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Cunninghams Manual of Practical Anatomy v3 1000902964
Cunninghams Manual of Practical Anatomy v3 1000902964
Cunninghams Manual of Practical Anatomy v3 1000902964
MANUAL OF
PUBLISHED BY THE JOINT COMMITTEE OF HENRY FROWDE AND HODDER " STOUGHTON
OF
Practical Anatomy
ARTHUR ROBINSON
PROFESSOR OF ANATOMY l.V THE UNIVERSITY OF EDINBURGH
CaicmMEDICALSCHOOI
VOLUME THIRD
1921
3/\
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2fu"( Edition, '
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1903;
2,rd Edition, 1906.
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tjth Editian^i loin.
6M Edition, 1914-
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PREFACE TO
ARTHUR ROBINSON.
2
Face and Frontal Region of Head,
Posterior Triangle, 32
Temporal Region, 42
120
The Anterior Part of the Neck,
161
Parotid Region, ...
262
Prevertebral Region, . , ...
Spheno -
Palatine Ganglion and Internal Maxillary
Artery, .
317
Ventriculi Tertii, . .
.
Nerve, ......
Vestibulum, ......
BULBUS OCUL]
INDEX 547
A GLOSSARY
OF THE
INTERNATIONAL (B.N.A.)
ANATOMICAL TERMINOLOGY
GENERAL TERMS.
t lateral structures,
Superficialis Superficial\ r Referring to structures nearer to and
Profundus Deep / \ further away from the surface.
Extemus Externah /-Referring, with few exceptions, to the
THE BONES.
GLOSSARY XI
Os sphenoidale Sphenoid
Crista
infratemporalis Pterygoid ridge
Sulcus chiasmatis Opticgroove
Crista
sphenoidalis Ethmoidal crest
Spinaangularis Spinousprocess
Lamina medialis processus ptery-
goids Internal pterygoid
plate
Canalis pterygoideus
[Vidii] Vidian canal
Fossa hypophyseos Pituitary
fossa
Sulcus caroticus Cavernous groove
Conchse sphenoidales turbinal bones
Sphenoidal
Hamulus pterygoideus Hamular process
Canalis pharyngeus canal
Pterygo-palatine
Tuberculum sellae eminence
Olivary
Fissura orbitalis superior Sphenoidalfissure
Os temporale Temporal Bone
Canalis facialis[Fallopii] Aqueductof Fallopius
Hiatus canalis facialis Hiatus Fallopii
Vaginaprocessus styloidei Vaginalprocess of tympanicbone
Incisura mastoidea Digastricfossa
Impressio
trigemini Impression for Gasserian ganglion
Eminentia arcuata Eminence for sup. semicircular
canal
Sulcus sigmoideus Fossa sigmoidea
Fissura petrotympanica Glaserian fissure
Fossa mandibularis Glenoid cavity
Semicanalis tubae auditivae Eustachian tube
Os ethmoidale Ethmoid
Labyrinthus
ethmoidalis Lateral mass
Lamina papyracea Os planum
Processus uncinatus Unciform process
Xll GLOSSARY
Foveolae es (Pacchioni)
granular Pacchionian depressions
Spheno-maxillary fossa
Fossa pterygo-palatina
Canalis pterygo-palatinus canal
Posterior palatine
Foramen lacerum Foramen lacerum medium
Choanae Posterior nares
Upper Extremity.
B.N, A. Terminology. Old Terminology.
Clavicula Clavicle
Tuberositas coracoidea for conoid ligament
Impression
Tuberositas costalis for rhomboid
Impression ligament
Scapula Scapula
scapularis
Incisura Supra-scapular notch
Anterior or lateral angle
Anguluslateralis
Angulusmedialis Superior angle
Humerus Humerus
Sulcus intertubercularis Bicipitalgroove
Crista tuberculi majoris External lip
Crista tuberculi minoris Internal lip
Facies anterior medialis Internal surface
Facies anterior lateralis External surface
Ulna Ulna
Incisura semilunaris Greater sigmoidcavity
Incisura radialis Lesser sigmoidcavity
Crista interossea External or interosseous border
Facies dorsalis Posterior surface
Facies volaris Anterior surface
Facies medialis Internal surface
dorsalis Posterior border
Margo
volaris Anterior border
Margo
Radius Radius
Tuberositas radii tuberosity
Bicipital
Incisura ulnaris Sigmoidcavity
Crista interossea Internal or interosseous border
Facies dorsalis Posterior surface
Facies volaris Anterior surface
Facies lateralis External surface
Carpus Carpus
Os naviculare Scaphoid
Os lunatum Semilunar
Os triquetrum Cuneiform
Os multangulum majus Trapezium
Os multangulum minus Trapezoid
Os capitatum Os magnum
Os hamatum Unciform
XIV GLOSSARY
Lower Extremity.
B.N. A. Terminology. Old Terminology.
Os cox" Innominate Bone
Linea anterior
glutaea Middle curved line
Linea glutasa
posterior Superiorcurved line
Linea terminalis Margin inlet of true pelvis
of
Spinaischiadica Spineof the ischium
Incisura ischiadica major Great sacro-sciaticnotch
Incisura ischiadica minor Lesser sacro-sciaticnotch
Tuberculum pubicum Spineof pubis
Ramus inferior oss.
pubis Descendingramus of pubis
Ramus superior
oss. pubis Ascendingramus of pubis
Ramus ossis ischii
superior Body of ischium
Ramus inferior oss. ischii Ramus of ischium
Pecten ossis pubis Pubic part of line
ilio-pectineal
Facies symphyseos Symphysispubis
Pelvis Pelvis
Pelvis major False pelvis
Pelvis minor True pelvis
Aperturapelvis
minoris superior Pelvic inlet
minoris inferior
Aperturapelvis Pelvic outlet
Linea terminalis Marginof inlet of true pelvis
Femur Femur
Fossa trochanterica Digitalfossa
Linea intertrochanterica line
Spiral
Crista intertrochanterica Post, intertrochanteric line
Condylusmedialis Inner condyle
Condyluslateralis Outer condyle
medialis
Epicondylus Inner tuberosity
lateralis
Epicondylus Outer tuberosity
Tibia Tibia
Condylusmedialis Internal tuberosity
Condyluslateralis External tuberosity
Eminentia intercondyloidea Spine
Tuberositas tibiae Tubercle
Malleolus medialis Internal malleolus
Fibala Fibula
Malleolus lateralis External malleolus
fibulae
Apex capituli Styloid
process
THE LIGAMENTS.
anterius
Lig.long^itudinale Anterior common ligament
Lig.longitudinale
posterius Posterior common ligament
Lig.flava Ligamentasubflava
Membrana tectoria Posterior
occipito-axial
ligament
Articulalioatlanto-epistrophica Jointbetween the atlas and the axis
Lig.alaria .Odontoid or check ligaments
Lig.apicis dentis Suspensory ligament
The Ribs
Lig.capituli
costae radiatum Anterior costo-vertebral or stellate
ligament
Lig.sterno-costale interarticulare Interarticular chondro-sternal ment
liga-
The Jaw.
Upper Extremity.
Lig.costo-claviculare Rhomboid
ligament
Labrum glenoidale Glenoid
ligament
Articulatio radio-ulnaris proximalis Superiorradio-ulnar joint
Lig.collateraleulnare Internal lateral ligamentof elbow
joint
Lig. collateraleradiale External lateral ligament
Lig. annulare radii Orbicularligament
Chorda obliqua of ulna
Oblique ligament
Articulatio radio-ulnaris distalis Inferior radio-ulnar joint
Discus articularis Triantjular
fibro-cartilage
Recessus sacciformis Membrana sacciformis
Lig.radio-carpeum
volare Anterior ligament of the carpal
radio-
joint
dorsale
Lig,radio-carpeum Posterior ligament of the carpal
radio-
joint
Lig.collaterale carpiulnare Internal lateral ligamentof the
wrist joint
VOL. Ill " b
XVI GLOSSARY
Lig.arcuatum Subpubicligament
Lig.sacro-tuberosum Greatsacro-sciatic ligament
Processus falciformis Falciform process
Lig.sacro-spinosum Small sacro-sciatic ligament
Labrum glenoidale Cotyloidligament
Zona orbicularis Zonular band
Ligamentum iliofemorale Y-shaped ligament
Lig.ischio-capsulare Ischio-capsular band
Lig.pubo-capsulare Pubo-femoral ligament
Lig.popliteumobliquum Ligament of Winslow
Axial Muscles.
Lumborum Sacro-lumbalis
Dorsi Accessorius
Cervicis Cervicalis ascendens
Longissimus "
Longissimus "
Dorsi Dorsi
Cervicis Transversalis cervicis
Capitis Trachelo-mastoid
Spinalis "
Spinalis "
Dorsi Dorsi
"
Cervicis Colli
Capitis Capitis
Semispinalis "
Semispinalis "
Dorsi Dorsi
Cervicis Colli
Capitis Complexus
Multifidus Multifidus spinse
Epicranius Occipito-frontalis
Galea aponeurotica aponeurosis
Epicranial
Procerus nasi
Pyramidalis
Pars transversa (nasalis) Compressor naris
Pars alaris (nasalis) Dilatores naris
Auricularis anterior Attrahens aurem
Muscles of Thorax.
(Halleri)
XX GLOSSARY
perinei
Transversus superficialis Transversus perinei
urethrse membranacese
M. sphincter Compressorurethroe
Diaphragmaurogenitale Deep transverse muscle and ter
sphinc-
urethrge
Fascia diaphragmatisurogenitalisDeep layerof triangular ligament
superior
Fascia diaphragmatisurogenitalisSuperficial layerof the triangular
inferior ligament
Arcus tendineus fasciae pelvis White line of pelvis
Ligamentapuboprostatica Anterior and lateral true ligaments
of bladder
Fascia diaphragmatis
pelvis
superior Visceral layerof pelvic
fascia
Fascia diaphragmatis inferior
pelvis Anal fascia
a,
o
a.
o
a.
O ro
c3 O "
.2 S S
ti ^ I" i
I B a,
O
a,
O
H
II
g
o
g
"a-3
I
o
.2
xxu GLOSSARY
Brain.
B.N. A. Terminology, Old Terminology.
Rhombencephalon
Eminentia medialis Eminentia teres
Ala cinerea Trigonum vagi
Ala acustica Trigonum acusticum
Ivucleus nervi abducentis Nucleus of 6th nerve
Cerebrum
Pedunculus cerebri Crus cerebri
Colliculus superior Anterior corpus quadrigeminum
CoUiculus interior Posterior corpus quadrigeminum
Aqueductuscerebri Iter e tertio ad quartum ventri-
culum, or aqued.of Sylvius
Foramen interventriculare Foramen of Monro
Hypothalamus Subthalmic region
hypothalamicus
Sulcus Sulcus of Monro
Massa intermedia Middle commissure
Fasciculus thalamo-mammillaris Bundle of Vicq d'Azyr
Pars opercularis Pars basilaris
Thalamus Optic thalamus
Pallium Cortex cerebri
Gyri transitivi Annectant gyri
Fissura cerebri lateralis Fissure of Sylvius
Gyrustemporalis superior First temporalgyrus
Gyrus temporalis medius Second temporalgyrus
Gyrustemporalis inferior Third temporalgyrus
Sulcus centralis (Rolandi) Fissure of Rolando
Sulcus temporalis superior Parallel sulcus
Sulcus temporalis medius Second temporalsulcus
Sulcus circularis Limitingsulcus of Reil
Sulcus inferior
temporalis Occipito-temporal sulcus
Gyrus fusiformis Occipito-temporal convolution
Sulcus interparietalis Intraparietal
sulcus
Sulcus callosi
corporis Callosal sulcus
Sulcus cinguli Calloso-marginal
fissure
Fissura hippocampi Dentate fissure
Gyrus cinguli Callosal convolution
GLOSSARY xxni
Membranes of Brain.
Cerebral Nerves.
Spinal Nerves.
Rami posteriores Posterior
primarydivisions
Rami anteriores Anterior
primarydivisions
N. cutaneus colli Superficial
cervical nerve
Nn. supraclavicularesanteriores Suprasternal
nerves
culo-spiral
N. axillaris Circumflex nerve
N. radialis Musculo-spiral
nerve
Arteries.
B.N. A. Terminology. Old Terminology.
Sinus aortae Sinuses of Valsalva
A. profundalinguae Ranine artery
A. maxillaris externa Facial artery
A. alveolaris inferior Inferior dental artery
Ramus meningeusaccessorius Small meningealartery
A. buccinatoria Buccal artery
A. alveolaris superior
posterior Posterior dental artery
Aa. alveolares anteriores
superiores Anterior superior dental arteries
Ramus carotico-tympanicus Tympanic branch of int. carotid
A. chorioidea Anterior choroidal artery
A. auditiva interna Auditoryartery
Rami ad pontem Transverse arteries (branches of
Basilar artery)
A. pericardiaco-phrenica Arteria nervi phrenici
comes
A. media
suprarenalis Middle capsular
artery
A. hypogastrica Internal iliacartery
A. umbilicalis Obliterated
hypogastric
A. pudenda interna Internal
pudicartery
A inferior
epigastrica Deep epigastric
artery
GLOSSARY XXVll
A. Cremasteric artery
spermatica
externa
Lsmiphatics.
B.N. A. Terminology. Old Terminology.
THE VISCERA.
Digestive Apparatus.
Arcus glosso-palatinus Anterior of fauces
pillar
Arcus pharyngo-palatinus Posterior of fauces
pillar
GI. anterior
lingualis Gland of Nuhn
Ductus submaxillaris Wharton's duct
Gl. accessoria
parotis Socia parotidis
Ductus parotideus (Stenonis) Stenson's duct
Dentes praemolares teeth
Bicuspid
Dens serotinus Wisdom tooth
Papillae vallatse Circumvallate papillae
Recessus pharyngeus Lateral
recess of pharynx
Tela submucosa Pharyngeal aponeurosis
Plicae circulares Valvulae conniventes
Gl. intestinales Cryptsof Lieberkuhn
Valvula coli Ileo-caecalvalve
Columnse rectales Columns of Morgagni
Plicae transversales recti Valves of Houston
Valvula spiralis Valves of Heister
Noduli lymphaticiaggregati patches
Peyer's
(Peyeri)
Intestinum jejunum Jejunum
Intestinum ileum Ileum
Noduli lymphaticilienales Malpighiancorpuscles
(Malpighii)
Respiratory Apparatus.
Larynx
Prominentia laryngea Adam's apple
Incisura thyreoidea
superior Superior notch
thyroid
M. ary-epiglotticus Aryteno-epiglottideanmuscle
M. vocalis -arytenoid
Internal thyro muscle
M. thyreo-epiglotticus Thyro-epiglottideanmuscle
Appendixventriculi laryngis Laryngealsac
Plica vocalis True vocal cord
Plica ventricularis False vocal cord
Ligamentum ventriculare Superior ligament
thyro-arytenoid
Ligamentum vocal e ligament
Inferior thyro-arytenoid
Glottis Glottis vera
Urogenital Apparatus.
renis
Corpuscula Malpighiancorpuscles
Paradidymis Organ of Giraldes
Appendix testis Hydatidof Morgagni(male)
Ductus deferens Vas deferens
Gl. urethrales Glands of Littre
Glandula bulbo-urethralis
(Cowperi) Cowper'sgland
FoUiculioophorivesiculosi Graafian follicles
Cumulus oophorus Discus proligerus
Tuba uterina Fallopian tube
Epoophoron Parovarium
Appendicesvesiculosi Hydatidsof Morgagni(female)
Ductus epoophorilongitudinalis Gartner's duct
Orificium internum uteri Internal os (ofuterus)
Orificium externum External os
Peritoneum.
Bursa omentalis Lesser peritoneal
sac
Foramen epiploicum Foramen of Winslow
Lig.phrenico-colicum Costo-colic ligament
Excavatio recto-uterina (cavum Pouch of Douglas
Douglasi)
Lig.gastro-lienale Gastro-splenic
omentum
SENSE ORGANS.
The Eye.
Sclera Sclerotic coat
Lamina elasticaanterior (Bowmani) Bowman's membrane
XXX GLOSSARY
cemeti)
Spatia anguli iridis Spaces of Fontana
The Ear.
cilii). 19.
M. buccinator, on alveolar cesses
pro-
M. caninus, on
maxilla. 28. Great wing of sphenoid bone,
muscle. of mandible.
origin of temporal
bone. 26 M. temporalis, insertion
Zygomatic on
infra-orbital
part, on maxilla 32- M. sterno-mastoid, on mastoid
.
M. quadratus labii inferioris,on 40. Inferior temporal line, a7id upper
body of mandible. lirnit of origin ofM. temporalis
M. triangularis, oji body of on parietal and frontal bones.
OF
PRACTICAL ANATOMY.
anterior part of the frontal region of the head and the face,
the study of the surface anatomy of the ocular appendages,
the reflection of the skin and the cleaning of the superficial
muscles of the face and anterior part of the scalp. On the
small triangular
space, called the lacus lacrimalis. If the
dissector now examines the free marginsof the lids he will
note that,to the lateral side of the lacus lacrimalis, they
are and
flat, that in each lid the cilia or eyelashesproject
from the anterior border, whilst the tarsal glands open,
by a series of minute apertures,along the posterior
border,
a between
distinct interval intervening the cilia and the
4 HEAD AND NECK
Papillalacrimalis,
with
punctum lacrimale on
the summit
Plica semilunaris
Caruncula lacrimalis
Papillalacrimalis
Tarsal gland
shiningthroughthe
conjunctiva
the adjoiningpart
ligament, of the frontal bone, and the
frontal process of the maxilla,
and they sweep laterallyround
the margin of the orbit in the form of a series of centric
con-
loops. The
upper fibres blend with the frontal belly
of the and the lower fibres overlapthe upper
epicranius,
parts of the muscles of the upper lip. Some of the fibres
springfrom the nasal part of the frontal bone and terminate
in the skin of the eyebrow.
The palpebralpart consists of fibres which sweep in
gentle curves from the medial palpebralligamentto the
lateral palpebralraphe,to both of which they are attached.
Peripherally they blend with the orbital part,and they form
a continuous layerof uniform thickness,except near the free
margins,where, close to the bases of the eyelashes, there is
a more termed
pronounced fasciculus, the bundle.
ciliary
Some of the fibres of the palpebralportionpass from the
deep surface of the medial ligamentto the lacrimal
palpebral
bone; they constitute the pars lacrimalis^ which will be
described when the eyelids are dissected (seep. 29).
The orbicularis oculi is suppliedby the facial nerve.
It closes the eyelids and compresses them against the eye-
ball.
The pars lacrimalis helpsto force the lacrimal secretion
from the lacrimal sac into the naso-lacrimal duct. Those
fibres of the orbital part of the muscle which springfrom
the nasal process of the frontal bone and terminate in the
skin of the eyebrow pullthe eyebrow towards the median
plane,and throw the skin of the central part of the fore-
head
into vertical folds ; they were at one time described as
a separate muscle which was called the corrugator supercilii.
Musculus Epicranius (O.T. Occipito Frontalis).The - "
epicraniusis a quadricipital
muscle possessing two occipital
heads, the occipitales
muscles, and two frontal heads, the
frontales muscles ; they are all inserted into an intermediate
aponeurosis, the galea aponeurotica "
part of the nasalis and others are inserted into the skin.
Jij by the facjal
i^jS\ipplip4 nerve.
nasal septum is
frequently difficult to display.It springs
from the fibresof the upper part of the orbicularis
superficial
oris,and is inserted into the anterior part of the septum of
the nose. It depressesthe septum and reduces the antero-
posterior
diameter of the anterior nasal aperture. The name
indicates the action of the muscle, which is supplied by the
facial nerve.
The Muscles of the Mouth and Cheeks. "
The muscles of
this group form two layers, and a deep. Those
a superficial
Frontalis
Orbicularis oculi
Procerus
M. zygomaticus
Orbicularis oris
M. caninus
Risorius
Orbicularis oris
M. triangularis
Platysma
thetrigeminal
nerve. It communicates with one of the zygomatic
twigs_ojL_thfi_iaciaL
nerve. Next follow the lower zygomatic
Hranches of the facial nerve forwards to the zygomaticus muscle,
and note that one of the twigs supplies it ; then detach the
zygomaticus from its origin,turn it down to the angle of the
mouth. When that has been done detach the zygomatic and
infra-orbital parts of the quadratus labii superiorisiram their
originsand turn them downwards. Now follow the anterior facial
vein and the external maxillary artery forwards and upwards
to the nose, and secure the branches of the artery. Some of the
smaller branches pass backwards, but the main branches,the
inferior and superiorlabial,pass forwards into the lower and
upper lipsrespectively, where they lie deep to the orbicularis
oris against the mucous membrane. Beyond the angle of the
mouth the lateral nasal branch arises, and the continuation of
the external maxillaryartery beyond that branch is called the
angularartery.
After the external maxillary artery and its branches have
been cleaned follow the lower zygomatic branches of the facial
nerve forwards through the fat exposed by the reflection of the
zygomaticus and the quadratuslabii superioris, and secure their
connections with the terminal branches of the infra-orbital
branch of the maxillarydivision of the trigeminalnerve, which
issues through the infra-orbital foramen accompanied by the
infra-orbital branch of the internal maxillary artery. The
interlacement of the zygomatic branches of the facial nerve
with the infra-orbital nerve constitutes the infra-orbital pleccus.
From the infra-orbital plexus branches ascend to the lower
eyelid,other branches descend to the upper lip,and still others
pass medially to the nose. After the branches of the infra-
orbital
plexus have been displayed clean the buccal branch of
the facial nerve. Follow it through the pad of fat called the
siiclorial pad which lies on the buccinator muscle. Secure,
if possible,its junction with the buccinator branch of the
mandibular division of the trigeminalnerve, which issues from
under cover of the middle of the anterior border of the
masseter muscle, and follow its branches of supply to the
buccinator muscle. It may be necessary to cut through the
anterior border of the masseter to secure the buccinator branch
of the mandibular nerve. Next detach the triangularis from the
angle of the mouth and turn it downwards to its insertion,
secure the twig it receives from the mandibular branch of the
facial_,jl"rxe, and display the union 'of that branch with the
mental branch of the alveolar division of the trigeminalnerve,
which JssufisJJirough...t!^~ni^fttal foramen, under cover of the
triangularis and below the second lower premolar tooth. Secure
also a twig from the mandibular branch of the facial nerve which
supplies the quadratus labii inferioris. Accompanying the
mandibular nerve deep to the triangularisthere is,usually,a
definite branch of the external maxillary artery which used to be
called the inferior labial. Finally,reflect the posterior part of
the platysma below the mandible to displaythe cervical branch
of the facial nerve, which issues from the lower part of the
parotid gland to supply the platysma and to communicate
with the upper branch of a cutaneous nerve called the nervus
cutaneus colli. Do not follow it to its termination at present
1 6 HEAD AND NECK
artery,and on a slightly
more superficialplane (Fig,1 5). It
commences as the angularvein^which is formed at the medial
commissure of the eyelids,
by the union of the frontal,and
veins,which
supra-orbital descend from the forehead. It
Superficial
temporal
Frontal branch of
ophthalmic artery
Siipra-orbitai
branch of
ophthalmic artery
Middle temporal
Transverse facial
\ Angular
'
ateral nasal
Infra-orbital
Superiorlabial
Inferior labial
(O.T. inferior
labial.)See p. i8
External maxillary
of the posterior
group pass backwards and are of small size.
They are distributed to the masseteric, buccal,and malar
where theyanastomose
regions, with the transverse the
facial,
and
buccinator, arteries.
the infra-orbital
The branches of the anterior group, which run forwards,
VOL. Ill "
2
i8 HEAD AND NECK
receive special
names : theyare the inferior labial,
the superior
labial,
the lateral nasal,and the angularcontinuation.
The inferior labial (O.T.inferior
coronary)arises below the
level of the angle of the mouth and passes towards the
median plane,under cover of the triangularis, the quadratus
labii inferioris,
and the orbicularisoris. In the substance of
the lipit liesimmediately adjacentto the mucous membrane,
and it anastomoses, in the median plane,with itsfellow of the
oppositeside.
The labial
superior arises about the level of the angle
of the mouth and runs mediallyin the upper between
lip,
the orbicularis oris and the mucous membrane. Before it
anastomoses with its fellow of the opposite side,it givesoff
a branch,the septalartery of the nose, which passes upwards
and ramifies onthe lower and anterior part of the nasal septum,
where it anastomoses with the septalbranch of the spheno-
palatine
artery.
The lateral nasal branch springs from the external
above
maxillary the angleof the mouth. It ramifies on the
side of the nose and anastomoses, in the median plane,with
its fellow of the side.
opposite
The angular artery is the continuation of the external
maxillary
beyond point of originof the lateral nasal
the
branch. It runs upwards in the substance of the angular
head of the quadratuslabii superioris, and it terminates,at
the medial commissure of the eye, by anastomosing with the
dorsal nasal branch of the ophthalmic artery.
In addition to the branches already noted,a very definite
branch is usuallygiven off from the anterior aspect of the
external maxillary artery immediatelyafter it crosses the
lower border of the mandible. This branch (O.T.inferior
labial)runs towards the median plane under cover of the
triangularisand the quadratus labii inferioris,and it anasto-
moses
not onlywith the inferiorlabial (O.T. inferiorcoronary)
above,and its fellow of the opposite side in the median plane,
but also with the mental branch of the inferior alveolar artery.
The Terminal Branches of the Facial Nerve. The sector
dis-"
Supra-orbital
Zygomatico-temporal
Supra-trochlear
Lacrimal
Infra-trochlear
External nasal
Auriculo-temporal
I nfra-orbital
Trunk of facial
Branch to posterior Mental
bellyof digastric
and stylo-hyoid
Buccinator
Fig. 5. " Nerves of the Face. The facial nerve is depictedin greei
the sensory branches of the trigeminal
in black.
Ill " 2 a
20 HEAD AND NECK
The cervical branch after its exit from the lower end of
the parotidgland runs downwards and forwards to supply
the platysmaand to communicate with the nervus cutaneus
but since neither
colli, the terminal branches nor the munication
com-
The Molar Glands. " The pad of fat which covered the
buccinator and
posteriorly, which removed, as the buccal
was
each springing
side, from the outer surface of the socket of the
canine tooth, under cover of the quadratus labii inferioris.
The two bundles converge and blendtogether,between the
medial borders of the musculi quadratilabii inferioris,
to
form a singlebundle which is inserted into the skin of the
chin. It is an elevator of the skin of the chin. It is sup-
plied
by the facial nerve.
the eyelashes.
The Palpebral Fascia. palpebral
" fascia is a sheet of
The
fibrous membrane which occupiesthe interval between the
tarsiand the marginsof the orbit, forming, with the tarsi, a
Raphe Falpebralis
Lateralis. " The lateral palpebral
raphe
(O.T.external tarsal is
ligament) merelya of the
thickening
palpebralfascia,between lateral commissure the
and the
medial border of the fronto-sphenoidal process of the zygomatic
bone (O.T.malar), to which it connects both the tarsi.
Ligamentum Palpebrale
Mediate (O.T. Internal Tarsal
Ligament).The "
medial ligamentis a strong fibrous
palpebral
band which connects the medial ends of both tarsi to the
frontal process of the maxilla. It lies between the skin
Supra-orbital
nerve
palpebrae
superioris
Superciliary
arch
fascia
Palpebral
branch
Palpebral of
lacrimal nerve Infra-trochlear nerve
Ligamentum palpe-
brale
Raphe palpebralis mediale
lateralis
Inferior tarsus
fascia
Palpebral
Infra-orbital nerve
Fig. 7. " Dissection of the Right Eyelid. The orbicularis ocuH has been
completelyremoved.
and
anteriorly, the lacrimal sac posteriorly.
By its upper and
lower borders it givesattachment to fibres of the orbicularis
oculi,and, by the lateral part of its posterior surface,to the
pars lacrimalis of the orbicularis oculi (O.T.tensor tarsi).
Levator Palpebrae Superioris. Only the anterior expanded "
M. orbicularis oculi
Palpebralfascia
Superiorconjunctival
fornix
Superiortarsus
Conjunctivalrecess
Inferior conjunctival
fornix
fascia/
Palpebral \ II
:V^^^^^^p^W^T- .o?'"j^'1
Fig. 8, "
Diagram of the Structure of the Eyelids.
fascia and
piercethe palpebral run laterally,
one in the upper
and one in the lower lid. At the lateral margin of the
orbit,one or of the lacrimal division of the
more branches
ophthalmicpiercethe palpebralfascia and anastomose with
branches of the ophthalmic. An arterialarch,
the palpebral
arcus iarseus,is thus formed close to the margin of each
between
eyelid, the orbicularis muscle and the tarsus.
The veins run towards
medially the root of the nose and
Lacrimal
gland,superiorpart
I'uncta lacrimalia
Lacrimal ducts
Lacrimal sac
Medial palpebral
ligament
M uco-periosteuni
Plica lacrimalis
Inferior meatus
Inferior concha
M. buccinator
Fig. 9. "
Dissection of Lacrimal Apparatus.
nor posteriorly
as far as the nasal notch of the maxilla. The
interval between it and the bone is filled in
by fibrous tissue
in which one or two small islands of cartilage (cartilagines
minores vel sesamoideae) appear. Anteriorly^ bent part
the
of cartilagecomes into contact with its neighbourand forms
the pointof the nose. The medial part of the cartilage is a
narrow stripwhich lies againstthe lower part of the septal
cartilage,and projects slightly below it,so as to support the
margin of the nostril upon the medial side. Its posterior
extremity is turned slightly laterally.
POSTERIOR TRIANGLE.
Dissection. " To
the boundaries
expose and contents of the
posteriortrianglemake the following three incisions through
the skin, (i) From the back of the auricle,along the upper
border of the mastoid part of the temporal bone and the superior
nuchal line to the external occipitalprotuberance. (2) From
the sternal to the acromial end of the clavicle, followingthe line
of that bone. (3)Join the anterior extremities of i and 2 by
an incision,passing along the back of the external acoustic
meatus, and then down the middle of the sterno -mastoid muscle.
Reflect the flap,thus marked out, from before backwards, and
note that the skin is thicker over the upper and posteriorpart
of the trianglethan over the lower and anterior part.
When the skin is reflected the superficial fascia and the
lower part of the platysma muscle will be exposed.
Greater occipital
nerve
Posterior
_
auricular vein
Lesser occipital
nerv
M. scalenusmedius
Anterior supra-
" clavicular nerve.
branches
perficial of the Cervical Plexus.
The
Deep Fascia. " The deep fascia forms the superficial
boundary or roof of the triangle.It
posterior is attached,
below,to the upper border of the middle third of the clavicle ;
above, to the superiornuchal line of the occipital bone ;
anteriorly,itis continuous with the fasciaof the sterno-mastoid,
and posteriorly, with the fascia of the trapezius.It is pierced
by (i)the supra-clavicular
"
(2)
branches of the cervical plexus,
the external jugular vein,(3)small cutaneous branches of the
transverse cervical, transverse scapular(O.T.suprascapular),
and occipital arteries, by the occipital
and, occasionally, artery
difficult
and itis frequently
itself. It is not a very strong layer,
to display it as a continuous sheet. Over the upper part of the
triangle it forms a singlelayer, but below it splitsinto two
lamellae,a superficial and a deep. The superficial which
layer,
is alreadydisplayed, is attached to the upper border of the
clavicle from the sterno-mastoid anteriorly to the trapezius
auricle.
Nervus Auricularis Magnus. "
The great auricular nerve y-
mastoid, auricular,
and facial. The mastoid branches go to
the skin of the mastoid region. The auricular branches
supplythe skin of the lower two-thirds of the cranial surface
and the lower third of the lateral surface of the auricle. The
facialbranches^ which have alreadybeen seen, ramifyin the
part of the face,in the parotid
posterior and masseteric regions.
Some of the filaments enter the substance of the parotid
gland.
36 HEAD AND NECK
; below by
trapezius the upper border of the middle third
of the clavicle; and nuchal line of the
ahove by the superior
bone,or by the meetingof the upper ends of the sterno-
occipital
mastoid and the trapezius. The roofis formed by the deep
M. semispinalis capitis
Posterior auricular vein
unication frcm facial
posterior vein
Int. jugular vein
Hypoglossal nerve
Posterior facial vein
Lesser occipital N.
Hypoglossal nerve
Great auricular N.
M. digastricus
Transverse
scapularartery
M. scalenus anteri
.j.Subclavian artery
%. 'Subclavian vein
Suprascapulai
Fig. 12. " The Trianglesof the Neck seen from the side. The clavicular head
of the sterno-mastoid muscle was small,and therefore a considerable part
of the scalenus anterior muscle is seen.
cervical which
fascia, fascia and skin,
is covered
by superficial
and in its lower and anterior part by the platysma, which is
embedded in the superficial fascia. It is piercedby (i)the "
verse and
cervical,
occipital arteries; (4) lymph vessels,
passingfrom the superficialstructures to the glandsin the
and
stated that the lesser occipital
triangle.It is frequently
great auricular nerves and the nervus cutaneus colli also
piercethe roof. As a generalrule, they turn round the
posteriorborder of the sterno-mastoid, under cover of the
fascia,
and piercethe fascia which lies on the sterno-mastoid
muscle.
The flooris formed by
spleniuscapitis, the
the levator
scapulae,the scalenus medius, and the scalenus posterior
muscles,with the addition, of a small part of the
occasionally,
semispinaliscapitis above,and the upper
(O.T. complexus),
serration of the serratus below; the latter appears
anterior,
in the area of the only when the clavicle is very
triangle
fullydepressed.The muscles of the floor are covered with
a layerof fascia which is the backward continuation of the
prevertebral fascia of the anterior cervical region.
The contents of the posterior triangle are : "
1. Fattyareolar tissue.
2. The posterior bellyof the omo-hyoidmuscle.
3. Lymph /Lateralsuperior deep cervical.
Glands, \ Inferior deep cervical (Supraclavicular).
part of subclavian.
