Head and Neck

Anatomy capsule
Summary And Illustrations
HEAD & NECK

FIRST EDITION
Dr. M.Rady
Lecturer ofAnatomy and Embryology

Faculty Of Medicine
Al-Azhar University
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index
-Bone :
- skull
- mandible
- cervical vertebrae
- Muscles :
1-muscles of the head :
A. Muscles of the Face and Scalp
B. Muscles of Mastication
C. Muscles of the Soft Palate
D. Muscles of the Tongue
E.Extra ocular muscles
2-Muscles of the Neck

A. Muscles of the Superficial Neck
B. Muscles of the Anterior Cervical Region
C. Muscles of the Prevertebral Area
D. Muscles of the Larynx
E. Muscles of the Pharynx
- Triangles:
-ant triangle
-post. Triangle
-suboccipital triangle
-Fascia of the neck
- Blood supply :
to scalp & face
- Arteries :
-subclavian a. & its brs.
-E.C.A. & its brs.
- I.C.A. & its brs.
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-Veins :
-ant.jugular v.
–int.jugular v.
–ext.jugular v.
–subclavian v.
-vertebral v.
- nerves & ganglion

-nerve supply to face & scalp
-cranial nerves
-cervical plexus
-phrenic nerves
-cervical symp. Chain
-Para sympathetic ganglion & nerves
-Otic , submandibular ,sphenopalatine and lacrimal ganglion
- glands:
-parotid
-submandibular
-thyroid
-para thyroid
-pitutary gland
-sublingual
-cranial cavity :
dura mater
venous sinus
hyoid bone & styloid apparatus
- organs ( pharynx , larynx , orbit & tounge )

- joints
- lymphatics
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Bone of the skull
The skull forms the skeleton of the head.

It is a difficult part of the skeleton to study as there is a very
large number of named features on it, and many of these are
difficult to identify.
Here we will confine ourselves only to the most important
features.
-Consists of 22 bones, 21 of which are firmly bound together;

mandible is moveable and
articulates with remainder of skull through paired synovial joints
- Subdivisions
1. Neurocranium
- Derived from occipital somites and somitomeres
- Contains and protects brain
-Subdivisions of Neurocranium
A. Calvaria (cranial vault or skullcap)
- Forms roof of cranial cavity, which houses brain
- Flat bones of skull or flat portions of bones
B. Cranial base
- Forms solid base for articulation with vertebral column and
facial skeleton
- Irregular bones which complete enclosed brain case
2. Viscerocranium
a. Derived from neural crest
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skull ossifications
A. Neurocranium
1. Membranous part (desmocranium)
2. Cartilaginous part (chondrocranium):
B. Viscerocranium:
consists of bones of face and formed by cartilages of 1st 2
pharyngeal arches
sutures
-The coronal suture divides the frontal from the parietal bones,
-the sagittal suture separates the parietal bones in the midline,
-the lambdoid suture marks off the occipital from the parietal
and temporal bones
- the squamosal suture separates the squamous temporal
bone from the parietal bone and greater wing of sphenoid.
-In about 8% of cases the metopic suture persists in the midline

between the two frontal bones;
in the rest, this suture fuses at about the 5th year.
Development
The skull vault develops in membrane,
the skull base develops in cartilage.
At birth,
the square anterior fontanelle
triangular posterior fontanelle are widely open.
The anterior fuses at about 18 months.

The posterior fuses at about 3 months.
Muscles attached & foramina
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Norma verticalis
Muscles attached : non
Foramina :
-bregma : point of meeting between sagittal & coronal sutures
At birth called: ant. Fontanelle ossifies at 18 months
-lambda: point of meeting between sagittal & lambdoid sutures

At birth called : post. Fontanelle ossifies at 6 months
-parital emissary foramen:

On each side of sagittal suture
Transmits : emissary v. between scalp vs.& sup. Sagittal sinus
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Norma occipitalis
Muscles attached :
-ext. occipital protuberance:
Upper part : origin to trapezius m.
Lower part : attach upper part of nuchal lig.
-Ext. occipital crest:

attach base of nuchal lig.
-Sup. Nuchal line:

Med. 1/3 : origin to trapezius m.
Lat. 1/3 : insertion of sternomastoid
-Highest nuchal line:

Med. : attach the epicranial aponeurosis
Lat. : origin to occipital belly of occipitofrontalis m.
Foramina:
-Mastoid emissary foramen:
Transmits: emissary v. between occipital vs. & sigmoid sinus
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Norma frontalis
Muscles attached: non

Foramina:
-Supra- orbital f.
-Infra- orbital f.
-Mental f.
Lie along vertical line pass between 2 premolar teeth

Transmit : nerves & vessels indicated by their names ( terminal
brs. Of trigeminal n.)
-Zygomatico-facial f. :
Transmits : zygomatico-facial n. & vessels
Each maxilla bears eight teeth.

Beginning from the midline there are:
a. two incisors
b. one canine
c. two premolars
d. three molars.
The part of the maxilla that bears the teeth is called the alveolar
process
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Norma lateralis
Muscles attached:
-Sup.temporal line : -epicranial aponeurosis , temporal fascia
-Inf. Temporal line: origin to temporalis m.
-Zygomatic arch:
Lower & inner surface : origin to masseter m.
-Mastoid process:
Outer surface give insrtion to 3 ms. ( S_I_S)
Sternomastoid m.
Longissimus capitis m.
Splenius capitis m.
-Styloid process: ( 2 lig. & 3 ms.)

stylomandibular lig.
stylohyoid lig.
stylohyoid m.
styloglossus m.
stylopharyngeus m.
Foramina:
-pterion: meet 4 bones

frontal – parital – squamous part of temporal bone
– greater wing of sphenoid
It lies 4cm behind the frontal process of zygomatic bone
at birth called ( sphenoidal fontaelle )
related to ant.br. of middle meningeal a.
-Asterion : meet 3 bones

Parital –occipital – mastoid temporal bone
At birth called mastoid fontanelle
-Pterygo-maxillary fissure:
Transmits : maxillary n. & a.
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Norma basalis externa
Muscles attached:
-maxillary tuberosity origin to superficial head of med.
Pterygoid m.
-med.surface of lat. Pterygoid plate origin to deep head of med.
Pterygoid m.
-infra. Temporal surface of greater wing of sphenoid origin to

upper head of lat. Pterygoid m.
-lat. Surface of lat. Pterygoid plate origin to lower head of lat.
Pterygoid m.
Post. Nasal spine origin to musculus uvulae

Pterygoid hammulus origin to sup. Constrictor m. of pharynx
Scaphoid fossa origin to tensor palati m.
Spine of sphenoid attach to sphenomandibular lig.
Quadrate area at apex of petrous temporal bone origin to
levator palati m.
Basilar part of occipital bone insertion to longus capitis m.
Pharyngeal tubercle insertion to median raphe of pharynx
Lat. Part of area infront of inf. Nuchal line insertion of

R.C.P.M.
Med. Part of area infront of inf. Nuchal line insertion of
R.C.P.m
Lat. Part of area between sup. & inf. Nuchal lines insertion of
sup. Oblique m.
Med. Part of area between sup. & inf. Nuchal lines insertions of
semispinalis capitis
Med. Surface of mastoid process insertion of post. Belly of

digastric
Lat. Surface of mastoid process :
- insertion of : sternomastoid - longissimus capitis - splenius
capitis ms.
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Foramina
a-foramen of Ant. Part
1-incisive fossa :
2 median f. ( ant, & post. ) passing long sphenopaiatine ns.
2 lat. F. ( RT. & LT. ) passing greater palatine n.
2-Greater palatine f. passing greater palatine n. & vs.
3-Lesser palatine f. passing lesser palatine n. & v.
b-foramen of Middle part

*3 small foramina
1-foramen oval :
passing
MALE:
Mandibular nerve, Motor root of Trigeminal, Middle meningeal
vein
Accessory meningeal artery
Lesser petrosal nerve
Emissary veins
2-Foramed spinosum :
: passing
Middle meningeal a.
Nervus spinosus
3-Stylomastoid f. :
Passing :
Facial n.
Stylomastoid a. ( post. Auricular a.)
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*3 large foramina.
1-Foramen lacerum :
( lower end) passing
-Meningeal br. Of ascending pharyngeal a.
-Emissary v. from pterygoid plexus to cavernous sinus
2-Carotid canal :
passing
-I.C.A.
-Internal carotid symp. Plexus
-Deep petrosal n. from plexus
-Emissary v. from cavernous sinus to I.J.V.
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3-Jugular f. :
passing
-Inf. Petrosal sinus
-Inf. Jugular v.
-9th , 10th , 11th cranial ns.
Mastoid canaliculus:
Minute canal open in lat. Wall of jugular f. transmits:
Auricular br. Of vagus n.
Tympanic canaliculus:
Minute canal between jugular fossa & carotid canal transmits:
Tympanic br. Of glossopharyngeal n. to middle ear
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*3 foramina. of Occipital condyles
1-Ant. Condylar f.:( hypoglossal canal) tramsmits:
-Hypoglossal n.
-Meningeal br. Of ascending pharyngeal a.
-Emissary v. from sigmoid sinus to I.J.V.
2-Post. Condylar f.: passing

Emissary v. from sigmoid sinus & suboccipital venous plexus
3-Foramen magnum : passing:

3 nervous :
-lower end of medulla oblongata
-tonsils of cerebellum
-spinal roots of accessory n.
3 vascular :
-vertebral as.
-spinal as.
Vertebral plexus of veins
3 membranes:
-meninges
-membrana tectoria
-apical lig.
*Hidden foramina
-Palatovaginal canal: passing
Pharyngeal br. Of sphenopalatine ganglion
-Pterygoid canal: passing

n. to pterygoid canal (vidian n.)
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*3 fissures
1-inf. Orbital fissure: passing
inf. Orbital n. & a.
orbital br. Of sphenopalatine ganglion
zygomatic n.
emissary v. from inf. Ophthalmic v. to pterygoid plexus of veins
2-pterygomaxillary fissure ; passing

maxillary a. & n.
brs. Of sphenopalatine ganglion
3-squamotympanic fissure: passing.

-Chorda tympani n.
Ant. Tympanic a.
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Norma basalis interna
Muscle attached: non
Foramina:
-ant. Cranial fossa:
-f. coecum :
usually closed transmits:
emissary v. from nasal vs. to sup. Sagittal sinus
-f. of cribriform plate of ethmoid : passing

olfactory ns.
-Ant. Ethmoidal f. : passing

Ant. Ethmoidal n. & vessels
-Post. Ethmoidal f. : passing

Post. Ethmoidal n. & vessels
-middle cranial fossa

-Optic f.: passing
Optic n.
Ophthalmic a.
f. lacerum: ( upper end ) passing:-

I.C.A.
Internal carotid symp. Plexus
-Sup. Orbital fissure: passing

Nasociliary nerve
Inferior branch of oculomotor nerve
-f. rotandum : passing maxillary n.
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The vault of the skull
• The vault of the skull comprises a number of flat bones, each
of which consists of two layers of compact bone separated by a
layer of cancellous bone (the diploë) which contains red bone
marrow and a number of diploic veins.
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The Fontanelles
1. In the skull of the newborn, there are some gaps in the vault
of the skull that are filled by membrane.
These gaps are called fontanelles or fonticuli.
They are located in relation to the angles of the parietal bone as
follows:
a. The anterior fontanelle lies at the junction of the sagittal,
coronal and frontal sutures.
(Note that at birth the frontal bone is in two halves that are
separated by a frontal suture).
b. The posterior fontanelle is triangular.

It lies at the junction of the sagittal and lambdoid sutures.
c. The sphenoidal (anterolateral) fontanelle is present in

relation to the anteroinferior angle of the parietal bone, where it
meets the greater wing of the sphenoid.
d. The mastoid fontanelle (posterolateral) is present in relation

to the posteroinferior angle of the parietal bone (that meets the
mastoid bone).
2. The fontanelles disappear (by growth of the bones around

them) at different ages after birth.
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Mandible
Development
The mandible develops as membrane bone in the fibrous sheath
of Meckel’s cartilage
(the cartilage of the first branchial arch, which also gives rise
to the malleus and incus).
The cartilage itself is completely absorbed.

Bony union of the two halves of the mandible occurs in the 2nd
year.
-muscles attached:
1-the ramus:
insertion of 4 ms. Of masticatins
-masseter: to outer surface of ramus
-temporalis: to coronoid process
-Lat. Pterygoid: to pterygoid fossa
-Med. Pterygoid : to inner surface of angle of mandible
2--The body:
( 1 insertion & 6 origins )
-platysma: inserted to lower border of body
-Buccinator: outer surface of scocket of 3 molar teeth
-Ant.belly of digastric : digastric fossa
-Genio-glossus: sup. Genil tubercle
-Genio-hyoid : inf. Genil tubercle
-Mylohyoid: mylohyoid line
-Sup.constrictor m. of pharynx: post end of mylohyoid line
3-Ligaments attached:
-temporo-mandibular lig.:
From articular eminence of the skull to lat. Surface of neck of
mandible
-stylo-mandibular lig.:
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From styloid process to post. Border of angle of mandible
-sphenomandibular lig. :
From spine of sphenoid to angle of mandible
-pterygo-mandibular lig. :
From pterygoid hammulus to post. End of mylohyoid line
4-Foramina:
Mandibular f.: passing inf. Alveolar n. & a.
Mental f. : mental n. & a.
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Cervical vertebrea
Introduction to the vertebral column
1. Below the skull, the central axis of the body is formed by the
backbone or vertebral column.
2. The vertebral column is made up of a large number of

bones of irregular shape called vertebrae.
a. There are seven cervical vertebrae in the neck.
b. Below these, there are twelve thoracic vertebrae that forming

the skeleton of the thorax.
c. Still lower down, there are five lumbar vertebrae that lie in
the posterior wall of the abdomen.
3. The lowest part of the vertebral column is made up of the

sacrum, which consists of five sacral vertebrae that are fused
together; and of a small bone called the coccyx.
The coccyx is made up of four rudimentary vertebrae

fused together.
4. There are thus thirty-three vertebrae in all.

Taking the sacrum and coccyx as single bones the vertebral
column has twenty-six bones.
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STRUCTURE OF A TYPICAL VERTEBRA
1. The parts of a typical vertebra are best seen by examining a
vertebra from the mid-thoracic region
The following parts can be distinguished:
a. The body lies anteriorly.
It is attached to those of adjoining vertebrae through
intervertebral discs.
b. The pedicles (right and left) are short from the posterior part
of the body.
c. Each pedicle is continuous, posteromedially, called the
lamina.
The laminae of the two sides pass to meet in the middle line.
The pedicles and laminae together constitute the vertebral arch.
d. Bounded anteriorly by the posterior aspect of the body, on the

sides by the pedicles, and behind by the laminae, there is a large
vertebral foramen.
Each vertebral foramen forms a short segment of the vertebral
canal that runs through the whole length of the vertebral column
and transmits the spinal cord.
e. Passing backwards from the junction of the two laminae, there

is the spine (or spinous process).
f. Passing laterally from the junction of each pedicle and the

corresponding lamina, there is a transverse process.
The spinous and transverse processes serve as levers for muscles
acting on the vertebral column.
2. When the vertebrae are viewed from the lateral side we see
certain additional features.
g. Projecting upwards from the junction of the pedicle and the

laminae there is, on either side, a superior articular process;
and projecting downwards there is an inferior articular process.
i. Each process bears a smooth articular facet.
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the superior facet is directed posteriorly
and the inferior facet is directed forwards
ii. The superior facet of one vertebra articulates with the inferior
facet of the vertebra above it.
iii. Two adjoining vertebrae, articulate at three joints;

two between the right and left articular processes and one
between the bodies of the vertebrae (through the intervertebral
disc).
i. below the pedicle. there is a large inferior vertebral notch
ii. Above the pedicle, there is a much shallower superior
vertebral notch.
iii. The superior and inferior notches of adjoining vertebrae join
to form the intervertebral foramina which give passage to
spinal nerves emerging from the spinal cord.
want to know more?

We may now consider additional differences between cervical,
thoracic and lumbar vertebrae.
1. The vertebral bodies progressively increase in size from
above downwards.
a. They are, smallest in the cervical vertebrae and largest in the
lumbar vertebrae.
b. the body is oval in the cervical and lumbar regions and
triangular or heart-shaped in the thoracic region.
2. In the thoracic region, the head of a typical rib articulates

with the sides of the bodies of two vertebrae.
a. the body of a typical thoracic vertebra bears two (upper and
lower) costal facets:.
b. Each of these is only half a facet (demifacet), the other half
being on the adjoining vertebra.
c. The upper facet is large and articulates with the numerically
corresponding rib.
d. The lower, smaller facet articulates with the next lower rib.
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3. The spinous processes
in a typical cervical vertebra they are short and bifid
in the thoracic region They are long and project downwards.
b. In lumbar vertebrae, they are large and quadrangular. they
are more or less horizontal and have a thick posterior edge.
4. The transverse processes

-In typical cervical vertebrae they are relatively short and, as
mentioned earlier, they are pierced by foramina transversaria.
When viewed from the lateral side the transverse process is seen
to be grooved.
The cervical nerves lie in these grooves after they pass out of
the intervertebral foramina.
-In typical thoracic vertebra they are large with solid blunt
ends.
They are directed backwards and laterally.
Each process lies just behind the corresponding rib and bears
a prominent facet for articulation with the rib.
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They are 7 in number
All are characterized by preasence of foramen transversum in
the transvers processes
They classified into :
Typical : ( 3-6 ) cervical vertebrea
Atypical : (1 , 2 , 7 ) cervical vertebrea
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typical cervical vertebrea
they characterized by :
1- the body :
Small , has 2 lat. Lips above & ant. , post. Lips below
2-the transvers process :

Perforated by foramen transversum & has ant. & post. Tubercles
a.The part of the process in front of the foramen is called the
anterior root; and the part behind it is called the posterior root
b. The part lateral to the foramen is usually called the
costotransverse bar, but it is more correct to call it the
intertubercular bar.
c. The anterior and posterior roots end in thickenings called the
anterior and posterior tubercles respectively.
3- the spine : short & bifid
4-the sup. Articular processes directed postero-superiorly

The inf. Articular processe directed antero-inferiorly
5-the vertebral foramen :

Large & triangular
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Atypical cervical vertebrea
the atlas
( 1st. cervical vertebrea )
it is ring shape
has no body , no spine
-formed of 2 lat. Masses connected by

short ant. Arch & long post. Arch
-the ant. Arch has :

anteriorly : ant. Tubercle
Posteriorly : facet for articulation of odontoid process
-the post. Arch has :

superiorly : groove for vertebral a. & 1st cervical nerve
Posteriorly : post. Tubercle
-Each lat. Mass has :

1-Superior kidney shaped facet for articulation with occipital
condyle of the skull to form an atlanto-occipital joint
2-Inferior circular shaped facet for articulation with the sup.

Articular facet of axis ( 2ns cervical vertebrea ) to form a
lateral atlanto-axial joint.
3-Med. Tubercle for attachment of the transvers ligament of

atlas
This ligament divides the large foramen
(bounded by the lateral masses and the arches) into anterior and
posterior parts.
b. The posterior part corresponds to the vertebral foramen of a

typical vertebra. The spinal cord passes through it.
c. The anterior part is occupied by the dens (which is an
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upward projection from the body of the axis).
The dens articulates with the posterior aspect of the anterior
arch.
b. The dens also articulates with the transverse ligament, these

two articulations collectively forming the (median atlanto-
occipital joint).
a. The upper surface of the posterior arch has a groove for the
vertebral artery.
4-Tr. Processes containing foramen transversaium for

vertebral artery and vein
ii. Vertebral arteries pass posterior to lateral masses to enter
skull via foramen magnum
iii. Vertebral veins do not originate inside skull; arise from
vessels of internal vertebral venous plexus; drain inferiorly to
brachiocephalic veins
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Structures passing through the vertebral canal include:
a. the spinal cord
b. the meninges
c. the spinal part of the accessory nerve
d. the anterior and posterior spinal arteries.
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The axis
( 2nd cervical vertebra )
Its body project upward forming odontoid process or the dens

The dens articulates with :
-the posterior aspect of the anterior arch.
-the transverse ligament,
these two articulations collectively forming the (median
atlanto-occipital joint).
The spine is thick & very strong
The vertebra prominans C 7th

The spine is long & not bifid
It is the 1st spine felt subcuteneously at the back of neck
Has small foramen tranversarius & may be abscent
Note that :
the vertebral artery and vein do not traverse the foramen
transversarium of this vertebra
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Anatomical events at the level of c6
-Level of cricoid cartilage
-C.C.A. can be compressed at its tubercle so called carotid
tubercle
-Intermediate tendon of omohyoid cross the carotid sheath
-The inf. Thyroid a.
-The middle thyroid a. emerge from the gland
-The vertebral a. enters the foramen transversium of c6
-Level of middle ganglion of sympathatic chain
-Termination of larynx & beginning the trachea
-Termination of pharynx & beginning the oesophegus
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The cervical, thoracic and lumbar vertebrae can be easily
distinguished from one another because of the following
characteristics:
a. The transverse process of a cervical vertebra is pierced by a

foramen called the foramen transversarium.
b. The thoracic vertebrae bear costal facets for articulation
with ribs. These are present on the sides of the
vertebral bodies and on the transverse processes.
c. A lumbar vertebra recognised by the large size of its body.
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Muscles of head & neck
1-muscles of the head

A. Muscles of the Face and Scalp include :
the occipitofrontalis, orbicularis oculi, orbicularis oris buccinator
m. and platysma.
All these muscles are innervated by CN VII.
B. Muscles of Mastication include :

the masseter , temporalis , medial pterygoid and
lateral pterygoid,
C. Muscles of the Soft Palate include :

the tensor palatini, levator palatini, palatoglossus,
palatopharyngeus, and musculus uvulae.
D. Muscles of the Tongue include :

the genioglossus, hyoglossus, styloglossus, and palatoglossus
E.Muscles of the eye (Extra ocular muscles) : include

The 4 recti muscles
Sup. & inf. Oblique muscles
levator palpebral superioris
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A. Muscles of the Superficial Neck include :

the platysma, sternocleidomastoid, and trapezius.
B. Muscles of the Anterior Cervical Region include :

the mylohyoid, geniohyoid, stylohyoid,
digastric, sternohyoid, omohyoid, sternothyroid, and thyrohyoid.
C. Muscles of the Prevertebral Area include :

-the longus colli, longus capitis,
-rectus capitis anterior, rectus capitis lateralis,
anterior scalene,, middle scalene, and posterior scalene.
D-Muscles on the back of the neck
4 layers arranged from superficial to deep

1st layer : sternomastoid & trapezius
2nd layer : levator scapulea & splenius muscle
3rd layer : semispinalis capitis & longissmus capitis
4th layer : ( sub-occipital muscles )

Rectu capitis post. Major
Rectus capitis post. Minor
Superior oblique m. ( the obliqus capitis sup. )
Inferior oblique m. ( the obliqus capitis inf. )
E.Muscles of the Larynx include :

-the cricothyroid, thyroarytenoid, posterior cricoarytenoid,
lateral cricoarytenoid, transverse and oblique arytenoids, and
vocalis.
F. Muscles of the Pharynx include :

-the superior constrictor, middle constrictor, inferior constrictor,
palatopharyngeus, salpingopharyngeus, and stylopharyngeus.-
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1-muscles of the head :
A. Muscles of the Face and Scalp
-they include :
1-the occipitofrontalis,
2-orbicularis oculi,
3-orbicularis oris
4-buccinator m.
5-platysma.
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-Schem for all muscles
general rules :
- lies in superfacial fascia
-insertion: in skin
-arranged around the openings
-n. supply : facial n.
Mandibular nerve: Mastication.

