-::rf 1-"

(. . ( (
[NeCk: Location & Boundaries I Objectives:
• Surface Anatomy
• lies between the upper part of thorax (inlet) and \,"

lower part of the skull e Division of Neck:

;'
Boundaries: (a) Triangles of Neck & Contents ",/ .,k- I C ",,~y-v
• Posterior - cervical vertebrae '

• Posterolateral - scalene muscles

• Lateral- sternocleidomastoid /
/
I Nbg¢> I
(i) Anterior - subdivisions- ''';;~/j ~
(ii) Posterior - subdivisions '--

(b) Divisions of Neck (cross section)

(i) Anterior - Visceral .~
vh~
f eo..:>.!- f ~

(ii) Posterior - Musculoskelet

o Anterior - infrahyoid muscles /
/ • Clinical Correlation
.;

Surface Anatomy: Triangles of Neck Classification of Triangles of Neck

Triangles of the neck can be grouped into: .

j. Anterior Triangle
• Posterior Triangle

\ ..(f.-nterior Triangle: can be subdivided into:

(i) submandibular (ii) submental (iii) carotid
(iv) muscular

J [1,)Posterior Triangle: can be subdivided into

----
(i) Posterior (ii) omoclavicular (subclavian)
..
.. ~----.--- ~- ..•.

I); \

 .'t!f'/'//
( (
C Lf' I
\,

Divisions of Neck Neck: Triangles & Divisions

~.~terior (visceral)

~
' '---' : The lateral side of the neck ca n b e
• Posterior (musculoskeletal) .!.-- divided into regions namely:
", ~--

terior part: /
I . ~ Anterior Triang Ie
(1)~eraand / I. Posterior Triang Ie
(2) Lateral to viscera is carotid sheath-.--. ('
(c~otict~teryJ internal jup ular vein and (Post Part 9f N~ck '. Ant. Part of Neck
(v isceral )
vagus m rve) %@:;;:::< (cervical spine) & ;
,-- z-=::==---- • -....~ muscles moving it
(musculoskeletal)

(1) cervtcat-verfebral spine l ~t' I Trapezius

~ , SternoCleidomasto i/
(2) m uscles th at move it. , J..
- ~k

" (. I Boundaries: Anterior Triangle

• Anterior: the median line of the
.I

\ neck
• Posterior: the anteriou· border of
'{
\ the sternocleidomastoid muscle
o Superior: Inferior border of the

\ mandible
• Superficial (roof): investing layer
of the deep cervical fascia
\
• Floor: larynx and pharynx
( 5u5utt v ' 0"1)
f?1(
 ~ ~
'- i'0J
Subdivision of Anterior Triangle I Boundaries: Posterior Triangle I
• The anterior triangle is divided by the
J. Anterior: sternocleidomastoid muscle
posterior border
digastrics and omohyoid muscles into

smaller triangles namely:

I. Posterior: the anterior border of

trapezius muscle
~ubmandibular
~Carotid
I. Inferior: the middle 1/3 of the clavicle
y Submental I. Superior (roof): investing layer of deep
y Muscular cervical fascia

I. Floor:
muscles of the neck covered with

paravertebral fascia

Subdivision of Posterior Triangle Transverse Section Neck

loves ling layer of deep

J
Anterior It .
Tr~chea
cervical fascia \

Prelraclie.1fascia
• The posterior triangle is further divided
by the omohyoid muscles into smaller
triangles namely:
~'~\
77)<\\ ISynlPafhClictrunq (/

o Occipital triangle
.. Omoclavicular triangle
~~)......
Trapezius m.

Cervical vertebra

Posterior Recurrent laryngeal N. ??

~II(

 '-,I}
Clinical Correlation

lIIIoveroent,of,'
. Thyroici '~'n }',
/',
Swaliowin~.:J'

Neck: Anterior Division-Contents rl! 'I Posterior Triangle Relationship I

p.r8vcr1obml tflscia
,fOor) Poslcr.ior auricular v. /
Cervical Viscera

e Pharynx and esophagus - superior/

part of digestive tract
If " F~ci~1 v.

• Larynx and trachea - superior part J

of the respiratory tract

• Thyroid gland and parathryoid J Sternot;!uido­

mastoid Ill.

glands
Clavicle

lif!
 (, ( Y;/J (

C Clinical Correlation I >. Clinical Correlation J

;'" ,"."'...':'{{:~i:'flf~+~~!~,i~r.t:l1l4~~r~~~~:hii,t~'

,- Clinical Correlation Clinical Correlation - J

ctaQl~~e6~use'it.j5iti~u#llv~r;Jnd.· r V~-v:t
,,' .}A'
":~"I.J,~~:L.~ ~I~. 1. 'II~~:U:.~ IIltO
..

· ;'';;r, ~<~r.19 . :;'j:. ._:~:,~,_, _",L_· __ •.. c~

" II"IIII~VJ ! 1.1" '11' II' Ii,Ill~' !leeale.ilthen: dire~re~<infclOlat'

",. ri~~;'i;Mi;;~:;:;i;a,;,;;~r··~:Dple " '·~ifJ

if!
· M [
~I
5

\.. Mandible

~ J;,/ ~--------------------~(
Bones, Cartilages Membranes Of Neck
c
U Hyoid Bone: at the angle between floor of the
L mouth and superior end of neck ,
A
R Thyroid membrane: is between the thyroid
cartilage and hyoid bone
T
R
I
• Thyroid cartilage: in the anterior midline of neck
A
N Cricoid cartilage: is below the thyroid cartilage
G
L
E i--f· Cricothyroid ligament: is between the thyroid
cartilage and cricoid cartilage
N
E • First ring of Trachea: between thee cricoid
C cartilage and superior part of thryroid
K

I Contents Of Carotid Triangle ~;,~ L,2 Clinical Correlation

,
'1.;-, ~ ..
• Common carotid ..
~ /t~ Ih ~ 1~ ~ fi.- 't-:: 7~1 aM4~ A b h
~ .

;;h-p.lf, n:M@ dip~~ p~ i CA-..s7,"UJ-t.[ ,

o Internal Jugular Vein
~
• External carotid and its branches
.
~·~::1.:.~:.~~~~·~~~~~-;:~~ ~,C::~;:~ :I~¥n, ~ .1 .'~":,ft~~'~ 7:r~ ·d.g7~.~ 'Il ,.. . ". . '. '" . ." . .
~~i 't;Y;'i:;iaiiJja.jjjl1ma~liliY{'rc1liSCihftJdff(;~fR). ,'Ahseti c~ iof n
• Hypoglossal nerve

o Branches ,o f vagus nerve

bl!
 (
Cl .1ts .'ol; C~fotid .
Hypo~lossal n~r.e (XII)
I
* ~ n (~ 1; (

c . Tri~n:~I~:·'.~; ~ '.' Ansa Cervicalis J

A R
[:'\1- c.,''?
E
Innervates~~

R
0 * A •
T T
. ~

I I / /
0 • /This includes sternohyoid, sternothyroid
D and omohyoid muscle
N r
A s
R / H • The~ss~erve carries the axon
T I from spinal N. C1 and then
E
R
Y
~/
Internal jugular vein ~ Sternothyroid m.
)
i
I
P

f)O~~' branches off to sLpply Jhyrohyoid M.

IExternal carotjd'g ·1
Pharyngeal branch
t'
Superiorlaryngeill nerve
C
A
Carotid Angiogram J
8
Sl)perficial temporal
B 7
Maxillar'/.a:.---'-..-/ R
~. 6Posliliior,auricular a./'
R 5 Facial a. --------.1 o
4 OcCipital a.-----:I
A 3 Lingual a. 1 T
2 Ascending .pharyngeala.
N 1 . Superior thyroid a I
C o
H
E A
S R
T
o E
F R
Subclavian a. Y

II -"""=p",,,,,,,ok ~ . ~ -L_~l
.J~~.!(
~ ~
(.f 1- 1t
·i ,ff.-.1,.,ew-t j J
~/
~
 C I

Contents of Submandibular Triangle I 11 I I Submandibuiar Gland - Relatio~sh;]

• Submandibular gland and its duct (blockage)

• Facial artery

• Facial vein

• Stylohyoid muscle '0/

• Hypoglossal N. (XII) Facial Ao

Int. Carotid A.
Submental Ao
Ext. Carotid
• Lymph nodes n d kr .I t5'()w",", , • fAf- s-w~~ V
~
0

('NH"t:Vr I ./ Submandibular A. Common Carotid A.

Mod<. - ~ 01"'-4~ I _ HY'poglo~INo (XII) I fi{)
0 / . , '

I'M 0 0

Jr-.j;~~ I 7~ a .~ - ----p.~("'j ~ k?.Jclv -b,j~ Q _ ~ J\ ,.-vvh~';"" i,~ t/-....J. V'(,~

'11'-'1 f7w 6uq-~ -=-Jw-d,('1' (~vt(",,,,,) ).L ,J ~~ ~.1i \
I f J~ d'~1 o~/ 1·t.Jr~O-" '" N,
I SUPerficial Submandibular Area I Contents of Subment-;I Tri;ngle J
anlerlor belly

$ An unpaired triangle L? ClI-1~ .,,4-,4--;p 6~

e Submental lymph nodes

(1~ 1rt~~~ ~r
/

Siernolhyroid Anterior lugular vein (A.JVI oJ

~/(

[Contents Muscular Triangle 1 4 ., Clinical Correlation ="l

• Infrahyoid muscles -/

• Thyroid gland ./ v
/
• Parathyroid glands

'<- M'~<' (VvV""-,,,

t?-f~ r (r~ (/~IN; hi i c~r
­

(r~)
Jflfi..A
f1.~
~
.;:.l -.~

[ Clinical Correlation ~ I .f Clinical Correlatio~--~~J

t~
$l,Jpe·!ror 1
thy~o;di '
vein
0' " -, c- - - -='tb...~ ~ '\. / Inter,nal
,,1
r' '
,-T-- --,--- - -- - -,
l ;aJ.!:T
' "' . ,;/
~'\., v'J"
-. A
Thyroid ~:H'exus
Dfvepns
ju:nu!ar
v-cin (IJ'V)

@i2' Interior UIlyrold'­

"f? artel'f ~(y
Mkfdle
mymid 2 A
tThyrocervtcal
In.n''lf{
~
t:~:r:iO( 03:f"
thyroid
, pi'J
rJ( Y
\'eiC1S ~ "

BrachiocephalLC Arch o~ aorta

trunk

- 6 cl c.;I-­
1ft fn~

i'kc( rn:J 1~
-~ ~CP, I~ ~~

 ( ( (

C Tracheotomy =J 1(13 Transverse Section (Tracheal Ri'n g ill

../
Trachea LeHlobe
of Ihyrold gland

C{lr{)jl(L~Ratt\.

0'>
~o
o~
.);.«j
In1emal '.'f<;'\,\;7
r~'·· .

~
i!tgtHar vein
Esophagtl$ /
Sl J1.. . j~- eft",;",
I""1 ~ l ,,.,/1
:t \
Clinical Correlation ~ Clinical Correlation J
Superior thyroid anery
. .
:.- Thyroid gJancl ,/
~
,,/'"
r

•f ~ :'~ ' ": ;:

'., ~";: :'.

