This lecture is review for the 1st exam ,,, we will talk about the most important topics

include in the exam ,suggested questions ,some new ideas in addotion to short summery about the Whole material,,, so focus on ^__^ the exam material include 4 main topics : -Skull -Cervical vertebrae -Neck -Face Lets start with skull >>>
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**Skull Bones dividede into : 1-Neurocraial bones(cranial bones)>>> 8 2-Viscerocranial bones(Facial bones)>>>14 Cranial Bones 2Parital Sphenoid Facial Bones 2 Nasal 2 palatine 2 Lacrimal 2 maxillary 2 Vomer inferioconchae 2 zygomatic Mandible 2 Temporal Ethmoid Frontal Occipital

Remember that Cranium is the skull without mandible,,, it is divided into: 1-vault(calvaria) 2-base

Sutures between nuerocranial bones on the calvaria : *coronal Suture *saggital Suture *Lambdoid Suture

The 4 intersections between the sutures:

1-Bregma 2-Lambda 3-Vertex 4-Pterion 5-Nasion

*Keep in mind there are other joints (sutures) like temprtoparietal joint,temprofrontal.. *the joints in cranial vault are fibrous(no movement) while the joints in cranial base are primary cartiliganious(limited movement)

Dont worry the exam will be like these questions just study well

1-Calvaria fractures: -Linear -Depressed -Comminuted -Pterion fractures 2-Cranial base Fractures: -Ant.cranial fossa fractures -mid.cranial fossa fractures -Posterior cranial Fossa fractures 3-Facial Fractures,,, 2 types : **Complicated(more than one bone) -Le Fort I (tranmaxillary) -Le Fort II(Pyramidal,subzygomatic) -Le Fort III(suprazygomatic,craniofacial) **Single (one bone) -nasal fractures -mandibular Fractures(condyler,body,ramus.) **The dr said that the exam contain some clinical questions related to Fractures and accidents >>>> For example : 35 years-old taxi driver was transferred to the hospital with mandibular fracture,during history take he said he was driving at speed 100 km/hr when ha suddenly pressed the brakes,he wasnt wearing the seat

belt so his chin hit the steering wheel interiorly. The question is :Which is the most common fracture : answ: Condyler fracture on the other hand if the hit (blow) is laterally the fracture will be on bodu of mandible another example about the fractures: *The most common area liable to fractures in body of the mandible is :Canine region Note: If there is fracture in cranial base (ant, mid, post)we must know the site (foramina) ,the structures that affected and the injury (signs). Q: Which the structure is affected by the fracture on the foramen rotundom: maxillary nerve Q:Epidural hemorrhage is due to the injury of: middle meningeal artery Q:Loss of innervations of the tongue is due to the injury of which nerve: CN XII hypoglossal nerve Q:Loss of vision is due to the injury of which nerve: optic nerve

Look to this pic ,it will help u in memorizing the foramina and the structures that pass through it :

 Lets talk about important things related to the neck and the cervical vertebrae :

-cervecal vertebral column (C1-C2) -Remember that the C1,C2,C7 are atypical vertebrae ,C3-C6 are typical. *Typical features of the cervical vertebra: 1-Small rectangular body. 2-Transverse foramina. 3-Short bifid spines. 4- Large vertebral foramen. *** We must know why the C1,C2,C7 are typical .

Types of curvetures of the vertebral column: -Normal -Abnormal Normal curvetures: -Primary -Secondary

Abnormal curvetures: -Kyphosis >>>increased thoracic curvature. -Lordosis>>>increased lumbar curvature -Scoliosis>>> lateral curvature in the vertebral column. As the Dr Alloh said there will be 2 Qs about this topic **Covering Layers of The Neck: -Skin -Superficial facia(Fatty ,cutanuous) contains: ***Playsma muscle >>>attachments,innervation (v.important) : Superior attachment: inferior border of the mandible and medially to angles of the Inferior attachment: the deep fascia that covering the pectoralis and deltoid muscle (deltopectoral fascia) Innervation: seventh cranial nerve (facial nerve)

***Cutanuous nerves (4) : 1-Lesser occipital nerve the origin :C2 Innervetion: -skin in the area behind the auricle -skin in the area over the mastoid process -even provide supply to the medial surface of the auricle

2-great oricular nerve *the origin :C2,C3 *Innervetion: -the skin over the parotid gland -the lower part of auricle (lobule of auricle the fat part) -the skin over the angle of the mandible 3-transverse(cutanuous)cervical nerve *the origin:C2,C3 *the innervetion: - provide innervations to the skin over the anterior triangle of the neck from the mandible to the sternum

4-Supraclavicular nerve *the origin:C3,C4 *the innervetion: -the skin of the lower lateral aspect of the neck which is the lower posterior triangle -the skin over the clavicle and sometimes goes to the level of the first rib in the thoracic region -the skin over the upper half of the shoulder Q :Which of these nerves is responsible for innervattion of the skin over the angle of mandible : answer:Gret auricular nerve Q:What is the nerve origin of the nerve that carries the pain sensation in the ear lobule answer:C2,C3 Be careful there are specific questions for the cutanuous nerves and their origins and innervations .