Facial nerve: Facial expression.
1-the occipito-frontalis muscle

Formed of :
-2 frontal bellies anteriorly
-2 occipital bellies posteriorly
-An aponeurosis called epicranial aponeurosis connect the
frontal & occipital bellies together
To don’t forget the direction of the muscle

Start from back forward ( occipital to frontal )
- occipital bellies : separated

Origin : from the highest nuchal line
Insertion : the post. Border of the epicanial aponerosis
n. supply : post. Auricular br. Of facial n.
action : tighten the epicranial aponeurosis
-frontal bellies : fused to gether

Origin : from the ant. Border of the epicranial aponeurosis
Insertion : into the skin of eye brow
n. supply : temporal br. Of facial n.
action : elevate the eye brow
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-the epicranial aponeurosis
Attachments :
Ant. To frontal bellies
Post. To occipital bellies
On each sides to the sup. Temporal line
2- Orbicularis oculi
-it consists of 3 parts ( orbital , palpebral & lacrimal )
1-orbital part :
Origin: upper border of med. Palpebral lig.
Insertio: lower border of med. Palpebral lig.
2-palpebral part:
The same as orbital part
3-lacrimal part :
Origin: post. Lacrimal crest & fascia covering it
Insertio: margin of eye lids
n.supply : temporal & zygomatic brs. Of facial n.
action:
-orbital part: firmly closure of eye
-palpebral part: gently closur of eye
-lacrimal part: dilate lacrimal sac
The whole m.: forcibly closure of eye
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3-Orbicularis oris
Origin:
-extrinsic (outer) fibers : from buccinator m.
-intrinsic (inner) fibers : from alveolar margin of maxilla &
mandible
Insertion :
-extrinsic fibers : into lips
-intrinsic fibers: attached by incisive & mental slips
n.supply: buccal br. Of facial n.
action :
-close the mouth
-compresses lips against teeth
-kissing
45
4-Buccinator m.
Origin :
-upper fiber : from alveolar margin of maxilla
opposit the 3 molar teeth
-middle fiber : from the pterygomandibular lig.
-lower fiber : from alveolar margin of mandible
opposit the 3 molar teeth
Insertion :
-upper fiber : into upper lip
-middle fiber : decussated at angle of mouth
-lower fiber : into lower lip
n. supply : buccal br. Of facial n.
action: prevent accumulation of food in mouth
used in wistling & suckling
46
B-Muscles of mastication
they include 4 muscles:
1-masseter
2-temporalis
3-medial pterygoid
4-lateral pterygoid
-Schem for all 4 muscles

General rules:
-origin: from temporal & infra temporal fossa

-insertion: into ramus of mandible
-n. supply:
mandibular n.
all from ant. Division
except the Med.pterygoid m. from main trunk
Action:
-elevate mandible
except. Lat. Pterygoid m. lowers it
-protrude mandible except temporalis retract it
-pterygoid ms. Move mandible from side to side
47
1-MASSETER M.
Origin: by 2 heads :
1-superfacial head: from lower border of zygomatic arch
2-deep head: from inner surface of zygomatic arch
Insertion: outer surface of ramus of mandible
N. supply: masseteric n. from ant. Division of mandibular n.
Action: elevate & protrude mandible
Relations:
a- deep relations:
Buccinator m.
Buccal pad of fat
Buccal n.
b- superfacial relations:
parotid gland & its duct
brs. Of facial n.
transverse facial a.
48
49
2-TEMPORALIS M.
Origin: -inf. Temporal line
-floor of temporal fossa & temporal fascia
Insertion: tip ,ant border & inner surface of coronoid process
n.supply: 2 deep temporal nerves from ant. Division of

mandibular nerve
action: elevate & retract mandible
3-MED. PTERYGOID M.
Origin:
1-superfacial head: from maxillary tuberosity
2-deep head: from medial surface of lat. Pterygoid plate
Insertion: med. Surface of angle of mandible
n.supply: main trunk of mandibular n.
action: -elevate & protrude mandible

- side to side movement
Deep relations:
( tensor + 3s )
Tensor palati m.
Sup. Constrictor m. of pharynx
Styloglossus m.
Stylopharyngeuse m.
50
51
4-LAT. PTERYGOID M..
Origin:
1-upper head:infratemporal surface & crest of greater
wing of sphenoid
2-lower head: lat. Surface of lat. Pterygoid plate
Insertion: pterygoid fossa on neck of mandible

n.supply: ant. Division of mandibular n.
action: as the medial pterygoid m. pluse
- protraction of mandible ( when 2 ms. Act together)
Relations:
1-upper border: -temporal nerves
-masseteric nerve
2-between 2 heads: -maxillary a.

-buccal n.
3-lower border: -lingual n.

-inf. Alveolar n.
4-superficial relations:
-temporalis m.
-masseter m.
-maxillary a.
- Buccal n.
-pterygoid plexus of veins
-med. Pterygoid m.(sup.head)
5-deep relations: ( so – 3m -2n )

-med. Pterygoid m.(deep head)
-middle & accesory meningeal as.
-mandibular n. & its branches
-Chorda tympani n.
-lesser superficial petrosal n.
-sphenomandibular ligament
-otic ganglion
52
C. Muscles of the Soft Palate include :
1-tensor palati m.
2-levator palati m.
3-palatoglossus m.
4-palatopharyngeus .
1-tensor palati m. :
Origin : from the scaphoid fossa of the base of the skull
& the lat. Surface of austachian tube
Insertion :
-by tendon around the pterygoid hamulus
-Then expand to form the palatin aponeurosis which attached
to the post. Border of hard palate
-The aponeurosis of RT. & LT. muscles join each other in the
median plane
Action :
-makes the soft palate tense & tight
-Separating the oropharynx from nasopharynx during
swallowing
-Keep the eustachian tube patent
Relations :
Superiorly : base of the skull
Inferiorly : sup. Constrictor muscles
Medially : eustachian tube
Laterally : the 2 pterygoid muscles
* structures between the tensor palati m. & the pterygoid

muscles :
-Mandibular n. & its branches
-Otic ganglion
-Chorda tympani
-Middle & accessory meningeal a.a.
53
2-Levator palati muscle :
Origin : from the apex of petrous part of temporal bone
& the lower acpect of eustachian tube
Insertion : into the upper surface of palatine aponurosis
Action :
Elevates the stiffened soft palate
-Shutting off the nasopharynx from the oropharynx
-open the eustachian tube for pressure squilibration
3-palatoglossus muscle:
origin : from the lower surface of palatine aponeurosis
insertion : post. 1/3 of side of the tongue to form the palato-
glossal fold
action :
pulls the tongue upwards to close the oropharynx in the 1st
phase of deglutination
4-palatopharyngeus muscle :
Origin : from the lower surface of palatine aponeurosis
Insertion : into the post. Border of thyroid cartilage to form
the palato-pharyngeus fold
Action :
pull the larynx up
Shortens the pharynx in 2nd phase of deglutition
5-Musculus uvulae :
Origin : from the post. Nasal spine of hard palate
Insertion : into the mucous membrane of uvula
Action : pull the uvula to its own side
54
D. Muscles of the Tongue include:
A-intrensic muscles :
-Lies inside the tongue
-Have no bony attachments
They include :
-vertical muscle fibers
-transvers muscle fibers
-sup. Longitudinal muscle fibers
-inf. Longitudinal muscle fibers
They all supplied by hypoglossal n.
B-extrinsic muscles
They arise from neabry bones & inserted into the tongue
They include :
Genioglossus m.
Hyoglossus m.
Styloglossus m.
Palatoglossus m.
They all supplied by hypoglossal n. except

the palatoglossus ( supplied by vagus n. )
55
1-genioglossus muscle :
origin : upper genial tubercle of mandible
insertion : the whole length of under surface of tongue
action :
single m. : pulls the tongue to the opposite side
the 2muscles : pull the tongue directly forward
hyoglossus muscle :-2

Origin: body & greater horn of hyoid bone
Insertion: post. 1/2 of side of tongue
n. supply : hypoglossal n.
action : depresses the tongue help in sucking
Relations:
-superficial relations: ( 2ms. – 2ns. )
stylohyoid m.
lingual n. & submandibular ganglion
submandibular gland & its duct
hypoglossal n. & mylohyoid m.
intermediate tendon of digastric
-deep relations: ( muscle-artery-nerve-lig. ) 4g

genioglossus m.
2nd part of lingual a.
Glossopharyngeal n.
Stylohyoid lig.
3-styloglossus muscles :
origin : tip of styloid process
insertion : the wole length of side of the tongue
decussating with hyoglossus m.
action : retract the tongue backward
56
glossal fold
action : pulls the tongue upwards to close the oropharynx in the
1st phase of deglutination
57
Extra ocular muscles
58
Origin: post. Part of the roof of orbit
Insertion: skin & tarsus of upper eye lid
n.supply: occulomotor n.
symp. Fibers to deep part of m. ( mullers m.)
action: elevate upper eye lid
59
4 recti ms.:
Origin: from tendnious ring like names
Insertion : sclera & corno-scleral junction
n.supply: all from occulomotor n.
except: lat. Rectus : from abducent n.
action: as its named
60
the oblique muscles
1-sup. Oblique:
Origin: post. Part of roof of orbit
Insertion:
lat. Ascpect of eye ball . between sup. & alt. rectus ms.
n.supply: trochlear n. ( S.O.4)
Action: ( look to your shoulder )
Depreesed , abducts & rotates eye lateraly
2-Inf. Oblique:
Origin: floor of orbit
Insertion: lat. Ascpect of eye ball
action:elevates , abducts & rotates eye lateraly
nerve supply of extraoccular ms.

All are supplied by occulomotor n. except:
-lat.rectus m. : by abducent n. (L.R.6)
-sup. Oblique m. : by trochlear n. (S.O.4)
61
A. Muscles of the Superficial Neck include :
the platysma
sternomastoid
trapezius.
1- platysma muscle :
Origin : from the deep fascia covering the pectoralis major &
deltiod muscle
Insertion : into the lower border of mandible
n. supply : cervical br. Of facial n.
action : wrinkles the skin of the neck
help to depress the mandible
2-STERNOMASTOID M.
Origin: by 2 heads:
Sternal head : front of manubrium sterni
Clavicular head: med. 1/3 of upper surface of clavicle
Insertion:
-lat. Surface of mastiod process
-lat. 1/3 of sup. Nuchal line
n. supply :
-spinal accessory n. ( motor)
-c2,3 ( proprioceptive)
Action:
-one m. : bend head to same side & face to opposite side
- 2 ms. : flex the neck
62
Relations:
-superficial relatios:
-skin
-s. fascia
( platysma, ext.jug.n , cervical ns. & superficial cervical l.ns.)
-deep fascia
-deep relations : ( 4s- 3c- 2l )

Sterno clavicular joint
Sternohyoid,sternothyroid ms.
Scalenus ant. & the structures infront it
Scalenus medius & roots of brachial plexus
Carotid sheath & its content
Ansa cervicalis
Deep cervical l.ns.
Levator scapulae & roots of cervical plexus
Lat. Lobe of thyroid gland
-the ant. Border : form post. Boundary of ant. Triangle

-the post. Border : form ant. Boundary of post. Triangle
& cutanuse cervical ns.
63
B. Muscles of the Anterior Cervical Region include :
-Supra-hyoid muscles
(the mylohyoid, geniohyoid, stylohyoid )
-digastric,
-infra-hyoid muscles :
(sternohyoid, omohyoid, sternothyroid, and thyrohyoid.)
64
A-SUPRAHYOID MS.
(stylohyoid-mylohyoid-geniohyoid)
1- stylohyoid m.
Origin: post. Aspect of styloid process
Insertion: hyoid bone
The tendon split by intermediate tendon of digastric m.
n.supply: 7th cranial n.
action: elevate hyoid bone
2-mylohyoid m.
Oral diaphragm
Origin: mylohyoid line of mandible
Insertion:
-ant. 2/3 fiber to median raphe (between symphysis menti &
hyoid bone
-post. 1/3 fiber to hyoid bone
n. supply : n. to mylohyoid br. From inf.alveolar n.

action: -support & elevate the floor of mouth
Relations:
superficial relations:
skin , superficial fascia, deep fascia
submental vessels & L.Ns.
mylohyoid vessele & its nerve
ant. Belly of digastric
deep relations: ( 4 muscles- 2 nerves- 2 glands )
hyoglossus m.
styloglossus m.
genioglossus & geniohyoid ms.
Lingual n. & its ganglion
Hypoglossal n.
Submandibular & sublingual glands
65
3-geniohyoid m.
Origin: inf. Genial tubercle
Insertion: body of hyoid bone
n. supply : c1 via hypoglossal n.
action: elevates hyoid bone
66
B-DIGASTRIC M.
Origin: 2 bellies
1-ant. Belly :(develop from 1st pharyngeal arch)
from digastric fossa of mandible
2-post. Belly:(develop from 2nd pharyngeal arch)
from digastric notch med. of mastoid process
Insertion: intermediate tendon

connect to hyoid by fibrous loop & fibers of insertion of
stylohyoid m.
n. supply:
-ant. Belly : by n. to mylohyoid
-post. Belly : by facial n.
Action:
-ant. Belly: depresses the chin
-post. Belly: retract hyoid bone upward
Both: fix hyoid bone in action of infra hyoid ms.
Relations:
1-ant. Belly:
Superficial relations:-skin
-superficial fascia ( platysma m. )
Deep relations: mylohyoid m. & its nerve
2-post. Belly:
Superficial relations:( bone-gland-bone-gland)
Mastoid process
Parotid gland
Angle of mandible
Submandibular gland
Deep relations : ( 3 vessels & 3 cranial nerves )
I.J.V. , I.C.A. , E.C.A.
10 , 11 , 12 cranial nerves
Upper border: stylohyoid m. & post. Auricular a.

Lower border : occipital a.
67
C-INFRAHYOID MS.
Superficial (sternohyoid_ omohyoid)
Deep (sternothyroid_thyrohyoid)
1-sterno-hyoid m.
Origin: manubrium & med. End of clavicle
Insertion:hyoid bone
n. supply : ansa cervicalis
action:depression of hyoid bone in 2nd phase of deglutition
2-omo-hyoid m.
Origin: has 2 bellies
-sup. Belly:hyoid bone
-Inf. Belly: upper border of scapula & supra scapular lig.
Insertion: intrmediate tendon connect to clavicle
-in deep fascia to keep Ext.Jug.v. patent
n.supply: ansa cervicalis
action : like sternohyoid
3-sterno-thyroid m.
Origin: manubrium & 1st costal cartilage
Insertion:obliqe line of thyroid cartilge
n. supply: ansa cervicalis
action: pull larynx down in 2nd phase of deglutition
Note: sternothyroid muscle is only strap muscle that

does not attach to hyoid bone
4-thyro-hyoid m.
Origin: obliqe line of thyroid cartilge
n. supply: n. to thyrohyoid ( from hypoglossal n. ) C1
action: pull larynx down in 1st phase of deglutition
68
C-Muscles of the Prevertebral Area include :
1-The prevertebral muscles
-Rectus capitis anterior
-Rectus capitis lateralis
-Longus colli ( cervicalis )
-Longus capitis
2-Scalene muscles
-anterior scalene,
-middle scalene,
- posterior scalene.
1-The prevertebral muscles
A-Rectus capitis anterior :

( very short , lies deep to longus capitis)
Origin : ant. Surface of atlas
Insertion : basilar part of occipital bone
Action : flexes head
B-Rectus capitis lateralis :

Origin : transvers process of atlas
Insertion : jugular process of occipital bone
Action : flexes head laterally
C-Longus colli ( cervicalis)

From atlas to T3
( upper oblique , middle vertical & lower oblique )
-upper oblique part :
Origin : transves process of C3,4,5
Insertion : atlas
-middle vertical part :

Origin : from bodies of C5,6,7 & T1,2,3
Insertion : to bodies of C2,3,4
69
-lower oblique part :
Origin : bodies of T2,3
Insertion : transvers process of C5,6
Actions :
-whole muscles : flex the neck
-oblique parts : flex the neck laterally
-lower oblique part : rotate neck to opposite side
D-Longus capitis :
Overlaps longus colli
Origin : transverse process of C3,4,5,6
Insertion : basilar part of occipital bone
Action : flex the head
All prevertebral muscles supplied by cervical nerves
70
2-scalene muscles
A-scalenus ant. M.:

Origin:
from ant. Tubercles of c3,4,5,6 vertebrae
Insertion: scalene tubercle of 1st rib
n. supply : c4,5,6
action: flexion of neck & elevation of 1st rib
Relations:
-ant. Relations: ( 1 n. – 2 ms. – 2 as. – 3 vs )

-phrenic n.: cross from lat. To med.
-sternomastoid m. :
-inf. Belly of omohyoid m.
-supra scapular a. & transverse cervical a.
-subclavian v.
-int. jugular v. : unite with subclavian v.
-ant. Jugular v. : crosses m. to reach post. Triangle
-post. Relations:
2nd part of subclavian a. & roots of brachial plexus
-lat. Relations:
3rd part of subclavian a. & trunks of brachial plexus
-med. Relations: = content of vertebral triangle

1st part of subclavian a. & its brs.
Thyro-cervical trunk & its brs.
Sympathetic chain & thoracic duct ( on LT. side)
B- scalenus medius m.
(largest one)
origin: post. Tubercle of all cervical vertebrae
insertion: in 1st rib behind subclavian groove
n. supply : all cervical ns.
Action: -flexion of cervical v. & fixation of 1st rib
71
C-scalenus pos. m.
(smallest one)
origin: post. Tubercle of c4,5,6 vertebrae
insertion: 2nd rib behind serrate tubercle
n. supply: c4,5,6
action: lat. Flexion of neck & fixation of 2nd rib
D-scalnus minimus:
origin: post. Tubercle of c7
insertion: supra pleural membrane
72
D-Muscles on the back of the neck
4 layers arranged from superficial to deep

1st layer : sternomastoid & trapezius
2nd layer : levator scapulea & splenius muscle
3rd layer : semispinalis capitis & longissmus capitis
4th layer : ( sub-occipital muscles )

Rectu capitis post. Major
Rectus capitis post. Minor
Superior oblique m. ( the obliqus capitis sup. )
Inferior oblique m. ( the obliqus capitis inf. )
73
1st layer :
1-STERNOMASTOID M.
Origin: by 2 heads:
Sternal head : front of manubrium sterni
Clavicular head: med. 1/3 of upper surface of clavicle
Insertion:
-lat. Surface of mastiod process
-lat. 1/3 of sup. Nuchal line
n. supply :
-spinal accessory n. ( motor)
-c2,3 ( proprioceptive)
Action:
-one m. : bend head to same side & face to opposite side
- 2 ms. : flex the neck
Relations:
-superficial relatios:
-skin
-s. fascia
( platysma, ext.jug.n , cervical ns. & superficial cervical l.ns.)
-deep fascia
-deep relations : ( 4s- 3c- 2l )

Sterno clavicular joint
Sternohyoid,sternothyroid ms.
Scalenus ant. & the structures infront it
Scalenus medius & roots of brachial plexus
Carotid sheath & its content
Ansa cervicalis & Deep cervical l.ns
Levator scapulae & roots of cervical plexus
-the ant. Border : form post. Boundary of ant. Triangle
-the post. Border : form ant. Boundary of post. Triangle
74
2-Trapezius :
Extend from the back of the skull to the back of thorax
It has 3 origins & 3 insertions
Origin :
-back of skull :
med. 1/3 of sup. Nuchal line & ext. occipital protuberance
-back of neck : from ligamentum nuchea & spine of C7
-back of thorax : from all thoracic spines & supraspinous ligs.
Insertion:
Upper fiber : ( occipital & sup. Cervical )
Into the post. Aspect of lat. 1/3 of clavicle
Middle fiber : ( lower cervical & upper thoracic )

Into the med. Border of acromion &
upper lip of the crest of the spine of scapula
Lower fiber :
into the tubercle of the crest of the spine of the scapula
n. supply :
-motor :spinal accesory n.
-sensory : ( proptioceptive ) from C3,4
Trapezius is the only muscle of the upper limb not supplied by

brachial plexus
Deep relations :
( rest of muscle of the back , artery & nerve )
Levator scapule , rhomboids , supra & infra spinatus m.
Spinal accessory n. & superficial br. Of transvers cervical a.
Action :
-upper fibers : elevate the scapula & shoulder
-Middle fibers: retract the scapula
-Lower fibers : rotate the scapula
Pulls the head backward & laterally
75
2nd layer
levator scapulea & splenius muscle
A-Levator scapulea:
Origin : from transvers process of C1,2,3,4
Insertion : dorsal aspect of med. Border of the scapula
n.supply :
C3,4 : (from cervical plexus )
n. to rhomboids C5 : (from brachial plexus)
action:
elevate the scapula & fix it
rotate the scapula dowewards
lat. Flexor of the neck
B--splenius muscle :
Origin :
Lower part of nuchal lig. & spines from C7 to T6
course :
Divided into 2 parts
Splenius capitis & splenius cervicis
Insertion :
s. capitis : to mastoid process & lat. 1/3 of sup. Nuchal line
s. cervicis : to tr. Process of C2,3
n.supply : cervical nerves

action : bends the head & neck backward
rotates the face towards its ownside
76
3rd layer
A-Semispinalis capitis
(deep to splenius capitis )
Origin : articular process C4 to C6
Transvers process of C7 , T1
Insertion : into med. Area between the sup. & inf. Nuchal lines
n.supply : cervical & thoracic nerves
B-semispinalis cervivis
( deep to semispinalis capitis )
origin : tr. Process of T1 to T6
insertion : spines of C2 to C5
n. supply : cervical & thoracic nerves
C-longissimus capitis
( lat. To semispinalis capitis )
origin : tr. Process of T1 to T5
articulate process of C5 to C7
insertion : post. Margin of mastoid process
n. supply : cervical & thoracic nerves
77
suboccipital muscles
short muscles form the boundaries of suboccipital triangle
1--rectus capitis post. Major

Origin : spine of C2
Insertion : lat. Part of area below inf. Nuchal line
n. supply : suboccipital n. ( from C1 )
action : one muscle :turn the fsce to the same side
two nuscles : extend the head
2--rectus capitis post. Minor :

Origin : post. Tubercle of C1
Insertion : med. Part of area below inf. Nuchal line
action : mainly posural & extend the head
3--obliquus capitis superioris

( sup. Oblique )
Origin : tr. Process of C1
Insertion : lat. Area between the nuchal lines
action : as R.C.P.M. & laterally head
4--obliquus capitis inferior

( inf. Oblique )
Origin : spine of C2
Insertion : tr. Process of C1
action : mainly postural & turn face to the same side
78
D. Muscles of the Larynx
-the cricothyroid, thyroarytenoid,
-posterior cricoarytenoid,lateral cricoarytenoid,
-transverse and oblique arytenoids, and vocalis.
79
Muscles of the larynx
-general rules :
They are intrensic muscles
( have no attachment outside the laryngeal cartilages)
All of them present inside the larynx except the cricothyroid
muscle
All of them supplied by recurrent laryngeal n. except the
cricothyroid which supplied by the external laryngeal n.
Muscles of larynx devided into 5 groups

according their action :
1-muscles close the laryngeal orifice
2-muscles stretch the vocal cord
3-muscles relax the vocal cord
4-muscles abduct the vocal cord
5-muscles adduct the vocal cord