:',"

. 5> \. ~
j " " - - _.• _ _ .........._-, ~ \1'0
I""~1_
, ..
Right~!enll~!~:'::j
I
* V
@<>
J'

';·'·'jF · '. . .'. .

+ \~'W\l,t~>",:~flj~~ {~g u1ati.en:of ca I~·
':~'",~~~'" "U:Wi, !~;~ysmat" .enciocrrl18

...., ......., ,,. ,.......... . . 'T"'·'· . ' . d -" I

i
V

I~(

 ,.,--.,..

-n__..

n-

OJ

o""'l
-~_.

OJ
t"'t'
o
::J

r-->.
 ( I~.
\ v
\. \
C Surface Anatomy Cutaneous Nerve Distribution of Head & Neck

r;'~~:",- ~';i~~/J;\:,,,-
··..v" · ··.··I~ v_
... ;:'i· rrigemin' ai , •N:\i4~-;:

/~:'"
· • , 'II.." , 11 ~v·rr""1-~

t·:, ~: , ::':Y hlj~ry;,-'f~:;tt~~~/?~

optlth Maxill Mandi C2,3 ,causeS'lt'o'SS"
,
Of:f~
,\, ,".t")"'\''''~
,,/ ' '-"'.. : . ·sensation '~'tJ.r:
..-:11 ~I
\" , r.:'-:r:/$'
" \ .... , .

Ao parts .o(~F,ac~-'t.,

Supraorbital ~ , zygomatic",

margin" '~ arch

Nasal bones .f ~.,

:-Zygomatlc cfr€i{k
. bone (Z ~
!\Iveolar process
of maxilla

Mental prolulJerante/.
of mandible .
ll,; . '{
\...)1'11
~
v ' ;VOr(-l!.r/~~ 7/1/,...1.. Q -1; fNv-t·-? ()JV;,

rnOD~\(Qr1 h~~~\\M( ) Q- ftri4 rh 4,e fu:-~.-> UV, ~ (vy~ N [['r1<j '" / (c,v5"'-)
S
e
n
Vz I c[),lti',"aimic ner~"e~
ZvaomaticotemoDtal ·n.

)~ @)I I Clinical Correlation I

s .. Supraorbil,al"'n.

r----:.......-suptair6~filear 11.
0
Inf(aJr9¢IiI~Jlr.. n, \J~l;
r I>.c 'r = = - Exto/ri?r:nils~.Ln.
V ,//

N
e
r _l~

v
e :Mandjbular,herv~
• , • • .:>­

F
a
c
e

.Vr G \j~ ~iO\,+(Y c~o~~~~1( ,i

1~ -~~t,Ik'; ~ 'l>J..nv..J:b ~
4l
. ~" . . . ..~~-! .
I
~~~-7
~-.
 (I-(

~1~b
('
\ ,), '

[
'(J

i Scalp: Layers I
The scalp consists of tlve layers that arefitm[y bound together Coiine,cUve tissue 2
~~,APoncllrosiS 3
~~ , L()oseconneclivctissue 4
1 (Skin
5
2 ~oIlnective tissue - dense$ubputaneous\~~sue cont'1in- /v':~t, Je,0~'

(1:\lg th~'es£el$ and,")uye~ ptt~esccllp CPCl)-fC!}:lJ. ~ ry:?I .<C-) D~

'1.~ Calvaria

3 ~one.urosis (epi(W~Uli'll(:p~l1etJrpsis) -: 'C0~ec~~ } ,~

6'
J~Ilt~hs Itluscle ta lli,ieQ!;G1pltaJrs ll1Uscle ",
c
~
v
4~Ose connective tis.$ue ... permit):the ,~,Galp to move
tx,~l)
~ \,;\
over the calvaria '

5 ~ticnUriui11 - the periosteumofthecrari.ihl bones

\ {tJ

,FrQ,llJ~ti~m~~~,1,e
D- -> W~ r~ v-Vv\A J 1f~~~ "'" ~ -: j)~r ~~
(~'.r!1 ' l ,f' Su-y ' ~Sr~17J)J<U> C~{Mh~
I
-7

C Ii n i ca I Co rre Ia ti 0 n Ir--s -e n-s-o-ry-N-e-rv-e-&-B-Io-o-d-S-u-p-p-Iy-O-f-S-ca-I-p-'

:r.m~~-
~~:IBWOIiVtSSElS I
I ,l " \
/lr.J.1"~ _'"
" <" ,;.-;11iIIIIIII 'i\. <1 \
1 ,1., 11
i.;(
' \- )

~L/ ',(\ ~
,¥ "
Vc~~~ \-rtr\\~v'~
~' rj/6" ' ~
tJwA

8fr
 ( ( '1 ~

[ Muscles of Face . \
Platysma
/. --,." JFrontal belly of ~
.. _
I'!"'"I
(-i e.,,,N'" ,"

nerve

nerve

/~v~1;1..-L« ~
v/
(::- f~u :;, ~~~~/J7 ' bVl, ) ~\;J
~- ft'tcJ/r1-(. [fr- -~ ~ 0\--'<,0:<"

Clinical Correlation
.-

~
.,'
;y

.... ..,\S

c:~

-- 1 drooping'iOT tfl€ the

affected~:side. Cfin;\~ ( 1- t~'N.r>-~J-:.t.~

g/fY

 ( /" JH

"
[ Parotid Region 1
The !w'otid gbnd develops as an eYrlgjnarjojJ ofthcnta·1 mucosa

'1I1e1 ir occupies all .avaihlhle space ,lr0\lI1d the ramus of the

Ill<lndihlc.

1/
/'

.,/'

/
@ ~. !".\- ''!>.' • .'.-'''. ,

~.

\J~i'JA~

d~/Oh-~!u,tr~
0.. -).. . .
->
Ie.',~.J -, r<Jf-·f tl..J- ~t" ~-')dr~Jt"\ j
i}....,..:t,j :l ,,/, J
;VJ -=-_.L- " "rr..v"ZI/vIv4!1:"a:! ~~pa

~
O~
L (. .,
>7CY../r v1 .::;~ J -=
.......--
,1 . •;?c:!. "c,.'I'}-:, ,--.;>

Lateral Aspect of t-ace

Facial nerve (VII):
T~--------~ Tra!lSverse f<1clal a.
Zygpmaticus major m.

Zygomatic br.

t.~~':( :r.)'~~'''''' ';;OJ ~:'V . ..... "" "'r" 0, J y

.~~~~~;~e,ta~iprs!lip:
'~i!"' E -t ' 'b'"' r" \"',:
1-'1. ~r,. ~ , I,.1, ~
:.·,:... ,r
~i~;B~t9.tid},ql!inCl}

BU~C(11 brs. \" . ).\\\\

MnndiDular br. ,.
Cervical br. r1
C

) stornCldeidoma~()!d m.

e-J?J~ Utv ~~ o.'~J~~ \ / ~~Jy;P (h...d.4i~~",X>;? h

,.~·· '-V"V····'!!)~'\.·----r~
.
\'

J~J<; ?~.f ~,~ '-)->«0) (

 II(
( /. ~J (
C Parotid Bed
.}
~
I Clinical Correlation
,

~sterior -ll1astoid process and posterior beJlyof the diW1S~ ~~ \,~ ~

tric muscle ' \ . ~~
~,
(Jl limerlOr - med
liU 'pterygO!tF!llUSC
A l ',1 Ie, ramus
' 0flt Ie' man'dJ)ill C, s,
tf\f '" /J'
, ~lI1d masseter muscle ~
~ - styloid process .aud asso,ciated n1l1sdes (sty]opllil- ()
~1gensisly.logjoSStl9;, andstylphyOld) " \
"-- ..t\ () 'craSH lerior - tlonrof.dlcexternal acotl$ticmeatus \".
'J .~ c-­
~ 0
' ~tf -,

\ (~

\\)\O '" j1<Cl-il,;(/7 ;J (]Jitio-'~~r.Av/ t;.7(Pv'(

t\1\ "" - ­ ~ ,
Nerves lol,empoflilis'm.
Spl\ef19palatine artery,
enterll)g pterygopalatine fossa

Jr.=::= Ner~er m, ' ~,

:::::,••,••. _._~ '"
, , .. ', .'. . ' h""
. " ,.:", !II~'~",,',i;'
. ',.
,:',t'tu;.,"",,", ;,.iJ1i.
' .;.W
.../''''
~~,\.::. ~~"t:" ,,'..rI; ~t1Y::: :J:. '
,' A
N
D
~v
\~fQ
I
~? Q ~IM
'~ ~ B
,I>l ,
•
tfU· rJI '
I

tJI. ; \l1 U
,~ v' ~h A
R
~,
N
E
R
V

a-g(e~~w oTt ,
~ t:JW.4. 5rv.;;
----== , I r; _
1/~ Cfii.2!::'JJ;;i P ~ J
? -t
p?tv<- ~fiJf~-
 ( 4r'

[ Clinical Correlation Temporomandibular Joint (Skeleton)

.(~
e

[(,b)!--­
~j £-, -
Ramus

Muscles of TMJ

TM1

The lateral
pterygoid
muscle
:m·<l'!~~'i';\::;'.'N;!' ·';W,i~~.:l, -ut:presses the
mandible
(opens jaw)

acoustic meatus
" " r"

Styloid process .C}(Vt ,-" - '"

o/?"
 ( /H'
(
L Muscles of Mastication

LQ..c

1. Temporal

2. Masseter } Nerve supply :

Anterior trunk
of mandibular
3. Lateral Pterygoid v
Nerve (eN 3)

4. Medial Pterygoid ~ lL,vIJ ~ f)

f'" (>.fJ \ (;J.JI
r
'f/-
~~ ['J
I

A
l (tr\,)­ i~\>
L-
_ /J -l
r----:.,r;...+i::::...:;;;;:.::;::::.1....:..:;:..:,:;;;.;;..._~~---.,;..;,;.;...{..f..;./..:;:::..;..~"'-~~;.:;:..:,~ c,.z.-.t (/!.11"{'­
/Cr-1/JW,_
[ Clinical Correlation Major Lymph Nodes Head & Neck
- ....... , .- -----­

~~.~

Tonsill ar
OU9VIOd I9 ....n(l@
: . .~
$uumonto f ' \
- l1hvC' r IIP7000i-' of
1'n000th. 4pe)( of tO~9u e

0/8"

 (H'
(
Clinical Correlation I
Dlff",ontl.1 di.gno"I"
I' SCalpinf«\iCO,.
, rnycw:Kterial irfectlon
Mali9'ha-n~.eS:
SYJn no:..:gj""". Iymphcmas.
, h.,ad ~I)d ned: ~:;'Jamcus
~II (.l(c:ino:tm~
Su~m.ndO>UI~r·nodt~CJ
Q
Dr.,n oral cavity ,
'Dlff ... ~nU.I, dlagnoSlS:

Mon~ude09'; ~lJIiJl~

respi... ~ Vir3I!t>,CteJj31 infectiCO.

mycoba<:lerial i ofeaicn.

=illasma, ct~\iieg~lc..riM.

detltal ;jj se"'J;d,"!b,~ta

~allgn~6e$: .'
Squall0n,03i:alId(>cma of \to~
head and 000;, ljii:ipncmas.
leukemias '"
I

Antarlor <~rvl.~'}\oV';
':;' ,';
Drain f3rynx. teng"'",;
orcpharynx, ,""l«ior n .
,

--\-c'""~v~
sec
Dlrt....ntlol dfa'",; '
tl ~ 1'1;JJIru; ,~, ....m~~W~"_
/~ -"~.-. S ub'r'A-V' ~j
Yrc OJJ.~\ d eve
~)~ // -...!;,. Ce.., c .<::,cc)
S(),b f'l'\Q ",-oL.lo lJ ~c.~f &JJI'-OJM\J" co ~ (- \·r'\. J jI. "­

( / lip
p osi c ~ v; (el I
~~~
~ eJ)) \l ~l;Af ~; ~.".J \ f 1)\ \1\0 ....'­
~ () -pc C\ (' tCtv '( uJ Cl l

~~ ,

Ar~e;l(\ en
cc:.r " I ( ( J",

\ (J..'(J\f'P (
j -\-C\~

?f

 ('_ _'_ _ • . _ ,_ _ _ _w_"',·"..