4. Arteries,^ {Third
Transverse
Occipital(sometimes).
External jugular.
cervical and its terminal branches.
Transverse cervical.
5. Veins Transverse scapular(O.T. suprascapular).
Termination of anterior jugular.
Accessory.
Lesser occipital.
Great auricular.
Nervus cutaneus colli.
To levator scapulae. Branches of cervical plexus.
,, trapezius.
,,
scalenus medius.
6. Nerves, ,, posterior.
,,
Supraclavicular.
To posterior bellyof omo-hyoid,from ansa hypoglossi.
Trunks of brachial plexus.
The nervus dorsalis scapulae.
\
longthoracic.
,,
(^Branches of the brachial
,, suprascapular. j plexus.
,,
nerve to the subclavius. j
^
The transverse scapularartery (O.T. suprascapular) lies posterior to
the clavicle and is not, strictly
speaking, in the triangle.
2
The subclavian vein is posterior to the clavicle and therefore is not
contained within the triangle.
40 HEAD AND NECK
further
require
displayed consideration.
Vena Jugularis Externa. " The external jugularvein is
superficial
except in the terminal part of its extent.
It commences on below
the surface of the sterno-mastoid,
the lower end of the parotidgland,by the union of the
auricular
posterior vein with a branch from the posterior
facial vein. After its formation it runs downwards and back-
wards,
across the upper and anterior
sterno-mastoid,
to the
portionof the posterior
angleof the supraclavicular triangle,
in which piercesfirst the superficial
it layerand then the
second layerof the deep fascia, and it terminates in the
subclavian vein (Figs. 12, 15).
As it crosses the sterno-mastoid it liesat firstparallel
with
but anterior to the trunk of the great auricular nerve, then
deep to the platysma,and whilst beneath the platysma it
crosses either
superficial
or deep to the nervus cutaneus colli
border
(Fig.12). At the posterior of the sterno-mastoid it
sometimes receives vein called the
external jugular
posterior
a
of two
valve, consisting or three semilunar
cusps. The
dissector should note that,as the vein piercesthe deep fascia,
its wall is closely
connected with the margin of the opening
through which it passes ; consequentlywhen the fascia is
stretched the lumen of the vein is expanded.
The Posterior Belly of the Omo-hyoid Muscle. " The
posteriorbellyof the
omo-hyoid muscle springsfrom the
upper border of the scapulaand upper transverse scapular
ligament. It enters the posterior at its lower and
triangle,
posterior angle;runs upwards and forwards,at a variable
distance from the clavicle, to the posterior border of the
sterno-mastoid, and divides the posteriortriangleinto occipital
and subclavian or supraclavicular portions.Either immedi-
ately
behind or under cover of the posteriorborder of the
POSTERIOR TRIANGLE 41
sterno-mastoid itjoins
the intermediate tendon which connects
it with the anterior belly. Its nerve has alreadybeen seen
its deep surface (p.36). As
entering it crosses the posterior
it lies superficial
triangle to the suprascapular
nerve, the
transverse cervical artery and the brachial plexus.
Nervus Accessorius (O.T.SpinalAccessory).The portion "
the branches
superficial "
(i)the lesser occipital
; (2)the great
(3)the
auricular; nervus cutaneuscolli,
and (4)the supra-
clavicular
nerves ; and the deepposterior that
branches^ is,the
nerves (i) the scalenus medius and (2) the scalenus
to
accessory nerve.
The Third Part of the Subclavian Artery. "
Only a portion
of the third part of the subclavian artery is the triangle; the
42 HEAD AND NECK
"
Under the term "
scalp are included the soft structures
which cover the vault of the cranium
above the temporal
lines and anterior to nuchal
the superior line. Its con-
AURICLE 43
Integument
fascia
Superficial
Galea aponeurotica
Cranial wall
_
,-
Dura mater
Fig. 13. " Section through the Scalp and Cranial Wall.
Crus antihelicis
Fossa triangularis
Darwin's
tubercle h l^^ "'''"' ^MtJj Crus antihelicis
"
c u -J r
^'J^ ,iallm^4 Concha
Scaphoid fossa
Helix
Antitragus
Lobulus
The auricular cartilage extends throughout the entire auricle, with the
exception of the lobule and the portion between the tragus and the helix.
Those portionsare composed merely of integument, fattytissue,and
condensed connective tissue. The shapeof the cartilage correspondswith
that of the auricle itself. It shows the same elevations and depressions,
and by its elasticity it serves to maintain the form of the auricle. But it
also enters into the formation of the cartilaginous or lateral portionof the
external acoustic meatus. By its medial marginthis part of the cartilage
is firmly fixed by fibrous tissue to the rough lateral edge of the auditory
process of the temporal bone, but it does not form a completetube. It is
deficient above and anteriorly, and there the tube of the meatus is completed
by tough fibrous membrane, which stretches between the tragus and the
commencement of the helix.
In a successful dissection of the cartilage of the auricle, two other points
will attract the attention of the student. The firstis a deep slit,which
passes upwards so as to separate the lower part of the cartilage of the
helix,termed the processus helicis caudatus, from the cartilage the anti-
of
tragus. The second is a sharpspur of cartilage which projects forwards
from the helix, at the level of the upper margin of the zygoma ; it is
termed the spinahelicis.
The Ligaments of the Aiiricle. The ligamentsare three bands of
"
fascia. The anterior passes from the spineof the helix to the root of the
zygoma. The superior and posterior are both attached to the cartilage in
the regionof the concha ; the former blends above with the temporalfascia,
and the latteris attached to the mastoid portion of the temporalbone.
The Intrinsic Muscles of the Auricle. The two
"
muscles of the helix,
and the tragicus and the antitragicus, are placed upon the lateral face
of the cartilage. The transversus and the obliquuslie upon the cranial
surface of the auricle.
The musculus antitragicus is the best-marked member of the lateral
It liesupon the lateral surface of the antitragus, and its fibres pass
group.
obliquelyupwards and backwards. Some fasciculi can be traced to the
processus helicis caudatus.
The musculus tragicusis a minute bundle of short vertical fibres
situated upon the lateral surface of the tragus. When well developeda
slender fasciculus may sometimes be observed to pass upwards from it to
the anterior part of the heUx, where itis inserted into the spine of the helix.
The musculus helicismajor is a well-marked band, which springs from
the spinahelicis, and extends upwardsupon the anterior part of the helix,
to be inserted into the skin which covers it.
The musculus helicis minor is a minute bundle of fleshy fibres which is
placedupon the crus helicis as it crosses the bottom of the concha.
The musctdus transversus auricula is found upon the cranial aspect of
the auricle. It is generally the most strongly developed muscle of the
series, a nd its fibres bridge across the hollow which, on this aspect of the
auricle,corresponds to the antihelix.
^
In most cases it will be advisable to defer this part of the dissection till
the body is turned on its back for the second time, and to proceedat once to
the dissection described on p. 47.
AURICLE 47
Fig. 15.
SCALP 49
PLATE I
VOL. Ill-
50 HEAD AND NECK
of the medial cord are the medial head of the median and
the ulnar nerve, and the cord
posterior divides into the axillary
Fig. i6. " Dissection to show the General Relations of the Brachial Plexus.
(O.T.circumflex)
nerve and the radial (O.T.musculo-spiral).
In addition to the terminal branches,collateral branches are
iiT " 4 a
54 HEAD AND NECK
Dissection.Make "
a median longitudinal incision from the
external occipitalprotuberance to the seventh cervical spine,
and a second incision laterally from the seventh cervical spine
to the acromion,and throw the flaplaterally.When that has
been done the posteriortrianglewill be exposed from behind,
and the dissector should take the opportunity of noting the
positionsof the contents and the constituent parts of the floor
from that aspect. Afterwards he must look for the superficial
nerves in the superficial fascia over the upper part of the trapezius.
If the greater occipital nerve was not found duringthe dissection
of the scalp,secure it at once, as it piercesthe deep fascia covering
the upper end of the trapezius,about midway between the
external occipital protuberance and the posteriorborder of the
mastoid portionof the temporal bone ; trace it upwards through
the dense superficial fascia of the scalp,and clean the branches
of the occipital artery which are distributed in the same region.
The third occipital nerve will be found in the superficial fascia
between the greater occipital and the median plane. It is the
medial division of the posterior ramus of the third cervical nerve,
III " 4 b
56 HEAD AND NECK
and it
suppliesthe skin of the medial and lower part of the
portion of
posterior the scalp and the adjacent part of the skin
of the back of the neck. Trace it upwards to its termination,
and downwards to the point where it piercesthe deep fascia
covering the trapezius. At a stilllower level look for the medial
divisions of the posteriorrami of the other cervical nerves.
They are variable in number and position, but those which are
artery emerges
from between the trapezius and the sterno-mastoid, at the apex
of the posterior triangle,or piercesthe upper part of the
trapezius, its terminal part piercesthe deep fascia of the
back of the neck and enters the fascia
superficial of the
posterior
part of the scalp. It anastomoses with its fellow of
the oppositeside,and with the auricular
posterior and the
temporalarteries.
superficial As a it breaks
rule, up into two
main branches,a lateral and a medial. The medial branch
givesoff cutaneous twigsand a meningealbranch,which passes
throughthe parietal foramen and anastomoses with a branch
of the middle meningealartery. Through the same foramen,
passes an emissary vein which connects the occipitalveins
with the superior sagittal(longitudinal) sinus.
Musculus Trapezius. The trapezius
" and latissimus dorsi
constitute the first layerof the muscles of the back. Only
that part of the trapezius which lies above the level of the
seventh cervical spinebelongsto the dissector of the head and
neck ; the lower part and the latissimus must be cleaned by
the dissector of the arm, but the dissector of the head should
take the opportunity
to revise his knowledge of the whole
originand insertion of the trapezius.It arises from the
medial third of the superior
nuchal line of the bone.
occipital
THE DISSECTION OF THE BACK 57
M. capitis
semispinalis
Occipital
artery (O.T. complexus)
M. auricularis
posterior
M. splenius
capitis
I'hird occipital Posterior
auricular nerve
Parotid gland
M. trapezius
jcsser occipital
nerve
M. sternomastoideus
Great auricular nerve
M. levator scapulae
root of the scapular spine, and which is inserted partly into the
lower lipand partly into the upper lipof the spine.The muscle
is supplied by the accessory and the third and fourth cervical
nerves. It draws the scapulamedially and braces the shoulder
backwards, raises the tip of the shoulder, or depressesthe
scapulaand turns the glenoidfossa upwards, accordingto
whether the middle,the upper, or the lower fibres are mainly
in action.
Dissection. On the second
"
day after the subjecthas been
in conjunctionwith the dissector
placed on its face,the dissector,
of the superior extremity,must reflect the trapezius muscle.
First separate the muscle from the occipital bone, and then divide
it about half an inch from the spines of the vertebrae. The
muscle can now be raised and thrown laterallytowards its
insertion. On its deep surface the accessory nerve, the twigs of
supply from the third and fourth cervical nerves and the ing
ascend-
branch of the transverse cervical artery will be noticed. It
is the duty of the dissector of the upper limb to dissect the
structures mentioned, but the dissector of the head and neck
should trace the artery to its originfrom the transverse cervical
artery.
The attachments of the levator scapulaealso must be defined.
Two twigs from the third and fourth cervical nerves, which lie
on its surface and finally enter its substance,have already been
secured. Further, passing downwards under cover of the
levator scapulaemuscle, the dorsal scapular nerve (O.T. nerve
to the rhomboids) and the descending branch (O.T. posterior
scapular) of the transverse cervical artery will be found. Almost
invariably the dorsal scapular nerve gives one or two twigs to
the levator scapulae.
The levator scapulae,the rhomboids, the posterior serrati and
the splenius are classed as muscles of the second layer. The
rhomboids and the lower part of the levator belong to the dis- sector
of the arm ; the remaining muscles are the property of
the dissector of the head and neck.
M. sacro-
spinalis
M. quadrati
liimljorum
M. psoas ma
M. transversus
abdominis
M. obliquus
intern us
M. obliquus
externus
Fascia
transversalis
Fig. 1 8. "
The Third Layer of Muscles. Under this head are included a series
"
The Longissimus is the middle and largest of the three muscle columns.
It extends upwards, through the thoracic and cervical regions, to the head,
and it also is separable
into three segments : longissimus dorsi, longissimus
and longissimus
cervicis, capitis.
Dissection. The interval between
" the longissimus and the
i s
spinalis frequently difficult to define, but if the fascia is care-
fully
attached to the tipsof the transverse processes of the thoracic and the
accessory processes of the lumbar vertebrae, and a lateral row of muscular
slips which are inserted into the lower ten ribs,on the lateral sides of their
tubercles, a nd to the transverse of the lumbar vertebrse, and to
processes
the posterior surface of the middle lamella of the lumbar fascia.
Lon^ssimusCervicis (O.T. Transversalis Cervicis). The cervical "
THE DISSECTION OF THE BACK 65
of the longissimus
portion from
springs the transverse processes of the upper
four thoracic vertebrae, and is inserted into the posterior tubercles of the
transverse processes of the cervical vertebrae from the second to the sixth
inclusive.
LongissimusCapitis(O.T. Trachelo- mastoid). The longissimus "
capitis
liesin the neck, under cover of the splenius. It arises, in common with the
longissimus cervicis, from the transverse processes of three or four of the upper
thoracic vertebrae, and, in addition,from the articular processes of a like
number of the lower cervicalvertebrae, Thenarrow, fleshy band which results
is inserted into the posterior part of the mastoid portionof the temporal
bone, under cover of the splenius capitis and sterno-mastoid muscles.
Musculus Spinalis. The spinalis muscle
"
is the most medial,shortest,
and weakest of the three columns, and the most difficultto define. Below,
it is intimately blended with the longissimus dorsi,but it may be regarded
as takingoriginby four tendons from the spines of the upper two lumbar
and lower two thoracic vertebrae. The tendons end in a small muscular
belly,which is inserted by a series of slips into a very variable number of
the upper thoracic spines.It is closely connected with the subjacent semi-
spinalis dorsi.
SpinalisCervicis. This upward prolongation
" of the spinalis is not
alwayseasy to define. It springs from the spines of the lower four cervical
vertebrae and is inserted into the spinesof the second, third,and fourth
cervical vertebrae.
The various segments of the sacro-spinalis are supplied by the posterior
rami of the spinal nerves. When the segments on one side only act they
bend the vertebral column to that side, but when the segments on both
sides act simultaneously theybend the vertebral column backwards.
Dissection. The occipital
"
artery has already been seen
process
the second part of the occipital is
artery very deeplyplaced;
indeed,no to it. These
less than five structures liesuperficial
are (enumeratingthem in order from the vessel to the
surface)(i)the origin
"
of the posterior bellyof the digastric
muscle ; (2)the mastoid process ; (3) the longissimuscapitis;
(4) the spleniuscapitis; and (5) the sterno-mastoid.^ As
the artery runs backwards,it very soon emerges from under
cover of the firstthree of the structures mentioned,and a
littlefarther on it leaves the shelter of the and is
splenius,
then covered by the sterno-mastoid alone. Issuingfrom
^ and the
It is not uncommon to find the artery between the splenius
longissimuscapitis,
as in Fig. 20.
VOL. Ill 5
66 HEAD AND NECK
Posterior atlanto-
membran-
occipital Posterior arch of atlas
Posterior ramus of
sub-occipital
nerve
Greater occipital
nerve
Ligamentum nuchae
Vertebral artery.
Anterior rami
of spinalnerves-
Posterior rami of spinal
nerves
spinalis,
and are concerned in the supply of that muscle,
and also of the lumbar intertransverse muscles. The lateral
divisions of the upper three lumbar largesize, nerves are of
theybecome cutaneous by piercing the superficiallamella of
the lumbo- dorsal fascia. They have alreadybeen traced by
the dissector of the lower limb to the skin of the gluteal
region. The lateral division of the fifth communicates with
the corresponding branch of the firstsacral nerve.
Blood Vessels of the Back. " In the cervical regionthe
dissector has alreadynoticed the arteria profundacervicis,
and the descending branch of the second part of the occipital
artery. Deep in the sub-occipital regionhe will subsequently
meet with a small portion of the vertebral artery. In addition,
however, minute twigsfrom the vertebral artery may be
discovered, in a well -injected subject, passingbackwards in
the intervals between the transverse processes, and also in
the sub -occipital
space. They supply the muscles, and
anastomose with the other arteriesin that region.
In the thoracic regionthe branches of the aortic
posterior
intercostal arteries and superiorintercostal artery make
their appearance between the transverse processes. Each of
them passes in
dorsally the interval between the body of a
viz.,(i) from the deep surface of the aponeurotic originof the sacrospinalis ;
(2) from the posterior surface of the sacrum, as low as the fourth aperture ;
(3) from the posterior sacro-iliac ligament ; (4) from the posterior superior
spine of the ilium ; and (5) from the mamillaryprocesses of the lumbar
vertebrae. In the thoracic regionittakes origin from the transverse processes
of the vertebra2, and in the cervical regionfrom the articular processes of at
least four of the lower cervical vertebrae. Each of the bundles of which the
multifidus is composed passes upwards and is inserted into the whole length
of the lower border of the spine of the second, third, or fourth vertel)ra
above. The insertions extend from the fifthlumbar vertebra to the second
cervical vertebra.
Musculi Kotatores. " The rotator muscles are a series of small muscles
which are exposed when the multifidus is pulledaside. In the thoracic
region each muscle springs from the root of a transverse process, and is
inserted into the lamina of the vertebra immediately above, close to the
root of the spinousprocess. Somewhat similar muscles have been
described in the cervical and lumbar regions, a nd also a series of longer
developed are found onlyin the lower three or four spaces. In the cervical
"
of the sub-occipital
nerve (Fig.20).
The Actions of the Deep Muscles of the Back. " The
dissector will have noted that many of the deep muscles of the
back,such as the various prolongations of the sacro-lumbalis,
run vertically upwards; others run upwards and medially,
viz.,the semispinalis dorsi and cervicis and the multifidus
spinse.A third group, exemplified by the splenius capitisand
cervicis,
the serratus posteriorinferior and the inferior oblique
muscle, run upwards and laterally. When the muscles which
run verticallyupwards contract, on one side only,theybend
the vertebral column to that side,but if the muscles of both
sides act simultaneously
they bend the vertebral column
backwards. When the muscles which run upwards and
laterally
contract they turn the head or trunk to the same
posterior the
recti, obliquemuscles,and the semispinalis
two
continuous
directly with the investments
corresponding of
the brain.
Dissection. The outer surface of the dura mater
" must now
be cleaned. This is effected by the removal of the loose areolar
tissue,soft fat,and posteriorinternal vertebral from the vertebral
canal. It is necessary, also,to define carefullythe numerous
lateral prolongations which the membrane gives to the spinal
nerves.
Dura mater
^Arachnoid
Ligamentum denticulalum
Dura mater
Anterior nerve-root
(cut)
Posterior nerve-root
Arachnoid
Anterior nerve-root
(cut)
Ligamentum
Posterior nerve-roof _,
denticulatum
Spinalganglion
Anterior ramus
of nerve
Fig. 21. " Membranes of the.Medulla Spinalis (O.T. SpinalCord), and the
mode of originof the SpinalNerves.
6
82 HEAD AND NECK
above and below than in the thoracic region connect the tube "
In the
anterior ment
compart-
the anterior
nerve-roots pass
; the
laterally terior
pos-
compartment
contains the terior
pos-
nerve -
roots,
and is imperfectly
subdivided into two
lateral subdivisions
by the septum sub-
arachnoideale.
Fig. 22. Lateral view of the Medulla Spinalis, Medulla Spinalis
"
14 mm.) opposite
the fifth or sixth
cervical vertebra, Conus
and subsides posite
op- L.V.I. meduUaris
the second
thoracic vertebra.
The lumbar largement
en-
is nected
con-
with the
nerves of the in-
ferior
extremities.
It beginsat the
level of the tenth
thoracic vertebra,
attains its maxi-
mum
transverse
diameter (11 to
13 mm.) opposite s.v.i.
the last thoracic
vertebra,then it
rapidly tapers
into the conus
medullaris.
Filum Termin-
ale. " The cate
deli-
thread - like
terminal filament
lies amidst the
Fig. 23. section through the
Sagittal lower part
long
"
numerous
of the Vertebral Canal.
nerve-roots which
occupy the lower part of the vertebral canal,but it can
line and
straight at the bottom of a slightfurrow. The fila
of the anterior root, on the other hand, are not so regularly
placed. They emerge from the medulla spinalis an area over
'A
ramus.
The origins
of the eightcervical nerves lie between the
level of the atlas and the level of the spine of the sixth
cervical vertebra ; the originsof the firstsix thoracic nerves
The lower six cervical nerves, the thoracic nerves, and the
lumbar nerves make their exit through the intervertebral
foramina ; whilst each of the two rami of the
upper four
sacral nerves finds its way out by a sacral foramen. The
upper two cervical nerves, the fifth sacral nerve, and the
coccygealnerve, however, follow a different course. The
sub-occipital
emerges by passingover the posteriorarch of
the and
atlas, the second cervical nerve by passingover the
vertebral arch of theepistropheus (O.T. axis). The fifth
sacral and the coccygealnerve leave the sacral canal through
its lower aperture (Fig.25).
Dissection. The nerve-roots
" of one or two spinalnerves in
each should
region be followed into the corresponding inter- vertebral
foramina. That can be easilydone by snipping away
the articular processes with the bone-forceps. The positionof
the ganglionon the posterior root, the connections of the sheath
of dura mater, the union of the two roots to form the spinalnerve-
trunk,and the division of the trunk into the anterior and posterior
rami can then be studied. An attempt should also be made, at
the same time, to discover the minute ramus meningeus. It
is a fine twig which is formed by the union of a small filament
from the spinal nerve-trunk with a minute branch from the
sympathetic trunk. It takes a recurrent course through the
intervertebral foramen to end in the bones and periosteum and
meninges of the vertebral canal.
the posterior
arch of the first and the vertebral arch of the
second cervical vertebrae, ; the gangliaof
respectively the
sacral nerves are placed within the sacral canal,but side
out-
the tube of dura mater. The ganglionon the posterior
root of the coccygeal
nerve is inside the tube of dura mater.
Filum terminale
Cauda equina
Dura mater
i ilum
terminale
Fifth sacra! nerve
Coccygealnerve
Fig. 25." The Sacral Nerve-roots (lowerpart of Cauda Equina) and the
Membranes in relation to them. (AfterTestut. ) The posterior
wall of
Sacral Canal has been removed.
How to the
distinguish anteriorfrom the posterior of
surface
the medulla spinalis.
Anterior Surface. Posterior Surface.
Fasciculus gracilis
Posterior funiculus. I /Fasciculus cuneatus
Entering filaof
posterior
nerve-root
Posterior column of
Formatio SSSESi!!?^\^^3^SW\'''-^^^^
reticularis-^ gi'"=ymatter
Lateral funiculus
Central canal
Root of accessory
Root of accessory
nerve
nerve
Anterior column of
grey matter
Fila of anterior
nerve-root
Anterior funiculus
Fig, 26. " Transverse section through the upper part of the
Cervical Region of the Medulla Spinalis.
correspondingfurrow on the
anterior part of each half of
the medulla spinalisin connection with the emergence of
the fila of the anterior nerve -roots ; and it should be noted
that the anterior root fila emerge over a broad
relatively
area, which correspondsin its width to the thickness of the
anterior
subjacent column of grey matter (Fig.26).
Grey Matter of the Medulla Spinalis. The grey matter "
in
the interior of the medulla has
spinalis the form of a fluted
column. When seen in transverse section,it presents the
shape of the letter H. In each half of the medulla spinalis
there is a of grey
matter, comma-shaped
mass section in
with the concavitydirected laterally.The grey columns of
oppositesides are connected across the median plane by a
transverse band, which is called the grey commissure. The
94 HEAD AND NECK
posterior
commissure;the portionanterior to it receives the
name of anterior grey commissure.
In each lateral mass of grey matter certain well-defined
parts may berecognised.The projecting portionswhich
extend and anterior to the connectingtransverse
posterior
grey commissure are termed the and
posterior the anterior grey
columns. They can be distinguished
from each other at a
glance.
anterior grey column is short,thick,and its anterior
The
marginis very blunt. Further,itsanterior marginis separated
from the surface by a moderatelythick coatingof white matter,
throughwhich the filaof the anterior nerve-roots pass on their
way to the surface. The thickened anterior margin of the
anterior column is termed its head^and the constricted part
close to the grey commissure is called the neck, l^he posterior
attached particular
to part of the medulla spinalis,
a there a
increase of the grey matter may be noticed. It
corresponding
follows that the districts in which the grey matter bulks
most largelyare the lumbar and cervical enlargements.
The great nerves which go to form the limb plexusesenter
and pass outportionsof the medulla spinalis.
from those In
the intervening thoracic regionthere is a reduction in the .
Thoracic nucleus
posterolateral
cus,
sul-
(O.T. posterior whilst, teriorly,
an-
vesicular column)
Lateral column
it extends
surface of
posterior the
funiculus of the medulla spinalis.
It indicates the position of a septum which passes into the
funiculus from the deep surface of the pia mater and divides
it incompletely into two unequal strands. The groove is
termed the intermediateposterior
sulcus. The strand on its
medialside is \he fasciculus (Goll's),
gracilis whilst the lateral
and larger
strand receives the name of the fasciculuscuneatus
(Burdach's).
The white matter of the medulla increases steadily
spinalis
in quantity
from below upwards.
Fasciculus gracilis
Postero-median septum- Fasciculus cuneatus
Postero-lateral sulcus-
Substantia gelatinosa
Rolandi
Fasciculus spino-
Fasciculus cerebro-. cerebellaris posterior
spinalislateralis
Fila of originof
the accessory nerve
Fasciculus cerebro
anterior Antero-median fissure
spinalis
Fig. 28. " Transverse section through the upper cervical part of the Medulla
of
Spinalis a full-time Foetus, treated by the Pal-Weigertprocess.
The fasciculi, gracilis and cuneatus, which form the posterior funiculus
of the medulla spinalis, are composed of fibreswhich enter the spinal medulla
as the filaof the posterior nerve-roots. In the lower portion of the medulla
spinalis the two fasciculiare not marked off from each other.
In the lateral and anterior funiculi of the adult spinal medulla it is not
possible with the naked eye to distinguish the different strands of fibres of
which theyconsist, but the student should remember that such strands or
tracts are present. The three best-defined tracts in the antero-lateral part
of the spinal medulla are, (i)the fasciculus spino-cerebellaris (O.T. direct
cerebellar tract) ; (2) the fasciculus cerebro-spinalislateralis (O.T. crossed
pyramidaltract); (3)the fasciculus cerebro-spinalis anterior (O.T. direct
pyramidaltract).
The. fasciculus discexids,
spino-cerebellaris to the cerebellum in the postero-
lateral
part of the lateral funiculus. Traced in the opposite direction, it
is found to disappear in the lower thoracic regionof the medulla spinalis.
The fasciculus cerebro-spinalis lateralis occupies a largerdistrict of the
medulla spinalis. It is placed in the lateralfuniculus, anterior to the pos-
terior
column of grey matter and immediately medial to the fasciculus spino-
cerebellaris. As the fasciculus spino-cerebellaris disappears in the lower
part of the medulla spinalis the fasciculus cerebro-spinalislateralis comes
to the surface, and it can be traced as low as the fourth sacral nerve. The
fasciculus cerebro-spinalis anterior forms the narrow stripof the anterior
VOL. Ill 7
98 HEAD AND NECK
After the body has been five days on its face it will be
replacedupon its back,with the thorax and pelvis supported
by blocks ; and the dissectors of the head and neck should at
once proceedto clean the temporalfascia, and afterwards to
remove the brain and study the interior of the cranium.
^
The term
"
lambda "
^he
signifies apex of the occipital
bone, or the point
at which the sagittal
and lambdoidll sumres meet.
niL^bu MhDIOL STd^aai
showingthat a number of small veins from the cranial bones
have been ruptured.The adhesion between the
degreeof
dura mater and the inner surface of the cranial bones varies
in different subjectsand in different localities. In all cases
it is strongly adherent along the lines of the sutures, like
the pericranium it ismuch
and,further,
externally; more firmly
attached to the base than to the vault of the cranium. In the
child "
indeed,as longas the bones
ing
grow- of the cranium are
"
more it is
adherent than in the adult ; and it is more
/
/
Fig, 30. " Median section throughthe Frontal Bone and correspondingpart of
the SuperiorSagittalBlood Sinus. The arachnoideal granulations
are
.vesselsof
also- the .nutrient table and diploe
thsiinjier of the
;crari:ial
bones (Fig,
32).*^
-' - "
\ ,^
Dura mater
Superiorsagittal
sii
Pia mater
Subarachnoid space
Arachnoid
Ix cerebri
Anterior branch of
mid. meningeal arte
and accompanying
Cerebral vein
rachnoideal
granulation
Posterior bran
of mid. mening
rtery, with vei
Arachnoideif
jvering cerebral
vein
Opening of a super]
cerebral vein
Cerebral veiir
of
portions the veins are directed forwards,whilst the blood
in the sinus flows backwards.
Ill " 7c
I04 HEAD AND NECK
Dissection. expose
"
the falx cerebri divide the
In order to
superior cerebral veins,on each side, and displace the upper
parts of the hemispheresof the brain laterally.
Falx cerebri
Inferior sinus
sagittal
Superiorsagittal
Cavernous sinus sinus
Tentorium ,
Straight
I'lansverse sinus
Falx cerebelli
Transverse sinus
Inferior petrosalsinus Superiorpetrosalsinus
Fig, 33. "
Sagittal
section through the Skull, a littleto the left of the
median plane,to show the processes of Dura Mater.
V. Trigeminalnerve. IX. Glossopharyngeal
nerve.
Falx Cerebri
(Figs.
33, 34). The falx cerebri is a "
sickle-
of the inner layerof the dura
shaped reduplication mater
which descends, in the median plane, between the two
cerebral hemispheres. it is
Anteriorly, small, and it is
attached to the crista galli
of the ethmoid bone. As it
passes backwards it increases in vertical extent, and the
lower border of its posterior portionis attached,in the
median the upper surface of the tentorium cerebelli.
plane,to
The anterior part of the falx is frequently cribriform,and
is sometimes perforated
by apertures to such an extent that
REMOVAL OF THE BRAIN 05
Falx cerebri
Cerebral
^''^fossa
Tentorium
Transverse
sinus
Transverse sinus
Cerebellar fossa Cerebellar fossa
^
For alternative method see p. 115.
io6 HEAD AND NECK
"
knife backwards through the falx cerebri along its line of union
with the tentorium. Then the falx cerebri must be cut away
from the occipital bone, and as that is done the posterior
part of the superiorsagittalsinus will be opened up. After
the falx has been removed the rightand left transverse and the
rightand left superiorpetrosalsinuses must be opened by incisions
carried along the attached border of the tentorium (Fig.36).
The dissectors will probablyfind that the superiorsagittal sinus
turns to the rightand becomes continuous with the righttrans-
verse
sinus,whilst the posteriorend of the straight sinus turns
to the left and joins the left transverse sinus. In a certain
number of cases that arrangement is reversed,and not uncom- monly,
as in the specimen shown in Fig.36, there is a communi-
cation
between the rightand left transverse sinuses across the front
of the internal occipital protuberance. Occasionally the superior
sagittal, the two transverse sinuses,the straightsinus,and the
occipital sinus unite,anterior to the internal occipital ance,
protuber-
in a common dilatation,the confluenssinuum (O.T.
torcular Herophili).The transverse sinus,on each side,runs
from the internal occipital protuberance to the lateral end of
the superior border of the petrous part of the temporal bone,
where it dips downwards into the posteriorfossa,and at the
same point it is joined by the superiorpetrosalsinus,which
runs postero laterally, along the superiorborder of the petrous
part of the temporal bone, from the cavernous sinus to the
transverse sinus,connecting the two together.
With the point of the scalpelopen the spheno-parietal sinus,
which runs along the posteriorborder of the small wing of the
sphenoid, and trace it medially to the cavernous sinus. fully
Care-
dissect the lateral wall of the cavernous sinus and find in
it :" the oculomotor nerve, dividinginto two branches ; the
slender trochlear nerve, crossingthe lateral side of the oculomotor ;
the ophthalmic division of the fifth and itsthree terminal branches
"
naso-ciliary, lacrimal,and frontal. Remove the remains of
the lateral wall and expose the internal carotid artery and the
abducens nerve (p. 234). Then remove the dura mater from
the lateral part of the middle fossa on one side to expose the
semilunar (O.T. Gasserian) ganglion of the trigeminalnerve ;
the middle meningeal artery and its two terminal branches ; the
accessory meningeal artery, if it is present; and the greater
superficialpetrosal nerve. Commence immediately to the
lateral side of the anterior part of the free border of the ten- torium,
where a cut through the inner layer of the dura will
open into a space between the two layersof the dura in which
lies the semilunar ganglion. From the postero-medial border
of the ganglion the sensory root passes backwards into the
posteriorfossa to enter the pons ; and from its anterior-lateral
border the ophthalmic branch passes upwards and forwards in
the lateral wall of the cavernous sinus, the maxillary branch
runs forwards to the foramen rotundum, and the mandibular
branch passes downwards into the foramen ovale. By the
side of the mandibular nerve the accessory meningeal artery
may be found entering the cranium ; and a little further
posteriorly the middle- meningeal artery will be seen passing
into the middle fossa through the foramen spinosuni. After
enteringthe cranium the middle meningeal artery runs forwards
no HEAD AND NECK
attached border
Abducent nerve
Tent, cerebelli,ant. end
of free border /'J^'^ Trochlear nerve
Spheno-parietal sin
Trigeminalnerve
sinus
Inferior petrosal
Facial nerve
Superior
petrosal sinu-
Middle /y,/j ^A.coustic
nerve
meningeal
artery
^V,,l,^",so-
pharyngeal
Sigmoidpai
transverse siiu.-"
Basilar N'agusnerve
Ligamentuni denticulatui
First cervical nerve
Occipital
sinu
Transverse sinus Spinalmedulla
Fig. 36."Dissection of the Interior of the Cranium after the removal of the
brain and the tentorium cerebelli.
