m

Face - facial expression

muscular

CN VII

76

frontalis m.

Face - facial expression

Muscular

temporal branch of CN VII

108

levator labii m.

Face - facial expression

Muscular

facial nerve (CN VII)

orbicularis oculi m.

Face - facial expression

155

Facial Artery

Facial a.

Muscular

Temporal & Zygomatic Superficial temporal a. branches of facial n. (CN VII)

orbicularis oris m.

Face - facial expression

Muscular

Buccal branch of facial n. (CN Inferior & Superior labial a. VII)

165

platysma m.

Face - facial expression

Muscular

facial nerve (CN VII) (terminal branches)

256

zygomaticus major m.

Muscular

Facial Nerve (CN VII)

Muscular

Facial Nerve (CN VII)

154

257 137

Face - facial expression Face - facial zygomaticus minor m. expression nasal septum / cartilage Face - nasal

submental artery, suprascapular artery

Terminal branch of maxillary artery

Source: External Carotid Artery passes from supraorbital margin to forhead and scalp origin: mandible; alveolar processes of maxilla and mandible; pterygomandibular raphe insertion: angle of mouth (modiolus), orbicularis oris Origin: Anterolateral base of mandible Insertion: Angle of mouth (modiolus) epicranial aponeurosis / skin and subcutaneous tissue of eyebrows and forehead front process of maxilla/ skin of upper lip and cartilage of nose O: Medial orbital margin, medial palpebral ligament, lacrimal b.; I: Skin around margin of orbit, Superior & inferior tarsal plates

Face - oral

Muscular

anterior trunk of mandibular nerve (CN V3) via masseteric nerve

128

medial pterygoid m.

face - oral

Muscular

anterior trunk of mandibular nerve (CN V3) via medial pterygoid nerve

229

temporalis m.

face - oral

Muscular

anterior trunk of mandibular nerve

84

inferior alveolar artery Face - oral

Vascular

Supplies Mandibular teeth

109

levator palpebrae superioris m.

Face - orbit

Muscular

lacrimal a. (branch of ophthalmic)

152

ophthalmic artery

face - orbit

Vascular

230

tensor veli palatini m. Face - pharynx Muscular

Medial pterygoid n. (CN V3) via otic ganglion

presses cheek against molar teeth; works w/tongue to keep food b/w occlusal surfaces and out of oral vestibule;

deep temporal branch of maxillary artery

(action continued) resists distension (when blowing); in infants it keeps cheeks from collapsing inward during suckling

26,54,65,68,12 845-850 3

Part of dilators of mouth; depresses labial commissure bilaterally to frown (sadness)

844-847

elevates eyebrows and wrinkles skin of forehead; protracts scalp to indicate surprise or curiosity

844, 848

elevates upper lip, dialates nostrils Closes eyelids in a lateral to medial direction (Palpebral part is gentle, Orbital part is tightly (ie. Winking)), Wrinkles the forehead vertically

26, 54 Keeps the corenea from drying, aids in drainage of tears, protects the eyeballs against glare & dust

26, 123

Bell's Palsy

26, 28, 60, 124 26 26

divides the nose into two nasal cavities elevates mandible, closing jaws

inferior branch of the Maxillary a (CN V3) lesser wing of sphenoid/skin of upper eyelid

pg.958 25, 27, 28, 54 922

acts with masseter to elevate mandible; contributes to protrusion; alternate unilateral activity produces smaller grinding movements

floor of temporal fossa/ medial surface of elevates mandible, closing jaw, coronoid process and ramus of mandible primary retractors of mandible

845, 848

Works with the buccinator and the tongue to keep food between the occlusal 26, 36, 54, 81, surfaces of the teeth during mastication 845-6 123 and to prevent food accumulation in the oral vestibule

Superficial fascia covering the superior Draws the lower lip and corner of the portions of the pectoralis major and mouth inferolaterally and partially deltoid muscles/mandible below oblique opens the mouth line Origin:zygomatic arch / Insertion: Corner Raises the corners of the mouth Bell's Palsy of mouth

inferior border and medial surface of maxillary process of zygomatic bone&arch / angle and lateral surface of ramus of mandible medial surface of lateral pterygoid plate&pyramidal process of palatine bone & tuberosity of maxilla / medial surface of mandible ramus.

masseter m.

69, 70, 71 23,40,81,85

Origin: zygomatic b. / Insertion: upper lipRaises the upper lip

123

oculomotor nerve (CN III)

Ascends anterior to ear to the temporal region and ends in scalp

Tonus closes oral fissure; Phasic O: medial maxilla & mandible, Deep contraction compresses & protrudes surface perioral skin, Angle of mouth; I: lips (kissing) or resists distension Mucous membbrane of lips (when blowing)

several branches of the external carotid artery

Skeletal

41

919, 923, 998, 1035 54 40, 53, 60

923, 934, 962

elevates upper eyelid

81, 83, 84, 86

O: Internal carotid a.

Primary supplier of the orbit

11, 23, 40, 83, 86, 132, 140, 905-6 143

O: Scaphoid fossa of medial pterygoid plate, spine off sphenoid bone, cartilage of pharyngotympanic tube; I: Palatine aponeurosis

Tenses soft palate, Opens mouth of pharyngotympanic tube during swallowing and yawning; Uses the pterygoid hamulus as a pulley

52, 93, 122

937-8, 970

external larynx

articulates with lateral parts of superior border of the cricoid cartilage superior to cricoid cartilage lamina lamina

infrahyoid muscles (omohyoid, sternothyriod, sternohyoid)

anterior/lateral to internal jugular vein

6

arytenoid cartilage

Larynx

Cartilage

1

ansa cervicalis

Larynx

Innervation

170

recurrent laryngeal nerve

Larynx

Innervation

Laryngeal muscles of the neck

Vagus Nerve (CN X) branch

206

superior laryngeal nerve

Larynx

Innervation

Divides into internal and external branches

Arises from the inferior vagal ganglion at the superior end of carotid triangle

nerve (C1-3 spinal nerves)

207

superior laryngeal Larynx nerve – external branch

Innervation

Inferior constrictor muscle of pharynx & cricothyroid muscle

208

superior laryngeal Larynx nerve – internal branch

Innervation

Laryngeal mucous membrane of laryngeal vestibule and middle laryngeal cavity

69

false vocal cord / ventricular fold

Larynx

Sensory & Autonomic nerve

40

cricothyroid m.

Larynx

muscular

external laryngeal nerve, one of the two terminal branches of the superior laryngeal nerve cricothyroid artery, a small (CN X). (all other intrinsic branch of the superior thyroid laryngeal m. supplied by artery recurrent laryngeal n, another branch of CN X.

103

lateral cricoarytenoid m.

Larynx

Muscular

recurrent laryngeal nerve (from CN X)

135

mylohyoid m.

Larynx

Muscular

nerve to the mylohoid m.

140

nerve to the mylohyoid Larynx m.

Muscular

mylohyoid m

146

omohyoid m. – inferior Larynx belly

Muscular

Ansa cervicalis (C1-C3)

Superior thyroid a.

147

omohyoid m. – superior belly

Larynx

Muscular

Ansa cervicalis (C1-C3)

Superior thyroid a.

167

posterior cricoarytenoid m.

Larynx

Muscular

Laryngeal nerve of vagus (recurrent [inferior]) (CN X)

191

sternohyoid m.