-transvers arytenoids muscle
- 2 ary-epiglottic muscles

The 2 thro-arytenoid muscles -

The 2 crico thyroid muscles

The 2 post. Crico-arytenoid muscles

The single transverse arytenoid muscle
The 2 lat. Crico-arytenoid muscles
80
E-muscles of Pharyngeal
3 constrictor muscles & 3 other muscles
General rules:
-Striated muscles
-Outer circular & inner longitudinal
( that opposite the wall of remaine alimentary tract)
-Outer circular ( constrictor ms have different origin but the
same insertion)
-All supplied by pharyngeal plexus
Inf. Constrictor has additional nerve supply from recurrent &
external laryngeal nerves
Nasopharynx supply by br. Of sphenopalatine ganglion
81
Constrictor muscles of pharnyx
1--superior constrictor :
Origin: pterygomandibular lig. & 2 bones which it attached
Pterygoid hamulus & post. End of mylohyoid line of mandible
2--middle constrictor: related to pharyngeal plexus

Origin: stylohyoid lig. & 2 horns of hyoid bone
3--inf. Constrictor:
Origin: line between upper border of thyroid cartilage & lower
border of cricoid cartilage
Has additional n.supply from recurrent laryngeal n.
Insertion of 3 muscles : fibrous median raphe

Extend from : base of skull to cricoid cartilage
82
83
3 other muscles:
1-stylopharyngeus m.:
Origin: styloid process
Insertion: thyroid cartilage
n.supply : glossopharyngeal n.
action: elevate pharynx& larynx during swallowing
2-palatopharyngeus m.:
Origin: lower surface of palatine aponeurosis
n.supply: pharyngeal plexus of nerves
action : like stylopharyngeus m.
3-salpingopharyngeus m.:
Origin: inf. Surface of eustachian tube
n.supply :pharyngeal plexus of nerves
action :help to keep the eustachian tube patent
84
triangles of head & neck
A-Ant. triangle
Bounded by:
Ant : middle line of neck
Post : post. Border of sternomastoid
Above: lower border of mandible
Subdivisions :
1-digastric triangle
2-carotid triangle
3-muscular triangle
4-submental triangle
85
1-Digastric triangle
-boundaries:
Above: lower border of mandible
Below & infront: ant. Belly of digastric
Below & behind : post. Belly of digastric
Roof: mylohyoid & hyoglossus ms.
Floor: skin, superficial & deep fascia
Content:
Submandibular ( gland , L.Ns & ganglion)
Facial a. & common facial v.
Hypoglossal n. & n. to mylohyoid
2-Carotid triangle
Boundaries:
Above: post. Belly of digastric
Below: sup. Belly of omohyoid
Behind: ant. Border of sternomastoid
Floor:
Ant: hyoglossus ms. & thyrohyoid
Post: middle & inf. Constrictor ms. Of pharynx
Roof:
Skin & superficial fascia
Contents: ( 3 as. – 6 ns. – 3 vs. )
-3 carotid arteries ( C.C.A. –I.C.A. – E.C.A. )

-3 last cranial ns.( 10 , 11 , 12 )
-3 small ns.(descendens hypoglossi & cervicalis –n. to
thyrohyoid m.)
-3 tributaries of I.J.V.(common facial –lingual-sup. Thyroid)
-Sympathetic chain
-Deep cervical L.Ns.
86
3-Muscular triangle
Boundaries:
Infront:middle line of neck
Behind &above: sup. Belly of omohyoid
Behind & below: ant. Border of sternomastoid
Content: infra-hyoid ms.
4-Submental triangle
Boundaries:
Base: hyoid bone
On each side : ant. Belly of digastric m.
Apex: symphysis menti
Floor: skin , superficial & deep fascia
Roof: mylohyoid m.
Content:
Submental (L.Ns. & vessels )
Beginning of ant.jugular veins
87
B-Post. triangle
Boundaries:
Infront:post. Border of sternomastoid m.
Behind: ant. Border of trapezius m.
Above (apex): meeting of 2 ms.
Below: middle 1/3 of clavicle
Floor: 3 ms (s-l-s) coverd by prevertebral fascia

Scalnus medius
Levator scapulae
Spleniuscapitis
Roof:
Skin , superficial & deep fascia
Superfiscial fascia contain: platysma , cut. Brs. Of cervical
plexus & E.J.V
88
Conte
nt: 1*2*2*3*4
1 m. : inf. Belly of omohyoid
2 vs. : subclavian v. – E.J.V.
2 L.Ns : occipital & suprsclavicular L.Ns.
3 ns. : spinal accessory n. – cervical & brachial plexus
4 as. : 3rd part of subclavian a. – 3rd part of occipital a.-
suprascapular a. –transverse cervical a. –
89
Muscle :
-inf. Belly of omohyoid :
Divides triangle into 2 triangle :
Small: supraclavicular triangle
Large : occipial triangle
Arteries:
-3rd part of subclavian a. :
From scalenus ant. To 1st rib & continuse as axillary a.
-suprascapular a. :
from thyrocervical trunk Share in anastomosis around scapula
-transverse cervical a. :
from thyrocervical trunk
Dividing into 2 brs. :
Superficial br. : deep to surface of trapezius m.
Deep br. : deep to levator scapulae to share in
anastomosis around scapula
-3rd part of occipital a. at apex of triangle
Veins:
-subclavian v. :
from 1st rib to med. End of clavicle
To join with I.J.V. to form innominate v.
Has only tributary : E.J.V.
-Ext.Jugular v. :
open in subclavian v.
Tributaries : ant. jugular v. – tr. cervical v. – suprascapular v.
90
Nerves:
-spinal accessory n. :
supply trapezius & sternomastoid ms
-brachial plexus : only roots & trunks between 2 scalene ms.
Upper trunk give 2 brs. In triangle :
suprascapular n. & n. to subclavius m.
-cervical plexus: 4 cutaneous brs.

Lesser occipital n. c2
Great auricular n. c2,3
Tr. Cervical n. c2,3
Supraclavicular n. c4,5
Lymph nodes:
-occipital L.Ns at the apex of triangle on occipital a.
-supraclavicular L.Ns at the base of triangle on subclavian a.
91
C-Sub occipital triangle
Boundaries:
Med.: rectus capitis post. Major & minor
Above & lat. : obliquus capitis sup.
Below & lat. : obliquus capitis inf.
Roof: semispinalis capitis m.

Floor: post. Arch of atlas
Post. Atlanto-occipital membrane
Contents:
3rd part of vertebral a.
Suboccipital venous plexus
Suboccipital n.
Greater occipital n.
Small occipital L.Ns.
92
Fascia of the neck
93
1- superficial fascia :
Contain :
platysma m.
cutaneous branches of cervical plexus
superficial veins
2- deep fascia :
Devided into :
Pretracheal fascia
Carotid sheath
Prevertebral fascia
Investing deep fascia
Parotid fascia
Pharyngo-basilar fascia
Bucco-pharyngeal fascia
Supra pleural membrane
Ligamentum nuchea
94
95
superficial fascia
1- platysma muscle :
Origin : from the deep fascia covering the pectoralis major &
deltiod muscle
Insertion : into the lower border of mandible
n. supply : cervical br. Of facial n.
action : wrinkles the skin of the neck
help to depress the mandible
2-cutaneouse branches of cervical nerves

1-the great auricular nerve ( C2,3)
2-the lesser occipital nerve ( C2)
3-the transvers ( anterior ) cutaneouse nerve of the neck ( C2,3)
4-the supraclavicular nerve ( C3,4 )
scheme :
-all of them appear at the middle of post. Border of
sternomastoid muscle
-The great auricular n.
run upward toward the angle of mandible
Supply : the skin of lower 1/2 of outer & inner surface of the
auricle
- lesser occipital n.:

run upward to ward the mastoid process
Supply : the skin of upper 1/2 of inner surface of the auricle
-The transvers nerve :

run transvers superficial to the sternomastoid & deep to the ext.
jugular vein
Supply : the skin of ant. Triangle
-The supraclavicular n.:

run down ward superficial to the clavicle
Divided into 3 branches ( med. , intermediate & lat. )
Supply : the skin of post. Triangle
the skin of chest to the sternal angle ( 2nd rib )
96
3-Superficial veins :
The external jugular vein-A
The anterior jugular vein-B
A-External jugular vein

Begins:
at angle of mandible
by union of post. Auricular v. & post. Division of
retromandibular v.
course & relations:

descends superficial to sternomastoid m. pierce deep fascia (to
keep it patent) infront of brachial plexus
ends: in subclavian v.
tributaries:
PAST:
Posterior external jugular vein
Anterior jugular vein
Suprascapular vein
Transverse cervical vein
B-anterior jugular vein

begins:
near hyoid bone by small veins
course & relations:

descends in superficial fascia in midline
above sternum pierces deep fascia between sternomastoid m. &
scalenus ant. M. to reach post. Triangle
ends: in ext. jugular vein

- RT & LT. ant. Jugular veins connected by transverse vein just
above the sternum called jugular arch
97
98
Deep fascia of the neck
The neck consists essentially of five blocks of tissue running
longitudinally
These are as follows:
-1 The cervical vertebrae :

surrounded by a number of muscles and enclosed in a dense
layer of prevertebral fascia.
-2 The pharynx and larynx:

partially enclosed in a thin layer of pretracheal fascia.
Below the level of C6 these give way to the oesophagus and
trachea.
3 & 4 -Two vascular packets :

consisting of the common and internal carotid arteries, the
internal jugular vein and the vagus nerve, all enclosed in the
fascial carotid sheath.
5- An outer enclosing sheath :

consisting of the sternomastoid and trapezius and the investing
layer of deep fascia of the neck.
99
1-prevertebral fascia
Site : infront of the prevertebral muscles
Attachments :
Above : the base of the skull
Laterally : cover the scalene muscles & the muscles in the floor
of post. Triangle
Below : to the level of 3rd thoracic vertebra
continues into mediastinum; forms 2 structures
i. Suprapleural membrane (Sibson’s fascia): scalene muscle
fascia covering cervical pleura
ii. Axillary sheath: scalene fascia covering axillary vessels and
brachial plexus as
they pass through interscalene triangle
Relations :
Superficial :
Subclavian vein , E.J.V.
Acessory n.
Deep :
Cervical & brachial plexus
Structures deep to the prevertebral fascia

• The upper, middle and lower trunks of the brachial plexus
which emerge between the scalenus anterior and the scalenus
medius, the lower trunk resting on the 1st rib.
• The supraclavicular branches of the brachial plexus
100
101
2- pretracheal fascia
Site : deep to the infra-hyoid muscles
Attachments :
Above: to hyoid bone & thyroid cartilage
Split to enclose the thyroid gland (forming false or
surgical capsule)
Below : into the thorax blend to the fibrous pericardium
On each side : continuous lat. To the carotid sheath as
buccopharyngeal fascia
Suspensory ligaments of thyroid gland:
from upper inner part of thyroid gland to
cricoid cartilage, anchoring gland to larynx;
must be cut before thyroid gland can be properly mobilized
102
3-carotid sheath :
Site : deep to the sternomastoid muscle
Attachments :
Above : the base of the skull around the carotid & jugular
foramens
Below : it blend with the advantitia of arch of aorta
Anreriorly : continuous with the pretracheal fascia
Posteriorly : continuous with the prevertebral fascia
Content :
In the upper part ( above the post. Belly of digastric)
-I.C.A. anteromedially
- I.J.V. posteriolaterally
- the lower 4 cranial nerves in between
In the lower part ( below the post. Belly of digastric)

- C.C.A. anteromedially
- I.J.V. posterolaterally
- vagus nerve inbetween
The sympathatic chain embedded in the post. Wall

The limbs of ansa cervicalis embeded in the ant. Wall
The carotid sheath is thick over the artery & thin over the vein to
allow its distension
Relations :
Superficial :
Skin , superficial fascia , deep fascia
All through :Sternomastoid , post. Belly of digastric m.
In the lower part :Infrahyoid muscles-
In the upper part : Styloid apparatus & parotid gland -
Deep :
-Tr. Process of cervical vertebrea
Prevertebral muscles ( longus coli & longus capitis )-
-Lat. Vertebral muscles ( levator scapule & scalene muscles )
-Cervical plexus of nerves
103
4-General investing deep fascia
-it surround the neck
Form the roof of ant. & post. Triangles
Splis to enclose sternomastoid & trapezius muscles
Attachments :
Above :
-the lower border of mandible
Split to enclose the parotid ( to form its fascia )
-Inf. Border of the external auditory meatus
-Sup.nuchal line
-Ext. occipital protuberance
Below :
To manubrium , clavicle,acromion & spine of scapula
Anteriorlly : to hyoid bone & thyroid cartilage
Posteriorlly : th the nuchal line
104
5-Parotid fascia :
-Derived from the general investing deep fascia
Splits at the lower end of parotid into superficial & deep
-the superficial layer :attached to the zygomatic arch
-The deep layer :
-attached to mastoid & styloid processes
-Form the stylomandibular lig. Which extend from the styloid
process to the angle of mandible
105
6-Pharyngo basilar fascia
- it connecting the muscular wall of pharynx to the base of the
skull
- it keep the nasopharynx always patent for breathing
7-Bucco-pharyngeal fascia
It cover the outer surface of buccinator muscle & the outer
surface of constrictor muscles of pharynx
Attached superiorly to pharyngeal tubercle and medial
pterygoid plates
8-Supra-pleural membrane
(Sibson’s fascia):
It fan shaped fascia cover the apex of the lung
Attachments :
Apex : attached to the tr. Process of the 7th cervical vertebra
Base : attached to the inner border of 1st rib
9-Ligamentum nuchae :
It represent the upward continuation of the supraspinous & the
infraspinous ligaments
Attachments :
apex ( below ) : attached to the spine of C7
base ( above ) : attached to the ext. occipital protuberance &
crest
ant. Border : to all cervical spines
post. Border : is free
106
107
Clinical Considerations of the neck fascia
A. Infection between superficial layer of deep cervical fascia

and infrahyoid fascia:
infection will usually stop at superior edge of sternum and
clavicle
B. Infection between infrahyoid fascia and pretracheal fascia:

can spread into thoracic cavity to position anterior to
pericardium
C. Infection deep to pretracheal fascia:

can follow trachea and esophagus to thoracic cavity and
terminate in posterior mediastinum
D. Infection in retropharyngeal space:

can spread into thoracic cavity into mediastinum in plane
anterior to vertebral column and posterior to esophagus
108
Blood supply of H & N
Blood supply of the scalp

Arterial supply of the scalp
10 arteries ( 5 on each side )
3 infront of the auricle & 2 behind the auricle
A- Arteries in front of the auricle :

1-supratrochlear a. : inside orbit
From ophthalmic a. run with its nerve
Supply the forehead & scalp
2-supraorbital a. : inside orbit

From ophthalmic a. run with its nerve
Supply the forehead & ant. Part of scalp
3-superficial temporal a. : inside the parotid gland

One of two terminal branches of ext. carotid a.
Branches : transverse facial a.
Zygomatico-orbital a.
Middle temporal a,
Ends by 2 branches :
Ant.frontal br.
Post. Parietal br.
Supply the scalp
109
B- Arteries behind the auricle :
1-post. Auricular a. :
from the back of ext.carotid a.
branches : stylomastoid br. ( enters the stylomastoid f.)
auricular br.
Occipital br.
2-Occipital a. :
From the back of ext.carotid a.
Supplay the back of the scalp
110
VEINS OF THE SCALP
5 veins drain the scalp on each side
They accompany the corresponding arteries
1- supra-trochlear v.
2- supra-orbital v. unite to form the ant.facial v.
3-superfacial temporal v. : inside the parotid gland

Unite with the maxillary v. to form retro-mandibular v.
(post.facial v.)
4-post auricular v. :
Unites with the post. Division of the retro-mandibular v.
To form the external jugular vein
5-occipital v. :
Ends in : - suboccipital plexus of veins
or – internal jugular v.
-it connected to the sup.sagital sinus by parietal emissary f.
Or to sigmoid sinus by mastoid emissary f.
111
Blood supply of the face
112
Arterial supply of the face
1-facial a.:
Origin:from ext.carotid a.
Course & relations in face:
Enter face at lower border of mandible
antro-inf-angle of masseter m. & superfacial to buccinator m.
infront of ant.facial v.
end:at the medial angle of th eye to become angular a.
branches:
-inf. Labial a.
-sup. Labial a.
-nasal a.
2-ophthalmic a.:
-supra-trochlear a.
-supra-orbital a.
3-maxillary a.:
-infra-orbital a.
- Mental a. from (inf. Alveolar a.)
B-post.set of arteries:
- Superfacial temporal a.:
-transverse facial a.(inside parotid gland)
-zygomatico-orbital a.(after leave gland)
113
Venouse drainage of the face
By:
1-ant. Facial vein
2-post. Facial vein(retromandibular vein)
1. The facial vein (no valves) :

provides the major venous drainage of the face and drains into
the internal jugular vein.
-The facial vein makes clinically important connections with the

cavernous sinus via the superior ophthalmic vein, inferior
ophthalmic vein, and pterygoid plexus of veins.
-This connection with the cavernous sinus provides a potential

route of infection from the superficial face
(“danger zone of the face”) to the dural venous sinuses within
the cranium.
2. Diploic Veins (no valves) :

run within the flat bones of the skull.
3. Emissary Veins (no valves) :

form an anastomosis between the superficial veins on the
outside of the skull and the dural venous sinuses.
114
1-Ant. Facial vein:
Begins: at the med. Angle of the eye
Union of supra-orbital & supra-trochlear veins
Run downward behind facial a.
Ends: by uniting with ant. Division of retromandibular vein to
form common facial vein which end in int. jugular vein
Tributaries:
1-supra-orbital & supra-trochlear veins
2-deep facial vein: connect ant. Facial vein with the
pterygoid plexus of veins
2-Post. Facial vein (retromandibular vein)

Begins: inside parotid gland (deep to facial n.) by union of
Maxillary v. & superficial temporal v.
Ends by two divisions:
1-ant. Division: joins ant. Facial v. to form common facial v.
2-post. Division: joins post. Auricular v. to form ext.jugular v.
115
Arteries of head & neck
1-SUBCLAVIAN ARTERY
Origin:
LT. subclavian : from arch of aorta
RT. Subclavian : from the innominate a.
Termination: at outer border of 1st rib as axillary a.
Course & relations:

-the artery in dividing by the scalenus ant. M. into 3 parts:
1st part : med. To scalenus ant.
2nd part: behind to scalenus ant.
3rd part : lat. To scalenus ant.
Relations of 1st part:

-ant. Relations: ( 3*3*3*3*3)
3 superficial structures : skin , superficial & deep fascia
3 ms. : sternomastoid , sternohyoid , sternothyroid
3 ns : vagus , symp.chain , ansa subclavia
3 vessels : C.C.A. , I.J.V. , vertebral v.
-other 3 structures related to LT. subclavian a.
LT.phrenic n. , LT. innominate v. , thoracic duct
-post. Relations: 3 structures

Apex of lung , cervical pleura , supra pleural membrane
Relations of 2nd part :

-Ant. Relations : 4s
Sternomastoid m.
Subclavian v.
Scalenus ant.
116
-Post. Relations: the same of 1st part
Relations of 3rd part: 4s

-ant. Relations :
Subclavius m. & subclavian v.
-post. Relations:
1st rib & lower trunk of brachial plexus
Branches:
1st part : 3 brs.
Vertebral a. – thyrocervical trunk – internal mammary a.
2nd part: 1 br.

Costo cervical trunk
3rd part : has no brs.
Surface anatomy:
Covex upward (one finger) line from sternoclavicular joint to
mid clavicular point
117
VERTEBRAL ARTERY
Origin : 1st part of subclavian a
Course & relations : the artery divided into 4 parts
1st part:
From its origin to tr. Procsee of c6
In vertebral triangle pass between longus colli m. (med.)
& scalenus ant. (lat)
Ant. Relations:
C.C.A - inf. Thyroid a. – thoracic duct – vertebral v.
Post. Relations:
Inf. Cervical symp. Ganglion – 7th & 8th cranial ns.
-2nd part: in tr. Foramina of upper 6 cervical vertebrae

Relations:
Nerves from c2 to c6
Symp. Plexus &plexus of veins
-3rd part: in suboccipital triangle

Pass in groove of upper surface of atlas
Relations: ant & post 1ry rami of c1
4th part :
Enter cranial cavity through f.magnum
Relations: on side of medulla in front root of hypoglossal n.
Ends:
At lower border of pons by join with other one to form basilar a.
Branches:
In the neck:
Spinal brs. : to supply spinal cord
Muscular brs. : to supply deep ms. Of neck
In the cranial cavity:

Ant & post. Spinal as.
Medullary brs.
Post. Inf. Cerebellar a.
118
INTERNAL MAMMARY ARTERY
Origin: 1st part of subclavian a.
Course & relations :

Descends behind the upper 6 costal cartilages
Ends:
Opposite the 6th intercostal space by 2 terminal brs.
Branches: (3p + 2 terminal brs).