/; l Sphenoidal Sinus and Pituitar~

1F
,J~ St ~::i;1 if;
k.. _ _._,,,..,.~ ........,,.,..,,......'" . .... ..

~ (fi'JV.J . / ' @r---"-'-~"-'

c: ....
I
"''''
hr.n,....nlhnll\ld~11 rrlr ,l<.:
C fronlal honc

B IIasal bOllc ,r;­

.•.._, Sphenopalatine
\
u~t' J
"

\J'
./
foramen

'" linus d~"G~ k

~;;;;id;I~~;'Sr r; ~(r

,\i ;,,:-£sa~: \.. C.; i~ ~ I:.

PlerYL'Oid hom"I"$

F
o.;Z~v/
Maxilla:
~",t.-,. ...
QS:I Palaline process E
Incisive canal ~ >A: ~/
f'<'>~ l- r<.J (. . j ~(!.,l evJd~
l') l: f£ ~,\,y- ~ l~N'> Horjlonlal plale .
i! C-t> (V"""'"," " L ,-*i'j f>'; n.,
Inferior meallJ$
LA"-}" A, p~~
I I rL..:rJ""A .
-r~ ~"r~M ,. !/) .:t...c

:..,.....'9<'..r..:;:.,,\O.~~ _O;>Q'l""·'mI~_IICf¥llr~QW"~;' '''.'I"'IWIO.'~' ''''''''''~' '~: b ,. ... t"~ ~..: ..: •• :.

\\:;.~\f,....... _
\,\\~
Pituitary
,,~_'"'
Gland:
_ _ _ _•____. __ Relationship
__ • __ __ ~. ,_~ .-.~~J i
l_ 1ft
Clinical Correlation
~..o:.&:J,W"'~·lWI<"'~~~~~:~',·· .· '. ,

,
,, ~ "" _I'C

C< - x- rMJ ) c0W:' ,''' f~ ?

(.':~' (~! ", - \'n f,.",..c...<\VI· hi'(
- p ;fw.;!?:; ~~ CkI, . 'pJt OJ .
j~rien(jlwal' J:Jif;{S .
0\
.j

.'i~
i:
Ii Ihh£lV<r' o .rf'~r~j(,~
':~;
a nic?t i
ecviD; J . Surgical aPPwa'GIleNo1hemitultary.qland tal(e adVJlit'::(J(' 0;'
~~)

J., J..U'J,!- Jr thefa{tth'atth~'sphen6idal:;simlsand nasal cavi ly provid(1 d f:' ·

f Dura .. . . , .... " .. , "'\....? v V
rectappro8ch.
b~",",' n;~~~~ I-<A/:~
t mater
~;:"",

.?",;M

f . Ie nerve (V;I LA, fItA-<..

G
! ~

, . :':;~:~:;~1 :.. ~t
. c··
/I
 Ir-{
I'
._-- -- '~~-"l) "
r·'~·=""·~'--"·'·~'=~~"---_W~"'=-""'~'"'<O_~'''''' ' ' ~ ....
~
rt...-.--
Question _~.=_,
~ ! Blood Supply'
~..u<I>I""~'~"""'<";"""'- __ 1

g Internal carotid arteries

/\ :>~-'y·;~'J,' -ol,.::l JJl.aJl is< ~drniH('d lU [lIe j)·J}splldL (1.11::
11.1 ~, ('VC'I'(' i'·:;·.)d.ld·lI's . .i', CT eX;l:roillallioll 1{'','f',iL,Hl ill
le-rn.'1:1 C.l:01d .}n('r:,~ ;mj'!l.lry~im in:;rdf' lbO'· L •.:f·/i.:!mOI.l~;
°1 Inferior & superior ------­
hypophyseal arteries Pituitary Clan.'
:;iuu:;... '.\-'hiell of dl l~ r(..lno·',vjnt~ JlI~:n"c,:::: ...... ould be lypj ·
'~J 1JIi d' f(-"ct"; 'l fi.~._
rc; t ·.c· ® The superior hypophyseal , ->.,," ~~\ .~;'> .-­
.... l .. . .

(
."C \,,~ r....
fop

~/J'~l : r"r - Jl ·,,·~-;~"·-7-J

;-.._ • \ . -U .J. I. "J: .. '~ ' • t. ._~


a.rtery run down in the pituita,:, -,
st3JR' supplies anterior lobe "n,,,"
' ·C'.\ ,\, ".\

"""'ri,,,
(tl

Ii!
·,t/·
·V~';
0111"'" / :' "

', 1'",.,.1"
"" ;" .'" 1

n. UCnlO:T[(lWr Ijf'r\le
o c. c..~~ d'I't '" The inferior hypophyseal artery Inl'~>~JIf\, ".. i":'-:';'
\ . : ...
C. Oplttil,It;Hlil. 1It:1 ·... V
r~~
supplies posterior lobe BUT
does not pass through the St.i·'~ ~ :
,(!flif
,,'/ . '
I/.c_~.)
III"!','.":'"
,,,r,"I:."'

n. ~~ \( r i
~Aa;,niLln'y fll,)'W'
10 <)'
i
c!I V, '- ---.;:,,;;,'
Q>.-..I •
L, lr(n:hl e,1T Tli"iT e
~-E,- .... A ~rc,-~Cf'·h-.;~ ')
r~~v . " The blood is drained from the
pituitary by inferior
hypophyseal veins into the
dural venous sinuses.

C'" r{l
~~ Q.- t! l' ~~iJtwM k;
-i, 1':::1.- sJ~~ c/ ~? tf'i.f. /L'...J ;. -­

l, M'e at

w ~- l '"
{L~'~")
Z
i
_.-\ 050l.:-:.::J:- ·-~ J\fo Front,,1 sinus

CJ-\; --f .~ '\-_._-_.. . Supelior concil2 ,,:(1;1

,---_ ._._ .._----... Rod entering opening
'---- ........;;- 01 Iroilial sinus

lb 1 ~/
'" "\hmoid~1 uullil -
C '~" \
L
.J
/ .
f _.. ' \0 ~ Ope~ill9Qf nnlerior

~
0\
2. H
~
W ethllloidal cells
Selllilunm hinilis
l!llenor COIKloc,I (1.'1.': 1
./

la Nasal veslibule

Openin~1 of lIlaxiliMy S! IlU~

2
a -Jt:-..
~ f) ,.,. "

r <"'\ (>"tl' f
,)
j I: ~'"
,.J~.;:;"
t...> I c;..c...,.,....,'(3-" --n,-, ~ ~ /1·

tu:fi;;;;;4_ .
 t...,~~~v~~~~-.p.,,,,,,,~,,,,,,,,,,,,,,,,~~.,.~~.\;/J.,!,.i..:·~. ·........·uu.· ...... · :·!\. C

. \ S'I ~r\'J j' (,ld

','/ i II ~ S>2.i.·'(,J'~~ i~.i l J1; i 11
" ;,;lll ,:'1 .l!dmitt;:·.:J. u) tLH! ' he :5pl t:t!
j tb, 11d ~;-Llt cavi IY. Ra di ogra p,lllC c.'};, ­
~ Nasolacrimal Duct Opening: lat. Wa n Nose:
a~,.,,>.Uol~ __ .IDIIII'- __

Sup'l.:riDl" l(1criln(l llx'!pIHa

iln d PIILlC 11.:I11l
1
~ ...--.;c,..\I<~·_\...... It_I:''''''''''-''''''''';·~'''_~''':~~.i''.r,'',,·,~
t{tf.Ji!ll~:£1l.ClS

I··
"".' .

1;.;l.c'~I~~~!~\/~!.I '(

~:~i~
laoima\ sac

:1fl1lT1:aIWfI r,~v('ols ,l (:.JjcinCl't'iI':: in hb niJs.:1! C.:l·.·t,y, Tn

','.,' h i:ch '_l~ (!lC fc;·1 ~(l'w ,. Pg IQr..Hion::. \·. . . U'uld. ,he" GI.,d lt CHll.'l:

.c~~,,.,~4" ~~~t)
block U'lt:: hl,'Hm: of the. m,lxi ;:I,lXY sinus?
A. ,
e.
(nl('F(; I' l):I(,<HllS

:v1IddlL' me:Jllls v
~
r&;Obstruction
. Nasolacrimal duel ~h
''? --

1I:;i-
~" "\"
l.acnnl(ll c,IJun:;jl:
c. sur,el'k 'T m (:',((ll ~,

D. NaslJph,")f ynx In!erior lacnnlill p.l;.lI!la

and nunc!Ulo
E. Sp,bC'11 :)t'(ll nlOiid.j! f(;~CC ~:s
L;'lcnm<11 cima hculi

r- ----'...."
1 Nostr~ I ... ...11

A 60 year lad re.s~~rus::tonef[iam+!y-p.hysician with a

[=~aXiliary S~~:~S ~~~~~~~~:~,~._ -

history 0'- ,t;ed~ ~~6 days. On
itl /Yi/\~ovv';J
examination the p YSICian observed a swelling in the lower

part of lateral wall of the nose. She also informed the

doctor that for the last 6 month she could not breath ~~~~J

through her nose and she was tearing in the right eye fpr

th~ same Eeriod . Which of the folloWi~9structure ~

affected with this tumor?

A Sphenoidal sinus

B. Frontal sinus
.u;tb('f "f/~ v-t
V,) ~~ ~f I
Lacrimal caniculi
@ Nasolacrimal duct ~ r'J
,.;:;
,/
tooth

E, Nostril
/"-?/ 'Nof~:l~i'~~~i:~~~ft9.i?,~~iP~~: ~r-w (tl~tJeNl~
lJ{tvlNIIII, t~
f"~ _~__~~." _ _ _~'_W'''_'_ _ '''''''''~'_'<_~'''·'';
~ II. _J~illary Sinus & Nasal, Oral Cavity ~ r-=~~-=~~~--=~~~-~"~"'"-'" . w·,· .....•• .•.. ... .' (

r . . ~ ~ Maxillary Sinus: Relation ship

l__.__ & Orbit .: .R~lationshi.E..~~u_~..J t.~ ~__
.. ,---~--~~'''''~-''''-'' -'''' '''''' '. \
O\~
if

Superior ?;,({"\CAd- ' ~ ~~ .

opening

/hr{...'hr.,.5~/ Anti gravity direction

Medial
(l "'~ut"lM.
~·. ll i '-~\

\-'-I e O\o-.r
1'-- .
ufeY'lcr
3: 'r­

~ ~ l _____._
'VV'" I: -\ , 0
-J (..J­
[\<.vl \<I"')

Mi(ltilc nasal conch" f\ n ~ 0"" .(Ie.!