Larynx

Muscular

C1-C3 by a branch of ansa cervicalis

192

sternothyroid m.

Larynx

Muscular

C2 and C3 by branch of ansa cervicalis

234

thyrohyoid m.

Larynx

Muscular

C1 via hypoglossal n (CN XII)

Origin: Anterolateral part of cricoid cartilage Insertion: Inferior margin and inferior horn of thyroid cartilage

arch of cricoid cartilage/muscular process of arytenoid cartilage mylohyoid branch of inferior medial body of mandible/mylohyoid alveolar a. raphe and body of hyoid bone

31;32 33, 71, 76, 130, 206, 209, 210, 211, 212, 226, 231, 232, 240 74, 75, 80, 130

Smaller branch of the superior laryngeal nerve, descends posterior to Motor nerve 74, 75 sternothyroid muscle with the superior thyroid artery Large branch of the sup. laryngeal n. - Can be injured during choking on foreign pierces the thyrohyoid membrane next bodies; Blocked by endotracheal 74, 75 to the superior laryngeal artery intubation

fold of mucosa located between the laryngeal vestibule and the laryngeal ventricle; also known as the “false vocal folds”; vestibular ligament covered by mucosa makes the vestibular fold; superior to vocal fold and extends from thyroid cartilage to arytenoid cartilage

Membrane

78

could not find

Stretches and tenses vocal ligament

The principal tensor, which tilt or pull the prominence or angle of the thyroid cartilage anteriorly and inferiorly toward the arch of the cricoid cartilage. This increases the distance between the thyroid prominence and the arytenoid cartilages. Because the anterior ends of the vocal ligaments attach to the posterior aspect of the prominence, the vocal ligaments elongate and tighten, raising the pitch of the voice.

adducts vocal fold

1027-1029

78, 80

support and elevate the tongue

O: Superior border of scapula near May be best seen contracting in thin suprascapular notch; I: Intermediate Depress, retract, & steady hyoid people when they are speaking tendon (fascia links to clavicle) O: Intermediate tendon (fascia links to Depress, retract, & steady hyoid clavicle); I: Inferior border of hyoid Posterior surface of the laminae of the abducts the vocal folds and widens the cricoid cartilage/muscular process of the rima glottidis (space between the arytenoid cartilage vocal cords) manubrium of sternum and medial end of depresses hyoid after elevation during clavicle; body of hyoid bone swallowing posterior surface of manubrium and first costal cartilage; oblique line of thyroid depresses hyoid and larynx cartilage O: Manubrium & thyroid cartilage; I: Inferior border of body & greater horn of Depresses hyoid b. & elevates larynx hyoid b.

pg.1016

1, 27, 29, 31-2, 923, 1001-3, 128,-9, 427 1007 27-9, 31-2, 128-9

923, 1001-3

78, 80, 235, 79 27, 28, 29 27, 29 27-9, 31-2, 53, 923, 1001, 128-9 1002

241

true vocal cord / Larynx vocalis m. / vocal fold

muscular

243

ventricle of larynx

Other

39

cricoid cartilage

Larynx

Larynx

Inferior laryngeal nerve (terminal part of recurrent Superior thyroid a. laryngeal nerve, from CN X)

hyoid b.

Larynx

Skeletal

235

thyrohyoid membrane Larynx

Skeletal

236

thyroid cartilage

Larynx

Skeletal

2

anterior jugular vein

Larynx

Vascular

205

superior laryngeal artery

Larynx

Vascular

239

torus tubarius

Nasal

Other

87

inferior nasal concha / Nasal turbinate b.

Produces minute adjustments of vocal ligaments, selectively tensing and muscle- 78, 79, relaxing anterior and posterior parts of 1028 80 vocal folds during animated speech and singing.

extend laterally from middle part of laryngeal cavity between vestibular and vocal folds

?

cricoid cartilage is shaped like a signet ring with its band facing anteriorly. The posterior (signet) part of the cricoid is the lamina, and the anterior (band) part is the arch (Fig. 8.32A). It attaches to the inferior margin of the thyroid cartilage by the median cricothyroid ligament and to the first tracheal ring by the cricotracheal ligament.

Skeletal

83

Lateral surface of vocal process of arytenoid cartilage/ Ipsilateral vocal Relaxes posterior vocal ligament ligament. vocalis muscle lies medial to while maintaining (or increasing) thyro-arytenoid muscles and lateral to the tension of anterior part. vocal ligaments within the vocal folds

This ring-like opening of the cartilage fits an average finger. Although much smaller than the thyroid cartilage, the cricoid cartilage is thicker and stronger and is the only complete ring of cartilage to encircle any part of the airway. Where the larynx is closest to the skin and most accessible, the median cricothyroid ligament may be felt as a soft spot during palpation inferior to the thyroid cartilage.

Fracture - occurs by manually strangling anterior part of neck, C3 region. serves as attachment for anterior neck of the throat. Makes swallowing and Suspended by muscles, isolated from rest muscles and a prop to keep the airway separation of alimentary and respiratory of skeleton open tracts difficult and may result in aspiration pneumonia Thick median = median thyrohyoid O: superior border & superior horns of ligament; Lateral = lateral thyrohyoid the thyroid cartilage; I: hyoid ligament Superior border opposite C4 vertebra, Inferior 2/3 of 2 laminae fuse to form laryngeal prominence (Adam's apple), tributaries = laryngeal veins anterior to sternohyoid m. Next to the internal branch of superior Branches to supply the laryngeal nerve as it goes through the internal surface of the larynx thyrohyoid membrane also called "torus of pharyngotympanic tube" in Moore

1023

1023-1027

984, 985

29, 74, 77, 235 1023 1023 31 34, 69, 74, 75, 136 37, 39

1033

Skeletal

forms the inferior nasal meatus below separate b on lateral wall of nasal cavity; it and the middle nasal meatus above it articulates with the maxilla it

37, 38, 82

825, 841, 892, 935, 939, 958, 961-962, 1022, 1033

rounded elevation on lateral wall of nasal cavity sup’r to semilunar hiatus (semicircular groove into which frontal sinus opens) which is visible when middle concha is removed;

37, 38

N/A

58

ethmoid bulla

Nasal

Vascular

159

parathyroid gland

neck

Gland

237

thyroid gland

Neck

Gland

238

thyroid gland – pyramidal lobe

Neck

Gland

made by middle ethmoidal cells that form the ethmoidal sinuses; under cover of middle nasal concha; middle ethmoidal air cells drain at its apex;

supplied by thyroid branches of cervical (symp) ganglia inferior thyroid arteries vasomotor (hormonally regulated)