Trochlear nerve
Abducens nerve
Sensoryroot of
facial nerve
Acoustic nerve
Right transverse
Mnus
losso-pharyngeal
nerve
Vagus nerve
Accessory nerve
Vertebral artery
Hypoglossal nerve
First spinalnerve
Accessory nerve
Fig. 37. " Section through the Head a little to the right of the median
plane. It shows the posterior cranial fossa and the upper part of the
vertebral canal after the removal of the brain and the medulla spinalis.
and the abducens nerve piercesthe dura mater below and to the
medial side of the opening for the trigeminal nerve, opposite
the side of the base of the dorsum sellse. The small trochlear
nerve piercesthe inferior surface of the free border of the ten-
torium
at the point where it is crossingthe attached border.
sinus 36).
(Fig. ^^-^
"
connected together,
across the upper surface of the basilar
part of the occipital
bone,by a plexusof small venous channels,
to which the term basilar plexus is applied. Unless the
channels happen to be distended with blood the dissectors will
probablybe unable to the plexus(Fig.36).
display
The dissectors should note that the dura mater is much
more attached
firmly to the bones of the base than it was to
sinuses,
spheno-parietal which run along the posteriorborders
of the small wingsof the sphenoidbone.
Six sinuses lie in a lower horizontal plane: (i ) the two
cavernous sinuses,
at the sides of the
body of the sphenoid;
(2)the two superior
petrosalsinuses,
alongthe upper borders
of the petrous parts of the temporal bones, in the anterior
parts of the attached border of the tentorium cerebelli; (3)
the horizontal parts of the transverse in
sinuses, the posterior
ii6 HEAD AND NECK
Emissaria. "
Emissary veins are blood channels which
connect the sinuses of the dura mater with the veins which
lie-outside the cranium.
They are: (i) Emissaryveins con-
nected
Fig. 38." Radiograph of Half a Head in which the various fissures, etc.,
shown have been made visible by metal filaments, by cords impregnated
with metallic powders, or by means of metallic powder.
Anterior cHnoid
process
Internal carotid
artery
"
Dorsum sellae
Occipito-sphenoid
synchondrosis
Floor of physeal
hypo-
fossa
relation of the internal carotid artery to the base of the skull. The
{a)a
vein which traverses the foramen ovale,or the foramen Vesalii,
and connects the cavernous sinus with the plexusof veins
around the external
pterygoidmuscle ; {b)a plexus of veins
which passes through the temporal bone with the internal
carotid s^Btery, and connects the cavernous sinus with the
pharyngeal venous plexus; {c)in a sense, the ophthalmic
vein may be considered an emissary vein,for,althoughunder
ordinary circumstances it is a tributary of the sinus,blood can
flow throughit, in the oppositedirection, from the sinus into
the orbit, and then along the tributaries which connect the
ophthalmic vein with the angularvein,and along the channels
which connect the ophthalmicvein, through the inferior
orbital fissure, with the veins in the infratemporal region.
The Arteries of the Cranial Cavity. (i) The vertebral "
Then it runs in
forwards, the cavernous sinus,to the medial
side of the anterior clinoid process, where it turns upwards,
pierces the inner layer of the dura mater and the arachnoid,
and givesoff its ophthalmicbranch,which runs forwards
below the opticnerve into the orbit. The artery was cut
arteries.
Each meningealartery is a branch of the corre-
middle sponding
Dissection. Cut
away
" the overhanging margins of the dia-
phragma carefullydislodgethe hypophysis from the
sellae and
fossa fossa)of the sphenoid bone ; then,
hypophyseos (pituitary
I20 HEAD AND NECK
the body of the sphenoid bone below the fossa. They are gener-
ally
of unequal size and may be replaced in some cases by a
singlecavity. Attempt to pass a probe through the aperture in
the anterior wall of each sinus into the corresponding section of
the nasal cavity(Fig.no).
After the
skull-cap has been replacedand the scalp has
been stitched over it,let the head hang down over the end of
the table,pull the chin as far from the sternum as possible
and fix it in with
position hooks. Then examine the regionof
the front of the neck. It is a largetriangular
area, bounded
by the anterior borders of the sterno-mastoid muscles,
laterally
above by the lower border of the mandible,and below by the
middle part of the upper border of the manubrium sterni ; and
it is divided by the median plane into two smaller subsidiary
the
triangles, anterior of the neck,each
triangles of which is
bounded above by the mandible, behind by the sterno-
hyoid to the
mylo-hyoid line of the mandible. In front of the
anteriorbelly of the digastric, the two layers blend with the
singlelayer of deep fascia which covers the lower surfaces of
the mylo-hyoid muscles. Behind the posteriorbelly of the
digastricthey unite with the connective tissue in which the
carotid vessels are embedded.
When the details of the deep fascia have been examined,the
sterno-mastoid should be studied.
the clavicular,
and half-wayup the neck the two heads
unite into a fleshy
mass which ascends to the mastoid portion
of the temporal bone and occiput. There the muscle
expands somewhat. At its insertion it is thick and tendinous
where it is attached to the and
fore-part lateral surface of the
mastoid it is thin and aponeurotic,
process ; posteriorly and
is inserted into rather more than half of the corresponding
nuchal
superior line of the bone.
occipital In the dissection
of the back, the latterpart of the muscle was detached from
the occiput.
The dissectors should note that the insertion of the
sterno-mastoid into the skull is to the trans-
mainlyposterior verse
axis of rotation of the joint. There-
atlanto-occipital fore
if one sterno-mastoid acts the head is drawn downwards
to that side and the face is turned to the side
opposite and
tilted upwards. If both sterno-mastoids act simultaneously
the head is drawn backwards. The muscle is suppliedby
the spinalpart of the accessory nerve and by the second
cervical nerve.
backwards and search for the arteries which supply it. At the
level of the angle of the mandible the sterno-mastoid branch of
the occipitalartery will be found entering the deep surface of
the muscle.
At the level of the cricoid cartilage the sterno-mastoid branch
of the superior thyreoidartery enters the muscle, and a short
THE ANTERIOR PART OF THE NECK 127
space, called
triangular the submental triangle 44).
(Fig. The
floor of the space is formed by the anterior portionsof the
128 HEAD AND NECK
Platysma
External maxilh
artery
Parotid gland
Anterior facial vein Submental lymp
gland
M. mylohyoideus," Submaxillarygl;
Common facial
Sterno-mastoid a
vein
Lingualvein Ext, carotid art"
Lesser occipital N.
Great auricular N.
Sup. thyreoidai
Common carotid
Nervus
artery
cutaneus colli
Internal jugularvein
Lymph gland
Descending Thyreo-glossalc
cervical
nerves M. omohyoideu
Brachicil \
Inferior
veins
thyreoid M. sternothyreo
Fig. 44. " Dissection of the Front of the Neck. The Right Sterno-mastoid
has been removed.
Posterior facialvein
l,esser occipitalN.
Hypoglossalnerve
Great auricular N.
Transverse
scapulararterj
M. scalenus an
Subclavian arti
Subclavian v"
SuprascapularN
^s" eep Cervical Fascia. " When the sterno-mastoid has been
a deep fascial planeof
reflected, the neck is exposedin which
^ liemany lymphglands. Before carrying
the dissectionfurther
the dissector should reconsider the arrangement of the deep
cervical fascia. He has already seen that it forms a complete
sheath the muscles
enclosing of the neck and the structures
which lie between and under cover of them. The general
arrangement of the fascia is studied best on transverse
sections of the neck made at the level of the isthmus of the
glandand
thyreoid a short distance above the sternum. At
the former level it is
possible (i)a superficial
to recognise
layer,which
pretracheal has been dissected
alreadyin the
median plane, ensheaths the thyreoidgland and blends
111"9 6
136 HEAD AND NECK
with the
postero-laterally medial surface of the carotid sheath.
The prevertebral layer covers the anterior surfaces of the
prevertebral muscles,and, passinglaterally, blends with the
posterior aspect of the carotid sheath ; then, turninground
the tipsof the transverse processes of the vertebrae,it passes
backwards, coveringthe muscles which form the floor of the
posteriortriangle; and itbecomes continuous with the sheaths
of the deep muscles of the back of the neck.
Laterallyand posteriorly, the superficiallayerof the deep
fascia passes upwards over the sterno- mastoid and the
trapeziusto be tached
at-
to the superior
nuchal lines and the
mastoid portionsof
the temporal bones.
In the anterior cervi-
cal
region it is at-
tached
to the body
and the greater
cornua of the hyoid
First layerof deep fascia
bone,and then, as it
Pretracheal layer
Isthmus of thyreoidgland
isprolongedfurther
Prevertebral fascia ]|riiTC
7
upwards,it splits
teriorly
an-
First layer f\\\"^^ to enclose
Second layer ^"'\\
Pretracheal layer";" n
the submaxillary
Left innominate vein ^sh- '
the gland is
submaxillary attached to the lower border of ,
, , , ,1 ,
thyreoidgland.
between the two lamellae has
been called the supra-sternalspace. Its boundaries and tents
con-
Capsule of thyreoid
gland First layerof deep fascia
(blackline) ISheath of thyreoid gland
muscles I(pretracheal
fascia)
Infra-hyoid
Sterno-mastoid
Scalene muscl
mo-hyoid
Trapezius
which pass from the medial side of the loop to the hypo-
glossal
nerve and to the superior cervical ganglion of the sym- pathetic
trunk, which lies behind the upper part of the internal
carotid artery.
After the dissector has defined the loops of the plexus he
THE ANTERIOR PART OF THE NECK 141
Great auricular,
To genio-hyoid
Nervus cutaneus colli
Thyreo-hyoidnerve
Descendens hypoglossi
Branch to levator
scapulae
Branch to levator
scapulae
Ansa hypoglossi
Descendingtrunk
Phrenic
Fig. 50 "
Fig. 51.
THE ANTERIOR PART OF THE NECK 143
PLATE VI
maxillaryartery. artery.
Superior labial branch of ternal
ex- 30- Transverse scapular vessels.
maxillaryartery. 31. First serration of serratus anterior
Inferior labial branch of ternal
ex- muscle.
Omo -
Inferior
thyreoidvein. vein.
Sterno-hyoidmuscle. auriculo-temporalnerve.
Subclavius muscle with nerve.
144 HEAD AND NECK
The muscle is
superficialto the brachial plexus, and the
tendon is superficial
to the phrenicnerve and the scalenus
anterior. The tendon is held in positionby a strong process
146 HEAD AND NECK
proceed study
to the relations of the common carotid and sub- clavian
arteries, t he cervical part of the thoracic duct, and the
dome of the pleura,before those structures are disturbed by the
dissectors of the thorax. Whilst this is being done, the omo- hyoid
Thyreo-hyoidligament M. sternohyoid
eus
Plica
vocalis^^^^^^^^^^
M. thyreohyoideus
Processus vocalis --^^^^^pj^^^^^^^^^^^
Thyreoidcartilage
Arytaenoidcartilage ^^^^^^^(y^l^BS^Km^^^sSi^^^^^
M- omohyoideu?
Platysma y^^^^J"A^^/lt^^K^B^^^^J^^^^^ Recessus piriformis
Posterior wall ,^^^B^^^^^mSK^KK^^'^'''^^i^^^
Superiorthyreoid
of pharynx ./^V^j^B^By/^^oS^aB^^^BKHrt*^ \l"WBi^!^L
Descendens
Retropharyn- Jj^m^MM f^^^^f^^^W^^^yvll^^i^^k.^YPOglossi
geal space jJVKJBj^^fflLv^^K^^^mB^C^-^^^URi^ X^JiP^^^S^^k
Common carotid
Vagus"
Fig, 53. " Transverse section through the Neck at the level of upper
part of Thyreoid Cartilage.
cartilage
; and the vertebral artery lies between it and the
transverse process of the seventh cervical vertebra. On the
THE ANTERIOR PART OF THE NECK 149
M. longuscolli Retro-pharyngeal
space Vertebral artery
Fig. 54. -Transverse section through the N eck at the level of the
Cricoid Cartilage.
oval,reddish-
brown body, placedupon the deep aspect of the common carotid artery at
the pointwhere it bifurcates. To expose it,therefore, the vessel must be
twisted round in such a manner that its posterior surface is turned forwards.
It is closelyconnected with the sympatheticfilaments which twine around
the carotid vessels ; and in structure it is similar in its nature to the
glomus coccygeum, which rests upon the anterior aspect of the coccyx.
It is included,therefore, in the group of ductless glands. Entering it are
numerous minute arterial twigs, which take originfrom the termination of
the common carotid and the commencement of the external carotid. The
in" 10 6
I50 HEAD AND NECK
M. sternohyoideus
M. omohyoideus
M. sternothyreoideus
Sympathetic
M. constrictor
inferior xternal
carotid artery
Thyreoidgland
Internal jugularvein
dragged forwards
calenus medius
M. longus capitis
Vagus nerve
Inferior thyreoid
Phrenic nerve
artery
Recurrent Vertebral vessels
nerve
M. scalenus
CEsophagus anterior
Subclavian
\essels
Transverse scapularand
cervical arteries
Thoracic duct
Pleura
Internal mammary artery and phrenicner
Inferior thyreoidvein
Innominate artery Left innominate vein
laterally
across the root of the neck,posterior to the scalenus
anterior and on the anterior surface of the cervical dome of
pleura,a short distance below its summit. At the outer
border of the firstrib it becomes the axillary
artery.
For purposes the artery is divided into three
descriptive
part extends from the originof the vessel
parts. The first
to the medial margin of the scalenus anterior ; the second
portionlies posterior
to that
muscle ; and the third part
extends from the lateral border of the scalenus anterior to
the outer border of the firstrib.
First Part. Owing to the differenceof origin,
" the relations
of the first portion of the subclavian artery are not the same
on the two sides of the body. The first part of the right
subclavian extends obliquely upwards and laterally, and at its
termination at the medial margin of the scalenus anterior
it has reached a pointabove the level of the clavicle. It is
placedvery deeply. Anteriorly, it is covered by the skin,
superficial fascia, platysma.deep fascia, and three muscular
strata "
viz.,the clavicular originof the sterno-mastoid, the
sterno-hyoid, and the sterno-thyreoid. Three veins and some
nerves are placed anterior to it. At the medial margin of
the scalenus anterior it is crossed by the internal jugular
and vertebral veins,whilst the anterior jugularvein,as it
passes laterally under cover of the sterno-mastoid, is separated
from it by the sternohyoid and sterno-thyreoid muscles. The
nerves which anterior to it are
the vagus, a loop from
cross
(ansasubdavia),
the syrnpathedc and in some cases cardiac
branches of the vagus and sympathetic
as they run to the
III" 10 c
152 HEAD AND NECK
^^
.L^\i,--fBasilar artery
-
Vertebral artery
Vertebral artery
the third part of the subclavian artery. In some cases it is the descend-
ing
branch of the transverse cervical, w hich then arises directly from the
subclavian. In other cases it is the transverse scapular artery.
1. Ascendingcervical. 5. CEsophageal.
2. Inferior laryngeal. 6. Glandular.
3. Tracheal. 7. Muscular.
4. Pharyngeal.
Arteria CervicalisAscendens. " The cervical artery
ascending
5 I ) is a
(Fig. small but constant vessel which runs upwards,in
the interval between the scalenus anterior and longuscapitis,
and givesbranches to the muscles in front of the vertebral
column. It also givesoff spinalbrmiches^which enter the
vertebral canal upon the spinalnerves, and anastomose with
branches vertebral artery. The
from the ultimate distribu-
tion
branches has been noticed already
of the spinal (p.79).
Arteria LaryngeaInferior.The " inferior artery is
laryngeal
a small vessel which accompaniesthe recurrent nerve to the
larynx.
Thetracheal^oesophageal^ and pharyngealbranches supply
the trachea,the gullet, and the pharynx. They are of small
size,and anastomose with the bronchial and oesophageal
branches of the thoracic aorta. The glandularbranches are
usuallytwo iq number. One ascends upon the posterior
lobe of the thyreoid
aspect of the corresponding gland,whilst
the other is givento its base or lower end. They inosculate
with the corresponding vessels of the side,and also
opposite
with the branches of the superiorthyreoidartery. The
muscular branches are a series of irregular twigs given to
neighbouring i nuscles.
VencB Thyreoidece Inferiores.The inferior thyreoidveins do
"
not run in company with the arteries of the same name. Each
is a largevessel
comparatively which comes from the sponding
corre-
External jugularvein
^ " '"- reflected with skin
tysma
Internal jugularvein
Supra-ciavicular
nerves
M. omohyoideus
Transverse cervic
vein
Brachial plexus
Scalenus anterioi
Trans, cervical a
M.
Cephalicvein
sterno
hyoideus Axillaryvein
in the majority
Posteriorly, of cases, the apex of the pleura
in
corresponds, level,with the neck of the firstrib. It forms
a dome-like roof for each cavity, side of the thoracic
and is
strengthenedby a fascial expansion(frequently
termed Stbson's
which covers
fascia), it completely,and is attached,on the
one hand, to the transverse process of the seventh cervical
^-i- ""'^
^^"M^^^^
Parotid duct
Accessory parotidgland
/ M. internus
pterycroideus
Lingu 1 nerv
Mandible
^^M. mylohyoideus
Surface of submaxi
~~"lary gland covered
Mandible by mandible
Surface covered by
ubtnaxillary
duct
Mucous membrane integument and fasciae
Sublingualgland
Tongue
M. mylohyoideus
M. digastricus(anterior
belly)
the mastoid
process, the posterior the
bellyof the digastric,
styloidprocess, and the hyoid muscle.
stylo- The space
extends upwards to the external acoustic meatus, and it is
prolongeddownwards into which
into the carotid triangle,
the lower extremityof the gland descends, for a short
distance,beyond the angle of the mandible. The gland,
however,is more the space and passes for a
extensive than
varyingdistance forwards,beyond the anterior border of the
5.Internal jugular
6. M. stylohyoideus M. quadratus
7. Glossopharyngeal ^x^labiisuperioris
\^Wv^Maxillarysinus
M. zygomaticus
M. buccinatorius
.M. temporalis
^Palatine tonsil
Pharynx
M. stylopharyngeus
M. styloglossus
-Internal carotid
Sympathetic
Fig. 59." Transverse section through the Head at the level of the Hard
Palate. It shows the relations of the parotidgland,etc.
Duct of parotid
Superficial
surface
Posterior border
T\\Q postero-medial
surfaceis marked by a series of sions
depres-
which correspondwith the structures in the medial
postero-
boundary of the parotidspace. Above is a shallow
depression
corresponding with the anterior border of the
mastoid process, and,below the latter,
a groove caused by the
anterior border of the sterno-mastoid. More mediallyis a
the postero-medial
surface glandis separatedfrom theof the
upper parts of the internal jugularvein and the internal
carotid artery,and from the last four cerebral nerves by the
posterior bellyof the digastric, the styloid process and the
muscles attached to it.
The 7nedtal border of the glandlies in the angle between
the postero-medialand the anterior boundaries of the parotid
space, where the styloidprocess, the stylo-hyoidmuscle,and
the bellyof
posterior the digastricdisappearunder cover of
the border
posterior of the internal pterygoidmuscle ; and
Mastoid area
Styloidarea
Facial nerve
Posterior border-''
Sterno-mastoid groove
veins,(3) all
maxillary the terminal branches of the facial
nerve except the cervical,
and (4)by the duct of the gland.
As the dissector examines the
parotidspace he will note
that as the external carotid disappearsunder cover of the
posteriorbellyof the it is placed so far forwards
digastric
that it is also under cover of the posterior border of the
mandible ; and it does not emerge from under cover of the
mandible until it reaches the level of the neck of the bone,
where it appears on the antero - medial surface of the
glandand divides into its two terminal branches. Further,
he will now readilyrecognisethe impossibility
of studying
Anterior part of
superiorborder
Posterior facial vein
Superficial
temporal artery -
Internal maxillary
artery
Internal vein
maxillary
Anterior border
Communication to ex
ternal jugular vein
bellyof
posterior the and
digastric the styloid
process ; and
as both of them are, to a certain extent, under cover of the
mandible it is obvious that the mandible must be removed.
That will be done
duringthe dissection of the temporaland
which must now
regions,
infratemporal be proceededwith.
bone,and
of the parietal to the temporal
anteriorly line of the
frontal bone. As it approaches
the arch,itspHtsinto
zygomatic
two laminae,which are separatedfrom each other by a narrow
interval filled with fat. The two laminae are attached one to
the upper border of the zygomaticarch and the posterior
border of the zygomatic bone, and the other to the medial
surfaces of those portionsof bone.
two They can readily
be demonstrated by dividingthe superficiallayerclose to its
attachment, and throwingit upwards ; by the handle of the
knife the attachment of the deep layercan then be made out.
In the upper part of its extent, the temporalfascia is com-
paratively
the masseter forwards and secure its nerve and artery of supply
which pass to it through the incisura mandibularis,behind the
tendon of the temporalmuscle. To displaythe temporal muscle,
70 HEAD AND NECK
and it
upwards with the attached temporal muscle.
turn A
very oblique cut is required; it should extend from the centre
of the incisura mandibulae above, downwards and forwards,
to the point where the anterior margin of the ramus meets the
body of the mandible. First use the saw, and then complete
the division with the bone forceps. The buccinator nerve
M. temporalis
,
Deep temporal nerve
Deep temporal artery
Superficial
temporalartery
Auriculo-temporal
nerve
M. pterygoideusexternus
Middle meningealartery
Mastoid process
External carotid
muscles.
pterygoid The Deep Temporal Branches are two in
number " anterior and posteriory
they pass upwards in Vhe
temporal fossa,between the bony wall of the cranium and the
temporalmuscle. They supplytwigsto the temporalmuscle,
and they anastomose with the middle temporalartery. The
Buccinator Branch accompanies the buccinator nerve, and
is distributed to the buccinator muscle and the mucous
[. Capsulaarticularis. 2. Lig.spheno-mandibulare.
Lig.temporo-mandibulare. 3. Lig.stylo-mandibulare.
Discus Articularis.
The articular
capsule cavity.Above, it is
encloses the joint
attached posteriorly,
laterallyand mediallyto the margin of
the mandibular to the anterior margin
fossa,and, anteriorly,
of the articular tubercle. Below, it is attached to the neck of
Tuberculum articulare
Upper jointcavitj'
Discus articularis
Lower jointcavity
Capsule \
Mastoid process
Styloidprocess
Tympanic plexus
Tympanic branch of
glosso-pharyngeal
.
Anterior deep temporal
Chorda tympani
Buccinator nerve
Auriculo-temporal ^
Stylo-glossus
Communication to hy poglos
Mylo-hyoid nerve
Submaxillaryganglion
Hyoglossus
Genio-glossus
Mental branch
Mylo-hyoid muscle
Incisivebranch
Branches of mylo-hyoid nerve J
Digastric
6^). In
luscle (Fig. some cases the buccinator nerve pierces
the temporalmuscle instead of passingunder cover of it.
The division
posterior of the mandibular nerve consists
mainly of sensory but it stillcontains
fibres, a few motor
fibres which ultimately
pass into its alveolar branch and
thence to the mylo-hyoid
nerve.
Nervus Auriculo -
Temporalis. " The auriculo -
temporal
nerve springsby two roots from the posterior
division of
the mandibular nerve, under cover of the external pterygoid.
The two roots are composed of sensory fibres and
each
receives a communication from the otic ganglion,
by means of
which it is brought, indirectly,into association with the glosso-
pharyngeal
nerve. The roots embrace the middle meningeal
artery,and unite posterior to it to form a stem which runs
backwards between the neck of the mandible and the
spheno-mandibular ligament.At the intervalbetween the ear
and mandible it turns upwards, in relationto the antero-medial
surface of the parotid gland,crosses the zygoma in company
with the superficial temporalartery,and enters the scalp,
where it breaks up into terminal branches (Fig. 51).
Its branches are: (i) one or two strong branches of
communication tothe upper division of the facial nerve; (2)
a few slender filaments which enter the posterior aspect of
the mandibular ; (3)some
joint twigsto the parotidgland;
(4)terminal filaments to the skin over the temporalregion
and summit of the head ; (5)auricular branches.
The auricular branches are usually two to the skin lining
the upper part of the interiorof the external meatus, and two
to the integumentover the upper and anterior part of the
auricle. The former gainthe interior of the meatus by passing
between the osseous and cartilaginous portions of the canal.
NervTis Alveolaris Inferior.
inferioralveolar nerve " The
(O.T.inferior dental) is the largest
branch of the posterior
division of the mandibular nerve. It emerges from under
cover of the external
pterygoid, at the lower border of the
muscle, passes downwards along the lateral surface of. the
spheno-mandibular ligament, and enters the mandibular fora-
men.
The inferioralveolar arteryruns downwards posterior
to it,
whilst the lingual nerve is anterior to it and upon a
somewhat deeper plane. The inferior alveolar is a sensory
nerve, but a few fibres from the motor root are prolonged
downwards within its sheath as far as the mandibular foramen.
Ill" 12 I
i82 HEAD AND NECK
sensory.
In the firstpart of its course, like the other branches of the
mandibular nerve, it lies medial to the external pterygoid
muscle. As it descends it appears at the lower border of
the muscle. Then it proceeds downwards and anteriorly,
between the internal
pterygoidmuscle and the mandible,and
enters the region,where
submaxillary it will afterwards be
traced to the tongue. It lies anterior to and on a slightly
deeper plane than the inferior alveolar nerve. It givesoff
no branches in
infratemporal the
region,but, whilst still
under cover it is joinedat an acute
of the external pterygoid,
angleby the chorda tympanibranch of the facial nerve. Not
infrequently,also,a communicatingtwig passes between it
and the inferioralveolar nerve.
SUBMAXILLARY REGION.
The
superficial
area of the submaxillaryregionhas been
dissected already,
under the name of the submental triangle
of the digastric triangle(p.T27). It is now necessary to
1. Submaxillaryglandand itsduct.
2. Sublingual
gland.
3. Side of the tongue, and the mucous membrane of the mouth.
Mylo-hyoid.
Digastric.
Stylo-hyoid.
4. Muscles. ^ Hyoglossus.
Stylo-glossus.
Genio-hyoid.
Genio-glossus.
6.
{Mylo-hyoid.
Hypoglossal.
Lingual.
Glosso-pharyngeal.
Submaxillaryganglion.
7. Lingualartery and veins.
8. Part of the external maxillaryartery.
9. Stylo-hyoid
ligament.
Dissection. To prepare the part for dissection,
" it is necessary
to throw back
the head to its full extent, and turn it slightly to
the opposite side. If the stuffingin the mouth has not been
previouslyremoved, it should be taken out now. When that
has been done, divide the external maxillary artery and the
anterior facial vein at the point where they cross the lower
border of the mandible. Next, detach the anterior bellyof the
digastricfrom its attachment to the anterior part of the medial
aspect of the lower border of the mandible ; and then, with the
saw, cut through the mandible lateral to the median plane.^
1
If the part is soft and pliablethere may be no necessity
to make this
division of the bone,
m" 12 c
i84 HEAD AND NECK
M. semispinaliscapitis -
Suprascapular
Fig. 67. " The Trianglesof the Neck seen from the side. Tlie clavicular head
of the sterno-mastoid muscle was small, and therefore a considerable part
of the scalenus anterior muscle is seen.
12. Superiorthyreoidartery.
13. Sterno-mastoid muscle. Lingual nerve.
14. External laryngealnerve. Internal pterygoid muscle.
15. Sterno-hyoidmuscle. Inferior alveolar nerve, and mylo-hyoid
16. Omo-hyoid muscle. branch with inferior alveolar artery.
17. Thyreo-hyoidmuscle.
It is to the
superficial internal
jugularvein,the internal
and the external carotid arteries,
the external maxillary
artery,
SUBMAXILLARY REGION 187
If the digastric
acts from its attachment
posterior it
depressesthe mandible. If the mandible is fixed and the
diagastric
acts from its anterior attachment it helps to pull
the head backwards. If both the bellies act simultaneously
the hyoidbone is raised.
Musculus stylo-hyoid
Stylohyoideus. The " muscle is a
small muscular bundle which springsfrom the posterior
border and lateral surface of the middle third of the styloid
process and descends alongthe upper border of the posterior
bellyof the digastric. It divides below into two slips
which embrace the intermediate tendon of the digastric
and are then inserted into the hyoid bone, at the junction
of the greater cornu with the body. Its main relations
are practically the same as those of the posterior bellyof the
digastric,but it is not under cover of the mastoid process,
the sterno-mastoid, and the splenius muscles. It is supplied
by the facia/nerve. It raises the hyoid bone and draws it
backwards.
Glandula Submaxillaris.
submaxillary
" The
salivarygland
consists of a superficiallargerportionand a deep smaller
portion. The superficial portionis lodged in a space which
is bounded by the anterior bellyof the digastric
anteriorly ;
posteriorlyby the posterior
bellyo f the the
digastric, stylo-hyoid,
and the stylo-mandibular ligament ; below by the deep fascia
by the medial surface of the body of
of the neck ; laterally
the mandible and the lower part of the medial surface of
the internal pterygoidmuscle ; and mediallyby the hyoid
mylo-
and muscles.
hyoglossus The fascial relations of the
gland have been described already(p.123). The dissector
should .note now that,in accordance with the contour of the
space in which it he
lies, can that
recognise the superficial
part of the gland possesses an anterior and a posterior
and
extremity, three more or less well-defined surfaces,
inferior, and
lateral, medial.
posteriorextremity abuts
The
againstthe stylo-mandibular ligament, which separates it from
the parotid, and it overlapsthe stylo-hyoid and posterior
bellyof the digastric. It is cleft by a groove in which
lies the external maxillary artery. The anterior extremity
rests on the anterior belly of the digastricmuscle.
The inferior surfaceis covered by the layerof deep
cervical fascia which extends upwards from the greater cornu
of the hyoid bone to the lower border of the mandible \ it
is crossed posteriorly, under cover of the deep fascia, by the
anterior facial vein. Along its upper border He the majority
of the submaxillary lymph glands; the external maxillary
artery turns round between it and the lower border of the
mandible,at the anterior border of the masseter ; and the sub-
mental
branch of the external maxillary
artery runs forwards
in the anglebetween it and the mandible.
SUBMAXILLARY REGION 189
Parotid duct
Accessory parotidgland
M. pterygoideus
internus
Lingualnerve
Mandible
M. mylohyoideus
Mandible Surface of lary
submaxil-
gland covered
imaxillary
duct
by mandible
Mucous membrane Surface covered by
Sublingual
gland integumentand fasciae
Tongue
M.
mylohyoideus
M. digastricus
(anterior
belly)
Fig. 69. "
Dissection of the Parotid, Submaxillary,and SublingualGlands.
M. styloglossus
M. stylopharyngeus
Glosso-pharyngeal Deep part of submaxillary gland pulledbackwards
nerve
/ ^Submaxillary ganglion
.Stylo-hyoid
'ligament ^Submaxillary duct (Wharton's)
Cut edge of mucous membrane
jLingua'
nerve I /Sublingualgland
Sublingualartery
M. geniohyoideus
Supra-hyoidartery
AT
JNl. . -J I
'
/
'
Soft palate ^
pterygoideus externus
I
"
M. temporali
M. styloglossus Tongue
the lingual
region, nerve was seen passing downwards between
the ramus of the mandible and the internal pterygoid
muscle.
As it descends, it inclines "
forwards,and, after passing
over the attachment of the superiorconstrictor muscle of
the pharynx to the end of
posterior mylo-hyoidline,it the
lies below and to the last
posterior molar tooth (Fig.68),
between the mucous membrane of the mouth and the body of
the mandible. At that pointit is in danger of beinghurt
by the clumsy extraction of one of the lower molars,and
there also it may be divided by the surgeon, from the inside
of the mouth. In its further course the nerve keeps close
to the side of the tongue,crossing the styloglossus
and the
upper part of the hyoglossus, and, beyond that, the sub-
maxillary
duct. Its terminal branches are placed immedi-
ately
under cover of the mucous membrane of the mouth,
and it can be traced as far as the tipof the tongue.
The branches which proceedfrom the lingual
nerve in the
submaxillary
regionare of two kinds "
(i) twigs of com-
munication;
(2)branches of distribution.
Distribution. 1 ^-
^ f^w twigsto the sublingual
gland.
\^ 3. Branches to the tongue.
1. from iYiit
Supra-hyoid, firstpart (p.133).
2. Dorsales from
linguae, the second part.
3. Sublingual.
4. Profunda,
in" 13 a
1 98 HEAD AND NECK
_;
200
v^t'HUC
^liAV^^I^'D^ECll-'''^L
Musculus Tensor Veli Palatini. " The tensor of the soft
palateis a flat,
triangular
muscle closely which
appHed to is
the deep surface of the internal pterygoidmuscle. It arises
from the scaphoidfossa at the root of the medial pterygoid
lamina,from the posterior border of the lower surface of the
great wing of the sphenoid, from the spineof the sphenoid,
and from the lateral aspect of the auditorytube (O.T.
Eustachian). It descends to the lower end of the medial
pterygoidlamina,and ends in a tendon which turns zontally,
hori-
under the hamulus,into the soft where
palate, its
attachments willbe seen later when the soft palate
is dissected.
oppositethe fibro-cartilage
cartilage, between the third and
fourth cervical vertebrae ; and, after running upwards and
backwards to the. level of the neck of the mandible,it
between
terminates, that portionof bone and the upper part
of the antero-medial surface of the gland,by dividing
parotid
into two branches
terminal the "
temporaland the
superficial
internal maxillaryarteries. At its commencement it lies
anterior and the internal carotid artery; and it is
medial to
called external because it is distributed mainlyto the parts
on the exterior^of the skull. It is,at first,comparatively
in the
superficial upper part of the carotid triangle
; next, it
passes under cover of the lower part of the postero-medial
gland,and
surface of the parotid the bellyof
posterior the
digastricand the stylo-hyoid muscles. At the upper border
it enters a groove in the
of the stylo-hyoid medial border of
the parotid,throughwhich it passes to theupper part of the
antero-medial surface of the gland,behind the neck of the
mandible,where it terminates (Figs.51, 73, 74).