L~~ ~~ (\
o Il Infel'ior
I ~~ 1:1'" "­ \'0Y\-O'('J\ f'"
V. " ""c)
. ~ UM.I'-- _'. ()
Nasal septuill
.t
~
tl,p fu,;tL. J- ()
/h~ 51 . __._ '~- ~e.
~. ~ . . }o.~
0
{IL
-\ 1
.0:~
AA.otA4- ....--- ()
v .- v-
~ 10M (. ~.;t;:.j ~ 0...._oJ."-l:. \ \-'~ ~ ()
II
IV ::: 0 - - ' , (j

.a-~~ ._ 0_. L ~o __- ~ cv{ ~ -

r"--~:-----OUI:V "'_t '_a,. , ._e"'1_ClN_ _ ~";f~_ ij ~ -- - --~=->-~'-' ...'... ."........,

I;
""'~ _ _ , _
Clinical Correlation .111_ _ _ _.... _ _ _~_~-a
~ Q uestion .......,~~.=:;!;: :-:.". . : .;_-=-= ;;
.
•.-:-=;;- ._.,...: -t::: .

, . @ a - c.~(...,~~ l.... 55 -yt:-ar-o-ld lTl,Jle has ~1 conpl.J.lu of } ,;:·L · ':·· l.k~;

l'ld...'~i.lld'il.Y WVHl pJiilL A dent,~ l ex,·u:uin,'tt.llJ.l). !(:'.• ('," h [' ':'
lVIaxtllary SinUS ."t;. . I ' cJv..ip
. ~I ;) bnn[frnJ~~~i(lf; of htf; tt,t:tlh . L)u.riru~,.. r"'C',l1vc.[Cll
.. (~\,J jrJi '1 ,) :[ ' :: 1
When the ~ .is in the umiql1! f)QSi;iQO; th0rntlxill~ry sinus .~ /''v.{':' hM-t'M:1, . on t'lts ' nf'lt !];.ax);.,.\<, t,. j'.h.. IL, :; rI<HI' 1-",11 ' "1 ',. '

'? cannot drain. If iIlfeclioils of the. 1:,axIUaIY SinUS perSISt, ~o pro-

mote drainage an opening IS surgically created .t hrough lhe In­
J' - v~J. ~
tap[Hug
. .

··,·t,tl ,.
nb.
. " . ~ . ~.

..-1 . I.-,to..\1;"1:) t''h.e.

"Ale
(0 .

.- '\"\",,,,
.' '. , "
".

'I . ·1:, '" -,i

Vli,t_ J..,:Lt.l..
'J.. . , ".
; ".. ,.. : !'
" .•.

;.,. " . . . ,' \" , [ '1 - " ~ . :, ~ ,., .

r..[.Iun:-. k H . . 1.... [ ... .
'" . I ' , ' " , ',

? ~erlor mearusnear the floor of the maxillilry ~ii1.us .. Post Nasal Drip

Jfh]'!~'ie~ ,. J L·. b (J'! tho

i1,-'li.
. • ~ .0 : _.,. . t' -r-GlT::"1dm'
'I ~ .. "d'lli,
' : LlL J,- '- '- _ I. . '..:." ... . I," .'['- :,;.
_.... r ' _, . ,. ~

mo.3C HkE'l:? di,q~:losis~

.1\. Spn:enni d siTflusj{i::

n. Anteri(1r t'!h I'nt:.ihiiJl Sliwsi [i::.
c.. Post.;:>rior l~thmoj.::!L"'.J Si!l:i lsiTi ~'.

--;;
JJ. ivldxiUJ ry ~; inu::iill::; ~ © ~lotAJ
. b ·rvc-
..J.,./
L Front.;)l ~[Jlllsilis

". II
 ( ( (
r......:..
.:>-' ."~,.,. ..·':. ~ "... : ..:' .-:..~~'~;f~oIJo~~1:ltW'(~...m<"'.~...UI..:.w....'\ao.,~~.~~ .~/. ' ~......,.;;:..~"O;·.'H..... .. ,"~ ,. }o<. • •

. ,,..~~.,."-. -,,,'-'""~.-_,_uv_
~."~., _ _< _ _ ac._-
e i X-ra}' Skull, OccipitC?-M..~r:tta~ ..~ne~i\!i
rv'.11"
'''''-''­
Y):
j 4',""
. t' .X-ray F
~
- -~
-.•~.-.
1M. , . ,' ,_.. ~ __" , ..... . ....,........... .., ,.. ...........' ,. " ...!"""' S\1t

, / .
@J.;. 'D - '-"" . }: r{J~ (
.' , CriSiS g~lIi _ _ _-10 Medi~1 lectlJS

/'

(f):~ ~111I110i(]~~ $Inus E,'ebaI1orbit

,
:1­
/
Middle concha4c}
t.a M?xillary OsliulIl

!'/jlddIO m':01Iu:;4b

f~.l l.~'h~!:lI.l.~!)~~§lQ~~· 4. r'1JaS~~~

' InieriQr CQn(;!ll!5a,r­
~.~~ t,ki$al scptum
.. . mea:usS
-Inferior ..
- ~,
b
,-.~--
/'

;: ,
C.\ if: bast; of skull commu nication be.tween nasal c~lIity I} base of sku it
. . ~)~
j ~~ ~
.... Separates till! (2) leite/'a! waH" /c~_Q.~
~
.,1"
','. ~
;.~. :::.' .
'j' f[/':
,,'~ I
~~
f~,, :
'.
[ Question 1
f\ntcrior ~lI IlTloitl ~ll

.' -.."{ ,. " . I!"/'1I . 11/,

:' ~. •... -'1 ;.'1 rli " ,... '" duIT....;
111::, . .4 ,:.1.,.f'IJ1 t"\: .'.
;':]1;-.. r.1U:'
..".' .f
t· ., I ,['
I' I,j

~ ni(J~It~ over 11 11: p ! i'ryq(J~O C;~: l ::

~
'••r'j ' • • •"'-'1"'('[
.-, :'I ·~ M " ~l'(r'il
l.i ' l"") ~ t••. 1..~1"'fjLl"
.. r.~.
I.
,p"'lnt'j'
.::)l: (,·t·· .L',,"·
..... o"IYCI,CL\,,'[·j·lll'(·j·,·'
_, .. u_.... L . . :a [ '("\:
_ ." I
,', :~;
..... lr,, l
­
we)
~.
,; UI ' n;j ;·i.':'

!
'~bfi(J,·.ql·L1LJ; l) frdl':un' 0:' ':ht.:' orbit. Orl:illdl. ~;lniC'
'::;C:C i'e'dop
iIJ\Clil)f
~f-- ~ull '
\ llh:'~, \\'u uI.J mc~;l lil,:,! ", h.: (o~md, ilDf('l'E(:rh i.u \\~;IJch (:,j' £,~ . '"
~~ :"~ I j";; :.....
8-'Yo.-v (t:thmold Bone)
I:n (' ~n] h)',>,'ing :~,r.a~\~ :) :
i ' .~:~" ?' ''~ ; : :::.
~ & INJURY

of !
A. U, }immL~:iI;jU:';
'I 1 ' 6J - 04.)1".-ft· t-J/cl.vrc...;J;4A Olfactory Bulb ' !

~
~ ~ !~;'d~r'-
@ FrO.nt<ll S~ll us L
(J~
A

- r ...

'
,
~
.(~ j. ~ • TJ ',.,., "- " / --r' J-.<-j" ,.IJ.. ~~

\
/v>u-( / '
.. LVi,j,G:. <1.1)' .:11 ~Hb ""

.:'
1), Nasa~ (;aV11}'

L ::-;1":I~[)c,i.j .:d :: illllS

~ ~
, r/
CS '
~-.- ..
. ",
 (
( -7

Nasal Septum: Nerve

i .\-o~_
O\~;7' ey)
,---­

~of0
+,
1>1/~ i\. JO"yi.'lfIN,rUIl1IIlI i, b",l1gbl It'Jl}c-"n.U;!'b-":!.o"!£LdqJllltn1',"H I
nnur .Ikr hi' "'os illv()lvcO In ,(:m"wu:v.clc colll;;:;1n.. He wJl:<
U ,0 Iii){ wcaring. n J,clmcl. f1hy;,itlll.l e,~m"inl1fi~lO ~h<>~ cleRr fluid

~\JJl ~\ drfWing ft~ Ul.~~$'hOW " fi"a.oiun:: or Ilw

~l\£-'ltJfu;...c.llim.QmJliJ~ Thi3 pUlicnU'; 'nl !\t\'"Jc..~
~ . . . _ fJmm"'llkil-~ ollt.)wiug Sitn....-c..?

l A) !la/nile<;
(WI HClJrin
,,;__~~:;~n~QJlt~"
LC
c. 1
ffi VU~~.
T .'
' .nN tw if 'ro
..
1'1'0111 Ihr. pastcnor 0 ~ of Ihe (OI1"U"
If.
nne lhlrd "f i'
MW"~
.,.
( l'Wtl
\'

rr'\
\.' "

' } Ioss of olfaction

~, \" ' Ill '

#'~' ~:<"
InCisive canal ( (inability to smell) .... { I ' .
lo,\v\f- .
",tJ {
,"'"
.~ ~
W '" , I ' , \
' ~J.
~ I~'>I.\cf
'9t" .' ",I
,
..-----.,

Nasal Cavity - Nasal Cavity - Blood Supply - ~pis.~i

"--­

'1
I
-~
ox·
;

~ . ,
\S~l¥' g.
~ ' (OV j;
...J
~

f\~:S_,

&/
/1;
e of its tributaries fe<
~1~
( ~~- ..........,~ =~~

( v,~.""""'~m~, ~~' __ _ _ __ .~ ~'.".'_W""M"". "--,, , .,' ., r

~ Question t: ~ _._. Pha~nx:
L . . Divisions;
_".____~__..,,~ , ...,.,.'
10lY _ _ n ' '"__ J 7= ':'=~,~

:\ ;~:J -\L",ll-uld [il<l)l ''''Id~; blUlU:sJH :o:he elner,gcl)c'~' ,,~ :''r~m:;i~~~e:of,:$k~i':-:'c~ ,'

,k·ll.j!'i-"';·W;·lt>l·\!I'ii:"
• ,I .. _ . '
..c>
I'll
. S'j)
'._~ " ',' '''Hj
.... P·I·
". · ~ 'nlhfl·lll-'·t\;·1

j"
·l.-; ".II,~
.. ,,)' .. "',
I.".~: ''I"' r I-, f' n.:!~-;,) I ~;~~p(i..1 j'n. ;rh~-a,r''''J ,-:ri-n;)W:5- ,is I( i (' .~,Sf'1 .
'·~',II:h':'. tor I.-itt'ie'<:, ,11'0'.1, 1I'lVr/VES 1~10.3Ih' :In,1S10[T,,(}c·e:;
''')('i \'; .. ··,'·1. "'jhll.'h ,:.~; I·IH' ff)llfl 1Nfll::,; ;ln i '-I'!'{"<,'
"".,,
,,1",'
D il:;: d,