Pericardiaco-phrenic a. : with phrenic n.
Pair of ant. Intercostal as.
Perforating as. : to supply skin & breast
Sup.epigastric ( enter the rectus sheath)
Musculophrenic ( along costal margin)
119
THYROCERVICAL TRUNK
Origin: 1st part of subclavian a.
Very short & dividing into 3 brs.:
1-inf. Thyroid a. 2–suprascapular a. 3–transverse cervical a.
1-Inf. Thyroid a.
Course &relations:
Run on med. Border of scalnus ant. & curve to reach the post.
Surface of thyroid gland with recurrent laryngeal n.
Branches:
Ascending cervical a.: to m.m & spinal cord
Muscular brs.: to infra hyoid , scalenus ant & longus colli m.
Inf. Laryngeal a.: with recurrent laryngeal n.
Pharyngeal brs.
Oesophageal & tracheal brs.
Terminal glandular brs.: to thyroid gland
2-Suprascapular a.
Run lat. To reach the post. Triangle
& downwards with suprascapular n.
Share in anastomosis around scapula
3-Transverse cervical a.
Dividing into 2 brs. :
Superficial br. : deep to surface of trapezius m.
Deep br. : deep to levator scapulae to share in
anastomosis around scapula
120
COSTO-CERVICAL TRUNK
Origin: 2nd part of subclavian a.
-ends in the neck of 1st rib bt dividing into:
1-sup-intercostal a.: which divides into 1st & 2nd post.
Intercostal as.
2-deep cervical a.:
Ascend in neck to reach the suboccipital triangle to
anastomosis with descending br. Of occipital a.
Carotid sheath contents

“I See 10 CC’s in the IV”:
I See (I.C.) = Internal Carotid artery
10 = CN 10 (Vagus nerve)
CC = Common Carotid artery
IV = Internal Jugular Vein
COMMON CAROTID ARTERY

Origin:
LT. CCA : from aortic arch
121
RT. CCA : from innominate a.
Course:
Inside carotid sheath ( with IJV & vagus n.)
Overlapped by sternomastoid m.
Ends: upper border of thyroid cartilage between c3,4

Dividing into 2 brs: ECA & ICA
Relations:
-superficial relations: (3*3*3)
3 superficial layers: skin , superficial & deep fascia
3 sterno ms.: sterno hyoid – sternothyroid – sternomastoid ms.
3 thyroid strustures:
Middle & sup. Thyroid vs.
Sup. Belly of omohyoid
-post. Relations: ( 2T + VIP)

Tr. Process of Lower 4 cervical vertebrae
Thoracic duct
Vertebral a.
Inf. thyroid a.
Prevertebral ms.
Symp. Chain
Med. Relations:
Trachea & oesophagus below
Larynx & pharynx above
Lat. Relations:
IJV & vagus n.
INTERNAL CAROTID ARTERY

Begins: upper border of thyroid cartilage between c3,4
Ends: in cranial cavity lat. To optic chiasma by 2 terminal brs.
122
-ant. & middle cerebral as.
Course: 4 parts
-cervical part: in carotid sheath
-intrapetrous part: in carotid canal
-intracavernouse part: in cavernous sinus
-intra cranial part: in cranial cavity
Cervical part
Relations:
Ant. Lat. Relations:( 2 ms. – 2 vs. – 2 ns.)
=superficial relations of ECA
Sternomastoid m.
Post. Belly of digastric m.
Ligual v. & common facial v.
Hypoglossal n. & descendes hypoglossi
ECA & the following structures:=deep relations of ECA
Styloid process & muscle attached
Glossopharyngeus n.
Vagus n. ( pharyngeal br.)
Part of parotid gland
Post. Relations:
Longus capitis m.
IJV & 9,10,11 cranial ns.
Sup.cervical symp. Ganglion
Lat. Relations:
IJV & vagus n.
Med. Relations: wall of pharynx
Branches: has no brs in the neck
Intrapetrous part
Course:
Carotid canal & reach cranial cavity via f. lacerum
123
Relations:
Infront of Middle & internal ear cavities
Surrounded by 2 plexuses ( venouse plexus & plexus of symp.
Fibers)
Branches:
-carotico-tympanic as. To middle ear
Br. To the pterygoid canal
Intracavernous part
Course:
Pierce post. Wall of cavernous sinus. Then curve upwards to
pierce the roof of sinus
Relations:
Med.:body of sphenoid & pituitary gland
Lat. : 3th, 4th, 5th ,6th cranial nerves
Antrosuperiorly: optic n.
Branches:
Sup. & inf. Hypophyseal as. To pitutary gland
Meningeal brs. To meninges of ant. Cranial fossa
Intracranial part
Course & relations:
After leave sinus it run upward above sinus & below optic n. till
reach the ant. Perforated subestance
Branches:
Ophthalmic a.
Ant. Choroid a.
Post. Communicating a.
Ant. & middle cerebral as.
Ophthalmic artery
Origin: from I.C.A. after leave cavernouse sinus
124
Course & relations:
Enter orbit through optic canal (below optic n.)
Passes from lat. To med. Ascpect of optic n. in med. Wall of
orbit
Termination: deviding :
Supratrochlear & dorsal nasal
Branches:
-central a. to retina : run inside optic n. ( only supply of
retina)
-lacrimal a.: run with lacrimal a. to lacrimal gland
-ant. & post. Ethmoidal as.
-ant. & post. Ciliary as, : to eye ball
-Supraorbital & supratrochlear as.
-muscular & palpebral brs. : to extraocular ms.
-Dorsal nasal a.:to dorsum of nose
External carotid artery

Origin:
one of 2 terminal brs. Of CCA at c3,4
125
Ends:
behind neck of mandible inside parotid gland bt dividind into
2 terminal brs. (supficial temporal a. & maxillary a.)
Course:
Ascend outside the sheath deep to post. Belly of digastric m.
Enter parotid gland from post. Med. Surface to become the
deepest structure inside gland
Relations:
Superficial relations:
below post. Belly of digastris m.
=ant. Relations of cervical part of ICA

( 2 ms. – 2 vs. – 2 ns.)
Sternomastoid m.
Ligual v. & common facial v.
Hypoglossal n. & descendes hypoglossi
Above post. Belly of digastris m..

Retromandibular v. & facial n.
Deep relations:
Lower part: wall of pharnx
Upper part:= structures between ECA & ICA :
Styloid process & muscle attached
Glossopharyngeus n.
Vagus n. ( pharyngeal br.)
Part of parotid gland
Branches: from blow to above

Some american ladies found our pyramids more satisfide
126
Some = sup. Thyroid a.
American = ascending pharyngeal a.
Ladies = lingual a.
Found = facial a.
Our = occipital a.
Pyramids = post. Auricular a.
More = maxillary a.
Satisfide = superficial temporal a.
1-sup. Thyroid a.
Origin:
from ant. Aspect of ECA
127
Course & relations:
Run deep to infrahyoid ms. With sup.thyroid v.
Enter apex of thyroid gland with ext. laryngeal n.
Branches
"May I Softly Squeeze Charlie's Girl?":
Muscular
Infrahyoid
Superior laryngeal
Sternomastoid
Cricothyroid
Glandular
Supply : upper 1/3 of lat.lobe & upper 1/2 of isthms
2-lingual a.
Origin:
From ant. Aspect of ECA
128
Course & relations
divided by hyoglossus m. into 3 parts
1st part : till post. Border of hyoglossus m.
2nd part: deep to hyoglossus m.
3rd part: ant. Border of hyoglossus m. & crossed by 3 :
-lingual n. –hypoglossal n. –submandibular duct
Ends:
to become deep (profunda) a. to tongue
Breanches:
1st part: gives supra hyoid a.
2nd part : gives 2 dorsalis lingulae as.
3rd part: gives sublingual a.
3-facial a.
Origin:
from ant. Aspect of ECA
129
Course & relations:
Ascend deep to : ( muscle – bone – muscle )
-post. Belly of digastric
-angle of mandible
-stylohyoid m.
Make deep groove of submandibular gland
Then run to pass between mandible & gland
Then curve around lower border of mandible to pierces deep
fascia
Branches:
In the neck:(Tom study gross anatomy)
Tonsillar brs. : to tonsil
Glandular brs. : to submandibular gland
Submental a.
Ascending palatine a. : to soft palat
In the face:
Sup. Labial a.
Inf. Labial a.
Nasal a.
Angular a.
4-occipital a.
Origin: from back of ECA
Course : has 4 parts
130
1st: deep to post. Belly of digastric m.
2nd: med. To mastoid process
3rd : cross apex of post. Triangle
4th :pierces trapezius m.
Branches:
-Mastoid br. : through mastoid f.
-Descending br.: in ms. In back & join with deep cervical a.
-Terminal occipital brs.:
5-post. Auricular a.
Origin: from post aspect of ECA
Course: run on upper border of post. Belly of digastric m.
Branches:
-Stylomastoid br.: enter stylomastoid f.
-Terminal brs. To scalp
6-ascending pharyngeal a.
Origin:med. Aspect of ECA
Course: ascend on side the pharnx till the skull
Branches:
-Pharyngeal brs. : to wall of pharynx
-Tonsillar brs. : to tonsil
-Inf. Tympanic a. : to middle ear
7-superficial temporal a.
Origin: inside parotid gland as one of 2 terminal brs of ECA
Course: emerges from upper pole of gland
Its vein infront of it & auriculotemporal a. behind it
Ascend for 5 cm to divided into ant. & post. Terminal bes.
Branches:
-Glandular -, Transvers facial a.,- Zygomatico orbital a.
-Ant. Auricular a. -,Middle temporal a.
-Terminal br.
8-Maxillary artery
Origin: in parotid gland as large of 2 terminal brs. Of
ext.carotid. a.
131
divided into 3 parts
1- 1st part : between ( neck of mandible & sphenomandibular
ligament
2- 2nd part : between ( lat.pterygoid m. & temporalis m.)
3- 3rd part : between 2 head of lat. Pterygoid m.
each part give 5 branches
Ends : as infra-obital a.
Pass through infra-orbital (fissure,groove,canal)
Reach face through infra-orbital f.
Branches:
1- from 1st part : ( M-I-A-D-A)
Passing through foramina
132
-Middle meningeal a.:
pass from f.spinosum
Supply : dura mater & trigeminal ganglion
-Inf. Alveolar a. : through mandibular f.

Give : mylohyoid a. befor foramen
Dividing opposite 3rd molar into 2 brs.
1-mental br. To chin
2-incisor br. To lower jaw
-Accessory meningeal a. : through f. oval

Supply dura mater
-Deep auricular a. : through ext. auditory meatus

Supply E.A.M. & outer layer of ear drum
-Anterior tympanic a. : through squamotympanic fissure
133
134
2-from 2nd part : ( muscular brs.)
-masseteric a.
-deep temporal a.
-a. to med. Pterygoid
-a. to lat. Pterygoid
-buccal a.
3- from 3rd part :

-post. Sup. Dental (alveolar ) a.
Supply : molar & permolar teeth
-greater palatine a.: to hard palate

-lesser palatine as. : to soft palat & tonsil
-sphenopalatine a. :
-pterygoid canal a. : to nasopharynx
4-from inf.alveolar a.:

-orbital brs. : to orbit
-ant. Sup. Dental a. : to canine & incisor teeth
- 3 terminal brs in face : palpebral,nasal,labial
135
Veins of head & neck
External jugular vein
Begins:
at angle of mandible
by union of post. Auricular v. & post. Division of
retromandibular v.
course & relations:
descends superficial to sternomastoid m. pierce deep fascia (to
keep it patent) infront of brachial plexus
ends: in subclavian v.
tributaries:
PAST:
Posterior external jugular vein
Anterior jugular vein
Suprascapular vein
Transverse cervical vein
136
137
anterior jugular vein
begins:
near hyoid bone by small veins
course & relations:
descends in superficial fascia in midline
above sternum pierces deep fascia between sternomastoid m.
& scalenus ant. M. to reach post. Triangle
ends: in ext. jugular vein
- RT & LT. ant. Jugular veins connected by transverse vein just
above the sternum called jugular arch
Internal jugular vein

Begins: in jugular f. as continuation of sigmoid venous sinus
Course:
Descends inside carotid sheath lat. To CCA & ICA
Undercover sternomastoid m.
Has sup.bulb lodged in jugular fossa
& inf. Bulb 1 cm above clavicle & has 2 valves above it
RT. IJV usually larger than LT. IJV
Ends: join with subclavian v. to form innominate v.
138
Relations:
-superficial relations: ( 4s – 2p -2d )
Sternomastoid m.
Styloid process & structures attached
Spinal root of accessory n.
Descends cervicalis n.
Deep cervical L.Ns
Posteromed. Surface of parotid gland
Infra hyoid ms.
139
Antro-medial relations:
Upper: ICA & last 4 cranial ns.
Lower: CCA & vagus n.
Pos. relations: from above downwards ( LR S3 )

Rectus capitis latralis m.
Levator scapulae m.
Scalenus medius & cervical plexus
Scalenus ant. & phrenic n.
Subclavian a. (1st part) & its branches
Tributaries:
"Medical Schools Let Confident People In":
· From inferior to superior:
Middle thyroid
Superior thyroid
Lingual
Common facial
Pharyngeal
Inferior petrosal sinus
Subclavian vein
Begins: at outer border of 1st rib
As continuation of axillart vein
Ends: join with IJV to form innominate v.
Relations:
Ant. Relations: Clavicle & subclavius m
Post. Sup. Relations: scalenus ant. & phrenic n.
Subclavian a.
Inf. Relations : 1st rib & cervical plexus
Tributaries: only Ext.Jugular v.
140
Vertebral vein
Beginning : it begins in the suboccipital triangle
-It descend in the form of plexus of veins around the 2nd part
of vertebral artery
-It run in the foramen transversum of upper 6 cervical
vertebrea
-emerge from foramen transversum of C6 as a single vein
infront of the 1st part of vertebral a. in the vertebral triangle
Termination : end by open in the corresponding innominate v.

Communications :
-with sigmoid sinus ( via the post. Condylar emissary vein)
-with occipital veins
-with internal vertebral venous plexus ( inside vertebral canal)
Pterygoid plexus of veins

Site:
around & inside subestance of la. Pterygoid m.
Formations : veins accompanying brs. Of maxillary a.
Drainage:
In Maxillary v. which uniting with superficial temporal v. to
form retromandibular v. ( post. Facial v.)
Communications:
Ant. Facial v. by deep facial v.
Cavernous sinus via emissary vs.
Inf. Ophthalmic v.
Clinical importance: infection in pterygoid plexus may reach

cranial cavity causing cavernous sinus thrombosis
141
Emissary veins
Def. : veins which connect the dural venous sinuses ( inside the
skull ) with the veins outside the skull
Characters :
- they are valveless ( blood flows in both directions )
-they pass through the foramina & fissure of the skull
Function : they serve to equalize the venous blood pressure

between the intra cranial venous sinuses & the extra cranial
nerves
Most important emissary veins are :

- parital emissary v. : passes through the parital emissary f.
It connect the sup. Sagittal sinus with the occipital v.
-mastoid emissary v. : passes through the mastoid emissary f.

It connect the sigmoid sinus with the occipital v.
-emissary v. passes through f. ovale :

It connect the pterygoid plexus of veins with the cavernous
sinus
-emissary v. passes through the post. Condylar f. :

It connect the sigmoid sinus with the suboccipital plexus of
veins
-the sup. Ophthalmic vein

Connect the ant. Facial vein with the cavernous sinus
It considered the longest emissary vein
Clinical importance :
It may transmit infection from outside the skull to the dural
sinus
142
Diploic veins
Def. : these are thin walled valvless veins liying in the dipole of
the skull bone
Communications : with
the meningeal veins & the dural venous sinus
Distribution:
( frontal , temporal & occipital diploic veins) as follow :
1-frontal diploic v. :
run in frontal bone near the middle line
It emerge the supraorbital notch to open into the supraorbital
veiv
2-temporal deploic vein : ( ant. & post. )

The ant. V. : descend in frontal bone to open into the
sphenoparital sinus
The post. V. : descend in parietal bone to open into the
transvers sinus
3-occipital deploic v. : ( largest deploic veins )

Descend in the occipital bone to open into the transvers sinus
143
Nerve supply of head & neck
Nerve supply of the scalp
20 nerves (10 on each side)
5 infront the auricle (4 sensory &1 motor)
5 behind the auricle (4 sensory &1 motor)
A- the 5 nerves infront the auricle:

-sensory :
1- Supra-trochlear n.
2-Supra-orbital n.
from ophthalmic n
Supply skin of forehead & scalp
3-zygomatico-temporal n.:
From zygomatic br. Of maxillary n.
Supply ant.part of temple
4-Auriculo-temporal n.:
From post. Division of mandiular n.
Supply:
-post. 1/2 of temporal
-upper 1/2 of outer surface of auricle
-ant. Part of ext.auditory meatus & ear drum
Motor:
5-temporal br. Of facial n. : inside parotid gland
Supply:
a-frontal belly of occioito-frontalis m.
b-upper part of orbicularis occuli m.
c-auricularis ant. & sup. Muscles
144
145
B- the 5 nerves behind the auricle :
-sensory ( from cervical nerves)
1-great auricular n.(c2,3)

Supplies: -small area of skin behind the auricle
-skin of lowre 1/2 of auricle (outer & inner surfaces)
-skin over parotid gland & angle of mandible
2-lesser occipital n.(c2)
Supplies: -skin of upper 1/2 of inner surface of auricle
3-greater occipital n. (c2)
The thickest cutaneous n. in the body
Supply: back of the scalp
4-third occipital n.(c3)

Supply: skin over the ext. occipital protuberance
-upper part of back of neck
Motor:
5-post.auricular br. Of facial n.
Supply:-occipital belly of occipito frontalis m.
-the auricularis post m.
146
Nerve supply of the face
Nerve supply of the face
Motor: facial n.
Sensory: -trigeminal n. (supply most of the skin)
-great auricular n.(c2,3): angle of mandible
147
Motor supply: from facial n.
A-facial n.:
It is 7th cranial & gives 7 motor brs.
Course:
-leaves skull through stylomastoid f.
-then pierces the postero-medial surface of parotid gland
-end in the gland by dividing into 5 brs.
Branches:
-2 brs Before parotid:
1-post. Auricular n.
Supply:-ocipital belly of occipito-frontalis ms.
-the auricularis post. Ms.
2-n. to post. Belly of digastric m.
& stylohyoid m.
-5 brs Inside parotid:

1-temporal br.
Supply:-frontal belly of occipito-frontalis m
-the auricularis ant. & sup.
2-zygomatic br.
a-upper: to orbicularis occuli m
b-lower: to ms. Of nose
3-buccal br.
Supply: -buccinator & orbiularis oris ms.
4-mandibular br. To ms. Of lower lip

5-cervical br. : to platysma m.
148
Sensory supply: from trigeminal n.& great auricular n.(c2,3)
Branches( ophthalmic,maxillary,mandibular)
B-ophthalmic n.:
Branches(lacrimal , frontal , nasociliary)
-lacrimal n.: (palpebral br.) to lat. Part of eye lide
-frontal n. :
-supra-orbital n. & supra-trochlear n.
To : medial part of upper eye lid & skin of forehead
-Nasociliary n.:
-infra-trochlear n.:to skin of bony part of nose
-Ext. nasal n. : to cartilagenous part of nose
C- Maxillary n
Branches:
a-zygomatico-temporal n.
b-zygomatico-facial n.
c-infra-orbital n.: to skin over lower eye lid ,side of nose &
upper lip
D-Mandibular n. :
Post. Division:
1-auriculo-temporal n.:
Supply: upper part of auricle & ant. Part of ext.auditory meatus
2-mental n.: from inf.alveolar n. To : lower lip
Ant. Division:
3-buccal n.:to skin & m.m. of Buccinator m.
-The great auricular n. C2,3

auricle
149
cranial nerves
“On Old Olympus's Towering Tops A Fin & German

Viewed Snowy Hops”
“Some Say Marry Money But My Brother Says Bad
Business Marry Money.
150
Cranial Nerves
I On (Olfactory) I Some(Sensory)
II Old (Optic) II Say(Sensory)
III Olympus (Oculomotor) III Marry(primarilyMotor)
IV Towering (Trochlear) IV Money,(primarilyMotor)
V Tops, (Trigeminal) V But(Both)
VIA(Abducens) VI My(primarilyMotor)
VII Finn (Facial) VII Brother (Both)
VIII And (Auditory) VIII Says(Sensory)
IX German (Glossopharyngeal) IX Big(Both)
X Viewed (Vagus) X Bras(Both)
XI Astounding (Accessory) XI Matter(primarilyMotor)
XII Hops (Hypoglossal) XII More(primarilyMotor)
151
1-olfactory nerves
Carry smell sensation from the olfactory mucosa in the
upper part of nasal cavity
152
2-Optic nerve
Its track of brain:

Has no shath & surrounded by meninges
Type: special sensory n. carry visual impulse
Origin:
axons of ganglion cells of the retina exite from post. Pole
-pass in sinous course to allow movement of eye ball
-Corsed from lat. to med. By ( nasociliary n. & ophthalmic a.)
-Pass inside tendinouse ring to reach optic canal with
ophthalmic a.
Termination: optic chiasma
153
154
3-Oculomotor nerve
Type: motor to most of extraocular m.

Contains parasymp. Fibers from edinger-westphall nucleus
Contains symp. Fibres from symp. Plexus around I.C.A.
Origin : cerebral peduncle of mid brain
Course & relations:

Pierces dura infront point of decussation of tentorium
Run in lat. Wall of cavernous sinus
To inf.orbital fissure ( inside tendenous ring)
Divid
ed into sup. & inf. Division:
Sup. Division : supply :

Sup. Rectus m.
Levator palpebral superioris
Symp. Fibers to mullers m.
Inf. Division : supply:

Inf.rectus
Inf. Oblique
Med. Rectus
155
4-Trochlear nerve
Type: purely motor to supply one m. ( sup. Oblique m. )
Origin: midbrain below inf. Colliculus
Course:
Turn around midbrain
Pierces dura at point of decussation of tentorium
Run in lat. Wall of cavernouse sinus
Enter orbit through sup. Orbital fissure outside tendinouse
ring
Terminations: to sup. Oblique m.
156
5- trigeminal nerve
thickest cranial n.
type: mixed n. (motor & sensory)
sensory fibers : receive sensation from :

ant. 1/2 of scalp , face , orbit , nasal & oral cavities
motor fibers : supply 8 ms. :
4 ms. Of mastication +
Origin: ( large sensory & small motor)

a-sensory root :from trigeminal ganglion ( main sensory &
spinal nuclei of trigeminal n.)
b-motor root: from motor nucleus of trigeminal n. join to
mandibular n. in f. oval
trigeminal ganglion
sensory ganglion in trigeminal impression on apex of petrus part
of temporal & covered by cavum trigeminal
connections:
-concave aspect : directed backwards
Contains : central process of bipolar cells
-convex aspect: directed forwards
Cotains : peripheral process of bipolar cells
Brs. Arise from this aspect
Branches of ganglion:
-ophthalmic n. ( smallest)
–maxillary n. ( medium sized)
–mandibular n. ( largest )
Trigeminal nerve: where branches exit skull
“Standing Room Only”:
Superior orbital fissure is V1
foramen Rotundum is V2
foramen Ovale is V3
157
158
V1-Ophthalmic n. : in orbit
Ophthalmic nerve
Type : general seneory n.
Origin: 1st br. Of trigeminal ganglion
Couse & relations :

Run in lat. Wall of cavernose sinus (recive symp. Br. From
plexus around I.C.A. )
After leave sinus divided into 3 brs. ( all pass from sup. Orbital
fissure)
Branches:( meningeal – lacrimal – frontal –nasociliary)

A-meningeal br. : sensory to dura
B-lacrimal br.:
Lacrimal nerve course
“Lacrimal’s story of 8 L’s”:

Lacrimal nerve runs on Lateral wall of orbit above Lateral
rectus, then Lets communicating branch join in, then
supplies Lacrimal gland, then Leaves it and supplies Lateral
upper eye Lid!
enter the orbit through sup. Orbital fissure

pass ( outside tendinouse ring)
Lat. Wall of orbit with lacrimal a.
Recive br. From zygomatic n. which is secretorymotor
parasymp. To lacrimal gland
Supply:
-lacrimal gland ( sensory & parasymp. Fibers)
-skin of lat. Eye lid by palbebral br.
159
C-frontal n.:
pass ( outside tendinouse ring)
pass above levator palbebral sup. Then divided to 2 brs.
-supra- trochlear : above sup. Obliqe m.