Relations. " As it lies in the carotid triangleit is covered
fascia and platysma,
by the skin,superficial branches of the
202 HEAD AND NECK
1. Hyoid. 4. Crico-thyreoid.
2. Superiorlaryngeal. 5. Terminal glandular.
3. Sterno-mastoid.
medially,
upon crico-thyreoid
the ligament,and anastomoses with
its fellow of the opposite side. It has alreadybeen noticed
in the dissection of the middle line of the neck (p.129).
Rami Glandulares. The glandularrami are the three
"
Superficial
temporal vessels
Internal maxillary
''
Y^" vessels
^--Styloid
process
''T^V'
facial nerve (cut)
"r External carotid
Internal carotid
Glossopharyngeal nerve
Stylo-pliaryngeus
Stylo-glossus
-
1. Ascendingpalatine. I 3. Glandular.
2. Tonsillar. | 4. Submental.
Superficial
temporal artery
Internal maxil-
lary
artery
Posterior auricu-
lar
artery
External carotid
Submental
Occipital
artery
artery
Sterno-mastoid artery External maxillary
Hypoglossalnerve artery
Ascending pharyngealartery
Sterno-mastoid artery
Sterno-hyoid
Omo-hyoid
Dissection. Divide
" the posteriorbelly of the digastric
immediately below its origin, and turn it downwards and
forwards towards the hyoid bone ; then examine the stylo-
pharyngeus muscle. It may be necessary to cut the occipital
and posteriorauricular arteries in order to gain free access to
the deeper parts, but that should not be done unless it is un- avoidable.
will be noted also that three nerves and three arteries cross the
vessel viz.:
superficially, "
1. The hypoglossal
nerve. 1. The occipital
artery.
2. The glosso-pharyngealnerve. 2. The sterno- mastoid branch of
3. The pharyngealbranch of the the occipital artery.
vagus nerve. 3. The posterior auricular artery.
Accessory Vagus
"Jugularganglion
Glosso-pharyngeal
Superficial
temporal
Internal maxillary
-Descendens hypoglossi-
Ascending pharyngeal-
Internal carotid-
External
laryngeal
Common carotid
The
hypoglossal nerve, as already noted,crosses it in the
carotid triangle
; the other nerves cross it under cover of the
posterior bellyof the digastric. The occipital artery crosses
GREAT VESSELS AND NERVES OF NECK 213
turns forwards.
The relationship of the external carotid artery to the
internal carotid is a varyingone. At first the external
carotid lies antero-medial to the internal carotid ; but soon,
owing to its inclination backwards,it comes to lie superficial
to the internal carotid. The following
structures intervene
between the two vessels : "
PLATE VII
Fig. 78.^" Dissection of the Head and Neck of the same subject
as that shown in Fig. 15, but the greater part of the parotid
gland, the greater part of the sterno-mastoid muscle, the
greater part of the external jugularvein, portionsof other
to displaydeeper structures.
Cephalic vein.
Lateral anterior thoracic nerve.
artery.
Transverse scapularvessels.
First serration of serratus anterior
.
muscle.
Subclavian artery.
Transverse cervical artery.
Upper root of long thoracic
nerve.
Trapezius.
Scalenus anterior.
Internal jugular vein.
Communicans hypoglossinerve.
Ascending branch of transverse
cervical artery.
Internal carotid artery.
External carotid artery.
Hypoglossal nerve.
mastoid branch.
Lesser occipital
nerve.
Digastricand stylo-hyoid
muscles.
Third occipitalnerve.
occipital
artery.
Posterior auricular artery and
vein.
Superficial
temporal vessels and
auriculo-temporal
nerve.
PLATE VII
P^IG. 78.
^mmsiM
#
2l6 HEAD AND NECK
sterno-mastoid,
except in the regionof the upper part of the
carotid where
triangle, it may projectforwards,beyond the
anterior border of the muscle, for a short distance. It is
from the sterno-mastoid
separated by numerous deep cervical
lymph glands;and under cover of the muscle it is crossed
at the level of the
superficially, upper part of the thyreoid
by the communicans
cartilage, cervicalis from the cervical
plexus,and, at the level of the cricoid cartilage,
by the
intermediate tendon of the
omo-hyoid,the sterno-mastoid
branch of the superiorthyreoid artery and the nerve to the
Glosso-pharyngealnerve
Superiorlaryngealnerve
Internal laryngealnerve
tubercles,
viz., (O.T.rectus
the longus capitis capitis anticus
major)and the scalenus anterior. Between its posterior
surface and the scalenus anterior are the ascendingcervical
artery,the phrenicnerve, and,crossing to the latter,
superficial
the transverse cervical and the transverse scapulararteries.
On the left side the terminal part of the thoracic duct also
GREAT VESSELS AND NERVES OF NECK 217
Trochlear nerve
Abducent nerve
-
Sensoryroot of
facial nerve
Acoustic nerve
Right transverse
stnus
G losio-pharyngeal
neive
Vagus nerve
Vccessorynerve
Vertebral ai teiy
Hypoglossal nerve
\ irst spinalnerve
Accessory nerve
Fig. 8 1. "
Section through the Head a littleto the rightof the Median Plane.
It shows the posteriorcranial fossa and the upper part of the vertebral
canal after the removal of the brain and the medulla spinalis.
vertically
downwards, firstbetween the internal jugularvein
and the internal carotid artery,and then between the vein
and the common carotid artery (Fig.
79).
In an ordinarydissection it is impossible to follow out many of the
minute twigs which take origin from the last four cerebral nerves in the
regionof the basis cranii. To do so it is necessary to possess a perfectly
fresh part which has been prepared by having the soft parts
specially
toughened with spirit and the bone softened by immersion in a weak
solution of acid. Even then the dissection is a difficultone, but it should
be undertaken by the advanced student,in the event of his beingable to
obtain a part for the purpose.
GREAT VESSELS AND NERVES OF NECK 219
In the following of
description the nerves the account
The stylo-pharyngeal
nerve is a small twigwhich enters the
muscle of the same name. The greater part of its fibres,
however, are continued throughthe muscle to the mucous
certain minute branches are givenoff. The upper ganglion is called the
ganglionsuperius; the lower one is termed the ganglionpetrosutn.
The superior ganglionis a small ganglionic swelling,which involves
only a portionof the fibres of the nerve trunk. It is placed in the
upper part of the bony groove in which the nerve liesas it proceedsthrough
the jugular foramen. No branches arise from it.
The petrous ganglion is a largerswelling, which involves the entire
nerve-trunk,and lies at the openingof the jugularforamen, between the
vagus nerve and the inferior petrosal sinus (which intervenes between it
and the anterior border of the foramen). Its length is not more than four or
five millimetres. Three branches of communication enter or proceedfrom
it and connect it with
"
(i) the superior cervical sympathetic ganglion ; (2)
the auricular branch of the vagus ; and (3) the jugularganglionof the
vagus.
In addition to the twigs mentioned,the tympanicnerve takes origin
from the petrous ganglion.
Nervus Tympanicus. The ultimate destination of the tympanicnerve
"
may be regardedas the otic ganglion, but it takes a very circuitous route
to gainthat structure,and it gives off branches on the way. It enters a small
foramen on the ridgewhich separates the jugular fossa from the carotid
foramen on the lower surface of the petrous bone, and it is conducted by
a narrow canal to the tympanic cavity. It crosses the medial wall of that
chamber, grooving promontory. Havinggainedthe anterior partof the
t he
tympanum, it enters the bone a second time, and runs in a minute canal,
which tunnels the petrous bone below the upper end of the channel which
lodgesthe tensor tympanimuscle. In that part of its course the tympanic
nerve is joinedby a branch from the gangliongeniculiof the facial nerve,
and, after the junction is effected,
it is termed the lessersuperficial petrosal
nerve.
The canal in which the lesser superficial petrosal nerve is lodgedopens,
by a small aperture, into the cranial cavity, the anterior surface of the
upon
petrous bone, immediately lateral to the hiatus canalis facialis. Through
the aperturethe nerve enters the cranial cavity, and it almost immediately
leaves it by passingdownwards in the interval between the great wing of
the sphenoidand the petrous part of the temporal bone, or throughthe
canaliculus innominatus, or throughthe foramen ovale. Outside the skull
it joins the otic ganglion.
In the tympanic cavitythe tympanic nerve givesbranches of supply
"
(i) to the mucous membrane of the tympanum; (2) to the lining
membrane of the mastoid cells ; and (3)to the mucous membrane of the
auditorytube (Eustachian).It is connected with the sympathetic plexus
on the internal carotid artery by the superior and inferior carotico-tympanic
branches which piercethe substance of the petrous part of the temporal
bone and form with the tympanicnerve the tympanicplexus.
ganglionis
situated within the jugularforamen. It is a rounded swellingwhich is
connected by communicatingtwigs with several of the nerves in the
neighbourhood, and it gives off two branches of distribution.
Branches of Communication. (i) With the facial nerve;
"
springs
from the upper part of the ganglionnodosum and runs
downwards and forwards, superficialto the internal carotid
Nervus hypoglossal
Hypoglossus.nerve makes
" its The
Iexit from the cranium through the hypoglossalcanal
'
(4)to the
hypoglossal.
It is not connected with the accessory.
The branches of distribution are: (i)nervus caroticus
internus; (2) nervi carotici externi ; (3) rami laryngo-
; (4)
pharyngei nervus cardiacus superior.
VOL. Ill "
15
226 HEAD AND NECK
the side,it is
left continued downwards between the common
After the vessels and nerves of the neck have been studied
the dissectorsshould examine the gland,the trachea,
thyreoid
and the oesophagus.
Glandula Thyreoidea. " The thyreoidgland is a highly
vascular,solid body, which claspsthe upper part of the
trachea and extends upwards
upon each for some distance
side of the larynx. It is enclosed in a sheath of the pre-
tracheal
layerof the cervical which
fascia, is attached above
to the front and sides of the larynx. It possesses also its
own proper fibrous capsule,which is continuous with the
stroma of the gland. Between the sheath and the capsule
the arteries of supply ramifybefore they enter the gland
substance, and the emerging veins anastomose with one
another to form
thyreoid the various
veins. It varies greatly
in size in different subjects
; and -in females and children it
is alwaysrelatively than
larger in adult males. It consists of
III " 15 a
228 HEAD AND NECK
"Platysma
external maxillary
"artery
\nterior facial vein Parotid gland
Submental lymph
M. mylohyoideus gland
Common
"Submaxillary
gland
facial
vein "
"
Sterno-mastoid artei
Lingualvein Ext. carotid artery
Lesser occipital N. ,
cervicar~/ "Thyreo-glossal
duel
nerves
M. omohyoideus
Brachial
plexus
External. .
-
M. cricothyreoideu:
jugularvein
Descendens M, sternohyoideus
hypoglossi
Anterior Isthmus of thyreoic
jugularvein' gland
Inferior
thyreoid
veins
i\I. sternothyreoidei
-"
*"ii^''"/
Fig. 82. -Dissection of the Anterior Part of the Neck. The Right Sterno-
mastoid has been removed.
vein.
of the inferiorthyreoid
The isthmus of the thyreoidgland has alreadybeen seen
another.
The veins which drain the blood away from the thyreoid
gland are still more numerous. They arise,in part, by
tributaries which springfrom a venous network on the
anterior surface of the by branches which
gland,but chiefly
emerge from its substance. They are three in number on
III" 15 6
230 HEAD AND NECK
Trachea
1' yrooidgland
Recurrent nerve ,' M. slernothyreoideus
Mm. sternohyoideusand
Common carotid a' omohyoideus
Sterno-mastoid
Internal jugular vein
-f-:-..-
Vagus ner^-e
feriorthyreoid
'
!"5 ^"
l^ecurrent
Vertebral vein
ne
artery -
Vertebral vein
Vertebral artery / (Kswpu ;"l ihoiacic veitebra
Longus colli
Fig. 83.
"
Transverse section through the ThyreoidGland, Trachea, and
patent by
constantly cartilaginous curved bars embedded
the
in its walls. The bars do not form complete circles; pos-
teriorly
and,
they are deficient, in consequence, the posterior
surface of the trachea is flattened. The trachea is tinuous
con-
Serratus posterior
superior (insertion)"
Scalenus posterior
(insertion)
Serratus anterior^
(origin)
It forms triangle
part of the floor of the posterior of the
neck. Its surface
superficial is in relation with the brachial
plexus and third part of the
the subclavian artery. Its
border touches the levator
posterior ; and
scapulae the dorsal
scapularnerve and the descendingbranch of the transverse
cervical artery pass between it and that muscle. The lower
part of its anterior border is in relation with the apex of
the pleura,and the upper two roots of the long thoracic
nerve piercethe substance of the muscle.
Musculus Scalenus Posterior. " The scalenus is
posterior
generally inseparable, at its origin,
from the scalenus medius.
It is the smallest of the three,and springs by two or three
slipsfrom the transverse processes of a correspondingnumber
of the lower cervical in
vertebrae, common with the scalenus
medius. It is inserted into the upper border of the second
rib, immediatelyanterior to the insertion of the levator
costae and behind the large rough area which marks the
originof the serratus anterior (Fig.84),
The scalene muscles are suppliedby twigs from the
anterior branches of the the lower
cervical nerves^ particularly
four. They elevated the ribs to which they are attached
and are, therefore,
muscles of thoracic respiration.
Dissection. " The little muscle termed the rectus capitis
lateralis should now be cleaned, and its attachments defined.
It lies in the interval between the transverse process of the atlas
and the jugular process of the occipitalbone, posteriorto the
commencement of the internal jugular vein. The anterior
ramus of the first cervical nerve will be seen emerging from
under cover of its medial margin.
Dissection. "
By the time that the dissectors of the head and
neck have arrived at this stage of their work, the dissectors of
the thorax have, in all probability,finished their dissection.
If that is the case, the head and neck may be removed from the
trunk by cuttingthrough the vertebral column at the level of
the intervertebral fibro-cartilage between the third and fourth
thoracic vertebrae. By this proceeding the upper three thoracic
vertebrae,with the attached portions of the first, second, and
third pairs of ribs, are removed with the neck. The scalene
muscles and the longus colli are therefore preservedintact.
234 HEAD AND NECK
INT. CAROTID I N F U N D |B U L
U IVT
TROC H LEAR N
Fig. 85.
"
Section through the Cavernous Sinus.
(AfterMerkel, somewhat modified. )
the other venous sinuses. The two layersof the dura mater
Infundibulum Optic
Hypophysis Internal carotid artery
Oculo-motor nerve
\ Oculo-motor nerve
Trochlear nerve
Ophthalmic Trochlear
nerve nerve
Abducens *
Ophthalmic
nerve
nerve
Int. carotid
artery
Al)ducens
nerve
Maxillary
Pterygoidfossa
Choana Vomer
Fig. 86. " Frontal section through the Cavernous Sinus to show the position
of the Nerves in its wall. Note the branch given to the hypophysis
body) by
(O.T. pituitary the internal carotid artery.
arrangement, whilst,
at the same time,the nerve-root increases
somewhat in breadth. The interlacement,thus brought
about, occupiesthe smooth depressionwhich marks the
anterior aspect of the apex of the petrous portionof the
temporalbone, and it sinks into the semilunar ganglion(O.T.
Gasserian).
M. obliquussuperior
Lacrimal gland
'^
\\^yiM.
'
obliquus
'-^/ superior
M. rectus lateralis
M. rectus medialis
yixth nerve
Ciliary
ganglion
Trochlear nerve
Naso-ciliary
nerve
^rAbducens nerve
Ophthamic division
oftrigeminalnerve
Maxillary division Opticnerve
of trigeminal
nerve
Motor root of
trigeminal
nerve
Oculo-motor
Semilunar ganglion \ 'nerve
Abducens nerve
Mandibular division of trigeminalnerve Trochlear nerve
and
antero-laterally from it emerge the three main divisions
of the
trigeminalnerve. They are (i) the first,or "
The maxillarydivision is of
composed entirely
sensory
fibres. It runs forwards,in relation to the lower and lateral
part of the sinus,and, after a short course
cavernous within
the cranium,makes its exit through the foramen rotundum.
Near its origin
it gives
off a fine meningealbranch to the dura
mater of the middle fossa of the cranium.
The division is the
ophthalmic smallest of the three branches
of the trigeminal it is com-
nerve, and, like the maxillary, posed
86, 92). It lies upon the lateral aspect of the body of the
sphenoid,and, for the greaterpart of its course, it traverses the
cavernous sinus.
It emerg^es from the carotid canal into the
foramen lacerum at the apex of the petrmis hone ; then itpasses
throughthe upper part of the foramen lacerum,pierces the outer
layerof dura mater, and enters the middle cranial fossa, at the
Infundibulum Opticnerve
Internal carotid
.jvj^ artery
Abducens nerve
Posterior
Trigeminalnerve , communicating
\ artery
Trochlear nerve
"^Oculo-motor
nerve
Accessory nerve
Section through
rSu
sin
penor
nus
petro;
sinus
Superiorsagittal Straightsinus (divided)
Fig. 88. " Floor of the Cranium after the removal of the Brain and the
Tentorium Cerebelli. The blood vessels forming the circulus arteriosus
have been left in place.
brain,
at the commencement of the lateralfissure (O.T.
Sylvian
fissure),by dividinginto the anterior and middle cerebral
arteries. Throughout its whole course it is surrounded by
sympathetic and soon
filaments, after its entrance into the
cranium the abducent nerve crosses its lateral side.
The intracranialportion of the internal carotid arterygives
off the followingbranches : "
.
Nervus Petrosus The lesser superficial
Minor.
Superficialis petrosal
"
nerve appears upon the anterior face of the petrous bone, throughan
aperture which is placedimmediatelylateral to the hiatus canalis facialis.
It leaves the cranial cavityby passingdownwards between the great wing
of the sphenoidand the petrous part of the temporalbone, or throughthe
canaliculusinnominatus or throughthe foramen ovale,to reach the otic
VOL. Ill "
16
242 HEAD AND NECK
petrosal.It
takes originfrom the sympathetic plexuswhich accompanies the middle
meningealartery, and, enteringthe petrous bone, is conducted to the
gangliongeniculi of the facial nerve.
ganglion.
THE ORBIT.
Rectus superior.
inferior.
Rectus
Rectus lateralis.
Muscles, .
.\Rectus medialis.
Obliquussuperior.
Obliquusinferior.
^Levatorpalpebrge superioris.
Ophthalmicarteryand its branches.
Vessels, . . \ Ophthalmicveins (superior with
and inferior), their tribu-
taries.
'Oculo-motor (3rdcerebral).
Trochlear (4thcerebral).
Abducent (6thcerebral).
Nerves, . .\Lacrimal Ifrom ophthalmicdivision of the trigeminal
^^^^ ^^"^^^^^^"^'^^^-
J
Naso-ciliary,
^^^
Ciliary
ganglion.
Lacrimal gland.
Fascia Bulbi.
] rontal sinus
Frontal sinus
Supra-orbital
margin
Ethmoidal cell
Coronoid process
of mandible
Tip of mastoid
process
Middle concha
Frontal sinus
Frontal sinus
Petrous part of
temporal bone
Ethmoidal cell-
INIastoid cells
Inferior concha
Infra-trochlear nerve
Lacrimal gland
Supra-trochlear
nerve
Supra-orbital
nerve
Short ciliary
nerves
Naso-ciliarynerve
Ciliaryganglion
Opticnerve
Ophthalmicnerve
Maxillarynerve
Motor root of trigemina
Mandibular nerve
Fig, 91. " The Ophthalmic Nerve of the Left Side. The semilunar ganglion
and the nerves have been everted and turned over to show the motor root.
orbit. In the middle line of the orbit the large frontal nerve
wiir be found lying in the fat on the surface of the levator pal-
pebrae superioris. Trace the nerve forwards to its division into
" Jtstwo terminal branches : a largesupra-orbital
" branch accom-
panied
PLATE X
Mandibular
Superior sagittal sinus. 17. nerve.
Optic nerve.
26. Superior rectus.
lum.
Semilunar ganglion.
Middle meningeal artery.
PLATE X
Fig. 92.
\
mi
THE ORBIT 247
inferior imperfectly
"
The ox pulleythroughwhich
trochlea the tendon passes is
a small fibro-cartilaginousring,which is attached by fibrous
tissue to the trochlear fossa of the frontal bone. The pulley
2SO HEAD AND NECK
ciliary
nerve. It leaves the orbit by the anterior ethmoidal
canal,and is conducted to the interior of the cranium,in which
it appears at the lateral marginof the cribriform plateof the
ethmoid. The canal in which it runs can be opened
readily
up with the
bone-forceps to expose the nerve. Upon the
cribriform plateit turns forwards, under the dura mater, and
almost immediately disappears, througha slit-likeaperture at
the side of the crista galli, into the nasal cavity.There it
givesinternal nasal branches to the mucous membrane, and is
continued downwards upon the posterior aspect of the nasal
bone. Finally,it emerges upon the face,as the external
nasal nerve, by passingbetween the lower margin of the
nasal bone and the lateral cartilage of the nose. Its terminal
filaments have been described already (p.30).
Ganglion Ciliare (Fig. 97). The ciliary
"
ganglionis a
small quadrangular body, not much largerthan the head
of a largepin. It is placedin the posterior part of the orbit,
between the opticnerve and the lateral rectus muscle,and
very commonly on the lateral side of the ophthalmic artery.
At its posteriorborder it receives its three roots ; whilst from
its anterior border the short ciliarynerves are givenoff.
The
sensory root is givenoff by the naso-ciliary,
and is called
the longroot. The short or 77iotorroot is a short,
stout trunk ;
it springsfrom the branch of the oculo-motor nerve which
goes to the inferioroblique
muscle. The
sytnpathetic root is
derived from the internal carotid plexus; it joins the ganglion,
close to the entrance of the long root from the naso-ciliary
nerve. In some cases it joins the longroot before it reaches
the ganglion.
Nervi Ciliares Breves. The short ciliary
"
Anterior ciliary
Anterior ciliary
artery
artery
muscle
Ciliary
Sclera
Long posterior
ciliary
artery
Vena vorticosa
Vena vorticosa
Long posterior
ciliary
artery
Long posterior
ciliary
artery
.
Dorsal nasal "
'
Infra-trochlear nerve 1
.
Anterior ethmoidal
\J artery and nerve
Supra-orbital3
Posterior ciliary
Arteria centralis")
Posterior ethmoidal retinae
Ophthalmic
Posterior ciliary
Muscular v
Lacrimal |
"
Ophthalmic
'Naso-ciliary
nerve
Internal carotid
Arteria
Supraorbitalis. The supra-orbital
artery accom-
"
panies
the supra-orbital
nerve where it was
to the forehead,
stage (p.47).
dissected at a previous
ArtericB Eth7noidales. " There are two ethmoidal branches,
an anterior and a ; they pass throughthe
posterior anterior
and posteriorethmoidal foramina in the medial wall of the
orbit. The posteriorethmoidal artery supplies the mucous
liningof the posterior and sends twigsto the
ethmoidal cells,
upper part,of the nose. The anterior ethmoidal artery is
a largerbranch. It runs in company with the anterior
ethmoidal nerve, and givesoff each stage of
minute twigsat
its course. Thus, in the anterior ethmoidal foramen,it gives
branches liningof the anterior ethmoidal cells
to the mucous
and the frontal sinus ; duringits short sojournin the cranial
cavityit givesoff a small anterior meningealartery; in the
nasal cavity,it givestwigsto the mucous membrane. Its
terminal branch appears on the face and supplies the side of
the nose.
sinus,either separately
or by a common trunk.
Musculi Recti et Obliqui Oculi. " Associated with the
of the recti muscles
origins of the eyeballare two tendinous
256 HEAD AND NECK
and
arches,a superior an inferior. Both are attached ally
later-
to projection
a on the great wing of the sphenoidbone
at the lateral margin of the superior orbital fissure. The two
bands divergefrom one another as they pass medially across
of the upper band, and one from the lateral part of the lower
band. The interval between the two heads is traversed by the
two divisions of the oculo-motor nerve, the naso-ciliary
nerve,
the abducens nerve, and the ophthalmicveins. The medial
rectus, which is the shortest and thickest of all the recti,
from the medial
springs part of the lower band. The superior
obhque springsfrom the body
sphenoid, of the
between the
and medial
superior recti. The origin of the inferioroblique
lies near the anterior margin of the orbital cavity, entirely
away from the other muscles which move the eyeball.It
arises from the orbital plateof the maxilla close to the lower
and medial angleof the orbital cavity.
Dissection. To display
" the attachments of the ocular muscles
which arise at the apex of the orbital cavity divide the optic
nerve close to the opticforamen, and turn the eyeballforwards.
Then define the origin of each muscle, but take care not to
injure the structures which pass between the upper and lower
heads of the lateral rectus. Next, replace the in
eyeball position
and displaythe inferior oblique which lies in the anterior part
of the orbital cavityand is best dissected from the front. Evert
the lower eyelidand make an incision through the conjunctiva,
along the level of its reflection from the eyelid to the eyeball.
A little dissection in the floor of the anterior part of the orbit
and the removal of some fat will expose the inferior oblique
muscle, as it passes laterally a nd backwards to gain the lateral
surface of the sclera.
After origins of the muscles
the have been satisfactorily
displayedstudy first the arrangement of the nerves which pass
through the superiororbital fissure,next the insertions of the
muscles which move the eyeball,and finallythe remaining
structures which lie in the orbital cavity.
the cavernous sinus can now be traced into the orbital cavity,
and the dissectorwill note
that the arrangement of the nerves
in the superior
orbital fissureis somewhat differentfrom that
in the sinus.
The lacrimal, and
frontal, trochlear nerves enter the orbit
above the upper head of the lateral rectus muscle, on very
much the same 96).
plane (P'ig. The other nerves enter,
between the heads of the lateral rectus " the division
superior
of the oculo-motor occupyingthe
nerve highestplace; next
comes the naso-ciliary
nerve ; then the inferior division of
the oculo-motor nerve ; and the abducent nerve is the lowest.
/^^O^Trochlear nerve
M. obliquussuperior
Trochlear nerve
Naso-ciliary
nerve Optic foramen
M. rectus inferior
ferior division of
Abducens nerve
oculo-motor nerve
Inferior orbital fissure
M. levator palpebrae
superioris-
M. rectus superior
M. obliquussuperior -
Lacrimal gland
M. rectus lateralis
Abducens nerve
ganglion
Ciliary
Naso-ciliary
nerve
Ophthalmic division
of trigeminalnerve
Maxillary division
of trigeminalnerve
Motor root of
trigeminal
nerve
Oculo-motor
Semilunar '''^ / ^
nerve
ganglion
Abducens nerve
Fig. 97. Dissection of the Orbit and the Middle Cranial Fossa.
"
Both
roots of the fifth nerve, with the semilunar ganglion,are turned laterally.
appliedto
closely the ocular surface of the lateral rectus. It
26o HEAD AND NECK
Tendon of oblique
superior
Tendon of superior
rectus
branch runs forwards and upwards upon the lateral wall of the
under
orbit, cover of the periosteum,and, after receiving a
PREVERTEBRAL REGION.
cuts through the cranial wall. The head having been placed
upon its side,the saw must be appliedto the lateral aspect of
the skull,half an inch posteriorto the mastoid process, and be
carried obliquely forwards and mediallyto reach a pointimmedi- ately
posterior t o the jugular foramen. A similar saw-cut must
be made upon the opposite side of the head.
To complete the dissection the dissector must again use
the chisel. Placing the preparationso that the floor of
the cranial cavity looks upwards, divide the base of the skull,
on each side,in the interval between the petrous portionof the
temporal bone and the basilar portion of the occipitalbone.
Anteriorly, this cut should reach the lateral extremityof the
incision already made through the basilar portion; whilst
posteriorly, it should be carried to the medial side of the jugular
foramen to reach the medial end of the correspondingsaw-cut.
When that has been done upon both sides of the basilar portion,
the anterior part of the skull,carryingthe pharynx and the great
blood-vessels and nerves, can be separated from the posterior
part of the skull and cervical portion of the vertebral column.
The only large nerve which will be divided is the hypoglossal,
but,as it is cut close to the basis cranii, and above its connection
with the ganglion nodosum of the vagus, it retains its position.
The pharynx and anterior portionof the skull should now
be covered with a piece of cloth soaked in preservative solution,
and the whole enveloped in an oil-cloth wrapper. It can then
be laid aside until the dissection of the prevertebral region and
the ligaments of the cervical vertebrae and the occiputhas been
completed.
Returning to the posteriorpart of the skull and the cervical
portion of the vertebral column, the dissector should proceed
to define the attachments of the muscles which lie anterior
to the transverse processes and the bodies of the vertebrae.
They are three in number on each side,viz. : "
powerfulof the
prevertebralmuscles of the neck,and it lies
nearest to the median plane. Its connections are somewhat
intricate,but when it has been thoroughly cleaned it will be
seen to consist of three portions viz., upper and "lower
obliqueparts,and a middle vertical part.
The lower division arises from
oblique the lateral aspect of
the bodies of the upper two or three thoracic vertebrae. It
extends upwards,and slightly and
laterally, ends in two
tendinous which
slips inserted into the anterior tubercles
are
Rectus lateralis
Rectus capitis
anterior
Longus colli
Scalenus anterior
Scalenus medius
Scalenus posterior
Fig. 99. " Prevertebral Muscles of the Neck. On the rightside the longus
has
capitis been removed. (Paterson.)
the arch of the atlas and the vertebral arch of the epi-
posterior strophe
respectively, behind the articular processes, whilst
the lower nerves situated in front of the articular processes.
are
aspects of
posterior the corresponding
upper articular process
of the in
atlas, a groove upon the upper surface of its posterior
arch (Figs.20, 38). As soon as it has passed under cover
of the lateral margin of the posterior
atlanto-occipital
brane
mem-
it becomes the fourth part. The fourth part turns
the triangle
from beneath its lower border. For the relations
of the fourth part see the precedingparagraph and pp.
117, 382.
Branches. " No branch of importanceis given off from
the first part. The second part gives off lateral spinal
(p. 90) and muscular branches. The branches from the
third part are muscular twigs,and branches to anastomose
with twigsfrom the occipitaland the deep cervical arteries.
The fourth part gives off a meningeal branch before it
the
perforates dura mater a series of branches
and, afterwards,
to the central nervous system (seepp. 382, 383).
PREVERTEBRAL REGION 269
Synovialpart of
jointbetween bodies
of vertebrae
Capsule around
jointbetween two
articular processes
Jointbetweei:
articular processes
Intervertebral fibro-
cartilage
regionit completely
covers the bodies and does not present
the denticulated appearance which is"so characteristic lower
down. to the fibro-cartilages
It is attached chiefly and the
removed for the displayof the spinal medulla, and which the dissector was
directed to retain. They fillup the gaps between the laminae of the
vertebrae, and can be seen best when the anterior aspect of the specimen
is viewed.
Root of vertebral
arch, divided
which
tissue, allows the egress from the vertebral canal of
some small veins. The width of the ligamentsin the different
regionsof the vertebral column
depends upon the size of
the vertebral canal. Therefore,they are widest in the neck
and in the lumbar part of the column. The ligamenta flava,
by virtue of their great strength and elasticity, are powerful
agents in maintaining curvatures
t he of the vertebral column ;
they also give valuable aid to the muscles in restoring the
vertebral column to its originalposition after it has been bent
in a ventral direction.
The interspinous
ligaments
are most developedin
strongly
the lumbar where they fill up the intervals between
region,
the adjacentmarginsof contiguousspinousprocesses. In
the thoracic region,
and more so in the neck, they are very
weak.
The supraspinous ligamentsare thickened bands which
connect the summits of the spinousprocesses. In the neck
they are replacedby the ligamentumnuchas (p.67).
The intertransverse ligamentsare feeblymarked in the
cervical regionand extend chiefly between the anterior bars
of the transverse processes.
Articulations of the Epistropheus,Atlas, and Occipital
Bone. " The articulations which exist between the atlas and
the occipitalbone and the atlas and the epistropheus all
belong to the diarthrodial class. Between the atlas and
epistropheus (O.T. axis)there are three such joints viz., "
Anterior longitudinal.
Ligamentaflava.
Capsular.
Ligaments connectingatlas Transverse portionof cruciate ligament
.
with epistropheus, . .
with inferior crus.
Accessory ligamentsof the atlanto-epi-
joints.
stropheal
JOINTS OF THE NECK 273
, Capsular.
tectoria.
IMembrana and
Superior
Alar.
Apical.
inferior
ligament.
crus of the cruciate
anterior membrane
occipito-atlantal the upper extends from
border of the anterior arch of the atlas to the under surface
of the basilar portionof the occipital bone,anterior to the
foramen magnum. On each side of the median plane it is
thin and membranous, laterallyand
so as to abut
stretches
the
against articularcapsule. In the median
atlanto-occipital
plane it is
strengthened
by the upper part of the anterior
longitudinal
ligament.
Membrana Atlanto-Occipitalis
Posterior. " The thin and
weak posterior membrane
occipito-atlantal occupiesthe gap
between the posterior
arch of the atlas and the posterior
border of the
magnum, foramen
to both of which it is
attached. It is very firmlyconnected with the dura mater,
and on each side it reaches the atlanto-occipital articular
capsule. Each of its lateral borders forms an arch over the
groove, posterior
to the upper articular facet of the atlas,in
which the vertebral artery and the first cervical nerve are
Atlanto -
Occipital Articular Capsules. " The atlanto-
occipital
capsulesconnect occipital the
condyleswith the
lateral masses of the atlas. They completely surround the
joints, and are connected anteriorly with the anterior atlanto-
occipital membrane, and posteriorly with the posterioratlanto-
occipital membrane.
The occipital bone,therefore,
around the foramen magnum
is attached by special ligamentsto each of the four portions
Basilar portion
of
occipitalbone
Dura mater.