..:\, :'\:::[x'(Icilnt'; ;.l3~C',tin,,· anLi i'1.~ccJ1iding phdryngcaJ f

~~ ;~~>-

H. P,;;.s1t:'rior s'Jv:'rior .::kc'Dl:;:r ;[nd <lCCCS:;Ci:\' i:

T"'I':il\·i'!J.:il i fl
"".
C. l..:m~r;tl
[fll:ddl,,·
\)r,HlLh'~;
II't'ning,\:~J
uJ l'OS:[('riO[ (thrloid,)i ,Lflrl
¥ ,pr1 \I
~~ '~~'l.
i:

J.D, •f~
,0)
J-I
~;(:'IHal Ilr.lnchr~; nf rh~E.s~!i;;~~nds,u i:Y'~/'" I

D
IwrillLJ<ibial -=--- - - - --'
~"",,~ , ~.!.::.:~~-
E, D""S(':n.lifnp; P;li.'1!Tbne ,-ll1,:o[ wmijjur hr:31J(:!tt':-l tJi

(I)r:' pl:.;rynge"j

~ ~-'_l_'_ 0::/IIII' ~--......~~~.....v~" ""' . r.::"J"'w ;;

!i~ -=~ m "ru~!,

,I ~
~ Question ~ harynx: Retropharyngeal Space!
_"'llLL _=rt...,,,.on_ _
It.....,.""'~\I<___ JJ
~"''''>:'''''·' "'' ~- -· ~ '' ~~· .'._.·'.r·.. ,.. ... ..

:\ >,{'M-old boy with a hlgh fever is bWLJgbt ~f.I

the pedj~urki:m, Dl2{c3 P:'l':.. ~,iCd:! -e;,:ami'TlMion ~hp., P~1- I'rr.lraclll~nl (:Is"i::

lienL Co:r:lpLttJ1S 0E P~.£-l In hb ear. Hi:; clnroat app(:a;'3

II~'d d,mi inll,lmccl, c(:I!:'lfimling the' diz(guo,S'rs oJ pbiJcyn'

f:bs, v/:~ti ch I) fIn.: follov;rlng stru Ctur'2S pr{Nided <l

to sprc·ad 10 th·[, tyrnp3DIL

ca '/
/L CfIUdl);1':.'

B. In;7(~rn,1il acollstic; fflealw·;

c_ f.XIC'1TI ,-Il ':l'<:':'cW~¥':;'~:I{:,~
~ ---=--";..- - , c- .~ ~
U . ~'1T."'r':-'l1,',(llv[T"I)d'n Ie HI [1~' '
I...\~ . '- ~

If.. 1'1 Ie,: I"')' '", "oj i l'f"C~"--

T~f"-n"F<- .' . ·; ,'.~,;I_ ..\

7:
'. /
.. ~

<~ ,
(
" r (
Retropharyngeal Space & Carotid Sheath !
Retropharyngeal Space Relationship
Illvesling layer or deep

/ cervical fascia

Tllyroid gland

./ ----.

'--'

{common emolid artery

Pharynx ....,cw.."),'l . (/, ,; J

J Intcrnnl jugular vein

Hyoid

Carolid shealh
Aelropllaryngeal space
mus<:h~

Skin

Pharyn~, Pharyngeal mUScle,)~coPha;eal fa~

Prove((cbrall~sclil
Trapezius m.
Anterior:
Cervical vertt!bra /
posteriorfP!ivertebfalfascia,!Jongus coli, Ant. Longitudinallig.
Body of vertebrae & Intervertebral disc
~L>f~r<S'~ \~<- <R
~t-. ~~f~~'
P•.zL p<'V'~~~

Question Pharynx: Extent & Layers

;

A 32 year old man was admitted to th~ ER with EJd:ent:

.......
Base of ~feriOr~bm:derof'
.

fever for 15 days. He was unable to sWallow. On cricoid cartilage ' 06)
! . - "-' ~.

examination the physician observed a lswelling in

posterior wall of pharynx. A CT scan r¢vealed that Wall has 3 layers: outside to innermost layer
swelling was a collection of pus. In which of the ot-rT
following was the pus collected? - Buccopharyngeal fascI~ v
>1 ..1. 1'. I
• A. Retropubic space "D~h,). o~ · /II

• B. Retromammary space
• C. Sub arachnoid space
~(f~f ~ eet7J - Muscular lay~.r . . /

-------.
r - - - - - ......- ....- ---::I
( D. Retopharyngeal space ~
% - Mucous membrane
r../
;Sri
 c "" l"#.,~.1\~"""" . """. _ _ _.. ~ '#.~. ____ ~_~~-q:"..e: __..,.,.....:~... 'A!o;:t'•.....,..c> ""- ~ ...
~,,.,':.> ~-:\, .,~, l ..
r
~\ ~~ct\lr _ _~-o>:r..,rol'U~~~_~_..._,..,.u;.~_ . ""'.'~'>",",'''-_~:''~ ::J . _~ ~ '''.· '··
('

'... '," ,"' W .... _.ft_w...

Pharynx: .. Wall Muscles
c.=______ ___ '"~·""'~ ~~_.~ ~,~.~'"".~ •.•._._~'"'~<J.
, ~"6'<:" <.:I~ _
Pharynx: Pharyngea i _ _' ' ' ' ' ' ' ' _ '_ _' _ _ _ ~~~"'''''' >::""I:''''''''
P i ex UJ1 ~:; ,
~ ~·''' ·'

,. location: posterolateral of phawYTlix

r. nferior pharyngeal constrictor musd(-~

a~cun.a",~ ~j iA't10·e~ ,J, (~<VrO~vTIu.-)

NHd die pharyngeal constrictor musde <D

~eSbranChes fWV"
~(u>,\.~~.
~

., Glossopharyngeal nerve
;.J,' " Superior pharyngeal constrictor rnuscle pharyngeal mucosa tA~~

e,.J!l.
Cdossopharyngeai Nerve enters the pharynx " Vagus nerv~ pharyngecd
;': l~h'l/(O;(;m the ~~!2§ii~~:...an..QjJ~lg.QJe_~o[!§,trL~~g!.? and constrictor muscles Q-ovJ~o<Jo- ~)..:!- .s~~ <J.t. . . . . . .

&-11/..v:~6~~ ·
F eeurre nt laryng ea l nerve .ilit~r~ the pha rynx where r5pe;ior ce~ical~ym~athetic 'g;.H1g'i(}' r·i ~
the Lr:!.f~Ti9.!.£gD.~!!!..~!~r_~_~_~_~le joins the~.~?J~.~.C!g~l~
ICH~~~ C '!.t C~)~<C 1

Go - 'Ii""" f'" ~ 1 ~ f~"'-' - e...~e.tVt.~ «~ @(,"4

.
~ ~ ",.....-~~ ...
~?
mr....,..._---~
CC

-=-'
.. -t.---~~-~ .. ~~'~~rl ~~

i
• --~~"""I.=~'''';''.>. . ''''''=.'''''.. ';.,~,.~,:~' .. "'.'.'~ ..

l. ""~,,. ,,~"_. .__ Musc Ie_~ Of Ph ar}!n x < ____ ~_~ !to- =
Nerves & Vessels Related
_
To Pharyrn~
__ ~'_' '.~~~,_.,_-," T.·"'·· '.

Pha,yngcalluDC'CI,

Cnrof.i:i
~1n(cm;uJu!)u\"r~!!ill
~~hC:"'lljl

'- - Symp:llllClictwr.\i:

(;'7;/ ,
1/,
c' .//
A nc{.urrcnrL1IVnor.;J11"IC'1\'tS 13 ttiUIII IC(IIIICll t t:II\"~jl:;IIIII' I :'>t.'

I? -~.--
 ¥( (
p ...
~~'OLI~·"''''' _''~"",--._·.~ 'Illl"""""~ ~.:1,.",,",,,,"~~~''17~'''''·"M'III~,''''':' '''·'''~· " .~."

A
H
Id
~"""""' __.... _~
Clinical Correlation __ ~\fIO - _"'''''I.b>· .... .....u .,- ,·,··.-·" ,·· ··
·~

q
v
N:
Adenoids
v t~
A
iII"
-- Enlargedpharyngeai tonsils are called aclenoids_:~i:.jg l_: i}:~i:, _.(I
!
L
A struct the flow of atr from the iK)Se-'through (!"if! ~}(JgJ.~~~~ :,': I',

T
, E making mouth breathing nKeSSaty.
R Hyoid t:.ont
"-'IL.::.",;",
. •
L , n"lI or l onglluQ,r,JI 1~~~~l l~
A ? i"" c""'-4I I?CJ ) Q.o-\A.'f f3~r ~",jC
~-
I
~

du ~ .0fS Cr'" c~r~ r . ~ - :(1)0 0

" _~'<P
00
\I ~'j -> v-JU--b s..,J-tL:} ;;
'iii"
'"
.
~
­
Adl.PAo-U)~

E ~

I
~ ... / /'/ ./1::; • :~)B~'~:?06t'
. W!,
I
I __ ___ ,_~-

J&~~ 6l~

i " ~"~' "~'~~~-~-~-~-o-~~Ca~'ty~-'="-='='''~~'~'-'~

reD...... on til ill ")I__ ~~, ..
':=I,,,,,,, ~,:,,,,,,,, ,~.':.I" · ''' ;'_ .•
'' . ·' ~. ..

i:."..,..-"' -r.l'-< ... ~, ~.. W!IUIII.. I'IIQf~ ...._ - - " ' _ ....... " _ ........_ _ _ _ _ _ _ _ _xre._ _ "'l."O.,d .
~
L __. .
PharYnx: Mucosal Fo~ds
_, _~'_'W.·"" ·"·.'··_'·' __ __ '