Supply: skin of med. Part of eye lid & forhead
-supra-orbital n. :
Supply : middle part of eye lid
Divided into : small med. Br. & large lat. Br. To forehead &
scalp
D-naso-ciliary n. :
pass ( intside tendinouse ring)
run with optic n. in med. Wall of orbit to dividing into : -.
Ethmoidal & infra. Trochlear ns.
Branches:
1-sensory root : to ciliary ganglion
2-2 long ciliary ns.: carring sensory & symp. Fibers ( from
plexus around ica ) to supply dilator pupillae m.
3-ant.ethmoidal n. : enter ant. Ethmoidal f. then descend to

nasal cavity close to cristagalli
Ends by int. & ext. nasal nerves
4-post. Ethmoidal n. : enter post. Ethmoidal f. to supply m.m.

of ethmoidal air sinus
5-infra-trochlear n. :
Supply : skin of med. End of 2 eye lid & skin of nose
160
161
V2-Maxillary nerve
Purely sensory
Origin: 2nd division of trigeminal ganglion

Supply: -maxillary area of face & teeth of upper jaw
Course & relations:

Arise from trigeminal ganglion
Pass in lat. Wall of cavernous sinus
Leave skull through f.rotundum
Reach the pterygopalatine fossa &
give 2 sensory roots to the sphenopalatine ganglion
Then enter infra-orbital fissure to become infra-orbital n.
Run in infra-orbital groove & cannal .
Reach face through infra-orbital f.
Ends: by 3 terminal brs. palpebral , nasal & labial ns.
Branches:
- in cranial cavity :
meningeal br. : Supply: dura mater of middle cranial fossa
-in pterygo-palatine fossa:

A- 2 ganglionic brs :
carry sensory fiber to spheno-palatine ganglion
B- zygomatic n. :
enter the orbit from infra-orbital fissure
Give 2 brs.:
1-zygomatico-facial n. supply skin over zygoma
2-zygomatico-temporal n. : give post.ganglionic secretomotor
fiber to lacrimal n. to supply lacrimal gland
Supply skin of temporal region
162
C-post. sup. Alveolar n. :
pass from pterygo-maxillary fissure
Supply: upper 3 molar teeth
-in infra-orbital groove :

-middle sup. Alveolar n.
Supply: upper 2 premolar teeth
-in infra-orbital canal :

Ant. Sup. Alveolar n.
Supply : upper 2 incisors & canine
Terminal brs. In face : palpebral ,nasal,labial
163
V3-Mandibular nerve
The 3rd division of trigeminal n.
Mixed n.
Large sensory & small motor
Origin: 2 roots :
a-sensory root: from trigeminal ganglion
b-motor root: from the trigeminal motor nucleus in pons
course & relations :

- the 2 roots unite together in f.oval to form The main trunk
which descends to reach in The infra-temporal fossa where it
related to:
lat: to lat.pterygoid m.
med: to otic ganglion & tensor palati m.
post: middle meningeal a.
branches:
motor: innervated muscles
My A$$ Meets The Toilet
Mylohyoid
Anterior digastric
Muscles of Mastication
Tensor veli palatini
Tensor tympani
sensory branches
Buccaneers Are Inferior Linguists
BAIL
Buccal
Auriculotemporal
Inferior alveolar
Lingual
164
165
branches:
A-branches of the main trunk:
( 1 sensory & 1 motor)
1-nervus spinosus (sensory) : to dura Through f.spinosum

with (M.M.A.)
2-n. to med. Pterygoid (motor) & br. Pass through otic
ganglion without relay to
Supply : (tensor palati & tensor tympani ms.)
166
B-branches from the ant. Division
(3 motor & 1 sensory)
1-masseteric n.
2-n. to lat. Pterygoid m.
3-2 deep temporal ns. To temporalis m.
4-buccal n. (sensory):
Supply: -skin of buccinator m.
-m.m. of the cheek & gums opposite the
premolar & molar teeth
C-branches from the post. Division (3 sensory & 1 motor)
167
1-auriculo-temporal n.
(sensory)
Arise by 2 roots surround middle meningeal a.
Supply:
-temporomandibular joint
- parenchyma of parotid gland
-carry symp. & parasymp. Fibers from otic
ganglion to parotid gland
-skin of ( E.O.M. , tragus & ear drum )
168
2-lingual n.
(sensory)
Origin: post. Division of mandibular n.
Course & relations:
-join with chorda tympani n.

-pass under lower border of lat. Pterygoid m.
-then between med. Pterygiod m. & mandible Infront of inf.
Alveolar n.
-enter mucosa of gum
-run superfacial to (styloglossus &hyoglossus ms.)
-then deep to ( submandibular gland,
submandibular ganglion ( hang it by 2 sensory roots ) &
mylohyoid m.)
Here : it has tripple relation with submandibular

duct ( lat. , below , med.)
-the duct & nerve pass between genioglossus m. &
sublingual gland to reach the tongue
End: ender m.m. of tongue
Supply:
-carry general & taste sensation from ant 2/3
of tongue
-carry secretomotor parasymp. Fibers from chorda tympani
to submandibular &sublingual gland ( relay 1st in
submandibular ganglion
169
3-inf. Alveolar n.
(mixed n. : motor & sensory)
The largest br. Of post. Division
Course & relations:

- pass under lower border of lat. Pterygoid m.
- then between med. Pterygiod m. & mandible Infront of inf.
Alveolar a.
-enter the mandibular f. & canal
Supply: lower molar & premolar teeth
Ends: near mental f. by 2 brs.
Brs. :
-mental n. : out of mental n. to the chin
-incisive n.: inside mandible to incisor teeth
4- n. to mylohyoid (motor)
Contains all motor fibers
Br. of inf.alveolar n. before mandibular f.
Run in mylohyoid groove
Supply : -mylohyoid m. & ant. Belly of digastric m.
170
6-Abducent nerve
Type: purely motor
Origin : lower part of pons
Course & relations:

Run on clivus then pierces dura in dorsum sellae
Run in cavernous sinus inf. Lat. To I.C.A.
Enter orbit through sup. Orbital fissure inside tendinous ring
Supply : lat.rectus m.
171
7- Facial nerve
Type:
mixed n. ( motor , sensory & parasymp. Fibers )
Origin: from anterolateral aspect of brain stem
At lower border of pons ( ponto-cerebellar angle)
Consists of: 2 parts :

1-facial n. proper : from facial motor nucleus in pons
2-nervus intermedius: carrying
a-parasymp. Fibers from sup. Salivary nucleus
b-taste fibers from solitary nucleus
-intracranial course
leaves cranial cavity through internal auditory meatus
run in facial canal inside petrous part of temporal bone
it passes lat. & backward then downwards
to reach stylomastoid f.
-extracranial course
run through stylomastoid f. to curve around styloid process
enter posteromedial surface of parotid gland
superficial to : ECA & retromandibular v.
ends: inside the gland by dividing into 5 terminal brs.
172
173
Branches:
1-Brs. Of intrapetrous part:

-greater superficial petrosal n.
-chorda tympani
-n. to stapedus m.
174
175
a-greater superficial petrosal n.
Parasymp. N. from nervus intermedius
Origin: geniculate ganglion of facial n.
Course:
Leave petrous bone via its hiatus to reach middle cranial
fossa
Then run in its groove to enter f.lacerum to join with deep
petrosal n. to form n. to pterygoid canal ( vidian n.)
-vidian n. run to reach pterygopalatine fossa

-in fossa the parasymp. Fiber of G.S. petrosal n. relay in
sphenopalatine ganglion
Post ganglionic fibers supply :
Mucous gland of palat , nose , nasophartnx & lacremal gland
176
177
B-chorda tympani n
Parasymp. Fiber from nervus intermedius
Origin : facial n.
It enter the middle ear cavity through the post. Canaliculus of
chorda tympani
Run between the malleus & the mucous membrane of ear
drum
Leaves the middle ear through the ant. Canaliculus of chorda
tympani ( squamo-tympanic fissure ) to reach the infra
temporal fossa
Ends by joining with lingual n. deep to lat. Pterygoid m.
Parasymp. Fibers leave lingual n. to relay in submandibular

ganglion to supply submandibular & sublingual glands
Taste fibers cotinue with lingual n. to supply m.m. of ant. 2/3

of tongue
c-Nerve to stapedius m.:
2-brs. Of extracranial part:

n. to post. Belly of digastric m. & stylohyoid m.
post. Auricular n. to occipitalis & auricularis ms.
178
Finally:
5 brs Inside parotid: "Two Zebras Bit My Coccyx".
1-temporal br.
Supply:-frontal belly of occipito-frontalis m
-the auricularis ant. & sup.
2-zygomatic br.
a-upper: to orbicularis occuli m
b-lower: to ms. Of nose
3-buccal br.
Supply: -buccinator & orbiularis oris ms.
4-mandibular br. To ms. Of lower lip
5-cervical br. : to platysma m.
CN VII innervated muscles (branchial arch 2 derivatives)

“Imagine someone making the facial expression to say ‘PSS…‘
Facial expression muscles
Posterior belly of digastric
Stapedius
Stylohyoid
179
8-vestibulo cochlear nerve
Supply the membranous labrinthas follows:
-its vestibular division ( equilibrium )

-Its fiber are the central process of cells of the vestibular
ganglion ( at the bottom of the internal auditory meatus )
-The peripheral processes end in the utricle , the sccule &

the ampullary crests of the semicircular ducts
Its cochlear division ( hearing )

Its fiber are the central process of cells of the spiral ganglion
Inside the modiolus
-The peripheral processes are connected with the organ of

corti
180
181
9-glossopharyngeal nerve
Type : mixed nerve ( sensory , motor & parasympahatic )
Origin : from posterolateral sulcus of medulla ( between olive

& inf. Cellebellar peduncle )

It leave the cranial cavity through the middle compartment of
jugular foramen
-Descend deep to the styloid process between I.C.A & I.J.V.
in the upper part of carotid sheath
-just below base of skull it bears 2 ganglia close together,
superior (jugular) and inferior (petrosal)
Then leave the sheath with the stylogharyngeus m.
Between I.C.A. & E.C.A.
Then passes between the sup. & middle constrictor muscles
of pharynx deep to the hypoglossal m. to reach the tounge
Termination : into branches

Supply : the mucous membrane of pharynx , tonsile & post.
1/3 of the tongue
Ganglia of glossopharyngeal nerve :

1-sup. Ganglion : smaal , has no branches
2-inf. Ganglion : large , give the tympanic br.
182
183
Branches :
A-sensory branches :
1- meningeal branches to dura
2-carotid branches to carotid body & carotid sinus
3-pharyngeal branches : to pharyngeal plexus
4-tonsillar branches ( with lesser palatin n. ) to palatine tonsil
5-terminal lingual branches carry the general & taste sensation
to the post. 1/3 of the tongue
-the pharyngeal plexus receives :

-sensory : the pharyngeal branches of glossopharyngeal n.
-motor : the pharyngeal branches of vagus n.
-sympathetic : the pharyngeal branches of sup. Cervical
sympathetic Ganglion
B-Motor branches :
Nerve to stylopharyngeal muscle
It is the only muscle innervated by CN IX
only muscle of pharynx not innervated by CN X
184
C-Parasympathetic branch
-Tympanic branch ( jacobson nerve )
Which is the preganglionic parasympathetic fibers to the
parotid
Arise : from inf. Ganglion of glossopharyngeal nerve
Course :
-In the jugular foramen it enter the tympanic canaliculus to
reach the middle ear cavity to form the tympanic plexus
-lesser superficial petrosal nerve arise from the plexus to
reach the middle cranial fossa
-Leave the cranial cavity by passes through the foramen oval to
the infra temporal fossa then relay in the otic ganglion
-The postganglionic fibers leave the ganglion to join with the
auriculo temporal nerve to reach the parotid gland
185
10- vaguse nerve
Type:
mixed n. (sensory, motor & parasymp)
Origin : postero-lateral sulcus of medulla
Course & relations:
Leave cranial caviyt through middle compartment of jugular f.
Here : It has sup. & inf. Ganglion
The cranial part of accessory n. joins the inf. Ganglion &
distributed with its brs.
Then descend in carotid sheath between IJV & ICA
Then btween IJV & CCA
-cross 1st part of subclavian a. to enter the thorax
186
Branches:
1- brs. From sup. Ganglion:

-meningeal br: sensory to dura mater in post. Cranial fossa
-auricular br. :to skin of med. Side of auricle & tympanic m.
2-brs. From inf. Ganglion:

1-pharyngeal br. (motor) from cranial accessory n.
Descend between ICA & ECA on lat. Surface of med.
Constrictor m. of pharynx to share in pharyngeal plexus
Supply
1-pharyngeal ms. Except : stylopharyngeus m.
& all ms. Of soft palate except : tensor palati m.
2-sup. Laryngeal n. ( mixed)

Deep to ICA & ECA to divided into :
a-internal laryngeal n. ( sensory)

supply: m.m. of upper 1/2 of larynx ( above vocal cords)
b-external laryngeal n. (motor)

to cricothyroid m.
3- 2 cardiac brs. : sup. & inf. (parasymp.)

Cross infront of 1st part of subclavian a. to join cardiac plexus
Lt. inf. Cardiac join superficial plexus
The remainig brs. Join to deep plexus
187
4-recurrent laryngeal n. ( mixed) :
a- RT. Recurrent laryngeal n.:
from RT. Vagus infront of 1st part of subclavian a.
ascend in RT. Groove between trachea & oesophagus close
related to med. Surface of thyroid gland & inf. Thyroid a.
b-LT. recurrent laryngeal n. :

from LT. vagus hooks around arch of aorta
ascend in LT. Groove between trachea & oesophagus close
related tomed. Surface of thyroid gland & inf. Thyroid a.
-each recurrent laryngeal n.

Deep to inf. Constrictor m. behind cricothyroid m. inside
ligament of burry with inf. Laryngeal a.
Brs. Of recurrent laryngeal ns.:

-motor : to all laryngeal ms. Except. Cricothyroid m.
To trachea , oesoph. & inf. Constrictor m. of pharnx
-sensory : to m.m. of lower 1/2 of larynx ( below vocal cords)
188
11- accessory nerve:
Type: purely motor n.
Origin: 2 roots
Cranial root : posterolateral surface of medulla
Spinal root: upper 6 cervical segment
Course & relations:

-spinal root ascend in f. magnum to join with cranial root in
cranial cavity
2 roots united & leave cranial cavity from middle
compartment of jugular f. & separeted just below it
-cranial root join inf. Ganglion of vagus n. & distributed with
its branches
-spinal root :
Decsend in carotid sheath between IJV & ICA
Then between IJV & post. Belly of digastric m.
Pierces deep surface of sternomastoid m. to supply it
Crosses the post. Triangle to pierces ant. Border of trapezius
m. to supply it
189
Branches:
-cranial accessory: with vagus
a-Pharyngeal br. : supply:
pharyngeal ms. Except : stylopharyngeus m.
& all ms. Of soft palate except : tensor palati m.
b-Laryngeal br. : supply ms. Of larynx
-spinal accessory: 2 ms.

Sternomastoid & trapezius ms.
190
12- hypoglossal nerve
: Type: purely motor n.
Origin
anterolateral sulcus of medulla & br. From c1
Course & relations:

Leave cranial cavity through ant. Condylar f. to form spiral
turn around vagus n.
Descend In carotid sheath between IJV & ICA
Descend deep to styloid procsee & post. Belly of digastric m.
Then cross the following structure:

ICA , ECA , lingual a. & occipital a.
Reach submandibular region to run on hyoglossus m.
Run deep to mylohyoid m.
Ends: between hyoglossus & genioglossus ms.
191
Branches: 4 * 4
- 4 brs. from hyoglossus it self
n. to styloglossus
n. to hyoglossus
n. to genioglossus
Nerves to all intrensic & extrinsic ms. Of tongue except
palatoglossus m.
- 4 brs. from c1 :
Meningeal br.
n. to geniohyoid & n. to thyrohyoid ms.
Descending hypoglossi ( sup. Limb of ansa cervicalis) to
infrahyoid ms.
192
The spinal nerves
• C1:
supplies the small suboccipital muscles.
Its anterior ramus joins the hypoglossal nerve but leaves it later
to form the descendens hypoglossi.
• C2:
The posterior ramus forms the greater occipital nerve which is
sensory to the scalp.
• The posterior rami of C2, 3 and 4

provide muscular and sensory branches to the back.
Their anterior rami provide muscular branches, including the
descendens cervicalis
They also supply sensory branches:

the greater auricular, lesser occipital, anterior cutaneous and
the three supraclavicular nerves
-The greater auricular supplies the skin in the parotid region,

the only sensory supply to the face which is not derived from
the trigeminal.
The others supply the skin of the neck and the upper part of the
thorax.
• The remaining cervical nerves (C5–8) join the brachial

plexus.
193
Cervical plexus
Formed by:
ant. 1ry rami of upper 4 cervical nerves
Each ramus dividing into ascending & descending brs.
Site : upper 4 cervical tr. Processes
Relations :
Superficial relations : Sternomastoid m. & IJV
Deep relations : levator scapulae & scalenus medius ms.
Branches:
A-4 cutaneouse branches of cervical nerves
B-communicating brs.
C-Muscular brs.
Arrangement of the important nerves “GLAST”

4 compass points:
clockwise from north on the right side of neck:
Great auricular (North)
Lesser occipital (East)
Accessory nerve (pops out between L and S)
Supraclavicular (South)
Transverse cervical (West)
A-4 cutaneouse branches of cervical nerves

1-the great auricular nerve ( C2,3)
2-the lesser occipital nerve ( C2)
3-the transvers ( anterior ) cutaneouse nerve of the neck ( C2,3)
4-the supraclavicular nerve ( C3,4 )
Erb’s point:
-point along posterior border of sternomastoid muscle where
anterior rami of C5–C6 meet;
-also marks approximate point at which cutaneous branches of
cervical plexus emerge along posterior border of SCM
194
195
scheme :
-all of them appear at the middle of post. Border of
sternomastoid muscle
-The great auricular n. :

auricle
- lesser occipital n.:

run upward to ward the mastoid process
Supply : the skin of upper 1/2 of inner surface of the auricle
-The transvers nerve :

run transvers superficial to the sternomastoid & deep to the ext.
jugular vein
Supply : the skin of ant. Triangle
-The supraclavicular n.:

run down ward superficial to the clavicle
Divided into 3 branches ( med. , intermediate & lat. )
Supply : the skin of post. Triangle
the skin of chest to the sternal angle ( 2nd rib )
B-communicating brs. :
Give br. To hypoglossal n. from c1
Receives brs. To all its roots from sup. Cervical ganglion
C-Muscular brs. :
-brs. To scalene ms. & prevertebral ms.
Brs. To sternomastoid c2, trapezius c3,4 , levator scapulae c3,4
Descending cervicalis c2,3 : form inf. Limb of ansa cevicalis
Phrenic n. ( c3,4,5 ) mainly c4
196
Phrenic nerves
Type: mixed n.
Origin: ant. 1ry rami of c3,4,5 of cervical plexus
Course & relations:

Start on scalenus medius m. then cross scalenus ant. From lat.
To med.
Covered by sternomastoid m. , tr. Cervical & suprascapular as.
The LT. n. cross infront of 1st part of subclavian a.
The RT. N. cross infront of 1st part of subclavian a. &
scalenus ant. M.
Ends: at the begning of the innominate v. to enter thorax
Distribution:
-motor fibers : supply diaphragm
Sensory fibers: supply 3P
-pericardium
-pleura above it
–peritoneum below it.
-RT. Phrenic supply gall bladder
Ansa cervicalis nerves

“GHost THought SOmeone STupid SHot Irene”:
 Geniohyoid
 Thyrohyoid
 Superior Omohyoid
 Sternothyroid
 Sternohyoid
 Inferior omohyoid
197
Sympathetic chain in the neck
It descend vertically in the neck
embedded in the post. Wall of carotid sheath ,
opposite the transverse process of the cervical vertebrea
198
Ant. Relations :
I.C.A. above
C.C.A. middle
vertebral a. below
Post. Relations :
longus capitis above
inf thyroid artery middle
1st rib below
Superiorly : it end by sup. Cervical ganglion
Inferiorly : it crosses the neck of 1st rib to enter the thorax
Ganglia :
it has 3 ganglia:
199
200
1-sup. Cervical sympathetic ganglion
Size: it is the largest ganglion ( 2-3 cm )
Site : opposite the 2nd , 3rd cervical vertebrea
Relations :
Anteriorly : I.C.A.
Posteriorly : longus capitis muscle
Branches :
-communicating branches to the last 3 cranial nerves
-communicating branches to the upper 4 cervical nerves
-int. carotid br. : forming symp. plexus around I.C.A.
-ext. carotid br. : forming symp. plexus around E.C.A.
-pharyngeal br. : joins the pharyngeal plexus of nerves
-sup. cardiac br. :

The br. Of LT. ganglion end in superficial cardiac plexus
The br. Of RT. Ganglion end in the deep cardiac plexus
201
202
2-middle cervical sympathetic ganglion
Size : it is the smallest ganglion
Site : opposite the 6th cervical vertebra
Relations :
Anteriorly : C.C.A.
Posteriorly : inf. Thyroid artery
Branches :
-communicating branches to the 5th , 6th cervical nerves
-thyroid br. : forming plexus around inf. Thyroid artery
-middle cardiac br. : to deep cardiac plexus
ansa subclavia : barnch from middle ganglia loop around 1st

part of subclavian artery to reach the inf. Cervical ganglion
203
3-inf. Cervical sympathetic ganglion
Size :
fuse with 1st thoracic ganglion to form the elongated cervico-
thoracic ( stellate ) ganglion
Site : between the tr. process of c7 & the neck of 1st rib
Relations :
Anteriorly : origin of vertebral artery
Posteriorly : 1st. rib
Branches :
Communicating branches to the 7th , 8th cervical nerves
-branches to the vertebral artery to form plexus around it
-branches to the subclavian artery to form plexus around it
- inf. cardiac br. : to the deep cardiac plexus
204
Petrosal nerves
These are autonomic nerves related to petrous part of temporal
bone
They include :
-deep petrosal n. ( symp. )
-greater superficial petrosal n. ( parasymp. )
-lesser superficial petrosal n. ( parasymp. )
1-deep petrosal n. ( symp. ) :

-Derived from the symp. plexus around I.C.A.
-Unite with the greater superficial petrosal n. (parasymp.)