Stimulates osteoclasts to break down usually 4 glands- 2 superior parathyroids Produce parathyroid hormone bone and release I130Ca, and activates and 2 inferior. Lie on posterior surface of (controls calcium levels - antagonist to 76 Vit D to increase Ca absorption, thryoid gland calcitonin) promotes Ca uptake by kidneys Thyroid ima a. is a potential source of Superior & inferior thyroid a. bleeding during midline neck surgeries; Anterior in the neck at C5-T1 vertebrae; (10% of people hae a small Remnants of thyroglossal duct may cause Superior, middle, & inferior Deep to the sternothyroid m. & unpaired thyroid ima a. thyroglossal duct cysts, lingual thyroid cervical ganglia (thru cardiac, sternohyoid m.; Anterolateral to larynx & originates from the glands or other areas of thyroid tissue: 29, 31, 74-6, superior thyroid periarterial, trachea; Right & left lobes united by thin brachiocephalic trunk, aortic 80, 196, 198, cysts may require removal unlike an & inferior thyroid periarterial isthmus over the trachea (usually anterior arch, right common carotid, ectopic thyroid gland; Goiter: lack of 206 plexi that accompany thyroid to 2 & 3 tracheal rings); Capsule attached subclavian, or internal iodine that causes enlargement of the a.) to cricoid cartilage & superior tracheal thoracic a.; supplies both gland that may compress the trachea, rings lobes) esophagus, & recurrent laryngeal n. (enlargement is not superiorly) Usually superiorly connected to the In 50% of thyroid glands; may have an isthmus & usually to the left of the 74 incomplete isthmus median plane

1018, 1020, 1041-3

1042

13 14 15 16

brachial plexus − lower neck trunk brachial plexus − neck middle trunk brachial plexus − root neck brachial plexus − upper neck trunk

innervation

various muscles of torso and upper extremities

Innervation

various muscles of torso and upper extremities C5-T1

Innervation

C5-C6

innervation

inferior cervical ganglion

Neck

Innervation

131

middle cervical ganglion

neck

Innervation

send gray rami communicantes to C5 and C6 spinal nerves

anterior aspect of inferior thyroid artery, at level of transverse process of C6 vertebra

163

phrenic nerve

Neck

Innervation

Diaphragm

Arises from C3 spinal nerve

204

superior cervical ganglion

Neck

Innervation

213

supraclavicular n.

Neck

Innervation

217

suprascapular nerve

neck

Innervation

220

sympathetic trunk

neck

Innervation

transverse cervical nerve

Neck

Innervation

3

anterior scalene m.

neck

Muscular

look up brachial plexus

C7

look up brachial plexus

in 80% of people, ICG fuses with first thoracic ganglion to from the large cervicothoracic (stellate) ganglion

86

240

C8; T1

Postsynaptic fibers pass from it by cephalic arterial branches to form the internal carotid sympathetic plexus and enter cranial cavity Skin of neck and shoulders supraspinatus and infraspinatus muscles

From C3 & C4

Innervates the abdominal diaphragm

722

Cervicothoracic ganglion block: local anesthetic relieves vascular spasms involving brain and upper limb. Lesion causes Horner Syndrome: contraction of pupil (miosis), drooping of superior 1016 eyelid (ptosis), sinking in of eye (enophthalmos), vasodilation and absence of sweating on face and neck (anhydrosis) Occassionally absent. Lesion of Cervical Sympathetic Trunk = Horner Syndrome. Vasodilation & absence of sweating on face, sinking in of eye, drooping of 165 1017 superior eyelid, contraction of pupil. Cervicothoracic Ganglion Block = relieve vascular spasms 30, 32, 74, Damage to the phrenic nerve can cause 129, 130, 189, paralysis of the associate half of the 193, 198, 206, diaphragm, making breathing difficult 210, 211, 226, 230, 243, 429

24, 31 429 125,133

from C2,C3. curves around middle of posterior border of sternocleidomastoid inferior to the great auricular nerve and passes anteriorly and horizontally across it deep to the external jugular vein and platysma

supplies sensory innervation to skin covering the anterior cervical region. anterior rami of C2-6 spinal nerves anterior rami of C1-C3 spinal nerves

24, 31, 129

transverse process C4-6; 1st rib

flex head at atlanto-occipital joint

anterior tubercles of C3-C6 transverse process / basilar part of occipital bone

flex head

Muscular

114

longus colli m.

neck

Muscular

Anterior rami of C2-C6 spinal nerves

bodies of C5-T3, transverse process C3flexes neck with rotation to opposite C5 / anetior tubercle of atlas, bodies of side if acting unilaterally C1-C3, transverse processes of C3-C6

134

middle scalene m.

neck

Muscular

ventral rami of cervical spinal nerves

flexes neck laterally; elevates 2nd rib during forced inspiration

Muscular

722

429,430

Under the SCM

neck

Neck

430; 429

165, 167, 130

longus capitis m.

posterior scalene m.

430; 429

429,430

At the level of C1 &C2 vertebrae

113

168

paralysis of fingers and wrist

C6-C8 (ventral rami)

cervical artery (ascending)

Posterior tubercles of the transverse processes of C4-6

Raises the 2nd rib and flexes and slightly rotates the neck

inferior to sternocleidomastoid m.

Often called lateral vertebral muscles, form a large portion of the floor of the posterior cervical triangle

53-54, 993,997, 1005

27 27, 30, 129

988, 10121014

30

166, 986, 988, 1012-1014

24,25,26

pg.1026

27, 30, 186, 189, 232

(action continued) (2) flexes cervical vertebrae so chin approaches manubrium, or (3) extends superior cervical vertebrae while flexing inf vertebrae so chin is thrust 27, 28 forward w/head kept level C. w/cervical vertebrae fixed, may elevate manubrium and medial ends of clavicles, assisting pump-handle action of deep respiration

190

sternocleidomastoid m. Neck

Muscular

Spinal Accessory Nerve (CN 11)

clavicle and sternum; mastoid process

A. unilateral: tilts head to same side (laterally flexes neck) and rotates so face is turned superiorly toward opposite side B. bilateral: (1) extends neck at atlantooccipital joints,

232

thyroarytenoid m.

Neck

Muscular

Inferior laryngeal n. (CN X)

O: Lower 1/2 posterior angle of thyroid laminae & cricothyroid ligament; I: Anteriolateral arytenoid surface

Relaxes vocal ligament

244

vertebra - atlas (C1)

Neck

Skeletal

245

vertebra - axis (C2)

Neck

Skeletal

246

vertebra - axis (C2) – Dens / Odontoid process

Neck

Skeletal

247

vertebra - body

Neck

Skeletal

17-22, 153-161

248

vertebra - C3

Neck

Skeletal

17-22, 153-161

249

vertebra - C4

Neck

Skeletal

17-22, 153-161

250

vertebra - C5

Neck

Skeletal

17-22, 153-161

251

vertebra - C6

Neck

Skeletal

252

37

59

vertebra - C7

Neck

common carotid artery neck

external carotid artery Neck

Holds up head

Provides point of rotation for head

78-80 Jefferson fracture

17-22, 153-161

Hangman's fracture

17-22, 153-161

Dens Fractures

17-22, 153-161

1028-9

17-22, 153-161

Skeletal

Inferior articulate facet faces anteriorly to properly align with the superior facet of Has a long spinous process T1

Vascular

internal and external carotid arteries

The right common carotid artery begins at the bifurcation of the brachiocephalic trunk. From the arch of the aorta, the left common carotid artery ascends into the neck. Each common carotid artery ascends within the carotid sheath with the IJV and vagus nerve to the level of the superior border of the thyroid cartilage. Here, each common carotid artery terminates by dividing into the internal and external carotid arteries.