Crus supenus
Second cervical
nerve
-Transverse ligament
Anterior longitudinal
ligament
Crus inferius
Cms superius
Apical
ligament
Lateral
= \ Accessory allan
mass of
atlas "epistropheal
Atlanto
ligament
pistropheal
joint Crus inferius
Pody of epistro-
pheus Membrana tectoria
Fig. 104. " Dissection showing the posterioraspects of the Ligaments necting
con-
except when the cheeks are inflated with air. It is into the
vestibule of the mouth that the parotidducts open (p.164).
Above and below ^ it is bounded by the reflection of the
mucous membrane from the lips and cheeks on to the
alveolar marginsof the maxilla and mandible. Anteriorly^
it opens upon the face by means of the oral fissure
; whilst
2 78 HEAD AND NECK
it communicates, on
posteriorly^ each side,with the cavity
of the mouth proper throughthe interval between the last
molar tooth and the anterior border of the ramus of the
mandible. The communicatingaperture is
existence of that
of importance in cases of spasmodicclosure of the jaws,when
all the teeth are in place,because throughit fluids may be
introduced into the posterior part of the mouth proper.
and laterally,
by the gums and teeth, whilst, posteriorly,
it communicates,by means with
of the isthmus of the fauces^
the pharynx. The flooris formed by tongue and the
the
mucous membrane which connects it with the inner aspect
of the mandible ; the roofis vaulted,and is formed by the
hard and the soft palates. It is into the mouth proper
that the ducts of the
submaxillary glandsand the ducts of
the sublingual glandsopen (p.194). When the mouth is
closed the dorsum of the tongue is usually appliedmore or
less closely
to the palateand the cavity is almost completely
obliterated.
The
various parts which bound the oral cavitymay now
be examined in turn.
Labia Oris. " The structure of the lipshas, in a great
measure, been examined alreadyin the dissection of the face
(p.10). Each Hp is composed of four layers: (i) Cuta-
neous;
(2)muscular; (3)glandular;and (4)mucous. The
skin and mucous membrane become continuous with each
other at the free margin of the lip. The mucous membrane
is reflected from inner aspect of the upper lipto the
the
alveolar marginof the maxillae,
and from the inner aspect of the
lower lipto the mandible. In each case it is raised in the
median plane in the form of a free fold termed the frenulum.
The muscular layerconstitutes the chief bulk of the lips. It
is formed by the orbicularis oris and the various muscles
which converge upon the oral fissure. Numerous labial
glandsHe in the submucous tissue which intervenes between
the mucous membrane and the muscular fibres. The ducts
of those glandspiercethe mucous membrane and open into
the vestibule. In each lipthere is an arterialarch formed
by the corresponding
labial arteries(p.16).
MOUTH 279
tongue ; but in the anterior part of the mouth the tongue lies
more or less free in the oral cavity,
and there the mucous
membrane stretches across the floor from one half of the
mandible to the other. On each side,in the anterior region,
the formed by
projection the sublingual
gland,the plicasub-
28o HEAD AND NECK
lingualis,
can be distinguished. Further,if the tongue is
pulledupwards,a median fold of mucous membrane will be
seen to connect itsunder surface to the floor. It isthe frenulujfi
lingucB.At the sides of the frenulum the dissector must
Frenulum linguae
Tip of tongue
turned up (
Plica fimbriata
vein
Deep lingual
Plica sublingualis
Orifice of
duct
submaxillary
Uvula
Pharyngo-
palatinearch
Palatine tonsil
Glosso-palatine
arch
Posterior wall of
oral part of
pharynx
Tongue
(Fig.
106). It is bounded above by the soft below by
palate,
the dorsum of the tongue, and on each side by a curved
fold of mucous membrane, termed the arcus glossopalatinus
(O.T.anterior pillar
of the fauces).
Each arch descends from
glosso-palatine posterior part the
of the inferior surface of the soft palateand, inclining forwards
as it descends,it ends upon the side of the posterior part of
the tongue. It encloses the glosso-palatinus muscle. "
the posterior wall and the borders of the pharynx, where they
anastomose together in a plexiform
manner. They constitute,
collectively, the pharyngealvenous plexus^ which receives
blood from the pharynx,soft palate, and prevertebral region.
It communicates with the pterygoid plexusand the cavernous
I'uccinator.
Tensor veli palatini.
Levatorveli palatini.
Superiorconstrictor.
Middle constrictor.
Inferior constrictor.
Thyreo-hyoid.
Hyoglossus.
Stylo-hyoid.
Mylo-hyoid.
. Crico-thyreoid.
Stylo-pharyngeus.
Stylo-glossus.
Stylo-hyoid
ligament.
Pterygo-mandibularraphe.
Glosso-pharyngealnerve.
Superiorlaryngealartery.
Superiorlaryngeal nerve.
External laryngealnerve.
artery.
nerve.
Musculus Medius.
Constrictor Pharyngis " The middle strictor
con-
is fan-shaped
a muscle (Fig. 107, e). It arises from
the greater and lesser cornua of the hyoid bone and from
the lower part of the stylo-hyoid
ligament.From those origins
its fibres pass round the pharyngealwall,to be inserted with
the corresponding fibres of the opposite side into the median
raphe. As they curve backwards and medially, the lowest
fibres descend,the highest ascend,and the intermediate fibres
run horizontally. The lower portionof the muscle is over-
lapped
plied
to the semilunar interval which intervenes between
the basis cranii and the upper crescentic margin of the
superior constrictor. The deficiency in the muscular wall of
the pharynxin that regionis compensatedfor by the increased
strength of the pharyngeal aponeurosis, which,in that situa-
tion,
is called the pharyngo-basilar fascia. In contact with the
outer surface of the aponeurosis are two muscles belonging
to the soft palate viz. the levator velipalatini
" and the tensor
velipalatini (Pig. 107, ^ and b). The levator, which is rounded
and fleshy, liesposterior to the tensor, which is flatand more
tendinous. The tensor can readilybe recognisedfrom its
positionin relation to the deep surface of the internal
pterygoid muscle,and because its tendon turns medially under
the hamulus of the medial pterygoid lamina. In the upper
PLATE XI
Atlas
Pharynx
inserted. (Gouldesbrough. )
PLATE XII
\ich of aorta
Fig. Radiograph of
109." Neck, anterior view, showing the position of
the oesophagus in which a bougie with a metal core had been inserted,
(Gouldesbrough. )
. PHARYNX 287
part of the space, close to the base of the skull and between
the originof the two muscles, the auditorytube (O.T.
Eustachian tube)
can be defined.
Pharyngeal Aponeurosis.^ The "
to
Lu the larynx. Below the
palate there are three
soft
openingsinto the pharynx,viz. the openingof the mouth or
isthmus faucium^the opening
of the larynx,and the openingof
Pharyngeal tonsil
Orifice of auditorytube
Upper surface
of soft palate
Salpingo-pharyngeal
fold
Pharyngo-palatine
arch
Palatine tonsil
Pharyngeal surface
of tongue
Epiglottis
M. genioglossus
M. geniohyoideus
M. mylohyoidei
Cuneiform tubercle
Hyoid bone'
of epiglotti
Cartilage
Corniculate cartilage
Laryngealventricle
Thyreoid cartilage
^ Cricoid cartijage
placedopening which
large,obliquely slopesrapidlyfrom
above downwards and backwards. It is somewhat triangular
in outline.
The basal part of the opening,
placedabove and
is formed
anteriorly, by the free border of the epiglottis.
Posteriorly, the opening rapidly narrows, and it ends in the
interval between the two arytsenoid cartilages.The sides of
the aperture are formed by two sharp and prominentfolds
of mucous membrane, termed folds,which
the ary -epiglottic
connect the
rightand left marginsof the epiglottiswith the
correspondingarytaenoid
cartilages.Two small nodules of
in the posteriorpart of each ary-epiglottic
cartilage, fold.
292 HEAD AND NECK
Tongue^ Glosso-epiglottic
fold
Vallecula
Pharyngo-
fold
epiglottic
Hyoid bone X
Ary-epiglottic
fold
Plica vocalis Laryngeal ventricle
Plica ventricularis
cartilageand the
ary-epiglotticfold ; whilst its posteriorwall
is formed by the posterior wall of the pharynx,when that is
in place. The piriformrecess has a wide entrance, which
looks upwards ; but it rapidly narrows towards the bottom
(Figs. Ill and 112). It is of practical importancebecause
sharp-pointed bodies introduced into the pharynx are liable
to be caughtin the walls of the sinus.
Below the level of the openingof the larynx, the anterior
PHARYNX 293
and walls
posterior of the
pharynxare alwaysclosely
applied
to each other,except duringthe passage of food.
The is placedoppositethe
operting
oesophageal lower border
of the cricoid cartilage,
at the narrowest part of the
pharynx.
Velum Palatinum. " The soft palateis a movable curtain,
which downwards
projects and backwards into the pharynx.
During it is
deglutition raised,and helps to shut off the
nasal part of the pharynxfrom the portionbelow. Anteriorly^
it is attached to the posteriormargin of the hard palate; on
each side it is connected with the side wall of the pharynx;
it presents
whilst posteriorly a free border. From the centre
Thyreo-hyoidligament M. sternohyoideus
Plica vocalis M. thyreohyoideus
Processus vocal Thyreoidcartilage
Arytaenoid
carti . omohyoideus
Recessuspiriformis
Platysma
Posterior wall Superiorthyreoid
of pharyn Descendens
Retropharyn- typoglossi
geal space Common carotid
Vagus
Fig. 112. " Transverse section through the Neck at the level of upper
part of the Thyreoid Cartilage.
and
aponeurotic, glandularstructures, togetherwith blood
vessels and nerves.
palatine
Each tonsil has a rich blood-supply. It derives
arterial twigs from the tonsillar and ascendingpalatine
branches of the external maxillary, the descendingpalatine
branch of the internal maxillary, the ascendingpharyngeal,
and the dorsalis linguaeof the correspondingside.
The dissectors should note that the tonsil lies at about
the level of the angleof the mandible,and that the wall of
the pharynx separates it from the external maxillaryartery.
The internal and external carotid arteries also lie lateral to
membrane will reveal the fact that the wall of the tube is
formed, in great part,by a triangular which
plateof cartilage,
is folded upon itselfso as to protectthe tube on its upper and,
PHARYNX 299
fT-mn _"hf"
and parts. As the tube is "^T-^r:pd
cardlag;inous
ISthmuS^tOthe pharynx it grndnally
inrrpngp"; in rghbrf, ^i2"^it
attains its greatestwidth at its pharyngeal
aperture.
CAROTID CANAL.
NERVUS MAXILLARIS.
As the maxillary
nerve passes from
forwards, the semilunar
ganglion
to the face,it traverses the foramen rotundum, the
upper part'^of
the pterygo-palatine^ossa/the
pterygo-maxillary
the mfra -temporal
fissure, the inferior orbital fissure,
fossa, and
the infra-orbitalcanal. The dissector should therefore proceed
to expose the nerve in those localities.
Dissection. Remove
" the temporal muscle and the upper
head of the external pterygoid muscle, and, placing the saw
NERVUS MAXILLARIS 301
Zygomatic nerve -
Posterior alveolar
superior
'1 Infra-orbital
Maxillarynerve Zygomatico-temporal
Ophthalmic ner\e ; ] Zygomatico-facial
ingeal
branch of maxillary Middle superioralveolar
'
nerve ..
; \
; Anterior superior
Sensoryroot } ; "
alveolar
lotorroot of ;^,^.^
trigeminal"' ,
i
Semilunar ganglion
Mandibular nerve
Spheno-palatine
ganglion '
Post, palatine''
Middle palatine
Ant. palatine
2. In the pterygo-pala-1 ^ 1 ,
"
r Palpebral,^
5. In the face, Nasal,
. . \
alreadydescribed : \ (p. 15).
(Labial, J
The spheno-palatine
branches twigswhich arise are two stout
from the inferior aspect of the maxillary
nerve, and proceed
verticallydownwards, in the pterygo-palatine fossa,to the
spheno-palatine ganglion,of which theyconstitute the sensory
roots.
The zygomaticnerve^ which has alreadybeen dissected
in the orbit,can now be traced to its originfrom the
maxillary
nerve in the infra-temporal
fossa.
Nervi Alveolares Superiores.There "
usuallythree
are
alveolar
superior nerves which are distinguishedas posterior,
middle,and anterior. The middle superior
alveolar nerve is
sometimes absent as a separate trunk,in which case itsfibres
arise in common alveolar branch.
with the anterior
superior
The posteriorsuperioralveolar nerve takes originin the
infra-temporalfossa, and almost immediatelydivides into
two branches,which proceed downwards upon the posterior
NERVUS MAXILLARIS 303
NASAL CAVITIES.
Stripthe muco-
periosteum
from the
exposed surface of the septum nasi,and
the parts formingthe septum will be rendered visible. The
bulk of the partition
is composed of the vomer and the per-
pendicular
lamina of the ethmoid and
posteriorly, of the
septal
cartilage Small portions
anteriorly. of other bones take
a mvnor part in its construction. Thus, above and posteriorly
there are the crest and rostrum of the sphenoid; above and
anteriorly
are the nasal spineof the frontal bone and the crest
of the nasal bones ; whilst below there is the crest of bone
formed by the apposition of the palatalprocesses of the
palateand maxillary
bones ofoppositesides.
CartilagoSeptiNasi. " The fills up
septalcartilage the
wide angulargap which intervenes between the vomer and the
perpendicular lamina of the ethmoid,and it projects forwards
towards the point of the nose. It is a broad irregularly
quadrilateral plate. Its upper and posterior border is in ap-
position
with the anterior border of the perpendicular lamina
of the ethmoid \ itslower and posteriorborder^much thickened,
is received into the groove in the anterior border of the vomer
and the nasal crest of the maxillae. The anglebetween the
two borders mentioned is prolongedbackwards,for varying a
two oval orifices which open upon the face and look down-
wards.
The. apertures,or choance,
posterior open into the pharynx
naso-
and
sphenoid, also of the ala of the vomer, the sphenoidal
process of the palatebone, and the vaginalprocess of the
medial pterygoid lamina,all of which are appliedto the inferior
surface of the body of the sphenoid.
The floorof the nasal cavity is of considerable width. It is
formed by the palatalprocesses of the maxilla and the palate
bones,and is concave from side to side. Further,it presents
Anterior
ethmoidal cell
Cavityof eyeball
from which the
N itreousbody has
been removed
Infuiidibulum
Middle nieatn
Posteriorangle of Middle conch
septalcartilage
between vomer.
and perpendicular
lamina of ethmoid
Maxillary
sinus
Inferior meatus
Inferior concha
Fig. 115. " Posterior aspect of Frontal section through the Nasal
Cavities oppositethe Crista GaUi of the Ethmoid Bone.
The upper arrow shows the opening of an anterior ethmoidal cell into the hiatus
semilunaris. The lower arrow passes from the maxillarysinus into the hiatus
semilunaris.
a gentleantero-posterior
slope,beingslightly higheranteriorly
than On
posteriorly. the anterior part of the floor,and close
to the septum nasi,the dissector may see a minute funnel-
shaped depressionof the muco-periosteum leadinginto the
incisive foramen. The depressionis of interest from a
downwards
obliquely and forwards. It represents an tional
addi-
concha which is present in some mammals. A shght
depressionabove the agger nasi,which leads posteriorly
to
Fig. 116. " Lateral wall of the Left Nasal Cavity. (From Schwalbe. )
Frontal air sinus. 11. Recessus spheno-ethmoidalis.
Free border of the nasal bone. 12. Superiorconcha.
Cribriformplateof ethmoid. 13. Superiormeatus.
Sphenoidal air sinus. 14. Middle concha.
Vibrissae. 15. Inferior concha.
6. The two parts of the vestibular area. 16. Plica naso-pharyngea.
Elevation intervening between the 17. Meatus naso-pharyngeus.
vestibular districtand the atrium. 18. Orifice of auditory tube.
Atrium meatus medii. 19. Posterior lipof auditorytube.
Agger nasi, or rudiment of an anterior 20. Pharyngeal recess.
the district of
olfactory the lateral wall of the nasal cavity,
is the sulcus olfadorius.
Conchae (O.T.turbinal bones). " Posterior to the vestibule
and the atrium are the with
conchae, the intervening
meatuses.
The superiorconcha (Fig.116, 12),which projectsfrom the
labyrinth
of the ethmoid bone, is very short,and is placed
312 HEAD AND NECK
convex downwards.
Meatus Nasi. " "Wv^ superior 116, 13)is a
meatus (Fig. short
narrow fissure between the superiorand middle conchse.
The posteriorethmoidal cells open into its upper and anterior
part,by one, or, in some cases, by several apertures.
The
olfactory
nerves are from twelve to twenty in number.
They are formed by numerous fine nerve filaments,which
springfrom the olfactory cells of the olfactorymucous brane,
mem-
Dissection. Follow
" the naso-palatinenerve, which was
exposed on the nasal septum, across the roof of the nasal cavity
to the spheno-palatine foramen in the lateral wall of the nose.
By dissectingcarefullyin the muco-periosteum in the neigh- bourhood
of the foramen, in a good part, the dissector may be
able to displayone or more of the posterior superiornasal nerves.
At the same time he should displaythe spheno-palatinebranch
of the internal maxillary artery which enters the nose through
the spheno-palatine foramen.
upon the lateral wall. They enter the nose through the
spheno-palatine foramen, which is situated at the posterior
end of the superior meatus ; and are distributed to the muco-
The nasal
inferior nerves are two in number; they both
arise from the anterior palatine
nerve.
The ganglionis
spheno-palatine situated in the pterygo-
palatine
fossa,on the lateral side of the spheno-palatine men
fora-
; and this stage it can
at be exposedbest by a dissection
from the medial or nasal side.
Dissection. The
"
muco-periosteum has already been re- moved
from the posteriorpart of the lateral wall of the nasal
cavity,and the inferior nasal branches of the anterior palatine
nerve have been found, piercing the perpendicularpart of the
palate bone. The dissector cannot fail to notice the course
taken by the trunk from which those filaments arise. The
lamina of bone which forms the medial wall of the pterygo-
palatine
canal is so thin that the nerve can be distinctly seen
;
downwards,to the palate; backwards,to establish connections
with the facial nerve and carotid plexus, as well as to supply
the mucous membrane of the pharynx; and, forwards,to the
orbit.
r Anterior palatine.
Descendingbranches, \ Middle palatine.
(
Posterior palatine.
\Nerve of pterygoidcanal.
Posterior branches, \ Some lateral posterior
. superiornasal
branches.\
Anterior branches, Orbital. .
Posterior Nasal
Superior Nerves. " There are two groups of
the posteriorsuperior
nasal nerves, a medial and a lateral.
The medial branches pass through the spheno-palatine
foramen and across to the posterior
the roof of the nasal cavity
part of the septum. The of them, the naso-palatine
largest
nerve, runs downwards arid forwards in a groove on the
surface of the vomer (p.307). Some of the branches of the
lateral posterior
group throughthe spheno-palatine
also pass
foramen and are distributed to the superiormeatus, to the
superior
and middle conchae, and to the posteriorethmoidal
air cells. Other branches of the lateral group pass backwards,
some in the muco-periosteum of the upper and posterior part
SPHENO-PALATINE GANGLION 319
parts.
nerves viz.,
" the middle and posteriorpalatine branches. They
leave the main canal and enter the lesser palatine canals,which
conduct them through the pyramidal process of the palatebone.
It is well to secure the nerves as they emerge from the lower
openings of the canals,before opening the canals. The dissector
can readilyfind them by dissectingposteriorto the hamulus of
the medial pterygoidlamina and gentlyseparatingthe soft parts
from the under aspect of the pyramid of the palate bone. As
the dissection is being made from the medial side,the middle
palatine nerve will be first encountered, and it will be seen to
pass backwards into the soft palate, under cover of the tendinous
^ be
expansion of the tensor veli palatini. The tensor must
divided, in order that the nerve may be followed to its tion.
distribu-
The posteriorpalatine nerve will be found issuingfrom
its canal a short distance to the lateral side of the preceding
nerve. It is distributed to the soft palate in the neighbourhood
of the palatinetonsil. It is smaller than the middle palatine
nerve, and is sometimes absent. The large anterior palatine
nerve should now be followed onwards to the hard palate. To
do that,open up the lower part of the pterygo-palatine can^l by
removing a small portion of the posteriorand lateral part of the
horizontal plateof the palatebone.
^
The present is a good opportunityto observe the corrugatedor wrinkled
appearance of the tendon of the tensor, as it passes under the hamulus.
320 HEAD AND NECK
1
equallygood method
An of tracingthe anterior palatinenerve is to
remove the palatalprocesses of the palate and maxilla with the bone
forceps,and then to display the nerve and artery on the upper surface of
the mucous membrane and glands.
322 HEAD AND NECK
THE LARYNX.
upper sub-
division
of thelaryngeal
cavity(Figs,
iii, 119);it extends
from the superior
aperture {aditus
laryngis)of the
Epiglottis
larynxdown to the
ventricular folds. Hyoid bone
width, therefore,
diminishes from Tubercle of epiglottis
above downwards,
whilst,
owingto the Thyreoidcartilage
obliquityof the
Plica ventricularis
aditus,
the anterior
wall is longer than Ventricle of larynx
the elevation
posterior is due to the anterior margin of the
arytjenoid
cartilageand the corniculate cartilage.
A shallow
in
object laryngoscopic examinations of the larynx.
Each ary-epiglotticfold of mucous membrane encloses
between its two layerssome connective tissue,the ary-
epiglotticmuscle, and, posteriorly, the cuneiform cartilage,
and the corniculate cartilage,
which surmounts the arytsenoid
cartilage. As already mentioned,the two small nodules of
cartilage produce elevations on the medial layer of the
posteriorpart of the ary-epiglottic
fold,which are easily
seen
when the larynxis examined with the laryngoscope.
The Middle Subdivision of the Laryngeal Cavity (Fig.
118)
THE LARYNX 325
Plica vocali
Cuneiform tubercle
Corniculate tubercle
Fic. 119. " The Larynx as seen in the living
person by means of the
Laryngoscope.
The vocal folds are the agents by means of which the voice
is produced. The ventricular folds are of littleimportance
in that respect; indeed,theycan be in great part,
destroyed,
without any appreciableeffect upon the voice.
The rima glottidis
is the elongatedfissure by means of
which the middle compartment of the larynxcommunicates
with the lower subdivision. It is placedsomewhat below
,
the middle of the
Hyoid bone
of
cavity,
laryngeal
Hyo-epiglottic
ligament
which it constitutes
the narrowest part.
of epiglottis
Cartilage it is the
Anteriorly,
interval between the
Fatty pad
vocal folds ; pos-
teriorly,
Thyreo-hyoidmembrane it is the in-
terval
Thyreoid cartilage
between the
Elevation produced by bases and vocal
cuneiform cartilage
,
processes of the
Ventricular fold
(i)
Processus vocalis a narrow, anterior
portion, between
Lamina of
cricoid cartilage the vocal folds,in-
volving
Arch of
cricoid cartilage less than
two - thirds of its
length,and called
the pars intermem-
branacea ; (2) a
Fig. 120. " Median section through the Larynx,
broader, shorter
to show the Side Wall of its Right Half. .
portion,between
the arytaenoid termed
cartilages, the pars intercartilaginea.
The form of the rima glottidisundergoesfrequentalterations
in the livingperson. During ordinaryquietrespiration it
is lanceolate in and
outline, the
intermembranous part has
the form of an with the base directed
elongatedtriangle,
backwards. When the rima is widelyopened
glottidis the
broadest part of the cleft lies between the extremities of the
vocal processes of the arytaenoid and there each
cartilages,
side of the rima presents a marked angle. The two vocal
THE LARYNX 327
Thyreoidcartilage
Vocal ligament
Rima glottidis
Vocal process of
arytaenoidcartilage
Arytajnoid
cartilage
leads downwards
directly it
into the trachea. Above, is narrow
and compressedfrom side to side,but widens
it gradually out
until in its lowest part it is circular. It is bounded by the
mucous membrane which covers the slopingmedial surface
of the conus elasticus,
and the inner aspect of the cricoid
It
cartilage. is through the anterior wall of the lowest
compartment of the larynxthat the opening is made in the
of laryngotomy.
operation
Mucous Membrane of the Larynx. " The mucous
Membrana thyreo-hyoid
Hyo-thyreoidea. " The
membrane
is a broad membranous sheet, which occupiesthe interval
between the hyoidbone and the thyreoid cartilage. It is not
ternal
laryngeal
Or ancti the of superior
laryngeal
nerve. The
crico-thyreor(3~*muscles
are the chief tensors of the vocal
ligaments.
Conus Elasticus. "
and bridgingacross
the interval between them, are the transverse
and obliqueparts of the arytaenoid muscle. Especial care must
be taken whilst that muscle is being cleaned,in order that the
connections of the superficial decussating fibres may be ascer-
tained
fully.
The lateral layer of the left ary-epiglottic fold of mucous
membrane should now be cautiouslyremoved, to expose the ary-
epiglottic muscle, the cuneiform cartilage,and the corniculate
cartilageof that side. This is perhaps the most difficult part of
the dissection, because the dissector has to establish the con-
tinuity
of the sparse fibres, which compose the pale ary-epiglottic
muscle, with the decussating fibres of the arjrtaenoid muscle
(Fig.123).
Epiglottis
.
-
fold
Ary-epiglottic
'T '
Cartilage
triticea
Thyreo-hyoid membrane
Thyreoid cartilage
M. cricoarytaenoideus
posterior
ring of
.Cartilage trachea
Epiglottis'
Lesser cornu of hyoidbone
Lamina of thyreoid
cartilage
Musculus vocalis
M. lateralis
cricoarytaenoideus ---
M. cricoarytaenoideus
posterior
Crico-thyreoidligament
Trachea
Fig. 124. " Side view of the Muscles of the Larynx. The fibres passing
backwards and upwards from the upper border of the musculus vocaUs
are the fibres of the thyreo-epiglotticus.
They blend above with the
ary-epiglotticus.
The aryfcenoideus
obliquus is composed of two bundles of
muscular each of which springs
fibres, from the posterior
aspect
of the muscular
process of the correspondingarytsenoid
cartilage
(Fig.123). From those pointsthe two fleshyslips
proceedupwards and medially,
and cross each other in the
median plane like the limbs of the letter X. Some of the
fibres are inserted into the summit of thearytaenoid
tilage
car-
of the
oppositeside, but the greater proportion
are prolonged,round the base of the corniculate cartilage.
THE LARYNX 333
inferiorlaryngeal
nerve.
Dissection. The
lateral crico-arytaenoid
" muscle should now
be carefullyremoved, and at the same time the dissector should
endeavour to disengage the fibres of the thyreo-arytaenoideus
from the deeper musculus vocalis,in order that the relation of
the vocalis to the vocal ligament may be studied. Finally,
remove the musculus vocalis. When the muscles are removed,
the lateral surface of the conus elasticus, the vocal ligament,
and the wall of the laryngealventricle will be displayed. By
carefully dissecting between the two layersof mucous membrane
which form the ventricular fold,the dissector may find the weak
ventricular ligament, which supports the fold, as well as a
number of racemose glands which lie in relation to it.
Epiglottis
"
-jr^'
Ary-epiglotticus
Tubercle of epiglottis "
Ventricular fold --
Ventricle of larynx
Vocal fold
Musculus vocalis
M. cricoarytaenoideus lateralis
M. cricothyreoideus
Cricoid cartilage
Trachea
Arytaenoidcartilage processus
Muscular
vocalis,and the
process of
medial surface
arytajnoidcartilage
of the arytsen-
oid cartilage
Vocal process of
arytaenoidcartilage (p. 343). They
are all clothed
with the lining
mucous brane
mem-
Rima glottidis of the
larynx.
folds.
Each is weak and
indefinite, but
somewhat longer
Fig. 126. " Conus elasticus. The rightlamina of
than the sponding
corre-
the thyreoidcartilage,
etc., have been removed.
vocal
upon immediately
the lateral aspect of the cricoid cartilage,
posteriorto the crico-thyreoid joint.There it is joinedby
the communicatingtwigfrom the internal laryngeal nerve, and
almost immediately afterwards it divides into two branches.
The larger of the two proceedsupwards,under cover of the
lamina of the thyreoid cartilage,and breaks up into filaments
which supplythe lateral crico-arytsenoid,the thyreo-arytaenoid,
the vocalis and the thyreo-epiglottic muscles; the smaller or
posteriorbranch inclines upwards and backwards,upon the
posterioraspect of the cricoid cartilage, and under cover of
the posterior crico-arytaenoid muscle. It supplies twigsto
that muscle,and is then continued onwards to end in the
arytaenoid muscles.
The inferior laryngeal nerve is,therefore,the motor nerve
2'Cricoid^ 1
'
4- Arytaenoid,]
3'. of the r^^^g^^- 5- Corniculate, paired,
Cartilage
epiglottis, J
6- Cuneiform, j
marginsof superiorthe
thyreoidnotch,which lies above,it
constitutes a marked subcutaneous prominencein the neck,
which receives the name of the laryngeal prominence(O.T.
pomum Adami). The posteriorborder of each lamina is thick
and rounded, and is prolonged, beyond the superiorand
inferior borders of the lamina,in the form of two slender
cylindrical
processes, termed the cornua. The superior
cornu.
Hyoid Epiglottis
triticea
Cartilage
ThjT-eo-hyoid
membrane,
Superiorcornu of
thyreoidcartilage
Thyreoidnotch
Prominentia laryngea
Crico-thyreoid
ligament.
a short posterior
part and a longeranterior part. The lateral
surfaceof the lamina is flat. Immediatelybelow
relatively
the posteriorpart of the upper border,and anterior to the root
of the superiorcornu, there is a distinctprominencecalled the
superiortubercle. From that pointan obliqueridgedescends
towards the inferior tubercle on the lower border of the lamina.
The ridgegivesattachment to the sterno- thyreoid,
thyreo-hyoid
and the inferior
constrictor muscles, ff\ Epiglottis
and divides the
lateral surface of Hyoid
the lamina into an
part. To the _
Thyreo-hyoid
membrane
part,which
posterior
Superiorcornu
is much the smaller of thethyreoid
of the is at-
tached cartilage
two,
the inferior
constrictor muscle Superior
tubercle
of the pharynx.
T^i^ medial of
surface Obliqueline
the lamina issmooth
Inferior tubercle
andslightly
concave.
Inferior cornu
To the angular
Conus elasticus
depressionbetween
Cricoid cartilage
the two laminae are
triticea
Cartilago
Thyreo-epiglottic
ligament
Superiorcornu
Corniculate cartilage
Arytaenoid
Muscular process
of arytaenoid
Inferior cornu
of thyreoid
itselfgivesorigin
to a tendinous band which proceedsupwards
from the
longitudinalfibres of the oesophagus.The anterior
part of the cricoid cartilage is the arcK and it narrows
anteriorly. The lower border of the arch is horizontal, and
is connected to the first tracheal ringby membrane, the
crico tracheal
-
ligament. The upper border is connected,
anteriorly,
to the lower border of the thyreoidcartilage"
by
the crico -thyreoid the
ligament.Posteriorly, upper border
ascends,and
rapidly to it is attached
corresponding half
the
of the conus elasticus. Upon the posterior part of the lateral
surface of the cricoid cartilage there is a circular, slightly
elevated, convex facet, which looks laterally and upwards,for
articulationwith the inferior cornu of the thyreoid cartilage.
Internally, the cricoid cartilageis lined with mucous brane.
mem-
by an articular capsule,
which is lined with a synovial
stratum. The cricoid articular surface is convex ; that of the
is concave
arytaenoid ; both are elongatedin form, but they
are placedin relation to each other so that the long axis of
the one intersects or crosses that of the other, and in no
position do
of the joint the two surfaces coincide.
accurately
The movements allowed at the joints,
as the dissector can
THE TONGUE.
.a^~
^Frenulumlinguae
Tip of tongue,
turned up
\ Plica fimbriata
^.^
Deep lingualvein
Plica sublingualis
Orifice of.
duct
submaxillary
posterior
or pharyngeal
part is developed
from the second pair
of visceral arches.
The mucous membrane of the pharyngealsurface lies in
relation with the soft palateand the
posteriorwall of the
pharynx,and it is continuous laterallywith the mucous brane
mem-
which diverge
from each other in an antero-lateral direction,
like the two limbs of the letter V. The foramen caecum
M. stylo-hyoideus
M, digastricus
belly)
(posterior
M. digastricus
(anterior
belly) M. mylo-hyoideus M. genio-hj'oideus
M. glosso-palatinus
"^M.stylo"glossus
i
Septum linguae
is
M. longitudinal
inferior
M. hyo-glossus
M. genioglossus
Genioglossus.
Hyo-glossus.
Extrinsic Muscles, Chondro-glossus.
Stylo-glossus.
Glosso-palatinus.
Superior longitudinal.
Inferior longitudinal.
Intrinsic Muscles,
Vertical.
Transverse.
The will
stylo-glossus be seen runningalong the side of
the tongue to the tip,where the muscles of oppositesides
become, to a certain extent, continuous. The hyo-glossus
extends upwards to the side of the tongue, and its fibres pass,
for the most part, under cover of those of the stylo-glossus
to
reach the dorsum, over the posterior
part of which theyspread
out, beneath the mucous membrane. The sends
genio-glossus
M. longitudinalis
'superior
Lamellae of
M. transversus
^
M. genio-glossus ^^^^^(Fs9l~ M; l?ngitudinalis
\^fl
"""
M. genio-hyoideus
Hyoid bone
Musculus Longitudinalis
Superior.The superior longitudi-
nal "
and
glossus, is intermixed with the fibres of the chondro-
glossus.
Musculi Longitudinales The
Inferiores. inferior longi-
tudinal "
M. transversus
M. ^'^^
stylo-glossus
M. longitudinal
inferior
M. hyo-glossus
M. genio-glossus
constitute thick
layerwhich extends laterally,
a from the
surface of the septum linguae, to the side of the tongue. The
fibres of the genio-glossus ascend through the transverse
stratum and break it up into numerous lamellae (Fig.134).