To form the nerve of pterygoid canal (vidian n. ) which
passes through the pterygoid canal to reach the spheno-
palatine ganglion
-Enter the spheno-palatine ganglion in the pterygo-palatine

fossa (no relay)
205
2- greater superficial petrosal n.
( parasymp. )
-Parasymp. N. from nervus intermedius
-Origin: geniculate ganglion of facial n.
-Course:
Leave petrous bone via its hiatus to reach middle cranial
fossa
Then run in its groove to enter f.lacerum to join with deep

petrosal n. to form n. to pterygoid canal ( vidian n.)
-vidian n. run to reach pterygopalatine fossa

-in fossa the parasymp. Fiber of G.S. petrosal n. relay in
sphenopalatine ganglion
Post ganglionic fibers supply :

Mucous gland of palat , nose , nasophartnx & lacremal gland
206
207
3-lesser superficial petrosal nerve
( parasymp. )
Arise from the tympanic plexus
reach the middle cranial fossa by foramen carry its name
-then passes through foramen ovale to reach the infra-
temporal fossa to relay in the otic ganglion
-The post.ganglionic fibers joins with auriculo tempoeal nerve

to reach the parotid gland
208
209
Ganglions
210
1-Otic ganglion
Type: parasymp. Ganglion
Topographically related to mandibular n.
Functionally connected to glossopharyngeal n.
Site: infratemporal fossa below f. oval
Relations:
Med. : tensor palati m.
Lat. : main trunk of mandibular n.
Post. : middle meningeal a.
211
Connections of ganglion:
A- roots entering:
-Parasymp. Root :
leser superficial petrosal n. from glossopharyngeal n. ( relays
in ganglion)
-Symp. Root :
from plexus around M.M.A. (without relay)
-Sensory root:
mandibular n. (without relay)
-Motor root :
from n. to med. Pterygoid m. (without relay)
B-Branches emerging:
-Parasymp. Post. Ganglionic to parotid
- Symp. To blood vessels of parotid
-Sensory fibers to parotid

( join the auriculotemporal n. to reach the parotid)
-Motor twig to
Tensor palati & tensor tympani ms
212
213
3-Submandibular ganglion
Site: submandibular region on hyoglossus m. & suspended

from lingual n. by 2 roots
Relations:
Sup. : lingual n.
Inf. : submandibular gland & its duct
Med. : hyoglossus m.
Lat. : mylohyoid m.
Roots entering the ganglion:

-Parasymp. : from chorda tympani & join to lingual n.
( relay )
-Symp. : from plexus around facial a. (without relay)
-Sensory: from lingual n. ( without relay)
Branches from the ganglion:

-several brs. Directily To sypply submandibular gland
-several brs. Join lingual n. to supply sublingual gland
214
215
4-Sphenopalatine ganglion
Site: pterygopalatine fossa suspended from maxillary n. by 2
roots
But functionslly related to facial n.
216
217
Roots entering the ganglion:
Parasymp. : greater superficial petrosal n. ( from facial n.)
( relay )
Symp. : deep petrosal n. from plexus around I.C.A. (without
relay)
Sensory : 2 sensory brs. From maxillary n.
-deep petrosal n. unite with greater superficial petrosal n. to

form n. to pterygoid canal ( vidian n. ) to reach the ganglion
218
219
Branches from ganglion:
-orbital brs. : through inf. Orbital fissure
Supply : orbit & sphenoidal air sinus
-pharyngeal brs, : through palato-vaginal canal

Supply : nasopharynx & eustachian tube
-greater palatine n. : pass in greater palatine canal &

foramen
Supply : m.m. of hard palate
-lesser palatine n. : pass in lesser palatine canal & foramen

Supply: m.m. of soft palate
-long & short sphenopalatine ns. : passes through

sphenopalatine foramen
Supply: wall of nose
220
5-Ciliary ganglion
Site: post. Part of orbit
Relations:
Med. : optic n. & lat. Lat. Rectus
Roots entering ganglion:

-parasymp. root (relay in ganglion)
From n. to inf. Oblique m.
-symp. root (without relay)

From plexus around int. carotid a.
-sensory root (without relay)

Br. From nasociliary n.
Branches :
-10 ciliary ns. Around optic n.
Supply:
Parasymp. : to sphincter pupillae & ciliary ms.
Symp. : to blood vessels of eye
Sensory : to cornia , iris, & choroid body
221
222
223
Ansa cervicalis
It is nerve loop formed by union of 2 descending nerves
Supplies : 3 infrahyoid muscles
Site : it lies infront of carotid sheath
224
Formation : formed by union of 2 descending nerves
1-descending hypoglossi ( sup. Limb of ansa)
Its fibers arise from C1 join the hypoglossal nerve
Then leave it to turn across the carotid sheath
2-descending cervicalis ( inf. Limb of ansa )

Its fibers arise from C2,3
It begins behind the I.J.V. then descend along its ant. Surface to
join with the descending hypoglossi infront of the carotid
sheath
Thus the ansa arises from C1,2,3
Branches :
Arise from the convexity of the loop
Supply :
- the 2 belly of omohyoid
- sternohyoid
- sternothyroid
There are 3 nerve loop in the body

1-Ansa cervicalis
2-Ansa subclavia
3-Ansa lenticularis
225
Glands on head & neck
parotid gland
largest salivary gland ( serous secration)
size:
226
site & extentions : blow auricle
between ramus of mandible & sternomastoid m.
upward: root of zygomatic arch
downward: angle of mandible
ant.: masseter m.
pos.: sternomastoid m.
med. : pharyngeal wall
it has 3 surfaces & 3 borders & 2 ends

-lat. (superficial )s. -antromedial s. -posteromedial s.
- ant. , med. , post. Borders
-upper & lower pole (ends)
227
228
Relations :
postero-medial surface:
mastoid psocess & 2ms. Attached
sternomastoid & post. Belly of digastric ms.
Styloid process & structures attached

IJV , ICA & last 4 cranial nerves In between
antro-medial surface: 4 m
-ramus of mandible between 2 ms.
-med. Pterygoid m. & masseter m. -maxillary a.
lat. (superficial ) surface:

skin & superficial fascia
contains : platysma , great auricular n.
parotid fascia & deep parotid LNs
upper end: from before backward

temporal br. Of facial n.
superficial temporal vessels
auriculo-temporal n.
lower end:= structure inside gland

E.C.A.
retromandibular v.
crevical br. Of facial n.
ant. Border: from above downward

zygomatic br. Of facial n..
parotid duct
buccal br. Of facial n.
tr. Facial a.
post. Border:
sternomastoid m. between
mastoid process deep to it &
great auricular n. superficial to it
229
structures inside the parotid gland:
(facial n. , retromandibular n. , E.C.A. & auriculo-temporal n.)
1-facial n. ( most superficial)

Enter through post.med. surface
Divides into 5 terminal brs.
2-Retromandibular v. :
formed by ( superficial temporal & maxillary vs.)
Divides into ant. & pot. Brs.
3-E.C.A. (the deepest one)

Enter through post.med. surface
Divides into 2 terminal brs.
Maxillary a. emerges from antromed. surface.
Superficial temporal a. emerges from upper end
4-Auriculo-temporal n.
Supply sensory & parasymp. To parotid gland
Leave it from upper end
5-Deep parotid L.Ns
230
231
Parotid duct:
Length: 5 cm
Beginning : ant. Border
Course & relations:
Run below zygomatic arch & parallel to it
Turn medially to pierces the following structures:
Buccal pad of fat
Bucco-pharyngeal fascia
Buccinator m. (oblique course as valvular mechanism)
Buccal m.m.
Ends: open in vestibule of mouth opposite upper 2nd molar
tooth
Capsule of parotid gland:

has no true fascia
Fascial capsule
From general investing deep fascia
Splits at lower end into 2 layers:
-superficial layer: cover outer surface of gland & masseter m.
attached above to zygomatic arch
-deep layer form ( stylomandibular lig.): cover inner surface
of gland attached above to base of the skull
Blood supply
Arterial : brs. From E.C.A.
Venous : retromandibular v.
Lymphatics drainage: superficial & deep parotid L.N.s
232
Nerve supply of parotid:
A-Sensory
Great auricular n. to the capsule & C.T.
Auriculo temporal n. to the parynchema
B-Sympathetic: relay in otic ganglion

Post ganglionic fibers to parotid with auriculo-temporal n.
C-Parasympathatic ( secreto motor)

preganglionic fibers : from inf. Salivary nucleus in medulla &
pass with glossopharyngeal n.
Leave glossopharyngeal n. as tympanic br. To tympanic
plexus in middle ear cavity which give lesser superficial
petrosal n.
To hiatus of its n. then to middle cranial fossa emerges from
f.oval to infra-temporal fossa
Surface anatomy of parotid gland:

Connect the following 4 points
-point on tragus of the ear
-point at the center of mastoid process
-point 2cm below & behind angle of mandible
-point at the center of mandibular notch
Surface anatomy of parotid duct:

Middle 1/3 of line extending from tragus to point midway
between angle of mouth & ala of nose
233
Submandibular gland
Site: digastric triangle
Extent:
Ant. : mental foramen
Post. : angle of mandible
Above: mylohyoid line
Below: intermediate tendon of digastric m.
Cosiste of : large superficial part & small deep part

Has 3 surfaces:
Infrolateral surface related to:
Skin & superficial fascia
Facical a.
Ant. Facial v.
Cervical br. Of Facial n.
Submandibular L.Ns
Lateral surface related to:

Submandibular fossa
Facial a.
n. to mylohyoid & med. Pterygoid m.
medial surface related to:

upper: mylohyoid & n. to mylohyoid
middle: hyoglossus m. & its superficial Relations :
( 2ms. & 2 ns.).
lingual n. & submandibular ganglion
hypoglossal n.
mylohyoid m. & intermediate tendon of digastric m.
post. : styloglossus m. & pos. belly of digastric m.
-deep part of the gland between 2 nerves
Above : lingual n.
Below: hypoglossal n.
234
235
The submandibular duct:
5cm , from med. Surface
Run between mylohyoid & hyoglossus ms.
Then between genioglossus med. & sublingual gland
lat.
Has triple relation with lingual n.
The nerve runs lat. , below, & med. To duct
Arterial supply: brs. From facial & lingual as.
Nerve supply:
submandibular ganglion
Sensory fibers:
From lingual n. (without relay)
Symp. Fibers:
From symp. Plexus around facial a. (without relay)
-parasymp. Fibers:
Preganglionc fibers
from sup. Salivary nucleus of pons
Pass with facial n. & chorda tympani to join with
lingual n. ( relay)
Post.ganglionic fibers directly to the gland
236
Thyroid gland
Largest endocrine gland
Consistes from:
2 lat. Lobes & isthmus in between
-pyramidal lobe may project from isthmus & connect
to hyoid bone by levator glandulae thyrodae
Site: infront & sides lower part of neck
Extentions:
Apex: on oblique line of thyroid cartilage
Base: 5th or 6th tracheal ring
Isthmus: 2,3,4, tracheal ring
Capsules:
-true fibrous capsule
-false facial capsule: from pretracheal fascia
Thickened lat. To form lat.
Suspensory lig. Of berry
-big vessels run between 2 capsules
237
238
239
Relations:
1-isthmus( 2 surfaces ( ant. & post )
2 borders ( upper & lower )
Ant. Relations:
Sternohyoid & sternothyroid ms.
Post. Relations:
2nd . 3rd , 4th, tracheal rings
Upper border:
Sup. Anastmosis between RT & LT sup. Thyroid as.
Pyramidal lobe
Lower relations
RT & LT inf. Thyroid vs.
Inf. Anastmosis between RT & LT inf. Thyroid as.
Thyroid ima a.
2-Lat. Lobes: has 3 surfaces

-relations of post. Surface:
2 parathyroid glande
2 arteries ( C.C.A. & inf. Thyroid a.)
240
-Relations of med. Surface:
( tubes & nerves)
Upper : lartnx , pharynx & ext.laryngeal n
Lower: trachea ,oesophaguse & recurrent laryngeal n.
Relations of antrolateral surface:

( skin , fascia , 4 ms. )
Skin,
superficial (platysma) & deep (pretracheal )fascia
upper : upper belly of omohyoid m.
middle: sternohyoid m.(superficial)
sternothyroid m.(deep ).
Lower: sternomastoid m.
241
242
Arterial supply:
1-sup. Thyroid a.:
Supply: upper 1/3 of lat lobes & upper 1/2 of isthmus
Origin: E.C.A.
Course & relations:

Run deep to infra hyoid ms. With sup. Thyroid v. to
enter lobe close to ext. laryngeal n.
Branches: (total special creminal investigations)
Infra hyoid a.
Sternomastoid br.
Cricothyroid br.
Sup. Laryngeal a.
Terminal glandular brs. ( ant. & post.) to thyroid gland
2- inf. Thyroid a.
Sypply: lower 2/3 of lobes & lower 1/2 of isthmus
Origin: thyro-cervical trunk
( 1st part of subclavian a.)
Course & relations:
Run on med.surface To scalenus ant. M.
Then between carotid sheath & vertebral a. to reach
gland close to recurrent laryngeal n.
3-thyroid ima a. ( may presnt or absent)

From arch of aorta
Venouse drainage :
-sup. Thyroid v. ends in I.J.V.
-middle thyroid v. ends in I.J.V.
-inf. Thyroid v. ends in innominate v.
Lymphatic drainage:
Prelaryngeal L.Ns.
Paratracheal L.Ns.
Deep cervical L.Ns.
Brachiocephalic L.Ns.
243
Parathyroid glands
These are 2 pairs ( 2 sup. & 2 inf. ) of small endocrine glands
Embeded in the post. Aspect of the 2 lobes of the thyroid
gland
Each of which has shape & size in split pea ( 6mm. long , 3mm.
wide)
-The sup. Parathyroid glands lies in the middle of post.

Surface of thyroid
-The inf. Parathyroid glands lies in the base of the lobs of
thyroid gland
Blood supply : branches of inf. Thyroid artery
244
Pituitary gland
Site: hypophyseal fossa
Relations:
Sup. : diaphragma sellae
Inf. : body of sphenoid & sphenoidal air sinus
Ant. : tuberculum sellae
Pos. : dorsum sellae
On each sides : cavernous sinus & its contents.
Connections:
To tuber cinerenum of hypothalamus by infundibulum
Arterial supply: sup. & inf. Hypophyseal as. ( I.C.A.)

Venous drainage : surround dural venous sinuses
245
Sublingual gland
Site: sublingual fossa of mandible
Relations:
Sup. : m.m. of mouth ( sublingual fold)
Inf. : mylohyoid line
Anterolateraly: sublingual fossa of mandible
Med. : genioglossus m. & lingual n.
246
Ducts of the gland:
10-20 ducts open either into submandibular duct or in m.m. of
mouth (sublingual fold)
Arterial supply:
Sublingual br. Of lingual a.
Submental br. Of facial a.
Nerve sypply:
from lingual n. containing :
-Parasymp. & symp. Fibers From submandibular ganglion
-Sensory fibers
247
Cranial cavity
Dura mater
It is white fibrous tissue placed in outer layer of meninges
248
Consists of 2 layers: outer (endosteum) layer
Inner (dura proper) layer
The 2 layers close to geather except in :
Dural folds:
Def: inward reduplication of inner layer of dura
Functions:
-minimizing the effect of vibration & shocks
-support upper part of brain to not pressed on lower part
-types:
-vertical folds: ( falx cerebri & falx cerebelli )
Horizontal folds : -tentorium cerebelli
-diaphragma sellae
-cavum trigeminale
1- falx cerebri
Site:occupy the median longitudinal fissure between the 2
cerebral hemispheres
Parts & attachments :
1-apex: attached to crista galli & frontal crest
2-base: continous with upper layer of tentorium cerebelli
3-upper covex border :attached to the sup. Sagittal sulcus
4-lower concave border:free in median longitudinal fissure of
brain Above corpus callosum
-venous sinuses related

1-sup. Sagittal sinus : in upper attached border
2-inf. Sagittal sinus : in post. 2/3 of lower free border
3-straight sinus : in the base
249
2-falx cerebelli
Site: between rt. & lt. cerebellar hemispheres
Parts & attachments :

1-apex: below & reaches to post. Free border of foramen
magnum
2-base: above & continuous with lower layer of tentorium
cerebelli
3-ant. Border : free between 2 cerebellar hemispheres
4-pos. border : attached to internal occipital crest
venous sinuses related

The occipital sinus run in post. Attached border
3-tentorium cerebelli
Site: in roof of post. Cranial fossa between cerebrum above &
cerebellum below
Surfaces:
1-upper surface: attachment to the base of falx cerebri
2-lower surface: rest on cerebellum & attach to base of falx
cerebelli
Borders:
1-attached (outer) border : attached to ( from befor backward)
-post. Clinoid process
-lips of sup. Petrosal sulcus
-lips of transverse sulcus
2-free (inner) border : surround midbrain
The ant. Border of it crosses the ant. Border of attached
border
250
* 3 cranial ns. Pierce dura in relation to crossing point
- 3rd cranial n. infront of point
-4th cranial n. at point
- 5th cranial n. behind the point
-venous sinus related
- RT & LT sup. Petrosal sinuses
- RT & LT transvers sinuses
Both run in attached border
-straight sinus run on the upper surface
4-cavum trigeminale
- cover the trigeminal ganglion near apex of petrous temporal
bone
5-diaphragma sellae
-form the roof of the sella turcica above pitutary gland
-it has central hole for the infundibulum
-stretched between 4 clinoid prosesses
251
Arterial supply of dura mater:
a-meningeal brs. Of ant. Cranial fossa
brs. Of ant. & post. Ethmoidal a.
brs. Of I.C.A.
brs. Of middle meningeal a.
b-meningeal brs. Of middle cranial fossa

brs. Of ascending pharyngeal a. through foramen lacerum
brs. Of I.C.A.
brs. Of middle meningeal a. & accessory meningeal a.
c-meningeal brs. Of post. Crainal fossa

brs. Of ascending pharyngeal a. through hypoglossal canal
brs. Of vertebral as.
Brs. Of occipital a.
Venous drainage:
1-dural venous sinus (discuss)
2-emissary veins ( discuss )
3-meningeal veins : inner aspect of vault of skull
Most important ( middle meningeal v.)
middle meningeal v. :
from dural venous plexus
run in groove of inner aspect of parital bone accompanying the
brs. Of middle meningeal a.
divides into 2 trunks ( ant. & post. )
-ant. Trunk : to
-sphenoparital sinus
-cavernous sinus
-Pterygoid plexus of veins
-Post. Trunk : to pterygoid plexus of veins
252
Nerve supply of dura matter:
1- supratetorial dura : by trigeminal nerve
a-ant. Cranial fossa by :

1-ophthalmic nerve
b-middle cranial fossa by:
2-maxillary nerve ( middle meningeal br. )
3-mandibular nerve ( nervous spinosus )
2-infra tetorial dura :

( post. Cranial fossa ) by :
Cranial nerves 9,10,12
3-dura around foramen magnum by :

the upper 3 cervical nerves
253
Dural venous sinus
Def.: venous channels between inner & outer layers of dura
General rules:
-single , paired or multiple channels
-valvless
Tributaries:
From : brian , meninges , orbit , internal ear & C.S.F.
Drainage: I.J.V.
Classification:
1-single sinuses : sup. Sagittal sinus
Inf. Sagittal sinus
Straight sinus
Occipital sinus
Basilar sinus
2-paired sinuses: spheno-parital sinus

Cavernous sinuses
Sup. Petrosal sinuses
Inf. Petrosal sinuses
Transvers sinuses
Sigmoid sinuses
Intercavernous sinuses
254
1-sup. Sagittal sinus
-Beginning : at the apex of falx cerebri above the crista galli
-Course : it passes backward along the upper convex border of
falx cerebri grooving the inner aspect of the skull cap to forming
the sup. Sagittal sulcus
-Size : it is the largest venous sinus
It increas as it passes backwards
-Termination : it end at the internal occipital protuberance by
turning to right & becoming the RT. Transverse sinus
-Variations :
-May turn to left to be the left transvers sinus
-May open into adilatation called confluence of sinuses at the
ext. occipital protuberance from which arise RT. & LT.
transverse sinuses
-Surface anatomy :
By line extending from the glabella to inion
-Tributaries :
1-emissary v.v. passes from f. coecum
communicating with nasal vv.
2-emissary vv. Passing from parital emissary f.
3-sup. Cerebral vv.
4-meningeal vv. & diploic vv.
5-arachnoid granulations which filter the C.S.F. into the
venous blood
2-inf. Sagittal sinus

-Site : lies in the post 2/3 of lower free border of the falx cerebri
-Termination : at the free margin of the tentorium by unite
with the great cerebral vein to form the straight sinus
-Tributaries : it drain the falx cerebri
255
3-straight sinus
Beginning : it is formed by union of the inf. Sagittal sinus & the
great cerebral v.
Course : run backward along the line of attachment of falx
cerebri to the tentorium
Termination:
-at the int. occipital prouberance
Turn to the LT. forming the LT. transvers sinus
-epithelio-sinusoidal body : lying in the ant. Part of sinus
controls the flow of venous blood from the great cerebral v
4-occipital sinus :
-Origin : it is formed posteriorly by 2 veins RT. & LT. arising
from the beginning of the RT. & LT. transvers sinus
-Course : run in the attached border of the falx cerebelli
-Termination : it ends anteriorly by dividing into 2 veins
passing along the free margins of the foramen magnum to join
the end of sigmoid sinus
5-basillar plexus of sinus

It is formed of plexus venous channels lying on the clivus of the
skull
It communicates on each side with the inf. Petrosal sinus
It communicates with the internal vertebral venous plexus
6-sphenoparietal sinuses :
Run along the free margin of the lesser wing of spheniod
It communicates with the middle meningeal v. & dural v.v.
It end by joining the antero-lateral ascpect of cavernous sinus
256
257
7-Cavernous sinuses
Site:
On the side of body of sphenoid
Extents:
from sup. Orbital fissure to apex of petrous temporal bone
Relations:
Ant.: sup. Orbital fissure
Post. : apex of petrous temporal bone
Med. ; pituitary gland
Lat. : uncus of temporal lobe of brain
Sup. : I.C.A.
Inf. : body of sphenoid & sphenoidal air sinus
258
259
O TOM CAT:
O TOM are lateral wall components, in order from superior to
inferior.
CA are the components within the sinus, from medial to
lateral.
CA ends at the level of T from O TOM.
·
Occulomotor nerve (III)
Trochlear nerve (IV)
Ophthalmic nerve (V1)
Maxillary nerve (V2)
Carotid artery
Abducent nerve (VI)
T: When written, connects to the T of OTOM.
Tributaries & communications of the sinus:

Ant: ophthalmic vs. & central v. of retina
Med. : intercavernous sinuses
Upper : cerebral vs.
Lower : pterygoid plexus of veins
Drainage of cavernous sinus:

Sup. Petrosal sinus to transvers sinus
Inf. Petrosal sinus to I.J.V.
Clinical importance:
Infection in dangerous area of face may reach to cavernous
sinus lead to cavernous sinus thrombosis
8-sup. Petrosal sinus :

-It begins from the post. End of cavernous sinus
-It runs along the upper border of the petrous part of
temporal bone in the attached margin of the tentorium
-It ends by joining the transvers sinus
260
9-inf. Petrosal sinus :
-Begins from the post end of cavernous sinus
-Run in the petro-occipital sulcus to reach the jugular
foramen
-End by opening into the sup. Bulb of I.J.V.
10-transvers sinus :
-It begins at the int. ocipital protuberance as follow:
The RT. Sinus is the continuation of the sup. Sagittal sinus
The LT. sinus is the continuation of the stright sinus
-It run in transvers sulcus in the attached margin of tentorium
-End opposite the mastoid temporal bone to become sigmoid
sinus
-Tributaries :
Inf. Cerebral v.v.
Inf. Anastomotic v.v. of brain
Sup. Petrosal sinus
-Surface anatomy :
Abroad line extending from the inion to the base of mastoid
process
11-sigmoid sinus :
-Begins : as a continuation of the transvers sinus
-Runs dowenwards & medially in sigmoid sulcus
-Ends by passing through the post. Compartment of jugular
foramen to become the I.J.V.
-Clinical importance:
The sigmoid sinus lies behind the tympanic cavity & mastoid air
cells
Their infection may extend to the sinus causing its thrombosis
-Surface anatomy : broad line along the post. Border of
mastoid process (from base to apex )
261
The orbit
Bony wall: formed of :
Apex , base & 4 walls
262
263
Foramina:
-optic f. :
Passing: optic n. ( surrounded by meninges)
Ophthalmic a.
-sup. Orbital fissure:

Passing: 3th , 4th , 5th , 6th cranial n.
Ophthalmic vs.
-inf.orbital fissure:
Passing: infraorbital n. & a.
Zygomatic n.
Orbital br. Of sphenopalatine ganglion
Emissary v. between inf.orbital v. & pterygoid plexus
Ant. Ethmoidal f. : passing ant. Ethmoidal ns & vs.-

-Post. Ethmoidal f. : passing post. Ethmoidal ns. & vs.
-Infra-orbital groove & canal : passing infra-orbital n. & vs.
Content of orbit
*Eye ball
*Lacremal apparatus
*7 extraoccular ms.
*nerves Of the orbit:
-special sensory : optic n.
-general sensory: ophthalmic n.
-motor nerves: oculomotor , trochlear , abducent ns.
-autonomic nerves: symp. , parasymp. & ciliary ganglion
*Vessels: ophthalmic a. – sup. & inf. Opthalmic vs.
*Orbital ligaments, fascia & fat
264
Eye ball
Formed of wall & cavity:
Wall:
-outer fibrius coat ( cornea & sclera )
-middle vascular coat ( choroid – ciliary body – iris )
-inner nervous coat : retina
Cavity: contain
-aqueous humour
-vitreous body
-the lens
265
Lacrimal apparatus
-lacrimal gland & its duct:

Has 2 parts ( main & palpebral ) supply by lacrimal n. & a.
Recieve parasymp. From greater superficial petrosal br. Of
facial n.
-conjunctival sac
-lacrimal puncti,canaliculi& sac
266
Extra ocular muscles
267
Origin: post. Part of the roof of orbit
Insertion: skin & tarsus of upper eye lid
symp. Fibers to deep part of m. ( mullers m.)
action: elevate upper eye lid
268
4 recti ms.:
Origin: from tendnious ring like names
Insertion : sclera & corno-scleral junction
n.supply: all from occulomotor n.
except: lat. Rectus : from abducent n.
action: as its named
269
the oblique muscles
1-sup. Oblique:
Origin: post. Part of roof of orbit
Insertion:
lat. Ascpect of eye ball . between sup. & alt. rectus ms.
n.supply: trochlear n. ( S.O.4)
Action: ( look to your shoulder )
Depreesed , abducts & rotates eye lateraly
2-Inf. Oblique:
Origin: floor of orbit
Insertion: lat. Ascpect of eye ball
action:elevates , abducts & rotates eye lateraly
nerve supply of extraoccular ms.