Vascular

upper neck, face, and scalp supplied off of common carotid a; superior thyroid by; main blood supply to face and Supplies upper neck, face, and a., ascending pharyngeal a., lingual a., superficial head; maxillary a and scalp facial a., occipital a., posterior auricular superficial temporal aa are its terminal a., maxillary a., superficial temporal a.; branches

17-22, 153-161 The carotid pulse (“neck pulse”) is easily felt by palpating the common carotid artery in the side of the neck, where it lies in a groove between the trachea and the infrahyoid muscles. It is usually easily palpated just deep to the anterior border of the SCM at the level of the superior border of the thyroid cartilage. It is routinely checked during cardiopulmonary resuscitation (CPR). Absence of a carotid pulse indicates cardiac arrest. Ligation of E.C. a. sometimes necessary to control bleeding from one of its relatively inaccessible branches. Decreases blood flow through the artery and its branches, but doesn't eliminate it. Read more on Moore pp.1009

1001, Figure 8.19

28, 32, 34, 40, 59, 75, 76, 85, 86, 121, 123, 128, 130, 131

855, 925, 943, 959, 972, 999, 1001, 1009, 1016, 1019, 1021, 1035-6, 1048

formed by the joining of the retromandibular and posterior auricular vv.; tributaries: posterior external jugular v., transverse cervical v., suprascapular Drains head, neck, shoulder v., anterior jugular v.; drains to subclavian v.; drains head & neck, shoulder; external jugular v. contains valves that may not be fully functional

66

external jugular vein

Neck

Vascular

92

inferior thyroid artery Neck

Vascular

from thyrocervical trunk; ascending supplies thyroid gland, lower cervical a., inferior laryngeal a., larynx, upper trachea, upper esophageal brs., tracheal brs., glandular esophagus, deep neck muscles brs

96

internal thoracic artery Neck

Vascular

supplies mediastinum, anterior thoracic wall, anterior off first part of subclavian a, also called abdominal wall, respiratory internal mammary a diaphragm

197 198

subclavian artery subclavian vein

Neck Neck

Vascular Vascular

212

superior thyroid artery Neck

Vascular

216

suprascapular artery

Vascular

neck

233

thyrocervical trunk

Neck

Vascular

253

vertebral artery

Neck

Vascular

199

sublingual gland

Oral

Gland

201

submandibular gland

Oral

Gland

106.5 lesser palatine nerve

Oral

Innervation

112

lingual nerve

Oral

Innervation

200

submandibular ganglion

Oral

Innervation

77

genioglossus m.

Oral

Muscular

runs along with artery Thyroid gland (mainly the anterosuperior aspect) and the infrahyoid muscles, SCM, & larynx divides into circumflex off thyrocervical trunk scapular and thoracodorsal Subclavian a.

CN XII - Hypoglossal Nerve

Severence of EJV: If EJV severed along post. border of SCM where it pierces 23, 31, 74, roof of lateral cervical region, its lumen 198, 206, 211, is held open by tough investing layer of 256 deep cervical fascia and negative intrathoracic pressure will cause air to be sucked into vein. Produces churning noise in thorax and cyanosis. Venous air embolism produced this way will fill right side of heart with froth, causing blood to stop flowing through it--> dyspnea. Apply firm pressure until it can be sutured properly to prevent entry of air and consequences (Moore pp. 1009).

40, 719, 854, 857, 858, 859, 915, 968, 982, 994-5, 1004, 1006, 1007, 1008-9

716-717, 727, 1003, 10131020, 1029, 1035-1040 89-90, 94, 95, 11, 162-164, 206,211, 237, 166, 192, 195, 244, 245 727, 10131015 30 30

inferior thyroid a. gives rise to the ascending cervical a. as it arches medially

33, 74, 75

Most inferior of 3 anterior branches of external carotid artery - runs anteroinferiorly deep to infrahyoid muscles

31, 32, 34, 74, 75, 76 429

Largest branch (inferior thyroid a.) is O: Anterior surface of first part of primary visceral a. of the neck which subclavian a.; I: Suprascapular a., supplies the larynx, trachea, Ascending cervical a., Interior thyroid a, esophagus, thyroid, parathyroid, & & Cervicodorsal trunk adjacent muscles

Supplies local muscles of the The two vertebral a.'s join together to cervical spine through anterior Forms from the Subclavian a. form the basilar artery spinal arteries smallest and deepest of salivary glands; in floor of mouth b/w mandible and Salivary Gland genioglossus m; ducts open into floor of mouth along sublingual folds Salivary Gland soft palate (branch of V2maxillary division of trigeminal) branch of V3 - sensation of anterior 2/3 of tongue Submandibular and Sublingual Glands

Prominence of E.J. v.: EJV may serve as 'internal barometer' b/c when venous pressure in normal range, EJV usually visible above clavicle for short distance. When venous pressure rises, vein prominent throughout its course along side of neck. See Moore pp. 1009 for diagnostic signs of EJV

32, 74-6, 237, 717, 1015 427

Passes through Transverse Foramen

21

53 53

enters palate through lesser palatine foramen

43,52 23, 40, 53

passes lateral to medial bilaterally - depresses tongue, creates short tendon from sup. Part of mental longitudinal furrow; posterior part spine of mandible / entire dorsum of pulls tongue anteriorally (protrusion); tongue and inferior/posterior fibers attach unilateral deviates (wags) tongue to to hyoid bone contralateral side

59 paralysis causes genioglossus to fall posteriorally, blocking airway. Total relaxation occurs during general anasthesia (must prevent tongue from relapsing)

942, 943, 945, 949-950, 998, 1077

inferior mental spine of mandible / anterior body of hyoid bone

geniohyoid m.

Oral

Muscular

C1 via hypoglossal n (CN XII)

82

hyoglossus m.

Oral

muscular

CN XII - Hypoglossal Nerve

110

levator veli palatini m. Oral

Muscular

CN XI

palatine arteries

157

palatoglossal arch / palatoglossus m.

Oral

Muscular

Pharyngeal plexus

Lingual a.

158

palatopharyngeal arch / Oral palatopharyngeus m.

muscular

pharyngeal branch of vagus nerve

hard palate/ lateral wall of pharynx

193

styloglossus m.

Oral

Muscular

CN XII (Hypoglossal n)

anterior border of distal styloid process retracts and elevates tongue, curling and stylohyoid ligament; most medial up at its sides

194

stylohyoid m.

Oral

Muscular

stylohoid branch of facial n (CN VII)

styloid process; hyoid bone

242

uvula

107

lesser palatine foramen Oral

Skeletal

106

lesser palatine artery

Vascular

soft palate

Vascular

tongue, suprahyoid mm, palatine tonsil

111 99 101

lingual artery lacrimal gland lacrimal sac / duct

Oral

Oral Oral orbit orbit

Other

Gland

body & greater horn of hyoid bone; inferior aspects of lateral part of tongue cartilage of auditory tube and petrous part of temporal bone/palatine aponeurosis O: Palatine aponeurosis of soft palate; I: Posterolateral tongue

20

ciliary ganglion

Orbit

Innervation

CN III (preganglionic parasympathetic axons come from this nerve)

ciliary ganglion is located on the lateral side of the optic n. near the apex of the orbit; sensory and sympathetic axons pass through the ciliary ganglion without synapse - the sensory root is carried via the nasociliary n.and the sympathetic root arrives in the orbit via the internal carotid a.

100

lacrimal nerve

Orbit

Innervation

lacrimal gland

branch of opthalmic nerve, passes through superior orbital fissure

Largest branch from bifurcation of frontal nerve

supraorbital nerve

Orbit

Innervation

88

inferior oblique m.