It is joinedby the fibres of the glosso-palatinus (Henle)(Fig.
132)-
Musculus VerticalisLingucR. The " verticalfibres extend in
a curved direction from the dorsum to the inferior aspect of
the tongue, and decussate with the fibres of the transverse
muscle.
Nerves and Vessels of the Tongue. " The nerves of the
tongue (i) the glosso-pharyngeal
are "
Superiorfrontal gyrus
Interparietal
sulcus (proprius)
Middle frontal gyrus
Angular gy PI
Inferior frontal su
Post-parietal
gyrus
'
Paroccipitalsulc"
A reusparieto-
occipitalis
',
Parieto-occipital
fissure
Olfactorybulb
\ Inferior frontal gyni
Calcarine Anterior horizontal brand
fissure ' '
lateral fissure
Sulcus lunatus Anterior ascending branch
of lateral fissure
'
.
Posterior branch of lateral fissure
Transverse occipital Superiortemporal gyrus
sulcus
Lateral sulcus
occipital
Horizontal sulcus of cerebellum
Olive of medulla oblongata
Right hemisphere of cerebellum
Fig. 135. " Lateral surface of Right Half of the Brain (semi-diagrammatic).
The horizontal dotted line completes the separationbetween
the parietal
and temporal areas, and the oblique dotted line,which runs from the
parieto-occipitalfissure to the pre-occipital
notch, separates the occipital
from the parietal and temporal areas.
(i)a dorsal
the lamina quadrigemina
portion, or tectum, which is divided
Subparietalsulcus
Calcarine fissure
Parietooccipital
fissure
Gyrus rectus'
Rostrum of corpus caliosum
Anterior commissure
1*0ni
Median aperture of fourth ventricie
Medulla spinalis
Fig. 136. Medial surface of the Right Hemisphere, and the structures
"
seen
aftftra sagittalsection has been made through the Corpus Caliosum, the
Fornix, the Diencephalon, the Mesencephalon, and the Rhomben-
cephalon,
and after the Septum Pellucidum has been removed from
between the Corpus Caliosum and the Fornix. The arrow passes
through the interventricular foramen from the rightlateral ventricle to
the third ventricle, where it lies in the hypothalamic sulcus in the side
wall of the third ventricle.
by a and
longitudinal a transverse sulcus into four rounded
(Fig.
bodies called the colliculior corpora quadrigemifia 195);
and (2)a the interpeduncular
ventral part,cut by a depression,
fossa,into two rounded columns, the pedunculicerebri. The
mid-brain is traversed,between the lamina quadrigemina
and
GENERAL FEATURES 357
the pedunculi,
by a canal,termed the
aquaeductus
cerebri,
which connects the third in the diencephalon,
ventricle, with
the fourth in the hind-brain.
ventricle,
Stilllower and more below
that is,
posteriorly " and behind
the mid-brain "
is the
rhombencephalonor hind-brain. It also
is separableinto dorsal and ventral portions, and between
them is the cavityof the hind-brain,
called tht fourthventricle
(Fig.136). The dorsal portionis the cerebellum) it lies im-
mediately
below the posterior parts of the cerebral hemi-
spheres
and above and behind the fourth ventricle. The
ventral part of the hind-brain consists of an upper part,called
pons^ which is continuous with the pedunculiof the mid-
\}i\" brain,
and
lower part,called the medulla
a which
oblongata^ is
below,with the spinal
continuous, medulla.
When the brain was removed, the dissector noticed that
the cerebral hemispheresoccupied the anterior and middle
fossae of the cranium and that,more posteriorly,theylayon
the tentorium cerebelli "
Inferior precentral
sulcus
Superior pre-
central
sulcus
Anterior
central gyrus
Lower buttress
Central
SULCUS
Upper
buttress
Posterior
central gyrus
Inferior post-
central
sulcus
Superior parietal^
lobule sulcus
Interparietal
part)
(occipital
Middle temporalsulcus
Interparietal
sulcus (occipital
part) ^^v^^27~!
Transverse sulcus
occipital
fissure
Parieto-occipital Parieto-occipital
fissure
sulci,
called the lateral occipital
sulcus and paramedial occipital
sulcus^into three gyri the superior, "
middle,and inferior.
lateral surface of the temporal lobe is divided by two
The
which run
sulci, into superior,
antero-posteriorly, middle, and
inferiortemporalgyri.
When surface is completed,
the survey of the supero-lateral
a specimen should be examined in which the lipsof the
lateral fissure have been separatedor removed. In such a
136).
the surface of section of the severed corpus callosum (Fig.
corpus callosum consists of
The a trunkswhich terminates
thick,rounded
in a free,
posteriorly posterior end, called the
in
and anteriorly
spleniunij a bent anterior extremity called
the genu. From the genu a taperingportionof the corpus
callosum,termed the rostrum, passes downwards and back-
wards.
It ends below in a thin lamina,called the lamina
terminalis^ which descends tillit reaches the ovoid transverse
section of the opticchiasma,which connects togetherthe two
opticnerves. The terminalis passes behind the optic
lamina
chiasma, and joinsthe tuber cinereum in the floor of the
third ventricle 136, 159).
(Figs. The transverse, small and
round,white bundle passes throughthe lamina termin-
which alis,
above the opticchiasma,is the anterior commissure.
In the median plane,in the anglebetween the body,genu,
and rostrum of the corpus callosum,there is a thin vertical
lamina called the septum pellucidum.It is bounded below
and behind by a flat band of white matter, called the fornix
136, 156).
(Figs.
The boundaries of the medial surface of the hemisphere
are "
(i)The border,which extends from the
supero-medial
frontal pole,and separates the medial
pole to the occipital
from the surface.
supero-lateral (2) The medial occipital
which
border, extends from the pole to the splenium
occipital
of the corpus callosum ; it separates the medial surface from
the posterior part of the inferior surface. (3) The medial
GENERAL FEATURES 363
Olfactorytract (cut)
Opticnerve
Lateral orbital gyrus^
Anterior perforated
substance
osterior orbital gy
Infundibulum
Stem of lateral Optic tract
fissure
^Mamillarybody
Posterior per-
forated
substar
Rhinal Pedunculus
fissure cerebri
Uncus
Calcarine fissurt
Sulcus lunati
Sulcus lunatus
Calcarine fissure | Calcarine fissure
Sulcus for superior sinus
sagittal
H-shaped outline.
The posterior part of the inferior surface, which lies
behind the temporal pole, looks downwards and medially.
366 THE BRAIN
Infundibulu Olfactorybulb
Olfactorytract
Motor root of
facial nerve
Acoustic nerve
Abducens
Sensory root of
nerve
facial nerve
Glosso-pharyngeal
nerve
which downwards
projects into the and
vallecula, is called
the inferior
vermis. .
with the dura mater and the pia mater along the
nerve roots and along the blood vessels of the brain. It
is an thin
exceedingly and delicate membrane, which can
'
Dura mater
""Subdural space
s
"Arachnoid
Pia mater
Fornix
Arrow in interventricular foramen
I Massa intermedia
Caudate nucleus in rightlateral ventricle \ arachnoid tissue in tela chorioidea_
Genu of corpus callosum of tela chorioidea ol
II I
'
"
Layers of pia mater
Subarachnoid space
1 ] J Supra-pinealrecess third vent
Arachnoid membrane u--" Pineal body
\
Aquaeductuscerebri
Lamina quadrigemi
V (Tectum). The poi
/S. crosses the cistt
\ venjE magnae cei
Anterior ^
commissure'' ^"'
Cisterna chiasmatis
Opticchiasma
Hypophysis
Cisterna interpeduncularis
Cisterna pout
Pia mater on pons ^
between the
projecting temporal lobes,and covers in the
deep hollow in that regionof the base of the brain. The
space so enclosed is called the cisterna interpeduncularis^
and
within it are placedthe largearterieswhich take part in the
formation of circulus arteriosus. The cisterna interpedun-
cularis is continuous, with
anteriorly, the cisterna chiasmatis^
which liesanterior to the opticchiasma and lodgesthe anterior
cerebral arteries(Fig.
141).
All the subarachnoid cisterns communicate in the freest
manner with one another,and also with the narrow arachnoid
sub-
intervals on the surface of the cerebrum. The
subarachnoid space does not communicate in any way with
the subdural space. however, it com-
In certain localities, municates
Superior sinu
sagittal
mater
Subarachnoid space
Arachnoid
Falx cerebri
carry with them sheaths derived from the pia mater. sequently,
Con-
if the dissector raises a portionof that membrane
from the surface of the cerebrum,a number of fine processes
will be seen to be withdrawn from the cerebral substance.
They are the blood vessels,
and they givethe deep surface
of the membrane a roughand flocculent appearance.
The piamater is not confined to the exterior of the brain.
A fold is carried into its interior. This will be exposed in
the dissection of the brain,and will be described under the
name of the tela chorioidea of the
(O.T.velum interpositum)
174).
third ventricle (Fig.
Ill" 24 c
376 THE BRAIN
Veins of the Pons. " The veins from the upper part of the
pons join the basal vein,and those from the inferior part
either join the cerebellar veins or they end in the inferior
sinuses.
petrosal
Veins of the Medulla Oblongata. " The smaller veins of
the medulla oblongataconverge to an anterior and a posterior
median vein,or they run along the roots of the last four
pairsof cerebral nerves. The anterior median vein municates,
com-
medially.
The vertebral arteries curve round the sides of the medulla
oblongataand theyunite at its upper border,in the median
plane,to form basilar artery, which runs
the to the upper
border of the pons, where it divides into the two posterior
cerebral arteries.
But the cerebral arteries which springfrom the internal
carotid arteries of oppositesides are broughtinto association
with one another, and with the posteriorcerebral arteries,
which springfrom the basilar,
by a remarkable and complete
38o THE BRAIN
Anterior communicating
Internal,carotid
Middle cerebral
P
Fig. 144. "
Infundibulum
Opticnerve
Internal carotid
artery
Abducens nerve
Trigeminalnerve /- Posterior
communicating
Trochlear nerve /, artery
Oculo-motor ner\
Acoustic and Posterior cerebr;
facial nerves
artery
Superior
cerebellar arte
Glosso-pharyn-
geal nerve Tentorium
Basilar
artery
Vertebral
artery
Superiorpetro
Accessory nerve sinus
Section through
the medulla
Transverse sinus
oblongata
sinus
Superiorsagittal Straightsinus (divided)
Arieria
Spinalis Posterior. The posterior spinalartery is
"
Parieto- ^ '^
li^^^^^-^iV
occipital ^-^
"
^ -^^
branch
Medial orbital
branches
Anterior cerebral artery
Arteria Basilaris. " The basilar artery runs from the lower
border to the upper border of the pons, occupyingthe median
groove of the pons and lyingin the median part of the cisterna
pontis. It is formed, at the lower border of the pons, by the
union of the two vertebral arteries,and it divides,
at the upper
border,into the
posterior cerebral arteries. It is sup-
two ported
anteriorly
by the basilar portion of the occipitalbone
and the dorsum sellae of the sphenoid(Fig.38).
The majorityof the branches which spring from the basilar
artery arise from its sides and pass from it. They
laterally
are :"
1. Pontine. cerebellar.
Superior
2. Internal auditory. Posterior cerebral.
-x. Anterior inferior cerebellar.
384 THE BRAIN
rPostero-median. r Temporal.
Central or basal \ Postero-lateral. Cortical \ Calcarine.
Posterior chorioidal. \Parieto-occipital.
median
The postero- central arteries arise close to the originof the parent
trunk. They proceedupwards, in the interval between the pedunculi cerebri,
and, after piercing the substantia perforata posterior (O.T. posterior per-
386 THE BRAIN
sulcus
Olfactory
Anterior communicating
artery ^
Internal carotid artery
Middle cerebral artery -^^
Chorioidal branch of
Posterior communicating
internal carotid
artery
Superiorcerebellar artery
Basilar artery'
Temporal
Posterior chorioidal artery branches
Collateral fissure
Fig. 147. " Inferior surface of the Cerebral Hemisphere. The districts sup-
plied
by the three cerebral arteries are tinted cerebral
: posterior
differently
artery,red ; middle cerebral artery,blue ; anterior cerebral artery,purple.
Central or basal 1 a 1 ,
\ Antero-lateral.
^ ^
branches.
orbital.
Cortical branches.
{Lateral
Inferior lateral frontal.
Ascendingfrontal.
Parietal { Ascendingparietal.
Parieto-temporal.
Temporal.
388 THE BRAIN
Thearteries of the ant ero -lateralcentral group are very numerous. They
pierce the substantia perforata anterior and supplythe lentiform nucleus,
the internal capsuleand the external capsule, the caudate nucleus,and a
portion o f the thalamus.
Temporal branches
to the lateral part of the orbital surface of the frontal lobe ; (2)inferior
lateralfrontal, to the inferior and middle frontal gyri; (3)ascending frontal,
which runs upwards in relation to the anterior central gyrus (Figs. 147, 148).
The ascending parietalbranch extends, in an upward and backward
direction, in relation to the posterior central gyrus, and its terminal twigs
the
supply greater part of the cortex of the superior parietal lobule (Fig. 187).
The parieto-temporal branch is a very largeartery which issues from
the posterior part of the posterior ramus of the lateral fissure; it sends
branches upwards to the inferior parietal lobule,and others which incline
downwards over the posterior part of the temporal lobe. Its twigs,as
a rule, do not encroach upon the .supero-lateral surface of the occipital
lobe (Fig.148).
The temporalbranches,two or three in number, issue from the posterior
ramus of the lateral fissure, and, turning downwards and backwards,over
its lower lip [i.e.the superiortemporal gyrus),they ramifyupon the
lateral surface of the temporallobe (Fig.148).
BLOOD VESSELS OF THE BRAIN 389
"
Each nerve is said to have "
attachment
superficial
a and
" "
a deep originor termination. By the term superficial "
"
attachment is meant the regionwhere itsfibres enter or leave
"
the brain surface ; the terms deep termination and origin
"
Optic chiasma
Infundibulum Olfactorybulb
Fig. 149. " The Base of the Brain with the Cerebral Nerves attached.
which they form are the accessory^ the vagus^ and the glosso-
pharyngeal.
The fila of the vagus and the glosso-pharyngeal
are much more closelycrowded togetherthan those of the
Trochlear nerve
Abducens nerve
^3- y ^
/ 1 i Sensoryroot of
/ ifJ
P^^y
/
^ ''
if
facial nerve
-Acoustic nerve
/ ^^
7 Right transverse
^/ _"/ sinus
Glosso-pharyngeal
nerve
Vagus nerve
Accessory nerve
/^Vertebralartery
Hypoglossal nerve
First spinalnerve
Accessory nerve
Fig. 151." Section through the Head a little to the right of the Median
Plane. It shows the posteriorcranial fossa and the upper part of the
vertebral canal after the removal of brain and the spinalmedulla.
emerges from the groove between the lower border of the pons
and the lateral part of the pyramid. It is flattened out near
itsoriginand a surface view of it in that regiongivesa
idea
deceptive of its size 149, 150).
(Figs.
Nervus Trigeminus. " is the largest
The trigeminal of all
the cerebral nerves. It is attached to the side of the pons,
nearer its upper than its lower border,by two roots a large "
THE CEREBRUM.
is
pushed into more detail many differences become
manifest,not only in the brains of different subjectsbut
also in the two cerebral of
hemispheres one subject.
The which
depressions intervene between the cerebral
gyrivary in depth. Some are due to foldingof the whole
thickness of the wall of the cerebrum,and consequentlythey
correspondwith elevations of the walls of the cavitiesof the
cerebrum which are called the lateral ventricles. Such
depressions
are called fissures.In this category are
complete
included (i)the anterior portionof the calcarine fissure;
"
Fronto-marginal
sulcus I
Inferior frontal sulcus
Inferior frontal gyrus
Pars orbitalis !
Ca
Lateral fissure (ant.horiz. branch)
fissur
Pars triangularis ! i brani
Lateral fissure I I Sulcus occ:
Iparamedial
Pars basilaris | ! Lunate sulcus
Sulcus diagonalis I Lateral occipitalsul
Lateral fissure (posterior branch) Inferior temporal gyrus
Superior temporal gyrus Middletemporal sulcus
Superior temporal sulcus Middle temporal gyrus
Posterior central gyrus Superiortemporal sulcus
Supero-lateral
aspect of Left Hemisphere (semi-diagrammatic).
The orbital surface is shaded.
are "
named "
Visual area J
Face area
Calcarine fissure
Posterior branch of lateral fissure !
Superiortemporal gyrus Acoustic area
somewhat
hemisphere, posterior than the anterior
nearer the
end. It lies between two gyri which, though they are
obliquely placed, are stillthe most vertical gyrion the supero-
lateral
surface,and it separates the frontal from the parietal
lobe. The upper end of the sulcus frequently cuts the
supero-medial border of the hemisphere, and, in such cases,
it appears on the medial surface of the hemisphere. The
lower end, as a rule,is separated from the posterior ramus of
the lateral fissure by a small bounding gyrus. The sulcus
does not take a straight course between its two extremities;
on the contrary,it is bent upon itself several times,on
account of buttress-like
projections from its bounding walls
(Figs.138, 153). The two most prominentbuttresses spring
from the anterior wall,
which is formed by the anterior central
gyrus. From itsupper end the sulcus runs, at first, downwards
and forwards to the base of the upper, buttress ; then it bends,
first round the upper and next round the lower buttress;
its lowest part
finally, runs almost downwards
vertically from
the base of the lower buttress. anterior central gyrus,
The
which forms the anterior boundary of the central sulcus,
constitutes the motor regionof the cerebral cortex, and by
means of the buttresses which springfrom its posterior face
it is possibleto define in a fairly
accurate manner the various
motor areas. The lower limb area extends from the upper
end of the central sulcus to the apex of the upper buttress ;
the trunk area corresponds with the lower face of the upper
buttress ; the upper limb area corresponds with the regionof
the lower buttress ; and the head area with
corresponds the
anterior boundary of the central sulcus below the lower
buttress.
When the marginsof the central sulcus are separated,
gently
a transverse gyrus will be found crossing
annectant its floor
and the anterior and posterior
unitingtogether central gyri.
It liesat the level of the lower part of the upper buttress of
the anterior central gyrus.
Fissura Parieto- occipitalis. The "
Interparietal
sulcus
Angular gyrus (proprius)
Superior
temporal
sulcus Par-occipital
sulcus
Post-parietal
gyrus
Superior
temporal sulcus
Middle Transverse
temporal sulcus
"occipital
gyrus Middle
Middle temporalsulcus
temporal .Paramedial
sulcus sulci
occipital IS
Inferior, Lateral
temporal occipital
su
gyrus
Lateral .-
Sulcus lunatus'
alcarine fissure
Calcarine fissure Sulcus for superior sinus
sagittal
Frontal sinus
W^^W^ -
Ethmoidal eel
Internal acoustic
meatus
Maxillarysini
ondyle of mandible
Floor of tympanic
antrum
Atlas
^^
PLATE V
Sphenoidal sinus
Petrous part of
temporal bone
Condyle of j
Atias
posterior
ramus of the lateral below.
fissure, It lies between
the central and the precentralsulci and is the regionof the
motor area of the brain. It is continuous, at its upper and
its lower ends, round the extremities of the central sulcus,
with the central
posterior gyrus. From its
posteriorface
two buttresses,
an upper and a lower,projectbackwards,as
pointedout on p. 403. The buttresses form excellent land-
marks
delimitation of the parts of the motor
for the area.
part of the superior frontal gyrus, a part of the gyrus cinguli and a part of
the paracentral lobule (Fig.159).
Paroccipitalsulcus
Arcus parieto-
occipitalis
',
Parieto-occipital
fissure
I
C'lfactory
bulb
Lateral sulcus
occipital
Horizontal sulcus of cerebellum
Olive of medulla oblongata
Right hemisphere of cerebellum
Fig. 155. " Lateral surface of Right Half of the Brain (semi-diagrammatic).
The horizontal dotted line completes the separationbetween the parietal
and temporal areas, and the oblique dotted line,which runs from the
fissure to the pre-occipital
parieto-occipital notch, separates the occipital
from the parietal and temporal areas.
and
superior an inferior. They are developedindependently,
4IO THE BRAIN
The
Gyri of the Supero-lateral Surfaceof the Pat-ietal Lobe.
" The subdivisions of the supero-lateral surface of the
parietal lobe are the posterior central gyrus ; the superior
parietallobule ; and the supra-marginal, the angular, and the
post-parietalgyri, which form collectively the inferior parietal
lobule (Fig. 152).
Gyrus Centralis Posterior. The posterior central gyrus lies
"
Sulcus Medius.
Temporalis "
The middle temporalsulcus,
which lies between the middle and the inferiortemporalgyri,
is very irregular
in its mode of formation ; not infrequently
it
is represented by two or more separate portions.
The Gyri of the Lateral Surfaceof the Temporal Lobe. "
middle,and inferior.
Gyrus TemporalisLnferior.The inferior temporal gyrus
"
_j^
*
1 Septum pellucidum
ippocampalrudiment (medial and lateral stria^) "
I Paraterminal body
^V#?^^ I
' '
Subcallosal gyrus
Splenium of corpus callosum callosur
I riiu of corpus
1 lippocampal rudime
'aneto-occipital
fissure
Calcarine fissure
/
I'/.
y'
Stem of cal-
carine \ Olfactorybulb
fissure Olfactorytract
Isthmus'
Lamina terminalis (cut)
Hippocampus-'
Medial stria of olfactorytract
Fasciola cinerea Lateral stria of tract
olfacjory
^
Thalamus (cut)' /' / / \ Rhinal fissure
-* ' \ Piriform area
Pia mater in chorioidal fissure J
Fascia dentata /
/
I
Cauda
Hippocampus
fascia; dentatae
^tsJr-
Collateral fissure
and
laterally on a lower level than the chorioidal fissure. It
lies below the stem of the calcarine fissure and extends
forwards beyond its anterior extremity 156, 159).
(Figs.
The Rhinal Fissure lies anterior to and above
slightly or
posteriorly lobe.
to the inferior surface of the occipital
S.R./
S.R.a.
27
4i8 THE BRAIN
Corpus callosum
Medial occipital
parieto-
fissure
Cuneus
Anterior cuneo-
lingualdeep yrus lingualis
gyrus
Posterior cuneo-
Anterior part of the
lingualdeep gyrus calcarine fissure
Fig. 158. Posterior part of medial airface of the Left Hemisphere. The
"
Gyrus cingul
Parieto-occipital
fissure'
Calcarine
fissure L ingualgyrus Superior
| [ frontal gyrus
Calcarine fissure i
I Genu of corpus callosum
Calcarine fissure below isthmus of gyrus
I Subcallosal gyrus
fornicatus Paraterminal
Lamina
,
body
quadrigeinina Anterior commissure
Pineal body :
Optic chiasma
Aquaeductus cerebri | |
Pedunculus cerebri I Infundibulum
I
Pons' Tuber cinereum
Ocult)-motor nerve Mamillary body
Fig. 159. "
Medial surface of Left Hemisphere (semi-diagrammatic).
Sulcus
Subparietalis. Behind the posterior end of the
"
Gyrus Frontalis
Superior.The superiorfrontal gyrus has
"
Frontal fibres
Cingulum
Genu
Fibres of corona radiata
Cut surface
Transverse fibres
Intersection of T ,
/ of corpus
callosal and corona J V callosum
radiata systems of 1
fibres L
"
Inferior longitu-
dinal
fasciculus
Corpus callosum
Tapetum
Cingulum
Splenium Forceps major
Stria medialis
longitudinalis
Fig. i6i. -The Corpus Callosum exposed from above and the righthalf
dissected to show the course taken by the fibres.
Genu of
Olfactorytracts
Lamina terniinalis
Gyrus subcallosus
Fig. 162. " -Anterior end of the Corpus Callosum and the Subcallosal Gyri
as seen from below when the frontal lobes of the hemispheres are
slightly
separated from each other. (From Cruveilhier. )
Ventriculus Lateralis.
Thalamus
Fornix
First frontal sulcus /^
Precentral sulcus
Postcentral
sulcus
Lateral fissure
Chorioid plexus
Chonoid plexus
Posterior horn of ventricle Calcar avis
Calcarine fissure
Corpus callosum
Longftudinal
fissure
Fig. 163. " Dissection of the Lateral Ventricles of the Brain. On the right
side the hemisphere was cut horizontally
at the level of the of
junction
the lateral wall with the roof of the ventricle. On the left side the part
of the hemisphere above the corpus callosum was torn obliquely ;
away
then the corpus callosum was cut through from above.
Hippocampus
Bulb of cornu
Crus of fomi
Hippocampus
Forcepsmajor
Body of fornix Crus of fornix
Fig. 164. " Dissection to show the Lateral Ventricles. The trunk of the
corpus callosum has been detached from the genu and the and
spleniuni
turned over to the left.
Pineal recess
Supra-pineal
recess
Aquaeductus
Interventricular
foramen
Third ventricle
Optic recess
ifundibular recess
Lateral recess
Fig. 165. " Cast of the Ventricles of the Brain. (From Retzius, )
is understood when
readily a cast of the cavityis examined
(Fig.165). It is composed of a central part (O.T. body)
Caudate nucleus
Putamen
tamen
.^tfHBB^^^
Anterior commissure
Pes hippocampi
Hippocampus ,'
Inferior cornu of
! Genu of corpus
lateral ventricle ill' t "l callosum
-Septum
pellucidum
Cavum sep. pell.
Caudate nucleus
Foramen
interventriculare
Stria terminalis
Medial longi-
~"
tudinal stria
Chorioid
plexus '
/'
Fimbria'
Posterior collateral
eminence
Posterior cornu
Calcar'avis
Forceps major
Fig. 166. " Dissection to show the Posterior and Inferior Cornua of the
Lateral Ventricle on the left side.
Corpus callosum
fissure
Longitudinal
Right column
_,
',
Caudate nucleus
Septum pe'lucidum
Fig. 167. " Frontal section through the Cerebrum through the anterior part
of the lentiform nucleus. Seen from the anterior aspect.
(i)the
caudate nucleus ; (2)a groove backwards
obliquely,
extending
Corpuscallosu Chorioid plexus
Lateral ventricle I Striae on corpus callosum
Caudate nucleus i fissure
Longitudinal
i'ronto-occipiial
fasciculus I /; ! Septum pellucidum
28
434 THE BRAIN
\ Opticradiation
bundle
Inferiorlongitudinal
Fig. 169. " Frontal section through the Posterior Horns of the
Lateral Ventricles.
the horn
posterior are formed by the tapetum of the corpus
callosum (seep. 426).
Upon the medial wall two curved
elongated, elevations
may be seen. The upper of the two is termed the bulb of
the cornu, and is producedby the fibres of the forceps
major
as they curve, backwards,from the lower part of the splenium
of the corpus callosum into the occipital lobe. The lower
elevation is known as the calcar avis. It varies greatlyin
in
size, different and is caused by an
brains, of the
infolding
ventricular wall which correspondswith the anterior part of
the calcarine fissure.
Dissection. "
operculahave not alreadybeen removed
If the
to expose the
insula, the dissector should now insinuate his
fingers underneath the fronto-parietal operculum of the insula
on the right side and tear that portion of the cortex away in an
upward direction. The frontal operculum (parstriangularis)
and the orbital operculum should be dealt with in the same
manner. The greater part of the temporal operculum has
already been removed in opening up the inferior horn of the
ventricle ; therefore the insula is how fullyexposed to view,
and its relation to the parts in the interior of the ventricle can
be seen.
the inferior
cavity.At firstdirected backwards and laterally,
sinks downwards,posterior
horn suddenly to the thalamus,into
the temporallobe,in which it takes a curved course, forwards
and medially, to a pointabout 25 mm. (oneincH)posterior to
the extremity of the terriporalpole. In the anglebetween the
diverging inferiorand posterior horns the cavity
of the ventricle
exhibits a triangular expansionof varying capacity.It is called
the trigonumcollaterale.
The lateral ivall of the inferior horn is formed, for the
most part, by the tapetum of the corpus callosum. At the
of
extremity roofpresentsa slight
the horn the bulginginto the
ventricular cavity.The bulging is called the amygdaloid
and it is produced by a superjacent
tubercle^ collection of grey
matter, termed the amygdaloidnucleus. The stria terminalis
and the greatlyattenuated tail of the caudate nucleus are
both prolonged into the inferior horn, and are carried
forwards,in its roof,to the amygdaloidnucleus.
436 THE BRAIN
Optictract
Stria terminalis Fimbria
Chorioid plexus| Subthalamic body
Caudate nucleus ', \ ! Basis pedunculi
Inferior cornu of lateral ventri ! "' Red nucleus
in a extremity,
thickened the pes hippocampi.The surface
of the pes hippocampiis marked by some faint grooves which
intervene between a number of ridgescalled the hippocampal
digitations. The hippocampalelevation is due to masses of
nerve cells and the nerve fibres associated with them.
Alveus. " The alveus is a thin white layerformed by nerve
direction
longitudinal at the margin of union of the campus
hippo-
and the fascia dentata,and ascend to become the
Pes hippocampi
Hippocampus
Anterior collateraleminence
Uncus -
Cauda fasciae
dentatce
Fimbria
Fascia dentata-
Fornix
Hippocampal
gyrus
Splenium
Trigonum collaterale
Posterior horn
Calcar avis
Bulb of cornu
Fig. 171. " Dissection to show the Posterior and Inferior Cornua of the
'Lateral Ventricle.
corresponding
crus of the fornix (seep. 442). It liesbetween
the chorioid fissure and (Fig. 171). the fascia dentata
it runs
Anteriorly, into the recurved extremityof the uncus ;
and postero-superiorly, as alreadystated,it becomes tinuous
con-
^
. . .
/ r)pticradiation
'
Inferior bu
longitudinal
rapetum
Chorioid plexus
,^
\ Inferiorhorn of lateral ventricle
Alveus
Medial body
geniculate Fascia dentata
Fig. 172." Frontal section through the Cerebrum, Mid-brain,and Pons in the
plane of the geniculatebodies. It shows the relation of the chorioid
fissure to the inferior horn of the lateral ventricle.
leads from
directly the exterior of the brain into the interior
of the inferiorhorn of the lateral ventricle.
Chorioideus.
Plexus The chorioid plexus is a system of
"
accessible.
crura posteriorly.
Fasciculus mamillo-thalamicus
i Corpus callosum
Taenia thalami Rostrum of corpus callosum
Base of pineal'..1
Upper quadrigeminal
body '
Crura Fornicis
(O.T.Posterior Pillars).The crura of the "
and so are in
prolonged, the inferior horn, into the fimbria
and the alveus. They constitute a transverse commissure
from one hippocampusto the other.
Caudate nucleus
Vena
terminalis ,' /
"
Stria
terminalis "-"/^ Tela chorioidea
of third ventricle
Crus of fornix
'
/
^_
I """. Body of fornix
^^^/f^ reversed
Fig. 174. " Dissection to show the Tela Chorioidea of the Third
Ventricle and the parts in its vicinity.The fornix has been
divided and thrown backwards.
!
3rd ventricle
Hypothalamicbody Chorioid plexus
Thalamus Red nucleus
Cavum --'
septipellucidi
Septum pellucidum
Caudate nucleus
Fornix
Right column of fornix
Anterior commissure
Anterior tubercle of
thalamus
Massa intermedia
Vena terminalis
Ventricle in.
"
Posterior commissure ^'' Trigonum habenulae
Trochlear nerve
Pulvinar
Brachium pontis
Stalk of pinealbody
Corporaquadrigemina
Pineal body
'
Brachium conjunctivum
Lingulaof cerebellum
Medulla oblongata ,
Fig. 176. " The two Thalami and the Third Ventricle as seen from above.
The projecting
most part is called the pulvinar. But the
posterior end of the thalamus shows another prominence,
which is situated below and to the lateral side of the pulvinar.
It is oval in form, and receives the name of the corpus
geniculatum
laterale.
The anterior two-thirds of the medial of
surfaces the two
thalami are placed very close together,
and are covered not
Gyrus cinguli
Tuber cinereum
Mamillary body
Oculo-motor nerve Median aperture of
fourth ventricle
Medulla oblongata
Medulla spinali
Fig. 177. "
Sagittal
section of Corpus Callosum, Fornix, Diencephalon,Mid-
brain,
and Hind-brain. The septum pellucidumhas been removed to
throughthe interventricularforamina^
and it communi-
cates
with the fourth ventricle by the cerebri
aqucediictus
{Sylvius)^
a narrow channel which tunnels the mesencephalon.
The opening of this canal will be seen in the wall
posterior
of the third ventricle,immediatelybelow the posterior
missure.
com-
THE MESENCEPHALON.
posterior
commissure. From its lower end a short but well-
defined narrow band of white called
fibres, the frenulum veli,
passes to the anterior medullaryvelum, a lamina which lies
immediately below the inferior pairof quadrigeminalpromi-
nences,
in the roof of the fourth ventricle. The upper part
of the longitudinal
groove is occupiedby the pinealbody.
The transverse
groove curves round below each of the two
c
superior olliculiand separates them from the inferiorpair.
Brachia of the Corpora Quadrigemina. corpora "
The
quadrigemina form the dorsal part of the mid-brain,but each
body is connected also with the corresponding lateral aspect
of themesencephalon by a prominent white strand,which
is prolonged upwards and forwards under the projecting
pulvinar. The strands are called the brachia of the corpora
quadrigemina, and they are separatedfrom each other by a
continuation,on the side of the mesencephalon,of the trans-
verse
Superiorquadrigeminal
body
Inferior
Stria terminalis quadrigeminal
body
Corpus geniculatum
laterale Aquaeductus cerebri
Corpus mamillare
Optic tract
Tuber cinereum
Anterior perforated
substance
Opticchiasma
Opticnerve
^"Mesencephalic
root of trigeminalnerve
Grey matter of
aqueduct
^'Nucleus of trochlear nerve
cerebri
--' Medial fasciculus
longitudinal
Raphe
Brachium conjunctivum
Basis pedimculi
Substantia nigra
midal tract)
as it descends from the motor area of the cerebral
cortex, but the cerebro-spinalfasciculus is quiteindistinguish-
able,
under ordinarycircumstances, from the fronto-pontine
fibres on its medial side and the temporo-pontine fibres on its
lateral side.