*** External jugular vein(EJV) : this vein is superficial to our reference muscle(SCM),it starts behind the angle of mandible by the fusion of 2 veins: - Posterior auricular vein -Retromandibular vein Extends mid. 1/3 of clavicle Draining into 2 veins either : -Subclavian vein (the most common) - Internal jugular vein

*** Lymph Nodes >>> superficial around the EJV

we end the superficial fascia ^_^

**Deep Fascia cosist of 4 parts :

Investing layer Pretracheal Prevertebral Carotit sheath

-Investing layer >>> covers the whole neck contents: -2 reference muscles :Trapezius & SCM -2 salivary glands:parotid & submandibular NOTE: Thickness of the investing layer between styloid & mandibular angle to form Stylomandibular Ligament -Pretracheal layer,,, 2parts : *visceral layar >>>covers the thyroid & parathyroid glands,larynx,pharynx,trachea and the oesophegus. *Muscular layer>>> covers the infrahyoid muscles -Prevertebral layer>>>covers the (post,ant,lateral) groups of vertebral muscles . -Carotid sheath(the only layer is paired sheath) its protected by SCM,so when we want to reach the carotid sheath we must cross the anterior border of the SCM,where the carotid puls is heared in this region.

This pic shows all the deep cervical layers .study it well it may help u in memorizing the structures & the relations between them ,,,enjoy

Contents of the carotid sheath: -Common carotid artery>>> the most medial -Internal jugular vein(IJV)>>> the most lateral -Vagus nerve>>>the most posterior -Deep cervical L.N>>> around (IJV) The common carotid artery in the left side originates directly from the arch of aorta and the right side from the brachiocephalic trunk . At the level of the Adams Apple which is located opposite to intervertebral disk between C3 &C4 ,the common carotid artery devides into External & Internal carotid arteries

Adams Apple is the prominence from the thyroid

cartilage ,,, it is also called laryngeal prominence because it protects the larynx behind. Adams Apple is more prominent in male than female Thyroid cartilage ,its function of protecting the vocal cords so the namethyroid comes from the shield

**when the common carotid artery bifurcate(devide) ,the external leaves the carotid sheath to give branches to the head and neck, while the internal still in the sheath all the way to reach the base of the skullthen it gets inside the skull through the carotid canal to provide the blood supply to brain. **The Internal carotid artery has no branches out of the skull but when it gets inside the skull it gives branches(anterior & middle cerebral arteries) ** The External carotid artery is located in the carotid triangle of the neck which is a part of the anterior triangle , it extend from the thyroid cartilage(intervertebral disc between the C3&C4) until it reaches the neck of the mandible ,in this region it terminates into 2 branches : 1-maxillary artery(the largest branch of the external) >>>provides the blood supply to maxilla,mandible,upper teeth,lower teeth ,,then it divides to 15 branches. 2-superficial temporal artery we can feel the pulse anterior the ear because it is just in the superficial fascia in the temporal region.

so we have >>>> 2 terminations (maxillary & superficial temporal arteries ) 1medial branche which ascends in the medial border of the pharynx is calledascending pharengeal 3 anterior branches : -the most anterior branch which descend to supply the thyoid gland is called superior thyroid artery because it reaches the gland from above. -lingual arter >>go to the tongue -Facial artery >> it is arise from the eterlan anterirly then will go through the inferior border of mandible to reach the face in a zigzag way to protect itself from tearing because there are may extentions in the face especially when u blow your cheek We can feel the pulse of the facial artery in the inferior border of the mandible . 2 posterior branches that arise from the posterioraspect of the external carotid artery : -Occipital artery>> pass over the occipital bone -posterior auricular artery >>pass behind the auricle So we have 8 branches from the external carotid artery . P.s see the picture of these branches

* now we move to Muscles of the cervical region :

1. Superficial and reference muscles : #note: you have to know complete details for each muscle of them. -superficial muscle which is the platysma muscle and the reference muscles which are the SCM sternocleidomastoid muscle and trapezius muscle. # -.- , attachment and innervation .

trapezius SCM

platysma

2. Hyoid related muscles : -we have : a. 4 suprahyoid muscles : 1. Geniohyoid : -the nerve supply is C1 via the hypoglossal nerve (CN X11) . 2. Mylohyoid : -the nerve supply is nerve to Mylohyoid, a branch of inferior alveolar nerve (CN V3). 3. Digastric : *anterior belly of digastric muscle : -the nerve supply is nerve to Mylohyoid, a branch of inferior alveolar nerve (CN V3). *posterior belly of digastric muscle : - the nerve supply is cervical branch of facial nerve (CN V11). 4. Stylohyoid : - the nerve supply is cervical branch of facial nerve (CN V11). b. 4 infrahyoid muscles : 1. Sternohyoid. 2. Sternothyroid. 3. Thyrohyoid. 4. Omohyoid.