Orbit

Muscular

CN III - oculomotor nerve

91

inferior rectus m.

Orbit

Muscular

CN III - oculomotor nerve

105

lateral rectus m.

orbit

Muscular

Abducent nerve (CN VI)

129

medial rectus m.

orbit

Muscular

CN III - oculomotor nerve

209

superior oblique m.

Orbit

Muscular

trochlear nerve (CN IV)

211

superior rectus m.

Orbit

Muscular

Oculomotor N.

elevates soft palate during swallowing and yawning

52, 55, 64

Constrict isthmus of fauces; Elevate posterior tongue; Depress soft palate tenses soft palate, pulls walls of pharynx superiorly, anteriorly, and medially during swallowing

51-2, 58-60, 64, 126

941-2

52, 58, 59 59, 68, 73

elevates and retracts hyoid, thus elongating floor of mouth

32, 59 51

935, 936, 950, 1032-1034

52

arises from external carotid a.

Gland

215

depresses tongue; helps shorten (retrude) tongue

curved free margin of soft palate, can clearly see it with the mouth open hanging down in the back of the throat opening in hard palate posterior to great lesser palatine artery and nerve passes palatine foramen through enters palate through lesser palatine foramen

lacrimal fluid production stimulated by CNVII

Distal mucosa of frontal sinus; skin & conjunctiva of middle of superior eyelid; skin & pericranium of anterolateral forehead & scalp to vertex

942, 943, 945, 962, 998, 1002, 1031, 1033, 1077 942, 943, 945, 998, 1077

pulls hyoid anterosuperiorly; shortens floor of mouth; widens pharynx, protrudes hyoid bone and tongue

78

23,32, 59 Secrete lacrimal fluid

in superolateral angle of orbit

convey lacrimal fluid from lacrimal glands to sac

lacrimal fluid usually flows across the eye into the lacrimal sac then enter nasal 82 cavity - when tears increase, they flow over lids

preganglionic parasympathetic axons arrive via the inferior division of the oculomotor n. (III); postganglionic parasympathetic axons which distribute via short ciliary nn.; sphincter pupillae m., ciliary m. of the eye; a parasympathetic ganglion

131132,86,121122,86

Carris postganglionic PS fibers and S fibers to lacrimal gland to stimulate secretion and vasoconstriction Approximately in middle of orbital roof

anterio part of floor of orbit / sclera deep abudcts, elevates, and laterally rotates to lateral rectus muscle eyeball common tendinous ring / sclera just depresses, adducts, and rotates eyeball posterior to corneoscleral junction medially common tendinous ring/sclera posterior abducts eyeball to cornea common tendinous ring / sclera just adducts eyeball posterior to corneoscleral junction O: Bone of sphenoid; I: Sclera deep to Abducts, depresses, and medially superior rectus m. rotates eye O: Common tendinous ring; I: Sclera just Elevates, adducts, and rotates eyeball posterior to cornea-scleral junction medially

82

905

86

24, 36, 81, 122, 86

83, 84 83, 84

892, 900, 902, 958 890, 900, 902, 961, 1064

84 83 83, 84, 86 83, 84, 86, 91, 121

895, 900, 902, 961, 1064

89

inferior orbital fissure Orbit

Skeletal

214

supraorbital artery

Vascular

52

epiglottis

Orbit

Pharynx

Cartilage

Muscle & skin of forehead and scalp Upper epiglottis: glossopharyngeal nerve (CN IX) [gag reflex] Lower epiglottis: superior laryngeal branch of vagus nerve (CN X) [cough reflex]

7 8

arytenoid m. − oblique Pharynx part arytenoid m. − Pharynx transverse part

43

digastric m. – anterior pharynx belly

44

digastric m. – posterior pharynx belly

90

inferior pharyngeal constrictor m.

104

passes through: maxillary n (CN V2), infraorbital vessels, zygomatic n, rami of pterygopalatine ganglion, inferior ophthalmic v. (sometimes) Terminal branch of ophthalmic artery & Passes superiorly and posteriorly from internal carotid supraorbital foramen Lie above glottis, guarding vocal folds. When breathing, pointed upward. When swallowing, elevation Elastic, heart-shaped, mucus covered of hyoid bone draws larynx up; cartilage. Attached to root of tongue. epiglottis folds down, preventing food Projects upward from tongue and hyoid from going into trachea (direct it to bone. esophagus). While breathing, it lies within pharynx. When swallowing it is part of anterior of the larynx. diagonally attached to both arytenoid closes epiglottis cartilages and epiglottis (aryepiglotticus) horizontally attached to both arythenoid closes epiglottis carilages Base of Cranium Depresses mandible against resistance (Digastric Fossa, Mandible) / Hyoid when infrahyoid muscles fix or Bone depress hyoid bone. Base of Cranium Depresses mandible against resistance (Mastoid Process, Temporal Bone) / when infrahyoid muscles fix or Hyoid Bone depress hyoid bone. between greater and lesser wings of sphenoid

Muscular Muscular

2 23, 36, 40, 81, 85

Epiglottis is one of nine cartilaginous structures making up the larynx (voice Pg. 1023 (text) box). Eat Phood with your Pharynx. Sing 63, 64, 66, 76Reference Fig. La La La with your Larynx 78 8.30 and 8.32

posterior to larynx

78

posterior to larynx

78

Muscular

Mandibular Division (V3) (CN V)

Facial Artery

Muscular

Facial Nerve (CN VII)

Occipital Artery

Pharynx

Muscular

pharyngeal branch of vagus n (CN X), pharyngeal plexus, branches of external and recurrent laryngeal nn of vagus n

lateral pterygoid m.

pharynx

Muscular

mandibular n. (CN V3) via lateral pterygoind nerve

133

middle pharyngeal constrictor m.

Pharynx

Muscular

pharyngeal plexus of nerves

173

salpingopharyngeal fold / Pharynx salpingopharyngeus m.

Muscular

vagus nerve (CN X)

inferior cartilage of eustacian tube/posterior fasciculus of the palatopharyngeus muscle

raise the pharynx and larynx during deglutition (swallowing) and laterally draws the pharyngeal walls up

126

196

stylopharyngeus m.

Muscular

glossopharyngeal n (CN IX)

styloid process; thyroid cartilage most posterior

elevate (shorten and widen) pharynx and larynx during swallowing and speaking

59

Pharyngeal branch of vagus & pharyngeal plexus

O: Pterygoid hamulus, pterygomandibular raphe, Posterior end of mylohyoid line of mandible & side of Constrict walls of pharynx during tongue; I: Pharyngeal tubercle on basilar swallowing part of occipital bone and pharyngeal raphe

pharynx

210

superior pharyngeal constrictor m.

Pharynx

Muscular

9

ascending pharyngeal Pharynx artery

Vascular

38

coronal suture

Skeletal

53

ethmoid b. – middle nasal concha / turbinate

Skull

Skull

Skeletal

oblique line of thyroid cartilage and side of cricoid cartilage / cricopharyngeal part constrict walls of pharynx during encircles pharyngoesophageal junction swallowing w/o forming a raphe Maxillary a.