All are supplied by occulomotor n. except:
-lat.rectus m. : by abducent n. (L.R.6)
-sup. Oblique m. : by trochlear n. (S.O.4)
270
271
Ophthalmic veins
-sup. Ophthalmic v.:
From tributaries corresponding brs. Of ophthalmic a.
Run above optic n.
Pass through sup. Orbital fissure to reach cavernous sinus
Communicates with ant. Facial v.
-inf. Ophthalmic v.:
From small veins in floor of orbit
Run below optic n.
Pass through sup. Orbital fissure to reach cavernous sinus
Ends in sup. Ophthalmic v.
Communicates with pterygoid plexus through inf. Orbital
fissure
272
Orbital ligaments
-suspensory lig. To eye ball
To supporting eye ball
Below eye ball
Attached med. To lacrimal bone & lat. To zygomatic bone
-check ligs.: ( med. & lat. )

Attached from med. & lat. Recti ms. To med. & lat. Wall of
orbit
To limit contraction of these ms.
273
Orbital fascia
-orbital periosteum :
Enclose all content except ( infraorbital & zygomatic ns)
-orbital septum:
Fused with tarsi of eye lid & orbital periosteum
Pierced by :
Levator palpebral superiories
Supraorbital & supratrochlear ns. & as.
Palpebral part of lacrimal gland
-bulber fascia ( tenons capsule)

From corno-scleral junction to optic n.
Pierced by:
Optic n.
Tendon of extraocullar ms.
Cilliary vessels & nerves
274
275
Pharnyx
-muscular tube from base of the skull to lower border of c6

cervical vertebrea
-Expanded from side to side & compressed ant. Post.

-covered inside& oute side by deep fascia
-wall consist of
Arranged from inside outward
mucous membrane
submucus coat
Pharyngo- basilar fascia
Pharyngeal muscles
Bucco- pharyngeal fascia ( cover buccinator ms infront)
276
277
Nerve supply of pharynx:
-Pharyngeal plexus at outer surface of sup. Constrictor m.
Nerves:
-Pharyngeal br. Of vagus : motor & parasympathetic
-Pharyngeal br. Of glossoph. N. : sensory
-Pharyngeal br. Of sup. Cervical symp. Ganglion : sympathetic
Arterial supply:
Ascending pharyngeal br. Of ECA
Ascending palatine & tonsilar brs. Of facial a.
-Pharyngeal brs. Of sup. Thyroid a.
-Pharyngeal brs. Of inf. Thyroid a.
Venouse drainage:
Pharyngeal plexus of veins , facial v. & IVC
Lymphatic drainage:
Retropharyngeal LNs & deep cervical LNs
278
Relations of pharynx
Sup. Relation : base of the skull
Post. Relations: bodies of upper 6 cervical vertebrea
Ant. Relations: nasal cavity , oral cavity , larynx
On each side:
Carotid sheath ,Great vessels & nerves of neck
Styloid process & structures attached to it
279
280
Gaps in lat wall of pharynx
Because narrow origin & wide insertion of constrictor ms.
-1st gap:
Between base of the skull & upper border of sup. Constrictor
It is occupied by 2 ms. ( tensor palati & levator palati )
Pharyngo-tympanic tube inbetween
-2nd gap:
Between lower border of sup. Constrictor m. & upper border
of middle constricrtor m.
It is occupied by ( muscle , lig. , nerve)
Stylo-pharyngeus m. , stylohyoid lig. & glossopharyngeal n.
-3rd gap:
Between lower border of middle constrictor m. & upper border
of inf. Constrictor m.
Traversed by : internal laryngeal nerve & sup. Laryngeal a.
Pierces thyrohyoid membrane
281
Cavity of pharynx
1-nasopharynx:
Show the followinf features:

-nasopharyngeal tonsile ( odontoids)
It is collection of lymphoid tissue in post. Wall of nasopharynx
Form with palatine tonsile & lingual tonsile acontinuous ring
of lymphatic tissue called waldeyer ring
-opening of eustachian tube:

At level of inf. Concha
-tubal elevation: at opening of eustachian tube
-salpingo-pharyngeal fold:
From tubal elevation produces by salpingo-pharyngeal ms.
-pharyngeal recess:
Space behind salpingo-pharyngeal fold
Communications of nasopharynx:
-nasal cavity throgh post. Nasal opening
-tympanic cavity through eustachian tube ( pterygo tympanic )
-oropharynx below through pharyngeal isthmus
282
283
2-Oropharynx:
behind oral cavity
Extend from soft palat to the epiglottis
Communicates with oral cavity by narrow isthmus
Palatine tonsil present on each side of oropharnx
284
3-Laryngopharynx:
Behind larynx
Extend from epiglottis above to cricoid cartilage below
Ant. Wall formed by laryngeal orifice
Lat. Wall show depresed area called piriform fossa
Continuous below oesophagus
The recess between tounge & epiglottis called valleculla
285
Palaetine tonsil
Structure: incomplete mass of lymphoid tissue surrounded by
capsule
Site: tonsillar fossa on lat. Wall of nasopharynx
Surfaces:
Lat. Related to :Sup. Constrictor ms.
Med. Related to : free surface presenting 12-15 tonsillar crypts
286
Relations :
Sup. : soft palate
Inf. : dorsum of tongue
Ant. : palatoglossal fold contain palatoglossus m.
Post. : palatopharyngeal fold contain palatopharyngeal m.
Med. :free surface
Lat.: sup. Costrictor m. & facial a.
n.supply:
lesser palatine n. : br. Of sphenopalatine ganglion
glossopharyngeal n.
arterial supply:
tonsillar br. Of facial
tonsillar br. Of ascending pharyngeal , ascending palatine &
greater palatine a.
287
Hyoid bone
-Site : below the tongue & infront of epiglottis opposite the disc
between C2,3
-Structure :
body
lesser horns : project upward
greater horns : project backward
- muscles arising from hyoid bone :
Hyoglossus m.
Middle constrictor m. of pharynx
( from greater horn )
-muscles inserted into hyoid bone :

1- supra-hyoid muscles
Stylo-hyoid m.
Mylo-hyoid m.
Genio-hyoid m.
2-infra-hyoid muscles
Omo-hyoid m.
Sterno-hyoid m.
Thyro-hyoid m.
- ligaments attached to hyoid bone :

Stylo-hyoid lig.
Thyro-hyoid membrane
Hyo-epiglottic lig.
-Functions:
Acts as centre for muscles acting on
( tongue , pharynx & larynx)
288
289
Styloid apparatus
Definition :
It is the styloid process & structure attached to it
- 2 ligaments : stylomandibular lig & stylohyoid lig.
- 3 muscles : styloglossus , stylohoid & stylopharyngeal muscles
1-stylo-mandibular lig.:
From styloid process above
to post. Border of angle of mandible below
it separetes the lower pole of parotid from the post. End of
submandibular gland
it is accessory ligaments of T.M.J.
2-stylo-hyoid lig. :
from styloid process above
to the lesser horn of hyoid bone below
-it lies between the sup. & mid. Constrictor muscles of pharynx
-give origin to the middle cinstrictor m.
-embryologically , arise from the 2nd pharyngeal arch
1-stylohyoid m.
Origin: post. Aspect of styloid process
The tendon split by intermediate tendon of digastric m.
n.supply: 7th cranial n.
embryological origin : 2nd pharyngeal arch
action: elevate hyoid bone
2-styloglossus muscles :
embryological origin : occipital myotomes
n. supply : hypoglossal n.
290
3-stylopharyngeus m.:
Origin: styloid process
n.supply : glossopharyngeal n.
embryological origin : 3rd pharyngeal arch
action: elevate pharynx& larynx during swallowing
the 3 muscles of styloid prosess have the same origin &

different insertions
at pelvis the 3 muscles have the different origin & the same
insertion
291
292
293
Oral cavity
It devided into 2 parts : vestibule & mouth proper
1- the vestibule of the mouth ( labial cavity )
Extend from
Externally : the lips & cheeks
Internally : the gums
2-the cavity of the mouth proper ( buccal cavity)

The roof : formed by the hard & soft palate
The floor : formed by the tongue & mucous membrane lies on
the sublingual salivary glands & mylohyoid muscle
Its sides : formed by dental arches carrying the teeth
The buccal cavity communicates posteriorly with the

oropharynx through the oropharyngeal isthmus
294
The tongue
Structure : it is mass of muscle envelope of mucous membrane
Site : at the floor of oral cavity
295
Parts of the tongue :
1- root : it is the post. Part through which the muscles
connecting the tongue with the hyoid bone & mandible
2-lip & margins : opposite gums & teeth
3-lower surface :
It is related to the floor of the mouth
It show :
-Frenulum lingulae : raised fole of mucosa in the middle line
-The deep lingual veins on each side of the frenulum lingulae
-the fimbriated fold is Lat. To the deep lingual veins
which is raised fold of mucosa having fimbria
4-dorsum of the tongue ( upper surface )

- it is devided by v shaped groove ( sulcus terminalis )
Into : ant 2/3 ( oral part ) & post. 1/3 ( pharyngeal part )
-The apex of sulcus terminalis is directed posteriorly &
presents the foramen called foramen coecum
296
297
Ant. 2/3 of dorsum of Post 1/3 of dorsum of
tongue tongue
Name Called the palatine or Called the pharyngeal
buccal part part
position Looks upwards Looks backwards
(forming the ant. Wall of
oropharynx)
papillae 1-filliform papillae :
small & numerous
2-fungifom papillae :
at the tip & the margins No papillae
3-vallate papillae :
infront of sulcus
terminalis & full the taste
buds
Lingual tonsils absent present
Embryological From the endoderm of From the endoderm of
origin 1st pharyngeal arch 3rd pharyngeal arch
Nerve supply 2 nerves : One nerve:
1- lingual n. : carry The
general sensation glossopharyngeal
2-chorda tympani : nerve : carry all
carry taste sensation sensations
298
Muscles of the tongue
1-intrensic muscles :
-Lies inside the tongue
-Have no bony attachments
They include :
-vertical muscle fibers
-transvers muscle fibers
-sup. Longitudinal muscle fibers
-inf. Longitudinal muscle fibers
They all supplied by hypoglossal n.
2-extrinsic muscles
They arise from neabry bones & inserted into the tongue
They include :
Genioglossus m.
Hyoglossus m.
Styloglossus m.
Palatoglossus m.
They all supplied by hypoglossal n. except

the palatoglossus ( supplied by vagus n. )
299
300
-genioglossus muscle :
origin : upper genial tubercle of mandible
insertion : the whole length of under surface of tongue
action :
single m. : pulls the tongue to the opposite side
the 2muscles : pull the tongue directly forward
hyoglossus muscle :-
origin : body of hyoid bone & greater horn
insertion : post 1/2 of side of tongue
action : depresses the tongue
-styloglossus muscles :
-palatoglossus muscle:
glossal fold
action : pulls the tongue upwards to close the oropharynx in the
1st phase of deglutination
301
302
nerve supply of the tongue
1-motor supply :
Hypoglossal n. supply all muscles of the tongue
except palatoglossus m. which is supplied by the cranial
accessory n. ( through vagus )
2- sensory supply :
a- ant. 2/3 of the mucous membrane
-the general sensation carried by lingual n. (mandibular n.)
-the taste sensation carried by chorda tympani ( facial n.)
b-post. 1/3 of the mucous membrane

all sensations are carried by the glossopharyngeal n.
sympathetic supply to tongue is from superior cervical

ganglion via lingual artery
arterial supply : lingual a.
303
venous draniage : the lingual v. which drains into I.J.V.
lymphatic drainage :
-the ant. 2/3 of tongue
The tip drains into the submental L.N.
The margins drain into the submandibular L.N. to the upper
deep cervical L.N.
-the post. 1/3 of tongue

Drains into the upper deep cervical L.N.
304
The palate
It is partition separating the nasal cavity above from the oral

cavity below
- it is formed of 2 parts :
Hard palate : bony septum between nose & mouth
Soft palate : fleshy septum between nasopharynx &
oropharynx
The soft palate

Functions :
-during respiration : it relaxed to allowing the passage of air
-during swallowing : preventing the food & fluid regurgitation
into nasopharynx
305
Structure of the soft palate:
It is formed of : a-palatine aponeurosis
b-palatine muscles
A- palatine aponurosis :
it is expanded tendon of tensor palati m. which is attached to
the post. Border of hard palate
it gives attachment to all palatine muscles
306
B-palatine muscles :
tensor palati m.
levator palati m.
palatoglossus m.
palatopharyngeus m.
1-tensor palati m. :
Origin : from the scaphoid fossa of the base of the skull
& the lat. Surface of austachian tube
Insertion :
-by tendon around the pterygoid hamulus
-Then expand to form the palatin aponeurosis which attached
to the post. Border of hard palate
-The aponeurosis of RT. & LT. muscles join each other in the
median plane
Action :
-makes the soft palate tense & tight
-Separating the oropharynx from nasopharynx during
swallowing
-Keep the eustachian tube patent
Relations :
Superiorly : base of the skull
Inferiorly : sup. Constrictor muscles
Medially : eustachian tube
Laterally : the 2 pterygoid muscles
* structures between the tensor palati m. & the pterygoid

muscles :
-Mandibular n. & its branches
-Otic ganglion
-Chorda tympani
-Middle & accessory meningeal a.a.
307
2-Levator palati muscle :
Origin : from the apex of petrous part of temporal bone
& the medial acpect of eustachian tube
Insertion : into the upper surface of palatine aponurosis
Action :
Elevates the stiffened soft palate
-Shutting off the nasopharynx from the oropharynx
-open the eustachian tube for pressure squilibration
glossal fold
action :
pulls the tongue upwards to close the oropharynx in the 1st
phase of deglutination
4-palatopharyngeus muscle :
Origin : from the lower surface of palatine aponeurosis
Insertion : into the post. Border of thyroid cartilage to form
the palato-pharyngeus fold
Action :
pull the larynx up
Shortens the pharynx in 2nd phase of deglutition
5-Musculus uvulae :
Origin : from the post. Nasal spine of hard palate
Insertion : into the mucous membrane of uvula
Action : pull the uvula to its own side
308
309
Nerve supply of the palate
1-motor :
All palatine muscles are supplied by
the cranial accessory n. ( through vagus n. )
Except the tensor palati muscle which is supplied by
mandibular n.
2-sensory :
-hard palate :
by the greater palatine
long spheno-palatine n.n.
the nasopalatine nerves from the maxillary division of the
trigeminal
-soft palate :
by lesser palatine nerve
These nerves also supply the inner surface of the gums.
310
Joints of the head & neck
1- temporo-mandibular joint ( T.M.J.)
-Type & variety : synovial of condylar varity
-Articular surfaces :
Above : the articular fossa & the articular tubercle of temporal
bone
Below : the head of mandible
-Capsule : attached around the articular surfaces

Gives attachment to the tendon of insertion of ptrygoid muscles
-The intra-capsular articular disc

The intra articular disc ( fibrocartilage) divided the joint cavity
into upper & lower comparment
-the upper surface of the disc is concavo-convex to be fit into
the articular surface above
-the lower surface is concave to fit into the head of mandible
311
312
-Accessory ligaments :
1- lateral tempomandibular lig. :
-Triangular in shape
Its base attached to articular eminence of the skull (the root of
zygoma)
The apex attached to the lat. Acpect of neck of mandible
It is the main lig. Of T.M.J.
2-stylo-mandibular lig.:
From styloid process to post. Border of ramus above the
angle of mandible
3-spheno-mandibular lig. :
From spine of sphenoid to the lingula of mandible
4-pterygo-mandibular lig. :
From pterygoid hammulus to post. End of mylohyoid line
Nerve supply of the joint :

Auriculo-temporal n. & masseteric n.
313
314
2-Atlanto-occipital joints
It is articulation between the occipital condyle of the skull &
the sup. Kidney shaped articular surface of 1st cervical
vertebra ( atlas)
Type & variety : it is synovial of condylar variety

Articular surface :
-above : the occipital condyles of the skull
-below : the sup. Articular facets of the atlas
Capsule : attached around the articular surface

Ligaments :
1- ant. Atlanto-occipital membrane :
From the upper border of ant. Arch of atlas
To the ant. Margin of the foramen magnum of the skull
2- post. Atlanto-occipital membrane :

From the upper border of the post. Arch of atlas
To the post. Margin of the foramen magnum of the skull
-Movement occuring in the atlanto-occipital joints

Flexion & extension ( nodding)
Slight lat. Flexion
Muscles producing movements:

Flexion : by longus capitis & rectus capitis ant.
Extension : by rectus capitis post. Major & minor
Splenius capitis & semispinalis capitis
315
316
3-Atlanto-axial joints
A- 2 lat. Atlanto-axial joints
Type : plane synovial
Articulation surfaces :
Above :The inf. Circular shape articular facet of the atlas
Below :To the facet on the upper surface of the body of axis
B- med. Atlanto-axial joint

Type : synovial of pivot variety
It lies between
-the odontoid process of the axis
-the ossuo-fibrous ring formed by the ant. Arch of atlas & the
transvers lig. Of atlas
Movement of the atlanto-axial joint : rotation
317
Ligaments Uniting the Atlas, the Axis and the Occipital Bone
1. The anterior longitudinal ligament (continued upwards from

lower vertebrae) is attached to :
the front of the body of the axis;
to the anterior arch of the atlas;
and to the basilar part of the occipital bone .
2. Between the atlas and the occipital bone, the anterior

longitudinal ligament is incorporated in the anterior
atlanto-occipital membrane.
This membrane is attached :
below to the upper border of the anterior arch of the atlas,
above to the anterior margin the foramen magnum.
3. The posterior atlanto-occipital membrane is attached :

below to the upper border of the posterior arch of the atlas
above to the posterior margin of the foramen magnum,.
[The ligament has a free inferolateral margin. The vertebral
artery enters the vertebral canal by passing deep to this edge].
4. The highest ligamentum flavum connects the posterior arch

of the atlas to the laminae of the axis vertebra.
1-membrana tectoria :
it is upper continuation of post. Longitudinal lig. Of the
vertebral column
It extend from the back of the body of axis
To the basilar part of occipital bone infront of f. magnum
2-Alar ligaments :
Extend from the sides of odontoid process
To the medial sides of occipital condyles
318
3-Apical ligament :
Extend from the tip of odontoid process
To the ant. Margin of the foramin magnum
7. the transverse ligament of the atlas stretches between the two
lateral masses of the bone, behind the dens of the axis.
319
320
The prevertebral region
It is the region infront of the vertebral region

It contains :
-the prevertebral muscles
-the prevertebral fascia
- 1st & 2nd parts of vertebral artery
- Vertebral vein
The prevertebral muscles

Rectus capitis anterior
Rectus capitis lateralis
Longus colli ( cervicalis )
Longus capitis
All are supplied by ventral rami of cervical nerves
Blood vessels in the back of the neck

1- deep cervical artery
2- 3rd part of vertebral artery
3- descending br. Of occipital artery
4- suboccipital plexus of veins
1-deep cervical artery .:

arise from costo-cervical trunk ( 2nd part of subclavian a.)
Ascend in neck to reach the suboccipital triangle to
anastomosis with descending br. Of occipital a.
321
2-vertebral artery :
Origin : 1st part of subclavian a
Course & relations : the artery divided into 4 parts
1st part:
From its origin to tr. Procsee of c6
In vertebral triangle pass between longus colli m. (med.)
& scalenus ant. (lat)
Ant. Relations:
C.C.A - inf. Thyroid a. – thoracic duct – vertebral v.
Post. Relations:
Inf. Cervical symp. Ganglion – 7th & 8th cranial ns.
-2nd part: in tr. Foramina of upper 6 cervical vertebrae

Relations:
Nerves from c2 to c6
Symp. Plexus &plexus of veins
-3rd part: in suboccipital triangle

Pass in groove of upper surface of atlas
Relations: ant & post 1ry rami of c1
4th part :
Enter cranial cavity through f.magnum
Relations: on side of medulla in front root of hypoglossal n.
Ends:
At lower border of pons by join with other one to form basilar a.
Branches:
In the neck:
Spinal brs. : to supply spinal cord
Muscular brs. : to supply deep ms. Of neck
In the cranial cavity:

Ant & post. Spinal as.
Medullary brs.
Post. Inf. Cerebellar a.
322
3-occipital a.
Origin: from back of ECA
Course : has 4 parts
1st: deep to post. Belly of digastric m.
2nd: med. To mastoid process
3rd : cross apex of post. Triangle
4th :pierces trapezius m.
Branches:
Mastoid br. : through mastoid f.
Descending br.: in ms. In back & join with deep cervical a.
Terminal occipital brs.:
4-Suboccipital plexus of veins

Site : it is network of veins lies in the suboccipital triangle
Communications :
-occipital veins
- internal vertebral plexus of veins
-Sigmoid sinus ( via post. Condylar emissary vein )
Drainage :
into the vertebral venous plexus around vertebral a.
5-Nerves in the back

The skin & muscles of the back supplied by cervical nerves
-dorsal rami of C1 ( suboccipital nerve )
-dorsal rami of C2 ( greater occipital nerve )
-dorsal rami of C3 ( 3rd occipital nerve )
-Each dorsal eamus of cervical ramus ( except the 1st ) devided

into :
- lat. Br. ( motor )
- med. Br. ( motor & sensory )
The dorsal rami of C1 dose not devided & is motor
-the dorsal rami supply all muscles in the back except trapezius
& levator scapulea
323
Nasal cavity
The cavity of the nose is divided into:
RT. & LT. halves by the nasal septum
-Each cavity opens on the face by the nostril
Opens posteriorly on to the nasopharynx by the post. Nasal
aperature ( choana )
324
325
-Boundaries of nasal cavity :
-the roof
-the floor
-the medial wall
-the lateral wall
326
The roof has the following parts :
1-ant. Sloping part : formed by the nasal bone
2-middle horizontal part : formed by cribriform plate of
ethmoid
3-post. Sloping part : formed by the body of sphenoid
The floor : formed by the hard palate
The medial wall ( nasal septum ) formed by :

Septal cartilage anteriorly
Perpendicular plate of ethmoid postero superiorly
Vomer bone postero inferiorly
The lateral wall :
Irrigular & has the following features :

1-the vestibule
2-atrium
3-Nasanl conchae :
3 elevation separated by spaces
( sup. , middle & inf. Concha )
The conchae are covered by thick highly vascular mucous
membrane
4-nasal meatuses :
These are spaces below each concha
-Sup.meatus:
Below sup. Concha
It receives the opening of the post ethmoidal air sinuses
-Middle meatus :
Below middle concha , it has the following features :
-bulba ethmoidalis : round elevation
-hiatus semilunaris : cresentric groove below the bulla
Receive the opening of :
( arranged from before backward )
327
Ant. Ethnoidal air sinuses
Frontal air sinus
Maxillary air sinus
Inferior meatus :
below the inf. Concha
Receive opening of naso-lacrimal duct
5-Spheno-ethmoidal recess :
Triangular fossa between the sup. Concha & the roof of the nose
It receive the opening of the sphenoidal air sinus
328
329
Blood supply of nasal cavity:
Arterial supply:
-Ant. & post. Ethmoidal branches of ophthalmic a.
-Sphenopalatine br. Of maxillary a.
-Greater palatine br. Of maxillary a.
-Septal br. Of sup. Labial br. Of facial a.
Venous drainage :
By veins accompanying the arteries with rich arterio-venous
shunt
330
Lymphatic drainage of the nasal cavity
-the ant. Part : drains into the submandibular lymph node
-the post. Part : drains into the upper deep cervical lymph node
331
Nerve supply of nasal cavity
A-nerve supply of lat. Wall

1-Olfactory nerves : carry smell sensations from the olfacrory
mucosa in the roof
2-branches of trigeminal nerve carry general sensation
3-lat. Int. nasal br. Of ant. Ethmoidal n.