{)v~

~
AuM-~

f~ t~O""-'
_ CAr- ,./"

r~(,~T)~
3-"'( vl L - _ - -..___...... Pd'>T --

:/ '
/'eJo )
.'M· " '_·' _ "~ - ·

.,'
-1.---
 ( (j (

Question Muscles of Pharyngeal W~'~~Ton~;~~

. __..J
Cortll..'lg o of ~ ~
~~~~
philryngotym panic lube
.,'\ n 1] -ye.ar-otd bo'/ 'i,~~tf:l..:.$·'''lQl1!el1 iP.;I;I.lline.J::9ns.i~~'is ..

palalin;n~

Mcdial lllale of
c,'.(J;n~i 11ed by ~m ot(}L;;1lry~?()Jo:giSt-:->tVhiCh of t]ie !6]~OW ng ptefygoid Droce$.$
/
(~n.1i!'ne~ :5 !u.lPph~~s unost of tbe bk'l'Dd ~o these tonslls ~;d

ml.1lf:~ be prot~red \,rh~t'J its t:on.sH!ar Dmn.d l is dljl,lide :

\ r".SCljjD.Qlng
1. .' lJ'1')I;r'TII2IeJ
1 1

----
~
. RF~
c--:::-:~~
Cx . - J ~ J2J:j ~S L"~?

. C. Lingua» J'!,, ~~- Cj ~ v'-"""I~ .

4lGlossophalyngeal N.
I), nll:~scendiitg pi!llaHru: G _ ~yV1 i (~ ~') & ligation of

: Tonsillar A.

E. Superior thywid

~
~...,
s:.V\O~
...
(\1'-1 c.Utu.
~~

Tonsil Bed: Boundary Relationship: Nerve and Muscle

St 10 lossus muscle IS attached to the styloid
6 Palatine Tonsil lies in the interval between thE
process and inser e in thetongue laterally
paltoglossal fold and palatopharyngeal fold

Beh i nd the paltoglossal mucosa is palatoglos\sal

G~;~ ~yp~sal nerve. C.0 IL.­

muscle. This muscle elevates the tongue and

• Action: retracts and draws tongue superiorly
depresses the soft palate --~

~ :;:~;;;ph,;;~~g;~ses between superior and

Anterior: palatoglossa! fold .~ i ~on5trictor
I ~-
muscles to enter the t~_e,. ~
and innervates th~posterior 1/3 the tongue and C!
posterior mucosa 01 pharynx
; 1:.1Me.r ior ~ palatopharyngealfold
!j@2

(I, .'
;
~~Jtl.
Recurrent farfngeal nerve enters the ph arynx where the inferior
Latera ll y: Styloglossus muscle & glossopharypgeal constrictor muscle joins the esophagus
" nerve

(I --~sc=a~lp--=_1 d1: If;;

I Scalp - Emissary Vein - Infection t,

\gJ?'~~'"~~~!9::J;i~(1:r:!l~#~1gf;;~ 011~~~;~1:'~1 ¢ef.eb, Ffll: ~~in

~J~~
~.
~,' '.'~, e.MJ;,~/ (t"'~ <31
, 1
2
/ '~t". ;~~~APoneurosis 3
, , ',.,' .,' ,'. ,G.onnattivetissua 4
. ~~~.' 4
,', , 0)'
.~:./~
"
" ploo,seConnective tissue
eri.crahlum 5
~
if
i.~ ",Calvaria" S' . L, A, L ,cr. 1!;\1.9-vHl,lUIU IlIlU'\,;' ·:'81
UDj~;·'f~b+oT'·1 ~'..' .;i. ' :

~''''~.' ii!:
'~_ btw
i4':·~e
v<"'b~
,. <\""'''
'0 t
cAV'cM (~~~
Subarachnoid space (CSF)
(Vle.f1.,~C<) -7 [til Sf'/.) ~h~
~ ~,II ~~t rM-­ 'iJ'~f~ll +u rwvvt (M~+
tf' (M IlJ'wf0 Q-:= ~,~k<,~
--->~~,

[ Clinical Correlation Question

A 5S-y.eal'-Dld m.'l!D is aI(lm[Ued W, tbi~ l~ttJier~t?'ru::y
depawnent aner: ,slipping ,0]) wet p.;rvement .t.i:nd fa1H[)g.
Physjc.ll €'xaminatiKHl :li:evea]s (hal1l1e-pdlttl.elll h,a;$ .ahe~
matoma that for.med in the ~~~~~
spreading to the area of tbe eyelWs, Which ()/n~ the fo]­
bwirJ;g laycr$ is regardE'di as, the "'danger z.one"?

1§.~c:o~n~cti~ ~/.-:'1
B. Skm ('r!)'
C.A~~
~oos~~~:mnecUve-t-is~I'P --'
E. Pericranium

I
-IF 'F'f~cj~HJ V~ ~~~!:J ~
e Cc.:.vo/) ~'-' ~ ~-&.~~
..::.q~
 (
U •. . ,JOe ••" '"-"

8­ 1 ,SKUll: latera~ V~ew

0~
.~')~ fJ'l ~vg
L

~ Anlerior nasal aperture ,,/

J.

[MandiQle: I
HjiJeQI;t~ process
_ Menlarfornmen - - - - - ­
Menial protuberance - - - - - , , ;
y

~"';(I ~
0\" .f
'ts'"'\
"i.s
~h:I.J'
,~
(kt\-1o-t-J
pAll'~~
(Z''''~

1oa:'1 w cA,

pterion: 4 Cranial Bones Junction & Relation

to Middle Meningeal Artery (Ant. Branch)
;;~l~ ::'·1c'·~~~}f~~~~{~:·I ~:~;;::.' .f: ). . \:~'7 ,.' ~;.,~ ~)'~.;"

.. f

I
SaggitaJ

suture

Occipital

~
:Mtd~:;n4tt &\\';.
~U;;s?~4f'~ui~;~
Itt
( (
l Calvaria (cranial cap) I Cranial Cavity
1. Artery grooves (impressions)
The inner part of cranium is known as cranial cavity
2. Arachnoid granulations
The cranial cavity is divided into three cranial fossa
3. Venous sinus grooves

4. Diploie (spongy bone)

2/ Middle cranial fossa: ¢ontains the 2 temporal
lobes af brain
5. Compact bone (inner)

6. Compact bone (outer)

3/' Posterior c · • Hower and wider than
. e cranial fossa. Contains occipital lobes
of the brain
\"

~
'0
~ <.&
) Floor of Cranial Cavity & R~lated Structure
. \
~

~.f
\.-,-----=~"'"
,;t d ~
~ J:;
t!~
~ ::
>x:(·
' ," .

:ji~:' ,¢~a;VJ~f;i;l,qQ§~

r!-J StA~
~

 ( ( \

[ Question I
~,(
ICranial Cavity and Cavern~us- Si;:;-;:;S]
rv'SilU
..
A 5J~-yE!'ar-Qtd m.o.Je iLl ruraSDoo0d . f~th art anC1l.1

('If Eh€ - ha.sllAr ~rl~fVJ cliotie.- to th~ --av.el'nous $:lnttS

~\i ~
An ~JltHrlo[' approac.h w the sella turcica dlLOt " . .

n~S~ll rl.~1v[ty is peri(lrrned. Ti'fmugh which of rhe Jo~­

~O(1j. .ri.f]g fOi~~tcs rs th.~ stmgoon roDst likely to ente:r tIle

Cl'.arltJi cavity?

J >(
.Ao. C[lili)lrifonfJ p~ate

~ R CavemoUJiS sinus ;,,,Y":Pj

\y C. Frontail sinus \>;~"

/l 0 (/ ~D'. M ul'~ . ,' us

lJ \) !' ~,~ . ~al ­

~ ;;1 ~" s' f:'" !:ij)UE'HOWl snllUS

~ ://
Q II
-'j

-fJ

A
Cranial Cavity & Cerebral Arterial Circle I Blood Supply - Brain ' ~--- '---I
r~
~
.. .~
<:
~ , c(x!1ri ~i'f!~.tj~g~
,'An ..•' ......., "" ."'O:.!. ';.

~\~
\c/

t'
:Co /

/ /

~ou--r:~
I
/
./

I i

f :
1/
I •

I f

I '

It/tr
 (
NCI
(
~ ­ rYtrn'I[" - Base SkL!lDB. (
""Ol~t.Ollac,or\' btJlb and lfilet (I) _ _~,-----"1 .---------"
Question
./

i ~ ~ Pt,c nerve (/I)

~ ,1 --- .
.~~~~ /) .~
b"" 'OPlic chiasm _ _ _ _ __
\
~ _I Oculomotor norve,(III) h
1 .... __.__ 0 .""''"'°.. 0 •. '1
\
~ .-JTroChlear'terv<;·(IVd
~ Trige minal ncrve (V)

I"' 1l"7
IAbdu cenl norv.· Ivn I""...
Facmlllervc (VII)

~ LI~:::v:"::g us: n:erv~e:~ )

./ Right l5eniohyoic]&;li.ndtlnit ·oe:rvi<:.al n ,e:rve
,e · : ;>
Posterior Inforlor c~regell~r artery
E. Cantraiater.a] '<liillgus and hypogt,os~a.1 ner~"e~
Vcrtel::iraJ artery "':--.

ri-o
.~
---:x \ '"

CO
\\

\'" Question Question -I

A 49 year women presented with severe headaches and
An l1m::onscious- S7.. year~old man ]8, transported
c:~-A CT scan revealed a tumor in the~ 'to the e.m.e~ency dep$'tm.ent after :falUn,.; from .a tree.
forame !l-~examination the patient it was observed that
}\ cr scan e·valuatiorfi rev~a.ls a. f['.acture of thecribp­
(arm p1.ateV;.rhkh of the fonn:J~lin;g cO,[1J;dii­
the patient has no p_b_g.IYngea~ or ~a~ reflex. Which of the
following structures was affected? HoJlJ.s 1iv:iU m.C1s1 Ilk~ly be prn-eSElnt "during the physk£l 1
ex:a:mination?
0f" cJ.te-f­
cf
, . ~Iossopharyngeal nerve
. Vagus f.\h
C. Accessory nerve :s~
:r
'J-
\j A. Entrapment of the eyeb8lH
~ Anosmia
-c. Hyperacu;sis

!~r-
D . Hypoglossal nerve -r(Y'v~\J c.....,.·
00. TinnHus
---
E. TrQcb.!ea-F-118rve--­
E. DMDnet1-S
~
II(
 ( (
(

( Clinical Correlation I Question

A 55,wyear-old IJ41n is a~ to the hospita!
~l~'l1Ll~ a compl~int ors~adac.::h~~ _t\ l~u~l\..It1Il p uoc­
tlilre reveaJis trac'es icC
\
blood m :tber\ cereO!'QSpJJ'Ja]
--­ fnnid=.-J
Vilh~iCh of the foUowing oonditiollsh..as JJilO$~ likely OC~
j
C'tIrfed in thls patR..;qJt?
U

. Fr<ll('~!1.1r~ ()f thf"p;PB"80n wi,h l.l.f'lst":ular injury

:~t'~~f::n'IP'~'ii
f 't--,") ..~hI'j.,! r.
~~\~ c
,: ,"
'
.' ' ruptured "berr:If'" aneurysm
c,~','Y'Y'~
,(;~~
.x. ,

C.--c
r
PY
/
1:-I"' ..
, J..eakage of branches of the- middle mcning;eall
ve1n,.,o'ilhin the tenl'poral, Ib01le
~ t/ -@~ ~ A tear of the ~::-1"1rl:"braM v('in "t thp «1:f1it'r;;n!f.@! to
(cr ~l'\. . -- !
~ the superior $agittai sinus
/l ~ -u E.. Occlusion of th@ internal carQHd (lrt'ery by a
, ' ,jI'
dot geri&ated in the Idt .;3tdl,liIll
0"~~
4 .j,

Sase of Skull Relationship: Int. Carotid A.,

Cavernous Sinus & Abducent N.

Clinical Correlation

,~

b
I7i
( ,

[ Clinical Correlation I'

IBlood Supply - Brain (Sum-mary) I ~ --­

"2/

,l~

Cranial Meninges * Cranial Meninges ~

Cranial meninges; coverings -coverrng
- . ( the
" The dura mater has 2 surfaces:

brain. There are 3 layers of meninge~: I~ ~1) ~riosteal~r: outer surface in contact
".-""" . CVi' ~M ~,M~ ~ w ana .
(i) ~ mate;ythlck outer most fibrous ~yer: inner surface adjacent to
P-'YV _

,..----{2)
layer ' (;) \JoV.J ~ ...(jJ-'