922-923

27-29, 53

922-923

40,55 pg.1056

40, 52, 55, 59, 69, 68, 121

arises near carotid bifurcation; ascends to the pharynx, deep and medial to internal carotid artery Bregma is the craniometric landmark formed by the intersection of the sagittal and coronal sutures Ethmoid bone articulates with 15 bones: Neurocranium: Frontal, Sphenoid, Sphenoid conchae (2) Viscerocranium, signgular bone, lying in Protects sinuses from direct contact Viscerocranium: Nasal (2), Maxillae (2), midline. Projects downwards over with pressurized nasal airflow. Inhaled Lacrimal (2), Palatine (2), Inferior Nasal 37-39 openings of maxillary and ethmoid airflow travels between middle and Conchae (2), Vomer sinuses. inferior concha. Four parts of ethmoid bone: Cribiform plate (base of cranium), Perpendicular plate (nasal septum), Lateral Masses (2) coronal suture separates the frontal and parietal bones

Purpose of Ethmoid Bone: Separate nasal cavity from brain. Located at roof of nose, between the two orbits. Cubical, lightweight bone. Spongy bone One of bones of the orbit

27-29, 53

27, 75, 76, 80, 986, 1036126 1038

superior head: infratemporal surface of protrude mandible and depress chin greater wing of sphenoid, inferior head: with medial pterygoid lateral pterygoid plate/ neck of mandible constrict wall of pharynx during hyoid bone/median raphe of pharynx swallowing

multiple cranial nerves; anastomotic channels to the anterior and posterior cerebral circulations

824-825, 834, 891, 917, 952, 1064

69

829

54

ethmoid b. – superior nasal concha / turbinate

Skull

Skeletal

Viscerocranium, signgular bone, lying in midline. Connects to middle nasal Protects olfactory blub concha by nerve endings. Median ridge bone projecting from cribriform plate of ethmoid bone. Falx Cerebri attaches anteriorly to skull at this location. Olfactory bulbs lie on either side of the crista galli on top of the cribriform plate. midline process projecting inferiorly into the nasal cavity; forms the superior part of the bony nasal septum; inf’rly from cribiform plate each drains through the frontonasal duct into the uppermost part of the pneumatized space in frontal b.; usually paired hiatus semilunaris in the middle nasal meatus articulates: anteriorly with frontal small bone forming part of medial wall process of maxilla, superiorly with of orbit; forms part of the canal for the frontal bone, posteriorly with ethmoid, nasolacrimal duct inferiorly with orbital process of maxilla; runs between parietal/occipital bones and temporal/occipital

55

ethmoid b. – crista galli Skull

Skeletal

57

ethmoid b. – perpendicular plate

Skull

Skeletal

73

frontal b. – sinus

Skull

Skeletal

98

lacrimal b.

Skull

Skeletal

102

lambdoid suture

skull

Skeletal

115

mandible b. – angle

Skull

Skeletal

posterior, lateral, inferior corner of bone

fracturs here usually oblique and involve 2-5, 13, 15, 16 827, 837-838 the bony socket or alveolus of 3rd molar

116

mandible b. – coronoid Skull process

Skeletal

superior and anterior projection of ramus

fractures here are rare and usually singular

2-5, 13, 15, 16 2-5, 13, 15, 16

117

mandible b. – head

Skull

Skeletal

of condylar process; place of ariculation with temporal bone

118

mandible b. – lingula

Skull

Skeletal

medial side of ramus; small protuberance

120

mandible b. – mandibular notch

Skull

Skeletal

122

mandible b. – ramus

Skull

Skeletal

124

maxilla b. – incisive fossa

Skull

Skeletal

Skull

Skeletal

superior alveolar nerves

136

nasal b.

Skull

Skeletal

viscerocranium

142

occipital b. – clivus

skull

Skeletal

143

occipital b. – condylar skull canal

Skeletal

148

opening of frontal sinus

Skull

Skeletal

Supraorbital n. (CN V1)

149

opening of maxillary sinus

Skull

Skeletal

Anterior, Middle, & Posterior Superior Alveolar n. Maxillary a. (Maxillary n. branches)

Skull

Skeletal

151

opening of sphenoid sinus

Skull

Skeletal

160

parietal b.

skull

Skeletal

172

sagittal suture

Skull

Skeletal

2, 6, 39

824, 891

822, 823-824

823-824, 826, 889

2-5, 13, 15, 16

2-5, 13, 15, 16 2-5, 13, 15, 16 2-6, 8, 12

maxillary sinus

opening of nasolacrimal duct

37-39

between coronoid process and condyle (projections of ramus) perpendicular portions of the mandible body

127

150

37-39

Posterior ethmoidal n.

maxillary a.

Posterior ethmoidal a.

air filled region of maxilla bone. Floor of decrease bone weight orbit to alveolar part of maxilla articulates with the frontal bone superiorly anterior portion of occipital b. & joins anterior part of posterior cranial fossa with sphenoid bone emissary vein passes through from sigmoid sinus to verterbral veins in neck Frontal sinus --> Semilunar hiatus --> Frontonasal duct --> Ethmoidal infundibulum --> Middle nasal meatus Posterior to the semilunar hiatus which is inferolateral to the root of the nose Nasolacrimal duct --> Inferior nasal meatus (inferolateral to the inferior nasal concha) Sphenoid sinus --> spheno-ethmoidal recess (superoposterior to the superior concha) One of the most superior bones of the skull (posterior to frontal bone), one of the bilaterally paired bones of the skull (separated by the sagittal suture)

Drains tears from the lacrimal sac

part of the neurocranium and calvaria, galea aponeurotica runs superiorly to Tuber (or eminence) is present in these bones, parietal foramen present newborns (Netter 12) (for emissary vein) separates the parietal bones

44, 47, 48, 49 841, 963 2,3,4,6,11 8, 9

pg.845

8,9,10

pg.846

37, 38

958-60

37

958-9

37, 82

959

37, 38

832, 960-1

2, 4, 6, 7, 8, 9 7, 12

174 175 179

sphenoid b. – hamulus of medial pterygoid skull plate sphenoid b. – anterior skull clinoid process sphenoid b. – greater skull wing

Skeletal

6

Skeletal

6,9

823-4, 830, 832 823-4, 830, 2,3,4,5,8,9,151 832

Skeletal

180

sphenoid b. – lateral pterygoid plate

skull

Skeletal

181

sphenoid b. – lesser wing

skull

Skeletal

Le Fort I fracture: horizontal fractures of the maxillae, passing superior to the maxillary alveolar process, crossing bony 6,8,39 nasal septum and possibly the pterygoid plates of sphenoid 2,3,4,5,8,9,151

182

sphenoid b. – medial pterygoid plate

skull

Skeletal

Le Fort I fracture: horizontal fractures of the maxillae, passing superior to the maxillary alveolar process, crossing bony 6,8,39 nasal septum and possibly the pterygoid plates of sphenoid

185

sphenoid b. – sella turcica

skull

Skeletal

6,9,39

187

sphenoid sinus

skull

Skeletal

37-9

224 225

temporal b. – mastoid Skull air cells temporal b. – mastoid Skull process

Skeletal

temporal b. – squamous part

Skull

Skeletal

227

temporal b. – styloid process

Skull

Skeletal

Skull

Skeletal

Skull Skull

Skeletal Skeletal

228 254 255

temporal b. – zygomatic process vomer b. zygomatic b.