-innervation for all is ansacervicalis (C1,C2,C3)

exceptthyrohyoid .

-innervation of thyrohyoid is C1 via hypoglossal nerve (CN X11). . *

3. cervical vertebral muscles : #note:you have to know only the name . a. Anterior(2) :

-longuscapitis and longuscoil . b. Lateral(3) : -Scalenesmuscles : -anterior , middle and posterior scalene muscle . **Scalene hiatus : -triangular gap bounded by the scalenus anterior and scalenusmedius muscles and the first rib *this definition from the net .

#note: you have to know its contents and Boundaries.

c. Posterior muscles(3) : -the splenius capitisand The semispinaliscapitis And the levator.

-you have to know only the name exceptthe suboccipital one (suboccipital region) which is locatd directly below the occipital bone.

-there we have 4 muscles : 1. Rectus capitis posterior minor : -Comes from posterior tubercule of atls to the inferior nuchal line of occipital bone . 2. Rectus capitis posterior major : -Comes from spinous process of axis to inferior nuchal line of occipital bone . *So we have inferior nuchal line for Rectus capitis posterior minor and major , and we have 2 straight muscles one is small (Rectus capitis posterior minor) and another one is large (Rectus capitis posterior major). 3. Obliquuscapitisinferioris : -comes from spinous process of axis to transverse process of atlas . 4. Obliquuscapitissuperioris : -comes from the transverse process of atlas to the region between the superior and inferior nuchal line . * the innervation of all these four muscles is suboccipital nerve (posterior ramus of C1).

**in the suboccipital region we have suboccipital triangle you have to know its contents and borders . -the borders of the suboccipitaltringle : *medialy :Rectus capitis posterior major. *inferiorly:Obliquuscapitisinferioris. *lateraly:Obliquuscapitissuperioris. -contents of the suboccipital triangle : *vertebral artery . *suboccipital nerve (C1) . -the roof : *Semispinaliscapitis . -the floor : *Atlantooccipitalmembrane .

** we can see the suboccipital triangle if we cut the trapezius then splenius capitis then semisoinaliscapitis in that point we can see the suboccipital triangle. (Trapezius> spleniuscapitis>semisoinaliscapitis)

*we have 3 nuchal lines : 1. Highest nuchal line : -You should know it ?! as the doctor said 2. Superior nuchal line : -established by SCM laterly and the trapezius medialy and from above occipital belly from the occipito-frontalis which related to face . 3. Inferior nuchal line : -established by Rectus capitis posterior minor and Rectus capitis posterior major only .

*posterior triangle of the neck : -borders : *anteriorly : SCM . *postrioly : trapezius . *inferiorly : middle third of the clavicle . -the floor: *semispinaliscapitis , splenius capitis , Levator scapulae and 3 scalenes muscles.

-We know the inferior belly of omo hyoid divide the posterior triangle into : *occipital triangle . *omoclavicular or subclavian or supraclavicular triangle . **contents of the posterior triangle : a. b. c. 1. We have 4 main arteryes there : In the apex (occipital artery) which comes from external carotedartery . Transverse cervical artery . Suprascapularartery . both of Transverse cervical artery and Suprascapularartery come from thyrocervical of subclavian artery . Third part of subclavianartery . *we have 5 veins , each artery has vein related to it . but we have vein ( )the fifth vein which is the external jugular vein ( desending down from the angle if the mandible superficial way to the medial third of the clavial).

d.

2. We have 3 kinds of nerves : a. 4 cutaneous nerves : -lessor occipital nerve (C2). -great auricular nerve(C2,C3). -transverse cutaneous nerve(C2,C3). -supraclavicular nerve (C3,C4).

*all of these cone from midpoint of the posterior border of the SCM . * -in the midpoint of the posterior border of the SCM . b. Spinal accessory nerve (cranial nerve X1) : -is very important nerve cuz ) 2 (important muscles : *SCM and trapezius . - this nerve is related to levator scapulae . - the Spinal accessory nerve is arising usually from the spinal nerve not from the brain .

#note : cranial nerve is any nerve that passes through cranial foramina . c. Brachial plexus : -brachial plexus after it emerges that will be inside the scalene hiatus between the middle and anterior scalene . - brachial plexus (C5-C8 ,T1 ) after it emerges in the scalene hiatus they get to posterior triangle , in the posterior triangle we will see the trunks of brachial plexus , the trunks of posterior triangle behind the clavical and there each trunck will give anterior and posterior division after the clavical down to axilla we will find the cords of brachial plexus .

*anterior triangle of the neck : . * -The muscular triangle called also surgical triangle. -the carotid triangle called also vasculare triangle. -submandibular triangle called also visceral triangle . #note:submandibular salivary gland has superfisial part in the submandibular triangle and deep part in the oral cavity .