Tegmentum. "
Unlike the bases the tegmentum
pedunculi,
is undivided,a faint line in the median plane,termed the
median raphe^alone indicating that it consists of a right
and
THE MESENCEPHALON 457
body
Superiorquadrigeminal Grey matter of aqueduct
Tegmentum
Inferiorbrachium \
body
Medial geniculate
Lateral geni- ',
culate body
Aqiiaeductuscerebri
Nucleus of oculo-
motor
nerve
Medial tudinal
longi-
fasciculus
Red nucleus
.
Fibres of brachiur
conjunct!
vum
"v,Filaof
oculo-motor nerve
Optictract '
Basis pedunculi
Medial lemniscus
largestrands which are continued upwards from the cerebellum into the
mesencephalon.By pulling
away the marginof the cerebellum,where it
overlapsthe inferior colliculi of the quadrigeminal lamina, the dissector
will see the brachia on the surface as theyconverge in an upward direction.
458 THE BRAIN
Stretching
across the interval between them, and bringingthem into
with
continuity one another, is a thin lamina called the anterior medullary
velum. When the brachia conjunctiva reach the bases of the inferior
quadrigeminal bodies,theysink into the substance of the mesencephalon,
and, in a transverse section throughthe lower part of that portionof the
brain,they may be seen as two white strands,semilunar in outline and
plaqed one on each side of the grey matter of the aqueduct. As they
ascend, they graduallyassume a deeper{i.e.a more ventral)position in
the tegmentalpart of the mesencephalon,and they decussate with each
other across the median planeand proceedupwards to the red nuclei.
The term lemniscus (O.T. Jillet)is given to two tracts which have
different connections. The medial lemniscus (Figs.180 and 181) is a
sensory tract passingupwards to the thalamus. The lateral lemniscus
belongs to the acoustic apparatus, and is a part of a chain throughwhich
the cochlear, nuclei of one side estabUsh connection with the inferior
quadrigeminal body and the medial geniculate body of the opposite side.
The lateral lemniscus can be readilydetected as it emerges from the
upper part of the lateral sulcus of the mid-brain, and passes, backwards
and upwards, to the lower border of the inferior quadrigeminate body and
inferior brachium. It has the form of a raised triangular band which
encircles the lateral surface of the upper end of the brachium conjunct! vum
(Fig.194).
Within the upper part of the tegmentum there is a collection of nuclear
matter which is termed the nucleus ruber, from its ruddy appearance
when seen in section. It is rod-like in form, and extends upwards into the
tegmentalregionbelow the thalamus (Fig.188). In transverse section it
presents a circular outline,and it is closelyassociated with the upward
prolongations of the majorityof the fibres of the brachium conjunctivum
of the opposite side. The brachium conjunctivumcerebelli is an efferent
tract from the nucleus dentatus of the hemisphere of the cerebellum,and
its fibres end in the red nucleus and the pulvinar of the thalamus of the
oppositeside. The tegmentum of each pedunculuscerebri may be con- sidered
Globus pallidas
Fasciculus maniillo-thalamicus
Posterior limb of internal capsule
Thalamus
Retrolenticular part
of internal capsule
Tail of caudate nucleus
Hippocampus
Splenium
Tapetum
radiation
bundle
Inferior longitudinal
Fig. 182. " Horizontal section through the Right Cerebral Hemisphere at the
level of the widest part of the lentiform nucleus.
capsule,a triangular
mass of grey matter called the lentiform
nucleus. It is divided into three parts by two thin white
laminae called the medial and lateral medullary laminae.
The lateral of the three parts is called the putamen ; it
most
laterally,
by "
(8) A thin lamina of grey matter called the
claustrum^which has a smooth medial surface and a scalloped
lateral surface. (9) The insula,which lies lateral to the
claustrum and consists of a layerof white and a layerof grey
matter. It forms the medial wall of "
Caudate nucleus
Opticradiation
Pulvinar
Stria terminalis '.
Caudate nucleus
Fig. 183. " Horizontal section of Corpus Striatum and adjacent parts on the
rightside, after the dissection representedin Fig. 182 had been made.
The line to the anterior horn of the lateral ventricle crosses the right
lamina of the septum pellucidum.
_
Longitudinalfissure
I^^^H^^^^H^^^^^ Genu corpus callosum
"
noted in
previously the floor of the central part of the
lateral ventricle (seep. 431). Trace it also along the roof
of the inferiorhorn to the amygdaloidtubercle.
Examine next the series of vertical transverse sections and
note (i)That, in the firstsection,
" which passes throughthe
part of the frontal lobe,the head of the caudate
posterior
nucleus the anterior part of the lentiform nucleus are
and
fusingtogether,ventro-lateral to the anterior horn of the
lateral ventricle (seeFig.185). Note also that,as they
blend,a striate appearance is producedby the intermingling
464 THE BRAIN
"'-
Corona radiata
Ventricular surface of
caudate nucleus
Caudate nucleus
Internal capsule
Lentiform nucleus
Anterior horn of lateral
ventricle
Paraterminal body
(grey matter)
White matter of para-
terminal
body
Gyrus subcallosum
? Anterior perforatedsubstance
Supra-optic
rece='^
Optic chiasm.
Uptic tract
Fig. 186. " Frontal section through anterior Perforated Substance and the
anterior part of Corpus Striatum, after the dissection represented in Fig.
183 had been made on the left hemisphere.
Note that
further, the plane of the section under sideration
con-
fissure
Longitudinal
Chorioid plexus
Lateral ventricle Corpus callosum
Claustrum
Fornix
Tela chorioidea of
'third ventricle
"^,^Caudate nucleus
"
Vena terminalis
Thalamus
Ventricle in.
(Jhorioid plexus
Internal capsule
For. interventriculare
Column of
fornix
Optictract
Anterior commissure
Opticnerve
Globus pallidus
Amygdaloid nucleus "' Olfactorytract
Fasciculus mamillo thalamicus Opticchiasma
Substantia perforataanterior Infundihulum
Column of fornix
Fig. 187. " Frontal section through the Cerebral Hemisphere in such a plane
as to cut the three
parts of the lentiform ; the posteriorcut
nucleus
surface of the anterior part of the is
hemisphere depicted.
.,^
above the roof af the inferior horn of the lateral ventricle,
^ from which it is
by a layerof
separated directed
transversely
*
white fibres (Fig.i88). (e)The lentiform nucleus is not
GaiKkite nucleus
Occipito-frontal
fasciculus i Thalamus
fasciculus
Superiorlongitudinal '.-^Ut^W*.
External cap"
Claustrmi
Corpus callosum
"'"^usula
Chorioid plexus
Septum pelluciduni
Fornix
Chorioid plexuses
Putamen of lenti-
form of third ventricle
nucleus
Third ventricle
Stria terminal is
Optictract
Chorioid plexus
'
Hippocampal fissure
'
- Collateral fissure
Cerebellum
Brachiuni pontis
Pyramid of medulla oblongata
now so divided
distinctly into three segments by the medullary
laminae. .
,
.
,
^
This Smith).
fissure is-an artifact (Elliot
BASAL GANGLIA 467
pyramid of
triangular
irregular grey'
matter. It possesses an
inferior surface or base (Figs.
18^7,188); a lateral surface;
468 THE BRAIN
in the anteripx-BLall^
the anterior end_,ofthe jnferior
horn
of the lateralventricle and partly in the adjacent portionof
fhe roof of the inferior horn. It is continuous with the tail
of the caudate nucleus ; with the antero-inferior part of the
putamen of the lentiform nucleus ; with the anterior perforated
and
substance, with the grey matter of the piriform
area of
the hippocampalgyrus.
Nuclei of the Thalamus." When sections of the thalamus
are examined it will be noticed that it is surrounded,except
on its medial surface,
by white matter.
The thin layerof white matter on the surface
superior is
termed the stratum zonale. It consists of fibresderived partly
from the partlyfrom the opticradiation of
optictract and
the internal capsule. The white lamina on the lateral surface,
which separatesthe grey matter from the internal capsule, is
the external medullarylamina. The lower surface rests,
anteriorly,
on the hypothalamusand the temporalpeduncle
of the thalamus (p.470) and posteriorlyon the upper part of
the tegmentum of the cerebral peduncle.
The grey matter of the thalamus is divided into three portions or nuclei
lobe and
nucleus, to the parietal posterior part of the the
frontal lobe. The ten.poralpeduncle or ventral stalk is
formed by fibres which springfrom the cells of the medial
and lateral nuclei. They issue from the lower surface of the
anterior part of the thalamus and pass, below the lentiform
Fibres of optic
radiations
Fibres of acoustic
ra tiations
Lateral geniculate
body
Medial geniculate
body
Lentiform nucleus
Fig. 189. " Dissection of the rightLentiform Nucleus and the rightCorona
Radiata from the lateral side.
hemisphere and from its lateral side tear away the grey and
white matter of the insula,then the claustrum, and, finally, the
external capsule,to expose the lateral surface of the lentiform
nucleus. As this is being done note the fibres which pass through
the region of the limen insulae and connect togetherthe frontal
and the temporal lobes ; they constitute the fnficicidus uncinatus.
Note also that the white layer which lies below the lentiform
nucleus contains (i) In its posteriorpart, the fibres of the
"
^
to putamen ^^"^^ T "-"
Frontal fibres of -^KTr ' A pfdiinculi
corona radiata I aeral
" iiiculatebody
Opticradiations
Medial culate
geni-
body
Olfactory bulb
Anterior commissure
Optictract Trochlear nerve
-'
Corpus mamillare
Oculo-motor nerve
Lateral lemniscus
Pyramidalfibres
Cut surface of pons /
Medial lemniscus
Pyramid
OH Brrchium pontis
Lower limb
Trunk
^Anterior
horn
,'*oi
lateral ventricle
.Caudate nucleus
Thalamus
Hippocampus
Claustrum'' Spleniumof corpus cal-
losum (horizontalsection)
Cuneus tical
(ver-
section)
Calcarine fissure
Opticradiations'
Lingual gyrus
(horizontal
section)
Calcar a\ Visual
area
Fio. 191. Diagram showing the Motor and the Acoustic and Visual Areas
of Iveft Hemisphere and their relations to the Internal Capsule.
The internal capsule and the auditory and visual areas are seen in
horizontal section. The motor areas, in red, are supposed to be in vertical
section and to be placedat rightanglesto the horizontal section.
The area of ordinarysensation is not shown, but the fibres from it lie
mainly in the posterior division of the internal capsule.
third of the posterior
474 THE BRAIN
Opticchiasma-
V*^^ Opticnerve
Infundibulum
Optictract ~
Tuber cinereum
Trigeminalnerve (v.)
Junctionof pons and Abducent nerve (vi.)
brachium pontis
Facial nerve (vii.)
Acoustic nerve (viii.)
Restiform body Vagus and Glosso-
pharyngeal
nerves
Olive
(ix.andx.)
Pyramid- Fila of hypo-
glossal
ExternaL. nerve (xii.)
arcuate fibres cut short
Accessory
Decussation of- nerve (xi.)
pyramids
Anterior root of
firstcervical nerve
which cross the median plane from one side to the other.
This is termed
intercrossing of the pyramids.
the decussation
Above the level of the decussation the furrow passes upwards
to the lower border of the pons. There it expands slightly,
and ends in a blind pit, termed ih^ foramen ccecu7?i.
The fissure
postero-median runs upwards for onlyhalf the
lengthof the medulla oblongata.Then the central canal,
continued upwards from the medulla spinalis,becomes the
fourth ventricle of the brain. As the canal expands dorsally
it pushes aside the Ups of the median
posterior fissure till
476 THE BRAIN
viz.,a
portions, small strand fasciculus
cerebro-
termed the
anterior
spinalis tract\
(O.T. directpyra7nidal which proceeds
downwards into the anterior funiculus of the spinalmedulla
close to the antero - median fissure,and a much larger
strand called the fascicuhcs lateralis
cerebrospinalis (O.T.
crossed which,at
pyramidaltract)^ the level of the decussation,
is broken up into three or more coarse bundles which sink
backwards and, at the same time,cross the median plane to
478 THE BRAIN
take up a in
positionoppositelateral funiculus of the
the
spinalmedulla,close to the posterior column of grey matter.
It is the intercrossingof the corresponding bundles of the
fasciculi of oppositesides which pro-
lateral cerebro-spinal duces
the characteristicdecussation.
But whilst the fasciculus
cerebrospinalisanterior of the
lateralis
anterior funiculus and the fasciculus cerebrospinalis
of the oppositelateral funiculus of the spinalmedulla are
Uptictract
Pedunculus cerebri
Corpus geniculatumlaterale
Pulvinar
Corpus geniculatummediale
Superiorbrachium
Inferior brachium
Inferior body
quadrigeminal
Lateral lemniscus
Brachium conjunctivum
Taenia pontis
Brachium pontis
Restiform body
Ligula
"Olive
"
Arcuate fibres
"Clava
Funiculus cuneatus
Tuberculum cinereum
Lateral districtof medulla oblongata
Anterior funiculus of spinalmedulla
both in
represented one district of the medulla oblongata,
it may be asked : What becomes of the larger lateral
part of the anterior funiculus of spinalmedulla in the
the medulla oblongata? It is thrust backwards by the
decussating bundles of the lateral cerebro-spinal fasciculus,
and occupiesa deep position in the medulla oblongata.
Lateral Area of the Medulla Oblongata. " The lateral area
is the district on the surface of the medulla which
oblongata
is included between the two rows of nerve fila, the hypo-
viz., glossal
and the filaof the accessory, vagus, and
filaanteriorly,
48o THE BRAIN
.Pineal body
Superior
quadrigeminalbody
Inferior
Frenulum veli quadrigeminal
body
Anterior
medullary velum Cerebral peduncle
Area acustica
Striae medullares
Restiform body
Area acustica
Trigonum hypoglossi
Ala cinerea
Clava
Funiculus Tuberculum
cuneatus
cinereum
Funiculus gracilis'
Funiculus cuneatus
Fig. 195. " Posterior view of the Medulla Oblongata, Pons, and cephalon
Mesen-
of a full-time Foetus. The greater part of the roof of the
fourth ventricle is removed.
it
ventricle, prominencesproduced by the
is seen that the
two strands and their enlargedextremities are in a great
measure due to the presence of two elor^gated nuclei,which
lie subjacent to them and graduallyincrease as theyare traced .
The fibreswhich build up the restiform bodies come from several differ-
ent
sources. It will be sufficientto indicate the more important of them "
Pons. "
The
pons is the marked prominence,on the base
of the which
brain, lies anterior to the cerebellum and is
between
interposed the medulla oblongataand the pedunculi
cerebri 160, 194).
(Figs. It is convex from side to side,
as well as from above downwards, and the transverse streaks
on its surface show it is composed of
that, superficially,
transverse bundles of nerve fibres. On each side the verse
trans-
fibres collect themselves together to form a large
compact strand which into the
sinks,postero-laterally, sponding
corre-
emerge.
Certain of the sulci which traverse the surface of the
cerebellum,deeper and longerthan the others,map out
districts which are termed lobes. The most conspicuous
of
all the clefts is the horizontal sulcus.
Sulcus Horizontalis Cerebelli. " The horizontal sulcus
where
beginsanteriorly, its
lipsseparate from one another
to enclose the largebrachia pontis,and it passes round the
Pons
Mesencephalon
1 Central lobule
Superiorsemilunar
lobule
Posterior notch
circumference of the
cerebellum, cuttingdeeplyinto its lateral
and posterior
margins. By means of the horizontal sulcus
the cerebellum is divided into an upper and a lower part,
which may be studied separately.
(2) the
central lobule ; (3)the culmen monticuli ; (4)the declive monticuli ; (5)the
folium vermis. With the exception of the lingula, each part is continuous
on each side with a corresponding d istricton the upper surface of the hemi-
sphere,
and forms with those districtsa cerebellar lobe. Thus, the central
lobule is prolongedlaterally on each side in an expansion called the ala \
486 THE BRAIN
Anterior medullaryvelum
Central lobule I Ventricle iv,
Brachium conjuncti i Ala
Brachium pontis Nodule
Posterior medullary^
velum Flocculus
Horizontal sulcus
Horizontal sulcus
Inferiorsemilunar lobule
Lobulus \ '
gracilis ^ Lobulus gracilis
Biventral lobule !
Biventral lobule
Pyramid
Uvula \ Tonsil
Tuber vermis
Fig, 197. " Lower surface of the Cerebellum. The tonsil of the rightside
has been removed so as to displaythe posteriormedullaryvelum and
the furrowed band.
of
largest the three. It is formed by the transverse fibres of
the pons, and it enters the hemisphereon the cerebellar
lateral side of the other two. The lipsof the anterior part
of the horizontal sulcus are separatedwidelyfrom each other
to giveit admission (Fig.195).
The hiferior peduncleis the restiform body of the medulla
oblongata.As it leaves the dorsum of the medulla oblongata
it turns sharplybackwards and enters the cerebellum between
the other two peduncles.
The superior peduncles are the brachia conjunctiva of the
cerebellum. They are composed of fibres which come, for
the most part, from the nucleus dentatus of the cerebellar
hemisphere. As they issue from the cerebellum, the
peduncles lie close to the medial sides of the corresponding
middle peduncles. They then proceedupwards towards the
inferior pairof quadrigeminal bodies. they form the
At first,
lateral boundaries of the upper part of the fourth ventricle,
but they converge, as they ascend on the dorsal aspect of the
stretches laterally
to the flocculus, therebybringingthose
two small portionsof the cerebellum into association with
each other. Where it issues from the white matter of the
cerebellum it might almost be said to be in contact with the
anterior medullaryvelum, but as the two laminae are traced
forwards theydivergefrom each other : the anterior velum is
carried upwards between the brachia
conjunctiva of the cere-
bellum,
position
at the lateral border of the medial and they
lemniscus,
form a more or lessseparate bundle termed the laterallemniscus.
In the regionof the upper part of the pons the fibres of the
lateral lemniscus turn dorsally,and, after emergingfrom the
upper border of the to the lateral
pons, they cross superficial
surface of the upper part of the brachium conjunctivum
of the
cerebellum (Fig.194), and disappearunder cover of the
inferiorcolliculus of the quadrigeminal lamina,and also under
the inferior brachium and the medial geniculatebody. They
terminate in association with the cells of the inferior col-
liculus,
and with those of the medial geniculate
body,whence
the acoustic radiations alreadynoted (p.474) pass to the
superior
temporalgyrus.
Dissection. " To trace
the lemniscus upwards it is necessary
to remove the deep fibres of the pons, and the sub-
transverse stantia
nigra of the mid-brain. As the dissector makes the
dissection, h e should note (i)"That the lemniscus increases in
width in the lower part of the pons on account of the accession
of fibres from the nuclei of the sensory cerebral nerves of the
opposite side. (2) That in the upper part of the pons the lem-
niscus
decreases in width as the lateral portionleaves it to pass
to the inferior colliculus.
After the dissector has displayed,as far as possible,the
positionand connections of the lemniscus he should turn to
the brachium conjunctivum of the cerebellum and attempt to
demonstrate its associations. It is quite easily recognisable,
as it lies behind the upper part of the pons, in the dorso-lateral
LEMNISCUS MEDIALIS 497
sections are made through the upper part of the medulla oblongata, a faint
matter ; {d)grey matter, which is present both in the form of direct con- tinuations
grey column remains close to the central canal, but the head and the
substantia gelatinosa remain near the surface, and, towards the upper part
of the lower half of the medulla oblongata, the head enlarges and forms a
prominence on the surface which has already been noticed as the tuberculum
cinereum (p.481).
The fibres which springfrom the cells of the nucleus gracilis and the
nucleus cuneatus and break through the neck of the posterior grey column
are called the internal arcuate fibres.They reach the rapheon the deep
or dorsal aspect of the pyramidal fasciculus and, in the median planeat the
VOL. Ill "
32
498 THE BRAIN
Cuneate nucleus
Tractus of fifth
spinalis
nerve
Substantia gelatinosa
Rolandi
Dorsal spino-cerebellar
fasciculus
Lateral cerebro-spinal
fasciculus
Detached anterior
column of grey matter
Decussation of pyramids
Decussation
of the lemnisci
Medial
accessory
olivary
nucleu
Filaof the
hypoglossal
nerve
Pyramid
Fig. 20I. " Transverse section through the lower part of the Medulla
Oblongata of a full-time
Foetus,above the Decussation of the Pyramids,
treated by the Weigert-Pal method. The grey matter is white, and the
medullated strands of nerve fibres are black.
Funiculus
Gracile nucleus
gracilis
Funiculus
cuneatus
Tractus spinalis
Cuneate of fifthnerve
nucleus T^
Substantia
gelatinosa
;:Y"
A Kolandi
Dorsal spino-
cerebell
fasciculus
Detached head of
Decussation anterior column
of grey matter
of pyramids
Fasciculus proprius
anterior pushed aside
by the decussation
Antero-median furrow
Oblongata of
a full-time Foetus, treated by the Weigert-Pal method. The grey matter
is therefore bleached white ; whilst the meduUated tracts are black.
anterior grey column, and the fibres of the glosso-pharyngeal and vagus
nerves, which are mainlysensory nerves, terminate in association with the
more laterally situated grey matter of the medulla oblongatawhich is
continued upwards from the base of the posterior grey column of the spinal
medulla.
As the central canal opens out into the cavity of the fourth ventricle and
the basal parts of the posterior grey columns are forced laterally, the
ependymal epithelium of the dorsal wall of the canal is expandedinto the
extensive epithelial membrane, which forms the roof of the lower part of
the fourth ventricle.
Every section of the upper portioutf)ipthfe |i"|"iiMa oblongatais divided
into medial,lateral, and dorsai^^tsfm[|ti^ili^
tl^j^uoglossal nerve
III " 32 a
CHig^GU MtDICAk^yiWl
and the roots of the vagus and glosso-pharyngeal nerves. The medial
part liesbetween the root fibresof the hypoglossal nerve and the median
raphe. It consists mainly of white matter, but on its ventral aspect,close
to the anterior median fissure, liesthe nucleus ofthe external arcuate fibres,
embedded amongst those fibres; and on the lateral part of the dorsal aspect
of the pyramidal fasciculus, there is a tract of nerve cells which iscalled the
tnedial accessory olive.
The nerve fibres of the medial area are longitudinal, transverse and
oblique.The longitudinal fibres form four main strands. Ventrally they
form the pyramidal fasciculus ; immediately dorsal to the pyramidal culus
fasci-
theyconstitute the medial lemniscus ; behind the lemniscus are the
tectospinal fibres, and stillmore dorsally, immediatelysubjacent to the
grey matter of the floor of the fourth ventricle, is the medial longitudinal
fasciculus. The medial lemniscus consistsof the fibresof the spino-thalamic
fasciculi, prolongedupwards from the lateral and anterior funiculi of the
spinal medulla, and of internal arcuate fibresderived from the gracile and
cuneate nuclei of the opposite side. The tecto-spinal fibres are descending
from the lamina quadrigeminato the spinal medulla. The medial longi-
tudinal
fasciculusis continuous, below, with the fasciculusanterior proprius
of the spinal medulla. It ascends throughthe medulla,pons, and mid-brain
to the subthalamic region, formingintimate associations with the motor
nuclei of the cerebral nerves.
The oblique and transverse fibres of the medial area are internal and
external arcuate fibres.
The most striking feature in transverse sections of the upper part of the
lateral area of the medulla oblongatais the olivary nucleus,which lies sub- jacent
to the olivary eminence. It presents the appearance of a thick
undulating layerof grey matter, folded on itselfso as to enclose a space
filled with white matter and open towards the median plane. It is in
reality a
grey lamina arranged in a purse-like manner with the open mouth
directed towards the raphe. Dorsal to the olivary nucleus lies the dorsal
accessory olivary nucleus. More dorsally there are columns of nerve cells
which form the nucleus lateralis and the nucleus ambiguus, and which
are continuous, below,with the head of the anterior grey column of the
spinal medulla. Still more dorsally is the ventral part of the nucleus of
the spinal tract of the trigeminal nerve.
The white matter of the lateralarea consists of longitudinal and oblique
fibres,and that portionof it which lies dorsal to the olivarynucleus is
sometimes spoken of as ihe for/natio reticularis grisea, because itcontains a
certain amount of grey matter, whilst the corresponding part of the medial
area, which is practically devoid of grey matter, is called the formatio
reticularisalba.
Some of the longitudinal white fibresof the lateral area of the medulla
oblongata form definite fasciculi which associate togetherdifferent grey
masses. Close to the surface, below the level of the olive, and immediately
dorso-lateral to the issuing filaof the hypoglossal nerve lies the bulbo-
spinal
fasciculus.On the superficial aspect of the olivary nucleus and
alongitsdorso-lateral border is the thalamo-olivary fasciculus, and dorsal
to the thalamo-olivary fasciculus are the ventral and the dorsal spino- cerebella
fasciculi. More medially lie the rubro-spinal fasciculusand fibres
of the spino-thalamic fasciculi; the obliquefibres are internal and external
arcuate fibres. Some of the internal arcuate fibres are passing between the
gracile and cuneate nuclei and the restiform body of the oppositeside,and
some are connecting the cerebellar hemisphere of one side with the olivary
nucleus of the opposite side.
The dorsal area of each half of the medulla oblongata also consists
STRUCTURE OF MEDULLA OBLONGATA 501
of the trigeminal
nerve which descend, close to the surface,and superficial
Anterior medullary velum
Grey matter on floor
Ventricle iv.
of ventricle iv.
Mesencephalicroot of Brachium
trigeminal
nerve
conjunctivum
Medial longitudinal
bundle Lateral lemniscus
Transverse
Trigeminal fibresof
nerve
pons
wards from the bases of the pedunculi cerebri ; some of the longitudinal
fibres are cerebro-spinal fibres, passingto the medulla oblongatawhere
theyform the bundles of the pyramids. Others are cc rebro- pontinefibres ;
theyterminate round the cells of the nuclei pontis,which are the sninll
masses of grey matter which occupy the interstices between the transverse
and longitudinal bundles of fibres. Of the transverse fibres two distinct
sets may be recognised, viz.,the superficial transverse fibres,through
the midst of which the bundles of cerebro-spinal fibres are prolonged,
and a deeperset termed the corpus trapezoidtmi. The superficial transverse
fibres traverse the entire thickness of the ventral part of the pons, and
on each side,pass into the corresponding brachium pontis. The trapezial
fibreslie posterior to the cerebro-spinal bundles in the boundary area
between the dorsal and ventral parts of the pons, but encroach siderably
con-
into the groundof the former. They are seen only in the lower
part of the pons, and they pass into the lateral lemniscus. They take origin
in the terminal nucleus of the cochlear division of the acoustic nerve.
The dorsal or tegmentalpart of the pons is,for the most part, formed
of a prolongation upwards of the formatio reticularis of the medulla.
Superiorly, it is carried into the tegmentalparts of the pedunculicerebri.
It is divided into two halves by a median raphe, which is continuous,
below, with the raphe of the medulla oblongata, and, above, with the raphe
of the tegmental part of the mesencephalon, whilst over itsdorsal surface is
of
spreada thick layer grey matter which belongsto the upper part of the
floor of the fourth ventricle. In transverse sections through the upper
part of the pons a dark spot in the lateral part of the floor indicates the
position of a small mass of pigmentedcells called the substantia ferruginea.
It underlies the locus coeruleus.
Four strands of longitudinal fibres are seen on each side in transverse
sections throughthe dorsal part of the pons. These are "
CRANIAL TOPOGRAPHY
which are situated on the inner surface of the skull wall. They should
note especially,in relation to the bones and the the
arterial
grooves,
situations of the posteriorhorizontal limb of the lateral fissure,the central
sulcus and the pole of
occipital each hemisphere, because : ( i ) in the lower
"
lipof the posteriorhorizontal limb of the lateral fissure lies the acoustic area ;
(2) the anterior central gyrus, which lies in front of the central sulcus, is the
general motor area of the brain; (3) the posteriorcentral gyrus, which
lies behind the central sulcus, is the general sensory area ; and (4) the
occipitalpole is in the region of
area the visual
(Figs. 153, 204),
The anterior branch of the middle
meningeal artery lies,as a rule, over
the regionof the anterior central gyrus (Fig. 204), and the posterior branch,
which is,however, more irregularin position,frequentlyruns along the
ine of the first temporal gyrus, which is immediately below the posterior
horizontal limb of the lateral fissure,and consequently it crosses or lies
close to the acoustic area (Fig.204).
The general positionsof the sulci and gyri are shown in Figs. 135, 152,
and in Fig. 38, which is a reproduction of a radiograph of a head in which
metallic rods and pieces of metallic paste had been introduced, other
important areas have also been made visible.
The positions
exact of the various cerebral sulci vary, to a certain extent,
in heads of different
shapes and sizes,but a sufficiently accurate estimation,
for practicalpurposes, can be made on any head or skull by the use of a
few easilyremembered points and lines (Fig. 204). They are : "
(i) A base line extending from the lower margin of the orbit to the
upper border of the external acoustic meatus (5-5,black. Fig. 204).
(2) A line, 30 mm. long, extending backwards from the lower end of
the zygomatic process of the frontal bone, parallel with the base line
(6, black. Fig. 204).
(3) A line, 10 mm. long, projectedupwards at rightangles to (2) from its
posterior end (8, black, Fig. 204). The upper end of (3)marks the Sylvian "
Epitympanicrecess
Aditus of tympanic antrum r
Lateral semi-circular canal 1
Superiorsemi-circular can
Vestibule
Internal acoustic '
. .
Concha
I External acoustic meatus
Mastoid process
Tympanic membrane
J Styloidprocess
Auditory tube Canal for facial nerve (cutabove)
Fig. 205. " The parts of the Ear (semi-diagrammatic). The purple colour
indicates the mucous liningof the tympaniccavity,which is continuous,
through the auditory
tube, with the mucous liningof the pharynx, and,
through the aditus,with the mucous liningof the tympanicantrum.
External Ear.
Pyramid
Apertura tympanica
canaliculi chorda;
Groove for
membrana
tympani
Fig. 206. " Frontal section of the Right Temporal Bone passingthrough the
external and the internal acoustic meatuses.
Crus antihelicis
inferior
Cyniba conchae
Crus helicis
Cartilaginous
Mty "
part of meatus
Y"Cavum conchae
Internal carotid
artery Lower boundary
of incisura
intertragica
Fig. 207. " Vertical transverse section through the Right Ear : anterior half
of section viewed from behind. (Howden.)
2.
^iTnl'l'vitWthe
iympamc cavity (the
mediately
to
nnner
upper "'
thc mcdid side of the
"
2
"
is in the recessus epi- mcmbrana tympani. The tympanic
tympanicus). cavity prcscnts for examination a
3. Promontory on medial wall. r i n i /- n
"
Recessus ephympanicus
Membrana
flaccida
tympani (cut)
Handle of
malleus
Membrana
tympani
Tympanic sulcus
-^"mt^S^^^
Fig. 2IO. " Left Membrana Tympani and Recessus Epitympanicusviewed
from within. The neck and head of the malleus have been removed to
show the membrana flaccida. (Howden.)
"
Superiorligamentof malleus
Head of malleus
t/^-"
fa" .
^"^^- -
Anterior ligament
"" w' ^e\ '" *
^
of malleus
Handle of malleus
Tensor tympani
Septum tubae
auditivae
Foot of stape'. Osseous part c
the auditory
tube
Fig, 211. " Left Membrana Tympani and Chain of Tympanic Ossicles
seen from the medial aspect. (Howden.)
Posterior
malleolar fold
Lateral process
flaccida of malleus
Membrana
Anterior Long crus of incus
malleolar fold
Postero-superior
quadrant
Handle of malleus
Postero-inferior
Antero-superior quadrant
quadrant
Cone of light
Antero-inferior quadrant
Fig. 212. " Left Tympanic Membrane as viewed from the external meatus
during an otoscopicexamination. The dotted lines indicate the manner
or quadrants. (Howden.)
Canalis facialis
Tegmen tympani
Fenestra vestibuli
Canal for
Lensor tympani
Septum tubae
auditivie
Promontory
Auditorytube
Foramen for
ympanic nerve
Fenestra cochleae
When the living ear is examined, with a speculum, the surface of the
membrane appears highly polished,and a cone of light extends downwards
and forwards from the tipof the handle of the malleus, A pairof striae
(Prussak'sstriae), which correspondto the anterior and posterior malleolar
folds,extend from the processus lateralisof the malleus to the margins
III" 33 a
5i6 THE AUDITORY APPARATUS
tympanicantrum is a recess
or air-chamber,
in the temporal bone. It lies immediately
behind the
epitympanic portionof the tympaniccavity and,
in the adult,it is 14 mm. {abouthalf an inch)from the
surface of the skull, medial to the suprameataltriangle. In
the child it is much more superficial.
The cavity of the tympanic antrum is lined with mucous
membrane continuous,which is
.^^",
anteriorly,
through a relatively
wide aperture called the aditus,
with the mucous membrane of
the and it is
tympanic cavity,
6 also continuous, and
posteriorly
below, with the mucous brane
mem-
6. Anterior process of the malleus. The lUg the infcriOr SUrfaCC Of the
"St":?The^.rSl Of'fh"temporallobe of the brain. The
"' ""
:"a""bri!.monh.'SS ^"''^ is f""-"'ed by
'''^^'-^^ that
portionof the
squamous part
of the temporal bone which lies immediately above and
behind the aperture of the external acoustic meatus. The
posterior
wall and ih^ floorare formed by the mastoid portion
of the temporal bone, and it is throughapertures in those
boundaries that the of
cavity the tympanicantrum cates
communi-
with the mastoid air-cells. On the 7nedial wall,which
is formed by the petrous part of the temporal bone, is a
horizontal bulging, caused by the lateral semicircular canal
of the internal ear ; the bulgingextends forwards into the
aditus (Fig.205). Immediatelyanterior to the medial margin
TYMPANIC MUCOUS MEMBRANE 517
Manubrium Manubrium
A B
Crus.
longum
Processus
lenticular!