823-4, 830, 832 823-4, 830, 832 823-4, 830, 832 823-4, 830, 832 823-4, 830, 832

94 posteroinferior to external acoustic contains mastoid air cells that open meatus into the tympanic cavity thin flat portion of temporal bone that consitutes the side of the skull above the ear attachment site for stylohyoid, spike of bone that projects inferiorly styloglossus, and stylopharngeus mm from the petrous part of the temporal as well as stylomandibular and bone stylohyoid ligaments projection of bone that arises anterior to articulates with zygomatic bone to the external acoustic meatus form zygomatic arch

Skeletal

226

823-4, 830, 832

8 8

8 8 Broken Nose, Deviated Septum Le Forte III Fracture

2 2

56

ethmoid b. – olfactory Skull - foramina Skeletal foramina

Holes in cribriform plate of ethmoid bone which transmit the olfactory nerves.

72

foramen lacerum

Skull - foramina Skeletal

medial to carotid canal.

deep petrosal nerve and some meningeal artery brances & small veins pass through

831, 833, 835, 883

Skull - foramina Skeletal

notch in the superior orbital margin; occasionally present as a foramen

opening for the passage of the for supraorbital neurovascular bundle

822, 823-824

Skull - foramina Skeletal

an opening in the hard palate located medial to the 3rd maxillary molar tooth

transmits greater palatine neurovascular bundle

74 81

frontal b. – supraorbital notch / foramen greater palatine foramen

97

jugular foramen

Skull - foramina Skeletal

119

mandible b. – mandibular foramen

Skull - foramina Skeletal

located on interior ramus

121

mandible b. – mental foramen

Skull - foramina Skeletal

located centrally on body

125

maxilla b. – infraorbital foramen

Skull - foramina Skeletal

144

occipital b. – foramen Skull - foramina Skeletal magnum

37-39

important site for oral anesthesia 11

The inferior alveolar nerve and artery enter traveling through the body inferior alveolar nerve & arteries exit at the mental foramen on the anterior mandible at which point the nerve is known as the mental nerve

830, 831, 834, 934, 936 829, 831, 833, 835, 1072, 1074, 1077

2-5, 13, 15, 16 2-5, 13, 15, 16 2-6, 8, 12

accessory nerve passes through

verterbral, ante. & post. spinal arteries pass through

Cranial base of the occipital b.

Passage for spinal cord, mininges, vertebral arteries, anterior and posterior spinal arteries, & spinal accessory nerve (CN XI)

8-9, 11, 14, 58, 829-31; 833, 123, 127 841

145 156

occipital b. – hypoglossal canal palatine b. – sphenopalatine foramen

Skull - foramina Skeletal Skull - foramina Skeletal

hypoglossal nerve

Superior to the anterolateral margin of Passage for hypoglossal nerve (CN the foramen magnum XII) Anterior & slightly inferior to the line of the infratemporal crest of the sphenoid; Inside the pterygomaxillary fissure

8, 10-1

833, 835

4, 6, 13-4, 38, 917, 952 40, 42

176

sphenoid b. – foramen Skull - foramina Skeletal ovale

between rotundum and spinosum

mandibular nerve (CN V3), accessory meningeal arty, lesser petrosal nerve (occasionally) pass through

8,10

823-4, 830, 832

177

sphenoid b. – foramen Skull - foramina Skeletal rotundum

most anterior medial of sphenoid foramens

Maxillary nerve (CN V2) pass through

11

823-4, 830, 832

178

sphenoid b. – foramen Skull - foramina Skeletal spinosum

most posterior lateral of sphenoid foramens

middle meningeal artery & vein, meningeal branch of mandibular nerve pass through

8,10

823-4, 830, 832

183 184

sphenoid b. – optic Skull - foramina Skeletal canal sphenoid b. – pterygoid Skull - foramina Skeletal canal

2,6,11 43-5

186

sphenoid b. – superior Skull - foramina Skeletal orbital fissure

195

stylomastoid foramen Skull - foramina skeletal

underside of skull

221

temporal b. – external auditory / acoustic Skull - foramina Skeletal meatus

opening in lateral surface of temporal bone

allows sound to reach tympanic membrane

8

222

temporal b. – internal auditory / acoustic meatus

Skull - foramina Skeletal

opening in lateral surface of temporal bone

transmits facial n, vestibulocochlear n, and labyrinthine a

6

223

temporal b. – carotid canal

Skull - foramina Skeletal

in petrous part of temporal bone

transmits internal carotid a. and internal carotid plexus of nerves to cranial cavity

8

11

123

823-4, 830, 832 823-4, 830, 832 823-4, 830, 832

Structure accessory hemiazygous vein aorta – abdominal aorta – arch / knob aorta – ascending aorta – descending / thoracic appendix azygos vein brachiocephalic artery / trunk brachiocephalic vein – left brachiocephalic vein – right cecum celiac artery / trunk cisterna chyli colic artery – left colic artery – right colon – ascending colon – descending colon – transverse common bile duct common carotid artery – left common carotid artery – right common hepatic artery common hepatic duct common iliac artery common iliac vein communicating ramus – white or gray cremaster m. cystic artery cystic duct diaphragm diaphragm – left crus diaphragm – right crus duodenum –asuperior (1st) part duodenum –bdescending (2nd) part duodenum –chorizontal (3rd) part duodenum –dascending (4th) part epididymis epiploic foramen (of Winslow) esophagus external / superficial inguinal ring external abdominal oblique m. falciform ligament femoral nerve gallbladder gastric artery – left gastric artery – right

Region

System

Netter

Plate Moore #'s

Page #'s

gastroduodenal artery gastroepiploic artery – left gastroepiploic artery – right genitofemoral nerve greater omentum interventricular heart – muscular septum heart – anterior interventricular branch of L. coronary artery (LAD) heart – aortic semilunar valve heart – atrial / nodal branch of R. coronary artery heart – chordae tendinae heart – circumflex branch of L. coronary artery heart – coronary sinus heart – crista terminalis heart – fossa ovalis heart – great cardiac vein heart – left atrioventricular / mitral / bicuspid valve heart – left atrium / auricle heart – left main coronary artery heart – left ventricle heart – membranous interventricular septum heart – middle cardiac vein heart – moderator band heart – papillary m. heart – pectinate m. heart – posterior interventricular branch of R. coronary artery heart – pulmonary semilunar valve heart – right atrioventricular / tricuspid valve heart – right atrium / auricle heart – right main coronary artery heart – right marginal branch of R. coronary artery heart – right ventricle heart – trabeculae carnae hemiazygous vein hepatic artery proper hepatogastric ligament hepatic portal vein hepatoduodenal ligament ileocolic artery ileum iliacus m. iliohypogastric nerve ilioinguinal nerve

inferior epigastric artery or vein inferior mesenteric artery inferior mesenteric vein inferior phrenic arteries inferior vena cava inguinal canal inguinal ligament intercostal m. – external intercostal m. – innermost intercostal m. – internal intercostal nerve, artery or vein internal / deep inguinal ring internal abdominal oblique m. internal thoracic artery internal thoracic vein jejunum kidney kidney – major calyx kidney – medullary pyramid kidney – minor calyx kidney – renal papillae kidney – renal pelvis lateral femoral cutaneous nerve left colic (splenic) flexure left subclavian artery ligamentum arteriosum round ligament of the liver liver – caudate lobe liver – left lobe liver – quadrate lobe liver – right lobe lumbar artery lumbosacral trunk lung – horizontal fissure lung – inferior lobe lung – lingula lung – major / oblique fissure lung – middle lobe lung – superior lobe main bronchus – left main bronchus – right major duodenal papillae marginal artery of large intestine middle colic artery musculophrenic artery oblique pericardial sinus obturator nerve ovarian artery ovarian vein – left