\ _ q--u \ 'lW't\\~"\
I
~ tf"V'" ~ " a ". ater

(ii~achnoi~ater: thin intermediate ~ Between these 2 layes is contained the

layer us.~ ~~ ~ venous sinus

(iii) ~'rnat;;;? delicate internal vascular J Between the archnoid m~ter a~d pi~ mater
layer is the subarchnoid space In which Circulates
the CSF
::t-:
-j;f
( (
[ Dural Infoldings ·1

peri steal layer and divi

com pa rtments,

These infoldings nmit the-movements of the brain

During vigrous shake and these include:

\(i)-Cerebral falx ~ ~
(ii) Cerebellar tentorium f o .) V -------­

(iii)Cerebeliarfalx f"dV~~ ~

(iv) Sellar diaphragm v ( (~h.1i)J .

L. Dural Infoldings Dural Infoldings

,.-­
"--)

'p ~

Cerebellulll Medulln

(
Dur~1 Sinus
)
-- ----1 Meninges - Coronal section
~1
~~ ~~sary --...,...........

./
../ va\!). Arachnoid granulations
3
,...-,

Stnlighl "'"""

Subaradll!1oid":
v
C(!rebtal falx , space (CSf)

( .Posterior Aspect - Dura Mater Cerebral Veins Relationshi

~ r---'1

(confluence

of sinuses

Straight~

_. ~e Sinus

:s~0
.1(;,'t> .lY'

\1'

0 '<:(.... . ....
0
~O ~- . l?d.bdu~~1'
~'t'r:,~ Hematdma,
Tear ofc~rei5fal V.
V

 (
-
.
_ _ _ _ _ _ _ _ _ _-....,.. l
c-~ Clinical Correlation J Clinical Correlation( - ~

: Subdural
'He~atoma

[-- -- Question I Periosteal Layer of Dura Mater & Meningeal A.

'.­ ,

A 65·year-old male i5 admitted to the hospital

tllrf::-~ weeks ane.f <'I. "small bump 01 his bead" a.crording

to hi!> [larratlv~. He '!tuffered the a.ccidental bump from

"~
a low-haF.Jging branch while drh'ing his tractor tlu'ough
, "A, Y
tbe ~pp;le ord'lard during .harve5tij~ season. DUlling

pt1,)'$,h;r,.} €x.:.lmimltuon the patien,t djs;pLays menta! con·

'~~~~
IUfi.ioH and pCiOf physic~l toorclina: , dio . <lphic:

l'xJcnlnatio.n I'~/{'"8]s lea[<a,qe from < ~ rebr~eri_ ' Vel'

f~
the fighl c01rebraJ h.e-mispheJ.'(', F poe of

bkedlngts (he patie-flt UWSl Hke!y suffering?

~(@,C~~5 "f. . .
A. Subaractmoid bleedtng
. :"*,~JQ)n~F'!Jng~n1
·,.art.ory.o.'iKJ-vofn
K Epiduraf hleeding

C. jr;:tracerebrJli bleeding into the brain paJ"€u­

thyma

~ Sl,I,MlITiJlOf Pleootn.g
lateral venous lacuna
E. m~edirig: Hue the cerebr~1 ventricular sy~'tem

--4%­
lH
P';qtl!:lrinr
 (

Clinical Correlation \. --,

Bloodc:oUection between the dura materandc:a!vari~
/ '"reJi{~~J~~~

r Clinical Correlation Clinical Correlation

",;SupraOdJ1tal ,ver:;" }' "-.,l.41f].1 ilihlltm_
lbV
i

~
"'1barachn'oid

~ "', hemorrage

~ArtM

l) r"~"'1

ater (subarachnoid spac~). V ~ ~r ~.... FaClal,v0in

If!
 (

C·~ Clinical Correlation Question I. - J

J f.\ . 'ki>L.. .."1;':' "-:.",;['{.." "~\iif.!:i~'ri~;'

.. ' ~ ~Z;~.r~·,k·." it ~6-yedr-o,~d boy i;s.admiut.--d ~o the h(~9pdlal I,,·iiLh
\;;I;f)tliltHq .m .~5t"ltl;tl1;f f~'Il~[. c:on:fused m~nlaJ state, and ruowsiness.. Dmlng.
physical ex.aminatiolJ -it Is notiEXt tbBt the boy suffe:rs
1 ...·. Ai1ast0EHGsgg~b~tWg~o~ttljl~tatigl!l,~r..y,"q I from s--@~n~diOjogiC exa.minataon reveals cav~
'~l" ':.•.... ¥l~
• ~. • • .. _- ~". • , . . ' ., ~. , " ' . '­ . - - _ . . . J' '" ," ~>, ' ,. '," _ , , '."

ern.ous sJtluts : rmnbQSiS. \Vllkh of the f:oli.owiflJ,groutes

(If; ,£ntry r~yemrulS' sinvs \tl'Quld m()~i likely be
), ~ ~ respollsibleoif Ule inrfretuon dlnd tb.rombo.ftfs?
2
J .
':.' ·.·i.·.·.··
) .'1., A. CU'otid artery
: '. 0P }e., - !'......
B. Mastoid em!lssai1j.r vein ~-

~Mladl~ m,enh:geal ~ln~ry

0 ..
~phthahnilC \ ern

R P(1rietat enJi,$$,Jiry vein

[ Dura - Nerve supply ] Clinical Correlation ---- I

• The innerva Jons_.of-the-du·Fa..ig..,p.r::ed.om·in,a~

supplied by 3_divisions of eN (TRIGERMINAL

v

• The sensory endings are numerous in the DURA

along each side of the SUPERIOR SAGGITAL SINUS

and in the CEREBELLAR TENTORIUM then they are

in the floor of the cranium

~ Therefore pain arising fro 0 eadache) is

generally REFERRED TO ~s supplied by
cervical nerve or division of the TRIGERMINAL
LAYER ~
-:::::--. fo
lit
 ,

Comparison of Spinal and Cranial Meninges [ Clinical Correlation

Spine Cranial
Extra Dural Present Periosteal layer
Space adherent to the
skull bone
Extra dural Fat and Potential space for
space venous plexus Epi Dural
Hematoma
Dura splits Accommodates
into periosteal sinus, Divides
and meningeal Cranial cavity by
layer infoldings of dura

~~t~ IO~S"I-~ -.i~~~~

01'" V",,",NtrN: .:::: ~~ / ..... I-, • .,,-h-- _ ~'~
l~l~ V€"rt7~

[ Clinical Correlation ~

. · ,ti~~-> .' ~ML

'f '~,,: '

t
~ r)

~
~

~~
(

L-ww..." (1,,\ ..

\ I .....
/ 3 I{V'\A£.~(\~
--/II Y"
 (
(
,- ----------Qu-~ion ]
A 2.-mo:nth-ojd female ini.ant is 11.ospltaJized ~,vith
h;rOrocepo,alus. Radiograp"n.ilc C'xamin,<lthm re'1/eal~
:~n)S:Plii:l!a! fll!'l.d ..beo.!J.:eei;l~.(JIm;PJ(J~blain aJ!)d ,.J
~C~f~..Q~
-?
1J-~~

~rol 'tv
J fPe ~e/tc. .

G~v C~

.!..\:J
IIYifer1:ying bones of the 5l~un. \Vbh.il of th~ 'flOUt\V\rmg <z
crYtRUrio.ns""'WiU most Illietvl~d to this lype of dirtica:~

v,,-I),\.- ~'
pi.cttl!re:i
tvL t 0 "'-- . -1
~ A. L,(wk o:J filtratioIl thWllgt! .rnu:::hnoid gl'an.uia- y­

tions
Et Ocdus]llltl.of c€J'-ehral aquedlilct (of SyhiD.ls)

c. Bloci<a.S,e ,of the toE';3rtliina of Lus:cw.,a

'.:

IP

/7 0'cX~ --7 Uf j LY\Y­

~ r-<"j Q~L~
0+ Cougen!tal abs;er~oe oI the [Olf8lmen of Mijgendie
E. CtO:5me of tb'lit imelventrlcular foramfna 011 ""If
~ . 6vV----' I

M:Oilro

(oG
~c'
~

( \~ O
,/' (0. cf'
C')::, :;;--.'V
,~~ ~;,
(;r>'
./' \ V VV ~
\)eY ~ _
c).:c.", (I' e;.r- ~

<0"0­ IV'-
~ Ci'-..!'
~o(

~
V

 (
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Eye .Muscles: Anferior& Posterior View Mo:v;ement of Orbit ~_J

<L(i '

'ft;All"~.WJ~t%~ilf~:!~(~~~~~~~~:
(Y
c,
. . .. ..

I Opposite is :true for the inferior pole

/,'<
/'ytTJ '/

Ocular Muscle
Primary &
Secondary ·
Actions
eN Innervation IE!y~': ,~'tef~l&Nerve sup-p}ij
Medial Rectus Oculomotor (III)* /siiPf1! oibit~t f irtcrYV" .
Infereior Rectus Oculomotor (III) *
~;Su(i~iiorr~~lUs'm . V
Lateral Rectus Abducent (VI)
Superior rectus Oculomotor (Ill) * . Latora.I.I1lCIUS V
Jilusclc.· t'l:::I
Whe~ntral retinal artery
SuperiorObliq ue Trochlear (IV) . :.gets occluded, there j ~ -...­
nl_ , d:'; ~b ~ .
~/~ j.{p..;..£.' u
comp lete 10S$ Of vi s i~
in
that e,y.e..EXCEE?I_tl:l-a-t--"'
the fovea is not affected
Inferior Oblique ' Oculomofor (III) * ·,'Poslcrlor.ditary-arter.ics • ­

I .

~1L~M;
~

 ( (
.;;f 11'
L Questi'~n [ E¥e:, VeJ1)~~:S o:r :ajnage-]
l\/3 · y~~r·old rnate pat[(Hllt . visits, the oiJJJtp..ati.e.n:t
. lOJ<lOIDltal>\4JEn(.
cJi!l'tk vvtith a. comp~,aint ()f progiess~ve. pEiiinie-s5 loss of

v j~I!f:Tl. Ra.dlO<l,-~mp,~it ~xan~inati,()n]iev€'als thromPQ'ph1e­

bit.i,t;, of tilc' G~~\fern(lus; sJi.1:t1lS. Tjlro~lf);h"ihich 01 the ({)]-.

lowtng SUUO:UI£-S mlCSi[ a; stliMm'bus pass to cause the

~Y InI)~(j) m;~ i(~f ~: f44s patknt?

/L St~b81r.(ld:moid sti<aiC€- . .~
. c." ;.3~
@ .:entr,a.llft<ery c;1' the leUna~ _ ~/ J/)
;:vt-
C. CenlJ.al ve~]'~, of the !r.dhl~l { CT
o

'." p~~~~- c;:111', ,~,I'" ..'";:J I''''

D-. ,("It" ,,, ~

if,?
i ;, •
,{ . ~.r, •., '''r , . ~'Ii,
•.·lri~dJ)' ~dnb-.,t)
n
fO'n[o:rvnOta '.: : " . ~~.""
"'<'.. ".:
.o."·,,,'h,~~:51(. : \f '
~~P.9P',"p,c;~uS !" " ' Wt~
s\- \

[~~~~~~s~ Si:nus:~Aibdiuce' p)t jMierve 1 .

. ,'I
A.6~-year::Qhl w{):ma~n . is ~dmi,tted to the hoopit~r
,~~:\
' f'A!-:U'. ~ '/)/I~ lIhf\1iClf' willI ~~gl.1~Or ~verholm a[Q.~~tl;nrQmbio8us. Radio,g raphk:
~~~:Z..Y ') eXrlml~~tvn; r~~~r·a". ? . , :·~!1)~~ ..... 0\[ .tbe:lntem~~I~
!}i'tiifl~ \l(I~!Dwittfi1J;;1h~ ;. ,b~e.r1l-9 ' ,.s #n!is, During .P~~uys;­
( :: ~~.
~i}6ii.;';;niJ..I.~lj~,a;,\~~b~'fr~~~oijl~>~)~leJ~fs<t,~e:mect to. S€~
.,.-.,·-,, -·=,,1
~- <.,' "
·~ - ,. i~,
J,
~
1 ..
/Oculo~oio~ miNe (UI} ~ if nery~ cfmt:n~5SJqn "lla'S OOCUTI~t.~;j!:nn t~~~ ~~:.eF:ft~ <\\ /
y
~
~.(:., ~n. l' . OllS.. Sl'IlU'S? . . . '. '
'''),
. A~hlabi,ljt~.,:to~¥ze:tI,o~n\!iard and mE·diaily on