Fig. 217. " Left Stapes. which join a medial plate called the basis
(Howden.) stapedis.The head is excavated by an articular
cup for the processus lenticularis of the incus.
The o'ura are grooved longitudinally on their concave sides (sulcus
stapedis). T he posterior c rus is more sharply curved than the anterior
crus. The base fits into the fenestra vestibuli and correspondsin its
outline with that aperture. Its lower border is straight, whilst its upper
border is curved.
Ligaments of the Auditory Ossicles. " In addition to the delicate
articular capsules, which surround the joints between the auditory ossicles,
there are certain bands which connect the bones to the walls of the tym- panum
and serve to restrain their movements.
In connection with the malleus there are "
Fig. 219. " Dissection of the Tympanic Antrum and the mastoid part of
the temporal bone from the outer side.
,
"
sigmoidpart of
jy_ transverse sinus
-|'%"y
Tympanic plate
Styloidprocess-;^
Wall of canal is ''^ih
facialis
objectsof the first stage of the dissection are (i) the removal "
(5)On the medial wall of the aditus and the anterior part of the
medial wall of the tympanic antrum is a horizontal ridgewhich
Acoustic Nerve.
the remains of the roof of the internal meatus and follow the
facial nerve along the canalis facialis to the hiatus canalis
facialis,and so expose the ganglion geniculi.Secure the
524 THE AUDITORY APPARATUS
branches which arise from the ganglion and then follow the
nerve backwards above the fenestra vestibuli. The greater part
of the vertical portionof the canal has already been opened from
the lateral aspect ; the remainder can now be displayed by
means of two saw cuts (i)a frontal section (vertical
"
transverse)
carried medially from the lateral surface of the bone to the
posteriorborder of the stylo-mastoidforamen ; (2) a sagittal
cut (vertical antero-posterior) carried from the posterior surface
of the bone to meet cut (i). The portion of bone between the
two cuts must then be removed, and the dissection must be
completed with bone forceps. Three branches are given off
from the facial nerve in the terminal part of the canal.
wards, posterior
to the pyramid,to gain the stylo-mastoid
foramen.
.
Motor part of facial nerve. 27. Anterior division of mandibular
Sensory part of facial nerve. nerve.
Acoustic nerve. 28. Lingual nerve.
External petrosalnerve. 29. Inferior alveolar nerve.
The greatersuperficial
petrosal nerve, ^
Communicating twig to the lesser superficial Ifrom ganglion
petrosal, | geniculi.
External superficial
petrosalnerve, J
Nerve to stapedius.
Chorda tympani.
Communicating twigsto the auricular branch of vagus.
The greatersuperficial
petrosalnerve has been examined
526 THE AUDITORY APPARATUS
it
sphcericus\ is bounded posteriorly
by a vertical ridge,
called the crista vestibuli. In the bottom of the recessus
Recessus ellipticus
Crista vestibuli
Recessus sphaericus
Lateral circular
semi-
canal
Scala tyiiipani
Lamina spiralis
ossea
Posterior semi-
circular
canal
Scala vestibul
Opening of
aquaeductuscochleae Opening of crus commune
Fenestra cochleae
Recessus cochlearis Opening of aquaeductusvestibuli
the surface
posterior of the petrous part of the temporalbone,
where it opens under the dura mater.
Canales Semicirculares Ossei. " There are three bony semi-
circular
canals or tubes placed posterior
to the vestibule.
Superiorsemicircular canal
with its ampulla
Cochlea |
Fenestra cochleae
Fenestra vestibuli Posterior semi-
circular
sacs, termed the utricle and the saccule. The utricle occupies
the recessus ellipticus on the upper wall of the vestibule, and lies above
LABYRINTH 531
and posterior
to the saccule. Into it open the membranous setnicircular
ducts which liein the bony semicircular canals.
Each semicircular duct corresponds in general form with the semi- circular
canal ^n which it lies, but it is of smaller diameter. Its convex
Ductus endolymphaticus
Dura mater
Semicircular
canal
Vestibule
Osseous
cochlea
Stapes
Fenestra cochleae
^-Aquaeductus cochleae
Modiolus
BULBUS OCULI,
anterior,
clear corneal part of the eyeball
appears, therefore,
as a convex window or prominence on the front of the
globeof the eye. The terms anterior pole and posteriorf ok
are respectively
appliedto the central pointsof the anterior
and posteriorsegments of the eyeball.The imaginaryline
which joinsthe two poles receives the name of the sagittal
axtSj whilst another line drawn in a frontal direction around
the globeof the eye,
midway between the two poles,so as
to divide the eyeball into two hemispheres,is termed the
equator. Imaginarymeridional lines also are drawn between
the two polesso as to cut the equatorial
line at right
angles.
Dissection of the Eyeball. " A satisfactory dissection of the
globe of the eye can be made only when the eyeballis fresh,or
after it has been hardened for several days in a io% solution
of formol. In the dissecting-room it is often impossible to
obtain suitable specimens ; but it is always easy to procure
eyeballsof the pig, sheep, or ox, and those suit the purpose
admirably. It is advisable,however, that the dissector should
complete his study of the organ by the examination of a fresh
human eyeball obtained from the post-mortem room. In point
of size,and also in other particulars, the eyeballof the pig more
closelyresembles the human eyeball than the eyeball of the
sheep or ox ; but it is perhaps better that the student should
begin with the eyeballof the ox, because the necessary dissection
can be more easilycarried out in it than in smaller eyeballs.
When the dissector has provided himself with six eyeballs
obtained from oxen, he should remove from them the conjunc-
tiva,
fascia bulbi, ocular muscles, and fat, which adhere to
them. Pinching up, with the forceps, the conjunctiva and the
fascia bulbi close to the corneal margin, he should snip through
those layerswith the scissors and divide them round the whole
edge of the cornea. He can then easilystripall the soft parts
from the surface of the sclera,working steadilybackwards
towards the entrance of the optic nerve. A little posteriorto
the equator of the eyeball the vence vorticosce will be noticed
issuingfrom the sclera,at wide intervals from each other ; and
as the posterioraspect of the eyeballis approached the posterior
ciliary arteries and the ciliarynerves will be seen piercingthe
sclera around the entrance of the opticnerve.
Before the student begins the actual dissection of the eyeball,
it is important that he should obtain a general conception of
the parts which compose it. That can be done by sections made
through three hardened specimens in three different planes.
One specimen should be divided,at the equator, into an anterior
and a posteriorportion. Another should be divided, in an
antero-posterior direction,into a medial and a lateral half. A
third should be divided horizontally and a portionof the vitreous
body should be removed (Fig. 226). When the sections are
made, they should be placed under water in a cork-lined tray,
and preserved for reference as the study of the eyeballis pro- ceeded
with.
EYEBALL 533
Ora serra
Retina wit
vessels
Cho
Vitreous
oid canal
Central fovea
4/ Optic nerve
lies posterior
to the cornea, and an intervening
ciliary
body;
(3)the nervous retina, internal tunic or
in which the fibres
of the opticnerve are outspread.
The refracting media are: (i) the cornea; (2)posterior
to the cornea a watery fluid called the aqueous hiwiour,con-
tained
in a space subdivided
partially by the iris into the
anterior and chambers
posterior of the eye; (3)the crystalline
lens,behind chamber; and (4)the vitreous body,
the posterior
which occupies part of
the posterior the interior of the eyeball.
Dissection. " surface of the sclera and of the
The superficial
cornea should now be examined ; but to complete the study of
534 BULBUS OCULI
In the eyes of many mammals, but not in man, the posterior part of the
chorioid, when viewed from the front,presents
an extensive brightly-coloured
area, which exhibits a metallic lustre. The appearance is due to the
Anterior ciliary,
Anterior ciliary
artery
artery
muscle
Ciliary
Scler;
Long posterior
ciliary
artery
Vena vorticosa
Vena vorticosa
Long posterior
ciliary
artery
' Long posterior
i f ciliary
artery
ganglionatedciliary
nerve plexus,and plexusesof arteries
and veins associated with ciliary the iris and
body. It is
continuous with the irisinternally,
the sclera
anteriorly,
and
the corona ciliaris
and the chorioid posteriorly.
Musculus Ciliaris. The ciliary muscle is composed of in-
"
voluntary
muscular tissue. The arrangement of its fibres can
be onlywhen thin sections of the eyeball
seen are examined
under the microscope. It is then obvious that the fibres are
disposedin two groups, viz., a radiatingand a circular.
The radiating fibresarise from the deep aspect of the
sclera close to the marginof the cornea. From their origin
they radiate in
backwards, a meridional direction, and gain
Chorioid
^",.--2|^^i^^"^
Sclera
Ciliaryfold -j-
Ciliary
process
elasticity.
Dissection. To obtain a view of the ciliaryprocesses, a
"
sphincter,
are suppliedby the oculo-motor nerve. The
dilator fibres are suppliedby sympathetic nerve fibres.
Ciliary Nerves. The ciliary nerves
" arise from the ciliary
ganglionand the naso-ciliary nerve. They piercethe sclera
around the opticentrance, and extend forwards, between
the sclera and the chorioid,in the perichorioidal lymph space.
They will be seen, in the specimen in which the sclera has
^ be well
It may as to mention here that the pupil in the ox and the
sheep is greatlyelongated in the transverse direction. In the pig, ever,
how-
it is approximatelycircular.
CILIARY ARTERIES 541
thin which
pigmentarylayer, adheres to the deep surface of
the chorioid coat, and has been removed with it,and a
^
There is no macula lutea in the eyeballof the ox or sheep.
544 BULBUS OCULI
for
hyaloidea, the
receptionof the posterior,
convex surface
of the lens.
crystalline
The substance of the vitreous
body is enclosed within a
delicate transparent membrane, which completelyenvelops
it,and receives the name of the hyaloid7nembrane. ing
Extend-
forwards throughthe midst of the vitreous mass, from the
regionof the opticdisc to the lens,is a minute
crystalline
canal, lined with a tube-like of the hyaloid
prolongation
membrane, and containing a watery fluid. The canal is termed
the hyaloid canal \ itrepresents the path taken by a branch of
the arteria centralis retinae,
which,in the foetus,extends to and
supplies the capsuleof the lens,but afterwards disappears.
in
matically Fig.226.
Zonula (O.T. Zonula of Zinn). Between
Ciliaris the "
corona ciliarisexternally
and the marginof the lens internally
lies a fibrous membrane called the zonula ciliaris. Its
peripheral marginis attached to the posterior surfaces of the
ciliary processes and the hyaloidmembrane, and its central
margin is connected with the lens. As it approaches the
marginof the crystalline lens,it splits
into two parts,viz., an
Retina
/ ,
Sclera
"Perichorioidal space
^^"v fibres)
Cilury muscle (radiating
fibres)
Ciliarymuscle (circular
Spatiaanguli iridis
".;^" Ciliaryprocess
"^^^^^^-Spatia
zonularia
Suspensory ligament
ris
Cornea
closure of,345 62
lumbo-costal,lateral,
tympanic,510, 511, 516 pharyngo-palatine,281, 290
Agger nasi,310 superciliary,
2
Appendix ventriculi,
327 posterior,in neck, 164, 207,
547
548 .
INDEX
branch, 233
descending of ethmoidal,118, 255
unusual origin, 154 oflacrimal,118
chorioid,of internal carotid,386 middle, 118, 178
385
posterior, below skull, 173, 177, 178,
ciliary,
254, 532 199
anterior,535 within skull,100, 108, 109,
posterior,
532, 535 118, 242
short,532, 537 surface marking,503
within eyeball,
541 of occipital, 66, 119, 207
communicating,anterior,
374, 387 of vertebral, 119, 268
posterior,
374, 385 mental, 18, 206
of
cortical, anterior cerebral,
387 mylo-hyoid,129, 173, 189
of middle cerebral,388 nasal, dorsal,18,255
of posteriorcerebral,385 lateral,15, 18
INDEX 549
Arteries{contd.) "
Arteries {contd.) "
Arteries,vertebral [contd.
) "
Canals "
atlanto-occipital
ligaments,274,
carotid canal,299 275, 276
to divide head and neck, 262 cervical plexus,140
to disarticulate mandible, 177 deep fascia,122
eyelids,
23 to divide head and neck, 262
to expose falx cerebri,
104 to expose arteries of sterno-
face,14 mastoid, 124
deep, 20 brachial plexus,51
face and scalp,5 vertebral artery, second part,
facial nerve in temporalbone, 523 266
fascia bulbi,248,260 internal carotid artery and bral
cere-
to inflateeyeball, 248 nerves, 211
Dissections of Neck
[could.
) " Dura mater of skull,99, 273
ligamentum nuchre,6^ on base of skull,114
middle line of neck, 126 80, 84
spinal,
muscular triangle,
134
nerves neck, 6"]
in back of Ear, external,44, 505, 506
to open internal
jugularvein,217 internal,506,527
32, 34, 36
triangle,
posterior middle, 506, 510
rectus lateralis,
233 Emboli, 385
to remove head and neck from Eminence, collateral,
439
trunk, 233 frontal,2
root of neck, 147 Eminentia medialis,
491
sterno-clavicular joint,
51 Emissaria. See Veins, emissary
structures under sterno-mastoid, Encephalon. See Brain
138 Endolymph, 506,527
208
stylo-pharyngeus, medulla, 85
Enlargementsof spinal
submaxillaryregion, 183, 187, Ependyma, 429
190, 197 Epicranius,
43
triangle,
suboccipital 74, 75 Epiglottis,
291, 323, 324
suprasternal
space, 122 338
cartilage,
sympathetictrunk, 224 ligaments,339
Dissections of Pharynx and nerves, 337, 353
Larynx "
duringswallowing,345
to remove pharynxfrom vertebral tubercle,324
column, 262 Epithalamus,
355
walls of pharynx,283 Equator of eyeball,
532
constrictor superior,285 Excavatio opticse,
papillse 542
stylo-pharyngeus, 208 Eyeball,
531
to open pharynx,287 Eyebrows,3
"
soft palate, 294 Eye kernel,"543
levator veli palatini,
295 Eyelashes,3
palatine
nerves, 319 Eyelids,
3, 23
pharyngealand pterygoid
canals, vessels and nerves, 26
3.-0
larynx,exterior,
328 Face, 2
Fasciculus [contd.)
"
Fissure {contd.) "
anterior,97, 477
cerebro-spinal, 363,419
parieto-occipital,
lateral,
97, 477, 499 lateral,
359, 403
circum-olivary,482 prima,407
cuneatus, 97, 480 rhinal,367, 413
456,472
fronto-pontine, transverse,great, 438, 444
gracilis,
97, 480 Flocculus,487,490
medial, 457, 500, Folds. See also Plicse
longitudinal,
502 ary-epiglottic,
291, 292, 323, 324,
superior,
471 339
442, 464,469
mamillo-thalamic, glosso-epiglottic,
324, 339, 347
467
occipito-frontal, malleolar,509, 515
482
olivo-cerebellar, pharyngo-epiglottic,
324, 339
rubro-spinal,
500 289
salpingo-pharyngeal,
ventricular,322, 325
solitarius,
501
dorsal,97, 479,
spino-cerebellar, vocal,322, 325
482, 500 movements, 345
ventral, 5CX) Folium vermis, 484, 486, 487
Foramen of medulla, 475
495, 498, 500
spino-thalamic, caecum
104, 374
basal,in horizontal section,460 Gullet. See CEsophagus
in vertical section,
462 Gums, 279
cervical,inferior,54, 225, 227 Gyri"
middle, 54, 226 surface
marking,503
superior,
142, 222, 224, 225 angular,
411
ciliary,
250, 252 annectant, 403, 410
roots, 241, 251, 252, 258 central,anterior,359, 361, 405
geniculate,226, 242, 524 359, 361, 410
posterior,
jugular,
221 .
363, 418
cinguli,
nodosum, 221 cuneus, 365, 422
otic,179, 181, 182, 199, 220 cunei,420
petrosum, 220 cuneo-lingual,
420
semilunar, 109, 234, 237, 241, fornicatus,
414
299 frontal,361
spheno-palatine,
317, 318 406
inferior,
roots, 302, 320 middle, 406
86, 88
spinal, superior,
406, 422
spiral,
530 fusiformis,367, 414, 416
submaxillary, 195 of Heschl, 412
superiusof glosso-pharyngeal,
220 hippocampi,367, 384, 389,414,
thoracic, first,
227 453, 454
Genu of corpus callosum, 362,425 of insula,417
of internal capsule,
468, 471 365,367, 414, 416, 422
lingual,
Gingivse.See Gums occipital,
415
Glabella,2 See
occipito-temporal. G. formis
fusi-
Glands "
of tongue, 351
apical, I orbital,365,408
buccal,279 post-parietal,
411
carotid. See Glomus caroticum praecuneus, 364, 422
labial,22, 278 rectus, 363,365, 407
lacrimal,27, 245, 247 rostral,
422
lymph. See Lymph glands 418, 426
subcallosus,
molar, 20, 21, 279 425, 426
supracallosus,
nasal,305, 315 supramarginal,
411
of Niihn, 351 362,368,412,
temporal,inferior,
palatine,
294, 320 414
parotid,
13, 20, 35, 40, 130, 161 middle, 362, 412
accessory, 14, 164 362, 412
superior,
duct, 14, 164, 279 transverse, 412
pterygoidlobe, 166
pharyngeal,287 Habenula, 355, 447
sublingual,
194 Hamulus, pterygoid,felt in mouth,
ducts, 195 281
openingin mouth, 290 Helicotrema, 530
submaxillary,
123, 129, 188, 205 Helix, 44
deep part, 194, 195 Hemisphere of cerebellum,483
duct, 194 cerebral,354, 396
opening in mouth, 280 borders,360,362, 397
tarsal,3, 24 lobes,404
thyreoid,134, 149, 227 structure, 399
isthmus, 126, 229 surface,inferior,365,397
middle lobe, 129, 322 medial, 362, 396, 419
Globus 460, 468
pallidus, orbital,365,397, 407
Glomus caroticum, 149, 226 361, 396,
supero-lateral, 399
556 INDEX
apicisdentis,276
arytenoid,
344 atlanto -
epistropheal,
accessory,
ary-corniculate,
343 275
See Membrane
atlanto-occipital.
atlanto-epistropheal,
272
movements,277 78
of atlas,oblique,
atlanto-occipital,
272, 274 of auditory 518
ossicles,
movements, 277 of auricle,46
338, 341
crico-thyreoid, of cervical vertebrae,270
of larynx,338, 341, 344 check, of eyeball,260
interspinous,
272 occipital,inferior surface,
416
intertransverse,272 medial surface,422
longitudinal, anterior,270 supero-lateralsurface,415
at atlas,273 parietal,
361, 408, 422
posterior,82, 270 temporal,360,362, 411
of malleus,518 inferior surface,412
nuchse,57, 59, 63, 67, 135, 272 lateral surface,
411
oblique,of atlas,78 upper surface,412
occipitoatlantal,posterior,
-
74, olfactory,417
76,78 pterygoid, gland,166
of parotid
of ossicles of ear, 5 18 of thyreoidgland,228
palpebral, 6, 25
lateral, middle,229, 322
medial, 6, 24, 25, 29 Lobules ofcerebelhim "
312 posterior,
45
Medulla oblongata,357, 369,474 superior,
14, 45, 50
structure,497 intrinsic,
46
surfaces,476 of the back,56
spinalis,
84 actions,65, 77
distinction between front and biventer cervicis,
67
back, 92 buccinator,
15, 16, 20, 21
matter, grey, 93 caninus,16, 20
white,95 of cheek, 10
membranes, 80 chondro-glossus,
351, 352
preservation,
92 ciliaris,
534, 538
segments, 87 bundle
ciliary of orbicularis oculi,
structure, 92 8
Membranes "
constrictors of pharynx,284
atlanto-occipital,
anterior,273 inferior,
132, 285, 330
posterior,74, 76, "j^,268, middle, 187, 197, 205, 209,
273 223, 285
of brain, 99, 273, 353, 370, superior,21, 195, 205, 210,
375 219, 286, 296, 297
chorio-capillaris.
See Lamina 8
corrugator supercilii,
costo-coracoid,
34 crico-arytenoideuslateralis,
330,
flaccida,
509, 515 333, 335
hyaloid,540, 544 posterior,331
hyo-thyreoid.See M. thyreo- crico-thyreoideus,
127, 329, 334
hyoid depressorseptinasi,6, 9
of medulla spinalis,
80 diaphragmaoris,190
nictitans,
5 digastricus,
185
occipito-atloid.
See M. atlanto- nerve supply,187
occipital tendon, 130
tectoria,
275 anterior belly,123, 126, 127,
thyreo-hyoid,
285,292, 328 130, 185
tympanic,506,509, 514, 526 posteriorbelly,65, 123, 130,
secondary,514 131, 162, 165, 166, 185,
Meninges of brain,99, 273, 353, 215
370, 375 dilatator pupilke,540
of spinalmedulla, 80 tubse,299
Meridians of eyeball,532 8
epicranius,
Mesencephalon.See Mid-brain frontal belly,
6, 8
Mid-brain, 108, III, 355, 356,376, occipital
belly,47
384,389,451, 464,465,483 6, 8
frontalis,
Modiolus, 529, 530, genio-glossus,
191, 192, 194, 196,
Monticulus of cerebellum,484 197, 198,351, 352
Mouth, 277 genio-hyoideus,
191, 193
floor,279 281, 294,
glosso-palatinus, 297,
roof,280 351. 352
vestibule,
5, 20, 277 maximus,
glutseus JT)
Muscles" helicis majorand minor, 46
antitragicus,
46 hyo-glossus,130, 131, 133, 187,
ary-epiglotticus,
324, 333, 334 188, 191, 192, 194, 195,
obliquus,
arytsenoideus 332 196,198,219, 351, 352
transversus, 324, 333 ilio-costalis,
64, 70, 73
ary-vocalis,
335 cervicis,
dorsi,lumborum, 64
56o INDEX
actions
sacro-spinalis, and nerves, thyreo-arytaenoideus,
334
.65,
70, 77 333, 334
thyreo-epiglotticus,
salpingo-pharyngeus,
295 thyreo-hyoideus,
133, 134, 145,
scalenus anterior,37, 52, 144, 146, 202
splenius, 70, 74
63, dura, no,
piercing 112, 113
capitis,39, 63, 65 in sinus,239, 241, 300
63
cervicis, in fissure,
257
stapedius,
512, 519 in orbit,258
sterno-hyoideus, 128, 133, 134, accessory, 41, 58, 217, 218, 223,
146, 148, 151, 216, 228 297, 394, 476
sterno-mastoideus, 31, 37, 63,65, at brain,369,394, 476
Nerves, facial{contd.
) "
Nerves {contd.
) " Nerves {contd.) "
to longuscolli,
54, 142 of
palpebral, lacrimal,
27
lumbar, posteriorrami, 70 petrosal,
deep,great, 241, 300
mandibular,109, 178, 199 superficial,
external,226, 242,
of facial,
14, 15, 20, 164 526
masseteric,168, 170, 180 greater, no, 234, 241, 299
maxillary,109, 238, 301 lesser,199, 220, 234, 241,
median, 52, 53 526
meningeal,of hypoglossal,
224 of glossopharyngeal,
phaiyngeal,
of mandibular. See N. spinosus 219
of maxillary, 238 of spheno-palatine
ganglion,
319
of ophthalmic, 239 of 226
sympathetic,
of vagus, 221 of vagus, 202, 222, 297
mental, 15, 20, 183 phrenic,141, 142, 154, 156,216
musculo-cutaneous,52 of pterygoidcanal,241, 320
mylo-hyoid,
129, 189 topterygoideusexternus, 180
nasal,external,30, 252 internus,
179, 199
internal,252 radial,
53
medial, 308 rami communicantes, 225
of palatine,
316, 320 to rectus anterior,142
capitis
of N. of pterygoidcanal, 307, lateralis,
142
316 recurrent, 147, 222, 337
of spheno-palatine
ganglion, 160
right,
307, 316, 318 of mandibular. See N. spinosus
of nasal septum, 307 rami, 73
sacral,posterior
naso-ciliary, 239, 251, 257, 300 to scalenus anterior,
54
naso-palatine, 307, 318, 320 medius, 54, 142
of nose, side wall,316 posterior, 54
occipital,
greater,48, 55, 56, 69, of scalp,47
70 ganglion,
to semilunar 241, 300
lesser,35, 41, 48 spheno-palatine,
302, 318
third,48, 55, 70 spinal,
86
to occipitalis,
45 roots, 81, 86
oculo-motor, 108, 239, 245, 257, trunk, 86, 88
258,390, 455 exit from vertebral canal,88
at brain, 368, 374, 384, 390, meningealramus, 88
395, 455 posteriorrami, 69
dura, 106, 108
piercing sheaths,81, 82, S3
in sinus, 109, 234, 239, 241, 178,179
spinosus,
300 to stapedius,
526
in fissure,
257 to stylo-pharyngeus,
219
in orbit,245, 258 tosubclavius,36, 37, 54, 144
olfactory,
106, 305, 307, 316, 395, suboccipital,
roots,89, in, 393,
417 476
toomo-hyoid,posteriorbelly,36 trunk, 86, 88, 268, 273
ophthalmic,
109, 234, 238, 239, anterior ramus, 265, 266, 268
241, 300 posterior
ramus, 67,69,74, 75,
optic,106, 250, 252, 395, 396, 77, 266, 268
.
534, 536 subscapular,
54
orbital,of spheno-palatine
glion,
gan- supra-clavicular,
32, 33, 34, 38
320 6, 9, 24,
supra-orbital, 27, 47,
anterior,319
palatine, 245
great. See N.
pal.ant. 36, 54, 59
supra-scapular,
middle,297, 319 6, 24,
supra-trochlear, 27, 47,
posterior,
297, 319 244, 245
of palate,
297 trunk,54, 147, 225
sympathetic
INDEX 563
Orbiculus ciliaris,
537, 539 Plexuses of Nerves )
{contd. "
lacrimalis,
4 basilar,80, 114, 379
348
lingual, chorioid,of lateral ventricle,
431,
conicse,
349 433" 434, 438, 444
filiformes, 350 of inferior horn,386
foliatae,
348 of fourth ventricle,
493 -
fungiformes,
349 of third ventricle,
444
348
vallatae, nasal,315
nervi optici, 542 pharyngeal,117, 217, 235, 283,
Pars basilaris,406 284, 379
ciliarisretinae,542 pterygoid,16, 117, 118,174, 235,
lacrimalis of orbicularis oculi,8, 255, 284, 303
25, 29 suboccipital,50, 117, 269
orbitalis,
407 vertebral,268, 269
triangularis,
407 of internal,79, 80
vertebrae,
Peduncle of cerebellum,inferior, posterior,
74
Plicse. See also Folds
481, 489
middle,482, 489 ciliares,
539
superior,484, 489 348
fimbriata,
of cerebrum, 108, ill, 356,376, lacrimalis,
29
384,389,454, 464,465, 483 semilunaris of eye, 5
of thalamus, 469 sublingualis,
194, 279
anterior,472 of
triangularistonsil,291
temporal,470 Pole of brain,frontal,
359, 396
Pericranium,98 occipital,
359, 396, 415
Perilymph, 506, 527 temporal,360, 397
Pes hippocampi, 436 of
eyeball, 532
Petiolus,
339 Pons, 357, 368,482
Pharynx, 282 structure, 501
287
interior, Portio major,236
nasal part, 288 minor, 238
oral part, 290 Praecuneus,364, 422
laryngealpart,291 Process, auditory,46
Pia materof brain,353, 375 539, 543, 544, 546
ciliary,
375, 382
arteries, cochleariformis,512
83 of maxilla,2
frontal,
spinal,
Pleura,cervical,
159, 217, 232, 233 helicis caudatus, 46
Plexuses of Nerves " 518
lenticularis,
brachial,31, 36, 37, 42, 62 of malleus, 509, 517
relations,54 muscular,of arytenoid,
344
roots, 52, 231, 232 vocal, 344
buccal,180 Prominence, laryngeal,
340
cardiac,226, 227. {^Seeunder Promontory of ear, 513, 530
oblique, 249
N, vagus also) Pulleyof superior 244,
external,202,
carotid, 226 Pulvinar,448, 470
INDEX S6S
Puncta lacrimalia,
4, 29 Segment,neural,87
Pupil,540 Septum of medulla 83, 92
spinalis,
Putamen, 460, 468, 469 of nose, 304, 306
Pyramidof cerebellum,487,488 362,431,
pellucidum, 432, 440
of ear, 511 subarachnoid,83
of medulla, 369,476 of tongue, 350, 353
Sheath of axillary
artery, 37
Radiation,acoustic,470, 471, 474, carotid,135, 136,138
496 of cerebral nerves, 114
of corpus callosum,426 of optic nerve, 250, 259
optic, 470, 471, 474 of orbital muscles, 260
Rami communicantes, 54 of parotid gland,136
of ganglioncervicale inferius,
227 of spinalnerves. Si, 82, 83
medium, 226 of subclavian vein, 157
superius,
225 of submaxillary
gland,136
Rami ad pontem, 384 of gland,227
thyreoid
Ramus of mandible, 2 Sinuses, Air"
Raphe of mylo-hyoids,126, 190 ethmoidal, 310, 312, 313
of palate,280,,293 nerves, 251, 318
palpebral, lateral,6, 25 frontal,312, 313
of pharynx,285 maxillary,
302, 303, 310, 312, 313
pterygo-mandibular, 21, 286 nerves, 303
Recessus ellipticus, 528 sphenoidal,
314
epitympanicus,367, 610, 513, nerves, 251, 319
514, 517 Sinuses, Blood, 114
infundibuli,
450 basilar. See Plexus
opticus,
450 cavernous, 108, 109, 235, 255,
pharyngeus, 289 302, 378
pinealis,
450 inter-cavernous,107, 235
piriformis,
291, 292, 337 occipital,80, 113, 378
sphaericus,
528 petrosal,inferior,109, 113, 114,
spheno-ethmoidalis,314 217, 235, 378, 379
sup'-a-pinealis,
451 superior, 109, 114, 235, 378
supra-tonsillaris. See Fossa sagittal,inferior, 105, 108, 109,
of ventricle,fourth,490, 491, 493 378
third,450 superior,
99, loi, 103, 105, 109,
Reflex,red, of eye, 543 zT^,360,365
Region, subthalamic,446, 465 sigmoid,113, 521
Retina,536,542, 543 106, 109, 235
spheno-parietal,
Rhombencephalon,355, 357 105, 108, 109, 378, 398
straight,
Rima glottidis,326, 336 transverse, 103, 109, 113, 213,
closure and opening,345 360,378
palpebrarum,3 venosus sclerge,535
vestibuli,
325 Morgagni, 286, 297
Sinus of
Rostrum of corpus callosum, 362, 80
Space,epidural,
426 perichorioidal,
534, 540
subarachnoid,of brain,370
Sac,conjunctival,29 82
spinal,
lacrimal,
4, 24, 25, 29 subdural, of skull,103
Saccule of ear, 531 spinal,82
Scala,media. See Duct, cochlear suboccipital,
74
tympani,530 supra-sternal,122
vestibuli,
527, 530 Spatiaanguliiridis, 536,546
Scalp,42, 47, 48, 51 zonularia,545, 546
Sclera,5, 531, 532, 534, 536, 538, Speculum,aural,515
541 Sphincter.See Muscles
566 INDEX
Spina helicis,
46 Sulci ofcerebrum (could.) "
)
Veins,facial{contd. "
Veins {contd.) "
posterior,
14, 40, 48, 50, 130, of retina,543
164,201 of scalp,
48
frontal,16, 26, 48 scapular,
transverse, 34, 40, 123
of hemispheres, cerebral,376 ofspinalmedulla, 91
infra-orbital,
303 striate,
376
innominate, 144 subclavian,39, 153, 157, 160, 231
left,140 16, 48
supra-orbital,
intercostal,
71, 74, 79 middle,
temporal, 48, 168
80
intervertebral, 48
superficial,
anterior,123
jugular, terminalis,
433, 445
anastomosis,122, 123 inferior,
thyreoid, 155, 230
insuperficialfascia,122, 123 middle, 148,230
under sterno-mastoid,34, 40, 131, 148,203, 230
superior,
123, 144, 148, 151, 216 of tongue, 130, 131, 191, 198,
jugular, external,40 201, 211
on sterno-mastoid,32, 34, deep,348
35, 40 transversecervical,34, 40, 123
in triangle,
posterior 34, 37, scapular,34, 40, 123
40, 123, 157 vertebral,66, 74, 80, 151, 154,
valves,37, 40 160, 269
external,posterior,40 anterior,154, 156
internal,213 vorticosse,532, 535, 537, 541
bulb, 213, 221, 511 Velum, medullary, anterior,395,
below skull,114, 213, 379 452, 484, 489, 492
in carotid triangle,
131, 134, posterior,
487, 489
213 palatinum. See Palate,soft
in root of neck, 31, 144, 213 Ventricle of brain,fourth,357, 490
valve,217 apertures,493
16
labial, roof,484
130, 131, 191, 198, 201,
lingual, 355, 426, 429
lateral,
211 central part, 432
of mid-brain,378
nasal,external,16 inferior,
370
occipital,
50, 66, 217 369
superior,
ophthalmic,117, 235, 250, 255 Vestibule of ear, 527, 529
inferior,
174, 255 of larynx,323
superior,
255 of mouth, 5, 20, 277
palpebral,16, 26 of nose, 304, 310
16
parotid, Vibrissoe,
304, 310
pharyngeal,284 Vomero-nasal organ, 305
of pons, 379
Windpipe. See Trachea
profundacervicis,66, 69, 154,
156
faciei,16, 174 Zonulaciliaris,
540, 541, 544
348
linguae, Zygomatic bone, 2