ovarian vein – right pampiniform plexus of veins pancreas – body pancreas – head pancreas – main pancreatic duct pancreas – neck pancreas – tail pancreas – uncinate process pericardiophrenic artery or vein pericardium phrenic n. porta hepatis psoas major m. psoas minor m. pulmonary artery – right or left pulmonary trunk pulmonary vein quadratus lumborum m. rectus abdominis m. rectus abdominis m. – tendinous intersections recurrent laryngeal nerve – left recurrent laryngeal nerve – right renal artery – left renal artery – right renal vein – left renal vein – right right colic (hepatic) flexure short gastric arteries sigmoid arteries sigmoid colon spermatic cord splanchnic nerve – greater splanchnic nerve – lesser spleen splenic artery splenic vein sternum – angle sternum – body sternum – manubrium sternum – xiphoid process stomach – greater curvature stomach – lesser curvature stomach – pyloric sphincter stomach – rugae / gastric folds subcostal nerve superior epigastric artery or vein superior intercostal vein – right superior mesenteric artery

superior mesenteric vein superior rectal artery superior vena cava suprarenal (adrenal) artery – inferior suprarenal (adrenal) artery – middle suprarenal (adrenal) artery – superior suprarenal (adrenal) gland suprarenal (adrenal) vein suspensory ligament of the doudenum (ligament of Trietz) sympathetic ganglion sympathetic trunk teniae coli testicular artery testicular vein – left testicular vein – right thoracic duct trachea trachea – bifurcation transversalis fascia transverse pericardial sinus transversus abdominis m. transversus thoracis m. tunica albuginae tunica vaginalis – parietal layer tunica vaginalis – visceral layer ureter vagus n. / CN X vas (ductus) deferens

Structure abductor digiti minimi m. abductor hallucis m. adductor brevis m. adductor hallucis m. – oblique head adductor hallucis m. – transverse head adductor hiatus adductor longus m. adductor magnus m. anterior cruciate ligament / ACL anterior inferior iliac spine anterior superior iliac spine anterior talofibular ligament anterior tibial artery anterior tibial vein biceps femoris – long head biceps femoris – short head broad ligament of uterus bulbospongiosus / bulbocavernosus m. calcaneal (Achilles) tendon calcaneofibular ligament calcaneus calcaneus – sustentaculum tali cervix coccygeus m. coccyx common fibular / peroneal nerve common iliac artery common iliac vein cremaster m. cuboid bone cuneiform bone – intermediate cuneiform bone – lateral cuneiform bone – medial deep femoral (profunda femoris) artery deep fibular (peroneal) nerve dorsalis pedis artery ejaculatory duct epididymis extensor digitorum brevis m. extensor digitorum longus m.

Region

System

Netter Plate #'s

Moore Page #'s

extensor hallucis brevis m. extensor hallucis longus m. external iliac artery external iliac vein fascia lata femoral nerve femoral vein femur – greater trochanter femur – head femur – lateral condyle femur – lateral epicondyle femur – lesser trochanter femur – ligament of the head femur – medial condyle femur – medial epicondyle femur – neck femur bone fibula – head fibula – lateral malleolus fibula bone fibular (lateral collateral) ligament fibular (peroneal) artery fibularis (peroneus) brevis m. fibularis (peroneus) longus m. fibularis (peroneus) tertius m. flexor digiti minimi m. flexor digitorum brevis m. flexor digitorum longus m. flexor hallucis brevis m. flexor hallucis longus m. gastrocnemius m. – lateral head gastrocnemius m. – medial head gluteus maximus m. gluteus medius m. gluteus minimus m. gracilis m. great (long) saphenous vein greater sciatic foramen iliofemoral ligament iliolumbar artery iliolumbar ligament iliopsoas m. iliotibial tract ilium bone inferior gemellus m.

inferior gluteal artery inferior gluteal nerve inferior rectal nerve inguinal ligament internal iliac / hypogastric artery internal iliac vein interosseous m. intervertebral disc L3/L4 level intervertebral disc L4/L5 level intervertebral disc L5/S1 level ischial spine ischial tuberosity ischiocavernosus m. ischiofemoral ligament ischium bone lateral circumflex artery lateral femoral cutaneous nerve of thigh lateral meniscus lateral plantar artery lateral plantar nerve lateral sacral artery lateral sural cutaneous nerve left testicular vein lesser sciatic foramen levator ani m. / pelvic diaphragm m. ligament of the ovary lumbosacral trunk lumbricals medial / deltoid ligament medial circumflex artery medial meniscus medial plantar artery medial plantar nerve medial sural cutaneous nerve medial umbilical ligament / obliterated umbilical artery median (middle) sacral artery median umbilical ligament metatarsal navicular bone obturator artery obturator externus m. obturator foramen obturator internus m.

obturator nerve obturator vein ovarian artery ovarian vein ovary pampiniform plexus of veins patella patellar tendon / ligament pectineus m. penis penis – bulb penis – corpus caverosum penis – corpus spongiosum penis – crura penis – deep dorsal vein penis – urethral orifice pes ancerinus piriformis m. plantar aponeurosis plantaris m. / tendon popliteal artery popliteal vein popliteus m. posterior cruciate ligament / PCL posterior femoral cutaneous nerve posterior talofibular ligament posterior tibial artery posterior tibial vein prostate gland psoas major m. pubic bone pubic symphysis pudendal nerve, artery or vein quadratus femoris m. quadratus plantae m. rectum rectus femoris m. right testicular vein round ligament of the uterus sacral nerve root – S1 sacral nerve root – S2 sacral nerve root – S3 sacroiliac joint sacrospinous ligament sacrotuberous ligament

sacrum saphenous nerve sartorius m. sciatic nerve semimembranosus m. seminal vesicle semitendinosus m. small saphenous vein soleus m. superficial femoral artery superficial fibular / peroneal nerve superficial transverse perineal m. superior gemellus m. superior gluteal artery superior gluteal nerve superior vesicular arteries sural cutaneous nerve suspensory ligament of the ovary sympathetic trunk talus bone tendinous arch of levator ani muscles tensor fascia lata m. testicular artery tibia – medial malleolus tibia bone tibial (medial collateral) ligament tibial nerve tibialis anterior m. tibialis posterior m. transverse cervical / cardinal / Mackenrodt's ligament tunica albuginea tunica vaginalis – parietal layer tunica vaginalis – visceral layer umbilical artery ureter urethra – membranous urethra – prostatic urethra – spongy urinary bladder urinary bladder – internal urethral orifice urinary bladder – trigone urinary bladder – ureteric orifice

urogenital diaphragm / deep transverse perineal m. / perineal membrane uterine artery uterine tube – fimbriae uterine tube / fallopian tube / oviduct uterosacral ligament uterus vagina vas (ductus) deferens vastus intermedius m. vastus lateralis m. vastus medialis m.