. . :tltea!f~cte(:) ~sldt\ '

I'"""

~co~. p.~e.".S\7}P~~~:'ffihhe~ S~~e

,~or :p,.tlp€bra
~~t~,ta:~~1~~?,~(~~m{1id~tI0n imd tOll;S of

~.(
r
I' lJo~~
ner'J'C {V I)
. rii1axll!~JY IlCflle (V21
/-iy
If .~it~~::;i:Co""fi$",l C(~n<al
~~;:~~~I I ~ipithi,ter.lfp~~ ahductlon_oJ tbg.g;pE.{
~
~;;y-:

/t:J
(
-;ttFr
Clinica1Correlati.on
Abducent
. . ,
:N.erve>tesion . . - .:. : , . ' ~'. : . '," , ,- '. "

~0) ¥,~y
'(109'<-;
.~ ~
\JJ',)
\J q cY yU"' t,.. (Z..-
, QJc .;;~ . v-,,<i' t}XZv~i..>P
V ~ '\ v
0C)1.\ 'Qj~

C.··I-·•.nlCa,.""o!rre!
.
···.,-...' "I ii" , " I',a~ ' <.'a;I:f);fi'I
. , . ' . . .::(
~ ,;" ." ", " .
" .', ' ': . ", ' ,' , .". ' " "::. ' . ...
CU,;n11cttJ,lr:,eOfr re\lation
.' .:, ' :' , ' ... " ·';r': 'I ':' .', ..:'. .. I ;: - ', ' .:. '" : ~ ' . ' ., '

1.
~
C():l1.lplete();c tu'lor11oto:r Nerve Paralysis

~
(sf,. !

(\0'& .
4\'/l ~ . . '-.. 2
7 ~.

nil innervates: (a) Inf. Oblique (10)

Kectus(SR) Cc)Inf. Rectus (IR) Cd) Medial. Rectus (MR)

~
1t9 $fL~~
 ( ( (
~rr
Horner~s"'S,Y4I}1~'~ ;t'o;mi e;:' Sympatheti c
ce'r\lical l!ru:n RlnterruDtio n

3:

~MIy~v~~~
(;, ~~;J ( ArtJ) to') fo~::

Visual Defects~~ndj~etherle· or
lesionsis (are ~ore, to~ pticchiasm

(t

~o @V ~
Field of Vision
~

Damage before the opti'c chiasm causes loss of vision in the

visual field ofthe same side only - - - - - - - - - - - - ­ ~
~~ , J .1 area

Damage at the chiasm causes loss of vi,sion laterally in both () 1t1

~ p~ ~
~ .~.p<V--
visual fields bitemporal hemianopia (D) (L

Damage afterthe chiasm caus,es loss of vision on one side

but affecting bpth visual fields: th~ visual field affected Is
(@~
locatedori: tti~ opposite side of thelesl~m '
~
+~
~
bril,a,.:n'dibwal' d.uct: - on the subli'ngual
Visual cortex (f/{ ,
'AAl1g):l~, ~eiris ,-s-een on either: s ide of the Fn!nulum
7h.(:. ~ r.r.)·~~:~11~.: .--:-.--' . '
Lt~

h­
-10
 (
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[ Tong,ue;l)orsam
~!1
C· ~{I;·': ',.
iaLtlU { 'lknigtJa,
~ .. . . .. ..
'1·R~eglon
c ., .- .
--
I
.
, ..
," '

... . . ~:/

:;~
'" ,"t. _

I!!'I'J!I
~

.. ;' /
-v
E
J

"':.'

T·0 'fr'I\g'
.i .
I·'ie·· :··•.",:~:M
" ·';•.
~! ":· .'U~
. "S'n 'I. '\e '.s i{\'.&' '
The lingual & glossopharynge~' !lerve suppli~s mucosa of

anterior 2/3 an~ posterior 1/3 pf~t_or:l'9J:}~ re'spectively wi~h

general sensation and taste fibers. 'Tlle 'c horda tympam

A"ie
;I'

j.
~ t .!PVi

II
((~v-<..)'-
lI1'':e "':S-'"tlit-'·t:--
· ;c- 'mm'I;Y
i
1, I

~.J- 7./~
AJYI
1 ;r:
"::1 .O':.•

.. _~
'1"
:; ~'li'Ii.,.:n;ll.
:~ .r'.:J:~.~ .~.J .. · ·· , I;

~wbv\
;:I'.~'
~~·
!~I :·' U
.'
·s·c·I'e·s
:· : .

(
supplies ant 2[3

Intrinsic muscles of tongue include:

­ J
( .
~-- r~4"
~ 0 ~~ ':l.j>
I (./.
("1
~
-1-

. c:::
1) Transverse ~) Superior ' (3) Inferior

4) Longtitudinal fibers

• Extrinsic muscles of the tO~'gue:

1) Styloglossus (2) gen.ioglo·S'sus , '(3}hyoglossus '

~. ." " :. ~ ' . .---.-'---­
• Both this group of muscles. are innerVated by Hypoglssal
nerve (XII) .

~
to
 (
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[miftiCa!ICe:rrelati'on TO ' ', n·nu;;e" , ~, , ' d:i.I"'t~~A¥~ >_ : O~ ;; A:I~e '!':"""e :Sup'
'• .:. : ~ . ': " '".r.. ,' ;-1iI ' It~::, ~~P~~ \~· ···~!. ~, I.~~ :.· '~':" v .'
.. .
p ly

\1\
,>,>,*~ •

~v.r

* Extrinsic muscles of Tongue

I .' f'acts , ~b();ut:ta: rynx~

. , . .

• AnterierrThyroid eiland'
.
Posterior: Pharynx ... ..J

• laterally Rt~&~~ar~tid Sheath and its Contents

, ,J ' - -~--~
c\ lfh'as ,'~ 'va~ve(~'lottis} with 2 functions
~ ~) 9.,~;,?~r~~U"rg airway
~ b) ',P,llolt'a bon

, TWo setsof>M;tiscles J
\ j a)If:1trJr1si.c~!1;trql ~: '()ttis
\~rE~~~ihsi¢':'CQ'f1~t~I::p~()~iti9nin neck (infra &
suprah'yoid -~'U'd stYloparyngeus)

• L~C~;~i,qn:"lJetw;e,e~
6
---u7
 c -11-
I
[ L-o-c-a-ti-'o-n-o-f-:·:-La-.{r-"y-,'n-x-',·-.;n -,N-'" -e-ck-. -] S A
U R
\'~~,i3$~~;:'~/'.'~ V
rit~;~~"
. ·f\;·~;,~~-~~~~!" :J '1\":;\· '· C · - • R T
: ,~:t(~·· ~~,j ~Y::·:f!f!i.wj/?' F I
A k t;aJ;iJjl'0 d f "E't ' A
C
E
.~~: G
e"'t.'eJi.li1g&tl1~ chea' E
~ ~~i.~ri~ft~~~d~:V:· . •
"Iii~
A 0
. , !¥ V,;
N "411:...,.. ~ F
T'
0 L
M A
Y R
~·fA'2nul,,"II..i, . .........
Y

M
U
S Neck: QqAe,~" ·q;~rti\I'~ges : &M;em bra nes
. . .. :sa '.' e:::v;:> < . .' I •

C
U
L
A
R

T
R
I the anterior midline of neck
~

e.r;i~Qid; ea·cti~~S 'ibelowthe thyroid cartilage

A
N .
G
L
E

N !Xio V
E
C
I * Submandibular
K . ... .
~
/D

 (
[
.

-L-a-· ·' . -in-x-:-R-

:ry-· :e'-
:lla-it-ii0-f:l-is-
~h-i::p, - ---'r* (
r
L.a,'rflx: ' C'a!t~j;I~~rfjJ;e$(& Me:m bra nes
(

1l\f+UiMIJ " 'fhl} "H'

..
It
. / '\.
:;-.suPolionhYloid'ito\Ch . .
Allmontary·lavor: ­
IEsopjagUsr
.
. . '. .
i<f't~~~~ty,ry: fRyer;

~·Thvrold gl."d
: C~pSUlo, a~d <opla
'01 lhyioid:glMd

- -------------,
Larynx: 111,;;t:r:,:a;~j:\~ :M :ytscles
,':.:'"
CUniqd COl1relation
_. : ! ". ,." . '. , "-:., :.r . .: . :­
:=J
A 25 .yea\r::,oJd;,:Wqht¢iji o~defgoes,~tracheal intubation
be:ci1:~$;e\6f'<;:h¢st~i:tjjti!rie'ssu$tai'nedbyroad traffic
a~i'~~!1lt~, ;ii.h~ siz(;i,6:f~,!!~flijiiQJLtube is limited by the
ciia;l;ttete[;lQfLth~iairw:caY@fw.1i ith ,of which of-the-'
f!l1bwiflgrh~v~I. · '. ., _.. ..... . ., ..

l ·C:liiCo'd! g.rt'i:l~ &

' H~' a ~ml!!.¢.~~ ;rjng.,:df~~d:ilagearound trachea. The
riilgs, qfth¢~:ta;a~beajl<1f~rior to cricoid cartilage have
ag;clpp;'Q.$~~rioJ1ly: anda:re .6shaped

: ~::~~~~'~i~:i!US-=-'
• V:estihij:l ar :folds - ...
• Vo,c alcords __ .
;@c \. ,
.~..
'.;'

;~ ~.'~
( . ( /1t
Ve5&e.5,and N'e rves of Larynx
'.. 'is . ' ... . .r:- ....~,:~ . . .~ , --· : .~Ii,·: ." . . .
"

'7""""-",,,'"" A '_,\
~,u!t
rD~'P//

-If

( .;r::r
of .
(
. ' :".

1:.' .•.• .

J{b
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