Supply the ant. Sup. Part
4-nasal br. Of ant. Sup. Alveolar n.

Supply the ant. Inf. Part
5-short sphenopalatine n.
Supplies the post. Sup. Part
6-Greater palatine n.
Supplies the post. Inf. Part
B-nerves supplying the med. Wall ( nasal septum )
1-olfactory nerves :
Carry smell sensation from the olfactory mucosa in the roof
2-branches of trigeminal nerve

( carry general sensation)
3-med. Int. nasal br. Of ant. Ethmoidal n.

Supply the ant. Part
4-long sphenopalatine n.
Supplies the post. Inf. Part
5-Short sphenopalatine n.
Supplies the post. Sup. Part
332
Paranasal air sinuses
Def. : they are air filled spaces inside the skull bone
Open in the lat. Wall of the nose
Functions :
-Give resonance of the voice
-Diminish the weight of the skull
-Warming & humidification of air
-Protection of brain against changes of temp.
333
Paranasal sinus
1-sphenoidal air sinus
inside the body of sphenoid bone

It open into the post. Part of spheno-ethmoidal recess
334
2-frontal air sinuses
Behind supraciliary arch
Open into the middle meatus of the nose
335
3-ethmoidal air sinuses
Ant. , middle & post groups inside the ethmoidal
labrynthin
The post group open into the sup. Meatus
The ant. & middle group open into the middle meatus
336
4-Maxillary air sinus
Site : fill the body of maxilla
Size : the largest paranasal sinus
Shape & relations :

It is pyramidal in shape having
-apex : at zygomatic processof maxilla
-Base :
directed medially & formed by the lat. Wall of the nasal cavity
Contain the opening of the sinus
-roof : formed by the orbital plate maxilla

It is traversed by the infra-orbital canal
-Floor :formed by the alveolar process of maxilla

-Ant. Wall : formed by the ant. Wall of maxilla
Contains the canal for the ant. Sup. Alveolar n. ( canalis
sinous)
-post. Wall : formed by the post. Wall of maxilla

Contains the canal for the post. Sup. Alveolar n.
Opening of the sinus:

Situated in the medial wall
Open into the hiatus semilunaris of middle meatus of nose
Nerves related to the sinus;

-ant. Sup. Alveolar n.
-middle sup. Alveolar n.
Run in the ant. Wall of the sinus
-post. Sup. Alveolar n. :

Run in the post wall of the sinus
-inf. Orbital n. :
Run in the roof of the sinus ( infra-orbital canal )
337
Nerve supply :
-Sup. Alveolar n.
-Infra-orbital n.
-Greater palatine n.
338
Larynx
It is the organ of voice & act as air passage
Site:
Extend from the root of tongue to trachea
From C3 vertebra to C6 vertebra
Relations :
-anteriorly :
skin , fascia & infrahyoid muscles
-postriorly : pharynx
-on each side : lat. Lobe of thyroid & carotid sheath
Structure of larynx :
It is formed by anumber of cartilages which connected together
by ligaments & membranes
Lined by mucouse membrane & moved by muscles
339
340
cartilages of larynx:
A-single :
1-Epiglottis
2-Thyroid cartilage
3-Cricoid cartilage
B-paired:
4-Arytenoid cartilage
5-Corniculate cartilage
6-Cuniform cartilage
1-epiglottis
It is leave like lamella of elastic cartilage
It project behind the tongue
The upper end: narrow & persrnt in the inner ascpect of
thyroid prominence
The lower end : wide & free
2-Thyroid cartilage:
It is 2 lamella separated posteriorly & united anteriorly
To form the laryngeal prominance ( adam apple)
-the angle between 2 lamella is 90 in males & 120 in females

The post. Border of each lamina has 2 horns:
-Sup. Horn :
attached with the greater horn of hyoid bone by
lat. Thyrohyoid lig.
-Inf. Horn : articulate with cricoid cartilage at the crico
thyroid joint
-the lat. Surface of the lamina shows an oblique line
3-cricoid cartilage ( below thyroid cartilage)

Rounded in shape
It has broad lamina posteriorly & narrow arch infront
-The upper border articulate with the arytenoid cartilages
-The anterolateral aspect of the arch articulates with inf. Horn
341
4-arytenoid cartilages ( RT. & LT. )
Each one articulates with the upper border of cricoid cartilage
Each one is pyramidal shape having:

-apex : (above) : articulate with corniculate cartilage
-base (below) : articulate with cricoid cartilage
-vocal process : attachment to vocal lig. (cord)
-muscular process : gives insertion to the muscles move the
arytenoid cartilage
5-corniculate cartilages : (RT. & LT. )

Lying on the apex of arytenoid cartilage
6-cuniform cartilages (RT. & LT.):

Lying infront of the corniculate cartilage in the oryepiglottic
fold
342
Membranes of the larynx
1-thyrohyoid membrane:
Extend from hyoid bone ( above)
To the thyroid cartilage ( below)
It is pierced by :
internal laryngeal n. & sup. Laryngeal a.
2-the quadrate membrane:

It is upper part of fibro-elastic membrane of larynx
It extend from the arytenoid cartilage & the epiglottis
Its lower border is thickened to form the vestibular fold ( fals
cord)
3-cricothyroid membrane & lig. :

It is the lower part of fibro-elastic membrane of larynx
It connects the thyroid , cricoid & arytenoid cartilage
-The ant. Median part of this membrane called the median

cricothyroid lig.
-The lat. Part of this membrane called the cricovocal

membrane
It is attaches below to the cricoid cartilage
-The upper border called ( true vocal cord) attached to :

-Inner aspect of thyroid prominence anteriorly
-The vocal peocess of arytenoid cartilage posteriorly
-the vocal cord is formed by vocal lig.
Covered by mucous membrane
343
Muscles of the larynx
-general rules :
They are intrensic muscles
( have no attachment outside the laryngeal cartilages)
All of them present inside the larynx except the cricothyroid
muscle
All of them supplied by recurrent laryngeal n. except the
cricothyroid which supplied by the external laryngeal n.
344
Muscles of larynx devided into 5 groups
according their action :

-transvers arytenoids muscle
- 2 ary-epiglottic muscles

The 2 thro-arytenoid muscles -

The 2 crico thyroid muscles

The 2 post. Crico-arytenoid muscles

The single transverse arytenoid muscle
The 2 lat. Crico-arytenoid muscles
345
Cavity of the larynx
The cavity devided into 3 compartments by 2 folds

extend from befor backwards
-upper fold called vestibular folds ( false vocal cords )
-lower fold called vocal folds ( true vocal cords )
346
-compartments of the larynx :
-Upper compartment : vestibule
Above the vestibular folds
-Middle compartment : ventricle or sinus of the larynx

Between the vestibular folds above & the vocal folds below
-Lower compartment : infra-epiglottic

Below the vocal folds & continuos with the trachea
Rami vestibuli : it is the space between the 2 vestibular folds

Rami glottidis : it is the space between the 2 vocal folds
The laryngeal orifice or inlet

It is bounded by:
Above & front : the epiglottis
On each side : the 2 aryepigllotic folds
Below & behind : inter arytenoid fold
Arterial supply of larynx :

Sup. Laryngeal n. ( br. Of sup. Thyroid a. )
Inf. Laryngeal a. ( br. Of inf. Thyroid a. )
Venous drainage :
-Veins of The upper part join the sup. Thyroid v. to ends in
I.J.V.
-Veins of the lower part join the inf. Thyroid v. to ends in

innominate v.
Lymphatic drainage of the larynx :

-Lamphatics of the vocal cords & upper part of larynx drain
into the upper deep cervical LN.
-Lymphatics of the lower part drain into the lower deep

cervical LN. & prelaryngeal LN.
347
348
Nerve supply of the larynx
A-motor supply of the laryngeal muscles
All laryngeal muscles supplied by the recurrent laryngeal n.
( br. Of vagus )
Except the cricothyroid muscle supplied by the external
laryngeal nerve ( br. Of sup. Laryngeal n. from vagus )
B-Sensory supply of the mucous membrane:

-Above the vocal cords is supplied by the int. laryngeal n.
( br. Of sup. Laryngeal n. of vagus ) which enters the larynx
through the thyrohyoid membrane.
-Below the vocal cords is supplied by the recurrent laryngeal

n. ( br. Of vagus ) (which is therefore a mixed nerve) which
enters the larynx just behind the cricothyroid joint.
349
Detalies of the nerves :
1-sup. Laryngeal n. ( mixed) :

Deep to ICA & ECA divided into :
a-internal laryngeal n. ( sensory)

supply: m.m. of upper 1/2 of larynx
( above vocal cords)
b-external laryngeal n. (motor)

to cricothyroid m.
2-recurrent laryngeal n. ( mixed) :
a- RT. Recurrent laryngeal n.:

from RT. Vagus infront of 1st part of subclavian a.
ascend in RT. Groove between trachea & oesophagus close
related to med. Surface of thyroid gland & inf. Thyroid a.
b-LT. recurrent laryngeal n. :

from LT. vagus hooks around arch of aorta
ascend in LT. Groove between trachea & oesophagus close
related tomed. Surface of thyroid gland & inf. Thyroid a.
-each recurrent laryngeal n.

Deep to inf. Constrictor m. behind cricothyroid m. inside
ligament of burry with inf. Laryngeal a.
-Brs. Of recurrent laryngeal ns.:

-motor : to all laryngeal ms. Except. Cricothyroid m.
To trachea , oesoph. & inf. Constrictor m. of pharnx
-sensory : to m.m. of lower 1/2 of larynx ( below vocal cords)
350
The Ear
Consists of :
-external ear
-Middle ear
-Inner ear
351
External ear :
-The auricle
-external auditory meatus (canal )
-Ear drum
352
1-the auricle :
It is elastic cartilage except its lobule
-cutaneous nerve supply :
-The upper 1/2 of outer surface supplied by
auriculotemporal n.
-The upper 1/2 of inner surface supplied by

the lesser occipital n.
-The lower 1/2 of outer & inner surfaces supplied by

the great auricular n.
Small area of inner surface supplied by auricular br. Of vagus
353
2-The external auditory meatus
Length : about one inch ( 24 mm )
Parts:
-outer 1/3 :
Cartilagenous , 16 mm , directed upwards & backwards
-inner 2/3 :
Bony , 16 mm , directed downwards & forwards
3-the ear drum :

-Size : 10mm * 8mm
-Site : it lies between the external auditory meatus & the middle
ear cavity
-Position : obliquely
Its outer surface directed downward & laterally
-Structure :
Formed of :
-Outer layer of skin
-Middle layer of fibrous tissue
-Inner layer of mucous membrane
The middle fibrous layer form the major part of ear drum
Called the pars tensa
-Absent in the upper most part called pars flaccida
-The pars tensa & pars flaccida separated from each othe by 2
folds called the ant. & post. Malleolar folds
The antero-inferior quadrant of the ear drum is called the
cone of light
(because it reflects the light coming from the examinar mirror)
Nerve supply of the E.A.M. & ear drum

Auriculotemporal n. : supply the ant. 1/2
Auricular br. Of vagus n. : supply the post. 1/2
Tympanic plexus : supplies the inner surface of ear drum
The tympanic plexus is formed mainly the tympanic br. Of

glossopharyngeal n.
354
Middle ear cavity
( tympanic cavity)
Site : inside the temporal part of petrous bone

Shape : biconcave box
Its vertical axis is roughly parallel to the plane of ear drum
Surfaces ; roof , floor & 4 walls
The roof ( tegmental wall )

Formed by bone called tegmen tympani
It separates the middle ear cavity from the temporal lobe
in the middle cranial fossa
the floor (jugular wall )

It separates the middle ear cavity from the sup. Bulb of the
I.J.V. in the jugular fossa
It pierced by the tympanic br. Of glossopharyngeal n.
-Lateral wall
Formed by ear drum
-Anteroir wall
Contains the following structures ( from above downwards)
Upper : opening of canal for the tensor tympani m.
Middle : opening of the eustachian tube
Lower : the bone separating the middle ear cavity from the
carotid canal ( I.C.A.)
-Posterior wall
Contains the following structures ( from above downwards)
-The aditus opening to mastoid antrum
-The pyramid : it is the hollow process
-Its inner walls give origin of the stapedius m.
-The vertical part of facial canal medial to the aditus
355
-Medial ( labryinthine) wall
It separates the middle ear cavity from the internal ear
Show the following features:
-Rounded bulge called peomontary which produced by

the 1st turn of the cochlea of the inner ear
356
-Oval window :
lies above & behind the promontery
It closed by the foot of the stapes
It leads to the vestibule of the internal ear
-Round window :
lies below & behind the promontery
It is closed by the 2ry tympanic membrane
-The horizontal part of facial canal:

Arching above the promontery & oval window
357
The pharyngo-tympanic tube
Eustachean tube
-It is an osseo-cartilagenous canal

Connecting the tympanic cavity with the nasopharynx
-It is 36mm long

-The bony part is 12mm
the cartilagenous part is 24mm
It extend downward , & medially
The cartilagenous part gives origin to the tensoe tympani m.
Relations:
Superiorly: base of the skull
Inferiorly ; sup. Constrictor m. of pharynx
Medially : gives origin to the levator palati m.
Laterally : gives origin to the tensor palati m.
Otic ganglion & mandibular n.
Nerve supply :
from tympanic plexus & pharyngeal br. Of sphenopalatine
ganglion
358
359
Contents of middle ear
- 3 ossicles : malleus , incus & stapes

- 2 muscles : stapedius m. & tensor tympani m.
- 2 nerves : chorda tympani & tympanic plexus
360
A-The 3 ossicles
1-Malleus ( the lat. Ossicle)
It attached to the inner surface of the ear drum
Recives insertion of the tensor tympani m.
Its head articulate with the incus
2-Incus ( the intermediate ossicle )

Formed of the body & 2 processes ( long & short )
The body articulate with the malleus
The long prosess articulates with the head of stapes
3-Stapes ( the med. Ossicle )

Its head articulates with the long process of incus
Its foot closses the oval window of the internal ear
B-the 2 muscles
1-tensor tympani muscle
Origin : from the cartilagenous part of the eustachian tube-
-Insertion : run in the canal on the upper of the ant. Wall of
the middle ear cavity to inserted into the handle of malleus
-Nerve supply :
from n. to med. Pterygoid m.
( the main trunk of mandibular n. )
-Action : pull the tympanic membrane inwards to protecting it
from excesive movements
2- stapedius mscle
Origin : from the inner wall of pyramid of the post. Wall of
tympanic cavity
Insertion : into the post. Aspect of stapes
Nerve supply : n. to stapes from the facial n.
Action: damps down excessive movements of stapes
The 2 muscles damping down the intensity of high

pitched sound
361
C.the nerves inside middle ear
chorda tympani & tympanic plexus
1-chorda tympani
Origin : Arises from the facial n. & passes in the vertical part
of the facial canal
Course :
-It enter the middle ear cavity through the post. Canaliculus of
chorda tympani
-Run between the malleus & the m.m. of ear drum
-Leaves the middle ear through the ant. Canaliculus of chorda
tympani ( squamo-tympanic fissure ) to reach the infra temporal
fossa
-Ends by joining with lingual n. deep to lat. Pterygoid m.
-Parasymp. Fibers leave lingual n. to relay in submandibular

ganglion to supply submandibular & sublingual glands
-Taste fibers cotinue with lingual n. to supply m.m. of ant. 2/3
of tongue
362
363
2-tympanic plexus :
Site : on the promontary of cochlea of the medial wall of the

middle ear cavity
-It is formed by:

-the tympanic br. Of glossopharyngeal n.
-the cortico tympanic symp. Fibers from the plexus around the
I.C.A.
-It supplies :
-the mucous membrane of tympanic cavity
-The eustachian tube
-mastoid air cells
-Branches :
the lesser superficial petrosal n.
( preganglionic para symp. Fiber to the parotid gland )
The facial canal has ::

horizontal part in the med. Wall of tympanic cavity
The vertical part in the post. Wall of tymp. Cavity
Arterial supply of the middle ear

1-ant. Tympanic a. ( br. Of maxillary a.)
2-post. Tympanic a. ( br. Of post. Auricular a. )
2-sup. Tympanic a. ( br. Of middle meningeal a. )
4-inf. Tympanic a. ( br. Of ascending pharyngeal a. )
Lymphatic drainage :
Into the parotid & upper deep cervical LNs.
364
Internal ear ( labyrinth )
Site : inside petrous part of temporal bone

Structures :
It formed of 2 parts :
1-bony labyrinth :
body cavity inside the petrous temporal bone
2-membranous labyrinth :
inter connected saces & ducts inside the bony labyrinth
A.bony labryinth :
-lined by endothelium
-fielled by perilymph
-enclosing the membranous labyrinth
bony labryinth
Consists of 3 parts
-semicircular canals
-vestibule
-cochlea
365
366
1-semicircular canals:
Are 3 arched canals set at right angles to each other forming
the postero-superior part of bony labyrinth
-the superior semicircular canal

Lies vertical to the pertous temporal bone
-the posterior semicirculsr canal

Lies parallel to the petrous temporal bone
-the lateral semicircular canal

Lies in horizontal plane
The 3 canals open in the post. Aspect of the vestibule by 5

orifices
2-the vestibule:
(it is the central part of bony labyrinth)
-Its ant. Wall :

show opening of the scala vestibuli of the cochlea
-Its post. Wall :

recieves the opening of the 3 semicircular canals
-Its med. Wall :

forms the bottom of the int. auditory meatus
It perforated by the 8th cranial n.
Its lat. Wall : -

show the oval window of the midlle ear which is closed by the
foot of stapes
-The vestibule :
lodges the utricle & saccule ( membranous labyrinth)
367
3-the cochlea :
It is the ant. Part of the bony labyrinth
-Its base directed medially toward the bottom of internal

auditory meatus
It is perforated by the cochlear n.
-Its apex directed laterally called cupula
-The cochlear canal

lodges the cochlear duct of the membranous labyrinth
-From the modiolus

project aspiral ridge of bone called spiral lamina
Deviding the cochlear canal into :
scala vestibule above & scala tympanic below
368
B-membranous labyrinth
Structure : it consists of anumber of inter connected

membranous cavities inside the bony labyrinth
-Filled with fluid called endolymph

-Separated from bony labyrinth by fliud called perilymph
369
membranous labyrinth
Parts :
1-The semicircular ducts
2-Utricle
3- saccule
4-Cochlear duct
1-the semicircular ducts:
They lie on the corresponding bony canals
They open anterio-inferiorly in the utricle
Each duct has adilatation at its ends called the ampulla
2-The utricle (small uterus)

It occupies the upper & post. Parts of the vestibule
It receives the 5 opening of the semicircular ducts
3-The saccule ( small sac)

It occupies the antero-inf. Part of the vestibule
It connect with the cochlea by ductus reuniens
4-The cochlear duct ( inside the cochlear canal)
It extend around the modiolus

-From the modiolus
project aspiral ridge of bone called spiral lamina
-the cochlear duct lies between :

the scala vestibuli above & the scala tympani below
-It is separated from the scala vestibuli by

the vestibular membrane
-It is separated from the scala tympani by

the basilar membrane
-It contains the spiral organ of corti
( the sensory end organ of hearing)
370
Nerve supply of the labyrinth
It is supplied by the vestibulo-cochlear n. as follows:
-its vestibular division ( equilibrium )

-Its fiber are the central process of cells of the vestibular
ganglion ( at the bottom of the internal auditory meatus )
-The peripheral processes end in the utricle , the sccule & the
ampullary crests of the semicircular ducts
Its cochlear division ( hearing )

Its fiber are the central process of cells of the spiral ganglion
Inside the modiolus
-The peripheral processes are connected with the organ of

corti
371
Blood supply of the labyrinth
Arterial supply :
labyrinthine br. Of basilar a.
Stylomastoid br. Of post. Auricular a.
Venous drainage :
Into sup. Petrosal sinus or transvers sinus
372
‫حقوق الطبع محفوظة للناشر‬
‫رقم ايداع بدار الكتب‬
‫‪8048/2014‬‬
‫‪I.S.B.N. 977 00-2207-1‬‬
‫‪373‬‬

Head and Neck

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Head and Neck

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Anatomy capsule

Summary And Illustrations

HEAD & NECK

Lecturer ofAnatomy and Embryology

2-Muscles of the Neck

-Fascia of the neck

- nerves & ganglion

hyoid bone & styloid apparatus

- organs ( pharynx , larynx , orbit & tounge )

The skull forms the skeleton of the head.

-Consists of 22 bones, 21 of which are firmly bound together;

-In about 8% of cases the metopic suture persists in the midline

The anterior fuses at about 18 months.

Muscles attached & foramina

-lambda: point of meeting between sagittal & lambdoid sutures

-parital emissary foramen:

-Ext. occipital crest:

-Sup. Nuchal line:

-Highest nuchal line:

Muscles attached: non

Lie along vertical line pass between 2 premolar teeth

Each maxilla bears eight teeth.

-Styloid process: ( 2 lig. & 3 ms.)

-pterion: meet 4 bones

-Asterion : meet 3 bones

-infra. Temporal surface of greater wing of sphenoid origin to

Post. Nasal spine origin to musculus uvulae

Lat. Part of area infront of inf. Nuchal line insertion of

Med. Surface of mastoid process insertion of post. Belly of

b-foramen of Middle part

2-Post. Condylar f.: passing

3-Foramen magnum : passing:

-Pterygoid canal: passing

2-pterygomaxillary fissure ; passing

3-squamotympanic fissure: passing.

-f. of cribriform plate of ethmoid : passing

-Ant. Ethmoidal f. : passing

-Post. Ethmoidal f. : passing

-middle cranial fossa

f. lacerum: ( upper end ) passing:-

-Sup. Orbital fissure: passing

b. The posterior fontanelle is triangular.

c. The sphenoidal (anterolateral) fontanelle is present in

d. The mastoid fontanelle (posterolateral) is present in relation

2. The fontanelles disappear (by growth of the bones around

The cartilage itself is completely absorbed.

2. The vertebral column is made up of a large number of

b. Below these, there are twelve thoracic vertebrae that forming

3. The lowest part of the vertebral column is made up of the

The coccyx is made up of four rudimentary vertebrae

4. There are thus thirty-three vertebrae in all.

d. Bounded anteriorly by the posterior aspect of the body, on the

e. Passing backwards from the junction of the two laminae, there

f. Passing laterally from the junction of each pedicle and the

g. Projecting upwards from the junction of the pedicle and the

iii. Two adjoining vertebrae, articulate at three joints;

want to know more?

2. In the thoracic region, the head of a typical rib articulates

4. The transverse processes

2-the transvers process :

3- the spine : short & bifid

4-the sup. Articular processes directed postero-superiorly

5-the vertebral foramen :

-formed of 2 lat. Masses connected by